interface/billing/sl_eob_invoice.php

   1 <?php
   2   // Copyright (C) 2005-2010 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   // This provides for manual posting of EOBs.  It is invoked from
  10   // sl_eob_search.php.  For automated (X12 835) remittance posting
  11   // see sl_eob_process.php.
  12
  13   require_once("../globals.php");
  14   require_once("$srcdir/log.inc");
  15   require_once("$srcdir/patient.inc");
  16   require_once("$srcdir/forms.inc");
  17   require_once("$srcdir/sl_eob.inc.php");
  18   require_once("$srcdir/invoice_summary.inc.php");
  19   require_once("../../custom/code_types.inc.php");
  20
  21   $debug = 0; // set to 1 for debugging mode
  22
  23   $INTEGRATED_AR = $GLOBALS['oer_config']['ws_accounting']['enabled'] === 2;
  24
  25   // If we permit deletion of transactions.  Might change this later.
  26   $ALLOW_DELETE = $INTEGRATED_AR;
  27
  28   $info_msg = "";
  29
  30   // Format money for display.
  31   //
  32   function bucks($amount) {
  33     if ($amount)
  34       printf("%.2f", $amount);
  35   }
  36
  37   // Delete rows, with logging, for the specified table using the
  38   // specified WHERE clause.  Borrowed from deleter.php.
  39   //
  40   function row_delete($table, $where) {
  41     $tres = sqlStatement("SELECT * FROM $table WHERE $where");
  42     $count = 0;
  43     while ($trow = sqlFetchArray($tres)) {
  44       $logstring = "";
  45       foreach ($trow as $key => $value) {
  46         if (! $value || $value == '0000-00-00 00:00:00') continue;
  47         if ($logstring) $logstring .= " ";
  48         $logstring .= $key . "='" . addslashes($value) . "'";
  49       }
  50       newEvent("delete", $_SESSION['authUser'], $_SESSION['authProvider'], 1, "$table: $logstring");
  51       ++$count;
  52     }
  53     if ($count) {
  54       $query = "DELETE FROM $table WHERE $where";
  55       echo $query . "<br>\n";
  56       sqlStatement($query);
  57     }
  58   }
  59 ?>
  60 <html>
  61 <head>
  62 <?php html_header_show(); ?>
  63 <link rel=stylesheet href="<?php echo $css_header;?>" type="text/css">
  64 <title><?php xl('EOB Posting - Invoice','e')?></title>
  65 <script language="JavaScript">
  66
  67 // An insurance radio button is selected.
  68 function setins(istr) {
  69 <?php if (!$INTEGRATED_AR) { ?>
  70  var f = document.forms[0];
  71  for (var i = 0; i < f.elements.length; ++i) {
  72   var ename = f.elements[i].name;
  73   if (ename.indexOf('[src]') < 0) continue;
  74   var evalue = f.elements[i].value;
  75   var tmp = evalue.substring(0, 4).toLowerCase();
  76   if (tmp >= 'ins1' && tmp <= 'ins3')
  77    evalue = evalue.substring(4);
  78   else if (evalue.substring(0, 2).toLowerCase() == 'pt')
  79    evalue = evalue.substring(2);
  80   while (evalue.substring(0, 1) == '/')
  81    evalue = evalue.substring(1);
  82   f.elements[i].value = istr + '/' + evalue;
  83  }
  84 <?php } ?>
  85  return true;
  86 }
  87
  88 // Compute an adjustment that writes off the balance:
  89 function writeoff(code) {
  90  var f = document.forms[0];
  91  var belement = f['form_line[' + code + '][bal]'];
  92  var pelement = f['form_line[' + code + '][pay]'];
  93  var aelement = f['form_line[' + code + '][adj]'];
  94  var relement = f['form_line[' + code + '][reason]'];
  95  var tmp = belement.value - pelement.value;
  96  aelement.value = Number(tmp).toFixed(2);
  97  if (aelement.value && ! relement.value) relement.selectedIndex = 1;
  98  return false;
  99 }
 100
 101 // Onsubmit handler.  A good excuse to write some JavaScript.
 102 function validate(f) {
 103  var delcount = 0;
 104  for (var i = 0; i < f.elements.length; ++i) {
 105   var ename = f.elements[i].name;
 106   // Count deletes.
