function era_callback(&$out) { global $encount, $debug, $claim_status_codes, $adjustment_reasons, $remark_codes; global $invoice_total, $last_code, $paydate, $INTEGRATED_AR; // Some heading information. if ($encount == 0) { writeMessageLine('#ffffff', 'infdetail', "Payer: " . htmlentities($out['payer_name'])); if ($debug) { writeMessageLine('#ffffff', 'infdetail', "WITHOUT UPDATE is selected; no changes will be applied."); } } $last_code = ''; $invoice_total = 0.0; $bgcolor = ++$encount & 1 ? "#ddddff" : "#ffdddd"; list($pid, $encounter, $invnumber) = slInvoiceNumber($out); // Get details, if we have them, for the invoice. $inverror = true; $codes = array(); if ($pid && $encounter) { // Get invoice data into $arrow or $ferow. if ($INTEGRATED_AR) { $ferow = sqlQuery("SELECT e.*, p.fname, p.mname, p.lname " . "FROM form_encounter AS e, patient_data AS p WHERE " . "e.pid = '{$pid}' AND e.encounter = '{$encounter}' AND " . "p.pid = e.pid"); if (empty($ferow)) { $pid = $encounter = 0; $invnumber = $out['our_claim_id']; } else { $inverror = false; $codes = ar_get_invoice_summary($pid, $encounter, true); // $svcdate = substr($ferow['date'], 0, 10); } } else { $arres = SLQuery("SELECT ar.id, ar.notes, ar.shipvia, customer.name " . "FROM ar, customer WHERE ar.invnumber = '{$invnumber}' AND " . "customer.id = ar.customer_id"); if ($sl_err) { die($sl_err); } $arrow = SLGetRow($arres, 0); if ($arrow) { $inverror = false; $codes = get_invoice_summary($arrow['id'], true); } else { // oops, no such invoice $pid = $encounter = 0; $invnumber = $out['our_claim_id']; } } // end not internal a/r } // 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'; } $primary = $inslabel == 'Ins1'; writeMessageLine($bgcolor, 'infdetail', "Claim status {$csc}: " . $claim_status_codes[$csc]); // Show an error message if the claim is missing or already posted. if ($inverror) { writeMessageLine($bgcolor, 'errdetail', "The following claim is not in our database"); } else { // 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 ($csc == '4') { $inverror = true; writeMessageLine($bgcolor, 'errdetail', "Not posting adjustments for denied claims, please follow up manually!"); } else { if ($csc == '22') { $inverror = true; writeMessageLine($bgcolor, 'errdetail', "Payment reversals are not automated, please enter manually!"); } } if ($out['warnings']) { writeMessageLine($bgcolor, 'infdetail', nl2br(rtrim($out['warnings']))); } // Simplify some claim attributes for cleaner code. $service_date = parse_date($out['dos']); $check_date = $paydate ? $paydate : parse_date($out['check_date']); $production_date = $paydate ? $paydate : parse_date($out['production_date']); if ($INTEGRATED_AR) { $insurance_id = arGetPayerID($pid, $service_date, substr($inslabel, 3)); if (empty($ferow['lname'])) { $patient_name = $out['patient_fname'] . ' ' . $out['patient_lname']; } else { $patient_name = $ferow['fname'] . ' ' . $ferow['lname']; } } else { $insurance_id = 0; foreach ($codes as $cdata) { if ($cdata['ins']) { $insurance_id = $cdata['ins']; break; } } $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) { // Treat a modifier in the remit data as part of the procedure key. // This key will then make its way into SQL-Ledger. $codekey = $svc['code']; if ($svc['mod']) { $codekey .= ':' . $svc['mod']; } $prev = $codes[$codekey]; // This reports detail lines already on file for this service item. if ($prev) { writeOldDetail($prev, $patient_name, $invnumber, $service_date, $codekey, $bgcolor); // Check for sanity in amount charged. $prevchg = sprintf("%.2f", $prev['chg'] + $prev['adj']); if ($prevchg != abs($svc['chg'])) { writeMessageLine($bgcolor, 'errdetail', "EOB charge amount " . $svc['chg'] . " for this code does not match our invoice"); $error = true; } // Check for already-existing primary remittance activity. // Removed this check because it was not allowing for copays manually // entered into the invoice under a non-copay billing code. /**** if ((sprintf("%.2f",$prev['chg']) != sprintf("%.2f",$prev['bal']) || $prev['adj'] != 0) && $primary) { writeMessageLine($bgcolor, 'errdetail', "This service item already has primary payments and/or adjustments!"); $error = true; } ****/ unset($codes[$codekey]); } else { // This is not an error. If we are not in error mode and not debugging, // insert the service item into SL. Then display it (in green if it // was inserted, or in red if we are in error mode). $description = "CPT4:{$codekey} Added by {$inslabel} {$production_date}"; if (!