- ABME5CLM ; IHS/ASDST/DMJ - 837 CLM Segment
- ;;2.6;IHS Third Party Billing System;**6,8,9,10,11,21**;NOV 12, 2009;Build 379
- ;Health Claim
- ;IHS/SD/SDR - 2.6*21 - HEAT183995 - Made Delayed Reason Code stop printing leading zero.
- ;IHS/SD/SDR 2.6*21 HEAT302468 Added line back in to send ORIGINAL BILL AMOUNT if billing the non-primary insurer
- ;
- START ;EP - START HERE
- K ABMREC("CLM"),ABMR("CLM")
- S ABME("RTYPE")="CLM"
- D LOOP
- K ABME,ABM
- Q
- LOOP ;LOOP HERE
- F I=10:10:210 D
- .D @I
- .I $D(^ABMEXLM("AA",+$G(ABMP("INS")),+$G(ABMP("EXP")),ABME("RTYPE"),I)) D @(^(I))
- .I $G(ABMREC("CLM"))'="" S ABMREC("CLM")=ABMREC("CLM")_"*"
- .S ABMREC("CLM")=$G(ABMREC("CLM"))_ABMR("CLM",I)
- Q
- 10 ;segment
- S ABMR("CLM",10)="CLM"
- Q
- 20 ;CLM01 - Claim Submitter's Identifier
- S ABMR("CLM",20)=ABMP("PCN")
- Q
- 30 ;CLM02 - Monetary Amount
- S ABMR("CLM",30)=$P(ABMB2,U) ;bill amount ;abm*2.6*11 COB billing
- ;abm*2.6*21 IHS/SD/SDR HEAT302468 Added below line back in; original bill amount should be send for secondary billing
- I ABMPSQ'=1,(+$P(ABMB2,U,7)'=0) S ABMR("CLM",30)=$P(ABMB2,U,7) ;abm*2.6*10 HEAT62019
- ;I ABMPSQ'=1,(+$P(ABMB2,U,3)'=0) S ABMR("CLM",30)=$P(ABMB2,U,3) ;abm*2.6*10 HEAT62019 ;abm*2.6*11 COB billing
- ;I ABMPSQ'=1,(+$P(ABMB2,U,7)>+$P(ABMB2,U,3)) S ABMR("CLM",30)=+$P(ABMB2,U,7) ;abm*2.6*10 HEAT61340 ;abm*2.6*11 COB billing
- ;removed below line; was sending wrong amount
- ;I ABMPSQ=2,(+$P(ABMB2,U,7)'=0),($P(^ABMNINS(ABMP("LDFN"),$P(ABMP("INS",1),U),0),U,11)="Y") S ABMR("CLM",30)=$P(ABMB2,U) ;abm*2.6*9 NOHEAT if secondary and primary is tribal self-insured ;abm*2.6*10 HEAT70085
- ;start new code abm*2.6*11 COB billing
- ;I $P(ABMB2,U,8)'="" S ABMR("CLM",30)=$P(ABMB2,U,8)
- ;S:+$G(ABMR("CLM",30))=0 ABMR("CLM",30)=$P(ABMB2,U,7)
- ;S:+$G(ABMR("CLM",30))=0 ABMR("CLM",30)=$P(ABMB2,U)
- ;end new code COB billing
- S ABMR("CLM",30)=$J(ABMR("CLM",30),0,2)
- Q
- 40 ;CLM03 - Claim Filing Indicator Code-not used
- S ABMR("CLM",40)=""
- Q
- 50 ;CLM04 - Non-Institutional Claim Type Code-not used
- S ABMR("CLM",50)=""
- Q
- 60 ;CLM05 - Health Care Service Location Information
- I ABMP("EXP")=31 D ;837I
- .S ABMR("CLM",60)=$E(ABMP("BTYP"),1,2)
- .S $P(ABMR("CLM",60),":",2)="A"
- .S $P(ABMR("CLM",60),":",3)=$E(ABMP("BTYP"),3)
- I ABMP("EXP")'=31 D
- .S ABMR("CLM",60)=$$POS^ABMERUTL()
- .S $P(ABMR("CLM",60),":",2)="B"
- .S $P(ABMR("CLM",60),":",3)=1
- Q
- 70 ;CLM06 - Provider Signature on File
- ;S ABMR("CLM",70)="Y" ;abm*2.6*8 5010
