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Routine: ACHSPOS2

ACHSPOS2.m

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  1. ACHSPOS2 ; IHS/ITSC/PMF - TMP DATA FOR DENIAL REASONS AND FORCE ENTRY ;   [ 10/19/2001  10:58 AM ]
  1.  ;;3.1;CONTRACT HEALTH MGMT SYSTEM;;JUN 11, 2001
  1.  ;
  1.  S $ZT="ERROR^"_$ZN
  1.  S %H=$H D YX^%DTC S NOW=Y
  1.  S ^ACHSINST(ACHSVERS,$ZN,"ENTERED")=NOW
  1.  ;
  1.  I $D(ACHSINST(ACHSVERS,"ERROR")) S ^ACHSINST(ACHSVERS,"ERROR","PREVIOUS ERRORS HAVE NOT BEEN CLEARED")=NOW S XPDABORT=1 Q
  1.  ;
  1.  ;WE ARE ADDING TO THIS FILE NO MATTER WHAT. ALSO KEEP THE OLD ENTRIES
  1.  ;BUT DEACTIVATE THEM
  1.  ;IF FILE CHECKSOK THEN FILE HAS ENTRIES DON'T OVERWRITE
  1.  ;I $$CHECKSOK("") S ^ACHSINST(ACHSVERS,$ZN,"CHS DENIAL REASON DATA FOUND")=NOW W !?15,"'CHS DENIAL REASON' data found! Not overwriting!" Q
  1.  ;
  1.  ;
  1.  N A,B,C
  1.  F A=1:2 S B=$P($T(TAG+A),";;",2) Q:B=""  S @B=$P($T(TAG+(A+1)),";;",2)
  1.  D ^ACHSPOS3     ;SET UP TMP DATA (CONTINUED) 
  1.  ;
  1.  ;DE-ACTIVATE OLD DENIAL REASONS
  1.  S X="T" S %DT="EX" D ^%DT S FMDATE=Y  ;GET TODAY'S FILEMAN DATE
  1.  W !?15,"Old Denial Reasons will be de-activated!"
  1.  S IEN=0
  1.  F  S IEN=$O(^ACHSDENS(IEN)) Q:+IEN=0  D
  1.  .Q:$P($G(^ACHSDENS(IEN,10)),U)'=""  ;QUIT IF REASON ALREADY DEACTIVATED
  1.  .S $P(^ACHSDENS(IEN,10),U)=FMDATE   ;SET 'INACTIVATION DATE'
  1.  ;
  1.  ;
  1.  ;ADD THE DATA TO THE FILE
  1.  D ENTER
  1.  ;
  1.  S %H=$H D YX^%DTC S NOW=Y
  1.  S ^ACHSINST(ACHSVERS,$ZN,"FINISHED")=NOW
  1.  ;
  1.  Q
  1. ENTER ;PLACE CODE FOR ENTRY TO ^ACHSDENS HERE
  1.  ;
  1.  S %H=$H D YX^%DTC S NOW=Y
  1.  S ^ACHSINST(ACHSVERS,"ENTER^"_$ZN,"ENTERED")=NOW
  1.  ;
  1.  W !?15,"Adding CHS DENIAL REASON data now...."
  1.  ;
  1.  ;GET LAST DIEN USED FOR DENIAL REASONS
  1.  S LASTDIEN=$O(^ACHSDENS(" "),-1)
  1.  ;
  1.  ;
