interface/billing/sl_eob_invoice.php

   1 <?php
   2 /**
   3  * This provides for manual posting of EOBs.  It is invoked from
   4  * sl_eob_search.php.  For automated (X12 835) remittance posting
   5  * see sl_eob_process.php.
   6  *
   7  * @package OpenEMR
   8  * @author  Rod Roark <rod@sunsetsystems.com>
   9  * @author  Roberto Vasquez <robertogagliotta@gmail.com>
  10  * @author  Terry Hill <terry@lillysystems.com>
  11  * @author  Jerry Padgett <sjpadgett@gmail.com>
  12  * @author  Stephen Waite <stephen.waite@cmsvt.com>
  13  * @copyright Copyright (c) 2005-2016 Rod Roark <rod@sunsetsystems.com>
  14  * @copyright Copyright (c) 2018 Stephen Waite <stephen.waite@cmsvt.com>
  15  * @link http://www.open-emr.org
  16  * @license https://github.com/openemr/openemr/blob/master/LICENSE GNU General Public License 3
  17  */
  18
  19
  20 require_once("../globals.php");
  21 require_once("$srcdir/log.inc");
  22 require_once("$srcdir/patient.inc");
  23 require_once("$srcdir/forms.inc");
  24 require_once("$srcdir/invoice_summary.inc.php");
  25 require_once("../../custom/code_types.inc.php");
  26 require_once "$srcdir/user.inc";
  27
  28 use OpenEMR\Billing\SLEOB;
  29 use OpenEMR\Core\Header;
  30
  31 $debug = 0; // set to 1 for debugging mode
  32 $save_stay = $_REQUEST['form_save'] == '1' ? true : false;
  33 $g_posting_adj_disable = $GLOBALS['posting_adj_disable'] ? 'checked' : '';
  34 $posting_adj_disable = prevSetting('sl_eob_search.', 'posting_adj_disable', 'posting_adj_disable', $g_posting_adj_disable);
  35 $from_posting = (0 + $_REQUEST['isPosting']) ? 1 : 0;
  36 if (!$from_posting) {
  37     // this means from past encounters so go with the global
  38     // otherwise posting search user setting is followed.
  39     $posting_adj_disable = $g_posting_adj_disable;
  40 }
  41 // If we permit deletion of transactions.  Might change this later.
  42 $ALLOW_DELETE = true;
  43
  44 $info_msg = "";
  45
  46 // Format money for display.
  47 //
  48 function bucks($amount)
  49 {
  50     if ($amount) {
  51         return sprintf("%.2f", $amount);
  52     }
  53 }
  54
  55 // Delete rows, with logging, for the specified table using the
  56 // specified WHERE clause.  Borrowed from deleter.php.
  57 //
  58 function row_delete($table, $where)
  59 {
  60     $tres = sqlStatement("SELECT * FROM $table WHERE $where");
  61     $count = 0;
  62     while ($trow = sqlFetchArray($tres)) {
  63         $logstring = "";
  64         foreach ($trow as $key => $value) {
  65             if (!$value || $value == '0000-00-00 00:00:00') {
  66                 continue;
  67             }
  68
  69             if ($logstring) {
  70                 $logstring .= " ";
  71             }
  72
  73             $logstring .= $key . "='" . addslashes($value) . "'";
  74         }
  75
  76         newEvent("delete", $_SESSION['authUser'], $_SESSION['authProvider'], 1, "$table: $logstring");
  77         ++$count;
  78     }
  79
  80     if ($count) { // Lets not echo the query for stay and save
  81         $query = "DELETE FROM $table WHERE $where";
  82         sqlStatement($query);
  83     }
  84 }
  85
  86 ?>
  87 <html>
  88 <head>
  89     <?php Header::setupHeader(['datetime-picker']); ?>
  90     <title><?php echo xlt('EOB Posting - Invoice') ?></title>
  91     <script language="JavaScript">
  92     var adjDisable = '<?php echo attr($posting_adj_disable); ?>';
  93     // An insurance radio button is selected.
  94     function setins(istr) {
  95         return true;
  96     }
  97
  98     function goEncounterSummary(pid) {
  99         if(pid) {
 100             if(typeof opener.toEncSummary  === 'function') {
 101                 opener.toEncSummary(pid);
 102             }
 103         }
 104         window.close();
 105     }
 106     function doClose(isPosting) {
 107         let encurl = 'patient_file/history/encounters.php?billing=1';
 108
 109         if(!isPosting)
 110             opener.top.left_nav.loadFrame('enc2', 'enc', encurl);
 111         window.close();
 112     }
 113     // Compute an adjustment that writes off the balance:
 114     function writeoff(code) {
 115         var f = document.forms[0];
 116         var belement = f['form_line[' + code + '][bal]'];
 117         var pelement = f['form_line[' + code + '][pay]'];
 118         var aelement = f['form_line[' + code + '][adj]'];
 119         var relement = f['form_line[' + code + '][reason]'];
 120         var tmp = belement.value - pelement.value;
 121         aelement.value = Number(tmp).toFixed(2);
 122         if (aelement.value && !relement.value) relement.selectedIndex = 1;
 123         return false;
 124     }
 125
 126     // Onsubmit handler.  A good excuse to write some JavaScript.
