public void ProcedureCodes_GetSubstituteCodeNum_Posterior()
{
//First, setup the test scenario.
string suffix = MethodBase.GetCurrentMethod().Name;
Patient pat = PatientT.CreatePatient(suffix);
Carrier carrier = CarrierT.CreateCarrier(MethodBase.GetCurrentMethod().Name);
InsPlan plan = new InsPlan();
plan.CarrierNum = carrier.CarrierNum;
plan.PlanType = "";
plan.CobRule = EnumCobRule.Basic;
plan.PlanNum = InsPlans.Insert(plan);
//Add a substitution code on the procedure level.
ProcedureCode originalProcCode = ProcedureCodes.GetProcCode("D2740");
ProcedureCode downgradeProcCode = ProcedureCodes.GetProcCode("D2750");
originalProcCode.SubstitutionCode = "D2750";
originalProcCode.SubstOnlyIf = SubstitutionCondition.Posterior;
ProcedureCodeT.Update(originalProcCode);
//Posterior Procedure= ToothNum 4
Procedure proc = ProcedureT.CreateProcedure(pat, originalProcCode.ProcCode, ProcStat.C, "4", 100);//Tooth 4
long subCodeNum = ProcedureCodes.GetSubstituteCodeNum(originalProcCode.ProcCode, proc.ToothNum, plan.PlanNum);
//Finally, use one or more asserts to verify the results.
Assert.AreEqual(downgradeProcCode.CodeNum, subCodeNum);
}
public void ProcedureCodes_GetSubstituteCodeNum_InsPlanOverrideAlways()
{
//First, setup the test scenario.
string suffix = MethodBase.GetCurrentMethod().Name;
Patient pat = PatientT.CreatePatient(suffix);
Carrier carrier = CarrierT.CreateCarrier(MethodBase.GetCurrentMethod().Name);
InsPlan plan = new InsPlan();
plan.CarrierNum = carrier.CarrierNum;
plan.PlanType = "";
plan.CobRule = EnumCobRule.Basic;
plan.PlanNum = InsPlans.Insert(plan);
//Add a substitution code on the procedure level.
ProcedureCode originalProcCode = ProcedureCodes.GetProcCode("D2330");
ProcedureCode downgradeProcCode = ProcedureCodes.GetProcCode("D2140");
originalProcCode.SubstitutionCode = "D2140";
originalProcCode.SubstOnlyIf = SubstitutionCondition.Always;
ProcedureCodeT.Update(originalProcCode);
//Add an override for the inplan above for the originalProcCode
ProcedureCode downgradeProcCodeForIns = ProcedureCodes.GetProcCode("D2150");
SubstitutionLinkT.CreateSubstitutionLink(originalProcCode.CodeNum, downgradeProcCodeForIns.ProcCode, SubstitutionCondition.Always, plan.PlanNum);
//Next, perform the thing you're trying to test.
Procedure proc = ProcedureT.CreateProcedure(pat, originalProcCode.ProcCode, ProcStat.C, "9", 100);//Tooth 9
long subCodeNum = ProcedureCodes.GetSubstituteCodeNum(originalProcCode.ProcCode, proc.ToothNum, plan.PlanNum);
//Finally, use one or more asserts to verify the results.
Assert.AreEqual(downgradeProcCodeForIns.CodeNum, subCodeNum);
}
public void ProcedureCodes_GetSubstituteCodeNum_InsPlanOverridePosterior()
{
//First, setup the test scenario.
string suffix = MethodBase.GetCurrentMethod().Name;
Patient pat = PatientT.CreatePatient(suffix);
Carrier carrier = CarrierT.CreateCarrier(MethodBase.GetCurrentMethod().Name);
InsPlan plan = new InsPlan();
plan.CarrierNum = carrier.CarrierNum;
plan.PlanType = "";
plan.CobRule = EnumCobRule.Basic;
plan.PlanNum = InsPlans.Insert(plan);
//Procedure code does not have a substitution code
ProcedureCode originalProcCode = ProcedureCodes.GetProcCode("D2740");
//clear out any substitution codes on this procedure
originalProcCode.SubstitutionCode = "";
ProcedureCodeT.Update(originalProcCode);
//Add an override for the inplan above for the originalProcCode to substitute if posterior
ProcedureCode downgradeProcCodeForIns = ProcedureCodes.GetProcCode("D2750");
SubstitutionLinkT.CreateSubstitutionLink(originalProcCode.CodeNum, downgradeProcCodeForIns.ProcCode, SubstitutionCondition.Posterior, plan.PlanNum);
//Posterior procedure
Procedure proc = ProcedureT.CreateProcedure(pat, originalProcCode.ProcCode, ProcStat.C, "4", 100);//Tooth 4
long subCodeNum = ProcedureCodes.GetSubstituteCodeNum(originalProcCode.ProcCode, proc.ToothNum, plan.PlanNum);
//The ins override is set to substitute only if posterior.
