hippo_eyeDoc 0.0.1

data/lib/hippo_eyeDoc/transaction_sets/HIPAA_837/L1000A.rb

@@ -0,0 +1,32 @@
+module Hippo_eyeDoc::TransactionSets
+  module HIPAA_837
+
+    class L1000A < Hippo_eyeDoc::TransactionSets::Base
+      loop_name 'L1000A'    #Submitter Name
+
+      #Submitter Name
+      segment Hippo_eyeDoc::Segments::NM1,
+                :name           => 'Submitter Name',
+                :minimum        => 1,
+                :maximum        => 1,
+                :position       => 200,
+                :identified_by => {
+                  'NM101' => '41',
+                  'NM102' => ["1", "2"],
+                  'NM108' => '46'
+                }
+
+      #Submitter EDI Contact Information
+      segment Hippo_eyeDoc::Segments::PER,
+                :name           => 'Submitter EDI Contact Information',
+                :minimum        => 1,
+                :maximum        => 2,
+                :position       => 450,
+                :identified_by => {
+                  'PER01' => 'IC',
+                  'PER03' => ["EM", "FX", "TE"]
+                }
+
+    end
+  end
+end

data/lib/hippo_eyeDoc/transaction_sets/HIPAA_837/L1000B.rb

@@ -0,0 +1,21 @@
+module Hippo_eyeDoc::TransactionSets
+  module HIPAA_837
+
+    class L1000B < Hippo_eyeDoc::TransactionSets::Base
+      loop_name 'L1000B'    #Receiver Name
+
+      #Receiver Name
+      segment Hippo_eyeDoc::Segments::NM1,
+                :name           => 'Receiver Name',
+                :minimum        => 1,
+                :maximum        => 1,
+                :position       => 500,
+                :identified_by => {
+                  'NM101' => '40',
+                  'NM102' => '2',
+                  'NM108' => '46'
+                }
+
+    end
+  end
+end

data/lib/hippo_eyeDoc/transaction_sets/HIPAA_837/L2000A.rb

@@ -0,0 +1,88 @@
+module Hippo_eyeDoc::TransactionSets
+  module HIPAA_837
+
+    class L2000A < Hippo_eyeDoc::TransactionSets::Base
+      include Hippo_eyeDoc::Outputters::PaperClaim
+
+      loop_name 'L2000A'    #Billing Provider Hierarchical Level
+
+      #Billing Provider Hierarchical Level
+      segment Hippo_eyeDoc::Segments::HL,
+                :name           => 'Billing Provider Hierarchical Level',
+                :minimum        => 1,
+                :maximum        => 1,
+                :position       => 10,
+                :identified_by => {
+                  'HL03' => '20',
+                  'HL04' => '1'
+                }
+
+      #Billing Provider Specialty Information
+      segment Hippo_eyeDoc::Segments::PRV,
+                :name           => 'Billing Provider Specialty Information',
+                :minimum        => 0,
+                :maximum        => 1,
+                :position       => 30,
+                :identified_by => {
+                  'PRV01' => 'BI',
+                  'PRV02' => 'PXC'
+                }
+
+      #Foreign Currency Information
+      segment Hippo_eyeDoc::Segments::CUR,
+                :name           => 'Foreign Currency Information',
+                :minimum        => 0,
+                :maximum        => 1,
+                :position       => 100,
+                :identified_by => {
+                  'CUR01' => '85'
+                }
+
+      #Billing Provider Name
+      loop    Hippo_eyeDoc::TransactionSets::HIPAA_837::L2010AA,
+                :name           => 'Billing Provider Name',
+                :minimum        => 1,
+                :maximum        => 1,
+                :position       => 150,
+                :identified_by => {
+                  'NM1.NM101' => '85',
+                  'NM1.NM102' => ["1", "2"]
+                }
+
+      #Pay-to Address Name
+      loop    Hippo_eyeDoc::TransactionSets::HIPAA_837::L2010AB,
+                :name           => 'Pay-to Address Name',
+                :minimum        => 0,
+                :maximum        => 1,
+                :position       => 150,
+                :identified_by => {
+                  'NM1.NM101' => '87',
+                  'NM1.NM102' => ["1", "2"]
+                }
+
+      #Pay-To Plan Name
+      loop    Hippo_eyeDoc::TransactionSets::HIPAA_837::L2010AC,
+                :name           => 'Pay-To Plan Name',
+                :minimum        => 0,
+                :maximum        => 1,
+                :position       => 450,
+                :identified_by => {
+                  'NM1.NM101' => 'PE',
+                  'NM1.NM102' => '2',
+                  'NM1.NM108' => ["PI", "XV"]
+                }
+
+      #Subscriber Hierarchical Level
+      loop    Hippo_eyeDoc::TransactionSets::HIPAA_837::L2000B,
+                :name           => 'Subscriber Hierarchical Level',
+                :minimum        => 1,
+                :maximum        => 99999,
+                :position       => 10,
+                :identified_by => {
+                  'HL.HL03' => '22',
+                  'HL.HL04' => ["0", "1"]
+                }
+
+    end
+  end
+end

