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     "*" . $claim->billingFacilityName() .
  81     "*" .
  82     "*" .
  83     "*" .
  84     "*" .
  85     "*46";
  86    if (trim($claim->x12gsreceiverid()) == '470819582') { // if ECLAIMS EDI
  87     $out  .=  "*" . $claim->clearingHouseETIN();
  88    } else {
  89     $out  .=  "*" . $claim->billingFacilityETIN();
  90    }
  91     $out .= "~\n";
  92
  93   ++$edicount;
  94   $out .= "PER" .
  95     "*IC" .
  96     "*" . $claim->billingContactName() .
  97     "*TE" .
  98     "*" . $claim->billingContactPhone();
  99   if ($claim->x12gsper06()) {
 100     $out .= "*ED*" . $claim->x12gsper06();
 101   }
 102   $out .= "~\n";
 103
 104   ++$edicount;
 105   $out .= "NM1" .       // Loop 1000B Receiver
 106     "*40" .
 107     "*2" .
 108     "*" . $claim->clearingHouseName() .
 109     "*" .
 110     "*" .
 111     "*" .
 112     "*" .
 113     "*46" .
 114     "*" . $claim->clearingHouseETIN() .
 115     "~\n";
 116
 117   $HLcount = 1;
 118
 119   ++$edicount;
 120   $out .= "HL" .        // Loop 2000A Billing/Pay-To Provider HL Loop
 121     "*$HLcount" .
 122     "*" .
 123     "*20" .
 124     "*1" .
 125     "~\n";
 126
 127   $HLBillingPayToProvider = $HLcount++;
 128
 129   ++$edicount;
 130   $out .= "NM1" .       // Loop 2010AA Billing Provider
 131     "*85" .
 132     "*2" .
 133     "*" . $claim->billingFacilityName() .
 134     "*" .
 135     "*" .
 136     "*" .
 137     "*";
 138   if ($claim->billingFacilityNPI()) {
 139     $out .= "*XX*" . $claim->billingFacilityNPI();
 140   } else {
 141     $log .= "*** Billing facility has no NPI.\n";
 142     $out .= "*24*" . $claim->billingFacilityETIN();
 143   }
 144   $out .= "~\n";
 145
 146   ++$edicount;
 147   $out .= "N3" .
 148     "*" . $claim->billingFacilityStreet() .
 149     "~\n";
 150
 151   ++$edicount;
 152   $out .= "N4" .
 153     "*" . $claim->billingFacilityCity() .
 154     "*" . $claim->billingFacilityState() .
 155     "*" . $claim->billingFacilityZip() .
 156     "~\n";
 157
 158   // Add a REF*EI*<ein> segment if NPI was specified in the NM1 above.
 159   if ($claim->billingFacilityNPI() && $claim->billingFacilityETIN()) {
 160     ++$edicount;
 161     $out .= "REF" ;
 162         if($claim->federalIdType()){
 163       $out .= "*" . $claim->federalIdType();
 164         }
 165         else{
 166           $out .= "*EI";//For dealing with the situation before adding selection for TaxId type In facility ie default to EIN.
 167         }
 168       $out .=  "*" . $claim->billingFacilityETIN() .
 169       "~\n";
 170   }
 171
 172   if ($claim->providerNumberType() && $claim->providerNumber()) {
 173     ++$edicount;
 174     $out .= "REF" .
 175       "*" . $claim->providerNumberType() .
 176       "*" . $claim->providerNumber() .
 177       "~\n";
 178   }
 179   else if ($claim->providerNumber()) {
 180     $log .= "*** Payer-specific provider insurance number is present but has no type assigned.\n";
 181   }
 182
 183   ++$edicount;
 184   $out .= "NM1" .       // Loop 2010AB Pay-To Provider
 185     "*87" .
 186     "*2" .
 187     "*" . $claim->billingFacilityName() .
 188     "*" .
 189     "*" .
 190     "*" .
