library/Claim.class.php

   1 <?php
   2 // Copyright (C) 2007-2008 Rod Roark <rod@sunsetsystems.com>
   3 //
   4 // This program is free software; you can redistribute it and/or
   5 // modify it under the terms of the GNU General Public License
   6 // as published by the Free Software Foundation; either version 2
   7 // of the License, or (at your option) any later version.
   8
   9 require_once(dirname(__FILE__) . "/classes/Address.class.php");
  10 require_once(dirname(__FILE__) . "/classes/InsuranceCompany.class.php");
  11 require_once(dirname(__FILE__) . "/sql-ledger.inc");
  12 require_once(dirname(__FILE__) . "/invoice_summary.inc.php");
  13
  14 // This enforces the X12 Basic Character Set. Page A2.
  15 //
  16 function x12clean($str) {
  17   return preg_replace('/[^A-Z0-9!"\\&\'()+,\\-.\\/;?= ]/', '', strtoupper($str));
  18 }
  19
  20 class Claim {
  21
  22   var $pid;               // patient id
  23   var $encounter_id;      // encounter id
  24   var $procs;             // array of procedure rows from billing table
  25   var $x12_partner;       // row from x12_partners table
  26   var $encounter;         // row from form_encounter table
  27   var $facility;          // row from facility table
  28   var $billing_facility;  // row from facility table
  29   var $provider;          // row from users table (rendering provider)
  30   var $referrer;          // row from users table (referring provider)
  31   var $insurance_numbers; // row from insurance_numbers table for current payer
  32   var $patient_data;      // row from patient_data table
  33   var $billing_options;   // row from form_misc_billing_options table
  34   var $invoice;           // result from get_invoice_summary()
  35   var $payers;            // array of arrays, for all payers
  36   var $copay;             // total of copays from the billing table
  37
  38   function loadPayerInfo(&$billrow) {
  39     global $sl_err;
  40     $encounter_date = substr($this->encounter['date'], 0, 10);
  41
  42     // Create the $payers array.  This contains data for all insurances
  43     // with the current one always at index 0, and the others in payment
  44     // order starting at index 1.
  45     //
  46     $this->payers = array();
  47     $this->payers[0] = array();
  48     $query = "SELECT * FROM insurance_data WHERE " .
  49       "pid = '{$this->pid}' AND " .
  50       "date <= '$encounter_date' " .
  51       "ORDER BY type ASC, date DESC";
  52     $dres = sqlStatement($query);
  53     $prevtype = '';
  54     while ($drow = sqlFetchArray($dres)) {
  55       if (strcmp($prevtype, $drow['type']) == 0) continue;
  56       $prevtype = $drow['type'];
  57       // Very important to look at entries with a missing provider because
  58       // they indicate no insurance as of the given date.
  59       if (empty($drow['provider'])) continue;
  60       $ins = count($this->payers);
  61       if ($drow['provider'] == $billrow['payer_id'] && empty($this->payers[0]['data'])) $ins = 0;
  62       $crow = sqlQuery("SELECT * FROM insurance_companies WHERE " .
  63         "id = '" . $drow['provider'] . "'");
  64       $orow = new InsuranceCompany($drow['provider']);
  65       $this->payers[$ins] = array();
  66       $this->payers[$ins]['data']    = $drow;
  67       $this->payers[$ins]['company'] = $crow;
  68       $this->payers[$ins]['object']  = $orow;
  69     }
  70
  71     // This kludge hands most cases of a rare ambiguous situation, where
  72     // the primary insurance company is the same as the secondary.  It seems
  73     // nobody planned for that!
  74     //
  75     for ($i = 1; $i < count($this->payers); ++$i) {
  76       if ($billrow['process_date'] &&
  77         $this->payers[0]['data']['provider'] == $this->payers[$i]['data']['provider'])
  78       {
  79         $tmp = $this->payers[0];
  80         $this->payers[0] = $this->payers[$i];
  81         $this->payers[$i] = $tmp;
  82       }
  83     }
  84
  85     $this->using_modifiers = true;
  86
  87     // Get payment and adjustment details if there are any previous payers.
  88     //
  89     $this->invoice = array();
  90     if ($this->payerSequence() != 'P') {
  91       if ($GLOBALS['oer_config']['ws_accounting']['enabled'] === 2) {
  92         $this->invoice = ar_get_invoice_summary($this->pid, $this->encounter_id, true);
  93       }
  94       else if ($GLOBALS['oer_config']['ws_accounting']['enabled']) {
  95         SLConnect();
  96         $arres = SLQuery("select id from ar where invnumber = " .
  97           "'{$this->pid}.{$this->encounter_id}'");
  98         if ($sl_err) die($sl_err);
  99         $arrow = SLGetRow($arres, 0);
 100         if ($arrow) {
 101           $this->invoice = get_invoice_summary($arrow['id'], true);
 102         }
 103         SLClose();
 104       }
 105       // Secondary claims might not have modifiers in SQL-Ledger data.
 106       // In that case, note that we should not try to match on them.
 107       $this->using_modifiers = false;
 108       foreach ($this->invoice as $key => $trash) {
 109         if (strpos($key, ':')) $this->using_modifiers = true;
 110       }
 111     }
 112   }
 113
 114   // Constructor. Loads relevant database information.
