private object SaveHierarchicalLoop(
HierarchicalLoop loop,
object interchangeId,
object transactionSetId,
string transactionSetCode,
object parentLoopId)
{
var hlId = _idProvider.NextId(_schema, "Loop");
var containerId = _idProvider.NextId(_commonDb.Schema, "Container");
var cmd = new SqlCommand(GetContainerIdSql("HL") + string.Format(@"
INSERT INTO [{0}].[Loop] (Id, ParentLoopId, InterchangeId, TransactionSetId, TransactionSetCode, SpecLoopId, LevelId, LevelCode, StartingSegmentId)
VALUES (@id, @parentLoopId, @interchangeId, @transactionSetId, @transactionSetCode, @specLoopId, @levelId, @levelCode, 'HL')
", _schema, _commonDb.Schema));
cmd.Parameters.AddWithValue("@id", hlId);
cmd.Parameters.AddWithValue("@containerId", containerId);
cmd.Parameters.AddWithValue("@parentLoopId", parentLoopId != null && parentLoopId != _defaultIdentityTypeValue ? parentLoopId : DBNull.Value);
cmd.Parameters.AddWithValue("@interchangeId", interchangeId);
cmd.Parameters.AddWithValue("@transactionSetId", transactionSetId);
cmd.Parameters.AddWithValue("@transactionSetCode", transactionSetCode);
cmd.Parameters.AddWithValue("@specLoopId", loop.Specification.LoopId);
cmd.Parameters.AddWithValue("@levelId", loop.Id);
cmd.Parameters.AddWithValue("@levelCode", loop.LevelCode);
ExecuteCmd(cmd);
return(hlId);
}
public void ClaimCreationTest()
{
Interchange interchange = CreateSample1WithFunctionGroup();
Transaction transaction = interchange.FunctionGroups.First().AddTransaction("837", "0034");
Segment bhtSegment = transaction.AddSegment("BHT*0019*00*3920394930203*20070816*1615*CH");
Segment refSegment = transaction.AddSegment("REF*87*004010X096A1");
Loop senderLoop = transaction.AddLoop("NM1*41*2*HOWDEE HOSPITAL*****XX*0123456789");
senderLoop.AddSegment("PER*IC*BETTY RUBBLE*TE*9195551111");
Loop receiverLoop = transaction.AddLoop("NM1*40*2*BLUE CROSS BLUE SHIELD OF NC*****46*987654321");
HierarchicalLoop providerLoop = transaction.AddHLoop("1", "20", true);
providerLoop.AddSegment("PRV*BI*ZZ*203BA0200N");
var billingProvider = providerLoop.AddLoop("NM1*85*2*HOWDEE HOSPITAL*****XX*0123456789");
billingProvider.AddSegment("N3*123 HOWDEE BOULEVARD");
billingProvider.AddSegment("N4*DURHAM*NC*27701");
billingProvider.AddSegment("REF*1J*654");
billingProvider.AddSegment("PER*IC*BETTY RUBBLE*TE*9195551111*FX*6145551212");
HierarchicalLoop subscriberLoop = providerLoop.AddHLoop("2", "22", false);
subscriberLoop.AddSegment("SBR*P*18*XYZ1234567******BL");
subscriberLoop.AddSegment("PAT*********Y");
var subscriberNameLoop = subscriberLoop.AddLoop("NM1*IL*1*DOUGH*MARY****MI*12312312312");
subscriberNameLoop.AddSegment("N3*BOX 12312");
subscriberNameLoop.AddSegment("N4*DURHAM*NC*27715");
subscriberNameLoop.AddSegment("DMG*D8*19670807*F");
subscriberLoop.AddLoop("NM1*PR*2*BLUE CROSS BLUE SHIELD OF NC*****PI*987654321");
var claimLoop = subscriberLoop.AddLoop("CLM*2235057*200***13:A:1*Y**Y*A*********N");
claimLoop.AddSegment("DTP*434*RD8*20070730-20070730");
claimLoop.AddSegment("CL1*1*9*01");
claimLoop.AddSegment("AMT*C5*160");
claimLoop.AddSegment("REF*F8*ASD0000123");
claimLoop.AddSegment("HI*BK:25000");
claimLoop.AddSegment("HI*BF:78901");
claimLoop.AddSegment("HI*BR:4491:D8:20070730");
claimLoop.AddSegment("HI*BH:41:D8:20070501*BH:27:D8:20070715*BH:33:D8:20070415*BH:C2:D8:20070410");
claimLoop.AddSegment("HI*BE:30:::20");
claimLoop.AddSegment("HI*BG:01");
var physicianLoop = claimLoop.AddLoop("NM1*71*1*SMITH*ELIZABETH*AL***34*243898989");
physicianLoop.AddSegment("REF*1G*P97777");
var claimLineLoop = claimLoop.AddLoop("LX*1");
claimLineLoop.AddSegment("SV2*0300*HC:81000*120*UN*1");
claimLineLoop.AddSegment("DTP*472*D8*20070730");
claimLineLoop = claimLoop.AddLoop("LX*2");
claimLineLoop.AddSegment("SV2*0320*HC:76092*50*UN*1");
claimLineLoop.AddSegment("DTP*472*D8*20070730");
claimLineLoop = claimLoop.AddLoop("LX*3");
claimLineLoop.AddSegment("SV2*0270*HC:J1120*30*UN*1");
claimLineLoop.AddSegment("DTP*472*D8*20070730");
Assert.AreEqual(new StreamReader(Extensions.GetEdi("INS._837I._4010.Example1.txt")).ReadToEnd(), interchange.SerializeToX12(true));
