public void TransformToInstitutionalClaim4010Test()
{
var service = new ClaimTransformationService();
Stream stream = Assembly.GetExecutingAssembly().GetManifestResourceStream("OopFactory.X12.Hipaa.Tests.Unit.Claims.TestData.InstitutionalClaim4010.txt");
var document = service.Transform837ToClaimDocument(stream);
string xml = document.Serialize();
Trace.Write(xml);
Assert.AreEqual(1, document.Claims.Count, "Expected one claim");
Claim claim = document.Claims.First();
// Box 1 - Service Location
Assert.AreEqual("JONES HOSPITAL", claim.ServiceLocation.Name.LastName, "Unexpected Billing Provider Last Name");
Assert.AreEqual("225 MAIN STREET BARKLEY BUILDING", claim.ServiceLocation.Address.Line1, "Unexpected Billing Provider Adddress Line 1");
Assert.AreEqual("CENTERVILLE", claim.ServiceLocation.Address.City, "Unexpected Billing Provider Address City");
Assert.AreEqual("PA", claim.ServiceLocation.Address.StateCode, "Unexpected Billing Provider Address State Code");
Assert.AreEqual("17111", claim.ServiceLocation.Address.PostalCode, "Unexpected Billing Provider Address Postal Code");
// Box 2 - Pay To Provider
Assert.AreEqual(ClaimTypeEnum.Institutional, claim.Type);
Assert.AreEqual("JONES HOSPITAL", claim.PayToProvider.Name.LastName, "Unexpected Billing Provider Last Name");
Assert.AreEqual("225 MAIN STREET BARKLEY BUILDING", claim.PayToProvider.Address.Line1, "Unexpected Billing Provider Adddress Line 1");
Assert.AreEqual("CENTERVILLE", claim.PayToProvider.Address.City, "Unexpected Billing Provider Address City");
Assert.AreEqual("PA", claim.PayToProvider.Address.StateCode, "Unexpected Billing Provider Address State Code");
Assert.AreEqual("17111", claim.PayToProvider.Address.PostalCode, "Unexpected Billing Provider Address Postal Code");
// Box 3a - Patient Control Number
Assert.AreEqual("756048Q", claim.PatientControlNumber, "Unexpected PatientControlNumber");
// Box 3b - Type of Bill
Assert.AreEqual("TEST MEDICAL RECORD NUMBER", claim.MedicalRecordNumber, "Unexpected MedicalRecordNumber");
// Box 4 - Type of Bill
Assert.AreEqual("14", claim.ServiceLocationInfo.FacilityCode, "Unexpected facility code");
Assert.AreEqual("A", claim.ServiceLocationInfo.Qualifier, "Unexpected facility code qualifier");
Assert.AreEqual("1", claim.ServiceLocationInfo.FrequencyTypeCode, "Unexpected frequency type code");
// Box 5 - Federal Tax Number
Assert.AreEqual("123456789", claim.PayToProvider.TaxId, "Unexpected Federal Tax ID");
// Box 6 Statement Covers Period
Assert.AreEqual(DateTime.Parse("1996-9-11"), claim.StatementFromDate, "Unexpected statement from date");
Assert.AreEqual(DateTime.Parse("1996-9-11"), claim.StatementToDate, "Unexpected statement through date");
// Box 7 - Filler
ClaimMember patient = claim.Patient ?? claim.Subscriber;
// Box 8 - Patient Name
Assert.AreEqual("DOE", patient.Name.LastName, "Unexpected patient last name");
Assert.AreEqual("JOHN", patient.Name.FirstName, "Unexpected patient first name");
Assert.AreEqual("T", patient.Name.MiddleName, "Unexpected patient middle name");
Assert.AreEqual("030005074A", patient.MemberId);
// Box 9 Patient Address
Assert.AreEqual("125 CITY AVENUE", patient.Address.Line1, "Unexpected patient address line 1");
Assert.AreEqual("CENTERVILLE", patient.Address.City, "Unexpected patient address city");
Assert.AreEqual("PA", patient.Address.StateCode, "Unexpected patient address state code");
Assert.AreEqual("17111", patient.Address.PostalCode, "Unexpected patient address postal code");
// Box 10 Birthdate
Assert.AreEqual(DateTime.Parse("1926-11-11"), patient.DateOfBirth);
// Box 11 Sex
Assert.AreEqual(GenderEnum.Male, patient.Gender);
// Box 12 & 13 Admission Date and Hour
Assert.AreEqual(DateTime.Parse("1996-09-10 2:02 PM"), claim.AdmissionDate);
// Box 14 Admission Type
// Box 15 Admission Source
Assert.AreEqual(2, claim.ServiceLines.Count, "Unexpected number of service lines.");
ServiceLine line = claim.ServiceLines[0];
Assert.AreEqual("305", line.RevenueCode);
Assert.AreEqual("85025", line.Procedure.ProcedureCode);
}
/// <summary>
/// Takes a generic claim object stream parameter and maps properties to
/// corresponding properties in the HCFA 1500 claim. Returns a HCFA1500 claim.