 115   //
 116   function Claim($pid, $encounter_id) {
 117     $this->pid = $pid;
 118     $this->encounter_id = $encounter_id;
 119     $this->procs = array();
 120     $this->copay = 0;
 121
 122     // We need the encounter date before we can identify the payers.
 123     $sql = "SELECT * FROM form_encounter WHERE " .
 124       "pid = '{$this->pid}' AND " .
 125       "encounter = '{$this->encounter_id}'";
 126     $this->encounter = sqlQuery($sql);
 127
 128     // Sort by procedure timestamp in order to get some consistency.  In particular
 129     // we determine the provider from the first procedure in this array.
 130     $sql = "SELECT * FROM billing WHERE " .
 131       "encounter = '{$this->encounter_id}' AND pid = '{$this->pid}' AND " .
 132       "(code_type = 'CPT4' OR code_type = 'HCPCS' OR code_type = 'COPAY') AND " .
 133       "activity = '1' ORDER BY date, id";
 134     $res = sqlStatement($sql);
 135     while ($row = sqlFetchArray($res)) {
 136       if ($row['code_type'] == 'COPAY') {
 137         $this->copay -= $row['fee'];
 138         continue;
 139       }
 140       if (!$row['units']) $row['units'] = 1;
 141       // Load prior payer data at the first opportunity in order to get
 142       // the using_modifiers flag that is referenced below.
 143       if (empty($this->procs)) $this->loadPayerInfo($row);
 144       // Consolidate duplicate procedures.
 145       foreach ($this->procs as $key => $trash) {
 146         if (strcmp($this->procs[$key]['code'],$row['code']) == 0 &&
 147             (strcmp($this->procs[$key]['modifier'],$row['modifier']) == 0 ||
 148              !$this->using_modifiers))
 149         {
 150           $this->procs[$key]['units'] += $row['units'];
 151           $this->procs[$key]['fee']   += $row['fee'];
 152           continue 2; // skip to next table row
 153         }
 154       }
 155       $this->procs[] = $row;
 156     }
 157
 158     $sql = "SELECT * FROM x12_partners WHERE " .
 159       "id = '" . $this->procs[0]['x12_partner_id'] . "'";
 160     $this->x12_partner = sqlQuery($sql);
 161
 162     $sql = "SELECT * FROM facility WHERE " .
 163       "id = '" . addslashes($this->encounter['facility_id']) . "' " .
 164       "LIMIT 1";
 165     $this->facility = sqlQuery($sql);
 166
 167     $provider_id = $this->procs[0]['provider_id'];
 168     $sql = "SELECT * FROM users WHERE id = '$provider_id'";
 169     $this->provider = sqlQuery($sql);
 170
 171     $sql = "SELECT * FROM facility " .
 172       "ORDER BY billing_location DESC, id ASC LIMIT 1";
 173     $this->billing_facility = sqlQuery($sql);
 174
 175     $sql = "SELECT * FROM insurance_numbers WHERE " .
 176       "(insurance_company_id = '" . $this->procs[0]['payer_id'] .
 177       "' OR insurance_company_id is NULL) AND " .
 178       "provider_id = '" . $this->provider['id'] .
 179       "' order by insurance_company_id DESC LIMIT 1";
 180     $this->insurance_numbers = sqlQuery($sql);
 181
 182     $sql = "SELECT * FROM patient_data WHERE " .
 183       "pid = '{$this->pid}' " .
 184       "ORDER BY id LIMIT 1";
 185     $this->patient_data = sqlQuery($sql);
 186
 187     $sql = "SELECT fpa.* FROM forms JOIN form_misc_billing_options AS fpa " .
 188       "ON fpa.id = forms.form_id WHERE " .
 189       "forms.encounter = '{$this->encounter_id}' AND " .
 190       "forms.pid = '{$this->pid}' AND " .
 191       "forms.formdir = 'misc_billing_options' " .
 192       "ORDER BY forms.date";
 193     $this->billing_options = sqlQuery($sql);
 194
 195     $referrer_id = (empty($GLOBALS['MedicareReferrerIsRenderer']) ||
 196       $this->insurance_numbers['provider_number_type'] != '1C') ?
 197       $this->patient_data['providerID'] : $provider_id;
 198     $sql = "SELECT * FROM users WHERE id = '$referrer_id'";
 199     $this->referrer = sqlQuery($sql);
 200     if (!$this->referrer) $this->referrer = array();
 201
 202   } // end constructor
 203
 204   // Return an array of adjustments from the designated prior payer for the
 205   // designated procedure key (might be procedure:modifier), or for the claim
 206   // level.  For each adjustment give date, group code, reason code, amount.
 207   // Note this will include "patient responsibility" adjustments which are
 208   // not adjustments to OUR invoice, but they reduce the amount that the
 209   // insurance company pays.
 210   //
 211   function payerAdjustments($ins, $code='Claim') {
 212     $aadj = array();
 213
 214     // If we have no modifiers stored in SQL-Ledger for this claim,
 215     // then we cannot use a modifier passed in with the key.
