library/gen_x12_837.inc.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("Claim.class.php");
  10
  11 function gen_x12_837($pid, $encounter, &$log) {
  12
  13   $today = time();
  14   $out = '';
  15   $claim = new Claim($pid, $encounter);
  16   $edicount = 0;
  17
  18   $log .= "Generating claim $pid-$encounter for " .
  19     $claim->patientFirstName()  . ' ' .
  20     $claim->patientMiddleName() . ' ' .
  21     $claim->patientLastName()   . ' on ' .
  22     date('Y-m-d H:i', $today) . ".\n";
  23
  24   $out .= "ISA" .
  25     "*00" .
  26     "*          " .
  27     "*00" .
  28     "*          " .
  29     "*ZZ" .
  30     "*" . $claim->x12gssenderid() .
  31     "*ZZ" .
  32     "*" . $claim->x12gsreceiverid() .
  33     "*030911" .
  34     "*1630" .
  35     "*U" .
  36     "*00401" .
  37     "*000000001" .
  38     "*0" .
  39     "*P" .
  40     "*:" .
  41     "~\n";
  42
  43   $out .= "GS" .
  44     "*HC" .
  45     "*" . $claim->x12gssenderid() .
  46     "*" . $claim->x12gsreceiverid() .
  47     "*" . date('Ymd', $today) .
  48     "*" . date('Hi', $today) .
  49     "*1" .
  50     "*X" .
  51     "*" . $claim->x12gsversionstring() .
  52     "~\n";
  53
  54   ++$edicount;
  55   $out .= "ST" .
  56     "*837" .
  57     "*0021" .
  58     "~\n";
  59
  60   ++$edicount;
  61   $out .= "BHT" .
  62     "*0019" .
  63     "*00" .
  64     "*0123" .
  65     "*" . date('Ymd', $today) .
  66     "*1023" .
  67     "*CH" .
  68     "~\n";
  69
  70   ++$edicount;
  71   $out .= "REF" .
  72     "*87" .
  73     "*" . $claim->x12gsversionstring() .
  74     "~\n";
  75
  76   ++$edicount;
  77   $out .= "NM1" .       // Loop 1000A Submitter
  78     "*41" .
  79     "*2" .
  80     "*" . $claim->billingFacilityName() .
  81     "*" .
  82     "*" .
  83     "*" .
  84     "*" .
  85     "*46" .
  86     "*" . $claim->billingFacilityETIN() .
  87     "~\n";
  88
  89   ++$edicount;
  90   $out .= "PER" .
  91     "*IC" .
  92     "*" . $claim->billingContactName() .
  93     "*TE" .
  94     "*" . $claim->billingContactPhone() .
  95     "~\n";
  96
  97   ++$edicount;
  98   $out .= "NM1" .       // Loop 1000B Receiver
  99     "*40" .
 100     "*2" .
 101     "*" . $claim->clearingHouseName() .
 102     "*" .
 103     "*" .
 104     "*" .
 105     "*" .
 106     "*46" .
 107     "*" . $claim->clearingHouseETIN() .
 108     "~\n";
 109
 110   $HLcount = 1;
 111
 112   ++$edicount;
 113   $out .= "HL" .        // Loop 2000A Billing/Pay-To Provider HL Loop
 114     "*$HLcount" .
 115     "*" .
 116     "*20" .
 117     "*1" .
 118     "~\n";
 119
 120   $HLBillingPayToProvider = $HLcount++;
 121
 122   ++$edicount;
 123   $out .= "NM1" .       // Loop 2010AA Billing Provider
 124     "*85" .
 125     "*2" .
 126     "*" . $claim->billingFacilityName() .
 127     "*" .
 128     "*" .
 129     "*" .
 130     "*";
 131   if ($claim->billingFacilityNPI()) {
 132     $out .= "*XX*" . $claim->billingFacilityNPI();
 133   } else {
 134     $log .= "*** Billing facility has no NPI.\n";
 135     $out .= "*24*" . $claim->billingFacilityETIN();
 136   }
 137   $out .= "~\n";
 138
 139   ++$edicount;
 140   $out .= "N3" .
