library/classes/WSClaim.class.php

   1 <?php
   2
   3 require_once (dirname(__FILE__) . "/WSWrapper.class.php");
   4 include_once (dirname(__FILE__) . "/../sqlconf.php");
   5 include_once (dirname(__FILE__) . "/../sql.inc");
   6 include_once (dirname(__FILE__) . "/../../includes/config.php");
   7
   8 class WSClaim extends WSWrapper{
   9
  10   var $patient_id;
  11   var $foreign_provider_id;
  12   var $foreign_patient_id;
  13   var $payer_id;
  14   var $encounter;
  15   var $foreign_payer_id;
  16   var $claim;
  17   var $_db;
  18
  19   function WSClaim($patient_id, $encounter) {
  20     if (!is_numeric($patient_id) && is_numeric($encounter)) return;
  21
  22     parent::WSWrapper(null,false);
  23
  24     $this->patient_id = $patient_id;
  25     $this->encounter = $encounter;
  26     $this->claim = null;
  27     $this->_db = $GLOBALS['adodb']['db'];
  28
  29     if ($this->_config['enabled'] === 2) {
  30       return;
  31     }
  32
  33     if ($this->load_claim()) {
  34       $function['ezybiz.add_invoice'] = array(new xmlrpcval($this->claim,"struct"));
  35       $this->send($function);
  36     }
  37     //print_r($this->claim);
  38   }
  39
  40   ///////////////////////////////////////////////////////////////////////
  41   // The remainder is used only for SQL-Ledger support, to be deprecated.
  42   ///////////////////////////////////////////////////////////////////////
  43
  44   function load_claim() {
  45     if (!$this->load_patient_foreign_id() ||
  46       !$this->load_payer_foreign_id() ||
  47       !$this->load_provider_foreign_id() )
  48       return false;
  49     $invoice_info = array();
  50
  51     // Get encounter date and patient name.
  52     $sql = "SELECT e.date AS dosdate, " .
  53       "CONCAT(pd.fname,' ',pd.mname,' ',pd.lname) as patient_name " .
  54       "FROM form_encounter AS e, patient_data AS pd " .
  55       "WHERE " .
  56       "e.encounter = '" . $this->encounter . "' AND " .
  57       "e.pid = '" . $this->patient_id . "' AND " .
  58       "pd.pid = e.pid";
  59     $eres = $this->_db->Execute($sql);
  60     $dosdate = substr($eres->fields['dosdate'], 0, 10);
  61
  62     // Create invoice notes for the new invoice that list the patient's
  63     // insurance plans.  This is so that when payments are posted, the user
  64     // can easily see if a secondary claim needs to be submitted.
  65     //
  66     $insnotes = "";
  67     $insno = 0;
  68     foreach (array("primary", "secondary", "tertiary") as $instype) {
  69       ++$insno;
  70       $sql = "SELECT ic.name " .
  71         "FROM insurance_data AS id, insurance_companies AS ic WHERE " .
  72         "id.pid = " . $this->patient_id . " AND " .
  73         "id.type = '$instype' AND " .
  74         "id.date <= '$dosdate' AND " .
  75         "ic.id = id.provider " .
  76         "ORDER BY id.date DESC LIMIT 1";
  77       $result = $this->_db->Execute($sql);
  78       if ($result && !$result->EOF && $result->fields['name']) {
  79         if ($insnotes) $insnotes .= "\n";
  80         $insnotes .= "Ins$insno: " . $result->fields['name'];
  81       }
  82     }
  83     $invoice_info['notes'] = $insnotes;
  84
  85     $sql = "SELECT * FROM billing WHERE " .
  86       "encounter = '" . $this->encounter . "' AND pid = '" . $this->patient_id .
  87       "' AND billed = 1 AND activity != 0 AND authorized = 1";
  88
  89     $result = $this->_db->Execute($sql);
  90
  91     $invoice_info['salesman'] = $this->foreign_provider_id;
  92     $invoice_info['customerid'] = $this->foreign_patient_id;
  93     $invoice_info['payer_id'] = $this->foreign_payer_id;
  94     $invoice_info['invoicenumber'] = $this->patient_id . "." . $this->encounter;
  95
  96     $counter = 0;
  97     $total = 0;
  98     $patient_info = array();
  99     $payer_info = array();
 100
 101     while ($result && !$result->EOF) {
 102
 103       // All bills should be in the accounting system, and mark-as-cleared
 104       // is the only reasonable way to process cash-only patients.
 105       //
 106       $process_date = ($result->fields['process_date'] == null) ?
 107         date("m-d-Y") :
 108         date("m-d-Y", strtotime($result->fields['process_date']));
 109
 110       if ($counter == 0) {
 111         //unused but supported by ezybiz, helpful in debugging
 112         // actualy the dosdate can be used if you want that as the invoice date
 113         $invoice_info['customer'] = $eres->fields['patient_name'];
 114         $invoice_info['invoicedate'] = $process_date;
 115         $invoice_info['duedate'] = $process_date;
 116         $invoice_info['items'] = array();
 117         $invoice_info['dosdate'] = date("m-d-Y",strtotime($eres->fields['dosdate']));
 118       }
 119
 120       $tii = array();
 121       //This is how we set the line items for the invoice, using codes from our encounter
 122       //if ($result->fields['code_type'] == "CPT4" || $result->fields['code_type'] == "HCPCS") {
 123       //if( $result->fields['code_type'] != "ICD9" ) {
 124       if( $result->fields['code_type'] == "COPAY")
 125       {
 126         $patient_info['payment_amount'] += sprintf("%01.2f",$result->fields['fee']);
 127       }
 128       else
 129       {
 130         $payer_info['payment_amount'] += sprintf("%01.2f",$result->fields['fee']);
 131       }
 132
 133       // New as of 2007-06-21: wherever we put a procedure code in the
 134       // invoice, append a colon and the modifier if there is one.  This way
 135       // we can better match up payments and adjustments with the billing data
 136       // in OpenEMR.
