library/Claim.class.php

   1 <?php
   2 /** @package OpenEMR
   3  *  @link http://www.open-emr.org
   4  *  @author Rod Roark <rod@sunsetsystems.com>
   5  *  @copyright Copyright (c) 2009 Rod Roark <rod@sunsetsystems.com>
   6  *  @license https://github.com/openemr/openemr/blob/master/LICENSE GNU General Public License 3
   7  */
   8
   9 require_once(dirname(__FILE__) . "/invoice_summary.inc.php");
  10
  11 // This enforces the X12 Basic Character Set. Page A2.
  12 //
  13 function x12clean($str)
  14 {
  15     return preg_replace('/[^A-Z0-9!"\\&\'()+,\\-.\\/;?= ]/', '', strtoupper($str));
  16 }
  17
  18 // Make sure dates have no formatting and zero filled becomes blank
  19 // Handles date time stamp formats as well
  20 //
  21 function cleanDate($date_field)
  22 {
  23       $cleandate = str_replace('-', '', substr($date_field, 0, 10));
  24
  25     if (substr_count($cleandate, '0')==8) {
  26         $cleandate='';
  27     }
  28
  29       return ($cleandate);
  30 }
  31
  32 class Claim
  33 {
  34
  35     var $pid;               // patient id
  36     var $encounter_id;      // encounter id
  37     var $procs;             // array of procedure rows from billing table
  38     var $diags;             // array of icd9 codes from billing table
  39     var $diagtype= "ICD10"; // diagnosis code_type; safe to assume ICD10 now
  40     var $x12_partner;       // row from x12_partners table
  41     var $encounter;         // row from form_encounter table
  42     var $facility;          // row from facility table
  43     var $billing_facility;  // row from facility table
  44     var $provider;          // row from users table (rendering provider)
  45     var $referrer;          // row from users table (referring provider)
  46     var $supervisor;        // row from users table (supervising provider)
  47     var $insurance_numbers; // row from insurance_numbers table for current payer
  48     var $supervisor_numbers;// row from insurance_numbers table for current payer
  49     var $patient_data;      // row from patient_data table
  50     var $billing_options;   // row from form_misc_billing_options table
  51     var $invoice;           // result from get_invoice_summary()
  52     var $payers;            // array of arrays, for all payers
  53     var $copay;             // total of copays from the ar_activity table
  54     var $facilityService;
  55
  56     function loadPayerInfo(&$billrow)
  57     {
  58         global $sl_err;
  59         $encounter_date = substr($this->encounter['date'], 0, 10);
  60
  61         // Create the $payers array.  This contains data for all insurances
  62         // with the current one always at index 0, and the others in payment
  63         // order starting at index 1.
  64         //
  65         $this->payers = array();
  66         $this->payers[0] = array();
  67         $query = "SELECT * FROM insurance_data WHERE " .
  68         "pid = '{$this->pid}' AND " .
  69         "date <= '$encounter_date' " .
  70         "ORDER BY type ASC, date DESC";
  71         $dres = sqlStatement($query);
  72         $prevtype = '';
  73         while ($drow = sqlFetchArray($dres)) {
  74             if (strcmp($prevtype, $drow['type']) == 0) {
  75                 continue;
  76             }
  77
  78             $prevtype = $drow['type'];
  79             // Very important to look at entries with a missing provider because
  80             // they indicate no insurance as of the given date.
  81             if (empty($drow['provider'])) {
  82                 continue;
  83             }
  84
  85             $ins = count($this->payers);
  86             if ($drow['provider'] == $billrow['payer_id'] && empty($this->payers[0]['data'])) {
  87                 $ins = 0;
  88             }
  89
  90             $crow = sqlQuery("SELECT * FROM insurance_companies WHERE " .
  91             "id = '" . $drow['provider'] . "'");
  92             $orow = new InsuranceCompany($drow['provider']);
  93             $this->payers[$ins] = array();
  94             $this->payers[$ins]['data']    = $drow;
  95             $this->payers[$ins]['company'] = $crow;
  96             $this->payers[$ins]['object']  = $orow;
  97         }
  98
  99         // This kludge hands most cases of a rare ambiguous situation, where
 100         // the primary insurance company is the same as the secondary.  It seems
 101         // nobody planned for that!
 102         //
 103         for ($i = 1; $i < count($this->payers); ++$i) {
 104             if ($billrow['process_date'] &&
 105             $this->payers[0]['data']['provider'] == $this->payers[$i]['data']['provider']) {
 106                 $tmp = $this->payers[0];
 107                 $this->payers[0] = $this->payers[$i];
 108                 $this->payers[$i] = $tmp;
 109             }
 110         }
 111
 112         $this->using_modifiers = true;
 113
 114         // Get payment and adjustment details if there are any previous payers.
 115         //
 116         $this->invoice = array();
 117         if ($this->payerSequence() != 'P') {
 118             $this->invoice = ar_get_invoice_summary($this->pid, $this->encounter_id, true);
 119             // Secondary claims might not have modifiers in SQL-Ledger data.
 120             // In that case, note that we should not try to match on them.
 121             $this->using_modifiers = false;
 122             foreach ($this->invoice as $key => $trash) {
 123                 if (strpos($key, ':')) {
 124                     $this->using_modifiers = true;
 125                 }
 126             }
 127         }
 128     }
 129
 130   // Constructor. Loads relevant database information.
 131   //
 132     function __construct($pid, $encounter_id)
 133     {
 134         $this->pid = $pid;
 135         $this->encounter_id = $encounter_id;
 136         $this->procs = array();
 137         $this->diags = array();
 138         $this->copay = 0;
 139
 140         $this->facilityService = new \services\FacilityService();
 141
 142         // We need the encounter date before we can identify the payers.
 143         $sql = "SELECT * FROM form_encounter WHERE " .
 144         "pid = '{$this->pid}' AND " .
 145         "encounter = '{$this->encounter_id}'";
 146         $this->encounter = sqlQuery($sql);
 147
 148         // Sort by procedure timestamp in order to get some consistency.
 149         $sql = "SELECT b.id, b.date, b.code_type, b.code, b.pid, b.provider_id, " .
 150         "b.user, b.groupname, b.authorized, b.encounter, b.code_text, b.billed, " .
 151         "b.activity, b.payer_id, b.bill_process, b.bill_date, b.process_date, " .
 152         "b.process_file, b.modifier, b.units, b.fee, b.justify, b.target, b.x12_partner_id, " .
 153         "b.ndc_info, b.notecodes, ct.ct_diag " .
 154         "FROM billing as b INNER JOIN code_types as ct " .
 155         "ON b.code_type = ct.ct_key " .
 156         "WHERE ct.ct_claim = '1' AND ct.ct_active = '1' AND " .
 157         "b.encounter = '{$this->encounter_id}' AND b.pid = '{$this->pid}' AND " .
 158         "b.activity = '1' ORDER BY b.date, b.id";
 159         $res = sqlStatement($sql);
 160         while ($row = sqlFetchArray($res)) {
 161             // Save all diagnosis codes.
 162             if ($row['ct_diag'] == '1') {
 163                 $this->diags[$row['code']] = $row['code'];
 164                 continue;
 165             }
 166
 167             if (!$row['units']) {
 168                 $row['units'] = 1;
 169             }
 170
 171             // Load prior payer data at the first opportunity in order to get
 172             // the using_modifiers flag that is referenced below.
