private void FormEtrans835ClaimEdit_Load(object sender,EventArgs e) {
long claimNum=_claimPaid.ClaimNum;
_claim=null;
if(claimNum!=0) {
_claim=Claims.GetClaim(claimNum);
}
FillAll();
}
///<summary></summary>
public FormEtrans835ClaimPay(Hx835_Claim claimPaid,Claim claim,Patient patCur,Family famCur,List<InsPlan> planList,List<PatPlan> patPlanList,List<InsSub> subList) {
InitializeComponent();
_claimPaid=claimPaid;
_claim=claim;
_famCur=famCur;
_patCur=patCur;
_listPlans=planList;
_listInsSubs=subList;
_listPatPlans=patPlanList;
Lan.F(this);
}
///<summary></summary>
public static void DetachProcsFromClaim(Claim Cur)
{
if(RemotingClient.RemotingRole==RemotingRole.ClientWeb) {
Meth.GetVoid(MethodBase.GetCurrentMethod(),Cur);
return;
}
string command = "UPDATE procedurelog SET "
+"claimnum = '0' "
+"WHERE claimnum = '"+POut.Long(Cur.ClaimNum)+"'";
//MessageBox.Show(string command);
Db.NonQ(command);
}
///<summary></summary>
public static void Delete(Claim Cur)
{
if(RemotingClient.RemotingRole==RemotingRole.ClientWeb) {
Meth.GetVoid(MethodBase.GetCurrentMethod(),Cur);
return;
}
string command = "DELETE FROM claim WHERE ClaimNum = '"+POut.Long(Cur.ClaimNum)+"'";
Db.NonQ(command);
//command = "DELETE FROM canadianclaim WHERE ClaimNum = '"+POut.Long(Cur.ClaimNum)+"'";
//Db.NonQ(command);
//command = "DELETE FROM canadianextract WHERE ClaimNum = '"+POut.Long(Cur.ClaimNum)+"'";
//Db.NonQ(command);
}
public static string Run(int scriptNum,string responseExpected,Claim claim) {
string retVal="";
InsPlan insPlan=InsPlans.GetPlan(claim.PlanNum,null);
InsSub insSub=InsSubs.GetOne(claim.InsSubNum);
long etransNum=CanadianOutput.SendClaimReversal(claim,insPlan,insSub);
Etrans etrans=Etranss.GetEtrans(etransNum);
string message=EtransMessageTexts.GetMessageText(etrans.EtransMessageTextNum);
CCDFieldInputter formData=new CCDFieldInputter(message);
string responseStatus=formData.GetValue("G05");
if(responseStatus!=responseExpected) {
return "G05 should be "+responseExpected+"\r\n";
}
retVal+="Reversal #"+scriptNum.ToString()+" successful.\r\n";
return retVal;
}
///<summary></summary>
public FormClaimEdit(Claim claimCur, Patient patCur,Family famCur){
PatCur=patCur;
FamCur=famCur;
ClaimCur=claimCur;
InitializeComponent();// Required for Windows Form Designer support
//tbPay.CellDoubleClicked += new OpenDental.ContrTable.CellEventHandler(tbPay_CellDoubleClicked);
//tbProc.CellClicked += new OpenDental.ContrTable.CellEventHandler(tbProc_CellClicked);
//tbPay.CellClicked += new OpenDental.ContrTable.CellEventHandler(tbPay_CellClicked);
Lan.F(this);
listAttachments.ContextMenu=contextMenuAttachments;
}
private void butPreview_Click(object sender, System.EventArgs e) {
if(!ClaimIsValid()) {
return;
}
UpdateClaim();
FormClaimPrint FormCP=new FormClaimPrint();
FormCP.PatNumCur=ClaimCur.PatNum;
FormCP.ClaimNumCur=ClaimCur.ClaimNum;
FormCP.PrintImmediately=false;
FormCP.ShowDialog();
if(FormCP.DialogResult==DialogResult.OK) {
//status will have changed to sent.
ClaimCur=Claims.GetClaim(ClaimCur.ClaimNum);
}
ClaimList=Claims.Refresh(PatCur.PatNum);
ClaimProcList=ClaimProcs.Refresh(PatCur.PatNum);
FillForm();
//no need to FillCanadian. Nothing has changed.
}
///<summary></summary>
public static long Insert(Claim claim) {
if(RemotingClient.RemotingRole==RemotingRole.ClientWeb) {
claim.ClaimNum=Meth.GetLong(MethodBase.GetCurrentMethod(),claim);
return claim.ClaimNum;
}
return Crud.ClaimCrud.Insert(claim);
}
///<summary></summary>
public static void Update(Claim claim){
if(RemotingClient.RemotingRole==RemotingRole.ClientWeb) {
Meth.GetVoid(MethodBase.GetCurrentMethod(),claim);
return;
}
Crud.ClaimCrud.Update(claim);
//now, delete all attachments and recreate.
string command="DELETE FROM claimattach WHERE ClaimNum="+POut.Long(claim.ClaimNum);
Db.NonQ(command);
for(int i=0;i<claim.Attachments.Count;i++) {
claim.Attachments[i].ClaimNum=claim.ClaimNum;
ClaimAttaches.Insert(claim.Attachments[i]);
}
}
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];
Eclaims.GetMissingData(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(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></summary>
public FormClaimInstEdit(Claim claimCur,Patient patCur,Family famCur) {
PatCur=patCur;
FamCur=famCur;
ClaimCur=claimCur;
if(ClaimCur.ClaimForm != 0){
ClaimFormCur=ClaimForms.GetClaimForm(ClaimCur.ClaimForm);
ClaimValCodes=ClaimValCodeLogs.GetValCodes(ClaimCur.ClaimNum);
CurCondCodeLog=ClaimCondCodeLogs.GetOne(ClaimCur.ClaimNum);
}
InitializeComponent();// Required for Windows Form Designer support
//tbPay.CellDoubleClicked += new OpenDental.ContrTable.CellEventHandler(tbPay_CellDoubleClicked);
//tbProc.CellClicked += new OpenDental.ContrTable.CellEventHandler(tbProc_CellClicked);
//tbPay.CellClicked += new OpenDental.ContrTable.CellEventHandler(tbPay_CellClicked);
Lan.F(this);
}
/// <summary>claimType="P" or "S".</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){
//Claim ClaimCur=CreateClaim("P",PatPlanList,InsPlanList,ClaimProcList,procsForPat);
long claimFormNum = 0;
EtransType eFormat = 0;
InsPlan PlanCur1=new InsPlan();
InsSub SubCur1=new InsSub();
InsPlan PlanCur2=new InsPlan();
InsSub SubCur2=new InsSub();
Relat relatOther=Relat.Self;
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;
}
//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.ClaimStatus="S";
//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;
}
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);
}
claimProcs[i].LineNumber=(byte)(i+1);
ClaimProcs.Update(claimProcs[i]);
}
ClaimProcList=ClaimProcs.Refresh(pat.PatNum);
ClaimL.CalculateAndUpdate(procsForPat,InsPlanList,claim,PatPlanList,benefitList,pat.Age,SubList);
return claim;
}
public static void ShowCdaClaimForm(Claim claim) {
FormClaimPrint FormCP=new FormClaimPrint();
FormCP.PatNumCur=claim.PatNum;
FormCP.ClaimNumCur=claim.ClaimNum;
FormCP.ClaimFormCur=null;//so that it will pull from the individual claim or plan.
FormCP.ShowDialog();
}
///<summary>Gets all necessary info from db based on ThisPatNum and ThisClaimNum. Then fills displayStrings with the actual text that will display on claim. The isRenaissance flag is very temporary.</summary>
private void FillDisplayStrings(bool isRenaissance){
if(PrintBlank){
if(CultureInfo.CurrentCulture.Name.EndsWith("CA")) {//Canadian. en-CA or fr-CA
ClaimFormCur=ClaimForms.GetClaimFormByUniqueId("OD6");//CDA claim form
}
else { //Assume USA
ClaimFormCur=ClaimForms.GetClaimFormByUniqueId("OD8");//ADA claim form
}
//ClaimFormItems.GetListForForm(ClaimFormCur.ClaimFormNum);
displayStrings=new string[ClaimFormCur.Items.Length];
ListClaimProcs=new List<ClaimProc>();
return;
}
Family FamCur=Patients.GetFamily(PatNumCur);
Patient PatCur=FamCur.GetPatient(PatNumCur);
List<Claim> ClaimList=Claims.Refresh(PatCur.PatNum);
ClaimCur=Claims.GetFromList(ClaimList,ClaimNumCur);
//((Claim)Claims.HList[ThisClaimNum]).Clone();
ListInsSub2=InsSubs.RefreshForFam(FamCur);
ListInsPlan=InsPlans.RefreshForSubList(ListInsSub2);
ListPatPlans=PatPlans.Refresh(ClaimCur.PatNum);
InsPlan otherPlan=InsPlans.GetPlan(ClaimCur.PlanNum2,ListInsPlan);
InsSub otherSub=InsSubs.GetSub(ClaimCur.InsSubNum2,ListInsSub2);
if(otherPlan==null){
otherPlan=new InsPlan();//easier than leaving it null
}
Carrier otherCarrier=new Carrier();
if(otherPlan.PlanNum!=0){
otherCarrier=Carriers.GetCarrier(otherPlan.CarrierNum);
}
//Employers.GetEmployer(otherPlan.EmployerNum);
//Employer otherEmployer=Employers.Cur;//not actually used
//then get the main plan
subCur=InsSubs.GetSub(ClaimCur.InsSubNum,ListInsSub2);
planCur=InsPlans.GetPlan(ClaimCur.PlanNum,ListInsPlan);
Clinic clinic=Clinics.GetClinic(ClaimCur.ClinicNum);
carrier=Carriers.GetCarrier(planCur.CarrierNum);
//Employers.GetEmployer(InsPlans.Cur.EmployerNum);
Patient subsc;
if(FamCur.GetIndex(subCur.Subscriber)==-1) {//from another family
subsc=Patients.GetPat(subCur.Subscriber);
//Patients.Cur;
//Patients.GetFamily(ThisPatNum);//return to current family
}
else{
subsc=FamCur.ListPats[FamCur.GetIndex(subCur.Subscriber)];
}
Patient otherSubsc=new Patient();
if(otherPlan.PlanNum!=0){//if secondary insurance exists
if(FamCur.GetIndex(otherSub.Subscriber)==-1) {//from another family
otherSubsc=Patients.GetPat(otherSub.Subscriber);
//Patients.Cur;
//Patients.GetFamily(ThisPatNum);//return to current family
}
else{
otherSubsc=FamCur.ListPats[FamCur.GetIndex(otherSub.Subscriber)];
}
}
if(ClaimCur.ReferringProv>0){
ClaimReferral=Referrals.GetReferral(ClaimCur.ReferringProv);
}
ListProc=Procedures.Refresh(PatCur.PatNum);
List<ToothInitial> initialList=ToothInitials.Refresh(PatCur.PatNum);
//List<ClaimProc> ClaimProcList=ClaimProcs.Refresh(PatCur.PatNum);
ClaimProcsForPat=ClaimProcs.Refresh(ClaimCur.PatNum);
ClaimProcsForClaim=ClaimProcs.RefreshForClaim(ClaimCur.ClaimNum);
ListClaimProcs=new List<ClaimProc>();
bool includeThis;
Procedure proc;
for(int i=0;i<ClaimProcsForClaim.Count;i++){//fill the arraylist
if(ClaimProcsForClaim[i].ProcNum==0){
continue;//skip payments
}
if(CultureInfo.CurrentCulture.Name.EndsWith("CA")) {//Canadian. en-CA or fr-CA
proc=Procedures.GetProcFromList(ListProc,ClaimProcsForClaim[i].ProcNum);
if(proc.ProcNumLab!=0) { //This is a lab fee procedure.
continue;//skip lab fee procedures in Canada, because they will show up on the same line as the procedure that they are attached to.
}
}
includeThis=true;
for(int j=0;j<ListClaimProcs.Count;j++){//loop through existing claimprocs
if(ListClaimProcs[j].ProcNum==ClaimProcsForClaim[i].ProcNum){
includeThis=false;//skip duplicate procedures
}
}
if(includeThis){
ListClaimProcs.Add(ClaimProcsForClaim[i]);
}
}
List<string> missingTeeth=ToothInitials.GetMissingOrHiddenTeeth(initialList);
ProcedureCode procCode;
for(int j=missingTeeth.Count-1;j>=0;j--) {//loop backwards to keep index accurate as items are removed
//if the missing tooth is missing because of an extraction being billed here, then exclude it
for(int p=0;p<ListClaimProcs.Count;p++) {
proc=Procedures.GetProcFromList(ListProc,ListClaimProcs[p].ProcNum);
procCode=ProcedureCodes.GetProcCode(proc.CodeNum);
if(procCode.PaintType==ToothPaintingType.Extraction && proc.ToothNum==missingTeeth[j]) {
missingTeeth.RemoveAt(j);
break;
}
}
}
//diagnoses---------------------------------------------------------------------------------------
diagnoses=new string[4];
for(int i=0;i<4;i++){
diagnoses[i]="";
}
for(int i=0;i<ListClaimProcs.Count;i++){
proc=Procedures.GetProcFromList(ListProc,ListClaimProcs[i].ProcNum);
if(proc.DiagnosticCode==""){
continue;
}
for(int d=0;d<4;d++){
if(diagnoses[d]==proc.DiagnosticCode){
break;//if it's already been added
}
if(diagnoses[d]==""){//we're at the end of the list of existing diagnoses, and no match
diagnoses[d]=proc.DiagnosticCode;//so add it.
break;
}
}
//There's still a chance that the diagnosis didn't get added, if there were more than 4.
}
Provider treatDent=ProviderC.ListLong[Providers.GetIndexLong(ClaimCur.ProvTreat)];
if(ClaimFormCur==null){
if(ClaimCur.ClaimForm>0){
ClaimFormCur=ClaimForms.GetClaimForm(ClaimCur.ClaimForm);
}
else {
ClaimFormCur=ClaimForms.GetClaimForm(planCur.ClaimFormNum);
}
}
List<PatPlan> patPlans=null;
displayStrings=new string[ClaimFormCur.Items.Length];
//a value is set for every item, but not every case will have a matching claimform item.
for(int i=0;i<ClaimFormCur.Items.Length;i++){
if(ClaimFormCur.Items[i]==null){//Renaissance does not use [0]
displayStrings[i]="";
continue;
}
switch(ClaimFormCur.Items[i].FieldName){
default://image. or procedure which gets filled in FillProcStrings.
displayStrings[i]="";
break;
case "FixedText":
displayStrings[i]=ClaimFormCur.Items[i].FormatString;
break;
case "IsPreAuth":
if(ClaimCur.ClaimType=="PreAuth") {
displayStrings[i]="X";
}
break;
case "IsStandardClaim":
if(ClaimCur.ClaimType!="PreAuth") {
displayStrings[i]="X";
}
break;
case "ShowPreauthorizationIfPreauth":
if(ClaimCur.ClaimType=="PreAuth") {
displayStrings[i]="Preauthorization";
}
break;
case "IsMedicaidClaim"://this should later be replaced with an insplan field.
if(PatCur.MedicaidID!="") {
displayStrings[i]="X";
}
break;
case "IsGroupHealthPlan":
string eclaimcode=InsFilingCodes.GetEclaimCode(planCur.FilingCode);
if(PatCur.MedicaidID==""
&& eclaimcode != "MC"//medicaid
&& eclaimcode != "CH"//champus
&& eclaimcode != "VA")//veterans
//&& eclaimcode != ""//medicare?
{
displayStrings[i]="X";
}
break;
case "PreAuthString":
displayStrings[i]=ClaimCur.PreAuthString;
break;
case "PriorAuthString":
displayStrings[i]=ClaimCur.PriorAuthorizationNumber;
break;
case "PriInsCarrierName":
displayStrings[i]=carrier.CarrierName;
break;
case "PriInsAddress":
displayStrings[i]=carrier.Address;
break;
case "PriInsAddress2":
displayStrings[i]=carrier.Address2;
break;
case "PriInsAddressComplete":
displayStrings[i]=carrier.Address+" "+carrier.Address2;
break;
case "PriInsCity":
displayStrings[i]=carrier.City;
break;
case "PriInsST":
displayStrings[i]=carrier.State;
break;
case "PriInsZip":
displayStrings[i]=carrier.Zip;
break;
case "OtherInsExists":
if(otherPlan.PlanNum!=0) {
displayStrings[i]="X";
}
break;
case "OtherInsNotExists":
if(otherPlan.PlanNum==0) {
displayStrings[i]="X";
}
break;
case "OtherInsExistsDent":
if(otherPlan.PlanNum!=0) {
if(!otherPlan.IsMedical) {
displayStrings[i]="X";
}
}
break;
case "OtherInsExistsMed":
if(otherPlan.PlanNum!=0) {
if(otherPlan.IsMedical) {
displayStrings[i]="X";
}
}
break;
case "OtherInsSubscrLastFirst":
if(otherPlan.PlanNum!=0) {
displayStrings[i]=otherSubsc.LName+", "+otherSubsc.FName+" "+otherSubsc.MiddleI;
}
break;
case "OtherInsSubscrDOB":
if(otherPlan.PlanNum!=0) {
if(ClaimFormCur.Items[i].FormatString=="") {
displayStrings[i]=otherSubsc.Birthdate.ToShortDateString();
}
else {
displayStrings[i]=otherSubsc.Birthdate.ToString(ClaimFormCur.Items[i].FormatString);
}
}
break;
case "OtherInsSubscrIsMale":
if(otherPlan.PlanNum!=0 && otherSubsc.Gender==PatientGender.Male) {
displayStrings[i]="X";
}
break;
case "OtherInsSubscrIsFemale":
if(otherPlan.PlanNum!=0 && otherSubsc.Gender==PatientGender.Female) {
displayStrings[i]="X";
}
break;
case "OtherInsSubscrID":
if(otherPlan.PlanNum!=0) {
displayStrings[i]=otherSub.SubscriberID;
}
break;
//if(otherPlan.PlanNum!=0 && otherSubsc.SSN.Length==9){
// displayStrings[i]=otherSubsc.SSN.Substring(0,3)
// +"-"+otherSubsc.SSN.Substring(3,2)
// +"-"+otherSubsc.SSN.Substring(5);
//}
//break;
case "OtherInsGroupNum":
if(otherPlan.PlanNum!=0) {
displayStrings[i]=otherPlan.GroupNum;
}
break;
case "OtherInsRelatIsSelf":
if(otherPlan.PlanNum!=0 && ClaimCur.PatRelat2==Relat.Self) {
displayStrings[i]="X";
}
break;
case "OtherInsRelatIsSpouse":
if(otherPlan.PlanNum!=0 && ClaimCur.PatRelat2==Relat.Spouse) {
displayStrings[i]="X";
}
break;
case "OtherInsRelatIsChild":
if(otherPlan.PlanNum!=0 && ClaimCur.PatRelat2==Relat.Child) {
displayStrings[i]="X";
}
break;
case "OtherInsRelatIsOther":
if(otherPlan.PlanNum!=0 && (
ClaimCur.PatRelat2==Relat.Dependent
|| ClaimCur.PatRelat2==Relat.Employee
|| ClaimCur.PatRelat2==Relat.HandicapDep
|| ClaimCur.PatRelat2==Relat.InjuredPlaintiff
|| ClaimCur.PatRelat2==Relat.LifePartner
|| ClaimCur.PatRelat2==Relat.SignifOther
))
displayStrings[i]="X";
break;
case "OtherInsCarrierName":
if(otherPlan.PlanNum!=0) {
displayStrings[i]=otherCarrier.CarrierName;
}
break;
case "OtherInsAddress":
if(otherPlan.PlanNum!=0) {
displayStrings[i]=otherCarrier.Address;
}
break;
case "OtherInsCity":
if(otherPlan.PlanNum!=0) {
displayStrings[i]=otherCarrier.City;
}
break;
case "OtherInsST":
if(otherPlan.PlanNum!=0) {
displayStrings[i]=otherCarrier.State;
}
break;
case "OtherInsZip":
if(otherPlan.PlanNum!=0) {
displayStrings[i]=otherCarrier.Zip;
}
break;
case "SubscrLastFirst":
displayStrings[i]=subsc.LName+", "+subsc.FName+" "+subsc.MiddleI;
break;
case "SubscrAddress":
displayStrings[i]=subsc.Address;
break;
case "SubscrAddress2":
displayStrings[i]=subsc.Address2;
break;
case "SubscrAddressComplete":
displayStrings[i]=subsc.Address+" "+subsc.Address2;
break;
case "SubscrCity":
displayStrings[i]=subsc.City;
break;
case "SubscrST":
displayStrings[i]=subsc.State;
break;
case "SubscrZip":
displayStrings[i]=subsc.Zip;
break;
case "SubscrPhone"://needs work. Only used for 1500
if(isRenaissance) {
//Expecting (XXX)XXX-XXXX
displayStrings[i]=subsc.HmPhone;
if(subsc.HmPhone.Length>14) {//Might have a note following the number.
