private static Claim CreatePredetermination(Patient pat, List <Procedure> procList, long provTreat) { Family fam = Patients.GetFamily(pat.PatNum); List <InsSub> subList = InsSubs.RefreshForFam(fam); List <InsPlan> planList = InsPlans.RefreshForSubList(subList); List <PatPlan> patPlanList = PatPlans.Refresh(pat.PatNum); List <Benefit> benefitList = Benefits.Refresh(patPlanList, subList); List <ClaimProc> claimProcList = ClaimProcs.Refresh(pat.PatNum); List <Procedure> procsForPat = Procedures.Refresh(pat.PatNum); InsSub sub = InsSubs.GetSub(PatPlans.GetInsSubNum(patPlanList, 1), subList); InsPlan insPlan = InsPlans.GetPlan(sub.PlanNum, planList); Claim claim = new Claim(); Claims.Insert(claim); //to retreive a key for new Claim.ClaimNum claim.PatNum = pat.PatNum; claim.DateService = procList[0].ProcDate; claim.DateSent = DateTime.Today; claim.ClaimStatus = "W"; claim.InsSubNum = PatPlans.GetInsSubNum(patPlanList, 1); claim.InsSubNum2 = PatPlans.GetInsSubNum(patPlanList, 2); InsSub sub1 = InsSubs.GetSub(claim.InsSubNum, subList); InsSub sub2 = InsSubs.GetSub(claim.InsSubNum, subList); claim.PlanNum = sub1.PlanNum; claim.PlanNum2 = sub2.PlanNum; claim.PatRelat = PatPlans.GetRelat(patPlanList, 1); claim.PatRelat2 = PatPlans.GetRelat(patPlanList, 2); claim.ClaimType = "PreAuth"; claim.ProvTreat = provTreat; claim.IsProsthesis = "N"; claim.ProvBill = Providers.GetBillingProvNum(claim.ProvTreat, 0); claim.EmployRelated = YN.No; ClaimProc cp; List <Procedure> procListClaim = new List <Procedure>(); //this list will exclude lab fees for (int i = 0; i < procList.Count; i++) { if (procList[i].ProcNumLab == 0) { procListClaim.Add(procList[i]); } } for (int i = 0; i < procListClaim.Count; i++) { cp = new ClaimProc(); ClaimProcs.CreateEst(cp, procListClaim[i], insPlan, sub); cp.ClaimNum = claim.ClaimNum; cp.Status = ClaimProcStatus.NotReceived; cp.CodeSent = ProcedureCodes.GetProcCode(procListClaim[i].CodeNum).ProcCode; cp.LineNumber = (byte)(i + 1); ClaimProcs.Update(cp); } claimProcList = ClaimProcs.Refresh(pat.PatNum); ClaimL.CalculateAndUpdate(procsForPat, planList, claim, patPlanList, benefitList, pat.Age, subList); return(claim); }
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 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 Claims_CalculateAndUpdate_PreauthOrderWriteoff() { string suffix = MethodBase.GetCurrentMethod().Name; //create the patient and insurance information Patient pat = PatientT.CreatePatient(suffix); //proc - Crown Procedure proc = ProcedureT.CreateProcedure(pat, "D2750", ProcStat.C, "8", 1000); long feeSchedNum1 = FeeSchedT.CreateFeeSched(FeeScheduleType.Normal, suffix); FeeT.CreateFee(feeSchedNum1, proc.CodeNum, 900); Carrier carrier = CarrierT.CreateCarrier(suffix); InsPlan insPlan = InsPlanT.CreateInsPlanPPO(carrier.CarrierNum, feeSchedNum1); BenefitT.CreateAnnualMax(insPlan.PlanNum, 1000); BenefitT.CreateCategoryPercent(insPlan.PlanNum, EbenefitCategory.Crowns, 100); InsSub sub = InsSubT.CreateInsSub(pat.PatNum, insPlan.PlanNum); PatPlan pp = PatPlanT.CreatePatPlan(1, pat.PatNum, sub.InsSubNum); //create lists and variables required for ComputeEstimates() List <InsSub> SubList = InsSubs.RefreshForFam(Patients.GetFamily(pat.PatNum)); List <InsPlan> listInsPlan = InsPlans.RefreshForSubList(SubList); List <PatPlan> listPatPlan = PatPlans.Refresh(pat.PatNum); List <Benefit> listBenefits = Benefits.Refresh(listPatPlan, SubList); List <Procedure> listProcsForPat = Procedures.Refresh(pat.PatNum); List <Procedure> procsForClaim = new List <Procedure>(); procsForClaim.Add(proc); //Create the claim and associated claimprocs //The order of these claimprocs is the whole point of the unit test. //Create Preauth ClaimProcs.CreateEst(new ClaimProc(), proc, insPlan, sub, 0, 500, true, true); //Create Estimate ClaimProcs.CreateEst(new ClaimProc(), proc, insPlan, sub, 1000, 1000, true, false); List <ClaimProc> listClaimProcs = ClaimProcs.Refresh(pat.PatNum); Claim claimWaiting = ClaimT.CreateClaim("W", listPatPlan, listInsPlan, listClaimProcs, listProcsForPat, pat, procsForClaim, listBenefits, SubList, false); Assert.AreEqual(100, claimWaiting.WriteOff, "WriteOff Amount"); }
/// <summary>claimType="P","S","PreAuth","W" (waiting to send).</summary> public static Claim CreateClaim(string claimType, List <PatPlan> PatPlanList, List <InsPlan> InsPlanList, List <ClaimProc> ClaimProcList, List <Procedure> procsForPat, Patient pat, List <Procedure> procsForClaim, List <Benefit> benefitList, List <InsSub> SubList, bool calculateLineNumber = true) { //Claim ClaimCur=CreateClaim("P",PatPlanList,InsPlanList,ClaimProcList,procsForPat); InsPlan PlanCur1 = new InsPlan(); InsSub SubCur1 = new InsSub(); InsPlan PlanCur2 = new InsPlan(); InsSub SubCur2 = new InsSub(); switch (claimType) { case "P": SubCur1 = InsSubs.GetSub(PatPlans.GetInsSubNum(PatPlanList, 1), SubList); PlanCur1 = InsPlans.GetPlan(SubCur1.PlanNum, InsPlanList); SubCur2 = InsSubs.GetSub(PatPlans.GetInsSubNum(PatPlanList, 2), SubList); //PlanCur2=InsPlans.GetPlan(SubCur.PlanNum,InsPlanList);//can end up null break; case "S": SubCur1 = InsSubs.GetSub(PatPlans.GetInsSubNum(PatPlanList, 2), SubList); PlanCur1 = InsPlans.GetPlan(SubCur1.PlanNum, InsPlanList); SubCur2 = InsSubs.GetSub(PatPlans.GetInsSubNum(PatPlanList, 1), SubList); //PlanCur2=InsPlans.GetPlan(SubCur.PlanNum,InsPlanList);//can end up null break; case "PreAuth": SubCur1 = InsSubs.GetSub(PatPlans.GetInsSubNum(PatPlanList, 1), SubList); PlanCur1 = InsPlans.GetPlan(SubCur1.PlanNum, InsPlanList); SubCur2 = InsSubs.GetSub(PatPlans.GetInsSubNum(PatPlanList, 2), SubList); break; case "W": SubCur1 = InsSubs.GetSub(PatPlans.GetInsSubNum(PatPlanList, 1), SubList); PlanCur1 = InsPlans.GetPlan(SubCur1.PlanNum, InsPlanList); SubCur2 = InsSubs.GetSub(PatPlans.GetInsSubNum(PatPlanList, 2), SubList); break; case "Med": SubCur1 = InsSubs.GetSub(PatPlans.GetInsSubNum(PatPlanList, PatPlans.GetOrdinal(PriSecMed.Medical, PatPlanList, InsPlanList, SubList)), SubList); PlanCur1 = InsPlans.GetPlan(SubCur1.PlanNum, InsPlanList); SubCur2 = InsSubs.GetSub(PatPlans.GetInsSubNum(PatPlanList, PatPlans.GetOrdinal(PriSecMed.Primary, PatPlanList, InsPlanList, SubList)), SubList); break; } //DataTable table=DataSetMain.Tables["account"]; Procedure proc; //proc=Procedures.GetProcFromList(procsForPat,PIn.Long(table.Rows[gridAccount.SelectedIndices[0]]["ProcNum"].ToString())); //long clinicNum=proc.ClinicNum; ClaimProc[] claimProcs = new ClaimProc[procsForClaim.Count]; //1:1 with procs long procNum; for (int i = 0; i < procsForClaim.Count; i++) //loop through