private void Import834_Unsafe()
{
if (!MsgBox.Show(this, true, "Importing insurance plans is a database intensive operation and can take 10 minutes or more to run. "
+ "It is best to import insurance plans after hours or during another time period when database usage is otherwise low.\r\n"
+ "Click OK to import insurance plans now, or click Cancel."))
{
return;
}
checkIsPatientCreate.Enabled = false;
gridInsPlans.Enabled = false;
butOK.Enabled = false;
butCancel.Enabled = false;
Cursor = Cursors.WaitCursor;
Prefs.UpdateBool(PrefName.Ins834IsPatientCreate, checkIsPatientCreate.Checked);
int rowIndex = 1;
int createdPatsCount = 0;
int updatedPatsCount = 0;
int skippedPatsCount = 0;
int createdCarrierCount = 0;
int createdPlanCount = 0;
int droppedPlanCount = 0;
int updatedPlanCount = 0;
StringBuilder sbErrorMessages = new StringBuilder();
List <int> listImportedSegments = new List <int> (); //Used to reconstruct the 834 with imported patients removed.
for (int i = 0; i < _x834.ListTransactions.Count; i++)
{
Hx834_Tran tran = _x834.ListTransactions[i];
for (int j = 0; j < tran.ListMembers.Count; j++)
{
Hx834_Member member = tran.ListMembers[j];
ShowStatus("Progress " + (rowIndex).ToString().PadLeft(6) + "/" + gridInsPlans.Rows.Count.ToString().PadLeft(6)
+ " Importing plans for patient " + member.Pat.GetNameLF());
//The patient's status is not affected by the maintenance code. After reviewing all of the possible maintenance codes in
//member.MemberLevelDetail.MaintenanceTypeCode, we believe that all statuses suggest either insert or update, except for "Cancel".
//Nathan and Derek feel that archiving the patinet in response to a Cancel request is a bit drastic.
//Thus we ignore the patient maintenance code and always assume insert/update.
//Even if the status was "Cancel", then updating the patient does not hurt.
bool isMemberImported = false;
bool isMultiMatch = false;
if (member.Pat.PatNum == 0)
{
//The patient may need to be created below. However, the patient may have already been inserted in a pervious iteration of this loop
//in following scenario: Two different 834s include updates for the same patient and both documents are being imported at the same time.
//If the patient was already inserted, then they would show up in _listPatients and also in the database. Attempt to locate the patient
//in _listPatients again before inserting.
List <Patient> listPatientMatches = Patients.GetPatientsByNameAndBirthday(member.Pat, _listPatients);
if (listPatientMatches.Count == 1)
{
member.Pat.PatNum = listPatientMatches[0].PatNum;
}
else if (listPatientMatches.Count > 1)
{
isMultiMatch = true;
}
}
if (isMultiMatch)
{
skippedPatsCount++;
}
else if (member.Pat.PatNum == 0 && checkIsPatientCreate.Checked)
{
//The code here mimcs the behavior of FormPatientSelect.butAddPt_Click().
Patients.Insert(member.Pat, false);
Patient memberPatOld = member.Pat.Copy();
member.Pat.PatStatus = PatientStatus.Patient;
member.Pat.BillingType = PrefC.GetLong(PrefName.PracticeDefaultBillType);
if (!PrefC.GetBool(PrefName.PriProvDefaultToSelectProv))
{
//Set the patients primary provider to the practice default provider.
member.Pat.PriProv = Providers.GetDefaultProvider().ProvNum;
}
member.Pat.ClinicNum = Clinics.ClinicNum;
member.Pat.Guarantor = member.Pat.PatNum;
Patients.Update(member.Pat, memberPatOld);
int patIdx = _listPatients.BinarySearch(member.Pat); //Preserve sort order by locating the index in which to insert the newly added patient.
int insertIdx = ~patIdx; //According to MSDN, the index returned by BinarySearch() is a "bitwise compliment", since not currently in list.
