public void X834_ImportInsurancePlans_ReplacePatPlan() { Patient pat = Createx834Patient(); string suffix = MethodBase.GetCurrentMethod().Name; //Create old insurance plan and associate it to them. InsuranceInfo insuranceOld = InsuranceT.AddInsurance(pat, "Old Carrier" + suffix); //Create x834 X834 x834 = new X834(new X12object(Properties.Resources.x834Test)); int createdPatsCount, updatedPatsCount, skippedPatsCount, createdCarrierCount, createdInsPlanCount, updatedInsPlanCount, createdInsSubCount, updatedInsSubCount, createdPatPlanCount, droppedPatPlanCount, updatedPatPlanCount; StringBuilder sbErrorMessages; //Pass in true for dropExistingInsurance EtransL.ImportInsurancePlans(x834, new List <Patient> { pat }, true, true, out createdPatsCount, out updatedPatsCount, out skippedPatsCount, out createdCarrierCount, out createdInsPlanCount, out updatedInsPlanCount, out createdInsSubCount, out updatedInsSubCount, out createdPatPlanCount, out droppedPatPlanCount, out updatedPatPlanCount, out sbErrorMessages); //Get the pat plans for this patient from the database. List <PatPlan> listPatPlans = PatPlans.GetPatPlansForPat(pat.PatNum); Assert.AreEqual(1, listPatPlans.Count); Assert.AreEqual(1, droppedPatPlanCount); InsSub subForPatPlan = InsSubs.GetOne(listPatPlans[0].InsSubNum); //These should be different as a new plan was created and the old plan was dropped. Assert.AreNotEqual(insuranceOld.PriInsPlan.PlanNum, subForPatPlan.PlanNum); }
public void X834_ImportInsurancePlans_ReplaceSecondaryPatPlan() { Patient pat = Createx834Patient(); string suffix = MethodBase.GetCurrentMethod().Name; //Create primary insurance plan that appears in the 834. InsuranceInfo insurancePrimary = InsuranceT.AddInsurance(pat, "Old Carrier" + suffix, subscriberID: "CG00000B"); //Create secondary insurance that does not appear in the 834. InsuranceInfo insuranceSecondary = InsuranceT.AddInsurance(pat, "Secondary Carrier" + suffix); //Get the pat plans for this patient from the database. List <PatPlan> listPatPlans = PatPlans.GetPatPlansForPat(pat.PatNum); Assert.AreEqual(2, listPatPlans.Count); //Create x834 X834 x834 = new X834(new X12object(Properties.Resources.x834Test)); int createdPatsCount, updatedPatsCount, skippedPatsCount, createdCarrierCount, createdInsPlanCount, updatedInsPlanCount, createdInsSubCount, updatedInsSubCount, createdPatPlanCount, droppedPatPlanCount, updatedPatPlanCount; StringBuilder sbErrorMessages; //Pass in true for dropExistingInsurance EtransL.ImportInsurancePlans(x834, new List <Patient> { pat }, true, true, out createdPatsCount, out updatedPatsCount, out skippedPatsCount, out createdCarrierCount, out createdInsPlanCount, out updatedInsPlanCount, out createdInsSubCount, out updatedInsSubCount, out createdPatPlanCount, out droppedPatPlanCount, out updatedPatPlanCount, out sbErrorMessages); //Get the pat plans for this patient from the database. listPatPlans = PatPlans.GetPatPlansForPat(pat.PatNum); Assert.AreEqual(1, listPatPlans.Count); Assert.AreEqual(1, droppedPatPlanCount); //These should be different as a new plan was created and the old plan was dropped. Assert.AreEqual(insurancePrimary.ListPatPlans[0].PatPlanNum, listPatPlans[0].PatPlanNum); }
public void X834_ImportInsurancePlans_DoNotReplacePatPlan() { Patient pat = Createx834Patient(); string suffix = MethodBase.GetCurrentMethod().Name; //Create old insurance plan and associate it to them. InsuranceInfo insuranceOld = InsuranceT.AddInsurance(pat, "Old Carrier" + suffix); //Create x834 X834 x834 = new X834(new X12object(Properties.Resources.x834Test)); int createdPatsCount, updatedPatsCount, skippedPatsCount, createdCarrierCount, createdInsPlanCount, updatedInsPlanCount, createdInsSubCount, updatedInsSubCount, createdPatPlanCount, droppedPatPlanCount, updatedPatPlanCount; StringBuilder