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1 | CPAC.zip\Billing Precertification for Fee Care | 22-001 BillingPrecert_SDD_v1.00.docx | Wed Feb 8 18:54:56 2017 UTC |
2 | CPAC.zip\Billing Precertification for Fee Care | 22-001 BillingPrecert_SDD_v1.00.docx | Fri Feb 10 14:59:32 2017 UTC |
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1 | Department of Vetera ns Affairs | |
2 | ||
3 | Billing Pr ecertifica tion for F ee Care | |
4 | System Des ign Docume nt | |
5 | FB*3.5*163 | |
6 | IB*2.0*554 | |
7 | ||
8 | ||
9 | ||
10 | February 2 017 | |
11 | Version 1. 00 | |
12 | Revision H istory | |
13 | Date | |
14 | Version | |
15 | Descriptio n | |
16 | Author | |
17 | Reviewer | |
18 | Issue Date | |
19 | Formal Rev iew | |
20 | 02/08/2017 | |
21 | 1.00 | |
22 | Updated ba sed on VA comments | |
23 | S. Ambrose | |
24 | ||
25 | 02/08/2017 | |
26 | ||
27 | 01/03/2017 | |
28 | 0.11 | |
29 | Formatting changes, per PMO | |
30 | P.Wild | |
31 | K. Marr | |
32 | 01/04/2017 | |
33 | ||
34 | 12/21/2016 | |
35 | 0.10 | |
36 | Formatting changes, per PMO | |
37 | P.Wild | |
38 | K. Marr | |
39 | 12/22/2016 | |
40 | ||
41 | 08/25/2016 | |
42 | 0.09 | |
43 | Per AERB, added stat ements reg arding SFT P | |
44 | P. Wild | |
45 | ||
46 | ||
47 | ||
48 | 03/08/2016 | |
49 | 0.08 | |
50 | Modified t ool versio n numbers, per AERB | |
51 | P.Wild | |
52 | ||
53 | ||
54 | ||
55 | 1/29/2016 | |
56 | 0.07 | |
57 | Updates pe r VA comme nts | |
58 | P.Wild | |
59 | S. Blair | |
60 | ||
61 | ||
62 | 01/04/2016 | |
63 | 0.06 | |
64 | Updates to Sections 5 & 6, rep laced term “UR Nurse ” with “RU R Nurse” t hroughout document | |
65 | P. Wild | |
66 | S. Blair | |
67 | 01/15/2016 | |
68 | ||
69 | 10/21/2015 | |
70 | 0.05 | |
71 | Updates to Sections 5 & 6 | |
72 | P. Wild | |
73 | S. Blair | |
74 | ||
75 | ||
76 | 08/28/2015 | |
77 | 0.04 | |
78 | Incorporat ed Governm ent commen ts | |
79 | P. Wild | |
80 | S. Ambrose | |
81 | 09/03/2015 | |
82 | ||
83 | 08/18/2015 | |
84 | 0.03 | |
85 | Updates pe r Formal R eview | |
86 | P. Wild | |
87 | S. Ambrose | |
88 | 08/20/2015 | |
89 | 08/24/2015 | |
90 | 07/31/2015 | |
91 | 0.02 | |
92 | Initial Dr aft | |
93 | P. Wild | |
94 | S. Ambrose | |
95 | 07/31/2015 | |
96 | 08/11/2015 | |
97 | 07/07/2015 | |
98 | 0.01 | |
99 | Sections 1 -4 for AER B Review R equest | |
100 | CPAC PMOSS | |
101 | ||
102 | ||
103 | ||
104 | ||
105 | Activity | |
106 | New Capabi lity (1) | |
107 | Feature En hancement (2) | |
108 | Field Depl oyment (A) | |
109 | Yes | |
110 | Yes | |
111 | Cloud/Web Deployment (B) | |
112 | No | |
113 | No | |
114 | Mobile App lication ( C) | |
115 | No | |
116 | No | |
117 | ||
118 | Table of C ontents | |
119 | 1.Introduc tion1 | |
120 | 1.1.Scope1 | |
121 | 1.2.User P rofiles2 | |
122 | 2.Backgrou nd2 | |
123 | 2.1.Overvi ew of the System2 | |
124 | 2.2.Overvi ew of the Business P rocess3 | |
125 | 2.3.Overvi ew of the Significan t Requirem ents3 | |
126 | 2.3.1.Over view of Fu nctional R equirement s3 | |
127 | 2.3.2.Over view of Fu nctional W orkload/Pe rformance Requiremen ts7 | |
128 | 2.3.3.Over view of Op erational Requiremen ts7 | |
129 | 2.3.4.Over view of Te chnical Re quirements 7 | |
130 | 2.3.5.Over view of Se curity or Privacy Re quirements 7 | |
131 | 2.3.6.Over view of Sy stem Criti cality and High Avai lability R equirement s7 | |
132 | 2.3.7.Sing le Sign-on Requireme nts8 | |
133 | 2.3.8.Requ irement fo r Use of E nterprise Portals8 | |
134 | 2.3.9.Spec ial Device Requireme nts8 | |
135 | 3.Conceptu al Design8 | |
136 | 3.1.Concep tual Appli cation Des ign8 | |
137 | 3.1.1.Appl ication Co ntext8 | |
138 | 3.1.2.High -Level App lication D esign8 | |
139 | 3.1.3.Appl ication Lo cations10 | |
140 | 3.2.Concep tual Data Design11 | |
141 | 3.2.1.Proj ect Concep tual Data Model11 | |
142 | 3.2.2.Data base Infor mation11 | |
143 | 3.2.3.User Interface Data Mapp ing12 | |
144 | 3.3.Concep tual Infra structure Design12 | |
145 | 3.3.1.Syst em Critica lity and H igh Availa bility12 | |
146 | 3.3.2.Spec ial Techno logy12 | |
147 | 3.3.3.Tech nology Loc ations12 | |
148 | 3.3.4.Conc eptual Inf rastructur e Diagram1 3 | |
149 | 3.3.4.1.Lo cation of Environmen ts and Ext ernal Inte rfaces13 | |
150 | 3.3.4.2.Co nceptual P roduction String Dia gram13 | |
151 | 4.System A rchitectur e13 | |
152 | 4.1.Hardwa re Archite cture13 | |
153 | 4.2.Softwa re Archite cture13 | |
154 | 4.3.Networ k Architec ture15 | |
155 | 4.4.SOA/ES S16 | |
156 | 4.5.Enterp rise Archi tecture16 | |
157 | 5.Data Des ign16 | |
158 | 5.1.Databa se Managem ent System (DBMS) Fi les16 | |
159 | 5.1.1.FEE BASIS PATI ENT FILE – AUTHORIZA TION SUB-F ILE (#161. 01) – New Trigger17 | |
160 | 5.1.2.FEE BASIS CONT RACT FILE (#161.43) – New Fiel d – CHOICE Indicator 18 | |
161 | 5.1.3.IB-F B INTERFAC E TRACKING FILE (#36 0) – New F ile19 | |
162 | 5.2.Non-DB MS Files26 | |
163 | 5.3.Data V iew26 | |
164 | 6.Detailed Design27 | |
165 | 6.1.Hardwa re Detaile d Design27 | |
166 | 6.2.Softwa re Detaile d Design27 | |
167 | 6.2.1.Conc eptual Des ign27 | |
168 | 6.2.1.1.Pr oduct Pers pective27 | |
169 | 6.2.1.1.1. User Inter faces27 | |
170 | 6.2.1.1.2. Hardware I nterfaces2 7 | |
171 | 6.2.1.1.3. Software I nterfaces2 7 | |
172 | 6.2.1.1.4. Communicat ions Inter faces28 | |
173 | 6.2.1.1.5. Memory Con straints28 | |
174 | 6.2.1.1.6. Special Op erations28 | |
175 | 6.2.1.2.Pr oduct Feat ures28 | |
176 | 6.2.1.3.Us er Charact eristics28 | |
177 | 6.2.1.4.De pendencies and Const raints28 | |
178 | 6.2.2.Spec ific Requi rements28 | |
179 | 6.2.2.1.Da tabase Rep ository28 | |
180 | 6.2.2.2.Sy stem Featu res28 | |
181 | 6.2.2.2.1. Non-VA Med ical Care (NVC) Prec ert Workli st28 | |
182 | 6.2.2.2.2. Potential Cost Recov ery Report 31 | |
183 | 6.2.2.3.De sign Eleme nt Tables3 3 | |
184 | 6.2.2.3.1. Routines ( Entry Poin ts)33 | |
185 | 6.2.2.3.2. Templates8 0 | |
186 | 6.2.2.3.3. Data Entri es Affecte d by the D esign80 | |
187 | 6.2.2.3.4. Unique Rec ord(s)80 | |
188 | 6.2.2.3.5. File or Gl obal Size Changes80 | |
189 | 6.2.2.3.6. Mail Group s80 | |
190 | 6.2.2.3.7. Security K eys81 | |
191 | 6.2.2.3.8. Options81 | |
192 | 6.2.2.3.9. Protocols8 1 | |
193 | 6.2.2.3.10 .RPC83 | |
194 | 6.2.2.3.11 .Constants Defined i n Interfac e83 | |
195 | 6.2.2.3.12 .Variables Defined i n Interfac e83 | |
196 | 6.2.2.3.13 .Types Def ined in In terface83 | |
197 | 6.2.2.3.14 .GUI83 | |
198 | 6.2.2.3.15 .GUI Class es83 | |
199 | 6.2.2.3.16 .Current F orm83 | |
200 | 6.2.2.3.17 .Modified Form83 | |
201 | 6.2.2.3.18 .Component s on Form8 3 | |
202 | 6.2.2.3.19 .Events83 | |
203 | 6.2.2.3.20 .Methods83 | |
204 | 6.2.2.3.21 .Special R eferences8 3 | |
205 | 6.2.2.3.22 .Class Eve nts84 | |
206 | 6.2.2.3.23 .Class Met hods84 | |
207 | 6.2.2.3.24 .Class Pro perties84 | |
208 | 6.2.2.3.25 .Uses Clau se84 | |
209 | 6.2.2.3.26 .Forms84 | |
210 | 6.2.2.3.27 .Functions 84 | |
211 | 6.2.2.3.28 .Dialog84 | |
212 | 6.2.2.3.29 .Help Fram e84 | |
213 | 6.2.2.3.30 .HL7 Appli cation Par ameter84 | |
214 | 6.2.2.3.31 .HL7 Logic al Link84 | |
215 | 6.2.2.3.32 .Commercia l Off-the- Shelf (COT S) Interfa ce84 | |
216 | 6.2.2.3.33 .RPC84 | |
217 | 6.3.Networ k Detailed Design84 | |
218 | 6.4.Securi ty and Pri vacy84 | |
219 | 6.4.1.Secu rity84 | |
220 | 6.4.2.Priv acy85 | |
221 | 6.5.SOA/ES S Detailed Design85 | |
222 | 7.External System In terface De sign85 | |
223 | 8.Human-Ma chine Inte rface85 | |
224 | Attachment A – Appro val Signat ures86 | |
225 | Attachment B – Acron yms87 | |
226 | Attachment C – Addit ional Info rmation89 | |
227 | A.1 Identi fication o f Technolo gy and Sta ndards89 | |
228 | A.2 Constr aining Pol icies, Dir ectives an d Procedur es89 | |
229 | A.3 RTM89 | |
230 | A.4 Packag ing and In stallation 89 | |
231 | A.5 Design Metrics89 | |
232 | Attachment D – Chang e Log90 | |
233 | ||
234 | ||
235 | List of Ta bles | |
236 | Table 1: P rimary and Secondary Users2 | |
237 | Table 2: F unctional Requiremen ts3 | |
238 | Table 3 : Database I nformation 12 | |
239 | Table 4: F ileMan Dat abases16 | |
240 | Table 5: F unctional Requiremen ts vs. Wor klist Scre ens30 | |
241 | Table 6: F unctional Requiremen trs vs. Re port Modif ications31 | |
242 | Table 7: ( Grouping): Routines3 3 | |
243 | Table 8: T emplates80 | |
244 | ||
245 | List of Fi gures | |
246 | Figure 1: Applicatio n Context Diagram8 | |
247 | Figure 2: Overview o f EDI X12 Messaging9 | |
248 | Figure 3: Overview o f Claims P rocessing and Eligib ility (CP& E) System and Interf aces10 | |
249 | Figure 4: Data Model 11 | |
250 | Figure 5: Network Ar chitecture 15 | |
251 | Figure 6: Enterprise Architect ure16 | |
252 | ||
253 | ||
254 | Introducti on | |
255 | Department of Vetera ns Affairs (VA) faci lities are able to p rovide all of the ne cessary me dical care and servi ces requir ed by its patients. However, t here are t imes when the Vetera n is not a ble to acc ess VA hea lth care f acilities based on g eographic constraint s, due to medical em ergencies, or becaus e it is ec onomically advantage ous to pro vide treat ment in th e communit y. In thes e cases, t he VA may authorize medical ca re at priv ate-sector facilitie s for thos e Veterans who meet the eligib ility requ irements. This is re ferred to as Non-VA care (NVC) . | |
256 | Regardless of where the care i s provided , precerti fication i s often a prerequisi te for cer tain servi ces before payment i s issued b y insuranc e companie s. Precert ification is the pro cess of ob taining ap proval fro m the Vete ran’s priv ate insura nce health plan for hospital i npatient a dmissions or outpati ent visits prior to the delive ry of heal th care. C urrently, Consolidat ed Patient Account C enters (CP AC) Staff is not not ified of s cheduled V A-provided outpatien t services requiring precertif ication. N otificatio n regardin g authoriz ed nonserv ice-connec ted NVCs r eceived af ter treatm ent has be en rendere d. As a re sult, VA M edical Cen ters (VAMC s) often m iss opport unities to be reimbu rsed by in surance co mpanies fo r care due to the la ck of obta ining time ly precert ification. | |
257 | The goal o f this pro ject [Refe rence: New Service R equest (NS R) #200810 10] is to assist the VAMCs in obtaining timely pre certificat ion from t hird party payers be fore care is rendere d by notif ying the a ppropriate staff as soon as VA -provided outpatient services requiring precertifi cation are authorize d in the V eterans He alth Infor mation Sys tems and T echnology Architectu re (VistA) Fee Packa ge for inp atient or outpatient care. Thi s would al so provide an opport unity for insurance identifica tion/verif ication pr ocesses (e ither inte rnally or externally /outsource d) to be c ompleted p rior to tr eatment. | |
258 | Scope | |
259 | The Billin g Precerti fication f or Fee Car e Business Requireme nts Docume nt (BRD) i s availabl e via Tech nical Serv ices Proje ct Reposit ory (TSPR) here: htt p:// DNS /warboard/ anotebk.as p?proj=178 4&Type=Act ive | |
260 | The enhanc ements imp lemented b y this pro ject are c onsistent with the f ollowing l egislation which req uires and authorizes Veterans Health Adm inistratio n (VHA) to seek reim bursement from third party hea lth insure rs for med ical care provided b y VA to in sured Vete rans: | |
261 | Title 38 U nited Stat es Code (U SC) Sectio n (§) 1729 Recovery by the Uni ted States of the co st of cert ain care a nd service s | |
262 | Title 38 U SC § 1729A VAMC Coll ections Fu nd | |
263 | Title 38 U SC § 1729B Health Se rvices Imp rovement F und | |
264 | Public Law 99-272 Co nsolidated Omnibus B udget Reco nciliation Act of 19 85 | |
265 | VHA Handbo ok 1601C.0 2 Utilizat ion Review (UR) outl ines the r esponsibil ities for Revenue Ut ilization Review (RU R) staff, which incl udes these prospecti ve reviews . | |
266 | Incorporat ing these enhancemen ts would a fford RUR Nurses the opportuni ty to comp lete prece rtificatio n reviews prior to t reatment a nd would a lso give B illers the informati on needed via the mo dified Pot ential Cos t Recovery Report (P CRR) to bi ll third p arty carri ers for FB -related t reatment. The VistA Fee Basis (FB) and I ntegrated Billing (I B) softwar e packages would be affected b y this req uest. | |
267 | User Profi les | |
268 | User profi les are el aborated i n Table 1: | |
269 | Table 1: P rimary and Secondary Users | |
270 | Name | |
271 | Descriptio n | |
272 | Responsibi lities | |
273 | Primary Us ers | |
274 | RUR Nurses | |
275 | ||
276 | Responsibl e for pros pective re views whic h include precertifi cation, al so called preadmissi on or prec ertificati on, for in patient an d/or outpa tient serv ices | |
277 | Primary Us ers | |
278 | Insurance Verificati on Clerks | |
279 | Responsibl e for veri fying the status of Veterans’ third part y health i nsurance | |
280 | Primary Us ers | |
281 | Billers | |
282 | Responsibl e for subm itting cla ims on beh alf of VHA to third party carr iers for r eimburseme nt for non service-co nnected tr eatment | |
283 | Secondary Users | |
284 | Accounts R eceivable Technician s | |
285 | Responsibl e for thir d party cl aim follow up and pa yment anal ysis to Ve terans’ th ird party (reimbursa ble) accou nts | |
286 | Secondary Users | |
287 | Revenue Ma nagers (Fa cility/Vet erans Inte grated Ser vice Netwo rk [VISN]) | |
288 | Generate/a ssess faci lity/VISN/ Consolida ted Patien t Account Center (CP AC) level performanc e reports | |
289 | Secondary Users | |
290 | Revenue Op erations S taff | |
291 | Generate/a ssess ente rprise-lev el perform ance repor ts | |
292 | Background | |
293 | Overview o f the Syst em | |
294 | The FB Sof tware Pack age suppor ts VHA’s F ee for Ser vice Progr am by prov iding the ability to perform t he entire purchased care proce ss from en tering pat ient NVC a uthorizati ons and ve ndors to t ransmittin g complete d batch da ta to Aust in Informa tion Techn ology Cent er (AITC) for paymen t. Once th e payment process is complete, VHA is pe rmitted to bill the Veteran’s third part y health i nsurance p lan for th e non-serv ice connec ted servic es provide d through Non-VA car e. However , the same precertif ication ru les apply regardless of whethe r the care was provi ded by a V A facility or not. | |
295 | The Claims Tracking Module wit hin the Vi stA IB Sof tware Pack age is use d by RUR n urses with Medical C are Collec tions Fund (MCCF) to track epi sodes of c are, compl ete precer tification s, complet e continue d stay rev iews, and other RUR tasks. Cur rently, th ey are not notified when outpa tient serv ices requi ring prece rtificatio n are sche duled. The y are noti fied of au thorized i npatient/o utpatient FB care af ter paymen t has been submitted to the No n-VA facil ity via th e PCRR. Th e timing o f this inf ormation n ot only de feats the concept of precertif ication, b ut also do es not pro vide enoug h informat ion to all ow the Bil ling Staff to submit timely th ird party bills with out comple ting addit ional rese arch. As a result, t he VA is m issing rev enue oppor tunities b ecause the precertif ication pr ocess was omitted an d wasting man-hours researchin g informat ion that s hould be r eadily ava ilable. | |
296 | Overview o f the Busi ness Proce ss | |
297 | The busine ss process es enabled with thes e enhancem ents inclu de CPAC RU R NVC Auth orizations and NVC P ayment Not ifications : | |
298 | Notify app ropriate m embers of the Revenu e Staff (I nsurance V erificatio n Clerks, RUR Nurses ) when an NVC author ization fo r an outpa tient serv ice requir ing precer tification is create d in the V istA FB Pa ckage for inpatient or outpati ent care; this would allow the m to ident ify and ve rify insur ance (inte rnally or using exte rnal/outso urced capa bilities) and comple te the pre certificat ion proces s before t reatment i s rendered . | |
299 | Expedite c ommunicati ons and in formation sharing be tween the Fee and Re venue Prog rams. | |
300 | A high-lev el view of the curre nt (as-is) and futur e (to-be) third-part y billing precertifi cation pro cesses/wor kflows are available via TSPR here: http :// DNS /warboard/ anotebk.as p?proj=178 4&Type=Act ive | |
301 | Overview o f the Sign ificant Re quirements | |
302 | The Billin g Precerti fication f or Fee Car e Business Requireme nts Docume nt (BRD), Requiremen ts Specifi cation Doc ument (RSD ), and Req uirements Traceabili ty Matrix (RTM) are available via TSPR h ere: | |
303 | http:// DNS /warboard/ anotebk.as p?proj=178 4&Type=Act ive | |
304 | Until docu ments are approved a nd posted to TSPR, t hey will b e made ava ilable upo n request from the p roject tea m. | |
305 | Overview o f Function al Require ments | |
306 | Modificati ons to Vis tA FB appl ication to create no tification mechanism and updat e the exis ting PCRR to display appropria te data el ements nee ded to sub mit timely third par ty FB care related b ills. | |
307 | Table 2: F unctional Requiremen ts | |
308 | Business N eed (BN) N umber | |
309 | Feature Nu mber | |
310 | Functional Capabilit ies / Feat ure Descri ption | |
311 | Ranking | |
312 | R=Required | |
313 | O=Optional | |
314 | BN 1: | |
315 | Appropriat e staff wo uld be not ified of a uthorized FB care up on entry i nto the Vi stA FB Pac kage. | |
316 | F 1.1 | |
317 | Create a m echanism t hat would notify RUR Nurses an d Insuranc e Verifica tion Clerk s when an NVC author ization is created i n the Vist A FB packa ge for Vet erans with active, b illable in surance. | |
318 | R | |
319 | BN 1: | |
320 | Appropriat e staff wo uld be not ified of a uthorized FB care up on entry i nto the Vi stA FB Pac kage. | |
321 | F 1.1.1 | |
322 | With the a bility to generate a report of the same, as needed . | |
323 | R | |
324 | BN 1: | |
325 | Appropriat e staff wo uld be not ified of a uthorized FB care up on entry i nto the Vi stA FB Pac kage. | |
326 | F 1.1.1.1 | |
327 | Data eleme nts commun icated wil l include: | |
328 | Name of or dering phy sician | |
329 | Diagnosis/ Procedure (including Internati onal Class ification of Disease s – 10th E dition – C linical Mo dification (ICD-1010 -CM)/Curre nt Procedu ral Termin ology (CPT ) codes if provided) for servi ces author ized, othe rwise free text entr y of diagn osis/proce dure (i.e. reason fo r referral ) | |
330 | Scheduled date of se rvice | |
331 | Name of No n-VA locat ion | |
332 | Insurance informatio n on file | |
333 | Last date insurance verified | |
334 | Type of se rvice (inp atient/out patient) | |
335 | Existing s ervice con nected con ditions (i f applicab le) | |
336 | Outpatient Copayment Status | |
337 | Medication Copayment Exemption Status | |
338 | R | |
339 | BN 2: | |
340 | Modify the existing PCRR to in clude the data eleme nts needed to submit timely th ird party FB care re lated bill s. | |
341 | F 2.1 | |
342 | Ability to generate the existi ng PCRR wi th additio nal data e lements ne eded to su bmit a thi rd party b ill. | |
343 | R | |
344 | BN 2: | |
345 | Modify the existing PCRR to in clude the data eleme nts needed to submit timely th ird party FB care re lated bill s. | |
346 | F 2.1.1 | |
347 | Data eleme nts commun icated wil l include: | |
348 | Station/Fa cility/Div ision Numb er | |
349 | Type of se rvice (inp atient/out patient/pr escription ) | |
350 | Name of re ndering ph ysician | |
351 | Name of or dering phy sician | |
352 | Diagnosis/ Procedure (including ICD-10-CM /CPT codes if provid ed) for se rvices aut horized | |
353 | Scheduled date of se rvice | |
354 | Name of No n-VA locat ion | |
355 | Insurance informatio n on file | |
356 | Last date insurance verified | |
357 | Existing s ervice con nected con ditions (i f applicab le) | |
358 | Outpatient Copayment Status | |
359 | Medication Copayment Exemption Status | |
360 | Indicator signifying whether o r not the FB care re lated epis ode of car e has been previousl y billed t o a third party carr ier | |
361 | If it has been bille d previous ly, indica te date bi lled and t he associa ted bill n umber(s) | |
362 | Display th e NVC auth orization number or precertifi cation num ber RUR re ceived fro m the insu rance carr ier | |
363 | R | |
364 | BN 2: | |
365 | Modify the existing PCRR to in clude the data eleme nts needed to submit timely th ird party FB care re lated bill s. | |
366 | F 2.1.2 | |
367 | Ability to different iate and s ort the da ta on this report by 5 digit s tation num ber. | |
368 | R | |
369 | BN 2: | |
370 | Modify the existing PCRR to in clude the data eleme nts needed to submit timely th ird party FB care re lated bill s. | |
371 | F 2.2 | |
372 | The episod es of care displayed on this m odified re port would be based on the fol lowing cri teria: | |
373 | R | |
374 | BN 2: | |
375 | Modify the existing PCRR to in clude the data eleme nts needed to submit timely th ird party FB care re lated bill s. | |
376 | F 2.2.1 | |
377 | Veteran ha s active, billable i nsurance ( similar to the curre nt Re-Gene rate Unbil led Amount s Report [ IBT RE-GEN UNBILLED REPORT]), include on ly Fee Bas is care re lated epis odes of ca re that ha ve not bee n billed t o a third party carr ier previo usly | |
378 | Insurance effective date | |
379 | Insurance expiration date | |
380 | Treatment date falls within ef fective/ex piration d ates | |
381 | Display th e authoriz ation numb er or prec ertificati on number UR receive d from the insurance carrier | |
382 | R | |
383 | BN 2: | |
384 | Modify the existing PCRR to in clude the data eleme nts needed to submit timely th ird party FB care re lated bill s. | |
385 | F 2.3 | |
386 | While the solution w ill be dev eloped wit hin the Vi stA IB sof tware, the necessary informati on from th e VistA Su rgery Pack age will n eed to be pulled ont o the repo rt | |
387 | O | |
388 | BN 3: | |
