///<summary>Throws exceptions. The insplan that's passed in need not be properly updated to the database first.</summary>
///<returns>The Etrans created from the request. Will be null if the request failed in any way.</returns>
public static Etrans RequestBenefits(Clearinghouse clearinghouseClin, InsPlan plan, long patNum, Carrier carrier, InsSub insSub, out string error)
{
error = "";
Patient pat = Patients.GetPat(patNum);
Patient subsc = Patients.GetPat(insSub.Subscriber);
Clinic clinic = Clinics.GetClinic(pat.ClinicNum);
Provider billProv = Providers.GetProv(Providers.GetBillingProvNum(pat.PriProv, pat.ClinicNum));
//validation. Throw exception if missing info----------------------------------------
string validationResult = X270.Validate(clearinghouseClin, carrier, billProv, clinic, plan, subsc, insSub, pat);
if (validationResult != "")
{
throw new Exception(Lans.g("FormInsPlan", "Please fix the following errors first:") + "\r\n" + validationResult);
}
//create a 270 message---------------------------------------------------------------
string x12message = X270.GenerateMessageText(clearinghouseClin, carrier, billProv, clinic, plan, subsc, insSub, pat);
EtransMessageText etransMessageText = new EtransMessageText();
etransMessageText.MessageText = x12message;
EtransMessageTexts.Insert(etransMessageText);
//attach it to an etrans-------------------------------------------------------------
Etrans etrans = new Etrans();
etrans.PatNum = patNum;
etrans.DateTimeTrans = DateTime.Now;
etrans.ClearingHouseNum = clearinghouseClin.HqClearinghouseNum;
etrans.Etype = EtransType.BenefitInquiry270;
etrans.PlanNum = plan.PlanNum;
etrans.InsSubNum = insSub.InsSubNum;
etrans.EtransMessageTextNum = etransMessageText.EtransMessageTextNum;
Etranss.Insert(etrans);
//send the 270----------------------------------------------------------------------
string x12response = "";
Etrans etransHtml = null;
//a connection error here needs to bubble up
try {
if (!String.IsNullOrWhiteSpace(FakeResponseOverride271))
{
x12response = FakeResponseOverride271;
}
else if (clearinghouseClin.CommBridge == EclaimsCommBridge.ClaimConnect)
{
x12response = ClaimConnect.Benefits270(clearinghouseClin, x12message);
}
else if (clearinghouseClin.CommBridge == EclaimsCommBridge.EDS)
{
x12response = EDS.Benefits270(clearinghouseClin, x12message, out etransHtml);
}
else if (clearinghouseClin.CommBridge == EclaimsCommBridge.WebMD)
{
x12response = WebMD.Benefits270(clearinghouseClin, x12message);
}
}
catch (Exception ex) {
EtransMessageTexts.Delete(etrans.EtransMessageTextNum);
Etranss.Delete(etrans.EtransNum);
throw new ApplicationException(Lans.g("FormInsPlan", "Connection Error:") + "\r\n" + ex.GetType().Name + "\r\n" + ex.Message);
}
//start to process the 271----------------------------------------------------------
X271 x271 = null;
if (X12object.IsX12(x12response))
{
X12object x12obj = new X12object(x12response);
if (x12obj.Is271())
{
x271 = new X271(x12response);
}
}
else //not a 997, 999, 277 or 271
{
EtransMessageTexts.Delete(etrans.EtransMessageTextNum);
Etranss.Delete(etrans.EtransNum);
throw new ApplicationException(Lans.g("FormInsPlan", "Error:") + "\r\n" + x12response);
}
/*
* //In realtime mode, X12 limits the request to one patient.
* //We will always use the subscriber.
* //So all EB segments are for the subscriber.
* List<EB271> listEB=new List<EB271>();
* EB271 eb;
* if(x271 != null) {
* for(int i=0;i<x271.Segments.Count;i++) {
* if(x271.Segments[i].SegmentID != "EB") {
* continue;
* }
* eb=new EB271(x271.Segments[i]);
* listEB.Add(eb);
* }
* }*/
//create an etrans for the 271------------------------------------------------------
etransMessageText = new EtransMessageText();
etransMessageText.MessageText = x12response;
EtransMessageTexts.Insert(etransMessageText);
Etrans etrans271 = new Etrans();
etrans271.PatNum = patNum;
etrans271.DateTimeTrans = DateTime.Now;
etrans271.ClearingHouseNum = clearinghouseClin.HqClearinghouseNum;
etrans271.Etype = EtransType.TextReport;
if (X12object.IsX12(x12response)) //this shouldn't need to be tested because it was tested above.
