change_health 4.11.0 → 4.13.0

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data/CHANGELOG.md

@@ -5,6 +5,59 @@ 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).
 
+# [4.13.0] - 2023-08-11
+
+### Added
+
+#### Ability to submit an institutional claim
+
+* Added the following classes
+ * ChangeHealth::Models::Claim::ClaimCodeInformation
+ * ChangeHealth::Models::Claim::InstitutionalService
+* Added fields to existing submission classes
+ * ClaimInformation - claimCodeInformation, claimNote, claimNotes, etc
+ * ServiceLine - assignedNumber, institutionalService
+* ChangeHealth::Request::Claim::Submission#submission now takes `is_professional` argument which defaults to `true`
+ * `true` for professional claim submission
+ * `false` for institutional claim submission
+
+
+#### Added other submission classes
+
+These are used by professional claims and sometimes institutional
+* ChangeHealth::Models::Claim::ClaimSupplementalInformation
+* ChangeHealth::Models::Claim::ContactInformation
+* ChangeHealth::Models::Claim::Diagnosis
+* ChangeHealth::Models::Claim::LineAdjudicationInformation
+* ChangeHealth::Models::Claim::OtherPayerName
+* ChangeHealth::Models::Claim::OtherSubscriberInformation
+* ChangeHealth::Models::Claim::OtherSubscriberName
+* ChangeHealth::Models::Claim::ProfessionalService
+* ChangeHealth::Models::Claim::Receiver
+* ChangeHealth::Models::Claim::ReportInformation
+* ChangeHealth::Models::Claim::ServiceFacilityLocation
+
+
+### Deprecated
+
+Some endpoint constants in Submission:
+* ChangeHealth::Request::Claim::Submission::ENDPOINT
+* ChangeHealth::Request::Claim::Submission::HEALTH_CHECK_ENDPOINT
+* ChangeHealth::Request::Claim::Submission::VALIDATION_ENDPOINT
+* ChangeHealth::Request::Claim::Submission::SUBMISSION_ENDPOINT
+
+Replace with:
+* ENDPOINT -> PROFESSIONAL_ENDPOINT
+* HEALTH_CHECK_ENDPOINT -> PROFESSIONAL_ENDPOINT || INSTITUTIONAL_ENDPOINT + HEALTH_CHECK_SUFFIX
+* VALIDATION_ENDPOINT -> PROFESSIONAL_ENDPOINT || INSTITUTIONAL_ENDPOINT + SUBMISSION_SUFFIX
+* SUBMISSION_ENDPOINT -> PROFESSIONAL_ENDPOINT || INSTITUTIONAL_ENDPOINT + VALIDATION_SUFFIX
+
+# [4.12.0] - 2023-1-23
+
+### Added
+
+* Property `insuranceTypeCode` for ChangeHealth::Models::Claim::Subscriber
+
 # [4.11.0] - 2022-12-30
 
 ### Added
@@ -466,6 +519,8 @@ Added the ability to hit professional claim submission API. For more details, se
 * Authentication
 * Configuration
 
+[4.13.0]: https://github.com/WeInfuse/change_health/compare/v4.12.0...v4.13.0
+[4.12.0]: https://github.com/WeInfuse/change_health/compare/v4.11.0...v4.12.0
 [4.11.0]: https://github.com/WeInfuse/change_health/compare/v4.10.1...v4.11.0
 [4.10.1]: https://github.com/WeInfuse/change_health/compare/v4.10.0...v4.10.1
 [4.10.0]: https://github.com/WeInfuse/change_health/compare/v4.9.0...v4.10.0

data/README.md

@@ -98,17 +98,26 @@ trading_partners.first.service_id
 ```
 
 ## Claim Submission
-[Change Healthcare Claim Submission Guide](https://developers.changehealthcare.com/eligibilityandclaims/docs/professional-claims-v3-getting-started)
+
+### Professional Claims
+[Change Healthcare Professional Claim Submission Guide](https://developers.changehealthcare.com/eligibilityandclaims/docs/professional-claims-v3-getting-started)
 ```ruby
 ChangeHealth::Request::Claim::Submission.ping # Test your connection
 
-contact_information = { name: "SUBMITTER CONTACT INFO", phoneNumber: "123456789"}
-claim_submitter = ChangeHealth::Models::Claim::Submitter.new(
+contact_information = ChangeHealth::Models::Claim::ContactInformation.new(
+  name: "SUBMITTER CONTACT INFO",
+  phone_number: "123456789"
+)
+
+submitter = ChangeHealth::Models::Claim::Submitter.new(
   organization_name: "REGIONAL PPO NETWORK",
   contact_information: contact_information
 )
 
-receiver = { organizationName: "EXTRA HEALTHY INSURANCE"}
+receiver = ChangeHealth::Models::Claim::Receiver.new(
+  organization_name: "EXTRA HEALTHY INSURANCE"
+)
+
 address = ChangeHealth::Models::Claim::Address.new(
   address1: "123 address1",
   city: "city1",
@@ -145,41 +154,44 @@ provider = ChangeHealth::Models::Claim::Provider.new(
