interface/billing/sl_eob_invoice.php

   1 <?php
   2
   3 /**
   4  * This provides for manual posting of EOBs.  It is invoked from
   5  * sl_eob_search.php.  For automated (X12 835) remittance posting
   6  * see sl_eob_process.php.
   7  *
   8  * @package   OpenEMR
   9  * @link      http://www.open-emr.org
  10  * @author    Rod Roark <rod@sunsetsystems.com>
  11  * @author    Roberto Vasquez <robertogagliotta@gmail.com>
  12  * @author    Terry Hill <terry@lillysystems.com>
  13  * @author    Jerry Padgett <sjpadgett@gmail.com>
  14  * @author    Stephen Waite <stephen.waite@cmsvt.com>
  15  * @author    Brady Miller <brady.g.miller@gmail.com>
  16  * @copyright Copyright (c) 2005-2020 Rod Roark <rod@sunsetsystems.com>
  17  * @copyright Copyright (c) 2018-2020 Stephen Waite <stephen.waite@cmsvt.com>
  18  * @copyright Copyright (c) 2019-2020 Brady Miller <brady.g.miller@gmail.com>
  19  * @license   https://github.com/openemr/openemr/blob/master/LICENSE GNU General Public License 3
  20  */
  21
  22 require_once("../globals.php");
  23 require_once("$srcdir/patient.inc.php");
  24 require_once("$srcdir/forms.inc.php");
  25 require_once("../../custom/code_types.inc.php");
  26 require_once "$srcdir/user.inc.php";
  27 require_once("$srcdir/payment.inc.php");
  28
  29 use OpenEMR\Billing\InvoiceSummary;
  30 use OpenEMR\Billing\SLEOB;
  31 use OpenEMR\Common\Csrf\CsrfUtils;
  32 use OpenEMR\Common\Logging\EventAuditLogger;
  33 use OpenEMR\Core\Header;
  34
  35 $debug = 0; // set to 1 for debugging mode
  36 $save_stay = (!empty($_REQUEST['form_save']) && ($_REQUEST['form_save'] == '1')) ? true : false;
  37 $from_posting = (0 + ($_REQUEST['isPosting'] ?? null)) ? 1 : 0;
  38 $g_posting_adj_disable = $GLOBALS['posting_adj_disable'] ? 'checked' : '';
  39 if ($from_posting) {
  40     $posting_adj_disable = prevSetting('sl_eob_search.', 'posting_adj_disable', 'posting_adj_disable', $g_posting_adj_disable);
  41 } else {
  42     $posting_adj_disable = $g_posting_adj_disable;
  43 }
  44
  45 // If we permit deletion of transactions.  Might change this later.
  46 $ALLOW_DELETE = true;
  47
  48 $info_msg = "";
  49
  50 // Format money for display.
  51 //
  52 function bucks($amount)
  53 {
  54     if ($amount) {
  55         return sprintf("%.2f", $amount);
  56     }
  57 }
  58
  59 ?>
  60 <html>
  61 <head>
  62     <?php Header::setupHeader(['datetime-picker', 'opener', 'no_dialog']); ?>
  63     <title><?php echo xlt('EOB Posting - Invoice') ?></title>
  64     <script>
  65
  66         const adjDisable = <?php echo js_escape($posting_adj_disable); ?>;
  67         // An insurance radio button is selected.
  68         function setins(istr) {
  69             return true;
  70         }
  71
  72         function goEncounterSummary(e, pid) {
  73             if(pid) {
  74                 if(typeof opener.toEncSummary  === 'function') {
  75                     opener.toEncSummary(e, pid);
  76                 }
  77             }
  78             doClose();
  79         }
  80
  81         function doClose() {
  82             window.close();
  83         }
  84
  85         // Compute an adjustment that writes off the balance:
  86         function writeoff(code) {
  87             const f = document.forms[0];
  88             const belement = f['form_line[' + code + '][bal]'];
  89             const pelement = f['form_line[' + code + '][pay]'];
  90             const aelement = f['form_line[' + code + '][adj]'];
  91             const relement = f['form_line[' + code + '][reason]'];
  92             const tmp = belement.value - pelement.value;
  93             aelement.value = Number(tmp).toFixed(2);
  94             if (aelement.value && !relement.value) {
  95                 relement.selectedIndex = 1;
  96             }
  97             return false;
  98         }
  99
 100         // Onsubmit handler.  A good excuse to write some JavaScript.
 101         function validate(f) {
 102             let delcount = 0;
 103             let allempty = true;
 104
 105             for (let i = 0; i < f.elements.length; ++i) {
 106                 let ename = f.elements[i].name;
 107                 // Count deletes.
