library/gen_x12_837.inc.php

   1 <?php
   2 // Copyright (C) 2007-2011 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("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   $today = time();
  17   $out = '';
  18   $claim = new Claim($pid, $encounter);
  19   $edicount = 0;
  20
  21   // This is true for the 5010 standard, false for 4010.
  22   // x12gsversionstring() should be "005010X222A1" or "004010X098A1".
  23   $CMS_5010 = strpos($claim->x12gsversionstring(), '5010') !== false;
  24
  25   $log .= "Generating claim $pid-$encounter for " .
  26     $claim->patientFirstName()  . ' ' .
  27     $claim->patientMiddleName() . ' ' .
  28     $claim->patientLastName()   . ' on ' .
  29     date('Y-m-d H:i', $today) . ".\n";
  30
  31   $out .= "ISA" .
  32     "*" . $claim->x12gsisa01() .
  33     "*" . $claim->x12gsisa02() .
  34     "*" . $claim->x12gsisa03() .
  35     "*" . $claim->x12gsisa04() .
  36     "*" . $claim->x12gsisa05() .
  37     "*" . $claim->x12gssenderid() .
  38     "*" . $claim->x12gsisa07() .
  39     "*" . $claim->x12gsreceiverid() .
  40     "*030911" .
  41     "*1630" .
  42     "*" . ($CMS_5010 ? "^"     : "U"    ) .
  43     "*" . ($CMS_5010 ? "00501" : "00401") .
  44     "*000000001" .
  45     "*" . $claim->x12gsisa14() .
  46     "*" . $claim->x12gsisa15() .
  47     "*:" .
  48     "~\n";
  49
  50   $out .= "GS" .
  51     "*HC" .
  52     "*" . $claim->x12gsgs02() .
  53     "*" . trim($claim->x12gs03()) .
  54     "*" . date('Ymd', $today) .
  55     "*" . date('Hi', $today) .
  56     "*1" .
  57     "*X" .
  58     "*" . $claim->x12gsversionstring() .
  59     "~\n";
  60
  61   ++$edicount;
  62   $out .= "ST" .
  63     "*837" .
  64     "*0021" .
  65     // Spec says the following is optional, so should be able to leave it out.
  66     ($CMS_5010 ? ("*" . $claim->x12gsversionstring()) : "") .
  67     "~\n";
  68
  69   ++$edicount;
  70   $out .= "BHT" .
  71     "*0019" .                             // 0019 is required here
  72     "*00" .                               // 00 = original transmission
  73     "*0123" .                             // reference identification
  74     "*" . date('Ymd', $today) .           // transaction creation date
  75     "*" . date('Hi', $today) .            // transaction creation time
  76     ($encounter_claim ? "*RP" : "*CH") .  // RP = reporting, CH = chargeable
  77     "~\n";
  78
  79   if (!$CMS_5010) {
  80     // This segment was deleted for 5010.
  81     ++$edicount;
  82     $out .= "REF" .
  83       "*87" .
  84       "*" . $claim->x12gsversionstring() .
  85       "~\n";
  86   }
  87
  88   ++$edicount;
  89
  90   if ($claim->federalIdType() == "SY") { // check entity type for NM*102 1 == person, 2 == non-person entity
  91     $tempName = $claim->billingFacilityName();
  92     $partsName = explode(' ', $tempName);// Loop 1000A submitter entity == person
  93     $num_parts = count($partsName);
  94     switch ($num_parts) {
  95       case "2":
  96         $firstName = $partsName[0];
  97         $middleName = '';
  98         $lastName = $partsName[1];
  99         $suffixName = '';
 100       break;
 101       case "3":
 102         $firstName = $partsName[0];
 103         $middleName = $partsName[1];
 104         $lastName = $partsName[2];
 105         $suffixName = '';
 106       break;
 107       case "4":
 108         $firstName = $partsName[0];
 109         $middleName = $partsName[1];
 110         $lastName = $partsName[2];
 111         $suffixName = $partsName[3];
 112       break;
 113       default:
 114         $log .= "*** submitter name in 1000A loop has more than 4 parts, may not be desirable\n";
 115         $firstName = $partsName[0];
 116         $middleName = $partsName[1];
 117         $lastName = $partsName[2];
 118         $suffixName = $partsName[3];
 119     }
 120     $out .= "NM1" . // Loop 1000A Submitter
 121     "*41" .
 122     "*1" .
 123     "*" . $lastName .
 124     "*" . $firstName .
 125     "*" . $middleName .
 126     "*" . // Name Prefix not used
 127     "*" . // Name Suffix not used
 128     "*46";
 129   } else {    //Field length is limited to 35. See nucc dataset page 63 www.nucc.org
 130     $billingFacilityName = substr($claim->billingFacilityName(), 0, $CMS_5010 ? 60 : 35);
 131     if ($billingFacilityName == '') $log .= "*** billing facility name in 1000A loop is empty\n";
 132     $out .= "NM1" .
 133     "*41" .
 134     "*2" .
 135     "*" . $billingFacilityName .
 136     "*" .
 137     "*" .
 138     "*" .
 139     "*" .
 140     "*46";
 141   }
 142
 143   if (trim($claim->x12gsreceiverid()) == '470819582') { // if ECLAIMS EDI
 144     $out  .=  "*" . $claim->clearingHouseETIN();
 145   } else {
 146     $out  .=  "*" . $claim->billingFacilityETIN();
 147   }
 148     $out .= "~\n";
 149
 150   ++$edicount;
 151   $out .= "PER" .
 152     "*IC" .
 153     "*" . $claim->billingContactName() .
 154     "*TE" .
 155     "*" . $claim->billingContactPhone();
 156   if (!$CMS_5010 && $claim->x12gsper06()) {
 157     $out .= "*ED*" . $claim->x12gsper06();
 158   }
 159   $out .= "~\n";
 160
 161   ++$edicount;
 162   $out .= "NM1" .       // Loop 1000B Receiver
 163     "*40" .
 164     "*2" .
 165     "*" . $claim->clearingHouseName() .
 166     "*" .
 167     "*" .
 168     "*" .
 169     "*" .
 170     "*46" .
 171     "*" . $claim->clearingHouseETIN() .
 172     "~\n";
 173
 174   $HLcount = 1;
 175
 176   ++$edicount;
 177   $out .= "HL" .        // Loop 2000A Billing/Pay-To Provider HL Loop
 178     "*$HLcount" .
 179     "*" .
 180     "*20" .
 181     "*1" .              // 1 indicates there are child segments
 182     "~\n";
 183
 184   $HLBillingPayToProvider = $HLcount++;
 185
 186   // Situational PRV segment for provider taxonomy code for Medicaid.
 187     if ($claim->claimType() == 'MC') {
 188         ++$edicount;
 189         $out .= "PRV*BI*ZZ" .
 190         "*" . $claim->providerTaxonomy() .
 191         "~\n";
 192     }
 193
 194   // Situational CUR segment (foreign currency information) omitted here.
