library/Claim.class.php

   1 <?php
   2 // Copyright (C) 2007-2009 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 $diags;             // array of icd9 codes from billing table
  26   var $x12_partner;       // row from x12_partners table
  27   var $encounter;         // row from form_encounter table
  28   var $facility;          // row from facility table
  29   var $billing_facility;  // row from facility table
  30   var $provider;          // row from users table (rendering provider)
  31   var $referrer;          // row from users table (referring provider)
  32   var $supervisor;        // row from users table (supervising provider)
  33   var $insurance_numbers; // row from insurance_numbers table for current payer
  34   var $supervisor_numbers; // row from insurance_numbers table for current payer
  35   var $patient_data;      // row from patient_data table
  36   var $billing_options;   // row from form_misc_billing_options table
  37   var $invoice;           // result from get_invoice_summary()
  38   var $payers;            // array of arrays, for all payers
  39   var $copay;             // total of copays from the billing table
  40
  41   function loadPayerInfo(&$billrow) {
  42     global $sl_err;
  43     $encounter_date = substr($this->encounter['date'], 0, 10);
  44
  45     // Create the $payers array.  This contains data for all insurances
  46     // with the current one always at index 0, and the others in payment
  47     // order starting at index 1.
  48     //
  49     $this->payers = array();
  50     $this->payers[0] = array();
  51     $query = "SELECT * FROM insurance_data WHERE " .
  52       "pid = '{$this->pid}' AND " .
  53       "date <= '$encounter_date' " .
  54       "ORDER BY type ASC, date DESC";
  55     $dres = sqlStatement($query);
  56     $prevtype = '';
  57     while ($drow = sqlFetchArray($dres)) {
  58       if (strcmp($prevtype, $drow['type']) == 0) continue;
  59       $prevtype = $drow['type'];
  60       // Very important to look at entries with a missing provider because
  61       // they indicate no insurance as of the given date.
  62       if (empty($drow['provider'])) continue;
  63       $ins = count($this->payers);
  64       if ($drow['provider'] == $billrow['payer_id'] && empty($this->payers[0]['data'])) $ins = 0;
  65       $crow = sqlQuery("SELECT * FROM insurance_companies WHERE " .
  66         "id = '" . $drow['provider'] . "'");
  67       $orow = new InsuranceCompany($drow['provider']);
  68       $this->payers[$ins] = array();
  69       $this->payers[$ins]['data']    = $drow;
  70       $this->payers[$ins]['company'] = $crow;
  71       $this->payers[$ins]['object']  = $orow;
  72     }
  73
  74     // This kludge hands most cases of a rare ambiguous situation, where
  75     // the primary insurance company is the same as the secondary.  It seems
  76     // nobody planned for that!
  77     //
  78     for ($i = 1; $i < count($this->payers); ++$i) {
  79       if ($billrow['process_date'] &&
  80         $this->payers[0]['data']['provider'] == $this->payers[$i]['data']['provider'])
  81       {
  82         $tmp = $this->payers[0];
  83         $this->payers[0] = $this->payers[$i];
  84         $this->payers[$i] = $tmp;
  85       }
  86     }
  87
  88     $this->using_modifiers = true;
  89
  90     // Get payment and adjustment details if there are any previous payers.
  91     //
  92     $this->invoice = array();
  93     if ($this->payerSequence() != 'P') {
  94       if ($GLOBALS['oer_config']['ws_accounting']['enabled'] === 2) {
  95         $this->invoice = ar_get_invoice_summary($this->pid, $this->encounter_id, true);
  96       }
  97       else if ($GLOBALS['oer_config']['ws_accounting']['enabled']) {
  98         SLConnect();
  99         $arres = SLQuery("select id from ar where invnumber = " .
 100           "'{$this->pid}.{$this->encounter_id}'");
 101         if ($sl_err) die($sl_err);
 102         $arrow = SLGetRow($arres, 0);
 103         if ($arrow) {
 104           $this->invoice = get_invoice_summary($arrow['id'], true);
 105         }
 106         SLClose();
 107       }
 108       // Secondary claims might not have modifiers in SQL-Ledger data.
 109       // In that case, note that we should not try to match on them.
 110       $this->using_modifiers = false;
 111       foreach ($this->invoice as $key => $trash) {
 112         if (strpos($key, ':')) $this->using_modifiers = true;
 113       }
 114     }
 115   }
 116
 117   // Constructor. Loads relevant database information.
 118   //
 119   function Claim($pid, $encounter_id) {
 120     $this->pid = $pid;
 121     $this->encounter_id = $encounter_id;
 122     $this->procs = array();
 123     $this->diags = array();
 124     $this->copay = 0;
 125
 126     // We need the encounter date before we can identify the payers.
 127     $sql = "SELECT * FROM form_encounter WHERE " .
 128       "pid = '{$this->pid}' AND " .
 129       "encounter = '{$this->encounter_id}'";
 130     $this->encounter = sqlQuery($sql);
 131
 132     // Sort by procedure timestamp in order to get some consistency.
 133     $sql = "SELECT * FROM billing WHERE " .
 134       "encounter = '{$this->encounter_id}' AND pid = '{$this->pid}' AND " .
 135       "(code_type = 'CPT4' OR code_type = 'HCPCS' OR code_type = 'COPAY' OR code_type = 'ICD9') AND " .
 136       "activity = '1' ORDER BY date, id";
 137     $res = sqlStatement($sql);
 138     while ($row = sqlFetchArray($res)) {
 139       if ($row['code_type'] == 'COPAY') {
 140         $this->copay -= $row['fee'];
 141         continue;
 142       }
 143       // Save all diagnosis codes.
 144       if ($row['code_type'] == 'ICD9') {
 145         $this->diags[$row['code']] = $row['code'];
 146         continue;
 147       }
 148       if (!$row['units']) $row['units'] = 1;
 149       // Load prior payer data at the first opportunity in order to get
 150       // the using_modifiers flag that is referenced below.
