Ejemplo n.º 1
0
        ///<summary>StringBuilder does not get altered if no invalid data.</summary>
        public static void BillProv(clsProvider billProv, StringBuilder strb)
        {
            if (billProv.LName.Trim() == "")
            {
                Comma(strb);
                strb.Append("Billing Prov LName");
            }
            if (!billProv.IsNotPerson && billProv.FName.Trim() == "")
            {//if is a person, first name cannot be blank.
                Comma(strb);
                strb.Append("Billing Prov FName");
            }
            if (!Regex.IsMatch(billProv.SSN.Trim(), "^[0-9]{9}$"))
            {//must be exactly 9 in length (no dashes)
                Comma(strb);
                strb.Append("Billing Prov SSN/TIN must be a 9 digit number");
            }
            if (!Regex.IsMatch(billProv.NationalProvID.Trim(), "^(80840)?[0-9]{10}$"))
            {
                Comma(strb);
                strb.Append("Billing Prov NPI must be a 10 digit number with an optional prefix of 80840");
            }
            if (billProv.TaxonomyCodeOverride.Trim().Length > 0 && billProv.TaxonomyCodeOverride.Trim().Length != 10)
            {
                Comma(strb);
                strb.Append("Billing Prov Taxonomy Code must be 10 characters");
            }
            //Always check provider name variables regardless of IsNotPerson.
            if (!billProv.IsNotPerson)
            {//The first name and middle name are only required if the billing provider is a person. For an organization, these fields are never sent.
                string fNameInvalidChars = GetNonAN(billProv.FName.Trim());
                if (fNameInvalidChars != "")
                {
                    Comma(strb);
                    strb.Append("Billing Prov First Name contains invalid characters: " + fNameInvalidChars);
                }
                string middleInvalidChars = GetNonAN(billProv.MI.Trim());
                if (middleInvalidChars != "")
                {
                    Comma(strb);
                    strb.Append("Billing Prov MI contains invalid characters: " + middleInvalidChars);
                }
            }
            string lNameInvalidChars = GetNonAN(billProv.LName.Trim());

            if (lNameInvalidChars != "")
            {
                Comma(strb);
                strb.Append("Billing Prov Last Name contains invalid characters: " + lNameInvalidChars);
            }

            /* This was causing problems when dummy providers were used for office and no license number was applicable.
             * Delta carriers key off this number and start assigning to wrong provider. Customer: ATD.
             * if(billProv.StateLicense=="") {
             *  if(strb.Length!=0) {
             *      strb.Append(",");
             *  }
             *  strb.Append("Billing Prov Lic #");
             * }*/
        }
        ///<summary>Returns the Provider Taxonomy code for the given specialty. Always 10 characters, validated.</summary>
        public static string GetTaxonomy(clsProvider provider)
        {
            if (provider.TaxonomyCodeOverride != "")
            {
                return(provider.TaxonomyCodeOverride);
            }
            string spec = "1223G0001X";//general

            switch (provider.Specialty.ToString().ToLower())
            {
            case "general": spec = "1223G0001X"; break;

            case "hygienist": spec = "124Q00000X"; break;

            case "publichealth": spec = "1223D0001X"; break;

            case "endodontics": spec = "1223E0200X"; break;

            case "pathology": spec = "1223P0106X"; break;

            case "radiology": spec = "1223X0008X"; break;

            case "surgery": spec = "1223S0112X"; break;

            case "ortho": spec = "1223X0400X"; break;

            case "pediatric": spec = "1223P0221X"; break;

            case "perio": spec = "1223P0300X"; break;

            case "prosth": spec = "1223P0700X"; break;

            case "denturist": spec = "122400000X"; break;

            case "assistant": spec = "126800000X"; break;

            case "labtech": spec = "126900000X"; break;
            }
            return(spec);
        }
Ejemplo n.º 3
0
        public static string Validate(clsClearinghouse clearhouse, clsCarrier carrier, clsProvider billProv, clsClinic clinic, clsInsPlan insPlan, clsPatientSubscriber subscriber, clsInsSub insSub, clsPractice practice, clsGeneral general)
        {
            try
            {
                // LogLibrary.WriteErrorLog("1");

                StringBuilder strb = new StringBuilder();
                X12Validate.ISA(clearhouse, strb);

