change_health 2.3.0 → 3.3.0

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data/CHANGELOG.md

@@ -4,10 +4,58 @@ 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).
 
+# [3.3.0] - 2022-02-11
+### Added
+* Report277Claim - 'message' from informationClaimStatuses, clearinghouse_trace_number, patient_account_number, referenced_transaction_trace_number, trading_partner_claim_number
+* Report835Claim - patient_control_number
+* ReportClaim - report_name, patient_member_id
+
+## [3.2.0] - 2021-12-23
+### Added
+* Report835HealthCareCheckRemarkCode
+* Report835Claim - added claim_payment_remark_codes
+
+## [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
-* Specific classes for 277 & 835 reports - Report277Data & Report835Data
-* ReportClaim & ReportInfoClaimStatus- only works for json 277 reports
+* Report277Data & Report835Data - Specific classes for 277 & 835 reports
+* ReportClaim & ReportInfoClaimStatus - only works for json 277 reports
 
 ### Fixed
 * Headers can now be nil for requests
@@ -188,6 +236,10 @@ Added the ability to hit professional claim submission API. For more details, se
 - Authentication
 - Configuration
 
+[3.3.0]: https://github.com/WeInfuse/change_health/compare/v3.2.0...v3.3.0
+[3.2.0]: https://github.com/WeInfuse/change_health/compare/v3.1.0...v3.2.0
+[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

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
 
@@ -76,7 +84,7 @@ edata.raw == edata.response.parsed_response
 # 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"]
     }
   }
 )
@@ -196,10 +205,10 @@ 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
+### Get Reports
 ```ruby
 ChangeHealth::Request::Claim::Report.ping # Test your connection
 
@@ -226,33 +235,78 @@ reports_edi = report_list.report_names.map {|report_name| ChangeHealth::Request:
 # all reports in edi format
 ```
 
-#### Review Individual Claims
-Currently only works for json 277 reports. json 835 reports coming soon!
+### 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
 
-From a report, you can get an array of claims. For a full list of fields, see `ChangeHealth::Response::Claim::ReportClaim`
+#### Report 277
 
 ```ruby
-report_claims = ChangeHealth::Request::Claim::Report.get_report("X3000000.AB", as_json_report: true).claims
-# list of claims in the report
+report_277_data = ChangeHealth::Request::Claim::Report.get_report("X3000000.AB", as_json_report: true)
 
-claim = report_claims.first
-claim.payer_org_name
+report_277_data.payer_name
 # "PREMERA"
 
-claim.subscriber_first_name
+report_277_data.report_creation_date
+# Tue, 01 Dec 2020
+
+claim_277 = report_277_data.claims.first
+claim_277.payer_name
+# "PREMERA"
+
+claim_277.report_name
+# "X3000000.AB"
+
+claim_277.patient_first_name
 # "JOHNONE"
 
-claim.transaction_set_creation_date
+claim_277.report_creation_date
 # Tue, 01 Dec 2020
 
-claim.latest_status_category_codes
+# Report 277 specific below
+claim_277.latest_status_category_codes
 # ["F1"]
 
-claim.latest_total_charge_amount
+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.patient_member_id
+# "7SL5RA7XR19"
+
+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
+## Configuration
 
 ```ruby
 ChangeHealth.configure do |c|
@@ -263,12 +317,12 @@ ChangeHealth.configure do |c|
 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/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

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/submission.rb

@@ -2,7 +2,6 @@ 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
@@ -25,11 +24,15 @@ module ChangeHealth
         end
 
         def submission
-          ChangeHealth::Response::Claim::SubmissionData.new(response: ChangeHealth::Connection.new.request(endpoint: SUBMISSION_ENDPOINT, body: self.to_h, headers: professional_headers))
+          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: self.to_h, headers: professional_headers))
+          ChangeHealth::Response::Claim::SubmissionData.new(response: ChangeHealth::Connection.new.request(
+            endpoint: VALIDATION_ENDPOINT, body: to_h, headers: professional_headers
+          ))
         end
 
         def self.health_check
@@ -37,19 +40,17 @@ 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['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

