Esempio n. 1
0
 /// <summary>Search predicate returns true if code matches.</summary>
 private bool EB03MatchesCode(EB03 eb03val)
 {
     if (Segment.Get(3) == eb03val.Code)
     {
         return(true);
     }
     return(false);
 }
Esempio n. 2
0
File: EB271.cs Progetto: mnisl/OD
		/// <summary>Search predicate returns true if code matches.</summary>
		private bool EB03MatchesCode(EB03 eb03val) {
			if(Segment.Get(3)==eb03val.Code) {
				return true;
			}
			return false;
		}
Esempio n. 3
0
        public EB271(X12Segment segment, bool isInNetwork, bool isCoinsuranceInverted, X12Segment segHsd = null)
        {
            if (eb01 == null)
            {
                FillDictionaries();
            }
            Segment = segment;
            SupplementalSegments = new List <X12Segment>();
            //start pattern matching to generate closest Benefit
            EB01          eb01val  = eb01.Find(EB01MatchesCode);
            EB02          eb02val  = eb02.Find(EB02MatchesCode);
            EB03          eb03val  = eb03.Find(EB03MatchesCode);
            EB06          eb06val  = eb06.Find(EB06MatchesCode);
            EB09          eb09val  = eb09.Find(EB09MatchesCode);
            ProcedureCode proccode = null;

            if (ProcedureCodes.IsValidCode(Segment.Get(13, 2)))
            {
                proccode = ProcedureCodes.GetProcCode(Segment.Get(13, 2));
            }
            if (!eb01val.IsSupported ||
                (eb02val != null && !eb02val.IsSupported) ||
                (eb03val != null && !eb03val.IsSupported) ||
                (eb06val != null && !eb06val.IsSupported) ||
                (eb09val != null && !eb09val.IsSupported))
            {
                Benefitt = null;
                return;
            }
            if (eb01val.BenefitType == InsBenefitType.ActiveCoverage && Segment.Get(3) == "30")
            {
                Benefitt = null;
                return;
            }
            if (eb01val.BenefitType == InsBenefitType.ActiveCoverage && proccode != null)
            {
                //A code is covered.  Informational only.
                Benefitt = null;
                return;
            }
            if (Segment.Get(8) != "")           //if percentage
            //must have either a category or a proc code
            {
                if (proccode == null)                                                                                                       //if no proc code is specified
                {
                    if (eb03val == null || eb03val.ServiceType == EbenefitCategory.None || eb03val.ServiceType == EbenefitCategory.General) //and no category specified
                    {
                        Benefitt = null;
                        return;
                    }
                }
            }
            //coinsurance amounts are handled with fee schedules rather than benefits
            if (eb01val.BenefitType == InsBenefitType.CoPayment || eb01val.BenefitType == InsBenefitType.CoInsurance)
            {
                if (Segment.Get(7) != "")               //and a monetary amount specified
                {
                    Benefitt = null;
                    return;
                }
            }
            //a limitation without an amount is meaningless
            if (eb01val.BenefitType == InsBenefitType.Limitations &&
                segHsd == null)                 //Some benefits do not have monetary value but limit service in a time period.  Originally done for customer 27936.
            {
                if (Segment.Get(7) == "")       //no monetary amount specified
                {
                    Benefitt = null;
                    return;
                }
            }
            if (isInNetwork && (Segment.Get(12) == "N" || Segment.Get(12) == "U"))
            {
                Benefitt = null;
                return;
            }
            if (!isInNetwork && Segment.Get(12) == "Y")
            {
                Benefitt = null;
                return;
            }
            //if only a quantity is specified with no qualifier, it's meaningless
            if (Segment.Get(10) != "" && eb09val == null)
            {
                Benefitt = null;
                return;
            }
            //if only a qualifier is specified with no quantity, it's meaningless
            if (eb09val != null && Segment.Get(10) == "")
            {
                Benefitt = null;
                return;
            }
            Benefitt = new Benefit();
            //1
            Benefitt.BenefitType = eb01val.BenefitType;
            //2
            if (eb02val != null)
            {
                Benefitt.CoverageLevel = eb02val.CoverageLevel;
            }
            //3
            if (eb03val != null)
            {
                Benefitt.CovCatNum = CovCats.GetForEbenCat(eb03val.ServiceType).CovCatNum;
            }
            //4-Insurance type - we ignore.
            //5-Plan description - we ignore.
            //6
            if (eb06val != null)
            {
                Benefitt.TimePeriod = eb06val.TimePeriod;
            }
            //7
            if (Segment.Get(7) != "")
            {
                Benefitt.MonetaryAmt = PIn.Double(Segment.Get(7));              //Monetary amount. Situational
            }
            //8
            if (Segment.Get(8) != "")
            {
                if (isCoinsuranceInverted && Benefitt.BenefitType == InsBenefitType.CoInsurance) //Some carriers incorrectly send insurance percentage.
                {
                    Benefitt.Percent = (int)(PIn.Double(Segment.Get(8)) * 100);                  //Percent. Came to us inverted, do Not Invert.
                }
                else
                {
                    //OD shows the percentage paid by Insurance by default.
                    //Some carriers submit 271s to us showing percentage paid by Patient, so we need to invert this case to match OD expectations.
                    Benefitt.Percent = 100 - (int)(PIn.Double(Segment.Get(8)) * 100);              //Percent. Invert.
                }
                Benefitt.CoverageLevel = BenefitCoverageLevel.None;
            }
            //9-Quantity qualifier
            if (eb09val != null)
            {
                Benefitt.QuantityQualifier = eb09val.QuantityQualifier;
            }
            //10-Quantity
            if (Segment.Get(10) != "")
            {
                Benefitt.Quantity = (byte)PIn.Double(Segment.Get(10));              //Example: "19.0" with Quantity qualifier "S7" (age).
            }
            //11-Authorization. Ignored.
            //12-In network. Ignored.
            //13-proc
            if (proccode != null)
            {
                Benefitt.CodeNum = proccode.CodeNum;              //element 13,2
            }
            if (Benefitt.BenefitType == InsBenefitType.Limitations &&
                proccode != null &&               //Valid ADA code.
                segHsd != null)
            {
                if (segHsd.Elements.Length < 6 || segHsd.Elements[2] == "" || segHsd.Elements[5] == "")
                {
                    Benefitt = null;
                    return;
                }
                Benefitt.Quantity   = PIn.Byte(segHsd.Elements[2]);                                      //HSD02: Quantity.
                Benefitt.TimePeriod = eb06.FirstOrDefault(x => x.Code == segHsd.Elements[5]).TimePeriod; //HSD05: Frequency.
            }
        }
Esempio n. 4
0
        ///<summary>The most human-readable description possible for a single element.</summary>
        public string GetDescript(int elementPos, bool isMessageMode, bool isCoinsurancePatPays = true)
        {
            string elementCode = Segment.Get(elementPos);