                X12Validate.Carrier(carrier, strb);
                if (carrier.ElectID.Trim().Length < 2)
                {
                    if (strb.Length != 0)
                    {
                        strb.Append(",");
                    }
                    strb.Append("Electronic ID");
                }
                if (billProv.SSN.Trim().Length != 9)
                {
                    if (strb.Length != 0)
                    {
                        strb.Append(",");
                    }
                    strb.Append("Prov TIN 9 digits");
                }
                X12Validate.BillProv(billProv, strb);
                if (general.UseBillingAddressOnClaims)
                {
                    X12Validate.BillingAddress(practice, strb);
                }
                else if (clinic == null)
                {
                    X12Validate.PracticeAddress(practice, strb);
                }
                else
                {
                    X12Validate.Clinic(clinic, strb);
                }

                if (insSub.SubscriberID.Trim().Length < 2)
                {
                    if (strb.Length != 0)
                    {
                        strb.Append(",");
                    }
                    strb.Append("SubscriberID");
                }

                if (subscriber.Birthdate.Year < 1880)
                {
                    if (strb.Length != 0)
                    {
                        strb.Append(",");
                    }
                    strb.Append("Subscriber Birthdate");
                }

                if (insPlan.GroupNum.Trim() == "")
                {
                    if (strb.Length != 0)
                    {
                        strb.Append(",");
                    }
                    strb.Append("Group Number");
                }

                return(strb.ToString());
            }
            catch (Exception ex)
            {
                Library.WriteErrorLog("Catch-" + ex.Message + Environment.NewLine + ex.StackTrace);

                //  MessageBox.Show("clsValidate-"+ex.InnerException+Environment.NewLine+ex.Message+Environment.NewLine+ex.StackTrace);
                throw ex;
            }
        }
Ejemplo n.º 4
0
        public static string GenerateMessageText(clsClearinghouse clearhouse, clsCarrier carrier, clsProvider billProv, clsClinic clinic, clsInsPlan insPlan, clsPatientSubscriber subscriber, clsInsSub insSub, clsGeneral general, clsPractice practice)
        {
            int           batchNum           = clearhouse.LastBatchNumber; //Clearinghouses.GetNextBatchNumber(clearhouse);
            string        groupControlNumber = batchNum.ToString();        //Must be unique within file.  We will use batchNum
            int           transactionNum     = 1;
            StringBuilder strb = new StringBuilder();

            //Interchange Control Header
            strb.AppendLine("ISA*00*          *"                         //ISA01,ISA02: 00 + 10 spaces
                            + "00*          *"                           //ISA03,ISA04: 00 + 10 spaces
                            + clearhouse.ISA05 + "*"                     //ISA05: Sender ID type: ZZ=mutually defined. 30=TIN. Validated
                            + clsX12Generator.GetISA06(clearhouse) + "*" //ISA06: Sender ID(TIN). Or might be TIN of Open Dental
                            + clearhouse.ISA07 + "*"                     //ISA07: Receiver ID type: ZZ=mutually defined. 30=TIN. Validated
                            + Sout(clearhouse.ISA08, 15, 15) + "*"       //ISA08: Receiver ID. Validated to make sure length is at least 2.
                            + DateTime.Today.ToString("yyMMdd") + "*"    //ISA09: today's date
                            + DateTime.Now.ToString("HHmm") + "*"        //ISA10: current time
                            + "U*00401*"                                 //ISA11 and ISA12.
                                                                         //ISA13: interchange control number, right aligned:
                            + batchNum.ToString().PadLeft(9, '0') + "*"
                            + "0*"                                       //ISA14: no acknowledgment requested
                            + clearhouse.ISA15 + "*"                     //ISA15: T=Test P=Production. Validated.
                            + ":~");                                     //ISA16: use ':'
            //Functional Group Header
            strb.AppendLine("GS*HS*"                                     //GS01: HS for 270 benefit inquiry
                            + clsX12Generator.GetGS02(clearhouse) + "*"  //GS02: Senders Code. Sometimes Jordan Sparks.  Sometimes the sending clinic.
                            + Sout(clearhouse.GS03, 15, 2) + "*"         //GS03: Application Receiver's Code
                            + DateTime.Today.ToString("yyyyMMdd") + "*"  //GS04: today's date
                            + DateTime.Now.ToString("HHmm") + "*"        //GS05: current time
                            + groupControlNumber + "*"                   //GS06: Group control number. Max length 9. No padding necessary.
                            + "X*"                                       //GS07: X
                            + "004010X092~");                            //GS08: Version
            //Beginning of transaction--------------------------------------------------------------------------------
            int seg = 0;                                                 //count segments for the ST-SE transaction

