public static string RunSeven(bool showForms)
{
Claim claim = Claims.GetClaim(ClaimNums[6]);
InsSubTC.SetAssignBen(false, claim.InsSubNum);
CarrierTC.SetEncryptionMethod(claim.PlanNum, 1);
return(Run(7, "", "21", claim, showForms));
}
public static string RunThree(bool showForms)
{
Claim claim = Claims.GetClaim(ClaimNums[2]);
InsSubTC.SetAssignBen(true, claim.InsSubNum);
CarrierTC.SetEncryptionMethod(claim.PlanNum, 2); //Even though the test says 1, the example message uses 2
return(Run(3, "", "21", claim, showForms)); //expecting EOB
}
public static string RunFour(bool showForms)
{
Claim claim = Claims.GetClaim(ClaimNums[3]);
InsSubTC.SetAssignBen(false, claim.InsSubNum);
CarrierTC.SetEncryptionMethod(claim.PlanNum, 2);
return(Run(4, "", "21", claim, showForms)); //expecting EOB
}
public void return_claim()
{
IClaims claims = new Claims();
claims.Create("1", "Test");
claims.GetClaim(JwtRegisteredClaimNames.Sub).Value.Should().Be("Test");
}
public static string RunOne(bool showForms)
{
Claim claim = Claims.GetClaim(ClaimNums[0]);
InsSubTC.SetAssignBen(false, claim.InsSubNum);
CarrierTC.SetEncryptionMethod(claim.PlanNum, 2);
return(Run(1, "C", "11", claim, showForms));
}
public void claim_is_null()
{
IClaims claims = new Claims();
claims.Create("1", "Test");
claims.GetClaim(JwtRegisteredClaimNames.Website).Should().BeNull();
}
public static string RunEight(bool showForms)
{
Claim claim = Claims.GetClaim(ClaimNums[9]);
InsSubTC.SetAssignBen(false, claim.InsSubNum);
CarrierTC.SetEncryptionMethod(claim.PlanNum, 1);
return(Run(8, "C", "13", claim, showForms, 1, 1, 0, 0));
}
public static string RunThree(bool showForms)
{
Claim claim = Claims.GetClaim(ClaimNums[2]);
InsSubTC.SetAssignBen(false, claim.InsSubNum);
CarrierTC.SetEncryptionMethod(claim.PlanNum, 1);
return(Run(3, "", "23", claim, showForms, 1, 1, 350, 250));
}
public static string RunTen(bool showForms)
{
Claim claim = Claims.GetClaim(ClaimNums[9]);
InsSubTC.SetAssignBen(true, claim.InsSubNum);
CarrierTC.SetEncryptionMethod(claim.PlanNum, 1);
return(Run(10, "", "21", claim, showForms)); //test the result of the COB
}
public static string RunEight(bool showForms)
{
Claim claim = Claims.GetClaim(ClaimNums[7]);
InsSubTC.SetAssignBen(true, claim.InsSubNum);
CarrierTC.SetEncryptionMethod(claim.PlanNum, 2);
return(Run(8, "", "21", claim, showForms));
}
public static string RunThree()
{
Claim claim = Claims.GetClaim(ClaimTC.ClaimNums[6]);
claim.CanadaTransRefNum = "CCC12345 ";
InsSubTC.SetAssignBen(false, claim.InsSubNum);
CarrierTC.SetEncryptionMethod(claim.PlanNum, 1);
return(Run(3, "R", claim));
}
public static string RunTwo()
{
Claim claim = Claims.GetClaim(ClaimTC.ClaimNums[2]);
claim.CanadaTransRefNum = "BCD88345 ";
InsSubTC.SetAssignBen(true, claim.InsSubNum);
CarrierTC.SetEncryptionMethod(claim.PlanNum, 1);
return(Run(2, "A", claim));
//TODO: We need to run the reversal for the secondary claim. Can't do this yet since we don't have COB claims implemented yet.