/// Follows crosswalk published at http://www.nucc.org/images/stories/PDF/1500_form_map_to_837p_4010a1_v1-0_112008.pdf
/// </summary>
/// <param name="claim"></param>
/// <returns></returns>
public virtual HCFA1500Claim TransformClaimToHcfa1500(Claim claim)
{
var hcfa = new HCFA1500Claim();
if (claim == null)
{
hcfa.Field24_ServiceLines = new List <HCFA1500ServiceLine>();
hcfa.Field24_ServiceLines.Add(new HCFA1500ServiceLine());
return(hcfa);
}
String indicatorCode = null;
if (claim.SubscriberInformation != null &&
claim.SubscriberInformation.ClaimFilingIndicatorCode != null)
{
indicatorCode = claim.SubscriberInformation.ClaimFilingIndicatorCode;
}
switch (indicatorCode)
{
case "CH":
hcfa.Field01_TypeOfCoverageIsTricareChampus = true;
break;
case "MB":
hcfa.Field01_TypeOfCoverageIsMedicare = true;
break;
case "MC":
hcfa.Field01_TypeOfCoverageIsMedicaid = true;
break;
case "VA":
hcfa.Field01_TypeOfCoverageIsChampVa = true;
break;
default:
if (claim.SubscriberInformation != null && claim.SubscriberInformation.ClaimFilingIndicatorCode != null)
{
hcfa.Field01_TypeOfCoverageIsOther = true;
}
break;
}
// XXX: I don't see any code corresponding to FECA Black Lung in the 837P standard
hcfa.Field01_TypeOfCoverageIsFECABlkLung = false;
hcfa.Field01_TypeOfCoverageIsGroupHealthPlan = false;
ClaimMember patient = claim.Patient ?? claim.Subscriber;
ClaimMember subscriber = claim.Subscriber;
if (!String.IsNullOrEmpty(patient.MemberId))
{
hcfa.Field01a_InsuredsIDNumber = patient.MemberId;
}
else if (patient != null &&
patient.Name != null &&
patient.Name.Identification != null &&
!string.IsNullOrEmpty(patient.Name.Identification.Id))
{
hcfa.Field01a_InsuredsIDNumber = patient.Name.Identification.Id;
}
else if (!String.IsNullOrEmpty(subscriber.MemberId))
{
hcfa.Field01a_InsuredsIDNumber = subscriber.MemberId;
}
else if (subscriber != null &&
subscriber.Name != null &&
subscriber.Name.Identification != null &&
!string.IsNullOrEmpty(subscriber.Name.Identification.Id))
{
hcfa.Field01a_InsuredsIDNumber = subscriber.Name.Identification.Id;
}
hcfa.Field01a_InsuredsIDNumber = hcfa.Field01a_InsuredsIDNumber;
// Patient Name
if (patient.Name != null)
{
hcfa.Field02_PatientsName = patient.Name.Formatted();
}
// patient birthdate
if (patient.DateOfBirth != null)
{
hcfa.Field03_PatientsDateOfBirth = formatFormDate(patient.DateOfBirth);
}
hcfa.Field03_PatientsSexFemale = patient.Gender == GenderEnum.Female;
hcfa.Field03_PatientsSexMale = patient.Gender == GenderEnum.Male;
if (subscriber.Name != null)
{
hcfa.Field04_InsuredsName = subscriber.Name.Formatted();
}
// Patient Address
if (patient.Address != null)
{
hcfa.Field05_PatientsAddress_Street = String.Format("{0} {1}", patient.Address.Line1, patient.Address.Line2).TrimEnd();
hcfa.Field05_PatientsAddress_City = patient.Address.City;
hcfa.Field05_PatientsAddress_State = patient.Address.StateCode;
hcfa.Field05_PatientsAddress_Zip = patient.Address.PostalCode;
}
// Relationship information from https://www.cahabagba.com/part_b/msp/Providers_Electronic_Billing_Instructions.htm
String patientRelationship = String.Empty;
if (claim.Patient != null && claim.Patient.Relationship != null)
{
patientRelationship = claim.Patient.Relationship.Code;
}
else if (claim.SubscriberInformation != null)
{
patientRelationship = claim.SubscriberInformation.IndividualRelationshipCode;
}
switch (patientRelationship)
{
case "01":
hcfa.Field06_PatientRelationshipToInsuredIsSpouseOf = true;
break;
case "19":
hcfa.Field06_PatientRelationshipToInsuredIsChildOf = true;
break;
case "18":
hcfa.Field06_PatientRelationshipToInsuredIsSelf = true;
break;
default:
if (claim.SubscriberInformation != null && claim.SubscriberInformation.ClaimFilingIndicatorCode != null)