 191     "*";
 192   if ($claim->billingFacilityNPI())
 193     $out .= "*XX*" . $claim->billingFacilityNPI();
 194   else
 195     $out .= "*24*" . $claim->billingFacilityETIN();
 196   $out .= "~\n";
 197
 198   ++$edicount;
 199   $out .= "N3" .
 200     "*" . $claim->billingFacilityStreet() .
 201     "~\n";
 202
 203   ++$edicount;
 204   $out .= "N4" .
 205     "*" . $claim->billingFacilityCity() .
 206     "*" . $claim->billingFacilityState() .
 207     "*" . $claim->billingFacilityZip() .
 208     "~\n";
 209
 210   if ($claim->billingFacilityNPI() && $claim->billingFacilityETIN()) {
 211     ++$edicount;
 212     $out .= "REF" .
 213       "*EI" .
 214       "*" . $claim->billingFacilityETIN() .
 215       "~\n";
 216   }
 217
 218   $PatientHL = 0;
 219
 220   ++$edicount;
 221   $out .= "HL" .        // Loop 2000B Subscriber HL Loop
 222     "*$HLcount" .
 223     "*$HLBillingPayToProvider" .
 224     "*22" .
 225     "*$PatientHL" .
 226     "~\n";
 227
 228   $HLSubscriber = $HLcount++;
 229
 230   if (!$claim->payerSequence()) {
 231     $log .= "*** Error: Insurance information is missing!\n";
 232   }
 233   ++$edicount;
 234   $out .= "SBR" .       // Subscriber Information
 235     "*" . $claim->payerSequence() .
 236     "*" . $claim->insuredRelationship() .
 237     "*" . $claim->groupNumber() .
 238     "*" . $claim->groupName() .
 239     "*" . $claim->insuredTypeCode() . // applies for secondary medicare
 240     "*" .
 241     "*" .
 242     "*" .
 243     "*" . $claim->claimType() . // Zirmed replaces this
 244     "~\n";
 245
 246   ++$edicount;
 247   $out .= "NM1" .       // Loop 2010BA Subscriber
 248     "*IL" .
 249     "*1" .
 250     "*" . $claim->insuredLastName() .
 251     "*" . $claim->insuredFirstName() .
 252     "*" . $claim->insuredMiddleName() .
 253     "*" .
 254     "*" .
 255     "*MI" .
 256     "*" . $claim->policyNumber() .
 257     "~\n";
 258
 259   ++$edicount;
 260   $out .= "N3" .
 261     "*" . $claim->insuredStreet() .
 262     "~\n";
 263
 264   ++$edicount;
 265   $out .= "N4" .
 266     "*" . $claim->insuredCity() .
 267     "*" . $claim->insuredState() .
 268     "*" . $claim->insuredZip() .
 269     "~\n";
 270
 271   ++$edicount;
 272   $out .= "DMG" .
 273     "*D8" .
 274     "*" . $claim->insuredDOB() .
 275     "*" . $claim->insuredSex() .
 276     "~\n";
 277
 278   ++$edicount;
 279   $out .= "NM1" .       // Loop 2010BB Payer
 280     "*PR" .
 281     "*2" .
 282     "*" . $claim->payerName() .
 283     "*" .
 284     "*" .
 285     "*" .
 286     "*" .
 287     "*PI" .
 288     // Zirmed ignores this if using payer name matching:
 289     "*" . ($encounter_claim ? $claim->payerAltID() : $claim->payerID()) .
 290     "~\n";
 291
 292   // if (!$claim->payerID()) {
 293   //   $log .= "*** CMS ID is missing for payer '" . $claim->payerName() . "'.\n";
 294   // }
 295
 296   ++$edicount;
 297   $out .= "N3" .
 298     "*" . $claim->payerStreet() .
 299     "~\n";
 300
 301   ++$edicount;
 302   $out .= "N4" .
 303     "*" . $claim->payerCity() .
 304     "*" . $claim->payerState() .
