hippo 0.0.4

data/lib/hippo/transaction_sets/HIPAA_837/L2310F.rb

@@ -0,0 +1,34 @@
+module Hippo::TransactionSets
+  module HIPAA_837
+
+    class L2310F < Hippo::TransactionSets::Base
+      loop_name 'L2310F'    #Ambulance Drop-off Location
+
+      #Ambulance Drop-off Location
+      segment Hippo::Segments::NM1,
+                :name           => 'Ambulance Drop-off Location',
+                :minimum        => 0,
+                :maximum        => 1,
+                :position       => 2500,
+                :defaults => {
+                  'NM101' => '45',
+                  'NM102' => '2'
+                }
+
+      #Ambulance Drop-off Location Address
+      segment Hippo::Segments::N3,
+                :name           => 'Ambulance Drop-off Location Address',
+                :minimum        => 1,
+                :maximum        => 1,
+                :position       => 2650
+
+      #Ambulance Drop-off Location City, State, ZIP Code
+      segment Hippo::Segments::N4,
+                :name           => 'Ambulance Drop-off Location City, State, ZIP Code',
+                :minimum        => 1,
+                :maximum        => 1,
+                :position       => 2700
+
+    end
+  end
+end

data/lib/hippo/transaction_sets/HIPAA_837/L2320.rb

@@ -0,0 +1,122 @@
+module Hippo::TransactionSets
+  module HIPAA_837
+
+    class L2320 < Hippo::TransactionSets::Base
+      loop_name 'L2320'    #Other Subscriber Information
+
+      #Other Subscriber Information
+      segment Hippo::Segments::SBR,
+                :name           => 'Other Subscriber Information',
+                :minimum        => 0,
+                :maximum        => 1,
+                :position       => 2900
+
+      #Claim Level Adjustments
+      segment Hippo::Segments::CAS,
+                :name           => 'Claim Level Adjustments',
+                :minimum        => 0,
+                :maximum        => 5,
+                :position       => 2950
+
+      #Coordination of Benefits (COB) Payer Paid Amount
+      segment Hippo::Segments::AMT,
+                :name           => 'Coordination of Benefits (COB) Payer Paid Amount',
+                :minimum        => 0,
+                :maximum        => 1,
+                :position       => 3000,
+                :defaults => {
+                  'AMT01' => 'D'
+                }
+
+      #Coordination of Benefits (COB) Total Non-Covered Amount
+      segment Hippo::Segments::AMT,
+                :name           => 'Coordination of Benefits (COB) Total Non-Covered Amount',
+                :minimum        => 0,
+                :maximum        => 1,
+                :position       => 3020,
+                :defaults => {
+                  'AMT01' => 'A8'
+                }
+
+      #Remaining Patient Liability
+      segment Hippo::Segments::AMT,
+                :name           => 'Remaining Patient Liability',
+                :minimum        => 0,
+                :maximum        => 1,
+                :position       => 3050,
+                :defaults => {
+                  'AMT01' => 'EAF'
+                }
+
+      #Other Insurance Coverage Information
+      segment Hippo::Segments::OI,
+                :name           => 'Other Insurance Coverage Information',
+                :minimum        => 1,
+                :maximum        => 1,
+                :position       => 3110
+
+      #Outpatient Adjudication Information
+      segment Hippo::Segments::MOA,
+                :name           => 'Outpatient Adjudication Information',
+                :minimum        => 0,
+                :maximum        => 1,
+                :position       => 3200
+
+      #Other Subscriber Name
+      loop    Hippo::TransactionSets::HIPAA_837::L2330A,
+                :name           => 'Other Subscriber Name',
+                :identified_by  => {'NM1.NM101' => 'IL'},
+                :minimum        => 1,
+                :maximum        => 1,
+                :position       => 3250
+
+      #Other Payer Name
+      loop    Hippo::TransactionSets::HIPAA_837::L2330B,
+                :name           => 'Other Payer Name',
+                :identified_by  => {'NM1.NM101' => 'PR'},
+                :minimum        => 1,
+                :maximum        => 1,
+                :position       => 3250
+
+      #Other Payer Referring Provider
+      loop    Hippo::TransactionSets::HIPAA_837::L2330C,
+                :name           => 'Other Payer Referring Provider',
+                :minimum        => 0,
+                :maximum        => 2,
+                :position       => 3250
+
+      #Other Payer Rendering Provider
+      loop    Hippo::TransactionSets::HIPAA_837::L2330D,
+                :name           => 'Other Payer Rendering Provider',
+                :identified_by  => {'NM1.NM101' => '82'},
+                :minimum        => 0,
+                :maximum        => 1,
+                :position       => 3650
+
+      #Other Payer Service Facility Location
+      loop    Hippo::TransactionSets::HIPAA_837::L2330E,
+                :name           => 'Other Payer Service Facility Location',
+                :identified_by  => {'NM1.NM101' => '77'},
+                :minimum        => 0,
+                :maximum        => 1,
+                :position       => 4650
+
+      #Other Payer Supervising Provider
+      loop    Hippo::TransactionSets::HIPAA_837::L2330F,
+                :name           => 'Other Payer Supervising Provider',
+                :identified_by  => {'NM1.NM101' => 'DQ'},
+                :minimum        => 0,
+                :maximum        => 1,
+                :position       => 5650
+
+      #Other Payer Billing Provider
+      loop    Hippo::TransactionSets::HIPAA_837::L2330G,
+                :name           => 'Other Payer Billing Provider',
+                :identified_by  => {'NM1.NM101' => '85'},
+                :minimum        => 0,
+                :maximum        => 1,
+                :position       => 6350
+
+    end
+  end
+end