data/lib/hippo_eyeDoc/transaction_sets/HIPAA_837/L2000B.rb

@@ -0,0 +1,87 @@
+module Hippo_eyeDoc::TransactionSets
+  module HIPAA_837
+
+    class L2000B < Hippo_eyeDoc::TransactionSets::Base
+      loop_name 'L2000B'    #Subscriber Hierarchical Level
+
+      #Subscriber Hierarchical Level
+      segment Hippo_eyeDoc::Segments::HL,
+                :name           => 'Subscriber Hierarchical Level',
+                :minimum        => 1,
+                :maximum        => 1,
+                :position       => 10,
+                :identified_by => {
+                  'HL03' => '22',
+                  'HL04' => ["0", "1"]
+                }
+
+      #Subscriber Information
+      segment Hippo_eyeDoc::Segments::SBR,
+                :name           => 'Subscriber Information',
+                :minimum        => 1,
+                :maximum        => 1,
+                :position       => 50,
+                :identified_by => {
+                  'SBR01' => ["A", "B", "C", "D", "E", "F", "G", "H", "P", "S", "T", "U"]
+                }
+
+      #Patient Information
+      segment Hippo_eyeDoc::Segments::PAT,
+                :name           => 'Patient Information',
+                :minimum        => 0,
+                :maximum        => 1,
+                :position       => 70
+
+      #Subscriber Name
+      loop    Hippo_eyeDoc::TransactionSets::HIPAA_837::L2010BA,
+                :name           => 'Subscriber Name',
+                :minimum        => 1,
+                :maximum        => 1,
+                :position       => 150,
+                :identified_by => {
+                  'NM1.NM101' => 'IL',
+                  'NM1.NM102' => ["1", "2"]
+                }
+
+      #Payer Name
+      loop    Hippo_eyeDoc::TransactionSets::HIPAA_837::L2010BB,
+                :name           => 'Payer Name',
+                :minimum        => 1,
+                :maximum        => 1,
+                :position       => 150,
+                :identified_by => {
+                  'NM1.NM101' => 'PR',
+                  'NM1.NM102' => '2',
+                  'NM1.NM108' => ["PI", "XV"]
+                }
+
+      #Claim Information
+      loop    Hippo_eyeDoc::TransactionSets::HIPAA_837::L2300,
+                :name           => 'Claim Information',
+                :minimum        => 1,
+                :maximum        => 100,
+                :position       => 1300,
+                :identified_by => {
+                  'CLM.CLM06' => ["N", "Y"],
+                  'CLM.CLM07' => ["A", "B", "C"],
+                  'CLM.CLM08' => ["N", "W", "Y"],
+                  'CLM.CLM09' => ["I", "Y"]
+                },
+                :parent_context_conditions => {
+                  'HL.HL04' => '0'
+                }
+
+      #Patient Hierarchical Level
+      loop    Hippo_eyeDoc::TransactionSets::HIPAA_837::L2000C,
+                :name           => 'Patient Hierarchical Level',
+                :minimum        => 0,
+                :maximum        => 99999,
+                :position       => 10,
+                :identified_by => {
+                  'HL.HL03' => '23',
+                  'HL.HL04' => '0'
+                }
+
+    end
+  end
+end