 305     "*" . $claim->payerZip() .
 306     "~\n";
 307
 308   if (! $claim->isSelfOfInsured()) {
 309     ++$edicount;
 310     $out .= "HL" .        // Loop 2000C Patient Information
 311       "*$HLcount" .
 312       "*$HLSubscriber" .
 313       "*23" .
 314       "*0" .
 315       "~\n";
 316
 317     $HLcount++;
 318
 319     ++$edicount;
 320     $out .= "PAT" .
 321       "*" . $claim->insuredRelationship() .
 322       "~\n";
 323
 324     ++$edicount;
 325     $out .= "NM1" .       // Loop 2010CA Patient
 326       "*QC" .
 327       "*1" .
 328       "*" . $claim->patientLastName() .
 329       "*" . $claim->patientFirstName() .
 330       "*" . $claim->patientMiddleName() .
 331       "~\n";
 332
 333     ++$edicount;
 334     $out .= "N3" .
 335       "*" . $claim->patientStreet() .
 336       "~\n";
 337
 338     ++$edicount;
 339     $out .= "N4" .
 340       "*" . $claim->patientCity() .
 341       "*" . $claim->patientState() .
 342       "*" . $claim->patientZip() .
 343       "~\n";
 344
 345     ++$edicount;
 346     $out .= "DMG" .
 347       "*D8" .
 348       "*" . $claim->patientDOB() .
 349       "*" . $claim->patientSex() .
 350       "~\n";
 351   } // end of patient different from insured
 352
 353   $proccount = $claim->procCount();
 354
 355   $clm_total_charges = 0;
 356   for ($prockey = 0; $prockey < $proccount; ++$prockey) {
 357     $clm_total_charges += $claim->cptCharges($prockey);
 358   }
 359
 360   if (!$clm_total_charges) {
 361     $log .= "*** This claim has no charges!\n";
 362   }
 363
 364
 365   ++$edicount;
 366   $out .= "CLM" .       // Loop 2300 Claim
 367     "*$pid-$encounter" .
 368     "*"  . sprintf("%.2f",$clm_total_charges) . // Zirmed computes and replaces this
 369     "*"  .
 370     "*"  .
 371     "*" . sprintf('%02d', $claim->facilityPOS()) . "::" . $claim->frequencyTypeCode() . // Changed to correct single digit output
 372     "*Y" .
 373     "*A" .
 374     "*"  . ($claim->billingFacilityAssignment() ? 'Y' : 'N') .
 375     "*Y" .
 376     "*C" .
 377     "~\n";
 378
 379   ++$edicount;
 380   $out .= "DTP" .       // Date of Onset
 381     "*431" .
 382     "*D8" .
 383     "*" . $claim->onsetDate() .
 384     "~\n";
 385
 386   if (strcmp($claim->facilityPOS(),'21') == 0) {
 387     ++$edicount;
 388     $out .= "DTP" .     // Date of Hospitalization
 389       "*435" .
 390       "*D8" .
 391       "*" . $claim->onsetDate() .
 392       "~\n";
 393   }
 394
 395   $patientpaid = $claim->patientPaidAmount();
 396   if ($patientpaid != 0) {
 397     ++$edicount;
 398     $out .= "AMT" .     // Patient paid amount. Page 220.
 399       "*F5" .
 400       "*" . $patientpaid .
 401       "~\n";
 402   }
 403
 404   if ($claim->priorAuth()) {
 405     ++$edicount;
 406     $out .= "REF" .     // Prior Authorization Number
 407       "*G1" .
 408       "*" . $claim->priorAuth() .
 409       "~\n";
 410   }
 411
 412   if ($claim->cliaCode() and $claim->claimType() === 'MB') {
 413     // Required by Medicare when in-house labs are done.
 414     ++$edicount;
 415     $out .= "REF" .     // Clinical Laboratory Improvement Amendment Number
 416       "*X4" .
 417       "*" . $claim->cliaCode() .