 173             if (empty($this->procs)) {
 174                 $this->loadPayerInfo($row);
 175             }
 176
 177             // The consolidate duplicate procedures, which was previously here, was removed
 178             // from codebase on 12/9/15. Reason: Some insurance companies decline consolidated
 179             // procedures, and this can be left up to the billing coder when they input the items.
 180
 181             // If there is a row-specific provider then get its details.
 182             if (!empty($row['provider_id'])) {
 183                 // Get service provider data for this row.
 184                 $sql = "SELECT * FROM users WHERE id = '" . $row['provider_id'] . "'";
 185                 $row['provider'] = sqlQuery($sql);
 186                 // Get insurance numbers for this row's provider.
 187                 $sql = "SELECT * FROM insurance_numbers WHERE " .
 188                 "(insurance_company_id = '" . $row['payer_id'] .
 189                 "' OR insurance_company_id is NULL) AND " .
 190                 "provider_id = '" . $row['provider_id'] . "' " .
 191                 "ORDER BY insurance_company_id DESC LIMIT 1";
 192                 $row['insurance_numbers'] = sqlQuery($sql);
 193             }
 194
 195             $this->procs[] = $row;
 196         }
 197
 198         $resMoneyGot = sqlStatement("SELECT pay_amount as PatientPay,session_id as id,".
 199         "date(post_time) as date FROM ar_activity where pid ='{$this->pid}' and encounter ='{$this->encounter_id}' ".
 200         "and payer_type=0 and account_code='PCP'");
 201           //new fees screen copay gives account_code='PCP'
 202         while ($rowMoneyGot = sqlFetchArray($resMoneyGot)) {
 203               $PatientPay=$rowMoneyGot['PatientPay']*-1;
 204               $this->copay -= $PatientPay;
 205         }
 206
 207         $sql = "SELECT * FROM x12_partners WHERE " .
 208         "id = '" . $this->procs[0]['x12_partner_id'] . "'";
 209         $this->x12_partner = sqlQuery($sql);
 210
 211         $this->facility = $this->facilityService->getById($this->encounter['facility_id']);
 212
 213         /*****************************************************************
 214       $provider_id = $this->procs[0]['provider_id'];
 215         *****************************************************************/
 216         $provider_id = $this->encounter['provider_id'];
 217         $sql = "SELECT * FROM users WHERE id = '$provider_id'";
 218         $this->provider = sqlQuery($sql);
 219         // Selecting the billing facility assigned  to the encounter.  If none,
 220         // try the first (and hopefully only) facility marked as a billing location.
 221         if (empty($this->encounter['billing_facility'])) {
 222               $this->billing_facility = $this->facilityService->getPrimaryBillingLocation();
 223         } else {
 224               $this->billing_facility = $this->facilityService->getById($this->encounter['billing_facility']);
 225         }
 226
 227         $sql = "SELECT * FROM insurance_numbers WHERE " .
 228         "(insurance_company_id = '" . $this->procs[0]['payer_id'] .
 229         "' OR insurance_company_id is NULL) AND " .
 230         "provider_id = '$provider_id' " .
 231         "ORDER BY insurance_company_id DESC LIMIT 1";
 232         $this->insurance_numbers = sqlQuery($sql);
 233
 234         $sql = "SELECT * FROM patient_data WHERE " .
 235         "pid = '{$this->pid}' " .
 236         "ORDER BY id LIMIT 1";
 237         $this->patient_data = sqlQuery($sql);
 238
 239         $sql = "SELECT fpa.* FROM forms JOIN form_misc_billing_options AS fpa " .
 240         "ON fpa.id = forms.form_id WHERE " .
 241         "forms.encounter = '{$this->encounter_id}' AND " .
 242         "forms.pid = '{$this->pid}' AND " .
 243         "forms.deleted = 0 AND " .
 244         "forms.formdir = 'misc_billing_options' " .
 245         "ORDER BY forms.date";
 246         $this->billing_options = sqlQuery($sql);
 247
 248         $referrer_id = (empty($GLOBALS['MedicareReferrerIsRenderer']) ||
 249         $this->insurance_numbers['provider_number_type'] != '1C') ?
 250           $this->patient_data['ref_providerID'] : $provider_id;
 251         $sql = "SELECT * FROM users WHERE id = '$referrer_id'";
 252         $this->referrer = sqlQuery($sql);
 253         if (!$this->referrer) {
 254             $this->referrer = array();
 255         }
 256
 257         $supervisor_id = $this->encounter['supervisor_id'];
 258         $sql = "SELECT * FROM users WHERE id = '$supervisor_id'";
 259         $this->supervisor = sqlQuery($sql);
 260         if (!$this->supervisor) {
 261             $this->supervisor = array();
 262         }
 263
 264         $billing_options_id = $this->billing_options['provider_id'];
 265         $sql = "SELECT * FROM users WHERE id = ?";
 266         $this->billing_prov_id = sqlQuery($sql, array($billing_options_id));
 267         if (!$this->billing_prov_id) {
 268             $this->billing_prov_id = array();
 269         }
 270
 271         $sql = "SELECT * FROM insurance_numbers WHERE " .
 272           "(insurance_company_id = '" . $this->procs[0]['payer_id'] .
 273           "' OR insurance_company_id is NULL) AND " .
 274           "provider_id = '$supervisor_id' " .
 275           "ORDER BY insurance_company_id DESC LIMIT 1";
 276         $this->supervisor_numbers = sqlQuery($sql);
 277         if (!$this->supervisor_numbers) {
 278             $this->supervisor_numbers = array();
 279         }
 280     } // end constructor
 281
 282   // Return an array of adjustments from the designated prior payer for the
 283   // designated procedure key (might be procedure:modifier), or for the claim
 284   // level.  For each adjustment give date, group code, reason code, amount.
 285   // Note this will include "patient responsibility" adjustments which are
 286   // not adjustments to OUR invoice, but they reduce the amount that the
 287   // insurance company pays.
 288   //
 289     function payerAdjustments($ins, $code = 'Claim')
 290     {
 291         $aadj = array();
 292
 293         // If we have no modifiers stored in SQL-Ledger for this claim,
 294         // then we cannot use a modifier passed in with the key.
 295         $tmp = strpos($code, ':');
 296         if ($tmp && !$this->using_modifiers) {
 297             $code = substr($code, 0, $tmp);
 298         }
 299
 300         // For payments, source always starts with "Ins" or "Pt".
 301         // Nonzero adjustment reason examples:
 302         //   Ins1 adjust code 42 (Charges exceed ... (obsolete))
 303         //   Ins1 adjust code 45 (Charges exceed your contracted/ legislated fee arrangement)
 304         //   Ins1 adjust code 97 (Payment is included in the allowance for another service/procedure)
 305         //   Ins1 adjust code A2 (Contractual adjustment)
 306         //   Ins adjust Ins1
 307         //   adjust code 45
 308         // Zero adjustment reason examples:
 309         //   Co-pay: 25.00
 310         //   Coinsurance: 11.46  (code 2)   Note: fix remits to identify insurance
 311         //   To deductible: 0.22 (code 1)   Note: fix remits to identify insurance
 312         //   To copay Ins1 (manual entry)
 313         //   To ded'ble Ins1 (manual entry)
 314
 315         if (!empty($this->invoice[$code])) {
 316             $date = '';
 317             $deductible  = 0;
 318             $coinsurance = 0;
 319             $inslabel = ($this->payerSequence($ins) == 'S') ? 'Ins2' : 'Ins1';
 320             $insnumber = substr($inslabel, 3);
 321
 322             // Compute this procedure's patient responsibility amount as of this
 323             // prior payer, which is the original charge minus all insurance
 324             // payments and "hard" adjustments up to this payer.
