library/gen_x12_837.inc.php

   1 <?php
   2 // Copyright (C) 2007-2011 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("Claim.class.php");
  10 function stripZipCode($zip)
  11 {
  12     return preg_replace('/[-\s]*/','',$zip);
  13 }
  14 function gen_x12_837($pid, $encounter, &$log, $encounter_claim=false) {
  15
  16   $today = time();
  17   $out = '';
  18   $claim = new Claim($pid, $encounter);
  19   $edicount = 0;
  20
  21   // This is true for the 5010 standard, false for 4010.
  22   // x12gsversionstring() should be "005010X222A1" or "004010X098A1".
  23   $CMS_5010 = strpos($claim->x12gsversionstring(), '5010') !== false;
  24
  25   $log .= "Generating claim $pid-$encounter for " .
  26     $claim->patientFirstName()  . ' ' .
  27     $claim->patientMiddleName() . ' ' .
  28     $claim->patientLastName()   . ' on ' .
  29     date('Y-m-d H:i', $today) . ".\n";
  30
  31   $out .= "ISA" .
  32     "*" . $claim->x12gsisa01() .
  33     "*" . $claim->x12gsisa02() .
  34     "*" . $claim->x12gsisa03() .
  35     "*" . $claim->x12gsisa04() .
  36     "*" . $claim->x12gsisa05() .
  37     "*" . $claim->x12gssenderid() .
  38     "*" . $claim->x12gsisa07() .
  39     "*" . $claim->x12gsreceiverid() .
  40     "*030911" .
  41     "*1630" .
  42     "*" . ($CMS_5010 ? "^"     : "U"    ) .
  43     "*" . ($CMS_5010 ? "00501" : "00401") .
  44     "*000000001" .
  45     "*" . $claim->x12gsisa14() .
  46     "*" . $claim->x12gsisa15() .
  47     "*:" .
  48     "~\n";
  49
  50   $out .= "GS" .
  51     "*HC" .
  52     "*" . $claim->x12gsgs02() .
  53     "*" . trim($claim->x12gs03()) .
  54     "*" . date('Ymd', $today) .
  55     "*" . date('Hi', $today) .
  56     "*1" .
  57     "*X" .
  58     "*" . $claim->x12gsversionstring() .
  59     "~\n";
  60
  61   ++$edicount;
  62   $out .= "ST" .
  63     "*837" .
  64     "*0021" .
  65     // Spec says the following is optional, so should be able to leave it out.
  66     ($CMS_5010 ? ("*" . $claim->x12gsversionstring()) : "") .
  67     "~\n";
  68
  69   ++$edicount;
  70   $out .= "BHT" .
  71     "*0019" .                             // 0019 is required here
  72     "*00" .                               // 00 = original transmission
  73     "*0123" .                             // reference identification
  74     "*" . date('Ymd', $today) .           // transaction creation date
  75     "*" . date('Hi', $today) .            // transaction creation time
  76     ($encounter_claim ? "*RP" : "*CH") .  // RP = reporting, CH = chargeable
  77     "~\n";
  78
  79   if (!$CMS_5010) {
  80     // This segment was deleted for 5010.
  81     ++$edicount;
  82     $out .= "REF" .
  83       "*87" .
  84       "*" . $claim->x12gsversionstring() .
  85       "~\n";
  86   }
  87
  88   ++$edicount;
  89   //Field length is limited to 35. See nucc dataset page 63 www.nucc.org
  90   $billingFacilityName = substr($claim->billingFacilityName(), 0, $CMS_5010 ? 60 : 35);
  91   $out .= "NM1" .       // Loop 1000A Submitter
  92     "*41" .
  93     "*2" .
  94     "*" . $billingFacilityName .
  95     "*" .
  96     "*" .
  97     "*" .
  98     "*" .
  99     "*46";
 100    if (trim($claim->x12gsreceiverid()) == '470819582') { // if ECLAIMS EDI
 101     $out  .=  "*" . $claim->clearingHouseETIN();
 102    } else {
 103     $out  .=  "*" . $claim->billingFacilityETIN();
 104    }
 105     $out .= "~\n";
 106
 107   ++$edicount;
 108   $out .= "PER" .
 109     "*IC" .
 110     "*" . $claim->billingContactName() .
 111     "*TE" .
 112     "*" . $claim->billingContactPhone();
 113   if (!$CMS_5010 && $claim->x12gsper06()) {
 114     $out .= "*ED*" . $claim->x12gsper06();
 115   }
 116   $out .= "~\n";
 117
 118   ++$edicount;
 119   $out .= "NM1" .       // Loop 1000B Receiver
 120     "*40" .
 121     "*2" .
 122     "*" . $claim->clearingHouseName() .
 123     "*" .
 124     "*" .
 125     "*" .
 126     "*" .
 127     "*46" .
 128     "*" . $claim->clearingHouseETIN() .
 129     "~\n";
 130
 131   $HLcount = 1;
 132
 133   ++$edicount;
 134   $out .= "HL" .        // Loop 2000A Billing/Pay-To Provider HL Loop
 135     "*$HLcount" .
 136     "*" .
 137     "*20" .
 138     "*1" .              // 1 indicates there are child segments
 139     "~\n";
 140
 141   $HLBillingPayToProvider = $HLcount++;
 142
 143   // Situational PRV segment (for provider taxonomy code) omitted here.
 144   // Situational CUR segment (foreign currency information) omitted here.
 145
 146   ++$edicount;
 147   //Field length is limited to 35. See nucc dataset page 63 www.nucc.org
 148   $billingFacilityName = substr($claim->billingFacilityName(), 0, $CMS_5010 ? 60 : 35);
 149   $out .= "NM1" .       // Loop 2010AA Billing Provider
 150     "*85" .
 151     "*2" .
 152     "*" . $billingFacilityName .
 153     "*" .
 154     "*" .
 155     "*" .
 156     "*";
 157   if ($claim->billingFacilityNPI()) {
 158     $out .= "*XX*" . $claim->billingFacilityNPI();
 159   }
 160   else {
 161     $log .= "*** Billing facility has no NPI.\n";
 162     if ($CMS_5010) {
 163       $out .= "*XX*";
 164     }
 165     else {
 166       $out .= "*24*" . $claim->billingFacilityETIN();
 167     }
 168   }
 169   $out .= "~\n";
 170
 171   ++$edicount;
 172   $out .= "N3" .
 173     "*" . $claim->billingFacilityStreet() .
 174     "~\n";
 175
 176   ++$edicount;
 177   $out .= "N4" .
