PSOCPIBC ;BHAM ISC/EJW - PHARMACY CO-PAY APPLICATION UTILITIES FOR IB ;01/15/02
;;7.0;OUTPATIENT PHARMACY;**93,303**;DEC 1997;Build 19
;External references to IBARX is supported by DBIA 125
;External reference to PSDRUG( is supported by DBIA 221
;This routine is called by PSOCPIBF to attempt to bill for released CMOP copays.
;For Rx fills with a release date prior to 01/01/02 this routine is called instead of CP^PSOCP. This routine does not check the additional
;exemption questions and does not send a MailMan message if an exemption question has not been answered.
CP ; Entry point to Check if COPAY - Requires RXP,PSOSITE7
I '$D(PSOPAR) D ^PSOLSET G CP
K PSOCP
; Q:'$D(^PSRX(RXP,"IB")) Q:"12"'[$E(+^PSRX(RXP,"IB"))
S PSOCPN=$P(^PSRX(RXP,0),"^",2) ; Set COPAY dfn PTR TO PATIENT
S PSOCP=$P($G(^PSRX(RXP,"IB")),"^") ; IB action type
S PSOSAVE=$S(PSOCP:1,1:"") ; save current copay status
; Set x=service^dfn^actiontype^user duz
I +$G(PSOSITE7)'>0 S PSOSITE7=$P(^PS(59,PSOSITE,"IB"),"^")
S X=PSOSITE7_"^"_PSOCPN_"^"_PSOCP_"^"_$P(^PSRX(RXP,0),"^",16)
;
RX ; Determine Original or Refill for RX
S PSOREF=0
I $G(^PSRX(RXP,1,+$G(YY),0))]"" S PSOREF=YY
; Check if bill # already exists for this RX or Refill
I 'PSOREF,+$P($G(^PSRX(RXP,"IB")),"^",2)>0 G QUIT
I PSOREF,+$G(^PSRX(RXP,1,PSOREF,"IB")) G QUIT
S PSOCHG=1 ; set temporary variable to copay and then look for exceptions
N MAILMSG
D COPAYREL
I 'PSOCHG D G QUIT
. I PSOSAVE S PSODA=RXP,PREA="R" D ACTLOG^PSOCPA S $P(^PSRX(RXP,"IB"),"^",1)=""
I PSOCHG=2 D I 'PSOCP G QUIT ; IF 'SC' QUESTION APPLIES, BUT HAS NOT BEEN ANSWERED, SEND MAIL MSG AND KEEP COPAY STATUS AS IT WAS
. ; D MAIL2^PSOCPE ; SEND MAIL TO PHARMACIST, PROVIDER, AND HOLDERS OF THE PSO COPAY KEY
I PSOCHG=1,PSOSAVE="" D I PSOREF S PSOCOMM="",PSOOLD="No Copay",PSONW="Copay" S PSODA=RXP,PREA="R" D ACTLOG^PSOCPA
. I '$D(^PSRX(RXP,"IB")),'PSOREF S $P(^PSRX(RXP,"IB"),"^",1)=1 Q
. S $P(^PSRX(RXP,"IB"),"^",1)=1
. S PSOCP=1,$P(X,"^",3)=PSOCP
I PSOCHG'=2 I $G(MAILMSG) ; D MAIL2^PSOCPE ; SEND MAIL TO PHARMACIST, PROVIDER, AND HOLDERS OF PSO COPAY KEY
; Units for COPAY
S PSOCPUN=$P(($P(^PSRX(RXP,0),"^",8)+29)/30,".",1)
; Build softlink for x(n)=softlink^units
S X(1)="52:"_RXP S:PSOREF>0 X(1)=X(1)_";1:"_PSOREF S X(1)=X(1)_"^"_PSOCPUN
; Set correct user duz if refill
I PSOREF S:+$P(^PSRX(RXP,1,PSOREF,0),"^",7)>0 $P(X,"^",4)=$P(^PSRX(RXP,1,PSOREF,0),"^",7)
;