 325             $ptresp = $this->invoice[$code]['chg'] + $this->invoice[$code]['adj'];
 326             foreach ($this->invoice[$code]['dtl'] as $key => $value) {
 327                 // plv (from ar_activity.payer_type) exists to
 328                 // indicate the payer level.
 329                 if (isset($value['pmt']) && $value['pmt'] != 0) {
 330                     if ($value['plv'] > 0 && $value['plv'] <= $insnumber) {
 331                         $ptresp -= $value['pmt'];
 332                     }
 333                 } else if (isset($value['chg']) && trim(substr($key, 0, 10))) {
 334                   // non-blank key indicates this is an adjustment and not a charge
 335                     if ($value['plv'] > 0 && $value['plv'] <= $insnumber) {
 336                         $ptresp += $value['chg']; // adjustments are negative charges
 337                     }
 338                 }
 339
 340                 $msp = isset($value['msp']) ? $value['msp'] : null; // record the reason for adjustment
 341             }
 342
 343             if ($ptresp < 0) {
 344                 $ptresp = 0; // we may be insane but try to hide it
 345             }
 346
 347             // Main loop, to extract adjustments for this payer and procedure.
 348             foreach ($this->invoice[$code]['dtl'] as $key => $value) {
 349                 $tmp = str_replace('-', '', trim(substr($key, 0, 10)));
 350                 if ($tmp) {
 351                     $date = $tmp;
 352                 }
 353
 354                 if ($tmp && $value['pmt'] == 0) { // not original charge and not a payment
 355                     $rsn = $value['rsn'];
 356                     $chg = 0 - $value['chg']; // adjustments are negative charges
 357
 358                     $gcode = 'CO'; // default group code = contractual obligation
 359                     $rcode = '45'; // default reason code = max fee exceeded (code 42 is obsolete)
 360
 361                     if (preg_match("/Ins adjust $inslabel/i", $rsn, $tmp)) {
 362                         // From manual post. Take the defaults.
 363                     } else if (preg_match("/To copay $inslabel/i", $rsn, $tmp) && !$chg) {
 364                         $coinsurance = $ptresp; // from manual post
 365                         continue;
 366                     } else if (preg_match("/To ded'ble $inslabel/i", $rsn, $tmp) && !$chg) {
 367                         $deductible = $ptresp; // from manual post
 368                         continue;
 369                     } else if (preg_match("/$inslabel copay: (\S+)/i", $rsn, $tmp) && !$chg) {
 370                         $coinsurance = $tmp[1]; // from 835 as of 6/2007
 371                         continue;
 372                     } else if (preg_match("/$inslabel coins: (\S+)/i", $rsn, $tmp) && !$chg) {
 373                         $coinsurance = $tmp[1]; // from 835 and manual post as of 6/2007
 374                         continue;
 375                     } else if (preg_match("/$inslabel dedbl: (\S+)/i", $rsn, $tmp) && !$chg) {
 376                         $deductible = $tmp[1]; // from 835 and manual post as of 6/2007
 377                         continue;
 378                     } else if (preg_match("/$inslabel ptresp: (\S+)/i", $rsn, $tmp) && !$chg) {
 379                         continue; // from 835 as of 6/2007
 380                     } else if (preg_match("/$inslabel adjust code (\S+)/i", $rsn, $tmp)) {
 381                         $rcode = $tmp[1]; // from 835
 382                     } else if (preg_match("/$inslabel/i", $rsn, $tmp)) {
 383                         // Take the defaults.
 384                     } else if (preg_match('/Ins(\d)/i', $rsn, $tmp) && $tmp[1] != $insnumber) {
 385                         continue; // it's for some other payer
 386                     } else if ($insnumber == '1') {
 387                         if (preg_match("/\$\s*adjust code (\S+)/i", $rsn, $tmp)) {
 388                             $rcode = $tmp[1]; // from 835
 389                         } else if ($chg) {
 390                             // Other adjustments default to Ins1.
 391                         } else if (preg_match("/Co-pay: (\S+)/i", $rsn, $tmp) ||
 392                         preg_match("/Coinsurance: (\S+)/i", $rsn, $tmp)) {
 393                             $coinsurance = 0 + $tmp[1]; // from 835 before 6/2007
 394                             continue;
 395                         } else if (preg_match("/To deductible: (\S+)/i", $rsn, $tmp)) {
 396                             $deductible = 0 + $tmp[1]; // from 835 before 6/2007
 397                             continue;
 398                         } else {
 399                             continue; // there is no adjustment amount
 400                         }
 401                     } else {
 402                         continue; // it's for primary and that's not us
 403                     }
 404
 405                     if ($rcode == '42') {
 406                         $rcode= '45'; // reason 42 is obsolete
 407                     }
 408
 409                     $aadj[] = array($date, $gcode, $rcode, sprintf('%.2f', $chg));
 410                 } // end if
 411             } // end foreach
 412
 413             // If we really messed it up, at least avoid negative numbers.
 414             if ($coinsurance > $ptresp) {
 415                 $coinsurance = $ptresp;
 416             }
 417
 418             if ($deductible  > $ptresp) {
 419                 $deductible  = $ptresp;
 420             }
 421
 422             // Find out if this payer paid anything at all on this claim.  This will
 423             // help us allocate any unknown patient responsibility amounts.
 424             $thispaidanything = 0;
 425             foreach ($this->invoice as $codekey => $codeval) {
 426                 foreach ($codeval['dtl'] as $key => $value) {
 427                     // plv exists to indicate the payer level.
 428                     if ($value['plv'] == $insnumber) {
 429                         $thispaidanything += $value['pmt'];
 430                     }
 431                 }
 432             }
 433
 434             // Allocate any unknown patient responsibility by guessing if the
 435             // deductible has been satisfied.
 436             if ($thispaidanything) {
 437                 $coinsurance = $ptresp - $deductible;
 438             } else {
 439                 $deductible = $ptresp - $coinsurance;
 440             }
 441
 442             $deductible  = sprintf('%.2f', $deductible);
 443             $coinsurance = sprintf('%.2f', $coinsurance);
 444
 445             if ($date && $deductible != 0) {
 446                 $aadj[] = array($date, 'PR', '1', $deductible, $msp);
 447             }
 448
 449             if ($date && $coinsurance != 0) {
 450                 $aadj[] = array($date, 'PR', '2', $coinsurance, $msp);
 451             }
 452         } // end if
 453
 454         return $aadj;
 455     }
 456
 457   // Return date, total payments and total "hard" adjustments from the given
 458   // prior payer. If $code is specified then only that procedure key is
 459   // selected, otherwise it's for the whole claim.
 460   //
 461     function payerTotals($ins, $code = '')
 462     {
 463         // If we have no modifiers stored in SQL-Ledger for this claim,
 464         // then we cannot use a modifier passed in with the key.
