public void FeeSchedTools_GlobalUpdateWriteoffEstimates_SubscriberInDifferentFamily()
{
string suffix = MethodBase.GetCurrentMethod().Name;
string procStr = "D0145";
double procFee = 100;
ProcedureCode procCode = ProcedureCodes.GetProcCode(procStr);
//Set up clinic, prov, pat
Clinic clinic = ClinicT.CreateClinic(suffix);
long feeSchedNum = FeeSchedT.CreateFeeSched(FeeScheduleType.Normal, suffix);
long provNum = ProviderT.CreateProvider(suffix, feeSchedNum: feeSchedNum);
Fee fee = FeeT.GetNewFee(feeSchedNum, procCode.CodeNum, procFee, clinic.ClinicNum, provNum);
Patient pat = PatientT.CreatePatient(suffix, provNum, clinic.ClinicNum);
Patient patSubscriber = PatientT.CreatePatient(suffix + "_Subscriber", provNum, clinic.ClinicNum);
//Set up insurance
InsuranceInfo info = InsuranceT.AddInsurance(pat, suffix, "p", feeSchedNum);
info.PriInsSub.Subscriber = patSubscriber.PatNum;
InsSubs.Update(info.PriInsSub);
info.ListBenefits.Add(BenefitT.CreatePercentForProc(info.PriInsPlan.PlanNum, procCode.CodeNum, 100));
//Create the procedure and claimproc
Procedure proc = ProcedureT.CreateProcedure(pat, procStr, ProcStat.TP, "", procFee);
ClaimProc priClaimProc = ClaimProcT.CreateClaimProc(pat.PatNum, proc.ProcNum, info.PriInsPlan.PlanNum, info.PriInsSub.InsSubNum, DateTime.Today,
-1, -1, -1, ClaimProcStatus.CapEstimate);
Procedures.ComputeEstimates(proc, pat.PatNum, new List <ClaimProc>(), true, info.ListInsPlans, info.ListPatPlans, info.ListBenefits, pat.Age,
info.ListInsSubs);
priClaimProc = ClaimProcs.Refresh(pat.PatNum).FirstOrDefault(x => x.ProcNum == proc.ProcNum);
Assert.AreEqual(procFee, priClaimProc.InsPayEst);
GlobalUpdateWriteoffs(clinic.ClinicNum);
priClaimProc = ClaimProcs.Refresh(pat.PatNum).FirstOrDefault(x => x.ClaimProcNum == priClaimProc.ClaimProcNum);
Assert.AreEqual(procFee, priClaimProc.InsPayEst);
}
public void InsPlan_GetInsUsedDisplay_OrthoProcsNotAffectInsUsed()
{
string suffix = "13";
Patient pat = PatientT.CreatePatient(suffix);
Carrier carrier = CarrierT.CreateCarrier(suffix);
InsPlan plan = InsPlanT.CreateInsPlan(carrier.CarrierNum);
InsSub sub = InsSubT.CreateInsSub(pat.PatNum, plan.PlanNum);
long subNum = sub.InsSubNum;
PatPlan patPlan = PatPlanT.CreatePatPlan(1, pat.PatNum, subNum);
BenefitT.CreateAnnualMax(plan.PlanNum, 100);
BenefitT.CreateOrthoMax(plan.PlanNum, 500);
BenefitT.CreateCategoryPercent(plan.PlanNum, EbenefitCategory.Diagnostic, 100);
BenefitT.CreateCategoryPercent(plan.PlanNum, EbenefitCategory.Orthodontics, 100);
