library/gen_x12_837.inc.php

   1 <?php
   2 /*
   3  * This program creates a 5010 837P file
   4  *
   5  * @package OpenEMR
   6  * @author Rod Roark <rod@sunsetsystems.com>
   7  * @author Stephen Waite <stephen.waite@cmsvt.com>
   8  * @copyright Copyright (c) 2009 Rod Roark <rod@sunsetsystems.com>
   9  * @copyright Copyright (c) 2018 Stephen Waite <stephen.waite@cmsvt.com>
  10  * @link https://github.com/openemr/openemr/tree/master
  11  * @license https://github.com/openemr/openemr/blob/master/LICENSE GNU General Public License 3
  12  */
  13
  14 require_once(dirname(__FILE__) . "/invoice_summary.inc.php");
  15
  16 use OpenEMR\Billing\Claim;
  17
  18 function stripZipCode($zip)
  19 {
  20     return preg_replace('/[-\s]*/', '', $zip);
  21 }
  22
  23 function gen_x12_837($pid, $encounter, &$log, $encounter_claim = false)
  24 {
  25     $today = time();
  26     $out = '';
  27     $claim = new Claim($pid, $encounter);
  28     $edicount = 0;
  29     $HLcount = 0;
  30
  31     $log .= "Generating claim $pid" . "-" . $encounter . " for " .
  32     $claim->patientFirstName() . ' ' .
  33     $claim->patientMiddleName() . ' ' .
  34     $claim->patientLastName() . ' on ' .
  35     date('Y-m-d H:i', $today) . ".\n";
  36
  37     $out .= "ISA" .
  38     "*" . $claim->x12gsisa01() .
  39     "*" . $claim->x12gsisa02() .
  40     "*" . $claim->x12gsisa03() .
  41     "*" . $claim->x12gsisa04() .
  42     "*" . $claim->x12gsisa05() .
  43     "*" . $claim->x12gssenderid() .
  44     "*" . $claim->x12gsisa07() .
  45     "*" . $claim->x12gsreceiverid() .
  46     "*" . "030911" .  // dummy data replace by billing_process.php
  47     "*" . "1630" . // ditto
  48     "*" . "^" .
  49     "*" . "00501" .
  50     "*" . "000000001" .
  51     "*" . $claim->x12gsisa14() .
  52     "*" . $claim->x12gsisa15() .
  53     "*:" .
  54     "~\n";
  55
  56     $out .= "GS" .
  57     "*" . "HC" .
  58     "*" . $claim->x12gsgs02() .
  59     "*" . trim($claim->x12gs03()) .
  60     "*" . date('Ymd', $today) .
  61     "*" . date('Hi', $today) .
  62     "*" . "1" .
  63     "*" . "X" .
  64     "*" . $claim->x12gsversionstring() .
  65     "~\n";
  66
  67     ++$edicount;
  68     $out .= "ST" .
  69     "*" . "837" .
  70     "*" . "0021" .
  71     "*" . $claim->x12gsversionstring() .
  72     "~\n";
  73
  74     ++$edicount;
  75     $out .= "BHT" .
  76     "*" . "0019" .                             // 0019 is required here
  77     "*" . "00" .                               // 00 = original transmission
  78     "*" . "0123" .                             // reference identification
  79     "*" . date('Ymd', $today) .           // transaction creation date
  80     "*" . date('Hi', $today) .            // transaction creation time
  81     "*" . ($encounter_claim ? "RP" : "CH") .  // RP = reporting, CH = chargeable
  82     "~\n";
  83
  84     ++$edicount;
  85     if ($claim->federalIdType() == "SY") { // check entity type for NM*102 1 == person, 2 == non-person entity
  86         $firstName = $claim->providerFirstName();
  87         $lastName = $claim->providerLastName();
  88         $middleName = $claim->providerMiddleName();
  89         $suffixName = $claim->providerSuffixName();
  90         $out .= "NM1" . // Loop 1000A Submitter
  91         "*" . "41" .
  92         "*" . "1" .
  93         "*" . $lastName .
  94         "*" . $firstName .
  95         "*" . $middleName .
  96         "*" . // Name Prefix not used
  97         "*" . $suffixName .
  98         "*" . "46";
  99     } else {
 100         $billingFacilityName = substr($claim->billingFacilityName(), 0, 60);
 101         if ($billingFacilityName == '') {
 102             $log .= "*** billing facility name in 1000A loop is empty\n";
 103         }
 104         $out .= "NM1" .
 105         "*" . "41" .
 106         "*" . "2" .
 107         "*" . $billingFacilityName .
 108         "*" .
 109         "*" .
 110         "*" .
 111         "*" .
 112         "*" . "46";
 113     }
 114     $out .= "*" . $claim->billingFacilityETIN();
 115     $out .= "~\n";
 116
 117     ++$edicount;
 118     $out .= "PER" . // Loop 1000A, Submitter EDI contact information
 119     "*" . "IC" .
 120     "*" . $claim->billingContactName() .
 121     "*" . "TE" .
 122     "*" . $claim->billingContactPhone() .
 123     "*" . "EM" .
 124     "*" . $claim->billingContactEmail();
 125     $out .= "~\n";
 126
 127     ++$edicount;
 128     $out .= "NM1" . // Loop 1000B Receiver
 129     "*" . "40" .
 130     "*" . "2" .
 131     "*" . $claim->clearingHouseName() .
 132     "*" .
 133     "*" .
 134     "*" .
 135     "*" .
 136     "*" . "46" .
 137     "*" . $claim->clearingHouseETIN() .
 138     "~\n";
 139
 140     ++$HLcount;
 141     ++$edicount;
 142     $out .= "HL" . // Loop 2000A Billing/Pay-To Provider HL Loop
 143     "*" . $HLcount .
 144     "*" .
 145     "*" . "20" .
 146     "*" . "1" . // 1 indicates there are child segments
 147     "~\n";
 148
 149     $HLBillingPayToProvider = $HLcount++;
 150
 151     // Situational PRV segment for provider taxonomy.
 152     if ($claim->facilityTaxonomy()) {
 153         ++$edicount;
 154         $out .= "PRV" .
 155         "*" . "BI" .
 156         "*" . "PXC" .
 157         "*" . $claim->facilityTaxonomy() .
