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Claim.class.php
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Claim.class.php
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<?php
// Copyright (C) 2007-2009 Rod Roark <[email protected]>
//
// This program is free software; you can redistribute it and/or
// modify it under the terms of the GNU General Public License
// as published by the Free Software Foundation; either version 2
// of the License, or (at your option) any later version.
require_once(dirname(__FILE__) . "/invoice_summary.inc.php");
// This enforces the X12 Basic Character Set. Page A2.
//
function x12clean($str) {
return preg_replace('/[^A-Z0-9!"\\&\'()+,\\-.\\/;?= ]/', '', strtoupper($str));
}
// Make sure dates have no formatting and zero filled becomes blank
// Handles date time stamp formats as well
//
function cleanDate($date_field)
{
$cleandate = str_replace('-', '', substr($date_field, 0, 10));
if(substr_count($cleandate,'0')==8)
{
$cleandate='';
}
return ($cleandate);
}
class Claim {
var $pid; // patient id
var $encounter_id; // encounter id
var $procs; // array of procedure rows from billing table
var $diags; // array of icd9 codes from billing table
var $diagtype= "ICD9"; // diagnosis code_type.Assume ICD9 unless otherwise specified.
var $x12_partner; // row from x12_partners table
var $encounter; // row from form_encounter table
var $facility; // row from facility table
var $billing_facility; // row from facility table
var $provider; // row from users table (rendering provider)
var $referrer; // row from users table (referring provider)
var $supervisor; // row from users table (supervising provider)
var $insurance_numbers; // row from insurance_numbers table for current payer
var $supervisor_numbers; // row from insurance_numbers table for current payer
var $patient_data; // row from patient_data table
var $billing_options; // row from form_misc_billing_options table
var $invoice; // result from get_invoice_summary()
var $payers; // array of arrays, for all payers
var $copay; // total of copays from the ar_activity table
function loadPayerInfo(&$billrow) {
global $sl_err;
$encounter_date = substr($this->encounter['date'], 0, 10);
// Create the $payers array. This contains data for all insurances
// with the current one always at index 0, and the others in payment
// order starting at index 1.
//
$this->payers = array();
$this->payers[0] = array();
$query = "SELECT * FROM insurance_data WHERE " .
"pid = '{$this->pid}' AND " .
"date <= '$encounter_date' " .
"ORDER BY type ASC, date DESC";
$dres = sqlStatement($query);
$prevtype = '';
while ($drow = sqlFetchArray($dres)) {
if (strcmp($prevtype, $drow['type']) == 0) continue;
$prevtype = $drow['type'];
// Very important to look at entries with a missing provider because
// they indicate no insurance as of the given date.
if (empty($drow['provider'])) continue;
$ins = count($this->payers);
if ($drow['provider'] == $billrow['payer_id'] && empty($this->payers[0]['data'])) $ins = 0;
$crow = sqlQuery("SELECT * FROM insurance_companies WHERE " .
"id = '" . $drow['provider'] . "'");
$orow = new InsuranceCompany($drow['provider']);
$this->payers[$ins] = array();
$this->payers[$ins]['data'] = $drow;
$this->payers[$ins]['company'] = $crow;
$this->payers[$ins]['object'] = $orow;
}
// This kludge hands most cases of a rare ambiguous situation, where
// the primary insurance company is the same as the secondary. It seems
// nobody planned for that!
//
for ($i = 1; $i < count($this->payers); ++$i) {
if ($billrow['process_date'] &&
$this->payers[0]['data']['provider'] == $this->payers[$i]['data']['provider'])
{
$tmp = $this->payers[0];
$this->payers[0] = $this->payers[$i];
$this->payers[$i] = $tmp;
}
}
$this->using_modifiers = true;
// Get payment and adjustment details if there are any previous payers.
//
$this->invoice = array();
if ($this->payerSequence() != 'P') {
$this->invoice = ar_get_invoice_summary($this->pid, $this->encounter_id, true);
// Secondary claims might not have modifiers in SQL-Ledger data.
// In that case, note that we should not try to match on them.
$this->using_modifiers = false;
foreach ($this->invoice as $key => $trash) {
if (strpos($key, ':')) $this->using_modifiers = true;
}
}
}
// Constructor. Loads relevant database information.
//
function __construct($pid, $encounter_id) {
$this->pid = $pid;
$this->encounter_id = $encounter_id;
$this->procs = array();
$this->diags = array();
$this->copay = 0;
// We need the encounter date before we can identify the payers.
