Beispiel #1
0
        ///<summary>Creates a procedure and computes estimates for a patient where the secondary insurance has a COB rule of Medicaid.</summary>
        private void ComputeEstimatesMedicaidCOB(string suffix, double procFee, double priAllowed, double secAllowed, int priPercentCovered,
                                                 int secPercentCovered, Action <ClaimProc /*Primary*/, ClaimProc /*Secondary*/, Procedure> assertAct)
        {
            Patient pat            = PatientT.CreatePatient(suffix);
            long    ppoFeeSchedNum = FeeSchedT.CreateFeeSched(FeeScheduleType.Normal, "PPO " + suffix);

            InsuranceT.AddInsurance(pat, suffix, "p", ppoFeeSchedNum);
            long medicaidFeeSchedNum = FeeSchedT.CreateFeeSched(FeeScheduleType.Normal, "PPO " + suffix);

            InsuranceT.AddInsurance(pat, suffix, "p", medicaidFeeSchedNum, 2, cobRule: EnumCobRule.SecondaryMedicaid);
            List <InsSub>  listSubs     = InsSubT.GetInsSubs(pat);
            List <InsPlan> listPlans    = InsPlans.RefreshForSubList(listSubs);
            List <PatPlan> listPatPlans = PatPlans.Refresh(pat.PatNum);
            InsPlan        priPlan      = InsPlanT.GetPlanForPriSecMed(PriSecMed.Primary, listPatPlans, listPlans, listSubs);

            BenefitT.CreateCategoryPercent(priPlan.PlanNum, EbenefitCategory.Diagnostic, priPercentCovered);
            InsPlan secPlan = InsPlanT.GetPlanForPriSecMed(PriSecMed.Secondary, listPatPlans, listPlans, listSubs);

            BenefitT.CreateCategoryPercent(secPlan.PlanNum, EbenefitCategory.Diagnostic, secPercentCovered);
            List <Benefit> listBens = Benefits.Refresh(listPatPlans, listSubs);
            string         procStr  = "D0150";
            Procedure      proc     = ProcedureT.CreateProcedure(pat, procStr, ProcStat.TP, "", procFee);
            ProcedureCode  procCode = ProcedureCodes.GetProcCode(procStr);

            FeeT.CreateFee(ppoFeeSchedNum, procCode.CodeNum, priAllowed);
            FeeT.CreateFee(medicaidFeeSchedNum, procCode.CodeNum, secAllowed);
            Procedures.ComputeEstimates(proc, pat.PatNum, new List <ClaimProc>(), false, listPlans, listPatPlans, listBens, pat.Age, listSubs);
            List <ClaimProc> listClaimProcs = ClaimProcs.Refresh(pat.PatNum);

            assertAct(listClaimProcs.FirstOrDefault(x => x.PlanNum == priPlan.PlanNum), listClaimProcs.FirstOrDefault(x => x.PlanNum == secPlan.PlanNum), proc);
        }
Beispiel #2
0
        ///<summary>Creates a general deductible of $50, a deductible of $50 on D0220, sets a $30 D0220 complete and creates a claim,
        ///creates a $100 D2750, that is TP'ed, and then creates a $30 D0220 that is TP'ed.</summary>
        ///<param name="actAssert">The first claimproc is for the D2750 and the second claimproc is for the second D0220.</param>
        public void GetDeductibleByCodeDeductLessThanGeneral(string suffix, Action <ClaimProc, ClaimProc> actAssert)
        {
            Patient pat = PatientT.CreatePatient(suffix);

            InsuranceT.AddInsurance(pat, suffix);
            List <InsSub>  listSubs     = InsSubT.GetInsSubs(pat);
            List <InsPlan> listPlans    = InsPlans.RefreshForSubList(listSubs);
            List <PatPlan> listPatPlans = PatPlans.Refresh(pat.PatNum);
            InsPlan        plan         = InsPlanT.GetPlanForPriSecMed(PriSecMed.Primary, listPatPlans, listPlans, listSubs);