 418       "~\n";
 419   }
 420
 421   // Note: This would be the place to implement the NTE segment for loop 2300.
 422
 423   // Diagnoses, up to 8 per HI segment.
 424   $da = $claim->diagArray();
 425   $diag_type_code = 'BK';
 426   $tmp = 0;
 427   foreach ($da as $diag) {
 428     if ($tmp % 8 == 0) {
 429       if ($tmp) $out .= "~\n";
 430       ++$edicount;
 431       $out .= "HI";         // Health Diagnosis Codes
 432     }
 433     $out .= "*$diag_type_code:" . $diag;
 434     $diag_type_code = 'BF';
 435     ++$tmp;
 436   }
 437   if ($tmp) $out .= "~\n";
 438
 439   if ($claim->referrerLastName()) {
 440     // Medicare requires referring provider's name and UPIN.
 441     ++$edicount;
 442     $out .= "NM1" .     // Loop 2310A Referring Provider
 443       "*DN" .
 444       "*1" .
 445       "*" . $claim->referrerLastName() .
 446       "*" . $claim->referrerFirstName() .
 447       "*" . $claim->referrerMiddleName() .
 448       "*" .
 449       "*";
 450     if ($claim->referrerNPI()) { $out .=
 451       "*XX" .
 452       "*" . $claim->referrerNPI();
 453     } else { $out .=
 454       "*34" .
 455       "*" . $claim->referrerSSN();
 456     }
 457     $out .= "~\n";
 458
 459     if ($claim->referrerTaxonomy()) {
 460       ++$edicount;
 461       $out .= "PRV" .
 462         "*RF" . // ReFerring provider
 463         "*ZZ" .
 464         "*" . $claim->referrerTaxonomy() .
 465         "~\n";
 466     }
 467
 468     if ($claim->referrerUPIN()) {
 469       ++$edicount;
 470       $out .= "REF" .   // Referring Provider Secondary Identification
 471         "*1G" .
 472         "*" . $claim->referrerUPIN() .
 473         "~\n";
 474     }
 475   }
 476
 477   ++$edicount;
 478   $out .= "NM1" .       // Loop 2310B Rendering Provider
 479     "*82" .
 480     "*1" .
 481     "*" . $claim->providerLastName() .
 482     "*" . $claim->providerFirstName() .
 483     "*" . $claim->providerMiddleName() .
 484     "*" .
 485     "*";
 486   if ($claim->providerNPI()) { $out .=
 487     "*XX" .
 488     "*" . $claim->providerNPI();
 489   } else { $out .=
 490     "*34" .
 491     "*" . $claim->providerSSN();
 492     $log .= "*** Rendering provider has no NPI.\n";
 493   }
 494   $out .= "~\n";
 495
 496   if ($claim->providerTaxonomy()) {
 497     ++$edicount;
 498     $out .= "PRV" .
 499       "*PE" . // PErforming provider
 500       "*ZZ" .
 501       "*" . $claim->providerTaxonomy() .
 502       "~\n";
 503   }
 504
 505   // REF*1C is required here for the Medicare provider number if NPI was
 506   // specified in NM109.  Not sure if other payers require anything here.
 507   // --- apparently ECLAIMS, INC wants the data in 2010 but NOT in 2310B - tony@mi-squared.com
 508
 509    if (trim($claim->x12gsreceiverid()) != '470819582') { // if NOT ECLAIMS EDI
 510       if ($claim->providerNumber()) {
 511         ++$edicount;
 512         $out .= "REF" .
 513           "*" . $claim->providerNumberType() .
 514           "*" . $claim->providerNumber() .
 515           "~\n";
 516       }
 517    }
 518
 519   // Loop 2310D is omitted in the case of home visits (POS=12).
 520   if ($claim->facilityPOS() != 12) {
 521     ++$edicount;
 522     $out .= "NM1" .       // Loop 2310D Service Location
 523       "*77" .