 178     "*" . $claim->billingFacilityCity() .
 179     "*" . $claim->billingFacilityState() .
 180     "*" . stripZipCode($claim->billingFacilityZip()) .
 181     "~\n";
 182
 183   if ($CMS_5010 || ($claim->billingFacilityNPI() && $claim->billingFacilityETIN())) {
 184     ++$edicount;
 185     $out .= "REF" ;
 186     if($claim->federalIdType()){
 187       $out .= "*" . $claim->federalIdType();
 188     }
 189     else{
 190       $out .= "*EI"; // For dealing with the situation before adding TaxId type In facility.
 191     }
 192     $out .=  "*" . $claim->billingFacilityETIN() .
 193       "~\n";
 194   }
 195
 196   if ($claim->providerNumberType() && $claim->providerNumber() &&
 197       !($CMS_5010 && $claim->billingFacilityNPI()))
 198   {
 199     ++$edicount;
 200     $out .= "REF" .
 201       "*" . $claim->providerNumberType() .
 202       "*" . $claim->providerNumber() .
 203       "~\n";
 204   }
 205   else if ($claim->providerNumber() && !$claim->providerNumberType()) {
 206     $log .= "*** Payer-specific provider insurance number is present but has no type assigned.\n";
 207   }
 208
 209   // Situational PER*1C segment omitted.
 210
 211   // Pay-To Address defaults to billing provider and is no longer required in 5010.
 212   if (!$CMS_5010) {
 213     ++$edicount;
 214     // Field length is limited to 35. See nucc dataset page 63 www.nucc.org
 215     $billingFacilityName = substr($claim->billingFacilityName(), 0, $CMS_5010 ? 60 : 35);
 216     $out .= "NM1" .       // Loop 2010AB Pay-To Provider
 217       "*87" .
 218       "*2" .
 219       "*" . $billingFacilityName .
 220       "*" .
 221       "*" .
 222       "*" .
 223       "*";
 224     if ($claim->billingFacilityNPI())
 225       $out .= "*XX*" . $claim->billingFacilityNPI();
 226     else
 227       $out .= "*24*" . $claim->billingFacilityETIN();
 228     $out .= "~\n";
 229
 230     ++$edicount;
 231     $out .= "N3" .
 232       "*" . $claim->billingFacilityStreet() .
 233       "~\n";
 234
 235     ++$edicount;
 236     $out .= "N4" .
 237       "*" . $claim->billingFacilityCity() .
 238       "*" . $claim->billingFacilityState() .
 239       "*" . stripZipCode($claim->billingFacilityZip()) .
 240       "~\n";
 241
 242     if ($claim->billingFacilityNPI() && $claim->billingFacilityETIN()) {
 243       ++$edicount;
 244       $out .= "REF" .
 245         "*EI" .
 246         "*" . $claim->billingFacilityETIN() .
 247         "~\n";
 248     }
 249   }
 250
 251   // Loop 2010AC Pay-To Plan Name omitted.  Includes:
 252   // NM1*PE, N3, N4, REF*2U, REF*EI
 253
 254   $PatientHL = $claim->isSelfOfInsured() ? 0 : 1;
 255   $HLSubscriber = $HLcount++;
 256
 257   ++$edicount;
 258   $out .= "HL" .        // Loop 2000B Subscriber HL Loop
 259     "*$HLSubscriber" .
 260     "*$HLBillingPayToProvider" .
 261     "*22" .
 262     "*$PatientHL" .
 263     "~\n";
 264
 265   if (!$claim->payerSequence()) {
 266     $log .= "*** Error: Insurance information is missing!\n";
 267   }
 268
 269   ++$edicount;
 270   $out .= "SBR" .       // Subscriber Information
 271     "*" . $claim->payerSequence() .
 272     "*" . ($claim->isSelfOfInsured() ? '18' : '') .
 273     "*" . $claim->groupNumber() .
 274     "*" . (($CMS_5010 && $claim->groupNumber()) ? '' : $claim->groupName()) .
 275     "*" . $claim->insuredTypeCode() . // applies for secondary medicare
 276     "*" .
 277     "*" .
 278     "*" .
 279     "*" . $claim->claimType() . // Zirmed replaces this
 280     "~\n";
 281
 282   // Segment PAT omitted.
 283
 284   ++$edicount;
 285   $out .= "NM1" .       // Loop 2010BA Subscriber
 286     "*IL" .
 287     "*1" . // 1 = person, 2 = non-person
 288     "*" . $claim->insuredLastName() .
 289     "*" . $claim->insuredFirstName() .
 290     "*" . $claim->insuredMiddleName() .
 291     "*" .
 292     "*" . // Name Suffix
 293     "*MI" .
 294     // "MI" = Member Identification Number
 295     // "II" = Standard Unique Health Identifier, "Required if the
 296     //        HIPAA Individual Patient Identifier is mandated use."
 297     //        Here we presume that is not true yet.
 298     "*" . $claim->policyNumber() .
 299     "~\n";
 300
 301   // For 5010, further subscriber info is sent only if they are the patient.
 302   if (!$CMS_5010 || $claim->isSelfOfInsured()) {
 303     ++$edicount;
 304     $out .= "N3" .
 305       "*" . $claim->insuredStreet() .
 306       "~\n";
 307
 308     ++$edicount;
 309     $out .= "N4" .
 310       "*" . $claim->insuredCity() .
 311       "*" . $claim->insuredState() .
 312       "*" . stripZipCode($claim->insuredZip()) .
 313       "~\n";
 314
 315     ++$edicount;
 316     $out .= "DMG" .
 317       "*D8" .
 318       "*" . $claim->insuredDOB() .
 319       "*" . $claim->insuredSex() .
 320       "~\n";
 321   }
 322
 323   // Segment REF*SY (Subscriber Secondary Identification) omitted.
 324   // Segment REF*Y4 (Property and Casualty Claim Number) omitted.
 325   // Segment PER*IC (Property and Casualty Subscriber Contact Information) omitted.
 326
 327   ++$edicount;
 328   //Field length is limited to 35. See nucc dataset page 81 www.nucc.org
 329   $payerName = substr($claim->payerName(), 0, $CMS_5010 ? 60 : 35);
 330   $out .= "NM1" .       // Loop 2010BB Payer
 331     "*PR" .
 332     "*2" .
 333     "*" . $payerName .
 334     "*" .
 335     "*" .
 336     "*" .
 337     "*" .
 338     // The 5010 spec says:
 339     // "On or after the mandated implementation date for the HIPAA
 340     // National Plan Identifier (National Plan ID), XV must be sent.
