public void X834_ImportInsurancePlans_ReplacePatPlan()
{
Patient pat = Createx834Patient();
string suffix = MethodBase.GetCurrentMethod().Name;
//Create old insurance plan and associate it to them.
InsuranceInfo insuranceOld = InsuranceT.AddInsurance(pat, "Old Carrier" + suffix);
//Create x834
X834 x834 = new X834(new X12object(Properties.Resources.x834Test));
int createdPatsCount, updatedPatsCount, skippedPatsCount, createdCarrierCount, createdInsPlanCount, updatedInsPlanCount, createdInsSubCount,
updatedInsSubCount, createdPatPlanCount, droppedPatPlanCount, updatedPatPlanCount;
StringBuilder sbErrorMessages;
//Pass in true for dropExistingInsurance
EtransL.ImportInsurancePlans(x834, new List <Patient> {
pat
}, true, true, out createdPatsCount,
out updatedPatsCount, out skippedPatsCount, out createdCarrierCount, out createdInsPlanCount, out updatedInsPlanCount, out createdInsSubCount,
out updatedInsSubCount, out createdPatPlanCount, out droppedPatPlanCount, out updatedPatPlanCount, out sbErrorMessages);
//Get the pat plans for this patient from the database.
List <PatPlan> listPatPlans = PatPlans.GetPatPlansForPat(pat.PatNum);
Assert.AreEqual(1, listPatPlans.Count);
Assert.AreEqual(1, droppedPatPlanCount);
InsSub subForPatPlan = InsSubs.GetOne(listPatPlans[0].InsSubNum);
//These should be different as a new plan was created and the old plan was dropped.
Assert.AreNotEqual(insuranceOld.PriInsPlan.PlanNum, subForPatPlan.PlanNum);
}
public void X834_ImportInsurancePlans_ReplaceSecondaryPatPlan()
{
Patient pat = Createx834Patient();
string suffix = MethodBase.GetCurrentMethod().Name;
//Create primary insurance plan that appears in the 834.
InsuranceInfo insurancePrimary = InsuranceT.AddInsurance(pat, "Old Carrier" + suffix, subscriberID: "CG00000B");
//Create secondary insurance that does not appear in the 834.
InsuranceInfo insuranceSecondary = InsuranceT.AddInsurance(pat, "Secondary Carrier" + suffix);
//Get the pat plans for this patient from the database.
List <PatPlan> listPatPlans = PatPlans.GetPatPlansForPat(pat.PatNum);
Assert.AreEqual(2, listPatPlans.Count);
//Create x834
X834 x834 = new X834(new X12object(Properties.Resources.x834Test));
int createdPatsCount, updatedPatsCount, skippedPatsCount, createdCarrierCount, createdInsPlanCount, updatedInsPlanCount, createdInsSubCount,
updatedInsSubCount, createdPatPlanCount, droppedPatPlanCount, updatedPatPlanCount;
StringBuilder sbErrorMessages;
//Pass in true for dropExistingInsurance
EtransL.ImportInsurancePlans(x834, new List <Patient> {
pat
}, true, true, out createdPatsCount,
out updatedPatsCount, out skippedPatsCount, out createdCarrierCount, out createdInsPlanCount, out updatedInsPlanCount, out createdInsSubCount,
out updatedInsSubCount, out createdPatPlanCount, out droppedPatPlanCount, out updatedPatPlanCount, out sbErrorMessages);
//Get the pat plans for this patient from the database.
listPatPlans = PatPlans.GetPatPlansForPat(pat.PatNum);
Assert.AreEqual(1, listPatPlans.Count);
Assert.AreEqual(1, droppedPatPlanCount);
//These should be different as a new plan was created and the old plan was dropped.
Assert.AreEqual(insurancePrimary.ListPatPlans[0].PatPlanNum, listPatPlans[0].PatPlanNum);
}
public void X834_ImportInsurancePlans_DoNotReplacePatPlan()
{
Patient pat = Createx834Patient();
string suffix = MethodBase.GetCurrentMethod().Name;
//Create old insurance plan and associate it to them.
