interface/billing/sl_eob_invoice.php

   1 <?php
   2   // Copyright (C) 2005-2010 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   // This provides for manual posting of EOBs.  It is invoked from
  10   // sl_eob_search.php.  For automated (X12 835) remittance posting
  11   // see sl_eob_process.php.
  12
  13   require_once("../globals.php");
  14   require_once("$srcdir/log.inc");
  15   require_once("$srcdir/patient.inc");
  16   require_once("$srcdir/forms.inc");
  17   require_once("$srcdir/sl_eob.inc.php");
  18   require_once("$srcdir/invoice_summary.inc.php");
  19   require_once("../../custom/code_types.inc.php");
  20   require_once("$srcdir/formdata.inc.php");
  21
  22   $debug = 0; // set to 1 for debugging mode
  23
  24   $INTEGRATED_AR = $GLOBALS['oer_config']['ws_accounting']['enabled'] === 2;
  25
  26   // If we permit deletion of transactions.  Might change this later.
  27   $ALLOW_DELETE = $INTEGRATED_AR;
  28
  29   $info_msg = "";
  30
  31   // Format money for display.
  32   //
  33   function bucks($amount) {
  34     if ($amount)
  35       printf("%.2f", $amount);
  36   }
  37
  38   // Delete rows, with logging, for the specified table using the
  39   // specified WHERE clause.  Borrowed from deleter.php.
  40   //
  41   function row_delete($table, $where) {
  42     $tres = sqlStatement("SELECT * FROM $table WHERE $where");
  43     $count = 0;
  44     while ($trow = sqlFetchArray($tres)) {
  45       $logstring = "";
  46       foreach ($trow as $key => $value) {
  47         if (! $value || $value == '0000-00-00 00:00:00') continue;
  48         if ($logstring) $logstring .= " ";
  49         $logstring .= $key . "='" . addslashes($value) . "'";
  50       }
  51       newEvent("delete", $_SESSION['authUser'], $_SESSION['authProvider'], 1, "$table: $logstring");
  52       ++$count;
  53     }
  54     if ($count) {
  55       $query = "DELETE FROM $table WHERE $where";
  56       echo $query . "<br>\n";
  57       sqlStatement($query);
  58     }
  59   }
  60 ?>
  61 <html>
  62 <head>
  63 <?php html_header_show(); ?>
  64 <link rel=stylesheet href="<?php echo $css_header;?>" type="text/css">
  65 <title><?php xl('EOB Posting - Invoice','e')?></title>
  66 <script language="JavaScript">
  67
  68 // An insurance radio button is selected.
  69 function setins(istr) {
  70 <?php if (!$INTEGRATED_AR) { ?>
  71  var f = document.forms[0];
  72  for (var i = 0; i < f.elements.length; ++i) {
  73   var ename = f.elements[i].name;
  74   if (ename.indexOf('[src]') < 0) continue;
  75   var evalue = f.elements[i].value;
  76   var tmp = evalue.substring(0, 4).toLowerCase();
  77   if (tmp >= 'ins1' && tmp <= 'ins3')
  78    evalue = evalue.substring(4);
  79   else if (evalue.substring(0, 2).toLowerCase() == 'pt')
  80    evalue = evalue.substring(2);
  81   while (evalue.substring(0, 1) == '/')
  82    evalue = evalue.substring(1);
  83   f.elements[i].value = istr + '/' + evalue;
  84  }
  85 <?php } ?>
  86  return true;
  87 }
  88
  89 // Compute an adjustment that writes off the balance:
  90 function writeoff(code) {
  91  var f = document.forms[0];
  92  var belement = f['form_line[' + code + '][bal]'];
  93  var pelement = f['form_line[' + code + '][pay]'];
  94  var aelement = f['form_line[' + code + '][adj]'];
  95  var relement = f['form_line[' + code + '][reason]'];
  96  var tmp = belement.value - pelement.value;
  97  aelement.value = Number(tmp).toFixed(2);
  98  if (aelement.value && ! relement.value) relement.selectedIndex = 1;
  99  return false;
 100 }
 101
 102 // Onsubmit handler.  A good excuse to write some JavaScript.
 103 function validate(f) {
 104  var delcount = 0;
 105  for (var i = 0; i < f.elements.length; ++i) {
 106   var ename = f.elements[i].name;
 107   // Count deletes.
