src/Billing/X125010837I.php

   1 <?php
   2
   3 /**
   4  * X12 837I
   5  *
   6  * @package OpenEMR
   7  * @link    https://www.open-emr.org
   8  * @author  Jerry Padgett <sjpadgett@gmail.com>
   9  * @copyright Copyright (c) 2017 Jerry Padgett <sjpadgett@gmail.com>
  10  * @license https://github.com/openemr/openemr/blob/master/LICENSE GNU General Public License 3
  11  */
  12
  13 namespace OpenEMR\Billing;
  14
  15 use OpenEMR\Billing\Claim;
  16
  17 class X125010837I
  18 {
  19     public function x12Date($frmdate)
  20     {
  21         return ('20' . substr($frmdate, 4, 2) . substr($frmdate, 0, 2) . substr($frmdate, 2, 2));
  22     }
  23
  24     public $ub04id = array();
  25
  26     public function generateX12837I($pid, $encounter, &$log, $ub04id)
  27     {
  28         $today = time();
  29         $out = '';
  30         $claim = new Claim($pid, $encounter);
  31         $edicount = 0;
  32
  33         $log .= "Generating 837I claim $pid-$encounter for " .
  34             $claim->patientFirstName() . ' ' .
  35             $claim->patientMiddleName() . ' ' .
  36             $claim->patientLastName() . ' on ' .
  37             date('Y-m-d H:i', $today) . ".\n";
  38         $out .= "ISA" .
  39             "*" . $claim->x12gsisa01() .
  40             "*" . $claim->x12gsisa02() .
  41             "*" . $claim->x12gsisa03() .
  42             "*" . $claim->x12gsisa04() .
  43             "*" . $claim->x12gsisa05() .
  44             "*" . $claim->x12_sender_id() .
  45             "*" . $claim->x12gsisa07() .
  46             "*" . $claim->x12gsreceiverid() .
  47             // date of transmission "*030911" .
  48             "*" . date('Ymd', $today) .
  49             //Time of transmission "*1630" .
  50             "*" . date('Hi', $today) .
  51             "*" . "^" .
  52             "*" . "00501" .
  53             "*" . "000000001" .
  54             "*" . $claim->x12gsisa14() .
  55             "*" . $claim->x12gsisa15() .
  56             "*:" .
  57             "~\n";
  58         $out .= "GS" .
  59             "*HC" .
  60             "*" . $claim->x12gsgs02() .
  61             "*" . trim($claim->x12gs03()) .
  62             "*" . date('Ymd', $today) .
  63             "*" . date('Hi', $today) .
  64             "*1" .
  65             "*X" .
  66             // "*" . $claim->x12gsversionstring() .
  67             "*" . "005010X223A2" .
  68             "~\n";
  69         ++$edicount;
  70         $out .= "ST" .
  71             "*" . "837" .
  72             "*" . "0021" .
  73             // "*" . $claim->x12gsversionstring() .
  74             "*" . "005010X223A2" .
  75             "~\n";
  76         ++$edicount;
  77         $out .= "BHT" .
  78             "*" . "0019" .                             // 0019 is required here
  79             "*" . "00" .                               // 00 = original transmission
  80             "*" . "0123" .                             // reference identification
  81             "*" . date('Ymd', $today) .           // transaction creation date
  82             "*" . date('Hi', $today) .            // transaction creation time
  83             ($encounter_claim ? "*RP" : "*CH") .  // RP = reporting, CH = chargeable
  84             "~\n";
  85
  86         ++$edicount;
  87         //Field length is limited to 35. See nucc dataset page 63 www.nucc.org
  88         $billingFacilityName = substr($claim->billingFacilityName(), 0, 60);
  89         if ($billingFacilityName == '') {
  90             $log .= "*** billing facility name in 1000A loop is empty\n";
  91         }
  92         $out .= "NM1" .       // Loop 1000A Submitter stays in the 837I
  93             "*" . "41" .
  94             "*" . "2" .
  95             "*" . $billingFacilityName .
  96             "*" .
  97             "*" .
  98             "*" .
  99             "*" .
 100             "*" . "46";
 101
 102         $out .= "*" . $claim->billingFacilityETIN();
 103         $out .= "~\n";
 104         ++$edicount;
 105
 106         $out .= "PER" .
 107             "*IC" .
 108             "*" . $claim->billingContactName() .
 109             "*TE" .
 110             "*" . $claim->billingContactPhone();
 111         $out .= "~\n";
 112
 113         ++$edicount;
 114
 115         $out .= "NM1" .       // Loop 1000B Receiver stays in the 837I
 116             "*" . "40" .
 117             "*" . "2" .
 118             "*" . $claim->clearingHouseName() .
 119             "*" .
 120             "*" .
 121             "*" .
 122             "*" .
 123             "*" . "46" .
 124             "*" . $claim->clearingHouseETIN() .
 125             "~\n";
 126         $HLcount = 1;
 127         ++$edicount;
 128
 129         $out .= "HL" .        // Loop 2000A Billing/Pay-To Provider HL Loop
 130             "*" . "$HLcount" .
 131             "*" .
 132             "*" . "20" .
 133             "*" . "1" .              // 1 indicates there are child segments
 134             "~\n";
 135         $HLBillingPayToProvider = $HLcount++;
 136         // Situational PRV segment (for provider taxonomy code) omitted here.
 137         // Situational CUR segment (foreign currency information) omitted here.
 138         ++$edicount;
 139         //Field length is limited to 35. See nucc dataset page 63 www.nucc.org
 140         $billingFacilityName = substr($claim->billingFacilityName(), 0, 60);
 141         $out .= "NM1" .       // Loop 2010AA Billing Provider stays in the 837I
 142             "*" . "85" .
 143             "*" . "2" .
 144             "*" . $billingFacilityName .
 145             "*" .
 146             "*" .
 147             "*" .
 148             "*";
 149         if ($claim->billingFacilityNPI()) {
 150             $out .= "*XX*" . $claim->billingFacilityNPI();
 151         } else {
 152             $log .= "*** Billing facility has no NPI.\n";
 153             $out .= "*XX*";
 154         }
 155         $out .= "~\n";
 156         ++$edicount;
 157         $out .= "N3" .
 158             "*" . $claim->billingFacilityStreet() .
 159             "~\n";
 160         ++$edicount;
 161         $out .= "N4" .
 162             "*" . $claim->billingFacilityCity() .
 163             "*" . $claim->billingFacilityState() .
 164             "*" . $claim->x12Zip($claim->billingFacilityZip()) .
