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public static void spPDE_Claim_Reimb_Automation_TEST(string _type, int claimID, int _clientID) { SqlConnection conn = new SqlConnection(); conn.ConnectionString = "Initial Catalog=dbPDE;Data Source=localhost;Trusted_Connection=yes;MultipleActiveResultSets=true;"; string strCPT = string.Empty; string strSql = string.Empty; string strSql2 = string.Empty; string strStatus = string.Empty; string testState = getState(_clientID); string strState = testState; string strState2 = testState; string year = "2010"; int iRec, intQTY; double monNatRate, monReimb, fltAWI; fltAWI = getAWI(_clientID); if (year == "2010") year = string.Empty; else year = "_" + year; // T Status Update strSql = "SELECT CAST(ISNULL(C.units" + _type + ", 0) AS varchar(50)), C.HCPCS" + _type + " AS HCPCS, " + "AB.Status, AB.Weight, CAST(AB.[Nat Rate] AS varchar(40)), CAST(claimDetailID AS varchar(50)) " + "FROM CLAIM_tblDetail AS C LEFT OUTER JOIN " + "dbMasterData.dbo.vwADDB" + year + " AS AB ON LEFT(C.HCPCS" + _type + ", 5) = AB.HCPCS " + "WHERE (AB.Status = 'T') AND (C.claimID = " + claimID + ") " + "ORDER BY AB.Weight DESC"; SqlDataReader objDR = SqlHelper.ExecuteReader(conn, CommandType.Text, strSql); if (objDR.HasRows) { iRec = 0; while (objDR.Read()) { strSql = "UPDATE CLAIM_tblDetail SET [reimb" + _type + "] = 0" + " WHERE claimDetailID = " + Convert.ToInt32(objDR.GetString(5)) + " AND claimID = " + claimID; SqlHelper.ExecuteNonQuery(conn, CommandType.Text, strSql); monNatRate = Convert.ToDouble(objDR.GetString(4)) * 0.6 * fltAWI + Convert.ToDouble(objDR.GetString(4)) * 0.4; iRec = iRec + 1; intQTY = Convert.ToInt32(objDR.GetString(0)); if (iRec >= 1) { monReimb = monNatRate + (intQTY - 1) * 0.5 * monNatRate; } else { monReimb = 0.5 * monNatRate * intQTY; } if (objDR.GetString(1).Length > 5) { if (Right(objDR.GetString(1), 2) == "50") { monReimb = 1.5 * monReimb; } if (Right(objDR.GetString(1), 2) == "ZN" || Right(objDR.GetString(1), 2) == "NM") { monReimb = 0; } } strSql2 = "UPDATE CLAIM_tblDetail SET [reimb" + _type + "] = CASE WHEN [units" + _type + "] = 0 THEN 0 ELSE " + monReimb + " END WHERE claimDetailID =" + Convert.ToInt32(objDR.GetString(5)) + " AND claimID = " + claimID; SqlHelper.ExecuteNonQuery(conn, CommandType.Text, strSql2); } } // All Statuses other than T monReimb = 0; strSql = "SELECT CAST(ISNULL(C.units" + _type + ", 0) AS varchar(50)), C.HCPCS" + _type + " AS HCPCS, " + "AB.Status, AB.Weight, CAST(ISNULL(AB.[Nat Rate], 0) AS varchar(40)) AS [NatRate], CAST(claimDetailID AS varchar(50)) " + "FROM CLAIM_tblDetail AS C LEFT OUTER JOIN " + "dbMasterData.dbo.vwADDB" + year + " AS AB ON LEFT(C.HCPCS" + _type + ", 5) = LEFT(AB.HCPCS, 5) " + "WHERE (AB.Status <> 'T') AND (C.claimID = " + claimID + ") " + "ORDER BY AB.Weight DESC"; objDR = SqlHelper.ExecuteReader(conn, CommandType.Text, strSql); if (objDR.HasRows) { iRec = 0; while (objDR.Read()) { strCPT = objDR.GetString(1); intQTY = Convert.ToInt32(objDR.GetString(0)); monNatRate = Convert.ToDouble(objDR.GetString(4)); strStatus = strNull(objDR.GetString(2)); if (strCPT == "G0378") intQTY = 1; // Status A if (strStatus == "A") { string strDME = getDME(strCPT, strState) ?? "None"; if (strDME != "None") { double dme = Convert.ToDouble(getDME(strCPT, strState)); monReimb = intQTY * dme; } else { string strClinLab = getClinLab(strCPT, strState) ?? "None"; if (strClinLab != "None") { monReimb = intQTY * Convert.ToDouble(getClinLab(strCPT, strState)); } else { string strProFee = getClaimProFee(strCPT, claimID, year) ?? "None"; if (strProFee != "None") { monReimb = intQTY * Convert.ToDouble(getClaimProFee(strCPT, claimID, year)); } } } } // Status G, H, K - Use unadjusted Nat Rate, if null use Hospital CCR * REV from TRANS else { if (strStatus == "G" || strStatus == "H" || strStatus == "K") { monReimb = intQTY * monNatRate; } else { monReimb = intQTY * ((monNatRate * 0.6 * fltAWI) + (monNatRate * 0.4)); } } if (objDR.GetString(1).Length > 5) { if (Right(objDR.GetString(1), 2) == "50") { monReimb = 1.5 * monReimb; } if (Right(objDR.GetString(1), 2) == "ZN" || Right(objDR.GetString(1), 2) == "NM") { monReimb = 0; } } // 9/26/2006 - Pete wants those Z or X medical codes to grab the reimbursement as well if (Left(strCPT, 1) == "X" || Left(strCPT, 1) == "Z") { strSql = "SELECT basic_rt FROM vwMedicaid_CA_ZX WHERE proc_code = '" + strCPT + "'"; objDR = SqlHelper.ExecuteReader(conn, CommandType.Text, strSql); if (objDR.HasRows) { while (objDR.Read()) { monReimb = Convert.ToDouble(objDR.GetString(0)); } } } // Perform last update strSql2 = "UPDATE CLAIM_tblDetail SET [reimb" + _type + "] = CASE WHEN [units" + _type + "] = 0 THEN 0 ELSE " + monReimb + " END WHERE claimDetailID =" + Convert.ToInt32(objDR.GetString(5)) + " AND claimID = " + claimID; SqlHelper.ExecuteNonQuery(conn, CommandType.Text, strSql2); } objDR.Close(); } } private static string getClaimProFee(string code, int clientID) { SqlConnection conn = new SqlConnection(); conn.ConnectionString = "Initial Catalog=dbPDE;Data Source=localhost;Trusted_Connection=yes"; string result = String.Empty; SqlParameter[] aryParams = new SqlParameter[2]; aryParams[0] = new SqlParameter("@clientID ", SqlDbType.Int); aryParams[0].Value = clientID; aryParams[1] = new SqlParameter("@code", SqlDbType.VarChar); aryParams[1].Value = code; try { result = (string)SqlHelper.ExecuteScalar(conn, CommandType.StoredProcedure, "spPDE_MDCR_REIMB_ProFee_GET", aryParams); } catch (Exception ex) { result = "None"; } return result; } private static string getClaimProFee(string code, int claimID, string year) { SqlConnection conn = new SqlConnection(); conn.ConnectionString = "Initial Catalog=dbPDE;Data Source=localhost;Trusted_Connection=yes"; string result = String.Empty; SqlParameter[] aryParams = new SqlParameter[3]; aryParams[0] = new SqlParameter("@claimID", SqlDbType.Int); aryParams[0].Value = claimID; aryParams[1] = new SqlParameter("@code", SqlDbType.VarChar); aryParams[1].Value = code; aryParams[2] = new SqlParameter("@year", SqlDbType.VarChar); aryParams[2].Value = year; try { result = (string)SqlHelper.ExecuteScalar(conn, CommandType.StoredProcedure, "spPDE_ClaimProFee_GET", aryParams); } catch (Exception ex) { result = "None"; } return result; } private static string getClaimClinLab(string code, string state) { SqlConnection conn = new SqlConnection(); conn.ConnectionString = "Initial Catalog=dbPDE;Data Source=localhost;Trusted_Connection=yes"; switch (state) { case "CA": state = "CA1"; break; case "NY": state = "NY1"; break; case "MO": state = "MO1"; break; } string result = String.Empty; SqlParameter[] aryParams = new SqlParameter[2]; aryParams[0] = new SqlParameter("@code", SqlDbType.VarChar); aryParams[0].Value = code; aryParams[1] = new SqlParameter("@state", SqlDbType.VarChar); aryParams[1].Value = state; try { result = (string)SqlHelper.ExecuteScalar(conn, CommandType.StoredProcedure, "spPDE_ClaimClinLab_GET", aryParams); } catch { result = "None"; } return result; } private static string getClaimDME(string code, string state) { SqlConnection conn = new SqlConnection(); conn.ConnectionString = "Initial Catalog=dbPDE;Data Source=localhost;Trusted_Connection=yes"; string result = String.Empty; SqlParameter[] aryParams = new SqlParameter[2]; aryParams[0] = new SqlParameter("@code", SqlDbType.VarChar); aryParams[0].Value = code; aryParams[1] = new SqlParameter("@state", SqlDbType.VarChar); aryParams[1].Value = state; try { result = (string)SqlHelper.ExecuteScalar(conn, CommandType.StoredProcedure, "spPDE_ClaimDME_GET", aryParams); } catch (Exception ex) { result = "none"; } return result; } private static string getClaimYear(string _date) { DateTime dt = Convert.ToDateTime(_date); string _year = dt.Year.ToString(); return _year; } private static double getClaimAWI(int clientID) { SqlConnection conn = new SqlConnection(); conn.ConnectionString = "Initial Catalog=dbPDE;Data Source=localhost;Trusted_Connection=yes"; double result = 1; SqlParameter[] aryParams = new SqlParameter[1]; aryParams[0] = new SqlParameter("@clientID", SqlDbType.Int); aryParams[0].Value = clientID; try { result = (double)SqlHelper.ExecuteScalar(conn, CommandType.StoredProcedure, "spPDE_ClientAWI_GET", aryParams); } catch (Exception ex) { result = 1; } return result; } private static string getClaimState(int _clientID) { SqlConnection conn = new SqlConnection(); conn.ConnectionString = "Initial Catalog=dbPDE;Data Source=localhost;Trusted_Connection=yes"; string result = String.Empty; SqlParameter[] aryParams = new SqlParameter[1]; aryParams[0] = new SqlParameter("@clientID", SqlDbType.Int); aryParams[0].Value = _clientID; try { result = (string)SqlHelper.ExecuteScalar(conn, CommandType.StoredProcedure, "spPDE_ClientState_GET", aryParams); } catch (Exception ex) { result = "CA"; } return result; } public static string claimRight(string param, int length) { string result = param.Substring(param.Length - length, length); return result; } public static string claimLeft(string param, int length) { string result = param.Substring(0, length); return result; } public static string claimstrNull(string _null) { string test; if (_null == null) test = ""; else test = _null; return test; } };
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public static void spPDE_Claim_Reimb_Automation_TEST(string _type, int claimID, int _clientID) { SqlConnection conn = new SqlConnection(); conn.ConnectionString = "Initial Catalog=dbPDE;Data Source=localhost;Trusted_Connection=yes;MultipleActiveResultSets=true;"; try { conn.Open(); spPDE_Claim_Reimb_Automation_TEST2(conn, _type, claimID, _clientID); } finally { conn.Dispose(); } } public static void spPDE_Claim_Reimb_Automation_TEST2(SqlConnection conn, string _type, int claimID, int _clientID) { string strCPT = string.Empty; string strSql = string.Empty; string strSql2 = string.Empty; string strStatus = string.Empty; string testState = getState(_clientID); string strState = testState; string strState2 = testState; string year = "2010"; int iRec, intQTY; double monNatRate, monReimb, fltAWI; fltAWI = getAWI(_clientID); if (year == "2010") year = string.Empty; else year = "_" + year; // T Status Update strSql = "SELECT CAST(ISNULL(C.units" + _type + ", 0) AS varchar(50)), C.HCPCS" + _type + " AS HCPCS, " + "AB.Status, AB.Weight, CAST(AB.[Nat Rate] AS varchar(40)), CAST(claimDetailID AS varchar(50)) " + "FROM CLAIM_tblDetail AS C LEFT OUTER JOIN " + "dbMasterData.dbo.vwADDB" + year + " AS AB ON LEFT(C.HCPCS" + _type + ", 5) = AB.HCPCS " + "WHERE (AB.Status = 'T') AND (C.claimID = " + claimID + ") " + "ORDER BY AB.Weight DESC"; SqlDataReader objDR = SqlHelper.ExecuteReader(conn, CommandType.Text, strSql); if (objDR.HasRows) { iRec = 0; while (objDR.Read()) { strSql = "UPDATE CLAIM_tblDetail SET [reimb" + _type + "] = 0" + " WHERE claimDetailID = " + Convert.ToInt32(objDR.GetString(5)) + " AND claimID = " + claimID; SqlHelper.ExecuteNonQuery(conn, CommandType.Text, strSql); monNatRate = Convert.ToDouble(objDR.GetString(4)) * 0.6 * fltAWI + Convert.ToDouble(objDR.GetString(4)) * 0.4; iRec = iRec + 1; intQTY = Convert.ToInt32(objDR.GetString(0)); if (iRec >= 1) { monReimb = monNatRate + (intQTY - 1) * 0.5 * monNatRate; } else { monReimb = 0.5 * monNatRate * intQTY; } if (objDR.GetString(1).Length > 5) { if (Right(objDR.GetString(1), 2) == "50") { monReimb = 1.5 * monReimb; } if (Right(objDR.GetString(1), 2) == "ZN" || Right(objDR.GetString(1), 2) == "NM") { monReimb = 0; } } strSql2 = "UPDATE CLAIM_tblDetail SET [reimb" + _type + "] = CASE WHEN [units" + _type + "] = 0 THEN 0 ELSE " + monReimb + " END WHERE claimDetailID =" + Convert.ToInt32(objDR.GetString(5)) + " AND claimID = " + claimID; SqlHelper.ExecuteNonQuery(conn, CommandType.Text, strSql2); } } // All Statuses other than T monReimb = 0; strSql = "SELECT CAST(ISNULL(C.units" + _type + ", 0) AS varchar(50)), C.HCPCS" + _type + " AS HCPCS, " + "AB.Status, AB.Weight, CAST(ISNULL(AB.[Nat Rate], 0) AS varchar(40)) AS [NatRate], CAST(claimDetailID AS varchar(50)) " + "FROM CLAIM_tblDetail AS C LEFT OUTER JOIN " + "dbMasterData.dbo.vwADDB" + year + " AS AB ON LEFT(C.HCPCS" + _type + ", 5) = LEFT(AB.HCPCS, 5) " + "WHERE (AB.Status <> 'T') AND (C.claimID = " + claimID + ") " + "ORDER BY AB.Weight DESC"; objDR = SqlHelper.ExecuteReader(conn, CommandType.Text, strSql); if (objDR.HasRows) { iRec = 0; while (objDR.Read()) { strCPT = objDR.GetString(1); intQTY = Convert.ToInt32(objDR.GetString(0)); monNatRate = Convert.ToDouble(objDR.GetString(4)); strStatus = strNull(objDR.GetString(2)); if (strCPT == "G0378") intQTY = 1; // Status A if (strStatus == "A") { string strDME = getDME(strCPT, strState) ?? "None"; if (strDME != "None") { double dme = Convert.ToDouble(getDME(strCPT, strState)); monReimb = intQTY * dme; } else { string strClinLab = getClinLab(strCPT, strState) ?? "None"; if (strClinLab != "None") { monReimb = intQTY * Convert.ToDouble(getClinLab(strCPT, strState)); } else { string strProFee = getClaimProFee(strCPT, claimID, year) ?? "None"; if (strProFee != "None") { monReimb = intQTY * Convert.ToDouble(getClaimProFee(strCPT, claimID, year)); } } } } // Status G, H, K - Use unadjusted Nat Rate, if null use Hospital CCR * REV from TRANS else { if (strStatus == "G" || strStatus == "H" || strStatus == "K") { monReimb = intQTY * monNatRate; } else { monReimb = intQTY * ((monNatRate * 0.6 * fltAWI) + (monNatRate * 0.4)); } } if (objDR.GetString(1).Length > 5) { if (Right(objDR.GetString(1), 2) == "50") { monReimb = 1.5 * monReimb; } if (Right(objDR.GetString(1), 2) == "ZN" || Right(objDR.GetString(1), 2) == "NM") { monReimb = 0; } } // 9/26/2006 - Pete wants those Z or X medical codes to grab the reimbursement as well if (Left(strCPT, 1) == "X" || Left(strCPT, 1) == "Z") { strSql = "SELECT basic_rt FROM vwMedicaid_CA_ZX WHERE proc_code = '" + strCPT + "'"; objDR = SqlHelper.ExecuteReader(conn, CommandType.Text, strSql); if (objDR.HasRows) { while (objDR.Read()) { monReimb = Convert.ToDouble(objDR.GetString(0)); } } } // Perform last update strSql2 = "UPDATE CLAIM_tblDetail SET [reimb" + _type + "] = CASE WHEN [units" + _type + "] = 0 THEN 0 ELSE " + monReimb + " END WHERE claimDetailID =" + Convert.ToInt32(objDR.GetString(5)) + " AND claimID = " + claimID; SqlHelper.ExecuteNonQuery(conn, CommandType.Text, strSql2); } objDR.Close(); } } private static string getClaimProFee(string code, int clientID) { SqlConnection conn = new SqlConnection(); conn.ConnectionString = "Initial Catalog=dbPDE;Data Source=localhost;Trusted_Connection=yes"; string result = String.Empty; try { SqlParameter[] aryParams = new SqlParameter[2]; aryParams[0] = new SqlParameter("@clientID ", SqlDbType.Int); aryParams[0].Value = clientID; aryParams[1] = new SqlParameter("@code", SqlDbType.VarChar); aryParams[1].Value = code; conn.Open(); result = (string)SqlHelper.ExecuteScalar(conn, CommandType.StoredProcedure, "spPDE_MDCR_REIMB_ProFee_GET", aryParams); } catch (Exception ex) { result = "None"; } finally { conn.Dispose(); } return result; } private static string getClaimProFee(string code, int claimID, string year) { SqlConnection conn = new