_listPatients.Insert(insertIdx, member.Pat);
SecurityLogs.MakeLogEntry(Permissions.PatientCreate, member.Pat.PatNum, "Created from Import Ins Plans 834.", LogSources.InsPlanImport834);
isMemberImported = true;
createdPatsCount++;
}
else if (member.Pat.PatNum == 0 && !checkIsPatientCreate.Checked)
{
skippedPatsCount++;
}
else //member.Pat.PatNum!=0
{
Patient patDb = _listPatients.FirstOrDefault(x => x.PatNum == member.Pat.PatNum); //Locate by PatNum, in case user selected manually.
member.MergePatientIntoDbPatient(patDb); //Also updates the patient to the database and makes log entry.
_listPatients.Remove(patDb); //Remove patient from list so we can add it back in the correct location (in case name or bday changed).
int patIdx = _listPatients.BinarySearch(patDb); //Preserve sort order by locating the index in which to insert the newly added patient.
//patIdx could be positive if the user manually selected a patient when there were multiple matches found.
//If patIdx is negative, then according to MSDN, the index returned by BinarySearch() is a "bitwise compliment".
//If there were mult instances of patDb BinarySearch() would return 0, which should not be complimented (OutOfRangeException)
int insertIdx = (patIdx >= 0)?patIdx:~patIdx;
_listPatients.Insert(insertIdx, patDb);
isMemberImported = true;
updatedPatsCount++;
}
if (isMemberImported)
{
//Import insurance changes for patient.
for (int k = 0; k < member.ListHealthCoverage.Count; k++)
{
Hx834_HealthCoverage healthCoverage = member.ListHealthCoverage[k];
if (k > 0)
{
rowIndex++;
}
List <Carrier> listCarriers = Carriers.GetByNameAndTin(tran.Payer.Name, tran.Payer.IdentificationCode);
if (listCarriers.Count == 0)
{
Carrier carrier = new Carrier();
carrier.CarrierName = tran.Payer.Name;
carrier.TIN = tran.Payer.IdentificationCode;
Carriers.Insert(carrier);
DataValid.SetInvalid(InvalidType.Carriers);
listCarriers.Add(carrier);
SecurityLogs.MakeLogEntry(Permissions.CarrierCreate, 0, "Carrier '" + carrier.CarrierName
+ "' created from Import Ins Plans 834.", LogSources.InsPlanImport834);
createdCarrierCount++;
}
//Update insurance plans. Match based on carrier and SubscriberId.
bool isDropping = false;
if (healthCoverage.HealthCoverage.MaintenanceTypeCode == "002")
{
isDropping = true;
}
//The insPlanNew will only be inserted if necessary. Created temporarily in order to determine if insert is needed.
InsPlan insPlanNew = InsertOrUpdateInsPlan(null, member, listCarriers[0], false);
//Since the insurance plans in the 834 do not include very much information, it is likely that many patients will share the same exact plan.
//We look for an existing plan being used by any other patinents which match the fields we typically import.
List <InsPlan> listInsPlans = InsPlans.GetAllByCarrierNum(listCarriers[0].CarrierNum);
InsPlan insPlanMatch = null;
for (int p = 0; p < listInsPlans.Count; p++)
{
//Set the PlanNums equal so that AreEqualValue() will ignore this field. We must ignore PlanNum, since we do not know the PlanNum.
insPlanNew.PlanNum = listInsPlans[p].PlanNum;
if (InsPlans.AreEqualValue(listInsPlans[p], insPlanNew))
{
insPlanMatch = listInsPlans[p];
break;
}
}
Family fam = Patients.GetFamily(member.Pat.PatNum);
List <InsSub> listInsSubs = InsSubs.RefreshForFam(fam);
List <PatPlan> listPatPlans = PatPlans.Refresh(member.Pat.PatNum);
InsSub insSubMatch = null;
PatPlan patPlanMatch = null;
for (int p = 0; p < listInsSubs.Count; p++)
{
InsSub insSub = listInsSubs[p];
//According to section 1.4.3 of the standard, the preferred method of matching a dependent to a subscriber is to use the subscriberId.
if (insSub.SubscriberID.Trim() != member.SubscriberId.Trim())
{
continue;
}
insSubMatch = insSub;
patPlanMatch = PatPlans.GetFromList(listPatPlans, insSub.InsSubNum);
break;
}
if (patPlanMatch == null && isDropping) //No plan match and dropping plan.