   provider_type: "BillingProvider"
 )
 
-health_care_code_information1 = {
-  diagnosisTypeCode: "ABK",
-  diagnosisCode: "S93401A"
-}
-health_care_code_information2 = {
-  diagnosisTypeCode: "ABF",
-  diagnosisCode: "S72044G"
+diagnosis1 = ChangeHealth::Models::Claim::Diagnosis.new(
+  diagnosis_type_code: "ABK",
+  diagnosis_code: "S93401A"
+)
+
+diagnosis2 = ChangeHealth::Models::Claim::Diagnosis.new(
+  diagnosis_type_code: "ABF",
+  diagnosis_code: "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: {
+  professional_service: ChangeHealth::Models::Claim::ProfessionalService.new(
+    line_item_charge_amount: "25",
+    measurement_unit: "UN",
+    procedure_code: "E0570",
+    procedure_identifier: "HC",
+    service_unit_count: "1",
+    composite_diagnosis_code_pointers: {
       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: {
+  professional_service: ChangeHealth::Models::Claim::ProfessionalService.new(
+    line_item_charge_amount: "3.75",
+    measurement_unit: "UN",
+    procedure_code: "A7003",
+    procedure_identifier: "HC",
+    service_unit_count: "1",
+    composite_diagnosis_code_pointers: {
       diagnosisCodePointers: ["1"]
     }
-  }
+  )
 )
+
 claim_information = ChangeHealth::Models::Claim::ClaimInformation.new(
   benefits_assignment_certification_indicator: "Y",
   claim_charge_amount: "28.75",
@@ -190,11 +202,11 @@ claim_information = ChangeHealth::Models::Claim::ClaimInformation.new(
   plan_participation_code: "A",
   release_information_code: "Y",
   signature_indicator: "Y",
-  health_care_code_information: [health_care_code_information1, health_care_code_information2],
+  health_care_code_information: [diagnosis1, diagnosis2],
   service_lines: [service_line1, service_line2]
 )
 
-professional_headers = {
+headers = {
   submitter_id: '111000',
   biller_id: '000111',
   username: '222333hey',
@@ -204,11 +216,11 @@ professional_headers = {
 claim_submission = ChangeHealth::Request::Claim::Submission.new(
   claim_information: claim_information,
   dependent: dependent,
-  headers: professional_headers,
+  headers: headers,
   pay_to_address: address,
   providers: [provider],
   receiver: receiver,
-  submitter: claim_submitter,
+  submitter: submitter,
   subscriber: subscriber,
   trading_partner_service_id: "9496"
 )
@@ -218,6 +230,136 @@ claim_submission_data = claim_submission.submission
 validation = claim_submission.validation
 ```
 
+### Institutional Claims
+[Change Healthcare Institutional Claim Submission Guide](https://developers.changehealthcare.com/eligibilityandclaims/docs/institutional-claims-v1-api-getting-started)
+```ruby
+ChangeHealth::Request::Claim::Submission.ping(is_professional: false) # Test your connection
+
+claim_code_information = ChangeHealth::Models::Claim::ClaimCodeInformation.new(
+  admission_source_code: "7",
+  admission_type_code: "1",
+  patient_status_code: "10"
+)
+
+other_diagnosis_information_list = [[
+  ChangeHealth::Models::Claim::Diagnosis.new(
+    other_diagnosis_code: "S72044G",
+    qualifier_code: "ABF"
+  ),
+  ChangeHealth::Models::Claim::Diagnosis.new(
+    other_diagnosis_code: "S72044H",
+    qualifier_code: "ABF"
+  )
+]]
+
+principal_diagnosis = ChangeHealth::Models::Claim::Diagnosis.new(
+  principal_diagnosis_code: "S93401A",
+  qualifier_code: "ABK"
+)
+
+service_line1 = ChangeHealth::Models::Claim::ServiceLine.new(
+  assigned_number: "1",
+  institutional_service: ChangeHealth::Models::Claim::InstitutionalService.new(
+    line_item_charge_amount: "25",
+    measurement_unit: "UN",
+    procedure_code: "E0570",
+    procedure_identifier: "HC",
+    service_line_revenue_code: "X",
+    service_unit_count: "1",
+  )
+)
+
+service_line2 = ChangeHealth::Models::Claim::ServiceLine.new(
+  assigned_number: "2",
+  institutional_service: ChangeHealth::Models::Claim::InstitutionalService.new(
+    line_item_charge_amount: "3.75",
+    measurement_unit: "UN",
+    procedure_code: "A7003",
+    procedure_identifier: "HC",
+    service_line_revenue_code: "Y",
