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("$srcdir/invoice_summary.inc.php");
  19   require_once("../../custom/code_types.inc.php");
  20   require_once("$srcdir/formdata.inc.php");
  21
  22   $debug = 0; // set to 1 for debugging mode
  23
  24   $INTEGRATED_AR = $GLOBALS['oer_config']['ws_accounting']['enabled'] === 2;
  25
  26   // If we permit deletion of transactions.  Might change this later.
  27   $ALLOW_DELETE = $INTEGRATED_AR;
  28
  29   $info_msg = "";
  30
  31   // Format money for display.
  32   //
  33   function bucks($amount) {
  34     if ($amount)
  35       printf("%.2f", $amount);
  36   }
  37
  38   // Delete rows, with logging, for the specified table using the
  39   // specified WHERE clause.  Borrowed from deleter.php.
  40   //
  41   function row_delete($table, $where) {
  42     $tres = sqlStatement("SELECT * FROM $table WHERE $where");
  43     $count = 0;
  44     while ($trow = sqlFetchArray($tres)) {
  45       $logstring = "";
  46       foreach ($trow as $key => $value) {
  47         if (! $value || $value == '0000-00-00 00:00:00') continue;
  48         if ($logstring) $logstring .= " ";
  49         $logstring .= $key . "='" . addslashes($value) . "'";
  50       }
  51       newEvent("delete", $_SESSION['authUser'], $_SESSION['authProvider'], 1, "$table: $logstring");
  52       ++$count;
  53     }
  54     if ($count) {
  55       $query = "DELETE FROM $table WHERE $where";
  56       echo $query . "<br>\n";
  57       sqlStatement($query);
  58     }
  59   }
  60 ?>
  61 <html>
  62 <head>
  63 <?php html_header_show(); ?>
  64 <link rel=stylesheet href="<?php echo $css_header;?>" type="text/css">
  65 <title><?php xl('EOB Posting - Invoice','e')?></title>
  66 <script language="JavaScript">
  67
  68 // An insurance radio button is selected.
  69 function setins(istr) {
  70 <?php if (!$INTEGRATED_AR) { ?>
  71  var f = document.forms[0];
  72  for (var i = 0; i < f.elements.length; ++i) {
  73   var ename = f.elements[i].name;
  74   if (ename.indexOf('[src]') < 0) continue;
  75   var evalue = f.elements[i].value;
  76   var tmp = evalue.substring(0, 4).toLowerCase();
  77   if (tmp >= 'ins1' && tmp <= 'ins3')
  78    evalue = evalue.substring(4);
  79   else if (evalue.substring(0, 2).toLowerCase() == 'pt')
  80    evalue = evalue.substring(2);
  81   while (evalue.substring(0, 1) == '/')
  82    evalue = evalue.substring(1);
  83   f.elements[i].value = istr + '/' + evalue;
  84  }
  85 <?php } ?>
  86  return true;
  87 }
  88
  89 // Compute an adjustment that writes off the balance:
  90 function writeoff(code) {
  91  var f = document.forms[0];
  92  var belement = f['form_line[' + code + '][bal]'];
  93  var pelement = f['form_line[' + code + '][pay]'];
  94  var aelement = f['form_line[' + code + '][adj]'];
  95  var relement = f['form_line[' + code + '][reason]'];
  96  var tmp = belement.value - pelement.value;
  97  aelement.value = Number(tmp).toFixed(2);
  98  if (aelement.value && ! relement.value) relement.selectedIndex = 1;
  99  return false;
 100 }
 101
 102 // Onsubmit handler.  A good excuse to write some JavaScript.
 103 function validate(f) {
 104  var delcount = 0;
 105  for (var i = 0; i < f.elements.length; ++i) {
 106   var ename = f.elements[i].name;
 107   // Count deletes.
