interface/billing/sl_eob_invoice.php

   1 <?php
   2   // Copyright (C) 2005-2006 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   include_once("../globals.php");
  14   include_once("../../library/patient.inc");
  15   include_once("../../library/forms.inc");
  16   include_once("../../library/sl_eob.inc.php");
  17   include_once("../../library/invoice_summary.inc.php");
  18   include_once("../../custom/code_types.inc.php");
  19
  20   $debug = 0; // set to 1 for debugging mode
  21
  22   $reasons = array(
  23     "", // not choosing this allows a reason with no adjustment amount
  24     xl("Ins adjust"),
  25     xl("Coll w/o"),
  26     xl("Pt released"),
  27     xl("Sm debt w/o"),
  28     xl("To ded'ble"),
  29     xl("To copay"),
  30     xl("Bad check"),
  31     xl("Bad debt"),
  32     xl("Discount"),
  33     xl("Hardship w/o"),
  34     xl("Ins refund"),
  35     xl("Pt refund"),
  36     xl("Ins overpaid"),
  37     xl("Pt overpaid"),
  38     xl("Adm adjust")
  39   );
  40
  41   $info_msg = "";
  42
  43   // Format money for display.
  44   //
  45   function bucks($amount) {
  46     if ($amount)
  47       printf("%.2f", $amount);
  48   }
  49 ?>
  50 <html>
  51 <head>
  52 <link rel=stylesheet href="<?php echo $css_header;?>" type="text/css">
  53 <title><?php xl('EOB Posting - Invoice','e')?></title>
  54 <script language="JavaScript">
  55
  56 // An insurance radio button is selected.
  57 function setins(istr) {
  58  var f = document.forms[0];
  59  for (var i = 0; i < f.elements.length; ++i) {
  60   var ename = f.elements[i].name;
  61   if (ename.indexOf('[src]') < 0) continue;
  62   var evalue = f.elements[i].value;
  63   var tmp = evalue.substring(0, 4).toLowerCase();
  64   if (tmp >= 'ins1' && tmp <= 'ins3')
  65    evalue = evalue.substring(4);
  66   else if (evalue.substring(0, 2).toLowerCase() == 'pt')
  67    evalue = evalue.substring(2);
  68   while (evalue.substring(0, 1) == '/')
  69    evalue = evalue.substring(1);
  70   f.elements[i].value = istr + '/' + evalue;
  71  }
  72  return true;
  73 }
  74
  75 // Compute an adjustment that writes off the balance:
  76 function writeoff(code) {
  77  var f = document.forms[0];
  78  var belement = f['form_line[' + code + '][bal]'];
  79  var pelement = f['form_line[' + code + '][pay]'];
  80  var aelement = f['form_line[' + code + '][adj]'];
  81  var relement = f['form_line[' + code + '][reason]'];
  82  var tmp = belement.value - pelement.value;
  83  aelement.value = Number(tmp).toFixed(2);
  84  if (aelement.value && ! relement.value) relement.selectedIndex = 1;
  85  return false;
  86 }
  87
  88 // Onsubmit handler.  A good excuse to write some JavaScript.