 195
 196   ++$edicount;
 197   //Field length is limited to 35. See nucc dataset page 63 www.nucc.org
 198   if ($claim->federalIdType() == "SY") { // check for entity type like in 1000A
 199     $tempName = $claim->billingFacilityName();
 200     $partsName = explode(' ', $tempName);// Loop 2010AA Billing Provider entity == person
 201     $num_parts = count($partsName);
 202     switch ($num_parts) {
 203       case "2":
 204         $firstName = $partsName[0];
 205         $middleName = '';
 206         $lastName = $partsName[1];
 207         $suffixName = '';
 208       break;
 209       case "3":
 210         $firstName = $partsName[0];
 211         $middleName = $partsName[1];
 212         $lastName = $partsName[2];
 213         $suffixName = '';
 214       break;
 215       case "4":
 216         $firstName = $partsName[0];
 217         $middleName = $partsName[1];
 218         $lastName = $partsName[2];
 219         $suffixName = $partsName[3];
 220       break;
 221       default:
 222         $log .= "*** billing provider name in 2010AA loop has more than 4 parts, may not be desirable\n";
 223         $firstName = $partsName[0];
 224         $middleName = $partsName[1];
 225         $lastName = $partsName[2];
 226         $suffixName = $partsName[3];
 227     }
 228   $out .= "NM1" .
 229   "*85" .
 230   "*1" .
 231   "*" . $lastName .
 232   "*" . $firstName .
 233   "*" . $middleName .
 234   "*" . // Name Prefix not used
 235   "*" . $suffixName;
 236   }
 237   else {
 238     $billingFacilityName = substr($claim->billingFacilityName(), 0, $CMS_5010 ? 60 : 35);
 239     if ($billingFacilityName == '') $log .= "*** billing facility name in 2010A loop is empty\n";
 240     $out .= "NM1" . // Loop 2010AA Billing Provider
 241     "*85" .
 242     "*2" .
 243     "*" . $billingFacilityName .
 244     "*" .
 245     "*" .
 246     "*" .
 247     "*";
 248   }
 249   if ($claim->billingFacilityNPI()) {
 250     $out .= "*XX*" . $claim->billingFacilityNPI();
 251   }
 252   else {
 253     $log .= "*** Billing facility has no NPI.\n";
 254     if ($CMS_5010) {
 255       $out .= "*XX*";
 256     }
 257     else {
 258       $out .= "*24*" . $claim->billingFacilityETIN();
 259     }
 260   }
 261   $out .= "~\n";
 262
 263   ++$edicount;
 264   $out .= "N3" .
 265     "*" . $claim->billingFacilityStreet() .
 266     "~\n";
 267
 268   ++$edicount;
 269   $out .= "N4" .
 270     "*" . $claim->billingFacilityCity() .
 271     "*" . $claim->billingFacilityState() .
 272     "*" . stripZipCode($claim->billingFacilityZip()) .
 273     "~\n";
 274
 275   if ($CMS_5010 || ($claim->billingFacilityNPI() && $claim->billingFacilityETIN())) {
 276     ++$edicount;
 277     $out .= "REF" ;
 278     if($claim->federalIdType()){
 279       $out .= "*" . $claim->federalIdType();
 280     }
 281     else{
 282       $out .= "*EI"; // For dealing with the situation before adding TaxId type In facility.
 283     }
 284     $out .=  "*" . $claim->billingFacilityETIN() .
 285       "~\n";
 286   }
 287
 288   if ($claim->providerNumberType() && $claim->providerNumber() &&
 289       !($CMS_5010 && $claim->billingFacilityNPI()))
 290   {
 291     ++$edicount;
 292     $out .= "REF" .
 293       "*" . $claim->providerNumberType() .
 294       "*" . $claim->providerNumber() .
 295       "~\n";
 296   }
 297   else if ($claim->providerNumber() && !$claim->providerNumberType()) {
 298     $log .= "*** Payer-specific provider insurance number is present but has no type assigned.\n";
 299   }
 300
 301   // Situational PER*1C segment omitted.
 302
 303   // Pay-To Address defaults to billing provider and is no longer required in 5010.
 304   if (!$CMS_5010) {
 305     ++$edicount;
 306     // Field length is limited to 35. See nucc dataset page 63 www.nucc.org
 307     $billingFacilityName = substr($claim->billingFacilityName(), 0, $CMS_5010 ? 60 : 35);
 308     $out .= "NM1" .       // Loop 2010AB Pay-To Provider
 309       "*87" .
 310       "*2" .
 311       "*" . $billingFacilityName .
 312       "*" .
 313       "*" .
 314       "*" .
 315       "*";
 316     if ($claim->billingFacilityNPI())
 317       $out .= "*XX*" . $claim->billingFacilityNPI();
 318     else
 319       $out .= "*24*" . $claim->billingFacilityETIN();
 320     $out .= "~\n";
 321
 322     ++$edicount;
 323     $out .= "N3" .
 324       "*" . $claim->billingFacilityStreet() .
 325       "~\n";
 326
 327     ++$edicount;
 328     $out .= "N4" .
 329       "*" . $claim->billingFacilityCity() .
 330       "*" . $claim->billingFacilityState() .
 331       "*" . stripZipCode($claim->billingFacilityZip()) .
 332       "~\n";
 333
 334     if ($claim->billingFacilityNPI() && $claim->billingFacilityETIN()) {
 335       ++$edicount;
 336       $out .= "REF" .
 337         "*EI" .
 338         "*" . $claim->billingFacilityETIN() .
 339         "~\n";
 340     }
 341   }
 342
 343   // Loop 2010AC Pay-To Plan Name omitted.  Includes:
 344   // NM1*PE, N3, N4, REF*2U, REF*EI
 345
 346   $PatientHL = $claim->isSelfOfInsured() ? 0 : 1;
 347   $HLSubscriber = $HLcount++;
 348
 349   ++$edicount;
 350   $out .= "HL" .        // Loop 2000B Subscriber HL Loop
 351     "*$HLSubscriber" .
 352     "*$HLBillingPayToProvider" .
 353     "*22" .
 354     "*$PatientHL" .
 355     "~\n";
 356
 357   if (!$claim->payerSequence()) {
 358     $log .= "*** Error: Insurance information is missing!\n";
 359   }
 360
 361   ++$edicount;
 362   $out .= "SBR" .       // Subscriber Information
 363     "*" . $claim->payerSequence() .
 364     "*" . ($claim->isSelfOfInsured() ? '18' : '') .
 365     "*" . $claim->groupNumber() .
 366     "*" . (($CMS_5010 && $claim->groupNumber()) ? '' : $claim->groupName()) .
 367     "*" . $claim->insuredTypeCode() . // applies for secondary medicare
 368     "*" .
 369     "*" .
 370     "*" .
 371     "*" . $claim->claimType() . // Zirmed replaces this
 372     "~\n";
 373
 374   // Segment PAT omitted.
 375
 376   ++$edicount;
 377   $out .= "NM1" .       // Loop 2010BA Subscriber
 378     "*IL" .
 379     "*1" . // 1 = person, 2 = non-person
 380     "*" . $claim->insuredLastName() .
 381     "*" . $claim->insuredFirstName() .