 216     $tmp = strpos($code, ':');
 217     if ($tmp && !$this->using_modifiers) $code = substr($code, 0, $tmp);
 218
 219     // For payments, source always starts with "Ins" or "Pt".
 220     // Nonzero adjustment reason examples:
 221     //   Ins1 adjust code 42 (Charges exceed ... (obsolete))
 222     //   Ins1 adjust code 45 (Charges exceed your contracted/ legislated fee arrangement)
 223     //   Ins1 adjust code 97 (Payment is included in the allowance for another service/procedure)
 224     //   Ins1 adjust code A2 (Contractual adjustment)
 225     //   Ins adjust Ins1
 226     //   adjust code 45
 227     // Zero adjustment reason examples:
 228     //   Co-pay: 25.00
 229     //   Coinsurance: 11.46  (code 2)   Note: fix remits to identify insurance
 230     //   To deductible: 0.22 (code 1)   Note: fix remits to identify insurance
 231     //   To copay Ins1 (manual entry)
 232     //   To ded'ble Ins1 (manual entry)
 233
 234     if (!empty($this->invoice[$code])) {
 235       $date = '';
 236       $deductible  = 0;
 237       $coinsurance = 0;
 238       $inslabel = ($this->payerSequence($ins) == 'S') ? 'Ins2' : 'Ins1';
 239       $insnumber = substr($inslabel, 3);
 240
 241       // Compute this procedure's patient responsibility amount as of this
 242       // prior payer, which is the original charge minus all insurance
 243       // payments and "hard" adjustments up to this payer.
 244       $ptresp = $this->invoice[$code]['chg'] + $this->invoice[$code]['adj'];
 245       foreach ($this->invoice[$code]['dtl'] as $key => $value) {
 246         if (preg_match("/^Ins(\d)/i", $value['src'], $tmp)) {
 247           if ($tmp[1] <= $insnumber) $ptresp -= $value['pmt'];
 248         }
 249         else if (trim(substr($key, 0, 10))) { // not an adjustment if no date
 250           if (!preg_match("/Ins(\d)/i", $value['rsn'], $tmp) || $tmp[1] <= $insnumber)
 251             $ptresp += $value['chg']; // adjustments are negative charges
 252         }
 253       }
 254       if ($ptresp < 0) $ptresp = 0; // we may be insane but try to hide it
 255
 256       // Main loop, to extract adjustments for this payer and procedure.
 257       foreach ($this->invoice[$code]['dtl'] as $key => $value) {
 258         $tmp = str_replace('-', '', trim(substr($key, 0, 10)));
 259         if ($tmp) $date = $tmp;
 260         if ($tmp && $value['pmt'] == 0) { // not original charge and not a payment
 261           $rsn = $value['rsn'];
 262           $chg = 0 - $value['chg']; // adjustments are negative charges
 263
 264           $gcode = 'CO'; // default group code = contractual obligation
 265           $rcode = '45'; // default reason code = max fee exceeded (code 42 is obsolete)
 266
 267           if (preg_match("/Ins adjust $inslabel/i", $rsn, $tmp)) {
 268             // From manual post. Take the defaults.
 269           }
 270           else if (preg_match("/To copay $inslabel/i", $rsn, $tmp) && !$chg) {
 271             $coinsurance = $ptresp; // from manual post
 272             continue;
 273           }
 274           else if (preg_match("/To ded'ble $inslabel/i", $rsn, $tmp) && !$chg) {
 275             $deductible = $ptresp; // from manual post
 276             continue;
 277           }
 278           else if (preg_match("/$inslabel copay: (\S+)/i", $rsn, $tmp) && !$chg) {
 279             $coinsurance = $tmp[1]; // from 835 as of 6/2007
 280             continue;
 281           }
 282           else if (preg_match("/$inslabel coins: (\S+)/i", $rsn, $tmp) && !$chg) {
 283             $coinsurance = $tmp[1]; // from 835 and manual post as of 6/2007
 284             continue;
 285           }
 286           else if (preg_match("/$inslabel dedbl: (\S+)/i", $rsn, $tmp) && !$chg) {
 287             $deductible = $tmp[1]; // from 835 and manual post as of 6/2007
 288             continue;
 289           }
 290           else if (preg_match("/$inslabel ptresp: (\S+)/i", $rsn, $tmp) && !$chg) {
 291             continue; // from 835 as of 6/2007
 292           }
 293           else if (preg_match("/$inslabel adjust code (\S+)/i", $rsn, $tmp)) {
 294             $rcode = $tmp[1]; // from 835
 295           }
 296           else if (preg_match("/$inslabel/i", $rsn, $tmp)) {
 297             // Take the defaults.
 298           }
 299           else if (preg_match('/Ins(\d)/i', $rsn, $tmp) && $tmp[1] != $insnumber) {
 300             continue; // it's for some other payer
 301           }
 302           else if ($insnumber == '1') {
 303             if (preg_match("/\$\s*adjust code (\S+)/i", $rsn, $tmp)) {
 304               $rcode = $tmp[1]; // from 835
 305             }
 306             else if ($chg) {
 307               // Other adjustments default to Ins1.