 165             "~\n";
 166         if ($claim->billingFacilityNPI() && $claim->billingFacilityETIN()) {
 167             ++$edicount;
 168             $out .= "REF";
 169             if ($claim->federalIdType()) {
 170                 $out .= "*" . $claim->federalIdType();
 171             } else {
 172                 $out .= "*EI"; // For dealing with the situation before adding TaxId type In facility.
 173             }
 174             $out .= "*" . $claim->billingFacilityETIN() . "~\n";
 175         } else {
 176             $log .= "*** No billing facility NPI and/or ETIN.\n";
 177         }
 178         if ($claim->providerNumberType() && $claim->providerNumber() && !$claim->billingFacilityNPI()) {
 179             ++$edicount;
 180             $out .= "REF" .
 181                 "*" . $claim->providerNumberType() .
 182                 "*" . $claim->providerNumber() .
 183                 "~\n";
 184         } elseif ($claim->providerNumber() && !$claim->providerNumberType()) {
 185             $log .= "*** Payer-specific provider insurance number is present but has no type assigned.\n";
 186         }
 187         // Situational PER*1C segment.
 188         ++$edicount;
 189         $out .= "PER" .
 190             "*" . "IC" .
 191             "*" . $claim->billingContactName() .
 192             "*" . "TE" .
 193             "*" . $claim->billingContactPhone();
 194         $out .= "~\n";
 195
 196         // This is also excluded in the 837I
 197         // Loop 2010AC Pay-To Plan Name omitted.  Includes:
 198         // NM1*PE, N3, N4, REF*2U, REF*EI
 199         $PatientHL = $claim->isSelfOfInsured() ? 0 : 1;
 200         $HLSubscriber = $HLcount++;
 201         ++$edicount;
 202
 203         // loop 2000B
 204         $out .= "HL" .        // Loop 2000B Subscriber HL Loop
 205             "*$HLSubscriber" .
 206             "*$HLBillingPayToProvider" .
 207             "*" . "22" .
 208             "*$PatientHL" .
 209             "~\n";
 210         if (!$claim->payerSequence()) {
 211             $log .= "*** Error: Insurance information is missing!\n";
 212         }
 213         ++$edicount;
 214
 215         //SBR01 is either a P or S    SBR02 for care is always 18 "patient"  SBR09 is always MA
 216         $out .= "SBR" .       // Subscriber Information
 217             "*" . $claim->payerSequence() .
 218             "*" . ($claim->isSelfOfInsured() ? '18' : '') .
 219             "*" . $claim->groupNumber() .
 220             "*" . (($claim->groupNumber()) ? '' : $claim->groupName()) .
 221             "*" . $claim->insuredTypeCode() . // applies for secondary medicare
 222             "*" .
 223             "*" .
 224             "*" .
 225             "*" . $claim->claimType() . // Zirmed replaces this
 226             "~\n";
 227         // 2000C Segment PAT omitted.
 228         ++$edicount;
 229         $out .= "NM1" .       // Loop 2010BA Subscriber  same in 837I
 230             "*IL" .
 231             "*" . "1" . // 1 = person, 2 = non-person
 232             "*" . $claim->insuredLastName() .
 233             "*" . $claim->insuredFirstName() .
 234             "*" . $claim->insuredMiddleName() .
 235             "*" .
 236             "*" . // Name Suffix
 237             "*MI" .
 238             // "MI" = Member Identification Number
 239             // "II" = Standard Unique Health Identifier, "Required if the
 240             //        HIPAA Individual Patient Identifier is mandated use."
 241             //        Here we presume that is not true yet.
 242             "*" . $claim->policyNumber() .
 243             "~\n";
 244         // For 5010, further subscriber info is sent only if they are the patient.
 245         if ($claim->isSelfOfInsured()) {
 246             ++$edicount;
 247             $out .= "N3" .
 248                 "*" . $claim->insuredStreet() .
 249                 "~\n";
 250             ++$edicount;
 251             $out .= "N4" .
 252                 "*" . $claim->insuredCity() .
 253                 "*" . $claim->insuredState() .
 254                 "*" . $claim->x12Zip($claim->insuredZip()) .
 255                 "~\n";
 256             ++$edicount;
 257             $out .= "DMG" .
 258                 "*D8" .
 259                 "*" . $claim->insuredDOB() .
 260                 "*" . $claim->insuredSex() .
 261                 "~\n";
 262         }
 263         // Segment REF*SY (Subscriber Secondary Identification) omitted.
 264         // Segment REF*Y4 (Property and Casualty Claim Number) omitted.
 265         // Segment PER*IC (Property and Casualty Subscriber Contact Information) omitted.
 266         ++$edicount;
 267         $payerName = substr($claim->payerName(), 0, 60);
 268         $out .= "NM1" .       // Loop 2010BB Payer
 269             "*PR" .
 270             "*" . "2" .
 271             "*" . $payerName .
 272             "*" .
 273             "*" .
 274             "*" .
 275             "*" .
 276             "*" . "PI" .
 277             "*" . ($encounter_claim ? $claim->payerAltID() : $claim->payerID()) .
 278             "~\n";
 279         if (!$claim->payerID()) {
 280             $log .= "*** Payer ID is missing for payer '" . $claim->payerName() . "'.\n";
 281         }
 282
 283         ++$edicount;
 284         $out .= "N3" .
 285             "*" . $claim->payerStreet() .
 286             "~\n";
 287         ++$edicount;
 288         $out .= "N4" .
 289             "*" . $claim->payerCity() .
 290             "*" . $claim->payerState() .
 291             "*" . $claim->x12Zip($claim->payerZip()) .
 292             "~\n";
 293
 294         // Segment REF (Payer Secondary Identification) omitted.
 295         // Segment REF (Billing Provider Secondary Identification) omitted.
 296
 297
 298         if (!$claim->isSelfOfInsured()) {
 299             ++$edicount;
 300             $out .= "HL" .        // Loop 2000C Patient Information
 301                 "*" . "$HLcount" .
 302                 "*$HLSubscriber" .
 303                 "*23" .
 304                 "*0" .
 305                 "~\n";
 306             $HLcount++;
 307             ++$edicount;
 308             $out .= "PAT" .
 309                 "*" . $claim->insuredRelationship() .
 310                 "~\n";
 311             ++$edicount;
 312             $out .= "NM1" .       // Loop 2010CA Patient may need this elsed in to the loop 2000C
 313                 "*QC" .
 314                 "*1" .
 315                 "*" . $claim->patientLastName() .
 316                 "*" . $claim->patientFirstName();
 317             if ($claim->patientMiddleName() !== '') {
 318                 $out .= "*" . $claim->patientMiddleName();
 319             }
 320             $out .= "~\n";
 321             ++$edicount;
 322             $out .= "N3" .
 323                 "*" . $claim->patientStreet() .
