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 encounter.  If none,
 197     // try the first (and hopefully only) facility marked as a billing location.
 198     if (empty($this->encounter['billing_facility'])) {
 199       $sql = "SELECT * FROM facility " .
 200         "ORDER BY billing_location DESC, id ASC LIMIT 1";
 201     }
 202     else {
 203       $sql = "SELECT * FROM facility " .
 204       " where id ='" . addslashes($this->encounter['billing_facility']) . "' ";
 205     }
 206     $this->billing_facility = sqlQuery($sql);
 207
 208     $sql = "SELECT * FROM insurance_numbers WHERE " .
 209       "(insurance_company_id = '" . $this->procs[0]['payer_id'] .
 210       "' OR insurance_company_id is NULL) AND " .
 211       "provider_id = '$provider_id' " .
 212       "ORDER BY insurance_company_id DESC LIMIT 1";
 213     $this->insurance_numbers = sqlQuery($sql);
 214
 215     $sql = "SELECT * FROM patient_data WHERE " .
 216       "pid = '{$this->pid}' " .
 217       "ORDER BY id LIMIT 1";
 218     $this->patient_data = sqlQuery($sql);
 219
 220     $sql = "SELECT fpa.* FROM forms JOIN form_misc_billing_options AS fpa " .
 221       "ON fpa.id = forms.form_id WHERE " .
 222       "forms.encounter = '{$this->encounter_id}' AND " .
 223       "forms.pid = '{$this->pid}' AND " .
 224       "forms.deleted = 0 AND " .
 225       "forms.formdir = 'misc_billing_options' " .
 226       "ORDER BY forms.date";
 227     $this->billing_options = sqlQuery($sql);
 228
 229     $referrer_id = (empty($GLOBALS['MedicareReferrerIsRenderer']) ||
 230       $this->insurance_numbers['provider_number_type'] != '1C') ?
 231       $this->patient_data['providerID'] : $provider_id;
 232     $sql = "SELECT * FROM users WHERE id = '$referrer_id'";
 233     $this->referrer = sqlQuery($sql);
 234     if (!$this->referrer) $this->referrer = array();
 235
 236     $supervisor_id = $this->encounter['supervisor_id'];
 237     $sql = "SELECT * FROM users WHERE id = '$supervisor_id'";
 238     $this->supervisor = sqlQuery($sql);
 239     if (!$this->supervisor) $this->supervisor = array();
 240
 241     $sql = "SELECT * FROM insurance_numbers WHERE " .
 242       "(insurance_company_id = '" . $this->procs[0]['payer_id'] .
 243       "' OR insurance_company_id is NULL) AND " .
 244       "provider_id = '$supervisor_id' " .
 245       "ORDER BY insurance_company_id DESC LIMIT 1";
 246     $this->supervisor_numbers = sqlQuery($sql);
 247     if (!$this->supervisor_numbers) $this->supervisor_numbers = array();
 248
 249   } // end constructor
 250
 251   // Return an array of adjustments from the designated prior payer for the
 252   // designated procedure key (might be procedure:modifier), or for the claim
 253   // level.  For each adjustment give date, group code, reason code, amount.
 254   // Note this will include "patient responsibility" adjustments which are
 255   // not adjustments to OUR invoice, but they reduce the amount that the
 256   // insurance company pays.
 257   //
 258   function payerAdjustments($ins, $code='Claim') {
 259     $aadj = array();
 260
 261     // If we have no modifiers stored in SQL-Ledger for this claim,
 262     // then we cannot use a modifier passed in with the key.
 263     $tmp = strpos($code, ':');
 264     if ($tmp && !$this->using_modifiers) $code = substr($code, 0, $tmp);
 265
 266     // For payments, source always starts with "Ins" or "Pt".
 267     // Nonzero adjustment reason examples:
 268     //   Ins1 adjust code 42 (Charges exceed ... (obsolete))
 269     //   Ins1 adjust code 45 (Charges exceed your contracted/ legislated fee arrangement)
 270     //   Ins1 adjust code 97 (Payment is included in the allowance for another service/procedure)
 271     //   Ins1 adjust code A2 (Contractual adjustment)
 272     //   Ins adjust Ins1
 273     //   adjust code 45
 274     // Zero adjustment reason examples:
 275     //   Co-pay: 25.00
 276     //   Coinsurance: 11.46  (code 2)   Note: fix remits to identify insurance
 277     //   To deductible: 0.22 (code 1)   Note: fix remits to identify insurance
 278     //   To copay Ins1 (manual entry)
 279     //   To ded'ble Ins1 (manual entry)
 280
 281     if (!empty($this->invoice[$code])) {
 282       $date = '';
 283       $deductible  = 0;
 284       $coinsurance = 0;
 285       $inslabel = ($this->payerSequence($ins) == 'S') ? 'Ins2' : 'Ins1';
 286       $insnumber = substr($inslabel, 3);
 287
 288       // Compute this procedure's patient responsibility amount as of this
 289       // prior payer, which is the original charge minus all insurance
 290       // payments and "hard" adjustments up to this payer.