 341     // Prior to the mandated implementation date and prior to any phase-
 342     // in period identified by Federal regulation, PI must be sent."
 343     // *************** Anybody know what that date is? ***************
 344         //    August 2011 - Publish interim final rule
 345 //    October 1, 2012-March 31, 2013 - Enumeration
 346 //    April 1, 2013-September 30, 2013 - Testing
 347  //   October 1, 2013 - Implementation
 348
 349     "*PI" .
 350     // Zirmed ignores this if using payer name matching:
 351     "*" . ($encounter_claim ? $claim->payerAltID() : $claim->payerID()) .
 352     "~\n";
 353
 354   // if (!$claim->payerID()) {
 355   //   $log .= "*** CMS ID is missing for payer '" . $claim->payerName() . "'.\n";
 356   // }
 357
 358   if (true) { // !$CMS_5010
 359     // The 5010 spec says:
 360     // "Required when the payer address is available and the submitter intends
 361     // for the claim to be printed on paper at the next EDI location (for example, a
 362     // clearinghouse). If not required by this implementation guide, do not send."
 363
 364     ++$edicount;
 365     $out .= "N3" .
 366       "*" . $claim->payerStreet() .
 367       "~\n";
 368
 369     ++$edicount;
 370     $out .= "N4" .
 371       "*" . $claim->payerCity() .
 372       "*" . $claim->payerState() .
 373       "*" . stripZipCode($claim->payerZip()) .
 374       "~\n";
 375   }
 376
 377   // Segment REF (Payer Secondary Identification) omitted.
 378   // Segment REF (Billing Provider Secondary Identification) omitted.
 379
 380   if (! $claim->isSelfOfInsured()) {
 381     ++$edicount;
 382     $out .= "HL" .        // Loop 2000C Patient Information
 383       "*$HLcount" .
 384       "*$HLSubscriber" .
 385       "*23" .
 386       "*0" .
 387       "~\n";
 388
 389     $HLcount++;
 390
 391     ++$edicount;
 392     $out .= "PAT" .
 393       "*" . $claim->insuredRelationship() .
 394       "~\n";
 395
 396     ++$edicount;
 397     $out .= "NM1" .       // Loop 2010CA Patient
 398       "*QC" .
 399       "*1" .
 400       "*" . $claim->patientLastName() .
 401       "*" . $claim->patientFirstName();
 402     if ($claim->patientMiddleName() !== '') $out .= "*"
 403 . $claim->patientMiddleName();
 404     $out .= "~\n";
 405
 406     ++$edicount;
 407     $out .= "N3" .
 408       "*" . $claim->patientStreet() .
 409       "~\n";
 410
 411     ++$edicount;
 412     $out .= "N4" .
 413       "*" . $claim->patientCity() .
 414       "*" . $claim->patientState() .
 415       "*" . stripZipCode($claim->patientZip()) .
 416       "~\n";
 417
 418     ++$edicount;
 419     $out .= "DMG" .
 420       "*D8" .
 421       "*" . $claim->patientDOB() .
 422       "*" . $claim->patientSex() .
 423       "~\n";
 424
 425     // Segment REF*Y4 (Property and Casualty Claim Number) omitted.
 426     // Segment REF (Property and Casualty Patient Identifier) omitted.
 427     // Segment PER (Property and Casualty Patient Contact Information) omitted.
 428
 429   } // end of patient different from insured
 430
 431   $proccount = $claim->procCount();
 432
 433   $clm_total_charges = 0;
 434   for ($prockey = 0; $prockey < $proccount; ++$prockey) {
 435     $clm_total_charges += $claim->cptCharges($prockey);
 436   }
 437
 438   if (!$clm_total_charges) {
 439     $log .= "*** This claim has no charges!\n";
 440   }
 441
 442   ++$edicount;
 443   $out .= "CLM" .       // Loop 2300 Claim
 444     "*$pid-$encounter" .
 445     "*"  . sprintf("%.2f",$clm_total_charges) . // Zirmed computes and replaces this
 446     "*"  .
 447     "*"  .
 448     "*"  . sprintf('%02d', $claim->facilityPOS()) . ":" .
 449            ($CMS_5010 ? "B" : "") . ":" .
 450            $claim->frequencyTypeCode() . // Changed to correct single digit output
 451     "*Y" .
 452     "*A" .
 453     "*"  . ($claim->billingFacilityAssignment() ? 'Y' : 'N') .
 454     "*Y" .
 455     ($CMS_5010 ? "" : "*C") .
 456     "~\n";
 457
 458   if ($claim->onsetDate() &&
 459       ($claim->onsetDate()!== $claim->serviceDate()) &&
 460       ($claim->onsetDateValid())
 461      ) {
 462     ++$edicount;
 463     $out .= "DTP" .       // Date of Onset
 464       "*431" .
 465       "*D8" .
 466       "*" . $claim->onsetDate() .
 467       "~\n";
 468   }
 469
 470   if ($claim->dateInitialTreatment() && ($claim->onsetDateValid())) {
 471     ++$edicount;
 472     $out .= "DTP" .       // Date of Initial Treatment
 473       "*454" .
 474       "*D8" .
 475       "*" . $claim->dateInitialTreatment() .
 476       "~\n";
 477   }
 478
 479   // Segment DTP*304 (Last Seen Date) omitted.
 480   // Segment DTP*453 (Acute Manifestation Date) omitted.
 481   // Segment DTP*439 (Accident Date) omitted.
 482   // Segment DTP*484 (Last Menstrual Period Date) omitted.
 483   // Segment DTP*455 (Last X-Ray Date) omitted.
 484   // Segment DTP*471 (Hearing and Vision Prescription Date) omitted.
 485   // Segments DTP (Disability Dates) omitted.
 486   // Segment DTP*297 (Last Worked Date) omitted.
 487   // Segment DTP*296 (Authorized Return to Work Date) omitted.
 488
 489   if (strcmp($claim->facilityPOS(),'21') == 0 && $claim->onsetDateValid() ) {
 490     ++$edicount;
 491     $out .= "DTP" .     // Date of Hospitalization
 492       "*435" .
 493       "*D8" .
 494       "*" . $claim->onsetDate() .
 495       "~\n";
 496   }
 497
 498   // Segment DTP*096 (Discharge Date) omitted.
 499   // Segments DTP (Assumed and Relinquished Care Dates) omitted.
 500   // Segment DTP*444 (Property and Casualty Date of First Contact) omitted.
 501   // Segment DTP*050 (Repricer Received Date) omitted.
 502   // Segment PWK (Claim Supplemental Information) omitted.