 465         $tmp = strpos($code, ':');
 466         if ($tmp && !$this->using_modifiers) {
 467             $code = substr($code, 0, $tmp);
 468         }
 469
 470         $inslabel = ($this->payerSequence($ins) == 'S') ? 'Ins2' : 'Ins1';
 471         $insnumber = substr($inslabel, 3);
 472         $paytotal = 0;
 473         $adjtotal = 0;
 474         $date = '';
 475         foreach ($this->invoice as $codekey => $codeval) {
 476             if ($code && strcmp($codekey, $code) != 0) {
 477                 continue;
 478             }
 479
 480             foreach ($codeval['dtl'] as $key => $value) {
 481                 // plv (from ar_activity.payer_type) exists to
 482                 // indicate the payer level.
 483                 if ($value['plv'] == $insnumber) {
 484                     if (!$date) {
 485                         $date = str_replace('-', '', trim(substr($key, 0, 10)));
 486                     }
 487
 488                     $paytotal += $value['pmt'];
 489                 }
 490             }
 491
 492             $aarr = $this->payerAdjustments($ins, $codekey);
 493             foreach ($aarr as $a) {
 494                 if (strcmp($a[1], 'PR') != 0) {
 495                     $adjtotal += $a[3];
 496                 }
 497
 498                 if (!$date) {
 499                     $date = $a[0];
 500                 }
 501             }
 502         }
 503
 504         return array($date, sprintf('%.2f', $paytotal), sprintf('%.2f', $adjtotal));
 505     }
 506
 507   // Return the amount already paid by the patient.
 508   //
 509     function patientPaidAmount()
 510     {
 511         // For primary claims $this->invoice is not loaded, so get the co-pay
 512         // from the ar_activity table instead.
 513         if (empty($this->invoice)) {
 514             return $this->copay;
 515         }
 516
 517         //
 518         $amount = 0;
 519         foreach ($this->invoice as $codekey => $codeval) {
 520             foreach ($codeval['dtl'] as $key => $value) {
 521                 // plv exists to indicate the payer level.
 522                 if ($value['plv'] == 0) { // 0 indicates patient
 523                     $amount += $value['pmt'];
 524                 }
 525             }
 526         }
 527
 528         return sprintf('%.2f', $amount);
 529     }
 530
 531   // Return invoice total, including adjustments but not payments.
 532   //
 533     function invoiceTotal()
 534     {
 535         $amount = 0;
 536         foreach ($this->invoice as $codekey => $codeval) {
 537             $amount += $codeval['chg'];
 538         }
 539
 540         return sprintf('%.2f', $amount);
 541     }
 542
 543   // Number of procedures in this claim.
 544     function procCount()
 545     {
 546         return count($this->procs);
 547     }
 548
 549   // Number of payers for this claim. Ranges from 1 to 3.
 550     function payerCount()
 551     {
 552         return count($this->payers);
 553     }
 554
 555     function x12gsversionstring()
 556     {
 557         return x12clean(trim($this->x12_partner['x12_version']));
 558     }
 559
 560     function x12gssenderid()
 561     {
 562         $tmp = $this->x12_partner['x12_sender_id'];
 563         while (strlen($tmp) < 15) {
 564             $tmp .= " ";
 565         }
 566
 567         return $tmp;
 568     }
 569
 570     function x12gs03()
 571     {
 572        /*
 573       * GS03: Application Receiver's Code
 574       * Code Identifying Party Receiving Transmission
 575       *
 576       * In most cases, the ISA08 and GS03 are the same. However
 577       *
 578       * In some clearing houses ISA08 and GS03 are different
 579       * Example: http://www.acs-gcro.com/downloads/DOL/DOL_CG_X12N_5010_837_v1_02.pdf - Page 18
 580       * In this .pdf, the ISA08 is specified to be 100000 while the GS03 is specified to be 77044
 581       *
 582       * Therefore if the x12_gs03 segement is explicitly specified we use that value,
 583       * otherwise we simply use the same receiver ID as specified for ISA03
 584         */
 585         if ($this->x12_partner['x12_gs03'] !== '') {
 586             return $this->x12_partner['x12_gs03'];
 587         } else {
 588             return $this->x12_partner['x12_receiver_id'];
 589         }
 590     }
 591
 592     function x12gsreceiverid()
 593     {
 594         $tmp = $this->x12_partner['x12_receiver_id'];
 595         while (strlen($tmp) < 15) {
 596             $tmp .= " ";
 597         }
 598
 599         return $tmp;
 600     }
 601
 602     function x12gsisa05()
 603     {
 604         return $this->x12_partner['x12_isa05'];
 605     }
 606 //adding in functions for isa 01 - isa 04
 607
 608     function x12gsisa01()
 609     {
 610         return $this->x12_partner['x12_isa01'];
 611     }
 612
 613     function x12gsisa02()
 614     {
 615         return $this->x12_partner['x12_isa02'];
 616     }
 617
 618     function x12gsisa03()
 619     {
 620         return $this->x12_partner['x12_isa03'];
 621     }
 622     function x12gsisa04()
 623     {
 624         return $this->x12_partner['x12_isa04'];
 625     }
 626
 627 /////////
 628     function x12gsisa07()
 629     {
 630         return $this->x12_partner['x12_isa07'];
 631     }
 632
 633     function x12gsisa14()
 634     {
 635         return $this->x12_partner['x12_isa14'];
 636     }
 637
 638     function x12gsisa15()
 639     {
 640         return $this->x12_partner['x12_isa15'];
 641     }
 642
 643     function x12gsgs02()
 644     {
 645         $tmp = $this->x12_partner['x12_gs02'];
 646         if ($tmp === '') {
 647             $tmp = $this->x12_partner['x12_sender_id'];
 648         }
 649
 650         return $tmp;
 651     }
 652
 653     function x12gsper06()
 654     {
 655         return $this->x12_partner['x12_per06'];
 656     }
 657
 658     function cliaCode()
 659     {
 660         return x12clean(trim($this->facility['domain_identifier']));
 661     }
 662
 663     function billingFacilityName()
 664     {
 665         return x12clean(trim($this->billing_facility['name']));
 666     }
 667
 668     function billingFacilityStreet()
 669     {
 670         return x12clean(trim($this->billing_facility['street']));
 671     }
 672
 673     function billingFacilityCity()
 674     {
 675         return x12clean(trim($this->billing_facility['city']));
 676     }
 677
 678     function billingFacilityState()
 679     {
 680         return x12clean(trim($this->billing_facility['state']));
 681     }
 682
 683     function billingFacilityZip()
 684     {
 685         return x12clean(trim($this->billing_facility['postal_code']));
 686     }
 687
 688     function billingFacilityETIN()
 689     {
 690         return x12clean(trim(str_replace('-', '', $this->billing_facility['federal_ein'])));
 691     }
 692
 693     function billingFacilityNPI()
 694     {
 695         return x12clean(trim($this->billing_facility['facility_npi']));
 696     }
 697
 698     function federalIdType()
 699     {
 700         if ($this->billing_facility['tax_id_type']) {
 701             return $this->billing_facility['tax_id_type'];
 702         } else {
 703             return null;
 704         }
 705     }
 706
 707   # The billing facility and the patient must both accept for this to return true.