sbErrorMessages; EtransL.ImportInsurancePlans(x834, new List <Patient> { pat }, true, false, out createdPatsCount, out updatedPatsCount, out skippedPatsCount, out createdCarrierCount, out createdInsPlanCount, out updatedInsPlanCount, out createdInsSubCount, out updatedInsSubCount, out createdPatPlanCount, out droppedPatPlanCount, out updatedPatPlanCount, out sbErrorMessages); //Get the pat plans for this patient from the database. List <PatPlan> listPatPlans = PatPlans.GetPatPlansForPat(pat.PatNum); //No patient was created. Should have matched the one we created. Assert.AreEqual(0, createdPatsCount); //There should be two now as the old was kept. Assert.AreEqual(2, listPatPlans.Count); Assert.AreEqual(1, createdPatPlanCount); }
///<summary>Creates a general deductible of $50, a deductible of $50 on D0220, sets a $30 D0220 complete and creates a claim, ///creates a $100 D2750, that is TP'ed, and then creates a $30 D0220 that is TP'ed.</summary> ///<param name="actAssert">The first claimproc is for the D2750 and the second claimproc is for the second D0220.</param> public void GetDeductibleByCodeDeductLessThanGeneral(string suffix, Action <ClaimProc, ClaimProc> actAssert) { Patient pat = PatientT.CreatePatient(suffix); InsuranceT.AddInsurance(pat, suffix); List <InsSub> listSubs = InsSubT.GetInsSubs(pat); List <InsPlan> listPlans = InsPlans.RefreshForSubList(listSubs); List <PatPlan> listPatPlans = PatPlans.Refresh(pat.PatNum); InsPlan plan = InsPlanT.GetPlanForPriSecMed(PriSecMed.Primary, listPatPlans, listPlans, listSubs); BenefitT.CreateDeductibleGeneral(plan.PlanNum, BenefitCoverageLevel.Individual, 50); BenefitT.CreateCategoryPercent(plan.PlanNum, EbenefitCategory.Diagnostic, 100); BenefitT.CreateCategoryPercent(plan.PlanNum, EbenefitCategory.Crowns, 50); BenefitT.CreateDeductible(plan.PlanNum, EbenefitCategory.Diagnostic, 0); BenefitT.CreateDeductible(plan.PlanNum, "D0220", 50); List <Benefit> listBens = Benefits.Refresh(listPatPlans, listSubs); Procedure proc1 = ProcedureT.CreateProcedure(pat, "D0220", ProcStat.C, "", 30);//proc1 - Intraoral - periapical first film ClaimT.CreateClaim("P", listPatPlans, listPlans, new List <ClaimProc>(), new List <Procedure> { proc1 }, pat, new List <Procedure> { proc1 }, listBens, listSubs); Procedure proc2 = ProcedureT.CreateProcedure(pat, "D2750", ProcStat.TP, "", 100, priority: 0); //proc2 - Crown Procedure proc3 = ProcedureT.CreateProcedure(pat, "D0220", ProcStat.TP, "", 30, priority: 1); //proc3 - Intraoral - periapical first film List <ClaimProc> claimProcs = ProcedureT.ComputeEstimates(pat, listPatPlans, listPlans, listSubs, listBens); ClaimProc claimProc2 = claimProcs.FirstOrDefault(x => x.ProcNum == proc2.ProcNum); ClaimProc claimProc3 = claimProcs.FirstOrDefault(x => x.ProcNum == proc3.ProcNum); actAssert(claimProc2, claimProc3); }
public void FeeSchedTools_GlobalUpdateWriteoffEstimates_SubscriberInDifferentFamily() { string suffix = MethodBase.GetCurrentMethod().Name; string procStr = "D0145"; double procFee = 100; ProcedureCode procCode = ProcedureCodes.GetProcCode(procStr); //Set up clinic, prov, pat Clinic clinic = ClinicT.CreateClinic(suffix); long feeSchedNum = FeeSchedT.CreateFeeSched(FeeScheduleType.Normal, suffix); long provNum = ProviderT.CreateProvider(suffix, feeSchedNum: feeSchedNum); Fee fee = FeeT.GetNewFee(feeSchedNum, procCode.CodeNum, procFee, clinic.ClinicNum, provNum); Patient pat = PatientT.CreatePatient(suffix, provNum, clinic.ClinicNum); Patient patSubscriber = PatientT.CreatePatient(suffix + "_Subscriber", provNum, clinic.ClinicNum); //Set up insurance InsuranceInfo info = InsuranceT.AddInsurance(pat, suffix, "p", feeSchedNum); info.PriInsSub.Subscriber = patSubscriber.PatNum; InsSubs.Update(info.PriInsSub); info.ListBenefits.Add(BenefitT.CreatePercentForProc(info.PriInsPlan.PlanNum, procCode.CodeNum, 