public override List <PaymentResult> EvaluatePaymentType(IEvaluateableClaim claim,
List <PaymentResult> paymentResults, bool isCarveOut, bool isContractFilter)
{
if (PaymentTypeMedicareOp != null)
{
if (isCarveOut ||
(PaymentTypeMedicareOp.PayAtClaimLevel &&
!paymentResults.Any(
currentPaymentResult => currentPaymentResult.Line == null && currentPaymentResult.ServiceTypeId == PaymentTypeMedicareOp.ServiceTypeId)) ||
(!PaymentTypeMedicareOp.PayAtClaimLevel && paymentResults.Any(
currentPaymentResult =>
currentPaymentResult.Line != null &&
PaymentTypeMedicareOp.ValidLineIds.Contains(currentPaymentResult.Line.Value) &&
currentPaymentResult.AdjudicatedValue == null)))
{
if (PaymentTypeMedicareOp != null)
{
MedicareOutPatientResult medicareOutPatientResult = GetMedicareOutPatientResult(claim);
paymentResults = PaymentTypeMedicareOp.PayAtClaimLevel
? EvaluateAtClaimLevel(paymentResults, medicareOutPatientResult, isCarveOut)
: EvaluateAtLineLevel(claim, paymentResults, isCarveOut, medicareOutPatientResult);
}
}
}
return(paymentResults);
}
/// <summary>
/// Gets the result data.
/// </summary>
/// <param name="apcResultsData">The apc results data.</param>
/// <returns></returns>
private static MedicareOutPatientResult GetResultData(string apcResultsData)
{
MedicareOutPatientResult medicareOutPatientResult = new MedicareOutPatientResult
{
IsEditSuccess = true,
PricerErrorCodes = null
};
string vRecord = apcResultsData.Substring(0, 200);
medicareOutPatientResult.ClaimId = vRecord.Substring(1, 17).Trim();
medicareOutPatientResult.TotalPaymentAmount = Convert.ToDouble(vRecord.Substring(53, 9), CultureInfo.InvariantCulture);
string wRecordFull = apcResultsData.Substring(200, apcResultsData.Length - 200);
int lineItemsCount = (apcResultsData.Length - 200) / 200; //This will give the number of W Records
List <string> wRecords = SplitW(wRecordFull, 200).ToList();
medicareOutPatientResult.ReturnCode = 0;
medicareOutPatientResult.Message = string.Empty;
medicareOutPatientResult.LineItemMedicareDetails = new List <WRecordData>();
if (wRecords.Count == lineItemsCount) //This ensures that the parsing if fine
{
foreach (string wRecord in wRecords)
{
WRecordData wRecordData = new WRecordData {
LineItemId = Convert.ToInt32(wRecord.Substring(18, 3), CultureInfo.InvariantCulture)
};
string wholeNumber = wRecord.Substring(21, 7);
string decimalNumber = wRecord.Substring(28, 2);
wRecordData.LinePaymentAmount = Convert.ToDouble(wholeNumber + "." + decimalNumber, CultureInfo.InvariantCulture);
wRecordData.ReturnCode = 0;
wRecordData.ErrorMessage = string.Empty;
medicareOutPatientResult.LineItemMedicareDetails.Add(wRecordData);
}
}
else
{
return(null);
}
return(medicareOutPatientResult);
}
/// <summary>
/// Gets the line level amount.