displayStrings[i]=subsc.HmPhone.Substring(0,14);
}
}
else {
string phone=subsc.HmPhone.Replace("(","");
phone=phone.Replace(")"," ");
phone=phone.Replace("-"," ");
displayStrings[i]=phone;
}
break;
case "SubscrDOB":
if(ClaimFormCur.Items[i].FormatString=="") {
displayStrings[i]=subsc.Birthdate.ToShortDateString();//MM/dd/yyyy
}
else {
displayStrings[i]=subsc.Birthdate.ToString(ClaimFormCur.Items[i].FormatString);
}
break;
case "SubscrIsMale":
if(subsc.Gender==PatientGender.Male) {
displayStrings[i]="X";
}
break;
case "SubscrIsFemale":
if(subsc.Gender==PatientGender.Female) {
displayStrings[i]="X";
}
break;
case "SubscrGender":
if(subsc.Gender==PatientGender.Male) {
displayStrings[i]="M";
}
else {
displayStrings[i]="F";
}
break;
case "SubscrIsMarried":
if(subsc.Position==PatientPosition.Married) {
displayStrings[i]="X";
}
break;
case "SubscrIsSingle":
if(subsc.Position==PatientPosition.Single
|| subsc.Position==PatientPosition.Child
|| subsc.Position==PatientPosition.Widowed) {
displayStrings[i]="X";
}
break;
case "SubscrID":
patPlans=PatPlans.Refresh(PatNumCur);
string patID=PatPlans.GetPatID(subCur.InsSubNum,patPlans);
if(patID=="") {
displayStrings[i]=subCur.SubscriberID;
}
else {
displayStrings[i]=patID;
}
break;
case "SubscrIDStrict":
displayStrings[i]=subCur.SubscriberID;
break;
case "SubscrIsFTStudent":
if(subsc.StudentStatus=="F") {
displayStrings[i]="X";
}
break;
case "SubscrIsPTStudent":
if(subsc.StudentStatus=="P") {
displayStrings[i]="X";
}
break;
case "GroupName":
displayStrings[i]=planCur.GroupName;
break;
case "GroupNum":
displayStrings[i]=planCur.GroupNum;
break;
case "DivisionNo":
displayStrings[i]=planCur.DivisionNo;
break;
case "EmployerName":
displayStrings[i]=Employers.GetEmployer(planCur.EmployerNum).EmpName;;
break;
case "RelatIsSelf":
if(ClaimCur.PatRelat==Relat.Self) {
displayStrings[i]="X";
}
break;
case "RelatIsSpouse":
if(ClaimCur.PatRelat==Relat.Spouse) {
displayStrings[i]="X";
}
break;
case "RelatIsChild":
if(ClaimCur.PatRelat==Relat.Child) {
displayStrings[i]="X";
}
break;
case "RelatIsOther":
if(ClaimCur.PatRelat==Relat.Dependent
|| ClaimCur.PatRelat==Relat.Employee
|| ClaimCur.PatRelat==Relat.HandicapDep
|| ClaimCur.PatRelat==Relat.InjuredPlaintiff
|| ClaimCur.PatRelat==Relat.LifePartner
|| ClaimCur.PatRelat==Relat.SignifOther) {
displayStrings[i]="X";
}
break;
case "Relationship":
if(CultureInfo.CurrentCulture.Name.EndsWith("CA")) {//Canadian. en-CA or fr-CA
if(ClaimCur.PatRelat==Relat.Self) {
displayStrings[i]="Self";
}
else if(ClaimCur.PatRelat==Relat.Spouse) {
displayStrings[i]="Spouse";
}
else if(ClaimCur.PatRelat==Relat.Child) {
displayStrings[i]="Child";
}
else if(ClaimCur.PatRelat==Relat.SignifOther || ClaimCur.PatRelat==Relat.LifePartner) {
displayStrings[i]="Common Law Spouse";
}
else {
displayStrings[i]="Other";
}
}
else {
displayStrings[i]=ClaimCur.PatRelat.ToString();
}
break;
case "IsFTStudent":
if(PatCur.StudentStatus=="F") {
displayStrings[i]="X";
}
break;
case "IsPTStudent":
if(PatCur.StudentStatus=="P") {
displayStrings[i]="X";
}
break;
case "IsStudent":
if(PatCur.StudentStatus=="P" || PatCur.StudentStatus=="F") {
displayStrings[i]="X";
}
break;
case "CollegeName":
displayStrings[i]=PatCur.SchoolName;
break;
case "PatientLastFirst":
displayStrings[i]=PatCur.LName+", "+PatCur.FName+" "+PatCur.MiddleI;
break;
case "PatientFirstMiddleLast":
displayStrings[i]=PatCur.FName+" "+PatCur.MiddleI+" "+PatCur.LName;
break;
case "PatientFirstName":
displayStrings[i] = PatCur.FName;
break;
case "PatientMiddleName":
displayStrings[i] = PatCur.MiddleI;
break;
case "PatientLastName":
displayStrings[i] = PatCur.LName;
break;
case "PatientAddress":
displayStrings[i]=PatCur.Address;
break;
case "PatientAddress2":
displayStrings[i]=PatCur.Address2;
break;
case "PatientAddressComplete":
displayStrings[i]=PatCur.Address+" "+PatCur.Address2;
break;
case "PatientCity":
displayStrings[i]=PatCur.City;
break;
case "PatientST":
displayStrings[i]=PatCur.State;
break;
case "PatientZip":
displayStrings[i]=PatCur.Zip;
break;
case "PatientPhone"://needs work. Only used for 1500
if(isRenaissance) {
//Expecting (XXX)XXX-XXXX
displayStrings[i]=PatCur.HmPhone;
if(PatCur.HmPhone.Length>14) {//Might have a note following the number.
displayStrings[i]=PatCur.HmPhone.Substring(0,14);
}
}
else {
string phonep=PatCur.HmPhone.Replace("(","");
phonep=phonep.Replace(")"," ");
phonep=phonep.Replace("-"," ");
displayStrings[i]=phonep;
}
break;
case "PatientDOB":
if(ClaimFormCur.Items[i].FormatString=="") {
displayStrings[i]=PatCur.Birthdate.ToShortDateString();//MM/dd/yyyy
}
else {
displayStrings[i]=PatCur.Birthdate.ToString
(ClaimFormCur.Items[i].FormatString);
}
break;
case "PatientIsMale":
if(PatCur.Gender==PatientGender.Male) {
displayStrings[i]="X";
}
break;
case "PatientIsFemale":
if(PatCur.Gender==PatientGender.Female) {
displayStrings[i]="X";
}
break;
case "PatientGender":
if(PatCur.Gender==PatientGender.Male) {
displayStrings[i]="Male";
}
else if(PatCur.Gender==PatientGender.Female) {
displayStrings[i]="Female";
}
break;
case "PatientGenderLetter":
if(subsc.Gender==PatientGender.Male) {
displayStrings[i]="M";
}
else {
displayStrings[i]="F";
}
break;
case "PatientIsMarried":
if(PatCur.Position==PatientPosition.Married) {
displayStrings[i]="X";
}
break;
case "PatientIsSingle":
if(PatCur.Position==PatientPosition.Single
|| PatCur.Position==PatientPosition.Child
|| PatCur.Position==PatientPosition.Widowed) {
displayStrings[i]="X";
}
break;
case "PatIDFromPatPlan": //Dependant Code for Canada
patPlans=PatPlans.Refresh(PatNumCur);
if(CultureInfo.CurrentCulture.Name.EndsWith("CA")) {//Canadian. en-CA or fr-CA
if(carrier.ElectID=="000064") { //Pacific Blue Cross (PBC)
displayStrings[i]=subCur.SubscriberID+"-"+PatPlans.GetPatID(subCur.InsSubNum,patPlans);
}
}
else {
displayStrings[i]=PatPlans.GetPatID(subCur.InsSubNum,patPlans);
}
break;
case "PatientSSN":
if(PatCur.SSN.Length==9) {
displayStrings[i]=PatCur.SSN.Substring(0,3)
+"-"+PatCur.SSN.Substring(3,2)
+"-"+PatCur.SSN.Substring(5);
}
else {
displayStrings[i]=PatCur.SSN;
}
break;
case "PatientMedicaidID":
displayStrings[i]=PatCur.MedicaidID;
break;
case "PatientID-MedicaidOrSSN":
if(PatCur.MedicaidID!="") {
displayStrings[i]=PatCur.MedicaidID;
}
else {
displayStrings[i]=PatCur.SSN;
}
break;
case "PatientChartNum":
displayStrings[i]=PatCur.ChartNumber;
break;
case "PatientPatNum":
displayStrings[i]=PatCur.PatNum.ToString();
break;
case "Diagnosis1":
if(ClaimFormCur.Items[i].FormatString=="") {
displayStrings[i]=diagnoses[0];
}
else if(ClaimFormCur.Items[i].FormatString=="NoDec") {
displayStrings[i]=diagnoses[0].Replace(".","");
}
break;
case "Diagnosis2":
if(ClaimFormCur.Items[i].FormatString=="") {
displayStrings[i]=diagnoses[1];
}
else if(ClaimFormCur.Items[i].FormatString=="NoDec") {
displayStrings[i]=diagnoses[1].Replace(".","");
}
break;
case "Diagnosis3":
if(ClaimFormCur.Items[i].FormatString=="") {
displayStrings[i]=diagnoses[2];
}
else if(ClaimFormCur.Items[i].FormatString=="NoDec") {
displayStrings[i]=diagnoses[2].Replace(".","");
}
break;
case "Diagnosis4":
if(ClaimFormCur.Items[i].FormatString=="") {
displayStrings[i]=diagnoses[3];
}
else if(ClaimFormCur.Items[i].FormatString=="NoDec") {
displayStrings[i]=diagnoses[3].Replace(".","");
}
break;
//this is where the procedures used to be
case "Miss1":
if(missingTeeth.Contains("1")) {
displayStrings[i]="X";
}
break;
case "Miss2":
if(missingTeeth.Contains("2")) {
displayStrings[i]="X";
}
break;
case "Miss3":
if(missingTeeth.Contains("3")) {
displayStrings[i]="X";
}
break;
case "Miss4":
if(missingTeeth.Contains("4")) {
displayStrings[i]="X";
}
break;
case "Miss5":
if(missingTeeth.Contains("5")) {
displayStrings[i]="X";
}
break;
case "Miss6":
if(missingTeeth.Contains("6")) {
displayStrings[i]="X";
}
break;
case "Miss7":
if(missingTeeth.Contains("7")) {
displayStrings[i]="X";
}
break;
case "Miss8":
if(missingTeeth.Contains("8")) {
displayStrings[i]="X";
}
break;
case "Miss9":
if(missingTeeth.Contains("9")) {
displayStrings[i]="X";
}
break;
case "Miss10":
if(missingTeeth.Contains("10")) {
displayStrings[i]="X";
}
break;
case "Miss11":
if(missingTeeth.Contains("11")) {
displayStrings[i]="X";
}
break;
case "Miss12":
if(missingTeeth.Contains("12")) {
displayStrings[i]="X";
}
break;
case "Miss13":
if(missingTeeth.Contains("13")) {
displayStrings[i]="X";
}
break;
case "Miss14":
if(missingTeeth.Contains("14")) {
displayStrings[i]="X";
}
break;
case "Miss15":
if(missingTeeth.Contains("15")) {
displayStrings[i]="X";
}
break;
case "Miss16":
if(missingTeeth.Contains("16")) {
displayStrings[i]="X";
}
break;
case "Miss17":
if(missingTeeth.Contains("17")) {
displayStrings[i]="X";
}
break;
case "Miss18":
if(missingTeeth.Contains("18")) {
displayStrings[i]="X";
}
break;
case "Miss19":
if(missingTeeth.Contains("19")) {
displayStrings[i]="X";
}
break;
case "Miss20":
if(missingTeeth.Contains("20")) {
displayStrings[i]="X";
}
break;
case "Miss21":
if(missingTeeth.Contains("21")) {
displayStrings[i]="X";
}
break;
case "Miss22":
if(missingTeeth.Contains("22")) {
displayStrings[i]="X";
}
break;
case "Miss23":
if(missingTeeth.Contains("23")) {
displayStrings[i]="X";
}
break;
case "Miss24":
if(missingTeeth.Contains("24")) {
displayStrings[i]="X";
}
break;
case "Miss25":
if(missingTeeth.Contains("25")) {
displayStrings[i]="X";
}
break;
case "Miss26":
if(missingTeeth.Contains("26")) {
displayStrings[i]="X";
}
break;
case "Miss27":
if(missingTeeth.Contains("27")) {
displayStrings[i]="X";
}
break;
case "Miss28":
if(missingTeeth.Contains("28")) {
displayStrings[i]="X";
}
break;
case "Miss29":
if(missingTeeth.Contains("29")) {
displayStrings[i]="X";
}
break;
case "Miss30":
if(missingTeeth.Contains("30")) {
displayStrings[i]="X";
}
break;
case "Miss31":
if(missingTeeth.Contains("31")) {
displayStrings[i]="X";
}
break;
case "Miss32":
if(missingTeeth.Contains("32")) {
displayStrings[i]="X";
}
break;
case "Remarks":
displayStrings[i]="";
if(CultureInfo.CurrentCulture.Name.EndsWith("CA")) {//Canadian. en-CA or fr-CA
if(carrier.ElectID=="000064") { //Pacific Blue Cross (PBC)
if(ClaimCur.ClaimType=="PreAuth") {
displayStrings[i]+="Predetermination only."+Environment.NewLine;
}
else {
if(subCur.AssignBen) {
displayStrings[i]+="Please pay provider."+Environment.NewLine;
}
else {
displayStrings[i]+="Please pay patient."+Environment.NewLine;
}
}
}
}
if(ClaimCur.AttachmentID!="" && !ClaimCur.ClaimNote.StartsWith(ClaimCur.AttachmentID)){
displayStrings[i]=ClaimCur.AttachmentID+" ";
}
displayStrings[i]+=ClaimCur.ClaimNote;
break;
case "PatientRelease":
if(subCur.ReleaseInfo) {
displayStrings[i]="Signature on File";
}
break;
case "PatientReleaseDate":
if(subCur.ReleaseInfo && ClaimCur.DateSent.Year > 1860) {
if(ClaimFormCur.Items[i].FormatString=="") {
displayStrings[i]=ClaimCur.DateSent.ToShortDateString();
}
else {
displayStrings[i]=ClaimCur.DateSent.ToString(ClaimFormCur.Items[i].FormatString);
}
}
break;
case "PatientAssignment":
if(subCur.AssignBen) {
displayStrings[i]="Signature on File";
}
break;
case "PatientAssignmentDate":
if(subCur.AssignBen && ClaimCur.DateSent.Year > 1860) {
if(ClaimFormCur.Items[i].FormatString=="") {
displayStrings[i]=ClaimCur.DateSent.ToShortDateString();
}
else {
displayStrings[i]=ClaimCur.DateSent.ToString(ClaimFormCur.Items[i].FormatString);
}
}
break;
case "PlaceIsOffice":
if(ClaimCur.PlaceService==PlaceOfService.Office) {
displayStrings[i]="X";
}
break;
case "PlaceIsHospADA2002":
if(ClaimCur.PlaceService==PlaceOfService.InpatHospital
|| ClaimCur.PlaceService==PlaceOfService.OutpatHospital) {
displayStrings[i]="X";
}
break;
case "PlaceIsExtCareFacilityADA2002":
if(ClaimCur.PlaceService==PlaceOfService.CustodialCareFacility
|| ClaimCur.PlaceService==PlaceOfService.SkilledNursFac) {
displayStrings[i]="X";
}
break;
case "PlaceIsOtherADA2002":
if(ClaimCur.PlaceService==PlaceOfService.PatientsHome
|| ClaimCur.PlaceService==PlaceOfService.OtherLocation) {
displayStrings[i]="X";
}
break;
case "PlaceIsInpatHosp":
if(ClaimCur.PlaceService==PlaceOfService.InpatHospital) {
displayStrings[i]="X";
}
break;
case "PlaceIsOutpatHosp":
if(ClaimCur.PlaceService==PlaceOfService.OutpatHospital) {
displayStrings[i]="X";
}
break;
case "PlaceIsAdultLivCareFac":
if(ClaimCur.PlaceService==PlaceOfService.CustodialCareFacility) {
displayStrings[i]="X";
}
break;
case "PlaceIsSkilledNursFac":
if(ClaimCur.PlaceService==PlaceOfService.SkilledNursFac) {
displayStrings[i]="X";
}
break;
case "PlaceIsPatientsHome":
if(ClaimCur.PlaceService==PlaceOfService.PatientsHome) {
displayStrings[i]="X";
}
break;
case "PlaceIsOtherLocation":
if(ClaimCur.PlaceService==PlaceOfService.OtherLocation) {
displayStrings[i]="X";
}
break;
case "PlaceNumericCode":
displayStrings[i]=GetPlaceOfServiceNum(ClaimCur.PlaceService);
break;
case "IsRadiographsAttached":
if(ClaimCur.Radiographs>0) {
displayStrings[i]="X";
}
break;
case "RadiographsNumAttached":
displayStrings[i]=ClaimCur.Radiographs.ToString();
break;
case "RadiographsNotAttached":
if(ClaimCur.Radiographs==0) {
displayStrings[i]="X";
}
break;
case "IsEnclosuresAttached":
if(ClaimCur.Radiographs>0 || ClaimCur.AttachedImages>0 || ClaimCur.AttachedModels>0) {
displayStrings[i]="X";
}
break;
case "AttachedImagesNum":
displayStrings[i]=ClaimCur.AttachedImages.ToString();
break;
case "AttachedModelsNum":
displayStrings[i]=ClaimCur.AttachedModels.ToString();
break;
case "IsNotOrtho":
if(!ClaimCur.IsOrtho) {
displayStrings[i]="X";
}
break;
case "IsOrtho":
if(ClaimCur.IsOrtho) {
displayStrings[i]="X";
}
break;
case "DateOrthoPlaced":
if(ClaimCur.OrthoDate.Year > 1880){
if(ClaimFormCur.Items[i].FormatString=="") {
displayStrings[i]=ClaimCur.OrthoDate.ToShortDateString();
}
else {
displayStrings[i]=ClaimCur.OrthoDate.ToString(ClaimFormCur.Items[i].FormatString);
}
}
break;
case "MonthsOrthoRemaining":
if(ClaimCur.OrthoRemainM > 0) {
displayStrings[i]=ClaimCur.OrthoRemainM.ToString();
}
break;
case "IsNotProsth":
if(ClaimCur.IsProsthesis=="N") {
displayStrings[i]="X";
}
break;
case "IsInitialProsth":
if(ClaimCur.IsProsthesis=="I") {
displayStrings[i]="X";
}
break;
case "IsNotReplacementProsth":
if(ClaimCur.IsProsthesis!="R") {//=='I'nitial or 'N'o
displayStrings[i]="X";
}
break;
case "IsReplacementProsth":
if(ClaimCur.IsProsthesis=="R") {
displayStrings[i]="X";
}
break;
case "DatePriorProsthPlaced":
if(ClaimCur.PriorDate.Year > 1860){
if(ClaimFormCur.Items[i].FormatString=="") {
displayStrings[i]=ClaimCur.PriorDate.ToShortDateString();
}
else {
displayStrings[i]=ClaimCur.PriorDate.ToString(ClaimFormCur.Items[i].FormatString);
}
}
break;
case "IsOccupational":
if(ClaimCur.AccidentRelated=="E") {
displayStrings[i]="X";
}
break;
case "IsNotOccupational":
if(ClaimCur.AccidentRelated!="E") {
displayStrings[i]="X";
}
break;
case "IsAutoAccident":
if(ClaimCur.AccidentRelated=="A") {
displayStrings[i]="X";
}
break;
case "IsNotAutoAccident":
if(ClaimCur.AccidentRelated!="A") {
displayStrings[i]="X";
}
break;
case "IsOtherAccident":
if(ClaimCur.AccidentRelated=="O") {
displayStrings[i]="X";
}
break;
case "IsNotOtherAccident":
if(ClaimCur.AccidentRelated!="O") {
displayStrings[i]="X";
}
break;
case "IsNotAccident":
if(ClaimCur.AccidentRelated!="O" && ClaimCur.AccidentRelated!="A") {
displayStrings[i]="X";
}
break;
case "IsAccident":
if(ClaimCur.AccidentRelated!="") {
displayStrings[i]="X";
}
break;
case "AccidentDate":
if(ClaimCur.AccidentDate.Year > 1860){
if(ClaimFormCur.Items[i].FormatString=="") {
displayStrings[i]=ClaimCur.AccidentDate.ToShortDateString();
}
else {
displayStrings[i]=ClaimCur.AccidentDate.ToString(ClaimFormCur.Items[i].FormatString);
}
}
break;
case "AccidentST":
displayStrings[i]=ClaimCur.AccidentST;
break;
case "BillingDentist":
Provider P=ProviderC.ListLong[Providers.GetIndexLong(ClaimCur.ProvBill)];
displayStrings[i]=P.FName+" "+P.MI+" "+P.LName+" "+P.Suffix;
break;
//case "BillingDentistAddress":
// if(PrefC.GetBool(PrefName.UseBillingAddressOnClaims)){
// displayStrings[i]=PrefC.GetString(PrefName.PracticeBillingAddress);
// }
// else if(clinic==null) {
// displayStrings[i]=PrefC.GetString(PrefName.PracticeAddress);
// }
// else {
// displayStrings[i]=clinic.Address;
// }
// break;
//case "BillingDentistAddress2":
// if(PrefC.GetBool(PrefName.UseBillingAddressOnClaims)) {
// displayStrings[i]=PrefC.GetString(PrefName.PracticeBillingAddress2);
// }
// else if(clinic==null) {
// displayStrings[i]=PrefC.GetString(PrefName.PracticeAddress2);
// }
// else {
// displayStrings[i]=clinic.Address2;
// }
// break;
//case "BillingDentistCity":
// if(PrefC.GetBool(PrefName.UseBillingAddressOnClaims)) {
// displayStrings[i]=PrefC.GetString(PrefName.PracticeBillingCity);
// }
// else if(clinic==null) {
// displayStrings[i]=PrefC.GetString(PrefName.PracticeCity);
// }
// else {
// displayStrings[i]=clinic.City;
// }
// break;
//case "BillingDentistST":
// if(PrefC.GetBool(PrefName.UseBillingAddressOnClaims)) {
// displayStrings[i]=PrefC.GetString(PrefName.PracticeBillingST);
// }
// else if(clinic==null) {
// displayStrings[i]=PrefC.GetString(PrefName.PracticeST);
// }
// else {
// displayStrings[i]=clinic.State;
// }
// break;
//case "BillingDentistZip":
// if(PrefC.GetBool(PrefName.UseBillingAddressOnClaims)) {
// displayStrings[i]=PrefC.GetString(PrefName.PracticeBillingZip);
// }
// else if(clinic==null) {
// displayStrings[i]=PrefC.GetString(PrefName.PracticeZip);
// }
// else {
// displayStrings[i]=clinic.Zip;
// }
// break;
case "BillingDentistMedicaidID":
displayStrings[i]=ProviderC.ListLong[Providers.GetIndexLong(ClaimCur.ProvBill)].MedicaidID;
break;
case "BillingDentistProviderID":
ProviderIdent[] provIdents=ProviderIdents.GetForPayor(ClaimCur.ProvBill,carrier.ElectID);
if(provIdents.Length>0){
displayStrings[i]=provIdents[0].IDNumber;//just use the first one we find
}
break;
case "BillingDentistNPI":
displayStrings[i]=ProviderC.ListLong[Providers.GetIndexLong(ClaimCur.ProvBill)].NationalProvID;
if(CultureInfo.CurrentCulture.Name.EndsWith("CA") && //Canadian. en-CA or fr-CA
carrier.ElectID=="000064" && //Pacific Blue Cross (PBC)
ProviderC.ListLong[Providers.GetIndexLong(ClaimCur.ProvBill)].NationalProvID!= ProviderC.ListLong[Providers.GetIndexLong(ClaimCur.ProvTreat)].NationalProvID && //Billing and treating providers are different
displayStrings[i].Length==9) { //Only for provider numbers which have been entered correctly (to prevent and indexing exception).
