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1 | CPEE_Build9_Sprint27.zip\HAC_CPE_CH | CH835BAL.m | Mon Nov 5 16:44:36 2018 UTC |
2 | CPEE_Build9_Sprint27.zip\HAC_CPE_CH | CH835BAL.m | Mon Nov 5 17:36:34 2018 UTC |
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1 | CH835BAL ; This routi ne check t hat an 835 balances for a give n I value from CHMED I. | |
2 | ;;1.0;CHA MPVA SYSTE M;;JULY 4, 1990;Buil d 10 | |
3 | ;HR - Tea m Track #: 5592 | |
4 | ;HR - New 835 Routi ne that re places the old CHEDI * Routines | |
5 | Q | |
6 | ; | |
7 | ;;;;;;;;; ;;;;;;;;;; ;;;;;;;;;; ;;;;;;;;;; ;;;;;;;;;; ;;;;;;;;;; ;;;;;;;;;; | |
8 | ; BALANCE CHECKS TH E BALANCE OF VALUES IN ^TMP($J ,"EDI_CREA TE","CLP", CLP) | |
9 | ; THE FIE LD DEFINIT IONS ARE D EFINED BEL OW: | |
10 | ;;;;;;;;; ;;;;;;;;;; ;;;;;;;;;; ;;;;;;;;;; ;;;;;;;;;; ;;;;;;;;;; ;;;;;;;;;; ; | |
11 | ;;1.RECOR D ID;"CLP" ;5;L;;5A;R ; | |
12 | ;;2.FILE NUMBER;NFI LE;36;L;;3 6AN;R; | |
13 | ;;3.TRX S EQUENCE NU MBER;STSEQ ;9;L;;9N;R ; | |
14 | ;;4.CLAIM KEY;CLMID ;36;L;;36A N;R; | |
15 | ;;5.AUTHO RIZATION;A UTH;25;L;; 25AN;R; | |
16 | ;;6.GROUP CTRL NUMB ER;GRPCTL; 10;L;;10N; R; | |
17 | ;;7.TRANS ACTION CTR L NUMBER;T XNCTL;12;L ;;12AN;R; | |
18 | ;;8.FILE AUTHORIZAT ION;FILEAU TH;25;L;;2 5AN;R; | |
19 | ;;9.PATIE NT CONTROL NUMBER;PT CTL;20;L;; 20AN;R; | |
20 | ;;10.BILL ED AMOUNT; CLMLVL("BI LLAMT");20 ;L;;18N;R; | |
21 | ;;11.PAID TO VENDOR ;CLMLVL("V PYMT");20; L;;18N;R; | |
22 | ;;12.PATI ENT RESPON SIBILITY;P ATRESP;20; L;;18N;R; | |
23 | ;;13.CLAI M NUMBER;$ P(^CHMPAY( PAYI,0),"^ ",1);30;L; ;30AN;R; | |
24 | ;;14.DRUG CODE;CLML VL("DRGCD" );4;L;;4AN ;R; | |
25 | ;;15.DRUG WEIGHT;CL MLVL("DRGW T");10;L;; 10N;R; | |
26 | ;;16.CLAI M CREATION DATE;$$DT OUT^CH835F U1($P(^CHM PAY(PAYI,0 ),"^",25)) ;8;L;;DATE ;R; | |
27 | ;;17.?;"N EW";5;L;;5 A;R; | |
28 | ;;18.CLAI M STATUS C ODE;"1";1; L;;1N;R; | |
29 | ;;END OF RECORD | |
30 | ;;;;;;;;; ;;;;;;;;;; ;;;;;;;;;; ;;;;;;;;;; ;;;;;;;;;; ;;;;;;;;;; ;;;;;;;;;; ;;;;;;; | |
31 | ; BALANCE CHECKS TH E BALANCE OF THE BIL LED AMT AG AINST THE VENDOR PAY MENT | |
32 | ; AND ALL RECORDED ADJUSTMENT S (CLPCAS AND SVCCAS ) | |
33 | ; ^TMP($J ,"EDI_CREA TE","CLP", TMPI) | |
34 | ; | |
35 | ; THE BAL ANCE ERROR INFORMATI ON IS STOR ED IN ^TMP ($J,"BALER R",PDI) AR RAY | |
36 | ;;;;;;;;; ;;;;;;;;;; ;;;;;;;;;; ;;;;;;;;;; ;;;;;;;;;; ;;;;;;;;;; ;;;;;;;;;; ;;;;;;; | |
37 | ; | |
38 | BALANCE() ; Balances the FMS D OC id | |
39 | ; call th is directl y if TMP($ J,"EDI_CRE ATE") is a lready def ined | |
40 | N CLP,TSV CCAS,CLPR, CLAIM,CLPC AS,CLPBAL, SVCBAL,CI, BALFLG,CHP DI,REJI,RE JCODE,PRAM T,BILLAMT, STATUS,EDI I,CHKAMT,C HKNUM,CHEC KS,PAYMENT S | |
41 | S (CLP,TS VCCAS,REJA MT,PRAMT,B ILLAMT)=0, (REJCODE,S TATUS,EDII ,CHKNUM,PA YCHK,CHECK S,PAYMENTS )="" | |
42 | K CH835AR R,BALDBG | |
43 | I ($$ENVI R^CHTFLIB' ="LIVE") S BALDBG=1 | |
44 | D NOW^%DT C S DATE= X ; GE T THE CURR ENT DATE V IA FILEMAN | |
