library/gen_x12_837.inc.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("Claim.class.php");
  10 function stripZipCode($zip)
  11 {
  12     return preg_replace('/[-\s]*/', '', $zip);
  13 }
  14 function gen_x12_837($pid, $encounter, &$log, $encounter_claim = false)
  15 {
  16
  17     $today = time();
  18     $out = '';
  19     $claim = new Claim($pid, $encounter);
  20     $edicount = 0;
  21
  22   // This is true for the 5010 standard, false for 4010.
  23   // x12gsversionstring() should be "005010X222A1" or "004010X098A1".
  24     $CMS_5010 = strpos($claim->x12gsversionstring(), '5010') !== false;
  25
  26     $log .= "Generating claim $pid-$encounter for " .
  27     $claim->patientFirstName()  . ' ' .
  28     $claim->patientMiddleName() . ' ' .
  29     $claim->patientLastName()   . ' on ' .
  30     date('Y-m-d H:i', $today) . ".\n";
  31
  32     $out .= "ISA" .
  33     "*" . $claim->x12gsisa01() .
  34     "*" . $claim->x12gsisa02() .
  35     "*" . $claim->x12gsisa03() .
  36     "*" . $claim->x12gsisa04() .
  37     "*" . $claim->x12gsisa05() .
  38     "*" . $claim->x12gssenderid() .
  39     "*" . $claim->x12gsisa07() .
  40     "*" . $claim->x12gsreceiverid() .
  41     "*030911" .
  42     "*1630" .
  43     "*" . ($CMS_5010 ? "^"     : "U"    ) .
  44     "*" . ($CMS_5010 ? "00501" : "00401") .
  45     "*000000001" .
  46     "*" . $claim->x12gsisa14() .
  47     "*" . $claim->x12gsisa15() .
  48     "*:" .
  49     "~\n";
  50
  51     $out .= "GS" .
  52     "*HC" .
  53     "*" . $claim->x12gsgs02() .
  54     "*" . trim($claim->x12gs03()) .
  55     "*" . date('Ymd', $today) .
  56     "*" . date('Hi', $today) .
  57     "*1" .
  58     "*X" .
  59     "*" . $claim->x12gsversionstring() .
  60     "~\n";
  61
  62     ++$edicount;
  63     $out .= "ST" .
  64     "*837" .
  65     "*0021" .
  66     // Spec says the following is optional, so should be able to leave it out.
  67     ($CMS_5010 ? ("*" . $claim->x12gsversionstring()) : "") .
  68     "~\n";
  69
  70     ++$edicount;
  71     $out .= "BHT" .
  72     "*0019" .                             // 0019 is required here
  73     "*00" .                               // 00 = original transmission
  74     "*0123" .                             // reference identification
  75     "*" . date('Ymd', $today) .           // transaction creation date
  76     "*" . date('Hi', $today) .            // transaction creation time
  77     ($encounter_claim ? "*RP" : "*CH") .  // RP = reporting, CH = chargeable
  78     "~\n";
  79
  80     if (!$CMS_5010) {
  81         // This segment was deleted for 5010.
  82         ++$edicount;
  83         $out .= "REF" .
  84         "*87" .
  85         "*" . $claim->x12gsversionstring() .
  86         "~\n";
  87     }
  88
  89     ++$edicount;
  90
  91     if ($claim->federalIdType() == "SY") { // check entity type for NM*102 1 == person, 2 == non-person entity
  92         $tempName = $claim->billingFacilityName();
  93         $partsName = explode(' ', $tempName);// Loop 1000A submitter entity == person
  94         $num_parts = count($partsName);
  95         switch ($num_parts) {
  96             case "2":
  97                 $firstName = $partsName[0];
  98                 $middleName = '';
  99                 $lastName = $partsName[1];
 100                 $suffixName = '';
 101                 break;
 102             case "3":
 103                 $firstName = $partsName[0];
 104                 $middleName = $partsName[1];
 105                 $lastName = $partsName[2];
 106                 $suffixName = '';
 107                 break;
 108             case "4":
 109                 $firstName = $partsName[0];
 110                 $middleName = $partsName[1];
 111                 $lastName = $partsName[2];
 112                 $suffixName = $partsName[3];
 113                 break;
 114             default:
 115                 $log .= "*** submitter name in 1000A loop has more than 4 parts, may not be desirable\n";
 116                 $firstName = $partsName[0];
 117                 $middleName = $partsName[1];
 118                 $lastName = $partsName[2];
 119                 $suffixName = $partsName[3];
 120         }
 121
 122         $out .= "NM1" . // Loop 1000A Submitter
 123         "*41" .
 124         "*1" .
 125         "*" . $lastName .
 126         "*" . $firstName .
 127         "*" . $middleName .
 128         "*" . // Name Prefix not used
 129         "*" . // Name Suffix not used
 130         "*46";
 131     } else {    //Field length is limited to 35. See nucc dataset page 63 www.nucc.org
 132         $billingFacilityName = substr($claim->billingFacilityName(), 0, $CMS_5010 ? 60 : 35);
 133         if ($billingFacilityName == '') {
 134             $log .= "*** billing facility name in 1000A loop is empty\n";
 135         }
 136
 137         $out .= "NM1" .
 138         "*41" .
 139         "*2" .
 140         "*" . $billingFacilityName .
 141         "*" .
 142         "*" .
 143         "*" .
 144         "*" .
 145         "*46";
 146     }
 147
 148     if (trim($claim->x12gsreceiverid()) == '470819582') { // if ECLAIMS EDI
 149         $out  .=  "*" . $claim->clearingHouseETIN();
 150     } else {
 151         $out  .=  "*" . $claim->billingFacilityETIN();
 152     }
 153
 154     $out .= "~\n";
 155
 156     ++$edicount;
 157     $out .= "PER" .
 158     "*IC" .
 159     "*" . $claim->billingContactName() .
 160     "*TE" .
 161     "*" . $claim->billingContactPhone();
 162     if (!$CMS_5010 && $claim->x12gsper06()) {
 163         $out .= "*ED*" . $claim->x12gsper06();
 164     }
 165
 166     $out .= "~\n";
 167
 168     ++$edicount;
 169     $out .= "NM1" .       // Loop 1000B Receiver
 170     "*40" .
 171     "*2" .
 172     "*" . $claim->clearingHouseName() .
 173     "*" .
 174     "*" .
 175     "*" .
 176     "*" .
 177     "*46" .
 178     "*" . $claim->clearingHouseETIN() .
 179     "~\n";
 180
 181     $HLcount = 1;
 182
 183     ++$edicount;
 184     $out .= "HL" .        // Loop 2000A Billing/Pay-To Provider HL Loop
 185     "*$HLcount" .
 186     "*" .
 187     "*20" .
 188     "*1" .              // 1 indicates there are child segments
 189     "~\n";
 190
 191     $HLBillingPayToProvider = $HLcount++;
 192
 193   // Situational PRV segment for provider taxonomy code for Medicaid.
 194     if ($claim->claimType() == 'MC') {
 195         ++$edicount;
 196         $out .= "PRV*BI*ZZ" .
 197         "*" . $claim->providerTaxonomy() .
 198         "~\n";
 199     }
 200
 201   // Situational CUR segment (foreign currency information) omitted here.
