library/Claim.class.php

   1 <?php
   2 // Copyright (C) 2007 Rod Roark <rod@sunsetsystems.com>
   3 //
   4 // This program is free software; you can redistribute it and/or
   5 // modify it under the terms of the GNU General Public License
   6 // as published by the Free Software Foundation; either version 2
   7 // of the License, or (at your option) any later version.
   8
   9 require_once(dirname(__FILE__) . "/classes/Address.class.php");
  10 require_once(dirname(__FILE__) . "/classes/InsuranceCompany.class.php");
  11 require_once(dirname(__FILE__) . "/sql-ledger.inc");
  12 require_once(dirname(__FILE__) . "/invoice_summary.inc.php");
  13
  14 // This enforces the X12 Basic Character Set. Page A2.
  15 //
  16 function x12clean($str) {
  17   return preg_replace('/[^A-Z0-9!"\\&\'()+,\\-.\\/;?= ]/', '', strtoupper($str));
  18 }
  19
  20 class Claim {
  21
  22   var $pid;               // patient id
  23   var $encounter_id;      // encounter id
  24   var $procs;             // array of procedure rows from billing table
  25   var $x12_partner;       // row from x12_partners table
  26   var $encounter;         // row from form_encounter table
  27   var $facility;          // row from facility table
  28   var $billing_facility;  // row from facility table
  29   var $provider;          // row from users table (rendering provider)
  30   var $referrer;          // row from users table (referring provider)
  31   var $insurance_numbers; // row from insurance_numbers table for current payer
  32   var $patient_data;      // row from patient_data table
  33   var $billing_options;   // row from form_misc_billing_options table
  34   var $invoice;           // result from get_invoice_summary()
  35   var $payers;            // array of arrays, for all payers
  36
  37   function loadPayerInfo(&$billrow) {
  38     global $sl_err;
  39     $encounter_date = substr($this->encounter['date'], 0, 10);
  40
  41     // Create the $payers array.  This contains data for all insurances
  42     // with the current one always at index 0, and the others in payment
  43     // order starting at index 1.
  44     //
  45     $this->payers = array();
  46     $this->payers[0] = array();
  47     $query = "SELECT * FROM insurance_data WHERE " .
  48       "pid = '{$this->pid}' AND provider != '' AND " .
  49       "date <= '$encounter_date' " .
  50       "ORDER BY type ASC, date DESC";
  51     // echo "<br>$query<br>"; // debugging
  52     $dres = sqlStatement($query);
  53     $prevtype = '';
  54     while ($drow = sqlFetchArray($dres)) {
  55       if (strcmp($prevtype, $drow['type']) == 0) continue;
  56       $prevtype = $drow['type'];
  57       $ins = ($drow['provider'] == $billrow['payer_id']) ?
  58         0 : count($this->payers);
  59       $crow = sqlQuery("SELECT * FROM insurance_companies WHERE " .
  60         "id = '" . $drow['provider'] . "'");
  61       $orow = new InsuranceCompany($drow['provider']);
  62       $this->payers[$ins] = array();
  63       $this->payers[$ins]['data']    = $drow;
  64       $this->payers[$ins]['company'] = $crow;
  65       $this->payers[$ins]['object']  = $orow;
  66     }
  67
  68     $this->using_modifiers = true;
  69
  70     // Get payment and adjustment details if there are any previous payers.
  71     //
  72     $this->invoice = array();
  73     if ($this->payerSequence() != 'P') {
  74       SLConnect();
  75       $arres = SLQuery("select id from ar where invnumber = " .
  76         "'{$this->pid}.{$this->encounter_id}'");
  77       if ($sl_err) die($sl_err);
  78       $arrow = SLGetRow($arres, 0);
  79       if ($arrow) {
  80         $this->invoice = get_invoice_summary($arrow['id'], true);
  81       }
  82       SLClose();
  83       // Secondary claims might not have modifiers in SQL-Ledger data.
  84       // In that case, note that we should not try to match on them.
  85       $this->using_modifiers = false;
  86       foreach ($this->invoice as $key => $trash) {
  87         if (strpos($key, ':')) $this->using_modifiers = true;
  88       }
  89     }
  90   }
  91
  92   // Constructor. Loads relevant database information.