100)); //Create the procedure and claimproc Procedure proc = ProcedureT.CreateProcedure(pat, procStr, ProcStat.TP, "", procFee); ClaimProc priClaimProc = ClaimProcT.CreateClaimProc(pat.PatNum, proc.ProcNum, info.PriInsPlan.PlanNum, info.PriInsSub.InsSubNum, DateTime.Today, -1, -1, -1, ClaimProcStatus.CapEstimate); Procedures.ComputeEstimates(proc, pat.PatNum, new List <ClaimProc>(), true, info.ListInsPlans, info.ListPatPlans, info.ListBenefits, pat.Age, info.ListInsSubs); priClaimProc = ClaimProcs.Refresh(pat.PatNum).FirstOrDefault(x => x.ProcNum == proc.ProcNum); Assert.AreEqual(procFee, priClaimProc.InsPayEst); GlobalUpdateWriteoffs(clinic.ClinicNum); priClaimProc = ClaimProcs.Refresh(pat.PatNum).FirstOrDefault(x => x.ClaimProcNum == priClaimProc.ClaimProcNum); Assert.AreEqual(procFee, priClaimProc.InsPayEst); }
///<summary>Creates a procedure and computes estimates for a patient where the secondary insurance has a COB rule of Medicaid.</summary> private void ComputeEstimatesMedicaidCOB(string suffix, double procFee, double priAllowed, double secAllowed, int priPercentCovered, int secPercentCovered, Action <ClaimProc /*Primary*/, ClaimProc /*Secondary*/, Procedure> assertAct) { Patient pat = PatientT.CreatePatient(suffix); long ppoFeeSchedNum = FeeSchedT.CreateFeeSched(FeeScheduleType.Normal, "PPO " + suffix); InsuranceT.AddInsurance(pat, suffix, "p", ppoFeeSchedNum); long medicaidFeeSchedNum = FeeSchedT.CreateFeeSched(FeeScheduleType.Normal, "PPO " + suffix); InsuranceT.AddInsurance(pat, suffix, "p", medicaidFeeSchedNum, 2, cobRule: EnumCobRule.SecondaryMedicaid); List <InsSub> listSubs = InsSubT.GetInsSubs(pat); List <InsPlan> listPlans = InsPlans.RefreshForSubList(listSubs); List <PatPlan> listPatPlans = PatPlans.Refresh(pat.PatNum); InsPlan priPlan = InsPlanT.GetPlanForPriSecMed(PriSecMed.Primary, listPatPlans, listPlans, listSubs); BenefitT.CreateCategoryPercent(priPlan.PlanNum, EbenefitCategory.Diagnostic, priPercentCovered); InsPlan secPlan = InsPlanT.GetPlanForPriSecMed(PriSecMed.Secondary, listPatPlans, listPlans, listSubs); BenefitT.CreateCategoryPercent(secPlan.PlanNum, EbenefitCategory.Diagnostic, secPercentCovered); List <Benefit> listBens = Benefits.Refresh(listPatPlans, listSubs); string procStr = "D0150"; Procedure proc = ProcedureT.CreateProcedure(pat, procStr, ProcStat.TP, "", procFee); ProcedureCode procCode = ProcedureCodes.GetProcCode(procStr); FeeT.CreateFee(ppoFeeSchedNum, procCode.CodeNum, priAllowed); FeeT.CreateFee(medicaidFeeSchedNum, procCode.CodeNum, secAllowed); Procedures.ComputeEstimates(proc, pat.PatNum, new List <ClaimProc>(), false, listPlans, listPatPlans, listBens, pat.Age, listSubs); List <ClaimProc> listClaimProcs = ClaimProcs.Refresh(pat.PatNum); assertAct(listClaimProcs.FirstOrDefault(x => x.PlanNum == priPlan.PlanNum), listClaimProcs.FirstOrDefault(x => x.PlanNum == secPlan.PlanNum), proc); }
public void InsPlan_PpoNoSubWriteoffsNoSub() { string suffix = MethodBase.GetCurrentMethod().Name; Patient pat = PatientT.CreatePatient(suffix); long ucrFeeSchedNum = FeeSchedT.CreateFeeSched(FeeScheduleType.Normal, "UCR Fees" + suffix); long ppoFeeSchedNum = FeeSchedT.CreateFeeSched(FeeScheduleType.Normal, "PPO " + suffix); InsuranceInfo ins = InsuranceT.AddInsurance(pat, suffix, planType: "p", feeSchedNum: ppoFeeSchedNum); ins.PriInsPlan.HasPpoSubstWriteoffs = false; InsPlans.Update(ins.PriInsPlan); BenefitT.CreateCategoryPercent(ins.PriInsPlan.PlanNum, EbenefitCategory.Restorative, 50); ProcedureCode originalProcCode = ProcedureCodes.GetProcCode("D2330"); ProcedureCode downgradeProcCode = ProcedureCodes.GetProcCode("D2140"); originalProcCode.SubstitutionCode = ""; //NOT substituting originalProcCode.SubstOnlyIf = SubstitutionCondition.Always; ProcedureCodeT.Update(originalProcCode); FeeT.CreateFee(ucrFeeSchedNum, originalProcCode.CodeNum, 