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;
}
protected function _populateCMS1500XML(SimpleXMLElement $xml, ClaimLine $claimLine)
{
$claimId = (int) $claimLine->claimId;
$visitId = (int) $claimLine->visitId;
$payerId = (int) $claimLine->insuranceProgramId;
$visit = new Visit();
$visit->visitId = $visitId;
$visit->populate();
$dateOfTreatment = $visit->dateOfTreatment;
$patientId = (int) $visit->patientId;
$providerId = (int) $visit->treatingPersonId;
$insuranceProgram = new InsuranceProgram();
$insuranceProgram->insuranceProgramId = $payerId;
$insuranceProgram->populate();
$insuranceAddress = $insuranceProgram->address;
$insuredRelationship = InsuredRelationship::filterByPayerPersonIds($payerId, $patientId);
$patient = new Patient();
$patient->personId = $patientId;
$patient->populate();
$patientAddress = $patient->address;
$patientPhone = $patient->phoneNumber;
$provider = new Provider();
$provider->personId = $providerId;
$provider->populate();
$providerAddress = $provider->person->address;
$providerPhone = $provider->phoneNumber;
$buildingId = (int) $visit->buildingId;
$building = new Building();
$building->buildingId = $buildingId;
$building->populate();
$address = $building->practice->primaryAddress;
$amountTotal = 0;
$claimLines = array();
$iterator = new ClaimLineIterator();
$iterator->setFilters(array('claimId' => $claimId));
foreach ($iterator as $orm) {
$amount = (double) $orm->baseFee;
$amountTotal += $amount;
$row = array();
$row['procedure'] = $orm->procedureCode;
$modifiers = array();
for ($i = 1; $i <= 4; $i++) {
$field = 'modifier' . $i;
$key = $orm->{$field};
if (strlen($key) > 0) {
$modifiers[$i] = $key;
}
}
$row['modifier'] = implode(',', $modifiers);
$row['amount'] = $amount;
$row['units'] = $orm->units;
$diagnoses = array();
for ($i = 1; $i <= 8; $i++) {
$field = 'diagnosisCode' . $i;
$key = $orm->{$field};
if (strlen($key) > 0) {
$diagnoses[$key] = $key;
}
}
$row['diagnoses'] = $diagnoses;
$row['diagnosis_pointer'] = '';
// TODO: need to resolve on the issue of multiple diagnoses per claimLine
$claimLines[] = $row;
}
$amountPaid = $claimLine->paid;
$netAmountTotal = $amountTotal - $amountPaid;
if ($payerId > 0) {
$xmlPayer = $xml->addChild('payer');
$this->_addChild($xmlPayer, 'name', InsuranceProgram::getInsuranceProgram($payerId));
if ($insuranceAddress->addressId > 0) {
$xmlFbaddress = $xmlPayer->addChild('fbaddress');
$this->_addChild($xmlFbaddress, 'line1', $insuranceAddress->line1);
$this->_addChild($xmlFbaddress, 'line2', $insuranceAddress->line2);
$this->_addChild($xmlFbaddress, 'city', $insuranceAddress->city);
$this->_addChild($xmlFbaddress, 'state', $insuranceAddress->state);
$this->_addChild($xmlFbaddress, 'zip', $insuranceAddress->zipCode);
}
}
$xmlPatient = $xml->addChild('patient');
$this->_addChild($xmlPatient, 'record_number', $patient->recordNumber);
$this->_addChild($xmlPatient, 'last_name', $patient->lastName);
$this->_addChild($xmlPatient, 'first_name', $patient->firstName);
$this->_addChild($xmlPatient, 'middle_name', $patient->middleName);
if ($patientAddress->addressId > 0) {
$xmlFbaddress = $xmlPatient->addChild('fbaddress');
$this->_addChild($xmlFbaddress, 'line1', $patientAddress->line1);
$this->_addChild($xmlFbaddress, 'line2', $patientAddress->line2);
$this->_addChild($xmlFbaddress, 'city', $patientAddress->city);
$this->_addChild($xmlFbaddress, 'state', $patientAddress->state);
$this->_addChild($xmlFbaddress, 'zip', $patientAddress->zipCode);
}
$this->_addChild($xmlPatient, 'phone_number', $patientPhone->number);
$this->_addChild($xmlPatient, 'date_of_birth', $patient->dateOfBirth);
$subscriber = $insuredRelationship->subscriber;
$subscriberAddress = $subscriber->address;
