private static void RetrieveReportsAutomaticHelper(Clearinghouse clearinghouseClin, Clearinghouse clearinghouseHq, long defaultClearingHouseNum
, bool isTimeToRetrieve)
{
if (!Directory.Exists(clearinghouseClin.ResponsePath))
{
return;
}
if (clearinghouseHq.ClearinghouseNum == defaultClearingHouseNum) //If it's the default dental clearinghouse
{
RetrieveAndImport(clearinghouseClin, true, isTimeToRetrieve: isTimeToRetrieve);
}
else if (clearinghouseHq.Eformat == ElectronicClaimFormat.None) //And the format is "None" (accessed from all regions)
{
RetrieveAndImport(clearinghouseClin, true, isTimeToRetrieve: isTimeToRetrieve);
}
else if (clearinghouseHq.CommBridge == EclaimsCommBridge.BCBSGA)
{
BCBSGA.Retrieve(clearinghouseClin, true, new TerminalConnector());
}
else if (clearinghouseHq.Eformat == ElectronicClaimFormat.Canadian && CultureInfo.CurrentCulture.Name.EndsWith("CA"))
{
//Or the Eformat is Canadian and the region is Canadian. In Canada, the "Outstanding Reports" are received upon request.
//Canadian reports must be retrieved using an office num and valid provider number for the office,
//which will cause all reports for that office to be returned.
//Here we loop through all providers and find CDAnet providers with a valid provider number and office number, and we only send
//one report download request for one provider from each office. For most offices, the loop will only send a single request.
List <Provider> listProvs = Providers.GetDeepCopy(true);
List <string> listOfficeNums = new List <string>();
for (int j = 0; j < listProvs.Count; j++) //Get all unique office numbers from the providers.
{
if (!listProvs[j].IsCDAnet || listProvs[j].NationalProvID == "" || listProvs[j].CanadianOfficeNum == "")
{
continue;
}
if (!listOfficeNums.Contains(listProvs[j].CanadianOfficeNum)) //Ignore duplicate office numbers.
{
listOfficeNums.Add(listProvs[j].CanadianOfficeNum);
try {
clearinghouseHq = Eclaims.Canadian.GetCanadianClearinghouseHq(null);
clearinghouseClin = Clearinghouses.OverrideFields(clearinghouseHq, Clinics.ClinicNum);
Eclaims.CanadianOutput.GetOutstandingTransactions(clearinghouseClin, false, true, null, listProvs[j], true, null, null);
}
catch {
//Supress errors importing reports.
}
}
}
}
else if (clearinghouseHq.Eformat == ElectronicClaimFormat.Dutch && CultureInfo.CurrentCulture.Name.EndsWith("DE"))
{
//Or the Eformat is German and the region is German
RetrieveAndImport(clearinghouseClin, true, isTimeToRetrieve: isTimeToRetrieve);
}
else if (clearinghouseHq.Eformat != ElectronicClaimFormat.Canadian &&
clearinghouseHq.Eformat != ElectronicClaimFormat.Dutch &&
CultureInfo.CurrentCulture.Name.EndsWith("US")) //Or the Eformat is in any other format and the region is US
{
RetrieveAndImport(clearinghouseClin, true, isTimeToRetrieve: isTimeToRetrieve);
}
}
///<summary>In progress. Probably needs a different name. Info must be validated first.
///Set dependent to the currently selected patient, compares dependent.PatNum to subscriber.PatNum to either contruct a subscriber based or dependent based benefit request.</summary>
public static string GenerateMessageText(Clearinghouse clearinghouseClin, Carrier carrier, Provider billProv, Clinic clinic, InsPlan insPlan, Patient subscriber, InsSub insSub, Patient patForRequest)
{
bool isSubscriberRequest = (subscriber.PatNum == patForRequest.PatNum);
int batchNum = Clearinghouses.GetNextBatchNumber(clearinghouseClin);
string groupControlNumber = batchNum.ToString(); //Must be unique within file. We will use batchNum
int transactionNum = 1;
StringBuilder strb = new StringBuilder();
//Interchange Control Header
strb.Append("ISA*00* *"); //ISA01,ISA02: 00 + 10 spaces
if (IsEmdeonDental(clearinghouseClin))
{
strb.Append("00*" + Sout(clearinghouseClin.Password, 10, 10) + "*" //ISA03,ISA04: 00 + emdeon password padded to 10 characters
+ clearinghouseClin.ISA05 + "*" //ISA05: Sender ID type: ZZ=mutually defined. 30=TIN. Validated
+ "316:" + Sout(clearinghouseClin.LoginID, 11, 11) + "*" //ISA06: Emdeon vendor number + username
+ clearinghouseClin.ISA07 + "*" //ISA07: Receiver ID type: ZZ=mutually defined. 30=TIN. Validated
+ Sout("EMDEONDENTAL", 15, 15) + "*"); //ISA08: Receiver ID. Validated to make sure length is at least 2.