            BenefitT.CreateDeductibleGeneral(plan.PlanNum, BenefitCoverageLevel.Individual, 50);
            BenefitT.CreateCategoryPercent(plan.PlanNum, EbenefitCategory.Diagnostic, 100);
            BenefitT.CreateCategoryPercent(plan.PlanNum, EbenefitCategory.Crowns, 50);
            BenefitT.CreateDeductible(plan.PlanNum, EbenefitCategory.Diagnostic, 0);
            BenefitT.CreateDeductible(plan.PlanNum, "D0220", 50);
            List <Benefit> listBens = Benefits.Refresh(listPatPlans, listSubs);
            Procedure      proc1    = ProcedureT.CreateProcedure(pat, "D0220", ProcStat.C, "", 30);//proc1 - Intraoral - periapical first film

            ClaimT.CreateClaim("P", listPatPlans, listPlans, new List <ClaimProc>(), new List <Procedure> {
                proc1
            }, pat, new List <Procedure> {
                proc1
            }, listBens,
                               listSubs);
            Procedure        proc2      = ProcedureT.CreateProcedure(pat, "D2750", ProcStat.TP, "", 100, priority: 0); //proc2 - Crown
            Procedure        proc3      = ProcedureT.CreateProcedure(pat, "D0220", ProcStat.TP, "", 30, priority: 1);  //proc3 - Intraoral - periapical first film
            List <ClaimProc> claimProcs = ProcedureT.ComputeEstimates(pat, listPatPlans, listPlans, listSubs, listBens);
            ClaimProc        claimProc2 = claimProcs.FirstOrDefault(x => x.ProcNum == proc2.ProcNum);
            ClaimProc        claimProc3 = claimProcs.FirstOrDefault(x => x.ProcNum == proc3.ProcNum);

            actAssert(claimProc2, claimProc3);
        }
Beispiel #3
0
        private InsPlan GeneratePPOPlan(string suffix, bool codeSubstNone = true)
        {
            long    baseFeeSchedNum = FeeSchedT.CreateFeeSched(FeeScheduleType.Normal, "Normal_" + suffix, true);
            Carrier carrier         = CarrierT.CreateCarrier("Carrier_" + suffix);

            return(InsPlanT.CreateInsPlanPPO(carrier.CarrierNum, baseFeeSchedNum, codeSubstNone));
        }
Beispiel #4
0
        private InsPlan GenerateMediFlatInsPlan(string suffix, bool codeSubstNone = true)
        {
            long    baseFeeSchedNum  = FeeSchedT.CreateFeeSched(FeeScheduleType.Normal, "Normal_" + suffix, true);
            long    copayFeeSchedNum = FeeSchedT.CreateFeeSched(FeeScheduleType.CoPay, "Copay_" + suffix, true);
            Carrier carrier          = CarrierT.CreateCarrier("Carrier_" + suffix);

            return(InsPlanT.CreateInsPlanMediFlatCopay(carrier.CarrierNum, baseFeeSchedNum, copayFeeSchedNum, codeSubstNone));
        }
Beispiel #5
0
        private InsPlan GenerateCapPlan(string suffix, bool createAllowed = true, bool codeSubstNone = true)
        {
            long baseFeeSchedNum    = FeeSchedT.CreateFeeSched(FeeScheduleType.Normal, "Normal_" + suffix, true);
            long allowedFeeSchedNum = 0;

            if (createAllowed)
            {
                allowedFeeSchedNum = FeeSchedT.CreateFeeSched(FeeScheduleType.Normal, "Allowed_" + suffix, true);
            }
            Carrier carrier = CarrierT.CreateCarrier("Carrier_" + suffix);

            return(InsPlanT.CreateInsPlanCapitation(carrier.CarrierNum, baseFeeSchedNum, allowedFeeSchedNum, codeSubstNone));
        }
Beispiel #6
0
        public void Procedures_ComputeEstimates_PrimaryInsuranceMedicaidCOB()
        {
            string        suffix         = MethodBase.GetCurrentMethod().Name;
            Patient       pat            = PatientT.CreatePatient(suffix);
            long          ppoFeeSchedNum = FeeSchedT.CreateFeeSched(FeeScheduleType.Normal, "PPO " + suffix);
            InsuranceInfo insInfo        = InsuranceT.AddInsurance(pat, suffix, "p", ppoFeeSchedNum, 1, cobRule: EnumCobRule.SecondaryMedicaid);
            InsPlan       priPlan        = InsPlanT.GetPlanForPriSecMed(PriSecMed.Primary, insInfo.ListPatPlans, insInfo.ListInsPlans, insInfo.ListInsSubs);

