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
 197     $sql = "SELECT * FROM facility " .
 198       "ORDER BY billing_location DESC, id ASC LIMIT 1";
 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 => $value) {
 396           if (preg_match("/$inslabel/i", $value['src'], $tmp)) {
 397             $thispaidanything += $value['pmt'];
 398           }
 399         }
 400       }
 401
 402       // Allocate any unknown patient responsibility by guessing if the
 403       // deductible has been satisfied.
 404       if ($thispaidanything)
 405         $coinsurance = $ptresp - $deductible;
 406       else
 407         $deductible = $ptresp - $coinsurance;
 408
 409       if ($date && $deductible != 0)
 410         $aadj[] = array($date, 'PR', '1', sprintf('%.2f', $deductible));
 411       if ($date && $coinsurance != 0)
 412         $aadj[] = array($date, 'PR', '2', sprintf('%.2f', $coinsurance));
 413
 414     } // end if
 415
 416     return $aadj;
 417   }
 418
 419   // Return date, total payments and total "hard" adjustments from the given
 420   // prior payer. If $code is specified then only that procedure key is
 421   // selected, otherwise it's for the whole claim.
 422   //
 423   function payerTotals($ins, $code='') {
 424     // If we have no modifiers stored in SQL-Ledger for this claim,
 425     // then we cannot use a modifier passed in with the key.
 426     $tmp = strpos($code, ':');
 427     if ($tmp && !$this->using_modifiers) $code = substr($code, 0, $tmp);
 428
 429     $inslabel = ($this->payerSequence($ins) == 'S') ? 'Ins2' : 'Ins1';
 430     $insnumber = substr($inslabel, 3);
 431     $paytotal = 0;
 432     $adjtotal = 0;
 433     $date = '';
 434     foreach($this->invoice as $codekey => $codeval) {
 435       if ($code && strcmp($codekey,$code) != 0) continue;
 436       foreach ($codeval['dtl'] as $key => $value) {
 437         if (isset($value['plv'])) {
 438           // New method; plv (from ar_activity.payer_type) exists to
 439           // indicate the payer level.
 440           if ($value['plv'] == $insnumber) {
 441             if (!$date) $date = str_replace('-', '', trim(substr($key, 0, 10)));
 442             $paytotal += $value['pmt'];
 443           }
 444         }
 445         else {
 446           // Old method: With SQL-Ledger payer level was stored in the memo.
 447           if (preg_match("/$inslabel/i", $value['src'], $tmp)) {
 448             if (!$date) $date = str_replace('-', '', trim(substr($key, 0, 10)));
 449             $paytotal += $value['pmt'];
 450           }
 451         }
 452       }
 453       $aarr = $this->payerAdjustments($ins, $codekey);
 454       foreach ($aarr as $a) {
 455         if (strcmp($a[1],'PR') != 0) $adjtotal += $a[3];
 456         if (!$date) $date = $a[0];
 457       }
 458     }
 459     return array($date, sprintf('%.2f', $paytotal), sprintf('%.2f', $adjtotal));
 460   }
 461
 462   // Return the amount already paid by the patient.
 463   //
 464   function patientPaidAmount() {
 465     // For primary claims $this->invoice is not loaded, so get the co-pay
 466     // from the billing table instead.
 467     if (empty($this->invoice)) return $this->copay;
 468     //
 469     $amount = 0;
 470     foreach($this->invoice as $codekey => $codeval) {
 471       foreach ($codeval['dtl'] as $key => $value) {
 472         if (!preg_match("/Ins/i", $value['src'], $tmp)) {
 473           $amount += $value['pmt'];
 474         }
 475       }
 476     }
 477     return sprintf('%.2f', $amount);
 478   }
 479
 480   // Return invoice total, including adjustments but not payments.
 481   //
 482   function invoiceTotal() {
 483     $amount = 0;
 484     foreach($this->invoice as $codekey => $codeval) {
 485       $amount += $codeval['chg'];
 486     }
 487     return sprintf('%.2f', $amount);
 488   }
 489
 490   // Number of procedures in this claim.
 491   function procCount() {
 492     return count($this->procs);
 493   }
 494
 495   // Number of payers for this claim. Ranges from 1 to 3.
