hippo_eyeDoc 0.0.1

data/lib/hippo_eyeDoc/transaction_sets/HIPAA_271/L2100D.rb

@@ -0,0 +1,124 @@
+module Hippo_eyeDoc::TransactionSets
+  module HIPAA_271
+
+    class L2100D < Hippo_eyeDoc::TransactionSets::Base
+      loop_name 'L2100D'    #Dependent Name
+
+      #Dependent Name
+      segment Hippo_eyeDoc::Segments::NM1,
+                :name           => 'Dependent Name',
+                :minimum        => 1,
+                :maximum        => 1,
+                :position       => 300,
+                :identified_by => {
+                  'NM101' => '03',
+                  'NM102' => '1'
+                }
+
+      #Dependent Additional Identification
+      segment Hippo_eyeDoc::Segments::REF,
+                :name           => 'Dependent Additional Identification',
+                :minimum        => 0,
+                :maximum        => 9,
+                :position       => 400,
+                :identified_by => {
+                  'REF01' => ["18", "1L", "1W", "49", "6P", "CE", "CT", "EA", "EJ", "F6", "GH", "HJ", "IF", "IG", "MRC", "N6", "NQ", "Q4", "SY", "Y4"]
+                }
+
+      #Dependent Address
+      segment Hippo_eyeDoc::Segments::N3,
+                :name           => 'Dependent Address',
+                :minimum        => 0,
+                :maximum        => 1,
+                :position       => 600
+
+      #Dependent City, State, ZIP Code
+      segment Hippo_eyeDoc::Segments::N4,
+                :name           => 'Dependent City, State, ZIP Code',
+                :minimum        => 0,
+                :maximum        => 1,
+                :position       => 700
+
+      #Dependent Request Validation
+      segment Hippo_eyeDoc::Segments::AAA,
+                :name           => 'Dependent Request Validation',
+                :minimum        => 0,
+                :maximum        => 9,
+                :position       => 850,
+                :identified_by => {
+                  'AAA01' => ["N", "Y"],
+                  'AAA03' => ["15", "35", "42", "43", "45", "47", "48", "49", "51", "52", "56", "57", "58", "60", "61", "62", "63", "64", "65", "66", "67", "68", "71", "77"],
+                  'AAA04' => ["C", "N", "R", "S", "W", "X", "Y"]
+                }
+
+      #Provider Information
+      segment Hippo_eyeDoc::Segments::PRV,
+                :name           => 'Provider Information',
+                :minimum        => 0,
+                :maximum        => 1,
+                :position       => 900,
+                :identified_by => {
+                  'PRV01' => ["AD", "AT", "BI", "CO", "CV", "H", "HH", "LA", "OT", "P1", "P2", "PC", "PE", "R", "RF", "SK", "SU"]
+                }
+
+      #Dependent Demographic Information
+      segment Hippo_eyeDoc::Segments::DMG,
+                :name           => 'Dependent Demographic Information',
+                :minimum        => 0,
+                :maximum        => 1,
+                :position       => 1000
+
+      #Dependent Relationship
+      segment Hippo_eyeDoc::Segments::INS,
+                :name           => 'Dependent Relationship',
+                :minimum        => 0,
+                :maximum        => 1,
+                :position       => 1100,
+                :identified_by => {
+                  'INS01' => 'N',
+                  'INS02' => ["01", "19", "20", "21", "39", "40", "53", "G8"]
+                }
+
+      #Dependent Health Care Diagnosis Code
+      segment Hippo_eyeDoc::Segments::HI,
+                :name           => 'Dependent Health Care Diagnosis Code',
+                :minimum        => 0,
+                :maximum        => 1,
+                :position       => 1150
+
+      #Dependent Date
+      segment Hippo_eyeDoc::Segments::DTP,
+                :name           => 'Dependent Date',
+                :minimum        => 0,
+                :maximum        => 9,
+                :position       => 1200,
+                :identified_by => {
+                  'DTP01' => ["096", "102", "152", "291", "307", "318", "340", "341", "342", "343", "346", "347", "356", "357", "382", "435", "442", "458", "472", "539", "540", "636", "771"],
+                  'DTP02' => ["D8", "RD8"]
+                }
+
+      #Dependent Military Personnel Information
+      segment Hippo_eyeDoc::Segments::MPI,
+                :name           => 'Dependent Military Personnel Information',
+                :minimum        => 0,
+                :maximum        => 1,
+                :position       => 1275,
+                :identified_by => {
+                  'MPI01' => ["A", "C", "L", "O", "P", "S", "T"],
+                  'MPI02' => ["AE", "AO", "AS", "AT", "AU", "CC", "DD", "HD", "IR", "LX", "PE", "RE", "RM", "RR", "RU"],
+                  'MPI03' => ["A", "B", "C", "D", "E", "F", "G", "H", "I", "J", "K", "L", "M", "N", "O", "Q", "R", "S", "U", "W"]
+                }
+
+      #Dependent Eligibility or Benefit Information
+      loop    Hippo_eyeDoc::TransactionSets::HIPAA_271::L2110D,
+                :name           => 'Dependent Eligibility or Benefit Information',
+                :minimum        => 0,
+                :maximum        => 99999,
+                :position       => 1300,
+                :identified_by => {
+                  'EB.EB01' => ["1", "2", "3", "4", "5", "6", "7", "8", "A", "B", "C", "CB", "D", "E", "F", "G", "H", "I", "J", "K", "L", "M", "MC", "N", "O", "P", "Q", "R", "S", "T", "U", "V", "W", "X", "Y"]
+                }
+
+    end
+  end
+end

