library/Claim.class.php

   1 <?php
   2 // Copyright (C) 2007-2009 Rod Roark <rod@sunsetsystems.com>
   3 //
   4 // This program is free software; you can redistribute it and/or
   5 // modify it under the terms of the GNU General Public License
   6 // as published by the Free Software Foundation; either version 2
   7 // of the License, or (at your option) any later version.
   8
   9 require_once(dirname(__FILE__) . "/classes/Address.class.php");
  10 require_once(dirname(__FILE__) . "/classes/InsuranceCompany.class.php");
  11 require_once(dirname(__FILE__) . "/sql-ledger.inc");
  12 require_once(dirname(__FILE__) . "/invoice_summary.inc.php");
  13
  14 // This enforces the X12 Basic Character Set. Page A2.
  15 //
  16 function x12clean($str) {
  17   return preg_replace('/[^A-Z0-9!"\\&\'()+,\\-.\\/;?= ]/', '', strtoupper($str));
  18 }
  19
  20 class Claim {
  21
  22   var $pid;               // patient id
  23   var $encounter_id;      // encounter id
  24   var $procs;             // array of procedure rows from billing table
  25   var $x12_partner;       // row from x12_partners table
  26   var $encounter;         // row from form_encounter table
  27   var $facility;          // row from facility table
  28   var $billing_facility;  // row from facility table
  29   var $provider;          // row from users table (rendering provider)
  30   var $referrer;          // row from users table (referring provider)
  31   var $supervisor;        // row from users table (supervising provider)
  32   var $insurance_numbers; // row from insurance_numbers table for current payer
  33   var $supervisor_numbers; // row from insurance_numbers table for current payer
  34   var $patient_data;      // row from patient_data table
  35   var $billing_options;   // row from form_misc_billing_options table
  36   var $invoice;           // result from get_invoice_summary()
  37   var $payers;            // array of arrays, for all payers
  38   var $copay;             // total of copays from the billing table
  39
  40   function loadPayerInfo(&$billrow) {
  41     global $sl_err;
  42     $encounter_date = substr($this->encounter['date'], 0, 10);
  43
  44     // Create the $payers array.  This contains data for all insurances
  45     // with the current one always at index 0, and the others in payment
  46     // order starting at index 1.
  47     //
  48     $this->payers = array();
  49     $this->payers[0] = array();
  50     $query = "SELECT * FROM insurance_data WHERE " .
  51       "pid = '{$this->pid}' AND " .
  52       "date <= '$encounter_date' " .
  53       "ORDER BY type ASC, date DESC";
  54     $dres = sqlStatement($query);
  55     $prevtype = '';
  56     while ($drow = sqlFetchArray($dres)) {
  57       if (strcmp($prevtype, $drow['type']) == 0) continue;
  58       $prevtype = $drow['type'];
  59       // Very important to look at entries with a missing provider because
  60       // they indicate no insurance as of the given date.
  61       if (empty($drow['provider'])) continue;
  62       $ins = count($this->payers);
  63       if ($drow['provider'] == $billrow['payer_id'] && empty($this->payers[0]['data'])) $ins = 0;
  64       $crow = sqlQuery("SELECT * FROM insurance_companies WHERE " .
  65         "id = '" . $drow['provider'] . "'");
  66       $orow = new InsuranceCompany($drow['provider']);
  67       $this->payers[$ins] = array();
  68       $this->payers[$ins]['data']    = $drow;
  69       $this->payers[$ins]['company'] = $crow;
  70       $this->payers[$ins]['object']  = $orow;
  71     }
  72
  73     // This kludge hands most cases of a rare ambiguous situation, where
  74     // the primary insurance company is the same as the secondary.  It seems
  75     // nobody planned for that!
  76     //
  77     for ($i = 1; $i < count($this->payers); ++$i) {
  78       if ($billrow['process_date'] &&
  79         $this->payers[0]['data']['provider'] == $this->payers[$i]['data']['provider'])
  80       {
  81         $tmp = $this->payers[0];
  82         $this->payers[0] = $this->payers[$i];
  83         $this->payers[$i] = $tmp;
  84       }
  85     }
  86
  87     $this->using_modifiers = true;
  88
  89     // Get payment and adjustment details if there are any previous payers.
  90     //
  91     $this->invoice = array();
  92     if ($this->payerSequence() != 'P') {
  93       if ($GLOBALS['oer_config']['ws_accounting']['enabled'] === 2) {
  94         $this->invoice = ar_get_invoice_summary($this->pid, $this->encounter_id, true);
  95       }
  96       else if ($GLOBALS['oer_config']['ws_accounting']['enabled']) {
  97         SLConnect();
  98         $arres = SLQuery("select id from ar where invnumber = " .
  99           "'{$this->pid}.{$this->encounter_id}'");
 100         if ($sl_err) die($sl_err);
 101         $arrow = SLGetRow($arres, 0);
 102         if ($arrow) {
 103           $this->invoice = get_invoice_summary($arrow['id'], true);
 104         }
 105         SLClose();
 106       }
 107       // Secondary claims might not have modifiers in SQL-Ledger data.
 108       // In that case, note that we should not try to match on them.
 109       $this->using_modifiers = false;
 110       foreach ($this->invoice as $key => $trash) {
 111         if (strpos($key, ':')) $this->using_modifiers = true;
 112       }
 113     }
 114   }
 115
 116   // Constructor. Loads relevant database information.
 117   //
 118   function Claim($pid, $encounter_id) {
 119     $this->pid = $pid;
 120     $this->encounter_id = $encounter_id;
 121     $this->procs = array();
 122     $this->copay = 0;
 123
 124     // We need the encounter date before we can identify the payers.
 125     $sql = "SELECT * FROM form_encounter WHERE " .
