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");
  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 $sessionId;
 101         }
 102     }
 103
 104     // Post a payment, new style.
 105     //
 106     public static function arPostPayment($patient_id, $encounter_id, $session_id, $amount, $code, $payer_type, $memo, $debug, $time = '', $codetype = '')
 107     {
 108         $codeonly = $code;
 109         $modifier = '';
 110         $tmp = strpos($code, ':');
 111         if ($tmp) {
 112             $codeonly = substr($code, 0, $tmp);
 113             $modifier = substr($code, $tmp + 1);
 114         }
 115
 116         if (empty($time)) {
 117             $time = date('Y-m-d H:i:s');
 118         }
 119
 120         sqlBeginTrans();
 121         $sequence_no = sqlQuery("SELECT IFNULL(MAX(sequence_no),0) + 1 AS increment FROM ar_activity WHERE pid = ? AND encounter = ?", array($patient_id, $encounter_id));
 122         $query = "INSERT INTO ar_activity ( " .
 123             "pid, encounter, sequence_no, code_type, code, modifier, payer_type, post_time, post_user, " .
 124             "session_id, memo, pay_amount " .
 125             ") VALUES (?, ?, ?, ?, ?, ?, ?, ?, ?, ?, ?, ?)";
 126         sqlStatement($query, array($patient_id, $encounter_id, $sequence_no['increment'], $codetype, $codeonly, $modifier, $payer_type, $time, $_SESSION['authUserID'], $session_id, $memo, $amount));
 127         sqlCommitTrans();
 128         return;
 129     }
 130
 131     // Post a charge.  This is called only from sl_eob_process.php where
 132     // automated remittance processing can create a new service item.
 133     // Here we add it as an unauthorized item to the billing table.
 134     //
 135     public static function arPostCharge($patient_id, $encounter_id, $session_id, $amount, $units, $thisdate, $code, $description, $debug, $codetype = '')
 136     {
 137         /*****************************************************************
 138          * // Select an existing billing item as a template.
 139          * $row= sqlQuery("SELECT * FROM billing WHERE " .
 140          * "pid = '$patient_id' AND encounter = '$encounter_id' AND " .
 141          * "code_type = 'CPT4' AND activity = 1 " .
 142          * "ORDER BY id DESC LIMIT 1");
 143          * $this_authorized = 0;
 144          * $this_provider = 0;
 145          * if (!empty($row)) {
 146          * $this_authorized = $row['authorized'];
 147          * $this_provider = $row['provider_id'];
 148          * }
 149          *****************************************************************/
 150
 151         if (empty($codetype)) {
 152             // default to CPT4 if empty, which is consistent with previous functionality.
 153             $codetype = "CPT4";
 154         }
 155
 156         $codeonly = $code;
 157         $modifier = '';
 158         $tmp = strpos($code, ':');
 159         if ($tmp) {
 160             $codeonly = substr($code, 0, $tmp);
 161             $modifier = substr($code, $tmp + 1);
 162         }
 163
 164         BillingUtilities::addBilling(
 165             $encounter_id,
 166             $codetype,
 167             $codeonly,
 168             $description,
 169             $patient_id,
 170             0,
 171             0,
 172             $modifier,
 173             $units,
 174             $amount,
 175             '',
 176             ''
 177         );
 178     }
 179
 180     // Post an adjustment, new style.
 181     //
 182     public static function arPostAdjustment($patient_id, $encounter_id, $session_id, $amount, $code, $payer_type, $reason, $debug, $time = '', $codetype = '')
 183     {
 184         $codeonly = $code;
 185         $modifier = '';
 186         $tmp = strpos($code, ':');
 187         if ($tmp) {
 188             $codeonly = substr($code, 0, $tmp);
 189             $modifier = substr($code, $tmp + 1);
 190         }
 191
 192         if (empty($time)) {
 193             $time = date('Y-m-d H:i:s');
 194         }
 195
 196         sqlBeginTrans();
 197         $sequence_no = sqlQuery("SELECT IFNULL(MAX(sequence_no),0) + 1 AS increment FROM ar_activity WHERE pid = ? AND encounter = ?", array($patient_id, $encounter_id));
 198         $query = "INSERT INTO ar_activity ( " .
 199             "pid, encounter, sequence_no, code_type, code, modifier, payer_type, post_user, post_time, " .
 200             "session_id, memo, adj_amount " .
 201             ") VALUES (?, ?, ?, ?, ?, ?, ?, ?, ?, ?, ?, ?)";
 202         sqlStatement($query, array($patient_id, $encounter_id, $sequence_no['increment'], $codetype, $codeonly, $modifier, $payer_type, $_SESSION['authUserID'], $time, $session_id, $reason, $amount));
 203         sqlCommitTrans();
 204         return;
 205     }
 206
 207     public static function arGetPayerID($patient_id, $date_of_service, $payer_type)
 208     {
 209         if ($payer_type < 1 || $payer_type > 3) {
 210             return 0;
 211         }
 212
 213         $tmp = array(1 => 'primary', 2 => 'secondary', 3 => 'tertiary');
 214         $value = $tmp[$payer_type];
 215         $query = "SELECT provider FROM insurance_data WHERE " .
 216             "pid = ? AND type = ? AND (date <= ? OR date IS NULL) " .
 217             "ORDER BY date DESC LIMIT 1";
 218         $nprow = sqlQuery($query, array($patient_id, $value, $date_of_service));
 219         if (empty($nprow)) {
 220             return 0;
 221         }
 222
 223         return $nprow['provider'];
 224     }
 225
 226     // Make this invoice re-billable, new style.
 227     //
 228     public static function arSetupSecondary($patient_id, $encounter_id, $debug, $crossover = 0)
 229     {
 230         if ($crossover == 1) {
 231             //if claim forwarded setting a new status
 232             $status = 6;
 233         } else {
 234             $status = 1;
 235         }
 236
 237         // Determine the next insurance level to be billed.
 238         $ferow = sqlQuery("SELECT date, last_level_billed " .
 239             "FROM form_encounter WHERE " .
 240             "pid = ? AND encounter = ?", array($patient_id, $encounter_id));
 241         $date_of_service = substr($ferow['date'], 0, 10);
 242         $new_payer_type = 0 + $ferow['last_level_billed'];
 243         if ($new_payer_type < 3 && !empty($ferow['last_level_billed']) || $new_payer_type == 0) {
 244             ++$new_payer_type;
 245         }
 246
 247         $new_payer_id = self::arGetPayerID($patient_id, $date_of_service, $new_payer_type);
 248
 249         if ($new_payer_id) {
 250             // Queue up the claim.
 251             if (!$debug) {
 252                 BillingUtilities::updateClaim(true, $patient_id, $encounter_id, $new_payer_id, $new_payer_type, $status, 5, '', 'hcfa', '', $crossover);
 253             }
 254         } else {
 255             // Just reopen the claim.
 256             if (!$debug) {
 257                 BillingUtilities::updateClaim(true, $patient_id, $encounter_id, -1, -1, $status, 0, '', '', '', $crossover);
 258             }
 259         }
 260
 261         return xl("Encounter ") . $encounter . xl(" is ready for re-billing.");
 262     }
 263 }