hippo_eyeDoc 0.0.1

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

@@ -0,0 +1,30 @@
+module Hippo_eyeDoc::TransactionSets
+  module HIPAA_837
+
+    class L2330C < Hippo_eyeDoc::TransactionSets::Base
+      loop_name 'L2330C'    #Other Payer Referring Provider
+
+      #Other Payer Referring Provider
+      segment Hippo_eyeDoc::Segments::NM1,
+                :name           => 'Other Payer Referring Provider',
+                :minimum        => 0,
+                :maximum        => 1,
+                :position       => 3250,
+                :identified_by => {
+                  'NM101' => ["DN", "P3"],
+                  'NM102' => '1'
+                }
+
+      #Other Payer Referring Provider Secondary Identification
+      segment Hippo_eyeDoc::Segments::REF,
+                :name           => 'Other Payer Referring Provider Secondary Identification',
+                :minimum        => 1,
+                :maximum        => 3,
+                :position       => 3550,
+                :identified_by => {
+                  'REF01' => ["0B", "1G", "G2"]
+                }
+
+    end
+  end
+end

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

@@ -0,0 +1,30 @@
+module Hippo_eyeDoc::TransactionSets
+  module HIPAA_837
+
+    class L2330D < Hippo_eyeDoc::TransactionSets::Base
+      loop_name 'L2330D'    #Other Payer Rendering Provider
+
+      #Other Payer Rendering Provider
+      segment Hippo_eyeDoc::Segments::NM1,
+                :name           => 'Other Payer Rendering Provider',
+                :minimum        => 0,
+                :maximum        => 1,
+                :position       => 3650,
+                :identified_by => {
+                  'NM101' => '82',
+                  'NM102' => ["1", "2"]
+                }
+
+      #Other Payer Rendering Provider Secondary Identification
+      segment Hippo_eyeDoc::Segments::REF,
+                :name           => 'Other Payer Rendering Provider Secondary Identification',
+                :minimum        => 1,
+                :maximum        => 3,
+                :position       => 4150,
+                :identified_by => {
+                  'REF01' => ["0B", "1G", "G2", "LU"]
+                }
+
+    end
+  end
+end

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

@@ -0,0 +1,30 @@
+module Hippo_eyeDoc::TransactionSets
+  module HIPAA_837
+
+    class L2330E < Hippo_eyeDoc::TransactionSets::Base
+      loop_name 'L2330E'    #Other Payer Service Facility Location
+
+      #Other Payer Service Facility Location
+      segment Hippo_eyeDoc::Segments::NM1,
+                :name           => 'Other Payer Service Facility Location',
+                :minimum        => 0,
+                :maximum        => 1,
+                :position       => 4650,
+                :identified_by => {
+                  'NM101' => '77',
+                  'NM102' => '2'
+                }
+
+      #Other Payer Service Facility Location Secondary Identification
+      segment Hippo_eyeDoc::Segments::REF,
+                :name           => 'Other Payer Service Facility Location Secondary Identification',
+                :minimum        => 1,
+                :maximum        => 3,
+                :position       => 5550,
+                :identified_by => {
+                  'REF01' => ["0B", "G2", "LU"]
+                }
+
+    end
+  end
+end

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

@@ -0,0 +1,30 @@
+module Hippo_eyeDoc::TransactionSets
+  module HIPAA_837
+
+    class L2330F < Hippo_eyeDoc::TransactionSets::Base
+      loop_name 'L2330F'    #Other Payer Supervising Provider
+
+      #Other Payer Supervising Provider
+      segment Hippo_eyeDoc::Segments::NM1,
+                :name           => 'Other Payer Supervising Provider',
+                :minimum        => 0,
+                :maximum        => 1,
+                :position       => 5650,
+                :identified_by => {
+                  'NM101' => 'DQ',
+                  'NM102' => '1'
+                }
+
+      #Other Payer Supervising Provider Secondary Identification
+      segment Hippo_eyeDoc::Segments::REF,
+                :name           => 'Other Payer Supervising Provider Secondary Identification',
+                :minimum        => 1,
+                :maximum        => 3,
+                :position       => 6050,
+                :identified_by => {
+                  'REF01' => ["0B", "1G", "G2", "LU"]
+                }
+
+    end
+  end
+end