 308             }
 309             else if (preg_match("/Co-pay: (\S+)/i", $rsn, $tmp) ||
 310               preg_match("/Coinsurance: (\S+)/i", $rsn, $tmp)) {
 311               $coinsurance = 0 + $tmp[1]; // from 835 before 6/2007
 312               continue;
 313             }
 314             else if (preg_match("/To deductible: (\S+)/i", $rsn, $tmp)) {
 315               $deductible = 0 + $tmp[1]; // from 835 before 6/2007
 316               continue;
 317             }
 318             else {
 319               continue; // there is no adjustment amount
 320             }
 321           }
 322           else {
 323             continue; // it's for primary and that's not us
 324           }
 325
 326           if ($rcode == '42') $rcode= '45'; // reason 42 is obsolete
 327           $aadj[] = array($date, $gcode, $rcode, sprintf('%.2f', $chg));
 328
 329         } // end if
 330       } // end foreach
 331
 332       // If we really messed it up, at least avoid negative numbers.
 333       if ($coinsurance > $ptresp) $coinsurance = $ptresp;
 334       if ($deductible  > $ptresp) $deductible  = $ptresp;
 335
 336       // Find out if this payer paid anything at all on this claim.  This will
 337       // help us allocate any unknown patient responsibility amounts.
 338       $thispaidanything = 0;
 339       foreach($this->invoice as $codekey => $codeval) {
 340         foreach ($codeval['dtl'] as $key => $value) {
 341           if (preg_match("/$inslabel/i", $value['src'], $tmp)) {
 342             $thispaidanything += $value['pmt'];
 343           }
 344         }
 345       }
 346
 347       // Allocate any unknown patient responsibility by guessing if the
 348       // deductible has been satisfied.
 349       if ($thispaidanything)
 350         $coinsurance = $ptresp - $deductible;
 351       else
 352         $deductible = $ptresp - $coinsurance;
 353
 354       if ($date && $deductible != 0)
 355         $aadj[] = array($date, 'PR', '1', sprintf('%.2f', $deductible));
 356       if ($date && $coinsurance != 0)
 357         $aadj[] = array($date, 'PR', '2', sprintf('%.2f', $coinsurance));
 358
 359     } // end if
 360
 361     return $aadj;
 362   }
 363
 364   // Return date, total payments and total "hard" adjustments from the given
 365   // prior payer. If $code is specified then only that procedure key is
 366   // selected, otherwise it's for the whole claim.
 367   //
 368   function payerTotals($ins, $code='') {
 369     // If we have no modifiers stored in SQL-Ledger for this claim,
 370     // then we cannot use a modifier passed in with the key.
 371     $tmp = strpos($code, ':');
 372     if ($tmp && !$this->using_modifiers) $code = substr($code, 0, $tmp);
 373
 374     $inslabel = ($this->payerSequence($ins) == 'S') ? 'Ins2' : 'Ins1';
 375     $paytotal = 0;
 376     $adjtotal = 0;
 377     $date = '';
 378     foreach($this->invoice as $codekey => $codeval) {
 379       if ($code && strcmp($codekey,$code) != 0) continue;
 380       foreach ($codeval['dtl'] as $key => $value) {
 381         if (preg_match("/$inslabel/i", $value['src'], $tmp)) {
 382           if (!$date) $date = str_replace('-', '', trim(substr($key, 0, 10)));
 383           $paytotal += $value['pmt'];
 384         }
 385       }
 386       $aarr = $this->payerAdjustments($ins, $codekey);
 387       foreach ($aarr as $a) {
 388         if (strcmp($a[1],'PR') != 0) $adjtotal += $a[3];
 389         if (!$date) $date = $a[0];
 390       }
 391     }
 392     return array($date, sprintf('%.2f', $paytotal), sprintf('%.2f', $adjtotal));
 393   }
 394
 395   // Return the amount already paid by the patient.
 396   //
 397   function patientPaidAmount() {
 398     // For primary claims $this->invoice is not loaded, so get the co-pay
 399     // from the billing table instead.
 400     if (empty($this->invoice)) return $this->copay;
 401     //
 402     $amount = 0;
 403     foreach($this->invoice as $codekey => $codeval) {
 404       foreach ($codeval['dtl'] as $key => $value) {
 405         if (!preg_match("/Ins/i", $value['src'], $tmp)) {
 406           $amount += $value['pmt'];
 407         }
 408       }
 409     }
 410     return sprintf('%.2f', $amount);
 411   }
 412
 413   // Return invoice total, including adjustments but not payments.
 414   //
 415   function invoiceTotal() {
 416     $amount = 0;
 417     foreach($this->invoice as $codekey => $codeval) {
 418       $amount += $codeval['chg'];
 419     }
 420     return sprintf('%.2f', $amount);
 421   }
 422
 423   // Number of procedures in this claim.
 424   function procCount() {
 425     return count($this->procs);
 426   }
 427
 428   // Number of payers for this claim. Ranges from 1 to 3.