 382     "*" . $claim->insuredMiddleName() .
 383     "*" .
 384     "*" . // Name Suffix
 385     "*MI" .
 386     // "MI" = Member Identification Number
 387     // "II" = Standard Unique Health Identifier, "Required if the
 388     //        HIPAA Individual Patient Identifier is mandated use."
 389     //        Here we presume that is not true yet.
 390     "*" . $claim->policyNumber() .
 391     "~\n";
 392
 393   // For 5010, further subscriber info is sent only if they are the patient.
 394   if (!$CMS_5010 || $claim->isSelfOfInsured()) {
 395     ++$edicount;
 396     $out .= "N3" .
 397       "*" . $claim->insuredStreet() .
 398       "~\n";
 399
 400     ++$edicount;
 401     $out .= "N4" .
 402       "*" . $claim->insuredCity() .
 403       "*" . $claim->insuredState() .
 404       "*" . stripZipCode($claim->insuredZip()) .
 405       "~\n";
 406
 407     ++$edicount;
 408     $out .= "DMG" .
 409       "*D8" .
 410       "*" . $claim->insuredDOB() .
 411       "*" . $claim->insuredSex() .
 412       "~\n";
 413   }
 414
 415   // Segment REF*SY (Subscriber Secondary Identification) omitted.
 416   // Segment REF*Y4 (Property and Casualty Claim Number) omitted.
 417   // Segment PER*IC (Property and Casualty Subscriber Contact Information) omitted.
 418
 419   ++$edicount;
 420   //Field length is limited to 35. See nucc dataset page 81 www.nucc.org
 421   $payerName = substr($claim->payerName(), 0, $CMS_5010 ? 60 : 35);
 422   $out .= "NM1" .       // Loop 2010BB Payer
 423     "*PR" .
 424     "*2" .
 425     "*" . $payerName .
 426     "*" .
 427     "*" .
 428     "*" .
 429     "*" .
 430     // The 5010 spec says:
 431     // "On or after the mandated implementation date for the HIPAA
 432     // National Plan Identifier (National Plan ID), XV must be sent.
 433     // Prior to the mandated implementation date and prior to any phase-
 434     // in period identified by Federal regulation, PI must be sent."
 435     // *************** Anybody know what that date is? ***************
 436         //    August 2011 - Publish interim final rule
 437 //    October 1, 2012-March 31, 2013 - Enumeration
 438 //    April 1, 2013-September 30, 2013 - Testing
 439  //   October 1, 2013 - Implementation
 440
 441     "*PI" .
 442     // Zirmed ignores this if using payer name matching:
 443     "*" . ($encounter_claim ? $claim->payerAltID() : $claim->payerID()) .
 444     "~\n";
 445
 446   // if (!$claim->payerID()) {
 447   //   $log .= "*** CMS ID is missing for payer '" . $claim->payerName() . "'.\n";
 448   // }
 449
 450   if (true) { // !$CMS_5010
 451     // The 5010 spec says:
 452     // "Required when the payer address is available and the submitter intends
 453     // for the claim to be printed on paper at the next EDI location (for example, a
 454     // clearinghouse). If not required by this implementation guide, do not send."
 455
 456     ++$edicount;
 457     $out .= "N3" .
 458       "*" . $claim->payerStreet() .
 459       "~\n";
 460
 461     ++$edicount;
 462     $out .= "N4" .
 463       "*" . $claim->payerCity() .
 464       "*" . $claim->payerState() .
 465       "*" . stripZipCode($claim->payerZip()) .
 466       "~\n";
 467   }
 468
 469   // Segment REF (Payer Secondary Identification) omitted.
 470   // Segment REF (Billing Provider Secondary Identification) omitted.
 471
 472   if (! $claim->isSelfOfInsured()) {
 473     ++$edicount;
 474     $out .= "HL" .        // Loop 2000C Patient Information
 475       "*$HLcount" .
 476       "*$HLSubscriber" .
 477       "*23" .
 478       "*0" .
 479       "~\n";
 480
 481     $HLcount++;
 482
 483     ++$edicount;
 484     $out .= "PAT" .
 485       "*" . $claim->insuredRelationship() .
 486       "~\n";
 487
 488     ++$edicount;
 489     $out .= "NM1" .       // Loop 2010CA Patient
 490       "*QC" .
 491       "*1" .
 492       "*" . $claim->patientLastName() .
 493       "*" . $claim->patientFirstName();
 494     if ($claim->patientMiddleName() !== '') $out .= "*"
 495 . $claim->patientMiddleName();
 496     $out .= "~\n";
 497
 498     ++$edicount;
 499     $out .= "N3" .
 500       "*" . $claim->patientStreet() .
 501       "~\n";
 502
 503     ++$edicount;
 504     $out .= "N4" .
 505       "*" . $claim->patientCity() .
 506       "*" . $claim->patientState() .
 507       "*" . stripZipCode($claim->patientZip()) .
 508       "~\n";
 509
 510     ++$edicount;
 511     $out .= "DMG" .
 512       "*D8" .
 513       "*" . $claim->patientDOB() .
 514       "*" . $claim->patientSex() .
 515       "~\n";
 516
 517     // Segment REF*Y4 (Property and Casualty Claim Number) omitted.
 518     // Segment REF (Property and Casualty Patient Identifier) omitted.
 519     // Segment PER (Property and Casualty Patient Contact Information) omitted.
 520
 521   } // end of patient different from insured
 522
 523   $proccount = $claim->procCount();
 524
 525   $clm_total_charges = 0;
 526   for ($prockey = 0; $prockey < $proccount; ++$prockey) {
 527     $clm_total_charges += $claim->cptCharges($prockey);
 528   }
 529
 530   if (!$clm_total_charges) {
 531     $log .= "*** This claim has no charges!\n";
 532   }
 533
 534   ++$edicount;
 535   $out .= "CLM" .       // Loop 2300 Claim
 536     "*$pid-$encounter" .
 537     "*"  . sprintf("%.2f",$clm_total_charges) . // Zirmed computes and replaces this
 538     "*"  .
 539     "*"  .
 540     "*"  . sprintf('%02d', $claim->facilityPOS()) . ":" .
 541            ($CMS_5010 ? "B" : "") . ":" .
 542            $claim->frequencyTypeCode() . // Changed to correct single digit output
 543     "*Y" .
 544     "*A" .
 545     "*"  . ($claim->billingFacilityAssignment() ? 'Y' : 'N') .
 546     "*Y" .
 547     ($CMS_5010 ? "" : "*C") .
 548     "~\n";
 549
 550   if ($claim->onsetDate() &&
 551       ($claim->onsetDate()!== $claim->serviceDate()) &&
 552       ($claim->onsetDateValid())
 553      ) {
 554     ++$edicount;
 555     $out .= "DTP" .       // Date of Onset
 556       "*431" .
 557       "*D8" .
 558       "*" . $claim->onsetDate() .
 559       "~\n";
 560   }
 561
 562   if ($claim->dateInitialTreatment() && ($claim->onsetDateValid())) {
 563     ++$edicount;
 564     $out .= "DTP" .       // Date of Initial Treatment
 565       "*454" .
