library/Claim.class.php

   1 <?php
   2 // Copyright (C) 2007-2008 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 require_once(dirname(__FILE__) . "/classes/Address.class.php");
  10 require_once(dirname(__FILE__) . "/classes/InsuranceCompany.class.php");
  11 require_once(dirname(__FILE__) . "/sql-ledger.inc");
  12 require_once(dirname(__FILE__) . "/invoice_summary.inc.php");
  13
  14 // This enforces the X12 Basic Character Set. Page A2.
  15 //
  16 function x12clean($str) {
  17   return preg_replace('/[^A-Z0-9!"\\&\'()+,\\-.\\/;?= ]/', '', strtoupper($str));
  18 }
  19
  20 class Claim {
  21
  22   var $pid;               // patient id
  23   var $encounter_id;      // encounter id
  24   var $procs;             // array of procedure rows from billing table
  25   var $x12_partner;       // row from x12_partners table
  26   var $encounter;         // row from form_encounter table
  27   var $facility;          // row from facility table
  28   var $billing_facility;  // row from facility table
  29   var $provider;          // row from users table (rendering provider)
  30   var $referrer;          // row from users table (referring provider)
  31   var $insurance_numbers; // row from insurance_numbers table for current payer
  32   var $patient_data;      // row from patient_data table
  33   var $billing_options;   // row from form_misc_billing_options table
  34   var $invoice;           // result from get_invoice_summary()
  35   var $payers;            // array of arrays, for all payers
  36
  37   function loadPayerInfo(&$billrow) {
  38     global $sl_err;
  39     $encounter_date = substr($this->encounter['date'], 0, 10);
  40
  41     // Create the $payers array.  This contains data for all insurances
  42     // with the current one always at index 0, and the others in payment
  43     // order starting at index 1.
  44     //
  45     $this->payers = array();
  46     $this->payers[0] = array();
  47     $query = "SELECT * FROM insurance_data WHERE " .
  48       "pid = '{$this->pid}' AND provider != '' AND " .
  49       "date <= '$encounter_date' " .
  50       "ORDER BY type ASC, date DESC";
  51     $dres = sqlStatement($query);
  52     $prevtype = '';
  53     while ($drow = sqlFetchArray($dres)) {
  54       if (strcmp($prevtype, $drow['type']) == 0) continue;
  55       $prevtype = $drow['type'];
  56       $ins = count($this->payers);
  57       if ($drow['provider'] == $billrow['payer_id'] && empty($this->payers[0]['data'])) $ins = 0;
  58       $crow = sqlQuery("SELECT * FROM insurance_companies WHERE " .
  59         "id = '" . $drow['provider'] . "'");
  60       $orow = new InsuranceCompany($drow['provider']);
  61       $this->payers[$ins] = array();
  62       $this->payers[$ins]['data']    = $drow;
  63       $this->payers[$ins]['company'] = $crow;
  64       $this->payers[$ins]['object']  = $orow;
  65     }
  66
  67     // This kludge hands most cases of a rare ambiguous situation, where
  68     // the primary insurance company is the same as the secondary.  It seems
  69     // nobody planned for that!
  70     //
  71     for ($i = 1; $i < count($this->payers); ++$i) {
  72       if ($billrow['process_date'] &&
  73         $this->payers[0]['data']['provider'] == $this->payers[$i]['data']['provider'])
  74       {
  75         $tmp = $this->payers[0];
  76         $this->payers[0] = $this->payers[$i];
  77         $this->payers[$i] = $tmp;
  78       }
  79     }
  80
  81     $this->using_modifiers = true;
  82
  83     // Get payment and adjustment details if there are any previous payers.
  84     //
  85     $this->invoice = array();
  86     if ($this->payerSequence() != 'P') {
  87       if ($GLOBALS['oer_config']['ws_accounting']['enabled']) {
  88         SLConnect();
  89         $arres = SLQuery("select id from ar where invnumber = " .
  90           "'{$this->pid}.{$this->encounter_id}'");
  91         if ($sl_err) die($sl_err);
  92         $arrow = SLGetRow($arres, 0);
  93         if ($arrow) {
  94           $this->invoice = get_invoice_summary($arrow['id'], true);
  95         }
  96         SLClose();
  97       }
  98       // Secondary claims might not have modifiers in SQL-Ledger data.
  99       // In that case, note that we should not try to match on them.
