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1 | MCCF_EDI_TAS_P2_PRCA_4_5_332.zip\MCCF_EDI_TAS_P2_PRCA_4_5_332\PRCA_4_5_332_IB_2_0_633.zip | TAS ePay US4340 SDD.docx | Fri Jan 25 13:51:20 2019 UTC |
2 | MCCF_EDI_TAS_P2_PRCA_4_5_332.zip\MCCF_EDI_TAS_P2_PRCA_4_5_332\PRCA_4_5_332_IB_2_0_633.zip | TAS ePay US4340 SDD.docx | Tue Feb 26 14:12:11 2019 UTC |
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1 | MCCF EDI T AS US4340 | |
2 | System Des ign Docume nt | |
3 | PRCA*4.5*x xx | |
4 | ||
5 | ||
6 | ||
7 | ||
8 | Department of Vetera ns Affairs | |
9 | August 201 8 | |
10 | Version 1 | |
11 | User Story ID: USxxx | |
12 | User Story Name: Me ssage Stor age Errors | |
13 | Sizing: 1 | |
14 | ||
15 | Epic Taxon omy | |
16 | eBiz Comp liance | |
17 | Port | |
18 | Update | |
19 | Increa se No Touc h | |
20 | TAS Apps | |
21 | Story | |
22 | As a... | |
23 | I want to. .. | |
24 | So that... | |
25 | ePayments user, I ne ed to see ERAs witho ut message storage e rrors. | |
26 | The 835 to be a read able forma t with rel evant erro r messages . | |
27 | I can accu rately rev iew ERAs. | |
28 | ||
29 | Conversati on (if des ired by de velopers) | |
30 | Most examp les show t he Revenue code in t he procedu re code fi eld and th at appears to be cau sing these to be err ors. There were only a couple of excepti ons to tha t but it w as clearly the vast majority. I didn’t s ee any of these that were erro rs for not returning the same number of lines on t he 835 as what was o n the 837. Its acros s multiple payers an d multiple CPACs so I don’t se e anything to indica te a payer issue. Be low is an example of rev code in the pro cedure fie ld and a s econd exam ple of mis matched un its with a ll line it ems return ed on the 835. | |
31 | ||
32 | 835 in TPJ I – EP opt ion | |
33 | May be eBi lling rela ted (needs research) | |
34 | ||
35 | Example1 | |
36 | This is wh at was bil led: | |
37 | Bill Charg es Jun 05, 20 18@14:19:3 3 Page: 1 of 4 | |
38 | %K80BHJ2 xxxxxxxxx xxxxxx DO B: xx/xx/x x Subsc ID: xxxxxx xx | |
39 | ||
40 | 02/26/18 - 02/26/18 AD MIT THRU D ISCHARGE Ori g Amt: 4,3 76.15 | |
41 | ||
42 | 0636 DRUGS /DETAIL CO DE J2175 02261 8 1 1799 000 | |
43 | 0636 DRUGS /DETAIL CO DE J2250 02261 8 3 1527 000 | |
44 | 0750 GASTR -INST SVS 45341 02261 8 1 434289 000 | |
45 | ||
46 | ERA detail s: | |
47 | ********** EOB/835 I NFORMATION (1 of 1) ********** | |
48 | EOB Type : NORMAL E OB EOB Paid D ate: APR 0 9, 2018 | |
49 | Svc From Date: Svc to Dat e: | |
50 | I CN: 201803 221236 | |
51 | Payer Na me/TIN: AC S BENEFIT SERVICES/1 341858379 | |
52 | ERA # : 282575 Auto-Post Status: | |
53 | Trace # : 15881658 | |
54 | ECME #: DOS: R x/Fill/Rel ease Statu s: | |
