///<summary>Called once for each claim to be created. For claims with a lot of procedures, this may actually create multiple claims.</summary>
public static bool CreateClaim(long patNum, long claimNum, int batchNum)
{
//this can be eliminated later after error checking complete:
FormCFI = new FormClaimFormItemEdit();
FormCFI.FillFieldNames();
items = new ClaimFormItem[241]; //0 is not used
Fill(1, "IsPreAuth");
Fill(2, "IsStandardClaim");
Fill(3, "IsMedicaidClaim");
Fill(4, ""); //EPSTD
Fill(5, "TreatingProviderSpecialty");
Fill(6, "PreAuthString");
Fill(7, "PriInsCarrierName");
Fill(8, "PriInsAddressComplete");
Fill(9, "PriInsCity");
Fill(10, "PriInsST");
Fill(11, "PriInsZip");
Fill(12, "PatientLastFirst");
Fill(13, "PatientAddressComplete");
Fill(14, "PatientCity");
Fill(15, "PatientST");
Fill(16, "PatientDOB", "MM/dd/yyyy");
Fill(17, "PatientID-MedicaidOrSSN");
Fill(18, "PatientIsMale");
Fill(19, "PatientIsFemale");
Fill(20, "PatientPhone");
Fill(21, "PatientZip");
Fill(22, "RelatIsSelf");
Fill(23, "RelatIsSpouse");
Fill(24, "RelatIsChild");
Fill(25, "RelatIsOther");
Fill(26, ""); //relat other descript
Fill(27, ""); //pat employer/school
Fill(28, ""); //pat employer/school address
Fill(29, "SubscrID");
Fill(30, "EmployerName");
Fill(31, "GroupNum");
Fill(32, "OtherInsNotExists");
Fill(33, "OtherInsExists");
Fill(34, "OtherInsExists"); //dental
Fill(35, ""); //other ins exists medical
Fill(36, "OtherInsSubscrID");
Fill(37, "SubscrLastFirst");
Fill(38, "OtherInsSubscrLastFirst");
Fill(39, "SubscrAddressComplete");
Fill(40, "SubscrPhone");
Fill(41, "OtherInsSubscrDOB", "MM/dd/yyyy");
Fill(42, "OtherInsSubscrIsMale");
Fill(43, "OtherInsSubscrIsFemale");
Fill(44, "OtherInsGroupNum"); //Other Plan/Program name
Fill(45, "SubscrCity");
Fill(46, "SubscrST");
Fill(47, "SubscrZip");
Fill(48, ""); //other subscr employer/school
Fill(49, ""); //other subscr emp/school address
Fill(50, "SubscrDOB", "MM/dd/yyyy");
Fill(51, "SubscrIsMarried");
Fill(52, "SubscrIsSingle");
Fill(53, ""); //subscr marital status other
Fill(54, "SubscrIsMale");
Fill(55, "SubscrIsFemale");
Fill(56, ""); //subscr is employed
Fill(57, ""); //subscr is part time
Fill(58, "SubscrIsFTStudent");
Fill(59, "SubscrIsPTStudent");
Fill(60, ""); //subsc employer/school
Fill(61, ""); //subsc employer/school address
Fill(62, "PatientRelease");
Fill(63, "PatientReleaseDate", "MM/dd/yyyy");
Fill(64, "PatientAssignment");
Fill(65, "PatientAssignmentDate", "MM/dd/yyyy");
Fill(66, "BillingDentist");
Fill(67, "BillingDentistPhoneFormatted");
Fill(68, "BillingDentistMedicaidID");
Fill(69, "BillingDentistSSNorTIN");
Fill(70, "PayToDentistAddress");
Fill(71, "PayToDentistAddress2");
Fill(72, "BillingDentistLicenseNum");
Fill(73, "DateService", "MM/dd/yyyy");
Fill(74, "PlaceIsOffice");
Fill(75, "PlaceIsHospADA2002");
Fill(76, "PlaceIsExtCareFacilityADA2002");