389 | Appropriat e staff wo uld be not ified of f uture VA p rovided ou tpatient a ppointment s that mee t certain criteria. | |
390 | F 3.1 | |
391 | Create a m echanism t hat would notify RUR Nurses wh en a futur e appointm ent that m eets the f ollowing c riteria is scheduled : | |
392 | O | |
393 | BN 3: | |
394 | Appropriat e staff wo uld be not ified of f uture VA p rovided ou tpatient a ppointment s that mee t certain criteria. | |
395 | F 3.1.1 | |
396 | Veteran wi th active, billable insurance | |
397 | O | |
398 | BN 3: | |
399 | Appropriat e staff wo uld be not ified of f uture VA p rovided ou tpatient a ppointment s that mee t certain criteria. | |
400 | F 3.1.2 | |
401 | Provide fu nctionalit y/option t hat gives certain us ers the ab ility to a dd or dele te specifi c clinic n ames neede d for the precertifi cation pro cess at th e local le vel for op timal use ([Note: Si milar func tionality has previo usly been written fo r CPAC use and codin g can be p rovided to the Offic e of Infor mation & T echnology (OI&T) whe n needed]) | |
402 | O | |
403 | BN 3: | |
404 | Appropriat e staff wo uld be not ified of f uture VA p rovided ou tpatient a ppointment s that mee t certain criteria. | |
405 | F 3.2 | |
406 | Ability to generate an on dema nd report listing qu alifying p atients/ap pointments . | |
407 | O | |
408 | Overview o f Function al Workloa d/Performa nce Requir ements | |
409 | Not applic able – the re are no functional workload/ performanc e requirem ents assoc iated with this proj ect. | |
410 | Overview o f Operatio nal Requir ements | |
411 | Not applic able – the re are no operationa l requirem ents assoc iated with this proj ect. | |
412 | Overview o f Technica l Requirem ents | |
413 | Not applic able – the re are no technical requiremen ts that dr ive the co nceptual d esign. | |
414 | Overview o f Security or Privac y Requirem ents | |
415 | All VA and VHA secur ity or pri vacy requi rements wi ll be adhe red to. Cr oss-cuttin g security requireme nts are co ntained in the VA En terprise R equirement s Reposito ry (ERR). Efforts th at involve the colle ction and maintenanc e of indiv idually id entifiable informati on must be covered b y a Privac y Act syst em of reco rds notice . | |
416 | Overview o f System C riticality and High Availabili ty Require ments | |
417 | The VistA FB and IB systems ar e composed of multip le VistA a pplication s. Each of these app lications has its ow n availabi lity and d owntime re quirements which wil l be VAMC dependent. The FB an d IB patch es do not impose any requireme nt beyond the requir ement alre ady specif ied by eac h of the a pplication s. Any rel ated claim that cann ot be subm itted due to communi cation or other issu es will be queued an d submitte d when the systems a re availab le. | |
418 | Single Sig n-on Requi rements | |
419 | Not applic able – the re are no changes to the exist ing single sign-on r equirement s. | |
420 | Requiremen t for Use of Enterpr ise Portal s | |
421 | Not applic able – no enterprise portals a re used by the VistA FB and IB modules. | |
422 | Special De vice Requi rements | |
423 | Not applic able – no special de vices are required. | |
424 | Conceptual Design | |
425 | This proje ct is comp osed of Vi stA FB and IB patche s and ther e are no c onceptual design con sideration s. The act ual softwa re detaile d design i s presente d in Secti on 6.2.2 S pecific Re quirements . | |
426 | Conceptual Applicati on Design | |
427 | Applicatio n Context | |
428 | These enha ncements d o not requ ire any ch anges to t he applica tion conte xt. | |
429 | Figure 1 p rovides th e applicat ion contex t. | |
430 | Figure 1: Applicatio n Context Diagram | |
431 | ||
432 | High-Level Applicati on Design | |
433 | This proje ct does no t require any change s to the h igh-level conceptual applicati on design. | |
434 | For inform ational pu rposes and applicati on context , Figure 2 and Figur e 3 displa y the Elec tronic Dat a Intercha nge (EDI) X12 messag ing infras tructure f or Veteran s and bene ficiaries. | |
435 | Figure 2: Overview o f EDI X12 Messaging | |
436 | ||
437 | Figure 3: Overview o f Claims P rocessing and Eligib ility (CP& E) System and Interf aces | |
438 | ||
439 | Applicatio n Location s | |
440 | VistA is d eployed un iversally across VHA at more t han 1,500 sites of c are, inclu ding each VAMC, Comm unity Base d Outpatie nt Clinic (CBOC) and Community Living Ce nter (CLC) , as well as at near ly 300 VA Vet Center s. The Fee Basis and Integrate d Billing applicatio n modules are locate d within t he nationa lly releas ed VistA a pplication . This wil l not chan ge as a re sult of th is project . | |
441 | Conceptual Data Desi gn | |
442 | Project Co nceptual D ata Model | |
443 | Figure 4 p rovides th e conceptu al data mo del for th is project . The PCRR is an exi sting repo rt, but it will be e nhanced to better se rve the NV C users. T he Fee Bas is Billing Worklist is a new t ool that w ill allow the NVC us ers to tra ck NVC aut horization s in the I nsurance V erificatio n and RUR department s. | |
444 | Figure 4: Data Model | |
445 | ||
446 | (Note: “F ee Basis A uthorizati on File” i n Figure 4 refers to the “Fee Basis Pati ent Author ization Su b-File (#1 61.01), wh ich will i nteract wi th the new IB FB Int erface Tra cking File (#360).) | |
447 | For a more detailed visual of the VistA data model , refer to the Entit y Relation ship Diagr am (ERD) a vailable v ia TSPR he re: http:/ /t DNS /warboard/ anotebk.as p?proj=178 4&Type=Act ive | |
448 | Until the ERD is app roved and posted to TSPR, it w ill be mad e availabl e upon req uest from the projec t team. | |
449 | Database I nformation | |
450 | The databa se being u tilized fo r this pro ject is Vi stA. Withi n the Vist A database , two soft ware modul es will be utilized – Fee Basi s and Inte grated Bil ling. | |
451 | Table 3 : Database I nformation | |
452 | Database N ame | |
453 | Descriptio n | |
454 | Type | |
455 | Steward | |
456 | VistA | |
457 | Veterans H ealth Info rmation Sy stems and Technology Architect ure | |
458 | I | |
459 | VA | |
460 | The VistA Fee Basis module, an d associat ed Massach usetts Gen eral Hospi tal Utilit y Multi-Pr ogramming System (Mu mps) datab ase, provi des for mo re efficie nt and acc urate oper ation of t he fee for service p rogram wit h reductio n of paper work, savi ngs in sta ff hours, minimizati on of erro rs, and by allowing medical fa cilities t o have gre ater contr ol over di sbursement of fee me dical, pha rmacy, and travel mo nies. | |
461 | The VistA Integrated Billing m odule, and associate d Mumps da tabase, al lows for t he capture , maintena nce, and s torage of insurance data inclu ding polic y informat ion and re lated bene fits. It p rovides th e ability to electro nically tr ansmit bil ls to paye rs with th e data req uired by H IPAA. It a lso provid es the abi lity to re ceive and store elec tronic 835 Health Ca re Claim P ayment/Adv ice. It in cludes the ability t o create p rinted bil ls which c an then be mailed to payers wh o are unab le to acce pt an elec tronic cla im. A Clai ms Trackin g feature is availab le to assi st utiliza tion revie w staff in tracking episodes o f care, co mpleting p re-certifi cations, c ompleting continued stay revie ws, and pr ocessing a ppeals and denials. An Automat ed Biller module pro vides a pr ocess that automatic ally creat es bills f or billabl e events w hich can t hen be fin ished and authorized by the bi lling staf f. The IB software a lso provid es many re porting fe atures tha t support the billin g staff by providing statistic s, trackin g and hist orical inf ormation. | |
462 | User Inter face Data Mapping | |
463 | VistA Fee Basis rece ives data from the F ee Basis C laims Syst em (FBCS), a Graphic al User In terface (G UI) system that send s authoriz ation and claim data to the Vi stA Fee Ba sis system . These fi elds are m apped in V istA, via Remote Pro cedure Cal ls (RPCs). There wil l be no ch anges to V istA Fee B asis inter face mappi ng for thi s project. | |
464 | The VistA IB package electroni cally tran smit bills to payers with the data requi red by HIP AA. It als o provides the abili ty to rece ive and st ore electr onic 835 H ealth Care Claim Pay ment/Advic e. There w ill be no changes to VistA IB interface mapping fo r this pro ject. | |
465 | Conceptual Infrastru cture Desi gn | |
466 | System Cri ticality a nd High Av ailability | |
467 | No changes are expec ted to sys tem critic ality and high avail ability as a result of this pr oject. Rel iability a nd availab ility requ irements f or VistA a re managed by region al data ce nters. | |
468 | Special Te chnology | |
469 | VistA has historical ly been bu ilt on a c lient-serv er archite cture, whi ch ties to gether wor kstations and person al compute rs with us er interfa ces at VA facilities . No speci al technol ogies will be modifi ed as a re sult of th is project . | |
470 | Technology Locations | |
471 | All softwa re changes for this project wi ll be comp leted with in nationa lly releas ed VistA s oftware co de. Mumps routines ( programs) will be mo dified and added to the Fee Ba sis and In tegrated B illing sof tware. | |
472 | Conceptual Infrastru cture Diag ram | |
473 | Location o f Environm ents and E xternal In terfaces | |
474 | Please see Figure 2 and Figure 3. Modifi cations fo r this pro ject will be complet ed within the bounds of the Vi stA system , only. | |
475 | Conceptual Productio n String D iagram | |
476 | No concept ual produc tion strin g diagram exists for the VistA Fee Basis and Integ rated Bill ing module s. The sta ndard Vist A configur ation will be utiliz ed. | |
477 | System Arc hitecture | |
478 | This proje ct is comp osed of Vi stA patche s which do not requi re any cha nges to th e VistA ar chitecture or hardwa re archite cture. How ever, brie f descript ions of th ese entiti es are pro vided belo w. | |
479 | Hardware A rchitectur e | |
480 | The FB and IB applic ations are part of t he VistA s uite of ap plications . The Vist A Monograp h states: | |
481 | “VistA is deployed u niversally across VH A at more than 1,500 sites of care, incl uding each VAMC, Com munity Bas ed Outpati ent Clinic (CBOC) an d Communit y Living C enter (CLC ), as well as at nea rly 300 VA Vet Cente rs. These locations will have a variety of hardwar e platform s but all meet a min imal stand ard requir ed to supp ort VistA. ” | |
482 | Software A rchitectur e | |
483 | The FB and IB system s are comp osed of mu ltiple Vis tA applica tions. The y also int eract with many othe r VistA st andard mod ules, such as Mailma n, Kernel, Health Le vel 7 (HL7 ), and Fil eMan. The entire Vis tA applica tion consi sts of 200 + modules. The VistA monograph includes this descr iption for VistA: | |
484 | “VistA is an integra ted Electr onic Healt h Record ( EHR) infor mation tec hnology sy stem with applicatio n packages that shar e a common data stor e and comm on interna l services . The data store and VistA ker nel are im plemented in the Mas sachusetts General H ospital Ut ility Mult i-Programm ing System (MUMPS) c omputer la nguage, an d the Comp uterized P atient Rec ord System (CPRS) Gr aphical Us er Interfa ce (GUI) i s implemen ted in Del phi. Appli cation cli ents use a highly-ef ficient pr oprietary protocol t o access d ata. VistA is highly configura ble and cu stomizable , and in a ddition to appropria te connect ivity amon gst VistA modules, V istA suppo rts the in tegration of best-of -breed app lications at multipl e levels, including MUMPS Appl ication Pr ogramming Interface (API), Rem ote Proced ure Call ( RPC), Medi cal Domain Web Servi ces (MDWS) , HL7, and data exch ange via B lue Button or eHealt h Exchange s. VistA c omprises n early 200 distinct a pplication s/modules, 15,000 ro utines, an d millions of lines of compute r code. | |
485 | The backbo ne of VHA’ s clinical and admin istrative informatio n technolo gy capabil ity, VistA has histo rically be en built o n a client -server ar chitecture , which ti es togethe r workstat ions and p ersonal co mputers wi th GUIs at VA facili ties. The CPRS GUI i s as highl y customiz able and r uns on wor kstations, laptops, tablets (i ncluding i Pads) and smart phon es. VistA interopera tes with n umerous co mmercial-o ff-the she lf softwar e applicat ions and w ith select ed informa tion techn ology syst ems of oth er federal agencies and, incre asingly, h ealth info rmation ex change net works. At the time o f publicat ion of thi s edition of the Mon ograph, co mprehensiv e proposed enhanceme nts to Vis tA were in the initi al stages; referred to as “Vis tA Evoluti on” these enhancemen ts are wil l reflect developmen t and arch itecture e nhancement s to allow greater i nteraction with data and great er efficie ncy for th e VistA sy stem.” | |
486 | Note that the change s required by this p roject are based in the MUMPS computer l anguage an d do not i mpact CPRS . | |
487 | Network Ar chitecture | |
488 | Figure 5: Network Ar chitecture | |
489 | ||
490 | Figure 5, above, dia grams netw ork archit ecture for the claim s processi ng and bil ling syste ms. Networ k architec ture is no t impacted or modifi ed by this project. | |
491 | ** Please note: | |
492 | Per Elizab eth Congdo n (Manager , Health S ystems Pla tform, Ent erprise Sy stems Engi neering, V A OI&T Ser vice Deliv ery and En gineering) “VistA is using SFT P and has for quite a while”. | |
493 | SOA/ESS | |
494 | Not applic able – the se applica tions do n ot use Ser vice Orien ted Archit ecture (SO A)/Enterpr ise Shared Services (ESS). | |
495 | Enterprise Architect ure | |
496 | Figure 6: Enterprise Architect ure | |
497 | ||
498 | Figure 6 i llustrates the curre nt Enterpr ise Archit ecture. No modificat ions will be made to the exist ing system ’s (VistA’ s) archite cture. | |
499 | Data Desig n | |
500 | Database M anagement System (DB MS) Files | |
501 | This is a VistA FEE BASIS patc h. The DBM S in use i s VA FileM an. | |
502 | The VistA FEE BASIS package us es the sta ndard VA F ileMan dat a dictiona ries (DDs) and files . This tab le identif ies the VA FileMan d atabases w hich are b eing modif ied by thi s VistA FE E BASIS pr oject. | |
503 | Table 4: F ileMan Dat abases | |
504 | Database | |
505 | File Numbe r | |
506 | FEE BASIS PATIENT FI LE - AUTHO RIZATION S UB-FILE (N ew Trigger ) | |
507 | 161.01 | |
508 | FEE BASIS CONTRACT F ILE (New F ield – CHO ICE Indica tor) | |
509 | 161.43 | |
510 | IB-FB INTE RFACE TRAC KING FILE (New File) | |
511 | 360 | |
512 | FEE BASIS PATIENT FI LE – AUTHO RIZATION S UB-FILE (# 161.01) – New Trigge r | |
513 | A new trig ger / cros s-referenc e (Field: FROM DATE, 161.01,.0 1) has bee n added so that each time a ne w or modif ied NVC au thorizatio n is set i n VistA, a new recor d will log to the IB -FB INTERF ACE TRACKI NG FILE (# 360). | |
514 | Note: Trig ger code ( EVENT^IBFB UTIL) is d etailed in the SDD f or NSR #20 110303 (Fe e Revenue Enhancemen ts). | |
515 | STANDARD D ATA DICTIO NARY #161. 01 -- AUTH ORIZATION SUB-FILE | |
516 | ||
517 | STORED IN ^FBAAA(D0, 1, | |
518 | ||
519 | DATA NAME GLOBAL DAT A | |
520 | ELEMENT TI TLE LOCATI ON TYPE | |
521 | ---------- ---------- ---------- ---------- ---------- ---------- ---------- --------- | |
522 | ||
523 | 161.01,.01 FROM DATE 0;1 DATE | |
524 | ||
525 | INPUT TRA NSFORM: S %DT="EX" D ^%DT S X= Y K:Y<1 X | |
526 | LAST EDIT ED: OCT 05 , 2015 | |
527 | DESCRIPTI ON: The be ginning da te for whi ch the pat ient is | |
528 | authorize d to obtai n services from priv ate | |
529 | vendors. For every claim made by a vend or for | |
530 | this pati ent, this date will be checked to | |
531 | insure th at the dat e the serv ice was pr ovided | |
532 | was on or after thi s date. | |
533 | ||
534 | DELETE TE ST: .01,0) = I $$DELA ^FBUCDD1(. DA,1) | |
535 | ||
536 | NOTES: XX XX--CAN'T BE ALTERED EXCEPT BY PROGRAMME R | |
537 | ||
538 | CROSS-REF ERENCE: 16 1^AIC1^MUM PS | |
539 | 1)= S:$P( ^FBAAA(DA( 1),1,DA,0) ,U,20)]"" ^FBAAA(" | |
540 | AIC",DA(1 ),-X,$P(^F BAAA(DA(1) ,1,DA,0),U ,20),DA) | |
541 | ="" | |
542 | 2)= K:$P( ^FBAAA(DA( 1),1,DA,0) ,U,20)]"" ^FBAAA(" | |
543 | AIC",DA(1 ),-X,$P(^F BAAA(DA(1) ,1,DA,0),U ,20),DA) | |
544 | Cross-ref erence use d to ident ify potent ial | |
545 | billables using inv erse date. Used to s et | |
546 | "AIC" cro ss-referen ce on fiel d .097, PO TENTIAL | |
547 | COST RECO VERY CASE. | |
548 | ||
549 | CROSS-REF ERENCE: 16 1^ATST | |
550 | 1)= S ^FB AAA("ATST" ,$E(X,1,30 ),DA(1),DA )="" | |
551 | ||
552 | 2)= K ^FB AAA("ATST" ,$E(X,1,30 ),DA(1),DA ) | |
553 | ||
554 | CROSS-REF ERENCE: 16 1.01^B | |
555 | 1)= S ^FB AAA(DA(1), 1,"B",$E(X ,1,30),DA) ="" | |
556 | 2)= K ^FB AAA(DA(1), 1,"B",$E(X ,1,30),DA) | |
557 | ||
558 | CROSS-REF ERENCE: 16 1^AENR01^M UMPS | |
559 | 1)= D:'$D (DIU(0)) E VENT^IVMPL OG(DA(1)) | |
560 | 2)= D:'$D (DIU(0)) E VENT^IVMPL OG(DA(1)) | |
561 | Notify HE C of chang es to FEE Authorizat ion. | |
562 | ||
563 | CROSS-REF ERENCE: 16 1^AC^MUMPS | |
564 | 1)= D:'$D (DIU(0)) E VENT^IBFBU TIL(DA(1)) | |
565 | 2)= D:'$D (DIU(0)) E VENT^IBFBU TIL(DA(1)) | |
566 | Add new e ntry into file 360 o n new Auth orization | |
567 | ||
568 | RECORD IN DEXES: AMR A (#1327), AUD (#120 4) | |
569 | FEE BASIS CONTRACT F ILE (#161. 43) – New Field – CH OICE Indic ator | |
570 | STANDARD D ATA DICTIO NARY #161. 43 -- FEE BASIS CONT RACT FILE | |
571 | STORED IN ^FBAA(161. 43, | |
572 | ||
573 | DATA NAME GLOBAL DAT A | |
574 | ELEMENT TI TLE LOCATI ON TYPE | |
575 | ---------- ---------- ---------- ---------- ---------- ---------- ---------- ------- | |
576 | ||
577 | 161.43,4 C HOICE INDI CATOR 0;3 SET | |
578 | ||
579 | CHOICE PR OGRAM INDI CATOR | |
580 | '0' FOR N O; | |
581 | '1' FOR Y ES; | |
582 | LAST EDIT ED: NOV 18 , 2015 | |
583 | HELP-PROM PT: Enter 'Yes' if t his Fee Ba sis Contra ct Number | |
584 | is indica tive of th e Veterans Choice Pr ogram. | |
585 | DESCRIPTI ON: This f ield is us ed to iden tify Fee B asis | |
586 | Contracts associate d with Non -VA Care V endors | |
587 | participa ting in th e Veterans Choice Pr ogram. | |
588 | TECHNICAL DESCR: A '1' in pie ce 3 of th e 0 node o n File #16 1.43 indic ates that this parti cular cont ract for | |
589 | Non-VA Ca re Vendor( s) is part of the Ve terans Cho ice Progra m. | |
590 | ||
591 | DATA NAME GLOBAL DAT A | |
592 | ELEMENT TI TLE LOCATI ON TYPE | |
593 | ---------- ---------- ---------- ---------- ---------- ---------- ---------- --------- | |
594 | ||
595 | 161.43,5 C HOICE PROV IDER AGREE MENT 0;4 S ET | |
596 | ||
597 | '0' FOR N O; | |
598 | '1' FOR Y ES; | |
599 | LAST EDIT ED: JAN 25 , 2016 | |
600 | HELP-PROM PT: Enter 'Yes' if t his Fee Ba sis Contra ct Number | |
601 | is indica tive of th e Veterans Choice Pr ogram - | |
602 | Choice Pr ovider Agr eement. | |
603 | DESCRIPTI ON: This f ield is us ed to iden tify Non-V A Care | |
604 | Vendors p articipati ng in the Veterans C hoice | |
605 | Program v ia a Choic e Provider Agreement . | |
606 | ||
607 | TECHNICAL DESCR: A '1' in pie ce 4 of th e 0 node o n File #16 1.43 | |
608 | IB-FB INTE RFACE TRAC KING FILE (#360) – N ew File | |
609 | STANDARD D ATA DICTIO NARY #360 -- IB-FB I NTERFACE T RACKING FI LE | |
610 | STORED IN ^IBFB(360, | |
611 | ||
612 | DATA NAME GLOBAL DAT A | |
613 | ELEMENT TI TLE LOCATI ON TYPE | |
614 | ---------- ---------- ---------- ---------- ---------- ---------- ---------- ------- | |
615 | DD ACCESS : | |
616 | RD ACCESS : | |
617 | WR ACCESS : | |
618 | DEL ACCES S: | |
619 | LAYGO ACC ESS: | |
620 | AUDIT ACC ESS: @ | |
621 | ||
622 | IDENTIFIED BY: PATIE NT (#.02), FB AUTHOR IZATION (# .03) | |
623 | NON-VA CA RE field ( #.33) of t he CLAIMS TRACKING F ile (#356) | |
624 | ||
625 | CROSS REFE RENCED BY: AUTH DELE TION DATE/ TIME (AC), CLAIM NUM BER(AD), E NTRY NUMBE R(B), PATI ENT(C) | |
626 | INDEXED BY : BI QUEUE (BI), REA DY TO BILL (BL), PAT IENT & FB AUTHORIZAT ION | |
627 | (D), INVO ICE NUMBER & FB PAYM ENT INDICA TOR (F), F R QUEUE (F R), | |
628 | IV QUEUE (IV), SC Q UEUE (SC), UR QUEUE (UR) | |
629 | ||
630 | 360,.01 EN TRY NUMBER 0;1 NUMBE R (Require d) | |
631 | INPUT TRA NSFORM: S: $D(X) DINU M=X | |
632 | LAST EDIT ED: DEC 15 , 2015 | |
633 | HELP-PROM PT: Enter an entry n umber. | |
634 | DESCRIPTI ON: This i s the inte rnal entry number to identify | |
635 | the link between cl aims/bills and Fee B asis | |
636 | payments and author izations. | |
637 | TECHNICAL DESCR: Ma nual cross reference s: | |
638 | ; ^IBFB(3 60,"DFN",D FN,DT,IEN, IBLOG)="" Log | |
639 | cross ref erence by Patient | |
640 | ; ^IBFB(3 60,"DT",DT ,DFN,IEN,I BLOG)="" L og | |
641 | cross ref erence by Date | |
642 | NOTES: XX XX--CAN'T BE ALTERED EXCEPT BY PROGRAMME R | |
643 | CROSS-REF ERENCE: 36 0^B | |
644 | 1)= S ^IB FB(360,"B" ,$E(X,1,30 ),DA)="" | |
645 | 2)= K ^IB FB(360,"B" ,$E(X,1,30 ),DA) | |
646 | ||
647 | 360,.02 PA TIENT 0;2 POINTER TO PATIENT F ILE (#2) | |
648 | LAST EDIT ED: DEC 03 , 2015 | |
649 | HELP-PROM PT: Enter a Patient name. | |
650 | DESCRIPTI ON: Patien t name to link autho rizations, payments | |
651 | and claim s/bills. | |
652 | CROSS-REF ERENCE: 36 0^C | |
653 | 1)= S ^IB FB(360,"C" ,$E(X,1,30 ),DA)="" | |
654 | 2)= K ^IB FB(360,"C" ,$E(X,1,30 ),DA) | |
655 | RECORD IN DEXES: D ( #1334) | |
656 | ||
657 | 360,.03 FB AUTHORIZA TION 0;3 N UMBER | |
658 | INPUT TRA NSFORM: K: +X'=X!(X>9 9999999)!( X<1)!(X?.E 1"."1.N) X | |
659 | LAST EDIT ED: DEC 03 , 2015 | |
660 | HELP-PROM PT: Enter a Patient Authorizat ion number . | |
661 | DESCRIPTI ON: Enter an Authori zation IEN to link | |
662 | authoriza tions, pay ments and claims/bil ls. | |
663 | TECHNICAL DESCR: Th is is the Authorizat ion number not a poi nter. | |