data/lib/hippo/transaction_sets/HIPAA_837/L2330A.rb

@@ -0,0 +1,43 @@
+module Hippo::TransactionSets
+  module HIPAA_837
+
+    class L2330A < Hippo::TransactionSets::Base
+      loop_name 'L2330A'    #Other Subscriber Name
+
+      #Other Subscriber Name
+      segment Hippo::Segments::NM1,
+                :name           => 'Other Subscriber Name',
+                :minimum        => 1,
+                :maximum        => 1,
+                :position       => 3250,
+                :defaults => {
+                  'NM101' => 'IL'
+                }
+
+      #Other Subscriber Address
+      segment Hippo::Segments::N3,
+                :name           => 'Other Subscriber Address',
+                :minimum        => 0,
+                :maximum        => 1,
+                :position       => 3320
+
+      #Other Subscriber City, State, ZIP Code
+      segment Hippo::Segments::N4,
+                :name           => 'Other Subscriber City, State, ZIP Code',
+                :minimum        => 0,
+                :maximum        => 1,
+                :position       => 3400
+
+      #Other Subscriber Secondary Identification
+      segment Hippo::Segments::REF,
+                :name           => 'Other Subscriber Secondary Identification',
+                :minimum        => 0,
+                :maximum        => 1,
+                :position       => 3550,
+                :defaults => {
+                  'REF01' => 'SY'
+                }
+
+    end
+  end
+end

data/lib/hippo/transaction_sets/HIPAA_837/L2330B.rb

@@ -0,0 +1,92 @@
+module Hippo::TransactionSets
+  module HIPAA_837
+
+    class L2330B < Hippo::TransactionSets::Base
+      loop_name 'L2330B'    #Other Payer Name
+
+      #Other Payer Name
+      segment Hippo::Segments::NM1,
+                :name           => 'Other Payer Name',
+                :minimum        => 1,
+                :maximum        => 1,
+                :position       => 3250,
+                :defaults => {
+                  'NM101' => 'PR',
+                  'NM102' => '2'
+                }
+
+      #Other Payer Address
+      segment Hippo::Segments::N3,
+                :name           => 'Other Payer Address',
+                :minimum        => 0,
+                :maximum        => 1,
+                :position       => 3320
+
+      #Other Payer City, State, ZIP Code
+      segment Hippo::Segments::N4,
+                :name           => 'Other Payer City, State, ZIP Code',
+                :minimum        => 0,
+                :maximum        => 1,
+                :position       => 3400
+
+      #Claim Check or Remittance Date
+      segment Hippo::Segments::DTP,
+                :name           => 'Claim Check or Remittance Date',
+                :minimum        => 0,
+                :maximum        => 1,
+                :position       => 3470,
+                :defaults => {
+                  'DTP01' => '573',
+                  'DTP02' => 'D8'
+                }
+
+      #Other Payer Secondary Identifier
+      segment Hippo::Segments::REF,
+                :name           => 'Other Payer Secondary Identifier',
+                :minimum        => 0,
+                :maximum        => 2,
+                :position       => 3550
+
+      #Other Payer Prior Authorization Number
+      segment Hippo::Segments::REF,
+                :name           => 'Other Payer Prior Authorization Number',
+                :minimum        => 0,
+                :maximum        => 1,
+                :position       => 3560,
+                :defaults => {
+                  'REF01' => 'G1'
+                }
+
+      #Other Payer Referral Number
+      segment Hippo::Segments::REF,
+                :name           => 'Other Payer Referral Number',
+                :minimum        => 0,
+                :maximum        => 1,
+                :position       => 3563,
+                :defaults => {
+                  'REF01' => '9F'
+                }
+
+      #Other Payer Claim Adjustment Indicator
+      segment Hippo::Segments::REF,
+                :name           => 'Other Payer Claim Adjustment Indicator',
+                :minimum        => 0,
+                :maximum        => 1,
+                :position       => 3570,
+                :defaults => {
+                  'REF01' => 'T4'
+                }
+
+      #Other Payer Claim Control Number
+      segment Hippo::Segments::REF,
+                :name           => 'Other Payer Claim Control Number',
+                :minimum        => 0,
+                :maximum        => 1,
+                :position       => 3575,
+                :defaults => {
+                  'REF01' => 'F8'
+                }
+
+    end
+  end
+end

