change_health 1.0.3 → 2.0.0

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data/CHANGELOG.md

@@ -4,6 +4,37 @@ 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).
 
+## [2.0.0] - [2021-10-08]
+### Added
+#### Models
+* ResponseData - for responses from calling change healthcare api used by EligibilityData and SubmissionData
+#### Claim Submission
+Added the ability to hit professional claim submission API. For more details, see [Change Healthcare documentation here](https://developers.changehealthcare.com/eligibilityandclaims/docs/professional-claims-v3-getting-started)
+* ClaimInformation
+* Provider
+* ServiceLine
+* Submission
+* SubmissionData
+* Submitter
+* Subscriber
+### Changed
+ * Using new Change Healthcare url. From apis to apigw. For more info see [change log here](https://developers.changehealthcare.com/eligibilityandclaims/docs/change-logrelease-notes-1)
+ * PARSE_DATE moved from ChangeHealth::Models::EligibilityData to ChangeHealth::Models
+ * Moved Error class into its own file
+#### Namespace
+ Many classes moved namespaces to be more consistent across the many endpoints in Change Healthcare
+| Previous | Current |
+|-|-|
+|ChangeHealth::Models::Eligibility | ChangeHealth::Request::Eligibility |
+| ChangeHealth::Models::Encounter | ChangeHealth::Models::Eligibility::Encounter|
+| ChangeHealth::Models::Provider | ChangeHealth::Models::Eligibility::Provider|
+| ChangeHealth::Models::Subscriber | ChangeHealth::Models::Eligibility::Subscriber|
+| ChangeHealth::Models::EligibilityBenefit | ChangeHealth::Response::EligibilityBenefit|
+| ChangeHealth::Models::EligibilityBenefits | ChangeHealth::Response::EligibilityBenefits|
+| ChangeHealth::Models::EligibilityData | ChangeHealth::Response::EligibilityData|
+### Fixed
+ * Eligibility#add_dependent actually works
+
 ## [1.0.3] - [2021-04-26]
 ### Added
 - Model::Error#represents_down? - adds ability to distinguish error representing down state
@@ -132,6 +163,7 @@ and this project adheres to [Semantic Versioning](http://semver.org/spec/v2.0.0.
 - Authentication
 - Configuration
 
+[Unreleased]: https://github.com/WeInfuse/change_health/compare/v1.0.3...HEAD
 [1.0.3]: https://github.com/WeInfuse/change_health/compare/v1.0.2...v1.0.3
 [1.0.2]: https://github.com/WeInfuse/change_health/compare/v1.0.1...v1.0.2
 [1.0.1]: https://github.com/WeInfuse/change_health/compare/v1.0.0...v1.0.1

data/README.md

@@ -26,24 +26,25 @@ Or install it yourself as:
 Make sure you're [configured](#configuration)!
 
 ### Eligibility
+[Change Healthcare Eligibility Guide](https://developers.changehealthcare.com/eligibilityandclaims/docs)
 ```ruby
-ChangeHealth::Models::Eligibility.ping # Test your connection
+ChangeHealth::Request::Eligibility.ping # Test your connection
 
-encounter  = ChangeHealth::Models::Encounter.new(date_of_service: Date.current, service_type_codes: ['98'])
-provider   = ChangeHealth::Models::Provider.new(npi: '0123456789', last_name: 'Bobson', first_name: 'Bob')
-subscriber = ChangeHealth::Models::Subscriber.new(member_id: '0000000000', first_name: 'johnOne', last_name: 'doeOne', date_of_birth: '18800102')
+encounter  = ChangeHealth::Models::Eligibility::Encounter.new(date_of_service: Date.current, service_type_codes: ['98'])
+provider   = ChangeHealth::Models::Eligibility::Provider.new(npi: '0123456789', last_name: 'Bobson', first_name: 'Bob')
+subscriber = ChangeHealth::Models::Eligibility::Subscriber.new(member_id: '0000000000', first_name: 'johnOne', last_name: 'doeOne', date_of_birth: '18800102')
 
-edata = ChangeHealth::Models::Eligibility.new(tradingPartnerServiceId: '000050', provider: provider, subscriber: subscriber, encounter: encounter).query
+edata = ChangeHealth::Request::Eligibility.new(tradingPartnerServiceId: '000050', provider: provider, subscriber: subscriber, encounter: encounter).query
 
 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.
 
-```
+```ruby
 edata.benefits # Returns Benefits querying object (extends Array)
 
 edata.benefits.individual # Only benefits matching the 'IND' identifier
@@ -57,7 +58,7 @@ 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
 
@@ -77,16 +78,115 @@ true
 
 ### Trading Partners
 ```ruby
-  # Query trading partners using a wildcard search
-  # Returns Array of ChangeHealth::Models::TradingPartner Objects
-  trading_partners = ChangeHealth::Request::TradingPartner.query("Aetna")
+# Query trading partners using a wildcard search
+# Returns Array of ChangeHealth::Models::TradingPartner Objects
+trading_partners = ChangeHealth::Request::TradingPartner.query("Aetna")
+
+trading_partners.first.name
+"Aetna"
 
