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| # | Location | File | Last Modified |
|---|---|---|---|
| 1 | ePharmacy_Bundle 12.zip | TAS+ePhm+SDD+US578+v1.00.docx | Wed Sep 12 15:17:00 2018 UTC |
| 2 | ePharmacy_Bundle 12.zip | TAS+ePhm+SDD+US578+v1.00.docx | Tue Sep 18 18:12:05 2018 UTC |
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| 1 | MCCF EDI T AS US578 | |
| 2 | System Des ign Docume nt | |
| 3 | ||
| 4 | ||
| 5 | ||
| 6 | ||
| 7 | ||
| 8 | Department of Vetera ns Affairs | |
| 9 | December 2 017 | |
| 10 | Version 1. 00 | |
| 11 | User Story Number: U SRX-18 | |
| 12 | User Story Name: Imp rove exist ing ePharm acy report s – TRI/CV A Bypass O verride Re port QTY f or partial fills | |
| 13 | Product Ba cklog ID: | |
| 14 | Backlog Pr iority: 34 | |
| 15 | Initial Si zing Estim ate: | |
| 16 | Rational I D: | |
| 17 | Rally ID: US578 | |
| 18 | Epic Taxon omy: Updat e | |
| 19 | ||
| 20 | Design – S ummary | |
| 21 | The TRICAR E-CHAMPVA Bypass Ove rride Repo rt [PSO TR I CVA OVER RIDE RPORT ] display s incorrec t quantity and cost for partia lly filled prescript ions. | |
| 22 | ||
| 23 | List of Co mponents: | |
| 24 | Routine: P SOTRI | |
| 25 | ||
| 26 | Design – D etail | |
| 27 | ||
| 28 | The TRICAR E CHAMPVA Bypass/Ove rride Repo rt pulls t he data di splayed fr om the PSO AUDIT LOG file #52. 87. This d esign call s for modi fying the routine PS OTRI so th at the cor rect data is stored into file #52.87. Th e report w ill then d isplay the correct q uantity an d cost for partial f ills. The cost shoul d display in $BILLED column ev en though a claim is not submi tted to bi ll. The qu antity is entered by the user when parti ally filli ng a presc ription. | |
| 29 | ||
| 30 | ||
| 31 | Subroutine Name | |
| 32 | AUDIT^PSOT RI | |
| 33 | Enhancemen t Category | |
| 34 | New | |
| 35 | Modify | |
| 36 | Delete | |
| 37 | No Change | |
| 38 | Current Lo gic | |
| 39 | ||
| 40 | PSOTRI ;BI RM/BNT - O P TRICARE/ CHAMPVA Au dit Log Ut ilities ;0 7/21/2010 ;;7.0;OUTP ATIENT PHA RMACY;**35 8,385,427* *;DEC 1997 ;Build 21. . . | |
| 41 | AUDIT(RX,R FL,RXCOB,J ST,AUD,ELI G) ; ; Mai n entry to create a new record in the PS O AUDIT LO G file #52 .87 ; Note that AUDI T^PSOTRI i s called b y ECME (BP SECMP2) - ICR 6156 ; INPUT: RX (r) = Pre scription IEN ; RFL (o) = Pres cription F ill # (Def ault is or iginal zer o fill) ; RXCOB (o) = Coordina tion of Be nefits ; 1 = Primary (Default) ; 2 = Sec ondary ; J ST (o) = J ustificati on text ; AUD (r) = Audit Type ; R = NCP DP REJECT - Associat ed with an Override audit acti on ; N = N ON BILLABL E - Associ ated with an Overrid e audit ac tion ; I = INPATIENT - Associa ted with a Bypass au dit action ; P = PAR TIAL