///<summary>Called once for each claim to be created. For claims with a lot of procedures, this may actually create multiple claims.
///Normally returns empty string unless something went wrong.</summary>
public static bool CreateClaim(Clearinghouse clearinghouseClin, ClaimSendQueueItem queueItem, int batchNum)
{
StringBuilder strb = new StringBuilder();
string t = "\t";
strb.Append("110\t111\t112\t118\t203/403\tF108/204/404\t205/405\t206\t207\t208\t209\t210\t211\t212\t215\t217\t219\t406\t408\t409\t410\t411\t413\t414\t415\t416\t418\t419\t420\t421\t422\t423\t424\t425\t426\t428\t429\t430\t432\t433\r\n");
Claim claim = Claims.GetClaim(queueItem.ClaimNum);
Provider provBill = Providers.GetProv(claim.ProvBill);
Patient pat = Patients.GetPat(claim.PatNum);
InsPlan insplan = InsPlans.GetPlan(claim.PlanNum, new List <InsPlan>());
InsSub insSub = InsSubs.GetSub(claim.InsSubNum, new List <InsSub>());
Carrier carrier = Carriers.GetCarrier(insplan.CarrierNum);
List <ClaimProc> claimProcList = ClaimProcs.Refresh(pat.PatNum);
List <ClaimProc> claimProcsForClaim = ClaimProcs.GetForSendClaim(claimProcList, claim.ClaimNum);
List <Procedure> procList = Procedures.Refresh(claim.PatNum);
Procedure proc;
ProcedureCode procCode;
//ProcedureCode procCode;
for (int i = 0; i < claimProcsForClaim.Count; i++)
{
//claimProcsForClaim already excludes any claimprocs with ProcNum=0, so no payments etc.
proc = Procedures.GetProcFromList(procList, claimProcsForClaim[i].ProcNum);
//procCode=Pro
strb.Append(provBill.SSN + t); //110
strb.Append(provBill.MedicaidID + t); //111
strb.Append(t); //112
strb.Append(t); //118
strb.Append(pat.SSN + t); //203/403
strb.Append(carrier.CarrierName + t); //carrier name?
strb.Append(insSub.SubscriberID + t);
strb.Append(pat.PatNum.ToString() + t);
strb.Append(pat.Birthdate.ToString("dd-MM-yyyy") + t);
if (pat.Gender == PatientGender.Female)
{
strb.Append("2" + t); //"V"+t);
}
else
{
strb.Append("1" + t); //M"+t);
}
strb.Append("1" + t);
strb.Append(DutchLName(pat.LName) + t); //last name without prefix
strb.Append(DutchLNamePrefix(pat.LName) + t); //prefix
strb.Append("2" + t);
strb.Append(DutchInitials(pat) + t); //215. initials
strb.Append(pat.Zip + t);
strb.Append(DutchAddressNumber(pat.Address) + t); //219 house number. Already validated.
strb.Append(t);
strb.Append(proc.ProcDate.ToString("dd-MM-yyyy") + t); //procDate
procCode = ProcedureCodes.GetProcCode(proc.CodeNum);
string strProcCode = procCode.ProcCode;
if (strProcCode.EndsWith("00")) //ending with 00 indicates it's a lab code.
{
strb.Append("02" + t);
}
else
{
strb.Append("01" + t); //409. Procedure code (01) or lab costs (02)
}
strb.Append(t);
strb.Append(t);
strb.Append(strProcCode + t);
strb.Append(GetUL(proc, procCode) + t); //414. U/L.