 496   function payerCount() {
 497     return count($this->payers);
 498   }
 499
 500   function x12gsversionstring() {
 501     return x12clean(trim($this->x12_partner['x12_version']));
 502   }
 503
 504   function x12gssenderid() {
 505     $tmp = $this->x12_partner['x12_sender_id'];
 506     while (strlen($tmp) < 15) $tmp .= " ";
 507     return $tmp;
 508   }
 509
 510   function x12gsreceiverid() {
 511     $tmp = $this->x12_partner['x12_receiver_id'];
 512     while (strlen($tmp) < 15) $tmp .= " ";
 513     return $tmp;
 514   }
 515
 516   function x12gsisa05() {
 517     return $this->x12_partner['x12_isa05'];
 518   }
 519
 520   function x12gsisa07() {
 521     return $this->x12_partner['x12_isa07'];
 522   }
 523
 524   function x12gsisa14() {
 525     return $this->x12_partner['x12_isa14'];
 526   }
 527
 528   function x12gsisa15() {
 529     return $this->x12_partner['x12_isa15'];
 530   }
 531
 532   function x12gsgs02() {
 533     $tmp = $this->x12_partner['x12_gs02'];
 534     if ($tmp === '') $tmp = $this->x12_partner['x12_sender_id'];
 535     return $tmp;
 536   }
 537
 538   function x12gsper06() {
 539     return $this->x12_partner['x12_per06'];
 540   }
 541
 542   function cliaCode() {
 543     return x12clean(trim($this->facility['domain_identifier']));
 544   }
 545
 546   function billingFacilityName() {
 547     return x12clean(trim($this->billing_facility['name']));
 548   }
 549
 550   function billingFacilityStreet() {
 551     return x12clean(trim($this->billing_facility['street']));
 552   }
 553
 554   function billingFacilityCity() {
 555     return x12clean(trim($this->billing_facility['city']));
 556   }
 557
 558   function billingFacilityState() {
 559     return x12clean(trim($this->billing_facility['state']));
 560   }
 561
 562   function billingFacilityZip() {
 563     return x12clean(trim($this->billing_facility['postal_code']));
 564   }
 565
 566   function billingFacilityETIN() {
 567     return x12clean(trim(str_replace('-', '', $this->billing_facility['federal_ein'])));
 568   }
 569
 570   function billingFacilityNPI() {
 571     return x12clean(trim($this->billing_facility['facility_npi']));
 572   }
 573
 574   function federalIdType() {
 575         if ($this->billing_facility['tax_id_type'])
 576         {
 577         return $this->billing_facility['tax_id_type'];
 578         }
 579         else{
 580         return null;
 581         }
 582   }
 583
 584   # The billing facility and the patient must both accept for this to return true.
 585   function billingFacilityAssignment($ins=0) {
 586     $tmp = strtoupper($this->payers[$ins]['data']['accept_assignment']);
 587     if (strcmp($tmp,'FALSE') == 0) return '0';
 588     return !empty($this->billing_facility['accepts_assignment']);
 589   }
 590
 591   function billingContactName() {
 592     return x12clean(trim($this->billing_facility['attn']));
 593   }
 594
 595   function billingContactPhone() {
 596     if (preg_match("/([2-9]\d\d)\D*(\d\d\d)\D*(\d\d\d\d)/",
 597       $this->billing_facility['phone'], $tmp))
 598     {
 599       return $tmp[1] . $tmp[2] . $tmp[3];
 600     }
 601     return '';
 602   }
 603
 604   function facilityName() {
 605     return x12clean(trim($this->facility['name']));
 606   }
 607
 608   function facilityStreet() {
 609     return x12clean(trim($this->facility['street']));
 610   }
 611
 612   function facilityCity() {
 613     return x12clean(trim($this->facility['city']));
 614   }
 615
 616   function facilityState() {
 617     return x12clean(trim($this->facility['state']));
 618   }
 619
 620   function facilityZip() {
 621     return x12clean(trim($this->facility['postal_code']));
 622   }
 623
 624   function facilityETIN() {
 625     return x12clean(trim(str_replace('-', '', $this->facility['federal_ein'])));
 626   }
 627
 628   function facilityNPI() {
 629     return x12clean(trim($this->facility['facility_npi']));
 630   }
 631
 632   function facilityPOS() {
 633     return x12clean(trim($this->facility['pos_code']));
 634   }
 635
 636   function clearingHouseName() {
 637     return x12clean(trim($this->x12_partner['name']));
 638   }
 639
 640   function clearingHouseETIN() {
 641     return x12clean(trim(str_replace('-', '', $this->x12_partner['id_number'])));
 642   }
 643
 644   function providerNumberType($prockey=-1) {
 645     $tmp = ($prockey < 0 || empty($this->procs[$prockey]['provider_id'])) ?