 100       $this->using_modifiers = false;
 101       foreach ($this->invoice as $key => $trash) {
 102         if (strpos($key, ':')) $this->using_modifiers = true;
 103       }
 104     }
 105   }
 106
 107   // Constructor. Loads relevant database information.
 108   //
 109   function Claim($pid, $encounter_id) {
 110     $this->pid = $pid;
 111     $this->encounter_id = $encounter_id;
 112     $this->procs = array();
 113
 114     // We need the encounter date before we can identify the payers.
 115     $sql = "SELECT * FROM form_encounter WHERE " .
 116       "pid = '{$this->pid}' AND " .
 117       "encounter = '{$this->encounter_id}'";
 118     $this->encounter = sqlQuery($sql);
 119
 120     // Sort by procedure timestamp in order to get some consistency.  In particular
 121     // we determine the provider from the first procedure in this array.
 122     $sql = "SELECT * FROM billing WHERE " .
 123       "encounter = '{$this->encounter_id}' AND pid = '{$this->pid}' AND " .
 124       "(code_type = 'CPT4' OR code_type = 'HCPCS') AND " .
 125       "activity = '1' ORDER BY date, id";
 126     $res = sqlStatement($sql);
 127     while ($row = sqlFetchArray($res)) {
 128       if (!$row['units']) $row['units'] = 1;
 129       // Load prior payer data at the first opportunity in order to get
 130       // the using_modifiers flag that is referenced below.
 131       if (empty($this->procs)) $this->loadPayerInfo($row);
 132       // Consolidate duplicate procedures.
 133       foreach ($this->procs as $key => $trash) {
 134         if (strcmp($this->procs[$key]['code'],$row['code']) == 0 &&
 135             (strcmp($this->procs[$key]['modifier'],$row['modifier']) == 0 ||
 136              !$this->using_modifiers))
 137         {
 138           $this->procs[$key]['units'] += $row['units'];
 139           $this->procs[$key]['fee']   += $row['fee'];
 140           continue 2; // skip to next table row
 141         }
 142       }
 143       $this->procs[] = $row;
 144     }
 145
 146     $sql = "SELECT * FROM x12_partners WHERE " .
 147       "id = '" . $this->procs[0]['x12_partner_id'] . "'";
 148     $this->x12_partner = sqlQuery($sql);
 149
 150     $sql = "SELECT * FROM facility WHERE " .
 151       "id = '" . addslashes($this->encounter['facility_id']) . "' " .
 152       "LIMIT 1";
 153     $this->facility = sqlQuery($sql);
 154
 155     $provider_id = $this->procs[0]['provider_id'];
 156     $sql = "SELECT * FROM users WHERE id = '$provider_id'";
 157     $this->provider = sqlQuery($sql);
 158
 159     $sql = "SELECT * FROM facility " .
 160       "ORDER BY billing_location DESC, id ASC LIMIT 1";
 161     $this->billing_facility = sqlQuery($sql);
 162
 163     $sql = "SELECT * FROM insurance_numbers WHERE " .
 164       "(insurance_company_id = '" . $this->procs[0]['payer_id'] .
 165       "' OR insurance_company_id is NULL) AND " .
 166       "provider_id = '" . $this->provider['id'] .
 167       "' order by insurance_company_id DESC LIMIT 1";
 168     $this->insurance_numbers = sqlQuery($sql);
 169
 170     $sql = "SELECT * FROM patient_data WHERE " .
 171       "pid = '{$this->pid}' " .
 172       "ORDER BY id LIMIT 1";
 173     $this->patient_data = sqlQuery($sql);
 174
 175     $sql = "SELECT fpa.* FROM forms JOIN form_misc_billing_options AS fpa " .
 176       "ON fpa.id = forms.form_id WHERE " .
 177       "forms.encounter = '{$this->encounter_id}' AND " .
 178       "forms.pid = '{$this->pid}' AND " .
 179       "forms.formdir = 'misc_billing_options' " .
 180       "ORDER BY forms.date";
 181     $this->billing_options = sqlQuery($sql);
 182
 183     $referrer_id = (empty($GLOBALS['MedicareReferrerIsRenderer']) ||
 184       $this->insurance_numbers['provider_number_type'] != '1C') ?
