change_health 2.2.1 → 2.3.0

checksums.yaml

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data/CHANGELOG.md

@@ -4,24 +4,32 @@ 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).
 
-## [2.2.1] - [2021-11-15-21]
+## [2.3.0] - 2021-11-18
+### Added
+* Specific classes for 277 & 835 reports - Report277Data & Report835Data
+* ReportClaim & ReportInfoClaimStatus- only works for json 277 reports
+
+### Fixed
+* Headers can now be nil for requests
+
+## [2.2.1] - 2021-11-15
 ### Added
 Custom Headers for Reports API and Professional Claims API
 * Report
 * Submission
 
-## [2.2.0] - [2021-11-04-21]
+## [2.2.0] - 2021-11-04
 ### Added
 Ability to hit [Claim Responses and Reports](https://developers.changehealthcare.com/eligibilityandclaims/docs/claims-responses-and-reports-getting-started)
 * Report
 * ReportListData
 * ReportData
 
-## [2.1.0] - [2021-10-12]
+## [2.1.0] - 2021-10-12
 ### Changed
 Model#to_h enhanced to change empty values AKA "" to nil. Reason: If a field is empty, Change Healthcare responds with an error - `Invalid value. Item must not be blank value.`. If the empty field is optional, Change Healthcare will accept the field as nil without error. If the empty field is required, Change Healthcare will return an error if the value is empty or nil.
 
-## [2.0.0] - [2021-10-08]
+## [2.0.0] - 2021-10-08
 ### Added
 #### Models
 * ResponseData - for responses from calling change healthcare api used by EligibilityData and SubmissionData
@@ -52,50 +60,50 @@ Added the ability to hit professional claim submission API. For more details, se
 ### Fixed
  * Eligibility#add_dependent actually works
 
-## [1.0.3] - [2021-04-26]
+## [1.0.3] - 2021-04-26
 ### Added
 - Model::Error#represents_down? - adds ability to distinguish error representing down state
 - Model::Error#retryable? - retryable when down
 - EligibilityData#recommend_retry? - recommend retry when down
 
-## [1.0.2] - [2021-04-06]
+## [1.0.2] - 2021-04-06
 ### Added
 - EligibilityData#recommend_retry? - fix a bug in the search statement
 
-## [1.0.1] - [2021-03-24]
+## [1.0.1] - 2021-03-24
 ### Added
 - EligibilityData#plan_status - adds ability to select instead of find
 - EligibilityData#inactive? active? - use new plan_status select
 
-## [1.0.0] - [2021-03-17]
+## [1.0.0] - 2021-03-17
 ### Added
 - Model::Error - help with error codes
 - EligibilityData#recommend_retry? - if it looks like you can retry the exact same request
 - EligibilityData#inactive? - looks for plan status 6
 
-## [0.15.0] - [2020-06-12]
+## [0.15.0] - 2020-06-12
 ### Added
 - Extensions - InNetworkMissing for plans that don't provide in network indicators.
 
 ### Fixed
 - Bug where active codes with no service codes cause exception.
 
-## [0.14.0] - [2020-05-07]
+## [0.14.0] - 2020-05-07
 ### Added
 - Extensions - mixins for common overrides
 
-## [0.13.0] - [2020-05-05]
+## [0.13.0] - 2020-05-05
 ### Changed
 - Removed `alias_method` for `where` helpers so you can override a single method
 - Added type Year to Date type 24
 - Added type Day type 7
 
-## [0.12.0] - [2020-04-30]
+## [0.12.0] - 2020-04-30
 ### Added
 - EligibilityData#errors
 - EligibilityData#errors?
 