 429   function payerCount() {
 430     return count($this->payers);
 431   }
 432
 433   function x12gsversionstring() {
 434     return x12clean(trim($this->x12_partner['x12_version']));
 435   }
 436
 437   function x12gssenderid() {
 438     $tmp = $this->x12_partner['x12_sender_id'];
 439     while (strlen($tmp) < 15) $tmp .= " ";
 440     return $tmp;
 441   }
 442
 443   function x12gsreceiverid() {
 444     $tmp = $this->x12_partner['x12_receiver_id'];
 445     while (strlen($tmp) < 15) $tmp .= " ";
 446     return $tmp;
 447   }
 448
 449   function cliaCode() {
 450     return x12clean(trim($this->facility['domain_identifier']));
 451   }
 452
 453   function billingFacilityName() {
 454     return x12clean(trim($this->billing_facility['name']));
 455   }
 456
 457   function billingFacilityStreet() {
 458     return x12clean(trim($this->billing_facility['street']));
 459   }
 460
 461   function billingFacilityCity() {
 462     return x12clean(trim($this->billing_facility['city']));
 463   }
 464
 465   function billingFacilityState() {
 466     return x12clean(trim($this->billing_facility['state']));
 467   }
 468
 469   function billingFacilityZip() {
 470     return x12clean(trim($this->billing_facility['postal_code']));
 471   }
 472
 473   function billingFacilityETIN() {
 474     return x12clean(trim(str_replace('-', '', $this->billing_facility['federal_ein'])));
 475   }
 476
 477   function billingFacilityNPI() {
 478     return x12clean(trim($this->billing_facility['facility_npi']));
 479   }
 480
 481   # The billing facility and the patient must both accept for this to return true.
 482   function billingFacilityAssignment($ins=0) {
 483     $tmp = strtoupper($this->payers[$ins]['data']['accept_assignment']);
 484     if (strcmp($tmp,'FALSE') == 0) return '0';
 485     return !empty($this->billing_facility['accepts_assignment']);
 486   }
 487
 488   function billingContactName() {
 489     return x12clean(trim($this->billing_facility['attn']));
 490   }
 491
 492   function billingContactPhone() {
 493     if (preg_match("/([2-9]\d\d)\D*(\d\d\d)\D*(\d\d\d\d)/",
 494       $this->billing_facility['phone'], $tmp))
 495     {
 496       return $tmp[1] . $tmp[2] . $tmp[3];
 497     }
 498     return '';
 499   }
 500
 501   function facilityName() {
 502     return x12clean(trim($this->facility['name']));
 503   }
 504
 505   function facilityStreet() {
 506     return x12clean(trim($this->facility['street']));
 507   }
 508
 509   function facilityCity() {
 510     return x12clean(trim($this->facility['city']));
 511   }
 512
 513   function facilityState() {
 514     return x12clean(trim($this->facility['state']));
 515   }
 516
 517   function facilityZip() {
 518     return x12clean(trim($this->facility['postal_code']));
 519   }
 520
 521   function facilityETIN() {
 522     return x12clean(trim(str_replace('-', '', $this->facility['federal_ein'])));
 523   }
 524
 525   function facilityNPI() {
 526     return x12clean(trim($this->facility['facility_npi']));
 527   }
 528
 529   function facilityPOS() {
 530     return x12clean(trim($this->facility['pos_code']));
 531   }
 532
 533   function clearingHouseName() {
 534     return x12clean(trim($this->x12_partner['name']));
 535   }
 536
 537   function clearingHouseETIN() {
 538     return x12clean(trim(str_replace('-', '', $this->x12_partner['id_number'])));
 539   }
 540
 541   function providerNumberType() {
 542     return $this->insurance_numbers['provider_number_type'];
 543   }
 544
 545   function providerNumber() {
 546     return x12clean(trim(str_replace('-', '', $this->insurance_numbers['provider_number'])));
 547   }
 548
 549   function providerGroupNumber() {
 550     return x12clean(trim(str_replace('-', '', $this->insurance_numbers['group_number'])));
 551   }
 552
 553   // Returns 'P', 'S' or 'T'.
 554   //
 555   function payerSequence($ins=0) {
 556     return strtoupper(substr($this->payers[$ins]['data']['type'], 0, 1));
 557   }
 558
 559   // Returns the HIPAA code of the patient-to-subscriber relationship.
 560   //
 561   function insuredRelationship($ins=0) {
 562     $tmp = strtolower($this->payers[$ins]['data']['subscriber_relationship']);
 563     if (strcmp($tmp,'self'  ) == 0) return '18';
 564     if (strcmp($tmp,'spouse') == 0) return '01';
 565     if (strcmp($tmp,'child' ) == 0) return '19';
 566     if (strcmp($tmp,'other' ) == 0) return 'G8';
 567     return $tmp; // should not happen
 568   }
 569
 570   function insuredTypeCode($ins=0) {
 571     if (strcmp($this->claimType($ins),'MB') == 0 && $this->payerSequence($ins) != 'P')
 572       return '12'; // medicare secondary working aged beneficiary or
 573                    // spouse with employer group health plan
 574     return '';
 575   }
 576
 577   // Is the patient also the subscriber?
