library/gen_x12_837.inc.php

   1 <?php
   2 /** @package OpenEMR
   3  *  @link http://www.open-emr.org
   4  *  @author Rod Roark <rod@sunsetsystems.com>
   5  *  @copyright Copyright (c) 2009 Rod Roark <rod@sunsetsystems.com>
   6  *  @license https://github.com/openemr/openemr/blob/master/LICENSE GNU General Public License 3
   7  */
   8
   9 require_once("Claim.class.php");
  10 function stripZipCode($zip)
  11 {
  12     return preg_replace('/[-\s]*/','',$zip);
  13 }
  14 function gen_x12_837($pid, $encounter, &$log, $encounter_claim=false)
  15 {
  16
  17     $today = time();
  18     $out = '';
  19     $claim = new Claim($pid, $encounter);
  20     $edicount = 0;
  21
  22   // This is true for the 5010 standard, false for 4010.
  23   // x12gsversionstring() should be "005010X222A1" or "004010X098A1".
  24     $CMS_5010 = strpos($claim->x12gsversionstring(), '5010') !== false;
  25
  26     $log .= "Generating claim $pid-$encounter for " .
  27     $claim->patientFirstName()  . ' ' .
  28     $claim->patientMiddleName() . ' ' .
  29     $claim->patientLastName()   . ' on ' .
  30     date('Y-m-d H:i', $today) . ".\n";
  31
  32     $out .= "ISA" .
  33     "*" . $claim->x12gsisa01() .
  34     "*" . $claim->x12gsisa02() .
  35     "*" . $claim->x12gsisa03() .
  36     "*" . $claim->x12gsisa04() .
  37     "*" . $claim->x12gsisa05() .
  38     "*" . $claim->x12gssenderid() .
  39     "*" . $claim->x12gsisa07() .
  40     "*" . $claim->x12gsreceiverid() .
  41     "*030911" .
  42     "*1630" .
  43     "*" . ($CMS_5010 ? "^"     : "U"    ) .
  44     "*" . ($CMS_5010 ? "00501" : "00401") .
  45     "*000000001" .
  46     "*" . $claim->x12gsisa14() .
  47     "*" . $claim->x12gsisa15() .
  48     "*:" .
  49     "~\n";
  50
  51     $out .= "GS" .
  52     "*HC" .
  53     "*" . $claim->x12gsgs02() .
  54     "*" . trim($claim->x12gs03()) .
  55     "*" . date('Ymd', $today) .
  56     "*" . date('Hi', $today) .
  57     "*1" .
  58     "*X" .
  59     "*" . $claim->x12gsversionstring() .
  60     "~\n";
  61
  62     ++$edicount;
  63     $out .= "ST" .
  64     "*837" .
  65     "*0021" .
  66     // Spec says the following is optional, so should be able to leave it out.
  67     ($CMS_5010 ? ("*" . $claim->x12gsversionstring()) : "") .
  68     "~\n";
  69
  70     ++$edicount;
  71     $out .= "BHT" .
  72     "*0019" .                             // 0019 is required here
  73     "*00" .                               // 00 = original transmission
  74     "*0123" .                             // reference identification
  75     "*" . date('Ymd', $today) .           // transaction creation date
  76     "*" . date('Hi', $today) .            // transaction creation time
  77     ($encounter_claim ? "*RP" : "*CH") .  // RP = reporting, CH = chargeable
  78     "~\n";
  79
  80     if (!$CMS_5010) {
  81         // This segment was deleted for 5010.
  82         ++$edicount;
  83         $out .= "REF" .
  84         "*87" .
  85         "*" . $claim->x12gsversionstring() .
  86         "~\n";
  87     }
  88
  89     ++$edicount;
  90
  91     if ($claim->federalIdType() == "SY") { // check entity type for NM*102 1 == person, 2 == non-person entity
  92         $tempName = $claim->billingFacilityName();
  93         $partsName = explode(' ', $tempName);// Loop 1000A submitter entity == person
  94         $num_parts = count($partsName);
  95         switch ($num_parts) {
  96             case "2":
  97                 $firstName = $partsName[0];
  98                 $middleName = '';
  99                 $lastName = $partsName[1];
 100                 $suffixName = '';
 101             break;
 102             case "3":
 103                 $firstName = $partsName[0];
 104                 $middleName = $partsName[1];
 105                 $lastName = $partsName[2];
 106                 $suffixName = '';
 107             break;
 108             case "4":
 109                 $firstName = $partsName[0];
 110                 $middleName = $partsName[1];
 111                 $lastName = $partsName[2];
 112                 $suffixName = $partsName[3];
 113             break;
 114             default:
 115                 $log .= "*** submitter name in 1000A loop has more than 4 parts, may not be desirable\n";
 116                 $firstName = $partsName[0];
 117                 $middleName = $partsName[1];
 118                 $lastName = $partsName[2];
 119                 $suffixName = $partsName[3];
 120         }
 121         $out .= "NM1" . // Loop 1000A Submitter
 122         "*41" .
 123         "*1" .
 124         "*" . $lastName .
 125         "*" . $firstName .
 126         "*" . $middleName .
 127         "*" . // Name Prefix not used
 128         "*" . // Name Suffix not used
 129         "*46";
 130     } else {    //Field length is limited to 35. See nucc dataset page 63 www.nucc.org
 131         $billingFacilityName = substr($claim->billingFacilityName(), 0, $CMS_5010 ? 60 : 35);
 132         if ($billingFacilityName == '') $log .= "*** billing facility name in 1000A loop is empty\n";
 133         $out .= "NM1" .
 134         "*41" .
 135         "*2" .
 136         "*" . $billingFacilityName .
 137         "*" .
 138         "*" .
 139         "*" .
 140         "*" .
 141         "*46";
 142     }
 143
 144     if (trim($claim->x12gsreceiverid()) == '470819582') { // if ECLAIMS EDI
 145         $out  .=  "*" . $claim->clearingHouseETIN();
 146     } else {
 147         $out  .=  "*" . $claim->billingFacilityETIN();
 148     }
 149     $out .= "~\n";
 150
 151     ++$edicount;
 152     $out .= "PER" .
 153     "*IC" .
 154     "*" . $claim->billingContactName() .
 155     "*TE" .
 156     "*" . $claim->billingContactPhone();
 157     if (!$CMS_5010 && $claim->x12gsper06()) {
 158         $out .= "*ED*" . $claim->x12gsper06();
 159     }
 160     $out .= "~\n";
 161
 162     ++$edicount;
 163     $out .= "NM1" .       // Loop 1000B Receiver
 164     "*40" .
 165     "*2" .
 166     "*" . $claim->clearingHouseName() .
 167     "*" .
 168     "*" .
 169     "*" .
 170     "*" .
 171     "*46" .
 172     "*" . $claim->clearingHouseETIN() .
 173     "~\n";
 174
 175     $HLcount = 1;
 176
 177     ++$edicount;
 178     $out .= "HL" .        // Loop 2000A Billing/Pay-To Provider HL Loop
 179     "*$HLcount" .
 180     "*" .
 181     "*20" .
 182     "*1" .              // 1 indicates there are child segments
 183     "~\n";
 184
 185     $HLBillingPayToProvider = $HLcount++;
 186
 187   // Situational PRV segment for provider taxonomy code for Medicaid.
 188     if ($claim->claimType() == 'MC') {
 189         ++$edicount;
 190         $out .= "PRV*BI*ZZ" .
