pokitdok-ruby 0.3.1 → 0.4.0
This diff represents the content of publicly available package versions that have been released to one of the supported registries. The information contained in this diff is provided for informational purposes only and reflects changes between package versions as they appear in their respective public registries.
- checksums.yaml +4 -4
- data/Gemfile.lock +19 -17
- data/README.md +53 -1
- data/VERSION +1 -1
- data/lib/pokitdok.rb +9 -1
- data/pokitdok-ruby.gemspec +5 -3
- data/spec/pokitdok_spec.rb +19 -6
- data/vcr_cassettes/activities.yml +1464 -343
- data/vcr_cassettes/auth.yml +5 -5
- data/vcr_cassettes/cash_prices.yml +42 -0
- data/vcr_cassettes/claims.yml +21 -20
- data/vcr_cassettes/eligibility.yml +8 -8
- data/vcr_cassettes/enrollment.yml +9 -9
- data/vcr_cassettes/files.yml +9 -9
- data/vcr_cassettes/insurance_prices.yml +42 -0
- data/vcr_cassettes/payers.yml +490 -96
- data/vcr_cassettes/providers.yml +25 -471
- metadata +4 -2
checksums.yaml
CHANGED
|
@@ -1,7 +1,7 @@
|
|
|
1
1
|
---
|
|
2
2
|
SHA1:
|
|
3
|
-
metadata.gz:
|
|
4
|
-
data.tar.gz:
|
|
3
|
+
metadata.gz: 68f585a9559068bd2afbfd05fd76bb3dadf1461e
|
|
4
|
+
data.tar.gz: 3d7982261da30902e009e7cdf145f02bc9c0ab5a
|
|
5
5
|
SHA512:
|
|
6
|
-
metadata.gz:
|
|
7
|
-
data.tar.gz:
|
|
6
|
+
metadata.gz: 8b2523ddda0205dd2758866800989a5ddf2d7476974e064813cac3479ce4e0b92291733a5fc41909467765ebe00f6827a46a6135a6fa137df3455a53d8c57cdf
|
|
7
|
+
data.tar.gz: 85411ae97b385dfcf20b3c88ba98ed007ea3f74b53d310fa74717e762366b8360e272a86bca6fff3b420ccae56f13116e799e7e9e886fe7b3a15035a2e3ad081
|
data/Gemfile.lock
CHANGED
|
@@ -18,12 +18,12 @@ GEM
|
|
|
18
18
|
safe_yaml (~> 1.0.0)
|
|
19
19
|
descendants_tracker (0.0.4)
|
|
20
20
|
thread_safe (~> 0.3, >= 0.3.1)
|
|
21
|
-
docile (1.1.
|
|
21
|
+
docile (1.1.5)
|
|
22
22
|
faraday (0.9.0)
|
|
23
23
|
multipart-post (>= 1.2, < 3)
|
|
24
24
|
ffi (1.9.3)
|
|
25
25
|
formatador (0.2.5)
|
|
26
|
-
git (1.2.
|
|
26
|
+
git (1.2.7)
|
|
27
27
|
github_api (0.11.3)
|
|
28
28
|
addressable (~> 2.3)
|
|
29
29
|
descendants_tracker (~> 0.0.1)
|
|
@@ -38,13 +38,13 @@ GEM
|
|
|
38
38
|
lumberjack (~> 1.0)
|
|
39
39
|
pry (>= 0.9.12)
|
|
40
40
|
thor (>= 0.18.1)
|
|
41
|
-
guard-minitest (2.3.
|
|
41
|
+
guard-minitest (2.3.1)
|
|
42
42
|
guard (~> 2.0)
|
|
43
43
|
minitest (>= 3.0)
|
|
44
44
|
guard-rubocop (1.1.0)
|
|
45
45
|
guard (~> 2.0)
|
|
46
46
|
rubocop (~> 0.20)
|
|
47
|
-
hashie (3.
|
|
47
|
+
hashie (3.1.0)
|
|
48
48
|
highline (1.6.21)
|
|
49
49
|
jeweler (2.0.1)
|
|
50
50
|
builder
|
|
@@ -57,17 +57,17 @@ GEM
|
|
|
57
57
|
rdoc
|
|
58
58
|
json (1.8.1)
|
|
59
59
|
jwt (1.0.0)
|
|
60
|
-
listen (2.7.
|
|
60
|
+
listen (2.7.9)
|
|
61
61
|
celluloid (>= 0.15.2)
|
|
62
62
|
rb-fsevent (>= 0.9.3)
|
|
63
63
|
rb-inotify (>= 0.9)
|
|
64
|
-
lumberjack (1.0.
|
|
64
|
+
lumberjack (1.0.9)
|
|
65
65
|
metaclass (0.0.4)
|
|
66
66
|
method_source (0.8.2)
|
|
67
67
|
mime-types (2.3)
|
|
68
68
|
mini_portile (0.6.0)
|
|
69
|
-
minitest (5.
|
|
70
|
-
minitest-reporters (1.0.
|
|
69
|
+
minitest (5.4.0)
|
|
70
|
+
minitest-reporters (1.0.5)
|
|
71
71
|
ansi
|
|
72
72
|
builder
|
|
73
73
|
minitest (>= 5.0)
|
|
@@ -77,6 +77,7 @@ GEM
|
|
|
77
77
|
multi_json (1.10.1)
|
|
78
78
|
multi_xml (0.5.5)
|
|
79
79
|
multipart-post (2.0.0)
|
|
80
|
+
netrc (0.7.7)
|
|
80
81
|
nokogiri (1.6.2.1)
|
|
81
82
|
mini_portile (= 0.6.0)
|
|
82
83
|
oauth2 (0.9.4)
|
|
@@ -85,27 +86,28 @@ GEM
|
|
|
85
86
|
multi_json (~> 1.3)
|
|
86
87
|
multi_xml (~> 0.5)
|
|
87
88
|
rack (~> 1.2)
|
|
88
|
-
parser (2.
|
|
89
|
+
parser (2.2.0.pre.3)
|
|
89
90
|
ast (>= 1.1, < 3.0)
|
|
90
91
|
slop (~> 3.4, >= 3.4.5)
|
|
91
92
|
powerpack (0.0.9)
|
|
92
|
-
pry (0.
|
|
93
|
-
coderay (~> 1.0)
|
|
94
|
-
method_source (~> 0.8)
|
|
93
|
+
pry (0.10.0)
|
|
94
|
+
coderay (~> 1.1.0)
|
|
95
|
+
method_source (~> 0.8.1)
|
|
95
96
|
slop (~> 3.4)
|
|
96
97
|
rack (1.5.2)
|
|
97
98
|
rainbow (2.0.0)
|
|
98
99
|
rake (10.3.2)
|
|
99
100
|
rb-fsevent (0.9.4)
|
|
100
|
-
rb-inotify (0.9.
|
|
101
|
+
rb-inotify (0.9.5)
|
|
101
102
|
ffi (>= 0.5.0)
|
|
102
103
|
rdoc (4.1.1)
|
|
103
104
|
json (~> 1.4)
|
|
104
|
-
rest-client (1.