 127     function validate(f) {
 128         let delcount = 0;
 129         let allempty = true;
 130
 131         for (var i = 0; i < f.elements.length; ++i) {
 132             let ename = f.elements[i].name;
 133             // Count deletes.
 134             if (ename.substring(0, 9) == 'form_del[') {
 135                 if (f.elements[i].checked) ++delcount;
 136                 continue;
 137             }
 138             let pfxlen = ename.indexOf('[pay]');
 139             if (pfxlen < 0) continue;
 140             let pfx = ename.substring(0, pfxlen);
 141             let code = pfx.substring(pfx.indexOf('[') + 1, pfxlen - 1);
 142             let cPay = parseFloat(f[pfx + '[pay]'].value).toFixed(2);
 143             let cAdjust = parseFloat(f[pfx + '[adj]'].value).toFixed(2);
 144
 145             if ((cPay != 0) || cAdjust != 0) {
 146                 allempty = false;
 147             }
 148             if(adjDisable) {
 149                 if ((cAdjust == 0 && f[pfx + '[reason]'].value)) {
 150                     allempty = false;
 151                 }
 152             }
 153             if ((cPay != 0) && isNaN(parseFloat(f[pfx + '[pay]'].value))) {
 154                 alert('<?php echo xls('Payment value for code ') ?>' + code + '<?php echo xls(' is not a number') ?>');
 155                 return false;
 156             }
 157             if ((cAdjust != 0) && isNaN(parseFloat(f[pfx + '[adj]'].value))) {
 158                 alert('<?php echo xls('Adjustment value for code ') ?>' + code + '<?php echo xls(' is not a number') ?>');
 159                 return false;
 160             }
 161             if ((cAdjust != 0) && !f[pfx + '[reason]'].value) {
 162                 alert('<?php echo xls('Please select an adjustment reason for code ') ?>' + code);
 163                 return false;
 164             }
 165 // TBD: validate the date format
 166         }
 167 // Check if save is clicked with nothing to post.
 168         if (allempty && delcount === 0) {
 169             alert('<?php echo xls('Nothing to Post! Please review entries or use Cancel to exit transaction')?>');
 170             return false;
 171         }
 172 // Demand confirmation if deleting anything.
 173         if (delcount > 0) {
 174             if (!confirm('<?php echo xls('Really delete'); ?> ' + delcount +
 175                 ' <?php echo xls('transactions'); ?>?' +
 176                 ' <?php echo xls('This action will be logged'); ?>!')
 177             ) return false;
 178         }
 179
 180         return true;
 181     }
 182
 183     <!-- Get current date -->
 184
 185     function getFormattedToday() {
 186         let today = new Date();
 187         let dd = today.getDate();
 188         let mm = today.getMonth() + 1; //January is 0!
 189         let yyyy = today.getFullYear();
 190         if (dd < 10) {
 191             dd = '0' + dd
 192         }
 193         if (mm < 10) {
 194             mm = '0' + mm
 195         }
 196
 197         return (yyyy + '-' + mm + '-' + dd);
 198     }
 199
 200     <!-- Update Payment Fields -->
 201
 202     function updateFields(payField, adjField, balField, coPayField, isFirstProcCode) {
 203         let payAmount = 0.0;
 204         let adjAmount = 0.0;
 205         let balAmount = 0.0;
 206         let coPayAmount = 0.0;
 207
 208 // coPayFiled will be null if there is no co-pay entry in the fee sheet
 209         if (coPayField)
 210             coPayAmount = coPayField.value;
 211
 212 // if balance field is 0.00, its value comes back as null, so check for nul-ness first
 213         if (balField)
 214             balAmount = (balField.value) ? balField.value : 0;
 215         if (payField)
 216             payAmount = (payField.value) ? payField.value : 0;
 217
 218 //alert('balance = >' + balAmount +'<  payAmount = ' + payAmount + '  copay = ' + coPayAmount + '  isFirstProcCode = ' + isFirstProcCode);
 219
 220 // subtract the co-pay only from the first procedure code
 221         if (isFirstProcCode == 1)
 222             balAmount = parseFloat(balAmount) + parseFloat(coPayAmount);
 223         if (adjDisable) return;
 224
 225         adjAmount = balAmount - payAmount;
 226 // Assign rounded adjustment value back to TextField
 227         adjField.value = adjAmount = Math.round(adjAmount * 100) / 100;
 228     }
 229
 230     $(document).ready(function () {
 231         $('.datepicker').datetimepicker({
 232             <?php $datetimepicker_timepicker = false; ?>
 233             <?php $datetimepicker_showseconds = false; ?>
 234             <?php $datetimepicker_formatInput = false; ?>