//Nothing to do. The plan either never existed or is already dropped.
{
}
else if (patPlanMatch == null && !isDropping) //No plan match and not dropping plan. Create the plan.
{
insPlanMatch = InsertOrUpdateInsPlan(insPlanMatch, member, listCarriers[0]);
insSubMatch = InsertOrUpdateInsSub(insSubMatch, insPlanMatch, member, healthCoverage, listCarriers[0]);
patPlanMatch = InsertOrUpdatePatPlan(patPlanMatch, insSubMatch, insPlanMatch, member, listCarriers[0], listPatPlans);
createdPlanCount++;
}
else if (patPlanMatch != null && isDropping) //Plan matched and dropping plan. Drop the plan.
//This code mimics the behavior of FormInsPlan.butDrop_Click(), except here we do not care if there are claims for this plan today.
//We need this feature to be as streamlined as possible so that it might become an automated process later.
//Testing for claims on today's date does not seem that useful anyway, or at least not as useful as checking for any claims
//associated to the plan, instead of just today's date.
{
PatPlans.Delete(patPlanMatch.PatPlanNum); //Estimates recomputed within Delete()
SecurityLogs.MakeLogEntry(Permissions.InsPlanDropPat, patPlanMatch.PatNum,
"Insurance plan dropped from patient for carrier '" + listCarriers[0].CarrierName + "' and groupnum "
+ "'" + insPlanMatch.GroupNum + "' and subscriber ID '" + insSubMatch.SubscriberID + "' "
+ "from Import Ins Plans 834.", insPlanMatch.PlanNum, LogSources.InsPlanImport834, insPlanMatch.SecDateTEdit);
droppedPlanCount++;
}
else if (patPlanMatch != null && !isDropping) //Plan matched and not dropping plan. Update the plan.
{
insPlanMatch = InsertOrUpdateInsPlan(insPlanMatch, member, listCarriers[0]);
insSubMatch = InsertOrUpdateInsSub(insSubMatch, insPlanMatch, member, healthCoverage, listCarriers[0]);
patPlanMatch = InsertOrUpdatePatPlan(patPlanMatch, insSubMatch, insPlanMatch, member, listCarriers[0], listPatPlans);
updatedPlanCount++;
}
} //end loop k
//Remove the member from the X834.
int endSegIndex = 0;
if (j < tran.ListMembers.Count - 1)
{
endSegIndex = tran.ListMembers[j + 1].MemberLevelDetail.SegmentIndex - 1;
}
else
{
X12Segment segSe = _x834.GetNextSegmentById(member.MemberLevelDetail.SegmentIndex + 1, "SE"); //SE segment is required.
endSegIndex = segSe.SegmentIndex - 1;
}
for (int s = member.MemberLevelDetail.SegmentIndex; s <= endSegIndex; s++)
{
listImportedSegments.Add(s);
}
}
rowIndex++;
} //end loop j
} //end loop i
if (listImportedSegments.Count > 0 && skippedPatsCount > 0) //Some patients imported, while others did not.
{
if (MoveFileToArchiveFolder())
{
//Save the unprocessed members back to the import directory, so the user can try to import them again.
File.WriteAllText(_x834.FilePath, _x834.ReconstructRaw(listImportedSegments));
}
}
else if (listImportedSegments.Count > 0) //All patinets imported.
{
MoveFileToArchiveFolder();
}
else if (skippedPatsCount > 0) //No patients imported. All patients were skipped.
//Leave the raw file unaltered and where it is, so it can be processed again.