+    service_unit_count: "1",
+  )
+)
+
+claim_information = ChangeHealth::Models::Claim::ClaimInformation.new(
+  benefits_assignment_certification_indicator: "Y",
+  claim_charge_amount: "28.75",
+  claim_code_information: claim_code_information,
+  claim_filing_code: "CI",
+  claim_frequency_code: "1",
+  other_diagnosis_information_list: other_diagnosis_information_list,
+  patient_control_number: "12345",
+  place_of_service_code: "11",
+  plan_participation_code: "A",
+  principal_diagnosis: principal_diagnosis,
+  release_information_code: "Y",
+  signature_indicator: "Y",
+  service_lines: [service_line1, service_line2]
+)
+
+headers = {
+  submitter_id: '111000',
+  biller_id: '000111',
+  username: '222333hey',
+  password: 'builder1'
+}
+
+address = ChangeHealth::Models::Claim::Address.new(
+  address1: "123 address1",
+  city: "city1",
+  state: "wa",
+  postalCode: "981010000"
+)
+
+provider = ChangeHealth::Models::Claim::Provider.new(
+  address: address,
+  employer_id: "000000000",
+  first_name: "johnone",
+  last_name: "doetwo",
+  npi: "1760854442",
+  organization_name: "EXTRA HEALTHY INSURANCE",
+  provider_type: "BillingProvider"
+)
+
+receiver = ChangeHealth::Models::Claim::Receiver.new(
+  organization_name: "EXTRA HEALTHY INSURANCE"
+)
+
+contact_information = ChangeHealth::Models::Claim::ContactInformation.new(
+  name: "SUBMITTER CONTACT INFO",
+  phone_number: "123456789"
+)
+
+submitter = ChangeHealth::Models::Claim::Submitter.new(
+  organization_name: "REGIONAL PPO NETWORK",
+  contact_information: contact_information
+)
+
+subscriber = ChangeHealth::Models::Claim::Subscriber.new(
+  member_id: "0000000001",
+  payment_responsibility_level_code: "P",
+  first_name: "johnone",
+  last_name: "doetwo",
+  gender: "M",
+  date_of_birth: "02/01/1980",
+  address: address
+)
+
+claim_submission = ChangeHealth::Request::Claim::Submission.new(
+  claim_information: claim_information,
+  headers: headers,
+  providers: [provider],
+  receiver: receiver,
+  submitter: submitter,
+  subscriber: subscriber,
+  trading_partner_service_id: "9496"
+)
+
+claim_submission_data = claim_submission.submission(is_professional: false)
+
+validation = claim_submission.validation(is_professional: false)
+```
+
 ## Claim Reports
 [Change Healthcare Claim Responses and Reports Guide](https://developers.changehealthcare.com/eligibilityandclaims/docs/claims-responses-and-reports-getting-started)
 

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

@@ -2,11 +2,11 @@ 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
+        property :address1
+        property :address2
+        property :city
+        property :postalCode, from: :postal_code
+        property :state
       end
     end
   end

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

@@ -0,0 +1,11 @@
+module ChangeHealth
+  module Models
+    module Claim
+      class ClaimCodeInformation < Model
+        property :admissionSourceCode, from: :admission_source_code
+        property :admissionTypeCode, from: :admission_type_code
+        property :patientStatusCode, from: :patient_status_code
+      end
+    end
+  end
+end

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

@@ -1,22 +1,27 @@
 module ChangeHealth
   module Models
     module Claim
-      class ClaimInformation < Hashie::Trash
-        property :benefitsAssignmentCertificationIndicator, from: :benefits_assignment_certification_indicator, required: false
-        property :claimChargeAmount, from: :claim_charge_amount, required: false
-        property :claimFilingCode, from: :claim_filing_code, required: false
-        property :claimFrequencyCode, from: :claim_frequency_code, required: false
-        property :claimSupplementalInformation, from: :claim_supplemental_information, required: false
-        property :healthCareCodeInformation, from: :health_care_code_information, required: false
-        property :patientControlNumber, from: :patient_control_number, required: false
-        property :placeOfServiceCode, from: :place_of_service_code, required: false