 235             <?php require($GLOBALS['srcdir'] . '/js/xl/jquery-datetimepicker-2-5-4.js.php'); ?>
 236             <?php // can add any additional javascript settings to datetimepicker here; need to prepend first setting with a comma ?>
 237         });
 238     });
 239
 240     </script>
 241     <style>
 242         @media only screen and (max-width: 768px) {
 243             [class*="col-"] {
 244                 width: 100%;
 245                 text-align: left !Important;
 246             }
 247         }
 248
 249         .table {
 250             margin: auto;
 251             width: 99%;
 252         }
 253
 254         .table > tbody > tr > td {
 255             border-top: none;
 256         }
 257
 258         .last_detail {
 259             border-bottom: 1px black solid;
 260             margin-top: 2px;
 261         }
 262
 263         @media (min-width: 992px) {
 264             .modal-lg {
 265                 width: 1000px !Important;
 266             }
 267         }
 268
 269         /*.modalclass {
 270         overflow-x: hidden !Important;
 271         }
 272         .oe-ckbox-label{
 273         padding-left: 30px;
 274         font-weight: 500;
 275         }*/
 276     </style>
 277 </head>
 278 <body>
 279 <?php
 280 $trans_id = 0 + $_GET['id'];
 281 if (!$trans_id) {
 282     die(xlt("You cannot access this page directly."));
 283 }
 284
 285 // A/R case, $trans_id matches form_encounter.id.
 286 $ferow = sqlQuery("SELECT e.*, p.fname, p.mname, p.lname FROM form_encounter AS e, patient_data AS p WHERE e.id = ? AND p.pid = e.pid", array($trans_id));
 287 if (empty($ferow)) {
 288     die("There is no encounter with form_encounter.id = '" . text($trans_id) . "'.");
 289 }
 290 $patient_id = 0 + $ferow['pid'];
 291 $encounter_id = 0 + $ferow['encounter'];
 292 $svcdate = substr($ferow['date'], 0, 10);
 293 $form_payer_id = 0 + $_POST['form_payer_id'];
 294 $form_reference = $_POST['form_reference'];
 295 $form_check_date = fixDate($_POST['form_check_date'], date('Y-m-d'));
 296 $form_deposit_date = fixDate($_POST['form_deposit_date'], $form_check_date);
 297 $form_pay_total = 0 + $_POST['form_pay_total'];
 298
 299 $payer_type = 0;
 300 if (preg_match('/^Ins(\d)/i', $_POST['form_insurance'], $matches)) {
 301     $payer_type = $matches[1];
 302 }
 303
 304 if (($_POST['form_save'] || $_POST['form_cancel'])) {
 305     if ($_POST['form_save']) {
 306         if (!verifyCsrfToken($_POST["csrf_token_form"])) {
 307             csrfNotVerified();
 308         }
 309
 310         if ($debug) {
 311             echo "<p><b>" . xlt("This module is in test mode. The database will not be changed.") . "</b><p>\n";
 312         }
 313
 314         $session_id = SLEOB::arGetSession($form_payer_id, $form_reference, $form_check_date, $form_deposit_date, $form_pay_total);
 315 // The sl_eob_search page needs its invoice links modified to invoke
 316 // javascript to load form parms for all the above and submit.
 317 // At the same time that page would be modified to work off the
 318 // openemr database exclusively.
 319 // And back to the sl_eob_invoice page, I think we may want to move
 320 // the source input fields from row level to header level.
 321
 322 // Handle deletes. row_delete() is borrowed from deleter.php.
 323         if ($ALLOW_DELETE && !$debug) {
 324             if (is_array($_POST['form_del'])) {
 325                 foreach ($_POST['form_del'] as $arseq => $dummy) {
 326                     row_delete("ar_activity", "pid = '" . add_escape_custom($patient_id) . "' AND " . "encounter = '" . add_escape_custom($encounter_id) . "' AND sequence_no = '" . add_escape_custom($arseq) . "'");
 327                 }
 328             }
 329         }
 330
 331         $paytotal = 0;
 332         foreach ($_POST['form_line'] as $code => $cdata) {
 333             $thispay = trim($cdata['pay']);
 334             $thisadj = trim($cdata['adj']);
 335             $thisins = trim($cdata['ins']);
 336             $thiscodetype = trim($cdata['code_type']);
 337             $reason = $cdata['reason'];
 338
 339 // Get the adjustment reason type.  Possible values are:
 340 // 1 = Charge adjustment
 341 // 2 = Coinsurance
 342 // 3 = Deductible
 343 // 4 = Other pt resp
 344 // 5 = Comment
 345             $reason_type = '1';
 346             if ($reason) {
 347                 $tmp = sqlQuery("SELECT option_value FROM list_options WHERE list_id = 'adjreason' AND activity = 1 AND option_id = ?", array($reason));
 348                 if (empty($tmp['option_value'])) {
 349 // This should not happen but if it does, apply old logic.
