library/gen_x12_837.inc.php

   1 <?php
   2 // Copyright (C) 2007-2009 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 require_once("Claim.class.php");
  10
  11 function gen_x12_837($pid, $encounter, &$log, $encounter_claim=false) {
  12
  13   $today = time();
  14   $out = '';
  15   $claim = new Claim($pid, $encounter);
  16   $edicount = 0;
  17
  18   $log .= "Generating claim $pid-$encounter for " .
  19     $claim->patientFirstName()  . ' ' .
  20     $claim->patientMiddleName() . ' ' .
  21     $claim->patientLastName()   . ' on ' .
  22     date('Y-m-d H:i', $today) . ".\n";
  23
  24   $out .= "ISA" .
  25     "*00" .
  26     "*          " .
  27     "*00" .
  28     "*          " .
  29     "*" . $claim->x12gsisa05() .
  30     "*" . $claim->x12gssenderid() .
  31     "*" . $claim->x12gsisa07() .
  32     "*" . $claim->x12gsreceiverid() .
  33     "*030911" .
  34     "*1630" .
  35     "*U" .
  36     "*00401" .
  37     "*000000001" .
  38     "*" . $claim->x12gsisa14() .
  39     "*" . $claim->x12gsisa15() .
  40     "*:" .
  41     "~\n";
  42
  43   $out .= "GS" .
  44     "*HC" .
  45     "*" . $claim->x12gsgs02() .
  46     "*" . trim($claim->x12gsreceiverid()) .
  47     "*" . date('Ymd', $today) .
  48     "*" . date('Hi', $today) .
  49     "*1" .
  50     "*X" .
  51     "*" . $claim->x12gsversionstring() .
  52     "~\n";
  53
  54   ++$edicount;
  55   $out .= "ST" .
  56     "*837" .
  57     "*0021" .
  58     "~\n";
  59
  60   ++$edicount;
  61   $out .= "BHT" .
  62     "*0019" .
  63     "*00" .
  64     "*0123" .
  65     "*" . date('Ymd', $today) .
  66     "*1023" .
  67     ($encounter_claim ? "*RP" : "*CH") .
  68     "~\n";
  69
  70   ++$edicount;
  71   $out .= "REF" .
  72     "*87" .
  73     "*" . $claim->x12gsversionstring() .
  74     "~\n";
  75
  76   ++$edicount;
  77   $out .= "NM1" .       // Loop 1000A Submitter
  78     "*41" .
  79     "*2" .
  80     "*" . $claim->billingFacilityName() .
  81     "*" .
  82     "*" .
  83     "*" .
  84     "*" .
  85     "*46" .
  86     "*" . $claim->billingFacilityETIN() .
  87     "~\n";
  88
  89   ++$edicount;
  90   $out .= "PER" .
  91     "*IC" .
  92     "*" . $claim->billingContactName() .
  93     "*TE" .
  94     "*" . $claim->billingContactPhone();
  95   if ($claim->x12gsper06()) {
  96     $out .= "*ED*" . $claim->x12gsper06();
  97   }
  98   $out .= "~\n";
  99
 100   ++$edicount;
 101   $out .= "NM1" .       // Loop 1000B Receiver
 102     "*40" .
 103     "*2" .
 104     "*" . $claim->clearingHouseName() .
 105     "*" .
 106     "*" .
 107     "*" .
 108     "*" .
 109     "*46" .
 110     "*" . $claim->clearingHouseETIN() .
 111     "~\n";
 112
 113   $HLcount = 1;
 114
 115   ++$edicount;
 116   $out .= "HL" .        // Loop 2000A Billing/Pay-To Provider HL Loop
 117     "*$HLcount" .
 118     "*" .
 119     "*20" .
 120     "*1" .
 121     "~\n";
 122
 123   $HLBillingPayToProvider = $HLcount++;
 124
 125   ++$edicount;
 126   $out .= "NM1" .       // Loop 2010AA Billing Provider
 127     "*85" .
 128     "*2" .
 129     "*" . $claim->billingFacilityName() .
 130     "*" .
 131     "*" .
 132     "*" .
