-
-
Notifications
You must be signed in to change notification settings - Fork 2.1k
/
edi.inc
1125 lines (1045 loc) · 47.8 KB
/
edi.inc
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100
101
102
103
104
105
106
107
108
109
110
111
112
113
114
115
116
117
118
119
120
121
122
123
124
125
126
127
128
129
130
131
132
133
134
135
136
137
138
139
140
141
142
143
144
145
146
147
148
149
150
151
152
153
154
155
156
157
158
159
160
161
162
163
164
165
166
167
168
169
170
171
172
173
174
175
176
177
178
179
180
181
182
183
184
185
186
187
188
189
190
191
192
193
194
195
196
197
198
199
200
201
202
203
204
205
206
207
208
209
210
211
212
213
214
215
216
217
218
219
220
221
222
223
224
225
226
227
228
229
230
231
232
233
234
235
236
237
238
239
240
241
242
243
244
245
246
247
248
249
250
251
252
253
254
255
256
257
258
259
260
261
262
263
264
265
266
267
268
269
270
271
272
273
274
275
276
277
278
279
280
281
282
283
284
285
286
287
288
289
290
291
292
293
294
295
296
297
298
299
300
301
302
303
304
305
306
307
308
309
310
311
312
313
314
315
316
317
318
319
320
321
322
323
324
325
326
327
328
329
330
331
332
333
334
335
336
337
338
339
340
341
342
343
344
345
346
347
348
349
350
351
352
353
354
355
356
357
358
359
360
361
362
363
364
365
366
367
368
369
370
371
372
373
374
375
376
377
378
379
380
381
382
383
384
385
386
387
388
389
390
391
392
393
394
395
396
397
398
399
400
401
402
403
404
405
406
407
408
409
410
411
412
413
414
415
416
417
418
419
420
421
422
423
424
425
426
427
428
429
430
431
432
433
434
435
436
437
438
439
440
441
442
443
444
445
446
447
448
449
450
451
452
453
454
455
456
457
458
459
460
461
462
463
464
465
466
467
468
469
470
471
472
473
474
475
476
477
478
479
480
481
482
483
484
485
486
487
488
489
490
491
492
493
494
495
496
497
498
499
500
501
502
503
504
505
506
507
508
509
510
511
512
513
514
515
516
517
518
519
520
521
522
523
524
525
526
527
528
529
530
531
532
533
534
535
536
537
538
539
540
541
542
543
544
545
546
547
548
549
550
551
552
553
554
555
556
557
558
559
560
561
562
563
564
565
566
567
568
569
570
571
572
573
574
575
576
577
578
579
580
581
582
583
584
585
586
587
588
589
590
591
592
593
594
595
596
597
598
599
600
601
602
603
604
605
606
607
608
609
610
611
612
613
614
615
616
617
618
619
620
621
622
623
624
625
626
627
628
629
630
631
632
633
634
635
636
637
638
639
640
641
642
643
644
645
646
647
648
649
650
651
652
653
654
655
656
657
658
659
660
661
662
663
664
665
666
667
668
669
670
671
672
673
674
675
676
677
678
679
680
681
682
683
684
685
686
687
688
689
690
691
692
693
694
695
696
697
698
699
700
701
702
703
704
705
706
707
708
709
710
711
712
713
714
715
716
717
718
719
720
721
722
723
724
725
726
727
728
729
730
731
732
733
734
735
736
737
738
739
740
741
742
743
744
745
746
747
748
749
750
751
752
753
754
755
756
757
758
759
760
761
762
763
764
765
766
767
768
769
770
771
772
773
774
775
776
777
778
779
780
781
782
783
784
785
786
787
788
789
790
791
792
793
794
795
796
797
798
799
800
801
802
803
804
805
806
807
808
809
810
811
812
813
814
815
816
817
818
819
820
821
822
823
824
825
826
827
828
829
830
831
832
833
834
835
836
837
838
839
840
841
842
843
844
845
846
847
848
849
850
851
852
853
854
855
856
857
858
859
860
861
862
863
864
865
866
867
868
869
870
871
872
873
874
875
876
877
878
879
880
881
882
883
884
885
886
887
888
889
890
891
892
893
894
895
896
897
898
899
900
901
902
903
904
905
906
907
908
909
910
911
912
913
914
915
916
917
918
919
920
921
922
923
924
925
926
927
928
929
930
931
932
933
934
935
936
937
938
939
940
941
942
943
944
945
946
947
948
949
950
951
952
953
954
955
956
957
958
959
960
961
962
963
964
965
966
967
968
969
970
971
972
973
974
975
976
977
978
979
980
981
982
983
984
985
986
987
988
989
990
991
992
993
994
995
996
997
998
999
1000
<?php
/**
* Inc file for the 270 / 271 creation and uploading
*
* This program creates the segments for the x12 270 eligibility file
* It also allows the reading and storing of the x12 271 file
*
* @package OpenEMR
* @link http://www.open-emr.org
* @author Terry Hill <terry@lilysystems.com>
* @author Brady Miller <brady.g.miller@gmail.com>
* @author Jerry Padgett <sjpadgett@gmail.com>
* @author Stephen Waite <stephen.waite@cmsvt.com>
* @copyright Copyright (c) 2010 MMF Systems, Inc
* @copyright Copyright (c) 2016 Terry Hill <terry@lillysystems.com>
* @copyright Copyright (c) 2017 Brady Miller <brady.g.miller@gmail.com>
* @copyright Copyright (c) 2019 Jerry Padgett <sjpadgett@gmail.com>
* @copyright Copyright (c) 2019 Stephen Waite <stephen.waite@cmsvt.com>
* @license https://github.com/openemr/openemr/blob/master/LICENSE GNU General Public License 3
*/
require_once("$srcdir/edihistory/codes/edih_271_code_class.php");
use OpenEMR\Common\Http\oeHttp;
use OpenEMR\Common\Utils\RandomGenUtils;
// @TODO global to become private var when this goes to a class.
