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| # | Location | File | Last Modified |
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| 1 | docs | TAS epay US3180 SDD - Copy.doc | Mon Oct 22 16:27:48 2018 UTC |
| 2 | docs | TAS epay US3180 SDD - Copy.doc | Mon Oct 22 16:33:18 2018 UTC |
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| 1 | MCCF EDI T AS US3180 | |
| 2 | System Des ign Docume nt | |
| 3 | PRCA*4.5*x xx | |
| 4 | ||
| 5 | Department of Vetera ns Affairs | |
| 6 | Nov 2017 | |
| 7 | Version 1 | |
| 8 | User Story ID: US318 0 | |
| 9 | User Story Name: Ad d fee clai ms to Auto -Audit (52 87.13) Rat e type = F ee | |
| 10 | Sizing: 1 | |
| 11 | Epic Taxon omy eBiz C ompliance Port Updat e Incre ase No Tou ch TAS Ap psStory | |
| 12 | As a...I w ant to...S o that...e Pay clerkA dd fee cla ims to Aut o-Audit (5 287.13) Ra te type = FeeAR fee claims are activated automatic allyConver sation (if desired b y develope rs) | |
| 13 | Auto-audit is curren tly not fu nctioning with new r ate type i ntroduced by new pat ch IB*2.0* 554. This user stor y will res olve that | |
| 14 | Summary: | |
| 15 | The schedu led option [PRCA NIG HTLY PROCE SS] will b e modified to includ e claims w here RATE TYPE = FEE REIMB INS . | |
| 16 | Existing r outine PRC ABJ2 will be modifie d. | |
| 17 | Resolution – Added C hanged Obj ects | |
| 18 | RoutinesAc tivitiesRo utine Name PRCABJ2Enh ancement C ategory Ne w Modify D elete No C hangeRTMRe lated Opti onsPRCA NI GHTLY PROC ESSRelated RoutinesR outines “C alled By”R outines “C alled” P RCABJ $$ GET1^DIQ | |
| 19 | $$BILLR EJ^PRCAUDT | |
| 20 | AUDITX^ PRCAUDT | |
| 21 | $$GETEC ME^RCDPENR 1Current L ogicPRCABJ 2 ;ALB/SAB - NIGHTLY PROCESS F OR ACCOUNT S RECEIVAB LE ;07-JUL -15 | |
| 22 | ;;4.5;Acc ounts Rece ivable;**3 04,321**;M ar 20, 199 5;Build 10 4 | |
| 23 | ;Per VA D irective 6 402, this routine sh ould not b e modified . | |
| 24 | ; | |
| 25 | ; read of DGCR(399. 2 allowed by DBIA 38 22 | |
| 26 | ; | |
| 27 | Q | |
| 28 | ; Auto-au dit Paper and Electr onic (EDI) bills if ready | |
| 29 | ABAUDIT ; | |
| 30 | ; Local V ariables | |
| 31 | ; APIEN - Accounts Payable (f ile #430) ien | |
| 32 | ; | |
| 33 | N APIEN,B ILLTYP,DIE ,DA,DR,DIR ,DIRUT,DTO UT,DUOUT,X ,Y,APD0,AP D202,FLG1, FLG2,FLG1E ,FLG2E,NBL IEN ; PRCA *4.5*321 | |
| 34 | N PRCABLN O,PRCAECME ,RATEIEN,R CPAPER,XX ; PRCA*4.5 *321 | |
| 35 | ; | |
| 36 | S APIEN=" " | |
| 37 | ; | |
| 38 | ;Check pa rameters t o see if i t needs to run. | |
| 39 | S FLG1=$$ GET1^DIQ(3 42,"1,",7. 05,"I") ; Get the va lue of the auto-audi t medical paper bill flag | |