-  trading_partners.first.name
-  "Aetna"
+trading_partners.first.service_id
+"ABC123"
+```
 
-  trading_partners.first.service_id
-  "ABC123"
+### 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
+
+contact_information = { name: "SUBMITTER CONTACT INFO", phoneNumber: "123456789"}
+claim_submitter = ChangeHealth::Models::Claim::Submitter.new(
+  organization_name: "REGIONAL PPO NETWORK",
+  contact_information: contact_information
+)
+
+receiver = { organizationName: "EXTRA HEALTHY INSURANCE"}
+address = {
+  "address1": "123 address1",
+  "city": "city1",
+  "state": "wa",
+  "postalCode": "981010000"
+}
+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
+)
+provider = ChangeHealth::Models::Claim::Provider.new(
+  address: address,
+ employer_id: "000000000",
+ first_name: "johnone",
+ last_name: "doetwo",
+ npi: "1760854442",
+ provider_type: "BillingProvider"
+)
+
+health_care_code_information1 = {
+  "diagnosisTypeCode": "ABK",
+  "diagnosisCode": "S93401A"
+}
+health_care_code_information2 = {
+  "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"]
+    }
+  }
+)
+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"]
+    }
+  }
+)
+claim_information = ChangeHealth::Models::Claim::ClaimInformation.new(
+  benefits_assignment_certification_indicator: "Y",
+  claim_charge_amount: "28.75",
+  claim_filing_code: "CI",
+  claim_frequency_code: "1",
+  patient_control_number: "12345",
+  place_of_service_code: "11",
+  plan_participation_code: "A",
+  release_information_code: "Y",
+  signature_indicator: "Y",
+  health_care_code_information: [health_care_code_information1, health_care_code_information2],
+  service_lines: [service_line1, service_line2]
+)
+
+
+claim_submission = ChangeHealth::Request::Claim::Submission.new(
+  trading_partner_service_id: "9496",
+  submitter: claim_submitter,
+  receiver: receiver,
+  subscriber: subscriber,
+  providers: [provider],
+  claim_information: claim_information
+)
+
+claim_submission_data = claim_submission.submission
 ```
+
 ### Configuration
 
 ```ruby

data/lib/change_health/connection.rb

@@ -1,6 +1,6 @@
 module ChangeHealth
   class Connection
-    URI_BUILDER = ->(host) { "https://#{host}apis.changehealthcare.com/".freeze }
+    URI_BUILDER = ->(host) { "https://#{host}apigw.changehealthcare.com/".freeze }
 
     QA_ENDPOINT   = URI_BUILDER.call('sandbox.')
     PROD_ENDPOINT = URI_BUILDER.call('')

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

@@ -0,0 +1,31 @@
+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
+
+        def add_service_line(service_line)
+          self[:serviceLines] ||= []
+          self[:serviceLines] << service_line
+        end
+
+        def add_health_care_code_information(health_care_code_information)
+          self[:healthCareCodeInformation] ||= []
+          self[:healthCareCodeInformation] << health_care_code_information
+        end
+      end
+    end
+  end
+end

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

@@ -0,0 +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 :ssn, required: false # or employer id
+      end
+    end
+  end
+end

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

@@ -0,0 +1,12 @@
+module ChangeHealth
+  module Models
+    module Claim
+      class ServiceLine < Model
+
+        property :serviceDate, from: :service_date, required: false
+        property :professionalService, from: :professional_service, required: false
+
+      end
+    end
+  end
+end

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

@@ -0,0 +1,11 @@
+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
+      end
+    end
+  end
+end