{
hcfa.Field06_PatientRelationshipToInsuredIsOther = true;
}
break;
}
if (subscriber.Address != null)
{
hcfa.Field07_InsuredsAddress_Street = subscriber.Address.Line1;
hcfa.Field07_InsuredsAddress_City = subscriber.Address.City;
hcfa.Field07_InsuredsAddress_State = subscriber.Address.StateCode;
hcfa.Field07_InsuredsAddress_Zip = subscriber.Address.PostalCode;
}
// Not present on 837P
hcfa.Field07_InsuredsAreaCode = String.Empty;
hcfa.Field07_InsuredsPhoneNumber = String.Empty;
// Not present on 837P
hcfa.Field08_PatientStatusIsEmployed = false;
hcfa.Field08_PatientStatusIsFullTimeStudent = false;
hcfa.Field08_PatientStatusIsMarried = false;
hcfa.Field08_PatientStatusIsOther = false;
hcfa.Field08_PatientStatusIsPartTimeStudent = false;
hcfa.Field08_PatientStatusIsSingle = false;
OtherSubscriberInformation otherSubscriber = null;
if (claim.OtherSubscriberInformations != null)
{
otherSubscriber = claim.OtherSubscriberInformations.FirstOrDefault();
}
// No way to get below three fields using 837P
hcfa.Field09b_OtherInsuredIsFemale = false;
hcfa.Field09b_OtherInsuredIsMale = false;
hcfa.Field09b_OtherInsuredsDateOfBirth = new FormDate();
if (otherSubscriber != null)
{
if (otherSubscriber.Name != null)
{
hcfa.Field09_OtherInsuredsName = otherSubscriber.Name.Formatted();
}
if (otherSubscriber.SubscriberInformation != null)
{
hcfa.Field09a_OtherInsuredsPolicyOrGroup = otherSubscriber.SubscriberInformation.ReferenceIdentification;
}
hcfa.Field09b_OtherInsuredsDateOfBirth = formatFormDate(otherSubscriber.DateOfBirth);
hcfa.Field09b_OtherInsuredIsFemale = otherSubscriber.Gender == GenderEnum.Female;
hcfa.Field09b_OtherInsuredIsMale = otherSubscriber.Gender == GenderEnum.Male;
hcfa.Field09c_OtherInsuredsEmployerNameOrSchoolName = String.Empty; // XXX: OK to assume org in last name? , Edit: this field should be left blank
if (otherSubscriber.OtherPayer != null)
{
hcfa.Field09d_OtherInsuredsInsurancePlanNameOrProgramName = otherSubscriber.OtherPayer.LastName;
}
}
hcfa.Field10a_PatientConditionRelatedToEmployment = claim.RelatedCauseCode1 == "EM" || claim.RelatedCauseCode2 == "EM" || claim.RelatedCauseCode3 == "EM";
hcfa.Field10b_PatientConditionRelatedToAutoAccident = claim.RelatedCauseCode1 == "AA" || claim.RelatedCauseCode2 == "AA" || claim.RelatedCauseCode3 == "AA";
hcfa.Field10c_PatientConditionRelatedToOtherAccident = claim.RelatedCauseCode1 == "AB" || claim.RelatedCauseCode1 == "AP" || claim.RelatedCauseCode1 == "OA" ||
claim.RelatedCauseCode2 == "AB" || claim.RelatedCauseCode2 == "AP" || claim.RelatedCauseCode2 == "OA" ||
claim.RelatedCauseCode3 == "AB" || claim.RelatedCauseCode3 == "AP" || claim.RelatedCauseCode3 == "OA";
hcfa.Field10b_PatientConditionRelToAutoAccidentState = claim.AutoAccidentState;
if (hcfa.Field10a_PatientConditionRelatedToEmployment)
{
hcfa.Field10d_ReservedForLocalUse = String.Empty;
}
if (claim.SubscriberInformation != null)
{
hcfa.Field11_InsuredsPolicyGroupOfFECANumber = claim.SubscriberInformation.ReferenceIdentification;
}
if (subscriber != null)
{
hcfa.Field11a_InsuredsDateOfBirth = formatFormDate(subscriber.DateOfBirth);
hcfa.Field11a_InsuredsSexIsFemale = subscriber.Gender == GenderEnum.Female;
hcfa.Field11a_InsuredsSexIsMale = subscriber.Gender == GenderEnum.Male;
}
if (claim.Payer != null)
{
hcfa.Field11b_InsuredsEmployerOrSchool = String.Empty; // should be left blank
if (claim.Payer.Name != null)
{
hcfa.Field11c_InsuredsPlanOrProgramName = claim.Payer.Name.LastName;
}
}
hcfa.Field11d_IsThereOtherHealthBenefitPlan = otherSubscriber != null;
hcfa.Field12_PatientsOrAuthorizedSignature = claim.ReleaseOfInformationCode == "Y" ? "Signature on file" : String.Empty;