 107   if (ename.substring(0, 9) == 'form_del[') {
 108    if (f.elements[i].checked) ++delcount;
 109    continue;
 110   }
 111   var pfxlen = ename.indexOf('[pay]');
 112   if (pfxlen < 0) continue;
 113   var pfx = ename.substring(0, pfxlen);
 114   var code = pfx.substring(pfx.indexOf('[')+1, pfxlen-1);
 115   if (f[pfx+'[pay]'].value || f[pfx+'[adj]'].value) {
 116 <?php if (!$INTEGRATED_AR) { // source validation not appropriate ?>
 117    var srcobj = f[pfx+'[src]'];
 118    while (srcobj.value.length) {
 119     var tmp = srcobj.value.substring(srcobj.value.length - 1);
 120     if (tmp > ' ' && tmp != '/') break;
 121     srcobj.value = srcobj.value.substring(0, srcobj.value.length - 1);
 122    }
 123    var svalue = srcobj.value;
 124    if (! svalue) {
 125     alert('<?php xl('Source is missing for code ','e') ?>' + code);
 126     return false;
 127    } else {
 128     var tmp = svalue.substring(0, 4).toLowerCase();
 129     if (tmp >= 'ins1' && tmp <= 'ins3') {
 130      svalue = svalue.substring(4);
 131     } else if (svalue.substring(0, 2).toLowerCase() == 'pt') {
 132      svalue = svalue.substring(2);
 133     } else {
 134      alert('<?php xl('Invalid or missing payer in source for code ','e')?>' + code);
 135      return false;
 136     }
 137     if (svalue) {
 138      if (svalue.substring(0, 1) != '/') {
 139       alert('<?php xl('Missing slash after payer in source for code ','e')?>' + code);
 140       return false;
 141      }
 142      if (false) { // Please keep this, Oakland Clinic wants it.  -- Rod
 143       tmp = svalue.substring(1, 3).toLowerCase();
 144       if (tmp != 'nm' && tmp != 'ci' && tmp != 'cp' && tmp != 'ne' &&
 145           tmp != 'it' && tmp != 'pf' && tmp != 'pp' && tmp != 'ok')
 146       {
 147        alert('<?php xl('Invalid source designation "','e') ?>' + tmp + '<?php xl('" for code ','e') ?>' + code);
 148        return false;
 149       }
 150      } // End of OC code
 151     }
 152    }
 153 <?php } ?>
 154    if (! f[pfx+'[date]'].value) {
 155     alert('<?php xl('Date is missing for code ','e')?>' + code);
 156     return false;
 157    }
 158   }
 159   if (f[pfx+'[pay]'].value && isNaN(parseFloat(f[pfx+'[pay]'].value))) {
 160    alert('<?php xl('Payment value for code ','e') ?>' + code + '<?php xl(' is not a number','e') ?>');
 161    return false;
 162   }
 163   if (f[pfx+'[adj]'].value && isNaN(parseFloat(f[pfx+'[adj]'].value))) {
 164    alert('<?php xl('Adjustment value for code ','e') ?>' + code + '<?php xl(' is not a number','e') ?>');
 165    return false;
 166   }
 167   if (f[pfx+'[adj]'].value && ! f[pfx+'[reason]'].value) {
 168    alert('<?php xl('Please select an adjustment reason for code ','e') ?>' + code);
 169    return false;
 170   }
 171   // TBD: validate the date format
 172  }
 173  // Demand confirmation if deleting anything.
 174  if (delcount > 0) {
 175   if (!confirm('<?php echo xl('Really delete'); ?> ' + delcount +
 176    ' <?php echo xl('transactions'); ?>?' +
 177    ' <?php echo xl('This action will be logged'); ?>!')
 178   ) return false;
 179  }
 180  return true;
 181 }
 182
 183 <!-- Get current date -->
 184
 185 function getFormattedToday()
 186 {
 187    var today = new Date();
 188    var dd = today.getDate();
 189    var mm = today.getMonth()+1; //January is 0!
 190    var yyyy = today.getFullYear();
 191    if(dd<10){dd='0'+dd}
 192    if(mm<10){mm='0'+mm}
 193
 194    return (yyyy + '-' + mm + '-' + dd);
 195 }
 196
 197 <!-- Update Payment Fields -->
 198
 199 function updateFields(payField, adjField, balField, coPayField, isFirstProcCode)
 200 {
 201    var payAmount = 0.0;
 202    var adjAmount = 0.0;
 203    var balAmount = 0.0;
 204    var coPayAmount = 0.0;
 205
 206    // coPayFiled will be null if there is no co-pay entry in the fee sheet
 207    if (coPayField)
 208       coPayAmount = coPayField.value;
 209
 210    // if balance field is 0.00, its value comes back as null, so check for nul-ness first
 211    if (balField)
 212       balAmount = (balField.value) ? balField.value : 0;
 213    if (payField)
 214       payAmount = (payField.value) ? payField.value : 0;
 215
 216    //alert('balance = >' + balAmount +'<  payAmount = ' + payAmount + '  copay = ' + coPayAmount + '  isFirstProcCode = ' + isFirstProcCode);
 217
 218    // subtract the co-pay only from the first procedure code
 219    if (isFirstProcCode == 1)
 220       balAmount = parseFloat(balAmount) + parseFloat(coPayAmount);
 221
 222    adjAmount = balAmount - payAmount;
 223
 224    // Assign rounded adjustment value back to TextField
 225    adjField.value = adjAmount = Math.round(adjAmount*100)/100;
 226 }
 227
 228 </script>
 229 </head>
 230 <body leftmargin='0' topmargin='0' marginwidth='0' marginheight='0'>
 231 <?php
 232   $trans_id = 0 + $_GET['id'];
 233   if (! $trans_id) die(xl("You cannot access this page directly."));
 234
 235   if ($INTEGRATED_AR) {
 236     // In the Integrated A/R case, $trans_id matches form_encounter.id.