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

@@ -0,0 +1,15 @@
+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 :lastName, from: :last_name, required: false
+        property :memberId, from: :member_id, required: false
+        property :paymentResponsibilityLevelCode, from: :payment_responsibility_level_code, required: false
+      end
+    end
+  end
+end

data/lib/change_health/models/eligibility/encounter.rb

@@ -0,0 +1,22 @@
+module ChangeHealth
+  module Models
+    module Eligibility
+      class Encounter < Model
+        property :beginningDateOfService, from: :beginning_date_of_service, required: false
+        property :dateOfService, from: :date_of_service, required: false
+        property :dateRange, from: :date_range, required: false, default: false
+        property :endDateOfService, from: :end_date_of_service, required: false
+        property :serviceTypeCodes, from: :service_type_codes, required: false
+
+        alias_method :dateRange?, :dateRange
+        alias_method :date_range?, :dateRange
+        alias_method :service_type_codes, :serviceTypeCodes
+
+        def add_service_type_code(code)
+          self[:serviceTypeCodes] ||= []
+          self[:serviceTypeCodes] << code
+        end
+      end
+    end
+  end
+end

data/lib/change_health/models/eligibility/provider.rb

@@ -0,0 +1,23 @@
+module ChangeHealth
+  module Models
+    module Eligibility
+      class Provider < Hashie::Trash
+        property :firstName, from: :first_name, required: false
+        property :lastName, from: :last_name, required: false
+        property :name, default: true, required: false
+        property :npi, required: false
+        property :organizationName, from: :organization_name, required: false
+        property :payorId, from: :payer_id, required: false
+        property :person, default: true, required: false
+        property :providerCode, from: :provider_code, required: false
+        property :providerName, from: :provider_name, required: false
+        property :providerType, from: :provider_type, required: false
+        property :referenceIdentification, from: :reference_identification, required: false
+        property :serviceProviderNumber, from: :service_provider_number, required: false
+        property :taxId, from: :tax_id, required: false
+
+        alias_method :name?, :name
+      end
+    end
+  end
+end

data/lib/change_health/models/eligibility/subscriber.rb

@@ -0,0 +1,31 @@
+module ChangeHealth
+  module Models
+    module Eligibility
+      class Subscriber < Model
+        property :additionalIdentification, required: false
+        property :address, required: false
+        property :birthSequenceNumber, from: :birth_sequence_number, required: false
+        property :caseNumber, from: :case_number, 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 :healthCareCodeInformation, from: :health_care_code_information, required: false
+        property :idCard, from: :id_card, required: false
+        property :idCardIssueDate, from: :id_card_issued_date, required: false
+        property :lastName, from: :last_name, required: false
+        property :medicaidRecipientIdentificationNumber, from: :medicaid_recipient_identification_number, required: false
+        property :memberId, from: :member_id, required: false
+        property :providerCode, from: :provider_code, required: false
+        property :providerIdentifier, from: :provider_identification, required: false
+        property :referenceIdentificationQualifier, from: :reference_identification_qualifier, required: false
+        property :ssn, required: false
+
+        def add_health_care_code_information(value)
+          self[:healthCareCodeInformation] ||= []
+          self[:healthCareCodeInformation] << value
+        end
+      end
+    end
+  end
+end

data/lib/change_health/models/error.rb

@@ -0,0 +1,56 @@
+module ChangeHealth
+  module Models
+    class Error
+      attr_reader :data
+
+      SIMPLE_RETRY_CODES = %w[
+            42
+            80
+          ].freeze
+
+      NO_RESUBMIT_MESSAGES = [
+        'resubmission not allowed',
+        'do not resubmit'
+      ].freeze
+
+      DOWN_FIELD = 'Http Header'.freeze
+
+      DOWN_MESSAGE = 'Please review http headers for this API, please contact support if you are unsure how to resolve.'.freeze
+
+      def initialize(data)
+        @data = data
+      end
+
+      def message
+        field_message || code_message
+      end
+
+      def field_message
+        "#{field}: #{description}" if field?
+      end
+
+      def code_message
+        "#{code}: #{description}" if code?
+      end
+
+      def represents_down?
+        field == DOWN_FIELD && description == DOWN_MESSAGE
+      end
+
+      def retryable?
+        represents_down? ||
+          (code? && SIMPLE_RETRY_CODES.include?(code) && followupAction? && NO_RESUBMIT_MESSAGES.none? {|msg| followupAction.downcase.include?(msg) })
+      end
+
+      %w[field description code followupAction location].each do |method_name|
+        define_method("#{method_name}?") do
+          false == send(method_name).nil?
+        end
+
+        define_method("#{method_name}") do
+          @data[method_name]
+        end
+      end
+    end
+  end
+end

