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Routine: BARADJR

BARADJR.m

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BARADJR ; IHS/SD/LSL - CREATE ENTRY IN A/R EDI STND CLAIM ADJ REASON ;
 ;;1.8;IHS ACCOUNTS RECEIVABLE;;OCT 26, 2005
 ;
 ; IHS/SD/LSL - 08/01/2002 - V1.6 Patch 3
 ;     For HIPAA compliance.  Populate A/R EDI STND CLAIM ADJ REASON
 ;     File with mapping to RPMS
 ;
 ; *********************************************************************
ENTRY ;
 ; Create entry
 S BARD=";;"
 S BARCNT=0
 F  D EN2 Q:BARVALUE="END"
 D ^BARVKL0
 Q
 ; ********************************************************************
EN2 ;
 S BARCNT=BARCNT+1
 S BARVALUE=$P($T(@1+BARCNT),BARD,2,5)
 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
 ; *********************************************************************
 ; IEN;;NAME;;TABLE TYPE;;ACRONYM
 ; *********************************************************************
1 ;;
 ;;602;;COINSURANCE;;CO-PAY
 ;;604;;CODING ERROR;;PENDING
 ;;605;;CODING ERROR;;PENDING
 ;;606;;CODING ERROR;;PENDING
 ;;607;;CODING ERROR;;PENDING
 ;;608;;CODING ERROR;;PENDING
 ;;609;;CODING ERROR;;PENDING
 ;;610;;CODING ERROR;;PENDING
 ;;611;;CODING ERROR;;PENDING
 ;;612;;CODING ERROR;;PENDING
 ;;613;;DEATH PRECEDES DOS;;PENDING
 ;;614;;BIRTH FOLLOWS DOS;;PENDING
 ;;615;;INFO NOT RECEIVED/SUFFICIENT;;PENDING
 ;;616;;MISSING DATA;;PENDING
 ;;617;;INFO NOT RECEIVED/SUFFICIENT;;PENDING
 ;;619;;OTHER TPL;;PENDING
 ;;620;;OTHER TPL;;PENDING
 ;;621;;OTHER TPL;;PENDING
 ;;622;;OTHER PRIMARY COVERAGE;;PENDING
 ;;623;;OTHER PRIMARY COVERAGE-OTH PAY;;NON PAYMENT
 ;;624;;OVER CONTRACTED AMOUNT-CAP;;NON PAYMENT
 ;;625;;STOP LOSS DEDUCT NOT MET;;NON PAYMENT
 ;;626;;OUTSIDE COVERAGE DATES-PRIOR;;NON PAYMENT
 ;;627;;OUTSIDE COVERAGE DATES-AFTER;;NON PAYMENT
 ;;628;;OUTSIDE COVERAGE DATES-COV/DOS;;NON PAYMENT
 ;;630;;PAT NOT MET REQD REQMNTS;;NON PAYMENT
 ;;632;;NO ELIG. FOUND-DEP NOT ELIG;;NON PAYMENT
 ;;633;;NO ELIG. FOUND-NO DEP COV;;NON PAYMENT
 ;;636;;BAL DOES NOT EXCEED COPAY;;NON PAYMENT
 ;;637;;BAL DOES NOT EXCEED DEDUCTIBLE;;NON PAYMENT
 ;;638;;PROVIDER NOT IN NETWORK;;NON PAYMENT
 ;;639;;SRVCS DENIED PRECERT RQSTD;;NON PAYMENT
 ;;640;;NOT MEDICALLY NECESSARY-ER/URG;;NON PAYMENT
 ;;643;;GRAM-RUDMAN REDUCTION;;NON PAYMENT
 ;;644;;PROMPT PAY DISCOUNT;;NON PAYMENT
 ;;645;;OVER CONTRACTED AMOUNT-EXCEED;;NON PAYMENT
 ;;647;;NON COVERED SERVICE;;PENDING
 ;;648;;NON COVERED SERVICE-PROCEDURE;;NON PAYMENT
 ;;653;;NON COVERED SERVICE-RELATIVE;;NON PAYMENT
 ;;654;;INCORRECT PROVIDER TYPE;;NON PAYMENT
 ;;655;;NON COVERED SERVICE;;PENDING
 ;;656;;NON COVERED SERVICE;;PENDING
 ;;657;;INFO NOT RECEIVED/SUFFICIENT;;PENDING
 ;;658;;NON COVERED SERVICE;;PENDING
 ;;659;;OVER ALLOWABLE AMOUNT;;NON PAYMENT
