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eligibility updates
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-  parse bug fix
- report updates
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@sjpadgett
sjpadgett committed Mar 12, 2019
1 parent 5deef73 commit 44c68b6
Showing 1 changed file with 51 additions and 114 deletions.
165 changes: 51 additions & 114 deletions library/edi.inc
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Original file line number Diff line number Diff line change
Expand Up @@ -16,6 +16,7 @@
* @copyright Copyright (c) 2019 Jerry Padgett <[email protected]>
* @license https://github.com/openemr/openemr/blob/master/LICENSE GNU General Public License 3
*/
require_once("$srcdir/edihistory/codes/edih_271_code_class.php");

use OpenEMR\Common\Http\oeHttp;

Expand Down Expand Up @@ -476,7 +477,7 @@ function show_elig($res, $X12info, $segTer, $compEleSep)
}

// To Show Eligibility Verification data
function show_eligibility_information($pid)
function show_eligibility_information($pid, $flag = false)
{
$query =
"SELECT eligr.*, eligv.insurance_id, eligv.copay, insd.pid, insc.name, " .
Expand All @@ -503,9 +504,23 @@ function show_eligibility_information($pid)
}
$benefit['start_date'] = strpos($benefit['start_date'], "0000") === false ? $benefit['start_date'] : '';
$benefit['end_date'] = strpos($benefit['end_date'], "0000") === false ? $benefit['end_date'] : '';

$showString .= "\n<div class='col col-sm-6'>\n";
$showString .= !empty($benefit['benefit_type']) ? "<b>" . xlt('Benefit Type') . ":</b> " . text($benefit['benefit_type']) . "<br />\n" : '';
$color = "";
switch ($benefit['type']) {
case '1':
$color = "darkred";
break;
case 'A':
$color = "blue";
break;
case 'B':
$color = "red";
break;
case 'C':
$color = "green";
break;
}
$showString .= "\n<div class='col col-sm-6' >\n";
$showString .= !empty($benefit['benefit_type']) ? "<b style='color: $color'>" . xlt('Benefit Type') . ": " . text($benefit['benefit_type']) . "</b><br />\n" : '';
$showString .= !empty($benefit['start_date']) ? "<b>" . xlt('Start Date') . ":</b> " . text(date("d/m/Y", strtotime($benefit['start_date']))) . "<br />\n" : '';
$showString .= !empty($benefit['end_date']) ? "<b>" . xlt('End Date') . ":</b> " . text(date("d/m/Y", strtotime($benefit['end_date']))) . "<br />\n" : '';
$showString .= !empty($benefit['coverage_level']) ? "<b>" . xlt('Coverage Level') . ":</b> " .text($benefit['coverage_level']) . "<br />\n" : '';
Expand All @@ -529,7 +544,9 @@ function show_eligibility_information($pid)
$showString .= "</div>";
}
$showString .= "</div></div>\n";

if ($title === 1) {
$showString = "<br /><span><b>" . xlt("Nothing To Report") . "</b></span><br />";
}
echo $showString;
}

Expand Down Expand Up @@ -792,93 +809,8 @@ function getPatientMatch($fn, $ln, $sex, $dob)

function parseEdi271($content)
{
// EB03
$coverage_type = [
'' => "",
'1' => xlt('Medical Care'),
'30' => xlt('Health Plan Benefit Coverage'),
'33' => xlt('Chiropractic'),
'35' => xlt('Dental'),
'42' => xlt('Home Health Care'),
'47' => xlt('Hospital'),
'48' => xlt('Hospital Inpatient'),
'50' => xlt('Hospital Outpatient'),
'51' => xlt('Hospital Emergency Accident'),
'52' => xlt('Emergency Room'),
'86' => xlt('Emergency Services'),
'88' => xlt('Pharmacy'),
'98' => xlt('Physician Office visit'),
'AE' => xlt('Physical and Speech Therapy'),
'AL' => xlt('Vision'),
'MH' => xlt('Mental Health'),
'UC' => xlt('Urgent Care'),
'BY' => xlt('Physician Visit Sick'),
'BZ' => xlt('Physician Visit Well')
];
// EB04
$plan_type = [
'' => "",
'C1' => xlt('Commercial'),
'HM' => xlt('HMO'),
'HN' => xlt('HMO Medicare Risk'),
'OT' => xlt('Other'),
'PR' => xlt('PPO'),
'PS' => xlt('POS'),
'MA' => xlt('Medicare Part A'),
'MB' => xlt('Medicare Part B'),
'MC' => xlt('Medicare Part C'),
'IN' => xlt('Indemnity'),
'SP' => xlt('Supplemental Policy')
];
// EB06
$coverage_period = [
'' => "",
'7' => xlt('Co-Insurance Days Co-Payment Amount'),
'22' => xlt('Service Year'),
'23' => xlt(''),
'26' => xlt('Full Days Co-Payment Amount'),
'27' => xlt('Visit'),
'29' => xlt(''),
'32' => xlt('Lifetime'),
'33' => xlt('Lifetime Rendering'),
'36' => xlt('Admission')
];
//EB01 Time Period Qualifier
$benefit_type = [
'' => "",
'1' => xlt('Active Coverage'),
'6' => xlt('Inactive'),
'A' => xlt('Co-insurance'),
'B' => xlt('Co-payment'),
'C' => xlt('Deductible'),
'F' => xlt('Limitation'),
'G' => xlt('Out of pocket'),
'I' => xlt('Non-covered'),
'L' => xlt('Primary Care Provider'),
'P' => xlt('Benefit disclaimer'),
'R' => xlt('Other payer information'),
'X' => xlt('Beneficiary is Medicare entitled')
];
$aaa_rejected = [
'' => xlt('Unknown rejection code'),
'41' => xlt('Authorization or Access Restrictions'),
'42' => xlt('Unable to Respond at Current Time'),
'43' => xlt('Invalid Provider Status'),
'57' => xlt('Invalid or Missing Date(s) of Service'),
'58' => xlt('Invalid or Missing Date of Birth'),
'60' => xlt('Date of Birth Follows Date Of Service'),
'63' => xlt('Date of Service in Future'),
'64' => xlt('Invalid or Missing Patient ID'),
'65' => xlt('Invalid or Missing Patient Name'),
'67' => xlt('Patient Not Found'),
'68' => xlt('Duplicate Patient Id Number'),
'71' => xlt('Patient Birth Date Does Not Match That for the Patient on the Database'),
'72' => xlt('72 Invalid or Missing Subscriber or Insured ID'),
'73' => xlt('Invalid or Missing Subscriber or Insured Name'),
'75' => xlt('Subscriber or Insured Not Found'),
'79' => xlt('270 2100A NM103 or NM109 Source Invalid')
];

