hippo_eyeDoc 0.0.1

data/lib/hippo_eyeDoc/transaction_sets/HIPAA_277/L2000D.rb

@@ -0,0 +1,41 @@
+module Hippo_eyeDoc::TransactionSets
+  module HIPAA_277
+
+    class L2000D < Hippo_eyeDoc::TransactionSets::Base
+      loop_name 'L2000D'    #Patient Level
+
+      #Patient Level
+      segment Hippo_eyeDoc::Segments::HL,
+                :name           => 'Patient Level',
+                :minimum        => 0,
+                :maximum        => 1,
+                :position       => 100,
+                :identified_by => {
+                  'HL03' => 'PT'
+                }
+
+      #Patient Name
+      loop    Hippo_eyeDoc::TransactionSets::HIPAA_277::L2100D,
+                :name           => 'Patient Name',
+                :minimum        => 1,
+                :maximum        => 1,
+                :position       => 500,
+                :identified_by => {
+                  'NM1.NM101' => 'QC',
+                  'NM1.NM102' => '1',
+                  'NM1.NM108' => ["II", "MI"]
+                }
+
+      #Claim Status Tracking Number
+      loop    Hippo_eyeDoc::TransactionSets::HIPAA_277::L2200D,
+                :name           => 'Claim Status Tracking Number',
+                :minimum        => 1,
+                :maximum        => 99999,
+                :position       => 900,
+                :identified_by => {
+                  'TRN.TRN01' => '2'
+                }
+
+    end
+  end
+end

data/lib/hippo_eyeDoc/transaction_sets/HIPAA_277/L2000E.rb

@@ -0,0 +1,40 @@
+module Hippo_eyeDoc::TransactionSets
+  module HIPAA_277
+
+    class L2000E < Hippo_eyeDoc::TransactionSets::Base
+      loop_name 'L2000E'    #Dependent Level
+
+      #Dependent Level
+      segment Hippo_eyeDoc::Segments::HL,
+                :name           => 'Dependent Level',
+                :minimum        => 0,
+                :maximum        => 1,
+                :position       => 100,
+                :identified_by => {
+                  'HL03' => '23'
+                }
+
+      #Dependent Name
+      loop    Hippo_eyeDoc::TransactionSets::HIPAA_277::L2100E,
+                :name           => 'Dependent Name',
+                :minimum        => 1,
+                :maximum        => 1,
+                :position       => 500,
+                :identified_by => {
+                  'NM1.NM101' => 'QC',
+                  'NM1.NM102' => '1'
+                }
+
+      #Claim Status Tracking Number
+      loop    Hippo_eyeDoc::TransactionSets::HIPAA_277::L2200E,
+                :name           => 'Claim Status Tracking Number',
+                :minimum        => 1,
+                :maximum        => 99999,
+                :position       => 900,
+                :identified_by => {
+                  'TRN.TRN01' => '2'
+                }
+
+    end
+  end
+end

data/lib/hippo_eyeDoc/transaction_sets/HIPAA_277/L2100A.rb

@@ -0,0 +1,21 @@
+module Hippo_eyeDoc::TransactionSets
+  module HIPAA_277
+
+    class L2100A < Hippo_eyeDoc::TransactionSets::Base
+      loop_name 'L2100A'    #Information Source Name
+
+      #Information Source Name
+      segment Hippo_eyeDoc::Segments::NM1,
+                :name           => 'Information Source Name',
+                :minimum        => 1,
+                :maximum        => 1,
+                :position       => 500,
+                :identified_by => {
+                  'NM101' => ["AY", "PR"],
+                  'NM102' => '2',
+                  'NM108' => ["46", "FI", "PI", "XV"]
+                }
+
+    end
+  end
+end

