src/Billing/Claim.php

   1 <?php
   2 /* Claim Class
   3  *
   4  * @package OpenEMR
   5  * @author Rod Roark <rod@sunsetsystems.com>
   6  * @author Stephen Waite <stephen.waite@cmsvt.com>
   7  * @copyright Copyright (c) 2009 Rod Roark <rod@sunsetsystems.com>
   8  * @copyright Copyright (c) 2017 Stephen Waite <stephen.waite@cmsvt.com>
   9  * @link https://github.com/openemr/openemr/tree/master
  10  * @license https://github.com/openemr/openemr/blob/master/LICENSE GNU General Public License 3
  11  */
  12
  13 namespace OpenEMR\Billing;
  14
  15 use InsuranceCompany;
  16 use OpenEMR\Services\FacilityService;
  17
  18 class Claim
  19 {
  20     const X12_VERSION = '005010X222A1';
  21
  22     public $pid;               // patient id
  23     public $encounter_id;      // encounter id
  24     public $procs;             // array of procedure rows from billing table
  25     public $diags;             // array of icd9 codes from billing table
  26     public $diagtype= "ICD10"; // diagnosis code_type; safe to assume ICD10 now
  27     public $x12_partner;       // row from x12_partners table
  28     public $encounter;         // row from form_encounter table
  29     public $facility;          // row from facility table
  30     public $billing_facility;  // row from facility table
  31     public $provider;          // row from users table (rendering provider)
  32     public $referrer;          // row from users table (referring provider)
  33     public $supervisor;        // row from users table (supervising provider)
  34     public $insurance_numbers; // row from insurance_numbers table for current payer
  35     public $supervisor_numbers;// row from insurance_numbers table for current payer
  36     public $patient_data;      // row from patient_data table
  37     public $billing_options;   // row from form_misc_billing_options table
  38     public $invoice;           // result from get_invoice_summary()
  39     public $payers;            // array of arrays, for all payers
  40     public $copay;             // total of copays from the ar_activity table
  41     public $facilityService;   // via matthew.vita orm work :)
  42     public $pay_to_provider;   // to be implemented in facility ui
  43
  44     // This enforces the X12 Basic Character Set. Page A2.
  45     public function x12Clean($str)
  46     {
  47         return preg_replace('/[^A-Z0-9!"\\&\'()+,\\-.\\/;?=@ ]/', '', strtoupper($str));
  48     }
  49
  50     // X12 likes 9 digit zip codes also moving this from gen_x12
  51     // to pursue PSR-0 and PSR-4
  52     public function x12Zip($zip)
  53     {
  54         $zip = $this->x12Clean($zip);
  55         if (strlen($zip) == 5) {
  56             return $zip . "9999";
  57         } else {
  58             return $zip;
  59         }
  60     }
  61
  62     // Make sure dates have no formatting and zero filled becomes blank
  63     // Handles date time stamp formats as well
  64     public function cleanDate($date_field)
  65     {
  66         $cleandate = str_replace('-', '', substr($date_field, 0, 10));
  67
  68         if (substr_count($cleandate, '0')==8) {
  69             $cleandate='';
  70         }
  71
  72         return ($cleandate);
  73     }
  74
  75     public function loadPayerInfo(&$billrow)
  76     {
  77         global $sl_err;
  78         $encounter_date = substr($this->encounter['date'], 0, 10);
  79
  80         // Create the $payers array.  This contains data for all insurances
  81         // with the current one always at index 0, and the others in payment
  82         // order starting at index 1.
  83         //
  84         $this->payers = array();
  85         $this->payers[0] = array();
  86         $query = "SELECT * FROM insurance_data WHERE pid = ? AND date <= ? ORDER BY type ASC, date DESC";
  87         $dres = sqlStatement($query, array($this->pid, $encounter_date));
  88         $prevtype = '';
  89         while ($drow = sqlFetchArray($dres)) {
  90             if (strcmp($prevtype, $drow['type']) == 0) {
  91                 continue;
  92             }
  93
  94             $prevtype = $drow['type'];
  95             // Very important to look at entries with a missing provider because
  96             // they indicate no insurance as of the given date.
  97             if (empty($drow['provider'])) {
  98                 continue;
  99             }
 100
 101             $ins = count($this->payers);
 102             if ($drow['provider'] == $billrow['payer_id'] && empty($this->payers[0]['data'])) {
 103                 $ins = 0;
 104             }
 105
 106             $crow = sqlQuery("SELECT * FROM insurance_companies WHERE id = ?", array($drow['provider']));
 107             $orow = new InsuranceCompany($drow['provider']);
 108             $this->payers[$ins] = array();
 109             $this->payers[$ins]['data']    = $drow;
 110             $this->payers[$ins]['company'] = $crow;
 111             $this->payers[$ins]['object']  = $orow;
 112         }
 113
 114         // This kludge hands most cases of a rare ambiguous situation, where
 115         // the primary insurance company is the same as the secondary.  It seems
 116         // nobody planned for that!
 117         //
 118         for ($i = 1; $i < count($this->payers); ++$i) {
 119             if ($billrow['process_date'] &&
 120             $this->payers[0]['data']['provider'] == $this->payers[$i]['data']['provider']) {
 121                 $tmp = $this->payers[0];
 122                 $this->payers[0] = $this->payers[$i];
 123                 $this->payers[$i] = $tmp;
 124             }
 125         }
 126
 127         $this->using_modifiers = true;
 128
 129         // Get payment and adjustment details if there are any previous payers.
 130         //
 131         $this->invoice = array();
 132         if ($this->payerSequence() != 'P') {
 133             $this->invoice = ar_get_invoice_summary($this->pid, $this->encounter_id, true);
 134             // Secondary claims might not have modifiers in SQL-Ledger data.
 135             // In that case, note that we should not try to match on them.
 136             $this->using_modifiers = false;
 137             foreach ($this->invoice as $key => $trash) {
 138                 if (strpos($key, ':')) {
 139                     $this->using_modifiers = true;
 140                 }
 141             }
 142         }
 143     }
 144
 145   // Constructor. Loads relevant database information.
 146   //
 147     public function __construct($pid, $encounter_id)
 148     {
 149         $this->pid = $pid;
 150         $this->encounter_id = $encounter_id;
 151         $this->procs = array();
 152         $this->diags = array();
 153         $this->copay = 0;
 154
 155         $this->facilityService = new FacilityService();
 156         $this->pay_to_provider = ''; // will populate from facility someday :)
 157
 158
 159         // We need the encounter date before we can identify the payers.
 160         $sql = "SELECT * FROM form_encounter WHERE pid = ? AND encounter = ?";
 161         $this->encounter = sqlQuery($sql, array($this->pid, $this->encounter_id));
 162
 163         // Sort by procedure timestamp in order to get some consistency.
 164         $sql = "SELECT b.id, b.date, b.code_type, b.code, b.pid, b.provider_id, " .
 165         "b.user, b.groupname, b.authorized, b.encounter, b.code_text, b.billed, " .
 166         "b.activity, b.payer_id, b.bill_process, b.bill_date, b.process_date, " .
 167         "b.process_file, b.modifier, b.units, b.fee, b.justify, b.target, b.x12_partner_id, " .
 168         "b.ndc_info, b.notecodes, b.revenue_code, ct.ct_diag " .
 169         "FROM billing as b INNER JOIN code_types as ct " .
 170         "ON b.code_type = ct.ct_key " .
 171         "WHERE ct.ct_claim = '1' AND ct.ct_active = '1' AND b.encounter = ? AND b.pid = ? AND " .
 172         "b.activity = '1' ORDER BY b.date, b.id";
 173         $res = sqlStatement($sql, array($this->encounter_id, $this->pid));
 174         while ($row = sqlFetchArray($res)) {
 175             // Save all diagnosis codes.
