///<summary>StringBuilder does not get altered if no invalid data.</summary>
public static void BillProv(clsProvider billProv, StringBuilder strb)
{
if (billProv.LName.Trim() == "")
{
Comma(strb);
strb.Append("Billing Prov LName");
}
if (!billProv.IsNotPerson && billProv.FName.Trim() == "")
{//if is a person, first name cannot be blank.
Comma(strb);
strb.Append("Billing Prov FName");
}
if (!Regex.IsMatch(billProv.SSN.Trim(), "^[0-9]{9}$"))
{//must be exactly 9 in length (no dashes)
Comma(strb);
strb.Append("Billing Prov SSN/TIN must be a 9 digit number");
}
if (!Regex.IsMatch(billProv.NationalProvID.Trim(), "^(80840)?[0-9]{10}$"))
{
Comma(strb);
strb.Append("Billing Prov NPI must be a 10 digit number with an optional prefix of 80840");
}
if (billProv.TaxonomyCodeOverride.Trim().Length > 0 && billProv.TaxonomyCodeOverride.Trim().Length != 10)
{
Comma(strb);
strb.Append("Billing Prov Taxonomy Code must be 10 characters");
}
//Always check provider name variables regardless of IsNotPerson.
if (!billProv.IsNotPerson)
{//The first name and middle name are only required if the billing provider is a person. For an organization, these fields are never sent.
string fNameInvalidChars = GetNonAN(billProv.FName.Trim());
if (fNameInvalidChars != "")
{
Comma(strb);
strb.Append("Billing Prov First Name contains invalid characters: " + fNameInvalidChars);
}
string middleInvalidChars = GetNonAN(billProv.MI.Trim());
if (middleInvalidChars != "")
{
Comma(strb);
strb.Append("Billing Prov MI contains invalid characters: " + middleInvalidChars);
}
}
string lNameInvalidChars = GetNonAN(billProv.LName.Trim());
if (lNameInvalidChars != "")
{
Comma(strb);
strb.Append("Billing Prov Last Name contains invalid characters: " + lNameInvalidChars);
}
/* This was causing problems when dummy providers were used for office and no license number was applicable.
* Delta carriers key off this number and start assigning to wrong provider. Customer: ATD.
* if(billProv.StateLicense=="") {
* if(strb.Length!=0) {
* strb.Append(",");
* }
* strb.Append("Billing Prov Lic #");
* }*/
}
///<summary>Returns the Provider Taxonomy code for the given specialty. Always 10 characters, validated.</summary>
public static string GetTaxonomy(clsProvider provider)
{
if (provider.TaxonomyCodeOverride != "")
{
return(provider.TaxonomyCodeOverride);
}
string spec = "1223G0001X";//general
switch (provider.Specialty.ToString().ToLower())
{
case "general": spec = "1223G0001X"; break;
case "hygienist": spec = "124Q00000X"; break;
case "publichealth": spec = "1223D0001X"; break;
case "endodontics": spec = "1223E0200X"; break;
case "pathology": spec = "1223P0106X"; break;
case "radiology": spec = "1223X0008X"; break;
case "surgery": spec = "1223S0112X"; break;
case "ortho": spec = "1223X0400X"; break;
case "pediatric": spec = "1223P0221X"; break;
case "perio": spec = "1223P0300X"; break;
case "prosth": spec = "1223P0700X"; break;
case "denturist": spec = "122400000X"; break;
case "assistant": spec = "126800000X"; break;
case "labtech": spec = "126900000X"; break;
}
return(spec);
}
public static string Validate(clsClearinghouse clearhouse, clsCarrier carrier, clsProvider billProv, clsClinic clinic, clsInsPlan insPlan, clsPatientSubscriber subscriber, clsInsSub insSub, clsPractice practice, clsGeneral general)