Procedure proc1 = ProcedureT.CreateProcedure(pat, "D0140", ProcStat.C, "", 59); //limEx
Procedure proc2 = ProcedureT.CreateProcedure(pat, "D8090", ProcStat.C, "", 348); //Comprehensive ortho
ClaimProcT.AddInsPaid(pat.PatNum, plan.PlanNum, proc1.ProcNum, 59, subNum, 0, 0);
ClaimProcT.AddInsPaid(pat.PatNum, plan.PlanNum, proc2.ProcNum, 348, subNum, 0, 0);
//Lists
Family fam = Patients.GetFamily(pat.PatNum);
List <InsSub> subList = InsSubs.RefreshForFam(fam);
List <InsPlan> planList = InsPlans.RefreshForSubList(subList);
List <PatPlan> patPlans = PatPlans.Refresh(pat.PatNum);
List <Benefit> benefitList = Benefits.Refresh(patPlans, subList);
List <ClaimProcHist> histList = ClaimProcs.GetHistList(pat.PatNum, benefitList, patPlans, planList, DateTime.Today, subList);
//Validate
double insUsed = InsPlans.GetInsUsedDisplay(histList, DateTime.Today, plan.PlanNum, patPlan.PatPlanNum, -1, planList, benefitList, pat.PatNum, subNum);
Assert.AreEqual(59, insUsed);
}
public void InsPlan_GetPendingDisplay_LimitationsOverrideGeneralLimitations()
{
string suffix = "31";
Patient pat = PatientT.CreatePatient(suffix);
long patNum = pat.PatNum;
Carrier carrier = CarrierT.CreateCarrier(suffix);
InsPlan plan = InsPlanT.CreateInsPlan(carrier.CarrierNum);
long planNum = plan.PlanNum;
InsSub sub = InsSubT.CreateInsSub(pat.PatNum, planNum); //guarantor is subscriber
long subNum = sub.InsSubNum;
long patPlanNum = PatPlanT.CreatePatPlan(1, pat.PatNum, subNum).PatPlanNum;
BenefitT.CreateAnnualMax(planNum, 1000);
BenefitT.CreateCategoryPercent(planNum, EbenefitCategory.RoutinePreventive, 100);
BenefitT.CreateLimitation(planNum, EbenefitCategory.RoutinePreventive, 1000); //Changing this amount would affect patient portion vs ins portion. But regardless of the amount, this should prevent any pending from showing in the box, which is for general pending only.
Procedure proc = ProcedureT.CreateProcedure(pat, "D1110", ProcStat.C, "", 125); //Prophy
//Lists
List <ClaimProc> claimProcs = ClaimProcs.Refresh(pat.PatNum);
Family fam = Patients.GetFamily(patNum);
List <InsSub> subList = InsSubs.RefreshForFam(fam);
List <InsPlan> planList = InsPlans.RefreshForSubList(subList);
List <PatPlan> patPlans = PatPlans.Refresh(patNum);
List <Benefit> benefitList = Benefits.Refresh(patPlans, subList);
List <Procedure> ProcList = Procedures.Refresh(pat.PatNum);
Claim claim = ClaimT.CreateClaim("P", patPlans, planList, claimProcs, ProcList, pat, ProcList, benefitList, subList);//Creates the claim in the same manner as the account module, including estimates and status NotReceived.
