claimer 0.0.1

checksums.yaml

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+SHA1:
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+  data.tar.gz: 1c1f862ad742a4880b55aed1a9eb325c4a7b281b
+SHA512:
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data/LICENSE

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+The MIT License (MIT)
+
+Copyright (c) 2014 The Well Inspired Ventures, Inc.
+
+Permission is hereby granted, free of charge, to any person obtaining a copy
+of this software and associated documentation files (the "Software"), to deal
+in the Software without restriction, including without limitation the rights
+to use, copy, modify, merge, publish, distribute, sublicense, and/or sell
+copies of the Software, and to permit persons to whom the Software is
+furnished to do so, subject to the following conditions:
+
+The above copyright notice and this permission notice shall be included in all
+copies or substantial portions of the Software.
+
+THE SOFTWARE IS PROVIDED "AS IS", WITHOUT WARRANTY OF ANY KIND, EXPRESS OR
+IMPLIED, INCLUDING BUT NOT LIMITED TO THE WARRANTIES OF MERCHANTABILITY,
+FITNESS FOR A PARTICULAR PURPOSE AND NONINFRINGEMENT. IN NO EVENT SHALL THE
+AUTHORS OR COPYRIGHT HOLDERS BE LIABLE FOR ANY CLAIM, DAMAGES OR OTHER
+LIABILITY, WHETHER IN AN ACTION OF CONTRACT, TORT OR OTHERWISE, ARISING FROM,
+OUT OF OR IN CONNECTION WITH THE SOFTWARE OR THE USE OR OTHER DEALINGS IN THE
+SOFTWARE.

data/LICENSE.txt

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+Copyright (c) 2014 Brady Bouchard
+
+MIT License
+
+Permission is hereby granted, free of charge, to any person obtaining
+a copy of this software and associated documentation files (the
+"Software"), to deal in the Software without restriction, including
+without limitation the rights to use, copy, modify, merge, publish,
+distribute, sublicense, and/or sell copies of the Software, and to
+permit persons to whom the Software is furnished to do so, subject to
+the following conditions:
+
+The above copyright notice and this permission notice shall be
+included in all copies or substantial portions of the Software.
+
+THE SOFTWARE IS PROVIDED "AS IS", WITHOUT WARRANTY OF ANY KIND,
+EXPRESS OR IMPLIED, INCLUDING BUT NOT LIMITED TO THE WARRANTIES OF
+MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE AND
+NONINFRINGEMENT. IN NO EVENT SHALL THE AUTHORS OR COPYRIGHT HOLDERS BE
+LIABLE FOR ANY CLAIM, DAMAGES OR OTHER LIABILITY, WHETHER IN AN ACTION
+OF CONTRACT, TORT OR OTHERWISE, ARISING FROM, OUT OF OR IN CONNECTION
+WITH THE SOFTWARE OR THE USE OR OTHER DEALINGS IN THE SOFTWARE.

data/README.md

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+claimer
+=======
+
+Ruby library for Automated Claim Submissions to Canadian Provincial Medical Service Branches.

data/Rakefile

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+require "bundler/gem_tasks"
+

data/lib/claimer.rb

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+module Claimer
+
+  autoload :SK, 'claimer/gateways/sk'
+
+end
+
+require 'claimer/version'
+require 'claimer/gateway'
+require 'claimer/record'

data/lib/claimer/gateway.rb

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+module Claimer
+  class Gateway
+  end
+end