 108                 if (ename.substring(0, 9) == 'form_del[') {
 109                     if (f.elements[i].checked) {
 110                         ++delcount;
 111                     }
 112                     continue;
 113                 }
 114                 let pfxlen = ename.indexOf('[pay]');
 115                 if (pfxlen < 0) {
 116                     continue
 117                 };
 118                 let pfx = ename.substring(0, pfxlen);
 119                 let code = pfx.substring(pfx.indexOf('[') + 1, pfxlen - 1);
 120                 let cPay = parseFloat(f[pfx + '[pay]'].value).toFixed(2);
 121                 let cAdjust = parseFloat(f[pfx + '[adj]'].value).toFixed(2);
 122
 123                 if ((cPay !== 0) || cAdjust !== 0) {
 124                     allempty = false;
 125                 }
 126                 if(adjDisable) {
 127                     if ((cAdjust == 0 && ins_done.value == 'changed')) {
 128                         allempty = false;
 129                     }
 130                 }
 131                 if ((cPay !== 0) && isNaN(parseFloat(f[pfx + '[pay]'].value))) {
 132                     let message = <?php echo xlj('Payment value for code') ?> + " " + code + " " + <?php echo xlj('is not a number') ?>;
 133                     (async (message, time) => {
 134                         await asyncAlertMsg(message, time, 'danger', 'lg');
 135                     })(message, 3000)
 136                     .then(res => { });
 137                     return false;
 138                 }
 139                 if ((cAdjust !== 0) && isNaN(parseFloat(f[pfx + '[adj]'].value))) {
 140                     let message = <?php echo xlj('Adjustment value for code') ?> + " " + code  + " " + <?php echo xlj('is not a number') ?>;
 141                     (async (message, time) => {
 142                         await asyncAlertMsg(message, time, 'danger', 'lg');
 143                     })(message, 3000)
 144                     .then(res => { });
 145                     return false;
 146                 }
 147                 if ((cAdjust !== 0) && !f[pfx + '[reason]'].value && !adjDisable) {
 148                     let message = <?php echo xlj('Please select an adjustment reason for code') ?> + " " + code;
 149                     (async (message, time) => {
 150                         await asyncAlertMsg(message, time, 'danger', 'lg');
 151                     })(message, 3000)
 152                     .then(res => { });
 153                     return false;
 154                 }
 155             // TBD: validate the date format
 156             }
 157             // Check if save is clicked with nothing to post.
 158             if (allempty && delcount === 0) {
 159                 let message = <?php echo xlj('Nothing to Post! Please review entries or use Cancel to exit transaction') ?>;
 160                 (async (message, time) => {
 161                     await asyncAlertMsg(message, time, 'danger', 'lg');
 162                 })(message, 3000)
 163                 .then(res => { });
 164                 return false;
 165             }
 166             // Demand confirmation if deleting anything.
 167             if (delcount > 0) {
 168                 if (!confirm(<?php echo xlj('Really delete'); ?> + ' ' + delcount +
 169                     ' ' + <?php echo xlj('transactions'); ?> + '?' +
 170                     ' ' + <?php echo xlj('This action will be logged'); ?> + '!')
 171                 ) return false;
 172             }
 173             return true;
 174         }
 175
 176         // Get current date
 177         function getFormattedToday() {
 178             let today = new Date();
 179             let dd = today.getDate();
 180             let mm = today.getMonth() + 1; //January is 0!
 181             let yyyy = today.getFullYear();
 182             if (dd < 10) {
 183                 dd = '0' + dd;
 184             }
 185             if (mm < 10) {
 186                 mm = '0' + mm;
 187             }
 188             return (yyyy + '-' + mm + '-' + dd);
 189         }
 190
 191         // Update Payment Fields
 192         function updateFields(payField, adjField, balField, coPayField, isFirstProcCode) {
 193             let payAmount = 0.0;
 194             let adjAmount = 0.0;
 195             let balAmount = 0.0;
 196             let coPayAmount = 0.0;
 197
 198             // coPayFiled will be null if there is no co-pay entry in the fee sheet
 199             if (coPayField) {
 200                 coPayAmount = coPayField.value;
 201             }
 202
 203             // if balance field is 0.00, its value comes back as null, so check for nul-ness first
 204             if (balField) {
 205                 balAmount = (balField.value) ? balField.value : 0;
 206             }
 207
 208             if (payField) {
 209                 payAmount = (payField.value) ? payField.value : 0;
 210             }
 211
 212             // alert('balance = >' + balAmount +'<  payAmount = ' + payAmount + '  copay = ' + coPayAmount + '  isFirstProcCode = ' + isFirstProcCode);
 213
 214             // subtract the co-pay only from the first procedure code
 215             if (isFirstProcCode == 1) {
 216                 balAmount = parseFloat(balAmount) + parseFloat(coPayAmount);
 217             }
 218
 219             if (adjDisable) {
 220                 return;
 221             }
 222
 223             adjAmount = balAmount - payAmount;
 224             // Assign rounded adjustment value back to TextField
 225             adjField.value = adjAmount = Math.round(adjAmount * 100) / 100;
 226         }
 227
 228         $(function () {
 229             $('.datepicker').datetimepicker({
 230                 <?php $datetimepicker_timepicker = false; ?>
 231                 <?php $datetimepicker_showseconds = false; ?>
 232                 <?php $datetimepicker_formatInput = true; ?>
 233                 <?php require($GLOBALS['srcdir'] . '/js/xl/jquery-datetimepicker-2-5-4.js.php'); ?>
 234                 <?php // can add any additional javascript settings to datetimepicker here; need to prepend first setting with a comma ?>
 235             });
 236         });
 237
 238         $("#ins_done").on("change", function() {
 239             $("#ins_done").val('changed');
 240         });
 241
 242     </script>
 243     <style>
 244         @media only screen and (max-width: 768px) {
 245             [class*="col-"] {
 246                 width: 100%;
 247                 text-align: left !Important;
 248             }
 249         }
 250
 251         .table {
 252             margin: auto;
 253             width: 99%;
 254         }
 255
 256         .table > tbody > tr > td {
 257             border-top: none;
 258         }
 259
 260         .last_detail {
 261             border-bottom: 1px var(--black) solid;
 262             margin-top: 2px;
 263         }
 264
 265         @media (min-width: 992px) {
 266             .modal-lg {
 267                 width: 1000px !Important;
 268             }
 269         }
 270     </style>
 271 </head>
 272 <body>
 273 <?php
 274 $trans_id = (int) $_GET['id'];
 275 if (!$trans_id) {
 276     die(xlt("You cannot access this page directly."));
 277 }
 278
 279 // A/R case, $trans_id matches form_encounter.id.
