library/Claim.class.php

   1 <?php
   2 // Copyright (C) 2007-2008 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 $insurance_numbers; // row from insurance_numbers table for current payer
  32   var $patient_data;      // row from patient_data table
  33   var $billing_options;   // row from form_misc_billing_options table
  34   var $invoice;           // result from get_invoice_summary()
  35   var $payers;            // array of arrays, for all payers
  36   var $copay;             // total of copays from the billing table
  37
  38   function loadPayerInfo(&$billrow) {
  39     global $sl_err;
  40     $encounter_date = substr($this->encounter['date'], 0, 10);
  41
  42     // Create the $payers array.  This contains data for all insurances
  43     // with the current one always at index 0, and the others in payment
  44     // order starting at index 1.
  45     //
  46     $this->payers = array();
  47     $this->payers[0] = array();
  48     $query = "SELECT * FROM insurance_data WHERE " .
  49       "pid = '{$this->pid}' AND provider != '' AND " .
  50       "date <= '$encounter_date' " .
  51       "ORDER BY type ASC, date DESC";
  52     $dres = sqlStatement($query);
  53     $prevtype = '';
  54     while ($drow = sqlFetchArray($dres)) {
  55       if (strcmp($prevtype, $drow['type']) == 0) continue;
  56       $prevtype = $drow['type'];
  57       $ins = count($this->payers);
  58       if ($drow['provider'] == $billrow['payer_id'] && empty($this->payers[0]['data'])) $ins = 0;
  59       $crow = sqlQuery("SELECT * FROM insurance_companies WHERE " .
  60         "id = '" . $drow['provider'] . "'");
  61       $orow = new InsuranceCompany($drow['provider']);
  62       $this->payers[$ins] = array();
  63       $this->payers[$ins]['data']    = $drow;
  64       $this->payers[$ins]['company'] = $crow;
  65       $this->payers[$ins]['object']  = $orow;
  66     }
  67
  68     // This kludge hands most cases of a rare ambiguous situation, where
  69     // the primary insurance company is the same as the secondary.  It seems
  70     // nobody planned for that!
  71     //
  72     for ($i = 1; $i < count($this->payers); ++$i) {
  73       if ($billrow['process_date'] &&
  74         $this->payers[0]['data']['provider'] == $this->payers[$i]['data']['provider'])
  75       {
  76         $tmp = $this->payers[0];
  77         $this->payers[0] = $this->payers[$i];
  78         $this->payers[$i] = $tmp;
  79       }
  80     }
  81
  82     $this->using_modifiers = true;
  83
  84     // Get payment and adjustment details if there are any previous payers.
  85     //
  86     $this->invoice = array();
  87     if ($this->payerSequence() != 'P') {
  88       if ($GLOBALS['oer_config']['ws_accounting']['enabled'] === 2) {
  89         $this->invoice = ar_get_invoice_summary($this->pid, $this->encounter_id, true);
  90       }
  91       else if ($GLOBALS['oer_config']['ws_accounting']['enabled']) {
  92         SLConnect();
  93         $arres = SLQuery("select id from ar where invnumber = " .
  94           "'{$this->pid}.{$this->encounter_id}'");
  95         if ($sl_err) die($sl_err);
  96         $arrow = SLGetRow($arres, 0);
  97         if ($arrow) {
  98           $this->invoice = get_invoice_summary($arrow['id'], true);
  99         }
 100         SLClose();
 101       }
 102       // Secondary claims might not have modifiers in SQL-Ledger data.
 103       // In that case, note that we should not try to match on them.
 104       $this->using_modifiers = false;
 105       foreach ($this->invoice as $key => $trash) {
 106         if (strpos($key, ':')) $this->using_modifiers = true;
 107       }
 108     }
 109   }
 110
 111   // Constructor. Loads relevant database information.
 112   //
 113   function Claim($pid, $encounter_id) {
 114     $this->pid = $pid;
 115     $this->encounter_id = $encounter_id;
 116     $this->procs = array();
 117     $this->copay = 0;
 118
 119     // We need the encounter date before we can identify the payers.
 120     $sql = "SELECT * FROM form_encounter WHERE " .
 121       "pid = '{$this->pid}' AND " .
 122       "encounter = '{$this->encounter_id}'";
 123     $this->encounter = sqlQuery($sql);
 124
 125     // Sort by procedure timestamp in order to get some consistency.  In particular
 126     // we determine the provider from the first procedure in this array.
 127     $sql = "SELECT * FROM billing WHERE " .
 128       "encounter = '{$this->encounter_id}' AND pid = '{$this->pid}' AND " .
 129       "(code_type = 'CPT4' OR code_type = 'HCPCS' OR code_type = 'COPAY') AND " .
 130       "activity = '1' ORDER BY date, id";
 131     $res = sqlStatement($sql);
 132     while ($row = sqlFetchArray($res)) {
 133       if ($row['code_type'] == 'COPAY') {
 134         $this->copay -= $row['fee'];
 135         continue;
 136       }
 137       if (!$row['units']) $row['units'] = 1;
 138       // Load prior payer data at the first opportunity in order to get
 139       // the using_modifiers flag that is referenced below.