664 | It refere nces file 161.01 | |
665 | RECORD IN DEXES: D ( #1334) | |
666 | ||
667 | 360,.04 AU TH DELETIO N DATE/TIM E 0;4 DATE | |
668 | INPUT TRA NSFORM: S %DT="ET" D ^%DT S X= Y K:X<1 X | |
669 | LAST EDIT ED: DEC 03 , 2015 | |
670 | HELP-PROM PT: Enter the date/t ime the Au thorizatio n was | |
671 | deleted. | |
672 | DESCRIPTI ON: This i s the date that an A uthorizati on was | |
673 | deleted c ompletely. Used for tracking p urposes. | |
674 | TECHNICAL DESCR: We 're tracki ng in an A uthorizati on was del eted | |
675 | and there were poin ters to cl aims or bi lls | |
676 | present. | |
677 | CROSS-REF ERENCE: 36 0^AC | |
678 | 1)= S ^IB FB(360,"AC ",$E(X,1,3 0),DA)="" | |
679 | 2)= K ^IB FB(360,"AC ",$E(X,1,3 0),DA) | |
680 | Payment I D cross re ference us ed for lin king FB | |
681 | to IB. | |
682 | ||
683 | 360,.05 FB PAYMENT I NDICATOR 0 ;5 FREE TE XT | |
684 | INPUT TRA NSFORM: K: $L(X)>25!( $L(X)<1) X | |
685 | LAST EDIT ED: DEC 04 , 2015 | |
686 | HELP-PROM PT: Enter a payment indicator | |
687 | DESCRIPTI ON: Fee Ba sis Paymen t indicato r, formatt ed as | |
688 | following : Patient IEN;Vendor IEN;Initi al | |
689 | treatment date IEN; Service pr ovided IEN | |
690 | Example: " 100000;4 55;2;4" | |
691 | TECHNICAL DESCR: Th is represn ts a compl ex pointer to the FB | |
692 | payment f ile (#162) . Where th e ID could be | |
693 | saved as (for examp le) "165;2 22;1;10". Patient | |
694 | pointer i s 165, ven dor pointe r is 222, Service | |
695 | date is 1 , service provided i s 10. Actu al | |
696 | pointer w ould be: ^ FBAAC(165, 1,222,1,1, 1,10). | |
697 | RECORD IN DEXES: F ( #1335) | |
698 | ||
699 | 360,1.01 C LAIM NUMBE R 1;1 POIN TER TO CLA IMS TRACKI NG FILE (# 356) | |
700 | LAST EDIT ED: DEC 16 , 2015 | |
701 | HELP-PROM PT: Enter a claim ID . | |
702 | DESCRIPTI ON: Enter a Claim ID to assist in linkin g fee basi s | |
703 | authoriza tions and payments t o claims i n file | |
704 | #356. | |
705 | TECHNICAL DESCR: We need a cl aim ID to assist in linking fe e | |
706 | basis aut horization s and thir d party cl aims to | |
707 | payments. Without t his field we lose th e | |
708 | ability t o link 3rd party cla ims to fee basis. | |
709 | CROSS-REF ERENCE: 36 0^AD | |
710 | 1)= S ^IB FB(360,"AD ",$E(X,1,3 0),DA)="" | |
711 | 2)= K ^IB FB(360,"AD ",$E(X,1,3 0),DA) | |
712 | ||
713 | 360,1.02 B ILL/CLAIMS 1;2 POINT ER TO BILL /CLAIMS FI LE (#399) | |
714 | LAST EDIT ED: DEC 03 , 2015 | |
715 | HELP-PROM PT: Enter an existin g Bill for the Patie nt. | |
716 | DESCRIPTI ON: We use this to l ink an exi sting entr y in file | |
717 | #399 to a n existing fee basis authoriza tion and | |
718 | payment. | |
719 | ||
720 | 360,1.03 I NVOICE NUM BER 1;3 PO INTER TO F EE BASIS I NVOICE FIL E (#162.5) | |
721 | LAST EDIT ED: DEC 03 , 2015 | |
722 | HELP-PROM PT: Enter a fee basi s invoice number. | |
723 | DESCRIPTI ON: We nee d to be ab le to link a fee bas is invoice | |
724 | to a clai m/bill and to an exi sting | |
725 | authoriza tion and p ayment. | |
726 | TECHNICAL DESCR: We need a In voice ID t o assist i n linking fee | |
727 | basis aut horization s and clai ms/bills t o | |
728 | payments. | |
729 | RECORD IN DEXES: F ( #1335) | |
730 | ||
731 | 360,1.04 I NTEGRATED BILLING AC TION 1;4 P OINTER TO INTEGRATED BILLING A CTION FILE (#350) | |
732 | LAST EDIT ED: DEC 03 , 2015 | |
733 | HELP-PROM PT: Enter a copaymen t associat ed with th e FB auth | |
734 | DESCRIPTI ON: Enter a first pa rty copay IEN to lin k to a FB | |
735 | Auth and payment. | |
736 | TECHNICAL DESCR: We need a Bi ll ID to a ssist in l inking fee | |
737 | basis aut horization s and firs t party cl aims to | |
738 | payments. Without t his field we lose th e | |
739 | ability t o link 1st party cla ims to fee basis | |
740 | Authoriza tions and payments. | |
741 | ||
742 | 360,2.01 I V QUEUE 2; 1 SET | |
743 | Insurance Verificat ion Precer t Queue | |
744 | 'IV' FOR IV QUEUE; | |
745 | 'XX' FOR REMOVED; | |
746 | LAST EDIT ED: DEC 15 , 2015 | |
747 | HELP-PROM PT: IV Pre cert Queue | |
748 | DESCRIPTI ON: This i s the Insu rance Veri fication | |
749 | Precertif ication Qu eue | |
750 | FIELD IND EX: IV (#1 337) REGUL AR IR LOOK UP & SORTI NG | |
751 | Short Des cr: IV QUE UE | |
752 | Set Logic : S ^IBFB( 360,"IV",$ E(X,1,240) ,DA)="" | |
753 | Kill Logi c: K ^IBFB (360,"IV", $E(X,1,240 ),DA) | |
754 | Whole Kil l: K ^IBFB (360,"IV") | |
755 | X(1): IV QUEUE (360 ,2.01) (Su bscr 1) (L en 240) | |
756 | (forwards ) | |
757 | ||
758 | 360,2.02 U R QUEUE 2; 2 SET | |
759 | RUR Prece rt Queue | |
760 | 'UR' FOR UR QUEUE; | |
761 | 'XX' FOR REMOVED; | |
762 | LAST EDIT ED: DEC 15 , 2015 | |
763 | HELP-PROM PT: UR Pre cert Queue | |
764 | DESCRIPTI ON: This i s the RUR Precertifi cation Que ue | |
765 | FIELD IND EX: UR (#1 339) REGUL AR IR LOOK UP & SORTI NG | |
766 | Short Des cr: UR QUE UE | |
767 | Set Logic : S ^IBFB( 360,"UR",$ E(X,1,240) ,DA)="" | |
768 | Kill Logi c: K ^IBFB (360,"UR", $E(X,1,240 ),DA) | |
769 | Whole Kil l: K ^IBFB (360,"UR") | |
770 | X(1): UR QUEUE (360 ,2.02) (Su bscr 1) (L en 240) | |
771 | (forwards ) | |
772 | ||
773 | 360,2.03 F R QUEUE 2; 3 SET | |
774 | Facility Revenue Bi lling Queu e | |
775 | 'FR' FOR FR QUEUE; | |
776 | 'XX' FOR REMOVED; | |
777 | LAST EDIT ED: DEC 15 , 2015 | |
778 | HELP-PROM PT: FR Bil ling Queue | |
779 | DESCRIPTI ON: This i s the Faci lity Reven ue Billing Queue | |
780 | FIELD IND EX: FR (#1 336) REGUL AR IR LOOK UP & SORTI NG | |
781 | Short Des cr: FR QUE UE | |
782 | Set Logic : S ^IBFB( 360,"FR",$ E(X,1,240) ,DA)="" | |
783 | Kill Logi c: K ^IBFB (360,"FR", $E(X,1,240 ),DA) | |
784 | Whole Kil l: K ^IBFB (360,"FR") | |
785 | X(1): FR QUEUE (360 ,2.03) (Su bscr 1) (L en 240) | |
786 | (forwards ) | |
787 | ||
788 | 360,2.04 S C QUEUE 2; 4 SET | |
789 | RUR Servi ce Connect ed Billing Queue | |
790 | 'SC' FOR SC QUEUE; | |
791 | 'XX' FOR REMOVED; | |
792 | LAST EDIT ED: DEC 15 , 2015 | |
793 | HELP-PROM PT: SC Bil ling Queue | |
794 | DESCRIPTI ON: This i s the RUR Service Co nnected Bi lling Queu e | |
795 | FIELD IND EX: SC (#1 338) REGUL AR IR LOOK UP & SORTI NG | |
796 | Short Des cr: SC QUE UE | |
797 | Set Logic : S ^IBFB( 360,"SC",$ E(X,1,240) ,DA)="" | |
798 | Kill Logi c: K ^IBFB (360,"SC", $E(X,1,240 ),DA) | |
799 | Whole Kil l: K ^IBFB (360,"SC") | |
800 | X(1): SC QUEUE (360 ,2.04) (Su bscr 1) (L en 240) | |
801 | (forwards ) | |
802 | ||
803 | 360,2.05 B I QUEUE 2; 5 SET | |
804 | Billing R eview Queu e | |
805 | 'BI' FOR BI QUEUE; | |
806 | 'XX' FOR REMOVED; | |
807 | LAST EDIT ED: DEC 15 , 2015 | |
808 | HELP-PROM PT: BI Bil ling Queue | |
809 | DESCRIPTI ON: This i s the Bill ing Review Queue | |
810 | FIELD IND EX: BI (#1 332) REGUL AR IR LOOK UP & SORTI NG | |
811 | Short Des cr: BI QUE UE | |
812 | Set Logic : S ^IBFB( 360,"BI",$ E(X,1,240) ,DA)="" | |
813 | Kill Logi c: K ^IBFB (360,"BI", $E(X,1,240 ),DA) | |
814 | Whole Kil l: K ^IBFB (360,"BI") | |
815 | X(1): BI QUEUE (360 ,2.05) (Su bscr 1) (L en 240) | |
816 | (forwards ) | |
817 | ||
818 | 360,3.01 N EXT REVIEW DT 3;1 DA TE | |
819 | Date of n ext RUR pr ecertifica tion revie w | |
820 | INPUT TRA NSFORM: S %DT="E" D ^%DT S X=Y K:X<1 X | |
821 | LAST EDIT ED: DEC 15 , 2015 | |
822 | HELP-PROM PT: (No ra nge limit on date) | |
823 | DESCRIPTI ON: This f ield holds the date of the nex t RUR | |
824 | precertif ication re view. If a date has been | |
825 | entered i n this fie ld, the au thorizatio n will | |
826 | not displ ay on the RUR precer tification work | |
827 | queue unt il the dat e specifie d. | |
828 | ||
829 | 360,3.02 1 ST OR 3RD PTY 3;2 NU MBER | |
830 | First Par ty Copay o r Third Pa rty Insura nce | |
831 | INPUT TRA NSFORM: K: +X'=X!(X>3 )!(X<1)!(X ?.E1"."1.N ) X | |
832 | LAST EDIT ED: DEC 15 , 2015 | |
833 | HELP-PROM PT: First party copa y or third party ins urance | |
834 | DESCRIPTI ON: This f ield indic ates if th e bill is for first | |
835 | party cop ay or thir d party in surance. | |
836 | TECHNICAL DESCR: Fi rst Party Copay = | |
837 | $P(^IBFB( 360,IEN,3) ,"^",2)=1 Third Part y | |
838 | Insurance = $P(^IBF B(360,IEN, 3),"^",2)= 3 | |
839 | ||
840 | 360,4 LOG 4;0 DATE M ultiple #3 60.04 | |
841 | (Add New Entry with out Asking ) | |
842 | ||
843 | 360.04,.01 DATE/TIME 0;1 DATE | |
844 | INPUT TRA NSFORM: S %DT="ESTR" D ^%DT S X=Y K:X<1 X | |
845 | LAST EDIT ED: NOV 05 , 2015 | |
846 | HELP-PROM PT: Enter the date/t ime of the change to the | |
847 | entries. | |
848 | DESCRIPTI ON: Used t o capture the change s to the e ntries in | |
849 | the file, by date a nd time of change. | |
850 | ||
851 | 360.04,.02 EVENT 0;2 FREE TEXT | |
852 | INPUT TRA NSFORM: K: $L(X)>45!( $L(X)<1) X | |
853 | LAST EDIT ED: NOV 05 , 2015 | |
854 | HELP-PROM PT: Enter the event that occur red that w e logged. | |
855 | DESCRIPTI ON: Used t o track wh at kind of event occ urred | |
856 | that we a re trackin g. | |
857 | ||
858 | 360.04,.03 USER 0;3 POINTER TO NEW PERSO N FILE (#2 00) | |
859 | LAST EDIT ED: NOV 05 , 2015 | |
860 | HELP-PROM PT: Enter the user t hat made t he change. | |
861 | ||
862 | FILES POI NTED TO FI ELDS | |
863 | BILL/CLAIM S (#399) B ILL/CLAIMS (#1.02) | |
864 | CLAIMS TRA CKING (#35 6) CLAIM N UMBER (#1. 01) | |
865 | FEE BASIS INVOICE (# 162.5) INV OICE NUMBE R (#1.03) | |
866 | INTEGRATED BILLING A CTION (#35 0) INTEGRA TED BILLIN G ACTION ( #1.04) | |
867 | NEW PERSON (#200) LO G:USER (#. 03) | |
868 | PATIENT (# 2) PATIENT (#.02) | |
869 | ||
870 | INDEX AND CROSS-REFE RENCE LIST -- FILE # 360 | |
871 | ||
872 | File #360 | |
873 | Record In dexes: | |
874 | D (#1334) RECORD RE GULAR IR L OOKUP & SO RTING | |
875 | Short Des cr: Lookup index | |
876 | Set Logic : S ^IBFB( 360,"D",X( 1),X(2),DA )="" | |
877 | Kill Logi c: K ^IBFB (360,"D",X (1),X(2),D A) | |
878 | Whole Kil l: K ^IBFB (360,"D") | |
879 | X(1): PAT IENT (360, .02) (Subs cr 1) (for wards) | |
880 | X(2): FB AUTHORIZAT ION (360,. 03) (Subsc r 2) (forw ards) | |
881 | ||
882 | F (#1335) RECORD RE GULAR IR L OOKUP & SO RTING | |
883 | Short Des cr: Cross reference by invoice and payme nt ID | |
884 | Set Logic : S ^IBFB( 360,"F",X( 1),$E(X(2) ,1,30),DA) ="" | |
885 | Kill Logi c: K ^IBFB (360,"F",X (1),$E(X(2 ),1,30),DA ) | |
886 | Whole Kil l: K ^IBFB (360,"F") | |
887 | X(1): INV OICE NUMBE R (360,1.0 3) (Subscr 1) (forwa rds) | |
888 | X(2): FB PAYMENT IN DICATOR (3 60,.05) (S ubscr 2) ( Len 30) | |
889 | (forwards ) | |
890 | INPUT TEMP LATE(S): | |
891 | PRINT TEMP LATE(S): | |
892 | SORT TEMPL ATE(S): | |
893 | FORM(S)/BL OCK(S): | |
894 | Non-DBMS F iles | |
895 | N/A. There are no no n-DBMS Fil es in use. | |
896 | Data View | |
897 | This proje ct is a Vi stA Fee Ba sis and In tegrated B illing pat ch. There is an ERD as one of the delive rables wit h this pro ject. | |
898 | http:// DNS /warboard/ anotebk.as p?proj=178 4&Type=Act ive | |
899 | Detailed D esign | |
900 | Hardware D etailed De sign | |
901 | This proje ct is a Vi stA Fee Ba sis and In tegrated B illing pat ch. There are no mod ifications to any ex isting har dware. | |
902 | Software D etailed De sign | |
903 | Conceptual Design | |
904 | Product Pe rspective | |
905 | The VistA FEE BASIS system is a software package t hat is bei ng modifie d to inter act and sh are data w ith the Vi stA Integr ated Billi ng system. Data from FEE BASIS authoriza tions will be tracke d and made available to the In tegrated B illing sys tem. | |
906 | User Inter faces | |
907 | User Inter face with all FEE BA SIS applic ation soft ware is pe rformed th rough exis ting and n ew VistA s creens. Vi stA is a c haracter-b ased appli cation acc essible th rough term inal emula tor softwa re residen t on netwo rked compu ters. | |
908 | The FEE BA SIS applic ation is a character -based sys tem using VA FileMan as its da tabase man ager and C ache/M as the progra mming lang uage. This software applicatio n is part of the Vis tA suite o f applicat ions, whic h include additional clinical and financ ial applic ations. Th ere are no GUIs. | |
909 | Hardware I nterfaces | |
910 | VistA FEE BASIS rece ives data from the F BCS, a GUI system th at sends a uthorizati on and cla im data to the VistA FEE BASIS system. | |
911 | Communicat ions betwe en VistA s ites and H IPAA EDI S ervices pa ss through the Local Area Netw orks (LANs ) and acro ss the Dep artment of Veterans Affairs (V A) intrane t. The Ser vices comm unicate ov er the AIT C LAN and through th e private frame rela y to the c ommunicati ons cleari nghouse fo r this pro ject. The clearingho use commun icates wit h the trad ing partne r processo rs that ar e continua lly design ated using previousl y negotiat ed contrac tual terms and condi tions. | |
912 | Software I nterfaces | |
913 | The follow ing softwa re must be installed prior to the releas e of this product. | |
914 | InterSyste ms Mumps V ersion Cac he 2014.1. 3 Ad Hoc 1 4809 | |
915 | VA FileMan Version 2 2.0 | |
916 | VistA Kern el Version 8.0 | |
917 | VistA Mail Man Versio n 8.0 | |
918 | VistA Fee Basis Vers ion 3.5 | |
919 | Vista Inte grated Bil ling Versi on 2.0 | |
920 | Vista Acco unts Recei vable Vers ion 4.5 | |
921 | VistA Regi stration V ersion 5.3 | |
922 | Other tool s utilized during de velopment and testin g: | |
923 | Rational T eam Concer t: Release 6.0 (VA N etwork-wid e version) | |
924 | Communicat ions Inter faces | |
925 | Memory Con straints | |
926 | N/A. There are no me mory const raints ass ociated wi th this pr oject. | |
927 | Special Op erations | |
928 | N/A. There are no sp ecial oper ations ass ociated wi th this pr oject. | |
929 | Product Fe atures | |
930 | Please see Section 1 .1 for a l ist of Sco pe Inclusi ons, Secti on 2.3.1 f or an over view of th e signific ant functi onal requi rements, a nd Section 6.2.2.2 f or a list of all of the functi onal requi rements. | |
931 | User Chara cteristics | |
932 | In general , the reso urces that shall wor k with FEE BASIS sof tware need to be kno wledgeable in the ar ea of FBCS , FEE BASI S and, to a lesser e xtent, Int egrated Bi lling. | |
933 | Dependenci es and Con straints | |
934 | N/A/ There are no de pendencies and const raints wit h this pro ject. | |
935 | Specific R equirement s | |
936 | Database R epository | |
937 | This proje ct is a Vi stA patch. The datab ase reposi tory is st andard Vis tA databas e using Fi leMan file s and fiel ds. Any mo dification s to this database r epository are detail ed in Sect ion 6.2.2. 2. | |
938 | System Fea tures | |
939 | The follow ing sub-se ctions of this Syste m Design D ocument (S DD) match the specif ic functio nal requir ements as presented in the RSD for this project. T ables at t he end of section 6. 2.2.2.1 as sociate th e function al require ment numbe r from the RSD with the propos ed design element. | |
940 | Non-VA Med ical Care (NVC) Prec ert Workli st | |
941 | This enhan cement see ks to assi st the VAM Cs in obta ining time ly precert ification from third party pay ers before care is r endered by notifying the appro priate sta ff as soon as VA-pro vided outp atient ser vices requ iring prec ertificati on are sch eduled and authoriza tions are created in the VistA Fee Packa ge for inp atient or outpatient care. Thi s also pro vides an o pportunity for the i nsurance i dentificat ion/verifi cation pro cess to be completed prior to treatment. | |
942 | The system shall not ify RUR Nu rses and I nsurance V erificatio n Clerks, via a work list, when an author ization is created i n the Vist A FEE BASI S package. | |
943 | Note: Auth orizations for veter ans with n o current third-part y insuranc e will not display o n the work list. Auth orizations for veter ans associ ated with NVC vendor contracts that have a CHOICE indicator will not d isplay on the workli st. | |
944 | IB NVC Pre cert Workl ist proces s will be as follows : (Note: T his is in “real time ” – this i s not a ni ghtly job) | |
945 | New or mod ified auth orization is filed i nto the Vi stA Fee Pa tient Auth orization Subfile (# 161.01). | |
946 | Authorizat ion displa ys on Insu rance Veri fication N VC Precert Worklist (IV Queue) . | |
947 | Insurance Verificati on Clerk d eems autho rization “ Precert Re quired” or “Precert Not Requir ed”, via W orklist Ac tion WA. | |
948 | If “Precer t Not Requ ired”, aut horization / action / user is logged for reporting in the ne w IB-FB In terface Fi le (#360) and remove d from IV NVC Precer t Worklist . | |
949 | If “Precer t Required ”, authori zation / a ction / us er is logg ed for rep orting in the new IB -FB Interf ace File ( #360), rem oved from Insurance Verificati on Worklis t and disp layed on R UR Precert Worklist (RUR Queue ). | |
950 | RUR Nurse reviews au thorizatio n and has access (vi a Worklist Actions) to Claims Tracking t o assist w ith their tasks – A new Claims Tracking entry may be entered and tied to the aut horization , via the new IB-FB Interface Tracking F ile (#360) . | |
951 | RUR deems authorizat ion “Certi fication C omplete”, “Removed f rom Workli st”, or se ts “Next R eview Date ” via Work list Actio n WA. | |
952 | If “Certif ication Co mplete”, a uthorizati on is reco rded in th e logging portion of the new I B-FB Inter face File (#360), wi th optiona l RUR stat us message , and remo ved from R UR Precert Worklist. | |
953 | If “Remove d from Wor klist”, au thorizatio n is recor ded in the logging p ortion of the new IB -FB Interf ace File ( #360), wit h optional RUR statu s message, and remov ed from RU R Precert Worklist. | |
954 | If “Next R eview Date ” is set, authorizat ion will n ot display on the RU R Precert Worklist u ntil desig nated date . | |
955 | Please Not e: The Ins urance Ver ification / RUR Prec ertificati on Worklis t process is a metho d of track ing and ha ndling wor kflow only . It was d esigned to notify an d assist t he two dep artments ( IV and RUR ) with the ir daily t asks. Ther e is a Wor klist Hist ory Action that will provide a means to view Workl ist author ization ac tions, as well as da te/time an d user. A report was written t o display past workl ist activi ties from the workli st log. Th is report is detaile d in the S DD for NSR #20110303 (Fee Reve nue Enhanc ements). | |
956 | This table attempts to demonst rate how f unctional requiremen ts from th e Precerti fication R SD tie int o the prop osed workl ist screen s: | |
957 | Table 5: F unctional Requiremen ts vs. Wor klist Scre ens | |
958 | Requiremen t | |
959 | RSD Functi onal Req I tem # | |
960 | Screen | |
961 | Notify RUR Nurses an d Insuranc e Verifica tion Clerk s, via a w orklist wh en an auth orization is created in the Vi stA Fee Ba sis packag e for Vete rans with active, bi llable ins urance | |
962 | FRPRE – 1. 1 | |
963 | Main Workl ist Screen | |
964 | ** At this point in time, all new and ch anged auth orizations will log to the IV worklist. This is be cause Cate gory of Ca re is an o pen issue (It is not yet sent from FBCS. ). There i s also a p ossibility that Insu rance Veri fication C lerks will have to a dd new ins urance for a patient who previ ously had no reporte d third-pa rty covera ge.** | |
965 | Ordering P hysician ( Last First MI, NPI#, Taxonomy) | |
966 | FRPRE – 1. 1.1.1 -01 | |
967 | Worklist A ction EE – Expand | |
968 | Diagnosis / Procedur e | |
969 | FRPRE – 1. 1.1.1 – 02 | |
970 | Worklist A ction EE – Expand | |
971 | Authorizat ion Range / Schedule d Date of Service Ra nge | |
972 | FRPRE – 1. 1.1.1 – 03 | |
973 | Main Workl ist Screen Worklist A ction EE – Expand | |
974 | Non-VA Loc ation | |
975 | FRPRE – 1. 1.1.1 – 04 | |
976 | Worklist A ction EE – Expand | |
977 | All Active Insurance | |
978 | FRPRE – 1. 1.1.1 – 05 | |
979 | Worklist A ction EE – Expand | |
980 | Last Date Insurance Verified | |
981 | FRPRE – 1. 1.1.1 – 06 | |
982 | Worklist A ction EE – Expand | |
983 | Type of Se rvice (Inp atient, Ou tpatient, etc.) – No te: This i s now refe rred to as “NVC” | |
984 | FRPRE – 1. 1.1.1 – 07 | |
985 | Main Workl ist Screen Worklist A ction EE - Expand | |
986 | All Servic e Connecte d and Spec ial Author ity Eligib ilities | |
987 | FRPRE – 1. 1.1.1 – 08 | |
988 | Worklist A ction EE - Expand | |
989 | Means Test (Copay) S tatus | |
990 | FRPRE – 1. 1.1.1 – 09 | |
991 | Worklist A ction EE - Expand | |
992 | Medication Copayment Exemption Status | |
993 | FRPRE – 1. 1.1.1 – 10 | |
994 | Worklist A ction EE - Expand | |
995 | Use contra ct numbers as a para meter when generatin g the pre- certificat ion workli st to filt er Choice Program co ntract num bers from the workli st | |
996 | FRPRE – 1. 1.1.1 – 11 | |
997 | A modifica tion has b een made t o the Fee Basis Cont ract File to designa te a contr act as CHO ICE. Inter nal workli st code wi ll filter authorizat ions assoc iated with a CHOICE contract a nd prevent them from displayin g on the w orklist. | |
998 | Potential Cost Recov ery Report | |
999 | An additio nal compon ent of thi s change w ill modify the exist ing PCRR t o include data eleme nts that w ould give the Billin g Staff th e informat ion needed to submit third par ty bills r elated to Non-VA car e in a mor e efficien t and time ly manner. | |
1000 | Changes wi ll provide the abili ty to gene rate the e xisting PC RR with ad ditional d ata elemen ts (FBCS d ata elemen ts availab le in Vist A Fee) nee ded to sub mit a thir d party bi ll. | |
1001 | This table attempts to demonst rate how f unctional requiremen ts from th e Precerti fication R SD tie int o the prop osed Poten tial Cost Recovery R eport chan ges: | |
1002 | Table 6: F unctional Requiremen trs vs. Re port Modif ications | |
1003 | Requiremen t | |
1004 | Functional Requireme nt | |
1005 | Design Cha nge | |
1006 | Station/Fa cility/Div ision numb er | |
1007 | FRPRE 2.1. 1 – 01 | |