55 | ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- | |
56 | CLAIM LEVE L PAY STAT US: | |
57 | Total Su bmitted Ch arges : 4376.15 Payer Cove red Amount : 0.00 | |
58 | Payer Pa id Amount : 0.00 MEDICARE A llowed Amo unt : 0.00 | |
59 | Patient Responsibi lity : 0.00 | |
60 | ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- | |
61 | CLAIM LEVE L ADJUSTME NTS: | |
62 | -- None -- | |
63 | CLAIM LEVE L REMARKS: | |
64 | -- None -- | |
65 | ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- | |
66 | EEOB LINE LEVEL ADJU STMENTS: | |
67 | -- No Li ne Level A djustments -- | |
68 | ||
69 | EEOB MESSA GE ERRORS: | |
70 | ||
71 | Mismatched Procedure Code: | |
72 | ||
73 | Payer repo rted the f ollowing w as billed to them vi a the Clai m (837): | |
74 | Proc/Rev C D: UNK M ods: Chg: 17.99 Units:1 | |
75 | Payer repo rted the f ollowing w as used fo r adjudica tion via t he EEOB (8 35): | |
76 | Proc/Rev C D: Mods:U NK Amt Pd: 0.00 Cov Uni ts:1 | |
77 | ||
78 | ---------- ---------- ---------- ---------- ---------- ---------- --------- | |
79 | Service li ne adjustm ent (EEOB Record 42) has no ma tching ser vice line | |
80 | Line I tem Remark Code: N13 0 | |
81 | Consult pl an benefit documents for infor mation abo ut restric tions for this servi | |
82 | ce. | |
83 | ---------- ---------- ---------- ---------- ---------- ---------- --------- | |
84 | Service li ne adjustm ent (EEOB Record 45) has no ma tching ser vice line | |
85 | Adj Gr oup Cd: OA Reason C d: A1 Amt : 17.99 Q uantity: 1 | |
86 | Claim deni ed charges . | |
87 | ---------- ---------- ---------- ---------- ---------- ---------- --------- | |
88 | ||
89 | Mismatched Procedure Code: | |
90 | ||
91 | Payer repo rted the f ollowing w as billed to them vi a the Clai m (837): | |
92 | Proc/Rev C D: UNK M ods: Chg: 15.27 Units:1 | |
93 | Payer repo rted the f ollowing w as used fo r adjudica tion via t he EEOB (8 35): | |
94 | Proc/Rev C D: Mods:U NK Amt Pd: 0.00 Cov Uni ts:1 | |
95 | ||
96 | ---------- ---------- ---------- ---------- ---------- ---------- --------- | |
97 | Service li ne adjustm ent (EEOB Record 42) has no ma tching ser vice line | |
98 | Line I tem Remark Code: N13 0 | |
99 | Consult pl an benefit documents for infor mation abo ut restric tions for this servi | |
100 | ce. | |
101 | ---------- ---------- ---------- ---------- ---------- ---------- --------- | |
102 | Service li ne adjustm ent (EEOB Record 45) has no ma tching ser vice line | |
103 | Adj Gr oup Cd: OA Reason C d: A1 Amt : 15.27 Q uantity: 1 | |
104 | Claim deni ed charges . | |
105 | ---------- ---------- ---------- ---------- ---------- ---------- --------- | |
106 | ||
107 | Mismatched Procedure Code: | |
108 | ||
109 | Payer repo rted the f ollowing w as billed to them vi a the Clai m (837): | |
