library/Claim.class.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(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 $diags;             // array of icd9 codes from billing table
  26   var $x12_partner;       // row from x12_partners table
  27   var $encounter;         // row from form_encounter table
  28   var $facility;          // row from facility table
  29   var $billing_facility;  // row from facility table
  30   var $provider;          // row from users table (rendering provider)
  31   var $referrer;          // row from users table (referring provider)
  32   var $supervisor;        // row from users table (supervising provider)
  33   var $insurance_numbers; // row from insurance_numbers table for current payer
  34   var $supervisor_numbers; // row from insurance_numbers table for current payer
  35   var $patient_data;      // row from patient_data table
  36   var $billing_options;   // row from form_misc_billing_options table
  37   var $invoice;           // result from get_invoice_summary()
  38   var $payers;            // array of arrays, for all payers
  39   var $copay;             // total of copays from the billing table
  40
  41   function loadPayerInfo(&$billrow) {
  42     global $sl_err;
  43     $encounter_date = substr($this->encounter['date'], 0, 10);
  44
  45     // Create the $payers array.  This contains data for all insurances
  46     // with the current one always at index 0, and the others in payment
  47     // order starting at index 1.
  48     //
  49     $this->payers = array();
  50     $this->payers[0] = array();
  51     $query = "SELECT * FROM insurance_data WHERE " .
  52       "pid = '{$this->pid}' AND " .
  53       "date <= '$encounter_date' " .
  54       "ORDER BY type ASC, date DESC";
  55     $dres = sqlStatement($query);
  56     $prevtype = '';
  57     while ($drow = sqlFetchArray($dres)) {
  58       if (strcmp($prevtype, $drow['type']) == 0) continue;
  59       $prevtype = $drow['type'];
  60       // Very important to look at entries with a missing provider because
  61       // they indicate no insurance as of the given date.
  62       if (empty($drow['provider'])) continue;
  63       $ins = count($this->payers);
  64       if ($drow['provider'] == $billrow['payer_id'] && empty($this->payers[0]['data'])) $ins = 0;
  65       $crow = sqlQuery("SELECT * FROM insurance_companies WHERE " .
  66         "id = '" . $drow['provider'] . "'");
  67       $orow = new InsuranceCompany($drow['provider']);
  68       $this->payers[$ins] = array();
  69       $this->payers[$ins]['data']    = $drow;
  70       $this->payers[$ins]['company'] = $crow;
  71       $this->payers[$ins]['object']  = $orow;
  72     }
  73
  74     // This kludge hands most cases of a rare ambiguous situation, where
  75     // the primary insurance company is the same as the secondary.  It seems
  76     // nobody planned for that!
  77     //
  78     for ($i = 1; $i < count($this->payers); ++$i) {
  79       if ($billrow['process_date'] &&
  80         $this->payers[0]['data']['provider'] == $this->payers[$i]['data']['provider'])
  81       {
  82         $tmp = $this->payers[0];
  83         $this->payers[0] = $this->payers[$i];
  84         $this->payers[$i] = $tmp;
  85       }
  86     }
  87
  88     $this->using_modifiers = true;
  89
  90     // Get payment and adjustment details if there are any previous payers.
  91     //
  92     $this->invoice = array();
  93     if ($this->payerSequence() != 'P') {
  94       if ($GLOBALS['oer_config']['ws_accounting']['enabled'] === 2) {
  95         $this->invoice = ar_get_invoice_summary($this->pid, $this->encounter_id, true);
  96       }
  97       else if ($GLOBALS['oer_config']['ws_accounting']['enabled']) {
  98         SLConnect();
  99         $arres = SLQuery("select id from ar where invnumber = " .
 100           "'{$this->pid}.{$this->encounter_id}'");
 101         if ($sl_err) die($sl_err);
 102         $arrow = SLGetRow($arres, 0);
 103         if ($arrow) {
 104           $this->invoice = get_invoice_summary($arrow['id'], true);
 105         }
 106         SLClose();
 107       }
 108       // Secondary claims might not have modifiers in SQL-Ledger data.
 109       // In that case, note that we should not try to match on them.
 110       $this->using_modifiers = false;
 111       foreach ($this->invoice as $key => $trash) {
 112         if (strpos($key, ':')) $this->using_modifiers = true;
 113       }
 114     }
 115   }
 116
 117   // Constructor. Loads relevant database information.
 118   //
 119   function Claim($pid, $encounter_id) {
 120     $this->pid = $pid;
 121     $this->encounter_id = $encounter_id;
 122     $this->procs = array();
 123     $this->diags = array();
 124     $this->copay = 0;
 125
 126     // We need the encounter date before we can identify the payers.
 127     $sql = "SELECT * FROM form_encounter WHERE " .
 128       "pid = '{$this->pid}' AND " .
 129       "encounter = '{$this->encounter_id}'";
 130     $this->encounter = sqlQuery($sql);
 131
 132     // Sort by procedure timestamp in order to get some consistency.
 133     $sql = "SELECT * FROM billing WHERE " .
 134       "encounter = '{$this->encounter_id}' AND pid = '{$this->pid}' AND " .
 135       "(code_type = 'CPT4' OR code_type = 'HCPCS' OR code_type = 'COPAY' OR code_type = 'ICD9') AND " .
 136       "activity = '1' ORDER BY date, id";
 137     $res = sqlStatement($sql);
 138     while ($row = sqlFetchArray($res)) {
 139       if ($row['code_type'] == 'COPAY') {
 140         $this->copay -= $row['fee'];
 141         continue;
 142       }
 143       // Save all diagnosis codes.
 144       if ($row['code_type'] == 'ICD9') {
 145         $this->diags[$row['code']] = $row['code'];
 146         continue;
 147       }
 148       if (!$row['units']) $row['units'] = 1;
 149       // Load prior payer data at the first opportunity in order to get
 150       // the using_modifiers flag that is referenced below.
 151       if (empty($this->procs)) $this->loadPayerInfo($row);
 152       // Consolidate duplicate procedures.
