pokitdok-ruby 0.2.3

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Files changed (28) hide show
  1. checksums.yaml +7 -0
  2. data/.document +5 -0
  3. data/.travis.yml +8 -0
  4. data/Gemfile +21 -0
  5. data/Gemfile.lock +140 -0
  6. data/Guardfile +18 -0
  7. data/LICENSE.txt +21 -0
  8. data/README.md +80 -0
  9. data/Rakefile +59 -0
  10. data/VERSION +1 -0
  11. data/lib/pokitdok.rb +167 -0
  12. data/pokitdok-ruby.gemspec +114 -0
  13. data/spec/fixtures/claim.json +116 -0
  14. data/spec/fixtures/enrollment.json +81 -0
  15. data/spec/fixtures/sample.270 +131 -0
  16. data/spec/pokitdok_spec.rb +168 -0
  17. data/spec/spec_helper.rb +44 -0
  18. data/spec/vcr_setup.rb +11 -0
  19. data/vcr_cassettes/activities.yml +512 -0
  20. data/vcr_cassettes/auth.yml +41 -0
  21. data/vcr_cassettes/claims.yml +99 -0
  22. data/vcr_cassettes/eligibility.yml +131 -0
  23. data/vcr_cassettes/enrollment.yml +85 -0
  24. data/vcr_cassettes/files.yml +57 -0
  25. data/vcr_cassettes/insurance_prices.yml +42 -0
  26. data/vcr_cassettes/payers.yml +163 -0
  27. data/vcr_cassettes/providers.yml +526 -0
  28. metadata +309 -0
data/vcr_cassettes/auth.yml ADDED
@@ -0,0 +1,41 @@
1
+ ---
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+ http_interactions:
3
+ - request:
4
+ method: post
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+ uri: http://4nhMZTpLxBxmiocveVb5:HUIpG9fFf9Qku9mh0lO50SPSDiju3D9Cjx17oeCN@localhost:5002/oauth2/token
6
+ body:
7
+ encoding: UTF-8
8
+ string: grant_type=client_credentials
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+ headers:
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+ User-Agent:
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+ - Faraday v0.9.0
12
+ Content-Type:
13
+ - application/x-www-form-urlencoded
14
+ Accept-Encoding:
15
+ - gzip;q=1.0,deflate;q=0.6,identity;q=0.3
16
+ Accept:
17
+ - "*/*"
18
+ response:
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+ status:
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+ code: 200
21
+ message: OK
22
+ headers:
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+ Content-Type:
24
+ - application/json;charset=UTF-8
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+ Content-Length:
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+ - '127'
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+ Pragma:
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+ - no-cache
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+ Cache-Control:
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+ - no-store
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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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+ body:
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+ encoding: UTF-8
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+ string: '{"access_token": "BR8J2PXhCIVnkwWLRsESQWSI198fztONOGc6Evlf", "token_type":
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+ "bearer", "expires": 1401831050, "expires_in": 3600}'
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+ http_version:
40
+ recorded_at: Tue, 03 Jun 2014 20:30:49 GMT
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+ recorded_with: VCR 2.9.2
data/vcr_cassettes/claims.yml ADDED
@@ -0,0 +1,99 @@
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+ ---
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+ http_interactions:
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+ - request:
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+ method: post
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+ uri: http://localhost:5002/api/v3/claims/
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+ body:
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+ encoding: UTF-8
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+ 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
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+ 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"}'
21
+ headers:
22
+ User-Agent:
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+ - pokitdok-ruby 0.2.1 ruby 2.1.1p76 (2014-02-24 revision 45161) [x86_64-darwin13.0]
