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gen_x12_837i.inc.php
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gen_x12_837i.inc.php
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<?php
/**
* X12 837I
*
* @package OpenEMR
* @link http:https://www.open-emr.org
* @author Jerry Padgett <[email protected]>
* @copyright Copyright (c) 2017 Jerry Padgett <[email protected]>
* @license https://github.com/openemr/openemr/blob/master/LICENSE GNU General Public License 3
*/
require_once(dirname(__FILE__) . "/invoice_summary.inc.php");
use OpenEMR\Billing\Claim;
function x12date($frmdate)
{
return ('20' . substr($frmdate, 4, 2) . substr($frmdate, 0, 2) . substr($frmdate, 2, 2));
}
$ub04id = array();
function generate_x12_837I($pid, $encounter, &$log, $ub04id)
{
$today = time();
$out = '';
$claim = new Claim($pid, $encounter);
$edicount = 0;
$log .= "Generating 837I claim $pid-$encounter for " .
$claim->patientFirstName() . ' ' .
$claim->patientMiddleName() . ' ' .
$claim->patientLastName() . ' on ' .
date('Y-m-d H:i', $today) . ".\n";
$out .= "ISA" .
"*" . $claim->x12gsisa01() .
"*" . $claim->x12gsisa02() .
"*" . $claim->x12gsisa03() .
"*" . $claim->x12gsisa04() .
"*" . $claim->x12gsisa05() .
"*" . $claim->x12gssenderid() .
"*" . $claim->x12gsisa07() .
"*" . $claim->x12gsreceiverid() .
// date of transmission "*030911" .
"*" . date('Ymd', $today) .
//Time of transmission "*1630" .
"*" . date('Hi', $today) .
"*" . "^" .
"*" . "00501" .
"*" . "000000001" .
"*" . $claim->x12gsisa14() .
"*" . $claim->x12gsisa15() .
"*:" .
"~\n";
$out .= "GS" .
"*HC" .
"*" . $claim->x12gsgs02() .
"*" . trim($claim->x12gs03()) .
"*" . date('Ymd', $today) .
"*" . date('Hi', $today) .
"*1" .
"*X" .
// "*" . $claim->x12gsversionstring() .
"*" . "005010X223A2".
"~\n";
++$edicount;
$out .= "ST" .
"*" . "837" .
"*" . "0021" .
// "*" . $claim->x12gsversionstring() .
"*" . "005010X223A2".
"~\n";
++$edicount;
$out .= "BHT" .
"*" . "0019" . // 0019 is required here
"*" . "00" . // 00 = original transmission
"*" . "0123" . // reference identification
"*" . date('Ymd', $today) . // transaction creation date
"*" . date('Hi', $today) . // transaction creation time
($encounter_claim ? "*RP" : "*CH") . // RP = reporting, CH = chargeable
"~\n";
++$edicount;
//Field length is limited to 35. See nucc dataset page 63 www.nucc.org
$billingFacilityName = substr($claim->billingFacilityName(), 0, 60);
if ($billingFacilityName == '') {
$log .= "*** billing facility name in 1000A loop is empty\n";
}
$out .= "NM1" . // Loop 1000A Submitter stays in the 837I
"*" . "41" .
"*" . "2" .
"*" . $billingFacilityName .
"*" .
"*" .
"*" .
"*" .
"*" . "46";
$out .= "*" . $claim->billingFacilityETIN();
$out .= "~\n";
++$edicount;
$out .= "PER" .
"*IC" .
"*" . $claim->billingContactName() .
"*TE" .
"*" . $claim->billingContactPhone();
$out .= "~\n";
++$edicount;
$out .= "NM1" . // Loop 1000B Receiver stays in the 837I
"*" . "40" .
"*" . "2" .
"*" . $claim->clearingHouseName() .
"*" .
"*" .
"*" .
"*" .
"*" . "46" .
"*" . $claim->clearingHouseETIN() .
"~\n";
$HLcount = 1;
++$edicount;
$out .= "HL" . // Loop 2000A Billing/Pay-To Provider HL Loop
"*" . "$HLcount" .
"*" .
"*" . "20" .