 153       foreach ($this->procs as $key => $trash) {
 154         if (strcmp($this->procs[$key]['code'],$row['code']) == 0 &&
 155             (strcmp($this->procs[$key]['modifier'],$row['modifier']) == 0 ||
 156              !$this->using_modifiers))
 157         {
 158           $this->procs[$key]['units'] += $row['units'];
 159           $this->procs[$key]['fee']   += $row['fee'];
 160           continue 2; // skip to next table row
 161         }
 162       }
 163
 164       // If there is a row-specific provider then get its details.
 165       if (!empty($row['provider_id'])) {
 166         // Get service provider data for this row.
 167         $sql = "SELECT * FROM users WHERE id = '" . $row['provider_id'] . "'";
 168         $row['provider'] = sqlQuery($sql);
 169         // Get insurance numbers for this row's provider.
 170         $sql = "SELECT * FROM insurance_numbers WHERE " .
 171           "(insurance_company_id = '" . $row['payer_id'] .
 172           "' OR insurance_company_id is NULL) AND " .
 173           "provider_id = '" . $row['provider_id'] . "' " .
 174           "ORDER BY insurance_company_id DESC LIMIT 1";
 175         $row['insurance_numbers'] = sqlQuery($sql);
 176       }
 177
 178       $this->procs[] = $row;
 179     }
 180
 181     $sql = "SELECT * FROM x12_partners WHERE " .
 182       "id = '" . $this->procs[0]['x12_partner_id'] . "'";
 183     $this->x12_partner = sqlQuery($sql);
 184
 185     $sql = "SELECT * FROM facility WHERE " .
 186       "id = '" . addslashes($this->encounter['facility_id']) . "' " .
 187       "LIMIT 1";
 188     $this->facility = sqlQuery($sql);
 189
 190     /*****************************************************************
 191     $provider_id = $this->procs[0]['provider_id'];
 192     *****************************************************************/
 193     $provider_id = $this->encounter['provider_id'];
 194     $sql = "SELECT * FROM users WHERE id = '$provider_id'";
 195     $this->provider = sqlQuery($sql);
 196 // Selecting the billing facility assigned  to the service facility
 197     $sql = "SELECT * FROM facility " .
 198     " where id ='" . addslashes($this->encounter['billing_facility']) . "' ";
 199     $this->billing_facility = sqlQuery($sql);
 200
 201     $sql = "SELECT * FROM insurance_numbers WHERE " .
 202       "(insurance_company_id = '" . $this->procs[0]['payer_id'] .
 203       "' OR insurance_company_id is NULL) AND " .
 204       "provider_id = '$provider_id' " .
 205       "ORDER BY insurance_company_id DESC LIMIT 1";
 206     $this->insurance_numbers = sqlQuery($sql);
 207
 208     $sql = "SELECT * FROM patient_data WHERE " .
 209       "pid = '{$this->pid}' " .
 210       "ORDER BY id LIMIT 1";
 211     $this->patient_data = sqlQuery($sql);
 212
 213     $sql = "SELECT fpa.* FROM forms JOIN form_misc_billing_options AS fpa " .
 214       "ON fpa.id = forms.form_id WHERE " .
 215       "forms.encounter = '{$this->encounter_id}' AND " .
 216       "forms.pid = '{$this->pid}' AND " .
 217       "forms.formdir = 'misc_billing_options' " .
 218       "ORDER BY forms.date";
 219     $this->billing_options = sqlQuery($sql);
 220
 221     $referrer_id = (empty($GLOBALS['MedicareReferrerIsRenderer']) ||
 222       $this->insurance_numbers['provider_number_type'] != '1C') ?
 223       $this->patient_data['providerID'] : $provider_id;
 224     $sql = "SELECT * FROM users WHERE id = '$referrer_id'";
 225     $this->referrer = sqlQuery($sql);
 226     if (!$this->referrer) $this->referrer = array();
 227
 228     $supervisor_id = $this->encounter['supervisor_id'];
 229     $sql = "SELECT * FROM users WHERE id = '$supervisor_id'";
 230     $this->supervisor = sqlQuery($sql);
 231     if (!$this->supervisor) $this->supervisor = array();
 232
 233     $sql = "SELECT * FROM insurance_numbers WHERE " .
 234       "(insurance_company_id = '" . $this->procs[0]['payer_id'] .
 235       "' OR insurance_company_id is NULL) AND " .
 236       "provider_id = '$supervisor_id' " .
 237       "ORDER BY insurance_company_id DESC LIMIT 1";
 238     $this->supervisor_numbers = sqlQuery($sql);
 239     if (!$this->supervisor_numbers) $this->supervisor_numbers = array();
 240
 241   } // end constructor
 242
 243   // Return an array of adjustments from the designated prior payer for the
 244   // designated procedure key (might be procedure:modifier), or for the claim
 245   // level.  For each adjustment give date, group code, reason code, amount.
 246   // Note this will include "patient responsibility" adjustments which are
 247   // not adjustments to OUR invoice, but they reduce the amount that the
 248   // insurance company pays.
 249   //
 250   function payerAdjustments($ins, $code='Claim') {
 251     $aadj = array();
 252
 253     // If we have no modifiers stored in SQL-Ledger for this claim,
 254     // then we cannot use a modifier passed in with the key.
 255     $tmp = strpos($code, ':');
 256     if ($tmp && !$this->using_modifiers) $code = substr($code, 0, $tmp);
 257
 258     // For payments, source always starts with "Ins" or "Pt".
 259     // Nonzero adjustment reason examples:
 260     //   Ins1 adjust code 42 (Charges exceed ... (obsolete))
 261     //   Ins1 adjust code 45 (Charges exceed your contracted/ legislated fee arrangement)
 262     //   Ins1 adjust code 97 (Payment is included in the allowance for another service/procedure)
 263     //   Ins1 adjust code A2 (Contractual adjustment)
 264     //   Ins adjust Ins1
 265     //   adjust code 45
 266     // Zero adjustment reason examples:
 267     //   Co-pay: 25.00
 268     //   Coinsurance: 11.46  (code 2)   Note: fix remits to identify insurance
 269     //   To deductible: 0.22 (code 1)   Note: fix remits to identify insurance
 270     //   To copay Ins1 (manual entry)
 271     //   To ded'ble Ins1 (manual entry)
 272
 273     if (!empty($this->invoice[$code])) {
 274       $date = '';
 275       $deductible  = 0;
 276       $coinsurance = 0;
 277       $inslabel = ($this->payerSequence($ins) == 'S') ? 'Ins2' : 'Ins1';
 278       $insnumber = substr($inslabel, 3);
 279
 280       // Compute this procedure's patient responsibility amount as of this
 281       // prior payer, which is the original charge minus all insurance
 282       // payments and "hard" adjustments up to this payer.