 280 $ferow = sqlQuery("SELECT e.*, p.fname, p.mname, p.lname FROM form_encounter AS e, patient_data AS p WHERE e.id = ? AND p.pid = e.pid", array($trans_id));
 281 if (empty($ferow)) {
 282     die("There is no encounter with form_encounter.id = '" . text($trans_id) . "'.");
 283 }
 284 $patient_id = (int) $ferow['pid'];
 285 $encounter_id = (int) $ferow['encounter'];
 286 $svcdate = substr($ferow['date'], 0, 10);
 287 $form_payer_id = (!empty($_POST['form_payer_id'])) ? (0 + $_POST['form_payer_id']) : 0;
 288 $form_reference = $_POST['form_reference'] ?? null;
 289 $form_check_date   = fixDate(($_POST['form_check_date'] ?? ''), date('Y-m-d'));
 290 $form_deposit_date = fixDate(($_POST['form_deposit_date'] ?? ''), $form_check_date);
 291 $form_pay_total = (!empty($_POST['form_pay_total'])) ? (0 + $_POST['form_pay_total']) : 0;
 292
 293 $payer_type = 0;
 294 if (preg_match('/^Ins(\d)/i', ($_POST['form_insurance'] ?? ''), $matches)) {
 295     $payer_type = $matches[1];
 296 }
 297
 298 if (!empty($_POST['form_save']) || !empty($_POST['form_cancel']) || !empty($_POST['isLastClosed']) || !empty($_POST['billing_note'])) {
 299     if (!empty($_POST['form_save'])) {
 300         if (!CsrfUtils::verifyCsrfToken($_POST["csrf_token_form"])) {
 301             CsrfUtils::csrfNotVerified();
 302         }
 303
 304         if ($debug) {
 305             echo "<p><b>" . xlt("This module is in test mode. The database will not be changed.") . "</b><p>\n";
 306         }
 307
 308         $session_id = SLEOB::arGetSession($form_payer_id, $form_reference, $form_check_date, $form_deposit_date, $form_pay_total);
 309 // The sl_eob_search page needs its invoice links modified to invoke
 310 // javascript to load form parms for all the above and submit.
 311 // At the same time that page would be modified to work off the
 312 // openemr database exclusively.
 313 // And back to the sl_eob_invoice page, I think we may want to move
 314 // the source input fields from row level to header level.
 315
 316 // Handle deletes. row_delete() is borrowed from deleter.php.
 317         if ($ALLOW_DELETE && !$debug) {
 318             if (!empty($_POST['form_del']) && is_array($_POST['form_del'])) {
 319                 foreach ($_POST['form_del'] as $arseq => $dummy) {
 320                     row_modify(
 321                         "ar_activity",
 322                         "deleted = NOW()",
 323                         "pid = '" . add_escape_custom($patient_id) .
 324                         "' AND encounter = '" . add_escape_custom($encounter_id) .
 325                         "' AND sequence_no = '" . add_escape_custom($arseq) .
 326                         "' AND deleted IS NULL"
 327                     );
 328                 }
 329             }
 330         }
 331
 332         $paytotal = 0;
 333         foreach ($_POST['form_line'] as $code => $cdata) {
 334             $thispay = trim($cdata['pay']);
 335             $thisadj = trim($cdata['adj']);
 336             $thisins = trim($cdata['ins']);
 337             $thiscodetype = trim($cdata['code_type']);
 338             $reason = $cdata['reason'];
 339
 340 // Get the adjustment reason type.  Possible values are:
 341 // 1 = Charge adjustment
 342 // 2 = Coinsurance
 343 // 3 = Deductible
 344 // 4 = Other pt resp
 345 // 5 = Comment
 346             $reason_type = '1';
 347             if ($reason) {
 348                 $tmp = sqlQuery("SELECT option_value FROM list_options WHERE list_id = 'adjreason' AND activity = 1 AND option_id = ?", array($reason));
 349                 if (empty($tmp['option_value'])) {
 350 // This should not happen but if it does, apply old logic.
