change_health 2.2.0 → 3.1.0

data/lib/change_health/models/model.rb

@@ -1,7 +1,7 @@
 module ChangeHealth
   module Models
     DATE_FORMAT = '%Y%m%d'
-    DATE_FORMATTER = ->(d) {
+    DATE_FORMATTER = lambda { |d|
       begin
         d = Date.parse(d) if d.is_a?(String)
       rescue ArgumentError
@@ -12,37 +12,65 @@ module ChangeHealth
       d
     }
 
-    PARSE_DATE = ->(d) {
+    PARSE_DATE = lambda { |d|
       begin
         d = Date.strptime(d, ChangeHealth::Models::DATE_FORMAT)
-      rescue
+      rescue StandardError
       end
 
       d
     }
 
-    CONTROL_NUMBER = ->() { '%09d' % rand(1_000_000_000) }
+    POSTAL_CODE_FORMATTER = lambda { |postal_code|
+      begin
+        formatted_postal_code = postal_code&.to_s&.tr('-', '')
+      rescue StandardError
+      end
+      formatted_postal_code || postal_code
+    }
+
+    CONTROL_NUMBER = -> { '%09d' % rand(1_000_000_000) }
 
     class Model < Hashie::Trash
       def to_h
-        result = super.to_h
+        self.class.hashify(self)
+      end
+
+      def self.hashify(model)
+        model.map do |key, value|
+          formatted_value = case value
+                            when Hash
+                              hashify(model[key])
+                            when Array
+                              value.map do |element|
+                                if element.is_a?(Hash)
+                                  hashify(element)
+                                else # if it's an array of arrays, can't handle it
+                                  format_value(key, element)
+                                end
+                              end
+                            else
+                              format_value(key, value)
+                            end
+          [key, formatted_value]
+        end.to_h
+      end
+
+      def self.format_value(key, value)
+        return nil if value == ''
 
-        self.each_pair do |key, value|
-          if key.to_s.downcase.include?('date')
-            result[key] = ChangeHealth::Models::DATE_FORMATTER.call(result[key])
-          end
-          result[key] = nil if value == ""
-        end
+        return ChangeHealth::Models::DATE_FORMATTER.call(value) if key.to_s.downcase.include?('date')
+        return ChangeHealth::Models::POSTAL_CODE_FORMATTER.call(value) if key.to_s.downcase.include?('postalcode')
 
-        result
+        value
       end
 
-      def as_json(args = {})
-        self.to_h
+      def as_json(_args = {})
+        to_h
       end
 
-      def to_json
-        self.to_h.to_json
+      def to_json(*_args)
+        to_h.to_json
       end
     end
   end

data/lib/change_health/request/report.rb

@@ -5,25 +5,35 @@ module ChangeHealth
         ENDPOINT = '/medicalnetwork/reports/v2'.freeze
         HEALTH_CHECK_ENDPOINT = ENDPOINT + '/healthcheck'.freeze
 
-        def self.report_list
-          ChangeHealth::Response::Claim::ReportListData.new(response: ChangeHealth::Connection.new.request(endpoint: ENDPOINT, verb: :get))
+        def self.report_list(headers: nil)
+          final_headers = ChangeHealth::Request::Claim::Report.report_headers(headers)
+          ChangeHealth::Response::Claim::ReportListData.new(response: ChangeHealth::Connection.new.request(endpoint: ENDPOINT, verb: :get, headers: final_headers))
         end
 
-        def self.get_report(report_name, as_json_report: true)
+        def self.get_report(report_name, as_json_report: true, headers: nil)
           return if report_name.nil? || report_name.empty?
+          final_headers =  ChangeHealth::Request::Claim::Report.report_headers(headers)
+
+          report_type = ChangeHealth::Response::Claim::ReportData.report_type(report_name)
+          return if report_type.nil?
 
           individual_report_endpoint = ENDPOINT + '/' + report_name
-          if as_json_report
-            # https://developers.changehealthcare.com/eligibilityandclaims/docs/what-file-types-does-this-api-get-from-the-mailbox
-            report_type = ChangeHealth::Response::Claim::ReportData.report_type(report_name)
-            return if report_type.nil?
 
