library/Claim.class.php

   1 <?php
   2 // Copyright (C) 2007 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 $x12_partner;       // row from x12_partners table
  26   var $encounter;         // row from form_encounter table
  27   var $facility;          // row from facility table
  28   var $billing_facility;  // row from facility table
  29   var $provider;          // row from users table (rendering provider)
  30   var $referrer;          // row from users table (referring provider)
  31   var $insurance_numbers; // row from insurance_numbers table for current payer
  32   var $patient_data;      // row from patient_data table
  33   var $billing_options;   // row from form_misc_billing_options table
  34   var $invoice;           // result from get_invoice_summary()
  35   var $payers;            // array of arrays, for all payers
  36
  37   function loadPayerInfo(&$billrow) {
  38     global $sl_err;
  39     $encounter_date = substr($this->encounter['date'], 0, 10);
  40
  41     // Create the $payers array.  This contains data for all insurances
  42     // with the current one always at index 0, and the others in payment
  43     // order starting at index 1.
  44     //
  45     $this->payers = array();
  46     $this->payers[0] = array();
  47     $query = "SELECT * FROM insurance_data WHERE " .
  48       "pid = '{$this->pid}' AND provider != '' AND " .
  49       "date <= '$encounter_date' " .
  50       "ORDER BY type ASC, date DESC";
  51     $dres = sqlStatement($query);
  52     $prevtype = '';
  53     while ($drow = sqlFetchArray($dres)) {
  54       if (strcmp($prevtype, $drow['type']) == 0) continue;
  55       $prevtype = $drow['type'];
  56       $ins = count($this->payers);
  57       if ($drow['provider'] == $billrow['payer_id'] && empty($this->payers[0]['data'])) $ins = 0;
  58       $crow = sqlQuery("SELECT * FROM insurance_companies WHERE " .
  59         "id = '" . $drow['provider'] . "'");
  60       $orow = new InsuranceCompany($drow['provider']);
  61       $this->payers[$ins] = array();
  62       $this->payers[$ins]['data']    = $drow;
  63       $this->payers[$ins]['company'] = $crow;
  64       $this->payers[$ins]['object']  = $orow;
  65     }
  66
  67     // This kludge hands most cases of a rare ambiguous situation, where
  68     // the primary insurance company is the same as the secondary.  It seems
  69     // nobody planned for that!
  70     //
  71     for ($i = 1; $i < count($this->payers); ++$i) {
  72       if ($billrow['process_date'] &&
  73         $this->payers[0]['data']['payer_id'] == $this->payers[$i]['data']['payer_id'])
  74       {
  75         $tmp = $this->payers[0];
  76         $this->payers[0] = $this->payers[$i];
  77         $this->payers[$i] = $tmp;
  78       }
  79     }
  80
  81     $this->using_modifiers = true;
  82
  83     // Get payment and adjustment details if there are any previous payers.
  84     //
  85     $this->invoice = array();
  86     if ($this->payerSequence() != 'P') {
  87       SLConnect();
  88       $arres = SLQuery("select id from ar where invnumber = " .
  89         "'{$this->pid}.{$this->encounter_id}'");
  90       if ($sl_err) die($sl_err);
  91       $arrow = SLGetRow($arres, 0);
  92       if ($arrow) {
  93         $this->invoice = get_invoice_summary($arrow['id'], true);
  94       }
  95       SLClose();
  96       // Secondary claims might not have modifiers in SQL-Ledger data.
  97       // In that case, note that we should not try to match on them.
  98       $this->using_modifiers = false;
  99       foreach ($this->invoice as $key => $trash) {
 100         if (strpos($key, ':')) $this->using_modifiers = true;
 101       }
 102     }
 103   }
 104
 105   // Constructor. Loads relevant database information.
 106   //
 107   function Claim($pid, $encounter_id) {
 108     $this->pid = $pid;
 109     $this->encounter_id = $encounter_id;
 110     $this->procs = array();
 111
 112     // We need the encounter date before we can identify the payers.
 113     $sql = "SELECT * FROM form_encounter WHERE " .
 114       "pid = '{$this->pid}' AND " .