 126       "pid = '{$this->pid}' AND " .
 127       "encounter = '{$this->encounter_id}'";
 128     $this->encounter = sqlQuery($sql);
 129
 130     // Sort by procedure timestamp in order to get some consistency.
 131     $sql = "SELECT * FROM billing WHERE " .
 132       "encounter = '{$this->encounter_id}' AND pid = '{$this->pid}' AND " .
 133       "(code_type = 'CPT4' OR code_type = 'HCPCS' OR code_type = 'COPAY') AND " .
 134       "activity = '1' ORDER BY date, id";
 135     $res = sqlStatement($sql);
 136     while ($row = sqlFetchArray($res)) {
 137       if ($row['code_type'] == 'COPAY') {
 138         $this->copay -= $row['fee'];
 139         continue;
 140       }
 141       if (!$row['units']) $row['units'] = 1;
 142       // Load prior payer data at the first opportunity in order to get
 143       // the using_modifiers flag that is referenced below.
 144       if (empty($this->procs)) $this->loadPayerInfo($row);
 145       // Consolidate duplicate procedures.
 146       foreach ($this->procs as $key => $trash) {
 147         if (strcmp($this->procs[$key]['code'],$row['code']) == 0 &&
 148             (strcmp($this->procs[$key]['modifier'],$row['modifier']) == 0 ||
 149              !$this->using_modifiers))
 150         {
 151           $this->procs[$key]['units'] += $row['units'];
 152           $this->procs[$key]['fee']   += $row['fee'];
 153           continue 2; // skip to next table row
 154         }
 155       }
 156
 157       // If there is a row-specific provider then get its details.
 158       if (!empty($row['provider_id'])) {
 159         // Get service provider data for this row.
 160         $sql = "SELECT * FROM users WHERE id = '" . $row['provider_id'] . "'";
 161         $row['provider'] = sqlQuery($sql);
 162         // Get insurance numbers for this row's provider.
 163         $sql = "SELECT * FROM insurance_numbers WHERE " .
 164           "(insurance_company_id = '" . $row['payer_id'] .
 165           "' OR insurance_company_id is NULL) AND " .
 166           "provider_id = '" . $row['provider_id'] . "' " .
 167           "ORDER BY insurance_company_id DESC LIMIT 1";
 168         $row['insurance_numbers'] = sqlQuery($sql);
 169       }
 170
 171       $this->procs[] = $row;
 172     }
 173
 174     $sql = "SELECT * FROM x12_partners WHERE " .
 175       "id = '" . $this->procs[0]['x12_partner_id'] . "'";
 176     $this->x12_partner = sqlQuery($sql);
 177
 178     $sql = "SELECT * FROM facility WHERE " .
 179       "id = '" . addslashes($this->encounter['facility_id']) . "' " .
 180       "LIMIT 1";
 181     $this->facility = sqlQuery($sql);
 182
 183     /*****************************************************************
 184     $provider_id = $this->procs[0]['provider_id'];
 185     *****************************************************************/
 186     $provider_id = $this->encounter['provider_id'];
 187     $sql = "SELECT * FROM users WHERE id = '$provider_id'";
 188     $this->provider = sqlQuery($sql);
 189
 190     $sql = "SELECT * FROM facility " .
 191       "ORDER BY billing_location DESC, id ASC LIMIT 1";
 192     $this->billing_facility = sqlQuery($sql);
 193
 194     $sql = "SELECT * FROM insurance_numbers WHERE " .
 195       "(insurance_company_id = '" . $this->procs[0]['payer_id'] .
 196       "' OR insurance_company_id is NULL) AND " .
 197       "provider_id = '$provider_id' " .
 198       "ORDER BY insurance_company_id DESC LIMIT 1";
 199     $this->insurance_numbers = sqlQuery($sql);
 200
 201     $sql = "SELECT * FROM patient_data WHERE " .
 202       "pid = '{$this->pid}' " .
 203       "ORDER BY id LIMIT 1";
 204     $this->patient_data = sqlQuery($sql);
 205
 206     $sql = "SELECT fpa.* FROM forms JOIN form_misc_billing_options AS fpa " .
 207       "ON fpa.id = forms.form_id WHERE " .
 208       "forms.encounter = '{$this->encounter_id}' AND " .
 209       "forms.pid = '{$this->pid}' AND " .
 210       "forms.formdir = 'misc_billing_options' " .
 211       "ORDER BY forms.date";
 212     $this->billing_options = sqlQuery($sql);
 213
 214     $referrer_id = (empty($GLOBALS['MedicareReferrerIsRenderer']) ||
 215       $this->insurance_numbers['provider_number_type'] != '1C') ?
 216       $this->patient_data['providerID'] : $provider_id;
 217     $sql = "SELECT * FROM users WHERE id = '$referrer_id'";
 218     $this->referrer = sqlQuery($sql);
 219     if (!$this->referrer) $this->referrer = array();
 220
 221     $supervisor_id = $this->encounter['supervisor_id'];
 222     $sql = "SELECT * FROM users WHERE id = '$supervisor_id'";
 223     $this->supervisor = sqlQuery($sql);
 224     if (!$this->supervisor) $this->supervisor = array();
 225
 226     $sql = "SELECT * FROM insurance_numbers WHERE " .
 227       "(insurance_company_id = '" . $this->procs[0]['payer_id'] .
 228       "' OR insurance_company_id is NULL) AND " .
 229       "provider_id = '$supervisor_id' " .
 230       "ORDER BY insurance_company_id DESC LIMIT 1";
 231     $this->supervisor_numbers = sqlQuery($sql);
 232     if (!$this->supervisor_numbers) $this->supervisor_numbers = array();
 233
 234   } // end constructor
 235
 236   // Return an array of adjustments from the designated prior payer for the
 237   // designated procedure key (might be procedure:modifier), or for the claim
 238   // level.  For each adjustment give date, group code, reason code, amount.