-            individual_report_endpoint += '/' + report_type
-          end
+          # https://developers.changehealthcare.com/eligibilityandclaims/docs/what-file-types-does-this-api-get-from-the-mailbox
+          individual_report_endpoint += '/' + report_type if as_json_report
 
-          ChangeHealth::Response::Claim::ReportData.new(report_name,
-                                                        as_json_report,
-                                                        response: ChangeHealth::Connection.new.request(endpoint: individual_report_endpoint, verb: :get))
+          response = ChangeHealth::Connection.new.request(endpoint: individual_report_endpoint, verb: :get, headers: final_headers)
+          if ChangeHealth::Response::Claim::ReportData.is_277?(report_name)
+            ChangeHealth::Response::Claim::Report277Data
+              .new(report_name,
+                   as_json_report,
+                   response: response)
+          else
+            ChangeHealth::Response::Claim::Report835Data
+              .new(report_name,
+                   as_json_report,
+                   response: response)
+          end
         end
 
         def self.health_check
@@ -33,6 +43,17 @@ module ChangeHealth
         def self.ping
           self.health_check
         end
+
+        def self.report_headers(headers)
+          if headers
+            extra_headers = {}
+            extra_headers["X-CHC-Reports-Username"] = headers[:username]
+            extra_headers["X-CHC-Reports-Password"] = headers[:password]
+            extra_headers
+          else
+            nil
+          end
+        end
       end
     end
   end

data/lib/change_health/request/submission.rb

@@ -5,6 +5,7 @@ module ChangeHealth
         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
@@ -12,6 +13,7 @@ module ChangeHealth
         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
@@ -22,7 +24,15 @@ module ChangeHealth
         end
 
         def submission
-          ChangeHealth::Response::Claim::SubmissionData.new(response: ChangeHealth::Connection.new.request(endpoint: SUBMISSION_ENDPOINT, body: self.to_h))
+          ChangeHealth::Response::Claim::SubmissionData.new(response: ChangeHealth::Connection.new.request(
+            endpoint: SUBMISSION_ENDPOINT, body: to_h, headers: professional_headers
+          ))
+        end
+
+        def validation
+          ChangeHealth::Response::Claim::SubmissionData.new(response: ChangeHealth::Connection.new.request(
+            endpoint: VALIDATION_ENDPOINT, body: to_h, headers: professional_headers
+          ))
         end
 
         def self.health_check
@@ -30,7 +40,18 @@ module ChangeHealth
         end
 
         def self.ping
-          self.health_check
+          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
+          end
         end
       end
     end

data/lib/change_health/response/claim/report/report_277_claim.rb

@@ -0,0 +1,40 @@
+module ChangeHealth
+  module Response
+    module Claim
+      class Report277Claim < ReportClaim
+        property :info_claim_statuses, required: false
+        property :procedure_codes, required: false
+
+        def add_info_claim_status(info_claim_status)
+          self[:info_claim_statuses] ||= []
+          self[:info_claim_statuses] << info_claim_status
+        end
+
+        def add_procedure_code(procedure_code)
+          self[:procedure_codes] ||= []
+          self[:procedure_codes] << procedure_code
+        end
+
+        def latest_status_category_codes
+          latest_info_claim_status&.status_category_codes
+        end
+
+        def total_charge_amount
+          latest_info_claim_status&.total_charge_amount
+        end
+
+        def latest_status_info_effective_date
+          latest_info_claim_status&.status_information_effective_date
+        end
+
+        def latest_info_claim_status
+          info_claim_statuses&.select do |info|
+            !info.status_information_effective_date.nil? &&
+              info.status_information_effective_date.is_a?(Date) &&
+              info.status_information_effective_date <= Date.today
+          end&.max_by(&:status_information_effective_date)
+        end
+      end
+    end
+  end
+end