 140       if (empty($this->procs)) $this->loadPayerInfo($row);
 141       // Consolidate duplicate procedures.
 142       foreach ($this->procs as $key => $trash) {
 143         if (strcmp($this->procs[$key]['code'],$row['code']) == 0 &&
 144             (strcmp($this->procs[$key]['modifier'],$row['modifier']) == 0 ||
 145              !$this->using_modifiers))
 146         {
 147           $this->procs[$key]['units'] += $row['units'];
 148           $this->procs[$key]['fee']   += $row['fee'];
 149           continue 2; // skip to next table row
 150         }
 151       }
 152       $this->procs[] = $row;
 153     }
 154
 155     $sql = "SELECT * FROM x12_partners WHERE " .
 156       "id = '" . $this->procs[0]['x12_partner_id'] . "'";
 157     $this->x12_partner = sqlQuery($sql);
 158
 159     $sql = "SELECT * FROM facility WHERE " .
 160       "id = '" . addslashes($this->encounter['facility_id']) . "' " .
 161       "LIMIT 1";
 162     $this->facility = sqlQuery($sql);
 163
 164     $provider_id = $this->procs[0]['provider_id'];
 165     $sql = "SELECT * FROM users WHERE id = '$provider_id'";
 166     $this->provider = sqlQuery($sql);
 167
 168     $sql = "SELECT * FROM facility " .
 169       "ORDER BY billing_location DESC, id ASC LIMIT 1";
 170     $this->billing_facility = sqlQuery($sql);
 171
 172     $sql = "SELECT * FROM insurance_numbers WHERE " .
 173       "(insurance_company_id = '" . $this->procs[0]['payer_id'] .
 174       "' OR insurance_company_id is NULL) AND " .
 175       "provider_id = '" . $this->provider['id'] .
 176       "' order by insurance_company_id DESC LIMIT 1";
 177     $this->insurance_numbers = sqlQuery($sql);
 178
 179     $sql = "SELECT * FROM patient_data WHERE " .
 180       "pid = '{$this->pid}' " .
 181       "ORDER BY id LIMIT 1";
 182     $this->patient_data = sqlQuery($sql);
 183
 184     $sql = "SELECT fpa.* FROM forms JOIN form_misc_billing_options AS fpa " .
 185       "ON fpa.id = forms.form_id WHERE " .
 186       "forms.encounter = '{$this->encounter_id}' AND " .
 187       "forms.pid = '{$this->pid}' AND " .
 188       "forms.formdir = 'misc_billing_options' " .
 189       "ORDER BY forms.date";
 190     $this->billing_options = sqlQuery($sql);
 191
 192     $referrer_id = (empty($GLOBALS['MedicareReferrerIsRenderer']) ||
 193       $this->insurance_numbers['provider_number_type'] != '1C') ?
 194       $this->patient_data['providerID'] : $provider_id;
 195     $sql = "SELECT * FROM users WHERE id = '$referrer_id'";
 196     $this->referrer = sqlQuery($sql);
 197     if (!$this->referrer) $this->referrer = array();
 198
 199   } // end constructor
 200
 201   // Return an array of adjustments from the designated prior payer for the
 202   // designated procedure key (might be procedure:modifier), or for the claim
 203   // level.  For each adjustment give date, group code, reason code, amount.
 204   // Note this will include "patient responsibility" adjustments which are
 205   // not adjustments to OUR invoice, but they reduce the amount that the
 206   // insurance company pays.
 207   //
 208   function payerAdjustments($ins, $code='Claim') {
 209     $aadj = array();
 210
 211     // If we have no modifiers stored in SQL-Ledger for this claim,
 212     // then we cannot use a modifier passed in with the key.
 213     $tmp = strpos($code, ':');
 214     if ($tmp && !$this->using_modifiers) $code = substr($code, 0, $tmp);
 215
 216     // For payments, source always starts with "Ins" or "Pt".
 217     // Nonzero adjustment reason examples:
 218     //   Ins1 adjust code 42 (Charges exceed ... (obsolete))
 219     //   Ins1 adjust code 45 (Charges exceed your contracted/ legislated fee arrangement)
 220     //   Ins1 adjust code 97 (Payment is included in the allowance for another service/procedure)
 221     //   Ins1 adjust code A2 (Contractual adjustment)
 222     //   Ins adjust Ins1
 223     //   adjust code 45
 224     // Zero adjustment reason examples:
 225     //   Co-pay: 25.00
 226     //   Coinsurance: 11.46  (code 2)   Note: fix remits to identify insurance
 227     //   To deductible: 0.22 (code 1)   Note: fix remits to identify insurance
 228     //   To copay Ins1 (manual entry)
 229     //   To ded'ble Ins1 (manual entry)
 230
 231     if (!empty($this->invoice[$code])) {
 232       $date = '';
 233       $deductible  = 0;
 234       $coinsurance = 0;
 235       $inslabel = ($this->payerSequence($ins) == 'S') ? 'Ins2' : 'Ins1';
 236       $insnumber = substr($inslabel, 3);
 237
 238       // Compute this procedure's patient responsibility amount as of this
 239       // prior payer, which is the original charge minus all insurance
 240       // payments and "hard" adjustments up to this payer.