}
public void Read270Test()
{
var parser = new X12Parser();
Interchange interchange = parser.ParseMultiple(new MemoryStream(Encoding.ASCII.GetBytes(this.inquiry))).First();
Assert.AreEqual("9088877320000 ", interchange.InterchangeReceiverId);
Transaction transaction = interchange.FunctionGroups.First().Transactions.First();
Segment bht = transaction.Segments.First();
Assert.AreEqual("10001234", bht.GetElement(3));
HierarchicalLoop subscriberLoop = transaction.FindHLoop("3");
Loop subscriberNameLoop = subscriberLoop.Loops.First();
Assert.AreEqual("SMITH", subscriberNameLoop.GetElement(3), "Subscriber last name not expected.");
Assert.AreEqual("11122333301", subscriberNameLoop.GetElement(9), "Subscriber member id not expected.");
}
private T SaveHierarchicalLoop(HierarchicalLoop loop, T interchangeId, T transactionSetId, string transactionSetCode, T?parentLoopId)
{
SqlCommand cmd = new SqlCommand(GetContainerIdSql("HL") + string.Format(@"
INSERT INTO [{0}].[Loop] (Id, ParentLoopId, InterchangeId, TransactionSetId, TransactionSetCode, SpecLoopId, LevelId, LevelCode, StartingSegmentId)
VALUES (@id, @parentLoopId, @interchangeId, @transactionSetId, @transactionSetCode, @specLoopId, @levelId, @levelCode, 'HL')
SELECT @id", _schema, _commonDb.Schema));
cmd.Parameters.AddWithValue("@parentLoopId", (object)parentLoopId ?? DBNull.Value);
cmd.Parameters.AddWithValue("@interchangeId", interchangeId);
cmd.Parameters.AddWithValue("@transactionSetId", transactionSetId);
cmd.Parameters.AddWithValue("@transactionSetCode", transactionSetCode);
cmd.Parameters.AddWithValue("@specLoopId", loop.Specification.LoopId);
cmd.Parameters.AddWithValue("@levelId", loop.Id);
cmd.Parameters.AddWithValue("@levelCode", loop.LevelCode);
return(ConvertT(ExecuteScalar(cmd)));
}
private List <AsnHlOneShipment> ExtractHlOne(HierarchicalLoop hlOne)
{
///////////////////////////////////////////////////////////////
// Root of Hierarchical Loop
///////////////////////////////////////////////////////////////
var hl = new AsnHlOneShipment()
{
HL01_IdNumber = hlOne.Id,
HL02_ParentId = hlOne.ParentId,
HL03_LevelCode = hlOne.LevelCode,
HL04_ChildCode = hlOne.HierarchicalChildCode,
};
// TD1 segment
if (hlOne.Segments.ToList().FirstOrDefault(x => x.SegmentId == "TD1") != null)
{
var td = hlOne.Segments.ToList().FirstOrDefault(x => x.SegmentId == "TD1");
hl.TD101_PackagingCode = td.GetElement(1);
hl.TD102_LadingQuantity = td.GetElement(2);
}
// TD5 segment
if (hlOne.Segments.ToList().FirstOrDefault(x => x.SegmentId == "TD5") != null)
{
var td = hlOne.Segments.ToList().FirstOrDefault(x => x.SegmentId == "TD5");
hl.TD501_RoutingSequenceCode = td.GetElement(1);
hl.TD502_IdCodeQualifier = td.GetElement(2);
hl.TD503_IdCode = td.GetElement(3);
hl.TD504_TransportationMethodMode = td.GetElement(4);
}
// TD3 segment
if (hlOne.Segments.ToList().FirstOrDefault(x => x.SegmentId == "TD3") != null)
{
var td = hlOne.Segments.ToList().FirstOrDefault(x => x.SegmentId == "TD3");
hl.TD301_EquipmentDescriptionCode = td.GetElement(1);
hl.TD302_EquipmentInitial = td.GetElement(2);
hl.TD303_EquipmentNumber = td.GetElement(3);
}
// Possible multiple REF segments
if (hlOne.Segments.ToList().FirstOrDefault(x => x.SegmentId == "REF") != null)
{
var asnref = hlOne.Segments.Where(x => x.SegmentId == "REF").ToList();
var asnrefs = new List <AsnHlOneShipmentRef>();
foreach (var seg in asnref)
{
var r = new AsnHlOneShipmentRef()
{
REF01_ReferenceIdentificationQualifier = seg.GetElement(1),
REF02_ReferenceIdentification = seg.GetElement(2),
REF03_Description = seg.GetElement(3)
};
asnrefs.Add(r);
}
hl.Refs = asnrefs;
}
// Possible multiple N1 loops
if (hlOne.Segments.ToList().FirstOrDefault(x => x.SegmentId == "N1") != null)
{
var n1 = hlOne.Loops.Where(x => x.SegmentId == "N1").ToList();
hl.Names = ExtractNames(n1);
}
// Start of chaining to fill out the guts of the hierarchy
var hlTwos = ExtractHlTwo(hlOne.HLoops.ToList());
hl.Orders = hlTwos;
var hLoop = new List <AsnHlOneShipment>();
hLoop.Add(hl);
return(hLoop);
}
/// <summary>
/// Generates the health care claim837 professional.
