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Routine: ABMPT266

ABMPT266.m

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  1. ABMPT266 ; IHS/SD/SDR - 3P BILLING 2.6 Patch 5 POST INIT ;  
  1.  ;;2.6;IHS Third Party Billing;**6**;NOV 12, 2009
  1.  ;
  1.  Q
  1. PRE ;
  1.  S DIK="^ABMDEXP("
  1.  S DA=23
  1.  D ^DIK
  1.  S DA=24
  1.  D ^DIK
  1.  S DA=32
  1.  D ^DIK
  1.  S DIK="^ABMPSTAT("
  1.  S DA=20
  1.  D ^DIK
  1.  S DA=24
  1.  D ^DIK
  1.  Q
  1. EN ;EP
  1.  D ERRCODES  ;new error codes
  1.  D ECODES ; new 3P Codes
  1.  D QUES  ;3P PAGE3 QUESTIONS
  1.  D CASHCK  ;check cashiering sessions for .01 field being populated
  1.  Q
  1. ERRCODES ;
  1.  ;235 - Facility NPI missing
  1.  K DIC,X
  1.  S DIC="^ABMDERR("
  1.  S DIC(0)="LM"
  1.  S DINUM=235
  1.  S X="Facility NPI missing"
  1.  S DIC("DR")=".02///Add NPI for facility"
  1.  S DIC("DR")=DIC("DR")_";.03///E"
  1.  K DD,DO
  1.  D FILE^DICN
  1.  D SITE(235)
  1.  ;236 - Subscriber Primary Identifier missing
  1.  K DIC,X
  1.  S DIC="^ABMDERR("
  1.  S DIC(0)="LM"
  1.  S DINUM=236
  1.  S X="Subscriber Primary Identifier missing"
  1.  S DIC("DR")=".02///Populate subscriber number"
  1.  S DIC("DR")=DIC("DR")_";.03///E"
  1.  K DD,DO
  1.  D FILE^DICN
  1.  D SITE(236)
  1.  ;237 - Special Program code not supported by 837 5010 format
  1.  K DIC,X
  1.  S DIC="^ABMDERR("
  1.  S DIC(0)="LM"
  1.  S DINUM=237
  1.  S X="Special Program code not supported by 837 5010 format"
  1.  S DIC("DR")=".02///Use 5010 or different special program code"
  1.  S DIC("DR")=DIC("DR")_";.03///W"
  1.  K DD,DO
  1.  D FILE^DICN
  1.  D SITE(237)
  1.  ;238 - Only one disability date populated
  1.  K DIC,X
  1.  S DIC="^ABMDERR("
  1.  S DIC(0)="LM"
  1.  S DINUM=238
  1.  S X="Only one disability date populated"
  1.  S DIC("DR")=".02///Populated both dates if possible"
  1.  S DIC("DR")=DIC("DR")_";.03///W"
  1.  K DD,DO
  1.  D FILE^DICN
  1.  D SITE(238)
  1.  ;239 - No Prescription Number
  1.  K DIC,X
  1.  S DIC="^ABMDERR("
  1.  S DIC(0)="LM"
  1.  S DINUM=239
  1.  S X="Prescription Number missing"
  1.  S DIC("DR")=".02///Populated Prescription Number"
  1.  S DIC("DR")=DIC("DR")_";.03///E"
  1.  K DD,DO
  1.  D FILE^DICN
  1.  D SITE(239)
  1.  Q
  1. SITE(ABMX) ;Add SITE multiple
  1.  S DUZHOLD=DUZ(2)
  1.  S DUZ(2)=0
  1.  F  S DUZ(2)=$O(^ABMDCLM(DUZ(2))) Q:'+DUZ(2)  D
  1.  .S DIC(0)="LX"
  1.  .S DA(1)=ABMX
  1.  .S DIC="^ABMDERR("_DA(1)_",31,"
  1.  .S DIC("P")=$P(^DD(9002274.04,31,0),U,2)
  1.  .S DINUM=DUZ(2)
  1.  .S X=$P($G(^DIC(4,DUZ(2),0)),U)
  1.  .S DIC("DR")=".03////"_$S(DA(1)=237!(DA(1)=238):"W",1:"E")
  1.  .D ^DIC
  1.  .K DA,DIC,DINUM
  1.  S DUZ(2)=DUZHOLD
  1.  K DUZHOLD,DLAYGO,ABMX
  1.  Q
  1. ECODES ;
  1.  K DIC,X
  1.  F ABMI=1:1 S ABMLN=$P($T(ECODETXT+ABMI),";;",2) Q:ABMLN="END"  D
  1.  .S ABMCODE=$P(ABMLN,U)
  1.  .I $D(^ABMDCODE("AC",$P(ABMLN,U,2),ABMCODE)) D  Q