 ;;660;;NON COVERED SERVICE-OUT/IN;;NON PAYMENT
 ;;661;;NO PRIOR APPROVAL;;PENDING
 ;;663;;CORRECTION TO PRIOR CLAIM;;PENDING
 ;;664;;DENIAL REVERSED PER MED REVIEW;;GENERAL INFORMATION
 ;;665;;CODING ERROR;;PENDING
 ;;666;;BLOOD DEDUCTIBLE;;DEDUCTIBLE
 ;;667;;MAXIMUM BENEFITS-LIFE RES DAYS;;NON PAYMENT
 ;;669;;DAY OUTLIER AMOUNT;;NON PAYMENT
 ;;670;;COST OUTLIER ADJUSTMENT;;NON PAYMENT
 ;;672;;COINSURANCE-DAY;;CO-PAY
 ;;673;;ADMINISTRATIVE DAYS;;NON PAYMENT
 ;;674;;INDIRECT MED ED ADJ;;NON PAYMENT
 ;;675;;DIRECT MED ED ADJ;;NON PAYMENT
 ;;676;;DISPROPORTIONATE SHARE ADJ;;NON PAYMENT
 ;;677;;COVERED DAYS;;NON PAYMENT
 ;;678;;NON COVERED SERVICE-NCD/ROOM;;NON PAYMENT
 ;;679;;COST REPORT DAYS;;NON PAYMENT
 ;;680;;OUTLIER DAYS;;NON PAYMENT
 ;;681;;DISCHARGES;;NON PAYMENT
 ;;682;;PIP DAYS;;NON PAYMENT
 ;;683;;TOTAL VISITS;;NON PAYMENT
 ;;684;;CAPITAL ADJUSTMENT;;NON PAYMENT
 ;;685;;INTEREST AMOUNT;;NON PAYMENT
 ;;686;;STATUTORY ADJUSTMENT;;NON PAYMENT
 ;;687;;TRANSFER AMOUNT;;NON PAYMENT
 ;;688;;PRIOR OVERPAYMENT;;PENDING
 ;;689;;PROFESSIONAL FEE REMOVED;;NON PAYMENT
 ;;690;;INGREDIENT COST ADJ;;NON PAYMENT
 ;;691;;DISPENSING FEE ADJUSTMENT;;WRITE OFF
 ;;692;;CLAIM PAID IN FULL;;GENERAL INFORMATION
 ;;693;;NO CLAIM LEVEL ADJUSTMENTS;;GENERAL INFORMATION
 ;;694;;PROCESSED IN EXCESS OF CHARGES;;GROUPER ALLOWANCE
 ;;695;;OVER ALLOWABLE AMOUNT;;NON PAYMENT
 ;;696;;NON COVERED SERVICE-CHARGE;;NON PAYMENT
 ;;698;;OTHER PRIMARY COVERAGE;;PENDING
 ;;697;;BUNDLED TO ANOTHER PROCEDURE;;NON PAYMENT
 ;;699;;OTHER PRIMARY COVERAGE-MCR SEC;;NON PAYMENT
 ;;701;;PREDETERMINATION;;PENDING
 ;;702;;MAJOR MEDICAL ADJ;;NON PAYMENT
 ;;703;;PROVIDER PROMO DISCOUNT;;NON PAYMENT
 ;;704;;OVER CONTRACTED AMOUNT-MG CARE;;NON PAYMENT
 ;;705;;TAX WITHHOLDING;;NON PAYMENT
 ;;706;;PT PYMT OPTION/ELECT NOT EFFCT;;NON PAYMENT
 ;;707;;MISSING DATA;;PENDING
 ;;708;;PYMT REDUCED-GUIDELINES;;NON PAYMENT
 ;;709;;ELIGIBILITY DENIED;;NON PAYMENT
 ;;710;;BILLING DATE PRECEDES DOS;;PENDING
 ;;711;;NON COVERED SERVICE-PRV ACCEPT;;NON PAYMENT
 ;;713;;NON COVERED SERVICE-OUT US/WAR;;NON PAYMENT
 ;;714;;NOT APPROVED BY FDA;;NON PAYMENT
 ;;715;;NON COVERED SERVICE-CNCL/POST;;NON PAYMENT
 ;;716;;INFO NOT RECEIVED/SUFFICIENT;;NON PAYMENT
 ;;717;;NON COVERED SERVICE-TRANSPORT;;NON PAYMENT
 ;;718;;NON COVERED SERVICE-ESRD;;NON PAYMENT
 ;;719;;MAXIMUM BENEFITS-FOR TIME PER;;NON PAYMENT
 ;;720;;OTHER PRIMARY COVERAGE-MG CARE;;NON PAYMENT
 ;;721;;INDEMNIFICATION ADJ;;NON PAYMENT
 ;;722;;PSYCHIATRIC REDUCTION;;NON PAYMENT
 ;;723;;PAYER REFUND DUE TO OVERPAYMNT;;GENERAL INFORMATION
 ;;724;;PAYER REFUND AMT-NOT OUTPAT;;GENERAL INFORMATION
 ;;725;;PYMT ADJ DUE TO BILLING ERRORS;;PENDING
 ;;726;;DEDUCTIBLE-MAJOR MEDICAL;;DEDUCTIBLE
 ;;727;;COINSURANCE-MAJOR MEDICAL;;CO-PAY