 291       $ptresp = $this->invoice[$code]['chg'] + $this->invoice[$code]['adj'];
 292       foreach ($this->invoice[$code]['dtl'] as $key => $value) {
 293         if (isset($value['plv'])) {
 294           // New method; plv (from ar_activity.payer_type) exists to
 295           // indicate the payer level.
 296           if (isset($value['pmt']) && $value['pmt'] != 0) {
 297             if ($value['plv'] > 0 && $value['plv'] <= $insnumber)
 298               $ptresp -= $value['pmt'];
 299           }
 300           else if (isset($value['chg']) && trim(substr($key, 0, 10))) {
 301             // non-blank key indicates this is an adjustment and not a charge
 302             if ($value['plv'] > 0 && $value['plv'] <= $insnumber)
 303               $ptresp += $value['chg']; // adjustments are negative charges
 304           }
 305
 306           $msp = isset( $value['msp'] ) ? $value['msp'] : null; // record the reason for adjustment
 307         }
 308         else {
 309           // Old method: With SQL-Ledger payer level was stored in the memo.
 310           if (preg_match("/^Ins(\d)/i", $value['src'], $tmp)) {
 311             if ($tmp[1] <= $insnumber) $ptresp -= $value['pmt'];
 312           }
 313           else if (trim(substr($key, 0, 10))) { // not an adjustment if no date
 314             if (!preg_match("/Ins(\d)/i", $value['rsn'], $tmp) || $tmp[1] <= $insnumber)
 315               $ptresp += $value['chg']; // adjustments are negative charges
 316           }
 317         }
 318       }
 319       if ($ptresp < 0) $ptresp = 0; // we may be insane but try to hide it
 320
 321       // Main loop, to extract adjustments for this payer and procedure.
 322       foreach ($this->invoice[$code]['dtl'] as $key => $value) {
 323         $tmp = str_replace('-', '', trim(substr($key, 0, 10)));
 324         if ($tmp) $date = $tmp;
 325         if ($tmp && $value['pmt'] == 0) { // not original charge and not a payment
 326           $rsn = $value['rsn'];
 327           $chg = 0 - $value['chg']; // adjustments are negative charges
 328
 329           $gcode = 'CO'; // default group code = contractual obligation
 330           $rcode = '45'; // default reason code = max fee exceeded (code 42 is obsolete)
 331
 332           if (preg_match("/Ins adjust $inslabel/i", $rsn, $tmp)) {
 333             // From manual post. Take the defaults.
 334           }
 335           else if (preg_match("/To copay $inslabel/i", $rsn, $tmp) && !$chg) {
 336             $coinsurance = $ptresp; // from manual post
 337             continue;
 338           }
 339           else if (preg_match("/To ded'ble $inslabel/i", $rsn, $tmp) && !$chg) {
 340             $deductible = $ptresp; // from manual post
 341             continue;
 342           }
 343           else if (preg_match("/$inslabel copay: (\S+)/i", $rsn, $tmp) && !$chg) {
 344             $coinsurance = $tmp[1]; // from 835 as of 6/2007
 345             continue;
 346           }
 347           else if (preg_match("/$inslabel coins: (\S+)/i", $rsn, $tmp) && !$chg) {
 348             $coinsurance = $tmp[1]; // from 835 and manual post as of 6/2007
 349             continue;
 350           }
 351           else if (preg_match("/$inslabel dedbl: (\S+)/i", $rsn, $tmp) && !$chg) {
 352             $deductible = $tmp[1]; // from 835 and manual post as of 6/2007
 353             continue;
 354           }
 355           else if (preg_match("/$inslabel ptresp: (\S+)/i", $rsn, $tmp) && !$chg) {
 356             continue; // from 835 as of 6/2007
 357           }
 358           else if (preg_match("/$inslabel adjust code (\S+)/i", $rsn, $tmp)) {
 359             $rcode = $tmp[1]; // from 835
 360           }
 361           else if (preg_match("/$inslabel/i", $rsn, $tmp)) {
 362             // Take the defaults.
 363           }
 364           else if (preg_match('/Ins(\d)/i', $rsn, $tmp) && $tmp[1] != $insnumber) {
 365             continue; // it's for some other payer
 366           }
 367           else if ($insnumber == '1') {
 368             if (preg_match("/\$\s*adjust code (\S+)/i", $rsn, $tmp)) {
 369               $rcode = $tmp[1]; // from 835
 370             }
 371             else if ($chg) {
 372               // Other adjustments default to Ins1.
 373             }
 374             else if (preg_match("/Co-pay: (\S+)/i", $rsn, $tmp) ||
 375               preg_match("/Coinsurance: (\S+)/i", $rsn, $tmp)) {
 376               $coinsurance = 0 + $tmp[1]; // from 835 before 6/2007
 377               continue;
 378             }
 379             else if (preg_match("/To deductible: (\S+)/i", $rsn, $tmp)) {
 380               $deductible = 0 + $tmp[1]; // from 835 before 6/2007
 381               continue;
 382             }
 383             else {
 384               continue; // there is no adjustment amount
 385             }
 386           }
 387           else {
 388             continue; // it's for primary and that's not us
 389           }
 390
 391           if ($rcode == '42') $rcode= '45'; // reason 42 is obsolete
 392           $aadj[] = array($date, $gcode, $rcode, sprintf('%.2f', $chg));
 393
 394         } // end if
 395       } // end foreach
 396
 397       // If we really messed it up, at least avoid negative numbers.