/// </summary>
/// <param name="medicareOutPatientResult">The medicare out patient result.</param>
/// <param name="lineId">The line identifier.</param>
/// <returns></returns>
private static double?GetLineLevelAmount(MedicareOutPatientResult medicareOutPatientResult, int lineId)
{
double?resultAmount = null;
if (medicareOutPatientResult != null && medicareOutPatientResult.IsEditSuccess && medicareOutPatientResult.IsPricerSuccess)
{
if (medicareOutPatientResult.LineItemMedicareDetails != null &&
medicareOutPatientResult.LineItemMedicareDetails.Count > 0 &&
medicareOutPatientResult.LineItemMedicareDetails.Any(q => q.LineItemId == lineId))
{
WRecordData wRecordData =
medicareOutPatientResult.LineItemMedicareDetails.First(
q => q.LineItemId == lineId);
resultAmount = wRecordData.LinePaymentAmount;
}
else if (medicareOutPatientResult.ReturnCode == 0 &&
medicareOutPatientResult.Message == Constants.MessageMicrodyneOff)
{
resultAmount = 0;
}
}
return(resultAmount);
}
private static void GetInstanceMessage(bool isNetApc, int returnCode, MedicareOutPatientResult medicareOutPatientResult)
{
switch (returnCode)
{
case 5:
medicareOutPatientResult.Message = Constants.MessageMajorClaimError;
break;
case 11:
medicareOutPatientResult.Message = Constants.MessageApcActiveError;
break;
case 98:
medicareOutPatientResult.Message = Constants.MessageSqlTableError;
break;
//Claim Level 'Error' Return Codes
case 50:
medicareOutPatientResult.Message = Constants.MessageWageIndexNotLocated;
break;
case 51:
medicareOutPatientResult.Message = Constants.MessageWageIndexZero;
break;
case 52:
medicareOutPatientResult.Message = Constants.MessageWageIndexError;
break;
case 53:
medicareOutPatientResult.Message = Constants.MessageServiceDateError;
break;
case 54:
medicareOutPatientResult.Message = Constants.MessageLesserServiceDate;
break;
case 55:
medicareOutPatientResult.Message = Constants.MessageInvalidProviderNumber;
break;
case 56:
medicareOutPatientResult.Message = Constants.MessageInvalidBeneficiaryAmount;
break;
case 90:
medicareOutPatientResult.Message = Constants.MessageInputNumberError;
break;
case 95:
medicareOutPatientResult.Message = Constants.MessageApcActivePricerError;
break;
//Reimbursement calculation is terminated for return codes > 50
//Line Item Level 'Error' Return Codes
case 30:
medicareOutPatientResult.Message = Constants.MessageLineItemApcError;
break;
case 38:
medicareOutPatientResult.Message = Constants.MessageLineItemDiscountFactorError;
break;
case 40:
medicareOutPatientResult.Message = Constants.MessageLineItemStatusIndicatorError;
break;
case 48:
medicareOutPatientResult.Message = Constants.MessageLineItemPaymentAdjustmentFlagError;
break;
//Line Item Level 'Processing' Return Codes
case 20:
medicareOutPatientResult.Message = Constants.MessageLinepaymentZero;
break;
case 22:
medicareOutPatientResult.Message = Constants.MessageLineCoInsuranceLimitation;
break;
case 25:
medicareOutPatientResult.Message = Constants.MessageLineReducedCoInsurance;
break;
case 41:
medicareOutPatientResult.Message = Constants.MessageStatusIndicatorNotProcessed;
break;
case 42:
medicareOutPatientResult.Message = Constants.MessageApcZero;
break;
case 43:
medicareOutPatientResult.Message = Constants.MessagePaymentIndicatorError;
break;
case 44:
medicareOutPatientResult.Message = Constants.MessageStatusIndicatorError;
break;
case 45:
medicareOutPatientResult.Message = Constants.MessagePackagingFlagError;
break;
case 46:
medicareOutPatientResult.Message = Constants.MessageLineItemReject;
break;
case 47:
medicareOutPatientResult.Message = Constants.MessageLineFlag;
break;
case 49:
medicareOutPatientResult.Message = Constants.MessagePaymentMethodFlag;
