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| # | Location | File | Last Modified |
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| 1 | ePharmacy_Bundle 12.zip | TAS ePhm SDD US211 v1.01.docx | Wed Sep 12 15:17:00 2018 UTC |
| 2 | ePharmacy_Bundle 12.zip | TAS ePhm SDD US211 v1.01.docx | Tue Sep 18 15:51:24 2018 UTC |
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| 1 | MCCF EDI T AS US211 | |
| 2 | System Des ign Docume nt | |
| 3 | ||
| 4 | ||
| 5 | ||
| 6 | ||
| 7 | ||
| 8 | Department of Vetera ns Affairs | |
| 9 | July 2018 | |
| 10 | Version 1. 01 | |
| 11 | User Story Number: U SRX-46 | |
| 12 | User Story Name: Pha rmacist Re solve Dual Eligible Claim from Reject In formation Screen | |
| 13 | Product Ba cklog ID: USRX-46 | |
| 14 | Priority: 46 | |
| 15 | Initial Si zing Estim ate: 21 | |
| 16 | Rational I D: 828283 | |
| 17 | Rally ID: US211 | |
| 18 | Epic Taxon omy: Updat e | |
| 19 | ||
| 20 | Design – S ummary | |
| 21 | Currently, the syste m does not allow pro cessing of a claim f or a dual eligible p atient exc ept via th e PRO Opti on. This s tory calls for allow ing the us er to resu bmit a cla im for a d ual-eligib le patient from the Reject Inf ormation S creen off of the Pha rmacist Wo rklist and View/Proc ess. | |
| 22 | ||
| 23 | There are five actio ns that sh ould be af fected by this enhan cement: | |
| 24 | RES Resubm it Claim | |
| 25 | OVR Submit Override Codes | |
| 26 | CLA Submit Clarif. C ode | |
| 27 | PA Submit Prior Auth . | |
| 28 | SMA Submit Mult. Act ions | |
| 29 | ||
| 30 | List of Co mponents: | |
| 31 | Routine: B PSNCPD4 | |
| 32 | Routine: I BNCPDP1 | |
| 33 | Routine: P SOBPSU1 | |
| 34 | Routine: P SOREJP3 | |
| 35 | ||
| 36 | Design – D etail | |
| 37 | The check for dual-e ligibility is in SET INSUR^IBNC PDP1. In t hat subrou tine, if t he Plan is already s pecified, then it by passes the check for dual-elig ibility. C urrently, there are only two t imes that the Plan i s already specified: a) when t he user ha s performe d the PRO Option, an d b) when the user i s resubmit ting a sec ondary cla im. | |
| 38 | ||
| 39 | The system will be m odified so that, whe n the user is perfor ming one o f the acti ons listed above, it determine s the COB, Plan, and Rate Type prior to initiating the claim s submissi on process . | |
| 40 | ||
| 41 | Each of th e five act ions liste d above ev entually c alls SEND^ PSOREJP3, and no oth er action calls this subroutin e. The sub routine SE ND^PSOREJP 3 will be updated to determine the COB, Plan, and Rate Type and to pas s those in to ECMESND ^PSOBPSU1. | |
| 42 | ||
| 43 | Subroutine Name | |
| 44 | SEND^PSORE JP3 | |
| 45 | Enhancemen t Category | |
| 46 | New | |
| 47 | Modify | |
| 48 | ||
| 49 | ||
| 50 | Current Lo gic | |
| 51 | ||
| 52 | PSOREJP3 ; ALB/SS - T hird Party Reject Di splay Scre en - Comme nts ;10/27 /06 | |
| 53 | ; ;7.0;OUTPA TIENT PHAR MACY;**260 ,287,289,2 90,358,359 ,385,403,4 21,427,448 ,482**;DEC 1997;Buil d 27 | |
| 54 | ; Reference to GETDAT^ BPSBUTL su pported by IA 4719 | |
| 55 | ; Reference to COM^BPS SCRU3 supp orted by I A 6214 | |
| 56 | ; | |
| 57 | ||
| 58 | ... | |
| 59 | ||
| 60 | SEND(OVRCO D,CLA,PA,P SOET) ; - Sends Clai m to ECME and closes Reject | |
| 61 | N DIR,RESP, ALTXT,COM, SMA | |
| 62 | S DIR(0)="Y ",DIR("A") =" Con firm",DIR( "B")="YES" | |
| 63 | S DIR("A",1 )=" Wh en you con firm, a ne w claim wi ll be subm itted for" | |
| 64 | S DIR("A",2 )=" th e prescrip tion and t his REJECT will be m arked" | |
| 65 | S DIR("A",3 )=" re solved." | |
| 66 | S DIR("A",4 )=" " | |
| 67 | W ! D ^DIR K DIR I $G (Y)=0!$D(D IRUT) S VA LMBCK="R" Q | |
| 68 | S SMA=0 I $ G(OVRCOD)] "",$G(CLA) ]"",$G(PA) ]"" S SMA= 1 | |
| 69 | S ALTXT="" | |
| 70 | I 'SMA D | |
| 71 | . S ALTXT=" REJECT WOR KLIST" | |
| 72 | . S:$G(OVRC OD)'="" AL TXT=ALTXT_ "-DUR OVER RIDE CODES ("_$TR(OVR COD,"^","/ ")_")" | |
| 73 | . S:$G(CLA) ]"" ALTXT= ALTXT_"-(C LARIF. COD E="_CLA_") " | |
| 74 | . S:$G(PA)] "" ALTXT=A LTXT_"-(PR IOR AUTH.= "_$TR(PA," ^","/")_") " | |