 503   // Segment CN1 (Contract Information) omitted.
 504
 505   $patientpaid = $claim->patientPaidAmount();
 506   if ($patientpaid != 0) {
 507     ++$edicount;
 508     $out .= "AMT" .     // Patient paid amount. Page 190/220.
 509       "*F5" .
 510       "*" . $patientpaid .
 511       "~\n";
 512   }
 513
 514   // Segment REF*4N (Service Authorization Exception Code) omitted.
 515   // Segment REF*F5 (Mandatory Medicare Crossover Indicator) omitted.
 516   // Segment REF*EW (Mammography Certification Number) omitted.
 517   // Segment REF*9F (Referral Number) omitted.
 518
 519   if ($claim->priorAuth()) {
 520     ++$edicount;
 521     $out .= "REF" .     // Prior Authorization Number
 522       "*G1" .
 523       "*" . $claim->priorAuth() .
 524       "~\n";
 525   }
 526
 527   // Segment REF*F8 (Payer Claim Control Number) omitted.
 528
 529   if ($claim->cliaCode() && ($CMS_5010 || $claim->claimType() === 'MB')) {
 530     // Required by Medicare when in-house labs are done.
 531     ++$edicount;
 532     $out .= "REF" .     // Clinical Laboratory Improvement Amendment Number
 533       "*X4" .
 534       "*" . $claim->cliaCode() .
 535       "~\n";
 536   }
 537
 538   // Segment REF*9A (Repriced Claim Number) omitted.
 539   // Segment REF*9C (Adjusted Repriced Claim Number) omitted.
 540   // Segment REF*LX (Investigational Device Exemption Number) omitted.
 541   // Segment REF*D9 (Claim Identifier for Transmission Intermediaries) omitted.
 542   // Segment REF*EA (Medical Record Number) omitted.
 543   // Segment REF*P4 (Demonstration Project Identifier) omitted.
 544   // Segment REF*1J (Care Plan Oversight) omitted.
 545   // Segment K3 (File Information) omitted.
 546
 547   if ($claim->additionalNotes()) {
 548     // Claim note.
 549     ++$edicount;
 550     $out .= "NTE" .     // comments box 19
 551       "*" . ($CMS_5010 ? "ADD" : "") .
 552       "*" . $claim->additionalNotes() .
 553       "~\n";
 554   }
 555
 556   // Segment CR1 (Ambulance Transport Information) omitted.
 557   // Segment CR2 (Spinal Manipulation Service Information) omitted.
 558   // Segment CRC (Ambulance Certification) omitted.
 559   // Segment CRC (Patient Condition Information: Vision) omitted.
 560   // Segment CRC (Homebound Indicator) omitted.
 561   // Segment CRC (EPSDT Referral) omitted.
 562
 563   // Diagnoses, up to $max_per_seg per HI segment.
 564   $max_per_seg = $CMS_5010 ? 12 : 8;
 565   $da = $claim->diagArray();
 566   $diag_type_code = 'BK';
 567   $tmp = 0;
 568   foreach ($da as $diag) {
 569     if ($tmp % $max_per_seg == 0) {
 570       if ($tmp) $out .= "~\n";
 571       ++$edicount;
 572       $out .= "HI";         // Health Diagnosis Codes
 573     }
 574     $out .= "*$diag_type_code:" . $diag;
 575     $diag_type_code = 'BF';
 576     ++$tmp;
 577   }
 578   if ($tmp) $out .= "~\n";
 579
 580   // Segment HI*BP (Anesthesia Related Procedure) omitted.
 581   // Segment HI*BG (Condition Information) omitted.
 582   // Segment HCP (Claim Pricing/Repricing Information) omitted.
 583
 584   if ($claim->referrerLastName()) {
 585     // Medicare requires referring provider's name and UPIN.
 586     ++$edicount;
 587     $out .= "NM1" .     // Loop 2310A Referring Provider
 588       "*DN" .
 589       "*1" .
 590       "*" . $claim->referrerLastName() .
 591       "*" . $claim->referrerFirstName() .
 592       "*" . $claim->referrerMiddleName() .
 593       "*" .
 594       "*";
 595     if ($CMS_5010 || $claim->referrerNPI()) { $out .=
 596       "*XX" .
 597       "*" . $claim->referrerNPI();
 598     } else { $out .=
 599       "*34" .                           // not allowed for 5010
 600       "*" . $claim->referrerSSN();
 601     }
 602     $out .= "~\n";
 603
 604     if (!$CMS_5010 && $claim->referrerTaxonomy()) {
 605       ++$edicount;
 606       $out .= "PRV" .
 607         "*RF" . // ReFerring provider
 608         "*ZZ" .
 609         "*" . $claim->referrerTaxonomy() .
 610         "~\n";
 611     }
 612
 613     if (!CMS_5010 && $claim->referrerUPIN()) {
 614       ++$edicount;
 615       $out .= "REF" .   // Referring Provider Secondary Identification
 616         "*1G" .
 617         "*" . $claim->referrerUPIN() .
 618         "~\n";
 619     }
 620   }
 621
 622
 623   /* Per the implementation guide lines, only include this information if it is different
 624    * than the Loop 2010AA information
 625    */
 626   if(!$CMS_5010 ||
 627           ($claim->providerNPIValid() &&
 628           $claim->billingFacilityNPI() !== $claim->providerNPI() ))
 629   {
 630     ++$edicount;
 631     $out .= "NM1" .       // Loop 2310B Rendering Provider
 632         "*82" .
 633         "*1" .
 634         "*" . $claim->providerLastName() .
 635         "*" . $claim->providerFirstName() .
 636         "*" . $claim->providerMiddleName() .
 637         "*" .
 638         "*";
 639     if ($CMS_5010 || $claim->providerNPI()) { $out .=
 640         "*XX" .
 641         "*" . $claim->providerNPI();
 642     } else { $out .=
 643         "*34" .                             // not allowed for 5010
 644         "*" . $claim->providerSSN();
 645         $log .= "*** Rendering provider has no NPI.\n";
 646     }
 647     $out .= "~\n";
 648
 649     if ($claim->providerTaxonomy()) {
 650         ++$edicount;
 651         $out .= "PRV" .
 652         "*PE" . // PErforming provider
 653         "*" . ($CMS_5010 ? "PXC" : "ZZ") .
 654         "*" . $claim->providerTaxonomy() .