List <ClaimProcHist> histList = ClaimProcs.GetHistList(patNum, benefitList, patPlans, planList, DateTime.Today, subList);
//Validate
Assert.AreEqual(0, InsPlans.GetPendingDisplay(histList, DateTime.Today, plan, patPlanNum, -1, patNum, subNum, benefitList));
}
public void InsPlan_GetInsUsedDisplay_LimitationsOverride()
{
string suffix = "6";
Patient pat = PatientT.CreatePatient(suffix);
long patNum = pat.PatNum;
Carrier carrier = CarrierT.CreateCarrier(suffix);
InsPlan plan = InsPlanT.CreateInsPlan(carrier.CarrierNum);
long planNum = plan.PlanNum;
InsSub sub = InsSubT.CreateInsSub(pat.PatNum, planNum); //guarantor is subscriber
long subNum = sub.InsSubNum;
long patPlanNum = PatPlanT.CreatePatPlan(1, pat.PatNum, subNum).PatPlanNum;
BenefitT.CreateAnnualMax(planNum, 1000);
BenefitT.CreateLimitation(planNum, EbenefitCategory.Diagnostic, 1000);
Procedure proc = ProcedureT.CreateProcedure(pat, "D0120", ProcStat.C, "", 50); //An exam
long procNum = proc.ProcNum;
Procedure proc2 = ProcedureT.CreateProcedure(pat, "D2750", ProcStat.C, "8", 830); //create a crown
ClaimProcT.AddInsPaid(patNum, planNum, procNum, 50, subNum, 0, 0);
ClaimProcT.AddInsPaid(patNum, planNum, proc2.ProcNum, 400, subNum, 0, 0);
//Lists
Family fam = Patients.GetFamily(patNum);
List <InsSub> subList = InsSubs.RefreshForFam(fam);
List <InsPlan> planList = InsPlans.RefreshForSubList(subList);
List <PatPlan> patPlans = PatPlans.Refresh(patNum);
List <Benefit> benefitList = Benefits.Refresh(patPlans, subList);
List <ClaimProcHist> histList = ClaimProcs.GetHistList(patNum, benefitList, patPlans, planList, DateTime.Today, subList);
//Validate
double insUsed = InsPlans.GetInsUsedDisplay(histList, DateTime.Today, planNum, patPlanNum, -1, planList, benefitList, patNum, subNum);
Assert.AreEqual(400, insUsed);
}
public void InsPlan_PpoNoSubWriteoffsNoSub()
{
string suffix = MethodBase.GetCurrentMethod().Name;
Patient pat = PatientT.CreatePatient(suffix);
long ucrFeeSchedNum = FeeSchedT.CreateFeeSched(FeeScheduleType.Normal, "UCR Fees" + suffix);
long ppoFeeSchedNum = FeeSchedT.CreateFeeSched(FeeScheduleType.Normal, "PPO " + suffix);
InsuranceInfo ins = InsuranceT.AddInsurance(pat, suffix, planType: "p", feeSchedNum: ppoFeeSchedNum);
ins.PriInsPlan.HasPpoSubstWriteoffs = false;
InsPlans.Update(ins.PriInsPlan);
BenefitT.CreateCategoryPercent(ins.PriInsPlan.PlanNum, EbenefitCategory.Restorative, 50);
ProcedureCode originalProcCode = ProcedureCodes.GetProcCode("D2330");
ProcedureCode downgradeProcCode = ProcedureCodes.GetProcCode("D2140");
originalProcCode.SubstitutionCode = ""; //NOT substituting
originalProcCode.SubstOnlyIf = SubstitutionCondition.Always;
ProcedureCodeT.Update(originalProcCode);
FeeT.CreateFee(ucrFeeSchedNum, originalProcCode.CodeNum, 100);
FeeT.CreateFee(ucrFeeSchedNum, downgradeProcCode.CodeNum, 80);
FeeT.CreateFee(ppoFeeSchedNum, originalProcCode.CodeNum, 60);
FeeT.CreateFee(ppoFeeSchedNum, downgradeProcCode.CodeNum, 50);
Procedure proc = ProcedureT.CreateProcedure(pat, "D2330", ProcStat.C, "9", 100);//Tooth 9
List <ClaimProc> listClaimProcs = ClaimProcs.Refresh(pat.PatNum);
List <Procedure> listProcs = Procedures.Refresh(pat.PatNum);
ins.RefreshBenefits();
Claim claim = ClaimT.CreateClaim("P", ins.ListPatPlans, ins.ListInsPlans, listClaimProcs, listProcs, pat, listProcs, ins.ListBenefits, ins.ListInsSubs);
ClaimProc clProc = ClaimProcs.Refresh(pat.PatNum)[0]; //Should only be one
Assert.AreEqual(50, clProc.Percentage);
Assert.AreEqual(30, clProc.BaseEst);
Assert.AreEqual(30, clProc.InsPayEst);
Assert.AreEqual(40, clProc.WriteOffEst);
}
public void RpProcNotBilledIns_GetProcsNotBilled_MedicalInsOnly()
{
string suffix = MethodBase.GetCurrentMethod().Name;
Patient patient = PatientT.CreatePatient(suffix);
Carrier carrier = CarrierT.CreateCarrier(suffix);
ProcedureCode procedureCode = ProcedureCodeT.CreateProcCode("T7782");
//Create a primary medical insurance plan
InsuranceInfo insuranceInfo = InsuranceT.AddInsurance(patient, carrier.CarrierName, ordinal: 1, isMedical: true);
insuranceInfo.AddBenefit(BenefitT.CreatePercentForProc(insuranceInfo.MedInsPlan.PlanNum, procedureCode.CodeNum, 80));
Procedure procedure = ProcedureT.CreateProcedure(patient, procedureCode.ProcCode, ProcStat.TP, "", 55, procDate: DateTime.Now.AddDays(-3));
ProcedureT.ComputeEstimates(patient, insuranceInfo);
ProcedureT.SetComplete(procedure, patient, insuranceInfo);
//Run the procs not billed report with "includeMedProcs" set to false.
