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 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_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 TearDownTest()
{
BenefitT.ClearBenefitTable();
CarrierT.ClearCarrierTable();
ClaimT.ClearClaimTable();
ClaimProcT.ClearClaimProcTable();
EtransT.ClearEtransTable();
InsPlanT.ClearInsPlanTable();
InsSubT.ClearInsSubTable();
PatientT.ClearPatientTable();
PatPlanT.ClearPatPlanTable();
ProcedureT.ClearProcedureTable();
SubstitutionLinkT.ClearSubstitutionLinkTable();
}
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 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 ClaimProcs_ComputeEstimatesByOrthoCase_SetClaimProcForEachProcType()
{
Prefs.UpdateString(PrefName.OrthoBandingCodes, "D8080");
Prefs.UpdateString(PrefName.OrthoDebondCodes, "D8070");
Prefs.UpdateString(PrefName.OrthoVisitCodes, "D8060");
Patient pat = PatientT.CreatePatient(MethodBase.GetCurrentMethod().Name);
Procedure bandingProc = ProcedureT.CreateProcedure(pat, "D8080", ProcStat.C, "", 0);
PatPlan patPlan = PatPlanT.CreatePatPlan(1, pat.PatNum, 0);
ClaimProc bandingClaimProc = ClaimProcT.CreateClaimProc(pat.PatNum, bandingProc.ProcNum, 0, 0, bandingProc.ProcDate, 1, 1, 1);
Procedure visitProc = ProcedureT.CreateProcedure(pat, "D8060", ProcStat.C, "", 0);
ClaimProc visitClaimProc = ClaimProcT.CreateClaimProc(pat.PatNum, visitProc.ProcNum, 0, 0, visitProc.ProcDate, 1, 1, 1);
Procedure debondProc = ProcedureT.CreateProcedure(pat, "D8070", ProcStat.C, "", 0);
ClaimProc debondClaimProc = ClaimProcT.CreateClaimProc(pat.PatNum, debondProc.ProcNum, 0, 0, debondProc.ProcDate, 1, 1, 1);
long orthoCaseNum = OrthoCaseT.InsertForFormOrthoCase(pat.PatNum, 2000, 1200, 0, 800, DateTime.Today, false, DateTime.Today.AddMonths(12), 1000, 400, 60, bandingProc);
OrthoCase orthoCase = OrthoCases.GetOne(orthoCaseNum);
OrthoPlanLink schedulePlanLink = OrthoPlanLinks.GetOneForOrthoCaseByType(orthoCaseNum, OrthoPlanLinkType.OrthoSchedule);
OrthoSchedule orthoSchedule = OrthoSchedules.GetOne(schedulePlanLink.FKey);
OrthoProcLinks.LinkProcForActiveOrthoCase(bandingProc);
OrthoProcLinks.LinkProcForActiveOrthoCase(visitProc);
OrthoProcLinks.LinkProcForActiveOrthoCase(debondProc);
List <OrthoProcLink> allProcLinks = OrthoProcLinks.GetManyByOrthoCase(orthoCaseNum);
OrthoProcLink bandingLink = allProcLinks.FirstOrDefault(x => x.ProcLinkType == OrthoProcType.Banding);
OrthoProcLink debondLink = allProcLinks.FirstOrDefault(x => x.ProcLinkType == OrthoProcType.Debond);
OrthoProcLink visitLink = allProcLinks.FirstOrDefault(x => x.ProcLinkType == OrthoProcType.Visit);
List <ClaimProc> listAllClaimProcs = new List <ClaimProc>()
{
bandingClaimProc, visitClaimProc, debondClaimProc
};
List <OrthoProcLink> listAllOrthoProcLinks = new List <OrthoProcLink>()
{
bandingLink, visitLink, debondLink
};
List <PatPlan> listPatPlans = new List <PatPlan>()
{
patPlan
};
ClaimProcs.ComputeEstimatesByOrthoCase(bandingProc, bandingLink, orthoCase, orthoSchedule, true, listAllClaimProcs,
new List <ClaimProc>()
{
bandingClaimProc
}, listPatPlans, listAllOrthoProcLinks);
ClaimProcs.ComputeEstimatesByOrthoCase(debondProc, debondLink, orthoCase, orthoSchedule, true, listAllClaimProcs,
new List <ClaimProc>()
{
debondClaimProc
}, listPatPlans, listAllOrthoProcLinks);
ClaimProcs.ComputeEstimatesByOrthoCase(visitProc, visitLink, orthoCase, orthoSchedule, true, listAllClaimProcs,
new List <ClaimProc>()
{
visitClaimProc
}, listPatPlans, listAllOrthoProcLinks);
Assert.AreEqual(bandingClaimProc.AllowedOverride, 0);
Assert.AreEqual(bandingClaimProc.CopayOverride, 0);
Assert.AreEqual(bandingClaimProc.PercentOverride, 0);
Assert.AreEqual(bandingClaimProc.PaidOtherInsOverride, 0);
Assert.AreEqual(bandingClaimProc.WriteOffEstOverride, 0);
Assert.AreEqual(bandingClaimProc.InsEstTotalOverride, 600);
Assert.AreEqual(debondClaimProc.AllowedOverride, 0);
Assert.AreEqual(debondClaimProc.CopayOverride, 0);
Assert.AreEqual(debondClaimProc.PercentOverride, 0);
Assert.AreEqual(debondClaimProc.PaidOtherInsOverride, 0);
Assert.AreEqual(debondClaimProc.WriteOffEstOverride, 0);
Assert.AreEqual(debondClaimProc.InsEstTotalOverride, 240);
Assert.AreEqual(visitClaimProc.AllowedOverride, 0);
Assert.AreEqual(visitClaimProc.CopayOverride, 0);
Assert.AreEqual(visitClaimProc.PercentOverride, 0);
Assert.AreEqual(visitClaimProc.PaidOtherInsOverride, 0);
Assert.AreEqual(visitClaimProc.WriteOffEstOverride, 0);
Assert.AreEqual(visitClaimProc.InsEstTotalOverride, 36);
}