 655         "~\n";
 656     }
 657     // End of Loop 2310B
 658   }
 659   else
 660   {
 661     // This loop can only get skipped if we are generating a 5010 claim
 662     if(!($claim->providerNPIValid()))
 663     {
 664         /* If the loop was skipped because the provider NPI was invalid, generate
 665          * a warning for the log.*/
 666         $log.="*** Skipping 2310B because ".$claim->providerLastName() ."," . $claim->providerFirstName() . " has invalid NPI.\n";
 667     }
 668     /* Skipping this segment because the providerNPI and the billingFacilityNPI are identical
 669      * is a normal condition, so no need to warn.
 670      */
 671
 672   }
 673
 674   // 4010: REF*1C is required here for the Medicare provider number if NPI was
 675   // specified in NM109.  Not sure if other payers require anything here.
 676   // --- apparently ECLAIMS, INC wants the data in 2010 but NOT in 2310B - tony@mi-squared.com
 677   //
 678   // 5010 spec says nothing here if NPI was specified.
 679   //
 680   if (($CMS_5010 && !$claim->providerNPI() && in_array($claim->providerNumberType(), array('0B','1G','G2','LU')))
 681       || (!$CMS_5010 && trim($claim->x12gsreceiverid()) != '470819582')) // if NOT ECLAIMS EDI
 682   {
 683     if ($claim->providerNumber()) {
 684       ++$edicount;
 685       $out .= "REF" .
 686         "*" . $claim->providerNumberType() .
 687         "*" . $claim->providerNumber() .
 688         "~\n";
 689     }
 690   }
 691
 692   // Loop 2310D is omitted in the case of home visits (POS=12).
 693   if ($claim->facilityPOS() != 12 &&
 694       (!$CMS_5010 || $claim->facilityNPI() != $claim->billingFacilityNPI()))
 695     {
 696     ++$edicount;
 697     $out .= "NM1" .       // Loop 2310D Service Location
 698       "*77" .
 699       "*2";
 700     //Field length is limited to 35. See nucc dataset page 77 www.nucc.org
 701     $facilityName = substr($claim->facilityName(), 0, $CMS_5010 ? 60 : 35);
 702     if ($claim->facilityName() || $claim->facilityNPI() || $claim->facilityETIN()) { $out .=
 703       "*" . $facilityName;
 704     }
 705     if ($claim->facilityNPI() || $claim->facilityETIN()) { $out .=
 706       "*" .
 707       "*" .
 708       "*" .
 709       "*";
 710       if ($CMS_5010 || $claim->facilityNPI()) { $out .=
 711         "*XX*" . $claim->facilityNPI();
 712       } else { $out .=
 713         "*24*" . $claim->facilityETIN();
 714       }
 715       if (!$claim->facilityNPI()) {
 716         $log .= "*** Service location has no NPI.\n";
 717       }
 718     }
 719     $out .= "~\n";
 720     if ($claim->facilityStreet()) {
 721       ++$edicount;
 722       $out .= "N3" .
 723         "*" . $claim->facilityStreet() .
 724         "~\n";
 725     }
 726     if ($claim->facilityState()) {
 727       ++$edicount;
 728       $out .= "N4" .
 729         "*" . $claim->facilityCity() .
 730         "*" . $claim->facilityState() .
 731         "*" . stripZipCode($claim->facilityZip()) .
 732         "~\n";
 733     }
 734   }
 735
 736   // Segment REF (Service Facility Location Secondary Identification) omitted.
 737   // Segment PER (Service Facility Contact Information) omitted.
 738
 739   // Loop 2310E, Supervising Provider
 740   //
 741   if ($claim->supervisorLastName()) {
 742     ++$edicount;
 743     $out .= "NM1" .
 744       "*DQ" . // Supervising Physician
 745       "*1" .  // Person
 746       "*" . $claim->supervisorLastName() .
 747       "*" . $claim->supervisorFirstName() .
 748       "*" . $claim->supervisorMiddleName() .
 749       "*" .   // NM106 not used
 750       "*";    // Name Suffix
 751     if ($CMS_5010 || $claim->supervisorNPI()) { $out .=
 752       "*XX" .
 753       "*" . $claim->supervisorNPI();
 754     } else { $out .=
 755       "*34" .
 756       "*" . $claim->supervisorSSN();
 757     }
 758     if (!$claim->supervisorNPI()) {
 759       $log .= "*** Supervising Provider has no NPI.\n";
 760     }
 761     $out .= "~\n";
 762
 763     if ($claim->supervisorNumber()) {
 764       ++$edicount;
 765       $out .= "REF" .
 766         "*" . $claim->supervisorNumberType() .
 767         "*" . $claim->supervisorNumber() .
 768         "~\n";
 769     }
 770   }
 771
 772   // Segments NM1*PW, N3, N4 (Ambulance Pick-Up Location) omitted.
 773   // Segments NM1*45, N3, N4 (Ambulance Drop-Off Location) omitted.
 774
 775   $prev_pt_resp = $clm_total_charges; // for computation below
 776
 777   // Loops 2320 and 2330*, other subscriber/payer information.
 778   // Remember that insurance index 0 is always for the payer being billed
 779   // by this claim, and 1 and above are always for the "other" payers.
 780   //
 781   for ($ins = 1; $ins < $claim->payerCount(); ++$ins) {
 782
 783     $tmp1 = $claim->claimType($ins);
 784     $tmp2 = 'C1'; // Here a kludge. See page 321.
 785     if ($tmp1 === 'CI') $tmp2 = 'C1';
 786     if ($tmp1 === 'AM') $tmp2 = 'AP';
 787     if ($tmp1 === 'HM') $tmp2 = 'HM';
 788     if ($tmp1 === 'MB') $tmp2 = 'MB';
 789     if ($tmp1 === 'MC') $tmp2 = 'MC';
 790     if ($tmp1 === '09') $tmp2 = 'PP';
 791     ++$edicount;
 792     $out .= "SBR" . // Loop 2320, Subscriber Information - page 297/318
 793       "*" . $claim->payerSequence($ins) .
 794       "*" . $claim->insuredRelationship($ins) .
 795       "*" . $claim->groupNumber($ins) .
 796       "*" . (($CMS_5010 && $claim->groupNumber($ins)) ? '' : $claim->groupName($ins)) .
 797       "*" . ($CMS_5010 ? $claim->insuredTypeCode($ins) : $tmp2) .
 798       "*" .
 799       "*" .
 800       "*" .
 801       "*" . $claim->claimType($ins) .
 802       "~\n";
 803
 804     // Things that apply only to previous payers, not future payers.
 805     //
 806     if ($claim->payerSequence($ins) < $claim->payerSequence()) {
 807
 808       // Generate claim-level adjustments.