 108   if (ename.substring(0, 9) == 'form_del[') {
 109    if (f.elements[i].checked) ++delcount;
 110    continue;
 111   }
 112   var pfxlen = ename.indexOf('[pay]');
 113   if (pfxlen < 0) continue;
 114   var pfx = ename.substring(0, pfxlen);
 115   var code = pfx.substring(pfx.indexOf('[')+1, pfxlen-1);
 116   if (f[pfx+'[pay]'].value || f[pfx+'[adj]'].value) {
 117 <?php if (!$INTEGRATED_AR) { // source validation not appropriate ?>
 118    var srcobj = f[pfx+'[src]'];
 119    while (srcobj.value.length) {
 120     var tmp = srcobj.value.substring(srcobj.value.length - 1);
 121     if (tmp > ' ' && tmp != '/') break;
 122     srcobj.value = srcobj.value.substring(0, srcobj.value.length - 1);
 123    }
 124    var svalue = srcobj.value;
 125    if (! svalue) {
 126     alert('<?php xl('Source is missing for code ','e') ?>' + code);
 127     return false;
 128    } else {
 129     var tmp = svalue.substring(0, 4).toLowerCase();
 130     if (tmp >= 'ins1' && tmp <= 'ins3') {
 131      svalue = svalue.substring(4);
 132     } else if (svalue.substring(0, 2).toLowerCase() == 'pt') {
 133      svalue = svalue.substring(2);
 134     } else {
 135      alert('<?php xl('Invalid or missing payer in source for code ','e')?>' + code);
 136      return false;
 137     }
 138     if (svalue) {
 139      if (svalue.substring(0, 1) != '/') {
 140       alert('<?php xl('Missing slash after payer in source for code ','e')?>' + code);
 141       return false;
 142      }
 143      if (false) { // Please keep this, Oakland Clinic wants it.  -- Rod
 144       tmp = svalue.substring(1, 3).toLowerCase();
 145       if (tmp != 'nm' && tmp != 'ci' && tmp != 'cp' && tmp != 'ne' &&
 146           tmp != 'it' && tmp != 'pf' && tmp != 'pp' && tmp != 'ok')
 147       {
 148        alert('<?php xl('Invalid source designation "','e') ?>' + tmp + '<?php xl('" for code ','e') ?>' + code);
 149        return false;
 150       }
 151      } // End of OC code
 152     }
 153    }
 154 <?php } ?>
 155    if (! f[pfx+'[date]'].value) {
 156     alert('<?php xl('Date is missing for code ','e')?>' + code);
 157     return false;
 158    }
 159   }
 160   if (f[pfx+'[pay]'].value && isNaN(parseFloat(f[pfx+'[pay]'].value))) {
 161    alert('<?php xl('Payment value for code ','e') ?>' + code + '<?php xl(' is not a number','e') ?>');
 162    return false;
 163   }
 164   if (f[pfx+'[adj]'].value && isNaN(parseFloat(f[pfx+'[adj]'].value))) {
 165    alert('<?php xl('Adjustment value for code ','e') ?>' + code + '<?php xl(' is not a number','e') ?>');
 166    return false;
 167   }
 168   if (f[pfx+'[adj]'].value && ! f[pfx+'[reason]'].value) {
 169    alert('<?php xl('Please select an adjustment reason for code ','e') ?>' + code);
 170    return false;
 171   }
 172   // TBD: validate the date format
 173  }
 174  // Demand confirmation if deleting anything.
 175  if (delcount > 0) {
 176   if (!confirm('<?php echo xl('Really delete'); ?> ' + delcount +
 177    ' <?php echo xl('transactions'); ?>?' +
 178    ' <?php echo xl('This action will be logged'); ?>!')
 179   ) return false;
 180  }
 181  return true;
 182 }
 183
 184 <!-- Get current date -->
 185
 186 function getFormattedToday()
 187 {
 188    var today = new Date();
 189    var dd = today.getDate();
 190    var mm = today.getMonth()+1; //January is 0!
 191    var yyyy = today.getFullYear();
 192    if(dd<10){dd='0'+dd}
 193    if(mm<10){mm='0'+mm}
 194
 195    return (yyyy + '-' + mm + '-' + dd);
 196 }
 197
 198 <!-- Update Payment Fields -->
 199
 200 function updateFields(payField, adjField, balField, coPayField, isFirstProcCode)
 201 {
 202    var payAmount = 0.0;
 203    var adjAmount = 0.0;
 204    var balAmount = 0.0;
 205    var coPayAmount = 0.0;
 206
 207    // coPayFiled will be null if there is no co-pay entry in the fee sheet
 208    if (coPayField)
 209       coPayAmount = coPayField.value;
 210
 211    // if balance field is 0.00, its value comes back as null, so check for nul-ness first
 212    if (balField)
 213       balAmount = (balField.value) ? balField.value : 0;
 214    if (payField)
 215       payAmount = (payField.value) ? payField.value : 0;
 216
 217    //alert('balance = >' + balAmount +'<  payAmount = ' + payAmount + '  copay = ' + coPayAmount + '  isFirstProcCode = ' + isFirstProcCode);
 218
 219    // subtract the co-pay only from the first procedure code
 220    if (isFirstProcCode == 1)
 221       balAmount = parseFloat(balAmount) + parseFloat(coPayAmount);
 222
 223    adjAmount = balAmount - payAmount;
 224
 225    // Assign rounded adjustment value back to TextField
 226    adjField.value = adjAmount = Math.round(adjAmount*100)/100;
 227 }
 228
 229 </script>
 230 </head>
 231 <body leftmargin='0' topmargin='0' marginwidth='0' marginheight='0'>
 232 <?php
 233   $trans_id = 0 + $_GET['id'];
 234   if (! $trans_id) die(xl("You cannot access this page directly."));
 235
 236   if ($INTEGRATED_AR) {
 237     // In the Integrated A/R case, $trans_id matches form_encounter.id.