 158         "~\n";
 159     }
 160
 161     // Situational CUR segment (foreign currency information) omitted here.
 162     ++$edicount;
 163     if ($claim->federalIdType() == "SY") { // check for entity type like in 1000A
 164         $firstName = $claim->providerFirstName();
 165         $lastName = $claim->providerLastName();
 166         $middleName = $claim->providerMiddleName();
 167         $out .= "NM1" .
 168         "*" . "85" .
 169         "*" . "1" .
 170         "*" . $lastName .
 171         "*" . $firstName .
 172         "*" . $middleName .
 173         "*" . // Name Prefix not used
 174         "*";
 175     } else {
 176         $billingFacilityName = substr($claim->billingFacilityName(), 0, 60);
 177         if ($billingFacilityName == '') {
 178             $log .= "*** billing facility name in 2010A loop is empty\n";
 179         }
 180         $out .= "NM1" . // Loop 2010AA Billing Provider
 181         "*" . "85" .
 182         "*" . "2" .
 183         "*" . $billingFacilityName .
 184         "*" .
 185         "*" .
 186         "*" .
 187         "*";
 188     }
 189     if ($claim->billingFacilityNPI()) {
 190         $out .= "*XX*" . $claim->billingFacilityNPI();
 191     } else {
 192         $log .= "*** Billing facility has no NPI.\n";
 193     }
 194     $out .= "~\n";
 195
 196     ++$edicount;
 197     $out .= "N3" .
 198     "*" . $claim->billingFacilityStreet() .
 199     "~\n";
 200
 201     ++$edicount;
 202     $out .= "N4" .
 203     "*" . $claim->billingFacilityCity() .
 204     "*" . $claim->billingFacilityState() .
 205     "*" . stripZipCode($claim->billingFacilityZip()) .
 206     "~\n";
 207
 208     if ($claim->billingFacilityNPI() && $claim->billingFacilityETIN()) {
 209         ++$edicount;
 210         $out .= "REF";
 211         if ($claim->federalIdType()) {
 212             $out .= "*" . $claim->federalIdType();
 213         } else {
 214             $out .= "*EI"; // For dealing with the situation before adding TaxId type In facility.
 215         }
 216         $out .= "*" . $claim->billingFacilityETIN() . "~\n";
 217     } else {
 218         $log .= "*** No billing facility NPI and/or ETIN.\n";
 219     }
 220     if ($claim->providerNumberType() && $claim->providerNumber() && !$claim->billingFacilityNPI()) {
 221         ++$edicount;
 222         $out .= "REF" .
 223             "*" . $claim->providerNumberType() .
 224             "*" . $claim->providerNumber() .
 225             "~\n";
 226     } else if ($claim->providerNumber() && !$claim->providerNumberType()) {
 227         $log .= "*** Payer-specific provider insurance number is present but has no type assigned.\n";
 228     }
 229
 230     // Situational PER*1C segment omitted.
 231
 232     // Pay-To Address defaults to billing provider and is no longer required in 5010 but may be useful
 233     if ($claim->facilityStreet() != $claim->billingFacilityStreet()) {
 234         ++$edicount;
 235         $billingFacilityName = substr($claim->billingFacilityName(), 0, 60);
 236         $out .= "NM1" .       // Loop 2010AB Pay-To Provider
 237             "*" . "87" .
 238             "*" . "2" .
 239             "*" . $billingFacilityName .
 240             "*" .
 241             "*" .
 242             "*" .
 243             "*";
 244         if ($claim->billingFacilityNPI()) {
 245             $out .= "*XX*" . $claim->billingFacilityNPI();
 246         }
 247         $out .= "~\n";
 248
 249         ++$edicount;
 250         $out .= "N3" .
 251             "*" . $claim->billingFacilityStreet() .
 252             "~\n";
 253
 254         ++$edicount;
 255         $out .= "N4" .
 256             "*" . $claim->billingFacilityCity() .
 257             "*" . $claim->billingFacilityState() .
 258             "*" . stripZipCode($claim->billingFacilityZip()) .
 259             "~\n";
 260
 261         if ($claim->billingFacilityNPI() && $claim->billingFacilityETIN()) {
 262             ++$edicount;
 263             $out .= "REF" .
 264                 "*" . "EI" .
 265                 "*" . $claim->billingFacilityETIN() .
 266                 "~\n";
 267         }
 268     }
 269
 270     // Loop 2010AC Pay-To Plan Name omitted.  Includes:
 271     // NM1*PE, N3, N4, REF*2U, REF*EI
 272
 273     $PatientHL = $claim->isSelfOfInsured() ? 0 : 1;
 274     $HLSubscriber = $HLcount++;
 275
 276     ++$edicount;
 277     $out .= "HL" .        // Loop 2000B Subscriber HL Loop
 278         "*" . $HLSubscriber .
 279         "*" . $HLBillingPayToProvider .
 280         "*" . "22" .
 281         "*" . $PatientHL .
 282         "~\n";
 283
 284     if (!$claim->payerSequence()) {
 285         $log .= "*** Error: Insurance information is missing!\n";
 286     }
 287
 288     ++$edicount;
 289     $out .= "SBR" .    // Subscriber Information
 290         "*" . $claim->payerSequence() .
 291         "*" . ($claim->isSelfOfInsured() ? '18' : '') .
 292         "*" . $claim->groupNumber() .
 293         "*" . $claim->groupName() .
 294         "*" . $claim->insuredTypeCode() . // applies for secondary medicare
 295         "*" .
 296         "*" .
 297         "*" .
 298         "*" . $claim->claimType() .
 299         "~\n";
 300
 301     // Segment PAT omitted.
 302
 303     ++$edicount;
 304     $out .= "NM1" .       // Loop 2010BA Subscriber
 305         "*" . "IL" .
 306         "*" . "1" . // 1 = person, 2 = non-person
 307         "*" . $claim->insuredLastName() .
 308         "*" . $claim->insuredFirstName() .
 309         "*" . $claim->insuredMiddleName() .
 310         "*" .
 311         "*" . // Name Suffix not used
 312         "*" . "MI" .
 313         // "MI" = Member Identification Number
 314         // "II" = Standard Unique Health Identifier, "Required if the
 315         //        HIPAA Individual Patient Identifier is mandated use."
 316         //        Here we presume that is not true yet.
 317         "*" . $claim->policyNumber() .