 237     $ferow = sqlQuery("SELECT e.*, p.fname, p.mname, p.lname " .
 238       "FROM form_encounter AS e, patient_data AS p WHERE " .
 239       "e.id = '$trans_id' AND p.pid = e.pid");
 240     if (empty($ferow)) die("There is no encounter with form_encounter.id = '$trans_id'.");
 241     $patient_id        = 0 + $ferow['pid'];
 242     $encounter_id      = 0 + $ferow['encounter'];
 243     $svcdate           = substr($ferow['date'], 0, 10);
 244     $form_payer_id     = 0 + $_POST['form_payer_id'];
 245     $form_reference    = $_POST['form_reference'];
 246     $form_check_date   = fixDate($_POST['form_check_date'], date('Y-m-d'));
 247     $form_deposit_date = fixDate($_POST['form_deposit_date'], $form_check_date);
 248     $form_pay_total    = 0 + $_POST['form_pay_total'];
 249   }
 250   else {
 251     slInitialize();
 252   }
 253
 254   $payer_type = 0;
 255   if (preg_match('/^Ins(\d)/i', $_POST['form_insurance'], $matches)) {
 256     $payer_type = $matches[1];
 257   }
 258
 259   if ($_POST['form_save'] || $_POST['form_cancel']) {
 260     if ($_POST['form_save']) {
 261       if ($debug) {
 262         echo xl("This module is in test mode. The database will not be changed.",'','<p><b>',"</b><p>\n");
 263       }
 264
 265       if ($INTEGRATED_AR) {
 266         $session_id = arGetSession($form_payer_id, $form_reference,
 267           $form_check_date, $form_deposit_date, $form_pay_total);
 268         // The sl_eob_search page needs its invoice links modified to invoke
 269         // javascript to load form parms for all the above and submit.
 270         // At the same time that page would be modified to work off the
 271         // openemr database exclusively.
 272         // And back to the sl_eob_invoice page, I think we may want to move
 273         // the source input fields from row level to header level.
 274
 275         // Handle deletes. row_delete() is borrowed from deleter.php.
 276         if ($ALLOW_DELETE && !$debug) {
 277           foreach ($_POST['form_del'] as $arseq => $dummy) {
 278             row_delete("ar_activity", "pid = '$patient_id' AND " .
 279               "encounter = '$encounter_id' AND sequence_no = '$arseq'");
 280           }
 281         }
 282       }
 283
 284       $paytotal = 0;
 285       foreach ($_POST['form_line'] as $code => $cdata) {
 286         if (!$INTEGRATED_AR) {
 287           $thissrc  = trim($cdata['src']);
 288           $thisdate = trim($cdata['date']);
 289         }
 290         $thispay  = trim($cdata['pay']);
 291         $thisadj  = trim($cdata['adj']);
 292         $thisins  = trim($cdata['ins']);
 293         $reason   = trim($cdata['reason']);
 294         if (strpos(strtolower($reason), 'ins') !== false)
 295           $reason .= ' ' . $_POST['form_insurance'];
 296         if (! $thisins) $thisins = 0;
 297
 298         if ($thispay) {
 299           if ($INTEGRATED_AR) {
 300             arPostPayment($patient_id, $encounter_id, $session_id,
 301               $thispay, $code, $payer_type, $reason, $debug);
 302           } else {
 303             slPostPayment($trans_id, $thispay, $thisdate, $thissrc, $code, $thisins, $debug);
 304           }
 305           $paytotal += $thispay;
 306         }
 307
 308         // Be sure to record adjustment reasons even for zero adjustments.
 309         if ($thisadj || $reason) {
 310           // "To copay" and "To ded'ble" need to become a comment in a zero
 311           // adjustment, formatted just like sl_eob_process.php.