 202
 203     ++$edicount;
 204   //Field length is limited to 35. See nucc dataset page 63 www.nucc.org
 205     if ($claim->federalIdType() == "SY") { // check for entity type like in 1000A
 206         $tempName = $claim->billingFacilityName();
 207         $partsName = explode(' ', $tempName);// Loop 2010AA Billing Provider entity == person
 208         $num_parts = count($partsName);
 209         switch ($num_parts) {
 210             case "2":
 211                 $firstName = $partsName[0];
 212                 $middleName = '';
 213                 $lastName = $partsName[1];
 214                 $suffixName = '';
 215                 break;
 216             case "3":
 217                 $firstName = $partsName[0];
 218                 $middleName = $partsName[1];
 219                 $lastName = $partsName[2];
 220                 $suffixName = '';
 221                 break;
 222             case "4":
 223                 $firstName = $partsName[0];
 224                 $middleName = $partsName[1];
 225                 $lastName = $partsName[2];
 226                 $suffixName = $partsName[3];
 227                 break;
 228             default:
 229                 $log .= "*** billing provider name in 2010AA loop has more than 4 parts, may not be desirable\n";
 230                 $firstName = $partsName[0];
 231                 $middleName = $partsName[1];
 232                 $lastName = $partsName[2];
 233                 $suffixName = $partsName[3];
 234         }
 235
 236         $out .= "NM1" .
 237         "*85" .
 238         "*1" .
 239         "*" . $lastName .
 240         "*" . $firstName .
 241         "*" . $middleName .
 242         "*" . // Name Prefix not used
 243         "*" . $suffixName;
 244     } else {
 245         $billingFacilityName = substr($claim->billingFacilityName(), 0, $CMS_5010 ? 60 : 35);
 246         if ($billingFacilityName == '') {
 247             $log .= "*** billing facility name in 2010A loop is empty\n";
 248         }
 249
 250         $out .= "NM1" . // Loop 2010AA Billing Provider
 251         "*85" .
 252         "*2" .
 253         "*" . $billingFacilityName .
 254         "*" .
 255         "*" .
 256         "*" .
 257         "*";
 258     }
 259
 260     if ($claim->billingFacilityNPI()) {
 261         $out .= "*XX*" . $claim->billingFacilityNPI();
 262     } else {
 263         $log .= "*** Billing facility has no NPI.\n";
 264         if ($CMS_5010) {
 265             $out .= "*XX*";
 266         } else {
 267             $out .= "*24*" . $claim->billingFacilityETIN();
 268         }
 269     }
 270
 271     $out .= "~\n";
 272
 273     ++$edicount;
 274     $out .= "N3" .
 275     "*" . $claim->billingFacilityStreet() .
 276     "~\n";
 277
 278     ++$edicount;
 279     $out .= "N4" .
 280     "*" . $claim->billingFacilityCity() .
 281     "*" . $claim->billingFacilityState() .
 282     "*" . stripZipCode($claim->billingFacilityZip()) .
 283     "~\n";
 284
 285     if ($CMS_5010 || ($claim->billingFacilityNPI() && $claim->billingFacilityETIN())) {
 286         ++$edicount;
 287         $out .= "REF" ;
 288         if ($claim->federalIdType()) {
 289             $out .= "*" . $claim->federalIdType();
 290         } else {
 291             $out .= "*EI"; // For dealing with the situation before adding TaxId type In facility.
 292         }
 293
 294         $out .=  "*" . $claim->billingFacilityETIN() .
 295         "~\n";
 296     }
 297
 298     if ($claim->providerNumberType() && $claim->providerNumber() &&
 299       !($CMS_5010 && $claim->billingFacilityNPI())) {
 300         ++$edicount;
 301         $out .= "REF" .
 302         "*" . $claim->providerNumberType() .
 303         "*" . $claim->providerNumber() .
 304         "~\n";
 305     } else if ($claim->providerNumber() && !$claim->providerNumberType()) {
 306         $log .= "*** Payer-specific provider insurance number is present but has no type assigned.\n";
 307     }
 308
 309   // Situational PER*1C segment omitted.
 310
 311   // Pay-To Address defaults to billing provider and is no longer required in 5010.
 312     if (!$CMS_5010) {
 313         ++$edicount;
 314         // Field length is limited to 35. See nucc dataset page 63 www.nucc.org
 315         $billingFacilityName = substr($claim->billingFacilityName(), 0, $CMS_5010 ? 60 : 35);
 316         $out .= "NM1" .       // Loop 2010AB Pay-To Provider
 317         "*87" .
 318         "*2" .
 319         "*" . $billingFacilityName .
 320         "*" .
 321         "*" .
 322         "*" .
 323         "*";
 324         if ($claim->billingFacilityNPI()) {
 325             $out .= "*XX*" . $claim->billingFacilityNPI();
 326         } else {
 327             $out .= "*24*" . $claim->billingFacilityETIN();
 328         }
 329
 330         $out .= "~\n";
 331
 332         ++$edicount;
 333         $out .= "N3" .
 334         "*" . $claim->billingFacilityStreet() .
 335         "~\n";
 336
 337         ++$edicount;
 338         $out .= "N4" .
 339         "*" . $claim->billingFacilityCity() .
 340         "*" . $claim->billingFacilityState() .
 341         "*" . stripZipCode($claim->billingFacilityZip()) .
 342         "~\n";
 343
 344         if ($claim->billingFacilityNPI() && $claim->billingFacilityETIN()) {
 345             ++$edicount;
 346             $out .= "REF" .
 347             "*EI" .
 348             "*" . $claim->billingFacilityETIN() .
 349             "~\n";
 350         }
 351     }
 352
 353   // Loop 2010AC Pay-To Plan Name omitted.  Includes:
 354   // NM1*PE, N3, N4, REF*2U, REF*EI
 355
 356     $PatientHL = $claim->isSelfOfInsured() ? 0 : 1;
 357     $HLSubscriber = $HLcount++;
 358
 359     ++$edicount;
 360     $out .= "HL" .        // Loop 2000B Subscriber HL Loop
 361     "*$HLSubscriber" .
 362     "*$HLBillingPayToProvider" .
 363     "*22" .
 364     "*$PatientHL" .
 365     "~\n";
 366
 367     if (!$claim->payerSequence()) {
 368         $log .= "*** Error: Insurance information is missing!\n";
 369     }
 370
 371     ++$edicount;
 372     $out .= "SBR" .       // Subscriber Information
 373     "*" . $claim->payerSequence() .
 374     "*" . ($claim->isSelfOfInsured() ? '18' : '') .
 375     "*" . $claim->groupNumber() .
 376     "*" . (($CMS_5010 && $claim->groupNumber()) ? '' : $claim->groupName()) .
 377     "*" . $claim->insuredTypeCode() . // applies for secondary medicare
 378     "*" .
 379     "*" .
 380     "*" .
 381     "*" . $claim->claimType() . // Zirmed replaces this
 382     "~\n";
 383
 384   // Segment PAT omitted.
 385
 386     ++$edicount;
 387     $out .= "NM1" .       // Loop 2010BA Subscriber
 388     "*IL" .
 389     "*1" . // 1 = person, 2 = non-person
 390     "*" . $claim->insuredLastName() .
 391     "*" . $claim->insuredFirstName() .
 392     "*" . $claim->insuredMiddleName() .
 393     "*" .
 394     "*" . // Name Suffix
 395     "*MI" .
 396     // "MI" = Member Identification Number
 397     // "II" = Standard Unique Health Identifier, "Required if the
 398     //        HIPAA Individual Patient Identifier is mandated use."
 399     //        Here we presume that is not true yet.
