private static Claim CreatePredetermination(Patient pat, List <Procedure> procList, long provTreat)
{
Family fam = Patients.GetFamily(pat.PatNum);
List <InsSub> subList = InsSubs.RefreshForFam(fam);
List <InsPlan> planList = InsPlans.RefreshForSubList(subList);
List <PatPlan> patPlanList = PatPlans.Refresh(pat.PatNum);
List <Benefit> benefitList = Benefits.Refresh(patPlanList, subList);
List <ClaimProc> claimProcList = ClaimProcs.Refresh(pat.PatNum);
List <Procedure> procsForPat = Procedures.Refresh(pat.PatNum);
InsSub sub = InsSubs.GetSub(PatPlans.GetInsSubNum(patPlanList, 1), subList);
InsPlan insPlan = InsPlans.GetPlan(sub.PlanNum, planList);
Claim claim = new Claim();
Claims.Insert(claim); //to retreive a key for new Claim.ClaimNum
claim.PatNum = pat.PatNum;
claim.DateService = procList[0].ProcDate;
claim.DateSent = DateTime.Today;
claim.ClaimStatus = "W";
claim.InsSubNum = PatPlans.GetInsSubNum(patPlanList, 1);
claim.InsSubNum2 = PatPlans.GetInsSubNum(patPlanList, 2);
InsSub sub1 = InsSubs.GetSub(claim.InsSubNum, subList);
InsSub sub2 = InsSubs.GetSub(claim.InsSubNum, subList);
claim.PlanNum = sub1.PlanNum;
claim.PlanNum2 = sub2.PlanNum;
claim.PatRelat = PatPlans.GetRelat(patPlanList, 1);
claim.PatRelat2 = PatPlans.GetRelat(patPlanList, 2);
claim.ClaimType = "PreAuth";
claim.ProvTreat = provTreat;
claim.IsProsthesis = "N";
claim.ProvBill = Providers.GetBillingProvNum(claim.ProvTreat, 0);
claim.EmployRelated = YN.No;
ClaimProc cp;
List <Procedure> procListClaim = new List <Procedure>(); //this list will exclude lab fees
for (int i = 0; i < procList.Count; i++)
{
if (procList[i].ProcNumLab == 0)
{
procListClaim.Add(procList[i]);
}
}
for (int i = 0; i < procListClaim.Count; i++)
{
cp = new ClaimProc();
ClaimProcs.CreateEst(cp, procListClaim[i], insPlan, sub);
cp.ClaimNum = claim.ClaimNum;
cp.Status = ClaimProcStatus.NotReceived;
cp.CodeSent = ProcedureCodes.GetProcCode(procListClaim[i].CodeNum).ProcCode;
cp.LineNumber = (byte)(i + 1);
ClaimProcs.Update(cp);
}
claimProcList = ClaimProcs.Refresh(pat.PatNum);
ClaimL.CalculateAndUpdate(procsForPat, planList, claim, patPlanList, benefitList, pat.Age, subList);
return(claim);
}
public void LedgersTests_ComputeAging_PayPlanDynamicCreditsWithClaimProcs()
{
List <Procedure> listProcs = new List <Procedure>();
List <Adjustment> listAdjs = new List <Adjustment>();
long provNum = ProviderT.CreateProvider("Aging_PayPlanDynamic");
string suffix = MethodBase.GetCurrentMethod().Name;
Patient pat = PatientT.CreatePatient(fName: "Aging_PayPlanDynamic", suffix: suffix);
Family fam = Patients.GetFamily(pat.PatNum);
Procedure proc45 = ProcedureT.CreateProcedure(pat, "D0210", ProcStat.C, "", 45, DateTime.Today.AddDays(-61), provNum: provNum);
ClaimProc cp45 = new ClaimProc();
InsuranceInfo insInfo = InsuranceT.AddInsurance(pat, "DynPayPlan");
ClaimProcs.CreateEst(cp45, proc45, insInfo.PriInsPlan, insInfo.PriInsSub);
cp45.Status = ClaimProcStatus.NotReceived;
cp45.InsEstTotal = -1;
cp45.InsPayEst = 15;
cp45.WriteOffEst = 0;
cp45.WriteOff = 0;
ClaimProcs.Update(cp45);
listProcs.AddRange(new List <Procedure> {