//
global $X12info;
// SEGMENT FUNCTION START
// ISA Segment - EDI-270 format
function create_ISA($row, $X12info, $segTer, $compEleSep)
{
$ISA = array();
$ISA[0] = "ISA"; // Interchange Control Header Segment ID
$ISA[1] = "00"; // Author Info Qualifier
$ISA[2] = str_pad("0000000", 10, " "); // Author Information
$ISA[3] = "00"; // Security Information Qualifier
// MEDI-CAL NOTE: For Leased-Line & Dial-Up use '01',
// for BATCH use '00'.
// '00' No Security Information Present
// (No Meaningful Information in I04)
$ISA[4] = str_pad("0000000000", 10, " "); // Security Information
$ISA[5] = str_pad($X12info['x12_isa05'], 2, " "); // Interchange ID Qualifier
$ISA[6] = str_pad($X12info['x12_sender_id'], 15, " "); // INTERCHANGE SENDER ID
$ISA[7] = str_pad($X12info['x12_isa07'], 2, " "); // Interchange ID Qualifier
$ISA[8] = str_pad($X12info['x12_receiver_id'], 15, " "); // INTERCHANGE RECEIVER ID
$ISA[9] = str_pad(date('ymd'), 6, " "); // Interchange Date (YYMMDD)
$ISA[10] = str_pad(date('Hi'), 4, " "); // Interchange Time (HHMM)
$ISA[11] = "^"; // Interchange Control Standards Identifier
$ISA[12] = str_pad("00501", 5, " "); // Interchange Control Version Number
$ISA[13] = str_pad("000000001", 9, " "); // INTERCHANGE CONTROL NUMBER
$ISA[14] = str_pad($X12info['x12_isa14'], 1, " "); // Acknowledgment Request [0= not requested, 1= requested]
$ISA[15] = str_pad($X12info['x12_isa15'], 1, " "); // Usage Indicator [ P = Production Data, T = Test Data ]
$ISA['Created'] = implode('*', $ISA); // Data Element Separator
$ISA['Created'] = $ISA['Created'] ."*";
$ISA['Created'] = $ISA ['Created'] . $compEleSep . $segTer;
return trim($ISA['Created']);
}
// GS Segment - EDI-270 format
function create_GS($row, $X12info, $segTer, $compEleSep)
{
$GS = array();
$GS[0] = "GS"; // Functional Group Header Segment ID
$GS[1] = "HS"; // Functional ID Code [ HS = Eligibility, Coverage or Benefit Inquiry (270) ]
$GS[2] = $X12info['x12_sender_id']; // Application Sender's ID
$GS[3] = $X12info['x12_receiver_id']; // Application Receiver's ID
$GS[4] = date('Ymd'); // Date [CCYYMMDD]
$GS[5] = date('His'); // Time [HHMM] Group Creation Time
$GS[6] = "2"; // Group Control Number No zeros for 5010
$GS[7] = "X"; // Responsible Agency Code Accredited Standards Committee X12 ]
$GS[8] = "005010X279A1"; // Version Release / Industry[ Identifier Code Query 005010X279A1
$GS['Created'] = implode('*', $GS); // Data Element Separator
$GS['Created'] = $GS ['Created'] . $segTer; // change the information in the tag or change the tag
return trim($GS['Created']);
}
// ST Segment - EDI-270 format
function create_ST($row, $X12info, $segTer, $compEleSep)
{
$ST = array();
$ST[0] = "ST"; // Transaction Set Header Segment ID
$ST[1] = "270"; // Transaction Set Identifier Code (Inquiry Request)
$ST[2] = "000000003"; // Transaction Set Control Number - Must match SE's
$ST[3] = "005010X279A1"; // Standard 005010X279A1 in $ST[3]
$ST['Created'] = implode('*', $ST); // Data Element Separator
$ST['Created'] = $ST ['Created'] . $segTer;
return trim($ST['Created']);
}
// BHT Segment - EDI-270 format
function create_BHT($row, $X12info, $segTer, $compEleSep)
{
$BHT = array();
$BHT[0] = "BHT"; // Beginning of Hierarchical Transaction Segment ID
$BHT[1] = "0022"; // Subscriber Structure Code
$BHT[2] = "13"; // Purpose Code - This is a Request
$BHT[3] = "PROVTest600"; // Submitter Transaction Identifier
// This information is required by the information Receiver when using Real Time transactions.
// For BATCH this can be used for optional information.
$BHT[4] = str_pad(date('Ymd'), 8, " "); // Date Transaction Set Created
$BHT[5] = str_pad(date('Hi'), 4, " "); // Time Transaction Set Created no space after and 1300 is plenty
$BHT['Created'] = implode('*', $BHT); // Data Element Separator
$BHT['Created'] = $BHT ['Created'] . $segTer;
return trim($BHT['Created']);
}
// HL Segment - EDI-270 format
function create_HL($row, $nHlCounter, $X12info, $segTer, $compEleSep)
{
$HL = array();
$HL[0] = "HL"; // Hierarchical Level Segment ID
$HL_LEN[0] = 2;
$HL[1] = $nHlCounter; // Hierarchical ID No.
if ($nHlCounter == 1) {
$HL[2] = "";
$HL[3] = 20; // Description: Identifies the payor, maintainer, or source of the information.
$HL[4] = 1; // 1 Additional Subordinate HL Data Segment in This Hierarchical Structure.
} else if ($nHlCounter == 2) {
$HL[2] = 1; // Hierarchical Parent ID Number
$HL[3] = 21; // Hierarchical Level Code. '21' Information Receiver
$HL[4] = 1; // 1 Additional Subordinate HL Data Segment in This Hierarchical Structure.
} else {
$HL[2] = 2;
$HL[3] = 22; // Hierarchical Level Code.'22' Subscriber
$HL[4] = 0; // 0 no Additional Subordinate in the Hierarchical Structure.
