private static Claim CreatePredetermination(Patient pat, List <Procedure> procList, long provTreat)
{
Family fam = Patients.GetFamily(pat.PatNum);
List <InsSub> subList = InsSubs.RefreshForFam(fam);
List <InsPlan> planList = InsPlans.RefreshForSubList(subList);
List <PatPlan> patPlanList = PatPlans.Refresh(pat.PatNum);
List <Benefit> benefitList = Benefits.Refresh(patPlanList, subList);
List <ClaimProc> claimProcList = ClaimProcs.Refresh(pat.PatNum);
List <Procedure> procsForPat = Procedures.Refresh(pat.PatNum);
InsSub sub = InsSubs.GetSub(PatPlans.GetInsSubNum(patPlanList, 1), subList);
InsPlan insPlan = InsPlans.GetPlan(sub.PlanNum, planList);
Claim claim = new Claim();
Claims.Insert(claim); //to retreive a key for new Claim.ClaimNum
claim.PatNum = pat.PatNum;
claim.DateService = procList[0].ProcDate;
claim.DateSent = DateTime.Today;
claim.ClaimStatus = "W";
claim.InsSubNum = PatPlans.GetInsSubNum(patPlanList, 1);
claim.InsSubNum2 = PatPlans.GetInsSubNum(patPlanList, 2);
InsSub sub1 = InsSubs.GetSub(claim.InsSubNum, subList);
InsSub sub2 = InsSubs.GetSub(claim.InsSubNum, subList);
claim.PlanNum = sub1.PlanNum;
claim.PlanNum2 = sub2.PlanNum;
claim.PatRelat = PatPlans.GetRelat(patPlanList, 1);
claim.PatRelat2 = PatPlans.GetRelat(patPlanList, 2);
claim.ClaimType = "PreAuth";
claim.ProvTreat = provTreat;
claim.IsProsthesis = "N";
claim.ProvBill = Providers.GetBillingProvNum(claim.ProvTreat, 0);
claim.EmployRelated = YN.No;
ClaimProc cp;
List <Procedure> procListClaim = new List <Procedure>(); //this list will exclude lab fees
for (int i = 0; i < procList.Count; i++)
{
if (procList[i].ProcNumLab == 0)
{
procListClaim.Add(procList[i]);
}
}
for (int i = 0; i < procListClaim.Count; i++)
{
cp = new ClaimProc();
ClaimProcs.CreateEst(cp, procListClaim[i], insPlan, sub);
cp.ClaimNum = claim.ClaimNum;
cp.Status = ClaimProcStatus.NotReceived;
cp.CodeSent = ProcedureCodes.GetProcCode(procListClaim[i].CodeNum).ProcCode;
cp.LineNumber = (byte)(i + 1);
ClaimProcs.Update(cp);
}
claimProcList = ClaimProcs.Refresh(pat.PatNum);
ClaimL.CalculateAndUpdate(procsForPat, planList, claim, patPlanList, benefitList, pat.Age, subList);
return(claim);
}
/// <summary>claimType="P" or "S".</summary>
public static Claim CreateClaim(string claimType, List <PatPlan> PatPlanList, List <InsPlan> InsPlanList, List <ClaimProc> ClaimProcList, List <Procedure> procsForPat, Patient pat, List <Procedure> procsForClaim, List <Benefit> benefitList, List <InsSub> SubList)
{
//Claim ClaimCur=CreateClaim("P",PatPlanList,InsPlanList,ClaimProcList,procsForPat);
long claimFormNum = 0;
EtransType eFormat = 0;
InsPlan PlanCur1 = new InsPlan();
InsSub SubCur1 = new InsSub();
InsPlan PlanCur2 = new InsPlan();
InsSub SubCur2 = new InsSub();
Relat relatOther = Relat.Self;
switch (claimType)
{
case "P":
SubCur1 = InsSubs.GetSub(PatPlans.GetInsSubNum(PatPlanList, 1), SubList);
PlanCur1 = InsPlans.GetPlan(SubCur1.PlanNum, InsPlanList);
SubCur2 = InsSubs.GetSub(PatPlans.GetInsSubNum(PatPlanList, 2), SubList);
//PlanCur2=InsPlans.GetPlan(SubCur.PlanNum,InsPlanList);//can end up null
break;
case "S":
SubCur1 = InsSubs.GetSub(PatPlans.GetInsSubNum(PatPlanList, 2), SubList);
PlanCur1 = InsPlans.GetPlan(SubCur1.PlanNum, InsPlanList);
SubCur2 = InsSubs.GetSub(PatPlans.GetInsSubNum(PatPlanList, 1), SubList);
//PlanCur2=InsPlans.GetPlan(SubCur.PlanNum,InsPlanList);//can end up null
break;
}
//DataTable table=DataSetMain.Tables["account"];
Procedure proc;
//proc=Procedures.GetProcFromList(procsForPat,PIn.Long(table.Rows[gridAccount.SelectedIndices[0]]["ProcNum"].ToString()));
//long clinicNum=proc.ClinicNum;
ClaimProc[] claimProcs = new ClaimProc[procsForClaim.Count]; //1:1 with procs
long procNum;
for (int i = 0; i < procsForClaim.Count; i++) //loop through selected procs
//and try to find an estimate that can be used
{
procNum = procsForClaim[i].ProcNum;
claimProcs[i] = Procedures.GetClaimProcEstimate(procNum, ClaimProcList, PlanCur1, SubCur1.InsSubNum);
}
for (int i = 0; i < claimProcs.Length; i++) //loop through each claimProc
//and create any missing estimates. This handles claims to 3rd and 4th ins co's.