{
try
{
// LogLibrary.WriteErrorLog("1");
StringBuilder strb = new StringBuilder();
X12Validate.ISA(clearhouse, strb);
X12Validate.Carrier(carrier, strb);
if (carrier.ElectID.Trim().Length < 2)
{
if (strb.Length != 0)
{
strb.Append(",");
}
strb.Append("Electronic ID");
}
if (billProv.SSN.Trim().Length != 9)
{
if (strb.Length != 0)
{
strb.Append(",");
}
strb.Append("Prov TIN 9 digits");
}
X12Validate.BillProv(billProv, strb);
if (general.UseBillingAddressOnClaims)
{
X12Validate.BillingAddress(practice, strb);
}
else if (clinic == null)
{
X12Validate.PracticeAddress(practice, strb);
}
else
{
X12Validate.Clinic(clinic, strb);
}
if (insSub.SubscriberID.Trim().Length < 2)
{
if (strb.Length != 0)
{
strb.Append(",");
}
strb.Append("SubscriberID");
}
if (subscriber.Birthdate.Year < 1880)
{
if (strb.Length != 0)
{
strb.Append(",");
}
strb.Append("Subscriber Birthdate");
}
if (insPlan.GroupNum.Trim() == "")
{
if (strb.Length != 0)
{
strb.Append(",");
}
strb.Append("Group Number");
}
return(strb.ToString());
}
catch (Exception ex)
{
Library.WriteErrorLog("Catch-" + ex.Message + Environment.NewLine + ex.StackTrace);
// MessageBox.Show("clsValidate-"+ex.InnerException+Environment.NewLine+ex.Message+Environment.NewLine+ex.StackTrace);
throw ex;
}
}
public static string GenerateMessageText(clsClearinghouse clearhouse, clsCarrier carrier, clsProvider billProv, clsClinic clinic, clsInsPlan insPlan, clsPatientSubscriber subscriber, clsInsSub insSub, clsGeneral general, clsPractice practice)
{
int batchNum = clearhouse.LastBatchNumber; //Clearinghouses.GetNextBatchNumber(clearhouse);
string groupControlNumber = batchNum.ToString(); //Must be unique within file. We will use batchNum
int transactionNum = 1;
StringBuilder strb = new StringBuilder();
//Interchange Control Header
strb.AppendLine("ISA*00* *" //ISA01,ISA02: 00 + 10 spaces
+ "00* *" //ISA03,ISA04: 00 + 10 spaces
+ clearhouse.ISA05 + "*" //ISA05: Sender ID type: ZZ=mutually defined. 30=TIN. Validated
+ clsX12Generator.GetISA06(clearhouse) + "*" //ISA06: Sender ID(TIN). Or might be TIN of Open Dental
+ clearhouse.ISA07 + "*" //ISA07: Receiver ID type: ZZ=mutually defined. 30=TIN. Validated
+ Sout(clearhouse.ISA08, 15, 15) + "*" //ISA08: Receiver ID. Validated to make sure length is at least 2.
+ DateTime.Today.ToString("yyMMdd") + "*" //ISA09: today's date
+ DateTime.Now.ToString("HHmm") + "*" //ISA10: current time
+ "U*00401*" //ISA11 and ISA12.
//ISA13: interchange control number, right aligned:
+ batchNum.ToString().PadLeft(9, '0') + "*"
+ "0*" //ISA14: no acknowledgment requested
+ clearhouse.ISA15 + "*" //ISA15: T=Test P=Production. Validated.
+ ":~"); //ISA16: use ':'
//Functional Group Header
strb.AppendLine("GS*HS*" //GS01: HS for 270 benefit inquiry
+ clsX12Generator.GetGS02(clearhouse) + "*" //GS02: Senders Code. Sometimes Jordan Sparks. Sometimes the sending clinic.
+ Sout(clearhouse.GS03, 15, 2) + "*" //GS03: Application Receiver's Code
+ DateTime.Today.ToString("yyyyMMdd") + "*" //GS04: today's date
+ DateTime.Now.ToString("HHmm") + "*" //GS05: current time
+ groupControlNumber + "*" //GS06: Group control number. Max length 9. No padding necessary.
