///<summary>Called from Eclaims and includes multiple claims.</summary>
public static string SendBatch(Clearinghouse clearinghouseClin, List <ClaimSendQueueItem> queueItems, int batchNum, IFormClaimFormItemEdit formCFI,
FillRenaissanceDelegate fillRenaissance)
{
for (int i = 0; i < queueItems.Count; i++)
{
_clearinghouseClin = clearinghouseClin;
if (!CreateClaim(queueItems[i].PatNum, queueItems[i].ClaimNum, batchNum, formCFI, fillRenaissance))
{
return("");
}
}
return("Sent");
}
///<summary>Called once for each claim to be created. For claims with a lot of procedures, this may actually create multiple claims.</summary>
public static bool CreateClaim(long patNum, long claimNum, int batchNum, IFormClaimFormItemEdit formCFI, FillRenaissanceDelegate fillRenaissance)
{
//this can be eliminated later after error checking complete:
FormCFI = formCFI;
FormCFI.FillFieldNames();
items = new ClaimFormItem[241]; //0 is not used
Fill(1, "IsPreAuth");
Fill(2, "IsStandardClaim");
Fill(3, "IsMedicaidClaim");
Fill(4, ""); //EPSTD
Fill(5, "TreatingProviderSpecialty");
Fill(6, "PreAuthString");
Fill(7, "PriInsCarrierName");
Fill(8, "PriInsAddressComplete");
Fill(9, "PriInsCity");
Fill(10, "PriInsST");
Fill(11, "PriInsZip");
Fill(12, "PatientLastFirst");
Fill(13, "PatientAddressComplete");
Fill(14, "PatientCity");
Fill(15, "PatientST");
Fill(16, "PatientDOB", "MM/dd/yyyy");
Fill(17, "PatientID-MedicaidOrSSN");
Fill(18, "PatientIsMale");
Fill(19, "PatientIsFemale");
Fill(20, "PatientPhone");
Fill(21, "PatientZip");
Fill(22, "RelatIsSelf");
Fill(23, "RelatIsSpouse");
Fill(24, "RelatIsChild");
Fill(25, "RelatIsOther");
Fill(26, ""); //relat other descript
Fill(27, ""); //pat employer/school
Fill(28, ""); //pat employer/school address
Fill(29, "SubscrID");
Fill(30, "EmployerName");
Fill(31, "GroupNum");
Fill(32, "OtherInsNotExists");
Fill(33, "OtherInsExists");
Fill(34, "OtherInsExists"); //dental
Fill(35, ""); //other ins exists medical
Fill(36, "OtherInsSubscrID");
Fill(37, "SubscrLastFirst");
Fill(38, "OtherInsSubscrLastFirst");
Fill(39, "SubscrAddressComplete");
Fill(40, "SubscrPhone");
Fill(41, "OtherInsSubscrDOB", "MM/dd/yyyy");
Fill(42, "OtherInsSubscrIsMale");
Fill(43, "OtherInsSubscrIsFemale");
Fill(44, "OtherInsGroupNum"); //Other Plan/Program name
Fill(45, "SubscrCity");
Fill(46, "SubscrST");
Fill(47, "SubscrZip");
Fill(48, ""); //other subscr employer/school
Fill(49, ""); //other subscr emp/school address
Fill(50, "SubscrDOB", "MM/dd/yyyy");
Fill(51, "SubscrIsMarried");
Fill(52, "SubscrIsSingle");
Fill(53, ""); //subscr marital status other
Fill(54, "SubscrIsMale");
Fill(55, "SubscrIsFemale");
Fill(56, ""); //subscr is employed
Fill(57, ""); //subscr is part time
Fill(58, "SubscrIsFTStudent");
Fill(59, "SubscrIsPTStudent");
Fill(60, ""); //subsc employer/school
Fill(61, ""); //subsc employer/school address
Fill(62, "PatientRelease");
Fill(63, "PatientReleaseDate", "MM/dd/yyyy");
Fill(64, "PatientAssignment");
Fill(65, "PatientAssignmentDate", "MM/dd/yyyy");
Fill(66, "BillingDentist");
Fill(67, "BillingDentistPhoneFormatted");
Fill(68, "BillingDentistMedicaidID");