"*" . "1" . // 1 indicates there are child segments
"~\n";
$HLBillingPayToProvider = $HLcount++;
// Situational PRV segment (for provider taxonomy code) omitted here.
// Situational CUR segment (foreign currency information) omitted here.
++$edicount;
//Field length is limited to 35. See nucc dataset page 63 www.nucc.org
$billingFacilityName = substr($claim->billingFacilityName(), 0, 60);
$out .= "NM1" . // Loop 2010AA Billing Provider stays in the 837I
"*" . "85" .
"*" . "2" .
"*" . $billingFacilityName .
"*" .
"*" .
"*" .
"*";
if ($claim->billingFacilityNPI()) {
$out .= "*XX*" . $claim->billingFacilityNPI();
} else {
$log .= "*** Billing facility has no NPI.\n";
$out .= "*XX*";
}
$out .= "~\n";
++$edicount;
$out .= "N3" .
"*" . $claim->billingFacilityStreet() .
"~\n";
++$edicount;
$out .= "N4" .
"*" . $claim->billingFacilityCity() .
"*" . $claim->billingFacilityState() .
"*" . stripZipCode($claim->billingFacilityZip()) .
"~\n";
if ($claim->billingFacilityNPI() && $claim->billingFacilityETIN()) {
++$edicount;
$out .= "REF";
if ($claim->federalIdType()) {
$out .= "*" . $claim->federalIdType();
} else {
$out .= "*EI"; // For dealing with the situation before adding TaxId type In facility.
}
$out .= "*" . $claim->billingFacilityETIN() . "~\n";
} else {
$log .= "*** No billing facility NPI and/or ETIN.\n";
}
if ($claim->providerNumberType() && $claim->providerNumber() && !$claim->billingFacilityNPI()) {
++$edicount;
$out .= "REF" .
"*" . $claim->providerNumberType() .
"*" . $claim->providerNumber() .
"~\n";
} else if ($claim->providerNumber() && !$claim->providerNumberType()) {
$log .= "*** Payer-specific provider insurance number is present but has no type assigned.\n";
}
// Situational PER*1C segment.
++$edicount;
$out .= "PER" .
"*" . "IC" .
"*" . $claim->billingContactName() .
"*" . "TE" .
"*" . $claim->billingContactPhone();
$out .= "~\n";
// This is also excluded in the 837I
// Loop 2010AC Pay-To Plan Name omitted. Includes:
// NM1*PE, N3, N4, REF*2U, REF*EI
$PatientHL = $claim->isSelfOfInsured() ? 0 : 1;
$HLSubscriber = $HLcount++;
++$edicount;
// loop 2000B
$out .= "HL" . // Loop 2000B Subscriber HL Loop
"*$HLSubscriber" .
"*$HLBillingPayToProvider" .
"*" . "22" .
"*$PatientHL" .
"~\n";
if (!$claim->payerSequence()) {
$log .= "*** Error: Insurance information is missing!\n";
}
++$edicount;
//SBR01 is either a P or S SBR02 for care is always 18 "patient" SBR09 is always MA
$out .= "SBR" . // Subscriber Information
"*" . $claim->payerSequence() .
"*" . ($claim->isSelfOfInsured() ? '18' : '') .
"*" . $claim->groupNumber() .
"*" . (($claim->groupNumber()) ? '' : $claim->groupName()) .
"*" . $claim->insuredTypeCode() . // applies for secondary medicare
"*" .
"*" .
"*" .
"*" . $claim->claimType() . // Zirmed replaces this
"~\n";
// 2000C Segment PAT omitted.
++$edicount;
$out .= "NM1" . // Loop 2010BA Subscriber same in 837I
"*IL" .
"*" . "1" . // 1 = person, 2 = non-person
"*" . $claim->insuredLastName() .
"*" . $claim->insuredFirstName() .
"*" . $claim->insuredMiddleName() .
"*" .
"*" . // Name Suffix
"*MI" .
// "MI" = Member Identification Number
// "II" = Standard Unique Health Identifier, "Required if the
// HIPAA Individual Patient Identifier is mandated use."
// Here we presume that is not true yet.
"*" . $claim->policyNumber() .
"~\n";
// For 5010, further subscriber info is sent only if they are the patient.
if ($claim->isSelfOfInsured()) {
++$edicount;
$out .= "N3" .
