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openemr/library/edihistory/test_edih_835_accounting.php

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<?php
/*
* test_edih_835_accounting.php
*
* Copyright 2016 Kevin McCormick <kevin@kt61p>
*
* This program is free software; you can redistribute it and/or modify
* it under the terms of the GNU General Public License as published by
* the Free Software Foundation; either version 2 of the License, or
* (at your option) any later version.
*
* This program is distributed in the hope that it will be useful,
* but WITHOUT ANY WARRANTY; without even the implied warranty of
* MERCHANTABILITY or FITNESS FOR A PARTICULAR PURPOSE. See the
* GNU General Public License for more details.
*
* You should have received a copy of the GNU General Public License
* along with this program; if not, write to the Free Software
* Foundation, Inc., 51 Franklin Street, Fifth Floor, Boston,
* MA 02110-1301, USA.
*
*
*/
// comment out below exit when need to use this script
exit;
use OpenEMR\Billing\ParseERA;
function edih_835_accounting($segments, $delimiters)
{
// accounting information is in
// BPR TRN CLP SVC PLB
/*****
*
*
*$out['check_number'] = trim($seg[2]); TRN
*$out['payer_tax_id'] = substr($seg[3], 1); // 9 digits
*$out['payer_id'] = trim($seg[4]);
*$out['production_date'] = trim($seg[2]); DTM 405
*$out['payer_name'] = trim($seg[2]); N1 loop 1000A
* $out['payer_street'] = trim($seg[1]); N3
* $out['payer_city'] = trim($seg[1]); N4
* $out['payer_state'] = trim($seg[2]);
* $out['payer_zip'] = trim($seg[3]);
* $out['payee_name'] = trim($seg[2]); N1 loop 1000B
*$out['payee_street'] = trim($seg[1]);
* $out['payee_city'] = trim($seg[1]);
* $out['payee_state'] = trim($seg[2]);
*$out['payee_zip'] = trim($seg[3]);
* CLP segment
* // Clear some stuff to start the new claim:
$out['subscriber_lname'] = '';
$out['subscriber_fname'] = '';
$out['subscriber_mname'] = '';
$out['subscriber_member_id'] = '';
$out['crossover']=0;
$out['svc'] = array();
* $out['our_claim_id'] = trim($seg[1]);
*$out['claim_status_code'] = trim($seg[2]);
*$out['amount_charged'] = trim($seg[3]);
* $out['amount_approved'] = trim($seg[4]);
* $out['amount_patient'] = trim($seg[5]); // pt responsibility, copay + deductible
* $out['payer_claim_id'] = trim($seg[7]); // payer's claim number
*
* else if ($segid == 'CAS' && $out['loopid'] == '2100') {
// This is a claim-level adjustment and should be unusual.
// Handle it by creating a dummy zero-charge service item and
// then populating the adjustments into it. See also code in
// ParseERA::parseERA2100() which will later plug in a payment reversal
// amount that offsets these adjustments.
$i = 0; // if present, the dummy service item will be first.
if (!$out['svc'][$i]) {
$out['svc'][$i] = array();
$out['svc'][$i]['code'] = 'Claim';
$out['svc'][$i]['mod'] = '';
$out['svc'][$i]['chg'] = '0';
$out['svc'][$i]['paid'] = '0';
$out['svc'][$i]['adj'] = array();
}
for ($k = 2; $k < 20; $k += 3) {
if (!$seg[$k]) break;
$j = count($out['svc'][$i]['adj']);
$out['svc'][$i]['adj'][$j] = array();
$out['svc'][$i]['adj'][$j]['group_code'] = $seg[1];
$out['svc'][$i]['adj'][$j]['reason_code'] = $seg[$k];
$out['svc'][$i]['adj'][$j]['amount'] = $seg[$k+1];
}
}
*
* // QC = Patient
else if ($segid == 'NM1' && $seg[1] == 'QC' && $out['loopid'] == '2100') {
$out['patient_lname'] = trim($seg[3]);
$out['patient_fname'] = trim($seg[4]);
$out['patient_mname'] = trim($seg[5]);
$out['patient_member_id'] = trim($seg[9]);
}
// IL = Insured or Subscriber
else if ($segid == 'NM1' && $seg[1] == 'IL' && $out['loopid'] == '2100') {
$out['subscriber_lname'] = trim($seg[3]);
$out['subscriber_fname'] = trim($seg[4]);
$out['subscriber_mname'] = trim($seg[5]);
$out['subscriber_member_id'] = trim($seg[9]);
}
// 82 = Rendering Provider
else if ($segid == 'NM1' && $seg[1] == '82' && $out['loopid'] == '2100') {
$out['provider_lname'] = trim($seg[3]);
$out['provider_fname'] = trim($seg[4]);
$out['provider_mname'] = trim($seg[5]);
$out['provider_member_id'] = trim($seg[9]);
}
else if ($segid == 'NM1' && $seg[1] == 'TT' && $out['loopid'] == '2100') {
$out['crossover'] = 1;//Claim automatic forward case.