data/lib/change_health/response/claim/report/report_277_data.rb

@@ -0,0 +1,84 @@
+module ChangeHealth
+  module Response
+    module Claim
+      # Methods only return meaningful data for json reports
+      class Report277Data < ChangeHealth::Response::Claim::ReportData
+        def transactions
+          @raw['transactions']
+        end
+
+        # Only one payer per report
+        def payer_name
+          transactions&.first&.dig('payers')&.first&.dig('organizationName')
+        end
+
+        def report_creation_date
+          ChangeHealth::Models::PARSE_DATE.call(transactions&.first&.dig('transactionSetCreationDate'))
+        end
+
+        def claims
+          report_claims = []
+
+          transactions&.each do |transaction|
+            report_creation_date = ChangeHealth::Models::PARSE_DATE.call(transaction['transactionSetCreationDate'])
+            transaction['payers']&.each do |payer|
+              payer_identification = payer['payerIdentification']
+              payer_name = payer['organizationName']
+              payer['claimStatusTransactions']&.each do |claim_status_txn|
+                claim_status_txn['claimStatusDetails']&.each do |claim_status_detail|
+                  service_provider_npi = claim_status_detail.dig('serviceProvider', 'npi')
+                  claim_status_detail['patientClaimStatusDetails']&.each do |patient_claim_status_detail|
+                    patient_first_name = patient_claim_status_detail.dig('subscriber', 'firstName')
+                    patient_last_name = patient_claim_status_detail.dig('subscriber', 'lastName')
+                    patient_claim_status_detail['claims']&.each do |claim|
+                      procedure_codes = []
+                      claim['serviceLines']&.each do |service_line|
+                        procedure_codes << service_line.dig('service', 'procedureCode')
+                      end
+                      claim_status = claim['claimStatus']
+                      next if claim_status.nil?
+
+                      service_date_begin = ChangeHealth::Models::PARSE_DATE.call(claim_status['claimServiceBeginDate'] || claim_status['claimServiceDate'])
+                      service_date_end = ChangeHealth::Models::PARSE_DATE.call(claim_status['claimServiceEndDate'] || claim_status['claimServiceDate'])
+
+                      info_claim_statuses = []
+                      claim_status['informationClaimStatuses']&.each do |info_claim_status|
+                        status_information_effective_date = ChangeHealth::Models::PARSE_DATE.call(info_claim_status['statusInformationEffectiveDate'])
+                        total_charge_amount = info_claim_status['totalClaimChargeAmount']
+
+                        status_category_codes = []
+                        info_claim_status['informationStatuses']&.each do |info_status|
+                          status_category_codes << info_status['healthCareClaimStatusCategoryCode']
+                        end
+
+                        info_claim_statuses << Report277InfoClaimStatus.new(
+                          status_category_codes: status_category_codes,
+                          total_charge_amount: total_charge_amount,
+                          status_information_effective_date: status_information_effective_date
+                        )
+                      end
+                      report_claims << Report277Claim.new(
+                        info_claim_statuses: info_claim_statuses,
+                        patient_first_name: patient_first_name,
+                        patient_last_name: patient_last_name,
+                        payer_identification: payer_identification,
+                        payer_name: payer_name,
+                        procedure_codes: procedure_codes,
+                        report_creation_date: report_creation_date,
+                        service_date_begin: service_date_begin,
+                        service_date_end: service_date_end,
+                        service_provider_npi: service_provider_npi
+                      )
+                    end
+                  end
+                end
+              end
+            end
+          end
+
+          report_claims
+        end
+      end
+    end
+  end
+end

data/lib/change_health/response/claim/report/report_277_info_claim_status.rb

@@ -0,0 +1,16 @@
+module ChangeHealth
+  module Response
+    module Claim
+      class Report277InfoClaimStatus < Hashie::Trash
+        property :status_category_codes, required: false
+        property :total_charge_amount, required: false
+        property :status_information_effective_date, required: false
+
+        def add_status_category_code(status_category_code)
+          self[:status_category_codes] ||= []
+          self[:status_category_codes] << status_category_code
+        end
+      end
+    end
+  end
+end

data/lib/change_health/response/claim/report/report_835_claim.rb

@@ -0,0 +1,17 @@
+module ChangeHealth
+  module Response
+    module Claim
+      class Report835Claim < ReportClaim
+        property :payer_claim_control_number, required: false
+        property :payment_method_code, required: false
+        property :service_lines, required: false
+        property :total_actual_provider_payment_amount, required: false
+        property :total_charge_amount, required: false
+
+        def procedure_codes
+          service_lines&.map(&:adjudicated_procedure_code)
+        end
+      end
+    end
+  end
+end