 108   if (ename.substring(0, 9) == 'form_del[') {
 109    if (f.elements[i].checked) ++delcount;
 110    continue;
 111   }
 112   var pfxlen = ename.indexOf('[pay]');
 113   if (pfxlen < 0) continue;
 114   var pfx = ename.substring(0, pfxlen);
 115   var code = pfx.substring(pfx.indexOf('[')+1, pfxlen-1);
 116   if (f[pfx+'[pay]'].value || f[pfx+'[adj]'].value) {
 117 <?php if (!$INTEGRATED_AR) { // source validation not appropriate ?>
 118    var srcobj = f[pfx+'[src]'];
 119    while (srcobj.value.length) {
 120     var tmp = srcobj.value.substring(srcobj.value.length - 1);
 121     if (tmp > ' ' && tmp != '/') break;
 122     srcobj.value = srcobj.value.substring(0, srcobj.value.length - 1);
 123    }
 124    var svalue = srcobj.value;
 125    if (! svalue) {
 126     alert('<?php xl('Source is missing for code ','e') ?>' + code);
 127     return false;
 128    } else {
 129     var tmp = svalue.substring(0, 4).toLowerCase();
 130     if (tmp >= 'ins1' && tmp <= 'ins3') {
 131      svalue = svalue.substring(4);
 132     } else if (svalue.substring(0, 2).toLowerCase() == 'pt') {
 133      svalue = svalue.substring(2);
 134     } else {
 135      alert('<?php xl('Invalid or missing payer in source for code ','e')?>' + code);
 136      return false;
 137     }
 138     if (svalue) {
 139      if (svalue.substring(0, 1) != '/') {
 140       alert('<?php xl('Missing slash after payer in source for code ','e')?>' + code);
 141       return false;
 142      }
 143      if (false) { // Please keep this, Oakland Clinic wants it.  -- Rod
 144       tmp = svalue.substring(1, 3).toLowerCase();
 145       if (tmp != 'nm' && tmp != 'ci' && tmp != 'cp' && tmp != 'ne' &&
 146           tmp != 'it' && tmp != 'pf' && tmp != 'pp' && tmp != 'ok')
 147       {
 148        alert('<?php xl('Invalid source designation "','e') ?>' + tmp + '<?php xl('" for code ','e') ?>' + code);
 149        return false;
 150       }
 151      } // End of OC code
 152     }
 153    }
 154 <?php } ?>
 155    if (! f[pfx+'[date]'].value) {
 156     alert('<?php xl('Date is missing for code ','e')?>' + code);
 157     return false;
 158    }
 159   }
 160   if (f[pfx+'[pay]'].value && isNaN(parseFloat(f[pfx+'[pay]'].value))) {
 161    alert('<?php xl('Payment value for code ','e') ?>' + code + '<?php xl(' is not a number','e') ?>');
 162    return false;
 163   }
 164   if (f[pfx+'[adj]'].value && isNaN(parseFloat(f[pfx+'[adj]'].value))) {
 165    alert('<?php xl('Adjustment value for code ','e') ?>' + code + '<?php xl(' is not a number','e') ?>');
 166    return false;
 167   }
 168   if (f[pfx+'[adj]'].value && ! f[pfx+'[reason]'].value) {
 169    alert('<?php xl('Please select an adjustment reason for code ','e') ?>' + code);
 170    return false;
 171   }
 172   // TBD: validate the date format
 173  }
 174  // Demand confirmation if deleting anything.
 175  if (delcount > 0) {
 176   if (!confirm('<?php echo xl('Really delete'); ?> ' + delcount +
 177    ' <?php echo xl('transactions'); ?>?' +
 178    ' <?php echo xl('This action will be logged'); ?>!')
 179   ) return false;
 180  }
 181  return true;
 182 }
 183
 184 <!-- Get current date -->
 185
 186 function getFormattedToday()
 187 {
 188    var today = new Date();
 189    var dd = today.getDate();
 190    var mm = today.getMonth()+1; //January is 0!
 191    var yyyy = today.getFullYear();
 192    if(dd<10){dd='0'+dd}
 193    if(mm<10){mm='0'+mm}
 194
 195    return (yyyy + '-' + mm + '-' + dd);
 196 }
 197
 198 <!-- Update Payment Fields -->
 199
 200 function updateFields(payField, adjField, balField, coPayField, isFirstProcCode)
 201 {
 202    var payAmount = 0.0;
 203    var adjAmount = 0.0;
 204    var balAmount = 0.0;
 205    var coPayAmount = 0.0;
 206
 207    // coPayFiled will be null if there is no co-pay entry in the fee sheet
 208    if (coPayField)
 209       coPayAmount = coPayField.value;
 210
 211    // if balance field is 0.00, its value comes back as null, so check for nul-ness first
 212    if (balField)
 213       balAmount = (balField.value) ? balField.value : 0;
 214    if (payField)
 215       payAmount = (payField.value) ? payField.value : 0;
 216
 217    //alert('balance = >' + balAmount +'<  payAmount = ' + payAmount + '  copay = ' + coPayAmount + '  isFirstProcCode = ' + isFirstProcCode);
 218
 219    // subtract the co-pay only from the first procedure code
 220    if (isFirstProcCode == 1)
 221       balAmount = parseFloat(balAmount) + parseFloat(coPayAmount);
 222
 223    adjAmount = balAmount - payAmount;
 224
 225    // Assign rounded adjustment value back to TextField
 226    adjField.value = adjAmount = Math.round(adjAmount*100)/100;
 227 }
 228
 229 </script>
 230 </head>
 231 <body leftmargin='0' topmargin='0' marginwidth='0' marginheight='0'>
 232 <?php
 233   $trans_id = 0 + $_GET['id'];
 234   if (! $trans_id) die(xl("You cannot access this page directly."));
 235
 236   if ($INTEGRATED_AR) {
 237     // In the Integrated A/R case, $trans_id matches form_encounter.id.
 238     $ferow = sqlQuery("SELECT e.*, p.fname, p.mname, p.lname " .