110 | Proc/Rev C D: UNK M ods: Chg: 4342.89 Units:1 | |
111 | Payer repo rted the f ollowing w as used fo r adjudica tion via t he EEOB (8 35): | |
112 | Proc/Rev C D: Mods:U NK Amt Pd: 0.00 Cov Uni ts:1 | |
113 | ||
114 | ---------- ---------- ---------- ---------- ---------- ---------- --------- | |
115 | Service li ne adjustm ent (EEOB Record 42) has no ma tching ser vice line | |
116 | Line I tem Remark Code: N13 0 | |
117 | Consult pl an benefit documents for infor mation abo ut restric tions for this servi | |
118 | ce. | |
119 | ---------- ---------- ---------- ---------- ---------- ---------- --------- | |
120 | Service li ne adjustm ent (EEOB Record 45) has no ma tching ser vice line | |
121 | Adj Gr oup Cd: OA Reason C d: A1 Amt : 4342.89 Quantity: 1 | |
122 | Claim deni ed charges . | |
123 | ||
124 | EPHRA | |
125 | ||
126 | ||
127 | Example2 | |
128 | This is wh at was bil led: | |
129 | Bill Charg es Jun 05, 20 18@14:35:3 9 Page: 1 of 3 | |
130 | %K80BU1Z xxxxxxxxx x DOB: xx/xx/xx Subsc ID : xxxxxxx | |
131 | 02/13/18 - 02/13/18 AD MIT THRU D ISCHARGE Ori g Amt: 443 .21 | |
132 | ||
133 | 0271 NON-S TER SUPPLY A7030NU 02131 8 1 24599 000 | |
134 | 0271 NON-S TER SUPPLY A7037NU 02131 8 1 9270 000 | |
135 | 0271 NON-S TER SUPPLY A7038NU 02131 8 1 1960 000 | |
136 | 0290 MED E QUIP/DURAB E1399NU 02131 8 1 8492 000 | |
137 | ||
138 | ERA Detail s: | |
139 | ********** EOB/835 I NFORMATION (1 of 1) ********** | |
140 | EOB Type : NORMAL E OB EOB Paid D ate: APR 2 7, 2018 | |
141 | Svc From Date: 02/ 13/18 Svc to Dat e: | |
142 | I CN: 620480 254N324190 7616400000 0000 | |
143 | Payer Na me/TIN: NA LC/1530114 650 | |
144 | ERA # : 283469 Auto-Post Status: CO MPLETE | |
145 | Trace # : 32419076 0001640 | |
146 | ECME #: DOS: R x/Fill/Rel ease Statu s: | |
147 | ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- | |
148 | CLAIM LEVE L PAY STAT US: | |
149 | Total Su bmitted Ch arges : 443.21 Payer Cove red Amount : 0.00 | |
150 | Payer Pa id Amount : 71.66 MEDICARE A llowed Amo unt : 0.00 | |
151 | Patient Responsibi lity : 0.00 | |
152 | ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- | |
153 | CLAIM LEVE L ADJUSTME NTS: | |
154 | -- None -- | |
155 | CLAIM LEVE L REMARKS: | |
156 | -- None -- | |
157 | ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- | |
158 | EEOB LINE LEVEL ADJU STMENTS: | |
159 | -- No Li ne Level A djustments -- | |
160 | ||
161 | EEOB MESSA GE ERRORS: | |
162 | ||
163 | Mismatched Amount of Units: | |
164 | ||
165 | Payer repo rted the f ollowing w as billed to them vi a the Clai m (837): | |
166 | Proc/Rev C D: A7030 M ods: Chg: 245.99 Units: | |
167 | Payer repo rted the f ollowing w as used fo r adjudica tion via t he EEOB (8 35): | |