 708     function billingFacilityAssignment($ins = 0)
 709     {
 710         $tmp = strtoupper($this->payers[$ins]['data']['accept_assignment']);
 711         if (strcmp($tmp, 'FALSE') == 0) {
 712             return '0';
 713         }
 714
 715         return !empty($this->billing_facility['accepts_assignment']);
 716     }
 717
 718     function billingContactName()
 719     {
 720         return x12clean(trim($this->billing_facility['attn']));
 721     }
 722
 723     function billingContactPhone()
 724     {
 725         if (preg_match(
 726             "/([2-9]\d\d)\D*(\d\d\d)\D*(\d\d\d\d)/",
 727             $this->billing_facility['phone'],
 728             $tmp
 729         )) {
 730             return $tmp[1] . $tmp[2] . $tmp[3];
 731         }
 732
 733         return '';
 734     }
 735
 736     function facilityName()
 737     {
 738         return x12clean(trim($this->facility['name']));
 739     }
 740
 741     function facilityStreet()
 742     {
 743         return x12clean(trim($this->facility['street']));
 744     }
 745
 746     function facilityCity()
 747     {
 748         return x12clean(trim($this->facility['city']));
 749     }
 750
 751     function facilityState()
 752     {
 753         return x12clean(trim($this->facility['state']));
 754     }
 755
 756     function facilityZip()
 757     {
 758         return x12clean(trim($this->facility['postal_code']));
 759     }
 760
 761     function facilityETIN()
 762     {
 763         return x12clean(trim(str_replace('-', '', $this->facility['federal_ein'])));
 764     }
 765
 766     function facilityNPI()
 767     {
 768         return x12clean(trim($this->facility['facility_npi']));
 769     }
 770
 771     function facilityPOS()
 772     {
 773         if ($this->encounter['pos_code']) {
 774             return sprintf('%02d', trim($this->encounter['pos_code']));
 775         } else {
 776             return sprintf('%02d', trim($this->facility['pos_code']));
 777         }
 778     }
 779
 780     function clearingHouseName()
 781     {
 782         return x12clean(trim($this->x12_partner['name']));
 783     }
 784
 785     function clearingHouseETIN()
 786     {
 787         return x12clean(trim(str_replace('-', '', $this->x12_partner['id_number'])));
 788     }
 789
 790     function providerNumberType($prockey = -1)
 791     {
 792         $tmp = ($prockey < 0 || empty($this->procs[$prockey]['provider_id'])) ?
 793         $this->insurance_numbers : $this->procs[$prockey]['insurance_numbers'];
 794         return $tmp['provider_number_type'];
 795     }
 796
 797     function providerNumber($prockey = -1)
 798     {
 799         $tmp = ($prockey < 0 || empty($this->procs[$prockey]['provider_id'])) ?
 800         $this->insurance_numbers : $this->procs[$prockey]['insurance_numbers'];
 801         return x12clean(trim(str_replace('-', '', $tmp['provider_number'])));
 802     }
 803
 804     function providerGroupNumber($prockey = -1)
 805     {
 806         $tmp = ($prockey < 0 || empty($this->procs[$prockey]['provider_id'])) ?
 807         $this->insurance_numbers : $this->procs[$prockey]['insurance_numbers'];
 808         return x12clean(trim(str_replace('-', '', $tmp['group_number'])));
 809     }
 810
 811   // Returns 'P', 'S' or 'T'.
 812   //
 813     function payerSequence($ins = 0)
 814     {
 815         return strtoupper(substr($this->payers[$ins]['data']['type'], 0, 1));
 816     }
 817
 818   // Returns the HIPAA code of the patient-to-subscriber relationship.
 819   //
 820     function insuredRelationship($ins = 0)
 821     {
 822         $tmp = strtolower($this->payers[$ins]['data']['subscriber_relationship']);
 823         if (strcmp($tmp, 'self') == 0) {
 824             return '18';
 825         }
 826
 827         if (strcmp($tmp, 'spouse') == 0) {
 828             return '01';
 829         }
 830
 831         if (strcmp($tmp, 'child') == 0) {
 832             return '19';
 833         }
 834
 835         if (strcmp($tmp, 'other') == 0) {
 836             return 'G8';
 837         }
 838
 839         return $tmp; // should not happen
 840     }
 841
 842     function insuredTypeCode($ins = 0)
 843     {
 844         if (strcmp($this->claimType($ins), 'MB') == 0 && $this->payerSequence($ins) != 'P') {
 845             return $this->payers[$ins]['data']['policy_type'];
 846         }
 847
 848         return '';
 849     }
 850
 851   // Is the patient also the subscriber?
 852   //
 853     function isSelfOfInsured($ins = 0)
 854     {
 855         $tmp = strtolower($this->payers[$ins]['data']['subscriber_relationship']);
 856         return (strcmp($tmp, 'self') == 0);
 857     }
 858
 859     function planName($ins = 0)
 860     {
 861         return x12clean(trim($this->payers[$ins]['data']['plan_name']));
 862     }
 863
 864     function policyNumber($ins = 0)
 865     {
 866  // "ID"
 867         return x12clean(trim($this->payers[$ins]['data']['policy_number']));
 868     }
 869
 870     function groupNumber($ins = 0)
 871     {
 872         return x12clean(trim($this->payers[$ins]['data']['group_number']));
 873     }
 874
 875     function groupName($ins = 0)
 876     {
 877         return x12clean(trim($this->payers[$ins]['data']['subscriber_employer']));
 878     }
 879
 880   // Claim types are:
 881   // 16 Other HCFA
 882   // MB Medicare Part B
 883   // MC Medicaid
 884   // CH ChampUSVA
 885   // CH ChampUS
 886   // BL Blue Cross Blue Shield
 887   // 16 FECA
 888   // 09 Self Pay
 889   // 10 Central Certification
 890   // 11 Other Non-Federal Programs
 891   // 12 Preferred Provider Organization (PPO)
 892   // 13 Point of Service (POS)
 893   // 14 Exclusive Provider Organization (EPO)
 894   // 15 Indemnity Insurance
 895   // 16 Health Maintenance Organization (HMO) Medicare Risk
 896   // AM Automobile Medical
 897   // CI Commercial Insurance Co.