 324                 "~\n";
 325             ++$edicount;
 326             $out .= "N4" .
 327                 "*" . $claim->patientCity() .
 328                 "*" . $claim->patientState() .
 329                 "*" . $claim->x12Zip($claim->patientZip()) .
 330                 "~\n";
 331             ++$edicount;
 332             $out .= "DMG" .
 333                 "*D8" .
 334                 "*" . $claim->patientDOB() .
 335                 "*" . $claim->patientSex() .
 336                 "~\n";
 337             // Segment REF*Y4 (Property and Casualty Claim Number) omitted.
 338             // Segment REF (Property and Casualty Patient Identifier) omitted.
 339             // Segment PER (Property and Casualty Patient Contact Information) omitted.
 340         } // end of patient different from insured
 341         $proccount = $claim->procCount();
 342         $clm_total_charges = 0;
 343         for ($prockey = 0; $prockey < $proccount; ++$prockey) {
 344             $clm_total_charges += $claim->cptCharges($prockey);
 345         }
 346         if (!$clm_total_charges) {
 347             $log .= "*** This claim has no charges!\n";
 348         }
 349         ++$edicount;
 350         $out .= "CLM" .       // Loop 2300 Claim
 351             "*" . $pid . "-" . $encounter .
 352             "*" . sprintf("%.2f", $clm_total_charges) . // Zirmed computes and replaces this
 353             "*" .
 354             "*";
 355         // Service location this need to be bill type from ub form type_of_bill
 356         if (strlen($ub04id[7]) >= 3) {
 357             $out .= "*" . substr($ub04id[7], 1, 1) . ":" . substr($ub04id[7], 2, 1) . ":" . substr($ub04id[7], 3, 1);
 358         }
 359
 360         $out .= "*" .
 361             "*" . "A" .
 362             "*" . ($claim->billingFacilityAssignment() ? 'Y' : 'N') .
 363             "*" . "Y" .
 364             "~\n";
 365         // discharge hour
 366         if ($ub04id[29]) {
 367             ++$edicount;
 368             $out .= "DTP" . // Loop 2300
 369                 "*" . "096" .
 370                 "*" . "TM" .
 371                 "*" . $ub04id[29] .
 372                 "~\n";
 373         }
 374
 375         // Statment Dates
 376         // DTP 434 RD8 (Statment from OR to date)
 377
 378         if ($ub04id[13]) {
 379             ++$edicount;
 380
 381             $tmp = self::x12Date($ub04id[13]);
 382             $tmp1 = self::x12Date($ub04id[14]);
 383             $out .= "DTP" . // Loop 2300
 384                 "*434" . "*" . "RD8" . "*" . $tmp . '-' . $tmp1 . "~\n";
 385         }
 386
 387         if ($ub04id[13]) {
 388             ++$edicount;
 389             $tmp = self::x12Date($ub04id[25]);
 390             $out .= "DTP" . // Loop 2300
 391                 "*435" . "*" . "DT" . "*" . $tmp . $ub04id[26] . "~\n";
 392         }
 393
 394         if (strlen(trim($ub04id[13])) == 0) {
 395             $log .= "*** Error: No Admission Date Entered!\n";
 396         }
 397
 398         // Repricer Received Date
 399         // DTP 050 D8 (Admission Date and Hour from form)
 400
 401         // Institutional Claim Code
 402         // CL1 (Admission Type Code) (Admission Source Code) (Patient Status Code)
 403
 404         if ($ub04id[27] != "014X") { // Type of bill
 405             ++$edicount;
 406             $out .= "CL1" . // Loop 2300
 407                 "*" . $ub04id[27] . "*" . $ub04id[28] . "*" . $ub04id[30] . "~\n";
 408         }
 409
 410         // Segment PWK (Claim Supplemental Information) omitted.
 411
 412         // Segment CN1 (Contract Information) omitted.
 413
 414         // Patient Estimated Amount Due
 415         // Check logic
 416
 417         // $patientpaid = $claim->patientPaidAmount();
 418         // if ($patientpaid != 0) {
 419         // ++$edicount;
 420         // $out .= "AMT" . // Patient paid amount. Page 190/220.
 421         // "*F5" .
 422         // "*" . $patientpaid .
 423         // "~\n";
 424         // }
 425
 426         // Segment REF*4N (Service Authorization Exception Code) omitted.
 427         // Segment REF*9F (Referral Number) omitted.
 428
 429         // Prior Authorization
 430         //
 431         if ($claim->priorAuth()) {
 432             ++$edicount;
 433             $out .= "REF" . // Prior Authorization Number
 434                 "*G1" . "*" . $claim->priorAuth() . "~\n";
 435         }
 436
 437         // Segment REF*F8 (Payer Claim Control Number) omitted.
 438
 439         // This may be needed for the UB04 Claim if so change the 'MB' to 'MA'
 440         // if ($claim->cliaCode() && ($CMS_5010 || $claim->claimType() === 'MB')) {
 441         // Required by Medicare when in-house labs are done.
 442         // ++$edicount;
 443         // $out .= "REF" . // Clinical Laboratory Improvement Amendment Number
 444         // "*X4" .
 445         // "*" . $claim->cliaCode() .
 446         // "~\n";
 447         // }
 448
 449         // Segment REF*9A (Repriced Claim Number) omitted.
 450         // Segment REF*9C (Adjusted Repriced Claim Number) omitted.
 451         // Segment REF*LX (Investigational Device Exemption Number) omitted.
 452         // Segment REF*S9 (Claim Identifier for Transmission Intermediaries) omitted.
 453         // Segment REF*LU (Auto Accident State) omitted.
 454         // Segment REF*EA (Medical Record Number) omitted.
 455         // Segment REF*P4 (Demonstration Project Identifier) omitted.
 456         // Segment REF*G4 (Peer Review Organization PRO Approval Number) omitted.
 457         // Segment K3 (File Information) omitted.
 458
 459         if ($claim->additionalNotes()) {
 460             // Claim Note
 461             // Has a list of valid codes. Required when PROVIDER deems necessary
 462
 463             // Billing note.
 464             // Check to verify I am getting this information on the ub04 form
 465
 466             ++$edicount;
 467             $out .= "NTE" . // comments box 19
 468                 "*" . "ADD" . "*" . $claim->additionalNotes() . "~\n";
 469         }
 470
 471         // Segment CRC (EPSDT Referral) omitted.
