change_health 2.2.0 → 3.1.0

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data/CHANGELOG.md

@@ -4,18 +4,69 @@ All notable changes to this project will be documented in this file.
 The format is based on [Keep a Changelog](http://keepachangelog.com/en/1.0.0/)
 and this project adheres to [Semantic Versioning](http://semver.org/spec/v2.0.0.html).
 
-## [2.2.0] - [2021-11-04-21]
+## [3.1.0] - 2021-12-21
+### Added
+#### Claim Submission
+* ServiceLine - drugIdentification & renderingProvider
+* Subscriber - groupNumber
+* Address model w/ postalCode that is formatted to remove dashes, '-'
+  * Note: Using a plain hash for address still works
+* Auto formatting of postal code fields
+
+## [3.0.0] - 2021-12-08
+### Added
+* Report277Claim - specific to claims from 277 reports
+* Report835Claim - specific to claims from 835 reports
+* Report835ServiceAdjustment & Report835ServiceLine - helper classes for readability of claims from 835 reports
+
+### Changed
+* ReportClaim - removed 277 report unique fields
+
+#### Namespace
+| Previous | Current |
+|-|-|
+| ChangeHealth::Models::Error | ChangeHealth::Response::Error |
+| ChangeHealth::Response::Claim::ReportInfoClaimStatus | ChangeHealth::Response::Claim::Report277InfoClaimStatus|
+
+#### Methods
+| Previous | Current |
+|-|-|
+| Report277Data#payer_org_name | Report277Data#payer_name |
+| ReportClaim#latest_total_charge_amount | ReportClaim#total_charge_amount |
+| ReportClaim#payer_org_name | ReportClaim#payer_name |
+| ReportClaim#service_begin_date | ReportClaim#service_date_begin |
+| ReportClaim#service_end_date | ReportClaim#service_date_end |
+| ReportClaim#subscriber_first_name | ReportClaim#patient_first_name |
+| ReportClaim#subscriber_last_name | ReportClaim#patient_last_name |
+| ReportClaim#transaction_set_creation_date | ReportClaim#report_creation_date |
+
+
+## [2.3.0] - 2021-11-18
+### Added
+* Report277Data & Report835Data - Specific classes for 277 & 835 reports
+* ReportClaim & ReportInfoClaimStatus - only works for json 277 reports
+
+### Fixed
+* Headers can now be nil for requests
+
+## [2.2.1] - 2021-11-15
+### Added
+Custom Headers for Reports API and Professional Claims API
+* Report
+* Submission
+
+## [2.2.0] - 2021-11-04
 ### Added
 Ability to hit [Claim Responses and Reports](https://developers.changehealthcare.com/eligibilityandclaims/docs/claims-responses-and-reports-getting-started)
 * Report
 * ReportListData
 * ReportData
 
-## [2.1.0] - [2021-10-12]
+## [2.1.0] - 2021-10-12
 ### Changed
 Model#to_h enhanced to change empty values AKA "" to nil. Reason: If a field is empty, Change Healthcare responds with an error - `Invalid value. Item must not be blank value.`. If the empty field is optional, Change Healthcare will accept the field as nil without error. If the empty field is required, Change Healthcare will return an error if the value is empty or nil.
 
-## [2.0.0] - [2021-10-08]
+## [2.0.0] - 2021-10-08
 ### Added
 #### Models
 * ResponseData - for responses from calling change healthcare api used by EligibilityData and SubmissionData
@@ -46,50 +97,50 @@ Added the ability to hit professional claim submission API. For more details, se
 ### Fixed
  * Eligibility#add_dependent actually works
 
-## [1.0.3] - [2021-04-26]
+## [1.0.3] - 2021-04-26
 ### Added
 - Model::Error#represents_down? - adds ability to distinguish error representing down state
 - Model::Error#retryable? - retryable when down
 - EligibilityData#recommend_retry? - recommend retry when down
 
-## [1.0.2] - [2021-04-06]
+## [1.0.2] - 2021-04-06
 ### Added
 - EligibilityData#recommend_retry? - fix a bug in the search statement
 