-        property :planParticipationCode, from: :plan_participation_code, required: false
-        property :releaseInformationCode, from: :release_information_code, required: false
-        property :serviceFacilityLocation, from: :service_facility_location, required: false
-        property :serviceLines, from: :service_lines, required: false
-        property :signatureIndicator, from: :signature_indicator, required: false
-        property :otherSubscriberInformation, from: :other_subscriber_information, required: false
-        property :claimNote, from: :claim_note, required: false
+      class ClaimInformation < Model
+        property :admittingDiagnosis, from: :admitting_diagnosis
+        property :benefitsAssignmentCertificationIndicator, from: :benefits_assignment_certification_indicator
+        property :claimChargeAmount, from: :claim_charge_amount
+        property :claimCodeInformation, from: :claim_code_information
+        property :claimFilingCode, from: :claim_filing_code
+        property :claimFrequencyCode, from: :claim_frequency_code
+        property :claimNote, from: :claim_note
+        property :claimNotes, from: :claim_notes
+        property :claimSupplementalInformation, from: :claim_supplemental_information
+        property :healthCareCodeInformation, from: :health_care_code_information
+        property :otherDiagnosisInformationList, from: :other_diagnosis_information_list
+        property :otherSubscriberInformation, from: :other_subscriber_information
+        property :patientControlNumber, from: :patient_control_number
+        property :placeOfServiceCode, from: :place_of_service_code
+        property :planParticipationCode, from: :plan_participation_code
+        property :principalDiagnosis, from: :principal_diagnosis
+        property :releaseInformationCode, from: :release_information_code
+        property :serviceFacilityLocation, from: :service_facility_location
+        property :serviceLines, from: :service_lines
+        property :signatureIndicator, from: :signature_indicator
 
         def add_service_line(service_line)
           self[:serviceLines] ||= []

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

@@ -0,0 +1,12 @@
+module ChangeHealth
+  module Models
+    module Claim
+      class ClaimSupplementalInformation < Model
+        property :claimControlNumber, from: :claim_control_number
+        property :priorAuthorizationNumber, from: :prior_authorization_number
+        property :referralNumber, from: :referral_number
+        property :reportInformation, from: :report_information
+      end
+    end
+  end
+end

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

@@ -0,0 +1,12 @@
+module ChangeHealth
+  module Models
+    module Claim
+      class ContactInformation < Model
+        property :email
+        property :faxNumber, from: :fax_number
+        property :name
+        property :phoneNumber, from: :phone_number
+      end
+    end
+  end
+end

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

@@ -2,13 +2,13 @@ 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
+        property :address
+        property :dateOfBirth, from: :date_of_birth
+        property :firstName, from: :first_name
+        property :gender
+        property :lastName, from: :last_name
+        property :memberId, from: :member_id
+        property :relationshipToSubscriberCode, from: :relationship_to_subscriber_code
       end
     end
   end

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

@@ -0,0 +1,19 @@
+module ChangeHealth
+  module Models
+    module Claim
+      # Can be used for
+      # - admittingDiagnosis
+      # - healthCareCodeInformation items
+      # - otherDiagnosisInformationList items
+      # - principalDiagnosis
+      class Diagnosis < Model
+        property :admittingDiagnosisCode, from: :admitting_diagnosis_code
+        property :diagnosisCode, from: :diagnosis_code
+        property :diagnosisTypeCode, from: :diagnosis_type_code
+        property :otherDiagnosisCode, from: :other_diagnosis_code
