interface/billing/sl_eob_invoice.php

   1 <?php
   2
   3 /**
   4  * This provides for manual posting of EOBs.  It is invoked from
   5  * sl_eob_search.php.  For automated (X12 835) remittance posting
   6  * see sl_eob_process.php.
   7  *
   8  * @package   OpenEMR
   9  * @link      http://www.open-emr.org
  10  * @author    Rod Roark <rod@sunsetsystems.com>
  11  * @author    Roberto Vasquez <robertogagliotta@gmail.com>
  12  * @author    Terry Hill <terry@lillysystems.com>
  13  * @author    Jerry Padgett <sjpadgett@gmail.com>
  14  * @author    Stephen Waite <stephen.waite@cmsvt.com>
  15  * @author    Brady Miller <brady.g.miller@gmail.com>
  16  * @copyright Copyright (c) 2005-2020 Rod Roark <rod@sunsetsystems.com>
  17  * @copyright Copyright (c) 2018-2020 Stephen Waite <stephen.waite@cmsvt.com>
  18  * @copyright Copyright (c) 2019-2020 Brady Miller <brady.g.miller@gmail.com>
  19  * @license   https://github.com/openemr/openemr/blob/master/LICENSE GNU General Public License 3
  20  */
  21
  22 require_once("../globals.php");
  23 require_once("$srcdir/patient.inc.php");
  24 require_once("$srcdir/forms.inc.php");
  25 require_once("../../custom/code_types.inc.php");
  26 require_once "$srcdir/user.inc.php";
  27 require_once("$srcdir/payment.inc.php");
  28
  29 use OpenEMR\Billing\InvoiceSummary;
  30 use OpenEMR\Billing\SLEOB;
  31 use OpenEMR\Common\Csrf\CsrfUtils;
  32 use OpenEMR\Common\Utils\FormatMoney;
  33 use OpenEMR\Core\Header;
  34
  35 $debug = 0; // set to 1 for debugging mode
  36 $save_stay = (!empty($_REQUEST['form_save']) && ($_REQUEST['form_save'] == '1')) ? true : false;
  37 $from_posting = (0 + ($_REQUEST['isPosting'] ?? null)) ? 1 : 0;
  38 $g_posting_adj_disable = $GLOBALS['posting_adj_disable'] ? 'checked' : '';
  39 if ($from_posting) {
  40     $posting_adj_disable = prevSetting('sl_eob_search.', 'posting_adj_disable', 'posting_adj_disable', $g_posting_adj_disable);
  41 } else {
  42     $posting_adj_disable = $g_posting_adj_disable;
  43 }
  44
  45 // If we permit deletion of transactions.  Might change this later.
  46 $ALLOW_DELETE = true;
  47
  48 $info_msg = "";
  49
  50 ?>
  51 <html>
  52 <head>
  53     <?php Header::setupHeader(['datetime-picker', 'opener', 'no_dialog']); ?>
  54     <title><?php echo xlt('EOB Posting - Invoice') ?></title>
  55     <script>
  56
  57         const adjDisable = <?php echo js_escape($posting_adj_disable); ?>;
  58         // An insurance radio button is selected.
  59         function setins(istr) {
  60             return true;
  61         }
  62
  63         function goEncounterSummary(e, pid) {
  64             if(pid) {
  65                 if(typeof opener.toEncSummary  === 'function') {
  66                     opener.toEncSummary(e, pid);
  67                 }
  68             }
  69             doClose();
  70         }
  71
  72         function doClose() {
  73             window.close();
  74         }
  75
  76         // Compute an adjustment that writes off the balance:
  77         function writeoff(code) {
  78             const f = document.forms[0];
  79             const belement = f['form_line[' + code + '][bal]'];
  80             const pelement = f['form_line[' + code + '][pay]'];
  81             const aelement = f['form_line[' + code + '][adj]'];
  82             const relement = f['form_line[' + code + '][reason]'];
  83             const tmp = belement.value - pelement.value;
  84             aelement.value = Number(tmp).toFixed(2);
  85             if (aelement.value && !relement.value) {
  86                 relement.selectedIndex = 1;
  87             }
  88             return false;
  89         }
  90
  91         // Onsubmit handler.  A good excuse to write some JavaScript.
  92         function validate(f) {
  93             let delcount = 0;
  94             let allempty = true;
  95
  96             for (let i = 0; i < f.elements.length; ++i) {
  97                 let ename = f.elements[i].name;
  98                 // Count deletes.