}
public void Ent_Get_Claim_ReturnClaimData()
{
//arrange
String claimId = "200002020654";
//act
Claims claim = new Claims(apiController);
var result = claim.GetClaim(claimId);
//assert
Assert.That(result, Is.TypeOf <ClaimDetail>());
}
public static string RunTwelve(bool showForms)
{
Claim claim = Claims.GetClaim(ClaimNums[11]);
InsSubTC.SetAssignBen(false, claim.InsSubNum);
CarrierTC.SetEncryptionMethod(claim.PlanNum, 1);
string oldVersion = CarrierTC.SetCDAnetVersion(claim.PlanNum, "02");
string retval = Run(12, "", "21", claim, showForms);
CarrierTC.SetCDAnetVersion(claim.PlanNum, oldVersion);
return(retval);
}
public void Get_Claim_ReturnClaimData()
{
//arrange
apiController.Setup(f => f.Get <ClaimDetail>(It.IsAny <long>(), It.IsAny <String>(), null))
.Returns(new ClaimDetail());
//act
Claims claim = new Claims(apiController.Object);
var result = claim.GetClaim(0, claimId);
//assert
Assert.That(result, Is.TypeOf <ClaimDetail>());
}
public static string RunFour()
{
Claim claim = Claims.GetClaim(ClaimTC.ClaimNums[11]);
claim.CanadaTransRefNum = "AB123456V2 ";
InsSubTC.SetAssignBen(false, claim.InsSubNum);
CarrierTC.SetEncryptionMethod(claim.PlanNum, 1);
string oldVersion = CarrierTC.SetCDAnetVersion(claim.PlanNum, "02");
string retval = Run(4, "A", claim);
CarrierTC.SetCDAnetVersion(claim.PlanNum, oldVersion);
return(retval);
}
public static string RunSeven(bool showForms)
{
Claim claim = Claims.GetClaim(ClaimNums[7]); //Claim 7 page 1
InsSubTC.SetAssignBen(false, claim.InsSubNum);
CarrierTC.SetEncryptionMethod(claim.PlanNum, 1);
string result = Run(7, "", "13", claim, showForms, 1, 2, 0, 0);
claim = Claims.GetClaim(ClaimNums[8]); //Claim 7 page 2
InsSubTC.SetAssignBen(false, claim.InsSubNum);
CarrierTC.SetEncryptionMethod(claim.PlanNum, 1);
result += Environment.NewLine + Run(7, "", "13", claim, showForms, 2, 2, 0, 0);
return(result);
}
///<summary>Returns a string describing all missing data on this claim. Claim will not be allowed to be sent electronically unless this string comes back empty. There is also an out parameter containing any warnings. Warnings will not block sending.</summary>
public static void GetMissingData(ClaimSendQueueItem queueItem) //,out string warning) {
{
StringBuilder strb = new StringBuilder();
string warning = "";
Claim claim = Claims.GetClaim(queueItem.ClaimNum);
Patient pat = Patients.GetPat(claim.PatNum);
if (!Regex.IsMatch(pat.Address, @"^[a-zA-Z ]+[0-9]+")) //format must be streetname, then some numbers, then anything else.
{
if (strb.Length != 0)
{
strb.Append(",");
}
strb.Append("Patient address format");
}
//return strb.ToString();
queueItem.MissingData = strb.ToString();
queueItem.Warnings = warning;
}
public void create_claims()
{
IClaims claims = new Claims(new List <Claim>()
{
new Claim("OwnClaim", "Test")
});
claims.Create("1", "Test");
claims.GetClaim(JwtRegisteredClaimNames.Sub).Value.Should().Be("Test");
claims.GetClaim(JwtRegisteredClaimNames.Jti).Value.Length.Should().Be(36);
claims.GetClaim(JwtRegisteredClaimNames.Iat).Value.Should().NotBeNullOrEmpty();
claims.GetClaim(Constants.JwtClaimIdentifiers.Id).Value.Should().Be("1");
claims.GetClaim(Constants.JwtClaimIdentifiers.Rol).Value.Should().Be(Constants.JwtClaims.ApiAccess);
claims.GetClaim("OwnClaim").Value.Should().Be("Test");
}
///<summary>Sets the MissingData and Warnings fields on the queueItem as appropriate.</summary>
public static void GetMissingData(ClaimSendQueueItem queueItem)
{
StringBuilder sbErrors = new StringBuilder();
StringBuilder sbWarnings = new StringBuilder();
Claim claim = Claims.GetClaim(queueItem.ClaimNum);
Provider provClaimTreat = Providers.GetProv(claim.ProvTreat);
InsSub insSub = InsSubs.GetOne(claim.InsSubNum);
Patient pat = Patients.GetPat(claim.PatNum);
#region Header
//DISP
if (!Regex.IsMatch(provClaimTreat.NationalProvID, @"^[27][0-9]{5}$"))
{
if (sbErrors.Length != 0)
{
sbErrors.Append(",");
}
sbErrors.Append("Claim treating provider ID for RAMQ is invalid");
}
//DISP_REFNT
if (claim.CanadianReferralProviderNum.Trim().Length > 0 &&
!Regex.IsMatch(claim.CanadianReferralProviderNum.Trim(), @"^[0-9]{6}$"))
{
if (sbErrors.Length != 0)
{
sbErrors.Append(",");
}
sbErrors.Append("Referral provider ID for RAMQ is invalid");
}
//ETAB
if (!Regex.IsMatch(provClaimTreat.CanadianOfficeNum, @"^[0-9]{5}$"))
{
if (sbErrors.Length != 0)
{
sbErrors.Append(",");
}
sbErrors.Append("Claim treating provider office number is invalid");
}
//SERV
if (claim.DateService.Year < 1880)
{
if (sbErrors.Length != 0)
{
sbErrors.Append(",");
}
sbErrors.Append("Claim date of service is invalid or missing");
}
#endregion Header
#region Insurance
//Most fields in the insuranace section are optional and thus do not require validation.
