private static TypedLoopNM1 AddClmProvider(TypedLoopCLM clm, ClaimLine claim, string entityIdentifier, string providerCode, string providerCodeQualifier = "ZZ")
{
var loop = clm.AddLoop(new TypedLoopNM1(entityIdentifier));
loop.NM102_EntityTypeQualifier = EntityTypeQualifier.Person;
//if (prov.ProviderTypeId == 1)
//{
// loop.NM102_EntityTypeQualifier = EntityTypeQualifier.NonPersonEntity;
// loop.NM103_NameLastOrOrganizationName = TypeEx.Clean(prov.FullName, 35);
//}
//else
//{
loop.NM103_NameLastOrOrganizationName = TypeEx.Clean(claim.RenderProvider);
loop.NM104_NameFirst = TypeEx.Clean(claim.RenderProvider);
//}
loop.NM108_IdCodeQualifier = "XX";
loop.NM109_IdCode = claim.RenderNPI.Clean();
return(loop);
}
public Tuple <bool, List <ClaimLine> > GetExcel(string file)
{
var results = new List <ClaimLine>();
try
{
var fileInfo = new FileInfo(file);
using (var xlPackage = new ExcelPackage(fileInfo, Password))
{
// get the first worksheet in the workbook
var ws = xlPackage.Workbook.Worksheets.FirstOrDefault();
for (int i = 0; i < ws.Dimension.End.Row; i++)
{
if (i < 1)
{
continue;
}
var row = ws.Row(i + 1);
var p = new ClaimLine();
p.ClaimNumber = ws.GetValue <string>(row.Row, 1);
p.ContractNumber = ws.GetValue <string>(row.Row, 2);
p.PatientLastName = ws.GetValue <string>(row.Row, 3);
p.PatientFirstName = ws.GetValue <string>(row.Row, 4);
p.PlaceOfService = ws.GetValue <string>(row.Row, 5);
p.Dx1 = ws.GetValue <string>(row.Row, 6);
p.Dx2 = ws.GetValue <string>(row.Row, 7);
p.Dx3 = ws.GetValue <string>(row.Row, 8);
p.Dx4 = ws.GetValue <string>(row.Row, 9);
p.Dx5 = ws.GetValue <string>(row.Row, 10);
p.Dx6 = ws.GetValue <string>(row.Row, 11);
p.Dx7 = ws.GetValue <string>(row.Row, 12);
p.RenderProvider = ws.GetValue <string>(row.Row, 13);
p.RenderNPI = ws.GetValue <string>(row.Row, 14);
p.CPT = ws.GetValue <string>(row.Row, 15);
p.ServiceFrom = ws.GetValue <DateTime?>(row.Row, 16);
p.ServiceTo = ws.GetValue <DateTime?>(row.Row, 17);
p.Tariff = ws.GetValue <decimal?>(row.Row, 18);
if (String.IsNullOrWhiteSpace(p.ClaimNumber) &&
String.IsNullOrWhiteSpace(p.PatientFirstName) &&
String.IsNullOrWhiteSpace(p.PatientLastName))
{
continue;
}
results.Add(p);
}
}
}
catch (Exception ex)
{
if (ex.Message.ToLower().Contains("password"))
{
ErrorMessage = "Excel file is encrypted. Please enter password before selecting it.";
}
else
{
ErrorMessage = ex.Message;
}
IsError = true;
return(new Tuple <bool, List <ClaimLine> >(false, null));
}
return(new Tuple <bool, List <ClaimLine> >(true, results));
}
public Transaction CreateProfessionalTransaction(ClaimLine claim, FunctionGroup fg, FileConfigModel config, int parentControlNumber = 1)
{
var controlNumber = parentControlNumber.ToString("D9"); // = (fg.Transactions.Count + 1).ToString("D9");
var t = fg.AddTransaction("837", controlNumber);
try
{
if (!string.IsNullOrWhiteSpace(fg.VersionIdentifierCode))
{
t.SetElement(3, fg.VersionIdentifierCode);
}
}
catch
{
}
var bht = t.AddSegment("BHT");
bht.SetElement(1, "0019");
bht.SetElement(2, "00");
bht.SetElement(3, t.ControlNumber);
bht.SetElement(4, DateTime.UtcNow.ToString("yyyyMMdd"));
bht.SetElement(5, DateTime.UtcNow.ToString("hhmm"));
bht.SetElement(6, "CH");
var submitterProvider =
new ProviderInfo()
{
FirstName = "",
LastName = "SUBMITTER NAME",
ProviderId = 1,
ProviderTypeId = 2,