data/lib/hippo_eyeDoc/transaction_sets/HIPAA_277/L2100B.rb

@@ -0,0 +1,21 @@
+module Hippo_eyeDoc::TransactionSets
+  module HIPAA_277
+
+    class L2100B < Hippo_eyeDoc::TransactionSets::Base
+      loop_name 'L2100B'    #Information Receiver Name
+
+      #Information Receiver Name
+      segment Hippo_eyeDoc::Segments::NM1,
+                :name           => 'Information Receiver Name',
+                :minimum        => 1,
+                :maximum        => 1,
+                :position       => 500,
+                :identified_by => {
+                  'NM101' => '41',
+                  'NM102' => ["1", "2"],
+                  'NM108' => '46'
+                }
+
+    end
+  end
+end

data/lib/hippo_eyeDoc/transaction_sets/HIPAA_277/L2100C.rb

@@ -0,0 +1,21 @@
+module Hippo_eyeDoc::TransactionSets
+  module HIPAA_277
+
+    class L2100C < Hippo_eyeDoc::TransactionSets::Base
+      loop_name 'L2100C'    #Billing Provider Name
+
+      #Billing Provider Name
+      segment Hippo_eyeDoc::Segments::NM1,
+                :name           => 'Billing Provider Name',
+                :minimum        => 1,
+                :maximum        => 1,
+                :position       => 500,
+                :identified_by => {
+                  'NM101' => '85',
+                  'NM102' => ["1", "2"],
+                  'NM108' => ["FI", "XX"]
+                }
+
+    end
+  end
+end

data/lib/hippo_eyeDoc/transaction_sets/HIPAA_277/L2100D.rb

@@ -0,0 +1,21 @@
+module Hippo_eyeDoc::TransactionSets
+  module HIPAA_277
+
+    class L2100D < Hippo_eyeDoc::TransactionSets::Base
+      loop_name 'L2100D'    #Patient Name
+
+      #Patient Name
+      segment Hippo_eyeDoc::Segments::NM1,
+                :name           => 'Patient Name',
+                :minimum        => 1,
+                :maximum        => 1,
+                :position       => 500,
+                :identified_by => {
+                  'NM101' => 'QC',
+                  'NM102' => '1',
+                  'NM108' => ["II", "MI"]
+                }
+
+    end
+  end
+end

data/lib/hippo_eyeDoc/transaction_sets/HIPAA_277/L2100E.rb

@@ -0,0 +1,20 @@
+module Hippo_eyeDoc::TransactionSets
+  module HIPAA_277
+
+    class L2100E < Hippo_eyeDoc::TransactionSets::Base
+      loop_name 'L2100E'    #Dependent Name
+
+      #Dependent Name
+      segment Hippo_eyeDoc::Segments::NM1,
+                :name           => 'Dependent Name',
+                :minimum        => 1,
+                :maximum        => 1,
+                :position       => 500,
+                :identified_by => {
+                  'NM101' => 'QC',
+                  'NM102' => '1'
+                }
+
+    end
+  end
+end

data/lib/hippo_eyeDoc/transaction_sets/HIPAA_277/L2200A.rb

@@ -0,0 +1,41 @@
+module Hippo_eyeDoc::TransactionSets
+  module HIPAA_277
+
+    class L2200A < Hippo_eyeDoc::TransactionSets::Base
+      loop_name 'L2200A'    #Transmission Receipt Control Identifier
+
+      #Transmission Receipt Control Identifier
+      segment Hippo_eyeDoc::Segments::TRN,
+                :name           => 'Transmission Receipt Control Identifier',
+                :minimum        => 1,
+                :maximum        => 1,
+                :position       => 900,
+                :identified_by => {
+                  'TRN01' => '1'
+                }
+
+      #Information Source Receipt Date
+      segment Hippo_eyeDoc::Segments::DTP,
+                :name           => 'Information Source Receipt Date',
+                :minimum        => 1,
+                :maximum        => 1,
+                :position       => 1200,
+                :identified_by => {
+                  'DTP01' => '050',
+                  'DTP02' => 'D8'
+                }
+
+      #Information Source Process Date
+      segment Hippo_eyeDoc::Segments::DTP,
+                :name           => 'Information Source Process Date',
+                :minimum        => 1,
+                :maximum        => 1,
+                :position       => 1205,
+                :identified_by => {
+                  'DTP01' => '009',
+                  'DTP02' => 'D8'
+                }
+
+    end
+  end
+end