 350                     if (preg_match("/To copay/", $reason)) {
 351                         $reason_type = 2;
 352                     } elseif (preg_match("/To ded'ble/", $reason)) {
 353                         $reason_type = 3;
 354                     }
 355                     $info_msg .= xl("No adjustment reason type found for") . " \"$reason\". ";
 356                 } else {
 357                     $reason_type = $tmp['option_value'];
 358                 }
 359             }
 360
 361             if (!$thisins) {
 362                 $thisins = 0;
 363             }
 364
 365             if (0.0 + $thispay) {
 366                 SLEOB::arPostPayment($patient_id, $encounter_id, $session_id, $thispay, $code, $payer_type, '', $debug, '', $thiscodetype);
 367                 $paytotal += $thispay;
 368             }
 369
 370 // Be sure to record adjustment reasons, even for zero adjustments if
 371 // they happen to be comments.
 372             if ((0.0 + $thisadj) ||
 373                 ($reason && $reason_type == 5) ||
 374                 ($reason && ($reason_type > 1 && $reason_type < 6))) {
 375 // "To copay" and "To ded'ble" need to become a comment in a zero
 376 // adjustment, formatted just like sl_eob_process.php.
 377                 if ($reason_type == '2') {
 378                     $reason = $_POST['form_insurance'] . " coins: $thisadj";
 379                     $thisadj = 0;
 380                 } elseif ($reason_type == '3') {
 381                     $reason = $_POST['form_insurance'] . " dedbl: $thisadj";
 382                     $thisadj = 0;
 383                 } elseif ($reason_type == '4') {
 384                     $reason = $_POST['form_insurance'] . " ptresp: $thisadj $reason";
 385                     $thisadj = 0;
 386                 } elseif ($reason_type == '5') {
 387                     $reason = $_POST['form_insurance'] . " note: $thisadj $reason";
 388                     $thisadj = 0;
 389                 } else {
 390 // An adjustment reason including "Ins" is assumed to be assigned by
 391 // insurance, and in that case we identify which one by appending
 392 // Ins1, Ins2 or Ins3.
 393                     if (strpos(strtolower($reason), 'ins') != false) {
 394                         $reason .= ' ' . $_POST['form_insurance'];
 395                     }
 396                 }
 397                 SLEOB::arPostAdjustment($patient_id, $encounter_id, $session_id, $thisadj, $code, $payer_type, $reason, $debug, '', $thiscodetype);
 398             }
 399         }
 400
 401 // Maintain which insurances are marked as finished.
 402
 403         $form_done = 0 + $_POST['form_done'];
 404         $form_stmt_count = 0 + $_POST['form_stmt_count'];
 405         sqlStatement("UPDATE form_encounter SET last_level_closed = ?, stmt_count = ? WHERE pid = ? AND encounter = ?", array($form_done, $form_stmt_count, $patient_id, $encounter_id));
 406
 407         if ($_POST['form_secondary']) {
 408             SLEOB::arSetupSecondary($patient_id, $encounter_id, $debug);
 409         }
 410         echo "<script language='JavaScript'>\n";
 411         echo " if (opener.document.forms[0] != undefined) {\n";
 412         echo "   if (opener.document.forms[0].form_amount) {\n";
 413         echo "     var tmp = opener.document.forms[0].form_amount.value - " . attr($paytotal) . ";\n";
 414         echo "     opener.document.forms[0].form_amount.value = Number(tmp).toFixed(2);\n";
 415         echo "   }\n";
 416         echo " }\n";
 417     } else {
 418         echo "<script language='JavaScript'>\n";
 419     }
 420     if ($info_msg) {
 421         echo " alert('" . addslashes($info_msg) . "');\n";
 422     }
 423     if ($from_posting) {
 424         echo "opener.$('#btn-inv-search').click();\n";
 425     }
 426     if (!$debug && !$save_stay) {
 427         echo "doClose(" . attr($from_posting) . ");\n";
 428     }
 429     echo "</script></body></html>\n";
 430     if (!$save_stay) {
 431         exit();
 432     }
 433 }
 434
 435 // Get invoice charge details.