}
*
* else if ($segid == 'REF' && $seg[1] == '1W' && $out['loopid'] == '2100') {
$out['claim_comment'] = trim($seg[2]);
}
*
* else if ($segid == 'DTM' && $seg[1] == '050' && $out['loopid'] == '2100') {
$out['claim_date'] = trim($seg[2]); // yyyymmdd
}
*
* else if ($segid == 'PER' && $out['loopid'] == '2100') {
$out['payer_insurance'] = trim($seg[2]);
$out['warnings'] .= 'Claim contact information: ' .
$seg[4] . "\n";
}
*
* else if ($segid == 'SVC') {
if (! $out['loopid']) return 'Unexpected SVC segment';
* $out['loopid'] = '2110';
if ($seg[6]) {
// SVC06 if present is our original procedure code that they are changing.
// We will not put their crap in our invoice, but rather log a note and
// treat it as adjustments to our originally submitted coding.
$svc = explode($delimiter3, $seg[6]);
$tmp = explode($delimiter3, $seg[1]);
$out['warnings'] .= "Payer is restating our procedure " . $svc[1] .
" as " . $tmp[1] . ".\n";
} else {
$svc = explode($delimiter3, $seg[1]);
}
if ($svc[0] != 'HC') return 'SVC segment has unexpected qualifier';
// TBD: Other qualifiers are possible; see IG pages 140-141.
$i = count($out['svc']);
$out['svc'][$i] = array();
*
* // It seems some payers append the modifier with no separator!
if (strlen($svc[1]) == 7 && empty($svc[2])) {
$out['svc'][$i]['code'] = substr($svc[1], 0, 5);
$out['svc'][$i]['mod'] = substr($svc[1], 5);
} else {
$out['svc'][$i]['code'] = $svc[1];
$out['svc'][$i]['mod'] = $svc[2] ? $svc[2] . ':' : '';
$out['svc'][$i]['mod'] .= $svc[3] ? $svc[3] . ':' : '';
$out['svc'][$i]['mod'] .= $svc[4] ? $svc[4] . ':' : '';
$out['svc'][$i]['mod'] .= $svc[5] ? $svc[5] . ':' : '';
$out['svc'][$i]['mod'] = preg_replace('/:$/','',$out['svc'][$i]['mod']);
}
$out['svc'][$i]['chg'] = $seg[2];
$out['svc'][$i]['paid'] = $seg[3];
$out['svc'][$i]['adj'] = array();
// Note: SVC05, if present, indicates the paid units of service.
// It defaults to 1.
}
* // DTM01 identifies the type of service date:
// 472 = a single date of service
// 150 = service period start
// 151 = service period end
else if ($segid == 'DTM' && $out['loopid'] == '2110') {
$out['dos'] = trim($seg[2]); // yyyymmdd
}
else if ($segid == 'CAS' && $out['loopid'] == '2110') {
$i = count($out['svc']) - 1;
for ($k = 2; $k < 20; $k += 3) {
if (!$seg[$k]) break;
if ($seg[1] == 'CO' && $seg[$k+1] < 0) {
$out['warnings'] .= "Negative Contractual Obligation adjustment " .
"seems wrong. Inverting, but should be checked!\n";
$seg[$k+1] = 0 - $seg[$k+1];
}
$j = count($out['svc'][$i]['adj']);
$out['svc'][$i]['adj'][$j] = array();
$out['svc'][$i]['adj'][$j]['group_code'] = $seg[1];
$out['svc'][$i]['adj'][$j]['reason_code'] = $seg[$k];
$out['svc'][$i]['adj'][$j]['amount'] = $seg[$k+1];
// Note: $seg[$k+2] is "quantity". A value here indicates a change to
// the number of units of service. We're ignoring that for now.