| 75 | D ECMESND^P SOBPSU1(RX ,FILL,,$S( $G(PSOET): "RSNB",1:" ED"),$$GET NDC^PSONDC UT(RX,FILL ),,,$G(OVR COD),,.RES P,,ALTXT,$ G(CLA),$G( PA),$$PSOC OB^PSOREJP 3(RX,FILL, REJ)) | |
| 76 | I $G(RESP) D Q | |
| 77 | . W !!?10," Claim coul d not be s ubmitted. Please try again lat er!" | |
| 78 | . W !,?10," Reason: ", $S($P(RESP ,"^",2)="" :"UNKNOWN" ,1:$P(RESP ,"^",2)),$ C(7) H 2 | |
| 79 | ; | |
| 80 | ; Get the e Pharmacy R esponse Pa use and ha ng for tha t amount o f time (de fault is 2 if not se t) | |
| 81 | N PAUSE,IEN 5286 | |
| 82 | I $G(PSOSIT E)="" N PS OSITE S PS OSITE=$$RX SITE^PSOBP SUT(RX,FIL L) | |
| 83 | S IEN5286=$ O(^PS(52.8 6,"B",+PSO SITE,"")) | |
| 84 | S PAUSE=$$G ET1^DIQ(52 .86,IEN528 6_",",6) | |
| 85 | I PAUSE="" S PAUSE=2 | |
| 86 | I PAUSE H P AUSE | |
| 87 | ; | |
| 88 | I $$PTLBL^P SOREJP2(RX ,FILL) D P RINT(RX,FI LL) | |
| 89 | N PSOTRIC S PSOTRIC=" ",PSOTRIC= $$TRIC^PSO REJP1(RX,F ILL,PSOTRI C) | |
| 90 | I $$GET1^DI Q(52,RX,10 0,"I")=5&( PSOTRIC) D | |
| 91 | . Q:$$STATU S^PSOBPSUT (RX,FILL)' ["PAYABLE" | |
| 92 | . N XXX S X XX="" | |
| 93 | . W !,"This prescript ion can be pulled ea rly from s uspense or the label will prin t" | |
| 94 | . W !,"when PRINT FRO M SUSPENSE occurs.", ! | |
| 95 | . R !,"Pres s enter to continue. .. ",XXX:6 0 | |
| 96 | I $D(PSOSTF LT),PSOSTF LT'="B" S CHANGE=1 | |
| 97 | Q | |
| 98 | ||
| 99 | Modified L ogic (Chan ges are hi ghlighted) | |
| 100 | ||
| 101 | PSOREJP3 ; ALB/SS - T hird Party Reject Di splay Scre en - Comme nts ;10/27 /06 | |
| 102 | ; ;7.0;OUTPA TIENT PHAR MACY;**260 ,287,289,2 90,358,359 ,385,403,4 21,427,448 ,482,512** ;DEC 1997; Build 27 | |
| 103 | ; Reference to GETDAT^ BPSBUTL su pported by IA 4719 | |
| 104 | ; Reference to COM^BPS SCRU3 supp orted by I A 6214 | |
| 105 | ; Reference to IEN59^B PSOSRX sup ported by ICR# 4412 | |
| 106 | ; Reference to GETPL59 ^BPSPRRX5 supported by ICR# TB D | |
| 107 | ; Reference to GETRTP5 9^BPSPRRX5 supported by ICR# T BD | |
| 108 | ; | |
| 109 | ||
| 110 | ... | |
| 111 | ||
| 112 | SEND(OVRCO D,CLA,PA,P SOET) ; - Sends Clai m to ECME and closes Reject | |
| 113 | ; Input: O VRCOD – Up to three ~-pieces, and each p opulated w ould be | |
| 114 | ; Reason for Servi ce Code ^ Prof Srvc Cd ^ Resul t of Srvc Cd | |
| 115 | ; C LA – Submi ssion Clar ification Code #1 ~ SCC #2 ~ S CC #3 | |
| 116 | ; P A – Prior Auth Type ^ Prior Au th Number | |
| 117 | ; P SOET – 1 i f eT/eC ps eudo-rejec t on claim | |
| 118 | N ALTXT,COM ,DIR,PSO59 ,PSOCOB,PS OPLAN,PSOR TYPE,RESP, SMA | |
| 119 | S DIR(0)="Y ",DIR("A") =" Con firm",DIR( "B")="YES" | |
| 120 | S DIR("A",1 )=" Wh en you con firm, a ne w claim wi ll be subm itted for" | |
| 121 | S DIR("A",2 )=" th e prescrip tion and t his REJECT will be m arked" | |
| 122 | S DIR("A",3 )=" re solved." | |
| 123 | S DIR("A",4 )=" " | |
| 124 | W ! D ^DIR K DIR I $G (Y)=0!$D(D IRUT) S VA LMBCK="R" Q | |
| 125 | S SMA=0 I $ G(OVRCOD)] "",$G(CLA) ]"",$G(PA) ]"" S SMA= 1 | |
| 126 | S ALTXT="" | |
| 127 | I 'SMA D | |
| 128 | . S ALTXT=" REJECT WOR KLIST" | |
| 129 | . S:$G(OVRC OD)'="" AL TXT=ALTXT_ "-DUR OVER RIDE CODES ("_$TR(OVR COD,"^","/ ")_")" | |
| 130 | . S:$G(CLA) ]"" ALTXT= ALTXT_"-(C LARIF. COD E="_CLA_") " | |
| 131 | . S:$G(PA)] "" ALTXT=A LTXT_"-(PR IOR AUTH.= "_$TR(PA," ^","/")_") " | |
| 132 | ; | |
| 133 | S PSOCOB=$$ PSOCOB^PSO REJP3(RX,F ILL,REJ) | |
| 134 | S PSO59=$$I EN59^BPSOS RX(RX,FILL ,PSOCOB) | |
| 135 | S PSOPLAN=$ $GETPL59^B PSPRRX5(PS O59) | |
| 136 | S PSORTYPE= $$GETRTP59 ^BPSPRRX5( PSO59) | |
| 137 | ; | |
| 138 | D ECMESND^P SOBPSU1(RX ,FILL,,$S( $G(PSOET): "RSNB",1:" ED"),$$GET NDC^PSONDC UT(RX,FILL ),,,$G(OVR COD),,.RES P,,ALTXT,$ G(CLA),$G( PA),PSOCOB ,PSOPLAN,P SORTYPE) | |
| 139 | I $G(RESP) D Q | |
| 140 | . W !!?10," Claim coul d not be s ubmitted. Please try again lat er!" | |
| 141 | . W !,?10," Reason: ", $S($P(RESP ,"^",2)="" :"UNKNOWN" ,1:$P(RESP ,"^",2)),$ C(7) H 2 | |
| 142 | ; | |
| 143 | ; Get the e Pharmacy R esponse Pa use and ha ng for tha t amount o f time (de fault is 2 if not se t) | |
| 144 | N PAUSE,IEN 5286 | |
| 145 | I $G(PSOSIT E)="" N PS OSITE S PS OSITE=$$RX SITE^PSOBP SUT(RX,FIL L) | |
