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| # | Location | File | Last Modified |
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| 1 | eBilling_Bld22_IB_2_608.zip | TAS eBill SDD US1109 v1.00.docx | Tue Dec 19 16:29:39 2017 UTC |
| 2 | eBilling_Bld22_IB_2_608.zip | TAS eBill SDD US1109 v1.00.docx | Thu Feb 15 18:17:32 2018 UTC |
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| 1 | MCCF EDI T AS US1109 SDD | |
| 2 | System Des ign Docume nt | |
| 3 | IB*2.0*592 | |
| 4 | ||
| 5 | ||
| 6 | ||
| 7 | ||
| 8 | Department of Vetera ns Affairs | |
| 9 | April 2017 | |
| 10 | Version 1. 0 | |
| 11 | User Story Number: US1109 | |
| 12 | User Story Name: Cre ate Dental Form / Up date Autob iller | |
| 13 | Product Ba cklog ID: n/a | |
| 14 | Rally ID: US-1109 | |
| 15 | Design/Ass umptions: | |
| 16 | The design for this user story is going on the fol lowing ass umptions: | |
| 17 | There is a way to id entify the events in Claims Tr acking as being appr opriate fo r dental s ervices. | |
| 18 | The Autobi ller will follow the same rule s for crea ting denta l claims a s it does for other appointmen t claims. Example: the patien t must hav e active i nsurance o n the date of servic e. | |
| 19 | Resolution Summary: | |
| 20 | To resolve this requ est, the f ollowing b ullet item s will nee d to be wo rked on: | |
| 21 | Form Type J430D will need to b e added to file 353 BILL FORM TYPE. Thi s is also a requirem ent for Us er Story U S1108 Ente r/Edit Den tal Claims . | |
| 22 | There is a Design As sumption t hat there is a way t o identify a dental services e ntry in Cl aims Track ing. The Autobiller , initial routine IB CD, search es through a cross r eference i n the 356 file, ‘ATO BIL’, whic h contains an index to all act ive billab le events that have not alread y been bil led. The format of the cross reference is ^IBT(35 6,”ATOBIL” ,Patient I EN, Event Type (poin ter to fil e 356.6), Earliest A uto Bill D ate, Clai ms Trackin g IEN). On ce the Cla ims Tracki ng IEN (DA ) is obtai ned, the f ourth (4) data field of the Cl aims Track ing Entry can be obt ained, whi ch is the pointer to the Out P atient Enc ounter, Fi le 409.68. Field .1 APPOINTME NT TYPE is a pointer to file 4 09.1 APPOI NTMENT TYP E FILE. E ntry #2 in this file is for CL ASS II DEN TAL appoin tments. | |
| 23 | In routine IBCD2 at label OUTP T, executi on of this code is f or Outpati ent claims . The set ting of a DENTAL var iable flag would be done here using the logic from resolutio n 2 above. Once exe cution get s to this section of routine I BCD2, assu mption #2 has been c onfirmed, in that ro utine IBCD checks fo r valid ac tive insur ance on th e date of service. In additio n, for ide ntified De ntal Claim s, the aut o-biller w ill be mod ified to l ook at the plan cove rage level limitatio ns (file 3 55.32 PLAN COVERAGE LIMITATION S) and cre ate claims for Denta l if the c overage le vel is any thing but ‘NO’. | |
| 24 | Routine IB CU82 at li ne EVNTCHK +37 needs to be modi fied to al low for th e processi ng of a De ntal Claim with a Cl inic Stop Code indic ating it c ontains a Dental sto p code. | |
| 25 | IBCD3 rout ine will b e modified according ly to file any Denta l claim sp ecific fie lds that a re necessa ry. These fields wi ll be iden tified in User Story 1108. | |
| 26 | Design Con straints: | |
| 27 | This SDD i s dependen t upon the following User Stor ies: | |
| 28 | US131 (Cre ate 837D T ransaction ) | |
| 29 | US1108 (En ter/Edit D ental Clai ms) | |
| 30 | IOC Sites must provi de Dental Services t o their bi llable Vet erans. | |
| 31 | Detailed D esign: | |
| 32 | Create a n ew Form Ty pe “J430D” in Bill F orm Type f ile #353 B ILL FORM T YPE. | |
| 33 | NUMBER: 7 NAME: J430 D | |
| 34 | FORMAT TYP E: TRANSMI TTED FORM SH ORT DESCRI PTION: Den tal Form | |
| 35 | Method to determine that a Cla ims Tracki ng Entry i s for Dent al. | |