  89 function validate(f) {
  90  for (var i = 0; i < f.elements.length; ++i) {
  91   var ename = f.elements[i].name;
  92   var pfxlen = ename.indexOf('[pay]');
  93   if (pfxlen < 0) continue;
  94   var pfx = ename.substring(0, pfxlen);
  95   var code = pfx.substring(pfx.indexOf('[')+1, pfxlen-1);
  96   if (f[pfx+'[pay]'].value || f[pfx+'[adj]'].value) {
  97    var srcobj = f[pfx+'[src]'];
  98    while (srcobj.value.length) {
  99     var tmp = srcobj.value.substring(srcobj.value.length - 1);
 100     if (tmp > ' ' && tmp != '/') break;
 101     srcobj.value = srcobj.value.substring(0, srcobj.value.length - 1);
 102    }
 103    var svalue = srcobj.value;
 104    if (! svalue) {
 105     alert('<?php xl('Source is missing for code ','e') ?>' + code);
 106     return false;
 107    } else {
 108     var tmp = svalue.substring(0, 4).toLowerCase();
 109     if (tmp >= 'ins1' && tmp <= 'ins3') {
 110      svalue = svalue.substring(4);
 111     } else if (svalue.substring(0, 2).toLowerCase() == 'pt') {
 112      svalue = svalue.substring(2);
 113     } else {
 114      alert('<?php xl('Invalid or missing payer in source for code ','e')?>' + code);
 115      return false;
 116     }
 117     if (svalue) {
 118      if (svalue.substring(0, 1) != '/') {
 119       alert('<?php xl('Missing slash after payer in source for code ','e')?>' + code);
 120       return false;
 121      }
 122      if (false) { // Please keep this, Oakland Clinic wants it.  -- Rod
 123       tmp = svalue.substring(1, 3).toLowerCase();
 124       if (tmp != 'nm' && tmp != 'ci' && tmp != 'cp' && tmp != 'ne' &&
 125           tmp != 'it' && tmp != 'pf' && tmp != 'pp' && tmp != 'ok')
 126       {
 127        alert('<?php xl('Invalid source designation "','e') ?>' + tmp + '<?php xl('" for code ','e') ?>' + code);
 128        return false;
 129       }
 130      } // End of OC code
 131     }
 132    }
 133    if (! f[pfx+'[date]'].value) {
 134     alert('<?php xl('Date is missing for code ','e')?>' + code);
 135     return false;
 136    }
 137   }
 138   if (f[pfx+'[pay]'].value && isNaN(parseFloat(f[pfx+'[pay]'].value))) {
 139    alert('<?php xl('Payment value for code ','e') ?>' + code + '<?php xl(' is not a number','e') ?>');
 140    return false;
 141   }
 142   if (f[pfx+'[adj]'].value && isNaN(parseFloat(f[pfx+'[adj]'].value))) {
 143    alert('<?php xl('Adjustment value for code ','e') ?>' + code + '<?php xl(' is not a number','e') ?>');
 144    return false;
 145   }
 146   if (f[pfx+'[adj]'].value && ! f[pfx+'[reason]'].value) {
 147    alert('<?php xl('Please select an adjustment reason for code ','e') ?>' + code);
 148    return false;
 149   }
 150   // TBD: validate the date format
 151  }
 152  return true;
 153 }
 154
 155 </script>
 156 </head>
 157 <body leftmargin='0' topmargin='0' marginwidth='0' marginheight='0'>
 158 <?php
 159   $trans_id = $_GET['id'];
 160   if (! $trans_id) die(xl("You cannot access this page directly."));
 161
 162   slInitialize();
 163
 164   if ($_POST['form_save'] || $_POST['form_cancel']) {
 165     if ($_POST['form_save']) {
 166       if ($debug) {
 167         echo xl("This module is in test mode. The database will not be changed.",'','<p><b>',"</b><p>\n");
 168       }
 169       $paytotal = 0;
 170       foreach ($_POST['form_line'] as $code => $cdata) {
 171         $thissrc  = trim($cdata['src']);
 172         $thisdate = trim($cdata['date']);
 173         $thispay  = trim($cdata['pay']);
 174         $thisadj  = trim($cdata['adj']);
 175         $thisins  = trim($cdata['ins']);
 176         $reason   = trim($cdata['reason']);
 177         if (strpos(strtolower($reason), 'ins') !== false)
 178           $reason .= ' ' . $_POST['form_insurance'];
 179         if (! $thisins) $thisins = 0;
 180
 181         if ($thispay) {
 182           slPostPayment($trans_id, $thispay, $thisdate, $thissrc, $code, $thisins, $debug);
 183           $paytotal += $thispay;
 184         }
 185
 186         // Be sure to record adjustment reasons even for zero adjustments.
 187         if ($thisadj || $reason) {
 188           // "To copay" and "To ded'ble" need to become a comment in a zero
 189           // adjustment, formatted just like sl_eob_process.php.
 190           if (preg_match("/To copay/", $reason)) {
 191             $reason = $_POST['form_insurance'] . " coins: $thisadj";
 192             $thisadj = 0;
 193           }
 194           else if (preg_match("/To ded'ble/", $reason)) {
 195             $reason = $_POST['form_insurance'] . " dedbl: $thisadj";
 196             $thisadj = 0;
 197           }
 198           slPostAdjustment($trans_id, $thisadj, $thisdate, $thissrc, $code, $thisins, $reason, $debug);
 199         }
 200       }
 201
 202       $form_duedate = fixDate($_POST['form_duedate']);
 203       $form_notes = trim($_POST['form_notes']);
 204
 205       // Maintain the list of insurances that we mark as finished.