AlternateId = "ID",
WorkPhoneNumber = "3050000000"
};
var sender = t.AddLoop(new TypedLoopNM1("41"));
sender.NM102_EntityTypeQualifier = EntityTypeQualifier.Person;
if (submitterProvider.ProviderTypeId == 2)
{
sender.NM102_EntityTypeQualifier = EntityTypeQualifier.NonPersonEntity;
sender.NM103_NameLastOrOrganizationName = submitterProvider.FullName.Clean(35);
}
else
{
if (submitterProvider?.LastName != null)
{
sender.NM103_NameLastOrOrganizationName = submitterProvider.LastName.Clean(35);
sender.NM104_NameFirst = submitterProvider.FirstName.Clean(35);
}
}
//SUBMITTER
sender.NM108_IdCodeQualifier = "46"; //ETIN
if (!String.IsNullOrWhiteSpace(config.SenderIDQualifier) && config.SenderIDQualifier != "30")
{
sender.NM108_IdCodeQualifier = config.SenderIDQualifier;
}
sender.NM109_IdCode = config.SenderID.Clean();
var senderPer = sender.AddSegment(new TypedSegmentPER());
senderPer.PER01_ContactFunctionCode = "IC";
//INMEDIATA BUSINESS RULE
var nameTest = (sender.NM104_NameFirst + " " + sender.NM103_NameLastOrOrganizationName).Clean();
if (nameTest != submitterProvider.FullName.Clean())
{
senderPer.PER02_Name = submitterProvider.FullName.Clean();
}
if (!string.IsNullOrWhiteSpace(submitterProvider.WorkPhoneNumber))
{
senderPer.PER03_CommunicationNumberQualifier = CommunicationNumberQualifer.Telephone;
senderPer.PER04_CommunicationNumber = submitterProvider.WorkPhoneNumber.StripNonNumeric();
}
else
{
senderPer.PER03_CommunicationNumberQualifier = CommunicationNumberQualifer.Telephone;
senderPer.PER04_CommunicationNumber = "3050001234";
}
//END SUBMITTER
//Loop 1000B
var reciever = t.AddLoop(new TypedLoopNM1("40"));
reciever.NM102_EntityTypeQualifier = EntityTypeQualifier.NonPersonEntity;
reciever.NM103_NameLastOrOrganizationName = "RECIEVER NAME";
reciever.NM108_IdCodeQualifier = "46";
reciever.NM109_IdCode = fg.Interchange.InterchangeReceiverId != null?fg.Interchange.InterchangeReceiverId.Trim() : "";
//BILLER
var providerLoop = t.AddHLoop("1", "20", true);
var billingProvider = new ProviderInfo()
{
FirstName = "",
LastName = "LASTNAME",
ProviderId = 1,
ProviderTypeId = 2,
ProviderNPI = 1111111111,
AlternateId = "660000000",
WorkAddress1 = "",
WorkAddress2 = "",
WorkCity = "",
WorkPhoneNumber = ""
};
if (!String.IsNullOrWhiteSpace(billingProvider.SpecialtyCode))
{
var provSpecialty = providerLoop.AddSegment(new TypedSegmentPRV());
provSpecialty.PRV01_ProviderCode = "BI";
provSpecialty.PRV02_ReferenceIdQualifier = "PXC";
provSpecialty.PRV03_ProviderTaxonomyCode = billingProvider.SpecialtyCode;
}
var provName = providerLoop.AddLoop(new TypedLoopNM1("85"));
provName.NM102_EntityTypeQualifier = EntityTypeQualifier.Person;
if (billingProvider.ProviderTypeId == 2)
{
provName.NM102_EntityTypeQualifier = EntityTypeQualifier.NonPersonEntity;
provName.NM103_NameLastOrOrganizationName = billingProvider.FullName.Clean(35);
}
else
{
if (!string.IsNullOrWhiteSpace(billingProvider.FirstName))
{
provName.NM103_NameLastOrOrganizationName = billingProvider.LastName.Clean(35);
provName.NM104_NameFirst = billingProvider.FirstName.Clean(35);
}
}
provName.NM108_IdCodeQualifier = "XX";//NPI
provName.NM109_IdCode = billingProvider.ProviderNPI?.ToString();
//QH
if (billingProvider.WorkAddress1 != null)
{
AddNm1Address(provName, billingProvider.WorkAddress1, billingProvider.WorkAddress2, "", billingProvider.WorkCity, "FL");
