Summary Table

Categories Total Count
PII 0
URL 0
DNS 0
EKL 0
IP 0
PORT 0
VsID 0
CF 0
AI 0
VPD 0
PL 0
Other 0

File Content

<div class="accordion ewv" [ngClass]="{'split': isSplitView}">
<input id="{{accordionId}}" type="checkbox" [(ngModel)]="collapseState" role="button" aria-label="Billing Miscellaneous Section">
<label for="{{accordionId}}">Billing Miscellaneous</label>
<!-- Accordion Content -->
<div class="accordion-content row">
<app-messages [ewvNoInfo]="!billingMiscellanousData" [ewvMsg]="billingMisMsg"></app-messages>
<div class="row"></div>
<div class="info-table">
<!-- Column One -->
<div *ngIf='billingMiscellanousData' class="col one">
<table id="TBL_info_billingMiscellaneous_1">
<tbody>
<tr>
<th>
Patient Account #:
</th>
<td>
<ng-container *ngIf="isRightSide">
<span appHighlight [rightSideData]="billingMiscellanousData?.patientAccountNumber" [leftSideData]="compareBillingMiscellanousData?.patientAccountNumber">
{{ billingMiscellanousData?.patientAccountNumber }}
</span>
</ng-container>
<ng-container *ngIf="!isRightSide">
{{ billingMiscellanousData?.patientAccountNumber }}
</ng-container>
</td>
</tr>
<tr>
<th>
<!-- NEED TO DO POS -->
<!-- POS/Frequency: -->
{{ typeOfBillingOrFrequencyLabelString }}
</th>
<td>
<ng-container *ngIf="billingMiscellanousData.placeOfService === '\u2013\u2013\u2013'">
<ng-container *ngIf="isRightSide">
<span appHighlight [rightSideData]="billingMiscellanousData?.typeOfBill" [leftSideData]="compareBillingMiscellanousData?.typeOfBill">
{{ billingMiscellanousData?.typeOfBill}}
</span>
</ng-container>
<ng-container *ngIf="!isRightSide">
{{ billingMiscellanousData?.typeOfBill}}
</ng-container>
</ng-container>
<ng-container *ngIf="billingMiscellanousData.placeOfService !== '\u2013\u2013\u2013'">
<ng-container *ngIf="isRightSide">
<span appHighlight [rightSideData]="billingMiscellanousData?.placeOfService" [leftSideData]="compareBillingMiscellanousData?.placeOfService">
{{ billingMiscellanousData?.placeOfService }}
</span>
</ng-container>
<ng-container *ngIf="!isRightSide">
{{ billingMiscellanousData?.placeOfService }}
</ng-container>
</ng-container>
<!-- TOB is used for Inst. claims; POS is used for Prof. claims. -->
<ng-container *ngIf="isRightSide">
/
<span appHighlight [rightSideData]="billingMiscellanousData?.frequency" [leftSideData]="compareBillingMiscellanousData?.frequency">
{{ billingMiscellanousData?.frequency }}
</span>
</ng-container>
<ng-container *ngIf="!isRightSide">
/{{ billingMiscellanousData?.frequency }}
</ng-container>
</td>
</tr>
<tr *ngIf="claimType === 'INSTITUTIONAL'">
<th>
Statement From/To:
</th>
<td>
<ng-container *ngIf="isRightSide">
<span appHighlight [rightSideData]="billingMiscellanousData?.statementFromTo" [leftSideData]="compareBillingMiscellanousData?.statementFromTo">
{{ billingMiscellanousData?.statementFromTo }}
</span>
</ng-container>
<ng-container *ngIf="!isRightSide">
{{ billingMiscellanousData?.statementFromTo }}
</ng-container>
</td>
</tr>
<tr>
<th>
Previous PDI/Claim ID:
</th>
<td>
<ng-container *ngIf="isRightSide">
<span appHighlight [rightSideData]="billingMiscellanousData?.previousPDIOrClaimNumber" [leftSideData]="compareBillingMiscellanousData?.previousPDIOrClaimNumber">
{{ billingMiscellanousData?.previousPDIOrClaimNumber }}
</span>
</ng-container>
<ng-container *ngIf="!isRightSide">
{{ billingMiscellanousData?.previousPDIOrClaimNumber }}
</ng-container>
</td>
</tr>
<tr>
<th>
Admission Type:
</th>
<td>
<ng-container *ngIf="isRightSide">
<span appHighlight [rightSideData]="billingMiscellanousData?.admissionType" [leftSideData]="compareBillingMiscellanousData?.admissionType">
