EVOLUTION-MANAGER

Edit File: gen_x12_837i.inc.php

<?php
/**
 * X12 837I
 *
 * @package OpenEMR
 * @link    http://www.open-emr.org
 * @author  Jerry Padgett <sjpadgett@gmail.com>
 * @copyright Copyright (c) 2017 Jerry Padgett <sjpadgett@gmail.com>
 * @license https://github.com/openemr/openemr/blob/master/LICENSE GNU General Public License 3
 */

require_once(dirname(__FILE__) . "/invoice_summary.inc.php");

use OpenEMR\Billing\Claim;

function x12date($frmdate)
{
    return ('20' . substr($frmdate, 4, 2) . substr($frmdate, 0, 2) . substr($frmdate, 2, 2));
}

$ub04id = array();
function generate_x12_837I($pid, $encounter, &$log, $ub04id)
{
    $today = time();
    $out = '';
    $claim = new Claim($pid, $encounter);
    $edicount = 0;

$log .= "Generating 837I claim $pid-$encounter for " .
    $claim->patientFirstName()  . ' ' .
    $claim->patientMiddleName() . ' ' .
    $claim->patientLastName()   . ' on ' .
    date('Y-m-d H:i', $today) . ".\n";
    $out .= "ISA" .
        "*" . $claim->x12gsisa01() .
        "*" . $claim->x12gsisa02() .
        "*" . $claim->x12gsisa03() .
        "*" . $claim->x12gsisa04() .
        "*" . $claim->x12gsisa05() .
        "*" . $claim->x12gssenderid() .
        "*" . $claim->x12gsisa07() .
        "*" . $claim->x12gsreceiverid() .
        // date of transmission "*030911" .
    "*" . date('Ymd', $today) .
    //Time of transmission "*1630" .
    "*" . date('Hi', $today) .
    "*" . "^"  .
    "*" . "00501" .
    "*" . "000000001" .
    "*" . $claim->x12gsisa14() .
    "*" . $claim->x12gsisa15() .
    "*:" .
    "~\n";
    $out .= "GS" .
        "*HC" .
        "*" . $claim->x12gsgs02() .
        "*" . trim($claim->x12gs03()) .
        "*" . date('Ymd', $today) .
        "*" . date('Hi', $today) .
        "*1" .
        "*X" .
        // "*" . $claim->x12gsversionstring() .
    "*" . "005010X223A2".
    "~\n";
    ++$edicount;
    $out .= "ST" .
    "*" . "837" .
    "*" . "0021" .
    // "*" . $claim->x12gsversionstring() .
    "*" . "005010X223A2".
    "~\n";
    ++$edicount;
    $out .= "BHT" .
        "*" . "0019" .                             // 0019 is required here
        "*" . "00" .                               // 00 = original transmission
        "*" . "0123" .                             // reference identification
        "*" . date('Ymd', $today) .           // transaction creation date
        "*" . date('Hi', $today) .            // transaction creation time
        ($encounter_claim ? "*RP" : "*CH") .  // RP = reporting, CH = chargeable
        "~\n";

++$edicount;
        //Field length is limited to 35. See nucc dataset page 63 www.nucc.org
        $billingFacilityName = substr($claim->billingFacilityName(), 0, 60);
    if ($billingFacilityName == '') {
        $log .= "*** billing facility name in 1000A loop is empty\n";
    }
        $out .= "NM1" .       // Loop 1000A Submitter stays in the 837I
        "*" . "41" .
        "*" . "2" .
        "*" . $billingFacilityName .
        "*" .
        "*" .
        "*" .
        "*" .
        "*" . "46";

$out  .=  "*" . $claim->billingFacilityETIN();
        $out .= "~\n";
        ++$edicount;

$out .= "PER" .
            "*IC" .
            "*" . $claim->billingContactName() .
            "*TE" .
            "*" . $claim->billingContactPhone();
        $out .= "~\n";

++$edicount;

$out .= "NM1" .       // Loop 1000B Receiver stays in the 837I
            "*" . "40" .
            "*" . "2" .
            "*" . $claim->clearingHouseName() .
            "*" .
            "*" .
            "*" .
            "*" .
            "*" . "46" .
            "*" . $claim->clearingHouseETIN() .
            "~\n";
        $HLcount = 1;
        ++$edicount;

$out .= "HL" .        // Loop 2000A Billing/Pay-To Provider HL Loop
            "*" . "$HLcount" .
            "*" .
            "*" . "20" .
            "*" . "1" .              // 1 indicates there are child segments
            "~\n";
        $HLBillingPayToProvider = $HLcount++;
        // Situational PRV segment (for provider taxonomy code) omitted here.
        // Situational CUR segment (foreign currency information) omitted here.
        ++$edicount;
        //Field length is limited to 35. See nucc dataset page 63 www.nucc.org
        $billingFacilityName = substr($claim->billingFacilityName(), 0, 60);
        $out .= "NM1" .       // Loop 2010AA Billing Provider stays in the 837I
            "*" . "85" .
            "*" . "2" .
            "*" . $billingFacilityName .
            "*" .
            "*" .
            "*" .
            "*";
    if ($claim->billingFacilityNPI()) {
        $out .= "*XX*" . $claim->billingFacilityNPI();
    } else {
        $log .= "*** Billing facility has no NPI.\n";
        $out .= "*XX*";
    }
        $out .= "~\n";
        ++$edicount;
        $out .= "N3" .
            "*" . $claim->billingFacilityStreet() .
            "~\n";
        ++$edicount;
        $out .= "N4" .
            "*" . $claim->billingFacilityCity() .
            "*" . $claim->billingFacilityState() .
            "*" . stripZipCode($claim->billingFacilityZip()) .
            "~\n";
    if ($claim->billingFacilityNPI() && $claim->billingFacilityETIN()) {
        ++$edicount;
        $out .= "REF";
        if ($claim->federalIdType()) {
            $out .= "*" . $claim->federalIdType();
        } else {
            $out .= "*EI"; // For dealing with the situation before adding TaxId type In facility.
        }
        $out .= "*" . $claim->billingFacilityETIN() . "~\n";
    } else {
        $log .= "*** No billing facility NPI and/or ETIN.\n";
    }
    if ($claim->providerNumberType() && $claim->providerNumber() && !$claim->billingFacilityNPI()) {
        ++$edicount;
        $out .= "REF" .
            "*" . $claim->providerNumberType() .
            "*" . $claim->providerNumber() .
            "~\n";
    } else if ($claim->providerNumber() && !$claim->providerNumberType()) {
        $log .= "*** Payer-specific provider insurance number is present but has no type assigned.\n";
    }
        // Situational PER*1C segment.
        ++$edicount;
        $out .= "PER" .
            "*" . "IC" .
            "*" . $claim->billingContactName() .
            "*" . "TE" .
            "*" . $claim->billingContactPhone();
        $out .= "~\n";