$sql = "SELECT * FROM form_encounter WHERE " .
"pid = '{$this->pid}' AND " .
"encounter = '{$this->encounter_id}'";
$this->encounter = sqlQuery($sql);
// Sort by procedure timestamp in order to get some consistency.
$sql = "SELECT b.id, b.date, b.code_type, b.code, b.pid, b.provider_id, " .
"b.user, b.groupname, b.authorized, b.encounter, b.code_text, b.billed, " .
"b.activity, b.payer_id, b.bill_process, b.bill_date, b.process_date, " .
"b.process_file, b.modifier, b.units, b.fee, b.justify, b.target, b.x12_partner_id, " .
"b.ndc_info, b.notecodes, ct.ct_diag " .
"FROM billing as b INNER JOIN code_types as ct " .
"ON b.code_type = ct.ct_key " .
"WHERE ct.ct_claim = '1' AND ct.ct_active = '1' AND " .
"b.encounter = '{$this->encounter_id}' AND b.pid = '{$this->pid}' AND " .
"b.activity = '1' ORDER BY b.date, b.id";
$res = sqlStatement($sql);
while ($row = sqlFetchArray($res)) {
// Save all diagnosis codes.
if ($row['ct_diag'] == '1') {
$this->diags[$row['code']] = $row['code'];
continue;
}
if (!$row['units']) $row['units'] = 1;
// Load prior payer data at the first opportunity in order to get
// the using_modifiers flag that is referenced below.
if (empty($this->procs)) $this->loadPayerInfo($row);
// The consolidate duplicate procedures, which was previously here, was removed
// from codebase on 12/9/15. Reason: Some insurance companies decline consolidated
// procedures, and this can be left up to the billing coder when they input the items.
// If there is a row-specific provider then get its details.
if (!empty($row['provider_id'])) {
// Get service provider data for this row.
$sql = "SELECT * FROM users WHERE id = '" . $row['provider_id'] . "'";
$row['provider'] = sqlQuery($sql);
// Get insurance numbers for this row's provider.
$sql = "SELECT * FROM insurance_numbers WHERE " .
"(insurance_company_id = '" . $row['payer_id'] .
"' OR insurance_company_id is NULL) AND " .
"provider_id = '" . $row['provider_id'] . "' " .
"ORDER BY insurance_company_id DESC LIMIT 1";
$row['insurance_numbers'] = sqlQuery($sql);
}
$this->procs[] = $row;
}
$resMoneyGot = sqlStatement("SELECT pay_amount as PatientPay,session_id as id,".
"date(post_time) as date FROM ar_activity where pid ='{$this->pid}' and encounter ='{$this->encounter_id}' ".
"and payer_type=0 and account_code='PCP'");
//new fees screen copay gives account_code='PCP'
while($rowMoneyGot = sqlFetchArray($resMoneyGot)){
$PatientPay=$rowMoneyGot['PatientPay']*-1;
$this->copay -= $PatientPay;
}
$sql = "SELECT * FROM x12_partners WHERE " .
"id = '" . $this->procs[0]['x12_partner_id'] . "'";
$this->x12_partner = sqlQuery($sql);
$sql = "SELECT * FROM facility WHERE " .
"id = '" . addslashes($this->encounter['facility_id']) . "' " .
"LIMIT 1";
$this->facility = sqlQuery($sql);
/*****************************************************************
$provider_id = $this->procs[0]['provider_id'];
*****************************************************************/
$provider_id = $this->encounter['provider_id'];
$sql = "SELECT * FROM users WHERE id = '$provider_id'";
$this->provider = sqlQuery($sql);
// Selecting the billing facility assigned to the encounter. If none,
// try the first (and hopefully only) facility marked as a billing location.
if (empty($this->encounter['billing_facility'])) {
$sql = "SELECT * FROM facility " .
"ORDER BY billing_location DESC, id ASC LIMIT 1";
}
else {
$sql = "SELECT * FROM facility " .
" where id ='" . addslashes($this->encounter['billing_facility']) . "' ";
}
$this->billing_facility = sqlQuery($sql);
$sql = "SELECT * FROM insurance_numbers WHERE " .
"(insurance_company_id = '" . $this->procs[0]['payer_id'] .
"' OR insurance_company_id is NULL) AND " .
"provider_id = '$provider_id' " .