 185       $this->patient_data['providerID'] : $provider_id;
 186     $sql = "SELECT * FROM users WHERE id = '$referrer_id'";
 187     $this->referrer = sqlQuery($sql);
 188     if (!$this->referrer) $this->referrer = array();
 189
 190   } // end constructor
 191
 192   // Return an array of adjustments from the designated prior payer for the
 193   // designated procedure key (might be procedure:modifier), or for the claim
 194   // level.  For each adjustment give date, group code, reason code, amount.
 195   // Note this will include "patient responsibility" adjustments which are
 196   // not adjustments to OUR invoice, but they reduce the amount that the
 197   // insurance company pays.
 198   //
 199   function payerAdjustments($ins, $code='Claim') {
 200     $aadj = array();
 201
 202     // If we have no modifiers stored in SQL-Ledger for this claim,
 203     // then we cannot use a modifier passed in with the key.
 204     $tmp = strpos($code, ':');
 205     if ($tmp && !$this->using_modifiers) $code = substr($code, 0, $tmp);
 206
 207     // For payments, source always starts with "Ins" or "Pt".
 208     // Nonzero adjustment reason examples:
 209     //   Ins1 adjust code 42 (Charges exceed ... (obsolete))
 210     //   Ins1 adjust code 45 (Charges exceed your contracted/ legislated fee arrangement)
 211     //   Ins1 adjust code 97 (Payment is included in the allowance for another service/procedure)
 212     //   Ins1 adjust code A2 (Contractual adjustment)
 213     //   Ins adjust Ins1
 214     //   adjust code 45
 215     // Zero adjustment reason examples:
 216     //   Co-pay: 25.00
 217     //   Coinsurance: 11.46  (code 2)   Note: fix remits to identify insurance
 218     //   To deductible: 0.22 (code 1)   Note: fix remits to identify insurance
 219     //   To copay Ins1 (manual entry)
 220     //   To ded'ble Ins1 (manual entry)
 221
 222     if (!empty($this->invoice[$code])) {
 223       $date = '';
 224       $deductible  = 0;
 225       $coinsurance = 0;
 226       $inslabel = ($this->payerSequence($ins) == 'S') ? 'Ins2' : 'Ins1';
 227       $insnumber = substr($inslabel, 3);
 228
 229       // Compute this procedure's patient responsibility amount as of this
 230       // prior payer, which is the original charge minus all insurance
 231       // payments and "hard" adjustments up to this payer.
 232       $ptresp = $this->invoice[$code]['chg'] + $this->invoice[$code]['adj'];
 233       foreach ($this->invoice[$code]['dtl'] as $key => $value) {
 234         if (preg_match("/^Ins(\d)/i", $value['src'], $tmp)) {
 235           if ($tmp[1] <= $insnumber) $ptresp -= $value['pmt'];
 236         }
 237         else if (trim(substr($key, 0, 10))) { // not an adjustment if no date
 238           if (!preg_match("/Ins(\d)/i", $value['rsn'], $tmp) || $tmp[1] <= $insnumber)
 239             $ptresp += $value['chg']; // adjustments are negative charges
 240         }
 241       }
 242       if ($ptresp < 0) $ptresp = 0; // we may be insane but try to hide it
 243
 244       // Main loop, to extract adjustments for this payer and procedure.
 245       foreach ($this->invoice[$code]['dtl'] as $key => $value) {
 246         $tmp = str_replace('-', '', trim(substr($key, 0, 10)));
 247         if ($tmp) $date = $tmp;
 248         if ($tmp && $value['pmt'] == 0) { // not original charge and not a payment
 249           $rsn = $value['rsn'];
 250           $chg = 0 - $value['chg']; // adjustments are negative charges
 251
 252           $gcode = 'CO'; // default group code = contractual obligation
 253           $rcode = '45'; // default reason code = max fee exceeded (code 42 is obsolete)
 254
 255           if (preg_match("/Ins adjust $inslabel/i", $rsn, $tmp)) {
 256             // From manual post. Take the defaults.