InsuranceInfo insuranceOld = InsuranceT.AddInsurance(pat, "Old Carrier" + suffix);
//Create x834
X834 x834 = new X834(new X12object(Properties.Resources.x834Test));
int createdPatsCount, updatedPatsCount, skippedPatsCount, createdCarrierCount, createdInsPlanCount, updatedInsPlanCount, createdInsSubCount,
updatedInsSubCount, createdPatPlanCount, droppedPatPlanCount, updatedPatPlanCount;
StringBuilder sbErrorMessages;
EtransL.ImportInsurancePlans(x834, new List <Patient> {
pat
}, true, false, out createdPatsCount,
out updatedPatsCount, out skippedPatsCount, out createdCarrierCount, out createdInsPlanCount, out updatedInsPlanCount, out createdInsSubCount,
out updatedInsSubCount, out createdPatPlanCount, out droppedPatPlanCount, out updatedPatPlanCount, out sbErrorMessages);
//Get the pat plans for this patient from the database.
List <PatPlan> listPatPlans = PatPlans.GetPatPlansForPat(pat.PatNum);
//No patient was created. Should have matched the one we created.
Assert.AreEqual(0, createdPatsCount);
//There should be two now as the old was kept.
Assert.AreEqual(2, listPatPlans.Count);
Assert.AreEqual(1, createdPatPlanCount);
}
///<summary>Creates a general deductible of $50, a deductible of $50 on D0220, sets a $30 D0220 complete and creates a claim,
///creates a $100 D2750, that is TP'ed, and then creates a $30 D0220 that is TP'ed.</summary>
///<param name="actAssert">The first claimproc is for the D2750 and the second claimproc is for the second D0220.</param>
public void GetDeductibleByCodeDeductLessThanGeneral(string suffix, Action <ClaimProc, ClaimProc> actAssert)
{
Patient pat = PatientT.CreatePatient(suffix);
InsuranceT.AddInsurance(pat, suffix);
List <InsSub> listSubs = InsSubT.GetInsSubs(pat);
List <InsPlan> listPlans = InsPlans.RefreshForSubList(listSubs);
List <PatPlan> listPatPlans = PatPlans.Refresh(pat.PatNum);
InsPlan plan = InsPlanT.GetPlanForPriSecMed(PriSecMed.Primary, listPatPlans, listPlans, listSubs);
BenefitT.CreateDeductibleGeneral(plan.PlanNum, BenefitCoverageLevel.Individual, 50);
BenefitT.CreateCategoryPercent(plan.PlanNum, EbenefitCategory.Diagnostic, 100);
BenefitT.CreateCategoryPercent(plan.PlanNum, EbenefitCategory.Crowns, 50);
BenefitT.CreateDeductible(plan.PlanNum, EbenefitCategory.Diagnostic, 0);
BenefitT.CreateDeductible(plan.PlanNum, "D0220", 50);
List <Benefit> listBens = Benefits.Refresh(listPatPlans, listSubs);
Procedure proc1 = ProcedureT.CreateProcedure(pat, "D0220", ProcStat.C, "", 30);//proc1 - Intraoral - periapical first film
ClaimT.CreateClaim("P", listPatPlans, listPlans, new List <ClaimProc>(), new List <Procedure> {
proc1
}, pat, new List <Procedure> {
proc1
}, listBens,
listSubs);
Procedure proc2 = ProcedureT.CreateProcedure(pat, "D2750", ProcStat.TP, "", 100, priority: 0); //proc2 - Crown
Procedure proc3 = ProcedureT.CreateProcedure(pat, "D0220", ProcStat.TP, "", 30, priority: 1); //proc3 - Intraoral - periapical first film
List <ClaimProc> claimProcs = ProcedureT.ComputeEstimates(pat, listPatPlans, listPlans, listSubs, listBens);
ClaimProc claimProc2 = claimProcs.FirstOrDefault(x => x.ProcNum == proc2.ProcNum);
ClaimProc claimProc3 = claimProcs.FirstOrDefault(x => x.ProcNum == proc3.ProcNum);
actAssert(claimProc2, claimProc3);
}
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);