"ORDER BY insurance_company_id DESC LIMIT 1";
$this->insurance_numbers = sqlQuery($sql);
$sql = "SELECT * FROM patient_data WHERE " .
"pid = '{$this->pid}' " .
"ORDER BY id LIMIT 1";
$this->patient_data = sqlQuery($sql);
$sql = "SELECT fpa.* FROM forms JOIN form_misc_billing_options AS fpa " .
"ON fpa.id = forms.form_id WHERE " .
"forms.encounter = '{$this->encounter_id}' AND " .
"forms.pid = '{$this->pid}' AND " .
"forms.deleted = 0 AND " .
"forms.formdir = 'misc_billing_options' " .
"ORDER BY forms.date";
$this->billing_options = sqlQuery($sql);
$referrer_id = (empty($GLOBALS['MedicareReferrerIsRenderer']) ||
$this->insurance_numbers['provider_number_type'] != '1C') ?
$this->patient_data['ref_providerID'] : $provider_id;
$sql = "SELECT * FROM users WHERE id = '$referrer_id'";
$this->referrer = sqlQuery($sql);
if (!$this->referrer) $this->referrer = array();
$supervisor_id = $this->encounter['supervisor_id'];
$sql = "SELECT * FROM users WHERE id = '$supervisor_id'";
$this->supervisor = sqlQuery($sql);
if (!$this->supervisor) $this->supervisor = array();
$billing_options_id = $this->billing_options['provider_id'];
$sql = "SELECT * FROM users WHERE id = ?";
$this->billing_prov_id = sqlQuery($sql, array($billing_options_id));
if (!$this->billing_prov_id) $this->billing_prov_id = array();
$sql = "SELECT * FROM insurance_numbers WHERE " .
"(insurance_company_id = '" . $this->procs[0]['payer_id'] .
"' OR insurance_company_id is NULL) AND " .
"provider_id = '$supervisor_id' " .
"ORDER BY insurance_company_id DESC LIMIT 1";
$this->supervisor_numbers = sqlQuery($sql);
if (!$this->supervisor_numbers) $this->supervisor_numbers = array();
} // end constructor
// Return an array of adjustments from the designated prior payer for the
// designated procedure key (might be procedure:modifier), or for the claim
// level. For each adjustment give date, group code, reason code, amount.
// Note this will include "patient responsibility" adjustments which are
// not adjustments to OUR invoice, but they reduce the amount that the
// insurance company pays.
//
function payerAdjustments($ins, $code='Claim') {
$aadj = array();
// If we have no modifiers stored in SQL-Ledger for this claim,
// then we cannot use a modifier passed in with the key.
$tmp = strpos($code, ':');
if ($tmp && !$this->using_modifiers) $code = substr($code, 0, $tmp);
// For payments, source always starts with "Ins" or "Pt".
// Nonzero adjustment reason examples:
// Ins1 adjust code 42 (Charges exceed ... (obsolete))
// Ins1 adjust code 45 (Charges exceed your contracted/ legislated fee arrangement)
// Ins1 adjust code 97 (Payment is included in the allowance for another service/procedure)
// Ins1 adjust code A2 (Contractual adjustment)
// Ins adjust Ins1
// adjust code 45
// Zero adjustment reason examples:
// Co-pay: 25.00
// Coinsurance: 11.46 (code 2) Note: fix remits to identify insurance
// To deductible: 0.22 (code 1) Note: fix remits to identify insurance
// To copay Ins1 (manual entry)
// To ded'ble Ins1 (manual entry)
if (!empty($this->invoice[$code])) {
$date = '';
$deductible = 0;
$coinsurance = 0;
$inslabel = ($this->payerSequence($ins) == 'S') ? 'Ins2' : 'Ins1';
$insnumber = substr($inslabel, 3);
// Compute this procedure's patient responsibility amount as of this
// prior payer, which is the original charge minus all insurance
// payments and "hard" adjustments up to this payer.