 283       $ptresp = $this->invoice[$code]['chg'] + $this->invoice[$code]['adj'];
 284       foreach ($this->invoice[$code]['dtl'] as $key => $value) {
 285         if (isset($value['plv'])) {
 286           // New method; plv (from ar_activity.payer_type) exists to
 287           // indicate the payer level.
 288           if (isset($value['pmt']) && $value['pmt'] != 0) {
 289             if ($value['plv'] > 0 && $value['plv'] <= $insnumber)
 290               $ptresp -= $value['pmt'];
 291           }
 292           else if (isset($value['chg']) && trim(substr($key, 0, 10))) {
 293             // non-blank key indicates this is an adjustment and not a charge
 294             if ($value['plv'] > 0 && $value['plv'] <= $insnumber)
 295               $ptresp += $value['chg']; // adjustments are negative charges
 296           }
 297         }
 298         else {
 299           // Old method: With SQL-Ledger payer level was stored in the memo.
 300           if (preg_match("/^Ins(\d)/i", $value['src'], $tmp)) {
 301             if ($tmp[1] <= $insnumber) $ptresp -= $value['pmt'];
 302           }
 303           else if (trim(substr($key, 0, 10))) { // not an adjustment if no date
 304             if (!preg_match("/Ins(\d)/i", $value['rsn'], $tmp) || $tmp[1] <= $insnumber)
 305               $ptresp += $value['chg']; // adjustments are negative charges
 306           }
 307         }
 308       }
 309       if ($ptresp < 0) $ptresp = 0; // we may be insane but try to hide it
 310
 311       // Main loop, to extract adjustments for this payer and procedure.
 312       foreach ($this->invoice[$code]['dtl'] as $key => $value) {
 313         $tmp = str_replace('-', '', trim(substr($key, 0, 10)));
 314         if ($tmp) $date = $tmp;
 315         if ($tmp && $value['pmt'] == 0) { // not original charge and not a payment
 316           $rsn = $value['rsn'];
 317           $chg = 0 - $value['chg']; // adjustments are negative charges
 318
 319           $gcode = 'CO'; // default group code = contractual obligation
 320           $rcode = '45'; // default reason code = max fee exceeded (code 42 is obsolete)
 321
 322           if (preg_match("/Ins adjust $inslabel/i", $rsn, $tmp)) {
 323             // From manual post. Take the defaults.
 324           }
 325           else if (preg_match("/To copay $inslabel/i", $rsn, $tmp) && !$chg) {
 326             $coinsurance = $ptresp; // from manual post
 327             continue;
 328           }
 329           else if (preg_match("/To ded'ble $inslabel/i", $rsn, $tmp) && !$chg) {
 330             $deductible = $ptresp; // from manual post
 331             continue;
 332           }
 333           else if (preg_match("/$inslabel copay: (\S+)/i", $rsn, $tmp) && !$chg) {
 334             $coinsurance = $tmp[1]; // from 835 as of 6/2007
 335             continue;
 336           }
 337           else if (preg_match("/$inslabel coins: (\S+)/i", $rsn, $tmp) && !$chg) {
 338             $coinsurance = $tmp[1]; // from 835 and manual post as of 6/2007
 339             continue;
 340           }
 341           else if (preg_match("/$inslabel dedbl: (\S+)/i", $rsn, $tmp) && !$chg) {
 342             $deductible = $tmp[1]; // from 835 and manual post as of 6/2007
 343             continue;
 344           }
 345           else if (preg_match("/$inslabel ptresp: (\S+)/i", $rsn, $tmp) && !$chg) {
 346             continue; // from 835 as of 6/2007
 347           }
 348           else if (preg_match("/$inslabel adjust code (\S+)/i", $rsn, $tmp)) {
 349             $rcode = $tmp[1]; // from 835
 350           }
 351           else if (preg_match("/$inslabel/i", $rsn, $tmp)) {
 352             // Take the defaults.
 353           }
 354           else if (preg_match('/Ins(\d)/i', $rsn, $tmp) && $tmp[1] != $insnumber) {
 355             continue; // it's for some other payer
 356           }
 357           else if ($insnumber == '1') {
 358             if (preg_match("/\$\s*adjust code (\S+)/i", $rsn, $tmp)) {
 359               $rcode = $tmp[1]; // from 835
 360             }
 361             else if ($chg) {
 362               // Other adjustments default to Ins1.
 363             }
 364             else if (preg_match("/Co-pay: (\S+)/i", $rsn, $tmp) ||
 365               preg_match("/Coinsurance: (\S+)/i", $rsn, $tmp)) {
 366               $coinsurance = 0 + $tmp[1]; // from 835 before 6/2007
 367               continue;
 368             }
 369             else if (preg_match("/To deductible: (\S+)/i", $rsn, $tmp)) {
 370               $deductible = 0 + $tmp[1]; // from 835 before 6/2007
 371               continue;
 372             }
 373             else {
 374               continue; // there is no adjustment amount
 375             }
 376           }
 377           else {
 378             continue; // it's for primary and that's not us
 379           }
 380
 381           if ($rcode == '42') $rcode= '45'; // reason 42 is obsolete
 382           $aadj[] = array($date, $gcode, $rcode, sprintf('%.2f', $chg));
 383
 384         } // end if
 385       } // end foreach
 386
 387       // If we really messed it up, at least avoid negative numbers.
 388       if ($coinsurance > $ptresp) $coinsurance = $ptresp;
 389       if ($deductible  > $ptresp) $deductible  = $ptresp;
 390
 391       // Find out if this payer paid anything at all on this claim.  This will
 392       // help us allocate any unknown patient responsibility amounts.