 312           if (preg_match("/To copay/", $reason)) {
 313             $reason = $_POST['form_insurance'] . " coins: $thisadj";
 314             $thisadj = 0;
 315           }
 316           else if (preg_match("/To ded'ble/", $reason)) {
 317             $reason = $_POST['form_insurance'] . " dedbl: $thisadj";
 318             $thisadj = 0;
 319           }
 320           if ($INTEGRATED_AR) {
 321             arPostAdjustment($patient_id, $encounter_id, $session_id,
 322               $thisadj, $code, $payer_type, $reason, $debug);
 323           } else {
 324             slPostAdjustment($trans_id, $thisadj, $thisdate, $thissrc, $code, $thisins, $reason, $debug);
 325           }
 326         }
 327       }
 328
 329       // Maintain which insurances are marked as finished.
 330
 331       if ($INTEGRATED_AR) {
 332         $form_done = 0 + $_POST['form_done'];
 333         $form_stmt_count = 0 + $_POST['form_stmt_count'];
 334         sqlStatement("UPDATE form_encounter " .
 335           "SET last_level_closed = $form_done, " .
 336           "stmt_count = $form_stmt_count WHERE " .
 337           "pid = '$patient_id' AND encounter = '$encounter_id'");
 338       }
 339       else {
 340         $form_duedate = fixDate($_POST['form_duedate']);
 341         $form_notes = trim($_POST['form_notes']);
 342         // We use the "Ship Via" field of the invoice to hold these.
 343         $form_eobs = "";
 344         foreach (array('Ins1', 'Ins2', 'Ins3') as $value) {
 345           if ($_POST["form_done_$value"]) {
 346             if ($form_eobs) $form_eobs .= ","; else $form_eobs = "Done: ";
 347             $form_eobs .= $value;
 348           }
 349         }
 350         $query = "UPDATE ar SET duedate = '$form_duedate', notes = '$form_notes', " .
 351           "shipvia = '$form_eobs' WHERE id = $trans_id";
 352         if ($debug) {
 353           echo $query . "<br>\n";
 354         } else {
 355           SLQuery($query);
 356           if ($sl_err) die($sl_err);
 357         }
 358       }
 359
 360       if ($_POST['form_secondary']) {
 361         if ($INTEGRATED_AR) {
 362           arSetupSecondary($patient_id, $encounter_id, $debug);
 363         } else {
 364           slSetupSecondary($trans_id, $debug);
 365         }
 366       }
 367
 368       echo "<script language='JavaScript'>\n";
 369       echo " if (opener.document.forms[0].form_amount) {\n";
 370       echo "  var tmp = opener.document.forms[0].form_amount.value - $paytotal;\n";
 371       echo "  opener.document.forms[0].form_amount.value = Number(tmp).toFixed(2);\n";
 372       echo " }\n";
 373     } else {
 374       echo "<script language='JavaScript'>\n";
 375     }
 376     if ($info_msg) echo " alert('$info_msg');\n";
 377     if (! $debug) echo " window.close();\n";
 378     echo "</script></body></html>\n";
 379     if (!$INTEGRATED_AR) SLClose();
 380     exit();
 381   }
 382
 383   if ($INTEGRATED_AR) {
 384     // Get invoice charge details.
 385     $codes = ar_get_invoice_summary($patient_id, $encounter_id, true);
 386   }
 387   else {
 388     // Get invoice data into $arrow.
 389     $arres = SLQuery("select ar.*, customer.name, employee.name as doctor " .
 390       "from ar, customer, employee where ar.id = $trans_id and " .
 391       "customer.id = ar.customer_id and employee.id = ar.employee_id");
 392     if ($sl_err) die($sl_err);
 393     $arrow = SLGetRow($arres, 0);
 394     if (! $arrow) die(xl("There is no match for invoice id = ") . $trans_id);
 395     //
 396     // Determine the date of service.  An 8-digit encounter number is
 397     // presumed to be a date of service imported during conversion.
 398     // Otherwise look it up in the form_encounter table.
 399     //
 400     $svcdate = "";
 401     list($patient_id, $encounter) = explode(".", $arrow['invnumber']);
 402     if (strlen($encounter) == 8) {
 403       $svcdate = substr($encounter, 0, 4) . "-" . substr($encounter, 4, 2) .
 404         "-" . substr($encounter, 6, 2);
 405     }
 406     else if ($encounter) {
 407       $tmp = sqlQuery("SELECT date FROM form_encounter WHERE " .
 408         "encounter = $encounter");
 409       $svcdate = substr($tmp['date'], 0, 10);
 410     }
 411
 412     // Get invoice charge details.
 413     $codes = get_invoice_summary($trans_id, true);
 414   }
 415
 416   $pdrow = sqlQuery("select genericname2, genericval2 " .
