library/gen_x12_837.inc.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("Claim.class.php");
  10
  11 function gen_x12_837($pid, $encounter, &$log, $encounter_claim=false) {
  12
  13   $today = time();
  14   $out = '';
  15   $claim = new Claim($pid, $encounter);
  16   $edicount = 0;
  17
  18   $log .= "Generating claim $pid-$encounter for " .
  19     $claim->patientFirstName()  . ' ' .
  20     $claim->patientMiddleName() . ' ' .
  21     $claim->patientLastName()   . ' on ' .
  22     date('Y-m-d H:i', $today) . ".\n";
  23
  24   $out .= "ISA" .
  25     "*00" .
  26     "*          " .
  27     "*00" .
  28     "*          " .
  29     "*" . $claim->x12gsisa05() .
  30     "*" . $claim->x12gssenderid() .
  31     "*" . $claim->x12gsisa07() .
  32     "*" . $claim->x12gsreceiverid() .
  33     "*030911" .
  34     "*1630" .
  35     "*U" .
  36     "*00401" .
  37     "*000000001" .
  38     "*" . $claim->x12gsisa14() .
  39     "*" . $claim->x12gsisa15() .
  40     "*:" .
  41     "~\n";
  42
  43   $out .= "GS" .
  44     "*HC" .
  45     "*" . $claim->x12gsgs02() .
  46     "*" . trim($claim->x12gsreceiverid()) .
  47     "*" . date('Ymd', $today) .
  48     "*" . date('Hi', $today) .
  49     "*1" .
  50     "*X" .
  51     "*" . $claim->x12gsversionstring() .
  52     "~\n";
  53
  54   ++$edicount;
  55   $out .= "ST" .
  56     "*837" .
  57     "*0021" .
  58     "~\n";
  59
  60   ++$edicount;
  61   $out .= "BHT" .
  62     "*0019" .
  63     "*00" .
  64     "*0123" .
  65     "*" . date('Ymd', $today) .
  66     "*1023" .
  67     ($encounter_claim ? "*RP" : "*CH") .
  68     "~\n";
  69
  70   ++$edicount;
  71   $out .= "REF" .
  72     "*87" .
  73     "*" . $claim->x12gsversionstring() .
  74     "~\n";
  75
  76   ++$edicount;
  77   $out .= "NM1" .       // Loop 1000A Submitter
  78     "*41" .
  79     "*2" .
  80     "*" . $claim->billingFacilityName() .
  81     "*" .
  82     "*" .
  83     "*" .
  84     "*" .
  85     "*46" .
  86     "*" . $claim->billingFacilityETIN() .
  87     "~\n";
  88
  89   ++$edicount;
  90   $out .= "PER" .
  91     "*IC" .
  92     "*" . $claim->billingContactName() .
  93     "*TE" .
  94     "*" . $claim->billingContactPhone();
  95   if ($claim->x12gsper06()) {
  96     $out .= "*ED*" . $claim->x12gsper06();
  97   }
  98   $out .= "~\n";
  99
 100   ++$edicount;
 101   $out .= "NM1" .       // Loop 1000B Receiver
 102     "*40" .
 103     "*2" .
 104     "*" . $claim->clearingHouseName() .
 105     "*" .
 106     "*" .
 107     "*" .
 108     "*" .
 109     "*46" .
 110     "*" . $claim->clearingHouseETIN() .
 111     "~\n";
 112
 113   $HLcount = 1;
 114
 115   ++$edicount;
 116   $out .= "HL" .        // Loop 2000A Billing/Pay-To Provider HL Loop
 117     "*$HLcount" .
 118     "*" .
 119     "*20" .
 120     "*1" .
 121     "~\n";
 122
 123   $HLBillingPayToProvider = $HLcount++;
 124
 125   ++$edicount;
 126   $out .= "NM1" .       // Loop 2010AA Billing Provider
 127     "*85" .
 128     "*2" .
 129     "*" . $claim->billingFacilityName() .
 130     "*" .
 131     "*" .
 132     "*" .