 472         // Diagnoses, up to $max_per_seg per HI segment. Check this
 473         $max_per_seg = 18;
 474         $da = $claim->diagArray();
 475         $diag_type_code = 'ABK'; // ICD10
 476         $tmp = 0;
 477         foreach ($da as $diag) {
 478             if ($tmp == 1) {
 479                 continue;
 480             }
 481             if ($tmp % $max_per_seg == 0) {
 482                 if ($tmp) {
 483                     $out .= "~\n";
 484                 }
 485                 ++$edicount;
 486                 $out .= "HI"; // Health Diagnosis Codes
 487             }
 488             $out .= "*" . $diag_type_code . ":" . $diag;
 489             if ($claim->diagtype == "ICD9") {
 490                 $diag_type_code = 'BF';
 491             } else {
 492                 $diag_type_code = 'ABF';
 493             }
 494
 495             ++$tmp;
 496         }
 497         if ($tmp) {
 498             $out .= "~\n";
 499         }
 500
 501         // Segment HI*BI (Occurrence Span Information).
 502         // HI BI (Occurrence Span Code 1) RD8 (Occurrence Span Code Associated Date)
 503         if ($ub04id[52]) {
 504             $max_per_seg = 4;
 505             $diag_type_code = 'BI';
 506             $tmp = 0;
 507             $os = 52;
 508             for ($i = 0; $i <= 3;) {
 509                 if ($tmp % $max_per_seg == 0) {
 510                     if ($tmp) {
 511                         $out .= "~\n";
 512                     }
 513                     ++$edicount;
 514                     $out .= "HI"; // Health Diagnosis Codes
 515                 }
 516                 if ($ub04id[$os]) {
 517                     $out .= "*" . $diag_type_code . ":" . $ub04id[$os++] . ":" . self::x12Date($ub04id[$os++]) . ":" . self::x12Date($ub04id[$os++]);
 518                     $diag_type_code = 'BI';
 519                 }
 520                 if ($os >= 57) {
 521                     $os = 67;
 522                 }
 523                 ++$tmp;
 524                 ++$i;
 525             }
 526             if ($tmp) {
 527                 $out .= "~\n";
 528             }
 529         }
 530
 531         // Segment HI*BH (Occurrence Information).
 532         // HI BH (Occurrence Code 1) D8 (Occurrence Code Associated Date)
 533
 534         if ($ub04id[44]) {
 535             $max_per_seg = 8;
 536             $diag_type_code = 'BH';
 537             $tmp = 0;
 538             $os = 44;
 539             for ($i = 0; $i <= 7;) {
 540                 if ($tmp % $max_per_seg == 0) {
 541                     if ($tmp) {
 542                         $out .= "~\n";
 543                     }
 544                     ++$edicount;
 545                     $out .= "HI"; // Health Diagnosis Codes
 546                 }
 547                 if ($ub04id[$os]) {
 548                     $out .= "*" . $diag_type_code . ":" . $ub04id[$os] . ":D8" . ":" . self::x12Date($ub04id[$os++]);
 549                     $diag_type_code = 'BH';
 550                 }
 551                 if ($os >= 51) {
 552                     $os = 59;
 553                 }
 554                 ++$tmp;
 555                 ++$i;
 556             }
 557             if ($tmp) {
 558                 $out .= "~\n";
 559             }
 560         }
 561
 562         // Segment HI*BE (Value Information).
 563         // HI BE (Value Code 1) *.* (Value Code Amount)
 564
 565         if ($ub04id[74]) {
 566             $max_per_seg = 12;
 567             $diag_type_code = 'BE';
 568             $os = 74;
 569             $tmp = 0;
 570             for ($i = 0; $i <= 11;) {
 571                 if ($tmp % $max_per_seg == 0) {
 572                     if ($tmp) {
 573                         $out .= "~\n";
 574                     }
 575                     ++$edicount;
 576                     $out .= "HI"; // Health Diagnosis Codes
 577                 }
 578                 if ($ub04id[$os]) {
 579                     // if ($i=1) {
 580                     $out .= "*" . $diag_type_code . ":" . $ub04id[$os++] . ":" . ":" . self::x12Date($ub04id[$os++]);
 581                     $diag_type_code = 'BE';
 582                     // }
 583                 }
 584                 ++$tmp;
 585                 ++$i;
 586             }
 587             if ($tmp) {
 588                 $out .= "~\n";
 589             }
 590         }
 591
 592         // Segment HI*BG (Condition Information).
 593         // HI BG (Condition Code 1)
 594
 595         if ($ub04id[31]) {
 596             $max_per_seg = 11;
 597             $diag_type_code = 'BG';
 598             $os = 31;
 599             $tmp = 0;
 600             for ($i = 0; $i <= 10;) {
 601                 if ($tmp % $max_per_seg == 0) {
 602                     if ($tmp) {
 603                         $out .= "~\n";
 604                     }
 605                     ++$edicount;
 606                     $out .= "HI"; // Health Diagnosis Codes
 607                 }
 608                 if ($ub04id[$os]) {
 609                     // if ($i=1) {
 610                     $out .= "*" . $diag_type_code . ":" . $ub04id[$os++];
 611                     $diag_type_code = 'BG';
 612                     // }
 613                 }
 614
 615                 ++$tmp;
 616                 ++$i;
 617             }
 618             if ($tmp) {
 619                 $out .= "~\n";
 620             }
 621         }
 622
 623         // Segment HI*TC (Treatment Code Information).
 624         // HI TC (Treatment Code 1)
 625         /* 63a. TREATMENT AUTHORIZATION CODES - PRIMARY PLAN */
 626         if ($ub04id[319]) {
 627             $max_per_seg = 3;
 628             $diag_type_code = 'TC';
 629             $tmp = 0;
 630
 631             for ($i = 0; $i <= 2;) {
 632                 if ($tmp % $max_per_seg == 0) {
 633                     if ($tmp) {
 634                         $out .= "~\n";
 635                     }
 636                     ++$edicount;
 637                     $out .= "HI"; // Health Diagnosis Codes
 638                 }
 639
 640                 if ($ub04id[319]) {
 641                     $out .= "*" . $diag_type_code . ":" . $ub04id[319];
 642                     $diag_type_code = 'TC';
 643                 }
 644                 if ($i = 1) {
 645                     if ($ub04id[322]) {
 646                         $out .= "*" . $diag_type_code . ":" . $ub04id[322];
 647                         $diag_type_code = 'TC';
 648                     }
 649                 }
 650                 if ($i = 2) {
 651                     if ($ub04id[325]) {
 652                         $out .= "*" . $diag_type_code . ":" . $ub04id[325];
 653                         $diag_type_code = 'TC';
 654                     }
 655                 }
 656
 657                 ++$tmp;
 658                 ++$i;
 659             }
 660             if ($tmp) {
 661                 $out .= "~\n";
 662             }
 663         }
 664
 665         // Segment HCP (Claim Pricing/Repricing Information) omitted.
