pokitdok-ruby 0.2.3 → 0.3.0

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Files changed (22) hide show
  1. checksums.yaml +4 -4
  2. data/.travis.yml +1 -2
  3. data/Gemfile +1 -0
  4. data/Gemfile.lock +13 -0
  5. data/Guardfile +4 -4
  6. data/README.md +32 -15
  7. data/Rakefile +3 -0
  8. data/VERSION +1 -1
  9. data/lib/pokitdok.rb +17 -32
  10. data/pokitdok-ruby.gemspec +6 -4
  11. data/spec/fixtures/claim.json +44 -114
  12. data/spec/pokitdok_spec.rb +35 -38
  13. data/vcr_cassettes/activities.yml +202 -333
  14. data/vcr_cassettes/auth.yml +4 -4
  15. data/vcr_cassettes/claims.yml +36 -65
  16. data/vcr_cassettes/eligibility.yml +73 -93
  17. data/vcr_cassettes/enrollment.yml +38 -41
  18. data/vcr_cassettes/files.yml +10 -10
  19. data/vcr_cassettes/payers.yml +81 -77
  20. data/vcr_cassettes/providers.yml +308 -297
  21. metadata +16 -3
  22. data/vcr_cassettes/insurance_prices.yml +0 -42
data/vcr_cassettes/auth.yml CHANGED
@@ -31,11 +31,11 @@ http_interactions:
31
31
  Server:
32
32
  - Werkzeug/0.9.4 Python/2.7.3
33
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  Date:
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- - Tue, 03 Jun 2014 20:30:49 GMT
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+ - Fri, 06 Jun 2014 17:15:35 GMT
35
35
  body:
36
36
  encoding: UTF-8
37
- string: '{"access_token": "BR8J2PXhCIVnkwWLRsESQWSI198fztONOGc6Evlf", "token_type":
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- "bearer", "expires": 1401831050, "expires_in": 3600}'
37
+ string: '{"access_token": "wRjqVdn8ezPmx5uviVocwL2u1edtJ8g809Tn4Ob5", "token_type":
38
+ "bearer", "expires": 1402078535, "expires_in": 3600}'
39
39
  http_version:
40
- recorded_at: Tue, 03 Jun 2014 20:30:49 GMT
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+ recorded_at: Fri, 06 Jun 2014 17:15:35 GMT
41
41
  recorded_with: VCR 2.9.2
data/vcr_cassettes/claims.yml CHANGED
@@ -2,27 +2,18 @@
2
2
  http_interactions:
3
3
  - request:
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  method: post
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- uri: http://localhost:5002/api/v3/claims/
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+ uri: http://localhost:5002/api/v4/claims/
6
6
  body:
7
7
  encoding: UTF-8
8
- string: '{"app_transaction_id":"00000000001","billing_provider":{"address_line_1":"418
9
- FARMS DR","city":"BURLINGTON","entity_identifier":"Billing Provider","entity_type":"Non-Person","id_code":"1730240128","id_type":"NPI","last_org_name":"KATIE
10
- BRADFORD","postal_code":"018033744","provider_code":"Billing","provider_id_code":"133V00000X","provider_id_type":"Provider
11
- Taxonomy Code","ref":[{"id_code":"587654321","id_type":"Employee Identification
12
- Number"}],"state":"MA"},"claim":{"assignment_code":"Assigned","benefit_assignment_code":"Yes","claim_frequency_code":"1","claim_total_amount":{"amount":"40.0","currency":"USD"},"dates":[{"date_qualifier":"Onset
13
- of Symptom or Illness","date_value":"04/15/2014"}],"facility_code_qualifier":"B","facility_code_value":"11","health_care_codes":[{"health_care_code_1":"BK:0340","health_care_code_2":"BF:V7389"}],"information_release_code":"Informed
14
- Consent","patient_control_number":"26462967","provider_signature_on_file":"Y","ref":[{"id_code":"1234567890","id_type":"Claim
15
- Number"}],"service_lines":[{"dates":[{"date_qualifier":"Service Date","date_value":"04/16/2014"}],"medical_charge_amount":{"amount":"40.0","currency":"USD"},"medical_diagnosis_code":"1","medical_procedure_identifier":"HC:99213","medical_service_quantity":"1.0","medical_service_unit":"Unit"}]},"payer":{"entity_identifier":"Payer","entity_type":"Non-Person","id_code":"HPHC","id_type":"Payor
