change_health 1.0.3 → 2.2.1

data/lib/change_health/request/submission.rb

@@ -0,0 +1,58 @@
+module ChangeHealth
+  module Request
+    module Claim
+      class Submission < Hashie::Trash
+        
+        ENDPOINT = '/medicalnetwork/professionalclaims/v3'.freeze
+        HEALTH_CHECK_ENDPOINT = ENDPOINT + '/healthcheck'.freeze
+        SUBMISSION_ENDPOINT = ENDPOINT + '/submission'.freeze
+        VALIDATION_ENDPOINT = ENDPOINT + '/validation'.freeze
+
+        property :claimInformation, from: :claim_information, required: false
+        property :controlNumber, from: :control_number, required: true, default: ChangeHealth::Models::CONTROL_NUMBER
+        property :providers, required: false
+        property :receiver, required: false
+        property :submitter, required: false
+        property :subscriber, required: false
+        property :headers, required: false
+        # Need one or the other, trading partner id or trading partner service id
+        property :tradingPartnerId, from: :trading_partner_id, required: false
+        property :tradingPartnerServiceId, from: :trading_partner_service_id, required: false
+
+        def add_provider(provider)
+          self[:providers] ||= []
+          self[:providers] << provider
+        end
+
+        def submission
+          ChangeHealth::Response::Claim::SubmissionData.new(response: ChangeHealth::Connection.new.request(endpoint: SUBMISSION_ENDPOINT, body: self.to_h, headers: professional_headers))
+        end
+
+        def validation
+          ChangeHealth::Response::Claim::SubmissionData.new(response: ChangeHealth::Connection.new.request(endpoint: VALIDATION_ENDPOINT, body: self.to_h, headers: professional_headers))
+        end
+
+        def self.health_check
+          ChangeHealth::Connection.new.request(endpoint: HEALTH_CHECK_ENDPOINT, verb: :get)
+        end
+
+        def self.ping
+          self.health_check
+        end
+
+        def professional_headers
+          if self[:headers]
+            extra_headers = {}
+            extra_headers["X-CHC-ClaimSubmission-SubmitterId"] = self[:headers][:submitter_id]
+            extra_headers["X-CHC-ClaimSubmission-BillerId"] = self[:headers][:biller_id]
+            extra_headers["X-CHC-ClaimSubmission-Username"] = self[:headers][:username]
+            extra_headers["X-CHC-ClaimSubmission-Pwd"] = self[:headers][:password]
+            extra_headers
+          else
+            nil
+          end
+        end
+      end
+    end
+  end
+end

data/lib/change_health/response/claim/report/report_data.rb

@@ -0,0 +1,45 @@
+module ChangeHealth
+  module Response
+    module Claim
+      class ReportData < ChangeHealth::Response::ResponseData
+        attr_reader :report_name, :json
+        alias_method :json?, :json
+
+        def initialize(report_name, json, data: nil, response: nil)
+          super(data: data, response: response)
+          @report_name = report_name
+          @json = json
+        end
+
+        def edi?
+          !@json
+        end
+
+        def report_type
+          self.class.report_type(@report_name)
+        end
+
+        def self.report_type(report_name)
+          return '277' if is_277?(report_name)
+          return '835' if is_835?(report_name)
+        end
+
+        def is_277?
+          self.class.is_277?(@report_name)
+        end
+
+        def self.is_277?(report_name)
+          report_name.start_with?('X3')
+        end
+
+        def is_835?
+          self.class.is_835?(@report_name)
+        end
+
+        def self.is_835?(report_name)
+          report_name.start_with?('R5')
+        end
+      end
+    end
+  end
+end

data/lib/change_health/response/claim/report/report_list_data.rb

@@ -0,0 +1,13 @@
+module ChangeHealth
+  module Response
+    module Claim
+      class ReportListData < ChangeHealth::Response::ResponseData
+
+        def report_names
+          @raw.dig('reports')
+        end
+        
+      end
+    end
+  end
+end

data/lib/change_health/response/claim/submission/submission_data.rb

@@ -0,0 +1,23 @@
+module ChangeHealth
+  module Response
+    module Claim
+      class SubmissionData < ChangeHealth::Response::ResponseData
+
+        %w(controlNumber status tradingPartnerId tradingPartnerServiceId).each do |v|
+          define_method(v) do
+            @raw.dig(v)
+          end
+        end
+
+        alias_method :control_number, :controlNumber
+        alias_method :trading_partner_id, :tradingPartnerId
+        alias_method :trading_partner_service_id, :tradingPartnerServiceId
+
+        def trading_partner?(name)
+          self.trading_partner_id == name || trading_partner_service_id == name
+        end
+
+      end
+    end
+  end
+end