hcfa.Field12_PatientsOrAuthorizedSignatureDate = new FormDate();
hcfa.Field13_InsuredsOrAuthorizedSignature = claim.BenefitsAssignmentCertificationIndicator == "Y" ? "Signature on file" : String.Empty;
var onsetDate = claim.Dates.FirstOrDefault(dr => dr.Qualifier == "431") ?? claim.Dates.FirstOrDefault(dr => dr.Qualifier == "439");
if (onsetDate != null)
{
hcfa.Field14_DateOfCurrentIllnessInjuryOrPregnancy = formatFormDate(onsetDate.Date);
}
var similarIllnessDate = claim.Dates.FirstOrDefault(dr => dr.Qualifier == "438"); // only supported in 4010 837P
if (similarIllnessDate != null)
{
hcfa.Field15_DatePatientHadSameOrSimilarIllness = formatFormDate(similarIllnessDate.Date);
}
var disabilityStart = claim.Dates.FirstOrDefault(dr => dr.Qualifier == "360");
var disabilityEnd = claim.Dates.FirstOrDefault(dr => dr.Qualifier == "361");
if (disabilityStart != null)
{
hcfa.Field16_DatePatientUnableToWork_Start = formatFormDate(disabilityStart.Date);
}
if (disabilityEnd != null)
{
hcfa.Field16_DatePatientUnableToWork_End = formatFormDate(disabilityEnd.Date);
}
var referringProvider = claim.Providers.FirstOrDefault(pr => pr.Name.Type.Identifier == "DN" && pr.Name.Identification.Qualifier == "XX");
if (referringProvider != null)
{
hcfa.Field17_ReferringProviderOrOtherSource_Name = referringProvider.Name.Formatted();
var id = referringProvider.Identifications.FirstOrDefault();
if (id != null)
{
hcfa.Field17a_OtherID_Number = id.Id;
hcfa.Field17a_OtherID_Qualifier = id.Qualifier;
}
hcfa.Field17b_NationalProviderIdentifier = referringProvider.Npi;
}
// Admission date and hour
hcfa.Field18_HospitalizationDateFrom = new FormDate();
hcfa.Field18_HospitalizationDateTo = new FormDate();
if (claim.AdmissionDate.HasValue)
{
hcfa.Field18_HospitalizationDateFrom = formatFormDate(claim.AdmissionDate);
}
if (claim.DischargeTime.HasValue)
{
hcfa.Field18_HospitalizationDateTo = formatFormDate(claim.DischargeTime);
}
// Populating Loc19 with notes from 837
// There can only be one note
hcfa.Field19_ReservedForLocalUse = (claim.Notes.Count >= 1) ? claim.Notes[0].Description : System.String.Empty;
// Outside services are stored in claim service lines
double totalAmountSpent = 0.0;
foreach (var line in claim.ServiceLines)
{
if (line.PurchasedServiceIdentifier != null)
{
hcfa.Field20_OutsideLab = true;
if (line.PurchasedServiceAmount != null)
{
totalAmountSpent += Convert.ToDouble(line.PurchasedServiceAmount);
}
}
}
hcfa.Field20_OutsideLabCharges = (Decimal)totalAmountSpent;
var principalDiagnosis = claim.Diagnoses.FirstOrDefault(d => d.DiagnosisType == DiagnosisTypeEnum.Principal);
var otherDiagnoses = claim.Diagnoses.Where(d => d.DiagnosisType == DiagnosisTypeEnum.Other).ToList();
// Diagnosis codes
if (principalDiagnosis != null)
{
hcfa.Field21_Diagnosis1 = principalDiagnosis.FormattedCode();
}
if (otherDiagnoses.Count >= 1)
{
hcfa.Field21_Diagnosis2 = otherDiagnoses[0].FormattedCode();
}
if (otherDiagnoses.Count >= 2)
{
hcfa.Field21_Diagnosis3 = otherDiagnoses[1].FormattedCode();
}
if (otherDiagnoses.Count >= 3)
{
hcfa.Field21_Diagnosis4 = otherDiagnoses[2].FormattedCode();
}
var frequencyType = "";
if (claim.BillTypeCode.Length == 3)
{
frequencyType = claim.BillTypeCode.Substring(2, 1);
}
if (frequencyType == "7" || frequencyType == "8")
{
hcfa.Field22_MedicaidSubmissionCode = frequencyType;
}
else
{
hcfa.Field22_MedicaidSubmissionCode = String.Empty;
}
var originalRef = claim.Identifications.FirstOrDefault(id => id.Qualifier == "F8");
if (originalRef != null)
{
hcfa.Field22_OriginalReferenceNumber = originalRef.Id;
}
else
{
hcfa.Field22_OriginalReferenceNumber = String.Empty;
}
hcfa.Field23_PriorAuthorizationNumber = claim.PriorAuthorizationNumber;
