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