{
if (x271 == null)
{
X12object Xobj = new X12object(x12response);
if (Xobj.Is997())
{
etrans271.Etype = EtransType.Acknowledge_997;
}
else if (Xobj.Is999())
{
etrans271.Etype = EtransType.Acknowledge_999;
}
else if (X277.Is277(Xobj))
{
etrans271.Etype = EtransType.StatusNotify_277;
}
else if (X835.Is835(Xobj))
{
etrans271.Etype = EtransType.ERA_835;
}
else if (Xobj.IsAckInterchange())
{
etrans271.Etype = EtransType.Ack_Interchange;
}
}
else
{
etrans271.Etype = EtransType.BenefitResponse271;
}
}
etrans271.PlanNum = plan.PlanNum;
etrans271.InsSubNum = insSub.InsSubNum;
etrans271.EtransMessageTextNum = etransMessageText.EtransMessageTextNum;
etrans271.MessageText = etransMessageText.MessageText; //Not a DB column, used to save queries for some calling methods (OpenDentalService).
if (etransHtml != null)
{
etrans271.AckEtransNum = etransHtml.EtransNum;
}
Etranss.Insert(etrans271);
etrans.AckEtransNum = etrans271.EtransNum;
etrans.AckEtrans = etrans271; //Not a DB column, used to save queries for some calling methods (OpenDentalService).
if (etrans271.Etype == EtransType.Acknowledge_997)
{
X997 x997 = new X997(x12response);
string error997 = x997.GetHumanReadable();
etrans.Note = "Error: " + error997; //"Malformed document sent. 997 error returned.";
Etranss.Update(etrans);
error = etrans.Note;
return(null);
}
else if (etrans271.Etype == EtransType.Acknowledge_999)
{
X999 x999 = new X999(x12response);
string error999 = x999.GetHumanReadable();
etrans.Note = "Error: " + error999; //"Malformed document sent. 999 error returned.";
Etranss.Update(etrans);
error = etrans.Note;
return(null);
}
else if (etrans271.Etype == EtransType.StatusNotify_277)
{
X277 x277 = new X277(x12response);
string error277 = x277.GetHumanReadable();
etrans.Note = "Error: " + error277; //"Malformed document sent. 277 error returned.";
Etranss.Update(etrans);
error = etrans.Note;
return(null);
}
else if (etrans271.Etype == EtransType.ERA_835)
{
X835 x835 = new X835(etrans271, x12response, "");
string error835 = x835.GetHumanReadable();
etrans.Note = "Error: " + error835; //"Malformed document sent. 835 error returned.";
Etranss.Update(etrans);
error = etrans.Note;
return(null);
}
else if (etrans271.Etype == EtransType.BenefitResponse271) //271
{
string processingerror = x271.GetProcessingError();
if (processingerror != "")
{
etrans.Note = processingerror;
Etranss.Update(etrans);
error = etrans.Note;
return(null);
}
else
{
etrans.Note = "Normal 271 response."; //change this later to be explanatory of content.
}
}
else if (etrans271.Etype == EtransType.Ack_Interchange) //See document "X092 Elig 270-271.pdf" pages 388 and 401.