- S ABMR("CLM",70)="" ;abm*2.6*8 5010
- S:ABMP("EXP")'=31 ABMR("CLM",70)="Y" ;abm*2.6*8 5010
- Q
- 80 ;CLM07 - Provider Accept Assignment Code
- S ABMR("CLM",80)="A"
- Q
- 90 ;CLM08 - Assignment of Benefits Indicator
- S ABMR("CLM",90)=$P(ABMB7,"^",5)
- Q
- 100 ;CLM09 - Release of Information Code
- S ABMR("CLM",100)=$P(ABMB7,"^",4)
- I ABMR("CLM",100)'="Y" S ABMR("CLM",100)="I"
- Q
- 110 ;CLM10 - Patient Signature Source-not used
- S ABMR("CLM",110)=""
- Q
- 120 ;CLM11 - Related Causes Information
- I ABMP("EXP")=31 S ABMR("CLM",120)="" Q
- N X
- S X=$P(ABMB8,"^",3)
- I X="" S ABMR("CLM",120)="" Q
- S ABMR("CLM",120)=$S(X=1:"AA",X=4:"EM",1:"OA")
- I ABMR("CLM",120)="AA" D
- .S X=$P(^AUTTLOC(ABMP("LDFN"),0),"^",14)
- .S X=$P(^DIC(5,+X,0),"^",2)
- .S ABMR("CLM",120)="AA:::"_X
- Q
- 130 ;CLM12 - Special Programs Code
- S ABMR("CLM",130)="" ;abm*2.6*9 NOHEAT
- I ABMP("EXP")=31 S ABMR("CLM",130)="" Q
- ;Q:$P($G(^AUTNINS(ABMP("INS"),2)),U)'="D" ;abm*2.6*9 NOHEAT ;abm*2.6*10 HEAT73780
- Q:($$GET1^DIQ(9999999.181,$$GET1^DIQ(9999999.18,ABMP("INS"),".211","I"),1,"I")'="D") ;abm*2.6*9 NOHEAT ;abm*2.6*10 HEAT73780
- S ABMR("CLM",130)=$O(^ABMDBILL(DUZ(2),ABMP("BDFN"),59,0))
- Q:ABMR("CLM",130)=""
- S ABMR("CLM",130)=$P($G(^ABMDCODE(ABMR("CLM",130),0)),U)
- Q
- 140 ;CLM13 - Yes/No-not used
- S ABMR("CLM",140)=""
- Q
- 150 ;CLM14 - Level of Service Code-not used
- S ABMR("CLM",150)=""
- Q
- 160 ;CLM15 - Yes/No-not used
- S ABMR("CLM",160)=""
- Q
- 170 ;CLM16 - Provider Agreement Code-not used
- S ABMR("CLM",170)=""
- Q
- 180 ;CLM17 - Claim Status Code-not used
- S ABMR("CLM",180)=""
- Q
- 190 ;CLM18 - Explanation of Benefits Indicator
- S ABMR("CLM",190)="" ;abm*2.6*8 5010
- ;start old code abm*2.6*8 5010
- ;I ABMP("EXP")=21 D
- ;.S ABMR("CLM",190)="Y"
- ;I ABMP("EXP")'=21 D
- ;.S ABMR("CLM",190)=""
- ;end old code abm*2.6*8 5010
- Q
- 200 ;CLM19 - Claim Submission Reason Code-not used
- S ABMR("CLM",200)=""
- Q
- 210 ;CLM20 - Delay Reason Code
- S ABMR("CLM",210)=""
- S ABMDRC=$P($G(^ABMDBILL(DUZ(2),ABMP("BDFN"),9)),"^",16)
- ;I ABMDRC'="" S ABMR("CLM",210)=$P($G(^ABMDCODE(ABMDRC,0)),"^") ;abm*2.6*21 IHS/SD/SDR HEAT183995
- I ABMDRC'="" S ABMR("CLM",210)=+$P($G(^ABMDCODE(ABMDRC,0)),"^") ;abm*2.6*21 IHS/SD/SDR HEAT183995
- Q
- ABME5CLM ; IHS/ASDST/DMJ - 837 CLM Segment
- +1 ;;2.6;IHS Third Party Billing System;**6,8,9,10,11,21**;NOV 12, 2009;Build 379
- +2 ;Health Claim
- +3 ;IHS/SD/SDR - 2.6*21 - HEAT183995 - Made Delayed Reason Code stop printing leading zero.