-## [1.0.1] - [2021-03-24]
+## [1.0.1] - 2021-03-24
 ### Added
 - EligibilityData#plan_status - adds ability to select instead of find
 - EligibilityData#inactive? active? - use new plan_status select
 
-## [1.0.0] - [2021-03-17]
+## [1.0.0] - 2021-03-17
 ### Added
 - Model::Error - help with error codes
 - EligibilityData#recommend_retry? - if it looks like you can retry the exact same request
 - EligibilityData#inactive? - looks for plan status 6
 
-## [0.15.0] - [2020-06-12]
+## [0.15.0] - 2020-06-12
 ### Added
 - Extensions - InNetworkMissing for plans that don't provide in network indicators.
 
 ### Fixed
 - Bug where active codes with no service codes cause exception.
 
-## [0.14.0] - [2020-05-07]
+## [0.14.0] - 2020-05-07
 ### Added
 - Extensions - mixins for common overrides
 
-## [0.13.0] - [2020-05-05]
+## [0.13.0] - 2020-05-05
 ### Changed
 - Removed `alias_method` for `where` helpers so you can override a single method
 - Added type Year to Date type 24
 - Added type Day type 7
 
-## [0.12.0] - [2020-04-30]
+## [0.12.0] - 2020-04-30
 ### Added
 - EligibilityData#errors
 - EligibilityData#errors?
 
-## [0.11.0] - [2020-04-24]
+## [0.11.0] - 2020-04-24
 ### Added
 - EligibilityData#medicare?
 - EligibilityData#plan\_id
@@ -104,7 +155,7 @@ Added the ability to hit professional claim submission API. For more details, se
 - EligibilityData initialize now checks for sub-classes of EligibilityBenefits with trading partner responds to `factory` to choose sub-class
 - EligibilityBenefits initializes `self.class` type in case it's a subclass
 
-## [0.10.0] - [2020-04-09]
+## [0.10.0] - 2020-04-09
 ### Added
 - Add Trading Partner API querying capability
 - Request::TradingPartner
@@ -112,7 +163,7 @@ Added the ability to hit professional claim submission API. For more details, se
 - Response::TradingPartnersData
 - Models::TradingPartner
 
-## [0.9.0] - [2020-04-08]
+## [0.9.0] - 2020-04-08
 ### Added
 - Added EligibilityBenefit#medicare?
 - Added EligibilityData#medicare?
@@ -121,20 +172,20 @@ Added the ability to hit professional claim submission API. For more details, se
 - EligibilityBenefit(s)#individual returns true for medicare in benefit and queries that look for 'IND'
 - EligibilityBenefit(s)#in\_network returns true for medicare in benefit and queries that look for 'Y'
 
-## [0.8.0] - [2020-04-04]
+## [0.8.0] - 2020-04-04
 ### Changed
 - Attempt to serialize all properties with 'date' in the name to ChangeHealth date format
 
-## [0.7.0] - [2020-04-03]
+## [0.7.0] - 2020-04-03
 ### Changed
 - Fixed bug in serializing date on subscriber and encounter
 
-## [0.6.0] - [2020-04-02]
+## [0.6.0] - 2020-04-02
 ### Changed
 - Added Indifferent Access to hashes
 - Fixed bug with Authentication endpoint
 
-## [0.5.0] - [2020-03-11]
+## [0.5.0] - 2020-03-11
 ### Added
 - EligibilityBenefit Deductible information
 - EligibilityBenefit benefits date information
@@ -146,17 +197,17 @@ Added the ability to hit professional claim submission API. For more details, se
 ### Changed
 - Broke EligibilityBenefit and EligibilityBenefits into separate files
 
-## [0.4.0] - [2020-03-10]
+## [0.4.0] - 2020-03-10
 ### Added
 - EligibilityBenefit(s) Employee information
 - EligibilityData plan date information
 - EligibilityData eligibility, plan and service date helpers on date info
 