1008 | Header - D ivision/St ation | |
1009 | Type of Se rvice (Inp atient/Out patient/Ph armacy) – Now referr ed to as N VC | |
1010 | FRPRE 2.1. 1 – 02 | |
1011 | Printed ab ove servic e detail l ines | |
1012 | Rendering Provider ( NPI#,Taxon omy Code,L ast Name,F irst Name, MI) | |
1013 | FRPRE 2.1. 1 – 03 | |
1014 | Printed in new autho rization s ection | |
1015 | Ordering ( Referring) Provider (NPI#,Taxo nomy Code, Last Name , First Na me, MI) | |
1016 | FRPRE 2.1. 1 – 04 | |
1017 | (Referring Provider) Printed i n new auth orization section | |
1018 | All availa ble Diagno sis/Proced ure data | |
1019 | FRPRE 2.1. 1 – 05 | |
1020 | Printed fr om invoice (current code) and in new aut horization section | |
1021 | Date of Se rvice | |
1022 | FRPRE 2.1. 1 – 06 | |
1023 | Printed in service d etail line (Svc Date ) – curren t code | |
1024 | Name of No n-VA Locat ion | |
1025 | FRPRE 2.1. 1 – 07 | |
1026 | “Vendor” p rinted abo ve service detail li ne | |
1027 | Active/Eff ective Ins urance Inf ormation a s of Date of Service | |
1028 | FRPRE 2.1. 1 – 08 | |
1029 | Printed in detailed insurance section | |
1030 | Date Insur ance was v erified (M M/DD/YY) | |
1031 | FRPRE 2.1. 1 – 09 | |
1032 | Printed in detailed insurance section | |
1033 | Service Co nnected Co ndition an d Special Authority Eligibilit y | |
1034 | FRPRE 2.1. 1 – 10 | |
1035 | Printed in new patie nt header | |
1036 | Outpatient Copayment Status fr om most re cent Means Test adju dication r esults | |
1037 | FRPRE 2.1. 1 – 11 | |
1038 | Printed in new patie nt header | |
1039 | Medication Copayment Exemption Status | |
1040 | FRPRE 2.1. 1 – 12 | |
1041 | Printed in new patie nt header | |
1042 | Previously Billed to third par ty carrier indicator | |
1043 | FRPRE 2.1. 1 – 13 | |
1044 | Printed in new servi ce detail line 3 (Bi lled?) | |
1045 | Bill Numbe r(s) if pr eviously b illed | |
1046 | FRPRE 2.1. 1 – 13.1 | |
1047 | Printed in new servi ce detail line 3 (Bi ll#) | |
1048 | Authorizat ion Number from insu rance carr ier (Redun dancy with 2.2.1-05) | |
1049 | FRPRE 2.1. 1 – 14 | |
1050 | Printed in new servi ce detail line 3 (In s Auth#) | |
1051 | Sort by st ation numb er | |
1052 | FRPRE 2.1. 2 | |
1053 | Current co de sorts b y station number | |
1054 | Display if Veteran h as active, billable insurance – Include only Fee B asis care episodes t hat have n ot been bi lled to a third part y carrier previously – Runtime prompt | |
1055 | FRPRE 2.2. 1 – 01 | |
1056 | New runtim e prompt a nd corresp onding cod e | |
1057 | Insurance Effective Date (MM/D D/YY) | |
1058 | FRPRE 2.2. 1 - 02 | |
1059 | Printed in detailed insurance section | |
1060 | Insurance Terminatio n Date (MM /DD/YY) | |
1061 | FRPRE 2.2. 1 – 03 | |
1062 | Printed in detailed insurance section | |
1063 | Display in surance on ly if it t reatment d ate falls within eff ective/exp iration da tes (MM/DD /YY) ** Co de will be written s o that onl y insuranc e that is effective as of DOS will displ ay. ** | |
1064 | FRPRE 2.2. 1 – 04 | |
1065 | Printed in detailed insurance section | |
1066 | Authorizat ion Number from insu rance carr ier (redun dancy with FRPRE 2.2 .1-14 | |
1067 | FRPRE 2.2. 1 – 05 | |
1068 | Printed in new servi ce detail line 3 (In s Auth#) | |
1069 | Design Ele ment Table s | |
1070 | Routines ( Entry Poin ts) | |
1071 | Table 7: ( Grouping): Routines | |
1072 | Routines | |
1073 | Activities | |
1074 | Routine Na me | |
1075 | ^FBAACFE | |
1076 | Enhancemen t Category | |
1077 | New | |
1078 | Modify | |
1079 | Delete | |
1080 | No Change | |
1081 | RTM | |
1082 | FRPRE – 1. 1.1.1 - 11 | |
1083 | Related Op tions | |
1084 | FBAA CONTR ACT FILE C ontract Fi le Enter/E dit | |
1085 | (Existing Option All ows Fee Ba sis Superv isors to E nter/Edit Fee Basis Contract D ata) | |
1086 | ||
1087 | Related Ro utines | |
1088 | Routines “ Called By” | |
1089 | Routines “ Called” | |
1090 | ||
1091 | Driver Rou tine – Cal led by Vis tA Option FBAA CONTR ACT FILE | |
1092 | ||
1093 | ||
1094 | Routines | |
1095 | Activities | |
1096 | Data Dicti onary (DD) Reference s | |
1097 | FEE BASIS CONTRACT F ILE (#161. 43) | |
1098 | Related Pr otocols | |
1099 | None | |
1100 | Related In tegration Control Re gistration s (ICRs) | |
1101 | None | |
1102 | Data Passi ng | |
1103 | Input | |
1104 | Output Re ference | |
1105 | Both | |
1106 | Global Re ference | |
1107 | Local | |
1108 | Input Attr ibute Name and Defin ition | |
1109 | Name: None | |
1110 | Definition : None | |
1111 | Output Att ribute Nam e and Defi nition | |
1112 | Name: None | |
1113 | Definition : None | |
1114 | ||
1115 | Current Lo gic | |
1116 | See “Modif ied Logic” for From/ To Routine Changes | |
1117 | ||
1118 | Modified L ogic (Chan ges are hi ghlighted) | |
1119 | Add CHOICE Indicator Field Ent er/Edit | |
1120 | From: | |
1121 | +24 . S DR ="W !,FBX; 1:3" | |
1122 | +25 E S DR =".01:3" | |
1123 | To: | |
1124 | +24 . S D R="W !,FBX ;1:5" | |
1125 | +25 E S D R=".01:5" ; FB*3.5*1 63 - Added fields 4 and 5 for CHOICE Pro gram Indic ator | |
1126 | ||
1127 | Routines | |
1128 | Activities | |
1129 | Routine Na me | |
1130 | ^FBPCR | |
1131 | Enhancemen t Category | |
1132 | New | |
1133 | Modify | |
1134 | Delete | |
1135 | No Change | |
1136 | RTM | |
1137 | FRPRE 2.1. 1 – 01 – F RPRE 2.1.1 – 14, FRP RE 2.2.1 – 01 – FRPR E 2.2.1 - 05 | |
1138 | Related Op tions | |
1139 | FB PCR Pot ential Cos t Recovery Report | |
1140 | ||
1141 | Related Ro utines | |
1142 | Routines “ Called By” | |
1143 | Routines “ Called” | |
1144 | ||
1145 | Driver Rou tine – Cal led by Vis tA Option: FB PCR | |
1146 | EN^FBPCR2 (outpatien t) | |
1147 | EN^FBPCR3 (pharmacy) | |
1148 | EN^FBPCR67 (civil ho spital and contract nursing ho me) | |
1149 | PRINT^FBPC R2 (outpt print) | |
1150 | PRINT^FBPC R3 (pharma cy print) | |
1151 | PRINT^FBPC R671 (CH, CNH print) | |
1152 | ||
1153 | Routines | |
1154 | Activities | |
1155 | Data Dicti onary (DD) Reference s | |
1156 | FEE BASIS PROGRAM FI LE (#161.8 ) | |
1157 | TYPE OF PL AN FILE (# 355.1) | |
1158 | PATIENT FI LE (#2) | |
1159 | INSTITUTIO N FILE (#4 ) | |
1160 | DISABILITY CONDITION FILE (#31 ) | |
1161 | Related Pr otocols | |
1162 | None | |
1163 | Related In tegration Control Re gistration s (ICRs) | |
1164 | Yes – in p rocess | |
1165 | Data Passi ng | |
1166 | Input | |
1167 | Output Re ference | |
1168 | Both | |
1169 | Global Re ference | |
1170 | Local | |
1171 | Input Attr ibute Name and Defin ition | |
1172 | Name: None | |
1173 | Definition : None | |
1174 | Output Att ribute Nam e and Defi nition | |
1175 | Name: None | |
1176 | Definition : None | |
1177 | ||
1178 | Current Lo gic | |
1179 | See “Modif ied Logic” for From/ To Routine Changes | |
1180 | ||
1181 | Modified L ogic (Chan ges are hi ghlighted) | |
1182 | Additional Variables to Kill ( FBPCR+7) | |
1183 | K FBBILL, FBNPB,FBAD J,FBADJR,F BPVL133,FB INV,FBPVLI ST,Y ;FB*3 .5*163 | |
1184 | ||
1185 | New Third Party Carr ier Prompt | |
1186 | PREBL ; In clude Only Not Previ ously Bill ed NVC FB* 3.5*163 | |
1187 | N Y,X | |
1188 | W ! | |
1189 | S DIR("A" )="Include only Non VA Care no t previous ly billed to third p arty carri er: " | |
1190 | S DIR("?" )="Please answer Yes or No." | |
1191 | S DIR("B" )="YES",DI R(0)="YA^^ " | |
1192 | D ^DIR K DIR | |
1193 | S FBNPB=Y | |
1194 | ; | |
1195 | ||
1196 | Fix Displa y Issue – No records found (Pr eviously, code would “quit” wi thout mess age) | |
1197 | +73 S FBFI RST=0 ; FB *3.5*163 | |
1198 | +80 I FBFI RST=0 D WM SG ; FB*3. 5*163 | |
1199 | +98 K A1,A 2,A3,BEGDA TE,C,D,D2, DFN,DIC,DI R,DTOUT,DU OUT,ENDDAT E,FBPDXC,F B | |
1200 | PARTY,FBCO PAY,FBARRL TC,FBINCUN K,FBFIRST | |
1201 | +178 S FBF IRST=1 | |
1202 | +179 I '$ D(DFN) Q | |
1203 | +180 D PA TDEMO ;FB* 3.5*163 | |
1204 | ||
1205 | Change Div ision Prom pt to Divi sion/Stati on | |
1206 | From: | |
1207 | +155 W !? (IOM-(11+$ L($G(FBPSF NAM))+$L($ G(FBPSFNUM )))/2),"Di vision: ", $G(FBPSFNU M)," ",$G( FBPSFNAM) | |
1208 | To: | |
1209 | +172 W !? (IOM-(11+$ L($G(FBPSF NAM))+$L($ G(FBPSFNUM )))/2),"Di vision/Sta tion: ",$G (FBPSFNUM) ," ",$G(FB PSFNAM) ;F B*3.5*163 | |
1210 | Change Div ision Disp lay | |
1211 | From: | |
1212 | +169 W !?( IOM-(11+$L ($G(FBPSFN AM))+$L($G (FBPSFNUM) ))/2),"Div ision: ",$ G( | |
1213 | FBPSFNUM), " ",$G(FBP SFNAM) | |
1214 | To: | |
1215 | +193 ;W !? (IOM-(11+$ L($G(FBPSF NAM))+$L($ G(FBPSFNUM )))/2),"Di vision: ", $G | |
1216 | (FBPSFNUM) ," ",$G(FB PSFNAM) ;F B*3.5*163 | |
1217 | +194 W !? (IOM-(19+$ L($G(FBPSF NAM))+$L($ G(FBPSFNUM )))/2),"Di vision/Sta tio | |
1218 | n: ",$G(FB PSFNUM)," ",$G(FBPSF NAM) ;FB*3 .5*163 | |
1219 | ||
1220 | Enhance In surance Di splay | |
1221 | From: | |
1222 | +164 W ! D :$D(DFN) I NS^DGRPDB | |
1223 | To: | |
1224 | FBPCR.INT. 1 | |
1225 | +184 W !! ," Health Insurance: " ;FB*3.5 *163 | |
1226 | +185 S Z= $$INSUR^IB BAPI(DFN,D T) | |
1227 | +186 W $S (Z:"YES",1 :"NO") | |
1228 | +187 D DI SP^IBCNS3( DFN,DT,5) | |
1229 | New Paragr aph to Pri nt Patient Demograph ics | |
1230 | PATDEMO ; Patient De mographics FB*3.5*16 3 | |
1231 | N VAEL,FB CP,FBMT | |
1232 | D ELIG^VA DPT | |
1233 | S FBMT=$P ($G(VAEL(9 )),U,2) | |
1234 | W !,?10," Outpatient Copayment Status: " ,FBMT | |
1235 | D DISP^IB ARXEU(DFN, DT,1,"") | |
1236 | D GETSC | |
1237 | D GETSTA | |
1238 | Q | |
1239 | ; | |
1240 | New Paragr aph to Pri nt Service Connected | |
1241 | GETSC ; Ge t Service Connected FB*3.5*163 | |
1242 | N FBD,FBI ,FBX,FBY,F BSC | |
1243 | W !,?20," Service Co nnected: " | |
1244 | I VAEL(3) =0 W "NO" Q | |
1245 | W $P(VAEL (3),U,2)_" %" | |
1246 | I '$O(^DP T(DFN,.372 ,0)) Q | |
1247 | S FBI=0 F S FBI=$O( ^DPT(DFN,. 372,FBI)) Q:'FBI D | |
1248 | . S FBX=$ G(^DPT(DFN ,.372,FBI, 0)),FBY=$G (^DIC(31,+ FBX,0)) | |
1249 | . S FBD=$ S($P(FBY,U ,4)="":$P( FBY,U,1),1 :$P(FBY,U, 4))_" ("_$ P(FBX,U,2) _"%-"_$S(+ $P(FBX,U,3 ):"SC",1:" NSC")_")" | |
1250 | . W !?39, FBD | |
1251 | Q | |
1252 | ; | |
1253 | New Paragr aph to Pri nt Special Authority Eligibili ty | |
1254 | GETSTA ; G et Special Authority Eligibili ty FB*3.5* 163 | |
1255 | N FBY,FBA DT,FBARR | |
1256 | W !,?13," Special Au th Eligibi lity: " | |
1257 | S FBADT=D T | |
1258 | D CL^SDCO 21(DFN,FBA DT,"",.FBA RR) | |
1259 | I $D(FBAR R(3)) W "S C TREATMEN T",! | |
1260 | I $D(FBAR R(7)),+$$C VEDT^DGCV( DFN,FBDAT) W ?13,"CO MBAT VETER AN",! | |
1261 | I $D(FBAR R(1)) W ?3 9,"AGENT O RANGE",! | |
1262 | I $D(FBAR R(2)) W ?3 9,"IONIZIN G RADIATIO N",! | |
1263 | I $D(FBAR R(4)) W ?3 9,"SOUTHWE ST ASIA",! | |
1264 | I $D(FBAR R(8)) W ?3 9,"PROJECT 112/SHAD" ,! | |
1265 | I $D(FBAR R(5)) W ?3 9,"MILITAR Y SEXUAL T RAUMA",! | |
1266 | I $D(FBAR R(6)) W ?3 9,"HEAD/NE CK CANCER" ,! | |
1267 | I '$D(FBA RR) W "NO" ,! | |
1268 | Q | |
1269 | .......... ...... | |
1270 | ||
1271 | Routines | |
1272 | Activities | |
1273 | Routine Na me | |
1274 | ^FBPCR2 | |
1275 | Enhancemen t Category | |
1276 | New | |
1277 | Modify | |
1278 | Delete | |
1279 | No Change | |
1280 | RTM | |
1281 | FRPRE 2.1. 1 – 01 – F RPRE 2.1.1 – 14, FRP RE 2.2.1 – 01 – FRPR E 2.2.1 - 05 | |
1282 | Related Op tions | |
1283 | FB PCR Pot ential Cos t Recovery Report | |
1284 | ||
1285 | Related Ro utines | |
1286 | Routines “ Called By” | |
1287 | Routines “ Called” | |
1288 | ||
1289 | FBPCR | |
1290 | SORT+2 .I FBPI=2 D E N^FBPCR2 ; outpatient payments | |
1291 | PRINT+7 .I FBPI=2,$D (^TMP($J," FB",FBPSF, FBPT,FBPI) ) D PRINT^ FBPCR2 Q | |
1292 | ||
1293 | FBPCR3 | |
1294 | KILL+5 D K ILL^FBPCR2 | |
1295 | SET+25 I F BAUTH D FB AUTH^FBPCR 2(FBAUTH,D FN) ;FB*3. 5*163 | |
1296 | SETTMP+4 D CHKBILL^F BPCR2(FBIN VN) ;FB*3. 5*163 | |
1297 | PRINT+21 . .W ! D PRT AUTH^FBPCR 2(L) ; FB* 3.5*163 | |
1298 | ||
1299 | FBPCR67 | |
1300 | KILL+4 D K ILL^FBPCR2 | |
1301 | ANC+8 ...D EN1^FBPCR 2 Q:'$D(FB AACPTC) S FBCNT=FBCN T+1 | |
1302 | ||
1303 | FBPCR671 | |
1304 | PRINT+48 . .W ! D PRT AUTH^FBPCR 2(FBI) ;FB *3.5*163 | |
1305 | ||
1306 | ||
1307 | ||
1308 | Routines | |
1309 | Activities | |
1310 | Data Dicti onary (DD) Reference s | |
1311 | FEE BASIS PAYMENT FI LE (#162) - ^FBAAC(“ AK”) – Loo pingFEE BA SIS SUSPEN SION FILE (#161.27) | |
1312 | FEE BASIS PATIENT FI LE – AUTH SUB FILE ( #161.01) | |
1313 | STATE FILE (#5) | |
1314 | IB-FB INTE RFACE TRAC KING FILE (#360) | |
1315 | NEW PERSON FILE (#20 0) | |
1316 | Related Pr otocols | |
1317 | None | |
1318 | Related In tegration Control Re gistration s (ICRs) | |
1319 | Yes – in p rocess | |
1320 | Data Passi ng | |
1321 | Input | |
1322 | Output Re ference | |
1323 | Both | |
1324 | Global Re ference | |
1325 | Local | |
1326 | Input Attr ibute Name and Defin ition | |
1327 | Name: None | |
1328 | Definition : None | |
1329 | Output Att ribute Nam e and Defi nition | |
1330 | Name: None | |
1331 | Definition : None | |
1332 | ||
1333 | Current Lo gic | |
1334 | See “Modif ied Logic” for From/ To Routine Changes | |
1335 | ||
1336 | Modified L ogic (Chan ges are hi ghlighted) | |
1337 | Additional Variables to Kill | |
1338 | +17 K FBAD X1,FBADX2, FBADX3,FBA ICD,FBAIEN ,FBAREF,FB AREFA,FBAR NPI,FBAUTH , | |
1339 | FBAVND,FBA VNDA,FBAVN PI,FBAVTAX ; FB*3.5* 163 | |
1340 | ||
1341 | Get Additi onal Data from Fee B asis Autho rization ( if availab le) | |
1342 | +52 ;FB*3. 5*163 - Ge t data fro m fee basi s authoriz ation if a vailable | |
1343 | +53 S FBAU TH=$P(FBDA T003,U,9) ;FB*3.5*16 3 | |
1344 | +54 I FBAU TH D FBAUT H(FBAUTH,J ) ;FB*3.5* 163 | |
1345 | ||
1346 | Check for New “Not P reviously Billed” Pr ompt | |
1347 | +58 N FBB ILL,FBINAU ,FBSKIP ;F B*3.5*163 | |
1348 | +59 S FBS KIP=0,(FBB ILL,FBINAU )="" ;FB*3 .5*163 | |
1349 | +62 D CHK BILL^IBFBU TIL(FBIN) ;FB*3.5*16 3 | |
1350 | +63 I FBS KIP,FBNPB Q ;Quit if running f or not pre viously bi lled and b ill IEN ex ists on Fi le #360 FB *3.5*163 | |
1351 | ||
1352 | If “NO” fo r Above Pr ompt – Sav e Bill Num ber to ^TM P | |
1353 | +66 I FBB ILL S ^TMP ($J,"FB",F BPSF,FBPAT ,FBP,FBVEN ,I,L_M,"FB BILL")=FBB ILL ; FB*3 .5*163 Bil l Number | |
1354 | ||
1355 | Save Insur ance Info to ^TMP | |
1356 | +67 I FBI NAU S ^TMP ($J,"FB",F BPSF,FBPAT ,FBP,FBVEN ,I,L_M,"FB INAU")=FBI NAU ; FB*3 .5*163 Ins urance Aut h | |
1357 | ||
1358 | Save Auth Info to ^T MP | |
1359 | +68 I $G( FBAUTH)'=" " S ^TMP($ J,"FB",FBP SF,FBPAT,F BP,FBVEN,I ,L_M,"FBAU TH | |
1360 | ")=FBADX1_ U_FBADX2_U _FBADX3_U_ FBAICD_U_F BAREF_U_$G (FBARNPI)_ U_FBAVND_U _$G | |
1361 | (FBAVNPI)_ U_$G(FBAVT AX) ; FB*3 .5*163 | |
1362 | ||
1363 | Addition t o Variable Kill List | |
1364 | From: | |
1365 | +69 N FB50 10PV,FBLIP VL,FBPVLIS T | |
1366 | To: | |
1367 | +86 N FB5 010PV,FBLI PVL,FBPVLI ST,FBBILL, FBINAU | |
1368 | Extract Bi ll and Aut h Data fro m ^TMP | |
1369 | +99 ..S F BBILL=$G(^ TMP($J,"FB ",FBPSF,FB PT,FBPI,FB VI,FBDT,M, "FBBILL")) | |
1370 | ;FB*3.5*16 3 | |
1371 | +100 ..S FBINAU=$G( ^TMP($J,"F B",FBPSF,F BPT,FBPI,F BVI,FBDT,M ,"FBINAU") ) | |
1372 | ;FB*3.5*16 3 | |
1373 | ||
1374 | Print Bill Number an d Insuranc e Auth Num ber on PCR Report | |
1375 | From: | |
1376 | +98 ..W ! ,$P(FBDATA ,U,3) | |
1377 | +99 ..W ? 13,$P(FBDA TA,U,4) | |
1378 | +100 ..W ?23,$S($P( FBADJ,U,3) ]"":$P(FBA DJ,U,3),1: $P(FBDATA, U,5)) | |
1379 | +101 ..W ?33,$J($S( $P(FBADJ,U ,4)]"":$J( $P(FBADJ,U ,4),14),1: $P(FBADJ,U ,1)),14) | |
1380 | +102 ..W ?48,$P(FBA DJ,U,5) | |
1381 | +103 ..W ?60,$P(FBA DJ,U,6) | |
1382 | To: | |
1383 | +117 ..W !,$P(FBDAT A,U,3) ;Am t Claimed | |
1384 | +118 ..W ?13,$P(FBD ATA,U,4) ; Amt Paid | |
1385 | +119 ..W ?23,$S($P( FBADJ,U,3) ]"":$P(FBA DJ,U,3),1: $P(FBDATA, U,5)) ;Adj Code | |
1386 | +120 ..W ?33,$J($S( $P(FBADJ,U ,4)]"":$J( $P(FBADJ,U ,4),14),1: $P(FBADJ,U ,1)),14) ; Adj Amts | |
1387 | +121 ..W ?48,$P(FBA DJ,U,5) ;R emit Remar ks | |
1388 | +122 ..W ?60,$P(FBA DJ,U,6) ;P atient Acc ount No. | |
1389 | +123 ..W !,?3,$S(FB BILL:"Y",1 :"N"),?9,F BBILL ;FB* 3.5*163 Bi lled Bill No. | |
1390 | +124 ..W ?24,FBINAU ;FB*3.5*1 63 Ins Aut h No. | |
1391 | ||
1392 | Print Auth Data on P CR Report | |
1393 | +135 .. D PRTAUTH(M ) ; FB*3.5 *163 | |
1394 | ||
1395 | Change Hea der From F EE PROGRAM to NVC PR OGRAM | |
1396 | From: | |
1397 | +119 HDR1 W !!?(IOM -(13+$L(FB XPROG))/2) ,"FEE PROG RAM: ",FBX PROG | |
1398 | To: | |
1399 | +141 HDR1 W !!?(IOM -(13+$L(FB XPROG))/2) ,"NVC PROG RAM: ",FBX PROG ;FB*3 .5*163 - | |
1400 | Changed f rom FEE to NVC | |
1401 | Change Out patient Re port Colum n Headers / Add New Header Lin e for Bill Number an d Ins Auth Number | |
1402 | From: | |
1403 | +123 W !, "Amt Claim ed",?13,"A mt Paid",? 23,"Adj Co de",?36,"A dj Amounts ",? | |
1404 | 48,"Remit Remark",?6 1,"Patient Account N o",!,FBDAS H | |
1405 | To: | |
1406 | +145 ;W ! ,"Amt Clai med",?13," Amt Paid", ?23,"Adj C ode",?36," Adj Amount s", | |
1407 | ?48,"Remit Remark",? 61,"Patien t Account No",!,FBDA SH | |
1408 | +146 W !, "Amt Claim ed",?13,"A mt Paid",? 23,"Adj Co de",?36,"A dj Amounts ",? | |
1409 | 48,"Remit Remark",?6 1,"Patient Account N o" ;FB*3.5 *163 | |
1410 | +147 W !, "Billed?", ?9,"Bill#" ,?24,"Ins Auth#",!,F BDASH ;FB* 3.5*163 | |
1411 | ||
1412 | New Paragr aph to Ext ract Addit ional Auth orization Data | |
1413 | FBAUTH(FBA UTH,FBDFN) ;Get Auth orization Data if it exists FB *3.5*163 | |
1414 | N FBIEN | |
1415 | S (FBADX1 ,FBADX2,FB ADX3,FBAIC D,FBAREF,F BAREFA,FBA RNPI,FBAVN D,FBAVNDA, FBAVNPI, FBAVTAX)=" " | |
1416 | Q:FBAUTH= "" | |
1417 | S FBIEN=F BAUTH_","_ FBDFN_"," | |
1418 | S FBADX1= $$GET1^DIQ (161.01,FB IEN_",",.0 8) | |
1419 | S FBADX2= $$GET1^DIQ (161.01,FB IEN_",",.0 85) | |
1420 | S FBADX3= $$GET1^DIQ (161.01,FB IEN_",",.0 86) | |
1421 | S FBAICD= $$GET1^DIQ (161.01,FB IEN_",",.0 87) | |
1422 | S FBAREF= $$GET1^DIQ (161.01,FB IEN_",",10 4) | |
1423 | S FBAREFA =$$GET1^DI Q(161.01,F BIEN_",",1 04,"I") | |
1424 | I FBAREFA '="" S FBA RNPI=$$GET 1^DIQ(200, FBAREFA_", ",41.99) | |
1425 | S FBAVND= $$GET1^DIQ (161.01,FB IEN_",",.0 4) | |
1426 | S FBAVNDA =$$GET1^DI Q(161.01,F BIEN_",",. 04,"I") | |
1427 | I FBAVNDA '="" D | |
1428 | . S FBAVN PI=$$GET1^ DIQ(161.2, FBAVNDA_", ",41.01) | |
1429 | . S FBAVT AX=$$GET1^ DIQ(161.2, FBAVNDA_", ",42) | |
1430 | Q | |
1431 | ; | |
1432 | ||
1433 | New Paragr aph to Pri nt Additio nal Author ization Da ta | |
1434 | PRTAUTH(FB X) ;Print Data from Authorizat ion FB*3.5 *163 | |
1435 | N FBAUPR | |
1436 | I '$D(^TM P($J,"FB", FBPSF,FBPT ,FBPI,FBVI ,FBDT,FBX, "FBAUTH")) Q | |
1437 | S FBAUPR= ^TMP($J,"F B",FBPSF,F BPT,FBPI,F BVI,FBDT,F BX,"FBAUTH ") | |
1438 | W !,"** A uthorizati on Data ** " | |
1439 | W !," Dia gnosis: ", $P(FBAUPR, U,1)," / " ,$P(FBAUPR ,U,2)," / ",$P(FBAUP R,U,3), " /",$P(FBAU PR,U,4) | |
1440 | W !," Ren dering Pro vider: "_$ P(FBAUPR,U ,7) | |
1441 | W !," NPI : "_$P(FBA UPR,U,8),? 30,"TAXONO MY CODE: " _$P(FBAUPR ,U,9) | |
1442 | W !," Ref erring Pro vider: "_$ P(FBAUPR,U ,5) | |
1443 | W !," NPI : "_$P(FBA UPR,U,6) | |
1444 | W ! | |
1445 | Q | |
1446 | ||
1447 | Routines | |
1448 | Activities | |
1449 | Routine Na me | |
1450 | ^FBPCR3 | |
1451 | Enhancemen t Category | |
1452 | New | |
1453 | Modify | |
1454 | Delete | |
1455 | No Change | |
1456 | RTM | |
1457 | FRPRE 2.1. 1 – 01 – F RPRE 2.1.1 – 14, FRP RE 2.2.1 – 01 – FRPR E 2.2.1 - 05 | |
1458 | Related Op tions | |
1459 | FB PCR Pot ential Cos t Recovery Report | |
1460 | ||
1461 | Related Ro utines | |
1462 | Routines “ Called By” | |
1463 | Routines “ Called” | |
1464 | ||
1465 | FBPCR | |
1466 | SORT+3 .I FBPI=3 D E N^FBPCR3 ; pharmacy p ayments | |
1467 | PRINT+8 .I FBPI=3 D: $D(^TMP($J ,"FB",FBPS F,FBPT,FBP I)) PRINT^ FBPCR3 Q | |
1468 | FBAUTH^FBP CR2 | |
1469 | CHKBILL^FB PCR2 | |
1470 | PRTAUTH^FB PCR2 | |
1471 | ||
1472 | Routines | |
1473 | Activities | |
1474 | Data Dicti onary (DD) Reference s | |
1475 | FEE BASIS PHARMACY I NVOICE FIL E (#162.1) - ^FBAA(1 62.1,”AA”) – Looping | |
1476 | FEE BASIS PATIENT FI LE (#161) | |
1477 | Related Pr otocols | |
1478 | None | |
1479 | Related In tegration Control Re gistration s (ICRs) | |
1480 | Yes – in p rocess | |
1481 | Data Passi ng | |
1482 | Input | |
1483 | Output Re ference | |
1484 | Both | |
1485 | Global Re ference | |
1486 | Local | |
1487 | Input Attr ibute Name and Defin ition | |
1488 | Name: None | |
1489 | Definition : None | |
1490 | Output Att ribute Nam e and Defi nition | |
1491 | Name: None | |
1492 | Definition : None | |
1493 | ||
1494 | Current Lo gic | |
1495 | See “Modif ied Logic” for From/ To Routine Changes | |
1496 | ||
1497 | Modified L ogic (Chan ges are hi ghlighted) | |
1498 | New/Kill N ew Variabl es | |
1499 | +15 K FBA UTH,FBIEN, FBX | |
1500 | +19 N FBI EN,FBX | |
1501 | ||
1502 | Get Linked Auth Data for Pharm acy Report Using FBA UTH^FBPCR2 | |
1503 | +42 S FBAU TH=$P(Y(1) ,U,7) ;Get linked au th FB*3.5* 163 | |
1504 | +43 I FBA UTH D FBAU TH^FBPCR2( FBAUTH,DFN ) ;FB*3.5* 163 | |
1505 | ||
1506 | New Billin g Data – C heck for P rior Bill Number usi ng CHKBILL ^FBPCR2 | |
1507 | +46 N FBB ILL,FBIBDT ,FBSKIP ;F B*3.5*163 | |
1508 | +47 S FBS KIP=0,(FBB ILL,FBINAU )="" ;FB*3 .5*163 | |
1509 | +49 D CHK BILL^IBFBU TIL(FBINVN ) ;FB*3.5* 163 | |
1510 | +50 I FBS KIP,FBNPB Q ;Quit if running f or not pre viously bi lled and b ill IEN ex ists on Fi le #360 FB *3.5*163 | |
1511 | ||
1512 | Extract Au th, Bill N umber and Ins Auth N umber Data to ^TMP | |
1513 | +53 S ^TM P($J,"FB", FBPSF,FBPA T,FBPI,FBV EN,I,K_L," FBAUTH")=$ G(FBADX1)_ U_ | |
1514 | $G(FBADX2) _U_$G(FBAD X3)_U_$G(F BAICD)_U_$ G(FBAREF)_ U_$G(FBARN PI)_U_$G(F BAV | |
1515 | ND)_U_$G(F BAVNPI)_U_ $G(FBAVTAX ) ; FB*3.5 *163 | |
1516 | +54 S ^TM P($J,"FB", FBPSF,FBPA T,FBPI,FBV EN,I,K_L," FBBILL")=F BBILL ; FB *3.5*163 B ill No. | |
1517 | +55 S ^TM P($J,"FB", FBPSF,FBPA T,FBPI,FBV EN,I,K_L," FBINAU")=F BINAU ; FB *3.5*163 I ns Auth No . | |
1518 | ||
1519 | Extract an d Print an d Bill Num ber/Insura nce Auth N umber on P harmacy Re port | |