| 36 | Routines | |
| 37 | Activities | |
| 38 | Routine Na me | |
| 39 | IBCD | |
| 40 | Enhancemen t Category | |
| 41 | New | |
| 42 | Modify | |
| 43 | Delete | |
| 44 | No Change | |
| 45 | RTM | |
| 46 | ||
| 47 | Related Op tions | |
| 48 | None | |
| 49 | Related Ro utines | |
| 50 | Routines “ Called By” | |
| 51 | Routines “ Called” | |
| 52 | ||
| 53 | ||
| 54 | ||
| 55 | ||
| 56 | Data Dicti onary (DD) Reference s | |
| 57 | CLAIMS TRA CKING File [#356] | |
| 58 | Related Pr otocols | |
| 59 | None | |
| 60 | Related In tegration Control Re gistration s (ICRs) | |
| 61 | None | |
| 62 | Data Passi ng | |
| 63 | Input | |
| 64 | Output Re ference | |
| 65 | Both | |
| 66 | Global Re ference | |
| 67 | Local | |
| 68 | Input Attr ibute Name and Defin ition | |
| 69 | Name: | |
| 70 | Definition : | |
| 71 | Output Att ribute Nam e and Defi nition | |
| 72 | Name: | |
| 73 | Definition : | |
| 74 | Current Lo gic | |
| 75 | IBCD ;ALB/ ARH - AUTO MATED BILL ER ;8/6/93 ;;2.0;INT EGRATED BI LLING;**31 2**;21-MAR -94 ;;Per VHA Direct ive 10-93- 142, this routine sh ould not b e modified . ; ;This routine is the begin ning of th e auto bil ler. No va riables ar e required on entry. It is be called by the ;IB ni ghtly job routine IB AMTC. It f irst check s to see i f it shoul d run base d on the a uto biller frequency ;site par ameter. It then gath ers the Cl aims Track ing events with an E ABD into a temporary file by p atient, ;e vent type, and episo de date. T his tempor ary file ( "IBACAB") is then us ed to sort the event s into gro ups ;that should be added to i ndividual bills base d on the i ndividual event type billing c ycle param eters. Thi s ;second temporary file is th en used to create th e actual b ills in IB CD1-2. ;EN ;begin pr ocess of f inding and creating bills ;det ermine if auto bille r should r un, check site param eters (350 .9,7.01-7. 02) N IBSW INFO,IBPFS S S IBSWIN FO=$$SWSTA T^IBBAPI() ;IB*2.0*3 12 S IBPAR 7=$G(^IBE( 350.9,1,7) ) G:'$P(IB PAR7,U,1) EXIT I +IB PAR7,+$P(I BPAR7,U,2) ,$$FMADD^X LFDT(+$P(I BPAR7,U,2) ,+IBPAR7)> DT G EXIT S IBAUTO=1 ; ;begin search for events to bill, cre ate array of events by patient ;^TMP("IB CAB",$J, P ATIENT, EV ENT TYPE, EPISODE DA TE, EVENT IFN)="" ;a dds all ev ents in Cl aims Track ing that h ave an EAB D not afte r today S IBDFN=0 F S IBDFN=$ O(^IBT(356 ,"ATOBIL", IBDFN)) Q: 'IBDFN D . S IBTYP= 0 F S IBT YP=$O(^IBT (356,"ATOB IL",IBDFN, IBTYP)) Q: 'IBTYP D .. S IBEAB D=0 F S I BEABD=$O(^ IBT(356,"A TOBIL",IBD FN,IBTYP,I BEABD)) Q: 'IBEABD!(I BEABD>DT) D ... S IB TRN=0 F S IBTRN=$O( ^IBT(356," ATOBIL",IB DFN,IBTYP, IBEABD,IBT RN)) Q:'IB TRN D ... . S IBX=$$ EVBILL^IBC U81(IBTRN) I 'IBX!(I BX>DT) D T EABD(IBTRN ,+IBX) D:$ P(IBX,U,2) '="" TERR( IBTRN,0,$P (IBX,U,2)) Q .... S IBX=$$EVNT CHK^IBCU82 (IBTRN) I +IBX D TEA BD(IBTRN,0 ) D TERR(I BTRN,0,$P( IBX,U,2)) Q .... S I BTRND=$G(^ IBT(356,IB TRN,0)) .. .. I +IBSW INFO D Q: IBPFSS ;IB *2.0*312 ..... S I BPFSS=1 ;I B*2.0*312 ..... ; Do NOT PRO CESS on Vi stA if DT> =Switch Ef f Date ;CC R-930 .. ... I ($P( IBTRND,"^" ,6)+1)>$P( IBSWINFO," ^",2) Q ;IB*2 .0*312 . .... I $P( $G(^DPT(IB DFN,.1))," ^")'="" Q ;IB* 2.0*312 ..... Q:$$ CHKDIS() ; CCR-1081 ..... S I BPFSS=0 ;B efore EffD t & Discha rged ;IB*2 .0*312 ... . ; .... S ^TMP("IBC AB",$J,IBD FN,IBTYP,+ $P(IBTRND, U,6),IBTRN )="" K IBD FN,IBTYP,I BEABD,IBTR N,IBTRND,I BX ; I $D( ^TMP("IBCA B",$J)) D ^IBCD1 ; c onsolidate events in to bills, create bil ls D ^IBCD C ; set co mments int o file S D IE="^IBE(3 50.9,",DA= 1,DR="7.02 ////"_DT D ^DIE ;res et last da te auto bi ller run K ^TMP("IBC AB",$J),^T MP("IBEABD ",$J),^TMP ("IBCE",$J ),^TMP("IB ILL",$J) F IBX=1:1:1 0 K ^TMP(( "IBC"_IBX) ,$J)EXIT K IBX,IBPAR 7,DIE,DA,D R,IBAUTO,I BBS,IBSC,I BT QCHKDIS () ; Retur ns 1 if di scharge wa s on or af ter effect ive date ; CCR-1081 N IBADMLNK, IBDISLNK S IBADMLNK= $P(IBTRND, "^",5) G:' IBADMLNK