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

@@ -0,0 +1,30 @@
+module Hippo_eyeDoc::TransactionSets
+  module HIPAA_837
+
+    class L2330G < Hippo_eyeDoc::TransactionSets::Base
+      loop_name 'L2330G'    #Other Payer Billing Provider
+
+      #Other Payer Billing Provider
+      segment Hippo_eyeDoc::Segments::NM1,
+                :name           => 'Other Payer Billing Provider',
+                :minimum        => 0,
+                :maximum        => 1,
+                :position       => 6350,
+                :identified_by => {
+                  'NM101' => '85',
+                  'NM102' => ["1", "2"]
+                }
+
+      #Other Payer Billing Provider Secondary Identification
+      segment Hippo_eyeDoc::Segments::REF,
+                :name           => 'Other Payer Billing Provider Secondary Identification',
+                :minimum        => 1,
+                :maximum        => 2,
+                :position       => 6600,
+                :identified_by => {
+                  'REF01' => ["G2", "LU"]
+                }
+
+    end
+  end
+end

data/lib/hippo_eyeDoc/transaction_sets/HIPAA_837/L2400.rb

@@ -0,0 +1,537 @@
+module Hippo_eyeDoc::TransactionSets
+  module HIPAA_837
+
+    class L2400 < Hippo_eyeDoc::TransactionSets::Base
+      loop_name 'L2400'    #Service Line Number
+
+      #Service Line Number
+      segment Hippo_eyeDoc::Segments::LX,
+                :name           => 'Service Line Number',
+                :minimum        => 1,
+                :maximum        => 1,
+                :position       => 3650
+
+      #Professional Service
+      segment Hippo_eyeDoc::Segments::SV1,
+                :name           => 'Professional Service',
+                :minimum        => 1,
+                :maximum        => 1,
+                :position       => 3700,
+                :identified_by => {
+                  'SV103' => ["MJ", "UN"]
+                }
+
+      #Durable Medical Equipment Service
+      segment Hippo_eyeDoc::Segments::SV5,
+                :name           => 'Durable Medical Equipment Service',
+                :minimum        => 0,
+                :maximum        => 1,
+                :position       => 4000,
+                :identified_by => {
+                  'SV502' => 'DA',
+                  'SV506' => ["1", "4", "6"]
+                }
+
+      #Line Supplemental Information
+      segment Hippo_eyeDoc::Segments::PWK,
+                :name           => 'Line Supplemental Information',
+                :minimum        => 0,
+                :maximum        => 10,
+                :position       => 4200,
+                :identified_by => {
+                  'PWK01' => ["03", "04", "05", "06", "07", "08", "09", "10", "11", "13", "15", "21", "A3", "A4", "AM", "AS", "B2", "B3", "B4", "BR", "BS", "BT", "CB", "CK", "CT", "D2", "DA", "DB", "DG", "DJ", "DS", "EB", "HC", "HR", "I5", "IR", "LA", "M1", "MT", "NN", "OB", "OC", "OD", "OE", "OX", "OZ", "P4", "P5", "PE", "PN", "PO", "PQ", "PY", "PZ", "RB", "RR", "RT", "RX", "SG", "V5", "XP"],
+                  'PWK02' => ["AA", "BM", "EL", "EM", "FT", "FX"]
+                }
+
+      #Durable Medical Equipment Certificate of Medical Necessity Indicator
+      segment Hippo_eyeDoc::Segments::PWK,
+                :name           => 'Durable Medical Equipment Certificate of Medical Necessity Indicator',
+                :minimum        => 0,
+                :maximum        => 1,
+                :position       => 4220,
+                :identified_by => {
+                  'PWK01' => 'CT',
+                  'PWK02' => ["AB", "AD", "AF", "AG", "NS"]
+                }
+
+      #Ambulance Transport Information
+      segment Hippo_eyeDoc::Segments::CR1,
+                :name           => 'Ambulance Transport Information',
+                :minimum        => 0,
+                :maximum        => 1,
+                :position       => 4250,
+                :identified_by => {
+                  'CR104' => ["A", "B", "C", "D", "E"],
+                  'CR105' => 'DH'
+                }
+
+      #Durable Medical Equipment Certification
+      segment Hippo_eyeDoc::Segments::CR3,
+                :name           => 'Durable Medical Equipment Certification',
+                :minimum        => 0,
+                :maximum        => 1,