displayStrings[i]="00"+displayStrings[i].Substring(2,5)+"00";
}
break;
case "BillingDentistLicenseNum":
displayStrings[i]=ProviderC.ListLong[Providers.GetIndexLong(ClaimCur.ProvBill)].StateLicense;
break;
case "BillingDentistSSNorTIN":
displayStrings[i]=ProviderC.ListLong[Providers.GetIndexLong(ClaimCur.ProvBill)].SSN;
break;
case "BillingDentistNumIsSSN":
if(!ProviderC.ListLong[Providers.GetIndexLong(ClaimCur.ProvBill)].UsingTIN) {
displayStrings[i]="X";
}
break;
case "BillingDentistNumIsTIN":
if(ProviderC.ListLong[Providers.GetIndexLong(ClaimCur.ProvBill)].UsingTIN) {
displayStrings[i]="X";
}
break;
case "BillingDentistPh123":
if(clinic==null){
if(PrefC.GetString(PrefName.PracticePhone).Length==10){
displayStrings[i]=PrefC.GetString(PrefName.PracticePhone).Substring(0,3);
}
}
else{
if(clinic.Phone.Length==10){
displayStrings[i]=clinic.Phone.Substring(0,3);
}
}
break;
case "BillingDentistPh456":
if(clinic==null){
if(PrefC.GetString(PrefName.PracticePhone).Length==10){
displayStrings[i]=PrefC.GetString(PrefName.PracticePhone).Substring(3,3);
}
}
else{
if(clinic.Phone.Length==10){
displayStrings[i]=clinic.Phone.Substring(3,3);
}
}
break;
case "BillingDentistPh78910":
if(clinic==null){
if(PrefC.GetString(PrefName.PracticePhone).Length==10){
displayStrings[i]=PrefC.GetString(PrefName.PracticePhone).Substring(6);
}
}
else{
if(clinic.Phone.Length==10){
displayStrings[i]=clinic.Phone.Substring(6);
}
}
break;
case "BillingDentistPhoneFormatted":
if(clinic==null){
if(PrefC.GetString(PrefName.PracticePhone).Length==10){
displayStrings[i]="("+PrefC.GetString(PrefName.PracticePhone).Substring(0,3)
+")"+PrefC.GetString(PrefName.PracticePhone).Substring(3,3)
+"-"+PrefC.GetString(PrefName.PracticePhone).Substring(6);
}
}
else{
if(clinic.Phone.Length==10){
displayStrings[i]="("+clinic.Phone.Substring(0,3)
+")"+clinic.Phone.Substring(3,3)
+"-"+clinic.Phone.Substring(6);
}
}
break;
case "BillingDentistPhoneRaw":
if(clinic==null) {
displayStrings[i]=PrefC.GetString(PrefName.PracticePhone);
}
else {
displayStrings[i]=clinic.Phone;
}
break;
case "PayToDentistAddress": //Behaves just like the old BillingDentistAddress field, but is overridden by the Pay-To address if the Pay-To address has been specified.
if(PrefC.GetString(PrefName.PracticePayToAddress)!="") { //All Pay-To address fields are used in 5010 eclaims when Pay-To address line 1 is not blank.
displayStrings[i]=PrefC.GetString(PrefName.PracticePayToAddress);
}
else if(PrefC.GetBool(PrefName.UseBillingAddressOnClaims)){
displayStrings[i]=PrefC.GetString(PrefName.PracticeBillingAddress);
}
else if(clinic==null) {
displayStrings[i]=PrefC.GetString(PrefName.PracticeAddress);
}
else {
displayStrings[i]=clinic.Address;
}
break;
case "PayToDentistAddress2": //Behaves just like the old BillingDentistAddress2 field, but is overridden by the Pay-To address if the Pay-To address has been specified.
if(PrefC.GetString(PrefName.PracticePayToAddress)!="") { //All Pay-To address fields are used in 5010 eclaims when Pay-To address line 1 is not blank.
displayStrings[i]=PrefC.GetString(PrefName.PracticePayToAddress2);
}
else if(PrefC.GetBool(PrefName.UseBillingAddressOnClaims)){
displayStrings[i]=PrefC.GetString(PrefName.PracticeBillingAddress2);
}
else if(clinic==null) {
displayStrings[i]=PrefC.GetString(PrefName.PracticeAddress2);
}
else {
displayStrings[i]=clinic.Address2;
}
break;
case "PayToDentistCity": //Behaves just like the old BillingDentistCity field, but is overridden by the Pay-To address if the Pay-To address has been specified.
if(PrefC.GetString(PrefName.PracticePayToAddress)!="") { //All Pay-To address fields are used in 5010 eclaims when Pay-To address line 1 is not blank.
displayStrings[i]=PrefC.GetString(PrefName.PracticePayToCity);
}
else if(PrefC.GetBool(PrefName.UseBillingAddressOnClaims)) {
displayStrings[i]=PrefC.GetString(PrefName.PracticeBillingCity);
}
else if(clinic==null) {
displayStrings[i]=PrefC.GetString(PrefName.PracticeCity);
}
else {
displayStrings[i]=clinic.City;
}
break;
case "PayToDentistST": //Behaves just like the old BillingDentistST field, but is overridden by the Pay-To address if the Pay-To address has been specified.
if(PrefC.GetString(PrefName.PracticePayToAddress)!="") { //All Pay-To address fields are used in 5010 eclaims when Pay-To address line 1 is not blank.
displayStrings[i]=PrefC.GetString(PrefName.PracticePayToST);
}
else if(PrefC.GetBool(PrefName.UseBillingAddressOnClaims)) {
displayStrings[i]=PrefC.GetString(PrefName.PracticeBillingST);
}
else if(clinic==null) {
displayStrings[i]=PrefC.GetString(PrefName.PracticeST);
}
else {
displayStrings[i]=clinic.State;
}
break;
case "PayToDentistZip": //Behaves just like the old BillingDentistZip field, but is overridden by the Pay-To address if the Pay-To address has been specified.
if(PrefC.GetString(PrefName.PracticePayToAddress)!="") { //All Pay-To address fields are used in 5010 eclaims when Pay-To address line 1 is not blank.
displayStrings[i]=PrefC.GetString(PrefName.PracticePayToZip);
}
else if(PrefC.GetBool(PrefName.UseBillingAddressOnClaims)) {
displayStrings[i]=PrefC.GetString(PrefName.PracticeBillingZip);
}
else if(clinic==null) {
displayStrings[i]=PrefC.GetString(PrefName.PracticeZip);
}
else {
displayStrings[i]=clinic.Zip;
}
break;
case "TreatingDentistFName":
displayStrings[i]=treatDent.FName;
break;
case "TreatingDentistLName":
displayStrings[i]=treatDent.LName;
break;
case "TreatingDentistSignature":
if(treatDent.SigOnFile){
if(PrefC.GetBool(PrefName.ClaimFormTreatDentSaysSigOnFile)){
displayStrings[i]="Signature on File";
}
else{
displayStrings[i]=treatDent.FName+" "+treatDent.MI+" "+treatDent.LName+" "+treatDent.Suffix;
}
}
break;
case "TreatingDentistSigDate":
if(treatDent.SigOnFile && ClaimCur.DateSent.Year > 1860){
if(ClaimFormCur.Items[i].FormatString=="") {
displayStrings[i]=ClaimCur.DateSent.ToShortDateString();
}
else {
displayStrings[i]=ClaimCur.DateSent.ToString(ClaimFormCur.Items[i].FormatString);
}
}
break;
case "TreatingDentistMedicaidID":
displayStrings[i]=treatDent.MedicaidID;
break;
case "TreatingDentistProviderID":
provIdents=ProviderIdents.GetForPayor(ClaimCur.ProvTreat,carrier.ElectID);
if(provIdents.Length>0) {
displayStrings[i]=provIdents[0].IDNumber;//just use the first one we find
}
break;
case "TreatingDentistNPI":
displayStrings[i]=treatDent.NationalProvID;
break;
case "TreatingDentistLicense":
displayStrings[i]=treatDent.StateLicense;
break;
case "TreatingDentistAddress":
if(clinic==null) {
displayStrings[i]=PrefC.GetString(PrefName.PracticeAddress);
}
else {
displayStrings[i]=clinic.Address;
}
break;
case "TreatingDentistCity":
if(clinic==null) {
displayStrings[i]=PrefC.GetString(PrefName.PracticeCity);
}
else {
displayStrings[i]=clinic.City;
}
break;
case "TreatingDentistST":
if(clinic==null) {
displayStrings[i]=PrefC.GetString(PrefName.PracticeST);
}
else {
displayStrings[i]=clinic.State;
}
break;
case "TreatingDentistZip":
if(clinic==null) {
displayStrings[i]=PrefC.GetString(PrefName.PracticeZip);
}
else {
displayStrings[i]=clinic.Zip;
}
break;
case "TreatingDentistPh123":
if(clinic==null){
if(PrefC.GetString(PrefName.PracticePhone).Length==10){
displayStrings[i]=PrefC.GetString(PrefName.PracticePhone).Substring(0,3);
}
}
else{
if(clinic.Phone.Length==10){
displayStrings[i]=clinic.Phone.Substring(0,3);
}
}
break;
case "TreatingDentistPh456":
if(clinic==null){
if(PrefC.GetString(PrefName.PracticePhone).Length==10){
displayStrings[i]=PrefC.GetString(PrefName.PracticePhone).Substring(3,3);
}
}
else{
if(clinic.Phone.Length==10){
displayStrings[i]=clinic.Phone.Substring(3,3);
}
}
break;
case "TreatingDentistPh78910":
if(clinic==null){
if(PrefC.GetString(PrefName.PracticePhone).Length==10){
displayStrings[i]=PrefC.GetString(PrefName.PracticePhone).Substring(6);
}
}
else{
if(clinic.Phone.Length==10){
displayStrings[i]=clinic.Phone.Substring(6);
}
}
break;
case "TreatingProviderSpecialty":
displayStrings[i]=X12Generator.GetTaxonomy
(ProviderC.ListLong[Providers.GetIndexLong(ClaimCur.ProvTreat)]);
break;
case "TotalPages":
displayStrings[i]="";//totalPages.ToString();//bugs with this field that we can't fix since we didn't write that code.
break;
case "ReferringProvNPI":
if(ClaimReferral==null){
displayStrings[i]="";
}
else{
displayStrings[i]=ClaimReferral.NationalProvID;
}
break;
case "ReferringProvNameFL":
if(ClaimReferral==null){
displayStrings[i]="";
}
else{
displayStrings[i]=ClaimReferral.GetNameFL();
}
break;
case "MedUniformBillType":
displayStrings[i]=ClaimCur.UniformBillType;
break;
case "MedAdmissionTypeCode":
displayStrings[i]=ClaimCur.AdmissionTypeCode;
break;
case "MedAdmissionSourceCode":
displayStrings[i]=ClaimCur.AdmissionSourceCode;
break;
case "MedPatientStatusCode":
displayStrings[i]=ClaimCur.PatientStatusCode;
break;
case "MedAccidentCode": //For UB04.
if(ClaimCur.AccidentRelated=="A") { //Auto accident
displayStrings[i]="01";
}
else if(ClaimCur.AccidentRelated=="E") { //Employment related accident
displayStrings[i]="04";
}
break;
}//switch
if(CultureInfo.CurrentCulture.Name=="nl-BE" && displayStrings[i]==""){//Dutch Belgium
displayStrings[i]="* * *";
}
//Renaissance eclaims only: Remove newlines from display strings to prevent formatting issues, because the .rss file format requires each field on a single line.
if(isRenaissance && displayStrings[i]!=null) {
displayStrings[i]=displayStrings[i].Replace("\r","").Replace("\n","");
}
}//for
}
///<summary>The only validation that's been done is just to make sure that only procedures are selected. All validation on the procedures selected is done here. Creates and saves claim initially, attaching all selected procedures. But it does not refresh any data. Does not do a final update of the new claim. Does not enter fee amounts. claimType=P,S,Med,or Other</summary>
private Claim CreateClaim(string claimType,List <PatPlan> PatPlanList,List <InsPlan> planList,List<ClaimProc> ClaimProcList,List<Procedure> procsForPat,List<InsSub> subList){
long claimFormNum = 0;
InsPlan PlanCur=new InsPlan();
InsSub SubCur=new InsSub();
Relat relatOther=Relat.Self;
switch(claimType){
case "P":
SubCur=InsSubs.GetSub(PatPlans.GetInsSubNum(PatPlanList,PatPlans.GetOrdinal(PriSecMed.Primary,PatPlanList,planList,subList)),subList);
PlanCur=InsPlans.GetPlan(SubCur.PlanNum,planList);
break;
case "S":
SubCur=InsSubs.GetSub(PatPlans.GetInsSubNum(PatPlanList,PatPlans.GetOrdinal(PriSecMed.Secondary,PatPlanList,planList,subList)),subList);
PlanCur=InsPlans.GetPlan(SubCur.PlanNum,planList);
break;
case "Med":
//It's already been verified that a med plan exists
SubCur=InsSubs.GetSub(PatPlans.GetInsSubNum(PatPlanList,PatPlans.GetOrdinal(PriSecMed.Medical,PatPlanList,planList,subList)),subList);
PlanCur=InsPlans.GetPlan(SubCur.PlanNum,planList);
break;
case "Other":
FormClaimCreate FormCC=new FormClaimCreate(PatCur.PatNum);
FormCC.ShowDialog();
if(FormCC.DialogResult!=DialogResult.OK){
return new Claim();
}
PlanCur=FormCC.SelectedPlan;
SubCur=FormCC.SelectedSub;
relatOther=FormCC.PatRelat;
break;
}
DataTable table=DataSetMain.Tables["account"];
Procedure proc;
for(int i=0;i<gridAccount.SelectedIndices.Length;i++){
proc=Procedures.GetProcFromList(procsForPat,PIn.Long(table.Rows[gridAccount.SelectedIndices[i]]["ProcNum"].ToString()));
if(Procedures.NoBillIns(proc,ClaimProcList,PlanCur.PlanNum)){
MsgBox.Show(this,"Not allowed to send procedures to insurance that are marked 'Do not bill to ins'.");
return new Claim();
}
}
for(int i=0;i<gridAccount.SelectedIndices.Length;i++){
proc=Procedures.GetProcFromList(procsForPat,PIn.Long(table.Rows[gridAccount.SelectedIndices[i]]["ProcNum"].ToString()));
if(Procedures.IsAlreadyAttachedToClaim(proc,ClaimProcList,SubCur.InsSubNum)){
MsgBox.Show(this,"Not allowed to send a procedure to the same insurance company twice.");
return new Claim();
}
}
proc=Procedures.GetProcFromList(procsForPat,PIn.Long(table.Rows[gridAccount.SelectedIndices[0]]["ProcNum"].ToString()));
long clinicNum=proc.ClinicNum;
PlaceOfService placeService=proc.PlaceService;
for(int i=1;i<gridAccount.SelectedIndices.Length;i++){//skips 0
proc=Procedures.GetProcFromList(procsForPat,PIn.Long(table.Rows[gridAccount.SelectedIndices[i]]["ProcNum"].ToString()));
if(clinicNum!=proc.ClinicNum){
MsgBox.Show(this,"All procedures do not have the same clinic.");
return new Claim();
}
if(proc.PlaceService!=placeService) {
MsgBox.Show(this,"All procedures do not have the same place of service.");
return new Claim();
}
}
ClaimProc[] claimProcs=new ClaimProc[gridAccount.SelectedIndices.Length];//1:1 with selectedIndices
long procNum;
for(int i=0;i<gridAccount.SelectedIndices.Length;i++){//loop through selected procs
//and try to find an estimate that can be used
procNum=PIn.Long(table.Rows[gridAccount.SelectedIndices[i]]["ProcNum"].ToString());
claimProcs[i]=Procedures.GetClaimProcEstimate(procNum,ClaimProcList,PlanCur,SubCur.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=Procedures.GetProcFromList(procsForPat,PIn.Long(table.Rows[gridAccount.SelectedIndices[i]]["ProcNum"].ToString()));//1:1
ClaimProcs.CreateEst(claimProcs[i],proc,PlanCur,SubCur);
}
}
Claim ClaimCur=new Claim();
Claims.Insert(ClaimCur);//to retreive a key for new Claim.ClaimNum
//now, all claimProcs have a valid value
//for any CapComplete, need to make a copy so that original doesn't get attached.
for(int i=0;i<claimProcs.Length;i++){
if(claimProcs[i].Status==ClaimProcStatus.CapComplete){
claimProcs[i].ClaimNum=ClaimCur.ClaimNum;
claimProcs[i]=claimProcs[i].Copy();
claimProcs[i].WriteOff=0;
claimProcs[i].CopayAmt=-1;
claimProcs[i].CopayOverride=-1;
//status will get changed down below
ClaimProcs.Insert(claimProcs[i]);//this makes a duplicate in db with different claimProcNum
}
}
ClaimCur.PatNum=PatCur.PatNum;
ClaimCur.DateService=claimProcs[claimProcs.Length-1].ProcDate;
ClaimCur.ClinicNum=clinicNum;
ClaimCur.PlaceService=proc.PlaceService;
//datesent
ClaimCur.ClaimStatus="U";
//datereceived
InsSub sub;
ClaimCur.PlanNum=PlanCur.PlanNum;
ClaimCur.InsSubNum=SubCur.InsSubNum;
switch(claimType){
case "P":
ClaimCur.PatRelat=PatPlans.GetRelat(PatPlanList,PatPlans.GetOrdinal(PriSecMed.Primary,PatPlanList,planList,subList));
ClaimCur.ClaimType="P";
ClaimCur.InsSubNum2=PatPlans.GetInsSubNum(PatPlanList,PatPlans.GetOrdinal(PriSecMed.Secondary,PatPlanList,planList,subList));
sub=InsSubs.GetSub(ClaimCur.InsSubNum2,subList);
if(sub.PlanNum>0 && InsPlans.RefreshOne(sub.PlanNum).IsMedical) {
ClaimCur.PlanNum2=0;//no sec ins
ClaimCur.PatRelat2=Relat.Self;
}
else {
ClaimCur.PlanNum2=sub.PlanNum;//might be 0 if no sec ins
ClaimCur.PatRelat2=PatPlans.GetRelat(PatPlanList,PatPlans.GetOrdinal(PriSecMed.Secondary,PatPlanList,planList,subList));
}
break;
case "S":
ClaimCur.PatRelat=PatPlans.GetRelat(PatPlanList,PatPlans.GetOrdinal(PriSecMed.Secondary,PatPlanList,planList,subList));
ClaimCur.ClaimType="S";
ClaimCur.InsSubNum2=PatPlans.GetInsSubNum(PatPlanList,PatPlans.GetOrdinal(PriSecMed.Primary,PatPlanList,planList,subList));
sub=InsSubs.GetSub(ClaimCur.InsSubNum2,subList);
ClaimCur.PlanNum2=sub.PlanNum;
ClaimCur.PatRelat2=PatPlans.GetRelat(PatPlanList,PatPlans.GetOrdinal(PriSecMed.Primary,PatPlanList,planList,subList));
break;
case "Med":
ClaimCur.PatRelat=PatPlans.GetFromList(PatPlanList,SubCur.InsSubNum).Relationship;
ClaimCur.ClaimType="Other";
if(PrefC.GetBool(PrefName.ClaimMedTypeIsInstWhenInsPlanIsMedical)){
ClaimCur.MedType=EnumClaimMedType.Institutional;
}
else{
ClaimCur.MedType=EnumClaimMedType.Medical;
}
break;
case "Other":
ClaimCur.PatRelat=relatOther;
ClaimCur.ClaimType="Other";
//plannum2 is not automatically filled in.
