public void PaymentEdit_Init_AutoSplitWithClaimPayments() //Legacy_TestFortyEight
{
string suffix = "48";
Patient pat = PatientT.CreatePatient(suffix);
long patNum = pat.PatNum;
InsPlan insPlan = InsPlanT.CreateInsPlan(CarrierT.CreateCarrier(suffix).CarrierNum);
InsSub insSub = InsSubT.CreateInsSub(patNum, insPlan.PlanNum);
PatPlan patPlan = PatPlanT.CreatePatPlan(1, patNum, insSub.InsSubNum);
Procedure procedure1 = ProcedureT.CreateProcedure(pat, "D1110", ProcStat.C, "", 50, DateTime.Now.AddDays(-1));
Procedure procedure2 = ProcedureT.CreateProcedure(pat, "D0120", ProcStat.C, "", 40, DateTime.Now.AddDays(-2));
Procedure procedure3 = ProcedureT.CreateProcedure(pat, "D0220", ProcStat.C, "", 60, DateTime.Now.AddDays(-3));
ClaimProcT.AddInsPaid(patNum, insPlan.PlanNum, procedure1.ProcNum, 20, insSub.InsSubNum, 0, 0);
ClaimProcT.AddInsPaid(patNum, insPlan.PlanNum, procedure2.ProcNum, 5, insSub.InsSubNum, 5, 0);
ClaimProcT.AddInsPaid(patNum, insPlan.PlanNum, procedure3.ProcNum, 20, insSub.InsSubNum, 0, 10);
Payment payment = PaymentT.MakePaymentNoSplits(patNum, 150, DateTime.Today);
Family famForPat = Patients.GetFamily(patNum);
List <Patient> listFamForPat = famForPat.ListPats.ToList();
PaymentEdit.InitData init = PaymentEdit.Init(listFamForPat, famForPat, new Family {
}, payment, new List <PaySplit>(), new List <Procedure>(), patNum);
//Auto Splits will be in opposite order from least recent to most recent.
//ListSplitsCur should contain four splits, 30, 35, and 30, then one unallocated for the remainder of the payment 55.
Assert.AreEqual(4, init.AutoSplitData.ListSplitsCur.Count);
Assert.IsFalse(init.AutoSplitData.ListSplitsCur[0].SplitAmt != 40 || init.AutoSplitData.ListSplitsCur[0].ProcNum != procedure3.ProcNum ||
init.AutoSplitData.ListSplitsCur[0].PatNum != patNum);
Assert.IsFalse(init.AutoSplitData.ListSplitsCur[1].SplitAmt != 35 || init.AutoSplitData.ListSplitsCur[1].ProcNum != procedure2.ProcNum ||
init.AutoSplitData.ListSplitsCur[1].PatNum != patNum);
Assert.IsFalse(init.AutoSplitData.ListSplitsCur[2].SplitAmt != 30 || init.AutoSplitData.ListSplitsCur[2].ProcNum != procedure1.ProcNum ||
init.AutoSplitData.ListSplitsCur[2].PatNum != patNum);
Assert.IsFalse(init.AutoSplitData.ListSplitsCur[3].SplitAmt != 45 || init.AutoSplitData.ListSplitsCur[3].ProcNum != 0);
}
public void InsPlan_GetPendingDisplay_LimitationsOverrideGeneralLimitations()
{
string suffix = "31";
Patient pat = PatientT.CreatePatient(suffix);
long patNum = pat.PatNum;
Carrier carrier = CarrierT.CreateCarrier(suffix);
InsPlan plan = InsPlanT.CreateInsPlan(carrier.CarrierNum);
long planNum = plan.PlanNum;
InsSub sub = InsSubT.CreateInsSub(pat.PatNum, planNum); //guarantor is subscriber
long subNum = sub.InsSubNum;
long patPlanNum = PatPlanT.CreatePatPlan(1, pat.PatNum, subNum).PatPlanNum;
BenefitT.CreateAnnualMax(planNum, 1000);
BenefitT.CreateCategoryPercent(planNum, EbenefitCategory.RoutinePreventive, 100);
BenefitT.CreateLimitation(planNum, EbenefitCategory.RoutinePreventive, 1000); //Changing this amount would affect patient portion vs ins portion. But regardless of the amount, this should prevent any pending from showing in the box, which is for general pending only.
