library/classes/WSClaim.class.php

   1 <?php
   2
   3 require_once (dirname(__FILE__) . "/WSWrapper.class.php");
   4 include_once (dirname(__FILE__) . "/../sqlconf.php");
   5 include_once (dirname(__FILE__) . "/../sql.inc");
   6 include_once (dirname(__FILE__) . "/../../includes/config.php");
   7
   8 class WSClaim extends WSWrapper{
   9
  10         var $patient_id;
  11         var $foreign_provider_id;
  12         var $foreign_patient_id;
  13         var $payer_id;
  14         var $encounter;
  15         var $foreign_payer_id;
  16         var $claim;
  17         var $_db;
  18
  19         function WSClaim($patient_id, $encounter) {
  20                 if (!is_numeric($patient_id) && is_numeric($encounter)) return;
  21
  22                 parent::WSWrapper(null,false);
  23
  24                 $this->patient_id = $patient_id;
  25                 $this->encounter = $encounter;
  26                 $this->claim = null;
  27                 $this->_db = $GLOBALS['adodb']['db'];
  28                 if (!$this->_config['enabled']) return;
  29
  30                 if ($this->load_claim()) {
  31                         $function['ezybiz.add_invoice'] = array(new xmlrpcval($this->claim,"struct"));
  32                         $this->send($function);
  33                 }
  34
  35                 //print_r($this->claim);
  36
  37         }
  38
  39         function load_claim() {
  40                 if (!$this->load_patient_foreign_id() ||
  41                         !$this->load_payer_foreign_id() ||
  42                         !$this->load_provider_foreign_id() )
  43                         return false;
  44                 $invoice_info = array();
  45
  46     // Get encounter date and patient name.
  47     $sql = "SELECT e.date AS dosdate, " .
  48       "CONCAT(pd.fname,' ',pd.mname,' ',pd.lname) as patient_name " .
  49       "FROM form_encounter AS e, patient_data AS pd " .
  50       "WHERE " .
  51       "e.encounter = '" . $this->encounter . "' AND " .
  52       "e.pid = '" . $this->patient_id . "' AND " .
  53       "pd.pid = e.pid";
  54     $eres = $this->_db->Execute($sql);
  55     $dosdate = substr($eres->fields['dosdate'], 0, 10);
  56
  57                 // Create invoice notes for the new invoice that list the patient's
  58                 // insurance plans.  This is so that when payments are posted, the user
  59                 // can easily see if a secondary claim needs to be submitted.
  60                 //
  61                 $insnotes = "";
  62                 $insno = 0;
  63                 foreach (array("primary", "secondary", "tertiary") as $instype) {
  64                         ++$insno;
  65       $sql = "SELECT ic.name " .
  66         "FROM insurance_data AS id, insurance_companies AS ic WHERE " .
  67         "id.pid = " . $this->patient_id . " AND " .
  68         "id.type = '$instype' AND " .
  69         "id.date <= '$dosdate' AND " .
  70         "ic.id = id.provider " .
  71         "ORDER BY id.date DESC LIMIT 1";
  72                         $result = $this->_db->Execute($sql);
  73                         if ($result && !$result->EOF && $result->fields['name']) {
  74                                 if ($insnotes) $insnotes .= "\n";
  75                                 $insnotes .= "Ins$insno: " . $result->fields['name'];
  76                         }
  77                 }
  78                 $invoice_info['notes'] = $insnotes;
  79
  80     $sql = "SELECT * FROM billing WHERE " .
  81       "encounter = '" . $this->encounter . "' AND pid = '" . $this->patient_id .
  82       "' AND billed = 1 AND activity != 0 AND authorized = 1";
  83
  84                 $result = $this->_db->Execute($sql);
  85
  86                 $invoice_info['salesman'] = $this->foreign_provider_id;
  87                 $invoice_info['customerid'] = $this->foreign_patient_id;
  88                 $invoice_info['payer_id'] = $this->foreign_payer_id;
  89                 $invoice_info['invoicenumber'] = $this->patient_id . "." . $this->encounter;
  90
  91                 $counter = 0;
  92                 $total = 0;
  93                 $patient_info = array();
  94                 $payer_info = array();
  95
  96                 while ($result && !$result->EOF) {
  97
  98       // All bills should be in the accounting system, and mark-as-cleared
  99       // is the only reasonable way to process cash-only patients.
 100       //
 101       $process_date = ($result->fields['process_date'] == null) ?
 102         date("m-d-Y") :
 103         date("m-d-Y", strtotime($result->fields['process_date']));
 104
 105                         if ($counter == 0) {
 106                                 //unused but supported by ezybiz, helpful in debugging
 107                                 // actualy the dosdate can be used if you want that as the invoice date
 108                                 $invoice_info['customer'] = $eres->fields['patient_name'];
 109                                 $invoice_info['invoicedate'] = $process_date;
 110                                 $invoice_info['duedate'] = $process_date;
 111                                 $invoice_info['items'] = array();
 112         $invoice_info['dosdate'] = date("m-d-Y",strtotime($eres->fields['dosdate']));
 113                         }
 114
 115                         $tii = array();
 116                         //This is how we set the line items for the invoice, using codes from our encounter
 117                         //if ($result->fields['code_type'] == "CPT4" || $result->fields['code_type'] == "HCPCS") {
 118                         //if( $result->fields['code_type'] != "ICD9" ) {
 119                         if( $result->fields['code_type'] == "COPAY")
 120                         {
 121                                 $patient_info['payment_amount'] += sprintf("%01.2f",$result->fields['fee']);
 122                         }
 123                         else
 124                         {
 125                                 $payer_info['payment_amount'] += sprintf("%01.2f",$result->fields['fee']);
 126                         }
 127
 128       // New as of 2007-06-21: wherever we put a procedure code in the
 129       // invoice, append a colon and the modifier if there is one.  This way
 130       // we can better match up payments and adjustments with the billing data
 131       // in OpenEMR.