 398       if ($coinsurance > $ptresp) $coinsurance = $ptresp;
 399       if ($deductible  > $ptresp) $deductible  = $ptresp;
 400
 401       // Find out if this payer paid anything at all on this claim.  This will
 402       // help us allocate any unknown patient responsibility amounts.
 403       $thispaidanything = 0;
 404       foreach($this->invoice as $codekey => $codeval) {
 405         foreach ($codeval['dtl'] as $key => $value) {
 406           if (isset($value['plv'])) {
 407             // New method; plv exists to indicate the payer level.
 408             if ($value['plv'] == $insnumber) {
 409               $thispaidanything += $value['pmt'];
 410             }
 411           }
 412           else {
 413             if (preg_match("/$inslabel/i", $value['src'], $tmp)) {
 414               $thispaidanything += $value['pmt'];
 415             }
 416           }
 417         }
 418       }
 419
 420       // Allocate any unknown patient responsibility by guessing if the
 421       // deductible has been satisfied.
 422       if ($thispaidanything)
 423         $coinsurance = $ptresp - $deductible;
 424       else
 425         $deductible = $ptresp - $coinsurance;
 426
 427       $deductible  = sprintf('%.2f', $deductible);
 428       $coinsurance = sprintf('%.2f', $coinsurance);
 429
 430       if ($date && $deductible != 0)
 431         $aadj[] = array($date, 'PR', '1', $deductible, $msp);
 432       if ($date && $coinsurance != 0)
 433         $aadj[] = array($date, 'PR', '2', $coinsurance, $msp);
 434
 435     } // end if
 436
 437     return $aadj;
 438   }
 439
 440   // Return date, total payments and total "hard" adjustments from the given
 441   // prior payer. If $code is specified then only that procedure key is
 442   // selected, otherwise it's for the whole claim.
 443   //
 444   function payerTotals($ins, $code='') {
 445     // If we have no modifiers stored in SQL-Ledger for this claim,
 446     // then we cannot use a modifier passed in with the key.
 447     $tmp = strpos($code, ':');
 448     if ($tmp && !$this->using_modifiers) $code = substr($code, 0, $tmp);
 449
 450     $inslabel = ($this->payerSequence($ins) == 'S') ? 'Ins2' : 'Ins1';
 451     $insnumber = substr($inslabel, 3);
 452     $paytotal = 0;
 453     $adjtotal = 0;
 454     $date = '';
 455     foreach($this->invoice as $codekey => $codeval) {
 456       if ($code && strcmp($codekey,$code) != 0) continue;
 457       foreach ($codeval['dtl'] as $key => $value) {
 458         if (isset($value['plv'])) {
 459           // New method; plv (from ar_activity.payer_type) exists to
 460           // indicate the payer level.
 461           if ($value['plv'] == $insnumber) {
 462             if (!$date) $date = str_replace('-', '', trim(substr($key, 0, 10)));
 463             $paytotal += $value['pmt'];
 464           }
 465         }
 466         else {
 467           // Old method: With SQL-Ledger payer level was stored in the memo.
 468           if (preg_match("/$inslabel/i", $value['src'], $tmp)) {
 469             if (!$date) $date = str_replace('-', '', trim(substr($key, 0, 10)));
 470             $paytotal += $value['pmt'];
 471           }
 472         }
 473       }
 474       $aarr = $this->payerAdjustments($ins, $codekey);
 475       foreach ($aarr as $a) {
 476         if (strcmp($a[1],'PR') != 0) $adjtotal += $a[3];
 477         if (!$date) $date = $a[0];
 478       }
 479     }
 480     return array($date, sprintf('%.2f', $paytotal), sprintf('%.2f', $adjtotal));
 481   }
 482
 483   // Return the amount already paid by the patient.
 484   //
 485   function patientPaidAmount() {
 486     // For primary claims $this->invoice is not loaded, so get the co-pay
 487     // from the billing table instead.
 488     if (empty($this->invoice)) return $this->copay;
 489     //
 490     $amount = 0;
 491     foreach($this->invoice as $codekey => $codeval) {
 492       foreach ($codeval['dtl'] as $key => $value) {
 493         if (isset($value['plv'])) {
 494           // New method; plv exists to indicate the payer level.
 495           if ($value['plv'] == 0) { // 0 indicates patient
 496             $amount += $value['pmt'];
 497           }
 498         }
 499         else {
 500           // Old method: With SQL-Ledger payer level was stored in the memo.
 501           if (!preg_match("/Ins/i", $value['src'], $tmp)) {
 502             $amount += $value['pmt'];
 503           }
 504         }
 505       }
 506     }
 507     return sprintf('%.2f', $amount);
 508   }
 509
 510   // Return invoice total, including adjustments but not payments.
 511   //
 512   function invoiceTotal() {
 513     $amount = 0;
 514     foreach($this->invoice as $codekey => $codeval) {
 515       $amount += $codeval['chg'];
 516     }
 517     return sprintf('%.2f', $amount);
 518   }
 519
 520   // Number of procedures in this claim.