 141     "*" . $claim->billingFacilityStreet() .
 142     "~\n";
 143
 144   ++$edicount;
 145   $out .= "N4" .
 146     "*" . $claim->billingFacilityCity() .
 147     "*" . $claim->billingFacilityState() .
 148     "*" . $claim->billingFacilityZip() .
 149     "~\n";
 150
 151   // Add a REF*EI*<ein> segment if NPI was specified in the NM1 above.
 152   if ($claim->billingFacilityNPI() && $claim->billingFacilityETIN()) {
 153     ++$edicount;
 154     $out .= "REF" .
 155       "*EI" .
 156       "*" . $claim->billingFacilityETIN() .
 157       "~\n";
 158   }
 159
 160   if ($claim->providerNumberType() && $claim->providerNumber()) {
 161     ++$edicount;
 162     $out .= "REF" .
 163       "*" . $claim->providerNumberType() .
 164       "*" . $claim->providerNumber() .
 165       "~\n";
 166   }
 167   else if ($claim->providerNumber()) {
 168     $log .= "*** Payer-specific provider insurance number is present but has no type assigned.\n";
 169   }
 170
 171   ++$edicount;
 172   $out .= "NM1" .       // Loop 2010AB Pay-To Provider
 173     "*87" .
 174     "*2" .
 175     "*" . $claim->billingFacilityName() .
 176     "*" .
 177     "*" .
 178     "*" .
 179     "*";
 180   if ($claim->billingFacilityNPI())
 181     $out .= "*XX*" . $claim->billingFacilityNPI();
 182   else
 183     $out .= "*24*" . $claim->billingFacilityETIN();
 184   $out .= "~\n";
 185
 186   ++$edicount;
 187   $out .= "N3" .
 188     "*" . $claim->billingFacilityStreet() .
 189     "~\n";
 190
 191   ++$edicount;
 192   $out .= "N4" .
 193     "*" . $claim->billingFacilityCity() .
 194     "*" . $claim->billingFacilityState() .
 195     "*" . $claim->billingFacilityZip() .
 196     "~\n";
 197
 198   if ($claim->billingFacilityNPI() && $claim->billingFacilityETIN()) {
 199     ++$edicount;
 200     $out .= "REF" .
 201       "*EI" .
 202       "*" . $claim->billingFacilityETIN() .
 203       "~\n";
 204   }
 205
 206   $PatientHL = 0;
 207
 208   ++$edicount;
 209   $out .= "HL" .        // Loop 2000B Subscriber HL Loop
 210     "*$HLcount" .
 211     "*$HLBillingPayToProvider" .
 212     "*22" .
 213     "*$PatientHL" .
 214     "~\n";
 215
 216   $HLSubscriber = $HLcount++;
 217
 218   if (!$claim->payerSequence()) {
 219     $log .= "*** Error: Insurance information is missing!\n";
 220   }
 221   ++$edicount;
 222   $out .= "SBR" .       // Subscriber Information
 223     "*" . $claim->payerSequence() .
 224     "*" . $claim->insuredRelationship() .
 225     "*" . $claim->groupNumber() .
 226     "*" . $claim->groupName() .
 227     "*" . $claim->insuredTypeCode() . // applies for secondary medicare
 228     "*" .
 229     "*" .
 230     "*" .
 231     "*" . $claim->claimType() . // Zirmed replaces this
 232     "~\n";
 233
 234   ++$edicount;
 235   $out .= "NM1" .       // Loop 2010BA Subscriber
 236     "*IL" .
 237     "*1" .
 238     "*" . $claim->insuredLastName() .
 239     "*" . $claim->insuredFirstName() .
 240     "*" . $claim->insuredMiddleName() .
 241     "*" .
 242     "*" .
 243     "*MI" .