 133     "*";
 134   if ($claim->billingFacilityNPI()) {
 135     $out .= "*XX*" . $claim->billingFacilityNPI();
 136   } else {
 137     $log .= "*** Billing facility has no NPI.\n";
 138     $out .= "*24*" . $claim->billingFacilityETIN();
 139   }
 140   $out .= "~\n";
 141
 142   ++$edicount;
 143   $out .= "N3" .
 144     "*" . $claim->billingFacilityStreet() .
 145     "~\n";
 146
 147   ++$edicount;
 148   $out .= "N4" .
 149     "*" . $claim->billingFacilityCity() .
 150     "*" . $claim->billingFacilityState() .
 151     "*" . $claim->billingFacilityZip() .
 152     "~\n";
 153
 154   // Add a REF*EI*<ein> segment if NPI was specified in the NM1 above.
 155   if ($claim->billingFacilityNPI() && $claim->billingFacilityETIN()) {
 156     ++$edicount;
 157     $out .= "REF" .
 158       "*EI" .
 159       "*" . $claim->billingFacilityETIN() .
 160       "~\n";
 161   }
 162
 163   if ($claim->providerNumberType() && $claim->providerNumber()) {
 164     ++$edicount;
 165     $out .= "REF" .
 166       "*" . $claim->providerNumberType() .
 167       "*" . $claim->providerNumber() .
 168       "~\n";
 169   }
 170   else if ($claim->providerNumber()) {
 171     $log .= "*** Payer-specific provider insurance number is present but has no type assigned.\n";
 172   }
 173
 174   ++$edicount;
 175   $out .= "NM1" .       // Loop 2010AB Pay-To Provider
 176     "*87" .
 177     "*2" .
 178     "*" . $claim->billingFacilityName() .
 179     "*" .
 180     "*" .
 181     "*" .
 182     "*";
 183   if ($claim->billingFacilityNPI())
 184     $out .= "*XX*" . $claim->billingFacilityNPI();
 185   else
 186     $out .= "*24*" . $claim->billingFacilityETIN();
 187   $out .= "~\n";
 188
 189   ++$edicount;
 190   $out .= "N3" .
 191     "*" . $claim->billingFacilityStreet() .
 192     "~\n";
 193
 194   ++$edicount;
 195   $out .= "N4" .
 196     "*" . $claim->billingFacilityCity() .
 197     "*" . $claim->billingFacilityState() .
 198     "*" . $claim->billingFacilityZip() .
 199     "~\n";
 200
 201   if ($claim->billingFacilityNPI() && $claim->billingFacilityETIN()) {
 202     ++$edicount;
 203     $out .= "REF" .
 204       "*EI" .
 205       "*" . $claim->billingFacilityETIN() .
 206       "~\n";
 207   }
 208
 209   $PatientHL = 0;
 210
 211   ++$edicount;
 212   $out .= "HL" .        // Loop 2000B Subscriber HL Loop
 213     "*$HLcount" .
 214     "*$HLBillingPayToProvider" .
 215     "*22" .
 216     "*$PatientHL" .
 217     "~\n";
 218
 219   $HLSubscriber = $HLcount++;
 220
 221   if (!$claim->payerSequence()) {
 222     $log .= "*** Error: Insurance information is missing!\n";
 223   }
 224   ++$edicount;
 225   $out .= "SBR" .       // Subscriber Information
 226     "*" . $claim->payerSequence() .
 227     "*" . $claim->insuredRelationship() .
 228     "*" . $claim->groupNumber() .
 229     "*" . $claim->groupName() .
 230     "*" . $claim->insuredTypeCode() . // applies for secondary medicare
 231     "*" .
 232     "*" .
 233     "*" .
 234     "*" . $claim->claimType() . // Zirmed replaces this
 235     "~\n";
 236
 237   ++$edicount;
 238   $out .= "NM1" .       // Loop 2010BA Subscriber
 239     "*IL" .
 240     "*1" .
 241     "*" . $claim->insuredLastName() .
 242     "*" . $claim->insuredFirstName() .
 243     "*" . $claim->insuredMiddleName() .
 244     "*" .
 245     "*" .
 246     "*MI" .
 247     "*" . $claim->policyNumber() .