}
///<summary>Creates a procedure and computes estimates for a patient where the secondary insurance has a COB rule of Medicaid.</summary>
private void ComputeEstimatesMedicaidCOB(string suffix, double procFee, double priAllowed, double secAllowed, int priPercentCovered,
int secPercentCovered, Action <ClaimProc /*Primary*/, ClaimProc /*Secondary*/, Procedure> assertAct)
{
Patient pat = PatientT.CreatePatient(suffix);
long ppoFeeSchedNum = FeeSchedT.CreateFeeSched(FeeScheduleType.Normal, "PPO " + suffix);
InsuranceT.AddInsurance(pat, suffix, "p", ppoFeeSchedNum);
long medicaidFeeSchedNum = FeeSchedT.CreateFeeSched(FeeScheduleType.Normal, "PPO " + suffix);
InsuranceT.AddInsurance(pat, suffix, "p", medicaidFeeSchedNum, 2, cobRule: EnumCobRule.SecondaryMedicaid);
List <InsSub> listSubs = InsSubT.GetInsSubs(pat);
List <InsPlan> listPlans = InsPlans.RefreshForSubList(listSubs);
List <PatPlan> listPatPlans = PatPlans.Refresh(pat.PatNum);
InsPlan priPlan = InsPlanT.GetPlanForPriSecMed(PriSecMed.Primary, listPatPlans, listPlans, listSubs);
BenefitT.CreateCategoryPercent(priPlan.PlanNum, EbenefitCategory.Diagnostic, priPercentCovered);
InsPlan secPlan = InsPlanT.GetPlanForPriSecMed(PriSecMed.Secondary, listPatPlans, listPlans, listSubs);
BenefitT.CreateCategoryPercent(secPlan.PlanNum, EbenefitCategory.Diagnostic, secPercentCovered);
List <Benefit> listBens = Benefits.Refresh(listPatPlans, listSubs);
string procStr = "D0150";
Procedure proc = ProcedureT.CreateProcedure(pat, procStr, ProcStat.TP, "", procFee);
ProcedureCode procCode = ProcedureCodes.GetProcCode(procStr);
FeeT.CreateFee(ppoFeeSchedNum, procCode.CodeNum, priAllowed);
FeeT.CreateFee(medicaidFeeSchedNum, procCode.CodeNum, secAllowed);
Procedures.ComputeEstimates(proc, pat.PatNum, new List <ClaimProc>(), false, listPlans, listPatPlans, listBens, pat.Age, listSubs);
List <ClaimProc> listClaimProcs = ClaimProcs.Refresh(pat.PatNum);
assertAct(listClaimProcs.FirstOrDefault(x => x.PlanNum == priPlan.PlanNum), listClaimProcs.FirstOrDefault(x => x.PlanNum == secPlan.PlanNum), proc);
}
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);
}
///<summary>Creates a procedure and returns its procedure fee.</summary>
private double GetProcFee(string suffix, bool doUseMedicalCode)
{
Prefs.UpdateBool(PrefName.InsPpoAlwaysUseUcrFee, true);
Prefs.UpdateBool(PrefName.MedicalFeeUsedForNewProcs, doUseMedicalCode);
Patient pat = PatientT.CreatePatient(suffix);
long ucrFeeSchedNum = FeeSchedT.CreateFeeSched(FeeScheduleType.Normal, "UCR " + suffix);
FeeSchedT.UpdateUCRFeeSched(pat, ucrFeeSchedNum);
long ppoFeeSchedNum = FeeSchedT.CreateFeeSched(FeeScheduleType.Normal, "PPO " + suffix);
InsuranceT.AddInsurance(pat, suffix, "p", ppoFeeSchedNum, 1, true);
List <InsSub> listSubs = InsSubT.GetInsSubs(pat);
List <InsPlan> listPlans = InsPlans.RefreshForSubList(listSubs);
List <PatPlan> listPatPlans = PatPlans.Refresh(pat.PatNum);
string procStr = "D0150";
string procStrMed = "D0120";
ProcedureCode procCode = ProcedureCodes.GetProcCode(procStr);
ProcedureCode procCodeMed = ProcedureCodes.GetProcCode(procStrMed);
procCode.MedicalCode = procCodeMed.ProcCode;
FeeT.CreateFee(ucrFeeSchedNum, procCode.CodeNum, 300);
FeeT.CreateFee(ppoFeeSchedNum, procCode.CodeNum, 120);