 133     "*";
 134   if ($claim->billingFacilityNPI()) {
 135     $out .= "*XX*" . $claim->billingFacilityNPI();
 136   } else {
 137     $log .= "*** Billing facility has no NPI.\n";
 138     $out .= "*24*" . $claim->billingFacilityETIN();
 139   }
 140   $out .= "~\n";
 141
 142   ++$edicount;
 143   $out .= "N3" .
 144     "*" . $claim->billingFacilityStreet() .
 145     "~\n";
 146
 147   ++$edicount;
 148   $out .= "N4" .
 149     "*" . $claim->billingFacilityCity() .
 150     "*" . $claim->billingFacilityState() .
 151     "*" . $claim->billingFacilityZip() .
 152     "~\n";
 153
 154   // Add a REF*EI*<ein> segment if NPI was specified in the NM1 above.
 155   if ($claim->billingFacilityNPI() && $claim->billingFacilityETIN()) {
 156     ++$edicount;
 157     $out .= "REF" ;
 158         if($claim->federalIdType()){
 159       $out .= "*" . $claim->federalIdType();
 160         }
 161         else{
 162           $out .= "*EI";//For dealing with the situation before adding selection for TaxId type In facility ie default to EIN.
 163         }
 164       $out .=  "*" . $claim->billingFacilityETIN() .
 165       "~\n";
 166   }
 167
 168   if ($claim->providerNumberType() && $claim->providerNumber()) {
 169     ++$edicount;
 170     $out .= "REF" .
 171       "*" . $claim->providerNumberType() .
 172       "*" . $claim->providerNumber() .
 173       "~\n";
 174   }
 175   else if ($claim->providerNumber()) {
 176     $log .= "*** Payer-specific provider insurance number is present but has no type assigned.\n";
 177   }
 178
 179   ++$edicount;
 180   $out .= "NM1" .       // Loop 2010AB Pay-To Provider
 181     "*87" .
 182     "*2" .
 183     "*" . $claim->billingFacilityName() .
 184     "*" .
 185     "*" .
 186     "*" .
 187     "*";
 188   if ($claim->billingFacilityNPI())
 189     $out .= "*XX*" . $claim->billingFacilityNPI();
 190   else
 191     $out .= "*24*" . $claim->billingFacilityETIN();
 192   $out .= "~\n";
 193
 194   ++$edicount;
 195   $out .= "N3" .
 196     "*" . $claim->billingFacilityStreet() .
 197     "~\n";
 198
 199   ++$edicount;
 200   $out .= "N4" .
 201     "*" . $claim->billingFacilityCity() .
 202     "*" . $claim->billingFacilityState() .
 203     "*" . $claim->billingFacilityZip() .
 204     "~\n";
 205
 206   if ($claim->billingFacilityNPI() && $claim->billingFacilityETIN()) {
 207     ++$edicount;
 208     $out .= "REF" .
 209       "*EI" .
 210       "*" . $claim->billingFacilityETIN() .
 211       "~\n";
 212   }
 213
 214   $PatientHL = 0;
 215
 216   ++$edicount;
 217   $out .= "HL" .        // Loop 2000B Subscriber HL Loop
 218     "*$HLcount" .
 219     "*$HLBillingPayToProvider" .
 220     "*22" .
 221     "*$PatientHL" .
 222     "~\n";
 223
 224   $HLSubscriber = $HLcount++;
 225
 226   if (!$claim->payerSequence()) {
 227     $log .= "*** Error: Insurance information is missing!\n";
 228   }
 229   ++$edicount;
 230   $out .= "SBR" .       // Subscriber Information
 231     "*" . $claim->payerSequence() .
 232     "*" . $claim->insuredRelationship() .
 233     "*" . $claim->groupNumber() .
 234     "*" . $claim->groupName() .
 235     "*" . $claim->insuredTypeCode() . // applies for secondary medicare
 236     "*" .
 237     "*" .
 238     "*" .
 239     "*" . $claim->claimType() . // Zirmed replaces this
 240     "~\n";
 241
 242   ++$edicount;
 243   $out .= "NM1" .       // Loop 2010BA Subscriber
 244     "*IL" .
 245     "*1" .
 246     "*" . $claim->insuredLastName() .
 247     "*" . $claim->insuredFirstName() .