16
- Identification","last_org_name":"HARVARD PILGRIM HEALTH CARE"},"receiver":{"entity_identifier":"Receiver","entity_type":"Non-Person","id_code":"HPHC","id_type":"ETIN","last_org_name":"HPHC"},"submitter":{"entity_identifier":"Submitter","entity_type":"Non-Person","id_code":"123456789","id_type":"ETIN","last_org_name":"ACME,
17
- INC."},"subscriber":{"address_line_1":"123 MAIN ST","birth_date":"Sat May 1
18
- 00:00:00 1943","city":"BURLINGTON","claim_filing_code":"Health Maintenance
19
- Organization","entity_identifier":"Subscriber","entity_type":"Person","first_name":"TED","gender_code":"Male","group_number":"12312-A","id_code":"HP123456700","id_type":"Member
20
- ID","is_patient":true,"last_org_name":"SMITH","payer_responsibility":"Primary","postal_code":"01803","relationship_code":"Self","state":"MA"},"trading_partner_id":"MOCKPAYER","transaction_purpose_code":"Original","transaction_type":"Reporting"}'
8
+ string: '{"transaction_code":"chargeable","trading_partner_id":"MOCKPAYER","billing_provider":{"taxonomy_code":"207Q00000X","first_name":"Jerome","last_name":"Aya-Ay","npi":"1467560003","address":{"address_lines":["8311
9
+ WARREN H ABERNATHY HWY"],"city":"SPARTANBURG","state":"SC","zipcode":"29301"},"tax_id":"123456789"},"subscriber":{"first_name":"Jane","last_name":"Doe","member_id":"W000000000","address":{"address_lines":["123
10
+ N MAIN ST"],"city":"SPARTANBURG","state":"SC","zipcode":"29301"},"birth_date":"1970-01-01","gender":"female"},"claim":{"total_charge_amount":60.0,"service_lines":[{"procedure_code":"99213","charge_amount":60.0,"unit_count":1.0,"diagnosis_codes":["487.1"],"service_date":"2014-06-01"}]},"payer":{"organization_name":"Acme
11
+ Ins Co","plan_id":"1234567890"}}'
21
12
  headers:
22
13
  User-Agent:
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- - pokitdok-ruby 0.2.1 ruby 2.1.1p76 (2014-02-24 revision 45161) [x86_64-darwin13.0]
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+ - pokitdok-ruby 0.4 ruby 2.1.1p76 (2014-02-24 revision 45161) [x86_64-darwin13.0]
24
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  Authorization:
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- - Bearer BR8J2PXhCIVnkwWLRsESQWSI198fztONOGc6Evlf
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+ - Bearer wRjqVdn8ezPmx5uviVocwL2u1edtJ8g809Tn4Ob5
26
17
  Content-Type:
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  - application/json
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  Accept-Encoding:
@@ -37,7 +28,7 @@ http_interactions:
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  Content-Type:
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  - text/html; charset=utf-8
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  Content-Length:
40
- - '3664'
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+ - '2075'
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  Mimetype:
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  - application/json
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  Charset:
@@ -45,55 +36,35 @@ http_interactions:
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  Server:
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  - Werkzeug/0.9.4 Python/2.7.3
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  Date:
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- - Tue, 03 Jun 2014 20:30:49 GMT
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+ - Fri, 06 Jun 2014 17:15:36 GMT
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  body:
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  encoding: UTF-8
51