 400     "*" . $claim->policyNumber() .
 401     "~\n";
 402
 403   // For 5010, further subscriber info is sent only if they are the patient.
 404     if (!$CMS_5010 || $claim->isSelfOfInsured()) {
 405         ++$edicount;
 406         $out .= "N3" .
 407         "*" . $claim->insuredStreet() .
 408         "~\n";
 409
 410         ++$edicount;
 411         $out .= "N4" .
 412         "*" . $claim->insuredCity() .
 413         "*" . $claim->insuredState() .
 414         "*" . stripZipCode($claim->insuredZip()) .
 415         "~\n";
 416
 417         ++$edicount;
 418         $out .= "DMG" .
 419         "*D8" .
 420         "*" . $claim->insuredDOB() .
 421         "*" . $claim->insuredSex() .
 422         "~\n";
 423     }
 424
 425   // Segment REF*SY (Subscriber Secondary Identification) omitted.
 426   // Segment REF*Y4 (Property and Casualty Claim Number) omitted.
 427   // Segment PER*IC (Property and Casualty Subscriber Contact Information) omitted.
 428
 429     ++$edicount;
 430   //Field length is limited to 35. See nucc dataset page 81 www.nucc.org
 431     $payerName = substr($claim->payerName(), 0, $CMS_5010 ? 60 : 35);
 432     $out .= "NM1" .       // Loop 2010BB Payer
 433     "*PR" .
 434     "*2" .
 435     "*" . $payerName .
 436     "*" .
 437     "*" .
 438     "*" .
 439     "*" .
 440     // The 5010 spec says:
 441     // "On or after the mandated implementation date for the HIPAA
 442     // National Plan Identifier (National Plan ID), XV must be sent.
 443     // Prior to the mandated implementation date and prior to any phase-
 444     // in period identified by Federal regulation, PI must be sent."
 445     // *************** Anybody know what that date is? ***************
 446     //    August 2011 - Publish interim final rule
 447 //    October 1, 2012-March 31, 2013 - Enumeration
 448 //    April 1, 2013-September 30, 2013 - Testing
 449  //   October 1, 2013 - Implementation
 450
 451     "*PI" .
 452     // Zirmed ignores this if using payer name matching:
 453     "*" . ($encounter_claim ? $claim->payerAltID() : $claim->payerID()) .
 454     "~\n";
 455
 456   // if (!$claim->payerID()) {
 457   //   $log .= "*** CMS ID is missing for payer '" . $claim->payerName() . "'.\n";
 458   // }
 459
 460     if (true) { // !$CMS_5010
 461         // The 5010 spec says:
 462         // "Required when the payer address is available and the submitter intends
 463         // for the claim to be printed on paper at the next EDI location (for example, a
 464         // clearinghouse). If not required by this implementation guide, do not send."
 465
 466         ++$edicount;
 467         $out .= "N3" .
 468         "*" . $claim->payerStreet() .
 469         "~\n";
 470
 471         ++$edicount;
 472         $out .= "N4" .
 473         "*" . $claim->payerCity() .
 474         "*" . $claim->payerState() .
 475         "*" . stripZipCode($claim->payerZip()) .
 476         "~\n";
 477     }
 478
 479   // Segment REF (Payer Secondary Identification) omitted.
 480   // Segment REF (Billing Provider Secondary Identification) omitted.
 481
 482     if (! $claim->isSelfOfInsured()) {
 483         ++$edicount;
 484         $out .= "HL" .        // Loop 2000C Patient Information
 485         "*$HLcount" .
 486         "*$HLSubscriber" .
 487         "*23" .
 488         "*0" .
 489         "~\n";
 490
 491         $HLcount++;
 492
 493         ++$edicount;
 494         $out .= "PAT" .
 495         "*" . $claim->insuredRelationship() .
 496         "~\n";
 497
 498         ++$edicount;
 499         $out .= "NM1" .       // Loop 2010CA Patient
 500         "*QC" .
 501         "*1" .
 502         "*" . $claim->patientLastName() .
 503         "*" . $claim->patientFirstName();
 504         if ($claim->patientMiddleName() !== '') {
 505             $out .= "*"
 506             . $claim->patientMiddleName();
 507         }
 508
 509         $out .= "~\n";
 510
 511         ++$edicount;
 512         $out .= "N3" .
 513         "*" . $claim->patientStreet() .
 514         "~\n";
 515
 516         ++$edicount;
 517         $out .= "N4" .
 518         "*" . $claim->patientCity() .
 519         "*" . $claim->patientState() .
 520         "*" . stripZipCode($claim->patientZip()) .
 521         "~\n";
 522
 523         ++$edicount;
 524         $out .= "DMG" .
 525         "*D8" .
 526         "*" . $claim->patientDOB() .
 527         "*" . $claim->patientSex() .
 528         "~\n";
 529
 530         // Segment REF*Y4 (Property and Casualty Claim Number) omitted.
 531         // Segment REF (Property and Casualty Patient Identifier) omitted.
 532         // Segment PER (Property and Casualty Patient Contact Information) omitted.
 533     } // end of patient different from insured
 534
 535     $proccount = $claim->procCount();
 536
 537     $clm_total_charges = 0;
 538     for ($prockey = 0; $prockey < $proccount; ++$prockey) {
 539         $clm_total_charges += $claim->cptCharges($prockey);
 540     }
 541
 542     if (!$clm_total_charges) {
 543         $log .= "*** This claim has no charges!\n";
 544     }
 545
 546     ++$edicount;
 547     $out .= "CLM" .       // Loop 2300 Claim
 548     "*$pid-$encounter" .
 549     "*"  . sprintf("%.2f", $clm_total_charges) . // Zirmed computes and replaces this
 550     "*"  .
 551     "*"  .
 552     "*"  . sprintf('%02d', $claim->facilityPOS()) . ":" .
 553            ($CMS_5010 ? "B" : "") . ":" .
 554            $claim->frequencyTypeCode() . // Changed to correct single digit output
 555     "*Y" .
 556     "*A" .
 557     "*"  . ($claim->billingFacilityAssignment() ? 'Y' : 'N') .
 558     "*Y" .
 559     ($CMS_5010 ? "" : "*C") .
 560     "~\n";
 561
 562     if ($claim->onsetDate() &&
 563       ($claim->onsetDate()!== $claim->serviceDate()) &&
 564       ($claim->onsetDateValid())
 565      ) {
 566         ++$edicount;
 567         $out .= "DTP" .       // Date of Onset
 568         "*431" .
 569         "*D8" .
 570         "*" . $claim->onsetDate() .
 571         "~\n";
 572     }
 573
 574   // above is for historical use of encounter onset date, now in misc_billing_options
 575   // Segment DTP*431 (Onset of Current Symptoms or Illness)
 576   // Segment DTP*484 (Last Menstrual Period Date)
 577
 578     if ($claim->miscOnsetDate() &&
 579       ($claim->box14Qualifier()) &&
 580       ($claim->miscOnsetDateValid())) {
 581         ++$edicount;
 582         $out .= "DTP" .       // Date Last Seen
 583         "*" . $claim->box14Qualifier() .
 584         "*D8" .
 585         "*" . $claim->miscOnsetDate() .