 241       $ptresp = $this->invoice[$code]['chg'] + $this->invoice[$code]['adj'];
 242       foreach ($this->invoice[$code]['dtl'] as $key => $value) {
 243         if (preg_match("/^Ins(\d)/i", $value['src'], $tmp)) {
 244           if ($tmp[1] <= $insnumber) $ptresp -= $value['pmt'];
 245         }
 246         else if (trim(substr($key, 0, 10))) { // not an adjustment if no date
 247           if (!preg_match("/Ins(\d)/i", $value['rsn'], $tmp) || $tmp[1] <= $insnumber)
 248             $ptresp += $value['chg']; // adjustments are negative charges
 249         }
 250       }
 251       if ($ptresp < 0) $ptresp = 0; // we may be insane but try to hide it
 252
 253       // Main loop, to extract adjustments for this payer and procedure.
 254       foreach ($this->invoice[$code]['dtl'] as $key => $value) {
 255         $tmp = str_replace('-', '', trim(substr($key, 0, 10)));
 256         if ($tmp) $date = $tmp;
 257         if ($tmp && $value['pmt'] == 0) { // not original charge and not a payment
 258           $rsn = $value['rsn'];
 259           $chg = 0 - $value['chg']; // adjustments are negative charges
 260
 261           $gcode = 'CO'; // default group code = contractual obligation
 262           $rcode = '45'; // default reason code = max fee exceeded (code 42 is obsolete)
 263
 264           if (preg_match("/Ins adjust $inslabel/i", $rsn, $tmp)) {
 265             // From manual post. Take the defaults.
 266           }
 267           else if (preg_match("/To copay $inslabel/i", $rsn, $tmp) && !$chg) {
 268             $coinsurance = $ptresp; // from manual post
 269             continue;
 270           }
 271           else if (preg_match("/To ded'ble $inslabel/i", $rsn, $tmp) && !$chg) {
 272             $deductible = $ptresp; // from manual post
 273             continue;
 274           }
 275           else if (preg_match("/$inslabel copay: (\S+)/i", $rsn, $tmp) && !$chg) {
 276             $coinsurance = $tmp[1]; // from 835 as of 6/2007
 277             continue;
 278           }
 279           else if (preg_match("/$inslabel coins: (\S+)/i", $rsn, $tmp) && !$chg) {
 280             $coinsurance = $tmp[1]; // from 835 and manual post as of 6/2007
 281             continue;
 282           }
 283           else if (preg_match("/$inslabel dedbl: (\S+)/i", $rsn, $tmp) && !$chg) {
 284             $deductible = $tmp[1]; // from 835 and manual post as of 6/2007
 285             continue;
 286           }
 287           else if (preg_match("/$inslabel ptresp: (\S+)/i", $rsn, $tmp) && !$chg) {
 288             continue; // from 835 as of 6/2007
 289           }
 290           else if (preg_match("/$inslabel adjust code (\S+)/i", $rsn, $tmp)) {
 291             $rcode = $tmp[1]; // from 835
 292           }
 293           else if (preg_match("/$inslabel/i", $rsn, $tmp)) {
 294             // Take the defaults.
 295           }
 296           else if (preg_match('/Ins(\d)/i', $rsn, $tmp) && $tmp[1] != $insnumber) {
 297             continue; // it's for some other payer
 298           }
 299           else if ($insnumber == '1') {
 300             if (preg_match("/\$\s*adjust code (\S+)/i", $rsn, $tmp)) {
 301               $rcode = $tmp[1]; // from 835
 302             }
 303             else if ($chg) {
 304               // Other adjustments default to Ins1.
 305             }
 306             else if (preg_match("/Co-pay: (\S+)/i", $rsn, $tmp) ||
 307               preg_match("/Coinsurance: (\S+)/i", $rsn, $tmp)) {
 308               $coinsurance = 0 + $tmp[1]; // from 835 before 6/2007
 309               continue;
 310             }
 311             else if (preg_match("/To deductible: (\S+)/i", $rsn, $tmp)) {
 312               $deductible = 0 + $tmp[1]; // from 835 before 6/2007
 313               continue;
 314             }
 315             else {
 316               continue; // there is no adjustment amount
 317             }
 318           }
 319           else {
 320             continue; // it's for primary and that's not us
 321           }
 322
 323           if ($rcode == '42') $rcode= '45'; // reason 42 is obsolete
 324           $aadj[] = array($date, $gcode, $rcode, sprintf('%.2f', $chg));
 325
 326         } // end if
 327       } // end foreach
 328
 329       // If we really messed it up, at least avoid negative numbers.