 176             if ($row['ct_diag'] == '1') {
 177                 $this->diags[$row['code']] = $row['code'];
 178                 continue;
 179             }
 180
 181             if (!$row['units']) {
 182                 $row['units'] = 1;
 183             }
 184
 185             // Load prior payer data at the first opportunity in order to get
 186             // the using_modifiers flag that is referenced below.
 187             if (empty($this->procs)) {
 188                 $this->loadPayerInfo($row);
 189             }
 190
 191             // The consolidate duplicate procedures, which was previously here, was removed
 192             // from codebase on 12/9/15. Reason: Some insurance companies decline consolidated
 193             // procedures, and this can be left up to the billing coder when they input the items.
 194
 195             // If there is a row-specific provider then get its details.
 196             if (!empty($row['provider_id'])) {
 197                 // Get service provider data for this row.
 198                 $sql = "SELECT * FROM users WHERE id = ?";
 199                 $row['provider'] = sqlQuery($sql, array($row['provider_id']));
 200                 // Get insurance numbers for this row's provider.
 201                 $sql = "SELECT * FROM insurance_numbers " .
 202                 "WHERE (insurance_company_id = ? OR insurance_company_id is NULL) AND provider_id = ?" .
 203                 "ORDER BY insurance_company_id DESC LIMIT 1";
 204                 $row['insurance_numbers'] = sqlQuery($sql, array($row['payer_id'], $row['provider_id']));
 205             }
 206
 207             $this->procs[] = $row;
 208         }
 209
 210         $resMoneyGot = sqlStatement("SELECT pay_amount as PatientPay,session_id as id,".
 211         "date(post_time) as date FROM ar_activity WHERE pid = ? AND encounter = ? AND ".
 212         "payer_type=0 AND account_code='PCP'", array($this->pid, $this->encounter_id));
 213           //new fees screen copay gives account_code='PCP'
 214         while ($rowMoneyGot = sqlFetchArray($resMoneyGot)) {
 215               $PatientPay=$rowMoneyGot['PatientPay']*-1;
 216               $this->copay -= $PatientPay;
 217         }
 218
 219         $sql = "SELECT * FROM x12_partners WHERE id = ?";
 220         $this->x12_partner = sqlQuery($sql, array($this->procs[0]['x12_partner_id']));
 221
 222         $this->facility = $this->facilityService->getById($this->encounter['facility_id']);
 223
 224         /*****************************************************************
 225         $provider_id = $this->procs[0]['provider_id'];
 226         *****************************************************************/
 227         $provider_id = $this->encounter['provider_id'];
 228         $sql = "SELECT * FROM users WHERE id = ?";
 229         $this->provider = sqlQuery($sql, array($provider_id));
 230         // Selecting the billing facility assigned  to the encounter.  If none,
 231         // try the first (and hopefully only) facility marked as a billing location.
 232         if (empty($this->encounter['billing_facility'])) {
 233               $this->billing_facility = $this->facilityService->getPrimaryBillingLocation();
 234         } else {
 235               $this->billing_facility = $this->facilityService->getById($this->encounter['billing_facility']);
 236         }
 237
 238         $sql = "SELECT * FROM insurance_numbers " .
 239         "WHERE (insurance_company_id = ? OR insurance_company_id is NULL) AND provider_id = ? " .
 240         "ORDER BY insurance_company_id DESC LIMIT 1";
 241         $this->insurance_numbers = sqlQuery($sql, array($this->procs[0]['payer_id'], $provider_id));
 242
 243         $sql = "SELECT * FROM patient_data WHERE pid = ? ORDER BY id LIMIT 1";
 244         $this->patient_data = sqlQuery($sql, array($this->pid));
 245
 246         $sql = "SELECT fpa.* FROM forms JOIN form_misc_billing_options AS fpa " .
 247         "ON fpa.id = forms.form_id " .
 248         "WHERE forms.encounter = ? AND forms.pid = ? AND forms.deleted = 0 AND forms.formdir = 'misc_billing_options' " .
 249         "ORDER BY forms.date";
 250         $this->billing_options = sqlQuery($sql, array($this->encounter_id, $this->pid));
 251
 252         $referrer_id = (empty($GLOBALS['MedicareReferrerIsRenderer']) ||
 253         $this->insurance_numbers['provider_number_type'] != '1C') ?
 254           $this->patient_data['ref_providerID'] : $provider_id;
 255         $sql = "SELECT * FROM users WHERE id = ?";
 256         $this->referrer = sqlQuery($sql, array($referrer_id));
 257         if (!$this->referrer) {
 258             $this->referrer = array();
 259         }
 260
 261         $supervisor_id = $this->encounter['supervisor_id'];
 262         $sql = "SELECT * FROM users WHERE id = ?";
 263         $this->supervisor = sqlQuery($sql, array($supervisor_id));
 264         if (!$this->supervisor) {
 265             $this->supervisor = array();
 266         }
 267
 268         $billing_options_id = $this->billing_options['provider_id'];
 269         $sql = "SELECT * FROM users WHERE id = ?";
 270         $this->billing_prov_id = sqlQuery($sql, array($billing_options_id));
 271         if (!$this->billing_prov_id) {
 272             $this->billing_prov_id = array();
 273         }
 274
 275         $sql = "SELECT * FROM insurance_numbers WHERE " .
 276           "(insurance_company_id = ? OR insurance_company_id is NULL) AND provider_id = ? " .
 277           "ORDER BY insurance_company_id DESC LIMIT 1";
 278         $this->supervisor_numbers = sqlQuery($sql, array($this->procs[0]['payer_id'], $supervisor_id));
 279         if (!$this->supervisor_numbers) {
 280             $this->supervisor_numbers = array();
 281         }
 282     } // end constructor
 283
 284   // Return an array of adjustments from the designated prior payer for the
 285   // designated procedure key (might be procedure:modifier), or for the claim
 286   // level.  For each adjustment give date, group code, reason code, amount.
 287   // Note this will include "patient responsibility" adjustments which are
 288   // not adjustments to OUR invoice, but they reduce the amount that the
 289   // insurance company pays.
 290   //
 291     public function payerAdjustments($ins, $code = 'Claim')
 292     {
 293         $aadj = array();
 294
 295         // If we have no modifiers stored in SQL-Ledger for this claim,
 296         // then we cannot use a modifier passed in with the key.
 297         $tmp = strpos($code, ':');
 298         if ($tmp && !$this->using_modifiers) {
 299             $code = substr($code, 0, $tmp);
 300         }
 301
 302         // For payments, source always starts with "Ins" or "Pt".
 303         // Nonzero adjustment reason examples:
 304         //   Ins1 adjust code 42 (Charges exceed ... (obsolete))
 305         //   Ins1 adjust code 45 (Charges exceed your contracted/ legislated fee arrangement)
 306         //   Ins1 adjust code 97 (Payment is included in the allowance for another service/procedure)
 307         //   Ins1 adjust code A2 (Contractual adjustment)
 308         //   Ins adjust Ins1
 309         //   adjust code 45
 310         // Zero adjustment reason examples:
 311         //   Co-pay: 25.00
 312         //   Coinsurance: 11.46  (code 2)   Note: fix remits to identify insurance
 313         //   To deductible: 0.22 (code 1)   Note: fix remits to identify insurance
 314         //   To copay Ins1 (manual entry)
 315         //   To ded'ble Ins1 (manual entry)
 316
 317         if (!empty($this->invoice[$code])) {
 318             $date = '';
 319             $deductible  = 0;
 320             $coinsurance = 0;
 321             $inslabel = ($this->payerSequence($ins) == 'S') ? 'Ins2' : 'Ins1';
 322             $insnumber = substr($inslabel, 3);
 323
 324             // Compute this procedure's patient responsibility amount as of this
 325             // prior payer, which is the original charge minus all insurance
 326             // payments and "hard" adjustments up to this payer.