100); FeeT.CreateFee(ucrFeeSchedNum, downgradeProcCode.CodeNum, 80); FeeT.CreateFee(ppoFeeSchedNum, originalProcCode.CodeNum, 60); FeeT.CreateFee(ppoFeeSchedNum, downgradeProcCode.CodeNum, 50); Procedure proc = ProcedureT.CreateProcedure(pat, "D2330", ProcStat.C, "9", 100);//Tooth 9 List <ClaimProc> listClaimProcs = ClaimProcs.Refresh(pat.PatNum); List <Procedure> listProcs = Procedures.Refresh(pat.PatNum); ins.RefreshBenefits(); Claim claim = ClaimT.CreateClaim("P", ins.ListPatPlans, ins.ListInsPlans, listClaimProcs, listProcs, pat, listProcs, ins.ListBenefits, ins.ListInsSubs); ClaimProc clProc = ClaimProcs.Refresh(pat.PatNum)[0]; //Should only be one Assert.AreEqual(50, clProc.Percentage); Assert.AreEqual(30, clProc.BaseEst); Assert.AreEqual(30, clProc.InsPayEst); Assert.AreEqual(40, clProc.WriteOffEst); }
///<summary>Creates a procedure and returns its procedure fee.</summary> private double GetProcFee(string suffix, bool doUseMedicalCode) { Prefs.UpdateBool(PrefName.InsPpoAlwaysUseUcrFee, true); Prefs.UpdateBool(PrefName.MedicalFeeUsedForNewProcs, doUseMedicalCode); Patient pat = PatientT.CreatePatient(suffix); long ucrFeeSchedNum = FeeSchedT.CreateFeeSched(FeeScheduleType.Normal, "UCR " + suffix); FeeSchedT.UpdateUCRFeeSched(pat, ucrFeeSchedNum); long ppoFeeSchedNum = FeeSchedT.CreateFeeSched(FeeScheduleType.Normal, "PPO " + suffix); InsuranceT.AddInsurance(pat, suffix, "p", ppoFeeSchedNum, 1, true); List <InsSub> listSubs = InsSubT.GetInsSubs(pat); List <InsPlan> listPlans = InsPlans.RefreshForSubList(listSubs); List <PatPlan> listPatPlans = PatPlans.Refresh(pat.PatNum); string procStr = "D0150"; string procStrMed = "D0120"; ProcedureCode procCode = ProcedureCodes.GetProcCode(procStr); ProcedureCode procCodeMed = ProcedureCodes.GetProcCode(procStrMed); procCode.MedicalCode = procCodeMed.ProcCode; FeeT.CreateFee(ucrFeeSchedNum, procCode.CodeNum, 300); FeeT.CreateFee(ppoFeeSchedNum, procCode.CodeNum, 120); FeeT.CreateFee(ucrFeeSchedNum, procCodeMed.CodeNum, 175); FeeT.CreateFee(ppoFeeSchedNum, procCodeMed.CodeNum, 85); Procedure proc = ProcedureT.CreateProcedure(pat, procStr, ProcStat.TP, "", 300); return(Procedures.GetProcFee(pat, listPatPlans, listSubs, listPlans, procCode.CodeNum, proc.ProvNum, proc.ClinicNum, procCode.MedicalCode)); }
public void RpProcNotBilledIns_GetProcsNotBilled_MedicalInsOnly() { string suffix = MethodBase.GetCurrentMethod().Name; Patient patient = PatientT.CreatePatient(suffix); Carrier carrier = CarrierT.CreateCarrier(suffix); ProcedureCode procedureCode = ProcedureCodeT.CreateProcCode("T7782"); //Create a primary medical insurance plan InsuranceInfo insuranceInfo = InsuranceT.AddInsurance(patient, carrier.CarrierName, ordinal: 1, isMedical: true); insuranceInfo.AddBenefit(BenefitT.CreatePercentForProc(insuranceInfo.MedInsPlan.PlanNum, procedureCode.CodeNum, 80)); Procedure procedure = ProcedureT.CreateProcedure(patient, procedureCode.ProcCode, ProcStat.TP, "", 55, procDate: DateTime.Now.AddDays(-3)); ProcedureT.ComputeEstimates(patient, insuranceInfo); ProcedureT.SetComplete(procedure, patient, insuranceInfo); //Run the procs not billed report with "includeMedProcs" set to false. //The patient should not be returned due to not having any dental insurance estimates. DataTable table = RpProcNotBilledIns.GetProcsNotBilled(new List <long>(), false, DateTime.Now.AddDays(-10), DateTime.Now, false, false); Assert.IsNotNull(table); Assert.IsFalse(table.Select().Select(x => PIn.Long(x["PatNum"].ToString())).Contains(patient.PatNum)); //Run the procs not billed report with "includeMedProcs" set to true. //The patient should be returned due to the medical insurance estimates. table = RpProcNotBilledIns.GetProcsNotBilled(new List <long>(), true, DateTime.Now.AddDays(-10), DateTime.Now, false, false); Assert.IsNotNull(table); Assert.IsTrue(table.Rows.Count > 0); Assert.IsTrue(table.Select().Select(x => PIn.Long(x["PatNum"].ToString())).Contains(patient.PatNum)); }
