public function getClaimLine()
{
$claimLine = new ClaimLine();
$claimLine->populateWithPatientProcedure($this, null);
return $claimLine;
}
public static function inquire($visitId)
{
$claimIds = ClaimLine::listAllMostRecentClaimIds(array($visitId));
$claimId = isset($claimIds[0]) ? $claimIds[0] : 0;
$claimFile = self::getClaimFile($claimId);
$query = array();
$query['apiKey'] = Zend_Registry::get('config')->healthcloud->apiKey;
$query['uid'] = $claimFile->claimFileId;
$ch = curl_init();
$url = Zend_Registry::get('config')->healthcloud->claimsServerUrl . '/check-status';
curl_setopt($ch, CURLOPT_URL, $url);
curl_setopt($ch, CURLOPT_POST, true);
curl_setopt($ch, CURLOPT_POSTFIELDS, json_encode($query));
curl_setopt($ch, CURLOPT_SSL_VERIFYPEER, false);
curl_setopt($ch, CURLOPT_SSL_VERIFYHOST, false);
curl_setopt($ch, CURLOPT_RETURNTRANSFER, true);
curl_setopt($ch, CURLOPT_SSL_VERIFYPEER, false);
$output = curl_exec($ch);
if (!curl_errno($ch)) {
$data = json_decode($output, true);
if ($data === null) {
$response = 'Invalid HC response';
} else {
if (array_key_exists('response', $data)) {
$response = $data['response'];
} else {
if (array_key_exists('error', $data)) {
$response = $data['error'];
} else {
$response = 'Unknown HC response: ' . print_r($data, true);
}
}
}
} else {
$response = __('There was an error connecting to HealthCloud to check claim status. Please try again or contact the system administrator.');
}
curl_close($ch);
trigger_error($response);
return $response . '';
}
public function listAction()
{
$posStart = $this->_getParam('posStart');
if ($posStart < 0) {
$msg = 'Invalid request';
trigger_error($msg);
throw new Exception($msg);
}
$sessions = $this->_session->filters;
$filters = array();
$filters['dateRange'] = array('start' => $sessions['DateStart'], 'end' => $sessions['DateEnd']);
if (isset($sessions['facilities']) && count($sessions['facilities']) > 0) {
// practiceId_buildingId_roomId
foreach ($sessions['facilities'] as $key => $value) {
if (!$value) {
continue;
}
if (!isset($filters['facilities'])) {
$filters['facilities'] = array();
}
$x = explode('_', $key);
$practiceId = $x[0];
$buildingId = $x[1];
$roomId = $x[2];
$filters['facilities'][] = array('practice' => $practiceId, 'building' => $buildingId, 'room' => $roomId);
}
}
if (isset($sessions['payers']) && count($sessions['payers']) > 0) {
foreach ($sessions['payers'] as $key => $value) {
if (!$value) {
continue;
}
if (!isset($filters['payers'])) {
$filters['payers'] = array();
}
$filters['payers'][] = $key;
}
}
if (isset($sessions['providers']) && count($sessions['providers']) > 0) {
foreach ($sessions['providers'] as $key => $value) {
if (!$value) {
continue;
}
if (!isset($filters['providers'])) {
$filters['providers'] = array();
}
$filters['providers'][] = $key;
}
}
$filters['billed'] = isset($sessions['billed']) ? $sessions['billed'] : 0;
$filters['paid'] = isset($sessions['paid']) ? $sessions['paid'] : 0;
$filters['writeoff'] = isset($sessions['writeoff']) ? $sessions['writeoff'] : 0;
$filters['balance'] = isset($sessions['balance']) ? $sessions['balance'] : 0;
$rows = array();
$appointmentId = 0;
$totalBilled = 0.0;
$totalPaid = 0.0;
$totalWriteoff = 0.0;
$totalBalance = 0.0;
$oneDay = 60 * 60 * 24;
$today = time();
$aging_0_30 = 0;
$aging_31_60 = 0;
$aging_61_90 = 0;
$aging_91_120 = 0;
$aging_120_plus = 0;
$filters['closed'] = 1;
foreach (ClaimLine::listCharges($filters) as $account) {
$billed = (double) $account['billed'];
$paid = (double) $account['paid'];
$writeoff = (double) $account['writeOff'];