//The patient should not be returned due to not having any dental insurance estimates.
DataTable table = RpProcNotBilledIns.GetProcsNotBilled(new List <long>(), false, DateTime.Now.AddDays(-10), DateTime.Now, false, false);
Assert.IsNotNull(table);
Assert.IsFalse(table.Select().Select(x => PIn.Long(x["PatNum"].ToString())).Contains(patient.PatNum));
//Run the procs not billed report with "includeMedProcs" set to true.
//The patient should be returned due to the medical insurance estimates.
table = RpProcNotBilledIns.GetProcsNotBilled(new List <long>(), true, DateTime.Now.AddDays(-10), DateTime.Now, false, false);
Assert.IsNotNull(table);
Assert.IsTrue(table.Rows.Count > 0);
Assert.IsTrue(table.Select().Select(x => PIn.Long(x["PatNum"].ToString())).Contains(patient.PatNum));
}
public void TearDownTest()
{
BenefitT.ClearBenefitTable();
CarrierT.ClearCarrierTable();
ClaimT.ClearClaimTable();
ClaimProcT.ClearClaimProcTable();
EtransT.ClearEtransTable();
InsPlanT.ClearInsPlanTable();
InsSubT.ClearInsSubTable();
PatientT.ClearPatientTable();
PatPlanT.ClearPatPlanTable();
ProcedureT.ClearProcedureTable();
SubstitutionLinkT.ClearSubstitutionLinkTable();
}
public void InsPlan_GetDedRemainDisplay_IndividualAndFamilyDeductiblesInsRemaining()
{
string suffix = "20";
Patient pat = PatientT.CreatePatient(suffix); //guarantor
long patNum = pat.PatNum;
Patient pat2 = PatientT.CreatePatient(suffix);
PatientT.SetGuarantor(pat2, pat.PatNum);
Patient pat3 = PatientT.CreatePatient(suffix);
PatientT.SetGuarantor(pat3, pat.PatNum);
Carrier carrier = CarrierT.CreateCarrier(suffix);
InsPlan plan = InsPlanT.CreateInsPlan(carrier.CarrierNum);
long planNum = plan.PlanNum;
InsSub sub = InsSubT.CreateInsSub(pat.PatNum, planNum); //guarantor is subscriber
long subNum = sub.InsSubNum;
PatPlan patPlan = PatPlanT.CreatePatPlan(1, pat.PatNum, subNum); //all three patients have the same plan
PatPlan patPlan2 = PatPlanT.CreatePatPlan(1, pat2.PatNum, subNum); //all three patients have the same plan
PatPlan patPlan3 = PatPlanT.CreatePatPlan(1, pat3.PatNum, subNum); //all three patients have the same plan
BenefitT.CreateDeductibleGeneral(planNum, BenefitCoverageLevel.Individual, 75);
BenefitT.CreateDeductibleGeneral(planNum, BenefitCoverageLevel.Family, 150);
ClaimProcT.AddInsUsedAdjustment(pat3.PatNum, planNum, 0, subNum, 75); //Adjustment goes on the third patient
Procedure proc = ProcedureT.CreateProcedure(pat2, "D2750", ProcStat.C, "20", 1280); //proc for second patient with a deductible already applied.