  1.  ..S DA=$O(^ABMDCODE("AC",$P(ABMLN,U,2),ABMCODE,0))
  1.  ..S $P(^ABMDCODE(DA,0),U,2)=$P(ABMLN,U,2),$P(^(0),U,3)=$P(ABMLN,U,3)
  1.  .S ABMDESC=$P(ABMLN,U,3)
  1.  .S DIC="^ABMDCODE("
  1.  .S DIC(0)="ML"
  1.  .S X=ABMCODE
  1.  .S DIC("DR")=".02///"_$P(ABMLN,U,2)
  1.  .S DIC("DR")=DIC("DR")_";.03///"_ABMDESC
  1.  .K DD,DO
  1.  .D FILE^DICN
  1.  ;
  1.  K DIC,X
  1.  S DIC="^ABMDCODE("
  1.  S DIC(0)="ML"
  1.  S X="05"
  1.  S DIC("DR")=".02///H"
  1.  S DIC("DR")=DIC("DR")_";.03///INDIAN HEALTH SERVICE FREE-STANDING FACILITY"
  1.  K DD,DO
  1.  D FILE^DICN
  1.  ;
  1.  K DIC,X
  1.  S DIC="^ABMDCODE("
  1.  S DIC(0)="ML"
  1.  S X="06"
  1.  S DIC("DR")=".02///H"
  1.  S DIC("DR")=DIC("DR")_";.03///INDIAN HEALTH SERVICE PROVIDER-BASED FACILITY"
  1.  K DD,DO
  1.  D FILE^DICN
  1.  Q
  1. ECODETXT ;
  1.  ;;09^I^Second Opinion or Surgery
  1.  ;;15^U^NATURAL DISASTER
  1.  ;;10^U^ADMINISTRATION DELAY IN THE PRIOR APPROVAL PROCESS
  1.  ;;11^U^OTHER
  1.  ;;01^U^PROOF OF ELIGIBILITY UNKNOWN OR UNAVALABLE
  1.  ;;02^U^LITIGATION
  1.  ;;03^U^AUTHORIZATION DELAYS
  1.  ;;04^U^DELAY IN CERTIFYING PROVIDER
  1.  ;;05^U^DELAY IN SUPPLYING BILLING FORM
  1.  ;;06^U^DELAY IN DELIVERY OF CUSTOM-MADE APPLIANCES
  1.  ;;07^U^THIRD PARTY PROCESSING DELAY
  1.  ;;08^U^DELAY IN ELIGIBILITY DETERMINATION
  1.  ;;09^U^ORIGINAL CLAIM REJECTED DENIED UNRELATED TO LIMITATION RULES
  1.  ;;03^W^Report Justifying Treatment Beyond Utilization Guidelines
  1.  ;;04^W^Drugs Administered
  1.  ;;05^W^Treatment Diagnosis
  1.  ;;06^W^Initial Assessment
  1.  ;;07^W^Functional Goals
  1.  ;;08^W^Plan of Treatment
  1.  ;;09^W^Progress Report
  1.  ;;10^W^Continued Treatment
  1.  ;;11^W^Chemical Analysis
  1.  ;;13^W^Certified Test Report
  1.  ;;15^W^Justification for Admission
  1.  ;;21^W^Recovery Plan
  1.  ;;A3^W^Allergies/Sensitivities Document
  1.  ;;A4^W^Autopsy Report
  1.  ;;AM^W^Ambulance Certification
  1.  ;;BR^W^Benchmark Testing Results
  1.  ;;BS^W^Baseline
  1.  ;;BT^W^Blanket Test Results
  1.  ;;CB^W^Chiropractic Justification
  1.  ;;CK^W^Consent Form(s)
  1.  ;;D2^W^Drug Profile Document
  1.  ;;DB^W^Durable Medical Equipment Prescription
  1.  ;;DJ^W^Discharge Monitoring Report
  1.  ;;HC^W^Health Certificate
  1.  ;;HR^W^Health Clinic Records
  1.  ;;I5^W^Immunization Record
  1.  ;;IR^W^State School Immunization Records
  1.  ;;LA^W^Laboratory Results
  1.  ;;M1^W^Medical Record Attachment
  1.  ;;OC^W^Oxygen Content Averaging Report
  1.  ;;OD^W^Orders and Treatments Document
  1.  ;;OE^W^Objective Physical Examination (including vital signs) Document
  1.  ;;OX^W^Oxygen Therapy Certification
  1.  ;;P4^W^Pathology Report
  1.  ;;P5^W^Patient Medical History Document
  1.  ;;PE^W^Parenteral or Enteral Certification
  1.  ;;PQ^W^Paramedical Results
  1.  ;;PY^W^Physician's Report
  1.  ;;RX^W^Renewable Oxygen Content Averaging Report
  1.  ;;SG^W^Symptoms Document