$ptresp = $this->invoice[$code]['chg'] + $this->invoice[$code]['adj'];
foreach ($this->invoice[$code]['dtl'] as $key => $value) {
// plv (from ar_activity.payer_type) exists to
// indicate the payer level.
if (isset($value['pmt']) && $value['pmt'] != 0) {
if ($value['plv'] > 0 && $value['plv'] <= $insnumber)
$ptresp -= $value['pmt'];
}
else if (isset($value['chg']) && trim(substr($key, 0, 10))) {
// non-blank key indicates this is an adjustment and not a charge
if ($value['plv'] > 0 && $value['plv'] <= $insnumber)
$ptresp += $value['chg']; // adjustments are negative charges
}
$msp = isset( $value['msp'] ) ? $value['msp'] : null; // record the reason for adjustment
}
if ($ptresp < 0) $ptresp = 0; // we may be insane but try to hide it
// Main loop, to extract adjustments for this payer and procedure.
foreach ($this->invoice[$code]['dtl'] as $key => $value) {
$tmp = str_replace('-', '', trim(substr($key, 0, 10)));
if ($tmp) $date = $tmp;
if ($tmp && $value['pmt'] == 0) { // not original charge and not a payment
$rsn = $value['rsn'];
$chg = 0 - $value['chg']; // adjustments are negative charges
$gcode = 'CO'; // default group code = contractual obligation
$rcode = '45'; // default reason code = max fee exceeded (code 42 is obsolete)
if (preg_match("/Ins adjust $inslabel/i", $rsn, $tmp)) {
// From manual post. Take the defaults.
}
else if (preg_match("/To copay $inslabel/i", $rsn, $tmp) && !$chg) {
$coinsurance = $ptresp; // from manual post
continue;
}
else if (preg_match("/To ded'ble $inslabel/i", $rsn, $tmp) && !$chg) {
$deductible = $ptresp; // from manual post
continue;
}
else if (preg_match("/$inslabel copay: (\S+)/i", $rsn, $tmp) && !$chg) {
$coinsurance = $tmp[1]; // from 835 as of 6/2007
continue;
}
else if (preg_match("/$inslabel coins: (\S+)/i", $rsn, $tmp) && !$chg) {
$coinsurance = $tmp[1]; // from 835 and manual post as of 6/2007
continue;
}
else if (preg_match("/$inslabel dedbl: (\S+)/i", $rsn, $tmp) && !$chg) {
$deductible = $tmp[1]; // from 835 and manual post as of 6/2007
continue;
}
else if (preg_match("/$inslabel ptresp: (\S+)/i", $rsn, $tmp) && !$chg) {
continue; // from 835 as of 6/2007
}
else if (preg_match("/$inslabel adjust code (\S+)/i", $rsn, $tmp)) {
$rcode = $tmp[1]; // from 835
}
else if (preg_match("/$inslabel/i", $rsn, $tmp)) {
// Take the defaults.
}
else if (preg_match('/Ins(\d)/i', $rsn, $tmp) && $tmp[1] != $insnumber) {
continue; // it's for some other payer
}
else if ($insnumber == '1') {
if (preg_match("/\$\s*adjust code (\S+)/i", $rsn, $tmp)) {
$rcode = $tmp[1]; // from 835
}
else if ($chg) {
// Other adjustments default to Ins1.
}
else if (preg_match("/Co-pay: (\S+)/i", $rsn, $tmp) ||
preg_match("/Coinsurance: (\S+)/i", $rsn, $tmp)) {
$coinsurance = 0 + $tmp[1]; // from 835 before 6/2007
continue;
}
else if (preg_match("/To deductible: (\S+)/i", $rsn, $tmp)) {
$deductible = 0 + $tmp[1]; // from 835 before 6/2007
continue;
}
else {
continue; // there is no adjustment amount
}
}
else {
continue; // it's for primary and that's not us
}
if ($rcode == '42') $rcode= '45'; // reason 42 is obsolete
$aadj[] = array($date, $gcode, $rcode, sprintf('%.2f', $chg));
} // end if
} // end foreach
// If we really messed it up, at least avoid negative numbers.
if ($coinsurance > $ptresp) $coinsurance = $ptresp;
if ($deductible > $ptresp) $deductible = $ptresp;
// Find out if this payer paid anything at all on this claim. This will
// help us allocate any unknown patient responsibility amounts.
$thispaidanything = 0;
foreach($this->invoice as $codekey => $codeval) {
foreach ($codeval['dtl'] as $key => $value) {
// plv exists to indicate the payer level.
if ($value['plv'] == $insnumber) {
$thispaidanything += $value['pmt'];
}
}
}
// Allocate any unknown patient responsibility by guessing if the
// deductible has been satisfied.
if ($thispaidanything)
$coinsurance = $ptresp - $deductible;
else
$deductible = $ptresp - $coinsurance;
$deductible = sprintf('%.2f', $deductible);
$coinsurance = sprintf('%.2f', $coinsurance);
if ($date && $deductible != 0)
$aadj[] = array($date, 'PR', '1', $deductible, $msp);
if ($date && $coinsurance != 0)
$aadj[] = array($date, 'PR', '2', $coinsurance, $msp);
} // end if
return $aadj;
}
// Return date, total payments and total "hard" adjustments from the given
// prior payer. If $code is specified then only that procedure key is
// selected, otherwise it's for the whole claim.