{
X12object xobj = new X12object(x12response);
X12Segment segTa1 = xobj.GetNextSegmentById(0, "TA1");
if (segTa1.Get(4) == "A")
{
etrans.Note = "The request was accepted, but the response is empty.";
}
else
{
if (segTa1.Get(4) == "E")
{
etrans.Note = "The request was accepted with errors: ";
}
else if (segTa1.Get(4) == "R")
{
etrans.Note = "The request was rejected with errors: ";
}
switch (segTa1.Get(5))
{
case "000": etrans.Note += "No error"; break;
case "001": etrans.Note += "The Interchange Control Number in the Header and Trailer Do Not Match. "
+ "The Value From the Header is Used in the Acknowledgment."; break;
case "002": etrans.Note += "This Standard as Noted in the Control Standards Identifier is Not Supported."; break;
case "003": etrans.Note += "This Version of the Controls is Not Supported"; break;
case "004": etrans.Note += "The Segment Terminator is Invalid"; break;
case "005": etrans.Note += "Invalid Interchange ID Qualifier for Sender"; break;
case "006": etrans.Note += "Invalid Interchange Sender ID"; break;
case "007": etrans.Note += "Invalid Interchange ID Qualifier for Receiver"; break;
case "008": etrans.Note += "Invalid Interchange Receiver ID"; break;
case "009": etrans.Note += "Unknown Interchange Receiver ID"; break;
case "010": etrans.Note += "Invalid Authorization Information Qualifier Value"; break;
case "011": etrans.Note += "Invalid Authorization Information Value"; break;
case "012": etrans.Note += "Invalid Security Information Qualifier Value"; break;
case "013": etrans.Note += "Invalid Security Information Value"; break;
case "014": etrans.Note += "Invalid Interchange Date Value"; break;
case "015": etrans.Note += "Invalid Interchange Time Value"; break;
case "016": etrans.Note += "Invalid Interchange Standards Identifier Value"; break;
case "017": etrans.Note += "Invalid Interchange Version ID Value"; break;
case "018": etrans.Note += "Invalid Interchange Control Number Value"; break;
case "019": etrans.Note += "Invalid Acknowledgment Requested Value"; break;
case "020": etrans.Note += "Invalid Test Indicator Value"; break;
case "021": etrans.Note += "Invalid Number of Included Groups Value"; break;
case "022": etrans.Note += "Invalid Control Structure"; break;
case "023": etrans.Note += "Improper (Premature) End-of-File (Transmission)"; break;
case "024": etrans.Note += "Invalid Interchange Content (e.g., Invalid GS Segment)"; break;
case "025": etrans.Note += "Duplicate Interchange Control Number"; break;
case "026": etrans.Note += "Invalid Data Element Separator"; break;
case "027": etrans.Note += "Invalid Component Element Separator"; break;
case "028": etrans.Note += "Invalid Delivery Date in Deferred Delivery Request"; break;
case "029": etrans.Note += "Invalid Delivery Time in Deferred Delivery Request"; break;
case "030": etrans.Note += "Invalid Delivery Time Code in Deferred Delivery Request"; break;
case "031": etrans.Note += "Invalid Grade of Service Code"; break;
}
}
}
else
{
throw new Exception("Unknown response");
}
Etranss.Update(etrans);
return(etrans);
}
///<summary>Etrans type will be figured out by this class. Either TextReport, Acknowledge_997, Acknowledge_999, or StatusNotify_277.</summary>
public static void ProcessIncomingReport(DateTime dateTimeTrans,long hqClearinghouseNum,string messageText,long userNum) {
if(RemotingClient.RemotingRole==RemotingRole.ClientWeb) {
Meth.GetVoid(MethodBase.GetCurrentMethod(),dateTimeTrans,hqClearinghouseNum,messageText,userNum);
return;
}
Etrans etrans=CreateEtrans(dateTimeTrans,hqClearinghouseNum,messageText,userNum);
string command;
X12object Xobj=X12object.ToX12object(messageText);
if(Xobj!=null) {//Is a correctly formatted X12 message.
if(Xobj.IsAckInterchange()) {
etrans.Etype=EtransType.Ack_Interchange;
Etranss.Insert(etrans);
//At some point in the future, we should use TA101 to match to batch number and TA104 to get the ack code,
//then update historic etrans entries like we do for 997s, 999s and 277s.
}
else if(Xobj.Is997()) {
X997 x997=new X997(messageText);
etrans.Etype=EtransType.Acknowledge_997;
etrans.BatchNumber=x997.GetBatchNumber();
Etranss.Insert(etrans);
string batchack=x997.GetBatchAckCode();
if(batchack=="A"||batchack=="R") {//accepted or rejected
command="UPDATE etrans SET AckCode='"+batchack+"', "
+"AckEtransNum="+POut.Long(etrans.EtransNum)
+" WHERE BatchNumber="+POut.Long(etrans.BatchNumber)
+" AND ClearinghouseNum="+POut.Long(hqClearinghouseNum)
+" AND DateTimeTrans > "+POut.DateT(dateTimeTrans.AddDays(-14))
+" AND DateTimeTrans < "+POut.DateT(dateTimeTrans.AddDays(1))
+" AND AckEtransNum=0";
Db.NonQ(command);
}
else {//partially accepted
List<int> transNums=x997.GetTransNums();
string ack;
for(int i=0;i<transNums.Count;i++) {
ack=x997.GetAckForTrans(transNums[i]);
if(ack=="A"||ack=="R") {//accepted or rejected
command="UPDATE etrans SET AckCode='"+ack+"', "
+"AckEtransNum="+POut.Long(etrans.EtransNum)
+" WHERE BatchNumber="+POut.Long(etrans.BatchNumber)
+" AND TransSetNum="+POut.Long(transNums[i])
+" AND ClearinghouseNum="+POut.Long(hqClearinghouseNum)
+" AND DateTimeTrans > "+POut.DateT(dateTimeTrans.AddDays(-14))
+" AND DateTimeTrans < "+POut.DateT(dateTimeTrans.AddDays(1))
+" AND AckEtransNum=0";
Db.NonQ(command);
}
}
}
//none of the other fields make sense, because this ack could refer to many claims.