 586         "~\n";
 587     }
 588
 589   // Segment DTP*454 (Initial Treatment Date)
 590   // Segment DTP*304 (Last Seen Date)
 591   // Segment DTP*453 (Acute Manifestation Date)
 592   // Segment DTP*439 (Accident Date)
 593   // Segment DTP*455 (Last X-Ray Date)
 594   // Segment DTP*471 (Hearing and Vision Prescription Date)
 595   // Segment DTP*314 (Disability) omitted.
 596   // Segment DTP*360 (Initial Disability Period Start) omitted.
 597   // Segment DTP*361 (Initial Disability Period End) omitted.
 598   // Segment DTP*297 (Last Worked Date)
 599   // Segment DTP*296 (Authorized Return to Work Date)
 600
 601     if ($claim->dateInitialTreatment() &&
 602       ($claim->box15Qualifier()) &&
 603       ($claim->dateInitialTreatmentValid())) {
 604         ++$edicount;
 605         $out .= "DTP" .       // Date Last Seen
 606         "*" . $claim->box15Qualifier() .
 607         "*D8" .
 608         "*" . $claim->dateInitialTreatment() .
 609         "~\n";
 610     }
 611
 612     if (strcmp($claim->facilityPOS(), '21') == 0 && $claim->onsetDateValid()) {
 613         ++$edicount;
 614         $out .= "DTP" .     // Date of Hospitalization
 615         "*435" .
 616         "*D8" .
 617         "*" . $claim->onsetDate() .
 618         "~\n";
 619     }
 620
 621   // above is for historical use of encounter onset date, now in misc_billing_options
 622     if (strcmp($claim->facilityPOS(), '21') == 0 && $claim->hospitalizedFromDateValid()) {
 623         ++$edicount;
 624         $out .= "DTP" .     // Date of Admission
 625         "*435" .
 626         "*D8" .
 627         "*" . $claim->hospitalizedFrom() .
 628         "~\n";
 629     }
 630
 631   // Segment DTP*096 (Discharge Date)
 632     if (strcmp($claim->facilityPOS(), '21') == 0 && $claim->hospitalizedToDateValid()) {
 633         ++$edicount;
 634         $out .= "DTP" .     // Date of Discharge
 635         "*96" .
 636         "*D8" .
 637         "*" . $claim->hospitalizedTo() .
 638         "~\n";
 639     }
 640
 641   // Segments DTP (Assumed and Relinquished Care Dates) omitted.
 642   // Segment DTP*444 (Property and Casualty Date of First Contact) omitted.
 643   // Segment DTP*050 (Repricer Received Date) omitted.
 644   // Segment PWK (Claim Supplemental Information) omitted.
 645   // Segment CN1 (Contract Information) omitted.
 646
 647     $patientpaid = $claim->patientPaidAmount();
 648     if ($patientpaid != 0) {
 649         ++$edicount;
 650         $out .= "AMT" .     // Patient paid amount. Page 190/220.
 651         "*F5" .
 652         "*" . $patientpaid .
 653         "~\n";
 654     }
 655
 656   // Segment REF*4N (Service Authorization Exception Code) omitted.
 657   // Segment REF*F5 (Mandatory Medicare Crossover Indicator) omitted.
 658   // Segment REF*EW (Mammography Certification Number) omitted.
 659   // Segment REF*9F (Referral Number) omitted.
 660
 661     if ($claim->priorAuth()) {
 662         ++$edicount;
 663         $out .= "REF" .     // Prior Authorization Number
 664         "*G1" .
 665         "*" . $claim->priorAuth() .
 666         "~\n";
 667     }
 668
 669   // Segment REF*F8 Payer Claim Control Number for claim re-submission.icn_resubmission_number
 670
 671   #if($claim->billing_options['replacement_claim'] == '1'){
 672     if (trim($claim->billing_options['icn_resubmission_number']) > 3) {
 673         ++$edicount;
 674         error_log("Method 1: ".$claim->billing_options['icn_resubmission_number'], 0);
 675         $out .= "REF" .
 676         "*F8" .
 677         "*" . $claim->icnResubmissionNumber() .
 678         "~\n";
 679     }
 680
 681
 682     if ($claim->cliaCode() && ($CMS_5010 || $claim->claimType() === 'MB')) {
 683         // Required by Medicare when in-house labs are done.
 684         ++$edicount;
 685         $out .= "REF" .     // Clinical Laboratory Improvement Amendment Number
 686         "*X4" .
 687         "*" . $claim->cliaCode() .
 688         "~\n";
 689     }
 690
 691   // Segment REF*9A (Repriced Claim Number) omitted.
 692   // Segment REF*9C (Adjusted Repriced Claim Number) omitted.
 693   // Segment REF*LX (Investigational Device Exemption Number) omitted.
 694   // Segment REF*D9 (Claim Identifier for Transmission Intermediaries) omitted.
 695   // Segment REF*EA (Medical Record Number) omitted.
 696   // Segment REF*P4 (Demonstration Project Identifier) omitted.
 697   // Segment REF*1J (Care Plan Oversight) omitted.
 698   // Segment K3 (File Information) omitted.
 699
 700     if ($claim->additionalNotes()) {
 701         // Claim note.
 702         ++$edicount;
 703         $out .= "NTE" .     // comments box 19
 704         "*" . ($CMS_5010 ? "ADD" : "") .
 705         "*" . $claim->additionalNotes() .
 706         "~\n";
 707     }
 708
 709   // Segment CR1 (Ambulance Transport Information) omitted.
 710   // Segment CR2 (Spinal Manipulation Service Information) omitted.
 711   // Segment CRC (Ambulance Certification) omitted.
 712   // Segment CRC (Patient Condition Information: Vision) omitted.
 713   // Segment CRC (Homebound Indicator) omitted.
 714
 715   // Segment CRC (EPSDT Referral).
 716     if ($claim->epsdtFlag()) {
 717         ++$edicount;
 718         $out .= "CRC" .
 719         "*ZZ" .
 720         "*Y" .
 721         "*" . $claim->medicaidReferralCode() .
 722         "~\n";
 723     }
 724
 725   // Diagnoses, up to $max_per_seg per HI segment.
 726     $max_per_seg = $CMS_5010 ? 12 : 8;
 727     $da = $claim->diagArray();
 728     if ($claim->diagtype == "ICD9") {
 729         $diag_type_code = 'BK';
 730     } else {
 731         $diag_type_code = 'ABK';
 732     }
 733
 734     $tmp = 0;
 735     foreach ($da as $diag) {
 736         if ($tmp % $max_per_seg == 0) {
 737             if ($tmp) {
 738                 $out .= "~\n";
 739             }
 740
 741             ++$edicount;
 742             $out .= "HI";         // Health Diagnosis Codes
 743         }
 744
 745         $out .= "*$diag_type_code:" . $diag;
 746         if ($claim->diagtype == "ICD9") {
 747             $diag_type_code = 'BF';
 748         } else {
 749             $diag_type_code = 'ABF';
 750         }
 751
 752         ++$tmp;
 753     }
 754
 755     if ($tmp) {
 756         $out .= "~\n";
 757     }
 758
 759   // Segment HI*BP (Anesthesia Related Procedure) omitted.
 760   // Segment HI*BG (Condition Information) omitted.
 761   // Segment HCP (Claim Pricing/Repricing Information) omitted.
 762
 763     if ($claim->referrerLastName()) {
 764         // Medicare requires referring provider's name and UPIN.
 765         ++$edicount;
 766         $out .= "NM1" .     // Loop 2310A Referring Provider
 767         "*DN" .
 768         "*1" .
 769         "*" . $claim->referrerLastName() .