proc45
});
PayPlan payPlan = PayPlanT.CreateDynamicPaymentPlan(pat.PatNum, pat.PatNum, DateTime.Today.AddDays(-1), 0, 0, 30, listProcs, listAdjs);
//make two non payplan productions to put on the account
Procedure procUnattached = ProcedureT.CreateProcedure(pat, "D0210", ProcStat.C, "", 35, DateTime.Today.AddDays(-91), provNum: provNum);
//Run pay plan logic to generate first set of charges
List <PayPlanCharge> listChargesDb = PayPlanCharges.GetForPayPlan(payPlan.PayPlanNum);
List <PayPlanLink> listEntries = PayPlanLinks.GetForPayPlans(new List <long> {
payPlan.PayPlanNum
});
PayPlanTerms terms = PayPlanT.GetTerms(payPlan, listEntries);
List <PayPlanCharge> listChargesThisPeriod = PayPlanEdit.GetListExpectedCharges(listChargesDb, terms, fam, listEntries, payPlan, true);
Assert.AreEqual(30, listChargesThisPeriod.Sum(x => x.Principal));
foreach (PayPlanCharge charge in listChargesThisPeriod)
{
PayPlanCharges.Insert(charge);
}
int payPlansVersionPrev = PrefC.GetInt(PrefName.PayPlansVersion);
try {
PrefT.UpdateInt(PrefName.PayPlansVersion, (int)PayPlanVersions.AgeCreditsAndDebits);
CheckAgingProcLifo(pat.PatNum, 30, 0, 15, 35, 30, YN.Yes); //new - pay plan credit of $30 gets applied to cooresponding procedure
CheckAgingProcLifo(pat.PatNum, 30, 0, 45, 5, 30, YN.No); //old - pay plan credit gets applied to oldest production on the account
CheckAgingProcLifo(pat.PatNum, 30, 0, 45, 5, 30, YN.Unknown);
}
finally {
PrefT.UpdateInt(PrefName.PayPlansVersion, payPlansVersionPrev);
}
}
public void LedgersTests_ComputeAgingProcLifo_InsWoEst_And_InsPayEst()
{
string suffix = MethodBase.GetCurrentMethod().Name;
Patient pat = PatientT.CreatePatient(fName: "Aging_InsEst", suffix: suffix);
InsuranceInfo insInfo = InsuranceT.AddInsurance(pat, "AgingInsEst");
Procedure proc95 = ProcedureT.CreateProcedure(pat, "D0270", ProcStat.C, "", 1000, DateTime.Today.AddDays(-95));
ClaimProc cp95 = new ClaimProc();
ClaimProcs.CreateEst(cp95, proc95, insInfo.PriInsPlan, insInfo.PriInsSub);
cp95.Status = ClaimProcStatus.NotReceived;
cp95.InsEstTotal = 800;
cp95.InsPayEst = 800;
cp95.WriteOffEst = 200;
cp95.WriteOff = 200;
ClaimProcs.Update(cp95);
Procedure proc85 = ProcedureT.CreateProcedure(pat, "D1110", ProcStat.C, "", 100, DateTime.Today.AddDays(-85));
ClaimProc cp85 = new ClaimProc();
ClaimProcs.CreateEst(cp85, proc85, insInfo.PriInsPlan, insInfo.PriInsSub);
cp85.Status = ClaimProcStatus.NotReceived;
cp85.InsEstTotal = 60;
cp85.InsPayEst = 60;
cp85.WriteOffEst = 40;
cp85.WriteOff = 40;
ClaimProcs.Update(cp85);
int agingProcLifoPrev = PrefC.GetInt(PrefName.AgingProcLifo);
try {
PrefT.UpdateInt(PrefName.AgingProcLifo, (int)YN.No);
Dictionary <long, DataRow> dictAging = Ledgers.GetAgingGuarTransTable(DateTime.Today, new List <long> {
pat.Guarantor
});
Assert.AreEqual(PIn.Double(dictAging[pat.Guarantor]["InsPayEst"].ToString()), 860);
Assert.AreEqual(PIn.Double(dictAging[pat.Guarantor]["InsWoEst"].ToString()), 240);
PrefT.UpdateInt(PrefName.AgingProcLifo, (int)YN.Yes);
dictAging = Ledgers.GetAgingGuarTransTable(DateTime.Today, new List <long> {
