library/gen_x12_837i.inc.php

   1 <?php
   2 /**
   3  * X12 837I
   4  *
   5  * @package OpenEMR
   6  * @link    http://www.open-emr.org
   7  * @author  Jerry Padgett <sjpadgett@gmail.com>
   8  * @copyright Copyright (c) 2017 Jerry Padgett <sjpadgett@gmail.com>
   9  * @license https://github.com/openemr/openemr/blob/master/LICENSE GNU General Public License 3
  10  */
  11
  12 require_once(dirname(__FILE__) . "/invoice_summary.inc.php");
  13
  14 use OpenEMR\Billing\Claim;
  15
  16 function x12date($frmdate)
  17 {
  18     return ('20' . substr($frmdate, 4, 2) . substr($frmdate, 0, 2) . substr($frmdate, 2, 2));
  19 }
  20
  21 $ub04id = array();
  22 function generate_x12_837I($pid, $encounter, &$log, $ub04id)
  23 {
  24     $today = time();
  25     $out = '';
  26     $claim = new Claim($pid, $encounter);
  27     $edicount = 0;
  28
  29     $log .= "Generating 837I claim $pid-$encounter for " .
  30     $claim->patientFirstName()  . ' ' .
  31     $claim->patientMiddleName() . ' ' .
  32     $claim->patientLastName()   . ' on ' .
  33     date('Y-m-d H:i', $today) . ".\n";
  34     $out .= "ISA" .
  35         "*" . $claim->x12gsisa01() .
  36         "*" . $claim->x12gsisa02() .
  37         "*" . $claim->x12gsisa03() .
  38         "*" . $claim->x12gsisa04() .
  39         "*" . $claim->x12gsisa05() .
  40         "*" . $claim->x12gssenderid() .
  41         "*" . $claim->x12gsisa07() .
  42         "*" . $claim->x12gsreceiverid() .
  43         // date of transmission "*030911" .
  44     "*" . date('Ymd', $today) .
  45     //Time of transmission "*1630" .
  46     "*" . date('Hi', $today) .
  47     "*" . "^"  .
  48     "*" . "00501" .
  49     "*" . "000000001" .
  50     "*" . $claim->x12gsisa14() .
  51     "*" . $claim->x12gsisa15() .
  52     "*:" .
  53     "~\n";
  54     $out .= "GS" .
  55         "*HC" .
  56         "*" . $claim->x12gsgs02() .
  57         "*" . trim($claim->x12gs03()) .
  58         "*" . date('Ymd', $today) .
  59         "*" . date('Hi', $today) .
  60         "*1" .
  61         "*X" .
  62         // "*" . $claim->x12gsversionstring() .
  63     "*" . "005010X223A2".
  64     "~\n";
  65     ++$edicount;
  66     $out .= "ST" .
  67     "*" . "837" .
  68     "*" . "0021" .
  69     // "*" . $claim->x12gsversionstring() .
  70     "*" . "005010X223A2".
  71     "~\n";
  72     ++$edicount;
  73     $out .= "BHT" .
  74         "*" . "0019" .                             // 0019 is required here
  75         "*" . "00" .                               // 00 = original transmission
  76         "*" . "0123" .                             // reference identification
  77         "*" . date('Ymd', $today) .           // transaction creation date
  78         "*" . date('Hi', $today) .            // transaction creation time
  79         ($encounter_claim ? "*RP" : "*CH") .  // RP = reporting, CH = chargeable
  80         "~\n";
  81
  82         ++$edicount;
  83         //Field length is limited to 35. See nucc dataset page 63 www.nucc.org
  84         $billingFacilityName = substr($claim->billingFacilityName(), 0, 60);
  85     if ($billingFacilityName == '') {
  86         $log .= "*** billing facility name in 1000A loop is empty\n";
  87     }
  88         $out .= "NM1" .       // Loop 1000A Submitter stays in the 837I
  89         "*" . "41" .
  90         "*" . "2" .
  91         "*" . $billingFacilityName .
  92         "*" .
  93         "*" .
  94         "*" .
  95         "*" .
  96         "*" . "46";
  97
  98         $out  .=  "*" . $claim->billingFacilityETIN();
  99         $out .= "~\n";
 100         ++$edicount;
 101
 102         $out .= "PER" .
 103             "*IC" .
 104             "*" . $claim->billingContactName() .
 105             "*TE" .
 106             "*" . $claim->billingContactPhone();
 107         $out .= "~\n";
 108
 109         ++$edicount;
 110
 111         $out .= "NM1" .       // Loop 1000B Receiver stays in the 837I
 112             "*" . "40" .
 113             "*" . "2" .
 114             "*" . $claim->clearingHouseName() .
 115             "*" .
 116             "*" .
 117             "*" .
 118             "*" .
 119             "*" . "46" .
 120             "*" . $claim->clearingHouseETIN() .
 121             "~\n";
 122         $HLcount = 1;
 123         ++$edicount;
 124
 125         $out .= "HL" .        // Loop 2000A Billing/Pay-To Provider HL Loop
 126             "*" . "$HLcount" .
 127             "*" .
 128             "*" . "20" .
 129             "*" . "1" .              // 1 indicates there are child segments
 130             "~\n";
 131         $HLBillingPayToProvider = $HLcount++;
 132         // Situational PRV segment (for provider taxonomy code) omitted here.
 133         // Situational CUR segment (foreign currency information) omitted here.
 134         ++$edicount;
 135         //Field length is limited to 35. See nucc dataset page 63 www.nucc.org
 136         $billingFacilityName = substr($claim->billingFacilityName(), 0, 60);
 137         $out .= "NM1" .       // Loop 2010AA Billing Provider stays in the 837I
 138             "*" . "85" .
 139             "*" . "2" .
 140             "*" . $billingFacilityName .
 141             "*" .
 142             "*" .
 143             "*" .
 144             "*";
 145     if ($claim->billingFacilityNPI()) {
 146         $out .= "*XX*" . $claim->billingFacilityNPI();
 147     } else {
 148         $log .= "*** Billing facility has no NPI.\n";
 149         $out .= "*XX*";
 150     }
 151         $out .= "~\n";
 152         ++$edicount;
 153         $out .= "N3" .
 154             "*" . $claim->billingFacilityStreet() .
 155             "~\n";
 156         ++$edicount;
 157         $out .= "N4" .
 158             "*" . $claim->billingFacilityCity() .
 159             "*" . $claim->billingFacilityState() .
 160             "*" . $claim->x12Zip($claim->billingFacilityZip()) .