 318         "~\n";
 319
 320     // For 5010, further subscriber info is sent only if they are the patient.
 321     if ($claim->isSelfOfInsured()) {
 322         ++$edicount;
 323         $out .= "N3" .
 324             "*" . $claim->insuredStreet() .
 325             "~\n";
 326
 327         ++$edicount;
 328         $out .= "N4" .
 329             "*" . $claim->insuredCity() .
 330             "*" . $claim->insuredState() .
 331             "*" . stripZipCode($claim->insuredZip()) .
 332             "~\n";
 333
 334         ++$edicount;
 335         $out .= "DMG" .
 336             "*" . "D8" .
 337             "*" . $claim->insuredDOB() .
 338             "*" . $claim->insuredSex() .
 339             "~\n";
 340     }
 341
 342     // Segment REF*SY (Subscriber Secondary Identification) omitted.
 343     // Segment REF*Y4 (Property and Casualty Claim Number) omitted.
 344     // Segment PER*IC (Property and Casualty Subscriber Contact Information) omitted.
 345
 346     ++$edicount;
 347     $payerName = substr($claim->payerName(), 0, 60);
 348     $out .= "NM1" .       // Loop 2010BB Payer
 349         "*" . "PR" .
 350         "*" . "2" .
 351         "*" . $payerName .
 352         "*" .
 353         "*" .
 354         "*" .
 355         "*" .
 356         "*" . "PI" .
 357         "*" . ($encounter_claim ? $claim->payerAltID() : $claim->payerID()) .
 358         "~\n";
 359     if (!$claim->payerID()) {
 360         $log .= "*** CMS ID is missing for payer '" . $claim->payerName() . "'.\n";
 361     }
 362
 363     ++$edicount;
 364     $out .= "N3" .
 365         "*" . $claim->payerStreet() .
 366         "~\n";
 367
 368     ++$edicount;
 369     $out .= "N4" .
 370         "*" . $claim->payerCity() .
 371         "*" . $claim->payerState() .
 372         "*" . stripZipCode($claim->payerZip()) .
 373         "~\n";
 374
 375     // Segment REF (Payer Secondary Identification) omitted.
 376     // Segment REF (Billing Provider Secondary Identification) omitted.
 377
 378     if (!$claim->isSelfOfInsured()) {
 379         ++$edicount;
 380         $out .= "HL" .        // Loop 2000C Patient Information
 381             "*" . $HLcount .
 382             "*" . $HLSubscriber .
 383             "*" . "23" .
 384             "*" . "0" .
 385             "~\n";
 386
 387         $HLcount++;
 388         ++$edicount;
 389         $out .= "PAT" .
 390             "*" . $claim->insuredRelationship() .
 391             "~\n";
 392
 393         ++$edicount;
 394         $out .= "NM1" .       // Loop 2010CA Patient
 395             "*" . "QC" .
 396             "*" . "1" .
 397             "*" . $claim->patientLastName() .
 398             "*" . $claim->patientFirstName();
 399
 400         if ($claim->patientMiddleName() !== '') {
 401             $out .= "*" . $claim->patientMiddleName();
 402         }
 403
 404         $out .= "~\n";
 405
 406         ++$edicount;
 407         $out .= "N3" .
 408             "*" . $claim->patientStreet() .
 409             "~\n";
 410
 411         ++$edicount;
 412         $out .= "N4" .
 413             "*" . $claim->patientCity() .
 414             "*" . $claim->patientState() .
 415             "*" . stripZipCode($claim->patientZip()) .
 416             "~\n";
 417
 418         ++$edicount;
 419         $out .= "DMG" .
 420             "*" . "D8" .
 421             "*" . $claim->patientDOB() .
 422             "*" . $claim->patientSex() .
 423             "~\n";
 424
 425         // Segment REF*Y4 (Property and Casualty Claim Number) omitted.
 426         // Segment REF (Property and Casualty Patient Identifier) omitted.
 427         // Segment PER (Property and Casualty Patient Contact Information) omitted.
 428     } // end of patient different from insured
 429
 430     $proccount = $claim->procCount();
 431     $clm_total_charges = 0;
 432     for ($prockey = 0; $prockey < $proccount; ++$prockey) {
 433         $clm_total_charges += $claim->cptCharges($prockey);
 434     }
 435     if (!$clm_total_charges) {
 436         $log .= "*** This claim has no charges!\n";
 437     }
 438
 439     ++$edicount;
 440     $out .= "CLM" .    // Loop 2300 Claim
 441         "*" . $pid . "-" . $encounter .
 442         "*" . sprintf("%.2f", $clm_total_charges) .
 443         "*" .
 444         "*" .
 445         "*" . sprintf('%02d', $claim->facilityPOS()) . ":" . "B" . ":" . $claim->frequencyTypeCode() .
 446         "*" . "Y" .
 447         "*" . "A" .
 448         "*" . ($claim->billingFacilityAssignment() ? 'Y' : 'N') .
 449         "*" . "Y" .
 450         "~\n";
 451
 452     if ($claim->onsetDate() && ($claim->onsetDate() !== $claim->serviceDate()) && ($claim->onsetDateValid())) {
 453         ++$edicount;
 454         $out .= "DTP" .       // Date of Onset
 455             "*" . "431" .
 456             "*" . "D8" .
 457             "*" . $claim->onsetDate() .
 458             "~\n";
 459     }
 460
 461     // above is for historical use of encounter onset date, now in misc_billing_options
 462     // Segment DTP*431 (Onset of Current Symptoms or Illness)
 463     // Segment DTP*484 (Last Menstrual Period Date)
 464
 465     if ($claim->miscOnsetDate() && ($claim->box14Qualifier()) && ($claim->miscOnsetDateValid())) {
 466         ++$edicount;
 467         $out .= "DTP" .       // Date Last Seen
 468             "*" . $claim->box14Qualifier() .
 469             "*" . "D8" .
 470             "*" . $claim->miscOnsetDate() .
 471             "~\n";
 472     }
 473
 474     // Segment DTP*454 (Initial Treatment Date)
 475     // Segment DTP*304 (Last Seen Date)
 476     // Segment DTP*453 (Acute Manifestation Date)
 477     // Segment DTP*439 (Accident Date)
 478     // Segment DTP*455 (Last X-Ray Date)
 479     // Segment DTP*471 (Hearing and Vision Prescription Date)
 480     // Segment DTP*314 (Disability) omitted.