pat.Guarantor
});
Assert.AreEqual(PIn.Double(dictAging[pat.Guarantor]["InsPayEst"].ToString()), 860);
Assert.AreEqual(PIn.Double(dictAging[pat.Guarantor]["InsWoEst"].ToString()), 240);
}
finally {
PrefT.UpdateInt(PrefName.AgingProcLifo, agingProcLifoPrev);
}
}
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");
}
/// <summary>claimType="P","S","PreAuth","W" (waiting to send).</summary>
public static Claim CreateClaim(string claimType, List <PatPlan> PatPlanList, List <InsPlan> InsPlanList, List <ClaimProc> ClaimProcList, List <Procedure> procsForPat, Patient pat, List <Procedure> procsForClaim, List <Benefit> benefitList, List <InsSub> SubList, bool calculateLineNumber = true)
{
//Claim ClaimCur=CreateClaim("P",PatPlanList,InsPlanList,ClaimProcList,procsForPat);
InsPlan PlanCur1 = new InsPlan();
InsSub SubCur1 = new InsSub();
InsPlan PlanCur2 = new InsPlan();
InsSub SubCur2 = new InsSub();
switch (claimType)
{
case "P":
SubCur1 = InsSubs.GetSub(PatPlans.GetInsSubNum(PatPlanList, 1), SubList);
PlanCur1 = InsPlans.GetPlan(SubCur1.PlanNum, InsPlanList);
SubCur2 = InsSubs.GetSub(PatPlans.GetInsSubNum(PatPlanList, 2), SubList);
//PlanCur2=InsPlans.GetPlan(SubCur.PlanNum,InsPlanList);//can end up null
break;
case "S":
SubCur1 = InsSubs.GetSub(PatPlans.GetInsSubNum(PatPlanList, 2), SubList);
PlanCur1 = InsPlans.GetPlan(SubCur1.PlanNum, InsPlanList);
SubCur2 = InsSubs.GetSub(PatPlans.GetInsSubNum(PatPlanList, 1), SubList);
//PlanCur2=InsPlans.GetPlan(SubCur.PlanNum,InsPlanList);//can end up null
break;
case "PreAuth":
SubCur1 = InsSubs.GetSub(PatPlans.GetInsSubNum(PatPlanList, 1), SubList);
PlanCur1 = InsPlans.GetPlan(SubCur1.PlanNum, InsPlanList);
SubCur2 = InsSubs.GetSub(PatPlans.GetInsSubNum(PatPlanList, 2), SubList);
break;
case "W":
SubCur1 = InsSubs.GetSub(PatPlans.GetInsSubNum(PatPlanList, 1), SubList);
PlanCur1 = InsPlans.GetPlan(SubCur1.PlanNum, InsPlanList);
SubCur2 = InsSubs.GetSub(PatPlans.GetInsSubNum(PatPlanList, 2), SubList);
break;
case "Med":
SubCur1 = InsSubs.GetSub(PatPlans.GetInsSubNum(PatPlanList, PatPlans.GetOrdinal(PriSecMed.Medical, PatPlanList, InsPlanList, SubList)), SubList);
PlanCur1 = InsPlans.GetPlan(SubCur1.PlanNum, InsPlanList);
SubCur2 = InsSubs.GetSub(PatPlans.GetInsSubNum(PatPlanList, PatPlans.GetOrdinal(PriSecMed.Primary, PatPlanList, InsPlanList, SubList)), SubList);
break;
}
//DataTable table=DataSetMain.Tables["account"];
Procedure proc;
//proc=Procedures.GetProcFromList(procsForPat,PIn.Long(table.Rows[gridAccount.SelectedIndices[0]]["ProcNum"].ToString()));
//long clinicNum=proc.ClinicNum;
ClaimProc[] claimProcs = new ClaimProc[procsForClaim.Count]; //1:1 with procs
long procNum;
for (int i = 0; i < procsForClaim.Count; i++) //loop through selected procs
//and try to find an estimate that can be used
{
procNum = procsForClaim[i].ProcNum;
claimProcs[i] = Procedures.GetClaimProcEstimate(procNum, ClaimProcList, PlanCur1, SubCur1.InsSubNum);
}
for (int i = 0; i < claimProcs.Length; i++) //loop through each claimProc
//and create any missing estimates. This handles claims to 3rd and 4th ins co's.
