$TXT Created by GINSBERG,ELIOT at MNTVLL.FO-ALBANY.MED.VA.GOV (KIDS) on Tuesday, 12/13/05 at 07:53 Run Date: MAR 31, 2006 Designation: IB*2*321 Package : IB - INTEGRATED BILLING Priority: Mandatory Version : 2 SEQ #300 Status: Released Compliance Date: MAY 01, 2006 ============================================================================= Associated patches: (v)IB*2*269 <<= must be installed BEFORE `IB*2*321' (v)IB*2*275 <<= must be installed BEFORE `IB*2*321' Subject: INTEGRATED BILLING (IB) RX COPAY EXEMPTION STATUS Category: - Routine Description: ============ Issue #1: Update Income Test Protocol ===================================== The background process to calculate the Medication Copayment Exemption Status of a patient is not correctly handling Income Verification Match (IVM) Converted Income Tests. The exemption calculator is working correctly for all Inbound Solicited (ORF) and Un-Solicited (ORU) Income Test Data (Z10) HL7 Transmissions. The Medication Copayment Exemption Status calculator is also called from the IB EXEMPTION EVENTS Protocol and is triggered from many menu options. When it is invoked from an option, it is occasionally evaluating the exemption for an IVM Converted Income Test incorrectly. This patch (IB*2.0*321) is modifying the IB EXEMPTION EVENTS Protocol to correctly handle all IVM Converted Income Tests when it is executed from a menu option as well as an HL7 Transmission. Issue #2: Create New Recalculation Process ========================================== The Print/Verify Patient Exemption Status [IB RX PRINT VERIFY EXEMP] option is used to search through the BILLING EXEMPTIONS (#354.1) file and compare the currently stored active exemption for each patient against what it calculates to be the correct exemption status for the patient based on current data in the MAS files. This functionality was used to create a new process to automatically correct/update discrepant records with an incorrect exemption status. This new process has been added to the beginning of the nightly background job (Queue Means Test Compilation of Charges [IB MT NIGHT COMP]) and will validate the records containing an effective date within the past thirty days. A recap of all updated records will be sent via a MailMan message to the mail group defined in the COPAY EXEMPTION MAIL GROUP (#.13) field of the IB SITE PARAMETERS (#350.9) file. Example of MailMan message: Subj: IB RX COPAY EXEMPT UPDATE [#38474] 11/22/05@13:22 8 lines From: IB PACKAGE In 'IN' basket. Page 1 *New* ------------------------------------------------------------------------ Medication Copayment Exemption Problem Report NOV 22, 2005 13:22 Patient PT. ID Error Current/Calc Exemption ------------------------------------------------------------------------ TESTA,PATIENT 000-01-2004 Incorr Exmpt INCOME>PENSION/NO INCOME DATA TESTB,PATIENT 000-23-9099 Incorr Exmpt NO INCOME DATA/INCOME>PENSION There were 2 discrepancies found in 83 exemptions checked. Enter message action (in IN basket): Ignore// Issue #3: Post Install Cleanup ============================== The new Medication Copay Exemption Calculation Process being added by this patch (IB*2.0*321) will be run as a background job from a post-install. The process will search through the BILLING EXEMPTIONS (#354.1) file and compare the currently stored active exemption for each patient against what it calculates to be the correct exemption status for the patient on records with an effective date from January 1, 2005 to the present. A recap of all updated records will be sent via a mailman message (defined in Issue #2 above) to the mail group defined in the COPAY EXEMPTION MAIL GROUP (#.13) field in the single entry in the IB SITE PARAMETERS (#350.9) file. This patch addresses the following New Service Request (NSR): ------------------------------------------------------------- There is no NSR associated with this patch. This patch addresses the following Remedy Ticket(s): --------------------------------------------------------- HD0000000064811 - TUC-0205-60087 RX EXEMPTION CALCULATION IS INCORRECT HD0000000098007 - INCORRECT RX COPAY EXEMPTION HD0000000102245 - Rx Copay Exemption calculated wrong. Overview of Remedy Tickets: ---------------------------- Ticket #: HD0000000064811 Problem: When a converted IVM CO-PAY EXEMPTION TEST is filed in VistA for the current income year, 2 exemptions result. One correctly files the NON-EXEMPT status but the next recalculates the exemption to EXEMPT. This is NOT correct and the sites will lose copay dollars as a result. Resolution: Update the Income Test Protocol to exclude all IVM Converted Test Transmissions from being evaluated. Ticket #: HD0000000098007 Problem: After receiving a "CONVERTED" CO-PAY EXEMPTION TEST from Income Verification at the HEC, the Rx Copay Exemption status is EXEMPT but should be NON-EXEMPT. Resolution: Update the Income Test Protocol to exclude all IVM Converted Test Transmissions from being evaluated. Ticket #: HD0000000102245 Problem: If the HEC also sends a verified CO-PAY EXEMPTION TEST, the new exemption that they send is filed followed immediately by a new calculation of the exemption which is going to be EXEMPT. Resolution: Update the Income Test Protocol to exclude all IVM Converted Test Transmissions from being evaluated. Test Sites: ----------- BRONX (Large) OKLAHOMA CITY (Large) TUCSON (Large) ================INSTALLATION INSTRUCTIONS ================= This patch may be installed with users on the system, and if it is installed during the normal workday, it is recommended that the following selections in the OPTION (#19) file be disabled to prevent possible conflicts while running the KIDS Install. Other VISTA users will not be affected. Print/Verify Patient Exemption Status [IB RX PRINT VERIFY EXEMP] Queue Means Test Compilation of Charges [IB MT NIGHT COMP] Install Time - less than 5 minutes 1. LOAD TRANSPORT GLOBAL --------------------- Choose the PackMan message containing this patch and invoke the INSTALL/CHECK MESSAGE PackMan option. 