- string: '{"meta": {"rate_limit_amount": 28, "rate_limit_reset": 1401829297,
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- "processing_time": 9, "rate_limit_cap": 8434, "credits_remaining": 9983, "credits_billed":
53
- 1}, "data": {"units_of_work": 1, "_type": "PlatformActivityModel", "name":
54
- "claims", "parameters": {"claim": {"dates": [{"date_value": "Tue Apr 15 00:00:00
55
- 2014", "date_qualifier": "Onset of Symptom or Illness"}], "facility_code_value":
56
- "11", "claim_total_amount": {"currency": "USD", "amount": "40.0"}, "health_care_codes":
57
- [{"health_care_code_1": "BK:0340", "health_care_code_2": "BF:V7389"}], "assignment_code":
58
- "Assigned", "information_release_code": "Informed Consent", "facility_code_qualifier":
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- "B", "benefit_assignment_code": "Yes", "claim_frequency_code": "1", "provider_signature_on_file":
60
- "Y", "service_lines": [{"medical_service_unit": "Unit", "medical_service_quantity":
61
- "1.0", "medical_procedure_identifier": "HC:99213", "dates": [{"date_value":
62
- "Wed Apr 16 00:00:00 2014", "date_qualifier": "Service Date"}], "medical_diagnosis_code":
63
- "1", "medical_charge_amount": {"currency": "USD", "amount": "40.0"}}], "ref":
64
- [{"id_type": "Claim Number", "id_code": "1234567890"}], "patient_control_number":
65
- "26462967"}, "major_version": "3", "transaction_purpose_code": "Original",
66
- "payer": {"id_code": "HPHC", "entity_identifier": "Payer", "id_type": "Payor
67
- Identification", "last_org_name": "HARVARD PILGRIM HEALTH CARE", "entity_type":
68
- "Non-Person"}, "update_dt": "Tue Jun 3 20:30:49 2014", "deleted": false,
69
- "version": "3.0.0", "transaction_type": "Reporting", "subscriber": {"city":
70
- "BURLINGTON", "first_name": "TED", "entity_identifier": "Subscriber", "last_org_name":
71
- "SMITH", "entity_type": "Person", "group_number": "12312-A", "gender_code":
72
- "Male", "id_code": "HP123456700", "relationship_code": "Self", "is_patient":
73
- true, "state": "MA", "payer_responsibility": "Primary", "id_type": "Member
74
- ID", "birth_date": "Sat May 1 00:00:00 1943", "postal_code": "01803", "claim_filing_code":
75
- "Health Maintenance Organization", "address_line_1": "123 MAIN ST"}, "correlation_id":
76
- "7c397f0b-4cd2-4455-8c90-b7cef091e92a", "insert_dt": "Tue Jun 3 20:30:49
77
- 2014", "client_id": "4nhMZTpLxBxmiocveVb5", "trading_partner_id": "MOCKPAYER",
78
- "receiver": {"id_code": "HPHC", "entity_identifier": "Receiver", "id_type":
79
- "ETIN", "last_org_name": "HPHC", "entity_type": "Non-Person"}, "submitter":
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- {"id_code": "123456789", "entity_identifier": "Submitter", "id_type": "ETIN",
81
- "last_org_name": "ACME, INC.", "entity_type": "Non-Person"}, "billing_provider":
82
- {"city": "BURLINGTON", "entity_identifier": "Billing Provider", "last_org_name":
83
- "KATIE BRADFORD", "entity_type": "Non-Person", "provider_id_type": "Provider
84
- Taxonomy Code", "id_code": "1730240128", "state": "MA", "provider_id_code":
85
- "133V00000X", "postal_code": "018033744", "id_type": "NPI", "provider_code":
86
- "Billing", "ref": [{"id_type": "Employee Identification Number", "id_code":
87
- "587654321"}], "address_line_1": "418 FARMS DR"}, "app_transaction_id": "00000000001"},
88
- "update_dt": "Tue Jun 3 20:30:49 2014", "remaining_transitions": ["generate",
89
- "transmit", "wait", "receive", "process", "complete"], "major_version": "3",
90
- "state": {"name": "pending", "title": "Pending Batch Transmission to Trading
91
- Partner"}, "deleted": false, "correlation_id": "7c397f0b-4cd2-4455-8c90-b7cef091e92a",
92