 646       $this->insurance_numbers : $this->procs[$prockey]['insurance_numbers'];
 647     return $tmp['provider_number_type'];
 648   }
 649
 650   function providerNumber($prockey=-1) {
 651     $tmp = ($prockey < 0 || empty($this->procs[$prockey]['provider_id'])) ?
 652       $this->insurance_numbers : $this->procs[$prockey]['insurance_numbers'];
 653     return x12clean(trim(str_replace('-', '', $tmp['provider_number'])));
 654   }
 655
 656   function providerGroupNumber($prockey=-1) {
 657     $tmp = ($prockey < 0 || empty($this->procs[$prockey]['provider_id'])) ?
 658       $this->insurance_numbers : $this->procs[$prockey]['insurance_numbers'];
 659     return x12clean(trim(str_replace('-', '', $tmp['group_number'])));
 660   }
 661
 662   // Returns 'P', 'S' or 'T'.
 663   //
 664   function payerSequence($ins=0) {
 665     return strtoupper(substr($this->payers[$ins]['data']['type'], 0, 1));
 666   }
 667
 668   // Returns the HIPAA code of the patient-to-subscriber relationship.
 669   //
 670   function insuredRelationship($ins=0) {
 671     $tmp = strtolower($this->payers[$ins]['data']['subscriber_relationship']);
 672     if (strcmp($tmp,'self'  ) == 0) return '18';
 673     if (strcmp($tmp,'spouse') == 0) return '01';
 674     if (strcmp($tmp,'child' ) == 0) return '19';
 675     if (strcmp($tmp,'other' ) == 0) return 'G8';
 676     return $tmp; // should not happen
 677   }
 678
 679   function insuredTypeCode($ins=0) {
 680     if (strcmp($this->claimType($ins),'MB') == 0 && $this->payerSequence($ins) != 'P')
 681       return '12'; // medicare secondary working aged beneficiary or
 682                    // spouse with employer group health plan
 683     return '';
 684   }
 685
 686   // Is the patient also the subscriber?
 687   //
 688   function isSelfOfInsured($ins=0) {
 689     $tmp = strtolower($this->payers[$ins]['data']['subscriber_relationship']);
 690     return (strcmp($tmp,'self') == 0);
 691   }
 692
 693   function planName($ins=0) {
 694     return x12clean(trim($this->payers[$ins]['data']['plan_name']));
 695   }
 696
 697   function policyNumber($ins=0) { // "ID"
 698     return x12clean(trim($this->payers[$ins]['data']['policy_number']));
 699   }
 700
 701   function groupNumber($ins=0) {
 702     return x12clean(trim($this->payers[$ins]['data']['group_number']));
 703   }
 704
 705   function groupName($ins=0) {
 706     return x12clean(trim($this->payers[$ins]['data']['subscriber_employer']));
 707   }
 708
 709   // Claim types are:
 710   // 16 Other HCFA
 711   // MB Medicare Part B
 712   // MC Medicaid
 713   // CH ChampUSVA
 714   // CH ChampUS
 715   // BL Blue Cross Blue Shield
 716   // 16 FECA
 717   // 09 Self Pay
 718   // 10 Central Certification
 719   // 11 Other Non-Federal Programs
 720   // 12 Preferred Provider Organization (PPO)
 721   // 13 Point of Service (POS)
 722   // 14 Exclusive Provider Organization (EPO)
 723   // 15 Indemnity Insurance
 724   // 16 Health Maintenance Organization (HMO) Medicare Risk
 725   // AM Automobile Medical
 726   // CI Commercial Insurance Co.
