public void InsPlans_GetAllowed_NoFeeSched()
{
Carrier carrier = CarrierT.CreateCarrier(MethodBase.GetCurrentMethod().Name);
InsPlan plan = new InsPlan();
plan.CarrierNum = carrier.CarrierNum;
plan.PlanType = "";
plan.CobRule = EnumCobRule.Basic;
plan.PlanNum = InsPlans.Insert(plan);
ProcedureCode procCode = _listProcCodes[13];
procCode.SubstitutionCode = _listProcCodes[14].ProcCode;
ProcedureCodes.Update(procCode);
ProcedureCodes.RefreshCache();
Provider prov = Providers.GetProv(PrefC.GetLong(PrefName.PracticeDefaultProv));
long provFeeSched = FeeSchedT.CreateFeeSched(FeeScheduleType.Normal, MethodBase.GetCurrentMethod().Name);
prov.FeeSched = provFeeSched;
Providers.Update(prov);
Providers.RefreshCache();
Fee defaultFee = FeeT.GetNewFee(Providers.GetProv(PrefC.GetLong(PrefName.PracticeDefaultProv)).FeeSched,
ProcedureCodes.GetSubstituteCodeNum(procCode.ProcCode, "", plan.PlanNum), 80);
double amt = InsPlans.GetAllowed(procCode.ProcCode, plan.FeeSched, plan.AllowedFeeSched, plan.CodeSubstNone, plan.PlanType, "", 0, 0, plan.PlanNum);
Assert.AreEqual(defaultFee.Amount, amt);
}
///<summary>Creates a procedure and returns its procedure fee.</summary>
private double GetProcFee(string suffix, bool doUseMedicalCode)
{
Prefs.UpdateBool(PrefName.InsPpoAlwaysUseUcrFee, true);
Prefs.UpdateBool(PrefName.MedicalFeeUsedForNewProcs, doUseMedicalCode);
Patient pat = PatientT.CreatePatient(suffix);
long ucrFeeSchedNum = FeeSchedT.CreateFeeSched(FeeScheduleType.Normal, "UCR " + suffix);
FeeSchedT.UpdateUCRFeeSched(pat, ucrFeeSchedNum);
long ppoFeeSchedNum = FeeSchedT.CreateFeeSched(FeeScheduleType.Normal, "PPO " + suffix);
InsuranceT.AddInsurance(pat, suffix, "p", ppoFeeSchedNum, 1, true);
List <InsSub> listSubs = InsSubT.GetInsSubs(pat);
List <InsPlan> listPlans = InsPlans.RefreshForSubList(listSubs);
List <PatPlan> listPatPlans = PatPlans.Refresh(pat.PatNum);
string procStr = "D0150";
string procStrMed = "D0120";
ProcedureCode procCode = ProcedureCodes.GetProcCode(procStr);
ProcedureCode procCodeMed = ProcedureCodes.GetProcCode(procStrMed);
procCode.MedicalCode = procCodeMed.ProcCode;
FeeT.CreateFee(ucrFeeSchedNum, procCode.CodeNum, 300);
FeeT.CreateFee(ppoFeeSchedNum, procCode.CodeNum, 120);
FeeT.CreateFee(ucrFeeSchedNum, procCodeMed.CodeNum, 175);
FeeT.CreateFee(ppoFeeSchedNum, procCodeMed.CodeNum, 85);
Procedure proc = ProcedureT.CreateProcedure(pat, procStr, ProcStat.TP, "", 300);
return(Procedures.GetProcFee(pat, listPatPlans, listSubs, listPlans, procCode.CodeNum, proc.ProvNum, proc.ClinicNum, procCode.MedicalCode));
}
///<summary>Creates a procedure and computes estimates for a patient where the secondary insurance has a COB rule of Medicaid.</summary>
private void ComputeEstimatesMedicaidCOB(string suffix, double procFee, double priAllowed, double secAllowed, int priPercentCovered,
int secPercentCovered, Action <ClaimProc /*Primary*/, ClaimProc /*Secondary*/, Procedure> assertAct)
{
Patient pat = PatientT.CreatePatient(suffix);
long ppoFeeSchedNum = FeeSchedT.CreateFeeSched(FeeScheduleType.Normal, "PPO " + suffix);
InsuranceT.AddInsurance(pat, suffix, "p", ppoFeeSchedNum);
long medicaidFeeSchedNum = FeeSchedT.CreateFeeSched(FeeScheduleType.Normal, "PPO " + suffix);
InsuranceT.AddInsurance(pat, suffix, "p", medicaidFeeSchedNum, 2, cobRule: EnumCobRule.SecondaryMedicaid);
List <InsSub> listSubs = InsSubT.GetInsSubs(pat);
List <InsPlan> listPlans = InsPlans.RefreshForSubList(listSubs);
List <PatPlan> listPatPlans = PatPlans.Refresh(pat.PatNum);
InsPlan priPlan = InsPlanT.GetPlanForPriSecMed(PriSecMed.Primary, listPatPlans, listPlans, listSubs);
BenefitT.CreateCategoryPercent(priPlan.PlanNum, EbenefitCategory.Diagnostic, priPercentCovered);
InsPlan secPlan = InsPlanT.GetPlanForPriSecMed(PriSecMed.Secondary, listPatPlans, listPlans, listSubs);
BenefitT.CreateCategoryPercent(secPlan.PlanNum, EbenefitCategory.Diagnostic, secPercentCovered);
List <Benefit> listBens = Benefits.Refresh(listPatPlans, listSubs);
string procStr = "D0150";
Procedure proc = ProcedureT.CreateProcedure(pat, procStr, ProcStat.TP, "", procFee);
ProcedureCode procCode = ProcedureCodes.GetProcCode(procStr);
FeeT.CreateFee(ppoFeeSchedNum, procCode.CodeNum, priAllowed);
FeeT.CreateFee(medicaidFeeSchedNum, procCode.CodeNum, secAllowed);
Procedures.ComputeEstimates(proc, pat.PatNum, new List <ClaimProc>(), false, listPlans, listPatPlans, listBens, pat.Age, listSubs);