 578   //
 579   function isSelfOfInsured($ins=0) {
 580     $tmp = strtolower($this->payers[$ins]['data']['subscriber_relationship']);
 581     return (strcmp($tmp,'self') == 0);
 582   }
 583
 584   function planName($ins=0) {
 585     return x12clean(trim($this->payers[$ins]['data']['plan_name']));
 586   }
 587
 588   function policyNumber($ins=0) { // "ID"
 589     return x12clean(trim($this->payers[$ins]['data']['policy_number']));
 590   }
 591
 592   function groupNumber($ins=0) {
 593     return x12clean(trim($this->payers[$ins]['data']['group_number']));
 594   }
 595
 596   function groupName($ins=0) {
 597     return x12clean(trim($this->payers[$ins]['data']['subscriber_employer']));
 598   }
 599
 600   // Claim types are:
 601   // 16 Other HCFA
 602   // MB Medicare Part B
 603   // MC Medicaid
 604   // CH ChampUSVA
 605   // CH ChampUS
 606   // BL Blue Cross Blue Shield
 607   // 16 FECA
 608   // 09 Self Pay
 609   // 10 Central Certification
 610   // 11 Other Non-Federal Programs
 611   // 12 Preferred Provider Organization (PPO)
 612   // 13 Point of Service (POS)
 613   // 14 Exclusive Provider Organization (EPO)
 614   // 15 Indemnity Insurance
 615   // 16 Health Maintenance Organization (HMO) Medicare Risk
 616   // AM Automobile Medical
 617   // CI Commercial Insurance Co.
 618   // DS Disability
 619   // HM Health Maintenance Organization
 620   // LI Liability
 621   // LM Liability Medical
 622   // OF Other Federal Program
 623   // TV Title V
 624   // VA Veterans Administration Plan
 625   // WC Workers Compensation Health Plan
 626   // ZZ Mutually Defined
 627   //
 628   function claimType($ins=0) {
 629     if (empty($this->payers[$ins]['object'])) return '';
 630     return $this->payers[$ins]['object']->get_freeb_claim_type();
 631   }
 632
 633   function insuredLastName($ins=0) {
 634     return x12clean(trim($this->payers[$ins]['data']['subscriber_lname']));
 635   }
 636
 637   function insuredFirstName($ins=0) {
 638     return x12clean(trim($this->payers[$ins]['data']['subscriber_fname']));
 639   }
 640
 641   function insuredMiddleName($ins=0) {
 642     return x12clean(trim($this->payers[$ins]['data']['subscriber_mname']));
 643   }
 644
 645   function insuredStreet($ins=0) {
 646     return x12clean(trim($this->payers[$ins]['data']['subscriber_street']));
 647   }
 648
 649   function insuredCity($ins=0) {
 650     return x12clean(trim($this->payers[$ins]['data']['subscriber_city']));
 651   }
 652
 653   function insuredState($ins=0) {
 654     return x12clean(trim($this->payers[$ins]['data']['subscriber_state']));
 655   }
 656
 657   function insuredZip($ins=0) {
 658     return x12clean(trim($this->payers[$ins]['data']['subscriber_postal_code']));
 659   }
 660
 661   function insuredPhone($ins=0) {
 662     if (preg_match("/([2-9]\d\d)\D*(\d\d\d)\D*(\d\d\d\d)/",
 663       $this->payers[$ins]['data']['subscriber_phone'], $tmp))
 664       return $tmp[1] . $tmp[2] . $tmp[3];
 665     return '';
 666   }
 667
 668   function insuredDOB($ins=0) {
 669     return str_replace('-', '', $this->payers[$ins]['data']['subscriber_DOB']);
 670   }
 671
 672   function insuredSex($ins=0) {
 673     return strtoupper(substr($this->payers[$ins]['data']['subscriber_sex'], 0, 1));
 674   }
 675
 676   function payerName($ins=0) {
 677     return x12clean(trim($this->payers[$ins]['company']['name']));
 678   }
 679
 680   function payerAttn($ins=0) {
 681     return x12clean(trim($this->payers[$ins]['company']['attn']));
 682   }
 683
 684   function payerStreet($ins=0) {
 685     if (empty($this->payers[$ins]['object'])) return '';
 686     $tmp = $this->payers[$ins]['object'];
 687     $tmp = $tmp->get_address();
 688     return x12clean(trim($tmp->get_line1()));
 689   }
 690
 691   function payerCity($ins=0) {
 692     if (empty($this->payers[$ins]['object'])) return '';
 693     $tmp = $this->payers[$ins]['object'];
 694     $tmp = $tmp->get_address();
 695     return x12clean(trim($tmp->get_city()));