Assert.AreEqual(downgradeProcCodeForIns.CodeNum, subCodeNum);
}
public void ProcedureCodes_GetSubstituteCodeNum_InsPlanOverrideNever()
{
//First, setup the test scenario.
string suffix = MethodBase.GetCurrentMethod().Name;
Patient pat = PatientT.CreatePatient(suffix);
Carrier carrier = CarrierT.CreateCarrier(MethodBase.GetCurrentMethod().Name);
InsPlan plan = new InsPlan();
plan.CarrierNum = carrier.CarrierNum;
plan.PlanType = "";
plan.CobRule = EnumCobRule.Basic;
plan.PlanNum = InsPlans.Insert(plan);
//Add a substitution code on the procedure level that has SubstitutionCondition.Never.
ProcedureCode originalProcCode = ProcedureCodes.GetProcCode("D2330");
//clear out any substitution codes on this procedure
originalProcCode.SubstitutionCode = "";
ProcedureCodeT.Update(originalProcCode);
//Add an override for the inplan above for the originalProcCode to never substitute
ProcedureCode downgradeProcCodeForIns = ProcedureCodes.GetProcCode("D2150");
SubstitutionLinkT.CreateSubstitutionLink(originalProcCode.CodeNum, downgradeProcCodeForIns.ProcCode, SubstitutionCondition.Never, plan.PlanNum);
//Next, perform the thing you're trying to test.
Procedure proc = ProcedureT.CreateProcedure(pat, originalProcCode.ProcCode, ProcStat.C, "9", 100);//Tooth 9
long subCodeNum = ProcedureCodes.GetSubstituteCodeNum(originalProcCode.ProcCode, proc.ToothNum, plan.PlanNum);
//The procedure level and ins override is set SubstitutionCondition.Never so it should use originalProcCode.CodeNum
Assert.AreEqual(originalProcCode.CodeNum, subCodeNum);
}
public void InsPlans_GetAllowed_NoFeeSched()
{
Carrier carrier = CarrierT.CreateCarrier(MethodBase.GetCurrentMethod().Name);
InsPlan plan = new InsPlan();
plan.CarrierNum = carrier.CarrierNum;
plan.PlanType = "";
plan.CobRule = EnumCobRule.Basic;
plan.PlanNum = InsPlans.Insert(plan);
ProcedureCode procCode = _listProcCodes[13];
procCode.SubstitutionCode = _listProcCodes[14].ProcCode;
ProcedureCodes.Update(procCode);
ProcedureCodes.RefreshCache();
Provider prov = Providers.GetProv(PrefC.GetLong(PrefName.PracticeDefaultProv));
long provFeeSched = FeeSchedT.CreateFeeSched(FeeScheduleType.Normal, MethodBase.GetCurrentMethod().Name);
prov.FeeSched = provFeeSched;
Providers.Update(prov);
Providers.RefreshCache();
Fee defaultFee = FeeT.GetNewFee(Providers.GetProv(PrefC.GetLong(PrefName.PracticeDefaultProv)).FeeSched,
ProcedureCodes.GetSubstituteCodeNum(procCode.ProcCode, "", plan.PlanNum), 80);
double amt = InsPlans.GetAllowed(procCode.ProcCode, plan.FeeSched, plan.AllowedFeeSched, plan.CodeSubstNone, plan.PlanType, "", 0, 0, plan.PlanNum);
Assert.AreEqual(defaultFee.Amount, amt);
}
public void InsPlans_GetAllowed_PPOSubstituteMoreExpensive()
{
InsPlan plan = GeneratePPOPlan(MethodBase.GetCurrentMethod().Name, false);
ProcedureCode procCode = _listProcCodes[9];
procCode.SubstitutionCode = _listProcCodes[10].ProcCode;
ProcedureCodes.Update(procCode);
Fee feeOrig = FeeT.GetNewFee(plan.FeeSched, procCode.CodeNum, 85);
Fee feeSubs = FeeT.GetNewFee(plan.FeeSched, ProcedureCodes.GetSubstituteCodeNum(procCode.SubstitutionCode, "", plan.PlanNum), 200);
double allowed = InsPlans.GetAllowed(procCode.ProcCode, plan.FeeSched, plan.AllowedFeeSched, plan.CodeSubstNone, plan.PlanType, "", 0, 0, plan.PlanNum);
Assert.AreEqual(feeOrig.Amount, allowed);
}
public void InsPlans_GetCopay_SubstituteFee()
{
ProcedureCode procCode = _listProcCodes[4];
procCode.SubstitutionCode = _listProcCodes[5].ProcCode;
ProcedureCodes.Update(procCode);
InsPlan plan = GenerateMediFlatInsPlan(MethodBase.GetCurrentMethod().Name, false);
Fee feeDefault = FeeT.GetNewFee(plan.FeeSched, procCode.CodeNum, 100);
Fee feeSubstitute = FeeT.GetNewFee(plan.CopayFeeSched, ProcedureCodes.GetSubstituteCodeNum(procCode.ProcCode, "", plan.PlanNum), 45);
double amt = InsPlans.GetCopay(procCode.CodeNum, plan.FeeSched, plan.CopayFeeSched, plan.CodeSubstNone, "", 0, 0, plan.PlanNum);
Assert.AreEqual(feeSubstitute.Amount, amt);
}
