various corrections and improvements to remit processing

interface/billing/claim_status_codes.php

@@ -1,8 +1,27 @@
 <?php
 
-// See http:https://www.wpc-edi.com/codes
-//
 $claim_status_codes = array(
+ '1' => 'Processed as Primary',
+ '2' => 'Processed as Secondary',
+ '3' => 'Processed as Tertiary',
+ '4' => 'Denied',
+ '5' => 'Pended',
+ '11' => 'Received, but not in process',
+ '13' => 'Suspended',
+ '15' => 'Suspended - investigation with field',
+ '16' => 'Suspended - return with material',
+ '17' => 'Suspended - review pending',
+ '19' => 'Processed as Primary, Forwarded to Additional Payer(s)',
+ '20' => 'Processed as Secondary, Forwarded to Additional Payer(s)',
+ '21' => 'Processed as Tertiary, Forwarded to Additional Payer(s)',
+ '22' => 'Reversal of Previous Payment',
+ '23' => 'Not Our Claim, Forwarded to Additional Payer(s)',
+ '25' => 'Predetermination Pricing Only - No Payment',
+ '27' => 'Reviewed'
+
+ /****
+ // See http:https://www.wpc-edi.com/codes
+ //
  '0' => 'Cannot provide further status electronically.',
  '1' => 'For more detailed information, see remittance advice.',
  '2' => 'More detailed information in letter.',
@@ -660,5 +679,6 @@
  '667' => 'Real-Time requests not supported by the information holder, do not resubmit',
  '668' => 'Missing Endodontics treatment history and prognosis',
  '669' => 'Dental service narrative needed.'
+ ****/
 );
 ?>

interface/billing/sl_eob_process.php

@@ -103,8 +103,7 @@ function writeOldDetail(&$prev, $ptname, $invnumber, $dos, $code, $bgcolor) {
  //
  function era_callback(&$out) {
  global $encount, $debug, $claim_status_codes, $adjustment_reasons, $remark_codes;
- global $invoice_total;
- // print_r($out); // debugging
+ global $invoice_total, $last_code;
 
  // Some heading information.
  if ($encount == 0) {
@@ -116,6 +115,7 @@ function era_callback(&$out) {
  }
  }
 
+ $last_code = '';
  $invoice_total = 0.00;
  $bgcolor = (++$encount & 1) ? "#ddddff" : "#ffdddd";
  list($pid, $encounter, $invnumber) = slInvoiceNumber($out);
@@ -139,8 +139,20 @@ function era_callback(&$out) {
  }
  }
 
+ $insurance_id = 0;
+ foreach ($codes as $cdata) {
+ if ($cdata['ins']) {
+ $insurance_id = $cdata['ins'];
+ break;
+ }
+ }
+
  // Show the claim status.
  $csc = $out['claim_status_code'];
+ $inslabel = 'Ins1';
+ if ($csc == '1' || $csc == '19') $inslabel = 'Ins1';
+ if ($csc == '2' || $csc == '20') $inslabel = 'Ins2';
+ if ($csc == '3' || $csc == '21') $inslabel = 'Ins3';
  writeMessageLine($bgcolor, 'infdetail',
  "Claim status $csc: " . $claim_status_codes[$csc]);
 
@@ -150,12 +162,14 @@ function era_callback(&$out) {
  "The following claim is not in our database");
  }
  else {
- $insdone = strtolower($arrow['shipvia']);
- if (strpos($insdone, 'ins1') !== false) {
- $inverror = true;
- writeMessageLine($bgcolor, 'errdetail',
- "Primary insurance EOB was already posted for the following claim");
- }
+ // Skip this test. Claims can get multiple CLPs from the same payer!
+ //
+ // $insdone = strtolower($arrow['shipvia']);
+ // if (strpos($insdone, 'ins1') !== false) {
+ // $inverror = true;
+ // writeMessageLine($bgcolor, 'errdetail',
+ // "Primary insurance EOB was already posted for the following claim");
+ // }
  }
 
  if ($out['warnings']) {
@@ -169,9 +183,10 @@ function era_callback(&$out) {
  $patient_name = $arrow['name'] ? $arrow['name'] :
  ($out['patient_fname'] . ' ' . $out['patient_lname']);
 
+ $error = $inverror;
+
  // This loops once for each service item in this claim.
  foreach ($out['svc'] as $svc) {
- $error = $inverror;
  $prev = $codes[$svc['code']];
 
  // This reports detail lines already on file for this service item.
@@ -184,7 +199,14 @@ function era_callback(&$out) {
  "EOB charge amount " . $svc['chg'] . " for this code does not match our invoice");
  $error = true;
  }
+
  // Check for duplicate payment. Should not happen.
+ //
+ // This is not right. What we want to do is check if we have
+ // any payments or adjustments from this payer for this service item,
+ // and produce an error if so. The point is that a duplicated claim
+ // submission may not give the same results as the original.
+ /****
  foreach ($prev['dtl'] as $dkey => $ddata) {
  if (! $ddata['pmt']) continue;
  $ddate = parse_date($dkey);
@@ -194,17 +216,43 @@ function era_callback(&$out) {
  $error = true;
  }
  }
+ ****/
+ // The following replaces the above.
+ if ((sprintf("%.2f",$prev['chg']) != sprintf("%.2f",$prev['bal']) ||
+ $prev['adj'] != 0) && $inslabel == 'Ins1')
+ {
+ writeMessageLine($bgcolor, 'errdetail',
+ "This service item already has payments and/or adjustments!");
+ $error = true;
+ }
+
  unset($codes[$svc['code']]);
  }
 