 239       "FROM form_encounter AS e, patient_data AS p WHERE " .
 240       "e.id = '$trans_id' AND p.pid = e.pid");
 241     if (empty($ferow)) die("There is no encounter with form_encounter.id = '$trans_id'.");
 242     $patient_id        = 0 + $ferow['pid'];
 243     $encounter_id      = 0 + $ferow['encounter'];
 244     $svcdate           = substr($ferow['date'], 0, 10);
 245     $form_payer_id     = 0 + $_POST['form_payer_id'];
 246     $form_reference    = $_POST['form_reference'];
 247     $form_check_date   = fixDate($_POST['form_check_date'], date('Y-m-d'));
 248     $form_deposit_date = fixDate($_POST['form_deposit_date'], $form_check_date);
 249     $form_pay_total    = 0 + $_POST['form_pay_total'];
 250   }
 251   else {
 252     slInitialize();
 253   }
 254
 255   $payer_type = 0;
 256   if (preg_match('/^Ins(\d)/i', $_POST['form_insurance'], $matches)) {
 257     $payer_type = $matches[1];
 258   }
 259
 260   if ($_POST['form_save'] || $_POST['form_cancel']) {
 261     if ($_POST['form_save']) {
 262       if ($debug) {
 263         echo xl("This module is in test mode. The database will not be changed.",'','<p><b>',"</b><p>\n");
 264       }
 265
 266       if ($INTEGRATED_AR) {
 267         $session_id = arGetSession($form_payer_id, $form_reference,
 268           $form_check_date, $form_deposit_date, $form_pay_total);
 269         // The sl_eob_search page needs its invoice links modified to invoke
 270         // javascript to load form parms for all the above and submit.
 271         // At the same time that page would be modified to work off the
 272         // openemr database exclusively.
 273         // And back to the sl_eob_invoice page, I think we may want to move
 274         // the source input fields from row level to header level.
 275
 276         // Handle deletes. row_delete() is borrowed from deleter.php.
 277         if ($ALLOW_DELETE && !$debug) {
 278           foreach ($_POST['form_del'] as $arseq => $dummy) {
 279             row_delete("ar_activity", "pid = '$patient_id' AND " .
 280               "encounter = '$encounter_id' AND sequence_no = '$arseq'");
 281           }
 282         }
 283       }
 284
 285       $paytotal = 0;
 286       foreach ($_POST['form_line'] as $code => $cdata) {
 287         if (!$INTEGRATED_AR) {
 288           $thissrc  = trim($cdata['src']);
 289           $thisdate = trim($cdata['date']);
 290         }
 291         $thispay  = trim($cdata['pay']);
 292         $thisadj  = trim($cdata['adj']);
 293         $thisins  = trim($cdata['ins']);
 294         $reason   = strip_escape_custom($cdata['reason']);
 295
 296         // Get the adjustment reason type.  Possible values are:
 297         // 1 = Charge adjustment
 298         // 2 = Coinsurance
 299         // 3 = Deductible
 300         // 4 = Other pt resp
 301         // 5 = Comment
 302         $reason_type = '1';
 303         if ($reason) {
 304           $tmp = sqlQuery("SELECT option_value FROM list_options WHERE " .
 305             "list_id = 'adjreason' AND " .
 306             "option_id = '" . add_escape_custom($reason) . "'");
 307           if (empty($tmp['option_value'])) {
 308             // This should not happen but if it does, apply old logic.
 309             if (preg_match("/To copay/", $reason)) {
 310               $reason_type = 2;
 311             }
 312             else if (preg_match("/To ded'ble/", $reason)) {
 313               $reason_type = 3;
 314             }
 315             $info_msg .= xl("No adjustment reason type found for") . " \"$reason\". ";
 316           }
 317           else {
 318             $reason_type = $tmp['option_value'];
 319           }
 320         }
 321
 322         if (! $thisins) $thisins = 0;
 323
 324         if ($thispay) {
 325           if ($INTEGRATED_AR) {
 326             arPostPayment($patient_id, $encounter_id, $session_id,
 327               $thispay, $code, $payer_type, '', $debug);
 328           } else {
 329             slPostPayment($trans_id, $thispay, $thisdate, $thissrc, $code, $thisins, $debug);
 330           }
 331           $paytotal += $thispay;
 332         }
 333
 334         // Be sure to record adjustment reasons, even for zero adjustments if
 335         // they happen to be comments.
 336         if ($thisadj || ($reason && $reason_type == 5)) {
 337           // "To copay" and "To ded'ble" need to become a comment in a zero
 338           // adjustment, formatted just like sl_eob_process.php.
