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Routine: ACHSDAR4

ACHSDAR4.m

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  1. ACHSDAR4 ; IHS/ITSC/TPF/PMF - APPEAL TO ALTERNATE RESOURCE (2/3) ; 
  1.  ;;3.1;CONTRACT HEALTH MGMT SYSTEM;;JUN 11, 2001
  1.  ;
  1. START ;EP
  1.  U IO
  1.  D BM^ACHS
  1.  S ACHSBM=ACHSBM-4,ACHDONE=""
  1.  F I=1:1:4 W "*** OFFICE COPY *** "
  1.  W !!!
  1.  S ACHSPG=1,DIWL=5,DIWR=$S($G(IOM):IOM,1:75),DIWF="W"
  1. DOC ;
  1.  D HEADER^ACHSDNL2
  1.  ;
  1.  ;get the patient name from one place if not registered,
  1.  ;from another if they are registered.
  1.  I $$DN^ACHS(0,6)'="Y" S ACHDPAT=$G(^ACHSDEN(DUZ(2),"D",ACHSA,10))
  1.  E  S ACHDPAT=$P($G(^DPT($$DN^ACHS(0,7),0)),U)
  1.  ;
  1.  ;reverse the name so that first name is first
  1.  S ACHDPAT=$P(ACHDPAT,",",2)_" "_$P(ACHDPAT,",",1)
  1.  S ACHDALR=$G(^AUTNINS(ACHDALRS,0))
  1. DOC1 ;
  1.  W !!!,?DIWL-1,$$DATE^ACHSDARR($$DN^ACHS(0,2),"MM",1)," ",$$DATE^ACHSDARR($$DN^ACHS(0,2),"DD"),", ",$$DATE^ACHSDARR($$DN^ACHS(0,2),"YY")
  1.  W !!!!,?DIWL-1,$P($G(^AUTNINS(ACHDALRS,4)),U)
  1.  ;
  1.  I $P(ACHDALR,U,2)']"" W !!! G DOC2
  1.  W !?DIWL-1,$P(ACHDALR,U,2),!?DIWL-1,$P(ACHDALR,U,3)_", "_$P($G(^DIC(5,$P(ACHDALR,U,4),0)),U,2)_"  "_$P(ACHDALR,U,5),!
  1.  ;
  1. DOC2 ;
  1.  S ACHDALR=$P(ACHDALR,U)
  1.  W !!,?DIWL-1,"Re:              Patient: ",ACHDPAT,!,?DIWL+8,"Date of service: ",$$DATE^ACHSDARR($$DN^ACHS(0,4),"MM",1)," ",$$DATE^ACHSDARR($$DN^ACHS(0,4),"DD"),", ",$$DATE^ACHSDARR($$DN^ACHS(0,4),"YY")
  1.  D PROV^ACHSDAR5
  1.  ;
  1.  ;
  1.  W !!,?DIWL-1,"Dear ",$P(ACHDALR,U),",",!!
  1.  S ACHDDAT=$P($G(^ACHSDEN(DUZ(2),"D",ACHSA,800,ACHDALRS,0)),U,5)
  1.  S ACHDDAT=$$DATE^ACHSDARR(ACHDDAT,"MM",1)_" "_$$DATE^ACHSDARR(ACHDDAT,"DD")_", "_$$DATE^ACHSDARR(ACHDDAT,"YY")
  1.  S X="The Indian Health Service (IHS), on behalf of |_|"_ACHDPAT_"|_|,"
  1.  D ^DIWP,PG:$Y>ACHSBM Q:$G(ACHSQUIT)
  1.  S X="hereby appeals the decision of |_|"_ACHDALR_"|_|,"
  1.  D ^DIWP,PG:$Y>ACHSBM Q:$G(ACHSQUIT)
  1.  S X="dated |_|"_ACHDDAT_"|_|.  The patient has authorized the IHS to act as the"
  1.  D ^DIWP,PG:$Y>ACHSBM Q:$G(ACHSQUIT)
  1.  S X="representative in this matter by signing the Authorization to Release and"
  1.  D ^DIWP,PG:$Y>ACHSBM Q:$G(ACHSQUIT)
  1.  S X="Appointment of Representative form, attached herein."
  1.  D ^DIWP,PG:$Y>ACHSBM Q:$G(ACHSQUIT)  D ^DIWW
  1.  S DIWF="I5C60W"
  1.  W !!
  1.  ; --- Alt Resource Appeal Option Text
  1.  S ACHDOP=0
  1.  F  S ACHDOP=$O(^ACHSDEN(DUZ(2),"D",ACHSA,800,ACHDALRS,4,ACHDOP)) Q:+ACHDOP=0  D  Q:$G(ACHSQUIT)
  1.  .S ACHDX=0
  1.  .F  S ACHDX=$O(^ACHSDENR(DUZ(2),13,ACHDOP,1,ACHDX)) Q:+ACHDX=0  D
  1.  ..S X=$G(^ACHSDENR(DUZ(2),13,ACHDOP,1,ACHDX,0)) D ^DIWP,PG:$Y>ACHSBM Q:$G(ACHSQUIT)
  1.  D ^DIWW
  1.  S DIWL=5,DIWR=$S($G(IOM):IOM,1:75)
  1.  K DIWF
  1.  ;