 257           }
 258           else if (preg_match("/To copay $inslabel/i", $rsn, $tmp) && !$chg) {
 259             $coinsurance = $ptresp; // from manual post
 260             continue;
 261           }
 262           else if (preg_match("/To ded'ble $inslabel/i", $rsn, $tmp) && !$chg) {
 263             $deductible = $ptresp; // from manual post
 264             continue;
 265           }
 266           else if (preg_match("/$inslabel copay: (\S+)/i", $rsn, $tmp) && !$chg) {
 267             $coinsurance = $tmp[1]; // from 835 as of 6/2007
 268             continue;
 269           }
 270           else if (preg_match("/$inslabel coins: (\S+)/i", $rsn, $tmp) && !$chg) {
 271             $coinsurance = $tmp[1]; // from 835 and manual post as of 6/2007
 272             continue;
 273           }
 274           else if (preg_match("/$inslabel dedbl: (\S+)/i", $rsn, $tmp) && !$chg) {
 275             $deductible = $tmp[1]; // from 835 and manual post as of 6/2007
 276             continue;
 277           }
 278           else if (preg_match("/$inslabel ptresp: (\S+)/i", $rsn, $tmp) && !$chg) {
 279             continue; // from 835 as of 6/2007
 280           }
 281           else if (preg_match("/$inslabel adjust code (\S+)/i", $rsn, $tmp)) {
 282             $rcode = $tmp[1]; // from 835
 283           }
 284           else if (preg_match("/$inslabel/i", $rsn, $tmp)) {
 285             // Take the defaults.
 286           }
 287           else if (preg_match('/Ins(\d)/i', $rsn, $tmp) && $tmp[1] != $insnumber) {
 288             continue; // it's for some other payer
 289           }
 290           else if ($insnumber == '1') {
 291             if (preg_match("/\$\s*adjust code (\S+)/i", $rsn, $tmp)) {
 292               $rcode = $tmp[1]; // from 835
 293             }
 294             else if ($chg) {
 295               // Other adjustments default to Ins1.
 296             }
 297             else if (preg_match("/Co-pay: (\S+)/i", $rsn, $tmp) ||
 298               preg_match("/Coinsurance: (\S+)/i", $rsn, $tmp)) {
 299               $coinsurance = 0 + $tmp[1]; // from 835 before 6/2007
 300               continue;
 301             }
 302             else if (preg_match("/To deductible: (\S+)/i", $rsn, $tmp)) {
 303               $deductible = 0 + $tmp[1]; // from 835 before 6/2007
 304               continue;
 305             }
 306             else {
 307               continue; // there is no adjustment amount
 308             }
 309           }
 310           else {
 311             continue; // it's for primary and that's not us
 312           }
 313
 314           if ($rcode == '42') $rcode= '45'; // reason 42 is obsolete
 315           $aadj[] = array($date, $gcode, $rcode, sprintf('%.2f', $chg));
 316
 317         } // end if
 318       } // end foreach
 319
 320       // If we really messed it up, at least avoid negative numbers.
 321       if ($coinsurance > $ptresp) $coinsurance = $ptresp;
 322       if ($deductible  > $ptresp) $deductible  = $ptresp;
 323
 324       // Find out if this payer paid anything at all on this claim.  This will
 325       // help us allocate any unknown patient responsibility amounts.
 326       $thispaidanything = 0;
 327       foreach($this->invoice as $codekey => $codeval) {
 328         foreach ($codeval['dtl'] as $key => $value) {
 329           if (preg_match("/$inslabel/i", $value['src'], $tmp)) {
 330             $thispaidanything += $value['pmt'];
 331           }
 332         }
 333       }
 334
 335       // Allocate any unknown patient responsibility by guessing if the
 336       // deductible has been satisfied.
 337       if ($thispaidanything)
 338         $coinsurance = $ptresp - $deductible;
 339       else
 340         $deductible = $ptresp - $coinsurance;
 341
 342       if ($date && $deductible != 0)
 343         $aadj[] = array($date, 'PR', '1', sprintf('%.2f', $deductible));
 344       if ($date && $coinsurance != 0)
 345         $aadj[] = array($date, 'PR', '2', sprintf('%.2f', $coinsurance));
 346
 347     } // end if
 348
 349     return $aadj;
 350   }
 351
 352   // Return date, total payments and total "hard" adjustments from the given
 353   // prior payer. If $code is specified then only that procedure key is
 354   // selected, otherwise it's for the whole claim.
 355   //
 356   function payerTotals($ins, $code='') {
 357     // If we have no modifiers stored in SQL-Ledger for this claim,
 358     // then we cannot use a modifier passed in with the key.