//
function payerTotals($ins, $code='') {
// If we have no modifiers stored in SQL-Ledger for this claim,
// then we cannot use a modifier passed in with the key.
$tmp = strpos($code, ':');
if ($tmp && !$this->using_modifiers) $code = substr($code, 0, $tmp);
$inslabel = ($this->payerSequence($ins) == 'S') ? 'Ins2' : 'Ins1';
$insnumber = substr($inslabel, 3);
$paytotal = 0;
$adjtotal = 0;
$date = '';
foreach($this->invoice as $codekey => $codeval) {
if ($code && strcmp($codekey,$code) != 0) continue;
foreach ($codeval['dtl'] as $key => $value) {
// plv (from ar_activity.payer_type) exists to
// indicate the payer level.
if ($value['plv'] == $insnumber) {
if (!$date) $date = str_replace('-', '', trim(substr($key, 0, 10)));
$paytotal += $value['pmt'];
}
}
$aarr = $this->payerAdjustments($ins, $codekey);
foreach ($aarr as $a) {
if (strcmp($a[1],'PR') != 0) $adjtotal += $a[3];
if (!$date) $date = $a[0];
}
}
return array($date, sprintf('%.2f', $paytotal), sprintf('%.2f', $adjtotal));
}
// Return the amount already paid by the patient.
//
function patientPaidAmount() {
// For primary claims $this->invoice is not loaded, so get the co-pay
// from the ar_activity table instead.
if (empty($this->invoice)) return $this->copay;
//
$amount = 0;
foreach($this->invoice as $codekey => $codeval) {
foreach ($codeval['dtl'] as $key => $value) {
// plv exists to indicate the payer level.
if ($value['plv'] == 0) { // 0 indicates patient
$amount += $value['pmt'];
}
}
}
return sprintf('%.2f', $amount);
}
// Return invoice total, including adjustments but not payments.
//
function invoiceTotal() {
$amount = 0;
foreach($this->invoice as $codekey => $codeval) {
$amount += $codeval['chg'];
}
return sprintf('%.2f', $amount);
}
// Number of procedures in this claim.
function procCount() {
return count($this->procs);
}
// Number of payers for this claim. Ranges from 1 to 3.
function payerCount() {
return count($this->payers);
}
function x12gsversionstring() {
return x12clean(trim($this->x12_partner['x12_version']));
}
function x12gssenderid() {
$tmp = $this->x12_partner['x12_sender_id'];
while (strlen($tmp) < 15) $tmp .= " ";
return $tmp;
}
function x12gs03() {
/*
* GS03: Application Receiver's Code
* Code Identifying Party Receiving Transmission
*
* In most cases, the ISA08 and GS03 are the same. However
*
* In some clearing houses ISA08 and GS03 are different
* Example: http:https://www.acs-gcro.com/downloads/DOL/DOL_CG_X12N_5010_837_v1_02.pdf - Page 18
* In this .pdf, the ISA08 is specified to be 100000 while the GS03 is specified to be 77044
*
* Therefore if the x12_gs03 segement is explicitly specified we use that value,
* otherwise we simply use the same receiver ID as specified for ISA03
*/
if($this->x12_partner['x12_gs03'] !== '')
return $this->x12_partner['x12_gs03'];
else
return $this->x12_partner['x12_receiver_id'];
}
function x12gsreceiverid() {
$tmp = $this->x12_partner['x12_receiver_id'];
while (strlen($tmp) < 15) $tmp .= " ";
return $tmp;
}
function x12gsisa05() {
return $this->x12_partner['x12_isa05'];
}
//adding in functions for isa 01 - isa 04
function x12gsisa01() {
return $this->x12_partner['x12_isa01'];
}
function x12gsisa02() {
return $this->x12_partner['x12_isa02'];
}
function x12gsisa03() {
return $this->x12_partner['x12_isa03'];
}
function x12gsisa04() {
return $this->x12_partner['x12_isa04'];
}
/////////
function x12gsisa07() {
return $this->x12_partner['x12_isa07'];
}
function x12gsisa14() {
return $this->x12_partner['x12_isa14'];
}
function x12gsisa15() {
return $this->x12_partner['x12_isa15'];
}
function x12gsgs02() {