  93   //
  94   function Claim($pid, $encounter_id) {
  95     $this->pid = $pid;
  96     $this->encounter_id = $encounter_id;
  97     $this->procs = array();
  98
  99     // We need the encounter date before we can identify the payers.
 100     $sql = "SELECT * FROM form_encounter WHERE " .
 101       "pid = '{$this->pid}' AND " .
 102       "encounter = '{$this->encounter_id}'";
 103     $this->encounter = sqlQuery($sql);
 104
 105     // Sort by procedure timestamp in order to get some consistency.  In particular
 106     // we determine the provider from the first procedure in this array.
 107     $sql = "SELECT * FROM billing WHERE " .
 108       "encounter = '{$this->encounter_id}' AND pid = '{$this->pid}' AND " .
 109       "(code_type = 'CPT4' OR code_type = 'HCPCS') AND " .
 110       "activity = '1' ORDER BY date, id";
 111     $res = sqlStatement($sql);
 112     while ($row = sqlFetchArray($res)) {
 113       if (!$row['units']) $row['units'] = 1;
 114       // Load prior payer data at the first opportunity in order to get
 115       // the using_modifiers flag that is referenced below.
 116       if (empty($this->procs)) $this->loadPayerInfo($row);
 117       // Consolidate duplicate procedures.
 118       foreach ($this->procs as $key => $trash) {
 119         if (strcmp($this->procs[$key]['code'],$row['code']) == 0 &&
 120             (strcmp($this->procs[$key]['modifier'],$row['modifier']) == 0 ||
 121              !$this->using_modifiers))
 122         {
 123           $this->procs[$key]['units'] += $row['units'];
 124           $this->procs[$key]['fee']   += $row['fee'];
 125           continue 2; // skip to next table row
 126         }
 127       }
 128       $this->procs[] = $row;
 129     }
 130
 131     $sql = "SELECT * FROM x12_partners WHERE " .
 132       "id = '" . $this->procs[0]['x12_partner_id'] . "'";
 133     $this->x12_partner = sqlQuery($sql);
 134
 135     $sql = "SELECT * FROM facility WHERE " .
 136       "name = '" . addslashes($this->encounter['facility']) . "' " .
 137       "ORDER BY id LIMIT 1";
 138     $this->facility = sqlQuery($sql);
 139
 140     $sql = "SELECT * FROM users WHERE " .
 141       "id = '" . $this->procs[0]['provider_id'] . "'";
 142     $this->provider = sqlQuery($sql);
 143
 144     $sql = "SELECT * FROM facility " .
 145       "ORDER BY billing_location DESC, id ASC LIMIT 1";
 146     $this->billing_facility = sqlQuery($sql);
 147
 148     $sql = "SELECT * FROM insurance_numbers WHERE " .
 149       "(insurance_company_id = '" . $this->procs[0]['payer_id'] .
 150       "' OR insurance_company_id is NULL) AND " .
 151       "provider_id = '" . $this->provider['id'] .
 152       "' order by insurance_company_id DESC LIMIT 1";
 153     $this->insurance_numbers = sqlQuery($sql);
 154
 155     $sql = "SELECT * FROM patient_data WHERE " .
 156       "pid = '{$this->pid}' " .
 157       "ORDER BY id LIMIT 1";
 158     $this->patient_data = sqlQuery($sql);
 159
 160     $sql = "SELECT fpa.* FROM forms JOIN form_misc_billing_options AS fpa " .
 161       "ON fpa.id = forms.form_id WHERE " .
 162       "forms.encounter = '{$this->encounter_id}' AND " .
 163       "forms.pid = '{$this->pid}' AND " .
 164       "forms.formdir = 'misc_billing_options' " .
 165       "ORDER BY forms.date";
 166     $this->billing_options = sqlQuery($sql);
 167
 168     $sql = "SELECT * FROM users WHERE " .
 169       "id = '" . $this->patient_data['providerID'] . "'";
 170     $this->referrer = sqlQuery($sql);
 171     if (!$this->referrer) $this->referrer = array();
 172
 173   } // end constructor
 174
 175   // Return an array of adjustments from the designated prior payer for the
 176   // designated procedure key (might be procedure:modifier), or for the claim
 177   // level.  For each adjustment give date, group code, reason code, amount.