 191         "*" . $claim->providerTaxonomy() .
 192         "~\n";
 193     }
 194
 195   // Situational CUR segment (foreign currency information) omitted here.
 196
 197     ++$edicount;
 198   //Field length is limited to 35. See nucc dataset page 63 www.nucc.org
 199     if ($claim->federalIdType() == "SY") { // check for entity type like in 1000A
 200         $tempName = $claim->billingFacilityName();
 201         $partsName = explode(' ', $tempName);// Loop 2010AA Billing Provider entity == person
 202         $num_parts = count($partsName);
 203         switch ($num_parts) {
 204             case "2":
 205                 $firstName = $partsName[0];
 206                 $middleName = '';
 207                 $lastName = $partsName[1];
 208                 $suffixName = '';
 209             break;
 210             case "3":
 211                 $firstName = $partsName[0];
 212                 $middleName = $partsName[1];
 213                 $lastName = $partsName[2];
 214                 $suffixName = '';
 215             break;
 216             case "4":
 217                 $firstName = $partsName[0];
 218                 $middleName = $partsName[1];
 219                 $lastName = $partsName[2];
 220                 $suffixName = $partsName[3];
 221             break;
 222             default:
 223                 $log .= "*** billing provider name in 2010AA loop has more than 4 parts, may not be desirable\n";
 224                 $firstName = $partsName[0];
 225                 $middleName = $partsName[1];
 226                 $lastName = $partsName[2];
 227                 $suffixName = $partsName[3];
 228         }
 229         $out .= "NM1" .
 230         "*85" .
 231         "*1" .
 232         "*" . $lastName .
 233         "*" . $firstName .
 234         "*" . $middleName .
 235         "*" . // Name Prefix not used
 236         "*" . $suffixName;
 237     }
 238     else {
 239         $billingFacilityName = substr($claim->billingFacilityName(), 0, $CMS_5010 ? 60 : 35);
 240         if ($billingFacilityName == '') $log .= "*** billing facility name in 2010A loop is empty\n";
 241         $out .= "NM1" . // Loop 2010AA Billing Provider
 242         "*85" .
 243         "*2" .
 244         "*" . $billingFacilityName .
 245         "*" .
 246         "*" .
 247         "*" .
 248         "*";
 249     }
 250     if ($claim->billingFacilityNPI()) {
 251         $out .= "*XX*" . $claim->billingFacilityNPI();
 252     }
 253     else {
 254         $log .= "*** Billing facility has no NPI.\n";
 255         if ($CMS_5010) {
 256             $out .= "*XX*";
 257         }
 258         else {
 259             $out .= "*24*" . $claim->billingFacilityETIN();
 260         }
 261     }
 262     $out .= "~\n";
 263
 264     ++$edicount;
 265     $out .= "N3" .
 266     "*" . $claim->billingFacilityStreet() .
 267     "~\n";
 268
 269     ++$edicount;
 270     $out .= "N4" .
 271     "*" . $claim->billingFacilityCity() .
 272     "*" . $claim->billingFacilityState() .
 273     "*" . stripZipCode($claim->billingFacilityZip()) .
 274     "~\n";
 275
 276     if ($CMS_5010 || ($claim->billingFacilityNPI() && $claim->billingFacilityETIN())) {
 277         ++$edicount;
 278         $out .= "REF" ;
 279         if($claim->federalIdType()){
 280             $out .= "*" . $claim->federalIdType();
 281         }
 282         else{
 283             $out .= "*EI"; // For dealing with the situation before adding TaxId type In facility.
 284         }
 285         $out .=  "*" . $claim->billingFacilityETIN() .
 286         "~\n";
 287     }
 288
 289     if ($claim->providerNumberType() && $claim->providerNumber() &&
 290       !($CMS_5010 && $claim->billingFacilityNPI()))
 291     {
 292         ++$edicount;
 293         $out .= "REF" .
 294         "*" . $claim->providerNumberType() .
 295         "*" . $claim->providerNumber() .
 296         "~\n";
 297     }
 298     else if ($claim->providerNumber() && !$claim->providerNumberType()) {
 299         $log .= "*** Payer-specific provider insurance number is present but has no type assigned.\n";
 300     }
 301
 302   // Situational PER*1C segment omitted.
 303
 304   // Pay-To Address defaults to billing provider and is no longer required in 5010.
 305     if (!$CMS_5010) {
 306         ++$edicount;
 307         // Field length is limited to 35. See nucc dataset page 63 www.nucc.org
 308         $billingFacilityName = substr($claim->billingFacilityName(), 0, $CMS_5010 ? 60 : 35);
 309         $out .= "NM1" .       // Loop 2010AB Pay-To Provider
 310         "*87" .
 311         "*2" .
 312         "*" . $billingFacilityName .
 313         "*" .
 314         "*" .
 315         "*" .
 316         "*";
 317         if ($claim->billingFacilityNPI())
 318         $out .= "*XX*" . $claim->billingFacilityNPI();
 319         else
 320         $out .= "*24*" . $claim->billingFacilityETIN();
 321         $out .= "~\n";
 322
 323         ++$edicount;
 324         $out .= "N3" .
 325         "*" . $claim->billingFacilityStreet() .
 326         "~\n";
 327
 328         ++$edicount;
 329         $out .= "N4" .
 330         "*" . $claim->billingFacilityCity() .
 331         "*" . $claim->billingFacilityState() .
 332         "*" . stripZipCode($claim->billingFacilityZip()) .
 333         "~\n";
 334
 335         if ($claim->billingFacilityNPI() && $claim->billingFacilityETIN()) {
 336             ++$edicount;
 337             $out .= "REF" .
 338             "*EI" .
 339             "*" . $claim->billingFacilityETIN() .
 340             "~\n";
 341         }
 342     }
 343
 344   // Loop 2010AC Pay-To Plan Name omitted.  Includes:
 345   // NM1*PE, N3, N4, REF*2U, REF*EI
 346
 347     $PatientHL = $claim->isSelfOfInsured() ? 0 : 1;
 348     $HLSubscriber = $HLcount++;
 349
 350     ++$edicount;
 351     $out .= "HL" .        // Loop 2000B Subscriber HL Loop
 352     "*$HLSubscriber" .
 353     "*$HLBillingPayToProvider" .
 354     "*22" .
 355     "*$PatientHL" .
 356     "~\n";
 357
 358     if (!$claim->payerSequence()) {
 359         $log .= "*** Error: Insurance information is missing!\n";
 360     }
 361
 362     ++$edicount;
 363     $out .= "SBR" .       // Subscriber Information
 364     "*" . $claim->payerSequence() .
 365     "*" . ($claim->isSelfOfInsured() ? '18' : '') .
 366     "*" . $claim->groupNumber() .
 367     "*" . (($CMS_5010 && $claim->groupNumber()) ? '' : $claim->groupName()) .
 368     "*" . $claim->insuredTypeCode() . // applies for secondary medicare
 369     "*" .
 370     "*" .
 371     "*" .
 372     "*" . $claim->claimType() . // Zirmed replaces this
 373     "~\n";
 374
 375   // Segment PAT omitted.
 376
 377     ++$edicount;
 378     $out .= "NM1" .       // Loop 2010BA Subscriber
 379     "*IL" .
 380     "*1" . // 1 = person, 2 = non-person
 381     "*" . $claim->insuredLastName() .
 382     "*" . $claim->insuredFirstName() .