"*" . $claim->insuredStreet() .
"~\n";
++$edicount;
$out .= "N4" .
"*" . $claim->insuredCity() .
"*" . $claim->insuredState() .
"*" . stripZipCode($claim->insuredZip()) .
"~\n";
++$edicount;
$out .= "DMG" .
"*D8" .
"*" . $claim->insuredDOB() .
"*" . $claim->insuredSex() .
"~\n";
}
// Segment REF*SY (Subscriber Secondary Identification) omitted.
// Segment REF*Y4 (Property and Casualty Claim Number) omitted.
// Segment PER*IC (Property and Casualty Subscriber Contact Information) omitted.
++$edicount;
$payerName = substr($claim->payerName(), 0, 60);
$out .= "NM1" . // Loop 2010BB Payer
"*PR" .
"*" . "2" .
"*" . $payerName .
"*" .
"*" .
"*" .
"*" .
"*" . "PI" .
"*" . ($encounter_claim ? $claim->payerAltID() : $claim->payerID()) .
"~\n";
if (!$claim->payerID()) {
$log .= "*** CMS ID is missing for payer '" . $claim->payerName() . "'.\n";
}
++$edicount;
$out .= "N3" .
"*" . $claim->payerStreet() .
"~\n";
++$edicount;
$out .= "N4" .
"*" . $claim->payerCity() .
"*" . $claim->payerState() .
"*" . stripZipCode($claim->payerZip()) .
"~\n";
// Segment REF (Payer Secondary Identification) omitted.
// Segment REF (Billing Provider Secondary Identification) omitted.
if (! $claim->isSelfOfInsured()) {
++$edicount;
$out .= "HL" . // Loop 2000C Patient Information
"*" . "$HLcount" .
"*$HLSubscriber" .
"*23" .
"*0" .
"~\n";
$HLcount++;
++$edicount;
$out .= "PAT" .
"*" . $claim->insuredRelationship() .
"~\n";
++$edicount;
$out .= "NM1" . // Loop 2010CA Patient may need this elsed in to the loop 2000C
"*QC" .
"*1" .
"*" . $claim->patientLastName() .
"*" . $claim->patientFirstName();
if ($claim->patientMiddleName() !== '') {
$out .= "*" . $claim->patientMiddleName();
}
$out .= "~\n";
++$edicount;
$out .= "N3" .
"*" . $claim->patientStreet() .
"~\n";
++$edicount;
$out .= "N4" .
"*" . $claim->patientCity() .
"*" . $claim->patientState() .
"*" . stripZipCode($claim->patientZip()) .
"~\n";
++$edicount;
$out .= "DMG" .
"*D8" .
"*" . $claim->patientDOB() .
"*" . $claim->patientSex() .
"~\n";
// Segment REF*Y4 (Property and Casualty Claim Number) omitted.
// Segment REF (Property and Casualty Patient Identifier) omitted.
// Segment PER (Property and Casualty Patient Contact Information) omitted.
} // end of patient different from insured
$proccount = $claim->procCount();
$clm_total_charges = 0;
for ($prockey = 0; $prockey < $proccount; ++$prockey) {
$clm_total_charges += $claim->cptCharges($prockey);
}
if (!$clm_total_charges) {
$log .= "*** This claim has no charges!\n";
}
++$edicount;
$out .= "CLM" . // Loop 2300 Claim
"*" . $pid . "-" . $encounter .
"*" . sprintf("%.2f", $clm_total_charges) . // Zirmed computes and replaces this
"*" .
"*" ;
// Service location this need to be bill type from ub form type_of_bill
if (strlen($ub04id[7]) >= 3) {
$out .= "*" . substr($ub04id[7], 1, 1) . ":" . substr($ub04id[7], 2, 1) . ":" . substr($ub04id[7], 3, 1);
}
$out .= "*" .
"*" . "A" .
"*" . ($claim->billingFacilityAssignment() ? 'Y' : 'N') .
"*" . "Y" .
"~\n";
// discharge hour
if ($ub04id[29]) {
++ $edicount;
$out .= "DTP" . // Loop 2300
"*" . "096" .
"*" . "TM" .
"*" . $ub04id[29] .