 327             $ptresp = $this->invoice[$code]['chg'] + $this->invoice[$code]['adj'];
 328             foreach ($this->invoice[$code]['dtl'] as $key => $value) {
 329                 // plv (from ar_activity.payer_type) exists to
 330                 // indicate the payer level.
 331                 if (isset($value['pmt']) && $value['pmt'] != 0) {
 332                     if ($value['plv'] > 0 && $value['plv'] <= $insnumber) {
 333                         $ptresp -= $value['pmt'];
 334                     }
 335                 } else if (isset($value['chg']) && trim(substr($key, 0, 10))) {
 336                   // non-blank key indicates this is an adjustment and not a charge
 337                     if ($value['plv'] > 0 && $value['plv'] <= $insnumber) {
 338                         $ptresp += $value['chg']; // adjustments are negative charges
 339                     }
 340                 }
 341
 342                 $msp = isset($value['msp']) ? $value['msp'] : null; // record the reason for adjustment
 343             }
 344
 345             if ($ptresp < 0) {
 346                 $ptresp = 0; // we may be insane but try to hide it
 347             }
 348
 349             // Main loop, to extract adjustments for this payer and procedure.
 350             foreach ($this->invoice[$code]['dtl'] as $key => $value) {
 351                 $tmp = str_replace('-', '', trim(substr($key, 0, 10)));
 352                 if ($tmp) {
 353                     $date = $tmp;
 354                 }
 355
 356                 if ($tmp && $value['pmt'] == 0) { // not original charge and not a payment
 357                     $rsn = $value['rsn'];
 358                     $chg = 0 - $value['chg']; // adjustments are negative charges
 359
 360                     $gcode = 'CO'; // default group code = contractual obligation
 361                     $rcode = '45'; // default reason code = max fee exceeded (code 42 is obsolete)
 362
 363                     if (preg_match("/Ins adjust $inslabel/i", $rsn, $tmp)) {
 364                         // From manual post. Take the defaults.
 365                     } else if (preg_match("/To copay $inslabel/i", $rsn, $tmp) && !$chg) {
 366                         $coinsurance = $ptresp; // from manual post
 367                         continue;
 368                     } else if (preg_match("/To ded'ble $inslabel/i", $rsn, $tmp) && !$chg) {
 369                         $deductible = $ptresp; // from manual post
 370                         continue;
 371                     } else if (preg_match("/$inslabel copay: (\S+)/i", $rsn, $tmp) && !$chg) {
 372                         $coinsurance = $tmp[1]; // from 835 as of 6/2007
 373                         continue;
 374                     } else if (preg_match("/$inslabel coins: (\S+)/i", $rsn, $tmp) && !$chg) {
 375                         $coinsurance = $tmp[1]; // from 835 and manual post as of 6/2007
 376                         continue;
 377                     } else if (preg_match("/$inslabel dedbl: (\S+)/i", $rsn, $tmp) && !$chg) {
 378                         $deductible = $tmp[1]; // from 835 and manual post as of 6/2007
 379                         continue;
 380                     } else if (preg_match("/$inslabel ptresp: (\S+)/i", $rsn, $tmp) && !$chg) {
 381                         continue; // from 835 as of 6/2007
 382                     } else if (preg_match("/$inslabel adjust code (\S+)/i", $rsn, $tmp)) {
 383                         $rcode = $tmp[1]; // from 835
 384                     } else if (preg_match("/$inslabel/i", $rsn, $tmp)) {
 385                         // Take the defaults.
 386                     } else if (preg_match('/Ins(\d)/i', $rsn, $tmp) && $tmp[1] != $insnumber) {
 387                         continue; // it's for some other payer
 388                     } else if ($insnumber == '1') {
 389                         if (preg_match("/Adjust code (\S+)/i", $rsn, $tmp)) {
 390                             $rcode = $tmp[1]; // from 835
 391                         } else if ($chg) {
 392                             // Other adjustments default to Ins1.
 393                         } else if (preg_match("/Co-pay: (\S+)/i", $rsn, $tmp) ||
 394                         preg_match("/Coinsurance: (\S+)/i", $rsn, $tmp)) {
 395                             $coinsurance = 0 + $tmp[1]; // from 835 before 6/2007
 396                             continue;
 397                         } else if (preg_match("/To deductible: (\S+)/i", $rsn, $tmp)) {
 398                             $deductible = 0 + $tmp[1]; // from 835 before 6/2007
 399                             continue;
 400                         } else {
 401                             continue; // there is no adjustment amount
 402                         }
 403                     } else {
 404                         continue; // it's for primary and that's not us
 405                     }
 406
 407                     if ($rcode == '42') {
 408                         $rcode= '45'; // reason 42 is obsolete
 409                     }
 410
 411                     $aadj[] = array($date, $gcode, $rcode, sprintf('%.2f', $chg));
 412                 } // end if
 413             } // end foreach
 414
 415             // If we really messed it up, at least avoid negative numbers.
 416             if ($coinsurance > $ptresp) {
 417                 $coinsurance = $ptresp;
 418             }
 419
 420             if ($deductible  > $ptresp) {
 421                 $deductible  = $ptresp;
 422             }
 423
 424             // Find out if this payer paid anything at all on this claim.  This will
 425             // help us allocate any unknown patient responsibility amounts.
 426             $thispaidanything = 0;
 427             foreach ($this->invoice as $codekey => $codeval) {
 428                 foreach ($codeval['dtl'] as $key => $value) {
 429                     // plv exists to indicate the payer level.
 430                     if ($value['plv'] == $insnumber) {
 431                         $thispaidanything += $value['pmt'];
 432                     }
 433                 }
 434             }
 435
 436             // Allocate any unknown patient responsibility by guessing if the
 437             // deductible has been satisfied.
 438             if ($thispaidanything) {
 439                 $coinsurance = $ptresp - $deductible;
 440             } else {
 441                 $deductible = $ptresp - $coinsurance;
 442             }
 443
 444             $deductible  = sprintf('%.2f', $deductible);
 445             $coinsurance = sprintf('%.2f', $coinsurance);
 446
 447             if ($date && $deductible != 0) {
 448                 $aadj[] = array($date, 'PR', '1', $deductible, $msp);
 449             }
 450
 451             if ($date && $coinsurance != 0) {
 452                 $aadj[] = array($date, 'PR', '2', $coinsurance, $msp);
 453             }
 454         } // end if
 455
 456         return $aadj;
 457     }
 458
 459   // Return date, total payments and total "hard" adjustments from the given
 460   // prior payer. If $code is specified then only that procedure key is
 461   // selected, otherwise it's for the whole claim.
 462   //
 463     public function payerTotals($ins, $code = '')
 464     {
 465         // If we have no modifiers stored in SQL-Ledger for this claim,
 466         // then we cannot use a modifier passed in with the key.
 467         $tmp = strpos($code, ':');
 468         if ($tmp && !$this->using_modifiers) {
 469             $code = substr($code, 0, $tmp);
 470         }
 471
 472         $inslabel = ($this->payerSequence($ins) == 'S') ? 'Ins2' : 'Ins1';
 473         $insnumber = substr($inslabel, 3);
 474         $paytotal = 0;
 475         $adjtotal = 0;
 476         $date = '';
 477         foreach ($this->invoice as $codekey => $codeval) {
 478             if ($code && strcmp($codekey, $code) != 0) {
 479                 continue;
 480             }
 481
 482             foreach ($codeval['dtl'] as $key => $value) {
 483                 // plv (from ar_activity.payer_type) exists to
 484                 // indicate the payer level.