data/lib/hippo_eyeDoc/transaction_sets/HIPAA_271/L2110C.rb

@@ -0,0 +1,98 @@
+module Hippo_eyeDoc::TransactionSets
+  module HIPAA_271
+
+    class L2110C < Hippo_eyeDoc::TransactionSets::Base
+      loop_name 'L2110C'    #Subscriber Eligibility or Benefit Information
+
+      #Subscriber Eligibility or Benefit Information
+      segment Hippo_eyeDoc::Segments::EB,
+                :name           => 'Subscriber Eligibility or Benefit Information',
+                :minimum        => 0,
+                :maximum        => 1,
+                :position       => 1300,
+                :identified_by => {
+                  'EB01' => ["1", "2", "3", "4", "5", "6", "7", "8", "A", "B", "C", "CB", "D", "E", "F", "G", "H", "I", "J", "K", "L", "M", "MC", "N", "O", "P", "Q", "R", "S", "T", "U", "V", "W", "X", "Y"]
+                }
+
+      #Health Care Services Delivery
+      segment Hippo_eyeDoc::Segments::HSD,
+                :name           => 'Health Care Services Delivery',
+                :minimum        => 0,
+                :maximum        => 9,
+                :position       => 1350
+
+      #Subscriber Additional Identification
+      segment Hippo_eyeDoc::Segments::REF,
+                :name           => 'Subscriber Additional Identification',
+                :minimum        => 0,
+                :maximum        => 9,
+                :position       => 1400,
+                :identified_by => {
+                  'REF01' => ["18", "1L", "1W", "49", "6P", "9F", "ALS", "CLI", "F6", "FO", "G1", "IG", "M7", "N6", "NQ"]
+                }
+
+      #Subscriber Eligibility/Benefit Date
+      segment Hippo_eyeDoc::Segments::DTP,
+                :name           => 'Subscriber Eligibility/Benefit Date',
+                :minimum        => 0,
+                :maximum        => 20,
+                :position       => 1500,
+                :identified_by => {
+                  'DTP01' => ["096", "193", "194", "198", "290", "291", "292", "295", "304", "307", "318", "346", "348", "349", "356", "357", "435", "472", "636", "771"],
+                  'DTP02' => ["D8", "RD8"]
+                }
+
+      #Subscriber Request Validation
+      segment Hippo_eyeDoc::Segments::AAA,
+                :name           => 'Subscriber Request Validation',
+                :minimum        => 0,
+                :maximum        => 9,
+                :position       => 1600,
+                :identified_by => {
+                  'AAA01' => ["N", "Y"],
+                  'AAA03' => ["15", "33", "52", "53", "54", "55", "56", "57", "60", "61", "62", "63", "69", "70", "98", "AA", "AE", "AF", "AG", "AO", "CI", "E8", "IA", "MA"],
+                  'AAA04' => ["C", "N", "R", "W", "X", "Y"]
+                }
+
+      #Message Text
+      segment Hippo_eyeDoc::Segments::MSG,
+                :name           => 'Message Text',
+                :minimum        => 0,
+                :maximum        => 10,
+                :position       => 1700
+
+      #Subscriber Eligibility or Benefit Additional Information
+      loop    Hippo_eyeDoc::TransactionSets::HIPAA_271::L2115C,
+                :name           => 'Subscriber Eligibility or Benefit Additional Information',
+                :minimum        => 0,
+                :maximum        => 10,
+                :position       => 1710
+
+      #Loop Header
+      segment Hippo_eyeDoc::Segments::LS,
+                :name           => 'Loop Header',
+                :minimum        => 0,
+                :maximum        => 1,
+                :position       => 1780
+
+      #Subscriber Benefit Related Entity Name
+      loop    Hippo_eyeDoc::TransactionSets::HIPAA_271::L2120C,
+                :name           => 'Subscriber Benefit Related Entity Name',
+                :minimum        => 0,
+                :maximum        => 23,
+                :position       => 1800,
+                :identified_by => {
+                  'NM1.NM101' => ["13", "1I", "1P", "2B", "36", "73", "FA", "GP", "GW", "I3", "IL", "LR", "OC", "P3", "P4", "P5", "PR", "PRP", "SEP", "TTP", "VER", "VN", "VY", "X3", "Y2"],
+                  'NM1.NM102' => ["1", "2"]
+                }
+
+      #Loop Trailer
+      segment Hippo_eyeDoc::Segments::LE,
+                :name           => 'Loop Trailer',
+                :minimum        => 0,
+                :maximum        => 1,
+                :position       => 2250
+
+    end
+  end
+end