 359     $tmp = strpos($code, ':');
 360     if ($tmp && !$this->using_modifiers) $code = substr($code, 0, $tmp);
 361
 362     $inslabel = ($this->payerSequence($ins) == 'S') ? 'Ins2' : 'Ins1';
 363     $paytotal = 0;
 364     $adjtotal = 0;
 365     $date = '';
 366     foreach($this->invoice as $codekey => $codeval) {
 367       if ($code && strcmp($codekey,$code) != 0) continue;
 368       foreach ($codeval['dtl'] as $key => $value) {
 369         if (preg_match("/$inslabel/i", $value['src'], $tmp)) {
 370           if (!$date) $date = str_replace('-', '', trim(substr($key, 0, 10)));
 371           $paytotal += $value['pmt'];
 372         }
 373       }
 374       $aarr = $this->payerAdjustments($ins, $codekey);
 375       foreach ($aarr as $a) {
 376         if (strcmp($a[1],'PR') != 0) $adjtotal += $a[3];
 377         if (!$date) $date = $a[0];
 378       }
 379     }
 380     return array($date, sprintf('%.2f', $paytotal), sprintf('%.2f', $adjtotal));
 381   }
 382
 383   // Return the amount already paid by the patient.
 384   //
 385   function patientPaidAmount() {
 386
 387     // TBD: This does not work for a primary claim because $this->invoice
 388     // is not loaded.  Might be good to get the co-pay from the billing
 389     // table in that case.
 390
 391     $amount = 0;
 392     foreach($this->invoice as $codekey => $codeval) {
 393       foreach ($codeval['dtl'] as $key => $value) {
 394         if (!preg_match("/Ins/i", $value['src'], $tmp)) {
 395           $amount += $value['pmt'];
 396         }
 397       }
 398     }
 399     return sprintf('%.2f', $amount);
 400   }
 401
 402   // Return invoice total, including adjustments but not payments.
 403   //
 404   function invoiceTotal() {
 405     $amount = 0;
 406     foreach($this->invoice as $codekey => $codeval) {
 407       $amount += $codeval['chg'];
 408     }
 409     return sprintf('%.2f', $amount);
 410   }
 411
 412   // Number of procedures in this claim.
 413   function procCount() {
 414     return count($this->procs);
 415   }
 416
 417   // Number of payers for this claim. Ranges from 1 to 3.
 418   function payerCount() {
 419     return count($this->payers);
 420   }
 421
 422   function x12gsversionstring() {
 423     return x12clean(trim($this->x12_partner['x12_version']));
 424   }
 425
 426   function x12gssenderid() {
 427     $tmp = $this->x12_partner['x12_sender_id'];
 428     while (strlen($tmp) < 15) $tmp .= " ";
 429     return $tmp;
 430   }
 431
 432   function x12gsreceiverid() {
 433     $tmp = $this->x12_partner['x12_receiver_id'];
 434     while (strlen($tmp) < 15) $tmp .= " ";
 435     return $tmp;
 436   }
 437
 438   function cliaCode() {
 439     return x12clean(trim($this->facility['domain_identifier']));
 440   }
 441
 442   function billingFacilityName() {
 443     return x12clean(trim($this->billing_facility['name']));
 444   }
 445
 446   function billingFacilityStreet() {
 447     return x12clean(trim($this->billing_facility['street']));
 448   }
 449
 450   function billingFacilityCity() {
 451     return x12clean(trim($this->billing_facility['city']));
 452   }
 453
 454   function billingFacilityState() {
 455     return x12clean(trim($this->billing_facility['state']));
 456   }
 457
 458   function billingFacilityZip() {
 459     return x12clean(trim($this->billing_facility['postal_code']));
 460   }
 461
 462   function billingFacilityETIN() {
 463     return x12clean(trim(str_replace('-', '', $this->billing_facility['federal_ein'])));
 464   }
 465
 466   function billingFacilityNPI() {
 467     return x12clean(trim($this->billing_facility['facility_npi']));
 468   }
 469
 470   function billingContactName() {
 471     return x12clean(trim($this->billing_facility['attn']));
 472   }
 473
 474   function billingContactPhone() {
 475     if (preg_match("/([2-9]\d\d)\D*(\d\d\d)\D*(\d\d\d\d)/",
 476       $this->billing_facility['phone'], $tmp))
 477     {
 478       return $tmp[1] . $tmp[2] . $tmp[3];
 479     }