List <ClaimProc> listClaimProcs = ClaimProcs.Refresh(pat.PatNum);
assertAct(listClaimProcs.FirstOrDefault(x => x.PlanNum == priPlan.PlanNum), listClaimProcs.FirstOrDefault(x => x.PlanNum == secPlan.PlanNum), proc);
}
public void FeeSchedTools_GlobalUpdateFees()
{
PrefT.UpdateBool(PrefName.MedicalFeeUsedForNewProcs, false);
string suffix = MethodBase.GetCurrentMethod().Name;
string procStr = "D0120";
string procStr2 = "D0145";
double procFee = 100;
ProcedureCode procCode = ProcedureCodes.GetProcCode(procStr);
ProcedureCode procCode2 = ProcedureCodes.GetProcCode(procStr2);
//Set up clinic, prov, pat
Clinic clinic = ClinicT.CreateClinic(suffix);
long feeSchedNum = FeeSchedT.CreateFeeSched(FeeScheduleType.Normal, suffix, false);
long provNum = ProviderT.CreateProvider(suffix, feeSchedNum: feeSchedNum);
Fee fee = FeeT.GetNewFee(feeSchedNum, procCode.CodeNum, procFee, clinic.ClinicNum, provNum);
Fee fee2 = FeeT.GetNewFee(feeSchedNum, procCode2.CodeNum, procFee, clinic.ClinicNum, provNum);
Patient pat = PatientT.CreatePatient(suffix, provNum, clinic.ClinicNum);
//Chart a procedure for this proccode/pat as well as a different proccode
Procedure proc = ProcedureT.CreateProcedure(pat, procStr, ProcStat.TP, "", fee.Amount);
Procedure proc2 = ProcedureT.CreateProcedure(pat, procStr2, ProcStat.TP, "", fee2.Amount);
//Update the fee amount for only the D0120 code
fee.Amount = 50;
Fees.Update(fee);
//Now run global update fees
Procedures.GlobalUpdateFees(Fees.GetByClinicNum(clinic.ClinicNum), clinic.ClinicNum, clinic.Abbr);
//Make sure we have the same number of updated fees, and fee amounts for both procs
proc = Procedures.GetOneProc(proc.ProcNum, false);
proc2 = Procedures.GetOneProc(proc2.ProcNum, false);
Assert.AreEqual(fee.Amount, proc.ProcFee);
Assert.AreEqual(fee2.Amount, proc2.ProcFee);
}
public void FeeSchedTools_GlobalUpdateWriteoffEstimates_SubscriberInDifferentFamily()
{
string suffix = MethodBase.GetCurrentMethod().Name;
string procStr = "D0145";
double procFee = 100;
ProcedureCode procCode = ProcedureCodes.GetProcCode(procStr);
//Set up clinic, prov, pat
Clinic clinic = ClinicT.CreateClinic(suffix);
long feeSchedNum = FeeSchedT.CreateFeeSched(FeeScheduleType.Normal, suffix);
long provNum = ProviderT.CreateProvider(suffix, feeSchedNum: feeSchedNum);
Fee fee = FeeT.GetNewFee(feeSchedNum, procCode.CodeNum, procFee, clinic.ClinicNum, provNum);
Patient pat = PatientT.CreatePatient(suffix, provNum, clinic.ClinicNum);
Patient patSubscriber = PatientT.CreatePatient(suffix + "_Subscriber", provNum, clinic.ClinicNum);
//Set up insurance
InsuranceInfo info = InsuranceT.AddInsurance(pat, suffix, "p", feeSchedNum);
info.PriInsSub.Subscriber = patSubscriber.PatNum;
InsSubs.Update(info.PriInsSub);
info.ListBenefits.Add(BenefitT.CreatePercentForProc(info.PriInsPlan.PlanNum, procCode.CodeNum, 100));
//Create the procedure and claimproc
Procedure proc = ProcedureT.CreateProcedure(pat, procStr, ProcStat.TP, "", procFee);
ClaimProc priClaimProc = ClaimProcT.CreateClaimProc(pat.PatNum, proc.ProcNum, info.PriInsPlan.PlanNum, info.PriInsSub.InsSubNum, DateTime.Today,
-1, -1, -1, ClaimProcStatus.CapEstimate);
Procedures.ComputeEstimates(proc, pat.PatNum, new List <ClaimProc>(), true, info.ListInsPlans, info.ListPatPlans, info.ListBenefits, pat.Age,
info.ListInsSubs);
priClaimProc = ClaimProcs.Refresh(pat.PatNum).FirstOrDefault(x => x.ProcNum == proc.ProcNum);
Assert.AreEqual(procFee, priClaimProc.InsPayEst);
GlobalUpdateWriteoffs(clinic.ClinicNum);
priClaimProc = ClaimProcs.Refresh(pat.PatNum).FirstOrDefault(x => x.ClaimProcNum == priClaimProc.ClaimProcNum);
Assert.AreEqual(procFee, priClaimProc.InsPayEst);
}
public void FeeSchedTools_CopyFeeSched_Concurrency()
{
//Make sure there are no duplicate fees already present within the database.
string dbmResult = DatabaseMaintenances.FeeDeleteDuplicates(true, DbmMode.Check);
if (dbmResult.Trim() != _feeDeleteDuplicatesExpectedResult)
{
DatabaseMaintenances.FeeDeleteDuplicates(true, DbmMode.Fix);
}
//Create two fee schedules; from and to
FeeSched feeSchedFrom = FeeSchedT.GetNewFeeSched(FeeScheduleType.Normal, MethodBase.GetCurrentMethod().Name + "_FROM");
FeeSched feeSchedTo = FeeSchedT.GetNewFeeSched(FeeScheduleType.Normal, MethodBase.GetCurrentMethod().Name + "_TO");
//Create a single fee and associate it to the "from" fee schedule.