 115       "encounter = '{$this->encounter_id}'";
 116     $this->encounter = sqlQuery($sql);
 117
 118     // Sort by procedure timestamp in order to get some consistency.  In particular
 119     // we determine the provider from the first procedure in this array.
 120     $sql = "SELECT * FROM billing WHERE " .
 121       "encounter = '{$this->encounter_id}' AND pid = '{$this->pid}' AND " .
 122       "(code_type = 'CPT4' OR code_type = 'HCPCS') AND " .
 123       "activity = '1' ORDER BY date, id";
 124     $res = sqlStatement($sql);
 125     while ($row = sqlFetchArray($res)) {
 126       if (!$row['units']) $row['units'] = 1;
 127       // Load prior payer data at the first opportunity in order to get
 128       // the using_modifiers flag that is referenced below.
 129       if (empty($this->procs)) $this->loadPayerInfo($row);
 130       // Consolidate duplicate procedures.
 131       foreach ($this->procs as $key => $trash) {
 132         if (strcmp($this->procs[$key]['code'],$row['code']) == 0 &&
 133             (strcmp($this->procs[$key]['modifier'],$row['modifier']) == 0 ||
 134              !$this->using_modifiers))
 135         {
 136           $this->procs[$key]['units'] += $row['units'];
 137           $this->procs[$key]['fee']   += $row['fee'];
 138           continue 2; // skip to next table row
 139         }
 140       }
 141       $this->procs[] = $row;
 142     }
 143
 144     $sql = "SELECT * FROM x12_partners WHERE " .
 145       "id = '" . $this->procs[0]['x12_partner_id'] . "'";
 146     $this->x12_partner = sqlQuery($sql);
 147
 148     $sql = "SELECT * FROM facility WHERE " .
 149       "name = '" . addslashes($this->encounter['facility']) . "' " .
 150       "ORDER BY id LIMIT 1";
 151     $this->facility = sqlQuery($sql);
 152
 153     $sql = "SELECT * FROM users WHERE " .
 154       "id = '" . $this->procs[0]['provider_id'] . "'";
 155     $this->provider = sqlQuery($sql);
 156
 157     $sql = "SELECT * FROM facility " .
 158       "ORDER BY billing_location DESC, id ASC LIMIT 1";
 159     $this->billing_facility = sqlQuery($sql);
 160
 161     $sql = "SELECT * FROM insurance_numbers WHERE " .
 162       "(insurance_company_id = '" . $this->procs[0]['payer_id'] .
 163       "' OR insurance_company_id is NULL) AND " .
 164       "provider_id = '" . $this->provider['id'] .
 165       "' order by insurance_company_id DESC LIMIT 1";
 166     $this->insurance_numbers = sqlQuery($sql);
 167
 168     $sql = "SELECT * FROM patient_data WHERE " .
 169       "pid = '{$this->pid}' " .
 170       "ORDER BY id LIMIT 1";
 171     $this->patient_data = sqlQuery($sql);
 172
 173     $sql = "SELECT fpa.* FROM forms JOIN form_misc_billing_options AS fpa " .
 174       "ON fpa.id = forms.form_id WHERE " .
 175       "forms.encounter = '{$this->encounter_id}' AND " .
 176       "forms.pid = '{$this->pid}' AND " .
 177       "forms.formdir = 'misc_billing_options' " .
 178       "ORDER BY forms.date";
 179     $this->billing_options = sqlQuery($sql);
 180
 181     $sql = "SELECT * FROM users WHERE " .
 182       "id = '" . $this->patient_data['providerID'] . "'";
 183     $this->referrer = sqlQuery($sql);
 184     if (!$this->referrer) $this->referrer = array();
 185
 186   } // end constructor
 187
 188   // Return an array of adjustments from the designated prior payer for the
 189   // designated procedure key (might be procedure:modifier), or for the claim
 190   // level.  For each adjustment give date, group code, reason code, amount.
 191   // Note this will include "patient responsibility" adjustments which are
 192   // not adjustments to OUR invoice, but they reduce the amount that the
 193   // insurance company pays.
