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("$srcdir/patient.inc");
  24 require_once("$srcdir/forms.inc");
  25 require_once("../../custom/code_types.inc.php");
  26 require_once "$srcdir/user.inc";
  27 require_once("$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(pid) {
  73             if(pid) {
  74                 if(typeof opener.toEncSummary  === 'function') {
  75                     opener.toEncSummary(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 = 0 + $_GET['id'];
 275 if (!$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 = 0 + $ferow['pid'];
 285 $encounter_id = 0 + $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'])) {
 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 || $_POST['isLastClosed'])) {
 430         if ($_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, $encounter_id));
 435         }
 436         // will reload page w/o reposting
 437         echo "location.replace(location)\n";
 438     }
 439     echo "</script>\n";
 440     if (!$save_stay && !$_POST['isLastClosed']) {
 441         exit();
 442     }
 443 }
 444
 445 // Get invoice charge details.
 446 $codes = InvoiceSummary::arGetInvoiceSummary($patient_id, $encounter_id, true);
 447 $pdrow = sqlQuery("select billing_note from patient_data where pid = ? limit 1", array($patient_id));
 448 ?>
 449
 450 <div class="container-fluid">
 451     <div class="row">
 452         <h2><?php echo xlt('EOB Invoice'); ?></h2>
 453     </div>
 454     <div class="container-fluid">
 455         <form class="form" action='sl_eob_invoice.php?id=<?php echo attr_url($trans_id); ?>' method='post' onsubmit='return validate(this)'>
 456             <input type="hidden" name="csrf_token_form" value="<?php echo attr(CsrfUtils::collectCsrfToken()); ?>"/>
 457             <input type="hidden" name="isPosting" value="<?php echo attr($from_posting); ?>"/>
 458             <input type="hidden" name="isLastClosed" value="" />
 459             <fieldset>
 460                 <legend><?php echo xlt('Invoice Actions'); ?></legend>
 461                 <div class="form-row">
 462                     <div class="form-group col-lg">
 463                         <label class="col-form-label" for="form_name"><?php echo xlt('Patient'); ?>:</label>
 464                         <input type="text" class="form-control" id='form_name'
 465                                name='form_name'
 466                                value="<?php echo attr($ferow['fname']) . ' ' . attr($ferow['mname']) . ' ' . attr($ferow['lname']); ?>"
 467                                disabled />
 468                     </div>
 469                     <div class="form-group col-lg">
 470                         <label class="col-form-label" for="form_provider"><?php echo xlt('Provider'); ?>:</label>
 471                         <?php
 472                         $tmp = sqlQuery("SELECT fname, mname, lname " .
 473                             "FROM users WHERE id = ?", array($ferow['provider_id']));
 474                         $provider = text($tmp['fname']) . ' ' . text($tmp['mname']) . ' ' . text($tmp['lname']);
 475                         $tmp = sqlQuery("SELECT bill_date FROM billing WHERE " .
 476                             "pid = ? AND encounter = ? AND " .
 477                             "activity = 1 ORDER BY fee DESC, id ASC LIMIT 1", array($patient_id, $encounter_id));
 478                         $billdate = substr(($tmp['bill_date'] . "Not Billed"), 0, 10);
 479                         ?>
 480                         <input type="text" class="form-control" id='form_provider'
 481                                name='form_provider' value="<?php echo attr($provider); ?>" disabled />
 482                     </div>
 483                     <div class="form-group col-lg">
 484                         <label class="col-form-label" for="form_invoice"><?php echo xlt('Invoice'); ?>:</label>
 485                         <input type="text" class="form-control" id='form_provider'
 486                                name='form_provider' value='<?php echo attr($patient_id) . "." . attr($encounter_id); ?>'
 487                                disabled />
 488                     </div>
 489                     <div class="form-group col-lg">
 490                         <label class="col-form-label" for="svc_date"><?php echo xlt('Svc Date'); ?>:</label>
 491                         <input type="text" class="form-control" id='svc_date' name='form_provider'
 492                                value='<?php echo attr($svcdate); ?>' disabled />
 493                     </div>
 494                     <div class="card bg-light col-lg-4">
 495                         <div class="card-title mx-auto"><?php echo xlt('Insurance'); ?></div>
 496                         <?php
 497                         for ($i = 1; $i <= 3; ++$i) {
 498                             $payerid = SLEOB::arGetPayerID($patient_id, $svcdate, $i);