 339           if ($reason_type == '2') {
 340             $reason = $_POST['form_insurance'] . " coins: $thisadj";
 341             $thisadj = 0;
 342           }
 343           else if ($reason_type == '3') {
 344             $reason = $_POST['form_insurance'] . " dedbl: $thisadj";
 345             $thisadj = 0;
 346           }
 347           else if ($reason_type == '4') {
 348             $reason = $_POST['form_insurance'] . " ptresp: $thisadj $reason";
 349             $thisadj = 0;
 350           }
 351           else if ($reason_type == '5') {
 352             $reason = $_POST['form_insurance'] . " note: $thisadj $reason";
 353             $thisadj = 0;
 354           }
 355           else {
 356             // An adjustment reason including "Ins" is assumed to be assigned by
 357             // insurance, and in that case we identify which one by appending
 358             // Ins1, Ins2 or Ins3.
 359             if (strpos(strtolower($reason), 'ins') !== false)
 360               $reason .= ' ' . $_POST['form_insurance'];
 361           }
 362           if ($INTEGRATED_AR) {
 363             arPostAdjustment($patient_id, $encounter_id, $session_id,
 364               $thisadj, $code, $payer_type, $reason, $debug);
 365           } else {
 366             slPostAdjustment($trans_id, $thisadj, $thisdate, $thissrc, $code, $thisins, $reason, $debug);
 367           }
 368         }
 369       }
 370
 371       // Maintain which insurances are marked as finished.
 372
 373       if ($INTEGRATED_AR) {
 374         $form_done = 0 + $_POST['form_done'];
 375         $form_stmt_count = 0 + $_POST['form_stmt_count'];
 376         sqlStatement("UPDATE form_encounter " .
 377           "SET last_level_closed = $form_done, " .
 378           "stmt_count = $form_stmt_count WHERE " .
 379           "pid = '$patient_id' AND encounter = '$encounter_id'");
 380       }
 381       else {
 382         $form_duedate = fixDate($_POST['form_duedate']);
 383         $form_notes = trim($_POST['form_notes']);
 384         // We use the "Ship Via" field of the invoice to hold these.
 385         $form_eobs = "";
 386         foreach (array('Ins1', 'Ins2', 'Ins3') as $value) {
 387           if ($_POST["form_done_$value"]) {
 388             if ($form_eobs) $form_eobs .= ","; else $form_eobs = "Done: ";
 389             $form_eobs .= $value;
 390           }
 391         }
 392         $query = "UPDATE ar SET duedate = '$form_duedate', notes = '$form_notes', " .
 393           "shipvia = '$form_eobs' WHERE id = $trans_id";
 394         if ($debug) {
 395           echo $query . "<br>\n";
 396         } else {
 397           SLQuery($query);
 398           if ($sl_err) die($sl_err);
 399         }
 400       }
 401
 402       if ($_POST['form_secondary']) {
 403         if ($INTEGRATED_AR) {
 404           arSetupSecondary($patient_id, $encounter_id, $debug);
 405         } else {
 406           slSetupSecondary($trans_id, $debug);
 407         }
 408       }
 409
 410       echo "<script language='JavaScript'>\n";
 411       echo " if (opener.document.forms[0].form_amount) {\n";
 412       echo "  var tmp = opener.document.forms[0].form_amount.value - $paytotal;\n";
 413       echo "  opener.document.forms[0].form_amount.value = Number(tmp).toFixed(2);\n";
 414       echo " }\n";
 415     } else {
 416       echo "<script language='JavaScript'>\n";
 417     }
 418     if ($info_msg) echo " alert('" . addslashes($info_msg) . "');\n";
 419     if (! $debug) echo " window.close();\n";
 420     echo "</script></body></html>\n";
 421     if (!$INTEGRATED_AR) SLClose();
 422     exit();
 423   }
 424
 425   if ($INTEGRATED_AR) {
 426     // Get invoice charge details.
 427     $codes = ar_get_invoice_summary($patient_id, $encounter_id, true);
 428   }
 429   else {
 430     // Get invoice data into $arrow.
 431     $arres = SLQuery("select ar.*, customer.name, employee.name as doctor " .
 432       "from ar, customer, employee where ar.id = $trans_id and " .
 433       "customer.id = ar.customer_id and employee.id = ar.employee_id");
 434     if ($sl_err) die($sl_err);
 435     $arrow = SLGetRow($arres, 0);
 436     if (! $arrow) die(xl("There is no match for invoice id = ") . $trans_id);
 437     //
 438     // Determine the date of service.  An 8-digit encounter number is
 439     // presumed to be a date of service imported during conversion.
 440     // Otherwise look it up in the form_encounter table.
 441     //
 442     $svcdate = "";
 443     list($patient_id, $encounter) = explode(".", $arrow['invnumber']);
 444     if (strlen($encounter) == 8) {
 445       $svcdate = substr($encounter, 0, 4) . "-" . substr($encounter, 4, 2) .
 446         "-" . substr($encounter, 6, 2);
 447     }
 448     else if ($encounter) {
 449       $tmp = sqlQuery("SELECT date FROM form_encounter WHERE " .
 450         "encounter = $encounter");
 451       $svcdate = substr($tmp['date'], 0, 10);
 452     }
 453
 454     // Get invoice charge details.