-## [0.3.0] - [2020-03-09]
+## [0.3.0] - 2020-03-09
 ### Added
 - Production endpoint
 
-## [0.0.2] - [2020-03-09]
+## [0.0.2] - 2020-03-09
 ### Added
 - EligibilityData
 - EligibilityBenefit
@@ -174,6 +225,10 @@ Added the ability to hit professional claim submission API. For more details, se
 - Authentication
 - Configuration
 
+[3.1.0]: https://github.com/WeInfuse/change_health/compare/v3.0.0...v3.1.0
+[3.0.0]: https://github.com/WeInfuse/change_health/compare/v2.3.0...v3.0.0
+[2.3.0]: https://github.com/WeInfuse/change_health/compare/v2.2.1...v2.3.0
+[2.2.1]: https://github.com/WeInfuse/change_health/compare/v2.2.0...v2.2.1
 [2.2.0]: https://github.com/WeInfuse/change_health/compare/v2.1.0...v2.2.0
 [2.1.0]: https://github.com/WeInfuse/change_health/compare/v2.0.0...v2.1.0
 [2.0.0]: https://github.com/WeInfuse/change_health/compare/v1.0.3...v2.0.0

data/README.md

@@ -1,9 +1,17 @@
 [![CircleCI](https://circleci.com/gh/WeInfuse/change_health.svg?style=svg)](https://circleci.com/gh/WeInfuse/change_health)
 
-# Change Health
+```
+   ____ _                              _   _            _ _   _     
+  / ___| |__   __ _ _ __   __ _  ___  | | | | ___  __ _| | |_| |__  
+ | |   | '_ \ / _` | '_ \ / _` |/ _ \ | |_| |/ _ \/ _` | | __| '_ \ 
+ | |___| | | | (_| | | | | (_| |  __/ |  _  |  __/ (_| | | |_| | | |
+  \____|_| |_|\__,_|_| |_|\__, |\___| |_| |_|\___|\__,_|_|\__|_| |_|
+                          |___/                                     
+```
+
 Ruby API wrapper for [Change Health](https://developers.changehealthcare.com/api)
 
-## Installation
+# Installation
 
 Add this line to your application's Gemfile:
 
@@ -19,13 +27,13 @@ Or install it yourself as:
 
     $ gem install change_health
 
-## Usage
+# Usage
 
-### Setup
+## Setup
 
 Make sure you're [configured](#configuration)!
 
-### Eligibility
+## Eligibility
 [Change Healthcare Eligibility Guide](https://developers.changehealthcare.com/eligibilityandclaims/docs)
 ```ruby
 ChangeHealth::Request::Eligibility.ping # Test your connection
@@ -39,7 +47,7 @@ edata = ChangeHealth::Request::Eligibility.new(tradingPartnerServiceId: '000050'
 edata.raw # Raw Hash of JSON response
 ```
 
-#### Benefit(s) objects
+### Benefit(s) objects
 Benefits extends Array and provides a query-like interface.
 
 Benefit extends Hash and provides helpers for single-benefit.
@@ -58,7 +66,7 @@ edata.benefits.where(name: 'Co-Payment', code: 'B', benefitAmount: '30) # Generi
 edata.benefits.find_by(name: 'Co-Payment', code: 'B', benefitAmount: '30) # Generic 'find_by' api returns first object found
 ```
 
-#### Response
+### Response
 
 Response is EligibilityData object
 
@@ -67,16 +75,16 @@ edata.response
 #<HTTParty::Response:0x7fa354c1fbe8>
 
 edata.response.ok?
-true
+# true
 
 edata.individual_oop_remaining(service_code: '30')
-1344.88
+# 1344.88
 
 edata.raw == edata.response.parsed_response
-true
+# true
 ```
 
-### Trading Partners
+## Trading Partners
 ```ruby
 # Query trading partners using a wildcard search
 # Returns Array of ChangeHealth::Models::TradingPartner Objects
@@ -89,7 +97,7 @@ trading_partners.first.service_id
 # "ABC123"
 ```
 