IBNEW ; Load ^TMP global for IB call
Q:$G(RXP)'>0
N D0
G QUIT:'$D(X)
S XTMP=X,XTMP(1)=X(1)
;
; Requires x=service^dfn^action type^user duz
; x(n)=softlink^units
I $P(X,"^",3)="" S $P(X,"^",3)=$P(^PSRX(RXP,"IB"),"^",1)
D NEW^IBARX
; Returns y=1^total charges for this group or Y=-1^error code
; y(n)=IB number^charge for this Rx^AR bill #^Cap met^Partial or Full charge^Copay Exempt^Number from file 354.71
; Cap met ('1' - If patient has met cap amount or
; reached cap with this charge or '0' if not)
; Partial or Full ('P' for partial billing, 'F' for
; full billing, null for no billing)
; Copay Exempt - ('1' for exempt, '0' for non-exempt,
; '-1' for copay off (manila))
; ('1' - If patient has met cap amount or reach cap with this charge
; Entry from file 354.71 will only be saved for fills that met the annual cap and could not be fully billed
;
G QUIT:+Y=-1
S XTMP=XTMP_"^"_Y,XTMP(1)=XTMP(1)_"^"_Y(1)
;
; see if exempt or copay cap was met for this fill
I $P(Y(1),"^",6) D G QUIT
. S PREA="R",PSOOLD="Copay",PSONW="No Copay"
. S PSOCOMM="RX COPAY INCOME EXEMPTION" S PSODA=RXP D ACTLOG^PSOCPA
. S $P(^PSRX(RXP,"IB"),"^",1)=""
I $P(Y(1),"^",4) D
. S PSOCOMM=$S($P(Y(1),"^",5)="F":" FULL BILLING FOR THIS FILL",$P(Y(1),"^",5)="P":" PARTIAL BILLING FOR THIS FILL ",1:" NO BILLING FOR THIS FILL")
. S PREA="A"
. S PSODA=RXP D ACTLOG^PSOCPA
. I $P(Y(1),"^",5)'="F" D
. . I PSOREF S $P(^PSRX(RXP,1,PSOREF,"IB"),"^",2)=$P(Y(1),"^",7) Q
. . S $P(^PSRX(RXP,"IB"),"^",4)=$P(Y(1),"^",7)
I $P(Y(1),"^",1)="" G QUIT
;
FILE ; File IB number in ^PSRX
S PSOCP2=0
S PSOCP2=+$P(XTMP(1),":",3)
S:PSOCP2>0 ^PSRX(RXP,1,PSOCP2,"IB")=$P(XTMP(1),U,3) ; Filing in refill node
I PSOCP2>0,'$D(^PSRX(RXP,"IB")) S ^PSRX(RXP,"IB")="1^^" ; If refill "IB" exists, need "IB" entry on original fill node
S:PSOCP2=0 $P(^PSRX(RXP,"IB"),"^",2)=$P(XTMP(1),U,3) ;Filing in original fill (zero node)
QUIT ;
K Y,PSOCP1,PSOCP2,QQ,PSOCPN,X,X2,XTMP,PSOCPUN,PSOREF,PSOCHG,PSOSAVE,PSOCOMM,PSOOLD,PSONW,PREA,PSORSN
Q
EN D ^PSOLSET
EN1 S DIR(0)="NO",DIR("A")="Enter PRESCRIPTION number" D ^DIR K DIR G:$D(DIRUT) EXIT S RXP=X I +$G(^PSRX(RXP,0))'>0!+$P($G(^PSRX(RXP,"IB")),"^",0)>0 W !,?10,"RE-CHECK PRESCRIPTION NUMBER AND RE-ENTER " G EN1
S PSOSITE7=$P(^PS(59,PSOSITE,"IB"),"^")
S PSODFN=$P(^PSRX(RXP,0),"^",2)
D CP G EN1
EXIT K RXP D FINAL^PSOLSET Q
;
COPAYREL ; Recheck copay status at release
;
; check Rx patient status
