///<summary>"CODE SOURCE 237: Place of Service Codes for Professional Claims" is published by CMS (Centers for Medicare and Medicaid Services),
///according to https://www.cms.gov/Medicare/Coding/place-of-service-codes/.
///See code list here: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/Downloads/Website-POS-database.pdf
///Copy of PDF saved to "Place-of-Service-Codes.pdf" in internal documents.</summary>
public static string GetPlaceService(PlaceOfService place)
{
switch (place)
{
case PlaceOfService.AmbulatorySurgicalCenter:
return("24");
case PlaceOfService.CustodialCareFacility:
return("33");
case PlaceOfService.EmergencyRoomHospital:
return("23");
case PlaceOfService.FederalHealthCenter:
return("50");
case PlaceOfService.InpatHospital:
return("21");
case PlaceOfService.MilitaryTreatFac:
return("26");
case PlaceOfService.MobileUnit:
return("15");
case PlaceOfService.Office:
case PlaceOfService.OtherLocation:
return("11");
case PlaceOfService.OutpatHospital:
return("22");
case PlaceOfService.PatientsHome:
return("12");
case PlaceOfService.PublicHealthClinic:
return("71");
case PlaceOfService.RuralHealthClinic:
return("72");
case PlaceOfService.School:
return("03");
case PlaceOfService.SkilledNursFac:
return("31");
case PlaceOfService.Telehealth:
return("02");
}
return("11");
}
public ProcNotBilled(Patient pat, long procNum, int rowIndex, bool isRowSelected,
bool hasPriClaim, bool hasSecClaim, long clinicNum, PlaceOfService placeService)
{
Patient = pat;
ProcNum = procNum;
RowIndex = rowIndex;
IsRowSelected = isRowSelected;
IsAttached = false;
HasPriClaim = hasPriClaim;
HasSecClaim = hasSecClaim;
ClinicNum = clinicNum;
PlaceService = placeService;
}
private static List <PlaceOfService> CreatePlaceOfServices(int numberPlaceofServices)
{
List <PlaceOfService> placeOfServices = new List <PlaceOfService>();
for (int n = 1; n <= numberPlaceofServices; n++)
{
PlaceOfService cpdArea = new PlaceOfService
{
PlaceOfServiceId = n,
Name = $"Place of Service {n}"
};
placeOfServices.Add(cpdArea);
}
return(placeOfServices);
}
private static string GetPlaceService(PlaceOfService place) {
switch(place) {
case PlaceOfService.AmbulatorySurgicalCenter:
return "24";
case PlaceOfService.CustodialCareFacility:
return "33";
case PlaceOfService.EmergencyRoomHospital:
return "23";
case PlaceOfService.FederalHealthCenter:
return "50";
case PlaceOfService.InpatHospital:
return "21";
case PlaceOfService.MilitaryTreatFac:
return "26";
case PlaceOfService.MobileUnit:
return "15";
case PlaceOfService.Office:
case PlaceOfService.OtherLocation:
return "11";
case PlaceOfService.OutpatHospital:
return "22";
case PlaceOfService.PatientsHome:
return "12";
case PlaceOfService.PublicHealthClinic:
return "71";
case PlaceOfService.RuralHealthClinic:
return "72";
case PlaceOfService.School:
return "03";
case PlaceOfService.SkilledNursFac:
return "31";
}
return "11";
}
private Claim CreateClaim(string claimType, List <PatPlan> patPlanList, List <InsPlan> planList, List <ClaimProc> claimProcList, Procedure proc, List <InsSub> subList)
{
long claimFormNum = 0;
InsPlan planCur = new InsPlan();
InsSub subCur = new InsSub();
Relat relatOther = Relat.Self;
long clinicNum = proc.ClinicNum;
PlaceOfService placeService = proc.PlaceService;
switch (claimType)
{
case "P":
subCur = InsSubs.GetSub(PatPlans.GetInsSubNum(patPlanList, PatPlans.GetOrdinal(PriSecMed.Primary, patPlanList, planList, subList)), subList);
planCur = InsPlans.GetPlan(subCur.PlanNum, planList);
break;
case "S":
subCur = InsSubs.GetSub(PatPlans.GetInsSubNum(patPlanList, PatPlans.GetOrdinal(PriSecMed.Secondary, patPlanList, planList, subList)), subList);
planCur = InsPlans.GetPlan(subCur.PlanNum, planList);
break;
case "Med":
//It's already been verified that a med plan exists
subCur = InsSubs.GetSub(PatPlans.GetInsSubNum(patPlanList, PatPlans.GetOrdinal(PriSecMed.Medical, patPlanList, planList, subList)), subList);
planCur = InsPlans.GetPlan(subCur.PlanNum, planList);
break;
}
ClaimProc claimProcCur = Procedures.GetClaimProcEstimate(proc.ProcNum, claimProcList, planCur, subCur.InsSubNum);