Fill(77, "PlaceIsOtherADA2002");
Fill(78, "PayToDentistCity");
Fill(79, "PayToDentistST");
Fill(80, "PayToDentistZip");
Fill(81, "IsRadiographsAttached");
Fill(82, "RadiographsNumAttached");
Fill(83, "RadiographsNotAttached");
Fill(84, "IsOrtho");
Fill(85, "IsNotOrtho");
Fill(86, "IsInitialProsth");
Fill(87, "IsReplacementProsth");
Fill(88, ""); //reason for replacement
Fill(89, "DatePriorProsthPlaced", "MM/dd/yyyy");
Fill(90, "DateOrthoPlaced");
Fill(91, "MonthsOrthoRemaining");
Fill(92, "IsNotOccupational");
Fill(93, "IsOccupational");
Fill(94, ""); //description of occupational injury
Fill(95, "IsAutoAccident");
Fill(96, "IsOtherAccident");
Fill(97, "IsNotAccident");
Fill(98, ""); //description of accident
Fill(99, "TreatingDentistNPI"); //Individual NPI
Fill(100, ""); //''
Fill(101, "BillingDentistNPI"); //Group NPI
Fill(102, ""); //''
Fill(103, ""); //''
Fill(104, ""); //''
Fill(105, ""); //''
Fill(106, ""); //''
//proc 1
Fill(107, "P1Date", "MM/dd/yyyy");
Fill(108, "P1ToothNumber");
Fill(109, "P1Surface");
Fill(110, ""); //diag index
Fill(111, "P1Code");
Fill(112, ""); //quantity
Fill(113, "P1Description");
Fill(114, "P1Fee");
//proc 2
Fill(115, "P2Date", "MM/dd/yyyy");
Fill(116, "P2ToothNumber");
Fill(117, "P2Surface");
Fill(118, "");
Fill(119, "P2Code");
Fill(120, "");
Fill(121, "P2Description");
Fill(122, "P2Fee");
//proc 3
Fill(123, "P3Date", "MM/dd/yyyy");
Fill(124, "P3ToothNumber");
Fill(125, "P3Surface");
Fill(126, "");
Fill(127, "P3Code");
Fill(128, "");
Fill(129, "P3Description");
Fill(130, "P3Fee");
//proc 4
Fill(131, "P4Date", "MM/dd/yyyy");
Fill(132, "P4ToothNumber");
Fill(133, "P4Surface");
Fill(134, "");
Fill(135, "P4Code");
Fill(136, "");
Fill(137, "P4Description");
Fill(138, "P4Fee");
//proc 5
Fill(139, "P5Date", "MM/dd/yyyy");
Fill(140, "P5ToothNumber");
Fill(141, "P5Surface");
Fill(142, "");
Fill(143, "P5Code");
Fill(144, "");
Fill(145, "P5Description");
Fill(146, "P5Fee");
//proc 6
Fill(147, "P6Date", "MM/dd/yyyy");
Fill(148, "P6ToothNumber");
Fill(149, "P6Surface");
Fill(150, "");
Fill(151, "P6Code");
Fill(152, "");
Fill(153, "P6Description");
Fill(154, "P6Fee");
//proc 7
Fill(155, "P7Date", "MM/dd/yyyy");
Fill(156, "P7ToothNumber");
Fill(157, "P7Surface");
Fill(158, "");
Fill(159, "P7Code");
Fill(160, "");
Fill(161, "P7Description");
Fill(162, "P7Fee");
//proc 8
Fill(163, "P8Date", "MM/dd/yyyy");
Fill(164, "P8ToothNumber");
Fill(165, "P8Surface");
Fill(166, "");
Fill(167, "P8Code");
Fill(168, "");
Fill(169, "P8Description");
Fill(170, "P8Fee");
//end of procs
Fill(171, "TotalFee");
Fill(172, ""); //payment by other plan. Only applicable on secondary insurance.
Fill(173, ""); //max allowable
Fill(174, ""); //deductible
Fill(175, ""); //carrier percent
Fill(176, ""); //carrier pays
Fill(177, ""); //patient pays
Fill(178, ""); //Work injury. Only x is accepted.