 455     $codes = get_invoice_summary($trans_id, true);
 456   }
 457
 458   $pdrow = sqlQuery("select genericname2, genericval2 " .
 459     "from patient_data where pid = '$patient_id' limit 1");
 460 ?>
 461 <center>
 462
 463 <form method='post' action='sl_eob_invoice.php?id=<?php echo $trans_id ?>'
 464  onsubmit='return validate(this)'>
 465
 466 <table border='0' cellpadding='3'>
 467  <tr>
 468   <td>
 469    <?php xl('Patient:','e')?>
 470   </td>
 471   <td>
 472 <?php
 473   if ($INTEGRATED_AR) {
 474     echo $ferow['fname'] . ' ' . $ferow['mname'] . ' ' . $ferow['lname'];
 475   }
 476   else {
 477     echo $arrow['name'];
 478   }
 479 ?>
 480   </td>
 481   <td colspan="2" rowspan="3">
 482 <?php
 483   if ($INTEGRATED_AR) {
 484     for ($i = 1; $i <= 3; ++$i) {
 485       $payerid = arGetPayerID($patient_id, $svcdate, $i);
 486       if ($payerid) {
 487         $tmp = sqlQuery("SELECT name FROM insurance_companies WHERE id = $payerid");
 488         echo "Ins$i: " . $tmp['name'] . "<br />";
 489       }
 490     }
 491   }
 492   else {
 493     echo "   <textarea name='form_notes' cols='50' style='height:100%'>";
 494     echo $arrow['notes'];
 495     echo "</textarea>\n";
 496   }
 497 ?>
 498   </td>
 499 <?php
 500   if ($INTEGRATED_AR) {
 501     echo "<td rowspan='3' valign='bottom'>\n";
 502     echo xl('Statements Sent:');
 503     echo "</td>\n";
 504     echo "<td rowspan='3' valign='bottom'>\n";
 505     echo "<input type='text' name='form_stmt_count' size='10' value='" .
 506       (0 + $ferow['stmt_count']) . "' />\n";
 507     echo "</td>\n";
 508   }
 509 ?>
 510  </tr>
 511  <tr>
 512   <td>
 513    <?php xl('Provider:','e')?>
 514   </td>
 515   <td>
 516    <?php
 517   if ($INTEGRATED_AR) {
 518     $tmp = sqlQuery("SELECT fname, mname, lname " .
 519       "FROM users WHERE id = " . $ferow['provider_id']);
 520     echo $tmp['fname'] . ' ' . $tmp['mname'] . ' ' . $tmp['lname'];
 521     $tmp = sqlQuery("SELECT bill_date FROM billing WHERE " .
 522       "pid = '$patient_id' AND encounter = '$encounter_id' AND " .
 523       "activity = 1 ORDER BY fee DESC, id ASC LIMIT 1");
 524     $billdate = substr(($tmp['bill_date'] . "Not Billed"), 0, 10);
 525   }
 526   else {
 527     echo $arrow['doctor'];
 528   }
 529 ?>
 530   </td>
 531  </tr>
 532  <tr>
 533   <td>
 534    <?php xl('Invoice:','e')?>
 535   </td>
 536   <td>
 537 <?php
 538   if ($INTEGRATED_AR) {
 539     echo "$patient_id.$encounter_id";
 540   }
 541   else {
 542     echo $arrow['invnumber'];
 543   }
 544 ?>
 545   </td>
 546  </tr>
 547
 548  <tr>
 549   <td>
 550 <?php xl('Svc Date:','e'); ?>
 551   </td>
 552   <td>
 553 <?php
 554     echo $svcdate;
 555 ?>
 556   </td>
 557   <td colspan="2">
 558    <?php xl('Done with:','e','',"&nbsp")?>;
 559 <?php
 560   // Write a checkbox for each insurance.  It is to be checked when
 561   // we no longer expect any payments from that company for the claim.
 562   if ($INTEGRATED_AR) {
 563     $last_level_closed = 0 + $ferow['last_level_closed'];
 564     foreach (array(0 => 'None', 1 => 'Ins1', 2 => 'Ins2', 3 => 'Ins3') as $key => $value) {
 565       if ($key && !arGetPayerID($patient_id, $svcdate, $key)) continue;
 566       $checked = ($last_level_closed == $key) ? " checked" : "";
 567       echo "   <input type='radio' name='form_done' value='$key'$checked />$value&nbsp;\n";
 568     }
 569   }
 570   else {
 571     // The information is stored in the 'shipvia' field of the invoice.