 393       $thispaidanything = 0;
 394       foreach($this->invoice as $codekey => $codeval) {
 395         foreach ($codeval['dtl'] as $key => $value) {
 396           if (isset($value['plv'])) {
 397             // New method; plv exists to indicate the payer level.
 398             if ($value['plv'] == $insnumber) {
 399               $thispaidanything += $value['pmt'];
 400             }
 401           }
 402           else {
 403             if (preg_match("/$inslabel/i", $value['src'], $tmp)) {
 404               $thispaidanything += $value['pmt'];
 405             }
 406           }
 407         }
 408       }
 409
 410       // Allocate any unknown patient responsibility by guessing if the
 411       // deductible has been satisfied.
 412       if ($thispaidanything)
 413         $coinsurance = $ptresp - $deductible;
 414       else
 415         $deductible = $ptresp - $coinsurance;
 416
 417       $deductible  = sprintf('%.2f', $deductible);
 418       $coinsurance = sprintf('%.2f', $coinsurance);
 419
 420       if ($date && $deductible != 0)
 421         $aadj[] = array($date, 'PR', '1', $deductible);
 422       if ($date && $coinsurance != 0)
 423         $aadj[] = array($date, 'PR', '2', $coinsurance);
 424
 425     } // end if
 426
 427     return $aadj;
 428   }
 429
 430   // Return date, total payments and total "hard" adjustments from the given
 431   // prior payer. If $code is specified then only that procedure key is
 432   // selected, otherwise it's for the whole claim.
 433   //
 434   function payerTotals($ins, $code='') {
 435     // If we have no modifiers stored in SQL-Ledger for this claim,
 436     // then we cannot use a modifier passed in with the key.
 437     $tmp = strpos($code, ':');
 438     if ($tmp && !$this->using_modifiers) $code = substr($code, 0, $tmp);
 439
 440     $inslabel = ($this->payerSequence($ins) == 'S') ? 'Ins2' : 'Ins1';
 441     $insnumber = substr($inslabel, 3);
 442     $paytotal = 0;
 443     $adjtotal = 0;
 444     $date = '';
 445     foreach($this->invoice as $codekey => $codeval) {
 446       if ($code && strcmp($codekey,$code) != 0) continue;
 447       foreach ($codeval['dtl'] as $key => $value) {
 448         if (isset($value['plv'])) {
 449           // New method; plv (from ar_activity.payer_type) exists to
 450           // indicate the payer level.
 451           if ($value['plv'] == $insnumber) {
 452             if (!$date) $date = str_replace('-', '', trim(substr($key, 0, 10)));
 453             $paytotal += $value['pmt'];
 454           }
 455         }
 456         else {
 457           // Old method: With SQL-Ledger payer level was stored in the memo.
 458           if (preg_match("/$inslabel/i", $value['src'], $tmp)) {
 459             if (!$date) $date = str_replace('-', '', trim(substr($key, 0, 10)));
 460             $paytotal += $value['pmt'];
 461           }
 462         }
 463       }
 464       $aarr = $this->payerAdjustments($ins, $codekey);
 465       foreach ($aarr as $a) {
 466         if (strcmp($a[1],'PR') != 0) $adjtotal += $a[3];
 467         if (!$date) $date = $a[0];
 468       }
 469     }
 470     return array($date, sprintf('%.2f', $paytotal), sprintf('%.2f', $adjtotal));
 471   }
 472
 473   // Return the amount already paid by the patient.
 474   //
 475   function patientPaidAmount() {
 476     // For primary claims $this->invoice is not loaded, so get the co-pay
 477     // from the billing table instead.
 478     if (empty($this->invoice)) return $this->copay;
 479     //
 480     $amount = 0;
 481     foreach($this->invoice as $codekey => $codeval) {
 482       foreach ($codeval['dtl'] as $key => $value) {
 483         if (isset($value['plv'])) {
 484           // New method; plv exists to indicate the payer level.
 485           if ($value['plv'] == 0) { // 0 indicates patient
 486             $amount += $value['pmt'];
 487           }
 488         }
 489         else {
 490           // Old method: With SQL-Ledger payer level was stored in the memo.
 491           if (!preg_match("/Ins/i", $value['src'], $tmp)) {
 492             $amount += $value['pmt'];
 493           }
 494         }
 495       }
 496     }
 497     return sprintf('%.2f', $amount);
 498   }
 499
 500   // Return invoice total, including adjustments but not payments.
 501   //
 502   function invoiceTotal() {
 503     $amount = 0;
 504     foreach($this->invoice as $codekey => $codeval) {
 505       $amount += $codeval['chg'];
 506     }
 507     return sprintf('%.2f', $amount);
 508   }
 509
 510   // Number of procedures in this claim.
 511   function procCount() {
 512     return count($this->procs);
 513   }
 514
 515   // Number of payers for this claim. Ranges from 1 to 3.