$balance = (double) $account['balance'];
$names = array('billed', 'paid', 'writeoff', 'balance');
foreach ($names as $name) {
if (!isset($filters[$name]) || !$filters[$name]['active']) {
continue;
}
$operator = $filters[$name]['operator'];
$operand1 = $filters[$name]['operand1'];
$operand2 = $filters[$name]['operand2'];
if ($operator == '=' && !(${$name} == $operand1)) {
continue 2;
} else {
if ($operator == '>' && !(${$name} > $operand1)) {
continue 2;
} else {
if ($operator == '>=' && !(${$name} >= $operand1)) {
continue 2;
} else {
if ($operator == '<' && !(${$name} < $operand1)) {
continue 2;
} else {
if ($operator == '<=' && !(${$name} <= $operand1)) {
continue 2;
} else {
if ($operator == 'between' && $operand2 > 0 && !(${$name} >= $operand1 && ${$name} <= $operand2)) {
continue 2;
}
}
}
}
}
}
}
$balance = abs($balance);
$totalBilled += $billed;
$totalPaid += $paid;
$totalWriteoff += $writeoff;
$totalBalance += $balance;
$dateBilled = substr($account['dateBilled'], 0, 10);
$db = strtotime($dateBilled);
// calculate aging
$aging = ($today - $db) / $oneDay;
if ($aging <= 30) {
$aging_0_30 += $balance;
} else {
if ($aging <= 60) {
$aging_31_60 += $balance;
} else {
if ($aging <= 90) {
$aging_61_90 += $balance;
} else {
if ($aging <= 120) {
$aging_91_120 += $balance;
} else {
$aging_120_plus += $balance;
}
}
}
}
$rows[] = array('id' => $account['id'], 'data' => array(substr($account['dateOfTreatment'], 0, 10), $dateBilled, $account['patientName'], $account['payer'], '$' . $billed, '$' . $paid, '$' . $writeoff, '$' . $balance, $account['facility'], $account['providerName']));
}
if (isset($rows[0])) {
$rows[0]['userdata']['totalBilled'] = $totalBilled;
trigger_error('total billed: ' . $totalBilled);
$rows[0]['userdata']['totalPaid'] = $totalPaid;
trigger_error('total paid: ' . $totalPaid);
$rows[0]['userdata']['totalWriteoff'] = $totalWriteoff;
trigger_error('total writeof: ' . $totalWriteoff);
$rows[0]['userdata']['totalBalance'] = $totalBalance;
trigger_error('total balance: ' . $totalBalance);
$rows[0]['userdata']['aging_0_30'] = $aging_0_30;
trigger_error('total aging 0-30: ' . $aging_0_30);
$rows[0]['userdata']['aging_31_60'] = $aging_31_60;
trigger_error('total aging 31-60: ' . $aging_31_60);
$rows[0]['userdata']['aging_61_90'] = $aging_61_90;
trigger_error('total aging 61-90: ' . $aging_61_90);
$rows[0]['userdata']['aging_91_120'] = $aging_91_120;
trigger_error('total aging 91-120: ' . $aging_91_120);
$rows[0]['userdata']['aging_120_plus'] = $aging_120_plus;
trigger_error('total aging 120+: ' . $aging_120_plus);
}
$data = array('rows' => $rows);
$json = Zend_Controller_Action_HelperBroker::getStaticHelper('json');
$json->suppressExit = true;
$json->direct($data);
}
public function getAccountSummary()
{
$visitId = (int) $this->visitId;
$total = 0;
$billed = 0;
$writeoff = 0;
$balance = 0;
$baseFee = 0;
$adjustedFee = 0;
$miscCharge = MiscCharge::total(array('visitId' => $visitId));
$payment = Payment::total(array('visitId' => $visitId));
$payment += Payment::unpostedTotal($visitId);
$writeoff += WriteOff::total(array('visitId' => $visitId));
if ($this->closed) {
$iterator = ClaimLine::mostRecentClaims($visitId);
foreach ($iterator as $claimLine) {
$baseFee += (double) $claimLine->baseFee;
$adjustedFee += (double) $claimLine->adjustedFee;
}
} else {
$fees = $this->calculateFees();
$baseFee += $fees['total'];
$adjustedFee = $fees['discounted'];
if (!$writeoff > 0 && $adjustedFee > 0) {
$writeoff += $baseFee - $adjustedFee;
}
}
$total = $baseFee + $miscCharge;
$billed = $miscCharge;
if ($adjustedFee > 0) {