data/lib/claimer/gateways/sk.rb

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+module Claimer
+  class SK < Gateway
+
+    attr_accessor :records, :first_claim_number
+
+    def initialize(values = {})
+      self.records = []
+      self.first_claim_number = 10000
+    end
+
+    def add_record(*args)
+      self.records << Claimer::Record.new(*args)
+    end
+
+    def finalize!
+      collate_records
+    end
+
+    def push!
+      finalize!
+    end
+
+    private
+
+    def header_record(selected_records)
+      [
+        '10', # Record type number
+        selected_records.first.doctor_number.to_s.rjust(4, '0'),
+        '000000', # Filler
+        selected_records.first.clinic_number.to_s.rjust(3, '0'),
+        selected_records.first.doctor_name.to_s[0..24].rjust(25, '0').upcase,
+        selected_records.first.clinic_address.to_s[0..24].rjust(25, '0').upcase,
+        selected_records.first.clinic_city_and_prov.to_s[0..24].rjust(25, '0').upcase,
+        selected_records.first.clinic_postal_code.to_s[0..24].rjust(25, '0').upcase,
+        '8', # Submission type: By Internet.
+        '' # Practitioner billing.
+      ].join('')
+    end
+
+    def trailer_record(selected_records)
+      [
+        '90', # Record type number
+        selected_records.first.doctor_number.to_s.rjust(4, '0'),
+        '999999', # Filler
+        selected_records.count.to_s.rjust(5, '0'),
+        selected_records.reject{ |r| r.comments.nil? || r.comments.length == 0 }.count.to_s.rjust(5, '0'),
+        selected_records.count.to_s.rjust(7, '0'),
+        '69' # Filler
+      ].join('')
+    end
+
+    def record_format(record)
+      if record.in_hospital
+        hospital_record_format(record)
+      else
+        visit_record_format(record)
+      end
+    end
+
+    def hospital_record_format(record)
+      [
+        '57', # Record type number
+        record.doctor_number.to_s.rjust(4, '0'),
+        record.claim_number.to_s[0..4],
+        '0', # Placeholder for claim sequence number.
+        record.hsn.to_s[0..8],
+        record.dob.strftime('%m%y'),
+        record.sex.to_s.upcase,
+        "#{record.last_name} #{record.first_name}"[0..24].ljust(25),
+        record.icd9.to_s[0..2].rjust(3, '0'),
+        record.referring_doctor_number.rjust(4),
+        record.date_of_service.strftime('%d%m%y'),
+        record.number_of_units.to_s.rjust(2, '0'),
+        '1', # Location of service
+        record.fee_code.to_s.rjust(4, '0'),
+        record.fee.to_s.gsub('.','').gsub('$','').rjust(6, '0'),
+        '1', # Physician code.
+        '8', # Submission by internet.
+        ' ' * 19 # Filler.
+      ].join('')
+    end
+
+    def visit_record_format(record)
+      [
+        '50', # Record type number
+        record.doctor_number.to_s.rjust(4, '0'),
+        record.claim_number.to_s[0..4],
+        '0', # Placeholder for claim sequence number.
+        record.hsn.to_s[0..8],
+        record.dob.strftime('%m%y'),
+        record.sex.to_s.upcase,
+        "#{record.last_name} #{record.first_name}"[0..24].ljust(25),
+        record.icd9.to_s[0..2].rjust(3, '0'),
+        record.referring_doctor_number.rjust(4),
+        record.date_of_service.strftime('%d%m%y'),
+        record.number_of_units.to_s.rjust(2, '0'),
+        '1', # Location of service
+        record.fee_code.to_s.rjust(4, '0'),
+        record.fee.to_s.gsub('.','').gsub('$','').rjust(6, '0'),
+        '1', # Physician code.
+        '8', # Submission by internet.
+        ' ' * 19 # Filler.
+      ].join('')
+    end
+
+    def comment_format(record)
+      return nil if record.comments.nil? || record.comments.length == 0
+      [
+        '60', # Record type number
+        record.doctor_number.to_s.rjust(4, '0'),
+        record.claim_number.to_s[0..4],
+        '0', # Placeholder for claim sequence number.
+        record.hsn.to_s[0..8],
+        record.comments.to_s[0..76].upcase # Comments.
+      ].join('')
+    end
+
+    # Claim numbers are assigned sequentially starting at first_claim_number.
+    # Claim sequence numbers are all 0 - this part of the API (if you can call it an API)
+    # hasn't been implemented yet.
+    def assign_claim_numbers
+      c = self.first_claim_number
+      self.records.each_with_index do |r|
+        r.claim_number ||= c + r - 1
+        r.claim_sequence_number ||= 0
+      end
+    end
+
+    # MSB requires records to be sent in clinic-doctor sets.
+    def collate_records
+
+      assign_claim_numbers
+
+      doctor_numbers = self.records.map{ |r| r.doctor_number }.uniq
+      clinic_numbers = self.records.map{ |r| r.clinic_number }.uniq
+
+      clinic_numbers.map do |cn|
+        doctor_numbers.map do |dn|
+          selected_records = self.records.select{ |r| r.doctor_number == dn && r.clinic_number == cn }
+          [
+            header_record(selected_records),
+            selected_records.map do |r|
+              formatted_result = record_format(r)
+              formatted_comment = comment_format(r)
+              [ formatted_result, formatted_comment ].compact.join("\n")
+            end.join("\n"),
+            trailer_record(selected_records)
+          ].join("\n")
+        end
+      end.flatten.join("\n")
+    end
+
+  end
+end