 178   // Note this will include "patient responsibility" adjustments which are
 179   // not adjustments to OUR invoice, but they reduce the amount that the
 180   // insurance company pays.
 181   //
 182   function payerAdjustments($ins, $code='Claim') {
 183     $aadj = array();
 184
 185     // If we have no modifiers stored in SQL-Ledger for this claim,
 186     // then we cannot use a modifier passed in with the key.
 187     $tmp = strpos($code, ':');
 188     if ($tmp && !$this->using_modifiers) $code = substr($code, 0, $tmp);
 189
 190     // For payments, source always starts with "Ins" or "Pt".
 191     // Nonzero adjustment reason examples:
 192     //   Ins1 adjust code 42 (Charges exceed ... (obsolete))
 193     //   Ins1 adjust code 45 (Charges exceed your contracted/ legislated fee arrangement)
 194     //   Ins1 adjust code 97 (Payment is included in the allowance for another service/procedure)
 195     //   Ins1 adjust code A2 (Contractual adjustment)
 196     //   Ins adjust Ins1
 197     //   adjust code 45
 198     // Zero adjustment reason examples:
 199     //   Co-pay: 25.00
 200     //   Coinsurance: 11.46  (code 2)   Note: fix remits to identify insurance
 201     //   To deductible: 0.22 (code 1)   Note: fix remits to identify insurance
 202     //   To copay Ins1 (manual entry)
 203     //   To ded'ble Ins1 (manual entry)
 204
 205     if (!empty($this->invoice[$code])) {
 206       $date = '';
 207       $deductible  = 0;
 208       $coinsurance = 0;
 209       $inslabel = ($this->payerSequence($ins) == 'S') ? 'Ins2' : 'Ins1';
 210       $insnumber = substr($inslabel, 3);
 211
 212       // Compute this procedure's patient responsibility amount as of this
 213       // prior payer, which is the original charge minus all insurance
 214       // payments and "hard" adjustments up to this payer.
 215       $ptresp = $this->invoice[$code]['chg'] + $this->invoice[$code]['adj'];
 216       foreach ($this->invoice[$code]['dtl'] as $key => $value) {
 217         if (preg_match("/^Ins(\d)/i", $value['src'], $tmp)) {
 218           if ($tmp[1] <= $insnumber) $ptresp -= $value['pmt'];
 219         }
 220         else if (trim(substr($key, 0, 10))) { // not an adjustment if no date
 221           if (!preg_match("/Ins(\d)/i", $value['rsn'], $tmp) || $tmp[1] <= $insnumber)
 222             $ptresp += $value['chg']; // adjustments are negative charges
 223         }
 224       }
 225       if ($ptresp < 0) $ptresp = 0; // we may be insane but try to hide it
 226
 227       // Main loop, to extract adjustments for this payer and procedure.
 228       foreach ($this->invoice[$code]['dtl'] as $key => $value) {
 229         $tmp = str_replace('-', '', trim(substr($key, 0, 10)));
 230         if ($tmp) $date = $tmp;
 231         if ($tmp && $value['pmt'] == 0) { // not original charge and not a payment
 232           $rsn = $value['rsn'];
 233           $chg = 0 - $value['chg']; // adjustments are negative charges
 234
 235           $gcode = 'CO'; // default group code = contractual obligation
 236           $rcode = '45'; // default reason code = max fee exceeded (code 42 is obsolete)
 237
 238           if (preg_match("/Ins adjust $inslabel/i", $rsn, $tmp)) {
 239             // From manual post. Take the defaults.