 481     // Segment DTP*360 (Initial Disability Period Start) omitted.
 482     // Segment DTP*361 (Initial Disability Period End) omitted.
 483     // Segment DTP*297 (Last Worked Date)
 484     // Segment DTP*296 (Authorized Return to Work Date)
 485
 486     if ($claim->dateInitialTreatment() && ($claim->box15Qualifier()) && ($claim->dateInitialTreatmentValid())) {
 487         ++$edicount;
 488         $out .= "DTP" .       // Date Last Seen
 489         "*" . $claim->box15Qualifier() .
 490         "*" . "D8" .
 491         "*" . $claim->dateInitialTreatment() .
 492         "~\n";
 493     }
 494
 495     if (strcmp($claim->facilityPOS(), '21') == 0 && $claim->onsetDateValid()) {
 496         ++$edicount;
 497         $out .= "DTP" .     // Date of Hospitalization
 498         "*" . "435" .
 499         "*" . "D8" .
 500         "*" . $claim->onsetDate() .
 501         "~\n";
 502     }
 503
 504     // above is for historical use of encounter onset date, now in misc_billing_options
 505     if (strcmp($claim->facilityPOS(), '21') == 0 && $claim->hospitalizedFromDateValid()) {
 506         ++$edicount;
 507         $out .= "DTP" .     // Date of Admission
 508         "*" . "435" .
 509         "*" . "D8" .
 510         "*" . $claim->hospitalizedFrom() .
 511         "~\n";
 512     }
 513
 514     // Segment DTP*096 (Discharge Date)
 515     if (strcmp($claim->facilityPOS(), '21') == 0 && $claim->hospitalizedToDateValid()) {
 516         ++$edicount;
 517         $out .= "DTP" .     // Date of Discharge
 518         "*" . "96" .
 519         "*" . "D8" .
 520         "*" . $claim->hospitalizedTo() .
 521         "~\n";
 522     }
 523
 524     // Segments DTP (Assumed and Relinquished Care Dates) omitted.
 525     // Segment DTP*444 (Property and Casualty Date of First Contact) omitted.
 526     // Segment DTP*050 (Repricer Received Date) omitted.
 527     // Segment PWK (Claim Supplemental Information) omitted.
 528     // Segment CN1 (Contract Information) omitted.
 529
 530     $patientpaid = $claim->patientPaidAmount();
 531     if ($patientpaid != 0) {
 532         ++$edicount;
 533         $out .= "AMT" .     // Patient paid amount. Page 190/220.
 534         "*" . "F5" .
 535         "*" . $patientpaid .
 536         "~\n";
 537     }
 538
 539     // Segment REF*4N (Service Authorization Exception Code) omitted.
 540     // Segment REF*F5 (Mandatory Medicare Crossover Indicator) omitted.
 541     // Segment REF*EW (Mammography Certification Number) omitted.
 542     // Segment REF*9F (Referral Number) omitted.
 543
 544     if ($claim->priorAuth()) {
 545         ++$edicount;
 546         $out .= "REF" .     // Prior Authorization Number
 547         "*" . "G1" .
 548         "*" . $claim->priorAuth() .
 549         "~\n";
 550     }
 551
 552     // Segment REF*F8 Payer Claim Control Number for claim re-submission.icn_resubmission_number
 553     if (trim($claim->billing_options['icn_resubmission_number']) > 3) {
 554         ++$edicount;
 555         error_log("Method 1: " . $claim->billing_options['icn_resubmission_number'], 0);
 556         $out .= "REF" .
 557         "*" . "F8" .
 558         "*" . $claim->icnResubmissionNumber() .
 559         "~\n";
 560     }
 561
 562     if ($claim->cliaCode() && ($claim->claimType() === 'MB')) {
 563         // Required by Medicare when in-house labs are done.
 564         ++$edicount;
 565         $out .= "REF" .     // Clinical Laboratory Improvement Amendment Number
 566         "*" . "X4" .
 567         "*" . $claim->cliaCode() .
 568         "~\n";
 569     }
 570
 571     // Segment REF*9A (Repriced Claim Number) omitted.
 572     // Segment REF*9C (Adjusted Repriced Claim Number) omitted.
 573     // Segment REF*LX (Investigational Device Exemption Number) omitted.
 574     // Segment REF*D9 (Claim Identifier for Transmission Intermediaries) omitted.
 575     // Segment REF*EA (Medical Record Number) omitted.
 576     // Segment REF*P4 (Demonstration Project Identifier) omitted.
 577     // Segment REF*1J (Care Plan Oversight) omitted.
 578     // Segment K3 (File Information) omitted.
 579     if ($claim->additionalNotes()) {
 580         // Claim note.
 581         ++$edicount;
 582         $out .= "NTE" .     // comments box 19
 583         "*" . "ADD" .
 584         "*" . $claim->additionalNotes() .
 585         "~\n";
 586     }
 587
 588     // Segment CR1 (Ambulance Transport Information) omitted.
 589     // Segment CR2 (Spinal Manipulation Service Information) omitted.
 590     // Segment CRC (Ambulance Certification) omitted.
 591     // Segment CRC (Patient Condition Information: Vision) omitted.
 592     // Segment CRC (Homebound Indicator) omitted.
 593     // Segment CRC (EPSDT Referral).
 594     if ($claim->epsdtFlag()) {
 595         ++$edicount;
 596         $out .= "CRC" .
 597         "*" . "ZZ" .
 598         "*" . "Y" .
 599         "*" . $claim->medicaidReferralCode() .
 600         "~\n";
 601     }
 602
 603     // Diagnoses, up to $max_per_seg per HI segment.
 604     $max_per_seg = 12;
 605     $da = $claim->diagArray();
 606     if ($claim->diagtype == "ICD9") {
 607         $diag_type_code = 'BK';
 608     } else {
 609         $diag_type_code = 'ABK';
 610     }
 611     $tmp = 0;
 612     foreach ($da as $diag) {
 613         if ($tmp % $max_per_seg == 0) {
 614             if ($tmp) {
 615                 $out .= "~\n";
 616             }
 617             ++$edicount;
 618             $out .= "HI";         // Health Diagnosis Codes
 619         }
 620         $out .= "*" . $diag_type_code . ":" . $diag;
 621         if ($claim->diagtype == "ICD9") {
 622             $diag_type_code = 'BF';
 623         } else {
 624             $diag_type_code = 'ABF';
 625         }
 626         ++$tmp;
 627     }
 628
 629     if ($tmp) {
 630         $out .= "~\n";
 631     }
 632
 633     // Segment HI*BP (Anesthesia Related Procedure) omitted.