1520 | +63 N FBB ILL,FBINAU ; FB*3.5* 163 | |
1521 | +71 ..S F BBILL=$G(^ TMP($J,"FB ",FBPSF,FB PT,FBPI,FB VI,FBDT,L, "FBBILL")) | |
1522 | ; FB*3.5*1 63 Bill No . | |
1523 | +72 ..S F BINAU=$G(^ TMP($J,"FB ",FBPSF,FB PT,FBPI,FB VI,FBDT,L, "FBINAU")) | |
1524 | ; FB*3.5*1 63 Ins Aut h No. | |
1525 | +80 ..W ! ,?2,$S(FBB ILL:"Y",1: "N"),?10,F BBILL ; FB *3.5*163 B ill No. | |
1526 | +81 ..W ? 25,FBINAU ; FB*3.5*1 63 Ins Aut h No. | |
1527 | Print Addi tional Aut h Data on Pharmacy R eport usin g PRTAUTH^ FBPCR2 | |
1528 | +83 ..W ! D PRTAUTH^ FBPCR2(L) ; FB*3.5*1 63 | |
1529 | ||
1530 | Change FEE PROGRAM t o NVC PROG RAM on Pha rmacy Repo rt | |
1531 | From: | |
1532 | +72 HDR1 W !!?(IOM-( 13+$L(FBXP ROG))/2)," FEE PROGRA M: ",FBXPR OG | |
1533 | To: | |
1534 | +89 HDR1 W !!?(IOM-( 13+$L(FBXP ROG))/2)," NVC PROGRA M: ",FBXPR OG ;FB*3.5 *163 | |
1535 | ||
1536 | Modify Col umn Header s on Pharm acy Report | |
1537 | From: | |
1538 | +75 W !?2 ,"Claimed" ,?12,"Paid ",?20,"Adj Code",?33 ,"Adj Amou nts",?47," In | |
1539 | voice #",? 58,"Batch #",?66,"Re mit Remark s",!,FBDAS H | |
1540 | To: | |
1541 | +92 ; W ! ?2,"Claime d",?12,"Pa id",?20,"A dj Code",? 33,"Adj Am ounts",?47 ," | |
1542 | Invoice #" ,?58,"Batc h #",?66," Remit Rema rks",!,FBD ASH | |
1543 | +93 W !?2 ,"Claimed" ,?12,"Paid ",?20,"Adj Code",?33 ,"Adj Amou nts",?47," In | |
1544 | voice #",? 58,"Batch #",?66,"Re mit Remark s" ;FB*3.5 *163 | |
1545 | +94 W !?2 ,"Billed?" ,?10,"Bill #",?25,"In s Auth#",! ,FBDASH ;F B*3.5*163 | |
1546 | ********** ********** ********** ********** ********** ********** ********** ********* | |
1547 | ||
1548 | Routines | |
1549 | Activities | |
1550 | Routine Na me | |
1551 | ^FBPCR671 | |
1552 | Enhancemen t Category | |
1553 | New | |
1554 | Modify | |
1555 | Delete | |
1556 | No Change | |
1557 | RTM | |
1558 | FRPRE 2.1. 1 – 01 – F RPRE 2.1.1 – 14, FRP RE 2.2.1 – 01 – FRPR E 2.2.1 – 05 | |
1559 | Related Op tions | |
1560 | FB PCR Pot ential Cos t Recovery Report | |
1561 | ||
1562 | Related Ro utines | |
1563 | Routines “ Called By” | |
1564 | Routines “ Called” | |
1565 | ||
1566 | ^FBPCR - | |
1567 | PRINT+9 .I FBPI=6!(F BPI=7) D:$ D(^TMP($J, "FB",FBPSF ,FBPT,FBPI )) PRINT^F BPCR671 Q | |
1568 | PRTAUTH^FB PCR2 | |
1569 | ||
1570 | Routines | |
1571 | Activities | |
1572 | Data Dicti onary (DD) Reference s | |
1573 | FEE BASIS INVOICE FI LE (#162.5 ) - ^FBAAI (“AD”) – L oopingFEE BASIS PATI ENT FILE ( #161)FEE B ASIS VENDE R FILE (#1 61.2) | |
1574 | STATE FILE (#5) | |
1575 | Related Pr otocols | |
1576 | None | |
1577 | Related In tegration Control Re gistration s (ICRs) | |
1578 | Yes – in p rocess | |
1579 | Data Passi ng | |
1580 | Input | |
1581 | Output Re ference | |
1582 | Both | |
1583 | Global Re ference | |
1584 | Local | |
1585 | Input Attr ibute Name and Defin ition | |
1586 | Name: None | |
1587 | Definition : None | |
1588 | Output Att ribute Nam e and Defi nition | |
1589 | Name: None | |
1590 | Definition : None | |
1591 | ||
1592 | Current Lo gic | |
1593 | See “Modif ied Logic” for From/ To Routine Changes | |
1594 | ||
1595 | Modified L ogic (Chan ges are hi ghlighted) | |
1596 | Kill New V ariables | |
1597 | +5 N FBBIL L,FBINAU ; FB*3.5*16 3 | |
1598 | ||
1599 | Extract Bi ll Number and Insura nce Auth N umber from ^TMP | |
1600 | +15 ..S F BBILL=$G(^ TMP($J,"FB ",FBPSF,FB PT,FBPI,FB VI,FBDT,FB I,"FBBILL" )) | |
1601 | ; FB*3.5* 163 Bill N o. | |
1602 | +16 ..S F BINAU=$G(^ TMP($J,"FB ",FBPSF,FB PT,FBPI,FB VI,FBDT,FB I,"FBINAU" )) | |
1603 | ; FB*3.5* 163 Ins Au th No. | |
1604 | ||
1605 | Current co de / old d ata issue, tester re quested fi x ($G) | |
1606 | S FBDATA=$ G(^TMP($J, "FB",FBPSF ,FBPT,FBPI ,FBVI,FBDT ,FBI)),FBC ATC=$P(FBD ATA,U,9),F BINS=$P(FB DATA,U,10) ;FB*3.5*1 63 Add $G | |
1607 | ..S FBINV =$G(^TMP($ J,"FB",FBP SF,FBPT,FB PI,FBVI,FB DT,FBI,"FB INV")) ; F B*3.5*163 Add $G | |
1608 | ||
1609 | Print Bill Number an d Insuranc e Auth Num ber on Civ il Hospita l/Contract Nursing H ome Report s | |
1610 | +25 ..W ! ,?2,$S(FBB ILL:"Y",1: "N"),?9,FB BILL ; FB* 3.5*163 Bi ll No. | |
1611 | +26 ..W ? 24,FBINAU ; FB*3.5*1 63 Ins Aut h No. | |
1612 | ||
1613 | Print Addi tional Aut horization Data Usin g PRTAUTH^ FBPCR2 | |
1614 | +52 ..W ! D PRTAUTH ^FBPCR2(FB I) ;FB*3.5 *163 | |
1615 | ||
1616 | Change Wor ding from FEE PROGRA M to NVC P ROGRAM | |
1617 | From: | |
1618 | +99 HDR1 W !!?(IOM- (13+$L(FBX PROG))/2), "FEE PROGR AM: ",FBXP ROG | |
1619 | To: | |
1620 | +105 HDR1 W !!?(IOM -(13+$L(FB XPROG))/2) ,"NVC PROG RAM: ",FBX PROG ;FB*3 .5*163 - | |
1621 | Changed f rom FEE to NVC | |
1622 | ||
1623 | Change Col umn Header s | |
1624 | From: | |
1625 | +101 W !? 1,"Amt Cla imed",?15, "Amt Paid" ,?25,"Cov Days",?36, "Adj Codes ",? | |
1626 | 49,"Adj Am ounts",?63 ,"Remit Re marks",!,F BDASH | |
1627 | To: | |
1628 | +107 ; W !?1,"Amt C laimed",?1 5,"Amt Pai d",?25,"Co v Days",?3 6,"Adj Cod es" | |
1629 | ,?49,"Adj Amounts",? 63,"Remit Remarks",! ,FBDASH | |
1630 | +108 W !? 1,"Amt Cla imed",?15, "Amt Paid" ,?25,"Cov Days",?36, "Adj Codes ",? | |
1631 | 49,"Adj Am ounts",?63 ,"Remit Re marks" ; F B*3.5*163 | |
1632 | +109 W !? 1,"Billed? ",?9,"Bill #",?24,"In s Auth#",! ,FBDASH ;F B*3.5*163 | |
1633 | ||
1634 | Routines | |
1635 | Activities | |
1636 | Routine Na me | |
1637 | ^IBFBWL – Main Prece rt and Bil ling Workl ist Routin e(Note: So me section s of this routine ar e used by the Billin g Worklist only.) | |
1638 | Enhancemen t Category | |
1639 | New | |
1640 | Modify | |
1641 | Delete | |
1642 | No Change | |
1643 | RTM | |
1644 | FRPRE – 1. 1, FRPRE – 1.1.1.1 – 03, FRPRE – 1.1.1.1 - 07 | |
1645 | Related Op tions | |
1646 | IB NVC PRE CERT WORKL IST | |
1647 | ||
1648 | ||
1649 | ||
1650 | ||
1651 | ||
1652 | ||
1653 | ||
1654 | ||
1655 | ||
1656 | ||
1657 | ||
1658 | Related Ro utines | |
1659 | Routines “ Called By” | |
1660 | Routines “ Called” | |
1661 | ||
1662 | Called by VistA Opti on -IB NVC PRECERT W ORKLIST | |
1663 | ||
1664 | Subroutine s Called b y ListMan Actions - EXPAND LIN KCT – Link to CT (RU R only)ACT IONSHISTOR Y | |
1665 | ||
1666 | 1. BLDWL^I BFBWL1 (Bi lling Work list only – NSR #201 10303)2. B LDWL^IBFBW L5 (Precer t Worklist ) | |
1667 | 3. Refresh Action ca lls GETAUT ,BLDWL in ^IBFBWL1/^ IBFBWL5 to rebuild l ists | |
1668 | ||
1669 | Routines | |
1670 | Activities | |
1671 | Data Dicti onary (DD) Reference s | |
1672 | Worklist S election C riteria | |
1673 | INSTITUTIO N FILE (#4 ) – Read-o nly via ^D IC/^DIQPAT IENT FILE (#2) – Rea d-only via ^DIC/^DIQ Worklist A ction Item (Claims T racking)FE E BASIS PA TIENT AUTH ORIZATION SUBFILE (# 161.01) – Read-only via ^DIQCL AIMS TRACK ING FILE ( #356) – Re ad-only vi a ^DIQ | |
1674 | Related Pr otocols | |
1675 | IB BILLING WORKLIST MENU | |
1676 | ||
1677 | Action Pro tocols | |
1678 | IB BILLING WORKLIST REFRESH - REFRESH^IB FBWL | |
1679 | IB BILLING WORKLIST EXPAND - E XPAND^IBFB WL | |
1680 | IB BILLING WORKLIST CLAIMS TRA CKING – LI NKCT^IBFBW L | |
1681 | IB BILLING WORKLIST ACTIONS – ACTIONS^IB FBWL | |
1682 | IB BILLING WORKLIST HISTORY – HISTORY^IB FBWL | |
1683 | ||
1684 | Related In tegration Control Re gistration s (ICRs) | |
1685 | Yes - In p rocess | |
1686 | Data Passi ng | |
1687 | Input | |
1688 | Output Re ference | |
1689 | Both | |
1690 | Global Re ference | |
1691 | Local | |
1692 | Input Attr ibute Name and Defin ition | |
1693 | Name: None | |
1694 | Definition : None | |
1695 | Output Att ribute Nam e and Defi nition | |
1696 | Name: None | |
1697 | Definition : None | |
1698 | ||
1699 | Current Lo gic | |
1700 | New Routin e | |
1701 | ||
1702 | ||
1703 | Modified L ogic (Chan ges are hi ghlighted) | |
1704 | IBFBWL ;AL B/PAW-IB B ILLING Wor klist ; 30 -SEP-2015 | |
1705 | ;;2.0;INT EGRATED BI LLING;**55 4**;21-MAR -94;Build 3 | |
1706 | ;;Per VA Directive 6402, this routine s hould not be modifie d. | |
1707 | EN ; -- Ma in entry p oint for I B BILLING WORKLIST | |
1708 | N FILTERS ,IBGRP,IBD IVS,IBWLTY P | |
1709 | S IBWLTYP ="B" | |
1710 | I '$$FILT ER(.FILTER S) Q | |
1711 | S IBGRP=$ P($G(FILTE RS(0)),U,1 ) | |
1712 | K XQORS,V ALMEVL | |
1713 | D EN^VALM ("IB BILLI NG WORKLIS T") | |
1714 | Q | |
1715 | ; | |
1716 | EN2 ; -- M ain entry point for IB NVC PRE CERT WORKL IST This i s the entr y point fo r precert | |
1717 | N FILTERS ,IBGRP,IBD IVS,IBWLTY P | |
1718 | S IBWLTYP ="P" | |
1719 | I '$$FILT ER(.FILTER S) Q | |
1720 | S IBGRP=$ P($G(FILTE RS(0)),U,1 ) | |
1721 | K XQORS,V ALMEVL | |
1722 | D EN^VALM ("IB NVC P RECERT WOR KLIST") | |
1723 | Q | |
1724 | ; | |
1725 | INIT ; Ini tialize va riables fo r IB BILLI NG WORKLIS T | |
1726 | D KILLGLB | |
1727 | D GETAUT^ IBFBWL1(IB GRP) | |
1728 | I '$D(^TM P("IBFBWL" ,$J)) D Q | |
1729 | . W !!,*7 ,"There ar e no new c ost recove rable invo ices on fi le." | |
1730 | . S DIR(0 )="E" | |
1731 | . D ^DIR | |
1732 | . S VALMQ UIT=1 | |
1733 | . D EXIT | |
1734 | S IBWLTYP ="B" | |
1735 | D BLDWL^I BFBWL1 | |
1736 | Q | |
1737 | ; | |
1738 | INIT2 ; In itialize v ariables f or IB NVC Precert Wo rklist Ini tializatio n for prec ert | |
1739 | D KILLGLB | |
1740 | D GETAUT^ IBFBWL5(IB GRP) Calls ^IBFBWL5 to build m ain workli st screen | |
1741 | I '$D(^TM P("IBFBWL" ,$J)) D Q | |
1742 | . W !!,*7 ,"There ar e no new a uthorizati ons on fil e." | |
1743 | . S DIR(0 )="E" | |
1744 | . D ^DIR | |
1745 | . S VALMQ UIT=1 | |
1746 | . D EXIT | |
1747 | S IBWLTYP ="P" | |
1748 | D BLDWL^I BFBWL5 | |
1749 | Q | |
1750 | ; | |
1751 | HDR ; Set header for IB BILLIN G Worklist | |
1752 | N IBDIVS, IBFST,IBIE N,IBXX,IBY | |
1753 | D CHKFILT | |
1754 | I IBWLTYP ="B" D | |
1755 | . S VALMH DR(1)=$S(I BY=1:"Faci lity Reven ue Review" ,IBY=2:"RU R SC/SA",I BY=3:"Bill ing") | |
1756 | . S VALMH DR(1)=VALM HDR(1)_" ( "_$S($P(FI LTERS(0),U ,4)=1:"Fir st Party C opay",1:"T hird Party ")_")" | |
1757 | I IBWLTYP ="P" D | |
1758 | . S VALMH DR(1)=$S(I BY=1:"Insu rance Veri fication", IBY=2:"RUR Pre-certi fication") | |
1759 | S VALMHDR (2)="Selec ted Divisi on(s): "_I BDIVS | |
1760 | Q | |
1761 | ; | |
1762 | HDR2 ; Set header fo r IB NVC P recert Wor klist Hea ders for p recert | |
1763 | N IBDIVS, IBFST,IBIE N,IBXX,IBY | |
1764 | D CHKFILT | |
1765 | S VALMHDR (1)=$S(IBY =1:"Insura nce Verifi cation",IB Y=2:"RUR P re-certifi cation") | |
1766 | S VALMHDR (2)="Selec ted Divisi on(s): "_I BDIVS | |
1767 | Q | |
1768 | ; | |
1769 | FILTER(FIL TERS) ; Se t up filte rs | |
1770 | ; Sets an array of filters to determine which ent ries to in clude in d isplay | |
1771 | ; Input: None | |
1772 | ; Output: | |
1773 | ; Returns : 0 if the user ente red '^' or timed out , 1 otherw ise | |
1774 | ; If Bill ing - FILT ERS(0) = f ee basis g roup (1=Fa cility Rev enue, 2=RU R | |
1775 | SC/SA, 3=B illing)^ 0 (all) 1 ( selected) institutio ns ^ 0 (al l) 1 (sele cted) pati ents ^ 1(F irst Party Copay) 2 (Third Par ty) | |
1776 | ; If Prec ert - FILT ERS(0) = f ee basis g roup (1=in surance ve rification , | |
1777 | 2=RUR)^ 0 (all) 1 (s elected) i nstitution s ^ 0 (all ) 1 (selec ted) patie nts | |
1778 | ; FILTERS (1) = inst ien ^ ins t ien ^ et c... | |
1779 | ; FILTERS (2) = pat ien ^ pat ien ^ etc. .. | |
1780 | N DIR,DIR OUT,DIRUT, DTOUT,DUOU T,IBXX,X,X X,Y | |
1781 | K FILTERS | |
1782 | ; | |
1783 | ; Billing Departmen t | |
1784 | I IBWLTYP ="B" D | |
1785 | . S DIR(0 )="S",DIR( "A")="Sele ct (F)acil ity Revenu e, (R)UR S C/SA or (B )lling" | |
1786 | . S DIR(" ?",1)="Ent er 'F' for Facility Revenue, ' R' for RUR SC/SA" | |
1787 | . S DIR(" ?")="or 'B ' to for B illing." | |
1788 | . S $P(DI R(0),U,2)= "F:Facilit y Revenue; R:RUR SC/S A;B:Billin g" | |
1789 | . W ! D ^ DIR K DIR | |
1790 | . I $G(DI RUT) Q | |
1791 | . S X=$$U P^XLFSTR(X ) | |
1792 | . S FILTE RS(0)=$S(Y ="F":1,Y=" R":2,Y="B" :3,1:0) | |
1793 | ; | |
1794 | ; Pre-cer tification Departmen t Precert filters | |
1795 | I IBWLTYP ="P" D | |
1796 | . S DIR(0 )="S",DIR( "A")="Sele ct (I)nsur ance Verif ication or (R)UR Pre -certifica tion" | |
1797 | . S DIR(" ?",1)="Ent er 'I' for insurance verificat ion author izations." | |
1798 | . S DIR(" ?")="Enter 'R' for R UR authori zations." | |
1799 | . S $P(DI R(0),U,2)= "I:Insuran ce Verific ation;R:RU R Pre-cert ification" | |
1800 | . W ! D ^ DIR K DIR | |
1801 | . I $G(DI RUT) Q | |
1802 | . S X=$$U P^XLFSTR(X ) | |
1803 | . S FILTE RS(0)=$S(Y ="I":1,Y=" R":2,1:0) | |
1804 | ; | |
1805 | ||
1806 | ; First P arty Copay or Third Party | |
1807 | I IBWLTYP ="B" D | |
1808 | . S DIR(0 )="S",DIR( "A")="Sele ct (F)irst Party Cop ay or (T)h ird Party Insurance" | |
1809 | . S $P(DI R(0),U,2)= "F:First P arty Copay ;T:Third P arty Insur ance" | |
1810 | . S DIR(" ?",1)="Ent er 'F' for First Par ty Copay." | |
1811 | . S DIR(" ?")="Enter 'T' for T hird Party Insurance ." | |
1812 | . S $P(DI R(0),U,2)= "F:First P arty Copay ;T:Third P arty Insur ance" | |
1813 | . W ! D ^ DIR K DIR | |
1814 | . I $G(DI RUT) Q | |
1815 | . S X=$$U P^XLFSTR(X ) | |
1816 | . S $P(FI LTERS(0),U ,4)=$S(Y=" F":1,Y="T" :3,1:0) | |
1817 | ; | |
1818 | I $G(DIRU T) Q 0 | |
1819 | ; | |
1820 | ; Site (D ivision) F ilter | |
1821 | S DIR(0)= "S",DIR("A ")="Select (A)ll or ( S)elected Division(s ):",DIR("B ")="All" | |
1822 | S DIR("?" ,1)="Enter 'A' for A LL Divisio ns." | |
1823 | S DIR("?" )="Enter ' S' to view entries f or selecte d Division (s)." | |
1824 | S $P(DIR( 0),U,2)="A :All Divis ions;S:Sel ected Divi sions" | |
1825 | W ! D ^DI R K DIR | |
1826 | I $G(DIRU T) Q 0 | |
1827 | S X=$$UP^ XLFSTR(X) | |
1828 | S $P(FILT ERS(0),U,2 )=$S(Y="A" :0,1:1) | |
1829 | ; | |
1830 | ; Set Div ision Filt er | |
1831 | I $P(FILT ERS(0),U,2 )=1 D ASKD IV(.FILTER S) | |
1832 | ; | |
1833 | ; Patient Filter | |
1834 | S DIR(0)= "S",DIR("A ")="Select (A)ll or ( S)elected Patient(s) :",DIR("B" )="All" | |
1835 | S DIR("?" ,1)="Enter 'A' to se lect ALL P atients." | |
1836 | S DIR("?" )="Enter ' S' to view entries f or selecte d Patients ." | |
1837 | S $P(DIR( 0),U,2)="A :All Patie nts;S:Sele cted Patie nts" | |
1838 | W ! D ^DI R K DIR | |
1839 | I $G(DIRU T) Q 0 | |
1840 | S X=$$UP^ XLFSTR(X) | |
1841 | S $P(FILT ERS(0),U,3 )=$S(Y="A" :0,1:1) | |
1842 | ; Set Pat ient / Vet eran filte r | |
1843 | I $P(FILT ERS(0),U,3 )=1 D ASKP AT(.FILTER S) | |
1844 | D SHOWFIL T(.FILTERS ) | |
1845 | Q 1 | |
1846 | ; | |
1847 | ASKDIV(FIL TERS) ; Se ts a list of Divisio ns to be d isplayed i n the Bill ing Workli st | |
1848 | ; Input: FILTERS - Current Ar ray of fil ter settin gs | |
1849 | ; Output: FILTERS - Updated A rray of fi lter setti ngs | |
1850 | N DIC,DIR ,DIRUT,DIV S,DUOUT,FI RST,IBIENS ,IBIENS2,I BXX,IEN,N, X,Y | |
1851 | S DIC=4,D IC(0)="AE" ,FIRST=1 | |
1852 | F D Q:+IE N<1 | |
1853 | . D ONEDI V(.DIC,.IE N,.FIRST) ; One Divi sion promp t | |
1854 | . Q:+IEN< 1 | |
1855 | . S IBIEN S($P(IEN,U ,2))=$P(IE N,U,7) | |
1856 | . S IBIEN S2($P(IEN, U,1))=$P(I EN,U,2) | |
1857 | I '$D(IBI ENS) S FIL TERS(1)="" Q | |
1858 | ; | |
1859 | ; Set the filter no de respons es in alph abetical o rder | |
1860 | S IBXX="" | |
1861 | F S IBXX= $O(IBIENS2 (IBXX)) Q: IBXX="" D | |
1862 | . S FILTE RS(1,IBXX) ="" | |
1863 | Q | |
1864 | ; | |
1865 | ONEDIV(DIC ,IEN,FIRST ) ; Prompt s the user for a Div ision | |
1866 | ; Input: DIC - Vari able/Array of settin gs needed for ^DIC c all | |
1867 | ; FIRST - Set to 1 initially and then 0 for subse quent call s | |
1868 | ; Output: FIRST - S et to 0 | |
1869 | ; IEN - I EN of the selected D ivision | |
1870 | ; null of no select ion was ma de | |
1871 | S DIC("A" )=$S(FIRST :"Select a Division: ",1:"Sele ct Another Division: ") | |
1872 | D ^DIC | |
1873 | S FIRST=0 ,IEN=Y | |
1874 | Q | |
1875 | ; | |
1876 | ||
1877 | ASKPAT(FIL TERS) ; Se ts a list of patient s | |
1878 | ; Input: FILTERS - Current Ar ray of fil ter settin gs | |
1879 | ; Output: FILTERS - Updated A rray of fi lter setti ngs | |
1880 | N DIC,DIR ,DIRUT,DIV S,DUOUT,FI RST,IBIENS ,IBIENS2,I BN,IBXX,IE N,X,Y | |
1881 | S DIC=2,D IC(0)="AE" ,FIRST=1 | |
1882 | F D Q:+IE N<1 | |
1883 | . D ONEPA T(.DIC,.IE N,.FIRST) ; One pati ent | |
1884 | . Q:+IEN< 1 | |
1885 | . S IBIEN S($P(IEN,U ,2))=$P(IE N,U,1) | |
1886 | . S IBIEN S2($P(IEN, U,1))=$P(I EN,U,2) | |
1887 | I '$D(IBI ENS) S FIL TERS(2)="" Q | |
1888 | ; | |
1889 | ; Set the filter no de respons es in alph abetical o rder | |
1890 | S IBXX="" | |
1891 | F D Q:IBX X="" | |
1892 | . S IBXX= $O(IBIENS( IBXX)) | |
1893 | . Q:IBXX= "" | |
1894 | . S IBN=I BIENS(IBXX ) | |
1895 | . S FILTE RS(2,IBN)= "" | |
1896 | Q | |
1897 | ; | |
1898 | ONEPAT(DIC ,IEN,FIRST ) ; Prompt s the user for a Pat ient | |
1899 | ; Input: DIC - Vari able/Array of settin gs needed for ^DIC c all | |
1900 | ; FIRST - Set to 1 initially and then 0 for subse quent call s | |
1901 | ; Output: FIRST - S et to 0 | |
1902 | ; IEN - I EN of the Patient | |
1903 | ; null of no select ion was ma de | |
1904 | S DIC("A" )=$S(FIRST :"Select P atient: ", 1:"Select Another Pa tient: ") | |
1905 | D ^DIC | |
1906 | S FIRST=0 ,IEN=Y | |
1907 | Q | |
1908 | ; | |
1909 | SHOWFILT(F ILTERS) ; Display | |
1910 | ; Display s the curr ently sele cted filte r selectio ns for the | |
1911 | ; Billing and NVC P recert Wor klist disp lay | |
1912 | ; Input: FILTERS() - Array of filter se ttings. Se e FILTERS for a deta iled | |
1913 | ; explana tion of th e FILTERS array | |
1914 | ; Output: Current F ilter sett ings are d isplayed | |
1915 | ; | |
1916 | N DIR,DIR OUT,DIRUT, DTOUT,DUOU T,IEN,LEN, IBXX,IBY,I BZ | |
1917 | I IBWLTYP ="B" D | |
1918 | . W !!!," Type of Re view: " | |
1919 | . S IBY=$ P(FILTERS( 0),U,1) | |
1920 | . W $S(IB Y=1:"Facil ity Revenu e",IBY=2:" RUR SC",IB Y=3:"Billi ng",1:"") | |
1921 | . S IBZ=$ P(FILTERS( 0),U,4) W " ("_$S(IB Z=1:"First Party Cop ay",1:"Thi rd Party") _")" | |
1922 | I IBWLTYP ="P" D | |
1923 | . W !!!," Pre-certif ication De partment: " | |
1924 | . S IBY=$ P(FILTERS( 0),U,1) | |
1925 | . W $S(IB Y=1:"Insur ance Verif ication",I BY=2:"RUR" ,1:"") | |
1926 | ; | |
1927 | W !,"Show All Divis ions or Se lected Div isions: " | |
1928 | W $S($P(F ILTERS(0), U,2)=0:"Al l",1:"Sele cted") | |
1929 | ; | |
1930 | ; Divisio n list (if any) | |
1931 | I ($P(FIL TERS(0),U, 2)=1) D | |
1932 | . W !,"Di visions to Display: " | |
1933 | . S LEN=2 0,IEN=0 | |
1934 | . F S IEN =$O(FILTER S(1,IEN)) Q:IEN="" D | |
1935 | . . S IBX X=$$GET1^D IQ(4,IEN_" ,",.01) | |
1936 | . . S LEN =LEN+$L(IB XX) | |
1937 | . . I LEN +2<80 D Q | |
1938 | . . . W I BXX | |
1939 | . . . I $ O(FILTERS( 1,IEN))'=" " D | |
1940 | . . . . S LEN=LEN+2 | |
1941 | . . . . W ", " | |
1942 | . . S LEN =20 | |
1943 | . . W !," ",IBXX | |
1944 | ; | |
1945 | W !,"All P atients or Selected Patients: " | |
1946 | W $S($P(F ILTERS(0), U,3)=0:"Al l",1:"Sele cted") | |
1947 | ; Patient Inclusion list (if any) | |
1948 | I ($P(FIL TERS(0),U, 3)=1) D | |
1949 | . W !,"Pa tients to Display: " | |
1950 | . S LEN=2 0,IEN=0 | |
1951 | . F S IEN =$O(FILTER S(2,IEN)) Q:IEN="" D | |
1952 | . . S IBX X=$$GET1^D IQ(2,IEN_" ,",.01) | |
1953 | . . S LEN =LEN+$L(IB XX) | |
1954 | . . I LEN +2<80 D Q | |
1955 | . . . W I BXX | |
1956 | . . . I $ O(FILTERS( 2,IEN))'=" " D | |
1957 | . . . . S LEN=LEN+2 | |
1958 | . . . . W ", " | |
1959 | . . S LEN =20 | |
1960 | . . W !," ",IBXX | |
1961 | ; | |
1962 | K DIR | |
1963 | D PAUSE^V ALM1 | |
1964 | Q | |
1965 | ; | |
1966 | EXPAND ; E xpand Item (EE) | |
1967 | D FULL^VA LM1 | |
1968 | N I,J,DFN ,IBFBA,IBX X,VALMY,EC NT,IBAUTH, IBNAME | |
1969 | D EN^VALM 2($G(XQORN OD(0))) | |
1970 | I $D(VALM Y) S IBXX= 0 F S IBXX =$O(VALMY( IBXX)) Q:' IBXX D | |
1971 | . K ^TMP( "IBFBWE",$ J) | |
1972 | . S ECNT= $G(^TMP("I BFBWLX",$J ,IBXX)) | |
1973 | . S DFN=$ P(ECNT,U,1 ),IBNAME=$ P(ECNT,U,2 ),IBAUTH=$ P(ECNT,U,3 ),IBFBA=$P (ECNT,U,4) | |
1974 | . S ^TMP( "IBFBWE",$ J)=DFN_U_I BNAME_U_IB AUTH_IBFBA | |
1975 | . D EN^VA LM("IB BIL LING WORKL IST EXPAND ") | |
1976 | . Q | |
1977 | K ^TMP("I BFBWE",$J) | |
1978 | S VALMBCK ="R" | |
1979 | Q | |
1980 | ; | |
1981 | LINKI ; In surance En ter/Edit ( IN) | |
1982 | D FULL^VA LM1 | |
1983 | N I,J,DFN ,IBXX,VALM Y,ECNT | |
1984 | D EN^VALM 2($G(XQORN OD(0))) | |
1985 | I $D(VALM Y) S IBXX= 0 F S IBXX =$O(VALMY( IBXX)) Q:' IBXX D | |
1986 | . S ECNT= $G(^TMP("I BFBWLX",$J ,IBXX)) | |
1987 | . S DFN=$ P(ECNT,U,1 ) | |
1988 | . D EN^VA LM("IBCNS PATIENT IN SURANCE") | |
1989 | S VALMBCK ="R" | |
1990 | Q | |
1991 | ; | |
1992 | LINKCT ; C laims Trac king (CT) | |
1993 | I IBWLTYP ="P",IBGRP =1 D Q Pr ecert spec ific code | |
1994 | . W !," T his action not avail able for I V queue." | |
1995 | . D PAUSE ^VALM1 | |
1996 | . K ^TMP( $J,"IBCLMT RK") | |
1997 | . S VALMB CK="R" | |
1998 | D FULL^VA LM1 | |
1999 | K ^TMP($J ,"IBCLMTRK ") | |
2000 | N I,J,CTD T,CTIEN,CT LN1,CTUSR, DFN,ECNT,G OTPAT,IBFB A,IBAUTH,I BEND,IBNAM E,IBST,IBX X,VALMY | |
2001 | D EN^VALM 2($G(XQORN OD(0))) | |
2002 | I $D(VALM Y) S IBXX= 0 F S IBXX =$O(VALMY( IBXX)) Q:' IBXX D | |
2003 | . S ECNT= $G(^TMP("I BFBWLX",$J ,IBXX)) | |
2004 | . S DFN=$ P(ECNT,U,1 ),IBNAME=$ P(ECNT,U,2 ),IBAUTH=$ P(ECNT,U,3 ),IBFBA=$P (ECNT,U,4) GOTPAT=1 | |
2005 | . D GETDTS ^IBFBUTIL( IBIEN) | |
2006 | . I IBEND ="" S IBEN D="3991231 " | |
2007 | . S ^TMP( $J,"IBCLMT RK")=DFN_U _IBST_U_IB END_U_IBAU TH_U_IBFBA | |
2008 | . D EN^VA LM("IBT CL AIMS TRACK ING EDITOR ") | |
2009 | I IBWLTYP ="P",$D(D0 ) D Precer t specific code | |
2010 | . S CTIEN =D0 | |
2011 | . I '$D(^ IBT(356,CT IEN)) Q | |
2012 | . S CTLN1 =^IBT(356, CTIEN,1) | |
2013 | . S CTDT= $P($P(CTLN 1,U,1),"." ,1) | |
2014 | . S CTUSR =$P(CTLN1, U,2) | |
2015 | . I $G(DU Z)=CTUSR,D T=CTDT D | |
2016 | .. N Y,X | |
2017 | .. W !! | |
2018 | .. S DIR( "A")="Link last Clai ms Trackin g entry to current a uth for "_ IBNAME_"? " | |
2019 | .. S DIR( "?")="Plea se answer Yes or No. " | |
2020 | .. S DIR( "B")="YES" ,DIR(0)="Y A^^" | |
2021 | .. D ^DIR K DIR | |