{
if (claimProcs[i] == null)
{
claimProcs[i] = new ClaimProc();
proc = procsForClaim[i];
ClaimProcs.CreateEst(claimProcs[i], proc, PlanCur1, SubCur1);
}
}
Claim claim = new Claim();
Claims.Insert(claim); //to retreive a key for new Claim.ClaimNum
claim.PatNum = pat.PatNum;
claim.DateService = claimProcs[claimProcs.Length - 1].ProcDate;
claim.ClinicNum = procsForClaim[0].ClinicNum;
claim.DateSent = DateTime.Today;
claim.ClaimStatus = "S";
//datereceived
switch (claimType)
{
case "P":
claim.PlanNum = SubCur1.PlanNum;
claim.InsSubNum = PatPlans.GetInsSubNum(PatPlanList, 1);
claim.PatRelat = PatPlans.GetRelat(PatPlanList, 1);
claim.ClaimType = "P";
claim.PlanNum2 = SubCur2.PlanNum; //might be 0 if no sec ins
claim.InsSubNum2 = PatPlans.GetInsSubNum(PatPlanList, 2);
claim.PatRelat2 = PatPlans.GetRelat(PatPlanList, 2);
break;
case "S":
claim.PlanNum = SubCur1.PlanNum;
claim.InsSubNum = PatPlans.GetInsSubNum(PatPlanList, 2);
claim.PatRelat = PatPlans.GetRelat(PatPlanList, 2);
claim.ClaimType = "S";
claim.PlanNum2 = SubCur2.PlanNum;
claim.InsSubNum2 = PatPlans.GetInsSubNum(PatPlanList, 1);
claim.PatRelat2 = PatPlans.GetRelat(PatPlanList, 1);
break;
}
claim.ProvTreat = procsForClaim[0].ProvNum;
claim.IsProsthesis = "I";
claim.ProvBill = Providers.GetBillingProvNum(claim.ProvTreat, claim.ClinicNum);
claim.EmployRelated = YN.No;
//attach procedures
Procedure ProcCur;
for (int i = 0; i < claimProcs.Length; i++)
{
ProcCur = procsForClaim[i];
claimProcs[i].ClaimNum = claim.ClaimNum;
claimProcs[i].Status = ClaimProcStatus.NotReceived; //status for claims unsent or sent.
//writeoff handled in ClaimL.CalculateAndUpdate()
claimProcs[i].CodeSent = ProcedureCodes.GetProcCode(ProcCur.CodeNum).ProcCode;
if (claimProcs[i].CodeSent.Length > 5 && claimProcs[i].CodeSent.Substring(0, 1) == "D")
{
claimProcs[i].CodeSent = claimProcs[i].CodeSent.Substring(0, 5);
}
claimProcs[i].LineNumber = (byte)(i + 1);
ClaimProcs.Update(claimProcs[i]);
}
ClaimProcList = ClaimProcs.Refresh(pat.PatNum);
ClaimL.CalculateAndUpdate(procsForPat, InsPlanList, claim, PatPlanList, benefitList, pat.Age, SubList);
return(claim);
}