| 146 | S IEN5286=$ O(^PS(52.8 6,"B",+PSO SITE,"")) | |
| 147 | S PAUSE=$$G ET1^DIQ(52 .86,IEN528 6_",",6) | |
| 148 | I PAUSE="" S PAUSE=2 | |
| 149 | I PAUSE H P AUSE | |
| 150 | ; | |
| 151 | I $$PTLBL^P SOREJP2(RX ,FILL) D P RINT(RX,FI LL) | |
| 152 | N PSOTRIC S PSOTRIC=" ",PSOTRIC= $$TRIC^PSO REJP1(RX,F ILL,PSOTRI C) | |
| 153 | I $$GET1^DI Q(52,RX,10 0,"I")=5&( PSOTRIC) D | |
| 154 | . Q:$$STATU S^PSOBPSUT (RX,FILL)' ["PAYABLE" | |
| 155 | . N XXX S X XX="" | |
| 156 | . W !,"This prescript ion can be pulled ea rly from s uspense or the label will prin t" | |
| 157 | . W !,"when PRINT FRO M SUSPENSE occurs.", ! | |
| 158 | . R !,"Pres s enter to continue. .. ",XXX:6 0 | |
| 159 | I $D(PSOSTF LT),PSOSTF LT'="B" S CHANGE=1 | |
| 160 | Q | |
| 161 | ||
| 162 | ||
| 163 | ||
| 164 | The subrou tine ECMES ND^PSOBPSU 1 will be updated to receive t wo additio nal parame ters – Pla n and Rate Type – an d to pass those into EN^BPSNCP DP. EN^BPS NCPDP alre ady includ es Plan an d Rate Typ e as param eters that may be pa ssed in. | |
| 165 | ||
| 166 | Subroutine Name | |
| 167 | ECMESND^PS OBPSU1 | |
| 168 | Enhancemen t Category | |
| 169 | New | |
| 170 | Modify | |
| 171 | ||
| 172 | ||
| 173 | Current Lo gic | |
| 174 | ||
| 175 | ECMESND(RX ,RFL,DATE, FROM,NDC,C MOP,RVTX,O VRC,CNDC,R ESP,IGSW,A LTX,CLA,PA ,RXCOB,PSO VRIEN) ; - Sends Rx Release | |
| 176 | ; informatio n to ECME/ IB and upd ates NDC i n the file s 50 & 52; DBIA4702 | |
| 177 | ; Input: (r) RX - Rx IEN (#52) | |
| 178 | ; (o) RFL - Re fill # (D efault: mo st recent) | |
| 179 | ; (o) DATE - Da te of Serv ice | |
| 180 | ; (r) FROM - Fu nction wit hin OP (Se e BWHERE p aram. in E N^BPSNCPDP api) | |
| 181 | ; (o) NDC - ND C Number ( If not pas sed, will be retriev ed from DR UG file) | |
| 182 | ; (o) CMOP - CM OP Rx (1-Y ES/0-NO) ( Default: 0 ) | |
| 183 | ; (o) RVTX - RE VERSE text (e.g., RX EDIT, RX RELEASE-ND C CHANGE, etc) | |
| 184 | ; (o) OVRC - Th ree sets o f 3 NCPDP override c odes separ ated by "~ ". Each p iece of th e set | |
| 185 | ; is delimited by an "^" | |
| 186 | ; Pi ece 1: NCP DP Reason for Servic e Code for overridin g DUR REJE CTS | |
| 187 | ; Pi ece 2: NCP DP Profess ional Serv ice Code f or overrid ing DUR RE JECTS | |
| 188 | ; Pi ece 3: NCP DP Result of Service Code for overriding DUR REJEC TS | |
| 189 | ; (o) CNDC - Ch anged NDC? 1 - Yes / 0 - No (D efault: NO ) | |
| 190 | ; (o) IGSW - Ig nore Switc hes (Maste r and CMOP )? 1 - Yes / 0 - No (Default: NO) | |
| 191 | ; (o) ALTX - Al ternative Text to be placed in the Rx EC ME Activit y Log | |
| 192 | ; (o) CLA - NC PDP Clarif ication Co de(s) for overriding DUR/RTS R EJECTS | |
| 193 | ; (o) PA - NC PDP Prior Authorizat ion Type a nd Number (separated by "^") | |
| 194 | ; (o) RXCOB- Pa yer Sequen ce | |
| 195 | ; (O) PSOVRIEN – IEN to B PS NCPDP O VERRIDE (# 9002313.51 1) | |
| 196 | ; Output: RESP - Re sponse fro m $$EN^BPS NCPDP api | |
| 197 | ; | |
| 198 | N ACT,NDCAC T,DA,PSOEL IG,PSOBYPS ,ACT1,SMA | |
| 199 | I '$D(RFL) S RFL=$$LS TRFL(RX) | |
| 200 | ; - ECME is not turne d ON for t he Rx's Di vision | |
| 201 | I '$G(IGSW) ,'$$ECMEON ^BPSUTIL($ $RXSITE^PS OBPSUT(RX, RFL)) S RE SP="-1^ECM E SWITCH O FF" Q | |
| 202 | ; - ECME CM OP is not turned ON for the Rx 's Divisio n | |
| 203 | I '$G(IGSW) ,$G(CMOP), '$$CMOPON^ BPSUTIL($$ RXSITE^PSO BPSUT(RX,R FL)) S RES P="-1^CMOP SWITCH OF F" Q | |
| 204 | ; - Saving the NDC to be displa yed on the ECME Act Log | |
| 205 | I $G(CNDC) D | |
| 206 | . I $G(NDC) '="" S NDC ACT=NDC Q | |
| 207 | . S NDCACT= $$GETNDC^P SONDCUT(RX ,RFL) | |
| 208 | I $$NDCFMT^ PSSNDCUT($ G(NDC))="" D | |
| 209 | . S NDC=$$G ETNDC^PSSN DCUT($$GET 1^DIQ(52,R X,6,"I"),$ $RXSITE^PS OBPSUT(RX, RFL),+$G(C MOP)) | |
| 210 | . I $G(NDC) '="" D SAV NDC^PSONDC UT(RX,RFL, NDC,+$G(CM OP),1) | |
| 211 | S PPDU="",P PDU=$$GPPD U^PSONDCUT (RX,RFL,ND C,,1,FROM) K PPDU | |
| 212 | ; | |
| 213 | ; Determine if this h as multipl e override s from the SMA actio n of the r eject work list | |
| 214 | S SMA=0 | |
| 215 | I $G(OVRC)] "",$G(CLA) ]"" S SMA= 1 | |
| 216 | I $G(OVRC)] "",$G(PA)] "" S SMA=1 | |