break;
default:
if (isNetApc && returnCode == 1)
{
medicareOutPatientResult.Message = Constants.MessageClaimError;
}
else if (!isNetApc && returnCode == 1)
{
medicareOutPatientResult.Message = Constants.MessageLineSuccess;
}
else if (isNetApc && returnCode == 99)
{
medicareOutPatientResult.Message = Constants.MessageApcActiveLicenseExpired;
}
else if (!isNetApc && returnCode == 99)
{
medicareOutPatientResult.Message = Constants.MessageApcActivePricerLicenseExpired;
}
else if (returnCode == 100)
{
medicareOutPatientResult.Message = Constants.MessageSqlError;
}
break;
}
}
private MedicareOutPatientResult GetMedicareOutPatientResult(IEvaluateableClaim claim)
{
StringBuilder inputData = new StringBuilder();
MedicareOutPatientResult medicareOutPatientResult = new MedicareOutPatientResult();
MicrodynApcEditInput microdynApcEditInput = claim.MicrodynApcEditInput;
string dLine = string.Empty;
string eLine = string.Empty;
string cLine = _cRecordLogic.GetCRecordLine(microdynApcEditInput.CRecord);
if (claim.StatementThru >= DateTime.Parse(Constants.IcdVersionDate, CultureInfo.InvariantCulture))
{
eLine = _eRecordLogic.GetERecordLine(microdynApcEditInput.ERecord);
}
else
{
dLine = _dRecordLogic.GetDRecordLine(microdynApcEditInput.DRecord);
}
string lLine = _lRecordLogic.GetLRecordLine(microdynApcEditInput.LRecords);
if (GlobalConfigVariable.IsMicrodynEnabled)
{
inputData.Append(cLine);
string diagnosisLine = (claim.StatementThru >= DateTime.Parse(Constants.IcdVersionDate, CultureInfo.InvariantCulture) ? eLine : dLine);
inputData.Append(diagnosisLine);
inputData.Append(lLine);
if (inputData.Length !=
Constants.CRecordLength + Constants.DRecordLength +
(microdynApcEditInput.LRecords.Count * Constants.LRecordLength))
{
medicareOutPatientResult.ReturnCode = 1;
medicareOutPatientResult.Message = Constants.MessageClaimDataError;
if (GlobalConfigVariable.IsMicrodynLogEnabled)
{
if (claim.StatementThru >= DateTime.Parse(Constants.IcdVersionDate, CultureInfo.InvariantCulture))
{
Log.LogInfo(
string.Format(CultureInfo.InvariantCulture, DataIssueMessageFormatWithERecord,
claim.ClaimId, cLine, Environment.NewLine,
_cRecordLogic.ValidationErrors, Environment.NewLine,
diagnosisLine, Environment.NewLine,
_eRecordLogic.ValidationErrors, Environment.NewLine,
lLine, Environment.NewLine,
_lRecordLogic.ValidationErrors),
Constants.MicrodynApcEditDllResultsData);
}
else
{
Log.LogInfo(
string.Format(CultureInfo.InvariantCulture, DataIssueMessageFormatWithDRecord,
claim.ClaimId, cLine, Environment.NewLine,
_cRecordLogic.ValidationErrors, Environment.NewLine,
diagnosisLine, Environment.NewLine,
_dRecordLogic.ValidationErrors, Environment.NewLine,
lLine, Environment.NewLine,
_lRecordLogic.ValidationErrors),
Constants.MicrodynApcEditDllResultsData);
}
}
return(medicareOutPatientResult);
}
Instance.InputLineCount = microdynApcEditInput.LRecords.Count;
Instance.InputData = inputData.ToString();
Instance.AutoDenyReject = false;
Instance.APCEdit();
if (Instance.APCErrorsFound)
{
//Processing Unsuccessful - Edit errors found
//ResultsData contains claim and line item errors
medicareOutPatientResult.ReturnCode = Instance.ReturnCode;
GetInstanceMessage(true, Instance.ReturnCode, medicareOutPatientResult);
if (Instance.ResultsData.Length % 200 == 0)
{
medicareOutPatientResult.EditErrorCodes = GetResultMessageData(Instance.ResultsData);
}
medicareOutPatientResult.MicrodynEditReturnRemarks = "Error Code:" + medicareOutPatientResult.ReturnCode + "; " +
medicareOutPatientResult.Message;
if (GlobalConfigVariable.IsMicrodynLogEnabled)
{
if (claim.StatementThru >= DateTime.Parse(Constants.IcdVersionDate, CultureInfo.InvariantCulture))
{