C HKDISQ S I BDISLNK=$P ($G(^DGPM( IBADMLNK,0 )),"^",17) G:'IBDISL NK CHKDISQ ; I (^DGP M(IBDISLNK ,0)+1)>$P( IBSWINFO," ^",2) Q 1C HKDISQ Q 0 ;TEABD(TR N,IBDT) ;a rray conta ins the li st of clai ms trackin g events t hat need E ABD update d, and the new date S IBDT=+$G (IBDT),^TM P("IBEABD" ,$J,TRN,+I BDT)="" QT ERR(TRN,IF N,ER) ;arr ay contain s events o r bills th at need en tries crea ted in the comments file, and the commen t N X S TR N=+$G(TRN) ,IFN=+$G(I FN),X=+$G( ^TMP("IBCE ",$J,DT,TR N,IFN))+1 S ^TMP("IB CE",$J,DT, TRN,IFN,X) =$G(ER),^T MP("IBCE", $J,DT,TRN, IFN)=X QTB ILL(TRN,IF N) ;array contains l ist of eve nts and bi lls to be inserted i nto 356.39 9 I '$D(^I BT(356,+$G (TRN),0))! ('$D(^DGCR (399,+$G(I FN),0))) Q S ^TMP("I BILL",$J,T RN,IFN)="" Q | |
| 76 | Modified L ogic (Chan ges are in bold) | |
| 77 | No changes should be required. Noted he re to show index ‘AT OBIL’ used to search for activ e billable events th at have no t been pre viously bi lled. | |
| 78 | ||
| 79 | Routines | |
| 80 | Activities | |
| 81 | Routine Na me | |
| 82 | IBCD2 | |
| 83 | Enhancemen t Category | |
| 84 | New | |
| 85 | Modify | |
| 86 | Delete | |
| 87 | No Change | |
| 88 | RTM | |
| 89 | ||
| 90 | Related Op tions | |
| 91 | None | |
| 92 | Related Ro utines | |
| 93 | Routines “ Called By” | |
| 94 | Routines “ Called” | |
| 95 | ||
| 96 | ||
| 97 | ||
| 98 | ||
| 99 | Data Dicti onary (DD) Reference s | |
| 100 | ||
| 101 | Related Pr otocols | |
| 102 | None | |
| 103 | Related In tegration Control Re gistration s (ICRs) | |
| 104 | None | |
| 105 | Data Passi ng | |
| 106 | Input | |
| 107 | Output Re ference | |
| 108 | Both | |
| 109 | Global Re ference | |
| 110 | Local | |
| 111 | Input Attr ibute Name and Defin ition | |
| 112 | Name: | |
| 113 | Definition : | |
| 114 | Output Att ribute Nam e and Defi nition | |
| 115 | Name: | |
| 116 | Definition : | |
| 117 | Current Lo gic | |
| 118 | IBCD2 ;ALB /ARH - AUT OMATED BIL LER (CREAT E - SETUP/ GATHER DAT A FIELDS) ; 8/6/93 ; ;2.0;INTEG RATED BILL ING;**4,55 ,91,106,38 4,458**;21 -MAR-94;Bu ild 4 ;;Pe r VHA Dire ctive 2004 -038, this routine s hould not be modifie d. ;FIND ; S IBX=$$C HKSYS^IBCD 4 I 'IBX D TERR(0,0, $P(IBX,U,2 )) G EXIT S IBS="IBC 0" F S IB S=$O(^TMP( IBS)) Q:IB S="" S IB X=$E(IBS,4 ,99) Q:$E( IBS,1,3)'= "IBC"!'+IB X D . N I BQUERY . S IBDFN=0 F S IBDFN= $O(^TMP(IB S,$J,IBDFN )) Q:'IBDF N D .. S IBSTDT="" F S IBSTD T=$O(^TMP( IBS,$J,IBD FN,IBSTDT) ) Q:IBSTDT ="" D I $D(IBCT)>9 D CREATE( .IBQUERY) ... K IBCT S IBTRN=0 F S IBTR N=$O(^TMP( IBS,$J,IBD FN,IBSTDT, IBTRN)) Q: 'IBTRN S IBCT(IBTRN )="",IBTF= ^TMP(IBS,$ J,IBDFN,IB STDT,IBTRN ) .I $G(IB QUERY) D C LOSE^IBSDU (IBQUERY)E XIT K IBS, IBDFN,IBST DT,IBCT,IB TRN,IBTF,I BX,X,DFN Q ;CREATE(I BQUERY) ;s et up a bi ll, requir ed: IBCT(I BTRN),IBDF N,IBSTDT ; IBQUERY, if defined , will be used to ac tivate the outpt vis it QUERY Q :$D(IBCT)< 9 K IB S I BSP=$G(^IB E(350.9,1, 1)),IBDIV= $P(IBSP,U, 25),IBTRN= +$O(IBCT(0 )) S IBTRN D=$G(^IBT( 356,IBTRN, 0)) I 'IBT RND D TERR (+IBTRN,0, "Claims Tr acking Rec ord not fo und or not complete. ") G QUIT S IBTYPE=$ P(IBTRND,U ,18) S IBX =$$CHK I ' IBX D TERR (+IBTRN,0, $P(IBX,U,2 )) G QUIT ; S IBX=$$ ARSET I 'I BX D TERR( IBTRN,0,$P (IBX,U,2)) G QUIT S IBIFN=+IBX ,IB(.01)=$ P(IBX,U,2) ,IB(.17)=$ P(IBX,U,3) ,IB(.2)=1, IB(.22)=IB DIV S (IB( .02),DFN)= IBDFN,IB(. 06)=IBTF S IB(.07)=$ O(^DGCR(39 9.3,"B","R EIMBURSABL E INS.",0) ) I 'IB(.0 7) S IB(.0 7)=8 S IBX =$O(^IBT(3 56.2,"ATRT P",IBTRN,1 ,"")) I +I BX S IB(16 3)=$E($P($ G(^IBT(356 .2,IBX,2)) ,U,2),1,18 ) ;pre-cer t # ; S IB X=$P($G(^I BE(356.6,+ IBTYPE,0)) ,U,1) I IB X="INPATIE NT ADMISSI ON" D INPT ^IBCD5 G C ONT I IBX= "PRESCRIPT ION REFILL " D RXRF G CONT I IB X="OUTPATI ENT VISIT" D OUTPT G CONT G QU IT ;CONT S IBX=$$BDT ^IBCU3(IBD FN,IB(.03) ) S IB(.17 )=$S(+IBX: IBX,1:IBIF N) ; conti nuing epis ode of car e ;Note if a primary bill is f ound for a n outpatie nt bill th en it allo ws them to choose th e bill dur ing bill c reation, . 