}
else
{
strb.Append("00* *" //ISA03,ISA04: 00 + 10 spaces
+ clearinghouseClin.ISA05 + "*" //ISA05: Sender ID type: ZZ=mutually defined. 30=TIN. Validated
+ X12Generator.GetISA06(clearinghouseClin) + "*" //ISA06: Sender ID(TIN). Or might be TIN of Open Dental
+ clearinghouseClin.ISA07 + "*" //ISA07: Receiver ID type: ZZ=mutually defined. 30=TIN. Validated
+ Sout(clearinghouseClin.ISA08, 15, 15) + "*"); //ISA08: Receiver ID. Validated to make sure length is at least 2.
}
strb.AppendLine(DateTime.Today.ToString("yyMMdd") + "*" //ISA09: today's date
+ DateTime.Now.ToString("HHmm") + "*" //ISA10: current time
+ "U*00401*" //ISA11 and ISA12.
//ISA13: interchange control number, right aligned:
+ batchNum.ToString().PadLeft(9, '0') + "*"
+ "0*" //ISA14: no acknowledgment requested
+ clearinghouseClin.ISA15 + "*" //ISA15: T=Test P=Production. Validated.
+ ":~"); //ISA16: use ':'
//Functional Group Header
if (IsEmdeonDental(clearinghouseClin))
{
strb.Append("GS*HS*" //GS01: HS for 270 benefit inquiry
+ X12Generator.GetGS02(clearinghouseClin) + "*" //GS02: Senders Code. Sometimes Jordan Sparks. Sometimes the sending clinic.
+ Sout("EMDEONDENTAL", 15, 15) + "*"); //GS03: Application Receiver's Code
}
else
{
strb.Append("GS*HS*" //GS01: HS for 270 benefit inquiry
+ X12Generator.GetGS02(clearinghouseClin) + "*" //GS02: Senders Code. Sometimes Jordan Sparks. Sometimes the sending clinic.
+ Sout(clearinghouseClin.GS03, 15, 2) + "*"); //GS03: Application Receiver's Code
}
strb.AppendLine(DateTime.Today.ToString("yyyyMMdd") + "*" //GS04: today's date
+ DateTime.Now.ToString("HHmm") + "*" //GS05: current time
+ groupControlNumber + "*" //GS06: Group control number. Max length 9. No padding necessary.
+ "X*" //GS07: X
+ "004010X092~"); //GS08: Version
//Beginning of transaction--------------------------------------------------------------------------------
int seg = 0; //count segments for the ST-SE transaction
//Transaction Set Header
//ST02 Transact. control #. Must be unique within ISA
seg++;
strb.AppendLine("ST*270*" //ST01
+ transactionNum.ToString().PadLeft(4, '0') + "~"); //ST02
seg++;
strb.AppendLine("BHT*0022*13*" //BHT02: 13=request
+ transactionNum.ToString().PadLeft(4, '0') + "*" //BHT03. Can be same as ST02
+ DateTime.Now.ToString("yyyyMMdd") + "*" //BHT04: Date
+ DateTime.Now.ToString("HHmmss") + "~"); //BHT05: Time, BHT06: not used
//HL Loops-----------------------------------------------------------------------------------------------
int HLcount = 1;
//2000A HL: Information Source--------------------------------------------------------------------------
seg++;
strb.AppendLine("HL*" + HLcount.ToString() + "*" //HL01: Heirarchical ID. Here, it's always 1.
+ "*" //HL02: No parent. Not used
+ "20*" //HL03: Heirarchical level code. 20=Information source
+ "1~"); //HL04: Heirarchical child code. 1=child HL present
//2100A NM1
seg++;
strb.AppendLine("NM1*PR*" //NM101: PR=Payer
+ "2*" //NM102: 2=Non person
+ Sout(carrier.CarrierName, 35) + "*" //NM103: Name Last.
+ "****" //NM104-07 not used
+ "PI*" //NM108: PI=PayorID
+ Sout(carrier.ElectID, 80, 2) + "~"); //NM109: PayorID. Validated to be at least length of 2.
HLcount++;
//2000B HL: Information Receiver------------------------------------------------------------------------
seg++;
strb.AppendLine("HL*" + HLcount.ToString() + "*" //HL01: Heirarchical ID. Here, it's always 2.