 770         "*" . $claim->referrerFirstName() .
 771         "*" . $claim->referrerMiddleName() .
 772         "*" .
 773         "*";
 774         if ($CMS_5010 || $claim->referrerNPI()) {
 775             $out .=
 776             "*XX" .
 777             "*" . $claim->referrerNPI();
 778         } else {
 779             $out .=
 780             "*34" .                           // not allowed for 5010
 781             "*" . $claim->referrerSSN();
 782         }
 783
 784         $out .= "~\n";
 785
 786         if (!$CMS_5010 && $claim->referrerTaxonomy()) {
 787             ++$edicount;
 788             $out .= "PRV" .
 789             "*RF" . // ReFerring provider
 790             "*ZZ" .
 791             "*" . $claim->referrerTaxonomy() .
 792             "~\n";
 793         }
 794
 795         if (!CMS_5010 && $claim->referrerUPIN()) {
 796             ++$edicount;
 797             $out .= "REF" .   // Referring Provider Secondary Identification
 798             "*1G" .
 799             "*" . $claim->referrerUPIN() .
 800             "~\n";
 801         }
 802     }
 803
 804
 805   /* Per the implementation guide lines, only include this information if it is different
 806    * than the Loop 2010AA information
 807    */
 808     if (!$CMS_5010 ||
 809           ($claim->providerNPIValid() &&
 810           $claim->billingFacilityNPI() !== $claim->providerNPI() )) {
 811         ++$edicount;
 812         $out .= "NM1" .       // Loop 2310B Rendering Provider
 813         "*82" .
 814         "*1" .
 815         "*" . $claim->providerLastName() .
 816         "*" . $claim->providerFirstName() .
 817         "*" . $claim->providerMiddleName() .
 818         "*" .
 819         "*";
 820         if ($CMS_5010 || $claim->providerNPI()) {
 821             $out .=
 822             "*XX" .
 823             "*" . $claim->providerNPI();
 824         } else {
 825             $out .=
 826             "*34" .                             // not allowed for 5010
 827             "*" . $claim->providerSSN();
 828             $log .= "*** Rendering provider has no NPI.\n";
 829         }
 830
 831         $out .= "~\n";
 832
 833         if ($claim->providerTaxonomy()) {
 834             ++$edicount;
 835             $out .= "PRV" .
 836             "*PE" . // Performing provider
 837             "*" .($claim->claimType() != 'MC' ? "PXC" : "ZZ") .
 838             "*" . $claim->providerTaxonomy() .
 839             "~\n";
 840         }
 841
 842         // End of Loop 2310B
 843     } else {
 844         // This loop can only get skipped if we are generating a 5010 claim
 845         if (!($claim->providerNPIValid())) {
 846             /* If the loop was skipped because the provider NPI was invalid, generate
 847              * a warning for the log.*/
 848             $log.="*** Skipping 2310B because ".$claim->providerLastName() ."," . $claim->providerFirstName() . " has invalid NPI.\n";
 849         }
 850
 851         /* Skipping this segment because the providerNPI and the billingFacilityNPI are identical
 852        * is a normal condition, so no need to warn.
 853          */
 854     }
 855
 856   // 4010: REF*1C is required here for the Medicare provider number if NPI was
 857   // specified in NM109.  Not sure if other payers require anything here.
 858   // --- apparently ECLAIMS, INC wants the data in 2010 but NOT in 2310B - tony@mi-squared.com
 859   //
 860   // 5010 spec says nothing here if NPI was specified.
 861   //
 862     if (($CMS_5010 && !$claim->providerNPI() && in_array($claim->providerNumberType(), array('0B','1G','G2','LU')))
 863       || (!$CMS_5010 && trim($claim->x12gsreceiverid()) != '470819582')) { // if NOT ECLAIMS EDI
 864         if ($claim->providerNumber()) {
 865             ++$edicount;
 866             $out .= "REF" .
 867             "*" . $claim->providerNumberType() .
 868             "*" . $claim->providerNumber() .
 869             "~\n";
 870         }
 871     }
 872
 873   // Loop 2310D is omitted in the case of home visits (POS=12).
 874     if ($claim->facilityPOS() != 12 && (!$CMS_5010 ||
 875       ($claim->facilityNPI() != $claim->billingFacilityNPI() ||
 876       ($claim->facilityNPI() == $claim->billingFacilityNPI() &&
 877        $claim->facilityStreet() != $claim->billingFacilityStreet())))) {
 878         ++$edicount;
 879         $out .= "NM1" .       // Loop 2310D Service Location
 880         "*77" .
 881         "*2";
 882         //Field length is limited to 35. See nucc dataset page 77 www.nucc.org
 883         $facilityName = substr($claim->facilityName(), 0, $CMS_5010 ? 60 : 35);
 884         if ($claim->facilityName() || $claim->facilityNPI() || $claim->facilityETIN()) {
 885             $out .=
 886             "*" . $facilityName;
 887         }
 888
 889         if ($claim->facilityNPI() || $claim->facilityETIN()) {
 890             $out .=
 891             "*" .
 892             "*" .
 893             "*" .
 894             "*";
 895             if ($CMS_5010 || $claim->facilityNPI()) {
 896                 $out .=
 897                 "*XX*" . $claim->facilityNPI();
 898             } else {
 899                 $out .=
 900                 "*24*" . $claim->facilityETIN();
 901             }
 902
 903             if (!$claim->facilityNPI()) {
 904                 $log .= "*** Service location has no NPI.\n";
 905             }
 906         }
 907
 908         $out .= "~\n";
 909         if ($claim->facilityStreet()) {
 910             ++$edicount;
 911             $out .= "N3" .
 912             "*" . $claim->facilityStreet() .
 913             "~\n";
 914         }
 915
 916         if ($claim->facilityState()) {
 917             ++$edicount;
 918             $out .= "N4" .
 919             "*" . $claim->facilityCity() .
 920             "*" . $claim->facilityState() .
 921             "*" . stripZipCode($claim->facilityZip()) .
 922             "~\n";
 923         }
 924     }
 925
 926   // Segment REF (Service Facility Location Secondary Identification) omitted.
 927   // Segment PER (Service Facility Contact Information) omitted.
 928
 929   // Loop 2310E, Supervising Provider
 930   //
 931     if ($claim->supervisorLastName()) {
 932         ++$edicount;
 933         $out .= "NM1" .
 934         "*DQ" . // Supervising Physician
 935         "*1" .  // Person
 936         "*" . $claim->supervisorLastName() .
 937         "*" . $claim->supervisorFirstName() .
 938         "*" . $claim->supervisorMiddleName() .
 939         "*" .   // NM106 not used
 940         "*";    // Name Suffix
 941         if ($CMS_5010 || $claim->supervisorNPI()) {
 942             $out .=
 943             "*XX" .
 944             "*" . $claim->supervisorNPI();
 945         } else {
 946             $out .=
 947             "*34" .
 948             "*" . $claim->supervisorSSN();
 949         }
 950
 951         if (!$claim->supervisorNPI()) {
 952             $log .= "*** Supervising Provider has no NPI.\n";
 953         }
 954
 955         $out .= "~\n";
 956
 957         if ($claim->supervisorNumber()) {
 958             ++$edicount;
 959             $out .= "REF" .
 960             "*" . $claim->supervisorNumberType() .
 961             "*" . $claim->supervisorNumber() .
 962             "~\n";
 963         }
 964     }
 965
 966   // Segments NM1*PW, N3, N4 (Ambulance Pick-Up Location) omitted.
