src/Billing/SLEOB.php

   1 <?php
   2
   3 /**
   4  * This class has various billing functions for posting charges and payments.
   5  *
   6  * @package OpenEMR
   7  * @author Rod Roark <rod@sunsetsystems.com>
   8  * @author Stephen Waite <stephen.waite@cmsvt.com>
   9  * @copyright Copyright (c) 2005-2009 Rod Roark <rod@sunsetsystems.com>
  10  * @copyright Copyright (c) 2018 Stephen Waite <stephen.waite@cmsvt.com>
  11  * @link https://www.open-emr.org
  12  * @license https://github.com/openemr/openemr/blob/master/LICENSE GNU General Public License 3
  13  */
  14
  15 namespace OpenEMR\Billing;
  16
  17 require_once(dirname(__FILE__) . "/../../library/patient.inc.php");
  18
  19 use OpenEMR\Billing\BillingUtilities;
  20
  21 class SLEOB
  22 {
  23     // Try to figure out our invoice number (pid.encounter) from the
  24     // claim ID and other stuff in the ERA.  This should be straightforward
  25     // except that some payers mangle the claim ID that we give them.
  26     //
  27     public static function slInvoiceNumber(&$out)
  28     {
  29         $invnumber = $out['our_claim_id'];
  30         $atmp = preg_split('/[ -]/', $invnumber);
  31         $acount = count($atmp);
  32
  33         $pid = 0;
  34         $encounter = 0;
  35         if ($acount == 2) {
  36             $pid = $atmp[0];
  37             $encounter = $atmp[1];
  38         } elseif ($acount == 3) {
  39             $pid = $atmp[0];
  40             $brow = sqlQuery("SELECT encounter FROM billing WHERE " .
  41                 "pid = '$pid' AND encounter = ? AND activity = 1", array($atmp[1]));
  42
  43             $encounter = $brow['encounter'];
  44         } elseif ($acount == 1) {
  45             $pres = sqlStatement("SELECT pid FROM patient_data WHERE " .
  46                 "lname LIKE ? AND " .
  47                 "fname LIKE ? " .
  48                 "ORDER BY pid DESC", array($out['patient_lname'], $out['patient_fname']));
  49             while ($prow = sqlFetchArray($pres)) {
  50                 if (strpos($invnumber, $prow['pid']) === 0) {
  51                     $pid = $prow['pid'];
  52                     $encounter = substr($invnumber, strlen($pid));
  53                     break;
  54                 }
  55             }
  56         }
  57
  58         if ($pid && $encounter) {
  59             $invnumber = "$pid.$encounter";
  60         }
  61
  62         return array($pid, $encounter, $invnumber);
  63     }
  64
  65     // This gets a posting session ID.  If the payer ID is not 0 and a matching
  66     // session already exists, then its ID is returned.  Otherwise a new session
  67     // is created.
  68     //
  69     public static function arGetSession($payer_id, $reference, $check_date, $deposit_date = '', $pay_total = 0)
  70     {
  71         if (empty($deposit_date)) {
  72             $deposit_date = $check_date;
  73         }
  74
  75         if ($payer_id) {
  76             $row = sqlQuery("SELECT session_id FROM ar_session WHERE " .
  77                 "payer_id = ? AND reference = ? AND " .
  78                 "check_date = ? AND deposit_date = ? " .
  79                 "ORDER BY session_id DESC LIMIT 1", array($payer_id, $reference, $check_date, $deposit_date));
  80             if (!empty($row['session_id'])) {
  81                 return $row['session_id'];
  82             }
  83         }
  84
  85         return sqlInsert("INSERT INTO ar_session ( " .
  86             "payer_id, user_id, reference, check_date, deposit_date, pay_total " .
  87             ") VALUES ( ?, ?, ?, ?, ?, ? )", array($payer_id, $_SESSION['authUserID'], $reference, $check_date, $deposit_date, $pay_total));
  88     }
  89
  90     //writing the check details to Session Table on ERA proxcessing
  91     public static function arPostSession($payer_id, $check_number, $check_date, $pay_total, $post_to_date, $deposit_date, $debug)
  92     {
  93         $query = "INSERT INTO ar_session( " .