ClaimCur.ClaimForm=claimFormNum;
if(PlanCur.IsMedical){
if(PrefC.GetBool(PrefName.ClaimMedTypeIsInstWhenInsPlanIsMedical)){
ClaimCur.MedType=EnumClaimMedType.Institutional;
}
else{
ClaimCur.MedType=EnumClaimMedType.Medical;
}
}
break;
}
if(PlanCur.PlanType=="c"){//if capitation
ClaimCur.ClaimType="Cap";
}
ClaimCur.ProvTreat=Procedures.GetProcFromList(procsForPat,PIn.Long(table.Rows[gridAccount.SelectedIndices[0]]["ProcNum"].ToString())).ProvNum;
for(int i=0;i<gridAccount.SelectedIndices.Length;i++){
proc=Procedures.GetProcFromList(procsForPat,PIn.Long(table.Rows[gridAccount.SelectedIndices[i]]["ProcNum"].ToString()));
if(!Providers.GetIsSec(proc.ProvNum)){//if not a hygienist
ClaimCur.ProvTreat=proc.ProvNum;
}
}
if(Providers.GetIsSec(ClaimCur.ProvTreat)){
ClaimCur.ProvTreat=PatCur.PriProv;
//OK if 0, because auto select first in list when open claim
}
//claimfee calcs in ClaimEdit
//inspayest ''
//inspayamt
//ClaimCur.DedApplied=0;//calcs in ClaimEdit.
//preauthstring, etc, etc
ClaimCur.IsProsthesis="N";
//int clinicInsBillingProv=0;
//bool useClinic=false;
//if(ClaimCur.ClinicNum>0){
// useClinic=true;
// clinicInsBillingProv=Clinics.GetClinic(ClaimCur.ClinicNum).InsBillingProv;
//}
ClaimCur.ProvBill=Providers.GetBillingProvNum(ClaimCur.ProvTreat,ClaimCur.ClinicNum);//,useClinic,clinicInsBillingProv);//OK if zero, because it will get fixed in claim
ClaimCur.EmployRelated=YN.No;
ClaimCur.ClaimForm=PlanCur.ClaimFormNum;
//attach procedures
Procedure ProcCur;
//for(int i=0;i<tbAccount.SelectedIndices.Length;i++){
for(int i=0;i<claimProcs.Length;i++){
ProcCur=Procedures.GetProcFromList(procsForPat,PIn.Long(table.Rows[gridAccount.SelectedIndices[i]]["ProcNum"].ToString()));//1:1
//ClaimProc ClaimProcCur=new ClaimProc();
//ClaimProcCur.ProcNum=ProcCur.ProcNum;
claimProcs[i].ClaimNum=ClaimCur.ClaimNum;
//ClaimProcCur.PatNum=Patients.Cur.PatNum;
//ClaimProcCur.ProvNum=ProcCur.ProvNum;
//ClaimProcs.Cur.FeeBilled=;//handle in call to ClaimL.CalculateAndUpdate()
//inspayest ''
//dedapplied ''
if(PlanCur.PlanType=="c")//if capitation
claimProcs[i].Status=ClaimProcStatus.CapClaim;
else
claimProcs[i].Status=ClaimProcStatus.NotReceived;
//inspayamt=0
//remarks
//claimpaymentnum=0
//ClaimProcCur.PlanNum=Claims.Cur.PlanNum;
//ClaimProcCur.DateCP=ProcCur.ProcDate;
//writeoff handled in ClaimL.CalculateAndUpdate()
if(PlanCur.UseAltCode && (ProcedureCodes.GetProcCode(ProcCur.CodeNum).AlternateCode1!="")){
claimProcs[i].CodeSent=ProcedureCodes.GetProcCode(ProcCur.CodeNum).AlternateCode1;
}
else if(PlanCur.IsMedical && ProcCur.MedicalCode!=""){
claimProcs[i].CodeSent=ProcCur.MedicalCode;
}
else{
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(CultureInfo.CurrentCulture.Name.EndsWith("CA")) {//Canadian. en-CA or fr-CA
if(claimProcs[i].CodeSent.Length>5) { //In Canadian electronic claims, codes can contain letters or numbers and cannot be longer than 5 characters.
claimProcs[i].CodeSent=claimProcs[i].CodeSent.Substring(0,5);
}
}
}
claimProcs[i].LineNumber=(byte)(i+1);
ClaimProcs.Update(claimProcs[i]);
}//for claimProc
return ClaimCur;
//return null;
}
private void ToolBarMainPreAuth_Click() {
if(!CheckClearinghouseDefaults()) {
return;
}
if(gridPlans.SelectedIndices[0]!=0){
MsgBox.Show(this,"You can only send a preauth from the current TP, not a saved TP.");
return;
}
if(CultureInfo.CurrentCulture.Name.EndsWith("CA")) {//Canada
int numLabProcsUnselected=0;
List<int> selectedIndices=new List<int>(gridMain.SelectedIndices);
for(int i=0;i<selectedIndices.Count;i++) {
Procedure proc=((Procedure)gridMain.Rows[selectedIndices[i]].Tag);
if(proc!=null) {
ProcedureCode procCode=ProcedureCodes.GetProcCodeFromDb(proc.CodeNum);
if(procCode.IsCanadianLab) {
gridMain.SetSelected(selectedIndices[i],false);//deselect
numLabProcsUnselected++;
}
}
}
if(numLabProcsUnselected>0) {
MessageBox.Show(Lan.g(this,"Number of lab fee procedures unselected")+": "+numLabProcsUnselected.ToString());
}
if(gridMain.SelectedIndices.Length>7) {
List <int> selectedIndicies=new List<int>(gridMain.SelectedIndices);
selectedIndicies.Sort();
for(int i=0;i<selectedIndicies.Count;i++) { //Unselect all but the first 7 procedures with the smallest index numbers.
gridMain.SetSelected(selectedIndicies[i],(i<7));
}
MsgBox.Show(this,"Only the first 7 procedures will be selected. You will need to create another preauth for the remaining procedures.");
}
}
bool procsSelected=false;
for(int i=0;i<gridMain.SelectedIndices.Length;i++){
if(gridMain.Rows[gridMain.SelectedIndices[i]].Tag!=null){
procsSelected=true;
}
}
if(!procsSelected) {
MessageBox.Show(Lan.g(this,"Please select procedures first."));
return;
}
Claim ClaimCur=new Claim();
FormInsPlanSelect FormIPS=new FormInsPlanSelect(PatCur.PatNum);
FormIPS.ViewRelat=true;
FormIPS.ShowDialog();
if(FormIPS.DialogResult!=DialogResult.OK) {
return;
}
ClaimCur.PatNum=PatCur.PatNum;
ClaimCur.ClaimStatus="W";
ClaimCur.DateSent=DateTimeOD.Today;
ClaimCur.PlanNum=FormIPS.SelectedPlan.PlanNum;
ClaimCur.InsSubNum=FormIPS.SelectedSub.InsSubNum;
ClaimCur.ProvTreat=0;
for(int i=0;i<gridMain.SelectedIndices.Length;i++){
if(gridMain.Rows[gridMain.SelectedIndices[i]].Tag==null){
continue;//skip any hightlighted subtotal lines
}
if(ClaimCur.ProvTreat==0){//makes sure that at least one prov is set
ClaimCur.ProvTreat=((Procedure)gridMain.Rows[gridMain.SelectedIndices[i]].Tag).ProvNum;
}
if(!Providers.GetIsSec(((Procedure)gridMain.Rows[gridMain.SelectedIndices[i]].Tag).ProvNum)){
ClaimCur.ProvTreat=((Procedure)gridMain.Rows[gridMain.SelectedIndices[i]].Tag).ProvNum;
}
}
ClaimCur.ClinicNum=PatCur.ClinicNum;
if(Providers.GetIsSec(ClaimCur.ProvTreat)){
ClaimCur.ProvTreat=PatCur.PriProv;
//OK if 0, because auto select first in list when open claim
}
ClaimCur.ProvBill=Providers.GetBillingProvNum(ClaimCur.ProvTreat,ClaimCur.ClinicNum);
ClaimCur.EmployRelated=YN.No;
ClaimCur.ClaimType="PreAuth";
//this could be a little better if we automate figuring out the patrelat
//instead of making the user enter it:
ClaimCur.PatRelat=FormIPS.PatRelat;
Claims.Insert(ClaimCur);
Procedure ProcCur;
ClaimProc ClaimProcCur;
ClaimProc cpExisting;
for(int i=0;i<gridMain.SelectedIndices.Length;i++){
if(gridMain.Rows[gridMain.SelectedIndices[i]].Tag==null) {
continue;//skip any highlighted subtotal lines
}
ProcCur=(Procedure)gridMain.Rows[gridMain.SelectedIndices[i]].Tag;
ClaimProcCur=new ClaimProc();
ClaimProcCur.ProcNum=ProcCur.ProcNum;
ClaimProcCur.ClaimNum=ClaimCur.ClaimNum;
ClaimProcCur.PatNum=PatCur.PatNum;
ClaimProcCur.ProvNum=ProcCur.ProvNum;
ClaimProcCur.Status=ClaimProcStatus.Preauth;
ClaimProcCur.FeeBilled=ProcCur.ProcFee;
ClaimProcCur.PlanNum=FormIPS.SelectedPlan.PlanNum;
ClaimProcCur.InsSubNum=FormIPS.SelectedSub.InsSubNum;
cpExisting=ClaimProcs.GetEstimate(ClaimProcList,ProcCur.ProcNum,FormIPS.SelectedPlan.PlanNum,FormIPS.SelectedSub.InsSubNum);
if(cpExisting!=null){
ClaimProcCur.InsPayEst=cpExisting.InsPayEst;
}
if(FormIPS.SelectedPlan.UseAltCode && (ProcedureCodes.GetProcCode(ProcCur.CodeNum).AlternateCode1!="")){
ClaimProcCur.CodeSent=ProcedureCodes.GetProcCode(ProcCur.CodeNum).AlternateCode1;
}
else if(FormIPS.SelectedPlan.IsMedical && ProcCur.MedicalCode!=""){
ClaimProcCur.CodeSent=ProcCur.MedicalCode;
}
else{
ClaimProcCur.CodeSent=ProcedureCodes.GetStringProcCode(ProcCur.CodeNum);
if(ClaimProcCur.CodeSent.Length>5 && ClaimProcCur.CodeSent.Substring(0,1)=="D"){
ClaimProcCur.CodeSent=ClaimProcCur.CodeSent.Substring(0,5);
}
if(CultureInfo.CurrentCulture.Name.EndsWith("CA")) {//Canadian. en-CA or fr-CA
if(ClaimProcCur.CodeSent.Length>5) { //In Canadian electronic claims, codes can contain letters or numbers and cannot be longer than 5 characters.
ClaimProcCur.CodeSent=ClaimProcCur.CodeSent.Substring(0,5);
}
}
}
ClaimProcCur.LineNumber=(byte)(i+1);
ClaimProcs.Insert(ClaimProcCur);
//ProcCur.Update(ProcOld);
}
ProcList=Procedures.Refresh(PatCur.PatNum);
//ClaimProcList=ClaimProcs.Refresh(PatCur.PatNum);
ClaimL.CalculateAndUpdate(ProcList,InsPlanList,ClaimCur,PatPlanList,BenefitList,PatCur.Age,SubList);
FormClaimEdit FormCE=new FormClaimEdit(ClaimCur,PatCur,FamCur);
//FormCE.CalculateEstimates(
FormCE.IsNew=true;//this causes it to delete the claim if cancelling.
FormCE.ShowDialog();
ModuleSelected(PatCur.PatNum);
}
public static string ClaimProcWithInvalidClaimNum(bool verbose,bool isCheck)
{
if(RemotingClient.RemotingRole==RemotingRole.ClientWeb) {
return Meth.GetString(MethodBase.GetCurrentMethod(),verbose,isCheck);
}
string log="";
if(isCheck){
command="SELECT COUNT(*) FROM claimproc WHERE claimproc.ClaimNum!=0 "
+"AND NOT EXISTS(SELECT * FROM claim WHERE claim.ClaimNum=claimproc.ClaimNum) "
+"AND (claimproc.InsPayAmt!=0 OR claimproc.WriteOff!=0)";
int numFound=PIn.Int(Db.GetCount(command));
if(numFound>0 || verbose) {
log+=Lans.g("FormDatabaseMaintenance","Claimprocs found with invalid ClaimNum: ")+numFound+"\r\n";
}
}
else{//fix
//We can't touch those claimprocs because it would mess up the accounting. So the only option, if we decide to fix automatically, is going to be to create some sort of claim that has the specific ClaimNum that seems to be missing.
command="SELECT * FROM claimproc WHERE claimproc.ClaimNum!=0 "
+"AND NOT EXISTS(SELECT * FROM claim WHERE claim.ClaimNum=claimproc.ClaimNum) "
+"AND (claimproc.InsPayAmt!=0 OR claimproc.WriteOff!=0) ";
table=Db.GetTable(command);
List<ClaimProc> cpList=Crud.ClaimProcCrud.TableToList(table);
Claim claim;
for(int i=0;i<cpList.Count;i++) {
claim=new Claim();
claim.ClaimNum=cpList[i].ClaimNum;
claim.PatNum=cpList[i].PatNum;
claim.ClinicNum=cpList[i].ClinicNum;
claim.ClaimStatus="R";//Status received because we know it's been paid on
claim.PlanNum=cpList[i].PlanNum;
claim.InsSubNum=cpList[i].InsSubNum;
claim.ProvTreat=cpList[i].ProvNum;
Crud.ClaimCrud.Insert(claim,true);//Allows us to use a primary key that was "used".
Patient pat=Patients.GetLim(claim.PatNum);
log+=Lans.g("FormDatabaseMaintenance","Claim created due to claimprocs with invalid ClaimNums for patient: ")
+pat.PatNum+" - "+Patients.GetNameFL(pat.LName,pat.FName,pat.Preferred,pat.MiddleI)+"\r\n";
}
}
return log;
}
public static void PrintManualClaimForm(Claim claim)
{
try {
FormClaimPrint FormCP=new FormClaimPrint();
FormCP.PatNumCur=claim.PatNum;
FormCP.ClaimNumCur=claim.ClaimNum;
FormCP.ClaimFormCur=null;//so that it will pull from the individual claim or plan.
PrintDocument pd=new PrintDocument();
if(PrinterL.SetPrinter(pd,PrintSituation.Claim)) {
if(FormCP.PrintImmediate(pd.PrinterSettings.PrinterName,1)) {
Etranss.SetClaimSentOrPrinted(claim.ClaimNum,claim.PatNum,0,EtransType.ClaimPrinted,0);
}
}
}
catch {
//Oh well, the user can manually reprint if needed.
}
}
///<summary>Called directly instead of from Eclaims.SendBatches. Includes one claim. Sets claim status internally if successfully sent. Returns the EtransNum of the ack. Includes various user interaction such as displaying of messages, printing, triggering of COB claims, etc. For a normal claim, primaryEOB will be blank. But if this is a COB(type7), then we need to embed the primary EOB by passing it in. The queueItem.ClearinghouseNum must refer to a valid Canadian clearinghouse.</summary>
public static long SendClaim(ClaimSendQueueItem queueItem,bool doPrint){
Clearinghouse clearhouse=Clearinghouses.GetClearinghouse(queueItem.ClearinghouseNum);
//Warning: this path is not handled properly if trailing slash is missing:
string saveFolder=clearhouse.ExportPath;
if(!Directory.Exists(saveFolder)) {
throw new ApplicationException(saveFolder+" not found.");
}
Etrans etrans;
Claim claim;
Clinic clinic;
Provider billProv;
Provider treatProv;
InsPlan insPlan;
InsSub insSub;
Carrier carrier;
InsPlan insPlan2=null;
InsSub insSub2=null;
Carrier carrier2=null;
List <PatPlan> patPlansForPatient;
Patient patient;
Patient subscriber;
List<ClaimProc> claimProcList;//all claimProcs for a patient.
List<ClaimProc> claimProcsClaim;
List<Procedure> procListAll;
List<Procedure> extracted;
List<Procedure> procListLabForOne;//Lab fees for one procedure
Patient subscriber2=null;
Procedure proc;
ProcedureCode procCode;
StringBuilder strb;
string primaryEOBResponse="";
string primaryClaimRequestMessage="";
claim=Claims.GetClaim(queueItem.ClaimNum);
claimProcList=ClaimProcs.Refresh(claim.PatNum);
claimProcsClaim=ClaimProcs.GetForSendClaim(claimProcList,claim.ClaimNum);
long planNum=claim.PlanNum;
long insSubNum=claim.InsSubNum;
Relat patRelat=claim.PatRelat;
long planNum2=claim.PlanNum2;
long insSubNum2=claim.InsSubNum2;
Relat patRelat2=claim.PatRelat2;
if(claim.ClaimType=="PreAuth") {
etrans=Etranss.SetClaimSentOrPrinted(queueItem.ClaimNum,queueItem.PatNum,clearhouse.ClearinghouseNum,EtransType.Predeterm_CA,0);
}
else if(claim.ClaimType=="S") {//Secondary
//We first need to verify that the claimprocs on the secondary/cob claim are the same as the claimprocs on the primary claim.
etrans=Etranss.SetClaimSentOrPrinted(queueItem.ClaimNum,queueItem.PatNum,clearhouse.ClearinghouseNum,EtransType.ClaimCOB_CA,0);
long claimNumPrimary=0;
for(int i=0;i<claimProcsClaim.Count;i++) {
List<ClaimProc> claimProcsForProc=ClaimProcs.GetForProc(claimProcList,claimProcsClaim[i].ProcNum);
bool matchingPrimaryProc=false;
for(int j=0;j<claimProcsForProc.Count;j++) {
if(claimProcsForProc[j].ClaimNum!=0 && claimProcsForProc[j].ClaimNum!=claim.ClaimNum && (claimNumPrimary==0 || claimNumPrimary==claimProcsForProc[j].ClaimNum)) {
claimNumPrimary=claimProcsForProc[j].ClaimNum;
matchingPrimaryProc=true;
break;
}
}
if(!matchingPrimaryProc) {
throw new ApplicationException(Lan.g("Canadian","The procedures attached to this COB claim must be the same as the procedures attached to the primary claim."));
}
}
if(ClaimProcs.GetForSendClaim(claimProcList,claimNumPrimary).Count!=claimProcsClaim.Count) {
throw new ApplicationException(Lan.g("Canadian","The procedures attached to this COB claim must be the same as the procedures attached to the primary claim."));
}
//Now ensure that the primary claim recieved an EOB response, or else we cannot send a COB.
List <Etrans> etransPrimary=Etranss.GetHistoryOneClaim(claimNumPrimary);
for(int i=0;i<etransPrimary.Count;i++) {
primaryClaimRequestMessage=EtransMessageTexts.GetMessageText(etransPrimary[i].EtransMessageTextNum);
Etrans etransPrimaryAck=Etranss.GetEtrans(etransPrimary[i].AckEtransNum);
if(etransPrimaryAck.AckCode.ToUpper()=="R") {
continue;
}
if(etransPrimaryAck!=null) {
primaryEOBResponse=EtransMessageTexts.GetMessageText(etransPrimaryAck.EtransMessageTextNum);
}
break;
}
if(primaryEOBResponse=="") {
throw new ApplicationException(Lan.g("Canadian","Cannot send secondary claim electronically until primary EOB has been received electronically."));
}
else if(primaryEOBResponse.Length<22) {
throw new ApplicationException(Lan.g("Canadian","Cannot send secondary claim electronically, because primary claim electronic response is malformed. Try sending the primary claim again."));
}
else {//primaryEOBResponse.Length>=22
string messageVersion=primaryEOBResponse.Substring(18,2);//Field A03 always exists on all messages and is always in the same location.
string messageType=primaryEOBResponse.Substring(20,2);//Field A04 always exists on all messages and is always in the same location.
if(messageVersion!="04") {
throw new ApplicationException(Lan.g("Canadian","Cannot send secondary claim electronically, because primary claim electronic response is in an older format. The secondary claim must be printed instead."));
}
if(messageType!="21") {//message type 21 is EOB
throw new ApplicationException(Lan.g("Canadian","Cannot send secondary claim electronically until primary EOB has been received electronically. The existing primary claim electronic response is not an EOB."));
}
}
Claim claimPrimary=Claims.GetClaim(claimNumPrimary);
planNum=claimPrimary.PlanNum;
insSubNum=claimPrimary.InsSubNum;
patRelat=claimPrimary.PatRelat;
planNum2=claimPrimary.PlanNum2;
insSubNum2=claimPrimary.InsSubNum2;
patRelat2=claimPrimary.PatRelat2;
}
else { //primary claim
etrans=Etranss.SetClaimSentOrPrinted(queueItem.ClaimNum,queueItem.PatNum,clearhouse.ClearinghouseNum,EtransType.Claim_CA,0);
}
claim=Claims.GetClaim(claim.ClaimNum);//Refresh the claim since the status might have changed above.
clinic=Clinics.GetClinic(claim.ClinicNum);
billProv=ProviderC.ListLong[Providers.GetIndexLong(claim.ProvBill)];
treatProv=ProviderC.ListLong[Providers.GetIndexLong(claim.ProvTreat)];
insPlan=InsPlans.GetPlan(planNum,new List <InsPlan> ());
insSub=InsSubs.GetSub(insSubNum,new List<InsSub>());
if(planNum2>0) {
insPlan2=InsPlans.GetPlan(planNum2,new List<InsPlan>());
insSub2=InsSubs.GetSub(insSubNum2,new List<InsSub>());
carrier2=Carriers.GetCarrier(insPlan2.CarrierNum);
subscriber2=Patients.GetPat(insSub2.Subscriber);
}
if(claim.ClaimType=="S") {
carrier=Carriers.GetCarrier(insPlan2.CarrierNum);
}
else {
carrier=Carriers.GetCarrier(insPlan.CarrierNum);
}
CanadianNetwork network=CanadianNetworks.GetNetwork(carrier.CanadianNetworkNum);
patPlansForPatient=PatPlans.Refresh(claim.PatNum);
patient=Patients.GetPat(claim.PatNum);
subscriber=Patients.GetPat(insSub.Subscriber);
procListAll=Procedures.Refresh(claim.PatNum);
extracted=Procedures.GetCanadianExtractedTeeth(procListAll);
strb=new StringBuilder();
//A01 transaction prefix 12 AN
strb.Append(TidyAN(network.CanadianTransactionPrefix,12));
//A02 office sequence number 6 N
strb.Append(TidyN(etrans.OfficeSequenceNumber,6));
//A03 format version number 2 N
if(carrier.CDAnetVersion=="") {
strb.Append("04");
}
else {
strb.Append(carrier.CDAnetVersion);
}
//A04 transaction code 2 N
if(claim.ClaimType=="PreAuth") {
strb.Append("03");//Predetermination
}
else {
if(claim.ClaimType=="S") {
strb.Append("07");//cob
}
else {
strb.Append("01");//claim
}
}
//A05 carrier id number 6 N
strb.Append(carrier.ElectID);//already validated as 6 digit number.