 666
 667         // This needs to allow Attending Physician 2310A, Operating Physician Name 2310B, Other Operating Physician Name 2310C
 668         // and Rendering Provider Name (Rendering Provider Name is futher down)
 669
 670         if ($ub04id[388]) {
 671             ++$edicount;
 672             // Loop 2310A Attending Physician
 673             $out .= "NM1" . "*71" . "*1" . "*" . $ub04id[388] . "*" . $ub04id[389] . "*" . "*";
 674             if ($ub04id[379]) { // NPI
 675                 $out .= "*" . "XX" . "*" . $ub04id[379];
 676             } else {
 677                 $out .= "*" . "*";
 678                 $log .= "*** Attending Physician has no NPI.\n";
 679             }
 680             $out .= "~\n";
 681
 682             if ($ub04id[380]) {
 683                 ++$edicount;
 684                 $out .= "REF" . // Attending Physician Secondary Identification
 685                     "*" . $ub04id[380] . "*" . $ub04id[381] . "~\n";
 686             }
 687         }
 688
 689         // 2310B
 690
 691         if ($ub04id[400]) {
 692             ++$edicount;
 693
 694             $out .= "NM1" . // Loop 2310B operating Physician
 695                 "*72" . "*1" . "*" . $ub04id[400] . "*" . $ub04id[400] . "*" . "*";
 696             if ($ub04id[390]) {
 697                 $out .= "*" . "XX" . "*" . $ub04id[390];
 698             } else {
 699                 $out .= "*" . "*";
 700                 $log .= "*** Operating Physician has no NPI qualifier.\n";
 701             }
 702             $out .= "~\n";
 703
 704             if ($ub04id[391]) {
 705                 ++$edicount;
 706                 $out .= "REF" . // operating Physician Secondary Identification
 707                     "*" . $claim->$ub04id[391] . "*" . $ub04id[392] . "~\n";
 708             }
 709         }
 710
 711         // 2310C
 712
 713         if ($ub04id[413]) {
 714             ++$edicount;
 715
 716             $out .= "NM1" . // Loop 2310C other operating Physician
 717                 "*73" . "*1" . "*" . $ub04id[413] . "*" . $ub04id[414] . "*" . "*";
 718             if ($ub04id[405]) {
 719                 $out .= "*" . $ub04id[405] . "*" . $ub04id[406];
 720             } else {
 721                 $out .= "*" . "*";
 722                 $log .= "*** Other Operating Physician has no NPI.\n";
 723             }
 724             $out .= "~\n";
 725
 726             if ($ub04id[407]) {
 727                 ++$edicount;
 728                 $out .= "REF" . // other operating Physician Secondary Identification
 729                     "*" . $ub04id[407] . "*" . $ub04id[408] . "~\n";
 730             }
 731         }
 732         if ($ub04id[427]) {
 733             ++$edicount;
 734
 735             $out .= "NM1" . // Loop 2310C other operating Physician
 736                 "*73" . "*1" . "*" . $ub04id[427] . "*" . $ub04id[428] . "*" . "*";
 737             if ($ub04id[420]) {
 738                 $out .= "*" . $ub04id[419] . "*" . $ub04id[420];
 739             } else {
 740                 $out .= "*" . "*";
 741                 $log .= "*** Other Operating Physician has no NPI.\n";
 742             }
 743             $out .= "~\n";
 744
 745             if ($ub04id[422]) {
 746                 ++$edicount;
 747                 $out .= "REF" . // other operating Physician Secondary Identification
 748                     "*" . $ub04id[422] . "*" . $ub04id[421] . "~\n";
 749             }
 750         }
 751         /*
 752          * Per the implementation guide lines, only include this information if it is different
 753          * than the Loop 2010AA information
 754          */
 755         if ($claim->providerNPIValid() && $claim->billingFacilityNPI() !== $claim->providerNPI()) {
 756             ++$edicount;
 757             $out .= "NM1" . // Loop 2310D Rendering Provider
 758                 "*82" . "*1" . "*" . $claim->providerLastName() . "*" . $claim->providerFirstName() . "*" . $claim->providerMiddleName() . "*" . "*";
 759             if ($claim->providerNPI()) {
 760                 $out .= "*XX" . "*" . $claim->providerNPI();
 761             } else {
 762                 $log .= "*** Rendering provider has no NPI.\n";
 763             }
 764             $out .= "~\n";
 765
 766             // End of Loop 2310D
 767         } else {
 768             // This loop can only get skipped if we are generating a 5010 claim
 769             if (!($claim->providerNPIValid())) {
 770                 //If the loop was skipped because the provider NPI was invalid, generate a warning for the log.
 771                 $log .= "*** Skipping 2310B because " . $claim->providerLastName() . "," . $claim->providerFirstName() . " has invalid NPI.\n";
 772             }
 773             /*
 774              * Skipping this segment because the providerNPI and the billingFacilityNPI are identical
 775              * is a normal condition, so no need to warn.
 776              */
 777         }
 778
 779         // 5010 spec says nothing here if NPI was specified.
 780         //
 781         if (!$claim->providerNPI() && in_array($claim->providerNumberType(), array('0B', '1G', 'G2', 'LU'))) {
 782             if ($claim->providerNumber()) {
 783                 ++$edicount;
 784                 $out .= "REF" . "*" . $claim->providerNumberType() . "*" . $claim->providerNumber() . "~\n";
 785             }
 786         }
 787
 788         // Loop 2310D is omitted in the case of home visits (POS=12).
 789         if ($claim->facilityPOS() != 12 && ($claim->facilityNPI() != $claim->billingFacilityNPI())) {
 790             ++$edicount;
 791
 792             // Service Facility Name
 793
 794             $out .= "NM1" . // Loop 2310E Service Location
 795                 "*77" . "*2";
 796             $facilityName = substr($claim->facilityName(), 0, 60);
 797             if ($claim->facilityName() || $claim->facilityNPI() || $claim->facilityETIN()) {
 798                 $out .= "*" . $facilityName;
 799             }
 800             if ($claim->facilityNPI() || $claim->facilityETIN()) {
 801                 $out .= "*" . "*" . "*" . "*";
 802                 if ($claim->facilityNPI()) {
 803                     $out .= "*XX*" . $claim->facilityNPI();
 804                 } else {
 805                     $log .= "*** Service location has no NPI.\n";
 806                 }
 807             }
 808             $out .= "~\n";
 809             if ($claim->facilityStreet()) {
 810                 ++$edicount;
 811                 $out .= "N3" . "*" . $claim->facilityStreet() . "~\n";
 812             }
 813             if ($claim->facilityState()) {
 814                 ++$edicount;
 815                 $out .= "N4" . "*" . $claim->facilityCity() . "*" . $claim->facilityState() . "*" . $claim->x12Zip($claim->facilityZip()) . "~\n";
 816             }
 817         }
 818
 819         // Segment REF (Service Facility Location Secondary Identification) omitted.