 151       if (empty($this->procs)) $this->loadPayerInfo($row);
 152       // Consolidate duplicate procedures.
 153       foreach ($this->procs as $key => $trash) {
 154         if (strcmp($this->procs[$key]['code'],$row['code']) == 0 &&
 155             (strcmp($this->procs[$key]['modifier'],$row['modifier']) == 0 ||
 156              !$this->using_modifiers))
 157         {
 158           $this->procs[$key]['units'] += $row['units'];
 159           $this->procs[$key]['fee']   += $row['fee'];
 160           continue 2; // skip to next table row
 161         }
 162       }
 163
 164       // If there is a row-specific provider then get its details.
 165       if (!empty($row['provider_id'])) {
 166         // Get service provider data for this row.
 167         $sql = "SELECT * FROM users WHERE id = '" . $row['provider_id'] . "'";
 168         $row['provider'] = sqlQuery($sql);
 169         // Get insurance numbers for this row's provider.
 170         $sql = "SELECT * FROM insurance_numbers WHERE " .
 171           "(insurance_company_id = '" . $row['payer_id'] .
 172           "' OR insurance_company_id is NULL) AND " .
 173           "provider_id = '" . $row['provider_id'] . "' " .
 174           "ORDER BY insurance_company_id DESC LIMIT 1";
 175         $row['insurance_numbers'] = sqlQuery($sql);
 176       }
 177
 178       $this->procs[] = $row;
 179     }
 180
 181     $sql = "SELECT * FROM x12_partners WHERE " .
 182       "id = '" . $this->procs[0]['x12_partner_id'] . "'";
 183     $this->x12_partner = sqlQuery($sql);
 184
 185     $sql = "SELECT * FROM facility WHERE " .
 186       "id = '" . addslashes($this->encounter['facility_id']) . "' " .
 187       "LIMIT 1";
 188     $this->facility = sqlQuery($sql);
 189
 190     /*****************************************************************
 191     $provider_id = $this->procs[0]['provider_id'];
 192     *****************************************************************/
 193     $provider_id = $this->encounter['provider_id'];
 194     $sql = "SELECT * FROM users WHERE id = '$provider_id'";
 195     $this->provider = sqlQuery($sql);
 196
 197     $sql = "SELECT * FROM facility " .
 198       "ORDER BY billing_location DESC, id ASC LIMIT 1";
 199     $this->billing_facility = sqlQuery($sql);
 200
 201     $sql = "SELECT * FROM insurance_numbers WHERE " .
 202       "(insurance_company_id = '" . $this->procs[0]['payer_id'] .
 203       "' OR insurance_company_id is NULL) AND " .
 204       "provider_id = '$provider_id' " .
 205       "ORDER BY insurance_company_id DESC LIMIT 1";
 206     $this->insurance_numbers = sqlQuery($sql);
 207
 208     $sql = "SELECT * FROM patient_data WHERE " .
 209       "pid = '{$this->pid}' " .
 210       "ORDER BY id LIMIT 1";
 211     $this->patient_data = sqlQuery($sql);
 212
 213     $sql = "SELECT fpa.* FROM forms JOIN form_misc_billing_options AS fpa " .
 214       "ON fpa.id = forms.form_id WHERE " .
 215       "forms.encounter = '{$this->encounter_id}' AND " .
 216       "forms.pid = '{$this->pid}' AND " .
 217       "forms.formdir = 'misc_billing_options' " .
 218       "ORDER BY forms.date";
 219     $this->billing_options = sqlQuery($sql);
 220
 221     $referrer_id = (empty($GLOBALS['MedicareReferrerIsRenderer']) ||
 222       $this->insurance_numbers['provider_number_type'] != '1C') ?
 223       $this->patient_data['providerID'] : $provider_id;
 224     $sql = "SELECT * FROM users WHERE id = '$referrer_id'";
 225     $this->referrer = sqlQuery($sql);
 226     if (!$this->referrer) $this->referrer = array();
 227
 228     $supervisor_id = $this->encounter['supervisor_id'];
 229     $sql = "SELECT * FROM users WHERE id = '$supervisor_id'";
 230     $this->supervisor = sqlQuery($sql);
 231     if (!$this->supervisor) $this->supervisor = array();
 232
 233     $sql = "SELECT * FROM insurance_numbers WHERE " .
 234       "(insurance_company_id = '" . $this->procs[0]['payer_id'] .
 235       "' OR insurance_company_id is NULL) AND " .
 236       "provider_id = '$supervisor_id' " .
 237       "ORDER BY insurance_company_id DESC LIMIT 1";
 238     $this->supervisor_numbers = sqlQuery($sql);
 239     if (!$this->supervisor_numbers) $this->supervisor_numbers = array();
 240
 241   } // end constructor
 242
 243   // Return an array of adjustments from the designated prior payer for the
 244   // designated procedure key (might be procedure:modifier), or for the claim
 245   // level.  For each adjustment give date, group code, reason code, amount.
 246   // Note this will include "patient responsibility" adjustments which are
 247   // not adjustments to OUR invoice, but they reduce the amount that the
 248   // insurance company pays.
 249   //
 250   function payerAdjustments($ins, $code='Claim') {
 251     $aadj = array();
 252
 253     // If we have no modifiers stored in SQL-Ledger for this claim,
 254     // then we cannot use a modifier passed in with the key.
 255     $tmp = strpos($code, ':');
 256     if ($tmp && !$this->using_modifiers) $code = substr($code, 0, $tmp);
 257
 258     // For payments, source always starts with "Ins" or "Pt".