|
|
105
|
-
mime-types (
|
|
106
|
-
|
|
105
|
+
rest-client (1.7.0)
|
|
106
|
+
mime-types (~> 2.0)
|
|
107
|
+
netrc (~> 0.7)
|
|
108
|
+
rubocop (0.24.1)
|
|
107
109
|
json (>= 1.7.7, < 2)
|
|
108
|
-
parser (
|
|
110
|
+
parser (>= 2.2.0.pre.3, < 3.0)
|
|
109
111
|
powerpack (~> 0.0.6)
|
|
110
112
|
rainbow (>= 1.99.1, < 3.0)
|
|
111
113
|
ruby-progressbar (~> 1.4)
|
data/README.md
CHANGED
|
@@ -55,7 +55,53 @@ pd.providers(zipcode: '29307', radius: '10mi', specialty: 'RHEUMATOLOGY')
|
|
|
55
55
|
trading_partner_id: 'MOCKPAYER'
|
|
56
56
|
}
|
|
57
57
|
|
|
58
|
-
pd.eligibility
|
|
58
|
+
pd.eligibility @eligibility_query
|
|
59
|
+
|
|
60
|
+
# Claim
|
|
61
|
+
@claim = {
|
|
62
|
+
transaction_code: 'chargeable',
|
|
63
|
+
trading_partner_id: 'MOCKPAYER',
|
|
64
|
+
billing_provider: {
|
|
65
|
+
taxonomy_code: '207Q00000X',
|
|
66
|
+
first_name: 'Jerome',
|
|
67
|
+
last_name: 'Aya-Ay',
|
|
68
|
+
npi: '1467560003',
|
|
69
|
+
address: {
|
|
70
|
+
address_lines: ['8311 WARREN H ABERNATHY HWY'],
|
|
71
|
+
city: 'SPARTANBURG',
|
|
72
|
+
state: 'SC',
|
|
73
|
+
zipcode: '29301'
|
|
74
|
+
},
|
|
75
|
+
tax_id: '123456789'
|
|
76
|
+
},
|
|
77
|
+
subscriber: {
|
|
78
|
+
first_name: 'Jane',
|
|
79
|
+
last_name: 'Doe',
|
|
80
|
+
member_id: 'W000000000',
|
|
81
|
+
address: {
|
|
82
|
+
address_lines: ['123 N MAIN ST'],
|
|
83
|
+
city: 'SPARTANBURG',
|
|
84
|
+
state: 'SC',
|
|
85
|
+
zipcode: '29301'
|
|
86
|
+
},
|
|
87
|
+
birth_date: '1970-01-01',
|
|
88
|
+
gender: 'female'
|
|
89
|
+
},
|
|
90
|
+
claim: {
|
|
91
|
+
total_charge_amount: 60.0,
|
|
92
|
+
service_lines: [
|
|
93
|
+
{
|
|
94
|
+
procedure_code: '99213',
|
|
95
|
+
charge_amount: 60.0,
|
|
96
|
+
unit_count: 1.0,
|
|
97
|
+
diagnosis_codes: ['487.1'],
|
|
98
|
+
service_date: '2014-06-01'
|
|
99
|
+
}
|
|
100
|
+
]
|
|
101
|
+
}
|
|
102
|
+
}
|
|
103
|
+
|
|
104
|
+
pd.claim @claim
|
|
59
105
|
|
|
60
106
|
# Retrieve an index of activities
|
|
61
107
|
pd.activities
|
|
@@ -68,6 +114,12 @@ pd.activities(parent_id: '537cd4b240b35755f5128d5c')
|
|
|
68
114
|
|
|
69
115
|
# Upload an EDI file
|
|
70
116
|
pd.files('trading_partner_id', 'path/to/a_file.edi')
|
|
117
|
+
|
|
118
|
+
# Get cash prices
|
|
119
|
+
pd.cash_prices(cpt_code: '87799', zip_code: '75201')
|
|
120
|
+
|
|
121
|
+
# Get insurance prices
|
|
122
|
+
pd.insurance_prices(cpt_code: '87799', zip_code: '29403')
|
|
71
123
|
|
|
72
124
|
```
|
|
73
125
|
|
data/VERSION
CHANGED
|
@@ -1 +1 @@
|
|
|
1
|
-
0.
|
|
1
|
+
0.4.0
|
data/lib/pokitdok.rb
CHANGED
|
@@ -74,7 +74,15 @@ module PokitDok
|
|
|
74
74
|
|
|
75
75
|
# Invokes the cash prices endpoint, with an optional Hash of parameters.
|
|
76
76
|
def cash_prices(params = {})
|
|
77
|
-
response = @token.get('
|
|
77
|
+
response = @token.get('prices/cash',
|
|
78
|
+
headers: headers,
|
|
79
|
+
params: params)
|
|
80
|
+
JSON.parse(response.body)
|
|
81
|
+
end
|
|
82
|
+
|
|
83
|
+
# Invokes the insurance prices endpoint, with an optional Hash of parameters.
|
|
84
|
+
def insurance_prices(params = {})
|
|
85
|
+
response = @token.get('prices/insurance',
|
|
78
86
|
headers: headers,
|
|
79
87
|
params: params)
|
|
80
88
|
JSON.parse(response.body)
|
data/pokitdok-ruby.gemspec
CHANGED
|
@@ -2,16 +2,16 @@
|
|
|
2
2
|
# DO NOT EDIT THIS FILE DIRECTLY
|
|
3
3
|
# Instead, edit Jeweler::Tasks in Rakefile, and run 'rake gemspec'
|
|
4
4
|
# -*- encoding: utf-8 -*-
|
|
5
|
-
# stub: pokitdok-ruby 0.
|
|
5
|
+
# stub: pokitdok-ruby 0.4.0 ruby lib
|
|
6
6
|
|
|
7
7
|
Gem::Specification.new do |s|
|
|
8
8
|
s.name = "pokitdok-ruby"
|
|
9
|
-
s.version = "0.
|
|
9
|
+
s.version = "0.4.0"
|
|
10
10
|
|
|
11
11
|
s.required_rubygems_version = Gem::Requirement.new(">= 0") if s.respond_to? :required_rubygems_version=
|
|
12
12
|
s.require_paths = ["lib"]
|
|
13
13
|
s.authors = ["John Riney"]
|
|
14
|
-
s.date = "2014-
|
|
14
|
+
s.date = "2014-07-08"
|
|
15
15
|
s.description = "Gem for easy access to the PokitDok Platform APIs."
|
|
16
16
|
s.email = "john.riney@pokitdok.com"
|
|
17
17
|
s.extra_rdoc_files = [
|
|
@@ -38,10 +38,12 @@ Gem::Specification.new do |s|
|
|
|
38
38
|
"spec/vcr_setup.rb",
|
|
39
39
|
"vcr_cassettes/activities.yml",
|
|
40
40
|
"vcr_cassettes/auth.yml",
|
|
41
|
+
"vcr_cassettes/cash_prices.yml",
|
|
41
42
|
"vcr_cassettes/claims.yml",
|
|
42
43
|
"vcr_cassettes/eligibility.yml",
|
|
43
44
|
"vcr_cassettes/enrollment.yml",
|
|
44
45
|
"vcr_cassettes/files.yml",
|
|
46
|
+
"vcr_cassettes/insurance_prices.yml",
|
|
45
47
|
"vcr_cassettes/payers.yml",
|
|
46
48
|
"vcr_cassettes/providers.yml"
|
|
47
49
|
]
|
data/spec/pokitdok_spec.rb
CHANGED
|
@@ -2,8 +2,8 @@
|
|
|
2
2
|
|
|
3
3
|
require 'spec_helper'
|
|
4
4
|
|
|
5
|
-
CLIENT_ID = '
|
|
6
|
-
CLIENT_SECRET = '
|
|
5
|
+
CLIENT_ID = '2MBlqahR2xiaBtVSS50n'
|
|
6
|
+
CLIENT_SECRET = 'FJaN1fyB1V5q7qPLNrb2F6yV1Xkaui0OB6eXotOS'
|
|
7
7
|
POKITDOK_TEST_URL = 'http://localhost:5002'
|
|
8
8
|
|
|
9
9
|
def check_meta_and_data(result)
|
|
@@ -57,7 +57,6 @@ describe PokitDok do
|
|
|
57
57
|
|
|
58
58
|
describe 'Cash Prices endpoint' do
|
|
59
59
|
it 'should expose the cash prices endpoint' do
|
|
60
|
-
skip 'in development'
|
|
61
60
|
query = { cpt_code: '12345', zip_code: '75201' }
|
|
62
61
|
|
|
63
62
|
VCR.use_cassette 'cash_prices' do
|
|
@@ -69,6 +68,20 @@ describe PokitDok do
|
|
|
69
68
|
end
|
|
70
69
|
end
|
|
71
70
|
|
|
71
|
+
describe 'Insurance Prices endpoint' do
|
|
72
|
+
it 'should expose the insurance prices endpoint' do
|
|
73
|
+
query = { cpt_code: '12345', zip_code: '75201' }
|
|
74
|
+
|
|
75
|
+
VCR.use_cassette 'insurance_prices' do
|
|
76
|
+
@prices = @pokitdok.insurance_prices query
|
|
77
|
+
end
|
|
78
|
+
|
|
79
|
+
check_meta_and_data @prices
|
|
80
|
+
refute_empty @prices['data']
|
|
81
|
+
end
|
|
82
|
+
end
|
|
83
|
+
|
|
84
|
+
|
|
72
85
|
describe 'Claims endpoint' do
|
|
73
86
|
it 'should expose the claims endpoint' do
|
|
74
87
|
query = JSON.parse(IO.read('spec/fixtures/claim.json'))
|
|
@@ -146,13 +159,13 @@ describe PokitDok do
|
|
|
146
159
|
|
|
147
160
|
check_meta_and_data @payers
|
|
148
161
|
refute_nil @payers['data']