 820         // Segment PER (Service Facility Contact Information) omitted.
 821
 822         // Loop 2310F Referring Provider
 823
 824         if ($claim->referrerLastName()) {
 825             // Medicare requires referring provider's name and UPIN.
 826             ++$edicount;
 827
 828             $out .= "NM1" . // Loop 2310F Referring Provider this needs to change position
 829                 "*DN" . "*1" . "*" . $claim->referrerLastName() . "*" . $claim->referrerFirstName() . "*" . $claim->referrerMiddleName() . "*" . "*";
 830             if ($claim->referrerNPI()) {
 831                 $out .= "*XX" . "*" . $claim->referrerNPI();
 832             } else {
 833                 $log .= "*** Referrer has no NPI.\n";
 834             }
 835             $out .= "~\n";
 836         }
 837
 838         // Loop 2310E, Supervising Provider
 839         // Omitted
 840
 841         // Segments NM1*PW, N3, N4 (Ambulance Pick-Up Location) omitted.
 842         // Segments NM1*45, N3, N4 (Ambulance Drop-Off Location) omitted.
 843
 844         $prev_pt_resp = $clm_total_charges; // for computation below
 845
 846         // Loops 2320 and 2330*, other subscriber/payer information.
 847         // Remember that insurance index 0 is always for the payer being billed
 848         // by this claim, and 1 and above are always for the "other" payers.
 849         //
 850         for ($ins = 1; $ins < $claim->payerCount(); ++$ins) {
 851             $tmp1 = $claim->claimType($ins);
 852             $tmp2 = 'C1'; // Here a kludge. See page 321.
 853             if ($tmp1 === 'CI') {
 854                 $tmp2 = 'C1';
 855             }
 856             if ($tmp1 === 'AM') {
 857                 $tmp2 = 'AP';
 858             }
 859             if ($tmp1 === 'HM') {
 860                 $tmp2 = 'HM';
 861             }
 862             if ($tmp1 === 'MB') {
 863                 $tmp2 = 'MB';
 864             }
 865             if ($tmp1 === 'MA') {
 866                 $tmp2 = 'MA';
 867             }
 868             if ($tmp1 === 'MC') {
 869                 $tmp2 = 'MC';
 870             }
 871             if ($tmp1 === '09') {
 872                 $tmp2 = 'PP';
 873             }
 874             ++$edicount;
 875
 876             $out .= "SBR" . // Loop 2320, Subscriber Information - page 297/318
 877                 "*" . $claim->payerSequence($ins) .
 878                 "*" . $claim->insuredRelationship($ins) .
 879                 "*" . $claim->groupNumber($ins) .
 880                 "*" . (($claim->groupNumber($ins)) ? '' : $claim->groupName($ins)) .
 881                 "*" . ($claim->insuredTypeCode($ins) ? $claim->insuredTypeCode($ins) : $tmp2) .
 882                 "*" .
 883                 "*" .
 884                 "*" .
 885                 "*" . $claim->claimType($ins) .
 886                 "~\n";
 887
 888             // Things that apply only to previous payers, not future payers.
 889             //
 890             if ($claim->payerSequence($ins) < $claim->payerSequence()) {
 891                 // Generate claim-level adjustments.
 892                 $aarr = $claim->payerAdjustments($ins);
 893                 foreach ($aarr as $a) {
 894                     ++$edicount;
 895                     $out .= "CAS" . // Previous payer's claim-level adjustments. Page 301/323.
 896                         "*" . $a[1] . "*" . $a[2] . "*" . $a[3] . "~\n";
 897                 }
 898
 899                 $payerpaid = $claim->payerTotals($ins);
 900                 ++$edicount;
 901                 $out .= "AMT" . // Previous payer's paid amount. Page 307/332.
 902                     "*D" . "*" . $payerpaid[1] . "~\n";
 903
 904                 // Segment AMT*A8 (COB Total Non-Covered Amount) omitted.
 905                 // Segment AMT*EAF (Remaining Patient Liability) omitted.
 906             } // End of things that apply only to previous payers.
 907
 908             ++$edicount;
 909             $out .= "OI" . // Other Insurance Coverage Information. Page 310/344.
 910                 "*" . "*" . "*" . ($claim->billingFacilityAssignment($ins) ? 'Y' : 'N') .
 911                 // For this next item, the 5010 example in the spec does not match its
 912                 // description. So this might be wrong.
 913                 "*" .
 914                 "*" .
 915                 "*" .
 916                 "Y" .
 917                 "~\n";
 918
 919             // Segment MOA (Medicare Outpatient Adjudication) omitted.
 920             ++$edicount;
 921             $out .= "NM1" . // Loop 2330A Subscriber info for other insco. Page 315/350.
 922                 "*" . "IL" .
 923                 "*" . "1" .
 924                 "*" . $claim->insuredLastName($ins) .
 925                 "*" . $claim->insuredFirstName($ins) .
 926                 "*" . $claim->insuredMiddleName($ins) .
 927                 "*" .
 928                 "*" .
 929                 "*" . "MI" .
 930                 "*" . $claim->policyNumber($ins) .
 931                 "~\n";
 932
 933             ++$edicount;
 934             $out .= "N3" .
 935                 "*" . $claim->insuredStreet($ins) .
 936                 "~\n";
 937
 938             ++$edicount;
 939             $out .= "N4" .
 940                 "*" . $claim->insuredCity($ins) .
 941                 "*" . $claim->insuredState($ins) .
 942                 "*" . $claim->x12Zip($claim->insuredZip($ins)) .
 943                 "~\n";
 944
 945             // Segment REF (Other Subscriber Secondary Identification) omitted.
 946             ++$edicount;
 947             $payerName = substr($claim->payerName($ins), 0, 60);
 948             $out .= "NM1" . // Loop 2330B Payer info for other insco. Page 322/359.
 949                 "*" . "PR" .
 950                 "*" . "2" .
 951                 "*" . $payerName .
 952                 "*" .
 953                 "*" .
 954                 "*" .
 955                 "*" .
 956                 "*" . "PI" .
 957                 "*" . $claim->payerID($ins) .
 958                 "~\n";
 959
 960             if (!$claim->payerID($ins)) {
 961                 $log .= "*** Payer ID is missing for payer '" . $claim->payerName($ins) . "'.\n";
 962             }
 963
 964             ++$edicount;
 965             $out .= "N3" .