 ;;728;;OTHER PRIMARY COVERAGE-NEWBORN;;NON PAYMENT
 ;;730;;PROCESSING FEE-CLAIM SUBMIT;;NON PAYMENT
 ;;731;;PROCESSING FEE-DISCOUNT;;NON PAYMENT
 ;;732;;PRE-DEMO PROJECT ADJ;;NON PAYMENT
 ;;733;;PENDING FURTHER REVIEW;;PENDING
 ;;734;;NON COVERED SERVICE-TECH FEE;;NON PAYMENT
 ;;735;;DENIED DO NOT PROC INTRM BILL;;NON PAYMENT
 ;;736;;PRIOR PAYER P&P NOT FOLLOWED;;NON PAYMENT
 ;;738;;APPEAL PROCEDURES NOT FOLLOWED;;NON PAYMENT
 ;;739;;OVER CONTRACTED AMOUNT-EMPLOYEE;;NON PAYMENT
 ;;740;;PAT ID# & NAME DON'T MATHCH;;PENDING
 ;;742;;OVER CONTRACTED AMOUNT-MCD PAT;;NON PAYMENT
 ;;743;;PORTION OF PAYMENT DEFERRED;;PENDING
 ;;744;;INCENTIVE ADJUSTMENT;;NON PAYMENT
 ;;800;;PATIENT REFUND AMOUNT;;REFUND
 ;;801;;CLAIM DENIED CHARGES;;NON PAYMENT
 ;;802;;OVER CONTRACTED AMOUNT-CTR ADJ;;NON PAYMENT
 ;;803;;MSP LIABILITY MET;;NON PAYMENT
 ;;804;;MEDICARE CLAIM PPS DAY OUTLIER;;NON PAYMENT
 ;;805;;MCR CLAIM PPS COST OUTLIER;;NON PAYMENT
 ;;806;;PRIOR HOSP/30 DAY TRF;;NON PAYMENT
 ;;807;;PRESUMPTIVE PYMT ADJUSTMENT;;NON PAYMENT
 ;;808;;UNGROUPABLE DRG;;NON PAYMENT
 ;;851;;NON COVERED SERVICE-VISIT;;NON PAYMENT
 ;;852;;NON-COVERED VISITS;;NON PAYMENT
 ;;853;;COVERED CHARGES;;NON PAYMENT
 ;;854;;LATE FILING PENALTY;;PENALTY
 ;;855;;GUIDELINES NOT MET/EXCEEDED;;NON PAYMENT
 ;;856;;INCORRECT PROVIDER TYPE;;NON PAYMENT
 ;;857;;INCORRECT PROVIDER TYPE;;NON PAYMENT
 ;;858;;OTHER PRIMARY COVERAGE-ALT SVC;;NON PAYMENT
 ;;859;;NON COVERED SERVICE-HOSPICE;;NON PAYMENT
 ;;860;;OVER ALLOWABLE AMOUNT;;NON PAYMENT
 ;;861;;OTHER PRIMARY COVERAGE-NOT COV;;NON PAYMENT
 ;;862;;SERVICES NOT DOCUMENTED IN MR;;PENDING
 ;;863;;PAYMT MADE IN PREV PAYMENT;;PENDING
 ;;864;;NON COVERED SERVICE-ONE/DAY;;NON PAYMENT
 ;;865;;NON COVERED SERVICE-NOT PD SEP;;NON PAYMENT
 ;;866;;"NEW PT" QUALIFICATION NOT MET;;PENDING
 ;;867;;NOT PRESCR BY MD, RX INCOMPLET;;NON PAYMENT
 ;;868;;PROC CODE/MODIFIER INVALID;;PENDING
 ;;869;;NOT MEDICALLY NECESSARY-RV FND;;NON PAYMENT
 ;;870;;INCORRECT PROVIDER TYPE;;NON PAYMENT
 ;;871;;INCORRECT PROVIDER TYPE;;NON PAYMENT
 ;;872;;AJDUSTED BASED ON DIAGNOSIS;;PENDING
 ;;873;;PROVIDER FAIL PROFICIENCY TEST;;PENDING
 ;;901;;LEVEL SUBLUXATION INADEQUATE;;PENDING
 ;;902;;CLAIM LACKS DRUG INFORMATION;;PENDING
 ;;903;;INFO ON PAT EQUIPMENT MISSING;;PENDING
 ;;904;;PERIOD OF TIME MISSING;;PENDING
 ;;905;;CODING ERROR;;PENDING
 ;;906;;MISSING FIELD;;PENDING
 ;;907;;INFO NOT RECEIVED/SUFFICIENT;;PENDING
 ;;908;;INFO NOT RECEIVED/SUFFICIENT;;PENDING
 ;;909;;INFO NOT RECEIVED/SUFFICIENT;;PENDING
 ;;910;;INFO NOT RECEIVED/SUFFICIENT;;PENDING
 ;;911;;INFO NOT RECEIVED/SUFFICIENT;;PENDING
 ;;912;;INFO NOT RECEIVED/SUFFICIENT;;PENDING
 ;;913;;FINANCIAL INTEREST-DOCTOR;;PENDING
 ;;914;;DOCUMENTATION REQUIRED;;PENDING
 ;;915;;DOCUMENTATION REQUIRED;;NON PAYMENT
 ;;END