data/lib/hippo_eyeDoc/transaction_sets/HIPAA_277/L2200B.rb

@@ -0,0 +1,69 @@
+module Hippo_eyeDoc::TransactionSets
+  module HIPAA_277
+
+    class L2200B < Hippo_eyeDoc::TransactionSets::Base
+      loop_name 'L2200B'    #Information Receiver Application Trace Identifier
+
+      #Information Receiver Application Trace Identifier
+      segment Hippo_eyeDoc::Segments::TRN,
+                :name           => 'Information Receiver Application Trace Identifier',
+                :minimum        => 1,
+                :maximum        => 1,
+                :position       => 900,
+                :identified_by => {
+                  'TRN01' => '2'
+                }
+
+      #Information Receiver Status Information
+      segment Hippo_eyeDoc::Segments::STC,
+                :name           => 'Information Receiver Status Information',
+                :minimum        => 1,
+                :maximum        => 99999,
+                :position       => 1000,
+                :identified_by => {
+                  'STC03' => ["U", "WQ"]
+                }
+
+      #Total Accepted Quantity
+      segment Hippo_eyeDoc::Segments::QTY,
+                :name           => 'Total Accepted Quantity',
+                :minimum        => 0,
+                :maximum        => 1,
+                :position       => 1210,
+                :identified_by => {
+                  'QTY01' => '90'
+                }
+
+      #Total Rejected Quantity
+      segment Hippo_eyeDoc::Segments::QTY,
+                :name           => 'Total Rejected Quantity',
+                :minimum        => 0,
+                :maximum        => 1,
+                :position       => 1211,
+                :identified_by => {
+                  'QTY01' => 'AA'
+                }
+
+      #Total Accepted Amount
+      segment Hippo_eyeDoc::Segments::AMT,
+                :name           => 'Total Accepted Amount',
+                :minimum        => 0,
+                :maximum        => 1,
+                :position       => 1220,
+                :identified_by => {
+                  'AMT01' => 'YU'
+                }
+
+      #Total Rejected Amount
+      segment Hippo_eyeDoc::Segments::AMT,
+                :name           => 'Total Rejected Amount',
+                :minimum        => 0,
+                :maximum        => 1,
+                :position       => 1222,
+                :identified_by => {
+                  'AMT01' => 'YY'
+                }
+
+    end
+  end
+end

data/lib/hippo_eyeDoc/transaction_sets/HIPAA_277/L2200C.rb

@@ -0,0 +1,79 @@
+module Hippo_eyeDoc::TransactionSets
+  module HIPAA_277
+
+    class L2200C < Hippo_eyeDoc::TransactionSets::Base
+      loop_name 'L2200C'    #Provider of Service Information Trace Identifier
+
+      #Provider of Service Information Trace Identifier
+      segment Hippo_eyeDoc::Segments::TRN,
+                :name           => 'Provider of Service Information Trace Identifier',
+                :minimum        => 0,
+                :maximum        => 1,
+                :position       => 900,
+                :identified_by => {
+                  'TRN01' => '1'
+                }
+
+      #Billing Provider Status Information
+      segment Hippo_eyeDoc::Segments::STC,
+                :name           => 'Billing Provider Status Information',
+                :minimum        => 0,
+                :maximum        => 99999,
+                :position       => 1000,
+                :identified_by => {
+                  'STC03' => ["U", "WQ"]
+                }
+
+      #Provider Secondary Identifier
+      segment Hippo_eyeDoc::Segments::REF,
+                :name           => 'Provider Secondary Identifier',
+                :minimum        => 0,
+                :maximum        => 3,
+                :position       => 1100,
+                :identified_by => {
+                  'REF01' => ["0B", "1G", "G2", "LU", "SY", "TJ"]
+                }
+
+      #Total Accepted Quantity
+      segment Hippo_eyeDoc::Segments::QTY,
+                :name           => 'Total Accepted Quantity',
+                :minimum        => 0,
+                :maximum        => 1,
+                :position       => 1210,
+                :identified_by => {
+                  'QTY01' => 'QA'
+                }
+
+      #Total Rejected Quantity
+      segment Hippo_eyeDoc::Segments::QTY,
+                :name           => 'Total Rejected Quantity',
+                :minimum        => 0,
+                :maximum        => 1,
+                :position       => 1215,
+                :identified_by => {
+                  'QTY01' => 'QC'
+                }
+
+      #Total Accepted Amount
+      segment Hippo_eyeDoc::Segments::AMT,
+                :name           => 'Total Accepted Amount',
+                :minimum        => 0,
+                :maximum        => 1,
+                :position       => 1220,
+                :identified_by => {
+                  'AMT01' => 'YU'
+                }
+
+      #Total Rejected Amount
+      segment Hippo_eyeDoc::Segments::AMT,
+                :name           => 'Total Rejected Amount',
+                :minimum        => 0,
+                :maximum        => 1,
+                :position       => 1225,
+                :identified_by => {
+                  'AMT01' => 'YY'
+                }
+
+    end
+  end
+end

