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openemr/interface/billing/ub04_dispose.php

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<?php
/**
* UB04 Functions
*
* @package OpenEMR
* @link http://www.open-emr.org
* @author Jerry Padgett <sjpadgett@gmail.com>
* @copyright Copyright (c) 2017 Jerry Padgett <sjpadgett@gmail.com>
* @license https://github.com/openemr/openemr/blob/master/LICENSE GNU General Public License 3
*/
require_once("../globals.php");
use OpenEMR\Billing\BillingUtilities;
use OpenEMR\Billing\Claim;
use OpenEMR\Billing\X125010837I;
use OpenEMR\Pdf\PdfCreator;
function ub04_dispose()
{
$dispose = isset($_POST['handler']) ? $_POST['handler'] : $_GET['handler'];
if ($dispose) {
if ($dispose == "edit_save") {
$ub04id = isset($_POST['ub04id']) ? $_POST['ub04id'] : $_GET['ub04id'];
$pid = isset($_POST['pid']) ? $_POST['pid'] : $_GET['pid'];
$encounter = isset($_POST['encounter']) ? $_POST['encounter'] : $_GET['encounter'];
$action = $_REQUEST['action'];
$ub04id = json_decode($ub04id, true);
saveTemplate($encounter, $pid, $ub04id, $action);
exit();
} elseif ($dispose == "payer_save") {
$ub04id = isset($_POST['ub04id']) ? $_POST['ub04id'] : $_GET['ub04id'];
$payerid = isset($_POST['payerid']) ? $_POST['payerid'] : $_GET['payerid'];
savePayerTemplate($payerid, $ub04id);
exit("done");
} elseif ($dispose == "batch_save") {
$pid = isset($_POST['pid']) ? $_POST['pid'] : $_GET['pid'];
$encounter = isset($_POST['encounter']) ? $_POST['encounter'] : $_GET['encounter'];
$ub04id = isset($_POST['ub04id']) ? $_POST['ub04id'] : $_GET['ub04id'];
saveTemplate($encounter, $pid, $ub04id, $dispose);
exit("done");
} elseif ($dispose == "reset_claim") {
$pid = isset($_POST['pid']) ? $_POST['pid'] : $_GET['pid'];
$encounter = isset($_POST['encounter']) ? $_POST['encounter'] : $_GET['encounter'];
// clear claim first otherwise get ub04 returns cuurent version.
//
$flg = exist_ub04_claim($pid, $encounter, true);
if ($flg === true) {
BillingUtilities::updateClaim(false, $pid, $encounter, -1, -1, -1, -1, '', 'ub04', -1, 0, "");
}
$ub04id = get_ub04_array($pid, $encounter);
$ub04id = json_encode($ub04id);
echo $ub04id;
exit();
}
die(xlt('Do not know what to do!'));
}
}
function get_payer_defaults($payerid)
{
$p = sqlQuery("SELECT insurance_companies.* FROM insurance_companies WHERE insurance_companies.id = ?", array($payerid));
if ($p['claim_template']) {
return $p['claim_template'];
} else {
return json_encode(array());
}
}
function savePayerTemplate($payerid, $ubo4id)
{
$ub04id = json_encode($ub04id);
sqlStatement("update insurance_companies set claim_template= ? where id = ?", array(
$ubo4id,
$payerid
));
}
function saveTemplate($encounter, $pid, $ub04id, $action = 'form')
{
global $isAuthorized;
if ($action != 'batch_save') {
$ub04id = json_encode($ub04id);
$isAuthorized = true;
ob_start();
require(dirname(__file__) . "/ub04_form.php");
$htmlin = ob_get_clean();
$isAuthorized = false;