Procedure proc = ProcedureT.CreateProcedure(pat, "D1110", ProcStat.C, "", 125); //Prophy
//Lists
List <ClaimProc> claimProcs = ClaimProcs.Refresh(pat.PatNum);
Family fam = Patients.GetFamily(patNum);
List <InsSub> subList = InsSubs.RefreshForFam(fam);
List <InsPlan> planList = InsPlans.RefreshForSubList(subList);
List <PatPlan> patPlans = PatPlans.Refresh(patNum);
List <Benefit> benefitList = Benefits.Refresh(patPlans, subList);
List <Procedure> ProcList = Procedures.Refresh(pat.PatNum);
Claim claim = ClaimT.CreateClaim("P", patPlans, planList, claimProcs, ProcList, pat, ProcList, benefitList, subList);//Creates the claim in the same manner as the account module, including estimates and status NotReceived.
List <ClaimProcHist> histList = ClaimProcs.GetHistList(patNum, benefitList, patPlans, planList, DateTime.Today, subList);
//Validate
Assert.AreEqual(0, InsPlans.GetPendingDisplay(histList, DateTime.Today, plan, patPlanNum, -1, patNum, subNum, benefitList));
}
public void InsPlan_GetInsUsedDisplay_OrthoProcsNotAffectInsUsed()
{
string suffix = "13";
Patient pat = PatientT.CreatePatient(suffix);
Carrier carrier = CarrierT.CreateCarrier(suffix);
InsPlan plan = InsPlanT.CreateInsPlan(carrier.CarrierNum);
InsSub sub = InsSubT.CreateInsSub(pat.PatNum, plan.PlanNum);
long subNum = sub.InsSubNum;
PatPlan patPlan = PatPlanT.CreatePatPlan(1, pat.PatNum, subNum);
BenefitT.CreateAnnualMax(plan.PlanNum, 100);
BenefitT.CreateOrthoMax(plan.PlanNum, 500);
BenefitT.CreateCategoryPercent(plan.PlanNum, EbenefitCategory.Diagnostic, 100);
BenefitT.CreateCategoryPercent(plan.PlanNum, EbenefitCategory.Orthodontics, 100);
Procedure proc1 = ProcedureT.CreateProcedure(pat, "D0140", ProcStat.C, "", 59); //limEx
Procedure proc2 = ProcedureT.CreateProcedure(pat, "D8090", ProcStat.C, "", 348); //Comprehensive ortho
ClaimProcT.AddInsPaid(pat.PatNum, plan.PlanNum, proc1.ProcNum, 59, subNum, 0, 0);
ClaimProcT.AddInsPaid(pat.PatNum, plan.PlanNum, proc2.ProcNum, 348, subNum, 0, 0);
//Lists
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 <ClaimProcHist> histList = ClaimProcs.GetHistList(pat.PatNum, benefitList, patPlans, planList, DateTime.Today, subList);
//Validate
double insUsed = InsPlans.GetInsUsedDisplay(histList, DateTime.Today, plan.PlanNum, patPlan.PatPlanNum, -1, planList, benefitList, pat.PatNum, subNum);
Assert.AreEqual(59, insUsed);
}
public void InsPlan_GetInsUsedDisplay_LimitationsOverride()
{
string suffix = "6";
Patient pat = PatientT.CreatePatient(suffix);
long patNum = pat.PatNum;
Carrier carrier = CarrierT.CreateCarrier(suffix);
InsPlan plan = InsPlanT.CreateInsPlan(carrier.CarrierNum);
long planNum = plan.PlanNum;
InsSub sub = InsSubT.CreateInsSub(pat.PatNum, planNum); //guarantor is subscriber
long subNum = sub.InsSubNum;