|
|
149
|
-
@payers['data'].size.must_equal
|
|
162
|
+
@payers['data'].size.must_equal 224
|
|
150
163
|
end
|
|
151
164
|
end
|
|
152
165
|
|
|
153
166
|
describe 'Providers endpoint' do
|
|
154
167
|
it 'should expose the providers endpoint' do
|
|
155
|
-
query = {
|
|
168
|
+
query = { npi: '1467560003' }
|
|
156
169
|
|
|
157
170
|
VCR.use_cassette 'providers' do
|
|
158
171
|
@providers = @pokitdok.providers(query)
|
|
@@ -160,7 +173,7 @@ describe PokitDok do
|
|
|
160
173
|
|
|
161
174
|
check_meta_and_data @providers
|
|
162
175
|
refute_nil @providers['data']
|
|
163
|
-
@providers['data'].size.must_equal
|
|
176
|
+
@providers['data'].size.must_equal 1
|
|
164
177
|
end
|
|
165
178
|
end
|
|
166
179
|
end
|
|
@@ -10,7 +10,7 @@ http_interactions:
|
|
|
10
10
|
User-Agent:
|
|
11
11
|
- pokitdok-ruby 0.4 ruby 2.1.1p76 (2014-02-24 revision 45161) [x86_64-darwin13.0]
|
|
12
12
|
Authorization:
|
|
13
|
-
- Bearer
|
|
13
|
+
- Bearer IVfoTbbbimnTM3DKVGPCpicTPYThOAazPSbAnLA0
|
|
14
14
|
Accept-Encoding:
|
|
15
15
|
- gzip;q=1.0,deflate;q=0.6,identity;q=0.3
|
|
16
16
|
Accept:
|
|
@@ -23,7 +23,7 @@ http_interactions:
|
|
|
23
23
|
Content-Type:
|
|
24
24
|
- text/html; charset=utf-8
|
|
25
25
|
Content-Length:
|
|
26
|
-
- '
|
|
26
|
+
- '119841'
|
|
27
27
|
Mimetype:
|
|
28
28
|
- application/json
|
|
29
29
|
Charset:
|
|
@@ -31,351 +31,1472 @@ http_interactions:
|
|
|
31
31
|
Server:
|
|
32
32
|
- Werkzeug/0.9.4 Python/2.7.3
|
|
33
33
|
Date:
|
|
34
|
-
-
|
|
34
|
+
- Tue, 08 Jul 2014 16:27:12 GMT
|
|
35
35
|
body:
|
|
36
36
|
encoding: UTF-8
|
|
37
|
-
string: '{"meta": {"processing_time":
|
|
38
|
-
|
|
39
|
-
"rate_limit_cap": 8434}, "data": [{"units_of_work": 1, "name": "
|
|
40
|
-
{"
|
|
41
|
-
"
|
|
42
|
-
"
|
|
43
|
-
"
|
|
44
|
-
"
|
|
45
|
-
1, "name": "providers", "parameters": {"member_name": "Junior Spencer", "service_types":
|
|
46
|
-
["Health Benefit Plan Coverage"], "client_id": "4nhMZTpLxBxmiocveVb5", "update_dt":
|
|
47
|
-
"Tue Jun 3 16:07:20 2014", "deleted": false, "payer_name": "Mock Payer for
|
|
48
|
-
Testing", "major_version": "3", "provider_id": "314087243", "control_number":
|
|
49
|
-
"000000001", "correlation_id": "3fb9a7b3-d83b-48d6-bc3e-50c87c5d10d4", "version":
|
|
50
|
-
"3.0.0", "member_first_name": "Junior", "trading_partner_id": "MOCKPAYER",
|
|
51
|
-
"member_id": "762008086", "member_last_name": "Spencer", "provider_name":
|
|
52
|
-
"Heathcote, Fahey and McCullough", "member_birth_date": "Sat Jan 6 00:00:00
|
|
53
|
-
1990", "insert_dt": "Tue Jun 3 16:07:20 2014", "provider_type": "Non-Person
|
|
54
|
-
Entity"}, "remaining_transitions": ["wait", "receive", "process", "complete"],
|
|
55
|
-
"state": {"name": "failed", "title": "Failed"}, "trading_partner_id": "MOCKPAYER",
|
|
56
|
-
"id": "538df2b856c02c36fb6c2f05", "transition_path": ["generate", "transmit",
|
|
57
|
-
"wait", "receive", "process", "complete"], "history": [{"record_dt": "2014-06-03T16:07:20.886000",
|
|
58
|
-
"name": "init", "title": "Initializing"}, {"record_dt": "2014-06-03T16:07:20.924000",
|
|
59
|
-
"name": "generating", "title": "Generating X12 transactions"}]}, {"units_of_work":
|
|
60
|
-
1, "name": "providers", "parameters": {"claim": {"dates": [{"date_value":
|
|
61
|
-
"Tue Apr 15 00:00:00 2014", "date_qualifier": "Onset of Symptom or Illness"}],
|
|
62
|
-
"facility_code_value": "11", "claim_total_amount": {"currency": "USD", "amount":
|
|
63
|
-
"40.0"}, "health_care_codes": [{"health_care_code_1": "BK:0340", "health_care_code_2":
|
|
64
|
-
"BF:V7389"}], "assignment_code": "Assigned", "information_release_code": "Informed
|
|
65
|
-
Consent", "facility_code_qualifier": "B", "benefit_assignment_code": "Yes",
|
|
66
|
-
"claim_frequency_code": "1", "provider_signature_on_file": "Y", "service_lines":
|
|
67
|
-
[{"medical_service_unit": "Unit", "medical_service_quantity": "1.0", "medical_procedure_identifier":
|
|
68
|
-
"HC:99213", "dates": [{"date_value": "Wed Apr 16 00:00:00 2014", "date_qualifier":
|
|
69
|
-
"Service Date"}], "medical_diagnosis_code": "1", "medical_charge_amount":
|
|
70
|
-
{"currency": "USD", "amount": "40.0"}}], "ref": [{"id_type": "Claim Number",
|
|
71
|
-
"id_code": "1234567890"}], "patient_control_number": "26462967"}, "transaction_purpose_code":
|
|
72
|
-
"Original", "payer": {"id_code": "HPHC", "entity_identifier": "Payer", "id_type":
|
|
73
|
-
"Payor Identification", "last_org_name": "HARVARD PILGRIM HEALTH CARE", "entity_type":
|
|
74
|
-
"Non-Person"}, "update_dt": "Tue Jun 3 17:28:32 2014", "deleted": false,
|
|
75
|
-
"major_version": "3", "transaction_type": "Reporting", "subscriber": {"city":
|
|
76
|
-
"BURLINGTON", "first_name": "TED", "entity_identifier": "Subscriber", "last_org_name":
|
|
77
|
-
"SMITH", "entity_type": "Person", "group_number": "12312-A", "gender_code":
|
|
78
|
-
"Male", "id_code": "HP123456700", "relationship_code": "Self", "is_patient":
|
|
79
|
-
true, "state": "MA", "payer_responsibility": "Primary", "id_type": "Member
|
|
80
|
-
ID", "birth_date": "Sat May 1 00:00:00 1943", "postal_code": "01803", "claim_filing_code":
|
|
81
|
-
"Health Maintenance Organization", "address_line_1": "123 MAIN ST"}, "correlation_id":
|
|
82
|
-
"11e00a63-959d-4686-be9c-3438a97797de", "version": "3.0.0", "client_id": "4nhMZTpLxBxmiocveVb5",
|
|
83
|
-
"trading_partner_id": "MOCKPAYER", "receiver": {"id_code": "HPHC", "entity_identifier":
|
|
84
|
-
"Receiver", "id_type": "ETIN", "last_org_name": "HPHC", "entity_type": "Non-Person"},
|
|
85
|
-
"submitter": {"id_code": "123456789", "entity_identifier": "Submitter", "id_type":
|
|
86
|
-
"ETIN", "last_org_name": "ACME, INC.", "entity_type": "Non-Person"}, "billing_provider":
|
|
87
|
-
{"city": "BURLINGTON", "entity_identifier": "Billing Provider", "last_org_name":
|
|
88
|
-
"KATIE BRADFORD", "entity_type": "Non-Person", "provider_id_type": "Provider
|
|
89
|
-
Taxonomy Code", "id_code": "1730240128", "state": "MA", "provider_id_code":
|
|
90
|
-
"133V00000X", "postal_code": "018033744", "id_type": "NPI", "provider_code":
|
|
91
|
-
"Billing", "ref": [{"id_type": "Employee Identification Number", "id_code":
