library/gen_x12_837.inc.php

   1 <?php
   2 /*
   3  * This program creates a 5010 837P file
   4  *
   5  * @package OpenEMR
   6  * @author Rod Roark <rod@sunsetsystems.com>
   7  * @author Stephen Waite <stephen.waite@cmsvt.com>
   8  * @copyright Copyright (c) 2009 Rod Roark <rod@sunsetsystems.com>
   9  * @copyright Copyright (c) 2018 Stephen Waite <stephen.waite@cmsvt.com>
  10  * @link https://github.com/openemr/openemr/tree/master
  11  * @license https://github.com/openemr/openemr/blob/master/LICENSE GNU General Public License 3
  12  */
  13
  14 require_once(dirname(__FILE__) . "/invoice_summary.inc.php");
  15
  16 use OpenEMR\Billing\Claim;
  17
  18 function stripZipCode($zip)
  19 {
  20     $temp = preg_replace('/[-\s]*/', '', $zip);
  21     if (strlen($temp) == 5) {
  22         return $temp . "9999";
  23     } else {
  24         return $temp;
  25     }
  26 }
  27
  28 function gen_x12_837($pid, $encounter, &$log, $encounter_claim = false)
  29 {
  30     $today = time();
  31     $out = '';
  32     $claim = new Claim($pid, $encounter);
  33     $edicount = 0;
  34     $HLcount = 0;
  35
  36     $log .= "Generating claim $pid" . "-" . $encounter . " for " .
  37     $claim->patientFirstName() . ' ' .
  38     $claim->patientMiddleName() . ' ' .
  39     $claim->patientLastName() . ' on ' .
  40     date('Y-m-d H:i', $today) . ".\n";
  41
  42     $out .= "ISA" .
  43     "*" . $claim->x12gsisa01() .
  44     "*" . $claim->x12gsisa02() .
  45     "*" . $claim->x12gsisa03() .
  46     "*" . $claim->x12gsisa04() .
  47     "*" . $claim->x12gsisa05() .
  48     "*" . $claim->x12gssenderid() .
  49     "*" . $claim->x12gsisa07() .
  50     "*" . $claim->x12gsreceiverid() .
  51     "*" . "030911" .  // dummy data replace by billing_process.php
  52     "*" . "1630" . // ditto
  53     "*" . "^" .
  54     "*" . "00501" .
  55     "*" . "000000001" .
  56     "*" . $claim->x12gsisa14() .
  57     "*" . $claim->x12gsisa15() .
  58     "*:" .
  59     "~\n";
  60
  61     $out .= "GS" .
  62     "*" . "HC" .
  63     "*" . $claim->x12gsgs02() .
  64     "*" . trim($claim->x12gs03()) .
  65     "*" . date('Ymd', $today) .
  66     "*" . date('Hi', $today) .
  67     "*" . "1" .
  68     "*" . "X" .
  69     "*" . $claim->x12gsversionstring() .
  70     "~\n";
  71
  72     ++$edicount;
  73     $out .= "ST" .
  74     "*" . "837" .
  75     "*" . "0021" .
  76     "*" . $claim->x12gsversionstring() .
  77     "~\n";
  78
  79     ++$edicount;
  80     $out .= "BHT" .
  81     "*" . "0019" .                             // 0019 is required here
  82     "*" . "00" .                               // 00 = original transmission
  83     "*" . "0123" .                             // reference identification
  84     "*" . date('Ymd', $today) .           // transaction creation date
  85     "*" . date('Hi', $today) .            // transaction creation time
  86     "*" . ($encounter_claim ? "RP" : "CH") .  // RP = reporting, CH = chargeable
  87     "~\n";
  88
  89     ++$edicount;
  90     if ($claim->federalIdType() == "SY") { // check entity type for NM*102 1 == person, 2 == non-person entity
  91         $firstName = $claim->providerFirstName();
  92         $lastName = $claim->providerLastName();
  93         $middleName = $claim->providerMiddleName();
  94         $suffixName = $claim->providerSuffixName();
  95         $out .= "NM1" . // Loop 1000A Submitter
  96         "*" . "41" .
  97         "*" . "1" .
  98         "*" . $lastName .
  99         "*" . $firstName .
 100         "*" . $middleName .
 101         "*" . // Name Prefix not used
 102         "*" . $suffixName .
 103         "*" . "46";
 104     } else {
 105         $billingFacilityName = substr($claim->billingFacilityName(), 0, 60);
 106         if ($billingFacilityName == '') {
 107             $log .= "*** billing facility name in 1000A loop is empty\n";
 108         }
 109         $out .= "NM1" .
 110         "*" . "41" .
 111         "*" . "2" .
 112         "*" . $billingFacilityName .
 113         "*" .
 114         "*" .
 115         "*" .
 116         "*" .
 117         "*" . "46";
 118     }
 119     $out .= "*" . $claim->billingFacilityETIN();
 120     $out .= "~\n";
 121
 122     ++$edicount;
 123     $out .= "PER" . // Loop 1000A, Submitter EDI contact information
 124     "*" . "IC" .
 125     "*" . $claim->billingContactName() .
 126     "*" . "TE" .
 127     "*" . $claim->billingContactPhone() .
 128     "*" . "EM" .
 129     "*" . $claim->billingContactEmail();
 130     $out .= "~\n";
 131
 132     ++$edicount;
 133     $out .= "NM1" . // Loop 1000B Receiver
 134     "*" . "40" .
 135     "*" . "2" .
 136     "*" . $claim->clearingHouseName() .
 137     "*" .
 138     "*" .
 139     "*" .
 140     "*" .
 141     "*" . "46" .
 142     "*" . $claim->clearingHouseETIN() .
 143     "~\n";
 144
 145     ++$HLcount;
 146     ++$edicount;
 147     $out .= "HL" . // Loop 2000A Billing/Pay-To Provider HL Loop
 148     "*" . $HLcount .
 149     "*" .
 150     "*" . "20" .
 151     "*" . "1" . // 1 indicates there are child segments
 152     "~\n";
 153
 154     $HLBillingPayToProvider = $HLcount++;
 155
 156     // Situational PRV segment for provider taxonomy.
 157     if ($claim->facilityTaxonomy()) {
 158         ++$edicount;
 159         $out .= "PRV" .
 160         "*" . "BI" .
 161         "*" . "PXC" .
 162         "*" . $claim->facilityTaxonomy() .
 163         "~\n";
 164     }
 165
 166     // Situational CUR segment (foreign currency information) omitted here.