 330       if ($coinsurance > $ptresp) $coinsurance = $ptresp;
 331       if ($deductible  > $ptresp) $deductible  = $ptresp;
 332
 333       // Find out if this payer paid anything at all on this claim.  This will
 334       // help us allocate any unknown patient responsibility amounts.
 335       $thispaidanything = 0;
 336       foreach($this->invoice as $codekey => $codeval) {
 337         foreach ($codeval['dtl'] as $key => $value) {
 338           if (preg_match("/$inslabel/i", $value['src'], $tmp)) {
 339             $thispaidanything += $value['pmt'];
 340           }
 341         }
 342       }
 343
 344       // Allocate any unknown patient responsibility by guessing if the
 345       // deductible has been satisfied.
 346       if ($thispaidanything)
 347         $coinsurance = $ptresp - $deductible;
 348       else
 349         $deductible = $ptresp - $coinsurance;
 350
 351       if ($date && $deductible != 0)
 352         $aadj[] = array($date, 'PR', '1', sprintf('%.2f', $deductible));
 353       if ($date && $coinsurance != 0)
 354         $aadj[] = array($date, 'PR', '2', sprintf('%.2f', $coinsurance));
 355
 356     } // end if
 357
 358     return $aadj;
 359   }
 360
 361   // Return date, total payments and total "hard" adjustments from the given
 362   // prior payer. If $code is specified then only that procedure key is
 363   // selected, otherwise it's for the whole claim.
 364   //
 365   function payerTotals($ins, $code='') {
 366     // If we have no modifiers stored in SQL-Ledger for this claim,
 367     // then we cannot use a modifier passed in with the key.
 368     $tmp = strpos($code, ':');
 369     if ($tmp && !$this->using_modifiers) $code = substr($code, 0, $tmp);
 370
 371     $inslabel = ($this->payerSequence($ins) == 'S') ? 'Ins2' : 'Ins1';
 372     $paytotal = 0;
 373     $adjtotal = 0;
 374     $date = '';
 375     foreach($this->invoice as $codekey => $codeval) {
 376       if ($code && strcmp($codekey,$code) != 0) continue;
 377       foreach ($codeval['dtl'] as $key => $value) {
 378         if (preg_match("/$inslabel/i", $value['src'], $tmp)) {
 379           if (!$date) $date = str_replace('-', '', trim(substr($key, 0, 10)));
 380           $paytotal += $value['pmt'];
 381         }
 382       }
 383       $aarr = $this->payerAdjustments($ins, $codekey);
 384       foreach ($aarr as $a) {
 385         if (strcmp($a[1],'PR') != 0) $adjtotal += $a[3];
 386         if (!$date) $date = $a[0];
 387       }
 388     }
 389     return array($date, sprintf('%.2f', $paytotal), sprintf('%.2f', $adjtotal));
 390   }
 391
 392   // Return the amount already paid by the patient.
 393   //
 394   function patientPaidAmount() {
 395     // For primary claims $this->invoice is not loaded, so get the co-pay
 396     // from the billing table instead.
 397     if (empty($this->invoice)) return $this->copay;
 398     //
 399     $amount = 0;
 400     foreach($this->invoice as $codekey => $codeval) {
 401       foreach ($codeval['dtl'] as $key => $value) {
 402         if (!preg_match("/Ins/i", $value['src'], $tmp)) {
 403           $amount += $value['pmt'];
 404         }
 405       }
 406     }
 407     return sprintf('%.2f', $amount);
 408   }
 409
 410   // Return invoice total, including adjustments but not payments.
 411   //
 412   function invoiceTotal() {
 413     $amount = 0;
 414     foreach($this->invoice as $codekey => $codeval) {
 415       $amount += $codeval['chg'];
 416     }
 417     return sprintf('%.2f', $amount);
 418   }
 419
 420   // Number of procedures in this claim.
 421   function procCount() {
 422     return count($this->procs);
 423   }
 424
 425   // Number of payers for this claim. Ranges from 1 to 3.
 426   function payerCount() {
 427     return count($this->payers);
 428   }
 429
 430   function x12gsversionstring() {
 431     return x12clean(trim($this->x12_partner['x12_version']));
 432   }
 433
 434   function x12gssenderid() {
 435     $tmp = $this->x12_partner['x12_sender_id'];
 436     while (strlen($tmp) < 15) $tmp .= " ";
 437     return $tmp;
 438   }
 439
 440   function x12gsreceiverid() {
 441     $tmp = $this->x12_partner['x12_receiver_id'];
 442     while (strlen($tmp) < 15) $tmp .= " ";
 443     return $tmp;
 444   }
 445
 446   function cliaCode() {
 447     return x12clean(trim($this->facility['domain_identifier']));
 448   }
 449
 450   function billingFacilityName() {
 451     return x12clean(trim($this->billing_facility['name']));
 452   }
 453
 454   function billingFacilityStreet() {
 455     return x12clean(trim($this->billing_facility['street']));
 456   }
 457
 458   function billingFacilityCity() {
 459     return x12clean(trim($this->billing_facility['city']));
 460   }
 461
 462   function billingFacilityState() {
 463     return x12clean(trim($this->billing_facility['state']));
 464   }
 465
 466   function billingFacilityZip() {
 467     return x12clean(trim($this->billing_facility['postal_code']));
 468   }
 469
 470   function billingFacilityETIN() {
 471     return x12clean(trim(str_replace('-', '', $this->billing_facility['federal_ein'])));
 472   }
 473
 474   function billingFacilityNPI() {
 475     return x12clean(trim($this->billing_facility['facility_npi']));
 476   }
 477
 478   # The billing facility and the patient must both accept for this to return true.
