library/parse_era.inc.php

   1 <?php
   2   // Copyright (C) 2006 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 function parse_era_2100(&$out, $cb) {
  10         if ($out['loopid'] == '2110') {
  11                 $cb($out);
  12         }
  13 }
  14
  15 function parse_era($filename, $cb) {
  16         $infh = fopen($filename, 'r');
  17         if (! $infh) return "ERA input file open failed";
  18
  19         $out = array();
  20         $out['loopid'] = '';
  21         $out['st_segment_count'] = 0;
  22         $buffer = '';
  23         $segid = '';
  24
  25         while (true) {
  26                 if (strlen($buffer) < 2048 && ! feof($infh))
  27                         $buffer .= fread($infh, 2048);
  28                 $tpos = strpos($buffer, '~');
  29                 if ($tpos === false) break;
  30                 $inline = substr($buffer, 0, $tpos);
  31                 $buffer = substr($buffer, $tpos + 1);
  32
  33                 // echo $inline . "\n"; // debugging
  34
  35                 $seg = explode('|', $inline);
  36                 $segid = $seg[0];
  37
  38                 if ($segid == 'ISA') {
  39                         if ($out['loopid']) return 'Unexpected ISA segment';
  40                         $out['isa_sender_id']      = trim($seg[6]);
  41                         $out['isa_receiver_id']    = trim($seg[8]);
  42                         $out['isa_control_number'] = trim($seg[13]);
  43                         // TBD: clear some stuff if we allow multiple transmission files.
  44                 }
  45                 else if ($segid == 'GS') {
  46                         if ($out['loopid']) return 'Unexpected GS segment';
  47                         $out['gs_date'] = trim($seg[4]);
  48                         $out['gs_time'] = trim($seg[5]);
  49                         $out['gs_control_number'] = trim($seg[6]);
  50                 }
  51                 else if ($segid == 'ST') {
  52                         parse_era_2100($out, $cb);
  53                         $out['loopid'] = '';
  54                         $out['st_control_number'] = trim($seg[2]);
  55                         $out['st_segment_count'] = 0;
  56                 }
  57                 else if ($segid == 'BPR') {
  58                         if ($out['loopid']) return 'Unexpected BPR segment';
  59                         $out['check_amount'] = trim($seg[2]);
  60                         $out['check_date'] = trim($seg[16]); // yyyymmdd
  61                 }
  62                 else if ($segid == 'TRN') {
  63                         if ($out['loopid']) return 'Unexpected TRN segment';
  64                         $out['check_number'] = trim($seg[2]);
  65                         $out['payer_tax_id'] = substr($seg[3], 1); // 9 digits
  66                         $out['payer_id'] = trim($seg[4]);
  67                 }
  68                 else if ($segid == 'REF' && $seg[1] == 'EV') {
  69                         if ($out['loopid']) return 'Unexpected REF|EV segment';
  70                 }
  71                 else if ($segid == 'CUR' && ! $out['loopid']) {
  72                         // ignore
  73                 }
  74                 else if ($segid == 'REF' && ! $out['loopid']) {
  75                         // ignore
  76                 }
  77                 else if ($segid == 'DTM' && $seg[1] == '405') {
  78                         if ($out['loopid']) return 'Unexpected DTM|405 segment';
  79                         $out['production_date'] = trim($seg[2]); // yyyymmdd
  80                 }
  81                 else if ($segid == 'N1' && $seg[1] == 'PR') {
  82                         if ($out['loopid']) return 'Unexpected N1|PR segment';
  83                         $out['loopid'] = '1000A';
  84                         $out['payer_name'] = trim($seg[2]);
  85                 }
  86                 else if ($segid == 'N3' && $out['loopid'] == '1000A') {
  87                         $out['payer_street'] = trim($seg[1]);
  88                 }
  89                 else if ($segid == 'N4' && $out['loopid'] == '1000A') {
  90                         $out['payer_city']  = trim($seg[1]);
  91                         $out['payer_state'] = trim($seg[2]);
  92                         $out['payer_zip']   = trim($seg[3]);
  93                 }
  94                 else if ($segid == 'REF' && $out['loopid'] == '1000A') {
  95                         // ignore
  96                 }
  97                 else if ($segid == 'PER' && $out['loopid'] == '1000A') {
  98                         // ignore
  99                 }
 100                 else if ($segid == 'N1' && $seg[1] == 'PE') {
 101                         if ($out['loopid'] != '1000A') return 'Unexpected N1|PE segment';
 102                         $out['loopid'] = '1000B';
 103                         $out['payee_name']   = trim($seg[2]);
 104                         $out['payee_tax_id'] = trim($seg[4]);
 105                 }
 106                 else if ($segid == 'N3' && $out['loopid'] == '1000B') {
 107                         $out['payee_street'] = trim($seg[1]);
 108                 }
 109                 else if ($segid == 'N4' && $out['loopid'] == '1000B') {
 110                         $out['payee_city']  = trim($seg[1]);
 111                         $out['payee_state'] = trim($seg[2]);
 112                         $out['payee_zip']   = trim($seg[3]);
 113                 }