  1. BOTTXT ;
  1.  W !!!?DIWL-1,"Please keep me informed on the status of this appeal."
  1.  D PG:$Y>ACHSBM Q:$G(ACHSQUIT)
  1.  ;
  1. SUD ; --- SUD Signature Block
  1.  D PG:$Y>(ACHSBM-15) Q:$G(ACHSQUIT)
  1.  W !!?30,"Sincerely yours,",!!!!!!?30,$$SUD^ACHS(1)
  1.  I $L($$SUD^ACHS(7)) W !?30,$$SUD^ACHS(7)
  1.  W !?30,$$SUD^ACHS(2),!?30,$$SUD^ACHS(3),", ",$P($G(^DIC(5,$$SUD^ACHS(4),0)),U,2),"  ",$$SUD^ACHS(5),!?30,"Telephone: ",$$SUD^ACHS(6)
  1.  ;
  1. CMT ; --- Office Comments
  1.  I '$D(ACHDONE) D END Q
  1.  W !!!,"Denial Number: ",$$DN^ACHS(0,1)
  1.  ;W !,"Chart Number: ",$S($$DN^ACHS(0,6)="Y":$P($G(^AUPNPAT($$DN^ACHS(0,7),41,DUZ(2),0)),U,2),$L($$DN^ACHS(10,6)):$$DN^ACHS(10,6),1:"No Chart Number Available")
  1.  ;IS THE 'PATIENT REGISTERED?'
  1.  I $$DN^ACHS(0,6)="Y" D
  1.  .;IF REGISTERED IS THERE A 'REGISTERED PATIENT' PTR?
  1.  .W:'$$DN^ACHS(0,7) !!,"CANNOT FIND A PATIENT POINTER FOR A APPARENTLY REGISTERED PATIENT WITHIN THE 'CHS DENIAL DATA' FILE!!",!,"REPORT THIS TO YOUR SITE MANAGER IMMEDIATELY!",!,"DOCUMENT IEN: ",ACHSA
  1.  .Q:'$$DN^ACHS(0,6)
  1.  .W $P($G(^AUPNPAT($$DN^ACHS(0,7),41,DUZ(2),0)),U,2)
  1.  W $S($L($$DN^ACHS(10,6)):$$DN^ACHS(10,6),1:"No Chart Number Available")
  1.  ;
  1.  I $$DN^ACHS(850,1)'="Y" W !,"No Receipt Information Available",! G CMT1
  1.  W !,"Method of receipt: ",$$DN^ACHS(850,2)
  1.  W !,"Date of receipt: ",$$FMTE^XLFDT($$DN^ACHS(850,3))
  1.  W !,"Received by: ",$$DN^ACHS(850,4)
  1.  ;
  1.  ;
  1. CMT1 ; --- Alternate Resources Appeal Comments
  1.  I '$D(^ACHSDEN(DUZ(2),"D",ACHSA,800,ACHDALRS,5,0)) D END Q
  1.  W !,"Alternate Resources Appeal Comments: ",!
  1.  S ACHD=0
  1.  F  S ACHD=$O(^ACHSDEN(DUZ(2),"D",ACHSA,800,ACHDALRS,5,ACHD)) Q:'ACHD  D  Q:$G(ACHSQUIT)
  1.  .S X=$G(^ACHSDEN(DUZ(2),"D",ACHSA,800,ACHDALRS,5,ACHD,0)) D ^DIWP,PG:$Y>ACHSBM Q:$G(ACHSQUIT)
  1.  D ^DIWW
  1.  D END
  1.  Q
  1.  ;
  1. END ;EP
  1.  W !!!
  1.  I $D(ACHDONE) D  G DOC
  1.  . F I=1:1:4 W "*** OFFICE COPY *** "
  1.  . K ACHDONE
  1.  . W @IOF
  1.  . S ACHSPG=1,DIWL=5,DIWR=$S($G(IOM):IOM,1:75),DIWF="W"
  1.  ;
  1.  I '$D(ACHDLKER) D ^ACHSDARR   ;PATIENT RELEASE OF INFORMATION FORM
  1.  I IO=IO(0) D RTRN^ACHS
  1.  W @IOF
  1.  K ACHSA,ACHDALRS,ACHDLKER,DIR,ACHDOCT,ACHD,ACHDX,ACHDDAT,ACHDPAT,ACHDALR,ACHDOP,ACHDPROV
  1.  D ^%ZISC
  1.  Q
  1.  ;
  1. PG ;
  1.  D RTRN^ACHS
  1.  Q:$G(ACHSQUIT)
  1.  S ACHSPG=ACHSPG+1
  1.  W @IOF,!!!?DIWL-1,ACHDPAT,?($S($G(IOM):IOM,1:75)-$L(ACHDALR)),ACHDALR,!?($S($G(IOM):IOM,1:75)-$L("Page "_ACHSPG)),"Page ",ACHSPG,!!
  1.  Q
  1.  ;