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