 521   function procCount() {
 522     return count($this->procs);
 523   }
 524
 525   // Number of payers for this claim. Ranges from 1 to 3.
 526   function payerCount() {
 527     return count($this->payers);
 528   }
 529
 530   function x12gsversionstring() {
 531     return x12clean(trim($this->x12_partner['x12_version']));
 532   }
 533
 534   function x12gssenderid() {
 535     $tmp = $this->x12_partner['x12_sender_id'];
 536     while (strlen($tmp) < 15) $tmp .= " ";
 537     return $tmp;
 538   }
 539
 540   function x12gsreceiverid() {
 541     $tmp = $this->x12_partner['x12_receiver_id'];
 542     while (strlen($tmp) < 15) $tmp .= " ";
 543     return $tmp;
 544   }
 545
 546   function x12gsisa05() {
 547     return $this->x12_partner['x12_isa05'];
 548   }
 549
 550   function x12gsisa07() {
 551     return $this->x12_partner['x12_isa07'];
 552   }
 553
 554   function x12gsisa14() {
 555     return $this->x12_partner['x12_isa14'];
 556   }
 557
 558   function x12gsisa15() {
 559     return $this->x12_partner['x12_isa15'];
 560   }
 561
 562   function x12gsgs02() {
 563     $tmp = $this->x12_partner['x12_gs02'];
 564     if ($tmp === '') $tmp = $this->x12_partner['x12_sender_id'];
 565     return $tmp;
 566   }
 567
 568   function x12gsper06() {
 569     return $this->x12_partner['x12_per06'];
 570   }
 571
 572   function cliaCode() {
 573     return x12clean(trim($this->facility['domain_identifier']));
 574   }
 575
 576   function billingFacilityName() {
 577     return x12clean(trim($this->billing_facility['name']));
 578   }
 579
 580   function billingFacilityStreet() {
 581     return x12clean(trim($this->billing_facility['street']));
 582   }
 583
 584   function billingFacilityCity() {
 585     return x12clean(trim($this->billing_facility['city']));
 586   }
 587
 588   function billingFacilityState() {
 589     return x12clean(trim($this->billing_facility['state']));
 590   }
 591
 592   function billingFacilityZip() {
 593     return x12clean(trim($this->billing_facility['postal_code']));
 594   }
 595
 596   function billingFacilityETIN() {
 597     return x12clean(trim(str_replace('-', '', $this->billing_facility['federal_ein'])));
 598   }
 599
 600   function billingFacilityNPI() {
 601     return x12clean(trim($this->billing_facility['facility_npi']));
 602   }
 603
 604   function federalIdType() {
 605         if ($this->billing_facility['tax_id_type'])
 606         {
 607         return $this->billing_facility['tax_id_type'];
 608         }
 609         else{
 610         return null;
 611         }
 612   }
 613
 614   # The billing facility and the patient must both accept for this to return true.
 615   function billingFacilityAssignment($ins=0) {
 616     $tmp = strtoupper($this->payers[$ins]['data']['accept_assignment']);
 617     if (strcmp($tmp,'FALSE') == 0) return '0';
 618     return !empty($this->billing_facility['accepts_assignment']);
 619   }
 620
 621   function billingContactName() {
 622     return x12clean(trim($this->billing_facility['attn']));
 623   }
 624
 625   function billingContactPhone() {
 626     if (preg_match("/([2-9]\d\d)\D*(\d\d\d)\D*(\d\d\d\d)/",
 627       $this->billing_facility['phone'], $tmp))
 628     {
 629       return $tmp[1] . $tmp[2] . $tmp[3];
 630     }
 631     return '';
 632   }
 633
 634   function facilityName() {
 635     return x12clean(trim($this->facility['name']));
 636   }
 637
 638   function facilityStreet() {
 639     return x12clean(trim($this->facility['street']));
 640   }
 641
 642   function facilityCity() {
 643     return x12clean(trim($this->facility['city']));
 644   }
 645
 646   function facilityState() {
 647     return x12clean(trim($this->facility['state']));
 648   }
 649
 650   function facilityZip() {
 651     return x12clean(trim($this->facility['postal_code']));
 652   }
 653
 654   function facilityETIN() {
 655     return x12clean(trim(str_replace('-', '', $this->facility['federal_ein'])));
 656   }
 657
 658   function facilityNPI() {
 659     return x12clean(trim($this->facility['facility_npi']));
 660   }
 661
 662   function facilityPOS() {
 663     return sprintf('%02d', trim($this->facility['pos_code']));
 664   }
 665
 666   function clearingHouseName() {
 667     return x12clean(trim($this->x12_partner['name']));
 668   }
 669
 670   function clearingHouseETIN() {
 671     return x12clean(trim(str_replace('-', '', $this->x12_partner['id_number'])));
 672   }
 673
 674   function providerNumberType($prockey=-1) {
 675     $tmp = ($prockey < 0 || empty($this->procs[$prockey]['provider_id'])) ?
 676       $this->insurance_numbers : $this->procs[$prockey]['insurance_numbers'];
 677     return $tmp['provider_number_type'];
 678   }
 679
 680   function providerNumber($prockey=-1) {
 681     $tmp = ($prockey < 0 || empty($this->procs[$prockey]['provider_id'])) ?