 248     "~\n";
 249
 250   ++$edicount;
 251   $out .= "N3" .
 252     "*" . $claim->insuredStreet() .
 253     "~\n";
 254
 255   ++$edicount;
 256   $out .= "N4" .
 257     "*" . $claim->insuredCity() .
 258     "*" . $claim->insuredState() .
 259     "*" . $claim->insuredZip() .
 260     "~\n";
 261
 262   ++$edicount;
 263   $out .= "DMG" .
 264     "*D8" .
 265     "*" . $claim->insuredDOB() .
 266     "*" . $claim->insuredSex() .
 267     "~\n";
 268
 269   ++$edicount;
 270   $out .= "NM1" .       // Loop 2010BB Payer
 271     "*PR" .
 272     "*2" .
 273     "*" . $claim->payerName() .
 274     "*" .
 275     "*" .
 276     "*" .
 277     "*" .
 278     "*PI" .
 279     // Zirmed ignores this if using payer name matching:
 280     "*" . ($encounter_claim ? $claim->payerAltID() : $claim->payerID()) .
 281     "~\n";
 282
 283   // if (!$claim->payerID()) {
 284   //   $log .= "*** CMS ID is missing for payer '" . $claim->payerName() . "'.\n";
 285   // }
 286
 287   ++$edicount;
 288   $out .= "N3" .
 289     "*" . $claim->payerStreet() .
 290     "~\n";
 291
 292   ++$edicount;
 293   $out .= "N4" .
 294     "*" . $claim->payerCity() .
 295     "*" . $claim->payerState() .
 296     "*" . $claim->payerZip() .
 297     "~\n";
 298
 299   if (! $claim->isSelfOfInsured()) {
 300     ++$edicount;
 301     $out .= "HL" .        // Loop 2000C Patient Information
 302       "*$HLcount" .
 303       "*$HLSubscriber" .
 304       "*23" .
 305       "*0" .
 306       "~\n";
 307
 308     $HLcount++;
 309
 310     ++$edicount;
 311     $out .= "PAT" .
 312       "*" . $claim->insuredRelationship() .
 313       "~\n";
 314
 315     ++$edicount;
 316     $out .= "NM1" .       // Loop 2010CA Patient
 317       "*QC" .
 318       "*1" .
 319       "*" . $claim->patientLastName() .
 320       "*" . $claim->patientFirstName() .
 321       "*" . $claim->patientMiddleName() .
 322       "~\n";
 323
 324     ++$edicount;
 325     $out .= "N3" .
 326       "*" . $claim->patientStreet() .
 327       "~\n";
 328
 329     ++$edicount;
 330     $out .= "N4" .
 331       "*" . $claim->patientCity() .
 332       "*" . $claim->patientState() .
 333       "*" . $claim->patientZip() .
 334       "~\n";
 335
 336     ++$edicount;
 337     $out .= "DMG" .
 338       "*D8" .
 339       "*" . $claim->patientDOB() .
 340       "*" . $claim->patientSex() .
 341       "~\n";
 342   } // end of patient different from insured
 343
 344   $proccount = $claim->procCount();
 345
 346   $clm_total_charges = 0;
 347   for ($prockey = 0; $prockey < $proccount; ++$prockey) {
 348     $clm_total_charges += $claim->cptCharges($prockey);
 349   }
 350
 351   if (!$clm_total_charges) {
 352     $log .= "*** This claim has no charges!\n";
 353   }
 354
 355   ++$edicount;
 356   $out .= "CLM" .       // Loop 2300 Claim
 357     "*$pid-$encounter" .
 358     "*"  . sprintf("%.2f",$clm_total_charges) . // Zirmed computes and replaces this
 359     "*"  .
 360     "*"  .
 361     "*"  . $claim->facilityPOS() . "::" . $claim->frequencyTypeCode() .
 362     "*Y" .
 363     "*A" .
 364     "*"  . ($claim->billingFacilityAssignment() ? 'Y' : 'N') .
 365     "*Y" .
 366     "*C" .
 367     "~\n";
 368
 369   ++$edicount;
 370   $out .= "DTP" .       // Date of Onset
 371     "*431" .
 372     "*D8" .