 259     // Nonzero adjustment reason examples:
 260     //   Ins1 adjust code 42 (Charges exceed ... (obsolete))
 261     //   Ins1 adjust code 45 (Charges exceed your contracted/ legislated fee arrangement)
 262     //   Ins1 adjust code 97 (Payment is included in the allowance for another service/procedure)
 263     //   Ins1 adjust code A2 (Contractual adjustment)
 264     //   Ins adjust Ins1
 265     //   adjust code 45
 266     // Zero adjustment reason examples:
 267     //   Co-pay: 25.00
 268     //   Coinsurance: 11.46  (code 2)   Note: fix remits to identify insurance
 269     //   To deductible: 0.22 (code 1)   Note: fix remits to identify insurance
 270     //   To copay Ins1 (manual entry)
 271     //   To ded'ble Ins1 (manual entry)
 272
 273     if (!empty($this->invoice[$code])) {
 274       $date = '';
 275       $deductible  = 0;
 276       $coinsurance = 0;
 277       $inslabel = ($this->payerSequence($ins) == 'S') ? 'Ins2' : 'Ins1';
 278       $insnumber = substr($inslabel, 3);
 279
 280       // Compute this procedure's patient responsibility amount as of this
 281       // prior payer, which is the original charge minus all insurance
 282       // payments and "hard" adjustments up to this payer.
 283       $ptresp = $this->invoice[$code]['chg'] + $this->invoice[$code]['adj'];
 284       foreach ($this->invoice[$code]['dtl'] as $key => $value) {
 285         if (preg_match("/^Ins(\d)/i", $value['src'], $tmp)) {
 286           if ($tmp[1] <= $insnumber) $ptresp -= $value['pmt'];
 287         }
 288         else if (trim(substr($key, 0, 10))) { // not an adjustment if no date
 289           if (!preg_match("/Ins(\d)/i", $value['rsn'], $tmp) || $tmp[1] <= $insnumber)
 290             $ptresp += $value['chg']; // adjustments are negative charges
 291         }
 292       }
 293       if ($ptresp < 0) $ptresp = 0; // we may be insane but try to hide it
 294
 295       // Main loop, to extract adjustments for this payer and procedure.
 296       foreach ($this->invoice[$code]['dtl'] as $key => $value) {
 297         $tmp = str_replace('-', '', trim(substr($key, 0, 10)));
 298         if ($tmp) $date = $tmp;
 299         if ($tmp && $value['pmt'] == 0) { // not original charge and not a payment
 300           $rsn = $value['rsn'];
 301           $chg = 0 - $value['chg']; // adjustments are negative charges
 302
 303           $gcode = 'CO'; // default group code = contractual obligation
 304           $rcode = '45'; // default reason code = max fee exceeded (code 42 is obsolete)
 305
 306           if (preg_match("/Ins adjust $inslabel/i", $rsn, $tmp)) {
 307             // From manual post. Take the defaults.
 308           }
 309           else if (preg_match("/To copay $inslabel/i", $rsn, $tmp) && !$chg) {
 310             $coinsurance = $ptresp; // from manual post
 311             continue;
 312           }
 313           else if (preg_match("/To ded'ble $inslabel/i", $rsn, $tmp) && !$chg) {
 314             $deductible = $ptresp; // from manual post
 315             continue;
 316           }
 317           else if (preg_match("/$inslabel copay: (\S+)/i", $rsn, $tmp) && !$chg) {
 318             $coinsurance = $tmp[1]; // from 835 as of 6/2007
 319             continue;
 320           }
 321           else if (preg_match("/$inslabel coins: (\S+)/i", $rsn, $tmp) && !$chg) {
 322             $coinsurance = $tmp[1]; // from 835 and manual post as of 6/2007
 323             continue;
 324           }
 325           else if (preg_match("/$inslabel dedbl: (\S+)/i", $rsn, $tmp) && !$chg) {
 326             $deductible = $tmp[1]; // from 835 and manual post as of 6/2007
 327             continue;
 328           }
 329           else if (preg_match("/$inslabel ptresp: (\S+)/i", $rsn, $tmp) && !$chg) {
 330             continue; // from 835 as of 6/2007
 331           }
 332           else if (preg_match("/$inslabel adjust code (\S+)/i", $rsn, $tmp)) {
 333             $rcode = $tmp[1]; // from 835
 334           }
 335           else if (preg_match("/$inslabel/i", $rsn, $tmp)) {
 336             // Take the defaults.
 337           }
 338           else if (preg_match('/Ins(\d)/i', $rsn, $tmp) && $tmp[1] != $insnumber) {
 339             continue; // it's for some other payer
 340           }
 341           else if ($insnumber == '1') {
 342             if (preg_match("/\$\s*adjust code (\S+)/i", $rsn, $tmp)) {
 343               $rcode = $tmp[1]; // from 835
 344             }
 345             else if ($chg) {
 346               // Other adjustments default to Ins1.
 347             }
 348             else if (preg_match("/Co-pay: (\S+)/i", $rsn, $tmp) ||
 349               preg_match("/Coinsurance: (\S+)/i", $rsn, $tmp)) {
 350               $coinsurance = 0 + $tmp[1]; // from 835 before 6/2007
 351               continue;
 352             }
 353             else if (preg_match("/To deductible: (\S+)/i", $rsn, $tmp)) {
 354               $deductible = 0 + $tmp[1]; // from 835 before 6/2007
 355               continue;
 356             }
 357             else {
 358               continue; // there is no adjustment amount
 359             }
 360           }
 361           else {
 362             continue; // it's for primary and that's not us
 363           }
 364
 365           if ($rcode == '42') $rcode= '45'; // reason 42 is obsolete
 366           $aadj[] = array($date, $gcode, $rcode, sprintf('%.2f', $chg));
 367
 368         } // end if
 369       } // end foreach
 370
 371       // If we really messed it up, at least avoid negative numbers.