45 | S BALFLG= 1 | |
46 | F S CLP= $O(^TMP($J ,"EDI_CREA TE","CLP", CLP)) Q:CL P="" D | |
47 | .S CLPR=^ TMP($J,"ED I_CREATE", "CLP",CLP) ; RETRIEVE ALL FIELD S FROM "CL P" STORE | |
48 | .;I $$ENV IR^CHTFLIB '="LIVE" U 0 W !!,"B ALANCE: ^T MP($J,""ED I_CREATE"" ,""CLP""", CLP,")= ", !,?8,CLPR | |
49 | .S CLAIM= $P(CLPR,"^ ",13) ; HA C CLAIM NU MBER RETRI EVAL | |
50 | .S CI=$O( ^CHMPAY("B ",CLAIM,"" )) ; ^CHMPAY(I) INDEX | |
51 | .S STATUS =$P(^CHMPA Y(CI,0),"^ ",2) ; CLAIM STAT US FROM ^C HMPAY() | |
52 | .S REJI=$ S(STATUS=0 :$P(^CHMPA Y(CI,0),"^ ",13),1:"" ) ; IF R EJECT, GET REJ INDEX | |
53 | .S:REJI R EJCODE=$$C LMREJ^CH83 5FU2(CI,RE JI) ; RETRIEVE THE REJEC T CODE | |
54 | .S CLPCAS =$$CLPCAS( CLP) ; CL PCAS STORE CHECK | |
55 | .S SVCBAL =$$SVCCHK( CI,CLP,.TS VCCAS,.BIL LAMT) ; SVC LI NE CHECK S ETS TOTAL SVC ADJUST MENTS | |
56 | .S CLPBAL =$P(CLPR," ^",10)-$P( CLPR,"^",1 1)-CLPCAS- TSVCCAS ; 10=B ILLED AMT, 11=VENDOR PAYMENT C LPCAS=CLAI M ADJ TSVC CAS=SVC LI NE ADJ | |
57 | .I $$ENVI R^CHTFLIB' ="LIVE" U 0 W !!,"** **BAL:CLPB AL(",CLPBA L,")= BILL ED AMT ",$ P(CLPR,"^" ,10),"- VN DR PMT ",$ P(CLPR,"^" ,11),"- CL PCAS ",CLP CAS,"- TSV CCAS ",TSV CCAS | |
58 | .S CH835A RR(CI)=+CL PBAL_"^"_+ $P(CLPR,"^ ",10)_"^"_ +$P(CLPR," ^",11)_"^" _+CLPCAS_" ^"_+TSVCCA S | |
59 | .S:(CLPBA L'=0)!(SVC BAL'=0) BA LFLG=0 ; CLAIM OR SVC LINE BALANCE CH ECKS | |
60 | .I 'BALFL G D | |
61 | ..S EDII= 0,EDII=$O( ^CHMEDI("C ",CI,EDII) ) ; GET THE ^CHMEDI(I) INDEX | |
62 | ..S ^CHME DI("H",DAT E,EDII)="" ; SET TH E CROSS-RE FERENCE FO R THE DATE INITIAL B ALANCE ERR OR OCCURRE D | |
63 | ..S CHPDI =$P($P(^CH MPAY(CI,0) ,"^",4),"* ",1) ; OFFEND ING PDI NU MBER | |
64 | ..S ^TMP( $J,"BALERR ",CHPDI)=C HPDI_"^"_C LAIM_"^"_S TATUS_"^"_ REJI_"^"_R EJCODE_"^" _$P(CLPR," ^",10)_"^" _$P(CLPR," ^",11)_"^" _CLPCAS_"^ "_TSVCCAS_ "^"_CLPBAL _"^"_$P(^C HMEDI(EDII ,0),"^",7) _"^"_PAYME NTS_"^"_CH ECKS | |
65 | Q BALFLG | |
66 | ; | |
67 | ;;;;;;;;; ;;;;;;;;;; ;;;;;;;;;; ;;;;;;;;;; ;;;;;;;;;; ;;;;;;;;;; ;;;;;;;;;; ;;;; | |
68 | ; CLPCAS BALANCE CH ECKS THE ^ TMP($J,"ED I_CREATE", "CLPCAS",C LP,CASCNT) STORE | |
69 | ; THE FIE LD DEFINIT IONS ARE D EFINED BEL OW: | |
70 | ;;;;;;;;; ;;;;;;;;;; ;;;;;;;;;; ;;;;;;;;;; ;;;;;;;;;; ;;;;;;;;;; ;;;;;;;;;; ;;;; | |
71 | ;;1.REC_I D;"CLPCAS" ;10;L;;10A ;R; | |
72 | ;;2.FILE NUMBER;NFI LE;36;L;;3 6AN;R; | |
73 | ;;3.TRX S EQUENCE NU MBER;STSEQ ;9;L;;9N;R ; | |
74 | ;;4.CLAIM KEY;CLMID ;36;L;;36A N;R; | |
75 | ;;5.HAC C LAIM NUMBE R;CLMLVL(" CLM");10;L ;;10AN;R; | |
76 | ;;6.CLAIM ADJ GRP(C AS01);GRP; 4;L;;4N;R; | |
77 | ;;7.CLAIM ADJ_REASO N1(CAS02); $P($P(CASL N,"^",1)," :",1);5;L; ;5AN;R; | |
78 | ;;8.CLAIM ADJ_AMT(C AS03);$P($ P(CASLN,"^ ",1),":",2 );20;L;;18 .2FP;R; | |
79 | ;;9.CLAIM ADJ QTY1( CAS04);$P( $P(CASLN," ^",1),":", 3);5;L;;5A N;R; | |
80 | ;;10.CLAI M ADJ RSN2 (CAS05);$P ($P(CASLN, "^",2),":" ,1);5;L;;5 AN;O; | |
81 | ;;11.CLAI M ADJ AMT2 (CAS06);$P ($P(CASLN, "^",2),":" ,2);20;L;; 18.2FP;O; | |