 373     "*" . $claim->onsetDate() .
 374     "~\n";
 375
 376   if (strcmp($claim->facilityPOS(),'21') == 0) {
 377     ++$edicount;
 378     $out .= "DTP" .     // Date of Hospitalization
 379       "*435" .
 380       "*D8" .
 381       "*" . $claim->onsetDate() .
 382       "~\n";
 383   }
 384
 385   $patientpaid = $claim->patientPaidAmount();
 386   if ($patientpaid != 0) {
 387     ++$edicount;
 388     $out .= "AMT" .     // Patient paid amount. Page 220.
 389       "*F5" .
 390       "*" . $patientpaid .
 391       "~\n";
 392   }
 393
 394   if ($claim->priorAuth()) {
 395     ++$edicount;
 396     $out .= "REF" .     // Prior Authorization Number
 397       "*G1" .
 398       "*" . $claim->priorAuth() .
 399       "~\n";
 400   }
 401
 402   if ($claim->cliaCode()) {
 403     // Required by Medicare when in-house labs are done.
 404     ++$edicount;
 405     $out .= "REF" .     // Clinical Laboratory Improvement Amendment Number
 406       "*X4" .
 407       "*" . $claim->cliaCode() .
 408       "~\n";
 409   }
 410
 411   // Note: This would be the place to implement the NTE segment for loop 2300.
 412
 413   // Diagnoses, up to 8 per HI segment.
 414   $da = $claim->diagArray();
 415   $diag_type_code = 'BK';
 416   $tmp = 0;
 417   foreach ($da as $diag) {
 418     if ($tmp % 8 == 0) {
 419       if ($tmp) $out .= "~\n";
 420       ++$edicount;
 421       $out .= "HI";         // Health Diagnosis Codes
 422     }
 423     $out .= "*$diag_type_code:" . $diag;
 424     $diag_type_code = 'BF';
 425     ++$tmp;
 426   }
 427   if ($tmp) $out .= "~\n";
 428
 429   if ($claim->referrerLastName()) {
 430     // Medicare requires referring provider's name and UPIN.
 431     ++$edicount;
 432     $out .= "NM1" .     // Loop 2310A Referring Provider
 433       "*DN" .
 434       "*1" .
 435       "*" . $claim->referrerLastName() .
 436       "*" . $claim->referrerFirstName() .
 437       "*" . $claim->referrerMiddleName() .
 438       "*" .
 439       "*";
 440     if ($claim->referrerNPI()) { $out .=
 441       "*XX" .
 442       "*" . $claim->referrerNPI();
 443     } else { $out .=
 444       "*34" .
 445       "*" . $claim->referrerSSN();
 446     }
 447     $out .= "~\n";
 448
 449     if ($claim->referrerTaxonomy()) {
 450       ++$edicount;
 451       $out .= "PRV" .
 452         "*RF" . // ReFerring provider
 453         "*ZZ" .
 454         "*" . $claim->referrerTaxonomy() .
 455         "~\n";
 456     }
 457
 458     if ($claim->referrerUPIN()) {
 459       ++$edicount;
 460       $out .= "REF" .   // Referring Provider Secondary Identification
 461         "*1G" .
 462         "*" . $claim->referrerUPIN() .
 463         "~\n";
 464     }
 465   }
 466
 467   ++$edicount;
 468   $out .= "NM1" .       // Loop 2310B Rendering Provider
 469     "*82" .
 470     "*1" .
 471     "*" . $claim->providerLastName() .
 472     "*" . $claim->providerFirstName() .
 473     "*" . $claim->providerMiddleName() .
 474     "*" .
 475     "*";
 476   if ($claim->providerNPI()) { $out .=
 477     "*XX" .
 478     "*" . $claim->providerNPI();
 479   } else { $out .=
 480     "*34" .
 481     "*" . $claim->providerSSN();
 482     $log .= "*** Rendering provider has no NPI.\n";
 483   }
 484   $out .= "~\n";
 485
 486   if ($claim->providerTaxonomy()) {
 487     ++$edicount;
 488     $out .= "PRV" .
 489       "*PE" . // PErforming provider
 490       "*ZZ" .