 240           }
 241           else if (preg_match("/To copay $inslabel/i", $rsn, $tmp) && !$chg) {
 242             $coinsurance = $ptresp; // from manual post
 243             continue;
 244           }
 245           else if (preg_match("/To ded'ble $inslabel/i", $rsn, $tmp) && !$chg) {
 246             $deductible = $ptresp; // from manual post
 247             continue;
 248           }
 249           else if (preg_match("/$inslabel copay: (\S+)/i", $rsn, $tmp) && !$chg) {
 250             $coinsurance = $tmp[1]; // from 835 as of 6/2007
 251             continue;
 252           }
 253           else if (preg_match("/$inslabel coins: (\S+)/i", $rsn, $tmp) && !$chg) {
 254             $coinsurance = $tmp[1]; // from 835 and manual post as of 6/2007
 255             continue;
 256           }
 257           else if (preg_match("/$inslabel dedbl: (\S+)/i", $rsn, $tmp) && !$chg) {
 258             $deductible = $tmp[1]; // from 835 and manual post as of 6/2007
 259             continue;
 260           }
 261           else if (preg_match("/$inslabel ptresp: (\S+)/i", $rsn, $tmp) && !$chg) {
 262             continue; // from 835 as of 6/2007
 263           }
 264           else if (preg_match("/$inslabel adjust code (\S+)/i", $rsn, $tmp)) {
 265             $rcode = $tmp[1]; // from 835
 266           }
 267           else if (preg_match("/$inslabel/i", $rsn, $tmp)) {
 268             // Take the defaults.
 269           }
 270           else if (preg_match('/Ins(\d)/i', $rsn, $tmp) && $tmp[1] != $insnumber) {
 271             continue; // it's for some other payer
 272           }
 273           else if ($insnumber == '1') {
 274             if (preg_match("/\$\s*adjust code (\S+)/i", $rsn, $tmp)) {
 275               $rcode = $tmp[1]; // from 835
 276             }
 277             else if ($chg) {
 278               // Other adjustments default to Ins1.
 279             }
 280             else if (preg_match("/Co-pay: (\S+)/i", $rsn, $tmp) ||
 281               preg_match("/Coinsurance: (\S+)/i", $rsn, $tmp)) {
 282               $coinsurance = 0 + $tmp[1]; // from 835 before 6/2007
 283               continue;
 284             }
 285             else if (preg_match("/To deductible: (\S+)/i", $rsn, $tmp)) {
 286               $deductible = 0 + $tmp[1]; // from 835 before 6/2007
 287               continue;
 288             }
 289             else {
 290               continue; // there is no adjustment amount
 291             }
 292           }
 293           else {
 294             continue; // it's for primary and that's not us
 295           }
 296
 297           $aadj[] = array($date, $gcode, $rcode, sprintf('%.2f', $chg));
 298
 299         } // end if
 300       } // end foreach
 301
 302       // If we really messed it up, at least avoid negative numbers.
 303       if ($coinsurance > $ptresp) $coinsurance = $ptresp;
 304       if ($deductible  > $ptresp) $deductible  = $ptresp;
 305
 306       // Find out if this payer paid anything at all on this claim.  This will
 307       // help us allocate any unknown patient responsibility amounts.
 308       $thispaidanything = 0;
 309       foreach($this->invoice as $codekey => $codeval) {
 310         foreach ($codeval['dtl'] as $key => $value) {
 311           if (preg_match("/$inslabel/i", $value['src'], $tmp)) {
 312             $thispaidanything += $value['pmt'];
 313           }
 314         }
 315       }
 316
 317       // Allocate any unknown patient responsibility by guessing if the
 318       // deductible has been satisfied.
 319       if ($thispaidanything)
 320         $coinsurance = $ptresp - $deductible;
 321       else
 322         $deductible = $ptresp - $coinsurance;
 323
 324       if ($date && $deductible != 0)
 325         $aadj[] = array($date, 'PR', '1', sprintf('%.2f', $deductible));
 326       if ($date && $coinsurance != 0)
 327         $aadj[] = array($date, 'PR', '2', sprintf('%.2f', $coinsurance));
 328
 329     } // end if
 330
 331     return $aadj;
 332   }
 333
 334   // Return date, total payments and total "hard" adjustments from the given
 335   // prior payer. If $code is specified then only that procedure key is
 336   // selected, otherwise it's for the whole claim.
 337   //
 338   function payerTotals($ins, $code='') {
 339     // If we have no modifiers stored in SQL-Ledger for this claim,
 340     // then we cannot use a modifier passed in with the key.