}
//CONTACT
var provNameRef = provName.AddSegment(new TypedSegmentREF());
if (!string.IsNullOrWhiteSpace(billingProvider.AlternateId) && billingProvider.AlternateId.StartsWith("66"))
{
provNameRef.REF01_ReferenceIdQualifier = "EI";
}
else
{
provNameRef.REF01_ReferenceIdQualifier = "SY";
}
provNameRef.REF02_ReferenceId = billingProvider.AlternateId;
//PATIENT
var subscriberLoop = providerLoop.AddHLoop("2", "22", false);
//PLAN
if (!string.IsNullOrWhiteSpace(claim.ContractNumber))
{
var sbr = subscriberLoop.AddSegment(new TypedSegmentSBR());
sbr.SBR01_PayerResponsibilitySequenceNumberCode = "P";
sbr.SBR02_IndividualRelationshipCode = "18";
sbr.SBR09_ClaimFilingIndicatorCode = "CI";
}
if (!string.IsNullOrWhiteSpace(claim.PatientFirstName))
{
var subsName = subscriberLoop.AddLoop(new TypedLoopNM1("IL"));
subsName.NM102_EntityTypeQualifier = EntityTypeQualifier.Person;
subsName.NM103_NameLastOrOrganizationName = claim.PatientLastName.Clean();
subsName.NM104_NameFirst = claim.PatientFirstName.Clean();
//if (!String.IsNullOrWhiteSpace(claim.PatientName))
// subsName.NM105_NameMiddle = TypeEx.Clean(claim.PatientName);
if (!string.IsNullOrWhiteSpace(claim.ContractNumber))
{
subsName.NM108_IdCodeQualifier = "MI";//Health Plan Member Identification Number
subsName.NM109_IdCode = claim.ContractNumber.Clean();
}
//Address
AddNm1Address(subsName, "ADDRESS1", "ADDRESS2", "33176", "MIAMI", "FL");
var subsNameDMG = subsName.AddSegment(new TypedSegmentDMG());
subsNameDMG.DMG01_DateTimePeriodFormatQualifier = $"D{DTPFormatQualifier.MMDDCCYY.ToString("d")}"; //"D8";
subsNameDMG.DMG02_DateOfBirth = claim.MemberBirthDate ?? fillerBirthDate;
subsNameDMG.DMG03_Gender = Gender.Unknown;
}
//PAYER
var pay = subscriberLoop.AddLoop(new TypedLoopNM1("PR"));
pay.NM102_EntityTypeQualifier = EntityTypeQualifier.NonPersonEntity;
pay.NM103_NameLastOrOrganizationName = "PAYER MEDICAL";
pay.NM108_IdCodeQualifier = "PI";
pay.NM109_IdCode = "GHP6600000000";
//CLAIM - LOOP 2300
var clm = subscriberLoop.AddLoop(new TypedLoopCLM());
clm.CLM02_TotalClaimChargeAmount = claim.Tariff ?? 0;
clm.CLM05._1_FacilityCodeValue = "11";
clm.CLM05._2_FacilityCodeQualifier = "B";
clm.CLM05._3_ClaimFrequencyTypeCode = "1";
//CLAIM NUMBER
if (!string.IsNullOrWhiteSpace(claim.ClaimNumber))
{
//CLM Claim Information
clm.CLM01_PatientControlNumber = claim.ClaimNumber.ToString();
//clm.CLM05._3_ClaimFrequencyTypeCode = "7";
//Header
//bht.SetElement(2, "18");//Reissue
//original claim from reissue
//var ref = clm.AddSegment(new TypedSegmentREF());
//ref.REF01_ReferenceIdQualifier = "F8";
//ref.REF02_ReferenceId = claim.ClaimNumber;
}
if (!string.IsNullOrWhiteSpace(claim.PlaceOfService))
{
clm.CLM05._1_FacilityCodeValue = claim.PlaceOfService;
}
clm.CLM06_ProviderOrSupplierSignatureIndicator = true;
clm.CLM07_ProviderAcceptAssignmentCode = "A";
clm.CLM08_BenefitsAssignmentCerficationIndicator = "Y";
clm.CLM09_ReleaseOfInformationCode = "Y";
clm.CLM10_PatientSignatureSourceCode = "P";
//Add DX
var dxList = new List <string>();
if (!string.IsNullOrWhiteSpace(claim.Dx1))
{
dxList.Add(claim.Dx1.Clean());
}
if (!string.IsNullOrWhiteSpace(claim.Dx2))
{
dxList.Add(claim.Dx2.Clean());
}
if (!string.IsNullOrWhiteSpace(claim.Dx3))
{
dxList.Add(claim.Dx3.Clean());
}
if (!string.IsNullOrWhiteSpace(claim.Dx4))