+                :position       => 4350,
+                :identified_by => {
+                  'CR301' => ["I", "R", "S"],
+                  'CR302' => 'MO'
+                }
+
+      #Ambulance Certification
+      segment Hippo_eyeDoc::Segments::CRC,
+                :name           => 'Ambulance Certification',
+                :minimum        => 0,
+                :maximum        => 3,
+                :position       => 4500,
+                :identified_by => {
+                  'CRC01' => '07',
+                  'CRC02' => ["N", "Y"],
+                  'CRC03' => ["01", "04", "05", "06", "07", "08", "09", "12"]
+                }
+
+      #Hospice Employee Indicator
+      segment Hippo_eyeDoc::Segments::CRC,
+                :name           => 'Hospice Employee Indicator',
+                :minimum        => 0,
+                :maximum        => 1,
+                :position       => 4520,
+                :identified_by => {
+                  'CRC01' => '70',
+                  'CRC02' => ["N", "Y"],
+                  'CRC03' => '65'
+                }
+
+      #Condition Indicator/Durable Medical Equipment
+      segment Hippo_eyeDoc::Segments::CRC,
+                :name           => 'Condition Indicator/Durable Medical Equipment',
+                :minimum        => 0,
+                :maximum        => 1,
+                :position       => 4530,
+                :identified_by => {
+                  'CRC01' => '09',
+                  'CRC02' => ["N", "Y"],
+                  'CRC03' => ["38", "ZV"]
+                }
+
+      #Date - Service Date
+      segment Hippo_eyeDoc::Segments::DTP,
+                :name           => 'Date - Service Date',
+                :minimum        => 1,
+                :maximum        => 1,
+                :position       => 4550,
+                :identified_by => {
+                  'DTP01' => '472',
+                  'DTP02' => ["D8", "RD8"]
+                }
+
+      #Date - Prescription Date
+      segment Hippo_eyeDoc::Segments::DTP,
+                :name           => 'Date - Prescription Date',
+                :minimum        => 0,
+                :maximum        => 1,
+                :position       => 4555,
+                :identified_by => {
+                  'DTP01' => '471',
+                  'DTP02' => 'D8'
+                }
+
+      #DATE - Certification Revision/Recertification Date
+      segment Hippo_eyeDoc::Segments::DTP,
+                :name           => 'DATE - Certification Revision/Recertification Date',
+                :minimum        => 0,
+                :maximum        => 1,
+                :position       => 4560,
+                :identified_by => {
+                  'DTP01' => '607',
+                  'DTP02' => 'D8'
+                }
+
+      #Date - Begin Therapy Date
+      segment Hippo_eyeDoc::Segments::DTP,
+                :name           => 'Date - Begin Therapy Date',
+                :minimum        => 0,
+                :maximum        => 1,
+                :position       => 4580,
+                :identified_by => {
+                  'DTP01' => '463',
+                  'DTP02' => 'D8'
+                }
+
+      #Date - Last Certification Date
+      segment Hippo_eyeDoc::Segments::DTP,
+                :name           => 'Date - Last Certification Date',
+                :minimum        => 0,
+                :maximum        => 1,
+                :position       => 4590,
+                :identified_by => {
+                  'DTP01' => '461',
+                  'DTP02' => 'D8'
+                }
+
+      #Date - Last Seen Date
+      segment Hippo_eyeDoc::Segments::DTP,
+                :name           => 'Date - Last Seen Date',
+                :minimum        => 0,
+                :maximum        => 1,
+                :position       => 45,
+                :identified_by => {
+                  'DTP01' => '304',
+                  'DTP02' => 'D8'
+                }
+
+      #Date - Test Date
+      segment Hippo_eyeDoc::Segments::DTP,
+                :name           => 'Date - Test Date',
+                :minimum        => 0,
+                :maximum        => 2,
+                :position       => 45,
+                :identified_by => {
+                  'DTP01' => ["738", "739"],
+                  'DTP02' => 'D8'