 566       "*D8" .
 567       "*" . $claim->dateInitialTreatment() .
 568       "~\n";
 569   }
 570
 571   // Segment DTP*304 (Last Seen Date) omitted.
 572   // Segment DTP*453 (Acute Manifestation Date) omitted.
 573   // Segment DTP*439 (Accident Date) omitted.
 574   // Segment DTP*484 (Last Menstrual Period Date) omitted.
 575   // Segment DTP*455 (Last X-Ray Date) omitted.
 576   // Segment DTP*471 (Hearing and Vision Prescription Date) omitted.
 577   // Segments DTP (Disability Dates) omitted.
 578   // Segment DTP*297 (Last Worked Date) omitted.
 579   // Segment DTP*296 (Authorized Return to Work Date) omitted.
 580
 581   if (strcmp($claim->facilityPOS(),'21') == 0 && $claim->onsetDateValid() ) {
 582     ++$edicount;
 583     $out .= "DTP" .     // Date of Hospitalization
 584       "*435" .
 585       "*D8" .
 586       "*" . $claim->onsetDate() .
 587       "~\n";
 588   }
 589
 590   // Segment DTP*096 (Discharge Date) omitted.
 591   // Segments DTP (Assumed and Relinquished Care Dates) omitted.
 592   // Segment DTP*444 (Property and Casualty Date of First Contact) omitted.
 593   // Segment DTP*050 (Repricer Received Date) omitted.
 594   // Segment PWK (Claim Supplemental Information) omitted.
 595   // Segment CN1 (Contract Information) omitted.
 596
 597   $patientpaid = $claim->patientPaidAmount();
 598   if ($patientpaid != 0) {
 599     ++$edicount;
 600     $out .= "AMT" .     // Patient paid amount. Page 190/220.
 601       "*F5" .
 602       "*" . $patientpaid .
 603       "~\n";
 604   }
 605
 606   // Segment REF*4N (Service Authorization Exception Code) omitted.
 607   // Segment REF*F5 (Mandatory Medicare Crossover Indicator) omitted.
 608   // Segment REF*EW (Mammography Certification Number) omitted.
 609   // Segment REF*9F (Referral Number) omitted.
 610
 611   if ($claim->priorAuth()) {
 612     ++$edicount;
 613     $out .= "REF" .     // Prior Authorization Number
 614       "*G1" .
 615       "*" . $claim->priorAuth() .
 616       "~\n";
 617   }
 618
 619   // Segment REF*F8 Payer Claim Control Number for claim re-submission.icn_resubmission_number
 620
 621   #if($claim->billing_options['replacement_claim'] == '1'){
 622   if(trim($claim->billing_options['icn_resubmission_number']) > 3){
 623     ++$edicount;
 624     error_log("Method 1: ".$claim->billing_options['icn_resubmission_number'], 0);
 625     $out .= "REF" .
 626       "*F8" .
 627       "*" . $claim->icnResubmissionNumber() .
 628       "~\n";
 629   }
 630
 631
 632   if ($claim->cliaCode() && ($CMS_5010 || $claim->claimType() === 'MB')) {
 633     // Required by Medicare when in-house labs are done.
 634     ++$edicount;
 635     $out .= "REF" .     // Clinical Laboratory Improvement Amendment Number
 636       "*X4" .
 637       "*" . $claim->cliaCode() .
 638       "~\n";
 639   }
 640
 641   // Segment REF*9A (Repriced Claim Number) omitted.
 642   // Segment REF*9C (Adjusted Repriced Claim Number) omitted.
 643   // Segment REF*LX (Investigational Device Exemption Number) omitted.
 644   // Segment REF*D9 (Claim Identifier for Transmission Intermediaries) omitted.
 645   // Segment REF*EA (Medical Record Number) omitted.
 646   // Segment REF*P4 (Demonstration Project Identifier) omitted.
 647   // Segment REF*1J (Care Plan Oversight) omitted.
 648   // Segment K3 (File Information) omitted.
 649
 650   if ($claim->additionalNotes()) {
 651     // Claim note.
 652     ++$edicount;
 653     $out .= "NTE" .     // comments box 19
 654       "*" . ($CMS_5010 ? "ADD" : "") .
 655       "*" . $claim->additionalNotes() .
 656       "~\n";
 657   }
 658
 659   // Segment CR1 (Ambulance Transport Information) omitted.
 660   // Segment CR2 (Spinal Manipulation Service Information) omitted.
 661   // Segment CRC (Ambulance Certification) omitted.
 662   // Segment CRC (Patient Condition Information: Vision) omitted.
 663   // Segment CRC (Homebound Indicator) omitted.
 664
 665   // Segment CRC (EPSDT Referral).
 666    if($claim->epsdtFlag()) {
 667       ++$edicount;
 668     $out .= "CRC" .
 669       "*ZZ" .
 670       "*Y" .
 671       "*" . $claim->medicaidReferralCode() .
 672       "~\n";
 673   }
 674
 675   // Diagnoses, up to $max_per_seg per HI segment.
 676   $max_per_seg = $CMS_5010 ? 12 : 8;
 677   $da = $claim->diagArray();
 678   if ($claim->diagtype == "ICD9") {
 679   $diag_type_code = 'BK';
 680   }
 681   ELSE
 682   {
 683   $diag_type_code = 'ABK';
 684   }
 685   $tmp = 0;
 686   foreach ($da as $diag) {
 687     if ($tmp % $max_per_seg == 0) {
 688       if ($tmp) $out .= "~\n";
 689       ++$edicount;
 690       $out .= "HI";         // Health Diagnosis Codes
 691     }
 692     $out .= "*$diag_type_code:" . $diag;
 693      if ($claim->diagtype == "ICD9") {
 694          $diag_type_code = 'BF';
 695       }
 696       ELSE
 697       {
 698       $diag_type_code = 'ABF';
 699       }
 700     ++$tmp;
 701   }
 702   if ($tmp) $out .= "~\n";
 703
 704   // Segment HI*BP (Anesthesia Related Procedure) omitted.
 705   // Segment HI*BG (Condition Information) omitted.
 706   // Segment HCP (Claim Pricing/Repricing Information) omitted.
 707
 708   if ($claim->referrerLastName()) {
 709     // Medicare requires referring provider's name and UPIN.
 710     ++$edicount;
 711     $out .= "NM1" .     // Loop 2310A Referring Provider
 712       "*DN" .
 713       "*1" .
 714       "*" . $claim->referrerLastName() .
 715       "*" . $claim->referrerFirstName() .
 716       "*" . $claim->referrerMiddleName() .
 717       "*" .
 718       "*";
 719     if ($CMS_5010 || $claim->referrerNPI()) { $out .=
 720       "*XX" .
 721       "*" . $claim->referrerNPI();
 722     } else { $out .=
 723       "*34" .                           // not allowed for 5010
 724       "*" . $claim->referrerSSN();
 725     }
 726     $out .= "~\n";
 727
 728     if (!$CMS_5010 && $claim->referrerTaxonomy()) {
 729       ++$edicount;
 730       $out .= "PRV" .