// This is also excluded in the 837I
        // Loop 2010AC Pay-To Plan Name omitted.  Includes:
        // NM1*PE, N3, N4, REF*2U, REF*EI
        $PatientHL = $claim->isSelfOfInsured() ? 0 : 1;
        $HLSubscriber = $HLcount++;
        ++$edicount;

// loop 2000B
        $out .= "HL" .        // Loop 2000B Subscriber HL Loop
            "*$HLSubscriber" .
            "*$HLBillingPayToProvider" .
            "*" . "22" .
            "*$PatientHL" .
            "~\n";
    if (!$claim->payerSequence()) {
        $log .= "*** Error: Insurance information is missing!\n";
    }
        ++$edicount;

//SBR01 is either a P or S    SBR02 for care is always 18 "patient"  SBR09 is always MA
        $out .= "SBR" .       // Subscriber Information
            "*" . $claim->payerSequence() .
            "*" . ($claim->isSelfOfInsured() ? '18' : '') .
            "*" . $claim->groupNumber() .
            "*" . (($claim->groupNumber()) ? '' : $claim->groupName()) .
            "*" . $claim->insuredTypeCode() . // applies for secondary medicare
            "*" .
            "*" .
            "*" .
            "*" . $claim->claimType() . // Zirmed replaces this
            "~\n";
        // 2000C Segment PAT omitted.
        ++$edicount;
        $out .= "NM1" .       // Loop 2010BA Subscriber  same in 837I
            "*IL" .
            "*" . "1" . // 1 = person, 2 = non-person
            "*" . $claim->insuredLastName() .
            "*" . $claim->insuredFirstName() .
            "*" . $claim->insuredMiddleName() .
            "*" .
            "*" . // Name Suffix
            "*MI" .
            // "MI" = Member Identification Number
        // "II" = Standard Unique Health Identifier, "Required if the
        //        HIPAA Individual Patient Identifier is mandated use."
        //        Here we presume that is not true yet.
        "*" . $claim->policyNumber() .
        "~\n";
        // For 5010, further subscriber info is sent only if they are the patient.
    if ($claim->isSelfOfInsured()) {
        ++$edicount;
        $out .= "N3" .
            "*" . $claim->insuredStreet() .
            "~\n";
        ++$edicount;
        $out .= "N4" .
            "*" . $claim->insuredCity() .
            "*" . $claim->insuredState() .
            "*" . stripZipCode($claim->insuredZip()) .
            "~\n";
        ++$edicount;
        $out .= "DMG" .
            "*D8" .
            "*" . $claim->insuredDOB() .
            "*" . $claim->insuredSex() .
            "~\n";
    }
        // Segment REF*SY (Subscriber Secondary Identification) omitted.
        // Segment REF*Y4 (Property and Casualty Claim Number) omitted.
        // Segment PER*IC (Property and Casualty Subscriber Contact Information) omitted.
        ++$edicount;
        $payerName = substr($claim->payerName(), 0, 60);
        $out .= "NM1" .       // Loop 2010BB Payer
            "*PR" .
            "*" . "2" .
            "*" . $payerName .
            "*" .
            "*" .
            "*" .
            "*" .
            "*" . "PI" .
            "*" . ($encounter_claim ? $claim->payerAltID() : $claim->payerID()) .
            "~\n";
    if (!$claim->payerID()) {
        $log .= "*** CMS ID is missing for payer '" . $claim->payerName() . "'.\n";
    }

++$edicount;
        $out .= "N3" .
            "*" . $claim->payerStreet() .
            "~\n";
        ++$edicount;
        $out .= "N4" .
            "*" . $claim->payerCity() .
            "*" . $claim->payerState() .
            "*" . stripZipCode($claim->payerZip()) .
            "~\n";

// Segment REF (Payer Secondary Identification) omitted.
        // Segment REF (Billing Provider Secondary Identification) omitted.