 161             "~\n";
 162     if ($claim->billingFacilityNPI() && $claim->billingFacilityETIN()) {
 163         ++$edicount;
 164         $out .= "REF";
 165         if ($claim->federalIdType()) {
 166             $out .= "*" . $claim->federalIdType();
 167         } else {
 168             $out .= "*EI"; // For dealing with the situation before adding TaxId type In facility.
 169         }
 170         $out .= "*" . $claim->billingFacilityETIN() . "~\n";
 171     } else {
 172         $log .= "*** No billing facility NPI and/or ETIN.\n";
 173     }
 174     if ($claim->providerNumberType() && $claim->providerNumber() && !$claim->billingFacilityNPI()) {
 175         ++$edicount;
 176         $out .= "REF" .
 177             "*" . $claim->providerNumberType() .
 178             "*" . $claim->providerNumber() .
 179             "~\n";
 180     } else if ($claim->providerNumber() && !$claim->providerNumberType()) {
 181         $log .= "*** Payer-specific provider insurance number is present but has no type assigned.\n";
 182     }
 183         // Situational PER*1C segment.
 184         ++$edicount;
 185         $out .= "PER" .
 186             "*" . "IC" .
 187             "*" . $claim->billingContactName() .
 188             "*" . "TE" .
 189             "*" . $claim->billingContactPhone();
 190         $out .= "~\n";
 191
 192         // This is also excluded in the 837I
 193         // Loop 2010AC Pay-To Plan Name omitted.  Includes:
 194         // NM1*PE, N3, N4, REF*2U, REF*EI
 195         $PatientHL = $claim->isSelfOfInsured() ? 0 : 1;
 196         $HLSubscriber = $HLcount++;
 197         ++$edicount;
 198
 199         // loop 2000B
 200         $out .= "HL" .        // Loop 2000B Subscriber HL Loop
 201             "*$HLSubscriber" .
 202             "*$HLBillingPayToProvider" .
 203             "*" . "22" .
 204             "*$PatientHL" .
 205             "~\n";
 206     if (!$claim->payerSequence()) {
 207         $log .= "*** Error: Insurance information is missing!\n";
 208     }
 209         ++$edicount;
 210
 211         //SBR01 is either a P or S    SBR02 for care is always 18 "patient"  SBR09 is always MA
 212         $out .= "SBR" .       // Subscriber Information
 213             "*" . $claim->payerSequence() .
 214             "*" . ($claim->isSelfOfInsured() ? '18' : '') .
 215             "*" . $claim->groupNumber() .
 216             "*" . (($claim->groupNumber()) ? '' : $claim->groupName()) .
 217             "*" . $claim->insuredTypeCode() . // applies for secondary medicare
 218             "*" .
 219             "*" .
 220             "*" .
 221             "*" . $claim->claimType() . // Zirmed replaces this
 222             "~\n";
 223         // 2000C Segment PAT omitted.
 224         ++$edicount;
 225         $out .= "NM1" .       // Loop 2010BA Subscriber  same in 837I
 226             "*IL" .
 227             "*" . "1" . // 1 = person, 2 = non-person
 228             "*" . $claim->insuredLastName() .
 229             "*" . $claim->insuredFirstName() .
 230             "*" . $claim->insuredMiddleName() .
 231             "*" .
 232             "*" . // Name Suffix
 233             "*MI" .
 234             // "MI" = Member Identification Number
 235         // "II" = Standard Unique Health Identifier, "Required if the
 236         //        HIPAA Individual Patient Identifier is mandated use."
 237         //        Here we presume that is not true yet.
 238         "*" . $claim->policyNumber() .
 239         "~\n";
 240         // For 5010, further subscriber info is sent only if they are the patient.
 241     if ($claim->isSelfOfInsured()) {
 242         ++$edicount;
 243         $out .= "N3" .
 244             "*" . $claim->insuredStreet() .
 245             "~\n";
 246         ++$edicount;
 247         $out .= "N4" .
 248             "*" . $claim->insuredCity() .
 249             "*" . $claim->insuredState() .
 250             "*" . $claim->x12Zip($claim->insuredZip()) .
 251             "~\n";
 252         ++$edicount;
 253         $out .= "DMG" .
 254             "*D8" .
 255             "*" . $claim->insuredDOB() .
 256             "*" . $claim->insuredSex() .
 257             "~\n";
 258     }
 259         // Segment REF*SY (Subscriber Secondary Identification) omitted.
 260         // Segment REF*Y4 (Property and Casualty Claim Number) omitted.
 261         // Segment PER*IC (Property and Casualty Subscriber Contact Information) omitted.
 262         ++$edicount;
 263         $payerName = substr($claim->payerName(), 0, 60);
 264         $out .= "NM1" .       // Loop 2010BB Payer
 265             "*PR" .
 266             "*" . "2" .
 267             "*" . $payerName .
 268             "*" .
 269             "*" .
 270             "*" .
 271             "*" .
 272             "*" . "PI" .
 273             "*" . ($encounter_claim ? $claim->payerAltID() : $claim->payerID()) .
 274             "~\n";
 275     if (!$claim->payerID()) {
 276         $log .= "*** CMS ID is missing for payer '" . $claim->payerName() . "'.\n";
 277     }
 278
 279         ++$edicount;
 280         $out .= "N3" .
 281             "*" . $claim->payerStreet() .
 282             "~\n";
 283         ++$edicount;
 284         $out .= "N4" .
 285             "*" . $claim->payerCity() .
 286             "*" . $claim->payerState() .
 287             "*" . $claim->x12Zip($claim->payerZip()) .
 288             "~\n";
 289
 290         // Segment REF (Payer Secondary Identification) omitted.
 291         // Segment REF (Billing Provider Secondary Identification) omitted.
 292
 293
 294     if (! $claim->isSelfOfInsured()) {
 295         ++$edicount;
 296         $out .= "HL" .        // Loop 2000C Patient Information
 297             "*" . "$HLcount" .
 298             "*$HLSubscriber" .
 299             "*23" .
 300             "*0" .
 301             "~\n";
 302         $HLcount++;
 303         ++$edicount;
 304         $out .= "PAT" .
 305             "*" . $claim->insuredRelationship() .
 306             "~\n";
 307         ++$edicount;
 308         $out .= "NM1" .       // Loop 2010CA Patient may need this elsed in to the loop 2000C
 309             "*QC" .
 310             "*1" .
 311             "*" . $claim->patientLastName() .
 312             "*" . $claim->patientFirstName();
 313         if ($claim->patientMiddleName() !== '') {
 314             $out .= "*" . $claim->patientMiddleName();
 315         }
 316             $out .= "~\n";
 317             ++$edicount;
 318             $out .= "N3" .