24
+ Authorization:
25
+ - Bearer BR8J2PXhCIVnkwWLRsESQWSI198fztONOGc6Evlf
26
+ Content-Type:
27
+ - application/json
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+ Accept-Encoding:
29
+ - gzip;q=1.0,deflate;q=0.6,identity;q=0.3
30
+ Accept:
31
+ - "*/*"
32
+ response:
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+ status:
34
+ code: 200
35
+ message: OK
36
+ headers:
37
+ Content-Type:
38
+ - text/html; charset=utf-8
39
+ Content-Length:
40
+ - '3664'
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+ Mimetype:
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+ - application/json
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+ Charset:
44
+ - utf-8
45
+ Server:
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+ - Werkzeug/0.9.4 Python/2.7.3
47
+ Date:
48
+ - Tue, 03 Jun 2014 20:30:49 GMT
49
+ body:
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+ encoding: UTF-8
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+ 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":
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+ "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":
59
+ "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",
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+ "last_org_name": "ACME, INC.", "entity_type": "Non-Person"}, "billing_provider":
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+ {"city": "BURLINGTON", "entity_identifier": "Billing Provider", "last_org_name":
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+ "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"},
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+ "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"}]}}'
97
+ http_version:
98
+ recorded_at: Tue, 03 Jun 2014 20:30:49 GMT
99
+ recorded_with: VCR 2.9.2
data/vcr_cassettes/eligibility.yml ADDED
@@ -0,0 +1,131 @@
1
+ ---
2
+ http_interactions:
3
+ - request:
4
+ method: post
5
+ uri: http://localhost:5002/api/v3/eligibility/
6
+ body:
7
+ encoding: UTF-8
8
+ 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"]}'
11
+ headers:
12
+ User-Agent:
13
+ - pokitdok-ruby 0.2.1 ruby 2.1.1p76 (2014-02-24 revision 45161) [x86_64-darwin13.0]
14
+ Authorization:
15
+ - Bearer BR8J2PXhCIVnkwWLRsESQWSI198fztONOGc6Evlf
16
+ Content-Type:
17
+ - application/json
18
+ Accept-Encoding:
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+ - gzip;q=1.0,deflate;q=0.6,identity;q=0.3
20
+ Accept:
21
+ - "*/*"
22
+ response:
23
+ status:
24
+ code: 200
25
+ message: OK
26
+ headers:
27
+ Content-Type:
28
+ - text/html; charset=utf-8
29
+ Content-Length:
30
+ - '7041'
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+ Mimetype:
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+ - application/json
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+ Charset:
34
+ - utf-8
35
+ Server:
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+ - Werkzeug/0.9.4 Python/2.7.3
37
+ Date:
38
+ - Tue, 03 Jun 2014 20:30:50 GMT
39
+ body:
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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":
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+ "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
83
+ OFFICE VS,DED INCLUDED IN OOP,GYN VISIT,SPEC OFFICE,SPEC VISIT,PRIMARY OFFICE,PRIME
84
+ CARE VST"}], "in_plan_network": "Y", "eligibility_date": "Tue Jan 1 00:00:00
85
+ 2013", "coverage_level_code": "FAM", "time_period": "Calendar Year", "coverage_level":
86
+ "Family", "benefit_amount": {"currency": "USD", "amount": "6000"}}, {"messages":
87
+ [{"message": "INT MED AND RX"}], "in_plan_network": "Y", "coverage_level_code":
88
+ "FAM", "time_period": "Remaining", "coverage_level": "Family", "benefit_amount":
89
+ {"currency": "USD", "amount": "5956.09"}}, {"messages": [{"message": "INT
90
+ MED AND RX,GYN OFFICE VS,DED INCLUDED IN OOP,GYN VISIT,SPEC OFFICE,SPEC VISIT,PRIMARY
91
+ OFFICE,PRIME CARE VST"}], "in_plan_network": "Y", "eligibility_date": "Tue
92
+ Jan 1 00:00:00 2013", "coverage_level_code": "IND", "time_period": "Calendar
93
+ Year", "coverage_level": "Individual", "benefit_amount": {"currency": "USD",
94
