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);
}