 634     // Segment HI*BG (Condition Information) omitted.
 635     // Segment HCP (Claim Pricing/Repricing Information) omitted.
 636     if ($claim->referrerLastName()) {
 637         // Medicare requires referring provider's name and UPIN.
 638         ++$edicount;
 639         $out .= "NM1" .     // Loop 2310A Referring Provider
 640         "*" . "DN" .
 641         "*" . "1" .
 642         "*" . $claim->referrerLastName() .
 643         "*" . $claim->referrerFirstName() .
 644         "*" . $claim->referrerMiddleName() .
 645         "*" .
 646         "*";
 647         if ($claim->referrerNPI()) {
 648             $out .=
 649             "*" . "XX" .
 650             "*" . $claim->referrerNPI();
 651         } else {
 652             $log .= "*** Referring provider has no NPI.\n";
 653         }
 654         $out .= "~\n";
 655     }
 656
 657     // Per the implementation guide lines, only include this information if it is different
 658     // than the Loop 2010AA information
 659     if ($claim->providerNPIValid() && ($claim->billingFacilityNPI() !== $claim->providerNPI())) {
 660         ++$edicount;
 661         $out .= "NM1" .       // Loop 2310B Rendering Provider
 662         "*" . "82" .
 663         "*" . "1" .
 664         "*" . $claim->providerLastName() .
 665         "*" . $claim->providerFirstName() .
 666         "*" . $claim->providerMiddleName() .
 667         "*" .
 668         "*";
 669         if ($claim->providerNPI()) {
 670             $out .=
 671             "*" . "XX" .
 672             "*" . $claim->providerNPI();
 673         } else {
 674             $log .= "*** Rendering provider has no NPI.\n";
 675         }
 676         $out .= "~\n";
 677
 678         if ($claim->providerTaxonomy()) {
 679             ++$edicount;
 680             $out .= "PRV" .
 681             "*" . "PE" . // Performing provider
 682             "*" . "PXC" .
 683             "*" . $claim->providerTaxonomy() .
 684             "~\n";
 685         } else {
 686             $log .= "*** Performing provider has no taxonomy code.\n";
 687         }
 688     } else {
 689         $log .= "*** Rendering provider is billing under a group.\n";
 690     }
 691     if (!$claim->providerNPIValid()) {
 692         // If the loop was skipped because the provider NPI was invalid, generate a warning for the log.
 693         $log .= "*** Skipping 2310B because " . $claim->providerLastName() . "," . $claim->providerFirstName() . " has invalid NPI.\n";
 694     }
 695
 696     if (!$claim->providerNPI() && in_array($claim->providerNumberType(), array('0B', '1G', 'G2', 'LU'))) {
 697         if ($claim->providerNumber()) {
 698             ++$edicount;
 699             $out .= "REF" .
 700             "*" . $claim->providerNumberType() .
 701             "*" . $claim->providerNumber() .
 702             "~\n";
 703         }
 704     }
 705     // End of Loop 2310B
 706
 707     // Loop 2310C is omitted in the case of home visits (POS=12).
 708     if ($claim->facilityPOS() != 12 && ($claim->facilityNPI() != $claim->billingFacilityNPI())) {
 709         ++$edicount;
 710         $out .= "NM1" .       // Loop 2310C Service Location
 711         "*" . "77" .
 712         "*" . "2";
 713         $facilityName = substr($claim->facilityName(), 0, 60);
 714         if ($claim->facilityName() || $claim->facilityNPI() || $claim->facilityETIN()) {
 715             $out .=
 716             "*" . $facilityName;
 717         } else {
 718             $log .= "*** Check for invalid facility name, NPI, and/or tax id.\n";
 719         }
 720         if ($claim->facilityNPI() || $claim->facilityETIN()) {
 721             $out .=
 722             "*" .
 723             "*" .
 724             "*" .
 725             "*";
 726             if ($claim->facilityNPI()) {
 727                 $out .=
 728                 "*" . "XX" . "*" . $claim->facilityNPI();
 729             } else {
 730                 $out .=
 731                 "*" . "24" . "*" . $claim->facilityETIN();
 732             }
 733             if (!$claim->facilityNPI()) {
 734                 $log .= "*** Service location has no NPI.\n";
 735             }
 736         }
 737
 738         $out .= "~\n";
 739         if ($claim->facilityStreet()) {
 740             ++$edicount;
 741             $out .= "N3" .
 742             "*" . $claim->facilityStreet() .
 743             "~\n";
 744         }
 745
 746         if ($claim->facilityState()) {
 747             ++$edicount;
 748             $out .= "N4" .
 749             "*" . $claim->facilityCity() .
 750             "*" . $claim->facilityState() .
 751             "*" . stripZipCode($claim->facilityZip()) .
 752             "~\n";
 753         }
 754     }
 755     // Segment REF (Service Facility Location Secondary Identification) omitted.
 756     // Segment PER (Service Facility Contact Information) omitted.
 757
 758     // Loop 2310E, Supervising Provider
 759     if ($claim->supervisorLastName()) {
 760         ++$edicount;
 761         $out .= "NM1" .
 762         "*" . "DQ" . // Supervising Physician
 763         "*" . "1" .  // Person
 764         "*" . $claim->supervisorLastName() .
 765         "*" . $claim->supervisorFirstName() .
 766         "*" . $claim->supervisorMiddleName() .
 767         "*" .   // NM106 not used
 768         "*";    // Name Suffix not used
 769         if ($claim->supervisorNPI()) {
 770             $out .=
 771             "*" . "XX" .
 772             "*" . $claim->supervisorNPI();
 773         } else {
 774             $log .= "*** Supervising Provider has no NPI.\n";
 775         }
 776         $out .= "~\n";
 777
 778         if ($claim->supervisorNumber()) {
 779             ++$edicount;
 780             $out .= "REF" .
 781             "*" . $claim->supervisorNumberType() .