//NAM
if (!Regex.IsMatch(insSub.SubscriberID, @"^[a-zA-Z]{4}[0-9]{6}[a-zA-Z0-9][0-9]$"))
{
if (sbErrors.Length != 0)
{
sbErrors.Append(",");
}
sbErrors.Append("Subscriber ID invalid");
}
#endregion Insurance
#region Procedures
List <ProcedureCode> listProcCodes = ProcedureCodes.GetAllCodes();
List <ClaimProc> listClaimProcsForPat = ClaimProcs.Refresh(claim.PatNum);
List <ClaimProc> listClaimProcsForClaim = ClaimProcs.GetForSendClaim(listClaimProcsForPat, claim.ClaimNum); //Excludes labs.
List <Procedure> listProcsForPat = Procedures.Refresh(claim.PatNum);
foreach (ClaimProc claimProc in listClaimProcsForClaim)
{
Procedure proc = Procedures.GetProcFromList(listProcsForPat, claimProc.ProcNum);
if (proc.ProcFee == 0)
{
continue;
}
ProcedureCode procCode = ProcedureCodes.GetProcCode(proc.CodeNum, listProcCodes);
if (procCode.NoBillIns)
{
continue;
}
//ACTE
if (procCode.ProcCode.Length < 5 || !Regex.IsMatch(procCode.ProcCode.Substring(0, 5), @"^[0-9]{5}$"))
{
if (sbErrors.Length != 0)
{
sbErrors.Append(",");
}
sbErrors.Append("Procedure code invalid '" + procCode.ProcCode + "'");
}
List <Procedure> listLabProcs = Procedures.GetCanadianLabFees(proc.ProcNum, listProcsForPat);
foreach (Procedure labProc in listLabProcs)
{
if (labProc.ProcFee == 0)
{
continue;
}
ProcedureCode labProcCode = ProcedureCodes.GetProcCode(labProc.CodeNum, listProcCodes);
if (labProcCode.ProcCode.Length < 5 || !Regex.IsMatch(labProcCode.ProcCode.Substring(0, 5), @"^[0-9]{5}$"))
{
if (sbErrors.Length != 0)
{
sbErrors.Append(",");
}
sbErrors.Append("Lab code invalid '" + labProcCode.ProcCode + "'");
}
}
}
#endregion Procedures
queueItem.MissingData = sbErrors.ToString();
queueItem.Warnings = sbWarnings.ToString();
}
///<summary>Called once for each claim to be created. For claims with a lot of procedures, this may actually create multiple claims.
///Normally returns empty string unless something went wrong.</summary>
public static bool CreateClaim(Clearinghouse clearinghouseClin, ClaimSendQueueItem queueItem, int batchNum)
{
StringBuilder strb = new StringBuilder();
string t = "\t";
strb.Append("110\t111\t112\t118\t203/403\tF108/204/404\t205/405\t206\t207\t208\t209\t210\t211\t212\t215\t217\t219\t406\t408\t409\t410\t411\t413\t414\t415\t416\t418\t419\t420\t421\t422\t423\t424\t425\t426\t428\t429\t430\t432\t433\r\n");
Claim claim = Claims.GetClaim(queueItem.ClaimNum);
Provider provBill = Providers.GetProv(claim.ProvBill);
Patient pat = Patients.GetPat(claim.PatNum);
InsPlan insplan = InsPlans.GetPlan(claim.PlanNum, new List <InsPlan>());
InsSub insSub = InsSubs.GetSub(claim.InsSubNum, new List <InsSub>());
Carrier carrier = Carriers.GetCarrier(insplan.CarrierNum);
List <ClaimProc> claimProcList = ClaimProcs.Refresh(pat.PatNum);
List <ClaimProc> claimProcsForClaim = ClaimProcs.GetForSendClaim(claimProcList, claim.ClaimNum);
List <Procedure> procList = Procedures.Refresh(claim.PatNum);
Procedure proc;
ProcedureCode procCode;
//ProcedureCode procCode;
for (int i = 0; i < claimProcsForClaim.Count; i++)
{
//claimProcsForClaim already excludes any claimprocs with ProcNum=0, so no payments etc.