-## [0.11.0] - [2020-04-24]
+## [0.11.0] - 2020-04-24
 ### Added
 - EligibilityData#medicare?
 - EligibilityData#plan\_id
@@ -110,7 +118,7 @@ Added the ability to hit professional claim submission API. For more details, se
 - EligibilityData initialize now checks for sub-classes of EligibilityBenefits with trading partner responds to `factory` to choose sub-class
 - EligibilityBenefits initializes `self.class` type in case it's a subclass
 
-## [0.10.0] - [2020-04-09]
+## [0.10.0] - 2020-04-09
 ### Added
 - Add Trading Partner API querying capability
 - Request::TradingPartner
@@ -118,7 +126,7 @@ Added the ability to hit professional claim submission API. For more details, se
 - Response::TradingPartnersData
 - Models::TradingPartner
 
-## [0.9.0] - [2020-04-08]
+## [0.9.0] - 2020-04-08
 ### Added
 - Added EligibilityBenefit#medicare?
 - Added EligibilityData#medicare?
@@ -127,20 +135,20 @@ Added the ability to hit professional claim submission API. For more details, se
 - EligibilityBenefit(s)#individual returns true for medicare in benefit and queries that look for 'IND'
 - EligibilityBenefit(s)#in\_network returns true for medicare in benefit and queries that look for 'Y'
 
-## [0.8.0] - [2020-04-04]
+## [0.8.0] - 2020-04-04
 ### Changed
 - Attempt to serialize all properties with 'date' in the name to ChangeHealth date format
 
-## [0.7.0] - [2020-04-03]
+## [0.7.0] - 2020-04-03
 ### Changed
 - Fixed bug in serializing date on subscriber and encounter
 
-## [0.6.0] - [2020-04-02]
+## [0.6.0] - 2020-04-02
 ### Changed
 - Added Indifferent Access to hashes
 - Fixed bug with Authentication endpoint
 
-## [0.5.0] - [2020-03-11]
+## [0.5.0] - 2020-03-11
 ### Added
 - EligibilityBenefit Deductible information
 - EligibilityBenefit benefits date information
@@ -152,17 +160,17 @@ Added the ability to hit professional claim submission API. For more details, se
 ### Changed
 - Broke EligibilityBenefit and EligibilityBenefits into separate files
 
-## [0.4.0] - [2020-03-10]
+## [0.4.0] - 2020-03-10
 ### Added
 - EligibilityBenefit(s) Employee information
 - EligibilityData plan date information
 - EligibilityData eligibility, plan and service date helpers on date info
 
-## [0.3.0] - [2020-03-09]
+## [0.3.0] - 2020-03-09
 ### Added
 - Production endpoint
 
-## [0.0.2] - [2020-03-09]
+## [0.0.2] - 2020-03-09
 ### Added
 - EligibilityData
 - EligibilityBenefit
@@ -180,6 +188,8 @@ Added the ability to hit professional claim submission API. For more details, se
 - Authentication
 - Configuration
 
+[2.3.0]: https://github.com/WeInfuse/change_health/compare/v2.2.1...v2.3.0
+[2.2.1]: https://github.com/WeInfuse/change_health/compare/v2.2.0...v2.2.1
 [2.2.0]: https://github.com/WeInfuse/change_health/compare/v2.1.0...v2.2.0
 [2.1.0]: https://github.com/WeInfuse/change_health/compare/v2.0.0...v2.1.0
 [2.0.0]: https://github.com/WeInfuse/change_health/compare/v1.0.3...v2.0.0

data/README.md

@@ -67,13 +67,13 @@ edata.response
 #<HTTParty::Response:0x7fa354c1fbe8>
 
 edata.response.ok?
-true
+# true
 
 edata.individual_oop_remaining(service_code: '30')
-1344.88
+# 1344.88
 
 edata.raw == edata.response.parsed_response
-true
+# true
 ```
 
 ### Trading Partners
@@ -198,6 +198,8 @@ validation = claim_submission.validation
 
 ### Claim Reports
 [Change Healthcare Claim Responses and Reports Guide](https://developers.changehealthcare.com/eligibilityandclaims/docs/claims-responses-and-reports-getting-started)
+
+#### Get Reports
 ```ruby
 ChangeHealth::Request::Claim::Report.ping # Test your connection
 
@@ -211,10 +213,10 @@ report_list = ChangeHealth::Request::Claim::Report.report_list(headers: report_h
 report_list.report_names
 # ["X3000000.XX", "R5000000.XY", "R5000000.XX", "X3000000.AB", "X3000000.AC", "X3000000.ZZ", "R5000000.XZ", "R5000000.YZ", "R5000000.WA", "R5000000.WB", "R5000000.WC"]
 