 436 $codes = ar_get_invoice_summary($patient_id, $encounter_id, true);
 437 $pdrow = sqlQuery("select billing_note from patient_data where pid = ? limit 1", array($patient_id));
 438 ?>
 439
 440 <div class="container">
 441     <div class="row">
 442         <div class="page-header">
 443             <h2><?php echo xlt('EOB Invoice'); ?></h2>
 444         </div>
 445     </div>
 446     <div class="row">
 447         <form action='sl_eob_invoice.php?id=<?php echo attr(urlencode($trans_id)); ?>' method='post' onsubmit='return validate(this)'>
 448             <input type="hidden" name="csrf_token_form" value="<?php echo attr(collectCsrfToken()); ?>"/>
 449             <input type="hidden" name="isPosting" value="<?php echo attr($from_posting); ?>"/>
 450             <fieldset>
 451                 <legend><?php echo xlt('Invoice Actions'); ?></legend>
 452                 <div class="col-xs-12 oe-custom-line">
 453                     <div class="col-xs-3">
 454                         <label class="control-label" for="form_name"><?php echo xlt('Patient'); ?>:</label>
 455                         <input type="text" class="form-control" class="form-control" class="form-control" id='form_name'
 456                                name='form_name'
 457                                value="<?php echo attr($ferow['fname']) . ' ' . attr($ferow['mname']) . ' ' . attr($ferow['lname']); ?>"
 458                                disabled>
 459                     </div>
 460                     <div class="col-xs-3">
 461                         <label class="control-label" for="form_provider"><?php echo xlt('Provider'); ?>:</label>
 462                         <?php
 463                         $tmp = sqlQuery("SELECT fname, mname, lname " .
 464                             "FROM users WHERE id = ?", array($ferow['provider_id']));
 465                         $provider = text($tmp['fname']) . ' ' . text($tmp['mname']) . ' ' . text($tmp['lname']);
 466                         $tmp = sqlQuery("SELECT bill_date FROM billing WHERE " .
 467                             "pid = ? AND encounter = ? AND " .
 468                             "activity = 1 ORDER BY fee DESC, id ASC LIMIT 1", array($patient_id, $encounter_id));
 469                         $billdate = substr(($tmp['bill_date'] . "Not Billed"), 0, 10);
 470                         ?>
 471                         <input type="text" class="form-control" class="form-control" id='form_provider'
 472                                name='form_provider' value="<?php echo attr($provider); ?>" disabled>
 473                     </div>
 474                     <div class="col-xs-2">
 475                         <label class="control-label" for="form_invoice"><?php echo xlt('Invoice'); ?>:</label>
 476                         <input type="text" class="form-control" class="form-control" id='form_provider'
 477                                name='form_provider' value='<?php echo attr($patient_id) . "." . attr($encounter_id); ?>'
 478                                disabled>
 479                     </div>
 480                     <div class="col-xs-2">
 481                         <label class="control-label" for="svc_date"><?php echo xlt('Svc Date'); ?>:</label>
 482                         <input type="text" class="form-control" class="form-control" id='svc_date' name='form_provider'
 483                                value='<?php echo attr($svcdate); ?>' disabled>
 484                     </div>
 485                     <div class="col-xs-2">
 486                         <label class="control-label" for="insurance_name"><?php echo xlt('Insurance'); ?>:</label>
 487                         <?php
 488                         for ($i = 1; $i <= 3; ++$i) {
 489                             $payerid = SLEOB::arGetPayerID($patient_id, $svcdate, $i);
 490                             if ($payerid) {
 491                                 $tmp = sqlQuery("SELECT name FROM insurance_companies WHERE id = ?", array($payerid));
 492                                 $insurance .= "$i: " . $tmp['name'] . "\n";
 493                             }
 494                         }
 495                         ?>
 496                         <textarea name="insurance_name" id="insurance_name" class="form-control" cols="5" rows="2"
 497                                   readonly><?php echo attr($insurance); ?></textarea>
 498                     </div>
 499                 </div>
 500                 <div class="col-xs-12 oe-custom-line">
 501                     <div class="col-xs-3">
 502                         <label class="control-label" for="form_stmt_count"><?php echo xlt('Statements Sent'); ?>
 503                             :</label>
 504                         <input type='text' name='form_stmt_count' id='form_stmt_count' class="form-control"
 505                                value='<?php echo attr((0 + $ferow['stmt_count'])); ?>'/>
 506                     </div>
 507                     <div class="col-xs-3">
 508                         <label class="control-label" for="form_reference"><?php echo xlt('Check/EOB No.'); ?>:</label>
 509                         <input type='text' name='form_reference' id='form_reference' class="form-control" value=''/>
 510                     </div>
 511                     <div class="col-xs-2">
 512                         <label class="control-label" for="form_check_date"><?php echo xlt('Check/EOB Date'); ?>:</label>
 513                         <input type='text' name='form_check_date' class='form-control datepicker' value=''/>
 514                     </div>
 515                     <div class="col-xs-2">
 516                         <label class="control-label" for="form_deposit_date"><?php echo xlt('Deposit Date'); ?>:</label>
 517                         <input type='text' name='form_deposit_date' id='form_deposit_date' class='form-control datepicker' value=''/>
 518                         <input type='hidden' name='form_payer_id' value=''/>
 519                         <input type='hidden' name='form_orig_reference' value=''/>
 520                         <input type='hidden' name='form_orig_check_date' value=''/>
 521                         <input type='hidden' name='form_orig_deposit_date' value=''/>
 522                         <input type='hidden' name='form_pay_total' value=''/>
 523                     </div>
 524                 </div>
 525                 <div class="col-xs-12 oe-custom-line">