if (! $claim->isSelfOfInsured()) {
        ++$edicount;
        $out .= "HL" .        // Loop 2000C Patient Information
            "*" . "$HLcount" .
            "*$HLSubscriber" .
            "*23" .
            "*0" .
            "~\n";
        $HLcount++;
        ++$edicount;
        $out .= "PAT" .
            "*" . $claim->insuredRelationship() .
            "~\n";
        ++$edicount;
        $out .= "NM1" .       // Loop 2010CA Patient may need this elsed in to the loop 2000C
            "*QC" .
            "*1" .
            "*" . $claim->patientLastName() .
            "*" . $claim->patientFirstName();
        if ($claim->patientMiddleName() !== '') {
            $out .= "*" . $claim->patientMiddleName();
        }
            $out .= "~\n";
            ++$edicount;
            $out .= "N3" .
                "*" . $claim->patientStreet() .
                "~\n";
            ++$edicount;
            $out .= "N4" .
                "*" . $claim->patientCity() .
                "*" . $claim->patientState() .
                "*" . stripZipCode($claim->patientZip()) .
                "~\n";
            ++$edicount;
            $out .= "DMG" .
                "*D8" .
                "*" . $claim->patientDOB() .
                "*" . $claim->patientSex() .
                "~\n";
            // Segment REF*Y4 (Property and Casualty Claim Number) omitted.
            // Segment REF (Property and Casualty Patient Identifier) omitted.
            // Segment PER (Property and Casualty Patient Contact Information) omitted.
    } // end of patient different from insured
        $proccount = $claim->procCount();
        $clm_total_charges = 0;
    for ($prockey = 0; $prockey < $proccount; ++$prockey) {
        $clm_total_charges += $claim->cptCharges($prockey);
    }
    if (!$clm_total_charges) {
        $log .= "*** This claim has no charges!\n";
    }
        ++$edicount;
        $out .= "CLM" .       // Loop 2300 Claim
            "*" . $pid . "-" . $encounter .
            "*"  . sprintf("%.2f", $clm_total_charges) . // Zirmed computes and replaces this
            "*"  .
            "*"  ;
    // Service location this need to be bill type from ub form type_of_bill
    if (strlen($ub04id[7]) >= 3) {
        $out .= "*" . substr($ub04id[7], 1, 1) . ":" . substr($ub04id[7], 2, 1) . ":" . substr($ub04id[7], 3, 1);
    }

$out .= "*" .
        "*" . "A" .
        "*" . ($claim->billingFacilityAssignment() ? 'Y' : 'N') .
        "*" . "Y" .
        "~\n";
    // discharge hour
    if ($ub04id[29]) {
        ++ $edicount;
        $out .= "DTP" . // Loop 2300
        "*" . "096" .
        "*" . "TM" .
        "*" . $ub04id[29] .
        "~\n";
    }

// Statment Dates
    // DTP 434 RD8 (Statment from OR to date)

if ($ub04id[13]) {
        ++ $edicount;

$tmp = x12date($ub04id[13]);
        $tmp1 = x12date($ub04id[14]);
        $out .= "DTP" . // Loop 2300
        "*434" . "*" . "RD8" . "*" . $tmp . '-' . $tmp1 . "~\n";
    }

if ($ub04id[13]) {
        ++ $edicount;
        $tmp = x12date($ub04id[25]);
        $out .= "DTP" . // Loop 2300
        "*435" . "*" . "DT" . "*" . $tmp . $ub04id[26] . "~\n";
    }

if (strlen(trim($ub04id[13])) == 0) {
        $log .= "*** Error: No Admission Date Entered!\n";
    }

// Repricer Received Date
    // DTP 050 D8 (Admission Date and Hour from form)

// Institutional Claim Code
    // CL1 (Admission Type Code) (Admission Source Code) (Patient Status Code)

if ($ub04id[27] != "014X") { // Type of bill
        ++ $edicount;
        $out .= "CL1" . // Loop 2300
        "*" . $ub04id[27] . "*" . $ub04id[28] . "*" . $ub04id[30] . "~\n";
    }

// Segment PWK (Claim Supplemental Information) omitted.

// Segment CN1 (Contract Information) omitted.

// Patient Estimated Amount Due
    // Check logic

// $patientpaid = $claim->patientPaidAmount();
    // if ($patientpaid != 0) {
    // ++$edicount;
    // $out .= "AMT" . // Patient paid amount. Page 190/220.
    // "*F5" .
    // "*" . $patientpaid .
    // "~\n";
    // }

// Segment REF*4N (Service Authorization Exception Code) omitted.
    // Segment REF*9F (Referral Number) omitted.

// Prior Authorization
    //
    if ($claim->priorAuth()) {
        ++ $edicount;
        $out .= "REF" . // Prior Authorization Number
        "*G1" . "*" . $claim->priorAuth() . "~\n";
    }

// Segment REF*F8 (Payer Claim Control Number) omitted.

// This may be needed for the UB04 Claim if so change the 'MB' to 'MA'
    // if ($claim->cliaCode() && ($CMS_5010 || $claim->claimType() === 'MB')) {
    // Required by Medicare when in-house labs are done.
    // ++$edicount;
    // $out .= "REF" . // Clinical Laboratory Improvement Amendment Number
    // "*X4" .
    // "*" . $claim->cliaCode() .
    // "~\n";
    // }

// Segment REF*9A (Repriced Claim Number) omitted.
    // Segment REF*9C (Adjusted Repriced Claim Number) omitted.
    // Segment REF*LX (Investigational Device Exemption Number) omitted.
    // Segment REF*S9 (Claim Identifier for Transmission Intermediaries) omitted.
    // Segment REF*LU (Auto Accident State) omitted.
    // Segment REF*EA (Medical Record Number) omitted.
    // Segment REF*P4 (Demonstration Project Identifier) omitted.
    // Segment REF*G4 (Peer Review Organization PRO Approval Number) omitted.
    // Segment K3 (File Information) omitted.

if ($claim->additionalNotes()) {
        // Claim Note
        // Has a list of valid codes. Required when PROVIDER deems necessary

// Billing note.
        // Check to verify I am getting this information on the ub04 form

++ $edicount;
        $out .= "NTE" . // comments box 19
        "*" . "ADD" . "*" . $claim->additionalNotes() . "~\n";
    }