 238     $ferow = sqlQuery("SELECT e.*, p.fname, p.mname, p.lname " .
 239       "FROM form_encounter AS e, patient_data AS p WHERE " .
 240       "e.id = '$trans_id' AND p.pid = e.pid");
 241     if (empty($ferow)) die("There is no encounter with form_encounter.id = '$trans_id'.");
 242     $patient_id        = 0 + $ferow['pid'];
 243     $encounter_id      = 0 + $ferow['encounter'];
 244     $svcdate           = substr($ferow['date'], 0, 10);
 245     $form_payer_id     = 0 + $_POST['form_payer_id'];
 246     $form_reference    = $_POST['form_reference'];
 247     $form_check_date   = fixDate($_POST['form_check_date'], date('Y-m-d'));
 248     $form_deposit_date = fixDate($_POST['form_deposit_date'], $form_check_date);
 249     $form_pay_total    = 0 + $_POST['form_pay_total'];
 250   }
 251   else {
 252     slInitialize();
 253   }
 254
 255   $payer_type = 0;
 256   if (preg_match('/^Ins(\d)/i', $_POST['form_insurance'], $matches)) {
 257     $payer_type = $matches[1];
 258   }
 259
 260   if ($_POST['form_save'] || $_POST['form_cancel']) {
 261     if ($_POST['form_save']) {
 262       if ($debug) {
 263         echo xl("This module is in test mode. The database will not be changed.",'','<p><b>',"</b><p>\n");
 264       }
 265
 266       if ($INTEGRATED_AR) {
 267         $session_id = arGetSession($form_payer_id, $form_reference,
 268           $form_check_date, $form_deposit_date, $form_pay_total);
 269         // The sl_eob_search page needs its invoice links modified to invoke
 270         // javascript to load form parms for all the above and submit.
 271         // At the same time that page would be modified to work off the
 272         // openemr database exclusively.
 273         // And back to the sl_eob_invoice page, I think we may want to move
 274         // the source input fields from row level to header level.
 275
 276         // Handle deletes. row_delete() is borrowed from deleter.php.
 277         if ($ALLOW_DELETE && !$debug) {
 278           foreach ($_POST['form_del'] as $arseq => $dummy) {
 279             row_delete("ar_activity", "pid = '$patient_id' AND " .
 280               "encounter = '$encounter_id' AND sequence_no = '$arseq'");
 281           }
 282         }
 283       }
 284
 285       $paytotal = 0;
 286       foreach ($_POST['form_line'] as $code => $cdata) {
 287         if (!$INTEGRATED_AR) {
 288           $thissrc  = trim($cdata['src']);
 289           $thisdate = trim($cdata['date']);
 290         }
 291         $thispay  = trim($cdata['pay']);
 292         $thisadj  = trim($cdata['adj']);
 293         $thisins  = trim($cdata['ins']);
 294         $thiscodetype = trim($cdata['code_type']);
 295         $reason   = strip_escape_custom($cdata['reason']);
 296
 297         // Get the adjustment reason type.  Possible values are:
 298         // 1 = Charge adjustment
 299         // 2 = Coinsurance
 300         // 3 = Deductible
 301         // 4 = Other pt resp
 302         // 5 = Comment
 303         $reason_type = '1';
 304         if ($reason) {
 305           $tmp = sqlQuery("SELECT option_value FROM list_options WHERE " .
 306             "list_id = 'adjreason' AND " .
 307             "option_id = '" . add_escape_custom($reason) . "'");
 308           if (empty($tmp['option_value'])) {
 309             // This should not happen but if it does, apply old logic.
 310             if (preg_match("/To copay/", $reason)) {
 311               $reason_type = 2;
 312             }
 313             else if (preg_match("/To ded'ble/", $reason)) {
 314               $reason_type = 3;
 315             }
 316             $info_msg .= xl("No adjustment reason type found for") . " \"$reason\". ";
 317           }
 318           else {
 319             $reason_type = $tmp['option_value'];
 320           }
 321         }
 322
 323         if (! $thisins) $thisins = 0;
 324
 325         if ($thispay) {
 326           if ($INTEGRATED_AR) {
 327             arPostPayment($patient_id, $encounter_id, $session_id,
 328               $thispay, $code, $payer_type, '', $debug, '', $thiscodetype);
 329           } else {
 330             slPostPayment($trans_id, $thispay, $thisdate, $thissrc, $code, $thisins, $debug);
 331           }
 332           $paytotal += $thispay;
 333         }
 334
 335         // Be sure to record adjustment reasons, even for zero adjustments if
 336         // they happen to be comments.
 337         if ($thisadj || ($reason && $reason_type == 5)) {
 338           // "To copay" and "To ded'ble" need to become a comment in a zero
 339           // adjustment, formatted just like sl_eob_process.php.