$error && !$debug) { if ($INTEGRATED_AR) { arPostCharge($pid, $encounter, 0, $svc['chg'], 1, $service_date, $codekey, $description, $debug); } else { slPostCharge($arrow['id'], $svc['chg'], 1, $service_date, $codekey, $insurance_id, $description, $debug); } $invoice_total += $svc['chg']; } $class = $error ? 'errdetail' : 'newdetail'; writeDetailLine($bgcolor, $class, $patient_name, $invnumber, $codekey, $production_date, $description, $svc['chg'], $error ? '' : $invoice_total); } $class = $error ? 'errdetail' : 'newdetail'; // Report Allowed Amount. if ($svc['allowed']) { // A problem here is that some payers will include an adjustment // reflecting the allowed amount, others not. So here we need to // check if the adjustment exists, and if not then create it. We // assume that any nonzero CO (Contractual Obligation) or PI // (Payer Initiated) adjustment is good enough. $contract_adj = sprintf("%.2f", $svc['chg'] - $svc['allowed']); foreach ($svc['adj'] as $adj) { if (($adj['group_code'] == 'CO' || $adj['group_code'] == 'PI') && $adj['amount'] != 0) { $contract_adj = 0; } } if ($contract_adj > 0) { $svc['adj'][] = array('group_code' => 'CO', 'reason_code' => 'A2', 'amount' => $contract_adj); } writeMessageLine($bgcolor, 'infdetail', 'Allowed amount is ' . sprintf("%.2f", $svc['allowed'])); } // Report miscellaneous remarks. if ($svc['remark']) { $rmk = $svc['remark']; writeMessageLine($bgcolor, 'infdetail', "{$rmk}: " . $remark_codes[$rmk]); } // Post and report the payment for this service item from the ERA. // By the way a 'Claim' level payment is probably going to be negative, // i.e. a payment reversal. if ($svc['paid']) { if (!$error && !$debug) { if ($INTEGRATED_AR) { $session_id = arGetSession($insurance_id, $out['check_number'], $check_date); arPostPayment($pid, $encounter, $session_id, $svc['paid'], $codekey, substr($inslabel, 3), $out['check_number'], $debug); } else { slPostPayment($arrow['id'], $svc['paid'], $check_date, "{$inslabel}/" . $out['check_number'], $codekey, $insurance_id, $debug); } $invoice_total -= $svc['paid']; } $description = "{$inslabel}/" . $out['check_number'] . ' payment'; if ($svc['paid'] < 0) { $description .= ' reversal'; } writeDetailLine($bgcolor, $class, $patient_name, $invnumber, $codekey, $check_date, $description, 0 - $svc['paid'], $error ? '' : $invoice_total); } // Post and report adjustments from this ERA. Posted adjustment reasons // must be 25 characters or less in order to fit on patient statements. foreach ($svc['adj'] as $adj) { $description = $adj['reason_code'] . ': ' . $adjustment_reasons[$adj['reason_code']]; if ($adj['group_code'] == 'PR' || !$primary) { // Group code PR is Patient Responsibility. Enter these as zero // adjustments to retain the note without crediting the claim. if ($primary) { /**** $reason = 'Pt resp: '; // Reasons should be 25 chars or less. if ($adj['reason_code'] == '1') $reason = 'To deductible: '; else if ($adj['reason_code'] == '2') $reason = 'Coinsurance: '; else if ($adj['reason_code'] == '3') $reason = 'Co-pay: '; ****/ $reason = "{$inslabel} ptresp: "; // Reasons should be 25 chars or less. if ($adj['reason_code'] == '1') { $reason = "{$inslabel} dedbl: "; } else { if ($adj['reason_code'] == '2') { $reason = "{$inslabel} coins: "; } else { if ($adj['reason_code'] == '3') { $reason = "{$inslabel} copay: "; } } } } else { $reason = "{$inslabel} note " . $adj['reason_code'] . ': '; /**** $reason .= sprintf("%.2f", $adj['amount']); ****/ } $reason .= sprintf("%.2f", $adj['amount']); // Post a zero-dollar adjustment just to save it as a comment. if (!$error && !$debug) { if ($INTEGRATED_AR) { $session_id = arGetSession($insurance_id, $out['check_number'], $check_date); arPostAdjustment($pid, $encounter, $session_id, 0, $codekey, substr($inslabel, 3), $reason, $debug); } else { slPostAdjustment($arrow['id'], 0, $production_date, $out['check_number'], $codekey, $insurance_id, $reason, $debug); } } writeMessageLine($bgcolor, $class, $description . ' ' . sprintf("%.2f", $adj['amount'])); } else { if (!