 696   }
 697
 698   function payerState($ins=0) {
 699     if (empty($this->payers[$ins]['object'])) return '';
 700     $tmp = $this->payers[$ins]['object'];
 701     $tmp = $tmp->get_address();
 702     return x12clean(trim($tmp->get_state()));
 703   }
 704
 705   function payerZip($ins=0) {
 706     if (empty($this->payers[$ins]['object'])) return '';
 707     $tmp = $this->payers[$ins]['object'];
 708     $tmp = $tmp->get_address();
 709     return x12clean(trim($tmp->get_zip()));
 710   }
 711
 712   function payerID($ins=0) {
 713     return x12clean(trim($this->payers[$ins]['company']['cms_id']));
 714   }
 715
 716   function patientLastName() {
 717     return x12clean(trim($this->patient_data['lname']));
 718   }
 719
 720   function patientFirstName() {
 721     return x12clean(trim($this->patient_data['fname']));
 722   }
 723
 724   function patientMiddleName() {
 725     return x12clean(trim($this->patient_data['mname']));
 726   }
 727
 728   function patientStreet() {
 729     return x12clean(trim($this->patient_data['street']));
 730   }
 731
 732   function patientCity() {
 733     return x12clean(trim($this->patient_data['city']));
 734   }
 735
 736   function patientState() {
 737     return x12clean(trim($this->patient_data['state']));
 738   }
 739
 740   function patientZip() {
 741     return x12clean(trim($this->patient_data['postal_code']));
 742   }
 743
 744   function patientPhone() {
 745     $ptphone = $this->patient_data['phone_home'];
 746     if (!$ptphone) $ptphone = $this->patient_data['phone_biz'];
 747     if (!$ptphone) $ptphone = $this->patient_data['phone_cell'];
 748     if (preg_match("/([2-9]\d\d)\D*(\d\d\d)\D*(\d\d\d\d)/", $ptphone, $tmp))
 749       return $tmp[1] . $tmp[2] . $tmp[3];
 750     return '';
 751   }
 752
 753   function patientDOB() {
 754     return str_replace('-', '', $this->patient_data['DOB']);
 755   }
 756
 757   function patientSex() {
 758     return strtoupper(substr($this->patient_data['sex'], 0, 1));
 759   }
 760
 761   // Patient Marital Status: M = Married, S = Single, or something else.
 762   function patientStatus() {
 763     return strtoupper(substr($this->patient_data['status'], 0, 1));
 764   }
 765
 766   // This should be UNEMPLOYED, STUDENT, PT STUDENT, or anything else to
 767   // indicate employed.
 768   function patientOccupation() {
 769     return strtoupper(x12clean(trim($this->patient_data['occupation'])));
 770   }
 771
 772   function cptCode($prockey) {
 773     return x12clean(trim($this->procs[$prockey]['code']));
 774   }
 775
 776   function cptModifier($prockey) {
 777     return x12clean(trim($this->procs[$prockey]['modifier']));
 778   }
 779
 780   // Returns the procedure code, followed by ":modifier" if there is one.
 781   function cptKey($prockey) {
 782     $tmp = $this->cptModifier($prockey);
 783     return $this->cptCode($prockey) . ($tmp ? ":$tmp" : "");
 784   }
 785
 786   function cptCharges($prockey) {
 787     return x12clean(trim($this->procs[$prockey]['fee']));
 788   }
 789
 790   function cptUnits($prockey) {
 791     if (empty($this->procs[$prockey]['units'])) return '1';
 792     return x12clean(trim($this->procs[$prockey]['units']));
 793   }
 794
 795   // NDC drug ID.
 796   function cptNDCID($prockey) {
 797     $ndcinfo = $this->procs[$prockey]['ndc_info'];
 798     if (preg_match('/^N4(\S+)\s+(\S\S)(.*)/', $ndcinfo, $tmp)) {
 799       $ndc = $tmp[1];
 800       if (preg_match('/^(\d+)-(\d+)-(\d+)$/', $ndc, $tmp)) {
 801         return sprintf('%05d-%04d-%02d', $tmp[1], $tmp[2], $tmp[3]);
 802       }
 803       return x12clean($ndc); // format is bad but return it anyway
 804     }
 805     return '';
 806   }
 807
 808   // NDC drug unit of measure code.
 809   function cptNDCUOM($prockey) {
 810     $ndcinfo = $this->procs[$prockey]['ndc_info'];
 811     if (preg_match('/^N4(\S+)\s+(\S\S)(.*)/', $ndcinfo, $tmp))
 812       return x12clean($tmp[2]);
 813     return '';
 814   }
 815
 816   // NDC drug number of units.