| 217 | I $G(CLA)]" ",$G(PA)]" " S SMA=1 | |
| 218 | ; | |
| 219 | ; if the re versal rea son text e xists, rem ove semi-c olons pso *7*448 | |
| 220 | I $G(RVTX)' ="" S RVTX =$TR(RVTX, ";","-") | |
| 221 | ; | |
| 222 | ; - Creatin g ECME Act Log in fi le 52 | |
| 223 | S ACT="" | |
| 224 | I $$STATUS^ PSOBPSUT(R X,RFL)="E PAYABLE" S ACT="Rev/ Resubmit " | |
| 225 | S ACT=ACT_" ECME:" | |
| 226 | ; | |
| 227 | ; - Marked any 'unres olved' REJ ECTS as 'r esolved' ( Reason: 1 - Claim re -submitted ) | |
| 228 | N CLSCOM | |
| 229 | I 'SMA D | |
| 230 | . I $P($G(O VRC),"~")' ="" S CLSC OM="DUR Ov erride Cod es "_$TR($ P(OVRC,"~" ),"^","/") _" submitt ed." | |
| 231 | . I $G(CLA) '="" S CLS COM="Clari fication C ode(s) "_C LA_" submi tted." | |
| 232 | . I $G(PA)' ="" S CLSC OM="Prior Authorizat ion Code ( "_$P(PA,"^ ")_"/"_$P( PA,"^",2)_ ") submitt ed." | |
| 233 | D CLSALL^PS OREJUT(RX, RFL,DUZ,1, $G(CLSCOM) ,$P($G(OVR C),"~",1), $P($G(OVRC ),"~",2),$ P($G(OVRC) ,"~",3),$G (CLA),$G(P A)) | |
| 234 | ; - Call to ECME (NEW ing STAT b ecause ECM E was over writing it - Importa nt variabl e for CMOP release P SXVND) | |
| 235 | N STAT | |
| 236 | I $G(RVTX)= "",FROM="E D" S RVTX= "RX EDITED " | |
| 237 | S RESP=$$EN ^BPSNCPDP( RX,RFL,$$D OS(RX,RFL, .DATE),FRO M,NDC,$G(R VTX),$G(OV RC),,$G(CL A),$G(PA), $G(RXCOB)) | |
| 238 | I $$STATUS^ PSOBPSUT(R X,RFL)="E PAYABLE" D | |
| 239 | . D SAVNDC^ PSONDCUT(R X,RFL,NDC, +$G(CMOP), 1,FROM) | |
| 240 | . ; | |
| 241 | . ; MRD;PSO *7.0*448 - If this i s a resubm it of a cl aim with a n RRR | |
| 242 | . ; reject, and it ca me back E PAYABLE, t hen displa y some add itional | |
| 243 | . ; informa tion about the respo nse to the claim, co nditional upon the | |
| 244 | . ; value o f FROM. | |
| 245 | . ; | |
| 246 | . I ",ED,PE ,PP,RF,RN, RRL,"[("," _FROM_",") ,$$RRR(RX, RFL) D ADD LINFO(RX,R FL,$G(RXCO B)) | |
| 247 | . ; | |
| 248 | . Q | |
| 249 | ; | |
| 250 | ; - Resetin g the Re-t ransmissio n flag | |
| 251 | D RETRXF^PS OREJU2(RX, RFL,0) | |
| 252 | ; Storing e ligibility flag | |
| 253 | S PSOELIG=$ P(RESP,"^" ,3) D:PSOE LIG'="" EL IG^PSOBPSU 2(RX,RFL,P SOELIG) | |
| 254 | ; | |
| 255 | ; Check if this is a bypass RX- claim. If it is, wr ite it to the Bypass -Override Report | |
| 256 | S PSOBYPS=$ $BYPASS(PS OELIG,$P(R ESP,"^",2) ) | |
| 257 | I PSOBYPS D EN^PSOBOR P2(RX,RFL, RESP) | |
| 258 | ; | |
| 259 | ; If from S MA action, split mes sage acros s multiple log entri es | |
| 260 | ; The last entry will be filed in the cod e that fol lows this section as we append other dat a | |
| 261 | ; to the last messa ge. | |
| 262 | I SMA,+RESP '=2,+RESP' =6,+RESP'= 10 D | |
| 263 | . N MSG | |
| 264 | . ; If ther e are DUR overrides, create th e message and file i t since th is will ne ver be the last mess age | |
| 265 | . I $G(OVRC )]"" D | |
| 266 | . . S MSG=AC T_"REJECT WORKLIST-D UR OVERRID E CODES("_ $TR(OVRC," ^","/")_") " | |
| 267 | . . D RXACT^ PSOBPSU2(R X,RFL,MSG, "M",DUZ) | |
| 268 | . ; If ther e are Clar ification codes, cre ate the me ssage | |
| 269 | . ; Only fi le it if w e also hav e a Prior Auth messa ge. | |
| 270 | . ; Otherwi se more da ta will be added to it and it will be fi led below. | |
| 271 | . I $G(CLA) ]"" D | |
| 272 | . . S MSG=AC T_"REJECT WORKLIST-( CLARIF. CO DE="_CLA_" )" | |
| 273 | . . I $G(PA) ]"" D RXAC T^PSOBPSU2 (RX,RFL,MS G,"M",DUZ) | |
| 274 | . ; If ther e are Prio r Auth ove rrides, cr eate the m essage. | |
| 275 | . ; More da ta will be added to it and it will be fi led below. | |
| 276 | . I $G(PA)] "" D | |
| 277 | . . S ALTX=" REJECT WOR KLIST-(PRI OR AUTH.=" _$TR(PA,"^ ","/")_")" | |
| 278 | ; | |
| 279 | ; - Logging ECME Act Log to fil e 52 | |
| 280 | I $G(ALTX)= "" D | |
| 281 | . N X,ROUTE S (ROUTE, X)="" | |
| 282 | . S ROUTE=$ S(FROM="RF ":$$GET1^D IQ(52.1,RF L_","_RX_" ,",2),FROM ="OF":$$GE T1^DIQ(52, RX_",",11) ,1:"") | |
| 283 | . S:FROM="O F" X=ROUTE _" FILL(ND C:"_$$GETN DC^PSONDCU T(RX,RFL)_ ")" | |
| 284 | . S:FROM="R F" X=ROUTE _" REFILL( NDC:"_$$GE TNDC^PSOND CUT(RX,RFL )_")" | |
| 285 | . S:FROM="R N" X="RX R ENEWED(NDC :"_$$GETND C^PSONDCUT (RX,RFL)_" )" | |