|
|
92
|
-
"587654321"}], "address_line_1": "418 FARMS DR"}, "insert_dt": "Tue Jun 3
|
|
93
|
-
17:28:32 2014", "app_transaction_id": "00000000001"}, "remaining_transitions":
|
|
94
|
-
["generate", "transmit", "wait", "receive", "process", "complete"], "state":
|
|
95
|
-
{"name": "pending", "title": "Pending Batch Transmission to Trading Partner"},
|
|
96
|
-
"trading_partner_id": "MOCKPAYER", "id": "538e05c056c02c40598300e3", "transition_path":
|
|
97
|
-
["batch", "generate", "transmit", "wait", "receive", "process", "complete"],
|
|
98
|
-
"history": [{"record_dt": "2014-06-03T17:28:32.202000", "name": "init", "title":
|
|
99
|
-
"Initializing"}]}, {"units_of_work": 1, "name": "providers", "parameters":
|
|
100
|
-
{"state": "CA"}, "state": {"name": "completed", "title": "Completed"}, "trading_partner_id":
|
|
101
|
-
"PokitDok", "id": "538e05c156c02c40598300e6", "transition_path": ["process",
|
|
102
|
-
"complete"], "history": [{"record_dt": "2014-06-03T17:28:33.074000", "name":
|
|
103
|
-
"init", "title": "Initializing"}, {"record_dt": "2014-06-03T17:28:33.124000",
|
|
104
|
-
"name": "processing", "title": "Processing X12 transactions"}]}, {"units_of_work":
|
|
105
|
-
1, "name": "cash_prices", "parameters": {"state": "CA"}, "state": {"name":
|
|
106
|
-
"completed", "title": "Completed"}, "trading_partner_id": "PokitDok", "id":
|
|
107
|
-
"538e06a456c02c40598300e8", "transition_path": ["process", "complete"], "history":
|
|
108
|
-
[{"record_dt": "2014-06-03T17:32:20.282000", "name": "init", "title": "Initializing"},
|
|
109
|
-
{"record_dt": "2014-06-03T17:32:20.313000", "name": "processing", "title":
|
|
110
|
-
"Processing X12 transactions"}]}, {"units_of_work": 1, "name": "providers",
|
|
111
|
-
"parameters": {"state": "CA"}, "state": {"name": "completed", "title": "Completed"},
|
|
112
|
-
"trading_partner_id": "PokitDok", "id": "5390d0e456c02c563bc2e060", "transition_path":
|
|
113
|
-
["process", "complete"], "history": [{"record_dt": "2014-06-05T20:19:48.433000",
|
|
114
|
-
"name": "init", "title": "Initializing"}, {"record_dt": "2014-06-05T20:19:48.453000",
|
|
115
|
-
"name": "processing", "title": "Processing X12 transactions"}]}, {"units_of_work":
|
|
116
|
-
1, "name": "enrollment", "parameters": {"state": "CA"}, "state": {"name":
|
|
117
|
-
"completed", "title": "Completed"}, "trading_partner_id": "PokitDok", "id":
|
|
118
|
-
"538e07f456c02c40598300eb", "transition_path": ["process", "complete"], "history":
|
|
119
|
-
[{"record_dt": "2014-06-03T17:37:56.351000", "name": "init", "title": "Initializing"},
|
|
120
|
-
{"record_dt": "2014-06-03T17:37:56.383000", "name": "processing", "title":
|
|
121
|
-
"Processing X12 transactions"}]}, {"units_of_work": 1, "name": "providers",
|
|
37
|
+
string: '{"meta": {"processing_time": 352, "rate_limit_amount": 12, "rate_limit_reset":
|
|
38
|
+
1404840303, "next": "http://localhost:5002/api/v4/activities/?offset=20",
|
|
39
|
+
"rate_limit_cap": 8434}, "data": [{"units_of_work": 1, "name": "payers", "state":
|
|
40
|
+
{"name": "completed", "title": "Completed"}, "trading_partner_id": "PokitDok",
|
|
41
|
+
"id": "53bc1b9856c02c08ce81adf6", "transition_path": ["process", "complete"],
|
|
42
|
+
"history": [{"record_dt": "2014-07-08T16:26:00.843000", "name": "init", "title":
|
|
43
|
+
"Initializing"}, {"record_dt": "2014-07-08T16:26:00.857000", "name": "processing",
|
|
44
|
+
"title": "Processing X12 transactions"}]}, {"units_of_work": 1, "name": "providers",
|
|
122
45
|
"parameters": {"state": "CA"}, "state": {"name": "completed", "title": "Completed"},
|
|
123
|
-
"trading_partner_id": "PokitDok", "id": "
|
|
124
|
-
["process", "complete"], "history": [{"record_dt": "2014-
|
|
125
|
-
"name": "init", "title": "Initializing"}, {"record_dt": "2014-
|
|
46
|
+
"trading_partner_id": "PokitDok", "id": "53bc1b9956c02c08ce81adfc", "transition_path":
|
|
47
|
+
["process", "complete"], "history": [{"record_dt": "2014-07-08T16:26:01.884000",
|
|
48
|
+
"name": "init", "title": "Initializing"}, {"record_dt": "2014-07-08T16:26:02.932000",
|
|
126
49
|
"name": "processing", "title": "Processing X12 transactions"}]}, {"units_of_work":
|
|
127
|
-
1, "name": "
|
|
128
|
-
"
|
|
129
|
-
|
|
130
|
-
"
|
|
50
|
+
1, "name": "enrollment", "parameters": {"service_types": ["health_benefit_plan_coverage"],
|
|
51
|
+
"trading_partner_id": "MOCKPAYER", "payer": {"id": "MOCKPAYER", "name": "Mockpayer
|
|
52
|
+
For Testing"}, "member": {"birth_date": "1983-02-19", "first_name": "Nicklaus",
|
|
53
|
+
"last_name": "Stanton", "plan_start_date": "2013-08-10", "id": "642531785"},
|
|
54
|
+
"correlation_id": "1d84a585-e10b-439f-8b51-628e1461acce", "client_id": "2MBlqahR2xiaBtVSS50n",
|
|
55
|
+
"provider": {"first_name": "Kadin", "last_name": "Cruickshank", "npi": "0646364168"},
|
|
56
|
+
"async": false, "transaction_code": "request"}, "state": {"name": "completed",
|
|
57
|
+
"title": "Completed"}, "result": {"service_types": ["professional_physician_visit_office"],
|
|
58
|
+
"client_id": "2MBlqahR2xiaBtVSS50n", "payer": {"id": "MOCKPAYER", "name":
|
|
59
|
+
"MOCK PAYER INC"}, "subscriber": {"birth_date": "1983-02-19", "first_name":
|
|
60
|
+
"Nicklaus", "last_name": "Stanton", "id": "642531785", "address": {"city":
|
|
61
|
+
"SPARTANBURG", "state": "SC", "zipcode": "29307", "address_lines": ["123 MAIN
|
|
62
|
+
ST"]}}, "correlation_id": "1d84a585-e10b-439f-8b51-628e1461acce", "trading_partner_id":
|
|
63
|
+
"MOCKPAYER", "provider": {"first_name": "Kadin", "last_name": "Kadin Cruickshank",
|
|
64
|
+
"npi": "0646364168"}, "coverage": {"service_types": ["professional_physician_visit_office"],
|
|
65
|
+
"group_number": "088818801000013", "out_of_pocket": [{"in_plan_network": "yes",
|
|
66
|
+
"benefit_amount": {"currency": "USD", "amount": "3000"}, "coverage_level":
|
|
67
|
+
"individual"}, {"in_plan_network": "yes", "benefit_amount": {"currency": "USD",
|
|
68
|
+
"amount": "2983.57"}, "coverage_level": "individual", "time_period": "remaining"},
|
|
69
|
+
{"in_plan_network": "yes", "benefit_amount": {"currency": "USD", "amount":
|
|
70
|
+