+ "1*" //HL02: Heirarchical parent id number. 1 in this simple message.
+ "21*" //HL03: Heirarchical level code. 21=Information receiver
+ "1~"); //HL04: Heirarchical child code. 1=child HL present
seg++;
//2100B NM1: Information Receiver Name
strb.AppendLine("NM1*1P*" //NM101: 1P=Provider
+ (billProv.IsNotPerson?"2":"1") + "*" //NM102: 1=person,2=non-person
+ Sout(billProv.LName, 35) + "*" //NM103: Last name
+ Sout(billProv.FName, 25) + "*" //NM104: First name
+ Sout(billProv.MI, 25, 1) + "*" //NM105: Middle name
+ "*" //NM106: not used
+ "*" //NM107: Name suffix. not used
+ "XX*" //NM108: ID code qualifier. 24=EIN. 34=SSN, XX=NPI
+ Sout(billProv.NationalProvID, 80) + "~"); //NM109: ID code. NPI validated
//2100B REF: Information Receiver ID
if (IsEmdeonDental(clearinghouseClin) && IsDentiCalCarrier(carrier))
{
string ref4aSegment = "";
Clearinghouse clearinghouseDentiCalHQ = Clearinghouses.GetFirstOrDefault(x => IsDentiCalClearinghouse(x), true);
if (clearinghouseDentiCalHQ != null)
{
Clearinghouse clearinghouseDentiCalClin = Clearinghouses.OverrideFields(clearinghouseDentiCalHQ, clearinghouseClin.ClinicNum);
if (clearinghouseDentiCalClin != null)
{
ref4aSegment = clearinghouseDentiCalClin.Password;
}
}
seg++;
strb.Append("REF*4A*" + ref4aSegment + "~");
}
seg++;
strb.Append("REF*");
if (billProv.UsingTIN)
{
strb.Append("TJ*"); //REF01: qualifier. TJ=Federal TIN
}
else //SSN
{
strb.Append("SY*"); //REF01: qualifier. SY=SSN
}
strb.AppendLine(Sout(billProv.SSN, 30) + "~"); //REF02: ID
//2100B N3: Information Receiver Address
seg++;
if (PrefC.GetBool(PrefName.UseBillingAddressOnClaims))
{
strb.Append("N3*" + Sout(PrefC.GetString(PrefName.PracticeBillingAddress), 55)); //N301: Address
}
else if (clinic == null)
{
strb.Append("N3*" + Sout(PrefC.GetString(PrefName.PracticeAddress), 55)); //N301: Address
}
else
{
strb.Append("N3*" + Sout(clinic.Address, 55)); //N301: Address
}
if (PrefC.GetBool(PrefName.UseBillingAddressOnClaims))
{
if (PrefC.GetString(PrefName.PracticeBillingAddress2) == "")
{
strb.AppendLine("~");
}
else
{
//N302: Address2. Optional.
strb.AppendLine("*" + Sout(PrefC.GetString(PrefName.PracticeBillingAddress2), 55) + "~");
}
}
else if (clinic == null)
{
if (PrefC.GetString(PrefName.PracticeAddress2) == "")
{
strb.AppendLine("~");
}
else
{
//N302: Address2. Optional.
strb.AppendLine("*" + Sout(PrefC.GetString(PrefName.PracticeAddress2), 55) + "~");
}
}
else
{
if (clinic.Address2 == "")
{
strb.AppendLine("~");
}
else
{
//N302: Address2. Optional.
strb.AppendLine("*" + Sout(clinic.Address2, 55) + "~");
}
}
//2100B N4: Information Receiver City/State/Zip
seg++;
if (PrefC.GetBool(PrefName.UseBillingAddressOnClaims))
{
strb.AppendLine("N4*" + Sout(PrefC.GetString(PrefName.PracticeBillingCity), 30) + "*" //N401: City
+ Sout(PrefC.GetString(PrefName.PracticeBillingST), 2) + "*" //N402: State
+ Sout(PrefC.GetString(PrefName.PracticeBillingZip).Replace("-", ""), 15) + "~"); //N403: Zip
}
else if (clinic == null)
{
strb.AppendLine("N4*" + Sout(PrefC.GetString(PrefName.PracticeCity), 30) + "*" //N401: City
+ Sout(PrefC.GetString(PrefName.PracticeST), 2) + "*" //N402: State
+ Sout(PrefC.GetString(PrefName.PracticeZip).Replace("-", ""), 15) + "~"); //N403: Zip
}
else
{
strb.AppendLine("N4*" + Sout(clinic.City, 30) + "*" //N401: City
+ Sout(clinic.State, 2) + "*" //N402: State
+ Sout(clinic.Zip.Replace("-", ""), 15) + "~"); //N403: Zip
}
//2100B PRV: Information Receiver Provider Info
seg++;
//PRV*PE*ZZ*1223G0001X~
strb.AppendLine("PRV*PE*" //PRV01: Provider Code. PE=Performing. There are many other choices.