 319                 "*" . $claim->patientStreet() .
 320                 "~\n";
 321             ++$edicount;
 322             $out .= "N4" .
 323                 "*" . $claim->patientCity() .
 324                 "*" . $claim->patientState() .
 325                 "*" . $claim->x12Zip($claim->patientZip()) .
 326                 "~\n";
 327             ++$edicount;
 328             $out .= "DMG" .
 329                 "*D8" .
 330                 "*" . $claim->patientDOB() .
 331                 "*" . $claim->patientSex() .
 332                 "~\n";
 333             // Segment REF*Y4 (Property and Casualty Claim Number) omitted.
 334             // Segment REF (Property and Casualty Patient Identifier) omitted.
 335             // Segment PER (Property and Casualty Patient Contact Information) omitted.
 336     } // end of patient different from insured
 337         $proccount = $claim->procCount();
 338         $clm_total_charges = 0;
 339     for ($prockey = 0; $prockey < $proccount; ++$prockey) {
 340         $clm_total_charges += $claim->cptCharges($prockey);
 341     }
 342     if (!$clm_total_charges) {
 343         $log .= "*** This claim has no charges!\n";
 344     }
 345         ++$edicount;
 346         $out .= "CLM" .       // Loop 2300 Claim
 347             "*" . $pid . "-" . $encounter .
 348             "*"  . sprintf("%.2f", $clm_total_charges) . // Zirmed computes and replaces this
 349             "*"  .
 350             "*"  ;
 351     // Service location this need to be bill type from ub form type_of_bill
 352     if (strlen($ub04id[7]) >= 3) {
 353         $out .= "*" . substr($ub04id[7], 1, 1) . ":" . substr($ub04id[7], 2, 1) . ":" . substr($ub04id[7], 3, 1);
 354     }
 355
 356     $out .= "*" .
 357         "*" . "A" .
 358         "*" . ($claim->billingFacilityAssignment() ? 'Y' : 'N') .
 359         "*" . "Y" .
 360         "~\n";
 361     // discharge hour
 362     if ($ub04id[29]) {
 363         ++ $edicount;
 364         $out .= "DTP" . // Loop 2300
 365         "*" . "096" .
 366         "*" . "TM" .
 367         "*" . $ub04id[29] .
 368         "~\n";
 369     }
 370
 371     // Statment Dates
 372     // DTP 434 RD8 (Statment from OR to date)
 373
 374     if ($ub04id[13]) {
 375         ++ $edicount;
 376
 377         $tmp = x12date($ub04id[13]);
 378         $tmp1 = x12date($ub04id[14]);
 379         $out .= "DTP" . // Loop 2300
 380         "*434" . "*" . "RD8" . "*" . $tmp . '-' . $tmp1 . "~\n";
 381     }
 382
 383     if ($ub04id[13]) {
 384         ++ $edicount;
 385         $tmp = x12date($ub04id[25]);
 386         $out .= "DTP" . // Loop 2300
 387         "*435" . "*" . "DT" . "*" . $tmp . $ub04id[26] . "~\n";
 388     }
 389
 390     if (strlen(trim($ub04id[13])) == 0) {
 391         $log .= "*** Error: No Admission Date Entered!\n";
 392     }
 393
 394     // Repricer Received Date
 395     // DTP 050 D8 (Admission Date and Hour from form)
 396
 397     // Institutional Claim Code
 398     // CL1 (Admission Type Code) (Admission Source Code) (Patient Status Code)
 399
 400     if ($ub04id[27] != "014X") { // Type of bill
 401         ++ $edicount;
 402         $out .= "CL1" . // Loop 2300
 403         "*" . $ub04id[27] . "*" . $ub04id[28] . "*" . $ub04id[30] . "~\n";
 404     }
 405
 406     // Segment PWK (Claim Supplemental Information) omitted.
 407
 408     // Segment CN1 (Contract Information) omitted.
 409
 410     // Patient Estimated Amount Due
 411     // Check logic
 412
 413     // $patientpaid = $claim->patientPaidAmount();
 414     // if ($patientpaid != 0) {
 415     // ++$edicount;
 416     // $out .= "AMT" . // Patient paid amount. Page 190/220.
 417     // "*F5" .
 418     // "*" . $patientpaid .
 419     // "~\n";
 420     // }
 421
 422     // Segment REF*4N (Service Authorization Exception Code) omitted.
 423     // Segment REF*9F (Referral Number) omitted.
 424
 425     // Prior Authorization
 426     //
 427     if ($claim->priorAuth()) {
 428         ++ $edicount;
 429         $out .= "REF" . // Prior Authorization Number
 430         "*G1" . "*" . $claim->priorAuth() . "~\n";
 431     }
 432
 433     // Segment REF*F8 (Payer Claim Control Number) omitted.
 434
 435     // This may be needed for the UB04 Claim if so change the 'MB' to 'MA'
 436     // if ($claim->cliaCode() && ($CMS_5010 || $claim->claimType() === 'MB')) {
 437     // Required by Medicare when in-house labs are done.
 438     // ++$edicount;
 439     // $out .= "REF" . // Clinical Laboratory Improvement Amendment Number
 440     // "*X4" .
 441     // "*" . $claim->cliaCode() .
 442     // "~\n";
 443     // }
 444
 445     // Segment REF*9A (Repriced Claim Number) omitted.
 446     // Segment REF*9C (Adjusted Repriced Claim Number) omitted.
 447     // Segment REF*LX (Investigational Device Exemption Number) omitted.
 448     // Segment REF*S9 (Claim Identifier for Transmission Intermediaries) omitted.
 449     // Segment REF*LU (Auto Accident State) omitted.
 450     // Segment REF*EA (Medical Record Number) omitted.
 451     // Segment REF*P4 (Demonstration Project Identifier) omitted.
 452     // Segment REF*G4 (Peer Review Organization PRO Approval Number) omitted.
 453     // Segment K3 (File Information) omitted.
 454
 455     if ($claim->additionalNotes()) {
 456         // Claim Note
 457         // Has a list of valid codes. Required when PROVIDER deems necessary
 458
 459         // Billing note.
 460         // Check to verify I am getting this information on the ub04 form
 461
 462         ++ $edicount;
 463         $out .= "NTE" . // comments box 19
 464         "*" . "ADD" . "*" . $claim->additionalNotes() . "~\n";
 465     }
 466
 467     // Segment CRC (EPSDT Referral) omitted.
