ACHSPOS2 ; IHS/ITSC/PMF - TMP DATA FOR DENIAL REASONS AND FORCE ENTRY ; [ 10/19/2001 10:58 AM ]
;;3.1;CONTRACT HEALTH MGMT SYSTEM;;JUN 11, 2001
;
S $ZT="ERROR^"_$ZN
S %H=$H D YX^%DTC S NOW=Y
S ^ACHSINST(ACHSVERS,$ZN,"ENTERED")=NOW
;
I $D(ACHSINST(ACHSVERS,"ERROR")) S ^ACHSINST(ACHSVERS,"ERROR","PREVIOUS ERRORS HAVE NOT BEEN CLEARED")=NOW S XPDABORT=1 Q
;
;WE ARE ADDING TO THIS FILE NO MATTER WHAT. ALSO KEEP THE OLD ENTRIES
;BUT DEACTIVATE THEM
;IF FILE CHECKSOK THEN FILE HAS ENTRIES DON'T OVERWRITE
;I $$CHECKSOK("") S ^ACHSINST(ACHSVERS,$ZN,"CHS DENIAL REASON DATA FOUND")=NOW W !?15,"'CHS DENIAL REASON' data found! Not overwriting!" Q
;
;
N A,B,C
F A=1:2 S B=$P($T(TAG+A),";;",2) Q:B="" S @B=$P($T(TAG+(A+1)),";;",2)
D ^ACHSPOS3 ;SET UP TMP DATA (CONTINUED)
;
;DE-ACTIVATE OLD DENIAL REASONS
S X="T" S %DT="EX" D ^%DT S FMDATE=Y ;GET TODAY'S FILEMAN DATE
W !?15,"Old Denial Reasons will be de-activated!"
S IEN=0
F S IEN=$O(^ACHSDENS(IEN)) Q:+IEN=0 D
.Q:$P($G(^ACHSDENS(IEN,10)),U)'="" ;QUIT IF REASON ALREADY DEACTIVATED
.S $P(^ACHSDENS(IEN,10),U)=FMDATE ;SET 'INACTIVATION DATE'
;
;
;ADD THE DATA TO THE FILE
D ENTER
;
S %H=$H D YX^%DTC S NOW=Y
S ^ACHSINST(ACHSVERS,$ZN,"FINISHED")=NOW
;
Q
ENTER ;PLACE CODE FOR ENTRY TO ^ACHSDENS HERE
;
S %H=$H D YX^%DTC S NOW=Y
S ^ACHSINST(ACHSVERS,"ENTER^"_$ZN,"ENTERED")=NOW
;
W !?15,"Adding CHS DENIAL REASON data now...."
;
;GET LAST DIEN USED FOR DENIAL REASONS
S LASTDIEN=$O(^ACHSDENS(" "),-1)
;
;
S X="^TMP("_$J_",""DEN"")"
F S X=$Q(@X) Q:X=""!(X'[("""DEN""")) D
.S NEWNODE=$P(X,",",4,99) ;GET THE NODE WE WANT TO SET
.I NEWNODE="0)" S LASTDIEN=LASTDIEN+1 ;IF ITS THE 0 NODE INCREMENT
. ;THE IEN
.;I $D(^ACHSDENS(LASTDIEN)) S LASTDIEN=LASTDIEN+1 Q
.S GLOBAL="^ACHSDENS("_LASTDIEN_","_NEWNODE
.S @GLOBAL=@X
S DIK="^ACHSDENS(" D IXALL^DIK
W !,"Done."