 682       $this->insurance_numbers : $this->procs[$prockey]['insurance_numbers'];
 683     return x12clean(trim(str_replace('-', '', $tmp['provider_number'])));
 684   }
 685
 686   function providerGroupNumber($prockey=-1) {
 687     $tmp = ($prockey < 0 || empty($this->procs[$prockey]['provider_id'])) ?
 688       $this->insurance_numbers : $this->procs[$prockey]['insurance_numbers'];
 689     return x12clean(trim(str_replace('-', '', $tmp['group_number'])));
 690   }
 691
 692   // Returns 'P', 'S' or 'T'.
 693   //
 694   function payerSequence($ins=0) {
 695     return strtoupper(substr($this->payers[$ins]['data']['type'], 0, 1));
 696   }
 697
 698   // Returns the HIPAA code of the patient-to-subscriber relationship.
 699   //
 700   function insuredRelationship($ins=0) {
 701     $tmp = strtolower($this->payers[$ins]['data']['subscriber_relationship']);
 702     if (strcmp($tmp,'self'  ) == 0) return '18';
 703     if (strcmp($tmp,'spouse') == 0) return '01';
 704     if (strcmp($tmp,'child' ) == 0) return '19';
 705     if (strcmp($tmp,'other' ) == 0) return 'G8';
 706     return $tmp; // should not happen
 707   }
 708
 709   function insuredTypeCode($ins=0) {
 710     if (strcmp($this->claimType($ins),'MB') == 0 && $this->payerSequence($ins) != 'P')
 711       return $this->payers[$ins]['data']['policy_type'];
 712     return '';
 713   }
 714
 715   // Is the patient also the subscriber?
 716   //
 717   function isSelfOfInsured($ins=0) {
 718     $tmp = strtolower($this->payers[$ins]['data']['subscriber_relationship']);
 719     return (strcmp($tmp,'self') == 0);
 720   }
 721
 722   function planName($ins=0) {
 723     return x12clean(trim($this->payers[$ins]['data']['plan_name']));
 724   }
 725
 726   function policyNumber($ins=0) { // "ID"
 727     return x12clean(trim($this->payers[$ins]['data']['policy_number']));
 728   }
 729
 730   function groupNumber($ins=0) {
 731     return x12clean(trim($this->payers[$ins]['data']['group_number']));
 732   }
 733
 734   function groupName($ins=0) {
 735     return x12clean(trim($this->payers[$ins]['data']['subscriber_employer']));
 736   }
 737
 738   // Claim types are:
 739   // 16 Other HCFA
 740   // MB Medicare Part B
 741   // MC Medicaid
 742   // CH ChampUSVA
 743   // CH ChampUS
 744   // BL Blue Cross Blue Shield
 745   // 16 FECA
 746   // 09 Self Pay
 747   // 10 Central Certification
 748   // 11 Other Non-Federal Programs
 749   // 12 Preferred Provider Organization (PPO)
 750   // 13 Point of Service (POS)
 751   // 14 Exclusive Provider Organization (EPO)
 752   // 15 Indemnity Insurance
 753   // 16 Health Maintenance Organization (HMO) Medicare Risk
 754   // AM Automobile Medical
 755   // CI Commercial Insurance Co.
 756   // DS Disability
 757   // HM Health Maintenance Organization
 758   // LI Liability
 759   // LM Liability Medical
 760   // OF Other Federal Program
 761   // TV Title V
 762   // VA Veterans Administration Plan
 763   // WC Workers Compensation Health Plan
 764   // ZZ Mutually Defined
 765   //
 766   function claimType($ins=0) {
 767     if (empty($this->payers[$ins]['object'])) return '';
 768     return $this->payers[$ins]['object']->get_freeb_claim_type();
 769   }
 770
 771   function insuredLastName($ins=0) {
 772     return x12clean(trim($this->payers[$ins]['data']['subscriber_lname']));
 773   }
 774
 775   function insuredFirstName($ins=0) {
 776     return x12clean(trim($this->payers[$ins]['data']['subscriber_fname']));
 777   }
 778
 779   function insuredMiddleName($ins=0) {
 780     return x12clean(trim($this->payers[$ins]['data']['subscriber_mname']));
 781   }
 782
 783   function insuredStreet($ins=0) {
 784     return x12clean(trim($this->payers[$ins]['data']['subscriber_street']));
 785   }
 786
 787   function insuredCity($ins=0) {
 788     return x12clean(trim($this->payers[$ins]['data']['subscriber_city']));
 789   }
 790
 791   function insuredState($ins=0) {
 792     return x12clean(trim($this->payers[$ins]['data']['subscriber_state']));
 793   }
 794
 795   function insuredZip($ins=0) {
 796     return x12clean(trim($this->payers[$ins]['data']['subscriber_postal_code']));
 797   }
 798
 799   function insuredPhone($ins=0) {
 800     if (preg_match("/([2-9]\d\d)\D*(\d\d\d)\D*(\d\d\d\d)/",
 801       $this->payers[$ins]['data']['subscriber_phone'], $tmp))
 802       return $tmp[1] . $tmp[2] . $tmp[3];