 526                     <div class="col-xs-4">
 527                         <label class="control-label" for="type_code"><?php echo xlt('Now posting for'); ?>:</label>
 528                         <div style="padding-left:15px">
 529                             <?php
 530                                 $last_level_closed = 0 + $ferow['last_level_closed'];
 531                             ?>
 532                             <label class="radio-inline">
 533                                 <input <?php echo $last_level_closed === 0 ? attr('checked') : ''; ?> name='form_insurance' onclick='setins("Ins1")' type='radio'
 534                                        value='Ins1'><?php echo xlt('Ins1') ?>
 535                             </label>
 536                             <label class="radio-inline">
 537                                 <input <?php echo $last_level_closed === 1 ? attr('checked') : ''; ?> name='form_insurance' onclick='setins("Ins2")' type='radio'
 538                                        value='Ins2'><?php echo xlt('Ins2') ?>
 539                             </label>
 540                             <label class="radio-inline">
 541                                 <input <?php echo $last_level_closed === 2 ? attr('checked') : ''; ?> name='form_insurance' onclick='setins("Ins3")' type='radio'
 542                                        value='Ins3'><?php echo xlt('Ins3') ?>
 543                             </label>
 544                             <label class="radio-inline">
 545                                 <input <?php echo $last_level_closed === 3 ? attr('checked') : ''; ?> name='form_insurance' onclick='setins("Pt")' type='radio'
 546                                        value='Pt'><?php echo xlt('Patient') ?>
 547                             </label>
 548                             <?php
 549                             // TBD: I think the following is unused and can be removed.
 550                             ?>
 551                             <input name='form_eobs' type='hidden' value='<?php echo attr($arrow['shipvia']) ?>'/>
 552                         </div>
 553                     </div>
 554                     <div class="col-xs-4">
 555                         <label class="control-label" for=""><?php echo xlt('Done with'); ?>:</label>
 556                         <div style="padding-left:15px">
 557                             <?php
 558                             // Write a checkbox for each insurance.  It is to be checked when
 559                             // we no longer expect any payments from that company for the claim.
 560                             $last_level_closed = 0 + $ferow['last_level_closed'];
 561                             foreach (array(0 => 'None', 1 => 'Ins1', 2 => 'Ins2', 3 => 'Ins3') as $key => $value) {
 562                                 if ($key && !SLEOB::arGetPayerID($patient_id, $svcdate, $key)) {
 563                                     continue;
 564                                 }
 565                                 $checked = ($last_level_closed == $key) ? " checked" : "";
 566                                 echo "<label class='radio-inline'>";
 567                                 echo "<input type='radio' name='form_done' value='" . attr($key) . "'$checked />" . text($value);
 568                                 echo "</label>";
 569                             }
 570                             ?>
 571                         </div>
 572                     </div>
 573                     <div class="col-xs-4">
 574                         <label class="control-label" for=""><?php echo xlt('Secondary billing'); ?>:</label>
 575                         <div style="padding-left:15px">
 576                             <label class="checkbox-inline">
 577                                 <input name="form_secondary" type="checkbox"
 578                                        value="1"><?php echo xlt('Needs secondary billing') ?>
 579                             </label>
 580                         </div>
 581                     </div>
 582                 </div>
 583
 584             </fieldset>
 585             <fieldset>
 586                 <legend><?php echo xlt('Invoice Details'); ?></legend>
 587                 <div class="table-responsive">
 588                     <table class="table table-condensed">
 589                         <thead>
 590                         <tr>
 591                             <th><?php echo xlt('Code') ?></th>
 592                             <th align="right"><?php echo xlt('Charge') ?></th>
 593                             <th align="right"><?php echo xlt('Balance') ?>&nbsp;</th>
 594                             <th><?php echo xlt('By/Source') ?></th>
 595                             <th><?php echo xlt('Date') ?></th>
 596                             <th><?php echo xlt('Pay') ?></th>
 597                             <th><?php echo xlt('Adjust') ?></th>
 598                             <th>&nbsp;</th>
 599                             <th><?php echo xlt('Reason') ?></th>
 600                             <?php
 601                             if ($ALLOW_DELETE) { ?>
 602                                 <th><?php echo xlt('Del') ?></th>
 603                                 <?php
 604                             } ?>
 605                         </tr>
 606                         </thead>
 607                         <?php
 608                         $firstProcCodeIndex = -1;
 609                         $encount = 0;
 610                         foreach ($codes as $code => $cdata) {
 611                             ++$encount;
 612                             $dispcode = $code;
 613
 614                             // remember the index of the first entry whose code is not "CO-PAY", i.e. it's a legitimate proc code
 615                             if ($firstProcCodeIndex == -1 && strcmp($code, "CO-PAY") != 0) {
 616                                 $firstProcCodeIndex = $encount;
 617                             }
 618
 619                             // this sorts the details more or less chronologically:
 620                             ksort($cdata['dtl']);
 621                             foreach ($cdata['dtl'] as $dkey => $ddata) {
 622                                 $ddate = substr($dkey, 0, 10);
 623                                 if (preg_match('/^(\d\d\d\d)(\d\d)(\d\d)\s*$/', $ddate, $matches)) {