 167     ++$edicount;
 168     if ($claim->federalIdType() == "SY") { // check for entity type like in 1000A
 169         $firstName = $claim->providerFirstName();
 170         $lastName = $claim->providerLastName();
 171         $middleName = $claim->providerMiddleName();
 172         $out .= "NM1" .
 173         "*" . "85" .
 174         "*" . "1" .
 175         "*" . $lastName .
 176         "*" . $firstName .
 177         "*" . $middleName .
 178         "*" . // Name Prefix not used
 179         "*";
 180     } else {
 181         $billingFacilityName = substr($claim->billingFacilityName(), 0, 60);
 182         if ($billingFacilityName == '') {
 183             $log .= "*** billing facility name in 2010A loop is empty\n";
 184         }
 185         $out .= "NM1" . // Loop 2010AA Billing Provider
 186         "*" . "85" .
 187         "*" . "2" .
 188         "*" . $billingFacilityName .
 189         "*" .
 190         "*" .
 191         "*" .
 192         "*";
 193     }
 194     if ($claim->billingFacilityNPI()) {
 195         $out .= "*XX*" . $claim->billingFacilityNPI();
 196     } else {
 197         $log .= "*** Billing facility has no NPI.\n";
 198     }
 199     $out .= "~\n";
 200
 201     ++$edicount;
 202     $out .= "N3" .
 203     "*" . $claim->billingFacilityStreet() .
 204     "~\n";
 205
 206     ++$edicount;
 207     $out .= "N4" .
 208     "*" . $claim->billingFacilityCity() .
 209     "*" . $claim->billingFacilityState() .
 210     "*" . stripZipCode($claim->billingFacilityZip()) .
 211     "~\n";
 212
 213     if ($claim->billingFacilityNPI() && $claim->billingFacilityETIN()) {
 214         ++$edicount;
 215         $out .= "REF";
 216         if ($claim->federalIdType()) {
 217             $out .= "*" . $claim->federalIdType();
 218         } else {
 219             $out .= "*EI"; // For dealing with the situation before adding TaxId type In facility.
 220         }
 221         $out .= "*" . $claim->billingFacilityETIN() . "~\n";
 222     } else {
 223         $log .= "*** No billing facility NPI and/or ETIN.\n";
 224     }
 225     if ($claim->providerNumberType() && $claim->providerNumber() && !$claim->billingFacilityNPI()) {
 226         ++$edicount;
 227         $out .= "REF" .
 228             "*" . $claim->providerNumberType() .
 229             "*" . $claim->providerNumber() .
 230             "~\n";
 231     } else if ($claim->providerNumber() && !$claim->providerNumberType()) {
 232         $log .= "*** Payer-specific provider insurance number is present but has no type assigned.\n";
 233     }
 234
 235     // Situational PER*1C segment omitted.
 236
 237     // Pay-To Address defaults to billing provider and is no longer required in 5010 but may be useful
 238     if ($claim->facilityStreet() != $claim->billingFacilityStreet()) {
 239         ++$edicount;
 240         $billingFacilityName = substr($claim->billingFacilityName(), 0, 60);
 241         $out .= "NM1" .       // Loop 2010AB Pay-To Provider
 242             "*" . "87" .
 243             "*" . "2" .
 244             "*" . $billingFacilityName .
 245             "*" .
 246             "*" .
 247             "*" .
 248             "*";
 249         if ($claim->billingFacilityNPI()) {
 250             $out .= "*XX*" . $claim->billingFacilityNPI();
 251         }
 252         $out .= "~\n";
 253
 254         ++$edicount;
 255         $out .= "N3" .
 256             "*" . $claim->billingFacilityStreet() .
 257             "~\n";
 258
 259         ++$edicount;
 260         $out .= "N4" .
 261             "*" . $claim->billingFacilityCity() .
 262             "*" . $claim->billingFacilityState() .
 263             "*" . stripZipCode($claim->billingFacilityZip()) .
 264             "~\n";
 265     }
 266
 267     // Loop 2010AC Pay-To Plan Name omitted.  Includes:
 268     // NM1*PE, N3, N4, REF*2U, REF*EI
 269
 270     $PatientHL = $claim->isSelfOfInsured() ? 0 : 1;
 271     $HLSubscriber = $HLcount++;
 272
 273     ++$edicount;
 274     $out .= "HL" .        // Loop 2000B Subscriber HL Loop
 275         "*" . $HLSubscriber .
 276         "*" . $HLBillingPayToProvider .
 277         "*" . "22" .
 278         "*" . $PatientHL .
 279         "~\n";
 280
 281     if (!$claim->payerSequence()) {
 282         $log .= "*** Error: Insurance information is missing!\n";
 283     }
 284
 285     ++$edicount;
 286     $out .= "SBR" .    // Subscriber Information
 287         "*" . $claim->payerSequence() .
 288         "*" . ($claim->isSelfOfInsured() ? '18' : '') .
 289         "*" . $claim->groupNumber() .
 290         "*" . ($claim->groupNumber() ? '' : $claim->groupName()) . // if groupNumber no groupName
 291         "*" . $claim->insuredTypeCode() . // applies for secondary medicare
 292         "*" .
 293         "*" .
 294         "*" .
 295         "*" . $claim->claimType() .
 296         "~\n";
 297
 298     // Segment PAT omitted.
 299
 300     ++$edicount;
 301     $out .= "NM1" .       // Loop 2010BA Subscriber
 302         "*" . "IL" .
 303         "*" . "1" . // 1 = person, 2 = non-person
 304         "*" . $claim->insuredLastName() .
 305         "*" . $claim->insuredFirstName() .
 306         "*" . $claim->insuredMiddleName() .
 307         "*" .
 308         "*" . // Name Suffix not used
 309         "*" . "MI" .
 310         // "MI" = Member Identification Number
 311         // "II" = Standard Unique Health Identifier, "Required if the
 312         //        HIPAA Individual Patient Identifier is mandated use."
 313         //        Here we presume that is not true yet.
 314         "*" . $claim->policyNumber() .
 315         "~\n";
 316
 317     // For 5010, further subscriber info is sent only if they are the patient.
 318     if ($claim->isSelfOfInsured()) {
 319         ++$edicount;
 320         $out .= "N3" .
 321             "*" . $claim->insuredStreet() .
 322             "~\n";
 323
 324         ++$edicount;
 325         $out .= "N4" .
 326             "*" . $claim->insuredCity() .