82 | ;;12.CLAI M ADJ QTY2 (CAS07);$P ($P(CASLN, "^",2),":" ,3);5;L;;5 AN;O; | |
83 | ;;13.CLAI M ADJ RSN3 (CAS08);$P ($P(CASLN, "^",3),":" ,1);5;L;;5 AN;O; | |
84 | ;;14.CLAI M ADJ AMT3 (CAS09);$P ($P(CASLN, "^",3),":" ,2);20;L;; 18.2FP;O; | |
85 | ;;15.CLAI M ADJ QTY3 (CAS07);$P ($P(CASLN, "^",3),":" ,3);5;L;;5 AN;O; | |
86 | ;;16.CLAI M ADJ RSN4 (CAS11);$P ($P(CASLN, "^",4),":" ,1);5;L;;5 AN;O; | |
87 | ;;17.CLAI M ADJ AMT4 (CAS12);$P ($P(CASLN, "^",4),":" ,2);20;L;; 18.2FP;O; | |
88 | ;;18.CLAI M ADJ QTY4 (CAS13);$P ($P(CASLN, "^",4),":" ,3);5;L;;5 AN;O; | |
89 | ;;19.CLAI M ADJ RSN5 (CAS14);$P ($P(CASLN, "^",5),":" ,1);5;L;;5 AN;O; | |
90 | ;;20.CLAI M ADJ AMT5 (CAS15);$P ($P(CASLN, "^",5),":" ,2);20;L;; 18.2FP;O; | |
91 | ;;21.CLAI M ADJ QTY5 (CAS16);$P ($P(CASLN, "^",5),":" ,3);5;L;;5 AN;O; | |
92 | ;;22.CLAI M_ADJ RSN6 (CAS17);$P ($P(CASLN, "^",6),":" ,1);5;L;;5 AN;O; | |
93 | ;;23.CLAI M ADJ AMT6 (CAS18);$P ($P(CASLN, "^",6),":" ,2);20;L;; 18.2FP;O; | |
94 | ;;24.CLAI M ADJ QTY6 (CAS19);$P ($P(CASLN, "^",6),":" ,3);5;L;;5 AN;O; | |
95 | ;;END OF RECORD | |
96 | ;;;;;;;;; ;;;;;;;;;; ;;;;;;;;;; ;;;;;;;;;; ;;;;;;;;;; ;;;;;;;;;; ;;;;;;;;;; ;; | |
97 | ; CLPCAS TOTALS THE ADJUSTMEN TS REPORTE D IN THE C LPCAS RECO RD | |
98 | ;;;;;;;;; ;;;;;;;;;; ;;;;;;;;;; ;;;;;;;;;; ;;;;;;;;;; ;;;;;;;;;; ;;;;;;;;;; ;; | |
99 | ; | |
100 | CLPCAS(CLP ) | |
101 | N CLPCAS, CASCNT,CR | |
102 | S CLPCAS= 0,CASCNT=0 , CR="" | |
103 | F S CASC NT=$O(^TMP ($J,"EDI_C REATE","CL PCAS",CLP, CASCNT)) Q :'CASCNT D | |
104 | .S CR=^TM P($J,"EDI_ CREATE","C LPCAS",CLP ,CASCNT) | |
105 | .;I $$ENV IR^CHTFLIB '="LIVE" U 0 W !," B ALANCE:CLP CAS ^TMP( $J,""EDI_C REATE"","" CLPCAS""", CLP,",",CA SCNT,")= " ,CR | |
106 | .S CLPCAS =CLPCAS+$P (CR,"^",8) +$P(CR,"^" ,11)+$P(CR ,"^",14)+$ P(CR,"^",1 7)+$P(CR," ^",20)+$P( CR,"^",23) | |
107 | I $$ENVIR ^CHTFLIB'= "LIVE" U 0 W !," BAL ANCE:CLPCA S: CLPCAS= ",CLPCAS | |
108 | Q CLPCAS | |
109 | ; | |
110 | ;;;;;;;;; ;;;;;;;;;; ;;;;;;;;;; ;;;;;;;;;; ;;;;;;;;;; ;;;;;;;;;; ;;;;;;;;;; ;;;;;; | |
111 | ; SVCCHK BALANCE CH ECKS THE ^ TMP($J,"ED I_CREATE", "SVC",CLP, SVC) STORE | |
112 | ; THE FIE LD DEFINIT IONS ARE D EFINED BEL OW: | |
113 | ;;;;;;;;; ;;;;;;;;;; ;;;;;;;;;; ;;;;;;;;;; ;;;;;;;;;; ;;;;;;;;;; ;;;;;;;;;; ;;;;;; | |
114 | ;;1.REC_I D;"SVC";3; L;;3A;0;R; | |
115 | ;;2.NEW_F ILE_AUTH_N BR;NFILE;2 0;L;;20AN; R; | |
116 | ;;3.NEW_S T02TXN_CTL _NBR;STSEQ ;5;L;;5N;R ; | |
117 | ;;4.HDR_C LM_ID;$$GT CLMID^CH83 5F3(PAYI,T OS);36;L;; 36AN;R; | |
118 | ;;5.PYR_C LM_NBR;$P( ^CHMPAY(PA YI,0),"^", 1);20;L;;2 0AN;R; | |
119 | ;;6.SVC_K EY;IMGL;10 ;L;;10N;R; | |
120 | ;;7.SVC01 PROC_CD;$$ PROC^CH835 FU1($P(I2P DATA,"^",4 ));20;L;;2 0AN;R; | |
121 | ;;8.SVC01 SVC_ID_QUA L;$$SVCQUA L^CH835FU1 (SERVI);5; L;;5AN;R; | |
122 | ;;9.SVC01 PROC_MOD1; $P(MODDATA ,"^",1);10 ;L;;10AN;R ; | |
123 | ;;10.SVC0 1PROC_MOD2 ;$P(MODDAT A,"^",2);1 0;L;;10AN; O; | |
