library/sl_eob.inc.php

   1 <?php
   2   // Copyright (C) 2005-2009 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   include_once("patient.inc");
  10   include_once("billing.inc");
  11   include_once("invoice_summary.inc.php");
  12
  13   $chart_id_cash   = 0;
  14   $chart_id_ar     = 0;
  15   $chart_id_income = 0;
  16   $services_id     = 0;
  17
  18
  19   // Try to figure out our invoice number (pid.encounter) from the
  20   // claim ID and other stuff in the ERA.  This should be straightforward
  21   // except that some payers mangle the claim ID that we give them.
  22   //
  23   function slInvoiceNumber(&$out) {
  24     $invnumber = $out['our_claim_id'];
  25     $atmp = preg_split('/[ -]/', $invnumber);
  26     $acount = count($atmp);
  27
  28     $pid = 0;
  29     $encounter = 0;
  30     if ($acount == 2) {
  31       $pid = $atmp[0];
  32       $encounter = $atmp[1];
  33     }
  34     else if ($acount == 3) {
  35       $pid = $atmp[0];
  36       $brow = sqlQuery("SELECT encounter FROM billing WHERE " .
  37         "pid = '$pid' AND encounter = '" . $atmp[1] . "' AND activity = 1");
  38
  39       $encounter = $brow['encounter'];
  40     }
  41     else if ($acount == 1) {
  42       $pres = sqlStatement("SELECT pid FROM patient_data WHERE " .
  43         "lname LIKE '" . addslashes($out['patient_lname']) . "' AND " .
  44         "fname LIKE '" . addslashes($out['patient_fname']) . "' " .
  45         "ORDER BY pid DESC");
  46       while ($prow = sqlFetchArray($pres)) {
  47         if (strpos($invnumber, $prow['pid']) === 0) {
  48           $pid = $prow['pid'];
  49           $encounter = substr($invnumber, strlen($pid));
  50           break;
  51         }
  52       }
  53     }
  54
  55     if ($pid && $encounter) $invnumber = "$pid.$encounter";
  56     return array($pid, $encounter, $invnumber);
  57   }
  58
  59   // This gets a posting session ID.  If the payer ID is not 0 and a matching
  60   // session already exists, then its ID is returned.  Otherwise a new session
  61   // is created.
  62   //
  63   function arGetSession($payer_id, $reference, $check_date, $deposit_date='', $pay_total=0) {
  64     if (empty($deposit_date)) $deposit_date = $check_date;
  65     if ($payer_id) {
  66       $row = sqlQuery("SELECT session_id FROM ar_session WHERE " .
  67         "payer_id = '$payer_id' AND reference = '$reference' AND " .
  68         "check_date = '$check_date' AND deposit_date = '$deposit_date' " .
  69         "ORDER BY session_id DESC LIMIT 1");
  70       if (!empty($row['session_id'])) return $row['session_id'];
  71     }
  72     return sqlInsert("INSERT INTO ar_session ( " .
  73       "payer_id, user_id, reference, check_date, deposit_date, pay_total " .
  74       ") VALUES ( " .
  75       "'$payer_id', " .
  76       "'" . $_SESSION['authUserID'] . "', " .
  77       "'$reference', " .
  78       "'$check_date', " .
  79       "'$deposit_date', " .
  80       "'$pay_total' " .
  81       ")");
  82   }
  83   //writing the check details to Session Table on ERA proxcessing
  84 function arPostSession($payer_id,$check_number,$check_date,$pay_total,$post_to_date,$deposit_date,$debug) {
  85       $query = "INSERT INTO ar_session( " .
  86       "payer_id,user_id,closed,reference,check_date,pay_total,post_to_date,deposit_date,patient_id,payment_type,adjustment_code,payment_method " .
  87       ") VALUES ( " .
  88       "'$payer_id'," .
  89       $_SESSION['authUserID']."," .
  90       "0," .
  91       "'ePay - $check_number'," .
  92       "'$check_date', " .
  93       "$pay_total, " .
  94       "'$post_to_date','$deposit_date', " .
  95       "0,'insurance','insurance_payment','electronic'" .
  96         ")";
  97     if ($debug) {
  98       echo $query . "<br>\n";
  99     } else {
 100      $sessionId=sqlInsert($query);
 101     return $sessionId;
 102     }
 103   }
 104
 105   // Post a payment, new style.
 106   //
 107   function arPostPayment($patient_id, $encounter_id, $session_id, $amount, $code, $payer_type, $memo, $debug, $time='', $codetype='') {
 108     $codeonly = $code;
 109     $modifier = '';
 110     $tmp = strpos($code, ':');
 111     if ($tmp) {
 112       $codeonly = substr($code, 0, $tmp);
 113       $modifier = substr($code, $tmp+1);
 114     }
 115     if (empty($time)) $time = date('Y-m-d H:i:s');
 116
 117     sqlBeginTrans();
 118     $sequence_no = sqlQuery( "SELECT IFNULL(MAX(sequence_no),0) + 1 AS increment FROM ar_activity WHERE pid = ? AND encounter = ?", array($patient_id, $encounter_id));
 119     $query = "INSERT INTO ar_activity ( " .
 120       "pid, encounter, sequence_no, code_type, code, modifier, payer_type, post_time, post_user, " .
 121       "session_id, memo, pay_amount " .
 122       ") VALUES ( " .
 123       "'$patient_id', " .
 124       "'$encounter_id', " .
 125       "'{$sequence_no['increment']}', " .
 126       "'$codetype', " .
 127       "'$codeonly', " .
 128       "'$modifier', " .
 129       "'$payer_type', " .
 130       "'$time', " .
 131       "'" . $_SESSION['authUserID'] . "', " .