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

@@ -0,0 +1,44 @@
+module ChangeHealth
+  module Response
+    module Claim
+      class Report277Claim < ReportClaim
+        property :clearinghouse_trace_number, required: false
+        property :info_claim_statuses, required: false
+        property :patient_account_number, required: false
+        property :procedure_codes, required: false
+        property :referenced_transaction_trace_number, required: false
+        property :trading_partner_claim_number, 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

@@ -8,23 +8,29 @@ module ChangeHealth
         end
 
         # Only one payer per report
-        def payer_org_name
+        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|
-            transaction_set_creation_date = ChangeHealth::Models::PARSE_DATE.call(transaction['transactionSetCreationDate'])
+            report_creation_date = ChangeHealth::Models::PARSE_DATE.call(transaction['transactionSetCreationDate'])
             transaction['payers']&.each do |payer|
-              payer_org_name = payer['organizationName']
+              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|
-                    subscriber_first_name = patient_claim_status_detail.dig('subscriber', 'firstName')
-                    subscriber_last_name = patient_claim_status_detail.dig('subscriber', 'lastName')
+                    patient_first_name = patient_claim_status_detail.dig('subscriber', 'firstName')
+                    patient_last_name = patient_claim_status_detail.dig('subscriber', 'lastName')
+                    patient_member_id = patient_claim_status_detail.dig('subscriber', 'memberId')
                     patient_claim_status_detail['claims']&.each do |claim|
                       procedure_codes = []
                       claim['serviceLines']&.each do |service_line|
@@ -33,11 +39,17 @@ module ChangeHealth
                       claim_status = claim['claimStatus']
                       next if claim_status.nil?
 
-                      service_begin_date = ChangeHealth::Models::PARSE_DATE.call(claim_status['claimServiceBeginDate'] || claim_status['claimServiceDate'])
-                      service_end_date = ChangeHealth::Models::PARSE_DATE.call(claim_status['claimServiceEndDate'] || claim_status['claimServiceDate'])
+                      clearinghouse_trace_number = claim_status['clearinghouseTraceNumber']
+                      patient_account_number = claim_status['patientAccountNumber']
+                      referenced_transaction_trace_number = claim_status['referencedTransactionTraceNumber']
+                      trading_partner_claim_number = claim_status['tradingPartnerClaimNumber']
+
+                      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|
+                        message = info_claim_status['message']
                         status_information_effective_date = ChangeHealth::Models::PARSE_DATE.call(info_claim_status['statusInformationEffectiveDate'])
                         total_charge_amount = info_claim_status['totalClaimChargeAmount']
 
@@ -46,22 +58,30 @@ module ChangeHealth
                           status_category_codes << info_status['healthCareClaimStatusCategoryCode']
                         end
 
-                        info_claim_statuses << ReportInfoClaimStatus.new(
+                        info_claim_statuses << Report277InfoClaimStatus.new(
+                          message: message,
                           status_category_codes: status_category_codes,
                           total_charge_amount: total_charge_amount,
                           status_information_effective_date: status_information_effective_date
                         )
                       end
-                      report_claims << ReportClaim.new(
-                        transaction_set_creation_date: transaction_set_creation_date,
-                        payer_org_name: payer_org_name,
-                        service_provider_npi: service_provider_npi,
-                        subscriber_first_name: subscriber_first_name,
-                        subscriber_last_name: subscriber_last_name,
+                      report_claims << Report277Claim.new(
+                        clearinghouse_trace_number: clearinghouse_trace_number,
+                        info_claim_statuses: info_claim_statuses,
+                        patient_account_number: patient_account_number,
+                        patient_first_name: patient_first_name,
+                        patient_last_name: patient_last_name,
+                        patient_member_id: patient_member_id,
+                        payer_identification: payer_identification,
+                        payer_name: payer_name,
                         procedure_codes: procedure_codes,
-                        service_begin_date: service_begin_date,
-                        service_end_date: service_end_date,
-                        info_claim_statuses: info_claim_statuses
+                        referenced_transaction_trace_number: referenced_transaction_trace_number,
+                        report_creation_date: report_creation_date,
+                        report_name: report_name,
+                        service_date_begin: service_date_begin,
+                        service_date_end: service_date_end,
+                        service_provider_npi: service_provider_npi,
+                        trading_partner_claim_number: trading_partner_claim_number
                       )
                     end
                   end

data/lib/change_health/response/claim/report/{report_info_claim_status.rb → report_277_info_claim_status.rb}