 480     return '';
 481   }
 482
 483   function facilityName() {
 484     return x12clean(trim($this->facility['name']));
 485   }
 486
 487   function facilityStreet() {
 488     return x12clean(trim($this->facility['street']));
 489   }
 490
 491   function facilityCity() {
 492     return x12clean(trim($this->facility['city']));
 493   }
 494
 495   function facilityState() {
 496     return x12clean(trim($this->facility['state']));
 497   }
 498
 499   function facilityZip() {
 500     return x12clean(trim($this->facility['postal_code']));
 501   }
 502
 503   function facilityETIN() {
 504     return x12clean(trim(str_replace('-', '', $this->facility['federal_ein'])));
 505   }
 506
 507   function facilityNPI() {
 508     return x12clean(trim($this->facility['facility_npi']));
 509   }
 510
 511   function facilityPOS() {
 512     return x12clean(trim($this->facility['pos_code']));
 513   }
 514
 515   function clearingHouseName() {
 516     return x12clean(trim($this->x12_partner['name']));
 517   }
 518
 519   function clearingHouseETIN() {
 520     return x12clean(trim(str_replace('-', '', $this->x12_partner['id_number'])));
 521   }
 522
 523   function providerNumberType() {
 524     return $this->insurance_numbers['provider_number_type'];
 525   }
 526
 527   function providerNumber() {
 528     return x12clean(trim(str_replace('-', '', $this->insurance_numbers['provider_number'])));
 529   }
 530
 531   // Returns 'P', 'S' or 'T'.
 532   //
 533   function payerSequence($ins=0) {
 534     return strtoupper(substr($this->payers[$ins]['data']['type'], 0, 1));
 535   }
 536
 537   // Returns the HIPAA code of the patient-to-subscriber relationship.
 538   //
 539   function insuredRelationship($ins=0) {
 540     $tmp = strtolower($this->payers[$ins]['data']['subscriber_relationship']);
 541     if (strcmp($tmp,'self'  ) == 0) return '18';
 542     if (strcmp($tmp,'spouse') == 0) return '01';
 543     if (strcmp($tmp,'child' ) == 0) return '19';
 544     if (strcmp($tmp,'other' ) == 0) return 'G8';
 545     return $tmp; // should not happen
 546   }
 547
 548   function insuredTypeCode($ins=0) {
 549     if (strcmp($this->claimType($ins),'MB') == 0 && $this->payerSequence($ins) != 'P')
 550       return '12'; // medicare secondary working aged beneficiary or
 551                    // spouse with employer group health plan
 552     return '';
 553   }
 554
 555   // Is the patient also the subscriber?
 556   //
 557   function isSelfOfInsured($ins=0) {
 558     $tmp = strtolower($this->payers[$ins]['data']['subscriber_relationship']);
 559     return (strcmp($tmp,'self') == 0);
 560   }
 561
 562   function groupNumber($ins=0) {
 563     return x12clean(trim($this->payers[$ins]['data']['group_number']));
 564   }
 565
 566   function groupName($ins=0) {
 567     return x12clean(trim($this->payers[$ins]['data']['subscriber_employer']));
 568   }
 569
 570   function claimType($ins=0) {
 571     if (empty($this->payers[$ins]['object'])) return '';
 572     return $this->payers[$ins]['object']->get_freeb_claim_type();
 573   }
 574
 575   function insuredLastName($ins=0) {
 576     return x12clean(trim($this->payers[$ins]['data']['subscriber_lname']));
 577   }
 578
 579   function insuredFirstName($ins=0) {
 580     return x12clean(trim($this->payers[$ins]['data']['subscriber_fname']));
 581   }
 582
 583   function insuredMiddleName($ins=0) {
 584     return x12clean(trim($this->payers[$ins]['data']['subscriber_mname']));
 585   }
 586
 587   function policyNumber($ins=0) { // "ID"
 588     return x12clean(trim($this->payers[$ins]['data']['policy_number']));
 589   }
 590
 591   function insuredStreet($ins=0) {
 592     return x12clean(trim($this->payers[$ins]['data']['subscriber_street']));
 593   }
 594
 595   function insuredCity($ins=0) {
 596     return x12clean(trim($this->payers[$ins]['data']['subscriber_city']));
 597   }
 598
 599   function insuredState($ins=0) {
 600     return x12clean(trim($this->payers[$ins]['data']['subscriber_state']));