if ($subscriber->personId > 0) {
$xmlSubscriber = $xml->addChild('subscriber');
$this->_addChild($xmlSubscriber, 'phone_number', $subscriber->phoneNumber->number);
if ($subscriberAddress->addressId > 0) {
$xmlFbaddress = $xmlSubscriber->addChild('fbaddress');
$this->_addChild($xmlFbaddress, 'line1', $subscriberAddress->line1);
$this->_addChild($xmlFbaddress, 'line2', $subscriberAddress->line2);
$this->_addChild($xmlFbaddress, 'city', $subscriberAddress->city);
$this->_addChild($xmlFbaddress, 'state', $subscriberAddress->state);
$this->_addChild($xmlFbaddress, 'zip', $subscriberAddress->zipCode);
}
$this->_addChild($xmlSubscriber, 'last_name', $subscriber->lastName);
$this->_addChild($xmlSubscriber, 'first_name', $subscriber->firstName);
$this->_addChild($xmlSubscriber, 'middle_name', $subscriber->middleName);
$this->_addChild($xmlSubscriber, 'group_number', $insuredRelationship->groupNumber);
$this->_addChild($xmlSubscriber, 'gender', $subscriber->gender);
$this->_addChild($xmlSubscriber, 'date_of_birth', $subscriber->dateOfBirth);
}
if ($building->buildingId > 0) {
$xmlPractice = $xml->addChild('practice');
$this->_addChild($xmlPractice, 'identifier', $building->practice->identifier);
$xmlTreatingFacility = $xml->addChild('treating_facility');
$this->_addChild($xmlTreatingFacility, 'identifier', $building->identifier);
$this->_addChild($xmlTreatingFacility, 'name', $building->name);
$xmlFbaddress = $xmlTreatingFacility->addChild('fbaddress');
$this->_addChild($xmlFbaddress, 'line1', $building->line1);
$this->_addChild($xmlFbaddress, 'line2', $building->line2);
$this->_addChild($xmlFbaddress, 'city', $building->city);
$this->_addChild($xmlFbaddress, 'state', $building->state);
$this->_addChild($xmlFbaddress, 'zip', $building->zipCode);
}
$xmlProvider = $xml->addChild('provider');
$this->_addChild($xmlProvider, 'identifier', $provider->identifier);
$this->_addChild($xmlProvider, 'first_name', $provider->firstName);
$this->_addChild($xmlProvider, 'last_name', $provider->lastName);
if ($providerAddress->addressId > 0) {
$xmlFbaddress = $xmlProvider->addChild('fbaddress');
$this->_addChild($xmlFbaddress, 'line1', $providerAddress->line1);
$this->_addChild($xmlFbaddress, 'line2', $providerAddress->line2);
$this->_addChild($xmlFbaddress, 'city', $providerAddress->city);
$this->_addChild($xmlFbaddress, 'state', $providerAddress->state);
$this->_addChild($xmlFbaddress, 'zip', $providerAddress->zipCode);
}
$xmlDiagnoses = null;
foreach ($claimLines as $row) {
foreach ($row['diagnoses'] as $diagnosis) {
if ($xmlDiagnoses === null) {
$xmlDiagnoses = $xml->addChild('diagnoses');
}
$this->_addChild($xmlDiagnoses, 'array', $diagnosis);
}
}
$xmlClaimLine = null;
$dateOfService = date('m d y', strtotime($dateOfTreatment));
foreach ($claimLines as $row) {
if ($xmlClaimLine === null) {
$xmlClaimLine = $xml->addChild('claim_lines');
}
// 0 - 5 ONLY
$xmlClaimLineArr = $xmlClaimLine->addChild('array');
$this->_addChild($xmlClaimLineArr, 'date_of_treatment', $dateOfService);
$this->_addChild($xmlClaimLineArr, 'procedure', $row['procedure']);
$this->_addChild($xmlClaimLineArr, 'modifier', $row['modifier']);
$this->_addChild($xmlClaimLineArr, 'diagnosis_pointer', $row['diagnosis_pointer']);
$this->_addChild($xmlClaimLineArr, 'amount', $row['amount']);
$this->_addChild($xmlClaimLineArr, 'units', $row['units']);
}
$xmlClaim = $xml->addChild('claim');
$this->_addChild($xmlClaim, 'amount_total', $amountTotal);
$this->_addChild($xmlClaim, 'amount_paid', $amountPaid);
$this->_addChild($xmlClaim, 'net_amount_total', $netAmountTotal);
//$doc = new DOMDocument();
//$doc->formatOutput = true;
//$doc->loadXML($xml->asXML());
//file_put_contents('/tmp/claims.xml',$doc->saveXML());
}