 372       if ($coinsurance > $ptresp) $coinsurance = $ptresp;
 373       if ($deductible  > $ptresp) $deductible  = $ptresp;
 374
 375       // Find out if this payer paid anything at all on this claim.  This will
 376       // help us allocate any unknown patient responsibility amounts.
 377       $thispaidanything = 0;
 378       foreach($this->invoice as $codekey => $codeval) {
 379         foreach ($codeval['dtl'] as $key => $value) {
 380           if (preg_match("/$inslabel/i", $value['src'], $tmp)) {
 381             $thispaidanything += $value['pmt'];
 382           }
 383         }
 384       }
 385
 386       // Allocate any unknown patient responsibility by guessing if the
 387       // deductible has been satisfied.
 388       if ($thispaidanything)
 389         $coinsurance = $ptresp - $deductible;
 390       else
 391         $deductible = $ptresp - $coinsurance;
 392
 393       if ($date && $deductible != 0)
 394         $aadj[] = array($date, 'PR', '1', sprintf('%.2f', $deductible));
 395       if ($date && $coinsurance != 0)
 396         $aadj[] = array($date, 'PR', '2', sprintf('%.2f', $coinsurance));
 397
 398     } // end if
 399
 400     return $aadj;
 401   }
 402
 403   // Return date, total payments and total "hard" adjustments from the given
 404   // prior payer. If $code is specified then only that procedure key is
 405   // selected, otherwise it's for the whole claim.
 406   //
 407   function payerTotals($ins, $code='') {
 408     // If we have no modifiers stored in SQL-Ledger for this claim,
 409     // then we cannot use a modifier passed in with the key.
 410     $tmp = strpos($code, ':');
 411     if ($tmp && !$this->using_modifiers) $code = substr($code, 0, $tmp);
 412
 413     $inslabel = ($this->payerSequence($ins) == 'S') ? 'Ins2' : 'Ins1';
 414     $paytotal = 0;
 415     $adjtotal = 0;
 416     $date = '';
 417     foreach($this->invoice as $codekey => $codeval) {
 418       if ($code && strcmp($codekey,$code) != 0) continue;
 419       foreach ($codeval['dtl'] as $key => $value) {
 420         if (preg_match("/$inslabel/i", $value['src'], $tmp)) {
 421           if (!$date) $date = str_replace('-', '', trim(substr($key, 0, 10)));
 422           $paytotal += $value['pmt'];
 423         }
 424       }
 425       $aarr = $this->payerAdjustments($ins, $codekey);
 426       foreach ($aarr as $a) {
 427         if (strcmp($a[1],'PR') != 0) $adjtotal += $a[3];
 428         if (!$date) $date = $a[0];
 429       }
 430     }
 431     return array($date, sprintf('%.2f', $paytotal), sprintf('%.2f', $adjtotal));
 432   }
 433
 434   // Return the amount already paid by the patient.
 435   //
 436   function patientPaidAmount() {
 437     // For primary claims $this->invoice is not loaded, so get the co-pay
 438     // from the billing table instead.
 439     if (empty($this->invoice)) return $this->copay;
 440     //
 441     $amount = 0;
 442     foreach($this->invoice as $codekey => $codeval) {
 443       foreach ($codeval['dtl'] as $key => $value) {
 444         if (!preg_match("/Ins/i", $value['src'], $tmp)) {
 445           $amount += $value['pmt'];
 446         }
 447       }
 448     }
 449     return sprintf('%.2f', $amount);
 450   }
 451
 452   // Return invoice total, including adjustments but not payments.
 453   //
 454   function invoiceTotal() {
 455     $amount = 0;
 456     foreach($this->invoice as $codekey => $codeval) {
 457       $amount += $codeval['chg'];
 458     }
 459     return sprintf('%.2f', $amount);
 460   }
 461
 462   // Number of procedures in this claim.
 463   function procCount() {
 464     return count($this->procs);
 465   }
 466
 467   // Number of payers for this claim. Ranges from 1 to 3.
 468   function payerCount() {
 469     return count($this->payers);
 470   }
 471
 472   function x12gsversionstring() {
 473     return x12clean(trim($this->x12_partner['x12_version']));
 474   }
 475
 476   function x12gssenderid() {
 477     $tmp = $this->x12_partner['x12_sender_id'];
 478     while (strlen($tmp) < 15) $tmp .= " ";
 479     return $tmp;
 480   }
 481
 482   function x12gsreceiverid() {
 483     $tmp = $this->x12_partner['x12_receiver_id'];
 484     while (strlen($tmp) < 15) $tmp .= " ";
 485     return $tmp;
 486   }
 487
 488   function x12gsisa05() {
 489     return $this->x12_partner['x12_isa05'];
 490   }
 491
 492   function x12gsisa07() {
 493     return $this->x12_partner['x12_isa07'];
 494   }
 495
 496   function x12gsisa14() {
 497     return $this->x12_partner['x12_isa14'];
 498   }
 499
 500   function x12gsisa15() {
 501     return $this->x12_partner['x12_isa15'];
 502   }
 503
 504   function x12gsgs02() {
 505     $tmp = $this->x12_partner['x12_gs02'];
 506     if ($tmp === '') $tmp = $this->x12_partner['x12_sender_id'];
 507     return $tmp;
 508   }
 509
 510   function x12gsper06() {
 511     return $this->x12_partner['x12_per06'];
 512   }
 513
 514   function cliaCode() {
 515     return x12clean(trim($this->facility['domain_identifier']));
 516   }
 517
 518   function billingFacilityName() {
 519     return x12clean(trim($this->billing_facility['name']));
 520   }
 521
 522   function billingFacilityStreet() {
 523     return x12clean(trim($this->billing_facility['street']));
 524   }
 525
 526   function billingFacilityCity() {
 527     return x12clean(trim($this->billing_facility['city']));
 528   }
 529
 530   function billingFacilityState() {
 531     return x12clean(trim($this->billing_facility['state']));
 532   }
 533
 534   function billingFacilityZip() {
 535     return x12clean(trim($this->billing_facility['postal_code']));
 536   }
 537
 538   function billingFacilityETIN() {
 539     return x12clean(trim(str_replace('-', '', $this->billing_facility['federal_ein'])));
 540   }
 541
 542   function billingFacilityNPI() {
 543     return x12clean(trim($this->billing_facility['facility_npi']));
 544   }
 545
 546   # The billing facility and the patient must both accept for this to return true.