proc = Procedures.GetProcFromList(procList, claimProcsForClaim[i].ProcNum);
//procCode=Pro
strb.Append(provBill.SSN + t); //110
strb.Append(provBill.MedicaidID + t); //111
strb.Append(t); //112
strb.Append(t); //118
strb.Append(pat.SSN + t); //203/403
strb.Append(carrier.CarrierName + t); //carrier name?
strb.Append(insSub.SubscriberID + t);
strb.Append(pat.PatNum.ToString() + t);
strb.Append(pat.Birthdate.ToString("dd-MM-yyyy") + t);
if (pat.Gender == PatientGender.Female)
{
strb.Append("2" + t); //"V"+t);
}
else
{
strb.Append("1" + t); //M"+t);
}
strb.Append("1" + t);
strb.Append(DutchLName(pat.LName) + t); //last name without prefix
strb.Append(DutchLNamePrefix(pat.LName) + t); //prefix
strb.Append("2" + t);
strb.Append(DutchInitials(pat) + t); //215. initials
strb.Append(pat.Zip + t);
strb.Append(DutchAddressNumber(pat.Address) + t); //219 house number. Already validated.
strb.Append(t);
strb.Append(proc.ProcDate.ToString("dd-MM-yyyy") + t); //procDate
procCode = ProcedureCodes.GetProcCode(proc.CodeNum);
string strProcCode = procCode.ProcCode;
if (strProcCode.EndsWith("00")) //ending with 00 indicates it's a lab code.
{
strb.Append("02" + t);
}
else
{
strb.Append("01" + t); //409. Procedure code (01) or lab costs (02)
}
strb.Append(t);
strb.Append(t);
strb.Append(strProcCode + t);
strb.Append(GetUL(proc, procCode) + t); //414. U/L.
strb.Append(Tooth.ToInternat(proc.ToothNum) + t);
strb.Append(Tooth.SurfTidyForClaims(proc.Surf, proc.ToothNum) + t); //needs validation
strb.Append(t);
if (claim.AccidentRelated == "") //not accident
{
strb.Append("N" + t);
}
else
{
strb.Append("J" + t);
}
strb.Append(pat.SSN + t);
strb.Append(t);
strb.Append(t);
strb.Append(t);
strb.Append(proc.ProcFee.ToString("F") + t);
strb.Append("1" + t);
strb.Append(proc.ProcFee.ToString("F") + t);
strb.Append(t);
strb.Append(t);
strb.Append(proc.ProcFee.ToString("F") + t);
strb.Append(t);
strb.Append(t);
strb.Append("\r\n");
}
string saveFolder = clearinghouseClin.ExportPath;
if (!Directory.Exists(saveFolder))
{
MessageBox.Show(saveFolder + " " + Lans.g("Dutch", "not found."));
return(false);
}
string saveFile = ODFileUtils.CombinePaths(saveFolder, "claims" + claim.ClaimNum.ToString() + ".txt");
File.WriteAllText(saveFile, strb.ToString());
//MessageBox.Show(strb.ToString());
return(true);
}
///<summary>Sets the MissingData and Warnings fields on the queueItem as appropriate.</summary>
public static void GetMissingData(Clearinghouse clearinghouseClin, ClaimSendQueueItem queueItem)
{
StringBuilder sbErrors = new StringBuilder();
StringBuilder sbWarnings = new StringBuilder();
Claim claim = Claims.GetClaim(queueItem.ClaimNum);
Provider provClaimTreat = Providers.GetProv(claim.ProvTreat);
InsSub insSub = InsSubs.GetOne(claim.InsSubNum);
#region Header
//TRNSM
if (!Regex.IsMatch(clearinghouseClin.SenderTIN, @"^[0-9]+$"))
{
if (sbErrors.Length != 0)
{
sbErrors.Append(",");
}
sbErrors.Append("Tax ID Number (RAMQ TRNSM) is invalid");
}
else
{
int trnsm = PIn.Int(clearinghouseClin.SenderTIN);
if (clearinghouseClin.ISA15 != "T" && trnsm >= 18000 && trnsm <= 18999)
{
if (sbErrors.Length != 0)
{
sbErrors.Append(",");
}
sbErrors.Append("Tax ID Number (RAMQ TRNSM) is a test value on this production claim");