"6000"}, "coverage_level": "family"}, {"in_plan_network": "yes", "benefit_amount":
|
|
71
|
+
{"currency": "USD", "amount": "5956.09"}, "coverage_level": "family", "time_period":
|
|
72
|
+
"remaining"}, {"in_plan_network": "no", "benefit_amount": {"currency": "USD",
|
|
73
|
+
"amount": "12500"}, "coverage_level": "individual"}, {"in_plan_network": "no",
|
|
74
|
+
"benefit_amount": {"currency": "USD", "amount": "12483.57"}, "coverage_level":
|
|
75
|
+
"individual", "time_period": "remaining"}, {"in_plan_network": "no", "benefit_amount":
|
|
76
|
+
{"currency": "USD", "amount": "25000"}, "coverage_level": "family"}, {"in_plan_network":
|
|
77
|
+
"no", "benefit_amount": {"currency": "USD", "amount": "24956.09"}, "coverage_level":
|
|
78
|
+
"family", "messages": [{"message": "Unlimited Lifetime Benefits"}], "time_period":
|
|
79
|
+
"remaining"}], "level": "employee_and_spouse", "copay": [{"in_plan_network":
|
|
80
|
+
"yes", "service_types": ["professional_physician_visit_office"], "coverage_level":
|
|
81
|
+
"employee_and_spouse", "messages": [{"message": "PRIMARY OFFICE"}]}, {"in_plan_network":
|
|
82
|
+
"not_applicable", "service_types": ["professional_physician_visit_office"],
|
|
83
|
+
"coverage_level": "employee_and_spouse", "messages": [{"message": "GYN OFFICE
|
|
84
|
+
VS"}, {"message": "GYN VISIT"}, {"message": "SPEC OFFICE"}, {"message": "SPEC
|
|
85
|
+
VISIT"}, {"message": "PRIME CARE VST"}, {"message": "Plan Requires PreCert"},
|
|
86
|
+
{"message": "Commercial"}, {"message": "Plan includes NAP"}, {"message": "Pre-Existing
|
|
87
|
+
may apply"}]}], "deductibles": [{"messages": [{"message": "INT MED AND RX,GYN
|
|
88
|
+
OFFICE VS,DED INCLUDED IN OOP,GYN VISIT,SPEC OFFICE,SPEC VISIT,PRIMARY OFFICE,PRIME
|
|
89
|
+
CARE VST"}], "in_plan_network": "yes", "eligibility_date": "2013-01-01", "time_period":
|
|
90
|
+
"calendar_year", "coverage_level": "family", "benefit_amount": {"currency":
|
|
91
|
+
"USD", "amount": "6000"}}, {"in_plan_network": "yes", "time_period": "remaining",
|
|
92
|
+
"coverage_level": "family", "messages": [{"message": "INT MED AND RX"}], "benefit_amount":
|
|
93
|
+
{"currency": "USD", "amount": "5956.09"}}, {"messages": [{"message": "INT
|
|
94
|
+
MED AND RX,GYN OFFICE VS,DED INCLUDED IN OOP,GYN VISIT,SPEC OFFICE,SPEC VISIT,PRIMARY
|
|
95
|
+
OFFICE,PRIME CARE VST"}], "in_plan_network": "yes", "eligibility_date": "2013-01-01",
|
|
96
|
+
"time_period": "calendar_year", "coverage_level": "individual", "benefit_amount":
|
|
97
|
+
{"currency": "USD", "amount": "3000"}}, {"in_plan_network": "yes", "time_period":
|
|
98
|
+
"remaining", "coverage_level": "individual", "messages": [{"message": "INT
|
|
99
|
+
MED AND RX"}], "benefit_amount": {"currency": "USD", "amount": "2983.57"}},
|
|
100
|
+
{"messages": [{"message": "INT MED AND RX,GYN OFFICE VS,DED INCLUDED IN OOP,GYN
|
|
101
|
+
VISIT,SPEC OFFICE,SPEC VISIT,PRIME CARE VST"}], "in_plan_network": "no", "eligibility_date":
|
|
102
|
+
"2013-01-01", "time_period": "calendar_year", "coverage_level": "family",
|
|
103
|
+
"benefit_amount": {"currency": "USD", "amount": "12000"}}, {"in_plan_network":
|
|
104
|
+
"no", "time_period": "remaining", "coverage_level": "family", "messages":
|
|
105
|
+
[{"message": "INT MED AND RX"}], "benefit_amount": {"currency": "USD", "amount":
|
|
106
|
+
"11956.09"}}, {"messages": [{"message": "INT MED AND RX,GYN OFFICE VS,DED
|
|
107
|
+
INCLUDED IN OOP,GYN VISIT,SPEC OFFICE,SPEC VISIT,PRIME CARE VST"}], "in_plan_network":
|
|
108
|
+
"no", "eligibility_date": "2013-01-01", "time_period": "calendar_year", "coverage_level":
|
|
109
|
+
"individual", "benefit_amount": {"currency": "USD", "amount": "6000"}}, {"in_plan_network":
|
|
110
|
+
"no", "time_period": "remaining", "coverage_level": "individual", "messages":
|
|
111
|
+
[{"message": "INT MED AND RX"}], "benefit_amount": {"currency": "USD", "amount":
|
|
112
|
+
"5983.57"}}], "plan_begin_date": "2013-02-15", "eligibility_begin_date": "2012-02-01",
|
|
113
|
+
"coinsurance": [{"benefit_percent": 0.0, "service_types": ["professional_physician_visit_office"],
|
|
114
|
+
"coverage_level": "employee_and_spouse", "messages": [{"message": "GYN OFFICE
|
|
115
|
+
VS"}, {"message": "GYN VISIT"}, {"message": "SPEC OFFICE"}, {"message": "SPEC
|
|
116
|
+
VISIT"}, {"message": "PRIMARY OFFICE"}, {"message": "PRIME CARE VST"}], "in_plan_network":
|
|
117
|
+
"yes"}, {"benefit_percent": 0.5, "service_types": ["professional_physician_visit_office"],
|
|
118
|
+
"coverage_level": "employee_and_spouse", "messages": [{"message": "GYN OFFICE
|
|
119
|
+
VS,COINS APPLIES TO OUT OF POCKET"}, {"message": "GYN VISIT,COINS APPLIES
|
|
120
|
+
TO OUT OF POCKET"}, {"message": "SPEC OFFICE,COINS APPLIES TO OUT OF POCKET"},
|
|
121
|
+
{"message": "SPEC VISIT,COINS APPLIES TO OUT OF POCKET"}, {"message": "PRIME
|
|
122
|
+
CARE VST,COINS APPLIES TO OUT OF POCKET"}], "in_plan_network": "no"}], "group_description":
|
|
123
|
+
"MOCK INDIVIDUAL ADVANTAGE PLAN", "plan_number": "0888188", "service_date":
|
|
124
|
+
"2013-08-10"}, "valid_request": true}, "trading_partner_id": "MOCKPAYER",
|
|
125
|
+
"id": "53bc0d2456c02c0671dde4dd", "transition_path": ["generate", "transmit",
|
|
126
|
+
"wait", "receive", "process", "complete"], "history": [{"record_dt": "2014-07-08T15:24:20.455000",
|
|
127
|
+
"name": "init", "title": "Initializing"}, {"record_dt": "2014-07-08T15:24:20.735000",
|
|
128
|
+
"name": "generating", "title": "Generating X12 transactions"}, {"record_dt":
|
|
129
|
+
"2014-07-08T15:24:20.736000", "name": "transmitting", "title": "Transmitting
|
|
130
|
+
transactions to Trading Partner"}, {"record_dt": "2014-07-08T15:24:20.737000",
|
|
131
|
+
"name": "waiting", "title": "Waiting on Trading Partner Response"}, {"record_dt":
|
|
132
|
+
"2014-07-08T15:24:20.738000", "name": "receiving", "title": "Receiving transactions
|
|
133
|
+
from Trading Partner"}, {"record_dt": "2014-07-08T15:24:20.830000", "name":
|
|
134
|
+
"processing", "title": "Processing X12 transactions"}]}, {"units_of_work":
|
|
135
|
+
1, "name": "enrollment", "parameters": {"service_types": ["health_benefit_plan_coverage"],