SqlConnection(); conn.ConnectionString = "Initial Catalog=dbPDE;Data Source=localhost;Trusted_Connection=yes"; string result = String.Empty; try { SqlParameter[] aryParams = new SqlParameter[3]; aryParams[0] = new SqlParameter("@claimID", SqlDbType.Int); aryParams[0].Value = claimID; aryParams[1] = new SqlParameter("@code", SqlDbType.VarChar); aryParams[1].Value = code; aryParams[2] = new SqlParameter("@year", SqlDbType.VarChar); aryParams[2].Value = year; conn.Open(); result = (string)SqlHelper.ExecuteScalar(conn, CommandType.StoredProcedure, "spPDE_ClaimProFee_GET", aryParams); } catch (Exception ex) { result = "None"; } finally { conn.Dispose(); } return result; } private static string getClaimClinLab(string code, string state) { SqlConnection conn = new SqlConnection(); conn.ConnectionString = "Initial Catalog=dbPDE;Data Source=localhost;Trusted_Connection=yes"; switch (state) { case "CA": state = "CA1"; break; case "NY": state = "NY1"; break; case "MO": state = "MO1"; break; } string result = String.Empty; try { SqlParameter[] aryParams = new SqlParameter[2]; aryParams[0] = new SqlParameter("@code", SqlDbType.VarChar); aryParams[0].Value = code; aryParams[1] = new SqlParameter("@state", SqlDbType.VarChar); aryParams[1].Value = state; conn.Open(); result = (string)SqlHelper.ExecuteScalar(conn, CommandType.StoredProcedure, "spPDE_ClaimClinLab_GET", aryParams); } catch { result = "None"; } finally { conn.Dispose(); } return result; } private static string getClaimDME(string code, string state) { SqlConnection conn = new SqlConnection(); conn.ConnectionString = "Initial Catalog=dbPDE;Data Source=localhost;Trusted_Connection=yes"; string result = String.Empty; try { SqlParameter[] aryParams = new SqlParameter[2]; aryParams[0] = new SqlParameter("@code", SqlDbType.VarChar); aryParams[0].Value = code; aryParams[1] = new SqlParameter("@state", SqlDbType.VarChar); aryParams[1].Value = state; conn.Open(); result = (string)SqlHelper.ExecuteScalar(conn, CommandType.StoredProcedure, "spPDE_ClaimDME_GET", aryParams); } catch (Exception ex) { result = "none"; } finally { conn.Dispose(); } return result; } private static string getClaimYear(string _date) { DateTime dt = Convert.ToDateTime(_date); string _year = dt.Year.ToString(); return _year; } private static double getClaimAWI(int clientID) { SqlConnection conn = new SqlConnection(); conn.ConnectionString = "Initial Catalog=dbPDE;Data Source=localhost;Trusted_Connection=yes"; double result = 1; try { SqlParameter[] aryParams = new SqlParameter[1]; aryParams[0] = new SqlParameter("@clientID", SqlDbType.Int); aryParams[0].Value = clientID; conn.Open(); result = (double)SqlHelper.ExecuteScalar(conn, CommandType.StoredProcedure, "spPDE_ClientAWI_GET", aryParams); } catch (Exception ex) { result = 1; } finally { conn.Dispose(); } return result; } private static string getClaimState(int _clientID) { SqlConnection conn = new SqlConnection(); conn.ConnectionString = "Initial Catalog=dbPDE;Data Source=localhost;Trusted_Connection=yes"; string result = String.Empty; try { SqlParameter[] aryParams = new SqlParameter[1]; aryParams[0] = new SqlParameter("@clientID", SqlDbType.Int); aryParams[0].Value = _clientID; conn.Open(); result = (string)SqlHelper.ExecuteScalar(conn, CommandType.StoredProcedure, "spPDE_ClientState_GET", aryParams); } catch (Exception ex) { result = "CA"; } finally { conn.Dispose(); } return result; } public static string claimRight(string param, int length) { string result = param.Substring(param.Length - length, length); return result; } public static string claimLeft(string param, int length) { string result = param.Substring(0, length); return result; } public static string claimstrNull(string _null) { string test; if (_null == null) test = ""; else test = _null; return test; }