library/sl_eob.inc.php

   1 <?php
   2   // Copyright (C) 2005-2009 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   include_once("patient.inc");
  10   include_once("billing.inc");
  11   include_once("invoice_summary.inc.php");
  12
  13   $chart_id_cash   = 0;
  14   $chart_id_ar     = 0;
  15   $chart_id_income = 0;
  16   $services_id     = 0;
  17
  18
  19   // Try to figure out our invoice number (pid.encounter) from the
  20   // claim ID and other stuff in the ERA.  This should be straightforward
  21   // except that some payers mangle the claim ID that we give them.
  22   //
  23 function slInvoiceNumber(&$out)
  24 {
  25     $invnumber = $out['our_claim_id'];
  26     $atmp = preg_split('/[ -]/', $invnumber);
  27     $acount = count($atmp);
  28
  29     $pid = 0;
  30     $encounter = 0;
  31     if ($acount == 2) {
  32         $pid = $atmp[0];
  33         $encounter = $atmp[1];
  34     } else if ($acount == 3) {
  35         $pid = $atmp[0];
  36         $brow = sqlQuery("SELECT encounter FROM billing WHERE " .
  37         "pid = '$pid' AND encounter = '" . $atmp[1] . "' AND activity = 1");
  38
  39         $encounter = $brow['encounter'];
  40     } else if ($acount == 1) {
  41         $pres = sqlStatement("SELECT pid FROM patient_data WHERE " .
  42         "lname LIKE '" . addslashes($out['patient_lname']) . "' AND " .
  43         "fname LIKE '" . addslashes($out['patient_fname']) . "' " .
  44         "ORDER BY pid DESC");
  45         while ($prow = sqlFetchArray($pres)) {
  46             if (strpos($invnumber, $prow['pid']) === 0) {
  47                 $pid = $prow['pid'];
  48                 $encounter = substr($invnumber, strlen($pid));
  49                 break;
  50             }
  51         }
  52     }
  53
  54     if ($pid && $encounter) {
  55         $invnumber = "$pid.$encounter";
  56     }
  57
  58     return array($pid, $encounter, $invnumber);
  59 }
  60
  61   // This gets a posting session ID.  If the payer ID is not 0 and a matching
  62   // session already exists, then its ID is returned.  Otherwise a new session
  63   // is created.
  64   //
  65 function arGetSession($payer_id, $reference, $check_date, $deposit_date = '', $pay_total = 0)
  66 {
  67     if (empty($deposit_date)) {
  68         $deposit_date = $check_date;
  69     }
  70
  71     if ($payer_id) {
  72         $row = sqlQuery("SELECT session_id FROM ar_session WHERE " .
  73         "payer_id = '$payer_id' AND reference = '$reference' AND " .
  74         "check_date = '$check_date' AND deposit_date = '$deposit_date' " .
  75         "ORDER BY session_id DESC LIMIT 1");
  76         if (!empty($row['session_id'])) {
  77             return $row['session_id'];
  78         }
  79     }
  80
  81     return sqlInsert("INSERT INTO ar_session ( " .
  82     "payer_id, user_id, reference, check_date, deposit_date, pay_total " .
  83     ") VALUES ( " .
  84     "'$payer_id', " .
  85     "'" . $_SESSION['authUserID'] . "', " .
  86     "'$reference', " .
  87     "'$check_date', " .
  88     "'$deposit_date', " .
  89     "'$pay_total' " .
  90     ")");
  91 }
  92   //writing the check details to Session Table on ERA proxcessing
  93 function arPostSession($payer_id, $check_number, $check_date, $pay_total, $post_to_date, $deposit_date, $debug)
  94 {
  95       $query = "INSERT INTO ar_session( " .
  96       "payer_id,user_id,closed,reference,check_date,pay_total,post_to_date,deposit_date,patient_id,payment_type,adjustment_code,payment_method " .
  97       ") VALUES ( " .
  98       "'$payer_id'," .
