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Routine: BARADJR2

BARADJR2.m

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  1. BARADJR2 ; IHS/SD/LSL - CREATE ENTRY IN A/R EDI STND CLAIM ADJ REASON ;
  1. ;;1.8;IHS ACCOUNTS RECEIVABLE;;OCT 26, 2005
  1. ;
  1. ; IHS/SD/LSL - 11/06/03 - V1.7 Patch 4 - routine created
  1. ; For HIPAA compliance. Ceate new entries in A/R EDI STND ADJ
  1. ; REASON CODES for new codes added since 6/02. Also create new
  1. ; RPMS reason codes for the standard codes to map to.
  1. ;
  1. ; *********************************************************************
  1. EN ; EP
  1. D RPMSREA ; Create RPMS Reasons
  1. D STND ; Create new StanJdard Adj
  1. D CLAIM ; Create new Claim Status Codes
  1. D ^BARVKL0
  1. Q
  1. ; ********************************************************************
  1. ;
  1. RPMSREA ;
  1. ; Create new Adjustment Reasons in A/R TABLE ENTRY
  1. S BARD=";;"
  1. S BARCNT=0
  1. F D RPMSREA2 Q:BARVALUE="END"
  1. Q
  1. ; ********************************************************************
  1. ;
  1. RPMSREA2 ;
  1. S BARCNT=BARCNT+1
  1. S BARVALUE=$P($T(@1+BARCNT),BARD,2,4)
  1. Q:BARVALUE="END"
  1. K DIC,DA,X,Y
  1. S DIC="^BARTBL("
  1. S DIC(0)="LZE"
  1. S DINUM=$P(BARVALUE,BARD)
  1. S X=$P(BARVALUE,BARD,2)
  1. S DIC("DR")="2////^S X=$P(BARVALUE,BARD,3)"
  1. K DD,DO
  1. D FILE^DICN
  1. Q
  1. ; ********************************************************************
  1. ; ********************************************************************
  1. ;
  1. CHNGREA ; EP
  1. ; Change category of these reasons to Non-Payment
  1. S BARD=";;"
  1. S BARCNT=0
  1. F D CHNGREA2 Q:BARVALUE="END"
  1. Q
  1. ; ********************************************************************
  1. ;
  1. CHNGREA2 ;
  1. S BARCNT=BARCNT+1
  1. S BARVALUE=$P($T(@4+BARCNT),BARD,3)
  1. Q:BARVALUE="END"
  1. K DIC,DA,X,Y,DIE
  1. S DIE="^BARTBL("
  1. S DA=BARVALUE
  1. S DR="2////^S X=4"
  1. D ^DIE
  1. Q
  1. ; ********************************************************************
  1. ; ********************************************************************
  1. ;
  1. STND ;
  1. ; Create entries in A/R EDI STND CLAIM ADJ REASONS to accomodate
  1. ; Standard codes added between 6/02 and 9/03.
  1. S BARD=";;"
  1. S BARCNT=0
  1. F D STND2 Q:BARVALUE="END"
  1. Q
  1. ; ********************************************************************
  1. ;
  1. STND2 ;
  1. S BARCNT=BARCNT+1
  1. S BARVALUE=$P($T(@2+BARCNT),BARD,2,6)
  1. Q:BARVALUE="END"
  1. K DIC,DA,X,Y
  1. S DIC="^BARADJ("
  1. S DIC(0)="LZE"
  1. S X=$P(BARVALUE,BARD) ; Stnd Code
  1. S DIC("DR")=".02///^S X=$P(BARVALUE,BARD,2)" ; Short Desc
  1. S DIC("DR")=DIC("DR")_";.03////^S X=$P(BARVALUE,BARD,3)" ; RPMS Cat
  1. S DIC("DR")=DIC("DR")_";.04////^S X=$P(BARVALUE,BARD,4)" ; RPMS Type
  1. S DIC("DR")=DIC("DR")_";101///^S X=$P(BARVALUE,BARD,5)" ; Long Desc
  1. K DD,DO
  1. D FILE^DICN
  1. Q
  1. ; ********************************************************************
  1. ; ********************************************************************
  1. ;
  1. CLAIM ;
  1. ; Populate A/R EDI CLAIM STATUS CODES to accomodate new codes added
  1. ; between 6/02 and 9/03. Inactivate necessary codes.