 340           if ($reason_type == '2') {
 341             $reason = $_POST['form_insurance'] . " coins: $thisadj";
 342             $thisadj = 0;
 343           }
 344           else if ($reason_type == '3') {
 345             $reason = $_POST['form_insurance'] . " dedbl: $thisadj";
 346             $thisadj = 0;
 347           }
 348           else if ($reason_type == '4') {
 349             $reason = $_POST['form_insurance'] . " ptresp: $thisadj $reason";
 350             $thisadj = 0;
 351           }
 352           else if ($reason_type == '5') {
 353             $reason = $_POST['form_insurance'] . " note: $thisadj $reason";
 354             $thisadj = 0;
 355           }
 356           else {
 357             // An adjustment reason including "Ins" is assumed to be assigned by
 358             // insurance, and in that case we identify which one by appending
 359             // Ins1, Ins2 or Ins3.
 360             if (strpos(strtolower($reason), 'ins') !== false)
 361               $reason .= ' ' . $_POST['form_insurance'];
 362           }
 363           if ($INTEGRATED_AR) {
 364             arPostAdjustment($patient_id, $encounter_id, $session_id,
 365               $thisadj, $code, $payer_type, $reason, $debug, '', $thiscodetype);
 366           } else {
 367             slPostAdjustment($trans_id, $thisadj, $thisdate, $thissrc, $code, $thisins, $reason, $debug);
 368           }
 369         }
 370       }
 371
 372       // Maintain which insurances are marked as finished.
 373
 374       if ($INTEGRATED_AR) {
 375         $form_done = 0 + $_POST['form_done'];
 376         $form_stmt_count = 0 + $_POST['form_stmt_count'];
 377         sqlStatement("UPDATE form_encounter " .
 378           "SET last_level_closed = $form_done, " .
 379           "stmt_count = $form_stmt_count WHERE " .
 380           "pid = '$patient_id' AND encounter = '$encounter_id'");
 381       }
 382       else {
 383         $form_duedate = fixDate($_POST['form_duedate']);
 384         $form_notes = trim($_POST['form_notes']);
 385         // We use the "Ship Via" field of the invoice to hold these.
 386         $form_eobs = "";
 387         foreach (array('Ins1', 'Ins2', 'Ins3') as $value) {
 388           if ($_POST["form_done_$value"]) {
 389             if ($form_eobs) $form_eobs .= ","; else $form_eobs = "Done: ";
 390             $form_eobs .= $value;
 391           }
 392         }
 393         $query = "UPDATE ar SET duedate = '$form_duedate', notes = '$form_notes', " .
 394           "shipvia = '$form_eobs' WHERE id = $trans_id";
 395         if ($debug) {
 396           echo $query . "<br>\n";
 397         } else {
 398           SLQuery($query);
 399           if ($sl_err) die($sl_err);
 400         }
 401       }
 402
 403       if ($_POST['form_secondary']) {
 404         if ($INTEGRATED_AR) {
 405           arSetupSecondary($patient_id, $encounter_id, $debug);
 406         } else {
 407           slSetupSecondary($trans_id, $debug);
 408         }
 409       }
 410
 411       echo "<script language='JavaScript'>\n";
 412       echo " if (opener.document.forms[0].form_amount) {\n";
 413       echo "  var tmp = opener.document.forms[0].form_amount.value - $paytotal;\n";
 414       echo "  opener.document.forms[0].form_amount.value = Number(tmp).toFixed(2);\n";
 415       echo " }\n";
 416     } else {
 417       echo "<script language='JavaScript'>\n";
 418     }
 419     if ($info_msg) echo " alert('" . addslashes($info_msg) . "');\n";
 420     if (! $debug) echo " window.close();\n";
 421     echo "</script></body></html>\n";
 422     if (!$INTEGRATED_AR) SLClose();
 423     exit();
 424   }
 425
 426   if ($INTEGRATED_AR) {
 427     // Get invoice charge details.
 428     $codes = ar_get_invoice_summary($patient_id, $encounter_id, true);
 429   }
 430   else {
 431     // Get invoice data into $arrow.
 432     $arres = SLQuery("select ar.*, customer.name, employee.name as doctor " .
 433       "from ar, customer, employee where ar.id = $trans_id and " .
 434       "customer.id = ar.customer_id and employee.id = ar.employee_id");
 435     if ($sl_err) die($sl_err);
 436     $arrow = SLGetRow($arres, 0);
 437     if (! $arrow) die(xl("There is no match for invoice id = ") . $trans_id);
 438     //
 439     // Determine the date of service.  An 8-digit encounter number is
 440     // presumed to be a date of service imported during conversion.
 441     // Otherwise look it up in the form_encounter table.
 442     //
 443     $svcdate = "";
 444     list($patient_id, $encounter) = explode(".", $arrow['invnumber']);
 445     if (strlen($encounter) == 8) {
 446       $svcdate = substr($encounter, 0, 4) . "-" . substr($encounter, 4, 2) .