 966                 "*" . $claim->payerStreet($ins) .
 967                 "~\n";
 968
 969             ++$edicount;
 970             $out .= "N4" .
 971                 "*" . $claim->payerCity($ins) .
 972                 "*" . $claim->payerState($ins) .
 973                 "*" . $claim->x12Zip($claim->payerZip($ins)) .
 974                 "~\n";
 975
 976             // Segment DTP*573 (Claim Check or Remittance Date) omitted.
 977             // Segment REF (Other Payer Secondary Identifier) omitted.
 978             // Segment REF*G1 (Other Payer Prior Authorization Number) omitted.
 979             // Segment REF*9F (Other Payer Referral Number) omitted.
 980             // Segment REF*T4 (Other Payer Claim Adjustment Indicator) omitted.
 981             // Segment REF*F8 (Other Payer Claim Control Number) omitted.
 982             // 2330C-I loops Omitted
 983         } // End loops 2320/2330*.
 984
 985         $loopcount = 0;
 986
 987         // Procedure loop starts here.
 988         //
 989
 990         for ($tlh = 0; $tlh < $proccount; ++$tlh) {
 991             $tmp = $claim->procs[$tlh][code_text];
 992
 993             if ($claim->procs[$tlh][code_type] == 'HCPCS') {
 994                 $tmpcode = '3';
 995             } else {
 996                 $tmpcode = '1';
 997             }
 998             $getrevcd = $claim->cptCode($tlh);
 999             $sql = "SELECT * FROM codes WHERE code_type = ? and code = ? ORDER BY revenue_code DESC";
1000             $revcode[$tlh] = sqlQuery($sql, array(
1001                 $tmpcode,
1002                 $getrevcd
1003             ));
1004         }
1005
1006
1007         for ($prockey = 0; $prockey < $proccount; ++$prockey) {
1008             $os = 99 + ($loopcount * 8); // Form revenue code offset
1009             $dosos = 102 + ($loopcount * 8); // Procedure date of service form start offset-add 8 for loop
1010             ++$loopcount;
1011
1012             ++$edicount;
1013             $out .= "LX" . // Loop 2400 LX Service Line. Page 398.
1014                 "*" . "$loopcount" . "~\n";
1015
1016             ++$edicount;
1017
1018             // Revenue code from form
1019             //
1020             $tmp = $ub04id[$os]; //$revcode[$prockey][revenue_code];
1021             if (empty($tmp)) {
1022                 $log .= "*** Error: Missing Revenue Code for " . $claim->cptKey($prockey) . "!\n";
1023             }
1024             // Institutional Service Line.
1025             //
1026             $out .= "SV2" . "*" . $tmp . // revenue code
1027
1028                 "*" . "HC:" . $claim->cptKey($prockey) . "*" . sprintf('%.2f', $claim->cptCharges($prockey)) . "*UN" . "*" . $claim->cptUnits($prockey) . "*" . "*" . "*";
1029
1030             $out .= "~\n";
1031
1032             if (!$claim->cptCharges($prockey)) {
1033                 $log .= "*** Procedure '" . $claim->cptKey($prockey) . "' has no charges!\n";
1034             }
1035
1036             // Segment SV5 (Durable Medical Equipment Service) omitted.
1037             // Segment PWK (Line Supplemental Information) omitted.
1038             // Segment PWK (Durable Medical Equipment Certificate of Medical Necessity Indicator) omitted.
1039             // Segment CR1 (Ambulance Transport Information) omitted.
1040             // Segment CR3 (Durable Medical Equipment Certification) omitted.
1041             // Segment CRC (Ambulance Certification) omitted.
1042             // Segment CRC (Hospice Employee Indicator) omitted.
1043             // Segment CRC (Condition Indicator / Durable Medical Equipment) omitted.
1044
1045             ++$edicount;
1046
1047             $out .= "DTP" . // Date of Service. Needs to be when service preformed.
1048                 "*" . "472" . "*" . "D8" . "*" . $ub04id[$dosos] . "~\n"; //$claim->serviceDate()
1049
1050             $testnote = rtrim($claim->cptNotecodes($prockey));
1051             if (!empty($testnote)) {
1052                 ++$edicount;
1053                 $out .= "NTE" . // Explain Unusual Circumstances.
1054                     "*ADD" . "*" . $claim->cptNotecodes($prockey) . "~\n";
1055             }
1056
1057             // Segment DTP*471 (Prescription Date) omitted.
1058             // Segment DTP*607 (Revision/Recertification Date) omitted.
1059             // Segment DTP*463 (Begin Therapy Date) omitted.
1060             // Segment DTP*461 (Last Certification Date) omitted.
1061             // Segment DTP*304 (Last Seen Date) omitted.
1062             // Segment DTP (Test Date) omitted.
1063             // Segment DTP*011 (Shipped Date) omitted.
1064             // Segment DTP*455 (Last X-Ray Date) omitted.
1065             // Segment DTP*454 (Initial Treatment Date) omitted.
1066             // Segment QTY (Ambulance Patient Count) omitted.
1067             // Segment QTY (Obstetric Anesthesia Additional Units) omitted.
1068             // Segment MEA (Test Result) omitted.
1069             // Segment CN1 (Contract Information) omitted.
1070             // Segment REF*9B (Repriced Line Item Reference Number) omitted.
1071             // Segment REF*9D (Adjusted Repriced Line Item Reference Number) omitted.
1072             // Segment REF*G1 (Prior Authorization) omitted.
1073             // Segment REF*6R (Line Item Control Number) omitted.
1074             // (Really oughta have this for robust 835 posting!)
1075             // Segment REF*EW (Mammography Certification Number) omitted.
1076             // Segment REF*X4 (CLIA Number) omitted.
1077             // Segment REF*F4 (Referring CLIA Facility Identification) omitted.
1078             // Segment REF*BT (Immunization Batch Number) omitted.
1079             // Segment REF*9F (Referral Number) omitted.
1080             // Segment AMT*GT (Sales Tax Amount) omitted.
1081             // Segment AMT*F4 (Postage Claimed Amount) omitted.
1082             // Segment K3 (File Information) omitted.
1083             // Segment NTE (Line Note) omitted.
1084             // Segment NTE (Third Party Organization Notes) omitted.
1085             // Segment PS1 (Purchased Service Information) omitted.
1086             // Segment HCP (Line Pricing/Repricing Information) omitted.
1087
1088             // Loop 2410, Drug Information. Medicaid insurers seem to want this
1089             // with HCPCS codes.
1090             //
1091             $ndc = $claim->cptNDCID($prockey);
1092
1093             if ($ndc) {
1094                 ++$edicount;
1095                 $out .= "LIN" . // Drug Identification. Page 500+ (Addendum pg 71).