ub04Dispose('download', $htmlin, "ub04_download.pdf", $action);
}
$flg = exist_ub04_claim($pid, $encounter, true);
if ($flg === true) {
BillingUtilities::updateClaim(false, $pid, $encounter, - 1, - 1, - 1, - 1, '', 'ub04', - 1, 0, $ub04id);
} else {
BillingUtilities::updateClaim(true, $pid, $encounter, - 1, - 1, 1, 1, '', 'ub04', - 1, 0, $ub04id);
}
}
function buildTemplate(string $pid = null, string $encounter = null, $htmlin, string $action = null, &$log)
{
global $srcdir, $isAuthorized;
if (!$action) {
$action = 'form';
}
$ub04id = get_ub04_array($pid, $encounter, $log);
$ub04id = json_encode($ub04id);
$isAuthorized = true;
ob_start();
require $srcdir . "/../interface/billing/ub04_form.php";
$htmlin = ob_get_clean();
$isAuthorized = false;
return $htmlin;
}
function ub04Dispose($dispose = 'download', $htmlin = "", $filename = "ub04.pdf", $form_action = "")
{
$top = isset($_POST["left_ubmargin"]) ? $_POST["left_ubmargin"] : $GLOBALS['left_ubmargin_default'];
$side = isset($_POST["top_ubmargin"]) ? $_POST["top_ubmargin"] : $GLOBALS['top_ubmargin_default'];
$form_filename = $GLOBALS['OE_SITE_DIR'] . "/documents/edi/$filename";
// convert points to inches-some tricky calculus here! 72 pts/inch
$top = round($top / 72.00, 2) . "in";
$side = round($side / 72.00, 2) . "in";
try {
if ($dispose == 'download') {
$isnotform = false;
if ($form_action == "noform") {
$isnotform = true;
}
$options = array(
'margin-top' => $top,
'margin-bottom' => '0in',
'margin-left' => $side,
'margin-right' => $side,
'zoom' => '1.045',
'print-media-type' => true,
'lowquality' => true,
'no-outline' => true,
'keep-relative-links' => true,
'no-images' => $isnotform,
'grayscale' => true,
'page-size' => 'Letter',
'orientation' => 'Portrait'
);
$PdfCreator = new PdfCreator();
$pdfwkout = $PdfCreator->getPdf($htmlin, $options);
/*
* $fh = @fopen($form_filename, 'w'); // Future Use!
* if ($fh) {
* fwrite($fh, $pdfwkout);
* fclose($fh);
* }
*/
header("Pragma: public");
header("Expires: 0");
header("Cache-Control: must-revalidate, post-check=0, pre-check=0");
header('Content-Type: application/pdf');
header("Content-Disposition: download; filename=$filename");
header("Content-Description: File Transfer");
echo $pdfwkout;
}
} catch (Exception $e) {
echo xlt($e->getMessage());
}
return true;
}
function exist_ub04_claim($pid, $encounter, $flag = false)
{
$sql = "SELECT * FROM claims WHERE patient_id = ? AND encounter_id = ? AND status > 0 AND status < 4 ";
$sql .= "ORDER BY version DESC LIMIT 1";
$row = sqlQuery($sql, array(
$pid,
$encounter
));
if ($row) {
if (! empty($row['submitted_claim'])) {
if ($flag === false) {
return $row['submitted_claim'];
} else {
return true;
}
} else {
return false;
}
}
return false;
}
function get_ub04_array($pid, $encounter, &$log = "")
{
$exist_ub04 = exist_ub04_claim($pid, $encounter);
if ($exist_ub04) {
$log .= "*** Info: Using saved edited claim.";
return json_decode($exist_ub04, true);