 244     "*" . $claim->policyNumber() .
 245     "~\n";
 246
 247   ++$edicount;
 248   $out .= "N3" .
 249     "*" . $claim->insuredStreet() .
 250     "~\n";
 251
 252   ++$edicount;
 253   $out .= "N4" .
 254     "*" . $claim->insuredCity() .
 255     "*" . $claim->insuredState() .
 256     "*" . $claim->insuredZip() .
 257     "~\n";
 258
 259   ++$edicount;
 260   $out .= "DMG" .
 261     "*D8" .
 262     "*" . $claim->insuredDOB() .
 263     "*" . $claim->insuredSex() .
 264     "~\n";
 265
 266   ++$edicount;
 267   $out .= "NM1" .       // Loop 2010BB Payer
 268     "*PR" .
 269     "*2" .
 270     "*" . $claim->payerName() .
 271     "*" .
 272     "*" .
 273     "*" .
 274     "*" .
 275     "*PI" .
 276     "*" . $claim->payerID() . // Zirmed ignores this if using Payer Name Matching.
 277     "~\n";
 278
 279   // if (!$claim->payerID()) {
 280   //   $log .= "*** CMS ID is missing for payer '" . $claim->payerName() . "'.\n";
 281   // }
 282
 283   ++$edicount;
 284   $out .= "N3" .
 285     "*" . $claim->payerStreet() .
 286     "~\n";
 287
 288   ++$edicount;
 289   $out .= "N4" .
 290     "*" . $claim->payerCity() .
 291     "*" . $claim->payerState() .
 292     "*" . $claim->payerZip() .
 293     "~\n";
 294
 295   if (! $claim->isSelfOfInsured()) {
 296     ++$edicount;
 297     $out .= "HL" .        // Loop 2000C Patient Information
 298       "*$HLcount" .
 299       "*$HLSubscriber" .
 300       "*23" .
 301       "*0" .
 302       "~\n";
 303
 304     $HLcount++;
 305
 306     ++$edicount;
 307     $out .= "PAT" .
 308       "*" . $claim->insuredRelationship() .
 309       "~\n";
 310
 311     ++$edicount;
 312     $out .= "NM1" .       // Loop 2010CA Patient
 313       "*QC" .
 314       "*1" .
 315       "*" . $claim->patientLastName() .
 316       "*" . $claim->patientFirstName() .
 317       "*" . $claim->patientMiddleName() .
 318       "~\n";
 319
 320     ++$edicount;
 321     $out .= "N3" .
 322       "*" . $claim->patientStreet() .
 323       "~\n";
 324
 325     ++$edicount;
 326     $out .= "N4" .
 327       "*" . $claim->patientCity() .
 328       "*" . $claim->patientState() .
 329       "*" . $claim->patientZip() .
 330       "~\n";
 331
 332     ++$edicount;
 333     $out .= "DMG" .
 334       "*D8" .
 335       "*" . $claim->patientDOB() .
 336       "*" . $claim->patientSex() .
 337       "~\n";
 338   } // end of patient different from insured
 339
 340   $proccount = $claim->procCount();
 341
 342   $clm_total_charges = 0;
 343   for ($prockey = 0; $prockey < $proccount; ++$prockey) {
 344     $clm_total_charges += $claim->cptCharges($prockey);
 345   }
 346
 347   if (!$clm_total_charges) {
 348     $log .= "*** This claim has no charges!\n";
 349   }
 350
 351   ++$edicount;
 352   $out .= "CLM" .       // Loop 2300 Claim
 353     "*$pid-$encounter" .
 354     "*"  . sprintf("%.2f",$clm_total_charges) . // Zirmed computes and replaces this
 355     "*"  .
 356     "*"  .
 357     "*"  . $claim->facilityPOS() . "::" . $claim->frequencyTypeCode() .
 358     "*Y" .
 359     "*A" .
 360     "*"  . ($claim->billingFacilityAssignment() ? 'Y' : 'N') .