 417     "from patient_data where pid = '$patient_id' limit 1");
 418 ?>
 419 <center>
 420
 421 <form method='post' action='sl_eob_invoice.php?id=<?php echo $trans_id ?>'
 422  onsubmit='return validate(this)'>
 423
 424 <table border='0' cellpadding='3'>
 425  <tr>
 426   <td>
 427    <?php xl('Patient:','e')?>
 428   </td>
 429   <td>
 430 <?php
 431   if ($INTEGRATED_AR) {
 432     echo $ferow['fname'] . ' ' . $ferow['mname'] . ' ' . $ferow['lname'];
 433   }
 434   else {
 435     echo $arrow['name'];
 436   }
 437 ?>
 438   </td>
 439   <td colspan="2" rowspan="3">
 440 <?php
 441   if ($INTEGRATED_AR) {
 442     for ($i = 1; $i <= 3; ++$i) {
 443       $payerid = arGetPayerID($patient_id, $svcdate, $i);
 444       if ($payerid) {
 445         $tmp = sqlQuery("SELECT name FROM insurance_companies WHERE id = $payerid");
 446         echo "Ins$i: " . $tmp['name'] . "<br />";
 447       }
 448     }
 449   }
 450   else {
 451     echo "   <textarea name='form_notes' cols='50' style='height:100%'>";
 452     echo $arrow['notes'];
 453     echo "</textarea>\n";
 454   }
 455 ?>
 456   </td>
 457 <?php
 458   if ($INTEGRATED_AR) {
 459     echo "<td rowspan='3' valign='bottom'>\n";
 460     echo xl('Statements Sent:');
 461     echo "</td>\n";
 462     echo "<td rowspan='3' valign='bottom'>\n";
 463     echo "<input type='text' name='form_stmt_count' size='10' value='" .
 464       (0 + $ferow['stmt_count']) . "' />\n";
 465     echo "</td>\n";
 466   }
 467 ?>
 468  </tr>
 469  <tr>
 470   <td>
 471    <?php xl('Provider:','e')?>
 472   </td>
 473   <td>
 474    <?php
 475   if ($INTEGRATED_AR) {
 476     $tmp = sqlQuery("SELECT fname, mname, lname " .
 477       "FROM users WHERE id = " . $ferow['provider_id']);
 478     echo $tmp['fname'] . ' ' . $tmp['mname'] . ' ' . $tmp['lname'];
 479     $tmp = sqlQuery("SELECT bill_date FROM billing WHERE " .
 480       "pid = '$patient_id' AND encounter = '$encounter_id' AND " .
 481       "activity = 1 ORDER BY fee DESC, id ASC LIMIT 1");
 482     $billdate = substr(($tmp['bill_date'] . "Not Billed"), 0, 10);
 483   }
 484   else {
 485     echo $arrow['doctor'];
 486   }
 487 ?>
 488   </td>
 489  </tr>
 490  <tr>
 491   <td>
 492    <?php xl('Invoice:','e')?>
 493   </td>
 494   <td>
 495 <?php
 496   if ($INTEGRATED_AR) {
 497     echo "$patient_id.$encounter_id";
 498   }
 499   else {
 500     echo $arrow['invnumber'];
 501   }
 502 ?>
 503   </td>
 504  </tr>
 505
 506  <tr>
 507   <td>
 508 <?php xl('Svc Date:','e'); ?>
 509   </td>
 510   <td>
 511 <?php
 512     echo $svcdate;
 513 ?>
 514   </td>
 515   <td colspan="2">
 516    <?php xl('Done with:','e','',"&nbsp")?>;
 517 <?php
 518   // Write a checkbox for each insurance.  It is to be checked when
 519   // we no longer expect any payments from that company for the claim.
 520   if ($INTEGRATED_AR) {
 521     $last_level_closed = 0 + $ferow['last_level_closed'];
 522     foreach (array(0 => 'None', 1 => 'Ins1', 2 => 'Ins2', 3 => 'Ins3') as $key => $value) {
 523       if ($key && !arGetPayerID($patient_id, $svcdate, $key)) continue;
 524       $checked = ($last_level_closed == $key) ? " checked" : "";
 525       echo "   <input type='radio' name='form_done' value='$key'$checked />$value&nbsp;\n";
 526     }
 527   }
 528   else {
 529     // The information is stored in the 'shipvia' field of the invoice.