 468     // Diagnoses, up to $max_per_seg per HI segment. Check this
 469     $max_per_seg = 18;
 470     $da = $claim->diagArray();
 471     $diag_type_code = 'ABK'; // ICD10
 472     $tmp = 0;
 473     foreach ($da as $diag) {
 474         if ($tmp == 1) {
 475             continue;
 476         }
 477         if ($tmp % $max_per_seg == 0) {
 478             if ($tmp) {
 479                 $out .= "~\n";
 480             }
 481             ++ $edicount;
 482             $out .= "HI"; // Health Diagnosis Codes
 483         }
 484         $out .= "*" . $diag_type_code . ":" . $diag;
 485         if ($claim->diagtype == "ICD9") {
 486             $diag_type_code = 'BF';
 487         } else {
 488             $diag_type_code = 'ABF';
 489         }
 490
 491         ++ $tmp;
 492     }
 493     if ($tmp) {
 494         $out .= "~\n";
 495     }
 496
 497     // Segment HI*BI (Occurrence Span Information).
 498     // HI BI (Occurrence Span Code 1) RD8 (Occurrence Span Code Associated Date)
 499     if ($ub04id[52]) {
 500         $max_per_seg = 4;
 501         $diag_type_code = 'BI';
 502         $tmp = 0;
 503         $os = 52;
 504         for ($i = 0; $i <= 3;) {
 505             if ($tmp % $max_per_seg == 0) {
 506                 if ($tmp) {
 507                     $out .= "~\n";
 508                 }
 509                 ++ $edicount;
 510                 $out .= "HI"; // Health Diagnosis Codes
 511             }
 512             if ($ub04id[$os]) {
 513                 $out .= "*" . $diag_type_code . ":" . $ub04id[$os ++] . ":" . x12date($ub04id[$os ++]) . ":" . x12date($ub04id[$os ++]);
 514                 $diag_type_code = 'BI';
 515             }
 516             if ($os >= 57) {
 517                 $os = 67;
 518             }
 519             ++ $tmp;
 520             ++ $i;
 521         }
 522         if ($tmp) {
 523             $out .= "~\n";
 524         }
 525     }
 526
 527     // Segment HI*BH (Occurrence Information).
 528     // HI BH (Occurrence Code 1) D8 (Occurrence Code Associated Date)
 529
 530     if ($ub04id[44]) {
 531         $max_per_seg = 8;
 532         $diag_type_code = 'BH';
 533         $tmp = 0;
 534         $os = 44;
 535         for ($i = 0; $i <= 7;) {
 536             if ($tmp % $max_per_seg == 0) {
 537                 if ($tmp) {
 538                     $out .= "~\n";
 539                 }
 540                 ++ $edicount;
 541                 $out .= "HI"; // Health Diagnosis Codes
 542             }
 543             if ($ub04id[$os]) {
 544                 $out .= "*" . $diag_type_code . ":" . $ub04id[$os] . ":D8" . ":" . x12date($ub04id[$os ++]);
 545                 $diag_type_code = 'BH';
 546             }
 547             if ($os >= 51) {
 548                 $os = 59;
 549             }
 550             ++ $tmp;
 551             ++ $i;
 552         }
 553         if ($tmp) {
 554             $out .= "~\n";
 555         }
 556     }
 557
 558     // Segment HI*BE (Value Information).
 559     // HI BE (Value Code 1) *.* (Value Code Amount)
 560
 561     if ($ub04id[74]) {
 562         $max_per_seg = 12;
 563         $diag_type_code = 'BE';
 564         $os = 74;
 565         $tmp = 0;
 566         for ($i = 0; $i <= 11;) {
 567             if ($tmp % $max_per_seg == 0) {
 568                 if ($tmp) {
 569                     $out .= "~\n";
 570                 }
 571                 ++ $edicount;
 572                 $out .= "HI"; // Health Diagnosis Codes
 573             }
 574             if ($ub04id[$os]) {
 575                 // if ($i=1) {
 576                 $out .= "*" . $diag_type_code . ":" . $ub04id[$os ++] . ":" . ":" . x12date($ub04id[$os ++]);
 577                 $diag_type_code = 'BE';
 578                 // }
 579             }
 580             ++ $tmp;
 581             ++ $i;
 582         }
 583         if ($tmp) {
 584             $out .= "~\n";
 585         }
 586     }
 587
 588     // Segment HI*BG (Condition Information).
 589     // HI BG (Condition Code 1)
 590
 591     if ($ub04id[31]) {
 592         $max_per_seg = 11;
 593         $diag_type_code = 'BG';
 594         $os = 31;
 595         $tmp = 0;
 596         for ($i = 0; $i <= 10;) {
 597             if ($tmp % $max_per_seg == 0) {
 598                 if ($tmp) {
 599                     $out .= "~\n";
 600                 }
 601                 ++ $edicount;
 602                 $out .= "HI"; // Health Diagnosis Codes
 603             }
 604             if ($ub04id[$os]) {
 605                 // if ($i=1) {
 606                 $out .= "*" . $diag_type_code . ":" . $ub04id[$os ++];
 607                 $diag_type_code = 'BG';
 608                 // }
 609             }
 610
 611             ++ $tmp;
 612             ++ $i;
 613         }
 614         if ($tmp) {
 615             $out .= "~\n";
 616         }
 617     }
 618
 619     // Segment HI*TC (Treatment Code Information).
 620     // HI TC (Treatment Code 1)
 621     /* 63a. TREATMENT AUTHORIZATION CODES - PRIMARY PLAN */
 622     if ($ub04id[319]) {
 623         $max_per_seg = 3;
 624         $diag_type_code = 'TC';
 625         $tmp = 0;
 626
 627         for ($i = 0; $i <= 2;) {
 628             if ($tmp % $max_per_seg == 0) {
 629                 if ($tmp) {
 630                     $out .= "~\n";
 631                 }
 632                 ++ $edicount;
 633                 $out .= "HI"; // Health Diagnosis Codes
 634             }
 635
 636             if ($ub04id[319]) {
 637                 $out .= "*" . $diag_type_code . ":" . $ub04id[319];
 638                 $diag_type_code = 'TC';
 639             }
 640             if ($i = 1) {
 641                 if ($ub04id[322]) {
 642                     $out .= "*" . $diag_type_code . ":" . $ub04id[322];
 643                     $diag_type_code = 'TC';
 644                 }
 645             }
 646             if ($i = 2) {
 647                 if ($ub04id[325]) {
 648                     $out .= "*" . $diag_type_code . ":" . $ub04id[325];
 649                     $diag_type_code = 'TC';
 650                 }
 651             }
 652
 653             ++ $tmp;
 654             ++ $i;
 655         }
 656         if ($tmp) {
 657             $out .= "~\n";
 658         }
 659     }
 660
 661     // Segment HCP (Claim Pricing/Repricing Information) omitted.