{
dxList.Add(claim.Dx4.Clean());
}
if (!string.IsNullOrWhiteSpace(claim.Dx5))
{
dxList.Add(claim.Dx5.Clean());
}
if (!string.IsNullOrWhiteSpace(claim.Dx6))
{
dxList.Add(claim.Dx6.Clean());
}
if (!string.IsNullOrWhiteSpace(claim.Dx7))
{
dxList.Add(claim.Dx7.Clean());
}
if (dxList.Count > 0)
{
var hiSegment = clm.AddSegment(new TypedSegmentHI());
foreach (var item in dxList)
{
var index = dxList.IndexOf(item) + 1;
if (string.IsNullOrWhiteSpace(item))
{
continue;
}
var prefix = "A";
//inmediata requires dotless notation
var code = item.Replace(".", "").ToUpper();
if (index == 1)
{
hiSegment.HI01_HealthCareCodeInformation = prefix + "BK:" + code;
}
if (index == 2)
{
hiSegment.HI02_HealthCareCodeInformation = prefix + "BF:" + code;
}
if (index == 3)
{
hiSegment.HI03_HealthCareCodeInformation = prefix + "BF:" + code;
}
if (index == 4)
{
hiSegment.HI04_HealthCareCodeInformation = prefix + "BF:" + code;
}
if (index == 5)
{
hiSegment.HI05_HealthCareCodeInformation = prefix + "BF:" + code;
}
if (index == 6)
{
hiSegment.HI06_HealthCareCodeInformation = prefix + "BF:" + code;
}
if (index == 7)
{
hiSegment.HI07_HealthCareCodeInformation = prefix + "BF:" + code;
}
if (index == 8)
{
hiSegment.HI08_HealthCareCodeInformation = prefix + "BF:" + code;
}
if (index == 9)
{
hiSegment.HI09_HealthCareCodeInformation = prefix + "BF:" + code;
}
if (index == 10)
{
hiSegment.HI10_HealthCareCodeInformation = prefix + "BF:" + code;
}
if (index == 11)
{
hiSegment.HI11_HealthCareCodeInformation = prefix + "BF:" + code;
}
if (index == 12)
{
hiSegment.HI12_HealthCareCodeInformation = prefix + "BF:" + code;
}
}
}
var serviceList = new List <string>();
if (!string.IsNullOrWhiteSpace(claim.CPT))
{
serviceList.Add(claim.CPT.Clean());
}
int cnt = 1;
foreach (var serviceCode in serviceList)
{
if (!string.IsNullOrWhiteSpace(claim.RenderNPI))
{
var clmProv = AddClmProvider(clm, claim, "82", "PE", "PXC");
}
//Service
var svc1 = clm.AddLoop(new TypedLoopLX("LX"));
svc1.LX01_AssignedNumber = cnt.ToString();
var compositeCodeBuilder = new System.Text.StringBuilder();
if (!string.IsNullOrWhiteSpace(serviceCode))
{
compositeCodeBuilder.Append("HC:" + serviceCode.Clean());
}
var svc101 = svc1.AddSegment(new TypedSegmentSV1());
if (!string.IsNullOrWhiteSpace(serviceCode))
{
svc101.SV101_CompositeMedicalProcedure = compositeCodeBuilder.ToString();
}
//AMOUNT
svc101.SV102_MonetaryAmount = claim.Tariff.toString("F");
svc101.SV103_UnitBasisMeasCode = "UN";
svc101.SV104_Quantity = "1";
//Only when not the same as CLM05
if (!string.IsNullOrWhiteSpace(claim.PlaceOfService) && clm.CLM05._1_FacilityCodeValue != claim.PlaceOfService)
{
svc101.SV105_FacilityCode = claim.PlaceOfService;
}
//DX Pointer
svc101.SV107_CompDiagCodePoint = "1";
var svc101DTP = svc1.AddSegment(new TypedSegmentDTP());
svc101DTP.DTP01_DateTimeQualifier = DTPQualifier.Service;
if (claim.ServiceFrom.HasValue && claim.ServiceTo.HasValue)
{
svc101DTP.DTP02_DateTimePeriodFormatQualifier = DTPFormatQualifier.CCYYMMDD_CCYYMMDD;
svc101DTP.DTP03_Date = new DateTimePeriod(claim.ServiceFrom.Value, claim.ServiceTo.Value);
}
else if (claim.ServiceFrom.HasValue)
{
svc101DTP.DTP02_DateTimePeriodFormatQualifier = DTPFormatQualifier.CCYYMMDD;
svc101DTP.DTP03_Date = new DateTimePeriod(claim.ServiceFrom.Value);
}
//End Service Date
cnt++;
}
return(t);
}