 485                 if ($value['plv'] == $insnumber) {
 486                     if (!$date) {
 487                         $date = str_replace('-', '', trim(substr($key, 0, 10)));
 488                     }
 489
 490                     $paytotal += $value['pmt'];
 491                 }
 492             }
 493
 494             $aarr = $this->payerAdjustments($ins, $codekey);
 495             foreach ($aarr as $a) {
 496                 if (strcmp($a[1], 'PR') != 0) {
 497                     $adjtotal += $a[3];
 498                 }
 499
 500                 if (!$date) {
 501                     $date = $a[0];
 502                 }
 503             }
 504         }
 505
 506         return array($date, sprintf('%.2f', $paytotal), sprintf('%.2f', $adjtotal));
 507     }
 508
 509   // Return the amount already paid by the patient.
 510   //
 511     public function patientPaidAmount()
 512     {
 513         // For primary claims $this->invoice is not loaded, so get the co-pay
 514         // from the ar_activity table instead.
 515         if (empty($this->invoice)) {
 516             return $this->copay;
 517         }
 518
 519         //
 520         $amount = 0;
 521         foreach ($this->invoice as $codekey => $codeval) {
 522             foreach ($codeval['dtl'] as $key => $value) {
 523                 // plv exists to indicate the payer level.
 524                 if ($value['plv'] == 0) { // 0 indicates patient
 525                     $amount += $value['pmt'];
 526                 }
 527             }
 528         }
 529
 530         return sprintf('%.2f', $amount);
 531     }
 532
 533   // Return invoice total, including adjustments but not payments.
 534   //
 535     public function invoiceTotal()
 536     {
 537         $amount = 0;
 538         foreach ($this->invoice as $codekey => $codeval) {
 539             $amount += $codeval['chg'];
 540         }
 541
 542         return sprintf('%.2f', $amount);
 543     }
 544
 545   // Number of procedures in this claim.
 546     public function procCount()
 547     {
 548         return count($this->procs);
 549     }
 550
 551   // Number of payers for this claim. Ranges from 1 to 3.
 552     public function payerCount()
 553     {
 554         return count($this->payers);
 555     }
 556
 557     public function x12gsversionstring()
 558     {
 559         return Claim::X12_VERSION;
 560     }
 561
 562     public function x12gssenderid()
 563     {
 564         $tmp = $this->x12_partner['x12_sender_id'];
 565         while (strlen($tmp) < 15) {
 566             $tmp .= " ";
 567         }
 568
 569         return $tmp;
 570     }
 571
 572     public function x12gs03()
 573     {
 574        /*
 575       * GS03: Application Receiver's Code
 576       * Code Identifying Party Receiving Transmission
 577       *
 578       * In most cases, the ISA08 and GS03 are the same. However
 579       *
 580       * In some clearing houses ISA08 and GS03 are different
 581       * Example: https://www.acs-gcro.com/downloads/DOL/DOL_CG_X12N_5010_837_v1_02.pdf - Page 18
 582       * In this .pdf, the ISA08 is specified to be 100000 while the GS03 is specified to be 77044
 583       *
 584       * Therefore if the x12_gs03 segement is explicitly specified we use that value,
 585       * otherwise we simply use the same receiver ID as specified for ISA03
 586         */
 587         if ($this->x12_partner['x12_gs03'] !== '') {
 588             return $this->x12_partner['x12_gs03'];
 589         } else {
 590             return $this->x12_partner['x12_receiver_id'];
 591         }
 592     }
 593
 594     public function x12gsreceiverid()
 595     {
 596         $tmp = $this->x12_partner['x12_receiver_id'];
 597         while (strlen($tmp) < 15) {
 598             $tmp .= " ";
 599         }
 600
 601         return $tmp;
 602     }
 603
 604     public function x12gsisa05()
 605     {
 606         return $this->x12_partner['x12_isa05'];
 607     }
 608 //adding in public functions for isa 01 - isa 04
 609
 610     public function x12gsisa01()
 611     {
 612         return $this->x12_partner['x12_isa01'];
 613     }
 614
 615     public function x12gsisa02()
 616     {
 617         return $this->x12_partner['x12_isa02'];
 618     }
 619
 620     public function x12gsisa03()
 621     {
 622         return $this->x12_partner['x12_isa03'];
 623     }
 624     public function x12gsisa04()
 625     {
 626         return $this->x12_partner['x12_isa04'];
 627     }
 628
 629 /////////
 630     public function x12gsisa07()
 631     {
 632         return $this->x12_partner['x12_isa07'];
 633     }
 634
 635     public function x12gsisa14()
 636     {
 637         return $this->x12_partner['x12_isa14'];
 638     }
 639
 640     public function x12gsisa15()
 641     {
 642         return $this->x12_partner['x12_isa15'];
 643     }
 644
 645     public function x12gsgs02()
 646     {
 647         $tmp = $this->x12_partner['x12_gs02'];
 648         if ($tmp === '') {
 649             $tmp = $this->x12_partner['x12_sender_id'];
 650         }
 651
 652         return $tmp;
 653     }
 654
 655     public function x12gsper06()
 656     {
 657         return $this->x12_partner['x12_per06'];
 658     }
 659
 660     public function cliaCode()
 661     {
 662         return $this->x12Clean(trim($this->facility['domain_identifier']));
 663     }
 664
 665     public function billingFacilityName()
 666     {
 667         return $this->x12Clean(trim($this->billing_facility['name']));
 668     }
 669
 670     public function billingFacilityStreet()
 671     {
 672         return $this->x12Clean(trim($this->billing_facility['street']));
 673     }
 674
 675     public function billingFacilityCity()
 676     {
 677         return $this->x12Clean(trim($this->billing_facility['city']));
 678     }
 679
 680     public function billingFacilityState()
 681     {
 682         return $this->x12Clean(trim($this->billing_facility['state']));
 683     }
 684
 685     public function billingFacilityZip()
 686     {
 687         return $this->x12Clean(trim($this->billing_facility['postal_code']));
 688     }
 689
 690     public function billingFacilityETIN()
 691     {
 692         return $this->x12Clean(trim(str_replace('-', '', $this->billing_facility['federal_ein'])));
 693     }
 694
 695     public function billingFacilityNPI()
 696     {
 697         return $this->x12Clean(trim($this->billing_facility['facility_npi']));
 698     }
 699
 700     public function federalIdType()
 701     {
 702         if ($this->billing_facility['tax_id_type']) {
 703             return $this->billing_facility['tax_id_type'];
 704         } else {
 705             return null;
 706         }
 707     }
 708
 709   # The billing facility and the patient must both accept for this to return true.
 710     public function billingFacilityAssignment($ins = 0)
 711     {
 712         $tmp = strtoupper($this->payers[$ins]['data']['accept_assignment']);
 713         if (strcmp($tmp, 'FALSE') == 0) {
 714             return '0';
 715         }
 716
 717         return !empty($this->billing_facility['accepts_assignment']);
 718     }
 719
 720     public function billingContactName()
 721     {
 722         return $this->x12Clean(trim($this->billing_facility['attn']));
 723     }
 724
 725     public function billingContactPhone()
 726     {
 727         if (preg_match(
 728             "/([2-9]\d\d)\D*(\d\d\d)\D*(\d\d\d\d)/",
 729             $this->billing_facility['phone'],
 730             $tmp
 731         )) {
 732             return $tmp[1] . $tmp[2] . $tmp[3];
 733         }
 734
 735         return '';
 736     }
 737
 738     public function billingContactEmail()
 739     {
 740         return $this->x12Clean(trim($this->billing_facility['email']));
 741     }
 742
 743     public function facilityName()
 744     {
 745         return $this->x12Clean(trim($this->facility['name']));
 746     }
 747
 748     public function facilityStreet()
 749     {
 750         return $this->x12Clean(trim($this->facility['street']));
 751     }
 752
 753     public function facilityCity()
 754     {
 755         return $this->x12Clean(trim($this->facility['city']));
 756     }
 757
 758     public function facilityState()
 759     {
 760         return $this->x12Clean(trim($this->facility['state']));
 761     }
 762
 763     public function facilityZip()
 764     {
 765         return $this->x12Clean(trim($this->facility['postal_code']));
 766     }
 767
 768     public function facilityETIN()
 769     {
 770         return $this->x12Clean(trim(str_replace('-', '', $this->facility['federal_ein'])));
 771     }
 772
 773     public function facilityNPI()
 774     {
 775         return $this->x12Clean(trim($this->facility['facility_npi']));
 776     }
 777
 778     public function facilityPOS()
 779     {
 780         if ($this->encounter['pos_code']) {
 781             return sprintf('%02d', trim($this->encounter['pos_code']));
 782         } else {
 783             return sprintf('%02d', trim($this->facility['pos_code']));
 784         }
 785     }
 786
 787     public function facilityTaxonomy()
 788     {
 789         return $this->x12Clean(trim($this->facility['facility_taxonomy']));
 790     }
 791
 792     public function clearingHouseName()
 793     {
 794         return $this->x12Clean(trim($this->x12_partner['name']));
 795     }
 796
 797     public function clearingHouseETIN()
 798     {
 799         return $this->x12Clean(trim(str_replace('-', '', $this->x12_partner['id_number'])));
 800     }
 801
 802     public function providerNumberType($prockey = -1)
 803     {
 804         $tmp = ($prockey < 0 || empty($this->procs[$prockey]['provider_id'])) ?