 662
 663     // This needs to allow Attending Physician 2310A, Operating Physician Name 2310B, Other Operating Physician Name 2310C
 664     // and Rendering Provider Name (Rendering Provider Name is futher down)
 665
 666     if ($ub04id[388]) {
 667         ++ $edicount;
 668         // Loop 2310A Attending Physician
 669         $out .= "NM1" . "*71" . "*1" . "*" . $ub04id[388] . "*" . $ub04id[389] . "*" . "*";
 670         if ($ub04id[379]) { // NPI
 671             $out .= "*" . "XX" . "*" . $ub04id[379];
 672         } else {
 673             $out .= "*" . "*";
 674             $log .= "*** Attending Physician has no NPI.\n";
 675         }
 676         $out .= "~\n";
 677
 678         if ($ub04id[380]) {
 679             ++ $edicount;
 680             $out .= "REF" . // Attending Physician Secondary Identification
 681             "*" . $ub04id[380] . "*" . $ub04id[381] . "~\n";
 682         }
 683     }
 684
 685     // 2310B
 686
 687     if ($ub04id[400]) {
 688         ++ $edicount;
 689
 690         $out .= "NM1" . // Loop 2310B operating Physician
 691         "*72" . "*1" . "*" . $ub04id[400] . "*" . $ub04id[400] . "*" . "*";
 692         if ($ub04id[390]) {
 693             $out .= "*" . "XX" . "*" . $ub04id[390];
 694         } else {
 695             $out .= "*" . "*";
 696             $log .= "*** Operating Physician has no NPI qualifier.\n";
 697         }
 698         $out .= "~\n";
 699
 700         if ($ub04id[391]) {
 701             ++ $edicount;
 702             $out .= "REF" . // operating Physician Secondary Identification
 703             "*" . $claim->$ub04id[391] . "*" . $ub04id[392] . "~\n";
 704         }
 705     }
 706
 707     // 2310C
 708
 709     if ($ub04id[413]) {
 710         ++ $edicount;
 711
 712         $out .= "NM1" . // Loop 2310C other operating Physician
 713         "*73" . "*1" . "*" . $ub04id[413] . "*" . $ub04id[414] . "*" . "*";
 714         if ($ub04id[405]) {
 715             $out .= "*" . $ub04id[405] . "*" . $ub04id[406];
 716         } else {
 717             $out .= "*" . "*";
 718             $log .= "*** Other Operating Physician has no NPI.\n";
 719         }
 720         $out .= "~\n";
 721
 722         if ($ub04id[407]) {
 723             ++ $edicount;
 724             $out .= "REF" . // other operating Physician Secondary Identification
 725             "*" . $ub04id[407] . "*" . $ub04id[408] . "~\n";
 726         }
 727     }
 728     if ($ub04id[427]) {
 729         ++ $edicount;
 730
 731         $out .= "NM1" . // Loop 2310C other operating Physician
 732         "*73" . "*1" . "*" . $ub04id[427] . "*" . $ub04id[428] . "*" . "*";
 733         if ($ub04id[420]) {
 734             $out .= "*" . $ub04id[419] . "*" . $ub04id[420];
 735         } else {
 736             $out .= "*" . "*";
 737             $log .= "*** Other Operating Physician has no NPI.\n";
 738         }
 739         $out .= "~\n";
 740
 741         if ($ub04id[422]) {
 742             ++ $edicount;
 743             $out .= "REF" . // other operating Physician Secondary Identification
 744             "*" . $ub04id[422] . "*" . $ub04id[421] . "~\n";
 745         }
 746     }
 747     /*
 748      * Per the implementation guide lines, only include this information if it is different
 749      * than the Loop 2010AA information
 750      */
 751     if ($claim->providerNPIValid() && $claim->billingFacilityNPI() !== $claim->providerNPI()) {
 752         ++ $edicount;
 753         $out .= "NM1" . // Loop 2310D Rendering Provider
 754         "*82" . "*1" . "*" . $claim->providerLastName() . "*" . $claim->providerFirstName() . "*" . $claim->providerMiddleName() . "*" . "*";
 755         if ($claim->providerNPI()) {
 756             $out .= "*XX" . "*" . $claim->providerNPI();
 757         } else {
 758             $log .= "*** Rendering provider has no NPI.\n";
 759         }
 760         $out .= "~\n";
 761
 762         // End of Loop 2310D
 763     } else {
 764         // This loop can only get skipped if we are generating a 5010 claim
 765         if (! ($claim->providerNPIValid())) {
 766             //If the loop was skipped because the provider NPI was invalid, generate a warning for the log.
 767             $log .= "*** Skipping 2310B because " . $claim->providerLastName() . "," . $claim->providerFirstName() . " has invalid NPI.\n";
 768         }
 769         /*
 770          * Skipping this segment because the providerNPI and the billingFacilityNPI are identical
 771          * is a normal condition, so no need to warn.
 772          */
 773     }
 774
 775     // 5010 spec says nothing here if NPI was specified.
 776     //
 777     if (! $claim->providerNPI() && in_array($claim->providerNumberType(), array('0B', '1G', 'G2', 'LU'))) {
 778         if ($claim->providerNumber()) {
 779             ++ $edicount;
 780             $out .= "REF" . "*" . $claim->providerNumberType() . "*" . $claim->providerNumber() . "~\n";
 781         }
 782     }
 783
 784     // Loop 2310D is omitted in the case of home visits (POS=12).
 785     if ($claim->facilityPOS() != 12 && ($claim->facilityNPI() != $claim->billingFacilityNPI())) {
 786         ++ $edicount;
 787
 788         // Service Facility Name
 789
 790         $out .= "NM1" . // Loop 2310E Service Location
 791         "*77" . "*2";
 792         $facilityName = substr($claim->facilityName(), 0, 60);
 793         if ($claim->facilityName() || $claim->facilityNPI() || $claim->facilityETIN()) {
 794             $out .= "*" . $facilityName;
 795         }
 796         if ($claim->facilityNPI() || $claim->facilityETIN()) {
 797             $out .= "*" . "*" . "*" . "*";
 798             if ($claim->facilityNPI()) {
 799                 $out .= "*XX*" . $claim->facilityNPI();
 800             } else {
 801                 $log .= "*** Service location has no NPI.\n";
 802             }
 803         }
 804         $out .= "~\n";
 805         if ($claim->facilityStreet()) {
 806             ++ $edicount;
 807             $out .= "N3" . "*" . $claim->facilityStreet() . "~\n";
 808         }
 809         if ($claim->facilityState()) {
 810             ++ $edicount;
 811             $out .= "N4" . "*" . $claim->facilityCity() . "*" . $claim->facilityState() . "*" . $claim->x12Zip($claim->facilityZip()) . "~\n";
 812         }
 813     }
 814
 815     // Segment REF (Service Facility Location Secondary Identification) omitted.