- +4 ;IHS/SD/SDR 2.6*21 HEAT302468 Added line back in to send ORIGINAL BILL AMOUNT if billing the non-primary insurer
- +5 ;
- START ;EP - START HERE
- +1 KILL ABMREC("CLM"),ABMR("CLM")
- +2 SET ABME("RTYPE")="CLM"
- +3 DO LOOP
- +4 KILL ABME,ABM
- +5 QUIT
- LOOP ;LOOP HERE
- +1 FOR I=10:10:210
- Begin DoDot:1
- +2 DO @I
- +3 IF $DATA(^ABMEXLM("AA",+$GET(ABMP("INS")),+$GET(ABMP("EXP")),ABME("RTYPE"),I))
- DO @(^(I))
- +4 IF $GET(ABMREC("CLM"))'=""
- SET ABMREC("CLM")=ABMREC("CLM")_"*"
- +5 SET ABMREC("CLM")=$GET(ABMREC("CLM"))_ABMR("CLM",I)
- End DoDot:1
- +6 QUIT
- 10 ;segment
- +1 SET ABMR("CLM",10)="CLM"
- +2 QUIT
- 20 ;CLM01 - Claim Submitter's Identifier
- +1 SET ABMR("CLM",20)=ABMP("PCN")
- +2 QUIT
- 30 ;CLM02 - Monetary Amount
- +1 ;bill amount ;abm*2.6*11 COB billing
- SET ABMR("CLM",30)=$PIECE(ABMB2,U)
- +2 ;abm*2.6*21 IHS/SD/SDR HEAT302468 Added below line back in; original bill amount should be send for secondary billing
- +3 ;abm*2.6*10 HEAT62019
- IF ABMPSQ'=1
- IF (+$PIECE(ABMB2,U,7)'=0)
- SET ABMR("CLM",30)=$PIECE(ABMB2,U,7)
- +4 ;I ABMPSQ'=1,(+$P(ABMB2,U,3)'=0) S ABMR("CLM",30)=$P(ABMB2,U,3) ;abm*2.6*10 HEAT62019 ;abm*2.6*11 COB billing
- +5 ;I ABMPSQ'=1,(+$P(ABMB2,U,7)>+$P(ABMB2,U,3)) S ABMR("CLM",30)=+$P(ABMB2,U,7) ;abm*2.6*10 HEAT61340 ;abm*2.6*11 COB billing
- +6 ;removed below line; was sending wrong amount
- +7 ;I ABMPSQ=2,(+$P(ABMB2,U,7)'=0),($P(^ABMNINS(ABMP("LDFN"),$P(ABMP("INS",1),U),0),U,11)="Y") S ABMR("CLM",30)=$P(ABMB2,U) ;abm*2.6*9 NOHEAT if secondary and primary is tribal self-insured ;abm*2.6*10 HEAT70085
- +8 ;start new code abm*2.6*11 COB billing
- +9 ;I $P(ABMB2,U,8)'="" S ABMR("CLM",30)=$P(ABMB2,U,8)
- +10 ;S:+$G(ABMR("CLM",30))=0 ABMR("CLM",30)=$P(ABMB2,U,7)
- +11 ;S:+$G(ABMR("CLM",30))=0 ABMR("CLM",30)=$P(ABMB2,U)
- +12 ;end new code COB billing
- +13 SET ABMR("CLM",30)=$JUSTIFY(ABMR("CLM",30),0,2)
- +14 QUIT
- 40 ;CLM03 - Claim Filing Indicator Code-not used
- +1 SET ABMR("CLM",40)=""
- +2 QUIT
- 50 ;CLM04 - Non-Institutional Claim Type Code-not used
- +1 SET ABMR("CLM",50)=""
- +2 QUIT
- 60 ;CLM05 - Health Care Service Location Information
- +1 ;837I
- IF ABMP("EXP")=31
- Begin DoDot:1
- +2 SET ABMR("CLM",60)=$EXTRACT(ABMP("BTYP"),1,2)
- +3 SET $PIECE(ABMR("CLM",60),":",2)="A"
- +4 SET $PIECE(ABMR("CLM",60),":",3)=$EXTRACT(ABMP("BTYP"),3)
- End DoDot:1
- +5 IF ABMP("EXP")'=31
- Begin DoDot:1
- +6 SET ABMR("CLM",60)=$$POS^ABMERUTL()
- +7 SET $PIECE(ABMR("CLM",60),":",2)="B"
- +8 SET $PIECE(ABMR("CLM",60),":",3)=1
- End DoDot:1
- +9 QUIT
- 70 ;CLM06 - Provider Signature on File
- +1 ;S ABMR("CLM",70)="Y" ;abm*2.6*8 5010
- +2 ;abm*2.6*8 5010