public void LedgersTests_ComputeAging_PayPlanDynamicCreditsWithClaimProcs() { List <Procedure> listProcs = new List <Procedure>(); List <Adjustment> listAdjs = new List <Adjustment>(); long provNum = ProviderT.CreateProvider("Aging_PayPlanDynamic"); string suffix = MethodBase.GetCurrentMethod().Name; Patient pat = PatientT.CreatePatient(fName: "Aging_PayPlanDynamic", suffix: suffix); Family fam = Patients.GetFamily(pat.PatNum); Procedure proc45 = ProcedureT.CreateProcedure(pat, "D0210", ProcStat.C, "", 45, DateTime.Today.AddDays(-61), provNum: provNum); ClaimProc cp45 = new ClaimProc(); InsuranceInfo insInfo = InsuranceT.AddInsurance(pat, "DynPayPlan"); ClaimProcs.CreateEst(cp45, proc45, insInfo.PriInsPlan, insInfo.PriInsSub); cp45.Status = ClaimProcStatus.NotReceived; cp45.InsEstTotal = -1; cp45.InsPayEst = 15; cp45.WriteOffEst = 0; cp45.WriteOff = 0; ClaimProcs.Update(cp45); listProcs.AddRange(new List <Procedure> { proc45 }); PayPlan payPlan = PayPlanT.CreateDynamicPaymentPlan(pat.PatNum, pat.PatNum, DateTime.Today.AddDays(-1), 0, 0, 30, listProcs, listAdjs); //make two non payplan productions to put on the account Procedure procUnattached = ProcedureT.CreateProcedure(pat, "D0210", ProcStat.C, "", 35, DateTime.Today.AddDays(-91), provNum: provNum); //Run pay plan logic to generate first set of charges List <PayPlanCharge> listChargesDb = PayPlanCharges.GetForPayPlan(payPlan.PayPlanNum); List <PayPlanLink> listEntries = PayPlanLinks.GetForPayPlans(new List <long> { payPlan.PayPlanNum }); PayPlanTerms terms = PayPlanT.GetTerms(payPlan, listEntries); List <PayPlanCharge> listChargesThisPeriod = PayPlanEdit.GetListExpectedCharges(listChargesDb, terms, fam, listEntries, payPlan, true); Assert.AreEqual(30, listChargesThisPeriod.Sum(x => x.Principal)); foreach (PayPlanCharge charge in listChargesThisPeriod) { PayPlanCharges.Insert(charge); } int payPlansVersionPrev = PrefC.GetInt(PrefName.PayPlansVersion); try { PrefT.UpdateInt(PrefName.PayPlansVersion, (int)PayPlanVersions.AgeCreditsAndDebits); CheckAgingProcLifo(pat.PatNum, 30, 0, 15, 35, 30, YN.Yes); //new - pay plan credit of $30 gets applied to cooresponding procedure CheckAgingProcLifo(pat.PatNum, 30, 0, 45, 5, 30, YN.No); //old - pay plan credit gets applied to oldest production on the account CheckAgingProcLifo(pat.PatNum, 30, 0, 45, 5, 30, YN.Unknown); } finally { PrefT.UpdateInt(PrefName.PayPlansVersion, payPlansVersionPrev); } }
public void Benefits_OverAgeWithLifetimeMax() { string suffix = MethodBase.GetCurrentMethod().Name; Patient pat = PatientT.CreatePatient(suffix, birthDate: DateTime.Now.AddYears(-20)); InsuranceInfo ins = InsuranceT.AddInsurance(pat, suffix); BenefitT.CreateCategoryPercent(ins.PrimaryInsPlan.PlanNum, EbenefitCategory.Orthodontics, 50); BenefitT.CreateAgeLimitation(ins.PrimaryInsPlan.PlanNum, EbenefitCategory.Orthodontics, 18); BenefitT.CreateOrthoMax(ins.PrimaryInsPlan.PlanNum, 1000); ins.RefreshBenefits(); Procedure proc = ProcedureT.CreateProcedure(pat, "D8090", ProcStat.TP, "", 3000);//comprehensive orthodontic treatment List <ClaimProc> listClaimProcs = ProcedureT.ComputeEstimates(pat, ins); Assert.AreEqual(0, listClaimProcs.First().InsEstTotal); }