 516   function payerCount() {
 517     return count($this->payers);
 518   }
 519
 520   function x12gsversionstring() {
 521     return x12clean(trim($this->x12_partner['x12_version']));
 522   }
 523
 524   function x12gssenderid() {
 525     $tmp = $this->x12_partner['x12_sender_id'];
 526     while (strlen($tmp) < 15) $tmp .= " ";
 527     return $tmp;
 528   }
 529
 530   function x12gsreceiverid() {
 531     $tmp = $this->x12_partner['x12_receiver_id'];
 532     while (strlen($tmp) < 15) $tmp .= " ";
 533     return $tmp;
 534   }
 535
 536   function x12gsisa05() {
 537     return $this->x12_partner['x12_isa05'];
 538   }
 539
 540   function x12gsisa07() {
 541     return $this->x12_partner['x12_isa07'];
 542   }
 543
 544   function x12gsisa14() {
 545     return $this->x12_partner['x12_isa14'];
 546   }
 547
 548   function x12gsisa15() {
 549     return $this->x12_partner['x12_isa15'];
 550   }
 551
 552   function x12gsgs02() {
 553     $tmp = $this->x12_partner['x12_gs02'];
 554     if ($tmp === '') $tmp = $this->x12_partner['x12_sender_id'];
 555     return $tmp;
 556   }
 557
 558   function x12gsper06() {
 559     return $this->x12_partner['x12_per06'];
 560   }
 561
 562   function cliaCode() {
 563     return x12clean(trim($this->facility['domain_identifier']));
 564   }
 565
 566   function billingFacilityName() {
 567     return x12clean(trim($this->billing_facility['name']));
 568   }
 569
 570   function billingFacilityStreet() {
 571     return x12clean(trim($this->billing_facility['street']));
 572   }
 573
 574   function billingFacilityCity() {
 575     return x12clean(trim($this->billing_facility['city']));
 576   }
 577
 578   function billingFacilityState() {
 579     return x12clean(trim($this->billing_facility['state']));
 580   }
 581
 582   function billingFacilityZip() {
 583     return x12clean(trim($this->billing_facility['postal_code']));
 584   }
 585
 586   function billingFacilityETIN() {
 587     return x12clean(trim(str_replace('-', '', $this->billing_facility['federal_ein'])));
 588   }
 589
 590   function billingFacilityNPI() {
 591     return x12clean(trim($this->billing_facility['facility_npi']));
 592   }
 593
 594   function federalIdType() {
 595         if ($this->billing_facility['tax_id_type'])
 596         {
 597         return $this->billing_facility['tax_id_type'];
 598         }
 599         else{
 600         return null;
 601         }
 602   }
 603
 604   # The billing facility and the patient must both accept for this to return true.
 605   function billingFacilityAssignment($ins=0) {
 606     $tmp = strtoupper($this->payers[$ins]['data']['accept_assignment']);
 607     if (strcmp($tmp,'FALSE') == 0) return '0';
 608     return !empty($this->billing_facility['accepts_assignment']);
 609   }
 610
 611   function billingContactName() {
 612     return x12clean(trim($this->billing_facility['attn']));
 613   }
 614
 615   function billingContactPhone() {
 616     if (preg_match("/([2-9]\d\d)\D*(\d\d\d)\D*(\d\d\d\d)/",
 617       $this->billing_facility['phone'], $tmp))
 618     {
 619       return $tmp[1] . $tmp[2] . $tmp[3];
 620     }
 621     return '';
 622   }
 623
 624   function facilityName() {
 625     return x12clean(trim($this->facility['name']));
 626   }
 627
 628   function facilityStreet() {
 629     return x12clean(trim($this->facility['street']));
 630   }
 631
 632   function facilityCity() {
 633     return x12clean(trim($this->facility['city']));
 634   }
 635
 636   function facilityState() {
 637     return x12clean(trim($this->facility['state']));
 638   }
 639
 640   function facilityZip() {
 641     return x12clean(trim($this->facility['postal_code']));
 642   }
 643
 644   function facilityETIN() {
 645     return x12clean(trim(str_replace('-', '', $this->facility['federal_ein'])));
 646   }
 647
 648   function facilityNPI() {
 649     return x12clean(trim($this->facility['facility_npi']));
 650   }
 651
 652   function facilityPOS() {
 653     return sprintf('%02d', trim($this->facility['pos_code']));
 654   }
 655
 656   function clearingHouseName() {
 657     return x12clean(trim($this->x12_partner['name']));
 658   }
 659
 660   function clearingHouseETIN() {
 661     return x12clean(trim(str_replace('-', '', $this->x12_partner['id_number'])));
 662   }
 663
 664   function providerNumberType($prockey=-1) {
 665     $tmp = ($prockey < 0 || empty($this->procs[$prockey]['provider_id'])) ?
 666       $this->insurance_numbers : $this->procs[$prockey]['insurance_numbers'];
 667     return $tmp['provider_number_type'];
 668   }
 669
 670   function providerNumber($prockey=-1) {
 671     $tmp = ($prockey < 0 || empty($this->procs[$prockey]['provider_id'])) ?
 672       $this->insurance_numbers : $this->procs[$prockey]['insurance_numbers'];
 673     return x12clean(trim(str_replace('-', '', $tmp['provider_number'])));
 674   }
 675
 676   function providerGroupNumber($prockey=-1) {
 677     $tmp = ($prockey < 0 || empty($this->procs[$prockey]['provider_id'])) ?
 678       $this->insurance_numbers : $this->procs[$prockey]['insurance_numbers'];
 679     return x12clean(trim(str_replace('-', '', $tmp['group_number'])));
 680   }
 681
 682   // Returns 'P', 'S' or 'T'.
 683   //
 684   function payerSequence($ins=0) {
 685     return strtoupper(substr($this->payers[$ins]['data']['type'], 0, 1));
 686   }
 687
 688   // Returns the HIPAA code of the patient-to-subscriber relationship.
 689   //
 690   function insuredRelationship($ins=0) {
 691     $tmp = strtolower($this->payers[$ins]['data']['subscriber_relationship']);
 692     if (strcmp($tmp,'self'  ) == 0) return '18';
 693     if (strcmp($tmp,'spouse') == 0) return '01';
 694     if (strcmp($tmp,'child' ) == 0) return '19';
 695     if (strcmp($tmp,'other' ) == 0) return 'G8';
 696     return $tmp; // should not happen
 697   }
 698
 699   function insuredTypeCode($ins=0) {
 700     if (strcmp($this->claimType($ins),'MB') == 0 && $this->payerSequence($ins) != 'P')
 701       return '12'; // medicare secondary working aged beneficiary or
 702                    // spouse with employer group health plan
 703     return '';
 704   }
 705
 706   // Is the patient also the subscriber?