-report1_edi = ChangeHealth::Request::Claim::Report.get_report(report_list.report_names.first, as_json_report: false, headers: report_headers)
+report0_edi = ChangeHealth::Request::Claim::Report.get_report(report_list.report_names.first, as_json_report: false)
 # Report in edi format
 
-report1_json = ChangeHealth::Request::Claim::Report.get_report(report_list.report_names.first, as_json_report: true, headers: report_headers)
+report0_json = ChangeHealth::Request::Claim::Report.get_report(report_list.report_names.first, as_json_report: true)
 # Report in json format
 
 reports_json = report_list.report_names.map {|report_name| ChangeHealth::Request::Claim::Report.get_report(report_name, headers: report_headers)}
@@ -224,6 +226,32 @@ reports_edi = report_list.report_names.map {|report_name| ChangeHealth::Request:
 # all reports in edi format
 ```
 
+#### Review Individual Claims
+Currently only works for json 277 reports. json 835 reports coming soon!
+
+From a report, you can get an array of claims. For a full list of fields, see `ChangeHealth::Response::Claim::ReportClaim`
+
+```ruby
+report_claims = ChangeHealth::Request::Claim::Report.get_report("X3000000.AB", as_json_report: true).claims
+# list of claims in the report
+
+claim = report_claims.first
+claim.payer_org_name
+# "PREMERA"
+
+claim.subscriber_first_name
+# "JOHNONE"
+
+claim.transaction_set_creation_date
+# Tue, 01 Dec 2020
+
+claim.latest_status_category_codes
+# ["F1"]
+
+claim.latest_total_charge_amount
+# "100"
+```
+
 ### Configuration
 
 ```ruby

data/lib/change_health/connection.rb

@@ -13,11 +13,12 @@ module ChangeHealth
 
     format :json
 
-    def request(endpoint: , query: nil, body: nil, headers: {}, auth: true, verb: :post)
+    def request(endpoint:, query: nil, body: nil, headers: {}, auth: true, verb: :post)
       body    = body.to_json if body.is_a?(Hash)
+      headers = {} if headers.nil?
       headers = auth_header.merge(headers) if auth
 
-      self.class.send("#{verb}", endpoint, query: query, body: body, headers: headers)
+      self.class.send(verb.to_s, endpoint, query: query, body: body, headers: headers)
     end
 
     private
@@ -25,7 +26,7 @@ module ChangeHealth
     def auth_header
       @auth ||= Authentication.new
 
-      return @auth.authenticate.access_header
+      @auth.authenticate.access_header
     end
   end
 end

data/lib/change_health/request/report.rb

@@ -14,18 +14,26 @@ module ChangeHealth
           return if report_name.nil? || report_name.empty?
           final_headers =  ChangeHealth::Request::Claim::Report.report_headers(headers)
 
+          report_type = ChangeHealth::Response::Claim::ReportData.report_type(report_name)
+          return if report_type.nil?
+
           individual_report_endpoint = ENDPOINT + '/' + report_name
-          if as_json_report
-            # https://developers.changehealthcare.com/eligibilityandclaims/docs/what-file-types-does-this-api-get-from-the-mailbox
-            report_type = ChangeHealth::Response::Claim::ReportData.report_type(report_name)
-            return if report_type.nil?
 
-            individual_report_endpoint += '/' + report_type
-          end
+          # https://developers.changehealthcare.com/eligibilityandclaims/docs/what-file-types-does-this-api-get-from-the-mailbox
+          individual_report_endpoint += '/' + report_type if as_json_report
 