 206       // We use the "Ship Via" field of the invoice to hold these.
 207       //
 208       $form_eobs = "";
 209       foreach (array('Ins1', 'Ins2', 'Ins3') as $value) {
 210         if ($_POST["form_done_$value"]) {
 211           if ($form_eobs) $form_eobs .= ","; else $form_eobs = "Done: ";
 212           $form_eobs .= $value;
 213         }
 214       }
 215
 216       $query = "UPDATE ar SET duedate = '$form_duedate', notes = '$form_notes', " .
 217         "shipvia = '$form_eobs' WHERE id = $trans_id";
 218
 219       if ($debug) {
 220         echo $query . "<br>\n";
 221       } else {
 222         SLQuery($query);
 223         if ($sl_err) die($sl_err);
 224       }
 225       if ($_POST['form_secondary']) {
 226         slSetupSecondary($trans_id, $debug);
 227       }
 228       echo "<script language='JavaScript'>\n";
 229       echo " if (opener.document.forms[0].form_amount) {\n";
 230       echo "  var tmp = opener.document.forms[0].form_amount.value - $paytotal;\n";
 231       echo "  opener.document.forms[0].form_amount.value = Number(tmp).toFixed(2);\n";
 232       echo " }\n";
 233     } else {
 234       echo "<script language='JavaScript'>\n";
 235     }
 236     if ($info_msg) echo " alert('$info_msg');\n";
 237     if (! $debug) echo " window.close();\n";
 238     echo "</script></body></html>\n";
 239     SLClose();
 240     exit();
 241   }
 242
 243   // Get invoice data into $arrow.
 244   $arres = SLQuery("select ar.*, customer.name, employee.name as doctor " .
 245     "from ar, customer, employee where ar.id = $trans_id and " .
 246     "customer.id = ar.customer_id and employee.id = ar.employee_id");
 247   if ($sl_err) die($sl_err);
 248   $arrow = SLGetRow($arres, 0);
 249   if (! $arrow) die(xl("There is no match for invoice id = ") . $trans_id);
 250
 251   // Determine the date of service.  An 8-digit encounter number is
 252   // presumed to be a date of service imported during conversion.
 253   // Otherwise look it up in the form_encounter table.
 254   //
 255   $svcdate = "";
 256   list($trash, $encounter) = explode(".", $arrow['invnumber']);
 257   if (strlen($encounter) == 8) {
 258     $svcdate = substr($encounter, 0, 4) . "-" . substr($encounter, 4, 2) .
 259       "-" . substr($encounter, 6, 2);
 260   }
 261   else if ($encounter) {
 262     $tmp = sqlQuery("SELECT date FROM form_encounter WHERE " .
 263       "encounter = $encounter");
 264     $svcdate = substr($tmp['date'], 0, 10);
 265   }
 266
 267   // Get invoice charge details.
 268   $codes = get_invoice_summary($trans_id, true);
 269 ?>
 270 <center>
 271
 272 <form method='post' action='sl_eob_invoice.php?id=<?php echo $trans_id ?>'
 273  onsubmit='return validate(this)'>
 274
 275 <table border='0' cellpadding='3'>
 276  <tr>
 277   <td>
 278    <?php xl('Patient:','e')?>
 279   </td>
 280   <td>
 281    <?php echo $arrow['name'] ?>
 282   </td>
 283   <td colspan="2" rowspan="3">
 284    <textarea name="form_notes" cols="50" style="height:100%"><?php echo $arrow['notes'] ?></textarea>
 285   </td>
 286  </tr>
 287  <tr>
 288   <td>
 289    <?php xl('Provider:','e')?>
 290   </td>
 291   <td>
 292    <?php echo $arrow['doctor'] ?>
 293   </td>
 294  </tr>
 295  <tr>
 296   <td>
 297    <?php xl('Invoice:','e')?>
 298   </td>
 299   <td>
 300    <?php echo $arrow['invnumber'] ?>
 301   </td>
 302  </tr>
 303
 304  <tr>
 305   <td>
 306    <?php xl('Svc Date:','e')?>
 307   </td>
 308   <td>
 309    <?php echo $svcdate ?>
 310   </td>
 311   <td colspan="2">
 312    <!-- <?php echo $arrow['shipvia'] ?> -->
 313    <?php xl('Done with:','e','',"&nbsp")?>;
 314 <?php
 315  // Write a checkbox for each insurance.  It is to be checked when
 316  // we no longer expect any payments from that company for the claim.