Fill(179, "P1Area");
Fill(180, "");
Fill(181, "P2Area");
Fill(182, "");
Fill(183, "P3Area");
Fill(184, "");
Fill(185, "P4Area");
Fill(186, "");
Fill(187, "P5Area");
Fill(188, "");
Fill(189, "P6Area");
Fill(190, "");
Fill(191, "P7Area");
Fill(192, "");
Fill(193, "P8Area");
Fill(194, "");
Fill(195, "");
Fill(196, "P9Area");
Fill(197, "");
Fill(198, "");
Fill(199, "");
Fill(200, "");
Fill(201, "");
Fill(202, "");
Fill(203, "");
Fill(204, "P10Area");
Fill(205, "");
Fill(206, "");
Fill(207, "");
Fill(208, "");
Fill(209, "");
Fill(210, "");
Fill(211, "");
Fill(212, "");
Fill(213, "");
Fill(214, "");
Fill(215, "");
Fill(216, "OtherInsCarrierName"); //COB insurance company name
Fill(217, "OtherInsAddress"); //COB address
Fill(218, "OtherInsCity"); //COB ins City
Fill(219, "OtherInsST"); //COB ins State
Fill(220, "OtherInsZip"); //COB Zip
Fill(221, "");
Fill(222, "");
Fill(223, "");
Fill(224, "");
Fill(225, "");
Fill(226, "");
Fill(227, "");
Fill(228, "");
Fill(229, "");
Fill(230, "Remarks");
Fill(231, "");
Fill(232, "");
Fill(233, "");
Fill(234, "TreatingDentistSignature"); //Treating Dentist Signature - Will accept any text string
Fill(235, "TreatingDentistLicense"); //Treating License # - Will accept any text string
Fill(236, "TreatingDentistSigDate"); //Date Signed - Expecting MM/DD/YYYY
Fill(237, "TreatingDentistAddress"); //Address Where Procedure Performed - Will accept any text string
Fill(238, "TreatingDentistCity"); //City Where Procedure Performed - Will accept any text string
Fill(239, "TreatingDentistST"); //State Where Procedure Performed - Will accept any text string
Fill(240, "TreatingDentistZip"); //Zip Code Where Procedure Performed - Expecting 5 digit
ClaimFormItem[] listForForm = new ClaimFormItem[241];
//items.CopyTo(ClaimFormItems.ListForForm,0);
FormClaimPrint FormCP = new FormClaimPrint();
FormCP.ClaimNumCur = claimNum;
FormCP.PatNumCur = patNum;
FormCP.ClaimFormCur = new ClaimForm();
FormCP.ClaimFormCur.Items = new ClaimFormItem[items.Length];
items.CopyTo(FormCP.ClaimFormCur.Items, 0);
DisplayStrings = FormCP.FillRenaissance();
SaveFile(batchNum);
return(true);
}
///<summary>Called once for each claim to be created. For claims with a lot of procedures, this may actually create multiple claims.</summary>
public static bool CreateClaim(long patNum,long claimNum,int batchNum) {
//this can be eliminated later after error checking complete:
FormCFI=new FormClaimFormItemEdit();
FormCFI.FillFieldNames();
items=new ClaimFormItem[241];//0 is not used
Fill(1,"IsPreAuth");
Fill(2,"IsStandardClaim");
Fill(3,"IsMedicaidClaim");
Fill(4,"");//EPSTD
Fill(5,"TreatingProviderSpecialty");
Fill(6,"PreAuthString");
Fill(7,"PriInsCarrierName");
Fill(8,"PriInsAddressComplete");
Fill(9,"PriInsCity");
Fill(10,"PriInsST");
Fill(11,"PriInsZip");
Fill(12,"PatientLastFirst");
Fill(13,"PatientAddressComplete");
Fill(14,"PatientCity");
Fill(15,"PatientST");
Fill(16,"PatientDOB","MM/dd/yyyy");
Fill(17,"PatientID-MedicaidOrSSN");
Fill(18,"PatientIsMale");
Fill(19,"PatientIsFemale");
Fill(20,"PatientPhone");
Fill(21,"PatientZip");
Fill(22,"RelatIsSelf");
Fill(23,"RelatIsSpouse");
Fill(24,"RelatIsChild");
Fill(25,"RelatIsOther");
Fill(26,"");//relat other descript