 194   //
 195   function payerAdjustments($ins, $code='Claim') {
 196     $aadj = array();
 197
 198     // If we have no modifiers stored in SQL-Ledger for this claim,
 199     // then we cannot use a modifier passed in with the key.
 200     $tmp = strpos($code, ':');
 201     if ($tmp && !$this->using_modifiers) $code = substr($code, 0, $tmp);
 202
 203     // For payments, source always starts with "Ins" or "Pt".
 204     // Nonzero adjustment reason examples:
 205     //   Ins1 adjust code 42 (Charges exceed ... (obsolete))
 206     //   Ins1 adjust code 45 (Charges exceed your contracted/ legislated fee arrangement)
 207     //   Ins1 adjust code 97 (Payment is included in the allowance for another service/procedure)
 208     //   Ins1 adjust code A2 (Contractual adjustment)
 209     //   Ins adjust Ins1
 210     //   adjust code 45
 211     // Zero adjustment reason examples:
 212     //   Co-pay: 25.00
 213     //   Coinsurance: 11.46  (code 2)   Note: fix remits to identify insurance
 214     //   To deductible: 0.22 (code 1)   Note: fix remits to identify insurance
 215     //   To copay Ins1 (manual entry)
 216     //   To ded'ble Ins1 (manual entry)
 217
 218     if (!empty($this->invoice[$code])) {
 219       $date = '';
 220       $deductible  = 0;
 221       $coinsurance = 0;
 222       $inslabel = ($this->payerSequence($ins) == 'S') ? 'Ins2' : 'Ins1';
 223       $insnumber = substr($inslabel, 3);
 224
 225       // Compute this procedure's patient responsibility amount as of this
 226       // prior payer, which is the original charge minus all insurance
 227       // payments and "hard" adjustments up to this payer.
 228       $ptresp = $this->invoice[$code]['chg'] + $this->invoice[$code]['adj'];
 229       foreach ($this->invoice[$code]['dtl'] as $key => $value) {
 230         if (preg_match("/^Ins(\d)/i", $value['src'], $tmp)) {
 231           if ($tmp[1] <= $insnumber) $ptresp -= $value['pmt'];
 232         }
 233         else if (trim(substr($key, 0, 10))) { // not an adjustment if no date
 234           if (!preg_match("/Ins(\d)/i", $value['rsn'], $tmp) || $tmp[1] <= $insnumber)
 235             $ptresp += $value['chg']; // adjustments are negative charges
 236         }
 237       }
 238       if ($ptresp < 0) $ptresp = 0; // we may be insane but try to hide it
 239
 240       // Main loop, to extract adjustments for this payer and procedure.
 241       foreach ($this->invoice[$code]['dtl'] as $key => $value) {
 242         $tmp = str_replace('-', '', trim(substr($key, 0, 10)));
 243         if ($tmp) $date = $tmp;
 244         if ($tmp && $value['pmt'] == 0) { // not original charge and not a payment
 245           $rsn = $value['rsn'];
 246           $chg = 0 - $value['chg']; // adjustments are negative charges
 247
 248           $gcode = 'CO'; // default group code = contractual obligation
 249           $rcode = '45'; // default reason code = max fee exceeded (code 42 is obsolete)
 250
 251           if (preg_match("/Ins adjust $inslabel/i", $rsn, $tmp)) {
 252             // From manual post. Take the defaults.
 253           }
 254           else if (preg_match("/To copay $inslabel/i", $rsn, $tmp) && !$chg) {
 255             $coinsurance = $ptresp; // from manual post
 256             continue;
 257           }
 258           else if (preg_match("/To ded'ble $inslabel/i", $rsn, $tmp) && !$chg) {
 259             $deductible = $ptresp; // from manual post
 260             continue;
 261           }
 262           else if (preg_match("/$inslabel copay: (\S+)/i", $rsn, $tmp) && !$chg) {
 263             $coinsurance = $tmp[1]; // from 835 as of 6/2007
 264             continue;
 265           }
 266           else if (preg_match("/$inslabel coins: (\S+)/i", $rsn, $tmp) && !$chg) {
 267             $coinsurance = $tmp[1]; // from 835 and manual post as of 6/2007
 268             continue;
 269           }
 270           else if (preg_match("/$inslabel dedbl: (\S+)/i", $rsn, $tmp) && !$chg) {
 271             $deductible = $tmp[1]; // from 835 and manual post as of 6/2007
 272             continue;
 273           }
 274           else if (preg_match("/$inslabel ptresp: (\S+)/i", $rsn, $tmp) && !$chg) {
 275             continue; // from 835 as of 6/2007
 276           }
 277           else if (preg_match("/$inslabel adjust code (\S+)/i", $rsn, $tmp)) {
 278             $rcode = $tmp[1]; // from 835
 279           }
 280           else if (preg_match("/$inslabel/i", $rsn, $tmp)) {
 281             // Take the defaults.