 898   // DS Disability
 899   // HM Health Maintenance Organization
 900   // LI Liability
 901   // LM Liability Medical
 902   // OF Other Federal Program
 903   // TV Title V
 904   // VA Veterans Administration Plan
 905   // WC Workers Compensation Health Plan
 906   // ZZ Mutually Defined
 907   //
 908     function claimType($ins = 0)
 909     {
 910         if (empty($this->payers[$ins]['object'])) {
 911             return '';
 912         }
 913
 914         return $this->payers[$ins]['object']->get_ins_claim_type();
 915     }
 916
 917     function claimTypeRaw($ins = 0)
 918     {
 919         if (empty($this->payers[$ins]['object'])) {
 920             return 0;
 921         }
 922
 923         return $this->payers[$ins]['object']->get_ins_type_code();
 924     }
 925
 926     function insuredLastName($ins = 0)
 927     {
 928         return x12clean(trim($this->payers[$ins]['data']['subscriber_lname']));
 929     }
 930
 931     function insuredFirstName($ins = 0)
 932     {
 933         return x12clean(trim($this->payers[$ins]['data']['subscriber_fname']));
 934     }
 935
 936     function insuredMiddleName($ins = 0)
 937     {
 938         return x12clean(trim($this->payers[$ins]['data']['subscriber_mname']));
 939     }
 940
 941     function insuredStreet($ins = 0)
 942     {
 943         return x12clean(trim($this->payers[$ins]['data']['subscriber_street']));
 944     }
 945
 946     function insuredCity($ins = 0)
 947     {
 948         return x12clean(trim($this->payers[$ins]['data']['subscriber_city']));
 949     }
 950
 951     function insuredState($ins = 0)
 952     {
 953         return x12clean(trim($this->payers[$ins]['data']['subscriber_state']));
 954     }
 955
 956     function insuredZip($ins = 0)
 957     {
 958         return x12clean(trim($this->payers[$ins]['data']['subscriber_postal_code']));
 959     }
 960
 961     function insuredPhone($ins = 0)
 962     {
 963         if (preg_match(
 964             "/([2-9]\d\d)\D*(\d\d\d)\D*(\d\d\d\d)/",
 965             $this->payers[$ins]['data']['subscriber_phone'],
 966             $tmp
 967         )) {
 968             return $tmp[1] . $tmp[2] . $tmp[3];
 969         }
 970
 971         return '';
 972     }
 973
 974     function insuredDOB($ins = 0)
 975     {
 976         return str_replace('-', '', $this->payers[$ins]['data']['subscriber_DOB']);
 977     }
 978
 979     function insuredSex($ins = 0)
 980     {
 981         return strtoupper(substr($this->payers[$ins]['data']['subscriber_sex'], 0, 1));
 982     }
 983
 984     function payerName($ins = 0)
 985     {
 986         return x12clean(trim($this->payers[$ins]['company']['name']));
 987     }
 988
 989     function payerAttn($ins = 0)
 990     {
 991         return x12clean(trim($this->payers[$ins]['company']['attn']));
 992     }
 993
 994     function payerStreet($ins = 0)
 995     {
 996         if (empty($this->payers[$ins]['object'])) {
 997             return '';
 998         }
 999
1000         $tmp = $this->payers[$ins]['object'];
1001         $tmp = $tmp->get_address();
1002         return x12clean(trim($tmp->get_line1()));
1003     }
1004
1005     function payerCity($ins = 0)
1006     {
1007         if (empty($this->payers[$ins]['object'])) {
1008             return '';
1009         }
1010
1011         $tmp = $this->payers[$ins]['object'];
1012         $tmp = $tmp->get_address();
1013         return x12clean(trim($tmp->get_city()));
1014     }
1015
1016     function payerState($ins = 0)
1017     {
1018         if (empty($this->payers[$ins]['object'])) {
1019             return '';
1020         }
1021
1022         $tmp = $this->payers[$ins]['object'];
1023         $tmp = $tmp->get_address();
1024         return x12clean(trim($tmp->get_state()));
1025     }
1026
1027     function payerZip($ins = 0)
1028     {
1029         if (empty($this->payers[$ins]['object'])) {
1030             return '';
1031         }
1032
1033         $tmp = $this->payers[$ins]['object'];
1034         $tmp = $tmp->get_address();
1035         return x12clean(trim($tmp->get_zip()));
1036     }
1037
1038     function payerID($ins = 0)
1039     {
1040         return x12clean(trim($this->payers[$ins]['company']['cms_id']));
1041     }
1042
1043     function payerAltID($ins = 0)
1044     {
1045         return x12clean(trim($this->payers[$ins]['company']['alt_cms_id']));
1046     }
1047
1048     function patientLastName()
1049     {
1050         return x12clean(trim($this->patient_data['lname']));
1051     }
1052
1053     function patientFirstName()
1054     {
1055         return x12clean(trim($this->patient_data['fname']));
1056     }
1057
1058     function patientMiddleName()
1059     {
1060         return x12clean(trim($this->patient_data['mname']));
1061     }
1062
1063     function patientStreet()
1064     {
1065         return x12clean(trim($this->patient_data['street']));
1066     }
1067
1068     function patientCity()
1069     {
1070         return x12clean(trim($this->patient_data['city']));
1071     }
1072
1073     function patientState()
1074     {
1075         return x12clean(trim($this->patient_data['state']));
1076     }
1077
1078     function patientZip()
1079     {
1080         return x12clean(trim($this->patient_data['postal_code']));
1081     }
1082
1083     function patientPhone()
1084     {
1085         $ptphone = $this->patient_data['phone_home'];
1086         if (!$ptphone) {
1087             $ptphone = $this->patient_data['phone_biz'];
1088         }
1089
1090         if (!$ptphone) {
1091             $ptphone = $this->patient_data['phone_cell'];
1092         }
1093
1094         if (preg_match("/([2-9]\d\d)\D*(\d\d\d)\D*(\d\d\d\d)/", $ptphone, $tmp)) {
1095             return $tmp[1] . $tmp[2] . $tmp[3];
1096         }
1097
1098         return '';
1099     }
1100
1101     function patientDOB()
1102     {
1103         return str_replace('-', '', $this->patient_data['DOB']);
1104     }
1105
1106     function patientSex()
1107     {
1108         return strtoupper(substr($this->patient_data['sex'], 0, 1));
1109     }
1110
1111   // Patient Marital Status: M = Married, S = Single, or something else.
1112     function patientStatus()
1113     {
1114         return strtoupper(substr($this->patient_data['status'], 0, 1));
1115     }
1116
1117   // This should be UNEMPLOYED, STUDENT, PT STUDENT, or anything else to
1118   // indicate employed.
1119     function patientOccupation()
1120     {
1121         return strtoupper(x12clean(trim($this->patient_data['occupation'])));
1122     }
1123
1124     function cptCode($prockey)
1125     {
1126         return x12clean(trim($this->procs[$prockey]['code']));
1127     }
1128
1129     function cptModifier($prockey)
1130     {
1131         // Split on the colon or space and clean each modifier
1132         $mods = array();
1133         $cln_mods = array();
1134         $mods = preg_split("/[: ]/", trim($this->procs[$prockey]['modifier']));
1135         foreach ($mods as $mod) {
1136             array_push($cln_mods, x12clean($mod));
1137         }
1138
1139         return (implode(':', $cln_mods));
1140     }
1141
1142     function cptNotecodes($prockey)
1143     {
1144         return x12clean(trim($this->procs[$prockey]['notecodes']));
1145     }
1146
1147   // Returns the procedure code, followed by ":modifier" if there is one.
1148     function cptKey($prockey)
1149     {
1150         $tmp = $this->cptModifier($prockey);
1151         return $this->cptCode($prockey) . ($tmp ? ":$tmp" : "");
1152     }
1153
1154     function cptCharges($prockey)
1155     {
1156         return x12clean(trim($this->procs[$prockey]['fee']));
1157     }
1158
1159     function cptUnits($prockey)
1160     {
1161         if (empty($this->procs[$prockey]['units'])) {
1162             return '1';
1163         }
1164
1165         return x12clean(trim($this->procs[$prockey]['units']));
1166     }
1167
1168   // NDC drug ID.
1169     function cptNDCID($prockey)
1170     {
1171         $ndcinfo = $this->procs[$prockey]['ndc_info'];
1172         if (preg_match('/^N4(\S+)\s+(\S\S)(.*)/', $ndcinfo, $tmp)) {
1173             $ndc = $tmp[1];
1174             if (preg_match('/^(\d+)-(\d+)-(\d+)$/', $ndc, $tmp)) {
1175                 return sprintf('%05d%04d%02d', $tmp[1], $tmp[2], $tmp[3]);
1176             }
1177
1178             return x12clean($ndc); // format is bad but return it anyway
1179         }
1180
1181         return '';
1182     }
1183
1184   // NDC drug unit of measure code.