}
$HL['Created'] = implode('*', $HL); // Data Element Separator
$HL['Created'] = $HL ['Created'] . $segTer;
return trim($HL['Created']);
}
// NM1 Segment - EDI-270 format
function create_NM1($row, $nm1Cast, $X12info, $segTer, $compEleSep)
{
$NM1 = array();
$NM1[0] = "NM1"; // Subscriber Name Segment ID
if ($nm1Cast == 'PR') {
$NM1[1] = "PR"; // Entity ID Code - Payer [PR Payer]
$NM1[2] = "2"; // Entity Type - Non-Person
$NM1[3] = $row["payer_name"]; // Organizational Name
$NM1[4] = ""; // Data Element not required.
$NM1[5] = ""; // Data Element not required.
$NM1[6] = ""; // Data Element not required.
$NM1[7] = ""; // Data Element not required.
$NM1[8] = "PI"; // 5010 no longer uses "46"
if ($GLOBALS['enable_oa']) {
$payerId = $row['eligibility_id'];
} else {
$payerId = $row['cms_id'];
}
$NM1[9] = $payerId; // Application Sender's ID
} else if ($nm1Cast == 'FA') {
$NM1[1] = "FA"; // Entity ID Code - Facility [FA Facility]
$NM1[2] = "2"; // Entity Type - Non-Person
$NM1[3] = $row['facility_name']; // Organizational Name
$NM1[4] = ""; // Data Element not required.
$NM1[5] = ""; // Data Element not required.
$NM1[6] = ""; // Data Element not required.
$NM1[7] = ""; // Data Element not required.
$NM1[8] = "FI";
$NM1[9] = $row['facility_npi'];
} else if ($nm1Cast == '1P') {
$NM1[1] = "1P"; // Entity ID Code - Provider
$NM1[2] = "2"; // Entity Type - Non-Person
$NM1[3] = $row['facility_name']; // Organizational Name
$NM1[4] = ""; // Data Element not required.
$NM1[5] = ""; // Data Element not required.
$NM1[6] = ""; // Data Element not required.
$NM1[7] = ""; // Data Element not required.
$NM1[8] = "XX";
$NM1[9] = $row['provider_npi'];
} else if ($nm1Cast == 'IL') {
$NM1[1] = "IL"; // Insured or Subscriber
$NM1[2] = "1"; // Entity Type - Person
$NM1[3] = $row['lname']; // last Name
$NM1[4] = $row['fname']; // first Name
$NM1[5] = $row['mname']; // middle Name
$NM1[6] = ""; // data element
$NM1[7] = ""; // data element
$NM1[8] = "MI"; // Identification Code Qualifier
$NM1[9] = $row['policy_number']; // Identification Code
}
$NM1['Created'] = implode('*', $NM1); // Data Element Separator
$NM1['Created'] = $NM1['Created'] . $segTer;
return trim($NM1['Created']);
}
// REF Segment - EDI-270 format
function create_REF($row, $ref, $X12info, $segTer, $compEleSep)
{
$REF = array();
$REF[0] = "REF"; // Subscriber Additional Identification does not want this for anything
if ($ref == '1P') {
$REF[1] = "4A"; // Reference Identification Qualifier
$REF[2] = $row['provider_pin']; // Provider Pin.
} else {
$REF[1] = "EJ"; // 'EJ' for Patient Account Number does not want this for patient
$REF[2] = $row['pid']; // Patient Account No.
}
$REF['Created'] = implode('*', $REF); // Data Element Separator
$REF['Created'] = $REF['Created'] . $segTer;
return trim($REF['Created']);
}
// TRN Segment - EDI-270 format
function create_TRN($row, $tracno, $refiden, $X12info, $segTer, $compEleSep)
{
$TRN = array();
$TRN[0] = "TRN"; // Subscriber Trace Number Segment ID
$TRN[1] = "1"; // Trace Type Code � Current Transaction Trace Numbers
$TRN[2] = $tracno; // Trace Number
$TRN[3] = "9000000000"; // Originating Company ID � must be 10 positions in length
$TRN[4] = $refiden; // Additional Entity Identifier (i.e. Subdivision)
$TRN['Created'] = implode('*', $TRN); // Data Element Separator
$TRN['Created'] = $TRN['Created'] . $segTer;
return trim($TRN['Created']);
}
// DMG Segment - EDI-270 format
function create_DMG($row, $X12info, $segTer, $compEleSep)
{
$DMG = array();
$DMG[0] = "DMG"; // Date or Time or Period Segment ID
$DMG[1] = "D8"; // Date Format Qualifier - (D8 means CCYYMMDD)
$DMG[2] = $row['dob']; // Subscriber's Birth date
$DMG[3] = strtoupper($row['sex'][0]);
$DMG['Created'] = implode('*', $DMG); // Data Element Separator
$DMG['Created'] = $DMG['Created'] . $segTer;
return trim($DMG['Created']);
}
// DTP Segment - EDI-270 format
function create_DTP($row, $qual, $X12info, $segTer, $compEleSep)
{
$DTP = array();
$DTP[0] = "DTP"; // Date or Time or Period Segment ID
$DTP[1] = $qual; // Qualifier - Date of Service
$DTP[2] = "D8"; // Date Format Qualifier - (D8 means CCYYMMDD)
if ($qual == '102') {
$DTP[3] = $row['date']; // Ins effective Date
} else {
switch ($X12info['x12_dtp03']) {
case 'A':
$dtp_date = !empty($row['pc_eventDate']) && $row['pc_eventDate'] > '20010101' ? $row['pc_eventDate'] : date("Ymd");
break;
case 'E':
$dtp_date = !empty($row['date']) && $row['date'] > '20010101' ? $row['date'] : date("Ymd");
break;
default:
$dtp_date = date("Ymd");
}
$DTP[3] = $dtp_date; // Date of Service
}
$DTP['Created'] = implode('*', $DTP); // Data Element Separator
$DTP['Created'] = $DTP['Created'] . $segTer;
return trim($DTP['Created']);
}
// EQ Segment - EDI-270 format
function create_EQ($row, $X12info, $segTer, $compEleSep)
{
$EQ = array();
$EQ[0] = "EQ"; // Subscriber Eligibility or Benefit Inquiry Information
$EQ[1] = "30"; // Service Type Code