 383     "*" . $claim->insuredMiddleName() .
 384     "*" .
 385     "*" . // Name Suffix
 386     "*MI" .
 387     // "MI" = Member Identification Number
 388     // "II" = Standard Unique Health Identifier, "Required if the
 389     //        HIPAA Individual Patient Identifier is mandated use."
 390     //        Here we presume that is not true yet.
 391     "*" . $claim->policyNumber() .
 392     "~\n";
 393
 394   // For 5010, further subscriber info is sent only if they are the patient.
 395     if (!$CMS_5010 || $claim->isSelfOfInsured()) {
 396         ++$edicount;
 397         $out .= "N3" .
 398         "*" . $claim->insuredStreet() .
 399         "~\n";
 400
 401         ++$edicount;
 402         $out .= "N4" .
 403         "*" . $claim->insuredCity() .
 404         "*" . $claim->insuredState() .
 405         "*" . stripZipCode($claim->insuredZip()) .
 406         "~\n";
 407
 408         ++$edicount;
 409         $out .= "DMG" .
 410         "*D8" .
 411         "*" . $claim->insuredDOB() .
 412         "*" . $claim->insuredSex() .
 413         "~\n";
 414     }
 415
 416   // Segment REF*SY (Subscriber Secondary Identification) omitted.
 417   // Segment REF*Y4 (Property and Casualty Claim Number) omitted.
 418   // Segment PER*IC (Property and Casualty Subscriber Contact Information) omitted.
 419
 420     ++$edicount;
 421   //Field length is limited to 35. See nucc dataset page 81 www.nucc.org
 422     $payerName = substr($claim->payerName(), 0, $CMS_5010 ? 60 : 35);
 423     $out .= "NM1" .       // Loop 2010BB Payer
 424     "*PR" .
 425     "*2" .
 426     "*" . $payerName .
 427     "*" .
 428     "*" .
 429     "*" .
 430     "*" .
 431     // The 5010 spec says:
 432     // "On or after the mandated implementation date for the HIPAA
 433     // National Plan Identifier (National Plan ID), XV must be sent.
 434     // Prior to the mandated implementation date and prior to any phase-
 435     // in period identified by Federal regulation, PI must be sent."
 436     // *************** Anybody know what that date is? ***************
 437     //    August 2011 - Publish interim final rule
 438 //    October 1, 2012-March 31, 2013 - Enumeration
 439 //    April 1, 2013-September 30, 2013 - Testing
 440  //   October 1, 2013 - Implementation
 441
 442     "*PI" .
 443     // Zirmed ignores this if using payer name matching:
 444     "*" . ($encounter_claim ? $claim->payerAltID() : $claim->payerID()) .
 445     "~\n";
 446
 447   // if (!$claim->payerID()) {
 448   //   $log .= "*** CMS ID is missing for payer '" . $claim->payerName() . "'.\n";
 449   // }
 450
 451     if (true) { // !$CMS_5010
 452         // The 5010 spec says:
 453         // "Required when the payer address is available and the submitter intends
 454         // for the claim to be printed on paper at the next EDI location (for example, a
 455         // clearinghouse). If not required by this implementation guide, do not send."
 456
 457         ++$edicount;
 458         $out .= "N3" .
 459         "*" . $claim->payerStreet() .
 460         "~\n";
 461
 462         ++$edicount;
 463         $out .= "N4" .
 464         "*" . $claim->payerCity() .
 465         "*" . $claim->payerState() .
 466         "*" . stripZipCode($claim->payerZip()) .
 467         "~\n";
 468     }
 469
 470   // Segment REF (Payer Secondary Identification) omitted.
 471   // Segment REF (Billing Provider Secondary Identification) omitted.
 472
 473     if (! $claim->isSelfOfInsured()) {
 474         ++$edicount;
 475         $out .= "HL" .        // Loop 2000C Patient Information
 476         "*$HLcount" .
 477         "*$HLSubscriber" .
 478         "*23" .
 479         "*0" .
 480         "~\n";
 481
 482         $HLcount++;
 483
 484         ++$edicount;
 485         $out .= "PAT" .
 486         "*" . $claim->insuredRelationship() .
 487         "~\n";
 488
 489         ++$edicount;
 490         $out .= "NM1" .       // Loop 2010CA Patient
 491         "*QC" .
 492         "*1" .
 493         "*" . $claim->patientLastName() .
 494         "*" . $claim->patientFirstName();
 495         if ($claim->patientMiddleName() !== '') $out .= "*"
 496         . $claim->patientMiddleName();
 497         $out .= "~\n";
 498
 499         ++$edicount;
 500         $out .= "N3" .
 501         "*" . $claim->patientStreet() .
 502         "~\n";
 503
 504         ++$edicount;
 505         $out .= "N4" .
 506         "*" . $claim->patientCity() .
 507         "*" . $claim->patientState() .
 508         "*" . stripZipCode($claim->patientZip()) .
 509         "~\n";
 510
 511         ++$edicount;
 512         $out .= "DMG" .
 513         "*D8" .
 514         "*" . $claim->patientDOB() .
 515         "*" . $claim->patientSex() .
 516         "~\n";
 517
 518         // Segment REF*Y4 (Property and Casualty Claim Number) omitted.
 519         // Segment REF (Property and Casualty Patient Identifier) omitted.
 520         // Segment PER (Property and Casualty Patient Contact Information) omitted.
 521
 522     } // end of patient different from insured
 523
 524     $proccount = $claim->procCount();
 525
 526     $clm_total_charges = 0;
 527     for ($prockey = 0; $prockey < $proccount; ++$prockey) {
 528         $clm_total_charges += $claim->cptCharges($prockey);
 529     }
 530
 531     if (!$clm_total_charges) {
 532         $log .= "*** This claim has no charges!\n";
 533     }
 534
 535     ++$edicount;
 536     $out .= "CLM" .       // Loop 2300 Claim
 537     "*$pid-$encounter" .
 538     "*"  . sprintf("%.2f",$clm_total_charges) . // Zirmed computes and replaces this
 539     "*"  .
 540     "*"  .
 541     "*"  . sprintf('%02d', $claim->facilityPOS()) . ":" .
 542            ($CMS_5010 ? "B" : "") . ":" .
 543            $claim->frequencyTypeCode() . // Changed to correct single digit output
 544     "*Y" .
 545     "*A" .
 546     "*"  . ($claim->billingFacilityAssignment() ? 'Y' : 'N') .
 547     "*Y" .
 548     ($CMS_5010 ? "" : "*C") .
 549     "~\n";
 550
 551     if ($claim->onsetDate() &&
 552       ($claim->onsetDate()!== $claim->serviceDate()) &&
 553       ($claim->onsetDateValid())
 554      ) {
 555         ++$edicount;
 556         $out .= "DTP" .       // Date of Onset
 557         "*431" .
 558         "*D8" .
 559         "*" . $claim->onsetDate() .
 560         "~\n";
 561     }
 562
 563   // above is for historical use of encounter onset date, now in misc_billing_options
 564   // Segment DTP*431 (Onset of Current Symptoms or Illness)
 565   // Segment DTP*484 (Last Menstrual Period Date)
 566
 567     if ($claim->miscOnsetDate() &&
 568       ($claim->box14Qualifier()) &&
 569       ($claim->miscOnsetDateValid())) {
 570         ++$edicount;
 571         $out .= "DTP" .       // Date Last Seen
 572         "*" . $claim->box14Qualifier() .
