FAQs

Custom Edit Checks

You can use the Setup/Edit Checks menu in SolAce to add custom edits using JavaScript. These edits can perform a variety of functions, including automatically correcting claims, clearing warnings from the built-in edits, and adding warnings of your own.

Syntax

Custom edit checks are written in a language called JavaScript. The script that you write will execute for every claim that is imported or edited in SolAce. There are three variables that can be used in your custom edits to access data:

• acc is the record accessor. It is used to get and set data on the claim being edited.
• fields is the field dictionary that lets you reference the field you want to get or set data in. The field names can be seen in the mapping screen of SolAce.
• severity is the severity list that lets you assign a severity when adding a warning on a field. The options are: severity.Low, severity.Medium, and severity.High. High severity warnings cannot be ignored by the user.
• record represents the record holding the claim, and is the object that lets you add and remove warnings on the claim.

Loops

Some fields are only available in loops depending on the transaction type that your edits apply to. In case it helps, some other names for loops are: instances, occurrences, items, or array. These fields are not accessed via the acc variable, which represents the top-level accessor for the claim. These fields must be accessed via a sub-level accessor, which is retrieved from the top-level acc accessor by asking for the line you want. The first loop is always numbered 1. Custom edit scripts for the 837P transaction type have the following loops: Insured - All the insured fields are accessed via a sub-accessor that can be retrieved with this code.

var accIns = acc.getInsAcc([payer #]);

where [payer #] is the payer number that you want. Note that 837P equates to HCFA-1500 claims, and the first payer is always the destination payer with a pay sequence indicated by the claim's BILL_TO field. This differs from 837I claims where the payers are always in pay sequence order (e.g. 1=Primary, 2=Secondary). Service Lines - All the service line fields are accessed via a sub-accessor that can be retrieved with this code.

var accSvc = acc.getSvcAcc([svc line #]);

where [svc line #] specifies the service line you want to access. Or, get an array of the service lines that already exist with:

var accSvcs = acc.getSvcAccs();

Service Line COB - The service line level COB fields are not at the service line level, but are accessed via loops that are subordinate to the service line accessor.

var accSvcCob = accSvc.getCobAcc([cob line #]);

Service Line COB Adjustments - The adjustments for a service line are attached to a specific COB line on that service line, so multiple levels below the top.

var accSvcCobAdj = accSvcCob.getCobAdjAcc([adj line #]);

Claim Level COB - Claim level COB fields are accessed via a sub-accessor that can be retrieved with this code.

var accCob = acc.getCobAcc([cob line #]);

where [cob line #] specifies the COB loop that you want. The first COB loop (getCobAcc(1)) corresponds to the first 'other payer' on the claim. There should be one less COB loop than there are total payers on the claim. Claim Level Adjustments - Claim level adjustment fields are attached to a specific claim level COB line.

var accCobAdj = accCob.getAdjAcc([adj line #]);

Or, get an array of the adjustments that already exist with:

var accCobAdjs = accCob.getAdjAccs();

Example Edit Checks

Set CLIA on claims for a specific Payer/Provider

  var providerId = acc.get(fields.PROVIDER_ID);
  var payerId = acc.getInsAcc(1).get(fields.PAYER_NAME);
  if (payerId.equals("00824") && providerId.equals("12345"))
    acc.set(fields.CLIA_NUMBER, "00D1234567"); 

Strip dashes from hyphenated patient names for OMAP

  var patientName = acc.getName(fields.PATIENT_NAME);
  var payerId = acc.getInsAcc(1).get(fields.PAYER_NAME);
  if (payerId.startsWith("ORDHS") && patientName.getLast().indexOf('-') != -1) {
    patientName.setLast(patientName.getLast().replace('-',' '));
    acc.setName(fields.PATIENT_NAME, patientName);
  }

Texas Medicaid PPI Numbers Custom Warning

var isRefPhysPinRequired = false;
var isTexasMedicaid = false;
var isCommunityFirst = false;

// REF-PHYS-PIN is required for Texas Medicaid Managed Care claims 
// (THN or PCCM in box 11c), and for all Community First
// (COMMF payer ID) claims
var accIns1 = acc.getInsAcc(1);
var payerId = accIns1.get(fields.PAYER_NAME);
isTexasMedicaid = payerId.equals("86916");
isCommunityFirst = payerId.equals("COMMF");
if (isCommunityFirst ||
     (isTexasMedicaid &&
       (accIns1.get(fields.INSURED_PLAN).startsWith("THN") ||
       accIns1.get(fields.INSURED_PLAN).startsWith("PCCM"))
     )
   ) {
    isRefPhysPinRequired = true;
}

if (isRefPhysPinRequired) {
    // make sure a referring physician PIN is present on the claim
    if (acc.get(fields.REFERPHYS_PIN).length() == 0) {
        record.addWarning(fields.REFERPHYS_PIN, severity.Medium, 1,
            "Referring Physician information is incomplete.");
    }
}

Community First Custom Auto-Fill of Modifier 25

var isCommunityFirst = false;

var accIns1 = acc.getInsAcc(1);
var payerId = accIns1.get(fields.PAYER_NAME);
isCommunityFirst = payerId.equals("COMMF");

// Community First requires modifier 25 on all claims.  don't even warn
// on it, just fill it in if it's missing.
if (isCommunityFirst) {
  var accSvc = acc.getSvcAccs();
  for (var line=0; line<accSvc.length; line++) {
    var proc = accSvc[line].get(fields.SVC_PROCEDURE);
    if (proc.length() == 0)
      continue;
    var mod1 = accSvc[line].get(fields.SVC_MOD1);
    var mod2 = accSvc[line].get(fields.SVC_MOD2);
    if (!mod1.equals("25") && !mod2.equals("25")) {
      if (mod1.length() == 0)
        accSvc[line].set(fields.SVC_MOD1, "25");
      else if (mod2.length() == 0)
        accSvc[line].set(fields.SVC_MOD2, "25");
      else
        accSvc[line].set(fields.SVC_MOD3, "25");  // blindly sets SVC_MOD3 if first two were filled
    }
  }
}

Southwest Medical Custom Rendering Provider Not Found

/*Give warning if Rendering Provider does not exist in the SolAce Provider list*/

// Check if Rendering NPI is present
if(acc.get(fields.RENDERING_NPI).length() > 0){
	// Search SolAce provider list for NPI
	var provider = record.getBatchModel().getProviderCache().findProviderByNPI(
                     acc.get(fields.RENDERING_NPI));
	//Add warning if provider is not found
	if(provider == null){
		record.addWarning(fields.RENDERING_NAME, severity.High, "Rendering Provider not on file.");
	}
}
// Check if Rendering Pin is present
else if(acc.get(fields.RENDERING_PIN).length() > 0){
	//resolve payer to search for pin
	var payer = record.getBatchModel().resolvePayer(acc);
	if(payer != null){
		var provider = record.getBatchModel().getProviderCache().findProviderByPayerAndPIN(
                          payer, acc.get(fields.RENDERING_PIN));
		//Add warning if provider is not found
		if(provider == null){
			record.addWarning(fields.RENDERING_NAME, severity.High,
                              "Rendering Provider not on file.");
		}
	}
}