  1. S BARCNT=0
  1. F D CLAIM2 Q:BARVALUE="END"
  1. S BARCNT=0
  1. F BARVALUE=8,10,11,13,14,28,69,70 D CLAIM3
  1. Q
  1. ; ********************************************************************
  1. ;
  1. CLAIM2 ;
  1. S BARCNT=BARCNT+1
  1. S BARVALUE=$P($T(@3+BARCNT),BARD,2,4)
  1. Q:BARVALUE="END"
  1. K DIC,DA,X,Y
  1. S DIC="^BARECSC("
  1. S DIC(0)="LZE"
  1. S X=$P(BARVALUE,BARD) ; Status Cd
  1. S DIC("DR")="11///^S X=$P(BARVALUE,BARD,2)" ; Description
  1. K DD,DO
  1. D FILE^DICN
  1. Q
  1. ; ********************************************************************
  1. ;
  1. CLAIM3 ;
  1. K DIC,DA,X,Y
  1. S DIC="^BARECSC("
  1. S DIC(0)="XZQ"
  1. S X=BARVALUE
  1. K DD,DO
  1. D ^DIC
  1. Q:+Y<1
  1. K DA,DIE,DR
  1. S DA=+Y
  1. S DIE=DIC
  1. S DR=".02///Y"
  1. D ^DIE
  1. Q
  1. ; ********************************************************************
  1. ; ********************************************************************
  1. ;
  1. MODIFY ; EP
  1. ; Change PENDING to NON PAYMENT
  1. S BARD=";;"
  1. S BARCNT=0
  1. F D MODIFY2 Q:BARVALUE="END"
  1. Q
  1. ; *********************************************************************
  1. ;
  1. MODIFY2 ;
  1. S BARCNT=BARCNT+1
  1. S BARVALUE=$P($T(@4+BARCNT),BARD,2)
  1. Q:BARVALUE="END"
  1. K DIC,DA,X,Y,DR
  1. S DIC="^BARADJ("
  1. S DIC(0)="Z"
  1. S X=$P(BARVALUE,BARD) ; Stnd Code
  1. K DD,DO
  1. D ^DIC
  1. Q:'+Y
  1. ;
  1. S DIE=DIC
  1. S DA=+Y
  1. S DR=".03////^S X=4"
  1. D ^DIE
  1. Q
  1. ;
  1. ; *********************************************************************
  1. ; IEN;;NAME;;TABLE TYPE
  1. ; *********************************************************************
  1. 1 ;;
  1. ;;745;;Premium Pmt Withholding;;21
  1. ;;746;;Pmt Den DX Invalid for DOS;;4
  1. ;;747;;Prv Rate Expired/Not on file;;4
  1. ;;748;;Clm/Srv Rej Info Incomplete;;21
  1. ;;749;;Lifetime Ben Max for Srv/Ben;;4
  1. ;;750;;PayAdj No Info for Lgthof Svc;;4
  1. ;;751;;PayAdj No Info for Lgth of Svc;;4
  1. ;;752;;PayAdj No Info for Dosage;;4
  1. ;;753;;PayAdj No Info for Days Supply;;4
  1. ;;754;;PayAdj No Info for Lvl of Svc;;4
  1. ;;755;;Clm DEn Pt Refused Srv/Proc;;4
  1. ;;756;;Flex Spending Accts Payable;;22
  1. ;;757;;Pmt Den/Red Result Act of War;;4
  1. ;;758;;Pmt Den/Red Outside US;;4
  1. ;;759;;Pmt Den/Red Result of Terrorsm;;4
  1. ;;760;;Pmt Den/Red Activity Ben Excl;;4
  1. ;;END
  1. ;
  1. ; ********************************************************************
  1. ; STND CODE ;; SHORT DESC ;; RPMS CAT ;; RPMS TYP ;; LONG DESC
  1. ; ********************************************************************
  1. 2 ;;
  1. ;;145;;Premium payment withholding;;21;;745;;Premium payment withholding
  1. ;;146;;Payment denied because diagnosis invalid for the date(s) of service reported.;;4;;746;;Payment denied because the diagnosis was invalid for the date(s) of service reported.
  1. ;;147;;Provider contracted/negotiated rate expired or not on file.;;4;;747;;Provider contracted/negotiated rate expired or not on file.
  1. ;;148;;Clm/Srvc rejectd at this time-info from another prv not provided/insuff/incmplet;;21;;748;;Claim/service rejected at this time because information from another provider was not provided or was insufficient/incomplete.