+                }
+
+      #Date - Shipped Date
+      segment Hippo_eyeDoc::Segments::DTP,
+                :name           => 'Date - Shipped Date',
+                :minimum        => 0,
+                :maximum        => 1,
+                :position       => 45,
+                :identified_by => {
+                  'DTP01' => '011',
+                  'DTP02' => 'D8'
+                }
+
+      #Date - Last X-ray Date
+      segment Hippo_eyeDoc::Segments::DTP,
+                :name           => 'Date - Last X-ray Date',
+                :minimum        => 0,
+                :maximum        => 1,
+                :position       => 45,
+                :identified_by => {
+                  'DTP01' => '455',
+                  'DTP02' => 'D8'
+                }
+
+      #Date - Initial Treatment Date
+      segment Hippo_eyeDoc::Segments::DTP,
+                :name           => 'Date - Initial Treatment Date',
+                :minimum        => 0,
+                :maximum        => 1,
+                :position       => 45,
+                :identified_by => {
+                  'DTP01' => '454',
+                  'DTP02' => 'D8'
+                }
+
+      #Ambulance Patient Count
+      segment Hippo_eyeDoc::Segments::QTY,
+                :name           => 'Ambulance Patient Count',
+                :minimum        => 0,
+                :maximum        => 1,
+                :position       => 4600,
+                :identified_by => {
+                  'QTY01' => 'PT'
+                }
+
+      #Obstetric Anesthesia Additional Units
+      segment Hippo_eyeDoc::Segments::QTY,
+                :name           => 'Obstetric Anesthesia Additional Units',
+                :minimum        => 0,
+                :maximum        => 1,
+                :position       => 4610,
+                :identified_by => {
+                  'QTY01' => 'FL'
+                }
+
+      #Test Result
+      segment Hippo_eyeDoc::Segments::MEA,
+                :name           => 'Test Result',
+                :minimum        => 0,
+                :maximum        => 5,
+                :position       => 4620,
+                :identified_by => {
+                  'MEA01' => ["OG", "TR"],
+                  'MEA02' => ["HT", "R1", "R2", "R3", "R4"]
+                }
+
+      #Contract Information
+      segment Hippo_eyeDoc::Segments::CN1,
+                :name           => 'Contract Information',
+                :minimum        => 0,
+                :maximum        => 1,
+                :position       => 4650,
+                :identified_by => {
+                  'CN101' => ["01", "02", "03", "04", "05", "06", "09"]
+                }
+
+      #Repriced Line Item Reference Number
+      segment Hippo_eyeDoc::Segments::REF,
+                :name           => 'Repriced Line Item Reference Number',
+                :minimum        => 0,
+                :maximum        => 1,
+                :position       => 4700,
+                :identified_by => {
+                  'REF01' => '9B'
+                }
+
+      #Adjusted Repriced Line Item Reference Number
+      segment Hippo_eyeDoc::Segments::REF,
+                :name           => 'Adjusted Repriced Line Item Reference Number',
+                :minimum        => 0,
+                :maximum        => 1,
+                :position       => 4710,
+                :identified_by => {
+                  'REF01' => '9D'
+                }
+
+      #Prior Authorization
+      segment Hippo_eyeDoc::Segments::REF,
+                :name           => 'Prior Authorization',
+                :minimum        => 0,
+                :maximum        => 5,
+                :position       => 4730,
+                :identified_by => {
+                  'REF01' => 'G1'
+                }
+
+      #Line Item Control Number
+      segment Hippo_eyeDoc::Segments::REF,
+                :name           => 'Line Item Control Number',
+                :minimum        => 0,
+                :maximum        => 1,
+                :position       => 47,
+                :identified_by => {
+                  'REF01' => '6R'
+                }
+
+      #Mammography Certification Number
+      segment Hippo_eyeDoc::Segments::REF,
+                :name           => 'Mammography Certification Number',