 782             "*" . $claim->supervisorNumber() .
 783             "~\n";
 784         }
 785     } else {
 786         $log .= "*** Supervising provider has invalid last name.\n";
 787     }
 788
 789     // Segments NM1*PW, N3, N4 (Ambulance Pick-Up Location) omitted.
 790     // Segments NM1*45, N3, N4 (Ambulance Drop-Off Location) omitted.
 791
 792     // Loops 2320 and 2330, other subscriber/payer information.
 793     // Remember that insurance index 0 is always for the payer being billed
 794     // by this claim, and 1 and above are always for the "other" payers.
 795
 796     for ($ins = 1; $ins < $claim->payerCount(); ++$ins) {
 797         $tmp1 = $claim->claimType($ins);
 798         $tmp2 = 'C1'; // Here a kludge. See page 321.
 799         if ($tmp1 === 'CI') {
 800             $tmp2 = 'C1';
 801         }
 802         if ($tmp1 === 'AM') {
 803             $tmp2 = 'AP';
 804         }
 805         if ($tmp1 === 'HM') {
 806             $tmp2 = 'HM';
 807         }
 808         if ($tmp1 === 'MB') {
 809             $tmp2 = 'MB';
 810         }
 811         if ($tmp1 === 'MC') {
 812             $tmp2 = 'MC';
 813         }
 814         if ($tmp1 === '09') {
 815             $tmp2 = 'PP';
 816         }
 817
 818         ++$edicount;
 819         $out .= "SBR" . // Loop 2320, Subscriber Information - page 297/318
 820         "*" . $claim->payerSequence($ins) .
 821         "*" . $claim->insuredRelationship($ins) .
 822         "*" . $claim->groupNumber($ins) .
 823         "*" . $claim->groupName($ins) .
 824         "*" . $claim->insuredTypeCode($ins) .
 825         "*" .
 826         "*" .
 827         "*" .
 828         "*" . $claim->claimType($ins) .
 829         "~\n";
 830
 831         // Things that apply only to previous payers, not future payers.
 832         if ($claim->payerSequence($ins) < $claim->payerSequence()) {
 833             // Generate claim-level adjustments.
 834             $aarr = $claim->payerAdjustments($ins);
 835             foreach ($aarr as $a) {
 836                 ++$edicount;
 837                 $out .= "CAS" . // Previous payer's claim-level adjustments. Page 301/323.
 838                 "*" . $a[1] .
 839                 "*" . $a[2] .
 840                 "*" . $a[3] .
 841                 "~\n";
 842             }
 843
 844             $payerpaid = $claim->payerTotals($ins);
 845             ++$edicount;
 846             $out .= "AMT" . // Previous payer's paid amount. Page 307/332.
 847             "*" . "D" .
 848             "*" . $payerpaid[1] .
 849             "~\n";
 850             // Segment AMT*A8 (COB Total Non-Covered Amount) omitted.
 851             // Segment AMT*EAF (Remaining Patient Liability) omitted.
 852         }   // End of things that apply only to previous payers.
 853
 854         ++$edicount;
 855         $out .= "OI" .  // Other Insurance Coverage Information. Page 310/344.
 856         "*" .
 857         "*" .
 858         "*" . ($claim->billingFacilityAssignment($ins) ? 'Y' : 'N') .
 859         // For this next item, the 5010 example in the spec does not match its
 860         // description.  So this might be wrong.
 861         "*" .
 862         "*" .
 863         "*" .
 864         "Y" .
 865         "~\n";
 866
 867         // Segment MOA (Medicare Outpatient Adjudication) omitted.
 868         ++$edicount;
 869         $out .= "NM1" . // Loop 2330A Subscriber info for other insco. Page 315/350.
 870         "*" . "IL" .
 871         "*" . "1" .
 872         "*" . $claim->insuredLastName($ins) .
 873         "*" . $claim->insuredFirstName($ins) .
 874         "*" . $claim->insuredMiddleName($ins) .
 875         "*" .
 876         "*" .
 877         "*" . "MI" .
 878         "*" . $claim->policyNumber($ins) .
 879         "~\n";
 880
 881         ++$edicount;
 882         $out .= "N3" .
 883         "*" . $claim->insuredStreet($ins) .
 884         "~\n";
 885
 886         ++$edicount;
 887         $out .= "N4" .
 888         "*" . $claim->insuredCity($ins) .
 889         "*" . $claim->insuredState($ins) .
 890         "*" . stripZipCode($claim->insuredZip($ins)) .
 891         "~\n";
 892
 893         // Segment REF (Other Subscriber Secondary Identification) omitted.
 894         ++$edicount;
 895         $payerName = substr($claim->payerName($ins), 0, 60);
 896         $out .= "NM1" . // Loop 2330B Payer info for other insco. Page 322/359.
 897         "*" . "PR" .
 898         "*" . "2" .
 899         "*" . $payerName .
 900         "*" .
 901         "*" .
 902         "*" .
 903         "*" .
 904         "*" . "PI" .
 905         "*" . $claim->payerID($ins) .
 906         "~\n";
 907
 908         if (!$claim->payerID($ins)) {
 909             $log .= "*** CMS ID is missing for payer '" . $claim->payerName($ins) . "'.\n";
 910         }
 911
 912         ++$edicount;
 913         $out .= "N3" .
 914         "*" . $claim->payerStreet($ins) .
 915         "~\n";
 916
 917         ++$edicount;
 918         $out .= "N4" .
 919         "*" . $claim->payerCity($ins) .
 920         "*" . $claim->payerState($ins) .
 921         "*" . stripZipCode($claim->payerZip($ins)) .
 922         "~\n";
 923         // Segment DTP*573 (Claim Check or Remittance Date) omitted.
 924         // Segment REF (Other Payer Secondary Identifier) omitted.
 925         // Segment REF*G1 (Other Payer Prior Authorization Number) omitted.
 926         // Segment REF*9F (Other Payer Referral Number) omitted.
 927         // Segment REF*T4 (Other Payer Claim Adjustment Indicator) omitted.
 928         // Segment REF*F8 (Other Payer Claim Control Number) omitted.
 929         // Segment NM1 (Other Payer Referring Provider) omitted.
 930         // Segment REF (Other Payer Referring Provider Secondary Identification) omitted.
 931         // Segment NM1 (Other Payer Rendering Provider) omitted.