var hcfaServiceLines = new List <HCFA1500ServiceLine>();
// Service Lines
foreach (var line in claim.ServiceLines)
{
var hcfaLine = new HCFA1500ServiceLine();
hcfaLine.DateFrom = new FormDate
{
MM = String.Format("{0:MM}", line.ServiceDateFrom),
DD = String.Format("{0:dd}", line.ServiceDateFrom),
YY = String.Format("{0:yy}", line.ServiceDateFrom)
};
hcfaLine.DateTo = new FormDate
{
MM = String.Format("{0:MM}", line.ServiceDateTo),
DD = String.Format("{0:dd}", line.ServiceDateTo),
YY = String.Format("{0:yy}", line.ServiceDateTo)
};
if (line.PlaceOfService != null && !string.IsNullOrWhiteSpace(line.PlaceOfService.Code))
{
hcfaLine.PlaceOfService = line.PlaceOfService.Code;
}
else
{
hcfaLine.PlaceOfService = claim.ServiceLocationInfo.FacilityCode;
}
hcfaLine.EmergencyIndicator = line.EmergencyIndicator;
hcfaLine.ProcedureCode = line.Procedure.ProcedureCode;
hcfaLine.ProcedureCode = line.Procedure.ProcedureCode;
hcfaLine.Mod1 = line.Procedure.Modifier1;
hcfaLine.Mod2 = line.Procedure.Modifier2;
hcfaLine.Mod3 = line.Procedure.Modifier3;
hcfaLine.Mod4 = line.Procedure.Modifier4;
hcfaLine.DiagnosisPointer1 = line.DiagnosisCodePointer1;
hcfaLine.DiagnosisPointer2 = line.DiagnosisCodePointer2;
hcfaLine.DiagnosisPointer3 = line.DiagnosisCodePointer3;
hcfaLine.DiagnosisPointer4 = line.DiagnosisCodePointer4;
hcfaLine.Charges = line.ChargeAmount;
hcfaLine.DaysOrUnits = line.Quantity;
hcfaLine.EarlyPeriodicScreeningDiagnosisAndTreatment = line.EpsdtIndicator;
if (line.RenderingProvider != null && !string.IsNullOrWhiteSpace(line.RenderingProvider.Npi))
{
hcfaLine.RenderingProviderNpi = line.RenderingProvider.Npi;
}
else if (claim.RenderingProvider != null && !string.IsNullOrWhiteSpace(claim.RenderingProvider.Npi))
{
hcfaLine.RenderingProviderNpi = claim.RenderingProvider.Npi;
}
if (line.RenderingProvider != null && line.RenderingProvider.Identifications.Count > 0)
{
hcfaLine.RenderingProviderIdQualifier = line.RenderingProvider.Identifications[0].Qualifier;
hcfaLine.RenderingProviderId = line.RenderingProvider.Identifications[0].Id;
}
else if (line.RenderingProvider != null && line.RenderingProvider.ProviderInfo != null)
{
hcfaLine.RenderingProviderIdQualifier = line.RenderingProvider.ProviderInfo.Qualifier;
hcfaLine.RenderingProviderId = line.RenderingProvider.ProviderInfo.Id;
}
else if (claim.RenderingProvider != null && claim.RenderingProvider.Identifications.Count > 0)
{
hcfaLine.RenderingProviderIdQualifier = claim.RenderingProvider.Identifications[0].Qualifier;
hcfaLine.RenderingProviderId = claim.RenderingProvider.Identifications[0].Id;
}
else if (claim.RenderingProvider != null && claim.RenderingProvider.ProviderInfo != null)
{
hcfaLine.RenderingProviderIdQualifier = claim.RenderingProvider.ProviderInfo.Qualifier;
hcfaLine.RenderingProviderId = claim.RenderingProvider.ProviderInfo.Id;
}
hcfaServiceLines.Add(hcfaLine);
}
hcfa.Field24_ServiceLines = hcfaServiceLines;
// Federal Tax Number
if (claim.PayToProvider != null && !string.IsNullOrWhiteSpace(claim.PayToProvider.TaxId))
{
hcfa.Field25_FederalTaxIDNumber = claim.PayToProvider.TaxId;
if (claim.PayToProvider.Identifications.Exists(id => id.Qualifier == "EI"))
{
hcfa.Field25_IsEIN = true;
}
if (claim.PayToProvider.Identifications.Exists(id => id.Qualifier == "SY"))
{
hcfa.Field25_IsSSN = true;
}
}
else
{
if (claim.BillingProvider != null)
{
hcfa.Field25_FederalTaxIDNumber = claim.BillingProvider.TaxId;
if (claim.BillingProvider.Identifications.Exists(id => id.Qualifier == "EI"))
{
hcfa.Field25_IsEIN = true;
}
if (claim.BillingProvider.Identifications.Exists(id => id.Qualifier == "SY"))
{
hcfa.Field25_IsSSN = true;
}
}
}
// shouldnt we represent hcfa.Field25_IsSSN and Field25_IsEIN to know which type TaxID?