{
}
Cursor = Cursors.Default;
string msg = Lan.g(this, "Done.");
if (createdPatsCount > 0)
{
msg += "\r\n" + Lan.g(this, "Number of patients created:") + " " + createdPatsCount;
}
if (updatedPatsCount > 0)
{
msg += "\r\n" + Lan.g(this, "Number of patients updated:") + " " + updatedPatsCount;
}
if (skippedPatsCount > 0)
{
msg += "\r\n" + Lan.g(this, "Number of patients skipped:") + " " + skippedPatsCount;
msg += sbErrorMessages.ToString();
}
if (createdCarrierCount > 0)
{
msg += "\r\n" + Lan.g(this, "Number of carriers created:") + " " + createdCarrierCount;
msg += sbErrorMessages.ToString();
}
if (createdPlanCount > 0)
{
msg += "\r\n" + Lan.g(this, "Number of plans created:") + " " + createdPlanCount;
msg += sbErrorMessages.ToString();
}
if (droppedPlanCount > 0)
{
msg += "\r\n" + Lan.g(this, "Number of plans dropped:") + " " + droppedPlanCount;
msg += sbErrorMessages.ToString();
}
if (updatedPlanCount > 0)
{
msg += "\r\n" + Lan.g(this, "Number of plans updated:") + " " + updatedPlanCount;
msg += sbErrorMessages.ToString();
}
MsgBoxCopyPaste msgBox = new MsgBoxCopyPaste(msg);
msgBox.ShowDialog();
}
private Claim CreateClaim(string claimType, List <PatPlan> patPlanList, List <InsPlan> planList, List <ClaimProc> claimProcList, Procedure proc, List <InsSub> subList)
{
long claimFormNum = 0;
InsPlan planCur = new InsPlan();
InsSub subCur = new InsSub();
Relat relatOther = Relat.Self;
long clinicNum = proc.ClinicNum;
PlaceOfService placeService = proc.PlaceService;
switch (claimType)
{
case "P":
subCur = InsSubs.GetSub(PatPlans.GetInsSubNum(patPlanList, PatPlans.GetOrdinal(PriSecMed.Primary, patPlanList, planList, subList)), subList);
planCur = InsPlans.GetPlan(subCur.PlanNum, planList);
break;
case "S":
subCur = InsSubs.GetSub(PatPlans.GetInsSubNum(patPlanList, PatPlans.GetOrdinal(PriSecMed.Secondary, patPlanList, planList, subList)), subList);
planCur = InsPlans.GetPlan(subCur.PlanNum, planList);
break;
case "Med":
//It's already been verified that a med plan exists
subCur = InsSubs.GetSub(PatPlans.GetInsSubNum(patPlanList, PatPlans.GetOrdinal(PriSecMed.Medical, patPlanList, planList, subList)), subList);
planCur = InsPlans.GetPlan(subCur.PlanNum, planList);
break;
}
ClaimProc claimProcCur = Procedures.GetClaimProcEstimate(proc.ProcNum, claimProcList, planCur, subCur.InsSubNum);
if (claimProcCur == null)
{
claimProcCur = new ClaimProc();
ClaimProcs.CreateEst(claimProcCur, proc, planCur, subCur);
}
Claim claimCur = new Claim();
claimCur.PatNum = proc.PatNum;
claimCur.DateService = proc.ProcDate;
claimCur.ClinicNum = proc.ClinicNum;
claimCur.PlaceService = proc.PlaceService;
claimCur.ClaimStatus = "W";
claimCur.DateSent = DateTimeOD.Today;
claimCur.PlanNum = planCur.PlanNum;
claimCur.InsSubNum = subCur.InsSubNum;
InsSub sub;
switch (claimType)
{
case "P":
claimCur.PatRelat = PatPlans.GetRelat(patPlanList, PatPlans.GetOrdinal(PriSecMed.Primary, patPlanList, planList, subList));
claimCur.ClaimType = "P";
claimCur.InsSubNum2 = PatPlans.GetInsSubNum(patPlanList, PatPlans.GetOrdinal(PriSecMed.Secondary, patPlanList, planList, subList));
sub = InsSubs.GetSub(claimCur.InsSubNum2, subList);