 341     $tmp = strpos($code, ':');
 342     if ($tmp && !$this->using_modifiers) $code = substr($code, 0, $tmp);
 343
 344     $inslabel = ($this->payerSequence($ins) == 'S') ? 'Ins2' : 'Ins1';
 345     $paytotal = 0;
 346     $adjtotal = 0;
 347     $date = '';
 348     foreach($this->invoice as $codekey => $codeval) {
 349       if ($code && strcmp($codekey,$code) != 0) continue;
 350       foreach ($codeval['dtl'] as $key => $value) {
 351         if (preg_match("/$inslabel/i", $value['src'], $tmp)) {
 352           if (!$date) $date = str_replace('-', '', trim(substr($key, 0, 10)));
 353           $paytotal += $value['pmt'];
 354         }
 355       }
 356       $aarr = $this->payerAdjustments($ins, $codekey);
 357       foreach ($aarr as $a) {
 358         if (strcmp($a[1],'PR') != 0) $adjtotal += $a[3];
 359         if (!$date) $date = $a[0];
 360       }
 361     }
 362     return array($date, sprintf('%.2f', $paytotal), sprintf('%.2f', $adjtotal));
 363   }
 364
 365   // Return the amount already paid by the patient.
 366   //
 367   function patientPaidAmount() {
 368
 369     // TBD: This does not work for a primary claim because $this->invoice
 370     // is not loaded.  Might be good to get the co-pay from the billing
 371     // table in that case.
 372
 373     $amount = 0;
 374     foreach($this->invoice as $codekey => $codeval) {
 375       foreach ($codeval['dtl'] as $key => $value) {
 376         if (!preg_match("/Ins/i", $value['src'], $tmp)) {
 377           $amount += $value['pmt'];
 378         }
 379       }
 380     }
 381     return sprintf('%.2f', $amount);
 382   }
 383
 384   // Return invoice total, including adjustments but not payments.
 385   //
 386   function invoiceTotal() {
 387     $amount = 0;
 388     foreach($this->invoice as $codekey => $codeval) {
 389       $amount += $codeval['chg'];
 390     }
 391     return sprintf('%.2f', $amount);
 392   }
 393
 394   // Number of procedures in this claim.
 395   function procCount() {
 396     return count($this->procs);
 397   }
 398
 399   // Number of payers for this claim. Ranges from 1 to 3.
 400   function payerCount() {
 401     return count($this->payers);
 402   }
 403
 404   function x12gsversionstring() {
 405     return x12clean(trim($this->x12_partner['x12_version']));
 406   }
 407
 408   function x12gssenderid() {
 409     $tmp = $this->x12_partner['x12_sender_id'];
 410     while (strlen($tmp) < 15) $tmp .= " ";
 411     return $tmp;
 412   }
 413
 414   function x12gsreceiverid() {
 415     $tmp = $this->x12_partner['x12_receiver_id'];
 416     while (strlen($tmp) < 15) $tmp .= " ";
 417     return $tmp;
 418   }
 419
 420   function cliaCode() {
 421     return x12clean(trim($this->facility['domain_identifier']));
 422   }
 423
 424   function billingFacilityName() {
 425     return x12clean(trim($this->billing_facility['name']));
 426   }
 427
 428   function billingFacilityStreet() {
 429     return x12clean(trim($this->billing_facility['street']));
 430   }
 431
 432   function billingFacilityCity() {
 433     return x12clean(trim($this->billing_facility['city']));
 434   }
 435
 436   function billingFacilityState() {
 437     return x12clean(trim($this->billing_facility['state']));
 438   }
 439
 440   function billingFacilityZip() {
 441     return x12clean(trim($this->billing_facility['postal_code']));
 442   }
 443
 444   function billingFacilityETIN() {
 445     return x12clean(trim(str_replace('-', '', $this->billing_facility['federal_ein'])));
 446   }
 447
 448   function billingFacilityNPI() {
 449     return x12clean(trim($this->billing_facility['facility_npi']));
 450   }
 451
 452   function billingContactName() {
 453     return x12clean(trim($this->billing_facility['attn']));
 454   }
 455
 456   function billingContactPhone() {