|
|
136
|
+
"trading_partner_id": "MOCKPAYER", "payer": {"id": "MOCKPAYER", "name": "Mockpayer
|
|
137
|
+
For Testing"}, "member": {"birth_date": "1992-05-28", "first_name": "Catharine",
|
|
138
|
+
"last_name": "Bruen", "plan_start_date": "2013-08-10", "id": "524890478"},
|
|
139
|
+
"correlation_id": "64333685-8004-4dad-84d0-cd2becfe0952", "client_id": "2MBlqahR2xiaBtVSS50n",
|
|
140
|
+
"provider": {"first_name": "Dewayne", "last_name": "Ondricka", "npi": "5038178180"},
|
|
141
|
+
"async": false, "transaction_code": "request"}, "state": {"name": "completed",
|
|
142
|
+
"title": "Completed"}, "result": {"service_types": ["professional_physician_visit_office"],
|
|
143
|
+
"client_id": "2MBlqahR2xiaBtVSS50n", "payer": {"id": "MOCKPAYER", "name":
|
|
144
|
+
"MOCK PAYER INC"}, "subscriber": {"birth_date": "1992-05-28", "first_name":
|
|
145
|
+
"Catharine", "last_name": "Bruen", "id": "524890478", "address": {"city":
|
|
146
|
+
"SPARTANBURG", "state": "SC", "zipcode": "29307", "address_lines": ["123 MAIN
|
|
147
|
+
ST"]}}, "correlation_id": "64333685-8004-4dad-84d0-cd2becfe0952", "trading_partner_id":
|
|
148
|
+
"MOCKPAYER", "provider": {"first_name": "Dewayne", "last_name": "Dewayne Ondricka",
|
|
149
|
+
"npi": "5038178180"}, "coverage": {"service_types": ["professional_physician_visit_office"],
|
|
150
|
+
"group_number": "088818801000013", "out_of_pocket": [{"in_plan_network": "yes",
|
|
151
|
+
"benefit_amount": {"currency": "USD", "amount": "3000"}, "coverage_level":
|
|
152
|
+
"individual"}, {"in_plan_network": "yes", "benefit_amount": {"currency": "USD",
|
|
153
|
+
"amount": "2983.57"}, "coverage_level": "individual", "time_period": "remaining"},
|
|
154
|
+
{"in_plan_network": "yes", "benefit_amount": {"currency": "USD", "amount":
|
|
155
|
+
"6000"}, "coverage_level": "family"}, {"in_plan_network": "yes", "benefit_amount":
|
|
156
|
+
{"currency": "USD", "amount": "5956.09"}, "coverage_level": "family", "time_period":
|
|
157
|
+
"remaining"}, {"in_plan_network": "no", "benefit_amount": {"currency": "USD",
|
|
158
|
+
"amount": "12500"}, "coverage_level": "individual"}, {"in_plan_network": "no",
|
|
159
|
+
"benefit_amount": {"currency": "USD", "amount": "12483.57"}, "coverage_level":
|
|
160
|
+
"individual", "time_period": "remaining"}, {"in_plan_network": "no", "benefit_amount":
|
|
161
|
+
{"currency": "USD", "amount": "25000"}, "coverage_level": "family"}, {"in_plan_network":
|
|
162
|
+
"no", "benefit_amount": {"currency": "USD", "amount": "24956.09"}, "coverage_level":
|
|
163
|
+
"family", "messages": [{"message": "Unlimited Lifetime Benefits"}], "time_period":
|
|
164
|
+
"remaining"}], "level": "employee_and_spouse", "copay": [{"in_plan_network":
|
|
165
|
+
"yes", "service_types": ["professional_physician_visit_office"], "coverage_level":
|
|
166
|
+
"employee_and_spouse", "messages": [{"message": "PRIMARY OFFICE"}]}, {"in_plan_network":
|
|
167
|
+
"not_applicable", "service_types": ["professional_physician_visit_office"],
|
|
168
|
+
"coverage_level": "employee_and_spouse", "messages": [{"message": "GYN OFFICE
|
|
169
|
+
VS"}, {"message": "GYN VISIT"}, {"message": "SPEC OFFICE"}, {"message": "SPEC
|
|
170
|
+
VISIT"}, {"message": "PRIME CARE VST"}, {"message": "Plan Requires PreCert"},
|
|
171
|
+
{"message": "Commercial"}, {"message": "Plan includes NAP"}, {"message": "Pre-Existing
|
|
172
|
+
may apply"}]}], "deductibles": [{"messages": [{"message": "INT MED AND RX,GYN
|
|
173
|
+
OFFICE VS,DED INCLUDED IN OOP,GYN VISIT,SPEC OFFICE,SPEC VISIT,PRIMARY OFFICE,PRIME
|
|
174
|
+
CARE VST"}], "in_plan_network": "yes", "eligibility_date": "2013-01-01", "time_period":
|
|
175
|
+
"calendar_year", "coverage_level": "family", "benefit_amount": {"currency":
|
|
176
|
+
"USD", "amount": "6000"}}, {"in_plan_network": "yes", "time_period": "remaining",
|
|
177
|
+
"coverage_level": "family", "messages": [{"message": "INT MED AND RX"}], "benefit_amount":
|
|
178
|
+
{"currency": "USD", "amount": "5956.09"}}, {"messages": [{"message": "INT
|
|
179
|
+
MED AND RX,GYN OFFICE VS,DED INCLUDED IN OOP,GYN VISIT,SPEC OFFICE,SPEC VISIT,PRIMARY
|
|
180
|
+
OFFICE,PRIME CARE VST"}], "in_plan_network": "yes", "eligibility_date": "2013-01-01",
|
|
181
|
+
"time_period": "calendar_year", "coverage_level": "individual", "benefit_amount":
|
|
182
|
+
{"currency": "USD", "amount": "3000"}}, {"in_plan_network": "yes", "time_period":
|
|
183
|
+
"remaining", "coverage_level": "individual", "messages": [{"message": "INT
|
|
184
|
+
MED AND RX"}], "benefit_amount": {"currency": "USD", "amount": "2983.57"}},
|
|
185
|
+
{"messages": [{"message": "INT MED AND RX,GYN OFFICE VS,DED INCLUDED IN OOP,GYN
|
|
186
|
+
VISIT,SPEC OFFICE,SPEC VISIT,PRIME CARE VST"}], "in_plan_network": "no", "eligibility_date":
|
|
187
|
+
"2013-01-01", "time_period": "calendar_year", "coverage_level": "family",
|
|
188
|
+
"benefit_amount": {"currency": "USD", "amount": "12000"}}, {"in_plan_network":
|
|
189
|
+
"no", "time_period": "remaining", "coverage_level": "family", "messages":
|
|
190
|
+
[{"message": "INT MED AND RX"}], "benefit_amount": {"currency": "USD", "amount":
|
|
191
|
+
"11956.09"}}, {"messages": [{"message": "INT MED AND RX,GYN OFFICE VS,DED
|
|
192
|
+
INCLUDED IN OOP,GYN VISIT,SPEC OFFICE,SPEC VISIT,PRIME CARE VST"}], "in_plan_network":
|
|
193
|
+
"no", "eligibility_date": "2013-01-01", "time_period": "calendar_year", "coverage_level":
|
|
194
|
+
"individual", "benefit_amount": {"currency": "USD", "amount": "6000"}}, {"in_plan_network":
|
|
195
|
+
"no", "time_period": "remaining", "coverage_level": "individual", "messages":
|
|
196
|
+
[{"message": "INT MED AND RX"}], "benefit_amount": {"currency": "USD", "amount":
|
|
197
|
+
"5983.57"}}], "plan_begin_date": "2013-02-15", "eligibility_begin_date": "2012-02-01",
|
|
198
|
+
"coinsurance": [{"benefit_percent": 0.0, "service_types": ["professional_physician_visit_office"],
|
|
199
|
+
"coverage_level": "employee_and_spouse", "messages": [{"message": "GYN OFFICE
|
|
200
|
+
VS"}, {"message": "GYN VISIT"}, {"message": "SPEC OFFICE"}, {"message": "SPEC
|
|
201
|
+