 361     "*Y" .
 362     "*C" .
 363     "~\n";
 364
 365   ++$edicount;
 366   $out .= "DTP" .       // Date of Onset
 367     "*431" .
 368     "*D8" .
 369     "*" . $claim->onsetDate() .
 370     "~\n";
 371
 372   if (strcmp($claim->facilityPOS(),'21') == 0) {
 373     ++$edicount;
 374     $out .= "DTP" .     // Date of Hospitalization
 375       "*435" .
 376       "*D8" .
 377       "*" . $claim->onsetDate() .
 378       "~\n";
 379   }
 380
 381   $patientpaid = $claim->patientPaidAmount();
 382   if ($patientpaid != 0) {
 383     ++$edicount;
 384     $out .= "AMT" .     // Patient paid amount. Page 220.
 385       "*F5" .
 386       "*" . $patientpaid .
 387       "~\n";
 388   }
 389
 390   if ($claim->priorAuth()) {
 391     ++$edicount;
 392     $out .= "REF" .     // Prior Authorization Number
 393       "*G1" .
 394       "*" . $claim->priorAuth() .
 395       "~\n";
 396   }
 397
 398   if ($claim->cliaCode()) {
 399     // Required by Medicare when in-house labs are done.
 400     ++$edicount;
 401     $out .= "REF" .     // Clinical Laboratory Improvement Amendment Number
 402       "*X4" .
 403       "*" . $claim->cliaCode() .
 404       "~\n";
 405   }
 406
 407   // Note: This would be the place to implement the NTE segment for loop 2300.
 408
 409   $da = $claim->diagArray();
 410   ++$edicount;
 411   $out .= "HI";         // Health Diagnosis Codes
 412   $diag_type_code = 'BK';
 413   foreach ($da as $diag) {
 414     $out .= "*$diag_type_code:" . $diag;
 415     $diag_type_code = 'BF';
 416   }
 417   $out .= "~\n";
 418
 419   if ($claim->referrerLastName()) {
 420     // Medicare requires referring provider's name and UPIN.
 421     ++$edicount;
 422     $out .= "NM1" .     // Loop 2310A Referring Provider
 423       "*DN" .
 424       "*1" .
 425       "*" . $claim->referrerLastName() .
 426       "*" . $claim->referrerFirstName() .
 427       "*" . $claim->referrerMiddleName() .
 428       "*" .
 429       "*";
 430     if ($claim->referrerNPI()) { $out .=
 431       "*XX" .
 432       "*" . $claim->referrerNPI();
 433     } else { $out .=
 434       "*34" .
 435       "*" . $claim->referrerSSN();
 436     }
 437     $out .= "~\n";
 438
 439     if ($claim->referrerTaxonomy()) {
 440       ++$edicount;
 441       $out .= "PRV" .
 442         "*RF" . // ReFerring provider
 443         "*ZZ" .
 444         "*" . $claim->referrerTaxonomy() .
 445         "~\n";
 446     }
 447
 448     if ($claim->referrerUPIN()) {
 449       ++$edicount;
 450       $out .= "REF" .   // Referring Provider Secondary Identification
 451         "*1G" .
 452         "*" . $claim->referrerUPIN() .
 453         "~\n";
 454     }
 455   }
 456
 457   ++$edicount;
 458   $out .= "NM1" .       // Loop 2310B Rendering Provider
 459     "*82" .
 460     "*1" .
 461     "*" . $claim->providerLastName() .
 462     "*" . $claim->providerFirstName() .
 463     "*" . $claim->providerMiddleName() .
 464     "*" .
 465     "*";
 466   if ($claim->providerNPI()) { $out .=
 467     "*XX" .
 468     "*" . $claim->providerNPI();
 469   } else { $out .=
 470     "*34" .