 547   function billingFacilityAssignment($ins=0) {
 548     $tmp = strtoupper($this->payers[$ins]['data']['accept_assignment']);
 549     if (strcmp($tmp,'FALSE') == 0) return '0';
 550     return !empty($this->billing_facility['accepts_assignment']);
 551   }
 552
 553   function billingContactName() {
 554     return x12clean(trim($this->billing_facility['attn']));
 555   }
 556
 557   function billingContactPhone() {
 558     if (preg_match("/([2-9]\d\d)\D*(\d\d\d)\D*(\d\d\d\d)/",
 559       $this->billing_facility['phone'], $tmp))
 560     {
 561       return $tmp[1] . $tmp[2] . $tmp[3];
 562     }
 563     return '';
 564   }
 565
 566   function facilityName() {
 567     return x12clean(trim($this->facility['name']));
 568   }
 569
 570   function facilityStreet() {
 571     return x12clean(trim($this->facility['street']));
 572   }
 573
 574   function facilityCity() {
 575     return x12clean(trim($this->facility['city']));
 576   }
 577
 578   function facilityState() {
 579     return x12clean(trim($this->facility['state']));
 580   }
 581
 582   function facilityZip() {
 583     return x12clean(trim($this->facility['postal_code']));
 584   }
 585
 586   function facilityETIN() {
 587     return x12clean(trim(str_replace('-', '', $this->facility['federal_ein'])));
 588   }
 589
 590   function facilityNPI() {
 591     return x12clean(trim($this->facility['facility_npi']));
 592   }
 593
 594   function facilityPOS() {
 595     return x12clean(trim($this->facility['pos_code']));
 596   }
 597
 598   function clearingHouseName() {
 599     return x12clean(trim($this->x12_partner['name']));
 600   }
 601
 602   function clearingHouseETIN() {
 603     return x12clean(trim(str_replace('-', '', $this->x12_partner['id_number'])));
 604   }
 605
 606   function providerNumberType($prockey=-1) {
 607     $tmp = ($prockey < 0 || empty($this->procs[$prockey]['provider_id'])) ?
 608       $this->insurance_numbers : $this->procs[$prockey]['insurance_numbers'];
 609     return $tmp['provider_number_type'];
 610   }
 611
 612   function providerNumber($prockey=-1) {
 613     $tmp = ($prockey < 0 || empty($this->procs[$prockey]['provider_id'])) ?
 614       $this->insurance_numbers : $this->procs[$prockey]['insurance_numbers'];
 615     return x12clean(trim(str_replace('-', '', $tmp['provider_number'])));
 616   }
 617
 618   function providerGroupNumber($prockey=-1) {
 619     $tmp = ($prockey < 0 || empty($this->procs[$prockey]['provider_id'])) ?
 620       $this->insurance_numbers : $this->procs[$prockey]['insurance_numbers'];
 621     return x12clean(trim(str_replace('-', '', $tmp['group_number'])));
 622   }
 623
 624   // Returns 'P', 'S' or 'T'.
 625   //
 626   function payerSequence($ins=0) {
 627     return strtoupper(substr($this->payers[$ins]['data']['type'], 0, 1));
 628   }
 629
 630   // Returns the HIPAA code of the patient-to-subscriber relationship.
 631   //
 632   function insuredRelationship($ins=0) {
 633     $tmp = strtolower($this->payers[$ins]['data']['subscriber_relationship']);
 634     if (strcmp($tmp,'self'  ) == 0) return '18';
 635     if (strcmp($tmp,'spouse') == 0) return '01';
 636     if (strcmp($tmp,'child' ) == 0) return '19';
 637     if (strcmp($tmp,'other' ) == 0) return 'G8';
 638     return $tmp; // should not happen
 639   }
 640
 641   function insuredTypeCode($ins=0) {
 642     if (strcmp($this->claimType($ins),'MB') == 0 && $this->payerSequence($ins) != 'P')
 643       return '12'; // medicare secondary working aged beneficiary or
 644                    // spouse with employer group health plan
 645     return '';
 646   }
 647
 648   // Is the patient also the subscriber?
 649   //
 650   function isSelfOfInsured($ins=0) {
 651     $tmp = strtolower($this->payers[$ins]['data']['subscriber_relationship']);
 652     return (strcmp($tmp,'self') == 0);
 653   }
 654
 655   function planName($ins=0) {
 656     return x12clean(trim($this->payers[$ins]['data']['plan_name']));
 657   }
 658
 659   function policyNumber($ins=0) { // "ID"
 660     return x12clean(trim($this->payers[$ins]['data']['policy_number']));
 661   }
 662
 663   function groupNumber($ins=0) {
 664     return x12clean(trim($this->payers[$ins]['data']['group_number']));
 665   }
 666
 667   function groupName($ins=0) {
 668     return x12clean(trim($this->payers[$ins]['data']['subscriber_employer']));
 669   }
 670
 671   // Claim types are:
 672   // 16 Other HCFA
 673   // MB Medicare Part B
 674   // MC Medicaid
 675   // CH ChampUSVA
 676   // CH ChampUS
 677   // BL Blue Cross Blue Shield
 678   // 16 FECA
 679   // 09 Self Pay
 680   // 10 Central Certification
 681   // 11 Other Non-Federal Programs
 682   // 12 Preferred Provider Organization (PPO)
 683   // 13 Point of Service (POS)
 684   // 14 Exclusive Provider Organization (EPO)
 685   // 15 Indemnity Insurance
 686   // 16 Health Maintenance Organization (HMO) Medicare Risk
 687   // AM Automobile Medical
 688   // CI Commercial Insurance Co.
