コード例 #1
0
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 = '{$encounter}' )";
    }
}
コード例 #2
0
ファイル: sl_eob_search.php プロジェクト: katopenzz/openemr
function era_callback(&$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}'";
        }
    }
}
コード例 #3
0
ファイル: sl_eob_process.php プロジェクト: rreddy70/openemr
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');
                    }
                }
            }
        }
    }
}