 573         "*D8" .
 574         "*" . $claim->miscOnsetDate() .
 575         "~\n";
 576     }
 577
 578   // Segment DTP*454 (Initial Treatment Date)
 579   // Segment DTP*304 (Last Seen Date)
 580   // Segment DTP*453 (Acute Manifestation Date)
 581   // Segment DTP*439 (Accident Date)
 582   // Segment DTP*455 (Last X-Ray Date)
 583   // Segment DTP*471 (Hearing and Vision Prescription Date)
 584   // Segment DTP*314 (Disability) omitted.
 585   // Segment DTP*360 (Initial Disability Period Start) omitted.
 586   // Segment DTP*361 (Initial Disability Period End) omitted.
 587   // Segment DTP*297 (Last Worked Date)
 588   // Segment DTP*296 (Authorized Return to Work Date)
 589
 590     if ($claim->dateInitialTreatment() &&
 591       ($claim->box15Qualifier()) &&
 592       ($claim->dateInitialTreatmentValid())){
 593         ++$edicount;
 594         $out .= "DTP" .       // Date Last Seen
 595         "*" . $claim->box15Qualifier() .
 596         "*D8" .
 597         "*" . $claim->dateInitialTreatment() .
 598         "~\n";
 599     }
 600
 601     if (strcmp($claim->facilityPOS(),'21') == 0 && $claim->onsetDateValid() ) {
 602         ++$edicount;
 603         $out .= "DTP" .     // Date of Hospitalization
 604         "*435" .
 605         "*D8" .
 606         "*" . $claim->onsetDate() .
 607         "~\n";
 608     }
 609
 610   // above is for historical use of encounter onset date, now in misc_billing_options
 611     if (strcmp($claim->facilityPOS(),'21') == 0 && $claim->hospitalizedFromDateValid() ) {
 612         ++$edicount;
 613         $out .= "DTP" .     // Date of Admission
 614         "*435" .
 615         "*D8" .
 616         "*" . $claim->hospitalizedFrom() .
 617         "~\n";
 618     }
 619
 620   // Segment DTP*096 (Discharge Date)
 621     if (strcmp($claim->facilityPOS(),'21') == 0 && $claim->hospitalizedToDateValid() ) {
 622         ++$edicount;
 623         $out .= "DTP" .     // Date of Discharge
 624         "*96" .
 625         "*D8" .
 626         "*" . $claim->hospitalizedTo() .
 627         "~\n";
 628     }
 629
 630   // Segments DTP (Assumed and Relinquished Care Dates) omitted.
 631   // Segment DTP*444 (Property and Casualty Date of First Contact) omitted.
 632   // Segment DTP*050 (Repricer Received Date) omitted.
 633   // Segment PWK (Claim Supplemental Information) omitted.
 634   // Segment CN1 (Contract Information) omitted.
 635
 636     $patientpaid = $claim->patientPaidAmount();
 637     if ($patientpaid != 0) {
 638         ++$edicount;
 639         $out .= "AMT" .     // Patient paid amount. Page 190/220.
 640         "*F5" .
 641         "*" . $patientpaid .
 642         "~\n";
 643     }
 644
 645   // Segment REF*4N (Service Authorization Exception Code) omitted.
 646   // Segment REF*F5 (Mandatory Medicare Crossover Indicator) omitted.
 647   // Segment REF*EW (Mammography Certification Number) omitted.
 648   // Segment REF*9F (Referral Number) omitted.
 649
 650     if ($claim->priorAuth()) {
 651         ++$edicount;
 652         $out .= "REF" .     // Prior Authorization Number
 653         "*G1" .
 654         "*" . $claim->priorAuth() .
 655         "~\n";
 656     }
 657
 658   // Segment REF*F8 Payer Claim Control Number for claim re-submission.icn_resubmission_number
 659
 660   #if($claim->billing_options['replacement_claim'] == '1'){
 661     if(trim($claim->billing_options['icn_resubmission_number']) > 3){
 662         ++$edicount;
 663         error_log("Method 1: ".$claim->billing_options['icn_resubmission_number'], 0);
 664         $out .= "REF" .
 665         "*F8" .
 666         "*" . $claim->icnResubmissionNumber() .
 667         "~\n";
 668     }
 669
 670
 671     if ($claim->cliaCode() && ($CMS_5010 || $claim->claimType() === 'MB')) {
 672         // Required by Medicare when in-house labs are done.
 673         ++$edicount;
 674         $out .= "REF" .     // Clinical Laboratory Improvement Amendment Number
 675         "*X4" .
 676         "*" . $claim->cliaCode() .
 677         "~\n";
 678     }
 679
 680   // Segment REF*9A (Repriced Claim Number) omitted.
 681   // Segment REF*9C (Adjusted Repriced Claim Number) omitted.
 682   // Segment REF*LX (Investigational Device Exemption Number) omitted.
 683   // Segment REF*D9 (Claim Identifier for Transmission Intermediaries) omitted.
 684   // Segment REF*EA (Medical Record Number) omitted.
 685   // Segment REF*P4 (Demonstration Project Identifier) omitted.
 686   // Segment REF*1J (Care Plan Oversight) omitted.
 687   // Segment K3 (File Information) omitted.
 688
 689     if ($claim->additionalNotes()) {
 690         // Claim note.
 691         ++$edicount;
 692         $out .= "NTE" .     // comments box 19
 693         "*" . ($CMS_5010 ? "ADD" : "") .
 694         "*" . $claim->additionalNotes() .
 695         "~\n";
 696     }
 697
 698   // Segment CR1 (Ambulance Transport Information) omitted.
 699   // Segment CR2 (Spinal Manipulation Service Information) omitted.
 700   // Segment CRC (Ambulance Certification) omitted.
 701   // Segment CRC (Patient Condition Information: Vision) omitted.
 702   // Segment CRC (Homebound Indicator) omitted.
 703
 704   // Segment CRC (EPSDT Referral).
 705     if($claim->epsdtFlag()) {
 706         ++$edicount;
 707         $out .= "CRC" .
 708         "*ZZ" .
 709         "*Y" .
 710         "*" . $claim->medicaidReferralCode() .
 711         "~\n";
 712     }
 713
 714   // Diagnoses, up to $max_per_seg per HI segment.
 715     $max_per_seg = $CMS_5010 ? 12 : 8;
 716     $da = $claim->diagArray();
 717     if ($claim->diagtype == "ICD9") {
 718         $diag_type_code = 'BK';
 719     }
 720     else
 721     {
 722         $diag_type_code = 'ABK';
 723     }
 724     $tmp = 0;
 725     foreach ($da as $diag) {
 726         if ($tmp % $max_per_seg == 0) {
 727             if ($tmp) $out .= "~\n";
 728             ++$edicount;
 729             $out .= "HI";         // Health Diagnosis Codes
 730         }
 731         $out .= "*$diag_type_code:" . $diag;
 732         if ($claim->diagtype == "ICD9") {
 733             $diag_type_code = 'BF';
 734         }
 735         else
 736           {
 737             $diag_type_code = 'ABF';
 738         }
 739         ++$tmp;
 740     }
 741     if ($tmp) $out .= "~\n";
 742
 743   // Segment HI*BP (Anesthesia Related Procedure) omitted.
 744   // Segment HI*BG (Condition Information) omitted.
 745   // Segment HCP (Claim Pricing/Repricing Information) omitted.