strb.Append(Tooth.ToInternat(proc.ToothNum) + t);
strb.Append(Tooth.SurfTidyForClaims(proc.Surf, proc.ToothNum) + t); //needs validation
strb.Append(t);
if (claim.AccidentRelated == "") //not accident
{
strb.Append("N" + t);
}
else
{
strb.Append("J" + t);
}
strb.Append(pat.SSN + t);
strb.Append(t);
strb.Append(t);
strb.Append(t);
strb.Append(proc.ProcFee.ToString("F") + t);
strb.Append("1" + t);
strb.Append(proc.ProcFee.ToString("F") + t);
strb.Append(t);
strb.Append(t);
strb.Append(proc.ProcFee.ToString("F") + t);
strb.Append(t);
strb.Append(t);
strb.Append("\r\n");
}
string saveFolder = clearinghouseClin.ExportPath;
if (!Directory.Exists(saveFolder))
{
MessageBox.Show(saveFolder + " " + Lans.g("Dutch", "not found."));
return(false);
}
string saveFile = ODFileUtils.CombinePaths(saveFolder, "claims" + claim.ClaimNum.ToString() + ".txt");
File.WriteAllText(saveFile, strb.ToString());
//MessageBox.Show(strb.ToString());
return(true);
}
///<summary>Called from Eclaims and includes multiple claims.</summary>
public static string SendBatch(Clearinghouse clearinghouseClin, List <ClaimSendQueueItem> queueItems, int batchNum)
{
//STEP 1 - Build XML output.
List <DP_RACINDP> listDps = new List <DP_RACINDP>();
List <ProcedureCode> listProcCodes = ProcedureCodes.GetAllCodes();
List <Etrans> listEtrans = new List <Etrans>();
foreach (ClaimSendQueueItem queueItem in queueItems)
{
Etrans etrans = Etranss.SetClaimSentOrPrinted(queueItem.ClaimNum, queueItem.PatNum, clearinghouseClin.HqClearinghouseNum, EtransType.Claim_Ramq, batchNum, Security.CurUser.UserNum);
listEtrans.Add(etrans);
//Now we need to update our cache of claims to reflect the change that took place in the database above in Etranss.SetClaimSentOrPrinted()
queueItem.ClaimStatus = "S";
Claim claim = Claims.GetClaim(queueItem.ClaimNum);
Provider provClaimTreat = Providers.GetProv(claim.ProvTreat);
DP_RACINDP dp = new DP_RACINDP();
#region Header
dp.CHN = DP_RACINDPCHN.Item06;
dp.CHNSpecified = true;
dp.ENRG = DP_RACINDPENRG.Item1;
dp.ENRGSpecified = true;
//We hijack the TaxID number for the TRNSM field. The TRNSM is a office identifying number. Test range for developers is 18000 to 18999.
dp.TRNSM = clearinghouseClin.SenderTIN;
dp.DISP = provClaimTreat.NationalProvID;
//dp.CPTE_ADMN=;//Administrative account number. Not currently used.
JulianCalendar calendar = new JulianCalendar();
dp.ATTES = (DateTime.Now.Year % 10).ToString() //One digit for year
+ calendar.GetDayOfYear(DateTime.Now).ToString().PadLeft(3, '0') //3 digits for Julian day of year.
+ (etrans.CarrierTransCounter % 1000).ToString().PadLeft(3, '0'); //3 digits for sequence number.
dp.NCE = (etrans.CarrierTransCounter % 10000).ToString().PadLeft(4, '0');
dp.DISP_REFNT = claim.CanadianReferralProviderNum.Trim();
//dp.DIAGN=;//Diagnostic code. Not currently used.
dp.ETAB = provClaimTreat.CanadianOfficeNum; //Usually empty.
//dp.ADMIS=;//Date of patient admission. Not currently used. This would be the same as the date of service for dental claims anyway.
//dp.SORTI=;//Date patient discharged. Not currently used. This would be the same as the date of service for dental claims anyway.
dp.TOT_DEM = claim.ClaimFee.ToString().Replace(".", "").PadLeft(6, '0');
dp.COMPL = TidyStr(claim.ClaimNote, 200);
//dp.CS=;//Not sure what this is. Not currently used.
//dp.AUTOR=claim.PreAuthString;//Authorization number when invoicing acrylic prostheses. Required if DAT_AUTOR is present. Not currently used.