| 40 | S FLG2=$$ GET1^DIQ(3 42,"1,",7. 06,"I") ; Get the va lue of the auto-audi t pharmacy paper bil l flag | |
| 41 | S FLG1E=$ $GET1^DIQ( 342,"1,",7 .07,"I") ; Get the v alue of th e auto-aud it medical EDI bill flag - PRC A*4.5*321 | |
| 42 | S FLG2E=$ $GET1^DIQ( 342,"1,",7 .08,"I") ; Get the v alue of th e auto-aud it pharmac y EDI bill flag - PR CA*4.5*321 | |
| 43 | ; | |
| 44 | ; Quit if all auto- audit para meters are set to 'N o' | |
| 45 | Q:('FLG1) &('FLG2)&( 'FLG1E)&(' FLG2E) ; P RCA*4.5*32 1 | |
| 46 | ; | |
| 47 | ;retrieve DB values | |
| 48 | S NBLIEN= $O(^PRCA(4 30.3,"B"," NEW BILL", "")) ; New Bill Stat us IEN | |
| 49 | ;S CATIEN =$O(^PRCA( 430.2,"C", "RI","")) ; Reimburs able Insur ance IEN ; removed P RCA*4.5*32 1 | |
| 50 | ;S HICD=$ O(^PRCA(43 0.6,"B","H I","")) ; Health ins urance IEN ; removed PRCA*4.5* 321 | |
| 51 | ;S ACTIVE =$O(^PRCA( 430.3,"B", "ACTIVE"," ")) ; New Bill Statu s IEN ; re moved PRCA *4.5*321 | |
| 52 | S BILLTYP =$O(^DGCR( 399.3,"B", "REIMBURSA BLE INS.", "")) ; Bil l Type IEN | |
| 53 | ;S RCPAPE R=1 ; Fiel d 27 in ^D GCR(399 ; 0 - is ele ctronic, 1 - FORCE L OCAL PRINT ; removed PRCA*4.5* 321 | |
| 54 | ; | |
| 55 | Q:NBLIEN= "" | |
| 56 | ; | |
| 57 | F S APIE N=$O(^PRCA (430,"AC", NBLIEN,API EN)) Q:'AP IEN D | |
| 58 | . S APD0= $G(^PRCA(4 30,APIEN,0 )) ; Patie nt info | |
| 59 | . S APD20 2=$G(^PRCA (430,APIEN ,202)) ;In sured info | |
| 60 | . Q:$$GET 1^DIQ(399, APIEN_",", .07,"I")'= BILLTYP ; Bill type is not Re imbursable Insurance . Skip | |
| 61 | . ; BEGIN - PRCA*4. 5*321 | |
| 62 | . Q:$$GET 1^DIQ(430, APIEN_",", 7,"I")="" ; Qu it if no P ATIENT IEN | |
| 63 | . Q:$$GET 1^DIQ(430, APIEN_",", 9,"I")="" ; Qu it if no D EBTOR info rmation | |
| 64 | . Q:$$GET 1^DIQ(430, APIEN_",", 239,"I")=" " ; qu it if no s ubscriber name store d | |
| 65 | . Q:$$GET 1^DIQ(430, APIEN_",", 243,"I")=" " ; qu it if no g roup name stored | |
| 66 | . Q:$$GET 1^DIQ(430, APIEN_",", 244,"I")=" " ; qu it if no g roup numbe r stored | |
| 67 | . Q:$$BIL LREJ^PRCAU DT(APIEN) ; PRCA*4.5 *321 - cla im has rej ect messag es, do not audit | |
| 68 | . ; | |
| 69 | . S RATEI EN=$$GET1^ DIQ(399,AP IEN_",",.0 7,"I") ; G et bill's rate type ; IA 4118 | |
| 70 | . Q:'RATE IEN | |
| 71 | . ; A rat e type is auto-audit ed if BILL RESULTING FROM fiel d is non-n ull | |
| 72 | . Q:'$$GE T1^DIQ(399 .3,RATEIEN _",",.11," I") ; Quit if not an auto-audi t rate typ e | |
| 73 | . ;Read o n IB file #399 field #27 cover ed by ICR #3820 | |
| 74 | . S RCPAP ER=$$GET1^ DIQ(399,AP IEN_",",27 ,"I") ; 0 - is elect ronic, 1 - is paper | |
| 75 | . ;Get th e Bill num ber to che ck if it i s a Pharma cy bill | |
