hippo_eyeDoc 0.0.1

data/lib/hippo_eyeDoc/transaction_sets/HIPAA_837/L2310A.rb

@@ -0,0 +1,30 @@
+module Hippo_eyeDoc::TransactionSets
+  module HIPAA_837
+
+    class L2310A < Hippo_eyeDoc::TransactionSets::Base
+      loop_name 'L2310A'    #Referring Provider Name
+
+      #Referring Provider Name
+      segment Hippo_eyeDoc::Segments::NM1,
+                :name           => 'Referring Provider Name',
+                :minimum        => 0,
+                :maximum        => 1,
+                :position       => 2500,
+                :identified_by => {
+                  'NM101' => ["DN", "P3"],
+                  'NM102' => '1'
+                }
+
+      #Referring Provider Secondary Identification
+      segment Hippo_eyeDoc::Segments::REF,
+                :name           => 'Referring Provider Secondary Identification',
+                :minimum        => 0,
+                :maximum        => 3,
+                :position       => 2710,
+                :identified_by => {
+                  'REF01' => ["0B", "1G", "G2"]
+                }
+
+    end
+  end
+end

data/lib/hippo_eyeDoc/transaction_sets/HIPAA_837/L2310B.rb

@@ -0,0 +1,41 @@
+module Hippo_eyeDoc::TransactionSets
+  module HIPAA_837
+
+    class L2310B < Hippo_eyeDoc::TransactionSets::Base
+      loop_name 'L2310B'    #Rendering Provider Name
+
+      #Rendering Provider Name
+      segment Hippo_eyeDoc::Segments::NM1,
+                :name           => 'Rendering Provider Name',
+                :minimum        => 0,
+                :maximum        => 1,
+                :position       => 2500,
+                :identified_by => {
+                  'NM101' => '82',
+                  'NM102' => ["1", "2"]
+                }
+
+      #Rendering Provider Specialty Information
+      segment Hippo_eyeDoc::Segments::PRV,
+                :name           => 'Rendering Provider Specialty Information',
+                :minimum        => 0,
+                :maximum        => 1,
+                :position       => 2550,
+                :identified_by => {
+                  'PRV01' => 'PE',
+                  'PRV02' => 'PXC'
+                }
+
+      #Rendering Provider Secondary Identification
+      segment Hippo_eyeDoc::Segments::REF,
+                :name           => 'Rendering Provider Secondary Identification',
+                :minimum        => 0,
+                :maximum        => 4,
+                :position       => 2710,
+                :identified_by => {
+                  'REF01' => ["0B", "1G", "G2", "LU"]
+                }
+
+    end
+  end
+end

data/lib/hippo_eyeDoc/transaction_sets/HIPAA_837/L2310C.rb

@@ -0,0 +1,55 @@
+module Hippo_eyeDoc::TransactionSets
+  module HIPAA_837
+
+    class L2310C < Hippo_eyeDoc::TransactionSets::Base
+      loop_name 'L2310C'    #Service Facility Location Name
+
+      #Service Facility Location Name
+      segment Hippo_eyeDoc::Segments::NM1,
+                :name           => 'Service Facility Location Name',
+                :minimum        => 0,
+                :maximum        => 1,
+                :position       => 2500,
+                :identified_by => {
+                  'NM101' => '77',
+                  'NM102' => '2'
+                }
+
+      #Service Facility Location Address
+      segment Hippo_eyeDoc::Segments::N3,
+                :name           => 'Service Facility Location Address',
+                :minimum        => 1,
+                :maximum        => 1,
+                :position       => 2650
+
+      #Service Facility Location City, State, ZIP Code
+      segment Hippo_eyeDoc::Segments::N4,
+                :name           => 'Service Facility Location City, State, ZIP Code',
+                :minimum        => 1,
+                :maximum        => 1,
+                :position       => 2700
+
+      #Service Facility Location Secondary Identification
+      segment Hippo_eyeDoc::Segments::REF,
+                :name           => 'Service Facility Location Secondary Identification',
+                :minimum        => 0,
+                :maximum        => 3,
+                :position       => 2710,
+                :identified_by => {
+                  'REF01' => ["0B", "G2", "LU"]
+                }
+
+      #Service Facility Contact Information
+      segment Hippo_eyeDoc::Segments::PER,
+                :name           => 'Service Facility Contact Information',
+                :minimum        => 0,
+                :maximum        => 1,
+                :position       => 2750,
+                :identified_by => {
+                  'PER01' => 'IC',
+                  'PER03' => 'TE'
+                }
+
+    end
+  end
+end