 248     "*" . $claim->insuredMiddleName() .
 249     "*" .
 250     "*" .
 251     "*MI" .
 252     "*" . $claim->policyNumber() .
 253     "~\n";
 254
 255   ++$edicount;
 256   $out .= "N3" .
 257     "*" . $claim->insuredStreet() .
 258     "~\n";
 259
 260   ++$edicount;
 261   $out .= "N4" .
 262     "*" . $claim->insuredCity() .
 263     "*" . $claim->insuredState() .
 264     "*" . $claim->insuredZip() .
 265     "~\n";
 266
 267   ++$edicount;
 268   $out .= "DMG" .
 269     "*D8" .
 270     "*" . $claim->insuredDOB() .
 271     "*" . $claim->insuredSex() .
 272     "~\n";
 273
 274   ++$edicount;
 275   $out .= "NM1" .       // Loop 2010BB Payer
 276     "*PR" .
 277     "*2" .
 278     "*" . $claim->payerName() .
 279     "*" .
 280     "*" .
 281     "*" .
 282     "*" .
 283     "*PI" .
 284     // Zirmed ignores this if using payer name matching:
 285     "*" . ($encounter_claim ? $claim->payerAltID() : $claim->payerID()) .
 286     "~\n";
 287
 288   // if (!$claim->payerID()) {
 289   //   $log .= "*** CMS ID is missing for payer '" . $claim->payerName() . "'.\n";
 290   // }
 291
 292   ++$edicount;
 293   $out .= "N3" .
 294     "*" . $claim->payerStreet() .
 295     "~\n";
 296
 297   ++$edicount;
 298   $out .= "N4" .
 299     "*" . $claim->payerCity() .
 300     "*" . $claim->payerState() .
 301     "*" . $claim->payerZip() .
 302     "~\n";
 303
 304   if (! $claim->isSelfOfInsured()) {
 305     ++$edicount;
 306     $out .= "HL" .        // Loop 2000C Patient Information
 307       "*$HLcount" .
 308       "*$HLSubscriber" .
 309       "*23" .
 310       "*0" .
 311       "~\n";
 312
 313     $HLcount++;
 314
 315     ++$edicount;
 316     $out .= "PAT" .
 317       "*" . $claim->insuredRelationship() .
 318       "~\n";
 319
 320     ++$edicount;
 321     $out .= "NM1" .       // Loop 2010CA Patient
 322       "*QC" .
 323       "*1" .
 324       "*" . $claim->patientLastName() .
 325       "*" . $claim->patientFirstName() .
 326       "*" . $claim->patientMiddleName() .
 327       "~\n";
 328
 329     ++$edicount;
 330     $out .= "N3" .
 331       "*" . $claim->patientStreet() .
 332       "~\n";
 333
 334     ++$edicount;
 335     $out .= "N4" .
 336       "*" . $claim->patientCity() .
 337       "*" . $claim->patientState() .
 338       "*" . $claim->patientZip() .
 339       "~\n";
 340
 341     ++$edicount;
 342     $out .= "DMG" .
 343       "*D8" .
 344       "*" . $claim->patientDOB() .
 345       "*" . $claim->patientSex() .
 346       "~\n";
 347   } // end of patient different from insured
 348
 349   $proccount = $claim->procCount();
 350
 351   $clm_total_charges = 0;
 352   for ($prockey = 0; $prockey < $proccount; ++$prockey) {
 353     $clm_total_charges += $claim->cptCharges($prockey);
 354   }
 355
 356   if (!$clm_total_charges) {
 357     $log .= "*** This claim has no charges!\n";
 358   }
 359
 360   ++$edicount;
 361   $out .= "CLM" .       // Loop 2300 Claim
 362     "*$pid-$encounter" .
 363     "*"  . sprintf("%.2f",$clm_total_charges) . // Zirmed computes and replaces this
 364     "*"  .
 365     "*"  .
 366     "*"  . $claim->facilityPOS() . "::" . $claim->frequencyTypeCode() .
 367     "*Y" .
 368     "*A" .
 369     "*"  . ($claim->billingFacilityAssignment() ? 'Y' : 'N') .
 370     "*Y" .