}
else if(Xobj.Is999()) {
X999 x999=new X999(messageText);
etrans.Etype=EtransType.Acknowledge_999;
etrans.BatchNumber=x999.GetBatchNumber();
Etranss.Insert(etrans);
string batchack=x999.GetBatchAckCode();
if(batchack=="A"||batchack=="R") {//accepted or rejected
command="UPDATE etrans SET AckCode='"+batchack+"', "
+"AckEtransNum="+POut.Long(etrans.EtransNum)
+" WHERE BatchNumber="+POut.Long(etrans.BatchNumber)
+" AND ClearinghouseNum="+POut.Long(hqClearinghouseNum)
+" AND DateTimeTrans > "+POut.DateT(dateTimeTrans.AddDays(-14))
+" AND DateTimeTrans < "+POut.DateT(dateTimeTrans.AddDays(1))
+" AND AckEtransNum=0";
Db.NonQ(command);
}
else {//partially accepted
List<int> transNums=x999.GetTransNums();
string ack;
for(int i=0;i<transNums.Count;i++) {
ack=x999.GetAckForTrans(transNums[i]);
if(ack=="A"||ack=="R") {//accepted or rejected
command="UPDATE etrans SET AckCode='"+ack+"', "
+"AckEtransNum="+POut.Long(etrans.EtransNum)
+" WHERE BatchNumber="+POut.Long(etrans.BatchNumber)
+" AND TransSetNum="+POut.Long(transNums[i])
+" AND ClearinghouseNum="+POut.Long(hqClearinghouseNum)
+" AND DateTimeTrans > "+POut.DateT(dateTimeTrans.AddDays(-14))
+" AND DateTimeTrans < "+POut.DateT(dateTimeTrans.AddDays(1))
+" AND AckEtransNum=0";
Db.NonQ(command);
}
}
}
//none of the other fields make sense, because this ack could refer to many claims.
}
else if(X277.Is277(Xobj)) {
X277 x277=new X277(messageText);
etrans.Etype=EtransType.StatusNotify_277;
Etranss.Insert(etrans);
List<string> listClaimIdentifiers=x277.GetClaimTrackingNumbers();
//Dictionary to run one update command per ack code for many claims.
Dictionary <string,List<X12ClaimMatch>> dictClaimMatchesByAck=new Dictionary<string,List<X12ClaimMatch>>();
for(int i=0;i<listClaimIdentifiers.Count;i++) {
X12ClaimMatch claimMatch=new X12ClaimMatch();
claimMatch.ClaimIdentifier=listClaimIdentifiers[i];
string[] arrayClaimInfo=x277.GetClaimInfo(claimMatch.ClaimIdentifier);
claimMatch.PatFname=PIn.String(arrayClaimInfo[0]);
claimMatch.PatLname=PIn.String(arrayClaimInfo[1]);
claimMatch.DateServiceStart=PIn.DateT(arrayClaimInfo[6]);
claimMatch.DateServiceEnd=PIn.DateT(arrayClaimInfo[7]);
claimMatch.ClaimFee=PIn.Double(arrayClaimInfo[9]);
claimMatch.SubscriberId=PIn.String(arrayClaimInfo[10]);
claimMatch.EtransNum=etrans.EtransNum;
string ack=arrayClaimInfo[3];
if(!dictClaimMatchesByAck.ContainsKey(ack)) {
dictClaimMatchesByAck.Add(ack,new List<X12ClaimMatch>());
}
dictClaimMatchesByAck[ack].Add(claimMatch);
}
foreach(string ack in dictClaimMatchesByAck.Keys) {
List <long> listClaimNums=Claims.GetClaimFromX12(dictClaimMatchesByAck[ack]);
if(listClaimNums!=null) {
listClaimNums=listClaimNums.Where(x => x!=0).ToList();
if(listClaimNums.Count > 0) {
//Locate the latest etrans entries for the claims based on DateTimeTrans with EType of ClaimSent or Claim_Ren and update the AckCode and AckEtransNum.