$EQ['Created'] = implode('*', $EQ); // Data Element Separator
$EQ['Created'] = $EQ['Created'] . $segTer;
return trim($EQ['Created']);
}
// SE Segment - EDI-270 format
function create_SE($row, $segmentcount, $X12info, $segTer, $compEleSep)
{
$SE = array();
$SE[0] = "SE"; // Transaction Set Trailer Segment ID
$SE[1] = $segmentcount; // Segment Count
$SE[2] = "000000003"; // Transaction Set Control Number - Must match ST's
$SE['Created'] = implode('*', $SE); // Data Element Separator
$SE['Created'] = $SE['Created'] . $segTer;
return trim($SE['Created']);
}
// GE Segment - EDI-270 format
function create_GE($row, $X12info, $segTer, $compEleSep)
{
$GE = array();
$GE[0] = "GE"; // Functional Group Trailer Segment ID
$GE[1] = "1"; // Number of included Transaction Sets
$GE[2] = "2"; // Group Control Number
$GE['Created'] = implode('*', $GE); // Data Element Separator
$GE['Created'] = $GE['Created'] . $segTer;
return trim($GE['Created']);
}
// IEA Segment - EDI-270 format
function create_IEA($row, $X12info, $segTer, $compEleSep)
{
$IEA = array();
$IEA[0] = "IEA"; // Interchange Control Trailer Segment ID
$IEA[1] = "1"; // Number of included Functional Groups
$IEA[2] = "000000001"; // Interchange Control Number
$IEA['Created'] = implode('*', $IEA);
$IEA['Created'] = $IEA['Created'] . $segTer;
return trim($IEA['Created']);
}
function translate_relationship($relationship)
{
switch ($relationship) {
case "spouse":
return "01";
break;
case "child":
return "19";
break;
case "self":
default:
return "S";
}
}
// EDI-270 Batch file Generation
function print_elig($res, $X12info, $segTer, $compEleSep)
{
$i=1;
$PATEDI = "";
// For Header Segment
$nHlCounter = 1;
$rowCount = 0;
$trcNo = 1234501;
$refiden = 5432101;
foreach ($res as $row) {
if ($nHlCounter == 1) {
// create ISA
$PATEDI = create_ISA($row, $X12info, $segTer, $compEleSep);
// create GS
$PATEDI .= create_GS($row, $X12info, $segTer, $compEleSep);
// create ST
$PATEDI .= create_ST($row, $X12info, $segTer, $compEleSep);
// create BHT
$PATEDI .= create_BHT($row, $X12info, $segTer, $compEleSep);
// For Payer Segment
$PATEDI .= create_HL($row, 1, $X12info, $segTer, $compEleSep);
$PATEDI .= create_NM1($row, 'PR', $X12info, $segTer, $compEleSep);
// For Provider Segment
$PATEDI .= create_HL($row, 2, $X12info, $segTer, $compEleSep);
$PATEDI .= create_NM1($row, '1P', $X12info, $segTer, $compEleSep); // 5010 no longer uses FA
$nHlCounter = $nHlCounter + 2;
$segmentcount = 6; // segment counts - start from ST
}
// For Subscriber Segment
$PATEDI .= create_HL($row, $nHlCounter, $X12info, $segTer, $compEleSep);
$PATEDI .= create_NM1($row, 'IL', $X12info, $segTer, $compEleSep);
// send pid so we get it back in 271
$PATEDI .= create_REF($row, 'EJ', '', $segTer, '');
$PATEDI .= create_DMG($row, $X12info, $segTer, $compEleSep);
$PATEDI .= create_DTP($row, '291', $X12info, $segTer, $compEleSep);
$PATEDI .= create_EQ($row, $X12info, $segTer, $compEleSep);
$segmentcount = $segmentcount + 6;
$nHlCounter = $nHlCounter + 1;
$rowCount = $rowCount + 1;
$trcNo = $trcNo + 1;
$refiden = $refiden + 1;
if ($rowCount == count($res)) {
$segmentcount = $segmentcount + 1;
$PATEDI .= create_SE($row, $segmentcount, $X12info, $segTer, $compEleSep);
$PATEDI .= create_GE($row, $X12info, $segTer, $compEleSep);
$PATEDI .= create_IEA($row, $X12info, $segTer, $compEleSep);
}
}
echo $PATEDI;
}
function requestEligibleTransaction($pid = 0, $eFlag = false)
{
$query = "SELECT
d.facility_id,
p.lname,
p.fname,
p.mname,
DATE_FORMAT(p.dob, '%Y%m%d') as dob,
p.ss,
p.sex,
p.pid,
p.pubpid,
p.providerID,
i.subscriber_ss,
i.policy_number,
i.provider as payer_id,
i.subscriber_relationship,
i.subscriber_lname,
i.subscriber_fname,
i.subscriber_mname,
DATE_FORMAT(i.subscriber_DOB, '%Y%m%d') as subscriber_dob,
i.policy_number,
i.subscriber_sex,
DATE_FORMAT(i.date, '%Y%m%d') as date,
d.lname as provider_lname,
d.fname as provider_fname,
d.npi as provider_npi,
d.upin as provider_pin,
f.federal_ein as federal_ein,
f.facility_npi as facility_npi,
f.name as facility_name,
c.cms_id as cms_id,
c.eligibility_id as eligibility_id,
c.x12_default_eligibility_id as partner,
c.name as payer_name
FROM patient_data AS p
LEFT JOIN users AS d on (p.providerID = d.id)
LEFT JOIN facility AS f on (f.id = d.facility_id)
LEFT JOIN insurance_data AS i ON (i.id =(SELECT id FROM insurance_data AS i WHERE pid = p.pid AND type = 'primary' ORDER BY date DESC LIMIT 1))
LEFT JOIN insurance_companies as c ON (c.id = i.provider)
WHERE p.pid = ?";
$res = sqlStatement($query, array($pid));
$details = requestRealTimeEligible($res, '', "~", ':', true);
$isError = strpos($details, "Error:");
$isError = $isError !== false ? $isError : strpos($details, "AAA");
if ($isError !== false) {
$details = substr($details, $isError);
return "<div>" . nl2br(text($details)) . "</div>";
}
return true;
}
// EDI-270 RealTime Request & Response
// RealTime requires one transaction per request.