Fill(69, "BillingDentistSSNorTIN");
Fill(70, "PayToDentistAddress");
Fill(71, "PayToDentistAddress2");
Fill(72, "BillingDentistLicenseNum");
Fill(73, "DateService", "MM/dd/yyyy");
Fill(74, "PlaceIsOffice");
Fill(75, "PlaceIsHospADA2002");
Fill(76, "PlaceIsExtCareFacilityADA2002");
Fill(77, "PlaceIsOtherADA2002");
Fill(78, "PayToDentistCity");
Fill(79, "PayToDentistST");
Fill(80, "PayToDentistZip");
Fill(81, "IsRadiographsAttached");
Fill(82, "RadiographsNumAttached");
Fill(83, "RadiographsNotAttached");
Fill(84, "IsOrtho");
Fill(85, "IsNotOrtho");
Fill(86, "IsInitialProsth");
Fill(87, "IsReplacementProsth");
Fill(88, ""); //reason for replacement
Fill(89, "DatePriorProsthPlaced", "MM/dd/yyyy");
Fill(90, "DateOrthoPlaced");
Fill(91, "MonthsOrthoRemaining");
Fill(92, "IsNotOccupational");
Fill(93, "IsOccupational");
Fill(94, ""); //description of occupational injury
Fill(95, "IsAutoAccident");
Fill(96, "IsOtherAccident");
Fill(97, "IsNotAccident");
Fill(98, ""); //description of accident
Fill(99, "TreatingDentistNPI"); //Individual NPI
Fill(100, ""); //Attachment ID
Fill(101, "BillingDentistNPI"); //Group NPI
Fill(102, ""); //Specail Tesia Remarks field Import Field gets moved to 232 on outbound
Fill(103, ""); //4th Carrier Address Line
Fill(104, ""); //4th Billing Address Line
Fill(105, ""); //4th Subscriber Address Line
Fill(106, ""); //4th Patient Address Line
//proc 1
Fill(107, "P1Date", "MM/dd/yyyy");
Fill(108, "P1ToothNumber");
Fill(109, "P1Surface");
Fill(110, ""); //diag index
Fill(111, "P1Code");
Fill(112, ""); //quantity
Fill(113, "P1Description");
Fill(114, "P1Fee");
//proc 2
Fill(115, "P2Date", "MM/dd/yyyy");
Fill(116, "P2ToothNumber");
Fill(117, "P2Surface");
Fill(118, "");
Fill(119, "P2Code");
Fill(120, "");
Fill(121, "P2Description");
Fill(122, "P2Fee");
//proc 3
Fill(123, "P3Date", "MM/dd/yyyy");
Fill(124, "P3ToothNumber");
Fill(125, "P3Surface");
Fill(126, "");
Fill(127, "P3Code");
Fill(128, "");
Fill(129, "P3Description");
Fill(130, "P3Fee");
//proc 4
Fill(131, "P4Date", "MM/dd/yyyy");
Fill(132, "P4ToothNumber");
Fill(133, "P4Surface");
Fill(134, "");
Fill(135, "P4Code");
Fill(136, "");
Fill(137, "P4Description");
Fill(138, "P4Fee");
//proc 5
Fill(139, "P5Date", "MM/dd/yyyy");
Fill(140, "P5ToothNumber");
Fill(141, "P5Surface");
Fill(142, "");
Fill(143, "P5Code");
Fill(144, "");
Fill(145, "P5Description");
Fill(146, "P5Fee");
//proc 6
Fill(147, "P6Date", "MM/dd/yyyy");
Fill(148, "P6ToothNumber");
Fill(149, "P6Surface");
Fill(150, "");
Fill(151, "P6Code");
Fill(152, "");
Fill(153, "P6Description");
Fill(154, "P6Fee");
//proc 7
Fill(155, "P7Date", "MM/dd/yyyy");
Fill(156, "P7ToothNumber");
Fill(157, "P7Surface");
Fill(158, "");
Fill(159, "P7Code");
Fill(160, "");
Fill(161, "P7Description");
Fill(162, "P7Fee");
//proc 8
Fill(163, "P8Date", "MM/dd/yyyy");
Fill(164, "P8ToothNumber");
Fill(165, "P8Surface");
Fill(166, "");
Fill(167, "P8Code");
Fill(168, "");
Fill(169, "P8Description");
Fill(170, "P8Fee");
//end of procs
Fill(171, "TotalFee");
Fill(172, ""); //payment by other plan. Only applicable on secondary insurance.
