private Claim CreateClaim(string claimType, List <PatPlan> patPlanList, List <InsPlan> planList, List <ClaimProc> claimProcList, Procedure proc, List <InsSub> subList)
{
long claimFormNum = 0;
InsPlan planCur = new InsPlan();
InsSub subCur = new InsSub();
Relat relatOther = Relat.Self;
long clinicNum = proc.ClinicNum;
PlaceOfService placeService = proc.PlaceService;
switch (claimType)
{
case "P":
subCur = InsSubs.GetSub(PatPlans.GetInsSubNum(patPlanList, PatPlans.GetOrdinal(PriSecMed.Primary, patPlanList, planList, subList)), subList);
planCur = InsPlans.GetPlan(subCur.PlanNum, planList);
break;
case "S":
subCur = InsSubs.GetSub(PatPlans.GetInsSubNum(patPlanList, PatPlans.GetOrdinal(PriSecMed.Secondary, patPlanList, planList, subList)), subList);
planCur = InsPlans.GetPlan(subCur.PlanNum, planList);
break;
case "Med":
//It's already been verified that a med plan exists
subCur = InsSubs.GetSub(PatPlans.GetInsSubNum(patPlanList, PatPlans.GetOrdinal(PriSecMed.Medical, patPlanList, planList, subList)), subList);
planCur = InsPlans.GetPlan(subCur.PlanNum, planList);
break;
}
ClaimProc claimProcCur = Procedures.GetClaimProcEstimate(proc.ProcNum, claimProcList, planCur, subCur.InsSubNum);
if (claimProcCur == null)
{
claimProcCur = new ClaimProc();
ClaimProcs.CreateEst(claimProcCur, proc, planCur, subCur);
}
Claim claimCur = new Claim();
claimCur.PatNum = proc.PatNum;
claimCur.DateService = proc.ProcDate;
claimCur.ClinicNum = proc.ClinicNum;
claimCur.PlaceService = proc.PlaceService;
claimCur.ClaimStatus = "W";
claimCur.DateSent = DateTimeOD.Today;
claimCur.PlanNum = planCur.PlanNum;
claimCur.InsSubNum = subCur.InsSubNum;
InsSub sub;
switch (claimType)
{
case "P":
claimCur.PatRelat = PatPlans.GetRelat(patPlanList, PatPlans.GetOrdinal(PriSecMed.Primary, patPlanList, planList, subList));
claimCur.ClaimType = "P";
claimCur.InsSubNum2 = PatPlans.GetInsSubNum(patPlanList, PatPlans.GetOrdinal(PriSecMed.Secondary, patPlanList, planList, subList));
sub = InsSubs.GetSub(claimCur.InsSubNum2, subList);
if (sub.PlanNum > 0 && InsPlans.RefreshOne(sub.PlanNum).IsMedical)
{
claimCur.PlanNum2 = 0; //no sec ins
claimCur.PatRelat2 = Relat.Self;
}
else
{
claimCur.PlanNum2 = sub.PlanNum; //might be 0 if no sec ins
claimCur.PatRelat2 = PatPlans.GetRelat(patPlanList, PatPlans.GetOrdinal(PriSecMed.Secondary, patPlanList, planList, subList));
}
break;
case "S":
claimCur.PatRelat = PatPlans.GetRelat(patPlanList, PatPlans.GetOrdinal(PriSecMed.Secondary, patPlanList, planList, subList));
claimCur.ClaimType = "S";
claimCur.InsSubNum2 = PatPlans.GetInsSubNum(patPlanList, PatPlans.GetOrdinal(PriSecMed.Primary, patPlanList, planList, subList));
sub = InsSubs.GetSub(claimCur.InsSubNum2, subList);
claimCur.PlanNum2 = sub.PlanNum;
claimCur.PatRelat2 = PatPlans.GetRelat(patPlanList, PatPlans.GetOrdinal(PriSecMed.Primary, patPlanList, planList, subList));
break;
case "Med":
claimCur.PatRelat = PatPlans.GetFromList(patPlanList, subCur.InsSubNum).Relationship;
claimCur.ClaimType = "Other";
if (PrefC.GetBool(PrefName.ClaimMedTypeIsInstWhenInsPlanIsMedical))
{
claimCur.MedType = EnumClaimMedType.Institutional;
}
else
{
claimCur.MedType = EnumClaimMedType.Medical;
}
break;
case "Other":
claimCur.PatRelat = relatOther;
claimCur.ClaimType = "Other";
//plannum2 is not automatically filled in.
claimCur.ClaimForm = claimFormNum;
if (planCur.IsMedical)
{
if (PrefC.GetBool(PrefName.ClaimMedTypeIsInstWhenInsPlanIsMedical))
{
claimCur.MedType = EnumClaimMedType.Institutional;
}
else
{
claimCur.MedType = EnumClaimMedType.Medical;
}
}
break;
}
if (planCur.PlanType == "c") //if capitation
{
claimCur.ClaimType = "Cap";
}
claimCur.ProvTreat = proc.ProvNum;
if (Providers.GetIsSec(proc.ProvNum))
{
claimCur.ProvTreat = Patients.GetPat(proc.PatNum).PriProv;
//OK if zero, because auto select first in list when open claim
}
claimCur.IsProsthesis = "N";
claimCur.ProvBill = Providers.GetBillingProvNum(claimCur.ProvTreat, claimCur.ClinicNum); //OK if zero, because it will get fixed in claim
claimCur.EmployRelated = YN.No;
claimCur.ClaimForm = planCur.ClaimFormNum;
Claims.Insert(claimCur);
//attach procedure
claimProcCur.ClaimNum = claimCur.ClaimNum;
if (planCur.PlanType == "c") //if capitation
{
claimProcCur.Status = ClaimProcStatus.CapClaim;
}
else
{
claimProcCur.Status = ClaimProcStatus.NotReceived;
}
if (planCur.UseAltCode && (ProcedureCodes.GetProcCode(proc.CodeNum).AlternateCode1 != ""))
{
claimProcCur.CodeSent = ProcedureCodes.GetProcCode(proc.CodeNum).AlternateCode1;
}
else if (planCur.IsMedical && proc.MedicalCode != "")
{
claimProcCur.CodeSent = proc.MedicalCode;
}
else
{
claimProcCur.CodeSent = ProcedureCodes.GetProcCode(proc.CodeNum).ProcCode;
if (claimProcCur.CodeSent.Length > 5 && claimProcCur.CodeSent.Substring(0, 1) == "D")
{
claimProcCur.CodeSent = claimProcCur.CodeSent.Substring(0, 5);
}
if (CultureInfo.CurrentCulture.Name.EndsWith("CA")) //Canadian. en-CA or fr-CA
{
if (claimProcCur.CodeSent.Length > 5) //In Canadian e-claims, codes can contain letters or numbers and cannot be longer than 5 characters.
{
claimProcCur.CodeSent = claimProcCur.CodeSent.Substring(0, 5);
}
}
}
claimProcCur.LineNumber = (byte)1;
ClaimProcs.Update(claimProcCur);
return(claimCur);
}