/// </summary>
/// <returns>A _healthCareClaim837Professional message.</returns>
public virtual HealthCareClaim837Professional GenerateHealthCareClaim837Professional( )
{
var healthCareClaim837ProfessionalFactory = IoC.CurrentContainer.Resolve <IHealthCareClaim837ProfessionalFactory> ();
var currenDateTime = DateTime.Now;
var autoIncrementedHierarchicalIDNumber = 1; // NOTE: The first HL01 within each ST-SE envelope must begin with "1".
var interchangeCopntrolNumber = GetInterchangeControlNumber(Key);
// Interchange.
var message = new Interchange(
currenDateTime,
interchangeCopntrolNumber,
false, // TODO: Use web.config to set InterchangeUsageIndicator.
PayorType.HealthCareClaim837Setup.X12Delimiters.SegmentDelimiter,
PayorType.HealthCareClaim837Setup.X12Delimiters.ElementDelimiter,
PayorType.HealthCareClaim837Setup.X12Delimiters.CompositeDelimiter)
{
InterchangeSenderIdQualifier = InterchangeIDQualifier.MutuallyDefined,
InterchangeSenderId = PayorType.HealthCareClaim837Setup.InterchangeSenderNumber,
InterchangeReceiverIdQualifier = InterchangeIDQualifier.MutuallyDefined,
InterchangeReceiverId = PayorType.HealthCareClaim837Setup.InterchangeReceiverNumber,
};
message.SetElement(11, PayorType.HealthCareClaim837Setup.X12Delimiters.RepetitionDelimiter.ToString(CultureInfo.InvariantCulture));
message.SetElement(12, InterchangeVersionControlNumber.ApprovedForPublicationByASCX12ProceduresReviewBoardThroughOctober2003);
message.SetElement(14, AcknowledgmentRequested.InterchangeAcknowledgmentRequested);
// Functional group.
var group = message.AddFunctionGroup(FunctionalIdentifierCode.HealthCareClaim, currenDateTime, interchangeCopntrolNumber, ImplementationConventionReference.Version5010);
group.ApplicationSendersCode = PayorType.HealthCareClaim837Setup.InterchangeSenderNumber;
group.ApplicationReceiversCode = PayorType.HealthCareClaim837Setup.InterchangeReceiverNumber;
group.ResponsibleAgencyCode = ResponsibleAgencyCode.AccreditedStandardsCommitteeX12;
var interchangeControlNumberString = interchangeCopntrolNumber.ToString(CultureInfo.InvariantCulture);
var transactionControlIdentifier = interchangeControlNumberString.Length < 4
? interchangeControlNumberString.PadLeft(4, '0')
: interchangeControlNumberString;
// Transaction set.
var transaction = group.AddTransaction(TransactionSetIdentifierCode.HealthCareClaim, transactionControlIdentifier);
transaction.SetElement(3, ImplementationConventionReference.Version5010);
// Beginning of hierarchical transaction.
var bhtSegment = transaction.AddSegment(BeginningOfHierarchicalTransaction);
bhtSegment.SetElement(1, HierarchicalStructureCode.InformationSourceOrSubscriberOrDependent);
bhtSegment.SetElement(2, TransactionSetPurposeCode.Original);
bhtSegment.SetElement(3, BatchControlNumber.ToString(CultureInfo.InvariantCulture));
bhtSegment.SetElement(4, currenDateTime.Date.ToString("yyyyMMdd"));
bhtSegment.SetElement(5, currenDateTime.ToString("HHmm"));
bhtSegment.SetElement(6, TransactionTypeCode.Chargeable);
// Submitter name.
