A Way to Work with Invoice Files in SAS

Transcription

1 A Way to Work with Invoice Files in SAS Anjan Matlapudi and J. Daniel Knapp Pharmacy Informatics, PerformRx, The Next Generation PBM, 200 Stevens Drive, Philadelphia, PA ABSTRACT This paper illustrates how to design an appropriate input program to handle invoice files electronically generated from a DB2 database. The invoice is a text file report document issued from the pharmacy claim payer which displays the pharmacy claim payment statistics for a given accounting period. The invoice file is the output of a COBOL program pulling data from a DB2 database which is then brought to the PC via FTP. The challenge we encountered consisted of taking text invoice summary reports files and converting them into electronic data that we could use to create monthly client dashboards. In the past a clerk had to print the invoice reports and type the information into an Excel file, in order to be able to electronically use the data. The various INFILE and INPUT options are illustrated in the process, and some related functions are considered. Although the program was written for the PC, the technique is applicable for any system. All the tools discussed are in BASE SAS. The typical attendee or reader will have some experience in SAS, but not a lot of experience dealing with the input of external data. INTRODUCTION The SAS system has an excellent facility for importing and analyzing data from delimited text files generated from different data sources. This presentation is designed to illustrate how to import, read and summarize invoice report data which is not in delimited file format. The invoice report summaries are plain ASCII (American Standard Code for Information Interchange) text files which provide financial pharmacy claim payment information. In this paper we will discuss how to transform this data into actionable information. The examples in this paper explain how to use the FILENAME and INPUT statements to read necessary fields as well as how to use PROC SUMMARY to summarize invoice data. INVOICE FILE STRUCTURE The invoice report summaries are billing statements consisting of headers and detail information such as claim counts, payment adjustments and payment totals as shown in the document below. We will walk through each step in SAS to explain how we process this data. The pointed arrows (blue and dark red) in the invoice file below serve to identify the fields which we will read and summarize. 1

2 STEP-1: IDENTIFY THE DATA SOURCE The invoice files are created and placed in specific paths on the network and can be pulled into our program using the INFILE statement. LRECL (logical record length) is used to specify the file length (default is 256 bytes) The following example shows how to code the specific file name or use a wildcard to pull all the files from the specified directory. data Innvoice; infile "C:\NESUG 2011 Papers\InvoiceFile.txt" lrecl=133;**full file name; infile "C:\NESUG 2011 Papers\*.txt" lrecl=133;**wildcard to access all files; infile "C:\NESUG 2011 Papers\*.*,txt" lrecl=133; *---more statements go here ---*; If we know the specific date that these files are placed in the network subdirectory, then we can use the following macro variables to grab the files. The %GLOBAL statement creates a global macro variable that exists for the entire SAS programming session. The %LOCAL statement creates a local macro variable that exists only during the execution of the macro. The below sample code shows the CALL SYMPUT routine in a DATA _NULL_ step to refer to yesterday s date and pull all applicable files. %**----Pull yesterday s or previous date files---**; %Global YR; %Global MO; %Global DD; data _Null_; yesterday=today()-1; **Change to previous data; call symput('yr', put(year (yesterday),4.) ); 2