  1. ;;149;;Lifetime benefit maximum has been reached for this service/benefit category.;;4;;749;;Lifetime benefit maximum has been reached for this service/benefit category.
  1. ;;150;;Pmt adjusted - payer deems the info submitted not support this level of service.;;4;;750;;Payment adjusted because the payer deems the information submitted does not support this level of service.
  1. ;;151;;Pmt adjusted - payer deems the info submitted not support this many svcs.;;4;;751;;Payment adjusted because the payer deems the information submitted does not support this many svcs.
  1. ;;152;;Pmt adjusted - payer deems the info submitted not support this lgth of svc.;;4;;752;;Payment adjusted because the payer deems the information submitted does not support this length of service.
  1. ;;153;;Pmt adjusted - payer deems the info submitted not support this dosage.;;4;;753;;Payment adjusted because the payer deems the information submitted does not support this dosage.
  1. ;;154;;Pmt adjusted - payer deems the info submitted not support this day's supply.;;4;;754;;Payment adjusted because the payer deems the information submitted does not support this day's supply.
  1. ;;155;;This claim is denied because the patient refused the service/procedure;;4;;755;;This claim is denied because the patient refused the service/procedure
  1. ;;156;;Flexible spending account payments.;;22;;756;;Flexible spending account payments.
  1. ;;157;;Pmt denied/reduced - service/procedure provided as a result of an act of war.;;4;;757;;Payment denied/reduced because service/procedure was provided as a result of an act of war.
  1. ;;158;;Pmt denied/reduced - service/procedure provided outside the United States.;;4;;758;;Payment denied/reduced because service/procedure was provided outside the United States.
  1. ;;159;;Pmt denied/reduced - service/procedure provided as a result of terrorism.;;4;;759;;Payment denied/reduced because service/procedure was provided as a result of terrorism.
  1. ;;160;;Pmt denied/reduce - injury/illness result of activity that's a benefit exclusion;;4;;760;;Payment denied/reduced because injury/illness was the result of an activity that is a benefit exclusion.
  1. ;;END
  1. ;
  1. ; ********************************************************************
  1. ; CLAIM STATUS CODE ;; DESCRIPTION
  1. ; ********************************************************************
  1. 3 ;;
  1. ;;489;;Attachment Control Number
  1. ;;490;;Other Procedure Code for Service(s) Rendered
  1. ;;491;;Entity not eligible for encounter submission
  1. ;;492;;Other Procedure Date
  1. ;;493;;Version/Release/Industry ID code not currently supported by information holder
  1. ;;494;;Real-time requests not supported by the information holder, resubmit as batch request
  1. ;;495;;Requests for re-adjudication must reference the newly assigned payer claim control number for this previously adjusted claim. Correct the payer claim control number and re-submit.
  1. ;;END
  1. ;
  1. ; ********************************************************************
  1. ; STANDARD CODE ;; RPMS REASON
  1. ; ********************************************************************
  1. 4 ;;
  1. ;;4;;604
  1. ;;5;;605
  1. ;;6;;606
  1. ;;7;;607
  1. ;;8;;608
  1. ;;9;;609
  1. ;;10;;610
  1. ;;11;;611
  1. ;;12;;612
  1. ;;13;;613
  1. ;;14;;614
  1. ;;15;;615
  1. ;;16;;616
  1. ;;17;;617
  1. ;;19;;619
  1. ;;20;;620
  1. ;;21;;621
  1. ;;22;;622
  1. ;;47;;647
  1. ;;55;;655
  1. ;;56;;656
  1. ;;57;;657
  1. ;;58;;658
  1. ;;61;;661
  1. ;;63;;663
  1. ;;65;;665
  1. ;;107;;707
  1. ;;110;;710
  1. ;;125;;725
  1. ;;140;;740
  1. ;;148;;748
  1. ;;B12;;862
  1. ;;B13;;863
  1. ;;B16;;866
  1. ;;B18;;868
  1. ;;B22;;872
  1. ;;B23;;873
  1. ;;D1;;901
  1. ;;D2;;902
  1. ;;D3;;903
  1. ;;D4;;904
  1. ;;D5;;905
  1. ;;D6;;906
  1. ;;D7;;907
  1. ;;D8;;908
  1. ;;D9;;909
  1. ;;D10;;910
  1. ;;D11;;911
  1. ;;D12;;912
  1. ;;D13;;913
  1. ;;D14;;914
  1. ;;END;;END