long patPlanNum = PatPlanT.CreatePatPlan(1, pat.PatNum, subNum).PatPlanNum;
BenefitT.CreateAnnualMax(planNum, 1000);
BenefitT.CreateLimitation(planNum, EbenefitCategory.Diagnostic, 1000);
Procedure proc = ProcedureT.CreateProcedure(pat, "D0120", ProcStat.C, "", 50); //An exam
long procNum = proc.ProcNum;
Procedure proc2 = ProcedureT.CreateProcedure(pat, "D2750", ProcStat.C, "8", 830); //create a crown
ClaimProcT.AddInsPaid(patNum, planNum, procNum, 50, subNum, 0, 0);
ClaimProcT.AddInsPaid(patNum, planNum, proc2.ProcNum, 400, subNum, 0, 0);
//Lists
Family fam = Patients.GetFamily(patNum);
List <InsSub> subList = InsSubs.RefreshForFam(fam);
List <InsPlan> planList = InsPlans.RefreshForSubList(subList);
List <PatPlan> patPlans = PatPlans.Refresh(patNum);
List <Benefit> benefitList = Benefits.Refresh(patPlans, subList);
List <ClaimProcHist> histList = ClaimProcs.GetHistList(patNum, benefitList, patPlans, planList, DateTime.Today, subList);
//Validate
double insUsed = InsPlans.GetInsUsedDisplay(histList, DateTime.Today, planNum, patPlanNum, -1, planList, benefitList, patNum, subNum);
Assert.AreEqual(400, insUsed);
}
public void InsPlans_ComputeEstimatesForSubscriber_CanadianLabFees()
{
string suffix = MethodBase.GetCurrentMethod().Name;
CultureInfo curCulture = CultureInfo.CurrentCulture;
Thread.CurrentThread.CurrentCulture = new CultureInfo("en-CA"); //Canada
try {
//Create a patient and treatment plan a procedure with a lab fee.
Patient pat = PatientT.CreatePatient();
ProcedureCodeT.AddIfNotPresent("14611");
ProcedureCodeT.AddIfNotPresent("99111", isCanadianLab: true);
Procedure proc = ProcedureT.CreateProcedure(pat, "14611", ProcStat.TP, "", 250);
Procedure procLab = ProcedureT.CreateProcedure(pat, "99111", ProcStat.TP, "", 149, procNumLab: proc.ProcNum);
//Create a new primary insurance plan for this patient.
//It is important that we add the insurance plan after the procedure has already been created for this particular scenario.
Carrier carrier = CarrierT.CreateCarrier(suffix);
InsPlan plan = InsPlanT.CreateInsPlan(carrier.CarrierNum);
InsSub sub = InsSubT.CreateInsSub(pat.PatNum, plan.PlanNum);
PatPlan patPlan = PatPlanT.CreatePatPlan(1, pat.PatNum, sub.InsSubNum);
//Invoking ComputeEstimatesForAll() will simulate the logic of adding a new insurance plan from the Family module.
//The bug that this unit test is preventing is that a duplicate claimproc was being created for the lab fee.
//This was causing a faux line to show up when a claim was created for the procedure in question.
//It ironically doesn't matter if the procedures above are even covered by insurance because they'll get claimprocs created regardless.
InsPlans.ComputeEstimatesForSubscriber(sub.Subscriber);
//Check to see how many claimproc enteries there are for the current patient. There should only be two.