@@ -1,7 +1,8 @@
 module ChangeHealth
   module Response
     module Claim
-      class ReportInfoClaimStatus < Hashie::Trash
+      class Report277InfoClaimStatus < Hashie::Trash
+        property :message, required: false
         property :status_category_codes, required: false
         property :total_charge_amount, required: false
         property :status_information_effective_date, required: false

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

@@ -0,0 +1,19 @@
+module ChangeHealth
+  module Response
+    module Claim
+      class Report835Claim < ReportClaim
+        property :claim_payment_remark_codes, required: false
+        property :patient_control_number, required: false
+        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

@@ -1,7 +1,138 @@
 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_control_number = payment_info.dig('claimPaymentInfo', 'patientControlNumber')
+                patient_first_name = payment_info.dig('patientName', 'firstName')
+                patient_last_name = payment_info.dig('patientName', 'lastName')
+                patient_member_id = payment_info.dig('patientName', 'memberId')
+                payer_claim_control_number = payment_info.dig('claimPaymentInfo', 'payerClaimControlNumber')
+                service_provider_npi = payment_info.dig('renderingProvider', 'npi')
+                total_charge_amount = payment_info.dig('claimPaymentInfo', 'totalClaimChargeAmount')
+
+                claim_payment_remark_codes = []
+                claim_payment_remark_codes_index = 1
+                while payment_info.dig('outpatientAdjudication',
+                                       "claimPaymentRemarkCode#{claim_payment_remark_codes_index}")
+                  claim_payment_remark_codes << payment_info.dig('outpatientAdjudication',
+                                                                 "claimPaymentRemarkCode#{claim_payment_remark_codes_index}")
+                  claim_payment_remark_codes_index += 1
+                end
+
+                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
+                  service_date_end = service_line_date if service_date_end.nil? || service_date_end < service_line_date
+
+                  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 = {}
+                    service_adjustment_index = 1
+                    while service_adjustment["adjustmentReasonCode#{service_adjustment_index}"]
+                      adjustment_reason = service_adjustment["adjustmentReasonCode#{service_adjustment_index}"]
+                      adjustment_amount = service_adjustment["adjustmentAmount#{service_adjustment_index}"]
+                      adjustments[adjustment_reason] = adjustment_amount
+                      service_adjustment_index += 1
+                    end
+
+                    claim_adjustment_group_code = service_adjustment['claimAdjustmentGroupCode']
+
+                    service_adjustments << Report835ServiceAdjustment.new(
+                      adjustments: adjustments,
+                      claim_adjustment_group_code: claim_adjustment_group_code
+                    )
+                  end
+
+                  health_care_check_remark_codes = []
+                  service_line['healthCareCheckRemarkCodes']&.each do |health_care_check_remark_code|
+                    health_care_check_remark_codes << Report835HealthCareCheckRemarkCode.new(
+                      code_list_qualifier_code: health_care_check_remark_code['codeListQualifierCode'],
+                      code_list_qualifier_code_value: health_care_check_remark_code['codeListQualifierCodeValue'],
+                      remark_code: health_care_check_remark_code['remarkCode']
+                    )
+                  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,
+                    health_care_check_remark_codes: health_care_check_remark_codes
+                  )
+                end
+
+                report_claims << Report835Claim.new(
+                  claim_payment_remark_codes: claim_payment_remark_codes,
+                  patient_control_number: patient_control_number,
+                  patient_first_name: patient_first_name,
+                  patient_last_name: patient_last_name,
+                  patient_member_id: patient_member_id,
+                  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,
+                  report_name: report_name,
+                  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

data/lib/change_health/response/claim/report/report_835_health_care_check_remark_code.rb