//
function requestRealTimeEligible($res, $X12info, $segTer, $compEleSep, $eFlag = false)
{
$rowCount = 0;
$totalCount = count($res);
$down_accum = $log = $error_accum = '';
foreach ($res as $row) {
if (!$X12info) {
$X12info = getX12Partner($row['partner']);
}
if ($row['providerID'] === 0 || !$row['provider_npi']) {
$error_accum .= xlt("Error") . ": " . xlt("Provider Missing Add one in Choices") . "\n";
}
if (!$row['eligibility_id']) {
$error_accum .= xlt("Error") . ": " . xlt("Missing Insurance Payer Id") . "\n";
}
if (!$row['policy_number'] || !$row['subscriber_dob']) {
$error_accum .= xlt("Error") . ": " . xlt("Missing Subscriber Policy Number or DOB") . "\n";
}
if (!empty($error_accum)) {
return $error_accum;
}
// create ISA
$PATEDI = create_ISA($row, $X12info, $segTer, $compEleSep);
// create GS
$PATEDI .= create_GS($row, $X12info, $segTer, $compEleSep);
// create ST
$PATEDI .= create_ST($row, $X12info, $segTer, $compEleSep);
// create BHT
$PATEDI .= create_BHT($row, $X12info, $segTer, $compEleSep);
// For Payer Segment
$PATEDI .= create_HL($row, 1, $X12info, $segTer, $compEleSep);
$PATEDI .= create_NM1($row, 'PR', $X12info, $segTer, $compEleSep);
// For Provider Segment
$PATEDI .= create_HL($row, 2, $X12info, $segTer, $compEleSep);
//$PATEDI .= create_NM1($row, 'FA', $X12info, $segTer, $compEleSep); // unsure but this may have to be an option
$PATEDI .= create_NM1($row, '1P', $X12info, $segTer, $compEleSep);
// For Subscriber Segment
$PATEDI .= create_HL($row, 3, $X12info, $segTer, $compEleSep);
$PATEDI .= create_NM1($row, 'IL', $X12info, $segTer, $compEleSep);
// send pid so we get it back in 271
$PATEDI .= create_REF($row, 'EJ', '', $segTer, '');
$PATEDI .= create_DMG($row, $X12info, $segTer, $compEleSep);
// 2110
$PATEDI .= create_DTP($row, '291', $X12info, $segTer, $compEleSep);
$PATEDI .= create_EQ($row, $X12info, $segTer, $compEleSep);
// the end
$PATEDI .= create_SE($row, 13, $X12info, $segTer, $compEleSep);
$PATEDI .= create_GE($row, $X12info, $segTer, $compEleSep);
$PATEDI .= create_IEA($row, $X12info, $segTer, $compEleSep);
// make request
$result = requestEligibility($X12info['id'], $PATEDI);
$rowCount++;
$e = strpos($result, "Error:");
if ($e !== false) {
$error_accum = $result;
} else {
$down_accum .= $result . "\n"; // delimit for next new request
}
$log .= "*** 270 " . xlt("Request Message") . " $rowCount of $totalCount\n" . $PATEDI . "\n" . $error_accum . "\n"; // keep a log.
$error_accum = '';
}
// parse the 271 responses from 270 requests sent.
$process = parseEdi271($down_accum);
$log = xlt("List of ") . $rowCount . " " . xlt("Requests Sent") . ":\n" . $log . "\n" . $process;
if ($eFlag) {
return $log;
}
return $rowCount;
}
// Report Generation
function show_elig($res, $X12info, $segTer, $compEleSep)
{
$i=0;
echo " <div id='report_results'>
<table class='table table-striped table-hover'>
<thead>
<th>". text(xl('Facility Name')) ."</th>
<th>". text(xl('Facility NPI')) ."</th>
<th>". text(xl('Insurance Comp')) ."</th>
<th>". text(xl('Appt Date')) ."</th>
<th>". text(xl('Policy No')) ."</th>
<th>". text(xl('Patient Name')) ."</th>
<th>". text(xl('DOB')) ."</th>
<th>". text(xl('Gender')) ."</th>
<th>". text(xl('SSN')) ."</th>
<th> </th>
</thead>
<tbody>";
foreach ($res as $row) {
$i= $i+1;
// what the heck is below for... looks abandoned.
