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Routine: BARADJR2

BARADJR2.m

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BARADJR2 ; IHS/SD/LSL - CREATE ENTRY IN A/R EDI STND CLAIM ADJ REASON ;

 ;;1.8;IHS ACCOUNTS RECEIVABLE;;OCT 26, 2005

 ;

 ; IHS/SD/LSL - 11/06/03 - V1.7 Patch 4 - routine created

 ;     For HIPAA compliance.  Ceate new entries in A/R EDI STND ADJ

 ;     REASON CODES for new codes added since 6/02.  Also create new

 ;     RPMS reason codes for the standard codes to map to.

 ;

 ; *********************************************************************

EN ; EP

 D RPMSREA                   ; Create RPMS Reasons

 D STND                      ; Create new StanJdard Adj

 D CLAIM                     ; Create new Claim Status Codes

 D ^BARVKL0

 Q

 ; ********************************************************************

 ;

RPMSREA ;

 ; Create new Adjustment Reasons in A/R TABLE ENTRY

 S BARD=";;"

 S BARCNT=0

 F  D RPMSREA2 Q:BARVALUE="END"

 Q

 ; ********************************************************************

 ;

RPMSREA2 ;

 S BARCNT=BARCNT+1

 S BARVALUE=$P($T(@1+BARCNT),BARD,2,4)

 Q:BARVALUE="END"

 K DIC,DA,X,Y

 S DIC="^BARTBL("

 S DIC(0)="LZE"

 S DINUM=$P(BARVALUE,BARD)

 S X=$P(BARVALUE,BARD,2)

 S DIC("DR")="2////^S X=$P(BARVALUE,BARD,3)"

 K DD,DO

 D FILE^DICN

 Q

 ; ********************************************************************

 ; ********************************************************************

 ;

CHNGREA ; EP

 ; Change category of these reasons to Non-Payment

 S BARD=";;"

 S BARCNT=0

 F  D CHNGREA2 Q:BARVALUE="END"

 Q

 ; ********************************************************************

 ;

CHNGREA2 ;

 S BARCNT=BARCNT+1

 S BARVALUE=$P($T(@4+BARCNT),BARD,3)

 Q:BARVALUE="END"

 K DIC,DA,X,Y,DIE

 S DIE="^BARTBL("

 S DA=BARVALUE

 S DR="2////^S X=4"

 D ^DIE

 Q

 ; ********************************************************************

 ; ********************************************************************

 ;

STND ;

 ; Create entries in A/R EDI STND CLAIM ADJ REASONS to accomodate

 ; Standard codes added between 6/02 and 9/03.

 S BARD=";;"

 S BARCNT=0

 F  D STND2 Q:BARVALUE="END"

 Q

 ; ********************************************************************

 ;

STND2 ;

 S BARCNT=BARCNT+1

 S BARVALUE=$P($T(@2+BARCNT),BARD,2,6)

 Q:BARVALUE="END"

 K DIC,DA,X,Y

 S DIC="^BARADJ("

 S DIC(0)="LZE"

 S X=$P(BARVALUE,BARD)                                     ; Stnd Code

 S DIC("DR")=".02///^S X=$P(BARVALUE,BARD,2)"              ; Short Desc

 S DIC("DR")=DIC("DR")_";.03////^S X=$P(BARVALUE,BARD,3)"   ; RPMS Cat

 S DIC("DR")=DIC("DR")_";.04////^S X=$P(BARVALUE,BARD,4)"   ; RPMS Type

 S DIC("DR")=DIC("DR")_";101///^S X=$P(BARVALUE,BARD,5)"    ; Long Desc

 K DD,DO

 D FILE^DICN

 Q

 ; ********************************************************************

 ; ********************************************************************

 ;

CLAIM ;

 ; Populate A/R EDI CLAIM STATUS CODES to accomodate new codes added

 ; between 6/02 and 9/03. Inactivate necessary codes.