Log.LogInfo(
string.Format(CultureInfo.InvariantCulture, ApcErrorMessageFormatWithERecord, claim.ClaimId,
medicareOutPatientResult.Message, Instance.ResultsData,
string.IsNullOrEmpty(medicareOutPatientResult.EditErrorCodes)
? string.Empty
: Constants.ErrorCodes + medicareOutPatientResult.EditErrorCodes,
Environment.NewLine, cLine, Environment.NewLine, diagnosisLine, Environment.NewLine,
lLine),
Constants.MicrodynApcEditDllResultsData);
}
else
{
Log.LogInfo(
string.Format(CultureInfo.InvariantCulture, ApcErrorMessageFormatWithDRecord, claim.ClaimId,
medicareOutPatientResult.Message, Instance.ResultsData,
string.IsNullOrEmpty(medicareOutPatientResult.EditErrorCodes)
? string.Empty
: Constants.ErrorCodes + medicareOutPatientResult.EditErrorCodes,
Environment.NewLine, cLine, Environment.NewLine, diagnosisLine, Environment.NewLine,
lLine),
Constants.MicrodynApcEditDllResultsData);
}
}
}
else
{
medicareOutPatientResult.IsEditSuccess = true;
string inputDataString = Instance.PaymentInputData;
MedicareOutPatient objPatientData = microdynApcEditInput.MedicareOutPatientRecord;
_apcPayDll = new NetAPCPay
{
InputLineCount = microdynApcEditInput.LRecords.Count,
InputData = inputDataString,
ProviderNumber = objPatientData.Npi,
ServiceFromDate = Convert.ToString(objPatientData.ServiceDate, CultureInfo.InvariantCulture),
BeneDeductible = Convert.ToDouble(objPatientData.BeneDeductible),
BloodDeductiblePints = Convert.ToInt32(objPatientData.BloodDeductiblePints),
AllowTerminatedProvider = Convert.ToBoolean(objPatientData.AllowTerminatorProvider, CultureInfo.InvariantCulture),
AdjustmentFactor = Convert.ToDouble(objPatientData.AdjustFactor),
AdjustmentOption = Convert.ToInt32(objPatientData.AdjustmentOptions)
};
_apcPayDll.APCCalc();
if (!_apcPayDll.CalcErrorsFound)
{
//No Errors found
//Parse the V and W records to get the out patient payment details
medicareOutPatientResult = GetResultData(_apcPayDll.ResultsData);
medicareOutPatientResult.ReturnCode = 0;
medicareOutPatientResult.Message = Constants.MessageNoError;
medicareOutPatientResult.IsPricerSuccess = true;
}
else
{
//Errors found in APC Payment calculation
medicareOutPatientResult.ReturnCode = _apcPayDll.ReturnCode;
GetInstanceMessage(false, _apcPayDll.ReturnCode, medicareOutPatientResult);
medicareOutPatientResult.PricerErrorCodes = medicareOutPatientResult.ReturnCode;
if (GlobalConfigVariable.IsMicrodynLogEnabled)
{
if (claim.StatementThru >= DateTime.Parse(Constants.IcdVersionDate, CultureInfo.InvariantCulture))
{
Log.LogInfo(
string.Format(CultureInfo.InvariantCulture, ApcCalcMessageFormatWithERecord, claim.ClaimId, medicareOutPatientResult.Message,
medicareOutPatientResult.PricerErrorCodes == 0
? string.Empty
: Constants.ErrorCodes + medicareOutPatientResult.PricerErrorCodes, _apcPayDll.ResultsData,
Environment.NewLine, cLine, Environment.NewLine, eLine, Environment.NewLine, lLine),
Constants.MicrodynApcCalcDllResultsData);
}
else
{
Log.LogInfo(
string.Format(CultureInfo.InvariantCulture, ApcCalcMessageFormatWithDRecord, claim.ClaimId, medicareOutPatientResult.Message,
medicareOutPatientResult.PricerErrorCodes == 0
? string.Empty
: Constants.ErrorCodes + medicareOutPatientResult.PricerErrorCodes, _apcPayDll.ResultsData,
Environment.NewLine, cLine, Environment.NewLine, dLine, Environment.NewLine, lLine),
Constants.MicrodynApcCalcDllResultsData);
}
}
}
_apcPayDll.Dispose();
}
}
else
{
medicareOutPatientResult.ReturnCode = 0;
medicareOutPatientResult.TotalPaymentAmount = 0;
medicareOutPatientResult.Message = Constants.MessageMicrodyneOff;
medicareOutPatientResult.IsEditSuccess = true;
}
return(medicareOutPatientResult);
}
/// <summary>
/// Evaluates at claim level.