124 | ;;11.SVC0 1PROC_MOD3 ;$P(MODDAT A,"^",3);1 0;L;;10AN; O; | |
125 | ;;12.SVC0 1PROC_MOD4 ;$P(MODDAT A,"^",4);1 0;L;;10AN; O; | |
126 | ;;13.SVC0 1PROC_CD_D ESC;$$PROC DESC^CH835 FU1(SERVI) ;80;L;;80A N;R; | |
127 | ;;14.SVC0 2CHRG_AMT; $S($P(SORT DATA,"^",8 )="":0,1:$ P(SORTDATA ,"^",8));2 0;L;;18.2F P;R; | |
128 | ;;15.SVC0 3PRVD_PMT; $S($P(SORT DATA,"^",1 4)="":0,1: $P(SORTDAT A,"^",14)) ;20;L;;18. 2FP;R; | |
129 | ;;16.SVC0 4NUBC_REVN U_CD;$P(IM GDATA,"^", 14);20;L;; 18.2FP;R; | |
130 | ;;17.SVC0 5UNIT_SVC_ PAID;$S($P (SORTDATA, "^",17)="" :0,1:$P(SO RTDATA,"^" ,17));10;L ;;10N;R; | |
131 | ;;18.SVC0 7ORGNUNIT_ SVC;$P(SOR TDATA,"^", 16);10;L;; 10N;R; | |
132 | ;;19.DTM0 1DDTM_QUAL ;"472";5;L ;;5N;R; | |
133 | ;;20.DTM0 1DT_FLD;$$ DTOUT^CH83 5FU1($P(IM GDATA,"^", 1));8;L;;D ATE;R; | |
134 | ;;21.DDTM _QUAL;"";1 5;L;;15AN; R; | |
135 | ;;22.DT_F LD;"";15;L ;;15N;R; | |
136 | ;;23.ADTL _ID;$P(IMG DATA,"^",1 6);20;L;;2 0AN;R; | |
137 | ;;24.PROV _ID;$$PROV ID^CH835FU 1(VENI);20 ;L;;20AN;R ; | |
138 | ;;25.ALLO WED AMT;$S ($P(SORTDA TA,"^",7)= "":0,1:$P( SORTDATA," ^",7));20; L;;18.2FP; R; | |
139 | ;;END OF RECORD | |
140 | ;;;;;;;;; ;;;;;;;;;; ;;;;;;;;;; ;;;;;;;;;; ;;;;;;;;;; ;;;;;;;;;; ;;;;;;;;;; ;;;;;; | |
141 | ; SVCCHK BALANCE CH ECKS THE S VC CHARGE AGAINST TH E PROVIDER PAYMENT | |
142 | ; RECORDE D IN THE S VC RECORD AND ALL AD JUSTMENTS REPORTED I N THE SVCC AS RECORD | |
143 | ; ^TMP($J ,"EDI_CREA TE","SVC", TMPI,SVCTI ) | |
144 | ; 4/2/13 DLB REMOVE D CALCULAT ED PR AMOU NT FROM TH E EQUATION | |
145 | ; 4/26/20 13 DLB AD DED BILLED AMOUNT SU MMING FROM THE SVC L INE FOR BA LANCE CHEC KS | |
146 | ; 6/19/13 DLB ADDED RECORDING OF THE SV C LINE BAL ANCE ERROR DATA; IDE NTIFIERS A RE THE | |
147 | ; PDI, HAC CLAIM NUMB ER, AND LI NE ITEM CO NTROL NUMB ER, DATA I NCLUDES BA LANCE ERRO R | |
148 | ; AMOUNT, B ILLED AMOU NT, PROVID ER PAYMENT AMT, AND THE ADJUST MENTS AMOU NT FROM SV CCAS | |
149 | ;;;;;;;;; ;;;;;;;;;; ;;;;;;;;;; ;;;;;;;;;; ;;;;;;;;;; ;;;;;;;;;; ;;;;;;;;;; ;;;;;; | |
150 | ; | |
151 | SVCCHK(CI, CLP,TSVCCA S,BILLAMT) ; | |
152 | N SVC,SVC BAL,SR,SVC CAS,PATRES P,HACCLM,C HPDI | |
153 | S (SVC,SV CBAL,TSVCC AS,BILLAMT )=0,SR="" | |
154 | S CHPDI=$ P($P(^CHMP AY(CI,0)," ^",4),"*", 1) ;RETRIEV E THE PDI FOR THE SE RVICE LINE | |
155 | F S SVC= $O(^TMP($J ,"EDI_CREA TE","SVC", CLP,SVC)) Q:SVC="" D | |
156 | .S SR=^TM P($J,"EDI_ CREATE","S VC",CLP,SV C) ; SVC LI NE RECORD DATA | |
157 | .S HACCLM =$P(SR,"^" ,5) ; RETRIEVE T HE HAC CLA IM NUMBER | |
158 | .;I $$ENV IR^CHTFLIB '="LIVE" U 0 W !!," BAL:SVCCHK ^TMP($J, ""EDI_CREA TE"",""SVC "",",CLP," ,",SVC,")= ",!,?8,SR | |
159 | .S BILLAM T=BILLAMT+ $P(SR,"^", 14) ; SUM OF S VC LINE CH ARGE AMOUN TS | |
160 | .I $$ENVI R^CHTFLIB' ="LIVE" U 0 W !," BA L:SVCCHK LINE CHG A MT: ",$P(S R,"^",14), " PRO V PMT= ",$ P(SR,"^",1 5)," SU M OF LINE CHGS: ",BI LLAMT | |
161 | .S SVCCAS =$$SVCCAS( CLP,SVC) ; ADJUSTME NTS MADE F OR EACH SV C LINE | |