 491       "*" . $claim->providerTaxonomy() .
 492       "~\n";
 493   }
 494
 495   // REF*1C is required here for the Medicare provider number if NPI was
 496   // specified in NM109.  Not sure if other payers require anything here.
 497   if ($claim->providerNumber()) {
 498     ++$edicount;
 499     $out .= "REF" .
 500       "*" . $claim->providerNumberType() .
 501       "*" . $claim->providerNumber() .
 502       "~\n";
 503   }
 504
 505   // Loop 2310D is omitted in the case of home visits (POS=12).
 506   if ($claim->facilityPOS() != 12) {
 507     ++$edicount;
 508     $out .= "NM1" .       // Loop 2310D Service Location
 509       "*77" .
 510       "*2";
 511     if ($claim->facilityName() || $claim->facilityNPI() || $claim->facilityETIN()) { $out .=
 512       "*" . $claim->facilityName();
 513     }
 514     if ($claim->facilityNPI() || $claim->facilityETIN()) { $out .=
 515       "*" .
 516       "*" .
 517       "*" .
 518       "*";
 519       if ($claim->facilityNPI()) { $out .=
 520         "*XX*" . $claim->facilityNPI();
 521       } else { $out .=
 522         "*24*" . $claim->facilityETIN();
 523         $log .= "*** Service location has no NPI.\n";
 524       }
 525     }
 526     $out .= "~\n";
 527     if ($claim->facilityStreet()) {
 528       ++$edicount;
 529       $out .= "N3" .
 530         "*" . $claim->facilityStreet() .
 531         "~\n";
 532     }
 533     if ($claim->facilityState()) {
 534       ++$edicount;
 535       $out .= "N4" .
 536         "*" . $claim->facilityCity() .
 537         "*" . $claim->facilityState() .
 538         "*" . $claim->facilityZip() .
 539         "~\n";
 540     }
 541   }
 542
 543   // Loop 2310E, Supervising Provider
 544   //
 545   if ($claim->supervisorLastName()) {
 546     ++$edicount;
 547     $out .= "NM1" .
 548       "*DQ" . // Supervising Physician
 549       "*1" .  // Person
 550       "*" . $claim->supervisorLastName() .
 551       "*" . $claim->supervisorFirstName() .
 552       "*" . $claim->supervisorMiddleName() .
 553       "*" .   // NM106 not used
 554       "*";    // Name Suffix
 555     if ($claim->supervisorNPI()) { $out .=
 556       "*XX" .
 557       "*" . $claim->supervisorNPI();
 558     } else { $out .=
 559       "*34" .
 560       "*" . $claim->supervisorSSN();
 561     }
 562     $out .= "~\n";
 563
 564     if ($claim->supervisorNumber()) {
 565       ++$edicount;
 566       $out .= "REF" .
 567         "*" . $claim->supervisorNumberType() .
 568         "*" . $claim->supervisorNumber() .
 569         "~\n";
 570     }
 571   }
 572
 573   $prev_pt_resp = $clm_total_charges; // for computation below
 574
 575   // Loops 2320 and 2330*, other subscriber/payer information.
 576   //
 577   for ($ins = 1; $ins < $claim->payerCount(); ++$ins) {
 578
 579     $tmp1 = $claim->claimType($ins);
 580     $tmp2 = 'C1'; // Here a kludge. See page 321.
 581     if ($tmp1 === 'CI') $tmp2 = 'C1';
 582     if ($tmp1 === 'AM') $tmp2 = 'AP';
 583     if ($tmp1 === 'HM') $tmp2 = 'HM';
 584     if ($tmp1 === 'MB') $tmp2 = 'MB';
 585     if ($tmp1 === 'MC') $tmp2 = 'MC';
 586     if ($tmp1 === '09') $tmp2 = 'PP';
 587     ++$edicount;
 588     $out .= "SBR" . // Loop 2320, Subscriber Information - page 318
 589       "*" . $claim->payerSequence($ins) .
 590       "*" . $claim->insuredRelationship($ins) .
 591       "*" . $claim->groupNumber($ins) .
 592       "*" . $claim->groupName($ins) .