 689   // DS Disability
 690   // HM Health Maintenance Organization
 691   // LI Liability
 692   // LM Liability Medical
 693   // OF Other Federal Program
 694   // TV Title V
 695   // VA Veterans Administration Plan
 696   // WC Workers Compensation Health Plan
 697   // ZZ Mutually Defined
 698   //
 699   function claimType($ins=0) {
 700     if (empty($this->payers[$ins]['object'])) return '';
 701     return $this->payers[$ins]['object']->get_freeb_claim_type();
 702   }
 703
 704   function insuredLastName($ins=0) {
 705     return x12clean(trim($this->payers[$ins]['data']['subscriber_lname']));
 706   }
 707
 708   function insuredFirstName($ins=0) {
 709     return x12clean(trim($this->payers[$ins]['data']['subscriber_fname']));
 710   }
 711
 712   function insuredMiddleName($ins=0) {
 713     return x12clean(trim($this->payers[$ins]['data']['subscriber_mname']));
 714   }
 715
 716   function insuredStreet($ins=0) {
 717     return x12clean(trim($this->payers[$ins]['data']['subscriber_street']));
 718   }
 719
 720   function insuredCity($ins=0) {
 721     return x12clean(trim($this->payers[$ins]['data']['subscriber_city']));
 722   }
 723
 724   function insuredState($ins=0) {
 725     return x12clean(trim($this->payers[$ins]['data']['subscriber_state']));
 726   }
 727
 728   function insuredZip($ins=0) {
 729     return x12clean(trim($this->payers[$ins]['data']['subscriber_postal_code']));
 730   }
 731
 732   function insuredPhone($ins=0) {
 733     if (preg_match("/([2-9]\d\d)\D*(\d\d\d)\D*(\d\d\d\d)/",
 734       $this->payers[$ins]['data']['subscriber_phone'], $tmp))
 735       return $tmp[1] . $tmp[2] . $tmp[3];
 736     return '';
 737   }
 738
 739   function insuredDOB($ins=0) {
 740     return str_replace('-', '', $this->payers[$ins]['data']['subscriber_DOB']);
 741   }
 742
 743   function insuredSex($ins=0) {
 744     return strtoupper(substr($this->payers[$ins]['data']['subscriber_sex'], 0, 1));
 745   }
 746
 747   function payerName($ins=0) {
 748     return x12clean(trim($this->payers[$ins]['company']['name']));
 749   }
 750
 751   function payerAttn($ins=0) {
 752     return x12clean(trim($this->payers[$ins]['company']['attn']));
 753   }
 754
 755   function payerStreet($ins=0) {
 756     if (empty($this->payers[$ins]['object'])) return '';
 757     $tmp = $this->payers[$ins]['object'];
 758     $tmp = $tmp->get_address();
 759     return x12clean(trim($tmp->get_line1()));
 760   }
 761
 762   function payerCity($ins=0) {
 763     if (empty($this->payers[$ins]['object'])) return '';
 764     $tmp = $this->payers[$ins]['object'];
 765     $tmp = $tmp->get_address();
 766     return x12clean(trim($tmp->get_city()));
 767   }
 768
 769   function payerState($ins=0) {
 770     if (empty($this->payers[$ins]['object'])) return '';
 771     $tmp = $this->payers[$ins]['object'];
 772     $tmp = $tmp->get_address();
 773     return x12clean(trim($tmp->get_state()));
 774   }
 775
 776   function payerZip($ins=0) {
 777     if (empty($this->payers[$ins]['object'])) return '';
 778     $tmp = $this->payers[$ins]['object'];
 779     $tmp = $tmp->get_address();
 780     return x12clean(trim($tmp->get_zip()));
 781   }
 782
 783   function payerID($ins=0) {
 784     return x12clean(trim($this->payers[$ins]['company']['cms_id']));
 785   }
 786
 787   function payerAltID($ins=0) {
 788     return x12clean(trim($this->payers[$ins]['company']['alt_cms_id']));
 789   }
 790
 791   function patientLastName() {
 792     return x12clean(trim($this->patient_data['lname']));
 793   }
 794
 795   function patientFirstName() {
 796     return x12clean(trim($this->patient_data['fname']));
 797   }
 798
 799   function patientMiddleName() {
 800     return x12clean(trim($this->patient_data['mname']));
 801   }
 802
 803   function patientStreet() {
 804     return x12clean(trim($this->patient_data['street']));
 805   }
 806
 807   function patientCity() {
 808     return x12clean(trim($this->patient_data['city']));
 809   }
 810
 811   function patientState() {
 812     return x12clean(trim($this->patient_data['state']));
 813   }
 814
 815   function patientZip() {
 816     return x12clean(trim($this->patient_data['postal_code']));
 817   }
 818
 819   function patientPhone() {
 820     $ptphone = $this->patient_data['phone_home'];
 821     if (!$ptphone) $ptphone = $this->patient_data['phone_biz'];
 822     if (!$ptphone) $ptphone = $this->patient_data['phone_cell'];
 823     if (preg_match("/([2-9]\d\d)\D*(\d\d\d)\D*(\d\d\d\d)/", $ptphone, $tmp))
 824       return $tmp[1] . $tmp[2] . $tmp[3];
 825     return '';
 826   }
 827
 828   function patientDOB() {
 829     return str_replace('-', '', $this->patient_data['DOB']);
 830   }
 831
 832   function patientSex() {
 833     return strtoupper(substr($this->patient_data['sex'], 0, 1));
 834   }
 835
 836   // Patient Marital Status: M = Married, S = Single, or something else.
