era_835_parser 0.0.1

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Files changed (17) hide show
  1. checksums.yaml +7 -0
  2. data/.gitignore +16 -0
  3. data/.rspec +1 -0
  4. data/.travis.yml +0 -0
  5. data/CODE_OF_CONDUCT.md +22 -0
  6. data/Gemfile +7 -0
  7. data/LICENSE.txt +23 -0
  8. data/README.md +108 -0
  9. data/Rakefile +5 -0
  10. data/era_835_parser.gemspec +24 -0
  11. data/lib/era_835_parser.rb +3 -0
  12. data/lib/era_835_parser/parser.rb +237 -0
  13. data/lib/era_835_parser/version.rb +3 -0
  14. data/spec/era_835_parser_spec.rb +633 -0
  15. data/spec/spec_helper.rb +3 -0
  16. data/spec/test_era.txt +95 -0
  17. metadata +108 -0
data/spec/spec_helper.rb ADDED
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+ require 'simplecov'
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+ SimpleCov.start
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+ require 'era_835_parser'
data/spec/test_era.txt ADDED
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+ Dear: Jane Doe
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+
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+
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+ Your Claims have been adjudicated by the Payer. Electronic Payment / Advise information has been received by Comapny and summarized as follows.
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+
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+ ==================================================
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+ ------- HEALTH CARE CLAIM PAYMENT/ADVICE -------
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+ ==================================================
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+
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+
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+ ========================================================================================================================================================
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+ Adjustment Date Provider ID Reference ID Adjustment Amt Reason
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+ ========================================================================================================================================================
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+ 12/30/2018 1111111111 BBBBBBVP31M0 -42.81 Overpayment Recover
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+ 12/31/2018 1111111112 BBBBBBVP31M1 -33.44 Overpayment Recover
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+ 12/30/2018 1111111113 BBBBBBVP31M2 33.45 Overpayment Recover
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+ ========================================================================================================================================================
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+
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+ ========================================================================================================================================================
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+ Check# Amount # Claims NPI or Tax ID Payee Date
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+ ========================================================================================================================================================
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+ 201812215555555555 48.80 1 1212121212 ABC COMPANY LLC 12/21/2018
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+ 201812215555555556 51.20 2 1212121213 ABC COMPANY 12/22/2018
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+ 201812215555555557 5.00 2 1212121212 ABC COMPANY LLC 12/21/2018
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+
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+ --------------------------------------------------------------------------------------------------------------------------------------------------------
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+ Check# Patient ID Last,First Charge Amt Payment Amt Accnt# Status Payer
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+ 201812215555555555 M11111110 DOE JR,DAVIS 65.00 48.80 1112 PROCESSED AS PRIMARY ABC HEALTHCARE EAST
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+ ONE CIRCLE RD
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+ SOMEWHERE,GA 11111
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+ Tax ID: 11-1111110
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+ Payer Claim Control Number: 111111111000
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+
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+ Line Item: Svc Date CPT Charge Amt Payment Amt Total Adj Amt Remarks
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+ 10/25/2018 92507 65.00 48.80 16.20 NO REMARKS
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+
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+ Adjustment Group Adj Amt Translated Reason Code
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+ CONTRACTUAL OBLIGATIONS 16.20 CHARGES EXCEED YOUR CONTRACTED/LEGISLATED FEE ARRANGEMENT.
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+ --------------------------------------------------------------------------------------------------------------------------------------------------------
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+ Check# Patient ID Last,First Charge Amt Payment Amt Accnt# Status Payer
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+ 201812215555555556 ZECM11111111 DOE,JANE -65.00 -48.80 L111 OTHER ABC HEALTHCARE WEST
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+ 50 EAST RD
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+ ANYWHERE,TN 00002-1111
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+ Tax ID: 11-1111111
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+ Payer Claim Control Number: BTBBB1111100
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+
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+ Line Item: Svc Date CPT Charge Amt Payment Amt Total Adj Amt Remarks
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+ 10/27/2017 92507 -65.00 -48.80 -16.20 NO REMARKS
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+
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+ Adjustment Group Adj Amt Translated Reason Code
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+ OTHER ADJUSTMENTS -16.20 CHARGES EXCEED YOUR CONTRACTED/LEGISLATED FEE ARRANGEMENT.
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+
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+ Line Item: Svc Date CPT Charge Amt Payment Amt Total Adj Amt Remarks
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+ 11/09/2017 92507 -5.00 0.00 -5.00 NO REMARKS
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+
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+ Adjustment Group Adj Amt Translated Reason Code
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+ OTHER ADJUSTMENTS -5.00 PAYMENT ADJUSTED BECAUSE CHARGES HAVE BEEN PAID BY ANOTHER PAYER.
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+ --------------------------------------------------------------------------------------------------------------------------------------------------------
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+ Check# Patient ID Last,First Charge Amt Payment Amt Accnt# Status Payer
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+ 201812215555555556 ZECM11111112 SMITH,JOSEPH 100.00 100.00 M111 PROCESSED AS SECONDARY ABC HEALTHCARE WEST
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+ 50 EAST RD
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+ ANYWHERE,TN 00002
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+ Tax ID: 11-1111111
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+ Payer Claim Control Number: BT1111111141
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+
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+ Line Item: Svc Date CPT Charge Amt Payment Amt Total Adj Amt Remarks
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+ 10/25/2017 92507 100.00 100.00 0.00 NO REMARKS
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+ --------------------------------------------------------------------------------------------------------------------------------------------------------
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+ Check# Patient ID Last,First Charge Amt Payment Amt Accnt# Status Payer
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+ 201812215555555557 ZECM11111112 LASTNAME,FIRST 45.00 0.00 M111 DENIED ABC HEALTHCARE EAST
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+ ONE CIRCLE RD
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+ SOMEWHERE,GA 11111
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+ Tax ID: 11-1111110
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+ Payer Claim Control Number: BT1111111131
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+ Claim Statement Period: 01/30/2019 - 01/30/2019
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+
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+ Line Item: Svc Date CPT Charge Amt Payment Amt Total Adj Amt Remarks
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+ 10/28/2017 92507 45.00 0.00 45.00 NO REMARKS
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+
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+ Adjustment Group Adj Amt Translated Reason Code
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+ CONTRACTUAL OBLIGATIONS 45.00 CHARGES EXCEED YOUR CONTRACTED/LEGISLATED FEE ARRANGEMENT.
