private MedicareOutPatientResult GetMedicareOutPatientResult(IEvaluateableClaim claim)
{
StringBuilder inputData = new StringBuilder();
MedicareOutPatientResult medicareOutPatientResult = new MedicareOutPatientResult();
MicrodynApcEditInput microdynApcEditInput = claim.MicrodynApcEditInput;
string dLine = string.Empty;
string eLine = string.Empty;
string cLine = _cRecordLogic.GetCRecordLine(microdynApcEditInput.CRecord);
if (claim.StatementThru >= DateTime.Parse(Constants.IcdVersionDate, CultureInfo.InvariantCulture))
{
eLine = _eRecordLogic.GetERecordLine(microdynApcEditInput.ERecord);
}
else
{
dLine = _dRecordLogic.GetDRecordLine(microdynApcEditInput.DRecord);
}
string lLine = _lRecordLogic.GetLRecordLine(microdynApcEditInput.LRecords);
if (GlobalConfigVariable.IsMicrodynEnabled)
{
inputData.Append(cLine);
string diagnosisLine = (claim.StatementThru >= DateTime.Parse(Constants.IcdVersionDate, CultureInfo.InvariantCulture) ? eLine : dLine);
inputData.Append(diagnosisLine);
inputData.Append(lLine);
if (inputData.Length !=
Constants.CRecordLength + Constants.DRecordLength +
(microdynApcEditInput.LRecords.Count * Constants.LRecordLength))
{
medicareOutPatientResult.ReturnCode = 1;
medicareOutPatientResult.Message = Constants.MessageClaimDataError;
if (GlobalConfigVariable.IsMicrodynLogEnabled)
{
if (claim.StatementThru >= DateTime.Parse(Constants.IcdVersionDate, CultureInfo.InvariantCulture))
{
Log.LogInfo(
string.Format(CultureInfo.InvariantCulture, DataIssueMessageFormatWithERecord,
claim.ClaimId, cLine, Environment.NewLine,
_cRecordLogic.ValidationErrors, Environment.NewLine,
diagnosisLine, Environment.NewLine,
_eRecordLogic.ValidationErrors, Environment.NewLine,
lLine, Environment.NewLine,
_lRecordLogic.ValidationErrors),
Constants.MicrodynApcEditDllResultsData);
}
else
{
Log.LogInfo(
string.Format(CultureInfo.InvariantCulture, DataIssueMessageFormatWithDRecord,
claim.ClaimId, cLine, Environment.NewLine,
_cRecordLogic.ValidationErrors, Environment.NewLine,
diagnosisLine, Environment.NewLine,
_dRecordLogic.ValidationErrors, Environment.NewLine,
lLine, Environment.NewLine,
_lRecordLogic.ValidationErrors),
Constants.MicrodynApcEditDllResultsData);
}
}
return(medicareOutPatientResult);
}
Instance.InputLineCount = microdynApcEditInput.LRecords.Count;
Instance.InputData = inputData.ToString();
Instance.AutoDenyReject = false;
Instance.APCEdit();
if (Instance.APCErrorsFound)
{
//Processing Unsuccessful - Edit errors found
//ResultsData contains claim and line item errors
medicareOutPatientResult.ReturnCode = Instance.ReturnCode;
GetInstanceMessage(true, Instance.ReturnCode, medicareOutPatientResult);
if (Instance.ResultsData.Length % 200 == 0)
{
medicareOutPatientResult.EditErrorCodes = GetResultMessageData(Instance.ResultsData);
}
medicareOutPatientResult.MicrodynEditReturnRemarks = "Error Code:" + medicareOutPatientResult.ReturnCode + "; " +
medicareOutPatientResult.Message;
if (GlobalConfigVariable.IsMicrodynLogEnabled)
{
if (claim.StatementThru >= DateTime.Parse(Constants.IcdVersionDate, CultureInfo.InvariantCulture))
{
Log.LogInfo(
string.Format(CultureInfo.InvariantCulture, ApcErrorMessageFormatWithERecord, claim.ClaimId,
medicareOutPatientResult.Message, Instance.ResultsData,
string.IsNullOrEmpty(medicareOutPatientResult.EditErrorCodes)
? string.Empty
: Constants.ErrorCodes + medicareOutPatientResult.EditErrorCodes,