 327             "*" . $claim->insuredState() .
 328             "*" . stripZipCode($claim->insuredZip()) .
 329             "~\n";
 330
 331         ++$edicount;
 332         $out .= "DMG" .
 333             "*" . "D8" .
 334             "*" . $claim->insuredDOB() .
 335             "*" . $claim->insuredSex() .
 336             "~\n";
 337     }
 338
 339     // Segment REF*SY (Subscriber Secondary Identification) omitted.
 340     // Segment REF*Y4 (Property and Casualty Claim Number) omitted.
 341     // Segment PER*IC (Property and Casualty Subscriber Contact Information) omitted.
 342
 343     ++$edicount;
 344     $payerName = substr($claim->payerName(), 0, 60);
 345     $out .= "NM1" .       // Loop 2010BB Payer
 346         "*" . "PR" .
 347         "*" . "2" .
 348         "*" . $payerName .
 349         "*" .
 350         "*" .
 351         "*" .
 352         "*" .
 353         "*" . "PI" .
 354         "*" . ($encounter_claim ? $claim->payerAltID() : $claim->payerID()) .
 355         "~\n";
 356     if (!$claim->payerID()) {
 357         $log .= "*** CMS ID is missing for payer '" . $claim->payerName() . "'.\n";
 358     }
 359
 360     ++$edicount;
 361     $out .= "N3" .
 362         "*" . $claim->payerStreet() .
 363         "~\n";
 364
 365     ++$edicount;
 366     $out .= "N4" .
 367         "*" . $claim->payerCity() .
 368         "*" . $claim->payerState() .
 369         "*" . stripZipCode($claim->payerZip()) .
 370         "~\n";
 371
 372     // Segment REF (Payer Secondary Identification) omitted.
 373     // Segment REF (Billing Provider Secondary Identification) omitted.
 374
 375     if (!$claim->isSelfOfInsured()) {
 376         ++$edicount;
 377         $out .= "HL" .        // Loop 2000C Patient Information
 378             "*" . $HLcount .
 379             "*" . $HLSubscriber .
 380             "*" . "23" .
 381             "*" . "0" .
 382             "~\n";
 383
 384         $HLcount++;
 385         ++$edicount;
 386         $out .= "PAT" .
 387             "*" . $claim->insuredRelationship() .
 388             "~\n";
 389
 390         ++$edicount;
 391         $out .= "NM1" .       // Loop 2010CA Patient
 392             "*" . "QC" .
 393             "*" . "1" .
 394             "*" . $claim->patientLastName() .
 395             "*" . $claim->patientFirstName();
 396
 397         if ($claim->patientMiddleName() !== '') {
 398             $out .= "*" . $claim->patientMiddleName();
 399         }
 400
 401         $out .= "~\n";
 402
 403         ++$edicount;
 404         $out .= "N3" .
 405             "*" . $claim->patientStreet() .
 406             "~\n";
 407
 408         ++$edicount;
 409         $out .= "N4" .
 410             "*" . $claim->patientCity() .
 411             "*" . $claim->patientState() .
 412             "*" . stripZipCode($claim->patientZip()) .
 413             "~\n";
 414
 415         ++$edicount;
 416         $out .= "DMG" .
 417             "*" . "D8" .
 418             "*" . $claim->patientDOB() .
 419             "*" . $claim->patientSex() .
 420             "~\n";
 421
 422         // Segment REF*Y4 (Property and Casualty Claim Number) omitted.
 423         // Segment REF (Property and Casualty Patient Identifier) omitted.
 424         // Segment PER (Property and Casualty Patient Contact Information) omitted.
 425     } // end of patient different from insured
 426
 427     $proccount = $claim->procCount();
 428     $clm_total_charges = 0;
 429     for ($prockey = 0; $prockey < $proccount; ++$prockey) {
 430         $clm_total_charges += $claim->cptCharges($prockey);
 431     }
 432     if (!$clm_total_charges) {
 433         $log .= "*** This claim has no charges!\n";
 434     }
 435
 436     ++$edicount;
 437     $out .= "CLM" .    // Loop 2300 Claim
 438         "*" . $pid . "-" . $encounter .
 439         "*" . sprintf("%.2f", $clm_total_charges) .
 440         "*" .
 441         "*" .
 442         "*" . sprintf('%02d', $claim->facilityPOS()) . ":" . "B" . ":" . $claim->frequencyTypeCode() .
 443         "*" . "Y" .
 444         "*" . "A" .
 445         "*" . ($claim->billingFacilityAssignment() ? 'Y' : 'N') .
 446         "*" . "Y" .
 447         "~\n";
 448
 449     // above is for historical use of encounter onset date, now in misc_billing_options
 450     // Segment DTP*431 (Onset of Current Symptoms or Illness)
 451     // Segment DTP*484 (Last Menstrual Period Date)
 452
 453     if ($claim->onsetDate() && ($claim->onsetDate() !== $claim->serviceDate()) && ($claim->onsetDateValid())) {
 454         ++$edicount;
 455         $out .= "DTP" .       // Date of Onset
 456             "*" . "431" .
 457             "*" . "D8" .
 458             "*" . $claim->onsetDate() .
 459             "~\n";
 460     } else if ($claim->miscOnsetDate() && ($claim->miscOnsetDate() !== $claim->serviceDate())
 461         && ($claim->box14Qualifier()) && ($claim->miscOnsetDateValid())) {
 462         ++$edicount;
 463         $out .= "DTP" .
 464             "*" . $claim->box14Qualifier() .
 465             "*" . "D8" .
 466             "*" . $claim->miscOnsetDate() .
 467             "~\n";
 468     }
 469
 470     // Segment DTP*304 (Last Seen Date)
 471     // Segment DTP*453 (Acute Manifestation Date)
 472     // Segment DTP*439 (Accident Date)
 473     // Segment DTP*455 (Last X-Ray Date)
 474     // Segment DTP*471 (Hearing and Vision Prescription Date)
 475     // Segment DTP*314 (Disability) omitted.
 476     // Segment DTP*360 (Initial Disability Period Start) omitted.
 477     // Segment DTP*361 (Initial Disability Period End) omitted.
 478     // Segment DTP*297 (Last Worked Date)
 479     // Segment DTP*296 (Authorized Return to Work Date)
 480
 481     // Segment DTP*454 (Initial Treatment Date)
 482
 483     if ($claim->dateInitialTreatment() && ($claim->box15Qualifier()) && ($claim->dateInitialTreatmentValid())) {
 484         ++$edicount;
 485         $out .= "DTP" .       // Date Last Seen
 486         "*" . $claim->box15Qualifier() .