$elig = array();
$elig[0] = $row['facility_name']; // Inquiring Provider Name calendadr
$elig[1] = $row['facility_npi']; // Inquiring Provider NPI
$elig[2] = $row['payer_name']; // Payer Name our insurance co name
$elig[3] = $row['policy_number']; // Subscriber ID
$elig[4] = $row['subscriber_lname']; // Subscriber Last Name
$elig[5] = $row['subscriber_fname']; // Subscriber First Name
$elig[6] = $row['subscriber_mname']; // Subscriber Middle Initial
$elig[7] = $row['subscriber_dob']; // Subscriber Date of Birth
$elig[8] = substr($row['subscriber_sex'], 0, 1); // Subscriber Sex
$elig[9] = $row['subscriber_ss']; // Subscriber SSN
$elig[10] = translate_relationship($row['subscriber_relationship']); // Pt Relationship to insured
$elig[11] = $row['lname']; // Dependent Last Name
$elig[12] = $row['fname']; // Dependent First Name
$elig[13] = $row['mname']; // Dependent Middle Initial
$elig[14] = $row['dob']; // Dependent Date of Birth
$elig[15] = substr($row['sex'], 0, 1); // Dependent Sex
$elig[16] = $row['pc_eventDate']; // Date of service
$elig[17] = "30"; // Service Type
$elig[18] = $row['pubpid']; // Patient Account Number pubpid
echo " <tr id='PR".$i."_". text($row['policy_number'])."'>
<td class ='detail'>". text($row['facility_name']) ."</td>
<td class ='detail'>". text($row['facility_npi']) ."</td>
<td class ='detail'>". text($row['payer_name']) ."</td>
<td class ='detail'>". text(date("m/d/Y", strtotime($row['pc_eventDate']))) ."</td>
<td class ='detail'>". text($row['policy_number']) ."</td>
<td class ='detail'>". text($row['subscriber_lname']." ". $row['subscriber_fname']) ."</td>
<td class ='detail'>". text($row['subscriber_dob']) ."</td>
<td class ='detail'>". text($row['subscriber_sex']) ."</td>
<td class ='detail'>". text($row['subscriber_ss']) ."</td>
<td class ='detail'>
<img src=\"" . $GLOBALS['images_static_relative'] . "/deleteBtn.png\" title=" .text(xl('Delete Row')) . " style='cursor:pointer;cursor:hand;' onclick='deletetherow(\"" . $i."_". text($row['policy_number']) . "\")'>
</td>
</tr>
";
unset($elig); // see ..
}
if ($i==0) {
echo " <tr>
<td class='norecord' colspan=9>
<div style='padding:5px;font-family:arial;font-size:13px;text-align:center;'>". text(xl('No records found')) . "</div>
</td>
</tr> ";
}
echo " </tbody>
</table>";
}
// To Show Eligibility Verification data
function show_eligibility_information($pid, $flag = false)
{
$query =
"SELECT eligr.*, eligv.insurance_id, eligv.copay, insd.pid, insc.name, " .
"Date_Format(eligv.eligibility_check_date, '%W %M %e, %Y %h:%i %p') AS verificationDate " .
"FROM eligibility_verification eligv " .
"INNER JOIN benefit_eligibility eligr ON eligr.verification_id = eligv.verification_id " .
"INNER JOIN insurance_data insd ON insd.id = eligv.insurance_id " .
"INNER JOIN insurance_companies insc ON insc.id = insd.provider " .
"WHERE insd.pid = ? AND eligv.eligibility_check_date = " .
"(SELECT Max(eligibility_verification.eligibility_check_date) FROM eligibility_verification ".
"WHERE eligibility_verification.insurance_id = eligv.insurance_id)";
$result = sqlStatement($query, array($pid));
$showString = "<div class='row'>";
$col = 1;
$title = 1;
while ($benefit = sqlFetchArray($result)) {
if ($title) {
$title = 0;
$showString .= "<div class='col col-sm-12'>\n";
$showString .= "<b>" . xlt('Insurance Provider') . ":</b> " . (!empty($benefit['name']) ? text($benefit['name']) : xlt('n/a')) . "<br/>\n";
$showString .= "<b>" . xlt('Verified On') . ":</b> " . text($benefit['verificationDate']) . "<br/><br/>\n";
$showString .= "</div><br/>\n";
}
$benefit['start_date'] = strpos($benefit['start_date'], "0000") === false ? $benefit['start_date'] : '';
$benefit['end_date'] = strpos($benefit['end_date'], "0000") === false ? $benefit['end_date'] : '';
$color = "";
switch ($benefit['type']) {
case '1':
$color = "darkred";
break;
case 'A':
$color = "blue";
break;
case 'B':
$color = "red";
break;
case 'C':
$color = "green";
break;
case 'F':
$color = "darkgreen";
break;
}
$showString .= "\n<div class='col col-sm-6' >\n";
$showString .= !empty($benefit['benefit_type']) ? "<b style='color: $color'>" . xlt('Benefit Type') . ": " . text($benefit['benefit_type']) . "</b><br />\n" : '';
$showString .= !empty($benefit['start_date']) ? "<b>" . xlt('Start Date') . ":</b> " . text(date("m/d/Y", strtotime($benefit['start_date']))) . "<br />\n" : '';
$showString .= !empty($benefit['end_date']) ? "<b>" . xlt('End Date') . ":</b> " . text(date("m/d/Y", strtotime($benefit['end_date']))) . "<br />\n" : '';
$showString .= !empty($benefit['coverage_level']) ? "<b>" . xlt('Coverage Level') . ":</b> " .text($benefit['coverage_level']) . "<br />\n" : '';
$showString .= !empty($benefit['coverage_type']) ? "<b>" . xlt('Coverage Type') . ":</b> " . text($benefit['coverage_type']) . "<br />\n" : '';
$showString .= !empty($benefit['plan_type']) ? "<b>" . xlt('Plan Type') . ":</b> " . text($benefit['plan_type']) . "<br />\n" : '';
$showString .= !empty($benefit['plan_desc']) ? "<b>" . xlt('Plan Description') . ":</b> " . text(text($benefit['plan_desc'])) . "<br />\n" : '';
$showString .= !empty($benefit['coverage_period']) ? "<b>" . xlt('Coverage Period') . ":</b> " . text($benefit['coverage_period']) . "<br />\n" : '';
$showString .= !empty($benefit['amount']) ? "<b>" . xlt('Amount') . ":</b> " . text($benefit['amount']) . "<br />\n" : '';
$showString .= !empty($benefit['percent']) ? "<b>" . xlt('Percentage') . ":</b> " . text($benefit['percent']) . "<br />\n" : '';
$showString .= !empty($benefit['network_ind']) ? "<b>" . xlt('Network Indicator') . ":</b> " . text($benefit['network_ind']) . "<br />\n" : '';