 132       $codekey = $result->fields['code'];
 133       if ($result->fields['modifier']) $codekey .= ':' . $result->fields['modifier'];
 134
 135       $tii['maincode'] = $codekey;
 136       $tii['itemtext'] = $result->fields['code_type'] .":" .
 137         $codekey . " " . $result->fields['code_text'] . " " .
 138         $result->fields['justify'];
 139
 140 //              $tii['qty'] = $result->fields['units'];
 141 //              if (!$tii['qty'] > 0) {
 142 //                      $tii['qty'] = 1;
 143 //              }
 144
 145       // We always store units as 1 in order to avoid awkward round-off errors
 146       // that might happen when dividing the fee by units.
 147       $tii['qty'] = 1;
 148
 149                         $tii['price'] = sprintf("%01.2f",$result->fields['fee']);
 150                         $total += $tii['price'];
 151                         $tii['glaccountid'] = $this->_config['income_acct'];
 152                         $invoice_info['items'][] = $tii;
 153
 154                         $result->MoveNext();
 155                         $counter++;
 156                 }
 157
 158     // I think maybe this info is not used.
 159     //
 160                 for($counter = 0; $counter < 2; $counter++)
 161                 {
 162                         $fee = 0;
 163                         $billto = 0;
 164                         if($counter == 0)
 165                         {
 166                                 $fee = $patient_info['payment_amount'];
 167                                 $billto = $this->foreign_patient_id;
 168                         }
 169                         else
 170                         {
 171                                 $fee = $payer_info['payment_amount'];
 172                                 $billto = $this->foreign_payer_id;
 173                         }
 174                         $invoice_info["invoiceid$counter"] = $this->patient_id . "000" . $this->encounter;
 175                         $invoice_info["amount$counter"] = $fee;
 176                         $invoice_info["invoicenumber$counter"] = $this->patient_id . "000" . $this->encounter;
 177                         $invoice_info["interest$counter"] = 0;
 178                         $invoice_info["billtoid$counter"] = $billto;
 179                 }
 180
 181                 $invoice_info['subtotal'] = sprintf("%01.2f",$total);
 182                 $invoice_info['total'] = sprintf("%01.2f",$total);
 183
 184                 $this->claim = $invoice_info;
 185                 return true;
 186         }
 187
 188         function load_provider_foreign_id() {
 189                 $sql = "SELECT foreign_id from integration_mapping as im LEFT JOIN billing as b on im.local_id=b.provider_id where encounter = '" . $this->encounter . "' and b.pid = '" . $this->patient_id . "' and im.local_table='users' and im.foreign_table='salesman'";
 190                 $result = $this->_db->Execute($sql);
 191                 if($result && !$result->EOF) {
 192                                 $this->foreign_provider_id = $result->fields['foreign_id'];
 193                                 return true;
 194                 }
 195                 else {
 196                         echo "Entry has not been previously sent to external system or no entry was found for them in the integration mapping, could not send claim. Provider: '" . $this->patient_id . "'<br>";
 197                         return false;
 198                 }
 199         }
 200
 201         function load_patient_foreign_id() {
 202                 $sql = "SELECT foreign_id from integration_mapping as im LEFT JOIN patient_data as pd on im.local_id=pd.id where pd.pid = '" . $this->patient_id . "' and im.local_table='patient_data' and im.foreign_table='customer'";
 203                 $result = $this->_db->Execute($sql);
 204                 if($result && !$result->EOF) {
 205                                 $this->foreign_patient_id = $result->fields['foreign_id'];
 206                                 return true;
 207                 }
 208                 else {
 209                         echo "Entry has not been previously sent to external system or no entry was found for them in the integration mapping, could not send claim. Patient: '" . $this->patient_id . "'<br>";
 210                         return false;
 211                 }
 212         }
 213
 214         function load_payer_foreign_id() {
 215                 $sql = "SELECT payer_id from billing where encounter = '" . $this->encounter . "' and pid = '" . $this->patient_id . "'";
 216                 $result = $this->_db->Execute($sql);
 217                 if($result && !$result->EOF) {
 218                                 $this->payer_id = $result->fields['payer_id'];
 219                 }
 220                 else {
 221                         echo "No payer id for this claim could be found";
 222                         return false;
 223                 }
 224                 // See comments in globals.php:
 225                 if ($GLOBALS['insurance_companies_are_not_customers']) {
 226                         $this->foreign_payer_id = $this->payer_id;
 227                 }
 228                 else {
 229                         $sql = "SELECT foreign_id from integration_mapping as im LEFT JOIN billing as b on im.local_id=b.payer_id where b.payer_id = '" . $this->payer_id . "' and im.local_table='insurance_companies' and im.foreign_table='customer'";
 230                         $result = $this->_db->Execute($sql);
 231                         if($result && !$result->EOF) {
 232                                 $this->foreign_payer_id = $result->fields['foreign_id'];
 233                         }
 234                         else {
 235                                 echo "Entry has not been previously sent to external system or no entry was found for them in the integration mapping, could not send claim. Insurance Company: '" . $this->payer_id . "'<br>";
 236                                 return false;
 237                         }
 238                 }
 239                 return true;
 240         }
 241 }
 242
 243 //$wsc = new WSClaim("3","20040622");
 244
 245 ?>