 601   }
 602
 603   function insuredZip($ins=0) {
 604     return x12clean(trim($this->payers[$ins]['data']['subscriber_postal_code']));
 605   }
 606
 607   function insuredDOB($ins=0) {
 608     return str_replace('-', '', $this->payers[$ins]['data']['subscriber_DOB']);
 609   }
 610
 611   function insuredSex($ins=0) {
 612     return strtoupper(substr($this->payers[$ins]['data']['subscriber_sex'], 0, 1));
 613   }
 614
 615   function payerName($ins=0) {
 616     return x12clean(trim($this->payers[$ins]['company']['name']));
 617   }
 618
 619   function payerStreet($ins=0) {
 620     if (empty($this->payers[$ins]['object'])) return '';
 621     $tmp = $this->payers[$ins]['object'];
 622     $tmp = $tmp->get_address();
 623     return x12clean(trim($tmp->get_line1()));
 624   }
 625
 626   function payerCity($ins=0) {
 627     if (empty($this->payers[$ins]['object'])) return '';
 628     $tmp = $this->payers[$ins]['object'];
 629     $tmp = $tmp->get_address();
 630     return x12clean(trim($tmp->get_city()));
 631   }
 632
 633   function payerState($ins=0) {
 634     if (empty($this->payers[$ins]['object'])) return '';
 635     $tmp = $this->payers[$ins]['object'];
 636     $tmp = $tmp->get_address();
 637     return x12clean(trim($tmp->get_state()));
 638   }
 639
 640   function payerZip($ins=0) {
 641     if (empty($this->payers[$ins]['object'])) return '';
 642     $tmp = $this->payers[$ins]['object'];
 643     $tmp = $tmp->get_address();
 644     return x12clean(trim($tmp->get_zip()));
 645   }
 646
 647   function payerID($ins=0) {
 648     return x12clean(trim($this->payers[$ins]['company']['cms_id']));
 649   }
 650
 651   function patientLastName() {
 652     return x12clean(trim($this->patient_data['lname']));
 653   }
 654
 655   function patientFirstName() {
 656     return x12clean(trim($this->patient_data['fname']));
 657   }
 658
 659   function patientMiddleName() {
 660     return x12clean(trim($this->patient_data['mname']));
 661   }
 662
 663   function patientStreet() {
 664     return x12clean(trim($this->patient_data['street']));
 665   }
 666
 667   function patientCity() {
 668     return x12clean(trim($this->patient_data['city']));
 669   }
 670
 671   function patientState() {
 672     return x12clean(trim($this->patient_data['state']));
 673   }
 674
 675   function patientZip() {
 676     return x12clean(trim($this->patient_data['postal_code']));
 677   }
 678
 679   function patientDOB() {
 680     return str_replace('-', '', $this->patient_data['DOB']);
 681   }
 682
 683   function patientSex() {
 684     return strtoupper(substr($this->patient_data['sex'], 0, 1));
 685   }
 686
 687   function cptCode($prockey) {
 688     return x12clean(trim($this->procs[$prockey]['code']));
 689   }
 690
 691   function cptModifier($prockey) {
 692     return x12clean(trim($this->procs[$prockey]['modifier']));
 693   }
 694
 695   // Returns the procedure code, followed by ":modifier" if there is one.
 696   function cptKey($prockey) {
 697     $tmp = $this->cptModifier($prockey);
 698     return $this->cptCode($prockey) . ($tmp ? ":$tmp" : "");
 699   }
 700
 701   function cptCharges($prockey) {
 702     return x12clean(trim($this->procs[$prockey]['fee']));
 703   }
 704
 705   function cptUnits($prockey) {
 706     if (empty($this->procs[$prockey]['units'])) return '1';
 707     return x12clean(trim($this->procs[$prockey]['units']));
 708   }
 709
 710   // NDC drug ID.
 711   function cptNDCID($prockey) {
 712     $ndcinfo = $this->procs[$prockey]['ndc_info'];
 713     if (preg_match('/^N4(\S+)\s+(\S\S)(.*)/', $ndcinfo, $tmp)) {
 714       $ndc = $tmp[1];
 715       if (preg_match('/^(\d+)-(\d+)-(\d+)$/', $ndc, $tmp)) {
 716         return sprintf('%05d-%04d-%02d', $tmp[1], $tmp[2], $tmp[3]);
 717       }
 718       return x12clean($ndc); // format is bad but return it anyway
 719     }
 720     return '';
 721   }
 722
 723   // NDC drug unit of measure code.