 809       $aarr = $claim->payerAdjustments($ins);
 810       foreach ($aarr as $a) {
 811         ++$edicount;
 812         $out .= "CAS" . // Previous payer's claim-level adjustments. Page 301/323.
 813           "*" . $a[1] .
 814           "*" . $a[2] .
 815           "*" . $a[3] .
 816           "~\n";
 817       }
 818
 819       $payerpaid = $claim->payerTotals($ins);
 820       ++$edicount;
 821       $out .= "AMT" . // Previous payer's paid amount. Page 307/332.
 822         "*D" .
 823         "*" . $payerpaid[1] .
 824         "~\n";
 825
 826       // Segment AMT*A8 (COB Total Non-Covered Amount) omitted.
 827       // Segment AMT*EAF (Remaining Patient Liability) omitted.
 828
 829       if (!$CMS_5010) {
 830         // Patient responsibility amount as of this previous payer.
 831         $prev_pt_resp -= $payerpaid[1]; // reduce by payments
 832         $prev_pt_resp -= $payerpaid[2]; // reduce by adjustments
 833
 834         ++$edicount;
 835         $out .= "AMT" . // Allowed amount per previous payer. Page 334.
 836           "*B6" .
 837           "*" . sprintf('%.2f', $payerpaid[1] + $prev_pt_resp) .
 838           "~\n";
 839
 840         ++$edicount;
 841         $out .= "AMT" . // Patient responsibility amount per previous payer. Page 335.
 842           "*F2" .
 843           "*" . sprintf('%.2f', $prev_pt_resp) .
 844           "~\n";
 845       }
 846     } // End of things that apply only to previous payers.
 847
 848     if (!$CMS_5010) {
 849       ++$edicount;
 850       $out .= "DMG" . // Other subscriber demographic information. Page 342.
 851         "*D8" .
 852         "*" . $claim->insuredDOB($ins) .
 853         "*" . $claim->insuredSex($ins) .
 854         "~\n";
 855     }
 856
 857     ++$edicount;
 858     $out .= "OI" .  // Other Insurance Coverage Information. Page 310/344.
 859       "*" .
 860       "*" .
 861       "*" . ($claim->billingFacilityAssignment($ins) ? 'Y' : 'N') .
 862       // For this next item, the 5010 example in the spec does not match its
 863       // description.  So this might be wrong.
 864       "*" . ($CMS_5010 ? '' : 'B') .
 865       "*" .
 866       "*Y" .
 867       "~\n";
 868
 869     // Segment MOA (Medicare Outpatient Adjudication) omitted.
 870
 871     ++$edicount;
 872     $out .= "NM1" . // Loop 2330A Subscriber info for other insco. Page 315/350.
 873       "*IL" .
 874       "*1" .
 875       "*" . $claim->insuredLastName($ins) .
 876       "*" . $claim->insuredFirstName($ins) .
 877       "*" . $claim->insuredMiddleName($ins) .
 878       "*" .
 879       "*" .
 880       "*MI" .
 881       "*" . $claim->policyNumber($ins) .
 882       "~\n";
 883
 884     ++$edicount;
 885     $out .= "N3" .
 886       "*" . $claim->insuredStreet($ins) .
 887       "~\n";
 888
 889     ++$edicount;
 890     $out .= "N4" .
 891       "*" . $claim->insuredCity($ins) .
 892       "*" . $claim->insuredState($ins) .
 893       "*" . stripZipCode($claim->insuredZip($ins)) .
 894       "~\n";
 895
 896     // Segment REF (Other Subscriber Secondary Identification) omitted.
 897
 898     ++$edicount;
 899     //Field length is limited to 35. See nucc dataset page 81 www.nucc.org
 900     $payerName = substr($claim->payerName($ins), 0, $CMS_5010 ? 60 : 35);
 901     $out .= "NM1" . // Loop 2330B Payer info for other insco. Page 322/359.
 902       "*PR" .
 903       "*2" .
 904       "*" . $payerName .
 905       "*" .
 906       "*" .
 907       "*" .
 908       "*" .
 909       "*PI" .
 910       "*" . $claim->payerID($ins) .
 911       "~\n";
 912
 913     // if (!$claim->payerID($ins)) {
 914     //   $log .= "*** CMS ID is missing for payer '" . $claim->payerName($ins) . "'.\n";
 915     // }
 916
 917     // Payer address (N3 and N4) are added below so that Gateway EDI can
 918     // auto-generate secondary claims.  These do NOT appear in my copy of
 919     // the spec!  -- Rod 2008-06-12
 920
 921     if ($CMS_5010 || trim($claim->x12gsreceiverid()) == '431420764') { // if Gateway EDI
 922       ++$edicount;
 923       $out .= "N3" .
 924         "*" . $claim->payerStreet($ins) .
 925         "~\n";
 926       //
 927       ++$edicount;
 928       $out .= "N4" .
 929         "*" . $claim->payerCity($ins) .
 930         "*" . $claim->payerState($ins) .
 931         "*" . stripZipCode($claim->payerZip($ins)) .
 932         "~\n";
 933     } // end Gateway EDI
 934
 935     // Segment DTP*573 (Claim Check or Remittance Date) omitted.
 936     // Segment REF (Other Payer Secondary Identifier) omitted.
 937     // Segment REF*G1 (Other Payer Prior Authorization Number) omitted.
 938     // Segment REF*9F (Other Payer Referral Number) omitted.
 939     // Segment REF*T4 (Other Payer Claim Adjustment Indicator) omitted.
 940     // Segment REF*F8 (Other Payer Claim Control Number) omitted.
 941     // Segment NM1 (Other Payer Referring Provider) omitted.
 942     // Segment REF (Other Payer Referring Provider Secondary Identification) omitted.
 943     // Segment NM1 (Other Payer Rendering Provider) omitted.
 944     // Segment REF (Other Payer Rendering Provider Secondary Identification) omitted.
 945     // Segment NM1 (Other Payer Service Facility Location) omitted.
 946     // Segment REF (Other Payer Service Facility Location Secondary Identification) omitted.
 947     // Segment NM1 (Other Payer Supervising Provider) omitted.
 948     // Segment REF (Other Payer Supervising Provider Secondary Identification) omitted.
 949     // Segment NM1 (Other Payer Billing Provider) omitted.
 950     // Segment REF (Other Payer Billing Provider Secondary Identification) omitted.
 951
 952   } // End loops 2320/2330*.
 953
 954   $loopcount = 0;
 955
 956   // Procedure loop starts here.