 746
 747     if ($claim->referrerLastName()) {
 748         // Medicare requires referring provider's name and UPIN.
 749         ++$edicount;
 750         $out .= "NM1" .     // Loop 2310A Referring Provider
 751         "*DN" .
 752         "*1" .
 753         "*" . $claim->referrerLastName() .
 754         "*" . $claim->referrerFirstName() .
 755         "*" . $claim->referrerMiddleName() .
 756         "*" .
 757         "*";
 758         if ($CMS_5010 || $claim->referrerNPI()) { $out .=
 759             "*XX" .
 760             "*" . $claim->referrerNPI();
 761         } else { $out .=
 762             "*34" .                           // not allowed for 5010
 763             "*" . $claim->referrerSSN();
 764         }
 765         $out .= "~\n";
 766
 767         if (!$CMS_5010 && $claim->referrerTaxonomy()) {
 768             ++$edicount;
 769             $out .= "PRV" .
 770             "*RF" . // ReFerring provider
 771             "*ZZ" .
 772             "*" . $claim->referrerTaxonomy() .
 773             "~\n";
 774         }
 775
 776         if (!CMS_5010 && $claim->referrerUPIN()) {
 777             ++$edicount;
 778             $out .= "REF" .   // Referring Provider Secondary Identification
 779             "*1G" .
 780             "*" . $claim->referrerUPIN() .
 781             "~\n";
 782         }
 783     }
 784
 785
 786   /* Per the implementation guide lines, only include this information if it is different
 787    * than the Loop 2010AA information
 788    */
 789     if(!$CMS_5010 ||
 790           ($claim->providerNPIValid() &&
 791           $claim->billingFacilityNPI() !== $claim->providerNPI() ))
 792     {
 793         ++$edicount;
 794         $out .= "NM1" .       // Loop 2310B Rendering Provider
 795         "*82" .
 796         "*1" .
 797         "*" . $claim->providerLastName() .
 798         "*" . $claim->providerFirstName() .
 799         "*" . $claim->providerMiddleName() .
 800         "*" .
 801         "*";
 802         if ($CMS_5010 || $claim->providerNPI()) { $out .=
 803             "*XX" .
 804             "*" . $claim->providerNPI();
 805         } else { $out .=
 806             "*34" .                             // not allowed for 5010
 807             "*" . $claim->providerSSN();
 808             $log .= "*** Rendering provider has no NPI.\n";
 809         }
 810         $out .= "~\n";
 811
 812         if ($claim->providerTaxonomy()) {
 813             ++$edicount;
 814             $out .= "PRV" .
 815             "*PE" . // Performing provider
 816             "*" .($claim->claimType() != 'MC' ? "PXC" : "ZZ") .
 817             "*" . $claim->providerTaxonomy() .
 818             "~\n";
 819         }
 820         // End of Loop 2310B
 821     }
 822     else
 823     {
 824         // This loop can only get skipped if we are generating a 5010 claim
 825         if(!($claim->providerNPIValid()))
 826         {
 827             /* If the loop was skipped because the provider NPI was invalid, generate
 828              * a warning for the log.*/
 829             $log.="*** Skipping 2310B because ".$claim->providerLastName() ."," . $claim->providerFirstName() . " has invalid NPI.\n";
 830         }
 831         /* Skipping this segment because the providerNPI and the billingFacilityNPI are identical
 832        * is a normal condition, so no need to warn.
 833          */
 834
 835     }
 836
 837   // 4010: REF*1C is required here for the Medicare provider number if NPI was
 838   // specified in NM109.  Not sure if other payers require anything here.
 839   // --- apparently ECLAIMS, INC wants the data in 2010 but NOT in 2310B - tony@mi-squared.com
 840   //
 841   // 5010 spec says nothing here if NPI was specified.
 842   //
 843     if (($CMS_5010 && !$claim->providerNPI() && in_array($claim->providerNumberType(), array('0B','1G','G2','LU')))
 844       || (!$CMS_5010 && trim($claim->x12gsreceiverid()) != '470819582')) // if NOT ECLAIMS EDI
 845     {
 846         if ($claim->providerNumber()) {
 847             ++$edicount;
 848             $out .= "REF" .
 849             "*" . $claim->providerNumberType() .
 850             "*" . $claim->providerNumber() .
 851             "~\n";
 852         }
 853     }
 854
 855   // Loop 2310D is omitted in the case of home visits (POS=12).
 856     if ($claim->facilityPOS() != 12 && (!$CMS_5010 ||
 857       ($claim->facilityNPI() != $claim->billingFacilityNPI() ||
 858       ($claim->facilityNPI() == $claim->billingFacilityNPI() &&
 859        $claim->facilityStreet() != $claim->billingFacilityStreet()))))
 860     {
 861         ++$edicount;
 862         $out .= "NM1" .       // Loop 2310D Service Location
 863         "*77" .
 864         "*2";
 865         //Field length is limited to 35. See nucc dataset page 77 www.nucc.org
 866         $facilityName = substr($claim->facilityName(), 0, $CMS_5010 ? 60 : 35);
 867         if ($claim->facilityName() || $claim->facilityNPI() || $claim->facilityETIN()) { $out .=
 868             "*" . $facilityName;
 869         }
 870         if ($claim->facilityNPI() || $claim->facilityETIN()) { $out .=
 871             "*" .
 872             "*" .
 873             "*" .
 874             "*";
 875             if ($CMS_5010 || $claim->facilityNPI()) { $out .=
 876                 "*XX*" . $claim->facilityNPI();
 877             } else { $out .=
 878                 "*24*" . $claim->facilityETIN();
 879             }
 880             if (!$claim->facilityNPI()) {
 881                 $log .= "*** Service location has no NPI.\n";
 882             }
 883         }
 884         $out .= "~\n";
 885         if ($claim->facilityStreet()) {
 886             ++$edicount;
 887             $out .= "N3" .
 888             "*" . $claim->facilityStreet() .
 889             "~\n";
 890         }
 891         if ($claim->facilityState()) {
 892             ++$edicount;
 893             $out .= "N4" .
 894             "*" . $claim->facilityCity() .
 895             "*" . $claim->facilityState() .
 896             "*" . stripZipCode($claim->facilityZip()) .
 897             "~\n";
 898         }
 899     }
 900
 901   // Segment REF (Service Facility Location Secondary Identification) omitted.
 902   // Segment PER (Service Facility Contact Information) omitted.
 903
 904   // Loop 2310E, Supervising Provider
 905   //
 906     if ($claim->supervisorLastName()) {
 907         ++$edicount;
 908         $out .= "NM1" .
 909         "*DQ" . // Supervising Physician
 910         "*1" .  // Person
 911         "*" . $claim->supervisorLastName() .
 912         "*" . $claim->supervisorFirstName() .
 913         "*" . $claim->supervisorMiddleName() .
 914         "*" .   // NM106 not used
 915         "*";    // Name Suffix
 916         if ($CMS_5010 || $claim->supervisorNPI()) { $out .=
 917             "*XX" .
 918             "*" . $claim->supervisorNPI();
 919         } else { $out .=
 920             "*34" .
 921             "*" . $claim->supervisorSSN();
 922         }
 923         if (!$claim->supervisorNPI()) {
 924             $log .= "*** Supervising Provider has no NPI.\n";
 925         }
 926         $out .= "~\n";
 927
 928         if ($claim->supervisorNumber()) {
 929             ++$edicount;
 930             $out .= "REF" .