 239   // Note this will include "patient responsibility" adjustments which are
 240   // not adjustments to OUR invoice, but they reduce the amount that the
 241   // insurance company pays.
 242   //
 243   function payerAdjustments($ins, $code='Claim') {
 244     $aadj = array();
 245
 246     // If we have no modifiers stored in SQL-Ledger for this claim,
 247     // then we cannot use a modifier passed in with the key.
 248     $tmp = strpos($code, ':');
 249     if ($tmp && !$this->using_modifiers) $code = substr($code, 0, $tmp);
 250
 251     // For payments, source always starts with "Ins" or "Pt".
 252     // Nonzero adjustment reason examples:
 253     //   Ins1 adjust code 42 (Charges exceed ... (obsolete))
 254     //   Ins1 adjust code 45 (Charges exceed your contracted/ legislated fee arrangement)
 255     //   Ins1 adjust code 97 (Payment is included in the allowance for another service/procedure)
 256     //   Ins1 adjust code A2 (Contractual adjustment)
 257     //   Ins adjust Ins1
 258     //   adjust code 45
 259     // Zero adjustment reason examples:
 260     //   Co-pay: 25.00
 261     //   Coinsurance: 11.46  (code 2)   Note: fix remits to identify insurance
 262     //   To deductible: 0.22 (code 1)   Note: fix remits to identify insurance
 263     //   To copay Ins1 (manual entry)
 264     //   To ded'ble Ins1 (manual entry)
 265
 266     if (!empty($this->invoice[$code])) {
 267       $date = '';
 268       $deductible  = 0;
 269       $coinsurance = 0;
 270       $inslabel = ($this->payerSequence($ins) == 'S') ? 'Ins2' : 'Ins1';
 271       $insnumber = substr($inslabel, 3);
 272
 273       // Compute this procedure's patient responsibility amount as of this
 274       // prior payer, which is the original charge minus all insurance
 275       // payments and "hard" adjustments up to this payer.
 276       $ptresp = $this->invoice[$code]['chg'] + $this->invoice[$code]['adj'];
 277       foreach ($this->invoice[$code]['dtl'] as $key => $value) {
 278         if (preg_match("/^Ins(\d)/i", $value['src'], $tmp)) {
 279           if ($tmp[1] <= $insnumber) $ptresp -= $value['pmt'];
 280         }
 281         else if (trim(substr($key, 0, 10))) { // not an adjustment if no date
 282           if (!preg_match("/Ins(\d)/i", $value['rsn'], $tmp) || $tmp[1] <= $insnumber)
 283             $ptresp += $value['chg']; // adjustments are negative charges
 284         }
 285       }
 286       if ($ptresp < 0) $ptresp = 0; // we may be insane but try to hide it
 287
 288       // Main loop, to extract adjustments for this payer and procedure.
 289       foreach ($this->invoice[$code]['dtl'] as $key => $value) {
 290         $tmp = str_replace('-', '', trim(substr($key, 0, 10)));
 291         if ($tmp) $date = $tmp;
 292         if ($tmp && $value['pmt'] == 0) { // not original charge and not a payment
 293           $rsn = $value['rsn'];
 294           $chg = 0 - $value['chg']; // adjustments are negative charges
 295
 296           $gcode = 'CO'; // default group code = contractual obligation
 297           $rcode = '45'; // default reason code = max fee exceeded (code 42 is obsolete)
 298
 299           if (preg_match("/Ins adjust $inslabel/i", $rsn, $tmp)) {
 300             // From manual post. Take the defaults.
 301           }
 302           else if (preg_match("/To copay $inslabel/i", $rsn, $tmp) && !$chg) {
 303             $coinsurance = $ptresp; // from manual post
 304             continue;
 305           }
 306           else if (preg_match("/To ded'ble $inslabel/i", $rsn, $tmp) && !$chg) {
 307             $deductible = $ptresp; // from manual post
 308             continue;
 309           }
 310           else if (preg_match("/$inslabel copay: (\S+)/i", $rsn, $tmp) && !$chg) {
 311             $coinsurance = $tmp[1]; // from 835 as of 6/2007
 312             continue;
 313           }
 314           else if (preg_match("/$inslabel coins: (\S+)/i", $rsn, $tmp) && !$chg) {
 315             $coinsurance = $tmp[1]; // from 835 and manual post as of 6/2007
 316             continue;
 317           }
 318           else if (preg_match("/$inslabel dedbl: (\S+)/i", $rsn, $tmp) && !$chg) {
 319             $deductible = $tmp[1]; // from 835 and manual post as of 6/2007
 320             continue;
 321           }
 322           else if (preg_match("/$inslabel ptresp: (\S+)/i", $rsn, $tmp) && !$chg) {
 323             continue; // from 835 as of 6/2007
 324           }
 325           else if (preg_match("/$inslabel adjust code (\S+)/i", $rsn, $tmp)) {
 326             $rcode = $tmp[1]; // from 835
 327           }
 328           else if (preg_match("/$inslabel/i", $rsn, $tmp)) {
 329             // Take the defaults.
 330           }
 331           else if (preg_match('/Ins(\d)/i', $rsn, $tmp) && $tmp[1] != $insnumber) {
 332             continue; // it's for some other payer
 333           }
 334           else if ($insnumber == '1') {
 335             if (preg_match("/\$\s*adjust code (\S+)/i", $rsn, $tmp)) {
 336               $rcode = $tmp[1]; // from 835
 337             }
 338             else if ($chg) {
 339               // Other adjustments default to Ins1.