// Segment CRC (EPSDT Referral) omitted.
    // Diagnoses, up to $max_per_seg per HI segment. Check this
    $max_per_seg = 18;
    $da = $claim->diagArray();
    $diag_type_code = 'ABK'; // ICD10
    $tmp = 0;
    foreach ($da as $diag) {
        if ($tmp == 1) {
            continue;
        }
        if ($tmp % $max_per_seg == 0) {
            if ($tmp) {
                $out .= "~\n";
            }
            ++ $edicount;
            $out .= "HI"; // Health Diagnosis Codes
        }
        $out .= "*" . $diag_type_code . ":" . $diag;
        if ($claim->diagtype == "ICD9") {
            $diag_type_code = 'BF';
        } else {
            $diag_type_code = 'ABF';
        }

++ $tmp;
    }
    if ($tmp) {
        $out .= "~\n";
    }

// Segment HI*BI (Occurrence Span Information).
    // HI BI (Occurrence Span Code 1) RD8 (Occurrence Span Code Associated Date)
    if ($ub04id[52]) {
        $max_per_seg = 4;
        $diag_type_code = 'BI';
        $tmp = 0;
        $os = 52;
        for ($i = 0; $i <= 3;) {
            if ($tmp % $max_per_seg == 0) {
                if ($tmp) {
                    $out .= "~\n";
                }
                ++ $edicount;
                $out .= "HI"; // Health Diagnosis Codes
            }
            if ($ub04id[$os]) {
                $out .= "*" . $diag_type_code . ":" . $ub04id[$os ++] . ":" . x12date($ub04id[$os ++]) . ":" . x12date($ub04id[$os ++]);
                $diag_type_code = 'BI';
            }
            if ($os >= 57) {
                $os = 67;
            }
            ++ $tmp;
            ++ $i;
        }
        if ($tmp) {
            $out .= "~\n";
        }
    }

// Segment HI*BH (Occurrence Information).
    // HI BH (Occurrence Code 1) D8 (Occurrence Code Associated Date)

if ($ub04id[44]) {
        $max_per_seg = 8;
        $diag_type_code = 'BH';
        $tmp = 0;
        $os = 44;
        for ($i = 0; $i <= 7;) {
            if ($tmp % $max_per_seg == 0) {
                if ($tmp) {
                    $out .= "~\n";
                }
                ++ $edicount;
                $out .= "HI"; // Health Diagnosis Codes
            }
            if ($ub04id[$os]) {
                $out .= "*" . $diag_type_code . ":" . $ub04id[$os] . ":D8" . ":" . x12date($ub04id[$os ++]);
                $diag_type_code = 'BH';
            }
            if ($os >= 51) {
                $os = 59;
            }
            ++ $tmp;
            ++ $i;
        }
        if ($tmp) {
            $out .= "~\n";
        }
    }

// Segment HI*BE (Value Information).
    // HI BE (Value Code 1) *.* (Value Code Amount)

if ($ub04id[74]) {
        $max_per_seg = 12;
        $diag_type_code = 'BE';
        $os = 74;
        $tmp = 0;
        for ($i = 0; $i <= 11;) {
            if ($tmp % $max_per_seg == 0) {
                if ($tmp) {
                    $out .= "~\n";
                }
                ++ $edicount;
                $out .= "HI"; // Health Diagnosis Codes
            }
            if ($ub04id[$os]) {
                // if ($i=1) {
                $out .= "*" . $diag_type_code . ":" . $ub04id[$os ++] . ":" . ":" . x12date($ub04id[$os ++]);
                $diag_type_code = 'BE';
                // }
            }
            ++ $tmp;
            ++ $i;
        }
        if ($tmp) {
            $out .= "~\n";
        }
    }

// Segment HI*BG (Condition Information).
    // HI BG (Condition Code 1)

if ($ub04id[31]) {
        $max_per_seg = 11;
        $diag_type_code = 'BG';
        $os = 31;
        $tmp = 0;
        for ($i = 0; $i <= 10;) {
            if ($tmp % $max_per_seg == 0) {
                if ($tmp) {
                    $out .= "~\n";
                }
                ++ $edicount;
                $out .= "HI"; // Health Diagnosis Codes
            }
            if ($ub04id[$os]) {
                // if ($i=1) {
                $out .= "*" . $diag_type_code . ":" . $ub04id[$os ++];
                $diag_type_code = 'BG';
                // }
            }

++ $tmp;
            ++ $i;
        }
        if ($tmp) {
            $out .= "~\n";
        }
    }

// Segment HI*TC (Treatment Code Information).
    // HI TC (Treatment Code 1)
    /* 63a. TREATMENT AUTHORIZATION CODES - PRIMARY PLAN */
    if ($ub04id[319]) {
        $max_per_seg = 3;
        $diag_type_code = 'TC';
        $tmp = 0;

for ($i = 0; $i <= 2;) {
            if ($tmp % $max_per_seg == 0) {
                if ($tmp) {
                    $out .= "~\n";
                }
                ++ $edicount;
                $out .= "HI"; // Health Diagnosis Codes
            }

if ($ub04id[319]) {
                $out .= "*" . $diag_type_code . ":" . $ub04id[319];
                $diag_type_code = 'TC';
            }
            if ($i = 1) {
                if ($ub04id[322]) {
                    $out .= "*" . $diag_type_code . ":" . $ub04id[322];
                    $diag_type_code = 'TC';
                }
            }
            if ($i = 2) {
                if ($ub04id[325]) {
                    $out .= "*" . $diag_type_code . ":" . $ub04id[325];
                    $diag_type_code = 'TC';
                }
            }

++ $tmp;
            ++ $i;
        }
        if ($tmp) {
            $out .= "~\n";
        }
    }

// Segment HCP (Claim Pricing/Repricing Information) omitted.