17 is not editable o n the scre ens S IB(. 18)=$$SC^I BCU3(IBDFN ) ; SC at time of ca re ; ; Not e: variabl e IBQUERY used in th is call to ^IBCD3 D EN^IBCD3(. IBQUERY) ; create bi ll ; S IBT RN=0 F S IBTRN=$O(I BCT(IBTRN) ) Q:'IBTRN D . D TE RR(IBTRN,I BIFN,"") ; bill crea ted . I ", 2,3,"'[+$G (IB(.06)) D TEABD(IB TRN,0) ; r emove eabd for final bills . D TBILL(IBT RN,IBIFN) ; set inde x for bill and event (356.399) . I $O(IB (43,0)),$$ NABSCT^IBC U81(IBTRN) D TERR(IB TRN,IBIFN, "Stop/Clin ic flagged to be ign ored by au to biller but anothe r visit is billed on same date .") . I $O (IB(43,0)) ,$$NBOE^IB CU81(+$P($ G(^IBT(356 ,+IBTRN,0) ),U,4)) D TERR(IBTRN ,IBIFN,"Vi sit flagge d as SC in source fi le but has no RNB.") ; S IBTRN =$O(IBCT(I BTRN)) Q:' IBTRN D . I $G(IB(. 05))>2,$G( IB(.27))=1 ,+$G(^DGCR (399,IBIFN ,"MP")),'$ O(^DGCR(39 9,IBIFN,"R C",0)) D T ERR(IBTRN, IBIFN,"Thi s RC Opt b ill appear s to have no institu tional cha rges but m ay have pr ofessional charges." ) ; S X=$$ PRCDIV^IBC U71(IBIFN) ; reset b ill divisi on from si te default to first procedures division ;QUIT K X, Y,IBX,IBY, IBSP,IBDIV ,IBTRN,IBT RND,IBTYPE ,IB Q ;OUT PT S IB(.0 4)=$S(+$P( $G(^DG(40. 8,+IBDIV,0 )),U,3):7, 1:1) ;divi sion outpa tient only or hospit al S IB(.0 5)=3,IB(.0 6)=1,IB(.0 9)=4 ;even t dt is da te of firs t visit, s tmt from i s first vi sit dt, st mt to is l ast visit dt on bill S (IB(.03 ),IB(151)) =9999999,I B(152)="" S IBTRNX=0 F S IBTR NX=$O(IBCT (IBTRNX)) Q:'IBTRNX S IBX=$P( $G(^IBT(35 6,IBTRNX,0 )),U,6)\1 D . S IB(4 3,+IBX)="" S:IB(152) <IBX IB(15 2)=IBX F I BI=.03,151 I IB(IBI) >IBX S IB( IBI)=IBX I +$$BILLRA TE^IBCRU3( +$G(IB(.07 )),IB(.05) ,IB(.03)," RC") S IB( .27)=1 ; r easonable charges in stitutiona l bill K I BI,IBX,IBT RNX QRXRF S IB(.04)= $S(+$P($G( ^DG(40.8,+ IBDIV,0)), U,3):7,1:1 ) ;divisio n outpatie nt only or hospital S IB(.05)= 3,IB(.06)= 1 ;event d t is date of first v isit, stmt from is f irst visit dt, stmt to is last visit dt on bill S (IB(.03),I B(151))=99 99999,IB(1 52)="" S I BTRNX=0 F S IBTRNX= $O(IBCT(IB TRNX)) Q:' IBTRNX S IBRX=$G(^I BT(356,IBT RNX,0)) D . S IBX=$$ RXRF^IBCD4 (+$P(IBRX, U,8),+$P(I BRX,U,10)) ,IB(362.4, +$P(IBRX,U ,8),+$P(IB RX,U,10))= IBX,IBX=$P (IBX,U,4) . S:IB(152 )<IBX IB(1 52)=IBX F IBI=.03,15 1 I IB(IBI )>IBX S IB (IBI)=IBX . I $P(IBR X,U,31)>1 D ;specia l consent roi .. S I B(155)=1,I B(157)=0 ; is dx sen sitive .. I $P(IBRX, U,31)=2 S IB(157)=1 ; ROI obta ined K IBI ,IBX,IBTRN X,IBRX Q ; ARSET() ; set up ent ry for new bill in A R returns IFN, bill number ;ot herwise "0 ^error mea asge" N X S X="0^Can not set u p bill in AR." S PRC ASV("SER") =$P($G(^IB E(350.9,1, 1)),U,14), PRCASV("SI TE")=+$P($ $SITE^VASI TE,U,3) D SETUP^PRCA SVC3 I $P( PRCASV("AR BIL"),U)=- 1 S X="0^" _$P(PRCASV ("ARBIL"), U,2)_" - " _$$ETXT^IB EFUNC($P(P RCASV("ARB IL"),U,2)) G ARSETQ I $P(PRCAS V("ARREC") ,U)=-1 S X ="0^"_$P(P RCASV("ARR EC"),U,2)_ " - "_$$ET XT^IBEFUNC ($P(PRCASV ("ARREC"), U,2)) G AR SETQ S X=P RCASV("ARR EC")_U_$P( PRCASV("AR BIL"),"-", 2)ARSETQ K PRCASV Q X ;CHK() ; other chec ks N X S X =1 I $G(^D PT(+$G(IBD FN),0))="" S X="0^Pa tient info rmation la cking." Q X ;TEABD(T RN,IBDT) ; S IBDT=+$ G(IBDT),^T MP("IBEABD ",$J,+TRN, +IBDT)="" QTERR(TRN, IFN,ER) ; N X S TRN= +$G(TRN),I FN=+$G(IFN ),X=+$G(^T MP("IBCE", $J,DT,TRN, IFN))+1 S ^TMP("IBCE ",$J,DT,TR N,IFN,X)=$ G(ER),^TMP ("IBCE",$J ,DT,TRN,IF N)=X QTBIL L(TRN,IFN) ; I '$D(^ IBT(356,+$ G(TRN),0)) !('$D(^DGC R(399,+$G( IFN),0))) Q S ^TMP(" IBILL",$J, TRN,IFN)=" " Q | |
| 119 | Modified L ogic (Chan ges are in bold) | |