 340             }
 341             else if (preg_match("/Co-pay: (\S+)/i", $rsn, $tmp) ||
 342               preg_match("/Coinsurance: (\S+)/i", $rsn, $tmp)) {
 343               $coinsurance = 0 + $tmp[1]; // from 835 before 6/2007
 344               continue;
 345             }
 346             else if (preg_match("/To deductible: (\S+)/i", $rsn, $tmp)) {
 347               $deductible = 0 + $tmp[1]; // from 835 before 6/2007
 348               continue;
 349             }
 350             else {
 351               continue; // there is no adjustment amount
 352             }
 353           }
 354           else {
 355             continue; // it's for primary and that's not us
 356           }
 357
 358           if ($rcode == '42') $rcode= '45'; // reason 42 is obsolete
 359           $aadj[] = array($date, $gcode, $rcode, sprintf('%.2f', $chg));
 360
 361         } // end if
 362       } // end foreach
 363
 364       // If we really messed it up, at least avoid negative numbers.
 365       if ($coinsurance > $ptresp) $coinsurance = $ptresp;
 366       if ($deductible  > $ptresp) $deductible  = $ptresp;
 367
 368       // Find out if this payer paid anything at all on this claim.  This will
 369       // help us allocate any unknown patient responsibility amounts.
 370       $thispaidanything = 0;
 371       foreach($this->invoice as $codekey => $codeval) {
 372         foreach ($codeval['dtl'] as $key => $value) {
 373           if (preg_match("/$inslabel/i", $value['src'], $tmp)) {
 374             $thispaidanything += $value['pmt'];
 375           }
 376         }
 377       }
 378
 379       // Allocate any unknown patient responsibility by guessing if the
 380       // deductible has been satisfied.
 381       if ($thispaidanything)
 382         $coinsurance = $ptresp - $deductible;
 383       else
 384         $deductible = $ptresp - $coinsurance;
 385
 386       if ($date && $deductible != 0)
 387         $aadj[] = array($date, 'PR', '1', sprintf('%.2f', $deductible));
 388       if ($date && $coinsurance != 0)
 389         $aadj[] = array($date, 'PR', '2', sprintf('%.2f', $coinsurance));
 390
 391     } // end if
 392
 393     return $aadj;
 394   }
 395
 396   // Return date, total payments and total "hard" adjustments from the given
 397   // prior payer. If $code is specified then only that procedure key is
 398   // selected, otherwise it's for the whole claim.
 399   //
 400   function payerTotals($ins, $code='') {
 401     // If we have no modifiers stored in SQL-Ledger for this claim,
 402     // then we cannot use a modifier passed in with the key.
 403     $tmp = strpos($code, ':');
 404     if ($tmp && !$this->using_modifiers) $code = substr($code, 0, $tmp);
 405
 406     $inslabel = ($this->payerSequence($ins) == 'S') ? 'Ins2' : 'Ins1';
 407     $paytotal = 0;
 408     $adjtotal = 0;
 409     $date = '';
 410     foreach($this->invoice as $codekey => $codeval) {
 411       if ($code && strcmp($codekey,$code) != 0) continue;
 412       foreach ($codeval['dtl'] as $key => $value) {
 413         if (preg_match("/$inslabel/i", $value['src'], $tmp)) {
 414           if (!$date) $date = str_replace('-', '', trim(substr($key, 0, 10)));
 415           $paytotal += $value['pmt'];
 416         }
 417       }
 418       $aarr = $this->payerAdjustments($ins, $codekey);
 419       foreach ($aarr as $a) {
 420         if (strcmp($a[1],'PR') != 0) $adjtotal += $a[3];
 421         if (!$date) $date = $a[0];
 422       }
 423     }
 424     return array($date, sprintf('%.2f', $paytotal), sprintf('%.2f', $adjtotal));
 425   }
 426
 427   // Return the amount already paid by the patient.
 428   //
 429   function patientPaidAmount() {
 430     // For primary claims $this->invoice is not loaded, so get the co-pay
 431     // from the billing table instead.
 432     if (empty($this->invoice)) return $this->copay;
 433     //
 434     $amount = 0;
 435     foreach($this->invoice as $codekey => $codeval) {
 436       foreach ($codeval['dtl'] as $key => $value) {
 437         if (!preg_match("/Ins/i", $value['src'], $tmp)) {
 438           $amount += $value['pmt'];
 439         }
 440       }
 441     }
 442     return sprintf('%.2f', $amount);
 443   }
 444
 445   // Return invoice total, including adjustments but not payments.
 446   //
 447   function invoiceTotal() {
 448     $amount = 0;
 449     foreach($this->invoice as $codekey => $codeval) {
 450       $amount += $codeval['chg'];
 451     }
 452     return sprintf('%.2f', $amount);
 453   }
 454
 455   // Number of procedures in this claim.
 456   function procCount() {
 457     return count($this->procs);
 458   }
 459
 460   // Number of payers for this claim. Ranges from 1 to 3.
 461   function payerCount() {
 462     return count($this->payers);
 463   }
 464
 465   function x12gsversionstring() {
 466     return x12clean(trim($this->x12_partner['x12_version']));
 467   }
 468
 469   function x12gssenderid() {
 470     $tmp = $this->x12_partner['x12_sender_id'];
 471     while (strlen($tmp) < 15) $tmp .= " ";
 472     return $tmp;
 473   }
 474
 475   function x12gsreceiverid() {
 476     $tmp = $this->x12_partner['x12_receiver_id'];
 477     while (strlen($tmp) < 15) $tmp .= " ";
 478     return $tmp;
 479   }
 480
 481   function cliaCode() {
 482     return x12clean(trim($this->facility['domain_identifier']));
 483   }
 484
 485   function billingFacilityName() {
 486     return x12clean(trim($this->billing_facility['name']));
 487   }
 488
 489   function billingFacilityStreet() {
 490     return x12clean(trim($this->billing_facility['street']));
 491   }
 492
 493   function billingFacilityCity() {
 494     return x12clean(trim($this->billing_facility['city']));
 495   }
 496
 497   function billingFacilityState() {
 498     return x12clean(trim($this->billing_facility['state']));
 499   }
 500
 501   function billingFacilityZip() {
 502     return x12clean(trim($this->billing_facility['postal_code']));
 503   }
 504
 505   function billingFacilityETIN() {
 506     return x12clean(trim(str_replace('-', '', $this->billing_facility['federal_ein'])));
 507   }
 508
 509   function billingFacilityNPI() {
 510     return x12clean(trim($this->billing_facility['facility_npi']));
 511   }
 512
 513   # The billing facility and the patient must both accept for this to return true.