 530     $insgot  = strtolower($arrow['notes']);
 531     $insdone = strtolower($arrow['shipvia']);
 532     foreach (array('Ins1', 'Ins2', 'Ins3') as $value) {
 533       $lcvalue = strtolower($value);
 534       $checked  = (strpos($insdone, $lcvalue) === false) ? "" : " checked";
 535       if (strpos($insgot, $lcvalue) !== false) {
 536         echo "   <input type='checkbox' name='form_done_$value' value='1'$checked />$value&nbsp;\n";
 537       }
 538     }
 539   }
 540 ?>
 541   </td>
 542 <?php
 543   if ($INTEGRATED_AR) {
 544     echo "<td>\n";
 545     echo xl('Check/EOB No.:');
 546     echo "</td>\n";
 547     echo "<td>\n";
 548     echo "<input type='text' name='form_reference' size='10' value='' />\n";
 549     echo "</td>\n";
 550   }
 551 ?>
 552  </tr>
 553
 554  <tr>
 555   <td>
 556    <?php xl('Last Bill Date:','e') ?>
 557   </td>
 558   <td>
 559    <?php
 560   if ($INTEGRATED_AR) {
 561     echo $billdate;
 562   }
 563   else {
 564     echo $arrow['transdate'];
 565   }
 566 ?>
 567   </td>
 568   <td colspan="2">
 569    <?php xl('Now posting for:','e','',"&nbsp")?>;
 570
 571 <?php
 572   // TBD: check the first not-done-with insurance, not always Ins1!
 573 ?>
 574    <input type='radio' name='form_insurance' value='Ins1' onclick='setins("Ins1")' checked /><?php xl('Ins1','e')?>&nbsp;
 575    <input type='radio' name='form_insurance' value='Ins2' onclick='setins("Ins2")' /><?php xl('Ins2','e')?>&nbsp;
 576    <input type='radio' name='form_insurance' value='Ins3' onclick='setins("Ins3")' /><?php xl('Ins3','e')?>&nbsp;
 577    <input type='radio' name='form_insurance' value='Pt'   onclick='setins("Pt")'   /><?php xl('Patient','e')?>
 578
 579 <?php
 580   // TBD: I think the following is unused and can be removed.
 581 ?>
 582    <input type='hidden' name='form_eobs' value='<?php echo addslashes($arrow['shipvia']) ?>' />
 583
 584   </td>
 585 <?php
 586   if ($INTEGRATED_AR) {
 587     echo "<td>\n";
 588     echo xl('Check/EOB Date:');
 589     echo "</td>\n";
 590     echo "<td>\n";
 591     echo "<input type='text' name='form_check_date' size='10' value='' />\n";
 592     echo "</td>\n";
 593   }
 594 ?>
 595  </tr>
 596  <tr>
 597   <td>
 598    <?php
 599   if (!$INTEGRATED_AR) xl('Due Date:','e');
 600 ?>
 601   </td>
 602   <td>
 603
 604 <?php if (!$INTEGRATED_AR) { ?>
 605    <input type='text' name='form_duedate' size='10' value='<?php echo $arrow['duedate'] ?>'
 606     title='<?php xl('Due date mm/dd/yyyy or yyyy-mm-dd','e')?>'>
 607 <?php } ?>
 608   </td>
 609   <td colspan="2">
 610    <input type="checkbox" name="form_secondary" value="1"> <?php xl('Needs secondary billing','e')?>
 611    &nbsp;&nbsp;
 612    <input type='submit' name='form_save' value='<?php xl('Save','e')?>'>
 613    &nbsp;
 614    <input type='button' value='<?php xl('Cancel','e')?>' onclick='window.close()'>
 615   </td>
 616 <?php
 617   if ($INTEGRATED_AR) {
 618     echo "<td>\n";
 619     echo xl('Deposit Date:');
 620     echo "</td>\n";
 621     echo "<td>\n";
 622     echo "<input type='text' name='form_deposit_date' size='10' value='' />\n";
 623     echo "<input type='hidden' name='form_payer_id' value='' />\n";
 624     echo "<input type='hidden' name='form_orig_reference' value='' />\n";
 625     echo "<input type='hidden' name='form_orig_check_date' value='' />\n";
 626     echo "<input type='hidden' name='form_orig_deposit_date' value='' />\n";
 627     echo "<input type='hidden' name='form_pay_total' value='' />\n";
 628     echo "</td>\n";
 629   }
 630 ?>
 631  </tr>
 632 <?php if ($pdrow['genericname2'] == 'Billing') { ?>
 633  <tr>
 634   <td>
 635    <?php xl('Billing Note:','e')?>
 636   </td>
 637   <td colspan='3' style='color:red'>
 638    <?php echo $pdrow['genericval2'] ?>
 639   </td>
 640  </tr>
 641 <?php } ?>
 642  <tr>
 643   <td height="1">
 644   </td>
 645  </tr>
 646 </table>
 647
 648 <table border='0' cellpadding='2' cellspacing='0' width='98%'>
 649
 650  <tr bgcolor="#cccccc">
 651   <td class="dehead">
 652    <?php xl('Code','e')?>
 653   </td>
 654   <td class="dehead" align="right">