}
}
*else if ($segid == 'LQ' && $seg[1] == 'HE' && $out['loopid'] == '2110') {
$i = count($out['svc']) - 1;
$out['svc'][$i]['remark'] = $seg[2];
}
*
*
* else if ($segid == 'PLB') {
// Provider-level adjustments are a General Ledger thing and should not
// alter the A/R for the claim, so we just report them as notes.
for ($k = 3; $k < 15; $k += 2) {
if (!$seg[$k]) break;
$out['warnings'] .= 'PROVIDER LEVEL ADJUSTMENT (not claim-specific): $' .
sprintf('%.2f', $seg[$k+1]) . " with reason code " . $seg[$k] . "\n";
// Note: For PLB adjustment reason codes see IG pages 165-170.
}
}
else if ($segid == 'SE') {
ParseERA::parseERA2100($out, $cb);
$out['loopid'] = '';
if ($out['st_control_number'] != trim($seg[2])) {
return 'Ending transaction set control number mismatch';
}
if (($out['st_segment_count'] + 1) != trim($seg[1])) {
return 'Ending transaction set segment count mismatch';
}
}
*
*
*
*
*/
if (is_array($segments) && count($segments)) {
$acct = array();
} else {
csv_edihist_log("edih_835_accounting: invalid segments argument");
return "835 accounting: invalid segments argument";
}
foreach ($segments as $seg) {
if (strncmp('GS' . $de, $seg, 3) === 0) {
$sar = explode($de, $seg);
$gs_date = (isset($sar[4]) && $sar[4]) ? trim($sar[4]) : '';
}
if (strncmp('BPR' . $de, $seg, 4) === 0) {
$sar = explode($de, $seg);
$check_amount = (isset($sar[2]) && $sar[2]) ? trim($sar[2]) : '';
$check_date = (isset($sar[16]) && $sar[16]) ? trim($sar[16]) : '';
}
if (strncmp('TRN' . $de, $seg, 4) === 0) {
$sar = explode($de, $seg);
$ck = (isset($sar[2]) && $sar[2]) ? trim($sar[2]) : count($out);
$out[$ck]['gs_date'] = $gs_date;
$out[$ck]['check_amount'] = $check_amount;
$out[$ck]['check_date'] = $check_date;
$out[$ck]['check_number'] = (isset($sar[2]) && $sar[2]) ? trim($sar[2]) : '';
}
if (strncmp('LX' . $de, $seg, 3) === 0) {
}
if (strncmp('CLP' . $de, $seg, 4) === 0) {
$sar = explode($de, $seg);
$loopid = '2100';
//
$i = (isset($out[$ck]['clp'])) ? count($out[$ck]['clp']) : 0;
//
$out[$ck]['loopid'] = '2100';
$out[$ck]['warnings'] = '';
// Clear some stuff to start the new claim:
$out[$ck]['clp'][$i]['subscriber_lname'] = '';
$out[$ck]['clp'][$i]['subscriber_fname'] = '';
$out[$ck]['clp'][$i]['subscriber_mname'] = '';
$out[$ck]['clp'][$i]['subscriber_member_id'] = '';
$out[$ck]['clp'][$i]['crossover'] = 0;
$out[$ck]['clp'][$i]['svc'] = array();
//
// This is the poorly-named "Patient Account Number". For 837p
// it comes from CLM01 which we populated as pid-diagid-procid,
// where diagid and procid are id values from the billing table.
// For HCFA 1500 claims it comes from field 26 which we
// populated with our familiar pid-encounter billing key.
//
// The 835 spec calls this the "provider-assigned claim control
// number" and notes that it is specifically intended for
// identifying the claim in the provider's database.
$out[$ck]['clp'][$i]['our_claim_id'] = (isset($sar[1]) && $sar[1]) ? trim($sar[1]) : "";
//
$out[$ck]['clp'][$i]['claim_status_code'] = (isset($sar[2]) && $sar[2]) ? trim($sar[2]) : "";
$out[$ck]['clp'][$i]['amount_charged'] = (isset($sar[3]) && $sar[3]) ? trim($sar[3]) : "";
$out[$ck]['clp'][$i]['amount_approved'] = (isset($sar[4]) && $sar[4]) ? trim($sar[4]) : "";
$out[$ck]['clp'][$i]['amount_patient'] = (isset($sar[5]) && $sar[5]) ? trim($sar[5]) : ""; // pt responsibility, copay + deductible
$out[$ck]['clp'][$i]['payer_claim_id'] = (isset($sar[7]) && $sar[7]) ? trim($sar[7]) : ""; // payer's claim number
}
if (strncmp('CAS' . $de, $seg, 4) === 0) {
$sar = explode($de, $seg);
if ($loop == '2100') {
//
// This is a claim-level adjustment and should be unusual.