  94             "payer_id,user_id,closed,reference,check_date,pay_total,post_to_date,deposit_date,patient_id,payment_type,adjustment_code,payment_method " .
  95             ") VALUES (?, ?, 0, ?, ?, ?, ? ,?, 0, 'insurance', 'insurance_payment', 'electronic')";
  96         if ($debug) {
  97             echo text($query) . "<br />\n";
  98         } else {
  99             $sessionId = sqlInsert($query, array($payer_id, $_SESSION['authUserID'], 'ePay - ' . $check_number, $check_date, $pay_total, $post_to_date, $deposit_date));
 100             return $sessionId;
 101         }
 102     }
 103
 104     // Post a payment, new style.
 105     //
 106     public static function arPostPayment(
 107         $patient_id,
 108         $encounter_id,
 109         $session_id,
 110         $amount,
 111         $code,
 112         $payer_type,
 113         $memo,
 114         $debug,
 115         $time = '',
 116         $codetype = '',
 117         $date = ''
 118     ) {
 119         $codeonly = $code;
 120         $modifier = '';
 121         $tmp = strpos($code, ':');
 122         if ($tmp) {
 123             $codeonly = substr($code, 0, $tmp);
 124             $modifier = substr($code, $tmp + 1);
 125         }
 126
 127         if (empty($time)) {
 128             $time = date('Y-m-d H:i:s');
 129         }
 130
 131         sqlBeginTrans();
 132         $sequence_no = sqlQuery(
 133             "SELECT IFNULL(MAX(sequence_no),0) + 1 AS increment FROM ar_activity WHERE pid = ? AND encounter = ?",
 134             array($patient_id, $encounter_id)
 135         );
 136         $query = "INSERT INTO ar_activity ( " .
 137             "pid, encounter, sequence_no, code_type, code, modifier, payer_type, post_time, post_date, post_user, " .
 138             "session_id, memo, pay_amount " .
 139             ") VALUES (?, ?, ?, ?, ?, ?, ?, ?, ?, ?, ?, ?, ?)";
 140         sqlStatement(
 141             $query,
 142             array(
 143                 $patient_id,
 144                 $encounter_id,
 145                 $sequence_no['increment'],
 146                 $codetype,
 147                 $codeonly,
 148                 $modifier,
 149                 $payer_type,
 150                 $time,
 151                 $date,
 152                 $_SESSION['authUserID'],
 153                 $session_id,
 154                 $memo,
 155                 $amount
 156             )
 157         );
 158         sqlCommitTrans();
 159         return;
 160     }
 161
 162     // Post a charge.  This is called only from sl_eob_process.php where
 163     // automated remittance processing can create a new service item.
 164     // Here we add it as an unauthorized item to the billing table.
 165     //
 166     public static function arPostCharge($patient_id, $encounter_id, $session_id, $amount, $units, $thisdate, $code, $description, $debug, $codetype = '')
 167     {
 168         /*****************************************************************
 169          * // Select an existing billing item as a template.
 170          * $row= sqlQuery("SELECT * FROM billing WHERE " .
 171          * "pid = '$patient_id' AND encounter = '$encounter_id' AND " .
 172          * "code_type = 'CPT4' AND activity = 1 " .
 173          * "ORDER BY id DESC LIMIT 1");
 174          * $this_authorized = 0;
 175          * $this_provider = 0;
 176          * if (!empty($row)) {
 177          * $this_authorized = $row['authorized'];
 178          * $this_provider = $row['provider_id'];
 179          * }
 180          *****************************************************************/
 181
 182         if (empty($codetype)) {
 183             // default to CPT4 if empty, which is consistent with previous functionality.
 184             $codetype = "CPT4";
 185         }
 186
 187         $codeonly = $code;
 188         $modifier = '';
 189         $tmp = strpos($code, ':');
 190         if ($tmp) {
 191             $codeonly = substr($code, 0, $tmp);
 192             $modifier = substr($code, $tmp + 1);
 193         }
 194
 195         BillingUtilities::addBilling(
 196             $encounter_id,
 197             $codetype,
 198             $codeonly,
 199             $description,
 200             $patient_id,
 201             0,
 202             0,
 203             $modifier,
 204             $units,
 205             $amount,
 206             '',
 207             ''
 208         );
 209     }
 210
 211     // Post an adjustment, new style.