 593       "*" . $tmp2 .
 594       "*" .
 595       "*" .
 596       "*" .
 597       "*" . $claim->claimType($ins) .
 598       "~\n";
 599
 600     // Things that apply only to previous payers, not future payers.
 601     //
 602     if ($claim->payerSequence($ins) < $claim->payerSequence()) {
 603
 604       // Generate claim-level adjustments.
 605       $aarr = $claim->payerAdjustments($ins);
 606       foreach ($aarr as $a) {
 607         ++$edicount;
 608         $out .= "CAS" . // Previous payer's claim-level adjustments. Page 323.
 609           "*" . $a[1] .
 610           "*" . $a[2] .
 611           "*" . $a[3] .
 612           "~\n";
 613       }
 614
 615       $payerpaid = $claim->payerTotals($ins);
 616       ++$edicount;
 617       $out .= "AMT" . // Previous payer's paid amount. Page 332.
 618         "*D" .
 619         "*" . $payerpaid[1] .
 620         "~\n";
 621
 622       // Patient responsibility amount as of this previous payer.
 623       $prev_pt_resp -= $payerpaid[1]; // reduce by payments
 624       $prev_pt_resp -= $payerpaid[2]; // reduce by adjustments
 625
 626       ++$edicount;
 627       $out .= "AMT" . // Allowed amount per previous payer. Page 334.
 628         "*B6" .
 629         "*" . sprintf('%.2f', $payerpaid[1] + $prev_pt_resp) .
 630         "~\n";
 631
 632       ++$edicount;
 633       $out .= "AMT" . // Patient responsibility amount per previous payer. Page 335.
 634         "*F2" .
 635         "*" . sprintf('%.2f', $prev_pt_resp) .
 636         "~\n";
 637
 638     } // End of things that apply only to previous payers.
 639
 640     ++$edicount;
 641     $out .= "DMG" . // Other subscriber demographic information. Page 342.
 642       "*D8" .
 643       "*" . $claim->insuredDOB($ins) .
 644       "*" . $claim->insuredSex($ins) .
 645       "~\n";
 646
 647     ++$edicount;
 648     $out .= "OI" .  // Other Insurance Coverage Information. Page 344.
 649       "*" .
 650       "*" .
 651       "*Y" .
 652       "*B" .
 653       "*" .
 654       "*Y" .
 655       "~\n";
 656
 657     ++$edicount;
 658     $out .= "NM1" . // Loop 2330A Subscriber info for other insco. Page 350.
 659       "*IL" .
 660       "*1" .
 661       "*" . $claim->insuredLastName($ins) .
 662       "*" . $claim->insuredFirstName($ins) .
 663       "*" . $claim->insuredMiddleName($ins) .
 664       "*" .
 665       "*" .
 666       "*MI" .
 667       "*" . $claim->policyNumber($ins) .
 668       "~\n";
 669
 670     ++$edicount;
 671     $out .= "N3" .
 672       "*" . $claim->insuredStreet($ins) .
 673       "~\n";
 674
 675     ++$edicount;
 676     $out .= "N4" .
 677       "*" . $claim->insuredCity($ins) .
 678       "*" . $claim->insuredState($ins) .
 679       "*" . $claim->insuredZip($ins) .
 680       "~\n";
 681
 682     ++$edicount;
 683     $out .= "NM1" . // Loop 2330B Payer info for other insco. Page 359.
 684       "*PR" .
 685       "*2" .
 686       "*" . $claim->payerName($ins) .
 687       "*" .
 688       "*" .
 689       "*" .
 690       "*" .
 691       "*PI" .
 692       "*" . $claim->payerID($ins) .
 693       "~\n";
 694
 695     // if (!$claim->payerID($ins)) {
 696     //   $log .= "*** CMS ID is missing for payer '" . $claim->payerName($ins) . "'.\n";
 697     // }
 698
 699     // Payer address (N3 and N4) are added below so that Gateway EDI can
 700     // auto-generate secondary claims.  These do NOT appear in my copy of
 701     // the spec!  -- Rod 2008-06-12
 702
 703     if (trim($claim->x12gsreceiverid()) == '431420764') { // if Gateway EDI
 704       ++$edicount;
 705       $out .= "N3" .