168 | Proc/Rev C D: A7030 M ods:UNK Amt Pd: 49.20 Cov Uni ts:1 | |
169 | ||
170 | ---------- ---------- ---------- ---------- ---------- ---------- --------- | |
171 | Service li ne adjustm ent (EEOB Record 45) has no ma tching ser vice line | |
172 | Adj Gr oup Cd: CO Reason C d: 45 Amt : 196.79 Quantity: 0 | |
173 | Charge exc eeds fee s chedule/ma ximum allo wable or c ontracted/ legislated fee arran | |
174 | gement. ( Use Group Coides PR or CO depe nding on l iability). | |
175 | ---------- ---------- ---------- ---------- ---------- ---------- --------- | |
176 | ||
177 | Mismatched Amount of Units: | |
178 | ||
179 | Payer repo rted the f ollowing w as billed to them vi a the Clai m (837): | |
180 | Proc/Rev C D: A7037 M ods: Chg: 92.70 Units: | |
181 | Payer repo rted the f ollowing w as used fo r adjudica tion via t he EEOB (8 35): | |
182 | Proc/Rev C D: A7037 M ods:UNK Amt Pd: 18.54 Cov Uni ts:1 | |
183 | ||
184 | ---------- ---------- ---------- ---------- ---------- ---------- --------- | |
185 | Service li ne adjustm ent (EEOB Record 45) has no ma tching ser vice line | |
186 | Adj Gr oup Cd: CO Reason C d: 45 Amt : 74.16 Q uantity: 0 | |
187 | Charge exc eeds fee s chedule/ma ximum allo wable or c ontracted/ legislated fee arran | |
188 | gement. ( Use Group Coides PR or CO depe nding on l iability). | |
189 | ---------- ---------- ---------- ---------- ---------- ---------- --------- | |
190 | ||
191 | Mismatched Amount of Units: | |
192 | ||
193 | Payer repo rted the f ollowing w as billed to them vi a the Clai m (837): | |
194 | Proc/Rev C D: A7038 M ods: Chg: 19.60 Units: | |
195 | Payer repo rted the f ollowing w as used fo r adjudica tion via t he EEOB (8 35): | |
196 | Proc/Rev C D: A7038 M ods:UNK Amt Pd: 3.92 Cov Uni ts:1 | |
197 | ||
198 | ---------- ---------- ---------- ---------- ---------- ---------- --------- | |
199 | Service li ne adjustm ent (EEOB Record 45) has no ma tching ser vice line | |
200 | Adj Gr oup Cd: CO Reason C d: 45 Amt : 15.68 Q uantity: 0 | |
201 | Charge exc eeds fee s chedule/ma ximum allo wable or c ontracted/ legislated fee arran | |
202 | gement. ( Use Group Coides PR or CO depe nding on l iability). | |
203 | ---------- ---------- ---------- ---------- ---------- ---------- --------- | |
204 | ||
205 | Mismatched Amount of Units: | |
206 | ||
207 | Payer repo rted the f ollowing w as billed to them vi a the Clai m (837): | |
208 | Proc/Rev C D: E1399 M ods: Chg: 84.92 Units: | |
209 | Payer repo rted the f ollowing w as used fo r adjudica tion via t he EEOB (8 35): | |
210 | Proc/Rev C D: E1399 M ods:UNK Amt Pd: 0.00 Cov Uni ts:1 | |
211 | ||
212 | ---------- ---------- ---------- ---------- ---------- ---------- --------- | |