| 120 | OUTPT S IB (.04)=$S(+ $P($G(^DG( 40.8,+IBDI V,0)),U,3) :7,1:1) ;d ivision ou tpatient o nly or hos pital S IB (.05)=3,IB (.06)=1,IB (.09)=4 ;e vent dt is date of f irst visit , stmt fro m is first visit dt, stmt to i s last vis it dt on b ill S (IB( .03),IB(15 1))=999999 9,IB(152)= "" S IBTRN X=0 F S I BTRNX=$O(I BCT(IBTRNX )) Q:'IBTR NX S IBX= $P($G(^IBT (356,IBTRN X,0)),U,6) \1 D . S I B(43,+IBX) ="" S:IB(1 52)<IBX IB (152)=IBX F IBI=.03, 151 I IB(I BI)>IBX S IB(IBI)=IB X I +$$BIL LRATE^IBCR U3(+$G(IB( .07)),IB(. 05),IB(.03 ),"RC") S IB(.27)=1 ; reasonab le charges instituti onal billS IBDENT=$F ($$GET1^DI Q(409.68,$ P(IBTRND," ^",4)_",", .10),"DENT AL") | |
| 121 | K IBI,IBX, IBTRNX Q | |
| 122 | ||
| 123 | ||
| 124 | CONT S IBX =$$BDT^IBC U3(IBDFN,I B(.03)) S IB(.17)=$S (+IBX:IBX, 1:IBIFN) ; continuin g episode of care ;N ote if a p rimary bil l is found for an ou tpatient b ill then i t allows t hem to cho ose the bi ll during bill creat ion, .17 i s not edit able on th e screens S IB(.18)= $$SC^IBCU3 (IBDFN) ; SC at time of care ; ; Note: v ariable IB QUERY used in this c all to ^IB CD3 D EN^I BCD3(.IBQU ERY) ; cre ate bill ; S IBTRN=0 F S IBTR N=$O(IBCT( IBTRN)) Q: 'IBTRN D . D TERR(I BTRN,IBIFN ,"") ; bil l created . I ",2,3, "'[+$G(IB( .06)) D TE ABD(IBTRN, 0) ; remov e eabd for final bil ls . D TBI LL(IBTRN,I BIFN) ; se t index fo r bill and event (35 6.399) . I $O(IB(43, 0)),$$NABS CT^IBCU81( IBTRN) D T ERR(IBTRN, IBIFN,"Sto p/Clinic f lagged to be ignored by auto b iller but another vi sit is bil led on sam e date.") . I $O(IB( 43,0)),$$N BOE^IBCU81 (+$P($G(^I BT(356,+IB TRN,0)),U, 4)) D TERR (IBTRN,IBI FN,"Visit flagged as SC in sou rce file b ut has no RNB.") ; S IBTRN=$O( IBCT(IBTRN )) Q:'IBTR N D . I $ G(IB(.05)) >2,$G(IB(. 27))=1,+$G (^DGCR(399 ,IBIFN,"MP ")),'$O(^D GCR(399,IB IFN,"RC",0 )) D TERR( IBTRN,IBIF N,"This RC Opt bill appears to have no i nstitution al charges but may h ave profes sional cha rges.") ; S X=$$PRCD IV^IBCU71( IBIFN) ; r eset bill division f rom site d efault to first proc edures div ision ;QUI T K X,Y,IB X,IBY,IBSP ,IBDIV,IBT RN,IBTRND, IBTYPE,IB, IBDENT Q | |
| 125 | ||
| 126 | Change cod e in routi ne IBCU82 to allow f or the pro cessing of a Dental Claim. | |
| 127 | Routines | |
| 128 | Activities | |
| 129 | Routine Na me | |
| 130 | IBCU82 | |
| 131 | Enhancemen t Category | |
| 132 | New | |
| 133 | Modify | |
| 134 | Delete | |
| 135 | No Change | |
| 136 | RTM | |
| 137 | ||
| 138 | Related Op tions | |
| 139 | None | |
| 140 | Related Ro utines | |
| 141 | Routines “ Called By” | |
| 142 | Routines “ Called” | |
| 143 | ||
| 144 | ||
| 145 | ||
| 146 | ||
| 147 | Data Dicti onary (DD) Reference s | |
| 148 | ||
| 149 | Related Pr otocols | |
| 150 | None | |
| 151 | Related In tegration Control Re gistration s (ICRs) | |
| 152 | None | |
| 153 | Data Passi ng | |
| 154 | Input | |
| 155 | Output Re ference | |
| 156 | Both | |
| 157 | Global Re ference | |
| 158 | Local | |
| 159 | Input Attr ibute Name and Defin ition | |
| 160 | Name: | |
| 161 | Definition : | |
| 162 | Output Att ribute Nam e and Defi nition | |
| 163 | Name: | |
| 164 | Definition : | |
| 165 | Current Lo gic | |
| 166 | IBCU82 ;AL B/ARH - TH IRD PARTY BILLING UT ILITIES (A UTOMATED B ILLER) ;02 JUL 93 ;; 2.0;INTEGR ATED BILLI NG;**43,55 ,91,124,16 0,304,347, 432**;21-M AR-94;Buil d 192 ;;Pe r VHA Dire ctive 2004 -038, this routine s hould not be modifie d. ; ;EVNT CHK(IBTRN) ;special checks to determine if event s hould be a uto billed ;checks f or INS, no n-veteran patient, p ossible wo rkers comp and tort feasor, ad mitted for sc cond., outp dent al stop, o ptv while inpt, cate gory cover ed by ins, non-billa ble stop o r clinic ; (assumes t hat Claims Tracking does the S C check fo r Outpatie nts) ;inpu t: IBTRN - claims tr acking eve nt ; DISP - if true then any e rror messa ge will be displayed on exit. ;output: r eturns "1^ error mess age" if on e of the c hecks fail ed, 0 othe rwise ; N X,IBX,IBY, IBZ,IBTRND ,IBCAT,IBC OV,DFN,IBE VDT,VAEL,V ADMVT,VAIN DT S X=0,I BTRND=$G(^ IBT(356,+$ G(IBTRN),0 )) G:IBTRN D="" EVNTC