 803     return '';
 804   }
 805
 806   function insuredDOB($ins=0) {
 807     return str_replace('-', '', $this->payers[$ins]['data']['subscriber_DOB']);
 808   }
 809
 810   function insuredSex($ins=0) {
 811     return strtoupper(substr($this->payers[$ins]['data']['subscriber_sex'], 0, 1));
 812   }
 813
 814   function payerName($ins=0) {
 815     return x12clean(trim($this->payers[$ins]['company']['name']));
 816   }
 817
 818   function payerAttn($ins=0) {
 819     return x12clean(trim($this->payers[$ins]['company']['attn']));
 820   }
 821
 822   function payerStreet($ins=0) {
 823     if (empty($this->payers[$ins]['object'])) return '';
 824     $tmp = $this->payers[$ins]['object'];
 825     $tmp = $tmp->get_address();
 826     return x12clean(trim($tmp->get_line1()));
 827   }
 828
 829   function payerCity($ins=0) {
 830     if (empty($this->payers[$ins]['object'])) return '';
 831     $tmp = $this->payers[$ins]['object'];
 832     $tmp = $tmp->get_address();
 833     return x12clean(trim($tmp->get_city()));
 834   }
 835
 836   function payerState($ins=0) {
 837     if (empty($this->payers[$ins]['object'])) return '';
 838     $tmp = $this->payers[$ins]['object'];
 839     $tmp = $tmp->get_address();
 840     return x12clean(trim($tmp->get_state()));
 841   }
 842
 843   function payerZip($ins=0) {
 844     if (empty($this->payers[$ins]['object'])) return '';
 845     $tmp = $this->payers[$ins]['object'];
 846     $tmp = $tmp->get_address();
 847     return x12clean(trim($tmp->get_zip()));
 848   }
 849
 850   function payerID($ins=0) {
 851     return x12clean(trim($this->payers[$ins]['company']['cms_id']));
 852   }
 853
 854   function payerAltID($ins=0) {
 855     return x12clean(trim($this->payers[$ins]['company']['alt_cms_id']));
 856   }
 857
 858   function patientLastName() {
 859     return x12clean(trim($this->patient_data['lname']));
 860   }
 861
 862   function patientFirstName() {
 863     return x12clean(trim($this->patient_data['fname']));
 864   }
 865
 866   function patientMiddleName() {
 867     return x12clean(trim($this->patient_data['mname']));
 868   }
 869
 870   function patientStreet() {
 871     return x12clean(trim($this->patient_data['street']));
 872   }
 873
 874   function patientCity() {
 875     return x12clean(trim($this->patient_data['city']));
 876   }
 877
 878   function patientState() {
 879     return x12clean(trim($this->patient_data['state']));
 880   }
 881
 882   function patientZip() {
 883     return x12clean(trim($this->patient_data['postal_code']));
 884   }
 885
 886   function patientPhone() {
 887     $ptphone = $this->patient_data['phone_home'];
 888     if (!$ptphone) $ptphone = $this->patient_data['phone_biz'];
 889     if (!$ptphone) $ptphone = $this->patient_data['phone_cell'];
 890     if (preg_match("/([2-9]\d\d)\D*(\d\d\d)\D*(\d\d\d\d)/", $ptphone, $tmp))
 891       return $tmp[1] . $tmp[2] . $tmp[3];
 892     return '';
 893   }
 894
 895   function patientDOB() {
 896     return str_replace('-', '', $this->patient_data['DOB']);
 897   }
 898
 899   function patientSex() {
 900     return strtoupper(substr($this->patient_data['sex'], 0, 1));
 901   }
 902
 903   // Patient Marital Status: M = Married, S = Single, or something else.
 904   function patientStatus() {
 905     return strtoupper(substr($this->patient_data['status'], 0, 1));
 906   }
 907
 908   // This should be UNEMPLOYED, STUDENT, PT STUDENT, or anything else to
 909   // indicate employed.
 910   function patientOccupation() {
 911     return strtoupper(x12clean(trim($this->patient_data['occupation'])));
 912   }
 913
 914   function cptCode($prockey) {
 915     return x12clean(trim($this->procs[$prockey]['code']));
 916   }
 917
 918   function cptModifier($prockey) {
 919     return x12clean(trim($this->procs[$prockey]['modifier']));
 920   }
 921
 922   // Returns the procedure code, followed by ":modifier" if there is one.
 923   function cptKey($prockey) {
 924     $tmp = $this->cptModifier($prockey);
 925     return $this->cptCode($prockey) . ($tmp ? ":$tmp" : "");
 926   }
 927
 928   function cptCharges($prockey) {
 929     return x12clean(trim($this->procs[$prockey]['fee']));
 930   }
 931
 932   function cptUnits($prockey) {
 933     if (empty($this->procs[$prockey]['units'])) return '1';
 934     return x12clean(trim($this->procs[$prockey]['units']));
 935   }
 936
 937   // NDC drug ID.