-          ChangeHealth::Response::Claim::ReportData.new(report_name,
-                                                        as_json_report,
-                                                        response: ChangeHealth::Connection.new.request(endpoint: individual_report_endpoint, verb: :get, headers: final_headers))
+          response = ChangeHealth::Connection.new.request(endpoint: individual_report_endpoint, verb: :get, headers: final_headers)
+          if ChangeHealth::Response::Claim::ReportData.is_277?(report_name)
+            ChangeHealth::Response::Claim::Report277Data
+              .new(report_name,
+                   as_json_report,
+                   response: response)
+          else
+            ChangeHealth::Response::Claim::Report835Data
+              .new(report_name,
+                   as_json_report,
+                   response: response)
+          end
         end
 
         def self.health_check

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

@@ -0,0 +1,78 @@
+module ChangeHealth
+  module Response
+    module Claim
+      # Methods only return meaningful data for json reports
+      class Report277Data < ChangeHealth::Response::Claim::ReportData
+        def transactions
+          @raw['transactions']
+        end
+
+        # Only one payer per report
+        def payer_org_name
+          transactions&.first&.dig('payers')&.first&.dig('organizationName')
+        end
+
+        def claims
+          report_claims = []
+
+          transactions&.each do |transaction|
+            transaction_set_creation_date = ChangeHealth::Models::PARSE_DATE.call(transaction['transactionSetCreationDate'])
+            transaction['payers']&.each do |payer|
+              payer_org_name = payer['organizationName']
+              payer['claimStatusTransactions']&.each do |claim_status_txn|
+                claim_status_txn['claimStatusDetails']&.each do |claim_status_detail|
+                  service_provider_npi = claim_status_detail.dig('serviceProvider', 'npi')
+                  claim_status_detail['patientClaimStatusDetails']&.each do |patient_claim_status_detail|
+                    subscriber_first_name = patient_claim_status_detail.dig('subscriber', 'firstName')
+                    subscriber_last_name = patient_claim_status_detail.dig('subscriber', 'lastName')
+                    patient_claim_status_detail['claims']&.each do |claim|
+                      procedure_codes = []
+                      claim['serviceLines']&.each do |service_line|
+                        procedure_codes << service_line.dig('service', 'procedureCode')
+                      end
+                      claim_status = claim['claimStatus']
+                      next if claim_status.nil?
+
+                      service_begin_date = ChangeHealth::Models::PARSE_DATE.call(claim_status['claimServiceBeginDate'] || claim_status['claimServiceDate'])
+                      service_end_date = ChangeHealth::Models::PARSE_DATE.call(claim_status['claimServiceEndDate'] || claim_status['claimServiceDate'])
+
+                      info_claim_statuses = []
+                      claim_status['informationClaimStatuses']&.each do |info_claim_status|
+                        status_information_effective_date = ChangeHealth::Models::PARSE_DATE.call(info_claim_status['statusInformationEffectiveDate'])
+                        total_charge_amount = info_claim_status['totalClaimChargeAmount']
+
+                        status_category_codes = []
+                        info_claim_status['informationStatuses']&.each do |info_status|
+                          status_category_codes << info_status['healthCareClaimStatusCategoryCode']
+                        end
+
+                        info_claim_statuses << ReportInfoClaimStatus.new(
+                          status_category_codes: status_category_codes,
+                          total_charge_amount: total_charge_amount,
+                          status_information_effective_date: status_information_effective_date
+                        )
+                      end
+                      report_claims << ReportClaim.new(
+                        transaction_set_creation_date: transaction_set_creation_date,
+                        payer_org_name: payer_org_name,
+                        service_provider_npi: service_provider_npi,
+                        subscriber_first_name: subscriber_first_name,
+                        subscriber_last_name: subscriber_last_name,
+                        procedure_codes: procedure_codes,
+                        service_begin_date: service_begin_date,
+                        service_end_date: service_end_date,
+                        info_claim_statuses: info_claim_statuses
+                      )
+                    end
+                  end
+                end
+              end
+            end
+          end
+
+          report_claims
+        end
+      end
+    end
+  end
+end

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

@@ -0,0 +1,8 @@
+module ChangeHealth
+  module Response
+    module Claim
+      class Report835Data < ChangeHealth::Response::Claim::ReportData
+      end
+    end
+  end
+end