 932         // Segment REF (Other Payer Rendering Provider Secondary Identification) omitted.
 933         // Segment NM1 (Other Payer Service Facility Location) omitted.
 934         // Segment REF (Other Payer Service Facility Location Secondary Identification) omitted.
 935         // Segment NM1 (Other Payer Supervising Provider) omitted.
 936         // Segment REF (Other Payer Supervising Provider Secondary Identification) omitted.
 937         // Segment NM1 (Other Payer Billing Provider) omitted.
 938         // Segment REF (Other Payer Billing Provider Secondary Identification) omitted.
 939     } // End loops 2320/2330*.
 940
 941     $loopcount = 0;
 942
 943     // Procedure loop starts here.
 944     for ($prockey = 0; $prockey < $proccount; ++$prockey) {
 945         ++$loopcount;
 946         ++$edicount;
 947         $out .= "LX" .      // Loop 2400 LX Service Line. Page 398.
 948         "*" . $loopcount .
 949         "~\n";
 950
 951         ++$edicount;
 952         $out .= "SV1" .     // Professional Service. Page 400.
 953         "*" . "HC:" . $claim->cptKey($prockey) .
 954         "*" . sprintf('%.2f', $claim->cptCharges($prockey)) .
 955         "*" . "UN" .
 956         "*" . $claim->cptUnits($prockey) .
 957         "*" .
 958         "*" .
 959         "*";
 960         $dia = $claim->diagIndexArray($prockey);
 961         $i = 0;
 962         foreach ($dia as $dindex) {
 963             if ($i) {
 964                 $out .= ':';
 965             }
 966
 967             $out .= $dindex;
 968             if (++$i >= 4) {
 969                 break;
 970             }
 971         }
 972
 973         # needed for epstd
 974         if ($claim->epsdtFlag()) {
 975             $out .= "*" .
 976             "*" .
 977             "*" .
 978             "*" . "Y" .
 979             "~\n";
 980         } else {
 981             $out .= "~\n";
 982         }
 983
 984         if (!$claim->cptCharges($prockey)) {
 985             $log .= "*** Procedure '" . $claim->cptKey($prockey) . "' has no charges!\n";
 986         }
 987
 988         if (empty($dia)) {
 989             $log .= "*** Procedure '" . $claim->cptKey($prockey) . "' is not justified!\n";
 990         }
 991
 992         // Segment SV5 (Durable Medical Equipment Service) omitted.
 993         // Segment PWK (Line Supplemental Information) omitted.
 994         // Segment PWK (Durable Medical Equipment Certificate of Medical Necessity Indicator) omitted.
 995         // Segment CR1 (Ambulance Transport Information) omitted.
 996         // Segment CR3 (Durable Medical Equipment Certification) omitted.
 997         // Segment CRC (Ambulance Certification) omitted.
 998         // Segment CRC (Hospice Employee Indicator) omitted.
 999         // Segment CRC (Condition Indicator / Durable Medical Equipment) omitted.
1000
1001         ++$edicount;
1002         $out .= "DTP" .     // Date of Service. Page 435.
1003         "*" . "472" .
1004         "*" . "D8" .
1005         "*" . $claim->serviceDate() .
1006         "~\n";
1007
1008         $testnote = rtrim($claim->cptNotecodes($prockey));
1009         if (!empty($testnote)) {
1010             ++$edicount;
1011             $out .= "NTE" .     // Explain Unusual Circumstances.
1012             "*" . "ADD" .
1013             "*" . $claim->cptNotecodes($prockey) .
1014             "~\n";
1015         }
1016
1017         // Segment DTP*471 (Prescription Date) omitted.
1018         // Segment DTP*607 (Revision/Recertification Date) omitted.
1019         // Segment DTP*463 (Begin Therapy Date) omitted.
1020         // Segment DTP*461 (Last Certification Date) omitted.
1021         // Segment DTP*304 (Last Seen Date) omitted.
1022         // Segment DTP (Test Date) omitted.
1023         // Segment DTP*011 (Shipped Date) omitted.
1024         // Segment DTP*455 (Last X-Ray Date) omitted.
1025         // Segment DTP*454 (Initial Treatment Date) omitted.
1026         // Segment QTY (Ambulance Patient Count) omitted.
1027         // Segment QTY (Obstetric Anesthesia Additional Units) omitted.
1028         // Segment MEA (Test Result) omitted.
1029         // Segment CN1 (Contract Information) omitted.
1030         // Segment REF*9B (Repriced Line Item Reference Number) omitted.
1031         // Segment REF*9D (Adjusted Repriced Line Item Reference Number) omitted.
1032         // Segment REF*G1 (Prior Authorization) omitted.
1033         // Segment REF*6R (Line Item Control Number) omitted.
1034         //   (Really oughta have this for robust 835 posting!)
1035         // Segment REF*EW (Mammography Certification Number) omitted.
1036         // Segment REF*X4 (CLIA Number) omitted.
1037         // Segment REF*F4 (Referring CLIA Facility Identification) omitted.
1038         // Segment REF*BT (Immunization Batch Number) omitted.
1039         // Segment REF*9F (Referral Number) omitted.
1040         // Segment AMT*T (Sales Tax Amount) omitted.
1041         // Segment AMT*F4 (Postage Claimed Amount) omitted.
1042         // Segment K3 (File Information) omitted.
1043         // Segment NTE (Line Note) omitted.
1044         // Segment NTE (Third Party Organization Notes) omitted.
1045         // Segment PS1 (Purchased Service Information) omitted.
1046         // Segment HCP (Line Pricing/Repricing Information) omitted.
1047
1048     // Loop 2410, Drug Information. Medicaid insurers seem to want this
1049     // with HCPCS codes.
1050     //
1051         $ndc = $claim->cptNDCID($prockey);
1052
1053         if ($ndc) {
1054             ++$edicount;
1055             $out .= "LIN" . // Drug Identification. Page 500+ (Addendum pg 71).
1056             "*" .         // Per addendum, LIN01 is not used.
1057             "*" . "N4" .
1058             "*" . $ndc .
1059             "~\n";
1060
1061             if (!preg_match('/^\d\d\d\d\d-\d\d\d\d-\d\d$/', $ndc, $tmp) && !preg_match('/^\d{11}$/', $ndc)) {
1062                 $log .= "*** NDC code '$ndc' has invalid format!\n";
1063             }
1064
1065             ++$edicount;
1066             $out .= "CTP" . // Drug Pricing. Page 500+ (Addendum pg 74).
