INSERT IGNORE INTO #Request.prefix_db_agency#.claim_bill (Type_of_Bill , Assignment_Accept ,Submitter_ID,Receiver_ID,PayName,Payer_Number,PayAdd1 ,PayCity,PayState,PayZip ,Referring_PNPI,MSA_Code, Agency_Name,Agency_State,Agency_ZIP,Agency_City,Agency_Address1,Agency_Contact_Phone,Agent_FEIN,ANPI,HI_Claim_Number,Agency_Assigned_ID,First_Name_M0040, Middle_Initial_M0040, Last_Name_M0040, State_M0050,Admission_Status,Zip_M0060,City, Street_Address ,Telephone ,DOB_M0066,Gender_M0069,Certification_Start,Certification_End , Start_of_Care_M0030,Source_of_Admission ,Assessment_Reason_M0100,Claim_Key,HHRG_175_Score,HHRG_230_Score,HHRG_250_Score,HHRG_390_Score ,HHRG_420_Score,HHRG_440_Score ,Referring_FirstName ,Referring_LastName, Invoice_ID,Payer_ID) VALUES ('', '', '#Trim(form.Submitter_ID)#', '#Trim(form.Receiver_ID)#', '#Trim(form.PayName)#', '#Trim(form.Payer_Number)#', '#Trim(form.Address1)#', '#Trim(form.payerCity)#', '#Trim(form.State)#', '#Trim(form.Zip)#', '', '#Trim(form.MSA_Code)#', '#Trim(form.Agency_Name)#', '#Trim(form.Agency_State)#', '#Trim(form.Agency_ZIP)#', '#Trim(form.Agency_City)#', '#Trim(form.Agency_Address1)#', '#Trim(form.Agency_Contact_Phone)#', '#Trim(form.Agent_FEIN)#', '#Trim(form.Natl_Provider_ID2)#', '#Trim(form.HI_Claim_Number)#', '#Trim(form.agency_assigned_id)#', '#Trim(form.firstname)#', '#Trim(form.MiddleInitial1)#', '#Trim(form.lastname)#', '#Trim(form.State_M0050)#', '#Trim(form.Admission_Status)#', '#Trim(form.Zip_M0060)#', '#Trim(form.City)#', '#Trim(form.Street_Address)#', '#form.phone#', #CreateODBCDate(form.DOB_M0066)#, '#Trim(form.gender)#', #CreateODBCDate(form.Certification_Start)#, #CreateODBCDate(form.Certification_End)#, #CreateODBCDate(form.Start_of_care_M0030)#, '#Trim(form.Source_of_Admission)#', '#Trim(form.Assessment_Reason_M0100)#', '#Trim(form.Claim_Key)#', '#Trim(form.HHRG_175_Score)#' , '#Trim(form.HHRG_230_Score)#', '#Trim(form.HHRG_250_Score)#', '#Trim(form.HHRG_390_Score)#', '#Trim(form.HHRG_420_Score)#', '#Trim(form.HHRG_440_Score)#', '#Trim(form.First_Name)#', '#Trim(form.Last_Name)#', '#url.inv#', '#form.PYID#') UPDATE #Request.prefix_db_agency#.claim_bill SET Agency_Name ='#Trim(form.Agency_Name)#', Agency_State = '#Trim(form.Agency_State)#', Agency_ZIP = '#Trim(form.Agency_ZIP)#', Agency_City = '#Trim(form.Agency_City)#', Agency_Address1 = '#Trim(form.Agency_Address1)#', Agency_Contact_Phone = '#Trim(form.Agency_Contact_Phone)#', Agent_FEIN = '#Trim(form.Agent_FEIN)#', ANPI ='#Trim(form.Natl_Provider_ID2)#', HI_Claim_Number = '#Trim(form.HI_Claim_Number)#', Agency_Assigned_ID = '#Trim(form.agency_assigned_id)#', First_Name_M0040 = '#Trim(form.firstname)#', Last_Name_M0040 = '#Trim(form.lastname)#', Middle_Initial_M0040 = '#Trim(form.MiddleInitial1)#', State_M0050 = '#Trim(form.State_M0050)#', Admission_Status = '#(form.Admission_Status)#', Zip_M0060 = '#Trim(form.Zip_M0060)#', City = '#Trim(form.City)#', Street_Address = '#Trim(form.Street_Address)#', Telephone = '#form.phone#', DOB_M0066 = #CreateODBCDate(form.DOB_M0066)#, Gender_M0069 = '#Trim(form.gender)#', Certification_Start = #CreateODBCDate(form.Certification_Start)#, Certification_End = #CreateODBCDate(form.Certification_End)#, Start_of_Care_M0030 = #CreateODBCDate(form.Start_of_care_M0030)#, Source_of_Admission = '#Trim(form.Source_of_Admission)#', Assessment_Reason_M0100 = '#Trim(form.Assessment_Reason_M0100)#', Claim_Key = '#Trim(form.Claim_Key)#', HHRG_175_Score = '#Trim(form.HHRG_175_Score)#' , HHRG_230_Score = '#Trim(form.HHRG_230_Score)#', HHRG_250_Score = '#Trim(form.HHRG_250_Score)#', HHRG_390_Score = '#Trim(form.HHRG_390_Score)#', HHRG_420_Score = '#Trim(form.HHRG_420_Score)#', HHRG_440_Score = '#Trim(form.HHRG_440_Score)#', Referring_FirstName = '#Trim(form.First_Name)#', Referring_LastName = '#Trim(form.Last_Name)#', Payer_ID = '#form.PYID#' WHERE Invoice_ID = '#url.inv#' AND ID = '#form.ID#' SELECT DISTINCT si.Rev_Code,si.Visit_Type,si.HCPCS,si.Visit_Date,si.Total_Units,si.Total_Eclaim ,si.ScheduleItems_ID,si.Output_Type, i.Invoice_ID, i.InvoiceTotal, i.PayerBalance, rc.Rev_CodeID, rc.Visit_Type, rc.Description, rc.Rev_Code, rc.HCPCS, rc.Payer_ID,rc.RevenueCodeStatus, rc.EClaim_Price, rc.Measure FROM #Request.prefix_db_agency#.Invoices i JOIN #Request.prefix_db_agency#.ScheduleItems si on si.invoice_id = i.invoice_id RIGHT OUTER JOIN #Request.prefix_db_agency#.Revenue_Code rc on rc.Rev_CodeID = si.Rev_CodeID WHERE i.invoice_id = '#url.inv#' AND i.Agency_ID = '#session.agencyid#' AND si.invoice_id = i.invoice_id AND rc.Payer_ID = si.Payer_ID AND si.Assessment_Tracker_ID = i.Assessment_Tracker_ID AND si.Total_Eclaim !=0 AND si.deleted = 0 Group by si.ScheduleItems_ID order by si.Visit_Date ASC UPDATE #Request.prefix_db_agency#.ScheduleItems SET HCPCS = '#form.HCPCS#', Visit_Date = '#DateFormat(form.Visit_Date,"yyyy-mm-dd")#', Total_Units = '#form.Total_Units#', Total_Eclaim = '#form.Total_Eclaim#' WHERE ScheduleItems_ID = '#GETSID.ScheduleItems_ID#' UPDATE #Request.prefix_db_agency#.ScheduleItems SET HCPCS = '#HCPCS#', Visit_Date = '#DateFormat(VD,'yyyy-mm-dd')#', Total_Units = '#TTU#', Total_Eclaim = '#TTE#' WHERE ScheduleItems_ID = '#ID#' UPDATE #Request.prefix_db_agency#.Invoices SET InvoiceTotal = '#Trim(form.InvoiceTotal)#' ,Record_Modified_By = '#Session.EmployeeId#' ,Record_Modified_Date = #now()# where invoice_id='#url.inv#' select p.TurboClaim,p.Payer_ID from #Request.prefix_db_agency#.Payer p JOIN #Request.prefix_db_agency#.Invoices i on i.PatientPayer_ID = p.Payer_ID where i.invoice_id = '#url.inv#'
HEALTH INSURANCECLAIM FORM

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