FeeT.CreateFee(ucrFeeSchedNum, procCodeMed.CodeNum, 175);
FeeT.CreateFee(ppoFeeSchedNum, procCodeMed.CodeNum, 85);
Procedure proc = ProcedureT.CreateProcedure(pat, procStr, ProcStat.TP, "", 300);
return(Procedures.GetProcFee(pat, listPatPlans, listSubs, listPlans, procCode.CodeNum, proc.ProvNum, proc.ClinicNum, procCode.MedicalCode));
}
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 LedgersTests_ComputeAging_PayPlanDynamicCreditsWithClaimProcs()
{
List <Procedure> listProcs = new List <Procedure>();
List <Adjustment> listAdjs = new List <Adjustment>();
long provNum = ProviderT.CreateProvider("Aging_PayPlanDynamic");
string suffix = MethodBase.GetCurrentMethod().Name;
Patient pat = PatientT.CreatePatient(fName: "Aging_PayPlanDynamic", suffix: suffix);
Family fam = Patients.GetFamily(pat.PatNum);
Procedure proc45 = ProcedureT.CreateProcedure(pat, "D0210", ProcStat.C, "", 45, DateTime.Today.AddDays(-61), provNum: provNum);
ClaimProc cp45 = new ClaimProc();
InsuranceInfo insInfo = InsuranceT.AddInsurance(pat, "DynPayPlan");
ClaimProcs.CreateEst(cp45, proc45, insInfo.PriInsPlan, insInfo.PriInsSub);
cp45.Status = ClaimProcStatus.NotReceived;
cp45.InsEstTotal = -1;
cp45.InsPayEst = 15;
cp45.WriteOffEst = 0;
cp45.WriteOff = 0;
ClaimProcs.Update(cp45);
listProcs.AddRange(new List <Procedure> {
proc45
});
PayPlan payPlan = PayPlanT.CreateDynamicPaymentPlan(pat.PatNum, pat.PatNum, DateTime.Today.AddDays(-1), 0, 0, 30, listProcs, listAdjs);
//make two non payplan productions to put on the account
Procedure procUnattached = ProcedureT.CreateProcedure(pat, "D0210", ProcStat.C, "", 35, DateTime.Today.AddDays(-91), provNum: provNum);
//Run pay plan logic to generate first set of charges
List <PayPlanCharge> listChargesDb = PayPlanCharges.GetForPayPlan(payPlan.PayPlanNum);
List <PayPlanLink> listEntries = PayPlanLinks.GetForPayPlans(new List <long> {
payPlan.PayPlanNum
});
PayPlanTerms terms = PayPlanT.GetTerms(payPlan, listEntries);
List <PayPlanCharge> listChargesThisPeriod = PayPlanEdit.GetListExpectedCharges(listChargesDb, terms, fam, listEntries, payPlan, true);
Assert.AreEqual(30, listChargesThisPeriod.Sum(x => x.Principal));
foreach (PayPlanCharge charge in listChargesThisPeriod)
{
PayPlanCharges.Insert(charge);
}
int payPlansVersionPrev = PrefC.GetInt(PrefName.PayPlansVersion);
try {
PrefT.UpdateInt(PrefName.PayPlansVersion, (int)PayPlanVersions.AgeCreditsAndDebits);
CheckAgingProcLifo(pat.PatNum, 30, 0, 15, 35, 30, YN.Yes); //new - pay plan credit of $30 gets applied to cooresponding procedure
CheckAgingProcLifo(pat.PatNum, 30, 0, 45, 5, 30, YN.No); //old - pay plan credit gets applied to oldest production on the account
CheckAgingProcLifo(pat.PatNum, 30, 0, 45, 5, 30, YN.Unknown);
}
finally {
PrefT.UpdateInt(PrefName.PayPlansVersion, payPlansVersionPrev);
}
}
public void Benefits_OverAgeWithLifetimeMax()
{
string suffix = MethodBase.GetCurrentMethod().Name;
Patient pat = PatientT.CreatePatient(suffix, birthDate: DateTime.Now.AddYears(-20));
InsuranceInfo ins = InsuranceT.AddInsurance(pat, suffix);
BenefitT.CreateCategoryPercent(ins.PrimaryInsPlan.PlanNum, EbenefitCategory.Orthodontics, 50);
BenefitT.CreateAgeLimitation(ins.PrimaryInsPlan.PlanNum, EbenefitCategory.Orthodontics, 18);
BenefitT.CreateOrthoMax(ins.PrimaryInsPlan.PlanNum, 1000);