//A06 software system id 3 AN
strb.Append(SoftwareSystemId());
if(carrier.CDAnetVersion!="02") { //version 04
//A10 encryption method 1 N
strb.Append(carrier.CanadianEncryptionMethod);//validated in UI
}
//A07 message length. 5 N in version 04, 4 N in version 02
//We simply create a place holder here. We come back at the end of message construction and record the actual final message length.
if(carrier.CDAnetVersion=="02") {
strb.Append("0000");
}
else { //version 04
strb.Append("00000");
}
if(carrier.CDAnetVersion=="02") {
//A08 email flag 1 N
if(claim.CanadianMaterialsForwarded=="") {
strb.Append("0"); //no additional information
}
else if(claim.CanadianMaterialsForwarded.Contains("E")) {
strb.Append("1"); //E-Mail to follow.
}
else {
strb.Append("2"); //Letter to follow
}
}
else { //version 04
//A08 materials forwarded 1 AN
strb.Append(GetMaterialsForwarded(claim.CanadianMaterialsForwarded));
}
if(carrier.CDAnetVersion!="02") { //version 04
//A09 carrier transaction counter 5 N
#if DEBUG
strb.Append("00001");
#else
strb.Append(TidyN(etrans.CarrierTransCounter,5));
#endif
}
//B01 CDA provider number 9 AN
strb.Append(TidyAN(treatProv.NationalProvID,9));//already validated
//B02 (treating) provider office number 4 AN
strb.Append(TidyAN(treatProv.CanadianOfficeNum,4));//already validated
if(carrier.CDAnetVersion!="02") { //version 04
//B03 billing provider number 9 AN
//might need to account for possible 5 digit prov id assigned by carrier
strb.Append(TidyAN(billProv.NationalProvID,9));//already validated
//B04 billing provider office number 4 AN
strb.Append(TidyAN(billProv.CanadianOfficeNum,4));//already validated
//B05 referring provider 10 AN
strb.Append(TidyAN(claim.CanadianReferralProviderNum,10));
//B06 referral reason 2 N
strb.Append(TidyN(claim.CanadianReferralReason,2));
}
if(carrier.CDAnetVersion=="02") {
//C01 primary policy/plan number 8 AN
//only validated to ensure that it's not blank and is less than 8. Also that no spaces.
strb.Append(TidyAN(insPlan.GroupNum,8));
}
else { //version 04
//C01 primary policy/plan number 12 AN
//only validated to ensure that it's not blank and is less than 12. Also that no spaces.
strb.Append(TidyAN(insPlan.GroupNum,12));
}
//C11 primary division/section number 10 AN
strb.Append(TidyAN(insPlan.DivisionNo,10));
if(carrier.CDAnetVersion=="02") {
//C02 subscriber id number 11 AN
strb.Append(TidyAN(insSub.SubscriberID.Replace("-",""),11));//validated
}
else { //version 04
//C02 subscriber id number 12 AN
strb.Append(TidyAN(insSub.SubscriberID.Replace("-",""),12));//validated
}
if(carrier.CDAnetVersion!="02") { //version 04
//C17 primary dependant code 2 N
string patID="";
for(int p=0;p<patPlansForPatient.Count;p++) {
if(patPlansForPatient[p].InsSubNum==insSubNum) {
patID=patPlansForPatient[p].PatID;
}
}
strb.Append(TidyN(patID,2));
}
//C03 relationship code 1 N
//User interface does not only show Canadian options, but all options are handled.
strb.Append(GetRelationshipCode(patRelat));
//C04 patient's sex 1 A
//validated to not include "unknown"
if(patient.Gender==PatientGender.Male){
strb.Append("M");
}
else{
strb.Append("F");
}
//C05 patient birthday 8 N
strb.Append(patient.Birthdate.ToString("yyyyMMdd"));//validated
if(carrier.CDAnetVersion=="02") {
//C06 patient last name 25 A
strb.Append(TidyA(patient.LName,25));//validated
}
else { //version 04
//C06 patient last name 25 AE
strb.Append(TidyAE(patient.LName,25,true));//validated
}
if(carrier.CDAnetVersion=="02") {
//C07 patient first name 15 A
strb.Append(TidyA(patient.FName,15));//validated
}
else { //version 04
//C07 patient first name 15 AE
strb.Append(TidyAE(patient.FName,15,true));//validated
}
if(carrier.CDAnetVersion=="02") {
//C08 patient middle initial 1 A
strb.Append(TidyA(patient.MiddleI,1));
}
else { //version 04
//C08 patient middle initial 1 AE
strb.Append(TidyAE(patient.MiddleI,1));
}
if(carrier.CDAnetVersion=="02") {
//C09 eligibility exception code 1 N
string exceptionCode=TidyN(patient.CanadianEligibilityCode,1);//Validated.
if(exceptionCode=="4") {
exceptionCode="0";//Code 4 in version 04 means "code not applicable", but in version 02, value 0 means "code not applicable".
}
strb.Append(exceptionCode);//validated
}
else { //version 04
//C09 eligibility exception code 1 N
strb.Append(TidyN((patient.CanadianEligibilityCode==0)?4:patient.CanadianEligibilityCode,1));//Validated. Use "code not applicable" when no value has been specified by the user.
}
if(carrier.CDAnetVersion=="02") {
//C10 name of school 25 A
//validated if patient 18yrs or older and full-time student (or disabled student)
strb.Append(TidyA(patient.SchoolName,25));
}
else { //version 04
//C10 name of school 25 AEN
//validated if patient 18yrs or older and full-time student (or disabled student)
strb.Append(TidyAEN(patient.SchoolName,25));
}
bool C19PlanRecordPresent=(insPlan.CanadianPlanFlag=="A" || insPlan.CanadianPlanFlag=="N" || insPlan.CanadianPlanFlag=="V");
if(carrier.CDAnetVersion!="02") { //version 04
//C12 plan flag 1 A
strb.Append(Canadian.GetPlanFlag(insPlan.CanadianPlanFlag));
//C18 plan record count 1 N
if(C19PlanRecordPresent) {
strb.Append("1");
}
else {
strb.Append("0");
}
}
CCDFieldInputter primaryClaimData=null;
if(claim.ClaimType=="S") {
primaryClaimData=new CCDFieldInputter(primaryClaimRequestMessage);
}
//D01 subscriber birthday 8 N
strb.Append(claim.ClaimType=="S"?primaryClaimData.GetFieldById("D01").valuestr:subscriber.Birthdate.ToString("yyyyMMdd"));//validated
if(carrier.CDAnetVersion=="02") {
//D02 subscriber last name 25 A
strb.Append(TidyA(claim.ClaimType=="S"?primaryClaimData.GetFieldById("D02").valuestr:subscriber.LName,25));//validated
}
else { //version 04
//D02 subscriber last name 25 AE
strb.Append(TidyAE(claim.ClaimType=="S"?primaryClaimData.GetFieldById("D02").valuestr:subscriber.LName,25,true));//validated
}
if(carrier.CDAnetVersion=="02") {
//D03 subscriber first name 15 A
strb.Append(TidyA(claim.ClaimType=="S"?primaryClaimData.GetFieldById("D03").valuestr:subscriber.FName,15));//validated
}
else { //version 04
//D03 subscriber first name 15 AE
strb.Append(TidyAE(claim.ClaimType=="S"?primaryClaimData.GetFieldById("D03").valuestr:subscriber.FName,15,true));//validated
}
if(carrier.CDAnetVersion=="02") {
//D04 subscriber middle initial 1 A
strb.Append(TidyA(claim.ClaimType=="S"?primaryClaimData.GetFieldById("D04").valuestr:subscriber.MiddleI,1));
}
else { //version 04
//D04 subscriber middle initial 1 AE
strb.Append(TidyAE(claim.ClaimType=="S"?primaryClaimData.GetFieldById("D04").valuestr:subscriber.MiddleI,1));
}
if(carrier.CDAnetVersion=="02") {
//D05 subscriber address line one 30 AN
strb.Append(TidyAN(claim.ClaimType=="S"?primaryClaimData.GetFieldById("D05").valuestr:subscriber.Address,30,true));//validated
}
else { //version 04
//D05 subscriber address line one 30 AEN
strb.Append(TidyAEN(claim.ClaimType=="S"?primaryClaimData.GetFieldById("D05").valuestr:subscriber.Address,30,true));//validated
}
if(carrier.CDAnetVersion=="02") {
//D06 subscriber address line two 30 AN
strb.Append(TidyAN(claim.ClaimType=="S"?primaryClaimData.GetFieldById("D06").valuestr:subscriber.Address2,30,true));
}
else { //version 04
//D06 subscriber address line two 30 AEN
strb.Append(TidyAEN(claim.ClaimType=="S"?primaryClaimData.GetFieldById("D06").valuestr:subscriber.Address2,30,true));
}
if(carrier.CDAnetVersion=="02") {
//D07 subscriber city 20 A
strb.Append(TidyA(claim.ClaimType=="S"?primaryClaimData.GetFieldById("D07").valuestr:subscriber.City,20));//validated
}
else { //version 04
//D07 subscriber city 20 AEN
strb.Append(TidyAEN(claim.ClaimType=="S"?primaryClaimData.GetFieldById("D07").valuestr:subscriber.City,20,true));//validated
}
//D08 subscriber province/state 2 A
strb.Append(claim.ClaimType=="S"?primaryClaimData.GetFieldById("D08").valuestr:subscriber.State);//very throroughly validated previously
if(carrier.CDAnetVersion=="02") {
//D09 subscriber postal/zip code 6 AN
strb.Append(TidyAN(claim.ClaimType=="S"?primaryClaimData.GetFieldById("D09").valuestr:subscriber.Zip.Replace("-","").Replace(" ",""),6));//validated.
}
else { //version 04
//D09 subscriber postal/zip code 9 AN
strb.Append(TidyAN(claim.ClaimType=="S"?primaryClaimData.GetFieldById("D09").valuestr:subscriber.Zip.Replace("-","").Replace(" ",""),9));//validated.
}
//D10 language of insured 1 A
strb.Append(claim.ClaimType=="S"?primaryClaimData.GetFieldById("D10").valuestr:(subscriber.Language=="fr"?"F":"E"));
bool orthoRecordFlag=false;
if(carrier.CDAnetVersion!="02") { //version 04
//D11 card sequence/version number 2 N
//Not validated against type of carrier yet. Might need to check if Dentaide.
strb.Append(TidyN(insPlan.DentaideCardSequence,2));
//E18 secondary coverage flag 1 A
if(planNum2>0) {
strb.Append("Y");
}
else {
strb.Append("N");
}
//E20 secondary record count 1 N
if(planNum2==0) {
strb.Append("0");
}
else {
strb.Append("1");
}
//F06 number of procedures performed 1 N. Must be between 1 and 7. UI prevents attaching more than 7.
strb.Append(TidyN(claimProcsClaim.Count,1));//number validated
//F22 extracted teeth count 2 N
strb.Append(TidyN(extracted.Count,2));//validated against matching prosthesis
if(claim.ClaimType=="PreAuth") {
orthoRecordFlag=(claim.CanadaEstTreatStartDate.Year>1880 || claim.CanadaInitialPayment!=0 || claim.CanadaPaymentMode!=0 ||
claim.CanadaTreatDuration!=0 || claim.CanadaNumAnticipatedPayments!=0 || claim.CanadaAnticipatedPayAmount!=0);
//F25 Orthodontic Record Flag 1 N
if(orthoRecordFlag) {
strb.Append("1");
}
else {
strb.Append("0");
}
}
if(claim.ClaimType=="S") { //cob
//G39 Embedded Transaction Length N 4
strb.Append(Canadian.TidyN(primaryEOBResponse.Length,4));
}
}
//Secondary carrier fields (E19 to E07) ONLY included if E20=1----------------------------------------------------
if(planNum2!=0) {
if(carrier.CDAnetVersion!="02") { //version 04
//E19 secondary carrier transaction number 6 N
strb.Append(TidyN(etrans.CarrierTransCounter2,6));
}
//E01 sec carrier id number 6 N
strb.Append(carrier2.ElectID);//already validated as 6 digit number.
if(carrier.CDAnetVersion=="02") {
//E02 sec carrier policy/plan num 8 AN
//only validated to ensure that it's not blank and is less than 8. Also that no spaces.
//We might later allow 999999 if sec carrier is unlisted or unknown.
strb.Append(TidyAN(insPlan2.GroupNum,8));
}
else { //version 04
//E02 sec carrier policy/plan num 12 AN
//only validated to ensure that it's not blank and is less than 12. Also that no spaces.
//We might later allow 999999 if sec carrier is unlisted or unknown.
strb.Append(TidyAN(insPlan2.GroupNum,12));
}
//E05 sec division/section num 10 AN
strb.Append(TidyAN(insPlan2.DivisionNo,10));
if(carrier.CDAnetVersion=="02") {
//E03 sec plan subscriber id 11 AN
strb.Append(TidyAN(insSub2.SubscriberID.Replace("-",""),11));//validated
}
else { //version 04
//E03 sec plan subscriber id 12 AN
strb.Append(TidyAN(insSub2.SubscriberID.Replace("-",""),12));//validated
}
if(carrier.CDAnetVersion!="02") { //version 04
//E17 sec dependent code 2 N
string patID="";
for(int p=0;p<patPlansForPatient.Count;p++) {
if(patPlansForPatient[p].InsSubNum==insSubNum2) {
patID=patPlansForPatient[p].PatID;
}
}
strb.Append(TidyN(patID,2));
//E06 sec relationship code 1 N
//User interface does not only show Canadian options, but all options are handled.
strb.Append(GetRelationshipCode(patRelat2));
}
//E04 sec subscriber birthday 8 N
strb.Append(claim.ClaimType=="S"?primaryClaimData.GetFieldById("E04").valuestr:subscriber2.Birthdate.ToString("yyyyMMdd"));//validated
if(carrier.CDAnetVersion!="02") { //version 04
//E08 sec subscriber last name 25 AE
strb.Append(TidyAE(claim.ClaimType=="S"?primaryClaimData.GetFieldById("E08").valuestr:subscriber2.LName,25,true));//validated
//E09 sec subscriber first name 15 AE
strb.Append(TidyAE(claim.ClaimType=="S"?primaryClaimData.GetFieldById("E09").valuestr:subscriber2.FName,15,true));//validated
//E10 sec subscriber middle initial 1 AE
strb.Append(TidyAE(claim.ClaimType=="S"?primaryClaimData.GetFieldById("E10").valuestr:subscriber2.MiddleI,1));
//E11 sec subscriber address one 30 AEN
strb.Append(TidyAEN(claim.ClaimType=="S"?primaryClaimData.GetFieldById("E11").valuestr:subscriber2.Address,30,true));//validated
//E12 sec subscriber address two 30 AEN
strb.Append(TidyAEN(claim.ClaimType=="S"?primaryClaimData.GetFieldById("E12").valuestr:subscriber2.Address2,30,true));
//E13 sec subscriber city 20 AEN
strb.Append(TidyAEN(claim.ClaimType=="S"?primaryClaimData.GetFieldById("E13").valuestr:subscriber2.City,20,true));//validated
//E14 sec subscriber province/state 2 A
strb.Append(claim.ClaimType=="S"?primaryClaimData.GetFieldById("E14").valuestr:subscriber2.State);//very throroughly validated previously
//E15 sec subscriber postal/zip code 9 AN
strb.Append(TidyAN(claim.ClaimType=="S"?primaryClaimData.GetFieldById("E15").valuestr:subscriber2.Zip.Replace("-","").Replace(" ",""),9));//validated
//E16 sec language 1 A
strb.Append(claim.ClaimType=="S"?primaryClaimData.GetFieldById("E16").valuestr:(subscriber2.Language=="fr"?"F":"E"));
//E07 sec card sequence/version num 2 N
//todo Not validated yet.
strb.Append(TidyN(claim.ClaimType=="S"?PIn.Int(primaryClaimData.GetFieldById("E07").valuestr):insPlan2.DentaideCardSequence,2));
}
//End of secondary subscriber fields---------------------------------------------------------------------------
}
else { //There is no secondary plan.
if(carrier.CDAnetVersion=="02") {
//Secondary subscriber fields are always available in version 2. Since there is no plan, put blank data as a filler.
//E01 N 6
strb.Append("000000");
//E02 AN 8
strb.Append(" ");
//E05 AN 10
strb.Append(" ");
//E03 AN 11
strb.Append(" ");
//E04 N 8
strb.Append("00000000");
}
}
if(claim.ClaimType!="PreAuth") {
//F01 payee code 1 N
if((claim.ClaimType!="S" && insSub.AssignBen) || (claim.ClaimType=="S" && insSub2.AssignBen)) {
if(carrier.CDAnetVersion=="02") {
strb.Append("0");//pay dentist
}
else { //version 04
strb.Append("4");//pay dentist
}
}
else {
strb.Append("1");//pay subscriber
}
}
//F02 accident date 8 N
if(claim.AccidentDate.Year>1900){//if accident related
strb.Append(claim.AccidentDate.ToString("yyyyMMdd"));//validated
}
else{
strb.Append(TidyN(0,8));
}
if(claim.ClaimType!="PreAuth") {
//F03 predetermination number 14 AN
strb.Append(TidyAN(claim.PreAuthString,14));
}
if(carrier.CDAnetVersion=="02") {
//F15 Is this an Initial Replacement? A 1
string initialPlacement="Y";
DateTime initialPlacementDate=DateTime.MinValue;
if(claim.CanadianIsInitialUpper=="Y"){
initialPlacement="Y";
initialPlacementDate=claim.CanadianDateInitialUpper;
}
else if(claim.CanadianIsInitialLower=="Y"){
initialPlacement="Y";
initialPlacementDate=claim.CanadianDateInitialLower;
}
else if(claim.CanadianIsInitialUpper=="N") {
initialPlacement="N";
initialPlacementDate=claim.CanadianDateInitialUpper;
}
else if(claim.CanadianIsInitialLower=="N"){
initialPlacement="N";
initialPlacementDate=claim.CanadianDateInitialLower;
}
strb.Append(initialPlacement);
//F04 date of initial placement 8 N
if(initialPlacementDate.Year>1900) {
strb.Append(initialPlacementDate.ToString("yyyyMMdd"));
}
else {
strb.Append("00000000");
}
//F05 tx req'd for ortho purposes 1 A
if(claim.IsOrtho) {
strb.Append("Y");
}
else {
strb.Append("N");
}
//F06 number of procedures performed 1 N. Must be between 1 and 7. UI prevents attaching more than 7.
strb.Append(TidyN(claimProcsClaim.Count,1));//number validated
}
else { //version 04
//F15 initial placement upper 1 A Y or N or X
strb.Append(Canadian.TidyA(claim.CanadianIsInitialUpper,1));//validated
//F04 date of initial placement upper 8 N
if(claim.CanadianDateInitialUpper.Year>1900) {
strb.Append(claim.CanadianDateInitialUpper.ToString("yyyyMMdd"));
}
else {
strb.Append("00000000");
}
//F18 initial placement lower 1 A
strb.Append(Canadian.TidyA(claim.CanadianIsInitialLower,1));//validated
//F19 date of initial placement lower 8 N
if(claim.CanadianDateInitialLower.Year>1900) {
strb.Append(claim.CanadianDateInitialLower.ToString("yyyyMMdd"));
}
else {
strb.Append("00000000");
}
//F05 tx req'd for ortho purposes 1 A
if(claim.IsOrtho) {
strb.Append("Y");
}
else {
strb.Append("N");
}
//F20 max prosth material 1 N
if(claim.CanadianMaxProsthMaterial==7) {//our fake crown code
strb.Append("0");
}
else {
strb.Append(claim.CanadianMaxProsthMaterial.ToString());//validated
}
//F21 mand prosth material 1 N
if(claim.CanadianMandProsthMaterial==7) {//our fake crown code
strb.Append("0");
}
else {
strb.Append(claim.CanadianMandProsthMaterial.ToString());//validated
}
}
if(carrier.CDAnetVersion!="02") { //version 04
//If F22 is non-zero. Repeat for the number of times specified by F22.----------------------------------------------
for(int t=0;t<extracted.Count;t++) {
//F23 extracted tooth num 2 N
//todo: check validation
strb.Append(TidyN(Tooth.ToInternat(extracted[t].ToothNum),2));//validated
//F24 extraction date 8 N
//todo: check validation
strb.Append(extracted[t].ProcDate.ToString("yyyyMMdd"));//validated
}
}
if(carrier.CDAnetVersion!="02") { //version 04
if(claim.ClaimType=="PreAuth") {
#if DEBUG
//We are required to test multi-page (up to 7 procs per page) predeterminations for certification. We do not actually do this in the real world.