 499                             if ($payerid) {
 500                                 $tmp = sqlQuery("SELECT name FROM insurance_companies WHERE id = ?", array($payerid));
 501                                 echo "$i: " . $tmp['name'] . "<br />";
 502                             }
 503                         }
 504                         ?>
 505                     </div>
 506                 </div>
 507                 <div class="form-group mt-3">
 508                      <textarea name="insurance_name" id="insurance_name" class="form-control" cols="5" rows="2" readonly><?php echo attr($insurance ?? ''); ?></textarea>
 509                 </div>
 510                 <div class="form-row">
 511                     <div class="form-group col-lg">
 512                         <label class="col-form-label" for="form_stmt_count"><?php echo xlt('Statements Sent'); ?>:</label>
 513                         <input type='text' name='form_stmt_count' id='form_stmt_count' class="form-control" value='<?php echo attr((0 + $ferow['stmt_count'])); ?>' />
 514                     </div>
 515                     <div class="form-group col-lg">
 516                         <label class="col-form-label" for="form_last_bill"><?php echo xlt('Last Bill Date'); ?>:</label>
 517                         <input type='text' name="form_last_bill" id='form_last_bill' class="form-control"
 518                                value ='<?php echo attr($billdate); ?>' disabled />
 519                     </div>
 520                     <div class="form-group col-lg">
 521                         <label class="col-form-label" for="form_reference"><?php echo xlt('Check/EOB No.'); ?>:</label>
 522                         <input type='text' name='form_reference' id='form_reference' class="form-control" value='' />
 523                     </div>
 524                     <div class="form-group col-lg">
 525                         <label class="col-form-label" for="form_check_date"><?php echo xlt('Check/EOB Date'); ?>:</label>
 526                         <input type='text' name='form_check_date' id='form_check_date' class='form-control datepicker' value='' />
 527                     </div>
 528                     <div class="form-group col-lg">
 529                         <label class="col-form-label" for="form_deposit_date"><?php echo xlt('Deposit Date'); ?>:</label>
 530                         <input type='text' name='form_deposit_date' id='form_deposit_date' class='form-control datepicker' value='' />
 531                         <input type='hidden' name='form_payer_id' value='' />
 532                         <input type='hidden' name='form_orig_reference' value='' />
 533                         <input type='hidden' name='form_orig_check_date' value='' />
 534                         <input type='hidden' name='form_orig_deposit_date' value='' />
 535                         <input type='hidden' name='form_pay_total' value='' />
 536                     </div>
 537                 </div>
 538                 <div class="form-row">
 539                     <div class="form-group col-lg">
 540                         <label class="col-form-label" for="type_code"><?php echo xlt('Now posting for'); ?>:</label>
 541                         <div class="pl-3">
 542                             <?php
 543                                 $last_level_closed = 0 + $ferow['last_level_closed'];
 544                             ?>
 545                             <label class="radio-inline">
 546                                 <input <?php echo $last_level_closed === 0 ? attr('checked') : ''; ?> name='form_insurance' onclick='setins("Ins1")' type='radio'
 547                                     value='Ins1' /><?php echo xlt('Ins1') ?>
 548                             </label>
 549                             <label class="radio-inline">
 550                                 <input <?php echo $last_level_closed === 1 ? attr('checked') : ''; ?> name='form_insurance' onclick='setins("Ins2")' type='radio'
 551                                     value='Ins2' /><?php echo xlt('Ins2') ?>
 552                             </label>
 553                             <label class="radio-inline">
 554                                 <input <?php echo $last_level_closed === 2 ? attr('checked') : ''; ?> name='form_insurance' onclick='setins("Ins3")' type='radio'
 555                                     value='Ins3' /><?php echo xlt('Ins3') ?>
 556                             </label>
 557                             <label class="radio-inline">
 558                                 <input <?php echo $last_level_closed === 3 ? attr('checked') : ''; ?> name='form_insurance' onclick='setins("Pt")' type='radio'
 559                                     value='Pt' /><?php echo xlt('Patient') ?>
 560                             </label>
 561                             <?php
 562                             // TBD: I think the following is unused and can be removed.