 457     if (preg_match("/([2-9]\d\d)\D*(\d\d\d)\D*(\d\d\d\d)/",
 458       $this->billing_facility['phone'], $tmp))
 459     {
 460       return $tmp[1] . $tmp[2] . $tmp[3];
 461     }
 462     return '';
 463   }
 464
 465   function facilityName() {
 466     return x12clean(trim($this->facility['name']));
 467   }
 468
 469   function facilityStreet() {
 470     return x12clean(trim($this->facility['street']));
 471   }
 472
 473   function facilityCity() {
 474     return x12clean(trim($this->facility['city']));
 475   }
 476
 477   function facilityState() {
 478     return x12clean(trim($this->facility['state']));
 479   }
 480
 481   function facilityZip() {
 482     return x12clean(trim($this->facility['postal_code']));
 483   }
 484
 485   function facilityETIN() {
 486     return x12clean(trim(str_replace('-', '', $this->facility['federal_ein'])));
 487   }
 488
 489   function facilityNPI() {
 490     return x12clean(trim($this->facility['facility_npi']));
 491   }
 492
 493   function facilityPOS() {
 494     return x12clean(trim($this->facility['pos_code']));
 495   }
 496
 497   function clearingHouseName() {
 498     return x12clean(trim($this->x12_partner['name']));
 499   }
 500
 501   function clearingHouseETIN() {
 502     return x12clean(trim(str_replace('-', '', $this->x12_partner['id_number'])));
 503   }
 504
 505   function providerNumberType() {
 506     return $this->insurance_numbers['provider_number_type'];
 507   }
 508
 509   function providerNumber() {
 510     return x12clean(trim(str_replace('-', '', $this->insurance_numbers['provider_number'])));
 511   }
 512
 513   // Returns 'P', 'S' or 'T'.
 514   //
 515   function payerSequence($ins=0) {
 516     return strtoupper(substr($this->payers[$ins]['data']['type'], 0, 1));
 517   }
 518
 519   // Returns the HIPAA code of the patient-to-subscriber relationship.
 520   //
 521   function insuredRelationship($ins=0) {
 522     $tmp = strtolower($this->payers[$ins]['data']['subscriber_relationship']);
 523     if (strcmp($tmp,'self'  ) == 0) return '18';
 524     if (strcmp($tmp,'spouse') == 0) return '01';
 525     if (strcmp($tmp,'child' ) == 0) return '19';
 526     if (strcmp($tmp,'other' ) == 0) return 'G8';
 527     return $tmp; // should not happen
 528   }
 529
 530   function insuredTypeCode($ins=0) {
 531     if (strcmp($this->claimType($ins),'MB') == 0 && $this->payerSequence($ins) != 'P')
 532       return '12'; // medicare secondary working aged beneficiary or
 533                    // spouse with employer group health plan
 534     return '';
 535   }
 536
 537   // Is the patient also the subscriber?
 538   //
 539   function isSelfOfInsured($ins=0) {
 540     $tmp = strtolower($this->payers[$ins]['data']['subscriber_relationship']);
 541     return (strcmp($tmp,'self') == 0);
 542   }
 543
 544   function groupNumber($ins=0) {
 545     return x12clean(trim($this->payers[$ins]['data']['group_number']));
 546   }
 547
 548   function groupName($ins=0) {
 549     return x12clean(trim($this->payers[$ins]['data']['subscriber_employer']));
 550   }
 551
 552   function claimType($ins=0) {
 553     if (empty($this->payers[$ins]['object'])) return '';
 554     return $this->payers[$ins]['object']->get_freeb_claim_type();
 555   }
 556
 557   function insuredLastName($ins=0) {
 558     return x12clean(trim($this->payers[$ins]['data']['subscriber_lname']));
 559   }
 560
 561   function insuredFirstName($ins=0) {
 562     return x12clean(trim($this->payers[$ins]['data']['subscriber_fname']));
 563   }
 564
 565   function insuredMiddleName($ins=0) {
 566     return x12clean(trim($this->payers[$ins]['data']['subscriber_mname']));
 567   }
 568
 569   function policyNumber($ins=0) { // "ID"
 570     return x12clean(trim($this->payers[$ins]['data']['policy_number']));
 571   }
 572