VISIT"}, {"message": "PRIMARY OFFICE"}, {"message": "PRIME CARE VST"}], "in_plan_network":
|
|
202
|
+
"yes"}, {"benefit_percent": 0.5, "service_types": ["professional_physician_visit_office"],
|
|
203
|
+
"coverage_level": "employee_and_spouse", "messages": [{"message": "GYN OFFICE
|
|
204
|
+
VS,COINS APPLIES TO OUT OF POCKET"}, {"message": "GYN VISIT,COINS APPLIES
|
|
205
|
+
TO OUT OF POCKET"}, {"message": "SPEC OFFICE,COINS APPLIES TO OUT OF POCKET"},
|
|
206
|
+
{"message": "SPEC VISIT,COINS APPLIES TO OUT OF POCKET"}, {"message": "PRIME
|
|
207
|
+
CARE VST,COINS APPLIES TO OUT OF POCKET"}], "in_plan_network": "no"}], "group_description":
|
|
208
|
+
"MOCK INDIVIDUAL ADVANTAGE PLAN", "plan_number": "0888188", "service_date":
|
|
209
|
+
"2013-08-10"}, "valid_request": true}, "trading_partner_id": "MOCKPAYER",
|
|
210
|
+
"id": "53bc0d2456c02c0671dde4e0", "transition_path": ["generate", "transmit",
|
|
211
|
+
"wait", "receive", "process", "complete"], "history": [{"record_dt": "2014-07-08T15:24:20.844000",
|
|
212
|
+
"name": "init", "title": "Initializing"}, {"record_dt": "2014-07-08T15:24:20.857000",
|
|
213
|
+
"name": "generating", "title": "Generating X12 transactions"}, {"record_dt":
|
|
214
|
+
"2014-07-08T15:24:20.858000", "name": "transmitting", "title": "Transmitting
|
|
215
|
+
transactions to Trading Partner"}, {"record_dt": "2014-07-08T15:24:20.859000",
|
|
216
|
+
"name": "waiting", "title": "Waiting on Trading Partner Response"}, {"record_dt":
|
|
217
|
+
"2014-07-08T15:24:20.861000", "name": "receiving", "title": "Receiving transactions
|
|
218
|
+
from Trading Partner"}, {"record_dt": "2014-07-08T15:24:20.923000", "name":
|
|
219
|
+
"processing", "title": "Processing X12 transactions"}]}, {"units_of_work":
|
|
220
|
+
1, "name": "cash_prices", "parameters": {"service_types": ["health_benefit_plan_coverage"],
|
|
221
|
+
"trading_partner_id": "MOCKPAYER", "payer": {"id": "MOCKPAYER", "name": "Mockpayer
|
|
222
|
+
For Testing"}, "member": {"birth_date": "1992-12-16", "first_name": "Agustin",
|
|
223
|
+
"last_name": "Swaniawski", "plan_start_date": "2013-08-10", "id": "294098048"},
|
|
224
|
+
"correlation_id": "99f8cf62-ce39-41b2-8826-9773b36aacf7", "client_id": "2MBlqahR2xiaBtVSS50n",
|
|
225
|
+
"provider": {"first_name": "Jace", "last_name": "Gislason", "npi": "0434188032"},
|
|
226
|
+
"async": false, "transaction_code": "request"}, "state": {"name": "completed",
|
|
227
|
+
"title": "Completed"}, "result": {"service_types": ["professional_physician_visit_office"],
|
|
228
|
+
"client_id": "2MBlqahR2xiaBtVSS50n", "payer": {"id": "MOCKPAYER", "name":
|
|
229
|
+
"MOCK PAYER INC"}, "subscriber": {"birth_date": "1992-12-16", "first_name":
|
|
230
|
+
"Agustin", "last_name": "Swaniawski", "id": "294098048", "address": {"city":
|
|
231
|
+
"SPARTANBURG", "state": "SC", "zipcode": "29307", "address_lines": ["123 MAIN
|
|
232
|
+
ST"]}}, "correlation_id": "99f8cf62-ce39-41b2-8826-9773b36aacf7", "trading_partner_id":
|
|
233
|
+
"MOCKPAYER", "provider": {"first_name": "Jace", "last_name": "Jace Gislason",
|
|
234
|
+
"npi": "0434188032"}, "coverage": {"service_types": ["professional_physician_visit_office"],
|
|
235
|
+
"group_number": "088818801000013", "out_of_pocket": [{"in_plan_network": "yes",
|
|
236
|
+
"benefit_amount": {"currency": "USD", "amount": "3000"}, "coverage_level":
|
|
237
|
+
"individual"}, {"in_plan_network": "yes", "benefit_amount": {"currency": "USD",
|
|
238
|
+
"amount": "2983.57"}, "coverage_level": "individual", "time_period": "remaining"},
|
|
239
|
+
{"in_plan_network": "yes", "benefit_amount": {"currency": "USD", "amount":
|
|
240
|
+
"6000"}, "coverage_level": "family"}, {"in_plan_network": "yes", "benefit_amount":
|
|
241
|
+
{"currency": "USD", "amount": "5956.09"}, "coverage_level": "family", "time_period":
|
|
242
|
+
"remaining"}, {"in_plan_network": "no", "benefit_amount": {"currency": "USD",
|
|
243
|
+
"amount": "12500"}, "coverage_level": "individual"}, {"in_plan_network": "no",
|
|
244
|
+
"benefit_amount": {"currency": "USD", "amount": "12483.57"}, "coverage_level":
|
|
245
|
+
"individual", "time_period": "remaining"}, {"in_plan_network": "no", "benefit_amount":
|
|
246
|
+
{"currency": "USD", "amount": "25000"}, "coverage_level": "family"}, {"in_plan_network":
|
|
247
|
+
"no", "benefit_amount": {"currency": "USD", "amount": "24956.09"}, "coverage_level":
|
|
248
|
+
"family", "messages": [{"message": "Unlimited Lifetime Benefits"}], "time_period":
|
|
249
|
+
"remaining"}], "level": "employee_and_spouse", "copay": [{"in_plan_network":
|
|
250
|
+
"yes", "service_types": ["professional_physician_visit_office"], "coverage_level":
|
|
251
|
+
"employee_and_spouse", "messages": [{"message": "PRIMARY OFFICE"}]}, {"in_plan_network":
|
|
252
|
+
"not_applicable", "service_types": ["professional_physician_visit_office"],
|
|
253
|
+
"coverage_level": "employee_and_spouse", "messages": [{"message": "GYN OFFICE
|
|
254
|
+
VS"}, {"message": "GYN VISIT"}, {"message": "SPEC OFFICE"}, {"message": "SPEC
|
|
255
|
+
VISIT"}, {"message": "PRIME CARE VST"}, {"message": "Plan Requires PreCert"},
|
|
256
|
+
{"message": "Commercial"}, {"message": "Plan includes NAP"}, {"message": "Pre-Existing
|
|
257
|
+
may apply"}]}], "deductibles": [{"messages": [{"message": "INT MED AND RX,GYN
|
|
258
|
+
OFFICE VS,DED INCLUDED IN OOP,GYN VISIT,SPEC OFFICE,SPEC VISIT,PRIMARY OFFICE,PRIME
|
|
259
|
+
CARE VST"}], "in_plan_network": "yes", "eligibility_date": "2013-01-01", "time_period":
|
|
260
|
+
"calendar_year", "coverage_level": "family", "benefit_amount": {"currency":
|
|
261
|
+
"USD", "amount": "6000"}}, {"in_plan_network": "yes", "time_period": "remaining",
|
|
262
|
+
"coverage_level": "family", "messages": [{"message": "INT MED AND RX"}], "benefit_amount":
|
|
263
|
+
{"currency": "USD", "amount": "5956.09"}}, {"messages": [{"message": "INT
|
|
264
|
+
MED AND RX,GYN OFFICE VS,DED INCLUDED IN OOP,GYN VISIT,SPEC OFFICE,SPEC VISIT,PRIMARY
|
|
265
|
+
OFFICE,PRIME CARE VST"}], "in_plan_network": "yes", "eligibility_date": "2013-01-01",
|
|
266
|
+
"time_period": "calendar_year", "coverage_level": "individual", "benefit_amount":