3 call symput('mo', put(month(yesterday),z2.) ); call symput('dd', put(day(yesterday),z2.) ); %put &yr. &mo. &dd.; data Innvoice; infile "C:\NESUG 2011 Papers\InvoiceFile&dd.&mm.&dd..txt" lrecl=133;; **---more statements follow ---**; Since in our example invoice files are generated on the 1 st, 15 th, and 30 th of every month, we use the %MACRO statement with keyword parameter as shown or we can even use positional parameters without keywords in order to read the files. data _null_; *Format = YYMMDD*; %let begin = ; %let middle = ; %let end = ; %macro Read_Invoice() data &Inv.; file = "&cycle."; infile "C:\NESUG 2011 Papers\InvoiceFile&cycle..txt" lrecl=133;; **----more statements go from here---**; %mend; %Read_Invoice(Inv=Invoice1,cycle = Begin); %Read_Invoice(Inv=Invoice2,cycle = Middle); %Read_Invoice(Inv=Invoice3,cycle = End); STEP-2: READING INVOICE DATA Once the data source has been identified using the INFILE statement, the INPUT statement does the actual reading. In this case two INPUT statements were used to read required fields (blue and red arrows) as shown in the file. Our challenge was to find a way to read the detail information for each Group ID. Therefore, we used the with the INPUT statement to read Group ID at position #2 on the invoice text report. If the value of Group ID matches the group ID list below, then we use / to move the SAS pointer to the next row, where we input the fields from their respective positions in the invoice report text file. %macro Read_Invoice(inv,cycle) data &Inv.; infile "C:\NESUG 2011 Papers\InvoiceFile&cycle..txt" lrecl=133; group_id $8.@; if group_id in ('PLANID01' 'PLANID02''PLANID03' 'PLANID04' 'PLANID05' 'PLANID06' 'PLANID07''PLANID08' 'PLANID09' 'PLANID10' 'PLANID11' 'PLANID12') then do; rxcount paid_amount copay adjustments adj_amount adj_copay admin_expense comma15.2; *----Addtional Caluculations----*; ADJ_AMOUNT = ADJ_AMOUNT * (-1); *Convert to +'ve values; ADJ_COPAY = ADJ_COPAY * (-1); NET_PAID = PAID_AMOUNT - COPAY + ADJ_AMOUNT - ADJ_COPAY; 3

4 TOTAL_COPAY = COPAY + ADJ_COPAY; TOTAL_PAID = NET_PAID + ADMIN_EXPENSE; TOTAL_RX = RXCOUNT - ADJUSTMENTS; format total_rx comma10. total_copay dollar20.2 total_paid dollar20.2; length GroupName $12.; select (group_id); when('planid01','planid02') GroupName='MedPland A'; when('planid03','planid10') GroupName='MedPland B'; when('planid11','planid12') GroupName='MedPland C'; otherwise error GroupName= 'No MedPlan'; end; output &Inv.; end; %mend; %Read_Invoice(Inv=Invoice1,cycle = Begin); %Read_Invoice(Inv=Invoice2,cycle = Middle); %Read_Invoice(Inv=Invoice3,cycle = End); Any additional calculations, formatting or subsetting can be done within the same DATA step as shown in the above code. STEP3 SUMMARIZE INVOICE DATA In order to summarize the data for our monthly client dashboard reports, we use the PROC SUMMARY procedure. Initially we combine all the billing cycle data into one dataset; then we run a simple summary using the NWAY option to suppress all subtotal and grand total records. We also use the MISSING option to specify that missing values of the CLASS variable be treatment as a valid class level. We specify GroupName as the CLASS variable in order to group observations appropriately. The OUTPUT statement is used to create the output data set (OUT= specifies the name of the output data set). We drop the two automatic variables ( _TYPE_ and _FREQ_) created by PROC SUMMARY, as we have no use for them in this example. *----stack all invoice files---*; data all(keep=file GroupName Total_Rx Total_Copay Total_Paid); set Invoice1 Invoice2 Invoice3; *----output invoice summary----*; proc summary nway missing data=all; class GroupName; var Total_Rx Total_Copay Total_Paid; output out=allsum(drop=_type freq_)sum=; run STEP4 OUTPUT INVOICE REPORT We use PROC REPORT to output the above summarized invoice data. The ODS RTF statement is used to OUTPUT the report as Invoice Summary Report.rtf. The following code generates three output files broken down by group name CREATE REPORT */ ods escapechar='#'; *****TO CREATE SPLIT STACK OF DATA ; options ls=133 ps=48 center nodate nonumber missing=' 'orientation=portrait ; ods rtf file=" C:\NESUG 2011 Papers\Invoice Paper 2011\ \Invoice sumary Report.rtf " style=styles.courier; title1 justify=center "Invoice Summary Report 2011" 4