data/lib/hippo_eyeDoc/transaction_sets/HIPAA_277/L2200D.rb

@@ -0,0 +1,77 @@
+module Hippo_eyeDoc::TransactionSets
+  module HIPAA_277
+
+    class L2200D < Hippo_eyeDoc::TransactionSets::Base
+      loop_name 'L2200D'    #Claim Status Tracking Number
+
+      #Claim Status Tracking Number
+      segment Hippo_eyeDoc::Segments::TRN,
+                :name           => 'Claim Status Tracking Number',
+                :minimum        => 1,
+                :maximum        => 1,
+                :position       => 900,
+                :identified_by => {
+                  'TRN01' => '2'
+                }
+
+      #Claim Level Status Information
+      segment Hippo_eyeDoc::Segments::STC,
+                :name           => 'Claim Level Status Information',
+                :minimum        => 1,
+                :maximum        => 99999,
+                :position       => 1000,
+                :identified_by => {
+                  'STC03' => ["U", "WQ"]
+                }
+
+      #Payer Claim Control Number
+      segment Hippo_eyeDoc::Segments::REF,
+                :name           => 'Payer Claim Control Number',
+                :minimum        => 0,
+                :maximum        => 1,
+                :position       => 1100,
+                :identified_by => {
+                  'REF01' => '1K'
+                }
+
+      #Claim Identifier Number For Clearinghouse and Other Transmission Intermediaries
+      segment Hippo_eyeDoc::Segments::REF,
+                :name           => 'Claim Identifier Number For Clearinghouse and Other Transmission Intermediaries',
+                :minimum        => 0,
+                :maximum        => 1,
+                :position       => 1110,
+                :identified_by => {
+                  'REF01' => 'D9'
+                }
+
+      #Institutional Bill Type Identification
+      segment Hippo_eyeDoc::Segments::REF,
+                :name           => 'Institutional Bill Type Identification',
+                :minimum        => 0,
+                :maximum        => 1,
+                :position       => 1120,
+                :identified_by => {
+                  'REF01' => 'BLT'
+                }
+
+      #Claim Level Service Date
+      segment Hippo_eyeDoc::Segments::DTP,
+                :name           => 'Claim Level Service Date',
+                :minimum        => 1,
+                :maximum        => 1,
+                :position       => 1200,
+                :identified_by => {
+                  'DTP01' => '472',
+                  'DTP02' => ["D8", "RD8"]
+                }
+
+      #Service Line Information
+      loop    Hippo_eyeDoc::TransactionSets::HIPAA_277::L2220D,
+                :name           => 'Service Line Information',
+                :minimum        => 0,
+                :maximum        => 99999,
+                :position       => 1800
+
+    end
+  end
+end