 479   function billingFacilityAssignment($ins=0) {
 480     $tmp = strtoupper($this->payers[$ins]['data']['accept_assignment']);
 481     if (strcmp($tmp,'FALSE') == 0) return '0';
 482     return !empty($this->billing_facility['accepts_assignment']);
 483   }
 484
 485   function billingContactName() {
 486     return x12clean(trim($this->billing_facility['attn']));
 487   }
 488
 489   function billingContactPhone() {
 490     if (preg_match("/([2-9]\d\d)\D*(\d\d\d)\D*(\d\d\d\d)/",
 491       $this->billing_facility['phone'], $tmp))
 492     {
 493       return $tmp[1] . $tmp[2] . $tmp[3];
 494     }
 495     return '';
 496   }
 497
 498   function facilityName() {
 499     return x12clean(trim($this->facility['name']));
 500   }
 501
 502   function facilityStreet() {
 503     return x12clean(trim($this->facility['street']));
 504   }
 505
 506   function facilityCity() {
 507     return x12clean(trim($this->facility['city']));
 508   }
 509
 510   function facilityState() {
 511     return x12clean(trim($this->facility['state']));
 512   }
 513
 514   function facilityZip() {
 515     return x12clean(trim($this->facility['postal_code']));
 516   }
 517
 518   function facilityETIN() {
 519     return x12clean(trim(str_replace('-', '', $this->facility['federal_ein'])));
 520   }
 521
 522   function facilityNPI() {
 523     return x12clean(trim($this->facility['facility_npi']));
 524   }
 525
 526   function facilityPOS() {
 527     return x12clean(trim($this->facility['pos_code']));
 528   }
 529
 530   function clearingHouseName() {
 531     return x12clean(trim($this->x12_partner['name']));
 532   }
 533
 534   function clearingHouseETIN() {
 535     return x12clean(trim(str_replace('-', '', $this->x12_partner['id_number'])));
 536   }
 537
 538   function providerNumberType() {
 539     return $this->insurance_numbers['provider_number_type'];
 540   }
 541
 542   function providerNumber() {
 543     return x12clean(trim(str_replace('-', '', $this->insurance_numbers['provider_number'])));
 544   }
 545
 546   function providerGroupNumber() {
 547     return x12clean(trim(str_replace('-', '', $this->insurance_numbers['group_number'])));
 548   }
 549
 550   // Returns 'P', 'S' or 'T'.
 551   //
 552   function payerSequence($ins=0) {
 553     return strtoupper(substr($this->payers[$ins]['data']['type'], 0, 1));
 554   }
 555
 556   // Returns the HIPAA code of the patient-to-subscriber relationship.
 557   //
 558   function insuredRelationship($ins=0) {
 559     $tmp = strtolower($this->payers[$ins]['data']['subscriber_relationship']);
 560     if (strcmp($tmp,'self'  ) == 0) return '18';
 561     if (strcmp($tmp,'spouse') == 0) return '01';
 562     if (strcmp($tmp,'child' ) == 0) return '19';
 563     if (strcmp($tmp,'other' ) == 0) return 'G8';
 564     return $tmp; // should not happen
 565   }
 566
 567   function insuredTypeCode($ins=0) {
 568     if (strcmp($this->claimType($ins),'MB') == 0 && $this->payerSequence($ins) != 'P')
 569       return '12'; // medicare secondary working aged beneficiary or
 570                    // spouse with employer group health plan
 571     return '';
 572   }
 573
 574   // Is the patient also the subscriber?