$billed += $adjustedFee;
}
if (!$billed > 0) {
$billed = $total;
}
$balance = abs($total) - ($payment + $writeoff);
if ($balance == $total) {
$balance = $billed;
}
// use total billed if balance equals to total
$ret = array();
$ret['total'] = $total;
$ret['billed'] = $billed;
$ret['payment'] = $payment;
$ret['balance'] = $balance;
$ret['writeoff'] = $writeoff;
$ret['baseFee'] = $baseFee;
$ret['adjustedFee'] = $adjustedFee;
$ret['miscCharge'] = $miscCharge;
if (isset($claimLine)) {
$ret['claimLine'] = $claimLine;
}
return $ret;
}
protected static function _generate4010A1($claimId, array $claim)
{
static $ctr = 0;
static $visits = array();
static $practices = array();
static $insurancePrograms = array();
static $providers = array();
static $patients = array();
$claimId = (int) $claimId;
$claimLine = new ClaimLine();
$claimLine->populateByClaimId($claimId);
$visitId = (int) $claimLine->visitId;
if (!isset($visits[$visitId])) {
$visit = new Visit();
$visit->visitId = $visitId;
$visit->populate();
$visits[$visitId] = $visit;
}
$visit = $visits[$visitId];
$patientId = (int) $visit->patientId;
if (!isset($patients[$patientId])) {
$patient = new Patient();
$patient->personId = $patientId;
$patient->populate();
$patients[$patientId] = $patient;
}
$patient = $patients[$patientId];
$practiceId = (int) $visit->practiceId;
if (!isset($practices[$practiceId])) {
$practice = new Practice();
$practice->practiceId = $practiceId;
$practice->populate();
$practices[$practiceId] = $practice;
}
$practice = $practices[$practiceId];
$insuranceProgramId = (int) $visit->activePayerId;
if (!isset($insurancePrograms[$insuranceProgramId])) {
$insurance = new InsuranceProgram();
$insurance->insuranceProgramId = $insuranceProgramId;
$insurance->populate();
$insurancePrograms[$insuranceProgramId] = $insurance;
}
$insuranceProgram = $insurancePrograms[$insuranceProgramId];
$providerId = (int) $visit->treatingPersonId;
if (!isset($providers[$providerId])) {
$provider = new Provider();
$provider->personId = $providerId;
$provider->populate();
$providers[$providerId] = $provider;
}
$provider = $providers[$providerId];
$billAs = (int) $provider->billAs;
if ($billAs > 0) {
$providerId = $billAs;
if (!isset($providers[$providerId])) {
$provider = new Provider();
$provider->personId = $providerId;
$provider->populate();
$providers[$providerId] = $provider;
}
$provider = $providers[$providerId];
}
$subscribers = array();
$enumeration = new Enumeration();
$enumeration->populateByUniqueName(InsuranceProgram::INSURANCE_ENUM_NAME);
$enumerationClosure = new EnumerationClosure();
foreach ($enumerationClosure->getAllDescendants($enumeration->enumerationId, 1, true) as $enum) {
$rowset = $enumerationClosure->getAllDescendants($enum->enumerationId, 1, true);
if ($enum->key == InsuranceProgram::INSURANCE_SUBSCRIBER_ENUM_KEY) {
foreach ($rowset as $row) {
$subscribers[$row->key] = $row->name;
}
break;
}
}
$insuredRelationship = new InsuredRelationship();
$db = Zend_Registry::get('dbAdapter');
$sqlSelect = $db->select()->from($insuredRelationship->_table)->where('insurance_program_id = ?', (int) $insuranceProgram->insuranceProgramId)->where('person_id = ?', (int) $patientId)->where('active = 1')->order('program_order')->limit(1);
if ($row = $db->fetchRow($sqlSelect)) {
$insuredRelationship->populateWithArray($row);
}
$subs = $insuredRelationship->subscriber;
$subscriberAddr = $subs->address;
$relationship = null;
$relationshipCode = $insuredRelationship->subscriberToPatientRelationship;
if (isset($subscribers[$relationshipCode])) {