// This needs to allow Attending Physician 2310A, Operating Physician Name 2310B, Other Operating Physician Name 2310C
    // and Rendering Provider Name (Rendering Provider Name is futher down)

if ($ub04id[388]) {
        ++ $edicount;
        // Loop 2310A Attending Physician
        $out .= "NM1" . "*71" . "*1" . "*" . $ub04id[388] . "*" . $ub04id[389] . "*" . "*";
        if ($ub04id[379]) { // NPI
            $out .= "*" . "XX" . "*" . $ub04id[379];
        } else {
            $out .= "*" . "*";
            $log .= "*** Attending Physician has no NPI.\n";
        }
        $out .= "~\n";

if ($ub04id[380]) {
            ++ $edicount;
            $out .= "REF" . // Attending Physician Secondary Identification
            "*" . $ub04id[380] . "*" . $ub04id[381] . "~\n";
        }
    }

// 2310B

if ($ub04id[400]) {
        ++ $edicount;

$out .= "NM1" . // Loop 2310B operating Physician
        "*72" . "*1" . "*" . $ub04id[400] . "*" . $ub04id[400] . "*" . "*";
        if ($ub04id[390]) {
            $out .= "*" . "XX" . "*" . $ub04id[390];
        } else {
            $out .= "*" . "*";
            $log .= "*** Operating Physician has no NPI qualifier.\n";
        }
        $out .= "~\n";

if ($ub04id[391]) {
            ++ $edicount;
            $out .= "REF" . // operating Physician Secondary Identification
            "*" . $claim->$ub04id[391] . "*" . $ub04id[392] . "~\n";
        }
    }

// 2310C

if ($ub04id[413]) {
        ++ $edicount;

$out .= "NM1" . // Loop 2310C other operating Physician
        "*73" . "*1" . "*" . $ub04id[413] . "*" . $ub04id[414] . "*" . "*";
        if ($ub04id[405]) {
            $out .= "*" . $ub04id[405] . "*" . $ub04id[406];
        } else {
            $out .= "*" . "*";
            $log .= "*** Other Operating Physician has no NPI.\n";
        }
        $out .= "~\n";

if ($ub04id[407]) {
            ++ $edicount;
            $out .= "REF" . // other operating Physician Secondary Identification
            "*" . $ub04id[407] . "*" . $ub04id[408] . "~\n";
        }
    }
    if ($ub04id[427]) {
        ++ $edicount;

$out .= "NM1" . // Loop 2310C other operating Physician
        "*73" . "*1" . "*" . $ub04id[427] . "*" . $ub04id[428] . "*" . "*";
        if ($ub04id[420]) {
            $out .= "*" . $ub04id[419] . "*" . $ub04id[420];
        } else {
            $out .= "*" . "*";
            $log .= "*** Other Operating Physician has no NPI.\n";
        }
        $out .= "~\n";

if ($ub04id[422]) {
            ++ $edicount;
            $out .= "REF" . // other operating Physician Secondary Identification
            "*" . $ub04id[422] . "*" . $ub04id[421] . "~\n";
        }
    }
    /*
     * Per the implementation guide lines, only include this information if it is different
     * than the Loop 2010AA information
     */
    if ($claim->providerNPIValid() && $claim->billingFacilityNPI() !== $claim->providerNPI()) {
        ++ $edicount;
        $out .= "NM1" . // Loop 2310D Rendering Provider
        "*82" . "*1" . "*" . $claim->providerLastName() . "*" . $claim->providerFirstName() . "*" . $claim->providerMiddleName() . "*" . "*";
        if ($claim->providerNPI()) {
            $out .= "*XX" . "*" . $claim->providerNPI();
        } else {
            $log .= "*** Rendering provider has no NPI.\n";
        }
        $out .= "~\n";

// End of Loop 2310D
    } else {
        // This loop can only get skipped if we are generating a 5010 claim
        if (! ($claim->providerNPIValid())) {
            //If the loop was skipped because the provider NPI was invalid, generate a warning for the log.
            $log .= "*** Skipping 2310B because " . $claim->providerLastName() . "," . $claim->providerFirstName() . " has invalid NPI.\n";
        }
        /*
         * Skipping this segment because the providerNPI and the billingFacilityNPI are identical
         * is a normal condition, so no need to warn.
         */
    }

// 5010 spec says nothing here if NPI was specified.
    //
    if (! $claim->providerNPI() && in_array($claim->providerNumberType(), array('0B', '1G', 'G2', 'LU'))) {
        if ($claim->providerNumber()) {
            ++ $edicount;
            $out .= "REF" . "*" . $claim->providerNumberType() . "*" . $claim->providerNumber() . "~\n";
        }
    }

// Loop 2310D is omitted in the case of home visits (POS=12).
    if ($claim->facilityPOS() != 12 && ($claim->facilityNPI() != $claim->billingFacilityNPI())) {
        ++ $edicount;

// Service Facility Name

$out .= "NM1" . // Loop 2310E Service Location
        "*77" . "*2";
        $facilityName = substr($claim->facilityName(), 0, 60);
        if ($claim->facilityName() || $claim->facilityNPI() || $claim->facilityETIN()) {
            $out .= "*" . $facilityName;
        }
        if ($claim->facilityNPI() || $claim->facilityETIN()) {
            $out .= "*" . "*" . "*" . "*";
            if ($claim->facilityNPI()) {
                $out .= "*XX*" . $claim->facilityNPI();
            } else {
                $log .= "*** Service location has no NPI.\n";
            }
        }
        $out .= "~\n";
        if ($claim->facilityStreet()) {
            ++ $edicount;
            $out .= "N3" . "*" . $claim->facilityStreet() . "~\n";
        }
        if ($claim->facilityState()) {
            ++ $edicount;
            $out .= "N4" . "*" . $claim->facilityCity() . "*" . $claim->facilityState() . "*" . stripZipCode($claim->facilityZip()) . "~\n";
        }
    }

// Segment REF (Service Facility Location Secondary Identification) omitted.
    // Segment PER (Service Facility Contact Information) omitted.