//We overwrite existing acks from 997s, 999s and older 277s.
command="UPDATE etrans SET AckCode='"+ack+"', "
+"AckEtransNum="+POut.Long(etrans.EtransNum)
+" WHERE EType IN ("+POut.Int((int)EtransType.ClaimSent)+","+POut.Int((int)EtransType.Claim_Ren)+") "
+" AND ClaimNum IN("+String.Join(",",listClaimNums.Select(x => POut.Long(x)))+")"
+" AND ClearinghouseNum="+POut.Long(hqClearinghouseNum)
+" AND DateTimeTrans > "+POut.DateT(dateTimeTrans.AddDays(-14))
+" AND DateTimeTrans < "+POut.DateT(dateTimeTrans.AddDays(1));
Db.NonQ(command);
}
}
//none of the other fields make sense, because this ack could refer to many claims.
}
}
else if(X835.Is835(Xobj)) {
etrans.Etype=EtransType.ERA_835;
List <string> listTranSetIds=Xobj.GetTranSetIds();
List <Etrans> listEtrans=new List<Etrans>();
List <X835> list835s=new List<X835>();
//We pull in the 835 data in two loops so that we can ensure the 835 is fully parsed before we create any etrans entries.
for(int i=0;i<listTranSetIds.Count;i++) {
etrans.TranSetId835=listTranSetIds[i];
if(i>0) {
etrans.EtransNum=0;//To get a new record to insert.
}
X835 x835=new X835(etrans,messageText,etrans.TranSetId835);//parse. If parsing fails, then no etrans entries will be inserted.
etrans.CarrierNameRaw=x835.PayerName;
List<string> listUniquePatientNames=new List<string>();
for(int j=0;j<x835.ListClaimsPaid.Count;j++) {
string patName=x835.ListClaimsPaid[j].PatientName.ToString(false);
if(!listUniquePatientNames.Contains(patName)) {
listUniquePatientNames.Add(patName);
}
}
if(listUniquePatientNames.Count==1) {
etrans.PatientNameRaw=listUniquePatientNames[0];
}
else {
etrans.PatientNameRaw="("+listUniquePatientNames.Count+" "+Lans.g("Etranss","patients")+")";
}
listEtrans.Add(etrans.Copy());
list835s.Add(x835);
}
//The 835 was completely parsed. Create etrans entries.
for(int i=0;i<listEtrans.Count;i++) {
etrans=listEtrans[i];
X835 x835=list835s[i];
Etranss.Insert(etrans);//insert
List<long> listClaimNums=x835.ListClaimsPaid.Select(x => x.ClaimNum).Where(x => x!=0).ToList();
if(listClaimNums.Count > 0) {
//Locate the latest etrans entries for the claim based on DateTimeTrans with EType of ClaimSent or Claim_Ren and update the AckCode and AckEtransNum.
//We overwrite existing acks from 997s, 999s, and 277s.
command="UPDATE etrans SET AckCode='A', "
+"AckEtransNum="+POut.Long(etrans.EtransNum)
+" WHERE EType IN (0,3) "//ClaimSent and Claim_Ren
+" AND ClaimNum IN("+String.Join(",",listClaimNums.Select(x => POut.Long(x)))+")"
+" AND ClearinghouseNum="+POut.Long(hqClearinghouseNum)
+" AND DateTimeTrans > "+POut.DateT(dateTimeTrans.AddDays(-14))
+" AND DateTimeTrans < "+POut.DateT(dateTimeTrans.AddDays(1));
Db.NonQ(command);
}
//none of the other fields make sense, because this ack could refer to many claims.
}
}
else {//unknown type of X12 report.
etrans.Etype=EtransType.TextReport;
Etranss.Insert(etrans);
}
}
else {//not X12
etrans.Etype=EtransType.TextReport;
Etranss.Insert(etrans);
}
}