data/lib/hippo_eyeDoc/transaction_sets/HIPAA_271/L2110D.rb

@@ -0,0 +1,98 @@
+module Hippo_eyeDoc::TransactionSets
+  module HIPAA_271
+
+    class L2110D < Hippo_eyeDoc::TransactionSets::Base
+      loop_name 'L2110D'    #Dependent Eligibility or Benefit Information
+
+      #Dependent Eligibility or Benefit Information
+      segment Hippo_eyeDoc::Segments::EB,
+                :name           => 'Dependent Eligibility or Benefit Information',
+                :minimum        => 0,
+                :maximum        => 1,
+                :position       => 1300,
+                :identified_by => {
+                  'EB01' => ["1", "2", "3", "4", "5", "6", "7", "8", "A", "B", "C", "CB", "D", "E", "F", "G", "H", "I", "J", "K", "L", "M", "MC", "N", "O", "P", "Q", "R", "S", "T", "U", "V", "W", "X", "Y"]
+                }
+
+      #Health Care Services Delivery
+      segment Hippo_eyeDoc::Segments::HSD,
+                :name           => 'Health Care Services Delivery',
+                :minimum        => 0,
+                :maximum        => 9,
+                :position       => 1350
+
+      #Dependent Additional Identification
+      segment Hippo_eyeDoc::Segments::REF,
+                :name           => 'Dependent Additional Identification',
+                :minimum        => 0,
+                :maximum        => 9,
+                :position       => 1400,
+                :identified_by => {
+                  'REF01' => ["18", "1L", "1W", "49", "6P", "9F", "ALS", "CLI", "F6", "FO", "G1", "IG", "N6", "NQ"]
+                }
+
+      #Dependent Eligibility/Benefit Date
+      segment Hippo_eyeDoc::Segments::DTP,
+                :name           => 'Dependent Eligibility/Benefit Date',
+                :minimum        => 0,
+                :maximum        => 20,
+                :position       => 1500,
+                :identified_by => {
+                  'DTP01' => ["096", "193", "194", "198", "290", "291", "292", "295", "304", "307", "318", "346", "348", "349", "356", "357", "435", "472", "636", "771"],
+                  'DTP02' => ["D8", "RD8"]
+                }
+
+      #Dependent Request Validation
+      segment Hippo_eyeDoc::Segments::AAA,
+                :name           => 'Dependent Request Validation',
+                :minimum        => 0,
+                :maximum        => 9,
+                :position       => 1600,
+                :identified_by => {
+                  'AAA01' => ["N", "Y"],
+                  'AAA03' => ["15", "33", "52", "53", "54", "55", "56", "57", "60", "61", "62", "63", "69", "70", "98", "AA", "AE", "AF", "AG", "AO", "CI", "E8", "IA", "MA"],
+                  'AAA04' => ["C", "N", "R", "W", "X", "Y"]
+                }
+
+      #Message Text
+      segment Hippo_eyeDoc::Segments::MSG,
+                :name           => 'Message Text',
+                :minimum        => 0,
+                :maximum        => 10,
+                :position       => 1700
+
+      #Dependent Eligibility or Benefit Additional Information
+      loop    Hippo_eyeDoc::TransactionSets::HIPAA_271::L2115D,
+                :name           => 'Dependent Eligibility or Benefit Additional Information',
+                :minimum        => 0,
+                :maximum        => 10,
+                :position       => 1710
+
+      #Loop Header
+      segment Hippo_eyeDoc::Segments::LS,
+                :name           => 'Loop Header',
+                :minimum        => 0,
+                :maximum        => 1,
+                :position       => 1780
+
+      #Dependent Benefit Related Entity Name
+      loop    Hippo_eyeDoc::TransactionSets::HIPAA_271::L2120D,
+                :name           => 'Dependent Benefit Related Entity Name',
+                :minimum        => 0,
+                :maximum        => 23,
+                :position       => 1800,
+                :identified_by => {
+                  'NM1.NM101' => ["13", "1I", "1P", "2B", "36", "73", "FA", "GP", "GW", "I3", "IL", "LR", "OC", "P3", "P4", "P5", "PR", "PRP", "SEP", "TTP", "VER", "VN", "VY", "X3", "Y2"],
+                  'NM1.NM102' => ["1", "2"]
+                }
+
+      #Loop Trailer
+      segment Hippo_eyeDoc::Segments::LE,
+                :name           => 'Loop Trailer',
+                :minimum        => 0,
+                :maximum        => 1,
+                :position       => 2250
+
+    end
+  end
+end