I $P(^PSRX(RXP,0),"^",3)'="",$P($G(^PS(53,$P(^PSRX(RXP,0),"^",3),0)),"^",7)=1 S PSOCHG=0,PSOCOMM="Rx Patient Status Change",PSOOLD="Copay",PSONW="No Copay" Q
; see if drug is nutritional supplement, investigational or supply
N DRG,DRGTYP
S DRG=+$P(^PSRX(RXP,0),"^",6),DRGTYP=$P($G(^PSDRUG(DRG,0)),"^",3)
I DRGTYP["I" S PSOCOMM="Investigational Drug",PSOCHG=0,PSOOLD="Copay",PSONW="No Copay",PSOCHG=0 Q
I DRGTYP["S" S PSOCOMM="Supply Item",PSOCHG=0,PSOOLD="Copay",PSONW="No Copay",PSOCHG=0 Q
I DRGTYP["N" S PSOCOMM="Nutritional Supplement",PSOCHG=0,PSOOLD="Copay",PSONW="No Copay",PSOCHG=0 Q
K PSOTG
N EXMT
D XTYPE
F EXMT="SC" I $D(PSOTG(EXMT)) D I 'PSOCHG Q
. I PSOTG(EXMT)=1 S PSOCHG=0 S PSOCOMM="Service Connected"
I 'PSOCHG S PSOOLD="Copay",PSONW="No Copay" Q
;
; If any of the applicable exemption questions have never been answered, generate a mail message with all of the questions
S EXMT="",MAILMSG=0 F S EXMT=$O(PSOTG(EXMT)) Q:EXMT="" I PSOTG(EXMT)="" S MAILMSG=1 Q
I MAILMSG,$D(PSOTG("SC")) I $G(PSOTG("SC"))="" S PSOCHG=2 ; 'SC' question not answered, don't reset copay status to 'copay'
Q
;
XTYPE ;
N PSOCIBQ,PSOSCMX,Y,I,J,X,SAVY
S (X,PSOSCMX,SAVY)=""
S PSOCIBQ=$G(^PSRX(RXP,"IBQ"))
I $P(PSOCIBQ,"^",1)'="" S PSOTG("SC")=$P(PSOCIBQ,"^",1)
I $D(PSOTG("SC")),$P(PSOCIBQ,"^",1)="" S PSOTG("SC")="" ; USE "CURRENT" SETTING AS ANSWER TO SERVICE CONNECTED QUESTION IF IT APPLIES
S J=0 F S J=$O(^PS(59,J)) Q:'J I +$G(^(J,"IB")) S X=+^("IB") Q
I 'X Q
S X=X_"^"_PSOCPN D XTYPE^IBARX
I $G(Y)'=1 Q
S J="" F S J=$O(Y(J)) Q:'J S I="" F S SAVY=I,I=$O(Y(J,I)) Q:I="" S:I>0 PSOSCMX=I
I PSOSCMX="",SAVY=0 S PSOCHG=0 S PSOCOMM="Exempt from copayment" Q ; INCOME EXEMPT OR SERVICE-CONNECTED
I PSOSCMX=2,'$D(PSOTG("SC")) S PSOTG("SC")=$S(($G(RXP)&($P($G(^PSRX(+$G(RXP),"IB")),"^")))!($P(PSOCIBQ,"^")=0):0,$P(PSOCIBQ,"^")=1:1,1:"") Q
Q
;
PSOCPIBC ;BHAM ISC/EJW - PHARMACY CO-PAY APPLICATION UTILITIES FOR IB ;01/15/02
+1 ;;7.0;OUTPATIENT PHARMACY;**93,303**;DEC 1997;Build 19
+2 ;External references to IBARX is supported by DBIA 125
+3 ;External reference to PSDRUG( is supported by DBIA 221
+4 ;This routine is called by PSOCPIBF to attempt to bill for released CMOP copays.
+5 ;For Rx fills with a release date prior to 01/01/02 this routine is called instead of CP^PSOCP. This routine does not check the additional
+6 ;exemption questions and does not send a MailMan message if an exemption question has not been answered.