 514   function billingFacilityAssignment($ins=0) {
 515     $tmp = strtoupper($this->payers[$ins]['data']['accept_assignment']);
 516     if (strcmp($tmp,'FALSE') == 0) return '0';
 517     return !empty($this->billing_facility['accepts_assignment']);
 518   }
 519
 520   function billingContactName() {
 521     return x12clean(trim($this->billing_facility['attn']));
 522   }
 523
 524   function billingContactPhone() {
 525     if (preg_match("/([2-9]\d\d)\D*(\d\d\d)\D*(\d\d\d\d)/",
 526       $this->billing_facility['phone'], $tmp))
 527     {
 528       return $tmp[1] . $tmp[2] . $tmp[3];
 529     }
 530     return '';
 531   }
 532
 533   function facilityName() {
 534     return x12clean(trim($this->facility['name']));
 535   }
 536
 537   function facilityStreet() {
 538     return x12clean(trim($this->facility['street']));
 539   }
 540
 541   function facilityCity() {
 542     return x12clean(trim($this->facility['city']));
 543   }
 544
 545   function facilityState() {
 546     return x12clean(trim($this->facility['state']));
 547   }
 548
 549   function facilityZip() {
 550     return x12clean(trim($this->facility['postal_code']));
 551   }
 552
 553   function facilityETIN() {
 554     return x12clean(trim(str_replace('-', '', $this->facility['federal_ein'])));
 555   }
 556
 557   function facilityNPI() {
 558     return x12clean(trim($this->facility['facility_npi']));
 559   }
 560
 561   function facilityPOS() {
 562     return x12clean(trim($this->facility['pos_code']));
 563   }
 564
 565   function clearingHouseName() {
 566     return x12clean(trim($this->x12_partner['name']));
 567   }
 568
 569   function clearingHouseETIN() {
 570     return x12clean(trim(str_replace('-', '', $this->x12_partner['id_number'])));
 571   }
 572
 573   function providerNumberType($prockey=-1) {
 574     $tmp = ($prockey < 0 || empty($this->procs[$prockey]['provider_id'])) ?
 575       $this->insurance_numbers : $this->procs[$prockey]['insurance_numbers'];
 576     return $tmp['provider_number_type'];
 577   }
 578
 579   function providerNumber($prockey=-1) {
 580     $tmp = ($prockey < 0 || empty($this->procs[$prockey]['provider_id'])) ?
 581       $this->insurance_numbers : $this->procs[$prockey]['insurance_numbers'];
 582     return x12clean(trim(str_replace('-', '', $tmp['provider_number'])));
 583   }
 584
 585   function providerGroupNumber($prockey=-1) {
 586     $tmp = ($prockey < 0 || empty($this->procs[$prockey]['provider_id'])) ?
 587       $this->insurance_numbers : $this->procs[$prockey]['insurance_numbers'];
 588     return x12clean(trim(str_replace('-', '', $tmp['group_number'])));
 589   }
 590
 591   // Returns 'P', 'S' or 'T'.
 592   //
 593   function payerSequence($ins=0) {
 594     return strtoupper(substr($this->payers[$ins]['data']['type'], 0, 1));
 595   }
 596
 597   // Returns the HIPAA code of the patient-to-subscriber relationship.
 598   //
 599   function insuredRelationship($ins=0) {
 600     $tmp = strtolower($this->payers[$ins]['data']['subscriber_relationship']);
 601     if (strcmp($tmp,'self'  ) == 0) return '18';
 602     if (strcmp($tmp,'spouse') == 0) return '01';
 603     if (strcmp($tmp,'child' ) == 0) return '19';
 604     if (strcmp($tmp,'other' ) == 0) return 'G8';
 605     return $tmp; // should not happen
 606   }
 607
 608   function insuredTypeCode($ins=0) {
 609     if (strcmp($this->claimType($ins),'MB') == 0 && $this->payerSequence($ins) != 'P')
 610       return '12'; // medicare secondary working aged beneficiary or
 611                    // spouse with employer group health plan
 612     return '';
 613   }
 614
 615   // Is the patient also the subscriber?
 616   //
 617   function isSelfOfInsured($ins=0) {
 618     $tmp = strtolower($this->payers[$ins]['data']['subscriber_relationship']);
 619     return (strcmp($tmp,'self') == 0);
 620   }
 621
 622   function planName($ins=0) {
 623     return x12clean(trim($this->payers[$ins]['data']['plan_name']));
 624   }
 625
 626   function policyNumber($ins=0) { // "ID"
 627     return x12clean(trim($this->payers[$ins]['data']['policy_number']));
 628   }
 629
 630   function groupNumber($ins=0) {
 631     return x12clean(trim($this->payers[$ins]['data']['group_number']));
 632   }
 633
 634   function groupName($ins=0) {
 635     return x12clean(trim($this->payers[$ins]['data']['subscriber_employer']));
 636   }
 637
 638   // Claim types are:
 639   // 16 Other HCFA
 640   // MB Medicare Part B
 641   // MC Medicaid
 642   // CH ChampUSVA
 643   // CH ChampUS
 644   // BL Blue Cross Blue Shield
 645   // 16 FECA
 646   // 09 Self Pay
 647   // 10 Central Certification
 648   // 11 Other Non-Federal Programs
 649   // 12 Preferred Provider Organization (PPO)
 650   // 13 Point of Service (POS)
 651   // 14 Exclusive Provider Organization (EPO)
 652   // 15 Indemnity Insurance
 653   // 16 Health Maintenance Organization (HMO) Medicare Risk
 654   // AM Automobile Medical
 655   // CI Commercial Insurance Co.
