From fd6500fb6ab5d8aaa4e4ab1c7c236ed488724569 Mon Sep 17 00:00:00 2001
From: stephen waite <stephen.waite@cmsvt.com>
Date: Tue, 26 Mar 2024 10:09:57 -0400
Subject: [PATCH] fix: ERA posting based on code mod combo billed that prevents
 insert into billing table (#7294)

* fix: assign codekey for ERA posting based on code mod combo billed

* silence minor warning

* add global for disabling adding to billing table

* separate out pt and enc billing note

* add canceled appts counter

* revert change, open new pr

* revert change, open new pr
---
 interface/billing/sl_eob_process.php | 41 +++++++++++++++++++++++++---
 library/globals.inc.php              |  7 +++++
 src/Billing/ParseERA.php             |  2 +-
 3 files changed, 45 insertions(+), 5 deletions(-)

diff --git a/interface/billing/sl_eob_process.php b/interface/billing/sl_eob_process.php
index a730a97c480..0751b2d6a3f 100644
--- a/interface/billing/sl_eob_process.php
+++ b/interface/billing/sl_eob_process.php
@@ -345,7 +345,7 @@ function era_callback(&$out)
             writeMessageLine($bgcolor, 'infdetail', rtrim($out['warnings']), true);
         }
 
-    // Simplify some claim attributes for cleaner code.
+        // Simplify some claim attributes for cleaner code.
         $service_date = parse_date(isset($out['dos']) ? $out['dos'] : $out['claim_date']);
         $check_date      = $paydate ? $paydate : parse_date($out['check_date']);
         $production_date = $paydate ? $paydate : parse_date($out['production_date']);
@@ -359,7 +359,19 @@ function era_callback(&$out)
 
         $error = $inverror;
 
-    // This loops once for each service item in this claim.
+        // create array of cpts and mods for complex matching
+        $codes_arr_keys = array_keys($codes);
+        foreach ($codes_arr_keys as $key => $value) {
+            $tmp = explode(":", $value);
+            $count = count($tmp) - 1;
+            $cpt = $tmp[0];
+            $cpts[] = $cpt;
+            for ($i = 1; $i <= $count; $i++) {
+                $mods[$cpt][] = $tmp[$i] ?? null;
+            }
+        }
+
+        // This loops once for each service item in this claim.
         foreach ($out['svc'] as $svc) {
           // Treat a modifier in the remit data as part of the procedure key.
           // This key will then make its way into SQL-Ledger.
@@ -369,6 +381,21 @@ function era_callback(&$out)
             }
 
             $prev = $codes[$codekey] ?? '';
+            // However sometimes a secondary insurance (take USAA LIFE for instance)
+            // sometimes doesn't return the modifier that was on the service item
+            // processed by the primary payer so try to deal with that
+            if (!$prev) {
+                if (!$svc['mod']) {
+                    if (in_array($svc['code'], $cpts)) {
+                        foreach ($cpts as $k => $v) {
+                            if ($v == $codekey) {
+                                $codekey = $cpt . ':' . implode(':', $mods[$v]);
+                            }
+                        }
+                    }
+                }
+                $prev = $codes[$codekey] ?? '';
+            }
             $codetype = ''; //will hold code type, if exists
 
             // This reports detail lines already on file for this service item.
@@ -389,9 +416,15 @@ function era_callback(&$out)
                 unset($codes[$codekey]);
             } else { // If the service item is not in our database...
                 // This is not an error. If we are not in error mode and not debugging,
-                // insert the service item into SL.  Then display it (in green if it
+                // insert the service item into billing. Then display it (in green if it
                 // was inserted, or in red if we are in error mode).
-                $description = "CPT4:$codekey Added by $inslabel $production_date";
+                // Check the global to see if this is preferred to be an error.
+                if ($GLOBALS['add_unmatched_code_from_ins_co_era_to_billing'] ?? '') {
+                    $description = "CPT4:$codekey Added by $inslabel $production_date";
+                } else {
+                    $error = true;
+                    $description = "CPT4:$codekey returned by $inslabel $production_date";
+                }
                 if (!$error && !$debug) {
                     SLEOB::arPostCharge(
                         $pid,
diff --git a/library/globals.inc.php b/library/globals.inc.php
index 266399cca2d..a757abaa257 100644
--- a/library/globals.inc.php
+++ b/library/globals.inc.php
@@ -1529,6 +1529,13 @@ function gblTimeZones()
             xl('Enable swap secondary insurance')
         ),
 
+        'add_unmatched_code_from_ins_co_era_to_billing' => array(
+            xl('Enable adding unmatched code from insurance company to billing table'),
+            'bool',                           // data type
+            '0',                              // default
+            xl('Enable adding unmatched code from insurance company to billing table')
+        ),
+
     ),
 
     // E-Sign Tab
diff --git a/src/Billing/ParseERA.php b/src/Billing/ParseERA.php
index 0aa08e6e051..433e4c2395f 100644
--- a/src/Billing/ParseERA.php
+++ b/src/Billing/ParseERA.php
@@ -183,7 +183,7 @@ public static function parseERA($filename, $cb)
                 }
                 $out['loopid'] = '1000A';
                 $out['payer_name'] = trim($seg[2]);
-                $out['payer_id'] = trim($seg[4] ?? null); // will be overwritten if in REF*2U below
+                $out['payer_id'] = trim($seg[4] ?? ''); // will be overwritten if in REF*2U below
             } elseif ($segid == 'N3' && $out['loopid'] == '1000A') {
                 $out['payer_street'] = trim($seg[1]);
                 // TBD: N302 may exist as an additional address line.