 957   //
 958   for ($prockey = 0; $prockey < $proccount; ++$prockey) {
 959     ++$loopcount;
 960
 961     ++$edicount;
 962     $out .= "LX" .      // Loop 2400 LX Service Line. Page 398.
 963       "*$loopcount" .
 964       "~\n";
 965
 966     ++$edicount;
 967     $out .= "SV1" .     // Professional Service. Page 400.
 968       "*HC:" . $claim->cptKey($prockey) .
 969       "*" . sprintf('%.2f', $claim->cptCharges($prockey)) .
 970       "*UN" .
 971       "*" . $claim->cptUnits($prockey) .
 972       "*" .
 973       "*" .
 974       "*";
 975     $dia = $claim->diagIndexArray($prockey);
 976     $i = 0;
 977     foreach ($dia as $dindex) {
 978       if ($i) $out .= ':';
 979       $out .= $dindex;
 980       if (++$i >= 4) break;
 981     }
 982     $out .= "~\n";
 983
 984     if (!$claim->cptCharges($prockey)) {
 985       $log .= "*** Procedure '" . $claim->cptKey($prockey) . "' has no charges!\n";
 986     }
 987
 988     if (empty($dia)) {
 989       $log .= "*** Procedure '" . $claim->cptKey($prockey) . "' is not justified!\n";
 990     }
 991
 992     // Segment SV5 (Durable Medical Equipment Service) omitted.
 993     // Segment PWK (Line Supplemental Information) omitted.
 994     // Segment PWK (Durable Medical Equipment Certificate of Medical Necessity Indicator) omitted.
 995     // Segment CR1 (Ambulance Transport Information) omitted.
 996     // Segment CR3 (Durable Medical Equipment Certification) omitted.
 997     // Segment CRC (Ambulance Certification) omitted.
 998     // Segment CRC (Hospice Employee Indicator) omitted.
 999     // Segment CRC (Condition Indicator / Durable Medical Equipment) omitted.
1000
1001     ++$edicount;
1002     $out .= "DTP" .     // Date of Service. Page 435.
1003       "*472" .
1004       "*D8" .
1005       "*" . $claim->serviceDate() .
1006       "~\n";
1007
1008     $testnote = rtrim($claim->cptNotecodes($prockey));
1009     if (!empty($testnote)) {
1010       ++$edicount;
1011       $out .= "NTE" .     // Explain Unusual Circumstances.
1012         "*ADD" .
1013         "*" . $claim->cptNotecodes($prockey) .
1014         "~\n";
1015     }
1016
1017     // Segment DTP*471 (Prescription Date) omitted.
1018     // Segment DTP*607 (Revision/Recertification Date) omitted.
1019     // Segment DTP*463 (Begin Therapy Date) omitted.
1020     // Segment DTP*461 (Last Certification Date) omitted.
1021     // Segment DTP*304 (Last Seen Date) omitted.
1022     // Segment DTP (Test Date) omitted.
1023     // Segment DTP*011 (Shipped Date) omitted.
1024     // Segment DTP*455 (Last X-Ray Date) omitted.
1025     // Segment DTP*454 (Initial Treatment Date) omitted.
1026     // Segment QTY (Ambulance Patient Count) omitted.
1027     // Segment QTY (Obstetric Anesthesia Additional Units) omitted.
1028     // Segment MEA (Test Result) omitted.
1029     // Segment CN1 (Contract Information) omitted.
1030     // Segment REF*9B (Repriced Line Item Reference Number) omitted.
1031     // Segment REF*9D (Adjusted Repriced Line Item Reference Number) omitted.
1032     // Segment REF*G1 (Prior Authorization) omitted.
1033     // Segment REF*6R (Line Item Control Number) omitted.
1034     //   (Really oughta have this for robust 835 posting!)
1035     // Segment REF*EW (Mammography Certification Number) omitted.
1036     // Segment REF*X4 (CLIA Number) omitted.
1037     // Segment REF*F4 (Referring CLIA Facility Identification) omitted.
1038     // Segment REF*BT (Immunization Batch Number) omitted.
1039     // Segment REF*9F (Referral Number) omitted.
1040     // Segment AMT*T (Sales Tax Amount) omitted.
1041     // Segment AMT*F4 (Postage Claimed Amount) omitted.
1042     // Segment K3 (File Information) omitted.
1043     // Segment NTE (Line Note) omitted.
1044     // Segment NTE (Third Party Organization Notes) omitted.
1045     // Segment PS1 (Purchased Service Information) omitted.
1046     // Segment HCP (Line Pricing/Repricing Information) omitted.
1047
1048     if (!$CMS_5010) {
1049       // This segment was deleted for 5010.
1050       //
1051       // AMT*AAE segment for Approved Amount from previous payer.
1052       // Medicare secondaries seem to require this.
1053       //
1054       for ($ins = $claim->payerCount() - 1; $ins > 0; --$ins) {
1055         if ($claim->payerSequence($ins) > $claim->payerSequence())
1056           continue; // payer is future, not previous
1057         $payerpaid = $claim->payerTotals($ins, $claim->cptKey($prockey));
1058         ++$edicount;
1059         $out .= "AMT" . // Approved amount per previous payer. Page 485.
1060           "*AAE" .
1061           "*" . sprintf('%.2f', $claim->cptCharges($prockey) - $payerpaid[2]) .
1062           "~\n";
1063         break;
1064       }
1065     }
1066
1067     // Loop 2410, Drug Information. Medicaid insurers seem to want this
1068     // with HCPCS codes.
1069     //
1070     $ndc = $claim->cptNDCID($prockey);
1071     if ($ndc) {
1072       ++$edicount;
1073       $out .= "LIN" . // Drug Identification. Page 500+ (Addendum pg 71).
1074         "*" .         // Per addendum, LIN01 is not used.
1075         "*N4" .
1076         "*" . $ndc .
1077         "~\n";
1078
1079       if (!preg_match('/^\d\d\d\d\d-\d\d\d\d-\d\d$/', $ndc, $tmp) && !preg_match('/^\d{11}$/', $ndc)) {
1080         $log .= "*** NDC code '$ndc' has invalid format!\n";
1081       }
1082
1083       ++$edicount;
1084       $tmpunits = $claim->cptNDCQuantity($prockey) * $claim->cptUnits($prockey);
1085       if (!$tmpunits) $tmpunits = 1;
1086       $out .= "CTP" . // Drug Pricing. Page 500+ (Addendum pg 74).
1087         "*" .
1088         "*" .
1089         "*" . ($CMS_5010 ? '' : sprintf('%.2f', $claim->cptCharges($prockey) / $tmpunits)) .