 938   function cptNDCID($prockey) {
 939     $ndcinfo = $this->procs[$prockey]['ndc_info'];
 940     if (preg_match('/^N4(\S+)\s+(\S\S)(.*)/', $ndcinfo, $tmp)) {
 941       $ndc = $tmp[1];
 942       if (preg_match('/^(\d+)-(\d+)-(\d+)$/', $ndc, $tmp)) {
 943         return sprintf('%05d%04d%02d', $tmp[1], $tmp[2], $tmp[3]);
 944       }
 945       return x12clean($ndc); // format is bad but return it anyway
 946     }
 947     return '';
 948   }
 949
 950   // NDC drug unit of measure code.
 951   function cptNDCUOM($prockey) {
 952     $ndcinfo = $this->procs[$prockey]['ndc_info'];
 953     if (preg_match('/^N4(\S+)\s+(\S\S)(.*)/', $ndcinfo, $tmp))
 954       return x12clean($tmp[2]);
 955     return '';
 956   }
 957
 958   // NDC drug number of units.
 959   function cptNDCQuantity($prockey) {
 960     $ndcinfo = $this->procs[$prockey]['ndc_info'];
 961     if (preg_match('/^N4(\S+)\s+(\S\S)(.*)/', $ndcinfo, $tmp)) {
 962       return x12clean(ltrim($tmp[3], '0'));
 963     }
 964     return '';
 965   }
 966
 967   function onsetDate() {//Without the else clause in the claim zero value is coming.
 968     $replace_value=str_replace('-', '', substr($this->encounter['onset_date'], 0, 10));
 969         if($replace_value*1<>0)
 970     {
 971          return $replace_value;
 972         }
 973         else{
 974          return '';
 975         }
 976   }
 977
 978   function serviceDate() {
 979     return str_replace('-', '', substr($this->encounter['date'], 0, 10));
 980   }
 981
 982   function priorAuth() {
 983     return x12clean(trim($this->billing_options['prior_auth_number']));
 984   }
 985
 986   function isRelatedEmployment() {
 987     return !empty($this->billing_options['employment_related']);
 988   }
 989
 990   function isRelatedAuto() {
 991     return !empty($this->billing_options['auto_accident']);
 992   }
 993
 994   function isRelatedOther() {
 995     return !empty($this->billing_options['other_accident']);
 996   }
 997
 998   function autoAccidentState() {
 999     return x12clean(trim($this->billing_options['accident_state']));
1000   }
1001
1002   function isUnableToWork() {
1003     return !empty($this->billing_options['is_unable_to_work']);
1004   }
1005
1006   function offWorkFrom() {
1007     return str_replace('-', '', substr($this->billing_options['off_work_from'], 0, 10));
1008   }
1009
1010   function offWorkTo() {
1011     return str_replace('-', '', substr($this->billing_options['off_work_to'], 0, 10));
1012   }
1013
1014   function isHospitalized() {
1015     return !empty($this->billing_options['is_hospitalized']);
1016   }
1017
1018   function hospitalizedFrom() {
1019     return str_replace('-', '', substr($this->billing_options['hospitalization_date_from'], 0, 10));
1020   }
1021
1022   function hospitalizedTo() {
1023     return str_replace('-', '', substr($this->billing_options['hospitalization_date_to'], 0, 10));
1024   }
1025
1026   function isOutsideLab() {
1027     return !empty($this->billing_options['outside_lab']);
1028   }
1029
1030   function outsideLabAmount() {
1031     return sprintf('%.2f', 0 + $this->billing_options['lab_amount']);
1032   }
1033
1034   function medicaidResubmissionCode() {
1035     return x12clean(trim($this->billing_options['medicaid_resubmission_code']));
1036   }
1037
1038   function medicaidOriginalReference() {
1039     return x12clean(trim($this->billing_options['medicaid_original_reference']));
1040   }
1041
1042   function frequencyTypeCode() {
1043     return empty($this->billing_options['replacement_claim']) ? '1' : '7';
1044   }
1045
1046   function additionalNotes() {
1047     return x12clean(trim($this->billing_options['comments']));
1048   }
1049
1050   function dateInitialTreatment() {
1051     return str_replace('-', '', substr($this->billing_options['date_initial_treatment'], 0, 10));
1052   }
1053
1054   // Returns an array of unique diagnoses.  Periods are stripped.
1055   function diagArray() {
1056     $da = array();
1057     foreach ($this->procs as $row) {
1058       $atmp = explode(':', $row['justify']);
1059       foreach ($atmp as $tmp) {
1060         if (!empty($tmp)) {
1061           $diag = str_replace('.', '', $tmp);
1062           $da[$diag] = $diag;
1063         }
1064       }
1065     }
1066     // The above got all the diagnoses used for justification, in the order
1067     // used for justification.  Next we go through all diagnoses, justified
1068     // or not, to make sure they all get into the claim.  We do it this way
1069     // so that the more important diagnoses appear first.
1070     foreach ($this->diags as $diag) {
1071       $diag = str_replace('.', '', $diag);
1072       $da[$diag] = $diag;
1073     }
1074     return $da;
1075   }
1076
1077   // Compute one 1-relative index in diagArray for the given procedure.
1078   // This function is obsolete, use diagIndexArray() instead.