public void LedgersTests_ComputeAgingProcLifo_InsWoEst_And_InsPayEst() { string suffix = MethodBase.GetCurrentMethod().Name; Patient pat = PatientT.CreatePatient(fName: "Aging_InsEst", suffix: suffix); InsuranceInfo insInfo = InsuranceT.AddInsurance(pat, "AgingInsEst"); Procedure proc95 = ProcedureT.CreateProcedure(pat, "D0270", ProcStat.C, "", 1000, DateTime.Today.AddDays(-95)); ClaimProc cp95 = new ClaimProc(); ClaimProcs.CreateEst(cp95, proc95, insInfo.PriInsPlan, insInfo.PriInsSub); cp95.Status = ClaimProcStatus.NotReceived; cp95.InsEstTotal = 800; cp95.InsPayEst = 800; cp95.WriteOffEst = 200; cp95.WriteOff = 200; ClaimProcs.Update(cp95); Procedure proc85 = ProcedureT.CreateProcedure(pat, "D1110", ProcStat.C, "", 100, DateTime.Today.AddDays(-85)); ClaimProc cp85 = new ClaimProc(); ClaimProcs.CreateEst(cp85, proc85, insInfo.PriInsPlan, insInfo.PriInsSub); cp85.Status = ClaimProcStatus.NotReceived; cp85.InsEstTotal = 60; cp85.InsPayEst = 60; cp85.WriteOffEst = 40; cp85.WriteOff = 40; ClaimProcs.Update(cp85); int agingProcLifoPrev = PrefC.GetInt(PrefName.AgingProcLifo); try { PrefT.UpdateInt(PrefName.AgingProcLifo, (int)YN.No); Dictionary <long, DataRow> dictAging = Ledgers.GetAgingGuarTransTable(DateTime.Today, new List <long> { pat.Guarantor }); Assert.AreEqual(PIn.Double(dictAging[pat.Guarantor]["InsPayEst"].ToString()), 860); Assert.AreEqual(PIn.Double(dictAging[pat.Guarantor]["InsWoEst"].ToString()), 240); PrefT.UpdateInt(PrefName.AgingProcLifo, (int)YN.Yes); dictAging = Ledgers.GetAgingGuarTransTable(DateTime.Today, new List <long> { pat.Guarantor }); Assert.AreEqual(PIn.Double(dictAging[pat.Guarantor]["InsPayEst"].ToString()), 860); Assert.AreEqual(PIn.Double(dictAging[pat.Guarantor]["InsWoEst"].ToString()), 240); } finally { PrefT.UpdateInt(PrefName.AgingProcLifo, agingProcLifoPrev); } }
public void ProcMultiVisitTests_CrownGroupComplete_ClaimDates() { string suffix = MethodBase.GetCurrentMethod().Name; Patient pat = PatientT.CreatePatient(suffix); InsuranceInfo insInfo = InsuranceT.AddInsurance(pat, suffix); List <Procedure> listProcs = new List <Procedure>(); Procedure procBillable = ProcedureT.CreateProcedure(pat, "D2750", ProcStat.TP, "1", 100, new DateTime(2018, 5, 1));//PFM listProcs.Add(procBillable); Procedure procDelivery = ProcedureT.CreateProcedure(pat, "N4118", ProcStat.TP, "1", 0, new DateTime(2018, 8, 20)); //Seat - usually completed several months later. listProcs.Add(procDelivery); List <ClaimProc> listClaimProcs = ProcedureT.ComputeEstimates(pat, insInfo); ProcMultiVisits.CreateGroup(listProcs); Procedure procBillableOld = procBillable.Copy(); procBillable.ProcStatus = ProcStat.C; Procedures.Update(procBillable, procBillableOld); Procedure procDeliveryOld = procDelivery.Copy(); procDelivery.ProcStatus = ProcStat.C; Procedures.Update(procDelivery, procDeliveryOld); Assert.AreEqual(ProcMultiVisits.IsProcInProcess(procBillable.ProcNum), false); //Both procedures complete means the group is now complete (not In Process). Assert.AreEqual(ProcMultiVisits.IsProcInProcess(procDelivery.ProcNum), false); //Both procedures complete means the group is now complete (not In Process). Claim claim = new Claim(); claim.DateSent = DateTimeOD.Today; claim.DateSentOrig = DateTime.MinValue; claim.ClaimStatus = "W"; //Dates of service are calculated inside AccountModules.CreateClaim(). //The procDelivery cannot be attached to the claim in the UI, because $0 procs are blocked by UI. Therefore, we only attach the procBilled to the claim here. ODTuple <bool, Claim, string> clmResult = AccountModules.CreateClaim(claim, "P", insInfo.ListPatPlans, insInfo.ListInsPlans, listClaimProcs, listProcs, insInfo.ListInsSubs, pat, null, new List <Procedure> { procBillable }, "", insInfo.PriInsPlan, insInfo.PriInsSub, Relat.Self); Assert.AreEqual(clmResult.Item3, ""); //Ensure no validation errors creating the claim. This is to verify the integrity of the unit test design. Assert.AreEqual(clmResult.Item2.DateService, procDelivery.ProcDate); //Claim date of service must always be the greatest date in the multi visit group. listClaimProcs = ClaimProcs.RefreshForClaim(clmResult.Item2.ClaimNum); Assert.AreEqual(listClaimProcs[0].ProcDate, procDelivery.ProcDate); //Proc date of service must always be the greatest date in the multi visit group, even if performed on a different day. }