data/lib/change_health/response/claim/report/report_835_data.rb

@@ -0,0 +1,116 @@
+module ChangeHealth
+  module Response
+    module Claim
+      # Methods only return meaningful data for json reports
+      class Report835Data < ChangeHealth::Response::Claim::ReportData
+        def transactions
+          @raw['transactions']
+        end
+
+        # Only one payer per report
+        def payer_name
+          transactions&.first&.dig('payer')&.dig('name')
+        end
+
+        def payment_method_code
+          transactions&.first&.dig('financialInformation', 'paymentMethodCode')
+        end
+
+        def report_creation_date
+          ChangeHealth::Models::PARSE_DATE.call(transactions&.first&.dig('productionDate'))
+        end
+
+        def total_actual_provider_payment_amount
+          transactions&.first&.dig('financialInformation', 'totalActualProviderPaymentAmount')
+        end
+
+        def claims
+          report_claims = []
+
+          transactions&.each do |transaction|
+            payment_method_code = transaction.dig('financialInformation', 'paymentMethodCode')
+            payer_name = transaction.dig('payer', 'name')
+            payer_identification = transaction.dig('payer', 'payerIdentificationNumber')
+            report_creation_date = ChangeHealth::Models::PARSE_DATE.call(transaction['productionDate'])
+            total_actual_provider_payment_amount = transaction.dig('financialInformation',
+                                                                   'totalActualProviderPaymentAmount')
+
+            transaction['detailInfo']&.each do |detail_info|
+              detail_info['paymentInfo']&.each do |payment_info|
+                patient_first_name = payment_info.dig('patientName', 'firstName')
+                patient_last_name = payment_info.dig('patientName', 'lastName')
+                service_provider_npi = payment_info.dig('renderingProvider', 'npi')
+                total_charge_amount = payment_info.dig('claimPaymentInfo', 'totalClaimChargeAmount')
+                payer_claim_control_number = payment_info.dig('claimPaymentInfo', 'payerClaimControlNumber')
+
+                service_date_begin = nil
+                service_date_end = nil
+                service_lines = []
+                payment_info['serviceLines']&.each do |service_line|
+                  service_line_date = ChangeHealth::Models::PARSE_DATE.call(service_line['serviceDate'])
+                  if service_date_begin.nil? || service_line_date < service_date_begin
+                    service_date_begin = service_line_date
+                  end
+                  if service_date_end.nil? || service_date_end < service_line_date
+                    service_date_end = service_line_date
+                  end
+
+                  adjudicated_procedure_code = service_line.dig('servicePaymentInformation', 'adjudicatedProcedureCode')
+                  allowed_actual = service_line.dig('serviceSupplementalAmounts', 'allowedActual')
+                  line_item_charge_amount = service_line.dig('servicePaymentInformation', 'lineItemChargeAmount')
+                  line_item_provider_payment_amount = service_line.dig('servicePaymentInformation',
+                                                                       'lineItemProviderPaymentAmount')
+
+                  service_adjustments = []
+                  service_line['serviceAdjustments']&.each do |service_adjustment|
+                    adjustments = {}
+                    # - 2 b/c group code & value, / 2 b/c come in pairs
+                    num_adjustments = (service_adjustment.keys.size - 2) / 2
+                    (1..num_adjustments).each do |index|
+                      adjustment_reason = service_adjustment["adjustmentReasonCode#{index}"]
+                      adjustment_amount = service_adjustment["adjustmentAmount#{index}"]
+                      adjustments[adjustment_reason] = adjustment_amount
+                    end
+
+                    claim_adjustment_group_code = service_adjustment['claimAdjustmentGroupCode']
+
+                    service_adjustments << Report835ServiceAdjustment.new(
+                      adjustments: adjustments,
+                      claim_adjustment_group_code: claim_adjustment_group_code
+                    )
+                  end
+
+                  service_lines << Report835ServiceLine.new(
+                    adjudicated_procedure_code: adjudicated_procedure_code,
+                    allowed_actual: allowed_actual,
+                    line_item_charge_amount: line_item_charge_amount,
+                    line_item_provider_payment_amount: line_item_provider_payment_amount,
+                    service_adjustments: service_adjustments
+                  )
+                end
+
+                report_claims << Report835Claim.new(
+                  patient_first_name: patient_first_name,
+                  patient_last_name: patient_last_name,
+                  payer_claim_control_number: payer_claim_control_number,
+                  payer_identification: payer_identification,
+                  payer_name: payer_name,
+                  payment_method_code: payment_method_code,
+                  report_creation_date: report_creation_date,
+                  service_date_begin: service_date_begin,
+                  service_date_end: service_date_end,
+                  service_lines: service_lines,
+                  service_provider_npi: service_provider_npi,
+                  total_actual_provider_payment_amount: total_actual_provider_payment_amount,
+                  total_charge_amount: total_charge_amount
+                )
+              end
+            end
+          end
+
+          report_claims
+        end
+      end
+    end
+  end
+end

data/lib/change_health/response/claim/report/report_835_service_adjustment.rb

@@ -0,0 +1,15 @@
+module ChangeHealth
+  module Response
+    module Claim
+      class Report835ServiceAdjustment < Hashie::Trash
+        property :adjustments, required: false
+        property :claim_adjustment_group_code, required: false
+
+        def add_adjustment(adjustment)
+          self[:adjustments] ||= []
+          self[:adjustments] << adjustment
+        end
+      end
+    end
+  end
+end

data/lib/change_health/response/claim/report/report_835_service_line.rb

@@ -0,0 +1,13 @@
+module ChangeHealth
+  module Response
+    module Claim
+      class Report835ServiceLine < Hashie::Trash
+        property :adjudicated_procedure_code, required: false
+        property :allowed_actual, required: false
+        property :line_item_charge_amount, required: false
+        property :line_item_provider_payment_amount, required: false
+        property :service_adjustments, required: false
+      end
+    end
+  end
+end