 282           }
 283           else if (preg_match('/Ins(\d)/i', $rsn, $tmp) && $tmp[1] != $insnumber) {
 284             continue; // it's for some other payer
 285           }
 286           else if ($insnumber == '1') {
 287             if (preg_match("/\$\s*adjust code (\S+)/i", $rsn, $tmp)) {
 288               $rcode = $tmp[1]; // from 835
 289             }
 290             else if ($chg) {
 291               // Other adjustments default to Ins1.
 292             }
 293             else if (preg_match("/Co-pay: (\S+)/i", $rsn, $tmp) ||
 294               preg_match("/Coinsurance: (\S+)/i", $rsn, $tmp)) {
 295               $coinsurance = 0 + $tmp[1]; // from 835 before 6/2007
 296               continue;
 297             }
 298             else if (preg_match("/To deductible: (\S+)/i", $rsn, $tmp)) {
 299               $deductible = 0 + $tmp[1]; // from 835 before 6/2007
 300               continue;
 301             }
 302             else {
 303               continue; // there is no adjustment amount
 304             }
 305           }
 306           else {
 307             continue; // it's for primary and that's not us
 308           }
 309
 310           if ($rcode == '42') $rcode= '45'; // reason 42 is obsolete
 311           $aadj[] = array($date, $gcode, $rcode, sprintf('%.2f', $chg));
 312
 313         } // end if
 314       } // end foreach
 315
 316       // If we really messed it up, at least avoid negative numbers.
 317       if ($coinsurance > $ptresp) $coinsurance = $ptresp;
 318       if ($deductible  > $ptresp) $deductible  = $ptresp;
 319
 320       // Find out if this payer paid anything at all on this claim.  This will
 321       // help us allocate any unknown patient responsibility amounts.
 322       $thispaidanything = 0;
 323       foreach($this->invoice as $codekey => $codeval) {
 324         foreach ($codeval['dtl'] as $key => $value) {
 325           if (preg_match("/$inslabel/i", $value['src'], $tmp)) {
 326             $thispaidanything += $value['pmt'];
 327           }
 328         }
 329       }
 330
 331       // Allocate any unknown patient responsibility by guessing if the
 332       // deductible has been satisfied.
 333       if ($thispaidanything)
 334         $coinsurance = $ptresp - $deductible;
 335       else
 336         $deductible = $ptresp - $coinsurance;
 337
 338       if ($date && $deductible != 0)
 339         $aadj[] = array($date, 'PR', '1', sprintf('%.2f', $deductible));
 340       if ($date && $coinsurance != 0)
 341         $aadj[] = array($date, 'PR', '2', sprintf('%.2f', $coinsurance));
 342
 343     } // end if
 344
 345     return $aadj;
 346   }
 347
 348   // Return date, total payments and total "hard" adjustments from the given
 349   // prior payer. If $code is specified then only that procedure key is
 350   // selected, otherwise it's for the whole claim.
 351   //
 352   function payerTotals($ins, $code='') {
 353     // If we have no modifiers stored in SQL-Ledger for this claim,
 354     // then we cannot use a modifier passed in with the key.