data/lib/hippo_eyeDoc/transaction_sets/HIPAA_837/L2000C.rb

@@ -0,0 +1,54 @@
+module Hippo_eyeDoc::TransactionSets
+  module HIPAA_837
+
+    class L2000C < Hippo_eyeDoc::TransactionSets::Base
+      loop_name 'L2000C'    #Patient Hierarchical Level
+
+      #Patient Hierarchical Level
+      segment Hippo_eyeDoc::Segments::HL,
+                :name           => 'Patient Hierarchical Level',
+                :minimum        => 0,
+                :maximum        => 1,
+                :position       => 10,
+                :identified_by => {
+                  'HL03' => '23',
+                  'HL04' => '0'
+                }
+
+      #Patient Information
+      segment Hippo_eyeDoc::Segments::PAT,
+                :name           => 'Patient Information',
+                :minimum        => 1,
+                :maximum        => 1,
+                :position       => 70,
+                :identified_by => {
+                  'PAT01' => ["01", "19", "20", "21", "39", "40", "53", "G8"]
+                }
+
+      #Patient Name
+      loop    Hippo_eyeDoc::TransactionSets::HIPAA_837::L2010CA,
+                :name           => 'Patient Name',
+                :minimum        => 1,
+                :maximum        => 1,
+                :position       => 150,
+                :identified_by => {
+                  'NM1.NM101' => 'QC',
+                  'NM1.NM102' => '1'
+                }
+
+      #Claim Information
+      loop    Hippo_eyeDoc::TransactionSets::HIPAA_837::L2300,
+                :name           => 'Claim Information',
+                :minimum        => 1,
+                :maximum        => 100,
+                :position       => 1300,
+                :identified_by => {
+                  'CLM.CLM06' => ["N", "Y"],
+                  'CLM.CLM07' => ["A", "B", "C"],
+                  'CLM.CLM08' => ["N", "W", "Y"],
+                  'CLM.CLM09' => ["I", "Y"]
+                }
+
+    end
+  end
+end

data/lib/hippo_eyeDoc/transaction_sets/HIPAA_837/L2010AA.rb

@@ -0,0 +1,65 @@
+module Hippo_eyeDoc::TransactionSets
+  module HIPAA_837
+
+    class L2010AA < Hippo_eyeDoc::TransactionSets::Base
+      loop_name 'L2010AA'    #Billing Provider Name
+
+      #Billing Provider Name
+      segment Hippo_eyeDoc::Segments::NM1,
+                :name           => 'Billing Provider Name',
+                :minimum        => 1,
+                :maximum        => 1,
+                :position       => 150,
+                :identified_by => {
+                  'NM101' => '85',
+                  'NM102' => ["1", "2"]
+                }
+
+      #Billing Provider Address
+      segment Hippo_eyeDoc::Segments::N3,
+                :name           => 'Billing Provider Address',
+                :minimum        => 1,
+                :maximum        => 1,
+                :position       => 250
+
+      #Billing Provider City, State, ZIP Code
+      segment Hippo_eyeDoc::Segments::N4,
+                :name           => 'Billing Provider City, State, ZIP Code',
+                :minimum        => 1,
+                :maximum        => 1,
+                :position       => 300
+
+      #Billing Provider Tax Identification
+      segment Hippo_eyeDoc::Segments::REF,
+                :name           => 'Billing Provider Tax Identification',
+                :minimum        => 1,
+                :maximum        => 1,
+                :position       => 350,
+                :identified_by => {
+                  'REF01' => ["EI", "SY"]
+                }
+
+      #Billing Provider UPIN/License Information
+      segment Hippo_eyeDoc::Segments::REF,
+                :name           => 'Billing Provider UPIN/License Information',
+                :minimum        => 0,
+                :maximum        => 2,
+                :position       => 360,
+                :identified_by => {
+                  'REF01' => ["0B", "1G"]
+                }
+
+      #Billing Provider Contact Information
+      segment Hippo_eyeDoc::Segments::PER,
+                :name           => 'Billing Provider Contact Information',
+                :minimum        => 0,
+                :maximum        => 2,
+                :position       => 400,
+                :identified_by => {
+                  'PER01' => 'IC',
+                  'PER03' => ["EM", "FX", "TE"]
+                }
+
+    end
+  end
+end

