/library/classes/WSClaim.class.php

<?php

require_once (dirname(__FILE__) . "/WSWrapper.class.php");
include_once (dirname(__FILE__) . "/../sqlconf.php");
include_once (dirname(__FILE__) . "/../sql.inc");
include_once (dirname(__FILE__) . "/../../includes/config.php");

class WSClaim extends WSWrapper{

  var $patient_id;
  var $foreign_provider_id;
  var $foreign_patient_id;
  var $payer_id;
  var $encounter;
  var $foreign_payer_id;
  var $claim;
  var $_db;

  function WSClaim($patient_id, $encounter) {
    if (!is_numeric($patient_id) && is_numeric($encounter)) return;

    parent::WSWrapper(null,false);

    $this->patient_id = $patient_id;
    $this->encounter = $encounter;
    $this->claim = null;
    $this->_db = $GLOBALS['adodb']['db'];

    if ($this->_config['enabled'] === 2) {
      return;
    }

    if ($this->load_claim()) {
      $function['ezybiz.add_invoice'] = array(new xmlrpcval($this->claim,"struct"));
      $this->send($function);
    }
    //print_r($this->claim);
  }

  ///////////////////////////////////////////////////////////////////////
  // The remainder is used only for SQL-Ledger support, to be deprecated.
  ///////////////////////////////////////////////////////////////////////

  function load_claim() {
    if (!$this->load_patient_foreign_id() ||
      !$this->load_payer_foreign_id() ||
      !$this->load_provider_foreign_id() )
      return false;
    $invoice_info = array();

    // Get encounter date and patient name.
    $sql = "SELECT e.date AS dosdate, " .
      "CONCAT(pd.fname,' ',pd.mname,' ',pd.lname) as patient_name " .
      "FROM form_encounter AS e, patient_data AS pd " .
      "WHERE " .
      "e.encounter = '" . $this->encounter . "' AND " .
      "e.pid = '" . $this->patient_id . "' AND " .
      "pd.pid = e.pid";
    $eres = $this->_db->Execute($sql);
    $dosdate = substr($eres->fields['dosdate'], 0, 10);

    // Create invoice notes for the new invoice that list the patient's
    // insurance plans.  This is so that when payments are posted, the user
    // can easily see if a secondary claim needs to be submitted.
    //
    $insnotes = "";
    $insno = 0;
    foreach (array("primary", "secondary", "tertiary") as $instype) {
      ++$insno;
      $sql = "SELECT ic.name " .
        "FROM insurance_data AS id, insurance_companies AS ic WHERE " .
        "id.pid = " . $this->patient_id . " AND " .
        "id.type = '$instype' AND " .
        "id.date <= '$dosdate' AND " .
        "ic.id = id.provider " .
        "ORDER BY id.date DESC LIMIT 1";
      $result = $this->_db->Execute($sql);
      if ($result && !$result->EOF && $result->fields['name']) {
        if ($insnotes) $insnotes .= "\n";
        $insnotes .= "Ins$insno: " . $result->fields['name'];
      }
    }
    $invoice_info['notes'] = $insnotes;

    $sql = "SELECT * FROM billing WHERE " .
      "encounter = '" . $this->encounter . "' AND pid = '" . $this->patient_id .
      "' AND billed = 1 AND activity != 0 AND authorized = 1";

    $result = $this->_db->Execute($sql);

    $invoice_info['salesman'] = $this->foreign_provider_id;
    $invoice_info['customerid'] = $this->foreign_patient_id;
    $invoice_info['payer_id'] = $this->foreign_payer_id;
    $invoice_info['invoicenumber'] = $this->patient_id . "." . $this->encounter;

    $counter = 0;
    $total = 0;
    $patient_info = array();
    $payer_info = array();

    while ($result && !$result->EOF) {

      // All bills should be in the accounting system, and mark-as-cleared
      // is the only reasonable way to process cash-only patients.
      //
      $process_date = ($result->fields['process_date'] == null) ?
        date("m-d-Y") :
        date("m-d-Y", strtotime($result->fields['process_date']));

      if ($counter == 0) {
        //unused but supported by ezybiz, helpful in debugging
        // actualy the dosdate can be used if you want that as the invoice date
        $invoice_info['customer'] = $eres->fields['patient_name'];
        $invoice_info['invoicedate'] = $process_date;
        $invoice_info['duedate'] = $process_date;
        $invoice_info['items'] = array();
        $invoice_info['dosdate'] = date("m-d-Y",strtotime($eres->fields['dosdate']));
      }

      $tii = array();
      //This is how we set the line items for the invoice, using codes from our encounter
      //if ($result->fields['code_type'] == "CPT4" || $result->fields['code_type'] == "HCPCS") {
      //if( $result->fields['code_type'] != "ICD9" ) {
      if( $result->fields['code_type'] == "COPAY")
      {
        $patient_info['payment_amount'] += sprintf("%01.2f",$result->fields['fee']);
      }
      else
      {
        $payer_info['payment_amount'] += sprintf("%01.2f",$result->fields['fee']);
      }