 727   // DS Disability
 728   // HM Health Maintenance Organization
 729   // LI Liability
 730   // LM Liability Medical
 731   // OF Other Federal Program
 732   // TV Title V
 733   // VA Veterans Administration Plan
 734   // WC Workers Compensation Health Plan
 735   // ZZ Mutually Defined
 736   //
 737   function claimType($ins=0) {
 738     if (empty($this->payers[$ins]['object'])) return '';
 739     return $this->payers[$ins]['object']->get_freeb_claim_type();
 740   }
 741
 742   function insuredLastName($ins=0) {
 743     return x12clean(trim($this->payers[$ins]['data']['subscriber_lname']));
 744   }
 745
 746   function insuredFirstName($ins=0) {
 747     return x12clean(trim($this->payers[$ins]['data']['subscriber_fname']));
 748   }
 749
 750   function insuredMiddleName($ins=0) {
 751     return x12clean(trim($this->payers[$ins]['data']['subscriber_mname']));
 752   }
 753
 754   function insuredStreet($ins=0) {
 755     return x12clean(trim($this->payers[$ins]['data']['subscriber_street']));
 756   }
 757
 758   function insuredCity($ins=0) {
 759     return x12clean(trim($this->payers[$ins]['data']['subscriber_city']));
 760   }
 761
 762   function insuredState($ins=0) {
 763     return x12clean(trim($this->payers[$ins]['data']['subscriber_state']));
 764   }
 765
 766   function insuredZip($ins=0) {
 767     return x12clean(trim($this->payers[$ins]['data']['subscriber_postal_code']));
 768   }
 769
 770   function insuredPhone($ins=0) {
 771     if (preg_match("/([2-9]\d\d)\D*(\d\d\d)\D*(\d\d\d\d)/",
 772       $this->payers[$ins]['data']['subscriber_phone'], $tmp))
 773       return $tmp[1] . $tmp[2] . $tmp[3];
 774     return '';
 775   }
 776
 777   function insuredDOB($ins=0) {
 778     return str_replace('-', '', $this->payers[$ins]['data']['subscriber_DOB']);
 779   }
 780
 781   function insuredSex($ins=0) {
 782     return strtoupper(substr($this->payers[$ins]['data']['subscriber_sex'], 0, 1));
 783   }
 784
 785   function payerName($ins=0) {
 786     return x12clean(trim($this->payers[$ins]['company']['name']));
 787   }
 788
 789   function payerAttn($ins=0) {
 790     return x12clean(trim($this->payers[$ins]['company']['attn']));
 791   }
 792
 793   function payerStreet($ins=0) {
 794     if (empty($this->payers[$ins]['object'])) return '';
 795     $tmp = $this->payers[$ins]['object'];
 796     $tmp = $tmp->get_address();
 797     return x12clean(trim($tmp->get_line1()));
 798   }
 799
 800   function payerCity($ins=0) {
 801     if (empty($this->payers[$ins]['object'])) return '';
 802     $tmp = $this->payers[$ins]['object'];
 803     $tmp = $tmp->get_address();
 804     return x12clean(trim($tmp->get_city()));
 805   }
 806
 807   function payerState($ins=0) {
 808     if (empty($this->payers[$ins]['object'])) return '';
 809     $tmp = $this->payers[$ins]['object'];
 810     $tmp = $tmp->get_address();
 811     return x12clean(trim($tmp->get_state()));
 812   }
 813
 814   function payerZip($ins=0) {
 815     if (empty($this->payers[$ins]['object'])) return '';
 816     $tmp = $this->payers[$ins]['object'];
 817     $tmp = $tmp->get_address();
 818     return x12clean(trim($tmp->get_zip()));
 819   }
 820
 821   function payerID($ins=0) {
 822     return x12clean(trim($this->payers[$ins]['company']['cms_id']));
 823   }
 824
 825   function payerAltID($ins=0) {
 826     return x12clean(trim($this->payers[$ins]['company']['alt_cms_id']));
 827   }
 828
 829   function patientLastName() {
 830     return x12clean(trim($this->patient_data['lname']));
 831   }
 832
 833   function patientFirstName() {
 834     return x12clean(trim($this->patient_data['fname']));
 835   }
 836
 837   function patientMiddleName() {
 838     return x12clean(trim($this->patient_data['mname']));
 839   }
 840
 841   function patientStreet() {
 842     return x12clean(trim($this->patient_data['street']));
 843   }
 844
 845   function patientCity() {
 846     return x12clean(trim($this->patient_data['city']));
 847   }
 848
 849   function patientState() {
 850     return x12clean(trim($this->patient_data['state']));
 851   }
 852
 853   function patientZip() {
 854     return x12clean(trim($this->patient_data['postal_code']));
 855   }
 856
 857   function patientPhone() {
 858     $ptphone = $this->patient_data['phone_home'];
 859     if (!$ptphone) $ptphone = $this->patient_data['phone_biz'];
 860     if (!$ptphone) $ptphone = $this->patient_data['phone_cell'];
 861     if (preg_match("/([2-9]\d\d)\D*(\d\d\d)\D*(\d\d\d\d)/", $ptphone, $tmp))
 862       return $tmp[1] . $tmp[2] . $tmp[3];
 863     return '';
 864   }
 865
 866   function patientDOB() {
 867     return str_replace('-', '', $this->patient_data['DOB']);
 868   }
 869
 870   function patientSex() {
 871     return strtoupper(substr($this->patient_data['sex'], 0, 1));
 872   }
 873
 874   // Patient Marital Status: M = Married, S = Single, or something else.