{
if (claimProcs[i] == null)
{
claimProcs[i] = new ClaimProc();
proc = procsForClaim[i];
ClaimProcs.CreateEst(claimProcs[i], proc, PlanCur1, SubCur1);
}
}
Claim claim = new Claim();
Claims.Insert(claim); //to retreive a key for new Claim.ClaimNum
claim.PatNum = pat.PatNum;
claim.DateService = claimProcs[claimProcs.Length - 1].ProcDate;
claim.ClinicNum = procsForClaim[0].ClinicNum;
claim.DateSent = DateTime.Today;
claim.DateSentOrig = claim.DateSent;
claim.ClaimStatus = "S";
claim.AttachedFlags = "Mail";
//datereceived
switch (claimType)
{
case "P":
claim.PlanNum = SubCur1.PlanNum;
claim.InsSubNum = PatPlans.GetInsSubNum(PatPlanList, 1);
claim.PatRelat = PatPlans.GetRelat(PatPlanList, 1);
claim.ClaimType = "P";
claim.PlanNum2 = SubCur2.PlanNum; //might be 0 if no sec ins
claim.InsSubNum2 = PatPlans.GetInsSubNum(PatPlanList, 2);
claim.PatRelat2 = PatPlans.GetRelat(PatPlanList, 2);
break;
case "S":
claim.PlanNum = SubCur1.PlanNum;
claim.InsSubNum = PatPlans.GetInsSubNum(PatPlanList, 2);
claim.PatRelat = PatPlans.GetRelat(PatPlanList, 2);
claim.ClaimType = "S";
claim.PlanNum2 = SubCur2.PlanNum;
claim.InsSubNum2 = PatPlans.GetInsSubNum(PatPlanList, 1);
claim.PatRelat2 = PatPlans.GetRelat(PatPlanList, 1);
break;
case "W":
claim.PlanNum = SubCur1.PlanNum;
claim.InsSubNum = PatPlans.GetInsSubNum(PatPlanList, 2);
claim.PatRelat = PatPlans.GetRelat(PatPlanList, 2);
claim.ClaimType = "P";
claim.ClaimStatus = "W";
claim.PlanNum2 = SubCur2.PlanNum;
claim.InsSubNum2 = PatPlans.GetInsSubNum(PatPlanList, 1);
claim.PatRelat2 = PatPlans.GetRelat(PatPlanList, 1);
break;
case "Med":
claim.PlanNum = SubCur1.PlanNum;
claim.InsSubNum = PatPlans.GetInsSubNum(PatPlanList, 1);
claim.PatRelat = PatPlans.GetRelat(PatPlanList, 1);
claim.ClaimType = "Other";
claim.PlanNum2 = SubCur2.PlanNum; //might be 0 if no other ins
claim.InsSubNum2 = PatPlans.GetInsSubNum(PatPlanList, 2);
claim.PatRelat2 = PatPlans.GetRelat(PatPlanList, 2);
break;
}
claim.ProvTreat = procsForClaim[0].ProvNum;
claim.IsProsthesis = "I";
claim.ProvBill = Providers.GetBillingProvNum(claim.ProvTreat, claim.ClinicNum);
claim.EmployRelated = YN.No;
//attach procedures
Procedure ProcCur;
for (int i = 0; i < claimProcs.Length; i++)
{
ProcCur = procsForClaim[i];
claimProcs[i].ClaimNum = claim.ClaimNum;
claimProcs[i].Status = ClaimProcStatus.NotReceived; //status for claims unsent or sent.
//writeoff handled in ClaimL.CalculateAndUpdate()
claimProcs[i].CodeSent = ProcedureCodes.GetProcCode(ProcCur.CodeNum).ProcCode;
if (claimProcs[i].CodeSent.Length > 5 && claimProcs[i].CodeSent.Substring(0, 1) == "D")
{
claimProcs[i].CodeSent = claimProcs[i].CodeSent.Substring(0, 5);
}
if (calculateLineNumber)
{
claimProcs[i].LineNumber = (byte)(i + 1);
}
ClaimProcs.Update(claimProcs[i]);
}
ClaimProcList = ClaimProcs.Refresh(pat.PatNum);
Claims.CalculateAndUpdate(procsForPat, InsPlanList, claim, PatPlanList, benefitList, pat.Age, SubList);
return(claim);
}