}
else if (clearinghouseClin.ISA15 == "T" && (trnsm < 18000 || trnsm > 18999))
{
if (sbErrors.Length != 0)
{
sbErrors.Append(",");
}
sbErrors.Append("Tax ID Number (RAMQ TRNSM) must be between 18000 and 18999 for this test claim");
}
}
//DISP
if (!Regex.IsMatch(provClaimTreat.NationalProvID, @"^[27][0-9]{5}$"))
{
if (sbErrors.Length != 0)
{
sbErrors.Append(",");
}
sbErrors.Append("Claim treating provider CDA Number for RAMQ is invalid");
}
//DISP_REFNT
if (claim.CanadianReferralProviderNum.Trim().Length > 0 &&
!Regex.IsMatch(claim.CanadianReferralProviderNum.Trim(), @"^[0-9]{6}$"))
{
if (sbErrors.Length != 0)
{
sbErrors.Append(",");
}
sbErrors.Append("Referral provider CDA Number for RAMQ is invalid");
}
//ETAB
if (!Regex.IsMatch(provClaimTreat.CanadianOfficeNum, @"^[0-9]{5}$"))
{
if (sbErrors.Length != 0)
{
sbErrors.Append(",");
}
sbErrors.Append("Claim treating provider Office Number for RAMQ is invalid");
}
//SERV
if (claim.DateService.Year < 1880)
{
if (sbErrors.Length != 0)
{
sbErrors.Append(",");
}
sbErrors.Append("Claim date of service is invalid or missing");
}
#endregion Header
#region Insurance
//Most fields in the insuranace section are optional and thus do not require validation.
//NAM
if (!Regex.IsMatch(insSub.SubscriberID, @"^[a-zA-Z]{4}[0-9]{6}[a-zA-Z0-9][0-9]$"))
{
if (sbErrors.Length != 0)
{
sbErrors.Append(",");
}
sbErrors.Append("Subscriber ID for RAMQ is invalid");
}
#endregion Insurance
#region Procedures
List <ProcedureCode> listProcCodes = ProcedureCodes.GetAllCodes();
List <ClaimProc> listClaimProcsForPat = ClaimProcs.Refresh(claim.PatNum);
List <ClaimProc> listClaimProcsForClaim = ClaimProcs.GetForSendClaim(listClaimProcsForPat, claim.ClaimNum); //Excludes labs.
List <Procedure> listProcsForPat = Procedures.Refresh(claim.PatNum);
foreach (ClaimProc claimProc in listClaimProcsForClaim)
{
Procedure proc = Procedures.GetProcFromList(listProcsForPat, claimProc.ProcNum);
if (proc.ProcFee == 0)
{
continue;
}
ProcedureCode procCode = ProcedureCodes.GetProcCode(proc.CodeNum, listProcCodes);
if (procCode.NoBillIns)
{
continue;
}
//ACTE
if (procCode.ProcCode.Length < 5 || !Regex.IsMatch(procCode.ProcCode.Substring(0, 5), @"^[0-9]{5}$"))
{
if (sbErrors.Length != 0)
{
sbErrors.Append(",");
}
sbErrors.Append("Procedure code invalid '" + procCode.ProcCode + "'");
}
List <Procedure> listLabProcs = Procedures.GetCanadianLabFees(proc.ProcNum, listProcsForPat);
foreach (Procedure labProc in listLabProcs)
{
if (labProc.ProcFee == 0)
{
continue;
}
ProcedureCode labProcCode = ProcedureCodes.GetProcCode(labProc.CodeNum, listProcCodes);
if (labProcCode.ProcCode.Length < 5 || !Regex.IsMatch(labProcCode.ProcCode.Substring(0, 5), @"^[0-9]{5}$"))
{
if (sbErrors.Length != 0)
{
sbErrors.Append(",");
}
sbErrors.Append("Lab code invalid '" + labProcCode.ProcCode + "'");
}
}
}
#endregion Procedures
queueItem.MissingData = sbErrors.ToString();
queueItem.Warnings = sbWarnings.ToString();
}
///<summary>Called from Eclaims and includes multiple claims.</summary>
public static string SendBatch(Clearinghouse clearinghouseClin, List <ClaimSendQueueItem> queueItems, int batchNum)
{
//STEP 1 - Build XML output.