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+ --------------------------------------------------------------------------------------------------------------------------------------------------------
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+ Check# Patient ID Last,First Charge Amt Payment Amt Accnt# Status Payer
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+ 201812215555555557 ZECM11111112 WORLD,HELLO 65.00 5.00 M111 PROCESSED AS PRIMARY, FWDED ABC HEALTHCARE EAST
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+ ONE CIRCLE RD
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+ SOMEWHERE,GA 11111
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+ Tax ID: 11-1111110
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+ Payer Claim Control Number: BT1111111121
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+
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+ Line Item: Svc Date CPT Charge Amt Payment Amt Total Adj Amt Remarks
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+ 10/30/2017 92507 65.00 5.00 60.00 NO REMARKS
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+
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+ Adjustment Group Adj Amt Translated Reason Code
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+ CONTRACTUAL OBLIGATIONS 16.20 CHARGES EXCEED YOUR CONTRACTED/LEGISLATED FEE ARRANGEMENT.
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+ OTHER ADJUSTMENTS 43.80 PAYMENT ADJUSTED BECAUSE CHARGES HAVE BEEN PAID BY ANOTHER PAYER.
metadata ADDED
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+ --- !ruby/object:Gem::Specification
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+ name: era_835_parser
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+ version: !ruby/object:Gem::Version
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+ version: 0.0.1
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+ platform: ruby
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+ authors:
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+ - Kevin S. Dias
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+ autorequire:
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+ bindir: bin
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+ cert_chain: []
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+ date: 2019-02-24 00:00:00.000000000 Z
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+ dependencies:
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+ - !ruby/object:Gem::Dependency
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+ name: bundler
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+ requirement: !ruby/object:Gem::Requirement
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+ requirements:
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+ - - "~>"
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+ - !ruby/object:Gem::Version
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+ version: '1.7'
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+ type: :development
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+ prerelease: false
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+ version_requirements: !ruby/object:Gem::Requirement
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+ requirements:
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+ - - "~>"
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+ - !ruby/object:Gem::Version
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+ version: '1.7'
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+ - !ruby/object:Gem::Dependency
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+ name: rake
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+ requirement: !ruby/object:Gem::Requirement
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+ requirements:
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+ - - "~>"
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+ - !ruby/object:Gem::Version
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+ version: '10.0'
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+ type: :development
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+ prerelease: false
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+ version_requirements: !ruby/object:Gem::Requirement
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+ requirements:
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+ - - "~>"
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+ - !ruby/object:Gem::Version
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+ version: '10.0'
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+ - !ruby/object:Gem::Dependency
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+ name: rspec
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+ requirement: !ruby/object:Gem::Requirement
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+ requirements:
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+ - - ">="
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+ - !ruby/object:Gem::Version
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+ version: '0'
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+ type: :development
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+ prerelease: false
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+ version_requirements: !ruby/object:Gem::Requirement
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+ requirements:
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+ - - ">="
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+ - !ruby/object:Gem::Version
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+ version: '0'
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+ description: This is a gem to parse ERAs, the electronic equivalent of a paper Explanation
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+ of Benefits (EOB). An electronic remittance advice (ERA) is an electronic data interchange
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+ (EDI) version of a medical insurance payment explanation. It provides details about
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+ providers' claims payment, and if the claims are denied, it would then contain the
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+ required explanations.
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+ email:
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+ - diasks2@gmail.com
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+ executables: []
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+ extensions: []
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+ extra_rdoc_files: []
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+ files:
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+ - ".gitignore"
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+ - ".rspec"
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+ - ".travis.yml"
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+ - CODE_OF_CONDUCT.md
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+ - Gemfile
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+ - LICENSE.txt
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+ - README.md
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+ - Rakefile
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+ - era_835_parser.gemspec
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+ - lib/era_835_parser.rb
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+ - lib/era_835_parser/parser.rb
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+ - lib/era_835_parser/version.rb
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+ - spec/era_835_parser_spec.rb
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+ - spec/spec_helper.rb
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+ - spec/test_era.txt
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+ homepage: https://github.com/diasks2/era_835_parser
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+ licenses:
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+ - MIT
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+ metadata: {}
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+ post_install_message:
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+ rdoc_options: []
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+ require_paths:
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+ - lib
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+ required_ruby_version: !ruby/object:Gem::Requirement
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+ requirements:
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+ - - ">="
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+ - !ruby/object:Gem::Version
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+ version: '0'
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+ required_rubygems_version: !ruby/object:Gem::Requirement
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+ requirements:
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+ - - ">="
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+ - !ruby/object:Gem::Version
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+ version: '0'
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+ requirements: []
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+ rubyforge_project:
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+ rubygems_version: 2.7.7
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+ signing_key:
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+ specification_version: 4
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+ summary: Electronic Remittance Advice (ERA) 835 parser
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+ test_files:
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+ - spec/era_835_parser_spec.rb
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+ - spec/spec_helper.rb
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+ - spec/test_era.txt