FILL ; ELIG (r) = Eligibi lity Type ; T = TRIC ARE ; C = CHAMPVA ; RETURN: Su ccessful A udit entry will retu rn the IEN of the ne w entry in file 52.8 7 ; Unsucc essful Aud it entry w ill return "0^Error Descriptio n" ; N PSO TRIC,PSODI V,RXFLDS,R FLFLDS,RXE CME,PSOFDA ,FN,SFN,PS OIEN,PSOIE NS,PSOUSER ,PSOTC,PSO ET N I,PSO AIEN,PSORE J,DFN,PSOD OA,PSODOS, PSOERR,PSO X,PSOY,RXA RR,RFLARR, PSOPHRM,PS OQTY Q:'$D (^PSRX(RX, 0)) "0^Pre scription does not e xist" | |
| 42 | . . . | |
| 43 | ||
| 44 | ; Date of Action is NOW S PSO DOA=$$NOW^ XLFDT() ; Date of Se rvice S PS ODOS=$$DOS ^PSOBPSU1( RX,RFL) ; User (If n ull OR Aud it Type is Inpatient OR bypass -type reje ct, set to POSTMASTE R) S PSOUS ER=DUZ I ( PSOUSER="" )!(AUD="I" )!$$BYPASS ^PSOBPSU1( ELIG,JST) S PSOUSER= .5 ; Quant ity S PSOQ TY=$S(RFL> 0:$G(RFLAR R(52.1,RFL _","_RX_", ",1,"I")), 1:$G(RXARR (52,RX_"," ,7,"I"))) ; ; Set up FDA array S PSOIEN= "+1," S PS OAIEN=$P($ G(^PS(52.8 7,0)),U,3) +1 ; AUDIT ID field S PSOFDA(F N,PSOIEN,. 01)=PSOAIE N ; PRESCR IPTION fie ld S PSOFD A(FN,PSOIE N,1)=RX ; FILL field S PSOFDA( FN,PSOIEN, 2)=RFL ; P ATIENT fie ld S PSOFD A(FN,PSOIE N,3)=$G(RX ARR(52,RX_ ",",2,"I") ) ; DIVISO IN field S PSOFDA(FN ,PSOIEN,4) =PSODIV ; PROVIDER f ield S PSO FDA(FN,PSO IEN,5)=$S( RFL>0:$G(R FLARR(52.1 ,RFL_","_R X_",",15," I")),1:$G( RXARR(52,R X_",",4,"I "))) ; NDC field S P SOFDA(FN,P SOIEN,6)=$ S(RFL>0:$G (RFLARR(52 .1,RFL_"," _RX_",",11 ,"I")),1:$ G(RXARR(52 ,RX_",",27 ,"I"))) ; DRUG field S PSOFDA( FN,PSOIEN, 7)=$G(RXAR R(52,RX_", ",6,"I")) ; BILL COS T field (T his needs to be veri fied) S PS OFDA(FN,PS OIEN,8)=$G (RXARR(52, RX_",",17, "I"))*PSOQ TY+8 ; ECM E NUMBER f ield S PSO FDA(FN,PSO IEN,9)=RXE CME ; QTY field S PS OFDA(FN,PS OIEN,10)=P SOQTY ; PA TIENT STAT US field S PSOFDA(FN ,PSOIEN,11 )=$G(RXARR (52,RX_"," ,3,"I")) ; AUDIT TYP E field S PSOFDA(FN, PSOIEN,12) =AUD ; USE R field S PSOFDA(FN, PSOIEN,14) =PSOUSER ; DATE OF A CTION fiel d S PSOFDA (FN,PSOIEN ,15)=PSODO A ; DATE O F SERVICE field S PS OFDA(FN,PS OIEN,16)=P SODOS ; TR ICARE JUST IFICATION field S PS OFDA(FN,PS OIEN,17)=J ST ; Eligi bility Cod e S PSOFDA (FN,PSOIEN ,18)=ELIG D DUR1^BPS NCPD3(RX,R FL,.PSOREJ ,.PSOERR,R XCOB) S PS OET=$$PSOE T^PSOREJP3 (RX,RFL) ; check to s ee if eT o r eC is th e reject c ode as no ecme claim . I PSOET S PSOTC=$S (PSOTRIC=1 :"eT",PSOT RIC=2:"eC" ,1:"") I P SOTC]"",'$ D(PSOREJ(R XCOB,"REJ CODES")) S PSOREJ(RX COB,"REJ C ODES",1,PS OTC)="",PS OREJ(RXCOB ,"REJ CODE LST")=PSO TC I $G(PS OREJ(RXCOB ,"REJ CODE LST"))]"" D . S PSO X="",PSOY= 1 F I=1:1 S PSOX=$O( PSOREJ(RXC OB,"REJ CO DES",I,0)) Q:PSOX="" D . . S PSOY=PSOY+ 1,PSOIENS= PSOY_","_P SOIEN . . S PSOFDA(S FN,"+"_PSO IENS,.01)= PSOX ; D U PDATE^DIE( "","PSOFDA ","","PSOE RR") I $D( PSOERR("DI ERR")) D B MES^XPDUTL (PSOERR("D IERR",1,"T EXT",1)) Q | |