            BenefitT.CreateCategoryPercent(priPlan.PlanNum, EbenefitCategory.Diagnostic, percent: 50);
            List <Benefit> listBens = Benefits.Refresh(insInfo.ListPatPlans, insInfo.ListInsSubs);
            string         procStr  = "D0150";
            Procedure      proc     = ProcedureT.CreateProcedure(pat, procStr, ProcStat.TP, "", 125);
            ProcedureCode  procCode = ProcedureCodes.GetProcCode(procStr);

            FeeT.CreateFee(ppoFeeSchedNum, procCode.CodeNum, amount: 80);
            Procedures.ComputeEstimates(proc, pat.PatNum, new List <ClaimProc>(), false, insInfo.ListInsPlans, insInfo.ListPatPlans, listBens, pat.Age,
                                        insInfo.ListInsSubs);
            List <ClaimProc> listClaimProcs = ClaimProcs.Refresh(pat.PatNum);

            Assert.AreEqual(40, listClaimProcs[0].InsEstTotal, 0.001);
            Assert.AreEqual(45, listClaimProcs[0].WriteOffEst, 0.001);
        }
Beispiel #7
0
        public void Claims_CalculateAndUpdate_PreauthOrderWriteoff()
        {
            string suffix = MethodBase.GetCurrentMethod().Name;
            //create the patient and insurance information
            Patient pat = PatientT.CreatePatient(suffix);
            //proc - Crown
            Procedure proc         = ProcedureT.CreateProcedure(pat, "D2750", ProcStat.C, "8", 1000);
            long      feeSchedNum1 = FeeSchedT.CreateFeeSched(FeeScheduleType.Normal, suffix);

            FeeT.CreateFee(feeSchedNum1, proc.CodeNum, 900);
            Carrier carrier = CarrierT.CreateCarrier(suffix);
            InsPlan insPlan = InsPlanT.CreateInsPlanPPO(carrier.CarrierNum, feeSchedNum1);

            BenefitT.CreateAnnualMax(insPlan.PlanNum, 1000);
            BenefitT.CreateCategoryPercent(insPlan.PlanNum, EbenefitCategory.Crowns, 100);
            InsSub  sub = InsSubT.CreateInsSub(pat.PatNum, insPlan.PlanNum);
            PatPlan pp  = PatPlanT.CreatePatPlan(1, pat.PatNum, sub.InsSubNum);
            //create lists and variables required for ComputeEstimates()
            List <InsSub>    SubList         = InsSubs.RefreshForFam(Patients.GetFamily(pat.PatNum));
            List <InsPlan>   listInsPlan     = InsPlans.RefreshForSubList(SubList);
            List <PatPlan>   listPatPlan     = PatPlans.Refresh(pat.PatNum);
            List <Benefit>   listBenefits    = Benefits.Refresh(listPatPlan, SubList);
            List <Procedure> listProcsForPat = Procedures.Refresh(pat.PatNum);
            List <Procedure> procsForClaim   = new List <Procedure>();

            procsForClaim.Add(proc);
            //Create the claim and associated claimprocs
            //The order of these claimprocs is the whole point of the unit test.
            //Create Preauth
            ClaimProcs.CreateEst(new ClaimProc(), proc, insPlan, sub, 0, 500, true, true);
            //Create Estimate
            ClaimProcs.CreateEst(new ClaimProc(), proc, insPlan, sub, 1000, 1000, true, false);
            List <ClaimProc> listClaimProcs = ClaimProcs.Refresh(pat.PatNum);
            Claim            claimWaiting   = ClaimT.CreateClaim("W", listPatPlan, listInsPlan, listClaimProcs, listProcsForPat, pat, procsForClaim, listBenefits, SubList, false);

