library/sl_eob.inc.php

   1 <?php
   2   // Copyright (C) 2005-2009 Rod Roark <rod@sunsetsystems.com>
   3   //
   4   // This program is free software; you can redistribute it and/or
   5   // modify it under the terms of the GNU General Public License
   6   // as published by the Free Software Foundation; either version 2
   7   // of the License, or (at your option) any later version.
   8
   9   require_once("patient.inc");
  10   require_once("billing.inc");
  11   require_once("invoice_summary.inc.php");
  12
  13   $chart_id_cash   = 0;
  14   $chart_id_ar     = 0;
  15   $chart_id_income = 0;
  16   $services_id     = 0;
  17
  18
  19   // Try to figure out our invoice number (pid.encounter) from the
  20   // claim ID and other stuff in the ERA.  This should be straightforward
  21   // except that some payers mangle the claim ID that we give them.
  22   //
  23 function slInvoiceNumber(&$out)
  24 {
  25     $invnumber = $out['our_claim_id'];
  26     $atmp = preg_split('/[ -]/', $invnumber);
  27     $acount = count($atmp);
  28
  29     $pid = 0;
  30     $encounter = 0;
  31     if ($acount == 2) {
  32         $pid = $atmp[0];
  33         $encounter = $atmp[1];
  34     } else if ($acount == 3) {
  35         $pid = $atmp[0];
  36         $brow = sqlQuery("SELECT encounter FROM billing WHERE " .
  37         "pid = '$pid' AND encounter = ? AND activity = 1", array($atmp[1]));
  38
  39         $encounter = $brow['encounter'];
  40     } else if ($acount == 1) {
  41         $pres = sqlStatement("SELECT pid FROM patient_data WHERE " .
  42         "lname LIKE ? AND " .
  43         "fname LIKE ? " .
  44         "ORDER BY pid DESC", array($out['patient_lname'], $out['patient_fname']));
  45         while ($prow = sqlFetchArray($pres)) {
  46             if (strpos($invnumber, $prow['pid']) === 0) {
  47                 $pid = $prow['pid'];
  48                 $encounter = substr($invnumber, strlen($pid));
  49                 break;
  50             }
  51         }
  52     }
  53
  54     if ($pid && $encounter) {
  55         $invnumber = "$pid.$encounter";
  56     }
  57
  58     return array($pid, $encounter, $invnumber);
  59 }
  60
  61   // This gets a posting session ID.  If the payer ID is not 0 and a matching
  62   // session already exists, then its ID is returned.  Otherwise a new session
  63   // is created.
  64   //
  65 function arGetSession($payer_id, $reference, $check_date, $deposit_date = '', $pay_total = 0)
  66 {
  67     if (empty($deposit_date)) {
  68         $deposit_date = $check_date;
  69     }
  70
  71     if ($payer_id) {
  72         $row = sqlQuery("SELECT session_id FROM ar_session WHERE " .
  73         "payer_id = ? AND reference = ? AND " .
  74         "check_date = ? AND deposit_date = ? " .
  75         "ORDER BY session_id DESC LIMIT 1", array($payer_id, $reference, $check_date, $deposit_date));
  76         if (!empty($row['session_id'])) {
  77             return $row['session_id'];
  78         }
  79     }
  80
  81     return sqlInsert("INSERT INTO ar_session ( " .
  82     "payer_id, user_id, reference, check_date, deposit_date, pay_total " .
  83     ") VALUES ( ?, ?, ?, ?, ?, ? )", array($payer_id, $_SESSION['authUserID'], $reference, $check_date, $deposit_date, $pay_total));
  84 }
  85   //writing the check details to Session Table on ERA proxcessing
  86 function arPostSession($payer_id, $check_number, $check_date, $pay_total, $post_to_date, $deposit_date, $debug)
  87 {
  88       $query = "INSERT INTO ar_session( " .
  89       "payer_id,user_id,closed,reference,check_date,pay_total,post_to_date,deposit_date,patient_id,payment_type,adjustment_code,payment_method " .
  90       ") VALUES (?, ?, 0, ?, ?, ?, ? ,?, 0, 'insurance', 'insurance_payment', 'electronic')";
  91     if ($debug) {
  92         echo text($query) . "<br>\n";
  93     } else {
  94         $sessionId=sqlInsert($query, array($payer_id, $_SESSION['authUserID'], 'ePay - '.$check_number, $check_date, $pay_total, $post_to_date, $deposit_date));
  95         return $sessionId;
  96     }
  97 }
  98
  99   // Post a payment, new style.
 100   //
 101 function arPostPayment($patient_id, $encounter_id, $session_id, $amount, $code, $payer_type, $memo, $debug, $time = '', $codetype = '')
 102 {
 103     $codeonly = $code;
 104     $modifier = '';
 105     $tmp = strpos($code, ':');
 106     if ($tmp) {
 107         $codeonly = substr($code, 0, $tmp);
 108         $modifier = substr($code, $tmp+1);
 109     }
 110
 111     if (empty($time)) {
 112         $time = date('Y-m-d H:i:s');
 113     }
 114
 115     sqlBeginTrans();
 116     $sequence_no = sqlQuery("SELECT IFNULL(MAX(sequence_no),0) + 1 AS increment FROM ar_activity WHERE pid = ? AND encounter = ?", array($patient_id, $encounter_id));
 117     $query = "INSERT INTO ar_activity ( " .
 118     "pid, encounter, sequence_no, code_type, code, modifier, payer_type, post_time, post_user, " .
 119     "session_id, memo, pay_amount " .