 524       "*2";
 525     if ($claim->facilityName() || $claim->facilityNPI() || $claim->facilityETIN()) { $out .=
 526       "*" . $claim->facilityName();
 527     }
 528     if ($claim->facilityNPI() || $claim->facilityETIN()) { $out .=
 529       "*" .
 530       "*" .
 531       "*" .
 532       "*";
 533       if ($claim->facilityNPI()) { $out .=
 534         "*XX*" . $claim->facilityNPI();
 535       } else { $out .=
 536         "*24*" . $claim->facilityETIN();
 537         $log .= "*** Service location has no NPI.\n";
 538       }
 539     }
 540     $out .= "~\n";
 541     if ($claim->facilityStreet()) {
 542       ++$edicount;
 543       $out .= "N3" .
 544         "*" . $claim->facilityStreet() .
 545         "~\n";
 546     }
 547     if ($claim->facilityState()) {
 548       ++$edicount;
 549       $out .= "N4" .
 550         "*" . $claim->facilityCity() .
 551         "*" . $claim->facilityState() .
 552         "*" . $claim->facilityZip() .
 553         "~\n";
 554     }
 555   }
 556
 557   // Loop 2310E, Supervising Provider
 558   //
 559   if ($claim->supervisorLastName()) {
 560     ++$edicount;
 561     $out .= "NM1" .
 562       "*DQ" . // Supervising Physician
 563       "*1" .  // Person
 564       "*" . $claim->supervisorLastName() .
 565       "*" . $claim->supervisorFirstName() .
 566       "*" . $claim->supervisorMiddleName() .
 567       "*" .   // NM106 not used
 568       "*";    // Name Suffix
 569     if ($claim->supervisorNPI()) { $out .=
 570       "*XX" .
 571       "*" . $claim->supervisorNPI();
 572     } else { $out .=
 573       "*34" .
 574       "*" . $claim->supervisorSSN();
 575     }
 576     $out .= "~\n";
 577
 578     if ($claim->supervisorNumber()) {
 579       ++$edicount;
 580       $out .= "REF" .
 581         "*" . $claim->supervisorNumberType() .
 582         "*" . $claim->supervisorNumber() .
 583         "~\n";
 584     }
 585   }
 586
 587   $prev_pt_resp = $clm_total_charges; // for computation below
 588
 589   // Loops 2320 and 2330*, other subscriber/payer information.
 590   //
 591   for ($ins = 1; $ins < $claim->payerCount(); ++$ins) {
 592
 593     $tmp1 = $claim->claimType($ins);
 594     $tmp2 = 'C1'; // Here a kludge. See page 321.
 595     if ($tmp1 === 'CI') $tmp2 = 'C1';
 596     if ($tmp1 === 'AM') $tmp2 = 'AP';
 597     if ($tmp1 === 'HM') $tmp2 = 'HM';
 598     if ($tmp1 === 'MB') $tmp2 = 'MB';
 599     if ($tmp1 === 'MC') $tmp2 = 'MC';
 600     if ($tmp1 === '09') $tmp2 = 'PP';
 601     ++$edicount;
 602     $out .= "SBR" . // Loop 2320, Subscriber Information - page 318
 603       "*" . $claim->payerSequence($ins) .
 604       "*" . $claim->insuredRelationship($ins) .
 605       "*" . $claim->groupNumber($ins) .
 606       "*" . $claim->groupName($ins) .
 607       "*" . $tmp2 .
 608       "*" .
 609       "*" .
 610       "*" .
 611       "*" . $claim->claimType($ins) .
 612       "~\n";
 613
 614     // Things that apply only to previous payers, not future payers.
 615     //
 616     if ($claim->payerSequence($ins) < $claim->payerSequence()) {
 617
 618       // Generate claim-level adjustments.
 619       $aarr = $claim->payerAdjustments($ins);
 620       foreach ($aarr as $a) {
 621         ++$edicount;
 622         $out .= "CAS" . // Previous payer's claim-level adjustments. Page 323.