1079   function diagIndex($prockey) {
1080     $da = $this->diagArray();
1081     $tmp = explode(':', $this->procs[$prockey]['justify']);
1082     if (empty($tmp)) return '';
1083     $diag = str_replace('.', '', $tmp[0]);
1084     $i = 0;
1085     foreach ($da as $value) {
1086       ++$i;
1087       if (strcmp($value,$diag) == 0) return $i;
1088     }
1089     return '';
1090   }
1091
1092   // Compute array of 1-relative diagArray indices for the given procedure.
1093   function diagIndexArray($prockey) {
1094     $dia = array();
1095     $da = $this->diagArray();
1096     $atmp = explode(':', $this->procs[$prockey]['justify']);
1097     foreach ($atmp as $tmp) {
1098       if (!empty($tmp)) {
1099         $diag = str_replace('.', '', $tmp);
1100         $i = 0;
1101         foreach ($da as $value) {
1102           ++$i;
1103           if (strcmp($value,$diag) == 0) $dia[] = $i;
1104         }
1105       }
1106     }
1107     return $dia;
1108   }
1109
1110   function providerLastName($prockey=-1) {
1111     $tmp = ($prockey < 0 || empty($this->procs[$prockey]['provider_id'])) ?
1112       $this->provider : $this->procs[$prockey]['provider'];
1113     return x12clean(trim($tmp['lname']));
1114   }
1115
1116   function providerFirstName($prockey=-1) {
1117     $tmp = ($prockey < 0 || empty($this->procs[$prockey]['provider_id'])) ?
1118       $this->provider : $this->procs[$prockey]['provider'];
1119     return x12clean(trim($tmp['fname']));
1120   }
1121
1122   function providerMiddleName($prockey=-1) {
1123     $tmp = ($prockey < 0 || empty($this->procs[$prockey]['provider_id'])) ?
1124       $this->provider : $this->procs[$prockey]['provider'];
1125     return x12clean(trim($tmp['mname']));
1126   }
1127
1128   function providerNPI($prockey=-1) {
1129     $tmp = ($prockey < 0 || empty($this->procs[$prockey]['provider_id'])) ?
1130       $this->provider : $this->procs[$prockey]['provider'];
1131     return x12clean(trim($tmp['npi']));
1132   }
1133
1134   function providerUPIN($prockey=-1) {
1135     $tmp = ($prockey < 0 || empty($this->procs[$prockey]['provider_id'])) ?
1136       $this->provider : $this->procs[$prockey]['provider'];
1137     return x12clean(trim($tmp['upin']));
1138   }
1139
1140   function providerSSN($prockey=-1) {
1141     $tmp = ($prockey < 0 || empty($this->procs[$prockey]['provider_id'])) ?
1142       $this->provider : $this->procs[$prockey]['provider'];
1143     return x12clean(trim(str_replace('-', '', $tmp['federaltaxid'])));
1144   }
1145
1146   function providerTaxonomy($prockey=-1) {
1147     $tmp = ($prockey < 0 || empty($this->procs[$prockey]['provider_id'])) ?
1148       $this->provider : $this->procs[$prockey]['provider'];
1149     if (empty($tmp['taxonomy'])) return '207Q00000X';
1150     return x12clean(trim($tmp['taxonomy']));
1151   }
1152
1153   function referrerLastName() {
1154     return x12clean(trim($this->referrer['lname']));
1155   }
1156
1157   function referrerFirstName() {
1158     return x12clean(trim($this->referrer['fname']));
1159   }
1160
1161   function referrerMiddleName() {
1162     return x12clean(trim($this->referrer['mname']));
1163   }
1164
1165   function referrerNPI() {
1166     return x12clean(trim($this->referrer['npi']));
1167   }
1168
1169   function referrerUPIN() {
1170     return x12clean(trim($this->referrer['upin']));
1171   }
1172
1173   function referrerSSN() {
1174     return x12clean(trim(str_replace('-', '', $this->referrer['federaltaxid'])));
1175   }
1176
1177   function referrerTaxonomy() {
1178     if (empty($this->referrer['taxonomy'])) return '207Q00000X';
1179     return x12clean(trim($this->referrer['taxonomy']));
1180   }
1181
1182   function supervisorLastName() {
1183     return x12clean(trim($this->supervisor['lname']));
1184   }
1185
1186   function supervisorFirstName() {
1187     return x12clean(trim($this->supervisor['fname']));
1188   }
1189
1190   function supervisorMiddleName() {
1191     return x12clean(trim($this->supervisor['mname']));
1192   }
1193
1194   function supervisorNPI() {
1195     return x12clean(trim($this->supervisor['npi']));
1196   }
1197
1198   function supervisorUPIN() {
1199     return x12clean(trim($this->supervisor['upin']));
1200   }
1201
1202   function supervisorSSN() {
1203     return x12clean(trim(str_replace('-', '', $this->supervisor['federaltaxid'])));
1204   }
1205
1206   function supervisorTaxonomy() {
1207     if (empty($this->supervisor['taxonomy'])) return '207Q00000X';
1208     return x12clean(trim($this->supervisor['taxonomy']));
1209   }
1210
1211   function supervisorNumberType() {
1212     return $this->supervisor_numbers['provider_number_type'];
1213   }
1214
1215   function supervisorNumber() {
1216     return x12clean(trim(str_replace('-', '', $this->supervisor_numbers['provider_number'])));
1217   }
1218
1219 }
1220 ?>