 371     "*C" .
 372     "~\n";
 373
 374   ++$edicount;
 375   $out .= "DTP" .       // Date of Onset
 376     "*431" .
 377     "*D8" .
 378     "*" . $claim->onsetDate() .
 379     "~\n";
 380
 381   if (strcmp($claim->facilityPOS(),'21') == 0) {
 382     ++$edicount;
 383     $out .= "DTP" .     // Date of Hospitalization
 384       "*435" .
 385       "*D8" .
 386       "*" . $claim->onsetDate() .
 387       "~\n";
 388   }
 389
 390   $patientpaid = $claim->patientPaidAmount();
 391   if ($patientpaid != 0) {
 392     ++$edicount;
 393     $out .= "AMT" .     // Patient paid amount. Page 220.
 394       "*F5" .
 395       "*" . $patientpaid .
 396       "~\n";
 397   }
 398
 399   if ($claim->priorAuth()) {
 400     ++$edicount;
 401     $out .= "REF" .     // Prior Authorization Number
 402       "*G1" .
 403       "*" . $claim->priorAuth() .
 404       "~\n";
 405   }
 406
 407   if ($claim->cliaCode()) {
 408     // Required by Medicare when in-house labs are done.
 409     ++$edicount;
 410     $out .= "REF" .     // Clinical Laboratory Improvement Amendment Number
 411       "*X4" .
 412       "*" . $claim->cliaCode() .
 413       "~\n";
 414   }
 415
 416   // Note: This would be the place to implement the NTE segment for loop 2300.
 417
 418   // Diagnoses, up to 8 per HI segment.
 419   $da = $claim->diagArray();
 420   $diag_type_code = 'BK';
 421   $tmp = 0;
 422   foreach ($da as $diag) {
 423     if ($tmp % 8 == 0) {
 424       if ($tmp) $out .= "~\n";
 425       ++$edicount;
 426       $out .= "HI";         // Health Diagnosis Codes
 427     }
 428     $out .= "*$diag_type_code:" . $diag;
 429     $diag_type_code = 'BF';
 430     ++$tmp;
 431   }
 432   if ($tmp) $out .= "~\n";
 433
 434   if ($claim->referrerLastName()) {
 435     // Medicare requires referring provider's name and UPIN.
 436     ++$edicount;
 437     $out .= "NM1" .     // Loop 2310A Referring Provider
 438       "*DN" .
 439       "*1" .
 440       "*" . $claim->referrerLastName() .
 441       "*" . $claim->referrerFirstName() .
 442       "*" . $claim->referrerMiddleName() .
 443       "*" .
 444       "*";
 445     if ($claim->referrerNPI()) { $out .=
 446       "*XX" .
 447       "*" . $claim->referrerNPI();
 448     } else { $out .=
 449       "*34" .
 450       "*" . $claim->referrerSSN();
 451     }
 452     $out .= "~\n";
 453
 454     if ($claim->referrerTaxonomy()) {
 455       ++$edicount;
 456       $out .= "PRV" .
 457         "*RF" . // ReFerring provider
 458         "*ZZ" .
 459         "*" . $claim->referrerTaxonomy() .
 460         "~\n";
 461     }
 462
 463     if ($claim->referrerUPIN()) {
 464       ++$edicount;
 465       $out .= "REF" .   // Referring Provider Secondary Identification
 466         "*1G" .
 467         "*" . $claim->referrerUPIN() .
 468         "~\n";
 469     }
 470   }
 471
 472   ++$edicount;
 473   $out .= "NM1" .       // Loop 2310B Rendering Provider
 474     "*82" .
 475     "*1" .
 476     "*" . $claim->providerLastName() .
 477     "*" . $claim->providerFirstName() .
 478     "*" . $claim->providerMiddleName() .
 479     "*" .
 480     "*";
 481   if ($claim->providerNPI()) { $out .=
 482     "*XX" .
 483     "*" . $claim->providerNPI();
 484   } else { $out .=
 485     "*34" .
 486     "*" . $claim->providerSSN();
 487     $log .= "*** Rendering provider has no NPI.\n";
 488   }
 489   $out .= "~\n";
 490
 491   if ($claim->providerTaxonomy()) {
 492     ++$edicount;
 493     $out .= "PRV" .