//dp.DAT_AUTOR=claim.CanadianDateInitialLower;//Date of authorization when invoicing acrylic prostheses. Format YYMMDD. Not currently used.
dp.SERV = claim.DateService.ToString("yyMMdd");
#endregion Header
#region Insurance
//Most fields in the insuranace section are optional.
InsSub insSub = InsSubs.GetOne(claim.InsSubNum);
dp.PERS_ASSU = new DP_RACINDPPERS_ASSU();
dp.PERS_ASSU.NAM = insSub.SubscriberID;
Patient pat = Patients.GetPat(claim.PatNum);
dp.PERS_ASSU.PRE = TidyStr(pat.FName, 20);
dp.PERS_ASSU.NOM = TidyStr(pat.LName, 30);
if (pat.Birthdate.Year > 1880)
{
dp.PERS_ASSU.NAISS = pat.Birthdate.ToString("yyyyMMdd");
}
if (pat.Gender == PatientGender.Male)
{
dp.PERS_ASSU.SEXE = DP_RACINDPPERS_ASSUSEXE.M;
}
else if (pat.Gender == PatientGender.Female)
{
dp.PERS_ASSU.SEXE = DP_RACINDPPERS_ASSUSEXE.F;
}
else
{
//There is no value for UNKNOWN. This field is optional if the subscriber ID is present anyway.
}
List <PatPlan> listPatPlans = PatPlans.Refresh(claim.PatNum);
PatPlan patPlan = PatPlans.GetByInsSubNum(listPatPlans, insSub.InsSubNum);
dp.PERS_ASSU.CAM = patPlan.PatID;
if (insSub.DateTerm.Year > 1880)
{
dp.PERS_ASSU.EXPIR_CAM = insSub.DateTerm.ToString("yyMM");
}
InsPlan insPlan = InsPlans.RefreshOne(claim.PlanNum);
InsPlan insPlan2 = InsPlans.RefreshOne(claim.PlanNum2);
Carrier carrier = null;
if (claim.ClaimType == "S")
{
carrier = Carriers.GetCarrier(insPlan2.CarrierNum);
}
else
{
carrier = Carriers.GetCarrier(insPlan.CarrierNum);
}
if (carrier.Address.Trim() != "")
{
dp.PERS_ASSU.ADR_1 = carrier.Address;
dp.PERS_ASSU.ADR_2 = carrier.Address2;
dp.PERS_ASSU.CP = carrier.Zip;
}
#endregion Insurance
#region Procedures
List <ClaimProc> listClaimProcsForPat = ClaimProcs.Refresh(claim.PatNum);
List <ClaimProc> listClaimProcsForClaim = ClaimProcs.GetForSendClaim(listClaimProcsForPat, claim.ClaimNum); //Excludes labs.
List <Procedure> listProcsForPat = Procedures.Refresh(claim.PatNum);
List <DP_RACINDPACTE> listProcs = new List <DP_RACINDPACTE>();
foreach (ClaimProc claimProc in listClaimProcsForClaim)
{
Procedure proc = Procedures.GetProcFromList(listProcsForPat, claimProc.ProcNum);
if (proc.ProcFee == 0)
{
continue;
}
ProcedureCode procCode = ProcedureCodes.GetProcCode(proc.CodeNum, listProcCodes);
if (procCode.NoBillIns)
{
continue;
}
DP_RACINDPACTE acteProc = new DP_RACINDPACTE();
acteProc.ACTE = procCode.ProcCode;
if (procCode.ProcCode.Length > 5)
{
acteProc.ACTE = procCode.ProcCode.Substring(0, 5);
}
acteProc.ROLE = "1"; //1 for principal role and 2 for assistant role.