| 76 | . S PRCAB LNO=$$GET1 ^DIQ(430,A PIEN_",",. 01,"I") | |
| 77 | . S PRCAE CME=$$GETE CME^RCDPEN R1(PRCABLN O) | |
| 78 | . I PRCAE CME="",'FL G1,RCPAPER Q ;Sk ip this pa per bill i f No Medic al process ing | |
| 79 | . I PRCAE CME'="",'F LG2,RCPAPE R Q ;Sk ip this pa per bill i f No Pharm acy proces sing | |
| 80 | . I PRCAE CME="",'FL G1E,'RCPAP ER Q ; Skip this EDI bill i f No Medic al process ing | |
| 81 | . I PRCAE CME'="",'F LG2E,'RCPA PER Q ; Skip this EDI bill i f No Pharm acy proces sing | |
| 82 | . ; | |
| 83 | . ; Bill Passed all checks no w call aut o-audit fo r this Bil l number | |
| 84 | . D AUDIT X^PRCAUDT( APIEN) | |
| 85 | QModified Logic (Ch anges are in bold)PR CABJ2 ;ALB /SAB - NIG HTLY PROCE SS FOR ACC OUNTS RECE IVABLE ;07 -JUL-15 | |
| 86 | ;;4.5;Acc ounts Rece ivable;**3 04,321**;M ar 20, 199 5;Build 10 4 | |
| 87 | ;Per VA D irective 6 402, this routine sh ould not b e modified . | |
| 88 | ; | |
| 89 | ; read of DGCR(399. 2 allowed by DBIA 38 22 | |
| 90 | ; | |
| 91 | Q | |
| 92 | ; Auto-au dit Paper and Electr onic (EDI) bills if ready | |
| 93 | ABAUDIT ; | |
| 94 | ; Local V ariables | |
| 95 | ; APIEN - Accounts Payable (f ile #430) ien | |
| 96 | ; | |
| 97 | N APIEN,B ILLTYP,BIL LTYPF,BILL VAL,DIE,DA ,DR,DIR,DI RUT,DTOUT, DUOUT,X,Y | |
| 98 | N APD0,AP D202,FLG1, FLG2,FLG1E ,FLG2E,NBL IEN ; PRCA *4.5*321 | |
| 99 | N PRCABLN O,PRCAECME ,RATEIEN,R CPAPER,XX ; PRCA*4.5 *321 | |
| 100 | ; | |
| 101 | S APIEN=" " | |
| 102 | ; | |
| 103 | ;Check pa rameters t o see if i t needs to run. | |
| 104 | S FLG1=$$ GET1^DIQ(3 42,"1,",7. 05,"I") ; Get the va lue of the auto-audi t medical paper bill flag | |
| 105 | S FLG2=$$ GET1^DIQ(3 42,"1,",7. 06,"I") ; Get the va lue of the auto-audi t pharmacy paper bil l flag | |
| 106 | S FLG1E=$ $GET1^DIQ( 342,"1,",7 .07,"I") ; Get the v alue of th e auto-aud it medical EDI bill flag - PRC A*4.5*321 | |
| 107 | S FLG2E=$ $GET1^DIQ( 342,"1,",7 .08,"I") ; Get the v alue of th e auto-aud it pharmac y EDI bill flag - PR CA*4.5*321 | |
| 108 | ; | |
| 109 | ; Quit if all auto- audit para meters are set to 'N o' | |
| 110 | Q:('FLG1) &('FLG2)&( 'FLG1E)&(' FLG2E) ; P RCA*4.5*32 1 | |
| 111 | ; | |
| 112 | ;retrieve DB values | |
| 113 | S NBLIEN= $O(^PRCA(4 30.3,"B"," NEW BILL", "")) ; New Bill Stat us IEN | |
| 114 | ;S CATIEN =$O(^PRCA( 430.2,"C", "RI","")) ; Reimburs able Insur ance IEN ; removed P RCA*4.5*32 1 | |
| 115 | ;S HICD=$ O(^PRCA(43 0.6,"B","H I","")) ; Health ins urance IEN ; removed PRCA*4.5* 321 | |
| 116 | ;S ACTIVE =$O(^PRCA( 430.3,"B", "ACTIVE"," ")) ; New Bill Statu s IEN ; re moved PRCA *4.5*321 | |