 563                             ?>
 564                             <input name='form_eobs' type='hidden' value='<?php echo attr($arrow['shipvia'] ?? '') ?>'/>
 565                         </div>
 566                     </div>
 567                     <div class="form-group col-lg" id='ins_done'>
 568                         <label class="col-form-label" for=""><?php echo xlt('Done with'); ?>:</label>
 569                         <a class="btn btn-save bg-light text-primary"
 570                             onclick="document.forms[0].isLastClosed.value='3'; document.forms[0].submit()"><?php echo xlt("Save Level"); ?>
 571                         </a>
 572                         <div class="pl-3">
 573                             <?php
 574                             // Write a checkbox for each insurance.  It is to be checked when
 575                             // we no longer expect any payments from that company for the claim.
 576                             $last_level_closed = 0 + $ferow['last_level_closed'];
 577                             foreach (array(0 => 'None', 1 => 'Ins1', 2 => 'Ins2', 3 => 'Ins3') as $key => $value) {
 578                                 if ($key && !SLEOB::arGetPayerID($patient_id, $svcdate, $key)) {
 579                                     continue;
 580                                 }
 581                                 $checked = ($last_level_closed == $key) ? " checked" : "";
 582                                 echo "<label class='radio-inline'>";
 583                                 echo "<input type='radio' name='form_done' value='" . attr($key) . "'$checked />" . text($value);
 584                                 echo "</label>";
 585                             }
 586                             ?>
 587                         </div>
 588                     </div>
 589                     <div class="form-group col-lg">
 590                         <label class="col-form-label" for=""><?php echo xlt('Secondary billing'); ?>:</label>
 591                         <div class="pl-3">
 592                             <label class="checkbox-inline">
 593                                 <input name="form_secondary" type="checkbox" value="1" /><?php echo xlt('Needs secondary billing') ?>
 594                             </label>
 595                         </div>
 596                     </div>
 597                 </div>
 598             </fieldset>
 599             <fieldset>
 600                 <legend><?php echo xlt('Invoice Details'); ?></legend>
 601                 <div class="table-responsive">
 602                     <table class="table table-sm">
 603                         <thead>
 604                             <tr>
 605                                 <th><?php echo xlt('Code') ?></th>
 606                                 <th class="text-left"><?php echo xlt('Charge') ?></th>
 607                                 <th class="text-left"><?php echo xlt('Balance') ?>&nbsp;</th>
 608                                 <th><?php echo xlt('By/Source') ?></th>
 609                                 <th><?php echo xlt('Date') ?></th>
 610                                 <th><?php echo xlt('Pay') ?></th>
 611                                 <th><?php echo xlt('Adjust') ?></th>
 612                                 <th>&nbsp;</th>
 613                                 <th><?php echo xlt('Reason') ?></th>
 614                                 <?php
 615                                 if ($ALLOW_DELETE) { ?>
 616                                     <th><?php echo xlt('Del') ?></th>
 617                                     <?php
 618                                 } ?>
 619                             </tr>
 620                         </thead>
 621                         <?php
 622                         $firstProcCodeIndex = -1;
 623                         $encount = 0;
 624                         foreach ($codes as $code => $cdata) {
 625                             ++$encount;
 626                             $dispcode = $code;
 627
 628                             // remember the index of the first entry whose code is not "CO-PAY", i.e. it's a legitimate proc code
 629                             if ($firstProcCodeIndex == -1 && strcmp($code, "CO-PAY") != 0) {
 630                                 $firstProcCodeIndex = $encount;
 631                             }
 632
 633                             // this sorts the details more or less chronologically:
 634                             ksort($cdata['dtl']);
 635                             foreach ($cdata['dtl'] as $dkey => $ddata) {
 636                                 $ddate = substr($dkey, 0, 10);
 637                                 if (preg_match('/^(\d\d\d\d)(\d\d)(\d\d)\s*$/', $ddate, $matches)) {
 638                                     $ddate = $matches[1] . '-' . $matches[2] . '-' . $matches[3];
 639                                 }
 640                                 $tmpchg = "";
 641                                 $tmpadj = "";
 642                                 if (!empty($ddata['chg']) && ($ddata['chg'] != 0)) {
 643                                     if (isset($ddata['rsn'])) {
 644                                         $tmpadj = 0 - $ddata['chg'];
 645                                     } else {
 646                                         $tmpchg = $ddata['chg'];
 647                                     }
 648                                 }
 649                                 ?>
 650                                 <tr>