 114                 else if ($segid == 'REF' && $out['loopid'] == '1000B') {
 115                         // ignore
 116                 }
 117                 else if ($segid == 'LX') {
 118                         if (! $out['loopid']) return 'Unexpected LX segment';
 119                         parse_era_2100($out, $cb);
 120                         $out['loopid'] = '2000';
 121                 }
 122                 else if ($segid == 'TS2' && $out['loopid'] == '2000') {
 123                         // ignore
 124                 }
 125                 else if ($segid == 'TS3' && $out['loopid'] == '2000') {
 126                         // ignore
 127                 }
 128                 else if ($segid == 'CLP') {
 129                         if (! $out['loopid']) return 'Unexpected CLP segment';
 130                         parse_era_2100($out, $cb);
 131                         $out['loopid'] = '2100';
 132                         $out['warnings'] = '';
 133                         // Clear some stuff to start the new claim:
 134                         $out['subscriber_lname']     = '';
 135                         $out['subscriber_fname']     = '';
 136                         $out['subscriber_mname']     = '';
 137                         $out['subscriber_member_id'] = '';
 138                         $out['svc'] = array();
 139                         //
 140                         // This is the poorly-named "Patient Account Number".  For 837p
 141                         // it comes from CLM01 which we populated as pid-diagid-procid,
 142                         // where diagid and procid are id values from the billing table.
 143                         // For HCFA 1500 claims it comes from field 26 which we
 144                         // populated with our familiar pid-encounter billing key.
 145                         //
 146                         // The 835 spec calls this the "provider-assigned claim control
 147                         // number" and notes that it is specifically intended for
 148                         // identifying the claim in the provider's database.
 149                         //
 150                         // When this field does not conform to either of our formats,
 151                         // it's likely that the claim pre-dates the clinic's OpenEMR
 152                         // installation and we should probably just flag it for manual
 153                         // posting.  A better solution might be tailored for sites
 154                         // where A/R was converted from a prior system.
 155                         $out['our_claim_id']      = trim($seg[1]);
 156                         //
 157                         $out['claim_status_code'] = trim($seg[2]);
 158                         $out['amount_charged']    = trim($seg[3]);
 159                         $out['amount_approved']   = trim($seg[4]);
 160                         $out['amount_patient']    = trim($seg[5]); // pt responsibility, copay + deductible
 161                         $out['payer_claim_id']    = trim($seg[7]); // payer's claim number
 162                 }
 163                 else if ($segid == 'CAS' && $out['loopid'] == '2100') {
 164                         // TBD: It is technically valid for adjustments to occur at the claim
 165                         // level.  I guess we need to create a dummy service item for these.
 166                         $out['warnings'] .= "Adjustment at claim level not handled!\n";
 167                 }
 168                 else if ($segid == 'NM1' && $seg[1] == 'QC' && $out['loopid'] == '2100') {
 169                         $out['patient_lname']     = trim($seg[3]);
 170                         $out['patient_fname']     = trim($seg[4]);
 171                         $out['patient_mname']     = trim($seg[5]);
 172                         $out['patient_member_id'] = trim($seg[9]);
 173                 }
 174                 else if ($segid == 'NM1' && $seg[1] == 'IL' && $out['loopid'] == '2100') {
 175                         $out['subscriber_lname']     = trim($seg[3]);
 176                         $out['subscriber_fname']     = trim($seg[4]);
 177                         $out['subscriber_mname']     = trim($seg[5]);
 178                         $out['subscriber_member_id'] = trim($seg[9]);
 179                 }
 180                 else if ($segid == 'NM1' && $seg[1] == '82' && $out['loopid'] == '2100') {
 181                         $out['provider_lname']     = trim($seg[3]);
 182                         $out['provider_fname']     = trim($seg[4]);
 183                         $out['provider_mname']     = trim($seg[5]);
 184                         $out['provider_member_id'] = trim($seg[9]);
 185                 }
 186                 else if ($segid == 'NM1' && $out['loopid'] == '2100') {
 187                         // $out['warnings'] .= "NM1 segment at claim level ignored.\n";
 188                 }
 189                 else if ($segid == 'MOA' && $out['loopid'] == '2100') {
 190                         $out['warnings'] .= "MOA segment at claim level ignored.\n";
 191                 }
 192                 else if ($segid == 'REF' && $seg[1] == '1W' && $out['loopid'] == '2100') {
 193                         $out['claim_comment'] = trim($seg[2]);
 194                 }
 195                 else if ($segid == 'REF' && $out['loopid'] == '2100') {
 196                         // ignore; saw a "REF|EA|X" from Tricare, dunno what that is.