 624                                     $ddate = $matches[1] . '-' . $matches[2] . '-' . $matches[3];
 625                                 }
 626                                 $tmpchg = "";
 627                                 $tmpadj = "";
 628                                 if ($ddata['chg'] != 0) {
 629                                     if (isset($ddata['rsn'])) {
 630                                         $tmpadj = 0 - $ddata['chg'];
 631                                     } else {
 632                                         $tmpchg = $ddata['chg'];
 633                                     }
 634                                 }
 635                                 ?>
 636                                 <tr>
 637                                     <td class="detail"
 638                                         style="background:<?php echo $dispcode ? 'lightyellow' : ''; ?>"><?php echo text($dispcode);
 639                                         $dispcode = "" ?></td>
 640                                     <td class="detail" class="detail"><?php echo text(bucks($tmpchg)); ?></td>
 641                                     <td class="detail" class="detail">&nbsp;</td>
 642                                     <td class="detail">
 643                                         <?php
 644                                         if (isset($ddata['plv'])) {
 645                                             if (!$ddata['plv']) {
 646                                                 echo 'Pt/';
 647                                             } else {
 648                                                 echo 'Ins' . text($ddata['plv']) . '/';
 649                                             }
 650                                         }
 651                                         echo text($ddata['src']);
 652                                         ?>
 653                                     </td>
 654                                     <td class="detail"><?php echo text($ddate); ?></td>
 655                                     <td class="detail"><?php echo text(bucks($ddata['pmt'])); ?></td>
 656                                     <td class="detail"><?php echo text(bucks($tmpadj)); ?></td>
 657                                     <td class="detail">&nbsp;</td>
 658                                     <td class="detail"><?php echo text($ddata['rsn']); ?></td>
 659                                     <?php
 660                                     if ($ALLOW_DELETE) { ?>
 661                                         <td class="detail">
 662                                             <?php
 663                                             if (!empty($ddata['arseq'])) { ?>
 664                                                 <input name="form_del[<?php echo attr($ddata['arseq']); ?>]"
 665                                                        type="checkbox">
 666                                                 <?php
 667                                             } else {
 668                                                 ?> &nbsp;
 669                                                 <?php
 670                                             } ?>
 671                                         </td>
 672                                     <?php } ?>
 673                                 </tr>
 674                             <?php } // end of prior detail line ?>
 675                             <tr>
 676                                 <td class="last_detail"><?php echo text($dispcode);
 677                                     $dispcode = "" ?></td>
 678                                 <td class="last_detail">&nbsp;</td>
 679                                 <td class="last_detail">
 680                                     <input name="form_line[<?php echo attr($code); ?>][bal]" type="hidden"
 681                                            value="<?php echo attr(bucks($cdata['bal'])); ?>">
 682                                     <input name="form_line[<?php echo attr($code); ?>][ins]" type="hidden"
 683                                            value="<?php echo attr($cdata['ins']); ?>">
 684                                     <input name="form_line[<?php echo attr($code); ?>][code_type]" type="hidden"
 685                                            value="<?php echo attr($cdata['code_type']); ?>"> <?php echo text(sprintf("%.2f", $cdata['bal'])); ?>
 686                                     &nbsp;
 687                                 </td>
 688                                 <td class="last_detail"></td>
 689                                 <td class="last_detail"></td>
 690                                 <td class="last_detail">
 691                                     <input name="form_line[<?php echo attr($code); ?>][pay]"
 692                                            onkeyup="updateFields(document.forms[0]['form_line[<?php echo attr(addslashes($code)); ?>][pay]'], document.forms[0]['form_line[<?php echo attr(addslashes($code)); ?>][adj]'], document.forms[0]['form_line[<?php echo attr(addslashes($code)); ?>][bal]'], document.forms[0]['form_line[CO-PAY][bal]'], <?php echo ($firstProcCodeIndex == $encount) ? 1 : 0 ?>)"
 693                                            onfocus="this.select()" autofocus size="10" type="text" class="form-control"
 694                                            value="0.00"></td>
 695                                 <td class="last_detail">
 696                                     <input name="form_line[<?php echo attr($code); ?>][adj]" size="10" type="text"
 697                                            class="form-control"
 698                                            value='<?php echo attr($totalAdjAmount ? $totalAdjAmount : '0.00'); ?>'
 699                                            onclick="this.select()">
 700                                 </td>
 701                                 <td class="last_detail" align="center"><a href=""
 702                                                                           onclick="return writeoff('<?php echo attr(addslashes($code)); ?>')">WO</a>
 703                                 </td>
 704                                 <td class="last_detail">
 705                                     <select class="form-control" name="form_line[<?php echo attr($code); ?>][reason]">
 706                                         <?php
 707                                         // Adjustment reasons are now taken from the list_options table.