 875   function patientStatus() {
 876     return strtoupper(substr($this->patient_data['status'], 0, 1));
 877   }
 878
 879   // This should be UNEMPLOYED, STUDENT, PT STUDENT, or anything else to
 880   // indicate employed.
 881   function patientOccupation() {
 882     return strtoupper(x12clean(trim($this->patient_data['occupation'])));
 883   }
 884
 885   function cptCode($prockey) {
 886     return x12clean(trim($this->procs[$prockey]['code']));
 887   }
 888
 889   function cptModifier($prockey) {
 890     return x12clean(trim($this->procs[$prockey]['modifier']));
 891   }
 892
 893   // Returns the procedure code, followed by ":modifier" if there is one.
 894   function cptKey($prockey) {
 895     $tmp = $this->cptModifier($prockey);
 896     return $this->cptCode($prockey) . ($tmp ? ":$tmp" : "");
 897   }
 898
 899   function cptCharges($prockey) {
 900     return x12clean(trim($this->procs[$prockey]['fee']));
 901   }
 902
 903   function cptUnits($prockey) {
 904     if (empty($this->procs[$prockey]['units'])) return '1';
 905     return x12clean(trim($this->procs[$prockey]['units']));
 906   }
 907
 908   // NDC drug ID.
 909   function cptNDCID($prockey) {
 910     $ndcinfo = $this->procs[$prockey]['ndc_info'];
 911     if (preg_match('/^N4(\S+)\s+(\S\S)(.*)/', $ndcinfo, $tmp)) {
 912       $ndc = $tmp[1];
 913       if (preg_match('/^(\d+)-(\d+)-(\d+)$/', $ndc, $tmp)) {
 914         return sprintf('%05d-%04d-%02d', $tmp[1], $tmp[2], $tmp[3]);
 915       }
 916       return x12clean($ndc); // format is bad but return it anyway
 917     }
 918     return '';
 919   }
 920
 921   // NDC drug unit of measure code.
 922   function cptNDCUOM($prockey) {
 923     $ndcinfo = $this->procs[$prockey]['ndc_info'];
 924     if (preg_match('/^N4(\S+)\s+(\S\S)(.*)/', $ndcinfo, $tmp))
 925       return x12clean($tmp[2]);
 926     return '';
 927   }
 928
 929   // NDC drug number of units.