| 286 | . S:FROM="P L" X="PRIN TED FROM S USPENSE(ND C:"_$$GETN DC^PSONDCU T(RX,RFL)_ ")" | |
| 287 | . S:FROM="P E"!(FROM=" PP") X="PU LLED FROM SUSPENSE(N DC:"_$$GET NDC^PSONDC UT(RX,RFL) _")" | |
| 288 | . S:FROM="P C" X="CMOP TRANSMISS ION(NDC:"_ $$GETNDC^P SONDCUT(RX ,RFL)_")" | |
| 289 | . S:FROM="R RL"!(FROM= "CRRL") X= "RELEASED RX PREVIOU SLY REVERS ED" | |
| 290 | . S:FROM="E D" X="RX E DITED" | |
| 291 | . S:$G(RVTX )'="" X=RV TX | |
| 292 | . I 'SMA,$G (OVRC)'="" S X="DUR OVERRIDE C ODES("_$TR (OVRC,"^", "/")_")" | |
| 293 | . S:$G(CNDC ) X=X_"(ND C:"_NDCACT _")" S ACT =ACT_X | |
| 294 | . S ACT=ACT _$$STS(RX, RFL,RESP) | |
| 295 | I $G(ALTX)' ="" S ACT= ACT_ALTX_$ $STS(RX,RF L,RESP) | |
| 296 | I +RESP=2 S ACT="Not ECME Billa ble: "_$P( RESP,"^",2 ) | |
| 297 | I +RESP=6 S ACT=$P(RE SP,"^",2) | |
| 298 | I +RESP=10 S ACT="ECM E reversed /NOT re-su bmitted: " _$P(RESP," ^",2) | |
| 299 | S :PSOELIG=" T" ACT="TR ICARE-"_AC T | |
| 300 | S :PSOELIG=" C" ACT="CH AMPVA-"_AC T | |
| 301 | S ACT1="" | |
| 302 | I $P(RESP," ^",6),$P(R ESP,"^",7) '="" S AC T1="-"_$S( $P(RESP,"^ ",6)="2":" s",$P(RESP ,"^",6)="3 ":"t",1:"p ")_$P(RESP ,"^",7) | |
| 303 | S ACT=$E(AC T_ACT1,1,7 5) | |
| 304 | D RXACT^PSO BPSU2(RX,R FL,ACT,"M" ,DUZ) | |
| 305 | D ELOG^PSOB PSU2(RESP) ;-Logs a n ECME Act Log if Rx Qty is di fferent th an Billing Qty | |
| 306 | ; If not a bypass RX- claim, the n call TRI CCHK so th e user can process | |
| 307 | I PSOELIG=" T"!(PSOELI G="C"),'PS OBYPS D TR ICCHK^PSOR EJU3(RX,RF L,RESP,FRO M,$G(RVTX) ) | |
| 308 | Q | |
| 309 | ||
| 310 | Modified L ogic (Chan ges are hi ghlighted) | |
| 311 | ||
| 312 | ECMESND(RX ,RFL,DATE, FROM,NDC,C MOP,RVTX,O VRC,CNDC,R ESP,IGSW,A LTX,CLA,PA ,RXCOB,PSO VRIEN,PSOP LAN,PSORTY PE) ; - Se nds Rx Rel ease | |
| 313 | ; informatio n to ECME/ IB and upd ates NDC i n the file s 50 & 52; DBIA4702 | |
| 314 | ; Input: (r) RX - Rx IEN (#52) | |
| 315 | ; (o) RFL - Re fill # (D efault: mo st recent) | |
| 316 | ; (o) DATE - Da te of Serv ice | |
| 317 | ; (r) FROM - Fu nction wit hin OP (Se e BWHERE p aram. in E N^BPSNCPDP api) | |
| 318 | ; (o) NDC - ND C Number ( If not pas sed, will be retriev ed from DR UG file) | |
| 319 | ; (o) CMOP - CM OP Rx (1-Y ES/0-NO) ( Default: 0 ) | |
| 320 | ; (o) RVTX - RE VERSE text (e.g., RX EDIT, RX RELEASE-ND C CHANGE, etc) | |
| 321 | ; (o) OVRC - Th ree sets o f 3 NCPDP override c odes separ ated by "~ ". Each p iece of th e set | |
| 322 | ; is delimited by an "^" | |
| 323 | ; Pi ece 1: NCP DP Reason for Servic e Code for overridin g DUR REJE CTS | |
| 324 | ; Pi ece 2: NCP DP Profess ional Serv ice Code f or overrid ing DUR RE JECTS | |
| 325 | ; Pi ece 3: NCP DP Result of Service Code for overriding DUR REJEC TS | |
| 326 | ; (o) CNDC - Ch anged NDC? 1 - Yes / 0 - No (D efault: NO ) | |
| 327 | ; (o) IGSW - Ig nore Switc hes (Maste r and CMOP )? 1 - Yes / 0 - No (Default: NO) | |
| 328 | ; (o) ALTX - Al ternative Text to be placed in the Rx EC ME Activit y Log | |
| 329 | ; (o) CLA - NC PDP Clarif ication Co de(s) for overriding DUR/RTS R EJECTS | |
| 330 | ; (o) PA - NC PDP Prior Authorizat ion Type a nd Number (separated by "^") | |
| 331 | ; (o) RXCOB- Pa yer Sequen ce | |
| 332 | ; (O) PSOVRIEN – IEN to B PS NCPDP O VERRIDE (# 9002313.51 1) | |
| 333 | ; (o) PSOPLAN – IEN to fi le# 355.3, GROUP INS URANCE PLA N | |
| 334 | ; (o) PSORTYPE – IEN to f ile# 399.3 , RATE TYP E | |
| 335 | ; Output: RESP - Re sponse fro m $$EN^BPS NCPDP api | |
| 336 | ; | |
| 337 | N ACT,NDCAC T,DA,PSOEL IG,PSOBYPS ,ACT1,SMA | |
| 338 | I '$D(RFL) S RFL=$$LS TRFL(RX) | |
| 339 | ; - ECME is not turne d ON for t he Rx's Di vision | |
| 340 | I '$G(IGSW) ,'$$ECMEON ^BPSUTIL($ $RXSITE^PS OBPSUT(RX, RFL)) S RE SP="-1^ECM E SWITCH O FF" Q | |
| 341 | ; - ECME CM OP is not turned ON for the Rx 's Divisio n | |
| 342 | I '$G(IGSW) ,$G(CMOP), '$$CMOPON^ BPSUTIL($$ RXSITE^PSO BPSUT(RX,R FL)) S RES P="-1^CMOP SWITCH OF F" Q | |
| 343 | ; - Saving the NDC to be displa yed on the ECME Act Log | |
| 344 | I $G(CNDC) D | |
| 345 | . I $G(NDC) '="" S NDC ACT=NDC Q | |
| 346 | . S NDCACT= $$GETNDC^P SONDCUT(RX ,RFL) | |