// Loop 2310F Referring Provider

if ($claim->referrerLastName()) {
        // Medicare requires referring provider's name and UPIN.
        ++ $edicount;

$out .= "NM1" . // Loop 2310F Referring Provider this needs to change position
        "*DN" . "*1" . "*" . $claim->referrerLastName() . "*" . $claim->referrerFirstName() . "*" . $claim->referrerMiddleName() . "*" . "*";
        if ($claim->referrerNPI()) {
            $out .= "*XX" . "*" . $claim->referrerNPI();
        } else {
            $log .= "*** Referrer has no NPI.\n";
        }
        $out .= "~\n";
    }

// Loop 2310E, Supervising Provider
    // Omitted

// Segments NM1*PW, N3, N4 (Ambulance Pick-Up Location) omitted.
    // Segments NM1*45, N3, N4 (Ambulance Drop-Off Location) omitted.

$prev_pt_resp = $clm_total_charges; // for computation below

// Loops 2320 and 2330*, other subscriber/payer information.
    // Remember that insurance index 0 is always for the payer being billed
    // by this claim, and 1 and above are always for the "other" payers.
    //
    for ($ins = 1; $ins < $claim->payerCount(); ++ $ins) {
        $tmp1 = $claim->claimType($ins);
        $tmp2 = 'C1'; // Here a kludge. See page 321.
        if ($tmp1 === 'CI') {
            $tmp2 = 'C1';
        }
        if ($tmp1 === 'AM') {
            $tmp2 = 'AP';
        }
        if ($tmp1 === 'HM') {
            $tmp2 = 'HM';
        }
        if ($tmp1 === 'MB') {
            $tmp2 = 'MB';
        }
        if ($tmp1 === 'MA') {
            $tmp2 = 'MA';
        }
        if ($tmp1 === 'MC') {
            $tmp2 = 'MC';
        }
        if ($tmp1 === '09') {
            $tmp2 = 'PP';
        }
        ++ $edicount;

$out .= "SBR" . // Loop 2320, Subscriber Information - page 297/318
        "*" . $claim->payerSequence($ins) .
        "*" . $claim->insuredRelationship($ins) .
        "*" . $claim->groupNumber($ins) .
        "*" . (($claim->groupNumber($ins)) ? '' : $claim->groupName($ins)) .
        "*" . ($claim->insuredTypeCode($ins) ? $claim->insuredTypeCode($ins) : $tmp2) .
        "*" .
        "*" .
        "*" .
        "*" . $claim->claimType($ins) .
        "~\n";

// Things that apply only to previous payers, not future payers.
        //
        if ($claim->payerSequence($ins) < $claim->payerSequence()) {
            // Generate claim-level adjustments.
            $aarr = $claim->payerAdjustments($ins);
            foreach ($aarr as $a) {
                ++ $edicount;
                $out .= "CAS" . // Previous payer's claim-level adjustments. Page 301/323.
                "*" . $a[1] . "*" . $a[2] . "*" . $a[3] . "~\n";
            }

$payerpaid = $claim->payerTotals($ins);
            ++ $edicount;
            $out .= "AMT" . // Previous payer's paid amount. Page 307/332.
            "*D" . "*" . $payerpaid[1] . "~\n";

// Segment AMT*A8 (COB Total Non-Covered Amount) omitted.
            // Segment AMT*EAF (Remaining Patient Liability) omitted.
        } // End of things that apply only to previous payers.

++ $edicount;
        $out .= "OI" . // Other Insurance Coverage Information. Page 310/344.
        "*" . "*" . "*" . ($claim->billingFacilityAssignment($ins) ? 'Y' : 'N') .
        // For this next item, the 5010 example in the spec does not match its
        // description. So this might be wrong.
        "*" .
        "*" .
        "*" .
        "Y" .
        "~\n";

// Segment MOA (Medicare Outpatient Adjudication) omitted.
        ++$edicount;
        $out .= "NM1" . // Loop 2330A Subscriber info for other insco. Page 315/350.
            "*" . "IL" .
            "*" . "1" .
            "*" . $claim->insuredLastName($ins) .
            "*" . $claim->insuredFirstName($ins) .
            "*" . $claim->insuredMiddleName($ins) .
            "*" .
            "*" .
            "*" . "MI" .
            "*" . $claim->policyNumber($ins) .
            "~\n";

++$edicount;
        $out .= "N3" .
            "*" . $claim->insuredStreet($ins) .
            "~\n";

++$edicount;
        $out .= "N4" .
            "*" . $claim->insuredCity($ins) .
            "*" . $claim->insuredState($ins) .
            "*" . stripZipCode($claim->insuredZip($ins)) .
            "~\n";

// Segment REF (Other Subscriber Secondary Identification) omitted.
        ++$edicount;
        $payerName = substr($claim->payerName($ins), 0, 60);
        $out .= "NM1" . // Loop 2330B Payer info for other insco. Page 322/359.
            "*" . "PR" .
            "*" . "2" .
            "*" . $payerName .
            "*" .
            "*" .
            "*" .
            "*" .
            "*" . "PI" .
            "*" . $claim->payerID($ins) .
            "~\n";

if (!$claim->payerID($ins)) {
            $log .= "*** CMS ID is missing for payer '" . $claim->payerName($ins) . "'.\n";
        }

++$edicount;
        $out .= "N3" .
            "*" . $claim->payerStreet($ins) .
            "~\n";

++$edicount;
        $out .= "N4" .
            "*" . $claim->payerCity($ins) .
            "*" . $claim->payerState($ins) .
            "*" . stripZipCode($claim->payerZip($ins)) .
            "~\n";

// Segment DTP*573 (Claim Check or Remittance Date) omitted.
        // Segment REF (Other Payer Secondary Identifier) omitted.
        // Segment REF*G1 (Other Payer Prior Authorization Number) omitted.
        // Segment REF*9F (Other Payer Referral Number) omitted.
        // Segment REF*T4 (Other Payer Claim Adjustment Indicator) omitted.
        // Segment REF*F8 (Other Payer Claim Control Number) omitted.
        // 2330C-I loops Omitted
    } // End loops 2320/2330*.