//We will use the claim.PreAuthString here to pass these useless numbers in for testing purposes, since this field is not used for predetermination claims for any other reason.
int currentPredeterminationPageNumber=1;
int lastPredeterminationPageNumber=1;
if(claim.PreAuthString!="") {
string[] predetermNums=claim.PreAuthString.Split(new char[] { ',' });
currentPredeterminationPageNumber=PIn.Int(predetermNums[0]);
lastPredeterminationPageNumber=PIn.Int(predetermNums[1]);
}
//G46 Current Predetermination Page Number N 1
strb.Append(Canadian.TidyN(currentPredeterminationPageNumber,1));
//G47 Last Predetermination Page Number N 1
strb.Append(Canadian.TidyN(lastPredeterminationPageNumber,1));
#else
//G46 Current Predetermination Page Number N 1
strb.Append("1");//Always 1 page, because UI prevents attaching more than 7 procedures per claim in Canadian mode.
//G47 Last Predetermination Page Number N 1
strb.Append("1");//Always 1 page, because UI prevents attaching more than 7 procedures per claim in Canadian mode.
#endif
if(orthoRecordFlag) { //F25 is set
//F37 Estimated Treatment Starting Date N 8
strb.Append(Canadian.TidyN(claim.CanadaEstTreatStartDate.ToString("yyyyMMdd"),8));
double firstExamFee=0;
double diagnosticPhaseFee=0;
#if DEBUG //Fields F26 and F27 are not required in the real world, but there are a few certification tests that require this information in order for the test to pass.
if(claim.PreAuthString!="") {
string[] preauthData=claim.PreAuthString.Split(new char[] { ',' });
if(preauthData.Length>2) {
firstExamFee=PIn.Double(preauthData[2]);
}
if(preauthData.Length>3) {
diagnosticPhaseFee=PIn.Double(preauthData[3]);
}
}
#endif
//F26 First Examination Fee D 6
strb.Append(Canadian.TidyD(firstExamFee,6));//optional
//F27 Diagnostic Phase Fee D 6
strb.Append(Canadian.TidyD(diagnosticPhaseFee,6));//optional
//F28 Initial Payment D 6
strb.Append(Canadian.TidyD(claim.CanadaInitialPayment,6));
//F29 Payment Mode N 1
strb.Append(Canadian.TidyN(claim.CanadaPaymentMode,1));//Validated in UI.
//F30 Treatment Duration N 2
strb.Append(Canadian.TidyN(claim.CanadaTreatDuration,2));
//F31 Number of Anticipated Payments N 2
strb.Append(Canadian.TidyN(claim.CanadaNumAnticipatedPayments,2));
//F32 Anticipated Payment Amount D 6
strb.Append(Canadian.TidyD(claim.CanadaAnticipatedPayAmount,6));
}
}
}
//Procedures: Repeat for number of times specified by F06.----------------------------------------------------------
for(int p=0;p<claimProcsClaim.Count;p++) {
//claimProcsClaim already excludes any claimprocs with ProcNum=0, so no payments etc.
proc=Procedures.GetProcFromList(procListAll,claimProcsClaim[p].ProcNum);
procCode=ProcedureCodes.GetProcCode(proc.CodeNum);
procListLabForOne=Procedures.GetCanadianLabFees(proc.ProcNum,procListAll);
//F07 proc line number 1 N
strb.Append((p+1).ToString());
if(carrier.CDAnetVersion=="02") {
//F08 procedure code 5 N
strb.Append(TidyN(claimProcsClaim[p].CodeSent,5).Trim().PadLeft(5,'0'));
}
else { //version 04
//F08 procedure code 5 AN
strb.Append(TidyAN(claimProcsClaim[p].CodeSent,5).Trim().PadLeft(5,'0'));
}
if(claim.ClaimType!="PreAuth") {
//F09 date of service 8 N
strb.Append(claimProcsClaim[p].ProcDate.ToString("yyyyMMdd"));//validated
}
//F10 international tooth, sextant, quad, or arch 2 N
strb.Append(GetToothQuadOrArch(proc,procCode));
//F11 tooth surface 5 A
//the SurfTidy function is very thorough, so it's OK to use TidyAN
if(procCode.TreatArea==TreatmentArea.Surf) {
#if DEBUG
//since the scripts use impossible surfaces, we need to just use raw database here
strb.Append(TidyAN(proc.Surf,5));
#else
strb.Append(TidyAN(Tooth.SurfTidyForClaims(proc.Surf,proc.ToothNum),5));
#endif
}
else {
strb.Append(" ");
}
//F12 dentist's fee claimed 6 D
strb.Append(TidyD(claimProcsClaim[p].FeeBilled,6));
if(carrier.CDAnetVersion!="02") { //version 04
//F34 lab procedure code #1 5 AN
if(procListLabForOne.Count>0) {
strb.Append(TidyAN(ProcedureCodes.GetProcCode(procListLabForOne[0].CodeNum).ProcCode,5).Trim().PadLeft(5,'0'));
}
else {
strb.Append(" ");
}
}
//F13 lab procedure fee #1 6 D
if(procListLabForOne.Count>0){
strb.Append(TidyD(procListLabForOne[0].ProcFee,6));
}
else{
strb.Append("000000");
}
if(carrier.CDAnetVersion=="02") {
//F14 Unit of Time D 4
//This is a somewhat deprecated field becacuse it no longer exists in version 04. Some carriers reject claims
//if there is a time specified for a procedure that does not require a time. It is safest for now to just set
//this value to zero always.
double procHours=0;
//procHours=(PrefC.GetInt(PrefName.AppointmentTimeIncrement)*procCode.ProcTime.Length)/60.0;
strb.Append(TidyD(procHours,4));
}
else { //version 04
//F35 lab procedure code #2 5 AN
if(procListLabForOne.Count>1) {
strb.Append(TidyAN(ProcedureCodes.GetProcCode(procListLabForOne[1].CodeNum).ProcCode,5).Trim().PadLeft(5,'0'));
}
else {
strb.Append(" ");
}
//F36 lab procedure fee #2 6 D
if(procListLabForOne.Count>1) {
strb.Append(TidyD(procListLabForOne[1].ProcFee,6));
}
else {
strb.Append("000000");
}
//F16 procedure type codes 5 A
strb.Append(TidyA((proc.CanadianTypeCodes==null || proc.CanadianTypeCodes=="")?"X":proc.CanadianTypeCodes,5));
//F17 remarks code 2 N
//optional. PMP field. See C12. Zeros when not used.
strb.Append("00");
}
}
if(carrier.CDAnetVersion!="02") { //version 04
//C19 plan record 30 AN
if(C19PlanRecordPresent) {
if(insPlan.CanadianPlanFlag=="A") {
//insPlan.CanadianDiagnosticCode and insPlan.CanadianInstitutionCode are validated in the UI.
strb.Append(Canadian.TidyAN(Canadian.TidyAN(insPlan.CanadianDiagnosticCode,6,true)+Canadian.TidyAN(insPlan.CanadianInstitutionCode,6,true),30,true));
}
else { //N or V. These two plan flags are not yet in use. Presumably, for future use.
strb.Append(Canadian.TidyAN("",30));
}
}
}
//We are required to append the primary EOB. This is not a data dictionary field.
if(claim.ClaimType=="S") {
strb.Append(ConvertEOBVersion(primaryEOBResponse,carrier.CDAnetVersion));
}
//Now we go back and fill in the actual message length now that we know the number for sure.
if(carrier.CDAnetVersion=="02") {
strb.Replace("0000",Canadian.TidyN(strb.Length,4),31,4);
}
else { //version 04
strb.Replace("00000",Canadian.TidyN(strb.Length,5),32,5);
}
//end of creating the message
//this is where we attempt the actual sending:
string result="";
bool resultIsError=false;
try{
#if DEBUG
if(claim.ClaimType=="PreAuth") { //Predeterminations
if(testNumber==3) { //Predetermination test #3
strb.Replace("Y","N",563,1);//We use claim.IsOrtho for fields F05 and F25, but for some reason in this example the values expected are opposite. We think this is a problem with the CDANet test.
strb.Replace("00000000","35000025",577,8);//These are optional fields (F26 and F27), so we have not implemented them, but the test does not work without them for some reason.
}
}
#endif
result=PassToIca(strb.ToString(),clearhouse);
}
catch(ApplicationException ex) {
result=ex.Message;
resultIsError=true;
}
//Attach an ack to the etrans
Etrans etransAck=new Etrans();
etransAck.PatNum=etrans.PatNum;
etransAck.PlanNum=etrans.PlanNum;
etransAck.InsSubNum=etrans.InsSubNum;
etransAck.CarrierNum=etrans.CarrierNum;
etransAck.ClaimNum=etrans.ClaimNum;
etransAck.DateTimeTrans=DateTime.Now;
CCDFieldInputter fieldInputter=null;
if(resultIsError){
etransAck.Etype=EtransType.AckError;
etrans.Note="failed";
}
else{
fieldInputter=new CCDFieldInputter(result);
CCDField fieldG05=fieldInputter.GetFieldById("G05");
if(fieldG05!=null) {
etransAck.AckCode=fieldG05.valuestr;
if(etransAck.AckCode=="M") { //Manually print the claim form.
PrintCdaClaimForm(claim);
}
}
etransAck.Etype=fieldInputter.GetEtransType();
}
Etranss.Insert(etransAck);
Etranss.SetMessage(etransAck.EtransNum,result);
etrans.AckEtransNum=etransAck.EtransNum;
Etranss.Update(etrans);
Etranss.SetMessage(etrans.EtransNum,strb.ToString());
if(resultIsError) {
throw new ApplicationException(result);
}
if(claim.ClaimType!="PreAuth") {
Claims.SetCanadianClaimSent(queueItem.ClaimNum);//when called from ClaimEdit, that window will close immediately, so we're directly changing the db.
CCDField fieldTransRefNum=fieldInputter.GetFieldById("G01");
if(fieldTransRefNum!=null) {
if(etransAck.AckCode!="R") {
claim.CanadaTransRefNum=fieldTransRefNum.valuestr;
Claims.Update(claim);
}
}
}
if(doPrint) {
new FormCCDPrint(etrans,result,true);//Physically print the form.
}
if(claim.ClaimType!="PreAuth" && claim.ClaimType!="S" && etransAck.Etype==EtransType.ClaimEOB_CA && planNum2>0) {//if an eob was returned and patient has secondary insurance.
//if an EOB is returned, there are two possibilities.
//1. The EOB contains an embedded EOB because the same carrier is both pri and sec. Both got printed above.
//2. The EOB does not contain an embedded EOB, indicating that a COB claim needs to be created and sent.
//That is done here, automatically.
//UI already prevents the initial automatic creation of the secondary claim for Canada.
string embeddedLength=fieldInputter.GetValue("G39");
if(embeddedLength=="" || embeddedLength=="0000") {//no embedded message
Claim claim2=new Claim();
claim2.PatNum=claim.PatNum;
claim2.DateService=claim.DateService;
claim2.DateSent=DateTime.Today;
claim2.ClaimStatus="W";
claim2.PlanNum=planNum2;
claim2.InsSubNum=insSubNum2;
claim2.PatRelat=patRelat2;
claim2.PlanNum2=planNum;
claim2.InsSubNum2=insSubNum;
claim2.PatRelat2=patRelat;
claim2.ClaimType="S";
claim2.ProvTreat=claim.ProvTreat;
claim2.IsProsthesis="N";
claim2.ProvBill=claim.ProvBill;
claim2.EmployRelated=YN.No;
claim2.AccidentDate=claim.AccidentDate;
claim2.IsOrtho=claim.IsOrtho;
claim2.CanadianDateInitialLower=claim.CanadianDateInitialLower;
claim2.CanadianDateInitialUpper=claim.CanadianDateInitialUpper;
claim2.CanadianIsInitialLower=claim.CanadianIsInitialLower;
claim2.CanadianIsInitialUpper=claim.CanadianIsInitialUpper;
claim2.CanadianMandProsthMaterial=claim.CanadianMandProsthMaterial;
claim2.CanadianMaterialsForwarded=claim.CanadianMaterialsForwarded;
claim2.CanadianMaxProsthMaterial=claim.CanadianMaxProsthMaterial;
claim2.CanadianReferralProviderNum=claim.CanadianReferralProviderNum;
claim2.CanadianReferralReason=claim.CanadianReferralReason;
Claims.Insert(claim2);//to retreive a key for new Claim.ClaimNum
ClaimProc[] claimProcsClaim2=new ClaimProc[claimProcsClaim.Count];
long procNum;
for(int i=0;i<claimProcsClaim.Count;i++) {//loop through the procs from claim 1
//and try to find an estimate that can be used
procNum=claimProcsClaim[i].ProcNum;
claimProcsClaim2[i]=Procedures.GetClaimProcEstimate(procNum,claimProcList,insPlan2,claim2.InsSubNum2);
}
for(int i=0;i<claimProcsClaim2.Length;i++) {//loop through each claimProc
//and create any missing estimates just in case
if(claimProcsClaim2[i]==null) {
claimProcsClaim2[i]=new ClaimProc();
//claimProcsClaim and claimProcsClaim2 already exclude any claimprocs with ProcNum=0, so no payments etc.
proc=Procedures.GetProcFromList(procListAll,claimProcsClaim[i].ProcNum);
ClaimProcs.CreateEst(claimProcsClaim2[i],proc,insPlan2,insSub2);
}
}
for(int i=0;i<claimProcsClaim2.Length;i++) {
//claimProcsClaim and claimProcsClaim2 already exclude any claimprocs with ProcNum=0, so no payments etc.
proc=Procedures.GetProcFromList(procListAll,claimProcsClaim2[i].ProcNum);//1:1
claimProcsClaim2[i].ClaimNum=claim2.ClaimNum;
claimProcsClaim2[i].Status=ClaimProcStatus.NotReceived;
claimProcsClaim2[i].CodeSent=claimProcsClaim[i].CodeSent;
claimProcsClaim2[i].LineNumber=(byte)(i+1);
ClaimProcs.Update(claimProcsClaim2[i]);
}
claimProcList=ClaimProcs.Refresh(claim2.PatNum);
Family fam=Patients.GetFamily(claim2.PatNum);
List<InsSub> subList=InsSubs.RefreshForFam(fam);
List<InsPlan> planList=InsPlans.RefreshForSubList(subList);
List<Benefit> benefitList=Benefits.Refresh(patPlansForPatient,subList);
ClaimL.CalculateAndUpdate(procListAll,planList,claim2,patPlansForPatient,benefitList,patient.Age,subList);
ClaimSendQueueItem queueItem2=Claims.GetQueueList(claim2.ClaimNum,claim2.ClinicNum,0)[0];
string responseMessageVersion=result.Substring(18,2);//Field A03 always exists on all messages and is always in the same location.
//ok to skip validation
//We can only send an electronic secondary claim when the EOB received from the primary insurance is a version 04 message and when
//the secondary carrier accepts secondary claims electronically (COBs). Otherwise, the user must send the claim by paper.
if(responseMessageVersion!="02" && (carrier2.CanadianSupportedTypes&CanSupTransTypes.CobClaimTransaction_07)==CanSupTransTypes.CobClaimTransaction_07) {
long etransNum=SendClaim(queueItem2,doPrint);//recursive
return etransNum;//for now, we'll return the etransnum of the secondary ack.
}
//The secondary carrier does not support COB claim transactions. We must print a manual claim form.
if(doPrint) {
PrintCdaClaimForm(claim2);
}
}
else {//an embedded message exists
//string embeddedMsg=fieldInputter.GetValue("G40");
//MsgBoxCopyPaste msgbox=new MsgBoxCopyPaste(embeddedMsg);
//msgbox.Show();
//actually, nothing to do here because already printed above.
}
}
return etransAck.EtransNum;
}
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];
Eclaims.GetMissingData(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(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;
}
///<summary>Prints the claim to a Canadian Dental Association (CDA) claim form. Tries to print to the printer chosen by the user in File | Printers | Claim.</summary>
public static void PrintCdaClaimForm(Claim claim) {
try {
FormClaimPrint FormCP=new FormClaimPrint();
FormCP.PatNumCur=claim.PatNum;
FormCP.ClaimNumCur=claim.ClaimNum;
FormCP.ClaimFormCur=null;//so that it will pull from the individual claim or plan.
PrintDocument pd=new PrintDocument();
if(PrinterL.SetPrinter(pd,PrintSituation.Claim,claim.PatNum,"CDA claim form printed")) {
pd.PrinterSettings.Copies=1; //Used to be sent in the FormCP.PrintImmediate function call below. Moved up here to keep same logic.
//steven's change
if (pd.PrinterSettings.PrinterName.Contains(" XPS "))
pd.PrintController = new System.Windows.Forms.PrintControllerWithStatusDialog(new XPSPrinterController(PrintSituation.Claim, claim.PatNum));
if(FormCP.PrintImmediate(pd.PrinterSettings, pd.PrintController)) {
Etranss.SetClaimSentOrPrinted(claim.ClaimNum,claim.PatNum,0,EtransType.ClaimPrinted,0);
}
}
}
catch {
//Oh well, the user can manually reprint if needed.
}
}
///<summary>Updates all claimproc estimates and also updates claim totals to db. Must supply procList which includes all procedures that this claim is linked to. Will also need to refresh afterwards to see the results</summary>
public static void CalculateAndUpdate(List<Procedure> procList,List <InsPlan> planList,Claim claimCur,List <PatPlan> patPlans,List <Benefit> benefitList,int patientAge,List<InsSub> subList){
//we need more than just the claimprocs for this claim.
//in order to run Procedures.ComputeEstimates, we need all claimprocs for all procedures attached to this claim
List<ClaimProc> ClaimProcsAll=ClaimProcs.Refresh(claimCur.PatNum);
List<ClaimProc> ClaimProcsForClaim=ClaimProcs.RefreshForClaim(claimCur.ClaimNum);//will be ordered by line number.
double claimFee=0;
double dedApplied=0;
double insPayEst=0;
double insPayAmt=0;
double writeoff=0;
InsPlan plan=InsPlans.GetPlan(claimCur.PlanNum,planList);
if(plan==null){
return;
}
long patPlanNum=PatPlans.GetPatPlanNum(claimCur.InsSubNum,patPlans);
//first loop handles totals for received items.
for(int i=0;i<ClaimProcsForClaim.Count;i++){
if(ClaimProcsForClaim[i].Status!=ClaimProcStatus.Received){
continue;//disregard any status except Receieved.
}
claimFee+=ClaimProcsForClaim[i].FeeBilled;
dedApplied+=ClaimProcsForClaim[i].DedApplied;
insPayEst+=ClaimProcsForClaim[i].InsPayEst;
insPayAmt+=ClaimProcsForClaim[i].InsPayAmt;
writeoff+=ClaimProcsForClaim[i].WriteOff;
}
//loop again only for procs not received.
//And for preauth.
Procedure ProcCur;
//InsPlan plan=InsPlans.GetPlan(claimCur.PlanNum,planList);
List<ClaimProcHist> histList=ClaimProcs.GetHistList(claimCur.PatNum,benefitList,patPlans,planList,claimCur.ClaimNum,claimCur.DateService,subList);
List<ClaimProc> claimProcListOld=new List<ClaimProc>();//make a copy
for(int i=0;i<ClaimProcsAll.Count;i++) {
claimProcListOld.Add(ClaimProcsAll[i].Copy());
}
List<ClaimProcHist> loopList=new List<ClaimProcHist>();
for(int i=0;i<ClaimProcsForClaim.Count;i++) {//loop through each proc
ProcCur=Procedures.GetProcFromList(procList,ClaimProcsForClaim[i].ProcNum);
//in order for ComputeEstimates to give accurate Writeoff when creating a claim, InsPayEst must be filled for the claimproc with status of NotReceived.
//So, we must set it here. We need to set it in the claimProcsAll list. Find the matching one.
for(int j=0;j<ClaimProcsAll.Count;j++){
if(ClaimProcsAll[j].ClaimProcNum==ClaimProcsForClaim[i].ClaimProcNum){//same claimproc in a different list
if(ClaimProcsForClaim[i].Status==ClaimProcStatus.NotReceived) {//ignores recieved, etc
ClaimProcsAll[j].InsPayEst=ClaimProcs.GetInsEstTotal(ClaimProcsAll[j]);
}
}
}
//When this is the secondary claim, HistList includes the primary estimates, which is something we don't want because the primary calculations gets confused.
//So, we must remove those bad entries from histList.
for(int h=histList.Count-1;h>=0;h--) {//loop through the histList backwards
if(histList[h].ProcNum!=ProcCur.ProcNum) {
continue;//Makes sure we will only be excluding histList entries for procs on this claim.