ClaimProcT.AddInsPaid(pat2.PatNum, planNum, proc.ProcNum, 304, subNum, 50, 597);
proc = ProcedureT.CreateProcedure(pat, "D4355", ProcStat.TP, "", 135); //proc is for the first patient
long procNum = proc.ProcNum;
//Lists
List <ClaimProc> claimProcs = ClaimProcs.Refresh(patNum);
Family fam = Patients.GetFamily(patNum);
List <InsSub> subList = InsSubs.RefreshForFam(fam);
List <InsPlan> planList = InsPlans.RefreshForSubList(subList);
List <PatPlan> patPlans = PatPlans.Refresh(patNum);
List <Benefit> benefitList = Benefits.Refresh(patPlans, subList);
List <ClaimProcHist> histList = ClaimProcs.GetHistList(patNum, benefitList, patPlans, planList, DateTime.Today, subList);
List <ClaimProcHist> loopList = new List <ClaimProcHist>();
//Validate
List <ClaimProcHist> HistList = ClaimProcs.GetHistList(pat.PatNum, benefitList, patPlans, planList, DateTime.Today, subList);
double dedFam = Benefits.GetDeductGeneralDisplay(benefitList, planNum, patPlan.PatPlanNum, BenefitCoverageLevel.Family);
double ded = Benefits.GetDeductGeneralDisplay(benefitList, planNum, patPlan.PatPlanNum, BenefitCoverageLevel.Individual);
double dedRem = InsPlans.GetDedRemainDisplay(HistList, DateTime.Today, planNum, patPlan.PatPlanNum, -1, planList, pat.PatNum, ded, dedFam); //test family and individual deductible together
Assert.AreEqual(25, dedRem);
dedRem = InsPlans.GetDedRemainDisplay(HistList, DateTime.Today, planNum, patPlan.PatPlanNum, -1, planList, pat.PatNum, ded, -1); //test individual deductible by itself
Assert.AreEqual(75, dedRem);
}
public void Claims_CalculateAndUpdate_ProcedureCodeDowngradeHigherFee()
{
string suffix = "61";
Patient pat = PatientT.CreatePatient(suffix);
long ucrFeeSchedNum = FeeSchedT.CreateFeeSched(FeeScheduleType.Normal, "UCR Fees" + suffix);
long ppoFeeSchedNum = FeeSchedT.CreateFeeSched(FeeScheduleType.Normal, "PPO Downgrades" + suffix);
Carrier carrier = CarrierT.CreateCarrier(suffix);
InsPlan plan = InsPlanT.CreateInsPlan(carrier.CarrierNum);
InsSub sub = InsSubT.CreateInsSub(pat.PatNum, plan.PlanNum);
long subNum = sub.InsSubNum;
BenefitT.CreateCategoryPercent(plan.PlanNum, EbenefitCategory.Restorative, 100);
PatPlanT.CreatePatPlan(1, pat.PatNum, subNum);
ProcedureCode originalProcCode = ProcedureCodes.GetProcCode("D2391");
ProcedureCode downgradeProcCode = ProcedureCodes.GetProcCode("D2140");
originalProcCode.SubstitutionCode = "D2140";
originalProcCode.SubstOnlyIf = SubstitutionCondition.Always;
ProcedureCodes.Update(originalProcCode);
FeeT.CreateFee(ucrFeeSchedNum, originalProcCode.CodeNum, 140);
FeeT.CreateFee(ucrFeeSchedNum, downgradeProcCode.CodeNum, 120);
FeeT.CreateFee(ppoFeeSchedNum, originalProcCode.CodeNum, 80);
FeeT.CreateFee(ppoFeeSchedNum, downgradeProcCode.CodeNum, 100);
Procedure proc = ProcedureT.CreateProcedure(pat, "D2391", ProcStat.C, "1", 140);//Tooth 1