$loopcount = 0;

// Procedure loop starts here.
    //

for ($tlh = 0; $tlh < $proccount; ++ $tlh) {
        $tmp = $claim->procs[$tlh][code_text];

if ($claim->procs[$tlh][code_type] == 'HCPCS') {
            $tmpcode = '3';
        } else {
            $tmpcode = '1';
        }
        $getrevcd = $claim->cptCode($tlh);
        $sql = "SELECT * FROM codes WHERE code_type = ? and code = ? ORDER BY revenue_code DESC";
        $revcode[$tlh] = sqlQuery($sql, array(
            $tmpcode,
            $getrevcd
        ));
    }

for ($prockey = 0; $prockey < $proccount; ++ $prockey) {
        $os = 99 + ($loopcount * 8); // Form revenue code offset
        $dosos = 102 + ($loopcount * 8); // Procedure date of service form start offset-add 8 for loop
        ++ $loopcount;

++ $edicount;
        $out .= "LX" . // Loop 2400 LX Service Line. Page 398.
        "*" . "$loopcount" . "~\n";

++ $edicount;

// Revenue code from form
        //
        $tmp = $ub04id[$os]; //$revcode[$prockey][revenue_code];
        if (empty($tmp)) {
            $log .= "*** Error: Missing Revenue Code for " . $claim->cptKey($prockey) . "!\n";
        }
        // Institutional Service Line.
        //
        $out .= "SV2" .  "*" . $tmp . // revenue code

"*" . "HC:" . $claim->cptKey($prockey) . "*" . sprintf('%.2f', $claim->cptCharges($prockey)) . "*UN" . "*" . $claim->cptUnits($prockey) . "*" . "*" . "*";

$out .= "~\n";

if (! $claim->cptCharges($prockey)) {
            $log .= "*** Procedure '" . $claim->cptKey($prockey) . "' has no charges!\n";
        }

// Segment SV5 (Durable Medical Equipment Service) omitted.
        // Segment PWK (Line Supplemental Information) omitted.
        // Segment PWK (Durable Medical Equipment Certificate of Medical Necessity Indicator) omitted.
        // Segment CR1 (Ambulance Transport Information) omitted.
        // Segment CR3 (Durable Medical Equipment Certification) omitted.
        // Segment CRC (Ambulance Certification) omitted.
        // Segment CRC (Hospice Employee Indicator) omitted.
        // Segment CRC (Condition Indicator / Durable Medical Equipment) omitted.

++ $edicount;

$out .= "DTP" . // Date of Service. Needs to be when service preformed.
            "*" . "472" . "*" . "D8" . "*" . $ub04id[$dosos] . "~\n"; //$claim->serviceDate()

$testnote = rtrim($claim->cptNotecodes($prockey));
        if (! empty($testnote)) {
            ++ $edicount;
            $out .= "NTE" . // Explain Unusual Circumstances.
            "*ADD" . "*" . $claim->cptNotecodes($prockey) . "~\n";
        }

// Segment DTP*471 (Prescription Date) omitted.
        // Segment DTP*607 (Revision/Recertification Date) omitted.
        // Segment DTP*463 (Begin Therapy Date) omitted.
        // Segment DTP*461 (Last Certification Date) omitted.
        // Segment DTP*304 (Last Seen Date) omitted.
        // Segment DTP (Test Date) omitted.
        // Segment DTP*011 (Shipped Date) omitted.
        // Segment DTP*455 (Last X-Ray Date) omitted.
        // Segment DTP*454 (Initial Treatment Date) omitted.
        // Segment QTY (Ambulance Patient Count) omitted.
        // Segment QTY (Obstetric Anesthesia Additional Units) omitted.
        // Segment MEA (Test Result) omitted.
        // Segment CN1 (Contract Information) omitted.
        // Segment REF*9B (Repriced Line Item Reference Number) omitted.
        // Segment REF*9D (Adjusted Repriced Line Item Reference Number) omitted.
        // Segment REF*G1 (Prior Authorization) omitted.
        // Segment REF*6R (Line Item Control Number) omitted.
        // (Really oughta have this for robust 835 posting!)
        // Segment REF*EW (Mammography Certification Number) omitted.
        // Segment REF*X4 (CLIA Number) omitted.
        // Segment REF*F4 (Referring CLIA Facility Identification) omitted.
        // Segment REF*BT (Immunization Batch Number) omitted.
        // Segment REF*9F (Referral Number) omitted.
        // Segment AMT*GT (Sales Tax Amount) omitted.
        // Segment AMT*F4 (Postage Claimed Amount) omitted.
        // Segment K3 (File Information) omitted.
        // Segment NTE (Line Note) omitted.
        // Segment NTE (Third Party Organization Notes) omitted.
        // Segment PS1 (Purchased Service Information) omitted.
        // Segment HCP (Line Pricing/Repricing Information) omitted.