FeeT.CreateFee(feeSchedFrom.FeeSchedNum, _listProcCodes[_rand.Next(_listProcCodes.Count - 1)].CodeNum, _defaultFeeAmt);
//Create a helper action that will simply copy the "from" schedule into the "to" schedule for the given fee cache passed in.
Action actionCopyFromTo = new Action(() => {
FeeScheds.CopyFeeSchedule(feeSchedFrom, 0, 0, feeSchedTo, null, 0);
});
//Mimic each user clicking the "Copy" button from within the Fee Tools window one right after the other (before they click OK).
actionCopyFromTo();
actionCopyFromTo();
//Make sure that there was NOT a duplicate fee inserted into the database.
dbmResult = DatabaseMaintenances.FeeDeleteDuplicates(true, DbmMode.Check);
Assert.AreEqual(dbmResult.Trim(), _feeDeleteDuplicatesExpectedResult, "Duplicate fees detected due to concurrent copying.");
}
public void InsPlan_PpoNoSubWriteoffsNoSub()
{
string suffix = MethodBase.GetCurrentMethod().Name;
Patient pat = PatientT.CreatePatient(suffix);
long ucrFeeSchedNum = FeeSchedT.CreateFeeSched(FeeScheduleType.Normal, "UCR Fees" + suffix);
long ppoFeeSchedNum = FeeSchedT.CreateFeeSched(FeeScheduleType.Normal, "PPO " + suffix);
InsuranceInfo ins = InsuranceT.AddInsurance(pat, suffix, planType: "p", feeSchedNum: ppoFeeSchedNum);
ins.PriInsPlan.HasPpoSubstWriteoffs = false;
InsPlans.Update(ins.PriInsPlan);
BenefitT.CreateCategoryPercent(ins.PriInsPlan.PlanNum, EbenefitCategory.Restorative, 50);
ProcedureCode originalProcCode = ProcedureCodes.GetProcCode("D2330");
ProcedureCode downgradeProcCode = ProcedureCodes.GetProcCode("D2140");
originalProcCode.SubstitutionCode = ""; //NOT substituting
originalProcCode.SubstOnlyIf = SubstitutionCondition.Always;
ProcedureCodeT.Update(originalProcCode);
FeeT.CreateFee(ucrFeeSchedNum, originalProcCode.CodeNum, 100);
FeeT.CreateFee(ucrFeeSchedNum, downgradeProcCode.CodeNum, 80);
FeeT.CreateFee(ppoFeeSchedNum, originalProcCode.CodeNum, 60);
FeeT.CreateFee(ppoFeeSchedNum, downgradeProcCode.CodeNum, 50);
Procedure proc = ProcedureT.CreateProcedure(pat, "D2330", ProcStat.C, "9", 100);//Tooth 9
List <ClaimProc> listClaimProcs = ClaimProcs.Refresh(pat.PatNum);
List <Procedure> listProcs = Procedures.Refresh(pat.PatNum);
ins.RefreshBenefits();
Claim claim = ClaimT.CreateClaim("P", ins.ListPatPlans, ins.ListInsPlans, listClaimProcs, listProcs, pat, listProcs, ins.ListBenefits, ins.ListInsSubs);
ClaimProc clProc = ClaimProcs.Refresh(pat.PatNum)[0]; //Should only be one
Assert.AreEqual(50, clProc.Percentage);
Assert.AreEqual(30, clProc.BaseEst);
Assert.AreEqual(30, clProc.InsPayEst);
Assert.AreEqual(40, clProc.WriteOffEst);
}
public void FeeSchedTools_CopyFeeSched_Clinics()
{
//Make sure there are no duplicate fees already present within the database.
string dbmResult = DatabaseMaintenances.FeeDeleteDuplicates(true, DbmMode.Check);
if (dbmResult.Trim() != _feeDeleteDuplicatesExpectedResult)
{
DatabaseMaintenances.FeeDeleteDuplicates(true, DbmMode.Fix);
}
//Make sure that there are more than six clinics
ClinicT.ClearClinicTable();
for (int i = 0; i < 10; i++)
{
ClinicT.CreateClinic(MethodBase.GetCurrentMethod().Name + "_" + i);
}
//Create two fee schedules; from and to
FeeSched feeSchedNumFrom = FeeSchedT.GetNewFeeSched(FeeScheduleType.Normal, MethodBase.GetCurrentMethod().Name + "_FROM");
FeeSched feeSchedNumTo = FeeSchedT.GetNewFeeSched(FeeScheduleType.Normal, MethodBase.GetCurrentMethod().Name + "_TO");
//Create a fee for every single procedure code in the database and associate it to the "from" fee schedule.
foreach (ProcedureCode code in _listProcCodes)
{
FeeT.CreateFee(feeSchedNumFrom.FeeSchedNum, code.CodeNum, _rand.Next(5000));
}
//Copy the "from" fee schedule into the "to" fee schedule and do it for at least seven clinics.