+ "ZZ*" //PRV02: ZZ=Mutually defined = health care provider taxonomy code
+ X12Generator.GetTaxonomy(billProv) + "~"); //PRV03: Specialty code
HLcount++;
//2000C HL: Subscriber-----------------------------------------------------------------------------------
seg++;
strb.AppendLine("HL*" + HLcount.ToString() + "*" //HL01: Heirarchical ID. Here, it's always 3.
+ "2*" //HL02: Heirarchical parent id number. 2 in this simple message.
+ "22*" //HL03: Heirarchical level code. 22=Subscriber
+ (isSubscriberRequest?"0~":"1~")); //HL04: Heirarchical child code. 0=no child HL present (no dependent) else 1
//2000C TRN: Subscriber Trace Number
seg++;
strb.AppendLine("TRN*1*" //TRN01: Trace Type Code. 1=Current Transaction Trace Numbers
+ "1*" //TRN02: Trace Number. We don't really have a good primary key yet. Keep it simple. Use 1.
+ "1" + billProv.SSN + "~"); //TRN03: Entity Identifier. First digit is 1=EIN. Next 9 digits are EIN. Length validated.
//2100C NM1: Subscriber Name
seg++;
strb.AppendLine("NM1*IL*" //NM101: IL=Insured or Subscriber
+ "1*" //NM102: 1=Person
+ Sout(subscriber.LName, 35) + "*" //NM103: LName
+ Sout(subscriber.FName, 25) + "*" //NM104: FName
+ Sout(subscriber.MiddleI, 25) + "*" //NM105: MiddleName
+ "*" //NM106: not used
+ "*" //NM107: suffix. Not present in Open Dental yet.
+ "MI*" //NM108: MI=MemberID
+ Sout(insSub.SubscriberID.Replace("-", ""), 80) + "~"); //NM109: Subscriber ID. Validated to be L>2.
//2100C REF: Subscriber Additional Information. Without this, old plans seem to be frequently returned.
seg++;
strb.AppendLine("REF*6P*" //REF01: 6P=GroupNumber
+ Sout(insPlan.GroupNum, 30) + "~"); //REF02: Supplemental ID. Validated.
//2100C DMG: Subscriber Demographic Information
seg++;
strb.AppendLine("DMG*D8*" //DMG01: Date Time Period Qualifier. D8=CCYYMMDD
+ subscriber.Birthdate.ToString("yyyyMMdd") + "~"); //DMG02: Subscriber birthdate. Validated
//DMG03: Gender code. Situational. F or M. Since this was left out in the example,
//and since we don't want to send the wrong gender, we will not send this element.
//2100C DTP: Subscriber Date. Deduced through trial and error that this is required by EHG even though not by X12 specs.
seg++;
strb.AppendLine("DTP*307*" //DTP01: Qualifier. 307=Eligibility
+ "D8*" //DTP02: Format Qualifier.
+ DateTime.Today.ToString("yyyyMMdd") + "~"); //DTP03: Date
//2000D HL: Dependent Level Hierarchical Level
if (isSubscriberRequest)
{
//2110C EQ: Subscriber Eligibility or Benefit Enquiry Information
//X12 documentation seems to say that we can loop this 99 times to request very specific benefits.
//ClaimConnect wants to see either an EQ*30 for "an eligibility request", or an EQ*35 for "a general benefits request".
//The director of vendor implementation at ClaimConnect has informed us that we should send an EQ*35 to get the full set of benefits.
seg++;
strb.AppendLine("EQ*35~"); //Dental Care
}
else //Dependent based request.
{
HLcount++;
seg++;
strb.AppendLine("HL*" + HLcount.ToString() + "*" //HL01: Heirarchical ID.
+ (HLcount - 1).ToString() + "*" //HL02: Heirarchical parent id number.
+ "23*" //HL03: Heirarchical level code. 23=Dependent
+ "0~"); //HL04: Heirarchical child code. 0=no child HL present (no dependent)
//2000D TRN: Dependent Trace Number
seg++;
strb.AppendLine("TRN*1*" //TRN01: Trace Type Code. 1=Current Transaction Trace Numbers
+ "1*" //TRN02: Trace Number. We don't really have a good primary key yet. Keep it simple. Use 1.