  99                 if (ename.substring(0, 9) == 'form_del[') {
 100                     if (f.elements[i].checked) {
 101                         ++delcount;
 102                     }
 103                     continue;
 104                 }
 105                 let pfxlen = ename.indexOf('[pay]');
 106                 if (pfxlen < 0) {
 107                     continue
 108                 };
 109                 let pfx = ename.substring(0, pfxlen);
 110                 let code = pfx.substring(pfx.indexOf('[') + 1, pfxlen - 1);
 111                 let cPay = parseFloat(f[pfx + '[pay]'].value).toFixed(2);
 112                 let cAdjust = parseFloat(f[pfx + '[adj]'].value).toFixed(2);
 113
 114                 if ((cPay !== 0) || cAdjust !== 0) {
 115                     allempty = false;
 116                 }
 117                 if(adjDisable) {
 118                     if ((cAdjust == 0 && ins_done.value == 'changed')) {
 119                         allempty = false;
 120                     }
 121                 }
 122                 if ((cPay !== 0) && isNaN(parseFloat(f[pfx + '[pay]'].value))) {
 123                     let message = <?php echo xlj('Payment value for code') ?> + " " + code + " " + <?php echo xlj('is not a number') ?>;
 124                     (async (message, time) => {
 125                         await asyncAlertMsg(message, time, 'danger', 'lg');
 126                     })(message, 3000)
 127                     .then(res => { });
 128                     return false;
 129                 }
 130                 if ((cAdjust !== 0) && isNaN(parseFloat(f[pfx + '[adj]'].value))) {
 131                     let message = <?php echo xlj('Adjustment value for code') ?> + " " + code  + " " + <?php echo xlj('is not a number') ?>;
 132                     (async (message, time) => {
 133                         await asyncAlertMsg(message, time, 'danger', 'lg');
 134                     })(message, 3000)
 135                     .then(res => { });
 136                     return false;
 137                 }
 138                 if ((cAdjust !== 0) && !f[pfx + '[reason]'].value && !adjDisable) {
 139                     let message = <?php echo xlj('Please select an adjustment reason for code') ?> + " " + code;
 140                     (async (message, time) => {
 141                         await asyncAlertMsg(message, time, 'danger', 'lg');
 142                     })(message, 3000)
 143                     .then(res => { });
 144                     return false;
 145                 }
 146             // TBD: validate the date format
 147             }
 148             // Check if save is clicked with nothing to post.
 149             if (allempty && delcount === 0) {
 150                 let message = <?php echo xlj('Nothing to Post! Please review entries or use Cancel to exit transaction') ?>;
 151                 (async (message, time) => {
 152                     await asyncAlertMsg(message, time, 'danger', 'lg');
 153                 })(message, 3000)
 154                 .then(res => { });
 155                 return false;
 156             }
 157             // Demand confirmation if deleting anything.
 158             if (delcount > 0) {
 159                 if (!confirm(<?php echo xlj('Really delete'); ?> + ' ' + delcount +
 160                     ' ' + <?php echo xlj('transactions'); ?> + '?' +
 161                     ' ' + <?php echo xlj('This action will be logged'); ?> + '!')
 162                 ) return false;
 163             }
 164             return true;
 165         }
 166
 167         // Get current date
 168         function getFormattedToday() {
 169             let today = new Date();
 170             let dd = today.getDate();
 171             let mm = today.getMonth() + 1; //January is 0!
 172             let yyyy = today.getFullYear();
 173             if (dd < 10) {
 174                 dd = '0' + dd;
 175             }
 176             if (mm < 10) {
 177                 mm = '0' + mm;
 178             }
 179             return (yyyy + '-' + mm + '-' + dd);
 180         }
 181
 182         // Update Payment Fields
 183         function updateFields(payField, adjField, balField, coPayField, isFirstProcCode) {
 184             let payAmount = 0.0;
 185             let adjAmount = 0.0;
 186             let balAmount = 0.0;
 187             let coPayAmount = 0.0;
 188
 189             // coPayFiled will be null if there is no co-pay entry in the fee sheet
 190             if (coPayField) {
 191                 coPayAmount = coPayField.value;
 192             }
 193
 194             // if balance field is 0.00, its value comes back as null, so check for nul-ness first
 195             if (balField) {
 196                 balAmount = (balField.value) ? balField.value : 0;
 197             }
 198
 199             if (payField) {
 200                 payAmount = (payField.value) ? payField.value : 0;
 201             }
 202
 203             // alert('balance = >' + balAmount +'<  payAmount = ' + payAmount + '  copay = ' + coPayAmount + '  isFirstProcCode = ' + isFirstProcCode);
 204
 205             // subtract the co-pay only from the first procedure code
 206             if (isFirstProcCode == 1) {
 207                 balAmount = parseFloat(balAmount) + parseFloat(coPayAmount);
 208             }
 209
 210             if (adjDisable) {
 211                 return;
 212             }
 213
 214             adjAmount = balAmount - payAmount;
 215             // Assign rounded adjustment value back to TextField
 216             adjField.value = adjAmount = Math.round(adjAmount * 100) / 100;
 217         }
 218
 219         $(function () {
 220             $('.datepicker').datetimepicker({
 221                 <?php $datetimepicker_timepicker = false; ?>
 222                 <?php $datetimepicker_showseconds = false; ?>
 223                 <?php $datetimepicker_formatInput = true; ?>
 224                 <?php require($GLOBALS['srcdir'] . '/js/xl/jquery-datetimepicker-2-5-4.js.php'); ?>
 225                 <?php // can add any additional javascript settings to datetimepicker here; need to prepend first setting with a comma ?>
 226             });
 227         });
 228
 229         $("#ins_done").on("change", function() {
 230             $("#ins_done").val('changed');
 231         });
 232
 233     </script>
 234     <style>
 235         @media only screen and (max-width: 768px) {
 236             [class*="col-"] {
 237                 width: 100%;
 238                 text-align: left !Important;
 239             }
 240         }
 241
 242         .table {
 243             margin: auto;
 244             width: 99%;
 245         }
 246
 247         .table > tbody > tr > td {
 248             border-top: none;
 249         }
 250
 251         .last_detail {
 252             border-bottom: 1px var(--black) solid;
 253             margin-top: 2px;
 254         }
 255
 256         @media (min-width: 992px) {
 257             .modal-lg {
 258                 width: 1000px !Important;
 259             }
 260         }
 261     </style>
 262 </head>
 263 <body>
 264 <?php
 265 $trans_id = (int) $_GET['id'];
 266 if (!$trans_id) {
 267     die(xlt("You cannot access this page directly."));
 268 }
 269
 270 // A/R case, $trans_id matches form_encounter.id.