$relationship = $subscribers[$relationshipCode];
}
if ($relationship === null) {
$relationship = 'Self';
$relationshipCode = 18;
$subs = new Person();
$subs->personId = $insuredRelationship->personId;
$subs->populate();
}
$subscriber = array('id' => (int) $subs->personId, 'relationship_code' => $relationshipCode, 'group_number' => $insuredRelationship->groupNumber, 'group_name' => $insuredRelationship->groupName, 'relationship' => $relationship, 'last_name' => $subs->lastName, 'first_name' => $subs->firstName, 'middle_name' => $subs->middleName, 'address' => array('line1' => $subscriberAddr->line1, 'line2' => $subscriberAddr->line2, 'city' => $subscriberAddr->city, 'state' => $subscriberAddr->state, 'zip' => $subscriberAddr->zipCode), 'date_of_birth' => date('Ymd', strtotime($subs->dateOfBirth)), 'gender' => $subs->gender, 'contract_type_code' => '', 'contract_amount' => '', 'contract_percent' => '', 'contract_code' => '', 'contract_discount_percent' => '', 'contract_version' => '');
$practiceAddr = $practice->primaryAddress;
$room = new Room();
$room->roomId = (int) $visit->roomId;
$room->populate();
$facility = $room->building;
$phoneNumber = PhoneNumber::autoFixNumber($practice->mainPhone->number);
$phoneLen = strlen($phoneNumber);
if ($phoneLen < 10) {
$phoneNumber = str_pad($phoneNumber, 10, '0', STR_PAD_LEFT);
} else {
if ($phoneLen > 10) {
$phoneNumber = substr($phoneNumber, -10);
}
}
$identifierType = '';
$identifier = $practice->identifier;
if (strlen($identifier) > 0) {
$identifierType = 'XX';
}
//24';
$data = array('hlCount' => ++$ctr);
$data['practice'] = array('name' => $practice->name, 'identifier_type' => $identifierType, 'identifier' => $identifier, 'address' => array('line1' => $practiceAddr->line1, 'line2' => $practiceAddr->line2, 'city' => $practiceAddr->city, 'state' => $practiceAddr->state, 'zip' => $practiceAddr->zipCode), 'phoneNumber' => $phoneNumber);
$data['treating_facility'] = array('identifier' => $facility->identifier);
$dateOfTreatment = date('Ymd', strtotime($visit->dateOfTreatment));
$payer2Id = $insuranceProgram->insuranceProgramId;
if (strlen($payer2Id) < 2) {
$payer2Id = str_pad($payer2Id, 2, '0', STR_PAD_LEFT);
}
$identifierType = '';
$identifier = $provider->person->identifier;
if (strlen($identifier) > 0) {
$identifierType = 'XX';
}
//34';
$claimData = array('claim' => $claim, 'patient' => array('date_of_initial_treatment' => $dateOfTreatment, 'date_of_onset' => $dateOfTreatment, 'comment_type' => '', 'comment' => ''), 'treating_facility' => array('facility_code' => $facility->facilityCodeId, 'name' => $facility->name, 'address' => array('line1' => $facility->line1, 'line2' => $facility->line2, 'city' => $facility->city, 'state' => $facility->state, 'zip' => $facility->zipCode)), 'provider' => array('signature_on_file' => 'Y', 'accepts_assignment' => 'A', 'last_name' => $provider->person->lastName, 'first_name' => $provider->person->firstName, 'identifier_type' => $identifierType, 'identifier' => $identifier, 'identifier_2' => ''), 'billing_facility' => array('clia_number' => ''), 'subscriber' => $subscriber, 'clearing_house' => array('credit_max_amount' => '', 'repricing_method' => '', 'allowed_amount' => '', 'savings_amount' => '', 'identifier' => '', 'rate' => '', 'apg_code' => '', 'apg_amount' => '', 'reject_code' => '', 'compliance_code' => '', 'exception_code' => ''), 'referring_provider' => array('last_name' => '', 'first_name' => '', 'referral_type' => '', 'identifier_type' => '', 'identifier' => '', 'taxonomy_code' => ''), 'supervising_provider' => array('last_name' => '', 'first_name' => '', 'identifier_type' => '', 'identifier' => ''), 'payer2' => array('id' => $payer2Id, 'name' => $insuranceProgram->name));