213 | Service li ne adjustm ent (EEOB Record 42) has no ma tching ser vice line | |
214 | Line I tem Remark Code: | |
215 | ---------- ---------- ---------- ---------- ---------- ---------- --------- | |
216 | Service li ne adjustm ent (EEOB Record 45) has no ma tching ser vice line | |
217 | Adj Gr oup Cd: OA Reason C d: 16 Amt : 84.92 Q uantity: 0 | |
218 | Claim/serv ice lacks informatio n which is needed fo r adjudica tion. Addi tional inf | |
219 | ormation i s supplied using rem ittance ad vice remar ks codes w henever ap propriate | |
220 | ||
221 | EPHRA | |
222 | ||
223 | ||
224 | ||
225 | Summary | |
226 | ||
227 | Based on a nalysis of the 835 a nd 837 mes sages for the above examples w e have two different scenarios involved. In the f irst examp le the bil l was not sent and r eceived el ectronical ly. A pap er bill wa s sent to the payer. There be ing no 837 message f rom which to draw th e procedur e codes, t he procedu re codes o n the 835 message we re null, l eading to the percei ved proced ure code m ismatch. | |
228 | ||
229 | This scena rio will b e addresse d by putti ng a more accurate d escriptive message o n the 835 report. If the proce dure codes are null on 835 mes sage, and there is e vidence th at the bil l was not sent elect ronically, instead o f saying “ Mismatched procedure Code” and giving th e line det ails, the message wi ll read “C laim was n ot Billed Electronic ally”. | |
230 | ||
231 | For the se cond scena rio, “Mis matched am ount of un its” it ap pears that these are being bil led electr onically w ith the un its correc tly listed on the 83 7 message, however t he 835 mes sage is re turned wit h “0” as t he origina l units an d the cove red units. Since th e error ou tput corre ctly ident ifies an i ssue with the units in the 835 message i t is propo sed that t his error message re main “as i s”. | |
232 | ||
233 | Resoluti on – Added Changed O bjects | |
234 | ||
235 | Routines | |
236 | Activities | |
237 | Routine Na me | |
238 | IBCEOB0 | |
239 | Enhancemen t Category | |
240 | New | |
241 | Modify | |
242 | Delete | |
243 | No Change | |
244 | RTM | |
245 | ||
246 | Related Op tions | |
247 | 835 EOB MS G PROCESSI NG | |
248 | Routines | |
249 | Activities | |
250 | Data Dicti onary (DD) Reference s | |
251 | ||
252 | Related Pr otocols | |
253 | ||
254 | Related In tegration Control Re gistration s (ICRs) | |
255 | ||
256 | Data Passi ng | |
257 | Input | |
258 | Output Re ference | |
259 | Both | |
260 | Global Re ference | |
261 | Local | |
262 | Input Attr ibute Name and Defin ition | |
263 | Name: | |
264 | Definition : | |
265 | Output Att ribute Nam e and Defi nition | |
266 | Name: | |
267 | Definition : | |
268 | Related Ro utines | |
