function era_callback(&$out)
{
global $where, $eracount, $eraname;
++$eracount;
$eraname = $out['gs_date'] . '_' . ltrim($out['isa_control_number'], '0') . '_' . ltrim($out['payer_id'], '0');
list($pid, $encounter, $invnumber) = slInvoiceNumber($out);
if ($pid && $encounter) {
if ($where) {
$where .= ' OR ';
}
$where .= "( f.pid = '{$pid}' AND f.encounter = '{$encounter}' )";
}
}
function era_callback(&$out)
{
global $where, $eracount, $eraname, $INTEGRATED_AR;
// print_r($out); // debugging
++$eracount;
// $eraname = $out['isa_control_number'];
$eraname = $out['gs_date'] . '_' . ltrim($out['isa_control_number'], '0') . '_' . ltrim($out['payer_id'], '0');
list($pid, $encounter, $invnumber) = slInvoiceNumber($out);
if ($pid && $encounter) {
if ($where) {
$where .= ' OR ';
}
if ($INTEGRATED_AR) {
$where .= "( f.pid = '{$pid}' AND f.encounter = '{$encounter}' )";
} else {
$where .= "invnumber = '{$invnumber}'";
}
}
}
function era_callback(&$out)
{
global $encount, $debug, $claim_status_codes, $adjustment_reasons, $remark_codes;
global $invoice_total, $last_code, $paydate, $INTEGRATED_AR;
global $InsertionId;
//last inserted ID of
// Some heading information.
$chk_123 = $out['check_number'];
$chk_123 = str_replace(' ', '_', $chk_123);
if (isset($_REQUEST['chk' . $chk_123])) {
if ($encount == 0) {
writeMessageLine('#ffffff', 'infdetail', "Payer: " . htmlspecialchars($out['payer_name'], ENT_QUOTES));
if ($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') {
//Denial case, code is stored in the claims table for display in the billing manager screen with reason explained.
$inverror = true;
if (!$debug) {
if ($pid && $encounter) {
$code_value = '';
foreach ($out['svc'] as $svc) {
foreach ($svc['adj'] as $adj) {
//Per code and modifier the reason will be showed in the billing manager.
$code_value .= $svc['code'] . '_' . $svc['mod'] . '_' . $adj['group_code'] . '_' . $adj['reason_code'] . ',';
}
}
$code_value = substr($code_value, 0, -1);
//We store the reason code to display it with description in the billing manager screen.
//process_file is used as for the denial case file name will not be there, and extra field(to store reason) can be avoided.
updateClaim(true, $pid, $encounter, $_REQUEST['InsId'], substr($inslabel, 3), 7, 0, $code_value);
}
}
writeMessageLine($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];
$codetype = '';
//will hold code type, if exists
// This reports detail lines already on file for this service item.
if ($prev) {
$codetype = $codes[$codekey]['code_type'];
//store code type
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, '', $codetype);
} else {
slPostCharge($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) {
arPostPayment($pid, $encounter, $InsertionId[$out['check_number']], $svc['paid'], $codekey, substr($inslabel, 3), $out['check_number'], $debug, '', $codetype);
} else {
slPostPayment($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) {
arPostAdjustment($pid, $encounter, $InsertionId[$out['check_number']], 0, $codekey, substr($inslabel, 3), $reason, $debug, '', $codetype);
} else {
slPostAdjustment($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) {
arPostAdjustment($pid, $encounter, $InsertionId[$out['check_number']], $adj['amount'], $codekey, substr($inslabel, 3), "Adjust code " . $adj['reason_code'], $debug, '', $codetype);
} else {
slPostAdjustment($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);
if ($out['crossover'] == 1) {
//Automatic forward case.So need not again bill from the billing manager screen.
sqlStatement("UPDATE form_encounter " . "SET last_level_closed = {$level_done},last_level_billed=" . $level_done . " WHERE " . "pid = '{$pid}' AND encounter = '{$encounter}'");
writeMessageLine($bgcolor, 'infdetail', 'This claim is processed by Insurance ' . $level_done . ' and automatically forwarded to Insurance ' . ($level_done + 1) . ' for processing. ');
} else {
"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, $out['crossover']);
if ($out['crossover'] != 1) {
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'], $debug);
if ($out['crossover'] != 1) {
writeMessageLine($bgcolor, 'infdetail', 'This claim is now re-queued for secondary paper billing');
}
}
}
}
}
}