+        property :principalDiagnosisCode, from: :principal_diagnosis_code
+        property :qualifierCode, from: :qualifier_code
+      end
+    end
+  end
+end

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

@@ -2,10 +2,10 @@ 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
+        property :measurementUnitCode, from: :measurement_unit_code
+        property :nationalDrugCode, from: :national_drug_code
+        property :nationalDrugUnitCount, from: :national_drug_unit_count
+        property :serviceIdQualifier, from: :service_id_qualifier
       end
     end
   end

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

@@ -0,0 +1,16 @@
+module ChangeHealth
+  module Models
+    module Claim
+      class InstitutionalService < Model
+        property :description
+        property :lineItemChargeAmount, from: :line_item_charge_amount
+        property :measurementUnit, from: :measurement_unit
+        property :procedureCode, from: :procedure_code
+        property :procedureIdentifier, from: :procedure_identifier
+        property :procedureModifiers, from: :procedure_modifiers
+        property :serviceLineRevenueCode, from: :service_line_revenue_code
+        property :serviceUnitCount, from: :service_unit_count
+      end
+    end
+  end
+end

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

@@ -0,0 +1,17 @@
+module ChangeHealth
+  module Models
+    module Claim
+      class LineAdjudicationInformation < Model
+        property :adjudicationOrPaymentDate, from: :adjudication_or_payment_date
+        property :claimAdjustmentInformation, from: :claim_adjustment_information
+        property :otherPayerPrimaryIdentifier, from: :other_payer_primary_identifier
+        property :paidServiceUnitCount, from: :paid_service_unit_count
+        property :procedureCode, from: :procedure_code
+        property :procedureModifier, from: :procedure_modifier
+        property :remainingPatientLiability, from: :remaining_patient_liability
+        property :serviceIdQualifier, from: :service_id_qualifier
+        property :serviceLinePaidAmount, from: :service_line_paid_amount
+      end
+    end
+  end
+end

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

@@ -0,0 +1,11 @@
+module ChangeHealth
+  module Models
+    module Claim
+      class OtherPayerName < Model
+        property :otherPayerIdentifier, from: :other_payer_identifier
+        property :otherPayerIdentifierTypeCode, from: :other_payer_identifier_type_code
+        property :otherPayerOrganizationName, from: :other_payer_organization_name
+      end
+    end
+  end
+end

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

@@ -0,0 +1,17 @@
+module ChangeHealth
+  module Models
+    module Claim
+      class OtherSubscriberInformation < Model
+        property :benefitsAssignmentCertificationIndicator, from: :benefits_assignment_certification_indicator
+        property :claimFilingIndicatorCode, from: :claim_filing_indicator_code
+        property :claimLevelAdjustments, from: :claim_level_adjustments
+        property :individualRelationshipCode, from: :individual_relationship_code
+        property :otherPayerName, from: :other_payer_name
+        property :otherSubscriberName, from: :other_subscriber_name
+        property :payerPaidAmount, from: :payer_paid_amount
+        property :paymentResponsibilityLevelCode, from: :payment_responsibility_level_code
+        property :releaseOfInformationCode, from: :release_of_information_code
+      end
+    end
+  end
+end

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

@@ -0,0 +1,13 @@
+module ChangeHealth
+  module Models
+    module Claim
+      class OtherSubscriberName < Model
+        property :otherInsuredFirstName, from: :other_insured_first_nsame
+        property :otherInsuredIdentifier, from: :other_insured_identifier
+        property :otherInsuredIdentifierTypeCode, from: :other_insured_identifier_type_code
+        property :otherInsuredLastName, from: :other_insured_last_name
+        property :otherInsuredQualifier, from: :other_insured_qualifier
+      end
+    end
+  end
+end