 656   // DS Disability
 657   // HM Health Maintenance Organization
 658   // LI Liability
 659   // LM Liability Medical
 660   // OF Other Federal Program
 661   // TV Title V
 662   // VA Veterans Administration Plan
 663   // WC Workers Compensation Health Plan
 664   // ZZ Mutually Defined
 665   //
 666   function claimType($ins=0) {
 667     if (empty($this->payers[$ins]['object'])) return '';
 668     return $this->payers[$ins]['object']->get_freeb_claim_type();
 669   }
 670
 671   function insuredLastName($ins=0) {
 672     return x12clean(trim($this->payers[$ins]['data']['subscriber_lname']));
 673   }
 674
 675   function insuredFirstName($ins=0) {
 676     return x12clean(trim($this->payers[$ins]['data']['subscriber_fname']));
 677   }
 678
 679   function insuredMiddleName($ins=0) {
 680     return x12clean(trim($this->payers[$ins]['data']['subscriber_mname']));
 681   }
 682
 683   function insuredStreet($ins=0) {
 684     return x12clean(trim($this->payers[$ins]['data']['subscriber_street']));
 685   }
 686
 687   function insuredCity($ins=0) {
 688     return x12clean(trim($this->payers[$ins]['data']['subscriber_city']));
 689   }
 690
 691   function insuredState($ins=0) {
 692     return x12clean(trim($this->payers[$ins]['data']['subscriber_state']));
 693   }
 694
 695   function insuredZip($ins=0) {
 696     return x12clean(trim($this->payers[$ins]['data']['subscriber_postal_code']));
 697   }
 698
 699   function insuredPhone($ins=0) {
 700     if (preg_match("/([2-9]\d\d)\D*(\d\d\d)\D*(\d\d\d\d)/",
 701       $this->payers[$ins]['data']['subscriber_phone'], $tmp))
 702       return $tmp[1] . $tmp[2] . $tmp[3];
 703     return '';
 704   }
 705
 706   function insuredDOB($ins=0) {
 707     return str_replace('-', '', $this->payers[$ins]['data']['subscriber_DOB']);
 708   }
 709
 710   function insuredSex($ins=0) {
 711     return strtoupper(substr($this->payers[$ins]['data']['subscriber_sex'], 0, 1));
 712   }
 713
 714   function payerName($ins=0) {
 715     return x12clean(trim($this->payers[$ins]['company']['name']));
 716   }
 717
 718   function payerAttn($ins=0) {
 719     return x12clean(trim($this->payers[$ins]['company']['attn']));
 720   }
 721
 722   function payerStreet($ins=0) {
 723     if (empty($this->payers[$ins]['object'])) return '';
 724     $tmp = $this->payers[$ins]['object'];
 725     $tmp = $tmp->get_address();
 726     return x12clean(trim($tmp->get_line1()));
 727   }
 728
 729   function payerCity($ins=0) {
 730     if (empty($this->payers[$ins]['object'])) return '';
 731     $tmp = $this->payers[$ins]['object'];
 732     $tmp = $tmp->get_address();
 733     return x12clean(trim($tmp->get_city()));
 734   }
 735
 736   function payerState($ins=0) {
 737     if (empty($this->payers[$ins]['object'])) return '';
 738     $tmp = $this->payers[$ins]['object'];
 739     $tmp = $tmp->get_address();
 740     return x12clean(trim($tmp->get_state()));
 741   }
 742
 743   function payerZip($ins=0) {
 744     if (empty($this->payers[$ins]['object'])) return '';
 745     $tmp = $this->payers[$ins]['object'];
 746     $tmp = $tmp->get_address();
 747     return x12clean(trim($tmp->get_zip()));
 748   }
 749
 750   function payerID($ins=0) {
 751     return x12clean(trim($this->payers[$ins]['company']['cms_id']));
 752   }
 753
 754   function patientLastName() {
 755     return x12clean(trim($this->patient_data['lname']));
 756   }
 757
 758   function patientFirstName() {
 759     return x12clean(trim($this->patient_data['fname']));
 760   }
 761
 762   function patientMiddleName() {
 763     return x12clean(trim($this->patient_data['mname']));
 764   }
 765
 766   function patientStreet() {
 767     return x12clean(trim($this->patient_data['street']));
 768   }
 769
 770   function patientCity() {
 771     return x12clean(trim($this->patient_data['city']));
 772   }
 773
 774   function patientState() {
 775     return x12clean(trim($this->patient_data['state']));
 776   }
 777
 778   function patientZip() {
 779     return x12clean(trim($this->patient_data['postal_code']));
 780   }
 781
 782   function patientPhone() {
 783     $ptphone = $this->patient_data['phone_home'];
 784     if (!$ptphone) $ptphone = $this->patient_data['phone_biz'];
 785     if (!$ptphone) $ptphone = $this->patient_data['phone_cell'];
 786     if (preg_match("/([2-9]\d\d)\D*(\d\d\d)\D*(\d\d\d\d)/", $ptphone, $tmp))
 787       return $tmp[1] . $tmp[2] . $tmp[3];
 788     return '';
 789   }
 790
 791   function patientDOB() {
 792     return str_replace('-', '', $this->patient_data['DOB']);
 793   }
 794
 795   function patientSex() {
 796     return strtoupper(substr($this->patient_data['sex'], 0, 1));
 797   }
 798
 799   // Patient Marital Status: M = Married, S = Single, or something else.