2022 | .. I Y(0) '="YES" Q | |
2023 | .. S CTTM P=^TMP($J, "IBCLMTRK" ) | |
2024 | .. S DFN= $P(CTTMP,U ,1) | |
2025 | .. S IBAU TH=$P(CTTM P,U,4) | |
2026 | .. S IBXX ="" | |
2027 | .. S IBXX =$O(^IBFB( 360,"D",DF N,IBAUTH,I BXX)) | |
2028 | .. S $P(^ IBFB(360,I BXX,1),U,1 )=CTIEN | |
2029 | K ^TMP($J ,"IBCLMTRK ") | |
2030 | S VALMBCK ="R" | |
2031 | Q | |
2032 | ; | |
2033 | ACTIONS ; Worklist A ction (WA) | |
2034 | D FULL^VA LM1 | |
2035 | N I,J,DFN ,IBFBA,IBX X,VALMY,EC NT,IBAUTH, IBNAME | |
2036 | D EN^VALM 2($G(XQORN OD(0))) | |
2037 | I $D(VALM Y) S IBXX= 0 F S IBXX =$O(VALMY( IBXX)) Q:' IBXX D | |
2038 | . K ^TMP( "IBFBWA",$ J) | |
2039 | . S ECNT= $G(^TMP("I BFBWLX",$J ,IBXX)) | |
2040 | . S DFN=$ P(ECNT,U,1 ),IBNAME=$ P(ECNT,U,2 ),IBAUTH=$ P(ECNT,U,3 ),IBFBA=$P (ECNT,U,4) | |
2041 | . S ^TMP( "IBFBWA",$ J)=DFN_U_I BNAME_U_IB AUTH_U_IBF BA | |
2042 | . I IBWLT YP="B" D | |
2043 | .. D EN^V ALM("IB BI LLING WORK LIST ACTIO NS") | |
2044 | . I IBWLT YP="P" D P recert spe cific code | |
2045 | .. I IBGR P=1 D EN^V ALM("IB NV C PRECERT WORKLIST I V") | |
2046 | .. I IBGR P=2 D EN^V ALM("IB NV C PRECERT WORKLIST R UR") | |
2047 | K ^TMP("I BFBWA",$J) | |
2048 | K ^TMP("V ALMAR",$J) | |
2049 | I IBWLTYP ="B" D BLD WL^IBFBWL1 | |
2050 | I IBWLTYP ="P" D BLD WL^IBFBWL5 If prece rt, calls actions in ^IBFBWL5 | |
2051 | S VALMBCK ="R" | |
2052 | Q | |
2053 | ; | |
2054 | HISTORY ; Worklist H istory (HI ) | |
2055 | HISTORY ; Worklist History (H I) | |
2056 | D FULL^VA LM1 | |
2057 | N I,J,DFN ,ECNT,IBA, IBAUTH,IBB ,IBHDT,IBH LG,IBHUSR, IBNAME,IBN AME,IBY,IB X,IBXX,VAL MY | |
2058 | D EN^VALM 2($G(XQORN OD(0))) | |
2059 | I $D(VALM Y) S IBXX= 0 F S IBXX =$O(VALMY( IBXX)) Q:' IBXX D | |
2060 | . K ^TMP( "IBFBWH",$ J) | |
2061 | . S ECNT= $G(^TMP("I BFBWLX",$J ,IBXX)) | |
2062 | . S DFN=$ P(ECNT,U,1 ),IBNAME=$ P(ECNT,U,2 ),IBAUTH=$ P(ECNT,U,3 ),IBFBA=$P (ECNT,U,4) | |
2063 | . I IBFBA ’=”” S IBY =IBFBA | |
2064 | . I IBFBA =”” D | |
2065 | .. S IBX= "" F S IBX =$O(^IBFB( 360,"C",DF N,IBX)) Q: IBX="" D | |
2066 | ... I $P( ^IBFB(360, IBX,0),U,3 )=IBAUTH S IBY=IBX | |
2067 | . S IBA=0 F S IBA=$ O(^IBFB(36 0,IBY,4,IB A)) Q:IBA= "" D | |
2068 | .. S IBHD T=$$FDATE^ VALM1($P(^ IBFB(360,I BY,4,IBA,0 ),U,1)) | |
2069 | .. S IBHL G=$P(^IBFB (360,IBY,4 ,IBA,0),U, 2) | |
2070 | .. S IBHU SR=$P(^IBF B(360,IBY, 4,IBA,0),U ,3) | |
2071 | .. S ^TMP ("IBFBWH", $J,IBA)=IB HDT_U_IBHL G_U_IBHUSR | |
2072 | . D EN^VA LM("IB BIL LING WORKL IST HISTOR Y") | |
2073 | . Q | |
2074 | K ^TMP("I BFBWH",$J) | |
2075 | S VALMBCK ="R" | |
2076 | Q | |
2077 | ; | |
2078 | ||
2079 | REFRESH ; Special Ma in Screen List Refre sh Special refresh c ode was ne eded to re display li st | |
2080 | K ^TMP("I BFBWL",$J) | |
2081 | I IBWLTYP ="B" D | |
2082 | . D GETAU T^IBFBWL1( IBGRP) | |
2083 | . D BLDWL ^IBFBWL1 | |
2084 | I IBWLTYP ="P" D | |
2085 | . D GETAU T^IBFBWL5( IBGRP) | |
2086 | . D BLDWL ^IBFBWL5 | |
2087 | S VALMBCK ="R" | |
2088 | Q | |
2089 | ; | |
2090 | KILLGLB ; Kill Workl ist Global s | |
2091 | K ^TMP("I BFBWL",$J) | |
2092 | K ^TMP("I BFBWLX",$J ) | |
2093 | K ^TMP("I BFBWA",$J) | |
2094 | K ^TMP("I BFBWE",$J) | |
2095 | K ^TMP("I BFBWH",$J) | |
2096 | K ^TMP("V ALMAR",$J) | |
2097 | K ^TMP("X QORS",$J) | |
2098 | D CLEAR^V ALM1 | |
2099 | Q | |
2100 | ; | |
2101 | CHKFILT ; Check Filt ers | |
2102 | I $P($G(F ILTERS(0)) ,U,2)=0 S IBDIVS="Al l" | |
2103 | I $P($G(F ILTERS(0)) ,U,2)'=0 D | |
2104 | . S IBIEN =0,IBFST=1 | |
2105 | . F S IBI EN=$O(FILT ERS(1,IBIE N)) Q:IBIE N="" D | |
2106 | .. S IBXX =$E($$GET1 ^DIQ(4,IBI EN_",",.01 ),1,15) | |
2107 | .. I IBFS T S IBFST= 0,IBDIVS=I BXX Q | |
2108 | .. S IBDI VS=IBDIVS_ ","_IBXX | |
2109 | S IBY=$P( FILTERS(0) ,U,1) | |
2110 | Q | |
2111 | ; | |
2112 | HELP ; -- help code | |
2113 | S X="?" D DISP^XQOR M1 W !! | |
2114 | Q | |
2115 | ; | |
2116 | EXIT ; -- exit code | |
2117 | D KILLGLB | |
2118 | D CLEAN^V ALM10 | |
2119 | D ^%ZISC | |
2120 | Q | |
2121 | ||
2122 | Routines | |
2123 | Activities | |
2124 | Routine Na me | |
2125 | ^IBFBWL2 – Expand Wo rklist Ite m | |
2126 | (Note: The Billing W orklist sh ares this routine wi th the Pre cert Workl ist. Many fields dis play on th e Billing Worklist o nly – NSR #20110303. ) | |
2127 | Enhancemen t Category | |
2128 | New | |
2129 | Modify | |
2130 | Delete | |
2131 | No Change | |
2132 | RTM | |
2133 | FRPRE 1.1. 1.1 – 01 t hrough FBP RE 1.1.1.1 - 10 | |
2134 | Related Op tions | |
2135 | IB NVC PRE CERT WORKL IST | |
2136 | ||
2137 | Related Ro utines | |
2138 | Routines “ Called By” | |
2139 | Routines “ Called” | |
2140 | ||
2141 | Called fro m IB NVC P RECERT WOR KLIST Acti on “EE” – EXPAND^IBF BWL | |
2142 | GETAUTH^IB FBUTIL | |
2143 | GETPAY^IBF BUTIL | |
2144 | ||
2145 | ||
2146 | Routines | |
2147 | Activities | |
2148 | Data Dicti onary (DD) Reference s | |
2149 | PATIENT FI LE (#2) | |
2150 | IB-FB INTE RFACE TRAC KING FILE (#360) | |
2151 | FEE BASIS VENDOR FIL E (#161.2) | |
2152 | NEW PERSON FILE (#20 0) | |
2153 | DISABILITY CONDITION FILE (#31 ) | |
2154 | INSURANCE COMPANY FI LE (#36) | |
2155 | FEE BASIS PATIENT FI LE AUTHORI ZATION SUB FILE (#161 .01) | |
2156 | Related Pr otocols | |
2157 | IB BILLING WORKLIST MENU | |
2158 | IB BILLING WORKLIST EXPAND - E XPAND^IBFB WL | |
2159 | ||
2160 | Correspond ing Menu ( Protocol) | |
2161 | IB BILLING WORKLIST EXPAND MEN U PROTOCOL | |
2162 | Action Pro tocols | |
2163 | IB BILLING WORKLIST EXPAND REF RESH – REF RESH^IBFBW L2 | |
2164 | Related In tegration Control Re gistration s (ICRs) | |
2165 | Yes – in p rocess | |
2166 | Data Passi ng | |
2167 | Input | |
2168 | Output Re ference | |
2169 | Both | |
2170 | Global Re ference | |
2171 | Local | |
2172 | Input Attr ibute Name and Defin ition | |
2173 | Name: None | |
2174 | Definition : None | |
2175 | Output Att ribute Nam e and Defi nition | |
2176 | Name: None | |
2177 | Definition : None | |
2178 | ||
2179 | Current Lo gic | |
2180 | New Routin e | |
2181 | ||
2182 | Modified L ogic (Chan ges are hi ghlighted) | |
2183 | IBFBWL2 ;A LB/PAW-IB BILLING Wo rklist Exp and Item ; 30-SEP-20 15 | |
2184 | ;;2.0;INT EGRATED BI LLING;**55 4**;21-MAR -94;Build 3 | |
2185 | ;;Per VA Directive 6402, this routine s hould not be modifie d. | |
2186 | ;; | |
2187 | EN ; -- ma in entry p oint for B ILLING WOR KLIST EXPA ND | |
2188 | D EN^VALM ("IB PRECE RT WORKLIS T EXPAND") | |
2189 | Q | |
2190 | ; | |
2191 | HDR ; -- h eader code | |
2192 | S VALM("T ITLE")=" E xpanded NV C" | |
2193 | Q | |
2194 | ; | |
2195 | INIT ; -- init varia bles and l ist array | |
2196 | ; input - ^TMP("IBF BWE",$J)=D FN^IBNAME^ IBAUTH | |
2197 | ; output - Expanded worklist screen | |
2198 | I '$D(^TM P("IBFBWE" ,$J)) Q | |
2199 | N CNT,DFN ,ECNT,IBNA ME,IBAUTH, IBST,LINE, VAEL | |
2200 | S ECNT=$G (^TMP("IBF BWE",$J)) | |
2201 | S DFN=$P( ECNT,U,1), IBNAME=$P( ECNT,U,2), IBAUTH=$P( ECNT,U,3) | |
2202 | D BLD | |
2203 | D GETSC | |
2204 | D GETSTA | |
2205 | D GETINS | |
2206 | D BLDEXP | |
2207 | S VALMBCK ="R" | |
2208 | Q | |
2209 | ; | |
2210 | BLD ; buil d data to display | |
2211 | N IBARRAY ,IB7078,IB CP,IBIEN,I BDX1,IBDX2 ,IBDX3,IBE ND,IBENDX, IBFILL,IBF P, | |
2212 | IBFPNO,IBI CDDX,IBINV ,IBINVPD,I BMT,IBPAYX ,IBNPI | |
2213 | N IBPUR,I BREF,IBREF A,IBREM,IB REM1,IBREM ARK,IBRET, IBSS,IBSTX ,IBTAX,IBV ND | |
2214 | ,IBVNDA,IB VNPI,IBSSX ,IBSSLE | |
2215 | N IBSSLS, IBVTAX,IBX ,IBXX,VA | |
2216 | S CNT=0 | |
2217 | D ELIG^VA DPT | |
2218 | S IBSSX=$ $GET1^DIQ( 2,DFN_",", .09,"I"),I BSSLE=$L(I BSSX),IBSS LS=6 I $E( IBSSX,IBSS LE)="P" S IBSSLS=5 | |
2219 | S IBSS=$E (IBNAME,1) _$E(IBSSX, IBSSLS,IBS SLE) | |
2220 | S CNT=CNT +1,^TMP("I BFBWE",$J, IBNAME,DFN ,IBAUTH,CN T)="PATIEN T | |
2221 | : "_IBNAME _" (ID: "_ IBSS_")" | |
2222 | S CNT=CNT +1,^TMP("I BFBWE",$J, IBNAME,DFN ,IBAUTH,CN T)="SSN : "_IBSSX | |
2223 | S IBIEN=I BAUTH_","_ DFN_"," | |
2224 | D GETAUTH ^IBFBUTIL( IBIEN,"IBA RRAY") ; C all API fo r Authoriz ation Sub- File (#161 .01) field s | |
2225 | I IBWLTYP ="P" D | |
2226 | . S IBST= $G(IBARRAY (161.01,IB IEN,.01,"I ")) | |
2227 | . S IBEND =$G(IBARRA Y(161.01,I BIEN,.02," I")) | |
2228 | . S IBSTX =$G(IBARRA Y(161.01,I BIEN,.01," E")) | |
2229 | . S IBEND X=$G(IBARR AY(161.01, IBIEN,.02, "E")) | |
2230 | . S CNT=C NT+1,^TMP( "IBFBWE",$ J,IBNAME,D FN,IBAUTH, CNT)="AUTH DOS RANGE | |
2231 | : "_IBSTX _" - "_IBE NDX | |
2232 | I IBWLTYP= "B" D | |
2233 | . S (IBST, IBINV)="" | |
2234 | . I IBFBA' ="" S IBXX =IBFBA | |
2235 | . I IBFBA= "" D | |
2236 | .. S IBX=" " F S IBX= $O(^IBFB(3 60,"C",DFN ,IBX)) Q:I BX="" D | |
2237 | ... I $$GE T1^DIQ(360 ,IBX_",",. 03)=IBAUTH S IBXX=IB X | |
2238 | . D GETST^ IBFBUTIL(I BXX) | |
2239 | . D GETPAY ^IBFBUTIL( IBXX) | |
2240 | . I IBST'= "" S IBSTX =$$FDATE^V ALM1(IBST) | |
2241 | . S CNT=CN T+1,^TMP(" IBFBWE",$J ,IBNAME,DF N,IBAUTH,C NT)="INVOI CE NVC | |
2242 | : "_$G(IBF PNOT) | |
2243 | . S CNT=CN T+1,^TMP(" IBFBWE",$J ,IBNAME,DF N,IBAUTH,C NT)="INVOI CE# | |
2244 | : "_IBINV | |
2245 | . I IBFPNO =2!(IBFPNO =3) S CNT= CNT+1,^TMP ("IBFBWE", $J,IBNAME, DFN,IBAUTH , | |
2246 | CNT)="SERV ICE DATE : "_$G(IBST X) | |
2247 | . I IBFPNO =6!(IBFPNO =7) S CNT= CNT+1,^TMP ("IBFBWE", $J,IBNAME, DFN,IBAUTH , | |
2248 | CNT)="DOS START DATE : "_$G(IB STX) | |
2249 | . ; I IBFP NO=3 S CNT =CNT+1,^TM P("IBFBWE" ,$J,IBNAME ,DFN,IBAUT H,CNT)="VE N | |
2250 | DOR : "_$G (IBVNDA) | |
2251 | . I $G(IBI NV)'="" D | |
2252 | .. S IBPAY X="" | |
2253 | .. F S IBP AYX=$O(IBR ET(162.03, IBPAYX)) Q :IBPAYX="" D | |
2254 | ... S CNT= CNT+1,^TMP ("IBFBWE", $J,IBNAME, DFN,IBAUTH ,CNT)=" SE RVICE CPT | |
2255 | : "_$G(IBR ET(162.03, IBPAYX,.01 ,"I")) | |
2256 | ... I $D(I BRET(162.0 3,IBPAYX,2 ,"I")) S I BINVPD=$FN (IBRET(162 .03,IBPAYX , | |
2257 | 2,"I"),"", 2) | |
2258 | ... S CNT= CNT+1,^TMP ("IBFBWE", $J,IBNAME, DFN,IBAUTH ,CNT)=" AM OUNT PAID | |
2259 | : "_$G(IBI NVPD) | |
2260 | ... S CNT= CNT+1,^TMP ("IBFBWE", $J,IBNAME, DFN,IBAUTH ,CNT)=" RE NDERING PR | |
2261 | OV : "_$G( IBRET(162. 03,IBPAYX, 63,"I")) | |
2262 | ... S CNT= CNT+1,^TMP ("IBFBWE", $J,IBNAME, DFN,IBAUTH ,CNT)=" RE NDERING NP | |
2263 | I : "_$G(I BRET(162.0 3,IBPAYX,6 4,"I")) | |
2264 | ... S CNT= CNT+1,^TMP ("IBFBWE", $J,IBNAME, DFN,IBAUTH ,CNT)=" RE NDERING TA | |
2265 | X : "_$G(I BRET(162.0 3,IBPAYX,6 5,"I")) | |
2266 | S IBFP=$G( IBARRAY(16 1.01,IBIEN ,.03,"E")) Begin cod e used for both Prec ert and Bi lling Work lists | |
2267 | S CNT=CNT +1,^TMP("I BFBWE",$J, IBNAME,DFN ,IBAUTH,CN T)="NVC : "_IBFP | |
2268 | S IBPUR=$ G(IBARRAY( 161.01,IBI EN,.07,"E" )) | |
2269 | S CNT=CNT +1,^TMP("I BFBWE",$J, IBNAME,DFN ,IBAUTH,CN T)="PURPOS E OF VISIT : "_IBPUR | |
2270 | S IBVND=$ G(IBARRAY( 161.01,IBI EN,.04,"E" )) | |
2271 | S IBVNDA= $G(IBARRAY (161.01,IB IEN,.04,"I ")) | |
2272 | S CNT=CNT +1,^TMP("I BFBWE",$J, IBNAME,DFN ,IBAUTH,CN T)="NON-VA LOCATION : "_IBVND | |
2273 | S IBVNPI= "" | |
2274 | I IBVNDA' ="" S IBVN PI=$$GET1^ DIQ(161.2, IBVNDA_"," ,41.01) | |
2275 | S CNT=CNT +1,^TMP("I BFBWE",$J, IBNAME,DFN ,IBAUTH,CN T)=" NPI# : "_IBVNPI | |
2276 | S IBVTAX= "" | |
2277 | I IBVNDA' ="" S IBVT AX=$$GET1^ DIQ(161.2, IBVNDA_"," ,42) | |
2278 | S CNT=CNT +1,^TMP("I BFBWE",$J, IBNAME,DFN ,IBAUTH,CN T)=" TAXON OMY : "_IB VTAX | |
2279 | S IB7078= $G(IBARRAY (161.01,IB IEN,.055," E")) | |
2280 | S CNT=CNT +1,^TMP("I BFBWE",$J, IBNAME,DFN ,IBAUTH,CN T)="ASSOC 7078/583 : "_IB7078 | |
2281 | S IBREF=$ G(IBARRAY( 161.01,IBI EN,104,"E" )) | |
2282 | S IBREFA= $G(IBARRAY (161.01,IB IEN,104,"I ")) | |
2283 | S CNT=CNT +1,^TMP("I BFBWE",$J, IBNAME,DFN ,IBAUTH,CN T)="ORDERI NG PHYSICI AN: "_IBRE F | |
2284 | S IBNPI=" " | |
2285 | I IBREFA' ="" S IBNP I=$$GET1^D IQ(200,IBR EFA_",",41 .99) | |
2286 | S CNT=CNT +1,^TMP("I BFBWE",$J, IBNAME,DFN ,IBAUTH,CN T)=" NPI# : "_IBNPI | |
2287 | ; Placeho lder if VA starts to use Taxon omy for VA physician s S IBTAX= "" | |
2288 | S CNT=CNT +1,^TMP("I BFBWE",$J, IBNAME,DFN ,IBAUTH,CN T)=" TAXON OMY : "_IB TAX | |
2289 | S IBMT=$P ($G(VAEL(9 )),U,2) | |
2290 | S CNT=CNT+ 1,^TMP("IB FBWE",$J,I BNAME,DFN, IBAUTH,CNT )="MEANS T EST STATUS : "_IBMT | |
2291 | D DISP^IBA RXEU(DFN,I BST,1,"") | |
2292 | S IBCP=$P( $G(X),U,2) | |
2293 | S CNT=CNT+ 1,^TMP("IB FBWE",$J,I BNAME,DFN, IBAUTH,CNT )="MED COP AY EXEMP S T: "_IBCP | |
2294 | S IBDX1=$G (IBARRAY(1 61.01,IBIE N,.08,"E") ) | |
2295 | S CNT=CNT+ 1,^TMP("IB FBWE",$J,I BNAME,DFN, IBAUTH,CNT )="DIAGNOS IS 1: "_IB DX1 | |
2296 | S IBDX2=$G (IBARRAY(1 61.01,IBIE N,.085,"E" )) | |
2297 | S CNT=CNT+ 1,^TMP("IB FBWE",$J,I BNAME,DFN, IBAUTH,CNT )="DIAGNOS IS 2: "_IB DX2 | |
2298 | S IBDX3=$G (IBARRAY(1 61.01,IBIE N,.086,"E" )) | |
2299 | S CNT=CNT+ 1,^TMP("IB FBWE",$J,I BNAME,DFN, IBAUTH,CNT )="DIAGNOS IS 3: "_IB DX3 | |
2300 | S IBICDDX= $G(IBARRAY (161.01,IB IEN,.087," E")) | |
2301 | S CNT=CNT+ 1,^TMP("IB FBWE",$J,I BNAME,DFN, IBAUTH,CNT )="ICD DIA GNOSIS: "_ IBICDDX | |
2302 | I '$D(IBAR RAY(161.01 ,IBIEN,.02 1)) S CNT= CNT+1,^TMP ("IBFBWE", $J,IBNAME, D | |
2303 | FN,IBAUTH, CNT)="AUTH REMARKS : " | |
2304 | S IBREM="" ,IBREM1=1 | |
2305 | F S IBREM= $O(IBARRAY (161.01,IB IEN,.021,I BREM)) Q:I BREM=""!(I BREM="E") | |
2306 | D | |
2307 | . S IBREMA RK=IBARRAY (161.01,IB IEN,.021,I BREM) | |
2308 | . I IBREM1 S CNT=CNT +1,^TMP("I BFBWE",$J, IBNAME,DFN ,IBAUTH,CN T)="AUTH R E | |
2309 | MARKS : "_ IBREMARK,I BREM1=0 | |
2310 | . E S CNT= CNT+1,^TMP ("IBFBWE", $J,IBNAME, DFN,IBAUTH ,CNT)=" | |
2311 | : "_IBREMA RK | |
2312 | Q | |
2313 | BLDEXP ; B uild expan d screen | |
2314 | D FULL^VA LM1 | |
2315 | N IBXX | |
2316 | S DFN=$P( ECNT,U,1), IBNAME=$P( ECNT,U,2), IBAUTH=$P( ECNT,U,3) | |
2317 | S VALMCNT =0 | |
2318 | S IBXX="" | |
2319 | F S IBXX= $O(^TMP("I BFBWE",$J, IBNAME,DFN ,IBAUTH,IB XX)) Q:+IB XX=0 D | |
2320 | . S LINE= ^TMP("IBFB WE",$J,IBN AME,DFN,IB AUTH,IBXX) | |
2321 | . S VALMC NT=VALMCNT +1 | |
2322 | . D SET^V ALM10(VALM CNT,LINE," ") | |
2323 | S VALMCNT =VALMCNT+1 | |
2324 | Q | |
2325 | ; | |
2326 | GETSC ; Ge t SC and S TA | |
2327 | N IBD,IBI ,IBX,IBY,I BSC,IBSC1, FIRST | |
2328 | S FIRST=1 | |
2329 | I VAEL(3) =0 S CNT=C NT+1,^TMP( "IBFBWE",$ J,IBNAME,D FN,IBAUTH, CNT)="SERV ICE CONNEC TED : NO" Q | |
2330 | S IBSC="S ERVICE CON NECTED : " _$P(VAEL(3 ),U,2)_"%" | |
2331 | S CNT=CNT +1,^TMP("I BFBWE",$J, IBNAME,DFN ,IBAUTH,CN T)=IBSC | |
2332 | I '$O(^DP T(DFN,.372 ,0)) S CNT =CNT+1,^TM P("IBFBWE" ,$J,IBNAME ,DFN,IBAUT H,CNT)="RA TED DISABI LITIES: NO NE" Q | |
2333 | S IBI=0 F S IBI=$O( ^DPT(DFN,. 372,IBI)) Q:'IBI D | |
2334 | . S IBX=$ G(^DPT(DFN ,.372,IBI, 0)),IBY=$G (^DIC(31,+ IBX,0)) | |
2335 | . S IBD=$ S($P(IBY,U ,4)="":$P( IBY,U,1),1 :$P(IBY,U, 4))_" ("_$ P(IBX,U,2) _"%-"_$S(+ $P(IBX,U,3 ):"SC",1:" NSC")_")" | |
2336 | . I FIRST S CNT=CNT +1,^TMP("I BFBWE",$J, IBNAME,DFN ,IBAUTH,CN T)="RATED DISABILITI ES: "_IBD, FIRST=0 Q | |
2337 | . S CNT=C NT+1,^TMP( "IBFBWE",$ J,IBNAME,D FN,IBAUTH, CNT)=" "_I BD | |
2338 | Q | |
2339 | ; | |
2340 | GETSTA ; G et Special Authority Eligibili ty | |
2341 | N IBY,FIR ST,FOUND,I BADT,IBARR | |
2342 | S IBADT=I BST | |
2343 | S FOUND=0 | |
2344 | S FIRST=1 | |
2345 | D CL^IBAC V(DFN,IBAD T,"",.IBAR R) | |
2346 | I $D(IBAR R(3)) S IB Y="SC TREA TMENT" D G ETSTA1 | |
2347 | I $D(IBAR R(7)),+$$C VEDT^IBACV (DFN,IBDAT ) S IBY="C OMBAT VETE RAN" D GET STA1 | |
2348 | I $D(IBAR R(1)) S IB Y="AGENT O RANGE" D G ETSTA1 | |
2349 | I $D(IBAR R(2)) S IB Y="IONIZIN G RADIATIO N" D GETST A1 | |
2350 | I $D(IBAR R(4)) S IB Y="SOUTHWE ST ASIA" D GETSTA1 | |
2351 | I $D(IBAR R(8)) S IB Y="PROJECT 112/SHAD" D GETSTA1 | |
2352 | I $D(IBAR R(5)) S IB Y="MILITAR Y SEXUAL T RAUMA" D G ETSTA1 | |
2353 | I $D(IBAR R(6)) S IB Y="HEAD/NE CK CANCER" D GETSTA1 | |
2354 | I 'FOUND S CNT=CNT+ 1,^TMP("IB FBWE",$J,I BNAME,DFN, IBAUTH,CNT )="STA | |
2355 | : NO" Q | |
2356 | Q | |
2357 | ; | |
2358 | GETSTA1 ; Set in ^TM P("IBFBWE" ,$J) | |
2359 | I FIRST S CNT=CNT+1 ,^TMP("IBF BWE",$J,IB NAME,DFN,I BAUTH,CNT) ="SPEC AUT HORITY ELG : "_IBY,FI RST=0,FOUN D=1 Q | |
2360 | S CNT=CNT +1,^TMP("I BFBWE",$J, IBNAME,DFN ,IBAUTH,CN T)=" : "_I BY | |
2361 | Q | |
2362 | ; | |
2363 | GETINS ; G et insuran ce informa tion | |
2364 | N EXDTCK, IBEFF,IBEX P,IBGRP,IB INSCO,IBIN S0,IBINS1, IBINS7,IBS T,IBSUB,IB VERBY,IBVE RDT,IBX,IB INS,IBINSY ES | |
2365 | D ALL^IBC NS1(DFN,"I BINS") | |
2366 | S (IBX,IB INSYES)=0 | |
2367 | I '$D(IBI NS) S CNT= CNT+1,^TMP ("IBFBWE", $J,IBNAME, DFN,IBAUTH ,CNT)="INS URANCE : N O" Q | |
2368 | F S IBX=$ O(IBINS(IB X)) Q:'IBX D | |
2369 | . S IBINS 0=IBINS(IB X,0) | |
2370 | . S IBINS 1=IBINS(IB X,1) | |
2371 | . S IBINS 7=$G(IBINS (IBX,7)) | |
2372 | . S IBINS CO=$P(^DIC (36,+IBINS 0,0),U,1) | |
2373 | . S IBSUB =$P(IBINS7 ,U,1) | |
2374 | . S IBGRP =$P(IBINS0 ,U,3) | |
2375 | . S EXDTC K=+$P(IBIN S0,U,4) | |
2376 | . S IBST= $$GET1^DIQ (161.01,DF N_",",.01, "I") | |
2377 | . I EXDTC K,EXDTCK<I BST Q ; if insurance expired b efore the from date of auth qu it | |
2378 | . S IBINS YES=1 | |
2379 | . S IBEFF =$$DAT1^IB OUTL($P(IB INS0,U,8)) | |
2380 | . S IBEXP =$$DAT1^IB OUTL($P(IB INS0,U,4)) | |
2381 | . S IBVER DT=$P($G(I BINS1),U,3 ) | |
2382 | . S IBVER BY=$P($G(I BINS1),U,4 ) | |
2383 | . I IBVER DT'="" S I BVERDT=$$F DATE^VALM1 (IBVERDT) | |
2384 | . I IBVER BY'="" S I BVERBY="BY "_$$GET1^ DIQ(200,IB VERBY_", " ,.01) | |
2385 | . S CNT=C NT+1,^TMP( "IBFBWE",$ J,IBNAME,D FN,IBAUTH, CNT)="INSU RANCE : "_ IBINSCO | |
2386 | . S CNT=C NT+1,^TMP( "IBFBWE",$ J,IBNAME,D FN,IBAUTH, CNT)=" SUB SCRIBER : "_IBSUB | |
2387 | . S CNT=C NT+1,^TMP( "IBFBWE",$ J,IBNAME,D FN,IBAUTH, CNT)=" GRO UP : "_IBG RP | |
2388 | . S CNT=C NT+1,^TMP( "IBFBWE",$ J,IBNAME,D FN,IBAUTH, CNT)=" EFF DATE : "_ IBEFF | |
2389 | . S CNT=C NT+1,^TMP( "IBFBWE",$ J,IBNAME,D FN,IBAUTH, CNT)=" EXP DATE : "_ IBEXP | |
2390 | . S CNT=C NT+1,^TMP( "IBFBWE",$ J,IBNAME,D FN,IBAUTH, CNT)=" DT LAST VERIF : "_IBVER DT_" "_IBV ERBY | |
2391 | I IBINSYE S=0 S CNT= CNT+1,^TMP (“IBFBWE”, $J,IBNAME, DFN,IBAUTH ,CNT)=”INS URANCE :NO ” | |
2392 | Q | |
2393 | ; | |
2394 | REFRESH ; Special E xpand Scre en Refresh | |
2395 | K ^TMP("I BFBWE",$J) | |
2396 | D BLD | |
2397 | D GETSC | |
2398 | D GETSTA | |
2399 | D GETINS | |
2400 | D BLDEXP | |
2401 | S VALMBCK ="R" | |
2402 | Q | |
2403 | ; | |
2404 | HELP ; -- help code | |
2405 | S X="?" D DISP^XQOR M1 W !! | |
2406 | Q | |
2407 | ; | |
2408 | EXIT ; -- exit code | |
2409 | K ^TMP("I BFBWE",$J) | |
2410 | D ^%ZISC | |
2411 | S VALMBCK ="R" Q | |
2412 | Q | |
2413 | ||
2414 | Routines | |
2415 | Activities | |
2416 | Routine Na me | |
2417 | ^IBFBWL4 – Worklist History | |
2418 | Enhancemen t Category | |
2419 | New | |
2420 | Modify | |
2421 | Delete | |
2422 | No Change | |
2423 | RTM | |
2424 | FRPRE – 1. 1 | |
2425 | Related Op tions | |
2426 | IB NVC PRE CERT WORKL IST | |
2427 | ||
2428 | Related Ro utines | |
2429 | Routines “ Called By” | |
2430 | Routines “ Called” | |
2431 | ||
2432 | Called by IB NVC PRE CERT WORKL IST Action “HI” – HI STORY^IBFB WL | |
2433 | ||
2434 | ||
2435 | ||
2436 | Routines | |
2437 | Activities | |
2438 | Data Dicti onary (DD) Reference s | |
2439 | PATIENT FI LE (#2) | |
2440 | NEW PERSON FILE (#20 0)IB-FB IN TERFACE TR ACKING FIL E (#360) | |
2441 | Related Pr otocols | |
2442 | IB BILLING WORKLIST MENU | |
2443 | IB BILLING WORKLIST HISTORY – HISTORY^IB FBWL | |
2444 | ||
2445 | Related In tegration Control Re gistration s (ICRs) | |
2446 | None | |
2447 | Data Passi ng | |
2448 | Input | |
2449 | Output Re ference | |
2450 | Both | |
2451 | Global Re ference | |
2452 | Local | |
2453 | Input Attr ibute Name and Defin ition | |
2454 | Name: None | |
2455 | Definition : None | |
2456 | Output Att ribute Nam e and Defi nition | |
2457 | Name: None | |
2458 | Definition : None | |
2459 | ||
2460 | Current Lo gic | |
2461 | New Routin e | |
2462 | ||
2463 | Modified L ogic (Chan ges are hi ghlighted) | |
2464 | IBFBWL4 ;A LB/PAW-IB BILLING Wo rklist Wor klist Hist ory ; 30-S EP-2015 | |
2465 | ;;2.0;INT EGRATED BI LLING;**55 4**;21-MAR -94;Build 3 | |
2466 | ;;Per VA Directive 6402, this routine s hould not be modifie d. | |
2467 | ;; | |
2468 | EN ; -- ma in entry p oint for I B BILLING WORKLIST H ISTORY | |
2469 | D EN^VALM ("IB BILLI NG WORKLIS T HISTORY" ) | |
2470 | Q | |
2471 | ; | |
2472 | HDR ; -- h eader code | |
2473 | N IBSS,IB SSX,IBSSLE ,IBSSLS | |
2474 | S VALM("T ITLE")=" W orklist Hi story" | |
2475 | S IBSSX=$ $GET1^DIQ( 2,DFN_",", .09,"I"),I BSSLE=$L(I BSSX),IBSS LS=6 I $E( IB | |
2476 | SSX,IBSSLE )="P" S IB SSLS=5 | |
2477 | S IBSS=$E (IBNAME,1) _$E(IBSSX, IBSSLS,IBS SLE) | |
2478 | S VALMHDR (2)=" PATI ENT: "_IBN AME_" (ID: "_IBSS_") " | |
2479 | Q | |
2480 | ; | |
2481 | INIT ; -- init varia bles and l ist array | |
2482 | ; input - ^TMP("IBF BWH",$J,IB A)=IBHDT^I BHLG^IBHUS R | |
2483 | ; output - Worklist History S creen for one Patien t / Auth | |
2484 | N IBA,IBH DT,IBHLG,I BLN,IBRUR, IBRURT,IBU SR,LINE,VC NT | |
2485 | S (VCNT,V ALMCNT)=0 | |
2486 | S IBA="" | |
2487 | F S IBA=$ O(^TMP("IB FBWH",$J,I BA)) Q:+IB A=0 D | |
2488 | . S IBRUR T="" | |
2489 | . S IBLN= ^TMP("IBFB WH",$J,IBA ) | |
2490 | . S IBHDT =$P(IBLN,U ,1) | |
2491 | . S IBHLG =$P($P(IBL N,U,2),"|" ) | |
2492 | . S IBRUR =$P($P(IBL N,U,2),"|" ,2) | |
2493 | . I IBRUR '="" D RUR | |
2494 | . S IBUSR =$P(IBLN,U ,3) | |
2495 | . I IBUSR ="" S IBUS R="SYSTEM" | |
2496 | . E S IBU SR=$$GET1^ DIQ(200,IB USR_",",.0 1) | |
2497 | . S VCNT= VCNT+1 | |
2498 | . S LINE= $$SETL("", VCNT,"",1, 4) ;line# | |
2499 | . D BLD | |
2500 | Q | |
2501 | ; | |
2502 | RUR ; Dete rmine RUR Reason Cod e | |
2503 | S IBRURT= $S(IBRUR=1 :"Pend Pay er Action" ,IBRUR=2:" Addl Info Req-FR",IB RUR=3:"Aut h Not Req - SC/SA",I BRUR=4:"Au thNotReq-P ayerCont", 1:"") | |
2504 | Q:IBRURT' ="" | |
2505 | S IBRURT= $S(IBRUR=5 :"Auth Not Reqd",IBR UR=6:"Auth Obtained" ,IBRUR=7:" Cont Stay Rev",IBRUR =8:"Discha rge Rev Re q",1:"") | |