List <ClaimProc> claimProcs = ClaimProcs.Refresh(pat.PatNum);
List <ClaimProc> claimProcListOld = new List <ClaimProc>();
Family fam = Patients.GetFamily(pat.PatNum);
List <InsSub> subList = InsSubs.RefreshForFam(fam);
List <InsPlan> planList = InsPlans.RefreshForSubList(subList);
List <PatPlan> patPlans = PatPlans.Refresh(pat.PatNum);
List <Benefit> benefitList = Benefits.Refresh(patPlans, subList);
List <Procedure> ProcList = Procedures.Refresh(pat.PatNum);
InsPlan insPlan = planList[0];//Should only be one
InsPlan planOld = insPlan.Copy();
insPlan.PlanType = "p";
insPlan.FeeSched = ppoFeeSchedNum;
InsPlans.Update(insPlan, planOld);
//Creates the claim in the same manner as the account module, including estimates.
Claim claim = ClaimT.CreateClaim("P", patPlans, planList, claimProcs, ProcList, pat, ProcList, benefitList, subList);
ClaimProc clProc = ClaimProcs.Refresh(pat.PatNum)[0]; //Should only be one
Assert.AreEqual(80, clProc.InsEstTotal);
Assert.AreEqual(60, clProc.WriteOff);
}
public void FeeSchedTools_GlobalUpdateWriteoffEstimates()
{
string suffix = MethodBase.GetCurrentMethod().Name;
string procStr = "D0145";
double procFee = 100;
ProcedureCode procCode = ProcedureCodes.GetProcCode(procStr);
//Set up clinic, prov, pat
Clinic clinic = ClinicT.CreateClinic(suffix);
long feeSchedNum = FeeSchedT.CreateFeeSched(FeeScheduleType.FixedBenefit, suffix);
long provNum = ProviderT.CreateProvider(suffix, feeSchedNum: feeSchedNum);
Fee fee = FeeT.GetNewFee(feeSchedNum, procCode.CodeNum, procFee, clinic.ClinicNum, provNum);
Patient pat = PatientT.CreatePatient(suffix, provNum, clinic.ClinicNum);
//Set up insurance
InsuranceInfo info = InsuranceT.AddInsurance(pat, suffix, "c", feeSchedNum);
List <InsSub> listSubs = info.ListInsSubs;
List <InsPlan> listPlans = info.ListInsPlans;
List <PatPlan> listPatPlans = info.ListPatPlans;
InsPlan priPlan = info.PriInsPlan;
InsSub priSub = info.PriInsSub;
info.ListBenefits.Add(BenefitT.CreatePercentForProc(priPlan.PlanNum, procCode.CodeNum, 90));
//Create the procedure and claimproc
Procedure proc = ProcedureT.CreateProcedure(pat, procStr, ProcStat.TP, "", procFee);
ClaimProc priClaimProc = ClaimProcT.CreateClaimProc(pat.PatNum, proc.ProcNum, priPlan.PlanNum, priSub.InsSubNum, DateTime.Today, -1, -1, -1,
ClaimProcStatus.CapEstimate);
Procedures.ComputeEstimates(proc, pat.PatNum, new List <ClaimProc>(), true, listPlans, listPatPlans, info.ListBenefits, pat.Age, info.ListInsSubs);
priClaimProc = ClaimProcs.Refresh(pat.PatNum).FirstOrDefault(x => x.ProcNum == proc.ProcNum);
Assert.AreEqual(procFee, priClaimProc.WriteOff);
procFee = 50;
Procedure procNew = proc.Copy();
procNew.ProcFee = procFee;
Procedures.Update(procNew, proc);
//GlobalUpdate
long updated = GlobalUpdateWriteoffs(clinic.ClinicNum);