 930   function cptNDCQuantity($prockey) {
 931     $ndcinfo = $this->procs[$prockey]['ndc_info'];
 932     if (preg_match('/^N4(\S+)\s+(\S\S)(.*)/', $ndcinfo, $tmp)) {
 933       return x12clean(ltrim($tmp[3], '0'));
 934     }
 935     return '';
 936   }
 937
 938   function onsetDate() {
 939     return str_replace('-', '', substr($this->encounter['onset_date'], 0, 10));
 940   }
 941
 942   function serviceDate() {
 943     return str_replace('-', '', substr($this->encounter['date'], 0, 10));
 944   }
 945
 946   function priorAuth() {
 947     return x12clean(trim($this->billing_options['prior_auth_number']));
 948   }
 949
 950   function isRelatedEmployment() {
 951     return !empty($this->billing_options['employment_related']);
 952   }
 953
 954   function isRelatedAuto() {
 955     return !empty($this->billing_options['auto_accident']);
 956   }
 957
 958   function isRelatedOther() {
 959     return !empty($this->billing_options['other_accident']);
 960   }
 961
 962   function autoAccidentState() {
 963     return x12clean(trim($this->billing_options['accident_state']));
 964   }
 965
 966   function isUnableToWork() {
 967     return !empty($this->billing_options['is_unable_to_work']);
 968   }
 969
 970   function offWorkFrom() {
 971     return str_replace('-', '', substr($this->billing_options['off_work_from'], 0, 10));
 972   }
 973
 974   function offWorkTo() {
 975     return str_replace('-', '', substr($this->billing_options['off_work_to'], 0, 10));
 976   }
 977
 978   function isHospitalized() {
 979     return !empty($this->billing_options['is_hospitalized']);
 980   }
 981
 982   function hospitalizedFrom() {
 983     return str_replace('-', '', substr($this->billing_options['hospitalization_date_from'], 0, 10));
 984   }
 985
 986   function hospitalizedTo() {
 987     return str_replace('-', '', substr($this->billing_options['hospitalization_date_to'], 0, 10));
 988   }
 989
 990   function isOutsideLab() {
 991     return !empty($this->billing_options['outside_lab']);
 992   }
 993
 994   function outsideLabAmount() {
 995     return sprintf('%.2f', 0 + $this->billing_options['lab_amount']);
 996   }
 997
 998   function medicaidResubmissionCode() {
 999     return x12clean(trim($this->billing_options['medicaid_resubmission_code']));
1000   }
1001
1002   function medicaidOriginalReference() {
1003     return x12clean(trim($this->billing_options['medicaid_original_reference']));
1004   }
1005
1006   function frequencyTypeCode() {
1007     return empty($this->billing_options['replacement_claim']) ? '1' : '7';
1008   }
1009
1010   function additionalNotes() {
1011     return x12clean(trim($this->billing_options['comments']));
1012   }
1013
1014   // Returns an array of unique diagnoses.  Periods are stripped.
1015   function diagArray() {
1016     $da = array();
1017     foreach ($this->procs as $row) {
1018       $atmp = explode(':', $row['justify']);
1019       foreach ($atmp as $tmp) {
1020         if (!empty($tmp)) {
1021           $diag = str_replace('.', '', $tmp);
1022           $da[$diag] = $diag;
1023         }
1024       }
1025     }
1026     // The above got all the diagnoses used for justification, in the order
1027     // used for justification.  Next we go through all diagnoses, justified
1028     // or not, to make sure they all get into the claim.  We do it this way
1029     // so that the more important diagnoses appear first.
1030     foreach ($this->diags as $diag) {
1031       $diag = str_replace('.', '', $diag);
1032       $da[$diag] = $diag;
1033     }
1034     return $da;
1035   }
1036
1037   // Compute one 1-relative index in diagArray for the given procedure.
1038   // This function is obsolete, use diagIndexArray() instead.
1039   function diagIndex($prockey) {
1040     $da = $this->diagArray();
1041     $tmp = explode(':', $this->procs[$prockey]['justify']);
1042     if (empty($tmp)) return '';
1043     $diag = str_replace('.', '', $tmp[0]);
1044     $i = 0;
1045     foreach ($da as $value) {
1046       ++$i;
1047       if (strcmp($value,$diag) == 0) return $i;
1048     }
1049     return '';
1050   }
1051
1052   // Compute array of 1-relative diagArray indices for the given procedure.
1053   function diagIndexArray($prockey) {
1054     $dia = array();
1055     $da = $this->diagArray();
1056     $atmp = explode(':', $this->procs[$prockey]['justify']);
1057     foreach ($atmp as $tmp) {
1058       if (!empty($tmp)) {
1059         $diag = str_replace('.', '', $tmp);
1060         $i = 0;
1061         foreach ($da as $value) {
1062           ++$i;
1063           if (strcmp($value,$diag) == 0) $dia[] = $i;
1064         }
1065       }
1066     }
1067     return $dia;
1068   }
1069
1070   function providerLastName($prockey=-1) {
1071     $tmp = ($prockey < 0 || empty($this->procs[$prockey]['provider_id'])) ?