data/lib/hippo_eyeDoc/transaction_sets/HIPAA_837/L2010AB.rb

@@ -0,0 +1,34 @@
+module Hippo_eyeDoc::TransactionSets
+  module HIPAA_837
+
+    class L2010AB < Hippo_eyeDoc::TransactionSets::Base
+      loop_name 'L2010AB'    #Pay-to Address Name
+
+      #Pay-to Address Name
+      segment Hippo_eyeDoc::Segments::NM1,
+                :name           => 'Pay-to Address Name',
+                :minimum        => 0,
+                :maximum        => 1,
+                :position       => 150,
+                :identified_by => {
+                  'NM101' => '87',
+                  'NM102' => ["1", "2"]
+                }
+
+      #Pay-to Address - ADDRESS
+      segment Hippo_eyeDoc::Segments::N3,
+                :name           => 'Pay-to Address - ADDRESS',
+                :minimum        => 1,
+                :maximum        => 1,
+                :position       => 250
+
+      #Pay-To Address City, State, ZIP Code
+      segment Hippo_eyeDoc::Segments::N4,
+                :name           => 'Pay-To Address City, State, ZIP Code',
+                :minimum        => 1,
+                :maximum        => 1,
+                :position       => 300
+
+    end
+  end
+end

data/lib/hippo_eyeDoc/transaction_sets/HIPAA_837/L2010AC.rb

@@ -0,0 +1,55 @@
+module Hippo_eyeDoc::TransactionSets
+  module HIPAA_837
+
+    class L2010AC < Hippo_eyeDoc::TransactionSets::Base
+      loop_name 'L2010AC'    #Pay-To Plan Name
+
+      #Pay-To Plan Name
+      segment Hippo_eyeDoc::Segments::NM1,
+                :name           => 'Pay-To Plan Name',
+                :minimum        => 0,
+                :maximum        => 1,
+                :position       => 450,
+                :identified_by => {
+                  'NM101' => 'PE',
+                  'NM102' => '2',
+                  'NM108' => ["PI", "XV"]
+                }
+
+      #Pay-to Plan Address
+      segment Hippo_eyeDoc::Segments::N3,
+                :name           => 'Pay-to Plan Address',
+                :minimum        => 1,
+                :maximum        => 1,
+                :position       => 550
+
+      #Pay-To Plan City, State, ZIP Code
+      segment Hippo_eyeDoc::Segments::N4,
+                :name           => 'Pay-To Plan City, State, ZIP Code',
+                :minimum        => 1,
+                :maximum        => 1,
+                :position       => 600
+
+      #Pay-to Plan Secondary Identification
+      segment Hippo_eyeDoc::Segments::REF,
+                :name           => 'Pay-to Plan Secondary Identification',
+                :minimum        => 0,
+                :maximum        => 1,
+                :position       => 650,
+                :identified_by => {
+                  'REF01' => ["2U", "FY", "NF"]
+                }
+
+      #Pay-To Plan Tax Identification Number
+      segment Hippo_eyeDoc::Segments::REF,
+                :name           => 'Pay-To Plan Tax Identification Number',
+                :minimum        => 1,
+                :maximum        => 1,
+                :position       => 655,
+                :identified_by => {
+                  'REF01' => 'EI'
+                }
+
+    end
+  end
+end