{{ billingMiscellanousData?.admissionType }}
</span>
</ng-container>
<ng-container *ngIf="!isRightSide">
{{ billingMiscellanousData?.admissionType }}
</ng-container>
</td>
</tr>
<tr>
<th>
Admission Source:
</th>
<td>
<ng-container *ngIf="isRightSide">
<span appHighlight [rightSideData]="billingMiscellanousData?.admissionSource" [leftSideData]="compareBillingMiscellanousData?.admissionSource">
{{ billingMiscellanousData?.admissionSource }}
</span>
</ng-container>
<ng-container *ngIf="!isRightSide">
{{ billingMiscellanousData?.admissionSource }}
</ng-container>
</td>
</tr>
<tr *ngIf="claimType !== 'DENTAL'">
<th>
Date/Hour:
</th>
<td>
<ng-container *ngIf="isRightSide">
<span appHighlight [rightSideData]="billingMiscellanousData?.admissionDateOrHour" [leftSideData]="compareBillingMiscellanousData?.admissionDateOrHour">
{{ billingMiscellanousData?.admissionDateOrHour }}
</span>
</ng-container>
<ng-container *ngIf="!isRightSide">
{{ billingMiscellanousData?.admissionDateOrHour }}
</ng-container>
</td>
</tr>
<tr>
<th>
Accident Date:
</th>
<td>
<ng-container *ngIf="isRightSide">
<span appHighlight [rightSideData]="billingMiscellanousData?.accidentDate" [leftSideData]="compareBillingMiscellanousData?.accidentDate">
{{ billingMiscellanousData?.accidentDate }}
</span>
</ng-container>
<ng-container *ngIf="!isRightSide">
{{ billingMiscellanousData?.accidentDate }}
</ng-container>
</td>
</tr>
<tr>
<th>
Accident Ind:
</th>
<td>
<ng-container *ngIf="isRightSide">
<span appHighlight [rightSideData]="billingMiscellanousData?.accidentIndicator" [leftSideData]="compareBillingMiscellanousData?.accidentIndicator">
{{ billingMiscellanousData?.accidentIndicator }}
</span>
</ng-container>
<ng-container *ngIf="!isRightSide">
{{ billingMiscellanousData?.accidentIndicator }}
</ng-container>
</td>
</tr>
</tbody>
</table>
</div>
<!-- Column Two -->
<div *ngIf='billingMiscellanousData' class="col one" [ngClass]="{'no-flow': isSplitView}">
<table id="TBL_info_billingMiscellaneous_2" class="td-test">
<tbody>
<tr>
<th>
Patient Paid Amt:
</th>
<!-- needs dollar sign -->
<td>
<ng-container *ngIf="isRightSide">
<span appHighlight [rightSideData]="billingMiscellanousData?.patientPaidAmount" [leftSideData]="compareBillingMiscellanousData?.patientPaidAmount">
{{ billingMiscellanousData?.patientPaidAmount ==='\u2013\u2013\u2013' ? '\u2013\u2013\u2013' : '$'+
billingMiscellanousData?.patientPaidAmount }}
</span>
</ng-container>
<ng-container *ngIf="!isRightSide">
{{ billingMiscellanousData?.patientPaidAmount ==='\u2013\u2013\u2013' ? '\u2013\u2013\u2013' : '$'+
billingMiscellanousData?.patientPaidAmount }}
</ng-container>
</td>
</tr>
<tr *ngIf="claimType !== 'DENTAL'">
<th>
Patient Signature:
</th>
<td>
<ng-container *ngIf="isRightSide">
<span appHighlight [rightSideData]="billingMiscellanousData?.patientSignature" [leftSideData]="compareBillingMiscellanousData?.patientSignature">
{{ billingMiscellanousData?.patientSignature }}
</span>
</ng-container>
<ng-container *ngIf="!isRightSide">
{{ billingMiscellanousData?.patientSignature }}
</ng-container>
</td>
</tr>
<tr *ngIf="claimType == 'INSTITUTIONAL'">
<th>
Patient Status:
</th>
<td>
<ng-container *ngIf="isRightSide">
<span appHighlight [rightSideData]="billingMiscellanousData?.patientStatus" [leftSideData]="compareBillingMiscellanousData?.patientStatus">
{{ billingMiscellanousData?.patientStatus }}
</span>
</ng-container>
<ng-container *ngIf="!isRightSide">
{{ billingMiscellanousData?.patientStatus }}
</ng-container>
</td>
</tr>
<tr>
<th>