data/lib/hippo_eyeDoc/transaction_sets/HIPAA_837/L2310D.rb

@@ -0,0 +1,30 @@
+module Hippo_eyeDoc::TransactionSets
+  module HIPAA_837
+
+    class L2310D < Hippo_eyeDoc::TransactionSets::Base
+      loop_name 'L2310D'    #Supervising Provider Name
+
+      #Supervising Provider Name
+      segment Hippo_eyeDoc::Segments::NM1,
+                :name           => 'Supervising Provider Name',
+                :minimum        => 0,
+                :maximum        => 1,
+                :position       => 2500,
+                :identified_by => {
+                  'NM101' => 'DQ',
+                  'NM102' => '1'
+                }
+
+      #Supervising Provider Secondary Identification
+      segment Hippo_eyeDoc::Segments::REF,
+                :name           => 'Supervising Provider Secondary Identification',
+                :minimum        => 0,
+                :maximum        => 4,
+                :position       => 2710,
+                :identified_by => {
+                  'REF01' => ["0B", "1G", "G2", "LU"]
+                }
+
+    end
+  end
+end

data/lib/hippo_eyeDoc/transaction_sets/HIPAA_837/L2310E.rb

@@ -0,0 +1,34 @@
+module Hippo_eyeDoc::TransactionSets
+  module HIPAA_837
+
+    class L2310E < Hippo_eyeDoc::TransactionSets::Base
+      loop_name 'L2310E'    #Ambulance Pick-up Location
+
+      #Ambulance Pick-up Location
+      segment Hippo_eyeDoc::Segments::NM1,
+                :name           => 'Ambulance Pick-up Location',
+                :minimum        => 0,
+                :maximum        => 1,
+                :position       => 2500,
+                :identified_by => {
+                  'NM101' => 'PW',
+                  'NM102' => '2'
+                }
+
+      #Ambulance Pick-up Location Address
+      segment Hippo_eyeDoc::Segments::N3,
+                :name           => 'Ambulance Pick-up Location Address',
+                :minimum        => 1,
+                :maximum        => 1,
+                :position       => 2650
+
+      #Ambulance Pick-up Location City, State, ZIP Code
+      segment Hippo_eyeDoc::Segments::N4,
+                :name           => 'Ambulance Pick-up Location City, State, ZIP Code',
+                :minimum        => 1,
+                :maximum        => 1,
+                :position       => 2700
+
+    end
+  end
+end