 707   //
 708   function isSelfOfInsured($ins=0) {
 709     $tmp = strtolower($this->payers[$ins]['data']['subscriber_relationship']);
 710     return (strcmp($tmp,'self') == 0);
 711   }
 712
 713   function planName($ins=0) {
 714     return x12clean(trim($this->payers[$ins]['data']['plan_name']));
 715   }
 716
 717   function policyNumber($ins=0) { // "ID"
 718     return x12clean(trim($this->payers[$ins]['data']['policy_number']));
 719   }
 720
 721   function groupNumber($ins=0) {
 722     return x12clean(trim($this->payers[$ins]['data']['group_number']));
 723   }
 724
 725   function groupName($ins=0) {
 726     return x12clean(trim($this->payers[$ins]['data']['subscriber_employer']));
 727   }
 728
 729   // Claim types are:
 730   // 16 Other HCFA
 731   // MB Medicare Part B
 732   // MC Medicaid
 733   // CH ChampUSVA
 734   // CH ChampUS
 735   // BL Blue Cross Blue Shield
 736   // 16 FECA
 737   // 09 Self Pay
 738   // 10 Central Certification
 739   // 11 Other Non-Federal Programs
 740   // 12 Preferred Provider Organization (PPO)
 741   // 13 Point of Service (POS)
 742   // 14 Exclusive Provider Organization (EPO)
 743   // 15 Indemnity Insurance
 744   // 16 Health Maintenance Organization (HMO) Medicare Risk
 745   // AM Automobile Medical
 746   // CI Commercial Insurance Co.
 747   // DS Disability
 748   // HM Health Maintenance Organization
 749   // LI Liability
 750   // LM Liability Medical
 751   // OF Other Federal Program
 752   // TV Title V
 753   // VA Veterans Administration Plan
 754   // WC Workers Compensation Health Plan
 755   // ZZ Mutually Defined
 756   //
 757   function claimType($ins=0) {
 758     if (empty($this->payers[$ins]['object'])) return '';
 759     return $this->payers[$ins]['object']->get_freeb_claim_type();
 760   }
 761
 762   function insuredLastName($ins=0) {
 763     return x12clean(trim($this->payers[$ins]['data']['subscriber_lname']));
 764   }
 765
 766   function insuredFirstName($ins=0) {
 767     return x12clean(trim($this->payers[$ins]['data']['subscriber_fname']));
 768   }
 769
 770   function insuredMiddleName($ins=0) {
 771     return x12clean(trim($this->payers[$ins]['data']['subscriber_mname']));
 772   }
 773
 774   function insuredStreet($ins=0) {
 775     return x12clean(trim($this->payers[$ins]['data']['subscriber_street']));
 776   }
 777
 778   function insuredCity($ins=0) {
 779     return x12clean(trim($this->payers[$ins]['data']['subscriber_city']));
 780   }
 781
 782   function insuredState($ins=0) {
 783     return x12clean(trim($this->payers[$ins]['data']['subscriber_state']));
 784   }
 785
 786   function insuredZip($ins=0) {
 787     return x12clean(trim($this->payers[$ins]['data']['subscriber_postal_code']));
 788   }
 789
 790   function insuredPhone($ins=0) {
 791     if (preg_match("/([2-9]\d\d)\D*(\d\d\d)\D*(\d\d\d\d)/",
 792       $this->payers[$ins]['data']['subscriber_phone'], $tmp))
 793       return $tmp[1] . $tmp[2] . $tmp[3];
 794     return '';
 795   }
 796
 797   function insuredDOB($ins=0) {
 798     return str_replace('-', '', $this->payers[$ins]['data']['subscriber_DOB']);
 799   }
 800
 801   function insuredSex($ins=0) {
 802     return strtoupper(substr($this->payers[$ins]['data']['subscriber_sex'], 0, 1));
 803   }
 804
 805   function payerName($ins=0) {
 806     return x12clean(trim($this->payers[$ins]['company']['name']));
 807   }
 808
 809   function payerAttn($ins=0) {
 810     return x12clean(trim($this->payers[$ins]['company']['attn']));
 811   }
 812
 813   function payerStreet($ins=0) {
 814     if (empty($this->payers[$ins]['object'])) return '';
 815     $tmp = $this->payers[$ins]['object'];
 816     $tmp = $tmp->get_address();
 817     return x12clean(trim($tmp->get_line1()));
 818   }
 819
 820   function payerCity($ins=0) {
 821     if (empty($this->payers[$ins]['object'])) return '';
 822     $tmp = $this->payers[$ins]['object'];
 823     $tmp = $tmp->get_address();
 824     return x12clean(trim($tmp->get_city()));
 825   }
 826
 827   function payerState($ins=0) {
 828     if (empty($this->payers[$ins]['object'])) return '';
 829     $tmp = $this->payers[$ins]['object'];
 830     $tmp = $tmp->get_address();
 831     return x12clean(trim($tmp->get_state()));
 832   }
 833
 834   function payerZip($ins=0) {
 835     if (empty($this->payers[$ins]['object'])) return '';
 836     $tmp = $this->payers[$ins]['object'];
 837     $tmp = $tmp->get_address();
 838     return x12clean(trim($tmp->get_zip()));
 839   }
 840
 841   function payerID($ins=0) {
 842     return x12clean(trim($this->payers[$ins]['company']['cms_id']));
 843   }
 844
 845   function payerAltID($ins=0) {
 846     return x12clean(trim($this->payers[$ins]['company']['alt_cms_id']));
 847   }
 848
 849   function patientLastName() {
 850     return x12clean(trim($this->patient_data['lname']));
 851   }
 852
 853   function patientFirstName() {
 854     return x12clean(trim($this->patient_data['fname']));
 855   }
 856
 857   function patientMiddleName() {
 858     return x12clean(trim($this->patient_data['mname']));
 859   }
 860
 861   function patientStreet() {
 862     return x12clean(trim($this->patient_data['street']));
 863   }
 864
 865   function patientCity() {
 866     return x12clean(trim($this->patient_data['city']));
 867   }
 868
 869   function patientState() {
 870     return x12clean(trim($this->patient_data['state']));
 871   }
 872
 873   function patientZip() {
 874     return x12clean(trim($this->patient_data['postal_code']));
 875   }
 876
 877   function patientPhone() {
 878     $ptphone = $this->patient_data['phone_home'];
 879     if (!$ptphone) $ptphone = $this->patient_data['phone_biz'];
 880     if (!$ptphone) $ptphone = $this->patient_data['phone_cell'];
 881     if (preg_match("/([2-9]\d\d)\D*(\d\d\d)\D*(\d\d\d\d)/", $ptphone, $tmp))
 882       return $tmp[1] . $tmp[2] . $tmp[3];
 883     return '';
 884   }
 885
 886   function patientDOB() {
 887     return str_replace('-', '', $this->patient_data['DOB']);
 888   }
 889
 890   function patientSex() {
 891     return strtoupper(substr($this->patient_data['sex'], 0, 1));
 892   }
 893
 894   // Patient Marital Status: M = Married, S = Single, or something else.