 805         $this->insurance_numbers : $this->procs[$prockey]['insurance_numbers'];
 806         return $tmp['provider_number_type'];
 807     }
 808
 809     public function providerNumber($prockey = -1)
 810     {
 811         $tmp = ($prockey < 0 || empty($this->procs[$prockey]['provider_id'])) ?
 812         $this->insurance_numbers : $this->procs[$prockey]['insurance_numbers'];
 813         return $this->x12Clean(trim(str_replace('-', '', $tmp['provider_number'])));
 814     }
 815
 816     public function providerGroupNumber($prockey = -1)
 817     {
 818         $tmp = ($prockey < 0 || empty($this->procs[$prockey]['provider_id'])) ?
 819         $this->insurance_numbers : $this->procs[$prockey]['insurance_numbers'];
 820         return $this->x12Clean(trim(str_replace('-', '', $tmp['group_number'])));
 821     }
 822
 823   // Returns 'P', 'S' or 'T'.
 824   //
 825     public function payerSequence($ins = 0)
 826     {
 827         return strtoupper(substr($this->payers[$ins]['data']['type'], 0, 1));
 828     }
 829
 830   // Returns the HIPAA code of the patient-to-subscriber relationship.
 831   //
 832     public function insuredRelationship($ins = 0)
 833     {
 834         $tmp = strtolower($this->payers[$ins]['data']['subscriber_relationship']);
 835         if (strcmp($tmp, 'self') == 0) {
 836             return '18';
 837         }
 838
 839         if (strcmp($tmp, 'spouse') == 0) {
 840             return '01';
 841         }
 842
 843         if (strcmp($tmp, 'child') == 0) {
 844             return '19';
 845         }
 846
 847         if (strcmp($tmp, 'other') == 0) {
 848             return 'G8';
 849         }
 850
 851         return $tmp; // should not happen
 852     }
 853
 854     public function insuredTypeCode($ins = 0)
 855     {
 856         if (strcmp($this->claimType($ins), 'MB') == 0 && $this->payerSequence($ins) != 'P') {
 857             return $this->payers[$ins]['data']['policy_type'];
 858         } else {
 859             return '';
 860         }
 861     }
 862
 863   // Is the patient also the subscriber?
 864   //
 865     public function isSelfOfInsured($ins = 0)
 866     {
 867         $tmp = strtolower($this->payers[$ins]['data']['subscriber_relationship']);
 868         return (strcmp($tmp, 'self') == 0);
 869     }
 870
 871     public function planName($ins = 0)
 872     {
 873         return $this->x12Clean(trim($this->payers[$ins]['data']['plan_name']));
 874     }
 875
 876     public function policyNumber($ins = 0)
 877     {
 878  // "ID"
 879         return $this->x12Clean(trim($this->payers[$ins]['data']['policy_number']));
 880     }
 881
 882     public function groupNumber($ins = 0)
 883     {
 884         return $this->x12Clean(trim($this->payers[$ins]['data']['group_number']));
 885     }
 886
 887     public function groupName($ins = 0)
 888     {
 889         return $this->x12Clean(trim($this->payers[$ins]['data']['subscriber_employer']));
 890     }
 891
 892   // Claim types are:
 893   // 16 Other HCFA
 894   // MB Medicare Part B
 895   // MC Medicaid
 896   // CH ChampUSVA
 897   // CH ChampUS
 898   // BL Blue Cross Blue Shield
 899   // 16 FECA
 900   // 09 Self Pay
 901   // 10 Central Certification
 902   // 11 Other Non-Federal Programs
 903   // 12 Preferred Provider Organization (PPO)
 904   // 13 Point of Service (POS)
 905   // 14 Exclusive Provider Organization (EPO)
 906   // 15 Indemnity Insurance
 907   // 16 Health Maintenance Organization (HMO) Medicare Risk
 908   // AM Automobile Medical
 909   // CI Commercial Insurance Co.
 910   // DS Disability
 911   // HM Health Maintenance Organization
 912   // LI Liability
 913   // LM Liability Medical
 914   // OF Other Federal Program
 915   // TV Title V
 916   // VA Veterans Administration Plan
 917   // WC Workers Compensation Health Plan
 918   // ZZ Mutually Defined
 919   //
 920     public function claimType($ins = 0)
 921     {
 922         if (empty($this->payers[$ins]['object'])) {
 923             return '';
 924         }
 925
 926         return $this->payers[$ins]['object']->get_ins_claim_type();
 927     }
 928
 929     public function claimTypeRaw($ins = 0)
 930     {
 931         if (empty($this->payers[$ins]['object'])) {
 932             return 0;
 933         }
 934
 935         return $this->payers[$ins]['object']->get_ins_type_code();
 936     }
 937
 938     public function insuredLastName($ins = 0)
 939     {
 940         return $this->x12Clean(trim($this->payers[$ins]['data']['subscriber_lname']));
 941     }
 942
 943     public function insuredFirstName($ins = 0)
 944     {
 945         return $this->x12Clean(trim($this->payers[$ins]['data']['subscriber_fname']));
 946     }
 947
 948     public function insuredMiddleName($ins = 0)
 949     {
 950         return $this->x12Clean(trim($this->payers[$ins]['data']['subscriber_mname']));
 951     }
 952
 953     public function insuredStreet($ins = 0)
 954     {
 955         return $this->x12Clean(trim($this->payers[$ins]['data']['subscriber_street']));
 956     }
 957
 958     public function insuredCity($ins = 0)
 959     {
 960         return $this->x12Clean(trim($this->payers[$ins]['data']['subscriber_city']));
 961     }
 962
 963     public function insuredState($ins = 0)
 964     {
 965         return $this->x12Clean(trim($this->payers[$ins]['data']['subscriber_state']));
 966     }
 967
 968     public function insuredZip($ins = 0)
 969     {
 970         return $this->x12Clean(trim($this->payers[$ins]['data']['subscriber_postal_code']));
 971     }
 972
 973     public function insuredPhone($ins = 0)
 974     {
 975         if (preg_match(
 976             "/([2-9]\d\d)\D*(\d\d\d)\D*(\d\d\d\d)/",
 977             $this->payers[$ins]['data']['subscriber_phone'],
 978             $tmp
 979         )) {
 980             return $tmp[1] . $tmp[2] . $tmp[3];
 981         }
 982
 983         return '';
 984     }
 985
 986     public function insuredDOB($ins = 0)
 987     {
 988         return str_replace('-', '', $this->payers[$ins]['data']['subscriber_DOB']);
 989     }
 990
 991     public function insuredSex($ins = 0)
 992     {
 993         return strtoupper(substr($this->payers[$ins]['data']['subscriber_sex'], 0, 1));
 994     }
 995
 996     public function payerName($ins = 0)
 997     {
 998         return $this->x12Clean(trim($this->payers[$ins]['company']['name']));
 999     }
1000
1001     public function payerAttn($ins = 0)