            if (elementCode == "")
            {
                return("");
            }
            switch (elementPos)
            {
            case 1:
                //This is a required element, but we still won't assume it's found
                EB01 eb01val = eb01.Find(EB01MatchesCode);
                if (eb01val == null)
                {
                    return("");
                }
                if (eb01val.Code == "D" && isMessageMode)                       //D is for benefit description, which is already obvious
                {
                    return("");
                }
                return(eb01val.Descript);

            case 2:
                EB02 eb02val = eb02.Find(EB02MatchesCode);
                if (eb02val == null)
                {
                    return("");
                }
                return(eb02val.Descript);

            case 3:
                EB03 eb03val = eb03.Find(EB03MatchesCode);
                if (eb03val == null)
                {
                    return("");
                }
                return(eb03val.Descript);

            case 4:
                if (!EB04.ContainsKey(elementCode))
                {
                    return("");
                }
                return(EB04[elementCode]);

            case 5:
                return(Segment.Get(5));

            case 6:
                EB06 eb06val = eb06.Find(EB06MatchesCode);
                if (eb06val == null)
                {
                    return("");
                }
                return(eb06val.Descript);

            case 7:
                return(PIn.Double(elementCode).ToString("c"));                       //Monetary amount. Situational

            case 8:
                if (isMessageMode)                                            //delta sends 80% instead of 20% like they should
                {
                    return((PIn.Double(elementCode) * 100).ToString() + "%"); //Percent.
                }
                else
                {
                    string leadingStr = "Patient pays ";
                    if (!isCoinsurancePatPays)
                    {
                        leadingStr = "Insurance pays ";
                    }
                    return(leadingStr + (PIn.Double(elementCode) * 100).ToString() + "%");                     //Percent. Situational
                }

            case 9:                    //Quantity qualifier. Situational
                EB09 eb09val = eb09.Find(EB09MatchesCode);
                if (eb09val == null)
                {
                    return("");
                }
                return(eb09val.Descript);

            case 10:
                return(elementCode);                       //Quantity. Situational

            case 11:
                return("Authorization Required-" + elementCode); //Situational.

            case 12:                                             //Situational.
                if (elementCode == "Y")
                {
                    return("In network");
                }
                else if (elementCode == "N")
                {
                    return("Out of network");
                }
                else                          //elementCode=="U"
                {
                    return("Unknown if in network");
                }

            case 13:
                string procStr = Segment.Get(13, 2);
                if (procStr == "")
                {
                    return("");
                }
                ProcedureCode procCode = ProcedureCodes.GetProcCode(procStr);
                return(procStr + " - " + procCode.AbbrDesc);                   //ProcedureCodes.GetLaymanTerm(procCode.CodeNum);