List <DP_RACINDP> listDps = new List <DP_RACINDP>();
List <ProcedureCode> listProcCodes = ProcedureCodes.GetAllCodes();
List <Etrans> listEtrans = new List <Etrans>();
foreach (ClaimSendQueueItem queueItem in queueItems)
{
Etrans etrans = Etranss.SetClaimSentOrPrinted(queueItem.ClaimNum, queueItem.PatNum, clearinghouseClin.HqClearinghouseNum, EtransType.Claim_Ramq, batchNum, Security.CurUser.UserNum);
listEtrans.Add(etrans);
//Now we need to update our cache of claims to reflect the change that took place in the database above in Etranss.SetClaimSentOrPrinted()
queueItem.ClaimStatus = "S";
Claim claim = Claims.GetClaim(queueItem.ClaimNum);
Provider provClaimTreat = Providers.GetProv(claim.ProvTreat);
DP_RACINDP dp = new DP_RACINDP();
#region Header
dp.CHN = DP_RACINDPCHN.Item06;
dp.CHNSpecified = true;
dp.ENRG = DP_RACINDPENRG.Item1;
dp.ENRGSpecified = true;
//We hijack the TaxID number for the TRNSM field. The TRNSM is a office identifying number. Test range for developers is 18000 to 18999.
dp.TRNSM = clearinghouseClin.SenderTIN;
dp.DISP = provClaimTreat.NationalProvID;
//dp.CPTE_ADMN=;//Administrative account number. Not currently used.
JulianCalendar calendar = new JulianCalendar();
dp.ATTES = (DateTime.Now.Year % 10).ToString() //One digit for year
+ calendar.GetDayOfYear(DateTime.Now).ToString().PadLeft(3, '0') //3 digits for Julian day of year.
+ (etrans.CarrierTransCounter % 1000).ToString().PadLeft(3, '0'); //3 digits for sequence number.
dp.NCE = (etrans.CarrierTransCounter % 10000).ToString().PadLeft(4, '0');
dp.DISP_REFNT = claim.CanadianReferralProviderNum.Trim();
//dp.DIAGN=;//Diagnostic code. Not currently used.
dp.ETAB = provClaimTreat.CanadianOfficeNum; //Usually empty.
//dp.ADMIS=;//Date of patient admission. Not currently used. This would be the same as the date of service for dental claims anyway.
//dp.SORTI=;//Date patient discharged. Not currently used. This would be the same as the date of service for dental claims anyway.
dp.TOT_DEM = claim.ClaimFee.ToString().Replace(".", "").PadLeft(6, '0');
dp.COMPL = TidyStr(claim.ClaimNote, 200);
//dp.CS=;//Not sure what this is. Not currently used.
//dp.AUTOR=claim.PreAuthString;//Authorization number when invoicing acrylic prostheses. Required if DAT_AUTOR is present. Not currently used.
//dp.DAT_AUTOR=claim.CanadianDateInitialLower;//Date of authorization when invoicing acrylic prostheses. Format YYMMDD. Not currently used.
dp.SERV = claim.DateService.ToString("yyMMdd");
#endregion Header
#region Insurance
//Most fields in the insuranace section are optional.
InsSub insSub = InsSubs.GetOne(claim.InsSubNum);
dp.PERS_ASSU = new DP_RACINDPPERS_ASSU();
dp.PERS_ASSU.NAM = insSub.SubscriberID;
Patient pat = Patients.GetPat(claim.PatNum);
dp.PERS_ASSU.PRE = TidyStr(pat.FName, 20);
dp.PERS_ASSU.NOM = TidyStr(pat.LName, 30);
if (pat.Birthdate.Year > 1880)
{
dp.PERS_ASSU.NAISS = pat.Birthdate.ToString("yyyyMMdd");
}
if (pat.Gender == PatientGender.Male)
{
dp.PERS_ASSU.SEXE = DP_RACINDPPERS_ASSUSEXE.M;
}
else if (pat.Gender == PatientGender.Female)
{
dp.PERS_ASSU.SEXE = DP_RACINDPPERS_ASSUSEXE.F;
}
else
{
//There is no value for UNKNOWN. This field is optional if the subscriber ID is present anyway.