- // Or if the service item is not in our database, show it in red for
- // manual resolution. Probably what happened is that the billing was
- // "corrected" in OpenEMR after the claim was generated... not good!
+ // If the service item is not in our database...
  else {
+
+ /****
  writeDetailLine($bgcolor, 'errdetail', $patient_name, $invnumber,
  $svc['code'], $service_date, '*** UNMATCHED SERVICE ITEM ***',
  $svc['chg'], '');
  $error = true;
+ ****/
+
+ // No, this is not an error. Instead, if we are not in error mode
+ // insert the service item into SL. Then display it (in green if it
+ // was inserted, or in red if we are in error mode).
+ $description = 'CPT4:' . $svc['code'] . " Added by $inslabel $production_date";
+ if (!$error && !$debug) {
+ slPostCharge($arrow['id'], $svc['chg'], $service_date, $svc['code'],
+ $insurance_id, $description, $debug);
+ $invoice_total += $svc['chg'];
+ }
+ $class = $error ? 'errdetail' : 'newdetail';
+ writeDetailLine($bgcolor, $class, $patient_name, $invnumber,
+ $svc['code'], $production_date, $description,
+ $svc['chg'], ($error ? '' : $invoice_total));
+
  }
 
  $class = $error ? 'errdetail' : 'newdetail';
@@ -239,11 +287,11 @@ function era_callback(&$out) {
  if ($svc['paid']) {
  if (!$error && !$debug) {
  slPostPayment($arrow['id'], $svc['paid'], $check_date,
- 'Ins1/' . $out['check_number'], $svc['code'], $prev['ins'], $debug);
+ "$inslabel/" . $out['check_number'], $svc['code'], $insurance_id, $debug);
  $invoice_total -= $svc['paid'];
  }
  writeDetailLine($bgcolor, $class, $patient_name, $invnumber,
- $svc['code'], $check_date, 'Ins1/' . $out['check_number'] . ' payment',
+ $svc['code'], $check_date, "$inslabel/" . $out['check_number'] . ' payment',
  0 - $svc['paid'], ($error ? '' : $invoice_total));
  }
 
@@ -261,7 +309,7 @@ function era_callback(&$out) {
  $reason .= sprintf("%.2f", $adj['amount']);
  if (!$error && !$debug) {
  slPostAdjustment($arrow['id'], 0, $production_date,
- $out['check_number'], $svc['code'], $prev['ins'],
+ $out['check_number'], $svc['code'], $insurance_id,
  $reason, $debug);
  }
  writeMessageLine($bgcolor, $class, $description . ' ' .
@@ -271,8 +319,8 @@ function era_callback(&$out) {
  else {
  if (!$error && !$debug) {
  slPostAdjustment($arrow['id'], $adj['amount'], $production_date,
- $out['check_number'], $svc['code'], $prev['ins'],
- 'Ins1 adjust code ' . $adj['reason_code'], $debug);
+ $out['check_number'], $svc['code'], $insurance_id,
+ "$inslabel adjust code " . $adj['reason_code'], $debug);
  $invoice_total -= $adj['amount'];
  }
  writeDetailLine($bgcolor, $class, $patient_name, $invnumber,
@@ -290,13 +338,15 @@ function era_callback(&$out) {
 
  // Cleanup: If all is well, mark Ins1 done and check for secondary billing.
  if (!$error && !$debug) {
- // Mark Ins1 done.
- $query = "UPDATE ar SET shipvia = 'Done: Ins1' WHERE id = " . $arrow['id'];
+ $shipvia = 'Done: Ins1';
+ if ($inslabel != 'Ins1') $shipvia .= ',Ins2';
+ if ($inslabel == 'Ins3') $shipvia .= ',Ins3';
+ $query = "UPDATE ar SET shipvia = '$shipvia' WHERE id = " . $arrow['id'];
  SLQuery($query);
  if ($sl_err) die($sl_err);
  // Check for secondary insurance.
  $insgot = strtolower($arrow['notes']);
- if (strpos($insgot, 'ins2') !== false) {
+ if ($inslabel == 'Ins1' && strpos($insgot, 'ins2') !== false) {
  slSetupSecondary($arrow['id'], $debug);
  writeMessageLine($bgcolor, 'infdetail',
  'This claim is now re-queued for secondary paper billing');

library/invoice_summary.inc.php

@@ -65,7 +65,7 @@ function get_invoice_summary($trans_id, $with_detail = false) {
  // Request all line items with money or adjustment reasons belonging
  // to the invoice.
  $inres = SLQuery("SELECT * FROM invoice WHERE trans_id = $trans_id AND " .
- "( sellprice != 0 OR description LIKE 'Adjustment%' )");
+ "( sellprice != 0 OR description LIKE 'Adjustment%' OR serialnumber = 'Claim' )");
  if ($sl_err) die($sl_err);
 
  // Add charges and adjustments for each procedure code into its total and balance.
@@ -76,7 +76,10 @@ function get_invoice_summary($trans_id, $with_detail = false) {
  $ins_id = $row['project_id'];
 
  $code = "Unknown";
- if (preg_match("/([A-Za-z0-9]\d\d\S*)/", $row['serialnumber'], $matches)) {
+ if ($row['serialnumber'] == 'Claim') {
+ $code = 'Claim';
+ }
+ else if (preg_match("/([A-Za-z0-9]\d\d\S*)/", $row['serialnumber'], $matches)) {
  $code = strtoupper($matches[1]);
  }
  else if (preg_match("/([A-Za-z0-9]\d\d\S*)/", $row['description'], $matches)) {