 355     $tmp = strpos($code, ':');
 356     if ($tmp && !$this->using_modifiers) $code = substr($code, 0, $tmp);
 357
 358     $inslabel = ($this->payerSequence($ins) == 'S') ? 'Ins2' : 'Ins1';
 359     $paytotal = 0;
 360     $adjtotal = 0;
 361     $date = '';
 362     foreach($this->invoice as $codekey => $codeval) {
 363       if ($code && strcmp($codekey,$code) != 0) continue;
 364       foreach ($codeval['dtl'] as $key => $value) {
 365         if (preg_match("/$inslabel/i", $value['src'], $tmp)) {
 366           if (!$date) $date = str_replace('-', '', trim(substr($key, 0, 10)));
 367           $paytotal += $value['pmt'];
 368         }
 369       }
 370       $aarr = $this->payerAdjustments($ins, $codekey);
 371       foreach ($aarr as $a) {
 372         if (strcmp($a[1],'PR') != 0) $adjtotal += $a[3];
 373         if (!$date) $date = $a[0];
 374       }
 375     }
 376     return array($date, sprintf('%.2f', $paytotal), sprintf('%.2f', $adjtotal));
 377   }
 378
 379   // Return the amount already paid by the patient.
 380   //
 381   function patientPaidAmount() {
 382
 383     // TBD: This does not work for a primary claim because $this->invoice
 384     // is not loaded.  Might be good to get the co-pay from the billing
 385     // table in that case.
 386
 387     $amount = 0;
 388     foreach($this->invoice as $codekey => $codeval) {
 389       foreach ($codeval['dtl'] as $key => $value) {
 390         if (!preg_match("/Ins/i", $value['src'], $tmp)) {
 391           $amount += $value['pmt'];
 392         }
 393       }
 394     }
 395     return sprintf('%.2f', $amount);
 396   }
 397
 398   // Return invoice total, including adjustments but not payments.
 399   //
 400   function invoiceTotal() {
 401     $amount = 0;
 402     foreach($this->invoice as $codekey => $codeval) {
 403       $amount += $codeval['chg'];
 404     }
 405     return sprintf('%.2f', $amount);
 406   }
 407
 408   // Number of procedures in this claim.
 409   function procCount() {
 410     return count($this->procs);
 411   }
 412
 413   // Number of payers for this claim. Ranges from 1 to 3.
 414   function payerCount() {
 415     return count($this->payers);
 416   }
 417
 418   function x12gsversionstring() {
 419     return x12clean(trim($this->x12_partner['x12_version']));
 420   }
 421
 422   function x12gssenderid() {
 423     $tmp = $this->x12_partner['x12_sender_id'];
 424     while (strlen($tmp) < 15) $tmp .= " ";
 425     return $tmp;
 426   }
 427
 428   function x12gsreceiverid() {
 429     $tmp = $this->x12_partner['x12_receiver_id'];
 430     while (strlen($tmp) < 15) $tmp .= " ";
 431     return $tmp;
 432   }
 433
 434   function cliaCode() {
 435     return x12clean(trim($this->facility['domain_identifier']));
 436   }
 437
 438   function billingFacilityName() {
 439     return x12clean(trim($this->billing_facility['name']));
 440   }
 441
 442   function billingFacilityStreet() {
 443     return x12clean(trim($this->billing_facility['street']));
 444   }
 445
 446   function billingFacilityCity() {
 447     return x12clean(trim($this->billing_facility['city']));
 448   }
 449
 450   function billingFacilityState() {
 451     return x12clean(trim($this->billing_facility['state']));
 452   }
 453
 454   function billingFacilityZip() {
 455     return x12clean(trim($this->billing_facility['postal_code']));
 456   }
 457
 458   function billingFacilityETIN() {
 459     return x12clean(trim(str_replace('-', '', $this->billing_facility['federal_ein'])));
 460   }
 461
 462   function billingFacilityNPI() {
 463     return x12clean(trim($this->billing_facility['facility_npi']));
 464   }
 465
 466   function billingContactName() {
 467     return x12clean(trim($this->billing_facility['attn']));
 468   }
 469
 470   function billingContactPhone() {