}
$log .= "*** Generating UB04 Claim.";
$today = time();
$claim = new Claim($pid, $encounter);
$ub04id = array();
$ub04id[0] = array();
// $ub04id[0] Is reserved for params
$ub04id[2] = $claim->billingFacilityName();
$ub04id[4] = $claim->billingFacilityStreet();
$ub04id[8] = $claim->billingFacilityCity() . ', ' . $claim->billingFacilityState() . ', ' . $claim->billingFacilityZip(); /* 1. BILLING PROVIDER CITY, STATE, ZIP */
$tmp = $claim->billingContactPhone();
$ub04id[10] = substr($tmp, 0, 3) . '-' . substr($tmp, 3, 3) . '-' . substr($tmp, 6);
$ub04id[3] = $pid . ' ' . $encounter; /* 3a. PATIENT CONTROL NUMBER */
$ub04id[6] = $pid; /* 3b. MEDICAL/HEALTH RECORD NUMBER */
$ub04id[7] = ! empty($ub04id[7]) ? $ub04id[7] : '831'; /* 4. TYPE OF BILL */
$ub04id[12] = $claim->facilityETIN(); /* 5. FEDERAL TAX NUMBER */
$tmp = $claim->serviceDate();
$ub04id[13] = substr($tmp, 4, 2) . substr($tmp, 6, 2) . substr($tmp, 2, 2); /* 6. STATEMENT COVERS PERIOD FROM DATE */
$ub04id[14] = ''; /* 6. STATEMENT COVERS PERIOD TO DATE */
// $ub04id[16] = ''; /* 8a. PATIENT IDENTIFIER */
$tmp = $claim->patientLastName() . ', ' . $claim->patientFirstName();
if ($claim->patientMiddleName()) {
$tmp .= ', ' . substr($claim->patientMiddleName(), 0, 1);
}
$ub04id[18] = $tmp; /* 8b. PATIENT NAME */
$ub04id[17] = $claim->patientStreet(); /* 9a. PATIENT STREET ADDRESS */
$ub04id[19] = $claim->patientCity(); /* 9b. PATIENT CITY */
$ub04id[20] = $claim->patientState(); /* 9c. PATIENT STATE */
$ub04id[21] = $claim->patientZip(); /* 9d. PATIENT ZIP CODE */
$ub04id[22] = ''; /* 9e. PATIENT COUNTRY CODE */
$tmp = $claim->patientDOB();
$ub04id[23] = substr($tmp, 4, 2) . substr($tmp, 6, 2) . substr($tmp, 0, 4); /* 10. PATIENT BIRTH DATE (MMDDYYYY) */
$ub04id[24] = $claim->patientSex(); /* 11. PATIENT SEX */
$tmp = $claim->onsetDate();
$ub04id[25] = substr($tmp, 4, 2) . substr($tmp, 6, 2) . substr($tmp, 2, 2); /* 12. PATIENT ADMISSION/START OF CARE DATE (MMDDYY) */
$ub04_proc_index = 0; // Test for second page of charges.
$proccount = $claim->procCount();
$clm_total_charges = 0;
$clm_amount_adjusted = 0;
$clm_amount_paid = $ub04_proc_index ? 0 : $claim->patientPaidAmount();
for ($tlh = 0; $tlh < $proccount; ++$tlh) {
$tmp = $claim->procs[$tlh][code_text];
if ($claim->procs[$tlh][code_type] == 'HCPCS') {
$tmpcode = '3';
} else {
$tmpcode = '1';
}
$getrevcd = $claim->cptCode($tlh);
$sql = "SELECT * FROM codes WHERE code_type = ? and code = ? ORDER BY revenue_code DESC";
$revcode[$tlh] = sqlQuery($sql, array(
$tmpcode,
$getrevcd
));
if (!empty($revcode[$tlh])) {
$claim->procs[$tlh]['revenue_code'] = $claim->procs[$tlh]['revenue_code'] ? $claim->procs[$tlh]['revenue_code'] : $revcode[$tlh]['revenue_code'];
$revcode2[$tlh] = array_merge($revcode[$tlh], $claim->procs[$tlh]);
}
}
foreach ($revcode as $key => $row) {
$revcod[$key] = $row['revenue_code'];
}
array_multisort($revcod, SORT_ASC, $revcode2);
// Procedure loop starts here.
