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