 317  // The information is stored in the 'shipvia' field of the invoice.
 318  //
 319  $insgot  = strtolower($arrow['notes']);
 320  $insdone = strtolower($arrow['shipvia']);
 321  foreach (array('Ins1', 'Ins2', 'Ins3') as $value) {
 322   $lcvalue = strtolower($value);
 323   $checked  = (strpos($insdone, $lcvalue) === false) ? "" : " checked";
 324   if (strpos($insgot, $lcvalue) !== false) {
 325    echo "   <input type='checkbox' name='form_done_$value' value='1'$checked />$value&nbsp;\n";
 326   }
 327  }
 328 ?>
 329   </td>
 330  </tr>
 331
 332  <tr>
 333   <td>
 334    <?php xl('Bill Date:','e') ?>
 335   </td>
 336   <td>
 337    <?php echo $arrow['transdate'] ?>
 338   </td>
 339   <td colspan="2">
 340    <?php xl('Now posting for:','e','',"&nbsp")?>;
 341    <input type='radio' name='form_insurance' value='Ins1' onclick='setins("Ins1")' checked /><?php xl('Ins1','e')?>&nbsp;
 342    <input type='radio' name='form_insurance' value='Ins2' onclick='setins("Ins2")' /><?php xl('Ins2','e')?>&nbsp;
 343    <input type='radio' name='form_insurance' value='Ins3' onclick='setins("Ins3")' /><?php xl('Ins3','e')?>&nbsp;
 344    <input type='radio' name='form_insurance' value='Pt'   onclick='setins("Pt")'   /><?php xl('Patient','e')?>
 345    <input type='hidden' name='form_eobs' value='<?php echo addslashes($arrow['shipvia']) ?>' />
 346   </td>
 347  </tr>
 348  <tr>
 349   <td>
 350    <?php xl('Due Date:','e')?>
 351   </td>
 352   <td>
 353    <input type='text' name='form_duedate' size='10' value='<?php echo $arrow['duedate'] ?>'
 354     title='<?php xl('Due date mm/dd/yyyy or yyyy-mm-dd','e')?>'>
 355   </td>
 356   <td colspan="2">
 357    <input type="checkbox" name="form_secondary" value="1"> <?php xl('Needs secondary billing','e')?>
 358    &nbsp;&nbsp;
 359    <input type='submit' name='form_save' value='<?php xl('Save','e')?>'>
 360    &nbsp;
 361    <input type='button' value='<?php xl('Cancel','e')?>' onclick='window.close()'>
 362   </td>
 363  </tr>
 364  <tr>
 365   <td height="1">
 366   </td>
 367  </tr>
 368 </table>
 369
 370 <table border='0' cellpadding='2' cellspacing='0' width='98%'>
 371
 372  <tr bgcolor="#cccccc">
 373   <td class="dehead">
 374    <?php xl('Code','e')?>
 375   </td>
 376   <td class="dehead" align="right">
 377    <?php xl('Charge','e')?>
 378   </td>
 379   <td class="dehead" align="right">
 380    <?php xl('Balance','e')?>&nbsp;
 381   </td>
 382   <td class="dehead">
 383    <?php xl('Source','e')?>
 384   </td>
 385   <td class="dehead">
 386    <?php xl('Date','e')?>
 387   </td>
 388   <td class="dehead">
 389    <?php xl('Pay','e')?>
 390   </td>
 391   <td class="dehead">
 392    <?php xl('Adjust','e')?>
 393   </td>
 394   <td class="dehead">
 395    <?php xl('Reason','e')?>
 396   </td>
 397  </tr>
 398 <?php
 399   $encount = 0;
 400   foreach ($codes as $code => $cdata) {
 401    ++$encount;
 402    $bgcolor = "#" . (($encount & 1) ? "ddddff" : "ffdddd");
 403    $dispcode = $code;
 404    // this sorts the details more or less chronologically:
 405    ksort($cdata['dtl']);
 406    foreach ($cdata['dtl'] as $dkey => $ddata) {
 407     $ddate = substr($dkey, 0, 10);
 408     if (preg_match('/^(\d\d\d\d)(\d\d)(\d\d)\s*$/', $ddate, $matches)) {
 409      $ddate = $matches[1] . '-' . $matches[2] . '-' . $matches[3];