List <ClaimProc> listClaimProcs = ClaimProcs.Refresh(pat.PatNum);
Assert.AreEqual(2, listClaimProcs.Count);
}
finally {
Thread.CurrentThread.CurrentCulture = curCulture;
}
}
public void X271_EB271_SetInsuranceHistoryDates()
{
Patient pat = PatientT.CreatePatient(lName: "Doe", fName: "John");
Carrier carrier = CarrierT.CreateCarrier("X271Test");
InsPlan insPlan = InsPlanT.CreateInsPlan(carrier.CarrierNum);
InsSub insSub = InsSubT.CreateInsSub(pat.PatNum, insPlan.PlanNum);
List <EB271> listEb = _x271.GetListEB(true, carrier.IsCoinsuranceInverted);
int countValidInsHist = EB271.SetInsuranceHistoryDates(listEb, pat.PatNum, insSub);
Assert.AreEqual(3, countValidInsHist); //There are 4 valid fields but 1 has an invalid date.
}
public void InsPlan_GetDedRemainDisplay_IndividualAndFamilyDeductiblesInsRemaining()
{
string suffix = "20";
Patient pat = PatientT.CreatePatient(suffix); //guarantor
long patNum = pat.PatNum;
Patient pat2 = PatientT.CreatePatient(suffix);
PatientT.SetGuarantor(pat2, pat.PatNum);
Patient pat3 = PatientT.CreatePatient(suffix);
PatientT.SetGuarantor(pat3, pat.PatNum);
Carrier carrier = CarrierT.CreateCarrier(suffix);
InsPlan plan = InsPlanT.CreateInsPlan(carrier.CarrierNum);
long planNum = plan.PlanNum;
InsSub sub = InsSubT.CreateInsSub(pat.PatNum, planNum); //guarantor is subscriber
long subNum = sub.InsSubNum;
PatPlan patPlan = PatPlanT.CreatePatPlan(1, pat.PatNum, subNum); //all three patients have the same plan
PatPlan patPlan2 = PatPlanT.CreatePatPlan(1, pat2.PatNum, subNum); //all three patients have the same plan
PatPlan patPlan3 = PatPlanT.CreatePatPlan(1, pat3.PatNum, subNum); //all three patients have the same plan
BenefitT.CreateDeductibleGeneral(planNum, BenefitCoverageLevel.Individual, 75);
BenefitT.CreateDeductibleGeneral(planNum, BenefitCoverageLevel.Family, 150);
ClaimProcT.AddInsUsedAdjustment(pat3.PatNum, planNum, 0, subNum, 75); //Adjustment goes on the third patient
Procedure proc = ProcedureT.CreateProcedure(pat2, "D2750", ProcStat.C, "20", 1280); //proc for second patient with a deductible already applied.
ClaimProcT.AddInsPaid(pat2.PatNum, planNum, proc.ProcNum, 304, subNum, 50, 597);
proc = ProcedureT.CreateProcedure(pat, "D4355", ProcStat.TP, "", 135); //proc is for the first patient
long procNum = proc.ProcNum;
//Lists
List <ClaimProc> claimProcs = ClaimProcs.Refresh(patNum);
Family fam = Patients.GetFamily(patNum);
List <InsSub> subList = InsSubs.RefreshForFam(fam);
List <InsPlan> planList = InsPlans.RefreshForSubList(subList);
List <PatPlan> patPlans = PatPlans.Refresh(patNum);
List <Benefit> benefitList = Benefits.Refresh(patPlans, subList);
List <ClaimProcHist> histList = ClaimProcs.GetHistList(patNum, benefitList, patPlans, planList, DateTime.Today, subList);
List <ClaimProcHist> loopList = new List <ClaimProcHist>();
//Validate
List <ClaimProcHist> HistList = ClaimProcs.GetHistList(pat.PatNum, benefitList, patPlans, planList, DateTime.Today, subList);
double dedFam = Benefits.GetDeductGeneralDisplay(benefitList, planNum, patPlan.PatPlanNum, BenefitCoverageLevel.Family);