162 | .S TSVCCA S=TSVCCAS+ SVCCAS ; SUM OF ALL SVC LINE ADJUSTMENT S | |
163 | .I $$ENVI R^CHTFLIB' ="LIVE" U 0 W !," BA L:SVCCHK: SVCCAS= ", SVCCAS," SUM OF LI NE ADJUSTM ENTS= ",TS VCCAS | |
164 | .S SVCBAL =$P(SR,"^" ,14)-$P(SR ,"^",15)-S VCCAS ; BILLAMT- (15=SVC03P RVD_PMT)-S VCCAS=SVC LINE ADJUS TMENTS | |
165 | .S:SVCBAL ^TMP($J," BALERR",CH PDI,HACCLM )=CHPDI_"^ "_HACCLM_" ^"_$P(SR," ^",23)_"^" _SVCBAL_"^ "_$P(SR,"^ ",14)_"^"_ $P(SR,"^", 15)_"^"_SV CCAS | |
166 | .S CH835A RR(CI,SVC) =+SVCBAL_" ^"_+$P(SR, "^",14)_"^ "_+SVCCAS ; DLB 4/2/1 3 REMOVED PR VALUE | |
167 | .I $$ENVI R^CHTFLIB' ="LIVE" U 0 W !," BA LANCE:SVCC HK:",SVC," SVCBAL: ",SVCBAL," = LINE CHG : ",$P(SR, "^",14),"- PRVDPYMNT : ",$P(SR, "^",15)," - SVCCAS: ",SVCCAS | |
168 | I $$ENVIR ^CHTFLIB'= "LIVE" U 0 W !," BAL ANCE:SVCCH K: SVCBAL= ",SVCBAL | |
169 | Q SVCBAL | |
170 | ; | |
171 | ;;;;;;;;; ;;;;;;;;;; ;;;;;;;;;; ;;;;;;;;;; ;;;;;;;;;; ;;;;;;;;;; ;;;;;;;;;; ; | |
172 | ; SVCCAS CHECKS THE BALANCE F OR ^TMP($J ,"EDI_CREA TE","SVCCA S",CLP,SVC ,CASCNT) | |
173 | ; THE FIE LDS ARE DE FINED BELO W: | |
174 | ;;;;;;;;; ;;;;;;;;;; ;;;;;;;;;; ;;;;;;;;;; ;;;;;;;;;; ;;;;;;;;;; ;;;;;;;;;; ; | |
175 | ;;1.REC_I D;"SVCCAS" ;10;L;;10A ;0;R; | |
176 | ;;2.NEW_F ILE_AUTH_N BR;NFILE;2 0;L;;20AN; R; | |
177 | ;;3.NEW_S T02TXN_CTL _NBR;STSEQ ;5;L;;5N;R ; | |
178 | ;;4.HDR_C LM_ID;$$GT CLMID^CH83 5F3(PAYI,T OS);36;L;; 36AN;R; | |
179 | ;;5.PYR_C LM_NBR;$P( ^CHMPAY(PA YI,0),"^", 1);20;L;;2 0AN;R; | |
180 | ;;6.SVC_K EY;IMGL;10 ;L;;10N;R; | |
181 | ;;7.CLM_A DJ_GRP(CAS 01);GRP;5; L;;5N;R; | |
182 | ;;8.CLM A DJ RSN1(CA S02);$P($P (SCASLN,"^ ",1),":",1 );5;L;;5AN ;O; | |
183 | ;;9.CLM A DJ AMT1(CA S03);$P($P (SCASLN,"^ ",1),":",2 );20;L;;18 .2FP;O; | |
184 | ;;10.CLM ADJ QTY1(C AS04);$P($ P(SCASLN," ^",1),":", 3);5;L;;5N ;O | |
185 | ;;11.CLM ADJ RSN2(C AS05);$P($ P(SCASLN," ^",2),":", 1);5;L;;5A N;O; | |
186 | ;;12.CLM ADJ_AMT2(C AS06);$P($ P(SCASLN," ^",2),":", 2);20;L;;1 8.2FP;O; | |
187 | ;;13.CLM ADJ QTY1(C AS04);$P($ P(SCASLN," ^",2),":", 3);5;L;;5N ;O | |
188 | ;;14.CLM_ ADJ_RSN3(C AS08);$P($ P(SCASLN," ^",3),":", 1);5;L;;5A N;O; | |
189 | ;;15.CLM ADJ_AMT3(C AS09);$P($ P(SCASLN," ^",3),":", 2);20;L;;1 8.2FP;O; | |
190 | ;;16.CLM ADJ QTY1(C AS04);$P($ P(SCASLN," ^",3),":", 3);5;L;;5N ;O | |
191 | ;;17.CLM_ ADJ_RSN4(C AS11);$P($ P(SCASLN," ^",4),":", 1);5;L;;5A N;O; | |
192 | ;;18.CLM ADJ_AMT4(C AS12);$P($ P(SCASLN," ^",4),":", 2);20;L;;1 8.2FP;O; | |
193 | ;;19.CLM ADJ QTY1(C AS04);$P($ P(SCASLN," ^",4),":", 3);5;L;;5N ;O | |
194 | ;;20.CLM_ ADJ_RSN5(C AS14);$P($ P(SCASLN," ^",5),":", 1);5;L;;5A N;O; | |
195 | ;;21.CLM ADJ_AMT5(C AS15);$P($ P(SCASLN," ^",5),":", 2);20;L;;1 8.2FP;O; | |
196 | ;;22.CLM ADJ QTY1(C AS04);$P($ P(SCASLN," ^",5),":", 3);5;L;;5N ;O | |
197 | ;;23.CLM_ ADJ_RSN6(C AS17);$P($ P(SCASLN," ^",6),":", 1);5;L;;5A N;O; | |
198 | ;;24.CLM ADJ_AMT6(C AS18);$P($ P(SCASLN," ^",6),":", 2);20;L;;1 8.2FP;O; | |