 271 $ferow = sqlQuery("SELECT e.*, p.fname, p.mname, p.lname FROM form_encounter AS e, patient_data AS p WHERE e.id = ? AND p.pid = e.pid", array($trans_id));
 272 if (empty($ferow)) {
 273     die("There is no encounter with form_encounter.id = '" . text($trans_id) . "'.");
 274 }
 275 $patient_id = (int) $ferow['pid'];
 276 $encounter_id = (int) $ferow['encounter'];
 277 $svcdate = substr($ferow['date'], 0, 10);
 278 $form_payer_id = (!empty($_POST['form_payer_id'])) ? (0 + $_POST['form_payer_id']) : 0;
 279 $form_reference = $_POST['form_reference'] ?? null;
 280 $form_check_date   = fixDate(($_POST['form_check_date'] ?? ''), date('Y-m-d'));
 281 $form_deposit_date = fixDate(($_POST['form_deposit_date'] ?? ''), $form_check_date);
 282 $form_pay_total = (!empty($_POST['form_pay_total'])) ? (0 + $_POST['form_pay_total']) : 0;
 283
 284 $payer_type = 0;
 285 if (preg_match('/^Ins(\d)/i', ($_POST['form_insurance'] ?? ''), $matches)) {
 286     $payer_type = $matches[1];
 287 }
 288
 289 if (!empty($_POST['form_save']) || !empty($_POST['form_cancel']) || !empty($_POST['isLastClosed']) || !empty($_POST['enc_billing_note'])) {
 290     if (!empty($_POST['form_save'])) {
 291         if (!CsrfUtils::verifyCsrfToken($_POST["csrf_token_form"])) {
 292             CsrfUtils::csrfNotVerified();
 293         }
 294
 295         if ($debug) {
 296             echo "<p><b>" . xlt("This module is in test mode. The database will not be changed.") . "</b><p>\n";
 297         }
 298
 299         $session_id = SLEOB::arGetSession($form_payer_id, $form_reference, $form_check_date, $form_deposit_date, $form_pay_total);
 300 // The sl_eob_search page needs its invoice links modified to invoke
 301 // javascript to load form parms for all the above and submit.
 302 // At the same time that page would be modified to work off the
 303 // openemr database exclusively.
 304 // And back to the sl_eob_invoice page, I think we may want to move
 305 // the source input fields from row level to header level.
 306
 307 // Handle deletes. row_delete() is borrowed from deleter.php.
 308         if ($ALLOW_DELETE && !$debug) {
 309             if (!empty($_POST['form_del']) && is_array($_POST['form_del'])) {
 310                 foreach ($_POST['form_del'] as $arseq => $dummy) {
 311                     row_modify(
 312                         "ar_activity",
 313                         "deleted = NOW()",
 314                         "pid = '" . add_escape_custom($patient_id) .
 315                         "' AND encounter = '" . add_escape_custom($encounter_id) .
 316                         "' AND sequence_no = '" . add_escape_custom($arseq) .
 317                         "' AND deleted IS NULL"
 318                     );
 319                 }
 320             }
 321         }
 322
 323         $paytotal = 0;
 324         foreach ($_POST['form_line'] as $code => $cdata) {
 325             $thispay = trim($cdata['pay']);
 326             $thisadj = trim($cdata['adj']);
 327             $thisins = trim($cdata['ins']);
 328             $thiscodetype = trim($cdata['code_type']);
 329             $reason = $cdata['reason'];
 330
 331 // Get the adjustment reason type.  Possible values are:
 332 // 1 = Charge adjustment
 333 // 2 = Coinsurance
 334 // 3 = Deductible
 335 // 4 = Other pt resp
 336 // 5 = Comment
 337             $reason_type = '1';
 338             if ($reason) {
 339                 $tmp = sqlQuery("SELECT option_value FROM list_options WHERE list_id = 'adjreason' AND activity = 1 AND option_id = ?", array($reason));
 340                 if (empty($tmp['option_value'])) {
 341 // This should not happen but if it does, apply old logic.
 342                     if (preg_match("/To copay/", $reason)) {
 343                         $reason_type = 2;
 344                     } elseif (preg_match("/To ded'ble/", $reason)) {
 345                         $reason_type = 3;
 346                     }
 347                     $info_msg .= xl("No adjustment reason type found for") . " \"$reason\". ";
 348                 } else {
 349                     $reason_type = $tmp['option_value'];
 350                 }
 351             }
 352
 353             if (!$thisins) {
 354                 $thisins = 0;
 355             }
 356
 357             if (0.0 + $thispay) {
 358                 SLEOB::arPostPayment($patient_id, $encounter_id, $session_id, $thispay, $code, $payer_type, '', $debug, '', $thiscodetype);
 359                 $paytotal += $thispay;
 360             }
 361
 362 // Be sure to record adjustment reasons, even for zero adjustments if
 363 // they happen to be comments.
