- BARADJRL ;IHS/SD/POT - CREATE ENTRY IN A/R EDI STND CLAIM ADJ REASON ;
- ;;1.8;IHS ACCOUNTS RECEIVABLE;**28**;OCT 26, 2005;Build 92
- ; IHS/SD/CPC HEAT326081 - V1.8 P28 - updated SARs
- ; code cloned from BARADJR7
- ;
- EN ; EP
- ; Change Name of these reasons
- S BARD=";;"
- S BARCNT=0
- D BMES^XPDUTL("Updating Adjustment Reasons to A/R Table Entry file Phase 2...")
- F D CHNGREA2 Q:BARVALUE="END"
- K DIC,DA,X,Y,DIE
- D ^BARVKL0
- D BMES^XPDUTL("SAR Codes Update Complete...")
- Q
- ; ********************************************************************
- CHNGREA2 ;
- S BARCNT=BARCNT+1
- S BARVALUE=$P($T(@4+BARCNT),BARD,2)
- Q:BARVALUE="END"
- K DIC,DA,X,Y,DIE
- S DIC="^BARTBL("
- S DIC(0)="M"
- S X=BARVALUE
- D ^DIC
- I +Y>0 D
- .K DIC,DIE,BARNAME
- .S DIE="^BARTBL("
- .S DA=+Y
- .S BARNAME=$P($T(@4+BARCNT),BARD,3)
- .S DR=".01////^S X=BARNAME"
- .D ^DIE
- .D MES^XPDUTL(BARVALUE_$S($L(BARVALUE)=2:" ",$L(BARVALUE)=1:" ",1:" ")_BARNAME)
- Q
- ; ********************************************************************
- ; STANDARD CODE ;; RPMS REASON
- ; ********************************************************************
- 4 ;;A/R Table Entry file - Edits DIE="^BARTBL("
- ;;900;;Clm Lacks Prior Pymt Info;;4;;D16
- ;;901;;Clm Den Inadq Level of Sublux;;4;;D1
- ;;902;;Claim lacks drug information;;4;;D2
- ;;903;;Clm Den Info Pt Equip Missing;;4;;D3
- ;;904;;Period of time missing;;4;;D4
- ;;905;;Clm Den Lacks Indvdl Lab Code;;4;;D5
- ;;906;;Clm Den No MR Copy Included;;4;;D6
- ;;907;;Clm Den Lacks Date of RecVisit;;4;;D7
- ;;908;;Clm Den Lacks Info Xray Avail;;4;;D8
- ;;909;;Clm Den Lacks Actual Lens Cost;;4;;D9
- ;;910;;Clm Den Pvdr Fin. Forms NOF;;4;;D10
- ;;911;;Clm Lacks Pcmkr Reg Form;;4;;D11
- ;;912;;Clm Den No Idtfr Who did DXtst;;4;;D12
- ;;913;;Clm Den Pvdr has Fin Interest;;4;;D13
- ;;914;;Clm Lacks TX Plan on File;;4;;D14
- ;;915;;Clm Lacks Sprvs MD Info;;4;;D15
- ;;919;;Penalty for interest pymt;;15;;225
- ;;922;;Provider Performance Bonus;;16;;161
- ;;927;;Clm/Svc invld noncoverd days;;4;;D17
- ;;928;;Clm/Svc missing DX info;;4;;D18
- ;;929;;Clm Lacks Supporting Dcmnt;;4;;D19
- ;;930;;DOS during lapse in coverage;;4;;200
- ;;931;;Pt resp thru set aside agreemt;;4;;201
- ;;932;;Non Cov Personal/Convenient;;4;;202
- ;;933;;Discontinued/Reduced Service;;4;;203
- ;;934;;Srvc Not Cov Under Ben Plan;;4;;204
- ;;935;;RX discount card proc fee;;3;;205
- ;;936;;NPI Missing;;21;;206
- ;;937;;Invalid NPI format;;21;;207
- ;;938;;NPI Not Matched;;21;;208
- ;;939;;Pt Resp. Bill Other Ins.;;4;;209
- ;;940;;Pymt Adj Precert Not Timely;;4;;210
- ;;941;;NDC not elg for rebate not cov;;4;;211
- ;;942;;Admin Surcharge Not Covered;;4;;212
- ;;943;;Non Compliant with Policy;;4;;213
- ;;944;;Work Comp Non-Compensable;;4;;214
- ;;945;;Subrogation of TP Settlement;;4;;215
- ;;946;;Findings of Review Org.;;4;;216
- ;;947;;Work Comp over UCR;;4;;217
- ;;948;;Work Comp entitlement to ben.;;4;;218
- ;;949;;Work Comp extent of injury;;4;;219
- ;;950;;Work Comp - Bill with Code;;4;;220
- ;;951;;Work Comp - Clm Under Invest;;21;;221
- ;;952;;Max Time/Hours for Provider;;4;;222
- ;;953;;Mandated Fed/State/Local Reg;;4;;223