Fill(173, ""); //max allowable
Fill(174, ""); //deductible
Fill(175, ""); //carrier percent
Fill(176, ""); //carrier pays
Fill(177, ""); //patient pays
Fill(178, ""); //Work injury. Only x is accepted.
Fill(179, "P1Area");
Fill(180, ""); //Tooth System 1- Will accept any text string
Fill(181, "P2Area");
Fill(182, ""); //Tooth System 2- Will accept any text string
Fill(183, "P3Area");
Fill(184, ""); //Tooth System 3- Will accept any text string
Fill(185, "P4Area");
Fill(186, ""); //Tooth System 4- Will accept any text string
Fill(187, "P5Area");
Fill(188, ""); //Tooth System 5- Will accept any text string
Fill(189, "P6Area");
Fill(190, ""); //Tooth System 6- Will accept any text string
Fill(191, "P7Area");
Fill(192, ""); //Tooth System 7- Will accept any text string
Fill(193, "P8Area");
Fill(194, ""); //Tooth System 8- Will accept any text string
Fill(195, "P9Date", "MM/dd/yyyy");
Fill(196, "P9Area");
Fill(197, ""); //Tooth System 9- Will accept any text string
Fill(198, "P9ToothNumber");
Fill(199, "P9Surface");
Fill(200, "P9Code");
Fill(201, "P9Description");
Fill(202, "P9Fee");
Fill(203, "P10Date", "MM/dd/yyyy");
Fill(204, "P10Area");
Fill(205, ""); //Tooth System 10- Will accept any text string
Fill(206, "P10ToothNumber");
Fill(207, "P10Surface");
Fill(208, "P10Code");
Fill(209, "P10Description");
Fill(210, "P10Fee");
Fill(211, "TreatingDentistProviderID"); //Treating/Rending Provider ID- Will accept any text string
Fill(212, ""); //COB Relationship To Subscriber (Self) - Only 'X' will be accepted
Fill(213, ""); //COB Relationship To Subscriber (Spouse) - Only 'X' will be accepted
Fill(214, ""); //COB Relationship To Subscriber (Child) - Only 'X' will be accepted
Fill(215, ""); //COB Relationship To Subscriber (Other) - Only 'X' will be accepted
Fill(216, "OtherInsCarrierName"); //COB insurance company name
Fill(217, "OtherInsAddress"); //COB address
Fill(218, "OtherInsCity"); //COB ins City
Fill(219, "OtherInsST"); //COB ins State
Fill(220, "OtherInsZip"); //COB Zip
Fill(221, ""); //Accident ST - Only 2 character state abbreviation.
Fill(222, "");
Fill(223, "");
Fill(224, "");
Fill(225, "");
Fill(226, "");
Fill(227, "");
Fill(228, "");
Fill(229, "");
Fill(230, "Remarks"); //Remarks (Such as NEA numbers etc.) - Will accept any text string
Fill(231, "");
Fill(232, ""); //Excellus Additional Info Field
Fill(233, ""); //COB Primary Payment Date- Expecting MM/DD/YYYY
Fill(234, "TreatingDentistSignature"); //Treating Dentist Signature - Will accept any text string
Fill(235, "TreatingDentistLicense"); //Treating License # - Will accept any text string
Fill(236, "TreatingDentistSigDate"); //Date Signed - Expecting MM/DD/YYYY
Fill(237, "TreatingDentistAddress"); //Address Where Procedure Performed - Will accept any text string
Fill(238, "TreatingDentistCity"); //City Where Procedure Performed - Will accept any text string
Fill(239, "TreatingDentistST"); //State Where Procedure Performed - Will accept any text string
Fill(240, "TreatingDentistZip"); //Zip Code Where Procedure Performed - Expecting 5 digit
DisplayStrings = fillRenaissance(claimNum, patNum, items.ToList());
SaveFile(batchNum);
return(true);
}