 197                 }
 198                 else if ($segid == 'DTM' && $seg[1] == '050' && $out['loopid'] == '2100') {
 199                         $out['claim_date'] = trim($seg[2]); // yyyymmdd
 200                 }
 201                 else if ($segid == 'DTM' && $out['loopid'] == '2100') {
 202                         // ignore?
 203                 }
 204                 else if ($segid == 'PER' && $out['loopid'] == '2100') {
 205                         $out['warnings'] .= 'Claim contact information: ' .
 206                                 $seg[4] . "\n";
 207                 }
 208                 else if ($segid == 'AMT' && $out['loopid'] == '2100') {
 209                         $out['warnings'] .= "AMT segment at claim level ignored.\n";
 210                 }
 211                 else if ($segid == 'QTY' && $out['loopid'] == '2100') {
 212                         $out['warnings'] .= "QTY segment at claim level ignored.\n";
 213                 }
 214                 else if ($segid == 'SVC') {
 215                         if (! $out['loopid']) return 'Unexpected SVC segment';
 216                         $out['loopid'] = '2110';
 217                         $svc = explode('^', $seg[1]);
 218                         if ($svc[0] != 'HC') return 'SVC segment has unexpected qualifier';
 219                         $i = count($out['svc']);
 220                         $out['svc'][$i] = array();
 221                         $out['svc'][$i]['code'] = $svc[1];
 222                         $out['svc'][$i]['chg']  = $seg[2];
 223                         $out['svc'][$i]['paid'] = $seg[3];
 224                         $out['svc'][$i]['adj']  = array();
 225                 }
 226                 else if ($segid == 'DTM' && $out['loopid'] == '2110') {
 227                         $out['dos'] = trim($seg[2]); // yyyymmdd
 228                 }
 229                 else if ($segid == 'CAS' && $out['loopid'] == '2110') {
 230                         // There may be multiple adjustments per service item.
 231                         $i = count($out['svc']) - 1;
 232                         $j = count($out['svc'][$i]['adj']);
 233                         $out['svc'][$i]['adj'][$j] = array();
 234                         $out['svc'][$i]['adj'][$j]['group_code']  = $seg[1];
 235                         $out['svc'][$i]['adj'][$j]['reason_code'] = $seg[2];
 236                         $out['svc'][$i]['adj'][$j]['amount']      = $seg[3];
 237                 }
 238                 else if ($segid == 'REF' && $out['loopid'] == '2110') {
 239                         // ignore
 240                 }
 241                 else if ($segid == 'AMT' && $seg[1] == 'B6' && $out['loopid'] == '2110') {
 242                         $i = count($out['svc']) - 1;
 243                         $out['svc'][$i]['allowed'] = $seg[2]; // report this amount as a note
 244                 }
 245                 else if ($segid == 'LQ' && $seg[1] == 'HE' && $out['loopid'] == '2110') {
 246                         $i = count($out['svc']) - 1;
 247                         $out['svc'][$i]['remark'] = $seg[2];
 248                 }
 249                 else if ($segid == 'QTY' && $out['loopid'] == '2110') {
 250                         $out['warnings'] .= "QTY segment at service level ignored.\n";
 251                 }
 252                 else if ($segid == 'PLB') {
 253                         $out['warnings'] .= 'PROVIDER LEVEL ADJUSTMENT (not claim-specific): $' .
 254                                 sprintf('%.2f', $seg[4]) . "\n";
 255                 }
 256                 else if ($segid == 'SE') {
 257                         parse_era_2100($out, $cb);
 258                         $out['loopid'] = '';
 259                         if ($out['st_control_number'] != trim($seg[2])) {
 260                                 return 'Ending transaction set control number mismatch';
 261                         }
 262                         if (($out['st_segment_count'] + 1) != trim($seg[1])) {
 263                                 return 'Ending transaction set segment count mismatch';
 264                         }
 265                 }
 266                 else if ($segid == 'GE') {
 267                         if ($out['loopid']) return 'Unexpected GE segment';
 268                         if ($out['gs_control_number'] != trim($seg[2])) {
 269                                 return 'Ending functional group control number mismatch';
 270                         }
 271                 }
 272                 else if ($segid == 'IEA') {
 273                         if ($out['loopid']) return 'Unexpected IEA segment';
 274                         if ($out['isa_control_number'] != trim($seg[2])) {
 275                                 return 'Ending interchange control number mismatch';
 276                         }
 277                 }
 278                 else {
 279                         return "Unknown or unexpected segment ID $segid";
 280                 }
 281
 282                 ++$out['st_segment_count'];
 283         }
 284
 285         if ($segid != 'IEA') return 'Premature end of ERA file';
 286         return '';
 287 }
 288 ?>