1002     {
1003         return $this->x12Clean(trim($this->payers[$ins]['company']['attn']));
1004     }
1005
1006     public function payerStreet($ins = 0)
1007     {
1008         if (empty($this->payers[$ins]['object'])) {
1009             return '';
1010         }
1011
1012         $tmp = $this->payers[$ins]['object'];
1013         $tmp = $tmp->get_address();
1014         return $this->x12Clean(trim($tmp->get_line1()));
1015     }
1016
1017     public function payerCity($ins = 0)
1018     {
1019         if (empty($this->payers[$ins]['object'])) {
1020             return '';
1021         }
1022
1023         $tmp = $this->payers[$ins]['object'];
1024         $tmp = $tmp->get_address();
1025         return $this->x12Clean(trim($tmp->get_city()));
1026     }
1027
1028     public function payerState($ins = 0)
1029     {
1030         if (empty($this->payers[$ins]['object'])) {
1031             return '';
1032         }
1033
1034         $tmp = $this->payers[$ins]['object'];
1035         $tmp = $tmp->get_address();
1036         return $this->x12Clean(trim($tmp->get_state()));
1037     }
1038
1039     public function payerZip($ins = 0)
1040     {
1041         if (empty($this->payers[$ins]['object'])) {
1042             return '';
1043         }
1044
1045         $tmp = $this->payers[$ins]['object'];
1046         $tmp = $tmp->get_address();
1047         return $this->x12Clean(trim($tmp->get_zip()));
1048     }
1049
1050     public function payerID($ins = 0)
1051     {
1052         return $this->x12Clean(trim($this->payers[$ins]['company']['cms_id']));
1053     }
1054
1055     public function payerAltID($ins = 0)
1056     {
1057         return $this->x12Clean(trim($this->payers[$ins]['company']['alt_cms_id']));
1058     }
1059
1060     public function patientLastName()
1061     {
1062         return $this->x12Clean(trim($this->patient_data['lname']));
1063     }
1064
1065     public function patientFirstName()
1066     {
1067         return $this->x12Clean(trim($this->patient_data['fname']));
1068     }
1069
1070     public function patientMiddleName()
1071     {
1072         return $this->x12Clean(trim($this->patient_data['mname']));
1073     }
1074
1075     public function patientStreet()
1076     {
1077         return $this->x12Clean(trim($this->patient_data['street']));
1078     }
1079
1080     public function patientCity()
1081     {
1082         return $this->x12Clean(trim($this->patient_data['city']));
1083     }
1084
1085     public function patientState()
1086     {
1087         return $this->x12Clean(trim($this->patient_data['state']));
1088     }
1089
1090     public function patientZip()
1091     {
1092         return $this->x12Clean(trim($this->patient_data['postal_code']));
1093     }
1094
1095     public function patientPhone()
1096     {
1097         $ptphone = $this->patient_data['phone_home'];
1098         if (!$ptphone) {
1099             $ptphone = $this->patient_data['phone_biz'];
1100         }
1101
1102         if (!$ptphone) {
1103             $ptphone = $this->patient_data['phone_cell'];
1104         }
1105
1106         if (preg_match("/([2-9]\d\d)\D*(\d\d\d)\D*(\d\d\d\d)/", $ptphone, $tmp)) {
1107             return $tmp[1] . $tmp[2] . $tmp[3];
1108         }
1109
1110         return '';
1111     }
1112
1113     public function patientDOB()
1114     {
1115         return str_replace('-', '', $this->patient_data['DOB']);
1116     }
1117
1118     public function patientSex()
1119     {
1120         return strtoupper(substr($this->patient_data['sex'], 0, 1));
1121     }
1122
1123   // Patient Marital Status: M = Married, S = Single, or something else.
1124     public function patientStatus()
1125     {
1126         return strtoupper(substr($this->patient_data['status'], 0, 1));
1127     }
1128
1129   // This should be UNEMPLOYED, STUDENT, PT STUDENT, or anything else to
1130   // indicate employed.
1131     public function patientOccupation()
1132     {
1133         return strtoupper($this->x12Clean(trim($this->patient_data['occupation'])));
1134     }
1135
1136     public function cptCode($prockey)
1137     {
1138         return $this->x12Clean(trim($this->procs[$prockey]['code']));
1139     }
1140
1141     public function cptModifier($prockey)
1142     {
1143         // Split on the colon or space and clean each modifier
1144         $mods = array();
1145         $cln_mods = array();
1146         $mods = preg_split("/[: ]/", trim($this->procs[$prockey]['modifier']));
1147         foreach ($mods as $mod) {
1148             array_push($cln_mods, $this->x12Clean($mod));
1149         }
1150
1151         return (implode(':', $cln_mods));
1152     }
1153
1154     public function cptNotecodes($prockey)
1155     {
1156         return $this->x12Clean(trim($this->procs[$prockey]['notecodes']));
1157     }
1158
1159   // Returns the procedure code, followed by ":modifier" if there is one.
1160     public function cptKey($prockey)
1161     {
1162         $tmp = $this->cptModifier($prockey);
1163         return $this->cptCode($prockey) . ($tmp ? ":$tmp" : "");
1164     }
1165
1166     public function cptCharges($prockey)
1167     {
1168         return $this->x12Clean(trim($this->procs[$prockey]['fee']));
1169     }
1170
1171     public function cptUnits($prockey)
1172     {
1173         if (empty($this->procs[$prockey]['units'])) {
1174             return '1';
1175         }
1176
1177         return $this->x12Clean(trim($this->procs[$prockey]['units']));
1178     }
1179
1180   // NDC drug ID.
1181     public function cptNDCID($prockey)
1182     {
1183         $ndcinfo = $this->procs[$prockey]['ndc_info'];
1184         if (preg_match('/^N4(\S+)\s+(\S\S)(.*)/', $ndcinfo, $tmp)) {
1185             $ndc = $tmp[1];
1186             if (preg_match('/^(\d+)-(\d+)-(\d+)$/', $ndc, $tmp)) {
1187                 return sprintf('%05d%04d%02d', $tmp[1], $tmp[2], $tmp[3]);
1188             }
1189
1190             return $this->x12Clean($ndc); // format is bad but return it anyway
1191         }
1192
1193         return '';
1194     }
1195
1196   // NDC drug unit of measure code.
1197     public function cptNDCUOM($prockey)
1198     {
1199         $ndcinfo = $this->procs[$prockey]['ndc_info'];
1200         if (preg_match('/^N4(\S+)\s+(\S\S)(.*)/', $ndcinfo, $tmp)) {
1201             return $this->x12Clean($tmp[2]);
1202         }
1203
1204         return '';
1205     }
1206
1207   // NDC drug number of units.