2506 | Q:IBRURT' ="" | |
2507 | S IBRURT= $S(IBRUR=9 :"Part SC- Auth Worke d",IBRUR=1 0:"PartSta y/VisitApp d",IBRUR=1 1:"Auth De nied",1:"" ) | |
2508 | Q:IBRURT' ="" | |
2509 | S IBRURT= $S(IBRUR=1 2:"AuthNot Obt/NoROI/ FR",IBRUR= 13:"Relate d to Legal ",1:"") | |
2510 | Q | |
2511 | ; | |
2512 | BLD ; buil d data to display | |
2513 | S LINE=$$ SETL(LINE, IBHDT,"",5 ,8) | |
2514 | S LINE=$$ SETL(LINE, IBHLG,"",1 4,20) | |
2515 | S LINE=$$ SETL(LINE, IBRURT,"", 35,20) | |
2516 | S LINE=$$ SETL(LINE, IBUSR,"",5 6,23) | |
2517 | S VALMCNT =VALMCNT+1 | |
2518 | D SET^VAL M10(VALMCN T,LINE,VCN T) | |
2519 | Q | |
2520 | ; | |
2521 | SETL(LINE, DATA,LABEL ,COL,LNG) ; Creates a line of data to be set into the body | |
2522 | ; of the worklist | |
2523 | ; Input: LINE - Cur rent line being crea ted | |
2524 | ; DATA - Informatio n to be ad ded to the end of th e current line | |
2525 | ; LABEL - Label to describe t he informa tion being added | |
2526 | ; COL - C olumn posi tion in li ne to add informatio n add | |
2527 | ; LNG - M aximum len gth of dat a informat ion to inc lude on th e line | |
2528 | ; Returns : Line upd ated with added info rmation | |
2529 | S LINE=LI NE_$J("",( COL-$L(LAB EL)-$L(LIN E)))_LABEL _$E(DATA,1 ,LNG) | |
2530 | Q LINE | |
2531 | ; | |
2532 | HELP ; -- help code | |
2533 | S X="?" D DISP^XQOR M1 W !! | |
2534 | Q | |
2535 | ; | |
2536 | EXIT ; -- exit code | |
2537 | D ^%ZISC | |
2538 | S VALMBCK ="R" Q | |
2539 | Q | |
2540 | ||
2541 | Routines | |
2542 | Activities | |
2543 | Routine Na me | |
2544 | ^IBFBWL5 – Loop and create mai n Precert Worklist p age | |
2545 | (Note: ^IB FBWL1 is N OT used fo r the Prec ert Workli st. It is used to cr eate the m ain Billin g Worklist page, onl y, NSR #20 110303)The Insurance Verificat ion (IBGRP =1) and RU R Precerti fication ( IBGRP=2) g roups have different sorts. | |
2546 | Enhancemen t Category | |
2547 | New | |
2548 | Modify | |
2549 | Delete | |
2550 | No Change | |
2551 | RTM | |
2552 | FRPRE – 1. 1, FRPRE – 1.1.1.1 – 03, FRPRE – 1.1.1.1 – 07, FBP RE – 1.1.1 .1 – 11 (o mit CHOICE ) | |
2553 | Related Op tions | |
2554 | IB NVC PRE CERT WORKL IST | |
2555 | ||
2556 | Related Ro utines | |
2557 | Routines “ Called By” | |
2558 | Routines “ Called” | |
2559 | ||
2560 | ^IBFBWL | |
2561 | ||
2562 | ||
2563 | ||
2564 | Routines | |
2565 | Activities | |
2566 | Data Dicti onary (DD) Reference s | |
2567 | FEE BASIS PATIENT AU THORIZATIO N SUBFILE (#161.01) | |
2568 | IB-FB INTE RFACE TRAC KING FILE (#360) | |
2569 | INSURANCE COMPANY FI LE (#36) | |
2570 | FEE BASIS CONTRACT F ILE (#161. 43) | |
2571 | Related Pr otocols | |
2572 | IB BILLING WORKLIST MENU | |
2573 | Related In tegration Control Re gistration s (ICRs) | |
2574 | Yes – in p rocess | |
2575 | Data Passi ng | |
2576 | Input | |
2577 | Output Re ference | |
2578 | Both | |
2579 | Global Re ference | |
2580 | Local | |
2581 | Input Attr ibute Name and Defin ition | |
2582 | Name: None | |
2583 | Definition : None | |
2584 | Output Att ribute Nam e and Defi nition | |
2585 | Name: None | |
2586 | Definition : None | |
2587 | ||
2588 | Current Lo gic | |
2589 | New Routin e | |
2590 | ||
2591 | Modified L ogic (Chan ges are hi ghlighted) | |
2592 | IBFBWL5 ;A LB/PAW-IB NVC Precer t Worklist Main ; 30 -SEP-2015 | |
2593 | ;;2.0;INT EGRATED BI LLING;**55 4**;21-MAR -94;Build 3 | |
2594 | ;;Per VA Directive 6402, this routine s hould not be modifie d. | |
2595 | ;; | |
2596 | GETAUT(IBG RP) ; Obta in new aut horization s, based u pon review group | |
2597 | ;required input IBG RP = 1 (IV ) or 2 (RU R) | |
2598 | ;output ^ TMP("IBFBW L",$J), co ntaining a uths for g roup queue | |
2599 | N IBA | |
2600 | S IBA="" | |
2601 | I IBGRP=1 D LOOP1 | |
2602 | I IBGRP=2 D LOOP2 | |
2603 | Q | |
2604 | ; | |
2605 | LOOP1 ; Lo op to crea te Insuran ce Verific ation Work list | |
2606 | F S IBA=$ O(^IBFB(36 0,"IV","IV ",IBA)) Q: IBA="" D | |
2607 | . D BLDTM P | |
2608 | Q | |
2609 | ; | |
2610 | LOOP2 ; Lo op to crea te RUR Wor klist | |
2611 | N IBNRD,I ENROOT | |
2612 | F S IBA=$ O(^IBFB(36 0,"UR","UR ",IBA)) Q: IBA="" D | |
2613 | . S IBNRD =$$GET1^DI Q(360,IBA_ ",",3.01," I") | |
2614 | . I IBNRD >DT Q ; RU R Next Rev iew Date i n future | |
2615 | . I IBNRD '<DT D | |
2616 | .. S IENR OOT="" | |
2617 | .. S FDA( 360,IBA_", ",3.01)="" | |
2618 | .. D UPDA TE^DIE("", "FDA","IEN ROOT") | |
2619 | . D BLDTM P | |
2620 | Q | |
2621 | BLDTMP ; B uild ^TMP( "IBFBWL",$ J) | |
2622 | N DFN,IBA UTH,IBCHO, IBCON,IBDI V,IBDOB,IB IEN,IBNAME ,IBSSN,IBF P,IBST,IBE ND | |
2623 | S IBCHO=" " | |
2624 | I '$D(^IB FB(360,IBA )) Q | |
2625 | S DFN=$$G ET1^DIQ(36 0,IBA_",", .02,"I") | |
2626 | S IBAUTH= $$GET1^DIQ (360,IBA_" ,",.03) | |
2627 | S IBIEN=I BAUTH_","_ DFN_"," | |
2628 | S IBDIV=$ $GET1^DIQ( 161.01,IBI EN_",",101 ,"I") | |
2629 | I IBDIV'= "",$D(FILT ERS(1)) I '$D(FILTER S(1,IBDIV) ) Q ; If f iltering b y select d ivisions | |
2630 | I IBDIV=" ",$D(FILTE RS(1)) Q ; Filtering by divisi on, but no division on auth | |
2631 | I $D(FILT ERS(2)) I '$D(FILTER S(2,DFN)) Q ; If fil tering by select pat ients | |
2632 | S IBCON=$ $GET1^DIQ( 161.01,IBI EN_",",105 ,”I”) ; Ge t contract number | |
2633 | I IBCON S IBCHO=$$G ET1^DIQ(16 1.43,IBIEN _",",4) ; Check CHOI CE Program Indicator on contra ct | |
2634 | I IBCHO=" YES" Q ; B ypass auth s with CHO ICE contra cts | |
2635 | D DEMOS | |
2636 | Q | |
2637 | ; | |
2638 | DEMOS ; Au th Demogra phics | |
2639 | N IBEND,I BFP,IBINDT ,IBSSN,IBS T,IBINS0,I BINSCO,IBI NS,IBSSX,I BSSLE,IBSS LS,VA,VAER R,VADM | |
2640 | D DEM^VAD PT | |
2641 | I VAERR K VADM | |
2642 | S IBNAME= $G(VADM(1) ) S:IBNAME ="" IBNAME =" " | |
2643 | S IBSSX=$ P($G(VADM( 2)),U,1),I BSSLE=$L(I BSSX),IBSS LS=6 I $E( IBSSX,IBSS LE)="P" S IBSSLS=5 | |
2644 | S IBSSN=$ E(IBNAME,1 )_$E(IBSSX ,IBSSLS,IB SSLE) | |
2645 | S IBFP=$$ GET1^DIQ(1 61.01,IBIE N_",",.03) | |
2646 | S IBST=$$ GET1^DIQ(1 61.01,IBIE N_",",.01, "I") | |
2647 | S IBEND=$ $GET1^DIQ( 161.01,IBI EN_",",.02 ,"I") | |
2648 | S IBINDT= IBST | |
2649 | I IBST="" S IBINDT= DT | |
2650 | D ALL^IBC NS1(DFN,"I BINS",1,IB INDT,1) ; Sort in CO B order - Need highe st / PRIMA RY | |
2651 | S IBINS0= $G(IBINS(1 ,0)) | |
2652 | S IBINSCO ="UNK" | |
2653 | I IBINS0' ="" S IBIN SCO=$$GET1 ^DIQ(36,+I BINS0_",", .01) | |
2654 | I IBINS0= "" S IBINS 0=99999999 | |
2655 | ; The nex t two line s sort for IV (IBGRP =1) or RUR (IBGRP=2) | |
2656 | ; IV sort is by pri mary insur ance | |
2657 | ; RUR sor t is by au th start d ate, then primary in surance | |
2658 | I IBGRP=1 S ^TMP("I BFBWL",$J, IBINSCO,IB NAME,DFN,I BAUTH)=IBN AME_U_IBSS N_U_IBFP_U _IBINSCO_U _IBST_U_IB END | |
2659 | I IBGRP=2 S ^TMP("I BFBWL",$J, IBST,IBINS CO,IBNAME, DFN,IBAUTH )=IBNAME_U _IBSSN_U_I BFP_U_IBIN SCO_U_IBST _U_IBEND | |
2660 | Q | |
2661 | ; | |
2662 | ||
2663 | BLDWL ; Bu ild Work L ist Screen | |
2664 | ; Build d isplay lin es | |
2665 | ; Loop by IV (IBGRP =1) or RUR (IBGRP=2) sort | |
2666 | K ^TMP("I BFBWLX",$J ) | |
2667 | N DFN,IBA UTH,IBINS0 ,IBNAME,IB XX,FIRST,L INE,VCNT | |
2668 | S (VALMCN T,FIRST,VC NT,CNT)=0 | |
2669 | I IBGRP=1 D Q | |
2670 | . S IBINS 0="" | |
2671 | . F S IBI NS0=$O(^TM P("IBFBWL" ,$J,IBINS0 )) Q:IBINS 0="" D | |
2672 | .. S IBNA ME="" | |
2673 | .. F S IB NAME=$O(^T MP("IBFBWL ",$J,IBINS 0,IBNAME)) Q:IBNAME= "" D | |
2674 | ... S FIR ST=1 | |
2675 | ... S DFN ="" | |
2676 | ... F S D FN=$O(^TMP ("IBFBWL", $J,IBINS0, IBNAME,DFN )) Q:DFN=" " D | |
2677 | .... S IB AUTH="" | |
2678 | .... F S IBAUTH=$O( ^TMP("IBFB WL",$J,IBI NS0,IBNAME ,DFN,IBAUT H)) Q:IBAU TH="" D | |
2679 | ..... S V CNT=VCNT+1 | |
2680 | ..... S L INE=$$SETL ("",VCNT," ",1,4) ;li ne# | |
2681 | ..... S I BXX=^TMP(" IBFBWL",$J ,IBINS0,IB NAME,DFN,I BAUTH) | |
2682 | ..... D S ETX | |
2683 | I IBGRP=2 D Q | |
2684 | . S IBST= "" | |
2685 | . F S IBS T=$O(^TMP( "IBFBWL",$ J,IBST)) Q :IBST="" D | |
2686 | .. S IBIN S0="" | |
2687 | .. F S IB INS0=$O(^T MP("IBFBWL ",$J,IBST, IBINS0)) Q :IBINS0="" D | |
2688 | ... S IBN AME="" | |
2689 | ... F S I BNAME=$O(^ TMP("IBFBW L",$J,IBST ,IBINS0,IB NAME)) Q:I BNAME="" D | |
2690 | .... S FI RST=1 | |
2691 | .... S DF N="" | |
2692 | .... F S DFN=$O(^TM P("IBFBWL" ,$J,IBST,I BINS0,IBNA ME,DFN)) Q :DFN="" D | |
2693 | ..... S I BAUTH="" | |
2694 | ..... F S IBAUTH=$O (^TMP("IBF BWL",$J,IB ST,IBINS0, IBNAME,DFN ,IBAUTH)) Q:IBAUTH=" " D | |
2695 | ...... S VCNT=VCNT+ 1 | |
2696 | ...... S LINE=$$SET L("",VCNT, "",1,4) ;l ine# | |
2697 | ...... S IBXX=^TMP( "IBFBWL",$ J,IBST,IBI NS0,IBNAME ,DFN,IBAUT H) | |
2698 | ...... D SETX | |
2699 | Q | |
2700 | ; | |
2701 | SETL(LINE, DATA,LABEL ,COL,LNG) ; Creates a line of data to be set into the body | |
2702 | ; of the worklist | |
2703 | ; Input: LINE - Cur rent line being crea ted | |
2704 | ; DATA - Informatio n to be ad ded to the end of th e current line | |
2705 | ; LABEL - Label to describe t he informa tion being added | |
2706 | ; COL - C olumn posi tion in li ne to add informatio n add | |
2707 | ; LNG - M aximum len gth of dat a informat ion to inc lude on th e line | |
2708 | ; Returns : Line upd ated with added info rmation | |
2709 | S LINE=LI NE_$J("",( COL-$L(LAB EL)-$L(LIN E)))_LABEL _$E(DATA,1 ,LNG) | |
2710 | Q LINE | |
2711 | ; | |
2712 | SETX ; Set temp glob al IBFBWLX by VCNT | |
2713 | S IBNAME= $P(IBXX,U) | |
2714 | S LINE=$$ SETL(LINE, IBNAME,"", 3,24) | |
2715 | S LINE=$$ SETL(LINE, $P(IBXX,U, 2),"",29,5 ) | |
2716 | S LINE=$$ SETL(LINE, $P(IBXX,U, 3),"",35,1 0) | |
2717 | S LINE=$$ SETL(LINE, $P(IBXX,U, 4),"",46,1 5) | |
2718 | I $P(IBXX ,U,5)'="" S LINE=$$S ETL(LINE,$ $FDATE^VAL M1($P(IBXX ,U,5)),"", 62,8) | |
2719 | I $P(IBXX ,U,6)'="" S LINE=$$S ETL(LINE,$ $FDATE^VAL M1($P(IBXX ,U,6)),"", 71,8) | |
2720 | S VALMCNT =VALMCNT+1 | |
2721 | D SET^VAL M10(VALMCN T,LINE,VCN T) | |
2722 | S ^TMP("I BFBWLX",$J ,VCNT)=DFN _U_IBNAME_ U_IBAUTH | |
2723 | Q | |
2724 | ||
2725 | Routines | |
2726 | Activities | |
2727 | Routine Na me | |
2728 | ^IBFBWL6 - Precert W orklist Ac tions(Note : ^IBFBWL3 is not us ed for the Precert W orklist. I t is for B illing Wor klist Acti ons, only – NSR #201 10303. The Insurance Verificat ion Group (IBGRP=1) uses diffe rent Workl ist Action s than the RUR Prece rt Group ( IBGRP=2).) | |
2729 | Enhancemen t Category | |
2730 | New | |
2731 | Modify | |
2732 | Delete | |
2733 | No Change | |
2734 | RTM | |
2735 | FBPRE – 1. 1 | |
2736 | Related Op tions | |
2737 | IB NVC PRE CERT WORKL IST | |
2738 | ||
2739 | Related Ro utines | |
2740 | Routines “ Called By” | |
2741 | Routines “ Called” | |
2742 | ||
2743 | ||
2744 | Called by IB NVC PRE CERT WORLI ST Action “WA” – ACT IONS^IBFBW L | |
2745 | None | |
2746 | ||
2747 | Routines | |
2748 | Activities | |
2749 | Data Dicti onary (DD) Reference s | |
2750 | PATIENT FI LE (#2) | |
2751 | Related Pr otocols | |
2752 | IB BILLING WORKLIST MENU | |
2753 | IB BILLING WORKLIST ACTIONS – ACTIONS^IB FBWL | |
2754 | ||
2755 | Correspond ing Menu ( Protocol) | |
2756 | IB NVC PRE CERT WORKL IST IVACTI ON MENU | |
2757 | Action Pro tocols | |
2758 | IB NVC PRE CERT WORKL IST IVPREC ERT – IVDO NE^IBFBWL6 | |
2759 | IB NVC PRE CERT WORKL IST IVREMO VE – IVREM ^IBFBWL6 | |
2760 | ||
2761 | ||
2762 | Correspond ing Menu ( Protocol) | |
2763 | IB NVC PRE CERT WORKL IST RURACT ION MENU | |
2764 | Action Pro tocols | |
2765 | IB NVC PRE CERT WORKL IST RURCOM P - RURDON E^IBFBWL6 | |
2766 | IB NVC PRE CERT WORKL IST RURNRD - RUNRD^I BFBWL6 | |
2767 | IB NVC PRE CERT WORKL IST RURREM OVE - RURE M^IBFBWL6 | |
2768 | Related In tegration Control Re gistration s (ICRs) | |
2769 | None | |
2770 | Data Passi ng | |
2771 | Input | |
2772 | Output Re ference | |
2773 | Both | |
2774 | Global Re ference | |
2775 | Local | |
2776 | Input Attr ibute Name and Defin ition | |
2777 | Name: None | |
2778 | Definition : None | |
2779 | Output Att ribute Nam e and Defi nition | |
2780 | Name: None | |
2781 | Definition : None | |
2782 | ||
2783 | Current Lo gic | |
2784 | New Routin e | |
2785 | ||
2786 | Modified L ogic (Chan ges are hi ghlighted) | |
2787 | IBFBWL6 ;A LB/PAW-IB NVC Precer t Worklist IV and RU R ; 30-SEP -2015 | |
2788 | ;;2.0;INT EGRATED BI LLING;**55 4**;21-MAR -94;Build 3 | |
2789 | ;;Per VA Directive 6402, this routine s hould not be modifie d. | |
2790 | ;; | |
2791 | EN ; -- ma in entry p oint for I B NVC PREC ERT WORKLI ST IV and RUR | |
2792 | ; add cod e to do fi lters here | |
2793 | ; | |
2794 | I IBGRP=1 D EN^VALM ("IB NVC P RECERT WOR KLIST IV") | |
2795 | I IBGRP=2 D EN^VALM ("IB NVC P RECERT WOR KLIST RUR" ) | |
2796 | Q | |
2797 | ; | |
2798 | HDR ; -- h eader code | |
2799 | ; | |
2800 | N IBSS,IB SSX,IBSSLE ,IBSSLS | |
2801 | S VALM("T ITLE")=" W orklist Ac tions" | |
2802 | S IBSSX=$ $GET1^DIQ( 2,DFN_",", .09,"I"),I BSSLE=$L(I BSSX),IBSS LS=6 I $E( IBSSX,IBSS LE)="P" S IBSSLS=5 | |
2803 | S IBSS=$E (IBNAME,1) _$E(IBSSX, IBSSLS,IBS SLE) | |
2804 | S VALMHDR (2)=" PATI ENT: "_IBN AME_" (ID: "_IBSS_") " | |
2805 | Q | |
2806 | ; | |
2807 | INIT ; -- init varia bles and l ist array | |
2808 | ; input - ^TMP("IBF BWA",$J)=D FN^IBNAME^ IBAUTH | |
2809 | ; output - none | |
2810 | N DFN,ECN T,IBAUTH,I BNAME | |
2811 | I '$D(^TM P("IBFBWA" ,$J)) Q | |
2812 | S ECNT=$G (^TMP("IBF BWA",$J)) | |
2813 | S DFN=$P( ECNT,U,1), IBNAME=$P( ECNT,U,2), IBAUTH=$P( ECNT,U,3) | |
2814 | D BLD | |
2815 | Q | |
2816 | ; | |
2817 | ||
2818 | BLD ; Buil d data to display | |
2819 | N IBGRPX, VALMY | |
2820 | D FULL^VA LM1 | |
2821 | S IBGRPX= $S(IBGRP=1 :"Insuranc e Verifica tion",1:"R UR Pre-cer tification ") | |
2822 | I IBGRP=1 D | |
2823 | . D SET^V ALM10(1,"" ,"") | |
2824 | . D SET^V ALM10(2," Available Actions:", "") | |
2825 | . D SET^V ALM10(3,"" ,"") | |
2826 | . D SET^V ALM10(4," Enter 1 if Pre-cert is require d.","") | |
2827 | . D SET^V ALM10(5," Enter 2 if Pre-cert is NOT req uired.","" ) | |
2828 | I IBGRP=2 D | |
2829 | . D SET^V ALM10(1,"A vailable A ctions:"," ") | |
2830 | . D SET^V ALM10(2,"" ,"") | |
2831 | . D SET^V ALM10(3," Enter 1 to remove au th from wo rklist."," ") | |
2832 | . D SET^V ALM10(4," Enter 2 to complete certificat ion.","") | |
2833 | . D SET^V ALM10(5," Enter 3 to set a nex t review d ate.","") | |
2834 | . D RURRC | |
2835 | S VALMBCK ="R" | |
2836 | Q | |
2837 | ; | |
2838 | IVDONE ; I V is compl ete | |
2839 | N IBEVENT ,IBIEN,IEN ROOT | |
2840 | S IENROOT ="" | |
2841 | D FIND | |
2842 | S FDA(360 ,IBIEN_"," ,2.01)="XX " | |
2843 | D UPDATE^ DIE("","FD A","IENROO T") | |
2844 | S FDA(360 ,IBIEN_"," ,2.02)="UR " | |
2845 | D UPDATE^ DIE("","FD A","IENROO T") | |
2846 | D RESET | |
2847 | D NOW^%DT C | |
2848 | S IBEVENT ="IV-Req P recert" | |
2849 | D LOGUPD | |
2850 | W !," Pre -cert for "_IBNAME_" is requir ed. Moved to RUR wor klist." | |
2851 | D PAUSE^V ALM1 | |
2852 | S VALMBCK ="R" | |
2853 | Q | |
2854 | ; | |
2855 | IVREM ; IV Remove Au th from Wo rklist | |
2856 | N IBEVENT ,IBIEN,IEN ROOT | |
2857 | D FIND | |
2858 | S FDA(360 ,IBIEN_"," ,2.01)="XX " | |
2859 | D UPDATE^ DIE("","FD A","IENROO T") | |
2860 | D RESET | |
2861 | D NOW^%DT C | |
2862 | S IBEVENT ="IV-Prece rt not req " | |
2863 | D LOGUPD | |
2864 | W !," Pre -cert for "_IBNAME_" not requi red. Remov ed from wo rklist." | |
2865 | D PAUSE^V ALM1 | |
2866 | S VALMBCK ="R" | |
2867 | Q | |
2868 | ; | |
2869 | RUDONE ; R UR Pre-cer tification is comple te | |
2870 | N IBEVENT ,IBIEN,IBR C,IENROOT | |
2871 | D FIND | |
2872 | S FDA(360 ,IBIEN_"," ,2.02)="XX " | |
2873 | D UPDATE^ DIE("","FD A","IENROO T") | |
2874 | D RESET | |
2875 | D RURRCPR | |
2876 | D NOW^%DT C | |
2877 | S IBEVENT ="RUR-Prec ert comple te|"_$G(IB RC) | |
2878 | D LOGUPD | |
2879 | W !," Aut horization for "_IBN AME_" has completed RUR Pre-ce rtificatio n." | |
2880 | D PAUSE^V ALM1 | |
2881 | S VALMBCK ="R" | |
2882 | Q | |
2883 | ; | |
2884 | RUREM ; RU R Remove A uth from W orklist | |
2885 | N IBEVENT ,IBIEN,IBR C | |
2886 | D FIND | |
2887 | S FDA(360 ,IBIEN_"," ,2.02)="XX " | |
2888 | D UPDATE^ DIE("","FD A","IENROO T") | |
2889 | D RESET | |
2890 | D RURRCPR | |
2891 | D NOW^%DT C | |
2892 | S IBEVENT ="RUR-Prec ert remove d|"_$G(IBR C) | |
2893 | D LOGUPD | |
2894 | W !," Aut horization for "_IBN AME_" has been remov ed from th e worklist ." | |
2895 | W !," Ple ase update Claims Tr acking wit h Non-bill able Reaso n, if need ed." | |
2896 | D PAUSE^V ALM1 | |
2897 | S VALMBCK ="R" | |
2898 | Q | |
2899 | ; | |
2900 | RUNRD ; RU R Set Next Review Da te | |
2901 | N IBNRD,I BIEN,IENRO OT | |
2902 | S (IBNRD, IENROOT)=" " | |
2903 | D FIND | |
2904 | S DIR(0)= "DA^"_DT_" ::EX",DIR( "A")="Next Review Da te: " | |
2905 | ; default to date i s last day of curren t month | |
2906 | S X=DT D DIM^IBYMTC | |
2907 | S DIR("B" )=$$FMTE^X LFDT($E(DT ,1,5)_X) | |
2908 | D ^DIR K DIR Q:$D(D IRUT) | |
2909 | S IBNRD=Y | |
2910 | S FDA(360 ,IBIEN_"," ,3.01)=IBN RD | |
2911 | D UPDATE^ DIE("","FD A","IENROO T") | |
2912 | D RESET | |
2913 | D RURRCPR | |
2914 | D NOW^%DT C | |
2915 | S IBEVENT ="RUR-Next RevDt "_$$ FDATE^VALM 1(IBNRD)_" |"_$G(IBRC ) | |
2916 | D LOGUPD | |
2917 | W !," Nex t review d ate for "_ IBNAME_" h as been se t to "_$$F DATE^VALM1 (IBNRD)_". " | |
2918 | D PAUSE^V ALM1 | |
2919 | S VALMBCK ="R" | |
2920 | Q | |
2921 | ; | |
2922 | FIND ; Fin d Auth Mat ch | |
2923 | N IBX | |
2924 | S IBX="" F S IBX=$O (^IBFB(360 ,"C",DFN,I BX)) Q:IBX ="" D | |
2925 | . I $P(^I BFB(360,IB X,0),U,3)= IBAUTH S I BIEN=IBX | |
2926 | Q | |
2927 | ; | |
2928 | LOGUPD ; U pdate Log | |
2929 | N FDA,IBD T,IBLOG | |
2930 | S IBDT=$$ NOW^XLFDT( ) | |
2931 | S FDA(360 .04,"+1,"_ IBIEN_",", .01)=IBDT, FDA(360.04 ,"+1,"_IBI EN_",",.03 )= | |
2932 | DUZ | |
2933 | S IBLOG=$ P($G(^IBFB (360,IBIEN ,4,0)),U,3 ) | |
2934 | S IBLOG=I BLOG+1 | |
2935 | S FDA(360 .04,"+1,"_ IBIEN_",", .02)=IBEVE NT | |
2936 | D UPDATE^ DIE("","FD A") | |
2937 | S ^IBFB(3 60,"DFN",D FN,DT,IBIE N,IBLOG)=" " | |
2938 | S ^IBFB(3 60,"DT",DT ,DFN,IBIEN ,IBLOG)="" | |
2939 | Q | |
2940 | ; | |
2941 | RESET ; Re set ^TMP g lobal | |
2942 | N IBDOS,I BINS | |
2943 | I IBGRP=1 D | |
2944 | . S IBINS ="" | |
2945 | . F S IBI NS=$O(^TMP ("IBFBWL", $J,IBINS)) Q:IBINS=" " D | |
2946 | .. I $D(^ TMP("IBFBW L",$J,IBIN S,IBNAME,D FN,IBAUTH) ) D | |
2947 | ... K ^TM P("IBFBWL" ,$J,IBINS, IBNAME,DFN ,IBAUTH) | |
2948 | I IBGRP=2 D | |
2949 | . S IBDOS ="" | |
2950 | . F S IBD OS=$O(^TMP ("IBFBWL", $J,IBDOS)) Q:IBDOS=" " D | |
2951 | .. S IBIN S="" F S I BINS=$O(^T MP("IBFBWL ",$J,IBDOS ,IBINS)) Q :IBINS="" D | |
2952 | ... I $D( ^TMP("IBFB WL",$J,IBD OS,IBINS,I BNAME,DFN, IBAUTH)) D | |
2953 | .... K ^T MP("IBFBWL ",$J,IBDOS ,IBINS,IBN AME,DFN,IB AUTH) | |
2954 | Q | |
2955 | ; | |
2956 | ||
2957 | RURRC ; Re ason Codes for RUR o nly (also called fro m ^IBFBWL3 RUR-SC/SA Billing R eview) | |
2958 | D SET^VAL M10(6,""," ") | |
2959 | D SET^VAL M10(7," At the secon d prompt, you may en ter one of the follo wing:","") | |
2960 | D SET^VAL M10(8,""," ") | |
2961 | D SET^VAL M10(9," 1. Pending P ayer Actio n 8. Disch arge Revie w Required ","") | |
2962 | D SET^VAL M10(10," 2 . Addl Inf o Req - Re fer to FR 9. Partial SC Stay - Auth Work ed","") | |
2963 | D SET^VAL M10(11," 3 . Auth Not Reqd - SC /SA 10. Pa rtial Stay /Visit App roved","") | |
2964 | D SET^VAL M10(12," 4 . Auth Not Reqd - Pa yer Contac ted 11. Au th Denied" ,"") | |
2965 | D SET^VAL M10(13," 5 . Auth Not Required 12. Auth N ot Obtaine d/No ROI/S ent to FR" ,"") | |
2966 | D SET^VAL M10(14," 6 . Auth Obt ained 13. Related to Legal","" ) | |
2967 | D SET^VAL M10(15," 7 . Continue d Stay Rev iew","") | |
2968 | Q | |
2969 | ; | |
2970 | RURRCPR ; RUR Reason Code Prom pt | |
2971 | S IBRC="" | |
2972 | K DIR S D IR(0)="NO^ 1:13" | |
2973 | S DIR("A" )="Enter R EASON CODE (1-13) or return: " | |
2974 | S DIR("?" ,1)="Enter a Reason Code betwe en 1 and 1 3 or Enter if no cod e." | |
2975 | D ^DIR K DIR | |
2976 | S IBRC=$G (Y) | |
2977 | Q | |
2978 | ; | |
2979 | HELP ; -- help code | |
2980 | S X="?" D DISP^XQOR M1 W !! | |
2981 | Q | |
2982 | ; | |
2983 | EXIT ; -- exit code | |
2984 | D ^%ZISC | |
2985 | S VALMBCK ="R" | |
2986 | Q | |
2987 | ||
2988 | Routines | |
2989 | Activities | |
2990 | Routine Na me | |
2991 | ^IBFBUTIL – IB FB Ut ilities(No te: Only t he subrout ines ident ified belo w are used in NSR #2 0081010) | |
2992 | Enhancemen t Category | |
2993 | New | |
2994 | Modify | |
2995 | Delete | |
2996 | No Change | |
2997 | RTM | |
2998 | Supports F BPRE – 1.1 , FBPRE – 1.1.1.1 – 01 through FBPRE – 1 .1.1.1 - 1 0 | |
2999 | Related Op tions | |
3000 | IB NVC PRE CERT WORKL IST | |
3001 | ||
3002 | ||
3003 | ||
3004 | ||
3005 | ||
3006 | Related Ro utines | |
3007 | Routines “ Called By” | |
3008 | Routines “ Called” | |
3009 | ||
3010 | DEMOS^IBFB WL1BLD^IBF BWL2 | |
3011 | ||
3012 | None | |
3013 | ||
3014 | Routines | |
3015 | Activities | |
3016 | Data Dicti onary (DD) Reference s | |
3017 | FEE BASIS PATIENT FI LE AUTHORI ZATION SUB FILE (#16 1.01) | |
3018 | IB-FB INTE RFACE TRAC KING FIL E (#360)FEE BASIS PROG RAM FILE ( #161.8)FEE BASIS PAY MENT FILE (#162) | |
3019 | FEE BASIS PHARMACY I NVOICE FIL E (#162.1) | |
3020 | FEE BASIS INVOICE FI LE (#162.5 ) | |
3021 | Related Pr otocols | |
3022 | None | |
3023 | Related In tegration Control Re gistration s (ICRs) | |
3024 | Yes - In p rocess | |
3025 | Data Passi ng | |
3026 | Input | |
3027 | Output Re ference | |
3028 | Both | |
3029 | Global Re ference | |
3030 | Local | |
3031 | Input Attr ibute Name and Defin ition | |
3032 | Name: None | |
3033 | Definition : None | |
3034 | Output Att ribute Nam e and Defi nition | |
3035 | Name: None | |
3036 | Definition : None | |
3037 | ||
3038 | Current Lo gic | |
3039 | New Routin e | |
3040 | ||
3041 | Modified L ogic (Chan ges are hi ghlighted) | |
3042 | New Subrou tine/API t o obtain A uthorizati on Data fo r Worklist GETAUTH(IE NS,AUTHARR ) ; API to call Auth orization Data | |