1067             "*" .
1068             "*" .
1069             "*" .
1070             "*" . $claim->cptNDCQuantity($prockey) .
1071             "*" . $claim->cptNDCUOM($prockey) .
1072             // Note: 5010 documents "ME" (Milligrams) as an additional unit of measure.
1073             "~\n";
1074         }
1075
1076     // Segment REF (Prescription or Compound Drug Association Number) omitted.
1077
1078     // Loop 2420A, Rendering Provider (service-specific).
1079     // Used if the rendering provider for this service line is different
1080     // from that in loop 2310B.
1081     //
1082         if ($claim->providerNPI() != $claim->providerNPI($prockey)) {
1083             ++$edicount;
1084             $out .= "NM1" .       // Loop 2420A Rendering Provider
1085             "*" . "82" .
1086             "*" . "1" .
1087             "*" . $claim->providerLastName($prockey) .
1088             "*" . $claim->providerFirstName($prockey) .
1089             "*" . $claim->providerMiddleName($prockey) .
1090             "*" .
1091             "*";
1092             if ($claim->providerNPI($prockey)) {
1093                 $out .=
1094                 "*" . "XX" .
1095                 "*" . $claim->providerNPI($prockey);
1096             } else {
1097                 $log .= "*** Rendering provider has no NPI.\n";
1098             }
1099             $out .= "~\n";
1100
1101             // Segment PRV*PE (Rendering Provider Specialty Information) .
1102
1103             if ($claim->providerTaxonomy($prockey)) {
1104                 ++$edicount;
1105                 $out .= "PRV" .
1106                 "*" . "PE" . // PErforming provider
1107                 "*" . "PXC" .
1108                 "*" . $claim->providerTaxonomy($prockey) .
1109                 "~\n";
1110             }
1111
1112             // Segment REF (Rendering Provider Secondary Identification) omitted.
1113             // Segment NM1 (Purchased Service Provider Name) omitted.
1114             // Segment REF (Purchased Service Provider Secondary Identification) omitted.
1115             // Segment NM1,N3,N4 (Service Facility Location) omitted.
1116             // Segment REF (Service Facility Location Secondary Identification) omitted.
1117             // Segment NM1 (Supervising Provider Name) omitted.
1118             // Segment REF (Supervising Provider Secondary Identification) omitted.
1119             // Segment NM1,N3,N4 (Ordering Provider) omitted.
1120             // Segment REF (Ordering Provider Secondary Identification) omitted.
1121             // Segment PER (Ordering Provider Contact Information) omitted.
1122             // Segment NM1 (Referring Provider Name) omitted.
1123             // Segment REF (Referring Provider Secondary Identification) omitted.
1124             // Segments NM1*PW, N3, N4 (Ambulance Pick-Up Location) omitted.
1125             // Segments NM1*45, N3, N4 (Ambulance Drop-Off Location) omitted.
1126
1127             // REF*1C is required here for the Medicare provider number if NPI was
1128             // specified in NM109.  Not sure if other payers require anything here.
1129
1130             if ($claim->providerNumberType($prockey) == "G2") {
1131                 ++$edicount; $out .= "REF" . "*" . $claim->providerNumberType($prockey) .
1132                 "*" . $claim->providerNumber($prockey) . "~\n";
1133             }
1134         } // end provider exception
1135
1136         // Loop 2430, adjudication by previous payers.
1137         //
1138         for ($ins = 1; $ins < $claim->payerCount(); ++$ins) {
1139             if ($claim->payerSequence($ins) > $claim->payerSequence()) {
1140                 continue; // payer is future, not previous
1141             }
1142
1143             $payerpaid = $claim->payerTotals($ins, $claim->cptKey($prockey));
1144             $aarr = $claim->payerAdjustments($ins, $claim->cptKey($prockey));
1145
1146             if ($payerpaid[1] == 0 && !count($aarr)) {
1147                 $log .= "*** Procedure '" . $claim->cptKey($prockey) .
1148                     "' has no payments or adjustments from previous payer!\n";
1149                 continue;
1150             }
1151
1152             ++$edicount;
1153             $out .= "SVD" . // Service line adjudication. Page 554.
1154             "*" . $claim->payerID($ins) .
1155             "*" . $payerpaid[1] .
1156             "*" . "HC:" . $claim->cptKey($prockey) .
1157             "*" .
1158             "*" . $claim->cptUnits($prockey) .
1159             "~\n";
1160
1161             $tmpdate = $payerpaid[0];
1162             foreach ($aarr as $a) {
1163                 ++$edicount;
1164                 $out .= "CAS" . // Previous payer's line level adjustments. Page 558.
1165                 "*" . $a[1] .
1166                 "*" . $a[2] .
1167                 "*" . $a[3] .
1168                 "~\n";
1169                 if (!$tmpdate) {
1170                     $tmpdate = $a[0];
1171                 }
1172             }
1173
1174             if ($tmpdate) {
1175                 ++$edicount;
1176                 $out .= "DTP" . // Previous payer's line adjustment date. Page 493/566.
1177                 "*" . "573" .
1178                 "*" . "D8" .
1179                 "*" . $tmpdate .
1180                 "~\n";
1181             }
1182
1183             // Segment AMT*EAF (Remaining Patient Liability) omitted.
1184             // Segment LQ (Form Identification Code) omitted.
1185             // Segment FRM (Supporting Documentation) omitted.
1186         } // end loop 2430
1187     } // end this procedure
1188
1189     ++$edicount;
1190     $out .= "SE" .        // SE Trailer
1191     "*" . $edicount .
1192     "*" . "0021" .
1193     "~\n";
1194
1195     $out .= "GE" .        // GE Trailer
1196     "*" . "1" .
1197     "*" . "1" .
1198     "~\n";
1199
1200     $out .= "IEA" .       // IEA Trailer
1201     "*" . "1" .
1202     "*" . "000000001" .
1203     "~\n";
1204
1205     // Remove any trailing empty fields (delimiters) from each segment.
1206     $out = preg_replace('/\*+~/', '~', $out);
1207
1208     $log .= "\n";
1209     return $out;
1210 }