CP ; Entry point to Check if COPAY - Requires RXP,PSOSITE7
+1 IF '$DATA(PSOPAR)
DO ^PSOLSET
GOTO CP
+2 KILL PSOCP
+3 ; Q:'$D(^PSRX(RXP,"IB")) Q:"12"'[$E(+^PSRX(RXP,"IB"))
+4 ; Set COPAY dfn PTR TO PATIENT
SET PSOCPN=$PIECE(^PSRX(RXP,0),"^",2)
+5 ; IB action type
SET PSOCP=$PIECE($GET(^PSRX(RXP,"IB")),"^")
+6 ; save current copay status
SET PSOSAVE=$SELECT(PSOCP:1,1:"")
+7 ; Set x=service^dfn^actiontype^user duz
+8 IF +$GET(PSOSITE7)'>0
SET PSOSITE7=$PIECE(^PS(59,PSOSITE,"IB"),"^")
+9 SET X=PSOSITE7_"^"_PSOCPN_"^"_PSOCP_"^"_$PIECE(^PSRX(RXP,0),"^",16)
+10 ;
RX ; Determine Original or Refill for RX
+1 SET PSOREF=0
+2 IF $GET(^PSRX(RXP,1,+$GET(YY),0))]""
SET PSOREF=YY
+3 ; Check if bill # already exists for this RX or Refill
+4 IF 'PSOREF
IF +$PIECE($GET(^PSRX(RXP,"IB")),"^",2)>0
GOTO QUIT
+5 IF PSOREF
IF +$GET(^PSRX(RXP,1,PSOREF,"IB"))
GOTO QUIT
+6 ; set temporary variable to copay and then look for exceptions
SET PSOCHG=1
+7 NEW MAILMSG
+8 DO COPAYREL
+9 IF 'PSOCHG
Begin DoDot:1
+10 IF PSOSAVE
SET PSODA=RXP
SET PREA="R"
DO ACTLOG^PSOCPA
SET $PIECE(^PSRX(RXP,"IB"),"^",1)=""
End DoDot:1
GOTO QUIT
+11 ; IF 'SC' QUESTION APPLIES, BUT HAS NOT BEEN ANSWERED, SEND MAIL MSG AND KEEP COPAY STATUS AS IT WAS
IF PSOCHG=2
Begin DoDot:1
+12 ; D MAIL2^PSOCPE ; SEND MAIL TO PHARMACIST, PROVIDER, AND HOLDERS OF THE PSO COPAY KEY
End DoDot:1
IF 'PSOCP
GOTO QUIT
+13 IF PSOCHG=1
IF PSOSAVE=""
Begin DoDot:1
+14 IF '$DATA(^PSRX(RXP,"IB"))
IF 'PSOREF
SET $PIECE(^PSRX(RXP,"IB"),"^",1)=1
QUIT
+15 SET $PIECE(^PSRX(RXP,"IB"),"^",1)=1
+16 SET PSOCP=1
SET $PIECE(X,"^",3)=PSOCP
End DoDot:1
IF PSOREF
SET PSOCOMM=""
SET PSOOLD="No Copay"
SET PSONW="Copay"
SET PSODA=RXP
SET PREA="R"
DO ACTLOG^PSOCPA
+17 ; D MAIL2^PSOCPE ; SEND MAIL TO PHARMACIST, PROVIDER, AND HOLDERS OF PSO COPAY KEY
IF PSOCHG'=2
IF $GET(MAILMSG)
+18 ; Units for COPAY
+19 SET PSOCPUN=$PIECE(($PIECE(^PSRX(RXP,0),"^",8)+29)/30,".",1)
+20 ; Build softlink for x(n)=softlink^units
+21 SET X(1)="52:"_RXP
IF PSOREF>0
SET X(1)=X(1)_";1:"_PSOREF
SET X(1)=X(1)_"^"_PSOCPUN
+22 ; Set correct user duz if refill
+23 IF PSOREF
IF +$PIECE(^PSRX(RXP,1,PSOREF,0),"^",7)>0
SET $PIECE(X,"^",4)=$PIECE(^PSRX(RXP,1,PSOREF,0),"^",7)
+24 ;
IBNEW ; Load ^TMP global for IB call
+1 IF $GET(RXP)'>0
QUIT
+2 NEW D0
+3 IF '$DATA(X)
GOTO QUIT
+4 SET XTMP=X
SET XTMP(1)=X(1)
+5 ;
+6 ; Requires x=service^dfn^action type^user duz
+7 ; x(n)=softlink^units
+8 IF $PIECE(X,"^",3)=""
SET $PIECE(X,"^",3)=$PIECE(^PSRX(RXP,"IB"),"^",1)
