private claim FindClaim(DataRow anImportRow, claim.ClaimTypes claimType)
{
string importID = anImportRow[dms.claim_id_column].ToString();
string importDB = anImportRow[dms.claim_db_column].ToString();
try
{
claim c = new claim();
c.claimidnum = importID;
c.claimdb = importDB;
DataTable matches = c.Search();
if (matches.Rows.Count != 0)
{
c.Load(matches.Rows[0]);
}
else
{
// ****** Finding recreated claims *************
// Above, we checked for the common ID/DB match
// Here we try to find if a claim that is not in Tracker has been recreated
// We match by all fields minus 1 - if two primary fields have been changed
// Tracker can't track it
// If we find a possible match, we check to see that the current claim isn't in Dentrix
// to avoid false positives
bool possibleMatchFound = false;
bool claimInDentrix = true;
claim workingClaim = new claim();
DateTime?dateOfService = null;
try
{ dateOfService = Convert.ToDateTime(anImportRow["PLDATE"]); }
catch { }
string lastName = anImportRow["PatLastName"].ToString();
string firstName = anImportRow["PatFirstName"].ToString();
decimal amount = Convert.ToDecimal(anImportRow["TOTAL"]); // stored as cents
string doctorFirstName = anImportRow["DoctorFirstName"].ToString();
string doctorLastName = anImportRow["DoctorLastName"].ToString();
string subscriberInsuranceID = anImportRow["ID_NUM_ON_CLAIM"].ToString();
string matchingClaimInfo = matchingClaimInfo = string.Format("Patient: {0}, Doctor: {1}, Total: {2}, DOS: {3}, Ins ID: {4}, ID: {5}, Type: {6}", firstName + " " + lastName,
doctorFirstName + " " + doctorLastName, amount, dateOfService, subscriberInsuranceID, importID + " | " + importDB, claimType.ToString());
int?newClaimID = null;
// Search for a patient match first. If the patient doesn't match try to match on the other two fields
workingClaim.patient_first_name = firstName;
workingClaim.patient_last_name = lastName;
workingClaim.open = 1;
DataTable patientMatches = workingClaim.Search();
if (patientMatches.Rows.Count > 0)
{
// Iterate through all rows where the patient data matches
foreach (DataRow aRow in patientMatches.Rows)
{
int numMatchesForclaim = 0;
workingClaim.Load(aRow);
if (workingClaim.amount_of_claim * 100 == amount)
{
numMatchesForclaim++;
}
if (workingClaim.doctor_first_name == doctorFirstName && workingClaim.doctor_last_name == doctorLastName)
{
numMatchesForclaim++;
}
if (workingClaim.date_of_service == dateOfService)
{
numMatchesForclaim++;
}
if (workingClaim.subscriber_alternate_number == subscriberInsuranceID)
{
numMatchesForclaim++;
}
if (workingClaim.claim_type == claimType)
{
numMatchesForclaim++;
}
if (numMatchesForclaim >= 4)
{
// Found a claim that appears to match
newClaimID = workingClaim.id;
possibleMatchFound = true;
break;
}
}
}
else
{
// Look for a match on date of service, amount, provider, insurance id, and type
workingClaim = new claim();
workingClaim.open = 1;
workingClaim.amount_of_claim = amount / 100;
workingClaim.doctor_first_name = doctorFirstName;
workingClaim.doctor_last_name = doctorLastName;
workingClaim.subscriber_alternate_number = subscriberInsuranceID;
workingClaim.claim_type = claimType;
string searchSQL = workingClaim.SearchSQL + string.Format(" AND DATEDIFF(d, [date_of_service], '{0}') = 0", dateOfService.GetValueOrDefault().ToShortDateString());
DataTable otherMatches = workingClaim.Search(searchSQL);
if (otherMatches.Rows.Count > 0)
{
newClaimID = (int)otherMatches.Rows[0]["id"];
possibleMatchFound = true;
}
}
if (possibleMatchFound)
{
// Check Dentrix to verify that the current ID/DB can't be found
if (newClaimID.HasValue && ClaimTrackerCommon.ClaimExists(new claim(newClaimID.Value))) // No match found
{
// Log this temporarily for recordkeeping
claimInDentrix = true;
AddReportMessage("Found a possible claim to merge, but the claim exists in Dentrix. Did not merge claim..." + matchingClaimInfo, true);
LoggingHelper.Log("Tried to merge a claim, but it was found in Dentrix. Claim info:\n" + matchingClaimInfo, LogSeverity.Information);
}
else
{
claimInDentrix = false;
}
}
if (!claimInDentrix && possibleMatchFound)
{
// Already loaded claim, should have "correct" data
c.Load(newClaimID.GetValueOrDefault(0));
AddReportMessage(string.Format("Merged a claim in Dentrix with an existing claim tracker claim. The claim's old ID/DB is {0}/{1}. The matching claim information is {2}",
c.claimidnum, c.claimdb, matchingClaimInfo), true);
c.claimidnum = importID;
c.claimdb = importDB;
LoggingHelper.Log("Successfully merged a claim. \n" + matchingClaimInfo, LogSeverity.Information);
}
else
{
AddReportMessage("New claim imported - " + matchingClaimInfo);
c.created_by = "Automatic Database Importer";
c.updated_on = null;
}
}
return(c);
}
catch (Exception err)
{
// Somewhat dangerous, but it ensures that the import won't crash
LoggingHelper.Log("Error in frmImportData.FindClaim", LogSeverity.Critical, err, false);
claim c = new claim();
c.claimidnum = importID;
c.claimdb = importDB;
return(c);
}
}
/// <summary>
/// Returns a list of all Insurance Company Groups and all Insurance Companies not in a group
/// </summary>
/// <returns></returns>
internal List <Claims_Primary.InsuranceCompanyGroups> GetInsuranceCompaniesAsGroup(bool includeMultipleCarriers = false)
{
List <Claims_Primary.InsuranceCompanyGroups> allGroups = new List <Claims_Primary.InsuranceCompanyGroups>();
List <company> companiesInAGroup = new List <company>();
insurance_company_group icg = new insurance_company_group();
foreach (DataRow aRow in icg.GetAllData("name").Rows)
{
icg = new insurance_company_group(aRow);
if (includeMultipleCarriers || !icg.multiple_carriers)
{
Claims_Primary.InsuranceCompanyGroups newGroup = new Claims_Primary.InsuranceCompanyGroups();
List <company> matchingComps = icg.GetMatchingCompanies();
newGroup.Name = icg.name;
newGroup.Companies = matchingComps;
newGroup.Group = icg;
allGroups.Add(newGroup);
companiesInAGroup.AddRange(matchingComps);
}
}
string searchSQL;
if (companiesInAGroup.Count == 0)
{
searchSQL = "SELECT * FROM companies ORDER BY name";
}
else
{
searchSQL = string.Format("SELECT * FROM companies WHERE ID NOT IN ({0}) ORDER BY name", ClaimTrackerCommon.CompaniesToInString(companiesInAGroup));
}
DataTable companiesNotInGroup = icg.Search(searchSQL);
foreach (DataRow aRow in companiesNotInGroup.Rows)
{
company c = new company(aRow);
Claims_Primary.InsuranceCompanyGroups newGroup = new Claims_Primary.InsuranceCompanyGroups(c.name, c);
allGroups.Add(newGroup);
}
allGroups.Sort(SortInsuranceGroupsByName);
return(allGroups);
}