 817   function cptNDCQuantity($prockey) {
 818     $ndcinfo = $this->procs[$prockey]['ndc_info'];
 819     if (preg_match('/^N4(\S+)\s+(\S\S)(.*)/', $ndcinfo, $tmp)) {
 820       return x12clean(ltrim($tmp[3], '0'));
 821     }
 822     return '';
 823   }
 824
 825   function onsetDate() {
 826     return str_replace('-', '', substr($this->encounter['onset_date'], 0, 10));
 827   }
 828
 829   function serviceDate() {
 830     return str_replace('-', '', substr($this->encounter['date'], 0, 10));
 831   }
 832
 833   function priorAuth() {
 834     return x12clean(trim($this->billing_options['prior_auth_number']));
 835   }
 836
 837   function isRelatedEmployment() {
 838     return !empty($this->billing_options['employment_related']);
 839   }
 840
 841   function isRelatedAuto() {
 842     return !empty($this->billing_options['auto_accident']);
 843   }
 844
 845   function isRelatedOther() {
 846     return !empty($this->billing_options['other_accident']);
 847   }
 848
 849   function autoAccidentState() {
 850     return x12clean(trim($this->billing_options['accident_state']));
 851   }
 852
 853   function isUnableToWork() {
 854     return !empty($this->billing_options['is_unable_to_work']);
 855   }
 856
 857   function offWorkFrom() {
 858     return str_replace('-', '', substr($this->billing_options['off_work_from'], 0, 10));
 859   }
 860
 861   function offWorkTo() {
 862     return str_replace('-', '', substr($this->billing_options['off_work_to'], 0, 10));
 863   }
 864
 865   function isHospitalized() {
 866     return !empty($this->billing_options['is_hospitalized']);
 867   }
 868
 869   function hospitalizedFrom() {
 870     return str_replace('-', '', substr($this->billing_options['hospitalization_date_from'], 0, 10));
 871   }
 872
 873   function hospitalizedTo() {
 874     return str_replace('-', '', substr($this->billing_options['hospitalization_date_to'], 0, 10));
 875   }
 876
 877   function isOutsideLab() {
 878     return !empty($this->billing_options['outside_lab']);
 879   }
 880
 881   function outsideLabAmount() {
 882     return sprintf('%.2f', 0 + $this->billing_options['lab_amount']);
 883   }
 884
 885   function medicaidResubmissionCode() {
 886     return x12clean(trim($this->billing_options['medicaid_resubmission_code']));
 887   }
 888
 889   function medicaidOriginalReference() {
 890     return x12clean(trim($this->billing_options['medicaid_original_reference']));
 891   }
 892
 893   function frequencyTypeCode() {
 894     return empty($this->billing_options['replacement_claim']) ? '1' : '7';
 895   }
 896
 897   function additionalNotes() {
 898     return x12clean(trim($this->billing_options['comments']));
 899   }
 900
 901   // Returns an array of unique diagnoses.  Periods are stripped.
 902   function diagArray() {
 903     $da = array();
 904     foreach ($this->procs as $row) {
 905       $atmp = explode(':', $row['justify']);
 906       foreach ($atmp as $tmp) {
 907         if (!empty($tmp)) {
 908           $diag = str_replace('.', '', $tmp);
 909           $da[$diag] = $diag;
 910         }
 911       }
 912     }
 913     return $da;
 914   }
 915
 916   // Compute one 1-relative index in diagArray for the given procedure.
 917   // This function is obsolete, use diagIndexArray() instead.
 918   function diagIndex($prockey) {
 919     $da = $this->diagArray();
 920     $tmp = explode(':', $this->procs[$prockey]['justify']);
 921     if (empty($tmp)) return '';
 922     $diag = str_replace('.', '', $tmp[0]);
 923     $i = 0;
 924     foreach ($da as $value) {
 925       ++$i;
 926       if (strcmp($value,$diag) == 0) return $i;
 927     }
 928     return '';
 929   }
 930
 931   // Compute array of 1-relative diagArray indices for the given procedure.
 932   function diagIndexArray($prockey) {
 933     $dia = array();
 934     $da = $this->diagArray();
 935     $atmp = explode(':', $this->procs[$prockey]['justify']);
 936     foreach ($atmp as $tmp) {
 937       if (!empty($tmp)) {
 938         $diag = str_replace('.', '', $tmp);
 939         $i = 0;
 940         foreach ($da as $value) {
 941           ++$i;
 942           if (strcmp($value,$diag) == 0) $dia[] = $i;
 943         }
 944       }
 945     }
 946     return $dia;
 947   }
 948
 949   function providerLastName() {
 950     return x12clean(trim($this->provider['lname']));
 951   }
 952
 953   function providerFirstName() {
 954     return x12clean(trim($this->provider['fname']));
 955   }
 956
 957   function providerMiddleName() {
 958     return x12clean(trim($this->provider['mname']));
 959   }
 960
 961   function providerNPI() {
 962     return x12clean(trim($this->provider['npi']));
 963   }
 964
 965   function providerUPIN() {
 966     return x12clean(trim($this->provider['upin']));
 967   }
 968
 969   function providerSSN() {
 970     return x12clean(trim(str_replace('-', '', $this->provider['federaltaxid'])));
 971   }
 972
 973   function providerTaxonomy() {
 974     if (empty($this->provider['taxonomy'])) return '207Q00000X';
 975     return x12clean(trim($this->provider['taxonomy']));
 976   }
 977
 978   function referrerLastName() {
 979     return x12clean(trim($this->referrer['lname']));
 980   }
 981
 982   function referrerFirstName() {
 983     return x12clean(trim($this->referrer['fname']));
 984   }
 985
 986   function referrerMiddleName() {
 987     return x12clean(trim($this->referrer['mname']));
 988   }
 989
 990   function referrerNPI() {
 991     return x12clean(trim($this->referrer['npi']));
 992   }
 993
 994   function referrerUPIN() {
 995     return x12clean(trim($this->referrer['upin']));
 996   }
 997
 998   function referrerSSN() {
 999     return x12clean(trim(str_replace('-', '', $this->referrer['federaltaxid'])));
1000   }
1001
1002   function referrerTaxonomy() {
1003     if (empty($this->referrer['taxonomy'])) return '207Q00000X';
1004     return x12clean(trim($this->referrer['taxonomy']));
1005   }
1006 }
1007 ?>