change_health 3.5.4 → 4.2.0

checksums.yaml

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data/CHANGELOG.md

@@ -5,6 +5,27 @@ 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).
 
+# [4.2.0] - 2022-06-23
+
+### Added
+* Dependent for Claim Submission
+
+# [4.1.0] - 2022-06-17
+
+### Added
+Report835Claim - Add another way to get `service_provider_npi`
+
+# [4.0.0] - 2022-05-26
+
+### Changed
+The assumption that only one payment would be in a report835 was wrong. Corrected that by adding in a model to hold the payment information - Report835Payment. Removed payment related info from Report835Data and Report835Claim. See README for usage
+* check_issue_or_eft_effective_date
+* check_or_eft_trace_number
+* payer_identifier
+* payment_method_code
+* report_creation_date
+* total_actual_provider_payment_amount
+
 # [3.5.4] - 2022-05-18
 
 * Used dig on `service_provider_npi` variable assigning because it produces way fewer bugs
@@ -357,6 +378,9 @@ Added the ability to hit professional claim submission API. For more details, se
 * Authentication
 * Configuration
 
+[4.2.0]: https://github.com/WeInfuse/change_health/compare/v4.1.0...v4.2.0
+[4.1.0]: https://github.com/WeInfuse/change_health/compare/v4.0.0...v4.1.0
+[4.0.0]: https://github.com/WeInfuse/change_health/compare/v3.5.4...v4.0.0
 [3.5.4]: https://github.com/WeInfuse/change_health/compare/v3.5.3...v3.5.4
 [3.5.3]: https://github.com/WeInfuse/change_health/compare/v3.5.2...v3.5.3
 [3.5.2]: https://github.com/WeInfuse/change_health/compare/v3.5.1...v3.5.2

data/README.md

@@ -113,7 +113,7 @@ address = ChangeHealth::Models::Claim::Address.new(
   address1: "123 address1",
   city: "city1",
   state: "wa",
-  postalCode: "98101-0000"
+  postalCode: "981010000"
 )
 
 subscriber = ChangeHealth::Models::Claim::Subscriber.new(
@@ -125,6 +125,17 @@ subscriber = ChangeHealth::Models::Claim::Subscriber.new(
   date_of_birth: "02/01/1980",
   address: address
 )
+
+dependent = ChangeHealth::Models::Claim::Dependent.new(
+  address: address,
+  date_of_birth: "02/01/1980",
+  first_name: "johnone",
+  gender: "M",
+  last_name: "doetwo",
+  member_id: "0000000001",
+  relationship_to_subscriber_code: "01"
+)
+
 provider = ChangeHealth::Models::Claim::Provider.new(
   address: address,
   employer_id: "000000000",
@@ -191,13 +202,14 @@ professional_headers = {
 }
 
 claim_submission = ChangeHealth::Request::Claim::Submission.new(
-  trading_partner_service_id: "9496",
-  submitter: claim_submitter,
+  claim_information: claim_information,
+  dependent: dependent,
+  headers: professional_headers,
+  providers: [provider],
   receiver: receiver,
+  submitter: claim_submitter,
   subscriber: subscriber,
-  providers: [provider],
-  claim_information: claim_information,
-  headers: professional_headers
+  trading_partner_service_id: "9496"
 )
 
 claim_submission_data = claim_submission.submission
@@ -243,66 +255,68 @@ 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)
+report277_data = ChangeHealth::Request::Claim::Report.get_report("X3000000.AB", as_json_report: true)
 
-report_277_data.payer_name
+report277_data.payer_name
 # "PREMERA"
 
-report_277_data.report_creation_date
+report277_data.report_creation_date
 # Tue, 01 Dec 2020
 
-claim_277 = report_277_data.claims.first
-claim_277.payer_name
+claim277 = report277_data.claims.first
+claim277.payer_name
 # "PREMERA"
 
-claim_277.report_name
+claim277.report_name
 # "X3000000.AB"
 
-claim_277.patient_first_name
+claim277.patient_first_name
 # "JOHNONE"
 
-claim_277.report_creation_date
+claim277.report_creation_date
 # Tue, 01 Dec 2020
 