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

@@ -0,0 +1,16 @@
+module ChangeHealth
+  module Response
+    module Claim
+      class ReportClaim < Hashie::Trash
+        property :patient_first_name, required: false
+        property :patient_last_name, required: false
+        property :payer_identification, required: false
+        property :payer_name, required: false
+        property :report_creation_date, required: false
+        property :service_date_begin, required: false
+        property :service_date_end, required: false
+        property :service_provider_npi, required: false
+      end
+    end
+  end
+end

data/lib/change_health/{models → response}/error.rb

@@ -1,13 +1,12 @@
 module ChangeHealth
-  # TODO: This should be the response module/folder... next major release
-  module Models
+  module Response
     class Error
       attr_reader :data
 
       SIMPLE_RETRY_CODES = %w[
-            42
-            80
-          ].freeze
+        42
+        80
+      ].freeze
 
       NO_RESUBMIT_MESSAGES = [
         'resubmission not allowed',
@@ -40,7 +39,9 @@ module ChangeHealth
 
       def retryable?
         represents_down? ||
-          (code? && SIMPLE_RETRY_CODES.include?(code) && followupAction? && NO_RESUBMIT_MESSAGES.none? {|msg| followupAction.downcase.include?(msg) })
+          (code? && SIMPLE_RETRY_CODES.include?(code) && followupAction? && NO_RESUBMIT_MESSAGES.none? do |msg|
+             followupAction.downcase.include?(msg)
+           end)
       end
 
       %w[field description code followupAction location].each do |method_name|
@@ -48,7 +49,7 @@ module ChangeHealth
           false == send(method_name).nil?
         end
 
-        define_method("#{method_name}") do
+        define_method(method_name.to_s) do
           @data[method_name]
         end
       end

data/lib/change_health/response/response_data.rb

@@ -16,13 +16,13 @@ module ChangeHealth
       end
 
       def errors?
-        self.errors.is_a?(Array) && false == self.errors.empty?
+        errors.is_a?(Array) && false == errors.empty?
       end
 
       def errors
         errors = @raw.dig('errors') || []
 
-        errors.flatten.map {|error| ChangeHealth::Models::Error.new(error) }
+        errors.flatten.map { |error| ChangeHealth::Response::Error.new(error) }
       end
 
       def recommend_retry?
@@ -34,7 +34,7 @@ module ChangeHealth
 
         return false if error_codes.empty?
 
-        return error_codes.all?(&:retryable?)
+        error_codes.all?(&:retryable?)
       end
     end
   end

data/lib/change_health/version.rb

@@ -1,3 +1,3 @@
 module ChangeHealth
-  VERSION = '2.2.0'.freeze
+  VERSION = '3.1.0'.freeze
 end

data/lib/change_health.rb

@@ -5,9 +5,10 @@ require 'change_health/authentication'
 require 'change_health/change_health_exception'
 require 'change_health/connection'
 require 'change_health/extensions'
-require 'change_health/models/error'
 require 'change_health/models/model'
+require 'change_health/models/claim/submission/address'
 require 'change_health/models/claim/submission/claim_information'
+require 'change_health/models/claim/submission/drug_identification'
 require 'change_health/models/claim/submission/provider'
 require 'change_health/models/claim/submission/service_line'
 require 'change_health/models/claim/submission/submitter'
@@ -20,10 +21,19 @@ 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/error'
 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/claim/report/report_277_data'
+require 'change_health/response/claim/report/report_835_data'
+require 'change_health/response/claim/report/report_claim'
+require 'change_health/response/claim/report/report_277_claim'
+require 'change_health/response/claim/report/report_277_info_claim_status'
+require 'change_health/response/claim/report/report_835_claim'
+require 'change_health/response/claim/report/report_835_service_adjustment'
+require 'change_health/response/claim/report/report_835_service_line'
 require 'change_health/response/eligibility/eligibility_benefit'
 require 'change_health/response/eligibility/eligibility_benefits'
 require 'change_health/response/eligibility/eligibility_data'
@@ -45,11 +55,11 @@ module ChangeHealth
     end
 
     def api_endpoint
-      return Connection.base_uri
+      Connection.base_uri
     end
 
     def to_h
-      return {
+      {
         client_id: @client_id,
         client_secret: @client_secret,
         grant_type: @grant_type,
@@ -63,7 +73,7 @@ module ChangeHealth
       self.grant_type    = h[:grant_type]
       self.api_endpoint  = h[:api_endpoint]
 
-      return self
+      self
     end
   end