Fill(27,"");//pat employer/school
Fill(28,"");//pat employer/school address
Fill(29,"SubscrID");
Fill(30,"EmployerName");
Fill(31,"GroupNum");
Fill(32,"OtherInsNotExists");
Fill(33,"OtherInsExists");
Fill(34,"OtherInsExists");//dental
Fill(35,"");//other ins exists medical
Fill(36,"OtherInsSubscrID");
Fill(37,"SubscrLastFirst");
Fill(38,"OtherInsSubscrLastFirst");
Fill(39,"SubscrAddressComplete");
Fill(40,"SubscrPhone");
Fill(41,"OtherInsSubscrDOB","MM/dd/yyyy");
Fill(42,"OtherInsSubscrIsMale");
Fill(43,"OtherInsSubscrIsFemale");
Fill(44,"OtherInsGroupNum");//Other Plan/Program name
Fill(45,"SubscrCity");
Fill(46,"SubscrST");
Fill(47,"SubscrZip");
Fill(48,"");//other subscr employer/school
Fill(49,"");//other subscr emp/school address
Fill(50,"SubscrDOB","MM/dd/yyyy");
Fill(51,"SubscrIsMarried");
Fill(52,"SubscrIsSingle");
Fill(53,"");//subscr marital status other
Fill(54,"SubscrIsMale");
Fill(55,"SubscrIsFemale");
Fill(56,"");//subscr is employed
Fill(57,"");//subscr is part time
Fill(58,"SubscrIsFTStudent");
Fill(59,"SubscrIsPTStudent");
Fill(60,"");//subsc employer/school
Fill(61,"");//subsc employer/school address
Fill(62,"PatientRelease");
Fill(63,"PatientReleaseDate","MM/dd/yyyy");
Fill(64,"PatientAssignment");
Fill(65,"PatientAssignmentDate","MM/dd/yyyy");
Fill(66,"BillingDentist");
Fill(67,"BillingDentistPhoneFormatted");
Fill(68,"BillingDentistMedicaidID");
Fill(69,"BillingDentistSSNorTIN");
Fill(70,"PayToDentistAddress");
Fill(71,"PayToDentistAddress2");
Fill(72,"BillingDentistLicenseNum");
Fill(73,"DateService","MM/dd/yyyy");
Fill(74,"PlaceIsOffice");
Fill(75,"PlaceIsHospADA2002");
Fill(76,"PlaceIsExtCareFacilityADA2002");
Fill(77,"PlaceIsOtherADA2002");
Fill(78,"PayToDentistCity");
Fill(79,"PayToDentistST");
Fill(80,"PayToDentistZip");
Fill(81,"IsRadiographsAttached");
Fill(82,"RadiographsNumAttached");
Fill(83,"RadiographsNotAttached");
Fill(84,"IsOrtho");
Fill(85,"IsNotOrtho");
Fill(86,"IsInitialProsth");
Fill(87,"IsReplacementProsth");
Fill(88,"");//reason for replacement
Fill(89,"DatePriorProsthPlaced","MM/dd/yyyy");
Fill(90,"DateOrthoPlaced");
Fill(91,"MonthsOrthoRemaining");
Fill(92,"IsNotOccupational");
Fill(93,"IsOccupational");
Fill(94,"");//description of occupational injury
Fill(95,"IsAutoAccident");
Fill(96,"IsOtherAccident");
Fill(97,"IsNotAccident");
Fill(98,"");//description of accident
Fill(99,"TreatingDentistNPI");//Individual NPI
Fill(100,"");//''
Fill(101,"BillingDentistNPI");//Group NPI
Fill(102,"");//''
Fill(103,"");//''
Fill(104,"");//''
Fill(105,"");//''
Fill(106,"");//''
//proc 1
Fill(107,"P1Date","MM/dd/yyyy");
Fill(108,"P1ToothNumber");
Fill(109,"P1Surface");
Fill(110,"");//diag index
Fill(111,"P1Code");
Fill(112,"");//quantity
Fill(113,"P1Description");
Fill(114,"P1Fee");
//proc 2
Fill(115,"P2Date","MM/dd/yyyy");
Fill(116,"P2ToothNumber");
Fill(117,"P2Surface");
Fill(118,"");
Fill(119,"P2Code");
Fill(120,"");
Fill(121,"P2Description");
Fill(122,"P2Fee");
//proc 3
Fill(123,"P3Date","MM/dd/yyyy");
Fill(124,"P3ToothNumber");
Fill(125,"P3Surface");
Fill(126,"");
Fill(127,"P3Code");
Fill(128,"");
Fill(129,"P3Description");
Fill(130,"P3Fee");
//proc 4
Fill(131,"P4Date","MM/dd/yyyy");
Fill(132,"P4ToothNumber");