| 347 | I $$NDCFMT^ PSSNDCUT($ G(NDC))="" D | |
| 348 | . S NDC=$$G ETNDC^PSSN DCUT($$GET 1^DIQ(52,R X,6,"I"),$ $RXSITE^PS OBPSUT(RX, RFL),+$G(C MOP)) | |
| 349 | . I $G(NDC) '="" D SAV NDC^PSONDC UT(RX,RFL, NDC,+$G(CM OP),1) | |
| 350 | S PPDU="",P PDU=$$GPPD U^PSONDCUT (RX,RFL,ND C,,1,FROM) K PPDU | |
| 351 | ; | |
| 352 | ; Determine if this h as multipl e override s from the SMA actio n of the r eject work list | |
| 353 | S SMA=0 | |
| 354 | I $G(OVRC)] "",$G(CLA) ]"" S SMA= 1 | |
| 355 | I $G(OVRC)] "",$G(PA)] "" S SMA=1 | |
| 356 | I $G(CLA)]" ",$G(PA)]" " S SMA=1 | |
| 357 | ; | |
| 358 | ; if the re versal rea son text e xists, rem ove semi-c olons pso *7*448 | |
| 359 | I $G(RVTX)' ="" S RVTX =$TR(RVTX, ";","-") | |
| 360 | ; | |
| 361 | ; - Creatin g ECME Act Log in fi le 52 | |
| 362 | S ACT="" | |
| 363 | I $$STATUS^ PSOBPSUT(R X,RFL)="E PAYABLE" S ACT="Rev/ Resubmit " | |
| 364 | S ACT=ACT_" ECME:" | |
| 365 | ; | |
| 366 | ; - Marked any 'unres olved' REJ ECTS as 'r esolved' ( Reason: 1 - Claim re -submitted ) | |
| 367 | N CLSCOM | |
| 368 | I 'SMA D | |
| 369 | . I $P($G(O VRC),"~")' ="" S CLSC OM="DUR Ov erride Cod es "_$TR($ P(OVRC,"~" ),"^","/") _" submitt ed." | |
| 370 | . I $G(CLA) '="" S CLS COM="Clari fication C ode(s) "_C LA_" submi tted." | |
| 371 | . I $G(PA)' ="" S CLSC OM="Prior Authorizat ion Code ( "_$P(PA,"^ ")_"/"_$P( PA,"^",2)_ ") submitt ed." | |
| 372 | D CLSALL^PS OREJUT(RX, RFL,DUZ,1, $G(CLSCOM) ,$P($G(OVR C),"~",1), $P($G(OVRC ),"~",2),$ P($G(OVRC) ,"~",3),$G (CLA),$G(P A)) | |
| 373 | ; - Call to ECME (NEW ing STAT b ecause ECM E was over writing it - Importa nt variabl e for CMOP release P SXVND) | |
| 374 | N STAT | |
| 375 | I $G(RVTX)= "",FROM="E D" S RVTX= "RX EDITED " | |
| 376 | S RESP=$$EN ^BPSNCPDP( RX,RFL,$$D OS(RX,RFL, .DATE),FRO M,NDC,$G(R VTX),$G(OV RC),$G(PSO VRIEN),$G( CLA),$G(PA ),$G(RXCOB ),,,,$G(PS OPLAN),,$G (PSORTYPE) ) | |
| 377 | I $$STATUS^ PSOBPSUT(R X,RFL)="E PAYABLE" D | |
| 378 | . D SAVNDC^ PSONDCUT(R X,RFL,NDC, +$G(CMOP), 1,FROM) | |
| 379 | . ; | |
| 380 | . ; MRD;PSO *7.0*448 - If this i s a resubm it of a cl aim with a n RRR | |
| 381 | . ; reject, and it ca me back E PAYABLE, t hen displa y some add itional | |
| 382 | . ; informa tion about the respo nse to the claim, co nditional upon the | |
| 383 | . ; value o f FROM. | |
| 384 | . ; | |
| 385 | . I ",ED,PE ,PP,RF,RN, RRL,"[("," _FROM_",") ,$$RRR(RX, RFL) D ADD LINFO(RX,R FL,$G(RXCO B)) | |
| 386 | . ; | |
| 387 | . Q | |
| 388 | ; | |
| 389 | ; - Resetin g the Re-t ransmissio n flag | |
| 390 | D RETRXF^PS OREJU2(RX, RFL,0) | |
| 391 | ; Storing e ligibility flag | |
| 392 | S PSOELIG=$ P(RESP,"^" ,3) D:PSOE LIG'="" EL IG^PSOBPSU 2(RX,RFL,P SOELIG) | |
| 393 | ; | |
| 394 | ; Check if this is a bypass RX- claim. If it is, wr ite it to the Bypass -Override Report | |
| 395 | S PSOBYPS=$ $BYPASS(PS OELIG,$P(R ESP,"^",2) ) | |
| 396 | I PSOBYPS D EN^PSOBOR P2(RX,RFL, RESP) | |
| 397 | ; | |
| 398 | ; If from S MA action, split mes sage acros s multiple log entri es | |
| 399 | ; The last entry will be filed in the cod e that fol lows this section as we append other dat a | |
| 400 | ; to the last messa ge. | |
| 401 | I SMA,+RESP '=2,+RESP' =6,+RESP'= 10 D | |
| 402 | . N MSG | |
| 403 | . ; If ther e are DUR overrides, create th e message and file i t since th is will ne ver be the last mess age | |
| 404 | . I $G(OVRC )]"" D | |
| 405 | . . S MSG=AC T_"REJECT WORKLIST-D UR OVERRID E CODES("_ $TR(OVRC," ^","/")_") " | |
| 406 | . . D RXACT^ PSOBPSU2(R X,RFL,MSG, "M",DUZ) | |
| 407 | . ; If ther e are Clar ification codes, cre ate the me ssage | |
| 408 | . ; Only fi le it if w e also hav e a Prior Auth messa ge. | |
| 409 | . ; Otherwi se more da ta will be added to it and it will be fi led below. | |
| 410 | . I $G(CLA) ]"" D | |
| 411 | . . S MSG=AC T_"REJECT WORKLIST-( CLARIF. CO DE="_CLA_" )" | |
| 412 | . . I $G(PA) ]"" D RXAC T^PSOBPSU2 (RX,RFL,MS G,"M",DUZ) | |
| 413 | . ; If ther e are Prio r Auth ove rrides, cr eate the m essage. | |
| 414 | . ; More da ta will be added to it and it will be fi led below. | |
