From bf520fc492fae61358b0857da06afb6dfb6e8d0c Mon Sep 17 00:00:00 2001
From: sunsetsystems <sunsetsystems>
Date: Tue, 14 Aug 2007 18:17:26 +0000
Subject: [PATCH] assorted bug fixes

---
 library/Claim.class.php     | 25 ++++++++++++++++++++-----
 library/gen_x12_837.inc.php | 17 ++++++++++++++---
 2 files changed, 34 insertions(+), 8 deletions(-)

diff --git a/library/Claim.class.php b/library/Claim.class.php
index 5f3fc3cf7..66d4e5664 100644
--- a/library/Claim.class.php
+++ b/library/Claim.class.php
@@ -48,14 +48,13 @@ class Claim {
       "pid = '{$this->pid}' AND provider != '' AND " .
       "date <= '$encounter_date' " .
       "ORDER BY type ASC, date DESC";
-    // echo "<br>$query<br>"; // debugging
     $dres = sqlStatement($query);
     $prevtype = '';
     while ($drow = sqlFetchArray($dres)) {
       if (strcmp($prevtype, $drow['type']) == 0) continue;
       $prevtype = $drow['type'];
-      $ins = ($drow['provider'] == $billrow['payer_id']) ?
-        0 : count($this->payers);
+      $ins = count($this->payers);
+      if ($drow['provider'] == $billrow['payer_id'] && empty($this->payers[0]['data'])) $ins = 0;
       $crow = sqlQuery("SELECT * FROM insurance_companies WHERE " .
         "id = '" . $drow['provider'] . "'");
       $orow = new InsuranceCompany($drow['provider']);
@@ -65,6 +64,20 @@ class Claim {
       $this->payers[$ins]['object']  = $orow;
     }
 
+    // This kludge hands most cases of a rare ambiguous situation, where
+    // the primary insurance company is the same as the secondary.  It seems
+    // nobody planned for that!
+    //
+    for ($i = 1; $i < count($this->payers); ++$i) {
+      if ($billrow['process_date'] &&
+        $this->payers[0]['data']['payer_id'] == $this->payers[$i]['data']['payer_id'])
+      {
+        $tmp = $this->payers[0];
+        $this->payers[0] = $this->payers[$i];
+        $this->payers[$i] = $tmp;
+      }
+    }
+
     $this->using_modifiers = true;
 
     // Get payment and adjustment details if there are any previous payers.
@@ -294,6 +307,7 @@ class Claim {
             continue; // it's for primary and that's not us
           }
 
+          if ($rcode == '42') $rcode= '45'; // reason 42 is obsolete
           $aadj[] = array($date, $gcode, $rcode, sprintf('%.2f', $chg));
 
         } // end if
@@ -713,8 +727,9 @@ class Claim {
   // NDC drug number of units.
   function cptNDCQuantity($prockey) {
     $ndcinfo = $this->procs[$prockey]['ndc_info'];
-    if (preg_match('/^N4(\S+)\s+(\S\S)(.*)/', $ndcinfo, $tmp))
-      return x12clean($tmp[3]);
+    if (preg_match('/^N4(\S+)\s+(\S\S)(.*)/', $ndcinfo, $tmp)) {
+      return x12clean(ltrim($tmp[3], '0'));
+    }
     return '';
   }
 
diff --git a/library/gen_x12_837.inc.php b/library/gen_x12_837.inc.php
index 86e46f202..b898cbb4f 100644
--- a/library/gen_x12_837.inc.php
+++ b/library/gen_x12_837.inc.php
@@ -149,7 +149,6 @@ function gen_x12_837($pid, $encounter, &$log) {
     "~\n";
 
   // Add a REF*EI*<ein> segment if NPI was specified in the NM1 above.
-
   if ($claim->billingFacilityNPI() && $claim->billingFacilityETIN()) {
     ++$edicount;
     $out .= "REF" .
@@ -460,8 +459,18 @@ function gen_x12_837($pid, $encounter, &$log) {
     "*207Q00000X" .
     "~\n";
 
+  // REF*1C is required here for the Medicare provider number if NPI was
+  // specified in NM109.  Not sure if other payers require anything here.
+  if ($claim->providerNumber()) {
+    ++$edicount;
+    $out .= "REF" .
+      "*" . $claim->providerNumberType() .
+      "*" . $claim->providerNumber() .
+      "~\n";
+  }
+
   ++$edicount;
-  $out .= "NM1" .       // Loop 2310B Service Location
+  $out .= "NM1" .       // Loop 2310D Service Location
     "*77" .
     "*2" .
     "*" . $claim->facilityName() .
@@ -646,10 +655,12 @@ function gen_x12_837($pid, $encounter, &$log) {
       }
 
       ++$edicount;
+      $tmpunits = $claim->cptNDCQuantity($prockey) * $claim->cptUnits($prockey);
+      if (!$tmpunits) $tmpunits = 1;
       $out .= "CTP" . // Drug Pricing. Page 500+ (Addendum pg 74).
         "*" .
         "*" .
-        "*0" . // dummy price, required by HIPAA
+        "*" . sprintf('%.2f', $claim->cptCharges($prockey) / $tmpunits) .
         "*" . $claim->cptNDCQuantity($prockey) .
         "*" . $claim->cptNDCUOM($prockey) .
         "~\n";
-- 
2.11.4.GIT