ins.RefreshBenefits();
Procedure proc = ProcedureT.CreateProcedure(pat, "D8090", ProcStat.TP, "", 3000);//comprehensive orthodontic treatment
List <ClaimProc> listClaimProcs = ProcedureT.ComputeEstimates(pat, ins);
Assert.AreEqual(0, listClaimProcs.First().InsEstTotal);
}
public void LedgersTests_ComputeAgingProcLifo_InsWoEst_And_InsPayEst()
{
string suffix = MethodBase.GetCurrentMethod().Name;
Patient pat = PatientT.CreatePatient(fName: "Aging_InsEst", suffix: suffix);
InsuranceInfo insInfo = InsuranceT.AddInsurance(pat, "AgingInsEst");
Procedure proc95 = ProcedureT.CreateProcedure(pat, "D0270", ProcStat.C, "", 1000, DateTime.Today.AddDays(-95));
ClaimProc cp95 = new ClaimProc();
ClaimProcs.CreateEst(cp95, proc95, insInfo.PriInsPlan, insInfo.PriInsSub);
cp95.Status = ClaimProcStatus.NotReceived;
cp95.InsEstTotal = 800;
cp95.InsPayEst = 800;
cp95.WriteOffEst = 200;
cp95.WriteOff = 200;
ClaimProcs.Update(cp95);
Procedure proc85 = ProcedureT.CreateProcedure(pat, "D1110", ProcStat.C, "", 100, DateTime.Today.AddDays(-85));
ClaimProc cp85 = new ClaimProc();
ClaimProcs.CreateEst(cp85, proc85, insInfo.PriInsPlan, insInfo.PriInsSub);
cp85.Status = ClaimProcStatus.NotReceived;
cp85.InsEstTotal = 60;
cp85.InsPayEst = 60;
cp85.WriteOffEst = 40;
cp85.WriteOff = 40;
ClaimProcs.Update(cp85);
int agingProcLifoPrev = PrefC.GetInt(PrefName.AgingProcLifo);
try {
PrefT.UpdateInt(PrefName.AgingProcLifo, (int)YN.No);
Dictionary <long, DataRow> dictAging = Ledgers.GetAgingGuarTransTable(DateTime.Today, new List <long> {
pat.Guarantor
});
Assert.AreEqual(PIn.Double(dictAging[pat.Guarantor]["InsPayEst"].ToString()), 860);
Assert.AreEqual(PIn.Double(dictAging[pat.Guarantor]["InsWoEst"].ToString()), 240);
PrefT.UpdateInt(PrefName.AgingProcLifo, (int)YN.Yes);
dictAging = Ledgers.GetAgingGuarTransTable(DateTime.Today, new List <long> {
pat.Guarantor
});
Assert.AreEqual(PIn.Double(dictAging[pat.Guarantor]["InsPayEst"].ToString()), 860);
Assert.AreEqual(PIn.Double(dictAging[pat.Guarantor]["InsWoEst"].ToString()), 240);
}
finally {
PrefT.UpdateInt(PrefName.AgingProcLifo, agingProcLifoPrev);
}
}
public void ProcMultiVisitTests_CrownGroupComplete_ClaimDates()
{
string suffix = MethodBase.GetCurrentMethod().Name;
Patient pat = PatientT.CreatePatient(suffix);
InsuranceInfo insInfo = InsuranceT.AddInsurance(pat, suffix);
List <Procedure> listProcs = new List <Procedure>();
Procedure procBillable = ProcedureT.CreateProcedure(pat, "D2750", ProcStat.TP, "1", 100, new DateTime(2018, 5, 1));//PFM
listProcs.Add(procBillable);
Procedure procDelivery = ProcedureT.CreateProcedure(pat, "N4118", ProcStat.TP, "1", 0, new DateTime(2018, 8, 20)); //Seat - usually completed several months later.
listProcs.Add(procDelivery);
List <ClaimProc> listClaimProcs = ProcedureT.ComputeEstimates(pat, insInfo);
ProcMultiVisits.CreateGroup(listProcs);
Procedure procBillableOld = procBillable.Copy();
procBillable.ProcStatus = ProcStat.C;
Procedures.Update(procBillable, procBillableOld);
Procedure procDeliveryOld = procDelivery.Copy();
procDelivery.ProcStatus = ProcStat.C;
Procedures.Update(procDelivery, procDeliveryOld);
Assert.AreEqual(ProcMultiVisits.IsProcInProcess(procBillable.ProcNum), false); //Both procedures complete means the group is now complete (not In Process).