  1.  S X="^TMP("_$J_",""DEN"")"
  1.  F  S X=$Q(@X) Q:X=""!(X'[("""DEN"""))  D
  1.  .S NEWNODE=$P(X,",",4,99)                 ;GET THE NODE WE WANT TO SET
  1.  .I NEWNODE="0)" S LASTDIEN=LASTDIEN+1     ;IF ITS THE 0 NODE INCREMENT
  1.  .                                         ;THE IEN
  1.  .;I $D(^ACHSDENS(LASTDIEN)) S LASTDIEN=LASTDIEN+1 Q
  1.  .S GLOBAL="^ACHSDENS("_LASTDIEN_","_NEWNODE
  1.  .S @GLOBAL=@X
  1.  S DIK="^ACHSDENS(" D IXALL^DIK
  1.  W !,"Done."
  1.  ;
  1.  S %H=$H D YX^%DTC S NOW=Y
  1.  S ^ACHSINST(ACHSVERS,"ENTER^"_$ZN,"FINISHED")=NOW
  1.  Q
  1.  ;
  1.  ;RESET 0 NODE AND RETURN NUMBER OF ENTRIES
  1. CHECKSOK(X) ;
  1.  I '$D(^ACHSDENS(0)) S ^ACHSDENS(0)="CHS DENIAL REASON^9002073^0^0"
  1.  S XBCFIXFL=9002073
  1.  D XBCFIXFL^XBCFIX
  1.  Q $G(XBCFIXC)
  1.  Q
  1.  ;
  1. ERROR S ^ACHSINST(ACHSVERS,"ERROR",$ZN,"ERROR TRAP CALLED")=NOW
  1.  G ^%ET
  1.  Q
  1.  ;
  1. TAG ;
  1.  ;;^TMP($J,"DEN",14,0)
  1.  ;;Alternate Resource Available^Alternate Resource Available
  1.  ;;^TMP($J,"DEN",14,1,1,0)
  1.  ;;Our records show that you have health care coverage/resources (such as private insurance, Medicare, Medicaid) available to pay for this
  1.  ;;^TMP($J,"DEN",14,1,2,0)
  1.  ;;medical care. [see 42 Code of Federal Regulations 36.61(c) (1990)]
  1.  ;;^TMP($J,"DEN",14,20,0)
  1.  ;;^9002073.01^2^2
  1.  ;;^TMP($J,"DEN",14,20,1,0)
  1.  ;;Other Coverage Available
  1.  ;;^TMP($J,"DEN",14,20,1,1,1,0)
  1.  ;;Any unpaid balances should be promptly submitted to the Indian Health Service Contract Health Service office for review.
  1.  ;;^TMP($J,"DEN",14,20,2,0)
  1.  ;;Would Have Been Eligible for Other Coverage
  1.  ;;^TMP($J,"DEN",14,20,2,1,1,0)
  1.  ;;You would have been eligible if you had applied and completed the application requirements.
  1.  ;;^TMP($J,"DEN",14,20,3,0)
  1.  ;;May be Eligible for Other Coverage
  1.  ;;^TMP($J,"DEN",14,20,3,1,1,0)
  1.  ;;You may be eligible if apply and complete the application requirements.
  1.  ;;^TMP($J,"DEN",15,0)
  1.  ;;Eligibility Not Established^Eligibility Not Established
  1.  ;;^TMP($J,"DEN",15,1,1,0)
  1.  ;;You have not provided evidence to prove that you are eligible for Contract Health Services (CHS). [see 42 Code of Federal Regulations 36.12 and 36.23 (1986)]
  1.  ;;^TMP($J,"DEN",15,20,0)
  1.  ;;^9002073.01^2^2
  1.  ;;^TMP($J,"DEN",15,20,1,0)
  1.  ;;Indian Descendency Not Established
  1.  ;;^TMP($J,"DEN",15,20,1,1,1,0)
  1.  ;;You did not provide your Certificate of Degree of Indian Blood (CDIB) and/or membership/descendency from a federally recognized tribe.
  1.  ;;^TMP($J,"DEN",15,20,2,0)
  1.  ;;Care for Non-Indian Pregnant Woman
  1.  ;;^TMP($J,"DEN",15,20,2,1,1,0)
  1.  ;;You did not provide a paternity form signed by the father and/or a marriage license.
  1.  ;;^TMP($J,"DEN",16,0)
  1.  ;;No Notification of Emergency Service Within 72 Hours^No Notification of Emergency Service Within 72 Hours
  1.  ;;^TMP($J,"DEN",16,1,1,0)
  1.  ;;You or someone acting on your behalf failed to notify an Indian Health Service official within 72 hours after the beginning of your emergency treatment [see 42 Code of Federal Regulations 36.24(c) (1986)]
  1.  ;;^TMP($J,"DEN",17,0)
  1.  ;;No Prior Approval for Non-Emergency Service^No Prior Approval for Non-Emergency Service
  1.  ;;^TMP($J,"DEN",17,1,1,0)
  1.  ;;You did not obtain prior approval for payment of Contract Health Services (CHS) from the Indian Health Services (IHS) authorizing official approval for this non-emergency care [Per 42 Code of Federal Regulations 36.24(b) (1986)].
  1.  ;;^TMP($J,"DEN",18,0)
  1.  ;;Care Not Within Medical Priority^Care Not Within Medical Priority
  1.  ;;^TMP($J,"DEN",18,1,1,0)
  1.  ;;The medical care you received is not within the CHS medical priorities. Medical priorities must be established when funding is limited. [Per 42 Code of Federal Regulations 36.23(e) (1986)].