 623           "*" . $a[1] .
 624           "*" . $a[2] .
 625           "*" . $a[3] .
 626           "~\n";
 627       }
 628
 629       $payerpaid = $claim->payerTotals($ins);
 630       ++$edicount;
 631       $out .= "AMT" . // Previous payer's paid amount. Page 332.
 632         "*D" .
 633         "*" . $payerpaid[1] .
 634         "~\n";
 635
 636       // Patient responsibility amount as of this previous payer.
 637       $prev_pt_resp -= $payerpaid[1]; // reduce by payments
 638       $prev_pt_resp -= $payerpaid[2]; // reduce by adjustments
 639
 640       ++$edicount;
 641       $out .= "AMT" . // Allowed amount per previous payer. Page 334.
 642         "*B6" .
 643         "*" . sprintf('%.2f', $payerpaid[1] + $prev_pt_resp) .
 644         "~\n";
 645
 646       ++$edicount;
 647       $out .= "AMT" . // Patient responsibility amount per previous payer. Page 335.
 648         "*F2" .
 649         "*" . sprintf('%.2f', $prev_pt_resp) .
 650         "~\n";
 651
 652     } // End of things that apply only to previous payers.
 653
 654     ++$edicount;
 655     $out .= "DMG" . // Other subscriber demographic information. Page 342.
 656       "*D8" .
 657       "*" . $claim->insuredDOB($ins) .
 658       "*" . $claim->insuredSex($ins) .
 659       "~\n";
 660
 661     ++$edicount;
 662     $out .= "OI" .  // Other Insurance Coverage Information. Page 344.
 663       "*" .
 664       "*" .
 665       "*Y" .
 666       "*B" .
 667       "*" .
 668       "*Y" .
 669       "~\n";
 670
 671     ++$edicount;
 672     $out .= "NM1" . // Loop 2330A Subscriber info for other insco. Page 350.
 673       "*IL" .
 674       "*1" .
 675       "*" . $claim->insuredLastName($ins) .
 676       "*" . $claim->insuredFirstName($ins) .
 677       "*" . $claim->insuredMiddleName($ins) .
 678       "*" .
 679       "*" .
 680       "*MI" .
 681       "*" . $claim->policyNumber($ins) .
 682       "~\n";
 683
 684     ++$edicount;
 685     $out .= "N3" .
 686       "*" . $claim->insuredStreet($ins) .
 687       "~\n";
 688
 689     ++$edicount;
 690     $out .= "N4" .
 691       "*" . $claim->insuredCity($ins) .
 692       "*" . $claim->insuredState($ins) .
 693       "*" . $claim->insuredZip($ins) .
 694       "~\n";
 695
 696     ++$edicount;
 697     $out .= "NM1" . // Loop 2330B Payer info for other insco. Page 359.
 698       "*PR" .
 699       "*2" .
 700       "*" . $claim->payerName($ins) .
 701       "*" .
 702       "*" .
 703       "*" .
 704       "*" .
 705       "*PI" .
 706       "*" . $claim->payerID($ins) .
 707       "~\n";
 708
 709     // if (!$claim->payerID($ins)) {
 710     //   $log .= "*** CMS ID is missing for payer '" . $claim->payerName($ins) . "'.\n";
 711     // }
 712
 713     // Payer address (N3 and N4) are added below so that Gateway EDI can
 714     // auto-generate secondary claims.  These do NOT appear in my copy of
 715     // the spec!  -- Rod 2008-06-12
 716
 717     if (trim($claim->x12gsreceiverid()) == '431420764') { // if Gateway EDI
 718       ++$edicount;
 719       $out .= "N3" .
 720         "*" . $claim->payerStreet($ins) .
 721         "~\n";
 722       //
 723       ++$edicount;
 724       $out .= "N4" .
 725         "*" . $claim->payerCity($ins) .
 726         "*" . $claim->payerState($ins) .
 727         "*" . $claim->payerZip($ins) .