 651                                     <td class="detail" style="background:<?php echo $dispcode ? 'lightyellow' : ''; ?>"><?php echo text($dispcode); $dispcode = "" ?></td>
 652                                     <td class="detail"><?php echo text(bucks($tmpchg)); ?></td>
 653                                     <td class="detail">&nbsp;</td>
 654                                     <td class="detail">
 655                                         <?php
 656                                         if (isset($ddata['plv'])) {
 657                                             if (!$ddata['plv']) {
 658                                                 echo 'Pt/';
 659                                             } else {
 660                                                 echo 'Ins' . text($ddata['plv']) . '/';
 661                                             }
 662                                         }
 663                                         echo text($ddata['src'] ?? '');
 664                                         ?>
 665                                     </td>
 666                                     <td class="detail"><?php echo text($ddate); ?></td>
 667                                     <td class="detail"><?php echo text(bucks($ddata['pmt'] ?? '')); ?></td>
 668                                     <td class="detail"><?php echo text(bucks($tmpadj)); ?></td>
 669                                     <td class="detail">&nbsp;</td>
 670                                     <td class="detail"><?php echo text($ddata['rsn'] ?? ''); ?></td>
 671                                     <?php
 672                                     if ($ALLOW_DELETE) { ?>
 673                                         <td class="detail">
 674                                             <?php
 675                                             if (!empty($ddata['arseq'])) { ?>
 676                                                 <input name="form_del[<?php echo attr($ddata['arseq']); ?>]"
 677                                                        type="checkbox" />
 678                                                 <?php
 679                                             } else {
 680                                                 ?> &nbsp;
 681                                                 <?php
 682                                             } ?>
 683                                         </td>
 684                                     <?php } ?>
 685                                 </tr>
 686                             <?php } // end of prior detail line ?>
 687                             <tr>
 688                                 <td class="last_detail"><?php echo text($dispcode);
 689                                     $dispcode = "" ?>
 690                                 </td>
 691                                 <td class="last_detail">&nbsp;</td>
 692                                 <td class="last_detail">
 693                                     <input name="form_line[<?php echo attr($code); ?>][bal]" type="hidden"
 694                                            value="<?php echo attr(bucks($cdata['bal'])); ?>" />
 695                                     <input name="form_line[<?php echo attr($code); ?>][ins]" type="hidden"
 696                                            value="<?php echo attr($cdata['ins'] ?? ''); ?>" />
 697                                     <input name="form_line[<?php echo attr($code); ?>][code_type]" type="hidden"
 698                                            value="<?php echo attr($cdata['code_type']); ?>" /> <?php echo text(sprintf("%.2f", $cdata['bal'])); ?>
 699                                     &nbsp;
 700                                 </td>
 701                                 <td class="last_detail"></td>
 702                                 <td class="last_detail"></td>
 703                                 <td class="last_detail">
 704                                     <input name="form_line[<?php echo attr($code); ?>][pay]"
 705                                            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 == $encount) ? 1 : 0 ?>)"
 706                                            onfocus="this.select()" autofocus size="10" type="text" class="form-control"
 707                                            value="0.00" />
 708                                 </td>
 709                                 <td class="last_detail">
 710                                     <input name="form_line[<?php echo attr($code); ?>][adj]" size="10" type="text"
 711                                            class="form-control"
 712                                            value='<?php echo attr((!empty($totalAdjAmount)) ? $totalAdjAmount : '0.00'); ?>'
 713                                            onclick="this.select()" />
 714                                 </td>
 715                                 <td class="last_detail text-center">
 716                                     <a href="#" class="text-decoration-none" onclick="return writeoff(<?php echo attr_js($code); ?>)">WO</a>
 717                                 </td>
 718                                 <td class="last_detail">
 719                                     <select class="form-control" name="form_line[<?php echo attr($code); ?>][reason]">
 720                                         <?php
 721                                         // Adjustment reasons are now taken from the list_options table.
 722                                         echo "    <option value=''></option>\n";
 723                                         $ores = sqlStatement("SELECT option_id, title, is_default FROM list_options " .