//acte.MODIF=;//Optional. Not sure what to put here, so leaving blank for now.
acteProc.UNIT = proc.UnitQty.ToString().PadLeft(3, '0');
acteProc.MNT = proc.ProcFee.ToString("F").Replace(".", "").PadLeft(6, '0');
acteProc.DENT = proc.ToothNum.ToString().PadLeft(2, '0');
acteProc.SURF = proc.Surf.ToString().PadLeft(2, '0');
listProcs.Add(acteProc);
List <Procedure> listLabProcs = Procedures.GetCanadianLabFees(proc.ProcNum, listProcsForPat);
foreach (Procedure labProc in listLabProcs)
{
if (labProc.ProcFee == 0)
{
continue;
}
ProcedureCode labProcCode = ProcedureCodes.GetProcCode(labProc.CodeNum, listProcCodes);
DP_RACINDPACTE acteLab = new DP_RACINDPACTE();
acteLab.ACTE = labProcCode.ProcCode;
if (labProcCode.ProcCode.Length > 5)
{
acteLab.ACTE = labProcCode.ProcCode.Substring(0, 5);
}
acteLab.ROLE = "1"; //1 for principal role and 2 for assistant role.
acteLab.MNT = labProc.ProcFee.ToString("F").Replace(".", "").PadLeft(6, '0');
listProcs.Add(acteLab);
}
}
dp.ACTE = listProcs.ToArray();
#endregion Procedures
listDps.Add(dp);
}
DP_RACIN batch = new DP_RACIN();
batch.DP = listDps.ToArray();
StringWriter sw = new StringWriter();
XmlSerializer serializer = new XmlSerializer(typeof(DP_RACIN));
serializer.Serialize(sw, batch);
string xml = sw.ToString();
//Save a copy of the batch xml to each etrans entry (one per claim).
EtransMessageText etransMsgText = new EtransMessageText();
etransMsgText.MessageText = xml;
EtransMessageTexts.Insert(etransMsgText);
foreach (Etrans etrans in listEtrans)
{
etrans.EtransMessageTextNum = etransMsgText.EtransMessageTextNum;
Etranss.Update(etrans);
}
//Step 2 - ZIP XML and save to report path. The zip file name and file name within the zip file do not matter.
string zipFilePath = CodeBase.ODFileUtils.CreateRandomFile(clearinghouseClin.ExportPath, ".zip", "claims");
ZipFile zip = null;
try {
zip = new ZipFile();
zip.UseZip64WhenSaving = Zip64Option.Always;
zip.AddEntry("claims" + DateTime.Now.ToString("yyyyMMddHHmmss") + ".xml", xml);
zip.Save(zipFilePath);
zip.Dispose();
}
catch (Exception ex) {
ex.ToString();
if (zip != null)
{
zip.Dispose();
}
if (File.Exists(zipFilePath))
{
try {
File.Delete(zipFilePath);
}
catch (Exception ex2) {
ex2.ToString();
}
}
}
return(xml);
}
///<summary>Sets the MissingData and Warnings fields on the queueItem as appropriate.</summary>
public static void GetMissingData(Clearinghouse clearinghouseClin, ClaimSendQueueItem queueItem)
{
StringBuilder sbErrors = new StringBuilder();
StringBuilder sbWarnings = new StringBuilder();
Claim claim = Claims.GetClaim(queueItem.ClaimNum);
Provider provClaimTreat = Providers.GetProv(claim.ProvTreat);
InsSub insSub = InsSubs.GetOne(claim.InsSubNum);
#region Header
//TRNSM
if (!Regex.IsMatch(clearinghouseClin.SenderTIN, @"^[0-9]+$"))
{
if (sbErrors.Length != 0)
{
sbErrors.Append(",");
}
sbErrors.Append("Tax ID Number (RAMQ TRNSM) is invalid");
}
else
{
int trnsm = PIn.Int(clearinghouseClin.SenderTIN);
if (clearinghouseClin.ISA15 != "T" && trnsm >= 18000 && trnsm <= 18999)
{
if (sbErrors.Length != 0)
{
sbErrors.Append(",");
}