data/lib/change_health/{models → response/eligibility}/eligibility_benefit.rb

@@ -1,5 +1,5 @@
 module ChangeHealth
-  module Models
+  module Response
     class EligibilityBenefit < Hash
       include Hashie::Extensions::MergeInitializer
       include Hashie::Extensions::IndifferentAccess
@@ -54,7 +54,7 @@ module ChangeHealth
         coverageLevelCode: COVERAGES,
         code: CODES
       }
-        
+
       HELPERS.each do |key, types|
         types.each do |method, value|
           define_method("#{method}?") do
@@ -99,13 +99,13 @@ module ChangeHealth
         self.coinsurance? ? self.benefitPercent : self.benefitAmount
       end
 
-      def services 
+      def services
         self['serviceTypeCodes']&.each_with_index&.map {|stc, i| [stc, self['serviceTypes']&.at(i)]} || []
       end
 
       %w(eligibilityBegin eligibilityEnd planBegin planEnd service).each do |f|
         define_method(f) do
-          return ChangeHealth::Models::EligibilityData::PARSE_DATE.call(self.date_info&.dig(f))
+          return ChangeHealth::Models::PARSE_DATE.call(self.date_info&.dig(f))
         end
       end
       alias_method :eligibility_begin_date, :eligibilityBegin
@@ -120,11 +120,11 @@ module ChangeHealth
       end
 
       def plan_date_range_start
-        ChangeHealth::Models::EligibilityData::PARSE_DATE.call(self.plan_date_range[0])
+        ChangeHealth::Models::PARSE_DATE.call(self.plan_date_range[0])
       end
 
       def plan_date_range_end
-        ChangeHealth::Models::EligibilityData::PARSE_DATE.call(self.plan_date_range[1])
+        ChangeHealth::Models::PARSE_DATE.call(self.plan_date_range[1])
       end
 
       private

data/lib/change_health/{models → response/eligibility}/eligibility_benefits.rb

@@ -1,8 +1,8 @@
 module ChangeHealth
-  module Models
+  module Response
     class EligibilityBenefits < Array
       def initialize(benefits)
-        super(benefits.map {|benefit| ChangeHealth::Models::EligibilityBenefit.new(benefit) })
+        super(benefits.map {|benefit| ChangeHealth::Response::EligibilityBenefit.new(benefit) })
       end
 
       def where(**kwargs)
@@ -25,7 +25,7 @@ module ChangeHealth
         self.where(inPlanNetworkIndicatorCode: 'Y')
       end
 
-      ChangeHealth::Models::EligibilityBenefit::HELPERS.each do |key, types|
+      ChangeHealth::Response::EligibilityBenefit::HELPERS.each do |key, types|
         types.each do |method, value|
           define_method("#{method}s") do
             self.where(key => value)

data/lib/change_health/response/eligibility/eligibility_data.rb

@@ -0,0 +1,94 @@
+module ChangeHealth
+  module Response
+    class EligibilityData < ChangeHealth::Response::ResponseData
+
+      ACTIVE = '1'
+      INACTIVE = '6'
+
+      def active?(service_code: '30')
+        plan_status(service_code: service_code, single: false).any? {|status| ACTIVE == status['statusCode'] }
+      end
+
+      def inactive?(service_code: '30')
+        plan_status(service_code: service_code, single: false).any? {|status| INACTIVE == status['statusCode'] }
+      end
+
+      def dependents?
+        true == self.dependents&.any?
+      end
+
+      %w(planStatus benefitsInformation controlNumber planDateInformation dependents).each do |v|
+        define_method(v) do
+          @raw.dig(v)
+        end
+      end
+
+      %w(eligibilityBegin planBegin service).each do |f|
+        define_method(f) do
+          return ChangeHealth::Models::PARSE_DATE.call(self.date_info&.dig(f))
+        end
+      end
+      alias_method :eligibility_begin_date, :eligibilityBegin
+      alias_method :plan_begin_date, :planBegin
+      alias_method :service_date, :service
+
+      def plan_date_range
+        pd = self.date_info&.dig('plan') || ''
+        pd.split('-')
+      end
+
+      def plan_date_range_start
+        ChangeHealth::Models::PARSE_DATE.call(self.plan_date_range[0])
+      end
+
+      def plan_date_range_end
+        ChangeHealth::Models::PARSE_DATE.call(self.plan_date_range[1])
+      end
+
+      def plan_status(service_code: , single: true)
+        if true == single
+          self.planStatus&.find {|plan| plan.dig('serviceTypeCodes')&.include?(service_code) } || {}
+        else
+          self.planStatus&.select {|plan| plan.dig('serviceTypeCodes')&.include?(service_code) } || []
+        end
+      end
+
+      def benefits
+        kname   = "ChangeHealth::Response::EligibilityBenefits#{self.trading_partner_id&.upcase}"
+        klazz   = Object.const_get(kname) if Module.const_defined?(kname)
+        klazz ||= ChangeHealth::Response::EligibilityBenefits
+
+        if klazz.respond_to?(:factory)
+          klazz = klazz.factory(self)
+        end
+
+        klazz.new(self.benefitsInformation || [])
+      end
+
+      def medicare?(**kwargs)
+        false == benefits.empty? && benefits.where(kwargs).all? {|b| b.medicare? }
+      end
+
+      def plan?(name)
+        self.plan_names.any? {|pname| name == pname }
+      end
+
+      def plan_names
+        self.planStatus&.map {|plan_status| plan_status['planDetails'] }&.compact || []
+      end
+
+      def trading_partner?(name)
+        self.trading_partner_id == name
+      end
+
+      def trading_partner_id
+        @raw['tradingPartnerServiceId']
+      end
+
+      alias_method :control_number, :controlNumber
+      alias_method :benefits_information, :benefitsInformation
+      alias_method :plan_statuses, :planStatus
+      alias_method :date_info, :planDateInformation
+    end
+  end
+end