| 45 | ||
| 46 | Modified L ogic (Chan ges are hi ghlighted) | |
| 47 | ||
| 48 | PSOTRI ;BI RM/BNT - O P TRICARE/ CHAMPVA Au dit Log Ut ilities ;0 7/21/2010 ;;7.0;OUTP ATIENT PHA RMACY;**35 8,385,427, 48#**;DEC 1997;Build 21. . . | |
| 49 | AUDIT(RX,R FL,RXCOB,J ST,AUD,ELI G) ; ; Mai n entry to create a new record in the PS O AUDIT LO G file #52 .87 ; Note that AUDI T^PSOTRI i s called b y ECME (BP SECMP2) - ICR 6156 ; INPUT: RX (r) = Pre scription IEN ; RFL (o) = Pres cription F ill # (Def ault is or iginal zer o fill) ; RXCOB (o) = Coordina tion of Be nefits ; 1 = Primary (Default) ; 2 = Sec ondary ; J ST (o) = J ustificati on text ; AUD (r) = Audit Type ; R = NCP DP REJECT - Associat ed with an Override audit acti on ; N = N ON BILLABL E - Associ ated with an Overrid e audit ac tion ; I = INPATIENT - Associa ted with a Bypass au dit action ; P = PAR TIAL FILL ; ELIG (r) = Eligibi lity Type ; T = TRIC ARE ; C = CHAMPVA ; RETURN: Su ccessful A udit entry will retu rn the IEN of the ne w entry in file 52.8 7 ; Unsucc essful Aud it entry w ill return "0^Error Descriptio n" ; | |
| 50 | N PSOTRIC ,PSODIV,RX FLDS,RFLFL DS,RXECME, PSOFDA,FN, SFN,PSOIEN ,PSOIENS,P SOUSER,PSO TC,PSOET N I,PSOAIEN ,PSOREJ,DF N,PSODOA,P SODOS,PSOE RR,PSOX,PS OY,RXARR,R FLARR,PSOP HRM,PSOQTY | |
| 51 | N DFN,IBA DT,IBBI,IB CHG,IBD,IB FEE,IBINS, IBRES,IBTY P,PFARR,PF FLDS,PFIEN ,PSOUNITCO ST ; Q:'$D (^PSRX(RX, 0)) "0^Pre scription does not e xist". . . | |
| 52 | ; Date of Action is NOW S PSO DOA=$$NOW^ XLFDT() ; Date of Se rvice S PS ODOS=$$DOS ^PSOBPSU1( RX,RFL) ; User (If n ull OR Aud it Type is Inpatient OR bypass -type reje ct, set to POSTMASTE R) S PSOUS ER=DUZ I ( PSOUSER="" )!(AUD="I" )!$$BYPASS ^PSOBPSU1( ELIG,JST) S PSOUSER= .5 | |
| 53 | ; Set up FDA array S PSOIEN=" +1," S PSO AIEN=$P($G (^PS(52.87 ,0)),U,3)+ 1 ; Quanti ty, Unit C ost, Provi der, NDC a nd Bill Co st fields I AUD="P" D . ; For Partial Fi lls pull t he QTY, Un it Cost, P ROVIDER, N DC and BIL LED from | |
| 54 | . ;the ap propriate entry in t he PARTIAL DATE sub- file. . ; | |
| 55 | . ; Attem pt to iden tify a par tial fill for today’ s date. | |
| 56 | . S PFIEN =0 | |
| 57 | . F S PF IEN=$O(^PS RX(RX,"P", PFIEN)) Q: 'PFIEN I $P($G(^PSR X(RX,"P",P FIEN,0)),U ,1)=$P(PSO DOA,".",1) Q . I ' PFIEN Q ; partial fi ll entry f or today n ot found | |
| 58 | . ; . ; Q TY;CURRENT UNIT PRIC E OF DRUG; PROVIDER;N DC . S PFF LDS=".04;. 042;6;1" | |
| 59 | . D GETS^ DIQ(52.2,P FIEN_","_R X,PFFLDS," I","PFARR" ) | |
| 60 | . ; . S P SOQTY=$G(P FARR(52.2, PFIEN_","_ RX_",",.04 ,"I")) . S PSOUNITCO ST=$G(PFAR R(52.2,PFI EN_","_RX_ ",",.042," I")) | |