 351                     if (preg_match("/To copay/", $reason)) {
 352                         $reason_type = 2;
 353                     } elseif (preg_match("/To ded'ble/", $reason)) {
 354                         $reason_type = 3;
 355                     }
 356                     $info_msg .= xl("No adjustment reason type found for") . " \"$reason\". ";
 357                 } else {
 358                     $reason_type = $tmp['option_value'];
 359                 }
 360             }
 361
 362             if (!$thisins) {
 363                 $thisins = 0;
 364             }
 365
 366             if (0.0 + $thispay) {
 367                 SLEOB::arPostPayment($patient_id, $encounter_id, $session_id, $thispay, $code, $payer_type, '', $debug, '', $thiscodetype);
 368                 $paytotal += $thispay;
 369             }
 370
 371 // Be sure to record adjustment reasons, even for zero adjustments if
 372 // they happen to be comments.
 373             if (
 374                 (0.0 + $thisadj) ||
 375                 ($reason && $reason_type == 5) ||
 376                 ($reason && ($reason_type > 1 && $reason_type < 6))
 377             ) {
 378 // "To copay" and "To ded'ble" need to become a comment in a zero
 379 // adjustment, formatted just like sl_eob_process.php.
 380                 if ($reason_type == '2') {
 381                     $reason = $_POST['form_insurance'] . " coins: $thisadj";
 382                     $thisadj = 0;
 383                 } elseif ($reason_type == '3') {
 384                     $reason = $_POST['form_insurance'] . " dedbl: $thisadj";
 385                     $thisadj = 0;
 386                 } elseif ($reason_type == '4') {
 387                     $reason = $_POST['form_insurance'] . " ptresp: $thisadj $reason";
 388                     $thisadj = 0;
 389                 } elseif ($reason_type == '5') {
 390                     $reason = $_POST['form_insurance'] . " note: $thisadj $reason";
 391                     $thisadj = 0;
 392                 } else {
 393 // An adjustment reason including "Ins" is assumed to be assigned by
 394 // insurance, and in that case we identify which one by appending
 395 // Ins1, Ins2 or Ins3.
 396                     if (strpos(strtolower($reason), 'ins') != false) {
 397                         $reason .= ' ' . $_POST['form_insurance'];
 398                     }
 399                 }
 400                 SLEOB::arPostAdjustment($patient_id, $encounter_id, $session_id, $thisadj, $code, $payer_type, $reason, $debug, '', $thiscodetype);
 401             }
 402         }
 403
 404 // Maintain which insurances are marked as finished.
 405
 406         $form_done = 0 + $_POST['form_done'];
 407         $form_stmt_count = 0 + $_POST['form_stmt_count'];
 408         sqlStatement("UPDATE form_encounter SET last_level_closed = ?, stmt_count = ? WHERE pid = ? AND encounter = ?", array($form_done, $form_stmt_count, $patient_id, $encounter_id));
 409
 410         if (!empty($_POST['form_secondary'])) {
 411             SLEOB::arSetupSecondary($patient_id, $encounter_id, $debug);
 412         }
 413         echo "<script>\n";
 414         echo " if (opener.document.forms[0] != undefined) {\n";
 415         echo "   if (opener.document.forms[0].form_amount) {\n";
 416         echo "     var tmp = opener.document.forms[0].form_amount.value - " . attr($paytotal) . ";\n";
 417         echo "     opener.document.forms[0].form_amount.value = Number(tmp).toFixed(2);\n";
 418         echo "   }\n";
 419         echo " }\n";
 420     } else {
 421         echo "<script>\n";
 422     }
 423     if ($info_msg) {
 424         echo " alert(" . js_escape($info_msg) . ");\n";
 425     }
 426     if (!$debug && !$save_stay && !$_POST['isLastClosed']) {
 427         echo "doClose();\n";
 428     }
 429     if (!$debug && ($save_stay || $_POST['isLastClosed'] || $_POST['billing_note'])) {
 430         if ($_POST['isLastClosed']) {
 431             // save last closed level
 432             $form_done = 0 + $_POST['form_done'];
 433             $form_stmt_count = 0 + $_POST['form_stmt_count'];
 434             sqlStatement("UPDATE form_encounter SET last_level_closed = ?, stmt_count = ? WHERE pid = ? AND encounter = ?", array($form_done, $form_stmt_count, $patient_id, $encounter_id));
 435             // also update billing for aging
 436             sqlStatement("UPDATE billing SET bill_date = ? WHERE pid = ? AND encounter = ?", array($form_deposit_date, $patient_id, $encounter_id));
 437             if (!empty($_POST['form_secondary'])) {
 438                 SLEOB::arSetupSecondary($patient_id, $encounter_id, $debug);
 439             }
 440         }
 441
 442         if ($_POST['billing_note']) {
 443             // save last closed level
 444             sqlStatement("UPDATE form_encounter SET billing_note = ? WHERE pid = ? AND encounter = ?", array($_POST['billing_note'], $patient_id, $encounter_id));
 445         }
 446
 447         // will reload page w/o reposting
 448         echo "location.replace(location)\n";
 449     }
 450     echo "</script>\n";
 451     if (!$save_stay && !$_POST['isLastClosed']) {
 452         exit();
 453     }
 454 }
 455
 456 // Get invoice charge details.