            //Transaction Set Header
            //ST02 Transact. control #. Must be unique within ISA
            seg++;
            strb.AppendLine("ST*270*"                                           //ST01
                            + transactionNum.ToString().PadLeft(4, '0') + "~"); //ST02
            seg++;
            strb.AppendLine("BHT*0022*13*"                                      //BHT02: 13=request
                            + transactionNum.ToString().PadLeft(4, '0') + "*"   //BHT03. Can be same as ST02
                            + DateTime.Now.ToString("yyyyMMdd") + "*"           //BHT04: Date
                            + DateTime.Now.ToString("HHmmss") + "~");           //BHT05: Time, BHT06: not used
            //HL Loops-----------------------------------------------------------------------------------------------
            int HLcount = 1;

            //2000A HL: Information Source--------------------------------------------------------------------------
            seg++;
            strb.AppendLine("HL*" + HLcount.ToString() + "*" //HL01: Heirarchical ID.  Here, it's always 1.
                            + "*"                            //HL02: No parent. Not used
                            + "20*"                          //HL03: Heirarchical level code. 20=Information source
                            + "1~");                         //HL04: Heirarchical child code. 1=child HL present
            //2100A NM1
            seg++;
            strb.AppendLine("NM1*PR*"                              //NM101: PR=Payer
                            + "2*"                                 //NM102: 2=Non person
                            + Sout(carrier.CarrierName, 35) + "*"  //NM103: Name Last.
                            + "****"                               //NM104-07 not used
                            + "PI*"                                //NM108: PI=PayorID
                            + Sout(carrier.ElectID, 80, 2) + "~"); //NM109: PayorID. Validated to be at least length of 2.
            HLcount++;
            //2000B HL: Information Receiver------------------------------------------------------------------------
            seg++;
            strb.AppendLine("HL*" + HLcount.ToString() + "*" //HL01: Heirarchical ID.  Here, it's always 2.
                            + "1*"                           //HL02: Heirarchical parent id number.  1 in this simple message.
                            + "21*"                          //HL03: Heirarchical level code. 21=Information receiver
                            + "1~");                         //HL04: Heirarchical child code. 1=child HL present
            seg++;
            //2100B NM1: Information Receiver Name
            strb.AppendLine("NM1*1P*"                                   //NM101: 1P=Provider
                            + (billProv.IsNotPerson ? "2" : "1") + "*"  //NM102: 1=person,2=non-person
                            + Sout(billProv.LName, 35) + "*"            //NM103: Last name
                            + Sout(billProv.FName, 25) + "*"            //NM104: First name
                            + Sout(billProv.MI, 25, 1) + "*"            //NM105: Middle name
                            + "*"                                       //NM106: not used
                            + "*"                                       //NM107: Name suffix. not used
                            + "XX*"                                     //NM108: ID code qualifier. 24=EIN. 34=SSN, XX=NPI
                            + Sout(billProv.NationalProvID, 80) + "~"); //NM109: ID code. NPI validated
            //2100B REF: Information Receiver ID
            seg++;
            strb.Append("REF*");
            if (billProv.UsingTIN)
            {
                strb.Append("TJ*");//REF01: qualifier. TJ=Federal TIN
            }
            else
            {                                              //SSN
                strb.Append("SY*");                        //REF01: qualifier. SY=SSN
            }
            strb.AppendLine(Sout(billProv.SSN, 30) + "~"); //REF02: ID
            //2100B N3: Information Receiver Address
            seg++;
            if (general.UseBillingAddressOnClaims)
            {
                strb.Append("N3*" + Sout(practice.PracticeBillingAddress, 55));//N301: Address
            }
            else if (clinic == null)
            {
                strb.Append("N3*" + Sout(practice.PracticeAddress, 55));//N301: Address
            }
            else
            {
                strb.Append("N3*" + Sout(clinic.Address, 55));//N301: Address
            }
            if (general.UseBillingAddressOnClaims)
            {
                if (practice.PracticeBillingAddress2 == "")
                {
                    strb.AppendLine("~");
                }
                else
                {
                    //N302: Address2. Optional.
                    strb.AppendLine("*" + Sout(practice.PracticeBillingAddress2, 55) + "~");
                }
            }
            else if (clinic == null)
            {
                if (practice.PracticeAddress2 == "")
                {
                    strb.AppendLine("~");
                }
                else
                {
                    //N302: Address2. Optional.
                    strb.AppendLine("*" + Sout(practice.PracticeAddress2, 55) + "~");
                }
            }
            else
            {
                if (clinic.Address2 == "")
                {
                    strb.AppendLine("~");
                }
                else
                {
                    //N302: Address2. Optional.
                    strb.AppendLine("*" + Sout(clinic.Address2, 55) + "~");
                }
            }
            //2100B N4: Information Receiver City/State/Zip
            seg++;
            if (general.UseBillingAddressOnClaims)
            {
                strb.AppendLine("N4*" + Sout(practice.PracticeBillingCity, 30) + "*"             //N401: City
                                + Sout(practice.PracticeBillingST, 2) + "*"                      //N402: State
                                + Sout(practice.PracticeBillingZip.Replace("-", ""), 15) + "~"); //N403: Zip
            }
            else if (clinic == null)
            {
                strb.AppendLine("N4*" + Sout(practice.PracticeCity, 30) + "*"             //N401: City
                                + Sout(practice.PracticeST, 2) + "*"                      //N402: State
                                + Sout(practice.PracticeZip.Replace("-", ""), 15) + "~"); //N403: Zip
            }
            else
            {
                strb.AppendLine("N4*" + Sout(clinic.City, 30) + "*"             //N401: City
                                + Sout(clinic.State, 2) + "*"                   //N402: State
                                + Sout(clinic.Zip.Replace("-", ""), 15) + "~"); //N403: Zip