 895   function patientStatus() {
 896     return strtoupper(substr($this->patient_data['status'], 0, 1));
 897   }
 898
 899   // This should be UNEMPLOYED, STUDENT, PT STUDENT, or anything else to
 900   // indicate employed.
 901   function patientOccupation() {
 902     return strtoupper(x12clean(trim($this->patient_data['occupation'])));
 903   }
 904
 905   function cptCode($prockey) {
 906     return x12clean(trim($this->procs[$prockey]['code']));
 907   }
 908
 909   function cptModifier($prockey) {
 910     return x12clean(trim($this->procs[$prockey]['modifier']));
 911   }
 912
 913   // Returns the procedure code, followed by ":modifier" if there is one.
 914   function cptKey($prockey) {
 915     $tmp = $this->cptModifier($prockey);
 916     return $this->cptCode($prockey) . ($tmp ? ":$tmp" : "");
 917   }
 918
 919   function cptCharges($prockey) {
 920     return x12clean(trim($this->procs[$prockey]['fee']));
 921   }
 922
 923   function cptUnits($prockey) {
 924     if (empty($this->procs[$prockey]['units'])) return '1';
 925     return x12clean(trim($this->procs[$prockey]['units']));
 926   }
 927
 928   // NDC drug ID.
 929   function cptNDCID($prockey) {
 930     $ndcinfo = $this->procs[$prockey]['ndc_info'];
 931     if (preg_match('/^N4(\S+)\s+(\S\S)(.*)/', $ndcinfo, $tmp)) {
 932       $ndc = $tmp[1];
 933       if (preg_match('/^(\d+)-(\d+)-(\d+)$/', $ndc, $tmp)) {
 934         return sprintf('%05d-%04d-%02d', $tmp[1], $tmp[2], $tmp[3]);
 935       }
 936       return x12clean($ndc); // format is bad but return it anyway
 937     }
 938     return '';
 939   }
 940
 941   // NDC drug unit of measure code.
 942   function cptNDCUOM($prockey) {
 943     $ndcinfo = $this->procs[$prockey]['ndc_info'];
 944     if (preg_match('/^N4(\S+)\s+(\S\S)(.*)/', $ndcinfo, $tmp))
 945       return x12clean($tmp[2]);
 946     return '';
 947   }
 948
 949   // NDC drug number of units.
 950   function cptNDCQuantity($prockey) {
 951     $ndcinfo = $this->procs[$prockey]['ndc_info'];
 952     if (preg_match('/^N4(\S+)\s+(\S\S)(.*)/', $ndcinfo, $tmp)) {
 953       return x12clean(ltrim($tmp[3], '0'));
 954     }
 955     return '';
 956   }
 957
 958   function onsetDate() {//Without the else clause in the claim zero value is coming.
 959     $replace_value=str_replace('-', '', substr($this->encounter['onset_date'], 0, 10));
 960         if($replace_value*1<>0)
 961     {
 962          return $replace_value;
 963         }
 964         else{
 965          return '';
 966         }
 967   }
 968
 969   function serviceDate() {
 970     return str_replace('-', '', substr($this->encounter['date'], 0, 10));
 971   }
 972
 973   function priorAuth() {
 974     return x12clean(trim($this->billing_options['prior_auth_number']));
 975   }
 976
 977   function isRelatedEmployment() {
 978     return !empty($this->billing_options['employment_related']);
 979   }
 980
 981   function isRelatedAuto() {
 982     return !empty($this->billing_options['auto_accident']);
 983   }
 984
 985   function isRelatedOther() {
 986     return !empty($this->billing_options['other_accident']);
 987   }
 988
 989   function autoAccidentState() {
 990     return x12clean(trim($this->billing_options['accident_state']));
 991   }
 992
 993   function isUnableToWork() {
 994     return !empty($this->billing_options['is_unable_to_work']);
 995   }
 996
 997   function offWorkFrom() {
 998     return str_replace('-', '', substr($this->billing_options['off_work_from'], 0, 10));
 999   }
1000
1001   function offWorkTo() {
1002     return str_replace('-', '', substr($this->billing_options['off_work_to'], 0, 10));
1003   }
1004
1005   function isHospitalized() {
1006     return !empty($this->billing_options['is_hospitalized']);
1007   }
1008
1009   function hospitalizedFrom() {
1010     return str_replace('-', '', substr($this->billing_options['hospitalization_date_from'], 0, 10));
1011   }
1012
1013   function hospitalizedTo() {
1014     return str_replace('-', '', substr($this->billing_options['hospitalization_date_to'], 0, 10));
1015   }
1016
1017   function isOutsideLab() {
1018     return !empty($this->billing_options['outside_lab']);
1019   }
1020
1021   function outsideLabAmount() {
1022     return sprintf('%.2f', 0 + $this->billing_options['lab_amount']);
1023   }
1024
1025   function medicaidResubmissionCode() {
1026     return x12clean(trim($this->billing_options['medicaid_resubmission_code']));
1027   }
1028
1029   function medicaidOriginalReference() {
1030     return x12clean(trim($this->billing_options['medicaid_original_reference']));
1031   }
1032
1033   function frequencyTypeCode() {
1034     return empty($this->billing_options['replacement_claim']) ? '1' : '7';
1035   }
1036
1037   function additionalNotes() {
1038     return x12clean(trim($this->billing_options['comments']));
1039   }
1040
1041   // Returns an array of unique diagnoses.  Periods are stripped.