/// </summary>
/// <param name="paymentResults">The payment results.</param>
/// <param name="medicareOutPatientResult">The medicare out patient result.</param>
/// <param name="isCarveOut">if set to <c>true</c> [is carve out].</param>
/// <returns></returns>
private List <PaymentResult> EvaluateAtClaimLevel(List <PaymentResult> paymentResults, MedicareOutPatientResult medicareOutPatientResult, bool isCarveOut)
{
PaymentResult claimPaymentResult = GetClaimLevelPaymentResult(paymentResults, isCarveOut);
if (claimPaymentResult != null && medicareOutPatientResult != null)
{
//Update PaymentResult and set matching ServiceTypeId,PaymentTypeDetailId & PaymentTypeId
Utilities.UpdatePaymentResult(claimPaymentResult, PaymentTypeMedicareOp.ServiceTypeId,
PaymentTypeMedicareOp.PaymentTypeDetailId, PaymentTypeMedicareOp.PaymentTypeId);
if (medicareOutPatientResult.IsEditSuccess && medicareOutPatientResult.IsPricerSuccess)
{
if (PaymentTypeMedicareOp.OutPatient.HasValue)
{
double adjValue = (PaymentTypeMedicareOp.OutPatient.Value / 100) * medicareOutPatientResult.TotalPaymentAmount;
claimPaymentResult.AdjudicatedValue = adjValue;
claimPaymentResult.ClaimStatus = (byte)Enums.AdjudicationOrVarianceStatuses.Adjudicated;
}
else
{
claimPaymentResult.ClaimStatus =
(byte)Enums.AdjudicationOrVarianceStatuses.AdjudicationErrorInvalidPaymentData;
}
}
else if (!medicareOutPatientResult.IsEditSuccess)
{
claimPaymentResult.ClaimStatus = (byte)Enums.AdjudicationOrVarianceStatuses.ClaimDataError;
claimPaymentResult.MicrodynEditErrorCodes = medicareOutPatientResult.EditErrorCodes;
claimPaymentResult.MicrodynEditReturnRemarks = medicareOutPatientResult.MicrodynEditReturnRemarks;
}
else
{
claimPaymentResult.ClaimStatus = (byte)Enums.AdjudicationOrVarianceStatuses.ClaimDataError;
claimPaymentResult.MicrodynPricerErrorCodes = medicareOutPatientResult.PricerErrorCodes;
claimPaymentResult.MicrodynEditReturnRemarks = medicareOutPatientResult.MicrodynEditReturnRemarks;
}
}
return(paymentResults);
}
/// <summary>
/// Evaluates at line level.