1185     function cptNDCUOM($prockey)
1186     {
1187         $ndcinfo = $this->procs[$prockey]['ndc_info'];
1188         if (preg_match('/^N4(\S+)\s+(\S\S)(.*)/', $ndcinfo, $tmp)) {
1189             return x12clean($tmp[2]);
1190         }
1191
1192         return '';
1193     }
1194
1195   // NDC drug number of units.
1196     function cptNDCQuantity($prockey)
1197     {
1198         $ndcinfo = $this->procs[$prockey]['ndc_info'];
1199         if (preg_match('/^N4(\S+)\s+(\S\S)(.*)/', $ndcinfo, $tmp)) {
1200             return x12clean(ltrim($tmp[3], '0'));
1201         }
1202
1203         return '';
1204     }
1205
1206     function onsetDate()
1207     {
1208         return cleanDate($this->encounter['onset_date']);
1209     }
1210
1211     function onsetDateValid()
1212     {
1213         return $this->onsetDate()!=='';
1214     }
1215
1216     function serviceDate()
1217     {
1218         return str_replace('-', '', substr($this->encounter['date'], 0, 10));
1219     }
1220
1221     function priorAuth()
1222     {
1223         return x12clean(trim($this->billing_options['prior_auth_number']));
1224     }
1225
1226     function isRelatedEmployment()
1227     {
1228         return !empty($this->billing_options['employment_related']);
1229     }
1230
1231     function isRelatedAuto()
1232     {
1233         return !empty($this->billing_options['auto_accident']);
1234     }
1235
1236     function isRelatedOther()
1237     {
1238         return !empty($this->billing_options['other_accident']);
1239     }
1240
1241     function autoAccidentState()
1242     {
1243         return x12clean(trim($this->billing_options['accident_state']));
1244     }
1245
1246     function isUnableToWork()
1247     {
1248         return !empty($this->billing_options['is_unable_to_work']);
1249     }
1250
1251     function offWorkFrom()
1252     {
1253         return cleanDate($this->billing_options['off_work_from']);
1254     }
1255
1256     function offWorkTo()
1257     {
1258         return cleanDate($this->billing_options['off_work_to']);
1259     }
1260
1261     function isHospitalized()
1262     {
1263         return !empty($this->billing_options['is_hospitalized']);
1264     }
1265
1266     function hospitalizedFrom()
1267     {
1268         return cleanDate($this->billing_options['hospitalization_date_from']);
1269     }
1270
1271     function hospitalizedFromDateValid()
1272     {
1273         return $this->hospitalizedFrom()!=='';
1274     }
1275
1276     function hospitalizedTo()
1277     {
1278         return cleanDate($this->billing_options['hospitalization_date_to']);
1279     }
1280     function hospitalizedToDateValid()
1281     {
1282         return $this->hospitalizedTo()!=='';
1283     }
1284
1285     function isOutsideLab()
1286     {
1287         return !empty($this->billing_options['outside_lab']);
1288     }
1289
1290     function outsideLabAmount()
1291     {
1292         return sprintf('%.2f', 0 + $this->billing_options['lab_amount']);
1293     }
1294
1295     function medicaidReferralCode()
1296     {
1297         return x12clean(trim($this->billing_options['medicaid_referral_code']));
1298     }
1299
1300     function epsdtFlag()
1301     {
1302         return x12clean(trim($this->billing_options['epsdt_flag']));
1303     }
1304
1305     function medicaidResubmissionCode()
1306     {
1307         return x12clean(trim($this->billing_options['medicaid_resubmission_code']));
1308     }
1309
1310     function medicaidOriginalReference()
1311     {
1312         return x12clean(trim($this->billing_options['medicaid_original_reference']));
1313     }
1314
1315     function frequencyTypeCode()
1316     {
1317         return ($this->billing_options['replacement_claim'] == 1) ? '7' : '1';
1318     }
1319
1320     function icnResubmissionNumber()
1321     {
1322         return x12clean($this->billing_options['icn_resubmission_number']);
1323     }
1324
1325     function additionalNotes()
1326     {
1327         return x12clean(trim($this->billing_options['comments']));
1328     }
1329
1330     function miscOnsetDate()
1331     {
1332         return cleanDate($this->billing_options['onset_date']);
1333     }
1334
1335     function miscOnsetDateValid()
1336     {
1337         return $this->miscOnsetDate()!=='';
1338     }
1339
1340     function dateInitialTreatment()
1341     {
1342         return cleanDate($this->billing_options['date_initial_treatment']);
1343     }
1344
1345     function dateInitialTreatmentValid()
1346     {
1347         return $this->dateInitialTreatment()!=='';
1348     }
1349
1350     function box14Qualifier()
1351     {
1352         // If no box qualifier specified use "431" indicating Onset
1353         return empty($this->billing_options['box_14_date_qual']) ? '431' :
1354               $this->billing_options['box_14_date_qual'];
1355     }
1356
1357     function box15Qualifier()
1358     {
1359         // If no box qualifier specified use "454" indicating Initial Treatment
1360         return empty($this->billing_options['box_15_date_qual']) ? '454' :
1361               $this->billing_options['box_15_date_qual'];
1362     }
1363   // Returns an array of unique diagnoses.  Periods are stripped by default
1364   // Option to keep periods is to support HCFA 1500 02/12 version
1365     function diagArray($strip_periods = true)
1366     {
1367         $da = array();
1368         foreach ($this->procs as $row) {
1369             $atmp = explode(':', $row['justify']);
1370             foreach ($atmp as $tmp) {
1371                 if (!empty($tmp)) {
1372                     $code_data = explode('|', $tmp);
1373
1374                     // If there was a | in the code data, the the first part of the array is the type, and the second is the identifier
1375                     if (!empty($code_data[1])) {
1376                         // This is the simplest way to determine if the claim is using ICD9 or ICD10 codes
1377                         // a mix of code types is generally not allowed as there is only one specifier for all diagnoses on HCFA-1500 form
1378                         // and there would be ambiguity with E and V codes
1379                         $this->diagtype=$code_data[0];
1380
1381                         //code is in the second part of the $code_data array.
1382                         if ($strip_periods==true) {
1383                                 $diag = str_replace('.', '', $code_data[1]);
1384                         } else {
1385                             $diag=$code_data[1];
1386                         }
1387                     } else {
1388                         //No prepended code type label
1389                         if ($strip_periods) {
1390                             $diag = str_replace('.', '', $code_data[0]);
1391                         } else {
1392                             $diag=$code_data[0];
1393                         }
1394                     }
1395
1396                     $da[$diag] = $diag;
1397                 }
1398             }
1399         }
1400
1401         // The above got all the diagnoses used for justification, in the order
1402         // used for justification.  Next we go through all diagnoses, justified
1403         // or not, to make sure they all get into the claim.  We do it this way
1404         // so that the more important diagnoses appear first.
1405         foreach ($this->diags as $diag) {
1406             if ($strip_periods) {
1407                 $diag = str_replace('.', '', $diag);
1408             }
1409
1410             $da[$diag] = $diag;
1411         }
1412
1413         return $da;
1414     }
1415
1416   // Compute one 1-relative index in diagArray for the given procedure.
1417   // This function is obsolete, use diagIndexArray() instead.
1418     function diagIndex($prockey)
1419     {
1420         $da = $this->diagArray();
1421         $tmp = explode(':', $this->procs[$prockey]['justify']);
1422         if (empty($tmp)) {
1423             return '';
1424         }
1425
1426         $diag = str_replace('.', '', $tmp[0]);
1427         $i = 0;
1428         foreach ($da as $value) {
1429             ++$i;
1430             if (strcmp($value, $diag) == 0) {
1431                 return $i;
1432             }
1433         }
1434
1435         return '';
1436     }
1437
1438   // Compute array of 1-relative diagArray indices for the given procedure.