 816     // Segment PER (Service Facility Contact Information) omitted.
 817
 818     // Loop 2310F Referring Provider
 819
 820     if ($claim->referrerLastName()) {
 821         // Medicare requires referring provider's name and UPIN.
 822         ++ $edicount;
 823
 824         $out .= "NM1" . // Loop 2310F Referring Provider this needs to change position
 825         "*DN" . "*1" . "*" . $claim->referrerLastName() . "*" . $claim->referrerFirstName() . "*" . $claim->referrerMiddleName() . "*" . "*";
 826         if ($claim->referrerNPI()) {
 827             $out .= "*XX" . "*" . $claim->referrerNPI();
 828         } else {
 829             $log .= "*** Referrer has no NPI.\n";
 830         }
 831         $out .= "~\n";
 832     }
 833
 834     // Loop 2310E, Supervising Provider
 835     // Omitted
 836
 837     // Segments NM1*PW, N3, N4 (Ambulance Pick-Up Location) omitted.
 838     // Segments NM1*45, N3, N4 (Ambulance Drop-Off Location) omitted.
 839
 840     $prev_pt_resp = $clm_total_charges; // for computation below
 841
 842     // Loops 2320 and 2330*, other subscriber/payer information.
 843     // Remember that insurance index 0 is always for the payer being billed
 844     // by this claim, and 1 and above are always for the "other" payers.
 845     //
 846     for ($ins = 1; $ins < $claim->payerCount(); ++ $ins) {
 847         $tmp1 = $claim->claimType($ins);
 848         $tmp2 = 'C1'; // Here a kludge. See page 321.
 849         if ($tmp1 === 'CI') {
 850             $tmp2 = 'C1';
 851         }
 852         if ($tmp1 === 'AM') {
 853             $tmp2 = 'AP';
 854         }
 855         if ($tmp1 === 'HM') {
 856             $tmp2 = 'HM';
 857         }
 858         if ($tmp1 === 'MB') {
 859             $tmp2 = 'MB';
 860         }
 861         if ($tmp1 === 'MA') {
 862             $tmp2 = 'MA';
 863         }
 864         if ($tmp1 === 'MC') {
 865             $tmp2 = 'MC';
 866         }
 867         if ($tmp1 === '09') {
 868             $tmp2 = 'PP';
 869         }
 870         ++ $edicount;
 871
 872         $out .= "SBR" . // Loop 2320, Subscriber Information - page 297/318
 873         "*" . $claim->payerSequence($ins) .
 874         "*" . $claim->insuredRelationship($ins) .
 875         "*" . $claim->groupNumber($ins) .
 876         "*" . (($claim->groupNumber($ins)) ? '' : $claim->groupName($ins)) .
 877         "*" . ($claim->insuredTypeCode($ins) ? $claim->insuredTypeCode($ins) : $tmp2) .
 878         "*" .
 879         "*" .
 880         "*" .
 881         "*" . $claim->claimType($ins) .
 882         "~\n";
 883
 884         // Things that apply only to previous payers, not future payers.
 885         //
 886         if ($claim->payerSequence($ins) < $claim->payerSequence()) {
 887             // Generate claim-level adjustments.
 888             $aarr = $claim->payerAdjustments($ins);
 889             foreach ($aarr as $a) {
 890                 ++ $edicount;
 891                 $out .= "CAS" . // Previous payer's claim-level adjustments. Page 301/323.
 892                 "*" . $a[1] . "*" . $a[2] . "*" . $a[3] . "~\n";
 893             }
 894
 895             $payerpaid = $claim->payerTotals($ins);
 896             ++ $edicount;
 897             $out .= "AMT" . // Previous payer's paid amount. Page 307/332.
 898             "*D" . "*" . $payerpaid[1] . "~\n";
 899
 900             // Segment AMT*A8 (COB Total Non-Covered Amount) omitted.
 901             // Segment AMT*EAF (Remaining Patient Liability) omitted.
 902         } // End of things that apply only to previous payers.
 903
 904         ++ $edicount;
 905         $out .= "OI" . // Other Insurance Coverage Information. Page 310/344.
 906         "*" . "*" . "*" . ($claim->billingFacilityAssignment($ins) ? 'Y' : 'N') .
 907         // For this next item, the 5010 example in the spec does not match its
 908         // description. So this might be wrong.
 909         "*" .
 910         "*" .
 911         "*" .
 912         "Y" .
 913         "~\n";
 914
 915         // Segment MOA (Medicare Outpatient Adjudication) omitted.
 916         ++$edicount;
 917         $out .= "NM1" . // Loop 2330A Subscriber info for other insco. Page 315/350.
 918             "*" . "IL" .
 919             "*" . "1" .
 920             "*" . $claim->insuredLastName($ins) .
 921             "*" . $claim->insuredFirstName($ins) .
 922             "*" . $claim->insuredMiddleName($ins) .
 923             "*" .
 924             "*" .
 925             "*" . "MI" .
 926             "*" . $claim->policyNumber($ins) .
 927             "~\n";
 928
 929         ++$edicount;
 930         $out .= "N3" .
 931             "*" . $claim->insuredStreet($ins) .
 932             "~\n";
 933
 934         ++$edicount;
 935         $out .= "N4" .
 936             "*" . $claim->insuredCity($ins) .
 937             "*" . $claim->insuredState($ins) .
 938             "*" . $claim->x12Zip($claim->insuredZip($ins)) .
 939             "~\n";
 940
 941         // Segment REF (Other Subscriber Secondary Identification) omitted.
 942         ++$edicount;
 943         $payerName = substr($claim->payerName($ins), 0, 60);
 944         $out .= "NM1" . // Loop 2330B Payer info for other insco. Page 322/359.
 945             "*" . "PR" .
 946             "*" . "2" .
 947             "*" . $payerName .
 948             "*" .
 949             "*" .
 950             "*" .
 951             "*" .
 952             "*" . "PI" .
 953             "*" . $claim->payerID($ins) .
 954             "~\n";
 955
 956         if (!$claim->payerID($ins)) {
 957             $log .= "*** CMS ID is missing for payer '" . $claim->payerName($ins) . "'.\n";
 958         }
 959
 960         ++$edicount;
 961         $out .= "N3" .