 447         "-" . substr($encounter, 6, 2);
 448     }
 449     else if ($encounter) {
 450       $tmp = sqlQuery("SELECT date FROM form_encounter WHERE " .
 451         "encounter = $encounter");
 452       $svcdate = substr($tmp['date'], 0, 10);
 453     }
 454
 455     // Get invoice charge details.
 456     $codes = get_invoice_summary($trans_id, true);
 457   }
 458
 459   $pdrow = sqlQuery("select genericname2, genericval2 " .
 460     "from patient_data where pid = '$patient_id' limit 1");
 461 ?>
 462 <center>
 463
 464 <form method='post' action='sl_eob_invoice.php?id=<?php echo $trans_id ?>'
 465  onsubmit='return validate(this)'>
 466
 467 <table border='0' cellpadding='3'>
 468  <tr>
 469   <td>
 470    <?php xl('Patient:','e')?>
 471   </td>
 472   <td>
 473 <?php
 474   if ($INTEGRATED_AR) {
 475     echo $ferow['fname'] . ' ' . $ferow['mname'] . ' ' . $ferow['lname'];
 476   }
 477   else {
 478     echo $arrow['name'];
 479   }
 480 ?>
 481   </td>
 482   <td colspan="2" rowspan="3">
 483 <?php
 484   if ($INTEGRATED_AR) {
 485     for ($i = 1; $i <= 3; ++$i) {
 486       $payerid = arGetPayerID($patient_id, $svcdate, $i);
 487       if ($payerid) {
 488         $tmp = sqlQuery("SELECT name FROM insurance_companies WHERE id = $payerid");
 489         echo "Ins$i: " . $tmp['name'] . "<br />";
 490       }
 491     }
 492   }
 493   else {
 494     echo "   <textarea name='form_notes' cols='50' style='height:100%'>";
 495     echo $arrow['notes'];
 496     echo "</textarea>\n";
 497   }
 498 ?>
 499   </td>
 500 <?php
 501   if ($INTEGRATED_AR) {
 502     echo "<td rowspan='3' valign='bottom'>\n";
 503     echo xl('Statements Sent:');
 504     echo "</td>\n";
 505     echo "<td rowspan='3' valign='bottom'>\n";
 506     echo "<input type='text' name='form_stmt_count' size='10' value='" .
 507       (0 + $ferow['stmt_count']) . "' />\n";
 508     echo "</td>\n";
 509   }
 510 ?>
 511  </tr>
 512  <tr>
 513   <td>
 514    <?php xl('Provider:','e')?>
 515   </td>
 516   <td>
 517    <?php
 518   if ($INTEGRATED_AR) {
 519     $tmp = sqlQuery("SELECT fname, mname, lname " .
 520       "FROM users WHERE id = " . $ferow['provider_id']);
 521     echo $tmp['fname'] . ' ' . $tmp['mname'] . ' ' . $tmp['lname'];
 522     $tmp = sqlQuery("SELECT bill_date FROM billing WHERE " .
 523       "pid = '$patient_id' AND encounter = '$encounter_id' AND " .
 524       "activity = 1 ORDER BY fee DESC, id ASC LIMIT 1");
 525     $billdate = substr(($tmp['bill_date'] . "Not Billed"), 0, 10);
 526   }
 527   else {
 528     echo $arrow['doctor'];
 529   }
 530 ?>
 531   </td>
 532  </tr>
 533  <tr>
 534   <td>
 535    <?php xl('Invoice:','e')?>
 536   </td>
 537   <td>
 538 <?php
 539   if ($INTEGRATED_AR) {
 540     echo "$patient_id.$encounter_id";
 541   }
 542   else {
 543     echo $arrow['invnumber'];
 544   }
 545 ?>
 546   </td>
 547  </tr>
 548
 549  <tr>
 550   <td>
 551 <?php xl('Svc Date:','e'); ?>
 552   </td>
 553   <td>
 554 <?php
 555     echo $svcdate;
 556 ?>
 557   </td>
 558   <td colspan="2">
 559    <?php xl('Done with:','e','',"&nbsp")?>;
 560 <?php
 561   // Write a checkbox for each insurance.  It is to be checked when
 562   // we no longer expect any payments from that company for the claim.
 563   if ($INTEGRATED_AR) {
 564     $last_level_closed = 0 + $ferow['last_level_closed'];
 565     foreach (array(0 => 'None', 1 => 'Ins1', 2 => 'Ins2', 3 => 'Ins3') as $key => $value) {
 566       if ($key && !arGetPayerID($patient_id, $svcdate, $key)) continue;
 567       $checked = ($last_level_closed == $key) ? " checked" : "";
 568       echo "   <input type='radio' name='form_done' value='$key'$checked />$value&nbsp;\n";
 569     }
 570   }
 571   else {
 572     // The information is stored in the 'shipvia' field of the invoice.