 728         "~\n";
 729     } // end Gateway EDI
 730
 731   } // End loops 2320/2330*.
 732
 733   $loopcount = 0;
 734
 735   // Procedure loop starts here.
 736   //
 737   for ($prockey = 0; $prockey < $proccount; ++$prockey) {
 738     ++$loopcount;
 739
 740     ++$edicount;
 741     $out .= "LX" .      // Loop 2400 LX Service Line. Page 398.
 742       "*$loopcount" .
 743       "~\n";
 744
 745     ++$edicount;
 746     $out .= "SV1" .     // Professional Service. Page 400.
 747       "*HC:" . $claim->cptKey($prockey) .
 748       "*" . sprintf('%.2f', $claim->cptCharges($prockey)) .
 749       "*UN" .
 750       "*" . $claim->cptUnits($prockey) .
 751       "*" .
 752       "*" .
 753       "*";
 754     $dia = $claim->diagIndexArray($prockey);
 755     $i = 0;
 756     foreach ($dia as $dindex) {
 757       if ($i) $out .= ':';
 758       $out .= $dindex;
 759       if (++$i >= 4) break;
 760     }
 761     $out .= "~\n";
 762
 763     if (!$claim->cptCharges($prockey)) {
 764       $log .= "*** Procedure '" . $claim->cptKey($prockey) . "' has no charges!\n";
 765     }
 766
 767     if (empty($dia)) {
 768       $log .= "*** Procedure '" . $claim->cptKey($prockey) . "' is not justified!\n";
 769     }
 770
 771     ++$edicount;
 772     $out .= "DTP" .     // Date of Service. Page 435.
 773       "*472" .
 774       "*D8" .
 775       "*" . $claim->serviceDate() .
 776       "~\n";
 777
 778     // AMT*AAE segment for Approved Amount from previous payer.
 779     // Medicare secondaries seem to require this.
 780     //
 781     for ($ins = $claim->payerCount() - 1; $ins > 0; --$ins) {
 782       if ($claim->payerSequence($ins) > $claim->payerSequence())
 783         continue; // payer is future, not previous
 784       $payerpaid = $claim->payerTotals($ins, $claim->cptKey($prockey));
 785       ++$edicount;
 786       $out .= "AMT" . // Approved amount per previous payer. Page 485.
 787         "*AAE" .
 788         "*" . sprintf('%.2f', $claim->cptCharges($prockey) - $payerpaid[2]) .
 789         "~\n";
 790       break;
 791     }
 792
 793     // Loop 2410, Drug Information. Medicaid insurers seem to want this
 794     // with HCPCS codes.
 795     //
 796     $ndc = $claim->cptNDCID($prockey);
 797     if ($ndc) {
 798       ++$edicount;
 799       $out .= "LIN" . // Drug Identification. Page 500+ (Addendum pg 71).
 800         "*" .         // Per addendum, LIN01 is not used.
 801         "*N4" .
 802         "*" . $ndc .
 803         "~\n";
 804
 805       if (!preg_match('/^\d\d\d\d\d-\d\d\d\d-\d\d$/', $ndc, $tmp)) {
 806         $log .= "*** NDC code '$ndc' has invalid format!\n";
 807       }
 808
 809       ++$edicount;
 810       $tmpunits = $claim->cptNDCQuantity($prockey) * $claim->cptUnits($prockey);
 811       if (!$tmpunits) $tmpunits = 1;
 812       $out .= "CTP" . // Drug Pricing. Page 500+ (Addendum pg 74).
 813         "*" .
 814         "*" .
 815         "*" . sprintf('%.2f', $claim->cptCharges($prockey) / $tmpunits) .
 816         "*" . $claim->cptNDCQuantity($prockey) .
 817         "*" . $claim->cptNDCUOM($prockey) .
 818         "~\n";
 819     }
 820
 821     // Loop 2420A, Rendering Provider (service-specific).
 822     // Used if the rendering provider for this service line is different
 823     // from that in loop 2310B.