"~\n";
}
// Statment Dates
// DTP 434 RD8 (Statment from OR to date)
if ($ub04id[13]) {
++ $edicount;
$tmp = x12date($ub04id[13]);
$tmp1 = x12date($ub04id[14]);
$out .= "DTP" . // Loop 2300
"*434" . "*" . "RD8" . "*" . $tmp . '-' . $tmp1 . "~\n";
}
if ($ub04id[13]) {
++ $edicount;
$tmp = x12date($ub04id[25]);
$out .= "DTP" . // Loop 2300
"*435" . "*" . "DT" . "*" . $tmp . $ub04id[26] . "~\n";
}
if (strlen(trim($ub04id[13])) == 0) {
$log .= "*** Error: No Admission Date Entered!\n";
}
// Repricer Received Date
// DTP 050 D8 (Admission Date and Hour from form)
// Institutional Claim Code
// CL1 (Admission Type Code) (Admission Source Code) (Patient Status Code)
if ($ub04id[27] != "014X") { // Type of bill
++ $edicount;
$out .= "CL1" . // Loop 2300
"*" . $ub04id[27] . "*" . $ub04id[28] . "*" . $ub04id[30] . "~\n";
}
// Segment PWK (Claim Supplemental Information) omitted.
// Segment CN1 (Contract Information) omitted.
// Patient Estimated Amount Due
// Check logic
// $patientpaid = $claim->patientPaidAmount();
// if ($patientpaid != 0) {
// ++$edicount;
// $out .= "AMT" . // Patient paid amount. Page 190/220.
// "*F5" .
// "*" . $patientpaid .
// "~\n";
// }
// Segment REF*4N (Service Authorization Exception Code) omitted.
// Segment REF*9F (Referral Number) omitted.
// Prior Authorization
//
if ($claim->priorAuth()) {
++ $edicount;
$out .= "REF" . // Prior Authorization Number
"*G1" . "*" . $claim->priorAuth() . "~\n";
}
// Segment REF*F8 (Payer Claim Control Number) omitted.
// This may be needed for the UB04 Claim if so change the 'MB' to 'MA'
// if ($claim->cliaCode() && ($CMS_5010 || $claim->claimType() === 'MB')) {
// Required by Medicare when in-house labs are done.
// ++$edicount;
// $out .= "REF" . // Clinical Laboratory Improvement Amendment Number
// "*X4" .
// "*" . $claim->cliaCode() .
// "~\n";
// }
// Segment REF*9A (Repriced Claim Number) omitted.
// Segment REF*9C (Adjusted Repriced Claim Number) omitted.
// Segment REF*LX (Investigational Device Exemption Number) omitted.
// Segment REF*S9 (Claim Identifier for Transmission Intermediaries) omitted.
// Segment REF*LU (Auto Accident State) omitted.
// Segment REF*EA (Medical Record Number) omitted.
// Segment REF*P4 (Demonstration Project Identifier) omitted.
// Segment REF*G4 (Peer Review Organization PRO Approval Number) omitted.
// Segment K3 (File Information) omitted.
if ($claim->additionalNotes()) {
// Claim Note
// Has a list of valid codes. Required when PROVIDER deems necessary
// Billing note.
// Check to verify I am getting this information on the ub04 form
++ $edicount;
$out .= "NTE" . // comments box 19
"*" . "ADD" . "*" . $claim->additionalNotes() . "~\n";
}
// Segment CRC (EPSDT Referral) omitted.
// Diagnoses, up to $max_per_seg per HI segment. Check this
$max_per_seg = 18;
$da = $claim->diagArray();
$diag_type_code = 'ABK'; // ICD10
$tmp = 0;
foreach ($da as $diag) {
if ($tmp == 1) {
continue;
}
if ($tmp % $max_per_seg == 0) {
if ($tmp) {
$out .= "~\n";
}
++ $edicount;
$out .= "HI"; // Health Diagnosis Codes
}
$out .= "*" . $diag_type_code . ":" . $diag;
if ($claim->diagtype == "ICD9") {
$diag_type_code = 'BF';
} else {
$diag_type_code = 'ABF';
}
++ $tmp;
}
if ($tmp) {
$out .= "~\n";
}
// Segment HI*BI (Occurrence Span Information).