 575   //
 576   function isSelfOfInsured($ins=0) {
 577     $tmp = strtolower($this->payers[$ins]['data']['subscriber_relationship']);
 578     return (strcmp($tmp,'self') == 0);
 579   }
 580
 581   function planName($ins=0) {
 582     return x12clean(trim($this->payers[$ins]['data']['plan_name']));
 583   }
 584
 585   function policyNumber($ins=0) { // "ID"
 586     return x12clean(trim($this->payers[$ins]['data']['policy_number']));
 587   }
 588
 589   function groupNumber($ins=0) {
 590     return x12clean(trim($this->payers[$ins]['data']['group_number']));
 591   }
 592
 593   function groupName($ins=0) {
 594     return x12clean(trim($this->payers[$ins]['data']['subscriber_employer']));
 595   }
 596
 597   // Claim types are:
 598   // 16 Other HCFA
 599   // MB Medicare Part B
 600   // MC Medicaid
 601   // CH ChampUSVA
 602   // CH ChampUS
 603   // BL Blue Cross Blue Shield
 604   // 16 FECA
 605   // 09 Self Pay
 606   // 10 Central Certification
 607   // 11 Other Non-Federal Programs
 608   // 12 Preferred Provider Organization (PPO)
 609   // 13 Point of Service (POS)
 610   // 14 Exclusive Provider Organization (EPO)
 611   // 15 Indemnity Insurance
 612   // 16 Health Maintenance Organization (HMO) Medicare Risk
 613   // AM Automobile Medical
 614   // CI Commercial Insurance Co.
 615   // DS Disability
 616   // HM Health Maintenance Organization
 617   // LI Liability
 618   // LM Liability Medical
 619   // OF Other Federal Program
 620   // TV Title V
 621   // VA Veterans Administration Plan
 622   // WC Workers Compensation Health Plan
 623   // ZZ Mutually Defined
 624   //
 625   function claimType($ins=0) {
 626     if (empty($this->payers[$ins]['object'])) return '';
 627     return $this->payers[$ins]['object']->get_freeb_claim_type();
 628   }
 629
 630   function insuredLastName($ins=0) {
 631     return x12clean(trim($this->payers[$ins]['data']['subscriber_lname']));
 632   }
 633
 634   function insuredFirstName($ins=0) {
 635     return x12clean(trim($this->payers[$ins]['data']['subscriber_fname']));
 636   }
 637
 638   function insuredMiddleName($ins=0) {
 639     return x12clean(trim($this->payers[$ins]['data']['subscriber_mname']));
 640   }
 641
 642   function insuredStreet($ins=0) {
 643     return x12clean(trim($this->payers[$ins]['data']['subscriber_street']));
 644   }
 645
 646   function insuredCity($ins=0) {
 647     return x12clean(trim($this->payers[$ins]['data']['subscriber_city']));
 648   }
 649
 650   function insuredState($ins=0) {
 651     return x12clean(trim($this->payers[$ins]['data']['subscriber_state']));
 652   }
 653
 654   function insuredZip($ins=0) {
 655     return x12clean(trim($this->payers[$ins]['data']['subscriber_postal_code']));
 656   }
 657
 658   function insuredPhone($ins=0) {
 659     if (preg_match("/([2-9]\d\d)\D*(\d\d\d)\D*(\d\d\d\d)/",
 660       $this->payers[$ins]['data']['subscriber_phone'], $tmp))
 661       return $tmp[1] . $tmp[2] . $tmp[3];
 662     return '';
 663   }
 664
 665   function insuredDOB($ins=0) {
 666     return str_replace('-', '', $this->payers[$ins]['data']['subscriber_DOB']);
 667   }
 668
 669   function insuredSex($ins=0) {
 670     return strtoupper(substr($this->payers[$ins]['data']['subscriber_sex'], 0, 1));
 671   }
 672
 673   function payerName($ins=0) {
 674     return x12clean(trim($this->payers[$ins]['company']['name']));
 675   }
 676
 677   function payerAttn($ins=0) {
 678     return x12clean(trim($this->payers[$ins]['company']['attn']));
 679   }
 680
 681   function payerStreet($ins=0) {
 682     if (empty($this->payers[$ins]['object'])) return '';
 683     $tmp = $this->payers[$ins]['object'];
 684     $tmp = $tmp->get_address();
 685     return x12clean(trim($tmp->get_line1()));
 686   }
 687
 688   function payerCity($ins=0) {
 689     if (empty($this->payers[$ins]['object'])) return '';
 690     $tmp = $this->payers[$ins]['object'];
 691     $tmp = $tmp->get_address();
 692     return x12clean(trim($tmp->get_city()));
 693   }
 694
 695   function payerState($ins=0) {
 696     if (empty($this->payers[$ins]['object'])) return '';
 697     $tmp = $this->payers[$ins]['object'];
 698     $tmp = $tmp->get_address();
 699     return x12clean(trim($tmp->get_state()));
 700   }
 701
 702   function payerZip($ins=0) {
 703     if (empty($this->payers[$ins]['object'])) return '';
 704     $tmp = $this->payers[$ins]['object'];
 705     $tmp = $tmp->get_address();
 706     return x12clean(trim($tmp->get_zip()));
 707   }
 708
 709   function payerID($ins=0) {
 710     return x12clean(trim($this->payers[$ins]['company']['cms_id']));
 711   }
 712
 713   function patientLastName() {
 714     return x12clean(trim($this->patient_data['lname']));
 715   }
 716
 717   function patientFirstName() {
 718     return x12clean(trim($this->patient_data['fname']));
 719   }
 720
 721   function patientMiddleName() {
 722     return x12clean(trim($this->patient_data['mname']));
 723   }
 724
 725   function patientStreet() {
 726     return x12clean(trim($this->patient_data['street']));
 727   }
 728
 729   function patientCity() {
 730     return x12clean(trim($this->patient_data['city']));
 731   }
 732
 733   function patientState() {
 734     return x12clean(trim($this->patient_data['state']));
 735   }
 736
 737   function patientZip() {
 738     return x12clean(trim($this->patient_data['postal_code']));
 739   }
 740
 741   function patientPhone() {
 742     $ptphone = $this->patient_data['phone_home'];
 743     if (!$ptphone) $ptphone = $this->patient_data['phone_biz'];
 744     if (!$ptphone) $ptphone = $this->patient_data['phone_cell'];
 745     if (preg_match("/([2-9]\d\d)\D*(\d\d\d)\D*(\d\d\d\d)/", $ptphone, $tmp))
 746       return $tmp[1] . $tmp[2] . $tmp[3];
 747     return '';
 748   }
 749
 750   function patientDOB() {
 751     return str_replace('-', '', $this->patient_data['DOB']);
 752   }
 753
 754   function patientSex() {
 755     return strtoupper(substr($this->patient_data['sex'], 0, 1));
 756   }
 757
 758   // Patient Marital Status: M = Married, S = Single, or something else.