 494       "*PE" . // PErforming provider
 495       "*ZZ" .
 496       "*" . $claim->providerTaxonomy() .
 497       "~\n";
 498   }
 499
 500   // REF*1C is required here for the Medicare provider number if NPI was
 501   // specified in NM109.  Not sure if other payers require anything here.
 502   if ($claim->providerNumber()) {
 503     ++$edicount;
 504     $out .= "REF" .
 505       "*" . $claim->providerNumberType() .
 506       "*" . $claim->providerNumber() .
 507       "~\n";
 508   }
 509
 510   // Loop 2310D is omitted in the case of home visits (POS=12).
 511   if ($claim->facilityPOS() != 12) {
 512     ++$edicount;
 513     $out .= "NM1" .       // Loop 2310D Service Location
 514       "*77" .
 515       "*2";
 516     if ($claim->facilityName() || $claim->facilityNPI() || $claim->facilityETIN()) { $out .=
 517       "*" . $claim->facilityName();
 518     }
 519     if ($claim->facilityNPI() || $claim->facilityETIN()) { $out .=
 520       "*" .
 521       "*" .
 522       "*" .
 523       "*";
 524       if ($claim->facilityNPI()) { $out .=
 525         "*XX*" . $claim->facilityNPI();
 526       } else { $out .=
 527         "*24*" . $claim->facilityETIN();
 528         $log .= "*** Service location has no NPI.\n";
 529       }
 530     }
 531     $out .= "~\n";
 532     if ($claim->facilityStreet()) {
 533       ++$edicount;
 534       $out .= "N3" .
 535         "*" . $claim->facilityStreet() .
 536         "~\n";
 537     }
 538     if ($claim->facilityState()) {
 539       ++$edicount;
 540       $out .= "N4" .
 541         "*" . $claim->facilityCity() .
 542         "*" . $claim->facilityState() .
 543         "*" . $claim->facilityZip() .
 544         "~\n";
 545     }
 546   }
 547
 548   // Loop 2310E, Supervising Provider
 549   //
 550   if ($claim->supervisorLastName()) {
 551     ++$edicount;
 552     $out .= "NM1" .
 553       "*DQ" . // Supervising Physician
 554       "*1" .  // Person
 555       "*" . $claim->supervisorLastName() .
 556       "*" . $claim->supervisorFirstName() .
 557       "*" . $claim->supervisorMiddleName() .
 558       "*" .   // NM106 not used
 559       "*";    // Name Suffix
 560     if ($claim->supervisorNPI()) { $out .=
 561       "*XX" .
 562       "*" . $claim->supervisorNPI();
 563     } else { $out .=
 564       "*34" .
 565       "*" . $claim->supervisorSSN();
 566     }
 567     $out .= "~\n";
 568
 569     if ($claim->supervisorNumber()) {
 570       ++$edicount;
 571       $out .= "REF" .
 572         "*" . $claim->supervisorNumberType() .
 573         "*" . $claim->supervisorNumber() .
 574         "~\n";
 575     }
 576   }
 577
 578   $prev_pt_resp = $clm_total_charges; // for computation below
 579
 580   // Loops 2320 and 2330*, other subscriber/payer information.
 581   //
 582   for ($ins = 1; $ins < $claim->payerCount(); ++$ins) {
 583
 584     $tmp1 = $claim->claimType($ins);
 585     $tmp2 = 'C1'; // Here a kludge. See page 321.
 586     if ($tmp1 === 'CI') $tmp2 = 'C1';
 587     if ($tmp1 === 'AM') $tmp2 = 'AP';
 588     if ($tmp1 === 'HM') $tmp2 = 'HM';
 589     if ($tmp1 === 'MB') $tmp2 = 'MB';
 590     if ($tmp1 === 'MC') $tmp2 = 'MC';
 591     if ($tmp1 === '09') $tmp2 = 'PP';
 592     ++$edicount;
 593     $out .= "SBR" . // Loop 2320, Subscriber Information - page 318
 594       "*" . $claim->payerSequence($ins) .
 595       "*" . $claim->insuredRelationship($ins) .