}
List <PatPlan> listPatPlans = PatPlans.Refresh(claim.PatNum);
PatPlan patPlan = PatPlans.GetByInsSubNum(listPatPlans, insSub.InsSubNum);
dp.PERS_ASSU.CAM = patPlan.PatID;
if (insSub.DateTerm.Year > 1880)
{
dp.PERS_ASSU.EXPIR_CAM = insSub.DateTerm.ToString("yyMM");
}
InsPlan insPlan = InsPlans.RefreshOne(claim.PlanNum);
InsPlan insPlan2 = InsPlans.RefreshOne(claim.PlanNum2);
Carrier carrier = null;
if (claim.ClaimType == "S")
{
carrier = Carriers.GetCarrier(insPlan2.CarrierNum);
}
else
{
carrier = Carriers.GetCarrier(insPlan.CarrierNum);
}
if (carrier.Address.Trim() != "")
{
dp.PERS_ASSU.ADR_1 = carrier.Address;
dp.PERS_ASSU.ADR_2 = carrier.Address2;
dp.PERS_ASSU.CP = carrier.Zip;
}
#endregion Insurance
#region Procedures
List <ClaimProc> listClaimProcsForPat = ClaimProcs.Refresh(claim.PatNum);
List <ClaimProc> listClaimProcsForClaim = ClaimProcs.GetForSendClaim(listClaimProcsForPat, claim.ClaimNum); //Excludes labs.
List <Procedure> listProcsForPat = Procedures.Refresh(claim.PatNum);
List <DP_RACINDPACTE> listProcs = new List <DP_RACINDPACTE>();
foreach (ClaimProc claimProc in listClaimProcsForClaim)
{
Procedure proc = Procedures.GetProcFromList(listProcsForPat, claimProc.ProcNum);
if (proc.ProcFee == 0)
{
continue;
}
ProcedureCode procCode = ProcedureCodes.GetProcCode(proc.CodeNum, listProcCodes);
if (procCode.NoBillIns)
{
continue;
}
DP_RACINDPACTE acteProc = new DP_RACINDPACTE();
acteProc.ACTE = procCode.ProcCode;
if (procCode.ProcCode.Length > 5)
{
acteProc.ACTE = procCode.ProcCode.Substring(0, 5);
}
acteProc.ROLE = "1"; //1 for principal role and 2 for assistant role.
//acte.MODIF=;//Optional. Not sure what to put here, so leaving blank for now.
acteProc.UNIT = proc.UnitQty.ToString().PadLeft(3, '0');
acteProc.MNT = proc.ProcFee.ToString("F").Replace(".", "").PadLeft(6, '0');
acteProc.DENT = proc.ToothNum.ToString().PadLeft(2, '0');
acteProc.SURF = proc.Surf.ToString().PadLeft(2, '0');
listProcs.Add(acteProc);
List <Procedure> listLabProcs = Procedures.GetCanadianLabFees(proc.ProcNum, listProcsForPat);
foreach (Procedure labProc in listLabProcs)
{
if (labProc.ProcFee == 0)
{
continue;
}
ProcedureCode labProcCode = ProcedureCodes.GetProcCode(labProc.CodeNum, listProcCodes);
DP_RACINDPACTE acteLab = new DP_RACINDPACTE();
acteLab.ACTE = labProcCode.ProcCode;
if (labProcCode.ProcCode.Length > 5)
{
acteLab.ACTE = labProcCode.ProcCode.Substring(0, 5);
}
acteLab.ROLE = "1"; //1 for principal role and 2 for assistant role.
acteLab.MNT = labProc.ProcFee.ToString("F").Replace(".", "").PadLeft(6, '0');
listProcs.Add(acteLab);
}
}
dp.ACTE = listProcs.ToArray();
#endregion Procedures
listDps.Add(dp);
}
DP_RACIN batch = new DP_RACIN();
batch.DP = listDps.ToArray();
StringWriter sw = new StringWriter();
XmlSerializer serializer = new XmlSerializer(typeof(DP_RACIN));
serializer.Serialize(sw, batch);
string xml = sw.ToString();
//Save a copy of the batch xml to each etrans entry (one per claim).