 137       $codekey = $result->fields['code'];
 138       if ($result->fields['modifier']) $codekey .= ':' . $result->fields['modifier'];
 139
 140       $tii['maincode'] = $codekey;
 141       $tii['itemtext'] = $result->fields['code_type'] . ":" .
 142         $codekey . " " . $result->fields['code_text'] . " " .
 143         $result->fields['justify'];
 144
 145       // New logic that respects units:
 146       $units = max(1, intval($result->fields['units']));
 147       $amount = sprintf("%01.2f", $result->fields['fee']);
 148       $price = $amount / $units;
 149       $tmp = sprintf("%01.2f", $price);
 150       if (abs($price - $tmp) < 0.000001) $price = $tmp;
 151       $tii['qty'] = $units;
 152       $tii['price'] = $price;
 153       $total += $amount;
 154
 155       $tii['glaccountid'] = $this->_config['income_acct'];
 156       $invoice_info['items'][] = $tii;
 157
 158       $result->MoveNext();
 159       $counter++;
 160     }
 161
 162     // I think maybe this info is not used.
 163     //
 164     for($counter = 0; $counter < 2; $counter++)
 165     {
 166       $fee = 0;
 167       $billto = 0;
 168       if($counter == 0)
 169       {
 170         $fee = $patient_info['payment_amount'];
 171         $billto = $this->foreign_patient_id;
 172       }
 173       else
 174       {
 175         $fee = $payer_info['payment_amount'];
 176         $billto = $this->foreign_payer_id;
 177       }
 178       $invoice_info["invoiceid$counter"] = $this->patient_id . "000" . $this->encounter;
 179       $invoice_info["amount$counter"] = $fee;
 180       $invoice_info["invoicenumber$counter"] = $this->patient_id . "000" . $this->encounter;
 181       $invoice_info["interest$counter"] = 0;
 182       $invoice_info["billtoid$counter"] = $billto;
 183     }
 184
 185     $invoice_info['subtotal'] = sprintf("%01.2f",$total);
 186     $invoice_info['total'] = sprintf("%01.2f",$total);
 187
 188     $this->claim = $invoice_info;
 189     return true;
 190   }
 191
 192   function load_provider_foreign_id() {
 193     $sql = "SELECT foreign_id FROM integration_mapping AS im " .
 194       "LEFT JOIN billing AS b ON im.local_id = b.provider_id WHERE " .
 195       "b.encounter = '" . $this->encounter . "' AND " .
 196       "b.pid = '" . $this->patient_id . "' AND im.local_table = 'users' " .
 197       "AND im.foreign_table = 'salesman'";
 198     $result = $this->_db->Execute($sql);
 199     if($result && !$result->EOF) {
 200         $this->foreign_provider_id = $result->fields['foreign_id'];
 201         return true;
 202     }
 203     else {
 204       echo "Provider has not been previously sent to external system or no " .
 205         "entry was found for them in the integration mapping, could not " .
 206         "send claim. Patient: '" . $this->patient_id . "', Encounter: '" .
 207         $this->encounter . "'<br>";
 208       return false;
 209     }
 210   }
 211
 212   function load_patient_foreign_id() {
 213     $sql = "SELECT foreign_id from integration_mapping as im LEFT JOIN patient_data as pd on im.local_id=pd.id where pd.pid = '" . $this->patient_id . "' and im.local_table='patient_data' and im.foreign_table='customer'";
 214     $result = $this->_db->Execute($sql);
 215     if($result && !$result->EOF) {
 216         $this->foreign_patient_id = $result->fields['foreign_id'];
 217         return true;
 218     }
 219     else {
 220       echo "Entry has not been previously sent to external system or no entry was found for them in the integration mapping, could not send claim. Patient: '" . $this->patient_id . "'<br>";
 221       return false;
 222     }
 223   }
 224
 225   function load_payer_foreign_id() {
 226     $sql = "SELECT payer_id from billing where encounter = '" . $this->encounter . "' and pid = '" . $this->patient_id . "'";
 227     $result = $this->_db->Execute($sql);
 228     if($result && !$result->EOF) {
 229         $this->payer_id = $result->fields['payer_id'];
 230     }
 231     else {
 232       echo "No payer id for this claim could be found";
 233       return false;
 234     }
 235     // See comments in globals.php:
 236     if ($GLOBALS['insurance_companies_are_not_customers']) {
 237       $this->foreign_payer_id = $this->payer_id;
 238     }
 239     else {
 240       $sql = "SELECT foreign_id from integration_mapping as im LEFT JOIN billing as b on im.local_id=b.payer_id where b.payer_id = '" . $this->payer_id . "' and im.local_table='insurance_companies' and im.foreign_table='customer'";
 241       $result = $this->_db->Execute($sql);
 242       if($result && !$result->EOF) {
 243         $this->foreign_payer_id = $result->fields['foreign_id'];
 244       }
 245       else {
 246         echo "Entry has not been previously sent to external system or no entry was found for them in the integration mapping, could not send claim. Insurance Company: '" . $this->payer_id . "'<br>";
 247         return false;
 248       }
 249     }
 250     return true;
 251   }
 252
 253 } // End class WSClaim
 254
 255 ?>