 837   function patientStatus() {
 838     return strtoupper(substr($this->patient_data['status'], 0, 1));
 839   }
 840
 841   // This should be UNEMPLOYED, STUDENT, PT STUDENT, or anything else to
 842   // indicate employed.
 843   function patientOccupation() {
 844     return strtoupper(x12clean(trim($this->patient_data['occupation'])));
 845   }
 846
 847   function cptCode($prockey) {
 848     return x12clean(trim($this->procs[$prockey]['code']));
 849   }
 850
 851   function cptModifier($prockey) {
 852     return x12clean(trim($this->procs[$prockey]['modifier']));
 853   }
 854
 855   // Returns the procedure code, followed by ":modifier" if there is one.
 856   function cptKey($prockey) {
 857     $tmp = $this->cptModifier($prockey);
 858     return $this->cptCode($prockey) . ($tmp ? ":$tmp" : "");
 859   }
 860
 861   function cptCharges($prockey) {
 862     return x12clean(trim($this->procs[$prockey]['fee']));
 863   }
 864
 865   function cptUnits($prockey) {
 866     if (empty($this->procs[$prockey]['units'])) return '1';
 867     return x12clean(trim($this->procs[$prockey]['units']));
 868   }
 869
 870   // NDC drug ID.
 871   function cptNDCID($prockey) {
 872     $ndcinfo = $this->procs[$prockey]['ndc_info'];
 873     if (preg_match('/^N4(\S+)\s+(\S\S)(.*)/', $ndcinfo, $tmp)) {
 874       $ndc = $tmp[1];
 875       if (preg_match('/^(\d+)-(\d+)-(\d+)$/', $ndc, $tmp)) {
 876         return sprintf('%05d-%04d-%02d', $tmp[1], $tmp[2], $tmp[3]);
 877       }
 878       return x12clean($ndc); // format is bad but return it anyway
 879     }
 880     return '';
 881   }
 882
 883   // NDC drug unit of measure code.
 884   function cptNDCUOM($prockey) {
 885     $ndcinfo = $this->procs[$prockey]['ndc_info'];
 886     if (preg_match('/^N4(\S+)\s+(\S\S)(.*)/', $ndcinfo, $tmp))
 887       return x12clean($tmp[2]);
 888     return '';
 889   }
 890
 891   // NDC drug number of units.
 892   function cptNDCQuantity($prockey) {
 893     $ndcinfo = $this->procs[$prockey]['ndc_info'];
 894     if (preg_match('/^N4(\S+)\s+(\S\S)(.*)/', $ndcinfo, $tmp)) {
 895       return x12clean(ltrim($tmp[3], '0'));
 896     }
 897     return '';
 898   }
 899
 900   function onsetDate() {
 901     return str_replace('-', '', substr($this->encounter['onset_date'], 0, 10));
 902   }
 903
 904   function serviceDate() {
 905     return str_replace('-', '', substr($this->encounter['date'], 0, 10));
 906   }
 907
 908   function priorAuth() {
 909     return x12clean(trim($this->billing_options['prior_auth_number']));
 910   }
 911
 912   function isRelatedEmployment() {
 913     return !empty($this->billing_options['employment_related']);
 914   }
 915
 916   function isRelatedAuto() {
 917     return !empty($this->billing_options['auto_accident']);
 918   }
 919
 920   function isRelatedOther() {
 921     return !empty($this->billing_options['other_accident']);
 922   }
 923
 924   function autoAccidentState() {
 925     return x12clean(trim($this->billing_options['accident_state']));
 926   }
 927
 928   function isUnableToWork() {
 929     return !empty($this->billing_options['is_unable_to_work']);
 930   }
 931
 932   function offWorkFrom() {
 933     return str_replace('-', '', substr($this->billing_options['off_work_from'], 0, 10));
 934   }
 935
 936   function offWorkTo() {
 937     return str_replace('-', '', substr($this->billing_options['off_work_to'], 0, 10));
 938   }
 939
 940   function isHospitalized() {
 941     return !empty($this->billing_options['is_hospitalized']);
 942   }
 943
 944   function hospitalizedFrom() {
 945     return str_replace('-', '', substr($this->billing_options['hospitalization_date_from'], 0, 10));
 946   }
 947
 948   function hospitalizedTo() {
 949     return str_replace('-', '', substr($this->billing_options['hospitalization_date_to'], 0, 10));
 950   }
 951
 952   function isOutsideLab() {
 953     return !empty($this->billing_options['outside_lab']);
 954   }
 955
 956   function outsideLabAmount() {
 957     return sprintf('%.2f', 0 + $this->billing_options['lab_amount']);
 958   }
 959
 960   function medicaidResubmissionCode() {
 961     return x12clean(trim($this->billing_options['medicaid_resubmission_code']));
 962   }
 963
 964   function medicaidOriginalReference() {
 965     return x12clean(trim($this->billing_options['medicaid_original_reference']));
 966   }
 967
 968   function frequencyTypeCode() {
 969     return empty($this->billing_options['replacement_claim']) ? '1' : '7';
 970   }
 971
 972   function additionalNotes() {
 973     return x12clean(trim($this->billing_options['comments']));
 974   }
 975
 976   // Returns an array of unique diagnoses.  Periods are stripped.
 977   function diagArray() {
 978     $da = array();
 979     foreach ($this->procs as $row) {
 980       $atmp = explode(':', $row['justify']);
 981       foreach ($atmp as $tmp) {
 982         if (!empty($tmp)) {
 983           $diag = str_replace('.', '', $tmp);
 984           $da[$diag] = $diag;
 985         }
 986       }
 987     }
 988     // The above got all the diagnoses used for justification, in the order
 989     // used for justification.  Next we go through all diagnoses, justified
 990     // or not, to make sure they all get into the claim.  We do it this way
 991     // so that the more important diagnoses appear first.