 706         "*" . $claim->payerStreet($ins) .
 707         "~\n";
 708       //
 709       ++$edicount;
 710       $out .= "N4" .
 711         "*" . $claim->payerCity($ins) .
 712         "*" . $claim->payerState($ins) .
 713         "*" . $claim->payerZip($ins) .
 714         "~\n";
 715     } // end Gateway EDI
 716
 717   } // End loops 2320/2330*.
 718
 719   $loopcount = 0;
 720
 721   // Procedure loop starts here.
 722   //
 723   for ($prockey = 0; $prockey < $proccount; ++$prockey) {
 724     ++$loopcount;
 725
 726     ++$edicount;
 727     $out .= "LX" .      // Loop 2400 LX Service Line. Page 398.
 728       "*$loopcount" .
 729       "~\n";
 730
 731     ++$edicount;
 732     $out .= "SV1" .     // Professional Service. Page 400.
 733       "*HC:" . $claim->cptKey($prockey) .
 734       "*" . sprintf('%.2f', $claim->cptCharges($prockey)) .
 735       "*UN" .
 736       "*" . $claim->cptUnits($prockey) .
 737       "*" .
 738       "*" .
 739       "*";
 740     $dia = $claim->diagIndexArray($prockey);
 741     $i = 0;
 742     foreach ($dia as $dindex) {
 743       if ($i) $out .= ':';
 744       $out .= $dindex;
 745       if (++$i >= 4) break;
 746     }
 747     $out .= "~\n";
 748
 749     if (!$claim->cptCharges($prockey)) {
 750       $log .= "*** Procedure '" . $claim->cptKey($prockey) . "' has no charges!\n";
 751     }
 752
 753     if (empty($dia)) {
 754       $log .= "*** Procedure '" . $claim->cptKey($prockey) . "' is not justified!\n";
 755     }
 756
 757     ++$edicount;
 758     $out .= "DTP" .     // Date of Service. Page 435.
 759       "*472" .
 760       "*D8" .
 761       "*" . $claim->serviceDate() .
 762       "~\n";
 763
 764     // AMT*AAE segment for Approved Amount from previous payer.
 765     // Medicare secondaries seem to require this.
 766     //
 767     for ($ins = $claim->payerCount() - 1; $ins > 0; --$ins) {
 768       if ($claim->payerSequence($ins) > $claim->payerSequence())
 769         continue; // payer is future, not previous
 770       $payerpaid = $claim->payerTotals($ins, $claim->cptKey($prockey));
 771       ++$edicount;
 772       $out .= "AMT" . // Approved amount per previous payer. Page 485.
 773         "*AAE" .
 774         "*" . sprintf('%.2f', $claim->cptCharges($prockey) - $payerpaid[2]) .
 775         "~\n";
 776       break;
 777     }
 778
 779     // Loop 2410, Drug Information. Medicaid insurers seem to want this
 780     // with HCPCS codes.
 781     //
 782     $ndc = $claim->cptNDCID($prockey);
 783     if ($ndc) {
 784       ++$edicount;
 785       $out .= "LIN" . // Drug Identification. Page 500+ (Addendum pg 71).
 786         "*" .         // Per addendum, LIN01 is not used.
 787         "*N4" .
 788         "*" . $ndc .
 789         "~\n";
 790
 791       if (!preg_match('/^\d\d\d\d\d-\d\d\d\d-\d\d$/', $ndc, $tmp)) {
 792         $log .= "*** NDC code '$ndc' has invalid format!\n";
 793       }
 794
 795       ++$edicount;
 796       $tmpunits = $claim->cptNDCQuantity($prockey) * $claim->cptUnits($prockey);
 797       if (!$tmpunits) $tmpunits = 1;
 798       $out .= "CTP" . // Drug Pricing. Page 500+ (Addendum pg 74).
 799         "*" .
 800         "*" .
 801         "*" . sprintf('%.2f', $claim->cptCharges($prockey) / $tmpunits) .
 802         "*" . $claim->cptNDCQuantity($prockey) .
 803         "*" . $claim->cptNDCUOM($prockey) .