1096                     "*" .         // Per addendum, LIN01 is not used.
1097                     "*" . "N4" .
1098                     "*" . $ndc .
1099                     "~\n";
1100
1101                 if (!preg_match('/^\d\d\d\d\d-\d\d\d\d-\d\d$/', $ndc, $tmp) && !preg_match('/^\d{11}$/', $ndc)) {
1102                     $log .= "*** NDC code '$ndc' has invalid format!\n";
1103                 }
1104
1105                 ++$edicount;
1106                 $out .= "CTP" . // Drug Pricing. Page 500+ (Addendum pg 74).
1107                     "*" .
1108                     "*" .
1109                     "*" .
1110                     "*" . $claim->cptNDCQuantity($prockey) .
1111                     "*" . $claim->cptNDCUOM($prockey) .
1112                     // Note: 5010 documents "ME" (Milligrams) as an additional unit of measure.
1113                     "~\n";
1114             }
1115
1116             // Segment REF (Prescription or Compound Drug Association Number) omitted.
1117
1118             // Loop 2420A, Rendering Provider (service-specific). (Operating Physician Name for 837I)
1119             // Used if the rendering provider for this service line is different
1120             // from that in loop 2310B.
1121             //
1122             if ($claim->providerNPI() != $claim->providerNPI($prockey)) {
1123                 ++$edicount;
1124                 $out .= "NM1" .       // Loop 2310B Rendering Provider
1125                     "*" . "82" .
1126                     "*" . "1" .
1127                     "*" . $claim->providerLastName($prockey) .
1128                     "*" . $claim->providerFirstName($prockey) .
1129                     "*" . $claim->providerMiddleName($prockey) .
1130                     "*" .
1131                     "*";
1132                 if ($claim->providerNPI($prockey)) {
1133                     $out .=
1134                         "*" . "XX" .
1135                         "*" . $claim->providerNPI($prockey);
1136                 } else {
1137                     $log .= "*** Rendering provider has no NPI.\n";
1138                 }
1139                 $out .= "~\n";
1140
1141                 if ($claim->providerTaxonomy($prockey)) {
1142                     ++$edicount;
1143                     $out .= "PRV" .
1144                         "*" . "PE" . // PErforming provider
1145                         "*" . "PXC" .
1146                         "*" . $claim->providerTaxonomy($prockey) .
1147                         "~\n";
1148                 }
1149
1150                 // Segment PRV*PE (Rendering Provider Specialty Information) omitted.
1151                 // Segment REF (Rendering Provider Secondary Identification) omitted.
1152                 // Segment NM1 (Purchased Service Provider Name) omitted.
1153                 // Segment REF (Purchased Service Provider Secondary Identification) omitted.
1154                 // Segment NM1,N3,N4 (Service Facility Location) omitted.
1155                 // Segment REF (Service Facility Location Secondary Identification) omitted.
1156                 // Segment NM1 (Supervising Provider Name) omitted.
1157                 // Segment REF (Supervising Provider Secondary Identification) omitted.
1158                 // Segment NM1,N3,N4 (Ordering Provider) omitted.
1159                 // Segment REF (Ordering Provider Secondary Identification) omitted.
1160                 // Segment PER (Ordering Provider Contact Information) omitted.
1161                 // Segment NM1 (Referring Provider Name) omitted.
1162                 // Segment REF (Referring Provider Secondary Identification) omitted.
1163                 // Segments NM1*PW, N3, N4 (Ambulance Pick-Up Location) omitted.
1164                 // Segments NM1*45, N3, N4 (Ambulance Drop-Off Location) omitted.
1165
1166                 // REF*1C is required here for the Medicare provider number if NPI was
1167                 // specified in NM109. Not sure if other payers require anything here.
1168                 if ($claim->providerNumberType($prockey) == "G2") {
1169                     ++$edicount;
1170                     $out .= "REF" . "*" . $claim->providerNumberType($prockey) .
1171                         "*" . $claim->providerNumber($prockey) . "~\n";
1172                 }
1173             } // provider exception
1174
1175             // Loop 2430, adjudication by previous payers.
1176             //
1177             for ($ins = 1; $ins < $claim->payerCount(); ++$ins) {
1178                 if ($claim->payerSequence($ins) > $claim->payerSequence()) {
1179                     continue; // payer is future, not previous
1180                 }
1181
1182                 $payerpaid = $claim->payerTotals($ins, $claim->cptKey($prockey));
1183                 $aarr = $claim->payerAdjustments($ins, $claim->cptKey($prockey));
1184
1185                 if ($payerpaid[1] == 0 && !count($aarr)) {
1186                     $log .= "*** Procedure '" . $claim->cptKey($prockey) . "' has no payments or adjustments from previous payer!\n";
1187                     continue;
1188                 }
1189
1190                 ++$edicount;
1191                 $out .= "SVD" . // Service line adjudication. Page 554.
1192                     "*" . $claim->payerID($ins) . "*" . $payerpaid[1] . "*HC:" . $claim->cptKey($prockey) . "*" . "*" . $claim->cptUnits($prockey) . "~\n";
1193
1194                 $tmpdate = $payerpaid[0];
1195                 foreach ($aarr as $a) {
1196                     ++$edicount;
1197                     $out .= "CAS" . // Previous payer's line level adjustments. Page 558.
1198                         "*" . $a[1] . "*" . $a[2] . "*" . $a[3] . "~\n";
1199                     if (!$tmpdate) {
1200                         $tmpdate = $a[0];
1201                     }
1202                 }
1203
1204                 if ($tmpdate) {
1205                     ++$edicount;
1206                     $out .= "DTP" . // Previous payer's line adjustment date. Page 493/566.
1207                         "*573" . "*D8" . "*$tmpdate" . "~\n";
1208                 }
1209
1210                 // Segment AMT*EAF (Remaining Patient Liability) omitted.
1211                 // Segment LQ (Form Identification Code) omitted.
1212                 // Segment FRM (Supporting Documentation) omitted.
1213             } // end loop 2430
1214         } // end this procedure
1215
1216         ++$edicount;
1217         $out .= "SE" . // SE Trailer
1218             "*$edicount" . "*0021" . "~\n";
1219
1220         $out .= "GE" . // GE Trailer
1221             "*1" . "*1" . "~\n";
1222
1223         $out .= "IEA" . // IEA Trailer
1224             "*1" . "*000000001" . "~\n";
1225
1226         // Remove any trailing empty fields (delimiters) from each segment.
1227         $out = preg_replace('/\*+~/', '~', $out);
1228
1229         $log .= "\n";
1230         return $out;
1231     }
1232 }