/// </summary>
/// <param name="claim">The claim.</param>
/// <param name="paymentResults">The payment results.</param>
/// <param name="isCarveOut">if set to <c>true</c> [is carve out].</param>
/// <param name="medicareOutPatientResult">The medicare out patient result.</param>
/// <returns></returns>
private List <PaymentResult> EvaluateAtLineLevel(IEvaluateableClaim claim, List <PaymentResult> paymentResults, bool isCarveOut, MedicareOutPatientResult medicareOutPatientResult)
{
foreach (ClaimCharge claimCharge in claim.ClaimCharges)
{
if (isCarveOut &&
paymentResults.Any(
currentPaymentResult =>
currentPaymentResult.Line == claimCharge.Line &&
currentPaymentResult.ServiceTypeId == PaymentTypeMedicareOp.ServiceTypeId))
{
break;
}
if (PaymentTypeMedicareOp.ValidLineIds.Contains(claimCharge.Line) && paymentResults.Any(
currentPaymentResult =>
currentPaymentResult.Line == claimCharge.Line &&
(currentPaymentResult.AdjudicatedValue == null || isCarveOut)))
{
PaymentResult paymentResult = GetPaymentResult(paymentResults, isCarveOut,
claimCharge.Line);
//Update PaymentResult and set matching ServiceTypeId,PaymentTypeDetailId & PaymentTypeId
Utilities.UpdatePaymentResult(paymentResult, PaymentTypeMedicareOp.ServiceTypeId,
PaymentTypeMedicareOp.PaymentTypeDetailId, PaymentTypeMedicareOp.PaymentTypeId);
//Get Line level Adjudciated amount from medicareOutPatientResult
double?resultAmount = GetLineLevelAmount(medicareOutPatientResult, claimCharge.Line);
if (resultAmount.HasValue)
{
if (PaymentTypeMedicareOp.OutPatient.HasValue)
{
double adjValue = (PaymentTypeMedicareOp.OutPatient.Value / 100) *
resultAmount.Value;
paymentResult.AdjudicatedValue = adjValue;
paymentResult.ClaimStatus =
(byte)Enums.AdjudicationOrVarianceStatuses.Adjudicated;
}
else
{
paymentResult.ClaimStatus =
(byte)
Enums.AdjudicationOrVarianceStatuses
.AdjudicationErrorInvalidPaymentData;
}
}
else if (!medicareOutPatientResult.IsEditSuccess)
{
paymentResult.ClaimStatus =
(byte)Enums.AdjudicationOrVarianceStatuses.ClaimDataError;
paymentResult.MicrodynEditErrorCodes = medicareOutPatientResult.EditErrorCodes;
paymentResult.MicrodynEditReturnRemarks = medicareOutPatientResult.MicrodynEditReturnRemarks;
}
else if (!medicareOutPatientResult.IsPricerSuccess)
{
paymentResult.ClaimStatus =
(byte)Enums.AdjudicationOrVarianceStatuses.ClaimDataError;
paymentResult.MicrodynPricerErrorCodes = medicareOutPatientResult.PricerErrorCodes;
paymentResult.MicrodynEditReturnRemarks = medicareOutPatientResult.MicrodynEditReturnRemarks;
}
}
}
return(paymentResults);
}
/// <summary>
/// Actual Method call for Microdyn output retrieval
/// </summary>
public MedicareOutPatientResult GetMedicareOutPatientResult(long claimId)
{
StringBuilder inputData = new StringBuilder();
MedicareOutPatientResult medicareOutPatientResult = new MedicareOutPatientResult();
MicrodynApcEditInput microdynApcEditInput = _medicareOutPatientRepository.GetMicrodynApcEditInput(claimId);
string cLine = GetCRecordLine(microdynApcEditInput.CRecord);
string dLine = GetDRecordLine(microdynApcEditInput.DRecord);
string lLine = GetLRecordLine(microdynApcEditInput.LRecords);
if (GlobalConfigVariable.IsMicrodynEnabled)
{
if (!string.IsNullOrEmpty(cLine) && !string.IsNullOrEmpty(dLine) && !string.IsNullOrEmpty(lLine))
{
int calcTotal = cLine.Length + dLine.Length + (microdynApcEditInput.LRecords.Count * 200);
inputData.Append(cLine);
inputData.Append(dLine);
inputData.Append(lLine);
if (inputData.Length != calcTotal)
{
medicareOutPatientResult.ReturnCode = 1;
medicareOutPatientResult.Message = "Claim Data Errors Found";
return(medicareOutPatientResult);
}
}
else
{
medicareOutPatientResult.ReturnCode = 1;
medicareOutPatientResult.Message = "Claim Data Errors Found";