;
S %H=$H D YX^%DTC S NOW=Y
S ^ACHSINST(ACHSVERS,"ENTER^"_$ZN,"FINISHED")=NOW
Q
;
;RESET 0 NODE AND RETURN NUMBER OF ENTRIES
CHECKSOK(X) ;
I '$D(^ACHSDENS(0)) S ^ACHSDENS(0)="CHS DENIAL REASON^9002073^0^0"
S XBCFIXFL=9002073
D XBCFIXFL^XBCFIX
Q $G(XBCFIXC)
Q
;
ERROR S ^ACHSINST(ACHSVERS,"ERROR",$ZN,"ERROR TRAP CALLED")=NOW
G ^%ET
Q
;
TAG ;
;;^TMP($J,"DEN",14,0)
;;Alternate Resource Available^Alternate Resource Available
;;^TMP($J,"DEN",14,1,1,0)
;;Our records show that you have health care coverage/resources (such as private insurance, Medicare, Medicaid) available to pay for this
;;^TMP($J,"DEN",14,1,2,0)
;;medical care. [see 42 Code of Federal Regulations 36.61(c) (1990)]
;;^TMP($J,"DEN",14,20,0)
;;^9002073.01^2^2
;;^TMP($J,"DEN",14,20,1,0)
;;Other Coverage Available
;;^TMP($J,"DEN",14,20,1,1,1,0)
;;Any unpaid balances should be promptly submitted to the Indian Health Service Contract Health Service office for review.
;;^TMP($J,"DEN",14,20,2,0)
;;Would Have Been Eligible for Other Coverage
;;^TMP($J,"DEN",14,20,2,1,1,0)
;;You would have been eligible if you had applied and completed the application requirements.
;;^TMP($J,"DEN",14,20,3,0)
;;May be Eligible for Other Coverage
;;^TMP($J,"DEN",14,20,3,1,1,0)
;;You may be eligible if apply and complete the application requirements.
;;^TMP($J,"DEN",15,0)
;;Eligibility Not Established^Eligibility Not Established
;;^TMP($J,"DEN",15,1,1,0)
;;You have not provided evidence to prove that you are eligible for Contract Health Services (CHS). [see 42 Code of Federal Regulations 36.12 and 36.23 (1986)]
;;^TMP($J,"DEN",15,20,0)
;;^9002073.01^2^2
;;^TMP($J,"DEN",15,20,1,0)
;;Indian Descendency Not Established
;;^TMP($J,"DEN",15,20,1,1,1,0)
;;You did not provide your Certificate of Degree of Indian Blood (CDIB) and/or membership/descendency from a federally recognized tribe.
;;^TMP($J,"DEN",15,20,2,0)
;;Care for Non-Indian Pregnant Woman
;;^TMP($J,"DEN",15,20,2,1,1,0)
;;You did not provide a paternity form signed by the father and/or a marriage license.
;;^TMP($J,"DEN",16,0)
;;No Notification of Emergency Service Within 72 Hours^No Notification of Emergency Service Within 72 Hours
;;^TMP($J,"DEN",16,1,1,0)
;;You or someone acting on your behalf failed to notify an Indian Health Service official within 72 hours after the beginning of your emergency treatment [see 42 Code of Federal Regulations 36.24(c) (1986)]
;;^TMP($J,"DEN",17,0)
;;No Prior Approval for Non-Emergency Service^No Prior Approval for Non-Emergency Service
;;^TMP($J,"DEN",17,1,1,0)
;;You did not obtain prior approval for payment of Contract Health Services (CHS) from the Indian Health Services (IHS) authorizing official approval for this non-emergency care [Per 42 Code of Federal Regulations 36.24(b) (1986)].
;;^TMP($J,"DEN",18,0)
;;Care Not Within Medical Priority^Care Not Within Medical Priority
;;^TMP($J,"DEN",18,1,1,0)
;;The medical care you received is not within the CHS medical priorities. Medical priorities must be established when funding is limited. [Per 42 Code of Federal Regulations 36.23(e) (1986)].