hcfa.Field26_PatientAccountNumber = claim.PatientControlNumber;
if (claim.ProviderAcceptAssignmentCode == "A" || claim.ProviderAcceptAssignmentCode == "B")
{
hcfa.Field27_AcceptAssignment = true;
}
else if (claim.ProviderAcceptAssignmentCode == "C")
{
hcfa.Field27_AcceptAssignment = false;
}
hcfa.Field28_TotalCharge = claim.TotalClaimChargeAmount;
hcfa.Field29_AmountPaid = claim.PatientAmountPaid ?? 0;
foreach (var otherSubscriberObj in claim.OtherSubscriberInformations)
{
if (otherSubscriberObj.Amounts.Count > 0)
{
hcfa.Field29_AmountPaid += otherSubscriberObj.Amounts[0].Amount;
}
}
hcfa.Field30_BalanceDue = hcfa.Field28_TotalCharge - hcfa.Field29_AmountPaid; // does not exist on 837P
if (claim.ProviderSignatureOnFile == "Y")
{
hcfa.Field31_PhysicianOrSupplierSignatureIsOnFile = true;
}
else if (claim.ProviderSignatureOnFile == "N")
{
hcfa.Field31_PhysicianOrSupplierSignatureIsOnFile = false;
}
// Service Location
var serviceLocation = claim.ServiceLocation;
if (serviceLocation != null)
{
if (serviceLocation.Name != null)
{
hcfa.Field32_ServiceFacilityLocation_Name = serviceLocation.Name.LastName;
}
else
{
hcfa.Field32_ServiceFacilityLocation_Name = null;
}
if (serviceLocation.Address != null)
{
hcfa.Field32_ServiceFacilityLocation_Street = serviceLocation.Address.Line1;
hcfa.Field32_ServiceFacilityLocation_City = serviceLocation.Address.City;
hcfa.Field32_ServiceFacilityLocation_State = serviceLocation.Address.StateCode;
hcfa.Field32_ServiceFacilityLocation_Zip = serviceLocation.Address.PostalCode;
}
else
{
hcfa.Field32_ServiceFacilityLocation_Street = string.Empty;
hcfa.Field32_ServiceFacilityLocation_City = string.Empty;
hcfa.Field32_ServiceFacilityLocation_State = string.Empty;
hcfa.Field32_ServiceFacilityLocation_Zip = string.Empty;
}
hcfa.Field32a_ServiceFacilityLocation_Npi = serviceLocation.Npi;
if (serviceLocation.Identifications != null && serviceLocation.Identifications.Count > 0)
{
hcfa.Field32b_ServiceFacilityLocation_OtherID = serviceLocation.Identifications.First().Id;
}
else
{
hcfa.Field32b_ServiceFacilityLocation_OtherID = null;
}
}
// Pay To Provider
if (claim.BillingProvider != null)
{
if (claim.BillingProvider.Name != null)
{
hcfa.Field33_BillingProvider_Name = claim.BillingProvider.Name.LastName;
}
else
{
hcfa.Field33_BillingProvider_Name = null;
}
if (claim.BillingProvider.Address != null)
{
hcfa.Field33_BillingProvider_Street = claim.BillingProvider.Address.Line1;
hcfa.Field33_BillingProvider_City = claim.BillingProvider.Address.City;
hcfa.Field33_BillingProvider_State = claim.BillingProvider.Address.StateCode;
hcfa.Field33_BillingProvider_Zip = claim.BillingProvider.Address.PostalCode;
}
else
{
hcfa.Field33_BillingProvider_Street = string.Empty;
hcfa.Field33_BillingProvider_City = string.Empty;
hcfa.Field33_BillingProvider_State = string.Empty;
hcfa.Field33_BillingProvider_Zip = string.Empty;
}
hcfa.Field33a_BillingProvider_Npi = claim.BillingProvider.Npi;
}
LimitFieldWidths(hcfa);
return(hcfa);
}
public void TransformToInstitutionalClaim5010Test()
{
var service = new ClaimTransformationService();
Stream stream = Assembly.GetExecutingAssembly().GetManifestResourceStream("OopFactory.X12.Hipaa.Tests.Unit.Claims.TestData.InstitutionalClaim5010.txt");
var document = service.Transform837ToClaimDocument(stream);
string xml = document.Serialize();
Assert.AreEqual(1, document.Claims.Count, "Expected one claim");
Claim claim = document.Claims.First();
Trace.Write(claim.Serialize());
Assert.AreEqual(ClaimTypeEnum.Institutional, claim.Type);
// Box 1 - Service Location
Assert.AreEqual("JONES HOSPITAL", claim.ServiceLocation.Name.LastName, "Unexpected Billing Provider Last Name");
Assert.AreEqual("225 MAIN STREET BARKLEY BUILDING", claim.ServiceLocation.Address.Line1, "Unexpected Billing Provider Adddress Line 1");
Assert.AreEqual("CENTERVILLE", claim.ServiceLocation.Address.City, "Unexpected Billing Provider Address City");
Assert.AreEqual("PA", claim.ServiceLocation.Address.StateCode, "Unexpected Billing Provider Address State Code");
Assert.AreEqual("17111", claim.ServiceLocation.Address.PostalCode, "Unexpected Billing Provider Address Postal Code");
// Box 2 - Pay To Provider