data/lib/claimer/record.rb

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+module Claimer
+  class Record
+
+    attr_accessor :doctor_number, :referring_doctor_number, :doctor_name, :clinic_number,
+      :clinic_address, :clinic_city_and_prov, :clinic_postal_code, :hsn, :dob,
+      :sex, :first_name, :last_name, :icd9, :date_of_service, :end_date_of_service,
+      :number_of_units, :fee, :fee_code, :comments, :claim_number,
+      :claim_sequence_number, :in_hospital
+
+    def initialize(values = {})
+      self.doctor_number           = values[:doctor_number]
+      self.referring_doctor_number = values[:referring_doctor_number] || ''
+      self.doctor_name             = values[:doctor_name]
+      self.clinic_number           = values[:clinic_number]
+      self.clinic_address          = values[:clinic_address]
+      self.clinic_city_and_prov    = values[:clinic_city_and_prov]
+      self.clinic_postal_code      = values[:clinic_postal_code]
+      self.hsn                     = values[:hsn]
+      self.dob                     = values[:dob]
+      self.sex                     = values[:sex]
+      self.first_name              = values[:first_name]
+      self.last_name               = values[:last_name]
+      self.icd9                    = values[:icd9]
+      self.date_of_service         = values[:date_of_service]
+      self.end_date_of_service     = values[:end_date_of_service]
+      self.number_of_units         = values[:number_of_units]
+      self.fee                     = values[:fee]
+      self.fee_code                = values[:fee_code]
+      self.comments                = values[:comments]
+      self.claim_number            = values[:claim_number] || 0
+      self.claim_sequence_number   = values[:claim_sequence_number] || 0
+      self.in_hospital             = values[:in_hospital] || false
+    end
+
+  end
+end

data/lib/claimer/version.rb

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+module Claimer
+  VERSION = "0.0.1"
+end

data/spec/provinces/sk_spec.rb

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+require 'spec_helper'
+require_relative 'test_submission'
+
+describe Claimer::SK do
+  before(:all) do
+    require 'csv'
+    @gateway = Claimer::SK.new
+    CSV.foreach(File.expand_path('./sk_test.csv', File.dirname(__FILE__)), :headers => true) do |csv|
+      @gateway.add_record(
+        :hsn                     => csv['hsn'],
+        :sex                     => csv['sex'],
+        :dob                     => parse_dob(csv['dob']),
+        :last_name               => csv['name'].split(',')[0].strip,
+        :first_name              => csv['name'].split(',')[1].strip,
+        :claim_number            => csv['claim_number'],
+        :claim_sequence_number   => csv['claim_sequence_number'],
+        :icd9                    => csv['icd9'],
+        :date_of_service         => parse_date(csv['start_date']),
+        :end_date_of_service     => parse_date(csv['end_date']),
+        :number_of_units         => csv['visits_or_units'],
+        :fee_code                => csv['fee_code'],
+        :fee                     => (csv['fee'].to_f * 100).round,
+        :referring_doctor        => csv['referring_doctor'],
+        :location                => csv['location'],
+        :comments                => csv['comment'],
+        :doctor_number           => 9800,
+        :doctor_name             => 'General Practice',
+        :clinic_number           => 000
+      )
+    end
+  end
+
+  it 'validates test data against known good submission' do
+    expect(@gateway.finalize!).to eq(KNOWN_GOOD_SUBMISSION)
+  end
+
+  def parse_date(d)
+    return d unless d.is_a?(String)
+    return nil if d.nil?
+    Date.strptime(d.rjust(6, '0'), '%d%m%y')
+  end
+
+  def parse_dob(d)
+    return d unless d.is_a?(String)
+    return nil if d.nil?
+    Date.strptime(d.rjust(4, '0'), '%m%y')
+  end
+end

data/spec/provinces/sk_test.csv

@@ -0,0 +1 @@
+hsn,sex,dob,name,claim_number,claim_sequence_number,icd9,start_date,end_date,visits_or_units,fee_code,fee,referring_doctor,location,comment

data/spec/provinces/test_submission.rb

@@ -0,0 +1,21 @@
+KNOWN_GOOD_SUBMISSION = %/109800000000000000000000GENERAL|PRACTICE0000000000000000000000000000000000000000000000000000000000000000000000000008
+509800100860621030081039FSAMPSON|MARY|||||||||||||737||||180600011003B00390018|||||||||||||||||||
+509800100870880060000669MSAMPSON|JOHN|||||||||||||078||||180600011005B00192518|||||||||||||||||||
+509800100880730700090874MGREEN|DAVID||||||||||||||535||||190600011003B00390018|||||||||||||||||||
+509800100890721650140514FHOERDT|OLGA||||||||||||||207||||190600011009L00600018|||||||||||||||||||
+509800100890721650140514FHOERDT|OLGA||||||||||||||207||||190600011817A00229018|||||||||||||||||||
+509800100900700030091161MBEACH|ANDY|||||||||||||||300||||210600011003B00390018|||||||||||||||||||
+509800100910620340061260MKIPLING|BRIAN||||||||||||729||||210600011005D00192518|||||||||||||||||||
+509800100920731020080261FFISHER|SUSAN|||||||||||||550||||190600011009L00600018|||||||||||||||||||
+509800100930620340061260MKIPLING|BRIAN||||||||||||214||||210600011362L01000018|||||||||||||||||||
+60980010093062034006THIS|IS|A|COMMENT|THAT|APPLIES|TO|THE|ABOVE|LINE
+509800100940722150110261FMYERS|SUSAN||||||||||||||221||||210600011005B00192518|||||||||||||||||||
+509800100950610010151039FANDERS|MARY||||||||||||||207||||180600011011B00235018|||||||||||||||||||
+509800100960621000090737MANDERS|FRANCIS|||||||||||490||||190600011005B00192518|||||||||||||||||||
+509800100970620040000667MANDERS|JOHN||||||||||||||289||||140600011009B00470018|||||||||||||||||||
+509800100980620040000667MANDERS|JOHN||||||||||||||289||||140600011025B00207018|||||||||||||||||||
+509800100990722610050737FPLUE|PENNY|||||||||||||||300||||210600011005B00192518|||||||||||||||||||
+509800101000600020001039FEDWARDS|MARY|||||||||||||194||||210600011005B00192518|||||||||||||||||||
+509800101010721710571037FMACK|MARY||||||||||||||||786||||210600011005B00192518|||||||||||||||||||
+509800101020621050190423MCRANE|REG||||||||||||||||V25||||210600011190R01630018|||||||||||||||||||
+9098009999990001800001000001869/.gsub('|',' ')