 931             "*" . $claim->supervisorNumberType() .
 932             "*" . $claim->supervisorNumber() .
 933             "~\n";
 934         }
 935     }
 936
 937   // Segments NM1*PW, N3, N4 (Ambulance Pick-Up Location) omitted.
 938   // Segments NM1*45, N3, N4 (Ambulance Drop-Off Location) omitted.
 939
 940     $prev_pt_resp = $clm_total_charges; // for computation below
 941
 942   // Loops 2320 and 2330*, other subscriber/payer information.
 943   // Remember that insurance index 0 is always for the payer being billed
 944   // by this claim, and 1 and above are always for the "other" payers.
 945   //
 946     for ($ins = 1; $ins < $claim->payerCount(); ++$ins) {
 947
 948         $tmp1 = $claim->claimType($ins);
 949         $tmp2 = 'C1'; // Here a kludge. See page 321.
 950         if ($tmp1 === 'CI') $tmp2 = 'C1';
 951         if ($tmp1 === 'AM') $tmp2 = 'AP';
 952         if ($tmp1 === 'HM') $tmp2 = 'HM';
 953         if ($tmp1 === 'MB') $tmp2 = 'MB';
 954         if ($tmp1 === 'MC') $tmp2 = 'MC';
 955         if ($tmp1 === '09') $tmp2 = 'PP';
 956         ++$edicount;
 957         $out .= "SBR" . // Loop 2320, Subscriber Information - page 297/318
 958         "*" . $claim->payerSequence($ins) .
 959         "*" . $claim->insuredRelationship($ins) .
 960         "*" . $claim->groupNumber($ins) .
 961         "*" . (($CMS_5010 && $claim->groupNumber($ins)) ? '' : $claim->groupName($ins)) .
 962         "*" . ($CMS_5010 ? $claim->insuredTypeCode($ins) : $tmp2) .
 963         "*" .
 964         "*" .
 965         "*" .
 966         "*" . $claim->claimType($ins) .
 967         "~\n";
 968
 969         // Things that apply only to previous payers, not future payers.
 970         //
 971         if ($claim->payerSequence($ins) < $claim->payerSequence()) {
 972
 973             // Generate claim-level adjustments.
 974             $aarr = $claim->payerAdjustments($ins);
 975             foreach ($aarr as $a) {
 976                 ++$edicount;
 977                 $out .= "CAS" . // Previous payer's claim-level adjustments. Page 301/323.
 978                 "*" . $a[1] .
 979                 "*" . $a[2] .
 980                 "*" . $a[3] .
 981                 "~\n";
 982             }
 983
 984             $payerpaid = $claim->payerTotals($ins);
 985             ++$edicount;
 986             $out .= "AMT" . // Previous payer's paid amount. Page 307/332.
 987             "*D" .
 988             "*" . $payerpaid[1] .
 989             "~\n";
 990
 991             // Segment AMT*A8 (COB Total Non-Covered Amount) omitted.
 992             // Segment AMT*EAF (Remaining Patient Liability) omitted.
 993
 994             if (!$CMS_5010) {
 995                 // Patient responsibility amount as of this previous payer.
 996                 $prev_pt_resp -= $payerpaid[1]; // reduce by payments
 997                 $prev_pt_resp -= $payerpaid[2]; // reduce by adjustments
 998
 999                 ++$edicount;
1000                 $out .= "AMT" . // Allowed amount per previous payer. Page 334.
1001                 "*B6" .
1002                 "*" . sprintf('%.2f', $payerpaid[1] + $prev_pt_resp) .
1003                 "~\n";
1004
1005                 ++$edicount;
1006                 $out .= "AMT" . // Patient responsibility amount per previous payer. Page 335.
1007                 "*F2" .
1008                 "*" . sprintf('%.2f', $prev_pt_resp) .
1009                 "~\n";
1010             }
1011         } // End of things that apply only to previous payers.
1012
1013         if (!$CMS_5010) {
1014             ++$edicount;
1015             $out .= "DMG" . // Other subscriber demographic information. Page 342.
1016             "*D8" .
1017             "*" . $claim->insuredDOB($ins) .
1018             "*" . $claim->insuredSex($ins) .
1019             "~\n";
1020         }
1021
1022         ++$edicount;
1023         $out .= "OI" .  // Other Insurance Coverage Information. Page 310/344.
1024         "*" .
1025         "*" .
1026         "*" . ($claim->billingFacilityAssignment($ins) ? 'Y' : 'N') .
1027         // For this next item, the 5010 example in the spec does not match its
1028         // description.  So this might be wrong.
1029         "*" . ($CMS_5010 ? '' : 'B') .
1030         "*" .
1031         "*Y" .
1032         "~\n";
1033
1034         // Segment MOA (Medicare Outpatient Adjudication) omitted.
1035
1036         ++$edicount;
1037         $out .= "NM1" . // Loop 2330A Subscriber info for other insco. Page 315/350.
1038         "*IL" .
1039         "*1" .
1040         "*" . $claim->insuredLastName($ins) .
1041         "*" . $claim->insuredFirstName($ins) .
1042         "*" . $claim->insuredMiddleName($ins) .
1043         "*" .
1044         "*" .
1045         "*MI" .
1046         "*" . $claim->policyNumber($ins) .
1047         "~\n";
1048
1049         ++$edicount;
1050         $out .= "N3" .
1051         "*" . $claim->insuredStreet($ins) .
1052         "~\n";
1053
1054         ++$edicount;
1055         $out .= "N4" .
1056         "*" . $claim->insuredCity($ins) .
1057         "*" . $claim->insuredState($ins) .
1058         "*" . stripZipCode($claim->insuredZip($ins)) .
1059         "~\n";
1060
1061         // Segment REF (Other Subscriber Secondary Identification) omitted.
1062
1063         ++$edicount;
1064         //Field length is limited to 35. See nucc dataset page 81 www.nucc.org
1065         $payerName = substr($claim->payerName($ins), 0, $CMS_5010 ? 60 : 35);
1066         $out .= "NM1" . // Loop 2330B Payer info for other insco. Page 322/359.
1067         "*PR" .
1068         "*2" .
1069         "*" . $payerName .
1070         "*" .
1071         "*" .
1072         "*" .
1073         "*" .
1074         "*PI" .
1075         "*" . $claim->payerID($ins) .
1076         "~\n";
1077
1078         // if (!$claim->payerID($ins)) {
1079         //   $log .= "*** CMS ID is missing for payer '" . $claim->payerName($ins) . "'.\n";
1080         // }
1081
1082         // Payer address (N3 and N4) are added below so that Gateway EDI can
1083         // auto-generate secondary claims.  These do NOT appear in my copy of
1084         // the spec!  -- Rod 2008-06-12
1085
1086         if ($CMS_5010 || trim($claim->x12gsreceiverid()) == '431420764') { // if Gateway EDI
1087             ++$edicount;
1088             $out .= "N3" .
1089             "*" . $claim->payerStreet($ins) .
1090             "~\n";
1091             //
1092             ++$edicount;
1093             $out .= "N4" .
1094             "*" . $claim->payerCity($ins) .
1095             "*" . $claim->payerState($ins) .
1096             "*" . stripZipCode($claim->payerZip($ins)) .
1097             "~\n";
1098         } // end Gateway EDI
1099
1100         // Segment DTP*573 (Claim Check or Remittance Date) omitted.