 471     "*" . $claim->providerSSN();
 472     $log .= "*** Rendering provider has no NPI.\n";
 473   }
 474   $out .= "~\n";
 475
 476   if ($claim->providerTaxonomy()) {
 477     ++$edicount;
 478     $out .= "PRV" .
 479       "*PE" . // PErforming provider
 480       "*ZZ" .
 481       "*" . $claim->providerTaxonomy() .
 482       "~\n";
 483   }
 484
 485   // REF*1C is required here for the Medicare provider number if NPI was
 486   // specified in NM109.  Not sure if other payers require anything here.
 487   if ($claim->providerNumber()) {
 488     ++$edicount;
 489     $out .= "REF" .
 490       "*" . $claim->providerNumberType() .
 491       "*" . $claim->providerNumber() .
 492       "~\n";
 493   }
 494
 495   // Loop 2310D is omitted in the case of home visits (POS=12).
 496   if ($claim->facilityPOS() != 12) {
 497     ++$edicount;
 498     $out .= "NM1" .       // Loop 2310D Service Location
 499       "*77" .
 500       "*2";
 501     if ($claim->facilityName() || $claim->facilityNPI() || $claim->facilityETIN()) { $out .=
 502       "*" . $claim->facilityName();
 503     }
 504     if ($claim->facilityNPI() || $claim->facilityETIN()) { $out .=
 505       "*" .
 506       "*" .
 507       "*" .
 508       "*";
 509       if ($claim->facilityNPI()) { $out .=
 510         "*XX*" . $claim->facilityNPI();
 511       } else { $out .=
 512         "*24*" . $claim->facilityETIN();
 513         $log .= "*** Service location has no NPI.\n";
 514       }
 515     }
 516     $out .= "~\n";
 517     if ($claim->facilityStreet()) {
 518       ++$edicount;
 519       $out .= "N3" .
 520         "*" . $claim->facilityStreet() .
 521         "~\n";
 522     }
 523     if ($claim->facilityState()) {
 524       ++$edicount;
 525       $out .= "N4" .
 526         "*" . $claim->facilityCity() .
 527         "*" . $claim->facilityState() .
 528         "*" . $claim->facilityZip() .
 529         "~\n";
 530     }
 531   }
 532
 533   // Loop 2310E, Supervising Provider
 534   //
 535   if ($claim->supervisorLastName()) {
 536     ++$edicount;
 537     $out .= "NM1" .
 538       "*DQ" . // Supervising Physician
 539       "*1" .  // Person
 540       "*" . $claim->supervisorLastName() .
 541       "*" . $claim->supervisorFirstName() .
 542       "*" . $claim->supervisorMiddleName() .
 543       "*" .   // NM106 not used
 544       "*";    // Name Suffix
 545     if ($claim->supervisorNPI()) { $out .=
 546       "*XX" .
 547       "*" . $claim->supervisorNPI();
 548     } else { $out .=
 549       "*34" .
 550       "*" . $claim->supervisorSSN();
 551     }
 552     $out .= "~\n";
 553
 554     if ($claim->supervisorNumber()) {
 555       ++$edicount;
 556       $out .= "REF" .
 557         "*" . $claim->supervisorNumberType() .
 558         "*" . $claim->supervisorNumber() .
 559         "~\n";
 560     }
 561   }
 562
 563   $prev_pt_resp = $clm_total_charges; // for computation below
 564
 565   // Loops 2320 and 2330*, other subscriber/payer information.
 566   //
 567   for ($ins = 1; $ins < $claim->payerCount(); ++$ins) {
 568
 569     $tmp1 = $claim->claimType($ins);
 570     $tmp2 = 'C1'; // Here a kludge. See page 321.
 571     if ($tmp1 === 'CI') $tmp2 = 'C1';
 572     if ($tmp1 === 'AM') $tmp2 = 'AP';
 573     if ($tmp1 === 'HM') $tmp2 = 'HM';
 574     if ($tmp1 === 'MB') $tmp2 = 'MB';
 575     if ($tmp1 === 'MC') $tmp2 = 'MC';
 576     if ($tmp1 === '09') $tmp2 = 'PP';
 577     ++$edicount;
 578     $out .= "SBR" . // Loop 2320, Subscriber Information - page 318
 579       "*" . $claim->payerSequence($ins) .