 364             if (
 365                 (0.0 + $thisadj) ||
 366                 ($reason && $reason_type == 5) ||
 367                 ($reason && ($reason_type > 1 && $reason_type < 6))
 368             ) {
 369 // "To copay" and "To ded'ble" need to become a comment in a zero
 370 // adjustment, formatted just like sl_eob_process.php.
 371                 if ($reason_type == '2') {
 372                     $reason = $_POST['form_insurance'] . " coins: $thisadj";
 373                     $thisadj = 0;
 374                 } elseif ($reason_type == '3') {
 375                     $reason = $_POST['form_insurance'] . " dedbl: $thisadj";
 376                     $thisadj = 0;
 377                 } elseif ($reason_type == '4') {
 378                     $reason = $_POST['form_insurance'] . " ptresp: $thisadj $reason";
 379                     $thisadj = 0;
 380                 } elseif ($reason_type == '5') {
 381                     $reason = $_POST['form_insurance'] . " note: $thisadj $reason";
 382                     $thisadj = 0;
 383                 } else {
 384 // An adjustment reason including "Ins" is assumed to be assigned by
 385 // insurance, and in that case we identify which one by appending
 386 // Ins1, Ins2 or Ins3.
 387                     if (strpos(strtolower($reason), 'ins') != false) {
 388                         $reason .= ' ' . $_POST['form_insurance'];
 389                     }
 390                 }
 391                 SLEOB::arPostAdjustment($patient_id, $encounter_id, $session_id, $thisadj, $code, $payer_type, $reason, $debug, '', $thiscodetype);
 392             }
 393         }
 394
 395 // Maintain which insurances are marked as finished.
 396
 397         $form_done = 0 + $_POST['form_done'];
 398         $form_stmt_count = 0 + (int) $_POST['form_stmt_count'];
 399         sqlStatement("UPDATE form_encounter SET last_level_closed = ?, stmt_count = ? WHERE pid = ? AND encounter = ?", array($form_done, $form_stmt_count, $patient_id, $encounter_id));
 400
 401         if (!empty($_POST['form_secondary'])) {
 402             SLEOB::arSetupSecondary($patient_id, $encounter_id, $debug);
 403         }
 404         echo "<script>\n";
 405         echo " if (opener.document.forms[0] != undefined) {\n";
 406         echo "   if (opener.document.forms[0].form_amount) {\n";
 407         echo "     var tmp = opener.document.forms[0].form_amount.value - " . attr($paytotal) . ";\n";
 408         echo "     opener.document.forms[0].form_amount.value = Number(tmp).toFixed(2);\n";
 409         echo "   }\n";
 410         echo " }\n";
 411     } else {
 412         echo "<script>\n";
 413     }
 414     if ($info_msg) {
 415         echo " alert(" . js_escape($info_msg) . ");\n";
 416     }
 417     if (!$debug && !$save_stay && !$_POST['isLastClosed']) {
 418         echo "doClose();\n";
 419     }
 420     if (!$debug && ($save_stay || $_POST['isLastClosed'] || $_POST['enc_billing_note'])) {
 421         if ($_POST['isLastClosed']) {
 422             // save last closed level
 423             $form_done = 0 + $_POST['form_done'];
 424             $form_stmt_count = 0 + $_POST['form_stmt_count'];
 425             sqlStatement("UPDATE form_encounter SET last_level_closed = ?, stmt_count = ? WHERE pid = ? AND encounter = ?", array($form_done, $form_stmt_count, $patient_id, $encounter_id));
 426             // also update billing for aging
 427             sqlStatement("UPDATE billing SET bill_date = ? WHERE pid = ? AND encounter = ?", array($form_deposit_date, $patient_id, $encounter_id));
 428             if (!empty($_POST['form_secondary'])) {
 429                 SLEOB::arSetupSecondary($patient_id, $encounter_id, $debug);
 430             }
 431         }
 432
 433         if ($_POST['enc_billing_note']) {
 434             // save enc billing note
 435             sqlStatement("UPDATE form_encounter SET billing_note = ? WHERE pid = ? AND encounter = ?", array($_POST['enc_billing_note'], $patient_id, $encounter_id));
 436         }
 437
 438         // will reload page w/o reposting
 439         echo "location.replace(location)\n";
 440     }
 441     echo "</script>\n";
 442     if (!$save_stay && !$_POST['isLastClosed']) {
 443         exit();
 444     }
 445 }
 446
 447 // Get invoice charge details.