data/lib/change_health/response/response_data.rb

@@ -0,0 +1,41 @@
+module ChangeHealth
+  module Response
+    class ResponseData
+      attr_reader :response, :raw
+
+      def initialize(data: nil, response: nil)
+        @response = response
+        @raw      = data
+
+        begin
+          @raw ||= response&.parsed_response
+        rescue JSON::ParserError
+        end
+
+        @raw ||= {}
+      end
+
+      def errors?
+        self.errors.is_a?(Array) && false == self.errors.empty?
+      end
+
+      def errors
+        errors = @raw.dig('errors') || []
+
+        errors.flatten.map {|error| ChangeHealth::Models::Error.new(error) }
+      end
+
+      def recommend_retry?
+        return false unless errors?
+
+        return true if errors.any?(&:represents_down?)
+
+        error_codes = errors.select(&:code?)
+
+        return false if error_codes.empty?
+
+        return error_codes.all?(&:retryable?)
+      end
+    end
+  end
+end

data/lib/change_health/version.rb

@@ -1,3 +1,3 @@
 module ChangeHealth
-  VERSION = '1.0.3'.freeze
+  VERSION = '2.2.1'.freeze
 end

data/lib/change_health.rb

@@ -1,22 +1,34 @@
 require 'httparty'
 require 'hashie'
 require 'change_health/version'
+require 'change_health/authentication'
 require 'change_health/change_health_exception'
 require 'change_health/connection'
-require 'change_health/authentication'
 require 'change_health/extensions'
+require 'change_health/models/error'
 require 'change_health/models/model'
-require 'change_health/models/eligibility'
-require 'change_health/models/eligibility_data'
-require 'change_health/models/eligibility_benefit'
-require 'change_health/models/eligibility_benefits'
-require 'change_health/models/trading_partner'
+require 'change_health/models/claim/submission/claim_information'
+require 'change_health/models/claim/submission/provider'
+require 'change_health/models/claim/submission/service_line'
+require 'change_health/models/claim/submission/submitter'
+require 'change_health/models/claim/submission/subscriber'
+require 'change_health/models/eligibility/encounter'
+require 'change_health/models/eligibility/provider'
+require 'change_health/models/eligibility/subscriber'
+require 'change_health/models/trading_partner/trading_partner'
+require 'change_health/request/eligibility'
+require 'change_health/request/submission'
+require 'change_health/request/report'
 require 'change_health/request/trading_partner'
-require 'change_health/response/trading_partner_data'
-require 'change_health/response/trading_partners_data'
-require 'change_health/models/encounter'
-require 'change_health/models/provider'
-require 'change_health/models/subscriber'
+require 'change_health/response/response_data'
+require 'change_health/response/claim/submission/submission_data'
+require 'change_health/response/claim/report/report_list_data'
+require 'change_health/response/claim/report/report_data'
+require 'change_health/response/eligibility/eligibility_benefit'
+require 'change_health/response/eligibility/eligibility_benefits'
+require 'change_health/response/eligibility/eligibility_data'
+require 'change_health/response/trading_partner/trading_partner_data'
+require 'change_health/response/trading_partner/trading_partners_data'
 