| 415 | . I $G(PA)] "" D | |
| 416 | . . S ALTX=" REJECT WOR KLIST-(PRI OR AUTH.=" _$TR(PA,"^ ","/")_")" | |
| 417 | ; | |
| 418 | ; - Logging ECME Act Log to fil e 52 | |
| 419 | I $G(ALTX)= "" D | |
| 420 | . N X,ROUTE S (ROUTE, X)="" | |
| 421 | . S ROUTE=$ S(FROM="RF ":$$GET1^D IQ(52.1,RF L_","_RX_" ,",2),FROM ="OF":$$GE T1^DIQ(52, RX_",",11) ,1:"") | |
| 422 | . S:FROM="O F" X=ROUTE _" FILL(ND C:"_$$GETN DC^PSONDCU T(RX,RFL)_ ")" | |
| 423 | . S:FROM="R F" X=ROUTE _" REFILL( NDC:"_$$GE TNDC^PSOND CUT(RX,RFL )_")" | |
| 424 | . S:FROM="R N" X="RX R ENEWED(NDC :"_$$GETND C^PSONDCUT (RX,RFL)_" )" | |
| 425 | . S:FROM="P L" X="PRIN TED FROM S USPENSE(ND C:"_$$GETN DC^PSONDCU T(RX,RFL)_ ")" | |
| 426 | . S:FROM="P E"!(FROM=" PP") X="PU LLED FROM SUSPENSE(N DC:"_$$GET NDC^PSONDC UT(RX,RFL) _")" | |
| 427 | . S:FROM="P C" X="CMOP TRANSMISS ION(NDC:"_ $$GETNDC^P SONDCUT(RX ,RFL)_")" | |
| 428 | . S:FROM="R RL"!(FROM= "CRRL") X= "RELEASED RX PREVIOU SLY REVERS ED" | |
| 429 | . S:FROM="E D" X="RX E DITED" | |
| 430 | . S:$G(RVTX )'="" X=RV TX | |
| 431 | . I 'SMA,$G (OVRC)'="" S X="DUR OVERRIDE C ODES("_$TR (OVRC,"^", "/")_")" | |
| 432 | . S:$G(CNDC ) X=X_"(ND C:"_NDCACT _")" S ACT =ACT_X | |
| 433 | . S ACT=ACT _$$STS(RX, RFL,RESP) | |
| 434 | I $G(ALTX)' ="" S ACT= ACT_ALTX_$ $STS(RX,RF L,RESP) | |
| 435 | I +RESP=2 S ACT="Not ECME Billa ble: "_$P( RESP,"^",2 ) | |
| 436 | I +RESP=6 S ACT=$P(RE SP,"^",2) | |
| 437 | I +RESP=10 S ACT="ECM E reversed /NOT re-su bmitted: " _$P(RESP," ^",2) | |
| 438 | S :PSOELIG=" T" ACT="TR ICARE-"_AC T | |
| 439 | S :PSOELIG=" C" ACT="CH AMPVA-"_AC T | |
| 440 | S ACT1="" | |
| 441 | I $P(RESP," ^",6),$P(R ESP,"^",7) '="" S AC T1="-"_$S( $P(RESP,"^ ",6)="2":" s",$P(RESP ,"^",6)="3 ":"t",1:"p ")_$P(RESP ,"^",7) | |
| 442 | S ACT=$E(AC T_ACT1,1,7 5) | |
| 443 | D RXACT^PSO BPSU2(RX,R FL,ACT,"M" ,DUZ) | |
| 444 | D ELOG^PSOB PSU2(RESP) ;-Logs a n ECME Act Log if Rx Qty is di fferent th an Billing Qty | |
| 445 | ; If not a bypass RX- claim, the n call TRI CCHK so th e user can process | |
| 446 | I PSOELIG=" T"!(PSOELI G="C"),'PS OBYPS D TR ICCHK^PSOR EJU3(RX,RF L,RESP,FRO M,$G(RVTX) ) | |
| 447 | Q | |
| 448 | ||
| 449 | ||
| 450 | ||
| 451 | Currently, in the su broutine R EVRESUB^BP SNCPD4, th e Plan and Rate Type passed in to the cla im submiss ion proces s are used only for secondary claims (wh en the COB indicator is 2). Wi th this en hancement, the Plan and Rate T ype will b e used whe never pass ed in. | |
| 452 | ||
| 453 | Subroutine Name | |
| 454 | REVRESUB^B PSNCPD4 | |
| 455 | Enhancemen t Category | |
| 456 | New | |
| 457 | Modify | |
| 458 | ||
| 459 | ||
| 460 | Current Lo gic | |
| 461 | ||
| 462 | ; == reversa l+resubmit for payab les | |
| 463 | ; returns: | |
| 464 | ; 0 - Submi tted throu gh ECME | |
| 465 | ; or | |
| 466 | ; RESPONSE code^CLAMS TAT^D(disp lay messag e)^number of seconds to hang^a dditional info | |
| 467 | ; see EN^BP SNCPD4 for RESPONSE values | |
| 468 | REVRESUB(B PREVREQ,BR XIEN,BFILL ,DOS,BWHER E,BILLNDC, REVREAS,DU RREC,BPOVR IEN,BPSCLA RF,BPSAUTH ,BPSDELAY, BPCOBIND,B PJOBFLG,IE N59,DFN,BP START,BPRE QIEN,OLDRE SP,BPSELIG ,BPSRTYPE, BPSPLAN,BP SPRDAT) ; | |
| 469 | N BPSITE,BP ECMOFF,BPS ARRY,MORED ATA,IB,BPR ETV,BPZRET ,BPCLMST,B PONLREV,BP RETVAL,BPU SRMSG,CERT IEN,BPRESP ,BPRETUNC | |
| 470 | I BPJOBFLG' ="F",BPJOB FLG'="B" D LOG^BPSOS L(IEN59,$T (+0)_"-Job Flag miss ing") Q "5 ^Job Flag missing" ;RESPONSE^ CLMSTAT | |
| 471 | I BPJOBFLG= "B" D LOG^ BPSOSL(IEN 59,$T(+0)_ "-Reversal +Resubmit cannot be done in ba ckground") Q "5^Reve rsal+Resub mit cannot be done i n backgrou nd" ;RESP ONSE^CLMST AT | |
| 472 | S BPCLMST=" ",BPONLREV =0,BPRESP= "" | |
| 473 | ; | |
| 474 | S BPSITE=+$ $GETSITE^B PSOSRX8(BR XIEN,BFILL ) | |
| 475 | ; | |
| 476 | ; populate M OREDATA wi th basic d ata | |
| 477 | D BASICMOR^ BPSOSRX8(B WHERE,DOS, BPSITE,REV REAS,DURRE C,BPOVRIEN ,BPSCLARF, BPSAUTH,BP SDELAY,.MO REDATA) | |
| 478 | I BPCOBIND= 2 D MORE4S EC^BPSPRRX 2(.MOREDAT A,.BPSPRDA T) S MORED ATA("RTYPE ")=$G(BPSR TYPE) | |
| 479 | ; | |