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

@@ -0,0 +1,47 @@
+module ChangeHealth
+  module Response
+    module Claim
+      class ReportClaim < Hashie::Trash
+        property :transaction_set_creation_date, required: false
+        property :payer_org_name, required: false
+        property :service_provider_npi, required: false
+        property :subscriber_first_name, required: false
+        property :subscriber_last_name, required: false
+        property :procedure_codes, required: false
+        property :service_begin_date, required: false
+        property :service_end_date, required: false
+        property :info_claim_statuses, required: false
+
+        def add_procedure_code(procedure_code)
+          self[:procedure_codes] ||= []
+          self[:procedure_codes] << procedure_code
+        end
+
+        def add_info_claim_status(info_claim_status)
+          self[:info_claim_statuses] ||= []
+          self[:info_claim_statuses] << info_claim_status
+        end
+
+        def latest_status_category_codes
+          latest_info_claim_status&.status_category_codes
+        end
+
+        def latest_total_charge_amount
+          latest_info_claim_status&.total_charge_amount
+        end
+
+        def latest_status_info_effective_date
+          latest_info_claim_status&.status_information_effective_date
+        end
+
+        def latest_info_claim_status
+          info_claim_statuses&.select do |info|
+            !info.status_information_effective_date.nil? &&
+              info.status_information_effective_date.is_a?(Date) &&
+              info.status_information_effective_date <= Date.today
+          end&.max_by(&:status_information_effective_date)
+        end
+      end
+    end
+  end
+end

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

@@ -0,0 +1,16 @@
+module ChangeHealth
+  module Response
+    module Claim
+      class ReportInfoClaimStatus < Hashie::Trash
+        property :status_category_codes, required: false
+        property :total_charge_amount, required: false
+        property :status_information_effective_date, required: false
+
+        def add_status_category_code(status_category_code)
+          self[:status_category_codes] ||= []
+          self[:status_category_codes] << status_category_code
+        end
+      end
+    end
+  end
+end

data/lib/change_health/version.rb

@@ -1,3 +1,3 @@
 module ChangeHealth
-  VERSION = '2.2.1'.freeze
+  VERSION = '2.3.0'.freeze
 end

data/lib/change_health.rb

@@ -24,6 +24,10 @@ require 'change_health/response/response_data'
 require 'change_health/response/claim/submission/submission_data'
 require 'change_health/response/claim/report/report_list_data'
 require 'change_health/response/claim/report/report_data'
+require 'change_health/response/claim/report/report_277_data'
+require 'change_health/response/claim/report/report_835_data'
+require 'change_health/response/claim/report/report_claim'
+require 'change_health/response/claim/report/report_info_claim_status'
 require 'change_health/response/eligibility/eligibility_benefit'
 require 'change_health/response/eligibility/eligibility_benefits'
 require 'change_health/response/eligibility/eligibility_data'
@@ -45,11 +49,11 @@ module ChangeHealth
     end
 
     def api_endpoint
-      return Connection.base_uri
+      Connection.base_uri
     end
 
     def to_h
-      return {
+      {
         client_id: @client_id,
         client_secret: @client_secret,
         grant_type: @grant_type,
@@ -63,7 +67,7 @@ module ChangeHealth
       self.grant_type    = h[:grant_type]
       self.api_endpoint  = h[:api_endpoint]
 
-      return self
+      self
     end
   end
 

metadata

@@ -1,14 +1,14 @@
 --- !ruby/object:Gem::Specification
 name: change_health
 version: !ruby/object:Gem::Version
-  version: 2.2.1
+  version: 2.3.0
 platform: ruby
 authors:
 - Mike Crockett
 autorequire: 
 bindir: exe
 cert_chain: []
-date: 2021-11-16 00:00:00.000000000 Z
+date: 2021-11-19 00:00:00.000000000 Z
 dependencies:
 - !ruby/object:Gem::Dependency
   name: httparty
@@ -162,7 +162,11 @@ files:
 - lib/change_health/request/report.rb
 - lib/change_health/request/submission.rb
 - lib/change_health/request/trading_partner.rb
+- lib/change_health/response/claim/report/report_277_data.rb
+- lib/change_health/response/claim/report/report_835_data.rb
+- lib/change_health/response/claim/report/report_claim.rb
 - lib/change_health/response/claim/report/report_data.rb
+- lib/change_health/response/claim/report/report_info_claim_status.rb
 - lib/change_health/response/claim/report/report_list_data.rb
 - lib/change_health/response/claim/submission/submission_data.rb
 - lib/change_health/response/eligibility/eligibility_benefit.rb
@@ -192,8 +196,7 @@ 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