1208     public function cptNDCQuantity($prockey)
1209     {
1210         $ndcinfo = $this->procs[$prockey]['ndc_info'];
1211         if (preg_match('/^N4(\S+)\s+(\S\S)(.*)/', $ndcinfo, $tmp)) {
1212             return $this->x12Clean(ltrim($tmp[3], '0'));
1213         }
1214
1215         return '';
1216     }
1217
1218     public function onsetDate()
1219     {
1220         return $this->cleanDate($this->encounter['onset_date']);
1221     }
1222
1223     public function onsetDateValid()
1224     {
1225         return $this->onsetDate()!=='';
1226     }
1227
1228     public function serviceDate()
1229     {
1230         return str_replace('-', '', substr($this->encounter['date'], 0, 10));
1231     }
1232
1233     public function priorAuth()
1234     {
1235         return $this->x12Clean(trim($this->billing_options['prior_auth_number']));
1236     }
1237
1238     public function isRelatedEmployment()
1239     {
1240         return !empty($this->billing_options['employment_related']);
1241     }
1242
1243     public function isRelatedAuto()
1244     {
1245         return !empty($this->billing_options['auto_accident']);
1246     }
1247
1248     public function isRelatedOther()
1249     {
1250         return !empty($this->billing_options['other_accident']);
1251     }
1252
1253     public function autoAccidentState()
1254     {
1255         return $this->x12Clean(trim($this->billing_options['accident_state']));
1256     }
1257
1258     public function isUnableToWork()
1259     {
1260         return !empty($this->billing_options['is_unable_to_work']);
1261     }
1262
1263     public function offWorkFrom()
1264     {
1265         return $this->cleanDate($this->billing_options['off_work_from']);
1266     }
1267
1268     public function offWorkTo()
1269     {
1270         return $this->cleanDate($this->billing_options['off_work_to']);
1271     }
1272
1273     public function isHospitalized()
1274     {
1275         return !empty($this->billing_options['is_hospitalized']);
1276     }
1277
1278     public function hospitalizedFrom()
1279     {
1280         return $this->cleanDate($this->billing_options['hospitalization_date_from']);
1281     }
1282
1283     public function hospitalizedFromDateValid()
1284     {
1285         return $this->hospitalizedFrom()!=='';
1286     }
1287
1288     public function hospitalizedTo()
1289     {
1290         return $this->cleanDate($this->billing_options['hospitalization_date_to']);
1291     }
1292     public function hospitalizedToDateValid()
1293     {
1294         return $this->hospitalizedTo()!=='';
1295     }
1296
1297     public function isOutsideLab()
1298     {
1299         return !empty($this->billing_options['outside_lab']);
1300     }
1301
1302     public function outsideLabAmount()
1303     {
1304         return sprintf('%.2f', 0 + $this->billing_options['lab_amount']);
1305     }
1306
1307     public function medicaidReferralCode()
1308     {
1309         return $this->x12Clean(trim($this->billing_options['medicaid_referral_code']));
1310     }
1311
1312     public function epsdtFlag()
1313     {
1314         return $this->x12Clean(trim($this->billing_options['epsdt_flag']));
1315     }
1316
1317     public function medicaidResubmissionCode()
1318     {
1319         return $this->x12Clean(trim($this->billing_options['medicaid_resubmission_code']));
1320     }
1321
1322     public function medicaidOriginalReference()
1323     {
1324         return $this->x12Clean(trim($this->billing_options['medicaid_original_reference']));
1325     }
1326
1327     public function frequencyTypeCode()
1328     {
1329         return ($this->billing_options['replacement_claim'] == 1) ? '7' : '1';
1330     }
1331
1332     public function icnResubmissionNumber()
1333     {
1334         return $this->x12Clean($this->billing_options['icn_resubmission_number']);
1335     }
1336
1337     public function additionalNotes()
1338     {
1339         return $this->x12Clean(trim($this->billing_options['comments']));
1340     }
1341
1342     public function miscOnsetDate()
1343     {
1344         return $this->cleanDate($this->billing_options['onset_date']);
1345     }
1346
1347     public function miscOnsetDateValid()
1348     {
1349         return $this->miscOnsetDate()!=='';
1350     }
1351
1352     public function dateInitialTreatment()
1353     {
1354         return $this->cleanDate($this->billing_options['date_initial_treatment']);
1355     }
1356
1357     public function dateInitialTreatmentValid()
1358     {
1359         return $this->dateInitialTreatment()!=='';
1360     }
1361
1362     public function box14Qualifier()
1363     {
1364         // If no box qualifier specified use "431" indicating Onset
1365         return empty($this->billing_options['box_14_date_qual']) ? '431' :
1366             $this->billing_options['box_14_date_qual'];
1367     }
1368
1369     public function box15Qualifier()
1370     {
1371         // If no box qualifier specified use "454" indicating Initial Treatment
1372         return empty($this->billing_options['box_15_date_qual']) ? '454' :
1373             $this->billing_options['box_15_date_qual'];
1374     }
1375
1376     public function box17Qualifier()
1377     {
1378         //If no box qualifier specified use "DK" for ordering provider
1379         //someday might make mbo form the place to set referring instead of demographics under choices
1380         return empty($this->billing_options['provider_qualifier_code']) ? '' :
1381             $this->billing_options['provider_qualifier_code'];
1382     }
1383
1384   // Returns an array of unique diagnoses.  Periods are stripped by default
1385   // Option to keep periods is to support HCFA 1500 02/12 version
1386     public function diagArray($strip_periods = true)
1387     {
1388         $da = array();
1389         foreach ($this->procs as $row) {
1390             $atmp = explode(':', $row['justify']);
1391             foreach ($atmp as $tmp) {
1392                 if (!empty($tmp)) {
1393                     $code_data = explode('|', $tmp);
1394
1395                     // If there was a | in the code data, the the first part of the array is the type, and the second is the identifier
1396                     if (!empty($code_data[1])) {
1397                         // This is the simplest way to determine if the claim is using ICD9 or ICD10 codes
1398                         // a mix of code types is generally not allowed as there is only one specifier for all diagnoses on HCFA-1500 form
1399                         // and there would be ambiguity with E and V codes
1400                         $this->diagtype=$code_data[0];
1401
1402                         //code is in the second part of the $code_data array.
1403                         if ($strip_periods==true) {
1404                                 $diag = str_replace('.', '', $code_data[1]);
1405                         } else {
1406                             $diag=$code_data[1];
1407                         }
1408                     } else {
1409                         //No prepended code type label
1410                         if ($strip_periods) {
1411                             $diag = str_replace('.', '', $code_data[0]);
1412                         } else {
1413                             $diag=$code_data[0];
1414                         }
1415                     }
1416
1417                     $da[$diag] = $diag;
1418                 }
1419             }
1420         }
1421
1422         // The above got all the diagnoses used for justification, in the order
1423         // used for justification.  Next we go through all diagnoses, justified
1424         // or not, to make sure they all get into the claim.  We do it this way
1425         // so that the more important diagnoses appear first.
1426         foreach ($this->diags as $diag) {
1427             if ($strip_periods) {
1428                 $diag = str_replace('.', '', $diag);
1429             }
1430
1431             $da[$diag] = $diag;
1432         }
1433
1434         return $da;
1435     }
1436
1437   // Compute one 1-relative index in diagArray for the given procedure.
1438   // This function is obsolete, use diagIndexArray() instead.
1439     public function diagIndex($prockey)
1440     {
1441         $da = $this->diagArray();
1442         $tmp = explode(':', $this->procs[$prockey]['justify']);
1443         if (empty($tmp)) {
1444             return '';
1445         }
1446
1447         $diag = str_replace('.', '', $tmp[0]);
1448         $i = 0;
1449         foreach ($da as $value) {
1450             ++$i;
1451             if (strcmp($value, $diag) == 0) {
1452                 return $i;
1453             }
1454         }
1455
1456         return '';
1457     }
1458
1459   // Compute array of 1-relative diagArray indices for the given procedure.
1460     public function diagIndexArray($prockey)
1461     {
1462         $dia = array();
1463         $da = $this->diagArray();
1464         $atmp = explode(':', $this->procs[$prockey]['justify']);
1465         foreach ($atmp as $tmp) {
1466             if (!empty($tmp)) {
1467                 $code_data = explode('|', $tmp);
1468                 if (!empty($code_data[1])) {
1469                     //Strip the prepended code type label
1470                     $diag = str_replace('.', '', $code_data[1]);
1471                 } else {
1472                     //No prepended code type label
1473                     $diag = str_replace('.', '', $code_data[0]);
1474                 }
1475
1476                 $i = 0;
1477                 foreach ($da as $value) {
1478                     ++$i;
1479                     if (strcmp($value, $diag) == 0) {
1480                         $dia[] = $i;
1481                     }
1482                 }
1483             }
1484         }
1485
1486         return $dia;
1487     }
1488
1489     public function providerLastName($prockey = -1)
1490     {
1491         $tmp = ($prockey < 0 || empty($this->procs[$prockey]['provider_id'])) ?