double ded = Benefits.GetDeductGeneralDisplay(benefitList, planNum, patPlan.PatPlanNum, BenefitCoverageLevel.Individual);
double dedRem = InsPlans.GetDedRemainDisplay(HistList, DateTime.Today, planNum, patPlan.PatPlanNum, -1, planList, pat.PatNum, ded, dedFam); //test family and individual deductible together
Assert.AreEqual(25, dedRem);
dedRem = InsPlans.GetDedRemainDisplay(HistList, DateTime.Today, planNum, patPlan.PatPlanNum, -1, planList, pat.PatNum, ded, -1); //test individual deductible by itself
Assert.AreEqual(75, dedRem);
}
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 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 Claims_CalculateAndUpdate_Allowed1Allowed2CompletedProcedures()
{
string suffix = "8";
Patient pat = PatientT.CreatePatient(suffix);
long patNum = pat.PatNum;
long feeSchedNum1 = FeeSchedT.CreateFeeSched(FeeScheduleType.Normal, suffix);
long feeSchedNum2 = FeeSchedT.CreateFeeSched(FeeScheduleType.Normal, suffix + "b");
//Standard Fee
long codeNum = ProcedureCodes.GetCodeNum("D2750");
Fee fee = Fees.GetFee(codeNum, 53, 0, 0);
if (fee == null)
{
fee = new Fee();
fee.CodeNum = codeNum;
fee.FeeSched = 53;
fee.Amount = 1200;
Fees.Insert(fee);
}
else
{
fee.Amount = 1200;
Fees.Update(fee);
}
//PPO fees
fee = new Fee();
fee.CodeNum = codeNum;
fee.FeeSched = feeSchedNum1;
fee.Amount = 600;
Fees.Insert(fee);
fee = new Fee();
fee.CodeNum = codeNum;
fee.FeeSched = feeSchedNum2;
fee.Amount = 800;
Fees.Insert(fee);
//Carrier
Carrier carrier = CarrierT.CreateCarrier(suffix);
long planNum1 = InsPlanT.CreateInsPlanPPO(carrier.CarrierNum, feeSchedNum1).PlanNum;
long planNum2 = InsPlanT.CreateInsPlanPPO(carrier.CarrierNum, feeSchedNum2).PlanNum;
InsSub sub1 = InsSubT.CreateInsSub(pat.PatNum, planNum1);
long subNum1 = sub1.InsSubNum;
InsSub sub2 = InsSubT.CreateInsSub(pat.PatNum, planNum2);
long subNum2 = sub2.InsSubNum;
BenefitT.CreateCategoryPercent(planNum1, EbenefitCategory.Crowns, 50);
BenefitT.CreateCategoryPercent(planNum2, EbenefitCategory.Crowns, 50);
BenefitT.CreateAnnualMax(planNum1, 1000);
BenefitT.CreateAnnualMax(planNum2, 1000);
PatPlanT.CreatePatPlan(1, patNum, subNum1);
PatPlanT.CreatePatPlan(2, patNum, subNum2);
Procedure proc = ProcedureT.CreateProcedure(pat, "D2750", ProcStat.TP, "8", Fees.GetAmount0(codeNum, 53)); //crown on 8
long procNum = proc.ProcNum;
//Lists
List <ClaimProc> claimProcs = ClaimProcs.Refresh(patNum);
Family fam = Patients.GetFamily(patNum);
List <InsSub> subList = InsSubs.RefreshForFam(fam);
List <InsPlan> planList = InsPlans.RefreshForSubList(subList);
List <PatPlan> patPlans = PatPlans.Refresh(patNum);
List <Benefit> benefitList = Benefits.Refresh(patPlans, subList);
List <Procedure> procList = Procedures.Refresh(patNum);
//Set complete and attach to claim
ProcedureT.SetComplete(proc, pat, planList, patPlans, claimProcs, benefitList, subList);
claimProcs = ClaimProcs.Refresh(patNum);
List <Procedure> procsForClaim = new List <Procedure>();
procsForClaim.Add(proc);
Claim claim = ClaimT.CreateClaim("P", patPlans, planList, claimProcs, procList, pat, procsForClaim, benefitList, subList);
//Validate
Assert.AreEqual(500, claim.WriteOff);
}