199 | ;;25.CLM ADJ QTY1(C AS04);$P($ P(SCASLN," ^",6),":", 3);5;L;;5N ;O | |
200 | ;;END OF RECORD | |
201 | ;;;;;;;;; ;;;;;;;;;; ;;;;;;;;;; ;;;;;;;;;; ;;;;;;;;;; ;;;;;;;;;; ;;;;;;;;;; ;;;;;; | |
202 | ; SVCCAS TOTALS THE AMOUNTS O F THE ADJU STMENTS RE CORDED IN THE SVCCAS RECORDS | |
203 | ; .S ^TM P($J,"EDI_ CREATE","S VCCAS",TMP I,SVCTI,SV CCTI) | |
204 | ;;;;;;;;; ;;;;;;;;;; ;;;;;;;;;; ;;;;;;;;;; ;;;;;;;;;; ;;;;;;;;;; ;;;;;;;;;; ;;;;;; | |
205 | ; | |
206 | SVCCAS(CLP ,SVC) ; | |
207 | ; CLP MO ST SIGNIFI CANT INDEX INTO ^TMP ($J,"EDI_C REATE","SV CCAS",CLP, SVC,CASCNT ) | |
208 | ; SVC 2N D MOST SIG NIFICANT I NDEX | |
209 | N SVCCAS, CASCNT | |
210 | S SVCCAS= 0,CASCNT=0 | |
211 | F S CASC NT=$O(^TMP ($J,"EDI_C REATE","SV CCAS",CLP, SVC,CASCNT )) Q:'CASC NT D | |
212 | .S CR=^TM P($J,"EDI_ CREATE","S VCCAS",CLP ,SVC,CASCN T) | |
213 | .;I $$ENV IR^CHTFLIB '="LIVE" U 0 W !," B ALANCE:SVC CAS ^TMP( $J,""EDI_C REATE"","" SVCCAS""," ,CLP,",",S VC,",",CAS CNT,")= ", !,?8,CR | |
214 | .S SVCCAS =SVCCAS+$P (CR,"^",9) +$P(CR,"^" ,12)+$P(CR ,"^",15)+$ P(CR,"^",1 8)+$P(CR," ^",21)+$P( CR,"^",24) | |
215 | .I $$ENVI R^CHTFLIB' ="LIVE" U 0 W !," BA LANCE:SVCC AS: ADJUST MENTS SUM= ",SVCCAS, " FLD 9= " ,$P(CR,"^" ,9)," 12= ",$P(CR,"^ ",12)," 15 = ",$P(CR, "^",15)," 18= ",$P(C R,"^",18), " 21= ",$P (CR,"^",21 )," 24= ", $P(CR,"^", 24) | |
216 | Q SVCCAS | |
217 | ||
218 | ;;;;;;;;; ;;;;;;;;;; ;;;;;;;;;; ;;;;;;;;;; ;;;;;;;;;; ;;;;;;;;;; ;;;;;;;;;; ;;; | |
219 | ; BALCHK( ) DETERMIN ES IF THE LINE LEVEL AND CLAIM LEVEL BIL LED VS | |
220 | ; PAID/PA TIENT RESP VALUES BA LANCE. IF THERE IS A N IMBALANC E, THE | |
221 | ; CLAIM I S LOGGED I N ^TMP($J, "BALERR"), AND NO 83 5 RECORD I S GENERATE D. | |
222 | ; THE IMB ALANCE IS REPORTED V IA EMAIL T O THE PST GROUP. | |
223 | ;;;;;;;;; ;;;;;;;;;; ;;;;;;;;;; ;;;;;;;;;; ;;;;;;;;;; ;;;;;;;;;; ;;;;;;;;;; ;;; | |
224 | ; BASED O N BRIAN MA TTHEWS' IN PUT, A COM MON BALANC E CHECK OP ERATION CA N | |
225 | ; BE IMPL EMENTED. | |
226 | ; 1a)Serv ice Line i s accepted , but HAC paid amoun t = 0 Th ere are tw o | |
227 | ; situati ons where this happe ns. The ex ample give n is for N ON OHI cla ims | |
228 | ; where t he amount the HAC wo uld have p aid is app lied to th e deductib le. | |
229 | ; BALANCE CHECK= Bi lled Charg es - all c laim adjus tments (to tal of CO, PR, PI, a nd OA) | |
230 | ; 1b) OHI claims ma y have OHI Service L ine paymen ts + OHI S ervice Lin e | |
231 | ; adjustm ents that equal the Billed cha rges. In this case we would h ave | |
232 | ; an OA23 adjustmen t for the total bill ed charges . | |
233 | ; BALANCE CHECK: Bi lled Charg es - all c laim adjus tments (to tal of CO, PR, PI, a nd OA) | |
234 | ; 2) Serv ice Line i s accepted and HAC p ays more t han zero. | |
235 | ; BALANCE CHECK: Bi lled Charg es - {HAC payment + all claim adjustment s (total o f CO, PR, PI, and OA )} | |
236 | ; 3) When we reject a line, t he allowab le amount will be ze ro and the HAC will pay zero. | |