FeeScheds.CopyFeeSchedule(feeSchedNumFrom, 0, 0, feeSchedNumTo, Clinics.GetDeepCopy(true).Select(x => x.ClinicNum).ToList(), 0);
//Make sure that there was NOT a duplicate fee inserted into the database.
dbmResult = DatabaseMaintenances.FeeDeleteDuplicates(true, DbmMode.Check);
Assert.AreEqual(dbmResult.Trim(), _feeDeleteDuplicatesExpectedResult, "Duplicate fees detected due to concurrent copying.");
}
public void InsPlans_GetAllowed_CapAllowedFeeSched()
{
InsPlan plan = GenerateCapPlan(MethodBase.GetCurrentMethod().Name);
ProcedureCode procCode = _listProcCodes[11];
Fee feeAllowed = FeeT.GetNewFee(plan.AllowedFeeSched, procCode.CodeNum, 70);
double amt = InsPlans.GetAllowed(procCode.ProcCode, plan.FeeSched, plan.AllowedFeeSched, plan.CodeSubstNone, plan.PlanType, "", 0, 0, plan.PlanNum);
Assert.AreEqual(feeAllowed.Amount, amt);
}
/// <summary>Creates a FeeSchedule, and if specified, a clinic and a provnum, and a fee associated to these three parameters with the specified
/// fee amount.. The procedure code is assigned randomly from the list of procedure codes, though the last procedure code will never be picked so
/// that we can safely use _listProcCodes.Last() for testing non-existing fees.</summary>
private Fee CreateSingleFee(string suffix, double amt = _defaultFeeAmt, bool hasClinic = false, bool hasProv = false, long feeSchedNum = 0, long codeNum = 0,
long clinicNum = 0, long provNum = 0, bool isGlobalFeeSched = false)
{
feeSchedNum = feeSchedNum == 0 ? FeeSchedT.CreateFeeSched(FeeScheduleType.Normal, suffix, isGlobalFeeSched) : feeSchedNum;
clinicNum = hasClinic && clinicNum == 0 ? ClinicT.CreateClinic(suffix).ClinicNum : clinicNum;
provNum = hasProv && provNum == 0 ? ProviderT.CreateProvider(suffix) : provNum;
codeNum = codeNum == 0 ? _listProcCodes[_rand.Next(_listProcCodes.Count - 2)].CodeNum : codeNum;
return(FeeT.GetNewFee(feeSchedNum, codeNum, amt, clinicNum, provNum));
}
public void InsPlans_GetAllowed_PPOExact()
{
InsPlan plan = GeneratePPOPlan(MethodBase.GetCurrentMethod().Name);
ProcedureCode procCode = _listProcCodes[6];
Fee fee = FeeT.GetNewFee(plan.FeeSched, procCode.CodeNum, 65);
double allowed = InsPlans.GetAllowed(procCode.ProcCode, plan.FeeSched, plan.AllowedFeeSched, plan.CodeSubstNone, plan.PlanType, "", 0, 0, plan.PlanNum);
Assert.AreEqual(fee.Amount, allowed);
}
public void InsPlans_GetCopay_ExactFee()
{
ProcedureCode procCode = _listProcCodes[3];
InsPlan plan = GenerateMediFlatInsPlan(MethodBase.GetCurrentMethod().Name);
Fee feeDefault = FeeT.GetNewFee(plan.FeeSched, procCode.CodeNum, 50);
Fee feeCopay = FeeT.GetNewFee(plan.CopayFeeSched, procCode.CodeNum, 15);
double amt = InsPlans.GetCopay(procCode.CodeNum, plan.FeeSched, plan.CopayFeeSched, plan.CodeSubstNone, "", 0, 0, plan.PlanNum);
Assert.AreEqual(feeCopay.Amount, amt);
}
public void InsPlans_GetCopay_NoExactFeeUseDefault()
{
ProcedureCode procCode = _listProcCodes[1];
InsPlan plan = GenerateMediFlatInsPlan(MethodBase.GetCurrentMethod().Name);
Fee feeDefault = FeeT.GetNewFee(plan.FeeSched, procCode.CodeNum, 25);
Prefs.UpdateBool(PrefName.CoPay_FeeSchedule_BlankLikeZero, false);
double amt = InsPlans.GetCopay(procCode.CodeNum, plan.FeeSched, plan.CopayFeeSched, plan.CodeSubstNone, "", 0, 0, plan.PlanNum);
Assert.AreEqual(feeDefault.Amount, amt);
}
public void InsPlans_GetCopay_SubstituteFee()
{
ProcedureCode procCode = _listProcCodes[4];
procCode.SubstitutionCode = _listProcCodes[5].ProcCode;
ProcedureCodes.Update(procCode);
InsPlan plan = GenerateMediFlatInsPlan(MethodBase.GetCurrentMethod().Name, false);
Fee feeDefault = FeeT.GetNewFee(plan.FeeSched, procCode.CodeNum, 100);
Fee feeSubstitute = FeeT.GetNewFee(plan.CopayFeeSched, ProcedureCodes.GetSubstituteCodeNum(procCode.ProcCode, "", plan.PlanNum), 45);
double amt = InsPlans.GetCopay(procCode.CodeNum, plan.FeeSched, plan.CopayFeeSched, plan.CodeSubstNone, "", 0, 0, plan.PlanNum);
Assert.AreEqual(feeSubstitute.Amount, amt);
}
public void InsPlans_GetAllowed_PPOSubstituteMoreExpensive()
{
InsPlan plan = GeneratePPOPlan(MethodBase.GetCurrentMethod().Name, false);
ProcedureCode procCode = _listProcCodes[9];
procCode.SubstitutionCode = _listProcCodes[10].ProcCode;
ProcedureCodes.Update(procCode);
Fee feeOrig = FeeT.GetNewFee(plan.FeeSched, procCode.CodeNum, 85);
Fee feeSubs = FeeT.GetNewFee(plan.FeeSched, ProcedureCodes.GetSubstituteCodeNum(procCode.SubstitutionCode, "", plan.PlanNum), 200);
double allowed = InsPlans.GetAllowed(procCode.ProcCode, plan.FeeSched, plan.AllowedFeeSched, plan.CodeSubstNone, plan.PlanType, "", 0, 0, plan.PlanNum);
Assert.AreEqual(feeOrig.Amount, allowed);
}
public void FeeSchedTools_CopyFeeSched()
{
//Create two fee schedules; from and to
FeeSched fromFeeSched = FeeSchedT.GetNewFeeSched(FeeScheduleType.Normal, MethodBase.GetCurrentMethod().Name + "_FROM");
FeeSched toFeeSched = FeeSchedT.GetNewFeeSched(FeeScheduleType.Normal, MethodBase.GetCurrentMethod().Name + "_TO");
//Create a single fee and associate it to the "from" fee schedule.