return(medicareOutPatientResult);
}
Instance.InputLineCount = microdynApcEditInput.LRecords.Count;
Instance.InputData = inputData.ToString();
Instance.AutoDenyReject = false;
Instance.APCEdit();
if (GlobalConfigVariable.IsMicrodynLogEnabled)
{
Log.LogInfo(Instance.ResultsData + "ClaimId-" + claimId, "MicrodynApcEditDllResultsData");
Log.LogInfo(Instance.PaymentInputData + "ClaimId-" + claimId, "MicrodynApcEditDllPaymentInputData");
}
if (Instance.APCErrorsFound)
{
//Processing Unsuccessful - Edit errors found
//ResultsData contains claim and line item errors
switch (Instance.ReturnCode)
{
case 1:
medicareOutPatientResult.ReturnCode = 1;
medicareOutPatientResult.Message = "Claim Errors Found";
break;
case 5:
medicareOutPatientResult.ReturnCode = 5;
medicareOutPatientResult.Message = "Major claim errors found - processing suspended";
break;
case 11:
medicareOutPatientResult.ReturnCode = 11;
medicareOutPatientResult.Message = "Misc. APCActive Error";
break;
case 98:
medicareOutPatientResult.ReturnCode = 98;
medicareOutPatientResult.Message = "SQL tables corrupted or loaded incorrectly";
break;
case 99:
medicareOutPatientResult.ReturnCode = 99;
medicareOutPatientResult.Message = "APCActive license id expired";
break;
case 100:
medicareOutPatientResult.ReturnCode = 100;
medicareOutPatientResult.Message = "SQL data access error";
break;
// *** Ignore
}
}
else
{
string inputDataString = Instance.PaymentInputData;
MedicareOutPatient objPatientData = microdynApcEditInput.MedicareOutPatientRecord;
_apcPayDll = new NetAPCPay
{
InputLineCount = microdynApcEditInput.LRecords.Count,
InputData = inputDataString,
// Test data - this gives some value for the total payment amount
//InputLineCount = 25,
//InputData = @"T$11411-018 001Q00810012000120 T 1200 0000000010000017000020030303 T$11411-018 002Q00810012000120 T 1200 0000000010000017000020030304 T$11411-018 003Q00810012000120 T 1200 0000000010000017000020030318 T$11411-018 004856100000000000 A 2100 0200000010000002098020030303 T$11411-018 005856100000000000 A 2100 0200000010000002098020030318 T$11411-018 006850250000000000 A 2100 0200000010000002625020030319 T$11411-018 007856510000000000 A 2100 0200000010000001890020030319 T$11411-018 008365400000000000 N 9101 0000000010000005000020030303 T$11411-018 009907840035900359 X 1100 0000000020000010000020030303 T$11411-018 010907840035900359 X 1100 0000000030000015000020030304 T$11411-018 011365400000000000 N 9101 0000000010000005000020030318 T$11411-018 012907840035900359 X 1100 0000000030000015000020030318 T$11411-018 013J11000000000000 N 9101 0000000030000001395020030303 T$11411-018 014J12000000000000 N 9101 0000000010000001885020030303 T$11411-018 015J15630090500905 K 1100 0000000720001352160020030303 T$11411-018 016J19400000000000 N 9101 0000000020000003660020030303 T$11411-018 017J11000000000000 N 9101 0000000030000001395020030304 T$11411-018 018J12000000000000 N 9101 0000000010000001885020030304 T$11411-018 019J15630090500905 K 1100 0000000720001352160020030304 T$11411-018 020J19400000000000 N 9101 0000000020000003660020030304 T$11411-018 021J34870911509115 G 5100 1000000040000199400020030304 T$11411-018 022J11000000000000 N 9101 0000000030000001395020030318 T$11411-018 023J12000000000000 N 9101 0000000010000001885020030318 T$11411-018 024J15630090500905 K 1100 0000000720001352160020030318 T$11411-018 025J19400000000000 N 9101 0000000020000003660020030318 ",
//ServiceFromDate = "03/03/2003",
ProviderNumber = objPatientData.NPI,
ServiceFromDate = Convert.ToString(objPatientData.ServiceDate),
BeneDeductible = Convert.ToDouble(objPatientData.BeneDeductible),
BloodDeductiblePints = Convert.ToInt32(objPatientData.BloodDeductiblePints),
AllowTerminatedProvider = Convert.ToBoolean(objPatientData.AllowTerminatorProvider),
