public static function recalculateClaims(self $visit, $newClaim = false)
{
$fees = $visit->calculateFees(true);
$hasProcedure = false;
if ($newClaim) {
$claimId = WebVista_Model_ORM::nextSequenceId('claimSequences');
}
$copay = $visit->getCopay();
$totalPaid = 0;
$personId = (int) $visit->patientId;
$userId = (int) Zend_Auth::getInstance()->getIdentity()->personId;
$visitId = (int) $visit->visitId;
$discountPayerId = InsuranceProgram::lookupSystemId('Discounts');
// ID of System->Discounts
$creditPayerId = InsuranceProgram::lookupSystemId('Credit');
// ID of System->Credit
$payerId = InsuranceProgram::lookupSystemId('Self Pay');
// ID of System->Self Pay
foreach ($fees['details'] as $id => $values) {
// update claim or create if not exists
$fee = (double) $values['fee'];
$feeDiscounted = (double) $values['feeDiscounted'];
$claimLine = new ClaimLine();
$claimLine->populateWithPatientProcedure($values['orm'], $visit);
if ($newClaim) {
$claimLine->claimLineId = 0;
$claimLine->claimId = $claimId;
}
$claimLine->baseFee = $fee;
$claimLine->adjustedFee = $feeDiscounted;
$claimLine->persist();
$claimLineId = (int) $claimLine->claimLineId;
$billable = $feeDiscounted;
/*$discount = 0;
if ($feeDiscounted > 0) $discount = $fee - $feeDiscounted;
if ($discount < 0) $discount = 0;*/
$discount = (double) $values['writeoff'];
if ($newClaim && $discount > 0) {
// add writeoffs
$writeOff = new WriteOff();
$writeOff->personId = $personId;
$writeOff->claimLineId = $claimLineId;
$writeOff->visitId = $visitId;
$writeOff->appointmentId = $visit->appointmentId;
$writeOff->amount = $discount;
$writeOff->userId = $userId;
$writeOff->timestamp = date('Y-m-d H:i:s');
$writeOff->title = 'discount';
$writeOff->payerId = $discountPayerId;
$writeOff->persist();
$billable -= $discount;
}
if ($newClaim && $billable > 0) {
foreach ($copay['details'] as $paymentId => $payment) {
$amount = (double) $payment->unallocated;
if (!$amount > 0) {
unset($copay['details'][$paymentId]);
continue;
}
if ($amount > $billable) {
$amount = $billable;
}
$payment->allocated += $amount;
$payment->payerId = $payerId;
$payment->persist();
$copay['details'][$paymentId] = $payment;
$totalPaid += $amount;
$postingJournal = new PostingJournal();
$postingJournal->paymentId = (int) $payment->paymentId;
$postingJournal->patientId = $personId;
$postingJournal->payerId = $payerId;
$postingJournal->claimLineId = $claimLineId;
$postingJournal->visitId = $visitId;
$postingJournal->amount = $amount;
$postingJournal->note = 'copay posting';
$postingJournal->userId = $userId;
$dateTime = date('Y-m-d H:i:s');
$postingJournal->datePosted = $dateTime;
$postingJournal->dateTime = $dateTime;
$postingJournal->persist();
$billable -= $amount;
if ($billable <= 0) {
break;
}
}
}
$hasProcedure = true;
}
if ($newClaim && $copay['total'] > $totalPaid) {
// if copay is greater than all claimlines reamining dollars are posted to credit program
foreach ($copay['details'] as $paymentId => $payment) {
$amount = (double) $payment->unallocated;
$payment->allocated += $amount;
$payment->persist();
$postingJournal = new PostingJournal();
$postingJournal->paymentId = (int) $payment->paymentId;
$postingJournal->patientId = $personId;
$postingJournal->payerId = $creditPayerId;
$postingJournal->visitId = $visitId;
$postingJournal->amount = $amount;
$postingJournal->note = 'remaining copay balance';
$postingJournal->userId = $userId;
$dateTime = date('Y-m-d H:i:s');
$postingJournal->datePosted = $dateTime;
$postingJournal->dateTime = $dateTime;
$postingJournal->persist();
}
}
if (!$hasProcedure) {
$visitId = $visit->visitId;
$payment = new Payment();
foreach ($payment->getIteratorByVisitId($visitId) as $row) {
// If visit has copay then at closing copay should be turned into unallocated payment (not associated with visit).
$row->visitId = 0;
$row->persist();
}
} else {
$visit = ClaimRule::checkRules($visit, $fees);
}
return $visit;
}
public function listGroupsAction()
{
$rows = array();
foreach (ClaimRule::listGroups() as $groupId => $value) {
$row = array();
$row['id'] = $groupId;
$row['data'] = array();
$row['data'][] = $value['title'];
$row['data'][] = $value['displayEvent'];
$row['data'][] = $value['message'];
$rows[] = $row;
}
$json = Zend_Controller_Action_HelperBroker::getStaticHelper('json');
$json->suppressExit = true;
$json->direct(array('rows' => $rows));
}
public function checkRulesAction()
{
$visitId = (int) $this->_getParam('visitId');
$data = array();
$visit = new Visit();
$visit->visitId = $visitId;
if ($visitId > 0 && $visit->populate()) {
$retVisit = ClaimRule::checkRules($visit);
$data = $retVisit->_claimRule;
}
$json = Zend_Controller_Action_HelperBroker::getStaticHelper('json');
$json->suppressExit = true;
$json->direct($data);
}