data/lib/hippo_eyeDoc/transaction_sets/HIPAA_271/L2115C.rb

@@ -0,0 +1,16 @@
+module Hippo_eyeDoc::TransactionSets
+  module HIPAA_271
+
+    class L2115C < Hippo_eyeDoc::TransactionSets::Base
+      loop_name 'L2115C'    #Subscriber Eligibility or Benefit Additional Information
+
+      #Subscriber Eligibility or Benefit Additional Information
+      segment Hippo_eyeDoc::Segments::III,
+                :name           => 'Subscriber Eligibility or Benefit Additional Information',
+                :minimum        => 0,
+                :maximum        => 1,
+                :position       => 1710
+
+    end
+  end
+end

data/lib/hippo_eyeDoc/transaction_sets/HIPAA_271/L2115D.rb

@@ -0,0 +1,16 @@
+module Hippo_eyeDoc::TransactionSets
+  module HIPAA_271
+
+    class L2115D < Hippo_eyeDoc::TransactionSets::Base
+      loop_name 'L2115D'    #Dependent Eligibility or Benefit Additional Information
+
+      #Dependent Eligibility or Benefit Additional Information
+      segment Hippo_eyeDoc::Segments::III,
+                :name           => 'Dependent Eligibility or Benefit Additional Information',
+                :minimum        => 0,
+                :maximum        => 1,
+                :position       => 1710
+
+    end
+  end
+end