$error && !$debug) { if ($INTEGRATED_AR) { $session_id = arGetSession($insurance_id, $out['check_number'], $check_date); arPostAdjustment($pid, $encounter, $session_id, $adj['amount'], $codekey, substr($inslabel, 3), "Adjust code " . $adj['reason_code'], $debug); } else { slPostAdjustment($arrow['id'], $adj['amount'], $production_date, $out['check_number'], $codekey, $insurance_id, "{$inslabel} adjust code " . $adj['reason_code'], $debug); } $invoice_total -= $adj['amount']; } writeDetailLine($bgcolor, $class, $patient_name, $invnumber, $codekey, $production_date, $description, 0 - $adj['amount'], $error ? '' : $invoice_total); } } } // End of service item // Report any existing service items not mentioned in the ERA, and // determine if any of them are still missing an insurance response // (if so, then insurance is not yet done with the claim). $insurance_done = true; foreach ($codes as $code => $prev) { // writeOldDetail($prev, $arrow['name'], $invnumber, $service_date, $code, $bgcolor); writeOldDetail($prev, $patient_name, $invnumber, $service_date, $code, $bgcolor); $got_response = false; foreach ($prev['dtl'] as $ddata) { if ($ddata['pmt'] || $ddata['rsn']) { $got_response = true; } } if (!$got_response) { $insurance_done = false; } } // Cleanup: If all is well, mark Ins<x> done and check for secondary billing. if (!$error && !$debug && $insurance_done) { if ($INTEGRATED_AR) { $level_done = 0 + substr($inslabel, 3); sqlStatement("UPDATE form_encounter " . "SET last_level_closed = {$level_done} WHERE " . "pid = '{$pid}' AND encounter = '{$encounter}'"); // Check for secondary insurance. if ($primary && arGetPayerID($pid, $service_date, 2)) { arSetupSecondary($pid, $encounter, $debug); writeMessageLine($bgcolor, 'infdetail', 'This claim is now re-queued for secondary paper billing'); } } else { $shipvia = 'Done: Ins1'; if ($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 ($primary && strpos($insgot, 'ins2') !== false) { slSetupSecondary($arrow['id'], $debug); writeMessageLine($bgcolor, 'infdetail', 'This claim is now re-queued for secondary paper billing'); } } } }
$form_deposit_date = fixDate($_POST['form_deposit_date'], $form_check_date); $form_pay_total = 0 + $_POST['form_pay_total']; } else { slInitialize(); } $payer_type = 0; if (preg_match('/^Ins(\\d)/i', $_POST['form_insurance'], $matches)) { $payer_type = $matches[1]; } if ($_POST['form_save'] || $_POST['form_cancel']) { if ($_POST['form_save']) { if ($debug) { echo xl("This module is in test mode. The database will not be changed.", '', '<p><b>', "</b><p>\n"); } if ($INTEGRATED_AR) { $session_id = arGetSession($form_payer_id, $form_reference, $form_check_date, $form_deposit_date, $form_pay_total); // The sl_eob_search page needs its invoice links modified to invoke // javascript to load form parms for all the above and submit. // At the same time that page would be modified to work off the // openemr database exclusively. // And back to the sl_eob_invoice page, I think we may want to move // the source input fields from row level to header level. } $paytotal = 0; foreach ($_POST['form_line'] as $code => $cdata) { if (!$INTEGRATED_AR) { $thissrc = trim($cdata['src']); $thisdate = trim($cdata['date']); } $thispay = trim($cdata['pay']); $thisadj = trim($cdata['adj']);
} // end if charge $payer_id = empty($dtlinfo['ins']) ? 0 : $dtlinfo['ins']; $session_id = 0; // Compute a reasonable "source" value. For payments this will // commonly be a check number, for adjustments we have none. $source = empty($dtlinfo['src']) ? '' : $dtlinfo['src']; $source = preg_replace('!^Ins[123]/!i', '', $source); $source = preg_replace('!^Pt/!i', '', $source); if ($source == '' && empty($dtlinfo['pmt'])) { $source = 'From SQL-Ledger'; } // For insurance payers look up or create the session table entry. if ($payer_id) { if (!$dry_run) { $session_id = arGetSession($payer_id, addslashes($source), $dtldate); } } else { if ($code == '') { if (!empty($dtlinfo['pmt'])) { // Skip payments that are already present in the billing table as copays. foreach ($billing as $key => $brow) { if ($brow['code_type'] == 'COPAY' && 0 - $brow['fee'] == $dtlinfo['pmt']) { unset($billing[$key]); continue 2; // done with this detail item } } } // end if payment }