 580       "*" . $claim->insuredRelationship($ins) .
 581       "*" . $claim->groupNumber($ins) .
 582       "*" . $claim->groupName($ins) .
 583       "*" . $tmp2 .
 584       "*" .
 585       "*" .
 586       "*" .
 587       "*" . $claim->claimType($ins) .
 588       "~\n";
 589
 590     // Things that apply only to previous payers, not future payers.
 591     //
 592     if ($claim->payerSequence($ins) < $claim->payerSequence()) {
 593
 594       // Generate claim-level adjustments.
 595       $aarr = $claim->payerAdjustments($ins);
 596       foreach ($aarr as $a) {
 597         ++$edicount;
 598         $out .= "CAS" . // Previous payer's claim-level adjustments. Page 323.
 599           "*" . $a[1] .
 600           "*" . $a[2] .
 601           "*" . $a[3] .
 602           "~\n";
 603       }
 604
 605       $payerpaid = $claim->payerTotals($ins);
 606       ++$edicount;
 607       $out .= "AMT" . // Previous payer's paid amount. Page 332.
 608         "*D" .
 609         "*" . $payerpaid[1] .
 610         "~\n";
 611
 612       // Patient responsibility amount as of this previous payer.
 613       $prev_pt_resp -= $payerpaid[1]; // reduce by payments
 614       $prev_pt_resp -= $payerpaid[2]; // reduce by adjustments
 615
 616       ++$edicount;
 617       $out .= "AMT" . // Patient responsibility amount per previous payer. Page 335.
 618         "*F2" .
 619         "*" . sprintf('%.2f', $prev_pt_resp) .
 620         "~\n";
 621
 622     } // End of things that apply only to previous payers.
 623
 624     ++$edicount;
 625     $out .= "DMG" . // Other subscriber demographic information. Page 342.
 626       "*D8" .
 627       "*" . $claim->insuredDOB($ins) .
 628       "*" . $claim->insuredSex($ins) .
 629       "~\n";
 630
 631     ++$edicount;
 632     $out .= "OI" .  // Other Insurance Coverage Information. Page 344.
 633       "*" .
 634       "*" .
 635       "*Y" .
 636       "*B" .
 637       "*" .
 638       "*Y" .
 639       "~\n";
 640
 641     ++$edicount;
 642     $out .= "NM1" . // Loop 2330A Subscriber info for other insco. Page 350.
 643       "*IL" .
 644       "*1" .
 645       "*" . $claim->insuredLastName($ins) .
 646       "*" . $claim->insuredFirstName($ins) .
 647       "*" . $claim->insuredMiddleName($ins) .
 648       "*" .
 649       "*" .
 650       "*MI" .
 651       "*" . $claim->policyNumber($ins) .
 652       "~\n";
 653
 654     ++$edicount;
 655     $out .= "N3" .
 656       "*" . $claim->insuredStreet($ins) .
 657       "~\n";
 658
 659     ++$edicount;
 660     $out .= "N4" .
 661       "*" . $claim->insuredCity($ins) .
 662       "*" . $claim->insuredState($ins) .
 663       "*" . $claim->insuredZip($ins) .
 664       "~\n";
 665
 666     ++$edicount;
 667     $out .= "NM1" . // Loop 2330B Payer info for other insco. Page 359.
 668       "*PR" .
 669       "*2" .
 670       "*" . $claim->payerName($ins) .
 671       "*" .
 672       "*" .
 673       "*" .
 674       "*" .
 675       "*PI" .
 676       "*" . $claim->payerID($ins) .