$showString .= !empty($benefit['message']) ? "<b>" . xlt('Message') . ":</b> " . text($benefit['message']) . "<br />\n" : '';
$showString .= "</div>";
if ($col === 2) {
$showString .= "</div>\n<br/><div class='row'>\n";
$col = 0;
}
$col++;
}
if ($col === 2) {
$showString .= "</div>";
}
if ($title === 1) {
$showString = "<br><span><b>" . xlt("Nothing To Report") . "</b></span><br>";
}
$showString .= "</div>\n";
echo $showString;
}
// For EDI 271
// Function to save the values in eligibility_verification table
function eligibility_verification_save($subscriber = [])
{
$verification_id = 0;
$insurance_id = 0;
$partner_id = $subscriber['isa_sender_id'];
$patient_id = $subscriber['pid'];
$query = "SELECT id, copay FROM insurance_data WHERE type = 'primary' and pid = ?";
$insId = sqlQuery($query, array($patient_id));
if ($insId !== false) {
$insurance_id = $insId['id'];
$copay = $insId['copay'];
}
$query = "SELECT verification_id FROM eligibility_verification WHERE insurance_id = ?";
$resId = sqlQuery($query, array($insurance_id));
if ($resId !== false) {
$verification_id = $resId['verification_id'];
}
if (!empty($insurance_id)) {
$sqlBindArray = array();
$query = "REPLACE INTO eligibility_verification SET verification_id = ?, insurance_id = ?, response_id = ?, eligibility_check_date = now(), create_date = now()";
array_push($sqlBindArray, $verification_id, $insurance_id, $partner_id);
$res = sqlInsert($query, $sqlBindArray);
if (!$verification_id) {
$verification_id = $res;
}
}
$query = "DELETE FROM `benefit_eligibility` WHERE `benefit_eligibility`.`verification_id` = ?";
$res = sqlStatement($query, array($verification_id));
foreach ($subscriber['benefits'] as $benefit) {
$bind = array(
$verification_id,
"A",
date('Y/m/d H:i'),
date('Y/m/d H:i'),
$benefit['type'],
$benefit['benefit_type'],
$benefit['start_date'],
$benefit['end_date'],
$benefit['coverage_level'],
$benefit['coverage_type'],
$benefit['plan_type'],
$benefit['plan_desc'],
$benefit['coverage_period'],
$benefit['amount'],
$benefit['percent'],
$benefit['network_ind'],
$benefit['message']
);
$query = "INSERT INTO `benefit_eligibility` " .
"(`verification_id`, `response_status`, `response_create_date`, `response_modify_date`, `type`, `benefit_type`, `start_date`, " .
"`end_date`, `coverage_level`, `coverage_type`, `plan_type`, `plan_description`, `coverage_period`, `amount`, `percent`, `network_ind`, `message`) " .
"VALUES (?, ?, ?, ?, ?, ?, ?, ?, ?, ?, ?, ?, ?, ?, ?, ?, ?)";
$res = sqlStatement($query, $bind);
}
}
// return array of X12 partners
// if id return just that id
function getX12Partner($id = 0)
{
// @TODO move to class
global $X12info;
$id = (int)$id;
$returnval = [];
if ((int)$id > 0) {
$returnval = sqlQuery("select * from x12_partners WHERE id = ?", array($id));
$X12info = $returnval;
} else {
$rez = sqlStatement("select * from x12_partners");
for ($iter = 0; $row = sqlFetchArray($rez); $iter++) {
$returnval[$iter] = $row;
}
}
return $returnval;
}
// return array of provider usernames
function getUsernames()
{
$rez = sqlStatement("select distinct username, lname, fname,id from users " .
"where authorized = 1 and username != ''");
for ($iter = 0; $row = sqlFetchArray($rez); $iter++) {
$returnval[$iter] = $row;
}
return $returnval;
}
// return formated array
function arrFormated(&$item, $key)
{
$item = strstr($item, '_');
$item = substr($item, 1, strlen($item) - 1);
$item = "'" . $item;
}
function requestEligibility($partner = '', $x12_270 = '')
{
global $X12info;
if (((int)$X12info['id'] !== (int)$partner) && (int)$partner > 0) {
$X12info = getX12Partner($partner);
}
$payloadId = "3b8c13f5-11e2-43bf-bc47-737cca04f3fe"; // a default fallback
if (function_exists('openssl_random_pseudo_bytes') === true) {
$data = openssl_random_pseudo_bytes(16);
$data[6] = chr(ord($data[6]) & 0x0f | 0x40);
$data[8] = chr(ord($data[8]) & 0x3f | 0x80);
$payloadId = vsprintf('%s%s-%s-%s-%s-%s%s%s', str_split(bin2hex($data), 4));
}
$boundary = RandomGenUtils::createUniqueToken(12);
$rt_passwrd = $X12info['x12_isa04'];
$rt_user = $X12info['x12_isa02'];
$sender_id = $X12info['x12_sender_id'];
$receiver_id = $X12info['x12_receiver_id'];
$now_date = date("Y-m-d\TH:i:s\Z");
$headers = array(
'Content-Type' => "multipart/form-data; boundary=$boundary",
'Host' => ' wsd.officeally.com'
);
// IMPORTANT: Do not change the format of $mime_body below.
// HTTP MIME Multipart is non-normative. LFs matter...
//
$mime_body = <<<MIMEBODY
--$boundary
Content-Disposition: form-data; name="ProcessingMode"
RealTime
--$boundary
Content-Disposition: form-data; name="TimeStamp"
$now_date
--$boundary
Content-Disposition: form-data; name="PayloadID"
$payloadId
--$boundary
Content-Disposition: form-data; name="CORERuleVersion"
2.2.0
--$boundary
Content-Disposition: form-data; name="ReceiverID"
$receiver_id
--$boundary
Content-Disposition: form-data; name="SenderID"
$sender_id
--$boundary
Content-Disposition: form-data; name="PayloadType"
X12_270_Request_005010X279A1
--$boundary
Content-Disposition: form-data; name="UserName"
$rt_user
--$boundary
Content-Disposition: form-data; name="Password"
$rt_passwrd
--$boundary
Content-Disposition: form-data; name="Payload"
$x12_270
--$boundary--
MIMEBODY;
// send the request
$response = oeHttp::bodyFormat('body')
//->setDebug('5000')/* @todo uncomment and set proxy port to debug eg Fiddler */
->usingHeaders($headers)
->post('https://wsd.officeally.com/TransactionSite/rtx.aspx', $mime_body); // @TODO put request urls in x12 partner's for versatility.