var submitterLoop = transaction.AddLoop(new TypedLoopNM1(EntityIdentifierCode.Submitter));
submitterLoop.NM102_EntityTypeQualifier = EntityTypeQualifier.NonPersonEntity;
submitterLoop.NM103_NameLastOrOrganizationName = PayorType.BillingOffice.Agency.AgencyProfile.AgencyName.LegalName;
submitterLoop.NM108_IdCodeQualifier = IdentificationCodeQualifier.ElectronicTransmitterIdentificationNumber;
submitterLoop.NM109_IdCode = PayorType.BillingOffice.ElectronicTransmitterIdentificationNumber;
// Submitter EDI contact information.
var perSegment = submitterLoop.AddSegment(new TypedSegmentPER());
perSegment.PER01_ContactFunctionCode = ContactFunctionCode.InfromationContact;
// NOTE: PER02_Name is situational. But, as we have provided a nonperson entity for submitter, this field is required.
perSegment.PER02_Name = PayorType.BillingOffice.AdministratorStaff.StaffProfile.StaffName.Complete;
perSegment.PER03_CommunicationNumberQualifier = CommunicationNumberQualifer.Telephone;
var staffPhone =
PayorType.BillingOffice.AdministratorStaff.PhoneNumbers.FirstOrDefault(
phoneNumber => phoneNumber.StaffPhoneType.WellKnownName == StaffPhoneType.Work);
if (staffPhone == null || staffPhone.Phone == null)
{
throw new ArgumentException(
string.Format(
"Unable to find '{0}' staff work phone number",
PayorType.BillingOffice.AdministratorStaff.StaffProfile.StaffName.Complete));
}
perSegment.PER04_CommunicationNumber = staffPhone.Phone.PhoneNumber.RemoveNonAlphanumericChar();
if (!string.IsNullOrEmpty(staffPhone.Phone.PhoneExtensionNumber))
{
perSegment.PER05_CommunicationNumberQualifier = CommunicationNumberQualifer.TelephoneExtension;
perSegment.PER06_CommunicationNumber = staffPhone.Phone.PhoneExtensionNumber;
}
// Receiver name.
var receiverLoop = transaction.AddLoop(new TypedLoopNM1(EntityIdentifierCode.Receiver));
receiverLoop.NM102_EntityTypeQualifier = EntityTypeQualifier.NonPersonEntity;
receiverLoop.NM103_NameLastOrOrganizationName = PayorType.Name;
receiverLoop.NM108_IdCodeQualifier = IdentificationCodeQualifier.ElectronicTransmitterIdentificationNumber;
receiverLoop.NM109_IdCode = PayorType.SubmitterIdentifier;
// Billing provider hierarchical level. ***** HL1 *****
var provider2000AHierachicalLoop = transaction.AddHLoop(
autoIncrementedHierarchicalIDNumber.ToString(CultureInfo.InvariantCulture),
HierarchicalLevelCode.InformationSource,
HierarchicalChildCode.AdditionalSubordinateHLDataSegmentInThisHierarchicalStructure);
// Billing provide specialty information.
var prvSegment = provider2000AHierachicalLoop.AddSegment(new TypedSegmentPRV());
prvSegment.PRV01_ProviderCode = ProviderCode.Billing;
prvSegment.PRV02_ReferenceIdQualifier = ReferenceIdentificationQualifier.HealthCareProviderTaxonomyCode;
prvSegment.PRV03_ProviderTaxonomyCode = ProviderTaxonomyCode;
// Billing provider Name
var provider2010AaLoop = provider2000AHierachicalLoop.AddLoop(new TypedLoopNM1(EntityIdentifierCode.BillingProvider));
provider2010AaLoop.NM102_EntityTypeQualifier = EntityTypeQualifier.NonPersonEntity;
provider2010AaLoop.NM103_NameLastOrOrganizationName = PayorType.BillingOffice.Agency.AgencyProfile.AgencyName.LegalName;
provider2010AaLoop.NM108_IdCodeQualifier = IdentificationCodeQualifier.CentersForMedicareAndMedicaidServicesNationalProviderIdentifier;
var agencyNpi =
PayorType.BillingOffice.Agency.AgencyIdentifiers.FirstOrDefault(
identifier => identifier.AgencyIdentifierType.WellKnownName == AgencyIdentifierType.Npi);
if (agencyNpi == null || agencyNpi.IdentifierNumber == null)
{
throw new ArgumentException(
string.Format(
"Unable to find '{0}' agency NPI identifier number", PayorType.BillingOffice.Agency.AgencyProfile.AgencyName.LegalName));
}
provider2010AaLoop.NM109_IdCode = agencyNpi.IdentifierNumber;
var agencyBillingAddressAndPhone =
PayorType.BillingOffice.Agency.AddressesAndPhones.FirstOrDefault(
address => address.AgencyAddress.AgencyAddressType.WellKnownName == AgencyAddressType.Billing);
if (agencyBillingAddressAndPhone == null || agencyBillingAddressAndPhone.AgencyAddress == null)
{
throw new ArgumentException(
string.Format(
"Unable to find '{0}' agency Billing address", PayorType.BillingOffice.Agency.AgencyProfile.AgencyName.LegalName));
}
// Billing provider address.