Environment.NewLine, cLine, Environment.NewLine, diagnosisLine, Environment.NewLine,
lLine),
Constants.MicrodynApcEditDllResultsData);
}
else
{
Log.LogInfo(
string.Format(CultureInfo.InvariantCulture, ApcErrorMessageFormatWithDRecord, claim.ClaimId,
medicareOutPatientResult.Message, Instance.ResultsData,
string.IsNullOrEmpty(medicareOutPatientResult.EditErrorCodes)
? string.Empty
: Constants.ErrorCodes + medicareOutPatientResult.EditErrorCodes,
Environment.NewLine, cLine, Environment.NewLine, diagnosisLine, Environment.NewLine,
lLine),
Constants.MicrodynApcEditDllResultsData);
}
}
}
else
{
medicareOutPatientResult.IsEditSuccess = true;
string inputDataString = Instance.PaymentInputData;
MedicareOutPatient objPatientData = microdynApcEditInput.MedicareOutPatientRecord;
_apcPayDll = new NetAPCPay
{
InputLineCount = microdynApcEditInput.LRecords.Count,
InputData = inputDataString,
ProviderNumber = objPatientData.Npi,
ServiceFromDate = Convert.ToString(objPatientData.ServiceDate, CultureInfo.InvariantCulture),
BeneDeductible = Convert.ToDouble(objPatientData.BeneDeductible),
BloodDeductiblePints = Convert.ToInt32(objPatientData.BloodDeductiblePints),
AllowTerminatedProvider = Convert.ToBoolean(objPatientData.AllowTerminatorProvider, CultureInfo.InvariantCulture),
AdjustmentFactor = Convert.ToDouble(objPatientData.AdjustFactor),
AdjustmentOption = Convert.ToInt32(objPatientData.AdjustmentOptions)
};
_apcPayDll.APCCalc();
if (!_apcPayDll.CalcErrorsFound)
{
//No Errors found
//Parse the V and W records to get the out patient payment details
medicareOutPatientResult = GetResultData(_apcPayDll.ResultsData);
medicareOutPatientResult.ReturnCode = 0;
medicareOutPatientResult.Message = Constants.MessageNoError;
medicareOutPatientResult.IsPricerSuccess = true;
}
else
{
//Errors found in APC Payment calculation
medicareOutPatientResult.ReturnCode = _apcPayDll.ReturnCode;
GetInstanceMessage(false, _apcPayDll.ReturnCode, medicareOutPatientResult);
medicareOutPatientResult.PricerErrorCodes = medicareOutPatientResult.ReturnCode;
if (GlobalConfigVariable.IsMicrodynLogEnabled)
{
if (claim.StatementThru >= DateTime.Parse(Constants.IcdVersionDate, CultureInfo.InvariantCulture))
{
Log.LogInfo(
string.Format(CultureInfo.InvariantCulture, ApcCalcMessageFormatWithERecord, claim.ClaimId, medicareOutPatientResult.Message,
medicareOutPatientResult.PricerErrorCodes == 0
? string.Empty
: Constants.ErrorCodes + medicareOutPatientResult.PricerErrorCodes, _apcPayDll.ResultsData,
Environment.NewLine, cLine, Environment.NewLine, eLine, Environment.NewLine, lLine),
Constants.MicrodynApcCalcDllResultsData);
}
else
{
Log.LogInfo(
string.Format(CultureInfo.InvariantCulture, ApcCalcMessageFormatWithDRecord, claim.ClaimId, medicareOutPatientResult.Message,
medicareOutPatientResult.PricerErrorCodes == 0
? string.Empty
: Constants.ErrorCodes + medicareOutPatientResult.PricerErrorCodes, _apcPayDll.ResultsData,
Environment.NewLine, cLine, Environment.NewLine, dLine, Environment.NewLine, lLine),
Constants.MicrodynApcCalcDllResultsData);
}
}
}
_apcPayDll.Dispose();
}
}
else
{
medicareOutPatientResult.ReturnCode = 0;
medicareOutPatientResult.TotalPaymentAmount = 0;
medicareOutPatientResult.Message = Constants.MessageMicrodyneOff;
medicareOutPatientResult.IsEditSuccess = true;
}
return(medicareOutPatientResult);
}