Q I +$P(IB TRND,U,18) =1,'+$P(IB TRND,U,5) S X="1^Cla ims Tracki ng event d oes not ha ve an asso ciated Inp atient Adm ission." G EVNTCQ I +$P(IBTRND ,U,18)=2,' +$P(IBTRND ,U,4) S X= "1^Claims Tracking e vent does not have a n associat ed Outpati ent Visit. " G EVNTCQ I +$P(IBT RND,U,18)= 4,'+$P(IBT RND,U,8) S X="1^Clai ms Trackin g event do es not hav e an assoc iated pres cription i n Pharmacy ." G EVNTC Q I +$P(IB TRND,U,18) =4,$P(IBTR ND,U,10)=" " S X="1^C laims Trac king event does not have an as sociated p rescriptio n refill i n Pharmacy ." G EVNTC Q ; S DFN= +$P(IBTRND ,U,2),IBEV DT=$P(IBTR ND,U,6) I '$$INSURED ^IBCNS1(DF N,IBEVDT) S X="1^Pat ient not i nsured for event dat e." G EVNT CQ ; Check filing ti meframe I '$$PTFTF^I BCNSU31(DF N,IBEVDT) S X="1^Fil ing timefr ame not me t" G EVNTC Q S IBCAT= $S($P(IBTR ND,U,18)=1 !($P(IBTRN D,U,18)=5) :"INPATIEN T",$P(IBTR ND,U,18)=2 :"OUTPATIE NT",$P(IBT RND,U,18)= 4:"PHARMAC Y",1:"") I IBCAT'="" ,'$$PTCOV^ IBCNSU3(DF N,IBEVDT,I BCAT) S X= "1^Patient insurance does not cover "_IB CAT_"." G EVNTCQ D E LIG^VADPT S X=0 I 'V AEL(4) S X ="1^Patien t is not a veteran." G EVNTCQ ; ;check t he last di sposition before the episode t o see if m aybe worke rs comp or tort feas or S IBX=9 999999-(IB EVDT\1+1), IBX=$O(^DP T(+DFN,"DI S",IBX)) I +IBX S IB Y=$$DT(IBX ),IBX=$G(^ DPT(DFN,"D IS",IBX,2) ) D G:+X EVNTCQ . I $P(IBX,U, 1)="Y" S X ="1^Need m ay be rela ted to occ upation, c heck "_IBY _" disposi tion." Q . I $P(IBX, U,4)="Y" S X="1^Need may be re lated to a n accident , check "_ IBY_" disp osition." Q ; I +$P( IBTRND,U,5 ) S IBX=$G (^DGPM(+$P (IBTRND,U, 5),0)) D G EVNTCQ ; inpatient specific . I IBX="" S X="1^In patient ad mission mo vement not found." Q . I +$P(I BX,U,11) S X="1^Admi tted for a n SC condi tion." Q ; I +$P(IBT RND,U,4) S IBX=$$SCE ^IBSDU(+$P (IBTRND,U, 4)) D G E VNTCQ ; ou tpatient s pecific . I IBX="" S X="1^Outp atient Enc ounter not found." Q . S IBY=$ $NBOE^IBCU 81(+$P(IBT RND,U,4),I BX) I +IBY D Q:+X . . ;I +IBY= 1 S X="1^S ervice Con nected vis it." Q .. I +IBY=2 S X="1^Non- billable S top Code." Q .. I +I BY=3 S X=" 1^Non-bill able Clini c." Q .. I +IBY=4 S X="1^Non-b illable St atus: "_$P (IBY,U,2) Q . ; dent al is gene rally bill ed differe ntly . I $ P($G(^DIC( 40.7,+$P(I BX,U,3),0) ),U,1)["DE NTAL" S X= "1^Outpati ent visit contains a dental st op code." Q . ;outpa tient visi t was a di sposition: applicati on without exam is n ot billabl e . I $P(I BX,U,8)=3 D Q:X .. S IBY=$$DI SND^IBSDU( +$P(IBTRND ,U,4),IBX) ; 0-node of "DIS" . . I $P(IBY ,U,2)=2 S X="1^Dispo sition was Applicati on Without Exam." Q .. I $P($G (^DIC(37,+ $P(IBY,U,7 ),0)),U,1) ="CANCEL W ITHOUT EXA M" S X="1^ Dispositio n was Canc el Without Exam." Q . ;can not bill twic e for same day so ig nore outpa tient visi ts if pati ent was an inpatient at end of day (this means tha t outpatie nt visits on the dat e of disch arge will be billed) . I $$ADM ^IBCU64(DF N,IBEVDT) S X="1^Not Billable: Patient w as an inpa tient on t his visit date." ; I +$P(IBTRN D,U,8) S I BX=$$RXZER O^IBRXUTL( +$P(IBTRND ,U,2),+$P( IBTRND,U,8 )) D G EV NTCQ ; rx refills . I IBX="" S X="1^Pres cription n ot found i n Pharmacy ." Q . I + $P(IBTRND, U,10)>0 S IBY=$$ZERO SUB^IBRXUT L(+$P(IBTR ND,U,2),+$ P(IBTRND,U ,8),+$P(IB TRND,U,10) ) I IBY="" S X="1^Pr escription refill no t found in Pharmacy. " Q . S IB Z=$$DBLCHK ^IBTRKR31( IBTRN) I ' IBZ S X="1 ^Can not a uto bill t his refill , check Cl aims Track ing." QEVN TCQ Q X ;D T(X) ;conv ert dispos ition type date/time to extern al format (9999999-d ate) N Y S Y=0 I +X S Y=999999 9-X X ^DD( "DD") Q Y | |
| 167 | Modified L ogic (Chan ges are in bold) | |
| 168 | . ; dental is genera lly billed different ly . ;; Co mment out to allow f or the pro cessing of a Dental Service I $P($G(^DIC (40.7,+$P( IBX,U,3),0 )),U,1)["D ENTAL" S X ="1^Outpat ient visit contains a dental s top code." Q | |
