change_health 3.1.0 → 3.4.0

checksums.yaml

@@ -1,7 +1,7 @@
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data/CHANGELOG.md

@@ -4,6 +4,21 @@ 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).
 
+# [3.4.0] - 2022-03-23
+### Added
+* Report835Claim - check_or_eft_trace_number & check_issue_or_eft_effective_date
+
+# [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
@@ -225,6 +240,9 @@ Added the ability to hit professional claim submission API. For more details, se
 - Authentication
 - Configuration
 
+[3.4.0]: https://github.com/WeInfuse/change_health/compare/v3.3.0...v3.4.0
+[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

data/README.md

@@ -255,6 +255,9 @@ claim_277 = report_277_data.claims.first
 claim_277.payer_name
 # "PREMERA"
 
+claim_277.report_name
+# "X3000000.AB"
+
 claim_277.patient_first_name
 # "JOHNONE"
 
@@ -290,6 +293,9 @@ claim_835.payer_name
 claim_835.patient_first_name
 # "JANE"
 
+claim_835.patient_member_id
+# "7SL5RA7XR19"
+
 claim_835.report_creation_date
 # Wed, 22 Apr 2020
 

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

@@ -2,8 +2,12 @@ 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] ||= []

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

@@ -30,6 +30,7 @@ module ChangeHealth
                   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_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|
@@ -38,11 +39,17 @@ module ChangeHealth
                       claim_status = claim['claimStatus']
                       next if claim_status.nil?
 
+                      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']
 
@@ -52,22 +59,29 @@ module ChangeHealth
                         end
 
                         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 << 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,
+                        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
+                        service_provider_npi: service_provider_npi,
+                        trading_partner_claim_number: trading_partner_claim_number
                       )
                     end
                   end

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

@@ -2,6 +2,7 @@ module ChangeHealth
   module Response
     module Claim
       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

@@ -2,6 +2,10 @@ module ChangeHealth
   module Response
     module Claim
       class Report835Claim < ReportClaim
+        property :check_issue_or_eft_effective_date, required: false
+        property :check_or_eft_trace_number, required: false
+        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

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

@@ -7,6 +7,18 @@ module ChangeHealth
           @raw['transactions']
         end
 
+        def check_or_eft_trace_number
+          transactions&.first&.dig('paymentAndRemitReassociationDetails', 'checkOrEFTTraceNumber')
+        end
+
+        def check_issue_or_eft_effective_date
+          ChangeHealth::Models::PARSE_DATE.call(transactions&.first&.dig('financialInformation', 'checkIssueOrEFTEffectiveDate'))
+        end
+
+        def payer_identification
+          transactions&.first&.dig('payer', 'payerIdentificationNumber')
+        end
+
         # Only one payer per report
         def payer_name
           transactions&.first&.dig('payer')&.dig('name')
@@ -28,32 +40,33 @@ module ChangeHealth
           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')
-                payer_claim_control_number = payment_info.dig('claimPaymentInfo', 'payerClaimControlNumber')
+
+                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_lines = payment_info['serviceLines']&.map 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
+                  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')
@@ -61,42 +74,56 @@ module ChangeHealth
                   line_item_provider_payment_amount = service_line.dig('servicePaymentInformation',
                                                                        'lineItemProviderPaymentAmount')
 
-                  service_adjustments = []
-                  service_line['serviceAdjustments']&.each do |service_adjustment|
+                  service_adjustments = service_line['serviceAdjustments']&.map 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}"]
+                    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(
+                    Report835ServiceAdjustment.new(
                       adjustments: adjustments,
                       claim_adjustment_group_code: claim_adjustment_group_code
                     )
                   end
 
-                  service_lines << Report835ServiceLine.new(
+                  health_care_check_remark_codes = service_line['healthCareCheckRemarkCodes']&.map do |health_care_check_remark_code|
+                    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
+
+                  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
+                    service_adjustments: service_adjustments,
+                    health_care_check_remark_codes: health_care_check_remark_codes
                   )
                 end
 
                 report_claims << Report835Claim.new(
+                  check_issue_or_eft_effective_date: check_issue_or_eft_effective_date,
+                  check_or_eft_trace_number: check_or_eft_trace_number,
+                  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,

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_line.rb

@@ -4,6 +4,7 @@ module ChangeHealth
       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

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

@@ -4,9 +4,11 @@ module ChangeHealth
       class ReportClaim < Hashie::Trash
         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

data/lib/change_health/version.rb

@@ -1,3 +1,3 @@
 module ChangeHealth
-  VERSION = '3.1.0'.freeze
+  VERSION = '3.4.0'.freeze
 end

data/lib/change_health.rb

@@ -32,6 +32,7 @@ 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_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'

metadata

@@ -1,14 +1,14 @@
 --- !ruby/object:Gem::Specification
 name: change_health
 version: !ruby/object:Gem::Version
-  version: 3.1.0
+  version: 3.4.0
 platform: ruby
 authors:
 - Mike Crockett
 autorequire: 
 bindir: exe
 cert_chain: []
-date: 2021-12-21 00:00:00.000000000 Z
+date: 2022-03-23 00:00:00.000000000 Z
 dependencies:
 - !ruby/object:Gem::Dependency
   name: httparty
@@ -168,6 +168,7 @@ files:
 - 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