data/lib/change_health/models/model.rb

@@ -12,6 +12,17 @@ module ChangeHealth
       d
     }
 
+    PARSE_DATE = ->(d) {
+      begin
+        d = Date.strptime(d, ChangeHealth::Models::DATE_FORMAT)
+      rescue
+      end
+
+      d
+    }
+
+    CONTROL_NUMBER = ->() { '%09d' % rand(1_000_000_000) }
+
     class Model < Hashie::Trash
       def to_h
         result = super.to_h

data/lib/change_health/{models → request}/eligibility.rb

@@ -1,10 +1,10 @@
 module ChangeHealth
-  module Models
+  module Request
     class Eligibility < Hashie::Trash
       ENDPOINT = '/medicalnetwork/eligibility/v3'.freeze
       HEALTH_CHECK_ENDPOINT = ENDPOINT + '/healthcheck'.freeze
 
-      property :controlNumber, from: :control_number, required: true, default: ->() { '%09d' % rand(1_000_000_000) }
+      property :controlNumber, from: :control_number, required: true, default: ChangeHealth::Models::CONTROL_NUMBER
       property :dependents, required: false
       property :encounter, required: false
       property :informationReceiverName, from: :information_receiver_name, required: false
@@ -20,12 +20,12 @@ module ChangeHealth
       alias_method :partner_id?, :partnerId
 
       def add_dependent(dependent)
-        self[:dependent] ||= []
-        self[:dependent] << dependent
+        self[:dependents] ||= []
+        self[:dependents] << dependent
       end
 
       def query
-        ChangeHealth::Models::EligibilityData.new(response: ChangeHealth::Connection.new.request(endpoint: ENDPOINT, body: self.to_h))
+        ChangeHealth::Response::EligibilityData.new(response: ChangeHealth::Connection.new.request(endpoint: ENDPOINT, body: self.to_h))
       end
 
       def self.health_check

data/lib/change_health/request/submission.rb

@@ -0,0 +1,38 @@
+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
+
+        property :claimInformation, from: :claim_information, required: false
+        property :controlNumber, from: :control_number, required: true, default: ChangeHealth::Models::CONTROL_NUMBER
+        property :providers, required: false
+        property :receiver, required: false
+        property :submitter, required: false
+        property :subscriber, 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
+
+        def add_provider(provider)
+          self[:providers] ||= []
+          self[:providers] << provider
+        end
+
+        def submission
+          ChangeHealth::Response::Claim::SubmissionData.new(response: ChangeHealth::Connection.new.request(endpoint: SUBMISSION_ENDPOINT, body: self.to_h))
+        end
+
+        def self.health_check
+          ChangeHealth::Connection.new.request(endpoint: HEALTH_CHECK_ENDPOINT, verb: :get)
+        end
+
+        def self.ping
+          self.health_check
+        end
+      end
+    end
+  end
+end

data/lib/change_health/response/claim/submission/submission_data.rb

@@ -0,0 +1,23 @@
+module ChangeHealth
+  module Response
+    module Claim
+      class SubmissionData < ChangeHealth::Response::ResponseData
+
+        %w(controlNumber status tradingPartnerId tradingPartnerServiceId).each do |v|
+          define_method(v) do
+            @raw.dig(v)
+          end
+        end
+
+        alias_method :control_number, :controlNumber
+        alias_method :trading_partner_id, :tradingPartnerId
+        alias_method :trading_partner_service_id, :tradingPartnerServiceId
+
+        def trading_partner?(name)
+          self.trading_partner_id == name || trading_partner_service_id == name
+        end
+
+      end
+    end
+  end
+end

data/lib/change_health/{models → response/eligibility}/eligibility_benefit.rb

@@ -1,5 +1,5 @@
 module ChangeHealth
-  module Models
+  module Response
     class EligibilityBenefit < Hash
       include Hashie::Extensions::MergeInitializer
       include Hashie::Extensions::IndifferentAccess
@@ -54,7 +54,7 @@ module ChangeHealth
         coverageLevelCode: COVERAGES,
         code: CODES
       }
-        
+
       HELPERS.each do |key, types|
         types.each do |method, value|
           define_method("#{method}?") do
@@ -99,13 +99,13 @@ module ChangeHealth
         self.coinsurance? ? self.benefitPercent : self.benefitAmount
       end
 
-      def services 
+      def services
         self['serviceTypeCodes']&.each_with_index&.map {|stc, i| [stc, self['serviceTypes']&.at(i)]} || []
       end
 