- "version": "3.0.0", "client_id": "4nhMZTpLxBxmiocveVb5", "trading_partner_id":
93
- "MOCKPAYER", "_id": "538e307956c02c5ec974954b", "insert_dt": "Tue Jun 3 20:30:49
94
- 2014", "transition_path": ["batch", "generate", "transmit", "wait", "receive",
95
- "process", "complete"], "history": [{"record_dt": "Tue Jun 3 20:30:49 2014",
96
- "name": "init", "title": "Initializing"}]}}'
42
+ string: '{"meta": {"rate_limit_amount": 32, "rate_limit_reset": 1402077424,
43
+ "processing_time": 13, "rate_limit_cap": 8434, "credits_remaining": 9969,
44
+ "credits_billed": 1}, "data": {"units_of_work": 1, "name": "claims", "parameters":
45
+ {"claim": {"plan_participation": "assigned", "provider_signature": true, "total_charge_amount":
46
+ "60.0", "claim_frequency": "original", "place_of_service": "office", "direct_payment":
47
+ "y", "patient_signature_on_file": true, "information_release": "informed_consent",
48
+ "service_lines": [{"diagnosis_codes": ["487.1"], "unit_count": "1.0", "unit_type":
49
+ "units", "charge_amount": "60.0", "service_date": "2014-06-01", "procedure_code":
50
+ "99213"}]}, "trading_partner_id": "MOCKPAYER", "payer": {"organization_name":
51
+ "Acme Ins Co", "plan_id": "1234567890"}, "subscriber": {"first_name": "Jane",
52
+ "last_name": "Doe", "gender": "female", "member_id": "W000000000", "payer_responsibility":
53
+ "primary", "address": {"address_lines": ["123 N MAIN ST"], "state": "SC",
54
+ "zipcode": "29301", "city": "SPARTANBURG"}, "birth_date": "1970-01-01"}, "correlation_id":
55
+ "c5b39b6f-741c-425d-a67d-3bc505b3d638", "client_id": "4nhMZTpLxBxmiocveVb5",
56
+ "receiver": {"organization_name": "PD App", "id": "4nhMZTpLxBxmiocveVb5"},
57
+ "submitter": {"organization_name": "PokitDok, Inc.", "id": "453504565"}, "billing_provider":
58
+ {"first_name": "Jerome", "last_name": "Aya-Ay", "npi": "1467560003", "taxonomy_code":
59
+ "207Q00000X", "address": {"address_lines": ["8311 WARREN H ABERNATHY HWY"],
60
+ "state": "SC", "zipcode": "29301", "city": "SPARTANBURG"}, "tax_id": "123456789"},
61
+ "transaction_code": "chargeable"}, "remaining_transitions": ["generate", "store",
62
+ "transmit", "wait", "receive", "process", "complete"], "state": {"name": "scheduled",
63
+ "title": "Scheduled for next available transmission to Trading Partner"},
64
+ "trading_partner_id": "MOCKPAYER", "id": "5391f73856c02c1338283bbd", "transition_path":
65
+ ["schedule", "generate", "store", "transmit", "wait", "receive", "process",
66
+ "complete"], "history": [{"record_dt": "2014-06-06T17:15:36.134800", "name":
67
+ "init", "title": "Initializing"}]}}'
97
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  http_version:
98
- recorded_at: Tue, 03 Jun 2014 20:30:49 GMT
69
+ recorded_at: Fri, 06 Jun 2014 17:15:36 GMT
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  recorded_with: VCR 2.9.2
data/vcr_cassettes/eligibility.yml CHANGED
@@ -2,17 +2,15 @@
2
2
  http_interactions:
3
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  - request:
4
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  method: post
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- uri: http://localhost:5002/api/v3/eligibility/
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+ uri: http://localhost:5002/api/v4/eligibility/
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  body:
7
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  encoding: UTF-8
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- string: '{"trading_partner_id":"MOCKPAYER","member_id":"W34237875729","provider_id":"1467560003","provider_name":"AYA-AY","provider_first_name":"JEROME","provider_type":"Person","member_name":"JOHN
9