 677       "~\n";
 678
 679     // if (!$claim->payerID($ins)) {
 680     //   $log .= "*** CMS ID is missing for payer '" . $claim->payerName($ins) . "'.\n";
 681     // }
 682
 683     // Payer address (N3 and N4) are added below so that Gateway EDI can
 684     // auto-generate secondary claims.  These do NOT appear in my copy of
 685     // the spec!  -- Rod 2008-06-12
 686
 687     if ($claim->x12gsreceiverid() == '431420764') { // if Gateway EDI
 688       ++$edicount;
 689       $out .= "N3" .
 690         "*" . $claim->payerStreet($ins) .
 691         "~\n";
 692       //
 693       ++$edicount;
 694       $out .= "N4" .
 695         "*" . $claim->payerCity($ins) .
 696         "*" . $claim->payerState($ins) .
 697         "*" . $claim->payerZip($ins) .
 698         "~\n";
 699     } // end Gateway EDI
 700
 701   } // End loops 2320/2330*.
 702
 703   $loopcount = 0;
 704
 705   // Procedure loop starts here.
 706   //
 707   for ($prockey = 0; $prockey < $proccount; ++$prockey) {
 708     ++$loopcount;
 709
 710     ++$edicount;
 711     $out .= "LX" .      // Loop 2400 LX Service Line. Page 398.
 712       "*$loopcount" .
 713       "~\n";
 714
 715     ++$edicount;
 716     $out .= "SV1" .     // Professional Service. Page 400.
 717       "*HC:" . $claim->cptKey($prockey) .
 718       "*" . sprintf('%.2f', $claim->cptCharges($prockey)) .
 719       "*UN" .
 720       "*" . $claim->cptUnits($prockey) .
 721       "*" .
 722       "*" .
 723       "*";
 724     $dia = $claim->diagIndexArray($prockey);
 725     $separator = '';
 726     foreach ($dia as $dindex) {
 727       $out .= $separator . $dindex;
 728       $separator = ':';
 729     }
 730     $out .= "~\n";
 731
 732     if (!$claim->cptCharges($prockey)) {
 733       $log .= "*** Procedure '" . $claim->cptKey($prockey) . "' has no charges!\n";
 734     }
 735
 736     if (empty($dia)) {
 737       $log .= "*** Procedure '" . $claim->cptKey($prockey) . "' is not justified!\n";
 738     }
 739
 740     ++$edicount;
 741     $out .= "DTP" .     // Date of Service. Page 435.
 742       "*472" .
 743       "*D8" .
 744       "*" . $claim->serviceDate() .
 745       "~\n";
 746
 747     // Loop 2410, Drug Information. Medicaid insurers seem to want this
 748     // with HCPCS codes.
 749     //
 750     $ndc = $claim->cptNDCID($prockey);
 751     if ($ndc) {
 752       ++$edicount;
 753       $out .= "LIN" . // Drug Identification. Page 500+ (Addendum pg 71).
 754         "*" .         // Per addendum, LIN01 is not used.
 755         "*N4" .
 756         "*" . $ndc .
 757         "~\n";
 758
 759       if (!preg_match('/^\d\d\d\d\d-\d\d\d\d-\d\d$/', $ndc, $tmp)) {
 760         $log .= "*** NDC code '$ndc' has invalid format!\n";
 761       }
 762
 763       ++$edicount;
 764       $tmpunits = $claim->cptNDCQuantity($prockey) * $claim->cptUnits($prockey);
 765       if (!$tmpunits) $tmpunits = 1;
 766       $out .= "CTP" . // Drug Pricing. Page 500+ (Addendum pg 74).
 767         "*" .
 768         "*" .
 769         "*" . sprintf('%.2f', $claim->cptCharges($prockey) / $tmpunits) .
 770         "*" . $claim->cptNDCQuantity($prockey) .
 771         "*" . $claim->cptNDCUOM($prockey) .
 772         "~\n";
 773     }
 774
 775     // Loop 2420A, Rendering Provider (service-specific).
 776     // Used if the rendering provider for this service line is different
 777     // from that in loop 2310B.