 457 $codes = InvoiceSummary::arGetInvoiceSummary($patient_id, $encounter_id, true);
 458 $pdrow = sqlQuery("select billing_note from patient_data where pid = ? limit 1", array($patient_id));
 459 $bnrow = sqlQuery("select billing_note from form_encounter where pid = ? AND encounter = ? limit 1", array($patient_id, $encounter_id));
 460 ?>
 461
 462 <div class="container-fluid">
 463     <div class="row">
 464         <h2><?php echo xlt('EOB Invoice'); ?></h2>
 465     </div>
 466     <div class="container-fluid">
 467         <form class="form" action='sl_eob_invoice.php?id=<?php echo attr_url($trans_id); ?>' method='post' onsubmit='return validate(this)'>
 468             <input type="hidden" name="csrf_token_form" value="<?php echo attr(CsrfUtils::collectCsrfToken()); ?>"/>
 469             <input type="hidden" name="isPosting" value="<?php echo attr($from_posting); ?>"/>
 470             <input type="hidden" name="isLastClosed" value="" />
 471             <fieldset>
 472                 <legend><?php echo xlt('Invoice Actions'); ?></legend>
 473                 <div class="form-row">
 474                     <div class="form-group col-lg">
 475                         <label class="col-form-label" for="form_name"><?php echo xlt('Patient'); ?>:</label>
 476                         <input type="text" class="form-control" id='form_name'
 477                                name='form_name'
 478                                value="<?php echo attr($ferow['fname']) . ' ' . attr($ferow['mname']) . ' ' . attr($ferow['lname']); ?>"
 479                                disabled />
 480                     </div>
 481                     <div class="form-group col-lg">
 482                         <label class="col-form-label" for="form_provider"><?php echo xlt('Provider'); ?>:</label>
 483                         <?php
 484                         $tmp = sqlQuery("SELECT fname, mname, lname " .
 485                             "FROM users WHERE id = ?", array($ferow['provider_id']));
 486                         $provider = text($tmp['fname']) . ' ' . text($tmp['mname']) . ' ' . text($tmp['lname']);
 487                         $tmp = sqlQuery("SELECT bill_date FROM billing WHERE " .
 488                             "pid = ? AND encounter = ? AND " .
 489                             "activity = 1 ORDER BY fee DESC, id ASC LIMIT 1", array($patient_id, $encounter_id));
 490                         $billdate = substr(($tmp['bill_date'] ?? '' . "Not Billed"), 0, 10);
 491                         ?>
 492                         <input type="text" class="form-control" id='form_provider'
 493                                name='form_provider' value="<?php echo attr($provider); ?>" disabled />
 494                     </div>
 495                     <div class="form-group col-lg">
 496                         <label class="col-form-label" for="form_invoice"><?php echo xlt('Invoice'); ?>:</label>
 497                         <input type="text" class="form-control" id='form_provider'
 498                                name='form_provider' value='<?php echo attr($patient_id) . "-" . attr($encounter_id); ?>'
 499                                disabled />
 500                     </div>
 501                     <div class="form-group col-lg">
 502                         <label class="col-form-label" for="svc_date"><?php echo xlt('Svc Date'); ?>:</label>
 503                         <input type="text" class="form-control" id='svc_date' name='form_provider'
 504                                value='<?php echo attr($svcdate); ?>' disabled />
 505                     </div>
 506                     <div class="card bg-light col-lg-4">
 507                         <div class="card-title mx-auto"><?php echo xlt('Insurance'); ?></div>
 508                         <?php
 509                         for ($i = 1; $i <= 3; ++$i) {
 510                             $payerid = SLEOB::arGetPayerID($patient_id, $svcdate, $i);
 511                             if ($payerid) {
 512                                 $tmp = sqlQuery("SELECT name FROM insurance_companies WHERE id = ?", array($payerid));
 513                                 echo "$i: " . $tmp['name'] . "<br />";
 514                             }
 515                         }
 516                         ?>
 517                     </div>
 518                 </div>
 519                 <div class="form-row">
 520                     <div class="form-group col-lg">
 521                         <label class="col-form-label" for="billing_note"><?php echo xlt('Billing Note'); ?>:</label>
 522                         <textarea name="billing_note" id="billing_note" class="form-control" cols="5" rows="2"><?php echo text(($pdrow['billing_note'] ?? '')) . "\n" . text(($bnrow['billing_note'] ?? '')); ?></textarea>
 523                     </div>
 524                 </div>
 525                 <div class="form-row">
 526                     <div class="form-group col-lg">
 527                         <label class="col-form-label" for="form_stmt_count"><?php echo xlt('Statements Sent'); ?>:</label>
 528                         <input type='text' name='form_stmt_count' id='form_stmt_count' class="form-control" value='<?php echo attr((0 + $ferow['stmt_count'])); ?>' />
 529                     </div>
 530                     <div class="form-group col-lg">
 531                         <label class="col-form-label" for="form_last_bill"><?php echo xlt('Last Bill Date'); ?>:</label>
 532                         <input type='text' name="form_last_bill" id='form_last_bill' class="form-control"
 533                                value ='<?php echo attr($billdate); ?>' disabled />
 534                     </div>
 535                     <div class="form-group col-lg">
 536                         <label class="col-form-label" for="form_reference"><?php echo xlt('Check/EOB No.'); ?>:</label>
 537                         <input type='text' name='form_reference' id='form_reference' class="form-control" value='' />
 538                     </div>
 539                     <div class="form-group col-lg">
 540                         <label class="col-form-label" for="form_check_date"><?php echo xlt('Check/EOB Date'); ?>:</label>
 541                         <input type='text' name='form_check_date' id='form_check_date' class='form-control datepicker' value='' />
 542                     </div>
 543                     <div class="form-group col-lg">
 544                         <label class="col-form-label" for="form_deposit_date"><?php echo xlt('Deposit Date'); ?>:</label>
 545                         <input type='text' name='form_deposit_date' id='form_deposit_date' class='form-control datepicker' value='' />
 546                         <input type='hidden' name='form_payer_id' value='' />