long feeCodeNum = _listProcCodes[_rand.Next(_listProcCodes.Count - 1)].CodeNum;
FeeT.CreateFee(fromFeeSched.FeeSchedNum, feeCodeNum, _defaultFeeAmt * _rand.NextDouble());
FeeScheds.CopyFeeSchedule(fromFeeSched, 0, 0, toFeeSched, null, 0);
//Get the two fees and check that they are the same.
Fee fromFee = Fees.GetFee(feeCodeNum, fromFeeSched.FeeSchedNum, 0, 0);
Fee toFee = Fees.GetFee(feeCodeNum, toFeeSched.FeeSchedNum, 0, 0);
Assert.AreEqual(fromFee.Amount, toFee.Amount);
}
public void Claims_CalculateAndUpdate_ProcedureCodeDowngradeHigherFee()
{
string suffix = "61";
Patient pat = PatientT.CreatePatient(suffix);
long ucrFeeSchedNum = FeeSchedT.CreateFeeSched(FeeScheduleType.Normal, "UCR Fees" + suffix);
long ppoFeeSchedNum = FeeSchedT.CreateFeeSched(FeeScheduleType.Normal, "PPO Downgrades" + suffix);
Carrier carrier = CarrierT.CreateCarrier(suffix);
InsPlan plan = InsPlanT.CreateInsPlan(carrier.CarrierNum);
InsSub sub = InsSubT.CreateInsSub(pat.PatNum, plan.PlanNum);
long subNum = sub.InsSubNum;
BenefitT.CreateCategoryPercent(plan.PlanNum, EbenefitCategory.Restorative, 100);
PatPlanT.CreatePatPlan(1, pat.PatNum, subNum);
ProcedureCode originalProcCode = ProcedureCodes.GetProcCode("D2391");
ProcedureCode downgradeProcCode = ProcedureCodes.GetProcCode("D2140");
originalProcCode.SubstitutionCode = "D2140";
originalProcCode.SubstOnlyIf = SubstitutionCondition.Always;
ProcedureCodes.Update(originalProcCode);
FeeT.CreateFee(ucrFeeSchedNum, originalProcCode.CodeNum, 140);
FeeT.CreateFee(ucrFeeSchedNum, downgradeProcCode.CodeNum, 120);
FeeT.CreateFee(ppoFeeSchedNum, originalProcCode.CodeNum, 80);
FeeT.CreateFee(ppoFeeSchedNum, downgradeProcCode.CodeNum, 100);
Procedure proc = ProcedureT.CreateProcedure(pat, "D2391", ProcStat.C, "1", 140);//Tooth 1
List <ClaimProc> claimProcs = ClaimProcs.Refresh(pat.PatNum);
List <ClaimProc> claimProcListOld = new List <ClaimProc>();
Family fam = Patients.GetFamily(pat.PatNum);
List <InsSub> subList = InsSubs.RefreshForFam(fam);
List <InsPlan> planList = InsPlans.RefreshForSubList(subList);
List <PatPlan> patPlans = PatPlans.Refresh(pat.PatNum);
List <Benefit> benefitList = Benefits.Refresh(patPlans, subList);
List <Procedure> ProcList = Procedures.Refresh(pat.PatNum);
InsPlan insPlan = planList[0];//Should only be one
InsPlan planOld = insPlan.Copy();
insPlan.PlanType = "p";
insPlan.FeeSched = ppoFeeSchedNum;
InsPlans.Update(insPlan, planOld);
//Creates the claim in the same manner as the account module, including estimates.