sbErrors.Append("Tax ID Number (RAMQ TRNSM) is a test value on this production claim");
}
else if (clearinghouseClin.ISA15 == "T" && (trnsm < 18000 || trnsm > 18999))
{
if (sbErrors.Length != 0)
{
sbErrors.Append(",");
}
sbErrors.Append("Tax ID Number (RAMQ TRNSM) must be between 18000 and 18999 for this test claim");
}
}
//DISP
if (!Regex.IsMatch(provClaimTreat.NationalProvID, @"^[27][0-9]{5}$"))
{
if (sbErrors.Length != 0)
{
sbErrors.Append(",");
}
sbErrors.Append("Claim treating provider CDA Number for RAMQ is invalid");
}
//DISP_REFNT
if (claim.CanadianReferralProviderNum.Trim().Length > 0 &&
!Regex.IsMatch(claim.CanadianReferralProviderNum.Trim(), @"^[0-9]{6}$"))
{
if (sbErrors.Length != 0)
{
sbErrors.Append(",");
}
sbErrors.Append("Referral provider CDA Number for RAMQ is invalid");
}
//ETAB
if (!Regex.IsMatch(provClaimTreat.CanadianOfficeNum, @"^[0-9]{5}$"))
{
if (sbErrors.Length != 0)
{
sbErrors.Append(",");
}
sbErrors.Append("Claim treating provider Office Number for RAMQ is invalid");
}
//SERV
if (claim.DateService.Year < 1880)
{
if (sbErrors.Length != 0)
{
sbErrors.Append(",");
}
sbErrors.Append("Claim date of service is invalid or missing");
}
#endregion Header
#region Insurance
//Most fields in the insuranace section are optional and thus do not require validation.
//NAM
if (!Regex.IsMatch(insSub.SubscriberID, @"^[a-zA-Z]{4}[0-9]{6}[a-zA-Z0-9][0-9]$"))
{
if (sbErrors.Length != 0)
{
sbErrors.Append(",");
}
sbErrors.Append("Subscriber ID for RAMQ is invalid");
}
#endregion Insurance
#region Procedures
List <ProcedureCode> listProcCodes = ProcedureCodes.GetAllCodes();
List <ClaimProc> listClaimProcsForPat = ClaimProcs.Refresh(claim.PatNum);
List <ClaimProc> listClaimProcsForClaim = ClaimProcs.GetForSendClaim(listClaimProcsForPat, claim.ClaimNum); //Excludes labs.
List <Procedure> listProcsForPat = Procedures.Refresh(claim.PatNum);
foreach (ClaimProc claimProc in listClaimProcsForClaim)
{
Procedure proc = Procedures.GetProcFromList(listProcsForPat, claimProc.ProcNum);
if (proc.ProcFee == 0)
{
continue;
}
ProcedureCode procCode = ProcedureCodes.GetProcCode(proc.CodeNum, listProcCodes);
if (procCode.NoBillIns)
{
continue;
}
//ACTE
if (procCode.ProcCode.Length < 5 || !Regex.IsMatch(procCode.ProcCode.Substring(0, 5), @"^[0-9]{5}$"))
{
if (sbErrors.Length != 0)
{
sbErrors.Append(",");
}
sbErrors.Append("Procedure code invalid '" + procCode.ProcCode + "'");
}
List <Procedure> listLabProcs = Procedures.GetCanadianLabFees(proc.ProcNum, listProcsForPat);
foreach (Procedure labProc in listLabProcs)
{
if (labProc.ProcFee == 0)
{
continue;
}
ProcedureCode labProcCode = ProcedureCodes.GetProcCode(labProc.CodeNum, listProcCodes);
if (labProcCode.ProcCode.Length < 5 || !Regex.IsMatch(labProcCode.ProcCode.Substring(0, 5), @"^[0-9]{5}$"))
{
if (sbErrors.Length != 0)
{
sbErrors.Append(",");
}
sbErrors.Append("Lab code invalid '" + labProcCode.ProcCode + "'");
}
}
}
#endregion Procedures
queueItem.MissingData = sbErrors.ToString();
queueItem.Warnings = sbWarnings.ToString();
}
///<summary>Sets the MissingData and Warnings fields on the queueItem as appropriate.</summary>