1439     function diagIndexArray($prockey)
1440     {
1441         $dia = array();
1442         $da = $this->diagArray();
1443         $atmp = explode(':', $this->procs[$prockey]['justify']);
1444         foreach ($atmp as $tmp) {
1445             if (!empty($tmp)) {
1446                 $code_data = explode('|', $tmp);
1447                 if (!empty($code_data[1])) {
1448                     //Strip the prepended code type label
1449                     $diag = str_replace('.', '', $code_data[1]);
1450                 } else {
1451                     //No prepended code type label
1452                     $diag = str_replace('.', '', $code_data[0]);
1453                 }
1454
1455                 $i = 0;
1456                 foreach ($da as $value) {
1457                     ++$i;
1458                     if (strcmp($value, $diag) == 0) {
1459                         $dia[] = $i;
1460                     }
1461                 }
1462             }
1463         }
1464
1465         return $dia;
1466     }
1467
1468     function providerLastName($prockey = -1)
1469     {
1470         $tmp = ($prockey < 0 || empty($this->procs[$prockey]['provider_id'])) ?
1471         $this->provider : $this->procs[$prockey]['provider'];
1472         return x12clean(trim($tmp['lname']));
1473     }
1474
1475     function providerFirstName($prockey = -1)
1476     {
1477         $tmp = ($prockey < 0 || empty($this->procs[$prockey]['provider_id'])) ?
1478         $this->provider : $this->procs[$prockey]['provider'];
1479         return x12clean(trim($tmp['fname']));
1480     }
1481
1482     function providerMiddleName($prockey = -1)
1483     {
1484         $tmp = ($prockey < 0 || empty($this->procs[$prockey]['provider_id'])) ?
1485         $this->provider : $this->procs[$prockey]['provider'];
1486         return x12clean(trim($tmp['mname']));
1487     }
1488
1489     function providerNPI($prockey = -1)
1490     {
1491         $tmp = ($prockey < 0 || empty($this->procs[$prockey]['provider_id'])) ?
1492         $this->provider : $this->procs[$prockey]['provider'];
1493         return x12clean(trim($tmp['npi']));
1494     }
1495
1496     function NPIValid($npi)
1497     {
1498         // A NPI MUST be a 10 digit number
1499         if ($npi==='') {
1500             return false;
1501         }
1502
1503         if (strlen($npi)!=10) {
1504             return false;
1505         }
1506
1507         if (!preg_match("/[0-9]*/", $npi)) {
1508             return false;
1509         }
1510
1511         return true;
1512     }
1513     function providerNPIValid($prockey = -1)
1514     {
1515         return $this->NPIValid($this->providerNPI($prockey));
1516     }
1517
1518     function providerUPIN($prockey = -1)
1519     {
1520         $tmp = ($prockey < 0 || empty($this->procs[$prockey]['provider_id'])) ?
1521         $this->provider : $this->procs[$prockey]['provider'];
1522         return x12clean(trim($tmp['upin']));
1523     }
1524
1525     function providerSSN($prockey = -1)
1526     {
1527         $tmp = ($prockey < 0 || empty($this->procs[$prockey]['provider_id'])) ?
1528         $this->provider : $this->procs[$prockey]['provider'];
1529         return x12clean(trim(str_replace('-', '', $tmp['federaltaxid'])));
1530     }
1531
1532     function providerTaxonomy($prockey = -1)
1533     {
1534         $tmp = ($prockey < 0 || empty($this->procs[$prockey]['provider_id'])) ?
1535         $this->provider : $this->procs[$prockey]['provider'];
1536         if (empty($tmp['taxonomy'])) {
1537             return '207Q00000X';
1538         }
1539
1540         return x12clean(trim($tmp['taxonomy']));
1541     }
1542
1543     function referrerLastName()
1544     {
1545         return x12clean(trim($this->referrer['lname']));
1546     }
1547
1548     function referrerFirstName()
1549     {
1550         return x12clean(trim($this->referrer['fname']));
1551     }
1552
1553     function referrerMiddleName()
1554     {
1555         return x12clean(trim($this->referrer['mname']));
1556     }
1557
1558     function referrerNPI()
1559     {
1560         return x12clean(trim($this->referrer['npi']));
1561     }
1562
1563     function referrerUPIN()
1564     {
1565         return x12clean(trim($this->referrer['upin']));
1566     }
1567
1568     function referrerSSN()
1569     {
1570         return x12clean(trim(str_replace('-', '', $this->referrer['federaltaxid'])));
1571     }
1572
1573     function referrerTaxonomy()
1574     {
1575         if (empty($this->referrer['taxonomy'])) {
1576             return '207Q00000X';
1577         }
1578
1579         return x12clean(trim($this->referrer['taxonomy']));
1580     }
1581
1582     function supervisorLastName()
1583     {
1584         return x12clean(trim($this->supervisor['lname']));
1585     }
1586
1587     function supervisorFirstName()
1588     {
1589         return x12clean(trim($this->supervisor['fname']));
1590     }
1591
1592     function supervisorMiddleName()
1593     {
1594         return x12clean(trim($this->supervisor['mname']));
1595     }
1596
1597     function supervisorNPI()
1598     {
1599         return x12clean(trim($this->supervisor['npi']));
1600     }
1601
1602     function supervisorUPIN()
1603     {
1604         return x12clean(trim($this->supervisor['upin']));
1605     }
1606
1607     function supervisorSSN()
1608     {
1609         return x12clean(trim(str_replace('-', '', $this->supervisor['federaltaxid'])));
1610     }
1611
1612     function supervisorTaxonomy()
1613     {
1614         if (empty($this->supervisor['taxonomy'])) {
1615             return '207Q00000X';
1616         }
1617
1618         return x12clean(trim($this->supervisor['taxonomy']));
1619     }
1620
1621     function supervisorNumberType()
1622     {
1623         return $this->supervisor_numbers['provider_number_type'];
1624     }
1625
1626     function supervisorNumber()
1627     {
1628         return x12clean(trim(str_replace('-', '', $this->supervisor_numbers['provider_number'])));
1629     }
1630
1631     function billingProviderLastName()
1632     {
1633         return x12clean(trim($this->billing_prov_id['lname']));
1634     }
1635
1636     function billingProviderFirstName()
1637     {
1638         return x12clean(trim($this->billing_prov_id['fname']));
1639     }
1640
1641     function billingProviderMiddleName()
1642     {
1643         return x12clean(trim($this->billing_prov_id['mname']));
1644     }
1645
1646     function billingProviderNPI()
1647     {
1648         return x12clean(trim($this->billing_prov_id['npi']));
1649     }
1650
1651     function billingProviderUPIN()
1652     {
1653         return x12clean(trim($this->billing_prov_id['upin']));
1654     }
1655
1656     function billingProviderSSN()
1657     {
1658         return x12clean(trim(str_replace('-', '', $this->billing_prov_id['federaltaxid'])));
1659     }
1660
1661     function billingProviderTaxonomy()
1662     {
1663         if (empty($this->billing_prov_id['taxonomy'])) {
1664             return '207Q00000X';
1665         }
1666
1667         return x12clean(trim($this->billing_prov_id['taxonomy']));
1668     }
1669 }