static void FinishTheEdits(int _lastConflict, string _claimNo, Dictionary <string, ClaimLinesIndex> _claimLinesList, Dictionary <string, Findings> _dic, int errLine)
{
string startId = _claimNo + "|" + (_lastConflict + 1).ToString();
string endId = _claimNo + "|z";
foreach (var pair in _claimLinesList)
{
if (pair.Key.CompareTo(startId) >= 0 && pair.Key.CompareTo(endId) < 0)
{
ClaimLinesIndex _cli = pair.Value;
if (_cli.hasDU)
{
Findings findings = new Findings();
findings.id = _claimNo;
findings.claimIndex = _cli.claimIndex;
findings.editType = "Review";
findings.mnemonic = "mMP";
findings.editConflit = "mMP";
findings.description = "PNS3 Multiple Procedure Reduction " + _cli.percentage;
try
{
_dic.Add(String.Format("{0}{1}{2}", _claimNo, _cli.claimIndex, (++errLine).ToString()), findings);
}catch (Exception mex)
{
log.LogError("In FinishTheEdits " + mex.Message);
}
}
}
}
}
static bool IsCleanClaim(string _claimNo, Dictionary <string, ClaimLinesIndex> _claimLinesList)
{
bool findings = true;
//string _claimNo = _findings.id;
string startId = (_claimNo + "|0").ToString();
string endId = _claimNo + "|z";
int results = 0;
if (_claimNo.Equals("20170309T33K00018"))
{
results = 0;
}
foreach (var pair in _claimLinesList)
{
if (pair.Key.CompareTo(_claimNo) >= 0 && pair.Key.CompareTo(endId) < 0)
{
ClaimLinesIndex _cli = pair.Value;
// if (!_cli.claimIndex.Equals("0") )
// results++;
if (_cli.hasDU)
{
findings = false;
}
}
}
if (results > 1)
{
findings = false;
}
return(findings);
}
static void MergeFindings(Dictionary <string, Findings> _dic, Dictionary <string, ClaimLinesIndex> _claimLinesList, List <string> _thisRun)
{
string lastClaim = String.Empty;
int errLine = 0;
foreach (var pair in _claimLinesList)
{
ClaimLinesIndex _cli = pair.Value;
if (!_thisRun.Contains(_cli.claim))
{
continue;
}
if (_cli.claim.CompareTo(lastClaim) != 0)
{
errLine = 0;
}
if (_cli.percentage != null)
{
Findings findings = new Findings();
findings.id = _cli.claim;
findings.claimIndex = _cli.claimIndex;
findings.editType = "Review";
findings.mnemonic = "mMP";
findings.editConflit = "mMP";
findings.description = "PNS4 Multiple Procedure Reduction " + _cli.percentage;
try
{
_dic.Add(String.Format("{0}{1}{2}", _cli.claim, _cli.claimIndex, (++errLine).ToString()), findings);
}catch (Exception mex)
{
log.LogError("MergeFindings " + mex.Message);
}
}
}
}
static void SplitFiles(string _file, string _network, SqlConnection _con)
{
TextReader tr = File.OpenText(_file);
string fileName = Path.GetFileName(_file);
int fileCount = 1;
log.LogInformation(String.Format("Spliting File {0}", _file));
string workingFile = String.Format(@"{0}\WORKING\{1}.{2}", _network, fileName, fileCount.ToString("000"));
TextWriter tw = null;
try
{
tw = File.CreateText(workingFile);
}
catch (Exception ex)
{
log.LogError(String.Format("SplitFiles Create File {0}", ex.Message));
}
string line = "";
int lineNo = 0;
int claimCount = 0;
ClaimLinesIndex _cl;
_cl = new ClaimLinesIndex();
_cl.claim = null;
_cl.hasDU = false;
string diagnosis = "";
string procedure = "";
string description = "";
int icdVersion = 9;
log.LogInformation(String.Format("Working file {0}", workingFile));
int surgicalCount = 0;
string surguryStarts = "123456";
string lastServiceDate = "";
try
{
while ((line = tr.ReadLine()) != null)
{
line = line.TrimStart();
if (line.StartsWith(@"<?xml") || line.StartsWith(@"<claims"))
{
tw.WriteLine(line);
}
else
{
if (line.StartsWith(@"<icd9v1></icd9v1>") || line.StartsWith(@"<modifier></modifier>") || line.StartsWith(@"<icd10cm></icd10cm"))
{
continue;
}
if (!line.StartsWith("<lineno"))
{
tw.WriteLine(line);
}
if (line.Contains(@"icd9v1") || line.Contains(@"icd10cm"))
{
if (line.Contains(@"icd10cm"))
{
icdVersion = 10;
}
else
{
icdVersion = 9;