 596       "*" . $claim->groupNumber($ins) .
 597       "*" . $claim->groupName($ins) .
 598       "*" . $tmp2 .
 599       "*" .
 600       "*" .
 601       "*" .
 602       "*" . $claim->claimType($ins) .
 603       "~\n";
 604
 605     // Things that apply only to previous payers, not future payers.
 606     //
 607     if ($claim->payerSequence($ins) < $claim->payerSequence()) {
 608
 609       // Generate claim-level adjustments.
 610       $aarr = $claim->payerAdjustments($ins);
 611       foreach ($aarr as $a) {
 612         ++$edicount;
 613         $out .= "CAS" . // Previous payer's claim-level adjustments. Page 323.
 614           "*" . $a[1] .
 615           "*" . $a[2] .
 616           "*" . $a[3] .
 617           "~\n";
 618       }
 619
 620       $payerpaid = $claim->payerTotals($ins);
 621       ++$edicount;
 622       $out .= "AMT" . // Previous payer's paid amount. Page 332.
 623         "*D" .
 624         "*" . $payerpaid[1] .
 625         "~\n";
 626
 627       // Patient responsibility amount as of this previous payer.
 628       $prev_pt_resp -= $payerpaid[1]; // reduce by payments
 629       $prev_pt_resp -= $payerpaid[2]; // reduce by adjustments
 630
 631       ++$edicount;
 632       $out .= "AMT" . // Allowed amount per previous payer. Page 334.
 633         "*B6" .
 634         "*" . sprintf('%.2f', $payerpaid[1] + $prev_pt_resp) .
 635         "~\n";
 636
 637       ++$edicount;
 638       $out .= "AMT" . // Patient responsibility amount per previous payer. Page 335.
 639         "*F2" .
 640         "*" . sprintf('%.2f', $prev_pt_resp) .
 641         "~\n";
 642
 643     } // End of things that apply only to previous payers.
 644
 645     ++$edicount;
 646     $out .= "DMG" . // Other subscriber demographic information. Page 342.
 647       "*D8" .
 648       "*" . $claim->insuredDOB($ins) .
 649       "*" . $claim->insuredSex($ins) .
 650       "~\n";
 651
 652     ++$edicount;
 653     $out .= "OI" .  // Other Insurance Coverage Information. Page 344.
 654       "*" .
 655       "*" .
 656       "*Y" .
 657       "*B" .
 658       "*" .
 659       "*Y" .
 660       "~\n";
 661
 662     ++$edicount;
 663     $out .= "NM1" . // Loop 2330A Subscriber info for other insco. Page 350.
 664       "*IL" .
 665       "*1" .
 666       "*" . $claim->insuredLastName($ins) .
 667       "*" . $claim->insuredFirstName($ins) .
 668       "*" . $claim->insuredMiddleName($ins) .
 669       "*" .
 670       "*" .
 671       "*MI" .
 672       "*" . $claim->policyNumber($ins) .
 673       "~\n";
 674
 675     ++$edicount;
 676     $out .= "N3" .
 677       "*" . $claim->insuredStreet($ins) .
 678       "~\n";
 679
 680     ++$edicount;
 681     $out .= "N4" .
 682       "*" . $claim->insuredCity($ins) .
 683       "*" . $claim->insuredState($ins) .
 684       "*" . $claim->insuredZip($ins) .
 685       "~\n";
 686
 687     ++$edicount;
 688     $out .= "NM1" . // Loop 2330B Payer info for other insco. Page 359.
 689       "*PR" .
 690       "*2" .
 691       "*" . $claim->payerName($ins) .
 692       "*" .
 693       "*" .
 694       "*" .
 695       "*" .
 696       "*PI" .
 697       "*" . $claim->payerID($ins) .
 698       "~\n";
 699
 700     // if (!$claim->payerID($ins)) {
 701     //   $log .= "*** CMS ID is missing for payer '" . $claim->payerName($ins) . "'.\n";
 702     // }
 703
 704     // Payer address (N3 and N4) are added below so that Gateway EDI can
 705     // auto-generate secondary claims.  These do NOT appear in my copy of
 706     // the spec!  -- Rod 2008-06-12
 707
 708     if (trim($claim->x12gsreceiverid()) == '431420764') { // if Gateway EDI
 709       ++$edicount;
 710       $out .= "N3" .