-### Claim Submission
+## Claim Submission
 [Change Healthcare Claim Submission Guide](https://developers.changehealthcare.com/eligibilityandclaims/docs/professional-claims-v3-getting-started)
 ```ruby
 ChangeHealth::Request::Claim::Submission.ping # Test your connection
@@ -101,12 +109,13 @@ claim_submitter = ChangeHealth::Models::Claim::Submitter.new(
 )
 
 receiver = { organizationName: "EXTRA HEALTHY INSURANCE"}
-address = {
-  "address1": "123 address1",
-  "city": "city1",
-  "state": "wa",
-  "postalCode": "981010000"
-}
+address = ChangeHealth::Models::Claim::Address.new(
+  address1: "123 address1",
+  city: "city1",
+  state: "wa",
+  postalCode: "98101-0000"
+)
+
 subscriber = ChangeHealth::Models::Claim::Subscriber.new(
   member_id: "0000000001",
   payment_responsibility_level_code: "P",
@@ -118,45 +127,45 @@ subscriber = ChangeHealth::Models::Claim::Subscriber.new(
 )
 provider = ChangeHealth::Models::Claim::Provider.new(
   address: address,
- employer_id: "000000000",
- first_name: "johnone",
- last_name: "doetwo",
- npi: "1760854442",
- provider_type: "BillingProvider"
+  employer_id: "000000000",
+  first_name: "johnone",
+  last_name: "doetwo",
+  npi: "1760854442",
+  provider_type: "BillingProvider"
 )
 
 health_care_code_information1 = {
-  "diagnosisTypeCode": "ABK",
-  "diagnosisCode": "S93401A"
+  diagnosisTypeCode: "ABK",
+  diagnosisCode: "S93401A"
 }
 health_care_code_information2 = {
-  "diagnosisTypeCode": "ABF",
-  "diagnosisCode": "S72044G"
+  diagnosisTypeCode: "ABF",
+  diagnosisCode: "S72044G"
 
 }
 service_line1 = ChangeHealth::Models::Claim::ServiceLine.new(
   service_date: "2018-05-14",
   professional_service: {
-    "procedureIdentifier": "HC",
-    "lineItemChargeAmount": "25",
-    "procedureCode": "E0570",
-    "measurementUnit": "UN",
-    "serviceUnitCount": "1",
-    "compositeDiagnosisCodePointers": {
-      "diagnosisCodePointers": ["1","2"]
+    procedureIdentifier: "HC",
+    lineItemChargeAmount: "25",
+    procedureCode: "E0570",
+    measurementUnit: "UN",
+    serviceUnitCount: "1",
+    compositeDiagnosisCodePointers: {
+      diagnosisCodePointers: ["1","2"]
     }
   }
 )
 service_line2 = ChangeHealth::Models::Claim::ServiceLine.new(
   service_date: "20180514",
   professional_service: {
-    "procedureIdentifier": "HC",
-    "lineItemChargeAmount": "3.75",
-    "procedureCode": "A7003",
-    "measurementUnit": "UN",
-    "serviceUnitCount": "1",
-    "compositeDiagnosisCodePointers": {
-      "diagnosisCodePointers": ["1"]
+    procedureIdentifier: "HC",
+    lineItemChargeAmount: "3.75",
+    procedureCode: "A7003",
+    measurementUnit: "UN",
+    serviceUnitCount: "1",
+    compositeDiagnosisCodePointers: {
+      diagnosisCodePointers: ["1"]
     }
   }
 )
@@ -174,6 +183,12 @@ claim_information = ChangeHealth::Models::Claim::ClaimInformation.new(
   service_lines: [service_line1, service_line2]
 )
 
+professional_headers = {
+  submitter_id: '111000',
+  biller_id: '000111',
+  username: '222333hey',
+  password: 'builder1'
+}
 
 claim_submission = ChangeHealth::Request::Claim::Submission.new(
   trading_partner_service_id: "9496",
@@ -181,52 +196,127 @@ claim_submission = ChangeHealth::Request::Claim::Submission.new(
   receiver: receiver,
   subscriber: subscriber,
   providers: [provider],
-  claim_information: claim_information
+  claim_information: claim_information,
+  headers: professional_headers
 )
 
 claim_submission_data = claim_submission.submission
+
+validation = claim_submission.validation
 ```
 