}
//we already excluded this claimNum when getting the histList.
if(histList[h].Status!=ClaimProcStatus.NotReceived) {
continue;//The only ones that are a problem are the ones on the primary claim not received yet.
}
histList.RemoveAt(h);
}
Procedures.ComputeEstimates(ProcCur,claimCur.PatNum,ref ClaimProcsAll,false,planList,patPlans,benefitList,histList,loopList,false,patientAge,subList);
//then, add this information to loopList so that the next procedure is aware of it.
loopList.AddRange(ClaimProcs.GetHistForProc(ClaimProcsAll,ProcCur.ProcNum,ProcCur.CodeNum));
}
//save changes in the list to the database
ClaimProcs.Synch(ref ClaimProcsAll,claimProcListOld);
ClaimProcsForClaim=ClaimProcs.RefreshForClaim(claimCur.ClaimNum);
//But ClaimProcsAll has not been refreshed.
for(int i=0;i<ClaimProcsForClaim.Count;i++) {
if(ClaimProcsForClaim[i].Status!=ClaimProcStatus.NotReceived
&& ClaimProcsForClaim[i].Status!=ClaimProcStatus.Preauth
&& ClaimProcsForClaim[i].Status!=ClaimProcStatus.CapClaim) {
continue;
}
ProcCur=Procedures.GetProcFromList(procList,ClaimProcsForClaim[i].ProcNum);
if(ProcCur.ProcNum==0) {
continue;//ignores payments, etc
}
//fee:
int qty=ProcCur.UnitQty + ProcCur.BaseUnits;
if(qty==0) {
qty=1;
}
if(plan.ClaimsUseUCR) {//use UCR for the provider of the procedure
long provNum=ProcCur.ProvNum;
if(provNum==0) {//if no prov set, then use practice default.
provNum=PrefC.GetLong(PrefName.PracticeDefaultProv);
}
//get the fee based on code and prov fee sched
double feebilled=Fees.GetAmount0(ProcCur.CodeNum,ProviderC.ListLong[Providers.GetIndexLong(provNum)].FeeSched);
if(feebilled > ProcCur.ProcFee) {
ClaimProcsForClaim[i].FeeBilled=qty*feebilled;
}
else {
ClaimProcsForClaim[i].FeeBilled=qty*ProcCur.ProcFee;
}
}
//else if(claimCur.ClaimType=="Cap") {//Even for capitation, use the proc fee.
// ClaimProcsForClaim[i].FeeBilled=0;
//}
else {//don't use ucr. Use the procedure fee instead.
ClaimProcsForClaim[i].FeeBilled=qty*ProcCur.ProcFee;
}
claimFee+=ClaimProcsForClaim[i].FeeBilled;
if(claimCur.ClaimType=="PreAuth" || claimCur.ClaimType=="Other" || claimCur.ClaimType=="Cap") {
//only the fee gets calculated, the rest does not
ClaimProcs.Update(ClaimProcsForClaim[i]);
continue;
}
//ClaimProcs.ComputeBaseEst(ClaimProcsForClaim[i],ProcCur.ProcFee,ProcCur.ToothNum,ProcCur.CodeNum,plan,patPlanNum,benefitList,histList,loopList);
ClaimProcsForClaim[i].InsPayEst=ClaimProcs.GetInsEstTotal(ClaimProcsForClaim[i]);//Yes, this is duplicated from further up.
ClaimProcsForClaim[i].DedApplied=ClaimProcs.GetDedEst(ClaimProcsForClaim[i]);
if(ClaimProcsForClaim[i].Status==ClaimProcStatus.NotReceived){//(vs preauth)
ClaimProcsForClaim[i].WriteOff=ClaimProcs.GetWriteOffEstimate(ClaimProcsForClaim[i]);
writeoff+=ClaimProcsForClaim[i].WriteOff;
/*
ClaimProcsForClaim[i].WriteOff=0;
if(claimCur.ClaimType=="P" && plan.PlanType=="p") {//Primary && PPO
double insplanAllowed=Fees.GetAmount(ProcCur.CodeNum,plan.FeeSched);
if(insplanAllowed!=-1) {
ClaimProcsForClaim[i].WriteOff=ProcCur.ProcFee-insplanAllowed;
}
//else, if -1 fee not found, then do not show a writeoff. User can change writeoff if they disagree.
}
writeoff+=ClaimProcsForClaim[i].WriteOff;*/
}
dedApplied+=ClaimProcsForClaim[i].DedApplied;
insPayEst+=ClaimProcsForClaim[i].InsPayEst;
ClaimProcsForClaim[i].ProcDate=ProcCur.ProcDate.Date;//this solves a rare bug. Keeps dates synched.
//It's rare enough that I'm not goint to add it to the db maint tool.
ClaimProcs.Update(ClaimProcsForClaim[i]);
//but notice that the ClaimProcs lists are not refreshed until the loop is finished.
}//for claimprocs.forclaim
claimCur.ClaimFee=claimFee;
claimCur.DedApplied=dedApplied;
claimCur.InsPayEst=insPayEst;
claimCur.InsPayAmt=insPayAmt;
claimCur.WriteOff=writeoff;
//Cur=ClaimCur;
Claims.Update(claimCur);
}
///<summary></summary>
public static long SendClaimReversal(Claim claim,InsPlan plan,InsSub insSub)
{
StringBuilder strb=new StringBuilder();
Clearinghouse clearhouse=Canadian.GetClearinghouse();
if(clearhouse==null) {
throw new ApplicationException(Lan.g("CanadianOutput","Canadian clearinghouse not found."));
}
string saveFolder=clearhouse.ExportPath;
if(!Directory.Exists(saveFolder)) {
throw new ApplicationException(saveFolder+" not found.");
}
Carrier carrier=Carriers.GetCarrier(plan.CarrierNum);
if((carrier.CanadianSupportedTypes&CanSupTransTypes.ClaimReversal_02)!=CanSupTransTypes.ClaimReversal_02) {
throw new ApplicationException(Lan.g("CanadianOutput","The carrier does not support reversal transactions."));
}
if(carrier.CanadianNetworkNum==0) {
throw new ApplicationException("Carrier network not set.");
}
CanadianNetwork network=CanadianNetworks.GetNetwork(carrier.CanadianNetworkNum);
Etrans etrans=Etranss.CreateCanadianOutput(claim.PatNum,carrier.CarrierNum,carrier.CanadianNetworkNum,
clearhouse.ClearinghouseNum,EtransType.ClaimReversal_CA,plan.PlanNum,insSub.InsSubNum);
etrans.ClaimNum=claim.ClaimNum;//We don't normally use a claim number with Etranss.CreateCanadianOutput(), but here we need the claim number so that we can show the claim reversal in the claim history.
Etranss.Update(etrans);
Patient patient=Patients.GetPat(claim.PatNum);
Provider prov=Providers.GetProv(claim.ProvTreat);
if(!prov.IsCDAnet) {
throw new ApplicationException(Lan.g("CanadianOutput","Treating provider is not setup to use CDANet."));
}
Provider billProv=ProviderC.ListLong[Providers.GetIndexLong(claim.ProvBill)];
if(!billProv.IsCDAnet) {
throw new ApplicationException(Lan.g("CanadianOutput","Billing provider is not setup to use CDANet."));
}
InsPlan insPlan=InsPlans.GetPlan(claim.PlanNum,new List<InsPlan>());
Patient subscriber=Patients.GetPat(insSub.Subscriber);
//create message----------------------------------------------------------------------------------------------
//A01 transaction prefix 12 AN
strb.Append(Canadian.TidyAN(network.CanadianTransactionPrefix,12));
//A02 office sequence number 6 N
//We are required to use the same office sequence number as the original claim.
etrans.OfficeSequenceNumber=0;//Clear the randomly generated office sequence number.
List<Etrans> claimTransactions=Etranss.GetAllForOneClaim(claim.ClaimNum);
DateTime originalEtransDateTime=DateTime.MinValue;//So we can get the latest matching transaction.
for(int i=0;i<claimTransactions.Count;i++) {
if(claimTransactions[i].Etype==EtransType.Claim_CA || claimTransactions[i].Etype==EtransType.ClaimCOB_CA) {
Etrans ack=Etranss.GetEtrans(claimTransactions[i].AckEtransNum);
if(ack==null) {//For those claims sent that didn't receive a response (i.e. when there is an exception while sending a claim).
continue;
}
string messageText=EtransMessageTexts.GetMessageText(ack.EtransMessageTextNum);
CCDFieldInputter messageData=new CCDFieldInputter(messageText);
CCDField transRefNum=messageData.GetFieldById("G01");
if(transRefNum!=null && transRefNum.valuestr==claim.CanadaTransRefNum && claimTransactions[i].DateTimeTrans>originalEtransDateTime) {
etrans.OfficeSequenceNumber=PIn.Int(messageData.GetFieldById("A02").valuestr);
originalEtransDateTime=claimTransactions[i].DateTimeTrans;
}
}
}
DateTime serverDate=MiscData.GetNowDateTime().Date;
if(originalEtransDateTime.Date!=serverDate) {
throw new ApplicationException(Lan.g("CanadianOutput","Claims can only be reversed on the day that they were sent. The claim can only be manually reversed."));
}
strb.Append(Canadian.TidyN(etrans.OfficeSequenceNumber,6));
//A03 format version number 2 N
strb.Append(carrier.CDAnetVersion);//eg. "04", validated in UI
//A04 transaction code 2 N
strb.Append("02");//Same for both versions 02 and 04.
//A05 carrier id number 6 N
strb.Append(carrier.ElectID);//already validated as 6 digit number.
//A06 software system id 3 AN
strb.Append(Canadian.SoftwareSystemId());
if(carrier.CDAnetVersion!="02") { //version 04
//A10 encryption method 1 N
strb.Append(carrier.CanadianEncryptionMethod);//validated in UI
}
if(carrier.CDAnetVersion=="02") {
//A07 message length N4
strb.Append(Canadian.TidyN("133",4));
}
else { //version 04
//A07 message length N 5
strb.Append(Canadian.TidyN("164",5));
}
if(carrier.CDAnetVersion!="02") { //version 04
//A09 carrier transaction counter 5 N
#if DEBUG
strb.Append("11111");
#else
strb.Append(Canadian.TidyN(etrans.CarrierTransCounter,5));
#endif
}
//B01 CDA provider number 9 AN
strb.Append(Canadian.TidyAN(prov.NationalProvID,9));//already validated
//B02 provider office number 4 AN
strb.Append(Canadian.TidyAN(prov.CanadianOfficeNum,4));//already validated
if(carrier.CDAnetVersion!="02") { //version 04
//B03 billing provider number 9 AN
//might need to account for possible 5 digit prov id assigned by carrier
strb.Append(Canadian.TidyAN(billProv.NationalProvID,9));//already validated
//B04 billing provider office number 4 AN
strb.Append(Canadian.TidyAN(billProv.CanadianOfficeNum,4));//already validated
}
if(carrier.CDAnetVersion=="02") {
//C01 primary policy/plan number 8 AN
//only validated to ensure that it's not blank and is less than 8. Also that no spaces.
strb.Append(Canadian.TidyAN(insPlan.GroupNum,8));
}
else { //version 04
//C01 primary policy/plan number 12 AN
//only validated to ensure that it's not blank and is less than 12. Also that no spaces.
strb.Append(Canadian.TidyAN(insPlan.GroupNum,12));
}
//C11 primary division/section number 10 AN
strb.Append(Canadian.TidyAN(insPlan.DivisionNo,10));
if(carrier.CDAnetVersion=="02") {
//C02 subscriber id number 11 AN
strb.Append(Canadian.TidyAN(insSub.SubscriberID.Replace("-",""),11));//validated
}
else { //version 04
//C02 subscriber id number 12 AN
strb.Append(Canadian.TidyAN(insSub.SubscriberID.Replace("-",""),12));//validated
}
//C03 relationship code 1 N
//User interface does not only show Canadian options, but all options are handled.
strb.Append(Canadian.GetRelationshipCode(claim.PatRelat));
if(carrier.CDAnetVersion=="02") {
//D02 subscriber last name 25 A
strb.Append(Canadian.TidyA(subscriber.LName,25));//validated
}
else { //version 04
//D02 subscriber last name 25 AE
strb.Append(Canadian.TidyAE(subscriber.LName,25,true));//validated
}
if(carrier.CDAnetVersion=="02") {
//D03 subscriber first name 15 A
strb.Append(Canadian.TidyA(subscriber.FName,15));//validated
}
else { //version 04
//D03 subscriber first name 15 AE
strb.Append(Canadian.TidyAE(subscriber.FName,15,true));//validated
}
if(carrier.CDAnetVersion=="02") {
//D04 subscriber middle initial 1 A
strb.Append(Canadian.TidyA(subscriber.MiddleI,1));
}
else { //version 04
//D04 subscriber middle initial 1 AE
strb.Append(Canadian.TidyAE(subscriber.MiddleI,1));
}
if(carrier.CDAnetVersion!="02") { //version 04
//For Future Use
strb.Append("000000");
}
//G01 transaction reference number of original claim AN 14
strb.Append(Canadian.TidyAN(claim.CanadaTransRefNum,14));
string result="";
bool resultIsError=false;
try {
result=Canadian.PassToIca(strb.ToString(),clearhouse);
}
catch(ApplicationException ex) {
result=ex.Message;
resultIsError=true;
//Etranss.Delete(etrans.EtransNum);//we don't want to do this, because we want the incremented etrans.OfficeSequenceNumber to be saved
//Attach an ack indicating failure.
}
//Attach an ack to the etrans
Etrans etransAck=new Etrans();
etransAck.PatNum=etrans.PatNum;
etransAck.PlanNum=etrans.PlanNum;
etransAck.InsSubNum=etrans.InsSubNum;
etransAck.CarrierNum=etrans.CarrierNum;
etransAck.DateTimeTrans=DateTime.Now;
if(resultIsError) {
etransAck.AckCode="R";//To allow the user to try and reverse the claim again.
etransAck.Etype=EtransType.AckError;
etrans.Note="failed";
}
else {
try {
CCDFieldInputter fieldInputter=new CCDFieldInputter(result);
CCDField fieldG05=fieldInputter.GetFieldById("G05");
if(fieldG05!=null) {
etransAck.AckCode=fieldG05.valuestr;
}
etransAck.Etype=fieldInputter.GetEtransType();
}
catch {
etransAck.AckCode="R";//To allow the user to try and reverse the claim again.
etransAck.Etype=EtransType.AckError;
etrans.Note="Could not parse response from ITRANS.";
}
}
Etranss.Insert(etransAck);
Etranss.SetMessage(etransAck.EtransNum,result);
etrans.AckEtransNum=etransAck.EtransNum;
Etranss.Update(etrans);
Etranss.SetMessage(etrans.EtransNum,strb.ToString());
if(resultIsError) {
throw new ApplicationException(result);
}
new FormCCDPrint(etrans,result,true);//Print the response.
if(etrans.AckCode=="R") {
throw new ApplicationException(Lan.g("CanadianOutput","Reversal was rejected by clearinghouse. The claim must be reversed manually."));
}
return etransAck.EtransNum;
}
public static string ClaimProcWithInvalidClaimNum(bool verbose,bool isCheck) {
if(RemotingClient.RemotingRole==RemotingRole.ClientWeb) {
return Meth.GetString(MethodBase.GetCurrentMethod(),verbose,isCheck);
}
string log="";
if(isCheck){
command="SELECT COUNT(*) FROM claimproc WHERE claimproc.ClaimNum!=0 "
+"AND NOT EXISTS(SELECT * FROM claim WHERE claim.ClaimNum=claimproc.ClaimNum) "
+"AND (claimproc.InsPayAmt!=0 OR claimproc.WriteOff!=0)";
int numFound=PIn.Int(Db.GetCount(command));
if(numFound>0 || verbose) {
log+=Lans.g("FormDatabaseMaintenance","Claimprocs found with invalid ClaimNum: ")+numFound+"\r\n";
}
}
else{//fix
//We can't touch those claimprocs because it would mess up the accounting.
//We will create dummy claims for all claimprocs with invalid ClaimNums if those claimprocs have amounts entered in the InsPayAmt or Writeoff columns, otherwise you could not delete the procedure or create a new claim
command="SELECT * FROM claimproc WHERE claimproc.ClaimNum!=0 "
+"AND NOT EXISTS(SELECT * FROM claim WHERE claim.ClaimNum=claimproc.ClaimNum) "
+"AND (claimproc.InsPayAmt!=0 OR claimproc.WriteOff!=0) "
+"GROUP BY claimproc.ClaimNum";
table=Db.GetTable(command);
List<ClaimProc> cpList=Crud.ClaimProcCrud.TableToList(table);
Claim claim;
for(int i=0;i<cpList.Count;i++) {
claim=new Claim();
claim.ClaimNum=cpList[i].ClaimNum;
claim.PatNum=cpList[i].PatNum;
claim.ClinicNum=cpList[i].ClinicNum;
if(cpList[i].Status==ClaimProcStatus.Received) {
claim.ClaimStatus="R";//Status received because we know it's been paid on and the claimproc status is received
}
else {
claim.ClaimStatus="W";
}
claim.PlanNum=cpList[i].PlanNum;
claim.InsSubNum=cpList[i].InsSubNum;
claim.ProvTreat=cpList[i].ProvNum;
Crud.ClaimCrud.Insert(claim,true);//Allows us to use a primary key that was "used".
Patient pat=Patients.GetLim(claim.PatNum);
log+=Lans.g("FormDatabaseMaintenance","Claim created due to claimprocs with invalid ClaimNums for patient: ")
+pat.PatNum+" - "+Patients.GetNameFL(pat.LName,pat.FName,pat.Preferred,pat.MiddleI)+"\r\n";
}
}
return log;
}
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;
}
private static string GetRelatedCauses(Claim claim) {
if(claim.AccidentRelated=="") {
return "";
}
//even though the specs let you submit all three types at once, we only allow one of the three
if(claim.AccidentRelated=="A") {//auto accident
return "AA"+isa16+isa16+isa16+Sout(claim.AccidentST,2,2);
}
else if(claim.AccidentRelated=="E") {//employment
return "EM";
}
else {// if(claim.AccidentRelated=="O"){ //other accident
return "OA";
}
}
private void Init(){
InitializeComponent();
breakLinePen.Width=2;
if(etrans.PatNum!=0) { //Some transactions are not patient specific.
patient=Patients.GetPat(etrans.PatNum);
patPlansForPat=PatPlans.Refresh(etrans.PatNum);
claim=Claims.GetClaim(etrans.ClaimNum);
primaryCarrier=Carriers.GetCarrier(etrans.CarrierNum);
if(claim==null) {//for eligibility
//Get primary info
insSub=InsSubs.GetSub(etrans.InsSubNum,new List<InsSub>());
subscriber=Patients.GetPat(insSub.Subscriber);
insplan=InsPlans.GetPlan(etrans.PlanNum,new List<InsPlan>());
patPlanPri=PatPlans.GetFromList(patPlansForPat,insSub.InsSubNum);
}
else {
//Get primary info
insSub=InsSubs.GetSub(claim.InsSubNum,new List<InsSub>());
subscriber=Patients.GetPat(insSub.Subscriber);
insplan=InsPlans.GetPlan(claim.PlanNum,new List<InsPlan>());
patPlanPri=PatPlans.GetFromList(patPlansForPat,insSub.InsSubNum);
//Get secondary info
if(claim.InsSubNum2!=0) {
patPlanSec=PatPlans.GetFromList(patPlansForPat,claim.InsSubNum2);
insSub2=InsSubs.GetSub(claim.InsSubNum2,new List<InsSub>());
subscriber2=Patients.GetPat(insSub2.Subscriber);
insplan2=InsPlans.GetPlan(claim.PlanNum2,new List<InsPlan>());
secondaryCarrier=Carriers.GetCarrier(insplan2.CarrierNum);
}
//Provider info
provTreat=Providers.GetProv(claim.ProvTreat);
provBill=Providers.GetProv(claim.ProvBill);
//Claim related info
claimprocs=ClaimProcs.RefreshForClaim(claim.ClaimNum);
long clinicNum=0;
for(int i=0;i<claimprocs.Count;i++) {
if(claimprocs[i].ClinicNum!=0) {
clinicNum=claimprocs[i].ClinicNum;
break;
}
}
if(clinicNum!=0) {
clinic=Clinics.GetClinic(clinicNum);
}
else if(!PrefC.GetBool(PrefName.EasyNoClinics) && Clinics.List.Length>0) {
clinic=Clinics.List[0];
}
}
if(provTreat==null) {
provTreat=Providers.GetProv(Patients.GetProvNum(patient));
}
if(provBill==null) {
provBill=Providers.GetProv(Patients.GetProvNum(patient));
}
List<Procedure> procsAll=Procedures.Refresh(etrans.PatNum);
extracted=Procedures.GetCanadianExtractedTeeth(procsAll);
}
if(MessageText==null || MessageText.Length<23) {
throw new Exception("CCD message format too short: "+MessageText);
}
formData=new CCDFieldInputter(MessageText);//Input the fields of the given message.
CCDField languageOfInsured=formData.GetFieldById("G27");
if(languageOfInsured!=null) {
if(languageOfInsured.valuestr=="F") {
isFrench=true;
}
}
else if(subscriber!=null && subscriber.Language=="fr") {
isFrench=true;
}
formatVersionNumber=formData.GetFieldById("A03").valuestr;//Must always exist so no error checking here.
transactionCode=formData.GetFieldById("A04").valuestr;//Must always exist so no error checking here.
if(formatVersionNumber=="04") {//FormId field does not exist in version 02 in any of the message texts.