 471     if (preg_match("/([2-9]\d\d)\D*(\d\d\d)\D*(\d\d\d\d)/",
 472       $this->billing_facility['phone'], $tmp))
 473     {
 474       return $tmp[1] . $tmp[2] . $tmp[3];
 475     }
 476     return '';
 477   }
 478
 479   function facilityName() {
 480     return x12clean(trim($this->facility['name']));
 481   }
 482
 483   function facilityStreet() {
 484     return x12clean(trim($this->facility['street']));
 485   }
 486
 487   function facilityCity() {
 488     return x12clean(trim($this->facility['city']));
 489   }
 490
 491   function facilityState() {
 492     return x12clean(trim($this->facility['state']));
 493   }
 494
 495   function facilityZip() {
 496     return x12clean(trim($this->facility['postal_code']));
 497   }
 498
 499   function facilityETIN() {
 500     return x12clean(trim(str_replace('-', '', $this->facility['federal_ein'])));
 501   }
 502
 503   function facilityNPI() {
 504     return x12clean(trim($this->facility['facility_npi']));
 505   }
 506
 507   function facilityPOS() {
 508     return x12clean(trim($this->facility['pos_code']));
 509   }
 510
 511   function clearingHouseName() {
 512     return x12clean(trim($this->x12_partner['name']));
 513   }
 514
 515   function clearingHouseETIN() {
 516     return x12clean(trim(str_replace('-', '', $this->x12_partner['id_number'])));
 517   }
 518
 519   function providerNumberType() {
 520     return $this->insurance_numbers['provider_number_type'];
 521   }
 522
 523   function providerNumber() {
 524     return x12clean(trim(str_replace('-', '', $this->insurance_numbers['provider_number'])));
 525   }
 526
 527   // Returns 'P', 'S' or 'T'.
 528   //
 529   function payerSequence($ins=0) {
 530     return strtoupper(substr($this->payers[$ins]['data']['type'], 0, 1));
 531   }
 532
 533   // Returns the HIPAA code of the patient-to-subscriber relationship.
 534   //
 535   function insuredRelationship($ins=0) {
 536     $tmp = strtolower($this->payers[$ins]['data']['subscriber_relationship']);
 537     if (strcmp($tmp,'self'  ) == 0) return '18';
 538     if (strcmp($tmp,'spouse') == 0) return '01';
 539     if (strcmp($tmp,'child' ) == 0) return '19';
 540     if (strcmp($tmp,'other' ) == 0) return 'G8';
 541     return $tmp; // should not happen
 542   }
 543
 544   function insuredTypeCode($ins=0) {
 545     if (strcmp($this->claimType($ins),'MB') == 0 && $this->payerSequence($ins) != 'P')
 546       return '12'; // medicare secondary working aged beneficiary or
 547                    // spouse with employer group health plan
 548     return '';
 549   }
 550
 551   // Is the patient also the subscriber?
 552   //
 553   function isSelfOfInsured($ins=0) {
 554     $tmp = strtolower($this->payers[$ins]['data']['subscriber_relationship']);
 555     return (strcmp($tmp,'self') == 0);
 556   }
 557
 558   function groupNumber($ins=0) {
 559     return x12clean(trim($this->payers[$ins]['data']['group_number']));
 560   }
 561
 562   function groupName($ins=0) {
 563     return x12clean(trim($this->payers[$ins]['data']['subscriber_employer']));
 564   }
 565
 566   function claimType($ins=0) {
 567     if (empty($this->payers[$ins]['object'])) return '';
 568     return $this->payers[$ins]['object']->get_freeb_claim_type();
 569   }
 570
 571   function insuredLastName($ins=0) {
 572     return x12clean(trim($this->payers[$ins]['data']['subscriber_lname']));
 573   }
 574
 575   function insuredFirstName($ins=0) {
 576     return x12clean(trim($this->payers[$ins]['data']['subscriber_fname']));
 577   }
 578
 579   function insuredMiddleName($ins=0) {
 580     return x12clean(trim($this->payers[$ins]['data']['subscriber_mname']));
 581   }
 582
 583   function policyNumber($ins=0) { // "ID"
 584     return x12clean(trim($this->payers[$ins]['data']['policy_number']));
 585   }
 586