 962             "*" . $claim->payerStreet($ins) .
 963             "~\n";
 964
 965         ++$edicount;
 966         $out .= "N4" .
 967             "*" . $claim->payerCity($ins) .
 968             "*" . $claim->payerState($ins) .
 969             "*" . $claim->x12Zip($claim->payerZip($ins)) .
 970             "~\n";
 971
 972         // Segment DTP*573 (Claim Check or Remittance Date) omitted.
 973         // Segment REF (Other Payer Secondary Identifier) omitted.
 974         // Segment REF*G1 (Other Payer Prior Authorization Number) omitted.
 975         // Segment REF*9F (Other Payer Referral Number) omitted.
 976         // Segment REF*T4 (Other Payer Claim Adjustment Indicator) omitted.
 977         // Segment REF*F8 (Other Payer Claim Control Number) omitted.
 978         // 2330C-I loops Omitted
 979     } // End loops 2320/2330*.
 980
 981     $loopcount = 0;
 982
 983     // Procedure loop starts here.
 984     //
 985
 986     for ($tlh = 0; $tlh < $proccount; ++ $tlh) {
 987         $tmp = $claim->procs[$tlh][code_text];
 988
 989         if ($claim->procs[$tlh][code_type] == 'HCPCS') {
 990             $tmpcode = '3';
 991         } else {
 992             $tmpcode = '1';
 993         }
 994         $getrevcd = $claim->cptCode($tlh);
 995         $sql = "SELECT * FROM codes WHERE code_type = ? and code = ? ORDER BY revenue_code DESC";
 996         $revcode[$tlh] = sqlQuery($sql, array(
 997             $tmpcode,
 998             $getrevcd
 999         ));
1000     }
1001
1002
1003     for ($prockey = 0; $prockey < $proccount; ++ $prockey) {
1004         $os = 99 + ($loopcount * 8); // Form revenue code offset
1005         $dosos = 102 + ($loopcount * 8); // Procedure date of service form start offset-add 8 for loop
1006         ++ $loopcount;
1007
1008         ++ $edicount;
1009         $out .= "LX" . // Loop 2400 LX Service Line. Page 398.
1010         "*" . "$loopcount" . "~\n";
1011
1012         ++ $edicount;
1013
1014         // Revenue code from form
1015         //
1016         $tmp = $ub04id[$os]; //$revcode[$prockey][revenue_code];
1017         if (empty($tmp)) {
1018             $log .= "*** Error: Missing Revenue Code for " . $claim->cptKey($prockey) . "!\n";
1019         }
1020         // Institutional Service Line.
1021         //
1022         $out .= "SV2" .  "*" . $tmp . // revenue code
1023
1024         "*" . "HC:" . $claim->cptKey($prockey) . "*" . sprintf('%.2f', $claim->cptCharges($prockey)) . "*UN" . "*" . $claim->cptUnits($prockey) . "*" . "*" . "*";
1025
1026         $out .= "~\n";
1027
1028         if (! $claim->cptCharges($prockey)) {
1029             $log .= "*** Procedure '" . $claim->cptKey($prockey) . "' has no charges!\n";
1030         }
1031
1032         // Segment SV5 (Durable Medical Equipment Service) omitted.
1033         // Segment PWK (Line Supplemental Information) omitted.
1034         // Segment PWK (Durable Medical Equipment Certificate of Medical Necessity Indicator) omitted.
1035         // Segment CR1 (Ambulance Transport Information) omitted.
1036         // Segment CR3 (Durable Medical Equipment Certification) omitted.
1037         // Segment CRC (Ambulance Certification) omitted.
1038         // Segment CRC (Hospice Employee Indicator) omitted.
1039         // Segment CRC (Condition Indicator / Durable Medical Equipment) omitted.
1040
1041         ++ $edicount;
1042
1043         $out .= "DTP" . // Date of Service. Needs to be when service preformed.
1044             "*" . "472" . "*" . "D8" . "*" . $ub04id[$dosos] . "~\n"; //$claim->serviceDate()
1045
1046         $testnote = rtrim($claim->cptNotecodes($prockey));
1047         if (! empty($testnote)) {
1048             ++ $edicount;
1049             $out .= "NTE" . // Explain Unusual Circumstances.
1050             "*ADD" . "*" . $claim->cptNotecodes($prockey) . "~\n";
1051         }
1052
1053         // Segment DTP*471 (Prescription Date) omitted.
1054         // Segment DTP*607 (Revision/Recertification Date) omitted.
1055         // Segment DTP*463 (Begin Therapy Date) omitted.
1056         // Segment DTP*461 (Last Certification Date) omitted.
1057         // Segment DTP*304 (Last Seen Date) omitted.
1058         // Segment DTP (Test Date) omitted.
1059         // Segment DTP*011 (Shipped Date) omitted.
1060         // Segment DTP*455 (Last X-Ray Date) omitted.
1061         // Segment DTP*454 (Initial Treatment Date) omitted.
1062         // Segment QTY (Ambulance Patient Count) omitted.
1063         // Segment QTY (Obstetric Anesthesia Additional Units) omitted.
1064         // Segment MEA (Test Result) omitted.
1065         // Segment CN1 (Contract Information) omitted.
1066         // Segment REF*9B (Repriced Line Item Reference Number) omitted.
1067         // Segment REF*9D (Adjusted Repriced Line Item Reference Number) omitted.
1068         // Segment REF*G1 (Prior Authorization) omitted.
1069         // Segment REF*6R (Line Item Control Number) omitted.
1070         // (Really oughta have this for robust 835 posting!)
1071         // Segment REF*EW (Mammography Certification Number) omitted.
1072         // Segment REF*X4 (CLIA Number) omitted.
1073         // Segment REF*F4 (Referring CLIA Facility Identification) omitted.
1074         // Segment REF*BT (Immunization Batch Number) omitted.
1075         // Segment REF*9F (Referral Number) omitted.
1076         // Segment AMT*GT (Sales Tax Amount) omitted.
1077         // Segment AMT*F4 (Postage Claimed Amount) omitted.
1078         // Segment K3 (File Information) omitted.
1079         // Segment NTE (Line Note) omitted.
1080         // Segment NTE (Third Party Organization Notes) omitted.
1081         // Segment PS1 (Purchased Service Information) omitted.
1082         // Segment HCP (Line Pricing/Repricing Information) omitted.
1083
1084         // Loop 2410, Drug Information. Medicaid insurers seem to want this
1085         // with HCPCS codes.