 804         "~\n";
 805     }
 806
 807     // Loop 2420A, Rendering Provider (service-specific).
 808     // Used if the rendering provider for this service line is different
 809     // from that in loop 2310B.
 810     //
 811     if ($claim->providerNPI() != $claim->providerNPI($prockey)) {
 812       ++$edicount;
 813       $out .= "NM1" .       // Loop 2310B Rendering Provider
 814         "*82" .
 815         "*1" .
 816         "*" . $claim->providerLastName($prockey) .
 817         "*" . $claim->providerFirstName($prockey) .
 818         "*" . $claim->providerMiddleName($prockey) .
 819         "*" .
 820         "*";
 821       if ($claim->providerNPI($prockey)) { $out .=
 822         "*XX" .
 823         "*" . $claim->providerNPI($prockey);
 824       } else { $out .=
 825         "*34" .
 826         "*" . $claim->providerSSN($prockey);
 827         $log .= "*** Rendering provider has no NPI.\n";
 828       }
 829       $out .= "~\n";
 830
 831       if ($claim->providerTaxonomy($prockey)) {
 832         ++$edicount;
 833         $out .= "PRV" .
 834           "*PE" . // PErforming provider
 835           "*ZZ" .
 836           "*" . $claim->providerTaxonomy($prockey) .
 837           "~\n";
 838       }
 839
 840       // REF*1C is required here for the Medicare provider number if NPI was
 841       // specified in NM109.  Not sure if other payers require anything here.
 842       if ($claim->providerNumber($prockey)) {
 843         ++$edicount;
 844         $out .= "REF" .
 845           "*" . $claim->providerNumberType($prockey) .
 846           "*" . $claim->providerNumber($prockey) .
 847           "~\n";
 848       }
 849     }
 850
 851     // Loop 2430, adjudication by previous payers.
 852     //
 853     for ($ins = 1; $ins < $claim->payerCount(); ++$ins) {
 854       if ($claim->payerSequence($ins) > $claim->payerSequence())
 855         continue; // payer is future, not previous
 856
 857       $payerpaid = $claim->payerTotals($ins, $claim->cptKey($prockey));
 858       $aarr = $claim->payerAdjustments($ins, $claim->cptKey($prockey));
 859
 860       if ($payerpaid[1] == 0 && !count($aarr)) {
 861         $log .= "*** Procedure '" . $claim->cptKey($prockey) .
 862           "' has no payments or adjustments from previous payer!\n";
 863         continue;
 864       }
 865
 866       ++$edicount;
 867       $out .= "SVD" . // Service line adjudication. Page 554.
 868         "*" . $claim->payerID($ins) .
 869         "*" . $payerpaid[1] .
 870         "*HC:" . $claim->cptKey($prockey) .
 871         "*" .
 872         "*" . $claim->cptUnits($prockey) .
 873         "~\n";
 874
 875       $tmpdate = $payerpaid[0];
 876       foreach ($aarr as $a) {
 877         ++$edicount;
 878         $out .= "CAS" . // Previous payer's line level adjustments. Page 558.
 879           "*" . $a[1] .
 880           "*" . $a[2] .
 881           "*" . $a[3] .
 882           "~\n";
 883         if (!$tmpdate) $tmpdate = $a[0];
 884       }
 885
 886       if ($tmpdate) {
 887         ++$edicount;
 888         $out .= "DTP" . // Previous payer's line adjustment date. Page 566.
 889           "*573" .
 890           "*D8" .
 891           "*$tmpdate" .
 892           "~\n";
 893       }
 894     } // end loop 2430
 895   } // end this procedure
 896
 897   ++$edicount;
 898   $out .= "SE" .        // SE Trailer
 899     "*$edicount" .
 900     "*0021" .
 901     "~\n";
 902
 903   $out .= "GE" .        // GE Trailer
 904     "*1" .
 905     "*1" .
 906     "~\n";
 907
 908   $out .= "IEA" .       // IEA Trailer
 909     "*1" .
 910     "*000000001" .
 911     "~\n";
 912
 913   $log .= "\n";
 914   return $out;
 915 }
 916 ?>