$os = 99; // Line 1 - 23 offset
$dos = 382;
$pcnt = 0;
for ($svccount = 0; $svccount < 22 && $ub04_proc_index < $proccount; ++$ub04_proc_index) {
$dia = $claim->diagIndexArray($ub04_proc_index);
if (! $claim->cptCharges($ub04_proc_index)) {
$log .= "*** Procedure '" . $claim->cptKey($ub04_proc_index) . "' has no charges!\n";
}
if (empty($dia)) {
$log .= "*** Procedure '" . $claim->cptKey($ub04_proc_index) . "' is not justified!\n";
}
$clm_total_charges += $claim->cptCharges($ub04_proc_index);
// Compute prior payments and "hard" adjustments.
for ($ins = 1; $ins < $claim->payerCount(); ++$ins) {
if ($claim->payerSequence($ins) > $claim->payerSequence()) {
continue; // skip future payers
}
$payerpaid = $claim->payerTotals($ins, $claim->cptKey($ub04_proc_index));
$clm_amount_paid += $payerpaid[1];
$clm_amount_adjusted += $payerpaid[2];
}
++$svccount;
$mcnt = $ub04_proc_index;
// @todo need if inpatient or out patient for box 74 - 74e
$tmp = $claim->cleanDate($revcode2[$mcnt][date]);
$sdate = substr($tmp, 4, 2) . substr($tmp, 6, 2) . substr($tmp, 2, 2);
if ($pcnt < 6) {
$ub04id[$dos++] = $revcode2[$mcnt][code]; /* 74. PRINCIPAL PROCEDURE CODE */
$ub04id[$dos++] = $sdate; /* 74. PRINCIPAL PROCEDURE DATE */
if ($dos == 388) {
$dos = 393;
}
$pcnt++;
}
// @todo Deal with code modifiers $revcode2[$mcnt][modifier]
$tmp = $claim->serviceDate();
$sdate = substr($tmp, 4, 2) . substr($tmp, 6, 2) . substr($tmp, 2, 2);
$ub04id[$os] = $claim->procs[$mcnt][revenue_code]; // 42. REVENUE CODE, Line 1-23 */
$ub04id[++$os] = strtoupper($revcode2[$mcnt][code_text]); /* 43. REVENUE DESCRIPTION, Line 1-23 */
$ub04id[++$os] = trim($revcode2[$mcnt][code] . ' ' . $revcode2[$mcnt][modifier]); /* 44. HCPCS/ACCOMMODATION RATES/HIPPS RATE CODES, Line 1-23 */
$ub04id[++$os] = $sdate; /* 45. SERVICE DATE, Line 1-23 */
$ub04id[++$os] = $revcode2[$mcnt][units]; /* 46. SERVICE UNITS, Line 1-23 */
$ub04id[++$os] = str_replace('.', ' ', sprintf('%8.2f', $revcode2[$mcnt][fee])); /* 47. TOTAL CHARGES, Line 1-23 */
$ub04id[++$os] = ''; /* 48. NON-COVERED CHARGES, Line 1-23 */
$os += 2;
}
$ub04id[275] = '0001'; /* 42. REVENUE CODE, Line 23 */
$ub04id[276] = '1'; /* 43. CLAIM PAGE NUMBER */
$ub04id[277] = '1'; /* 43. TOTAL NUMBER OF CLAIM PAGES */
$ub04id[278] = date('mdy', $today); /* 45. CREATION DATE, Line 23 */
$ub04id[279] = str_replace('.', ' ', sprintf('%8.2f', $clm_total_charges)); /* 47. TOTAL OF TOTAL CHARGES, Line 23 */
if (! $clm_total_charges) {
$log .= "* Claim total is zero charges!\n";
}
// Diagnosis Should be ICD10
$ub04id[347] = '0'; /* 66. DIAGNOSIS AND PROCEDURE CODE QUALIFIER (ICD VERSION INDICATOR) */
$os = 328; /* 67. PRINCIPAL DIAGNOSIS CODE AND POA INDICATOR */