  99       $_SESSION['authUserID']."," .
 100       "0," .
 101       "'ePay - $check_number'," .
 102       "'$check_date', " .
 103       "$pay_total, " .
 104       "'$post_to_date','$deposit_date', " .
 105       "0,'insurance','insurance_payment','electronic'" .
 106         ")";
 107     if ($debug) {
 108         echo $query . "<br>\n";
 109     } else {
 110         $sessionId=sqlInsert($query);
 111         return $sessionId;
 112     }
 113 }
 114
 115   // Post a payment, new style.
 116   //
 117 function arPostPayment($patient_id, $encounter_id, $session_id, $amount, $code, $payer_type, $memo, $debug, $time = '', $codetype = '')
 118 {
 119     $codeonly = $code;
 120     $modifier = '';
 121     $tmp = strpos($code, ':');
 122     if ($tmp) {
 123         $codeonly = substr($code, 0, $tmp);
 124         $modifier = substr($code, $tmp+1);
 125     }
 126
 127     if (empty($time)) {
 128         $time = date('Y-m-d H:i:s');
 129     }
 130
 131     sqlBeginTrans();
 132     $sequence_no = sqlQuery("SELECT IFNULL(MAX(sequence_no),0) + 1 AS increment FROM ar_activity WHERE pid = ? AND encounter = ?", array($patient_id, $encounter_id));
 133     $query = "INSERT INTO ar_activity ( " .
 134     "pid, encounter, sequence_no, code_type, code, modifier, payer_type, post_time, post_user, " .
 135     "session_id, memo, pay_amount " .
 136     ") VALUES ( " .
 137     "'$patient_id', " .
 138     "'$encounter_id', " .
 139     "'{$sequence_no['increment']}', " .
 140     "'$codetype', " .
 141     "'$codeonly', " .
 142     "'$modifier', " .
 143     "'$payer_type', " .
 144     "'$time', " .
 145     "'" . $_SESSION['authUserID'] . "', " .
 146     "'$session_id', " .
 147     "'$memo', " .
 148     "'$amount' " .
 149     ")";
 150     sqlStatement($query);
 151     sqlCommitTrans();
 152     return;
 153 }
 154
 155   // Post a charge.  This is called only from sl_eob_process.php where
 156   // automated remittance processing can create a new service item.
 157   // Here we add it as an unauthorized item to the billing table.
 158   //
 159 function arPostCharge($patient_id, $encounter_id, $session_id, $amount, $units, $thisdate, $code, $description, $debug, $codetype = '')
 160 {
 161     /*****************************************************************
 162     // Select an existing billing item as a template.
 163     $row= sqlQuery("SELECT * FROM billing WHERE " .
 164     "pid = '$patient_id' AND encounter = '$encounter_id' AND " .
 165     "code_type = 'CPT4' AND activity = 1 " .
 166     "ORDER BY id DESC LIMIT 1");
 167     $this_authorized = 0;
 168     $this_provider = 0;
 169     if (!empty($row)) {
 170     $this_authorized = $row['authorized'];
 171     $this_provider = $row['provider_id'];
 172     }
 173     *****************************************************************/
 174
 175     if (empty($codetype)) {
 176       // default to CPT4 if empty, which is consistent with previous functionality.
 177         $codetype="CPT4";
 178     }
 179
 180     $codeonly = $code;
 181     $modifier = '';
 182     $tmp = strpos($code, ':');
 183     if ($tmp) {
 184         $codeonly = substr($code, 0, $tmp);
 185         $modifier = substr($code, $tmp+1);
 186     }
 187
 188     addBilling(
 189         $encounter_id,
 190         $codetype,
 191         $codeonly,
 192         $description,
 193         $patient_id,
 194         0,
 195         0,
 196         $modifier,
 197         $units,
 198         $amount,
 199         '',
 200         ''
 201     );
 202 }
 203
 204   // Post an adjustment, new style.