1042   function diagArray() {
1043     $da = array();
1044     foreach ($this->procs as $row) {
1045       $atmp = explode(':', $row['justify']);
1046       foreach ($atmp as $tmp) {
1047         if (!empty($tmp)) {
1048           $diag = str_replace('.', '', $tmp);
1049           $da[$diag] = $diag;
1050         }
1051       }
1052     }
1053     // The above got all the diagnoses used for justification, in the order
1054     // used for justification.  Next we go through all diagnoses, justified
1055     // or not, to make sure they all get into the claim.  We do it this way
1056     // so that the more important diagnoses appear first.
1057     foreach ($this->diags as $diag) {
1058       $diag = str_replace('.', '', $diag);
1059       $da[$diag] = $diag;
1060     }
1061     return $da;
1062   }
1063
1064   // Compute one 1-relative index in diagArray for the given procedure.
1065   // This function is obsolete, use diagIndexArray() instead.
1066   function diagIndex($prockey) {
1067     $da = $this->diagArray();
1068     $tmp = explode(':', $this->procs[$prockey]['justify']);
1069     if (empty($tmp)) return '';
1070     $diag = str_replace('.', '', $tmp[0]);
1071     $i = 0;
1072     foreach ($da as $value) {
1073       ++$i;
1074       if (strcmp($value,$diag) == 0) return $i;
1075     }
1076     return '';
1077   }
1078
1079   // Compute array of 1-relative diagArray indices for the given procedure.
1080   function diagIndexArray($prockey) {
1081     $dia = array();
1082     $da = $this->diagArray();
1083     $atmp = explode(':', $this->procs[$prockey]['justify']);
1084     foreach ($atmp as $tmp) {
1085       if (!empty($tmp)) {
1086         $diag = str_replace('.', '', $tmp);
1087         $i = 0;
1088         foreach ($da as $value) {
1089           ++$i;
1090           if (strcmp($value,$diag) == 0) $dia[] = $i;
1091         }
1092       }
1093     }
1094     return $dia;
1095   }
1096
1097   function providerLastName($prockey=-1) {
1098     $tmp = ($prockey < 0 || empty($this->procs[$prockey]['provider_id'])) ?
1099       $this->provider : $this->procs[$prockey]['provider'];
1100     return x12clean(trim($tmp['lname']));
1101   }
1102
1103   function providerFirstName($prockey=-1) {
1104     $tmp = ($prockey < 0 || empty($this->procs[$prockey]['provider_id'])) ?
1105       $this->provider : $this->procs[$prockey]['provider'];
1106     return x12clean(trim($tmp['fname']));
1107   }
1108
1109   function providerMiddleName($prockey=-1) {
1110     $tmp = ($prockey < 0 || empty($this->procs[$prockey]['provider_id'])) ?
1111       $this->provider : $this->procs[$prockey]['provider'];
1112     return x12clean(trim($tmp['mname']));
1113   }
1114
1115   function providerNPI($prockey=-1) {
1116     $tmp = ($prockey < 0 || empty($this->procs[$prockey]['provider_id'])) ?
1117       $this->provider : $this->procs[$prockey]['provider'];
1118     return x12clean(trim($tmp['npi']));
1119   }
1120
1121   function providerUPIN($prockey=-1) {
1122     $tmp = ($prockey < 0 || empty($this->procs[$prockey]['provider_id'])) ?
1123       $this->provider : $this->procs[$prockey]['provider'];
1124     return x12clean(trim($tmp['upin']));
1125   }
1126
1127   function providerSSN($prockey=-1) {
1128     $tmp = ($prockey < 0 || empty($this->procs[$prockey]['provider_id'])) ?
1129       $this->provider : $this->procs[$prockey]['provider'];
1130     return x12clean(trim(str_replace('-', '', $tmp['federaltaxid'])));
1131   }
1132
1133   function providerTaxonomy($prockey=-1) {
1134     $tmp = ($prockey < 0 || empty($this->procs[$prockey]['provider_id'])) ?
1135       $this->provider : $this->procs[$prockey]['provider'];
1136     if (empty($tmp['taxonomy'])) return '207Q00000X';
1137     return x12clean(trim($tmp['taxonomy']));
1138   }
1139
1140   function referrerLastName() {
1141     return x12clean(trim($this->referrer['lname']));
1142   }
1143
1144   function referrerFirstName() {
1145     return x12clean(trim($this->referrer['fname']));
1146   }
1147
1148   function referrerMiddleName() {
1149     return x12clean(trim($this->referrer['mname']));
1150   }
1151
1152   function referrerNPI() {
1153     return x12clean(trim($this->referrer['npi']));
1154   }
1155
1156   function referrerUPIN() {
1157     return x12clean(trim($this->referrer['upin']));
1158   }
1159
1160   function referrerSSN() {
1161     return x12clean(trim(str_replace('-', '', $this->referrer['federaltaxid'])));
1162   }
1163
1164   function referrerTaxonomy() {
1165     if (empty($this->referrer['taxonomy'])) return '207Q00000X';
1166     return x12clean(trim($this->referrer['taxonomy']));
1167   }
1168
1169   function supervisorLastName() {
1170     return x12clean(trim($this->supervisor['lname']));
1171   }
1172
1173   function supervisorFirstName() {
1174     return x12clean(trim($this->supervisor['fname']));
1175   }
1176
1177   function supervisorMiddleName() {
1178     return x12clean(trim($this->supervisor['mname']));
1179   }
1180
1181   function supervisorNPI() {
1182     return x12clean(trim($this->supervisor['npi']));
1183   }
1184
1185   function supervisorUPIN() {
1186     return x12clean(trim($this->supervisor['upin']));
1187   }
1188
1189   function supervisorSSN() {
1190     return x12clean(trim(str_replace('-', '', $this->supervisor['federaltaxid'])));
1191   }
1192
1193   function supervisorTaxonomy() {
1194     if (empty($this->supervisor['taxonomy'])) return '207Q00000X';
1195     return x12clean(trim($this->supervisor['taxonomy']));
1196   }
1197
1198   function supervisorNumberType() {
1199     return $this->supervisor_numbers['provider_number_type'];
1200   }
1201
1202   function supervisorNumber() {
1203     return x12clean(trim(str_replace('-', '', $this->supervisor_numbers['provider_number'])));
1204   }
1205
1206 }
1207 ?>