public override List <PaymentResult> EvaluatePaymentType(IEvaluateableClaim claim,
List <PaymentResult> paymentResults, bool isCarveOut, bool isContractFilter)
{
MedicareInPatientResult medicareInPatientResult = GetMedicareInPatientResult(claim);
var claimPaymentResult = GetClaimLevelPaymentResult(paymentResults, isCarveOut);
if (claimPaymentResult != null && medicareInPatientResult != null)
{
//Update PaymentResult and set matching ServiceTypeId,PaymentTypeDetailId & PaymentTypeId
Utilities.UpdatePaymentResult(claimPaymentResult, PaymentTypeMedicareIp.ServiceTypeId,
PaymentTypeMedicareIp.PaymentTypeDetailId, PaymentTypeMedicareIp.PaymentTypeId);
if (medicareInPatientResult.IsSucess)
{
if (PaymentTypeMedicareIp.InPatient.HasValue)
{
claimPaymentResult.AdjudicatedValue = (PaymentTypeMedicareIp.InPatient.Value / 100) *
medicareInPatientResult.TotalPaymentAmount;
claimPaymentResult.ClaimStatus = (byte)Enums.AdjudicationOrVarianceStatuses.Adjudicated;
}
else
{
claimPaymentResult.ClaimStatus =
(byte)Enums.AdjudicationOrVarianceStatuses.AdjudicationErrorInvalidPaymentData;
}
}
else
{
claimPaymentResult.ClaimStatus = (byte)Enums.AdjudicationOrVarianceStatuses.ClaimDataError;
}
}
return(paymentResults);
}
private MedicareInPatientResult GetMedicareInPatientResult(IEvaluateableClaim claim)
{
MedicareInPatientResult medicareInPatientResult = new MedicareInPatientResult();
MedicareInPatient medicarePatient = claim.MedicareInPatient;
_pricerDll = new NetPrcM5
{
Provider = medicarePatient.Npi,
DDate = medicarePatient.DischargeDate.ToString(CultureInfo.InvariantCulture),
DRG = medicarePatient.Drg,
DStat = medicarePatient.DischargeStatus
};
_pricerDll.ReviewCode = _pricerDll.DStat;
_pricerDll.LOS = medicarePatient.LengthOfStay;
_pricerDll.Charges = medicarePatient.Charges;
//A string of diagnosis codes formatted as 7-Byte values.
//Each code is left justified and blank filled to a length of 7 bytes.
//Any decimal point in the diagnosis code should be removed before passing the code to PRICERActive.
_pricerDll.DiagnosisCodes = GetDiagnosisCodeString(claim.DiagnosisCodes, claim.StatementThru);
//A string of procedure codes formatted as 7-Byte values.
//Each code is left justified and blank filled to a length of 7 bytes.
//Any decimal point in the procedure code should be removed before passing the code to PRICERActive.
_pricerDll.ProcedureCodes = GetProcedureCodeString(claim.ProcedureCodes, claim.StatementThru);
//If statementThru Date is equal to or greater than 10/01/2015, then we pass "0" as ICDVersion10 else "9" as ICDVersion 9
_pricerDll.ICDVersion = claim.StatementThru >= DateTime.Parse(Constants.IcdVersionDate, CultureInfo.InvariantCulture) ? Constants.IcdVersion10 : Constants.IcdVersion9;
_pricerDll.DeviceCreditAmount = Constants.DeviceCreditAmount; // 0; // Source unknown.
_pricerDll.DIFICIDOnClaim = Constants.DificidOnClaim; // false;
_pricerDll.HMOClaim = Constants.HmoClaim; // false;
_pricerDll.IncludePassthru = Constants.IncludePassthru; //false;
_pricerDll.AllowTerminatedProvider = Constants.AllowTerminatedProvider; // false;
_pricerDll.AdjustmentFactor = Constants.AdjustmentFactor; // 1;
_pricerDll.AdjustmentOption = Constants.AdjustmentOption; // 0;
if (GlobalConfigVariable.IsMicrodynLogEnabled)
{
XmlSerializer xsSubmit = new XmlSerializer(typeof(NetPrcM5));
StringWriter sww = new StringWriter();
XmlWriter writer = XmlWriter.Create(sww);
xsSubmit.Serialize(writer, _pricerDll);
var xml = sww.ToString();
Log.LogInfo("MedicareInPatient Input : \n" + xml, "MicrodynPriceInputData");
}
if (GlobalConfigVariable.IsMicrodynEnabled)
{
_pricerDll.PRICERCalc();
string message = string.Empty;
medicareInPatientResult.TotalPaymentAmount = _pricerDll.PRICERSuccess ? GetTotalAmount(_pricerDll) : 0.00;
medicareInPatientResult.IsSucess = _pricerDll.PRICERSuccess;
message = GetPricerReturnValue(_pricerDll.ReturnCode, message, _pricerDll.PRICERSuccess);
medicareInPatientResult.ClaimId = claim.ClaimId;
medicareInPatientResult.ReturnCode = _pricerDll.ReturnCode;
medicareInPatientResult.Message = message;
if (GlobalConfigVariable.IsMicrodynLogEnabled)
{
Log.LogInfo(
string.Format(CultureInfo.InvariantCulture, Constants.MedicareIpClaimIdLog, medicareInPatientResult.Message,
medicareInPatientResult.ClaimId), Constants.MicrodynInPatientMessage);
}
}
else
{
medicareInPatientResult.ReturnCode = 0;
medicareInPatientResult.TotalPaymentAmount = 0;
medicareInPatientResult.Message = Constants.MessageMicrodyneOff;
medicareInPatientResult.IsSucess = true;
}
//After processing, destroy the Reimbursement DLL object
_pricerDll.Dispose();
return(medicareInPatientResult);
}