 205   //
 206 function arPostAdjustment($patient_id, $encounter_id, $session_id, $amount, $code, $payer_type, $reason, $debug, $time = '', $codetype = '')
 207 {
 208     $codeonly = $code;
 209     $modifier = '';
 210     $tmp = strpos($code, ':');
 211     if ($tmp) {
 212         $codeonly = substr($code, 0, $tmp);
 213         $modifier = substr($code, $tmp+1);
 214     }
 215
 216     if (empty($time)) {
 217         $time = date('Y-m-d H:i:s');
 218     }
 219
 220     sqlBeginTrans();
 221     $sequence_no = sqlQuery("SELECT IFNULL(MAX(sequence_no),0) + 1 AS increment FROM ar_activity WHERE pid = ? AND encounter = ?", array($patient_id, $encounter_id));
 222     $query = "INSERT INTO ar_activity ( " .
 223     "pid, encounter, sequence_no, code_type, code, modifier, payer_type, post_user, post_time, " .
 224     "session_id, memo, adj_amount " .
 225     ") VALUES ( " .
 226     "'$patient_id', " .
 227     "'$encounter_id', " .
 228     "'{$sequence_no['increment']}', " .
 229     "'$codetype', " .
 230     "'$codeonly', " .
 231     "'$modifier', " .
 232     "'$payer_type', " .
 233     "'" . $_SESSION['authUserID'] . "', " .
 234     "'$time', " .
 235     "'$session_id', " .
 236     "'$reason', " .
 237     "'$amount' " .
 238     ")";
 239     sqlStatement($query);
 240     sqlCommitTrans();
 241     return;
 242 }
 243
 244 function arGetPayerID($patient_id, $date_of_service, $payer_type)
 245 {
 246     if ($payer_type < 1 || $payer_type > 3) {
 247         return 0;
 248     }
 249
 250     $tmp = array(1 => 'primary', 2 => 'secondary', 3 => 'tertiary');
 251     $value = $tmp[$payer_type];
 252     $query = "SELECT provider FROM insurance_data WHERE " .
 253     "pid = ? AND type = ? AND date <= ? " .
 254     "ORDER BY date DESC LIMIT 1";
 255     $nprow = sqlQuery($query, array($patient_id,$value,$date_of_service));
 256     if (empty($nprow)) {
 257         return 0;
 258     }
 259
 260     return $nprow['provider'];
 261 }
 262
 263   // Make this invoice re-billable, new style.
 264   //
 265 function arSetupSecondary($patient_id, $encounter_id, $debug, $crossover = 0)
 266 {
 267     if ($crossover==1) {
 268     //if claim forwarded setting a new status
 269         $status=6;
 270     } else {
 271         $status=1;
 272     }
 273
 274     // Determine the next insurance level to be billed.
 275     $ferow = sqlQuery("SELECT date, last_level_billed " .
 276     "FROM form_encounter WHERE " .
 277     "pid = '$patient_id' AND encounter = '$encounter_id'");
 278     $date_of_service = substr($ferow['date'], 0, 10);
 279     $new_payer_type = 0 + $ferow['last_level_billed'];
 280     if ($new_payer_type < 3 && !empty($ferow['last_level_billed']) || $new_payer_type == 0) {
 281         ++$new_payer_type;
 282     }
 283
 284     $new_payer_id = arGetPayerID($patient_id, $date_of_service, $new_payer_type);
 285
 286     if ($new_payer_id) {
 287         // Queue up the claim.
 288         if (!$debug) {
 289             updateClaim(true, $patient_id, $encounter_id, $new_payer_id, $new_payer_type, $status, 5, '', 'hcfa', '', $crossover);
 290         }
 291     } else {
 292       // Just reopen the claim.
 293         if (!$debug) {
 294             updateClaim(true, $patient_id, $encounter_id, -1, -1, $status, 0, '', '', '', $crossover);
 295         }
 296     }
 297
 298     return xl("Encounter ") . $encounter . xl(" is ready for re-billing.");
 299 }