 448 $codes = InvoiceSummary::arGetInvoiceSummary($patient_id, $encounter_id, true);
 449 $pdrow = sqlQuery("select billing_note from patient_data where pid = ? limit 1", array($patient_id));
 450 $bnrow = sqlQuery("select billing_note from form_encounter where pid = ? AND encounter = ? limit 1", array($patient_id, $encounter_id));
 451 ?>
 452
 453 <div class="container-fluid">
 454     <div class="row">
 455         <h2><?php echo xlt('EOB Invoice'); ?></h2>
 456     </div>
 457     <div class="container-fluid">
 458         <form class="form" action='sl_eob_invoice.php?id=<?php echo attr_url($trans_id); ?>' method='post' onsubmit='return validate(this)'>
 459             <input type="hidden" name="csrf_token_form" value="<?php echo attr(CsrfUtils::collectCsrfToken()); ?>"/>
 460             <input type="hidden" name="isPosting" value="<?php echo attr($from_posting); ?>"/>
 461             <input type="hidden" name="isLastClosed" value="" />
 462             <fieldset>
 463                 <legend><?php echo xlt('Invoice Actions'); ?></legend>
 464                 <div class="form-row">
 465                     <div class="form-group col-lg">
 466                         <label class="col-form-label" for="form_name"><?php echo xlt('Patient'); ?>:</label>
 467                         <input type="text" class="form-control" id='form_name'
 468                                name='form_name'
 469                                value="<?php echo attr($ferow['fname']) . ' ' . attr($ferow['mname']) . ' ' . attr($ferow['lname']); ?>"
 470                                disabled />
 471                     </div>
 472                     <div class="form-group col-lg">
 473                         <label class="col-form-label" for="form_provider"><?php echo xlt('Provider'); ?>:</label>
 474                         <?php
 475                         $tmp = sqlQuery("SELECT fname, mname, lname " .
 476                             "FROM users WHERE id = ?", array($ferow['provider_id']));
 477                         $provider = text($tmp['fname']) . ' ' . text($tmp['mname']) . ' ' . text($tmp['lname']);
 478                         $tmp = sqlQuery("SELECT bill_date FROM billing WHERE " .
 479                             "pid = ? AND encounter = ? AND " .
 480                             "activity = 1 ORDER BY fee DESC, id ASC LIMIT 1", array($patient_id, $encounter_id));
 481                         $billdate = substr(($tmp['bill_date'] ?? '' . "Not Billed"), 0, 10);
 482                         ?>
 483                         <input type="text" class="form-control" id='form_provider'
 484                                name='form_provider' value="<?php echo attr($provider); ?>" disabled />
 485                     </div>
 486                     <div class="form-group col-lg">
 487                         <label class="col-form-label" for="form_invoice"><?php echo xlt('Invoice'); ?>:</label>
 488                         <input type="text" class="form-control" id='form_provider'
 489                                name='form_provider' value='<?php echo attr($patient_id) . "-" . attr($encounter_id); ?>'
 490                                disabled />
 491                     </div>
 492                     <div class="form-group col-lg">
 493                         <label class="col-form-label" for="svc_date"><?php echo xlt('Svc Date'); ?>:</label>
 494                         <input type="text" class="form-control" id='svc_date' name='form_provider'
 495                                value='<?php echo attr($svcdate); ?>' disabled />
 496                     </div>
 497                     <div class="card bg-light col-lg-4">
 498                         <div class="card-title mx-auto"><?php echo xlt('Insurance'); ?></div>
 499                         <?php
 500                         for ($i = 1; $i <= 3; ++$i) {
 501                             $payerid = SLEOB::arGetPayerID($patient_id, $svcdate, $i);
 502                             if ($payerid) {
 503                                 $tmp = sqlQuery("SELECT name FROM insurance_companies WHERE id = ?", array($payerid));
 504                                 echo "$i: " . $tmp['name'] . "<br />";
 505                             }
 506                         }
 507                         ?>
 508                     </div>
 509                 </div>
 510                 <div class="form-row">
 511                     <div class="form-group col-lg">
 512                         <label class="col-form-label" for="pt_billing_note"><?php echo xlt('Patient Billing Note'); ?>:</label>
 513                         <textarea name="pt_billing_note" id="pt_billing_note" class="form-control" cols="5" rows="1" readonly><?php echo text($pdrow['billing_note'] ?? ''); ?></textarea>
 514                     </div>
 515                 </div>
 516                 <div class="form-row">
 517                     <div class="form-group col-lg">
 518                         <label class="col-form-label" for="enc_billing_note"><?php echo xlt('Encounter Billing Note'); ?>:</label>
 519                         <textarea name="enc_billing_note" id="enc_billing_note" class="form-control" cols="5" rows="2"><?php echo text($bnrow['billing_note'] ?? ''); ?></textarea>
 520                     </div>
 521                 </div>
 522                 <div class="form-row">
 523                     <div class="form-group col-lg">
 524                         <label class="col-form-label" for="form_stmt_count"><?php echo xlt('Statements Sent'); ?>:</label>
 525                         <input type='text' name='form_stmt_count' id='form_stmt_count' class="form-control" value='<?php echo attr((0 + $ferow['stmt_count'])); ?>' />
 526                     </div>
 527                     <div class="form-group col-lg">
 528                         <label class="col-form-label" for="form_last_bill"><?php echo xlt('Last Bill Date'); ?>:</label>
 529                         <input type='text' name="form_last_bill" id='form_last_bill' class="form-control"
 530                                value ='<?php echo attr($billdate); ?>' disabled />
 531                     </div>
 532                     <div class="form-group col-lg">
 533                         <label class="col-form-label" for="form_reference"><?php echo xlt('Check/EOB No.'); ?>:</label>
 534                         <input type='text' name='form_reference' id='form_reference' class="form-control" value='' />
 535                     </div>
 536                     <div class="form-group col-lg">
 537                         <label class="col-form-label" for="form_check_date"><?php echo xlt('Check/EOB Date'); ?>:</label>
 538                         <input type='text' name='form_check_date' id='form_check_date' class='form-control datepicker' value='' />
 539                     </div>
 540                     <div class="form-group col-lg">
 541                         <label class="col-form-label" for="form_deposit_date"><?php echo xlt('Deposit Date'); ?>:</label>