            }
            //2100B PRV: Information Receiver Provider Info
            seg++;
            //PRV*PE*ZZ*1223G0001X~
            strb.AppendLine("PRV*PE*"                                       //PRV01: Provider Code. PE=Performing.  There are many other choices.
                            + "ZZ*"                                         //PRV02: ZZ=Mutually defined = health care provider taxonomy code
                            + clsX12Generator.GetTaxonomy(billProv) + "~"); //PRV03: Specialty code
            HLcount++;
            //2000C HL: Subscriber-----------------------------------------------------------------------------------
            seg++;
            strb.AppendLine("HL*" + HLcount.ToString() + "*" //HL01: Heirarchical ID.  Here, it's always 3.
                            + "2*"                           //HL02: Heirarchical parent id number.  2 in this simple message.
                            + "22*"                          //HL03: Heirarchical level code. 22=Subscriber
                            + "0~");                         //HL04: Heirarchical child code. 0=no child HL present (no dependent)
            //2000C TRN: Subscriber Trace Number
            seg++;
            strb.AppendLine("TRN*1*"                     //TRN01: Trace Type Code.  1=Current Transaction Trace Numbers
                            + "1*"                       //TRN02: Trace Number.  We don't really have a good primary key yet.  Keep it simple. Use 1.
                            + "1" + billProv.SSN + "~"); //TRN03: Entity Identifier. First digit is 1=EIN.  Next 9 digits are EIN.  Length validated.
            //2100C NM1: Subscriber Name
            seg++;
            strb.AppendLine("NM1*IL*"                                                //NM101: IL=Insured or Subscriber
                            + "1*"                                                   //NM102: 1=Person
                            + Sout(subscriber.LName, 35) + "*"                       //NM103: LName
                            + Sout(subscriber.FName, 25) + "*"                       //NM104: FName
                            + Sout(subscriber.MiddleI, 25) + "*"                     //NM105: MiddleName
                            + "*"                                                    //NM106: not used
                            + "*"                                                    //NM107: suffix. Not present in Open Dental yet.
                            + "MI*"                                                  //NM108: MI=MemberID
                            + Sout(insSub.SubscriberID.Replace("-", ""), 80) + "~"); //NM109: Subscriber ID. Validated to be L>2.
            //2100C REF: Subscriber Additional Information.  Without this, old plans seem to be frequently returned.
            seg++;
            strb.AppendLine("REF*6P*"                            //REF01: 6P=GroupNumber
                            + Sout(insPlan.GroupNum, 30) + "~"); //REF02: Supplemental ID. Validated.
            //2100C DMG: Subscriber Demographic Information
            seg++;
            strb.AppendLine("DMG*D8*"                                           //DMG01: Date Time Period Qualifier.  D8=CCYYMMDD
                            + subscriber.Birthdate.ToString("yyyyMMdd") + "~"); //DMG02: Subscriber birthdate.  Validated
            //DMG03: Gender code.  Situational.  F or M.  Since this was left out in the example,
            //and since we don't want to send the wrong gender, we will not send this element.
            //2100C DTP: Subscriber Date.  Deduced through trial and error that this is required by EHG even though not by X12 specs.
            seg++;
            strb.AppendLine("DTP*307*"                                    //DTP01: Qualifier.  307=Eligibility
                            + "D8*"                                       //DTP02: Format Qualifier.
                            + DateTime.Today.ToString("yyyyMMdd") + "~"); //DTP03: Date
            //2110C EQ: Subscriber Eligibility or Benefit Enquiry Information
            //X12 documentation seems to say that we can loop this 99 times to request very specific benefits.
            //ClaimConnect wants to see either an EQ*30 for "an eligibility request", or an EQ*35 for "a general benefits request".
            //The director of vendor implementation at ClaimConnect has informed us that we should send an EQ*35 to get the full set of benefits.
            seg++;
            strb.AppendLine("EQ*35~");//Dental Care
            //seg++;
            //strb.AppendLine("EQ*30~");//EQ01: 30=General Coverage
            //seg++;
            //strb.AppendLine("EQ*23~");//Diagnostic
            //seg++;
            //strb.AppendLine("EQ*4~");//Diagnostic Xray
            //seg++;
            //strb.AppendLine("EQ*41~");//Routine Preventive
            //seg++;
            //strb.AppendLine("EQ*25~");//Restorative
            //seg++;
            //strb.AppendLine("EQ*26~");//Endo
            //seg++;
            //strb.AppendLine("EQ*24~");//Perio
            //seg++;
            //strb.AppendLine("EQ*40~");//Oral Surgery
            //seg++;
            //strb.AppendLine("EQ*36~");//Crowns
            //seg++;
            //strb.AppendLine("EQ*39~");//Prosth
            //seg++;
            //strb.AppendLine("EQ*27~");//Maxillofacial Prosth
            //seg++;
            //strb.AppendLine("EQ*37~");//Accident
            //seg++;
            //strb.AppendLine("EQ*38~");//Ortho
            //seg++;
            //strb.AppendLine("EQ*28~");//Adjunctive
            //
            //2000D If we add a dependent loop it would go here.  It would be about 20 lines.
            //2100D, etc
            //EQ series, etc.
            //Not allowed to send this unless subscriber and dependent are different
            //We would also have to add code to process the EBs which distinguishes between subscribers and dependents.
            //
            //Transaction Trailer
            seg++;
            strb.AppendLine("SE*"
                            + seg.ToString() + "*"//SE01: Total segments, including ST & SE
                            + transactionNum.ToString().PadLeft(4, '0') + "~");
            //End of transaction--------------------------------------------------------------------------------------
            //Functional Group Trailer
            strb.AppendLine("GE*" + transactionNum.ToString() + "*"       //GE01: Number of transaction sets included
                            + groupControlNumber + "~");                  //GE02: Group Control number. Must be identical to GS06
            //Interchange Control Trailer
            strb.AppendLine("IEA*1*"                                      //IEA01: number of functional groups
                            + batchNum.ToString().PadLeft(9, '0') + "~"); //IEA02: Interchange control number
            return(strb.ToString());