 731         "*RF" . // ReFerring provider
 732         "*ZZ" .
 733         "*" . $claim->referrerTaxonomy() .
 734         "~\n";
 735     }
 736
 737     if (!CMS_5010 && $claim->referrerUPIN()) {
 738       ++$edicount;
 739       $out .= "REF" .   // Referring Provider Secondary Identification
 740         "*1G" .
 741         "*" . $claim->referrerUPIN() .
 742         "~\n";
 743     }
 744   }
 745
 746
 747   /* Per the implementation guide lines, only include this information if it is different
 748    * than the Loop 2010AA information
 749    */
 750   if(!$CMS_5010 ||
 751           ($claim->providerNPIValid() &&
 752           $claim->billingFacilityNPI() !== $claim->providerNPI() ))
 753   {
 754     ++$edicount;
 755     $out .= "NM1" .       // Loop 2310B Rendering Provider
 756         "*82" .
 757         "*1" .
 758         "*" . $claim->providerLastName() .
 759         "*" . $claim->providerFirstName() .
 760         "*" . $claim->providerMiddleName() .
 761         "*" .
 762         "*";
 763     if ($CMS_5010 || $claim->providerNPI()) { $out .=
 764         "*XX" .
 765         "*" . $claim->providerNPI();
 766     } else { $out .=
 767         "*34" .                             // not allowed for 5010
 768         "*" . $claim->providerSSN();
 769         $log .= "*** Rendering provider has no NPI.\n";
 770     }
 771     $out .= "~\n";
 772
 773     if ($claim->providerTaxonomy()) {
 774         ++$edicount;
 775         $out .= "PRV" .
 776         "*PE" . // Performing provider
 777         "*" .($claim->claimType() != 'MC' ? "PXC" : "ZZ") .
 778         "*" . $claim->providerTaxonomy() .
 779         "~\n";
 780     }
 781     // End of Loop 2310B
 782   }
 783   else
 784   {
 785     // This loop can only get skipped if we are generating a 5010 claim
 786     if(!($claim->providerNPIValid()))
 787     {
 788         /* If the loop was skipped because the provider NPI was invalid, generate
 789          * a warning for the log.*/
 790         $log.="*** Skipping 2310B because ".$claim->providerLastName() ."," . $claim->providerFirstName() . " has invalid NPI.\n";
 791     }
 792     /* Skipping this segment because the providerNPI and the billingFacilityNPI are identical
 793      * is a normal condition, so no need to warn.
 794      */
 795
 796   }
 797
 798   // 4010: REF*1C is required here for the Medicare provider number if NPI was
 799   // specified in NM109.  Not sure if other payers require anything here.
 800   // --- apparently ECLAIMS, INC wants the data in 2010 but NOT in 2310B - tony@mi-squared.com
 801   //
 802   // 5010 spec says nothing here if NPI was specified.
 803   //
 804   if (($CMS_5010 && !$claim->providerNPI() && in_array($claim->providerNumberType(), array('0B','1G','G2','LU')))
 805       || (!$CMS_5010 && trim($claim->x12gsreceiverid()) != '470819582')) // if NOT ECLAIMS EDI
 806   {
 807     if ($claim->providerNumber()) {
 808       ++$edicount;
 809       $out .= "REF" .
 810         "*" . $claim->providerNumberType() .
 811         "*" . $claim->providerNumber() .
 812         "~\n";
 813     }
 814   }
 815
 816   // Loop 2310D is omitted in the case of home visits (POS=12).
 817   if ($claim->facilityPOS() != 12 &&
 818       (!$CMS_5010 || $claim->facilityNPI() != $claim->billingFacilityNPI()))
 819     {
 820     ++$edicount;
 821     $out .= "NM1" .       // Loop 2310D Service Location
 822       "*77" .
 823       "*2";
 824     //Field length is limited to 35. See nucc dataset page 77 www.nucc.org
 825     $facilityName = substr($claim->facilityName(), 0, $CMS_5010 ? 60 : 35);
 826     if ($claim->facilityName() || $claim->facilityNPI() || $claim->facilityETIN()) { $out .=
 827       "*" . $facilityName;
 828     }
 829     if ($claim->facilityNPI() || $claim->facilityETIN()) { $out .=
 830       "*" .
 831       "*" .
 832       "*" .
 833       "*";
 834       if ($CMS_5010 || $claim->facilityNPI()) { $out .=
 835         "*XX*" . $claim->facilityNPI();
 836       } else { $out .=
 837         "*24*" . $claim->facilityETIN();
 838       }
 839       if (!$claim->facilityNPI()) {
 840         $log .= "*** Service location has no NPI.\n";
 841       }
 842     }
 843     $out .= "~\n";
 844     if ($claim->facilityStreet()) {
 845       ++$edicount;
 846       $out .= "N3" .
 847         "*" . $claim->facilityStreet() .
 848         "~\n";
 849     }
 850     if ($claim->facilityState()) {
 851       ++$edicount;
 852       $out .= "N4" .
 853         "*" . $claim->facilityCity() .
 854         "*" . $claim->facilityState() .
 855         "*" . stripZipCode($claim->facilityZip()) .
 856         "~\n";
 857     }
 858   }
 859
 860   // Segment REF (Service Facility Location Secondary Identification) omitted.
 861   // Segment PER (Service Facility Contact Information) omitted.
 862
 863   // Loop 2310E, Supervising Provider
 864   //
 865   if ($claim->supervisorLastName()) {
 866     ++$edicount;
 867     $out .= "NM1" .
 868       "*DQ" . // Supervising Physician
 869       "*1" .  // Person
 870       "*" . $claim->supervisorLastName() .
 871       "*" . $claim->supervisorFirstName() .
 872       "*" . $claim->supervisorMiddleName() .
 873       "*" .   // NM106 not used
 874       "*";    // Name Suffix
 875     if ($CMS_5010 || $claim->supervisorNPI()) { $out .=
 876       "*XX" .
 877       "*" . $claim->supervisorNPI();
 878     } else { $out .=
 879       "*34" .
 880       "*" . $claim->supervisorSSN();
 881     }
 882     if (!$claim->supervisorNPI()) {
 883       $log .= "*** Supervising Provider has no NPI.\n";
 884     }
 885     $out .= "~\n";
 886
 887     if ($claim->supervisorNumber()) {
 888       ++$edicount;
 889       $out .= "REF" .
 890         "*" . $claim->supervisorNumberType() .
 891         "*" . $claim->supervisorNumber() .
 892         "~\n";
 893     }
 894   }
 895
 896   // Segments NM1*PW, N3, N4 (Ambulance Pick-Up Location) omitted.
 897   // Segments NM1*45, N3, N4 (Ambulance Drop-Off Location) omitted.
 898
 899   $prev_pt_resp = $clm_total_charges; // for computation below
 900
 901   // Loops 2320 and 2330*, other subscriber/payer information.
 902   // Remember that insurance index 0 is always for the payer being billed
 903   // by this claim, and 1 and above are always for the "other" payers.