5 j=r "{Page} {\field{\*\fldinst{ PAGE }}}\~{of}\~{\field{\*\fldinst {NUMPAGES }}}"; title2 j=center "Health Plans "; footnote1 j = center "&sysdate9. &systime." ; proc report data=innvoicesum nowd split='#' formchar(2)=' ' missing style=[preimage = "C:\NESUG 2011 Papers\perform_rx.gif"] style(report)=[background=white bordercolor=black borderwidth=0.2 asis=off frame = HSIDES rules = groups cellpadding = 1.0 cellspacing = 1.0] style(header)=[background=white font = Fonts('headingFont')] ; by GroupName; columns GroupName Group_ID Total_Rx Total_Copay Total_paid ; label GroupName='Plan'; define GroupName / dispaly 'Group Name 'style()={just=left cellwidth=1.8in}; define Group_ID / dispaly 'Group ID style()={just=left cellwidth=1.1in}; define Total_Rx / 'Rx Count' style()={just=right cellwidth=1.1in}; define Total_Copay/ 'Co-Pay' style()={just=right cellwidth=1.1in}; define Total_paid / 'Total Paid' style()={just=right cellwidth=1.1in}; compute after GroupName / style()={cellheight=0.4in}; line ' ' ; endcomp; quit; ods rtf close; ods listing; Invoice Summary Report 2011 Health Plans 2011 Plan=MedPlan A Group Name Group ID Rx Count Co-Pay Total Paid MedPlan A PLANID $6, $19, MedPlan A PLANID $9, $29, Plan=MedPlan B Group Name Group ID Rx Count Co-Pay Total Paid MedPlan B PLANID $12, $37, MedPlan B PLANID04 3,151 $44, $139, MedPlan B PLANID05 11,804 $155, $388, MedPlan B PLANID $2, $25, MedPlan B PLANID08 7 $5.00 $2, MedPlan B PLANID $1, $12, MedPlan B PLANID10 14 $36.00 $

6 Plan=MedPlan C Group Name Group ID Rx Count Co-Pay Total Paid MedPlan C PLANID11 1,116 $16, $55, MedPlan C PLANID12 5,279 $70, $212, CONCLUSION We have illustrated a very simple way to read and summarize data from invoice report text files. The data is then used to create pharmacy dashboard reports. Although this paper illustrates summarizing pharmacy claims data, the SAS program can used for reading any invoice report text file. REFERENCES John Leveille, Healthcare Intelligence: The Challenge of OLAP for Healthcare Data, HealthCare Providers & Insures Paper Kuligowski, T. Andew. Datalines, Sequential Files, CVS, HTML and More Using INFILE and INPUT Statements to Introduce External Data into the SAS System, SUGI 31 Tutorials Paper AKNOWLDEGMENTS We would like to acknowledge Mr. Shimels Afework, Senior Director, PerformRx. PerformRx, LLC provides pharmacy benefit management (PBM) services through proactively managing escalating pharmacy costs while focusing on clinical improvement and financial results. CONTACT INFORMATION: Your comments and questions are valued and encouraged. Contact the authors at Name Anjan Matlapudi Senior Pharmacy Analyst Address PerformRx, The Next Generation PBM 200 Stevens Drive Philadelphia, PA Work Phone: (215) Fax: (215) anjan.matlapudi@performrx.com anjanmat@gmail.com Name Knapp, J. Daniel Senior Manager Address PerformRx, The Next Generation PBM 200 Stevens Drive Philadelphia, PA Work Phone: ( Fax: (215) Daniel.Knapp@performrx.com Jdjeep57@yahoo.com SAS is a registered trademark or trademark of SAS Institute, Inc. in the USA and other countries. IBM, OS/390, and MVS are registered trademarks of International Business Machines Inc. 6