| 169 | ||
| 170 | Routine IB CD3 at lab el EN will be modifi ed to add the data f or the new Dental re lated fiel ds in file 399 BILL/ CLAIMS fil e. | |
| 171 | Routines | |
| 172 | Activities | |
| 173 | Routine Na me | |
| 174 | IBCD3 | |
| 175 | Enhancemen t Category | |
| 176 | New | |
| 177 | Modify | |
| 178 | Delete | |
| 179 | No Change | |
| 180 | RTM | |
| 181 | ||
| 182 | Related Op tions | |
| 183 | None | |
| 184 | Related Ro utines | |
| 185 | Routines “ Called By” | |
| 186 | Routines “ Called” | |
| 187 | ||
| 188 | ||
| 189 | ||
| 190 | ||
| 191 | Data Dicti onary (DD) Reference s | |
| 192 | ||
| 193 | Related Pr otocols | |
| 194 | None | |
| 195 | Related In tegration Control Re gistration s (ICRs) | |
| 196 | None | |
| 197 | Data Passi ng | |
| 198 | Input | |
| 199 | Output Re ference | |
| 200 | Both | |
| 201 | Global Re ference | |
| 202 | Local | |
| 203 | Input Attr ibute Name and Defin ition | |
| 204 | Name: | |
| 205 | Definition : | |
| 206 | Output Att ribute Nam e and Defi nition | |
| 207 | Name: | |
| 208 | Definition : | |
| 209 | Current Lo gic | |
| 210 | IBCD3 ;ALB /ARH - AUT OMATED BIL LER (ADD N EW BILL - CREATE BIL L ENTRY) ; 9/5/93 ;;2 .0;INTEGRA TED BILLIN G;**14,55, 52,91,106, 125,51,148 ,160,137,2 10,245,260 ,405,384,5 16,522**;2 1-MAR-94;B uild 11 ;; Per VA Dir ective 640 2, this ro utine shou ld not be modified. ; ;Called by IBCD2,I BACUS2 ;EN (IBQUERY) ; N IBI,IB X,IBY,I,X, X1,X2,IBAC ,IBCPY K I BDR,IBDR22 2 S IBAC=1 S X=$P($T (WHERE),"; ;",2),X2=$ P($T(WHERE +1),";;",2 ) F I=0:0 S I=$O(IB( I)) Q:'I S X1=$P($E (X,$F(X,I) +1,999),"; ",1) S:X1= "" X1=$P($ E(X2,$F(X2 ,I)+1,999) ,";",1) I $D(IB(I))= 1 S $P(IBD R($P(X1,"^ ",1)),"^", $P(X1,"^", 2))=IB(I) F I=0,"C", "M","M1"," S","U","U1 ","U2" I $ D(IBDR(I)) S ^DGCR(3 99,IBIFN,I )=IBDR(I) S $P(^DGCR (399,0),"^ ",3)=IBIFN ,$P(^(0)," ^",4)=$P(^ (0),"^",4) +1 S DIK=" ^DGCR(399, ",DA=IBIFN D IX1^DIK K DA,DIK ; set cros s-referenc es ; ; Set the atten ding/rende ring provi der into p rovider mu ltiple I $ G(IB("PRV" ,.01))'="" D . S DIC ("DR")="", I=.01 . N IBV . ; On ly file if the provi der has an NPI. othe rwise it's not billa ble and wo uld have t o be remov ed from th e claim la ter . I $$ GETNPI^IBC EF73A($G(I B("PRV",.0 2)))]"" F S I=$O(IB ("PRV",I)) Q:'I D . . I IB("PR V",I)="" Q .. S IBV( I)=IB("PRV ",I),DIC(" DR")=DIC(" DR")_$S(DI C("DR")="" :"",1:";") _I_"////^S X=IBV("_I _")" . S D IC="^DGCR( 399,"_IBIF N_",""PRV" ",",DIC(0) ="L",DLAYG O=399,DA(1 )=IBIFN,X= IB("PRV",. 01) . K DO ,DD D FILE ^DICN K DO ,DD,DLAYGO ,DA,DIC ; ; Set the occurrence span code s for leav e/pass day s I $O(IB( "OC",0)) D . N I,I1 . S I1=0 F S I1=$O( IB("OC",I1 )) Q:'I1 D .. S I=0 ,DIC("DR") ="" .. F S I=$O(IB( "OC",I1,I) ) Q:'I S DIC("DR")= DIC("DR")_ $S(DIC("DR ")="":"",1 :";")_I_"/ ///"_IB("O C",I1,I) . . S DIC="^ DGCR(399," _IBIFN_"," "OC"",",DI C(0)="L",D LAYGO=399, DA(1)=IBIF N,DIC("P") =$$GETSPEC ^IBEFUNC(3 99,41),X=I B("OC") .. K DO,DD D FILE^DICN K DO,DD,D LAYGO,DA,D IC ; ; fil e rx refil ls, defaul t CPT and Dx if defi ned I $D(I B(362.4))> 2 D G END . N IBZ . S IBRX=0 F S IBRX= $O(IB(362. 4,IBRX)) Q :'IBRX S IBY="" F S IBY=$O(I B(362.4,IB RX,IBY)) Q :IBY="" D .. S IBX= IB(362.4,I BRX,IBY) Q :IBX="" .. S IBZ=$$A DD^IBCSC5A ($P(IBX,U) ,IBIFN,$P( IBX,U,4),$ P(IBX,U,2) ,+IBRX,$P( IBX,U,3)_U _$P(IBX,U, 5)_U_$P(IB X,U,6),IBY ) ; ;file outpatient visit dat es and fin d/store ou tpatient p rocedures and dx ;NO TE: If IBQ UERY is de fined at t his point, it will b e used to perform ; the scan f or outpati ent proced ures I '$$ INPAT^IBCE F(IBIFN) D G END . I $D(IB(43 ))>2 D .. S ^DGCR(39 9,IBIFN,"O P",0)="^39 9.043DA^" S IBX=0 F S IBX=$O( IB(43,IBX) ) Q:'IBX D ... S DI C="^DGCR(3 99,"_IBIFN _",""OP"", ",DIC(0)=" L",DA(1)=I BIFN,(DINU M,X)=IBX,D LAYGO=399. 