| 61 | . S PSOFD A(FN,PSOIE N,5)=$G(PF ARR(52.2,P FIEN_","_R X_",",6,"I ")) . S PS OFDA(FN,PS OIEN,6)=$G (PFARR(52. 2,PFIEN_", "_RX_",",1 ,"I")) | |
| 62 | . D GETCO ST S PSOFD A(FN,PSOEI N,8)=+IBCH G E D | |
| 63 | . S PSOQT Y=$S(RFL>0 :$G(RFLARR (52.1,RFL_ ","_RX_"," ,1,"I")),1 :$G(RXARR( 52,RX_",", 7,"I"))) | |
| 64 | . S PSOFD A(FN,PSOIE N,5)=$S(RF L>0:$G(RFL ARR(52.1,R FL_","_RX_ ",",15,"I" )),1:$G(RX ARR(52,RX_ ",", | |
| 65 | 4,"I"))) . S PSOFDA( FN,PSOIEN, 6)=$S(RFL> 0:$G(RFLAR R(52.1,RFL _","_RX_", ",11,"I")) ,1:$G(RXAR R(52,RX_", ", | |
| 66 | 27,"I"))) | |
| 67 | . S PSOFD A(FN,PSOIE N,8)=$G(RX ARR(52,RX_ ",",17,"I" ))*PSOQTY+ 8 ;This ne eds to be verified ; AUDIT ID field S PS OFDA(FN,PS OIEN,.01)= PSOAIEN ; PRESCRIPTI ON field S PSOFDA(FN ,PSOIEN,1) =RX ; FILL field S P SOFDA(FN,P SOIEN,2)=R FL ; PATIE NT field S PSOFDA(FN ,PSOIEN,3) =$G(RXARR( 52,RX_",", 2,"I")) ; DIVISION f ield S PSO FDA(FN,PSO IEN,4)=PSO DIV ; DRUG field S P SOFDA(FN,P SOIEN,7)=$ G(RXARR(52 ,RX_",",6, "I")) ; EC ME NUMBER field S PS OFDA(FN,PS OIEN,9)=RX ECME ; QTY field S P SOFDA(FN,P SOIEN,10)= PSOQTY ; P ATIENT STA TUS field S PSOFDA(F N,PSOIEN,1 1)=$G(RXAR R(52,RX_", ",3,"I")) ; AUDIT TY PE field S PSOFDA(FN ,PSOIEN,12 )=AUD ; US ER field S PSOFDA(FN ,PSOIEN,14 )=PSOUSER ; DATE OF ACTION fie ld S PSOFD A(FN,PSOIE N,15)=PSOD OA ; DATE OF SERVICE field S P SOFDA(FN,P SOIEN,16)= PSODOS ; T RICARE JUS TIFICATION field S P SOFDA(FN,P SOIEN,17)= JST ; Elig ibility Co de S PSOFD A(FN,PSOIE N,18)=ELIG D DUR1^BP SNCPD3(RX, RFL,.PSORE J,.PSOERR, RXCOB) S P SOET=$$PSO ET^PSOREJP 3(RX,RFL) ;check to see if eT or eC is t he reject code as no ecme clai m. I PSOET S PSOTC=$ S(PSOTRIC= 1:"eT",PSO TRIC=2:"eC ",1:"") I PSOTC]"",' $D(PSOREJ( RXCOB,"REJ CODES")) S PSOREJ(R XCOB,"REJ CODES",1,P SOTC)="",P SOREJ(RXCO B,"REJ COD E LST")=PS OTC I $G(P SOREJ(RXCO B,"REJ COD E LST"))]" " D . S PS OX="",PSOY =1 F I=1:1 S PSOX=$O (PSOREJ(RX COB,"REJ C ODES",I,0) ) Q:PSOX=" " D . . S PSOY=PSOY +1,PSOIENS =PSOY_","_ PSOIEN . . S PSOFDA( SFN,"+"_PS OIENS,.01) =PSOX ; D UPDATE^DIE ("","PSOFD A","","PSO ERR") I $D (PSOERR("D IERR")) D BMES^XPDUT L(PSOERR(" DIERR",1," TEXT",1)) Q | |
| 68 | ;GETCOST ; For Part ial Fills the BILL C OST needs to be calc ulated usi ng the sam e calculat ion that ; is used during cla im submiss ion (model ed after R X^IBNCPDP1 ) ; S DFN= $G(RXARR(5 2,RX_",",2 ,"I")) S I BADT=DT D RXINS^IBNC PDPU(DFN,I BADT,.IBIN S) S IBRT= $$RT^IBNCP DPU(DFN,IB ADT,.IBINS ,.IBTYP) D SETINSUR^ IBNCPDP1(I BADT,IBRT, "T",.IBINS ,.IBD,.IBR ES) S IBBI =$$EVNTITM ^IBCRU3(+I BRT,3,"PRE SCRIPTION FILL",IBAD T,.IBRS) S IBRS=+$O( IBRS($P(IB BI,";"),0) ) S IBCHG= $$RATECHG^ IBCRCC(+IB RS,$S($P(I BRT,U,2)'= "C":1,1:PS OQTY*PSOUN ITCOST),IB ADT,.IBFEE ) Q | |
