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Routine: ABME5CLM

ABME5CLM.m

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