 542                         <input type='text' name='form_deposit_date' id='form_deposit_date' class='form-control datepicker' value='' />
 543                         <input type='hidden' name='form_payer_id' value='' />
 544                         <input type='hidden' name='form_orig_reference' value='' />
 545                         <input type='hidden' name='form_orig_check_date' value='' />
 546                         <input type='hidden' name='form_orig_deposit_date' value='' />
 547                         <input type='hidden' name='form_pay_total' value='' />
 548                     </div>
 549                 </div>
 550                 <div class="form-row">
 551                     <div class="form-group col-lg">
 552                         <label class="col-form-label" for="type_code"><?php echo xlt('Now posting for'); ?>:</label>
 553                         <div class="pl-3">
 554                             <?php
 555                                 $last_level_closed = 0 + $ferow['last_level_closed'];
 556                             ?>
 557                             <label class="radio-inline">
 558                                 <input <?php echo $last_level_closed === 0 ? attr('checked') : ''; ?> name='form_insurance' onclick='setins("Ins1")' type='radio'
 559                                     value='Ins1' /><?php echo xlt('Ins1') ?>
 560                             </label>
 561                             <label class="radio-inline">
 562                                 <input <?php echo $last_level_closed === 1 ? attr('checked') : ''; ?> name='form_insurance' onclick='setins("Ins2")' type='radio'
 563                                     value='Ins2' /><?php echo xlt('Ins2') ?>
 564                             </label>
 565                             <label class="radio-inline">
 566                                 <input <?php echo $last_level_closed === 2 ? attr('checked') : ''; ?> name='form_insurance' onclick='setins("Ins3")' type='radio'
 567                                     value='Ins3' /><?php echo xlt('Ins3') ?>
 568                             </label>
 569                             <label class="radio-inline">
 570                                 <input <?php echo $last_level_closed === 3 ? attr('checked') : ''; ?> name='form_insurance' onclick='setins("Pt")' type='radio'
 571                                     value='Pt' /><?php echo xlt('Patient') ?>
 572                             </label>
 573                             <?php
 574                             // TBD: I think the following is unused and can be removed.
 575                             ?>
 576                             <input name='form_eobs' type='hidden' value='<?php echo attr($arrow['shipvia'] ?? '') ?>'/>
 577                         </div>
 578                     </div>
 579                     <div class="form-group col-lg" id='ins_done'>
 580                         <label class="col-form-label" for=""><?php echo xlt('Done with'); ?>:</label>
 581                         <a class="btn btn-save bg-light text-primary"
 582                             onclick="document.forms[0].isLastClosed.value='3'; document.forms[0].submit()"><?php echo xlt("Save Level"); ?>
 583                         </a>
 584                         <div class="pl-3">
 585                             <?php
 586                             // Write a checkbox for each insurance.  It is to be checked when
 587                             // we no longer expect any payments from that company for the claim.
 588                             $last_level_closed = 0 + $ferow['last_level_closed'];
 589                             foreach (array(0 => 'None', 1 => 'Ins1', 2 => 'Ins2', 3 => 'Ins3') as $key => $value) {
 590                                 if ($key && !SLEOB::arGetPayerID($patient_id, $svcdate, $key)) {
 591                                     continue;
 592                                 }
 593                                 $checked = ($last_level_closed == $key) ? " checked" : "";
 594                                 echo "<label class='radio-inline'>";
 595                                 echo "<input type='radio' name='form_done' value='" . attr($key) . "'$checked />" . text($value);
 596                                 echo "</label>";
 597                             }
 598                             ?>
 599                         </div>
 600                     </div>
 601                     <div class="form-group col-lg">
 602                         <label class="col-form-label" for=""><?php echo xlt('Secondary billing'); ?>:</label>
 603                         <div class="pl-3">
 604                             <label class="checkbox-inline">
 605                                 <input name="form_secondary" type="checkbox" value="1" /><?php echo xlt('Needs secondary billing') ?>
 606                             </label>
 607                         </div>
 608                     </div>
 609                 </div>
 610             </fieldset>
 611             <fieldset>
 612                 <legend><?php echo xlt('Invoice Details'); ?></legend>
 613                 <div class="table-responsive">
 614                     <table class="table table-sm">
 615                         <thead>
 616                             <tr>
 617                                 <th><?php echo xlt('Code') ?></th>
 618                                 <th class="text-left"><?php echo xlt('Charge') ?></th>
 619                                 <th class="text-left"><?php echo xlt('Balance') ?>&nbsp;</th>
 620                                 <th><?php echo xlt('By/Source') ?></th>
 621                                 <th><?php echo xlt('Date') ?></th>
 622                                 <th><?php echo xlt('Pay') ?></th>
 623                                 <th><?php echo xlt('Adjust') ?></th>
 624                                 <th>&nbsp;</th>
 625                                 <th><?php echo xlt('Reason') ?></th>
 626                                 <?php
 627                                 if ($ALLOW_DELETE) { ?>
 628                                     <th><?php echo xlt('Del') ?></th>
 629                                     <?php
 630                                 } ?>
 631                             </tr>
 632                         </thead>
 633                         <?php
 634                         $firstProcCodeIndex = -1;
 635                         $encount = 0;
 636                         foreach ($codes as $code => $cdata) {
 637                             ++$encount;
 638                             $dispcode = $code;
 639
 640                             // remember the index of the first entry whose code is not "CO-PAY", i.e. it's a legitimate proc code
 641                             if ($firstProcCodeIndex == -1 && strcmp($code, "CO-PAY") != 0) {
 642                                 $firstProcCodeIndex = $encount;
