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                 // Create invoice notes for the new invoice that list the patient's
  47                 // insurance plans.  This is so that when payments are posted, the user
  48                 // can easily see if a secondary claim needs to be submitted.
  49                 //
  50                 $insnotes = "";
  51                 $insno = 0;
  52                 foreach (array("primary", "secondary", "tertiary") as $instype) {
  53                         ++$insno;
  54                         $sql = "SELECT insurance_companies.name " .
  55                                 "FROM insurance_data, insurance_companies WHERE " .
  56                                 "insurance_data.pid = " . $this->patient_id . " AND " .
  57                                 "insurance_data.type = '$instype' AND " .
  58                                 "insurance_companies.id = insurance_data.provider " .
  59                                 "LIMIT 1";
  60                         $result = $this->_db->Execute($sql);
  61                         if ($result && !$result->EOF && $result->fields['name']) {
  62                                 if ($insnotes) $insnotes .= "\n";
  63                                 $insnotes .= "Ins$insno: " . $result->fields['name'];
  64                         }
  65                 }
  66                 $invoice_info['notes'] = $insnotes;
  67
  68     /****
  69                 $sql = "SELECT b.*, CONCAT(pd.fname,' ',pd.mname,' ',pd.lname) as patient_name " .
  70                         "FROM billing as b LEFT JOIN patient_data as pd on b.pid=pd.pid where " .
  71                         "b.encounter = '" . $this->encounter ."' AND b.pid = '" . $this->patient_id .
  72                         "' AND b.billed = 1 AND b.activity != '0' AND authorized = '1'";
  73     ****/
  74
  75     $sql = "SELECT b.*, e.date AS dosdate, " .
  76       "CONCAT(pd.fname,' ',pd.mname,' ',pd.lname) as patient_name " .
  77       "FROM billing AS b " .
  78       "LEFT JOIN form_encounter AS e ON e.encounter = b.encounter AND e.pid = b.pid " .
  79       "LEFT JOIN patient_data AS pd ON b.pid = pd.pid " .
  80       "WHERE " .
  81       "b.encounter = '" . $this->encounter . "' AND b.pid = '" . $this->patient_id .
  82       "' AND b.billed = 1 AND b.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 . "000" . $this->encounter;
  90                 $invoice_info['invoicenumber'] = $this->patient_id . "." . $this->encounter;
  91
  92                 $counter = 0;
  93                 $total = 0;
  94                 $patient_info = array();
  95                 $payer_info = array();
  96
  97                 while ($result && !$result->EOF) {
  98
  99 //              if ($result->fields['process_date'] == null) {
 100 //                      //don't sync a claim that has not been processed, they may just want to mark this as billed
 101 //                              return false;
 102 //              }
 103
 104       // The above is silly.  If we don't want to sync, why are we here?
 105       // All bills should be in the accounting system, and mark-as-cleared
 106       // is the only reasonable way to process cash-only patients.
 107       //
 108       $process_date = ($result->fields['process_date'] == null) ?
 109         date("m-d-Y") :
 110         date("m-d-Y", strtotime($result->fields['process_date']));
 111
 112                         if ($counter == 0) {
 113                                 //unused but supported by ezybiz, helpful in debugging
 114                                 // actualy the dosdate can be used if you want that as the invoice date
 115                                 $invoice_info['customer'] = $result->fields['patient_name'];
 116                                 $invoice_info['invoicedate'] = $process_date;
 117                                 $invoice_info['duedate'] = $process_date;
 118                                 $invoice_info['items'] = array();
 119 //                      $invoice_info['dosdate'] = date("m-d-Y",strtotime($result->fields['date']));
 120         $invoice_info['dosdate'] = date("m-d-Y",strtotime($result->fields['dosdate']));
 121                         }
 122
 123                         $tii = array();
 124                         //This is how we set the line items for the invoice, using codes from our encounter
 125                         //if ($result->fields['code_type'] == "CPT4" || $result->fields['code_type'] == "HCPCS") {
 126                         //if( $result->fields['code_type'] != "ICD9" ) {
 127                         if( $result->fields['code_type'] == "COPAY")
 128                         {
 129                                 $patient_info['payment_amount'] += sprintf("%01.2f",$result->fields['fee']);
 130                         }
 131                         else
 132                         {
 133                                 $payer_info['payment_amount'] += sprintf("%01.2f",$result->fields['fee']);
 134                         }
 135
 136                         $tii['maincode'] = $result->fields['code'];
 137                         $tii['itemtext'] = $result->fields['code_type'] .":" .