       %w(eligibilityBegin eligibilityEnd planBegin planEnd service).each do |f|
         define_method(f) do
-          return ChangeHealth::Models::EligibilityData::PARSE_DATE.call(self.date_info&.dig(f))
+          return ChangeHealth::Models::PARSE_DATE.call(self.date_info&.dig(f))
         end
       end
       alias_method :eligibility_begin_date, :eligibilityBegin
@@ -120,11 +120,11 @@ module ChangeHealth
       end
 
       def plan_date_range_start
-        ChangeHealth::Models::EligibilityData::PARSE_DATE.call(self.plan_date_range[0])
+        ChangeHealth::Models::PARSE_DATE.call(self.plan_date_range[0])
       end
 
       def plan_date_range_end
-        ChangeHealth::Models::EligibilityData::PARSE_DATE.call(self.plan_date_range[1])
+        ChangeHealth::Models::PARSE_DATE.call(self.plan_date_range[1])
       end
 
       private

data/lib/change_health/{models → response/eligibility}/eligibility_benefits.rb

@@ -1,8 +1,8 @@
 module ChangeHealth
-  module Models
+  module Response
     class EligibilityBenefits < Array
       def initialize(benefits)
-        super(benefits.map {|benefit| ChangeHealth::Models::EligibilityBenefit.new(benefit) })
+        super(benefits.map {|benefit| ChangeHealth::Response::EligibilityBenefit.new(benefit) })
       end
 
       def where(**kwargs)
@@ -25,7 +25,7 @@ module ChangeHealth
         self.where(inPlanNetworkIndicatorCode: 'Y')
       end
 
-      ChangeHealth::Models::EligibilityBenefit::HELPERS.each do |key, types|
+      ChangeHealth::Response::EligibilityBenefit::HELPERS.each do |key, types|
         types.each do |method, value|
           define_method("#{method}s") do
             self.where(key => value)

data/lib/change_health/response/eligibility/eligibility_data.rb

@@ -0,0 +1,94 @@
+module ChangeHealth
+  module Response
+    class EligibilityData < ChangeHealth::Response::ResponseData
+
+      ACTIVE = '1'
+      INACTIVE = '6'
+
+      def active?(service_code: '30')
+        plan_status(service_code: service_code, single: false).any? {|status| ACTIVE == status['statusCode'] }
+      end
+
+      def inactive?(service_code: '30')
+        plan_status(service_code: service_code, single: false).any? {|status| INACTIVE == status['statusCode'] }
+      end
+
+      def dependents?
+        true == self.dependents&.any?
+      end
+
+      %w(planStatus benefitsInformation controlNumber planDateInformation dependents).each do |v|
+        define_method(v) do
+          @raw.dig(v)
+        end
+      end
+
+      %w(eligibilityBegin planBegin service).each do |f|
+        define_method(f) do
+          return ChangeHealth::Models::PARSE_DATE.call(self.date_info&.dig(f))
+        end
+      end
+      alias_method :eligibility_begin_date, :eligibilityBegin
+      alias_method :plan_begin_date, :planBegin
+      alias_method :service_date, :service
+
+      def plan_date_range
+        pd = self.date_info&.dig('plan') || ''
+        pd.split('-')
+      end
+
+      def plan_date_range_start
+        ChangeHealth::Models::PARSE_DATE.call(self.plan_date_range[0])
+      end
+
+      def plan_date_range_end
+        ChangeHealth::Models::PARSE_DATE.call(self.plan_date_range[1])
+      end
+
+      def plan_status(service_code: , single: true)
+        if true == single
+          self.planStatus&.find {|plan| plan.dig('serviceTypeCodes')&.include?(service_code) } || {}
+        else
+          self.planStatus&.select {|plan| plan.dig('serviceTypeCodes')&.include?(service_code) } || []
+        end
+      end
+
+      def benefits
+        kname   = "ChangeHealth::Response::EligibilityBenefits#{self.trading_partner_id&.upcase}"
+        klazz   = Object.const_get(kname) if Module.const_defined?(kname)
+        klazz ||= ChangeHealth::Response::EligibilityBenefits
+
+        if klazz.respond_to?(:factory)
+          klazz = klazz.factory(self)
+        end
+
+        klazz.new(self.benefitsInformation || [])
+      end
+
+      def medicare?(**kwargs)
+        false == benefits.empty? && benefits.where(kwargs).all? {|b| b.medicare? }
+      end
+
+      def plan?(name)
+        self.plan_names.any? {|pname| name == pname }
+      end
+
+      def plan_names
+        self.planStatus&.map {|plan_status| plan_status['planDetails'] }&.compact || []
+      end
+
+      def trading_partner?(name)
+        self.trading_partner_id == name
+      end
+
+      def trading_partner_id
+        @raw['tradingPartnerServiceId']
+      end
+
+      alias_method :control_number, :controlNumber
+      alias_method :benefits_information, :benefitsInformation
+      alias_method :plan_statuses, :planStatus
+      alias_method :date_info, :planDateInformation
+    end
+  end
+end