+ "X*" //GS07: X
+ "004010X092~"); //GS08: Version
//Beginning of transaction--------------------------------------------------------------------------------
int seg = 0; //count segments for the ST-SE transaction
//Transaction Set Header
//ST02 Transact. control #. Must be unique within ISA
seg++;
strb.AppendLine("ST*270*" //ST01
+ transactionNum.ToString().PadLeft(4, '0') + "~"); //ST02
seg++;
strb.AppendLine("BHT*0022*13*" //BHT02: 13=request
+ transactionNum.ToString().PadLeft(4, '0') + "*" //BHT03. Can be same as ST02
+ DateTime.Now.ToString("yyyyMMdd") + "*" //BHT04: Date
+ DateTime.Now.ToString("HHmmss") + "~"); //BHT05: Time, BHT06: not used
//HL Loops-----------------------------------------------------------------------------------------------
int HLcount = 1;
//2000A HL: Information Source--------------------------------------------------------------------------
seg++;
strb.AppendLine("HL*" + HLcount.ToString() + "*" //HL01: Heirarchical ID. Here, it's always 1.
+ "*" //HL02: No parent. Not used
+ "20*" //HL03: Heirarchical level code. 20=Information source
+ "1~"); //HL04: Heirarchical child code. 1=child HL present
//2100A NM1
seg++;
strb.AppendLine("NM1*PR*" //NM101: PR=Payer
+ "2*" //NM102: 2=Non person
+ Sout(carrier.CarrierName, 35) + "*" //NM103: Name Last.
+ "****" //NM104-07 not used
+ "PI*" //NM108: PI=PayorID
+ Sout(carrier.ElectID, 80, 2) + "~"); //NM109: PayorID. Validated to be at least length of 2.
HLcount++;
//2000B HL: Information Receiver------------------------------------------------------------------------
seg++;
strb.AppendLine("HL*" + HLcount.ToString() + "*" //HL01: Heirarchical ID. Here, it's always 2.
+ "1*" //HL02: Heirarchical parent id number. 1 in this simple message.
+ "21*" //HL03: Heirarchical level code. 21=Information receiver
+ "1~"); //HL04: Heirarchical child code. 1=child HL present
seg++;
//2100B NM1: Information Receiver Name
strb.AppendLine("NM1*1P*" //NM101: 1P=Provider
+ (billProv.IsNotPerson ? "2" : "1") + "*" //NM102: 1=person,2=non-person
+ Sout(billProv.LName, 35) + "*" //NM103: Last name
+ Sout(billProv.FName, 25) + "*" //NM104: First name
+ Sout(billProv.MI, 25, 1) + "*" //NM105: Middle name
+ "*" //NM106: not used
+ "*" //NM107: Name suffix. not used
+ "XX*" //NM108: ID code qualifier. 24=EIN. 34=SSN, XX=NPI
+ Sout(billProv.NationalProvID, 80) + "~"); //NM109: ID code. NPI validated
//2100B REF: Information Receiver ID
seg++;
strb.Append("REF*");
if (billProv.UsingTIN)
{
strb.Append("TJ*");//REF01: qualifier. TJ=Federal TIN
}
else
{ //SSN
strb.Append("SY*"); //REF01: qualifier. SY=SSN
}
strb.AppendLine(Sout(billProv.SSN, 30) + "~"); //REF02: ID
//2100B N3: Information Receiver Address
seg++;
if (general.UseBillingAddressOnClaims)
{
strb.Append("N3*" + Sout(practice.PracticeBillingAddress, 55));//N301: Address
}
else if (clinic == null)
{
strb.Append("N3*" + Sout(practice.PracticeAddress, 55));//N301: Address
}
else
{
strb.Append("N3*" + Sout(clinic.Address, 55));//N301: Address
}
if (general.UseBillingAddressOnClaims)
{
if (practice.PracticeBillingAddress2 == "")
{
strb.AppendLine("~");
}
else
{
//N302: Address2. Optional.
strb.AppendLine("*" + Sout(practice.PracticeBillingAddress2, 55) + "~");
}
}
else if (clinic == null)
{
if (practice.PracticeAddress2 == "")
{
strb.AppendLine("~");
}
else
{
//N302: Address2. Optional.
strb.AppendLine("*" + Sout(practice.PracticeAddress2, 55) + "~");
}
}
else
{
if (clinic.Address2 == "")
{
strb.AppendLine("~");
}
else
{
//N302: Address2. Optional.