 module ChangeHealth
   class Configuration

metadata

@@ -1,14 +1,14 @@
 --- !ruby/object:Gem::Specification
 name: change_health
 version: !ruby/object:Gem::Version
-  version: 1.0.3
+  version: 2.2.1
 platform: ruby
 authors:
 - Mike Crockett
 autorequire: 
 bindir: exe
 cert_chain: []
-date: 2021-04-26 00:00:00.000000000 Z
+date: 2021-11-16 00:00:00.000000000 Z
 dependencies:
 - !ruby/object:Gem::Dependency
   name: httparty
@@ -147,18 +147,30 @@ files:
 - lib/change_health/change_health_exception.rb
 - lib/change_health/connection.rb
 - lib/change_health/extensions.rb
-- lib/change_health/models/eligibility.rb
-- lib/change_health/models/eligibility_benefit.rb
-- lib/change_health/models/eligibility_benefits.rb
-- lib/change_health/models/eligibility_data.rb
-- lib/change_health/models/encounter.rb
+- lib/change_health/models/claim/submission/claim_information.rb
+- lib/change_health/models/claim/submission/provider.rb
+- lib/change_health/models/claim/submission/service_line.rb
+- lib/change_health/models/claim/submission/submitter.rb
+- lib/change_health/models/claim/submission/subscriber.rb
+- lib/change_health/models/eligibility/encounter.rb
+- lib/change_health/models/eligibility/provider.rb
+- lib/change_health/models/eligibility/subscriber.rb
+- lib/change_health/models/error.rb
 - lib/change_health/models/model.rb
-- lib/change_health/models/provider.rb
-- lib/change_health/models/subscriber.rb
-- lib/change_health/models/trading_partner.rb
+- lib/change_health/models/trading_partner/trading_partner.rb
+- lib/change_health/request/eligibility.rb
+- lib/change_health/request/report.rb
+- lib/change_health/request/submission.rb
 - lib/change_health/request/trading_partner.rb
-- lib/change_health/response/trading_partner_data.rb
-- lib/change_health/response/trading_partners_data.rb
+- lib/change_health/response/claim/report/report_data.rb
+- lib/change_health/response/claim/report/report_list_data.rb
+- lib/change_health/response/claim/submission/submission_data.rb
+- lib/change_health/response/eligibility/eligibility_benefit.rb
+- lib/change_health/response/eligibility/eligibility_benefits.rb
+- lib/change_health/response/eligibility/eligibility_data.rb
+- lib/change_health/response/response_data.rb
+- lib/change_health/response/trading_partner/trading_partner_data.rb
+- lib/change_health/response/trading_partner/trading_partners_data.rb
 - lib/change_health/version.rb
 homepage: https://github.com/WeInfuse/change_health
 licenses:

data/lib/change_health/models/eligibility_data.rb

@@ -1,191 +0,0 @@
-module ChangeHealth
-  module Models
-    class Error
-      attr_reader :data
-
-      SIMPLE_RETRY_CODES = %w[
-        42
-        80
-      ].freeze
-
-      NO_RESUBMIT_MESSAGES = [
-        'resubmission not allowed',
-        'do not resubmit'
-      ].freeze
-
-      DOWN_FIELD = 'Http Header'.freeze
-
-      DOWN_MESSAGE = 'Please review http headers for this API, please contact support if you are unsure how to resolve.'.freeze
-
-      def initialize(data)
-        @data = data
-      end
-
-      def message
-        field_message || code_message
-      end
-
-      def field_message
-        "#{field}: #{description}" if field?
-      end
-
-      def code_message
-        "#{code}: #{description}" if code?
-      end
-
-      def represents_down?
-        field == DOWN_FIELD && description == DOWN_MESSAGE
-      end
-
-      def retryable?
-        represents_down? ||
-        (code? && SIMPLE_RETRY_CODES.include?(code) && followupAction? && NO_RESUBMIT_MESSAGES.none? {|msg| followupAction.downcase.include?(msg) })
-      end
-
-      %w[field description code followupAction location].each do |method_name|
-        define_method("#{method_name}?") do
-          false == send(method_name).nil?
-        end
-
-        define_method("#{method_name}") do
-          @data[method_name]
-        end
-      end
-    end
-
-    class EligibilityData
-      attr_reader :response, :raw
-
-      ACTIVE = '1'
-      INACTIVE = '6'
-
-      PARSE_DATE = ->(d) {
-        begin
-          d = Date.strptime(d, ChangeHealth::Models::DATE_FORMAT)
-        rescue
-        end
-
-        d
-      }
-
-      def initialize(data: nil, response: nil)
-        @response = response
-        @raw      = data
-
-        begin
-          @raw ||= response&.parsed_response
-        rescue JSON::ParserError
-        end
-
-        @raw ||= {}
-      end
-
-      def active?(service_code: '30')
-        plan_status(service_code: service_code, single: false).any? {|status| ACTIVE == status['statusCode'] }
-      end
-
-      def inactive?(service_code: '30')
-        plan_status(service_code: service_code, single: false).any? {|status| INACTIVE == status['statusCode'] }
-      end
-
-      def errors?
-        self.errors.is_a?(Array) && false == self.errors.empty?
-      end
-
-      def errors
-        errors = @raw.dig('errors') || []
-
-        errors.flatten.map {|error| ChangeHealth::Models::Error.new(error) }
-      end
-
-      def recommend_retry?
-        return false unless errors?
-
-        return true if errors.any?(&:represents_down?)
-
-        error_codes = errors.select(&:code?)
-
-        return false if error_codes.empty?
-
-        return error_codes.all?(&:retryable?)
-      end
-
-      def dependents?
-        true == self.dependents&.any?
-      end
-
-      %w(planStatus benefitsInformation controlNumber planDateInformation dependents).each do |v|
-        define_method(v) do
-          @raw.dig(v)
-        end
-      end
-
-      %w(eligibilityBegin planBegin service).each do |f|
-        define_method(f) do
-          return PARSE_DATE.call(self.date_info&.dig(f))
-        end
-      end
-      alias_method :eligibility_begin_date, :eligibilityBegin
-      alias_method :plan_begin_date, :planBegin
-      alias_method :service_date, :service
-
-      def plan_date_range
-        pd = self.date_info&.dig('plan') || ''
-        pd.split('-')
-      end
-
-      def plan_date_range_start
-        ChangeHealth::Models::EligibilityData::PARSE_DATE.call(self.plan_date_range[0])
-      end
-
-      def plan_date_range_end
-        ChangeHealth::Models::EligibilityData::PARSE_DATE.call(self.plan_date_range[1])
-      end
-
-      def plan_status(service_code: , single: true)
-        if true == single
-          self.planStatus&.find {|plan| plan.dig('serviceTypeCodes')&.include?(service_code) } || {}
-        else
-          self.planStatus&.select {|plan| plan.dig('serviceTypeCodes')&.include?(service_code) } || []
-        end
-      end
-
-      def benefits
-        kname   = "ChangeHealth::Models::EligibilityBenefits#{self.trading_partner_id&.upcase}"
-        klazz   = Object.const_get(kname) if Module.const_defined?(kname)
-        klazz ||= ChangeHealth::Models::EligibilityBenefits
-
-        if klazz.respond_to?(:factory)
-          klazz = klazz.factory(self)
-        end
-
-        klazz.new(self.benefitsInformation || [])
-      end
-
-      def medicare?(**kwargs)
-        false == benefits.empty? && benefits.where(kwargs).all? {|b| b.medicare? }
-      end
-
-      def plan?(name)
-        self.plan_names.any? {|pname| name == pname }
-      end
-
-      def plan_names
-        self.planStatus&.map {|plan_status| plan_status['planDetails'] }&.compact || []
-      end
-
-      def trading_partner?(name)
-        self.trading_partner_id == name
-      end
-
-      def trading_partner_id
-        @raw['tradingPartnerServiceId']
-      end
-
-      alias_method :control_number, :controlNumber
-      alias_method :benefits_information, :benefitsInformation
-      alias_method :plan_statuses, :planStatus
-      alias_method :date_info, :planDateInformation
-    end
-  end
-end

data/lib/change_health/models/encounter.rb

@@ -1,20 +0,0 @@
-module ChangeHealth
-  module Models
-    class Encounter < Model
-      property :beginningDateOfService, from: :beginning_date_of_service, required: false
-      property :dateOfService, from: :date_of_service, required: false
-      property :dateRange, from: :date_range, required: false, default: false
-      property :endDateOfService, from: :end_date_of_service, required: false
-      property :serviceTypeCodes, from: :service_type_codes, required: false
-
-      alias_method :dateRange?, :dateRange
-      alias_method :date_range?, :dateRange
-      alias_method :service_type_codes, :serviceTypeCodes
-
-      def add_service_type_code(code)
-        self[:serviceTypeCodes] ||= []
-        self[:serviceTypeCodes] << code
-      end
-    end
-  end
-end