043 K DD,D O D FILE^D ICN K DIC, DA,DINUM,D O,DD,DLAYG O . ; . D VST^IBCCPT (.IBQUERY) I $D(^UTI LITY($J,"C PT-CNT")) D .. N IBP RX .. S DI C("P")=$$G ETSPEC^IBE FUNC(399,3 04) .. S I BY=0 F S IBY=$O(^UT ILITY($J," CPT-CNT",I BY)) Q:'IB Y S IBX=^ (IBY) I '$ P(IBX,U,6) D ... S I BPRX(+$P(I BX,U,8))=" " ... S DI C="^DGCR(3 99,"_IBIFN _",""CP"", ",DIC(0)=" L",DA(1)=I BIFN,X=+IB X_";ICPT(" ,DLAYGO=39 9 K DD,DO D FILE^DIC N K DO,DD, DLAYGO Q:Y '>0 ... ; ... S IBCP Y=+Y ... ; ... ; add dx to 362 .3 for ass ociations if they ex ist ... I $G(^UTILIT Y($J,"CPT- CNT",IBY," DX")) D AD DDX^IBCCPT 1(IBIFN,IB CPY,^("DX" ),.IBDR) I $L($G(IBD R)) S IBDR =IBDR_";" ... ; ... ; ... S DR =$G(IBDR)_ "1////"_$P (IBX,U,2)_ $S(+$P(IBX ,U,8):";18 ////"_+$P( IBX,U,8),1 :"") K IBD R ... S DR =DR_$S(+$P (IBX,U,9): ";6////"_+ $P(IBX,U,9 ),1:"")_$S (+$P(IBX,U ,5):";5/// /"_+$P(IBX ,U,5),1:"" ) ... S DR =DR_$S(+$P (IBX,U,11) :";20////" _+$P(IBX,U ,11),1:"") ... S DIE =DIC,DA=+I BCPY D ^DI E K DIE,DI C,DA,DINUM ,DO,DD ... I $P(IBX, U,10) D AD DMOD^IBCCP T(IBIFN,IB CPY,$P(IBX ,U,10)) ;M odifiers . . I $O(IBP RX(""))=$O (IBPRX("") ,-1),$O(IB PRX(0)) D ... ;If on ly 1 provi der - make it the re ndering .. . S IB("PR V",.02)=+$ O(IBPRX(0) )_";VA(200 ,",IB("PRV ",.01)=3 . K DGCNT,V ,IBOPV1,IB OPV2,I,DGD IV,I1,DGNO D,DGCPTS,I 7,I2,DGCPT ,^UTILITY( $J,"CPT-CN T") . ; . D OPTDX^IB CSC4D(DFN, IB(151),IB (152),.IBD X) I +IBDX D K IBDX .. S IBY= 0 F S IBY =$O(IBDX(I BY)) Q:IBY ="" S IBX =IBDX(IBY) I '$P(IBX ,U,5) D .. . I '$D(^D GCR(399,"A OPV",DFN,( +$P(IBX,U, 4)\1),IBIF N)) Q ... S DIC("DR" )=".02//// "_IBIFN,DI C="^IBA(36 2.3,",DIC( 0)="L",X=+ IBX,DLAYGO =362.3 K D D,DO D FIL E^DICN ... K DIE,DIC ,DA,DLAYGO ,DO,DD ; ; store inpa tient diag nosis and procedures , default admit dx t o first dx found I $ $INPAT^IBC EF(IBIFN) D G END . I $G(^TMP ("IBDX",$J ))=IB(.08) D K ^TMP ("IBDX",$J ) .. N IBX DEF S IBXD EF=0 .. S (IBI,IBX)= "" F S IB X=$O(^TMP( "IBDX",$J, IBX)) Q:'I BX S IBY= 0 F S IBY =$O(^TMP(" IBDX",$J,I BX,IBY)) Q :'IBY D . .. S IBZ=^ TMP("IBDX" ,$J,IBX,IB Y) Q:($$IC D9^IBACSV( +IBZ)="") S IBI=IBI+ 1 ... S DI C("DR")=". 02////"_IB IFN_";.03/ ///"_IBI I $P(IBZ,U, 3)'="" S D IC("DR")=D IC("DR")_" ;.04///"_$ P(IBZ,U,3) ... S DIC ="^IBA(362 .3,",DIC(0 )="L",X=+I BZ,DLAYGO= 362.3 K DD ,DO D FILE ^DICN K DI E,DIC,DA,D LAYGO,DO,D D ... I Y> 0,'IBXDEF S IBXDEF=1 ,DR="215// //"_+IBZ,D IE="^DGCR( 399,",DA=I BIFN D ^DI E . ; . D PTFPRDT^IB CSC4A(+IB( .08),IB(15 1),IB(152) ,9) I $D(^ UTILITY($J ,"IB")) D K ^UTILIT Y($J,"IB") .. S ^DGC R(399,IBIF N,"CP",0)= "^399.0304 AVI^" .. S IBX=0 F S IBX=$O(^ UTILITY($J ,"IB",IBX) ) Q:'IBX S IBY=0 F S IBY=$O( ^UTILITY($ J,"IB",IBX ,IBY)) Q:' IBY D ... S IBZ=^UT ILITY($J," IB",IBX,IB Y) Q:($$IC D0^IBACSV( +IBZ)="") S IBI=$P(^ UTILITY($J ,"IB",IBX, 1),U,2) .. . S DIC="^ DGCR(399," _IBIFN_"," "CP"",",DI C(0)="L",D A(1)=IBIFN ,X=+IBZ_"; ICD0(",DLA YGO=399.03 04 K DD,DO D FILE^DI CN ... I Y >0 S DIE=D IC,DA=+Y,D R="1////"_ (IBI\1) D ^DIE K DIE ,DIC,DA,DL AYGO,DO,DD ;END S IB X="1^Billi ng Record #"_$P(^DGC R(399,+IBI FN,0),"^", 1)_" estab lished for "_$P($G(^ DPT(IBDFN, 0)),U,1) ; S IBAUTO= 1,DGPTUPDT ="" I '$G( IBCHTRN) D PROC^IBCU 7A(IBIFN) D ^IBCU6 ; auto calc ulate/stor e revenue codes ;Q K %,%DT,IBD R,X1,X2,X3 ,X4,Y,DGDI RA,DGDIRB, DGDIR0,DIR ,DGRVRCAL, DIC,DA,DR, DINUM,DGPT UPDT,DGXRF 1,IBCHK,IB INDT,IBIDS ,DLAYGO Q ;WHERE ;;. 01^0^1;.02 ^0^2;.03^0 ^3;.04^0^4 ;.05^0^5;. 06^0^6;.07 ^0^7;.08^0 ^8;.09^0^9 ;.11^0^11; .17^0^17;. 16^0^16;.1 8^0^18;.19 ^0^19;.2^0 ^20;.22^0^ 22;.27^0^2 7;112^M^12 ;151^U^1;1 52^U^2;155 ^U^5;157^U ^7;101^M^1 ;158^U^8;1 59^U^9;160 ^U^10;161^ U^11;162^U ^12; ;;217 ^U2^3;221^ U2^7; | |
| 211 | Modified L ogic (Chan ges are in bold) | |
| 212 | New code w ill be add ed to this routine t o file the necessary data valu es for the new Denta l Claim re lated fiel ds in file 399 BILL/ CLAIMS fil e, that wi ll be adde d as part of user st ory 1108. | |
| 213 | ||
| 214 | ||
| 215 | ||
| 216 |
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