strb.AppendLine("*" + Sout(clinic.Address2, 55) + "~");
}
}
//2100B N4: Information Receiver City/State/Zip
seg++;
if (general.UseBillingAddressOnClaims)
{
strb.AppendLine("N4*" + Sout(practice.PracticeBillingCity, 30) + "*" //N401: City
+ Sout(practice.PracticeBillingST, 2) + "*" //N402: State
+ Sout(practice.PracticeBillingZip.Replace("-", ""), 15) + "~"); //N403: Zip
}
else if (clinic == null)
{
strb.AppendLine("N4*" + Sout(practice.PracticeCity, 30) + "*" //N401: City
+ Sout(practice.PracticeST, 2) + "*" //N402: State
+ Sout(practice.PracticeZip.Replace("-", ""), 15) + "~"); //N403: Zip
}
else
{
strb.AppendLine("N4*" + Sout(clinic.City, 30) + "*" //N401: City
+ Sout(clinic.State, 2) + "*" //N402: State
+ Sout(clinic.Zip.Replace("-", ""), 15) + "~"); //N403: Zip
}
//2100B PRV: Information Receiver Provider Info
seg++;
//PRV*PE*ZZ*1223G0001X~
strb.AppendLine("PRV*PE*" //PRV01: Provider Code. PE=Performing. There are many other choices.
+ "ZZ*" //PRV02: ZZ=Mutually defined = health care provider taxonomy code
+ clsX12Generator.GetTaxonomy(billProv) + "~"); //PRV03: Specialty code
HLcount++;
//2000C HL: Subscriber-----------------------------------------------------------------------------------
seg++;
strb.AppendLine("HL*" + HLcount.ToString() + "*" //HL01: Heirarchical ID. Here, it's always 3.
+ "2*" //HL02: Heirarchical parent id number. 2 in this simple message.
+ "22*" //HL03: Heirarchical level code. 22=Subscriber
+ "0~"); //HL04: Heirarchical child code. 0=no child HL present (no dependent)
//2000C TRN: Subscriber Trace Number
seg++;
strb.AppendLine("TRN*1*" //TRN01: Trace Type Code. 1=Current Transaction Trace Numbers
+ "1*" //TRN02: Trace Number. We don't really have a good primary key yet. Keep it simple. Use 1.
+ "1" + billProv.SSN + "~"); //TRN03: Entity Identifier. First digit is 1=EIN. Next 9 digits are EIN. Length validated.
//2100C NM1: Subscriber Name
seg++;
strb.AppendLine("NM1*IL*" //NM101: IL=Insured or Subscriber
+ "1*" //NM102: 1=Person
+ Sout(subscriber.LName, 35) + "*" //NM103: LName
+ Sout(subscriber.FName, 25) + "*" //NM104: FName
+ Sout(subscriber.MiddleI, 25) + "*" //NM105: MiddleName
+ "*" //NM106: not used
+ "*" //NM107: suffix. Not present in Open Dental yet.
+ "MI*" //NM108: MI=MemberID
+ Sout(insSub.SubscriberID.Replace("-", ""), 80) + "~"); //NM109: Subscriber ID. Validated to be L>2.
//2100C REF: Subscriber Additional Information. Without this, old plans seem to be frequently returned.
seg++;
strb.AppendLine("REF*6P*" //REF01: 6P=GroupNumber
+ Sout(insPlan.GroupNum, 30) + "~"); //REF02: Supplemental ID. Validated.
//2100C DMG: Subscriber Demographic Information
seg++;
strb.AppendLine("DMG*D8*" //DMG01: Date Time Period Qualifier. D8=CCYYMMDD
+ subscriber.Birthdate.ToString("yyyyMMdd") + "~"); //DMG02: Subscriber birthdate. Validated
//DMG03: Gender code. Situational. F or M. Since this was left out in the example,
//and since we don't want to send the wrong gender, we will not send this element.
//2100C DTP: Subscriber Date. Deduced through trial and error that this is required by EHG even though not by X12 specs.
seg++;
strb.AppendLine("DTP*307*" //DTP01: Qualifier. 307=Eligibility
+ "D8*" //DTP02: Format Qualifier.
+ DateTime.Today.ToString("yyyyMMdd") + "~"); //DTP03: Date
//2110C EQ: Subscriber Eligibility or Benefit Enquiry Information
//X12 documentation seems to say that we can loop this 99 times to request very specific benefits.
//ClaimConnect wants to see either an EQ*30 for "an eligibility request", or an EQ*35 for "a general benefits request".