- SET ABMR("CLM",70)=""
- +3 ;abm*2.6*8 5010
- IF ABMP("EXP")'=31
- SET ABMR("CLM",70)="Y"
- +4 QUIT
- 80 ;CLM07 - Provider Accept Assignment Code
- +1 SET ABMR("CLM",80)="A"
- +2 QUIT
- 90 ;CLM08 - Assignment of Benefits Indicator
- +1 SET ABMR("CLM",90)=$PIECE(ABMB7,"^",5)
- +2 QUIT
- 100 ;CLM09 - Release of Information Code
- +1 SET ABMR("CLM",100)=$PIECE(ABMB7,"^",4)
- +2 IF ABMR("CLM",100)'="Y"
- SET ABMR("CLM",100)="I"
- +3 QUIT
- 110 ;CLM10 - Patient Signature Source-not used
- +1 SET ABMR("CLM",110)=""
- +2 QUIT
- 120 ;CLM11 - Related Causes Information
- +1 IF ABMP("EXP")=31
- SET ABMR("CLM",120)=""
- QUIT
- +2 NEW X
- +3 SET X=$PIECE(ABMB8,"^",3)
- +4 IF X=""
- SET ABMR("CLM",120)=""
- QUIT
- +5 SET ABMR("CLM",120)=$SELECT(X=1:"AA",X=4:"EM",1:"OA")
- +6 IF ABMR("CLM",120)="AA"
- Begin DoDot:1
- +7 SET X=$PIECE(^AUTTLOC(ABMP("LDFN"),0),"^",14)
- +8 SET X=$PIECE(^DIC(5,+X,0),"^",2)
- +9 SET ABMR("CLM",120)="AA:::"_X
- End DoDot:1
- +10 QUIT
- 130 ;CLM12 - Special Programs Code
- +1 ;abm*2.6*9 NOHEAT
- SET ABMR("CLM",130)=""
- +2 IF ABMP("EXP")=31
- SET ABMR("CLM",130)=""
- QUIT
- +3 ;Q:$P($G(^AUTNINS(ABMP("INS"),2)),U)'="D" ;abm*2.6*9 NOHEAT ;abm*2.6*10 HEAT73780
- +4 ;abm*2.6*9 NOHEAT ;abm*2.6*10 HEAT73780
- IF ($$GET1^DIQ(9999999.181,$$GET1^DIQ(9999999.18,ABMP("INS"),".211","I"),1,"I")'="D")
- QUIT
- +5 SET ABMR("CLM",130)=$ORDER(^ABMDBILL(DUZ(2),ABMP("BDFN"),59,0))
- +6 IF ABMR("CLM",130)=""
- QUIT
- +7 SET ABMR("CLM",130)=$PIECE($GET(^ABMDCODE(ABMR("CLM",130),0)),U)
- +8 QUIT
- 140 ;CLM13 - Yes/No-not used
- +1 SET ABMR("CLM",140)=""
- +2 QUIT
- 150 ;CLM14 - Level of Service Code-not used
- +1 SET ABMR("CLM",150)=""
- +2 QUIT
- 160 ;CLM15 - Yes/No-not used
- +1 SET ABMR("CLM",160)=""
- +2 QUIT
- 170 ;CLM16 - Provider Agreement Code-not used
- +1 SET ABMR("CLM",170)=""
- +2 QUIT
- 180 ;CLM17 - Claim Status Code-not used
- +1 SET ABMR("CLM",180)=""
- +2 QUIT
- 190 ;CLM18 - Explanation of Benefits Indicator
- +1 ;abm*2.6*8 5010
- SET ABMR("CLM",190)=""
- +2 ;start old code abm*2.6*8 5010
- +3 ;I ABMP("EXP")=21 D
- +4 ;.S ABMR("CLM",190)="Y"
- +5 ;I ABMP("EXP")'=21 D
- +6 ;.S ABMR("CLM",190)=""
- +7 ;end old code abm*2.6*8 5010
- +8 QUIT
- 200 ;CLM19 - Claim Submission Reason Code-not used
- +1 SET ABMR("CLM",200)=""
- +2 QUIT
- 210 ;CLM20 - Delay Reason Code
- +1 SET ABMR("CLM",210)=""
- +2 SET ABMDRC=$PIECE($GET(^ABMDBILL(DUZ(2),ABMP("BDFN"),9)),"^",16)
- +3 ;I ABMDRC'="" S ABMR("CLM",210)=$P($G(^ABMDCODE(ABMDRC,0)),"^") ;abm*2.6*21 IHS/SD/SDR HEAT183995
- +4 ;abm*2.6*21 IHS/SD/SDR HEAT183995
- IF ABMDRC'=""
- SET ABMR("CLM",210)=+$PIECE($GET(^ABMDCODE(ABMDRC,0)),"^")
- +5 QUIT