237 | ; BALANCE CHECK: Bi lled Charg es - all c laim adjus tments (to tal of CO, PR, PI, a nd OA) | |
238 | ;;;;;;;;; ;;;;;;;;;; ;;;;;;;;;; ;;;;;;;;;; ;;;;;;;;;; ;;;;;;;;;; ;;;;;;;;;; ;;;;; | |
239 | ; 1a, 1b, AND 3: H AC PAID AM OUNT SHOUL D BE 0, SO INCLUDING THE VARIA BLE HAS NO EFFECT | |
240 | ; 2: HAC PAID AMOUN T IS REPOR TED, SO IT SHOULD BE INCLUDED IN THE CHE CK | |
241 | ;;;;;;;;; ;;;;;;;;;; ;;;;;;;;;; ;;;;;;;;;; ;;;;;;;;;; ;;;;;;;;;; ;;;;;;;;;; ;;;;;; | |
242 | ; | |
243 | BALCHK(PAY I,EDII) | |
244 | ; PAYI "I" INDEX TO T HE ^CHMPAY () GLOBAL | |
245 | ; EDII "I" INDEX FOR THE ^CHMED I FILE | |
246 | N SORTDAT A,POHIPD,O HIPR,ADDOH IPD,OHIPRB AL,MDCAIDP D,TPLPD,HA CPD,ALLOHI ,ALLPAID,C HGAMT,ALLO WAMT,BALER R | |
247 | S BALERR= 0 | |
248 | I '$D(GLP AY) S X1=P AYI D PROG TYP^CHFCD0 01 ;AEB 4 20/2012 D EV007820 S ETS GLPAY IF NOT DEF INED. | |
249 | I GLPAY=" " S X1=PAY I D PROGTY P^CHFCD001 ;AEB 4 2 0/2012 DEV 007820 SET S GLPAY IF NOT DEFIN ED. | |
250 | I $P(@(GL PAY_"PAYI, ""COMMON"" )"),"^",18 )=1!('$$DS LA^CHTFLIB 2(PAYI)) D ;if auto distribut e OR claim prior to SLA (Servi ce Line Ad judication ) ;JAK 7/2 8/11 DEV00 7820 | |
251 | .D INIT^C HGCUU3(PAY I,"ALLOW", "AUTO") ; AUTO-D ISTRIBUTIO N (creates LINEID if not exist ) ;JAK 7/2 8/11 DEV00 7820 | |
252 | E D | |
253 | .D INIT^C HGCUU3(PAY I,"ALLOW", "TPLBENE") ; MANUAL ...distrib ute tpl & bene pmts and calc o hi | |
254 | S PDI=$P( $P(^CHMPAY (PAYI,0)," ^",4),"*", 1) ; CLAIM PDI FROM ^ CHMPAY(PAY I,0),"^",4 ) | |
255 | D SORT^CH FBCUTL(PAY I) ; AEB UTIL F OR UNITS, ALLOWED AM OUNT, ETC. | |
256 | S IMGL=0 | |
257 | F S IMGL =$O(^TMP($ J,"IMG2PAY ",PAYI,IMG L)) Q:+(IM GL)=0 D ; LOOP THROUGH T HE SERVICE LINES | |
258 | .S SORTDA TA=^TMP($J ,"LINE",PA YI,IMGL) | |
259 | .S POHIPD =+$P(SORTD ATA,"^",1) ; PRIMARY OHI PAID V ALUE | |
260 | .S OHIPR= +$P(SORTDA TA,"^",2) ; OHI PATI ENT RESPON SIBILITY | |
261 | .S ADDOHI PD=+$P(SOR TDATA,"^", 3) ; RETRIEVE ADDITIONA L OHI PAID AMOUNT | |
262 | .S OHIPRB AL=+$P(SOR TDATA,"^", 4) ; RETRIEVE OHI PR BA LANCE AMOU NT | |
263 | .S MDCAID PD=+$P(SOR TDATA,"^", 5) ; MEDICAID PAYMENTS RECEIVED | |
264 | .S TPLPD= +$P(SORTDA TA,"^",6) ; TPL PAYM ENTS RECEI VED | |
265 | .S HACPD= +$P(SORTDA TA,"^",12) ; ADJUDICA TED PAYMEN T AMOUNT | |
266 | .S ALLOHI =POHIPD+AD DOHIPD ; GET OHI TO TAL PAID | |
267 | .S ALLPAI D=(ALLOHI+ MDCAIDPD+T PLPD+HACPD ) ; TOTAL ALL PAYMEN TS RECEIVE D + AMT HA C PAID | |
268 | .S CHGAMT =+$P(SORTD ATA,"^",8) ; LINE CHA RGE FROM S ORT^CHFBCU TL | |
269 | .S ALLOWA MT=+$P(SOR TDATA,"^", 7) ; ALLOWED AMOUNT FRO M SORT^CHF BCUTL | |
270 | .I (CHGAM T-(ALLPAID +OHIPRBAL) '=0) D ; LINE L EVEL BALAN CE CHECK | |
271 | ..S BALER R=1 ; RE TURN VALUE | |
272 | ..D NOW^% DTC ; GE T TODAY'S DATE | |
273 | ..S TODAY =X ; DA TE BALANCE ERROR REC ORDED | |
274 | ..S ARR(. 02)=2 ; SE T STATUS T O BALANCE ERROR | |
275 | ..S ARR(. 07)=TODAY ; SE T DATE BAL ANCE ERROR ENCOUNTER ED | |