// Handle it by creating a dummy zero-charge service item and
// then populating the adjustments into it. See also code in
// ParseERA::parseERA2100() which will later plug in a payment reversal
// amount that offsets these adjustments.
$j = 0; // if present, the dummy service item will be first.
if (!$out['svc'][$j]) {
$out[$ck]['clp'][$i]['svc'][$j] = array();
$out[$ck]['clp'][$i]['svc'][$j]['code'] = 'Claim';
$out[$ck]['clp'][$i]['svc'][$j]['mod'] = '';
$out[$ck]['clp'][$i]['svc'][$j]['chg'] = '0';
$out[$ck]['clp'][$i]['svc'][$j]['paid'] = '0';
$out[$ck]['clp'][$i]['svc'][$j]['adj'] = array();
}
for ($k = 2; $k < 20; $k += 3) {
if (!isset($sar[$k])) {
break;
}
$k = count($out['svc'][$j]['adj']);
$out[$ck]['clp'][$i]['svc'][$j]['adj'][$k] = array();
$out[$ck]['clp'][$i]['svc'][$j]['adj'][$k]['group_code'] = $sar[1];
$out[$ck]['clp'][$i]['svc'][$j]['adj'][$k]['reason_code'] = $sar[$k];
$out[$ck]['clp'][$i]['svc'][$j]['adj'][$k]['amount'] = $sar[$k + 1];
}
} elseif ($loopid == '2110') {
$sar = explode($de, $seg);
$j = count($out[$ck]['clp'][$i]['svc']);
$out[$ck]['clp'][$i]['svc'][$j] = array();
if (! $out['loopid']) {
return 'Unexpected SVC segment';
}
//
if (isset($sar[6]) && $sar[6]) {
// SVC06 if present is our original procedure code that they are changing.
// We will not put their crap in our invoice, but rather log a note and
// treat it as adjustments to our originally submitted coding.
$svc = explode($ds, $sar[6]);
$tmp = (isset($sar[1]) && $sar[1]) ? explode($ds, $sar[1]) : "";
$out[$ck]['clp'][$i]['warnings'] .= "Submitted procedure modified " . $svc[1] .
" as " . $tmp[1] . ".\n";
} else {
$svc = explode($delimiter3, $seg[1]);
}
if ($svc[0] != 'HC') {
return 'SVC segment has unexpected qualifier';
}
// TBD: Other qualifiers are possible; see IG pages 140-141.
$j = count($out[$ck]['clp'][$i]['svc']);
$out['svc'][$j] = array();
// It seems some payers append the modifier with no separator!
if (strlen($svc[1]) == 7 && empty($svc[2])) {
$out['svc'][$j]['code'] = substr($svc[1], 0, 5);
$out['svc'][$j]['mod'] = substr($svc[1], 5);
} else {
$out['svc'][$j]['code'] = $svc[1];
$out['svc'][$j]['mod'] = $svc[2] ? $svc[2] . ':' : '';
$out['svc'][$j]['mod'] .= $svc[3] ? $svc[3] . ':' : '';
$out['svc'][$j]['mod'] .= $svc[4] ? $svc[4] . ':' : '';
$out['svc'][$j]['mod'] .= $svc[5] ? $svc[5] . ':' : '';
$out['svc'][$j]['mod'] = preg_replace('/:$/', '', $out['svc'][$j]['mod']);
}
$out['svc'][$j]['chg'] = $seg[2];
$out['svc'][$j]['paid'] = $seg[3];
$out['svc'][$j]['adj'] = array();
// Note: SVC05, if present, indicates the paid units of service.
// It defaults to 1.