 778     //
 779     if ($claim->providerNPI() != $claim->providerNPI($prockey)) {
 780       ++$edicount;
 781       $out .= "NM1" .       // Loop 2310B Rendering Provider
 782         "*82" .
 783         "*1" .
 784         "*" . $claim->providerLastName($prockey) .
 785         "*" . $claim->providerFirstName($prockey) .
 786         "*" . $claim->providerMiddleName($prockey) .
 787         "*" .
 788         "*";
 789       if ($claim->providerNPI($prockey)) { $out .=
 790         "*XX" .
 791         "*" . $claim->providerNPI($prockey);
 792       } else { $out .=
 793         "*34" .
 794         "*" . $claim->providerSSN($prockey);
 795         $log .= "*** Rendering provider has no NPI.\n";
 796       }
 797       $out .= "~\n";
 798
 799       if ($claim->providerTaxonomy($prockey)) {
 800         ++$edicount;
 801         $out .= "PRV" .
 802           "*PE" . // PErforming provider
 803           "*ZZ" .
 804           "*" . $claim->providerTaxonomy($prockey) .
 805           "~\n";
 806       }
 807
 808       // REF*1C is required here for the Medicare provider number if NPI was
 809       // specified in NM109.  Not sure if other payers require anything here.
 810       if ($claim->providerNumber($prockey)) {
 811         ++$edicount;
 812         $out .= "REF" .
 813           "*" . $claim->providerNumberType($prockey) .
 814           "*" . $claim->providerNumber($prockey) .
 815           "~\n";
 816       }
 817     }
 818
 819     // Loop 2430, adjudication by previous payers.
 820     //
 821     for ($ins = 1; $ins < $claim->payerCount(); ++$ins) {
 822       if ($claim->payerSequence($ins) > $claim->payerSequence())
 823         continue; // payer is future, not previous
 824
 825       $payerpaid = $claim->payerTotals($ins, $claim->cptKey($prockey));
 826       $aarr = $claim->payerAdjustments($ins, $claim->cptKey($prockey));
 827
 828       if ($payerpaid[1] == 0 && !count($aarr)) {
 829         $log .= "*** Procedure '" . $claim->cptKey($prockey) .
 830           "' has no payments or adjustments from previous payer!\n";
 831         continue;
 832       }
 833
 834       ++$edicount;
 835       $out .= "SVD" . // Service line adjudication. Page 554.
 836         "*" . $claim->payerID($ins) .
 837         "*" . $payerpaid[1] .
 838         "*HC:" . $claim->cptKey($prockey) .
 839         "*" .
 840         "*" . $claim->cptUnits($prockey) .
 841         "~\n";
 842
 843       $tmpdate = $payerpaid[0];
 844       foreach ($aarr as $a) {
 845         ++$edicount;
 846         $out .= "CAS" . // Previous payer's line level adjustments. Page 558.
 847           "*" . $a[1] .
 848           "*" . $a[2] .
 849           "*" . $a[3] .
 850           "~\n";
 851         if (!$tmpdate) $tmpdate = $a[0];
 852       }
 853
 854       if ($tmpdate) {
 855         ++$edicount;
 856         $out .= "DTP" . // Previous payer's line adjustment date. Page 566.
 857           "*573" .
 858           "*D8" .
 859           "*$tmpdate" .
 860           "~\n";
 861       }
 862     } // end loop 2430
 863   } // end this procedure
 864
 865   ++$edicount;
 866   $out .= "SE" .        // SE Trailer
 867     "*$edicount" .
 868     "*0021" .
 869     "~\n";
 870
 871   $out .= "GE" .        // GE Trailer
 872     "*1" .
 873     "*1" .
 874     "~\n";
 875
 876   $out .= "IEA" .       // IEA Trailer
 877     "*1" .
 878     "*000000001" .
 879     "~\n";
 880
 881   $log .= "\n";
 882   return $out;
 883 }
 884 ?>