 487         "*" . "D8" .
 488         "*" . $claim->dateInitialTreatment() .
 489         "~\n";
 490     }
 491
 492     if (strcmp($claim->facilityPOS(), '21') == 0 && $claim->onsetDateValid()) {
 493         ++$edicount;
 494         $out .= "DTP" .     // Date of Hospitalization
 495         "*" . "435" .
 496         "*" . "D8" .
 497         "*" . $claim->onsetDate() .
 498         "~\n";
 499     }
 500
 501     // above is for historical use of encounter onset date, now in misc_billing_options
 502     if (strcmp($claim->facilityPOS(), '21') == 0 && $claim->hospitalizedFromDateValid()) {
 503         ++$edicount;
 504         $out .= "DTP" .     // Date of Admission
 505         "*" . "435" .
 506         "*" . "D8" .
 507         "*" . $claim->hospitalizedFrom() .
 508         "~\n";
 509     }
 510
 511     // Segment DTP*096 (Discharge Date)
 512     if (strcmp($claim->facilityPOS(), '21') == 0 && $claim->hospitalizedToDateValid()) {
 513         ++$edicount;
 514         $out .= "DTP" .     // Date of Discharge
 515         "*" . "96" .
 516         "*" . "D8" .
 517         "*" . $claim->hospitalizedTo() .
 518         "~\n";
 519     }
 520
 521     // Segments DTP (Assumed and Relinquished Care Dates) omitted.
 522     // Segment DTP*444 (Property and Casualty Date of First Contact) omitted.
 523     // Segment DTP*050 (Repricer Received Date) omitted.
 524     // Segment PWK (Claim Supplemental Information) omitted.
 525     // Segment CN1 (Contract Information) omitted.
 526
 527     $patientpaid = $claim->patientPaidAmount();
 528     if ($patientpaid != 0) {
 529         ++$edicount;
 530         $out .= "AMT" .     // Patient paid amount. Page 190/220.
 531         "*" . "F5" .
 532         "*" . $patientpaid .
 533         "~\n";
 534     }
 535
 536     // Segment REF*4N (Service Authorization Exception Code) omitted.
 537     // Segment REF*F5 (Mandatory Medicare Crossover Indicator) omitted.
 538     // Segment REF*EW (Mammography Certification Number) omitted.
 539     // Segment REF*9F (Referral Number) omitted.
 540
 541     if ($claim->priorAuth()) {
 542         ++$edicount;
 543         $out .= "REF" .     // Prior Authorization Number
 544         "*" . "G1" .
 545         "*" . $claim->priorAuth() .
 546         "~\n";
 547     }
 548
 549     // Segment REF*F8 Payer Claim Control Number for claim re-submission.icn_resubmission_number
 550     if (trim($claim->billing_options['icn_resubmission_number']) > 3) {
 551         ++$edicount;
 552         error_log("Method 1: " . $claim->billing_options['icn_resubmission_number'], 0);
 553         $out .= "REF" .
 554         "*" . "F8" .
 555         "*" . $claim->icnResubmissionNumber() .
 556         "~\n";
 557     }
 558
 559     if ($claim->cliaCode() && ($claim->claimType() === 'MB')) {
 560         // Required by Medicare when in-house labs are done.
 561         ++$edicount;
 562         $out .= "REF" .     // Clinical Laboratory Improvement Amendment Number
 563         "*" . "X4" .
 564         "*" . $claim->cliaCode() .
 565         "~\n";
 566     }
 567
 568     // Segment REF*9A (Repriced Claim Number) omitted.
 569     // Segment REF*9C (Adjusted Repriced Claim Number) omitted.
 570     // Segment REF*LX (Investigational Device Exemption Number) omitted.
 571     // Segment REF*D9 (Claim Identifier for Transmission Intermediaries) omitted.
 572     // Segment REF*EA (Medical Record Number) omitted.
 573     // Segment REF*P4 (Demonstration Project Identifier) omitted.
 574     // Segment REF*1J (Care Plan Oversight) omitted.
 575     // Segment K3 (File Information) omitted.
 576     if ($claim->additionalNotes()) {
 577         // Claim note.
 578         ++$edicount;
 579         $out .= "NTE" .     // comments box 19
 580         "*" . "ADD" .
 581         "*" . $claim->additionalNotes() .
 582         "~\n";
 583     }
 584
 585     // Segment CR1 (Ambulance Transport Information) omitted.
 586     // Segment CR2 (Spinal Manipulation Service Information) omitted.
 587     // Segment CRC (Ambulance Certification) omitted.
 588     // Segment CRC (Patient Condition Information: Vision) omitted.
 589     // Segment CRC (Homebound Indicator) omitted.
 590     // Segment CRC (EPSDT Referral).
 591     if ($claim->epsdtFlag()) {
 592         ++$edicount;
 593         $out .= "CRC" .
 594         "*" . "ZZ" .
 595         "*" . "Y" .
 596         "*" . $claim->medicaidReferralCode() .
 597         "~\n";
 598     }
 599
 600     // Diagnoses, up to $max_per_seg per HI segment.
 601     $max_per_seg = 12;
 602     $da = $claim->diagArray();
 603     if ($claim->diagtype == "ICD9") {
 604         $diag_type_code = 'BK';
 605     } else {
 606         $diag_type_code = 'ABK';
 607     }
 608     $tmp = 0;
 609     foreach ($da as $diag) {
 610         if ($tmp % $max_per_seg == 0) {
 611             if ($tmp) {
 612                 $out .= "~\n";
 613             }
 614             ++$edicount;
 615             $out .= "HI";         // Health Diagnosis Codes
 616         }
 617         $out .= "*" . $diag_type_code . ":" . $diag;
 618         if ($claim->diagtype == "ICD9") {
 619             $diag_type_code = 'BF';
 620         } else {
 621             $diag_type_code = 'ABF';
 622         }
 623         ++$tmp;
 624     }
 625
 626     if ($tmp) {
 627         $out .= "~\n";
 628     }
 629
 630     // Segment HI*BP (Anesthesia Related Procedure) omitted.
 631     // Segment HI*BG (Condition Information) omitted.
 632     // Segment HCP (Claim Pricing/Repricing Information) omitted.
 633     if ($claim->referrerLastName()) {
 634         // Medicare requires referring provider's name and UPIN.