  1.  ;;V5^W^Death Notification
  1.  ;;XP^W^Photographs
  1.  ;;END
  1. QUES ;
  1.  K DIC,X,DINUM,DR,DLAYGO
  1.  S DIC="^ABMQUES("
  1.  S DIC(0)="LM"
  1.  S DLAYGO=9002274
  1.  S DINUM=36,X="HEARING/VISION RX DATE"
  1.  S DIC("DR")=".02////W36;.03////ABMDE301;.04////36;1////ABMDE3C"
  1.  K DD,DO
  1.  D ^DIC
  1.  K DIC,X,DINUM,DR,DLAYGO
  1.  S DIC="^ABMQUES("
  1.  S DIC(0)="LM"
  1.  S DLAYGO=9002274
  1.  S DINUM=37,X="Start/End Disability Dates"
  1.  S DIC("DR")=".02////W37;.03////ABMDE301;.04////37;1////ABMDE3C"
  1.  K DD,DO
  1.  D ^DIC
  1.  K DIC,X,DINUM,DR,DLAYGO
  1.  S DIC="^ABMQUES("
  1.  S DIC(0)="LM"
  1.  S DLAYGO=9002274
  1.  S DINUM=38,X="Assumed/Relinquished Care Date"
  1.  S DIC("DR")=".02////W38;.03////ABMDE301;.04////38;1////ABMDE3C"
  1.  K DD,DO
  1.  D ^DIC
  1.  K DIC,X,DINUM,DR,DLAYGO
  1.  S DIC="^ABMQUES("
  1.  S DIC(0)="LM"
  1.  S DLAYGO=9002274
  1.  S DINUM=39,X="Prop/Casualty Date 1st Contact"
  1.  S DIC("DR")=".02////W39;.03////ABMDE301;.04////39;1////ABMDE3C"
  1.  K DD,DO
  1.  D ^DIC
  1.  K DIC,X,DINUM,DR,DLAYGO
  1.  S DIC="^ABMQUES("
  1.  S DIC(0)="LM"
  1.  S DLAYGO=9002274
  1.  S DINUM=40,X="Patient Paid Amount"
  1.  S DIC("DR")=".02////W40;.03////ABMDE301;.04////40;1////ABMDE3C"
  1.  K DD,DO
  1.  D ^DIC
  1.  K DIC,X,DINUM,DR,DLAYGO
  1.  S DIC="^ABMQUES("
  1.  S DIC(0)="LM"
  1.  S DLAYGO=9002274
  1.  S DINUM=41,X="Spinal Manipulation Cond Code"
  1.  S DIC("DR")=".02////W41;.03////ABMDE301;.04////41;1////ABMDE3C"
  1.  K DD,DO
  1.  D ^DIC
  1.  K DIC,X,DINUM,DR,DLAYGO
  1.  S DIC="^ABMQUES("
  1.  S DIC(0)="LM"
  1.  S DLAYGO=9002274
  1.  S DINUM=42,X="Vision Condition Info"
  1.  S DIC("DR")=".02////W42;.03////ABMDE301;.04////42;1////ABMDE3C"
  1.  K DD,DO
  1.  D ^DIC
  1. CASHCK ;
  1.  ;
  1.  D BMES^XPDUTL("Checking UFMS Cashiering Sessions for .01 field....")
  1.  S ABMLOC=0
  1.  S ABMBFLG=0
  1.  F  S ABMLOC=$O(^ABMUCASH(ABMLOC)) Q:'ABMLOC  D
  1.  .S ABMUSER=0
  1.  .F  S ABMUSER=$O(^ABMUCASH(ABMLOC,10,ABMUSER)) Q:'ABMUSER  D
  1.  ..S ABMSESS=0
  1.  ..F  S ABMSESS=$O(^ABMUCASH(ABMLOC,10,ABMUSER,20,ABMSESS)) Q:'ABMSESS  D
  1.  ...I $P($G(^ABMUCASH(ABMLOC,10,ABMUSER,20,ABMSESS,0)),U)="" D
  1.  ....S ABMBFLG=1
  1.  ....S ABMAFLG=$$ACTIVCK^ABMUUTL(ABMLOC,ABMSESS,ABMUSER)
  1.  ....D BMES^XPDUTL(ABMLOC_"  "_ABMUSER_"  "_ABMSESS_$S(ABMAFLG=1:" *",1:""))
  1.  .S ABMUSER=0
  1.  .F  S ABMUSER=$O(^ABMUCASH(ABMLOC,20,ABMUSER)) Q:'ABMUSER  D
  1.  ..S ABMSESS=0
  1.  ..F  S ABMSESS=$O(^ABMUCASH(ABMLOC,20,ABMUSER,20,ABMSESS)) Q:'ABMSESS  D
  1.  ...I $P($G(^ABMUCASH(ABMLOC,20,ABMUSER,20,ABMSESS,0)),U)="" D
  1.  ....S ABMBFLG=1
  1.  ....S ABMAFLG=$$ACTIVCK^ABMUUTL(ABMLOC,ABMSESS,ABMUSER)
  1.  ....D BMES^XPDUTL(ABMLOC_"  "_ABMUSER_"  "_ABMSESS_$S(ABMAFLG=1:" *",1:""))
  1.  I ABMBFLG=1 D BMES^XPDUTL("Sessions found.  Please contact OIT with above list")
  1.  I ABMBFLG=0 D BMES^XPDUTL("Sessions checked out ok.")
  1.  Q