///<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 void GetMissingData(ClaimSendQueueItem queueItem) //, out string warnings){
{
queueItem.Warnings = "";
queueItem.MissingData = "";
Clearinghouse clearhouse = ClearinghouseL.GetClearinghouse(queueItem.ClearinghouseNum, true); //Suppress error message in case no default medical clearinghouse set.
//this is usually just the default clearinghouse or the clearinghouse for the PayorID.
if (clearhouse == null)
{
if (queueItem.MedType == EnumClaimMedType.Dental)
{
queueItem.MissingData += "No default dental clearinghouse set.";
}
else
{
queueItem.MissingData += "No default medical/institutional clearinghouse set.";
}
return;
}
if (clearhouse.Eformat == ElectronicClaimFormat.x837D_4010)
{
X837_4010.Validate(queueItem); //,out warnings);
//return;
}
else if (clearhouse.Eformat == ElectronicClaimFormat.x837D_5010_dental ||
clearhouse.Eformat == ElectronicClaimFormat.x837_5010_med_inst)
{
X837_5010.Validate(queueItem); //,out warnings);
//return;
}
else if (clearhouse.Eformat == ElectronicClaimFormat.Renaissance)
{
queueItem.MissingData = Renaissance.GetMissingData(queueItem);
//return;
}
else if (clearhouse.Eformat == ElectronicClaimFormat.Canadian)
{
queueItem.MissingData = Canadian.GetMissingData(queueItem);
//return;
}
else if (clearhouse.Eformat == ElectronicClaimFormat.Dutch)
{
Dutch.GetMissingData(queueItem); //,out warnings);
//return;
}
//return "";
}
public static string Run(int scriptNum, string responseExpected, string responseTypeExpected, Claim claim, bool showForms, int pageNumber, int lastPageNumber, double firstExamFee, double diagnosticPhaseFee)
{
string retVal = "";
ClaimSendQueueItem queueItem = Claims.GetQueueList(claim.ClaimNum, claim.ClinicNum, 0)[0];
Clearinghouse clearinghouseHq = ClearinghouseL.GetClearinghouseHq(queueItem.ClearinghouseNum);
Clearinghouse clearinghouseClin = Clearinghouses.OverrideFields(clearinghouseHq, Clinics.ClinicNum);
Eclaims.GetMissingData(clearinghouseClin, queueItem); //,out warnings);
if (queueItem.MissingData != "")
{
return("Cannot send predetermination until missing data is fixed:\r\n" + queueItem.MissingData + "\r\n");
}
#if DEBUG
Canadian.testNumber = scriptNum;
claim.PreAuthString = "" + pageNumber + "," + lastPageNumber + "," + firstExamFee + "," + diagnosticPhaseFee;
#endif
long etransNum = Canadian.SendClaim(clearinghouseClin, queueItem, showForms);
Etrans etrans = Etranss.GetEtrans(etransNum);
string message = EtransMessageTexts.GetMessageText(etrans.EtransMessageTextNum);
CCDFieldInputter formData = new CCDFieldInputter(message);
string responseType = formData.GetValue("A04");
if (responseType != responseTypeExpected)
{
return("Form type is '" + responseType + "' but should be '" + responseTypeExpected + "'\r\n");
}
string responseStatus = formData.GetValue("G05");
if (responseStatus != responseExpected)
{
return("G05 is '" + responseStatus + "' but should be '" + responseExpected + "'\r\n");
}
if (responseExpected == "R" && responseTypeExpected == "11")
{
//so far, only for #6. We need some other way to test if successful transaction
string errorMsgCount = formData.GetValue("G06");
if (errorMsgCount == "00")
{
return("Wrong message count.\r\n");
}
}
retVal += "Predetermination #" + scriptNum + " page " + pageNumber + " of " + lastPageNumber + " successful.\r\n";
return(retVal);
}
public static string Run(int scriptNum, string responseExpected, string responseTypeExpected, Claim claim, bool showForms)
{
string retVal = "";
ClaimSendQueueItem queueItem = Claims.GetQueueList(claim.ClaimNum, claim.ClinicNum, 0)[0];
Clearinghouse clearinghouseHq = ClearinghouseL.GetClearinghouseHq(queueItem.ClearinghouseNum);
Clearinghouse clearinghouseClin = Clearinghouses.OverrideFields(clearinghouseHq, Clinics.ClinicNum);
Eclaims.GetMissingData(clearinghouseClin, queueItem); //,out warnings);
if (queueItem.MissingData != "")
{
return("Cannot send claim until missing data is fixed:\r\n" + queueItem.MissingData + "\r\n");
}
#if DEBUG
Canadian.testNumber = scriptNum;
#endif
long etransNum = Canadian.SendClaim(clearinghouseClin, queueItem, showForms);
Etrans etrans = Etranss.GetEtrans(etransNum);
string message = EtransMessageTexts.GetMessageText(etrans.EtransMessageTextNum);
CCDFieldInputter formData = new CCDFieldInputter(message);
string responseType = formData.GetValue("A04");
if (responseType != responseTypeExpected)
{
return("Form type should be " + responseTypeExpected + "\r\n");
}
string responseStatus = formData.GetValue("G05");
if (responseStatus != responseExpected)
{
return("G05 should be " + responseExpected + "\r\n");
}
if (responseExpected == "R" && responseTypeExpected == "11")
{
//so far, only for #6. We need some other way to test if successful transaction
string errorMsgCount = formData.GetValue("G06");
if (errorMsgCount == "00")
{
return("Wrong message count.\r\n");
}
}
retVal += "Claim #" + scriptNum.ToString() + " successful.\r\n";
return(retVal);
}
///<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(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");
Clearinghouse clearhouse = ClearinghouseL.GetClearinghouse(queueItem.ClearinghouseNum);
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++)
{
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 = clearhouse.ExportPath;
if (!Directory.Exists(saveFolder))
{
MessageBox.Show(saveFolder + " " + Lan.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);
}