// HI BI (Occurrence Span Code 1) RD8 (Occurrence Span Code Associated Date)
if ($ub04id[52]) {
$max_per_seg = 4;
$diag_type_code = 'BI';
$tmp = 0;
$os = 52;
for ($i = 0; $i <= 3;) {
if ($tmp % $max_per_seg == 0) {
if ($tmp) {
$out .= "~\n";
}
++ $edicount;
$out .= "HI"; // Health Diagnosis Codes
}
if ($ub04id[$os]) {
$out .= "*" . $diag_type_code . ":" . $ub04id[$os ++] . ":" . x12date($ub04id[$os ++]) . ":" . x12date($ub04id[$os ++]);
$diag_type_code = 'BI';
}
if ($os >= 57) {
$os = 67;
}
++ $tmp;
++ $i;
}
if ($tmp) {
$out .= "~\n";
}
}
// Segment HI*BH (Occurrence Information).
// HI BH (Occurrence Code 1) D8 (Occurrence Code Associated Date)
if ($ub04id[44]) {
$max_per_seg = 8;
$diag_type_code = 'BH';
$tmp = 0;
$os = 44;
for ($i = 0; $i <= 7;) {
if ($tmp % $max_per_seg == 0) {
if ($tmp) {
$out .= "~\n";
}
++ $edicount;
$out .= "HI"; // Health Diagnosis Codes
}
if ($ub04id[$os]) {
$out .= "*" . $diag_type_code . ":" . $ub04id[$os] . ":D8" . ":" . x12date($ub04id[$os ++]);
$diag_type_code = 'BH';
}
if ($os >= 51) {
$os = 59;
}
++ $tmp;
++ $i;
}
if ($tmp) {
$out .= "~\n";
}
}
// Segment HI*BE (Value Information).
// HI BE (Value Code 1) *.* (Value Code Amount)
if ($ub04id[74]) {
$max_per_seg = 12;
$diag_type_code = 'BE';
$os = 74;
$tmp = 0;
for ($i = 0; $i <= 11;) {
if ($tmp % $max_per_seg == 0) {
if ($tmp) {
$out .= "~\n";
}
++ $edicount;
$out .= "HI"; // Health Diagnosis Codes
}
if ($ub04id[$os]) {
// if ($i=1) {
$out .= "*" . $diag_type_code . ":" . $ub04id[$os ++] . ":" . ":" . x12date($ub04id[$os ++]);
$diag_type_code = 'BE';
// }
}
++ $tmp;
++ $i;
}
if ($tmp) {
$out .= "~\n";
}
}
// Segment HI*BG (Condition Information).
// HI BG (Condition Code 1)
if ($ub04id[31]) {
$max_per_seg = 11;
$diag_type_code = 'BG';
$os = 31;
$tmp = 0;
for ($i = 0; $i <= 10;) {
if ($tmp % $max_per_seg == 0) {
if ($tmp) {
$out .= "~\n";
}
++ $edicount;
$out .= "HI"; // Health Diagnosis Codes
}
if ($ub04id[$os]) {
// if ($i=1) {
$out .= "*" . $diag_type_code . ":" . $ub04id[$os ++];
$diag_type_code = 'BG';
// }
}
++ $tmp;
++ $i;
}
if ($tmp) {
$out .= "~\n";
}
}
// Segment HI*TC (Treatment Code Information).
// HI TC (Treatment Code 1)
/* 63a. TREATMENT AUTHORIZATION CODES - PRIMARY PLAN */
if ($ub04id[319]) {
$max_per_seg = 3;
$diag_type_code = 'TC';
$tmp = 0;
for ($i = 0; $i <= 2;) {
if ($tmp % $max_per_seg == 0) {
if ($tmp) {
$out .= "~\n";
}
++ $edicount;
$out .= "HI"; // Health Diagnosis Codes
}
if ($ub04id[319]) {
$out .= "*" . $diag_type_code . ":" . $ub04id[319];
$diag_type_code = 'TC';
}
if ($i = 1) {
if ($ub04id[322]) {
$out .= "*" . $diag_type_code . ":" . $ub04id[322];
$diag_type_code = 'TC';
}
}
if ($i = 2) {
if ($ub04id[325]) {
$out .= "*" . $diag_type_code . ":" . $ub04id[325];
$diag_type_code = 'TC';
}
}
++ $tmp;
++ $i;
}
if ($tmp) {
$out .= "~\n";
}
}
// Segment HCP (Claim Pricing/Repricing Information) omitted.