data/lib/hippo/transaction_sets/HIPAA_837/L2330C.rb

@@ -0,0 +1,26 @@
+module Hippo::TransactionSets
+  module HIPAA_837
+
+    class L2330C < Hippo::TransactionSets::Base
+      loop_name 'L2330C'    #Other Payer Referring Provider
+
+      #Other Payer Referring Provider
+      segment Hippo::Segments::NM1,
+                :name           => 'Other Payer Referring Provider',
+                :minimum        => 0,
+                :maximum        => 1,
+                :position       => 3250,
+                :defaults => {
+                  'NM102' => '1'
+                }
+
+      #Other Payer Referring Provider Secondary Identification
+      segment Hippo::Segments::REF,
+                :name           => 'Other Payer Referring Provider Secondary Identification',
+                :minimum        => 1,
+                :maximum        => 3,
+                :position       => 3550
+
+    end
+  end
+end

data/lib/hippo/transaction_sets/HIPAA_837/L2330D.rb

@@ -0,0 +1,26 @@
+module Hippo::TransactionSets
+  module HIPAA_837
+
+    class L2330D < Hippo::TransactionSets::Base
+      loop_name 'L2330D'    #Other Payer Rendering Provider
+
+      #Other Payer Rendering Provider
+      segment Hippo::Segments::NM1,
+                :name           => 'Other Payer Rendering Provider',
+                :minimum        => 0,
+                :maximum        => 1,
+                :position       => 3650,
+                :defaults => {
+                  'NM101' => '82'
+                }
+
+      #Other Payer Rendering Provider Secondary Identification
+      segment Hippo::Segments::REF,
+                :name           => 'Other Payer Rendering Provider Secondary Identification',
+                :minimum        => 1,
+                :maximum        => 3,
+                :position       => 4150
+
+    end
+  end
+end

data/lib/hippo/transaction_sets/HIPAA_837/L2330E.rb

@@ -0,0 +1,27 @@
+module Hippo::TransactionSets
+  module HIPAA_837
+
+    class L2330E < Hippo::TransactionSets::Base
+      loop_name 'L2330E'    #Other Payer Service Facility Location
+
+      #Other Payer Service Facility Location
+      segment Hippo::Segments::NM1,
+                :name           => 'Other Payer Service Facility Location',
+                :minimum        => 0,
+                :maximum        => 1,
+                :position       => 4650,
+                :defaults => {
+                  'NM101' => '77',
+                  'NM102' => '2'
+                }
+
+      #Other Payer Service Facility Location Secondary Identification
+      segment Hippo::Segments::REF,
+                :name           => 'Other Payer Service Facility Location Secondary Identification',
+                :minimum        => 1,
+                :maximum        => 3,
+                :position       => 5550
+
+    end
+  end
+end

data/lib/hippo/transaction_sets/HIPAA_837/L2330F.rb

@@ -0,0 +1,27 @@
+module Hippo::TransactionSets
+  module HIPAA_837
+
+    class L2330F < Hippo::TransactionSets::Base
+      loop_name 'L2330F'    #Other Payer Supervising Provider
+
+      #Other Payer Supervising Provider
+      segment Hippo::Segments::NM1,
+                :name           => 'Other Payer Supervising Provider',
+                :minimum        => 0,
+                :maximum        => 1,
+                :position       => 5650,
+                :defaults => {
+                  'NM101' => 'DQ',
+                  'NM102' => '1'
+                }
+
+      #Other Payer Supervising Provider Secondary Identification
+      segment Hippo::Segments::REF,
+                :name           => 'Other Payer Supervising Provider Secondary Identification',
+                :minimum        => 1,
+                :maximum        => 3,
+                :position       => 6050
+
+    end
+  end
+end

data/lib/hippo/transaction_sets/HIPAA_837/L2330G.rb

@@ -0,0 +1,26 @@
+module Hippo::TransactionSets
+  module HIPAA_837
+
+    class L2330G < Hippo::TransactionSets::Base
+      loop_name 'L2330G'    #Other Payer Billing Provider
+
+      #Other Payer Billing Provider
+      segment Hippo::Segments::NM1,
+                :name           => 'Other Payer Billing Provider',
+                :minimum        => 0,
+                :maximum        => 1,
+                :position       => 6350,
+                :defaults => {
+                  'NM101' => '85'
+                }
+
+      #Other Payer Billing Provider Secondary Identification
+      segment Hippo::Segments::REF,
+                :name           => 'Other Payer Billing Provider Secondary Identification',
+                :minimum        => 1,
+                :maximum        => 2,
+                :position       => 6600
+
+    end
+  end
+end