            Assert.AreEqual(100, claimWaiting.WriteOff, "WriteOff Amount");
        }
Beispiel #8
0
        ///<summary>Creates a procedure and computes estimates for a patient where the secondary insurance has a COB rule of Medicaid.</summary>
        private void ComputeEstimatesFixedBenefits(string suffix, double procFee, double ppoFee, double fixedBenefitFee
                                                   , int priPercentCoveredOverride, bool hasSecondary, double secFee, Action <FixedBenefitAssertItem> assertAct)
        {
            Patient       pat                     = PatientT.CreatePatient(suffix);
            string        procStr                 = "D0150";
            Procedure     proc                    = ProcedureT.CreateProcedure(pat, procStr, ProcStat.TP, "", procFee);
            ProcedureCode procCode                = ProcedureCodes.GetProcCode(procStr);
            long          ppoFeeSchedNum          = FeeSchedT.CreateFeeSched(FeeScheduleType.Normal, "PPO " + suffix);
            long          catPercFeeSchedNum      = FeeSchedT.CreateFeeSched(FeeScheduleType.Normal, "Category % " + suffix);
            long          fixedBenefitFeeSchedNum = FeeSchedT.CreateFeeSched(FeeScheduleType.FixedBenefit, "Fixed Benefit " + suffix);

            if (ppoFee > -1)
            {
                FeeT.CreateFee(ppoFeeSchedNum, procCode.CodeNum, ppoFee);
            }
            FeeT.CreateFee(fixedBenefitFeeSchedNum, procCode.CodeNum, fixedBenefitFee);
            InsuranceT.AddInsurance(pat, suffix, "p", ppoFeeSchedNum, copayFeeSchedNum: fixedBenefitFeeSchedNum);
            if (hasSecondary)
            {
                FeeT.CreateFee(catPercFeeSchedNum, procCode.CodeNum, secFee);
                InsuranceT.AddInsurance(pat, suffix, "", catPercFeeSchedNum, 2, false, EnumCobRule.Standard);
            }
            List <InsSub>  listSubs     = InsSubT.GetInsSubs(pat);
            List <InsPlan> listPlans    = InsPlans.RefreshForSubList(listSubs);
            List <PatPlan> listPatPlans = PatPlans.Refresh(pat.PatNum);
            InsPlan        priPlan      = InsPlanT.GetPlanForPriSecMed(PriSecMed.Primary, listPatPlans, listPlans, listSubs);
            InsPlan        secPlan      = null;

            if (hasSecondary)
            {
                secPlan = InsPlanT.GetPlanForPriSecMed(PriSecMed.Secondary, listPatPlans, listPlans, listSubs);
                //TODO:  Add diagnostic code benefit for 100%
                BenefitT.CreateCategoryPercent(secPlan.PlanNum, EbenefitCategory.Diagnostic, 100);
            }
            List <Benefit> listBens = Benefits.Refresh(listPatPlans, listSubs);

            Procedures.ComputeEstimates(proc, pat.PatNum, new List <ClaimProc>(), false, listPlans, listPatPlans, listBens, pat.Age, listSubs);
            List <ClaimProc> listClaimProcs = ClaimProcs.Refresh(pat.PatNum);

            if (priPercentCoveredOverride > 0)
            {
                foreach (ClaimProc cpCur in listClaimProcs)
                {
                    cpCur.PercentOverride = priPercentCoveredOverride;
                    ClaimProcs.Update(cpCur);
                }
                Procedures.ComputeEstimates(proc, pat.PatNum, new List <ClaimProc>(), false, listPlans, listPatPlans, listBens, pat.Age, listSubs);
                listClaimProcs = ClaimProcs.Refresh(pat.PatNum);
            }
            foreach (ClaimProc cpCur in listClaimProcs)
            {
                cpCur.PercentOverride = priPercentCoveredOverride;
                ClaimProcs.Update(cpCur);
            }
            Procedures.ComputeEstimates(proc, pat.PatNum, listClaimProcs, false, listPlans, listPatPlans, listBens, pat.Age, listSubs);
            listClaimProcs = ClaimProcs.Refresh(pat.PatNum);
            assertAct(new FixedBenefitAssertItem()
            {
                Procedure          = proc,
                PrimaryClaimProc   = listClaimProcs.FirstOrDefault(x => x.PlanNum == priPlan.PlanNum),
                SecondaryClaimProc = secPlan == null ? null : listClaimProcs.FirstOrDefault(x => x.PlanNum == secPlan.PlanNum),
            });
        }