// This needs to allow Attending Physician 2310A, Operating Physician Name 2310B, Other Operating Physician Name 2310C
// and Rendering Provider Name (Rendering Provider Name is futher down)
if ($ub04id[388]) {
++ $edicount;
// Loop 2310A Attending Physician
$out .= "NM1" . "*71" . "*1" . "*" . $ub04id[388] . "*" . $ub04id[389] . "*" . "*";
if ($ub04id[379]) { // NPI
$out .= "*" . "XX" . "*" . $ub04id[379];
} else {
$out .= "*" . "*";
$log .= "*** Attending Physician has no NPI.\n";
}
$out .= "~\n";
if ($ub04id[380]) {
++ $edicount;
$out .= "REF" . // Attending Physician Secondary Identification
"*" . $ub04id[380] . "*" . $ub04id[381] . "~\n";
}
}
// 2310B
if ($ub04id[400]) {
++ $edicount;
$out .= "NM1" . // Loop 2310B operating Physician
"*72" . "*1" . "*" . $ub04id[400] . "*" . $ub04id[400] . "*" . "*";
if ($ub04id[390]) {
$out .= "*" . "XX" . "*" . $ub04id[390];
} else {
$out .= "*" . "*";
$log .= "*** Operating Physician has no NPI qualifier.\n";
}
$out .= "~\n";
if ($ub04id[391]) {
++ $edicount;
$out .= "REF" . // operating Physician Secondary Identification
"*" . $claim->$ub04id[391] . "*" . $ub04id[392] . "~\n";
}
}
// 2310C
if ($ub04id[413]) {
++ $edicount;
$out .= "NM1" . // Loop 2310C other operating Physician
"*73" . "*1" . "*" . $ub04id[413] . "*" . $ub04id[414] . "*" . "*";
if ($ub04id[405]) {
$out .= "*" . $ub04id[405] . "*" . $ub04id[406];
} else {
$out .= "*" . "*";
$log .= "*** Other Operating Physician has no NPI.\n";
}
$out .= "~\n";
if ($ub04id[407]) {
++ $edicount;
$out .= "REF" . // other operating Physician Secondary Identification
"*" . $ub04id[407] . "*" . $ub04id[408] . "~\n";
}
}
if ($ub04id[427]) {
++ $edicount;
$out .= "NM1" . // Loop 2310C other operating Physician
"*73" . "*1" . "*" . $ub04id[427] . "*" . $ub04id[428] . "*" . "*";
if ($ub04id[420]) {
$out .= "*" . $ub04id[419] . "*" . $ub04id[420];
} else {
$out .= "*" . "*";
$log .= "*** Other Operating Physician has no NPI.\n";
}
$out .= "~\n";
if ($ub04id[422]) {
++ $edicount;
$out .= "REF" . // other operating Physician Secondary Identification
"*" . $ub04id[422] . "*" . $ub04id[421] . "~\n";
}
}
/*
* Per the implementation guide lines, only include this information if it is different
* than the Loop 2010AA information
*/
if ($claim->providerNPIValid() && $claim->billingFacilityNPI() !== $claim->providerNPI()) {
++ $edicount;
$out .= "NM1" . // Loop 2310D Rendering Provider
"*82" . "*1" . "*" . $claim->providerLastName() . "*" . $claim->providerFirstName() . "*" . $claim->providerMiddleName() . "*" . "*";
if ($claim->providerNPI()) {
$out .= "*XX" . "*" . $claim->providerNPI();
} else {
$log .= "*** Rendering provider has no NPI.\n";
}
$out .= "~\n";
// End of Loop 2310D
} else {
// This loop can only get skipped if we are generating a 5010 claim
if (! ($claim->providerNPIValid())) {
//If the loop was skipped because the provider NPI was invalid, generate a warning for the log.