+ "amount": "3000"}}, {"messages": [{"message": "INT MED AND RX"}], "in_plan_network":
95
+ "Y", "coverage_level_code": "IND", "time_period": "Remaining", "coverage_level":
96
+ "Individual", "benefit_amount": {"currency": "USD", "amount": "2983.57"}},
97
+ {"messages": [{"message": "INT MED AND RX,GYN OFFICE VS,DED INCLUDED IN OOP,GYN
98
+ VISIT,SPEC OFFICE,SPEC VISIT,PRIME CARE VST"}], "in_plan_network": "N", "eligibility_date":
99
+ "Tue Jan 1 00:00:00 2013", "coverage_level_code": "FAM", "time_period": "Calendar
100
+ Year", "coverage_level": "Family", "benefit_amount": {"currency": "USD", "amount":
101
+ "12000"}}, {"messages": [{"message": "INT MED AND RX"}], "in_plan_network":
102
+ "N", "coverage_level_code": "FAM", "time_period": "Remaining", "coverage_level":
103
+ "Family", "benefit_amount": {"currency": "USD", "amount": "11956.09"}}, {"messages":
104
+ [{"message": "INT MED AND RX,GYN OFFICE VS,DED INCLUDED IN OOP,GYN VISIT,SPEC
105
+ OFFICE,SPEC VISIT,PRIME CARE VST"}], "in_plan_network": "N", "eligibility_date":
106
+ "Tue Jan 1 00:00:00 2013", "coverage_level_code": "IND", "time_period": "Calendar
107
+ Year", "coverage_level": "Individual", "benefit_amount": {"currency": "USD",
108
+ "amount": "6000"}}, {"messages": [{"message": "INT MED AND RX"}], "in_plan_network":
109
+ "N", "coverage_level_code": "IND", "time_period": "Remaining", "coverage_level":
110
+ "Individual", "benefit_amount": {"currency": "USD", "amount": "5983.57"}}],
111
+ "plan_begin_date": "Fri Feb 15 00:00:00 2013", "eligibility_begin_date": "Wed
112
+ Feb 1 00:00:00 2012", "coinsurance": [{"service_type_codes": ["98"], "service_types":
113
+ ["Professional (Physician) Visit - Office"], "benefit_percent": 0.0, "messages":
114
+ [{"message": "GYN OFFICE VS"}, {"message": "GYN VISIT"}, {"message": "SPEC
115
+ OFFICE"}, {"message": "SPEC VISIT"}, {"message": "PRIMARY OFFICE"}, {"message":
116
+ "PRIME CARE VST"}], "in_plan_network": "Y", "coverage_level_code": "ESP",
117
+ "coverage_level": "Employee and Spouse"}, {"service_type_codes": ["98"], "service_types":
118
+ ["Professional (Physician) Visit - Office"], "benefit_percent": 0.5, "messages":
119
+ [{"message": "GYN OFFICE VS,COINS APPLIES TO OUT OF POCKET"}, {"message":
120
+ "GYN VISIT,COINS APPLIES TO OUT OF POCKET"}, {"message": "SPEC OFFICE,COINS
121
+ APPLIES TO OUT OF POCKET"}, {"message": "SPEC VISIT,COINS APPLIES TO OUT OF
122
+ POCKET"}, {"message": "PRIME CARE VST,COINS APPLIES TO OUT OF POCKET"}], "in_plan_network":
123
+ "N", "coverage_level_code": "ESP", "coverage_level": "Employee and Spouse"}],
124
+ "group_description": "MOCK INDIVIDUAL ADVANTAGE PLAN", "plan_number": "0888188",
125
+ "service_date": "Sat Aug 10 00:00:00 2013"}, "member_last_name": "DOE", "service_types":
126
+ ["Professional (Physician) Visit - Office"], "insert_dt": "Tue Jun 3 20:30:50
127
+ 2014", "major_version": "3", "member_birth_date": "Wed May 21 00:00:00 1975",
128
+ "member_id": "W34237875729", "_id": "538e307a56c02c5ec9749550"}}'
129
+ http_version:
130
+ recorded_at: Tue, 03 Jun 2014 20:30:50 GMT
131
+ recorded_with: VCR 2.9.2
data/vcr_cassettes/enrollment.yml ADDED
@@ -0,0 +1,85 @@
1
+ ---
2
+ http_interactions:
3
+ - request:
4
+ method: post
5
+ uri: http://localhost:5002/api/v3/enrollment/
6
+ body:
7
+ encoding: UTF-8
8
+ string: '{"action":"Change","client_id":"x12parse","correlation_id":"123456789","deleted":false,"dependents":[],"insert_dt":"Wed
9
+ Mar 26 22:18:47 2014","payer":{"tax_id":"654456654"},"purpose":"Original","reference_number":"12456","sponsor":{"tax_id":"999888777"},"subscriber":{"address":{"city":"CAMP
10
+ HILL","county":"CUMBERLAND","line":"100 MARKET ST","line2":"APT 3G","postal_code":"17011","state":"PA"},"benefit_status":"Active","benefits":[{"begin_date":"Sat
11
+ Jun 1 00:00:00 1996","benefit_type":"Health","coordination_of_benefits":[{"group_or_policy_number":"890111","payer_responsibility":"Primary","status":"Unknown"}],"late_enrollment":false,"maintenance_type":"Addition"},{"begin_date":"Sat
12
+ Jun 1 00:00:00 1996","benefit_type":"Dental","late_enrollment":false,"maintenance_type":"Addition"},{"begin_date":"Sat
13
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