 212     //
 213     public static function arPostAdjustment($patient_id, $encounter_id, $session_id, $amount, $code, $payer_type, $reason, $debug, $time = '', $codetype = '')
 214     {
 215         $codeonly = $code;
 216         $modifier = '';
 217         $tmp = strpos($code, ':');
 218         if ($tmp) {
 219             $codeonly = substr($code, 0, $tmp);
 220             $modifier = substr($code, $tmp + 1);
 221         }
 222
 223         if (empty($time)) {
 224             $time = date('Y-m-d H:i:s');
 225         }
 226
 227         sqlBeginTrans();
 228         $sequence_no = sqlQuery("SELECT IFNULL(MAX(sequence_no),0) + 1 AS increment FROM ar_activity WHERE pid = ? AND encounter = ?", array($patient_id, $encounter_id));
 229         $query = "INSERT INTO ar_activity ( " .
 230             "pid, encounter, sequence_no, code_type, code, modifier, payer_type, post_user, post_time, " .
 231             "session_id, memo, adj_amount " .
 232             ") VALUES (?, ?, ?, ?, ?, ?, ?, ?, ?, ?, ?, ?)";
 233         sqlStatement($query, array($patient_id, $encounter_id, $sequence_no['increment'], $codetype, $codeonly, $modifier, $payer_type, $_SESSION['authUserID'], $time, $session_id, $reason, $amount));
 234         sqlCommitTrans();
 235         return;
 236     }
 237
 238     public static function arGetPayerID($patient_id, $date_of_service, $payer_type)
 239     {
 240         if ($payer_type < 1 || $payer_type > 3) {
 241             return 0;
 242         }
 243
 244         $tmp = array(1 => 'primary', 2 => 'secondary', 3 => 'tertiary');
 245         $value = $tmp[$payer_type];
 246         $query = "SELECT provider FROM insurance_data WHERE " .
 247             "pid = ? AND type = ? AND (date <= ? OR date IS NULL) " .
 248             "ORDER BY date DESC LIMIT 1";
 249         $nprow = sqlQuery($query, array($patient_id, $value, $date_of_service));
 250         if (empty($nprow)) {
 251             return 0;
 252         }
 253
 254         return $nprow['provider'];
 255     }
 256
 257     // Make this invoice re-billable, new style.
 258     //
 259     public static function arSetupSecondary($patient_id, $encounter_id, $debug, $crossover = 0)
 260     {
 261         if ($crossover == 1) {
 262             //if claim forwarded setting a new status
 263             $status = 6;
 264         } else {
 265             $status = 1;
 266         }
 267
 268         // Determine the next insurance level to be billed.
 269         $ferow = sqlQuery("SELECT date, last_level_billed " .
 270             "FROM form_encounter WHERE " .
 271             "pid = ? AND encounter = ?", array($patient_id, $encounter_id));
 272         $date_of_service = substr($ferow['date'], 0, 10);
 273         $new_payer_type = 0 + $ferow['last_level_billed'];
 274         if ($new_payer_type < 3 && !empty($ferow['last_level_billed']) || $new_payer_type == 0) {
 275             ++$new_payer_type;
 276         }
 277
 278         $new_payer_id = self::arGetPayerID($patient_id, $date_of_service, $new_payer_type);
 279
 280         if ($new_payer_id) {
 281             // Queue up the claim.
 282             if (!$debug) {
 283                 BillingUtilities::updateClaim(true, $patient_id, $encounter_id, $new_payer_id, $new_payer_type, $status, 5, '', 'hcfa', '', $crossover);
 284             }
 285         } else {
 286             // Just reopen the claim.
 287             if (!$debug) {
 288                 BillingUtilities::updateClaim(true, $patient_id, $encounter_id, -1, -1, $status, 0, '', '', '', $crossover);
 289             }
 290         }
 291
 292         return xl("Encounter ") . $encounter_id . xl(" is ready for re-billing.");
 293     }
 294 }