 635         ++$edicount;
 636         $out .= "NM1" .     // Loop 2310A Referring Provider
 637         "*" . "DN" .
 638         "*" . "1" .
 639         "*" . $claim->referrerLastName() .
 640         "*" . $claim->referrerFirstName() .
 641         "*" . $claim->referrerMiddleName() .
 642         "*" .
 643         "*";
 644         if ($claim->referrerNPI()) {
 645             $out .=
 646             "*" . "XX" .
 647             "*" . $claim->referrerNPI();
 648         } else {
 649             $log .= "*** Referring provider has no NPI.\n";
 650         }
 651         $out .= "~\n";
 652     }
 653
 654     // Per the implementation guide lines, only include this information if it is different
 655     // than the Loop 2010AA information
 656     if ($claim->providerNPIValid() && ($claim->billingFacilityNPI() !== $claim->providerNPI())) {
 657         ++$edicount;
 658         $out .= "NM1" .       // Loop 2310B Rendering Provider
 659         "*" . "82" .
 660         "*" . "1" .
 661         "*" . $claim->providerLastName() .
 662         "*" . $claim->providerFirstName() .
 663         "*" . $claim->providerMiddleName() .
 664         "*" .
 665         "*";
 666         if ($claim->providerNPI()) {
 667             $out .=
 668             "*" . "XX" .
 669             "*" . $claim->providerNPI();
 670         } else {
 671             $log .= "*** Rendering provider has no NPI.\n";
 672         }
 673         $out .= "~\n";
 674
 675         if ($claim->providerTaxonomy()) {
 676             ++$edicount;
 677             $out .= "PRV" .
 678             "*" . "PE" . // Performing provider
 679             "*" . "PXC" .
 680             "*" . $claim->providerTaxonomy() .
 681             "~\n";
 682         } else {
 683             $log .= "*** Performing provider has no taxonomy code.\n";
 684         }
 685     } else {
 686         $log .= "*** Rendering provider is billing under a group.\n";
 687     }
 688     if (!$claim->providerNPIValid()) {
 689         // If the loop was skipped because the provider NPI was invalid, generate a warning for the log.
 690         $log .= "*** Skipping 2310B because " . $claim->providerLastName() . "," . $claim->providerFirstName() . " has invalid NPI.\n";
 691     }
 692
 693     if (!$claim->providerNPI() && in_array($claim->providerNumberType(), array('0B', '1G', 'G2', 'LU'))) {
 694         if ($claim->providerNumber()) {
 695             ++$edicount;
 696             $out .= "REF" .
 697             "*" . $claim->providerNumberType() .
 698             "*" . $claim->providerNumber() .
 699             "~\n";
 700         }
 701     }
 702     // End of Loop 2310B
 703
 704     // Loop 2310C is omitted in the case of home visits (POS=12).
 705     if ($claim->facilityPOS() != 12 && ($claim->facilityNPI() != $claim->billingFacilityNPI())) {
 706         ++$edicount;
 707         $out .= "NM1" .       // Loop 2310C Service Location
 708         "*" . "77" .
 709         "*" . "2";
 710         $facilityName = substr($claim->facilityName(), 0, 60);
 711         if ($claim->facilityName() || $claim->facilityNPI() || $claim->facilityETIN()) {
 712             $out .=
 713             "*" . $facilityName;
 714         } else {
 715             $log .= "*** Check for invalid facility name, NPI, and/or tax id.\n";
 716         }
 717         if ($claim->facilityNPI() || $claim->facilityETIN()) {
 718             $out .=
 719             "*" .
 720             "*" .
 721             "*" .
 722             "*";
 723             if ($claim->facilityNPI()) {
 724                 $out .=
 725                 "*" . "XX" . "*" . $claim->facilityNPI();
 726             } else {
 727                 $out .=
 728                 "*" . "24" . "*" . $claim->facilityETIN();
 729             }
 730             if (!$claim->facilityNPI()) {
 731                 $log .= "*** Service location has no NPI.\n";
 732             }
 733         }
 734
 735         $out .= "~\n";
 736         if ($claim->facilityStreet()) {
 737             ++$edicount;
 738             $out .= "N3" .
 739             "*" . $claim->facilityStreet() .
 740             "~\n";
 741         }
 742
 743         if ($claim->facilityState()) {
 744             ++$edicount;
 745             $out .= "N4" .
 746             "*" . $claim->facilityCity() .
 747             "*" . $claim->facilityState() .
 748             "*" . stripZipCode($claim->facilityZip()) .
 749             "~\n";
 750         }
 751     }
 752     // Segment REF (Service Facility Location Secondary Identification) omitted.
 753     // Segment PER (Service Facility Contact Information) omitted.
 754
 755     // Loop 2310D, Supervising Provider
 756     if (! empty($claim->supervisorLastName())) {
 757         ++$edicount;
 758         $out .= "NM1" .
 759         "*" . "DQ" . // Supervising Physician
 760         "*" . "1" .  // Person
 761         "*" . $claim->supervisorLastName() .
 762         "*" . $claim->supervisorFirstName() .
 763         "*" . $claim->supervisorMiddleName() .
 764         "*" .   // NM106 not used
 765         "*";    // Name Suffix not used
 766         if ($claim->supervisorNPI()) {
 767             $out .=
 768             "*" . "XX" .
 769             "*" . $claim->supervisorNPI();
 770         } else {
 771             $log .= "*** Supervising Provider has no NPI.\n";
 772         }
 773         $out .= "~\n";
 774
 775         if ($claim->supervisorNumber()) {
 776             ++$edicount;
 777             $out .= "REF" .
 778             "*" . $claim->supervisorNumberType() .
 779             "*" . $claim->supervisorNumber() .
 780             "~\n";
 781         }
 782     }
 783
 784     // Segments NM1*PW, N3, N4 (Ambulance Pick-Up Location) omitted.
 785     // Segments NM1*45, N3, N4 (Ambulance Drop-Off Location) omitted.
 786
 787     // Loops 2320 and 2330, other subscriber/payer information.
 788     // Remember that insurance index 0 is always for the payer being billed
 789     // by this claim, and 1 and above are always for the "other" payers.
 790
 791     for ($ins = 1; $ins < $claim->payerCount(); ++$ins) {
 792         $tmp1 = $claim->claimType($ins);
 793         $tmp2 = 'C1'; // Here a kludge. See page 321.