 724   function cptNDCUOM($prockey) {
 725     $ndcinfo = $this->procs[$prockey]['ndc_info'];
 726     if (preg_match('/^N4(\S+)\s+(\S\S)(.*)/', $ndcinfo, $tmp))
 727       return x12clean($tmp[2]);
 728     return '';
 729   }
 730
 731   // NDC drug number of units.
 732   function cptNDCQuantity($prockey) {
 733     $ndcinfo = $this->procs[$prockey]['ndc_info'];
 734     if (preg_match('/^N4(\S+)\s+(\S\S)(.*)/', $ndcinfo, $tmp)) {
 735       return x12clean(ltrim($tmp[3], '0'));
 736     }
 737     return '';
 738   }
 739
 740   function onsetDate() {
 741     return str_replace('-', '', substr($this->encounter['onset_date'], 0, 10));
 742   }
 743
 744   function serviceDate() {
 745     return str_replace('-', '', substr($this->encounter['date'], 0, 10));
 746   }
 747
 748   function priorAuth() {
 749     return x12clean(trim($this->billing_options['prior_auth_number']));
 750   }
 751
 752   // Returns an array of unique diagnoses.  Periods are stripped.
 753   function diagArray() {
 754     $da = array();
 755     foreach ($this->procs as $row) {
 756       $atmp = explode(':', $row['justify']);
 757       foreach ($atmp as $tmp) {
 758         if (!empty($tmp)) {
 759           $diag = str_replace('.', '', $tmp);
 760           $da[$diag] = $diag;
 761         }
 762       }
 763     }
 764     return $da;
 765   }
 766
 767   // Compute one 1-relative index in diagArray for the given procedure.
 768   // This function is obsolete, use diagIndexArray() instead.
 769   function diagIndex($prockey) {
 770     $da = $this->diagArray();
 771     $tmp = explode(':', $this->procs[$prockey]['justify']);
 772     if (empty($tmp)) return '';
 773     $diag = str_replace('.', '', $tmp[0]);
 774     $i = 0;
 775     foreach ($da as $value) {
 776       ++$i;
 777       if (strcmp($value,$diag) == 0) return $i;
 778     }
 779     return '';
 780   }
 781
 782   // Compute array of 1-relative diagArray indices for the given procedure.
 783   function diagIndexArray($prockey) {
 784     $dia = array();
 785     $da = $this->diagArray();
 786     $atmp = explode(':', $this->procs[$prockey]['justify']);
 787     foreach ($atmp as $tmp) {
 788       if (!empty($tmp)) {
 789         $diag = str_replace('.', '', $tmp);
 790         $i = 0;
 791         foreach ($da as $value) {
 792           ++$i;
 793           if (strcmp($value,$diag) == 0) $dia[] = $i;
 794         }
 795       }
 796     }
 797     return $dia;
 798   }
 799
 800   function providerLastName() {
 801     return x12clean(trim($this->provider['lname']));
 802   }
 803
 804   function providerFirstName() {
 805     return x12clean(trim($this->provider['fname']));
 806   }
 807
 808   function providerMiddleName() {
 809     return x12clean(trim($this->provider['mname']));
 810   }
 811
 812   function providerNPI() {
 813     return x12clean(trim($this->provider['npi']));
 814   }
 815
 816   function providerUPIN() {
 817     return x12clean(trim($this->provider['upin']));
 818   }
 819
 820   function providerSSN() {
 821     return x12clean(trim(str_replace('-', '', $this->provider['federaltaxid'])));
 822   }
 823
 824   function referrerLastName() {
 825     return x12clean(trim($this->referrer['lname']));
 826   }
 827
 828   function referrerFirstName() {
 829     return x12clean(trim($this->referrer['fname']));
 830   }
 831
 832   function referrerMiddleName() {
 833     return x12clean(trim($this->referrer['mname']));
 834   }
 835
 836   function referrerNPI() {
 837     return x12clean(trim($this->referrer['npi']));
 838   }
 839
 840   function referrerUPIN() {
 841     return x12clean(trim($this->referrer['upin']));
 842   }
 843
 844   function referrerSSN() {
 845     return x12clean(trim(str_replace('-', '', $this->referrer['federaltaxid'])));
 846   }
 847 }
 848 ?>