 967   // Segments NM1*45, N3, N4 (Ambulance Drop-Off Location) omitted.
 968
 969     $prev_pt_resp = $clm_total_charges; // for computation below
 970
 971   // Loops 2320 and 2330*, other subscriber/payer information.
 972   // Remember that insurance index 0 is always for the payer being billed
 973   // by this claim, and 1 and above are always for the "other" payers.
 974   //
 975     for ($ins = 1; $ins < $claim->payerCount(); ++$ins) {
 976         $tmp1 = $claim->claimType($ins);
 977         $tmp2 = 'C1'; // Here a kludge. See page 321.
 978         if ($tmp1 === 'CI') {
 979             $tmp2 = 'C1';
 980         }
 981
 982         if ($tmp1 === 'AM') {
 983             $tmp2 = 'AP';
 984         }
 985
 986         if ($tmp1 === 'HM') {
 987             $tmp2 = 'HM';
 988         }
 989
 990         if ($tmp1 === 'MB') {
 991             $tmp2 = 'MB';
 992         }
 993
 994         if ($tmp1 === 'MC') {
 995             $tmp2 = 'MC';
 996         }
 997
 998         if ($tmp1 === '09') {
 999             $tmp2 = 'PP';
1000         }
1001
1002         ++$edicount;
1003         $out .= "SBR" . // Loop 2320, Subscriber Information - page 297/318
1004         "*" . $claim->payerSequence($ins) .
1005         "*" . $claim->insuredRelationship($ins) .
1006         "*" . $claim->groupNumber($ins) .
1007         "*" . (($CMS_5010 && $claim->groupNumber($ins)) ? '' : $claim->groupName($ins)) .
1008         "*" . ($CMS_5010 ? $claim->insuredTypeCode($ins) : $tmp2) .
1009         "*" .
1010         "*" .
1011         "*" .
1012         "*" . $claim->claimType($ins) .
1013         "~\n";
1014
1015         // Things that apply only to previous payers, not future payers.
1016         //
1017         if ($claim->payerSequence($ins) < $claim->payerSequence()) {
1018             // Generate claim-level adjustments.
1019             $aarr = $claim->payerAdjustments($ins);
1020             foreach ($aarr as $a) {
1021                 ++$edicount;
1022                 $out .= "CAS" . // Previous payer's claim-level adjustments. Page 301/323.
1023                 "*" . $a[1] .
1024                 "*" . $a[2] .
1025                 "*" . $a[3] .
1026                 "~\n";
1027             }
1028
1029             $payerpaid = $claim->payerTotals($ins);
1030             ++$edicount;
1031             $out .= "AMT" . // Previous payer's paid amount. Page 307/332.
1032             "*D" .
1033             "*" . $payerpaid[1] .
1034             "~\n";
1035
1036             // Segment AMT*A8 (COB Total Non-Covered Amount) omitted.
1037             // Segment AMT*EAF (Remaining Patient Liability) omitted.
1038
1039             if (!$CMS_5010) {
1040                 // Patient responsibility amount as of this previous payer.
1041                 $prev_pt_resp -= $payerpaid[1]; // reduce by payments
1042                 $prev_pt_resp -= $payerpaid[2]; // reduce by adjustments
1043
1044                 ++$edicount;
1045                 $out .= "AMT" . // Allowed amount per previous payer. Page 334.
1046                 "*B6" .
1047                 "*" . sprintf('%.2f', $payerpaid[1] + $prev_pt_resp) .
1048                 "~\n";
1049
1050                 ++$edicount;
1051                 $out .= "AMT" . // Patient responsibility amount per previous payer. Page 335.
1052                 "*F2" .
1053                 "*" . sprintf('%.2f', $prev_pt_resp) .
1054                 "~\n";
1055             }
1056         } // End of things that apply only to previous payers.
1057
1058         if (!$CMS_5010) {
1059             ++$edicount;
1060             $out .= "DMG" . // Other subscriber demographic information. Page 342.
1061             "*D8" .
1062             "*" . $claim->insuredDOB($ins) .
1063             "*" . $claim->insuredSex($ins) .
1064             "~\n";
1065         }
1066
1067         ++$edicount;
1068         $out .= "OI" .  // Other Insurance Coverage Information. Page 310/344.
1069         "*" .
1070         "*" .
1071         "*" . ($claim->billingFacilityAssignment($ins) ? 'Y' : 'N') .
1072         // For this next item, the 5010 example in the spec does not match its
1073         // description.  So this might be wrong.
1074         "*" . ($CMS_5010 ? '' : 'B') .
1075         "*" .
1076         "*Y" .
1077         "~\n";
1078
1079         // Segment MOA (Medicare Outpatient Adjudication) omitted.
1080
1081         ++$edicount;
1082         $out .= "NM1" . // Loop 2330A Subscriber info for other insco. Page 315/350.
1083         "*IL" .
1084         "*1" .
1085         "*" . $claim->insuredLastName($ins) .
1086         "*" . $claim->insuredFirstName($ins) .
1087         "*" . $claim->insuredMiddleName($ins) .
1088         "*" .
1089         "*" .
1090         "*MI" .
1091         "*" . $claim->policyNumber($ins) .
1092         "~\n";
1093
1094         ++$edicount;
1095         $out .= "N3" .
1096         "*" . $claim->insuredStreet($ins) .
1097         "~\n";
1098
1099         ++$edicount;
1100         $out .= "N4" .
1101         "*" . $claim->insuredCity($ins) .
1102         "*" . $claim->insuredState($ins) .
1103         "*" . stripZipCode($claim->insuredZip($ins)) .
1104         "~\n";
1105
1106         // Segment REF (Other Subscriber Secondary Identification) omitted.
1107
1108         ++$edicount;
1109         //Field length is limited to 35. See nucc dataset page 81 www.nucc.org
1110         $payerName = substr($claim->payerName($ins), 0, $CMS_5010 ? 60 : 35);
1111         $out .= "NM1" . // Loop 2330B Payer info for other insco. Page 322/359.
1112         "*PR" .
1113         "*2" .
1114         "*" . $payerName .
1115         "*" .
1116         "*" .
1117         "*" .
1118         "*" .
1119         "*PI" .
1120         "*" . $claim->payerID($ins) .
1121         "~\n";
1122
1123         // if (!$claim->payerID($ins)) {
1124         //   $log .= "*** CMS ID is missing for payer '" . $claim->payerName($ins) . "'.\n";
1125         // }
1126
1127         // Payer address (N3 and N4) are added below so that Gateway EDI can
1128         // auto-generate secondary claims.  These do NOT appear in my copy of
1129         // the spec!  -- Rod 2008-06-12
1130
1131         if ($CMS_5010 || trim($claim->x12gsreceiverid()) == '431420764') { // if Gateway EDI
1132             ++$edicount;
1133             $out .= "N3" .
1134             "*" . $claim->payerStreet($ins) .
1135             "~\n";
1136             //
1137             ++$edicount;
1138             $out .= "N4" .
1139             "*" . $claim->payerCity($ins) .
1140             "*" . $claim->payerState($ins) .
1141             "*" . stripZipCode($claim->payerZip($ins)) .
1142             "~\n";
1143         } // end Gateway EDI
1144
1145         // Segment DTP*573 (Claim Check or Remittance Date) omitted.
1146         // Segment REF (Other Payer Secondary Identifier) omitted.