 904   //
 905   for ($ins = 1; $ins < $claim->payerCount(); ++$ins) {
 906
 907     $tmp1 = $claim->claimType($ins);
 908     $tmp2 = 'C1'; // Here a kludge. See page 321.
 909     if ($tmp1 === 'CI') $tmp2 = 'C1';
 910     if ($tmp1 === 'AM') $tmp2 = 'AP';
 911     if ($tmp1 === 'HM') $tmp2 = 'HM';
 912     if ($tmp1 === 'MB') $tmp2 = 'MB';
 913     if ($tmp1 === 'MC') $tmp2 = 'MC';
 914     if ($tmp1 === '09') $tmp2 = 'PP';
 915     ++$edicount;
 916     $out .= "SBR" . // Loop 2320, Subscriber Information - page 297/318
 917       "*" . $claim->payerSequence($ins) .
 918       "*" . $claim->insuredRelationship($ins) .
 919       "*" . $claim->groupNumber($ins) .
 920       "*" . (($CMS_5010 && $claim->groupNumber($ins)) ? '' : $claim->groupName($ins)) .
 921       "*" . ($CMS_5010 ? $claim->insuredTypeCode($ins) : $tmp2) .
 922       "*" .
 923       "*" .
 924       "*" .
 925       "*" . $claim->claimType($ins) .
 926       "~\n";
 927
 928     // Things that apply only to previous payers, not future payers.
 929     //
 930     if ($claim->payerSequence($ins) < $claim->payerSequence()) {
 931
 932       // Generate claim-level adjustments.
 933       $aarr = $claim->payerAdjustments($ins);
 934       foreach ($aarr as $a) {
 935         ++$edicount;
 936         $out .= "CAS" . // Previous payer's claim-level adjustments. Page 301/323.
 937           "*" . $a[1] .
 938           "*" . $a[2] .
 939           "*" . $a[3] .
 940           "~\n";
 941       }
 942
 943       $payerpaid = $claim->payerTotals($ins);
 944       ++$edicount;
 945       $out .= "AMT" . // Previous payer's paid amount. Page 307/332.
 946         "*D" .
 947         "*" . $payerpaid[1] .
 948         "~\n";
 949
 950       // Segment AMT*A8 (COB Total Non-Covered Amount) omitted.
 951       // Segment AMT*EAF (Remaining Patient Liability) omitted.
 952
 953       if (!$CMS_5010) {
 954         // Patient responsibility amount as of this previous payer.
 955         $prev_pt_resp -= $payerpaid[1]; // reduce by payments
 956         $prev_pt_resp -= $payerpaid[2]; // reduce by adjustments
 957
 958         ++$edicount;
 959         $out .= "AMT" . // Allowed amount per previous payer. Page 334.
 960           "*B6" .
 961           "*" . sprintf('%.2f', $payerpaid[1] + $prev_pt_resp) .
 962           "~\n";
 963
 964         ++$edicount;
 965         $out .= "AMT" . // Patient responsibility amount per previous payer. Page 335.
 966           "*F2" .
 967           "*" . sprintf('%.2f', $prev_pt_resp) .
 968           "~\n";
 969       }
 970     } // End of things that apply only to previous payers.
 971
 972     if (!$CMS_5010) {
 973       ++$edicount;
 974       $out .= "DMG" . // Other subscriber demographic information. Page 342.
 975         "*D8" .
 976         "*" . $claim->insuredDOB($ins) .
 977         "*" . $claim->insuredSex($ins) .
 978         "~\n";
 979     }
 980
 981     ++$edicount;
 982     $out .= "OI" .  // Other Insurance Coverage Information. Page 310/344.
 983       "*" .
 984       "*" .
 985       "*" . ($claim->billingFacilityAssignment($ins) ? 'Y' : 'N') .
 986       // For this next item, the 5010 example in the spec does not match its
 987       // description.  So this might be wrong.
 988       "*" . ($CMS_5010 ? '' : 'B') .
 989       "*" .
 990       "*Y" .
 991       "~\n";
 992
 993     // Segment MOA (Medicare Outpatient Adjudication) omitted.
 994
 995     ++$edicount;
 996     $out .= "NM1" . // Loop 2330A Subscriber info for other insco. Page 315/350.
 997       "*IL" .
 998       "*1" .
 999       "*" . $claim->insuredLastName($ins) .
1000       "*" . $claim->insuredFirstName($ins) .
1001       "*" . $claim->insuredMiddleName($ins) .
1002       "*" .
1003       "*" .
1004       "*MI" .
1005       "*" . $claim->policyNumber($ins) .
1006       "~\n";
1007
1008     ++$edicount;
1009     $out .= "N3" .
1010       "*" . $claim->insuredStreet($ins) .
1011       "~\n";
1012
1013     ++$edicount;
1014     $out .= "N4" .
1015       "*" . $claim->insuredCity($ins) .
1016       "*" . $claim->insuredState($ins) .
1017       "*" . stripZipCode($claim->insuredZip($ins)) .
1018       "~\n";
1019
1020     // Segment REF (Other Subscriber Secondary Identification) omitted.
1021
1022     ++$edicount;
1023     //Field length is limited to 35. See nucc dataset page 81 www.nucc.org
1024     $payerName = substr($claim->payerName($ins), 0, $CMS_5010 ? 60 : 35);
1025     $out .= "NM1" . // Loop 2330B Payer info for other insco. Page 322/359.
1026       "*PR" .
1027       "*2" .
1028       "*" . $payerName .
1029       "*" .
1030       "*" .
1031       "*" .
1032       "*" .
1033       "*PI" .
1034       "*" . $claim->payerID($ins) .
1035       "~\n";
1036
1037     // if (!$claim->payerID($ins)) {
1038     //   $log .= "*** CMS ID is missing for payer '" . $claim->payerName($ins) . "'.\n";
1039     // }
1040
1041     // Payer address (N3 and N4) are added below so that Gateway EDI can
1042     // auto-generate secondary claims.  These do NOT appear in my copy of
1043     // the spec!  -- Rod 2008-06-12
1044
1045     if ($CMS_5010 || trim($claim->x12gsreceiverid()) == '431420764') { // if Gateway EDI
1046       ++$edicount;
1047       $out .= "N3" .
1048         "*" . $claim->payerStreet($ins) .
1049         "~\n";
1050       //
1051       ++$edicount;
1052       $out .= "N4" .
1053         "*" . $claim->payerCity($ins) .
1054         "*" . $claim->payerState($ins) .
1055         "*" . stripZipCode($claim->payerZip($ins)) .
1056         "~\n";
1057     } // end Gateway EDI
1058
1059     // Segment DTP*573 (Claim Check or Remittance Date) omitted.
1060     // Segment REF (Other Payer Secondary Identifier) omitted.
1061     // Segment REF*G1 (Other Payer Prior Authorization Number) omitted.
1062     // Segment REF*9F (Other Payer Referral Number) omitted.
1063     // Segment REF*T4 (Other Payer Claim Adjustment Indicator) omitted.
1064     // Segment REF*F8 (Other Payer Claim Control Number) omitted.
1065     // Segment NM1 (Other Payer Referring Provider) omitted.