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

@@ -0,0 +1,16 @@
+module ChangeHealth
+  module Models
+    module Claim
+      class ProfessionalService < Model
+        property :compositeDiagnosisCodePointers, from: :composite_diagnosis_code_pointers
+        property :description
+        property :lineItemChargeAmount, from: :line_item_charge_amount
+        property :measurementUnit, from: :measurement_unit
+        property :procedureCode, from: :procedure_code
+        property :procedureIdentifier, from: :procedure_identifier
+        property :procedureModifiers, from: :procedure_modifiers
+        property :serviceUnitCount, from: :service_unit_count
+      end
+    end
+  end
+end

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

@@ -1,17 +1,17 @@
 module ChangeHealth
   module Models
     module Claim
-      class Provider < Hashie::Trash
-        property :address, required: false
-        property :contactInformation, from: :contact_information, required: false
-        property :employerId, from: :employer_id, required: false # or ssn
-        property :firstName, from: :first_name, required: false
-        property :lastName, from: :last_name, required: false
-        property :organizationName, from: :organization_name, required: false
-        property :npi, required: false
-        property :providerType, from: :provider_type, required: false
-        property :taxonomyCode, from: :taxonomy_code, required: false
-        property :ssn, required: false # or employer id
+      class Provider < Model
+        property :address
+        property :contactInformation, from: :contact_information
+        property :employerId, from: :employer_id # or ssn
+        property :firstName, from: :first_name
+        property :lastName, from: :last_name
+        property :npi
+        property :organizationName, from: :organization_name
+        property :providerType, from: :provider_type
+        property :ssn # or employer id
+        property :taxonomyCode, from: :taxonomy_code
       end
     end
   end

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

@@ -0,0 +1,9 @@
+module ChangeHealth
+  module Models
+    module Claim
+      class Receiver < Model
+        property :organizationName, from: :organization_name
+      end
+    end
+  end
+end

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

@@ -0,0 +1,11 @@
+module ChangeHealth
+  module Models
+    module Claim
+      class ReportInformation < Model
+        property :attachmentControlNumber, from: :attachment_control_number
+        property :attachmentReportTypeCode, from: :attachment_report_type_code
+        property :attachmentTransmissionCode, from: :attachment_transmission_code
+      end
+    end
+  end
+end

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

@@ -0,0 +1,12 @@
+module ChangeHealth
+  module Models
+    module Claim
+      class ServiceFacilityLocation < Model
+        property :address
+        property :organizationName, from: :organization_name
+        property :npi
+        property :phoneNumber, from: :phone_number
+      end
+    end
+  end
+end

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

@@ -2,11 +2,13 @@ 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
-        property :lineAdjudicationInformation, from: :line_adjudication_information, required: false
+        property :assignedNumber, from: :assigned_number
+        property :drugIdentification, from: :drug_identification
+        property :institutionalService, from: :institutional_service
+        property :lineAdjudicationInformation, from: :line_adjudication_information
+        property :professionalService, from: :professional_service
+        property :renderingProvider, from: :rendering_provider
+        property :serviceDate, from: :service_date
       end
     end
   end

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

@@ -1,10 +1,9 @@
 module ChangeHealth
   module Models
     module Claim
-      class Submitter < Hashie::Trash
-        property :organizationName, from: :organization_name, required: false