 572     $insgot  = strtolower($arrow['notes']);
 573     $insdone = strtolower($arrow['shipvia']);
 574     foreach (array('Ins1', 'Ins2', 'Ins3') as $value) {
 575       $lcvalue = strtolower($value);
 576       $checked  = (strpos($insdone, $lcvalue) === false) ? "" : " checked";
 577       if (strpos($insgot, $lcvalue) !== false) {
 578         echo "   <input type='checkbox' name='form_done_$value' value='1'$checked />$value&nbsp;\n";
 579       }
 580     }
 581   }
 582 ?>
 583   </td>
 584 <?php
 585   if ($INTEGRATED_AR) {
 586     echo "<td>\n";
 587     echo xl('Check/EOB No.:');
 588     echo "</td>\n";
 589     echo "<td>\n";
 590     echo "<input type='text' name='form_reference' size='10' value='' />\n";
 591     echo "</td>\n";
 592   }
 593 ?>
 594  </tr>
 595
 596  <tr>
 597   <td>
 598    <?php xl('Last Bill Date:','e') ?>
 599   </td>
 600   <td>
 601    <?php
 602   if ($INTEGRATED_AR) {
 603     echo $billdate;
 604   }
 605   else {
 606     echo $arrow['transdate'];
 607   }
 608 ?>
 609   </td>
 610   <td colspan="2">
 611    <?php xl('Now posting for:','e','',"&nbsp")?>;
 612
 613 <?php
 614   // TBD: check the first not-done-with insurance, not always Ins1!
 615 ?>
 616    <input type='radio' name='form_insurance' value='Ins1' onclick='setins("Ins1")' checked /><?php xl('Ins1','e')?>&nbsp;
 617    <input type='radio' name='form_insurance' value='Ins2' onclick='setins("Ins2")' /><?php xl('Ins2','e')?>&nbsp;
 618    <input type='radio' name='form_insurance' value='Ins3' onclick='setins("Ins3")' /><?php xl('Ins3','e')?>&nbsp;
 619    <input type='radio' name='form_insurance' value='Pt'   onclick='setins("Pt")'   /><?php xl('Patient','e')?>
 620
 621 <?php
 622   // TBD: I think the following is unused and can be removed.
 623 ?>
 624    <input type='hidden' name='form_eobs' value='<?php echo addslashes($arrow['shipvia']) ?>' />
 625
 626   </td>
 627 <?php
 628   if ($INTEGRATED_AR) {
 629     echo "<td>\n";
 630     echo xl('Check/EOB Date:');
 631     echo "</td>\n";
 632     echo "<td>\n";
 633     echo "<input type='text' name='form_check_date' size='10' value='' />\n";
 634     echo "</td>\n";
 635   }
 636 ?>
 637  </tr>
 638  <tr>
 639   <td>
 640    <?php
 641   if (!$INTEGRATED_AR) xl('Due Date:','e');
 642 ?>
 643   </td>
 644   <td>
 645
 646 <?php if (!$INTEGRATED_AR) { ?>
 647    <input type='text' name='form_duedate' size='10' value='<?php echo $arrow['duedate'] ?>'
 648     title='<?php xl('Due date mm/dd/yyyy or yyyy-mm-dd','e')?>'>
 649 <?php } ?>
 650   </td>
 651   <td colspan="2">
 652    <input type="checkbox" name="form_secondary" value="1"> <?php xl('Needs secondary billing','e')?>
 653    &nbsp;&nbsp;
 654    <input type='submit' name='form_save' value='<?php xl('Save','e')?>'>
 655    &nbsp;
 656    <input type='button' value='<?php xl('Cancel','e')?>' onclick='window.close()'>
 657   </td>
 658 <?php
 659   if ($INTEGRATED_AR) {
 660     echo "<td>\n";
 661     echo xl('Deposit Date:');
 662     echo "</td>\n";
 663     echo "<td>\n";
 664     echo "<input type='text' name='form_deposit_date' size='10' value='' />\n";
 665     echo "<input type='hidden' name='form_payer_id' value='' />\n";
 666     echo "<input type='hidden' name='form_orig_reference' value='' />\n";
 667     echo "<input type='hidden' name='form_orig_check_date' value='' />\n";
 668     echo "<input type='hidden' name='form_orig_deposit_date' value='' />\n";
 669     echo "<input type='hidden' name='form_pay_total' value='' />\n";
 670     echo "</td>\n";
 671   }
 672 ?>
 673  </tr>
 674 <?php if ($pdrow['genericname2'] == 'Billing') { ?>
 675  <tr>
 676   <td>
 677    <?php xl('Billing Note:','e')?>
 678   </td>
 679   <td colspan='3' style='color:red'>
 680    <?php echo $pdrow['genericval2'] ?>
 681   </td>
 682  </tr>
 683 <?php } ?>
 684  <tr>
 685   <td height="1">
 686   </td>
 687  </tr>
 688 </table>
 689
 690 <table border='0' cellpadding='2' cellspacing='0' width='98%'>
 691
 692  <tr bgcolor="#cccccc">
 693   <td class="dehead">
 694    <?php xl('Code','e')?>
 695   </td>
 696   <td class="dehead" align="right">
 697    <?php xl('Charge','e')?>
 698   </td>