1066     // Segment REF (Other Payer Referring Provider Secondary Identification) omitted.
1067     // Segment NM1 (Other Payer Rendering Provider) omitted.
1068     // Segment REF (Other Payer Rendering Provider Secondary Identification) omitted.
1069     // Segment NM1 (Other Payer Service Facility Location) omitted.
1070     // Segment REF (Other Payer Service Facility Location Secondary Identification) omitted.
1071     // Segment NM1 (Other Payer Supervising Provider) omitted.
1072     // Segment REF (Other Payer Supervising Provider Secondary Identification) omitted.
1073     // Segment NM1 (Other Payer Billing Provider) omitted.
1074     // Segment REF (Other Payer Billing Provider Secondary Identification) omitted.
1075
1076   } // End loops 2320/2330*.
1077
1078   $loopcount = 0;
1079
1080   // Procedure loop starts here.
1081   //
1082   for ($prockey = 0; $prockey < $proccount; ++$prockey) {
1083     ++$loopcount;
1084
1085     ++$edicount;
1086     $out .= "LX" .      // Loop 2400 LX Service Line. Page 398.
1087       "*$loopcount" .
1088       "~\n";
1089
1090     ++$edicount;
1091     $out .= "SV1" .     // Professional Service. Page 400.
1092       "*HC:" . $claim->cptKey($prockey) .
1093       "*" . sprintf('%.2f', $claim->cptCharges($prockey)) .
1094       "*UN" .
1095       "*" . $claim->cptUnits($prockey) .
1096       "*" .
1097       "*" .
1098       "*";
1099     $dia = $claim->diagIndexArray($prockey);
1100     $i = 0;
1101     foreach ($dia as $dindex) {
1102       if ($i) $out .= ':';
1103       $out .= $dindex;
1104       if (++$i >= 4) break;
1105     }
1106     # needed for epstd
1107   if($claim->epsdtFlag()) {
1108     $out .= "*" .
1109     "*" .
1110     "*" .
1111     "*Y" .
1112     "~\n";
1113   }
1114   else
1115   {
1116     $out .= "~\n";
1117   }
1118
1119     if (!$claim->cptCharges($prockey)) {
1120       $log .= "*** Procedure '" . $claim->cptKey($prockey) . "' has no charges!\n";
1121     }
1122
1123     if (empty($dia)) {
1124       $log .= "*** Procedure '" . $claim->cptKey($prockey) . "' is not justified!\n";
1125     }
1126
1127     // Segment SV5 (Durable Medical Equipment Service) omitted.
1128     // Segment PWK (Line Supplemental Information) omitted.
1129     // Segment PWK (Durable Medical Equipment Certificate of Medical Necessity Indicator) omitted.
1130     // Segment CR1 (Ambulance Transport Information) omitted.
1131     // Segment CR3 (Durable Medical Equipment Certification) omitted.
1132     // Segment CRC (Ambulance Certification) omitted.
1133     // Segment CRC (Hospice Employee Indicator) omitted.
1134     // Segment CRC (Condition Indicator / Durable Medical Equipment) omitted.
1135
1136     ++$edicount;
1137     $out .= "DTP" .     // Date of Service. Page 435.
1138       "*472" .
1139       "*D8" .
1140       "*" . $claim->serviceDate() .
1141       "~\n";
1142
1143     $testnote = rtrim($claim->cptNotecodes($prockey));
1144     if (!empty($testnote)) {
1145       ++$edicount;
1146       $out .= "NTE" .     // Explain Unusual Circumstances.
1147         "*ADD" .
1148         "*" . $claim->cptNotecodes($prockey) .
1149         "~\n";
1150     }
1151
1152     // Segment DTP*471 (Prescription Date) omitted.
1153     // Segment DTP*607 (Revision/Recertification Date) omitted.
1154     // Segment DTP*463 (Begin Therapy Date) omitted.
1155     // Segment DTP*461 (Last Certification Date) omitted.
1156     // Segment DTP*304 (Last Seen Date) omitted.
1157     // Segment DTP (Test Date) omitted.
1158     // Segment DTP*011 (Shipped Date) omitted.
1159     // Segment DTP*455 (Last X-Ray Date) omitted.
1160     // Segment DTP*454 (Initial Treatment Date) omitted.
1161     // Segment QTY (Ambulance Patient Count) omitted.
1162     // Segment QTY (Obstetric Anesthesia Additional Units) omitted.
1163     // Segment MEA (Test Result) omitted.
1164     // Segment CN1 (Contract Information) omitted.
1165     // Segment REF*9B (Repriced Line Item Reference Number) omitted.
1166     // Segment REF*9D (Adjusted Repriced Line Item Reference Number) omitted.
1167     // Segment REF*G1 (Prior Authorization) omitted.
1168     // Segment REF*6R (Line Item Control Number) omitted.
1169     //   (Really oughta have this for robust 835 posting!)
1170     // Segment REF*EW (Mammography Certification Number) omitted.
1171     // Segment REF*X4 (CLIA Number) omitted.
1172     // Segment REF*F4 (Referring CLIA Facility Identification) omitted.
1173     // Segment REF*BT (Immunization Batch Number) omitted.
1174     // Segment REF*9F (Referral Number) omitted.
1175     // Segment AMT*T (Sales Tax Amount) omitted.
1176     // Segment AMT*F4 (Postage Claimed Amount) omitted.
1177     // Segment K3 (File Information) omitted.
1178     // Segment NTE (Line Note) omitted.
1179     // Segment NTE (Third Party Organization Notes) omitted.
1180     // Segment PS1 (Purchased Service Information) omitted.
1181     // Segment HCP (Line Pricing/Repricing Information) omitted.
1182
1183     if (!$CMS_5010) {
1184       // This segment was deleted for 5010.
1185       //
1186       // AMT*AAE segment for Approved Amount from previous payer.
1187       // Medicare secondaries seem to require this.
1188       //
1189       for ($ins = $claim->payerCount() - 1; $ins > 0; --$ins) {
1190         if ($claim->payerSequence($ins) > $claim->payerSequence())
1191           continue; // payer is future, not previous
1192         $payerpaid = $claim->payerTotals($ins, $claim->cptKey($prockey));
1193         ++$edicount;
1194         $out .= "AMT" . // Approved amount per previous payer. Page 485.
1195           "*AAE" .
1196           "*" . sprintf('%.2f', $claim->cptCharges($prockey) - $payerpaid[2]) .
1197           "~\n";
1198         break;
1199       }
1200     }
1201
1202     // Loop 2410, Drug Information. Medicaid insurers seem to want this
1203     // with HCPCS codes.
1204     //
1205     $ndc = $claim->cptNDCID($prockey);
1206     if ($ndc) {
1207       ++$edicount;
1208       $out .= "LIN" . // Drug Identification. Page 500+ (Addendum pg 71).
1209         "*" .         // Per addendum, LIN01 is not used.
1210         "*N4" .
1211         "*" . $ndc .