 587   function insuredStreet($ins=0) {
 588     return x12clean(trim($this->payers[$ins]['data']['subscriber_street']));
 589   }
 590
 591   function insuredCity($ins=0) {
 592     return x12clean(trim($this->payers[$ins]['data']['subscriber_city']));
 593   }
 594
 595   function insuredState($ins=0) {
 596     return x12clean(trim($this->payers[$ins]['data']['subscriber_state']));
 597   }
 598
 599   function insuredZip($ins=0) {
 600     return x12clean(trim($this->payers[$ins]['data']['subscriber_postal_code']));
 601   }
 602
 603   function insuredDOB($ins=0) {
 604     return str_replace('-', '', $this->payers[$ins]['data']['subscriber_DOB']);
 605   }
 606
 607   function insuredSex($ins=0) {
 608     return strtoupper(substr($this->payers[$ins]['data']['subscriber_sex'], 0, 1));
 609   }
 610
 611   function payerName($ins=0) {
 612     return x12clean(trim($this->payers[$ins]['company']['name']));
 613   }
 614
 615   function payerStreet($ins=0) {
 616     if (empty($this->payers[$ins]['object'])) return '';
 617     $tmp = $this->payers[$ins]['object'];
 618     $tmp = $tmp->get_address();
 619     return x12clean(trim($tmp->get_line1()));
 620   }
 621
 622   function payerCity($ins=0) {
 623     if (empty($this->payers[$ins]['object'])) return '';
 624     $tmp = $this->payers[$ins]['object'];
 625     $tmp = $tmp->get_address();
 626     return x12clean(trim($tmp->get_city()));
 627   }
 628
 629   function payerState($ins=0) {
 630     if (empty($this->payers[$ins]['object'])) return '';
 631     $tmp = $this->payers[$ins]['object'];
 632     $tmp = $tmp->get_address();
 633     return x12clean(trim($tmp->get_state()));
 634   }
 635
 636   function payerZip($ins=0) {
 637     if (empty($this->payers[$ins]['object'])) return '';
 638     $tmp = $this->payers[$ins]['object'];
 639     $tmp = $tmp->get_address();
 640     return x12clean(trim($tmp->get_zip()));
 641   }
 642
 643   function payerID($ins=0) {
 644     return x12clean(trim($this->payers[$ins]['company']['cms_id']));
 645   }
 646
 647   function patientLastName() {
 648     return x12clean(trim($this->patient_data['lname']));
 649   }
 650
 651   function patientFirstName() {
 652     return x12clean(trim($this->patient_data['fname']));
 653   }
 654
 655   function patientMiddleName() {
 656     return x12clean(trim($this->patient_data['mname']));
 657   }
 658
 659   function patientStreet() {
 660     return x12clean(trim($this->patient_data['street']));
 661   }
 662
 663   function patientCity() {
 664     return x12clean(trim($this->patient_data['city']));
 665   }
 666
 667   function patientState() {
 668     return x12clean(trim($this->patient_data['state']));
 669   }
 670
 671   function patientZip() {
 672     return x12clean(trim($this->patient_data['postal_code']));
 673   }
 674
 675   function patientDOB() {
 676     return str_replace('-', '', $this->patient_data['DOB']);
 677   }
 678
 679   function patientSex() {
 680     return strtoupper(substr($this->patient_data['sex'], 0, 1));
 681   }
 682
 683   function cptCode($prockey) {
 684     return x12clean(trim($this->procs[$prockey]['code']));
 685   }
 686
 687   function cptModifier($prockey) {
 688     return x12clean(trim($this->procs[$prockey]['modifier']));
 689   }
 690
 691   // Returns the procedure code, followed by ":modifier" if there is one.
 692   function cptKey($prockey) {
 693     $tmp = $this->cptModifier($prockey);
 694     return $this->cptCode($prockey) . ($tmp ? ":$tmp" : "");
 695   }
 696
 697   function cptCharges($prockey) {
 698     return x12clean(trim($this->procs[$prockey]['fee']));
 699   }
 700
 701   function cptUnits($prockey) {
 702     if (empty($this->procs[$prockey]['units'])) return '1';
 703     return x12clean(trim($this->procs[$prockey]['units']));
 704   }
 705
 706   // NDC drug ID.