var provider2010AaN3Segment = provider2010AaLoop.AddSegment(new TypedSegmentN3());
provider2010AaN3Segment.N301_AddressInformation = agencyBillingAddressAndPhone.AgencyAddress.Address.FirstStreetAddress
+
(string.IsNullOrWhiteSpace(
agencyBillingAddressAndPhone.AgencyAddress.Address.SecondStreetAddress)
? string.Empty
: " "
+ agencyBillingAddressAndPhone.AgencyAddress.Address.SecondStreetAddress);
// Billing provider City,State,Zip code
var provider2010AaN4Segment = provider2010AaLoop.AddSegment(new TypedSegmentN4());
provider2010AaN4Segment.N401_CityName = agencyBillingAddressAndPhone.AgencyAddress.Address.CityName;
provider2010AaN4Segment.N402_StateOrProvinceCode = agencyBillingAddressAndPhone.AgencyAddress.Address.StateProvince.ShortName;
provider2010AaN4Segment.N403_PostalCode = agencyBillingAddressAndPhone.AgencyAddress.Address.PostalCode.Code;
var agencyFederalTaxID =
PayorType.BillingOffice.Agency.AgencyIdentifiers.FirstOrDefault(
identifier => identifier.AgencyIdentifierType.WellKnownName == AgencyIdentifierType.FederalTaxId);
if (agencyFederalTaxID == null || agencyFederalTaxID.IdentifierNumber == null)
{
throw new ArgumentException(
string.Format(
"Unable to find '{0}' agency Federal Tax ID", PayorType.BillingOffice.Agency.AgencyProfile.AgencyName.LegalName));
}
// Billing provider - tax identification
var provider2010AaRefSegment = provider2010AaLoop.AddSegment(new TypedSegmentREF());
provider2010AaRefSegment.REF01_ReferenceIdQualifier = ReferenceIdentificationQualifier.EmployersIdentificationNumber;
provider2010AaRefSegment.REF02_ReferenceId = agencyFederalTaxID.IdentifierNumber;
//If it is the same as Billing provider, no need.
/*
* var provider2010ABLoop = provider2000AHierachicalLoop.AddLoop ( new TypedLoopNM1 ( EntityIdentifierCode.PayToProvider ) );
* provider2010ABLoop.NM102_EntityTypeQualifier = EntityTypeQualifier.NonPersonEntity;
*
* // NOTE: Pay-To address is same as Billing provider address ie., same N3 and N4 segments.
* provider2010ABLoop.AddSegment ( provider2010AAN3Segment );
* provider2010ABLoop.AddSegment ( provider2010AAN4Segment );
*/
var claimDictionary = GroupClaimsByPrimaryPayorCoverage(Claims);
//TODO: needs confirm if this loop pulling the correct data *** need bill every insurance or just the primary???
foreach (var keyValuePair in claimDictionary)
{
var payorCoverage = keyValuePair.Key;
var claimList = keyValuePair.Value;
var isPatientTheSubscriber =
payorCoverage.PayorSubscriber.PayorSubscriberRelationshipType.WellKnownName.Equals(PayorSubscriberRelationshipType.Self);
autoIncrementedHierarchicalIDNumber++;
// Subscriber hierarchical level. **** HL 2 ******
var subscriber2000BHierarchicalLoop =
provider2000AHierachicalLoop.AddHLoop(
autoIncrementedHierarchicalIDNumber.ToString(CultureInfo.InvariantCulture),
HierarchicalLevelCode.Subscriber,
isPatientTheSubscriber
? HierarchicalChildCode.NoSubordinateHLSegmentInThisHierarchicalStructure
: HierarchicalChildCode.AdditionalSubordinateHLDataSegmentInThisHierarchicalStructure);
// Subscriber information.