 794         if ($tmp1 === 'CI') {
 795             $tmp2 = 'C1';
 796         }
 797         if ($tmp1 === 'AM') {
 798             $tmp2 = 'AP';
 799         }
 800         if ($tmp1 === 'HM') {
 801             $tmp2 = 'HM';
 802         }
 803         if ($tmp1 === 'MB') {
 804             $tmp2 = 'MB';
 805         }
 806         if ($tmp1 === 'MC') {
 807             $tmp2 = 'MC';
 808         }
 809         if ($tmp1 === '09') {
 810             $tmp2 = 'PP';
 811         }
 812
 813         ++$edicount;
 814         $out .= "SBR" . // Loop 2320, Subscriber Information - page 297/318
 815         "*" . $claim->payerSequence($ins) .
 816         "*" . $claim->insuredRelationship($ins) .
 817         "*" . $claim->groupNumber($ins) .
 818         "*" . ($claim->groupNumber() ? '' : $claim->groupName()) .
 819         "*" . $claim->insuredTypeCode($ins) .
 820         "*" .
 821         "*" .
 822         "*" .
 823         "*" . $claim->claimType($ins) .
 824         "~\n";
 825
 826         // Things that apply only to previous payers, not future payers.
 827         if ($claim->payerSequence($ins) < $claim->payerSequence()) {
 828             // Generate claim-level adjustments.
 829             $aarr = $claim->payerAdjustments($ins);
 830             foreach ($aarr as $a) {
 831                 ++$edicount;
 832                 $out .= "CAS" . // Previous payer's claim-level adjustments. Page 301/323.
 833                 "*" . $a[1] .
 834                 "*" . $a[2] .
 835                 "*" . $a[3] .
 836                 "~\n";
 837             }
 838
 839             $payerpaid = $claim->payerTotals($ins);
 840             ++$edicount;
 841             $out .= "AMT" . // Previous payer's paid amount. Page 307/332.
 842             "*" . "D" .
 843             "*" . $payerpaid[1] .
 844             "~\n";
 845             // Segment AMT*A8 (COB Total Non-Covered Amount) omitted.
 846             // Segment AMT*EAF (Remaining Patient Liability) omitted.
 847         }   // End of things that apply only to previous payers.
 848
 849         ++$edicount;
 850         $out .= "OI" .  // Other Insurance Coverage Information. Page 310/344.
 851         "*" .
 852         "*" .
 853         "*" . ($claim->billingFacilityAssignment($ins) ? 'Y' : 'N') .
 854         // For this next item, the 5010 example in the spec does not match its
 855         // description.  So this might be wrong.
 856         "*" .
 857         "*" .
 858         "*" .
 859         "Y" .
 860         "~\n";
 861
 862         // Segment MOA (Medicare Outpatient Adjudication) omitted.
 863         ++$edicount;
 864         $out .= "NM1" . // Loop 2330A Subscriber info for other insco. Page 315/350.
 865         "*" . "IL" .
 866         "*" . "1" .
 867         "*" . $claim->insuredLastName($ins) .
 868         "*" . $claim->insuredFirstName($ins) .
 869         "*" . $claim->insuredMiddleName($ins) .
 870         "*" .
 871         "*" .
 872         "*" . "MI" .
 873         "*" . $claim->policyNumber($ins) .
 874         "~\n";
 875
 876         ++$edicount;
 877         $out .= "N3" .
 878         "*" . $claim->insuredStreet($ins) .
 879         "~\n";
 880
 881         ++$edicount;
 882         $out .= "N4" .
 883         "*" . $claim->insuredCity($ins) .
 884         "*" . $claim->insuredState($ins) .
 885         "*" . stripZipCode($claim->insuredZip($ins)) .
 886         "~\n";
 887
 888         // Segment REF (Other Subscriber Secondary Identification) omitted.
 889         ++$edicount;
 890         $payerName = substr($claim->payerName($ins), 0, 60);
 891         $out .= "NM1" . // Loop 2330B Payer info for other insco. Page 322/359.
 892         "*" . "PR" .
 893         "*" . "2" .
 894         "*" . $payerName .
 895         "*" .
 896         "*" .
 897         "*" .
 898         "*" .
 899         "*" . "PI" .
 900         "*" . $claim->payerID($ins) .
 901         "~\n";
 902
 903         if (!$claim->payerID($ins)) {
 904             $log .= "*** CMS ID is missing for payer '" . $claim->payerName($ins) . "'.\n";
 905         }
 906
 907         ++$edicount;
 908         $out .= "N3" .
 909         "*" . $claim->payerStreet($ins) .
 910         "~\n";
 911
 912         ++$edicount;
 913         $out .= "N4" .
 914         "*" . $claim->payerCity($ins) .
 915         "*" . $claim->payerState($ins) .
 916         "*" . stripZipCode($claim->payerZip($ins)) .
 917         "~\n";
 918         // Segment DTP*573 (Claim Check or Remittance Date) omitted.
 919         // Segment REF (Other Payer Secondary Identifier) omitted.
 920         // Segment REF*G1 (Other Payer Prior Authorization Number) omitted.
 921         // Segment REF*9F (Other Payer Referral Number) omitted.
 922         // Segment REF*T4 (Other Payer Claim Adjustment Indicator) omitted.
 923         // Segment REF*F8 (Other Payer Claim Control Number) omitted.
 924         // Segment NM1 (Other Payer Referring Provider) omitted.
 925         // Segment REF (Other Payer Referring Provider Secondary Identification) omitted.
 926         // Segment NM1 (Other Payer Rendering Provider) omitted.
 927         // Segment REF (Other Payer Rendering Provider Secondary Identification) omitted.
 928         // Segment NM1 (Other Payer Service Facility Location) omitted.
 929         // Segment REF (Other Payer Service Facility Location Secondary Identification) omitted.
 930         // Segment NM1 (Other Payer Supervising Provider) omitted.
 931         // Segment REF (Other Payer Supervising Provider Secondary Identification) omitted.
 932         // Segment NM1 (Other Payer Billing Provider) omitted.
 933         // Segment REF (Other Payer Billing Provider Secondary Identification) omitted.
 934     } // End loops 2320/2330*.
 935
 936     $loopcount = 0;
 937
 938     // Loop 2400 Procedure Loop.
 939     //
 940
 941     for ($prockey = 0; $prockey < $proccount; ++$prockey) {
 942         ++$loopcount;
 943         ++$edicount;
 944         $out .= "LX" .      // Segment LX, Service Line. Page 398.
 945         "*" . $loopcount .