ACHSPOS2 ; IHS/ITSC/PMF - TMP DATA FOR DENIAL REASONS AND FORCE ENTRY ; [ 10/19/2001 10:58 AM ]
+1 ;;3.1;CONTRACT HEALTH MGMT SYSTEM;;JUN 11, 2001
+2 ;
+3 SET $ZT="ERROR^"_$ZN
+4 SET %H=$HOROLOG
DO YX^%DTC
SET NOW=Y
+5 SET ^ACHSINST(ACHSVERS,$ZN,"ENTERED")=NOW
+6 ;
+7 IF $DATA(ACHSINST(ACHSVERS,"ERROR"))
SET ^ACHSINST(ACHSVERS,"ERROR","PREVIOUS ERRORS HAVE NOT BEEN CLEARED")=NOW
SET XPDABORT=1
QUIT
+8 ;
+9 ;WE ARE ADDING TO THIS FILE NO MATTER WHAT. ALSO KEEP THE OLD ENTRIES
+10 ;BUT DEACTIVATE THEM
+11 ;IF FILE CHECKSOK THEN FILE HAS ENTRIES DON'T OVERWRITE
+12 ;I $$CHECKSOK("") S ^ACHSINST(ACHSVERS,$ZN,"CHS DENIAL REASON DATA FOUND")=NOW W !?15,"'CHS DENIAL REASON' data found! Not overwriting!" Q
+13 ;
+14 ;
+15 NEW A,B,C
+16 FOR A=1:2
SET B=$PIECE($TEXT(TAG+A),";;",2)
IF B=""
QUIT
SET @B=$PIECE($TEXT(TAG+(A+1)),";;",2)
+17 ;SET UP TMP DATA (CONTINUED)
DO ^ACHSPOS3
+18 ;
+19 ;DE-ACTIVATE OLD DENIAL REASONS
+20 ;GET TODAY'S FILEMAN DATE
SET X="T"
SET %DT="EX"
DO ^%DT
SET FMDATE=Y
+21 WRITE !?15,"Old Denial Reasons will be de-activated!"
+22 SET IEN=0
+23 FOR
SET IEN=$ORDER(^ACHSDENS(IEN))
IF +IEN=0
QUIT
Begin DoDot:1
+24 ;QUIT IF REASON ALREADY DEACTIVATED
IF $PIECE($GET(^ACHSDENS(IEN,10)),U)'=""
QUIT
+25 ;SET 'INACTIVATION DATE'
SET $PIECE(^ACHSDENS(IEN,10),U)=FMDATE
End DoDot:1
+26 ;
+27 ;
+28 ;ADD THE DATA TO THE FILE
+29 DO ENTER
+30 ;
+31 SET %H=$HOROLOG
DO YX^%DTC
SET NOW=Y
+32 SET ^ACHSINST(ACHSVERS,$ZN,"FINISHED")=NOW
+33 ;
+34 QUIT
ENTER ;PLACE CODE FOR ENTRY TO ^ACHSDENS HERE
+1 ;
+2 SET %H=$HOROLOG
DO YX^%DTC
SET NOW=Y
+3 SET ^ACHSINST(ACHSVERS,"ENTER^"_$ZN,"ENTERED")=NOW
+4 ;
+5 WRITE !?15,"Adding CHS DENIAL REASON data now...."
+6 ;
+7 ;GET LAST DIEN USED FOR DENIAL REASONS
+8 SET LASTDIEN=$ORDER(^ACHSDENS(" "),-1)
+9 ;
+10 ;
+11 SET X="^TMP("_$JOB_",""DEN"")"
+12 FOR
SET X=$QUERY(@X)
IF X=""!(X'[("""DEN"""))
QUIT
Begin DoDot:1
+13 ;GET THE NODE WE WANT TO SET
SET NEWNODE=$PIECE(X,",",4,99)
+14 ;IF ITS THE 0 NODE INCREMENT
IF NEWNODE="0)"
SET LASTDIEN=LASTDIEN+1
+15 ;THE IEN
+16 ;I $D(^ACHSDENS(LASTDIEN)) S LASTDIEN=LASTDIEN+1 Q
+17 SET GLOBAL="^ACHSDENS("_LASTDIEN_","_NEWNODE
+18 SET @GLOBAL=@X
End DoDot:1
+19 SET DIK="^ACHSDENS("
DO IXALL^DIK
+20 WRITE !,"Done."