}
} elseif (strncmp('NM1' . $de, $seg, 4) === 0) {
$sar = explode($de, $seg);
$id = (isset($sar[1]) && $sar[1]) ? trim($sar[1]) : "";
if ($id == 'QC') {
// QC Patient
$out[$ck]['clp'][$i]['patient_lname'] = (isset($sar[3]) && $sar[3]) ? trim($sar[3]) : "";
$out[$ck]['clp'][$i]['patient_fname'] = (isset($sar[4]) && $sar[4]) ? trim($sar[4]) : "";
$out[$ck]['clp'][$i]['patient_mname'] = (isset($sar[5]) && $sar[5]) ? trim($sar[5]) : "";
$out[$ck]['clp'][$i]['patient_member_id'] = (isset($sar[9]) && $sar[9]) ? trim($sar[9]) : "";
} elseif ($id == 'IL') {
// IL = Insured or Subscriber
$out[$ck]['clp'][$i]['subscriber_lname'] = (isset($sar[3]) && $sar[3]) ? trim($sar[3]) : "";
$out[$ck]['clp'][$i]['subscriber_fname'] = (isset($sar[4]) && $sar[4]) ? trim($sar[4]) : "";
$out[$ck]['clp'][$i]['subscriber_mname'] = (isset($sar[5]) && $sar[5]) ? trim($sar[5]) : "";
$out[$ck]['clp'][$i]['subscriber_member_id'] = (isset($sar[9]) && $sar[9]) ? trim($sar[9]) : "";
} elseif ($id == '82') {
// 82 = Rendering Provider
$out[$ck]['clp'][$i]['provider_lname'] = (isset($sar[3]) && $sar[3]) ? trim($sar[3]) : "";
$out[$ck]['clp'][$i]['provider_fname'] = (isset($sar[4]) && $sar[4]) ? trim($sar[4]) : "";
$out[$ck]['clp'][$i]['provider_mname'] = (isset($sar[5]) && $sar[5]) ? trim($sar[5]) : "";
$out[$ck]['clp'][$i]['provider_member_id'] = (isset($sar[9]) && $sar[9]) ? trim($sar[9]) : "";
} elseif ($id == 'TT') {
//Claim automatic forward case.
$out[$ck]['clp'][$i]['crossover'] = 1;
}
} elseif ((strncmp('PER' . $de, $seg, 4) === 0 ) && ($segid == 'PER' && $out['loopid'] == '2100')) {
$sar = explode($de, $seg);
$out['payer_insurance'] = trim($seg[2]);
$out['warnings'] .= 'Claim contact information: ' . $seg[4];
} elseif (strncmp('PLB' . $de, $seg, 4) === 0) {
$sar = explode($de, $seg);
$p = (isset($out[$ck]['plb'])) ? count($out[$ck]['plb']) : 0;
$q = 0;
//
$out[$ck]['plb'][$p] = array();
$out[$ck]['plb']['adj'] = array();
$out[$ck]['plb'][$p]['provider'] = (isset($sar[1]) && $sar[1]) ? trim($sar[1]) : "";
$out[$ck]['plb'][$p]['fye'] = (isset($sar[2]) && $sar[2]) ? trim($sar[2]) : "";
// PLB02 is provider fiscal year end or CCYY1231
//
$plbar = array_slice($sar, 3);
foreach ($plbar as $ky => $plb) {
switch ($ky % 2) {
// PLB04 06 08 ...
case 0:
$out[$ck]['clp'][$p]['adj'][$q]['amt'] = $plb;
break;
// PLB03 05 07 ...
case 1:
if (strpos($plb, $ds)) {
$plb02 = explode($ds, $plb);
$out[$ck]['per'][$p]['adj'][$q]['code'] = $plb02[0];
$out[$ck]['per'][$p]['adj'][$q]['ref'] = $plb02[1];
} else {
$out[$ck]['per'][$p]['adj'][$q]['code'] = $plb;
$out[$ck]['per'][$p]['adj'][$q]['ref'] = '';
}
$q++;
break;
}
}
}
$plbar .= (isset($sar[3]) && $sar[3]) ? trim($sar[3]) : '0';
// I am not sure that the assignment is corrent here, but based on the flow, I frame it.
}
}
if (strncmp('SVC' . $de, $seg, 4) === 0) {
$loopid = '2110';
}
$acctng['lx'][$lx01] = array('ts3amt' => 0, 'fee' => 0, 'clmpmt' => 0, 'clmadj' => 0, 'prvadj' => 0, 'ptrsp' => 0);
if ($chk) {
$acctng['pmt'] = $bpr02;
}
// try a little accounting
if ($chk) {
if ($acctng['pmt'] == ($acctng['clmpmt'] + $acctng['prvadj'])) {
$bal = 'Balanced';
} else {
$bal = 'Not Balanced';
}
$pmt_html .= "<tr class='pmt'><td colspan=4>Accounting " . text($bal) . "</td></tr>" . PHP_EOL;
$pmt_html .= "<tr class='pmt'><td>Fee " . text($acctng['fee']) . "</td><td>Adj " . text($acctng['clmadj']) . "</td><td>PtRsp " . text($acctng['ptrsp']) . "</td></tr>" . PHP_EOL;
$pmt_html .= "<tr class='pmt'><td>PMT " . text($acctng['pmt']) . "</td><td>CLP " . text($acctng['clmpmt']) . "</td><td>PLB " . text($acctng['prvadj']) . "</td></tr>" . PHP_EOL;
}