data/lib/change_health/response/response_data.rb

@@ -0,0 +1,41 @@
+module ChangeHealth
+  module Response
+    class ResponseData
+      attr_reader :response, :raw
+
+      def initialize(data: nil, response: nil)
+        @response = response
+        @raw      = data
+
+        begin
+          @raw ||= response&.parsed_response
+        rescue JSON::ParserError
+        end
+
+        @raw ||= {}
+      end
+
+      def errors?
+        self.errors.is_a?(Array) && false == self.errors.empty?
+      end
+
+      def errors
+        errors = @raw.dig('errors') || []
+
+        errors.flatten.map {|error| ChangeHealth::Models::Error.new(error) }
+      end
+
+      def recommend_retry?
+        return false unless errors?
+
+        return true if errors.any?(&:represents_down?)
+
+        error_codes = errors.select(&:code?)
+
+        return false if error_codes.empty?
+
+        return error_codes.all?(&:retryable?)
+      end
+    end
+  end
+end

data/lib/change_health/version.rb

@@ -1,3 +1,3 @@
 module ChangeHealth
-  VERSION = '1.0.3'.freeze
+  VERSION = '2.0.0'.freeze
 end

data/lib/change_health.rb

@@ -1,22 +1,31 @@
 require 'httparty'
 require 'hashie'
 require 'change_health/version'
+require 'change_health/authentication'
 require 'change_health/change_health_exception'
 require 'change_health/connection'
-require 'change_health/authentication'
 require 'change_health/extensions'
+require 'change_health/models/error'
 require 'change_health/models/model'
-require 'change_health/models/eligibility'
-require 'change_health/models/eligibility_data'
-require 'change_health/models/eligibility_benefit'
-require 'change_health/models/eligibility_benefits'
-require 'change_health/models/trading_partner'
+require 'change_health/models/claim/submission/claim_information'
+require 'change_health/models/claim/submission/provider'
+require 'change_health/models/claim/submission/service_line'
+require 'change_health/models/claim/submission/submitter'
+require 'change_health/models/claim/submission/subscriber'
+require 'change_health/models/eligibility/encounter'
+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/trading_partner'
-require 'change_health/response/trading_partner_data'
-require 'change_health/response/trading_partners_data'
-require 'change_health/models/encounter'
-require 'change_health/models/provider'
-require 'change_health/models/subscriber'
+require 'change_health/response/response_data'
+require 'change_health/response/claim/submission/submission_data'
+require 'change_health/response/eligibility/eligibility_benefit'
+require 'change_health/response/eligibility/eligibility_benefits'
+require 'change_health/response/eligibility/eligibility_data'
+require 'change_health/response/trading_partner/trading_partner_data'
+require 'change_health/response/trading_partner/trading_partners_data'
 
 module ChangeHealth
   class Configuration

metadata

@@ -1,14 +1,14 @@
 --- !ruby/object:Gem::Specification
 name: change_health
 version: !ruby/object:Gem::Version
-  version: 1.0.3
+  version: 2.0.0
 platform: ruby
 authors:
 - Mike Crockett
 autorequire: 
 bindir: exe
 cert_chain: []
-date: 2021-04-26 00:00:00.000000000 Z
+date: 2021-10-11 00:00:00.000000000 Z
 dependencies:
 - !ruby/object:Gem::Dependency
   name: httparty
@@ -147,18 +147,27 @@ files:
 - lib/change_health/change_health_exception.rb
 - lib/change_health/connection.rb
 - lib/change_health/extensions.rb
-- lib/change_health/models/eligibility.rb
-- lib/change_health/models/eligibility_benefit.rb
-- lib/change_health/models/eligibility_benefits.rb
-- lib/change_health/models/eligibility_data.rb
-- lib/change_health/models/encounter.rb
+- lib/change_health/models/claim/submission/claim_information.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
+- lib/change_health/models/claim/submission/subscriber.rb
+- 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/provider.rb
-- lib/change_health/models/subscriber.rb
-- lib/change_health/models/trading_partner.rb
+- lib/change_health/models/trading_partner/trading_partner.rb
+- lib/change_health/request/eligibility.rb
+- lib/change_health/request/submission.rb
 - lib/change_health/request/trading_partner.rb
-- lib/change_health/response/trading_partner_data.rb
-- lib/change_health/response/trading_partners_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/response_data.rb
+- lib/change_health/response/trading_partner/trading_partner_data.rb
+- lib/change_health/response/trading_partner/trading_partners_data.rb
 - lib/change_health/version.rb
 homepage: https://github.com/WeInfuse/change_health
 licenses:
@@ -180,8 +189,7 @@ required_rubygems_version: !ruby/object:Gem::Requirement
     - !ruby/object:Gem::Version
       version: '0'
 requirements: []
-rubyforge_project: 
-rubygems_version: 2.7.6
+rubygems_version: 3.1.6
 signing_key: 
 specification_version: 4
 summary: Ruby wrapper for the ChangeHealth API