public void FeeSchedTools_GlobalUpdateWriteoffEstimates() { string suffix = MethodBase.GetCurrentMethod().Name; string procStr = "D0145"; double procFee = 100; ProcedureCode procCode = ProcedureCodes.GetProcCode(procStr); //Set up clinic, prov, pat Clinic clinic = ClinicT.CreateClinic(suffix); long feeSchedNum = FeeSchedT.CreateFeeSched(FeeScheduleType.FixedBenefit, suffix); long provNum = ProviderT.CreateProvider(suffix, feeSchedNum: feeSchedNum); Fee fee = FeeT.GetNewFee(feeSchedNum, procCode.CodeNum, procFee, clinic.ClinicNum, provNum); Patient pat = PatientT.CreatePatient(suffix, provNum, clinic.ClinicNum); //Set up insurance InsuranceInfo info = InsuranceT.AddInsurance(pat, suffix, "c", feeSchedNum); List <InsSub> listSubs = info.ListInsSubs; List <InsPlan> listPlans = info.ListInsPlans; List <PatPlan> listPatPlans = info.ListPatPlans; InsPlan priPlan = info.PriInsPlan; InsSub priSub = info.PriInsSub; info.ListBenefits.Add(BenefitT.CreatePercentForProc(priPlan.PlanNum, procCode.CodeNum, 90)); //Create the procedure and claimproc Procedure proc = ProcedureT.CreateProcedure(pat, procStr, ProcStat.TP, "", procFee); ClaimProc priClaimProc = ClaimProcT.CreateClaimProc(pat.PatNum, proc.ProcNum, priPlan.PlanNum, priSub.InsSubNum, DateTime.Today, -1, -1, -1, ClaimProcStatus.CapEstimate); Procedures.ComputeEstimates(proc, pat.PatNum, new List <ClaimProc>(), true, listPlans, listPatPlans, info.ListBenefits, pat.Age, info.ListInsSubs); priClaimProc = ClaimProcs.Refresh(pat.PatNum).FirstOrDefault(x => x.ProcNum == proc.ProcNum); Assert.AreEqual(procFee, priClaimProc.WriteOff); procFee = 50; Procedure procNew = proc.Copy(); procNew.ProcFee = procFee; Procedures.Update(procNew, proc); //GlobalUpdate long updated = GlobalUpdateWriteoffs(clinic.ClinicNum); Assert.AreEqual(1, updated); ClaimProc priClaimProcDb = ClaimProcs.Refresh(pat.PatNum).FirstOrDefault(x => x.ClaimProcNum == priClaimProc.ClaimProcNum); Assert.AreEqual(procFee, priClaimProcDb.WriteOff); }
public void RpProcNotBilledIns_GetProcsNotBilled_ShowProcsBeforeIns() { string suffix = MethodBase.GetCurrentMethod().Name; Patient patient = PatientT.CreatePatient(suffix); Carrier carrier = CarrierT.CreateCarrier(suffix); ProcedureCode procedureCode = ProcedureCodeT.CreateProcCode("T7782"); Procedure procedure = ProcedureT.CreateProcedure(patient, procedureCode.ProcCode, ProcStat.C, "", 55, procDate: DateTime.Now.AddDays(-3)); //Add insurance after the procedure has been set complete. InsuranceInfo insuranceInfo = InsuranceT.AddInsurance(patient, carrier.CarrierName, ordinal: 1, isMedical: true); //The patient should not be returned when 'showProcsBeforeIns' is set to false. DataTable table = RpProcNotBilledIns.GetProcsNotBilled(new List <long>(), false, DateTime.Now.AddDays(-10), DateTime.Now, false, false); Assert.IsNotNull(table); Assert.IsFalse(table.Select().Select(x => PIn.Long(x["PatNum"].ToString())).Contains(patient.PatNum)); //The patient should be returned when 'showProcsBeforeIns' is set to true. table = RpProcNotBilledIns.GetProcsNotBilled(new List <long>(), true, DateTime.Now.AddDays(-10), DateTime.Now, true, false); Assert.IsNotNull(table); Assert.IsTrue(table.Rows.Count > 0); Assert.IsTrue(table.Select().Select(x => PIn.Long(x["PatNum"].ToString())).Contains(patient.PatNum)); }