 643                             }
 644
 645                             // this sorts the details more or less chronologically:
 646                             ksort($cdata['dtl']);
 647                             foreach ($cdata['dtl'] as $dkey => $ddata) {
 648                                 $ddate = substr($dkey, 0, 10);
 649                                 if (preg_match('/^(\d\d\d\d)(\d\d)(\d\d)\s*$/', $ddate, $matches)) {
 650                                     $ddate = $matches[1] . '-' . $matches[2] . '-' . $matches[3];
 651                                 }
 652                                 $tmpchg = "";
 653                                 $tmpadj = "";
 654                                 if (!empty($ddata['chg']) && ($ddata['chg'] != 0)) {
 655                                     if (isset($ddata['rsn'])) {
 656                                         $tmpadj = 0 - $ddata['chg'];
 657                                     } else {
 658                                         $tmpchg = $ddata['chg'];
 659                                     }
 660                                 }
 661                                 ?>
 662                                 <tr>
 663                                     <td class="detail" style="background:<?php echo $dispcode ? 'lightyellow' : ''; ?>"><?php echo text($dispcode); $dispcode = "" ?></td>
 664                                     <td class="detail"><?php echo text(FormatMoney::getBucks($tmpchg)); ?></td>
 665                                     <td class="detail">&nbsp;</td>
 666                                     <td class="detail">
 667                                         <?php
 668                                         if (isset($ddata['plv'])) {
 669                                             if (!$ddata['plv']) {
 670                                                 echo 'Pt/';
 671                                             } else {
 672                                                 echo 'Ins' . text($ddata['plv']) . '/';
 673                                             }
 674                                         }
 675                                         echo text($ddata['src'] ?? '');
 676                                         ?>
 677                                     </td>
 678                                     <td class="detail"><?php echo text($ddate); ?></td>
 679                                     <td class="detail"><?php echo text(FormatMoney::getBucks($ddata['pmt'] ?? '')); ?></td>
 680                                     <td class="detail"><?php echo text(FormatMoney::getBucks($tmpadj ?? '')); ?></td>
 681                                     <td class="detail">&nbsp;</td>
 682                                     <td class="detail"><?php echo text($ddata['rsn'] ?? ''); ?></td>
 683                                     <?php
 684                                     if ($ALLOW_DELETE) { ?>
 685                                         <td class="detail">
 686                                             <?php
 687                                             if (!empty($ddata['arseq'])) { ?>
 688                                                 <input name="form_del[<?php echo attr($ddata['arseq']); ?>]"
 689                                                        type="checkbox" />
 690                                                 <?php
 691                                             } else {
 692                                                 ?> &nbsp;
 693                                                 <?php
 694                                             } ?>
 695                                         </td>
 696                                     <?php } ?>
 697                                 </tr>
 698                             <?php } // end of prior detail line ?>
 699                             <tr>
 700                                 <td class="last_detail"><?php echo text($dispcode);
 701                                     $dispcode = "" ?>
 702                                 </td>
 703                                 <td class="last_detail">&nbsp;</td>
 704                                 <td class="last_detail">
 705                                     <input name="form_line[<?php echo attr($code); ?>][bal]" type="hidden"
 706                                            value="<?php echo attr(FormatMoney::getBucks($cdata['bal'] ?? '')); ?>" />
 707                                     <input name="form_line[<?php echo attr($code); ?>][ins]" type="hidden"
 708                                            value="<?php echo attr($cdata['ins'] ?? ''); ?>" />
 709                                     <input name="form_line[<?php echo attr($code); ?>][code_type]" type="hidden"
 710                                            value="<?php echo attr($cdata['code_type'] ?? ''); ?>" /> <?php echo text(FormatMoney::getBucks($cdata['bal'], true)); ?>
 711                                     &nbsp;
 712                                 </td>
 713                                 <td class="last_detail"></td>
 714                                 <td class="last_detail"></td>
 715                                 <td class="last_detail">
 716                                     <input name="form_line[<?php echo attr($code); ?>][pay]"
 717                                            onkeyup="updateFields(document.forms[0]['form_line[<?php echo attr($code); ?>][pay]'], document.forms[0]['form_line[<?php echo attr($code); ?>][adj]'], document.forms[0]['form_line[<?php echo attr($code); ?>][bal]'], document.forms[0]['form_line[CO-PAY][bal]'], <?php echo ($firstProcCodeIndex == $encount) ? 1 : 0 ?>)"
 718                                            onfocus="this.select()" autofocus size="10" type="text" class="form-control"
 719                                            value="0.00" />
 720                                 </td>
 721                                 <td class="last_detail">
 722                                     <input name="form_line[<?php echo attr($code); ?>][adj]" size="10" type="text"
 723                                            class="form-control"
 724                                            value='<?php echo attr((!empty($totalAdjAmount)) ? $totalAdjAmount : '0.00'); ?>'
 725                                            onclick="this.select()" />
 726                                 </td>
 727                                 <td class="last_detail text-center">
 728                                     <a href="#" class="text-decoration-none" onclick="return writeoff(<?php echo attr_js($code); ?>)">WO</a>
 729                                 </td>
 730                                 <td class="last_detail">
 731                                     <select class="form-control" name="form_line[<?php echo attr($code); ?>][reason]">
 732                                         <?php
 733                                         // Adjustment reasons are now taken from the list_options table.