 132       "'$session_id', " .
 133       "'$memo', " .
 134       "'$amount' " .
 135       ")";
 136     sqlStatement($query);
 137     sqlCommitTrans();
 138     return;
 139   }
 140
 141   // Post a charge.  This is called only from sl_eob_process.php where
 142   // automated remittance processing can create a new service item.
 143   // Here we add it as an unauthorized item to the billing table.
 144   //
 145   function arPostCharge($patient_id, $encounter_id, $session_id, $amount, $units, $thisdate, $code, $description, $debug, $codetype='') {
 146     /*****************************************************************
 147     // Select an existing billing item as a template.
 148     $row= sqlQuery("SELECT * FROM billing WHERE " .
 149       "pid = '$patient_id' AND encounter = '$encounter_id' AND " .
 150       "code_type = 'CPT4' AND activity = 1 " .
 151       "ORDER BY id DESC LIMIT 1");
 152     $this_authorized = 0;
 153     $this_provider = 0;
 154     if (!empty($row)) {
 155       $this_authorized = $row['authorized'];
 156       $this_provider = $row['provider_id'];
 157     }
 158     *****************************************************************/
 159
 160     if (empty($codetype)) {
 161       // default to CPT4 if empty, which is consistent with previous functionality.
 162       $codetype="CPT4";
 163     }
 164     $codeonly = $code;
 165     $modifier = '';
 166     $tmp = strpos($code, ':');
 167     if ($tmp) {
 168       $codeonly = substr($code, 0, $tmp);
 169       $modifier = substr($code, $tmp+1);
 170     }
 171
 172     addBilling($encounter_id,
 173       $codetype,
 174       $codeonly,
 175       $description,
 176       $patient_id,
 177       0,
 178       0,
 179       $modifier,
 180       $units,
 181       $amount,
 182       '',
 183       '');
 184   }
 185
 186   // Post an adjustment, new style.
 187   //
 188   function arPostAdjustment($patient_id, $encounter_id, $session_id, $amount, $code, $payer_type, $reason, $debug, $time='', $codetype='') {
 189     $codeonly = $code;
 190     $modifier = '';
 191     $tmp = strpos($code, ':');
 192     if ($tmp) {
 193       $codeonly = substr($code, 0, $tmp);
 194       $modifier = substr($code, $tmp+1);
 195     }
 196     if (empty($time)) $time = date('Y-m-d H:i:s');
 197
 198     sqlBeginTrans();
 199     $sequence_no = sqlQuery( "SELECT IFNULL(MAX(sequence_no),0) + 1 AS increment FROM ar_activity WHERE pid = ? AND encounter = ?", array($patient_id, $encounter_id));
 200     $query = "INSERT INTO ar_activity ( " .
 201       "pid, encounter, sequence_no, code_type, code, modifier, payer_type, post_user, post_time, " .
 202       "session_id, memo, adj_amount " .
 203       ") VALUES ( " .
 204       "'$patient_id', " .
 205       "'$encounter_id', " .
 206       "'{$sequence_no['increment']}', " .
 207       "'$codetype', " .
 208       "'$codeonly', " .
 209       "'$modifier', " .
 210       "'$payer_type', " .
 211       "'" . $_SESSION['authUserID'] . "', " .
 212       "'$time', " .
 213       "'$session_id', " .
 214       "'$reason', " .
 215       "'$amount' " .
 216       ")";
 217     sqlStatement($query);
 218     sqlCommitTrans();
 219     return;
 220   }
 221
 222   function arGetPayerID($patient_id, $date_of_service, $payer_type) {
 223     if ($payer_type < 1 || $payer_type > 3) return 0;
 224     $tmp = array(1 => 'primary', 2 => 'secondary', 3 => 'tertiary');
 225     $value = $tmp[$payer_type];
 226     $query = "SELECT provider FROM insurance_data WHERE " .
 227       "pid = ? AND type = ? AND date <= ? " .
 228       "ORDER BY date DESC LIMIT 1";
 229     $nprow = sqlQuery($query, array($patient_id,$value,$date_of_service) );
 230     if (empty($nprow)) return 0;
 231     return $nprow['provider'];
 232   }
 233
 234   // Make this invoice re-billable, new style.
 235   //
 236   function arSetupSecondary($patient_id, $encounter_id, $debug,$crossover=0) {
 237     if ($crossover==1) {
 238     //if claim forwarded setting a new status
 239     $status=6;
 240
 241     } else {
 242
 243     $status=1;
 244
 245     }
 246     // Determine the next insurance level to be billed.
 247     $ferow = sqlQuery("SELECT date, last_level_billed " .
 248       "FROM form_encounter WHERE " .
 249       "pid = '$patient_id' AND encounter = '$encounter_id'");
 250     $date_of_service = substr($ferow['date'], 0, 10);
 251     $new_payer_type = 0 + $ferow['last_level_billed'];
 252     if ($new_payer_type < 3 && !empty($ferow['last_level_billed']) || $new_payer_type == 0)
 253       ++$new_payer_type;
 254
 255     $new_payer_id = arGetPayerID($patient_id, $date_of_service, $new_payer_type);
 256
 257     if ($new_payer_id) {
 258       // Queue up the claim.
 259       if (!$debug)
 260         updateClaim(true, $patient_id, $encounter_id, $new_payer_id, $new_payer_type,$status, 5, '', 'hcfa','',$crossover);
 261     }
 262     else {
 263       // Just reopen the claim.
 264       if (!$debug)
 265         updateClaim(true, $patient_id, $encounter_id, -1, -1, $status, 0, '','','',$crossover);
 266     }
 267
 268     return xl("Encounter ") . $encounter . xl(" is ready for re-billing.");
 269   }
 270 ?>