private InsPlan GeneratePPOPlan(string suffix, bool codeSubstNone = true)
{
long baseFeeSchedNum = FeeSchedT.CreateFeeSched(FeeScheduleType.Normal, "Normal_" + suffix, true);
Carrier carrier = CarrierT.CreateCarrier("Carrier_" + suffix);
return(InsPlanT.CreateInsPlanPPO(carrier.CarrierNum, baseFeeSchedNum, codeSubstNone));
}
private InsPlan GenerateMediFlatInsPlan(string suffix, bool codeSubstNone = true)
{
long baseFeeSchedNum = FeeSchedT.CreateFeeSched(FeeScheduleType.Normal, "Normal_" + suffix, true);
long copayFeeSchedNum = FeeSchedT.CreateFeeSched(FeeScheduleType.CoPay, "Copay_" + suffix, true);
Carrier carrier = CarrierT.CreateCarrier("Carrier_" + suffix);
return(InsPlanT.CreateInsPlanMediFlatCopay(carrier.CarrierNum, baseFeeSchedNum, copayFeeSchedNum, codeSubstNone));
}
private InsPlan GenerateCapPlan(string suffix, bool createAllowed = true, bool codeSubstNone = true)
{
long baseFeeSchedNum = FeeSchedT.CreateFeeSched(FeeScheduleType.Normal, "Normal_" + suffix, true);
long allowedFeeSchedNum = 0;
if (createAllowed)
{
allowedFeeSchedNum = FeeSchedT.CreateFeeSched(FeeScheduleType.Normal, "Allowed_" + suffix, true);
}
Carrier carrier = CarrierT.CreateCarrier("Carrier_" + suffix);
return(InsPlanT.CreateInsPlanCapitation(carrier.CarrierNum, baseFeeSchedNum, allowedFeeSchedNum, codeSubstNone));
}
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 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);
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, ""), 80);
double amt = InsPlans.GetAllowed(procCode.ProcCode, plan.FeeSched, plan.AllowedFeeSched, plan.CodeSubstNone, plan.PlanType, "", 0, 0);
Assert.AreEqual(defaultFee.Amount, amt);
}