1212         "~\n";
1213
1214       if (!preg_match('/^\d\d\d\d\d-\d\d\d\d-\d\d$/', $ndc, $tmp) && !preg_match('/^\d{11}$/', $ndc)) {
1215         $log .= "*** NDC code '$ndc' has invalid format!\n";
1216       }
1217
1218       ++$edicount;
1219       $tmpunits = $claim->cptNDCQuantity($prockey) * $claim->cptUnits($prockey);
1220       if (!$tmpunits) $tmpunits = 1;
1221       $out .= "CTP" . // Drug Pricing. Page 500+ (Addendum pg 74).
1222         "*" .
1223         "*" .
1224         "*" . ($CMS_5010 ? '' : sprintf('%.2f', $claim->cptCharges($prockey) / $tmpunits)) .
1225         "*" . $claim->cptNDCQuantity($prockey) .
1226         "*" . $claim->cptNDCUOM($prockey) .
1227         // Note: 5010 documents "ME" (Milligrams) as an additional unit of measure.
1228         "~\n";
1229     }
1230
1231     // Segment REF (Prescription or Compound Drug Association Number) omitted.
1232
1233     // Loop 2420A, Rendering Provider (service-specific).
1234     // Used if the rendering provider for this service line is different
1235     // from that in loop 2310B.
1236     //
1237     if ($claim->providerNPI() != $claim->providerNPI($prockey)) {
1238       ++$edicount;
1239       $out .= "NM1" .       // Loop 2310B Rendering Provider
1240         "*82" .
1241         "*1" .
1242         "*" . $claim->providerLastName($prockey) .
1243         "*" . $claim->providerFirstName($prockey) .
1244         "*" . $claim->providerMiddleName($prockey) .
1245         "*" .
1246         "*";
1247       if ($CMS_5010 || $claim->providerNPI($prockey)) { $out .=
1248         "*XX" .
1249         "*" . $claim->providerNPI($prockey);
1250       } else { $out .=
1251         "*34" .                         // Not allowed for 5010
1252         "*" . $claim->providerSSN($prockey);
1253       }
1254       if (!$claim->providerNPI($prockey)) {
1255         $log .= "*** Rendering provider has no NPI.\n";
1256       }
1257       $out .= "~\n";
1258
1259       if ($claim->providerTaxonomy($prockey)) {
1260         ++$edicount;
1261         $out .= "PRV" .
1262           "*PE" . // PErforming provider
1263           "*" . ($CMS_5010 ? "PXC" : "ZZ") .
1264           "*" . $claim->providerTaxonomy($prockey) .
1265           "~\n";
1266       }
1267
1268       // Segment PRV*PE (Rendering Provider Specialty Information) omitted.
1269       // Segment REF (Rendering Provider Secondary Identification) omitted.
1270       // Segment NM1 (Purchased Service Provider Name) omitted.
1271       // Segment REF (Purchased Service Provider Secondary Identification) omitted.
1272       // Segment NM1,N3,N4 (Service Facility Location) omitted.
1273       // Segment REF (Service Facility Location Secondary Identification) omitted.
1274       // Segment NM1 (Supervising Provider Name) omitted.
1275       // Segment REF (Supervising Provider Secondary Identification) omitted.
1276       // Segment NM1,N3,N4 (Ordering Provider) omitted.
1277       // Segment REF (Ordering Provider Secondary Identification) omitted.
1278       // Segment PER (Ordering Provider Contact Information) omitted.
1279       // Segment NM1 (Referring Provider Name) omitted.
1280       // Segment REF (Referring Provider Secondary Identification) omitted.
1281       // Segments NM1*PW, N3, N4 (Ambulance Pick-Up Location) omitted.
1282       // Segments NM1*45, N3, N4 (Ambulance Drop-Off Location) omitted.
1283
1284       // REF*1C is required here for the Medicare provider number if NPI was
1285       // specified in NM109.  Not sure if other payers require anything here.
1286       if (!$CMS_5010 && $claim->providerNumber($prockey)) {
1287         ++$edicount;
1288         $out .= "REF" .
1289           "*" . $claim->providerNumberType($prockey) .
1290           // Note: 5010 documents that type 1D (Medicaid) is changed to G2.
1291           "*" . $claim->providerNumber($prockey) .
1292           "~\n";
1293       }
1294     }
1295
1296     // Loop 2430, adjudication by previous payers.
1297     //
1298     for ($ins = 1; $ins < $claim->payerCount(); ++$ins) {
1299       if ($claim->payerSequence($ins) > $claim->payerSequence())
1300         continue; // payer is future, not previous
1301
1302       $payerpaid = $claim->payerTotals($ins, $claim->cptKey($prockey));
1303       $aarr = $claim->payerAdjustments($ins, $claim->cptKey($prockey));
1304
1305       if ($payerpaid[1] == 0 && !count($aarr)) {
1306         $log .= "*** Procedure '" . $claim->cptKey($prockey) .
1307           "' has no payments or adjustments from previous payer!\n";
1308         continue;
1309       }
1310
1311       ++$edicount;
1312       $out .= "SVD" . // Service line adjudication. Page 554.
1313         "*" . $claim->payerID($ins) .
1314         "*" . $payerpaid[1] .
1315         "*HC:" . $claim->cptKey($prockey) .
1316         "*" .
1317         "*" . $claim->cptUnits($prockey) .
1318         "~\n";
1319
1320       $tmpdate = $payerpaid[0];
1321       foreach ($aarr as $a) {
1322         ++$edicount;
1323         $out .= "CAS" . // Previous payer's line level adjustments. Page 558.
1324           "*" . $a[1] .
1325           "*" . $a[2] .
1326           "*" . $a[3] .
1327           "~\n";
1328         if (!$tmpdate) $tmpdate = $a[0];
1329
1330         // WTH is this??
1331         /*************************************************************
1332         if ( isset($a[4]) &&
1333                 $a[4] != null ) {
1334                 $out .= "CAS02" . // Previous payer's adjustment reason
1335                   "*" . $a[4] .
1336                   "~\n";
1337         }
1338         *************************************************************/
1339       }
1340
1341       if ($tmpdate) {
1342         ++$edicount;
1343         $out .= "DTP" . // Previous payer's line adjustment date. Page 493/566.
1344           "*573" .
1345           "*D8" .
1346           "*$tmpdate" .
1347           "~\n";
1348       }
1349
1350       // Segment AMT*EAF (Remaining Patient Liability) omitted.
1351       // Segment LQ (Form Identification Code) omitted.
1352       // Segment FRM (Supporting Documentation) omitted.
1353
1354     } // end loop 2430
1355   } // end this procedure
1356
1357   ++$edicount;
1358   $out .= "SE" .        // SE Trailer
1359     "*$edicount" .
1360     "*0021" .
1361     "~\n";
1362
1363   $out .= "GE" .        // GE Trailer
1364     "*1" .
1365     "*1" .
1366     "~\n";
1367
1368   $out .= "IEA" .       // IEA Trailer
1369     "*1" .
1370     "*000000001" .
1371     "~\n";
1372
1373   // Remove any trailing empty fields (delimiters) from each segment.
1374   $out = preg_replace('/\*+~/', '~', $out);
1375
1376   $log .= "\n";
1377   return $out;
1378 }
1379 ?>