$codes = new edih_271_codes('*', '^');
$target = $GLOBALS['edi_271_file_path'];
$log = "";
// not sure if want to save yet
Expand Down Expand Up @@ -972,20 +904,23 @@ function parseEdi271($content)
break;

case 'TRN':
$trace = ++$trace + ((int)$elements[2] - (int)$elements[2]);
if ($trace === 0) {
if ($trace === -1) {
$trace++;
break; // subscriber not set yet
}
$in['benefits'] = $benefits ? $benefits : [];
array_push($subscribers, $in);
$loop['context'] = $elements[0];
$benefits = [];
$trace++;
if ($in['pid']) {
$in['benefits'] = $benefits ? $benefits : [];
array_push($subscribers, $in);
$loop['context'] = $elements[0];
$benefits = [];
}
break;

case 'REQ':
case 'REF':
if ($elements[1] == "EJ") {
$in['pid'] = $elements[2];
if (!(int)$in['pid']) {
$in['pid'] = (int)$elements[2];
if (!$in['pid']) {
$in['pid'] = (int)getPatientMatch(
$in['subscriber_fname'],
$in['subscriber_lname'],
Expand Down Expand Up @@ -1015,17 +950,17 @@ function parseEdi271($content)
case 'EB':
$eb = array(
'type' => $elements[1],
'benefit_type' => $benefit_type[$elements[1]] ? $benefit_type[$elements[1]] : $elements[1],
'benefit_type' => $codes->get_271_code("EB01", $elements[1]) ? $codes->get_271_code("EB01", $elements[1]) : $elements[1],
'start_date' => '',
'end_date' => '',
'coverage_level' => $elements[2],
'coverage_type' => $coverage_type[$elements[3]] ? $coverage_type[$elements[3]] :$elements[3],
'plan_type' => $plan_type[$elements[4]] ? $plan_type[$elements[4]] : $elements[4],
'coverage_level' => $elements[2] ? $codes->get_271_code("EB02", $elements[2]) :$elements[2],
'coverage_type' => $elements[3] ? $codes->get_271_code("EB03", $elements[3]) :$elements[3],
'plan_type' => $elements[4] ? $codes->get_271_code("EB04", $elements[4]) : $elements[4],
'plan_description' => $elements[5],
'coverage_period' => $coverage_period[$elements[6]] ? $coverage_period[$elements[6]] : $elements[6],
'coverage_period' => $elements[6] ? $codes->get_271_code("EB06", $elements[6]) : $elements[6],
'amount' => $elements[7] ? number_format($elements[7], 2, '.', '') : '',
'percent' => $elements[8],
'network_ind' => $elements[12],
'network_ind' => $elements[12] ? $codes->get_271_code("EB12", $elements[12]) : $elements[12],
'message' => '' // any MSG segments that may be assoc with this EB.
);
$loop['context'] = "EB";
Expand All @@ -1036,8 +971,8 @@ function parseEdi271($content)
$error = array(
'request_ind' => $elements[1],
'reason_code' => $elements[3],
'follow_up' => $elements[4],
'reason_text' => $elements[3] . " : " . $aaa_rejected[$elements[3]]
'follow_up' => $elements[4] . " : " . $codes->get_271_code("AAA03", $elements[4]),
'reason_text' => $elements[3] . " : " . $codes->get_271_code("AAA03", $elements[3])
);
array_push($AAA, $error);
break;
Expand All @@ -1052,13 +987,18 @@ function parseEdi271($content)

case 'SE':
$in['benefits'] = $benefits ? $benefits : [];
array_push($subscribers, $in);
if ($in['pid']) {
array_push($subscribers, $in);
}
$loop['context'] = $elements[0];
$benefits = [];
break;

case 'IEA':
// done
// save
foreach ($subscribers as $subscriber) {
eligibility_verification_save($subscriber);
}
break;
}
}
Expand All @@ -1068,10 +1008,7 @@ function parseEdi271($content)
$log .= makeEligibilityReport($subscribers);
}
}
// save
foreach ($subscribers as $subscriber) {
eligibility_verification_save($subscriber);
}


return $log;
}
Expand Down

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