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

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

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

@@ -0,0 +1,157 @@
+module Hippo_eyeDoc::TransactionSets
+  module HIPAA_837
+
+    class L2320 < Hippo_eyeDoc::TransactionSets::Base
+      loop_name 'L2320'    #Other Subscriber Information
+
+      #Other Subscriber Information
+      segment Hippo_eyeDoc::Segments::SBR,
+                :name           => 'Other Subscriber Information',
+                :minimum        => 0,
+                :maximum        => 1,
+                :position       => 2900,
+                :identified_by => {
+                  'SBR01' => ["A", "B", "C", "D", "E", "F", "G", "H", "P", "S", "T", "U"],
+                  'SBR02' => ["01", "18", "19", "20", "21", "39", "40", "53", "G8"]
+                }
+
+      #Claim Level Adjustments
+      segment Hippo_eyeDoc::Segments::CAS,
+                :name           => 'Claim Level Adjustments',
+                :minimum        => 0,
+                :maximum        => 5,
+                :position       => 2950,
+                :identified_by => {
+                  'CAS01' => ["CO", "CR", "OA", "PI", "PR"]
+                }
+
+      #Coordination of Benefits (COB) Payer Paid Amount
+      segment Hippo_eyeDoc::Segments::AMT,
+                :name           => 'Coordination of Benefits (COB) Payer Paid Amount',
+                :minimum        => 0,
+                :maximum        => 1,
+                :position       => 3000,
+                :identified_by => {
+                  'AMT01' => 'D'
+                }
+
+      #Coordination of Benefits (COB) Total Non-Covered Amount
+      segment Hippo_eyeDoc::Segments::AMT,
+                :name           => 'Coordination of Benefits (COB) Total Non-Covered Amount',
+                :minimum        => 0,
+                :maximum        => 1,
+                :position       => 3020,
+                :identified_by => {
+                  'AMT01' => 'A8'
+                }
+
+      #Remaining Patient Liability
+      segment Hippo_eyeDoc::Segments::AMT,
+                :name           => 'Remaining Patient Liability',
+                :minimum        => 0,
+                :maximum        => 1,
+                :position       => 3050,
+                :identified_by => {
+                  'AMT01' => 'EAF'
+                }
+
+      #Other Insurance Coverage Information
+      segment Hippo_eyeDoc::Segments::OI,
+                :name           => 'Other Insurance Coverage Information',
+                :minimum        => 1,
+                :maximum        => 1,
+                :position       => 3110,
+                :identified_by => {
+                  'OI03' => ["N", "W", "Y"],
+                  'OI06' => ["I", "Y"]
+                }
+
+      #Outpatient Adjudication Information
+      segment Hippo_eyeDoc::Segments::MOA,
+                :name           => 'Outpatient Adjudication Information',
+                :minimum        => 0,
+                :maximum        => 1,
+                :position       => 3200
+
+      #Other Subscriber Name
+      loop    Hippo_eyeDoc::TransactionSets::HIPAA_837::L2330A,
+                :name           => 'Other Subscriber Name',
+                :minimum        => 1,
+                :maximum        => 1,
+                :position       => 3250,
+                :identified_by => {
+                  'NM1.NM101' => 'IL',
+                  'NM1.NM102' => ["1", "2"],
+                  'NM1.NM108' => ["II", "MI"]
+                }
+
+      #Other Payer Name
+      loop    Hippo_eyeDoc::TransactionSets::HIPAA_837::L2330B,
+                :name           => 'Other Payer Name',
+                :minimum        => 1,
+                :maximum        => 1,
+                :position       => 3250,
+                :identified_by => {
+                  'NM1.NM101' => 'PR',
+                  'NM1.NM102' => '2',
+                  'NM1.NM108' => ["PI", "XV"]
+                }
+
+      #Other Payer Referring Provider
+      loop    Hippo_eyeDoc::TransactionSets::HIPAA_837::L2330C,
+                :name           => 'Other Payer Referring Provider',
+                :minimum        => 0,
+                :maximum        => 2,
+                :position       => 3250,
+                :identified_by => {
+                  'NM1.NM101' => ["DN", "P3"],
+                  'NM1.NM102' => '1'
+                }
+
+      #Other Payer Rendering Provider
+      loop    Hippo_eyeDoc::TransactionSets::HIPAA_837::L2330D,
+                :name           => 'Other Payer Rendering Provider',
+                :minimum        => 0,
+                :maximum        => 1,
+                :position       => 3650,
+                :identified_by => {
+                  'NM1.NM101' => '82',
+                  'NM1.NM102' => ["1", "2"]
+                }
+
+      #Other Payer Service Facility Location
+      loop    Hippo_eyeDoc::TransactionSets::HIPAA_837::L2330E,
+                :name           => 'Other Payer Service Facility Location',
+                :minimum        => 0,
+                :maximum        => 1,
+                :position       => 4650,
+                :identified_by => {
+                  'NM1.NM101' => '77',
+                  'NM1.NM102' => '2'
+                }
+
+      #Other Payer Supervising Provider
+      loop    Hippo_eyeDoc::TransactionSets::HIPAA_837::L2330F,
+                :name           => 'Other Payer Supervising Provider',
+                :minimum        => 0,
+                :maximum        => 1,
+                :position       => 5650,
+                :identified_by => {
+                  'NM1.NM101' => 'DQ',
+                  'NM1.NM102' => '1'
+                }
+
+      #Other Payer Billing Provider
+      loop    Hippo_eyeDoc::TransactionSets::HIPAA_837::L2330G,
+                :name           => 'Other Payer Billing Provider',
+                :minimum        => 0,
+                :maximum        => 1,
+                :position       => 6350,
+                :identified_by => {
+                  'NM1.NM101' => '85',
+                  'NM1.NM102' => ["1", "2"]
+                }
+
+    end
+  end
+end