 759   function patientStatus() {
 760     return strtoupper(substr($this->patient_data['status'], 0, 1));
 761   }
 762
 763   // This should be UNEMPLOYED, STUDENT, PT STUDENT, or anything else to
 764   // indicate employed.
 765   function patientOccupation() {
 766     return strtoupper(x12clean(trim($this->patient_data['occupation'])));
 767   }
 768
 769   function cptCode($prockey) {
 770     return x12clean(trim($this->procs[$prockey]['code']));
 771   }
 772
 773   function cptModifier($prockey) {
 774     return x12clean(trim($this->procs[$prockey]['modifier']));
 775   }
 776
 777   // Returns the procedure code, followed by ":modifier" if there is one.
 778   function cptKey($prockey) {
 779     $tmp = $this->cptModifier($prockey);
 780     return $this->cptCode($prockey) . ($tmp ? ":$tmp" : "");
 781   }
 782
 783   function cptCharges($prockey) {
 784     return x12clean(trim($this->procs[$prockey]['fee']));
 785   }
 786
 787   function cptUnits($prockey) {
 788     if (empty($this->procs[$prockey]['units'])) return '1';
 789     return x12clean(trim($this->procs[$prockey]['units']));
 790   }
 791
 792   // NDC drug ID.
 793   function cptNDCID($prockey) {
 794     $ndcinfo = $this->procs[$prockey]['ndc_info'];
 795     if (preg_match('/^N4(\S+)\s+(\S\S)(.*)/', $ndcinfo, $tmp)) {
 796       $ndc = $tmp[1];
 797       if (preg_match('/^(\d+)-(\d+)-(\d+)$/', $ndc, $tmp)) {
 798         return sprintf('%05d-%04d-%02d', $tmp[1], $tmp[2], $tmp[3]);
 799       }
 800       return x12clean($ndc); // format is bad but return it anyway
 801     }
 802     return '';
 803   }
 804
 805   // NDC drug unit of measure code.
 806   function cptNDCUOM($prockey) {
 807     $ndcinfo = $this->procs[$prockey]['ndc_info'];
 808     if (preg_match('/^N4(\S+)\s+(\S\S)(.*)/', $ndcinfo, $tmp))
 809       return x12clean($tmp[2]);
 810     return '';
 811   }
 812
 813   // NDC drug number of units.