            /*
             * return @"
             * ISA*00*          *00*          *30*AA0989922      *30*330989922      *030519*1608*U*00401*000012145*1*T*:~
             * GS*HS*AA0989922*330989922*20030519*1608*12145*X*004010X092~
             * ST*270*0001~
             * BHT*0022*13*ASX012145WEB*20030519*1608~
             * HL*1**20*1~
             * NM1*PR*2*Metlife*****PI*65978~
             * HL*2*1*21*1~
             * NM1*1P*1*PROVLAST*PROVFIRST****XX*1234567893~
             * REF*TJ*200384584~
             * N3*JUNIT ROAD~
             * N4*CHICAGO*IL*60602~
             * PRV*PE*ZZ*1223G0001X~
             * HL*3*2*22*0~
             * TRN*1*12145*1AA0989922~
             * NM1*IL*1*SUBLASTNAME*SUBFIRSTNAME****MI*123456789~
             * DMG*D8*19750323~
             * DTP*307*D8*20030519~
             * EQ*30~
             * SE*17*0001~
             * GE*1*12145~
             * IEA*1*000012145~";
             */

            //return "ISA*00*          *00*          *30*AA0989922      *30*330989922      *030519*1608*U*00401*000012145*1*T*:~GS*HS*AA0989922*330989922*20030519*1608*12145*X*004010X092~ST*270*0001~BHT*0022*13*ASX012145WEB*20030519*1608~HL*1**20*1~NM1*PR*2*Metlife*****PI*65978~HL*2*1*21*1~NM1*1P*1*PROVLAST*PROVFIRST****XX*1234567893~REF*TJ*200384584~N3*JUNIT ROAD~N4*CHICAGO*IL*60602~PRV*PE*ZZ*1223G0001X~HL*3*2*22*0~TRN*1*12145*1AA0989922~NM1*IL*1*SUBLASTNAME*SUBFIRSTNAME****MI*123456789~DMG*D8*19750323~DTP*307*D8*20030519~EQ*30~SE*17*0001~GE*1*12145~IEA*1*000012145~";
        }