 655    <?php xl('Charge','e')?>
 656   </td>
 657   <td class="dehead" align="right">
 658    <?php xl('Balance','e')?>&nbsp;
 659   </td>
 660   <td class="dehead">
 661    <?php xl('By/Source','e')?>
 662   </td>
 663   <td class="dehead">
 664    <?php xl('Date','e')?>
 665   </td>
 666   <td class="dehead">
 667    <?php xl('Pay','e')?>
 668   </td>
 669   <td class="dehead">
 670    <?php xl('Adjust','e')?>
 671   </td>
 672   <td class="dehead">
 673    <?php xl('Reason','e')?>
 674   </td>
 675 <?php if ($ALLOW_DELETE) { ?>
 676   <td class="dehead">
 677    <?php xl('Del','e')?>
 678   </td>
 679 <?php } ?>
 680  </tr>
 681 <?php
 682   $firstProcCodeIndex = -1;
 683   $encount = 0;
 684   foreach ($codes as $code => $cdata) {
 685    ++$encount;
 686    $bgcolor = "#" . (($encount & 1) ? "ddddff" : "ffdddd");
 687    $dispcode = $code;
 688
 689    // remember the index of the first entry whose code is not "CO-PAY", i.e. it's a legitimate proc code
 690    if ($firstProcCodeIndex == -1 && strcmp($code, "CO-PAY") !=0)
 691     $firstProcCodeIndex = $encount;
 692
 693    // this sorts the details more or less chronologically:
 694    ksort($cdata['dtl']);
 695    foreach ($cdata['dtl'] as $dkey => $ddata) {
 696     $ddate = substr($dkey, 0, 10);
 697     if (preg_match('/^(\d\d\d\d)(\d\d)(\d\d)\s*$/', $ddate, $matches)) {
 698      $ddate = $matches[1] . '-' . $matches[2] . '-' . $matches[3];
 699     }
 700     $tmpchg = "";
 701     $tmpadj = "";
 702     /*****************************************************************
 703     if ($ddata['chg'] > 0)
 704      $tmpchg = $ddata['chg'];
 705     else if ($ddata['chg'] < 0)
 706      $tmpadj = 0 - $ddata['chg'];
 707     *****************************************************************/
 708     if ($ddata['chg'] != 0) {
 709       if (isset($ddata['rsn'])) $tmpadj = 0 - $ddata['chg'];
 710       else $tmpchg = $ddata['chg'];
 711     }
 712 ?>
 713  <tr bgcolor='<?php echo $bgcolor ?>'>
 714   <td class="detail">
 715    <?php echo $dispcode; $dispcode = "" ?>
 716   </td>
 717   <td class="detail" align="right">
 718    <?php bucks($tmpchg) ?>
 719   </td>
 720   <td class="detail" align="right">
 721    &nbsp;
 722   </td>
 723   <td class="detail">
 724    <?php
 725     if (isset($ddata['plv'])) {
 726       if (!$ddata['plv']) echo 'Pt/';
 727       else echo 'Ins' . $ddata['plv'] . '/';
 728     }
 729     echo $ddata['src'];
 730    ?>
 731   </td>
 732   <td class="detail">
 733    <?php echo $ddate ?>
 734   </td>
 735   <td class="detail">
 736    <?php bucks($ddata['pmt']) ?>
 737   </td>
 738   <td class="detail">
 739    <?php bucks($tmpadj) ?>
 740   </td>
 741   <td class="detail">
 742    <?php echo $ddata['rsn'] ?>
 743   </td>
 744 <?php if ($ALLOW_DELETE) { ?>
 745   <td class="detail">
 746 <?php if (!empty($ddata['arseq'])) { ?>
 747    <input type="checkbox" name="form_del[<?php echo $ddata['arseq']; ?>]" />
 748 <?php } else { ?>
 749    &nbsp;
 750 <?php } ?>
 751   </td>
 752 <?php } ?>
 753  </tr>
 754 <?php
 755    } // end of prior detail line
 756 ?>
 757  <tr bgcolor='<?php echo $bgcolor ?>'>
 758   <td class="detail">
 759    <?php echo $dispcode; $dispcode = "" ?>
 760   </td>
 761   <td class="detail" align="right">
 762    &nbsp;
 763   </td>
 764   <td class="detail" align="right">
 765    <input type="hidden" name="form_line[<?php echo $code ?>][bal]" value="<?php bucks($cdata['bal']) ?>">
 766    <input type="hidden" name="form_line[<?php echo $code ?>][ins]" value="<?php echo $cdata['ins'] ?>">
 767    <?php printf("%.2f", $cdata['bal']) ?>&nbsp;
 768   </td>
 769   <td class="detail">
 770
 771 <?php if (!$INTEGRATED_AR) { ?>
 772    <input type="text" name="form_line[<?php echo $code ?>][src]" size="10"
 773     style="background-color:<?php echo $bgcolor ?>" />
 774     <!-- title="NM=notmet, CI=coins, CP=copay, NE=notelig, IT=insterm, PF=ptfull, PP=ptpart" -->
 775 <?php } ?>
 776
 777   </td>
 778   <td class="detail">
 779
 780 <?php if (!$INTEGRATED_AR) { ?>
 781    <input type="text" name="form_line[<?php echo $code ?>][date]" size="10"