 # Report 277 specific below
-claim_277.latest_status_category_codes
+claim277.latest_status_category_codes
 # ["F1"]
 
-claim_277.total_charge_amount
+claim277.total_charge_amount
 # "100"
 
-claim_277.procedure_codes
+claim277.procedure_codes
 # ["97161"]
 ```
 
 #### Report 835
 
 ```ruby
-report_835_data = ChangeHealth::Request::Claim::Report.get_report("R5000000.XY", as_json_report: true)
+report835_data = ChangeHealth::Request::Claim::Report.get_report("R5000000.XY", as_json_report: true)
+
+payment835 = report835_data.payments.first
 
-report_835_data.payment_method_code
+payment835.payment_method_code
 # "ACH"
 
-report_835_data.total_actual_provider_payment_amount
+payment835.total_actual_provider_payment_amount
 # "2563.13"
 
-claim_835 = report_835_data.claims.first
-claim_835.payer_name
+claim835 = payment835.claims.first
+claim835.payer_name
 # "NATIONAL GOVERNMENT SERVICES, INC."
 
-claim_835.patient_first_name
+claim835.patient_first_name
 # "JANE"
 
-claim_835.patient_member_id
+claim835.patient_member_id
 # "7SL5RA7XR19"
 
-claim_835.report_creation_date
+claim835.report_creation_date
 # Wed, 22 Apr 2020
 
-claim_835.procedure_codes
+claim835.procedure_codes
 # ["21210", "21026", "21208", "30580"]
 