+9 DO NEW^IBARX
+10 ; Returns y=1^total charges for this group or Y=-1^error code
+11 ; y(n)=IB number^charge for this Rx^AR bill #^Cap met^Partial or Full charge^Copay Exempt^Number from file 354.71
+12 ; Cap met ('1' - If patient has met cap amount or
+13 ; reached cap with this charge or '0' if not)
+14 ; Partial or Full ('P' for partial billing, 'F' for
+15 ; full billing, null for no billing)
+16 ; Copay Exempt - ('1' for exempt, '0' for non-exempt,
+17 ; '-1' for copay off (manila))
+18 ; ('1' - If patient has met cap amount or reach cap with this charge
+19 ; Entry from file 354.71 will only be saved for fills that met the annual cap and could not be fully billed
+20 ;
+21 IF +Y=-1
GOTO QUIT
+22 SET XTMP=XTMP_"^"_Y
SET XTMP(1)=XTMP(1)_"^"_Y(1)
+23 ;
+24 ; see if exempt or copay cap was met for this fill
+25 IF $PIECE(Y(1),"^",6)
Begin DoDot:1
+26 SET PREA="R"
SET PSOOLD="Copay"
SET PSONW="No Copay"
+27 SET PSOCOMM="RX COPAY INCOME EXEMPTION"
SET PSODA=RXP
DO ACTLOG^PSOCPA
+28 SET $PIECE(^PSRX(RXP,"IB"),"^",1)=""
End DoDot:1
GOTO QUIT
+29 IF $PIECE(Y(1),"^",4)
Begin DoDot:1
+30 SET PSOCOMM=$SELECT($PIECE(Y(1),"^",5)="F":" FULL BILLING FOR THIS FILL",$PIECE(Y(1),"^",5)="P":" PARTIAL BILLING FOR THIS FILL ",1:" NO BILLING FOR THIS FILL")
+31 SET PREA="A"
+32 SET PSODA=RXP
DO ACTLOG^PSOCPA
+33 IF $PIECE(Y(1),"^",5)'="F"
Begin DoDot:2
+34 IF PSOREF
SET $PIECE(^PSRX(RXP,1,PSOREF,"IB"),"^",2)=$PIECE(Y(1),"^",7)
QUIT
+35 SET $PIECE(^PSRX(RXP,"IB"),"^",4)=$PIECE(Y(1),"^",7)
End DoDot:2
End DoDot:1
+36 IF $PIECE(Y(1),"^",1)=""
GOTO QUIT
+37 ;
FILE ; File IB number in ^PSRX
+1 SET PSOCP2=0
+2 SET PSOCP2=+$PIECE(XTMP(1),":",3)
+3 ; Filing in refill node
IF PSOCP2>0
SET ^PSRX(RXP,1,PSOCP2,"IB")=$PIECE(XTMP(1),U,3)
+4 ; If refill "IB" exists, need "IB" entry on original fill node
IF PSOCP2>0
IF '$DATA(^PSRX(RXP,"IB"))
SET ^PSRX(RXP,"IB")="1^^"
+5 ;Filing in original fill (zero node)
IF PSOCP2=0
SET $PIECE(^PSRX(RXP,"IB"),"^",2)=$PIECE(XTMP(1),U,3)
QUIT ;
+1 KILL Y,PSOCP1,PSOCP2,QQ,PSOCPN,X,X2,XTMP,PSOCPUN,PSOREF,PSOCHG,PSOSAVE,PSOCOMM,PSOOLD,PSONW,PREA,PSORSN
+2 QUIT
EN DO ^PSOLSET
EN1 SET DIR(0)="NO"
SET DIR("A")="Enter PRESCRIPTION number"
DO ^DIR
KILL DIR
IF $DATA(DIRUT)
GOTO EXIT
SET RXP=X
IF +$GET(^PSRX(RXP,0))'>0!+$PIECE($GET(^PSRX(RXP,"IB")),"^",0)>0
WRITE !,?10,"RE-CHECK PRESCRIPTION NUMBER AND RE-ENTER "
GOTO EN1
+1 SET PSOSITE7=$PIECE(^PS(59,PSOSITE,"IB"),"^")
+2 SET PSODFN=$PIECE(^PSRX(RXP,0),"^",2)