$clm = array();
$iterator = new ClaimLineIterator();
$iterator->setFilters(array('claimId' => $claimId));
foreach ($iterator as $row) {
$baseFee = (double) $row->baseFee;
$adjustedFee = (double) $row->adjustedFee;
$paid = (double) $row->paid;
$billed = $row->totalMiscCharge;
if ($baseFee > 0) {
$billed += $baseFee - $adjustedFee;
}
$balance = abs($billed) - $paid;
$clm[] = array('claim' => $claimData['claim'], 'patient' => $claimData['patient'], 'claim_line' => array('amount' => $balance, 'diagnosis1' => preg_replace('/[\\.]/', '', $row->diagnosisCode1), 'diagnosis2' => preg_replace('/[\\.]/', '', $row->diagnosisCode2), 'diagnosis3' => preg_replace('/[\\.]/', '', $row->diagnosisCode3), 'diagnosis4' => preg_replace('/[\\.]/', '', $row->diagnosisCode4), 'diagnosis5' => preg_replace('/[\\.]/', '', $row->diagnosisCode5), 'diagnosis6' => preg_replace('/[\\.]/', '', $row->diagnosisCode6), 'diagnosis7' => preg_replace('/[\\.]/', '', $row->diagnosisCode7), 'diagnosis8' => preg_replace('/[\\.]/', '', $row->diagnosisCode8), 'procedure' => $row->procedureCode, 'modifier1' => $row->modifier1, 'modifier2' => $row->modifier2, 'modifier3' => $row->modifier3, 'modifier4' => $row->modifier4, 'units' => str_replace('.00', '', $row->units), 'date_of_treatment' => $dateOfTreatment, 'clia_number' => ''), 'treating_facility' => $claimData['treating_facility'], 'provider' => $claimData['provider'], 'billing_facility' => $claimData['billing_facility'], 'subscriber' => $subscriber, 'clearing_house' => $claimData['clearing_house'], 'referring_provider' => $claimData['referring_provider'], 'supervising_provider' => $claimData['supervising_provider'], 'payer2' => $claimData['payer2']);
}
$hl2 = array();
$hl2[] = array('hlCount' => $ctr, 'hlCount2' => ++$ctr, 'payer' => array('responsibility' => 'P'), 'subscriber' => $subscriber, 'patient' => array('weight' => '', 'last_name' => $patient->lastName, 'first_name' => $patient->firstName), 'responsible_party' => array('last_name' => '', 'first_name' => '', 'address' => array('line1' => '', 'line2' => '', 'city' => '', 'state' => '', 'zip' => '')), 'CLM' => $clm);
$data['HL2'] = $hl2;
return $data;
}
public function getClaimDetailsAction()
{
$claimId = (int) $this->_getParam('claimId');
$data = array();
$claimLine = new ClaimLine();
$claimLine->claimId = $claimId;
$claimLine->populateByClaimId();
$visitId = (int) $claimLine->visitId;
$visit = new Visit();
$visit->visitId = $visitId;
$visit->populate();
$personId = (int) $visit->patientId;
$data['claimId'] = $claimId;
$data['dos'] = substr($visit->dateOfTreatment, 0, 10);
$data['dateBilled'] = substr($claimLine->dateTime, 0, 10);
$patient = new Patient();
$patient->personId = $personId;
$patient->populate();
$data['patientId'] = $personId;
$data['patient'] = $patient->displayName;
$data['payerId'] = $claimLine->insuranceProgramId;
$data['facility'] = $visit->facility;
$checkNos = array('' => array('checkNo' => '', 'unallocated' => ''));
foreach ($claimLine->checkNumbers as $chk) {
$checkNos[(int) $chk['paymentId']] = array('checkNo' => $chk['checkNo'], 'unallocated' => (double) $chk['unallocated']);
}
$data['checkNos'] = $checkNos;
$insured = new InsuredRelationship();
$insured->personId = $personId;
$data['listPayers'] = $insured->programList;
$json = Zend_Controller_Action_HelperBroker::getStaticHelper('json');
$json->suppressExit = true;
$json->direct($data);
}