-        # contact information has a name & phone number inside
-        property :contactInformation, from: :contact_information, required: false
+      class Submitter < Model
+        property :contactInformation, from: :contact_information
+        property :organizationName, from: :organization_name
       end
     end
   end

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

@@ -2,14 +2,15 @@ module ChangeHealth
   module Models
     module Claim
       class Subscriber < 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 :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
+        property :address
+        property :dateOfBirth, from: :date_of_birth
+        property :firstName, from: :first_name
+        property :gender
+        property :groupNumber, from: :group_number
+        property :insuranceTypeCode, from: :insurance_type_code
+        property :lastName, from: :last_name
+        property :memberId, from: :member_id
+        property :paymentResponsibilityLevelCode, from: :payment_responsibility_level_code
       end
     end
   end

data/lib/change_health/request/submission.rb

@@ -2,20 +2,28 @@ module ChangeHealth
   module Request
     module Claim
       class Submission < Hashie::Trash
-        ENDPOINT = '/medicalnetwork/professionalclaims/v3'.freeze
+        PROFESSIONAL_ENDPOINT = '/medicalnetwork/professionalclaims/v3'.freeze
+        INSTITUTIONAL_ENDPOINT = '/medicalnetwork/institutionalclaims/v1'.freeze
+        HEALTH_CHECK_SUFFIX = '/healthcheck'.freeze
+        SUBMISSION_SUFFIX = '/submission'.freeze
+        VALIDATION_SUFFIX = '/validation'.freeze
+
+        # Deprecated but still here for backwards compatibility
+        ENDPOINT = PROFESSIONAL_ENDPOINT
         HEALTH_CHECK_ENDPOINT = ENDPOINT + '/healthcheck'.freeze
         SUBMISSION_ENDPOINT = ENDPOINT + '/submission'.freeze
         VALIDATION_ENDPOINT = ENDPOINT + '/validation'.freeze
+        # End Deprecated
 
         property :claimInformation, from: :claim_information, required: false
         property :controlNumber, from: :control_number, required: true, default: ChangeHealth::Models::CONTROL_NUMBER
         property :dependent, required: false
+        property :headers, required: false
         property :payToAddress, from: :pay_to_address, required: false
         property :providers, required: false
         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
@@ -25,35 +33,41 @@ module ChangeHealth
           self[:providers] << provider
         end
 
-        def submission
+        def submission(is_professional: true)
+          endpoint = is_professional ? PROFESSIONAL_ENDPOINT : INSTITUTIONAL_ENDPOINT
+          endpoint += SUBMISSION_SUFFIX
           ChangeHealth::Response::Claim::SubmissionData.new(response: ChangeHealth::Connection.new.request(
-            endpoint: SUBMISSION_ENDPOINT, body: to_h, headers: professional_headers
+            endpoint: endpoint, body: to_h, headers: professional_headers
           ))
         end
 
-        def validation
+        def validation(is_professional: true)
+          endpoint = is_professional ? PROFESSIONAL_ENDPOINT : INSTITUTIONAL_ENDPOINT
+          endpoint += VALIDATION_SUFFIX
           ChangeHealth::Response::Claim::SubmissionData.new(response: ChangeHealth::Connection.new.request(
-            endpoint: VALIDATION_ENDPOINT, body: to_h, headers: professional_headers
+            endpoint: endpoint, body: to_h, headers: professional_headers
           ))
         end
 
-        def self.health_check
-          ChangeHealth::Connection.new.request(endpoint: HEALTH_CHECK_ENDPOINT, verb: :get)
+        def self.health_check(is_professional: true)
+          endpoint = is_professional ? PROFESSIONAL_ENDPOINT : INSTITUTIONAL_ENDPOINT
+          endpoint += HEALTH_CHECK_SUFFIX
+          ChangeHealth::Connection.new.request(endpoint: endpoint, verb: :get)
         end
 
-        def self.ping
-          health_check
+        def self.ping(is_professional: true)
+          health_check(is_professional: is_professional)