+3 DO CP
GOTO EN1
EXIT KILL RXP
DO FINAL^PSOLSET
QUIT
+1 ;
COPAYREL ; Recheck copay status at release
+1 ;
+2 ; check Rx patient status
+3 IF $PIECE(^PSRX(RXP,0),"^",3)'=""
IF $PIECE($GET(^PS(53,$PIECE(^PSRX(RXP,0),"^",3),0)),"^",7)=1
SET PSOCHG=0
SET PSOCOMM="Rx Patient Status Change"
SET PSOOLD="Copay"
SET PSONW="No Copay"
QUIT
+4 ; see if drug is nutritional supplement, investigational or supply
+5 NEW DRG,DRGTYP
+6 SET DRG=+$PIECE(^PSRX(RXP,0),"^",6)
SET DRGTYP=$PIECE($GET(^PSDRUG(DRG,0)),"^",3)
+7 IF DRGTYP["I"
SET PSOCOMM="Investigational Drug"
SET PSOCHG=0
SET PSOOLD="Copay"
SET PSONW="No Copay"
SET PSOCHG=0
QUIT
+8 IF DRGTYP["S"
SET PSOCOMM="Supply Item"
SET PSOCHG=0
SET PSOOLD="Copay"
SET PSONW="No Copay"
SET PSOCHG=0
QUIT
+9 IF DRGTYP["N"
SET PSOCOMM="Nutritional Supplement"
SET PSOCHG=0
SET PSOOLD="Copay"
SET PSONW="No Copay"
SET PSOCHG=0
QUIT
+10 KILL PSOTG
+11 NEW EXMT
+12 DO XTYPE
+13 FOR EXMT="SC"
IF $DATA(PSOTG(EXMT))
Begin DoDot:1
+14 IF PSOTG(EXMT)=1
SET PSOCHG=0
SET PSOCOMM="Service Connected"
End DoDot:1
IF 'PSOCHG
QUIT
+15 IF 'PSOCHG
SET PSOOLD="Copay"
SET PSONW="No Copay"
QUIT
+16 ;
+17 ; If any of the applicable exemption questions have never been answered, generate a mail message with all of the questions
+18 SET EXMT=""
SET MAILMSG=0
FOR
SET EXMT=$ORDER(PSOTG(EXMT))
IF EXMT=""
QUIT
IF PSOTG(EXMT)=""
SET MAILMSG=1
QUIT
+19 ; 'SC' question not answered, don't reset copay status to 'copay'
IF MAILMSG
IF $DATA(PSOTG("SC"))
IF $GET(PSOTG("SC"))=""
SET PSOCHG=2
+20 QUIT
+21 ;
XTYPE ;
+1 NEW PSOCIBQ,PSOSCMX,Y,I,J,X,SAVY
+2 SET (X,PSOSCMX,SAVY)=""
+3 SET PSOCIBQ=$GET(^PSRX(RXP,"IBQ"))
+4 IF $PIECE(PSOCIBQ,"^",1)'=""
SET PSOTG("SC")=$PIECE(PSOCIBQ,"^",1)
+5 ; USE "CURRENT" SETTING AS ANSWER TO SERVICE CONNECTED QUESTION IF IT APPLIES
IF $DATA(PSOTG("SC"))
IF $PIECE(PSOCIBQ,"^",1)=""
SET PSOTG("SC")=""
+6 SET J=0
FOR
SET J=$ORDER(^PS(59,J))
IF 'J
QUIT
IF +$GET(^(J,"IB"))
SET X=+^("IB")
QUIT
+7 IF 'X
QUIT
+8 SET X=X_"^"_PSOCPN
DO XTYPE^IBARX
+9 IF $GET(Y)'=1
QUIT
+10 SET J=""
FOR
SET J=$ORDER(Y(J))
IF 'J
QUIT
SET I=""
FOR
SET SAVY=I
SET I=$ORDER(Y(J,I))
IF I=""
QUIT
IF I>0
SET PSOSCMX=I
+11 ; INCOME EXEMPT OR SERVICE-CONNECTED
IF PSOSCMX=""
IF SAVY=0
SET PSOCHG=0
SET PSOCOMM="Exempt from copayment"
QUIT
+12 IF PSOSCMX=2
IF '$DATA(PSOTG("SC"))
SET PSOTG("SC")=$SELECT(($GET(RXP)&($PIECE($GET(^PSRX(+$GET(RXP),"IB")),"^")))!($PIECE(PSOCIBQ,"^")=0):0,$PIECE(PSOCIBQ,"^")=1:1,1:"")
QUIT
+13 QUIT
+14 ;