 699   <td class="dehead" align="right">
 700    <?php xl('Balance','e')?>&nbsp;
 701   </td>
 702   <td class="dehead">
 703    <?php xl('By/Source','e')?>
 704   </td>
 705   <td class="dehead">
 706    <?php xl('Date','e')?>
 707   </td>
 708   <td class="dehead">
 709    <?php xl('Pay','e')?>
 710   </td>
 711   <td class="dehead">
 712    <?php xl('Adjust','e')?>
 713   </td>
 714   <td class="dehead">
 715    <?php xl('Reason','e')?>
 716   </td>
 717 <?php if ($ALLOW_DELETE) { ?>
 718   <td class="dehead">
 719    <?php xl('Del','e')?>
 720   </td>
 721 <?php } ?>
 722  </tr>
 723 <?php
 724   $firstProcCodeIndex = -1;
 725   $encount = 0;
 726   foreach ($codes as $code => $cdata) {
 727    ++$encount;
 728    $bgcolor = "#" . (($encount & 1) ? "ddddff" : "ffdddd");
 729    $dispcode = $code;
 730
 731    // remember the index of the first entry whose code is not "CO-PAY", i.e. it's a legitimate proc code
 732    if ($firstProcCodeIndex == -1 && strcmp($code, "CO-PAY") !=0)
 733     $firstProcCodeIndex = $encount;
 734
 735    // this sorts the details more or less chronologically:
 736    ksort($cdata['dtl']);
 737    foreach ($cdata['dtl'] as $dkey => $ddata) {
 738     $ddate = substr($dkey, 0, 10);
 739     if (preg_match('/^(\d\d\d\d)(\d\d)(\d\d)\s*$/', $ddate, $matches)) {
 740      $ddate = $matches[1] . '-' . $matches[2] . '-' . $matches[3];
 741     }
 742     $tmpchg = "";
 743     $tmpadj = "";
 744     /*****************************************************************
 745     if ($ddata['chg'] > 0)
 746      $tmpchg = $ddata['chg'];
 747     else if ($ddata['chg'] < 0)
 748      $tmpadj = 0 - $ddata['chg'];
 749     *****************************************************************/
 750     if ($ddata['chg'] != 0) {
 751       if (isset($ddata['rsn'])) $tmpadj = 0 - $ddata['chg'];
 752       else $tmpchg = $ddata['chg'];
 753     }
 754 ?>
 755  <tr bgcolor='<?php echo $bgcolor ?>'>
 756   <td class="detail">
 757    <?php echo $dispcode; $dispcode = "" ?>
 758   </td>
 759   <td class="detail" align="right">
 760    <?php bucks($tmpchg) ?>
 761   </td>
 762   <td class="detail" align="right">
 763    &nbsp;
 764   </td>
 765   <td class="detail">
 766    <?php
 767     if (isset($ddata['plv'])) {
 768       if (!$ddata['plv']) echo 'Pt/';
 769       else echo 'Ins' . $ddata['plv'] . '/';
 770     }
 771     echo $ddata['src'];
 772    ?>
 773   </td>
 774   <td class="detail">
 775    <?php echo $ddate ?>
 776   </td>
 777   <td class="detail">
 778    <?php bucks($ddata['pmt']) ?>
 779   </td>
 780   <td class="detail">
 781    <?php bucks($tmpadj) ?>
 782   </td>
 783   <td class="detail">
 784    <?php echo $ddata['rsn'] ?>
 785   </td>
 786 <?php if ($ALLOW_DELETE) { ?>
 787   <td class="detail">
 788 <?php if (!empty($ddata['arseq'])) { ?>
 789    <input type="checkbox" name="form_del[<?php echo $ddata['arseq']; ?>]" />
 790 <?php } else { ?>
 791    &nbsp;
 792 <?php } ?>
 793   </td>
 794 <?php } ?>
 795  </tr>
 796 <?php
 797    } // end of prior detail line
 798 ?>
 799  <tr bgcolor='<?php echo $bgcolor ?>'>
 800   <td class="detail">
 801    <?php echo $dispcode; $dispcode = "" ?>
 802   </td>
 803   <td class="detail" align="right">
 804    &nbsp;
 805   </td>
 806   <td class="detail" align="right">
 807    <input type="hidden" name="form_line[<?php echo $code ?>][bal]" value="<?php bucks($cdata['bal']) ?>">
 808    <input type="hidden" name="form_line[<?php echo $code ?>][ins]" value="<?php echo $cdata['ins'] ?>">
 809    <?php printf("%.2f", $cdata['bal']) ?>&nbsp;
 810   </td>
 811   <td class="detail">
 812
 813 <?php if (!$INTEGRATED_AR) { ?>
 814    <input type="text" name="form_line[<?php echo $code ?>][src]" size="10"
 815     style="background-color:<?php echo $bgcolor ?>" />
 816     <!-- title="NM=notmet, CI=coins, CP=copay, NE=notelig, IT=insterm, PF=ptfull, PP=ptpart" -->
 817 <?php } ?>
 818
 819   </td>
 820   <td class="detail">
 821
 822 <?php if (!$INTEGRATED_AR) { ?>
 823    <input type="text" name="form_line[<?php echo $code ?>][date]" size="10"
 824     style="background-color:<?php echo $bgcolor ?>" />
 825 <?php } ?>
 826
 827   </td>