Assert.AreEqual("JONES HOSPITAL", claim.PayToProvider.Name.LastName, "Unexpected Billing Provider Last Name");
Assert.AreEqual("225 MAIN STREET BARKLEY BUILDING", claim.PayToProvider.Address.Line1, "Unexpected Billing Provider Adddress Line 1");
Assert.AreEqual("CENTERVILLE", claim.PayToProvider.Address.City, "Unexpected Billing Provider Address City");
Assert.AreEqual("PA", claim.PayToProvider.Address.StateCode, "Unexpected Billing Provider Address State Code");
Assert.AreEqual("17111", claim.PayToProvider.Address.PostalCode, "Unexpected Billing Provider Address Postal Code");
// Box 3a - Patient Control Number
Assert.AreEqual("756048Q", claim.PatientControlNumber, "Unexpected PatientControlNumber");
// Box 3b - Type of Bill
Assert.AreEqual("TEST MEDICAL RECORD NUMBER", claim.MedicalRecordNumber, "Unexpected MedicalRecordNumber");
// Box 4 - Type of Bill
Assert.AreEqual("14", claim.ServiceLocationInfo.FacilityCode, "Unexpected facility code");
Assert.AreEqual("A", claim.ServiceLocationInfo.Qualifier, "Unexpected facility code qualifier");
Assert.AreEqual("1", claim.ServiceLocationInfo.FrequencyTypeCode, "Unexpected frequency type code");
// Box 5 - Federal Tax Number
Assert.AreEqual("567891234", claim.PayToProvider.TaxId, "Unexpected Federal Tax ID");
// Box 6 Statement Covers Period
Assert.AreEqual(DateTime.Parse("1996-9-11"), claim.StatementFromDate, "Unexpected statement from date");
Assert.AreEqual(DateTime.Parse("1996-9-11"), claim.StatementToDate, "Unexpected statement through date");
// Box 7 - Filler
ClaimMember patient = claim.Patient ?? claim.Subscriber;
// Box 8 - Patient Name
Assert.AreEqual("DOE", patient.Name.LastName, "Unexpected patient last name");
Assert.AreEqual("JOHN", patient.Name.FirstName, "Unexpected patient first name");
Assert.AreEqual("T", patient.Name.MiddleName, "Unexpected patient middle name");
Assert.AreEqual("030005074A", patient.MemberId);
// Box 9 Patient Address
Assert.AreEqual("125 CITY AVENUE", patient.Address.Line1, "Unexpected patient address line 1");
Assert.AreEqual("CENTERVILLE", patient.Address.City, "Unexpected patient address city");
Assert.AreEqual("PA", patient.Address.StateCode, "Unexpected patient address state code");
Assert.AreEqual("17111", patient.Address.PostalCode, "Unexpected patient address postal code");
// Box 10 Birthdate
Assert.AreEqual(DateTime.Parse("1926-11-11"), patient.DateOfBirth);
// Box 11 Sex
Assert.AreEqual(GenderEnum.Male, patient.Gender);
// Box 12 & 13 Admission Date and Hour
Assert.AreEqual(DateTime.Parse("1996-09-11 2:02 PM"), claim.AdmissionDate);
// Box 14 Admission Type
// Box 15 Admission Source
// Box 16 Discharge Hour
// Box 17 Discharge Status
// Box 18 through 28 Condition Codes
Assert.AreEqual(14, claim.Conditions.Count);
Assert.AreEqual("01", claim.Conditions[0].Code);
Assert.AreEqual("02", claim.Conditions[1].Code);
Assert.AreEqual("03", claim.Conditions[2].Code);
Assert.AreEqual("04", claim.Conditions[3].Code);
Assert.AreEqual("05", claim.Conditions[4].Code);
Assert.AreEqual("06", claim.Conditions[5].Code);
Assert.AreEqual("07", claim.Conditions[6].Code);
Assert.AreEqual("08", claim.Conditions[7].Code);
Assert.AreEqual("09", claim.Conditions[8].Code);
Assert.AreEqual("10", claim.Conditions[9].Code);
Assert.AreEqual("11", claim.Conditions[10].Code);
// Box 29
// Box 30
// Box 31 through 34 - Occurrences
Assert.AreEqual(8, claim.Occurrences.Count);
Assert.AreEqual("A1", claim.Occurrences[0].Code);
Assert.AreEqual(DateTime.Parse("1926-11-11"), claim.Occurrences[0].Date);
Assert.AreEqual("A2", claim.Occurrences[1].Code);
Assert.AreEqual(DateTime.Parse("1991-11-01"), claim.Occurrences[1].Date);
Assert.AreEqual("B1", claim.Occurrences[2].Code);
Assert.AreEqual(DateTime.Parse("1926-11-11"), claim.Occurrences[2].Date);
Assert.AreEqual("B2", claim.Occurrences[3].Code);
Assert.AreEqual(DateTime.Parse("1987-1-1"), claim.Occurrences[3].Date);
Assert.AreEqual("C1", claim.Occurrences[4].Code);
Assert.AreEqual(DateTime.Parse("1926-11-11"), claim.Occurrences[4].Date);
Assert.AreEqual("C2", claim.Occurrences[5].Code);
Assert.AreEqual(DateTime.Parse("1991-11-1"), claim.Occurrences[5].Date);
Assert.AreEqual("D1", claim.Occurrences[6].Code);