1090         "*" . $claim->cptNDCQuantity($prockey) .
1091         "*" . $claim->cptNDCUOM($prockey) .
1092         // Note: 5010 documents "ME" (Milligrams) as an additional unit of measure.
1093         "~\n";
1094     }
1095
1096     // Segment REF (Prescription or Compound Drug Association Number) omitted.
1097
1098     // Loop 2420A, Rendering Provider (service-specific).
1099     // Used if the rendering provider for this service line is different
1100     // from that in loop 2310B.
1101     //
1102     if ($claim->providerNPI() != $claim->providerNPI($prockey)) {
1103       ++$edicount;
1104       $out .= "NM1" .       // Loop 2310B Rendering Provider
1105         "*82" .
1106         "*1" .
1107         "*" . $claim->providerLastName($prockey) .
1108         "*" . $claim->providerFirstName($prockey) .
1109         "*" . $claim->providerMiddleName($prockey) .
1110         "*" .
1111         "*";
1112       if ($CMS_5010 || $claim->providerNPI($prockey)) { $out .=
1113         "*XX" .
1114         "*" . $claim->providerNPI($prockey);
1115       } else { $out .=
1116         "*34" .                         // Not allowed for 5010
1117         "*" . $claim->providerSSN($prockey);
1118       }
1119       if (!$claim->providerNPI($prockey)) {
1120         $log .= "*** Rendering provider has no NPI.\n";
1121       }
1122       $out .= "~\n";
1123
1124       if ($claim->providerTaxonomy($prockey)) {
1125         ++$edicount;
1126         $out .= "PRV" .
1127           "*PE" . // PErforming provider
1128           "*" . ($CMS_5010 ? "PXC" : "ZZ") .
1129           "*" . $claim->providerTaxonomy($prockey) .
1130           "~\n";
1131       }
1132
1133       // Segment PRV*PE (Rendering Provider Specialty Information) omitted.
1134       // Segment REF (Rendering Provider Secondary Identification) omitted.
1135       // Segment NM1 (Purchased Service Provider Name) omitted.
1136       // Segment REF (Purchased Service Provider Secondary Identification) omitted.
1137       // Segment NM1,N3,N4 (Service Facility Location) omitted.
1138       // Segment REF (Service Facility Location Secondary Identification) omitted.
1139       // Segment NM1 (Supervising Provider Name) omitted.
1140       // Segment REF (Supervising Provider Secondary Identification) omitted.
1141       // Segment NM1,N3,N4 (Ordering Provider) omitted.
1142       // Segment REF (Ordering Provider Secondary Identification) omitted.
1143       // Segment PER (Ordering Provider Contact Information) omitted.
1144       // Segment NM1 (Referring Provider Name) omitted.
1145       // Segment REF (Referring Provider Secondary Identification) omitted.
1146       // Segments NM1*PW, N3, N4 (Ambulance Pick-Up Location) omitted.
1147       // Segments NM1*45, N3, N4 (Ambulance Drop-Off Location) omitted.
1148
1149       // REF*1C is required here for the Medicare provider number if NPI was
1150       // specified in NM109.  Not sure if other payers require anything here.
1151       if (!$CMS_5010 && $claim->providerNumber($prockey)) {
1152         ++$edicount;
1153         $out .= "REF" .
1154           "*" . $claim->providerNumberType($prockey) .
1155           // Note: 5010 documents that type 1D (Medicaid) is changed to G2.
1156           "*" . $claim->providerNumber($prockey) .
1157           "~\n";
1158       }
1159     }
1160
1161     // Loop 2430, adjudication by previous payers.
1162     //
1163     for ($ins = 1; $ins < $claim->payerCount(); ++$ins) {
1164       if ($claim->payerSequence($ins) > $claim->payerSequence())
1165         continue; // payer is future, not previous
1166
1167       $payerpaid = $claim->payerTotals($ins, $claim->cptKey($prockey));
1168       $aarr = $claim->payerAdjustments($ins, $claim->cptKey($prockey));
1169
1170       if ($payerpaid[1] == 0 && !count($aarr)) {
1171         $log .= "*** Procedure '" . $claim->cptKey($prockey) .
1172           "' has no payments or adjustments from previous payer!\n";
1173         continue;
1174       }
1175
1176       ++$edicount;
1177       $out .= "SVD" . // Service line adjudication. Page 554.
1178         "*" . $claim->payerID($ins) .
1179         "*" . $payerpaid[1] .
1180         "*HC:" . $claim->cptKey($prockey) .
1181         "*" .
1182         "*" . $claim->cptUnits($prockey) .
1183         "~\n";
1184
1185       $tmpdate = $payerpaid[0];
1186       foreach ($aarr as $a) {
1187         ++$edicount;
1188         $out .= "CAS" . // Previous payer's line level adjustments. Page 558.
1189           "*" . $a[1] .
1190           "*" . $a[2] .
1191           "*" . $a[3] .
1192           "~\n";
1193         if (!$tmpdate) $tmpdate = $a[0];
1194
1195         // WTH is this??
1196         /*************************************************************
1197         if ( isset($a[4]) &&
1198                 $a[4] != null ) {
1199                 $out .= "CAS02" . // Previous payer's adjustment reason
1200                   "*" . $a[4] .
1201                   "~\n";
1202         }
1203         *************************************************************/
1204       }
1205
1206       if ($tmpdate) {
1207         ++$edicount;
1208         $out .= "DTP" . // Previous payer's line adjustment date. Page 493/566.
1209           "*573" .
1210           "*D8" .
1211           "*$tmpdate" .
1212           "~\n";
1213       }
1214
1215       // Segment AMT*EAF (Remaining Patient Liability) omitted.
1216       // Segment LQ (Form Identification Code) omitted.
1217       // Segment FRM (Supporting Documentation) omitted.
1218
1219     } // end loop 2430
1220   } // end this procedure
1221
1222   ++$edicount;
1223   $out .= "SE" .        // SE Trailer
1224     "*$edicount" .
1225     "*0021" .
1226     "~\n";
1227
1228   $out .= "GE" .        // GE Trailer
1229     "*1" .
1230     "*1" .
1231     "~\n";
1232
1233   $out .= "IEA" .       // IEA Trailer
1234     "*1" .
1235     "*000000001" .
1236     "~\n";
1237
1238   // Remove any trailing empty fields (delimiters) from each segment.
1239   $out = preg_replace('/\*+~/', '~', $out);
1240
1241   $log .= "\n";
1242   return $out;
1243 }
1244 ?>