}
//diagnosis = GetValue(line);
}
if (line.StartsWith("<service-begin-date>"))
{
if (lastServiceDate.CompareTo(GetValue(line)) != 0)
{
lastServiceDate = GetValue(line);
if (surgicalCount > 0)
{
surgicalCount = 0;
}
}
}
if (line.StartsWith("<diagnostic-code>"))
{
diagnosis = GetValue(line);
_cl.diag = diagnosis;
}
if (line.StartsWith(@"<procedure-code"))
{
procedure = GetValue(line);
_cl.cpt = procedure;
_cl.hasDU = false;
// this is a surgery
if (surguryStarts.IndexOf(procedure.Substring(0, 1)) >= 0)
{
if (!gCPTExclusions.Contains(procedure))
{
surgicalCount++;
if (surgicalCount > 1)
{
_cl.hasDU = true;
_cl.percentage = "";
switch (surgicalCount)
{
case 1: /* doing nothing here to avoid default */
break;
case 2: _cl.percentage = p2;
break;
case 3: _cl.percentage = p3;
break;
case 4: _cl.percentage = p4;
break;
case 5: _cl.percentage = p5;
break;
default: _cl.percentage = p6;
break;
}
}
}
}
}
if (line.StartsWith(@"<claim id="))
{
_cl = new ClaimLinesIndex();
_cl.claim = GetClaimID(line);
if (_cl.claim.CompareTo("20170309T33K00018") == 0)
{
_cl.hasDU = false;
}
_cl.hasDU = false;
_cl.percentage = null;
lineNo = 0;
claimCount++;
surgicalCount = 0;
lastServiceDate = "";
}
if (line.StartsWith("<claim-line"))
{
diagnosis = "";
procedure = "";
description = "";
lineNo++;
}
if (line.StartsWith("<lineno"))
{
_cl.claimIndex = GetClaimIndex(line);
_cl.lineNo = lineNo.ToString();
_cl.key = String.Format("{0}|{1}", _cl.claim, _cl.lineNo);
_cl.hasDU = false;
_cl.percentage = null;
continue;
}
if (line.StartsWith(@"</claim-line"))
{
claimLinesList.Add(_cl.key, _cl);
}
if (claimCount == 100 && line.StartsWith(@"</claim>"))
{
tw.WriteLine(@"</claims>");
tw.Flush();
tw.Close();
workingFile = String.Format(@"{0}\WORKING\{1}.{2}", _network, fileName, (++fileCount).ToString("000"));
tw = File.CreateText(workingFile);
tw.WriteLine(@"<?xml version='1.0' encoding='UTF-8'?>");
tw.WriteLine(@"<claims>");
claimCount = 0;
}
}
}
}
catch (Exception ex)
{
log.LogError(String.Format("Exception in SplitFiles {0}", ex.Message));
}
tw.Close();
tr.Close();
}
static void SendFiles(string _fileName, string _dir)
{
TextWriter tw = null;
var dic = new Dictionary <string, Findings>();
if (optumFindings == null)
{
optumFindings = new List <Findings>();
}
else
{
optumFindings.Clear();
}
List <string> thisRun = new List <string>();
int loop = 0;
int lineCounter = 0;
try
{
log.LogInformation(String.Format("In SendFiles {0} {1}", _fileName, _dir));
string user = "******";
string password = "******";
string claimsDotXml = _fileName;
WebRequest req = WebRequest.Create("https://realtimeecontent.com/ws/claims5x");
req.Method = "POST";
req.ContentType = "application/xml";
req.Credentials = new NetworkCredential(user, password);
FileStream fs = new FileStream(claimsDotXml, FileMode.Open);
string outFile = String.Format(@"{0}\OUT\{1}.out", _dir, Path.GetFileName(_fileName));
string outFile2 = String.Format(@"{0}\OUT\{1}2.out", _dir, Path.GetFileName(_fileName));
if (File.Exists(outFile))
{
File.Delete(outFile);
}
log.LogInformation(String.Format("Creating File {0} ", outFile));
tw = File.CreateText(outFile);
ServicePointManager.SecurityProtocol = SecurityProtocolType.Tls12;
using (Stream reqStream = req.GetRequestStream())
{
byte[] buffer = new byte[1024];
int bytesRead = 0;
while ((bytesRead = fs.Read(buffer, 0, buffer.Length)) != 0)
{
reqStream.Write(buffer, 0, bytesRead);
}
fs.Close();
}
System.Net.HttpWebResponse resp = req.GetResponse() as System.Net.HttpWebResponse;
if (resp.StatusCode == System.Net.HttpStatusCode.OK)
{
System.Xml.XPath.XPathDocument xmlDoc = new System.Xml.XPath.XPathDocument(resp.GetResponseStream());
System.Xml.XPath.XPathNavigator nav = xmlDoc.CreateNavigator();