- DOE","member_birth_date":"05-21-1975","service_types":["Health Benefit Plan
10
- Coverage"]}'
8
+ string: '{"member":{"birth_date":"1970-01-01","first_name":"Jane","last_name":"Doe","id":"W000000000"},"provider":{"first_name":"JEROME","last_name":"AYA-AY","npi":"1467560003"},"service_types":["health_benefit_plan_coverage"],"trading_partner_id":"MOCKPAYER"}'
11
9
  headers:
12
10
  User-Agent:
13
- - pokitdok-ruby 0.2.1 ruby 2.1.1p76 (2014-02-24 revision 45161) [x86_64-darwin13.0]
11
+ - pokitdok-ruby 0.4 ruby 2.1.1p76 (2014-02-24 revision 45161) [x86_64-darwin13.0]
14
12
  Authorization:
15
- - Bearer BR8J2PXhCIVnkwWLRsESQWSI198fztONOGc6Evlf
13
+ - Bearer wRjqVdn8ezPmx5uviVocwL2u1edtJ8g809Tn4Ob5
16
14
  Content-Type:
17
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  - application/json
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  Accept-Encoding:
@@ -27,7 +25,7 @@ http_interactions:
27
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  Content-Type:
28
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  - text/html; charset=utf-8
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  Content-Length:
30
- - '7041'
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+ - '5655'
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  Mimetype:
32
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  - application/json
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31
  Charset:
@@ -35,97 +33,79 @@ http_interactions:
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  Server:
36
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  - Werkzeug/0.9.4 Python/2.7.3
37
35
  Date:
38
- - Tue, 03 Jun 2014 20:30:50 GMT
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+ - Fri, 06 Jun 2014 17:15:36 GMT
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  body:
40
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  encoding: UTF-8
41
- string: '{"meta": {"rate_limit_amount": 33, "rate_limit_reset": 1401829297,
42
- "processing_time": 350, "rate_limit_cap": 8434, "credits_remaining": 9975,
43
- "credits_billed": 1}, "data": {"provider_id": "1467560003", "client_id": "4nhMZTpLxBxmiocveVb5",
44
- "payer_name": "MOCK PAYER INC", "correlation_id": "e05cfdf6-e23e-4a7e-83e2-a275c1e81f95",
45
- "member_first_name": "JOHN", "member_name": "JOHN DOE", "valid_request": true,
46
- "update_dt": "Tue Jun 3 20:30:50 2014", "subscriber": {"first_name": "JOHN",
47
- "last_name": "DOE", "address": {"city": "SPARTANBURG", "line": "123 MAIN ST",
48
- "postal_code": "29307", "state": "SC"}, "member_id": "W34237875729", "birth_date":
49
- "Wed May 21 00:00:00 1975"}, "dependent": {"address": {}}, "version": "3.0.0",
50
- "provider_name": "JEROME AYA-AY", "provider_first_name": "JEROME", "trading_partner_id":
51
- "MOCKPAYER", "provider_type": "Person", "_type": "Eligibility", "deleted":
52
- false, "payer_id": "MOCKPAYER", "coverage": {"service_type_codes": ["98"],
53
- "service_types": ["Professional (Physician) Visit - Office"], "group_number":
54
- "088818801000013", "out_of_pocket": [{"messages": [], "in_plan_network": "Y",
55
- "coverage_level_code": "IND", "coverage_level": "Individual", "benefit_amount":
56
- {"currency": "USD", "amount": "3000"}}, {"messages": [], "in_plan_network":
57
- "Y", "coverage_level_code": "IND", "time_period": "Remaining", "coverage_level":
58
- "Individual", "benefit_amount": {"currency": "USD", "amount": "2983.57"}},
59
- {"messages": [], "in_plan_network": "Y", "coverage_level_code": "FAM", "coverage_level":
60
- "Family", "benefit_amount": {"currency": "USD", "amount": "6000"}}, {"messages":
61
- [], "in_plan_network": "Y", "coverage_level_code": "FAM", "time_period": "Remaining",