 573   function insuredStreet($ins=0) {
 574     return x12clean(trim($this->payers[$ins]['data']['subscriber_street']));
 575   }
 576
 577   function insuredCity($ins=0) {
 578     return x12clean(trim($this->payers[$ins]['data']['subscriber_city']));
 579   }
 580
 581   function insuredState($ins=0) {
 582     return x12clean(trim($this->payers[$ins]['data']['subscriber_state']));
 583   }
 584
 585   function insuredZip($ins=0) {
 586     return x12clean(trim($this->payers[$ins]['data']['subscriber_postal_code']));
 587   }
 588
 589   function insuredDOB($ins=0) {
 590     return str_replace('-', '', $this->payers[$ins]['data']['subscriber_DOB']);
 591   }
 592
 593   function insuredSex($ins=0) {
 594     return strtoupper(substr($this->payers[$ins]['data']['subscriber_sex'], 0, 1));
 595   }
 596
 597   function payerName($ins=0) {
 598     return x12clean(trim($this->payers[$ins]['company']['name']));
 599   }
 600
 601   function payerStreet($ins=0) {
 602     if (empty($this->payers[$ins]['object'])) return '';
 603     $tmp = $this->payers[$ins]['object'];
 604     $tmp = $tmp->get_address();
 605     return x12clean(trim($tmp->get_line1()));
 606   }
 607
 608   function payerCity($ins=0) {
 609     if (empty($this->payers[$ins]['object'])) return '';
 610     $tmp = $this->payers[$ins]['object'];
 611     $tmp = $tmp->get_address();
 612     return x12clean(trim($tmp->get_city()));
 613   }
 614
 615   function payerState($ins=0) {
 616     if (empty($this->payers[$ins]['object'])) return '';
 617     $tmp = $this->payers[$ins]['object'];
 618     $tmp = $tmp->get_address();
 619     return x12clean(trim($tmp->get_state()));
 620   }
 621
 622   function payerZip($ins=0) {
 623     if (empty($this->payers[$ins]['object'])) return '';
 624     $tmp = $this->payers[$ins]['object'];
 625     $tmp = $tmp->get_address();
 626     return x12clean(trim($tmp->get_zip()));
 627   }
 628
 629   function payerID($ins=0) {
 630     return x12clean(trim($this->payers[$ins]['company']['cms_id']));
 631   }
 632
 633   function patientLastName() {
 634     return x12clean(trim($this->patient_data['lname']));
 635   }
 636
 637   function patientFirstName() {
 638     return x12clean(trim($this->patient_data['fname']));
 639   }
 640
 641   function patientMiddleName() {
 642     return x12clean(trim($this->patient_data['mname']));
 643   }
 644
 645   function patientStreet() {
 646     return x12clean(trim($this->patient_data['street']));
 647   }
 648
 649   function patientCity() {
 650     return x12clean(trim($this->patient_data['city']));
 651   }
 652
 653   function patientState() {
 654     return x12clean(trim($this->patient_data['state']));
 655   }
 656
 657   function patientZip() {
 658     return x12clean(trim($this->patient_data['postal_code']));
 659   }
 660
 661   function patientDOB() {
 662     return str_replace('-', '', $this->patient_data['DOB']);
 663   }
 664
 665   function patientSex() {
 666     return strtoupper(substr($this->patient_data['sex'], 0, 1));
 667   }
 668
 669   function cptCode($prockey) {
 670     return x12clean(trim($this->procs[$prockey]['code']));
 671   }
 672
 673   function cptModifier($prockey) {
 674     return x12clean(trim($this->procs[$prockey]['modifier']));
 675   }
 676
 677   // Returns the procedure code, followed by ":modifier" if there is one.
 678   function cptKey($prockey) {
 679     $tmp = $this->cptModifier($prockey);
 680     return $this->cptCode($prockey) . ($tmp ? ":$tmp" : "");
 681   }
 682
 683   function cptCharges($prockey) {
 684     return x12clean(trim($this->procs[$prockey]['fee']));
 685   }
 686
 687   function cptUnits($prockey) {
 688     if (empty($this->procs[$prockey]['units'])) return '1';
 689     return x12clean(trim($this->procs[$prockey]['units']));
 690   }
 691
 692   // NDC drug ID.