//Console.WriteLine("Claim A5 had {0} Edits.", nav.Evaluate("count(/claim-responses/claim-response[@claim-id='43']/edit)"));
//Console.WriteLine(nav.Evaluate("/claim-responses/claim-response/edit"));
lineCounter++;
loop = 1;
XPathNodeIterator xPathIterator = nav.Select("/claim-responses//claim-response");
int errLine = 0;
int lastConflictFound = 0, iClaimLine = 0;
string lastClaim = "";
foreach (XPathNavigator claimResponse in xPathIterator)
{
XPathNavigator onav = claimResponse.SelectSingleNode("@claim-id");
string id = onav == null ? string.Empty : onav.Value;
try {
thisRun.Add(id);
}catch (Exception mex)
{
log.LogError(mex.Message);
}
if (id.CompareTo("20170309T33K00018") == 0)
{
errLine = 0;
}
XPathNodeIterator ixPathIterator = claimResponse.Select("edit");
bool hasEdits = false;
int noOfEdits = 0;
foreach (XPathNavigator editLines in ixPathIterator)
{
hasEdits = true;
noOfEdits++;
onav = editLines.SelectSingleNode("@line");
string claimLine = onav == null ? string.Empty : onav.Value;
string key = id.Trim() + "|" + claimLine.Trim();
ClaimLinesIndex _cli;
try
{
iClaimLine = int.Parse(claimLine);
}
catch (Exception ex)
{
iClaimLine = 0;
}
if (iClaimLine > lastConflictFound)
{
string myId = "";
lastConflictFound = iClaimLine;
}
XPathNavigator inav = editLines.SelectSingleNode("description");
string description = editLines == null ? string.Empty : inav.Value;
//if (description.Contains("[Pattern 10372]"))
// hasEdits = false;
//inav = editLines.SelectSingleNode("edit-conflict");
string editConflict = ""; // editLines == null ? string.Empty : inav.Value;
inav = editLines.SelectSingleNode("edit-type");
string editType = editLines == null ? string.Empty : inav.Value;
inav = editLines.SelectSingleNode("mnemonic");
string mnemonic = editLines == null ? string.Empty : inav.Value;
Findings opFind = new Findings();
opFind.id = id;
opFind.lineNo = claimLine;
opFind.editType = editType;
opFind.mnemonic = mnemonic;
opFind.editConflit = editConflict;
opFind.description = description;
optumFindings.Add(opFind);
if (!claimLinesList.ContainsKey(key))
{
log.LogError(String.Format("The claim does not contain {0}", key));
_cli = new ClaimLinesIndex();
_cli.claim = id;
_cli.hasDU = true;
_cli.lineNo = "-99";
_cli.claimIndex = "-99";
}
else
{
_cli = claimLinesList[key];
}
if (!_cli.hasDU)
{
if (!description.Contains("50.0%")) // Ignore Optum
{
Findings findings = new Findings();
findings.id = id;
findings.claimIndex = _cli.claimIndex;
findings.editType = editType;
findings.mnemonic = mnemonic;
findings.editConflit = editConflict;
findings.description = description;
try {
dic.Add(String.Format("{0}{1}{2}", id, _cli.claimIndex, (++errLine).ToString()), findings);
}catch (Exception mex)
{
log.LogError(mex.Message);
}
}
else
{
if (noOfEdits == 1) // this is the only edit for the claim and it's a wrong one mMP
{
hasEdits = false;
}
noOfEdits--;
}
}
}
if (hasEdits == false)
{ // claim does not have any edits
//string percentage = "";
//ClaimLinesIndex _cli;
//int found = 0;
//if (found == 0)
//{
if (IsCleanClaim(id, claimLinesList))
{
Findings findings = new Findings();
findings.id = id;
findings.claimIndex = "0";
findings.editType = "";
findings.mnemonic = "";
findings.editConflit = "";
findings.description = "";
try {
dic.Add(String.Format("{0}{1}{2}", id, findings.claimIndex, (++errLine).ToString()), findings);
}catch (Exception mex)
{
log.LogError(mex.Message);
}
}
//tw.WriteLine("************ Claim {0} is clean ********", id);
//}
}
}
//FinishTheEdits(lastConflictFound - 1, lastClaim, claimLinesList, dic, errLine);
}
ReviewClaimLineList(tw);
optumFindings.Clear();
dic.Clear();
dic = null;
tw.Close();
}
catch (Exception ex)
{
log.LogError(String.Format("Sending Files {0}", ex.Message));
}
finally
{
//claimLinesList.Clear();
thisRun.Clear();
}
}