@@ -0,0 +1,11 @@
+module ChangeHealth
+  module Response
+    module Claim
+      class Report835HealthCareCheckRemarkCode < Hashie::Trash
+        property :code_list_qualifier_code, required: false
+        property :code_list_qualifier_code_value, required: false
+        property :remark_code, required: false
+      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 +1,14 @@
+module ChangeHealth
+  module Response
+    module Claim
+      class Report835ServiceLine < Hashie::Trash
+        property :adjudicated_procedure_code, required: false
+        property :allowed_actual, required: false
+        property :health_care_check_remark_codes, 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

@@ -2,45 +2,16 @@ module ChangeHealth
   module Response
     module Claim
       class ReportClaim < Hashie::Trash
-        property :transaction_set_creation_date, required: false
-        property :payer_org_name, required: false
+        property :patient_first_name, required: false
+        property :patient_last_name, required: false
+        property :patient_member_id, required: false
+        property :payer_identification, required: false
+        property :payer_name, required: false
+        property :report_creation_date, required: false
+        property :report_name, required: false
+        property :service_date_begin, required: false
+        property :service_date_end, required: false
         property :service_provider_npi, required: false
-        property :subscriber_first_name, required: false
-        property :subscriber_last_name, required: false
-        property :procedure_codes, required: false
-        property :service_begin_date, required: false
-        property :service_end_date, required: false
-        property :info_claim_statuses, required: false
-
-        def add_procedure_code(procedure_code)
-          self[:procedure_codes] ||= []
-          self[:procedure_codes] << procedure_code
-        end
-
-        def add_info_claim_status(info_claim_status)
-          self[:info_claim_statuses] ||= []
-          self[:info_claim_statuses] << info_claim_status
-        end
-
-        def latest_status_category_codes
-          latest_info_claim_status&.status_category_codes
-        end
-
-        def latest_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

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 = '2.3.0'.freeze
+  VERSION = '3.3.0'.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'
@@ -20,6 +21,7 @@ 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'
@@ -27,7 +29,12 @@ 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_info_claim_status'
+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_health_care_check_remark_code'
+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'

metadata

@@ -1,14 +1,14 @@
 --- !ruby/object:Gem::Specification
 name: change_health
 version: !ruby/object:Gem::Version
-  version: 2.3.0
+  version: 3.3.0
 platform: ruby
 authors:
 - Mike Crockett
 autorequire: 
 bindir: exe
 cert_chain: []
-date: 2021-11-19 00:00:00.000000000 Z
+date: 2022-02-11 00:00:00.000000000 Z
 dependencies:
 - !ruby/object:Gem::Dependency
   name: httparty
@@ -147,7 +147,9 @@ files:
 - lib/change_health/change_health_exception.rb
 - lib/change_health/connection.rb
 - lib/change_health/extensions.rb
+- lib/change_health/models/claim/submission/address.rb
 - lib/change_health/models/claim/submission/claim_information.rb
+- lib/change_health/models/claim/submission/drug_identification.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
@@ -155,23 +157,28 @@ files:
 - 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/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/claim/report/report_277_claim.rb
 - lib/change_health/response/claim/report/report_277_data.rb
+- lib/change_health/response/claim/report/report_277_info_claim_status.rb
+- lib/change_health/response/claim/report/report_835_claim.rb
 - lib/change_health/response/claim/report/report_835_data.rb
+- lib/change_health/response/claim/report/report_835_health_care_check_remark_code.rb
+- lib/change_health/response/claim/report/report_835_service_adjustment.rb
+- lib/change_health/response/claim/report/report_835_service_line.rb
 - lib/change_health/response/claim/report/report_claim.rb
 - lib/change_health/response/claim/report/report_data.rb
-- lib/change_health/response/claim/report/report_info_claim_status.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/error.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