 138         $result->fields['code'] . " " . $result->fields['code_text'] . " " .
 139         $result->fields['justify'];
 140
 141 //              $tii['qty'] = $result->fields['units'];
 142 //              if (!$tii['qty'] > 0) {
 143 //                      $tii['qty'] = 1;
 144 //              }
 145       $tii['qty'] = 1;
 146
 147                         $tii['price'] = sprintf("%01.2f",$result->fields['fee']);
 148                         $total += $tii['price'];
 149                         $tii['glaccountid'] = $this->_config['income_acct'];
 150                         $invoice_info['items'][] = $tii;
 151
 152                         $result->MoveNext();
 153                         $counter++;
 154                 }
 155
 156                 for($counter = 0; $counter < 2; $counter++)
 157                 {
 158                         $fee = 0;
 159                         $billto = 0;
 160                         if($counter == 0)
 161                         {
 162                                 $fee = $patient_info['payment_amount'];
 163                                 $billto = $this->foreign_patient_id;
 164                         }
 165                         else
 166                         {
 167                                 $fee = $payer_info['payment_amount'];
 168                                 $billto = $this->foreign_payer_id;
 169                         }
 170                         $invoice_info["invoiceid$counter"] = $this->patient_id . "000" . $this->encounter;
 171                         $invoice_info["amount$counter"] = $fee;
 172                         $invoice_info["invoicenumber$counter"] = $this->patient_id . "000" . $this->encounter;
 173                         $invoice_info["interest$counter"] = 0;
 174                         $invoice_info["billtoid$counter"] = $billto;
 175                 }
 176                 $invoice_info['subtotal'] = sprintf("%01.2f",$total);
 177                 $invoice_info['total'] = sprintf("%01.2f",$total);
 178
 179                 $this->claim = $invoice_info;
 180                 return true;
 181         }
 182
 183         function load_provider_foreign_id() {
 184                 $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'";
 185                 $result = $this->_db->Execute($sql);
 186                 if($result && !$result->EOF) {
 187                                 $this->foreign_provider_id = $result->fields['foreign_id'];
 188                                 return true;
 189                 }
 190                 else {
 191                         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>";
 192                         return false;
 193                 }
 194         }
 195
 196         function load_patient_foreign_id() {
 197                 $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'";
 198                 $result = $this->_db->Execute($sql);
 199                 if($result && !$result->EOF) {
 200                                 $this->foreign_patient_id = $result->fields['foreign_id'];
 201                                 return true;
 202                 }
 203                 else {
 204                         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>";
 205                         return false;
 206                 }
 207         }
 208
 209         function load_payer_foreign_id() {
 210                 $sql = "SELECT payer_id from billing where encounter = '" . $this->encounter . "' and pid = '" . $this->patient_id . "'";
 211                 $result = $this->_db->Execute($sql);
 212                 if($result && !$result->EOF) {
 213                                 $this->payer_id = $result->fields['payer_id'];
 214                 }
 215                 else {
 216                         echo "No payer id for this claim could be found";
 217                         return false;
 218                 }
 219                 // See comments in globals.php:
 220                 if ($GLOBALS['insurance_companies_are_not_customers']) {
 221                         $this->foreign_payer_id = $this->payer_id;
 222                 }
 223                 else {
 224                         $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'";
 225                         $result = $this->_db->Execute($sql);
 226                         if($result && !$result->EOF) {
 227                                 $this->foreign_payer_id = $result->fields['foreign_id'];
 228                         }
 229                         else {
 230                                 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: '" . $this->payer_id . "'<br>";
 231                                 return false;
 232                         }
 233                 }
 234                 return true;
 235         }
 236 }
 237
 238 //$wsc = new WSClaim("3","20040622");
 239
 240 ?>