            //Even though we don't make requests about specific procedure codes, some ins co's will send back codes.
            default:
                return("");
            }
        }
Esempio n. 5
0
        public EB271(X12Segment segment, bool isInNetwork)
        {
            if (eb01 == null)
            {
                FillDictionaries();
            }
            Segment = segment;
            SupplementalSegments = new List <X12Segment>();
            //start pattern matching to generate closest Benefit
            EB01          eb01val  = eb01.Find(EB01MatchesCode);
            EB02          eb02val  = eb02.Find(EB02MatchesCode);
            EB03          eb03val  = eb03.Find(EB03MatchesCode);
            EB06          eb06val  = eb06.Find(EB06MatchesCode);
            EB09          eb09val  = eb09.Find(EB09MatchesCode);
            ProcedureCode proccode = null;

            if (ProcedureCodes.IsValidCode(Segment.Get(13, 2)))
            {
                proccode = ProcedureCodes.GetProcCode(Segment.Get(13, 2));
            }
            if (!eb01val.IsSupported ||
                (eb02val != null && !eb02val.IsSupported) ||
                (eb03val != null && !eb03val.IsSupported) ||
                (eb06val != null && !eb06val.IsSupported) ||
                (eb09val != null && !eb09val.IsSupported))
            {
                Benefitt = null;
                return;
            }
            if (eb01val.BenefitType == InsBenefitType.ActiveCoverage && Segment.Get(3) == "30")
            {
                Benefitt = null;
                return;
            }
            if (eb01val.BenefitType == InsBenefitType.ActiveCoverage && proccode != null)
            {
                //A code is covered.  Informational only.
                Benefitt = null;
                return;
            }
            if (Segment.Get(8) != "")           //if percentage
            //must have either a category or a proc code
            {
                if (proccode == null)                                                                                                       //if no proc code is specified
                {
                    if (eb03val == null || eb03val.ServiceType == EbenefitCategory.None || eb03val.ServiceType == EbenefitCategory.General) //and no category specified
                    {
                        Benefitt = null;
                        return;
                    }
                }
            }
            //coinsurance amounts are handled with fee schedules rather than benefits
            if (eb01val.BenefitType == InsBenefitType.CoPayment || eb01val.BenefitType == InsBenefitType.CoInsurance)
            {
                if (Segment.Get(7) != "")               //and a monetary amount specified
                {
                    Benefitt = null;
                    return;
                }
            }
            //a limitation without an amount is meaningless
            if (eb01val.BenefitType == InsBenefitType.Limitations)
            {
                if (Segment.Get(7) == "")               //no monetary amount specified
                {
                    Benefitt = null;
                    return;
                }
            }
            if (isInNetwork && Segment.Get(12) == "N")
            {
                Benefitt = null;
                return;
            }
            if (!isInNetwork && Segment.Get(12) == "Y")
            {
                Benefitt = null;
                return;
            }
            //if only a quantity is specified with no qualifier, it's meaningless
            if (Segment.Get(10) != "" && eb09val == null)
            {
                Benefitt = null;
                return;
            }
            //if only a qualifier is specified with no quantity, it's meaningless
            if (eb09val != null && Segment.Get(10) == "")
            {
                Benefitt = null;
                return;
            }
            Benefitt = new Benefit();
            //1
            Benefitt.BenefitType = eb01val.BenefitType;
            //2
            if (eb02val != null)
            {
                Benefitt.CoverageLevel = eb02val.CoverageLevel;
            }
            //3
            if (eb03val != null)
            {
                Benefitt.CovCatNum = CovCats.GetForEbenCat(eb03val.ServiceType).CovCatNum;
            }
            //4-Insurance type - we ignore.
            //5-Plan description - we ignore.
            //6
            if (eb06val != null)
            {
                Benefitt.TimePeriod = eb06val.TimePeriod;
            }
            //7
            if (Segment.Get(7) != "")
            {
                Benefitt.MonetaryAmt = PIn.Double(Segment.Get(7));              //Monetary amount. Situational
            }
            //8
            if (Segment.Get(8) != "")
            {
                Benefitt.Percent       = 100 - (int)(PIn.Double(Segment.Get(8)) * 100);    //Percent. Situational
                Benefitt.CoverageLevel = BenefitCoverageLevel.None;
            }
            //9-Quantity qualifier
            if (eb09val != null)
            {
                Benefitt.QuantityQualifier = eb09val.QuantityQualifier;
            }
            //10-Quantity
            if (Segment.Get(10) != "")
            {
                Benefitt.Quantity = (byte)PIn.Double(Segment.Get(10));              //Example: "19.0" with Quantity qualifier "S7" (age).
            }
            //11-Authorization. Ignored.
            //12-In network. Ignored.
            //13-proc
            if (proccode != null)
            {
                Benefitt.CodeNum = proccode.CodeNum;              //element 13,2
            }
        }