 547                         <input type='hidden' name='form_orig_reference' value='' />
 548                         <input type='hidden' name='form_orig_check_date' value='' />
 549                         <input type='hidden' name='form_orig_deposit_date' value='' />
 550                         <input type='hidden' name='form_pay_total' value='' />
 551                     </div>
 552                 </div>
 553                 <div class="form-row">
 554                     <div class="form-group col-lg">
 555                         <label class="col-form-label" for="type_code"><?php echo xlt('Now posting for'); ?>:</label>
 556                         <div class="pl-3">
 557                             <?php
 558                                 $last_level_closed = 0 + $ferow['last_level_closed'];
 559                             ?>
 560                             <label class="radio-inline">
 561                                 <input <?php echo $last_level_closed === 0 ? attr('checked') : ''; ?> name='form_insurance' onclick='setins("Ins1")' type='radio'
 562                                     value='Ins1' /><?php echo xlt('Ins1') ?>
 563                             </label>
 564                             <label class="radio-inline">
 565                                 <input <?php echo $last_level_closed === 1 ? attr('checked') : ''; ?> name='form_insurance' onclick='setins("Ins2")' type='radio'
 566                                     value='Ins2' /><?php echo xlt('Ins2') ?>
 567                             </label>
 568                             <label class="radio-inline">
 569                                 <input <?php echo $last_level_closed === 2 ? attr('checked') : ''; ?> name='form_insurance' onclick='setins("Ins3")' type='radio'
 570                                     value='Ins3' /><?php echo xlt('Ins3') ?>
 571                             </label>
 572                             <label class="radio-inline">
 573                                 <input <?php echo $last_level_closed === 3 ? attr('checked') : ''; ?> name='form_insurance' onclick='setins("Pt")' type='radio'
 574                                     value='Pt' /><?php echo xlt('Patient') ?>
 575                             </label>
 576                             <?php
 577                             // TBD: I think the following is unused and can be removed.
 578                             ?>
 579                             <input name='form_eobs' type='hidden' value='<?php echo attr($arrow['shipvia'] ?? '') ?>'/>
 580                         </div>
 581                     </div>
 582                     <div class="form-group col-lg" id='ins_done'>
 583                         <label class="col-form-label" for=""><?php echo xlt('Done with'); ?>:</label>
 584                         <a class="btn btn-save bg-light text-primary"
 585                             onclick="document.forms[0].isLastClosed.value='3'; document.forms[0].submit()"><?php echo xlt("Save Level"); ?>
 586                         </a>
 587                         <div class="pl-3">
 588                             <?php
 589                             // Write a checkbox for each insurance.  It is to be checked when
 590                             // we no longer expect any payments from that company for the claim.
 591                             $last_level_closed = 0 + $ferow['last_level_closed'];
 592                             foreach (array(0 => 'None', 1 => 'Ins1', 2 => 'Ins2', 3 => 'Ins3') as $key => $value) {
 593                                 if ($key && !SLEOB::arGetPayerID($patient_id, $svcdate, $key)) {
 594                                     continue;
 595                                 }
 596                                 $checked = ($last_level_closed == $key) ? " checked" : "";
 597                                 echo "<label class='radio-inline'>";
 598                                 echo "<input type='radio' name='form_done' value='" . attr($key) . "'$checked />" . text($value);
 599                                 echo "</label>";
 600                             }
 601                             ?>
 602                         </div>
 603                     </div>
 604                     <div class="form-group col-lg">
 605                         <label class="col-form-label" for=""><?php echo xlt('Secondary billing'); ?>:</label>
 606                         <div class="pl-3">
 607                             <label class="checkbox-inline">
 608                                 <input name="form_secondary" type="checkbox" value="1" /><?php echo xlt('Needs secondary billing') ?>
 609                             </label>
 610                         </div>
 611                     </div>
 612                 </div>
 613             </fieldset>
 614             <fieldset>
 615                 <legend><?php echo xlt('Invoice Details'); ?></legend>
 616                 <div class="table-responsive">
 617                     <table class="table table-sm">
 618                         <thead>
 619                             <tr>
 620                                 <th><?php echo xlt('Code') ?></th>
 621                                 <th class="text-left"><?php echo xlt('Charge') ?></th>
 622                                 <th class="text-left"><?php echo xlt('Balance') ?>&nbsp;</th>
 623                                 <th><?php echo xlt('By/Source') ?></th>
 624                                 <th><?php echo xlt('Date') ?></th>
 625                                 <th><?php echo xlt('Pay') ?></th>
 626                                 <th><?php echo xlt('Adjust') ?></th>
 627                                 <th>&nbsp;</th>
 628                                 <th><?php echo xlt('Reason') ?></th>
 629                                 <?php
 630                                 if ($ALLOW_DELETE) { ?>
 631                                     <th><?php echo xlt('Del') ?></th>
 632                                     <?php
 633                                 } ?>
 634                             </tr>
 635                         </thead>
 636                         <?php
 637                         $firstProcCodeIndex = -1;
 638                         $encount = 0;
 639                         foreach ($codes as $code => $cdata) {
 640                             ++$encount;
 641                             $dispcode = $code;
 642
 643                             // remember the index of the first entry whose code is not "CO-PAY", i.e. it's a legitimate proc code
 644                             if ($firstProcCodeIndex == -1 && strcmp($code, "CO-PAY") != 0) {
 645                                 $firstProcCodeIndex = $encount;
 646                             }
 647
 648                             // this sorts the details more or less chronologically:
 649                             ksort($cdata['dtl']);
 650                             foreach ($cdata['dtl'] as $dkey => $ddata) {
 651                                 $ddate = substr($dkey, 0, 10);
 652                                 if (preg_match('/^(\d\d\d\d)(\d\d)(\d\d)\s*$/', $ddate, $matches)) {
 653                                     $ddate = $matches[1] . '-' . $matches[2] . '-' . $matches[3];
 654                                 }
 655                                 $tmpchg = "";
 656                                 $tmpadj = "";
 657                                 if (!empty($ddata['chg']) && ($ddata['chg'] != 0)) {
 658                                     if (isset($ddata['rsn'])) {
 659                                         $tmpadj = 0 - $ddata['chg'];
 660                                     } else {
 661                                         $tmpchg = $ddata['chg'];
 662                                     }
 663                                 }
 664                                 ?>
 665                                 <tr>
 666                                     <td class="detail" style="background:<?php echo $dispcode ? 'lightyellow' : ''; ?>"><?php echo text($dispcode); $dispcode = "" ?></td>
 667                                     <td class="detail"><?php echo text(bucks($tmpchg)); ?></td>
 668                                     <td class="detail">&nbsp;</td>
 669                                     <td class="detail">
 670                                         <?php
 671                                         if (isset($ddata['plv'])) {
 672                                             if (!$ddata['plv']) {
 673                                                 echo 'Pt/';
 674                                             } else {
 675                                                 echo 'Ins' . text($ddata['plv']) . '/';
 676                                             }
 677                                         }
 678                                         echo text($ddata['src'] ?? '');
 679                                         ?>
 680                                     </td>
 681                                     <td class="detail"><?php echo text($ddate); ?></td>
 682                                     <td class="detail"><?php echo text(bucks($ddata['pmt'] ?? '')); ?></td>
 683                                     <td class="detail"><?php echo text(bucks($tmpadj)); ?></td>
 684                                     <td class="detail">&nbsp;</td>
 685                                     <td class="detail"><?php echo text($ddata['rsn'] ?? ''); ?></td>
 686                                     <?php
 687                                     if ($ALLOW_DELETE) { ?>
 688                                         <td class="detail">
 689                                             <?php
 690                                             if (!empty($ddata['arseq'])) { ?>
 691                                                 <input name="form_del[<?php echo attr($ddata['arseq']); ?>]"
 692                                                        type="checkbox" />
 693                                                 <?php
 694                                             } else {
 695                                                 ?> &nbsp;
 696                                                 <?php
 697                                             } ?>
 698                                         </td>
 699                                     <?php } ?>
 700                                 </tr>
 701                             <?php } // end of prior detail line ?>
 702                             <tr>
 703                                 <td class="last_detail"><?php echo text($dispcode);
 704                                     $dispcode = "" ?>
 705                                 </td>
 706                                 <td class="last_detail">&nbsp;</td>
 707                                 <td class="last_detail">
 708                                     <input name="form_line[<?php echo attr($code); ?>][bal]" type="hidden"
 709                                            value="<?php echo attr(bucks($cdata['bal'])); ?>" />
 710                                     <input name="form_line[<?php echo attr($code); ?>][ins]" type="hidden"
 711                                            value="<?php echo attr($cdata['ins'] ?? ''); ?>" />
 712                                     <input name="form_line[<?php echo attr($code); ?>][code_type]" type="hidden"
 713                                            value="<?php echo attr($cdata['code_type'] ?? ''); ?>" /> <?php echo text(sprintf("%.2f", $cdata['bal'])); ?>
 714                                     &nbsp;
 715                                 </td>
 716                                 <td class="last_detail"></td>
 717                                 <td class="last_detail"></td>
 718                                 <td class="last_detail">
 719                                     <input name="form_line[<?php echo attr($code); ?>][pay]"
 720                                            onkeyup="updateFields(document.forms[0]['form_line[<?php echo attr($code); ?>][pay]'], document.forms[0]['form_line[<?php echo attr($code); ?>][adj]'], document.forms[0]['form_line[<?php echo attr($code); ?>][bal]'], document.forms[0]['form_line[CO-PAY][bal]'], <?php echo ($firstProcCodeIndex == $encount) ? 1 : 0 ?>)"
 721                                            onfocus="this.select()" autofocus size="10" type="text" class="form-control"
 722                                            value="0.00" />
 723                                 </td>
 724                                 <td class="last_detail">
 725                                     <input name="form_line[<?php echo attr($code); ?>][adj]" size="10" type="text"
 726                                            class="form-control"
 727                                            value='<?php echo attr((!empty($totalAdjAmount)) ? $totalAdjAmount : '0.00'); ?>'
 728                                            onclick="this.select()" />
 729                                 </td>
 730                                 <td class="last_detail text-center">
 731                                     <a href="#" class="text-decoration-none" onclick="return writeoff(<?php echo attr_js($code); ?>)">WO</a>
 732                                 </td>
 733                                 <td class="last_detail">
 734                                     <select class="form-control" name="form_line[<?php echo attr($code); ?>][reason]">
 735                                         <?php
 736                                         // Adjustment reasons are now taken from the list_options table.