$tmp = $this->x12_partner['x12_gs02'];
if ($tmp === '') $tmp = $this->x12_partner['x12_sender_id'];
return $tmp;
}
function x12gsper06() {
return $this->x12_partner['x12_per06'];
}
function cliaCode() {
return x12clean(trim($this->facility['domain_identifier']));
}
function billingFacilityName() {
return x12clean(trim($this->billing_facility['name']));
}
function billingFacilityStreet() {
return x12clean(trim($this->billing_facility['street']));
}
function billingFacilityCity() {
return x12clean(trim($this->billing_facility['city']));
}
function billingFacilityState() {
return x12clean(trim($this->billing_facility['state']));
}
function billingFacilityZip() {
return x12clean(trim($this->billing_facility['postal_code']));
}
function billingFacilityETIN() {
return x12clean(trim(str_replace('-', '', $this->billing_facility['federal_ein'])));
}
function billingFacilityNPI() {
return x12clean(trim($this->billing_facility['facility_npi']));
}
function federalIdType() {
if ($this->billing_facility['tax_id_type'])
{
return $this->billing_facility['tax_id_type'];
}
else{
return null;
}
}
# The billing facility and the patient must both accept for this to return true.
function billingFacilityAssignment($ins=0) {
$tmp = strtoupper($this->payers[$ins]['data']['accept_assignment']);
if (strcmp($tmp,'FALSE') == 0) return '0';
return !empty($this->billing_facility['accepts_assignment']);
}
function billingContactName() {
return x12clean(trim($this->billing_facility['attn']));
}
function billingContactPhone() {
if (preg_match("/([2-9]\d\d)\D*(\d\d\d)\D*(\d\d\d\d)/",
$this->billing_facility['phone'], $tmp))
{
return $tmp[1] . $tmp[2] . $tmp[3];
}
return '';
}
function facilityName() {
return x12clean(trim($this->facility['name']));
}
function facilityStreet() {
return x12clean(trim($this->facility['street']));
}
function facilityCity() {
return x12clean(trim($this->facility['city']));
}
function facilityState() {
return x12clean(trim($this->facility['state']));
}
function facilityZip() {
return x12clean(trim($this->facility['postal_code']));
}
function facilityETIN() {
return x12clean(trim(str_replace('-', '', $this->facility['federal_ein'])));
}
function facilityNPI() {
return x12clean(trim($this->facility['facility_npi']));
}
function facilityPOS() {
if($this->encounter['pos_code']){
return sprintf('%02d', trim($this->encounter['pos_code']));
}else{
return sprintf('%02d', trim($this->facility['pos_code']));
}
}
function clearingHouseName() {
return x12clean(trim($this->x12_partner['name']));
}
function clearingHouseETIN() {
return x12clean(trim(str_replace('-', '', $this->x12_partner['id_number'])));
}
function providerNumberType($prockey=-1) {
$tmp = ($prockey < 0 || empty($this->procs[$prockey]['provider_id'])) ?
$this->insurance_numbers : $this->procs[$prockey]['insurance_numbers'];
return $tmp['provider_number_type'];
}
function providerNumber($prockey=-1) {
$tmp = ($prockey < 0 || empty($this->procs[$prockey]['provider_id'])) ?
$this->insurance_numbers : $this->procs[$prockey]['insurance_numbers'];
return x12clean(trim(str_replace('-', '', $tmp['provider_number'])));
}
function providerGroupNumber($prockey=-1) {
$tmp = ($prockey < 0 || empty($this->procs[$prockey]['provider_id'])) ?
$this->insurance_numbers : $this->procs[$prockey]['insurance_numbers'];
return x12clean(trim(str_replace('-', '', $tmp['group_number'])));
}
// Returns 'P', 'S' or 'T'.
//
function payerSequence($ins=0) {
return strtoupper(substr($this->payers[$ins]['data']['type'], 0, 1));
}
// Returns the HIPAA code of the patient-to-subscriber relationship.
