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 = null,
 118         $payer_claim_number = null
 119     ) {
 120         $codeonly = $code;
 121         $modifier = '';
 122         $tmp = strpos($code, ':');
 123         if ($tmp) {
 124             $codeonly = substr($code, 0, $tmp);
 125             $modifier = substr($code, $tmp + 1);
 126         }
 127
 128         if (empty($time)) {
 129             $time = date('Y-m-d H:i:s');
 130         }
 131
 132         sqlBeginTrans();
 133         $sequence_no = sqlQuery(
 134             "SELECT IFNULL(MAX(sequence_no),0) + 1 AS increment FROM ar_activity WHERE pid = ? AND encounter = ?",
 135             array($patient_id, $encounter_id)
 136         );
 137         $query = "INSERT INTO ar_activity ( " .
 138             "pid, encounter, sequence_no, code_type, code, modifier, payer_type, post_time, post_date, post_user, " .
 139             "session_id, memo, pay_amount, payer_claim_number " .
 140             ") VALUES (?, ?, ?, ?, ?, ?, ?, ?, ?, ?, ?, ?, ?, ?)";
 141         sqlStatement(
 142             $query,
 143             array(
 144                 $patient_id,
 145                 $encounter_id,
 146                 $sequence_no['increment'],
 147                 $codetype,
 148                 $codeonly,
 149                 $modifier,
 150                 $payer_type,
 151                 $time,
 152                 $date,
 153                 $_SESSION['authUserID'],
 154                 $session_id,
 155                 $memo,
 156                 $amount,
 157                 $payer_claim_number
 158             )
 159         );
 160         sqlCommitTrans();
 161         return;
 162     }
 163
 164     // Post a charge.  This is called only from sl_eob_process.php where
 165     // automated remittance processing can create a new service item.
 166     // Here we add it as an unauthorized item to the billing table.
 167     //
 168     public static function arPostCharge($patient_id, $encounter_id, $session_id, $amount, $units, $thisdate, $code, $description, $debug, $codetype = '')
 169     {
 170         /*****************************************************************
 171          * // Select an existing billing item as a template.
 172          * $row= sqlQuery("SELECT * FROM billing WHERE " .
 173          * "pid = '$patient_id' AND encounter = '$encounter_id' AND " .
 174          * "code_type = 'CPT4' AND activity = 1 " .
 175          * "ORDER BY id DESC LIMIT 1");
 176          * $this_authorized = 0;
 177          * $this_provider = 0;
 178          * if (!empty($row)) {
 179          * $this_authorized = $row['authorized'];
 180          * $this_provider = $row['provider_id'];
 181          * }
 182          *****************************************************************/
 183
 184         if (empty($codetype)) {
 185             // default to CPT4 if empty, which is consistent with previous functionality.
 186             $codetype = "CPT4";
 187         }
 188
 189         $codeonly = $code;
 190         $modifier = '';
 191         $tmp = strpos($code, ':');
 192         if ($tmp) {
 193             $codeonly = substr($code, 0, $tmp);
 194             $modifier = substr($code, $tmp + 1);
 195         }
 196
 197         BillingUtilities::addBilling(
 198             $encounter_id,
 199             $codetype,
 200             $codeonly,
 201             $description,
 202             $patient_id,
 203             0,
 204             0,
 205             $modifier,
 206             $units,
 207             $amount,
 208             '',
 209             ''
 210         );
 211     }
 212
 213     // Post an adjustment, new style.
 214     //
 215     public static function arPostAdjustment($patient_id, $encounter_id, $session_id, $amount, $code, $payer_type, $reason, $debug, $time = '', $codetype = '')
 216     {
 217         $codeonly = $code;
 218         $modifier = '';
 219         $tmp = strpos($code, ':');
 220         if ($tmp) {
 221             $codeonly = substr($code, 0, $tmp);
 222             $modifier = substr($code, $tmp + 1);
 223         }
 224
 225         if (empty($time)) {
 226             $time = date('Y-m-d H:i:s');
 227         }
 228
 229         sqlBeginTrans();
 230         $sequence_no = sqlQuery("SELECT IFNULL(MAX(sequence_no),0) + 1 AS increment FROM ar_activity WHERE pid = ? AND encounter = ?", array($patient_id, $encounter_id));
 231         $query = "INSERT INTO ar_activity ( " .
 232             "pid, encounter, sequence_no, code_type, code, modifier, payer_type, post_user, post_time, " .
 233             "session_id, memo, adj_amount " .
 234             ") VALUES (?, ?, ?, ?, ?, ?, ?, ?, ?, ?, ?, ?)";
 235         sqlStatement($query, array($patient_id, $encounter_id, $sequence_no['increment'], $codetype, $codeonly, $modifier, $payer_type, $_SESSION['authUserID'], $time, $session_id, $reason, $amount));
 236         sqlCommitTrans();
 237         return;
 238     }
 239
 240     public static function arGetPayerID($patient_id, $date_of_service, $payer_type)
 241     {
 242         if ($payer_type < 1 || $payer_type > 3) {
 243             return 0;
 244         }
 245
 246         $tmp = array(1 => 'primary', 2 => 'secondary', 3 => 'tertiary');
 247         $value = $tmp[$payer_type];
 248         $query = "SELECT provider FROM insurance_data WHERE " .
 249             "pid = ? AND type = ? AND (date <= ? OR date IS NULL) AND (date_end >= ? OR date_end IS NULL) " .
 250             "ORDER BY date DESC LIMIT 1";
 251         $nprow = sqlQuery($query, array($patient_id, $value, $date_of_service, $date_of_service));
 252         if (empty($nprow)) {
 253             return 0;
 254         }
 255
 256         return $nprow['provider'];
 257     }
 258
 259     // Make this invoice re-billable, new style.
 260     //
 261     public static function arSetupSecondary($patient_id, $encounter_id, $debug, $crossover = 0)
 262     {
 263         if ($crossover == 1) {
 264             //if claim forwarded setting a new status
 265             $status = 6;
 266         } else {
 267             $status = 1;
 268         }
 269
 270         // Determine the next insurance level to be billed.
 271         $ferow = sqlQuery("SELECT date, last_level_billed " .
 272             "FROM form_encounter WHERE " .
 273             "pid = ? AND encounter = ?", array($patient_id, $encounter_id));
 274         $date_of_service = substr($ferow['date'], 0, 10);
 275         $new_payer_type = 0 + $ferow['last_level_billed'];
 276         if ($new_payer_type < 3 && !empty($ferow['last_level_billed']) || $new_payer_type == 0) {
 277             ++$new_payer_type;
 278         }
 279
 280         $new_payer_id = self::arGetPayerID($patient_id, $date_of_service, $new_payer_type);
 281
 282         if ($new_payer_id) {
 283             // Queue up the claim.
 284             if (!$debug) {
 285                 BillingUtilities::updateClaim(true, $patient_id, $encounter_id, $new_payer_id, $new_payer_type, $status, 5, '', 'hcfa', '', $crossover);
 286             }
 287         } else {
 288             // Just reopen the claim.
 289             if (!$debug) {
 290                 BillingUtilities::updateClaim(true, $patient_id, $encounter_id, -1, -1, $status, 0, '', '', '', $crossover);
 291             }
 292         }
 293
 294         return xl("Encounter ") . $encounter_id . xl(" is ready for re-billing.");
 295     }
 296 }