276 | ..S RESUL T=$$UPDATE ^CHHRLIBFM ("CHMEDI(I ,0)",EDII, $$SETDR^CH HRLIBFM("A RR")) ; UP DATE THE ^ CHMEDI FIL E | |
277 | ..S CHPDI =$P($P($G( ^CHMPAY(PA YI,0)),"^" ,4),"*",1) ; GET THE OFFEND ING PDI | |
278 | ..S HACCL M=$P($G(^C HMPAY(PAYI ,0)),"^",1 ) ; GET TH E OFFENDIN G HAC CLAI M NUMBER | |
279 | ..S ^TMP( $J,"BALERR ",CHPDI)=C HPDI_"^"_H ACCLM_"^"_ EDII_"^"_T ODAY_"^"_C HGAMT_"^"_ ALLPAID_"^ "_OHIPRBAL | |
280 | ..;U 0 W !,"LINE LV L BALERR: ",CHPDI_"^ "_HACCLM_" ^"_EDII_"^ "_TODAY_"^ "_CHGAMT_" ^"_ALLPAID _"^"_OHIPR BAL | |
281 | ;U 0 W !, "LINE LEVE L BALANCE: ",CHGAMT- (ALLPAID+O HIPRBAL) | |
282 | Q BALERR | |
283 | ; | |
284 | FMS(FMSI) ; Call thi s to check the balan ce of a FM SI | |
285 | ; Do not call usin g this tag if creati ng 835 FIL E | |
286 | ; becaus e it will change the value of variale NF ILE | |
287 | ; | |
288 | ;D TEST^C H835F2(FMS I) ; DLB 11/27/2012 | |
289 | Q $$BALAN CE | |
290 | ; | |
291 | ;;;;;;;;; ;;;;;;;;;; ;;;;;;;;;; ;;;;;;;;;; ;;;;;;;;;; ;;;;;;;;;; ;;;;;;;;;; ;;;;;;;;;; ;;;;;;;;;; ;;;;;; | |
292 | ; BALEMAI L REPORTS THE BALANC E ERROR IN FORMATION FROM ^TMP( $J,"BALERR ",PDI) ARR AY. THE CO NTENTS | |
293 | ; STORED IN THE ARR AY FRO REP ORTING: | |
294 | ; ..S ^T MP($J,"BAL ERR",CHPDI )=PDI_"^"_ HAC CLM #_ "^"_^CHMED I(I) INDEX _"^"_DATE_ "^"_CHGAMT _"^"_ALLPA ID_"^"_OHI PRBAL | |
295 | ;;;;;;;;; ;;;;;;;;;; ;;;;;;;;;; ;;;;;;;;;; ;;;;;;;;;; ;;;;;;;;;; ;;;;;;;;;; ;;;;;;;;;; ;;;;;;;;;; ;;;;;;; | |
296 | ; | |
297 | BALEMAIL ; Email BALA NCE ERROR INFORMATIO N TO USERS | |
298 | N PID,ZML ,DATA,CHPI D,BERRCT | |
299 | S BERRCT= 0 | |
300 | S CHNB=2, ZML(CHNB)= "Balance E rror(s) en countered ...Claims not proces sed!",CHNB =CHNB+2,ZM L(CHNB)=" " | |
301 | S CHPDI=" " | |
302 | F S CHPD I=$O(^TMP( $J,"BALERR ",CHPDI)) Q:CHPDI="" D | |
303 | .S DATA=$ G(^TMP($J, "BALERR",C HPDI)) | |
304 | .S CHNB=C HNB+1,ZML( CHNB)="PDI = "_$ P(DATA,"^" ,1) | |
305 | .S CHNB=C HNB+1,ZML( CHNB)="CLA IM NUMBER = "_$P (DATA,"^", 2) | |
306 | .S CHNB=C HNB+1,ZML( CHNB)="IVA L..^CHMEDI (I) = "_$P (DATA,"^", 3) | |
307 | .S CHNB=C HNB+1,ZML( CHNB)="DAT E RECORDED = "_$P(DA TA,"^",4) | |
308 | .S CHNB=C HNB+1,ZML( CHNB)="CHA RGE AMT = "_$P(DATA, "^",5) | |
309 | .S CHNB=C HNB+1,ZML( CHNB)="TOT AL PAID AM T = "_$P(D ATA,"^",6) | |
310 | .S CHNB=C HNB+1,ZML( CHNB)="OHI PR BAL = "_$P(DATA, "^",7) | |
311 | .S CHNB=C HNB+1,CHNB =CHNB+1,ZM L(CHNB)="- ---------- ---------- ---------- ---------- ---------- ---------- ---------- --------" | |
312 | .S BERRCT =BERRCT+1 | |
313 | S CHNB=CH NB+1,ZML(C HNB)="TOTA L NUMBER O F ERRORS T O CORRECT "_BERRCT | |
314 | S XMDUZ=. 5 | |
315 | S XMY(" PII ")="" ;MTN014040 12/20/11 JEH - ADDE D PST EMAI L ADDRESS | |
316 | S XMY(XMD UZ)="" | |
317 | S XMY(DUZ )="" ;JE H 2/1/11 D EV007820 | |
318 | S XMTEXT= "ZML(",XMS UB="835 Ba lance Erro r Info" | |
319 | D ^XMD | |
320 | Q | |
321 | ; |
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