 573     $insgot  = strtolower($arrow['notes']);
 574     $insdone = strtolower($arrow['shipvia']);
 575     foreach (array('Ins1', 'Ins2', 'Ins3') as $value) {
 576       $lcvalue = strtolower($value);
 577       $checked  = (strpos($insdone, $lcvalue) === false) ? "" : " checked";
 578       if (strpos($insgot, $lcvalue) !== false) {
 579         echo "   <input type='checkbox' name='form_done_$value' value='1'$checked />$value&nbsp;\n";
 580       }
 581     }
 582   }
 583 ?>
 584   </td>
 585 <?php
 586   if ($INTEGRATED_AR) {
 587     echo "<td>\n";
 588     echo xl('Check/EOB No.:');
 589     echo "</td>\n";
 590     echo "<td>\n";
 591     echo "<input type='text' name='form_reference' size='10' value='' />\n";
 592     echo "</td>\n";
 593   }
 594 ?>
 595  </tr>
 596
 597  <tr>
 598   <td>
 599    <?php xl('Last Bill Date:','e') ?>
 600   </td>
 601   <td>
 602    <?php
 603   if ($INTEGRATED_AR) {
 604     echo $billdate;
 605   }
 606   else {
 607     echo $arrow['transdate'];
 608   }
 609 ?>
 610   </td>
 611   <td colspan="2">
 612    <?php xl('Now posting for:','e','',"&nbsp")?>;
 613
 614 <?php
 615   // TBD: check the first not-done-with insurance, not always Ins1!
 616 ?>
 617    <input type='radio' name='form_insurance' value='Ins1' onclick='setins("Ins1")' checked /><?php xl('Ins1','e')?>&nbsp;
 618    <input type='radio' name='form_insurance' value='Ins2' onclick='setins("Ins2")' /><?php xl('Ins2','e')?>&nbsp;
 619    <input type='radio' name='form_insurance' value='Ins3' onclick='setins("Ins3")' /><?php xl('Ins3','e')?>&nbsp;
 620    <input type='radio' name='form_insurance' value='Pt'   onclick='setins("Pt")'   /><?php xl('Patient','e')?>
 621
 622 <?php
 623   // TBD: I think the following is unused and can be removed.
 624 ?>
 625    <input type='hidden' name='form_eobs' value='<?php echo addslashes($arrow['shipvia']) ?>' />
 626
 627   </td>
 628 <?php
 629   if ($INTEGRATED_AR) {
 630     echo "<td>\n";
 631     echo xl('Check/EOB Date:');
 632     echo "</td>\n";
 633     echo "<td>\n";
 634     echo "<input type='text' name='form_check_date' size='10' value='' />\n";
 635     echo "</td>\n";
 636   }
 637 ?>
 638  </tr>
 639  <tr>
 640   <td>
 641    <?php
 642   if (!$INTEGRATED_AR) xl('Due Date:','e');
 643 ?>
 644   </td>
 645   <td>
 646
 647 <?php if (!$INTEGRATED_AR) { ?>
 648    <input type='text' name='form_duedate' size='10' value='<?php echo $arrow['duedate'] ?>'
 649     title='<?php xl('Due date mm/dd/yyyy or yyyy-mm-dd','e')?>'>
 650 <?php } ?>
 651   </td>
 652   <td colspan="2">
 653    <input type="checkbox" name="form_secondary" value="1"> <?php xl('Needs secondary billing','e')?>
 654    &nbsp;&nbsp;
 655    <input type='submit' name='form_save' value='<?php xl('Save','e')?>'>
 656    &nbsp;
 657    <input type='button' value='<?php xl('Cancel','e')?>' onclick='window.close()'>
 658   </td>
 659 <?php
 660   if ($INTEGRATED_AR) {
 661     echo "<td>\n";
 662     echo xl('Deposit Date:');
 663     echo "</td>\n";
 664     echo "<td>\n";
 665     echo "<input type='text' name='form_deposit_date' size='10' value='' />\n";
 666     echo "<input type='hidden' name='form_payer_id' value='' />\n";
 667     echo "<input type='hidden' name='form_orig_reference' value='' />\n";
 668     echo "<input type='hidden' name='form_orig_check_date' value='' />\n";
 669     echo "<input type='hidden' name='form_orig_deposit_date' value='' />\n";
 670     echo "<input type='hidden' name='form_pay_total' value='' />\n";
 671     echo "</td>\n";
 672   }
 673 ?>
 674  </tr>
 675 <?php if ($pdrow['genericname2'] == 'Billing') { ?>
 676  <tr>
 677   <td>
 678    <?php xl('Billing Note:','e')?>
 679   </td>
 680   <td colspan='3' style='color:red'>
 681    <?php echo $pdrow['genericval2'] ?>
 682   </td>
 683  </tr>
 684 <?php } ?>
 685  <tr>
 686   <td height="1">
 687   </td>
 688  </tr>
 689 </table>
 690
 691 <table border='0' cellpadding='2' cellspacing='0' width='98%'>
 692
 693  <tr bgcolor="#cccccc">
 694   <td class="dehead">
 695    <?php xl('Code','e')?>
 696   </td>
 697   <td class="dehead" align="right">
 698    <?php xl('Charge','e')?>
 699   </td>
 700   <td class="dehead" align="right">