//
function insuredRelationship($ins=0) {
$tmp = strtolower($this->payers[$ins]['data']['subscriber_relationship']);
if (strcmp($tmp,'self' ) == 0) return '18';
if (strcmp($tmp,'spouse') == 0) return '01';
if (strcmp($tmp,'child' ) == 0) return '19';
if (strcmp($tmp,'other' ) == 0) return 'G8';
return $tmp; // should not happen
}
function insuredTypeCode($ins=0) {
if (strcmp($this->claimType($ins),'MB') == 0 && $this->payerSequence($ins) != 'P')
return $this->payers[$ins]['data']['policy_type'];
return '';
}
// Is the patient also the subscriber?
//
function isSelfOfInsured($ins=0) {
$tmp = strtolower($this->payers[$ins]['data']['subscriber_relationship']);
return (strcmp($tmp,'self') == 0);
}
function planName($ins=0) {
return x12clean(trim($this->payers[$ins]['data']['plan_name']));
}
function policyNumber($ins=0) { // "ID"
return x12clean(trim($this->payers[$ins]['data']['policy_number']));
}
function groupNumber($ins=0) {
return x12clean(trim($this->payers[$ins]['data']['group_number']));
}
function groupName($ins=0) {
return x12clean(trim($this->payers[$ins]['data']['subscriber_employer']));
}
// Claim types are:
// 16 Other HCFA
// MB Medicare Part B
// MC Medicaid
// CH ChampUSVA
// CH ChampUS
// BL Blue Cross Blue Shield
// 16 FECA
// 09 Self Pay
// 10 Central Certification
// 11 Other Non-Federal Programs
// 12 Preferred Provider Organization (PPO)
// 13 Point of Service (POS)
// 14 Exclusive Provider Organization (EPO)
// 15 Indemnity Insurance
// 16 Health Maintenance Organization (HMO) Medicare Risk
// AM Automobile Medical
// CI Commercial Insurance Co.
// DS Disability
// HM Health Maintenance Organization
// LI Liability
// LM Liability Medical
// OF Other Federal Program
// TV Title V
// VA Veterans Administration Plan
// WC Workers Compensation Health Plan
// ZZ Mutually Defined
//
function claimType($ins=0) {
if (empty($this->payers[$ins]['object'])) return '';
return $this->payers[$ins]['object']->get_ins_claim_type();
}
function claimTypeRaw($ins=0) {
if (empty($this->payers[$ins]['object'])) return 0;
return $this->payers[$ins]['object']->get_ins_type_code();
}
function insuredLastName($ins=0) {
return x12clean(trim($this->payers[$ins]['data']['subscriber_lname']));
}
function insuredFirstName($ins=0) {
return x12clean(trim($this->payers[$ins]['data']['subscriber_fname']));
}
function insuredMiddleName($ins=0) {
return x12clean(trim($this->payers[$ins]['data']['subscriber_mname']));
}
function insuredStreet($ins=0) {
return x12clean(trim($this->payers[$ins]['data']['subscriber_street']));
}
function insuredCity($ins=0) {
return x12clean(trim($this->payers[$ins]['data']['subscriber_city']));
}
function insuredState($ins=0) {
return x12clean(trim($this->payers[$ins]['data']['subscriber_state']));
}
function insuredZip($ins=0) {
return x12clean(trim($this->payers[$ins]['data']['subscriber_postal_code']));
}
function insuredPhone($ins=0) {
if (preg_match("/([2-9]\d\d)\D*(\d\d\d)\D*(\d\d\d\d)/",
$this->payers[$ins]['data']['subscriber_phone'], $tmp))
return $tmp[1] . $tmp[2] . $tmp[3];
return '';
}
function insuredDOB($ins=0) {
return str_replace('-', '', $this->payers[$ins]['data']['subscriber_DOB']);
}
function insuredSex($ins=0) {
return strtoupper(substr($this->payers[$ins]['data']['subscriber_sex'], 0, 1));
}
function payerName($ins=0) {
return x12clean(trim($this->payers[$ins]['company']['name']));
}
function payerAttn($ins=0) {
return x12clean(trim($this->payers[$ins]['company']['attn']));
}
function payerStreet($ins=0) {
if (empty($this->payers[$ins]['object'])) return '';
$tmp = $this->payers[$ins]['object'];
$tmp = $tmp->get_address();
return x12clean(trim($tmp->get_line1()));
}
function payerCity($ins=0) {
if (empty($this->payers[$ins]['object'])) return '';
$tmp = $this->payers[$ins]['object'];
$tmp = $tmp->get_address();