Assert.AreEqual(ProcMultiVisits.IsProcInProcess(procDelivery.ProcNum), false); //Both procedures complete means the group is now complete (not In Process).
Claim claim = new Claim();
claim.DateSent = DateTimeOD.Today;
claim.DateSentOrig = DateTime.MinValue;
claim.ClaimStatus = "W";
//Dates of service are calculated inside AccountModules.CreateClaim().
//The procDelivery cannot be attached to the claim in the UI, because $0 procs are blocked by UI. Therefore, we only attach the procBilled to the claim here.
ODTuple <bool, Claim, string> clmResult = AccountModules.CreateClaim(claim, "P", insInfo.ListPatPlans, insInfo.ListInsPlans, listClaimProcs, listProcs,
insInfo.ListInsSubs, pat, null, new List <Procedure> {
procBillable
}, "", insInfo.PriInsPlan, insInfo.PriInsSub, Relat.Self);
Assert.AreEqual(clmResult.Item3, ""); //Ensure no validation errors creating the claim. This is to verify the integrity of the unit test design.
Assert.AreEqual(clmResult.Item2.DateService, procDelivery.ProcDate); //Claim date of service must always be the greatest date in the multi visit group.
listClaimProcs = ClaimProcs.RefreshForClaim(clmResult.Item2.ClaimNum);
Assert.AreEqual(listClaimProcs[0].ProcDate, procDelivery.ProcDate); //Proc date of service must always be the greatest date in the multi visit group, even if performed on a different day.
}
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 RpProcNotBilledIns_GetProcsNotBilled_ShowProcsBeforeIns()
{
string suffix = MethodBase.GetCurrentMethod().Name;
Patient patient = PatientT.CreatePatient(suffix);
Carrier carrier = CarrierT.CreateCarrier(suffix);
ProcedureCode procedureCode = ProcedureCodeT.CreateProcCode("T7782");
Procedure procedure = ProcedureT.CreateProcedure(patient, procedureCode.ProcCode, ProcStat.C, "", 55, procDate: DateTime.Now.AddDays(-3));
//Add insurance after the procedure has been set complete.
InsuranceInfo insuranceInfo = InsuranceT.AddInsurance(patient, carrier.CarrierName, ordinal: 1, isMedical: true);
//The patient should not be returned when 'showProcsBeforeIns' is set to false.
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));
//The patient should be returned when 'showProcsBeforeIns' is set to true.
table = RpProcNotBilledIns.GetProcsNotBilled(new List <long>(), true, DateTime.Now.AddDays(-10), DateTime.Now, true, 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 Procedures_ComputeEstimates_PrimaryInsuranceMedicaidCOB()
{
string suffix = MethodBase.GetCurrentMethod().Name;
Patient pat = PatientT.CreatePatient(suffix);
long ppoFeeSchedNum = FeeSchedT.CreateFeeSched(FeeScheduleType.Normal, "PPO " + suffix);
InsuranceInfo insInfo = InsuranceT.AddInsurance(pat, suffix, "p", ppoFeeSchedNum, 1, cobRule: EnumCobRule.SecondaryMedicaid);
InsPlan priPlan = InsPlanT.GetPlanForPriSecMed(PriSecMed.Primary, insInfo.ListPatPlans, insInfo.ListInsPlans, insInfo.ListInsSubs);
BenefitT.CreateCategoryPercent(priPlan.PlanNum, EbenefitCategory.Diagnostic, percent: 50);
List <Benefit> listBens = Benefits.Refresh(insInfo.ListPatPlans, insInfo.ListInsSubs);
string procStr = "D0150";
Procedure proc = ProcedureT.CreateProcedure(pat, procStr, ProcStat.TP, "", 125);
ProcedureCode procCode = ProcedureCodes.GetProcCode(procStr);
FeeT.CreateFee(ppoFeeSchedNum, procCode.CodeNum, amount: 80);