+                :minimum        => 0,
+                :maximum        => 1,
+                :position       => 47,
+                :identified_by => {
+                  'REF01' => 'EW'
+                }
+
+      #Clinical Laboratory Improvement Amendment (CLIA) Number
+      segment Hippo_eyeDoc::Segments::REF,
+                :name           => 'Clinical Laboratory Improvement Amendment (CLIA) Number',
+                :minimum        => 0,
+                :maximum        => 1,
+                :position       => 47,
+                :identified_by => {
+                  'REF01' => 'X4'
+                }
+
+      #Referring Clinical Laboratory Improvement Amendment (CLIA) Facility Identification
+      segment Hippo_eyeDoc::Segments::REF,
+                :name           => 'Referring Clinical Laboratory Improvement Amendment (CLIA) Facility Identification',
+                :minimum        => 0,
+                :maximum        => 1,
+                :position       => 47,
+                :identified_by => {
+                  'REF01' => 'F4'
+                }
+
+      #Immunization Batch Number
+      segment Hippo_eyeDoc::Segments::REF,
+                :name           => 'Immunization Batch Number',
+                :minimum        => 0,
+                :maximum        => 1,
+                :position       => 47,
+                :identified_by => {
+                  'REF01' => 'BT'
+                }
+
+      #Referral Number
+      segment Hippo_eyeDoc::Segments::REF,
+                :name           => 'Referral Number',
+                :minimum        => 0,
+                :maximum        => 5,
+                :position       => 47,
+                :identified_by => {
+                  'REF01' => '9F'
+                }
+
+      #Sales Tax Amount
+      segment Hippo_eyeDoc::Segments::AMT,
+                :name           => 'Sales Tax Amount',
+                :minimum        => 0,
+                :maximum        => 1,
+                :position       => 4810,
+                :identified_by => {
+                  'AMT01' => 'T'
+                }
+
+      #Postage Claimed Amount
+      segment Hippo_eyeDoc::Segments::AMT,
+                :name           => 'Postage Claimed Amount',
+                :minimum        => 0,
+                :maximum        => 1,
+                :position       => 4830,
+                :identified_by => {
+                  'AMT01' => 'F4'
+                }
+
+      #File Information
+      segment Hippo_eyeDoc::Segments::K3,
+                :name           => 'File Information',
+                :minimum        => 0,
+                :maximum        => 10,
+                :position       => 4850
+
+      #Line Note
+      segment Hippo_eyeDoc::Segments::NTE,
+                :name           => 'Line Note',
+                :minimum        => 0,
+                :maximum        => 1,
+                :position       => 4860,
+                :identified_by => {
+                  'NTE01' => ["ADD", "DCP"]
+                }
+
+      #Third Party Organization Notes
+      segment Hippo_eyeDoc::Segments::NTE,
+                :name           => 'Third Party Organization Notes',
+                :minimum        => 0,
+                :maximum        => 1,
+                :position       => 4865,
+                :identified_by => {
+                  'NTE01' => 'TPO'
+                }
+
+      #Purchased Service Information
+      segment Hippo_eyeDoc::Segments::PS1,
+                :name           => 'Purchased Service Information',
+                :minimum        => 0,
+                :maximum        => 1,
+                :position       => 4880
+
+      #Line Pricing/Repricing Information
+      segment Hippo_eyeDoc::Segments::HCP,
+                :name           => 'Line Pricing/Repricing Information',
+                :minimum        => 0,
+                :maximum        => 1,
+                :position       => 4920,
+                :identified_by => {
+                  'HCP01' => ["00", "01", "02", "03", "04", "05", "06", "07", "08", "09", "10", "11", "12", "13", "14"]
+                }
+
+      #Drug Identification
+      loop    Hippo_eyeDoc::TransactionSets::HIPAA_837::L2410,
+                :name           => 'Drug Identification',
+                :minimum        => 0,