269 | Routines “ Called By” | |
270 | Routines “ Called” | |
271 | ||
272 | ^IBCOEB | |
273 | ||
274 | $$DOLLA R^IBCEOB | |
275 | DET40^I BCEOB00 | |
276 | DET4X^I BCEOB00 | |
277 | $$FINDL N^IBCEOB1 | |
278 | $$STORE ^IBCEOB1 | |
279 | $$DATE^ IBCEU | |
280 | $$GETSP EC^IBEFUNC | |
281 | ||
282 | ||
283 | ||
284 | ||
285 | ||
286 | Current Lo gic – IBCE OB0 | |
287 | IBCEOB0 ;A LB/TMP/PJH - 835 EDI EOB MSG P ROCESSING ; 8/24/10 7:23pm ;;2 .0;INTEGRA TED BILLIN G;**135,28 0,155,431, 488,516**; 21-MAR-94; Build 123 ;;Per VA D irective 6 402, this routine sh ould not b e modified . Q ; | |
288 | . | |
289 | . | |
290 | . | |
291 | 40(IB0,IBE OB,IBOK) ; Process r ecord type 40 for EO B ; IB0 = the record being pro cessed ; I BEOB = the ien of th e EOB entr y in file 361.1 ; IB OK = Retur ned as 1 i f record f iled OK, 0 if error occurred ; ; IBZDATA is also a ssumed to exist or i f not, it is created in FINDLN ; N A,LEV EL,IBSEQ,I BDA,IBPC,I BLREF,IBIF N,Q,X,Y,DA ,DD,DO,DIC ,DLAYGO,PL REF,ERRCOD K ^TMP($J ,40) ; the entry # f or corresp onding 41, 42, and 4 5 records ; S IBIFN= +$G(^IBM(3 61.1,IBEOB ,0)) L +^I BM(361.1,I BEOB,15):0 I $T S IB SEQ=+$O(^I BM(361.1,I BEOB,15," "),-1)+1 I '$G(IBSEQ ) S ^TMP(I BEGBL,$J,+ $O(^TMP(IB EGBL,$J,"" ),-1)+1)=" Record loc k failure - could no t acquire next servi ce line nu mber" G Q4 0 ; ; Upda te the 40 record dat a a little bit (piec es 3/4/16) I $P(IB0, U,21)="NU" S $P(IB0, U,4)=$P(IB 0,U,3),$P( IB0,U,3)=" " S $P(IB0 ,U,16)=$S( +$P(IB0,U, 16):$P(IB0 ,U,16)/100 ,1:+$P(IB0 ,U,18)/100 ) I $P(IB0 ,U,4)?1.N S $P(IB0,U ,4)=+$P(IB 0,U,4) ; ; Find the line item from origi nal bill f or this ad justment S PLREF=$S( 'HIPAA:$P( IB0,U,22), 1:$$LINE() ) ; old fo rmat from 40 record, new forma t from 42 S ERRCOD=0 S IBLREF= +$$FINDLN^ IBCEOB1(IB 0,IBEOB,.I BZDATA,+PL REF,.ERRCO D) I 'IBLR EF D G Q4 0 . N Z,Z0 ,CT,ETEXT . S EFLAG= 0,ETEXT="" . ;;S ^TM P(IBEGBL,$ J,+$O(^TMP (IBEGBL,$J ,""),-1)+1 )="Service line deta il could n ot be matc hed to a b illed item " . S ^TMP (IBEGBL,$J ,+$O(^TMP( IBEGBL,$J, ""),-1)+1) =" " . S E TEXT=$P("R evenue Cod e^Procedur e Code^Amo unt of Uni ts^Charge Amount^Pro cedure Cod e Modifier ",U,+ERRCO D) . I ETE XT="" S ET EXT="Data" . S ^TMP( IBEGBL,$J, +$O(^TMP(I BEGBL,$J," "),-1)+1)= "Mismatche d "_ETEXT_ ":" . S ^T MP(IBEGBL, $J,+$O(^TM P(IBEGBL,$ J,""),-1)+ 1)=" " . D DET40^IBC EOB00(IB0, .Z0,ERRCOD ) . S CT=+ $O(^TMP(IB EGBL,$J,"" ),-1),Z=0 F S Z=$O( Z0(Z)) Q:' Z S CT=CT +1,^TMP(IB EGBL,$J,CT )=Z0(Z) ; S DIC="^IB M(361.1,"_ IBEOB_",15 ,",DIC(0)= "L",DLAYGO =361.115,D A(1)=IBEOB S X=IBSEQ S DIC("DR ")=".12/// /"_+IBLREF _$S($P(IBL REF,U,2)=" ":"",1:";. 