Claim claim = ClaimT.CreateClaim("P", patPlans, planList, claimProcs, ProcList, pat, ProcList, benefitList, subList);
ClaimProc clProc = ClaimProcs.Refresh(pat.PatNum)[0]; //Should only be one
Assert.AreEqual(80, clProc.InsEstTotal);
Assert.AreEqual(60, clProc.WriteOff);
}
public void FeeSchedTools_GlobalUpdateWriteoffEstimates()
{
string suffix = MethodBase.GetCurrentMethod().Name;
string procStr = "D0145";
double procFee = 100;
ProcedureCode procCode = ProcedureCodes.GetProcCode(procStr);
//Set up clinic, prov, pat
Clinic clinic = ClinicT.CreateClinic(suffix);
long feeSchedNum = FeeSchedT.CreateFeeSched(FeeScheduleType.FixedBenefit, suffix);
long provNum = ProviderT.CreateProvider(suffix, feeSchedNum: feeSchedNum);
Fee fee = FeeT.GetNewFee(feeSchedNum, procCode.CodeNum, procFee, clinic.ClinicNum, provNum);
Patient pat = PatientT.CreatePatient(suffix, provNum, clinic.ClinicNum);
//Set up insurance
InsuranceInfo info = InsuranceT.AddInsurance(pat, suffix, "c", feeSchedNum);
List <InsSub> listSubs = info.ListInsSubs;
List <InsPlan> listPlans = info.ListInsPlans;
List <PatPlan> listPatPlans = info.ListPatPlans;
InsPlan priPlan = info.PriInsPlan;
InsSub priSub = info.PriInsSub;
info.ListBenefits.Add(BenefitT.CreatePercentForProc(priPlan.PlanNum, procCode.CodeNum, 90));
//Create the procedure and claimproc
Procedure proc = ProcedureT.CreateProcedure(pat, procStr, ProcStat.TP, "", procFee);
ClaimProc priClaimProc = ClaimProcT.CreateClaimProc(pat.PatNum, proc.ProcNum, priPlan.PlanNum, priSub.InsSubNum, DateTime.Today, -1, -1, -1,
ClaimProcStatus.CapEstimate);
Procedures.ComputeEstimates(proc, pat.PatNum, new List <ClaimProc>(), true, listPlans, listPatPlans, info.ListBenefits, pat.Age, info.ListInsSubs);
priClaimProc = ClaimProcs.Refresh(pat.PatNum).FirstOrDefault(x => x.ProcNum == proc.ProcNum);
Assert.AreEqual(procFee, priClaimProc.WriteOff);
procFee = 50;
Procedure procNew = proc.Copy();
procNew.ProcFee = procFee;
Procedures.Update(procNew, proc);
//GlobalUpdate
long updated = GlobalUpdateWriteoffs(clinic.ClinicNum);
Assert.AreEqual(1, updated);
ClaimProc priClaimProcDb = ClaimProcs.Refresh(pat.PatNum).FirstOrDefault(x => x.ClaimProcNum == priClaimProc.ClaimProcNum);
Assert.AreEqual(procFee, priClaimProcDb.WriteOff);
}
public void Fees_GetByFeeSchedNumsClinicNums_MiddleTier()
{
List <long> listFeeSchedNums = new List <long>();
long codeNum1 = ProcedureCodes.GetCodeNum("D1110");
long codeNum2 = ProcedureCodes.GetCodeNum("D1206");
for (int i = 0; i < 300; i++)
{
FeeSched feeSched = FeeSchedT.GetNewFeeSched(FeeScheduleType.Normal, "FS" + i);
FeeT.GetNewFee(feeSched.FeeSchedNum, codeNum1, 11);
FeeT.GetNewFee(feeSched.FeeSchedNum, codeNum2, 13);
listFeeSchedNums.Add(feeSched.FeeSchedNum);
}
DataAction.RunMiddleTierMock(() => {
List <FeeLim> listFees = Fees.GetByFeeSchedNumsClinicNums(listFeeSchedNums, new List <long> {
0
});
Assert.AreEqual(600, listFees.Count);
});
}
public void Fees_GetFee_ClinicSpecificFees()
{
Patient pat = PatientT.CreatePatient("58");
long feeSchedNum = FeeSchedT.CreateFeeSched(FeeScheduleType.Normal, "Standard UCR", false);
long codeNum = ProcedureCodes.GetCodeNum("D2750");
long clinicNum2 = ClinicT.CreateClinic("2-58").ClinicNum;
long clinicNum3 = ClinicT.CreateClinic("3-58").ClinicNum;
long clinicNum1 = ClinicT.CreateClinic("1-58").ClinicNum;
FeeT.CreateFee(feeSchedNum, codeNum, 65, clinicNum1, 0);
FeeT.CreateFee(feeSchedNum, codeNum, 70, clinicNum2, 0);
FeeT.CreateFee(feeSchedNum, codeNum, 75, clinicNum3, 0);
double fee1 = Fees.GetFee(codeNum, feeSchedNum, clinicNum1, 0).Amount;
double fee2 = Fees.GetFee(codeNum, feeSchedNum, clinicNum2, 0).Amount;
double fee3 = Fees.GetFee(codeNum, feeSchedNum, clinicNum3, 0).Amount;
Assert.AreEqual(fee1, 65);
Assert.AreEqual(fee2, 70);
Assert.AreEqual(fee3, 75);
}
public void Fees_GetFee_ProviderSpecificFees()
{
Patient pat = PatientT.CreatePatient("57");
long feeSchedNum = FeeSchedT.CreateFeeSched(FeeScheduleType.Normal, "PPOInsPlan1", false);
long codeNum = ProcedureCodes.GetCodeNum("D2750");
long provNum1 = ProviderT.CreateProvider("1-57");
long provNum2 = ProviderT.CreateProvider("2-57");
long provNum3 = ProviderT.CreateProvider("3-57");
FeeT.CreateFee(feeSchedNum, codeNum, 50, 0, provNum1);
FeeT.CreateFee(feeSchedNum, codeNum, 55, 0, provNum2);