data/lib/hippo_eyeDoc/transaction_sets/HIPAA_271/L2120C.rb

@@ -0,0 +1,54 @@
+module Hippo_eyeDoc::TransactionSets
+  module HIPAA_271
+
+    class L2120C < Hippo_eyeDoc::TransactionSets::Base
+      loop_name 'L2120C'    #Subscriber Benefit Related Entity Name
+
+      #Subscriber Benefit Related Entity Name
+      segment Hippo_eyeDoc::Segments::NM1,
+                :name           => 'Subscriber Benefit Related Entity Name',
+                :minimum        => 0,
+                :maximum        => 1,
+                :position       => 1800,
+                :identified_by => {
+                  'NM101' => ["13", "1I", "1P", "2B", "36", "73", "FA", "GP", "GW", "I3", "IL", "LR", "OC", "P3", "P4", "P5", "PR", "PRP", "SEP", "TTP", "VER", "VN", "VY", "X3", "Y2"],
+                  'NM102' => ["1", "2"]
+                }
+
+      #Subscriber Benefit Related Entity Address
+      segment Hippo_eyeDoc::Segments::N3,
+                :name           => 'Subscriber Benefit Related Entity Address',
+                :minimum        => 0,
+                :maximum        => 1,
+                :position       => 2000
+
+      #Subscriber Benefit Related Entity City, State, ZIP Code
+      segment Hippo_eyeDoc::Segments::N4,
+                :name           => 'Subscriber Benefit Related Entity City, State, ZIP Code',
+                :minimum        => 0,
+                :maximum        => 1,
+                :position       => 2100
+
+      #Subscriber Benefit Related Entity Contact Information
+      segment Hippo_eyeDoc::Segments::PER,
+                :name           => 'Subscriber Benefit Related Entity Contact Information',
+                :minimum        => 0,
+                :maximum        => 3,
+                :position       => 2200,
+                :identified_by => {
+                  'PER01' => 'IC'
+                }
+
+      #Subscriber Benefit Related Provider Information
+      segment Hippo_eyeDoc::Segments::PRV,
+                :name           => 'Subscriber Benefit Related Provider Information',
+                :minimum        => 0,
+                :maximum        => 1,
+                :position       => 2230,
+                :identified_by => {
+                  'PRV01' => ["AD", "AT", "BI", "CO", "CV", "H", "HH", "LA", "OT", "P1", "P2", "PC", "PE", "R", "RF", "SB", "SK", "SU"]
+                }
+
+    end
+  end
+end

data/lib/hippo_eyeDoc/transaction_sets/HIPAA_271/L2120D.rb

@@ -0,0 +1,54 @@
+module Hippo_eyeDoc::TransactionSets
+  module HIPAA_271
+
+    class L2120D < Hippo_eyeDoc::TransactionSets::Base
+      loop_name 'L2120D'    #Dependent Benefit Related Entity Name
+
+      #Dependent Benefit Related Entity Name
+      segment Hippo_eyeDoc::Segments::NM1,
+                :name           => 'Dependent Benefit Related Entity Name',
+                :minimum        => 0,
+                :maximum        => 1,
+                :position       => 1800,
+                :identified_by => {
+                  'NM101' => ["13", "1I", "1P", "2B", "36", "73", "FA", "GP", "GW", "I3", "IL", "LR", "OC", "P3", "P4", "P5", "PR", "PRP", "SEP", "TTP", "VER", "VN", "VY", "X3", "Y2"],
+                  'NM102' => ["1", "2"]
+                }
+
+      #Dependent Benefit Related Entity Address
+      segment Hippo_eyeDoc::Segments::N3,
+                :name           => 'Dependent Benefit Related Entity Address',
+                :minimum        => 0,
+                :maximum        => 1,
+                :position       => 2000
+
+      #Dependent Benefit Related Entity City, State, ZIP Code
+      segment Hippo_eyeDoc::Segments::N4,
+                :name           => 'Dependent Benefit Related Entity City, State, ZIP Code',
+                :minimum        => 0,
+                :maximum        => 1,
+                :position       => 2100
+
+      #Dependent Benefit Related Entity Contact Information
+      segment Hippo_eyeDoc::Segments::PER,
+                :name           => 'Dependent Benefit Related Entity Contact Information',
+                :minimum        => 0,
+                :maximum        => 3,
+                :position       => 2200,
+                :identified_by => {
+                  'PER01' => 'IC'
+                }
+
+      #Dependent Benefit Related Provider Information
+      segment Hippo_eyeDoc::Segments::PRV,
+                :name           => 'Dependent Benefit Related Provider Information',
+                :minimum        => 0,
+                :maximum        => 1,
+                :position       => 2230,
+                :identified_by => {
+                  'PRV01' => ["AD", "AT", "BI", "CO", "CV", "H", "HH", "LA", "OT", "P1", "P2", "PC", "PE", "R", "RF", "SB", "SK", "SU"]
+                }
+
+    end
+  end
+end