 800   function patientStatus() {
 801     return strtoupper(substr($this->patient_data['status'], 0, 1));
 802   }
 803
 804   // This should be UNEMPLOYED, STUDENT, PT STUDENT, or anything else to
 805   // indicate employed.
 806   function patientOccupation() {
 807     return strtoupper(x12clean(trim($this->patient_data['occupation'])));
 808   }
 809
 810   function cptCode($prockey) {
 811     return x12clean(trim($this->procs[$prockey]['code']));
 812   }
 813
 814   function cptModifier($prockey) {
 815     return x12clean(trim($this->procs[$prockey]['modifier']));
 816   }
 817
 818   // Returns the procedure code, followed by ":modifier" if there is one.
 819   function cptKey($prockey) {
 820     $tmp = $this->cptModifier($prockey);
 821     return $this->cptCode($prockey) . ($tmp ? ":$tmp" : "");
 822   }
 823
 824   function cptCharges($prockey) {
 825     return x12clean(trim($this->procs[$prockey]['fee']));
 826   }
 827
 828   function cptUnits($prockey) {
 829     if (empty($this->procs[$prockey]['units'])) return '1';
 830     return x12clean(trim($this->procs[$prockey]['units']));
 831   }
 832
 833   // NDC drug ID.
 834   function cptNDCID($prockey) {
 835     $ndcinfo = $this->procs[$prockey]['ndc_info'];
 836     if (preg_match('/^N4(\S+)\s+(\S\S)(.*)/', $ndcinfo, $tmp)) {
 837       $ndc = $tmp[1];
 838       if (preg_match('/^(\d+)-(\d+)-(\d+)$/', $ndc, $tmp)) {
 839         return sprintf('%05d-%04d-%02d', $tmp[1], $tmp[2], $tmp[3]);
 840       }
 841       return x12clean($ndc); // format is bad but return it anyway
 842     }
 843     return '';
 844   }
 845
 846   // NDC drug unit of measure code.
 847   function cptNDCUOM($prockey) {
 848     $ndcinfo = $this->procs[$prockey]['ndc_info'];
 849     if (preg_match('/^N4(\S+)\s+(\S\S)(.*)/', $ndcinfo, $tmp))
 850       return x12clean($tmp[2]);
 851     return '';
 852   }
 853
 854   // NDC drug number of units.
 855   function cptNDCQuantity($prockey) {
 856     $ndcinfo = $this->procs[$prockey]['ndc_info'];
 857     if (preg_match('/^N4(\S+)\s+(\S\S)(.*)/', $ndcinfo, $tmp)) {
 858       return x12clean(ltrim($tmp[3], '0'));
 859     }
 860     return '';
 861   }
 862
 863   function onsetDate() {
 864     return str_replace('-', '', substr($this->encounter['onset_date'], 0, 10));
 865   }
 866
 867   function serviceDate() {
 868     return str_replace('-', '', substr($this->encounter['date'], 0, 10));
 869   }
 870
 871   function priorAuth() {
 872     return x12clean(trim($this->billing_options['prior_auth_number']));
 873   }
 874
 875   function isRelatedEmployment() {
 876     return !empty($this->billing_options['employment_related']);
 877   }
 878
 879   function isRelatedAuto() {
 880     return !empty($this->billing_options['auto_accident']);
 881   }
 882
 883   function isRelatedOther() {
 884     return !empty($this->billing_options['other_accident']);
 885   }
 886
 887   function autoAccidentState() {
 888     return x12clean(trim($this->billing_options['accident_state']));
 889   }
 890
 891   function isUnableToWork() {
 892     return !empty($this->billing_options['is_unable_to_work']);
 893   }
 894
 895   function offWorkFrom() {
 896     return str_replace('-', '', substr($this->billing_options['off_work_from'], 0, 10));
 897   }
 898
 899   function offWorkTo() {
 900     return str_replace('-', '', substr($this->billing_options['off_work_to'], 0, 10));
 901   }
 902
 903   function isHospitalized() {
 904     return !empty($this->billing_options['is_hospitalized']);
 905   }
 906
 907   function hospitalizedFrom() {
 908     return str_replace('-', '', substr($this->billing_options['hospitalization_date_from'], 0, 10));
 909   }
 910
 911   function hospitalizedTo() {
 912     return str_replace('-', '', substr($this->billing_options['hospitalization_date_to'], 0, 10));
 913   }
 914
 915   function isOutsideLab() {
 916     return !empty($this->billing_options['outside_lab']);
 917   }
 918
 919   function outsideLabAmount() {
 920     return sprintf('%.2f', 0 + $this->billing_options['lab_amount']);
 921   }
 922
 923   function medicaidResubmissionCode() {
 924     return x12clean(trim($this->billing_options['medicaid_resubmission_code']));
 925   }
 926
 927   function medicaidOriginalReference() {
 928     return x12clean(trim($this->billing_options['medicaid_original_reference']));
 929   }
 930
 931   function frequencyTypeCode() {
 932     return empty($this->billing_options['replacement_claim']) ? '1' : '7';
 933   }
 934
 935   function additionalNotes() {
 936     return x12clean(trim($this->billing_options['comments']));
 937   }
 938
 939   // Returns an array of unique diagnoses.  Periods are stripped.