 S BARCNT=0

 F  D CLAIM2 Q:BARVALUE="END"

 S BARCNT=0

 F BARVALUE=8,10,11,13,14,28,69,70 D CLAIM3

 Q

 ; ********************************************************************

 ;

CLAIM2 ;

 S BARCNT=BARCNT+1

 S BARVALUE=$P($T(@3+BARCNT),BARD,2,4)

 Q:BARVALUE="END"

 K DIC,DA,X,Y

 S DIC="^BARECSC("

 S DIC(0)="LZE"

 S X=$P(BARVALUE,BARD)                                     ; Status Cd

 S DIC("DR")="11///^S X=$P(BARVALUE,BARD,2)"              ; Description

 K DD,DO

 D FILE^DICN

 Q

 ; ********************************************************************

 ;

CLAIM3 ;

 K DIC,DA,X,Y

 S DIC="^BARECSC("

 S DIC(0)="XZQ"

 S X=BARVALUE

 K DD,DO

 D ^DIC

 Q:+Y<1

 K DA,DIE,DR

 S DA=+Y

 S DIE=DIC

 S DR=".02///Y"

 D ^DIE

 Q

 ; ********************************************************************

 ; ********************************************************************

 ;

MODIFY ; EP

 ; Change PENDING to NON PAYMENT

 S BARD=";;"

 S BARCNT=0

 F  D MODIFY2 Q:BARVALUE="END"

 Q

 ; *********************************************************************

 ;

MODIFY2 ;

 S BARCNT=BARCNT+1

 S BARVALUE=$P($T(@4+BARCNT),BARD,2)

 Q:BARVALUE="END"

 K DIC,DA,X,Y,DR

 S DIC="^BARADJ("

 S DIC(0)="Z"

 S X=$P(BARVALUE,BARD)                                     ; Stnd Code

 K DD,DO

 D ^DIC

 Q:'+Y

 ;

 S DIE=DIC

 S DA=+Y

 S DR=".03////^S X=4"

 D ^DIE

 Q

 ;

 ; *********************************************************************

 ; IEN;;NAME;;TABLE TYPE

 ; *********************************************************************

1 ;;

 ;;745;;Premium Pmt Withholding;;21

 ;;746;;Pmt Den DX Invalid for DOS;;4

 ;;747;;Prv Rate Expired/Not on file;;4

 ;;748;;Clm/Srv Rej Info Incomplete;;21

 ;;749;;Lifetime Ben Max for Srv/Ben;;4

 ;;750;;PayAdj No Info for Lgthof Svc;;4

 ;;751;;PayAdj No Info for Lgth of Svc;;4

 ;;752;;PayAdj No Info for Dosage;;4

 ;;753;;PayAdj No Info for Days Supply;;4

 ;;754;;PayAdj No Info for Lvl of Svc;;4

 ;;755;;Clm DEn Pt Refused Srv/Proc;;4

 ;;756;;Flex Spending Accts Payable;;22

 ;;757;;Pmt Den/Red Result Act of War;;4

 ;;758;;Pmt Den/Red Outside US;;4

 ;;759;;Pmt Den/Red Result of Terrorsm;;4

 ;;760;;Pmt Den/Red Activity Ben Excl;;4

 ;;END

 ;

 ; ********************************************************************

 ; STND CODE ;; SHORT DESC ;; RPMS CAT ;; RPMS TYP ;; LONG DESC

 ; ********************************************************************

2 ;;

 ;;145;;Premium payment withholding;;21;;745;;Premium payment withholding

 ;;146;;Payment denied because diagnosis invalid for the date(s) of service reported.;;4;;746;;Payment denied because the diagnosis was invalid for the date(s) of service reported.

 ;;147;;Provider contracted/negotiated rate expired or not on file.;;4;;747;;Provider contracted/negotiated rate expired or not on file.

 ;;148;;Clm/Srvc rejectd at this time-info from another prv not provided/insuff/incmplet;;21;;748;;Claim/service rejected at this time because information from another provider was not provided or was insufficient/incomplete.