var sbrSegment = subscriber2000BHierarchicalLoop.AddSegment(new TypedSegmentSBR());
sbrSegment.SBR01_PayerResponsibilitySequenceNumberCode = payorCoverage.PayorCoverageType.ShortName;
if (isPatientTheSubscriber)
{
sbrSegment.SBR02_IndividualRelationshipCode = payorCoverage.PayorSubscriber.PayorSubscriberRelationshipType.ShortName;
}
// Subscriber Name
var subscriberName2010BaLoop =
subscriber2000BHierarchicalLoop.AddLoop(new TypedLoopNM1(EntityIdentifierCode.InsuredOrSubscriber));
subscriberName2010BaLoop.NM102_EntityTypeQualifier = EntityTypeQualifier.Person;
subscriberName2010BaLoop.NM104_NameFirst = payorCoverage.PayorSubscriber.Name.First;
subscriberName2010BaLoop.NM103_NameLastOrOrganizationName = payorCoverage.PayorSubscriber.Name.Last;
subscriberName2010BaLoop.NM108_IdCodeQualifier = IdentificationCodeQualifier.MemberIdentificationNumber;
subscriberName2010BaLoop.NM109_IdCode = payorCoverage.MemberNumber;
if (isPatientTheSubscriber)
{
// Subscriber address
var provider2010BaN3Segment = subscriberName2010BaLoop.AddSegment(new TypedSegmentN3());
provider2010BaN3Segment.N301_AddressInformation = payorCoverage.PayorSubscriber.Address.FirstStreetAddress +
(string.IsNullOrWhiteSpace(
payorCoverage.PayorSubscriber.Address.SecondStreetAddress)
? string.Empty
: " "
+ payorCoverage.PayorSubscriber.Address.SecondStreetAddress);
// Subscriber city,state,postal code.
var provider2010BaN4Segment = subscriberName2010BaLoop.AddSegment(new TypedSegmentN4());
provider2010BaN4Segment.N401_CityName = payorCoverage.PayorSubscriber.Address.CityName;
provider2010BaN4Segment.N402_StateOrProvinceCode = payorCoverage.PayorSubscriber.Address.StateProvince.ShortName;
provider2010BaN4Segment.N403_PostalCode = payorCoverage.PayorSubscriber.Address.PostalCode.Code;
// Demographic information
var subscriberDmgSegment = subscriberName2010BaLoop.AddSegment(new TypedSegmentDMG());
subscriberDmgSegment.DMG01_DateTimePeriodFormatQualifier = DateTimePeriodFormatQualifier.DateExpressedAsCCYYMMDD;
subscriberDmgSegment.DMG02_DateOfBirth = payorCoverage.PayorSubscriber.BirthDate;
subscriberDmgSegment.DMG03_Gender =
ConvertToGenderCodeFromAdministrativeGender(payorCoverage.PayorSubscriber.AdministrativeGender);
}
// Loop 2010BB - Payer Name.
var subscriberName2010BbLoop = subscriber2000BHierarchicalLoop.AddLoop(new TypedLoopNM1(EntityIdentifierCode.Payer));
subscriberName2010BbLoop.NM102_EntityTypeQualifier = EntityTypeQualifier.NonPersonEntity;
subscriberName2010BbLoop.NM103_NameLastOrOrganizationName = payorCoverage.Payor.Name;
subscriberName2010BbLoop.NM108_IdCodeQualifier = IdentificationCodeQualifier.PayorIdentification;
subscriberName2010BbLoop.NM109_IdCode = payorCoverage.Payor.ElectronicTransmitterIdentificationNumber;
// TODO: Kate needs to get back on this.
HierarchicalLoop parentHierarchicalLoop = subscriber2000BHierarchicalLoop;
if (!isPatientTheSubscriber)
{
autoIncrementedHierarchicalIDNumber++;
// PATIENT HIERARCHICAL LEVEL Loop Repeat: >1 **** HL 3 ******
var patientDetailLoop2000CLoop =
subscriber2000BHierarchicalLoop.AddHLoop(
autoIncrementedHierarchicalIDNumber.ToString(CultureInfo.InvariantCulture),
HierarchicalLevelCode.Dependent,
HierarchicalChildCode.NoSubordinateHLSegmentInThisHierarchicalStructure);
parentHierarchicalLoop = patientDetailLoop2000CLoop;
var hl3PatSegment = patientDetailLoop2000CLoop.AddSegment(new TypedSegmentPAT());
hl3PatSegment.PAT01_IndividualRelationshipCode =
payorCoverage.PayorSubscriber.PayorSubscriberRelationshipType.ShortName;
var hl3Nm1Segment = patientDetailLoop2000CLoop.AddLoop(new TypedLoopNM1(EntityIdentifierCode.Patient));
hl3Nm1Segment.NM102_EntityTypeQualifier = EntityTypeQualifier.Person;
hl3Nm1Segment.NM104_NameFirst = payorCoverage.PatientAccount.Name.First; //TODO: confirm it comes from primaryPayorCoverage.PatientAccount, not from Claim.PatientAccount, the later make more sense