Assert.AreEqual(DateTime.Parse("1926-11-11"), claim.Occurrences[6].Date);
Assert.AreEqual("D2", claim.Occurrences[7].Code);
Assert.AreEqual(DateTime.Parse("1987-1-1"), claim.Occurrences[7].Date);
// Box 35 through 36 - Occurrence Spans
Assert.AreEqual(4, claim.OccurrenceSpans.Count);
Assert.AreEqual("A1", claim.OccurrenceSpans[0].Code);
Assert.AreEqual(DateTime.Parse("1926-11-11"), claim.OccurrenceSpans[0].FromDate);
Assert.AreEqual(DateTime.Parse("1927-12-31"), claim.OccurrenceSpans[0].ThroughDate);
// Box 37 - Filler
// Box 38 - Responsible Party
// Box 39 through 41 - Value Codes
Assert.AreEqual(14, claim.Values.Count);
Assert.AreEqual("A2", claim.Values[0].Code);
Assert.AreEqual(15.31m, claim.Values[0].Amount);
Assert.AreEqual("N2", claim.Values[13].Code);
Assert.AreEqual(28.31m, claim.Values[13].Amount);
// Box 42 through 49 - Service Lines
Assert.AreEqual(2, claim.ServiceLines.Count, "Unexpected number of service lines.");
ServiceLine line = claim.ServiceLines[0];
Assert.AreEqual("0305", line.RevenueCode);
Assert.AreEqual("85025", line.Procedure.ProcedureCode);
Assert.AreEqual(13.39m, line.ChargeAmount);
Assert.AreEqual(1, line.Quantity);
Assert.AreEqual(DateTime.Parse("1996-9-11"), line.ServiceDateFrom);
Assert.IsNull(line.OperatingPhysician);
line = claim.ServiceLines[1];
Assert.AreEqual("0730", line.RevenueCode);
Assert.AreEqual("93005", line.Procedure.ProcedureCode);
Assert.AreEqual("AA", line.Procedure.Modifier1);
Assert.AreEqual("BB", line.Procedure.Modifier2);
Assert.AreEqual("CC", line.Procedure.Modifier3);
Assert.AreEqual("DD", line.Procedure.Modifier4);
Assert.AreEqual("Test Procedure", line.Procedure.Description);
Assert.AreEqual(76.54m, line.ChargeAmount);
Assert.AreEqual(3, line.Quantity);
Assert.AreEqual(11.15m, line.NonCoveredChargeAmount);
Assert.AreEqual(DateTime.Parse("1996-9-11"), line.ServiceDateFrom);
Assert.AreEqual(1, line.Notes.Count);
Assert.AreEqual("TPO", line.Notes[0].Code);
Assert.IsNotNull(line.OperatingPhysician);
Assert.AreEqual("JONES", line.OperatingPhysician.Name.LastName);
Assert.AreEqual("JOHN", line.OperatingPhysician.Name.FirstName);
Assert.AreEqual("B99937", line.OperatingPhysician.Npi);
Assert.AreEqual("363LP0200N", line.OperatingPhysician.ProviderInfo.Id);
// Box 50 through 55 - Payers
// Box 56 - NPI
// Box 57 - Other Provider ID
// Box 68 through 62 - Insured
// Box 63 through 65 - Authorizations
// Box 66 - Diagnosis Version
// Box 67 - Diagnosis
Assert.AreEqual("3669", claim.Diagnoses.First(d => d.DiagnosisType == DiagnosisTypeEnum.Principal).Code);
// Box 68
// Box 69 - Admitting Diagnosis
// Box 70 - Patient Reason Diagnosis
// Box 71 - PPS Code
// Box 72 - ECI
// Box 73
// Box 74 - Procedures
Assert.AreEqual(3, claim.Procedures.Count);
var principal = claim.Procedures.FirstOrDefault(p => p.IsPrincipal);
Assert.IsNotNull(principal);
Assert.AreEqual("BBR", principal.Qualifier);
Assert.AreEqual("0B110F5", principal.Code);
Assert.AreEqual(DateTime.Parse("2005-3-21"), principal.Date);
// Box 75 - Blank
// Box 76 - Attending Physician
Assert.IsNotNull(claim.AttendingProvider);
Assert.AreEqual("JOHN", claim.AttendingProvider.Name.FirstName);
Assert.AreEqual("1G", claim.AttendingProvider.Identifications[0].Qualifier);
Assert.AreEqual("B99937A", claim.AttendingProvider.Identifications[0].Id);
// Box 77 - Operating Physician
Assert.IsNotNull(claim.OperatingPhysician);
Assert.AreEqual("JANE", claim.OperatingPhysician.Name.FirstName);
// Box 78 - Other
Assert.IsNotNull(claim.OtherOperatingPhysician);
Assert.AreEqual("JOE", claim.OtherOperatingPhysician.Name.FirstName);
// Box 79 - Other
// Box 80 - Remarks
// Box 81CC
}
private static void TransformLoop2010BATo837(XmlNode loop2010BA, ClaimMember subscriber)
{
var gender = loop2010BA.SelectSingleNode("DMG/DMG03");
switch (subscriber.Gender)
{
case OopFactory.X12.Hipaa.Common.GenderEnum.Unknown:
gender.InnerText = "";
break;
case OopFactory.X12.Hipaa.Common.GenderEnum.Male:
gender.InnerText = "M";
break;
case OopFactory.X12.Hipaa.Common.GenderEnum.Female:
gender.InnerText= "F";
break;
default:
break;
}
var dob= loop2010BA.SelectSingleNode("DMG/DMG02");
if (subscriber.DateOfBirth.HasValue)
dob.InnerText= subscriber.DateOfBirth.Value.ToString("yyyyMMdd");
}