Prior Authorization:
</th>
<!-- need clarification -->
<td [class.ellipsis]="billingMiscellanousData?.priorAuthorizationReferralLong.length> 21" [attr.title]="billingMiscellanousData?.priorAuthorizationReferralLong.length> 21? billingMiscellanousData?.priorAuthorizationReferralLong: ''">
<ng-container *ngIf="isRightSide">
<span appHighlight [rightSideData]="billingMiscellanousData?.priorAuthorizationReferralLong"
[leftSideData]="compareBillingMiscellanousData?.priorAuthorizationReferralLong">
{{ billingMiscellanousData?.priorAuthorizationReferralLong }}
</span>
</ng-container>
<ng-container *ngIf="!isRightSide">
{{ billingMiscellanousData?.priorAuthorizationReferralLong }}
</ng-container>
</td>
</tr>
<tr>
<th>
Referral Number:
</th>
<!-- need clarification -->
<td [class.ellipsis]="billingMiscellanousData?.referralLong_5010.length> 25" [attr.title]="billingMiscellanousData?.referralLong_5010.length> 25? billingMiscellanousData?.referralLong_5010: ''">
<ng-container *ngIf="isRightSide">
<span appHighlight [rightSideData]="billingMiscellanousData?.referralLong_5010" [leftSideData]="compareBillingMiscellanousData?.referralLong_5010">
{{ billingMiscellanousData?.referralLong_5010 }}
</span>
</ng-container>
<ng-container *ngIf="!isRightSide">
{{ billingMiscellanousData?.referralLong_5010 }}
</ng-container>
</td>
</tr>
<tr>
<th>
Provider Accept Asgmt:
</th>
<td>
<ng-container *ngIf="isRightSide">
<span appHighlight [rightSideData]="billingMiscellanousData?.providerAcceptsAssignment"
[leftSideData]="compareBillingMiscellanousData?.providerAcceptsAssignment">
{{ billingMiscellanousData?.providerAcceptsAssignment }}
</span>
</ng-container>
<ng-container *ngIf="!isRightSide">
{{ billingMiscellanousData?.providerAcceptsAssignment }}
</ng-container>
</td>
</tr>
<tr>
<th>
Assignment of Benefits:
</th>
<td>
<ng-container *ngIf="isRightSide">
<span appHighlight [rightSideData]="billingMiscellanousData?.assignmentOfBenefits" [leftSideData]="compareBillingMiscellanousData?.assignmentOfBenefits">
{{ billingMiscellanousData?.assignmentOfBenefits }}
</span>
</ng-container>
<ng-container *ngIf="!isRightSide">
{{ billingMiscellanousData?.assignmentOfBenefits }}
</ng-container>
</td>
</tr>
<tr *ngIf="claimType !== 'DENTAL'">
<th>
Discharge Date/Hour:
</th>
<td>
<ng-container *ngIf="isRightSide">
<span appHighlight [rightSideData]="billingMiscellanousData?.dischargeDateOrHour" [leftSideData]="compareBillingMiscellanousData?.dischargeDateOrHour">
{{ billingMiscellanousData?.dischargeDateOrHour }}
</span>
</ng-container>
<ng-container *ngIf="!isRightSide">
{{ billingMiscellanousData?.dischargeDateOrHour }}
</ng-container>
</td>
</tr>
<tr *ngIf="claimType !== 'DENTAL'">
<th>
Medicare Int. Ctrl. Num:
</th>
<td>
<ng-container *ngIf="isRightSide">
<span appHighlight [rightSideData]="billingMiscellanousData?.medicareIcn" [leftSideData]="compareBillingMiscellanousData?.medicareIcn">
{{ billingMiscellanousData?.medicareIcn }}
</span>
</ng-container>
<ng-container *ngIf="!isRightSide">
{{ billingMiscellanousData?.medicareIcn }}
</ng-container>
</td>
</tr>
</tbody>
</table>
</div>

<!-- Column Three -->
<div *ngIf='billingMiscellanousData' class="col one no-flow">
<table id="TBL_info_billingMiscellaneous_3" class="td-test">
<tbody>
<tr>
<th>
Rendering Prov. Name:
</th>
<td>
<ng-container *ngIf="isRightSide">
<span appHighlight [rightSideData]="billingMiscellanousData?.renderingPrvdName" [leftSideData]="compareBillingMiscellanousData?.renderingPrvdName">
{{ billingMiscellanousData?.renderingPrvdName }}
</span>
</ng-container>
<ng-container *ngIf="!isRightSide">