+ "1" + billProv.SSN + "~"); //TRN03: Entity Identifier. First digit is 1=EIN. Next 9 digits are EIN. Length validated.
//2100D NM1: Dependent Name
seg++;
strb.AppendLine("NM1*03*" //NM101: 03=Dependent
+ "1*" //NM102: 1=Person
+ Sout(patForRequest.LName, 35) + "*" //NM103: Name Last or Organization Name
+ Sout(patForRequest.FName, 25) + "*" //NM104: Name First
+ Sout(patForRequest.MiddleI, 25) + "~"); //NM105: Name Middle
//2100D REF: Dependent Additional Identification
seg++;
strb.AppendLine("REF*6P*" //REF01: 6P=GroupNumber
+ Sout(insPlan.GroupNum, 30) + "~"); //REF02: Supplemental ID. Validated.
//2100D DMG: Dependent Demographic Information
seg++;
strb.AppendLine("DMG*D8*" //DMG01: Date Time Period Qualifier. D8=CCYYMMDD
+ patForRequest.Birthdate.ToString("yyyyMMdd") + "~"); //DMG02: Dependent birthdate. Validated
//DMG03: Gender code. Situational. F or M. Since this was left out in the example,
//and since we don't want to send the wrong gender, we will not send this element.
//2100D DTP: DEPENDENT Date. Deduced through trial and error that this is required by EHG even though not by X12 specs.
seg++;
strb.AppendLine("DTP*307*" //DTP01: Qualifier. 307=Eligibility
+ "D8*" //DTP02: Format Qualifier.
+ DateTime.Today.ToString("yyyyMMdd") + "~"); //DTP03: Date
seg++;
strb.AppendLine("EQ*35~"); //Dental Care
}
//Transaction Trailer
seg++;
strb.AppendLine("SE*"
+ seg.ToString() + "*" //SE01: Total segments, including ST & SE
+ transactionNum.ToString().PadLeft(4, '0') + "~");
//End of transaction--------------------------------------------------------------------------------------
//Functional Group Trailer
strb.AppendLine("GE*" + transactionNum.ToString() + "*" //GE01: Number of transaction sets included
+ groupControlNumber + "~"); //GE02: Group Control number. Must be identical to GS06
//Interchange Control Trailer
strb.AppendLine("IEA*1*" //IEA01: number of functional groups
+ batchNum.ToString().PadLeft(9, '0') + "~"); //IEA02: Interchange control number
return(strb.ToString());
/*
* return @"
* ISA*00* *00* *30*AA0989922 *30*330989922 *030519*1608*U*00401*000012145*1*T*:~
* GS*HS*AA0989922*330989922*20030519*1608*12145*X*004010X092~
* ST*270*0001~
* BHT*0022*13*ASX012145WEB*20030519*1608~
* HL*1**20*1~
* NM1*PR*2*Metlife*****PI*65978~
* HL*2*1*21*1~
* NM1*1P*1*PROVLAST*PROVFIRST****XX*1234567893~
* REF*TJ*200384584~
* N3*JUNIT ROAD~
* N4*CHICAGO*IL*60602~
* PRV*PE*ZZ*1223G0001X~
* HL*3*2*22*0~
* TRN*1*12145*1AA0989922~
* NM1*IL*1*SUBLASTNAME*SUBFIRSTNAME****MI*123456789~
* DMG*D8*19750323~
* DTP*307*D8*20030519~
* EQ*30~
* SE*17*0001~
* GE*1*12145~
* IEA*1*000012145~";
*/
//return "ISA*00* *00* *30*AA0989922 *30*330989922 *030519*1608*U*00401*000012145*1*T*:~GS*HS*AA0989922*330989922*20030519*1608*12145*X*004010X092~ST*270*0001~BHT*0022*13*ASX012145WEB*20030519*1608~HL*1**20*1~NM1*PR*2*Metlife*****PI*65978~HL*2*1*21*1~NM1*1P*1*PROVLAST*PROVFIRST****XX*1234567893~REF*TJ*200384584~N3*JUNIT ROAD~N4*CHICAGO*IL*60602~PRV*PE*ZZ*1223G0001X~HL*3*2*22*0~TRN*1*12145*1AA0989922~NM1*IL*1*SUBLASTNAME*SUBFIRSTNAME****MI*123456789~DMG*D8*19750323~DTP*307*D8*20030519~EQ*30~SE*17*0001~GE*1*12145~IEA*1*000012145~";
}