 946         "~\n";
 947
 948         ++$edicount;
 949         $out .= "SV1" .     // Segment SV1, Professional Service. Page 400.
 950         "*" . "HC:" . $claim->cptKey($prockey) .
 951         "*" . sprintf('%.2f', $claim->cptCharges($prockey)) .
 952         "*" . "UN" .
 953         "*" . $claim->cptUnits($prockey) .
 954         "*" .
 955         "*" .
 956         "*";
 957         $dia = $claim->diagIndexArray($prockey);
 958         $i = 0;
 959         foreach ($dia as $dindex) {
 960             if ($i) {
 961                 $out .= ':';
 962             }
 963
 964             $out .= $dindex;
 965             if (++$i >= 4) {
 966                 break;
 967             }
 968         }
 969
 970         # needed for epstd
 971         if ($claim->epsdtFlag()) {
 972             $out .= "*" .
 973             "*" .
 974             "*" .
 975             "*" . "Y" .
 976             "~\n";
 977         } else {
 978             $out .= "~\n";
 979         }
 980
 981         if (!$claim->cptCharges($prockey)) {
 982             $log .= "*** Procedure '" . $claim->cptKey($prockey) . "' has no charges!\n";
 983         }
 984
 985         if (empty($dia)) {
 986             $log .= "*** Procedure '" . $claim->cptKey($prockey) . "' is not justified!\n";
 987         }
 988
 989         // Segment SV5 (Durable Medical Equipment Service) omitted.
 990         // Segment PWK01 (Line Supplemental Information) omitted.
 991         // Segment CR1 (Ambulance Transport Information) omitted.
 992         // Segment CR3 (Durable Medical Equipment Certification) omitted.
 993         // Segment CRC (Ambulance Certification) omitted.
 994         // Segment CRC (Hospice Employee Indicator) omitted.
 995         // Segment CRC (Condition Indicator / Durable Medical Equipment) omitted.
 996
 997         ++$edicount;
 998         $out .= "DTP" .     // Date of Service. Page 435.
 999         "*" . "472" .
1000         "*" . "D8" .
1001         "*" . $claim->serviceDate() .
1002         "~\n";
1003
1004         $testnote = rtrim($claim->cptNotecodes($prockey));
1005         if (!empty($testnote)) {
1006             ++$edicount;
1007             $out .= "NTE" .     // Explain Unusual Circumstances.
1008             "*" . "ADD" .
1009             "*" . $claim->cptNotecodes($prockey) .
1010             "~\n";
1011         }
1012
1013         // Segment DTP*471 (Prescription Date) omitted.
1014         // Segment DTP*607 (Revision/Recertification Date) omitted.
1015         // Segment DTP*463 (Begin Therapy Date) omitted.
1016         // Segment DTP*461 (Last Certification Date) omitted.
1017         // Segment DTP*304 (Last Seen Date) omitted.
1018         // Segment DTP (Test Date) omitted.
1019         // Segment DTP*011 (Shipped Date) omitted.
1020         // Segment DTP*455 (Last X-Ray Date) omitted.
1021         // Segment DTP*454 (Initial Treatment Date) omitted.
1022         // Segment QTY (Ambulance Patient Count) omitted.
1023         // Segment QTY (Obstetric Anesthesia Additional Units) omitted.
1024         // Segment MEA (Test Result) omitted.
1025         // Segment CN1 (Contract Information) omitted.
1026         // Segment REF*9B (Repriced Line Item Reference Number) omitted.
1027         // Segment REF*9D (Adjusted Repriced Line Item Reference Number) omitted.
1028         // Segment REF*G1 (Prior Authorization) omitted.
1029         // Segment REF*6R (Line Item Control Number) omitted.
1030         //   (Really oughta have this for robust 835 posting!)
1031         // Segment REF*EW (Mammography Certification Number) omitted.
1032         // Segment REF*X4 (CLIA Number) omitted.
1033         // Segment REF*F4 (Referring CLIA Facility Identification) omitted.
1034         // Segment REF*BT (Immunization Batch Number) omitted.
1035         // Segment REF*9F (Referral Number) omitted.
1036         // Segment AMT*T (Sales Tax Amount) omitted.
1037         // Segment AMT*F4 (Postage Claimed Amount) omitted.
1038         // Segment K3 (File Information) omitted.
1039         // Segment NTE (Line Note) omitted.
1040         // Segment NTE (Third Party Organization Notes) omitted.
1041         // Segment PS1 (Purchased Service Information) omitted.
1042         // Segment HCP (Line Pricing/Repricing Information) omitted.
1043
1044     // Loop 2410, Drug Information. Medicaid insurers seem to want this
1045     // with HCPCS codes.
1046     //
1047         $ndc = $claim->cptNDCID($prockey);
1048
1049         if ($ndc) {
1050             ++$edicount;
1051             $out .= "LIN" . // Drug Identification. Page 500+ (Addendum pg 71).
1052             "*" .         // Per addendum, LIN01 is not used.
1053             "*" . "N4" .
1054             "*" . $ndc .
1055             "~\n";
1056
1057             if (!preg_match('/^\d\d\d\d\d-\d\d\d\d-\d\d$/', $ndc, $tmp) && !preg_match('/^\d{11}$/', $ndc)) {
1058                 $log .= "*** NDC code '$ndc' has invalid format!\n";
1059             }
1060
1061             ++$edicount;
1062             $out .= "CTP" . // Drug Pricing. Page 500+ (Addendum pg 74).
1063             "*" .
1064             "*" .
1065             "*" .
1066             "*" . $claim->cptNDCQuantity($prockey) .
1067             "*" . $claim->cptNDCUOM($prockey) .
1068             // Note: 5010 documents "ME" (Milligrams) as an additional unit of measure.
1069             "~\n";
1070
1071             // Segment REF (Prescription or Compound Drug Association Number) omitted.
1072         }
1073
1074
1075     // Loop 2420A, Rendering Provider (service-specific).
1076     // Used if the rendering provider for this service line is different
1077     // from that in loop 2310B.
1078
1079         if ($claim->providerNPI() != $claim->providerNPI($prockey)) {
1080             ++$edicount;
1081             $out .= "NM1" .       // Loop 2420A Rendering Provider
1082             "*" . "82" .
1083             "*" . "1" .
1084             "*" . $claim->providerLastName($prockey) .
1085             "*" . $claim->providerFirstName($prockey) .
1086             "*" . $claim->providerMiddleName($prockey) .
1087             "*" .