EtransMessageText etransMsgText = new EtransMessageText();
etransMsgText.MessageText = xml;
EtransMessageTexts.Insert(etransMsgText);
foreach (Etrans etrans in listEtrans)
{
etrans.EtransMessageTextNum = etransMsgText.EtransMessageTextNum;
Etranss.Update(etrans);
}
//Step 2 - ZIP XML and save to report path. The zip file name and file name within the zip file do not matter.
string zipFilePath = CodeBase.ODFileUtils.CreateRandomFile(clearinghouseClin.ExportPath, ".zip", "claims");
ZipFile zip = null;
try {
zip = new ZipFile();
zip.UseZip64WhenSaving = Zip64Option.Always;
zip.AddEntry("claims" + DateTime.Now.ToString("yyyyMMddHHmmss") + ".xml", xml);
zip.Save(zipFilePath);
zip.Dispose();
}
catch (Exception ex) {
ex.ToString();
if (zip != null)
{
zip.Dispose();
}
if (File.Exists(zipFilePath))
{
try {
File.Delete(zipFilePath);
}
catch (Exception ex2) {
ex2.ToString();
}
}
}
return(xml);
}
///<summary>Fills the missing data field on the queueItem that was passed in. This contains all missing data on this claim. Claim will not be allowed to be sent electronically unless this string comes back empty.</summary>
public static ClaimSendQueueItem GetMissingData(Clearinghouse clearinghouseClin, ClaimSendQueueItem queueItem)
{
if (RemotingClient.RemotingRole == RemotingRole.ClientWeb)
{
return(Meth.GetObject <ClaimSendQueueItem>(MethodBase.GetCurrentMethod(), clearinghouseClin, queueItem));
}
queueItem.Warnings = "";
queueItem.MissingData = "";
//this is usually just the default clearinghouse or the clearinghouse for the PayorID.
if (clearinghouseClin == null)
{
if (queueItem.MedType == EnumClaimMedType.Dental)
{
queueItem.MissingData += "No default dental clearinghouse set.";
}
else
{
queueItem.MissingData += "No default medical/institutional clearinghouse set.";
}
return(queueItem);
}
#region Data Sanity Checking (for Replication)
//Example: We had one replication customer who was able to delete an insurance plan for which was attached to a claim.
//Imagine two replication servers, server A and server B. An insplan is created which is not associated to any claims.
//Both databases have a copy of the insplan. The internet connection is lost. On server A, a user deletes the insurance
//plan (which is allowed because no claims are attached). On server B, a user creates a claim with the insurance plan.
//When the internet connection returns, the delete insplan statement is run on server B, which then creates a claim with
//an invalid InsPlanNum on server B. Without the checking below, the send claims window would crash for this one scenario.
Claim claim = Claims.GetClaim(queueItem.ClaimNum); //This should always exist, because we just did a select to get the queue item.
InsPlan insPlan = InsPlans.RefreshOne(claim.PlanNum);
if (insPlan == null) //Check for missing PlanNums
{
queueItem.MissingData = Lans.g("Eclaims", "Claim insurance plan record missing. Please recreate claim.");
return(queueItem);
}
if (claim.InsSubNum2 != 0)
{
InsPlan insPlan2 = InsPlans.RefreshOne(claim.PlanNum2);
if (insPlan2 == null) //Check for missing PlanNums
{
queueItem.MissingData = Lans.g("Eclaims", "Claim other insurance plan record missing. Please recreate claim.");
return(queueItem); //This will let the office send other claims that passed validation without throwing an exception.
}
}
#endregion Data Sanity Checking (for Replication)
if (clearinghouseClin.Eformat == ElectronicClaimFormat.x837D_4010)
{
X837_4010.Validate(clearinghouseClin, queueItem); //,out warnings);
//return;
}
else if (clearinghouseClin.Eformat == ElectronicClaimFormat.x837D_5010_dental ||
clearinghouseClin.Eformat == ElectronicClaimFormat.x837_5010_med_inst)
{
X837_5010.Validate(clearinghouseClin, queueItem); //,out warnings);
//return;
}
else if (clearinghouseClin.Eformat == ElectronicClaimFormat.Renaissance)
{
queueItem.MissingData = Renaissance.GetMissingData(queueItem);
//return;
}
else if (clearinghouseClin.Eformat == ElectronicClaimFormat.Canadian)
{
queueItem.MissingData = Canadian.GetMissingData(queueItem);
//return;
}
else if (clearinghouseClin.Eformat == ElectronicClaimFormat.Dutch)
{
Dutch.GetMissingData(queueItem); //,out warnings);
//return;
}
else if (clearinghouseClin.Eformat == ElectronicClaimFormat.Ramq)
{
Ramq.GetMissingData(queueItem);
}
return(queueItem);
}