data/lib/change_health/models/eligibility_data.rb

@@ -1,191 +0,0 @@
-module ChangeHealth
-  module Models
-    class Error
-      attr_reader :data
-
-      SIMPLE_RETRY_CODES = %w[
-        42
-        80
-      ].freeze
-
-      NO_RESUBMIT_MESSAGES = [
-        'resubmission not allowed',
-        'do not resubmit'
-      ].freeze
-
-      DOWN_FIELD = 'Http Header'.freeze
-
-      DOWN_MESSAGE = 'Please review http headers for this API, please contact support if you are unsure how to resolve.'.freeze
-
-      def initialize(data)
-        @data = data
-      end
-
-      def message
-        field_message || code_message
-      end
-
-      def field_message
-        "#{field}: #{description}" if field?
-      end
-
-      def code_message
-        "#{code}: #{description}" if code?
-      end
-
-      def represents_down?
-        field == DOWN_FIELD && description == DOWN_MESSAGE
-      end
-
-      def retryable?
-        represents_down? ||
-        (code? && SIMPLE_RETRY_CODES.include?(code) && followupAction? && NO_RESUBMIT_MESSAGES.none? {|msg| followupAction.downcase.include?(msg) })
-      end
-
-      %w[field description code followupAction location].each do |method_name|
-        define_method("#{method_name}?") do
-          false == send(method_name).nil?
-        end
-
-        define_method("#{method_name}") do
-          @data[method_name]
-        end
-      end
-    end
-
-    class EligibilityData
-      attr_reader :response, :raw
-
-      ACTIVE = '1'
-      INACTIVE = '6'
-
-      PARSE_DATE = ->(d) {
-        begin
-          d = Date.strptime(d, ChangeHealth::Models::DATE_FORMAT)
-        rescue
-        end
-
-        d
-      }
-
-      def initialize(data: nil, response: nil)
-        @response = response
-        @raw      = data
-
-        begin
-          @raw ||= response&.parsed_response
-        rescue JSON::ParserError
-        end
-
-        @raw ||= {}
-      end
-
-      def active?(service_code: '30')
-        plan_status(service_code: service_code, single: false).any? {|status| ACTIVE == status['statusCode'] }
-      end
-
-      def inactive?(service_code: '30')
-        plan_status(service_code: service_code, single: false).any? {|status| INACTIVE == status['statusCode'] }
-      end
-
-      def errors?
-        self.errors.is_a?(Array) && false == self.errors.empty?
-      end
-
-      def errors
-        errors = @raw.dig('errors') || []
-
-        errors.flatten.map {|error| ChangeHealth::Models::Error.new(error) }
-      end
-
-      def recommend_retry?
-        return false unless errors?
-
-        return true if errors.any?(&:represents_down?)
-
-        error_codes = errors.select(&:code?)
-
-        return false if error_codes.empty?
-
-        return error_codes.all?(&:retryable?)
-      end
-
-      def dependents?
-        true == self.dependents&.any?
-      end
-
-      %w(planStatus benefitsInformation controlNumber planDateInformation dependents).each do |v|
-        define_method(v) do
-          @raw.dig(v)
-        end
-      end
-
-      %w(eligibilityBegin planBegin service).each do |f|
-        define_method(f) do
-          return PARSE_DATE.call(self.date_info&.dig(f))
-        end
-      end
-      alias_method :eligibility_begin_date, :eligibilityBegin
-      alias_method :plan_begin_date, :planBegin
-      alias_method :service_date, :service
-
-      def plan_date_range
-        pd = self.date_info&.dig('plan') || ''
-        pd.split('-')
-      end
-
-      def plan_date_range_start
-        ChangeHealth::Models::EligibilityData::PARSE_DATE.call(self.plan_date_range[0])
-      end
-
-      def plan_date_range_end
-        ChangeHealth::Models::EligibilityData::PARSE_DATE.call(self.plan_date_range[1])
-      end
-
-      def plan_status(service_code: , single: true)
-        if true == single
-          self.planStatus&.find {|plan| plan.dig('serviceTypeCodes')&.include?(service_code) } || {}
-        else
-          self.planStatus&.select {|plan| plan.dig('serviceTypeCodes')&.include?(service_code) } || []
-        end
-      end
-
-      def benefits
-        kname   = "ChangeHealth::Models::EligibilityBenefits#{self.trading_partner_id&.upcase}"
-        klazz   = Object.const_get(kname) if Module.const_defined?(kname)
-        klazz ||= ChangeHealth::Models::EligibilityBenefits
-
-        if klazz.respond_to?(:factory)
-          klazz = klazz.factory(self)
-        end
-
-        klazz.new(self.benefitsInformation || [])
-      end
-
-      def medicare?(**kwargs)
-        false == benefits.empty? && benefits.where(kwargs).all? {|b| b.medicare? }
-      end
-
-      def plan?(name)
-        self.plan_names.any? {|pname| name == pname }
-      end
-
-      def plan_names
-        self.planStatus&.map {|plan_status| plan_status['planDetails'] }&.compact || []
-      end
-
-      def trading_partner?(name)
-        self.trading_partner_id == name
-      end
-
-      def trading_partner_id
-        @raw['tradingPartnerServiceId']
-      end
-
-      alias_method :control_number, :controlNumber
-      alias_method :benefits_information, :benefitsInformation
-      alias_method :plan_statuses, :planStatus
-      alias_method :date_info, :planDateInformation
-    end
-  end
-end