| 69 | ||
| 70 | ||
| 71 | With the a ddition of the GETCO ST subrout ine, an ex isting ICR #5714 wil l need to be updated as descri bed in the table bel ow. PSO (O utpatient Pharmacy) will be ad ded as a s ubscribing package, and the co mponent $$ RT will be added, al ong with i nput and o utput vari ables. | |
| 72 | ||
| 73 | Integratio n Control Registrati on # | |
| 74 | 5714 | |
| 75 | Name | |
| 76 | IB PHARMAC Y INSURANC E | |
| 77 | Enhancemen t Category | |
| 78 | New Modify Expand | |
| 79 | Custodial Package | |
| 80 | Integrated Billing | |
| 81 | Subscribin g Package( s) | |
| 82 | E Claims M gmt Engine | |
| 83 | Oupatient Pharmacy | |
| 84 | Usage | |
| 85 | Private | |
| 86 | Type | |
| 87 | Routine | |
| 88 | Routine | |
| 89 | IBNCPDPU | |
| 90 | Component | |
| 91 | $$RT | |
| 92 | Input Vari ables | |
| 93 | Name: IBIN S | |
| 94 | Descriptio n: insuran ce array ( pass by re ference) | |
| 95 | Output Var iables | |
| 96 | Name: IBRT | |
| 97 | Descriptio n: 3 piece string in the follo wing forma t | |
| 98 | [1] rate t ype ien, | |
| 99 | [2] Rate T ype (Tort or Awp or Cost) | |
| 100 | [3] Eligib ility Basi s (V=VETER AN, T=TRIC ARE, C=CHA MPVA) | |
| 101 | ||
| 102 | Additional ly a new I CR will be created t o allow th e PSO rout ine to cal l SETINSUR ^IBNCPDP1. | |
| 103 | ||
| 104 | Integratio n Control Registrati on # | |
| 105 | TBD | |
| 106 | Name | |
| 107 | SET INSURA NCE | |
| 108 | Enhancemen t Category | |
| 109 | New Modify Expand | |
| 110 | Custodial Package | |
| 111 | Integrated Billing | |
| 112 | Subscribin g Package( s) | |
| 113 | Outpatient Pharmacy | |
| 114 | Usage | |
| 115 | Private | |
| 116 | Type | |
| 117 | Routine | |
| 118 | Routine | |
| 119 | IBNCPDP1 | |
| 120 | Component | |
| 121 | SETINSUR | |
| 122 | Input Vari ables | |
| 123 | Name: IBAD T | |
| 124 | Descriptio n: date of service/i dentify in surance as of this d ate | |
| 125 | Name: IBRT | |
| 126 | Descriptio n: rate ty pe variabl e – [1] ra te type ie n, [2] typ e (A/C/T), [3] eligi bility (V/ T/C) | |
| 127 | Name: IBEL IG | |
| 128 | Descriptio n: eligibi lity reque st flag (1 /0) | |
| 129 | Name: IBIN S | |
| 130 | Descriptio n: insuran ce array a s returned by RXINS^ IBNCPDPU | |
| 131 | Name: IBD | |
| 132 | Descriptio n: input/o utput – ar ray entrie s passed i n and cert ain array entries re turned | |
| 133 | Output Var iables | |
| 134 | Name: IBRE S | |
| 135 | Descriptio n: only re turned if insurance errors | |
| 136 | Name: IBD | |
| 137 | Descriptio n: input/o utput – ar ray entrie s passed i n and cert ain array entries re turned |
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