 734                                         echo "    <option value=''></option>\n";
 735                                         $ores = sqlStatement("SELECT option_id, title, is_default FROM list_options " .
 736                                             "WHERE list_id = 'adjreason' AND activity = 1 ORDER BY seq, title");
 737                                         while ($orow = sqlFetchArray($ores)) {
 738                                             echo "    <option value='" . attr($orow['option_id']) . "'";
 739                                             if ($orow['is_default']) {
 740                                                 echo " selected";
 741                                             }
 742                                             echo ">" . text($orow['title']) . "</option>\n";
 743                                         }
 744                                         ?>
 745                                     </select>
 746                                     <?php
 747                                     // TBD: Maybe a comment field would be good here, for appending
 748                                     // to the reason.
 749                                     ?>
 750                                 </td>
 751                                 <?php if ($ALLOW_DELETE) { ?>
 752                                     <td class="last_detail">&nbsp;</td>
 753                                 <?php } ?>
 754                             </tr>
 755                         <?php } // end of code ?>
 756                     </table>
 757                 </div>
 758             </fieldset>
 759             <?php //can change position of buttons by creating a class 'position-override' and adding rule text-align:center or right as the case may be in individual stylesheets ?>
 760             <div class="form-group col-lg clearfix">
 761                 <div class="col-sm-12 text-left position-override" id="search-btn">
 762                     <div class="btn-group" role="group">
 763                         <!-- @todo leave as I may still use sjp 08/2020 -->
 764                         <!--<button type='submit' class="btn btn-primary btn-save" name='form_save' id="btn-save-stay"
 765                             onclick="this.value='1';"><?php /*echo xlt("Save Current"); */?></button>-->
 766                         <button type='submit' class="btn btn-primary btn-save" name='form_save' id="btn-save"
 767                             onclick="this.value='2';"><?php echo xlt("Save"); ?></button>
 768                         <button type='button' class="btn btn-secondary btn-cancel" name='form_cancel'
 769                             id="btn-cancel" onclick='doClose()'><?php echo xlt("Close"); ?></button>
 770                     </div>
 771                     <?php if ($from_posting) { ?>
 772                         <button type='button' class="btn btn-secondary btn-view float-right" name='form_goto' id="btn-goto"
 773                             onclick="goEncounterSummary(event, <?php echo attr_js($patient_id) ?>)"><?php echo xlt("Past Encounters"); ?></button>
 774                     <?php } ?>
 775                 </div>
 776             </div>
 777         </form>
 778     </div>
 779 </div><!--End of container div-->
 780 <?php if ($from_posting) { ?>
 781 <script>
 782     var f1 = opener.document.forms[0];
 783     var f2 = document.forms[0];
 784     if (f1.form_source) {
 785         <?php
 786         // These support creation and lookup of ar_session table entries:
 787         echo "  f2.form_reference.value         = f1.form_source.value;\n";
 788         echo "  f2.form_check_date.value        = f1.form_paydate.value;\n";
 789         echo "  //f2.form_deposit_date.value      = f1.form_deposit_date.value;\n";
 790         echo "  if (f1.form_deposit_date.value != '')\n";
 791         echo "     f2.form_deposit_date.value      = f1.form_deposit_date.value;\n";
 792         echo "  else\n";
 793         echo "     f2.form_deposit_date.value      = getFormattedToday();\n";
 794         echo "  f2.form_payer_id.value          = f1.form_payer_id.value;\n";
 795         echo "  f2.form_pay_total.value         = f1.form_amount.value;\n";
 796         echo "  f2.form_orig_reference.value    = f1.form_source.value;\n";
 797         echo "  f2.form_orig_check_date.value   = f1.form_paydate.value;\n";
 798         echo "  f2.form_orig_deposit_date.value = f1.form_deposit_date.value;\n";
 799
 800         // While I'm thinking about it, some notes about eob sessions.
 801         // If they do not have all of the session key fields in the search
 802         // page, then show a warning at the top of the invoice page.
 803         // Also when they go to save the invoice page and a session key
 804         // field has changed, alert them to that and allow a cancel.
 805
 806         // Another point... when posting EOBs, the incoming payer ID might
 807         // not match the payer ID for the patient's insurance.  This is
 808         // because the same payer might be entered more than once into the
 809         // insurance_companies table.  I don't think it matters much.
 810         ?>
 811     }
 812     setins("Ins1");
 813 </script>
 814 <?php } ?>
 815 </body>
 816 </html>