 828   <td class="detail">
 829    <input type="text" name="form_line[<?php echo $code ?>][pay]" size="10"
 830     style="background-color:<?php echo $bgcolor ?>"
 831     onKeyUp="updateFields(document.forms[0]['form_line[<?php echo $code ?>][pay]'],
 832                           document.forms[0]['form_line[<?php echo $code ?>][adj]'],
 833                           document.forms[0]['form_line[<?php echo $code ?>][bal]'],
 834                           document.forms[0]['form_line[CO-PAY][bal]'],
 835                           <?php echo ($firstProcCodeIndex == $encount) ? 1 : 0 ?>)"/>
 836   </td>
 837   <td class="detail">
 838    <input type="text" name="form_line[<?php echo $code ?>][adj]" size="10"
 839     value='<?php echo $totalAdjAmount ?>'
 840     style="background-color:<?php echo $bgcolor ?>" />
 841    &nbsp; <a href="" onclick="return writeoff('<?php echo $code ?>')">W</a>
 842   </td>
 843   <td class="detail">
 844    <select name="form_line[<?php echo $code ?>][reason]"
 845     style="background-color:<?php echo $bgcolor ?>">
 846 <?php
 847 // Adjustment reasons are now taken from the list_options table.
 848 echo "    <option value=''></option>\n";
 849 $ores = sqlStatement("SELECT option_id, title, is_default FROM list_options " .
 850   "WHERE list_id = 'adjreason'  ORDER BY seq, title");
 851 while ($orow = sqlFetchArray($ores)) {
 852   echo "    <option value='" . htmlspecialchars($orow['option_id'], ENT_QUOTES) . "'";
 853   if ($orow['is_default']) echo " selected";
 854   echo ">" . htmlspecialchars($orow['title']) . "</option>\n";
 855 }
 856 ?>
 857
 858    </select>
 859 <?php
 860     // TBD: Maybe a comment field would be good here, for appending
 861     // to the reason.
 862 ?>
 863   </td>
 864
 865 <?php if ($ALLOW_DELETE) { ?>
 866   <td class="detail">
 867    &nbsp;
 868   </td>
 869 <?php } ?>
 870
 871  </tr>
 872 <?php
 873   } // end of code
 874   if (!$INTEGRATED_AR) SLClose();
 875 ?>
 876
 877 </table>
 878 </form>
 879 </center>
 880 <script language="JavaScript">
 881  var f1 = opener.document.forms[0];
 882  var f2 = document.forms[0];
 883  if (f1.form_source) {
 884 <?php
 885   if ($INTEGRATED_AR) {
 886     // These support creation and lookup of ar_session table entries:
 887     echo "  f2.form_reference.value         = f1.form_source.value;\n";
 888     echo "  f2.form_check_date.value        = f1.form_paydate.value;\n";
 889     echo "  //f2.form_deposit_date.value      = f1.form_deposit_date.value;\n";
 890     echo "  if (f1.form_deposit_date.value != '')\n";
 891     echo "     f2.form_deposit_date.value      = f1.form_deposit_date.value;\n";
 892     echo "  else\n";
 893     echo "     f2.form_deposit_date.value      = getFormattedToday();\n";
 894     echo "  f2.form_payer_id.value          = f1.form_payer_id.value;\n";
 895     echo "  f2.form_pay_total.value         = f1.form_amount.value;\n";
 896     echo "  f2.form_orig_reference.value    = f1.form_source.value;\n";
 897     echo "  f2.form_orig_check_date.value   = f1.form_paydate.value;\n";
 898     echo "  f2.form_orig_deposit_date.value = f1.form_deposit_date.value;\n";
 899
 900     // While I'm thinking about it, some notes about eob sessions.
 901     // If they do not have all of the session key fields in the search
 902     // page, then show a warning at the top of the invoice page.
 903     // Also when they go to save the invoice page and a session key
 904     // field has changed, alert them to that and allow a cancel.
 905
 906     // Another point... when posting EOBs, the incoming payer ID might
 907     // not match the payer ID for the patient's insurance.  This is
 908     // because the same payer might be entered more than once into the
 909     // insurance_companies table.  I don't think it matters much.
 910   }
 911   else {
 912     foreach ($codes as $code => $cdata) {
 913       echo "  f2['form_line[$code][src]'].value  = f1.form_source.value;\n";
 914       echo "  f2['form_line[$code][date]'].value = f1.form_paydate.value;\n";
 915     }
 916   }
 917 ?>
 918  }
 919  setins("Ins1");
 920 </script>
 921 </body>
 922 </html>