Assert.AreEqual(1, updated);
ClaimProc priClaimProcDb = ClaimProcs.Refresh(pat.PatNum).FirstOrDefault(x => x.ClaimProcNum == priClaimProc.ClaimProcNum);
Assert.AreEqual(procFee, priClaimProcDb.WriteOff);
}
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");
}
public void Claims_CalculateAndUpdate_Allowed1Allowed2CompletedProcedures()
{
string suffix = "8";
Patient pat = PatientT.CreatePatient(suffix);
long patNum = pat.PatNum;
long feeSchedNum1 = FeeSchedT.CreateFeeSched(FeeScheduleType.Normal, suffix);
long feeSchedNum2 = FeeSchedT.CreateFeeSched(FeeScheduleType.Normal, suffix + "b");
//Standard Fee
long codeNum = ProcedureCodes.GetCodeNum("D2750");
Fee fee = Fees.GetFee(codeNum, 53, 0, 0);
if (fee == null)
{
fee = new Fee();
fee.CodeNum = codeNum;
fee.FeeSched = 53;
fee.Amount = 1200;
Fees.Insert(fee);
}
else
{
fee.Amount = 1200;
Fees.Update(fee);
}
//PPO fees
fee = new Fee();
fee.CodeNum = codeNum;
fee.FeeSched = feeSchedNum1;
fee.Amount = 600;
Fees.Insert(fee);
fee = new Fee();
fee.CodeNum = codeNum;
fee.FeeSched = feeSchedNum2;
fee.Amount = 800;
Fees.Insert(fee);
//Carrier
Carrier carrier = CarrierT.CreateCarrier(suffix);
long planNum1 = InsPlanT.CreateInsPlanPPO(carrier.CarrierNum, feeSchedNum1).PlanNum;
long planNum2 = InsPlanT.CreateInsPlanPPO(carrier.CarrierNum, feeSchedNum2).PlanNum;
InsSub sub1 = InsSubT.CreateInsSub(pat.PatNum, planNum1);
long subNum1 = sub1.InsSubNum;
InsSub sub2 = InsSubT.CreateInsSub(pat.PatNum, planNum2);
long subNum2 = sub2.InsSubNum;
BenefitT.CreateCategoryPercent(planNum1, EbenefitCategory.Crowns, 50);
BenefitT.CreateCategoryPercent(planNum2, EbenefitCategory.Crowns, 50);
BenefitT.CreateAnnualMax(planNum1, 1000);
BenefitT.CreateAnnualMax(planNum2, 1000);
PatPlanT.CreatePatPlan(1, patNum, subNum1);
PatPlanT.CreatePatPlan(2, patNum, subNum2);
Procedure proc = ProcedureT.CreateProcedure(pat, "D2750", ProcStat.TP, "8", Fees.GetAmount0(codeNum, 53)); //crown on 8
long procNum = proc.ProcNum;
//Lists
List <ClaimProc> claimProcs = ClaimProcs.Refresh(patNum);
Family fam = Patients.GetFamily(patNum);
List <InsSub> subList = InsSubs.RefreshForFam(fam);
List <InsPlan> planList = InsPlans.RefreshForSubList(subList);
List <PatPlan> patPlans = PatPlans.Refresh(patNum);
List <Benefit> benefitList = Benefits.Refresh(patPlans, subList);
List <Procedure> procList = Procedures.Refresh(patNum);
//Set complete and attach to claim
ProcedureT.SetComplete(proc, pat, planList, patPlans, claimProcs, benefitList, subList);
claimProcs = ClaimProcs.Refresh(patNum);
List <Procedure> procsForClaim = new List <Procedure>();
procsForClaim.Add(proc);
Claim claim = ClaimT.CreateClaim("P", patPlans, planList, claimProcs, procList, pat, procsForClaim, benefitList, subList);
//Validate
Assert.AreEqual(500, claim.WriteOff);
}