 693   function cptNDCID($prockey) {
 694     $ndcinfo = $this->procs[$prockey]['ndc_info'];
 695     if (preg_match('/^N4(\S+)\s+(\S\S)(.*)/', $ndcinfo, $tmp)) {
 696       $ndc = $tmp[1];
 697       if (preg_match('/^(\d+)-(\d+)-(\d+)$/', $ndc, $tmp)) {
 698         return sprintf('%05d-%04d-%02d', $tmp[1], $tmp[2], $tmp[3]);
 699       }
 700       return x12clean($ndc); // format is bad but return it anyway
 701     }
 702     return '';
 703   }
 704
 705   // NDC drug unit of measure code.
 706   function cptNDCUOM($prockey) {
 707     $ndcinfo = $this->procs[$prockey]['ndc_info'];
 708     if (preg_match('/^N4(\S+)\s+(\S\S)(.*)/', $ndcinfo, $tmp))
 709       return x12clean($tmp[2]);
 710     return '';
 711   }
 712
 713   // NDC drug number of units.
 714   function cptNDCQuantity($prockey) {
 715     $ndcinfo = $this->procs[$prockey]['ndc_info'];
 716     if (preg_match('/^N4(\S+)\s+(\S\S)(.*)/', $ndcinfo, $tmp))
 717       return x12clean($tmp[3]);
 718     return '';
 719   }
 720
 721   function onsetDate() {
 722     return str_replace('-', '', substr($this->encounter['onset_date'], 0, 10));
 723   }
 724
 725   function serviceDate() {
 726     return str_replace('-', '', substr($this->encounter['date'], 0, 10));
 727   }
 728
 729   function priorAuth() {
 730     return x12clean(trim($this->billing_options['prior_auth_number']));
 731   }
 732
 733   // Returns an array of unique primary diagnoses.  Periods are stripped.
 734   function diagArray() {
 735     $da = array();
 736     foreach ($this->procs as $row) {
 737       $tmp = explode(':', $row['justify']);
 738       if (count($tmp)) {
 739         $diag = str_replace('.', '', $tmp[0]);
 740         $da[$diag] = $diag;
 741       }
 742     }
 743     return $da;
 744   }
 745
 746   // Compute the 1-relative index in diagArray for the given procedure.
 747   function diagIndex($prockey) {
 748     $da = $this->diagArray();
 749     $tmp = explode(':', $this->procs[$prockey]['justify']);
 750     if (empty($tmp)) return '';
 751     $diag = str_replace('.', '', $tmp[0]);
 752     $i = 0;
 753     foreach ($da as $value) {
 754       ++$i;
 755       if (strcmp($value,$diag) == 0) return $i;
 756     }
 757     return '';
 758   }
 759
 760   function providerLastName() {
 761     return x12clean(trim($this->provider['lname']));
 762   }
 763
 764   function providerFirstName() {
 765     return x12clean(trim($this->provider['fname']));
 766   }
 767
 768   function providerMiddleName() {
 769     return x12clean(trim($this->provider['mname']));
 770   }
 771
 772   function providerNPI() {
 773     return x12clean(trim($this->provider['npi']));
 774   }
 775
 776   function providerUPIN() {
 777     return x12clean(trim($this->provider['upin']));
 778   }
 779
 780   function providerSSN() {
 781     return x12clean(trim(str_replace('-', '', $this->provider['federaltaxid'])));
 782   }
 783
 784   function referrerLastName() {
 785     return x12clean(trim($this->referrer['lname']));
 786   }
 787
 788   function referrerFirstName() {
 789     return x12clean(trim($this->referrer['fname']));
 790   }
 791
 792   function referrerMiddleName() {
 793     return x12clean(trim($this->referrer['mname']));
 794   }
 795
 796   function referrerNPI() {
 797     return x12clean(trim($this->referrer['npi']));
 798   }
 799
 800   function referrerUPIN() {
 801     return x12clean(trim($this->referrer['upin']));
 802   }
 803
 804   function referrerSSN() {
 805     return x12clean(trim(str_replace('-', '', $this->referrer['federaltaxid'])));
 806   }
 807 }
 808 ?>