library/classes/WSClaim.class.php

   1 <?php
   2
   3 require_once (dirname(__FILE__) . "/WSWrapper.class.php");
   4 include_once (dirname(__FILE__) . "/../sqlconf.php");
   5 include_once (dirname(__FILE__) . "/../sql.inc");
   6 include_once (dirname(__FILE__) . "/../../includes/config.php");
   7
   8 class WSClaim extends WSWrapper{
   9
  10         var $patient_id;
  11         var $foreign_provider_id;
  12         var $foreign_patient_id;
  13         var $payer_id;
  14         var $encounter;
  15         var $foreign_payer_id;
  16         var $claim;
  17         var $_db;
  18
  19         function WSClaim($patient_id, $encounter) {
  20                 if (!is_numeric($patient_id) && is_numeric($encounter)) return;
  21
  22                 parent::WSWrapper(null,false);
  23
  24                 $this->patient_id = $patient_id;
  25                 $this->encounter = $encounter;
  26                 $this->claim = null;
  27                 $this->_db = $GLOBALS['adodb']['db'];
  28                 if (!$this->_config['enabled']) return;
  29
  30                 if ($this->load_claim()) {
  31                         $function['ezybiz.add_invoice'] = array(new xmlrpcval($this->claim,"struct"));
  32                         $this->send($function);
  33                 }
  34
  35                 //print_r($this->claim);
  36
  37         }
  38
  39         function load_claim() {
  40                 if (!$this->load_patient_foreign_id() ||
  41                         !$this->load_payer_foreign_id() ||
  42                         !$this->load_provider_foreign_id() )
  43                         return false;
  44                 $invoice_info = array();
  45
  46                 $sql = "SELECT b.*, CONCAT(pd.fname,' ',pd.mname,' ',pd.lname) as patient_name FROM billing as b LEFT JOIN patient_data as pd on b.pid=pd.pid where "
  47                         ."b.encounter ='" . $this->encounter ."' AND b.pid = '" . $this->patient_id ."' AND b.billed = 1 AND b.activity != '0' AND authorized='1'";
  48
  49                 $result = $this->_db->Execute($sql);
  50
  51                 $invoice_info['salesman'] = $this->foreign_provider_id;
  52                 $invoice_info['customerid'] = $this->foreign_patient_id;
  53                 $invoice_info['payer_id'] = $this->foreign_payer_id;
  54 //      $invoice_info['invoicenumber'] = $this->patient_id . "000" . $this->encounter;
  55                 $invoice_info['invoicenumber'] = $this->patient_id . "." . $this->encounter;
  56
  57                 $counter = 0;
  58                 $total = 0;
  59                 $patient_info = array();
  60                 $payer_info = array();
  61                 while ($result && !$result->EOF) {
  62                         if ($result->fields['process_date'] == null) {
  63                                 //don't sync a claim that has not been processed, they may just want to mark this as billed
  64                                         return false;
  65                         }
  66                         // create a paymentline item for each code
  67                         /*
  68                         $invoice_info["invoiceid$counter"] = $result->fields['code'];
  69                         $invoice_info["amount$counter"] = $result->fields['fee'];
  70                         $invoice_info["invoicenumber$counter"] = $this->patient_id . "000" . $this->encounter;
  71                         $invoice_info["interest$counter"] = 0;
  72                         */
  73                         if ($counter == 0) {
  74                                 //unused but supported by ezybiz, helpful in debugging
  75                                 $invoice_info['customer'] = $result->fields['patient_name'];
  76                                 $invoice_info['invoicedate'] = date("m-d-Y",strtotime($result->fields['process_date']));
  77                                 $invoice_info['duedate'] = date("m-d-Y",strtotime($result->fields['process_date']));
  78                                 $invoice_info['items'] = array();
  79                         }
  80
  81                         $tii = array();
  82                         //This is how we set the line items for the invoice, using codes from our encounter
  83                         //if ($result->fields['code_type'] == "CPT4" || $result->fields['code_type'] == "HCPCS") {
  84                         //if( $result->fields['code_type'] != "ICD9" ) {
  85                         if( $result->fields['code_type'] == "COPAY")
  86                         {
  87                                 $patient_info['payment_amount'] += sprintf("%01.2f",$result->fields['fee']);
  88                         }
  89                         else
  90                         {
  91                                 $payer_info['payment_amount'] += sprintf("%01.2f",$result->fields['fee']);
  92                         }
  93                                 $tii['maincode'] = $result->fields['code'];
  94                                 $tii['itemtext'] = $result->fields['code_type'] .":" . $result->fields['code'] . " " . $result->fields['code_text'] . " "
  95                                         . $result->fields['justify'];
  96
  97                                 $tii['qty'] = $result->fields['units'];
  98                                 if (!$tii['qty'] > 0) {
  99                                         $tii['qty'] = 1;
 100                                 }