 782     style="background-color:<?php echo $bgcolor ?>" />
 783 <?php } ?>
 784
 785   </td>
 786   <td class="detail">
 787    <input type="text" name="form_line[<?php echo $code ?>][pay]" size="10"
 788     style="background-color:<?php echo $bgcolor ?>"
 789     onKeyUp="updateFields(document.forms[0]['form_line[<?php echo $code ?>][pay]'],
 790                           document.forms[0]['form_line[<?php echo $code ?>][adj]'],
 791                           document.forms[0]['form_line[<?php echo $code ?>][bal]'],
 792                           document.forms[0]['form_line[CO-PAY][bal]'],
 793                           <?php echo ($firstProcCodeIndex == $encount) ? 1 : 0 ?>)"/>
 794   </td>
 795   <td class="detail">
 796    <input type="text" name="form_line[<?php echo $code ?>][adj]" size="10"
 797     value='<?php echo $totalAdjAmount ?>'
 798     style="background-color:<?php echo $bgcolor ?>" />
 799    &nbsp; <a href="" onclick="return writeoff('<?php echo $code ?>')">W</a>
 800   </td>
 801   <td class="detail">
 802    <select name="form_line[<?php echo $code ?>][reason]"
 803     style="background-color:<?php echo $bgcolor ?>">
 804 <?php
 805 // Adjustment reasons are now taken from the list_options table.
 806 echo "    <option value=''></option>\n";
 807 $ores = sqlStatement("SELECT option_id, title FROM list_options " .
 808   "WHERE list_id = 'adjreason' ORDER BY seq, title");
 809 while ($orow = sqlFetchArray($ores)) {
 810   echo "    <option value='" . addslashes($orow['option_id']) . "'";
 811   echo ">" . $orow['title'] . "</option>\n";
 812 }
 813 ?>
 814    </select>
 815 <?php
 816     // TBD: Maybe a comment field would be good here, for appending
 817     // to the reason.
 818 ?>
 819   </td>
 820
 821 <?php if ($ALLOW_DELETE) { ?>
 822   <td class="detail">
 823    &nbsp;
 824   </td>
 825 <?php } ?>
 826
 827  </tr>
 828 <?php
 829   } // end of code
 830   if (!$INTEGRATED_AR) SLClose();
 831 ?>
 832
 833 </table>
 834 </form>
 835 </center>
 836 <script language="JavaScript">
 837  var f1 = opener.document.forms[0];
 838  var f2 = document.forms[0];
 839  if (f1.form_source) {
 840 <?php
 841   if ($INTEGRATED_AR) {
 842     // These support creation and lookup of ar_session table entries:
 843     echo "  f2.form_reference.value         = f1.form_source.value;\n";
 844     echo "  f2.form_check_date.value        = f1.form_paydate.value;\n";
 845     echo "  //f2.form_deposit_date.value      = f1.form_deposit_date.value;\n";
 846     echo "  if (f1.form_deposit_date.value != '')\n";
 847     echo "     f2.form_deposit_date.value      = f1.form_deposit_date.value;\n";
 848     echo "  else\n";
 849     echo "     f2.form_deposit_date.value      = getFormattedToday();\n";
 850     echo "  f2.form_payer_id.value          = f1.form_payer_id.value;\n";
 851     echo "  f2.form_pay_total.value         = f1.form_amount.value;\n";
 852     echo "  f2.form_orig_reference.value    = f1.form_source.value;\n";
 853     echo "  f2.form_orig_check_date.value   = f1.form_paydate.value;\n";
 854     echo "  f2.form_orig_deposit_date.value = f1.form_deposit_date.value;\n";
 855
 856     // While I'm thinking about it, some notes about eob sessions.
 857     // If they do not have all of the session key fields in the search
 858     // page, then show a warning at the top of the invoice page.
 859     // Also when they go to save the invoice page and a session key
 860     // field has changed, alert them to that and allow a cancel.
 861
 862     // Another point... when posting EOBs, the incoming payer ID might
 863     // not match the payer ID for the patient's insurance.  This is
 864     // because the same payer might be entered more than once into the
 865     // insurance_companies table.  I don't think it matters much.
 866   }
 867   else {
 868     foreach ($codes as $code => $cdata) {
 869       echo "  f2['form_line[$code][src]'].value  = f1.form_source.value;\n";
 870       echo "  f2['form_line[$code][date]'].value = f1.form_paydate.value;\n";
 871     }
 872   }
 873 ?>
 874  }
 875  setins("Ins1");
 876 </script>
 877 </body>
 878 </html>