 940   function diagArray() {
 941     $da = array();
 942     foreach ($this->procs as $row) {
 943       $atmp = explode(':', $row['justify']);
 944       foreach ($atmp as $tmp) {
 945         if (!empty($tmp)) {
 946           $diag = str_replace('.', '', $tmp);
 947           $da[$diag] = $diag;
 948         }
 949       }
 950     }
 951     return $da;
 952   }
 953
 954   // Compute one 1-relative index in diagArray for the given procedure.
 955   // This function is obsolete, use diagIndexArray() instead.
 956   function diagIndex($prockey) {
 957     $da = $this->diagArray();
 958     $tmp = explode(':', $this->procs[$prockey]['justify']);
 959     if (empty($tmp)) return '';
 960     $diag = str_replace('.', '', $tmp[0]);
 961     $i = 0;
 962     foreach ($da as $value) {
 963       ++$i;
 964       if (strcmp($value,$diag) == 0) return $i;
 965     }
 966     return '';
 967   }
 968
 969   // Compute array of 1-relative diagArray indices for the given procedure.
 970   function diagIndexArray($prockey) {
 971     $dia = array();
 972     $da = $this->diagArray();
 973     $atmp = explode(':', $this->procs[$prockey]['justify']);
 974     foreach ($atmp as $tmp) {
 975       if (!empty($tmp)) {
 976         $diag = str_replace('.', '', $tmp);
 977         $i = 0;
 978         foreach ($da as $value) {
 979           ++$i;
 980           if (strcmp($value,$diag) == 0) $dia[] = $i;
 981         }
 982       }
 983     }
 984     return $dia;
 985   }
 986
 987   function providerLastName($prockey=-1) {
 988     $tmp = ($prockey < 0 || empty($this->procs[$prockey]['provider_id'])) ?
 989       $this->provider : $this->procs[$prockey]['provider'];
 990     return x12clean(trim($tmp['lname']));
 991   }
 992
 993   function providerFirstName($prockey=-1) {
 994     $tmp = ($prockey < 0 || empty($this->procs[$prockey]['provider_id'])) ?
 995       $this->provider : $this->procs[$prockey]['provider'];
 996     return x12clean(trim($tmp['fname']));
 997   }
 998
 999   function providerMiddleName($prockey=-1) {
1000     $tmp = ($prockey < 0 || empty($this->procs[$prockey]['provider_id'])) ?
1001       $this->provider : $this->procs[$prockey]['provider'];
1002     return x12clean(trim($tmp['mname']));
1003   }
1004
1005   function providerNPI($prockey=-1) {
1006     $tmp = ($prockey < 0 || empty($this->procs[$prockey]['provider_id'])) ?
1007       $this->provider : $this->procs[$prockey]['provider'];
1008     return x12clean(trim($tmp['npi']));
1009   }
1010
1011   function providerUPIN($prockey=-1) {
1012     $tmp = ($prockey < 0 || empty($this->procs[$prockey]['provider_id'])) ?
1013       $this->provider : $this->procs[$prockey]['provider'];
1014     return x12clean(trim($tmp['upin']));
1015   }
1016
1017   function providerSSN($prockey=-1) {
1018     $tmp = ($prockey < 0 || empty($this->procs[$prockey]['provider_id'])) ?
1019       $this->provider : $this->procs[$prockey]['provider'];
1020     return x12clean(trim(str_replace('-', '', $tmp['federaltaxid'])));
1021   }
1022
1023   function providerTaxonomy($prockey=-1) {
1024     $tmp = ($prockey < 0 || empty($this->procs[$prockey]['provider_id'])) ?
1025       $this->provider : $this->procs[$prockey]['provider'];
1026     if (empty($tmp['taxonomy'])) return '207Q00000X';
1027     return x12clean(trim($tmp['taxonomy']));
1028   }
1029
1030   function referrerLastName() {
1031     return x12clean(trim($this->referrer['lname']));
1032   }
1033
1034   function referrerFirstName() {
1035     return x12clean(trim($this->referrer['fname']));
1036   }
1037
1038   function referrerMiddleName() {
1039     return x12clean(trim($this->referrer['mname']));
1040   }
1041
1042   function referrerNPI() {
1043     return x12clean(trim($this->referrer['npi']));
1044   }
1045
1046   function referrerUPIN() {
1047     return x12clean(trim($this->referrer['upin']));
1048   }
1049
1050   function referrerSSN() {
1051     return x12clean(trim(str_replace('-', '', $this->referrer['federaltaxid'])));
1052   }
1053
1054   function referrerTaxonomy() {
1055     if (empty($this->referrer['taxonomy'])) return '207Q00000X';
1056     return x12clean(trim($this->referrer['taxonomy']));
1057   }
1058
1059   function supervisorLastName() {
1060     return x12clean(trim($this->supervisor['lname']));
1061   }
1062
1063   function supervisorFirstName() {
1064     return x12clean(trim($this->supervisor['fname']));
1065   }
1066
1067   function supervisorMiddleName() {
1068     return x12clean(trim($this->supervisor['mname']));
1069   }
1070
1071   function supervisorNPI() {
1072     return x12clean(trim($this->supervisor['npi']));
1073   }
1074
1075   function supervisorUPIN() {
1076     return x12clean(trim($this->supervisor['upin']));
1077   }
1078
1079   function supervisorSSN() {
1080     return x12clean(trim(str_replace('-', '', $this->supervisor['federaltaxid'])));
1081   }
1082
1083   function supervisorTaxonomy() {
1084     if (empty($this->supervisor['taxonomy'])) return '207Q00000X';
1085     return x12clean(trim($this->supervisor['taxonomy']));
1086   }
1087
1088   function supervisorNumberType() {
1089     return $this->supervisor_numbers['provider_number_type'];
1090   }
1091
1092   function supervisorNumber() {
1093     return x12clean(trim(str_replace('-', '', $this->supervisor_numbers['provider_number'])));
1094   }
1095
1096 }
1097 ?>