// Loop 2410, Drug Information. Medicaid insurers seem to want this
        // with HCPCS codes.
        //
        $ndc = $claim->cptNDCID($prockey);

if ($ndc) {
            ++$edicount;
            $out .= "LIN" . // Drug Identification. Page 500+ (Addendum pg 71).
                "*" .         // Per addendum, LIN01 is not used.
                "*" . "N4" .
                "*" . $ndc .
                "~\n";

if (!preg_match('/^\d\d\d\d\d-\d\d\d\d-\d\d$/', $ndc, $tmp) && !preg_match('/^\d{11}$/', $ndc)) {
                $log .= "*** NDC code '$ndc' has invalid format!\n";
            }

++$edicount;
            $out .= "CTP" . // Drug Pricing. Page 500+ (Addendum pg 74).
                "*" .
                "*" .
                "*" .
                "*" . $claim->cptNDCQuantity($prockey) .
                "*" . $claim->cptNDCUOM($prockey) .
                // Note: 5010 documents "ME" (Milligrams) as an additional unit of measure.
            "~\n";
        }

// Segment REF (Prescription or Compound Drug Association Number) omitted.

// Loop 2420A, Rendering Provider (service-specific). (Operating Physician Name for 837I)
        // Used if the rendering provider for this service line is different
        // from that in loop 2310B.
        //
        if ($claim->providerNPI() != $claim->providerNPI($prockey)) {
            ++$edicount;
            $out .= "NM1" .       // Loop 2310B Rendering Provider
                "*" . "82" .
                "*" . "1" .
                "*" . $claim->providerLastName($prockey) .
                "*" . $claim->providerFirstName($prockey) .
                "*" . $claim->providerMiddleName($prockey) .
                "*" .
                "*";
            if ($claim->providerNPI($prockey)) {
                $out .=
                "*" . "XX" .
                "*" . $claim->providerNPI($prockey);
            } else {
                $log .= "*** Rendering provider has no NPI.\n";
            }
            $out .= "~\n";

if ($claim->providerTaxonomy($prockey)) {
                ++$edicount;
                $out .= "PRV" .
                    "*" . "PE" . // PErforming provider
                    "*" . "PXC" .
                    "*" . $claim->providerTaxonomy($prockey) .
                    "~\n";
            }

// Segment PRV*PE (Rendering Provider Specialty Information) omitted.
            // Segment REF (Rendering Provider Secondary Identification) omitted.
            // Segment NM1 (Purchased Service Provider Name) omitted.
            // Segment REF (Purchased Service Provider Secondary Identification) omitted.
            // Segment NM1,N3,N4 (Service Facility Location) omitted.
            // Segment REF (Service Facility Location Secondary Identification) omitted.
            // Segment NM1 (Supervising Provider Name) omitted.
            // Segment REF (Supervising Provider Secondary Identification) omitted.
            // Segment NM1,N3,N4 (Ordering Provider) omitted.
            // Segment REF (Ordering Provider Secondary Identification) omitted.
            // Segment PER (Ordering Provider Contact Information) omitted.
            // Segment NM1 (Referring Provider Name) omitted.
            // Segment REF (Referring Provider Secondary Identification) omitted.
            // Segments NM1*PW, N3, N4 (Ambulance Pick-Up Location) omitted.
            // Segments NM1*45, N3, N4 (Ambulance Drop-Off Location) omitted.

// REF*1C is required here for the Medicare provider number if NPI was
            // specified in NM109. Not sure if other payers require anything here.
            if ($claim->providerNumberType($prockey) == "G2") {
                ++$edicount; $out .= "REF" . "*" . $claim->providerNumberType($prockey) .
                "*" . $claim->providerNumber($prockey) . "~\n";
            }
        } // provider exception

// Loop 2430, adjudication by previous payers.
        //
        for ($ins = 1; $ins < $claim->payerCount(); ++ $ins) {
            if ($claim->payerSequence($ins) > $claim->payerSequence()) {
                continue; // payer is future, not previous
            }

$payerpaid = $claim->payerTotals($ins, $claim->cptKey($prockey));
            $aarr = $claim->payerAdjustments($ins, $claim->cptKey($prockey));

if ($payerpaid[1] == 0 && ! count($aarr)) {
                $log .= "*** Procedure '" . $claim->cptKey($prockey) . "' has no payments or adjustments from previous payer!\n";
                continue;
            }

++ $edicount;
            $out .= "SVD" . // Service line adjudication. Page 554.
            "*" . $claim->payerID($ins) . "*" . $payerpaid[1] . "*HC:" . $claim->cptKey($prockey) . "*" . "*" . $claim->cptUnits($prockey) . "~\n";

$tmpdate = $payerpaid[0];
            foreach ($aarr as $a) {
                ++ $edicount;
                $out .= "CAS" . // Previous payer's line level adjustments. Page 558.
                "*" . $a[1] . "*" . $a[2] . "*" . $a[3] . "~\n";
                if (! $tmpdate) {
                    $tmpdate = $a[0];
                }
            }

if ($tmpdate) {
                ++ $edicount;
                $out .= "DTP" . // Previous payer's line adjustment date. Page 493/566.
                "*573" . "*D8" . "*$tmpdate" . "~\n";
            }

// Segment AMT*EAF (Remaining Patient Liability) omitted.
            // Segment LQ (Form Identification Code) omitted.
            // Segment FRM (Supporting Documentation) omitted.
        } // end loop 2430
    } // end this procedure

++ $edicount;
    $out .= "SE" . // SE Trailer
    "*$edicount" . "*0021" . "~\n";

$out .= "GE" . // GE Trailer
    "*1" . "*1" . "~\n";

$out .= "IEA" . // IEA Trailer
    "*1" . "*000000001" . "~\n";

// Remove any trailing empty fields (delimiters) from each segment.
    $out = preg_replace('/\*+~/', '~', $out);

$log .= "\n";
    return $out;
}