hl3Nm1Segment.NM103_NameLastOrOrganizationName = payorCoverage.PatientAccount.Name.Last;
var hl3Nm1N3Segment = hl3Nm1Segment.AddSegment(new TypedSegmentN3());
hl3Nm1N3Segment.N301_AddressInformation = payorCoverage.PatientAccount.HomeAddress.FirstStreetAddress
+
(string.IsNullOrWhiteSpace(
payorCoverage.PatientAccount.HomeAddress.SecondStreetAddress)
? string.Empty
: " " + payorCoverage.PatientAccount.HomeAddress.SecondStreetAddress);
var hl3Nm1N4Segment = hl3Nm1Segment.AddSegment(new TypedSegmentN4());
hl3Nm1N4Segment.N401_CityName = payorCoverage.PatientAccount.HomeAddress.CityName;
hl3Nm1N4Segment.N402_StateOrProvinceCode = payorCoverage.PatientAccount.HomeAddress.StateProvince.ShortName;
hl3Nm1N4Segment.N403_PostalCode = payorCoverage.PatientAccount.HomeAddress.PostalCode.Code;
var hl3Nm1DmgSegment = hl3Nm1Segment.AddSegment(new TypedSegmentDMG());
hl3Nm1DmgSegment.DMG01_DateTimePeriodFormatQualifier = DateTimePeriodFormatQualifier.DateExpressedAsCCYYMMDD;
hl3Nm1DmgSegment.DMG02_DateOfBirth = payorCoverage.PatientAccount.BirthDate;
hl3Nm1DmgSegment.DMG03_Gender =
ConvertToGenderCodeFromAdministrativeGender(payorCoverage.PatientAccount.AdministrativeGender);
}
// 2300 Claim Information loop repeat 100
// LX loop repeat 50 => total 5000 claims in a HCC837 message or a Subscriber HL? ( seems the later make more sense)
// TODO: confirm it with Kate and how to handle it if exceed the max loop repeat
foreach (var claim in claimList)
{
var claim2300Loop = parentHierarchicalLoop.AddLoop(new TypedLoopCLM()); // Claim 2300 loop: repeat 100
claim2300Loop.CLM01_PatientControlNumber = claim.Key.ToString(CultureInfo.InvariantCulture);
claim2300Loop.CLM02_TotalClaimChargeAmount = decimal.Parse(X12Utility.ConvertToDecimalString(claim.ChargeAmount.Amount));
claim2300Loop.CLM05._1_FacilityCodeValue = PlaceOfServiceCode.Office;
claim2300Loop.CLM05._2_FacilityCodeQualifier = FacilityCodeQualifier.PlaceOfServiceCodesForProfessionalOrDentalService;
claim2300Loop.CLM05._3_ClaimFrequencyTypeCode = ClaimFrequencyTypeCode.Original;
claim2300Loop.CLM06_ProviderOrSupplierSignatureIndicator = YesOrNoConditionResponseCode.YesIndicator;
claim2300Loop.CLM07_ProviderAcceptAssignmentCode = ProviderAcceptAssignementCode.Assigned;
claim2300Loop.CLM08_BenefitsAssignmentCerficationIndicator = YesOrNoConditionResponseCode.Yes;
claim2300Loop.CLM09_ReleaseOfInformationCode = ReleaseOfInformationCode.Yes;
// TODO: diagnosis code -- Diagnosis is associated with Claim Line Item
// List the principal Dx with BK and others with BF, like HI✽BK:8901✽BF:87200✽BF:5559~, up to 12 diagnosis
// assume the 1st Dx is the principal Dx
var hiSegment = claim2300Loop.AddSegment(new TypedSegmentHI());
var index = 0;
foreach (var claimLineItem in claim.ClaimLineItems)
{
index++;
if (index == 1)
{
hiSegment.HI01_HealthCareCodeInformation =
X12Utility.BuildCompositeElement(
PayorType.HealthCareClaim837Setup.X12Delimiters.CompositeDelimiter,
CodeListQualifierCode.ICD9CMPrincipleDiagnostics,
claimLineItem.Diagnosis.CodedConceptCode);
}
else if (index == 2)
{
hiSegment.HI02_HealthCareCodeInformation =
X12Utility.BuildCompositeElement(
PayorType.HealthCareClaim837Setup.X12Delimiters.CompositeDelimiter,
CodeListQualifierCode.ICD9CMDiagnostics,
claimLineItem.Diagnosis.CodedConceptCode);
}
else if (index == 3)
{
hiSegment.HI03_HealthCareCodeInformation =
X12Utility.BuildCompositeElement(
PayorType.HealthCareClaim837Setup.X12Delimiters.CompositeDelimiter,
CodeListQualifierCode.ICD9CMDiagnostics,
claimLineItem.Diagnosis.CodedConceptCode);
}
else if (index == 4)
{
hiSegment.HI04_HealthCareCodeInformation =
X12Utility.BuildCompositeElement(
PayorType.HealthCareClaim837Setup.X12Delimiters.CompositeDelimiter,
CodeListQualifierCode.ICD9CMDiagnostics,
claimLineItem.Diagnosis.CodedConceptCode);
}
else if (index == 5)
{
hiSegment.HI05_HealthCareCodeInformation =