 824     //
 825     if ($claim->providerNPI() != $claim->providerNPI($prockey)) {
 826       ++$edicount;
 827       $out .= "NM1" .       // Loop 2310B Rendering Provider
 828         "*82" .
 829         "*1" .
 830         "*" . $claim->providerLastName($prockey) .
 831         "*" . $claim->providerFirstName($prockey) .
 832         "*" . $claim->providerMiddleName($prockey) .
 833         "*" .
 834         "*";
 835       if ($claim->providerNPI($prockey)) { $out .=
 836         "*XX" .
 837         "*" . $claim->providerNPI($prockey);
 838       } else { $out .=
 839         "*34" .
 840         "*" . $claim->providerSSN($prockey);
 841         $log .= "*** Rendering provider has no NPI.\n";
 842       }
 843       $out .= "~\n";
 844
 845       if ($claim->providerTaxonomy($prockey)) {
 846         ++$edicount;
 847         $out .= "PRV" .
 848           "*PE" . // PErforming provider
 849           "*ZZ" .
 850           "*" . $claim->providerTaxonomy($prockey) .
 851           "~\n";
 852       }
 853
 854       // REF*1C is required here for the Medicare provider number if NPI was
 855       // specified in NM109.  Not sure if other payers require anything here.
 856       if ($claim->providerNumber($prockey)) {
 857         ++$edicount;
 858         $out .= "REF" .
 859           "*" . $claim->providerNumberType($prockey) .
 860           "*" . $claim->providerNumber($prockey) .
 861           "~\n";
 862       }
 863     }
 864
 865     // Loop 2430, adjudication by previous payers.
 866     //
 867     for ($ins = 1; $ins < $claim->payerCount(); ++$ins) {
 868       if ($claim->payerSequence($ins) > $claim->payerSequence())
 869         continue; // payer is future, not previous
 870
 871       $payerpaid = $claim->payerTotals($ins, $claim->cptKey($prockey));
 872       $aarr = $claim->payerAdjustments($ins, $claim->cptKey($prockey));
 873
 874       if ($payerpaid[1] == 0 && !count($aarr)) {
 875         $log .= "*** Procedure '" . $claim->cptKey($prockey) .
 876           "' has no payments or adjustments from previous payer!\n";
 877         continue;
 878       }
 879
 880       ++$edicount;
 881       $out .= "SVD" . // Service line adjudication. Page 554.
 882         "*" . $claim->payerID($ins) .
 883         "*" . $payerpaid[1] .
 884         "*HC:" . $claim->cptKey($prockey) .
 885         "*" .
 886         "*" . $claim->cptUnits($prockey) .
 887         "~\n";
 888
 889       $tmpdate = $payerpaid[0];
 890       foreach ($aarr as $a) {
 891         ++$edicount;
 892         $out .= "CAS" . // Previous payer's line level adjustments. Page 558.
 893           "*" . $a[1] .
 894           "*" . $a[2] .
 895           "*" . $a[3] .
 896           "~\n";
 897         if (!$tmpdate) $tmpdate = $a[0];
 898       }
 899
 900       if ($tmpdate) {
 901         ++$edicount;
 902         $out .= "DTP" . // Previous payer's line adjustment date. Page 566.
 903           "*573" .
 904           "*D8" .
 905           "*$tmpdate" .
 906           "~\n";
 907       }
 908     } // end loop 2430
 909   } // end this procedure
 910
 911   ++$edicount;
 912   $out .= "SE" .        // SE Trailer
 913     "*$edicount" .
 914     "*0021" .
 915     "~\n";
 916
 917   $out .= "GE" .        // GE Trailer
 918     "*1" .
 919     "*1" .
 920     "~\n";
 921
 922   $out .= "IEA" .       // IEA Trailer
 923     "*1" .
 924     "*000000001" .
 925     "~\n";
 926
 927   $log .= "\n";
 928   return $out;
 929 }
 930 ?>