 737                                         echo "    <option value=''></option>\n";
 738                                         $ores = sqlStatement("SELECT option_id, title, is_default FROM list_options " .
 739                                             "WHERE list_id = 'adjreason' AND activity = 1 ORDER BY seq, title");
 740                                         while ($orow = sqlFetchArray($ores)) {
 741                                             echo "    <option value='" . attr($orow['option_id']) . "'";
 742                                             if ($orow['is_default']) {
 743                                                 echo " selected";
 744                                             }
 745                                             echo ">" . text($orow['title']) . "</option>\n";
 746                                         }
 747                                         ?>
 748                                     </select>
 749                                     <?php
 750                                     // TBD: Maybe a comment field would be good here, for appending
 751                                     // to the reason.
 752                                     ?>
 753                                 </td>
 754                                 <?php if ($ALLOW_DELETE) { ?>
 755                                     <td class="last_detail">&nbsp;</td>
 756                                 <?php } ?>
 757                             </tr>
 758                         <?php } // end of code ?>
 759                     </table>
 760                 </div>
 761             </fieldset>
 762             <?php //can change position of buttons by creating a class 'position-override' and adding rule text-align:center or right as the case may be in individual stylesheets ?>
 763             <div class="form-group col-lg clearfix">
 764                 <div class="col-sm-12 text-left position-override" id="search-btn">
 765                     <div class="btn-group" role="group">
 766                         <!-- @todo leave as I may still use sjp 08/2020 -->
 767                         <!--<button type='submit' class="btn btn-primary btn-save" name='form_save' id="btn-save-stay"
 768                             onclick="this.value='1';"><?php /*echo xlt("Save Current"); */?></button>-->
 769                         <button type='submit' class="btn btn-primary btn-save" name='form_save' id="btn-save"
 770                             onclick="this.value='2';"><?php echo xlt("Save"); ?></button>
 771                         <button type='button' class="btn btn-secondary btn-cancel" name='form_cancel'
 772                             id="btn-cancel" onclick='doClose()'><?php echo xlt("Close"); ?></button>
 773                     </div>
 774                     <?php if ($from_posting) { ?>
 775                         <button type='button' class="btn btn-secondary btn-view float-right" name='form_goto' id="btn-goto"
 776                             onclick="goEncounterSummary(event, <?php echo attr_js($patient_id) ?>)"><?php echo xlt("Past Encounters"); ?></button>
 777                     <?php } ?>
 778                 </div>
 779             </div>
 780         </form>
 781     </div>
 782 </div><!--End of container div-->
 783 <?php if ($from_posting) { ?>
 784 <script>
 785     var f1 = opener.document.forms[0];
 786     var f2 = document.forms[0];
 787     if (f1.form_source) {
 788         <?php
 789         // These support creation and lookup of ar_session table entries:
 790         echo "  f2.form_reference.value         = f1.form_source.value;\n";
 791         echo "  f2.form_check_date.value        = f1.form_paydate.value;\n";
 792         echo "  //f2.form_deposit_date.value      = f1.form_deposit_date.value;\n";
 793         echo "  if (f1.form_deposit_date.value != '')\n";
 794         echo "     f2.form_deposit_date.value      = f1.form_deposit_date.value;\n";
 795         echo "  else\n";
 796         echo "     f2.form_deposit_date.value      = getFormattedToday();\n";
 797         echo "  f2.form_payer_id.value          = f1.form_payer_id.value;\n";
 798         echo "  f2.form_pay_total.value         = f1.form_amount.value;\n";
 799         echo "  f2.form_orig_reference.value    = f1.form_source.value;\n";
 800         echo "  f2.form_orig_check_date.value   = f1.form_paydate.value;\n";
 801         echo "  f2.form_orig_deposit_date.value = f1.form_deposit_date.value;\n";
 802
 803         // While I'm thinking about it, some notes about eob sessions.
 804         // If they do not have all of the session key fields in the search
 805         // page, then show a warning at the top of the invoice page.
 806         // Also when they go to save the invoice page and a session key
 807         // field has changed, alert them to that and allow a cancel.
 808
 809         // Another point... when posting EOBs, the incoming payer ID might
 810         // not match the payer ID for the patient's insurance.  This is
 811         // because the same payer might be entered more than once into the
 812         // insurance_companies table.  I don't think it matters much.
 813         ?>
 814     }
 815     setins("Ins1");
 816 </script>
 817 <?php } ?>
 818 </body>
 819 </html>