Procedures.ComputeEstimates(proc, pat.PatNum, new List <ClaimProc>(), false, insInfo.ListInsPlans, insInfo.ListPatPlans, listBens, pat.Age,
insInfo.ListInsSubs);
List <ClaimProc> listClaimProcs = ClaimProcs.Refresh(pat.PatNum);
Assert.AreEqual(40, listClaimProcs[0].InsEstTotal, 0.001);
Assert.AreEqual(45, listClaimProcs[0].WriteOffEst, 0.001);
}
///<summary>Creates a procedure and computes estimates for a patient where the secondary insurance has a COB rule of Medicaid.</summary>
private void ComputeEstimatesFixedBenefits(string suffix, double procFee, double ppoFee, double fixedBenefitFee
, int priPercentCoveredOverride, bool hasSecondary, double secFee, Action <FixedBenefitAssertItem> assertAct)
{
Patient pat = PatientT.CreatePatient(suffix);
string procStr = "D0150";
Procedure proc = ProcedureT.CreateProcedure(pat, procStr, ProcStat.TP, "", procFee);
ProcedureCode procCode = ProcedureCodes.GetProcCode(procStr);
long ppoFeeSchedNum = FeeSchedT.CreateFeeSched(FeeScheduleType.Normal, "PPO " + suffix);
long catPercFeeSchedNum = FeeSchedT.CreateFeeSched(FeeScheduleType.Normal, "Category % " + suffix);
long fixedBenefitFeeSchedNum = FeeSchedT.CreateFeeSched(FeeScheduleType.FixedBenefit, "Fixed Benefit " + suffix);
if (ppoFee > -1)
{
FeeT.CreateFee(ppoFeeSchedNum, procCode.CodeNum, ppoFee);
}
FeeT.CreateFee(fixedBenefitFeeSchedNum, procCode.CodeNum, fixedBenefitFee);
InsuranceT.AddInsurance(pat, suffix, "p", ppoFeeSchedNum, copayFeeSchedNum: fixedBenefitFeeSchedNum);
if (hasSecondary)
{
FeeT.CreateFee(catPercFeeSchedNum, procCode.CodeNum, secFee);
InsuranceT.AddInsurance(pat, suffix, "", catPercFeeSchedNum, 2, false, EnumCobRule.Standard);
}
List <InsSub> listSubs = InsSubT.GetInsSubs(pat);
List <InsPlan> listPlans = InsPlans.RefreshForSubList(listSubs);
List <PatPlan> listPatPlans = PatPlans.Refresh(pat.PatNum);
InsPlan priPlan = InsPlanT.GetPlanForPriSecMed(PriSecMed.Primary, listPatPlans, listPlans, listSubs);
InsPlan secPlan = null;
if (hasSecondary)
{
secPlan = InsPlanT.GetPlanForPriSecMed(PriSecMed.Secondary, listPatPlans, listPlans, listSubs);
//TODO: Add diagnostic code benefit for 100%
BenefitT.CreateCategoryPercent(secPlan.PlanNum, EbenefitCategory.Diagnostic, 100);
}
List <Benefit> listBens = Benefits.Refresh(listPatPlans, listSubs);
Procedures.ComputeEstimates(proc, pat.PatNum, new List <ClaimProc>(), false, listPlans, listPatPlans, listBens, pat.Age, listSubs);
List <ClaimProc> listClaimProcs = ClaimProcs.Refresh(pat.PatNum);
if (priPercentCoveredOverride > 0)
{
foreach (ClaimProc cpCur in listClaimProcs)
{
cpCur.PercentOverride = priPercentCoveredOverride;
ClaimProcs.Update(cpCur);
}
Procedures.ComputeEstimates(proc, pat.PatNum, new List <ClaimProc>(), false, listPlans, listPatPlans, listBens, pat.Age, listSubs);
listClaimProcs = ClaimProcs.Refresh(pat.PatNum);
}
foreach (ClaimProc cpCur in listClaimProcs)
{
cpCur.PercentOverride = priPercentCoveredOverride;
ClaimProcs.Update(cpCur);
}
Procedures.ComputeEstimates(proc, pat.PatNum, listClaimProcs, false, listPlans, listPatPlans, listBens, pat.Age, listSubs);
listClaimProcs = ClaimProcs.Refresh(pat.PatNum);
assertAct(new FixedBenefitAssertItem()
{
Procedure = proc,
PrimaryClaimProc = listClaimProcs.FirstOrDefault(x => x.PlanNum == priPlan.PlanNum),
SecondaryClaimProc = secPlan == null ? null : listClaimProcs.FirstOrDefault(x => x.PlanNum == secPlan.PlanNum),
});
}