62
- "coverage_level": "Family", "benefit_amount": {"currency": "USD", "amount":
63
- "5956.09"}}, {"messages": [], "in_plan_network": "N", "coverage_level_code":
64
- "IND", "coverage_level": "Individual", "benefit_amount": {"currency": "USD",
65
- "amount": "12500"}}, {"messages": [], "in_plan_network": "N", "coverage_level_code":
66
- "IND", "time_period": "Remaining", "coverage_level": "Individual", "benefit_amount":
67
- {"currency": "USD", "amount": "12483.57"}}, {"messages": [], "in_plan_network":
68
- "N", "coverage_level_code": "FAM", "coverage_level": "Family", "benefit_amount":
69
- {"currency": "USD", "amount": "25000"}}, {"messages": [{"message": "Unlimited
70
- Lifetime Benefits"}], "in_plan_network": "N", "coverage_level_code": "FAM",
71
- "time_period": "Remaining", "coverage_level": "Family", "benefit_amount":
72
- {"currency": "USD", "amount": "24956.09"}}], "level": "Employee and Spouse",
73
- "copay": [{"service_type_codes": ["98"], "service_types": ["Professional (Physician)
74
- Visit - Office"], "messages": [{"message": "PRIMARY OFFICE"}], "in_plan_network":
75
- "Y", "coverage_level_code": "ESP", "coverage_level": "Employee and Spouse"},
76
- {"service_type_codes": ["98"], "service_types": ["Professional (Physician)
77
- Visit - Office"], "messages": [{"message": "GYN OFFICE VS"}, {"message": "GYN
78
- VISIT"}, {"message": "SPEC OFFICE"}, {"message": "SPEC VISIT"}, {"message":
79
- "PRIME CARE VST"}, {"message": "Plan Requires PreCert"}, {"message": "Commercial"},
80
- {"message": "Plan includes NAP"}, {"message": "Pre-Existing may apply"}],
81
- "in_plan_network": "W", "coverage_level_code": "ESP", "coverage_level": "Employee
82
- and Spouse"}], "deductibles": [{"messages": [{"message": "INT MED AND RX,GYN
39
+ string: '{"meta": {"rate_limit_amount": 30, "rate_limit_reset": 1402077424,
40
+ "processing_time": 86, "rate_limit_cap": 8434, "credits_remaining": 9961,
41
+ "credits_billed": 1}, "data": {"service_types": ["professional_physician_visit_office"],
42
+ "client_id": "4nhMZTpLxBxmiocveVb5", "payer": {"id": "MOCKPAYER", "name":
43
+ "MOCK PAYER INC"}, "subscriber": {"birth_date": "1970-01-01", "first_name":
44
+ "Jane", "last_name": "Doe", "id": "W000000000", "address": {"city": "SPARTANBURG",
45
+ "state": "SC", "zipcode": "29307", "address_lines": ["123 MAIN ST"]}}, "correlation_id":
46
+ "39d77716-110e-4c8e-b310-de921d53aef5", "trading_partner_id": "MOCKPAYER",
47
+ "provider": {"first_name": "JEROME", "last_name": "JEROME AYA-AY", "npi":
48
+ "1467560003"}, "coverage": {"plan_number": "0888188", "service_types": ["professional_physician_visit_office"],
49
+ "group_number": "088818801000013", "out_of_pocket": [{"in_plan_network": "yes",
50
+ "benefit_amount": {"currency": "USD", "amount": "3000"}, "coverage_level":
51
+ "individual"}, {"in_plan_network": "yes", "benefit_amount": {"currency": "USD",
52
+ "amount": "2983.57"}, "coverage_level": "individual", "time_period": "remaining"},
53
+ {"in_plan_network": "yes", "benefit_amount": {"currency": "USD", "amount":
54
+ "6000"}, "coverage_level": "family"}, {"in_plan_network": "yes", "benefit_amount":
55
+ {"currency": "USD", "amount": "5956.09"}, "coverage_level": "family", "time_period":
56
+ "remaining"}, {"in_plan_network": "no", "benefit_amount": {"currency": "USD",
57
+ "amount": "12500"}, "coverage_level": "individual"}, {"in_plan_network": "no",
58
+ "benefit_amount": {"currency": "USD", "amount": "12483.57"}, "coverage_level":
59
+ "individual", "time_period": "remaining"}, {"in_plan_network": "no", "benefit_amount":
60
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