15////"_$P (IBLREF,U, 2))_";.16/ ///"_$$DAT E^IBCEU($P (IB0,U,19) )_$S($P(IB 0,U,20):"; .17////"_$ $DATE^IBCE U($P(IB0,U ,20)),1:"" ) D FILE^D ICN K DIC, DO,DD,DLAY GO ;Add a new LINE L EVEL ADJUS TMENT ('SV C') I Y<0 S ^TMP(IBE GBL,$J,+$O (^TMP(IBEG BL,$J,""), -1)+1)="Co uld not ad d a LINE L EVEL ADJUS TMENT ("_I BSEQ_")" G Q40 ; L - ^IBM(361.1 ,IBEOB,15) ; S LEVEL =15.1,LEVE L(0)=+Y,LE VEL(1)=IBE OB,LEVEL(" DIE")="^IB M(361.1,"_ IBEOB_",15 ," S A="3; .04;0;0;0^ 4;.1;0;0;0 ^9;.09;0;0 ;0^17;.03; 1;0;0^18;. 11;0;1;D2^ 21;.18;0;0 ;0" I '$P( IB0,U,18), $P(IB0,U,1 6) S $P(A, U,5)="16;. 11;0;1;1" I $$STORE^ IBCEOB1(A, IB0,IBEOB, .LEVEL) S ^TMP($J,40 )=LEVEL(0) ,IBOK=1 I '$G(IBOK) S ^TMP(IBE GBL,$J,+$O (^TMP(IBEG BL,$J,""), -1)+1)="Ba d data for line leve l adjustme nt "_IBSEQ G Q40 ; ; Store mod ifiers in multiple S DIC="^IBM (361.1,"_I BEOB_",15, "_LEVEL(0) _",2,",DIC (0)="L",DL AYGO=361.1 152,DA(2)= IBEOB,DA(1 )=LEVEL(0) F Q=5:1:8 S X=$P(IB 0,U,Q) I X '="" D FIL E^DICN K D O,DD I Y<0 S IBOK=0 Q K DLAYGO ,DIC,DR,DA I '$G(IBO K) S ^TMP( IBEGBL,$J, +$O(^TMP(I BEGBL,$J," "),-1)+1)= "Could not file modi fier data for line l evel adjus tment "_IB SEQ G Q40Q 40 Q ; | |
292 | . | |
293 | . | |
294 | . | |
295 | ||
296 | Modified L ogic – IBC EOB0 | |
297 | IBCEOB0 ;A LB/TMP/PJH - 835 EDI EOB MSG P ROCESSING ; 8/24/10 7:23pm ;;2 .0;INTEGRA TED BILLIN G;**135,28 0,155,431, 488,516,XX X**;21-MAR -94;Build 123 ;;Per VA Directi ve 6402, t his routin e should n ot be modi fied. Q ; | |
298 | . | |
299 | . | |
300 | . | |
301 | 40(IB0,IBE OB,IBOK) ; Process r ecord type 40 for EO B ; IB0 = the record being pro cessed ; I BEOB = the ien of th e EOB entr y in file 361.1 ; IB OK = Retur ned as 1 i f record f iled OK, 0 if error occurred ; ; IBZDATA is also a ssumed to exist or i f not, it is created in FINDLN ; N A,LEV EL,IBSEQ,I BDA,IBPC,I BLREF,IBIF N,Q,X,Y,DA ,DD,DO,DIC ,DLAYGO,PL REF,ERRCOD K ^TMP($J ,40) ; the entry # f or corresp onding 41, 42, and 4 5 records ; S IBIFN= +$G(^IBM(3 61.1,IBEOB ,0)) L +^I BM(361.1,I BEOB,15):0 I $T S IB SEQ=+$O(^I BM(361.1,I BEOB,15," "),-1)+1 I '$G(IBSEQ ) S ^TMP(I BEGBL,$J,+ $O(^TMP(IB EGBL,$J,"" ),-1)+1)=" Record loc k failure - could no t acquire next servi ce line nu mber" G Q4 0 ; ; Upda te the 40 record dat a a little bit (piec es 3/4/16) I $P(IB0, U,21)="NU" S $P(IB0, U,4)=$P(IB 0,U,3),$P( IB0,U,3)=" " S $P(IB0 ,U,16)=$S( +$P(IB0,U, 16):$P(IB0 ,U,16)/100 ,1:+$P(IB0 ,U,18)/100 ) I $P(IB0 ,U,4)?1.N S $P(IB0,U ,4)=+$P(IB 0,U,4) ; ; Find the line item from origi nal bill f or this ad justment S PLREF=$S( 'HIPAA:$P( IB0,U,22), 1:$$LINE() ) ; old fo rmat from 40 record, new forma t from 42 S ERRCOD=0 S IBLREF= +$$FINDLN^ IBCEOB1(IB 0,IBEOB,.I BZDATA,+PL REF,.ERRCO D) I 'IBLR EF D G Q4 0 . N Z,Z0 ,CT,ETEXT . S EFLAG= 0,ETEXT="" . ;;S ^TM P(IBEGBL,$ J,+$O(^TMP (IBEGBL,$J ,""),-1)+1 )="Service line deta il could n ot be matc hed to a b illed item " . S ^TMP (IBEGBL,$J ,+$O(^TMP( IBEGBL,$J, ""),-1)+1) =" " . S E TEXT=$P("R evenue Cod e^Procedur e Code^Amo unt of Uni ts^Charge Amount^Pro cedure Cod e Modifier ",U,+ERRCO D) . I ETE XT="" S ET EXT="Data" | |
