Home   Package List   Routine Alphabetical List   Global Alphabetical List   FileMan Files List   FileMan Sub-Files List   Package Component Lists   Package-Namespace Mapping  
Routine: BARADJR8

BARADJR8.m

Go to the documentation of this file. 
BARADJR8 ; IHS/SD/POT - CREATE ENTRY IN A/R EDI STND CLAIM ADJ REASON ;

 ;;1.8;IHS ACCOUNTS RECEIVABLE**24**;;OCT 26, 2005;Build 69

 ; IHS/SD/POTT HEAT147789 - v1.8 p24 - updated SARs part1

 ; IHS/SD/POTT HEAT146880 1 v1.8 p24

 ; IHS/SD/POTT 3/26/2014 FIXED TYPE IN SAR code 247: Adj code should be 13 instead of 1.

 ; code cloned from BARADJR7

 ;

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

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

 D BMES^XPDUTL("Adding New Adjustment Reasons to A/R Table Entry file...")

 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 MES^XPDUTL($P(BARVALUE,BARD)_"  "_$P(BARVALUE,BARD,2))

 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

 D BMES^XPDUTL("Updating Standard Adjustment Reasons in A/R EDI STND CLAIM ADJ REASONS file...")

 F  D STND2 Q:BARVALUE="END"

 Q

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

STND2 ;

 S BARCNT=BARCNT+1

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

 Q:BARVALUE="END"

STND3 ;

 ;look for existing entry

 K DIC,DA,X,Y

 S DIC="^BARADJ("

 S DIC(0)="M"

 S X=$P(BARVALUE,BARD)

 D ^DIC

 I +Y>0 D  Q  ;if existing entry found - edit it

 .D MES^XPDUTL($P(BARVALUE,BARD)_$S($L($P(BARVALUE,BARD))=2:"   ",$L($P(BARVALUE,BARD))=1:"    ",1:"  ")_$E($P(BARVALUE,BARD,2),1,65))

 .K DIC,DIE

 .S DIE="^BARADJ("

 .S DA=+Y

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

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

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

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

 .D ^DIE

 ;create new entry if none found

 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 MES^XPDUTL($P(BARVALUE,BARD)_$S($L($P(BARVALUE,BARD))=2:"   ",$L($P(BARVALUE,BARD))=1:"    ",1:"  ")_$E($P(BARVALUE,BARD,2),1,65))

 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 ;; A/R Table Entry file - Adds (S DIC="^BARTBL(")