 711         "*" . $claim->payerStreet($ins) .
 712         "~\n";
 713       //
 714       ++$edicount;
 715       $out .= "N4" .
 716         "*" . $claim->payerCity($ins) .
 717         "*" . $claim->payerState($ins) .
 718         "*" . $claim->payerZip($ins) .
 719         "~\n";
 720     } // end Gateway EDI
 721
 722   } // End loops 2320/2330*.
 723
 724   $loopcount = 0;
 725
 726   // Procedure loop starts here.
 727   //
 728   for ($prockey = 0; $prockey < $proccount; ++$prockey) {
 729     ++$loopcount;
 730
 731     ++$edicount;
 732     $out .= "LX" .      // Loop 2400 LX Service Line. Page 398.
 733       "*$loopcount" .
 734       "~\n";
 735
 736     ++$edicount;
 737     $out .= "SV1" .     // Professional Service. Page 400.
 738       "*HC:" . $claim->cptKey($prockey) .
 739       "*" . sprintf('%.2f', $claim->cptCharges($prockey)) .
 740       "*UN" .
 741       "*" . $claim->cptUnits($prockey) .
 742       "*" .
 743       "*" .
 744       "*";
 745     $dia = $claim->diagIndexArray($prockey);
 746     $i = 0;
 747     foreach ($dia as $dindex) {
 748       if ($i) $out .= ':';
 749       $out .= $dindex;
 750       if (++$i >= 4) break;
 751     }
 752     $out .= "~\n";
 753
 754     if (!$claim->cptCharges($prockey)) {
 755       $log .= "*** Procedure '" . $claim->cptKey($prockey) . "' has no charges!\n";
 756     }
 757
 758     if (empty($dia)) {
 759       $log .= "*** Procedure '" . $claim->cptKey($prockey) . "' is not justified!\n";
 760     }
 761
 762     ++$edicount;
 763     $out .= "DTP" .     // Date of Service. Page 435.
 764       "*472" .
 765       "*D8" .
 766       "*" . $claim->serviceDate() .
 767       "~\n";
 768
 769     // AMT*AAE segment for Approved Amount from previous payer.
 770     // Medicare secondaries seem to require this.
 771     //
 772     for ($ins = $claim->payerCount() - 1; $ins > 0; --$ins) {
 773       if ($claim->payerSequence($ins) > $claim->payerSequence())
 774         continue; // payer is future, not previous
 775       $payerpaid = $claim->payerTotals($ins, $claim->cptKey($prockey));
 776       ++$edicount;
 777       $out .= "AMT" . // Approved amount per previous payer. Page 485.
 778         "*AAE" .
 779         "*" . sprintf('%.2f', $claim->cptCharges($prockey) - $payerpaid[2]) .
 780         "~\n";
 781       break;
 782     }
 783
 784     // Loop 2410, Drug Information. Medicaid insurers seem to want this
 785     // with HCPCS codes.
 786     //
 787     $ndc = $claim->cptNDCID($prockey);
 788     if ($ndc) {
 789       ++$edicount;
 790       $out .= "LIN" . // Drug Identification. Page 500+ (Addendum pg 71).
 791         "*" .         // Per addendum, LIN01 is not used.
 792         "*N4" .
 793         "*" . $ndc .
 794         "~\n";
 795
 796       if (!preg_match('/^\d\d\d\d\d-\d\d\d\d-\d\d$/', $ndc, $tmp)) {
 797         $log .= "*** NDC code '$ndc' has invalid format!\n";
 798       }
 799
 800       ++$edicount;
 801       $tmpunits = $claim->cptNDCQuantity($prockey) * $claim->cptUnits($prockey);
 802       if (!$tmpunits) $tmpunits = 1;
 803       $out .= "CTP" . // Drug Pricing. Page 500+ (Addendum pg 74).
 804         "*" .
 805         "*" .
 806         "*" . sprintf('%.2f', $claim->cptCharges($prockey) / $tmpunits) .
 807         "*" . $claim->cptNDCQuantity($prockey) .