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

@@ -0,0 +1,45 @@
+module Hippo_eyeDoc::TransactionSets
+  module HIPAA_837
+
+    class L2330A < Hippo_eyeDoc::TransactionSets::Base
+      loop_name 'L2330A'    #Other Subscriber Name
+
+      #Other Subscriber Name
+      segment Hippo_eyeDoc::Segments::NM1,
+                :name           => 'Other Subscriber Name',
+                :minimum        => 1,
+                :maximum        => 1,
+                :position       => 3250,
+                :identified_by => {
+                  'NM101' => 'IL',
+                  'NM102' => ["1", "2"],
+                  'NM108' => ["II", "MI"]
+                }
+
+      #Other Subscriber Address
+      segment Hippo_eyeDoc::Segments::N3,
+                :name           => 'Other Subscriber Address',
+                :minimum        => 0,
+                :maximum        => 1,
+                :position       => 3320
+
+      #Other Subscriber City, State, ZIP Code
+      segment Hippo_eyeDoc::Segments::N4,
+                :name           => 'Other Subscriber City, State, ZIP Code',
+                :minimum        => 0,
+                :maximum        => 1,
+                :position       => 3400
+
+      #Other Subscriber Secondary Identification
+      segment Hippo_eyeDoc::Segments::REF,
+                :name           => 'Other Subscriber Secondary Identification',
+                :minimum        => 0,
+                :maximum        => 1,
+                :position       => 3550,
+                :identified_by => {
+                  'REF01' => 'SY'
+                }
+
+    end
+  end
+end

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

@@ -0,0 +1,96 @@
+module Hippo_eyeDoc::TransactionSets
+  module HIPAA_837
+
+    class L2330B < Hippo_eyeDoc::TransactionSets::Base
+      loop_name 'L2330B'    #Other Payer Name
+
+      #Other Payer Name
+      segment Hippo_eyeDoc::Segments::NM1,
+                :name           => 'Other Payer Name',
+                :minimum        => 1,
+                :maximum        => 1,
+                :position       => 3250,
+                :identified_by => {
+                  'NM101' => 'PR',
+                  'NM102' => '2',
+                  'NM108' => ["PI", "XV"]
+                }
+
+      #Other Payer Address
+      segment Hippo_eyeDoc::Segments::N3,
+                :name           => 'Other Payer Address',
+                :minimum        => 0,
+                :maximum        => 1,
+                :position       => 3320
+
+      #Other Payer City, State, ZIP Code
+      segment Hippo_eyeDoc::Segments::N4,
+                :name           => 'Other Payer City, State, ZIP Code',
+                :minimum        => 0,
+                :maximum        => 1,
+                :position       => 3400
+
+      #Claim Check or Remittance Date
+      segment Hippo_eyeDoc::Segments::DTP,
+                :name           => 'Claim Check or Remittance Date',
+                :minimum        => 0,
+                :maximum        => 1,
+                :position       => 3470,
+                :identified_by => {
+                  'DTP01' => '573',
+                  'DTP02' => 'D8'
+                }
+
+      #Other Payer Secondary Identifier
+      segment Hippo_eyeDoc::Segments::REF,
+                :name           => 'Other Payer Secondary Identifier',
+                :minimum        => 0,
+                :maximum        => 2,
+                :position       => 3550,
+                :identified_by => {
+                  'REF01' => ["2U", "EI", "FY", "NF"]
+                }
+
+      #Other Payer Prior Authorization Number
+      segment Hippo_eyeDoc::Segments::REF,
+                :name           => 'Other Payer Prior Authorization Number',
+                :minimum        => 0,
+                :maximum        => 1,
+                :position       => 3560,
+                :identified_by => {
+                  'REF01' => 'G1'
+                }
+
+      #Other Payer Referral Number
+      segment Hippo_eyeDoc::Segments::REF,
+                :name           => 'Other Payer Referral Number',
+                :minimum        => 0,
+                :maximum        => 1,
+                :position       => 3563,
+                :identified_by => {
+                  'REF01' => '9F'
+                }
+
+      #Other Payer Claim Adjustment Indicator
+      segment Hippo_eyeDoc::Segments::REF,
+                :name           => 'Other Payer Claim Adjustment Indicator',
+                :minimum        => 0,
+                :maximum        => 1,
+                :position       => 3570,
+                :identified_by => {
+                  'REF01' => 'T4'
+                }
+
+      #Other Payer Claim Control Number
+      segment Hippo_eyeDoc::Segments::REF,
+                :name           => 'Other Payer Claim Control Number',
+                :minimum        => 0,
+                :maximum        => 1,
+                :position       => 3575,
+                :identified_by => {
+                  'REF01' => 'F8'
+                }
+
+    end
+  end
+end