AdjustmentFactor = Convert.ToDouble(objPatientData.AdjustFactor),
AdjustmentOption = Convert.ToInt32(objPatientData.AdjustmentOptions)
};
_apcPayDll.APCCalc();
if (!_apcPayDll.CalcErrorsFound)
{
//No Errors found
//Parse the V and W records to get the out patient payment details
medicareOutPatientResult = GetResultData(_apcPayDll.ResultsData);
medicareOutPatientResult.ReturnCode = 0;
medicareOutPatientResult.Message = "No errors Found";
}
else
{
//Errors found in APC Payment calculation
medicareOutPatientResult.ReturnCode = _apcPayDll.ReturnCode;
switch (_apcPayDll.ReturnCode)
{
//Claim Level 'Error' Return Codes
case 50:
medicareOutPatientResult.Message = "Wage Index not located ";
break;
case 51:
medicareOutPatientResult.Message = "Wage Index = 0 ";
break;
case 52:
medicareOutPatientResult.Message = "Provider file Wage Index reclassification code invalid or missing ";
break;
case 53:
medicareOutPatientResult.Message = "Service date not numeric or < 8/1/2000 Provider file waiver indicator = “Y”. Case cannot be processed. ";
break;
case 54:
medicareOutPatientResult.Message = "Service date < provider effective date ";
break;
case 55:
medicareOutPatientResult.Message = "Invalid provider number ";
break;
case 56:
medicareOutPatientResult.Message = "Invalid beneficiary deductible amount ";
break;
case 90:
medicareOutPatientResult.Message = "Input number of line items in error ";
break;
case 95:
medicareOutPatientResult.Message = "Misc. APCActive Pricer DLL error ";
break;
case 99:
medicareOutPatientResult.Message = "APCActive Pricer License is expired ";
break;
case 100:
medicareOutPatientResult.Message = "SQL data access error ";
break;
//Reimbursement calculation is terminated for return codes > 50
//Line Item Level 'Error' Return Codes
case 30:
medicareOutPatientResult.Message = "Line item APC is missing or invalid";
break;
case 38:
medicareOutPatientResult.Message = "Line item Discount factor is invalid";
break;
case 40:
medicareOutPatientResult.Message = "Line item Status Indicator is invalid";
break;
case 48:
medicareOutPatientResult.Message = "Line item Payment Adjustment Flag is invalid";
break;
//Line Item Level 'Processing' Return Codes
case 1:
medicareOutPatientResult.Message = " Line processed successfully ";
break;
case 20:
medicareOutPatientResult.Message = " Line processed but payment =0, all applied to deductible. ";
break;
case 22:
medicareOutPatientResult.Message = " Daily coinsurance limitation – claim processed ";
break;
case 25:
medicareOutPatientResult.Message = " Line item has reduced coinsurance amount ";
break;
case 41:
medicareOutPatientResult.Message = " Status Indicator not processed by OPPS Pricer ";
break;
case 42:
medicareOutPatientResult.Message = " APC = 00000 ";
break;
case 43:
medicareOutPatientResult.Message = " Payment Indicator not = 1 or 5 thru 9 ";
break;
case 44:
medicareOutPatientResult.Message = " Status indicator = 'H', but payment indicator not = '6' ";
break;
case 45:
medicareOutPatientResult.Message = " Packaging flag <> '0' ";
break;
case 46:
medicareOutPatientResult.Message = " Line item denial/reject flag not = to 0 and line item action flag not = to 1 ";
break;
case 47:
medicareOutPatientResult.Message = " Line item action flag = 2 or 3 ";
break;
case 49:
medicareOutPatientResult.Message = " Payment Method Flag not = to 0 ";
break;
}
if (GlobalConfigVariable.IsMicrodynLogEnabled)
{
Log.LogInfo(medicareOutPatientResult.Message + "ClaimId-" + claimId, "MicrodynApcEditDllResultsData");
}
}
_apcPayDll.Dispose();
}
}
else
{
medicareOutPatientResult.ReturnCode = 0;
medicareOutPatientResult.TotalPaymentAmount = 0;
medicareOutPatientResult.Message = "Microdyne Switched Off";
}
return(medicareOutPatientResult);
}