1147         // Segment REF*G1 (Other Payer Prior Authorization Number) omitted.
1148         // Segment REF*9F (Other Payer Referral Number) omitted.
1149         // Segment REF*T4 (Other Payer Claim Adjustment Indicator) omitted.
1150         // Segment REF*F8 (Other Payer Claim Control Number) omitted.
1151         // Segment NM1 (Other Payer Referring Provider) omitted.
1152         // Segment REF (Other Payer Referring Provider Secondary Identification) omitted.
1153         // Segment NM1 (Other Payer Rendering Provider) omitted.
1154         // Segment REF (Other Payer Rendering Provider Secondary Identification) omitted.
1155         // Segment NM1 (Other Payer Service Facility Location) omitted.
1156         // Segment REF (Other Payer Service Facility Location Secondary Identification) omitted.
1157         // Segment NM1 (Other Payer Supervising Provider) omitted.
1158         // Segment REF (Other Payer Supervising Provider Secondary Identification) omitted.
1159         // Segment NM1 (Other Payer Billing Provider) omitted.
1160         // Segment REF (Other Payer Billing Provider Secondary Identification) omitted.
1161     } // End loops 2320/2330*.
1162
1163     $loopcount = 0;
1164
1165   // Procedure loop starts here.
1166   //
1167     for ($prockey = 0; $prockey < $proccount; ++$prockey) {
1168         ++$loopcount;
1169
1170         ++$edicount;
1171         $out .= "LX" .      // Loop 2400 LX Service Line. Page 398.
1172         "*$loopcount" .
1173         "~\n";
1174
1175         ++$edicount;
1176         $out .= "SV1" .     // Professional Service. Page 400.
1177         "*HC:" . $claim->cptKey($prockey) .
1178         "*" . sprintf('%.2f', $claim->cptCharges($prockey)) .
1179         "*UN" .
1180         "*" . $claim->cptUnits($prockey) .
1181         "*" .
1182         "*" .
1183         "*";
1184         $dia = $claim->diagIndexArray($prockey);
1185         $i = 0;
1186         foreach ($dia as $dindex) {
1187             if ($i) {
1188                 $out .= ':';
1189             }
1190
1191             $out .= $dindex;
1192             if (++$i >= 4) {
1193                 break;
1194             }
1195         }
1196
1197         # needed for epstd
1198         if ($claim->epsdtFlag()) {
1199             $out .= "*" .
1200             "*" .
1201             "*" .
1202             "*Y" .
1203             "~\n";
1204         } else {
1205             $out .= "~\n";
1206         }
1207
1208         if (!$claim->cptCharges($prockey)) {
1209             $log .= "*** Procedure '" . $claim->cptKey($prockey) . "' has no charges!\n";
1210         }
1211
1212         if (empty($dia)) {
1213             $log .= "*** Procedure '" . $claim->cptKey($prockey) . "' is not justified!\n";
1214         }
1215
1216         // Segment SV5 (Durable Medical Equipment Service) omitted.
1217         // Segment PWK (Line Supplemental Information) omitted.
1218         // Segment PWK (Durable Medical Equipment Certificate of Medical Necessity Indicator) omitted.
1219         // Segment CR1 (Ambulance Transport Information) omitted.
1220         // Segment CR3 (Durable Medical Equipment Certification) omitted.
1221         // Segment CRC (Ambulance Certification) omitted.
1222         // Segment CRC (Hospice Employee Indicator) omitted.
1223         // Segment CRC (Condition Indicator / Durable Medical Equipment) omitted.
1224
1225         ++$edicount;
1226         $out .= "DTP" .     // Date of Service. Page 435.
1227         "*472" .
1228         "*D8" .
1229         "*" . $claim->serviceDate() .
1230         "~\n";
1231
1232         $testnote = rtrim($claim->cptNotecodes($prockey));
1233         if (!empty($testnote)) {
1234             ++$edicount;
1235             $out .= "NTE" .     // Explain Unusual Circumstances.
1236             "*ADD" .
1237             "*" . $claim->cptNotecodes($prockey) .
1238             "~\n";
1239         }
1240
1241         // Segment DTP*471 (Prescription Date) omitted.
1242         // Segment DTP*607 (Revision/Recertification Date) omitted.
1243         // Segment DTP*463 (Begin Therapy Date) omitted.
1244         // Segment DTP*461 (Last Certification Date) omitted.
1245         // Segment DTP*304 (Last Seen Date) omitted.
1246         // Segment DTP (Test Date) omitted.
1247         // Segment DTP*011 (Shipped Date) omitted.
1248         // Segment DTP*455 (Last X-Ray Date) omitted.
1249         // Segment DTP*454 (Initial Treatment Date) omitted.
1250         // Segment QTY (Ambulance Patient Count) omitted.
1251         // Segment QTY (Obstetric Anesthesia Additional Units) omitted.
1252         // Segment MEA (Test Result) omitted.
1253         // Segment CN1 (Contract Information) omitted.
1254         // Segment REF*9B (Repriced Line Item Reference Number) omitted.
1255         // Segment REF*9D (Adjusted Repriced Line Item Reference Number) omitted.
1256         // Segment REF*G1 (Prior Authorization) omitted.
1257         // Segment REF*6R (Line Item Control Number) omitted.
1258         //   (Really oughta have this for robust 835 posting!)
1259         // Segment REF*EW (Mammography Certification Number) omitted.
1260         // Segment REF*X4 (CLIA Number) omitted.
1261         // Segment REF*F4 (Referring CLIA Facility Identification) omitted.
1262         // Segment REF*BT (Immunization Batch Number) omitted.
1263         // Segment REF*9F (Referral Number) omitted.
1264         // Segment AMT*T (Sales Tax Amount) omitted.
1265         // Segment AMT*F4 (Postage Claimed Amount) omitted.
1266         // Segment K3 (File Information) omitted.
1267         // Segment NTE (Line Note) omitted.
1268         // Segment NTE (Third Party Organization Notes) omitted.
1269         // Segment PS1 (Purchased Service Information) omitted.
1270         // Segment HCP (Line Pricing/Repricing Information) omitted.
1271
1272         if (!$CMS_5010) {
1273             // This segment was deleted for 5010.
1274             //
1275             // AMT*AAE segment for Approved Amount from previous payer.
1276             // Medicare secondaries seem to require this.
1277             //
1278             for ($ins = $claim->payerCount() - 1; $ins > 0; --$ins) {
1279                 if ($claim->payerSequence($ins) > $claim->payerSequence()) {
1280                     continue; // payer is future, not previous
1281                 }
1282
1283                 $payerpaid = $claim->payerTotals($ins, $claim->cptKey($prockey));
1284                 ++$edicount;
1285                 $out .= "AMT" . // Approved amount per previous payer. Page 485.
1286                 "*AAE" .
1287                 "*" . sprintf('%.2f', $claim->cptCharges($prockey) - $payerpaid[2]) .
1288                 "~\n";
1289                 break;
1290             }
1291         }
1292
1293         // Loop 2410, Drug Information. Medicaid insurers seem to want this
1294         // with HCPCS codes.
1295         //
1296         $ndc = $claim->cptNDCID($prockey);
1297         if ($ndc) {
1298             ++$edicount;
1299             $out .= "LIN" . // Drug Identification. Page 500+ (Addendum pg 71).
1300             "*" .         // Per addendum, LIN01 is not used.
1301             "*N4" .
1302             "*" . $ndc .