 410     }
 411     $tmpchg = "";
 412     $tmpadj = "";
 413     if ($ddata['chg'] > 0)
 414      $tmpchg = $ddata['chg'];
 415     else if ($ddata['chg'] < 0)
 416      $tmpadj = 0 - $ddata['chg'];
 417 ?>
 418  <tr bgcolor='<?php echo $bgcolor ?>'>
 419   <td class="detail">
 420    <?php echo $dispcode; $dispcode = "" ?>
 421   </td>
 422   <td class="detail" align="right">
 423    <?php bucks($tmpchg) ?>
 424   </td>
 425   <td class="detail" align="right">
 426    &nbsp;
 427   </td>
 428   <td class="detail">
 429    <?php echo $ddata['src'] ?>
 430   </td>
 431   <td class="detail">
 432    <?php echo $ddate ?>
 433   </td>
 434   <td class="detail">
 435    <?php bucks($ddata['pmt']) ?>
 436   </td>
 437   <td class="detail">
 438    <?php bucks($tmpadj) ?>
 439   </td>
 440   <td class="detail">
 441    <?php echo $ddata['rsn'] ?>
 442   </td>
 443  </tr>
 444 <?php
 445    } // end of prior detail line
 446 ?>
 447  <tr bgcolor='<?php echo $bgcolor ?>'>
 448   <td class="detail">
 449    <?php echo $dispcode; $dispcode = "" ?>
 450   </td>
 451   <td class="detail" align="right">
 452    &nbsp;
 453   </td>
 454   <td class="detail" align="right">
 455    <input type="hidden" name="form_line[<?php echo $code ?>][bal]" value="<?php bucks($cdata['bal']) ?>">
 456    <input type="hidden" name="form_line[<?php echo $code ?>][ins]" value="<?php echo $cdata['ins'] ?>">
 457    <?php printf("%.2f", $cdata['bal']) ?>&nbsp;
 458   </td>
 459   <td class="detail">
 460    <input type="text" name="form_line[<?php echo $code ?>][src]" size="10"
 461     style="background-color:<?php echo $bgcolor ?>"
 462 <?php if (false) { ?>
 463     title="NM=notmet, CI=coins, CP=copay, NE=notelig, IT=insterm, PF=ptfull, PP=ptpart"
 464 <?php } ?>
 465    />
 466   </td>
 467   <td class="detail">
 468    <input type="text" name="form_line[<?php echo $code ?>][date]" size="10"
 469     style="background-color:<?php echo $bgcolor ?>" />
 470   </td>
 471   <td class="detail">
 472    <input type="text" name="form_line[<?php echo $code ?>][pay]" size="10"
 473     style="background-color:<?php echo $bgcolor ?>" />
 474   </td>
 475   <td class="detail">
 476    <input type="text" name="form_line[<?php echo $code ?>][adj]" size="10"
 477     style="background-color:<?php echo $bgcolor ?>" />
 478    &nbsp; <a href="" onclick="return writeoff('<?php echo $code ?>')">W</a>
 479   </td>
 480   <td class="detail">
 481    <select name="form_line[<?php echo $code ?>][reason]"
 482     style="background-color:<?php echo $bgcolor ?>">
 483 <?php
 484  foreach ($reasons as $value) {
 485   echo "    <option value=\"$value\">$value</option>\n";
 486  }
 487 ?>
 488    </select>
 489   </td>
 490  </tr>
 491 <?php
 492   } // end of code
 493   SLClose();
 494 ?>
 495
 496 </table>
 497 </form>
 498 </center>
 499 <script language="JavaScript">
 500  var f1 = opener.document.forms[0];
 501  var f2 = document.forms[0];
 502  if (f1.form_source) {
 503 <?php
 504   foreach ($codes as $code => $cdata) {
 505     echo "  f2['form_line[$code][src]'].value  = f1.form_source.value;\n";
 506     echo "  f2['form_line[$code][date]'].value = f1.form_paydate.value;\n";
 507   }
 508 ?>
 509  }
 510  setins("Ins1");
 511 </script>
 512 </body>
 513 </html>