1492         $this->provider : $this->procs[$prockey]['provider'];
1493         return $this->x12Clean(trim($tmp['lname']));
1494     }
1495
1496     public function providerFirstName($prockey = -1)
1497     {
1498         $tmp = ($prockey < 0 || empty($this->procs[$prockey]['provider_id'])) ?
1499         $this->provider : $this->procs[$prockey]['provider'];
1500         return $this->x12Clean(trim($tmp['fname']));
1501     }
1502
1503     public function providerMiddleName($prockey = -1)
1504     {
1505         $tmp = ($prockey < 0 || empty($this->procs[$prockey]['provider_id'])) ?
1506         $this->provider : $this->procs[$prockey]['provider'];
1507         return $this->x12Clean(trim($tmp['mname']));
1508     }
1509
1510     public function providerSuffixName($prockey = -1)
1511     {
1512         $tmp = ($prockey < 0 || empty($this->procs[$prockey]['provider_id'])) ?
1513             $this->provider : $this->procs[$prockey]['provider'];
1514         return $this->x12Clean(trim($tmp['suffix']));
1515     }
1516
1517     public function providerNPI($prockey = -1)
1518     {
1519         $tmp = ($prockey < 0 || empty($this->procs[$prockey]['provider_id'])) ?
1520         $this->provider : $this->procs[$prockey]['provider'];
1521         return $this->x12Clean(trim($tmp['npi']));
1522     }
1523
1524     public function NPIValid($npi)
1525     {
1526         // A NPI MUST be a 10 digit number
1527         if ($npi==='') {
1528             return false;
1529         }
1530
1531         if (strlen($npi)!=10) {
1532             return false;
1533         }
1534
1535         if (!preg_match("/[0-9]*/", $npi)) {
1536             return false;
1537         }
1538
1539         return true;
1540     }
1541     public function providerNPIValid($prockey = -1)
1542     {
1543         return $this->NPIValid($this->providerNPI($prockey));
1544     }
1545
1546     public function providerUPIN($prockey = -1)
1547     {
1548         $tmp = ($prockey < 0 || empty($this->procs[$prockey]['provider_id'])) ?
1549         $this->provider : $this->procs[$prockey]['provider'];
1550         return $this->x12Clean(trim($tmp['upin']));
1551     }
1552
1553     public function providerSSN($prockey = -1)
1554     {
1555         $tmp = ($prockey < 0 || empty($this->procs[$prockey]['provider_id'])) ?
1556         $this->provider : $this->procs[$prockey]['provider'];
1557         return $this->x12Clean(trim(str_replace('-', '', $tmp['federaltaxid'])));
1558     }
1559
1560     public function providerTaxonomy($prockey = -1)
1561     {
1562         $tmp = ($prockey < 0 || empty($this->procs[$prockey]['provider_id'])) ?
1563         $this->provider : $this->procs[$prockey]['provider'];
1564         if (empty($tmp['taxonomy'])) {
1565             return '207Q00000X';
1566         }
1567
1568         return $this->x12Clean(trim($tmp['taxonomy']));
1569     }
1570
1571     public function referrerLastName()
1572     {
1573         return $this->x12Clean(trim($this->referrer['lname']));
1574     }
1575
1576     public function referrerFirstName()
1577     {
1578         return $this->x12Clean(trim($this->referrer['fname']));
1579     }
1580
1581     public function referrerMiddleName()
1582     {
1583         return $this->x12Clean(trim($this->referrer['mname']));
1584     }
1585
1586     public function referrerNPI()
1587     {
1588         return $this->x12Clean(trim($this->referrer['npi']));
1589     }
1590
1591     public function referrerUPIN()
1592     {
1593         return $this->x12Clean(trim($this->referrer['upin']));
1594     }
1595
1596     public function referrerSSN()
1597     {
1598         return $this->x12Clean(trim(str_replace('-', '', $this->referrer['federaltaxid'])));
1599     }
1600
1601     public function referrerTaxonomy()
1602     {
1603         if (empty($this->referrer['taxonomy'])) {
1604             return '207Q00000X';
1605         }
1606
1607         return $this->x12Clean(trim($this->referrer['taxonomy']));
1608     }
1609
1610     public function supervisorLastName()
1611     {
1612         return $this->x12Clean(trim($this->supervisor['lname']));
1613     }
1614
1615     public function supervisorFirstName()
1616     {
1617         return $this->x12Clean(trim($this->supervisor['fname']));
1618     }
1619
1620     public function supervisorMiddleName()
1621     {
1622         return $this->x12Clean(trim($this->supervisor['mname']));
1623     }
1624
1625     public function supervisorNPI()
1626     {
1627         return $this->x12Clean(trim($this->supervisor['npi']));
1628     }
1629
1630     public function supervisorUPIN()
1631     {
1632         return $this->x12Clean(trim($this->supervisor['upin']));
1633     }
1634
1635     public function supervisorSSN()
1636     {
1637         return $this->x12Clean(trim(str_replace('-', '', $this->supervisor['federaltaxid'])));
1638     }
1639
1640     public function supervisorTaxonomy()
1641     {
1642         if (empty($this->supervisor['taxonomy'])) {
1643             return '207Q00000X';
1644         }
1645
1646         return $this->x12Clean(trim($this->supervisor['taxonomy']));
1647     }
1648
1649     public function supervisorNumberType()
1650     {
1651         return $this->supervisor_numbers['provider_number_type'];
1652     }
1653
1654     public function supervisorNumber()
1655     {
1656         return $this->x12Clean(trim(str_replace('-', '', $this->supervisor_numbers['provider_number'])));
1657     }
1658
1659     public function billingProviderLastName()
1660     {
1661         return $this->x12Clean(trim($this->billing_prov_id['lname']));
1662     }
1663
1664     public function billingProviderFirstName()
1665     {
1666         return $this->x12Clean(trim($this->billing_prov_id['fname']));
1667     }
1668
1669     public function billingProviderMiddleName()
1670     {
1671         return $this->x12Clean(trim($this->billing_prov_id['mname']));
1672     }
1673
1674     public function billingProviderNPI()
1675     {
1676         return $this->x12Clean(trim($this->billing_prov_id['npi']));
1677     }
1678
1679     public function billingProviderUPIN()
1680     {
1681         return $this->x12Clean(trim($this->billing_prov_id['upin']));
1682     }
1683
1684     public function billingProviderSSN()
1685     {
1686         return $this->x12Clean(trim(str_replace('-', '', $this->billing_prov_id['federaltaxid'])));
1687     }
1688
1689     public function billingProviderTaxonomy()
1690     {
1691         if (empty($this->billing_prov_id['taxonomy'])) {
1692             return '207Q00000X';
1693         }
1694         return $this->x12Clean(trim($this->billing_prov_id['taxonomy']));
1695     }
1696
1697     public function billingProviderStreet()
1698     {
1699         return $this->x12Clean(trim($this->billing_prov_id['street']));
1700     }
1701
1702     public function billingProviderStreetB()
1703     {
1704         return $this->x12Clean(trim($this->billing_prov_id['streetb']));
1705     }
1706
1707     public function billingProviderCity()
1708     {
1709         return $this->x12Clean(trim($this->billing_prov_id['city']));
1710     }
1711
1712     public function billingProviderState()
1713     {
1714         return $this->x12Clean(trim($this->billing_prov_id['state']));
1715     }
1716
1717     public function billingProviderZip()
1718     {
1719         return $this->x12Clean(trim($this->billing_prov_id['zip']));
1720     }
1721 }