$formBody = $response->body();
$contentType = $response->header('Content-Type')[0];
$hContentLength = (int)$response->header('Content-Length')[0];
$cksum = ($hContentLength - strlen($formBody)) === 0 ? true : false; // validate content size
$formData = mimeParse($formBody, $contentType);
$errors = '';
if (!$cksum) {
$errors .= "Error:" . xlt("Request Content Fails Integrity Test");
}
if ($response->status() !== 200) {
$errors .= "\nError:" . xlt("Http Error") . ": " . $response->getReasonPhrase() . " : " . $response->status();
}
if ($formData['ErrorCode'] != "Success") {
$errors .= "\nError:" . $formData['ErrorCode'] . "\n" . $formData['ErrorMessage'];
}
if ($errors) {
$errors .= $formData['Payload'] ? "\nError:" . $formData['Payload'] : '';
return $errors;
}
$x12_271 = $formData['Payload'];
return $x12_271;
}
function mimeParse($formBody = '', $contentType)
{
$mimeBody = preg_replace('~\r\n?~', "\r", $formBody);
list($contentType, $bound, $cs) = explode(";", trim($contentType)); // $contentType & $cs are throwaways
$bound = explode("=", trim($bound, ' '))[1];
$mimeFields = preg_split("/-+$bound/", $mimeBody);
array_pop($mimeFields);
$hold = $isMatches = [];
foreach ($mimeFields as $id => $field) {
if (empty($field)) {
continue;
}
preg_match('/name=\"([^\"]*)\"[\n|\r]+([^\n\r].*)?\r$/s', $field, $isMatches);
if (preg_match('/^(.*)\[\]$/i', $isMatches[1], $hold)) {
$mimeData[$hold[1]][] = $isMatches[2];
} else {
$mimeData[$isMatches[1]] = $isMatches[2];
}
}
return $mimeData;
}
function getPatientMatch($fn, $ln, $sex, $dob)
{
$fn = "%" . $fn . "%";
$ln = "%" . $ln . "%";
$sex = "%" . $sex . "%";
$dob = date("Y-m-d", strtotime($dob));
$sql = "SELECT pid FROM patient_data WHERE fname LIKE ? && lname LIKE ? && sex LIKE ? && DOB LIKE ?";
$rtn = sqlQuery($sql, array($fn, $ln, $sex, $dob));
return $rtn['pid'] ? $rtn['pid'] : 0;
}
function parseEdi271($content)
{
$codes = new edih_271_codes('*', '^');
$target = $GLOBALS['edi_271_file_path'];
$log = "";
// not sure if want to save yet
$target = $target . time();
$responses = explode("\n", $content);
if (empty($responses)) {
$responses = $content;
}
// Loop through each 271. '\n' delims records in batch.
foreach ($responses as $new) {
if (empty($new)) {
continue;
}
$AAA = array();
$subscribers = array();
$benefits = array();
$in = array();
$in['pid'] = 0;
$loop = array();
$loop['id'] = 0;
$loop['parent'] = 0;
$loop['error'] = 1;
$trace = -1;
$segments = explode("~", $new);
if (count($segments) < 6) {
if (file_exists($target)) {
unlink($target);
}
continue;
}
foreach ($segments as $segment) {
$elements = explode("*", $segment);
$ecnt = count($elements);
// sanitize
for ($i = 0; $i < $ecnt; $i++) {
$elements[$i] = text(trim($elements[$i]));
}
// Switch Case for Segment
switch ($elements[0]) {
case 'ISA':
$loop[1] = $elements[2];
$in['isa_sender_id'] = $elements[6];
$in['isa_receiver_id'] = $elements[8];
$in['isa_control_number'] = $elements[13];
break;
case 'HL':
$loop['id'] = (int)$elements[1];
$loop['parent'] = (int)$elements[2];
$loop['error'] = (int)$elements[4];
break;
case 'NM1':
if ($loop['id'] === 1) {//"PR" payer
$in['payer_org'] = $elements[3];
$in['payer_member_id'] = $elements[9];
} elseif ($loop['id'] === 2) { //"1P" or "FA"
$in['provider_org'] = $elements[3];
$in['provider_member_id'] = $elements[9];
} elseif ($elements[1] == "IL" || $loop['context'] == "TRN") { //"IL"
$in['trace'] = $trace;
$in['subscriber_lname'] = $elements[3];
$in['subscriber_fname'] = $elements[4];
$in['subscriber_mname'] = $elements[5];
$in['subscriber_member_id'] = $elements[9];
$in['verify_date'] = date('Y/m/d H:i:s');
}
$loop['context'] = $elements[0];
break;
case 'DMG':
if ($elements[1] == "D8") {
$in['subscriber_dob'] = $elements[2];
}
$in['subscriber_sex'] = $elements[3];
$loop['context'] = $elements[0];
// 2100A-C should be done so get our patient id.
if (!(int)$in['pid']) {
$in['pid'] = (int)getPatientMatch(
$in['subscriber_fname'],
$in['subscriber_lname'],
$in['subscriber_sex'],
$in['subscriber_dob']
);
}
break;
case 'TRN':
if ($trace === -1) {
$trace++;
break; // subscriber not set yet
}
$trace++;
if ($in['pid']) {
$in['benefits'] = $benefits ? $benefits : [];
array_push($subscribers, $in);
$loop['context'] = $elements[0];
$benefits = [];
}
break;