| 117 | S BILLTYP =$O(^DGCR( 399.3,"B", "REIMBURSA BLE INS.", "")) ; Bil l Type IEN | |
| 118 | S BILLTYP F=$O(^DGCR (399.3,"B" ,"FEE REIM B INS","") ) ; Re-Imb . Fee Bill Type IEN | |
| 119 | ;S RCPAPE R=1 ; Fiel d 27 in ^D GCR(399 ; 0 - is ele ctronic, 1 - FORCE L OCAL PRINT ; removed PRCA*4.5* 321 | |
| 120 | ; | |
| 121 | Q:NBLIEN= "" | |
| 122 | ; | |
| 123 | F S APIE N=$O(^PRCA (430,"AC", NBLIEN,API EN)) Q:'AP IEN D | |
| 124 | . S APD0= $G(^PRCA(4 30,APIEN,0 )) ; Patie nt info | |
| 125 | . S APD20 2=$G(^PRCA (430,APIEN ,202)) ;In sured info | |
| 126 | . S BILLV AL=$$GET1^ DIQ(399,AP IEN_",",.0 7,"I") | |
| 127 | . I BILLV AL'=BILLTY P,BILLVAL’ =BILLTYPF Q ; Rate Type must be Reimbur sable Insu rance | |
| 128 | . ; BEGIN - PRCA*4. 5*321 | |
| 129 | . Q:$$GET 1^DIQ(430, APIEN_",", 7,"I")="" ; Qu it if no P ATIENT IEN | |
| 130 | . Q:$$GET 1^DIQ(430, APIEN_",", 9,"I")="" ; Qu it if no D EBTOR info rmation | |
| 131 | . Q:$$GET 1^DIQ(430, APIEN_",", 239,"I")=" " ; qu it if no s ubscriber name store d | |
| 132 | . Q:$$GET 1^DIQ(430, APIEN_",", 243,"I")=" " ; qu it if no g roup name stored | |
| 133 | . Q:$$GET 1^DIQ(430, APIEN_",", 244,"I")=" " ; qu it if no g roup numbe r stored | |
| 134 | . Q:$$BIL LREJ^PRCAU DT(APIEN) ; PRCA*4.5 *321 - cla im has rej ect messag es, do not audit | |
| 135 | . ; | |
| 136 | . S RATEI EN=$$GET1^ DIQ(399,AP IEN_",",.0 7,"I") ; G et bill's rate type ; IA 4118 | |
| 137 | . Q:'RATE IEN | |
| 138 | . ; A rat e type is auto-audit ed if BILL RESULTING FROM fiel d is non-n ull | |
| 139 | . Q:'$$GE T1^DIQ(399 .3,RATEIEN _",",.11," I") ; Quit if not an auto-audi t rate typ e | |
| 140 | . ;Read o n IB file #399 field #27 cover ed by ICR #3820 | |
| 141 | . S RCPAP ER=$$GET1^ DIQ(399,AP IEN_",",27 ,"I") ; 0 - is elect ronic, 1 - is paper | |
| 142 | . ;Get th e Bill num ber to che ck if it i s a Pharma cy bill | |
| 143 | . S PRCAB LNO=$$GET1 ^DIQ(430,A PIEN_",",. 01,"I") | |
| 144 | . S PRCAE CME=$$GETE CME^RCDPEN R1(PRCABLN O) | |
| 145 | . I PRCAE CME="",'FL G1,RCPAPER Q ;Sk ip this pa per bill i f No Medic al process ing | |
| 146 | . I PRCAE CME'="",'F LG2,RCPAPE R Q ;Sk ip this pa per bill i f No Pharm acy proces sing | |
| 147 | . I PRCAE CME="",'FL G1E,'RCPAP ER Q ; Skip this EDI bill i f No Medic al process ing | |
| 148 | . I PRCAE CME'="",'F LG2E,'RCPA PER Q ; Skip this EDI bill i f No Pharm acy proces sing | |
| 149 | . ; | |
| 150 | . ; Bill Passed all checks no w call aut o-audit fo r this Bil l number | |
| 151 | . D AUDIT X^PRCAUDT( APIEN) | |
| 152 | Q |
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