 ;;149;;Lifetime benefit maximum has been reached for this service/benefit category.;;4;;749;;Lifetime benefit maximum has been reached for this service/benefit category.

 ;;150;;Pmt adjusted - payer deems the info submitted not support this level of service.;;4;;750;;Payment adjusted because the payer deems the information submitted does not support this level of service.

 ;;151;;Pmt adjusted - payer deems the info submitted not support this many svcs.;;4;;751;;Payment adjusted because the payer deems the information submitted does not support this many svcs.

 ;;152;;Pmt adjusted - payer deems the info submitted not support this lgth of svc.;;4;;752;;Payment adjusted because the payer deems the information submitted does not support this length of service.

 ;;153;;Pmt adjusted - payer deems the info submitted not support this dosage.;;4;;753;;Payment adjusted because the payer deems the information submitted does not support this dosage.

 ;;154;;Pmt adjusted - payer deems the info submitted not support this day's supply.;;4;;754;;Payment adjusted because the payer deems the information submitted does not support this day's supply.

 ;;155;;This claim is denied because the patient refused the service/procedure;;4;;755;;This claim is denied because the patient refused the service/procedure

 ;;156;;Flexible spending account payments.;;22;;756;;Flexible spending account payments.

 ;;157;;Pmt denied/reduced - service/procedure provided as a result of an act of war.;;4;;757;;Payment denied/reduced because service/procedure was provided as a result of an act of war.

 ;;158;;Pmt denied/reduced - service/procedure provided outside the United States.;;4;;758;;Payment denied/reduced because service/procedure was provided outside the United States.

 ;;159;;Pmt denied/reduced - service/procedure provided as a result of terrorism.;;4;;759;;Payment denied/reduced because service/procedure was provided as a result of terrorism.

 ;;160;;Pmt denied/reduce - injury/illness result of activity that's a benefit exclusion;;4;;760;;Payment denied/reduced because injury/illness was the result of an activity that is a benefit exclusion.

 ;;END

 ;

 ; ********************************************************************

 ; CLAIM STATUS CODE ;; DESCRIPTION

 ; ********************************************************************

3 ;;

 ;;489;;Attachment Control Number

 ;;490;;Other Procedure Code for Service(s) Rendered

 ;;491;;Entity not eligible for encounter submission

 ;;492;;Other Procedure Date

 ;;493;;Version/Release/Industry ID code not currently supported by information holder

 ;;494;;Real-time requests not supported by the information holder, resubmit as batch request

 ;;495;;Requests for re-adjudication must reference the newly assigned payer claim control number for this previously adjusted claim.  Correct the payer claim control number and re-submit.

 ;;END

 ;

 ; ********************************************************************

 ; STANDARD CODE ;; RPMS REASON

 ; ********************************************************************

4 ;;

 ;;4;;604

 ;;5;;605

 ;;6;;606

 ;;7;;607

 ;;8;;608

 ;;9;;609

 ;;10;;610

 ;;11;;611

 ;;12;;612

 ;;13;;613

 ;;14;;614

 ;;15;;615

 ;;16;;616

 ;;17;;617

 ;;19;;619

 ;;20;;620

 ;;21;;621

 ;;22;;622

 ;;47;;647

 ;;55;;655

 ;;56;;656

 ;;57;;657

 ;;58;;658

 ;;61;;661

 ;;63;;663

 ;;65;;665

 ;;107;;707

 ;;110;;710

 ;;125;;725

 ;;140;;740

 ;;148;;748

 ;;B12;;862

 ;;B13;;863

 ;;B16;;866

 ;;B18;;868

 ;;B22;;872

 ;;B23;;873

 ;;D1;;901

 ;;D2;;902

 ;;D3;;903

 ;;D4;;904

 ;;D5;;905

 ;;D6;;906

 ;;D7;;907

 ;;D8;;908

 ;;D9;;909

 ;;D10;;910

 ;;D11;;911

 ;;D12;;912

 ;;D13;;913

 ;;D14;;914

 ;;END;;END