 701    <?php xl('Balance','e')?>&nbsp;
 702   </td>
 703   <td class="dehead">
 704    <?php xl('By/Source','e')?>
 705   </td>
 706   <td class="dehead">
 707    <?php xl('Date','e')?>
 708   </td>
 709   <td class="dehead">
 710    <?php xl('Pay','e')?>
 711   </td>
 712   <td class="dehead">
 713    <?php xl('Adjust','e')?>
 714   </td>
 715   <td class="dehead">
 716    <?php xl('Reason','e')?>
 717   </td>
 718 <?php if ($ALLOW_DELETE) { ?>
 719   <td class="dehead">
 720    <?php xl('Del','e')?>
 721   </td>
 722 <?php } ?>
 723  </tr>
 724 <?php
 725   $firstProcCodeIndex = -1;
 726   $encount = 0;
 727   foreach ($codes as $code => $cdata) {
 728    ++$encount;
 729    $bgcolor = "#" . (($encount & 1) ? "ddddff" : "ffdddd");
 730    $dispcode = $code;
 731
 732    // remember the index of the first entry whose code is not "CO-PAY", i.e. it's a legitimate proc code
 733    if ($firstProcCodeIndex == -1 && strcmp($code, "CO-PAY") !=0)
 734     $firstProcCodeIndex = $encount;
 735
 736    // this sorts the details more or less chronologically:
 737    ksort($cdata['dtl']);
 738    foreach ($cdata['dtl'] as $dkey => $ddata) {
 739     $ddate = substr($dkey, 0, 10);
 740     if (preg_match('/^(\d\d\d\d)(\d\d)(\d\d)\s*$/', $ddate, $matches)) {
 741      $ddate = $matches[1] . '-' . $matches[2] . '-' . $matches[3];
 742     }
 743     $tmpchg = "";
 744     $tmpadj = "";
 745     /*****************************************************************
 746     if ($ddata['chg'] > 0)
 747      $tmpchg = $ddata['chg'];
 748     else if ($ddata['chg'] < 0)
 749      $tmpadj = 0 - $ddata['chg'];
 750     *****************************************************************/
 751     if ($ddata['chg'] != 0) {
 752       if (isset($ddata['rsn'])) $tmpadj = 0 - $ddata['chg'];
 753       else $tmpchg = $ddata['chg'];
 754     }
 755 ?>
 756  <tr bgcolor='<?php echo $bgcolor ?>'>
 757   <td class="detail">
 758    <?php echo $dispcode; $dispcode = "" ?>
 759   </td>
 760   <td class="detail" align="right">
 761    <?php bucks($tmpchg) ?>
 762   </td>
 763   <td class="detail" align="right">
 764    &nbsp;
 765   </td>
 766   <td class="detail">
 767    <?php
 768     if (isset($ddata['plv'])) {
 769       if (!$ddata['plv']) echo 'Pt/';
 770       else echo 'Ins' . $ddata['plv'] . '/';
 771     }
 772     echo $ddata['src'];
 773    ?>
 774   </td>
 775   <td class="detail">
 776    <?php echo $ddate ?>
 777   </td>
 778   <td class="detail">
 779    <?php bucks($ddata['pmt']) ?>
 780   </td>
 781   <td class="detail">
 782    <?php bucks($tmpadj) ?>
 783   </td>
 784   <td class="detail">
 785    <?php echo $ddata['rsn'] ?>
 786   </td>
 787 <?php if ($ALLOW_DELETE) { ?>
 788   <td class="detail">
 789 <?php if (!empty($ddata['arseq'])) { ?>
 790    <input type="checkbox" name="form_del[<?php echo $ddata['arseq']; ?>]" />
 791 <?php } else { ?>
 792    &nbsp;
 793 <?php } ?>
 794   </td>
 795 <?php } ?>
 796  </tr>
 797 <?php
 798    } // end of prior detail line
 799 ?>
 800  <tr bgcolor='<?php echo $bgcolor ?>'>
 801   <td class="detail">
 802    <?php echo $dispcode; $dispcode = "" ?>
 803   </td>
 804   <td class="detail" align="right">
 805    &nbsp;
 806   </td>
 807   <td class="detail" align="right">
 808    <input type="hidden" name="form_line[<?php echo $code ?>][bal]" value="<?php bucks($cdata['bal']) ?>">
 809    <input type="hidden" name="form_line[<?php echo $code ?>][ins]" value="<?php echo $cdata['ins'] ?>">
 810    <input type="hidden" name="form_line[<?php echo $code ?>][code_type]" value="<?php echo $cdata['code_type'] ?>">
 811    <?php printf("%.2f", $cdata['bal']) ?>&nbsp;
 812   </td>
 813   <td class="detail">
 814
 815 <?php if (!$INTEGRATED_AR) { ?>
 816    <input type="text" name="form_line[<?php echo $code ?>][src]" size="10"
 817     style="background-color:<?php echo $bgcolor ?>" />
 818     <!-- title="NM=notmet, CI=coins, CP=copay, NE=notelig, IT=insterm, PF=ptfull, PP=ptpart" -->
 819 <?php } ?>
 820
 821   </td>
 822   <td class="detail">
 823
 824 <?php if (!$INTEGRATED_AR) { ?>
 825    <input type="text" name="form_line[<?php echo $code ?>][date]" size="10"
 826     style="background-color:<?php echo $bgcolor ?>" />