 707   function cptNDCID($prockey) {
 708     $ndcinfo = $this->procs[$prockey]['ndc_info'];
 709     if (preg_match('/^N4(\S+)\s+(\S\S)(.*)/', $ndcinfo, $tmp)) {
 710       $ndc = $tmp[1];
 711       if (preg_match('/^(\d+)-(\d+)-(\d+)$/', $ndc, $tmp)) {
 712         return sprintf('%05d-%04d-%02d', $tmp[1], $tmp[2], $tmp[3]);
 713       }
 714       return x12clean($ndc); // format is bad but return it anyway
 715     }
 716     return '';
 717   }
 718
 719   // NDC drug unit of measure code.
 720   function cptNDCUOM($prockey) {
 721     $ndcinfo = $this->procs[$prockey]['ndc_info'];
 722     if (preg_match('/^N4(\S+)\s+(\S\S)(.*)/', $ndcinfo, $tmp))
 723       return x12clean($tmp[2]);
 724     return '';
 725   }
 726
 727   // NDC drug number of units.
 728   function cptNDCQuantity($prockey) {
 729     $ndcinfo = $this->procs[$prockey]['ndc_info'];
 730     if (preg_match('/^N4(\S+)\s+(\S\S)(.*)/', $ndcinfo, $tmp)) {
 731       return x12clean(ltrim($tmp[3], '0'));
 732     }
 733     return '';
 734   }
 735
 736   function onsetDate() {
 737     return str_replace('-', '', substr($this->encounter['onset_date'], 0, 10));
 738   }
 739
 740   function serviceDate() {
 741     return str_replace('-', '', substr($this->encounter['date'], 0, 10));
 742   }
 743
 744   function priorAuth() {
 745     return x12clean(trim($this->billing_options['prior_auth_number']));
 746   }
 747
 748   // Returns an array of unique primary diagnoses.  Periods are stripped.
 749   function diagArray() {
 750     $da = array();
 751     foreach ($this->procs as $row) {
 752       $tmp = explode(':', $row['justify']);
 753       if (count($tmp)) {
 754         $diag = str_replace('.', '', $tmp[0]);
 755         $da[$diag] = $diag;
 756       }
 757     }
 758     return $da;
 759   }
 760
 761   // Compute the 1-relative index in diagArray for the given procedure.
 762   function diagIndex($prockey) {
 763     $da = $this->diagArray();
 764     $tmp = explode(':', $this->procs[$prockey]['justify']);
 765     if (empty($tmp)) return '';
 766     $diag = str_replace('.', '', $tmp[0]);
 767     $i = 0;
 768     foreach ($da as $value) {
 769       ++$i;
 770       if (strcmp($value,$diag) == 0) return $i;
 771     }
 772     return '';
 773   }
 774
 775   function providerLastName() {
 776     return x12clean(trim($this->provider['lname']));
 777   }
 778
 779   function providerFirstName() {
 780     return x12clean(trim($this->provider['fname']));
 781   }
 782
 783   function providerMiddleName() {
 784     return x12clean(trim($this->provider['mname']));
 785   }
 786
 787   function providerNPI() {
 788     return x12clean(trim($this->provider['npi']));
 789   }
 790
 791   function providerUPIN() {
 792     return x12clean(trim($this->provider['upin']));
 793   }
 794
 795   function providerSSN() {
 796     return x12clean(trim(str_replace('-', '', $this->provider['federaltaxid'])));
 797   }
 798
 799   function referrerLastName() {
 800     return x12clean(trim($this->referrer['lname']));
 801   }
 802
 803   function referrerFirstName() {
 804     return x12clean(trim($this->referrer['fname']));
 805   }
 806
 807   function referrerMiddleName() {
 808     return x12clean(trim($this->referrer['mname']));
 809   }
 810
 811   function referrerNPI() {
 812     return x12clean(trim($this->referrer['npi']));
 813   }
 814
 815   function referrerUPIN() {
 816     return x12clean(trim($this->referrer['upin']));
 817   }
 818
 819   function referrerSSN() {
 820     return x12clean(trim(str_replace('-', '', $this->referrer['federaltaxid'])));
 821   }
 822 }
 823 ?>