| 480 | ; Certificat ion Testin g - sets C ERTIEN whi ch is used in BILLAB LE | |
| 481 | S BPRESP=$$ CERTTEST(. CERTIEN) I +BPRESP=1 Q BPRESP | |
| 482 | ; populate B PSARRY | |
| 483 | D STARRAY^B PSNCPD1(BR XIEN,BFILL ,BWHERE,.B PSARRY,BPS ITE,DOS,BI LLNDC) | |
| 484 | S BPSARRY(" RXCOB")=BP COBIND | |
| 485 | I BPCOBIND= 2 S BPSARR Y("PLAN")= $G(BPSPLAN ),BPSARRY( "RTYPE")=$ G(BPSRTYPE ) ;for sec ondary bil ling, to b e used by RX^IBNCPDP | |
| 486 | ||
| 487 | Modified L ogic (Chan ges are hi ghlighted) | |
| 488 | ||
| 489 | ; == reversa l+resubmit for payab les | |
| 490 | ; returns: | |
| 491 | ; 0 - Submi tted throu gh ECME | |
| 492 | ; or | |
| 493 | ; RESPONSE code^CLAMS TAT^D(disp lay messag e)^number of seconds to hang^a dditional info | |
| 494 | ; see EN^BP SNCPD4 for RESPONSE values | |
| 495 | REVRESUB(B PREVREQ,BR XIEN,BFILL ,DOS,BWHER E,BILLNDC, REVREAS,DU RREC,BPOVR IEN,BPSCLA RF,BPSAUTH ,BPSDELAY, BPCOBIND,B PJOBFLG,IE N59,DFN,BP START,BPRE QIEN,OLDRE SP,BPSELIG ,BPSRTYPE, BPSPLAN,BP SPRDAT) ; | |
| 496 | N BPSITE,BP ECMOFF,BPS ARRY,MORED ATA,IB,BPR ETV,BPZRET ,BPCLMST,B PONLREV,BP RETVAL,BPU SRMSG,CERT IEN,BPRESP ,BPRETUNC | |
| 497 | I BPJOBFLG' ="F",BPJOB FLG'="B" D LOG^BPSOS L(IEN59,$T (+0)_"-Job Flag miss ing") Q "5 ^Job Flag missing" ;RESPONSE^ CLMSTAT | |
| 498 | I BPJOBFLG= "B" D LOG^ BPSOSL(IEN 59,$T(+0)_ "-Reversal +Resubmit cannot be done in ba ckground") Q "5^Reve rsal+Resub mit cannot be done i n backgrou nd" ;RESP ONSE^CLMST AT | |
| 499 | S BPCLMST=" ",BPONLREV =0,BPRESP= "" | |
| 500 | ; | |
| 501 | S BPSITE=+$ $GETSITE^B PSOSRX8(BR XIEN,BFILL ) | |
| 502 | ; | |
| 503 | ; populate M OREDATA wi th basic d ata | |
| 504 | D BASICMOR^ BPSOSRX8(B WHERE,DOS, BPSITE,REV REAS,DURRE C,BPOVRIEN ,BPSCLARF, BPSAUTH,BP SDELAY,.MO REDATA) | |
| 505 | I BPCOBIND= 2 D MORE4S EC^BPSPRRX 2(.MOREDAT A,.BPSPRDA T) S MORED ATA("RTYPE ")=$G(BPSR TYPE) | |
| 506 | ; | |
| 507 | ; Certificat ion Testin g - sets C ERTIEN whi ch is used in BILLAB LE | |
| 508 | S BPRESP=$$ CERTTEST(. CERTIEN) I +BPRESP=1 Q BPRESP | |
| 509 | ; populate B PSARRY | |
| 510 | D STARRAY^B PSNCPD1(BR XIEN,BFILL ,BWHERE,.B PSARRY,BPS ITE,DOS,BI LLNDC) | |
| 511 | S BPSARRY(" RXCOB")=BP COBIND | |
| 512 | I BPCOBIND= 2 S BPSARR Y("PLAN")= $G(BPSPLAN ),BPSARRY( "RTYPE")=$ G(BPSRTYPE ) ;for sec ondary bil ling, to b e used by RX^IBNCPDP | |
| 513 | ||
| 514 | ||
| 515 | ||
| 516 | A comment will be up dated in R X^IBNCPDP1 . | |
| 517 | ||
| 518 | Subroutine Name | |
| 519 | RX^IBNCPDP 1 | |
| 520 | Enhancemen t Category | |
| 521 | New | |
| 522 | Modify | |
| 523 | ||
| 524 | ||
| 525 | Current Lo gic | |
| 526 | ||
| 527 | RX(DFN,IBD ) ; pharma cy package call, pas sing in IB D by ref | |
| 528 | ; this is c alled by P SO for all prescript ions issue d, return is | |
| 529 | ; a respons e to bill ECME or no t with arr ay for bil ling data elements | |
| 530 | ; | |
| 531 | ; warning: b ack-billin g flag: | |
| 532 | ; if passed IBSCRES(IB RXN,IBFIL) =1 | |
| 533 | ; - then th e SC Deter mination i s just don e by the I B clerk (b illable) | |
| 534 | ; - set by routine IB NCPBB | |
| 535 | ; | |
| 536 | ; IBD("PLAN ") - is sp ecified on ly if RX A PI is call ed for bil ling deter mination f or 2ndary claim. | |
| 537 | ; | |
| 538 | ||
| 539 | Modified L ogic (Chan ges are hi ghlighted) | |
| 540 | ||
| 541 | RX(DFN,IBD ) ; pharma cy package call, pas sing in IB D by ref | |
| 542 | ; this is c alled by P SO for all prescript ions issue d, return is | |
| 543 | ; a respons e to bill ECME or no t with arr ay for bil ling data elements | |
| 544 | ; | |
| 545 | ; warning: b ack-billin g flag: | |
| 546 | ; if passed IBSCRES(IB RXN,IBFIL) =1 | |
| 547 | ; - then th e SC Deter mination i s just don e by the I B clerk (b illable) | |
| 548 | ; - set by routine IB NCPBB | |
| 549 | ; | |
| 550 | ; IBD("PLAN ") - is sp ecified on ly if RX A PI is call ed for bil ling | |
| 551 | ; determina tion for s econdary c laims or i f the user is resubm itting | |
| 552 | ; a claim f rom the PS O Reject I nformation Screen. | |
| 553 | ; | |
| 554 | ||
| 555 |
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