 708                                         echo "    <option value=''></option>\n";
 709                                         $ores = sqlStatement("SELECT option_id, title, is_default FROM list_options " .
 710                                             "WHERE list_id = 'adjreason' AND activity = 1 ORDER BY seq, title");
 711                                         while ($orow = sqlFetchArray($ores)) {
 712                                             echo "    <option value='" . attr($orow['option_id']) . "'";
 713                                             if ($orow['is_default']) {
 714                                                 echo " selected";
 715                                             }
 716                                             echo ">" . text($orow['title']) . "</option>\n";
 717                                         }
 718                                         ?>
 719                                     </select>
 720                                     <?php
 721                                     // TBD: Maybe a comment field would be good here, for appending
 722                                     // to the reason.
 723                                     ?>
 724                                 </td>
 725                                 <?php if ($ALLOW_DELETE) { ?>
 726                                     <td class="last_detail">&nbsp;</td>
 727                                 <?php } ?>
 728                             </tr>
 729                         <?php } // end of code ?>
 730                     </table>
 731                 </div>
 732             </fieldset>
 733             <?php //can change position of buttons by creating a class 'position-override' and adding rule text-align:center or right as the case may be in individual stylesheets ?>
 734             <div class="form-group clearfix">
 735                 <div class="col-sm-12 text-left position-override" id="search-btn">
 736                     <div class="btn-group" role="group">
 737                         <button type='submit' class="btn btn-default btn-save" name='form_save' id="btn-save-stay"
 738                             onclick="this.value='1';"><?php echo xlt("Save Current"); ?></button>
 739                         <button type='submit' class="btn btn-default btn-save" name='form_save' id="btn-save"
 740                             onclick="this.value='2';"><?php echo xlt("Save & Exit"); ?></button>
 741                         <button type='button' class="btn btn-link btn-cancel btn-separate-left" name='form_cancel'
 742                             id="btn-cancel" onclick='doClose(<?php echo attr($from_posting); ?>)'><?php echo xlt("Close"); ?></button>
 743                     </div>
 744                     <?php if ($GLOBALS['new_tabs_layout'] && $from_posting) { ?>
 745                         <button type='button' class="btn btn-default btn-view pull-right" name='form_goto' id="btn-goto"
 746                             onclick="goEncounterSummary(<?php echo attr($patient_id) ?>)"><?php echo xlt("Past Encounters"); ?></button>
 747                     <?php } ?>
 748                 </div>
 749             </div>
 750         </form>
 751     </div>
 752 </div><!--End of container div-->
 753 <?php if ($from_posting) { ?>
 754 <script language="JavaScript">
 755     var f1 = opener.document.forms[0];
 756     var f2 = document.forms[0];
 757     if (f1.form_source) {
 758         <?php
 759         // These support creation and lookup of ar_session table entries:
 760         echo "  f2.form_reference.value         = f1.form_source.value;\n";
 761         echo "  f2.form_check_date.value        = f1.form_paydate.value;\n";
 762         echo "  //f2.form_deposit_date.value      = f1.form_deposit_date.value;\n";
 763         echo "  if (f1.form_deposit_date.value != '')\n";
 764         echo "     f2.form_deposit_date.value      = f1.form_deposit_date.value;\n";
 765         echo "  else\n";
 766         echo "     f2.form_deposit_date.value      = getFormattedToday();\n";
 767         echo "  f2.form_payer_id.value          = f1.form_payer_id.value;\n";
 768         echo "  f2.form_pay_total.value         = f1.form_amount.value;\n";
 769         echo "  f2.form_orig_reference.value    = f1.form_source.value;\n";
 770         echo "  f2.form_orig_check_date.value   = f1.form_paydate.value;\n";
 771         echo "  f2.form_orig_deposit_date.value = f1.form_deposit_date.value;\n";
 772
 773         // While I'm thinking about it, some notes about eob sessions.
 774         // If they do not have all of the session key fields in the search
 775         // page, then show a warning at the top of the invoice page.
 776         // Also when they go to save the invoice page and a session key
 777         // field has changed, alert them to that and allow a cancel.
 778
 779         // Another point... when posting EOBs, the incoming payer ID might
 780         // not match the payer ID for the patient's insurance.  This is
 781         // because the same payer might be entered more than once into the
 782         // insurance_companies table.  I don't think it matters much.
 783         ?>
 784     }
 785     setins("Ins1");
 786 </script>
 787 <?php } ?>
 788 </body>
 789 </html>