public static void GetMissingData(ClaimSendQueueItem queueItem)
{
StringBuilder sbErrors = new StringBuilder();
StringBuilder sbWarnings = new StringBuilder();
Claim claim = Claims.GetClaim(queueItem.ClaimNum);
Provider provClaimTreat = Providers.GetProv(claim.ProvTreat);
InsSub insSub = InsSubs.GetOne(claim.InsSubNum);
Patient pat = Patients.GetPat(claim.PatNum);
#region Header
//DISP
if (!Regex.IsMatch(provClaimTreat.NationalProvID, @"^[27][0-9]{5}$"))
{
if (sbErrors.Length != 0)
{
sbErrors.Append(",");
}
sbErrors.Append("Claim treating provider ID for RAMQ is invalid");
}
//DISP_REFNT
if (claim.CanadianReferralProviderNum.Trim().Length > 0 &&
!Regex.IsMatch(claim.CanadianReferralProviderNum.Trim(), @"^[0-9]{6}$"))
{
if (sbErrors.Length != 0)
{
sbErrors.Append(",");
}
sbErrors.Append("Referral provider ID for RAMQ is invalid");
}
//ETAB
if (!Regex.IsMatch(provClaimTreat.CanadianOfficeNum, @"^[0-9]{5}$"))
{
if (sbErrors.Length != 0)
{
sbErrors.Append(",");
}
sbErrors.Append("Claim treating provider office number is invalid");
}
//SERV
if (claim.DateService.Year < 1880)
{
if (sbErrors.Length != 0)
{
sbErrors.Append(",");
}
sbErrors.Append("Claim date of service is invalid or missing");
}
#endregion Header
#region Insurance
//Most fields in the insuranace section are optional and thus do not require validation.
//NAM
if (!Regex.IsMatch(insSub.SubscriberID, @"^[a-zA-Z]{4}[0-9]{6}[a-zA-Z0-9][0-9]$"))
{
if (sbErrors.Length != 0)
{
sbErrors.Append(",");
}
sbErrors.Append("Subscriber ID invalid");
}
#endregion Insurance
#region Procedures
List <ProcedureCode> listProcCodes = ProcedureCodes.GetAllCodes();
List <ClaimProc> listClaimProcsForPat = ClaimProcs.Refresh(claim.PatNum);
List <ClaimProc> listClaimProcsForClaim = ClaimProcs.GetForSendClaim(listClaimProcsForPat, claim.ClaimNum); //Excludes labs.
List <Procedure> listProcsForPat = Procedures.Refresh(claim.PatNum);
foreach (ClaimProc claimProc in listClaimProcsForClaim)
{
Procedure proc = Procedures.GetProcFromList(listProcsForPat, claimProc.ProcNum);
if (proc.ProcFee == 0)
{
continue;
}
ProcedureCode procCode = ProcedureCodes.GetProcCode(proc.CodeNum, listProcCodes);
if (procCode.NoBillIns)
{
continue;
}
//ACTE
if (procCode.ProcCode.Length < 5 || !Regex.IsMatch(procCode.ProcCode.Substring(0, 5), @"^[0-9]{5}$"))
{
if (sbErrors.Length != 0)
{
sbErrors.Append(",");
}
sbErrors.Append("Procedure code invalid '" + procCode.ProcCode + "'");
}
List <Procedure> listLabProcs = Procedures.GetCanadianLabFees(proc.ProcNum, listProcsForPat);
foreach (Procedure labProc in listLabProcs)
{
if (labProc.ProcFee == 0)
{
continue;
}
ProcedureCode labProcCode = ProcedureCodes.GetProcCode(labProc.CodeNum, listProcCodes);
if (labProcCode.ProcCode.Length < 5 || !Regex.IsMatch(labProcCode.ProcCode.Substring(0, 5), @"^[0-9]{5}$"))
{
if (sbErrors.Length != 0)
{
sbErrors.Append(",");
}
sbErrors.Append("Lab code invalid '" + labProcCode.ProcCode + "'");
}
}
}
#endregion Procedures
queueItem.MissingData = sbErrors.ToString();
queueItem.Warnings = sbWarnings.ToString();
}