1101         // Segment REF (Other Payer Secondary Identifier) omitted.
1102         // Segment REF*G1 (Other Payer Prior Authorization Number) omitted.
1103         // Segment REF*9F (Other Payer Referral Number) omitted.
1104         // Segment REF*T4 (Other Payer Claim Adjustment Indicator) omitted.
1105         // Segment REF*F8 (Other Payer Claim Control Number) omitted.
1106         // Segment NM1 (Other Payer Referring Provider) omitted.
1107         // Segment REF (Other Payer Referring Provider Secondary Identification) omitted.
1108         // Segment NM1 (Other Payer Rendering Provider) omitted.
1109         // Segment REF (Other Payer Rendering Provider Secondary Identification) omitted.
1110         // Segment NM1 (Other Payer Service Facility Location) omitted.
1111         // Segment REF (Other Payer Service Facility Location Secondary Identification) omitted.
1112         // Segment NM1 (Other Payer Supervising Provider) omitted.
1113         // Segment REF (Other Payer Supervising Provider Secondary Identification) omitted.
1114         // Segment NM1 (Other Payer Billing Provider) omitted.
1115         // Segment REF (Other Payer Billing Provider Secondary Identification) omitted.
1116
1117     } // End loops 2320/2330*.
1118
1119     $loopcount = 0;
1120
1121   // Procedure loop starts here.
1122   //
1123     for ($prockey = 0; $prockey < $proccount; ++$prockey) {
1124         ++$loopcount;
1125
1126         ++$edicount;
1127         $out .= "LX" .      // Loop 2400 LX Service Line. Page 398.
1128         "*$loopcount" .
1129         "~\n";
1130
1131         ++$edicount;
1132         $out .= "SV1" .     // Professional Service. Page 400.
1133         "*HC:" . $claim->cptKey($prockey) .
1134         "*" . sprintf('%.2f', $claim->cptCharges($prockey)) .
1135         "*UN" .
1136         "*" . $claim->cptUnits($prockey) .
1137         "*" .
1138         "*" .
1139         "*";
1140         $dia = $claim->diagIndexArray($prockey);
1141         $i = 0;
1142         foreach ($dia as $dindex) {
1143             if ($i) $out .= ':';
1144             $out .= $dindex;
1145             if (++$i >= 4) break;
1146         }
1147         # needed for epstd
1148         if($claim->epsdtFlag()) {
1149             $out .= "*" .
1150             "*" .
1151             "*" .
1152             "*Y" .
1153             "~\n";
1154         }
1155         else
1156         {
1157             $out .= "~\n";
1158         }
1159
1160         if (!$claim->cptCharges($prockey)) {
1161             $log .= "*** Procedure '" . $claim->cptKey($prockey) . "' has no charges!\n";
1162         }
1163
1164         if (empty($dia)) {
1165             $log .= "*** Procedure '" . $claim->cptKey($prockey) . "' is not justified!\n";
1166         }
1167
1168         // Segment SV5 (Durable Medical Equipment Service) omitted.
1169         // Segment PWK (Line Supplemental Information) omitted.
1170         // Segment PWK (Durable Medical Equipment Certificate of Medical Necessity Indicator) omitted.
1171         // Segment CR1 (Ambulance Transport Information) omitted.
1172         // Segment CR3 (Durable Medical Equipment Certification) omitted.
1173         // Segment CRC (Ambulance Certification) omitted.
1174         // Segment CRC (Hospice Employee Indicator) omitted.
1175         // Segment CRC (Condition Indicator / Durable Medical Equipment) omitted.
1176
1177         ++$edicount;
1178         $out .= "DTP" .     // Date of Service. Page 435.
1179         "*472" .
1180         "*D8" .
1181         "*" . $claim->serviceDate() .
1182         "~\n";
1183
1184         $testnote = rtrim($claim->cptNotecodes($prockey));
1185         if (!empty($testnote)) {
1186             ++$edicount;
1187             $out .= "NTE" .     // Explain Unusual Circumstances.
1188             "*ADD" .
1189             "*" . $claim->cptNotecodes($prockey) .
1190             "~\n";
1191         }
1192
1193         // Segment DTP*471 (Prescription Date) omitted.
1194         // Segment DTP*607 (Revision/Recertification Date) omitted.
1195         // Segment DTP*463 (Begin Therapy Date) omitted.
1196         // Segment DTP*461 (Last Certification Date) omitted.
1197         // Segment DTP*304 (Last Seen Date) omitted.
1198         // Segment DTP (Test Date) omitted.
1199         // Segment DTP*011 (Shipped Date) omitted.
1200         // Segment DTP*455 (Last X-Ray Date) omitted.
1201         // Segment DTP*454 (Initial Treatment Date) omitted.
1202         // Segment QTY (Ambulance Patient Count) omitted.
1203         // Segment QTY (Obstetric Anesthesia Additional Units) omitted.
1204         // Segment MEA (Test Result) omitted.
1205         // Segment CN1 (Contract Information) omitted.
1206         // Segment REF*9B (Repriced Line Item Reference Number) omitted.
1207         // Segment REF*9D (Adjusted Repriced Line Item Reference Number) omitted.
1208         // Segment REF*G1 (Prior Authorization) omitted.
1209         // Segment REF*6R (Line Item Control Number) omitted.
1210         //   (Really oughta have this for robust 835 posting!)
1211         // Segment REF*EW (Mammography Certification Number) omitted.
1212         // Segment REF*X4 (CLIA Number) omitted.
1213         // Segment REF*F4 (Referring CLIA Facility Identification) omitted.
1214         // Segment REF*BT (Immunization Batch Number) omitted.
1215         // Segment REF*9F (Referral Number) omitted.
1216         // Segment AMT*T (Sales Tax Amount) omitted.
1217         // Segment AMT*F4 (Postage Claimed Amount) omitted.
1218         // Segment K3 (File Information) omitted.
1219         // Segment NTE (Line Note) omitted.
1220         // Segment NTE (Third Party Organization Notes) omitted.
1221         // Segment PS1 (Purchased Service Information) omitted.
1222         // Segment HCP (Line Pricing/Repricing Information) omitted.
1223
1224         if (!$CMS_5010) {
1225             // This segment was deleted for 5010.
1226             //
1227             // AMT*AAE segment for Approved Amount from previous payer.
1228             // Medicare secondaries seem to require this.
1229             //
1230             for ($ins = $claim->payerCount() - 1; $ins > 0; --$ins) {
1231                 if ($claim->payerSequence($ins) > $claim->payerSequence())
1232                 continue; // payer is future, not previous
1233                 $payerpaid = $claim->payerTotals($ins, $claim->cptKey($prockey));
1234                 ++$edicount;
1235                 $out .= "AMT" . // Approved amount per previous payer. Page 485.
1236                 "*AAE" .
1237                 "*" . sprintf('%.2f', $claim->cptCharges($prockey) - $payerpaid[2]) .
1238                 "~\n";
1239                 break;
1240             }
1241         }
1242
1243         // Loop 2410, Drug Information. Medicaid insurers seem to want this
1244         // with HCPCS codes.
1245         //
1246         $ndc = $claim->cptNDCID($prockey);
1247         if ($ndc) {
1248             ++$edicount;
1249             $out .= "LIN" . // Drug Identification. Page 500+ (Addendum pg 71).
1250             "*" .         // Per addendum, LIN01 is not used.