$log .= "*** Skipping 2310B because " . $claim->providerLastName() . "," . $claim->providerFirstName() . " has invalid NPI.\n";
}
/*
* Skipping this segment because the providerNPI and the billingFacilityNPI are identical
* is a normal condition, so no need to warn.
*/
}
// 5010 spec says nothing here if NPI was specified.
//
if (! $claim->providerNPI() && in_array($claim->providerNumberType(), array('0B', '1G', 'G2', 'LU'))) {
if ($claim->providerNumber()) {
++ $edicount;
$out .= "REF" . "*" . $claim->providerNumberType() . "*" . $claim->providerNumber() . "~\n";
}
}
// Loop 2310D is omitted in the case of home visits (POS=12).
if ($claim->facilityPOS() != 12 && ($claim->facilityNPI() != $claim->billingFacilityNPI())) {
++ $edicount;
// Service Facility Name
$out .= "NM1" . // Loop 2310E Service Location
"*77" . "*2";
$facilityName = substr($claim->facilityName(), 0, 60);
if ($claim->facilityName() || $claim->facilityNPI() || $claim->facilityETIN()) {
$out .= "*" . $facilityName;
}
if ($claim->facilityNPI() || $claim->facilityETIN()) {
$out .= "*" . "*" . "*" . "*";
if ($claim->facilityNPI()) {
$out .= "*XX*" . $claim->facilityNPI();
} else {
$log .= "*** Service location has no NPI.\n";
}
}
$out .= "~\n";
if ($claim->facilityStreet()) {
++ $edicount;
$out .= "N3" . "*" . $claim->facilityStreet() . "~\n";
}
if ($claim->facilityState()) {
++ $edicount;
$out .= "N4" . "*" . $claim->facilityCity() . "*" . $claim->facilityState() . "*" . stripZipCode($claim->facilityZip()) . "~\n";
}
}
// Segment REF (Service Facility Location Secondary Identification) omitted.
// Segment PER (Service Facility Contact Information) omitted.
// Loop 2310F Referring Provider
if ($claim->referrerLastName()) {
// Medicare requires referring provider's name and UPIN.
++ $edicount;
$out .= "NM1" . // Loop 2310F Referring Provider this needs to change position
"*DN" . "*1" . "*" . $claim->referrerLastName() . "*" . $claim->referrerFirstName() . "*" . $claim->referrerMiddleName() . "*" . "*";
if ($claim->referrerNPI()) {
$out .= "*XX" . "*" . $claim->referrerNPI();
} else {
$log .= "*** Referrer has no NPI.\n";
}
$out .= "~\n";
}
// Loop 2310E, Supervising Provider
// Omitted
// Segments NM1*PW, N3, N4 (Ambulance Pick-Up Location) omitted.
// Segments NM1*45, N3, N4 (Ambulance Drop-Off Location) omitted.
$prev_pt_resp = $clm_total_charges; // for computation below
// Loops 2320 and 2330*, other subscriber/payer information.
// Remember that insurance index 0 is always for the payer being billed
// by this claim, and 1 and above are always for the "other" payers.
//
for ($ins = 1; $ins < $claim->payerCount(); ++ $ins) {
$tmp1 = $claim->claimType($ins);
$tmp2 = 'C1'; // Here a kludge. See page 321.
if ($tmp1 === 'CI') {
$tmp2 = 'C1';
}
if ($tmp1 === 'AM') {
$tmp2 = 'AP';
}
if ($tmp1 === 'HM') {
$tmp2 = 'HM';
}
if ($tmp1 === 'MB') {
$tmp2 = 'MB';
}
if ($tmp1 === 'MA') {
$tmp2 = 'MA';
}
if ($tmp1 === 'MC') {
$tmp2 = 'MC';
}
if ($tmp1 === '09') {
$tmp2 = 'PP';
}
++ $edicount;
$out .= "SBR" . // Loop 2320, Subscriber Information - page 297/318
"*" . $claim->payerSequence($ins) .
"*" . $claim->insuredRelationship($ins) .
"*" . $claim->groupNumber($ins) .
"*" . (($claim->groupNumber($ins)) ? '' : $claim->groupName($ins)) .
"*" . ($claim->insuredTypeCode($ins) ? $claim->insuredTypeCode($ins) : $tmp2) .