+                :maximum        => 1,
+                :position       => 4940,
+                :identified_by => {
+                  'LIN.LIN02' => ["EN", "EO", "HI", "N4", "ON", "UK", "UP"]
+                }
+
+      #Rendering Provider Name
+      loop    Hippo_eyeDoc::TransactionSets::HIPAA_837::L2420A,
+                :name           => 'Rendering Provider Name',
+                :minimum        => 0,
+                :maximum        => 1,
+                :position       => 5000,
+                :identified_by => {
+                  'NM1.NM101' => '82',
+                  'NM1.NM102' => ["1", "2"]
+                }
+
+      #Purchased Service Provider Name
+      loop    Hippo_eyeDoc::TransactionSets::HIPAA_837::L2420B,
+                :name           => 'Purchased Service Provider Name',
+                :minimum        => 0,
+                :maximum        => 1,
+                :position       => 5000,
+                :identified_by => {
+                  'NM1.NM101' => 'QB',
+                  'NM1.NM102' => ["1", "2"]
+                }
+
+      #Service Facility Location Name
+      loop    Hippo_eyeDoc::TransactionSets::HIPAA_837::L2420C,
+                :name           => 'Service Facility Location Name',
+                :minimum        => 0,
+                :maximum        => 1,
+                :position       => 5000,
+                :identified_by => {
+                  'NM1.NM101' => '77',
+                  'NM1.NM102' => '2'
+                }
+
+      #Supervising Provider Name
+      loop    Hippo_eyeDoc::TransactionSets::HIPAA_837::L2420D,
+                :name           => 'Supervising Provider Name',
+                :minimum        => 0,
+                :maximum        => 1,
+                :position       => 5000,
+                :identified_by => {
+                  'NM1.NM101' => 'DQ',
+                  'NM1.NM102' => '1'
+                }
+
+      #Ordering Provider Name
+      loop    Hippo_eyeDoc::TransactionSets::HIPAA_837::L2420E,
+                :name           => 'Ordering Provider Name',
+                :minimum        => 0,
+                :maximum        => 1,
+                :position       => 5000,
+                :identified_by => {
+                  'NM1.NM101' => 'DK',
+                  'NM1.NM102' => '1'
+                }
+
+      #Referring Provider Name
+      loop    Hippo_eyeDoc::TransactionSets::HIPAA_837::L2420F,
+                :name           => 'Referring Provider Name',
+                :minimum        => 0,
+                :maximum        => 2,
+                :position       => 5000,
+                :identified_by => {
+                  'NM1.NM101' => ["DN", "P3"],
+                  'NM1.NM102' => '1'
+                }
+
+      #Ambulance Pick-up Location
+      loop    Hippo_eyeDoc::TransactionSets::HIPAA_837::L2420G,
+                :name           => 'Ambulance Pick-up Location',
+                :minimum        => 0,
+                :maximum        => 1,
+                :position       => 5310,
+                :identified_by => {
+                  'NM1.NM101' => 'PW',
+                  'NM1.NM102' => '2'
+                }
+
+      #Ambulance Drop-off Location
+      loop    Hippo_eyeDoc::TransactionSets::HIPAA_837::L2420H,
+                :name           => 'Ambulance Drop-off Location',
+                :minimum        => 0,
+                :maximum        => 1,
+                :position       => 5380,
+                :identified_by => {
+                  'NM1.NM101' => '45',
+                  'NM1.NM102' => '2'
+                }
+
+      #Line Adjudication Information
+      loop    Hippo_eyeDoc::TransactionSets::HIPAA_837::L2430,
+                :name           => 'Line Adjudication Information',
+                :minimum        => 0,
+                :maximum        => 15,
+                :position       => 5400
+
+      #Form Identification Code
+      loop    Hippo_eyeDoc::TransactionSets::HIPAA_837::L2440,
+                :name           => 'Form Identification Code',
+                :minimum        => 0,
+                :maximum        => 99999,
+                :position       => 5510,
+                :identified_by => {
+                  'LQ.LQ01' => ["AS", "UT"]
+                }
+
+    end
+  end
+end