1072       $this->provider : $this->procs[$prockey]['provider'];
1073     return x12clean(trim($tmp['lname']));
1074   }
1075
1076   function providerFirstName($prockey=-1) {
1077     $tmp = ($prockey < 0 || empty($this->procs[$prockey]['provider_id'])) ?
1078       $this->provider : $this->procs[$prockey]['provider'];
1079     return x12clean(trim($tmp['fname']));
1080   }
1081
1082   function providerMiddleName($prockey=-1) {
1083     $tmp = ($prockey < 0 || empty($this->procs[$prockey]['provider_id'])) ?
1084       $this->provider : $this->procs[$prockey]['provider'];
1085     return x12clean(trim($tmp['mname']));
1086   }
1087
1088   function providerNPI($prockey=-1) {
1089     $tmp = ($prockey < 0 || empty($this->procs[$prockey]['provider_id'])) ?
1090       $this->provider : $this->procs[$prockey]['provider'];
1091     return x12clean(trim($tmp['npi']));
1092   }
1093
1094   function providerUPIN($prockey=-1) {
1095     $tmp = ($prockey < 0 || empty($this->procs[$prockey]['provider_id'])) ?
1096       $this->provider : $this->procs[$prockey]['provider'];
1097     return x12clean(trim($tmp['upin']));
1098   }
1099
1100   function providerSSN($prockey=-1) {
1101     $tmp = ($prockey < 0 || empty($this->procs[$prockey]['provider_id'])) ?
1102       $this->provider : $this->procs[$prockey]['provider'];
1103     return x12clean(trim(str_replace('-', '', $tmp['federaltaxid'])));
1104   }
1105
1106   function providerTaxonomy($prockey=-1) {
1107     $tmp = ($prockey < 0 || empty($this->procs[$prockey]['provider_id'])) ?
1108       $this->provider : $this->procs[$prockey]['provider'];
1109     if (empty($tmp['taxonomy'])) return '207Q00000X';
1110     return x12clean(trim($tmp['taxonomy']));
1111   }
1112
1113   function referrerLastName() {
1114     return x12clean(trim($this->referrer['lname']));
1115   }
1116
1117   function referrerFirstName() {
1118     return x12clean(trim($this->referrer['fname']));
1119   }
1120
1121   function referrerMiddleName() {
1122     return x12clean(trim($this->referrer['mname']));
1123   }
1124
1125   function referrerNPI() {
1126     return x12clean(trim($this->referrer['npi']));
1127   }
1128
1129   function referrerUPIN() {
1130     return x12clean(trim($this->referrer['upin']));
1131   }
1132
1133   function referrerSSN() {
1134     return x12clean(trim(str_replace('-', '', $this->referrer['federaltaxid'])));
1135   }
1136
1137   function referrerTaxonomy() {
1138     if (empty($this->referrer['taxonomy'])) return '207Q00000X';
1139     return x12clean(trim($this->referrer['taxonomy']));
1140   }
1141
1142   function supervisorLastName() {
1143     return x12clean(trim($this->supervisor['lname']));
1144   }
1145
1146   function supervisorFirstName() {
1147     return x12clean(trim($this->supervisor['fname']));
1148   }
1149
1150   function supervisorMiddleName() {
1151     return x12clean(trim($this->supervisor['mname']));
1152   }
1153
1154   function supervisorNPI() {
1155     return x12clean(trim($this->supervisor['npi']));
1156   }
1157
1158   function supervisorUPIN() {
1159     return x12clean(trim($this->supervisor['upin']));
1160   }
1161
1162   function supervisorSSN() {
1163     return x12clean(trim(str_replace('-', '', $this->supervisor['federaltaxid'])));
1164   }
1165
1166   function supervisorTaxonomy() {
1167     if (empty($this->supervisor['taxonomy'])) return '207Q00000X';
1168     return x12clean(trim($this->supervisor['taxonomy']));
1169   }
1170
1171   function supervisorNumberType() {
1172     return $this->supervisor_numbers['provider_number_type'];
1173   }
1174
1175   function supervisorNumber() {
1176     return x12clean(trim(str_replace('-', '', $this->supervisor_numbers['provider_number'])));
1177   }
1178
1179 }
1180 ?>