1086         //
1087         $ndc = $claim->cptNDCID($prockey);
1088
1089         if ($ndc) {
1090             ++$edicount;
1091             $out .= "LIN" . // Drug Identification. Page 500+ (Addendum pg 71).
1092                 "*" .         // Per addendum, LIN01 is not used.
1093                 "*" . "N4" .
1094                 "*" . $ndc .
1095                 "~\n";
1096
1097             if (!preg_match('/^\d\d\d\d\d-\d\d\d\d-\d\d$/', $ndc, $tmp) && !preg_match('/^\d{11}$/', $ndc)) {
1098                 $log .= "*** NDC code '$ndc' has invalid format!\n";
1099             }
1100
1101             ++$edicount;
1102             $out .= "CTP" . // Drug Pricing. Page 500+ (Addendum pg 74).
1103                 "*" .
1104                 "*" .
1105                 "*" .
1106                 "*" . $claim->cptNDCQuantity($prockey) .
1107                 "*" . $claim->cptNDCUOM($prockey) .
1108                 // Note: 5010 documents "ME" (Milligrams) as an additional unit of measure.
1109             "~\n";
1110         }
1111
1112         // Segment REF (Prescription or Compound Drug Association Number) omitted.
1113
1114         // Loop 2420A, Rendering Provider (service-specific). (Operating Physician Name for 837I)
1115         // Used if the rendering provider for this service line is different
1116         // from that in loop 2310B.
1117         //
1118         if ($claim->providerNPI() != $claim->providerNPI($prockey)) {
1119             ++$edicount;
1120             $out .= "NM1" .       // Loop 2310B Rendering Provider
1121                 "*" . "82" .
1122                 "*" . "1" .
1123                 "*" . $claim->providerLastName($prockey) .
1124                 "*" . $claim->providerFirstName($prockey) .
1125                 "*" . $claim->providerMiddleName($prockey) .
1126                 "*" .
1127                 "*";
1128             if ($claim->providerNPI($prockey)) {
1129                 $out .=
1130                 "*" . "XX" .
1131                 "*" . $claim->providerNPI($prockey);
1132             } else {
1133                 $log .= "*** Rendering provider has no NPI.\n";
1134             }
1135             $out .= "~\n";
1136
1137             if ($claim->providerTaxonomy($prockey)) {
1138                 ++$edicount;
1139                 $out .= "PRV" .
1140                     "*" . "PE" . // PErforming provider
1141                     "*" . "PXC" .
1142                     "*" . $claim->providerTaxonomy($prockey) .
1143                     "~\n";
1144             }
1145
1146             // Segment PRV*PE (Rendering Provider Specialty Information) omitted.
1147             // Segment REF (Rendering Provider Secondary Identification) omitted.
1148             // Segment NM1 (Purchased Service Provider Name) omitted.
1149             // Segment REF (Purchased Service Provider Secondary Identification) omitted.
1150             // Segment NM1,N3,N4 (Service Facility Location) omitted.
1151             // Segment REF (Service Facility Location Secondary Identification) omitted.
1152             // Segment NM1 (Supervising Provider Name) omitted.
1153             // Segment REF (Supervising Provider Secondary Identification) omitted.
1154             // Segment NM1,N3,N4 (Ordering Provider) omitted.
1155             // Segment REF (Ordering Provider Secondary Identification) omitted.
1156             // Segment PER (Ordering Provider Contact Information) omitted.
1157             // Segment NM1 (Referring Provider Name) omitted.
1158             // Segment REF (Referring Provider Secondary Identification) omitted.
1159             // Segments NM1*PW, N3, N4 (Ambulance Pick-Up Location) omitted.
1160             // Segments NM1*45, N3, N4 (Ambulance Drop-Off Location) omitted.
1161
1162             // REF*1C is required here for the Medicare provider number if NPI was
1163             // specified in NM109. Not sure if other payers require anything here.
1164             if ($claim->providerNumberType($prockey) == "G2") {
1165                 ++$edicount; $out .= "REF" . "*" . $claim->providerNumberType($prockey) .
1166                 "*" . $claim->providerNumber($prockey) . "~\n";
1167             }
1168         } // provider exception
1169
1170         // Loop 2430, adjudication by previous payers.
1171         //
1172         for ($ins = 1; $ins < $claim->payerCount(); ++ $ins) {
1173             if ($claim->payerSequence($ins) > $claim->payerSequence()) {
1174                 continue; // payer is future, not previous
1175             }
1176
1177             $payerpaid = $claim->payerTotals($ins, $claim->cptKey($prockey));
1178             $aarr = $claim->payerAdjustments($ins, $claim->cptKey($prockey));
1179
1180             if ($payerpaid[1] == 0 && ! count($aarr)) {
1181                 $log .= "*** Procedure '" . $claim->cptKey($prockey) . "' has no payments or adjustments from previous payer!\n";
1182                 continue;
1183             }
1184
1185             ++ $edicount;
1186             $out .= "SVD" . // Service line adjudication. Page 554.
1187             "*" . $claim->payerID($ins) . "*" . $payerpaid[1] . "*HC:" . $claim->cptKey($prockey) . "*" . "*" . $claim->cptUnits($prockey) . "~\n";
1188
1189             $tmpdate = $payerpaid[0];
1190             foreach ($aarr as $a) {
1191                 ++ $edicount;
1192                 $out .= "CAS" . // Previous payer's line level adjustments. Page 558.
1193                 "*" . $a[1] . "*" . $a[2] . "*" . $a[3] . "~\n";
1194                 if (! $tmpdate) {
1195                     $tmpdate = $a[0];
1196                 }
1197             }
1198
1199             if ($tmpdate) {
1200                 ++ $edicount;
1201                 $out .= "DTP" . // Previous payer's line adjustment date. Page 493/566.
1202                 "*573" . "*D8" . "*$tmpdate" . "~\n";
1203             }
1204
1205             // Segment AMT*EAF (Remaining Patient Liability) omitted.
1206             // Segment LQ (Form Identification Code) omitted.
1207             // Segment FRM (Supporting Documentation) omitted.
1208         } // end loop 2430
1209     } // end this procedure
1210
1211     ++ $edicount;
1212     $out .= "SE" . // SE Trailer
1213     "*$edicount" . "*0021" . "~\n";
1214
1215     $out .= "GE" . // GE Trailer
1216     "*1" . "*1" . "~\n";
1217
1218     $out .= "IEA" . // IEA Trailer
1219     "*1" . "*000000001" . "~\n";
1220
1221     // Remove any trailing empty fields (delimiters) from each segment.
1222     $out = preg_replace('/\*+~/', '~', $out);
1223
1224     $log .= "\n";
1225     return $out;
1226 }