FeeT.CreateFee(feeSchedNum, codeNum, 60, 0, provNum3);
double fee1 = Fees.GetFee(codeNum, feeSchedNum, 0, provNum1).Amount;
double fee2 = Fees.GetFee(codeNum, feeSchedNum, 0, provNum2).Amount;
double fee3 = Fees.GetFee(codeNum, feeSchedNum, 0, provNum3).Amount;
Assert.AreEqual(50, fee1);
Assert.AreEqual(55, fee2);
Assert.AreEqual(60, fee3);
}
public void Fees_GetFee_ClinicAndProviderSpecificFees()
{
Patient pat = PatientT.CreatePatient("59");
long feeSchedNum = FeeSchedT.CreateFeeSched(FeeScheduleType.Normal, "Standard", false);
long codeNum = ProcedureCodes.GetCodeNum("D2750");
long provNum1 = ProviderT.CreateProvider("1-59");
long provNum2 = ProviderT.CreateProvider("2-59");
long clinicNum1 = ClinicT.CreateClinic("1-59").ClinicNum;
long clinicNum2 = ClinicT.CreateClinic("2-59").ClinicNum;
FeeT.CreateFee(feeSchedNum, codeNum, 80, clinicNum1, provNum1);
FeeT.CreateFee(feeSchedNum, codeNum, 85, clinicNum1, provNum2);
FeeT.CreateFee(feeSchedNum, codeNum, 90, clinicNum2, provNum2);
double fee1 = Fees.GetFee(codeNum, feeSchedNum, clinicNum1, provNum1).Amount;
double fee2 = Fees.GetFee(codeNum, feeSchedNum, clinicNum1, provNum2).Amount;
double fee3 = Fees.GetFee(codeNum, feeSchedNum, clinicNum2, provNum2).Amount;
Assert.AreEqual(fee1, 80);
Assert.AreEqual(fee2, 85);
Assert.AreEqual(fee3, 90);
}
public void Procedures_ComputeEstimates_PrimaryInsuranceMedicaidCOB()
{
string suffix = MethodBase.GetCurrentMethod().Name;
Patient pat = PatientT.CreatePatient(suffix);
long ppoFeeSchedNum = FeeSchedT.CreateFeeSched(FeeScheduleType.Normal, "PPO " + suffix);
InsuranceInfo insInfo = InsuranceT.AddInsurance(pat, suffix, "p", ppoFeeSchedNum, 1, cobRule: EnumCobRule.SecondaryMedicaid);
InsPlan priPlan = InsPlanT.GetPlanForPriSecMed(PriSecMed.Primary, insInfo.ListPatPlans, insInfo.ListInsPlans, insInfo.ListInsSubs);
BenefitT.CreateCategoryPercent(priPlan.PlanNum, EbenefitCategory.Diagnostic, percent: 50);
List <Benefit> listBens = Benefits.Refresh(insInfo.ListPatPlans, insInfo.ListInsSubs);
string procStr = "D0150";
Procedure proc = ProcedureT.CreateProcedure(pat, procStr, ProcStat.TP, "", 125);
ProcedureCode procCode = ProcedureCodes.GetProcCode(procStr);
FeeT.CreateFee(ppoFeeSchedNum, procCode.CodeNum, amount: 80);
Procedures.ComputeEstimates(proc, pat.PatNum, new List <ClaimProc>(), false, insInfo.ListInsPlans, insInfo.ListPatPlans, listBens, pat.Age,
insInfo.ListInsSubs);
List <ClaimProc> listClaimProcs = ClaimProcs.Refresh(pat.PatNum);
Assert.AreEqual(40, listClaimProcs[0].InsEstTotal, 0.001);
Assert.AreEqual(45, listClaimProcs[0].WriteOffEst, 0.001);
}
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");
}
public void Procedures_GlobalUpdateFees()
{
string name = MethodBase.GetCurrentMethod().Name;
Random rand = new Random();
//set up fees
List <Clinic> listClinics = new List <Clinic>();
for (int i = 0; i < 3; i++)
{
listClinics.Add(ClinicT.CreateClinic(name + "_" + i));
}
List <long> listFeeSchedNums = new List <long>();
for (int i = 0; i < 2; i++)
{
listFeeSchedNums.Add(FeeSchedT.CreateFeeSched(FeeScheduleType.Normal, name + "_" + i, false));
}
List <long> listProvNums = new List <long>();
for (int i = 0; i < 2; i++)
{
long feeSched = listFeeSchedNums[rand.Next(listFeeSchedNums.Count - 1)];
listProvNums.Add(ProviderT.CreateProvider(name + "_" + i, feeSchedNum: feeSched));
}
List <ProcedureCode> listProcCodes = ProcedureCodes.GetAllCodes();
List <Fee> listFees = new List <Fee>();
foreach (ProcedureCode procCode in listProcCodes)
{
foreach (long feeSched in listFeeSchedNums)
{
foreach (Clinic clinic in listClinics)
{
foreach (long provNum in listProvNums)
{
listFees.Add(FeeT.GetNewFee(feeSched, procCode.CodeNum, 50 * rand.NextDouble(), clinic.ClinicNum, provNum));
}
}
}
}
//set up patients
List <Patient> listPatients = new List <Patient>();
for (int i = 0; i < 3; i++)
{
listPatients.Add(PatientT.CreatePatient(name + "_" + i,
listProvNums[rand.Next(listProvNums.Count - 1)],
listClinics[rand.Next(listClinics.Count - 1)].ClinicNum));
}
//TP some procedures
List <Fee> listTPFees = new List <Fee>();
for (int i = 0; i < 100; i++)
{
ProcedureCode procCode = listProcCodes[rand.Next(listProcCodes.Count - 1)];
Patient patient = listPatients[rand.Next(listPatients.Count - 1)];