1088             "*";
1089             if ($claim->providerNPI($prockey)) {
1090                 $out .=
1091                 "*" . "XX" .
1092                 "*" . $claim->providerNPI($prockey);
1093             } else {
1094                 $log .= "*** Rendering provider has no NPI.\n";
1095             }
1096             $out .= "~\n";
1097
1098             // Segment PRV*PE (Rendering Provider Specialty Information) .
1099
1100             if ($claim->providerTaxonomy($prockey)) {
1101                 ++$edicount;
1102                 $out .= "PRV" .
1103                 "*" . "PE" . // PErforming provider
1104                 "*" . "PXC" .
1105                 "*" . $claim->providerTaxonomy($prockey) .
1106                 "~\n";
1107             }
1108
1109             // Segment REF (Rendering Provider Secondary Identification).
1110             // REF*1C is required here for the Medicare provider number if NPI was
1111             // specified in NM109.  Not sure if other payers require anything here.
1112
1113             if ($claim->providerNumberType($prockey) == "G2") {
1114                 ++$edicount; $out .= "REF" . "*" . $claim->providerNumberType($prockey) .
1115                 "*" . $claim->providerNumber($prockey) . "~\n";
1116             }
1117         } // end provider exception
1118
1119         // Segment NM1 (Loop 2420B Purchased Service Provider Name) omitted.
1120         // Segment REF (Loop 2420B Purchased Service Provider Secondary Identification) omitted.
1121         // Segment NM1,N3,N4 (Loop 2420C Service Facility Location) omitted.
1122         // Segment REF (Loop 2420C Service Facility Location Secondary Identification) omitted.
1123         // Segment NM1 (Loop 2420D Supervising Provider Name) omitted.
1124         // Segment REF (Loop 2420D Supervising Provider Secondary Identification) omitted.
1125
1126         // Loop 2420E, Ordering Provider.
1127         // for Medicare DME claims esp @joe on chat.open-emr.org :)
1128
1129         if ($claim->Box17Qualifier() == "DK" && ($claim->claimType() === 'MB')) {
1130             ++$edicount;
1131             $out .= "NM1" .
1132                 "*" . $claim->Box17Qualifier() .
1133                 "*" . "1" .
1134                 "*" . $claim->billingProviderLastName() .
1135                 "*" . $claim->billingProviderFirstName() .
1136                 "*" . $claim->billingProviderMiddleName() .
1137                 "*" .
1138                 "*";
1139             if ($claim->billingProviderNPI()) {
1140                 $out .=
1141                     "*" . "XX" .
1142                     "*" . $claim->billingProviderNPI();
1143             } else {
1144                 $log .= "*** Ordering provider has no NPI.\n";
1145             }
1146             $out .= "~\n";
1147
1148             ++$edicount;
1149             $out .= "N3" .
1150                 "*" . $claim->billingProviderStreet() .
1151                 "*" . $claim->billingProviderStreetB() .
1152                 "~\n";
1153
1154             ++$edicount;
1155             $out .= "N4" .
1156                 "*" . $claim->billingProviderCity() .
1157                 "*" . $claim->billingProviderState() .
1158                 "*" . stripZipCode($claim->billingProviderZip()) .
1159                 "~\n";
1160             // Segment REF (Ordering Provider Secondary Identification) omitted.
1161             // Segment PER (Ordering Provider Contact Information) omitted.
1162         }
1163
1164
1165         // Segment NM1 (Referring Provider Name) omitted.
1166         // Segment REF (Referring Provider Secondary Identification) omitted.
1167         // Segments NM1*PW, N3, N4 (Ambulance Pick-Up Location) omitted.
1168         // Segments NM1*45, N3, N4 (Ambulance Drop-Off Location) omitted.
1169
1170     // Loop 2430, adjudication by previous payers.
1171     //
1172
1173         for ($ins = 1; $ins < $claim->payerCount(); ++$ins) {
1174             if ($claim->payerSequence($ins) > $claim->payerSequence()) {
1175                 continue; // payer is future, not previous
1176             }
1177
1178             $payerpaid = $claim->payerTotals($ins, $claim->cptKey($prockey));
1179             $aarr = $claim->payerAdjustments($ins, $claim->cptKey($prockey));
1180
1181             if ($payerpaid[1] == 0 && !count($aarr)) {
1182                 $log .= "*** Procedure '" . $claim->cptKey($prockey) .
1183                     "' has no payments or adjustments from previous payer!\n";
1184                 continue;
1185             }
1186
1187             ++$edicount;
1188             $out .= "SVD" . // Service line adjudication. Page 554.
1189             "*" . $claim->payerID($ins) .
1190             "*" . $payerpaid[1] .
1191             "*" . "HC:" . $claim->cptKey($prockey) .
1192             "*" .
1193             "*" . $claim->cptUnits($prockey) .
1194             "~\n";
1195
1196             $tmpdate = $payerpaid[0];
1197             foreach ($aarr as $a) {
1198                 ++$edicount;
1199                 $out .= "CAS" . // Previous payer's line level adjustments. Page 558.
1200                 "*" . $a[1] .
1201                 "*" . $a[2] .
1202                 "*" . $a[3] .
1203                 "~\n";
1204                 if (!$tmpdate) {
1205                     $tmpdate = $a[0];
1206                 }
1207             }
1208
1209             if ($tmpdate) {
1210                 ++$edicount;
1211                 $out .= "DTP" . // Previous payer's line adjustment date. Page 493/566.
1212                 "*" . "573" .
1213                 "*" . "D8" .
1214                 "*" . $tmpdate .
1215                 "~\n";
1216             }
1217
1218             // Segment AMT*EAF (Remaining Patient Liability) omitted.
1219             // Segment LQ (Form Identification Code) omitted.
1220             // Segment FRM (Supporting Documentation) omitted.
1221         } // end loop 2430
1222     } // end this procedure
1223
1224     ++$edicount;
1225     $out .= "SE" .        // SE Trailer
1226     "*" . $edicount .
1227     "*" . "0021" .
1228     "~\n";
1229
1230     $out .= "GE" .        // GE Trailer
1231     "*" . "1" .
1232     "*" . "1" .
1233     "~\n";
1234
1235     $out .= "IEA" .       // IEA Trailer
1236     "*" . "1" .
1237     "*" . "000000001" .
1238     "~\n";
1239
1240     // Remove any trailing empty fields (delimiters) from each segment.
1241     $out = preg_replace('/\*+~/', '~', $out);
1242
1243     $log .= "\n";
1244     return $out;
1245 }