if (sub.PlanNum > 0 && InsPlans.RefreshOne(sub.PlanNum).IsMedical)
{
claimCur.PlanNum2 = 0; //no sec ins
claimCur.PatRelat2 = Relat.Self;
}
else
{
claimCur.PlanNum2 = sub.PlanNum; //might be 0 if no sec ins
claimCur.PatRelat2 = PatPlans.GetRelat(patPlanList, PatPlans.GetOrdinal(PriSecMed.Secondary, patPlanList, planList, subList));
}
break;
case "S":
claimCur.PatRelat = PatPlans.GetRelat(patPlanList, PatPlans.GetOrdinal(PriSecMed.Secondary, patPlanList, planList, subList));
claimCur.ClaimType = "S";
claimCur.InsSubNum2 = PatPlans.GetInsSubNum(patPlanList, PatPlans.GetOrdinal(PriSecMed.Primary, patPlanList, planList, subList));
sub = InsSubs.GetSub(claimCur.InsSubNum2, subList);
claimCur.PlanNum2 = sub.PlanNum;
claimCur.PatRelat2 = PatPlans.GetRelat(patPlanList, PatPlans.GetOrdinal(PriSecMed.Primary, patPlanList, planList, subList));
break;
case "Med":
claimCur.PatRelat = PatPlans.GetFromList(patPlanList, subCur.InsSubNum).Relationship;
claimCur.ClaimType = "Other";
if (PrefC.GetBool(PrefName.ClaimMedTypeIsInstWhenInsPlanIsMedical))
{
claimCur.MedType = EnumClaimMedType.Institutional;
}
else
{
claimCur.MedType = EnumClaimMedType.Medical;
}
break;
case "Other":
claimCur.PatRelat = relatOther;
claimCur.ClaimType = "Other";
//plannum2 is not automatically filled in.
claimCur.ClaimForm = claimFormNum;
if (planCur.IsMedical)
{
if (PrefC.GetBool(PrefName.ClaimMedTypeIsInstWhenInsPlanIsMedical))
{
claimCur.MedType = EnumClaimMedType.Institutional;
}
else
{
claimCur.MedType = EnumClaimMedType.Medical;
}
}
break;
}
if (planCur.PlanType == "c") //if capitation
{
claimCur.ClaimType = "Cap";
}
claimCur.ProvTreat = proc.ProvNum;
if (Providers.GetIsSec(proc.ProvNum))
{
claimCur.ProvTreat = Patients.GetPat(proc.PatNum).PriProv;
//OK if zero, because auto select first in list when open claim
}
claimCur.IsProsthesis = "N";
claimCur.ProvBill = Providers.GetBillingProvNum(claimCur.ProvTreat, claimCur.ClinicNum); //OK if zero, because it will get fixed in claim
claimCur.EmployRelated = YN.No;
claimCur.ClaimForm = planCur.ClaimFormNum;
Claims.Insert(claimCur);
//attach procedure
claimProcCur.ClaimNum = claimCur.ClaimNum;
if (planCur.PlanType == "c") //if capitation
{
claimProcCur.Status = ClaimProcStatus.CapClaim;
}
else
{
claimProcCur.Status = ClaimProcStatus.NotReceived;
}
if (planCur.UseAltCode && (ProcedureCodes.GetProcCode(proc.CodeNum).AlternateCode1 != ""))
{
claimProcCur.CodeSent = ProcedureCodes.GetProcCode(proc.CodeNum).AlternateCode1;
}
else if (planCur.IsMedical && proc.MedicalCode != "")
{
claimProcCur.CodeSent = proc.MedicalCode;
}
else
{
claimProcCur.CodeSent = ProcedureCodes.GetProcCode(proc.CodeNum).ProcCode;
if (claimProcCur.CodeSent.Length > 5 && claimProcCur.CodeSent.Substring(0, 1) == "D")
{
claimProcCur.CodeSent = claimProcCur.CodeSent.Substring(0, 5);
}
if (CultureInfo.CurrentCulture.Name.EndsWith("CA")) //Canadian. en-CA or fr-CA
{
if (claimProcCur.CodeSent.Length > 5) //In Canadian e-claims, codes can contain letters or numbers and cannot be longer than 5 characters.
{
claimProcCur.CodeSent = claimProcCur.CodeSent.Substring(0, 5);
}
}
}
claimProcCur.LineNumber = (byte)1;
ClaimProcs.Update(claimProcCur);
return(claimCur);
}