 ;;300;;Doc rcvd inconsist w/exp cntnt;;4

 ;;301;;Doc rcvd not contain req cntnt;;4

 ;;302;;Doc reqd to adjudicate clm/svc;;4

 ;;303;;Sequestration-red in fed pymt;;15

 ;;304;;Submit svcs to pt's med plan;;4

 ;;305;;Clm pending due to litigation;;21

 ;;306;;Not payable per mngd care cont;;4

 ;;307;;Clm pndng during prem grace pd;;21

 ;;308;;Clm not cvrd - pt incarcerated;;4

 ;;400;;Cancelled/Expired Appropriation;;22

 ;;401;;ST-mandated rqrmt for property;;22

 ;;402;;Not work related inj/illness;;4

 ;;403;;WC case settled, pt resp;;4

 ;;404;;WC case adjudicated as non-WC;;4

 ;;405;;Based on payer reas & cust fee;;4

 ;;406;;Based on entitlement to bnfts;;4

 ;;407;;Resub w/correct proc code;;22

 ;;408;;Clm is under investigation;;22

 ;;409;;No CPT/HCPCS to describe svc;;4

 ;;410;;Zero pmt due to litigation;;4

 ;;411;;Clm pending due to litigation;;21

 ;;412;;WC fee schedule adjustment;;4

 ;;413;;Pmt reduced due to WC policies;;4

 ;;414;;Pmt incl w/pmt for other svc;;4

 ;;415;;WC Med Trtmt Guideline adjstmt;;4

 ;;416;;Med prov not auth'd for WC;;4

 ;;417;;Referral not auth'd by attndng;;15

 ;;418;;Proc not listed/comp svc allwd;;4

 ;;419;;No pymt due,proc fee is zero;;4

 ;;420;;Svc not pd under oupt fee schd;;4

 ;;421;;TPL Payment denied-MPC/PIP;;4

 ;;422;;TPL Payment adjusted-MPC/PIP;;4

 ;;423;;TPL Fee Sch Adjust-MPC/PIP;;4

 ;;762;;Property & Casualty Require;;4

 ;;823;;Pmt incl w/pmt for other svc;;4

 ;;824;;WC Med Trtmt Guideline adjstmt;;4

 ;;825;;Med prov not auth'd for WC;;4

 ;;826;;Referral not auth'd by attndng;;15

 ;;827;;Proc not listed/comp svc allwd;;22

 ;;828;;No pymt due,proc fee is zero;;22

 ;;829;;Svc not pd under oupt fee schd;;4

 ;;841;;Payment denied;;4

 ;;842;;Payment adjusted;;4

 ;;843;;Fee schedule adjustment;;22

 ;;980;;Dx inconsist w pt's birth wt;;4

 ;;981;;Low Income Subsidy copay amt;;14

 ;;982;;Svcs not provided by netwk/pcp;;4

 ;;983;;Svcs not auth'd by network/pcp;;4

 ;;984;;Pmt reduced to zero due to lit;;21

 ;;985;;Prov performance prog withhold;;15

 ;;986;;Non-payable code for req'd rep;;4

 ;;987;;Ded-Prof svc rendered in Inst;;1

 ;;988;;Coins-Prof svc rendrd in Inst;;14

 ;;989;;Clm identified as readmission;;4

 ;;END

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

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

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

2 ;;DIC="^BARADJ("

 ;;133;;The disposition of this claim/service is pending further review;;21;;733;;The disposition of the claim/service is pending further review. (Use only with Group Code OA)

 ;;240;;Dx inconsistent with pt's birth weight.;;4;;980;;The diagnosis is inconsistent with the patient's birth weight. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.

 ;;241;;Low Income Subsidy (LIS) co-pay amount;;14;;981;;Low Income Subsidy (LIS) Co-payment Amount

 ;;242;;Svcs not provided by network/primary care providers;;4;;982;;Services not provided by network/primary care providers.

 ;;243;;Svcs not authorized by network/primary care providers;;4;;983;;Services not authorized by network/primary care providers.

 ;;244;;Pymt red to zero due to lit. Addt'l info will be sent following concl of lit.;;21;;984;;Payment reduced to zero due to litigation. Additional information will be sent following the conclusion of litigation. To be used for Property & Casualty only.

 ;;245;;Prov performance program withhold.;;15;;985;;Provider performance program withhold.

 ;;246;;This non-payable code is for req'd reporting only.;;4;;986;;This non-payable code is for required reporting only.

 ;;247;;Ded for Prof svc rendered in Institutional setting and billed on Inst clm.;;13;;987;;Deductible for Professional service rendered in an Institutional setting and billed on an Institutional claim.

 ;;248;;Coins for Prof svc rendered in Institutional setting and billed on Inst clm.;;14;;988;;Coinsurance for Professional service rendered in an Institutional setting and billed on an Institutional claim.

 ;;249;;Clm identified as a readmission.;;4;;989;;This claim has been identified as a readmission. (Use only with Group Code CO).

 ;;250;;Documentation recv'd is inconsistent w/expected content.;;4;;300;;The attachment/other documentation content received is inconsistent with the expected content.

 ;;251;;Documentation recv'd did not contain content required to process clm/svc.;;4;;301;;The attachment/other documentation content received did not contain the content required to process this claim or service.

 ;;252;;Doc required to adjudicate clm/svc. At least one Remark Code must be provided.;;4;;302;;An attachment/other documentation is required to adjudicate this claim/service. At least one Remark Code must be provided.

 ;;253;;Sequestration - reduction in federal pymt.;;15;;303;;Sequestration - reduction in federal payment

 ;;254;;Clm rcvd by dental plan but bnfts not avail. Submit to pt's medical plan.;;4;;304;;Claim received by the dental plan, but benefits not available under this plan. Submit these services to the patient's medical plan for further consideration.

 ;;255;;Clm pending due to litigation.;;21;;305;;The disposition of the related Property & Casualty claim (injury or illness) is pending due to litigation. (Use only with Group Code OA)

 ;;256;;Svc not payable per managed care contract.;;4;;306;;Service not payable per managed care contract.

 ;;257;;Clm pending during the prem grace period, per Health Ins Exchange requirements.;;21;;307;;The disposition of the claim/service is pending during the premium payment grace period, per Health Insurance Exchange requirements. (Use only with Group Code OA)

 ;;258;;Clm/svc not cvrd when pt in cust/incarcerated. Fed,state,local auth may cover.;;4;;308;;Claim/service not covered when patient is in custody/incarcerated. Applicable federal, state or local authority may cover the claim/service.

 ;;END

 ;

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

 ; CLAIM STATUS CODE ;; DESCRIPTION

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

3 ;; - A/R EDI Claim Status Codes file - Adds DIC="^BARECSC("

 ;;END

 ;

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

 ; STANDARD CODE ;; RPMS REASON

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

4 ;;A/R Table Entry file - Edits DIE="^BARTBL("

 ;;END;;END