CCDField formIdField=formData.GetFieldById("G42");//Usually exists in version 04 response messages.
//Only a few response transactions don't define field G42. So far, those are transactions 15 (Summary Reconciliation), 16 (Payment Reconciliation) and 24 (Email).
//In these cases, we simply do not use the formId field later on in the display code.
if(formIdField!=null) {
formId=formIdField.valuestr;
}
}
else {//Version 02
//Since there is no FormID field in version 02, we figure out what the formId should be based on the transaction type.
if(transactionCode=="10") {//Eligibility Response.
formId="08";//Eligibility Form
}
else if(transactionCode=="11") {//Claim Response.
formId="03";//Claim Acknowledgement Form
}
else if(transactionCode=="21") {//EOB
formId="01";//EOB Form
CCDField g02=formData.GetFieldById("G02");
if(g02!=null && g02.valuestr=="Y") {
formId="04";//Employer Certified.
}
}
else if(transactionCode=="13") {//Response to Pre-Determination.
formId="06";//Pre-Determination Acknowledgement Form
}
else if(transactionCode=="12") { //Reversal response
//There is no standard form for a reversal response, but we print the reversal response later on based on the transactioncode so we don't need to do anything here.
}
else {
throw new Exception("Unhandled transactionCode '"+transactionCode+"' for version 02 message.");
}
}
CCDField status=formData.GetFieldById("G05");
if(status!=null && status.valuestr!=null) {
responseStatus=status.valuestr.ToUpper();
}
transactionCode=formData.GetFieldById("A04").valuestr;
predetermination=(transactionCode=="23"||transactionCode=="13");//Be sure to list all predetermination response types here!
if(copiesToPrint<=0) { //Show the form on screen if there are no copies to print.
ShowDisplayMessages();
CCDField fieldPayTo=formData.GetFieldById("F01");
if(fieldPayTo!=null) {
bool paySubscriber=(fieldPayTo.valuestr=="1");//same for version 02 and version 04
//Typically, insurance companies in Canada prefer to pay the subscriber instead of the dentist.
if(AssignmentOfBenefits()) {//The insurance plan is set to pay the dentist
if(paySubscriber) {//The carrier has decided to pay the subscriber.
MsgBox.Show("Canadian","INFORMATION: The carrier changed the payee from the dentist to the subscriber.");//This check was required for certification.
}
}
else {//The insurance plan is set to pay the subscriber
if(!paySubscriber) {//The carrier has decided to pay the dentist.
MsgBox.Show("Canadian","INFORMATION: The carrier changed the payee from the subscriber to the dentist.");//This check was required for certification.
}
}
}
CCDField paymentAdjustmentAmount=formData.GetFieldById("G33");
if(paymentAdjustmentAmount!=null) {
if(paymentAdjustmentAmount.valuestr.Substring(1)!="000000") {
MessageBox.Show(Lan.g(this,"Payment adjustment amount")+": "+RawMoneyStrToDisplayMoney(paymentAdjustmentAmount.valuestr));
}
}
if(autoPrint) {
if(responseStatus!="R") { //We are not required to automatically print rejection notices.
//Automatically print a patient copy only. We are never required to autoprint a dentist copy, but it can be done manually instead.
new FormCCDPrint(etrans.Copy(),MessageText,1,false,true);
}
}
if(formId=="05") { //Manual claim form
Canadian.ShowManualClaimForm(claim);
Close();
}
else {
pd=CreatePrintDocument();
printPreviewControl1.Document=pd;//Setting the document causes system to call pd_PrintPage, which will print the document in the preview window.
ShowDialog();
}
}
else {
pd=CreatePrintDocument();
if(formId=="05") { //Manual claim form
#if DEBUG
Canadian.ShowManualClaimForm(claim);
#else
Canadian.PrintManualClaimForm(claim);//Send the print job to the physical printer.
#endif
}
else {
#if DEBUG
new FormCCDPrint(etrans.Copy(),MessageText,0,false,patientCopy);//Show the form on the screen.
#else
pd.Print();//Send the print job to the physical printer.
#endif
}
//Print the remaining copies recursively.
if(copiesToPrint>=2) {
new FormCCDPrint(etrans.Copy(),MessageText,copiesToPrint-1,false,patientCopy);
}
}
CCDField embeddedTransaction=formData.GetFieldById("G40");
if(embeddedTransaction!=null) {
new FormCCDPrint(etrans.Copy(),embeddedTransaction.valuestr,copiesToPrint,autoPrint,patientCopy);
}
}
private Claim CreateClaim(string claimType,List<PatPlan> patPlanList,List<InsPlan> planList,List<ClaimProc> claimProcList,Procedure proc,List<InsSub> subList) {
long claimFormNum=0;
InsPlan planCur=new InsPlan();
InsSub subCur=new InsSub();
Relat relatOther=Relat.Self;
long clinicNum=proc.ClinicNum;
PlaceOfService placeService=proc.PlaceService;
switch(claimType) {
case "P":
subCur=InsSubs.GetSub(PatPlans.GetInsSubNum(patPlanList,PatPlans.GetOrdinal(PriSecMed.Primary,patPlanList,planList,subList)),subList);
planCur=InsPlans.GetPlan(subCur.PlanNum,planList);
break;
case "S":
subCur=InsSubs.GetSub(PatPlans.GetInsSubNum(patPlanList,PatPlans.GetOrdinal(PriSecMed.Secondary,patPlanList,planList,subList)),subList);
planCur=InsPlans.GetPlan(subCur.PlanNum,planList);
break;
case "Med":
//It's already been verified that a med plan exists
subCur=InsSubs.GetSub(PatPlans.GetInsSubNum(patPlanList,PatPlans.GetOrdinal(PriSecMed.Medical,patPlanList,planList,subList)),subList);
planCur=InsPlans.GetPlan(subCur.PlanNum,planList);
break;
}
ClaimProc claimProcCur=Procedures.GetClaimProcEstimate(proc.ProcNum,claimProcList,planCur,subCur.InsSubNum);
if(claimProcCur==null) {
claimProcCur=new ClaimProc();
ClaimProcs.CreateEst(claimProcCur,proc,planCur,subCur);
}
Claim claimCur=new Claim();
claimCur.PatNum=proc.PatNum;
claimCur.DateService=proc.ProcDate;
claimCur.ClinicNum=proc.ClinicNum;
claimCur.PlaceService=proc.PlaceService;
claimCur.ClaimStatus="W";
claimCur.DateSent=DateTimeOD.Today;
claimCur.PlanNum=planCur.PlanNum;
claimCur.InsSubNum=subCur.InsSubNum;
InsSub sub;
switch(claimType) {
case "P":
claimCur.PatRelat=PatPlans.GetRelat(patPlanList,PatPlans.GetOrdinal(PriSecMed.Primary,patPlanList,planList,subList));
claimCur.ClaimType="P";
claimCur.InsSubNum2=PatPlans.GetInsSubNum(patPlanList,PatPlans.GetOrdinal(PriSecMed.Secondary,patPlanList,planList,subList));
sub=InsSubs.GetSub(claimCur.InsSubNum2,subList);
if(sub.PlanNum>0 && InsPlans.RefreshOne(sub.PlanNum).IsMedical) {
claimCur.PlanNum2=0;//no sec ins
claimCur.PatRelat2=Relat.Self;
}
else {
claimCur.PlanNum2=sub.PlanNum;//might be 0 if no sec ins
claimCur.PatRelat2=PatPlans.GetRelat(patPlanList,PatPlans.GetOrdinal(PriSecMed.Secondary,patPlanList,planList,subList));
}
break;
case "S":
claimCur.PatRelat=PatPlans.GetRelat(patPlanList,PatPlans.GetOrdinal(PriSecMed.Secondary,patPlanList,planList,subList));
claimCur.ClaimType="S";
claimCur.InsSubNum2=PatPlans.GetInsSubNum(patPlanList,PatPlans.GetOrdinal(PriSecMed.Primary,patPlanList,planList,subList));
sub=InsSubs.GetSub(claimCur.InsSubNum2,subList);
claimCur.PlanNum2=sub.PlanNum;
claimCur.PatRelat2=PatPlans.GetRelat(patPlanList,PatPlans.GetOrdinal(PriSecMed.Primary,patPlanList,planList,subList));
break;
case "Med":
claimCur.PatRelat=PatPlans.GetFromList(patPlanList,subCur.InsSubNum).Relationship;
claimCur.ClaimType="Other";
if(PrefC.GetBool(PrefName.ClaimMedTypeIsInstWhenInsPlanIsMedical)){
claimCur.MedType=EnumClaimMedType.Institutional;
}
else{
claimCur.MedType=EnumClaimMedType.Medical;
}
break;
case "Other":
claimCur.PatRelat=relatOther;
claimCur.ClaimType="Other";
//plannum2 is not automatically filled in.
claimCur.ClaimForm=claimFormNum;
if(planCur.IsMedical){
if(PrefC.GetBool(PrefName.ClaimMedTypeIsInstWhenInsPlanIsMedical)){
claimCur.MedType=EnumClaimMedType.Institutional;
}
else{
claimCur.MedType=EnumClaimMedType.Medical;
}
}
break;
}
if(planCur.PlanType=="c"){//if capitation
claimCur.ClaimType="Cap";
}
claimCur.ProvTreat=proc.ProvNum;
if(Providers.GetIsSec(proc.ProvNum)) {
claimCur.ProvTreat=Patients.GetPat(proc.PatNum).PriProv;
//OK if zero, because auto select first in list when open claim
}
claimCur.IsProsthesis="N";
claimCur.ProvBill=Providers.GetBillingProvNum(claimCur.ProvTreat,claimCur.ClinicNum);//OK if zero, because it will get fixed in claim
claimCur.EmployRelated=YN.No;
claimCur.ClaimForm=planCur.ClaimFormNum;
Claims.Insert(claimCur);
//attach procedure
claimProcCur.ClaimNum=claimCur.ClaimNum;
if(planCur.PlanType=="c") {//if capitation
claimProcCur.Status=ClaimProcStatus.CapClaim;
}
else {
claimProcCur.Status=ClaimProcStatus.NotReceived;
}
if(planCur.UseAltCode && (ProcedureCodes.GetProcCode(proc.CodeNum).AlternateCode1!="")) {
claimProcCur.CodeSent=ProcedureCodes.GetProcCode(proc.CodeNum).AlternateCode1;
}
else if(planCur.IsMedical && proc.MedicalCode!="") {
claimProcCur.CodeSent=proc.MedicalCode;
}
else {
claimProcCur.CodeSent=ProcedureCodes.GetProcCode(proc.CodeNum).ProcCode;
if(claimProcCur.CodeSent.Length>5 && claimProcCur.CodeSent.Substring(0,1)=="D") {
claimProcCur.CodeSent=claimProcCur.CodeSent.Substring(0,5);
}
if(CultureInfo.CurrentCulture.Name.EndsWith("CA")) {//Canadian. en-CA or fr-CA
if(claimProcCur.CodeSent.Length>5) {//In Canadian e-claims, codes can contain letters or numbers and cannot be longer than 5 characters.
claimProcCur.CodeSent=claimProcCur.CodeSent.Substring(0,5);
}
}
}
claimProcCur.LineNumber=(byte)1;
ClaimProcs.Update(claimProcCur);
return claimCur;
}
public static void PrintManualClaimForm(Claim claim) {
try {
FormClaimPrint FormCP=new FormClaimPrint();
FormCP.PatNumCur=claim.PatNum;
FormCP.ClaimNumCur=claim.ClaimNum;
FormCP.ClaimFormCur=null;//so that it will pull from the individual claim or plan.
PrintDocument pd=new PrintDocument();
if(PrinterL.SetPrinter(pd,PrintSituation.Claim,claim.PatNum,"Canadian claim manually printed")) {
pd.PrinterSettings.Copies=1; //Used to be sent in the FormCP.PrintImmediate function call below. Moved up here to keep same logic.
if(FormCP.PrintImmediate(pd.PrinterSettings)) {
Etranss.SetClaimSentOrPrinted(claim.ClaimNum,claim.PatNum,0,EtransType.ClaimPrinted,0);
}
}
}
catch {
//Oh well, the user can manually reprint if needed.
}
}
///<summary>Enter either by total and/or by procedure, depending on whether or not procedure detail was provided in the 835 for this claim.
///This function creates the payment claimprocs and displays the payment entry window.</summary>
public static void EnterPayment(Hx835_Claim claimPaid,Claim claim,bool isAutomatic) {
Patient pat=Patients.GetPat(claim.PatNum);
Family fam=Patients.GetFamily(claim.PatNum);
List<InsSub> listInsSubs=InsSubs.RefreshForFam(fam);
List<InsPlan> listInsPlans=InsPlans.RefreshForSubList(listInsSubs);
List<PatPlan> listPatPlans=PatPlans.Refresh(claim.PatNum);
List<ClaimProc> listClaimProcsForClaim=ClaimProcs.RefreshForClaim(claim.ClaimNum);
ClaimProc cpByTotal=new ClaimProc();
cpByTotal.DedApplied=(double)claimPaid.PatientPortion;
cpByTotal.AllowedOverride=(double)claimPaid.AllowedAmt;
cpByTotal.InsPayAmt=(double)claimPaid.InsPaid;
cpByTotal.WriteOff=(double)claimPaid.Writeoff;
List<ClaimProc> listClaimProcsToEdit=new List<ClaimProc>();
//Automatically set PayPlanNum if there is a payplan with matching PatNum, PlanNum, and InsSubNum that has not been paid in full.
long insPayPlanNum=0;
if(claim.ClaimType!="PreAuth" && claim.ClaimType!="Cap") {//By definition, capitation insurance pays in one lump-sum, not over an extended period of time.
//By sending in ClaimNum, we ensure that we only get the payplan a claimproc from this claim was already attached to or payplans with no claimprocs attached.
List<PayPlan> listPayPlans=PayPlans.GetValidInsPayPlans(claim.PatNum,claim.PlanNum,claim.InsSubNum,claim.ClaimNum);
if(listPayPlans.Count==1) {
insPayPlanNum=listPayPlans[0].PayPlanNum;
}
else if(listPayPlans.Count>1 && !isAutomatic) {
//More than one valid PayPlan. Cannot show this prompt when entering automatically, because it would disrupt workflow.
List<PayPlanCharge> listPayPlanCharges=PayPlanCharges.Refresh(claim.PatNum);
FormPayPlanSelect FormPPS=new FormPayPlanSelect(listPayPlans,listPayPlanCharges);
FormPPS.ShowDialog();
if(FormPPS.DialogResult==DialogResult.OK) {
insPayPlanNum=listPayPlans[FormPPS.IndexSelected].PayPlanNum;
}
}
}
//Choose the claimprocs which are not received.
for(int i=0;i<listClaimProcsForClaim.Count;i++) {
if(listClaimProcsForClaim[i].ProcNum==0) {//Exclude any "by total" claimprocs. Choose claimprocs for procedures only.
continue;
}
if(listClaimProcsForClaim[i].Status!=ClaimProcStatus.NotReceived) {//Ignore procedures already received.
continue;
}
listClaimProcsToEdit.Add(listClaimProcsForClaim[i]);//Procedures not yet received.
}
//If all claimprocs are received, then choose claimprocs if not paid on.
if(listClaimProcsToEdit.Count==0) {
for(int i=0;i<listClaimProcsForClaim.Count;i++) {
if(listClaimProcsForClaim[i].ProcNum==0) {//Exclude any "by total" claimprocs. Choose claimprocs for procedures only.
continue;
}
if(listClaimProcsForClaim[i].ClaimPaymentNum!=0) {//Exclude claimprocs already paid.
continue;
}
listClaimProcsToEdit.Add(listClaimProcsForClaim[i]);//Procedures not paid yet.
}
}
//For each NotReceived/unpaid procedure on the claim where the procedure information can be successfully located on the EOB, enter the payment information.
List <List <Hx835_Proc>> listProcsForClaimProcs=claimPaid.GetPaymentsForClaimProcs(listClaimProcsToEdit);
for(int i=0;i<listClaimProcsToEdit.Count;i++) {
ClaimProc claimProc=listClaimProcsToEdit[i];
List<Hx835_Proc> listProcsForProcNum=listProcsForClaimProcs[i];
//If listProcsForProcNum.Count==0, then procedure payment details were not not found for this one specific procedure.
//This can happen with procedures from older 837s, when we did not send out the procedure identifiers, in which case ProcNum would be 0.
//Since we cannot place detail on the service line, we will leave the amounts for the procedure on the total payment line.
//If listProcsForPorcNum.Count==1, then we know that the procedure was adjudicated as is or it might have been bundled, but we treat both situations the same way.
//The 835 is required to include one line for each bundled procedure, which gives is a direct manner in which to associate each line to its original procedure.
//If listProcForProcNum.Count > 1, then the procedure was either split or unbundled when it was adjudicated by the payer.
//We will not bother to modify the procedure codes on the claim, because the user can see how the procedure was split or unbunbled by viewing the 835 details.
//Instead, we will simply add up all of the partial payment lines for the procedure, and report the full payment amount on the original procedure.
claimProc.DedApplied=0;
claimProc.AllowedOverride=0;
claimProc.InsPayAmt=0;
claimProc.WriteOff=0;
StringBuilder sb=new StringBuilder();
for(int j=0;j<listProcsForProcNum.Count;j++) {
Hx835_Proc procPaidPartial=listProcsForProcNum[j];
claimProc.DedApplied+=(double)procPaidPartial.PatientPortion;
claimProc.AllowedOverride+=(double)procPaidPartial.AllowedAmt;
claimProc.InsPayAmt+=(double)procPaidPartial.InsPaid;
claimProc.WriteOff+=(double)procPaidPartial.Writeoff;
if(sb.Length>0) {
sb.Append("\r\n");
}
sb.Append(procPaidPartial.GetRemarks());
}
claimProc.Remarks=sb.ToString();
if(claim.ClaimType=="PreAuth") {
claimProc.Status=ClaimProcStatus.Preauth;
}
else if(claim.ClaimType=="Cap") {
//Do nothing. The claimprocstatus will remain Capitation.
}
else {
claimProc.Status=ClaimProcStatus.Received;
claimProc.DateEntry=DateTime.Now;//Date is was set rec'd
claimProc.PayPlanNum=insPayPlanNum;//Payment plans do not exist for PreAuths or Capitation claims, by definition.
}
claimProc.DateCP=DateTimeOD.Today;
}
//Displace the procedure totals from the "by total" payment, since they have now been accounted for on the individual procedure lines. Totals will not be affected if no procedure details could be located.
//If a total payment was previously entered manually, this will subtract the existing total payment from the new total payment, causing the new total payment to be discarded below where zero amounts are checked.
for(int i=0;i<listClaimProcsForClaim.Count;i++) {
ClaimProc claimProc=listClaimProcsForClaim[i];
cpByTotal.DedApplied-=claimProc.DedApplied;
cpByTotal.AllowedOverride-=claimProc.AllowedOverride;
cpByTotal.InsPayAmt-=claimProc.InsPayAmt;
cpByTotal.WriteOff-=claimProc.WriteOff;
}
bool isByTotalIncluded=true;
//Do not create a total payment if the payment contains all zero amounts, because it would not be useful. Written to account for potential rounding errors in the amounts.
if(Math.Round(cpByTotal.DedApplied,2,MidpointRounding.AwayFromZero)==0
&& Math.Round(cpByTotal.AllowedOverride,2,MidpointRounding.AwayFromZero)==0
&& Math.Round(cpByTotal.InsPayAmt,2,MidpointRounding.AwayFromZero)==0
&& Math.Round(cpByTotal.WriteOff,2,MidpointRounding.AwayFromZero)==0)
{
isByTotalIncluded=false;
}
if(claim.ClaimType=="PreAuth") {
//In the claim edit window we currently block users from entering PreAuth payments by total, presumably because total payments affect the patient balance.
isByTotalIncluded=false;
}
else if(claim.ClaimType=="Cap") {
//In the edit claim window, we currently warn and discourage users from entering Capitation payments by total, because total payments affect the patient balance.
isByTotalIncluded=false;
}
if(isByTotalIncluded) {
cpByTotal.Status=ClaimProcStatus.Received;
cpByTotal.ClaimNum=claim.ClaimNum;
cpByTotal.PatNum=claim.PatNum;
cpByTotal.ProvNum=claim.ProvTreat;
cpByTotal.PlanNum=claim.PlanNum;
cpByTotal.InsSubNum=claim.InsSubNum;
cpByTotal.DateCP=DateTimeOD.Today;
cpByTotal.ProcDate=claim.DateService;
cpByTotal.DateEntry=DateTime.Now;
cpByTotal.ClinicNum=claim.ClinicNum;
cpByTotal.Remarks=claimPaid.GetRemarks();
cpByTotal.PayPlanNum=insPayPlanNum;
//Add the total payment to the beginning of the list, so that the ins paid amount for the total payment will be highlighted when FormEtrans835ClaimPay loads.
listClaimProcsForClaim.Insert(0,cpByTotal);
}
FormEtrans835ClaimPay FormP=new FormEtrans835ClaimPay(claimPaid,claim,pat,fam,listInsPlans,listPatPlans,listInsSubs);
FormP.ListClaimProcsForClaim=listClaimProcsForClaim;
if(isAutomatic) {
FormP.ReceivePayment();
}
else if(FormP.ShowDialog()!=DialogResult.OK) {
if(cpByTotal.ClaimProcNum!=0) {
ClaimProcs.Delete(cpByTotal);
}
}
}