return x12clean(trim($tmp->get_city()));
}
function payerState($ins=0) {
if (empty($this->payers[$ins]['object'])) return '';
$tmp = $this->payers[$ins]['object'];
$tmp = $tmp->get_address();
return x12clean(trim($tmp->get_state()));
}
function payerZip($ins=0) {
if (empty($this->payers[$ins]['object'])) return '';
$tmp = $this->payers[$ins]['object'];
$tmp = $tmp->get_address();
return x12clean(trim($tmp->get_zip()));
}
function payerID($ins=0) {
return x12clean(trim($this->payers[$ins]['company']['cms_id']));
}
function payerAltID($ins=0) {
return x12clean(trim($this->payers[$ins]['company']['alt_cms_id']));
}
function patientLastName() {
return x12clean(trim($this->patient_data['lname']));
}
function patientFirstName() {
return x12clean(trim($this->patient_data['fname']));
}
function patientMiddleName() {
return x12clean(trim($this->patient_data['mname']));
}
function patientStreet() {
return x12clean(trim($this->patient_data['street']));
}
function patientCity() {
return x12clean(trim($this->patient_data['city']));
}
function patientState() {
return x12clean(trim($this->patient_data['state']));
}
function patientZip() {
return x12clean(trim($this->patient_data['postal_code']));
}
function patientPhone() {
$ptphone = $this->patient_data['phone_home'];
if (!$ptphone) $ptphone = $this->patient_data['phone_biz'];
if (!$ptphone) $ptphone = $this->patient_data['phone_cell'];
if (preg_match("/([2-9]\d\d)\D*(\d\d\d)\D*(\d\d\d\d)/", $ptphone, $tmp))
return $tmp[1] . $tmp[2] . $tmp[3];
return '';
}
function patientDOB() {
return str_replace('-', '', $this->patient_data['DOB']);
}
function patientSex() {
return strtoupper(substr($this->patient_data['sex'], 0, 1));
}
// Patient Marital Status: M = Married, S = Single, or something else.
function patientStatus() {
return strtoupper(substr($this->patient_data['status'], 0, 1));
}
// This should be UNEMPLOYED, STUDENT, PT STUDENT, or anything else to
// indicate employed.
function patientOccupation() {
return strtoupper(x12clean(trim($this->patient_data['occupation'])));
}
function cptCode($prockey) {
return x12clean(trim($this->procs[$prockey]['code']));
}
function cptModifier($prockey) {
// Split on the colon or space and clean each modifier
$mods = array();
$cln_mods = array();
$mods = preg_split("/[: ]/",trim($this->procs[$prockey]['modifier']));
foreach ($mods as $mod) {
array_push($cln_mods, x12clean($mod));
}
return (implode (':', $cln_mods));
}
function cptNotecodes($prockey) {
return x12clean(trim($this->procs[$prockey]['notecodes']));
}
// Returns the procedure code, followed by ":modifier" if there is one.
function cptKey($prockey) {
$tmp = $this->cptModifier($prockey);
return $this->cptCode($prockey) . ($tmp ? ":$tmp" : "");
}
function cptCharges($prockey) {
return x12clean(trim($this->procs[$prockey]['fee']));
}
function cptUnits($prockey) {
if (empty($this->procs[$prockey]['units'])) return '1';
return x12clean(trim($this->procs[$prockey]['units']));
}
// NDC drug ID.
function cptNDCID($prockey) {
$ndcinfo = $this->procs[$prockey]['ndc_info'];
if (preg_match('/^N4(\S+)\s+(\S\S)(.*)/', $ndcinfo, $tmp)) {
$ndc = $tmp[1];
if (preg_match('/^(\d+)-(\d+)-(\d+)$/', $ndc, $tmp)) {
return sprintf('%05d%04d%02d', $tmp[1], $tmp[2], $tmp[3]);
}
return x12clean($ndc); // format is bad but return it anyway
}
return '';
}
// NDC drug unit of measure code.
function cptNDCUOM($prockey) {
$ndcinfo = $this->procs[$prockey]['ndc_info'];
if (preg_match('/^N4(\S+)\s+(\S\S)(.*)/', $ndcinfo, $tmp))
return x12clean($tmp[2]);
return '';
}
// NDC drug number of units.
function cptNDCQuantity($prockey) {
$ndcinfo = $this->procs[$prockey]['ndc_info'];
if (preg_match('/^N4(\S+)\s+(\S\S)(.*)/', $ndcinfo, $tmp)) {
return x12clean(ltrim($tmp[3], '0'));
}
return '';
}
function onsetDate() {
return cleanDate($this->encounter['onset_date']);
}