ABME8CLM.m

ABME8CLM ; IHS/ASDST/DMJ - 837 CLM Segment 

 ;;2.6;IHS 3P BILLING SYSTEM;;NOV 12, 2009

 ;Health Claim

 ;

 ; IHS/SD/SDR - v2.5 p9 - IM18516

 ;   Delayed Reason Code added inCLM20

 ;

 ; IHS/SD/SDR - v2.5 p10 - COB issue

 ;   Added code to change CLM02 amount if COB claim (use original

 ;   bill amount)

 ;

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

 I ABMPSQ'=1,(+$P(ABMB2,U,7)'=0) S ABMR("CLM",30)=$P(ABMB2,U,7)

 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")=21 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")'=21 D

 .S ABMR("CLM",60)=$$POS^ABMERUTL()

 .S $P(ABMR("CLM",60),":",3)=1

 Q

70 ;CLM06 - Provider Signature on File

 S ABMR("CLM",70)="Y"

 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)="R" S ABMR("CLM",100)="M"

 Q

110 ;CLM10 - Patient Signature Source-not used

 I ABMP("EXP")'=22 D

 .S ABMR("CLM",110)=""

 I ABMP("EXP")=22 D

 .S ABMR("CLM",110)=""

 .I ABMR("CLM",90)="Y" S ABMR("CLM",110)="M"

 .Q:ABMR("CLM",100)="N"

 .I ABMR("CLM",90)="N" S ABMR("CLM",110)="S" Q

 .S ABMR("CLM",110)="B"

 Q

120 ;CLM11 - Related Causes Information

 I ABMP("EXP")=21 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

 I ABMP("EXP")=21 S ABMR("CLM",130)="" Q

 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

 I ABMP("EXP")=21 D

 .S ABMR("CLM",190)="Y"

 I ABMP("EXP")'=21 D

 .S ABMR("CLM",190)=""

 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)),"^")

 Q

ABME8CLM  ; IHS/ASDST/DMJ - 837 CLM Segment 

 +1       ;;2.6;IHS 3P BILLING SYSTEM;;NOV 12, 2009

 +2       ;Health Claim

 +3       ;

 +4       ; IHS/SD/SDR - v2.5 p9 - IM18516

 +5       ;   Delayed Reason Code added inCLM20

 +6       ;

 +7       ; IHS/SD/SDR - v2.5 p10 - COB issue

 +8       ;   Added code to change CLM02 amount if COB claim (use original

 +9       ;   bill amount)

 +10      ;

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

           SET ABMR("CLM",30)=$PIECE(ABMB2,U)

 +2        IF ABMPSQ'=1

               IF (+$PIECE(ABMB2,U,7)'=0)

                   SET ABMR("CLM",30)=$PIECE(ABMB2,U,7)

 +3        SET ABMR("CLM",30)=$JUSTIFY(ABMR("CLM",30),0,2)

 +4        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")=21

               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")'=21

               Begin DoDot:1

 +6                SET ABMR("CLM",60)=$$POS^ABMERUTL()

 +7                SET $PIECE(ABMR("CLM",60),":",3)=1

               End DoDot:1

 +8        QUIT 

70        ;CLM06 - Provider Signature on File

 +1        SET ABMR("CLM",70)="Y"

 +2        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)="R"

               SET ABMR("CLM",100)="M"

 +3        QUIT 

110       ;CLM10 - Patient Signature Source-not used

 +1        IF ABMP("EXP")'=22

               Begin DoDot:1

 +2                SET ABMR("CLM",110)=""

               End DoDot:1

 +3        IF ABMP("EXP")=22

               Begin DoDot:1

 +4                SET ABMR("CLM",110)=""

 +5                IF ABMR("CLM",90)="Y"

                       SET ABMR("CLM",110)="M"

 +6                IF ABMR("CLM",100)="N"

                       QUIT 

 +7                IF ABMR("CLM",90)="N"

                       SET ABMR("CLM",110)="S"

                       QUIT 

 +8                SET ABMR("CLM",110)="B"

               End DoDot:1

 +9        QUIT 

120       ;CLM11 - Related Causes Information

 +1        IF ABMP("EXP")=21

               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        IF ABMP("EXP")=21

               SET ABMR("CLM",130)=""

               QUIT 

 +2        SET ABMR("CLM",130)=$ORDER(^ABMDBILL(DUZ(2),ABMP("BDFN"),59,0))

 +3        IF ABMR("CLM",130)=""

               QUIT 

 +4        SET ABMR("CLM",130)=$PIECE($GET(^ABMDCODE(ABMR("CLM",130),0)),U)

 +5        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        IF ABMP("EXP")=21

               Begin DoDot:1

 +2                SET ABMR("CLM",190)="Y"

               End DoDot:1

 +3        IF ABMP("EXP")'=21

               Begin DoDot:1

 +4                SET ABMR("CLM",190)=""

               End DoDot:1

 +5        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        IF ABMDRC'=""

               SET ABMR("CLM",210)=$PIECE($GET(^ABMDCODE(ABMDRC,0)),"^")

 +4        QUIT