+21 ;
+22 SET %H=$HOROLOG
DO YX^%DTC
SET NOW=Y
+23 SET ^ACHSINST(ACHSVERS,"ENTER^"_$ZN,"FINISHED")=NOW
+24 QUIT
+25 ;
+26 ;RESET 0 NODE AND RETURN NUMBER OF ENTRIES
CHECKSOK(X) ;
+1 IF '$DATA(^ACHSDENS(0))
SET ^ACHSDENS(0)="CHS DENIAL REASON^9002073^0^0"
+2 SET XBCFIXFL=9002073
+3 DO XBCFIXFL^XBCFIX
+4 QUIT $GET(XBCFIXC)
+5 QUIT
+6 ;
ERROR SET ^ACHSINST(ACHSVERS,"ERROR",$ZN,"ERROR TRAP CALLED")=NOW
+1 GOTO ^%ET
+2 QUIT
+3 ;
TAG ;
+1 ;;^TMP($J,"DEN",14,0)
+2 ;;Alternate Resource Available^Alternate Resource Available
+3 ;;^TMP($J,"DEN",14,1,1,0)
+4 ;;Our records show that you have health care coverage/resources (such as private insurance, Medicare, Medicaid) available to pay for this
+5 ;;^TMP($J,"DEN",14,1,2,0)
+6 ;;medical care. [see 42 Code of Federal Regulations 36.61(c) (1990)]
+7 ;;^TMP($J,"DEN",14,20,0)
+8 ;;^9002073.01^2^2
+9 ;;^TMP($J,"DEN",14,20,1,0)
+10 ;;Other Coverage Available
+11 ;;^TMP($J,"DEN",14,20,1,1,1,0)
+12 ;;Any unpaid balances should be promptly submitted to the Indian Health Service Contract Health Service office for review.
+13 ;;^TMP($J,"DEN",14,20,2,0)
+14 ;;Would Have Been Eligible for Other Coverage
+15 ;;^TMP($J,"DEN",14,20,2,1,1,0)
+16 ;;You would have been eligible if you had applied and completed the application requirements.
+17 ;;^TMP($J,"DEN",14,20,3,0)
+18 ;;May be Eligible for Other Coverage
+19 ;;^TMP($J,"DEN",14,20,3,1,1,0)
+20 ;;You may be eligible if apply and complete the application requirements.
+21 ;;^TMP($J,"DEN",15,0)
+22 ;;Eligibility Not Established^Eligibility Not Established
+23 ;;^TMP($J,"DEN",15,1,1,0)
+24 ;;You have not provided evidence to prove that you are eligible for Contract Health Services (CHS). [see 42 Code of Federal Regulations 36.12 and 36.23 (1986)]
+25 ;;^TMP($J,"DEN",15,20,0)
+26 ;;^9002073.01^2^2
+27 ;;^TMP($J,"DEN",15,20,1,0)
+28 ;;Indian Descendency Not Established
+29 ;;^TMP($J,"DEN",15,20,1,1,1,0)
+30 ;;You did not provide your Certificate of Degree of Indian Blood (CDIB) and/or membership/descendency from a federally recognized tribe.
+31 ;;^TMP($J,"DEN",15,20,2,0)
+32 ;;Care for Non-Indian Pregnant Woman
+33 ;;^TMP($J,"DEN",15,20,2,1,1,0)
+34 ;;You did not provide a paternity form signed by the father and/or a marriage license.
+35 ;;^TMP($J,"DEN",16,0)
+36 ;;No Notification of Emergency Service Within 72 Hours^No Notification of Emergency Service Within 72 Hours
+37 ;;^TMP($J,"DEN",16,1,1,0)
+38 ;;You or someone acting on your behalf failed to notify an Indian Health Service official within 72 hours after the beginning of your emergency treatment [see 42 Code of Federal Regulations 36.24(c) (1986)]
+39 ;;^TMP($J,"DEN",17,0)
+40 ;;No Prior Approval for Non-Emergency Service^No Prior Approval for Non-Emergency Service
+41 ;;^TMP($J,"DEN",17,1,1,0)
+42 ;;You did not obtain prior approval for payment of Contract Health Services (CHS) from the Indian Health Services (IHS) authorizing official approval for this non-emergency care [Per 42 Code of Federal Regulations 36.24(b) (1986)].
+43 ;;^TMP($J,"DEN",18,0)
+44 ;;Care Not Within Medical Priority^Care Not Within Medical Priority
+45 ;;^TMP($J,"DEN",18,1,1,0)
+46 ;;The medical care you received is not within the CHS medical priorities. Medical priorities must be established when funding is limited. [Per 42 Code of Federal Regulations 36.23(e) (1986)].