{{ billingMiscellanousData?.renderingPrvdName }}
</ng-container>
</td>
</tr>
<tr>
<th>
NPI:
</th>
<td>
<ng-container *ngIf="isRightSide">
<span appHighlight [rightSideData]="billingMiscellanousData?.renderingPrvdNpi" [leftSideData]="compareBillingMiscellanousData?.renderingPrvdNpi">
{{ billingMiscellanousData?.renderingPrvdNpi }}
</span>
</ng-container>
<ng-container *ngIf="!isRightSide">
{{ billingMiscellanousData?.renderingPrvdNpi }}
</ng-container>
</td>
</tr>
<tr>
<th>
Taxonomy Code:
</th>
<td [class.ellipsis]="billingMiscellanousData.renderingPrvdTaxonomyCode.length> 21" [attr.title]="billingMiscellanousData.renderingPrvdTaxonomyCode.length> 21? billingMiscellanousData.renderingPrvdTaxonomyCode: ''">
<ng-container *ngIf="isRightSide">
<span appHighlight [rightSideData]="billingMiscellanousData?.renderingPrvdTaxonomyCode"
[leftSideData]="compareBillingMiscellanousData?.renderingPrvdTaxonomyCode">
{{ billingMiscellanousData?.renderingPrvdTaxonomyCode }}
</span>
</ng-container>
<ng-container *ngIf="!isRightSide">
{{ billingMiscellanousData?.renderingPrvdTaxonomyCode }}
</ng-container>
</td>
</tr>
<tr *ngIf="claimType == 'INSTITUTIONAL'">
<th>
Diagnosis Related Grp:
</th>
<!-- TODO find value differences -->
<td>
<ng-container *ngIf="isRightSide">
<span appHighlight [rightSideData]="diagnosisRelatedGroup" [leftSideData]="compareDiagnosisRelatedGroup">
{{ diagnosisRelatedGroup }}
</span>
</ng-container>
<ng-container *ngIf="!isRightSide">
{{ diagnosisRelatedGroup }}
</ng-container>
</td>
</tr>
<tr>
<th>
DME Procedure:
</th>
<td>
<ng-container *ngIf="isRightSide">
<span appHighlight [rightSideData]="billingMiscellanousData?.dmeProcedure" [leftSideData]="compareBillingMiscellanousData?.dmeProcedure">
{{ billingMiscellanousData?.dmeProcedure }}
</span>
</ng-container>
<ng-container *ngIf="!isRightSide">
{{ billingMiscellanousData?.dmeProcedure }}
</ng-container>
</td>
</tr>
<tr>
<th>
DME Modifier:
</th>
<td>
<ng-container *ngIf="isRightSide">
<span appHighlight [rightSideData]="billingMiscellanousData?.dmeModifier" [leftSideData]="compareBillingMiscellanousData?.dmeModifier">
{{ billingMiscellanousData?.dmeModifier }}
</span>
</ng-container>
<ng-container *ngIf="!isRightSide">
{{ billingMiscellanousData?.dmeModifier }}
</ng-container>
</td>
</tr>
<tr>
<th>
DME Frequency:
</th>
<td>
<ng-container *ngIf="isRightSide">
<span appHighlight [rightSideData]="billingMiscellanousData?.dmeFrequency" [leftSideData]="compareBillingMiscellanousData?.dmeFrequency">
{{ billingMiscellanousData?.dmeFrequency }}
</span>
</ng-container>
<ng-container *ngIf="!isRightSide">
{{ billingMiscellanousData?.dmeFrequency }}
</ng-container>
</td>
</tr>
</tbody>
</table>
</div>

<div [ngStyle]="{'width': isSplitView ? '788px' : '1191px'}" class="row col three">
<div class="fix">
<div *ngFor="let link of attachmentList" class="attachment-links">
<div class="label">Attachment(s):</div>
<div class="icon">
<a style="cursor:pointer" (click)="onDisplayAttachmentViewer(link)">
<img [src]="getAttachmentIcon(link)" [alt]="getAttachmentIcon(link)" /><!-- fix method call on html property binding -->
</a>
</div>
<div class="code">
<a style="cursor:pointer" (click)="onDisplayAttachmentViewer(link)">
{{link?.attachmentId}}
</a>
</div>
<div class="description">{{link?.reportCode}}: {{link?.reportDefinition}}</div>
</div>
</div>
</div>
</div>
</div>
<app-attachment-viewer [attachKey]="{attachIdLx: selectedAttachment, status: 'Active'}" [open]="displayAttachmentViewer"
(notify)="onAttachmentViewerClose($event)"></app-attachment-viewer>
</div>