 808         "*" . $claim->cptNDCUOM($prockey) .
 809         "~\n";
 810     }
 811
 812     // Loop 2420A, Rendering Provider (service-specific).
 813     // Used if the rendering provider for this service line is different
 814     // from that in loop 2310B.
 815     //
 816     if ($claim->providerNPI() != $claim->providerNPI($prockey)) {
 817       ++$edicount;
 818       $out .= "NM1" .       // Loop 2310B Rendering Provider
 819         "*82" .
 820         "*1" .
 821         "*" . $claim->providerLastName($prockey) .
 822         "*" . $claim->providerFirstName($prockey) .
 823         "*" . $claim->providerMiddleName($prockey) .
 824         "*" .
 825         "*";
 826       if ($claim->providerNPI($prockey)) { $out .=
 827         "*XX" .
 828         "*" . $claim->providerNPI($prockey);
 829       } else { $out .=
 830         "*34" .
 831         "*" . $claim->providerSSN($prockey);
 832         $log .= "*** Rendering provider has no NPI.\n";
 833       }
 834       $out .= "~\n";
 835
 836       if ($claim->providerTaxonomy($prockey)) {
 837         ++$edicount;
 838         $out .= "PRV" .
 839           "*PE" . // PErforming provider
 840           "*ZZ" .
 841           "*" . $claim->providerTaxonomy($prockey) .
 842           "~\n";
 843       }
 844
 845       // REF*1C is required here for the Medicare provider number if NPI was
 846       // specified in NM109.  Not sure if other payers require anything here.
 847       if ($claim->providerNumber($prockey)) {
 848         ++$edicount;
 849         $out .= "REF" .
 850           "*" . $claim->providerNumberType($prockey) .
 851           "*" . $claim->providerNumber($prockey) .
 852           "~\n";
 853       }
 854     }
 855
 856     // Loop 2430, adjudication by previous payers.
 857     //
 858     for ($ins = 1; $ins < $claim->payerCount(); ++$ins) {
 859       if ($claim->payerSequence($ins) > $claim->payerSequence())
 860         continue; // payer is future, not previous
 861
 862       $payerpaid = $claim->payerTotals($ins, $claim->cptKey($prockey));
 863       $aarr = $claim->payerAdjustments($ins, $claim->cptKey($prockey));
 864
 865       if ($payerpaid[1] == 0 && !count($aarr)) {
 866         $log .= "*** Procedure '" . $claim->cptKey($prockey) .
 867           "' has no payments or adjustments from previous payer!\n";
 868         continue;
 869       }
 870
 871       ++$edicount;
 872       $out .= "SVD" . // Service line adjudication. Page 554.
 873         "*" . $claim->payerID($ins) .
 874         "*" . $payerpaid[1] .
 875         "*HC:" . $claim->cptKey($prockey) .
 876         "*" .
 877         "*" . $claim->cptUnits($prockey) .
 878         "~\n";
 879
 880       $tmpdate = $payerpaid[0];
 881       foreach ($aarr as $a) {
 882         ++$edicount;
 883         $out .= "CAS" . // Previous payer's line level adjustments. Page 558.
 884           "*" . $a[1] .
 885           "*" . $a[2] .
 886           "*" . $a[3] .
 887           "~\n";
 888         if (!$tmpdate) $tmpdate = $a[0];
 889       }
 890
 891       if ($tmpdate) {
 892         ++$edicount;
 893         $out .= "DTP" . // Previous payer's line adjustment date. Page 566.
 894           "*573" .
 895           "*D8" .
 896           "*$tmpdate" .
 897           "~\n";
 898       }
 899     } // end loop 2430
 900   } // end this procedure
 901
 902   ++$edicount;
 903   $out .= "SE" .        // SE Trailer
 904     "*$edicount" .
 905     "*0021" .
 906     "~\n";
 907
 908   $out .= "GE" .        // GE Trailer
 909     "*1" .
 910     "*1" .
 911     "~\n";
 912
 913   $out .= "IEA" .       // IEA Trailer
 914     "*1" .
 915     "*000000001" .
 916     "~\n";
 917
 918   $log .= "\n";
 919   return $out;
 920 }
 921 ?>