-### Claim Reports
+## Claim Reports
 [Change Healthcare Claim Responses and Reports Guide](https://developers.changehealthcare.com/eligibilityandclaims/docs/claims-responses-and-reports-getting-started)
+
+### Get Reports
 ```ruby
 ChangeHealth::Request::Claim::Report.ping # Test your connection
 
-report_list = ChangeHealth::Request::Claim::Report.report_list
+report_headers = {
+  username: '111000john',
+  password: 'WeInfuse1'
+}
+
+report_list = ChangeHealth::Request::Claim::Report.report_list(headers: report_headers)
 
 report_list.report_names
 # ["X3000000.XX", "R5000000.XY", "R5000000.XX", "X3000000.AB", "X3000000.AC", "X3000000.ZZ", "R5000000.XZ", "R5000000.YZ", "R5000000.WA", "R5000000.WB", "R5000000.WC"]
 
-report1_edi = ChangeHealth::Request::Claim::Report.get_report(report_list.report_names.first, as_json_report: false)
+report0_edi = ChangeHealth::Request::Claim::Report.get_report(report_list.report_names.first, as_json_report: false)
 # Report in edi format
 
-report1_json = ChangeHealth::Request::Claim::Report.get_report(report_list.report_names.first, as_json_report: true)
+report0_json = ChangeHealth::Request::Claim::Report.get_report(report_list.report_names.first, as_json_report: true)
 # Report in json format
 
-reports_json = report_list.report_names.map {|report_name| ChangeHealth::Request::Claim::Report.get_report(report_name)}
+reports_json = report_list.report_names.map {|report_name| ChangeHealth::Request::Claim::Report.get_report(report_name, headers: report_headers)}
 # all reports in json format
 
-reports_edi = report_list.report_names.map {|report_name| ChangeHealth::Request::Claim::Report.get_report(report_name, as_json_report: false)}
+reports_edi = report_list.report_names.map {|report_name| ChangeHealth::Request::Claim::Report.get_report(report_name, as_json_report: false, headers: report_headers)}
 # all reports in edi format
 ```
 
-### Configuration
+### Inspect Reports
+Currently only works for json 277 reports and json 835 reports. Not for EDI reports
+
+From a report, you can get an array of claims
+
+#### Report 277
+
+```ruby
+report_277_data = ChangeHealth::Request::Claim::Report.get_report("X3000000.AB", as_json_report: true)
+
+report_277_data.payer_name
+# "PREMERA"
+
+report_277_data.report_creation_date
+# Tue, 01 Dec 2020
+
+claim_277 = report_277_data.claims.first
+claim_277.payer_name
+# "PREMERA"
+
+claim_277.patient_first_name
+# "JOHNONE"
+
+claim_277.report_creation_date
+# Tue, 01 Dec 2020
+
+# Report 277 specific below
+claim_277.latest_status_category_codes
+# ["F1"]
+
+claim_277.total_charge_amount
+# "100"
+
+claim_277.procedure_codes
+# ["97161"]
+```
+
+#### Report 835
+
+```ruby
+report_835_data = ChangeHealth::Request::Claim::Report.get_report("R5000000.XY", as_json_report: true)
+
+report_835_data.payment_method_code
+# "ACH"
+
+report_835_data.total_actual_provider_payment_amount
+# "2563.13"
+
+claim_835 = report_835_data.claims.first
+claim_835.payer_name
+# "NATIONAL GOVERNMENT SERVICES, INC."
+
+claim_835.patient_first_name
+# "JANE"
+
+claim_835.report_creation_date
+# Wed, 22 Apr 2020
+
+claim_835.procedure_codes
+# ["21210", "21026", "21208", "30580"]
+
+claim_835.service_lines.map(&:line_item_charge_amount)
+# ["3600", "1890", "1836", "1680"]
+```
+
+## Configuration
 
 ```ruby
 ChangeHealth.configure do |c|
   c.client_id     = ENV['CHANGE_HEALTH_CLIENT_ID']
   c.client_secret = ENV['CHANGE_HEALTH_SECRET']
-  c.grant_type    = 'bob' # Defaults to client_credentials
-  c.api_endpoint  = 'http://hello.com' # Defaults to Change Health Sandbox endpoint
+  c.grant_type    = 'client_credentials' # Defaults to client_credentials
+  c.api_endpoint  = 'https://sandbox.apigw.changehealthcare.com' # Defaults to Change Health Sandbox endpoint
 end
 ```
 