 101                                 $tii['price'] = sprintf("%01.2f",$result->fields['fee']);
 102                                 $total += $tii['price'];
 103                                 $tii['glaccountid'] = $this->_config['income_acct'];
 104                                 $invoice_info['items'][] = $tii;
 105                         //}
 106
 107                         $result->MoveNext();
 108                         $counter++;
 109                 }
 110
 111
 112                 for($counter = 0; $counter < 2; $counter++)
 113                 {
 114                         $fee = 0;
 115                         $billto = 0;
 116                         if($counter == 0)
 117                         {
 118                                 $fee = $patient_info['payment_amount'];
 119                                 $billto = $this->foreign_patient_id;
 120                         }
 121                         else
 122                         {
 123                                 $fee = $payer_info['payment_amount'];
 124                                 $billto = $this->foreign_payer_id;
 125                         }
 126                         $invoice_info["invoiceid$counter"] = $this->patient_id . "000" . $this->encounter;
 127                         $invoice_info["amount$counter"] = $fee;
 128                         $invoice_info["invoicenumber$counter"] = $this->patient_id . "000" . $this->encounter;
 129                         $invoice_info["interest$counter"] = 0;
 130                         $invoice_info["billtoid$counter"] = $billto;
 131                 }
 132                 $invoice_info['subtotal'] = sprintf("%01.2f",$total);
 133                 $invoice_info['total'] = sprintf("%01.2f",$total);
 134
 135                 $this->claim = $invoice_info;
 136                 return true;
 137         }
 138
 139         function load_provider_foreign_id() {
 140                 $sql = "SELECT foreign_id from integration_mapping as im LEFT JOIN billing as b on im.local_id=b.provider_id where encounter = '" . $this->encounter . "' and b.pid = '" . $this->patient_id . "' and im.local_table='users' and im.foreign_table='salesman'";
 141                 $result = $this->_db->Execute($sql);
 142                 if($result && !$result->EOF) {
 143                                 $this->foreign_provider_id = $result->fields['foreign_id'];
 144                                 return true;
 145                 }
 146                 else {
 147                         echo "Entry has not been previously sent to external system or no entry was found for them in the integration mapping, could not send claim. Provider: '" . $this->patient_id . "'<br>";
 148                         return false;
 149                 }
 150         }
 151         function load_patient_foreign_id() {
 152                 $sql = "SELECT foreign_id from integration_mapping as im LEFT JOIN patient_data as pd on im.local_id=pd.id where pd.pid = '" . $this->patient_id . "' and im.local_table='patient_data' and im.foreign_table='customer'";
 153                 $result = $this->_db->Execute($sql);
 154                 if($result && !$result->EOF) {
 155                                 $this->foreign_patient_id = $result->fields['foreign_id'];
 156                                 return true;
 157                 }
 158                 else {
 159                         echo "Entry has not been previously sent to external system or no entry was found for them in the integration mapping, could not send claim. Patient: '" . $this->patient_id . "'<br>";
 160                         return false;
 161                 }
 162         }
 163         function load_payer_foreign_id() {
 164                 $sql = "SELECT payer_id from billing where encounter = '" . $this->encounter . "' and pid = '" . $this->patient_id . "'";
 165                 $result = $this->_db->Execute($sql);
 166                 if($result && !$result->EOF) {
 167                                 $this->payer_id = $result->fields['payer_id'];
 168                 }
 169                 else {
 170                         echo "No payer id for this claim could be found";
 171                         return false;
 172                 }
 173                 // See comments in globals.php:
 174                 if ($GLOBALS['insurance_companies_are_not_customers']) {
 175                         $this->foreign_payer_id = $this->payer_id;
 176                 }
 177                 else {
 178                         $sql = "SELECT foreign_id from integration_mapping as im LEFT JOIN billing as b on im.local_id=b.payer_id where b.payer_id = '" . $this->payer_id . "' and im.local_table='insurance_companies' and im.foreign_table='customer'";
 179                         $result = $this->_db->Execute($sql);
 180                         if($result && !$result->EOF) {
 181                                 $this->foreign_payer_id = $result->fields['foreign_id'];
 182                         }
 183                         else {
 184                                 echo "Entry has not been previously sent to external system or no entry was found for them in the integration mapping, could not send claim. Insurance Company: '" . $this->payer_id . "'<br>";
 185                                 return false;
 186                         }
 187                 }
 188                 return true;
 189         }
 190 }
 191
 192 //$wsc = new WSClaim("3","20040622");
 193
 194 ?>