"*" .
"*" .
"*" .
"*" . $claim->claimType($ins) .
"~\n";
// Things that apply only to previous payers, not future payers.
//
if ($claim->payerSequence($ins) < $claim->payerSequence()) {
// Generate claim-level adjustments.
$aarr = $claim->payerAdjustments($ins);
foreach ($aarr as $a) {
++ $edicount;
$out .= "CAS" . // Previous payer's claim-level adjustments. Page 301/323.
"*" . $a[1] . "*" . $a[2] . "*" . $a[3] . "~\n";
}
$payerpaid = $claim->payerTotals($ins);
++ $edicount;
$out .= "AMT" . // Previous payer's paid amount. Page 307/332.
"*D" . "*" . $payerpaid[1] . "~\n";
// Segment AMT*A8 (COB Total Non-Covered Amount) omitted.
// Segment AMT*EAF (Remaining Patient Liability) omitted.
} // End of things that apply only to previous payers.
++ $edicount;
$out .= "OI" . // Other Insurance Coverage Information. Page 310/344.
"*" . "*" . "*" . ($claim->billingFacilityAssignment($ins) ? 'Y' : 'N') .
// For this next item, the 5010 example in the spec does not match its
// description. So this might be wrong.
"*" .
"*" .
"*" .
"Y" .
"~\n";
// Segment MOA (Medicare Outpatient Adjudication) omitted.
++$edicount;
$out .= "NM1" . // Loop 2330A Subscriber info for other insco. Page 315/350.
"*" . "IL" .
"*" . "1" .
"*" . $claim->insuredLastName($ins) .
"*" . $claim->insuredFirstName($ins) .
"*" . $claim->insuredMiddleName($ins) .
"*" .
"*" .
"*" . "MI" .
"*" . $claim->policyNumber($ins) .
"~\n";
++$edicount;
$out .= "N3" .
"*" . $claim->insuredStreet($ins) .
"~\n";
++$edicount;
$out .= "N4" .
"*" . $claim->insuredCity($ins) .
"*" . $claim->insuredState($ins) .
"*" . stripZipCode($claim->insuredZip($ins)) .
"~\n";
// Segment REF (Other Subscriber Secondary Identification) omitted.
++$edicount;
$payerName = substr($claim->payerName($ins), 0, 60);
$out .= "NM1" . // Loop 2330B Payer info for other insco. Page 322/359.
"*" . "PR" .
"*" . "2" .
"*" . $payerName .
"*" .
"*" .
"*" .
"*" .
"*" . "PI" .
"*" . $claim->payerID($ins) .
"~\n";
if (!$claim->payerID($ins)) {
$log .= "*** CMS ID is missing for payer '" . $claim->payerName($ins) . "'.\n";
}
++$edicount;
$out .= "N3" .
"*" . $claim->payerStreet($ins) .
"~\n";
++$edicount;
$out .= "N4" .
"*" . $claim->payerCity($ins) .
"*" . $claim->payerState($ins) .
"*" . stripZipCode($claim->payerZip($ins)) .
"~\n";
// Segment DTP*573 (Claim Check or Remittance Date) omitted.
// Segment REF (Other Payer Secondary Identifier) omitted.
// Segment REF*G1 (Other Payer Prior Authorization Number) omitted.
// Segment REF*9F (Other Payer Referral Number) omitted.
// Segment REF*T4 (Other Payer Claim Adjustment Indicator) omitted.
// Segment REF*F8 (Other Payer Claim Control Number) omitted.
// 2330C-I loops Omitted
} // End loops 2320/2330*.
$loopcount = 0;
// Procedure loop starts here.
//
for ($tlh = 0; $tlh < $proccount; ++ $tlh) {
$tmp = $claim->procs[$tlh][code_text];
if ($claim->procs[$tlh][code_type] == 'HCPCS') {
$tmpcode = '3';
} else {
$tmpcode = '1';
}
$getrevcd = $claim->cptCode($tlh);
$sql = "SELECT * FROM codes WHERE code_type = ? and code = ? ORDER BY revenue_code DESC";
$revcode[$tlh] = sqlQuery($sql, array(
$tmpcode,
$getrevcd
));
}