2. COMPONENTS SENT WITH PATCH -------------------------- The following is a list of the routines included in this patch. The second line of each of these routines now looks like: ;;2.0;INTEGRATED BILLING;** [patch list]**; 21-MAR-94 CHECK^XTSUMBLD results Routine Before Patch After Patch Patch List ------- ------------ ----------- ---------- IBAMTC 7580630 7641901 34,52,70,93,100 118,115,132,150,153 137,176,215,275,321 IBAMTED 3758888 5009481 15,255,269,321 IBARXEPS N/A 10247819 321 Total number of routines - 3 Total number of routines modified: 2 Total number of new routines: 1 Total number of deleted routines: 0 3. START UP KIDS ------------- Start up the Kernel Installation and Distribution System Menu [XPD MAIN]: Edits and Distribution ... Utilities ... Installation ... Select Kernel Installation & Distribution System Option: INStallation --- Load a Distribution Print Transport Global Compare Transport Global to Current System Verify Checksums in Transport Global Install Package(s) Restart Install of Package(s) Unload a Distribution Backup a Transport Global Select Installation Option: 4. Select Installation Option: --------------------------- NOTE: The following are OPTIONAL - (When prompted for the INSTALL NAME, enter IB*2.0*321): a. Backup a Transport Global - This option will create a backup message of any routines exported with this patch. It will not backup any other changes such as DD's or templates. b. Compare Transport Global to Current System - This option will allow you to view all changes that will be made when this patch is installed. It compares all components of this patch (routines, DD's, templates, etc.). c. Verify Checksums in Transport Global - This option will allow you to ensure the integrity of the routines that are in the transport global. 5. Select Installation Option: Install Package(s) ---------------- **This is the step to start the installation of this KIDS patch: a. Choose the Install Package(s) option to start the patch install. b. When prompted 'Want KIDS to INHIBIT LOGONs during the install? YES//' answer NO. c. When prompted 'Want to DISABLE Scheduled Options, Menu Options, and Protocols? YES//' answer YES. d. When prompted 'Enter options you wish to mark as 'Out Of Order':' Enter the following options: Print/Verify Patient Exemption Status [IB RX PRINT VERIFY EXEMP] Queue Means Test Compilation of Charges [IB MT NIGHT COMP] e. When prompted 'Enter protocols you wish to mark as 'Out Of Order':' press . Routine Information: ==================== The checksums below are new checksums, and can be checked with CHECK1^XTSUMBLD. Routine Name: IBAMTC Before: B23660778 After: B24161099 **34,52,70,93,100,118,115,132, 150,153,137,176,215,275,321** Description of Changes: Original Code: -------------- D NIGHTLY^IBTRKR ; claims tracking nightly update ; D ^IBCD ; automated biller Modified Code: -------------- D UPDT^IBARXEPS($$FMADD^XLFDT(DT,-30),DT,1) ; D NIGHTLY^IBTRKR ; claims tracking nightly update ; D ^IBCD ; automated biller Routine Name: IBAMTED Before: B8126243 After: B10970561 **15,255,269,321** Description of Changes: Original Code: -------------- ;Original Non-Z06 Copay processing D:'$D(EASZ06) ^IBAMTED1 ; ; -- end medication copayment exemption processing Modified Code: -------------- ;Original Non-Z06 Copay processing I '$D(EASZ06) D ; . ;this routine is called from the DG namespace and IB namespace . ;when coming in from the DG namespace, variable DGMTD and DGMTDT is . ;used to define the means test test. When coming in . ;from the IB namespace, variable IBDT OR IVMMTDT is used . I '$D(IBDT) N IBDT . S IBDT=$S($D(IBDT):IBDT,$D(IVMMTDT):IVMMTDT,$D(DGMTDT):DGMTDT,$D(DGMTD):DGMT D,1:0) . I $P($G(^DGMT(408.31,+$$LST^DGMTCOU1(DFN,IBDT,2),0)),"^",23)=2 Q . I $G(^DGMT(408.31,+$$LST^DGMTCOU1(DFN,IBDT,2),"C",1,0))["Z06 MT via Edb" Q . D ^IBAMTED1 . Q ; -- end medication copayment exemption processing Routine Name: IBARXEPS Before: After: B42904497 **321** Description of Changes: This routine is a new routine introduced with this patch and is a modified version of program IBARXEPV. Routine IBARXEPV outputs the 'Medication Copayment Exemption Problems' to a printer (it actually requires output to 132 columns), routine IBARXEPS outputs the same information to a MailMan message. ============================================================================= User Information: Entered By : ADES,ROBERT Date Entered : JUL 20, 2005 Completed By: RUDINGER,NANCY L. Date Completed: MAR 30, 2006 Released By : GANUS,MAUNETTE Date Released : MAR 31, 2006 ============================================================================= Packman Mail Message: ===================== $END TXT