 724                                             "WHERE list_id = 'adjreason' AND activity = 1 ORDER BY seq, title");
 725                                         while ($orow = sqlFetchArray($ores)) {
 726                                             echo "    <option value='" . attr($orow['option_id']) . "'";
 727                                             if ($orow['is_default']) {
 728                                                 echo " selected";
 729                                             }
 730                                             echo ">" . text($orow['title']) . "</option>\n";
 731                                         }
 732                                         ?>
 733                                     </select>
 734                                     <?php
 735                                     // TBD: Maybe a comment field would be good here, for appending
 736                                     // to the reason.
 737                                     ?>
 738                                 </td>
 739                                 <?php if ($ALLOW_DELETE) { ?>
 740                                     <td class="last_detail">&nbsp;</td>
 741                                 <?php } ?>
 742                             </tr>
 743                         <?php } // end of code ?>
 744                     </table>
 745                 </div>
 746             </fieldset>
 747             <?php //can change position of buttons by creating a class 'position-override' and adding rule text-align:center or right as the case may be in individual stylesheets ?>
 748             <div class="form-group col-lg clearfix">
 749                 <div class="col-sm-12 text-left position-override" id="search-btn">
 750                     <div class="btn-group" role="group">
 751                         <!-- @todo leave as I may still use sjp 08/2020 -->
 752                         <!--<button type='submit' class="btn btn-primary btn-save" name='form_save' id="btn-save-stay"
 753                             onclick="this.value='1';"><?php /*echo xlt("Save Current"); */?></button>-->
 754                         <button type='submit' class="btn btn-primary btn-save" name='form_save' id="btn-save"
 755                             onclick="this.value='2';"><?php echo xlt("Save"); ?></button>
 756                         <button type='button' class="btn btn-secondary btn-cancel" name='form_cancel'
 757                             id="btn-cancel" onclick='doClose()'><?php echo xlt("Close"); ?></button>
 758                     </div>
 759                     <?php if ($from_posting) { ?>
 760                         <button type='button' class="btn btn-secondary btn-view float-right" name='form_goto' id="btn-goto"
 761                             onclick="goEncounterSummary(<?php echo attr_js($patient_id) ?>)"><?php echo xlt("Past Encounters"); ?></button>
 762                     <?php } ?>
 763                 </div>
 764             </div>
 765         </form>
 766     </div>
 767 </div><!--End of container div-->
 768 <?php if ($from_posting) { ?>
 769 <script>
 770     var f1 = opener.document.forms[0];
 771     var f2 = document.forms[0];
 772     if (f1.form_source) {
 773         <?php
 774         // These support creation and lookup of ar_session table entries:
 775         echo "  f2.form_reference.value         = f1.form_source.value;\n";
 776         echo "  f2.form_check_date.value        = f1.form_paydate.value;\n";
 777         echo "  //f2.form_deposit_date.value      = f1.form_deposit_date.value;\n";
 778         echo "  if (f1.form_deposit_date.value != '')\n";
 779         echo "     f2.form_deposit_date.value      = f1.form_deposit_date.value;\n";
 780         echo "  else\n";
 781         echo "     f2.form_deposit_date.value      = getFormattedToday();\n";
 782         echo "  f2.form_payer_id.value          = f1.form_payer_id.value;\n";
 783         echo "  f2.form_pay_total.value         = f1.form_amount.value;\n";
 784         echo "  f2.form_orig_reference.value    = f1.form_source.value;\n";
 785         echo "  f2.form_orig_check_date.value   = f1.form_paydate.value;\n";
 786         echo "  f2.form_orig_deposit_date.value = f1.form_deposit_date.value;\n";
 787
 788         // While I'm thinking about it, some notes about eob sessions.
 789         // If they do not have all of the session key fields in the search
 790         // page, then show a warning at the top of the invoice page.
 791         // Also when they go to save the invoice page and a session key
 792         // field has changed, alert them to that and allow a cancel.
 793
 794         // Another point... when posting EOBs, the incoming payer ID might
 795         // not match the payer ID for the patient's insurance.  This is
 796         // because the same payer might be entered more than once into the
 797         // insurance_companies table.  I don't think it matters much.
 798         ?>
 799     }
 800     setins("Ins1");
 801 </script>
 802 <?php } ?>
 803 </body>
 804 </html>