data/spec/spec_helper.rb

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+require 'bundler/setup'
+Bundler.setup
+
+require 'claimer'
+
+RSpec.configure do |config|
+  # some (optional) config here
+end

metadata

@@ -0,0 +1,105 @@
+--- !ruby/object:Gem::Specification
+name: claimer
+version: !ruby/object:Gem::Version
+  version: 0.0.1
+platform: ruby
+authors:
+- Brady Bouchard
+autorequire: 
+bindir: bin
+cert_chain: []
+date: 2014-08-16 00:00:00.000000000 Z
+dependencies:
+- !ruby/object:Gem::Dependency
+  name: bundler
+  requirement: !ruby/object:Gem::Requirement
+    requirements:
+    - - "~>"
+      - !ruby/object:Gem::Version
+        version: '1.6'
+  type: :development
+  prerelease: false
+  version_requirements: !ruby/object:Gem::Requirement
+    requirements:
+    - - "~>"
+      - !ruby/object:Gem::Version
+        version: '1.6'
+- !ruby/object:Gem::Dependency
+  name: rake
+  requirement: !ruby/object:Gem::Requirement
+    requirements:
+    - - "~>"
+      - !ruby/object:Gem::Version
+        version: '10.0'
+  type: :development
+  prerelease: false
+  version_requirements: !ruby/object:Gem::Requirement
+    requirements:
+    - - "~>"
+      - !ruby/object:Gem::Version
+        version: '10.0'
+- !ruby/object:Gem::Dependency
+  name: rspec
+  requirement: !ruby/object:Gem::Requirement
+    requirements:
+    - - "~>"
+      - !ruby/object:Gem::Version
+        version: '3.0'
+  type: :development
+  prerelease: false
+  version_requirements: !ruby/object:Gem::Requirement
+    requirements:
+    - - "~>"
+      - !ruby/object:Gem::Version
+        version: '3.0'
+description: A Ruby library for preparing, formatting and submitting claim submissions
+  for medicare services provided by physicians, segmented by province in Canada.
+email:
+- brady@thewellinspired.com
+executables: []
+extensions: []
+extra_rdoc_files: []
+files:
+- LICENSE
+- LICENSE.txt
+- README.md
+- Rakefile
+- lib/claimer.rb
+- lib/claimer/gateway.rb
+- lib/claimer/gateways/sk.rb
+- lib/claimer/record.rb
+- lib/claimer/version.rb
+- spec/provinces/sk_spec.rb
+- spec/provinces/sk_test.csv
+- spec/provinces/test_submission.rb
+- spec/spec_helper.rb
+homepage: https://github.com/bouchard/claimer
+licenses:
+- MIT
+metadata: {}
+post_install_message: 
+rdoc_options: []
+require_paths:
+- lib
+required_ruby_version: !ruby/object:Gem::Requirement
+  requirements:
+  - - ">="
+    - !ruby/object:Gem::Version
+      version: '0'
+required_rubygems_version: !ruby/object:Gem::Requirement
+  requirements:
+  - - ">="
+    - !ruby/object:Gem::Version
+      version: '0'
+requirements: []
+rubyforge_project: 
+rubygems_version: 2.2.2
+signing_key: 
+specification_version: 4
+summary: Ruby library for automated claim submissions to Canadian Provincial Medical
+  Service Branches.
+test_files:
+- spec/provinces/sk_spec.rb
+- spec/provinces/sk_test.csv
+- spec/provinces/test_submission.rb
+- spec/spec_helper.rb