 120     ") VALUES (?, ?, ?, ?, ?, ?, ?, ?, ?, ?, ?, ?)";
 121     sqlStatement($query, array($patient_id, $encounter_id, $sequence_no['increment'], $codetype, $codeonly, $modifier, $payer_type, $time, $_SESSION['authUserID'], $session_id, $memo, $amount));
 122     sqlCommitTrans();
 123     return;
 124 }
 125
 126   // Post a charge.  This is called only from sl_eob_process.php where
 127   // automated remittance processing can create a new service item.
 128   // Here we add it as an unauthorized item to the billing table.
 129   //
 130 function arPostCharge($patient_id, $encounter_id, $session_id, $amount, $units, $thisdate, $code, $description, $debug, $codetype = '')
 131 {
 132     /*****************************************************************
 133     // Select an existing billing item as a template.
 134     $row= sqlQuery("SELECT * FROM billing WHERE " .
 135     "pid = '$patient_id' AND encounter = '$encounter_id' AND " .
 136     "code_type = 'CPT4' AND activity = 1 " .
 137     "ORDER BY id DESC LIMIT 1");
 138     $this_authorized = 0;
 139     $this_provider = 0;
 140     if (!empty($row)) {
 141     $this_authorized = $row['authorized'];
 142     $this_provider = $row['provider_id'];
 143     }
 144     *****************************************************************/
 145
 146     if (empty($codetype)) {
 147       // default to CPT4 if empty, which is consistent with previous functionality.
 148         $codetype="CPT4";
 149     }
 150
 151     $codeonly = $code;
 152     $modifier = '';
 153     $tmp = strpos($code, ':');
 154     if ($tmp) {
 155         $codeonly = substr($code, 0, $tmp);
 156         $modifier = substr($code, $tmp+1);
 157     }
 158
 159     addBilling(
 160         $encounter_id,
 161         $codetype,
 162         $codeonly,
 163         $description,
 164         $patient_id,
 165         0,
 166         0,
 167         $modifier,
 168         $units,
 169         $amount,
 170         '',
 171         ''
 172     );
 173 }
 174
 175   // Post an adjustment, new style.
 176   //
 177 function arPostAdjustment($patient_id, $encounter_id, $session_id, $amount, $code, $payer_type, $reason, $debug, $time = '', $codetype = '')
 178 {
 179     $codeonly = $code;
 180     $modifier = '';
 181     $tmp = strpos($code, ':');
 182     if ($tmp) {
 183         $codeonly = substr($code, 0, $tmp);
 184         $modifier = substr($code, $tmp+1);
 185     }
 186
 187     if (empty($time)) {
 188         $time = date('Y-m-d H:i:s');
 189     }
 190
 191     sqlBeginTrans();
 192     $sequence_no = sqlQuery("SELECT IFNULL(MAX(sequence_no),0) + 1 AS increment FROM ar_activity WHERE pid = ? AND encounter = ?", array($patient_id, $encounter_id));
 193     $query = "INSERT INTO ar_activity ( " .
 194     "pid, encounter, sequence_no, code_type, code, modifier, payer_type, post_user, post_time, " .
 195     "session_id, memo, adj_amount " .
 196     ") VALUES (?, ?, ?, ?, ?, ?, ?, ?, ?, ?, ?, ?)";
 197     sqlStatement($query, array($patient_id, $encounter_id, $sequence_no['increment'], $codetype, $codeonly, $modifier, $payer_type, $_SESSION['authUserID'], $time, $session_id, $reason, $amount));
 198     sqlCommitTrans();
 199     return;
 200 }
 201
 202 function arGetPayerID($patient_id, $date_of_service, $payer_type)
 203 {
 204     if ($payer_type < 1 || $payer_type > 3) {
 205         return 0;
 206     }
 207
 208     $tmp = array(1 => 'primary', 2 => 'secondary', 3 => 'tertiary');
 209     $value = $tmp[$payer_type];
 210     $query = "SELECT provider FROM insurance_data WHERE " .
 211     "pid = ? AND type = ? AND date <= ? " .
 212     "ORDER BY date DESC LIMIT 1";
 213     $nprow = sqlQuery($query, array($patient_id,$value,$date_of_service));
 214     if (empty($nprow)) {
 215         return 0;
 216     }
 217
 218     return $nprow['provider'];
 219 }
 220
 221   // Make this invoice re-billable, new style.
 222   //
 223 function arSetupSecondary($patient_id, $encounter_id, $debug, $crossover = 0)
 224 {
 225     if ($crossover==1) {
 226     //if claim forwarded setting a new status
 227         $status=6;
 228     } else {
 229         $status=1;
 230     }
 231
 232     // Determine the next insurance level to be billed.
 233     $ferow = sqlQuery("SELECT date, last_level_billed " .
 234     "FROM form_encounter WHERE " .
 235     "pid = ? AND encounter = ?", array($patient_id, $encounter_id));
 236     $date_of_service = substr($ferow['date'], 0, 10);
 237     $new_payer_type = 0 + $ferow['last_level_billed'];
 238     if ($new_payer_type < 3 && !empty($ferow['last_level_billed']) || $new_payer_type == 0) {
 239         ++$new_payer_type;
 240     }
 241
 242     $new_payer_id = arGetPayerID($patient_id, $date_of_service, $new_payer_type);
 243
 244     if ($new_payer_id) {
 245         // Queue up the claim.
 246         if (!$debug) {
 247             updateClaim(true, $patient_id, $encounter_id, $new_payer_id, $new_payer_type, $status, 5, '', 'hcfa', '', $crossover);
 248         }
 249     } else {
 250       // Just reopen the claim.
 251         if (!$debug) {
 252             updateClaim(true, $patient_id, $encounter_id, -1, -1, $status, 0, '', '', '', $crossover);
 253         }
 254     }
 255
 256     return xl("Encounter ") . $encounter . xl(" is ready for re-billing.");
 257 }