X12Utility.BuildCompositeElement(
PayorType.HealthCareClaim837Setup.X12Delimiters.CompositeDelimiter,
CodeListQualifierCode.ICD9CMDiagnostics,
claimLineItem.Diagnosis.CodedConceptCode);
}
else if (index == 6)
{
hiSegment.HI06_HealthCareCodeInformation =
X12Utility.BuildCompositeElement(
PayorType.HealthCareClaim837Setup.X12Delimiters.CompositeDelimiter,
CodeListQualifierCode.ICD9CMDiagnostics,
claimLineItem.Diagnosis.CodedConceptCode);
}
else if (index == 7)
{
hiSegment.HI07_HealthCareCodeInformation =
X12Utility.BuildCompositeElement(
PayorType.HealthCareClaim837Setup.X12Delimiters.CompositeDelimiter,
CodeListQualifierCode.ICD9CMDiagnostics,
claimLineItem.Diagnosis.CodedConceptCode);
}
else if (index == 8)
{
hiSegment.HI08_HealthCareCodeInformation =
X12Utility.BuildCompositeElement(
PayorType.HealthCareClaim837Setup.X12Delimiters.CompositeDelimiter,
CodeListQualifierCode.ICD9CMDiagnostics,
claimLineItem.Diagnosis.CodedConceptCode);
}
else if (index == 9)
{
hiSegment.HI09_HealthCareCodeInformation =
X12Utility.BuildCompositeElement(
PayorType.HealthCareClaim837Setup.X12Delimiters.CompositeDelimiter,
CodeListQualifierCode.ICD9CMDiagnostics,
claimLineItem.Diagnosis.CodedConceptCode);
}
else if (index == 10)
{
hiSegment.HI10_HealthCareCodeInformation =
X12Utility.BuildCompositeElement(
PayorType.HealthCareClaim837Setup.X12Delimiters.CompositeDelimiter,
CodeListQualifierCode.ICD9CMDiagnostics,
claimLineItem.Diagnosis.CodedConceptCode);
}
else if (index == 11)
{
hiSegment.HI11_HealthCareCodeInformation =
X12Utility.BuildCompositeElement(
PayorType.HealthCareClaim837Setup.X12Delimiters.CompositeDelimiter,
CodeListQualifierCode.ICD9CMDiagnostics,
claimLineItem.Diagnosis.CodedConceptCode);
}
else if (index == 12)
{
hiSegment.HI12_HealthCareCodeInformation =
X12Utility.BuildCompositeElement(
PayorType.HealthCareClaim837Setup.X12Delimiters.CompositeDelimiter,
CodeListQualifierCode.ICD9CMDiagnostics,
claimLineItem.Diagnosis.CodedConceptCode);
}
}
var autoIncrementedServiceLineNumber = 0;
foreach (var claimLineItem in claim.ClaimLineItems)
{
autoIncrementedServiceLineNumber++;
var lxLoop = claim2300Loop.AddLoop(new TypedLoopLX(string.Empty)); // LX loop repeat: 50
lxLoop.LX01_AssignedNumber = autoIncrementedServiceLineNumber.ToString(CultureInfo.InvariantCulture);
var sv1Segment = lxLoop.AddSegment(new TypedSegmentSV1());
sv1Segment.SV101_CompositeMedicalProcedure =
X12Utility.BuildCompositeElement(
PayorType.HealthCareClaim837Setup.X12Delimiters.CompositeDelimiter,
ProductOrServiceIDQualifier.HCPCS, //TODO: Confirm with Kate if we can use HCPCS for all procedures.
claimLineItem.Procedure.CodedConceptCode);
sv1Segment.SV102_MonetaryAmount = X12Utility.ConvertToDecimalString(claimLineItem.ChargeAmount.Amount);
sv1Segment.SV103_UnitBasisMeasCode = UnitsOrBasisOfMeasurementCode.Unit;
sv1Segment.SV104_Quantity = claimLineItem.BillingUnitCount.Count.ToString(CultureInfo.InvariantCulture);
sv1Segment.SV107_CompDiagCodePoint = DiagnosisCodePointer;
var dtpSegment = lxLoop.AddSegment(new TypedSegmentDTP());
dtpSegment.DTP01_DateTimeQualifier = DateTimeQualifier.Service;
dtpSegment.DTP02_DateTimePeriodFormatQualifier = DateTimePeriodFormatQualifier.DateExpressedAsCCYYMMDD;
dtpSegment.DTP03_Date = claim.ServiceDate;
}
}
}
var healthCareClaim837ProfessionalX12Message = message.SerializeToX12(true); //TODO: Configure the whitespace option.
var healthCareClaim837Professional = healthCareClaim837ProfessionalFactory.CreateHealthCareClaim837Professional(this, Encoding.ASCII.GetBytes(healthCareClaim837ProfessionalX12Message));
var lookupValueRepository = IoC.CurrentContainer.Resolve <ILookupValueRepository>();
ReviseClaimBatchStatus(lookupValueRepository.GetLookupByWellKnownName <ClaimBatchStatus>(WellKnownNames.ClaimModule.ClaimBatchStatus.Hcc837PGenerated));
return(healthCareClaim837Professional);
}