1251             "*N4" .
1252             "*" . $ndc .
1253             "~\n";
1254
1255             if (!preg_match('/^\d\d\d\d\d-\d\d\d\d-\d\d$/', $ndc, $tmp) && !preg_match('/^\d{11}$/', $ndc)) {
1256                 $log .= "*** NDC code '$ndc' has invalid format!\n";
1257             }
1258
1259             ++$edicount;
1260             $tmpunits = $claim->cptNDCQuantity($prockey) * $claim->cptUnits($prockey);
1261             if (!$tmpunits) $tmpunits = 1;
1262             $out .= "CTP" . // Drug Pricing. Page 500+ (Addendum pg 74).
1263             "*" .
1264             "*" .
1265             "*" . ($CMS_5010 ? '' : sprintf('%.2f', $claim->cptCharges($prockey) / $tmpunits)) .
1266             "*" . $claim->cptNDCQuantity($prockey) .
1267             "*" . $claim->cptNDCUOM($prockey) .
1268             // Note: 5010 documents "ME" (Milligrams) as an additional unit of measure.
1269             "~\n";
1270         }
1271
1272         // Segment REF (Prescription or Compound Drug Association Number) omitted.
1273
1274         // Loop 2420A, Rendering Provider (service-specific).
1275         // Used if the rendering provider for this service line is different
1276         // from that in loop 2310B.
1277         //
1278         if ($claim->providerNPI() != $claim->providerNPI($prockey)) {
1279             ++$edicount;
1280             $out .= "NM1" .       // Loop 2310B Rendering Provider
1281             "*82" .
1282             "*1" .
1283             "*" . $claim->providerLastName($prockey) .
1284             "*" . $claim->providerFirstName($prockey) .
1285             "*" . $claim->providerMiddleName($prockey) .
1286             "*" .
1287             "*";
1288             if ($CMS_5010 || $claim->providerNPI($prockey)) { $out .=
1289                 "*XX" .
1290                 "*" . $claim->providerNPI($prockey);
1291             } else { $out .=
1292                 "*34" .                         // Not allowed for 5010
1293                 "*" . $claim->providerSSN($prockey);
1294             }
1295             if (!$claim->providerNPI($prockey)) {
1296                 $log .= "*** Rendering provider has no NPI.\n";
1297             }
1298             $out .= "~\n";
1299
1300             if ($claim->providerTaxonomy($prockey)) {
1301                 ++$edicount;
1302                 $out .= "PRV" .
1303                 "*PE" . // PErforming provider
1304                 "*" . ($CMS_5010 ? "PXC" : "ZZ") .
1305                 "*" . $claim->providerTaxonomy($prockey) .
1306                 "~\n";
1307             }
1308
1309             // Segment PRV*PE (Rendering Provider Specialty Information) omitted.
1310             // Segment REF (Rendering Provider Secondary Identification) omitted.
1311             // Segment NM1 (Purchased Service Provider Name) omitted.
1312             // Segment REF (Purchased Service Provider Secondary Identification) omitted.
1313             // Segment NM1,N3,N4 (Service Facility Location) omitted.
1314             // Segment REF (Service Facility Location Secondary Identification) omitted.
1315             // Segment NM1 (Supervising Provider Name) omitted.
1316             // Segment REF (Supervising Provider Secondary Identification) omitted.
1317             // Segment NM1,N3,N4 (Ordering Provider) omitted.
1318             // Segment REF (Ordering Provider Secondary Identification) omitted.
1319             // Segment PER (Ordering Provider Contact Information) omitted.
1320             // Segment NM1 (Referring Provider Name) omitted.
1321             // Segment REF (Referring Provider Secondary Identification) omitted.
1322             // Segments NM1*PW, N3, N4 (Ambulance Pick-Up Location) omitted.
1323             // Segments NM1*45, N3, N4 (Ambulance Drop-Off Location) omitted.
1324
1325             // REF*1C is required here for the Medicare provider number if NPI was
1326             // specified in NM109.  Not sure if other payers require anything here.
1327             if (!$CMS_5010 && $claim->providerNumber($prockey)) {
1328                 ++$edicount;
1329                 $out .= "REF" .
1330                 "*" . $claim->providerNumberType($prockey) .
1331                 // Note: 5010 documents that type 1D (Medicaid) is changed to G2.
1332                 "*" . $claim->providerNumber($prockey) .
1333                 "~\n";
1334             }
1335         }
1336
1337         // Loop 2430, adjudication by previous payers.
1338         //
1339         for ($ins = 1; $ins < $claim->payerCount(); ++$ins) {
1340             if ($claim->payerSequence($ins) > $claim->payerSequence())
1341             continue; // payer is future, not previous
1342
1343             $payerpaid = $claim->payerTotals($ins, $claim->cptKey($prockey));
1344             $aarr = $claim->payerAdjustments($ins, $claim->cptKey($prockey));
1345
1346             if ($payerpaid[1] == 0 && !count($aarr)) {
1347                 $log .= "*** Procedure '" . $claim->cptKey($prockey) .
1348                 "' has no payments or adjustments from previous payer!\n";
1349                 continue;
1350             }
1351
1352             ++$edicount;
1353             $out .= "SVD" . // Service line adjudication. Page 554.
1354             "*" . $claim->payerID($ins) .
1355             "*" . $payerpaid[1] .
1356             "*HC:" . $claim->cptKey($prockey) .
1357             "*" .
1358             "*" . $claim->cptUnits($prockey) .
1359             "~\n";
1360
1361             $tmpdate = $payerpaid[0];
1362             foreach ($aarr as $a) {
1363                 ++$edicount;
1364                 $out .= "CAS" . // Previous payer's line level adjustments. Page 558.
1365                 "*" . $a[1] .
1366                 "*" . $a[2] .
1367                 "*" . $a[3] .
1368                 "~\n";
1369                 if (!$tmpdate) $tmpdate = $a[0];
1370
1371                 // WTH is this??
1372                 /*************************************************************
1373               if ( isset($a[4]) &&
1374                   $a[4] != null ) {
1375                   $out .= "CAS02" . // Previous payer's adjustment reason
1376                     "*" . $a[4] .
1377                     "~\n";
1378               }
1379                 *************************************************************/
1380             }
1381
1382             if ($tmpdate) {
1383                 ++$edicount;
1384                 $out .= "DTP" . // Previous payer's line adjustment date. Page 493/566.
1385                 "*573" .
1386                 "*D8" .
1387                 "*$tmpdate" .
1388                 "~\n";
1389             }
1390
1391             // Segment AMT*EAF (Remaining Patient Liability) omitted.
1392             // Segment LQ (Form Identification Code) omitted.
1393             // Segment FRM (Supporting Documentation) omitted.
1394
1395         } // end loop 2430
1396     } // end this procedure
1397
1398     ++$edicount;
1399     $out .= "SE" .        // SE Trailer
1400     "*$edicount" .
1401     "*0021" .
1402     "~\n";
1403
1404     $out .= "GE" .        // GE Trailer
1405     "*1" .
1406     "*1" .
1407     "~\n";
1408
1409     $out .= "IEA" .       // IEA Trailer
1410     "*1" .
1411     "*000000001" .
1412     "~\n";
1413
1414   // Remove any trailing empty fields (delimiters) from each segment.
1415     $out = preg_replace('/\*+~/', '~', $out);
1416
1417     $log .= "\n";
1418     return $out;
1419 }
1420 ?>