if (claimProcCur == null)
{
claimProcCur = new ClaimProc();
ClaimProcs.CreateEst(claimProcCur, proc, planCur, subCur);
}
Claim claimCur = new Claim();
claimCur.PatNum = proc.PatNum;
claimCur.DateService = proc.ProcDate;
claimCur.ClinicNum = proc.ClinicNum;
claimCur.PlaceService = proc.PlaceService;
claimCur.ClaimStatus = "W";
claimCur.DateSent = DateTimeOD.Today;
claimCur.PlanNum = planCur.PlanNum;
claimCur.InsSubNum = subCur.InsSubNum;
InsSub sub;
switch (claimType)
{
case "P":
claimCur.PatRelat = PatPlans.GetRelat(patPlanList, PatPlans.GetOrdinal(PriSecMed.Primary, patPlanList, planList, subList));
claimCur.ClaimType = "P";
claimCur.InsSubNum2 = PatPlans.GetInsSubNum(patPlanList, PatPlans.GetOrdinal(PriSecMed.Secondary, patPlanList, planList, subList));
sub = InsSubs.GetSub(claimCur.InsSubNum2, subList);
if (sub.PlanNum > 0 && InsPlans.RefreshOne(sub.PlanNum).IsMedical)
{
claimCur.PlanNum2 = 0; //no sec ins
claimCur.PatRelat2 = Relat.Self;
}
else
{
claimCur.PlanNum2 = sub.PlanNum; //might be 0 if no sec ins
claimCur.PatRelat2 = PatPlans.GetRelat(patPlanList, PatPlans.GetOrdinal(PriSecMed.Secondary, patPlanList, planList, subList));
}
break;
case "S":
claimCur.PatRelat = PatPlans.GetRelat(patPlanList, PatPlans.GetOrdinal(PriSecMed.Secondary, patPlanList, planList, subList));
claimCur.ClaimType = "S";
claimCur.InsSubNum2 = PatPlans.GetInsSubNum(patPlanList, PatPlans.GetOrdinal(PriSecMed.Primary, patPlanList, planList, subList));
sub = InsSubs.GetSub(claimCur.InsSubNum2, subList);
claimCur.PlanNum2 = sub.PlanNum;
claimCur.PatRelat2 = PatPlans.GetRelat(patPlanList, PatPlans.GetOrdinal(PriSecMed.Primary, patPlanList, planList, subList));
break;
case "Med":
claimCur.PatRelat = PatPlans.GetFromList(patPlanList, subCur.InsSubNum).Relationship;
claimCur.ClaimType = "Other";
if (PrefC.GetBool(PrefName.ClaimMedTypeIsInstWhenInsPlanIsMedical))
{
claimCur.MedType = EnumClaimMedType.Institutional;
}
else
{
claimCur.MedType = EnumClaimMedType.Medical;
}
break;
case "Other":
claimCur.PatRelat = relatOther;
claimCur.ClaimType = "Other";
//plannum2 is not automatically filled in.
claimCur.ClaimForm = claimFormNum;
if (planCur.IsMedical)
{
if (PrefC.GetBool(PrefName.ClaimMedTypeIsInstWhenInsPlanIsMedical))
{
claimCur.MedType = EnumClaimMedType.Institutional;
}
else
{
claimCur.MedType = EnumClaimMedType.Medical;
}
}
break;
}
if (planCur.PlanType == "c") //if capitation
{
claimCur.ClaimType = "Cap";
}
claimCur.ProvTreat = proc.ProvNum;
if (Providers.GetIsSec(proc.ProvNum))
{
claimCur.ProvTreat = Patients.GetPat(proc.PatNum).PriProv;
//OK if zero, because auto select first in list when open claim
}
claimCur.IsProsthesis = "N";
claimCur.ProvBill = Providers.GetBillingProvNum(claimCur.ProvTreat, claimCur.ClinicNum); //OK if zero, because it will get fixed in claim
claimCur.EmployRelated = YN.No;
claimCur.ClaimForm = planCur.ClaimFormNum;
Claims.Insert(claimCur);
//attach procedure
claimProcCur.ClaimNum = claimCur.ClaimNum;
if (planCur.PlanType == "c") //if capitation
{
claimProcCur.Status = ClaimProcStatus.CapClaim;
}
else
{
claimProcCur.Status = ClaimProcStatus.NotReceived;
}
if (planCur.UseAltCode && (ProcedureCodes.GetProcCode(proc.CodeNum).AlternateCode1 != ""))
{
claimProcCur.CodeSent = ProcedureCodes.GetProcCode(proc.CodeNum).AlternateCode1;
}
else if (planCur.IsMedical && proc.MedicalCode != "")
{
claimProcCur.CodeSent = proc.MedicalCode;
}
else
{
claimProcCur.CodeSent = ProcedureCodes.GetProcCode(proc.CodeNum).ProcCode;
if (claimProcCur.CodeSent.Length > 5 && claimProcCur.CodeSent.Substring(0, 1) == "D")
{
claimProcCur.CodeSent = claimProcCur.CodeSent.Substring(0, 5);
}
if (CultureInfo.CurrentCulture.Name.EndsWith("CA")) //Canadian. en-CA or fr-CA
{
if (claimProcCur.CodeSent.Length > 5) //In Canadian e-claims, codes can contain letters or numbers and cannot be longer than 5 characters.
{
claimProcCur.CodeSent = claimProcCur.CodeSent.Substring(0, 5);
}
}
}
claimProcCur.LineNumber = (byte)1;
ClaimProcs.Update(claimProcCur);
return(claimCur);
}