selected procs //and try to find an estimate that can be used { procNum = procsForClaim[i].ProcNum; claimProcs[i] = Procedures.GetClaimProcEstimate(procNum, ClaimProcList, PlanCur1, SubCur1.InsSubNum); } for (int i = 0; i < claimProcs.Length; i++) //loop through each claimProc //and create any missing estimates. This handles claims to 3rd and 4th ins co's. { if (claimProcs[i] == null) { claimProcs[i] = new ClaimProc(); proc = procsForClaim[i]; ClaimProcs.CreateEst(claimProcs[i], proc, PlanCur1, SubCur1); } } Claim claim = new Claim(); Claims.Insert(claim); //to retreive a key for new Claim.ClaimNum claim.PatNum = pat.PatNum; claim.DateService = claimProcs[claimProcs.Length - 1].ProcDate; claim.ClinicNum = procsForClaim[0].ClinicNum; claim.DateSent = DateTime.Today; claim.DateSentOrig = claim.DateSent; claim.ClaimStatus = "S"; claim.AttachedFlags = "Mail"; //datereceived switch (claimType) { case "P": claim.PlanNum = SubCur1.PlanNum; claim.InsSubNum = PatPlans.GetInsSubNum(PatPlanList, 1); claim.PatRelat = PatPlans.GetRelat(PatPlanList, 1); claim.ClaimType = "P"; claim.PlanNum2 = SubCur2.PlanNum; //might be 0 if no sec ins claim.InsSubNum2 = PatPlans.GetInsSubNum(PatPlanList, 2); claim.PatRelat2 = PatPlans.GetRelat(PatPlanList, 2); break; case "S": claim.PlanNum = SubCur1.PlanNum; claim.InsSubNum = PatPlans.GetInsSubNum(PatPlanList, 2); claim.PatRelat = PatPlans.GetRelat(PatPlanList, 2); claim.ClaimType = "S"; claim.PlanNum2 = SubCur2.PlanNum; claim.InsSubNum2 = PatPlans.GetInsSubNum(PatPlanList, 1); claim.PatRelat2 = PatPlans.GetRelat(PatPlanList, 1); break; case "W": claim.PlanNum = SubCur1.PlanNum; claim.InsSubNum = PatPlans.GetInsSubNum(PatPlanList, 2); claim.PatRelat = PatPlans.GetRelat(PatPlanList, 2); claim.ClaimType = "P"; claim.ClaimStatus = "W"; claim.PlanNum2 = SubCur2.PlanNum; claim.InsSubNum2 = PatPlans.GetInsSubNum(PatPlanList, 1); claim.PatRelat2 = PatPlans.GetRelat(PatPlanList, 1); break; case "Med": claim.PlanNum = SubCur1.PlanNum; claim.InsSubNum = PatPlans.GetInsSubNum(PatPlanList, 1); claim.PatRelat = PatPlans.GetRelat(PatPlanList, 1); claim.ClaimType = "Other"; claim.PlanNum2 = SubCur2.PlanNum; //might be 0 if no other ins claim.InsSubNum2 = PatPlans.GetInsSubNum(PatPlanList, 2); claim.PatRelat2 = PatPlans.GetRelat(PatPlanList, 2); break; } claim.ProvTreat = procsForClaim[0].ProvNum; claim.IsProsthesis = "I"; claim.ProvBill = Providers.GetBillingProvNum(claim.ProvTreat, claim.ClinicNum); claim.EmployRelated = YN.No; //attach procedures Procedure ProcCur; for (int i = 0; i < claimProcs.Length; i++) { ProcCur = procsForClaim[i]; claimProcs[i].ClaimNum = claim.ClaimNum; claimProcs[i].Status = ClaimProcStatus.NotReceived; //status for claims unsent or sent. //writeoff handled in ClaimL.CalculateAndUpdate() claimProcs[i].CodeSent = ProcedureCodes.GetProcCode(ProcCur.CodeNum).ProcCode; if (claimProcs[i].CodeSent.Length > 5 && claimProcs[i].CodeSent.Substring(0, 1) == "D") { claimProcs[i].CodeSent = claimProcs[i].CodeSent.Substring(0, 5); } if (calculateLineNumber) { claimProcs[i].LineNumber = (byte)(i + 1); } ClaimProcs.Update(claimProcs[i]); } ClaimProcList = ClaimProcs.Refresh(pat.PatNum); Claims.CalculateAndUpdate(procsForPat, InsPlanList, claim, PatPlanList, benefitList, pat.Age, SubList); return(claim); }