Fee fee = Fees.GetFee(procCode.CodeNum, Providers.GetProv(patient.PriProv).FeeSched, patient.ClinicNum, patient.PriProv);
Procedure proc = ProcedureT.CreateProcedure(patient, procCode.ProcCode, ProcStat.TP, "", fee.Amount);
listTPFees.Add(fee);
}
//change some of the fees
List <Fee> listTPFeesChanged = listTPFees.OrderBy(x => rand.Next()).Take(50).ToList();
List <Fee> listNonTPFeesChanged = (listFees.Except(listTPFees)).OrderBy(x => rand.Next()).Take(50).ToList();
FeeCache cache = new FeeCache(listTPFeesChanged.Union(listNonTPFeesChanged).ToList());
cache.BeginTransaction();
foreach (Fee fee in listTPFeesChanged)
{
fee.Amount = 50 * rand.NextDouble();
cache.Update(fee);
}
foreach (Fee fee in listNonTPFeesChanged)
{
fee.Amount = 50 * rand.NextDouble();
cache.Update(fee);
}
cache.SaveToDb();
//Run the global update
long updatedCount = 0;
cache = new FeeCache();
for (int i = 0; i < listClinics.Count; i++)
{
updatedCount += Procedures.GlobalUpdateFees(cache.GetFeesForClinics(listClinics.Select(x => x.ClinicNum)), listClinics[i].ClinicNum, listClinics[i].Abbr);
}
//check the counts are the same
List <Fee> listToCount = listTPFees.Where(x => listTPFeesChanged.Select(y => y.FeeNum).Contains(x.FeeNum)).ToList();
Assert.AreEqual(listToCount.Count, updatedCount);
}
///<summary>Creates a procedure and computes estimates for a patient where the secondary insurance has a COB rule of Medicaid.</summary>
private void ComputeEstimatesFixedBenefits(string suffix, double procFee, double ppoFee, double fixedBenefitFee
, int priPercentCoveredOverride, bool hasSecondary, double secFee, Action <FixedBenefitAssertItem> assertAct)
{
Patient pat = PatientT.CreatePatient(suffix);
string procStr = "D0150";
Procedure proc = ProcedureT.CreateProcedure(pat, procStr, ProcStat.TP, "", procFee);
ProcedureCode procCode = ProcedureCodes.GetProcCode(procStr);
long ppoFeeSchedNum = FeeSchedT.CreateFeeSched(FeeScheduleType.Normal, "PPO " + suffix);
long catPercFeeSchedNum = FeeSchedT.CreateFeeSched(FeeScheduleType.Normal, "Category % " + suffix);
long fixedBenefitFeeSchedNum = FeeSchedT.CreateFeeSched(FeeScheduleType.FixedBenefit, "Fixed Benefit " + suffix);
if (ppoFee > -1)
{
FeeT.CreateFee(ppoFeeSchedNum, procCode.CodeNum, ppoFee);
}
FeeT.CreateFee(fixedBenefitFeeSchedNum, procCode.CodeNum, fixedBenefitFee);
InsuranceT.AddInsurance(pat, suffix, "p", ppoFeeSchedNum, copayFeeSchedNum: fixedBenefitFeeSchedNum);
if (hasSecondary)
{
FeeT.CreateFee(catPercFeeSchedNum, procCode.CodeNum, secFee);
InsuranceT.AddInsurance(pat, suffix, "", catPercFeeSchedNum, 2, false, EnumCobRule.Standard);
}
List <InsSub> listSubs = InsSubT.GetInsSubs(pat);
List <InsPlan> listPlans = InsPlans.RefreshForSubList(listSubs);
List <PatPlan> listPatPlans = PatPlans.Refresh(pat.PatNum);
InsPlan priPlan = InsPlanT.GetPlanForPriSecMed(PriSecMed.Primary, listPatPlans, listPlans, listSubs);
InsPlan secPlan = null;
if (hasSecondary)
{
secPlan = InsPlanT.GetPlanForPriSecMed(PriSecMed.Secondary, listPatPlans, listPlans, listSubs);
//TODO: Add diagnostic code benefit for 100%
BenefitT.CreateCategoryPercent(secPlan.PlanNum, EbenefitCategory.Diagnostic, 100);
}
List <Benefit> listBens = Benefits.Refresh(listPatPlans, listSubs);
Procedures.ComputeEstimates(proc, pat.PatNum, new List <ClaimProc>(), false, listPlans, listPatPlans, listBens, pat.Age, listSubs);
List <ClaimProc> listClaimProcs = ClaimProcs.Refresh(pat.PatNum);
if (priPercentCoveredOverride > 0)
{
foreach (ClaimProc cpCur in listClaimProcs)
{
cpCur.PercentOverride = priPercentCoveredOverride;
ClaimProcs.Update(cpCur);
}
Procedures.ComputeEstimates(proc, pat.PatNum, new List <ClaimProc>(), false, listPlans, listPatPlans, listBens, pat.Age, listSubs);
listClaimProcs = ClaimProcs.Refresh(pat.PatNum);
}
foreach (ClaimProc cpCur in listClaimProcs)
{
cpCur.PercentOverride = priPercentCoveredOverride;
ClaimProcs.Update(cpCur);
}
Procedures.ComputeEstimates(proc, pat.PatNum, listClaimProcs, false, listPlans, listPatPlans, listBens, pat.Age, listSubs);
listClaimProcs = ClaimProcs.Refresh(pat.PatNum);
assertAct(new FixedBenefitAssertItem()
{
Procedure = proc,
PrimaryClaimProc = listClaimProcs.FirstOrDefault(x => x.PlanNum == priPlan.PlanNum),
SecondaryClaimProc = secPlan == null ? null : listClaimProcs.FirstOrDefault(x => x.PlanNum == secPlan.PlanNum),
});
}