- ;;954;;Pt ID compromised by ID theft;;4;;224
- ;;956;;Info req from prov not rec/suf;;4;;226
- ;;957;;Pymt Adj Pat. Infor Incmplt;;4;;227
- ;;958;;Req info not prov for proc;;4;;228
- ;;959;;Partial Chg Unall due to TOB;;4;;229
- ;;960;;No CPT/HCPCS to describe svc;;4;;230
- ;;961;;Proc not allowed same day/set;;4;;231
- ;;962;;Institutional Transfer Amt;;4;;232
- ;;963;;Hospital acquired condition;;4;;233
- ;;964;;Proc not paid seperately;;4;;234
- ;;965;;Sales Tax;;4;;235
- ;;966;;Proc/mod not comp,othr,NCCI;;4;;236
- ;;967;;Clm spans elig/inelg cov-PT;;4;;238
- ;;969;;Clm spans elig/inelg cov-rebi;;4;;239
- ;;970;;Clm/Svc miss svc/prod info;;4;;D20
- ;;971;;DX(s) missing or invalid;;4;;D21
- ;;972;;WC Pymt Adj Reason issue separ;;4;;D22
- ;;973;;Other primary coverage;;4;;D23
- ;;975;;Legislative/Regulatory Penalty;;15;;237
- ;;980;;Dx inconsist w pt's birth wt;;4;;240
- ;;981;;Low Income Subsidy copay amt;;14;;241
- ;;982;;Svcs not provided by netwk/pcp;;4;;242
- ;;983;;Svcs not auth'd by network/pcp;;4;;243
- ;;984;;Pmt reduced to zero due to lit;;21;;244
- ;;985;;Prov performance prog withhold;;15;;245
- ;;986;;Non-payable code for req'd rep;;4;;246
- ;;987;;Ded-Prof svc rendered in Inst;;13;;247
- ;;988;;Coins-Prof svc rendrd in Inst;;14;;248
- ;;989;;Clm identified as readmission;;4;;249
- ;;END
- BARADJRL ;IHS/SD/POT - CREATE ENTRY IN A/R EDI STND CLAIM ADJ REASON ;
- +1 ;;1.8;IHS ACCOUNTS RECEIVABLE;**28**;OCT 26, 2005;Build 92
- +2 ; IHS/SD/CPC HEAT326081 - V1.8 P28 - updated SARs
- +3 ; code cloned from BARADJR7
- +4 ;
- EN ; EP
- +1 ; Change Name of these reasons
- +2 SET BARD=";;"
- +3 SET BARCNT=0
- +4 DO BMES^XPDUTL("Updating Adjustment Reasons to A/R Table Entry file Phase 2...")
- +5 FOR
- DO CHNGREA2
- IF BARVALUE="END"
- QUIT
- +6 KILL DIC,DA,X,Y,DIE
- +7 DO ^BARVKL0
- +8 DO BMES^XPDUTL("SAR Codes Update Complete...")
- +9 QUIT
- +10 ; ********************************************************************
- CHNGREA2 ;
- +1 SET BARCNT=BARCNT+1
- +2 SET BARVALUE=$PIECE($TEXT(@4+BARCNT),BARD,2)
- +3 IF BARVALUE="END"
- QUIT
- +4 KILL DIC,DA,X,Y,DIE
- +5 SET DIC="^BARTBL("
- +6 SET DIC(0)="M"
- +7 SET X=BARVALUE
- +8 DO ^DIC
- +9 IF +Y>0
- Begin DoDot:1
- +10 KILL DIC,DIE,BARNAME
- +11 SET DIE="^BARTBL("
- +12 SET DA=+Y
- +13 SET BARNAME=$PIECE($TEXT(@4+BARCNT),BARD,3)
- +14 SET DR=".01////^S X=BARNAME"
- +15 DO ^DIE
- +16 DO MES^XPDUTL(BARVALUE_$SELECT($LENGTH(BARVALUE)=2:" ",$LENGTH(BARVALUE)=1:" ",1:" ")_BARNAME)
- End DoDot:1
- +17 QUIT
- +18 ; ********************************************************************
- +19 ; STANDARD CODE ;; RPMS REASON
- +20 ; ********************************************************************
- 4 ;;A/R Table Entry file - Edits DIE="^BARTBL("
- +1 ;;900;;Clm Lacks Prior Pymt Info;;4;;D16
- +2 ;;901;;Clm Den Inadq Level of Sublux;;4;;D1
- +3 ;;902;;Claim lacks drug information;;4;;D2
- +4 ;;903;;Clm Den Info Pt Equip Missing;;4;;D3
- +5 ;;904;;Period of time missing;;4;;D4
- +6 ;;905;;Clm Den Lacks Indvdl Lab Code;;4;;D5
- +7 ;;906;;Clm Den No MR Copy Included;;4;;D6
- +8 ;;907;;Clm Den Lacks Date of RecVisit;;4;;D7
- +9 ;;908;;Clm Den Lacks Info Xray Avail;;4;;D8