      // New as of 2007-06-21: wherever we put a procedure code in the
      // invoice, append a colon and the modifier if there is one.  This way
      // we can better match up payments and adjustments with the billing data
      // in OpenEMR.
      $codekey = $result->fields['code'];
      if ($result->fields['modifier']) $codekey .= ':' . $result->fields['modifier'];

      $tii['maincode'] = $codekey;
      $tii['itemtext'] = $result->fields['code_type'] . ":" .
        $codekey . " " . $result->fields['code_text'] . " " .
        $result->fields['justify'];

      // New logic that respects units:
      $units = max(1, intval($result->fields['units']));
      $amount = sprintf("%01.2f", $result->fields['fee']);
      $price = $amount / $units;
      $tmp = sprintf("%01.2f", $price);
      if (abs($price - $tmp) < 0.000001) $price = $tmp;
      $tii['qty'] = $units;
      $tii['price'] = $price;
      $total += $amount;

      $tii['glaccountid'] = $this->_config['income_acct'];
      $invoice_info['items'][] = $tii;

      $result->MoveNext();
      $counter++;
    }

    // I think maybe this info is not used.
    //
    for($counter = 0; $counter < 2; $counter++)
    {
      $fee = 0;
      $billto = 0;
      if($counter == 0)
      {
        $fee = $patient_info['payment_amount'];
        $billto = $this->foreign_patient_id;
      }
      else
      {
        $fee = $payer_info['payment_amount'];
        $billto = $this->foreign_payer_id;
      }
      $invoice_info["invoiceid$counter"] = $this->patient_id . "000" . $this->encounter;
      $invoice_info["amount$counter"] = $fee;
      $invoice_info["invoicenumber$counter"] = $this->patient_id . "000" . $this->encounter;
      $invoice_info["interest$counter"] = 0;
      $invoice_info["billtoid$counter"] = $billto;
    }

    $invoice_info['subtotal'] = sprintf("%01.2f",$total);
    $invoice_info['total'] = sprintf("%01.2f",$total);

    $this->claim = $invoice_info;
    return true;
  }

  function load_provider_foreign_id() {
    $sql = "SELECT foreign_id FROM integration_mapping AS im " .
      "LEFT JOIN billing AS b ON im.local_id = b.provider_id WHERE " .
      "b.encounter = '" . $this->encounter . "' AND " .
      "b.pid = '" . $this->patient_id . "' AND im.local_table = 'users' " .
      "AND im.foreign_table = 'salesman'";
    $result = $this->_db->Execute($sql);
    if($result && !$result->EOF) {
        $this->foreign_provider_id = $result->fields['foreign_id'];
        return true;
    }
    else {
      echo "Provider has not been previously sent to external system or no " .
        "entry was found for them in the integration mapping, could not " .
        "send claim. Patient: '" . $this->patient_id . "', Encounter: '" .
        $this->encounter . "'<br>";
      return false;
    }
  }

  function load_patient_foreign_id() {
    $sql = "SELECT foreign_id from integration_mapping as im LEFT JOIN patient_data as pd on im.local_id=pd.id where pd.pid = '" . $this->patient_id . "' and im.local_table='patient_data' and im.foreign_table='customer'";
    $result = $this->_db->Execute($sql);
    if($result && !$result->EOF) {
        $this->foreign_patient_id = $result->fields['foreign_id'];
        return true;
    }
    else {
      echo "Entry has not been previously sent to external system or no entry was found for them in the integration mapping, could not send claim. Patient: '" . $this->patient_id . "'<br>";
      return false;
    }
  }

  function load_payer_foreign_id() {
    $sql = "SELECT payer_id from billing where encounter = '" . $this->encounter . "' and pid = '" . $this->patient_id . "'";
    $result = $this->_db->Execute($sql);
    if($result && !$result->EOF) {
        $this->payer_id = $result->fields['payer_id'];
    }
    else {
      echo "No payer id for this claim could be found";
      return false;
    }
    // See comments in globals.php:
    if ($GLOBALS['insurance_companies_are_not_customers']) {
      $this->foreign_payer_id = $this->payer_id;
    }
    else {
      $sql = "SELECT foreign_id from integration_mapping as im LEFT JOIN billing as b on im.local_id=b.payer_id where b.payer_id = '" . $this->payer_id . "' and im.local_table='insurance_companies' and im.foreign_table='customer'";
      $result = $this->_db->Execute($sql);
      if($result && !$result->EOF) {
        $this->foreign_payer_id = $result->fields['foreign_id'];
      }
      else {
        echo "Entry has not been previously sent to external system or no entry was found for them in the integration mapping, could not send claim. Insurance Company: '" . $this->payer_id . "'<br>";
        return false;
      }
    }
    return true;
  }

} // End class WSClaim

?>