-claim_835.service_lines.map(&:line_item_charge_amount)
+claim835.service_lines.map(&:line_item_charge_amount)
 # ["3600", "1890", "1836", "1680"]
 ```
 

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

@@ -0,0 +1,15 @@
+module ChangeHealth
+  module Models
+    module Claim
+      class Dependent < Model
+        property :address, required: false
+        property :dateOfBirth, from: :date_of_birth, required: false
+        property :firstName, from: :first_name, required: false
+        property :gender, required: false
+        property :lastName, from: :last_name, required: false
+        property :memberId, from: :member_id, required: false
+        property :relationshipToSubscriberCode, from: :relationship_to_subscriber_code, required: false
+      end
+    end
+  end
+end

data/lib/change_health/request/submission.rb

@@ -9,6 +9,7 @@ module ChangeHealth
 
         property :claimInformation, from: :claim_information, required: false
         property :controlNumber, from: :control_number, required: true, default: ChangeHealth::Models::CONTROL_NUMBER
+        property :dependent, required: false
         property :providers, required: false
         property :receiver, required: false
         property :submitter, required: false

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

@@ -2,15 +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 :payer_identifier, 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

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

@@ -7,14 +7,6 @@ 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
@@ -24,34 +16,41 @@ module ChangeHealth
           transactions&.first&.dig('payer')&.dig('name')
         end
 
-        def payer_identifier
-          ChangeHealth::Models::PARSE_DATE.call(transactions&.first&.dig('financialInformation', 'payerIdentifier'))
-        end
-
-        def payment_method_code
-          transactions&.first&.dig('financialInformation', 'paymentMethodCode')
-        end
-
         def report_creation_date
-          ChangeHealth::Models::PARSE_DATE.call(transactions&.first&.dig('productionDate'))
+          payments.map(&:report_creation_date).min
         end
 
-        def total_actual_provider_payment_amount
-          transactions&.first&.dig('financialInformation', 'totalActualProviderPaymentAmount')
+        def claims
+          payments.flat_map(&:claims).compact
         end
 
-        def claims
-          report_claims = []
+        def payments
+          report_payments = []
 
           transactions&.each do |transaction|
-            transaction['detailInfo']&.each do |detail_info|
-              detail_info['paymentInfo']&.each do |payment_info|
+            check_or_eft_trace_number = transaction.dig('paymentAndRemitReassociationDetails', 'checkOrEFTTraceNumber')
+            check_issue_or_eft_effective_date =
+              ChangeHealth::Models::PARSE_DATE.call(
+                transaction.dig('financialInformation', 'checkIssueOrEFTEffectiveDate')
+              )
+            payer_identifier = transaction.dig('financialInformation', 'payerIdentifier')
+            payment_method_code = transaction.dig('financialInformation', 'paymentMethodCode')
+            report_creation_date = ChangeHealth::Models::PARSE_DATE.call(transaction.dig('productionDate'))
+            total_actual_provider_payment_amount =
+              transaction.dig('financialInformation', 'totalActualProviderPaymentAmount')
+            claims = transaction['detailInfo']&.flat_map do |detail_info|
+              detail_info['paymentInfo']&.map 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') || payment_info.dig('subscriber', 'memberId')
+                patient_member_id =
+                  payment_info.dig('patientName', 'memberId') ||
+                  payment_info.dig('subscriber', 'memberId')
                 payer_claim_control_number = payment_info.dig('claimPaymentInfo', 'payerClaimControlNumber')
-                service_provider_npi = payment_info.dig('renderingProvider', 'npi') || detail_info.dig('providerSummaryInformation', 'providerIdentifier')
+                service_provider_npi =
+                  payment_info.dig('renderingProvider', 'npi') ||
+                  detail_info.dig('providerSummaryInformation', 'providerIdentifier') ||
+                  transaction.dig('payee', 'npi')
                 total_charge_amount = payment_info.dig('claimPaymentInfo', 'totalClaimChargeAmount')
 
                 claim_payment_remark_codes = []
@@ -114,9 +113,7 @@ module ChangeHealth
                   )
                 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,
+                Report835Claim.new(
                   claim_payment_remark_codes: claim_payment_remark_codes,
                   patient_control_number: patient_control_number,
                   patient_first_name: patient_first_name,
@@ -124,23 +121,31 @@ module ChangeHealth
                   patient_member_id: patient_member_id,
                   payer_claim_control_number: payer_claim_control_number,
                   payer_identification: payer_identification,
-                  payer_identifier: payer_identifier,
                   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
+            report_payments << Report835Payment.new(
+              check_issue_or_eft_effective_date: check_issue_or_eft_effective_date,
+              check_or_eft_trace_number: check_or_eft_trace_number,
+              claims: claims,
+              payer_identifier: payer_identifier,
+              payer_name: payer_name,
+              payment_method_code: payment_method_code,
+              report_creation_date: report_creation_date,
+              report_name: report_name,
+              total_actual_provider_payment_amount: total_actual_provider_payment_amount
+            )
           end
 
-          report_claims
+          report_payments
         end
       end
     end

data/lib/change_health/response/claim/report/report_835_payment.rb

@@ -0,0 +1,17 @@
+module ChangeHealth
+  module Response
+    module Claim
+      class Report835Payment < Hashie::Trash
+        property :check_issue_or_eft_effective_date, required: false
+        property :check_or_eft_trace_number, required: false
+        property :claims, required: false
+        property :payer_identifier, required: false
+        property :payer_name, required: false
+        property :payment_method_code, required: false
+        property :report_creation_date, required: false
+        property :report_name, required: false
+        property :total_actual_provider_payment_amount, required: false
+      end
+    end
+  end
+end

data/lib/change_health/version.rb

@@ -1,3 +1,3 @@
 module ChangeHealth
-  VERSION = '3.5.4'.freeze
+  VERSION = '4.2.0'.freeze
 end

data/lib/change_health.rb

@@ -8,6 +8,7 @@ require 'change_health/extensions'
 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/dependent'
 require 'change_health/models/claim/submission/drug_identification'
 require 'change_health/models/claim/submission/provider'
 require 'change_health/models/claim/submission/service_line'
@@ -33,6 +34,7 @@ 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_payment'
 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: 3.5.4
+  version: 4.2.0
 platform: ruby
 authors:
 - Mike Crockett
 autorequire: 
 bindir: exe
 cert_chain: []
-date: 2022-05-18 00:00:00.000000000 Z
+date: 2022-06-23 00:00:00.000000000 Z
 dependencies:
 - !ruby/object:Gem::Dependency
   name: httparty
@@ -149,6 +149,7 @@ files:
 - 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/dependent.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
@@ -169,6 +170,7 @@ files:
 - 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_payment.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