//The director of vendor implementation at ClaimConnect has informed us that we should send an EQ*35 to get the full set of benefits.
seg++;
strb.AppendLine("EQ*35~");//Dental Care
//seg++;
//strb.AppendLine("EQ*30~");//EQ01: 30=General Coverage
//seg++;
//strb.AppendLine("EQ*23~");//Diagnostic
//seg++;
//strb.AppendLine("EQ*4~");//Diagnostic Xray
//seg++;
//strb.AppendLine("EQ*41~");//Routine Preventive
//seg++;
//strb.AppendLine("EQ*25~");//Restorative
//seg++;
//strb.AppendLine("EQ*26~");//Endo
//seg++;
//strb.AppendLine("EQ*24~");//Perio
//seg++;
//strb.AppendLine("EQ*40~");//Oral Surgery
//seg++;
//strb.AppendLine("EQ*36~");//Crowns
//seg++;
//strb.AppendLine("EQ*39~");//Prosth
//seg++;
//strb.AppendLine("EQ*27~");//Maxillofacial Prosth
//seg++;
//strb.AppendLine("EQ*37~");//Accident
//seg++;
//strb.AppendLine("EQ*38~");//Ortho
//seg++;
//strb.AppendLine("EQ*28~");//Adjunctive
//
//2000D If we add a dependent loop it would go here. It would be about 20 lines.
//2100D, etc
//EQ series, etc.
//Not allowed to send this unless subscriber and dependent are different
//We would also have to add code to process the EBs which distinguishes between subscribers and dependents.
//
//Transaction Trailer
seg++;
strb.AppendLine("SE*"
+ seg.ToString() + "*"//SE01: Total segments, including ST & SE
+ transactionNum.ToString().PadLeft(4, '0') + "~");
//End of transaction--------------------------------------------------------------------------------------
//Functional Group Trailer
strb.AppendLine("GE*" + transactionNum.ToString() + "*" //GE01: Number of transaction sets included
+ groupControlNumber + "~"); //GE02: Group Control number. Must be identical to GS06
//Interchange Control Trailer
strb.AppendLine("IEA*1*" //IEA01: number of functional groups
+ batchNum.ToString().PadLeft(9, '0') + "~"); //IEA02: Interchange control number
return(strb.ToString());
/*
* return @"
* ISA*00* *00* *30*AA0989922 *30*330989922 *030519*1608*U*00401*000012145*1*T*:~
* GS*HS*AA0989922*330989922*20030519*1608*12145*X*004010X092~
* ST*270*0001~
* BHT*0022*13*ASX012145WEB*20030519*1608~
* HL*1**20*1~
* NM1*PR*2*Metlife*****PI*65978~
* HL*2*1*21*1~
* NM1*1P*1*PROVLAST*PROVFIRST****XX*1234567893~
* REF*TJ*200384584~
* N3*JUNIT ROAD~
* N4*CHICAGO*IL*60602~
* PRV*PE*ZZ*1223G0001X~
* HL*3*2*22*0~
* TRN*1*12145*1AA0989922~
* NM1*IL*1*SUBLASTNAME*SUBFIRSTNAME****MI*123456789~
* DMG*D8*19750323~
* DTP*307*D8*20030519~
* EQ*30~
* SE*17*0001~
* GE*1*12145~
* IEA*1*000012145~";
*/
//return "ISA*00* *00* *30*AA0989922 *30*330989922 *030519*1608*U*00401*000012145*1*T*:~GS*HS*AA0989922*330989922*20030519*1608*12145*X*004010X092~ST*270*0001~BHT*0022*13*ASX012145WEB*20030519*1608~HL*1**20*1~NM1*PR*2*Metlife*****PI*65978~HL*2*1*21*1~NM1*1P*1*PROVLAST*PROVFIRST****XX*1234567893~REF*TJ*200384584~N3*JUNIT ROAD~N4*CHICAGO*IL*60602~PRV*PE*ZZ*1223G0001X~HL*3*2*22*0~TRN*1*12145*1AA0989922~NM1*IL*1*SUBLASTNAME*SUBFIRSTNAME****MI*123456789~DMG*D8*19750323~DTP*307*D8*20030519~EQ*30~SE*17*0001~GE*1*12145~IEA*1*000012145~";
}