data/lib/change_health/models/encounter.rb

@@ -1,20 +0,0 @@
-module ChangeHealth
-  module Models
-    class Encounter < Model
-      property :beginningDateOfService, from: :beginning_date_of_service, required: false
-      property :dateOfService, from: :date_of_service, required: false
-      property :dateRange, from: :date_range, required: false, default: false
-      property :endDateOfService, from: :end_date_of_service, required: false
-      property :serviceTypeCodes, from: :service_type_codes, required: false
-
-      alias_method :dateRange?, :dateRange
-      alias_method :date_range?, :dateRange
-      alias_method :service_type_codes, :serviceTypeCodes
-
-      def add_service_type_code(code)
-        self[:serviceTypeCodes] ||= []
-        self[:serviceTypeCodes] << code
-      end
-    end
-  end
-end

data/lib/change_health/models/provider.rb

@@ -1,21 +0,0 @@
-module ChangeHealth
-  module Models
-    class Provider < Hashie::Trash
-      property :firstName, from: :first_name, required: false
-      property :lastName, from: :last_name, required: false
-      property :name, default: true, required: false
-      property :npi, required: false
-      property :organizationName, from: :organization_name, required: false
-      property :payorId, from: :payer_id, required: false
-      property :person, default: true, required: false
-      property :providerCode, from: :provider_code, required: false
-      property :providerName, from: :provider_name, required: false
-      property :providerType, from: :provider_type, required: false
-      property :referenceIdentification, from: :reference_identification, required: false
-      property :serviceProviderNumber, from: :service_provider_number, required: false
-      property :taxId, from: :tax_id, required: false
-
-      alias_method :name?, :name
-    end
-  end
-end

data/lib/change_health/models/subscriber.rb

@@ -1,29 +0,0 @@
-module ChangeHealth
-  module Models
-    class Subscriber < Model
-      property :additionalIdentification, required: false
-      property :address, required: false
-      property :birthSequenceNumber, from: :birth_sequence_number, required: false
-      property :caseNumber, from: :case_number, 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 :healthCareCodeInformation, from: :health_care_code_information, required: false
-      property :idCard, from: :id_card, required: false
-      property :idCardIssueDate, from: :id_card_issued_date, required: false
-      property :lastName, from: :last_name, required: false
-      property :medicaidRecipientIdentificationNumber, from: :medicaid_recipient_identification_number, required: false
-      property :memberId, from: :member_id, required: false
-      property :providerCode, from: :provider_code, required: false
-      property :providerIdentifier, from: :provider_identification, required: false
-      property :referenceIdentificationQualifier, from: :reference_identification_qualifier, required: false
-      property :ssn, required: false
-
-      def add_health_care_code_information(value)
-        self[:healthCareCodeInformation] ||= []
-        self[:healthCareCodeInformation] << value
-      end
-    end
-  end
-end