         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
+          return unless 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

data/lib/change_health/version.rb

@@ -1,3 +1,3 @@
 module ChangeHealth
-  VERSION = '4.11.0'.freeze
+  VERSION = '4.13.0'.freeze
 end

data/lib/change_health.rb

@@ -7,10 +7,23 @@ require 'change_health/connection'
 require 'change_health/extensions'
 require 'change_health/models/model'
 require 'change_health/models/claim/submission/address'
+require 'change_health/models/claim/submission/claim_code_information'
 require 'change_health/models/claim/submission/claim_information'
+require 'change_health/models/claim/submission/claim_supplemental_information'
+require 'change_health/models/claim/submission/contact_information'
 require 'change_health/models/claim/submission/dependent'
+require 'change_health/models/claim/submission/diagnosis'
 require 'change_health/models/claim/submission/drug_identification'
+require 'change_health/models/claim/submission/institutional_service'
+require 'change_health/models/claim/submission/line_adjudication_information'
+require 'change_health/models/claim/submission/other_payer_name'
+require 'change_health/models/claim/submission/other_subscriber_information'
+require 'change_health/models/claim/submission/other_subscriber_name'
+require 'change_health/models/claim/submission/professional_service'
 require 'change_health/models/claim/submission/provider'
+require 'change_health/models/claim/submission/receiver'
+require 'change_health/models/claim/submission/report_information'
+require 'change_health/models/claim/submission/service_facility_location'
 require 'change_health/models/claim/submission/service_line'
 require 'change_health/models/claim/submission/submitter'
 require 'change_health/models/claim/submission/subscriber'
@@ -19,8 +32,8 @@ require 'change_health/models/eligibility/provider'
 require 'change_health/models/eligibility/subscriber'
 require 'change_health/models/trading_partner/trading_partner'
 require 'change_health/request/eligibility'
-require 'change_health/request/submission'
 require 'change_health/request/report'
+require 'change_health/request/submission'
 require 'change_health/request/trading_partner'
 require 'change_health/response/error'
 require 'change_health/response/response_data'

metadata

@@ -1,14 +1,14 @@
 --- !ruby/object:Gem::Specification
 name: change_health
 version: !ruby/object:Gem::Version
-  version: 4.11.0
+  version: 4.13.0
 platform: ruby
 authors:
 - Mike Crockett
 autorequire: 
 bindir: exe
 cert_chain: []
-date: 2023-01-03 00:00:00.000000000 Z
+date: 2023-08-14 00:00:00.000000000 Z
 dependencies:
 - !ruby/object:Gem::Dependency
   name: httparty
@@ -148,10 +148,23 @@ files:
 - 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_code_information.rb
 - lib/change_health/models/claim/submission/claim_information.rb
+- lib/change_health/models/claim/submission/claim_supplemental_information.rb
+- lib/change_health/models/claim/submission/contact_information.rb
 - lib/change_health/models/claim/submission/dependent.rb
+- lib/change_health/models/claim/submission/diagnosis.rb
 - lib/change_health/models/claim/submission/drug_identification.rb
+- lib/change_health/models/claim/submission/institutional_service.rb
+- lib/change_health/models/claim/submission/line_adjudication_information.rb
+- lib/change_health/models/claim/submission/other_payer_name.rb
+- lib/change_health/models/claim/submission/other_subscriber_information.rb
+- lib/change_health/models/claim/submission/other_subscriber_name.rb
+- lib/change_health/models/claim/submission/professional_service.rb
 - lib/change_health/models/claim/submission/provider.rb
+- lib/change_health/models/claim/submission/receiver.rb
+- lib/change_health/models/claim/submission/report_information.rb
+- lib/change_health/models/claim/submission/service_facility_location.rb
 - lib/change_health/models/claim/submission/service_line.rb
 - lib/change_health/models/claim/submission/submitter.rb
 - lib/change_health/models/claim/submission/subscriber.rb