- +10 ;;909;;Clm Den Lacks Actual Lens Cost;;4;;D9
- +11 ;;910;;Clm Den Pvdr Fin. Forms NOF;;4;;D10
- +12 ;;911;;Clm Lacks Pcmkr Reg Form;;4;;D11
- +13 ;;912;;Clm Den No Idtfr Who did DXtst;;4;;D12
- +14 ;;913;;Clm Den Pvdr has Fin Interest;;4;;D13
- +15 ;;914;;Clm Lacks TX Plan on File;;4;;D14
- +16 ;;915;;Clm Lacks Sprvs MD Info;;4;;D15
- +17 ;;919;;Penalty for interest pymt;;15;;225
- +18 ;;922;;Provider Performance Bonus;;16;;161
- +19 ;;927;;Clm/Svc invld noncoverd days;;4;;D17
- +20 ;;928;;Clm/Svc missing DX info;;4;;D18
- +21 ;;929;;Clm Lacks Supporting Dcmnt;;4;;D19
- +22 ;;930;;DOS during lapse in coverage;;4;;200
- +23 ;;931;;Pt resp thru set aside agreemt;;4;;201
- +24 ;;932;;Non Cov Personal/Convenient;;4;;202
- +25 ;;933;;Discontinued/Reduced Service;;4;;203
- +26 ;;934;;Srvc Not Cov Under Ben Plan;;4;;204
- +27 ;;935;;RX discount card proc fee;;3;;205
- +28 ;;936;;NPI Missing;;21;;206
- +29 ;;937;;Invalid NPI format;;21;;207
- +30 ;;938;;NPI Not Matched;;21;;208
- +31 ;;939;;Pt Resp. Bill Other Ins.;;4;;209
- +32 ;;940;;Pymt Adj Precert Not Timely;;4;;210
- +33 ;;941;;NDC not elg for rebate not cov;;4;;211
- +34 ;;942;;Admin Surcharge Not Covered;;4;;212
- +35 ;;943;;Non Compliant with Policy;;4;;213
- +36 ;;944;;Work Comp Non-Compensable;;4;;214
- +37 ;;945;;Subrogation of TP Settlement;;4;;215
- +38 ;;946;;Findings of Review Org.;;4;;216
- +39 ;;947;;Work Comp over UCR;;4;;217
- +40 ;;948;;Work Comp entitlement to ben.;;4;;218
- +41 ;;949;;Work Comp extent of injury;;4;;219
- +42 ;;950;;Work Comp - Bill with Code;;4;;220
- +43 ;;951;;Work Comp - Clm Under Invest;;21;;221
- +44 ;;952;;Max Time/Hours for Provider;;4;;222
- +45 ;;953;;Mandated Fed/State/Local Reg;;4;;223
- +46 ;;954;;Pt ID compromised by ID theft;;4;;224
- +47 ;;956;;Info req from prov not rec/suf;;4;;226
- +48 ;;957;;Pymt Adj Pat. Infor Incmplt;;4;;227
- +49 ;;958;;Req info not prov for proc;;4;;228
- +50 ;;959;;Partial Chg Unall due to TOB;;4;;229
- +51 ;;960;;No CPT/HCPCS to describe svc;;4;;230
- +52 ;;961;;Proc not allowed same day/set;;4;;231
- +53 ;;962;;Institutional Transfer Amt;;4;;232
- +54 ;;963;;Hospital acquired condition;;4;;233
- +55 ;;964;;Proc not paid seperately;;4;;234
- +56 ;;965;;Sales Tax;;4;;235
- +57 ;;966;;Proc/mod not comp,othr,NCCI;;4;;236
- +58 ;;967;;Clm spans elig/inelg cov-PT;;4;;238
- +59 ;;969;;Clm spans elig/inelg cov-rebi;;4;;239
- +60 ;;970;;Clm/Svc miss svc/prod info;;4;;D20
- +61 ;;971;;DX(s) missing or invalid;;4;;D21
- +62 ;;972;;WC Pymt Adj Reason issue separ;;4;;D22
- +63 ;;973;;Other primary coverage;;4;;D23
- +64 ;;975;;Legislative/Regulatory Penalty;;15;;237
- +65 ;;980;;Dx inconsist w pt's birth wt;;4;;240
- +66 ;;981;;Low Income Subsidy copay amt;;14;;241
- +67 ;;982;;Svcs not provided by netwk/pcp;;4;;242
- +68 ;;983;;Svcs not auth'd by network/pcp;;4;;243
- +69 ;;984;;Pmt reduced to zero due to lit;;21;;244
- +70 ;;985;;Prov performance prog withhold;;15;;245
- +71 ;;986;;Non-payable code for req'd rep;;4;;246
- +72 ;;987;;Ded-Prof svc rendered in Inst;;13;;247
- +73 ;;988;;Coins-Prof svc rendrd in Inst;;14;;248
- +74 ;;989;;Clm identified as readmission;;4;;249
- +75 ;;END