public void Procedures_ComputeEstimates_PrimaryInsuranceMedicaidCOB() { string suffix = MethodBase.GetCurrentMethod().Name; Patient pat = PatientT.CreatePatient(suffix); long ppoFeeSchedNum = FeeSchedT.CreateFeeSched(FeeScheduleType.Normal, "PPO " + suffix); InsuranceInfo insInfo = InsuranceT.AddInsurance(pat, suffix, "p", ppoFeeSchedNum, 1, cobRule: EnumCobRule.SecondaryMedicaid); InsPlan priPlan = InsPlanT.GetPlanForPriSecMed(PriSecMed.Primary, insInfo.ListPatPlans, insInfo.ListInsPlans, insInfo.ListInsSubs); BenefitT.CreateCategoryPercent(priPlan.PlanNum, EbenefitCategory.Diagnostic, percent: 50); List <Benefit> listBens = Benefits.Refresh(insInfo.ListPatPlans, insInfo.ListInsSubs); string procStr = "D0150"; Procedure proc = ProcedureT.CreateProcedure(pat, procStr, ProcStat.TP, "", 125); ProcedureCode procCode = ProcedureCodes.GetProcCode(procStr); FeeT.CreateFee(ppoFeeSchedNum, procCode.CodeNum, amount: 80); Procedures.ComputeEstimates(proc, pat.PatNum, new List <ClaimProc>(), false, insInfo.ListInsPlans, insInfo.ListPatPlans, listBens, pat.Age, insInfo.ListInsSubs); List <ClaimProc> listClaimProcs = ClaimProcs.Refresh(pat.PatNum); Assert.AreEqual(40, listClaimProcs[0].InsEstTotal, 0.001); Assert.AreEqual(45, listClaimProcs[0].WriteOffEst, 0.001); }
///<summary>Creates a procedure and computes estimates for a patient where the secondary insurance has a COB rule of Medicaid.</summary> private void ComputeEstimatesFixedBenefits(string suffix, double procFee, double ppoFee, double fixedBenefitFee , int priPercentCoveredOverride, bool hasSecondary, double secFee, Action <FixedBenefitAssertItem> assertAct) { Patient pat = PatientT.CreatePatient(suffix); string procStr = "D0150"; Procedure proc = ProcedureT.CreateProcedure(pat, procStr, ProcStat.TP, "", procFee); ProcedureCode procCode = ProcedureCodes.GetProcCode(procStr); long ppoFeeSchedNum = FeeSchedT.CreateFeeSched(FeeScheduleType.Normal, "PPO " + suffix); long catPercFeeSchedNum = FeeSchedT.CreateFeeSched(FeeScheduleType.Normal, "Category % " + suffix); long fixedBenefitFeeSchedNum = FeeSchedT.CreateFeeSched(FeeScheduleType.FixedBenefit, "Fixed Benefit " + suffix); if (ppoFee > -1) { FeeT.CreateFee(ppoFeeSchedNum, procCode.CodeNum, ppoFee); } FeeT.CreateFee(fixedBenefitFeeSchedNum, procCode.CodeNum, fixedBenefitFee); InsuranceT.AddInsurance(pat, suffix, "p", ppoFeeSchedNum, copayFeeSchedNum: fixedBenefitFeeSchedNum); if (hasSecondary) { FeeT.CreateFee(catPercFeeSchedNum, procCode.CodeNum, secFee); InsuranceT.AddInsurance(pat, suffix, "", catPercFeeSchedNum, 2, false, EnumCobRule.Standard); } List <InsSub> listSubs = InsSubT.GetInsSubs(pat); List <InsPlan> listPlans = InsPlans.RefreshForSubList(listSubs); List <PatPlan> listPatPlans = PatPlans.Refresh(pat.PatNum); InsPlan priPlan = InsPlanT.GetPlanForPriSecMed(PriSecMed.Primary, listPatPlans, listPlans, listSubs); InsPlan secPlan = null; if (hasSecondary) { secPlan = InsPlanT.GetPlanForPriSecMed(PriSecMed.Secondary, listPatPlans, listPlans, listSubs); //TODO: Add diagnostic code benefit for 100% BenefitT.CreateCategoryPercent(secPlan.PlanNum, EbenefitCategory.Diagnostic, 100); } List <Benefit> listBens = Benefits.Refresh(listPatPlans, listSubs); Procedures.ComputeEstimates(proc, pat.PatNum, new List <ClaimProc>(), false, listPlans, listPatPlans, listBens, pat.Age, listSubs); List <ClaimProc> listClaimProcs = ClaimProcs.Refresh(pat.PatNum); if (priPercentCoveredOverride > 0) { foreach (ClaimProc cpCur in listClaimProcs) { cpCur.PercentOverride = priPercentCoveredOverride; ClaimProcs.Update(cpCur); } Procedures.ComputeEstimates(proc, pat.PatNum, new List <ClaimProc>(), false, listPlans, listPatPlans, listBens, pat.Age, listSubs); listClaimProcs = ClaimProcs.Refresh(pat.PatNum); } foreach (ClaimProc cpCur in listClaimProcs) { cpCur.PercentOverride = priPercentCoveredOverride; ClaimProcs.Update(cpCur); } Procedures.ComputeEstimates(proc, pat.PatNum, listClaimProcs, false, listPlans, listPatPlans, listBens, pat.Age, listSubs); listClaimProcs = ClaimProcs.Refresh(pat.PatNum); assertAct(new FixedBenefitAssertItem() { Procedure = proc, PrimaryClaimProc = listClaimProcs.FirstOrDefault(x => x.PlanNum == priPlan.PlanNum), SecondaryClaimProc = secPlan == null ? null : listClaimProcs.FirstOrDefault(x => x.PlanNum == secPlan.PlanNum), }); }