 814   function cptNDCQuantity($prockey) {
 815     $ndcinfo = $this->procs[$prockey]['ndc_info'];
 816     if (preg_match('/^N4(\S+)\s+(\S\S)(.*)/', $ndcinfo, $tmp)) {
 817       return x12clean(ltrim($tmp[3], '0'));
 818     }
 819     return '';
 820   }
 821
 822   function onsetDate() {
 823     return str_replace('-', '', substr($this->encounter['onset_date'], 0, 10));
 824   }
 825
 826   function serviceDate() {
 827     return str_replace('-', '', substr($this->encounter['date'], 0, 10));
 828   }
 829
 830   function priorAuth() {
 831     return x12clean(trim($this->billing_options['prior_auth_number']));
 832   }
 833
 834   function isRelatedEmployment() {
 835     return !empty($this->billing_options['employment_related']);
 836   }
 837
 838   function isRelatedAuto() {
 839     return !empty($this->billing_options['auto_accident']);
 840   }
 841
 842   function isRelatedOther() {
 843     return !empty($this->billing_options['other_accident']);
 844   }
 845
 846   function autoAccidentState() {
 847     return x12clean(trim($this->billing_options['accident_state']));
 848   }
 849
 850   function isUnableToWork() {
 851     return !empty($this->billing_options['is_unable_to_work']);
 852   }
 853
 854   function offWorkFrom() {
 855     return str_replace('-', '', substr($this->billing_options['off_work_from'], 0, 10));
 856   }
 857
 858   function offWorkTo() {
 859     return str_replace('-', '', substr($this->billing_options['off_work_to'], 0, 10));
 860   }
 861
 862   function isHospitalized() {
 863     return !empty($this->billing_options['is_hospitalized']);
 864   }
 865
 866   function hospitalizedFrom() {
 867     return str_replace('-', '', substr($this->billing_options['hospitalization_date_from'], 0, 10));
 868   }
 869
 870   function hospitalizedTo() {
 871     return str_replace('-', '', substr($this->billing_options['hospitalization_date_to'], 0, 10));
 872   }
 873
 874   function isOutsideLab() {
 875     return !empty($this->billing_options['outside_lab']);
 876   }
 877
 878   function outsideLabAmount() {
 879     return sprintf('%.2f', 0 + $this->billing_options['lab_amount']);
 880   }
 881
 882   function medicaidResubmissionCode() {
 883     return x12clean(trim($this->billing_options['medicaid_resubmission_code']));
 884   }
 885
 886   function medicaidOriginalReference() {
 887     return x12clean(trim($this->billing_options['medicaid_original_reference']));
 888   }
 889
 890   function frequencyTypeCode() {
 891     return empty($this->billing_options['replacement_claim']) ? '1' : '7';
 892   }
 893
 894   function additionalNotes() {
 895     return x12clean(trim($this->billing_options['comments']));
 896   }
 897
 898   // Returns an array of unique diagnoses.  Periods are stripped.
 899   function diagArray() {
 900     $da = array();
 901     foreach ($this->procs as $row) {
 902       $atmp = explode(':', $row['justify']);
 903       foreach ($atmp as $tmp) {
 904         if (!empty($tmp)) {
 905           $diag = str_replace('.', '', $tmp);
 906           $da[$diag] = $diag;
 907         }
 908       }
 909     }
 910     return $da;
 911   }
 912
 913   // Compute one 1-relative index in diagArray for the given procedure.
 914   // This function is obsolete, use diagIndexArray() instead.
 915   function diagIndex($prockey) {
 916     $da = $this->diagArray();
 917     $tmp = explode(':', $this->procs[$prockey]['justify']);
 918     if (empty($tmp)) return '';
 919     $diag = str_replace('.', '', $tmp[0]);
 920     $i = 0;
 921     foreach ($da as $value) {
 922       ++$i;
 923       if (strcmp($value,$diag) == 0) return $i;
 924     }
 925     return '';
 926   }
 927
 928   // Compute array of 1-relative diagArray indices for the given procedure.
 929   function diagIndexArray($prockey) {
 930     $dia = array();
 931     $da = $this->diagArray();
 932     $atmp = explode(':', $this->procs[$prockey]['justify']);
 933     foreach ($atmp as $tmp) {
 934       if (!empty($tmp)) {
 935         $diag = str_replace('.', '', $tmp);
 936         $i = 0;
 937         foreach ($da as $value) {
 938           ++$i;
 939           if (strcmp($value,$diag) == 0) $dia[] = $i;
 940         }
 941       }
 942     }
 943     return $dia;
 944   }
 945
 946   function providerLastName() {
 947     return x12clean(trim($this->provider['lname']));
 948   }
 949
 950   function providerFirstName() {
 951     return x12clean(trim($this->provider['fname']));
 952   }
 953
 954   function providerMiddleName() {
 955     return x12clean(trim($this->provider['mname']));
 956   }
 957
 958   function providerNPI() {
 959     return x12clean(trim($this->provider['npi']));
 960   }
 961
 962   function providerUPIN() {
 963     return x12clean(trim($this->provider['upin']));
 964   }
 965
 966   function providerSSN() {
 967     return x12clean(trim(str_replace('-', '', $this->provider['federaltaxid'])));
 968   }
 969
 970   function providerTaxonomy() {
 971     if (empty($this->provider['taxonomy'])) return '207Q00000X';
 972     return x12clean(trim($this->provider['taxonomy']));
 973   }
 974
 975   function referrerLastName() {
 976     return x12clean(trim($this->referrer['lname']));
 977   }
 978
 979   function referrerFirstName() {
 980     return x12clean(trim($this->referrer['fname']));
 981   }
 982
 983   function referrerMiddleName() {
 984     return x12clean(trim($this->referrer['mname']));
 985   }
 986
 987   function referrerNPI() {
 988     return x12clean(trim($this->referrer['npi']));
 989   }
 990
 991   function referrerUPIN() {
 992     return x12clean(trim($this->referrer['upin']));
 993   }
 994
 995   function referrerSSN() {
 996     return x12clean(trim(str_replace('-', '', $this->referrer['federaltaxid'])));
 997   }
 998
 999   function referrerTaxonomy() {
1000     if (empty($this->referrer['taxonomy'])) return '207Q00000X';
1001     return x12clean(trim($this->referrer['taxonomy']));
1002   }
1003 }
1004 ?>