3043 | D GETS^DI Q(161.01,I ENS,".01;. 02;.021;.0 3;.04;.055 ;.06;.065; .07;.08;.0 85 | |
3044 | ;.086;.087 ;.095;.096 ;.097;101; 104;105"," IEN",AUTHA RR) | |
3045 | Q | |
3046 | ; | |
3047 | New Subrou tine to ge t NVC Paym ent Data u sing Invoi ce | |
3048 | GETPAY(IEN ) ; Get NV C Payment Data using Invoice | |
3049 | N IBFLDS,I BINIEN,IBI NLN1,IBINL N2,IBFPNO1 | |
3050 | S IBINV=$$ GET1^DIQ(3 60,IEN_"," ,1.03,"I") ; Invoice # | |
3051 | S IBFPNO=$ $GET1^DIQ( 161.01,IBI EN_",",.03 ,"I") ; NV C IEN (Typ e) on FEE | |
3052 | BASIS PROG RAM File ( #161.8) | |
3053 | ; For Bill ing Workli st Only, N VC may hav e changed -- Check F ee Basis P a | |
3054 | yment File (#162) | |
3055 | I IBINV'=" " D | |
3056 | . S IBINIE N="" | |
3057 | . S IBINIE N=$O(^FBAA C("C",IBIN V,DFN,IBIN IEN)) Q:IB INIEN="" D | |
3058 | .. S IBINL N1="" | |
3059 | .. S IBINL N1=$O(^FBA AC("C",IBI NV,DFN,IBI NIEN,IBINL N1)) Q:IBI NLN1="" D | |
3060 | ... S IBIN LN2="" | |
3061 | ... S IBIN LN2=$O(^FB AAC("C",IB INV,DFN,IB INIEN,IBIN LN1,IBINLN 2)) Q:IBIN L | |
3062 | N2="" D | |
3063 | .... S IBF PNO1=$$GET 1^DIQ(162. 03,IBINLN2 _","_IBINL N1_","_IBI NIEN_","_D F | |
3064 | N_",",23," I") | |
3065 | .... I $G( IBFPNO1)'= "" S IBFPN O=IBFPNO1 | |
3066 | .... S IBF LDS="2;63; 64;65" | |
3067 | .... D GET S^DIQ(162. 03,IBINLN2 _","_IBINL N1_","_IBI NIEN_","_D FN_",",IBF L | |
3068 | DS,"I","IB RET") ; Ge t Payment Data | |
3069 | Q | |
3070 | ; | |
3071 | ||
3072 | PCR Report – Check f or Prior B illCHKBILL (IBIN) ;Ch eck for pr ior bill | |
3073 | N IBINV,IB FBDT,IBCLM ,IBFBAU | |
3074 | S IBINV=$T R(IBIN," " ,"") | |
3075 | S IBFBDT=" " | |
3076 | F S IBFBDT =$O(^IBFB( 360,"DFN", DFN,IBFBDT )) Q:IBFBD T="" D | |
3077 | . S IBFBAU ="" | |
3078 | . F S IBFB AU=$O(^IBF B(360,"DFN ",DFN,IBFB DT,IBFBAU) ) Q:IBFBAU ="" D | |
3079 | .. I $P($G (^IBFB(360 ,IBFBAU,1) ),U,3)=IBI NV D | |
3080 | ... S IBCL M=$$GET1^D IQ(360,IBF BAU_",",1. 01,"I") | |
3081 | ... I IBCL M'="" S FB INAU=$$PRE CRT^IBTRC1 (IBCLM,18) | |
3082 | ... S FBBI LL=$$GET1^ DIQ(360,IB FBAU_",",1 .02,"I") | |
3083 | ... I FBBI LL'="" S F BSKIP=1 | |
3084 | Q | |
3085 | ; | |
3086 | ||
3087 | Get Begin / End Auth Dates | |
3088 | GETDTS(IBI EN) ;Get B egin and E nd Dates f rom Author ization | |
3089 | S IBST=$$G ET1^DIQ(16 1.01,IBIEN _",",.01," I") | |
3090 | S IBEND=$$ GET1^DIQ(1 61.01,IBIE N_",",.02, "I") | |
3091 | Q | |
3092 | ; | |
3093 | ||
3094 | ||
3095 | Routines | |
3096 | Activities | |
3097 | Routine Na me | |
3098 | ^IBCNS3 – Added abil ity to dis play Date Insurance Verified | |
3099 | Enhancemen t Category | |
3100 | New | |
3101 | Modify | |
3102 | Delete | |
3103 | No Change | |
3104 | RTM | |
3105 | FBPRE 2.1. 1 - 09 | |
3106 | Related Op tions | |
3107 | FB PCR | |
3108 | ||
3109 | Related Ro utines | |
3110 | Routines “ Called By” | |
3111 | Routines “ Called” | |
3112 | ||
3113 | ||
3114 | HDR+18^FBP CR | |
3115 | None | |
3116 | ||
3117 | Routines | |
3118 | Activities | |
3119 | Data Dicti onary (DD) Reference s | |
3120 | INSURANCE FILE (#36) | |
3121 | Related Pr otocols | |
3122 | None | |
3123 | Related In tegration Control Re gistration s (ICRs) | |
3124 | Yes - In p rocess | |
3125 | Data Passi ng | |
3126 | Input | |
3127 | Output Re ference | |
3128 | Both | |
3129 | Global Re ference | |
3130 | Local | |
3131 | Input Attr ibute Name and Defin ition | |
3132 | Name: None | |
3133 | Definition : None | |
3134 | Output Att ribute Nam e and Defi nition | |
3135 | Name: None | |
3136 | Definition : None | |
3137 | ||
3138 | Current Lo gic | |
3139 | See below | |
3140 | ||
3141 | ||
3142 | ||
3143 | Modified L ogic (Chan ges are hi ghlighted) | |
3144 | Added the following lines to c all new di splay with Date Insu rance Veri fied: | |
3145 | +43 I DIS PLAY[5 D H DRV ; IB*2 .0*554 | |
3146 | +44 I DIS PLAY'[5 D HDR ; IB*2 .0*554 | |
3147 | +45 S IBS UB="IBCNS3 ",IBCOUNT= 3,IBQUIT=0 ; IB*2.0* 554 | |
3148 | +46 ; D H DR S IBSUB ="IBCNS3", IBCOUNT=3, IBQUIT=0 ; IB*2.0*55 4 | |
3149 | ||
3150 | If origina l code (no Date Insu rance Veri fied) cont inue as be fore: | |
3151 | From: | |
3152 | +55 . I 'I BQUIT,DISP LAY>1 W !, IBDASH S I BCOUNT=IBC OUNT+1 | |
3153 | To: | |
3154 | +59 . ; I 'IBQUIT,D ISPLAY>1 W !,IBDASH S IBCOUNT= IBCOUNT+1 IB*2.0*554 | |
3155 | +60 . I ' IBQUIT,DIS PLAY'=1,DI SPLAY'=5 W !,IBDASH S IBCOUNT= IBCOUNT+1 ; IB*2.0*5 54 | |
3156 | Code added to proces s new/alte rnate disp lay vs. or iginal dis play: | |
3157 | +89 ; IB*2 .0*554 - s tart | |
3158 | +90 ; S I BX=$$DAT1^ IBOUTL($P( IBPOL0,U,8 )) S IBLIN E=$$FRMLN( IBX,IBLINE ,8,55) | |
3159 | +91 ; S I BX=$$DAT1^ IBOUTL($P( IBPOL0,U,4 )) S IBLIN E=$$FRMLN( IBX,IBLINE ,8,65) | |
3160 | +92 ; S I BX=$$FNDCO V(+IBPOL0, +$P(IBPOL0 ,U,18),$G( IBDATE)) S IBLINE=$$ FRMLN(IBX, IBLINE,6,7 4) | |
3161 | +93 I DIS PLAY[5 D | |
3162 | +94 . S I BX=$$DAT1^ IBOUTL($P( IBPOL0,U,8 )) S IBLIN E=$$FRMLN( IBX,IBLINE ,8,54) | |
3163 | +95 . S I BX=$$DAT1^ IBOUTL($P( IBPOL0,U,4 )) S IBLIN E=$$FRMLN( IBX,IBLINE ,8,63) | |
3164 | +96 . S I BX=$P($G(I BINS(IBPOL FN,1)),U,3 ) I IBX'=" " S IBX=$$ DAT1^IBOUT L( | |
3165 | IBX) S IBL INE=$$FRML N(IBX,IBLI NE,8,72) ; Date Veri fied | |
3166 | +97 I DIS PLAY'[5 D | |
3167 | +98 . S I BX=$$DAT1^ IBOUTL($P( IBPOL0,U,8 )) S IBLIN E=$$FRMLN( IBX,IBLINE ,8,55) | |
3168 | +99 . S I BX=$$DAT1^ IBOUTL($P( IBPOL0,U,4 )) S IBLIN E=$$FRMLN( IBX,IBLINE ,8,65) | |
3169 | +100 . S IBX=$$FNDC OV(+IBPOL0 ,+$P(IBPOL 0,U,18),$G (IBDATE)) S IBLINE=$ $FR | |
3170 | MLN(IBX,IB LINE,6,74) | |
3171 | +101 ; IB *2.0*554 – end | |
3172 | New paragr aph added to print n ew header: | |
3173 | HDRV ; -- print head er for typ e 5 (Verif ied info i ncluded) | |
3174 | N IBX W ! | |
3175 | W !,"Insu rance",?13 ,"COB",?17 ,"Subscrib er ID",?35 ,"Group",? 47,"Holder ",?54,"Eff Dt",?63," Exp Dt",?7 2,"Verifie d" | |
3176 | S IBX="", $P(IBX,"=" ,80)="=" W !,IBX | |
3177 | Q | |
3178 | ; | |
3179 | Templates | |
3180 | Table 8: T emplates | |
3181 | Templates | |
3182 | Descriptio n | |
3183 | Template N ame | |
3184 | The follow ing List M anager Tem plates hav e been add ed for thi s project: | |
3185 | The Pre-ce rtificatio n Worklist utilizes VistA List Manager “ Lists” tha t are supp orted by “ Protocols” . Some of the Workli sts / Prot ocols are “shared” w ith the Bi lling Work list (NSR #20110303) | |
3186 | ||
3187 | List Templ ate (Main) | |
3188 | IB NVC PRE CERT WORKL IST – EN2^ IBFBWL | |
3189 | ||
3190 | List Templ ate (Insur ance Verif ication Ac tions) | |
3191 | IB NVC PRE CERT WORKL IST IV - A CTIONS^IBF BWL | |
3192 | ||
3193 | List Templ ate (RUR P re-certifi cation Act ions) | |
3194 | IB NVC PRE CERT WORKL IST RUR – ACTIONS^IB FBWL | |
3195 | ||
3196 | List Templ ate (Expan d Authoriz ation View ) | |
3197 | IB BILLING WORKLIST EXPAND – E XPAND^IBFB WL | |
3198 | ||
3199 | List Templ ate (Autho rization H istory) | |
3200 | IB BILLING WORKLIST HISTORY – HISTORY^IB FBWL | |
3201 | Correspond ing Menu ( Protocol) | |
3202 | ||
3203 | Enhancemen t Category | |
3204 | New | |
3205 | Modify | |
3206 | Delete | |
3207 | No Change | |
3208 | RSD | |
3209 | None | |
3210 | Template T ype | |
3211 | Sort | |
3212 | Input | |
3213 | ||
3214 | Other | |
3215 | Related Op tions | |
3216 | None | |
3217 | Data Entri es Affecte d by the D esign | |
3218 | No data En tries affe cted by th e Design. | |
3219 | Unique Rec ord(s) | |
3220 | No Unique Records ch anged. | |
3221 | File or Gl obal Size Changes | |
3222 | No File or Global si ze changes . | |
3223 | Mail Group s | |
3224 | No Mail Gr oups chang es. | |
3225 | ||
3226 | ||
3227 | Security K eys | |
3228 | No Securit y Keys cha nged. | |
3229 | Options | |
3230 | Table 9: O ptions | |
3231 | Options | |
3232 | Activities | |
3233 | Option Nam e | |
3234 | IB NVC PRE CERT WORKL IST | |
3235 | Enhancemen t Category | |
3236 | New | |
3237 | Modify | |
3238 | Delete | |
3239 | No Change | |
3240 | Associated Menu Opti ons that w ill invoke this refe rence | |
3241 | None | |
3242 | Data Passi ng | |
3243 | Input | |
3244 | Output | |
3245 | Both | |
3246 | Global Re ference | |
3247 | Local Ref erence | |
3248 | Menu Text Descriptio n | |
3249 | IB NVC Pre cert Workl ist | |
3250 | Option Typ e | |
3251 | Edit | |
3252 | ||
3253 | Menu | |
3254 | Inquire | |
3255 | ||
3256 | Action | |
3257 | Run Routi ne | |
3258 | Other | |
3259 | ||
3260 | Associated Routine | |
3261 | EN2^IBFBWL | |
3262 | Option Def inition | |
3263 | This optio n will dis play the N VC Precert Worklist for Insura nce | |
3264 | Verificat ion and RU R Precerti fication o f Authoriz ations. | |
3265 | Protocols | |
3266 | Table 10: Protocols | |
3267 | Protocols | |
3268 | Activities | |
3269 | Protocol N ame | |
3270 | The Pre-ce rtificatio n Worklist utilizes VistA List Manager “ Lists” tha t are supp orted by “ Protocols” . Some of the Workli sts / Prot ocols are “shared” w ith the Bi lling Work list (NSR #20110303) | |
3271 | ||
3272 | Following details th e relation ship betwe en the Lis t Template s and Prot ocols: | |
3273 | List Templ ate (Main) | |
3274 | IB NVC PRE CERT WORKL IST – EN2^ IBFBWL | |
3275 | Correspond ing Menu ( Protocol) | |
3276 | IB BILLING WORKLIST MENU | |
3277 | Action Pro tocols | |
3278 | IB BILLING WORKLIST REFRESH - REFRESH^IB FBWL | |
3279 | IB BILLING WORKLIST EXPAND - E XPAND^IBFB WL | |
3280 | IB BILLING WORKLIST INSURANCE LINK – LIN KI^IBFBWL | |
3281 | IB BILLING WORKLIST CLAIMS TRA CKING – LI NKCT^IBFBW L | |
3282 | IB BILLING WORKLIST ACTIONS – ACTIONS^IB FBWL | |
3283 | IB BILLING WORKLIST HISTORY – HISTORY^IB FBWL | |
3284 | ||
3285 | List Templ ate (Insur ance Verif ication Ac tions) | |
3286 | IB NVC PRE CERT WORKL IST IV - A CTIONS^IBF BWL | |
3287 | Correspond ing Menu ( Protocol) | |
3288 | IB NVC PRE CERT WORKL IST IVACTI ON MENU | |
3289 | Action Pro tocols | |
3290 | IB NVC PRE CERT WORKL IST IVPREC ERT – IVDO NE^IBFBWL6 | |
3291 | IB NVC PRE CERT WORKL IST IVREMO VE – IVREM ^IBFBWL6 | |
3292 | ||
3293 | List Templ ate (RUR P re-certifi cation Act ions) | |
3294 | IB NVC PRE CERT WORKL IST RUR – ACTIONS^IB FBWL | |
3295 | Correspond ing Menu ( Protocol) | |
3296 | IB NVC PRE CERT WORKL IST RURACT ION MENU | |
3297 | Action Pro tocols | |
3298 | IB NVC PRE CERT WORKL IST RURCOM P - RURDON E^IBFBWL6 | |
3299 | IB NVC PRE CERT WORKL IST RURNRD - RUNRD^I BFBWL6 | |
3300 | IB NVC PRE CERT WORKL IST RURREM OVE - RURE M^IBFBWL6 | |
3301 | ||
3302 | List Templ ate (Expan d Authoriz ation View ) | |
3303 | IB BILLING WORKLIST EXPAND – E XPAND^IBFB WL | |
3304 | Correspond ing Menu ( Protocol) | |
3305 | IB BILLING WORKLIST EXPAND MEN U PROTOCOL | |
3306 | Action Pro tocols | |
3307 | IB BILLING WORKLIST EXPAND REF RESH – REF RESH^IBFBW L2 | |
3308 | ||
3309 | List Templ ate (Autho rization H istory) | |
3310 | IB BILLING WORKLIST HISTORY – HISTORY^IB FBWL | |
3311 | Correspond ing Menu ( Protocol) | |
3312 | None | |
3313 | Action Pro tocols | |
3314 | None | |
3315 | Enhancemen t Category | |
3316 | New Modi fy Delete No Chang e | |
3317 | Associated Protocols | |
3318 | See above | |
3319 | Data Passi ng | |
3320 | Input Ou tput Both Global R eference Local Refe rence | |
3321 | Item Text Descriptio n | |
3322 | None | |
3323 | Protocol T ype | |
3324 | Action M enu Proto col Proto col Menu Limited Pr otocol Ex tended Act ion Dialo g Other | |
3325 | Associated Routine | |
3326 | See above | |
3327 | ||
3328 | ||
3329 | RPC | |
3330 | No RPC cha nges. | |
3331 | Constants Defined in Interface | |
3332 | No Constan ts Defined in Interf ace. | |
3333 | Variables Defined in Interface | |
3334 | No Variabl es Defined in Interf ace. | |
3335 | Types Defi ned in Int erface | |
3336 | No Types d efined in Interface. | |
3337 | GUI | |
3338 | No GUI cha nges. | |
3339 | GUI Classe s | |
3340 | No GUI Cla ss changes . | |
3341 | Current Fo rm | |
3342 | No changes . | |
3343 | Modified F orm | |
3344 | No changes . | |
3345 | Components on Form | |
3346 | No changes . | |
3347 | Events | |
3348 | No Changes . | |
3349 | Methods | |
3350 | No Changes . | |
3351 | Special Re ferences | |
3352 | No changes . | |
3353 | Class Even ts | |
3354 | No changes . | |
3355 | Class Meth ods | |
3356 | No changes . | |
3357 | Class Prop erties | |
3358 | No changes . | |
3359 | Uses Claus e | |
3360 | No changes . | |
3361 | Forms | |
3362 | No changes . | |
3363 | Functions | |
3364 | No changes . | |
3365 | ||
3366 | Dialog | |
3367 | No changes . | |
3368 | Help Frame | |
3369 | No changes . | |
3370 | ||
3371 | HL7 Applic ation Para meter | |
3372 | No changes . | |
3373 | HL7 Logica l Link | |
3374 | No changes . | |
3375 | ||
3376 | Commercial Off-the-S helf (COTS ) Interfac e | |
3377 | No changes . | |
3378 | RPC | |
3379 | Network De tailed Des ign | |
3380 | There are no network topology changes re lated to t his projec t. | |
3381 | Security a nd Privacy | |
3382 | This proje ct does no t add any additional security or privacy design co nsideratio ns. | |
3383 | Security | |
3384 | Security a nd Privacy are contr olled by t he VistA a pplication and the u nderlying operating system. Th is applica tion does not mandat e any addi tional sec urity or p rivacy req uirements. | |
3385 | Privacy | |
3386 | Security a nd Privacy are contr olled by t he VistA a pplication and the u nderlying operating system. Th is applica tion does not mandat e any addi tional sec urity or p rivacy req uirements. | |
3387 | SOA/ESS De tailed Des ign | |
3388 | Not applic able – ref erence Sec tion 4.4. | |
3389 | External S ystem Inte rface Desi gn | |
3390 | Not applic able – the re is no e xternal sy stem invol ved with t his projec t. | |
3391 | Human-Mach ine Interf ace | |
3392 | Not applic able – thi s project does not c hange the human-mach ine interf ace, which is done v ia the Vis tA user op tions. | |
3393 | ||
3394 | Attachment A – Appro val Signat ures | |
3395 | The signat ure below is an ackn owledgemen t that the signatory understan ds the pur pose and c ontent of this docum ent. By si gning this document, you agree to this a s the SDD to begin w ork on the project d escribed w ithin, and commitmen t of the n ecessary r esources. | |
3396 | ||
3397 | ||
3398 | ||
3399 | __________ __________ __________ __________ __________ __________ __________ ______ | |
3400 | Charles Du nn | |
3401 | OI&T Proje ct Manager (PjM),Dat e | |
3402 | Integrate d Project Team (IPT) Co-Chair | |
3403 | ||
3404 | ||
3405 | ||
3406 | __________ __________ __________ __________ __________ __________ __________ ______ | |
3407 | Greg Estes | |
3408 | Business S ponsorDate | |
3409 | ||
3410 | ||
3411 | ||
3412 | __________ __________ __________ __________ __________ __________ __________ ______ | |
3413 | Ann Kliegl | |
3414 | VHA PjM, I PT Co-Chai rDate | |
3415 | ||
3416 | ||
3417 | Attachment B – Acron yms | |
3418 | Term | |
3419 | Definition | |
3420 | AITC | |
3421 | Austin Inf ormation T echnology Center | |
3422 | API | |
3423 | Applicatio n Programm ing Interf ace | |
3424 | BN | |
3425 | Business N eed | |
3426 | BRD | |
3427 | Business R equirement s Document | |
3428 | CBOC | |
3429 | Community Based Outp atient Cli nic | |
3430 | CLC | |
3431 | Community Living Cen ter | |
3432 | COTS | |
3433 | Commercial Off-the-S helf | |
3434 | CP&E | |
3435 | Claims Pro cessing an d Eligibil ity | |
3436 | CPAC | |
3437 | Consolidat ed Patient Account C enter | |
3438 | CPRS | |
3439 | Computeriz ed Patient Record Sy stem | |
3440 | CPT | |
3441 | Current Pr ocedural T erminology | |
3442 | DBMS | |
3443 | Database M anagement System | |
3444 | DD | |
3445 | Data Dicti onary | |
3446 | EDI | |
3447 | Electronic Data Inte rchange | |
3448 | EHR | |
3449 | Electronic Health Re cord | |
3450 | ERD | |
3451 | Entity Rel ationship Diagram | |
3452 | ERR | |
3453 | VA Enterpr ise Requir ements Rep ository | |
3454 | ESS | |
3455 | Enterprise Shared Se rvices | |
3456 | FB | |
3457 | FEE BASIS | |
3458 | FBCS | |
3459 | FEE BASIS Claim Syst em | |
3460 | GUI | |
3461 | Graphical User Inter face | |
3462 | HL7 | |
3463 | Health Lev el 7 | |
3464 | IB | |
3465 | Integrated Billing | |
3466 | ICD-9-CM | |
3467 | Internatio nal Classi fication o f Diseases – 9th Edi tion – Cli nical Modi fication | |
3468 | ICR | |
3469 | Integratio n Control Registrati on | |
3470 | IPT | |
3471 | Integrated Project T eam | |
3472 | LAN | |
3473 | Local Area Network | |
3474 | MCCF | |
3475 | Medical Ca re Collect ions Fund | |
3476 | MDWS | |
3477 | Medical Do main Web S ervices | |
3478 | MUMPS | |
3479 | Massachuse tts Genera l Hospital Utility M ulti-Progr amming Sys tem | |
3480 | NSR | |
3481 | New Servic e Request | |
3482 | NVC | |
3483 | Non-VA Med ical Care | |
3484 | OI&T | |
3485 | Office of Informatio n and Tech nology | |
3486 | PCRR | |
3487 | Potential Cost Recov ery Report | |
3488 | PjM | |
3489 | Project Ma nager | |
3490 | RPC | |
3491 | Remote Pro cedure Cal l | |
3492 | RSD | |
3493 | Requiremen ts Specifi cation Doc ument | |
3494 | RTM | |
3495 | Requiremen ts Traceab ility Matr ix | |
3496 | RUR | |
3497 | Revenue Ut ilization Review | |
3498 | SDD | |
3499 | System Des ign Docume nt | |
3500 | SOA | |
3501 | Service Or iented Arc hitecture | |
3502 | TSPR | |
3503 | Technical Services P roject Rep ository | |
3504 | UR | |
3505 | Utilizatio n Review | |
3506 | USC | |
3507 | United Sta tes Code | |
3508 | VA | |
3509 | Department of Vetera ns Affairs | |
3510 | VAMC | |
3511 | VA Medical Center | |
3512 | VHA | |
3513 | Veterans H ealth Admi nistration | |
3514 | VISN | |
3515 | Veterans I ntegrated Service Ne twork | |
3516 | VistA | |
3517 | Veterans H ealth Info rmation Sy stems and Technology Architect ure | |
3518 | ||
3519 | Attachment C – Addit ional Info rmation | |
3520 | This secti on and its sub-secti ons are to be determ ined. Blan k sections have been kept for version co ntrol. | |
3521 | A.1 Identi fication o f Technolo gy and Sta ndards | |
3522 | A.2 Constr aining Pol icies, Dir ectives an d Procedur es | |
3523 | A.3 RTM | |
3524 | The Billin g Precerti fication f or Fee Car e RTM is a vailable v ia TSPR he re: http:/ / DNS /warboard/ anotebk.as p?proj=178 4&Type=Act ive | |
3525 | A.4 Packag ing and In stallation | |
3526 | A.5 Design Metrics | |
3527 | ||
3528 | Attachment D – Chang e Log | |
3529 | Version | |
3530 | Change | |
3531 | Notes | |
3532 | Status/Res olution | |
3533 | 0.02 | |
3534 | Replace em bedded dia grams with links to master/lat est file l ocation (T SPR) globa lly | |
3535 | Avoids blu rriness an d/or versi on control issues | |
3536 | Completed in v0.032t racked cha nges retur ned to ven dor | |
3537 | 0.02 | |
3538 | Update acr onyms glob ally | |
3539 | ||
3540 | ||
3541 | 0.02 | |
3542 | Section 1. 1: “The en hancements …treatment :” | |
3543 | Not sure o f the rela tionship b etween non -service c onnected t reatment a nd Non-VA care. | |
3544 | ||
3545 | 0.02 | |
3546 | 508d entir e document | |
3547 | Use this t emplate mo ving forwa rd | |
3548 | Completed in v0.02tr acked chan ges return ed to vend or | |
3549 | 0.03 | |
3550 | Globally: Verbiage u pdated to match acro ss all 5 S DDs | |
3551 | ||
3552 | ||
3553 | 0.03 | |
3554 | Globally: Ensure acr onyms are defined at first men tion; upda te Acronym s table ac cordingly | |
3555 | ||
3556 | ||
3557 | 0.03 | |
3558 | Globally: 508 diagra ms – add a lternative text | |
3559 | ||
3560 | ||
3561 | 0.03 | |
3562 | Sections 3 .1.1 and 3 .2.1: Othe r SDDs hav e diagrams here; nee ded? | |
3563 | ||
3564 | ||
3565 | ||
3566 | ||
3567 | Template R evision Hi story | |
3568 | Date | |
3569 | Version | |
3570 | Descriptio n | |
3571 | Author | |
3572 | June 2015 | |
3573 | 2.10 | |
3574 | Changed He ading 1 de fault sett ing to eli minate pag e break be fore | |
3575 | Process Ma nagement | |
3576 | May 2015 | |
3577 | 2.9 | |
3578 | Edited for Section 5 08 conform ance and r emediated with Commo n Look Off ice tool | |
3579 | Process Ma nagement | |
3580 | February 2 015 | |
3581 | 2.8 | |
3582 | Incorporat es revisio ns from PM AS Reform Lockdown; namely rem oving requ irements f or informa tion that can be obt ained from other PMA S authorit ative sour ces. | |
3583 | Andrew Sla wter, Offi ce of Tech nology Str ategies | |
3584 | September 2014 | |
3585 | 2.7 | |
3586 | Adds Enter prise Shar ed Service s terms an d requires AERB Comp liance Cer tificate a ttachment. | |
3587 | Process Ma nagement | |
3588 | August 201 4 | |
3589 | 2.6 | |
3590 | Signature block upda te authori zed by AER B CR_01893 4 | |
3591 | Process Ma nagement | |
3592 | March 2014 | |
3593 | 2.5 | |
3594 | Section 50 8 repairs to new ver sion appro ved by AER B Chair ap proved | |
3595 | Process Ma nagement | |
3596 | August 201 3 | |
3597 | 2.3 | |
3598 | Replaced t he Service Architect ure sub-se ction with new sub-s ections fo r consumed and provi ded servic es. Also a pplied mis cellaneous feedback from VA te am. | |
3599 | ASD Enterp rise Share d Services (ESS) Wor k Group | |
3600 | June 2013 | |
3601 | 1.3 | |
3602 | Upgraded t o MS Offic e 2007-201 0 format | |
3603 | Process Ma nagement | |
3604 | June 2013 | |
3605 | 1.2 | |
3606 | Address in consistenc ies in Sec tion 3, Co nceptual D esign, Cor rect headi ngs | |
3607 | Process Ma nagement | |
3608 | March 2013 | |
3609 | 1.1 | |
3610 | Formatted to documen tation sta ndards and edited fo r Section 508 confor mance | |
3611 | Process Ma nagement | |
3612 | January 20 13 | |
3613 | 1.0 | |
3614 | Initial Do cument | |
3615 | PMAS Busin ess Office | |
3616 | ||
3617 | ||
3618 | See TOGAF® 9.1, Part III: ADM Guidelines & Techniq ues, Gap A nalysis on TOGAF web site at ht tp://pubs. opengroup. org/archit ecture/tog af9-doc/ar ch/chap27. html |
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