302 | . S ^TMP( IBEGBL,$J, +$O(^TMP(I BEGBL,$J," "),-1)+1)= $$ERRTXT(E TEXT,) . S ^TMP(IBEG BL,$J,+$O( ^TMP(IBEGB L,$J,""),- 1)+1)=" " . D DET40^ IBCEOB00(I B0,.Z0,ERR COD) . S C T=+$O(^TMP (IBEGBL,$J ,""),-1),Z =0 F S Z= $O(Z0(Z)) Q:'Z S CT =CT+1,^TMP (IBEGBL,$J ,CT)=Z0(Z) ; S DIC=" ^IBM(361.1 ,"_IBEOB_" ,15,",DIC( 0)="L",DLA YGO=361.11 5,DA(1)=IB EOB S X=IB SEQ S DIC( "DR")=".12 ////"_+IBL REF_$S($P( IBLREF,U,2 )="":"",1: ";.15////" _$P(IBLREF ,U,2))_";. 16////"_$$ DATE^IBCEU ($P(IB0,U, 19))_$S($P (IB0,U,20) :";.17//// "_$$DATE^I BCEU($P(IB 0,U,20)),1 :"") D FIL E^DICN K D IC,DO,DD,D LAYGO ;Add a new LIN E LEVEL AD JUSTMENT ( 'SVC') I Y <0 S ^TMP( IBEGBL,$J, +$O(^TMP(I BEGBL,$J," "),-1)+1)= "Could not add a LIN E LEVEL AD JUSTMENT ( "_IBSEQ_") " G Q40 ; L -^IBM(36 1.1,IBEOB, 15) ; S LE VEL=15.1,L EVEL(0)=+Y ,LEVEL(1)= IBEOB,LEVE L("DIE")=" ^IBM(361.1 ,"_IBEOB_" ,15," S A= "3;.04;0;0 ;0^4;.1;0; 0;0^9;.09; 0;0;0^17;. 03;1;0;0^1 8;.11;0;1; D2^21;.18; 0;0;0" I ' $P(IB0,U,1 8),$P(IB0, U,16) S $P (A,U,5)="1 6;.11;0;1; 1" I $$STO RE^IBCEOB1 (A,IB0,IBE OB,.LEVEL) S ^TMP($J ,40)=LEVEL (0),IBOK=1 I '$G(IBO K) S ^TMP( IBEGBL,$J, +$O(^TMP(I BEGBL,$J," "),-1)+1)= "Bad data for line l evel adjus tment "_IB SEQ G Q40 ; ; Store modifiers in multipl e S DIC="^ IBM(361.1, "_IBEOB_", 15,"_LEVEL (0)_",2,", DIC(0)="L" ,DLAYGO=36 1.1152,DA( 2)=IBEOB,D A(1)=LEVEL (0) F Q=5: 1:8 S X=$P (IB0,U,Q) I X'="" D FILE^DICN K DO,DD I Y<0 S IBOK =0 Q K DLA YGO,DIC,DR ,DA I '$G( IBOK) S ^T MP(IBEGBL, $J,+$O(^TM P(IBEGBL,$ J,""),-1)+ 1)="Could not file m odifier da ta for lin e level ad justment " _IBSEQ G Q 40Q40 Q ; | |
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306 | ERRTXT(X,I BEOB) ; Se t error te xt based o n circumst ances ; In put – X = Standard E rror messa ge passed in ; IB0 ; Returns modified e rror messa ge text N RETURN S R ETURN="Mis matched "_ X_":" I '$ $EBILL(IBE OB) S RETU RN="Claim was not Bi lled Elect ronically: "Q RETURN ;EBILL(IBE OB) ; Chec k If EOB w as billed electronic ally ; Inp ut : IBEOB = Interna l entry nu mber from file 361.1 ; Returns : 1 - Bil led electr onically ; 0 - Not b illed elec tronically N IEN399, IEN364,STA TUS S IEN3 99=$$GET1^ DIQ(361.1, IBEOB_",", .01,"I") S IEN364=$O (^IBA(364, "B",+IEN39 9,0)) I 'I EN364 Q 0 ; No EDI T RANSMIT BI LL ; S STA TUS=$$GET1 ^DIQ(364,I EN364,.03, "I") I STA TUS="E"!(S TATUS="C") Q 0 ; Err or or canc eled Q 1 | |
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