 992     foreach ($this->diags as $diag) {
 993       $diag = str_replace('.', '', $diag);
 994       $da[$diag] = $diag;
 995     }
 996     return $da;
 997   }
 998
 999   // Compute one 1-relative index in diagArray for the given procedure.
1000   // This function is obsolete, use diagIndexArray() instead.
1001   function diagIndex($prockey) {
1002     $da = $this->diagArray();
1003     $tmp = explode(':', $this->procs[$prockey]['justify']);
1004     if (empty($tmp)) return '';
1005     $diag = str_replace('.', '', $tmp[0]);
1006     $i = 0;
1007     foreach ($da as $value) {
1008       ++$i;
1009       if (strcmp($value,$diag) == 0) return $i;
1010     }
1011     return '';
1012   }
1013
1014   // Compute array of 1-relative diagArray indices for the given procedure.
1015   function diagIndexArray($prockey) {
1016     $dia = array();
1017     $da = $this->diagArray();
1018     $atmp = explode(':', $this->procs[$prockey]['justify']);
1019     foreach ($atmp as $tmp) {
1020       if (!empty($tmp)) {
1021         $diag = str_replace('.', '', $tmp);
1022         $i = 0;
1023         foreach ($da as $value) {
1024           ++$i;
1025           if (strcmp($value,$diag) == 0) $dia[] = $i;
1026         }
1027       }
1028     }
1029     return $dia;
1030   }
1031
1032   function providerLastName($prockey=-1) {
1033     $tmp = ($prockey < 0 || empty($this->procs[$prockey]['provider_id'])) ?
1034       $this->provider : $this->procs[$prockey]['provider'];
1035     return x12clean(trim($tmp['lname']));
1036   }
1037
1038   function providerFirstName($prockey=-1) {
1039     $tmp = ($prockey < 0 || empty($this->procs[$prockey]['provider_id'])) ?
1040       $this->provider : $this->procs[$prockey]['provider'];
1041     return x12clean(trim($tmp['fname']));
1042   }
1043
1044   function providerMiddleName($prockey=-1) {
1045     $tmp = ($prockey < 0 || empty($this->procs[$prockey]['provider_id'])) ?
1046       $this->provider : $this->procs[$prockey]['provider'];
1047     return x12clean(trim($tmp['mname']));
1048   }
1049
1050   function providerNPI($prockey=-1) {
1051     $tmp = ($prockey < 0 || empty($this->procs[$prockey]['provider_id'])) ?
1052       $this->provider : $this->procs[$prockey]['provider'];
1053     return x12clean(trim($tmp['npi']));
1054   }
1055
1056   function providerUPIN($prockey=-1) {
1057     $tmp = ($prockey < 0 || empty($this->procs[$prockey]['provider_id'])) ?
1058       $this->provider : $this->procs[$prockey]['provider'];
1059     return x12clean(trim($tmp['upin']));
1060   }
1061
1062   function providerSSN($prockey=-1) {
1063     $tmp = ($prockey < 0 || empty($this->procs[$prockey]['provider_id'])) ?
1064       $this->provider : $this->procs[$prockey]['provider'];
1065     return x12clean(trim(str_replace('-', '', $tmp['federaltaxid'])));
1066   }
1067
1068   function providerTaxonomy($prockey=-1) {
1069     $tmp = ($prockey < 0 || empty($this->procs[$prockey]['provider_id'])) ?
1070       $this->provider : $this->procs[$prockey]['provider'];
1071     if (empty($tmp['taxonomy'])) return '207Q00000X';
1072     return x12clean(trim($tmp['taxonomy']));
1073   }
1074
1075   function referrerLastName() {
1076     return x12clean(trim($this->referrer['lname']));
1077   }
1078
1079   function referrerFirstName() {
1080     return x12clean(trim($this->referrer['fname']));
1081   }
1082
1083   function referrerMiddleName() {
1084     return x12clean(trim($this->referrer['mname']));
1085   }
1086
1087   function referrerNPI() {
1088     return x12clean(trim($this->referrer['npi']));
1089   }
1090
1091   function referrerUPIN() {
1092     return x12clean(trim($this->referrer['upin']));
1093   }
1094
1095   function referrerSSN() {
1096     return x12clean(trim(str_replace('-', '', $this->referrer['federaltaxid'])));
1097   }
1098
1099   function referrerTaxonomy() {
1100     if (empty($this->referrer['taxonomy'])) return '207Q00000X';
1101     return x12clean(trim($this->referrer['taxonomy']));
1102   }
1103
1104   function supervisorLastName() {
1105     return x12clean(trim($this->supervisor['lname']));
1106   }
1107
1108   function supervisorFirstName() {
1109     return x12clean(trim($this->supervisor['fname']));
1110   }
1111
1112   function supervisorMiddleName() {
1113     return x12clean(trim($this->supervisor['mname']));
1114   }
1115
1116   function supervisorNPI() {
1117     return x12clean(trim($this->supervisor['npi']));
1118   }
1119
1120   function supervisorUPIN() {
1121     return x12clean(trim($this->supervisor['upin']));
1122   }
1123
1124   function supervisorSSN() {
1125     return x12clean(trim(str_replace('-', '', $this->supervisor['federaltaxid'])));
1126   }
1127
1128   function supervisorTaxonomy() {
1129     if (empty($this->supervisor['taxonomy'])) return '207Q00000X';
1130     return x12clean(trim($this->supervisor['taxonomy']));
1131   }
1132
1133   function supervisorNumberType() {
1134     return $this->supervisor_numbers['provider_number_type'];
1135   }
1136
1137   function supervisorNumber() {
1138     return x12clean(trim(str_replace('-', '', $this->supervisor_numbers['provider_number'])));
1139   }
1140
1141 }
1142 ?>