$diagnosis = array();
foreach ($claim->diagArray() as $diag) {
$diagnosis[] = $diag;
if (! empty($diag)) {
if ($os == 362) {
$ub04id[$os++] = substr($diag, 0, 7);
$ub04id[366] = "";
continue;
}
$ub04id[$os++] = substr($diag, 0, 7);
$ub04id[$os++] = "";
}
if ($os == 346) {
$os = 348;
}
if ($os == 365) {
break;
}
}
// @todo Not sure
$ub04id[367] = $diagnosis[0] ? substr($diagnosis[0], 0, 7) : ''; /* 69. ADMITTING DIAGNOSIS CODE */
$ub04id[368] = $diagnosis[1] ? substr($diagnosis[1], 0, 7) : ''; /* 70a. PATIENT'S REASON FOR VISIT */
$ub04id[369] = $diagnosis[2] ? substr($diagnosis[2], 0, 7) : ''; /* 70b. PATIENT'S REASON FOR VISIT */
$ub04id[370] = $diagnosis[3] ? substr($diagnosis[3], 0, 7) : ''; /* 70c. PATIENT'S REASON FOR VISIT */
$payer_os = 0;
if (empty($claim->payerName(0))) {
$payer_os = 1;
}
$ub04id[282] = $claim->facilityNPI(); /* 56. NATIONAL PROVIDER IDENTIFIER - BILLING PROVIDER */
$ub04id[283] = $claim->payerName($payer_os); /* 50a. PRIMARY PAYER NAME */
$ub04id[284] = $claim->planName($payer_os); /* 51a. PRIMARY PAYER HEALTH PLAN ID */
$ub04id[285] = 'Y'; /* 52a. RELEASE OF INFORMATION CERTIFICATION INDICATOR, PRIMARY PAYER */
$tmp = $claim->billingFacilityAssignment() ? 'Y' : 'N';
$ub04id[286] = $tmp; /* 53a. ASSIGNMENT OF BENEFITS CERTIFICATION INDICATOR, PRIMARY PAYER */
//$ub04id[287] = ''; /* 54a. PRIMARY PAYER PRIOR PAYMENTS */
//$ub04id[288] = ''; /* 55a. PRIMARY PAYER ESTIMATED AMOUNT DUE */
if (!empty($claim->payerName($payer_os + 1))) {
$ub04id[290] = $claim->payerName($payer_os + 1); /* 50b. SECONDARY PAYER NAME */
$ub04id[291] = $claim->planName($payer_os + 1); /* 51b. SECONDARY PAYER HEALTH PLAN ID */
$ub04id[292] = 'Y'; /* 52b. RELEASE OF INFORMATION CERTIFICATION INDICATOR, SECONDARY PAYER */
$tmp = (null !== $claim->payerName($payer_os + 1)) && $claim->billingFacilityAssignment() ? 'Y' : 'N';
$ub04id[293] = $tmp; /* 53b. ASSIGNMENT OF BENEFITS CERTIFICATION INDICATOR, SECONDARY PAYER */
}
if ($claim->insuredMiddleName()) {
$tmp = $claim->insuredLastName() . ', ' . $claim->insuredFirstName() . ' ' . substr($claim->insuredMiddleName(), 0, 1);
} else {
$tmp = $claim->insuredLastName() . ', ' . $claim->insuredFirstName();
}
$ub04id[304] = $tmp; /* 58a. INSURED'S NAME - PRIMARY PLAN */
$ub04id[305] = $claim->insuredRelationship(); /* 59a. PATIENT'S RELATIONSHIP TO INSURED - PRIMARY PLAN */
$ub04id[306] = $claim->policyNumber(); /* 60a. INSURED'S UNIQUE IDENTIFIER - PRIMARY PLAN */
$ub04id[307] = $claim->groupName(); /* 61a. INSURED'S GROUP NAME - PRIMARY PLAN */
$ub04id[308] = $claim->groupNumber(); /* 62a. INSURANCE GROUP NUMBER - PRIMARY PLAN */
return $ub04id;
}