Fill(133,"P4Surface");
Fill(134,"");
Fill(135,"P4Code");
Fill(136,"");
Fill(137,"P4Description");
Fill(138,"P4Fee");
//proc 5
Fill(139,"P5Date","MM/dd/yyyy");
Fill(140,"P5ToothNumber");
Fill(141,"P5Surface");
Fill(142,"");
Fill(143,"P5Code");
Fill(144,"");
Fill(145,"P5Description");
Fill(146,"P5Fee");
//proc 6
Fill(147,"P6Date","MM/dd/yyyy");
Fill(148,"P6ToothNumber");
Fill(149,"P6Surface");
Fill(150,"");
Fill(151,"P6Code");
Fill(152,"");
Fill(153,"P6Description");
Fill(154,"P6Fee");
//proc 7
Fill(155,"P7Date","MM/dd/yyyy");
Fill(156,"P7ToothNumber");
Fill(157,"P7Surface");
Fill(158,"");
Fill(159,"P7Code");
Fill(160,"");
Fill(161,"P7Description");
Fill(162,"P7Fee");
//proc 8
Fill(163,"P8Date","MM/dd/yyyy");
Fill(164,"P8ToothNumber");
Fill(165,"P8Surface");
Fill(166,"");
Fill(167,"P8Code");
Fill(168,"");
Fill(169,"P8Description");
Fill(170,"P8Fee");
//end of procs
Fill(171,"TotalFee");
Fill(172,"");//payment by other plan. Only applicable on secondary insurance.
Fill(173,"");//max allowable
Fill(174,"");//deductible
Fill(175,"");//carrier percent
Fill(176,"");//carrier pays
Fill(177,"");//patient pays
Fill(178,"");//Work injury. Only x is accepted.
Fill(179,"P1Area");
Fill(180,"");
Fill(181,"P2Area");
Fill(182,"");
Fill(183,"P3Area");
Fill(184,"");
Fill(185,"P4Area");
Fill(186,"");
Fill(187,"P5Area");
Fill(188,"");
Fill(189,"P6Area");
Fill(190,"");
Fill(191,"P7Area");
Fill(192,"");
Fill(193,"P8Area");
Fill(194,"");
Fill(195,"");
Fill(196,"P9Area");
Fill(197,"");
Fill(198,"");
Fill(199,"");
Fill(200,"");
Fill(201,"");
Fill(202,"");
Fill(203,"");
Fill(204,"P10Area");
Fill(205,"");
Fill(206,"");
Fill(207,"");
Fill(208,"");
Fill(209,"");
Fill(210,"");
Fill(211,"");
Fill(212,"");
Fill(213,"");
Fill(214,"");
Fill(215,"");
Fill(216,"OtherInsCarrierName");//COB insurance company name
Fill(217,"OtherInsAddress");//COB address
Fill(218,"OtherInsCity");//COB ins City
Fill(219,"OtherInsST");//COB ins State
Fill(220,"OtherInsZip");//COB Zip
Fill(221,"");
Fill(222,"");
Fill(223,"");
Fill(224,"");
Fill(225,"");
Fill(226,"");
Fill(227,"");
Fill(228,"");
Fill(229,"");
Fill(230,"Remarks");
Fill(231,"");
Fill(232,"");
Fill(233,"");
Fill(234,"TreatingDentistSignature");//Treating Dentist Signature - Will accept any text string
Fill(235,"TreatingDentistLicense");//Treating License # - Will accept any text string
Fill(236,"TreatingDentistSigDate");//Date Signed - Expecting MM/DD/YYYY
Fill(237,"TreatingDentistAddress");//Address Where Procedure Performed - Will accept any text string
Fill(238,"TreatingDentistCity");//City Where Procedure Performed - Will accept any text string
Fill(239,"TreatingDentistST");//State Where Procedure Performed - Will accept any text string
Fill(240,"TreatingDentistZip");//Zip Code Where Procedure Performed - Expecting 5 digit
ClaimFormItem[] listForForm=new ClaimFormItem[241];
//items.CopyTo(ClaimFormItems.ListForForm,0);
FormClaimPrint FormCP=new FormClaimPrint();
FormCP.ClaimNumCur=claimNum;
FormCP.PatNumCur=patNum;
FormCP.ClaimFormCur=new ClaimForm();
FormCP.ClaimFormCur.Items=new ClaimFormItem[items.Length];
items.CopyTo(FormCP.ClaimFormCur.Items,0);
DisplayStrings=FormCP.FillRenaissance();
SaveFile(batchNum);
return true;
}