1303             "~\n";
1304
1305             if (!preg_match('/^\d\d\d\d\d-\d\d\d\d-\d\d$/', $ndc, $tmp) && !preg_match('/^\d{11}$/', $ndc)) {
1306                 $log .= "*** NDC code '$ndc' has invalid format!\n";
1307             }
1308
1309             ++$edicount;
1310             $tmpunits = $claim->cptNDCQuantity($prockey) * $claim->cptUnits($prockey);
1311             if (!$tmpunits) {
1312                 $tmpunits = 1;
1313             }
1314
1315             $out .= "CTP" . // Drug Pricing. Page 500+ (Addendum pg 74).
1316             "*" .
1317             "*" .
1318             "*" . ($CMS_5010 ? '' : sprintf('%.2f', $claim->cptCharges($prockey) / $tmpunits)) .
1319             "*" . $claim->cptNDCQuantity($prockey) .
1320             "*" . $claim->cptNDCUOM($prockey) .
1321             // Note: 5010 documents "ME" (Milligrams) as an additional unit of measure.
1322             "~\n";
1323         }
1324
1325         // Segment REF (Prescription or Compound Drug Association Number) omitted.
1326
1327         // Loop 2420A, Rendering Provider (service-specific).
1328         // Used if the rendering provider for this service line is different
1329         // from that in loop 2310B.
1330         //
1331         if ($claim->providerNPI() != $claim->providerNPI($prockey)) {
1332             ++$edicount;
1333             $out .= "NM1" .       // Loop 2310B Rendering Provider
1334             "*82" .
1335             "*1" .
1336             "*" . $claim->providerLastName($prockey) .
1337             "*" . $claim->providerFirstName($prockey) .
1338             "*" . $claim->providerMiddleName($prockey) .
1339             "*" .
1340             "*";
1341             if ($CMS_5010 || $claim->providerNPI($prockey)) {
1342                 $out .=
1343                 "*XX" .
1344                 "*" . $claim->providerNPI($prockey);
1345             } else {
1346                 $out .=
1347                 "*34" .                         // Not allowed for 5010
1348                 "*" . $claim->providerSSN($prockey);
1349             }
1350
1351             if (!$claim->providerNPI($prockey)) {
1352                 $log .= "*** Rendering provider has no NPI.\n";
1353             }
1354
1355             $out .= "~\n";
1356
1357             if ($claim->providerTaxonomy($prockey)) {
1358                 ++$edicount;
1359                 $out .= "PRV" .
1360                 "*PE" . // PErforming provider
1361                 "*" . ($CMS_5010 ? "PXC" : "ZZ") .
1362                 "*" . $claim->providerTaxonomy($prockey) .
1363                 "~\n";
1364             }
1365
1366             // Segment PRV*PE (Rendering Provider Specialty Information) omitted.
1367             // Segment REF (Rendering Provider Secondary Identification) omitted.
1368             // Segment NM1 (Purchased Service Provider Name) omitted.
1369             // Segment REF (Purchased Service Provider Secondary Identification) omitted.
1370             // Segment NM1,N3,N4 (Service Facility Location) omitted.
1371             // Segment REF (Service Facility Location Secondary Identification) omitted.
1372             // Segment NM1 (Supervising Provider Name) omitted.
1373             // Segment REF (Supervising Provider Secondary Identification) omitted.
1374             // Segment NM1,N3,N4 (Ordering Provider) omitted.
1375             // Segment REF (Ordering Provider Secondary Identification) omitted.
1376             // Segment PER (Ordering Provider Contact Information) omitted.
1377             // Segment NM1 (Referring Provider Name) omitted.
1378             // Segment REF (Referring Provider Secondary Identification) omitted.
1379             // Segments NM1*PW, N3, N4 (Ambulance Pick-Up Location) omitted.
1380             // Segments NM1*45, N3, N4 (Ambulance Drop-Off Location) omitted.
1381
1382             // REF*1C is required here for the Medicare provider number if NPI was
1383             // specified in NM109.  Not sure if other payers require anything here.
1384             if (!$CMS_5010 && $claim->providerNumber($prockey)) {
1385                 ++$edicount;
1386                 $out .= "REF" .
1387                 "*" . $claim->providerNumberType($prockey) .
1388                 // Note: 5010 documents that type 1D (Medicaid) is changed to G2.
1389                 "*" . $claim->providerNumber($prockey) .
1390                 "~\n";
1391             }
1392         }
1393
1394         // Loop 2430, adjudication by previous payers.
1395         //
1396         for ($ins = 1; $ins < $claim->payerCount(); ++$ins) {
1397             if ($claim->payerSequence($ins) > $claim->payerSequence()) {
1398                 continue; // payer is future, not previous
1399             }
1400
1401             $payerpaid = $claim->payerTotals($ins, $claim->cptKey($prockey));
1402             $aarr = $claim->payerAdjustments($ins, $claim->cptKey($prockey));
1403
1404             if ($payerpaid[1] == 0 && !count($aarr)) {
1405                 $log .= "*** Procedure '" . $claim->cptKey($prockey) .
1406                 "' has no payments or adjustments from previous payer!\n";
1407                 continue;
1408             }
1409
1410             ++$edicount;
1411             $out .= "SVD" . // Service line adjudication. Page 554.
1412             "*" . $claim->payerID($ins) .
1413             "*" . $payerpaid[1] .
1414             "*HC:" . $claim->cptKey($prockey) .
1415             "*" .
1416             "*" . $claim->cptUnits($prockey) .
1417             "~\n";
1418
1419             $tmpdate = $payerpaid[0];
1420             foreach ($aarr as $a) {
1421                 ++$edicount;
1422                 $out .= "CAS" . // Previous payer's line level adjustments. Page 558.
1423                 "*" . $a[1] .
1424                 "*" . $a[2] .
1425                 "*" . $a[3] .
1426                 "~\n";
1427                 if (!$tmpdate) {
1428                     $tmpdate = $a[0];
1429                 }
1430
1431                 // WTH is this??
1432                 /*************************************************************
1433               if ( isset($a[4]) &&
1434                   $a[4] != null ) {
1435                   $out .= "CAS02" . // Previous payer's adjustment reason
1436                     "*" . $a[4] .
1437                     "~\n";
1438               }
1439                 *************************************************************/
1440             }
1441
1442             if ($tmpdate) {
1443                 ++$edicount;
1444                 $out .= "DTP" . // Previous payer's line adjustment date. Page 493/566.
1445                 "*573" .
1446                 "*D8" .
1447                 "*$tmpdate" .
1448                 "~\n";
1449             }
1450
1451             // Segment AMT*EAF (Remaining Patient Liability) omitted.
1452             // Segment LQ (Form Identification Code) omitted.
1453             // Segment FRM (Supporting Documentation) omitted.
1454         } // end loop 2430
1455     } // end this procedure
1456
1457     ++$edicount;
1458     $out .= "SE" .        // SE Trailer
1459     "*$edicount" .
1460     "*0021" .
1461     "~\n";
1462
1463     $out .= "GE" .        // GE Trailer
1464     "*1" .
1465     "*1" .
1466     "~\n";
1467
1468     $out .= "IEA" .       // IEA Trailer
1469     "*1" .
1470     "*000000001" .
1471     "~\n";
1472
1473   // Remove any trailing empty fields (delimiters) from each segment.
1474     $out = preg_replace('/\*+~/', '~', $out);
1475
1476     $log .= "\n";
1477     return $out;
1478 }