-## Development
+# Development
 
 After checking out the repo, run `bin/setup` to install dependencies. Then, run `rake test` to run the tests. You can also run `bin/console` for an interactive prompt that will allow you to experiment.
 
 To install this gem onto your local machine, run `bundle exec rake install`. To release a new version, update the version number in `version.rb`, and then run `bundle exec rake release`, which will create a git tag for the version, push git commits and tags, and push the `.gem` file to [rubygems.org](https://rubygems.org).
 
-## Contributing
+# Contributing
 
 Bug reports and pull requests are welcome on GitHub at https://github.com/WeInfuse/change\_health.

data/lib/change_health/connection.rb

@@ -13,11 +13,12 @@ module ChangeHealth
 
     format :json
 
-    def request(endpoint: , query: nil, body: nil, headers: {}, auth: true, verb: :post)
+    def request(endpoint:, query: nil, body: nil, headers: {}, auth: true, verb: :post)
       body    = body.to_json if body.is_a?(Hash)
+      headers = {} if headers.nil?
       headers = auth_header.merge(headers) if auth
 
-      self.class.send("#{verb}", endpoint, query: query, body: body, headers: headers)
+      self.class.send(verb.to_s, endpoint, query: query, body: body, headers: headers)
     end
 
     private
@@ -25,7 +26,7 @@ module ChangeHealth
     def auth_header
       @auth ||= Authentication.new
 
-      return @auth.authenticate.access_header
+      @auth.authenticate.access_header
     end
   end
 end

data/lib/change_health/models/claim/submission/address.rb

@@ -0,0 +1,13 @@
+module ChangeHealth
+  module Models
+    module Claim
+      class Address < Model
+        property :address1, required: false
+        property :address2, required: false
+        property :city, required: false
+        property :postalCode, from: :postal_code, required: false
+        property :state, required: false
+      end
+    end
+  end
+end

data/lib/change_health/models/claim/submission/drug_identification.rb

@@ -0,0 +1,12 @@
+module ChangeHealth
+  module Models
+    module Claim
+      class DrugIdentification < Model
+        property :measurementUnitCode, from: :measurement_unit_code, required: false
+        property :nationalDrugCode, from: :national_drug_code, required: false
+        property :nationalDrugUnitCount, from: :national_drug_unit_count, required: false
+        property :serviceIdQualifier, from: :service_id_qualifier, required: false
+      end
+    end
+  end
+end

data/lib/change_health/models/claim/submission/service_line.rb

@@ -2,10 +2,10 @@ module ChangeHealth
   module Models
     module Claim
       class ServiceLine < Model
-
+        property :drugIdentification, from: :drug_identification, required: false
         property :serviceDate, from: :service_date, required: false
         property :professionalService, from: :professional_service, required: false
-
+        property :renderingProvider, from: :rendering_provider, required: false
       end
     end
   end

data/lib/change_health/models/claim/submission/subscriber.rb

@@ -6,6 +6,7 @@ module ChangeHealth
         property :dateOfBirth, from: :date_of_birth, required: false
         property :firstName, from: :first_name, required: false
         property :gender, required: false
+        property :groupNumber, from: :group_number, required: false
         property :lastName, from: :last_name, required: false
         property :memberId, from: :member_id, required: false
         property :paymentResponsibilityLevelCode, from: :payment_responsibility_level_code, required: false