 827 <?php } ?>
 828
 829   </td>
 830   <td class="detail">
 831    <input type="text" name="form_line[<?php echo $code ?>][pay]" size="10"
 832     style="background-color:<?php echo $bgcolor ?>"
 833     onKeyUp="updateFields(document.forms[0]['form_line[<?php echo $code ?>][pay]'],
 834                           document.forms[0]['form_line[<?php echo $code ?>][adj]'],
 835                           document.forms[0]['form_line[<?php echo $code ?>][bal]'],
 836                           document.forms[0]['form_line[CO-PAY][bal]'],
 837                           <?php echo ($firstProcCodeIndex == $encount) ? 1 : 0 ?>)"/>
 838   </td>
 839   <td class="detail">
 840    <input type="text" name="form_line[<?php echo $code ?>][adj]" size="10"
 841     value='<?php echo $totalAdjAmount ?>'
 842     style="background-color:<?php echo $bgcolor ?>" />
 843    &nbsp; <a href="" onclick="return writeoff('<?php echo $code ?>')">W</a>
 844   </td>
 845   <td class="detail">
 846    <select name="form_line[<?php echo $code ?>][reason]"
 847     style="background-color:<?php echo $bgcolor ?>">
 848 <?php
 849 // Adjustment reasons are now taken from the list_options table.
 850 echo "    <option value=''></option>\n";
 851 $ores = sqlStatement("SELECT option_id, title, is_default FROM list_options " .
 852   "WHERE list_id = 'adjreason'  ORDER BY seq, title");
 853 while ($orow = sqlFetchArray($ores)) {
 854   echo "    <option value='" . htmlspecialchars($orow['option_id'], ENT_QUOTES) . "'";
 855   if ($orow['is_default']) echo " selected";
 856   echo ">" . htmlspecialchars($orow['title']) . "</option>\n";
 857 }
 858 ?>
 859
 860    </select>
 861 <?php
 862     // TBD: Maybe a comment field would be good here, for appending
 863     // to the reason.
 864 ?>
 865   </td>
 866
 867 <?php if ($ALLOW_DELETE) { ?>
 868   <td class="detail">
 869    &nbsp;
 870   </td>
 871 <?php } ?>
 872
 873  </tr>
 874 <?php
 875   } // end of code
 876   if (!$INTEGRATED_AR) SLClose();
 877 ?>
 878
 879 </table>
 880 </form>
 881 </center>
 882 <script language="JavaScript">
 883  var f1 = opener.document.forms[0];
 884  var f2 = document.forms[0];
 885  if (f1.form_source) {
 886 <?php
 887   if ($INTEGRATED_AR) {
 888     // These support creation and lookup of ar_session table entries:
 889     echo "  f2.form_reference.value         = f1.form_source.value;\n";
 890     echo "  f2.form_check_date.value        = f1.form_paydate.value;\n";
 891     echo "  //f2.form_deposit_date.value      = f1.form_deposit_date.value;\n";
 892     echo "  if (f1.form_deposit_date.value != '')\n";
 893     echo "     f2.form_deposit_date.value      = f1.form_deposit_date.value;\n";
 894     echo "  else\n";
 895     echo "     f2.form_deposit_date.value      = getFormattedToday();\n";
 896     echo "  f2.form_payer_id.value          = f1.form_payer_id.value;\n";
 897     echo "  f2.form_pay_total.value         = f1.form_amount.value;\n";
 898     echo "  f2.form_orig_reference.value    = f1.form_source.value;\n";
 899     echo "  f2.form_orig_check_date.value   = f1.form_paydate.value;\n";
 900     echo "  f2.form_orig_deposit_date.value = f1.form_deposit_date.value;\n";
 901
 902     // While I'm thinking about it, some notes about eob sessions.
 903     // If they do not have all of the session key fields in the search
 904     // page, then show a warning at the top of the invoice page.
 905     // Also when they go to save the invoice page and a session key
 906     // field has changed, alert them to that and allow a cancel.
 907
 908     // Another point... when posting EOBs, the incoming payer ID might
 909     // not match the payer ID for the patient's insurance.  This is
 910     // because the same payer might be entered more than once into the
 911     // insurance_companies table.  I don't think it matters much.
 912   }
 913   else {
 914     foreach ($codes as $code => $cdata) {
 915       echo "  f2['form_line[$code][src]'].value  = f1.form_source.value;\n";
 916       echo "  f2['form_line[$code][date]'].value = f1.form_paydate.value;\n";
 917     }
 918   }
 919 ?>
 920  }
 921  setins("Ins1");
 922 </script>
 923 </body>
 924 </html>