|
|
267
|
+
{"currency": "USD", "amount": "3000"}}, {"in_plan_network": "yes", "time_period":
|
|
268
|
+
"remaining", "coverage_level": "individual", "messages": [{"message": "INT
|
|
269
|
+
MED AND RX"}], "benefit_amount": {"currency": "USD", "amount": "2983.57"}},
|
|
270
|
+
{"messages": [{"message": "INT MED AND RX,GYN OFFICE VS,DED INCLUDED IN OOP,GYN
|
|
271
|
+
VISIT,SPEC OFFICE,SPEC VISIT,PRIME CARE VST"}], "in_plan_network": "no", "eligibility_date":
|
|
272
|
+
"2013-01-01", "time_period": "calendar_year", "coverage_level": "family",
|
|
273
|
+
"benefit_amount": {"currency": "USD", "amount": "12000"}}, {"in_plan_network":
|
|
274
|
+
"no", "time_period": "remaining", "coverage_level": "family", "messages":
|
|
275
|
+
[{"message": "INT MED AND RX"}], "benefit_amount": {"currency": "USD", "amount":
|
|
276
|
+
"11956.09"}}, {"messages": [{"message": "INT MED AND RX,GYN OFFICE VS,DED
|
|
277
|
+
INCLUDED IN OOP,GYN VISIT,SPEC OFFICE,SPEC VISIT,PRIME CARE VST"}], "in_plan_network":
|
|
278
|
+
"no", "eligibility_date": "2013-01-01", "time_period": "calendar_year", "coverage_level":
|
|
279
|
+
"individual", "benefit_amount": {"currency": "USD", "amount": "6000"}}, {"in_plan_network":
|
|
280
|
+
"no", "time_period": "remaining", "coverage_level": "individual", "messages":
|
|
281
|
+
[{"message": "INT MED AND RX"}], "benefit_amount": {"currency": "USD", "amount":
|
|
282
|
+
"5983.57"}}], "plan_begin_date": "2013-02-15", "eligibility_begin_date": "2012-02-01",
|
|
283
|
+
"coinsurance": [{"benefit_percent": 0.0, "service_types": ["professional_physician_visit_office"],
|
|
284
|
+
"coverage_level": "employee_and_spouse", "messages": [{"message": "GYN OFFICE
|
|
285
|
+
VS"}, {"message": "GYN VISIT"}, {"message": "SPEC OFFICE"}, {"message": "SPEC
|
|
286
|
+
VISIT"}, {"message": "PRIMARY OFFICE"}, {"message": "PRIME CARE VST"}], "in_plan_network":
|
|
287
|
+
"yes"}, {"benefit_percent": 0.5, "service_types": ["professional_physician_visit_office"],
|
|
288
|
+
"coverage_level": "employee_and_spouse", "messages": [{"message": "GYN OFFICE
|
|
289
|
+
VS,COINS APPLIES TO OUT OF POCKET"}, {"message": "GYN VISIT,COINS APPLIES
|
|
290
|
+
TO OUT OF POCKET"}, {"message": "SPEC OFFICE,COINS APPLIES TO OUT OF POCKET"},
|
|
291
|
+
{"message": "SPEC VISIT,COINS APPLIES TO OUT OF POCKET"}, {"message": "PRIME
|
|
292
|
+
CARE VST,COINS APPLIES TO OUT OF POCKET"}], "in_plan_network": "no"}], "group_description":
|
|
293
|
+
"MOCK INDIVIDUAL ADVANTAGE PLAN", "plan_number": "0888188", "service_date":
|
|
294
|
+
"2013-08-10"}, "valid_request": true}, "trading_partner_id": "MOCKPAYER",
|
|
295
|
+
"id": "53bc0d2456c02c0671dde4e3", "transition_path": ["generate", "transmit",
|
|
296
|
+
"wait", "receive", "process", "complete"], "history": [{"record_dt": "2014-07-08T15:24:20.935000",
|
|
297
|
+
"name": "init", "title": "Initializing"}, {"record_dt": "2014-07-08T15:24:20.949000",
|
|
298
|
+
"name": "generating", "title": "Generating X12 transactions"}, {"record_dt":
|
|
299
|
+
"2014-07-08T15:24:20.950000", "name": "transmitting", "title": "Transmitting
|
|
300
|
+
transactions to Trading Partner"}, {"record_dt": "2014-07-08T15:24:20.953000",
|
|
301
|
+
"name": "waiting", "title": "Waiting on Trading Partner Response"}, {"record_dt":
|
|
302
|
+
"2014-07-08T15:24:20.954000", "name": "receiving", "title": "Receiving transactions
|
|
303
|
+
from Trading Partner"}, {"record_dt": "2014-07-08T15:24:21.002000", "name":
|
|
304
|
+
"processing", "title": "Processing X12 transactions"}]}, {"units_of_work":
|
|
305
|
+
1, "name": "enrollment", "parameters": {"service_types": ["health_benefit_plan_coverage"],
|
|
306
|
+
"trading_partner_id": "MOCKPAYER", "payer": {"id": "MOCKPAYER", "name": "Mockpayer
|
|
307
|
+
For Testing"}, "member": {"birth_date": "1986-08-03", "first_name": "Whitney",
|
|
308
|
+
"last_name": "Dickinson", "plan_start_date": "2013-08-10", "id": "797189692"},
|
|
309
|
+
"correlation_id": "4c706d09-6f98-4b68-8eba-002be5e34c9c", "client_id": "2MBlqahR2xiaBtVSS50n",
|
|
310
|
+
"provider": {"first_name": "Lavern", "last_name": "Lesch", "npi": "9520785023"},
|
|
311
|
+
"async": false, "transaction_code": "request"}, "state": {"name": "completed",
|
|
312
|
+
"title": "Completed"}, "result": {"service_types": ["professional_physician_visit_office"],
|
|
313
|
+
"client_id": "2MBlqahR2xiaBtVSS50n", "payer": {"id": "MOCKPAYER", "name":
|
|
314
|
+
"MOCK PAYER INC"}, "subscriber": {"birth_date": "1986-08-03", "first_name":
|
|
315
|
+
"Whitney", "last_name": "Dickinson", "id": "797189692", "address": {"city":
|
|
316
|
+
"SPARTANBURG", "state": "SC", "zipcode": "29307", "address_lines": ["123 MAIN
|
|
317
|
+
ST"]}}, "correlation_id": "4c706d09-6f98-4b68-8eba-002be5e34c9c", "trading_partner_id":
|
|
318
|
+
"MOCKPAYER", "provider": {"first_name": "Lavern", "last_name": "Lavern Lesch",
|
|
319
|
+
"npi": "9520785023"}, "coverage": {"service_types": ["professional_physician_visit_office"],
|
|
320
|
+
"group_number": "088818801000013", "out_of_pocket": [{"in_plan_network": "yes",
|
|
321
|
+
"benefit_amount": {"currency": "USD", "amount": "3000"}, "coverage_level":
|
|
322
|
+
"individual"}, {"in_plan_network": "yes", "benefit_amount": {"currency": "USD",
|
|
323
|
+
"amount": "2983.57"}, "coverage_level": "individual", "time_period": "remaining"},
|
|
324
|
+
{"in_plan_network": "yes", "benefit_amount": {"currency": "USD", "amount":
|
|
325
|
+
"6000"}, "coverage_level": "family"}, {"in_plan_network": "yes", "benefit_amount":
|
|
326
|
+
{"currency": "USD", "amount": "5956.09"}, "coverage_level": "family", "time_period":
|
|
327
|
+
"remaining"}, {"in_plan_network": "no", "benefit_amount": {"currency": "USD",
|
|
328
|
+
"amount": "12500"}, "coverage_level": "individual"}, {"in_plan_network": "no",
|
|
329
|
+
"benefit_amount": {"currency": "USD", "amount": "12483.57"}, "coverage_level":
|
|
330
|
+
"individual", "time_period": "remaining"}, {"in_plan_network": "no", "benefit_amount":
|
|
331
|
+
{"currency": "USD", "amount": "25000"}, "coverage_level": "family"}, {"in_plan_network":
|
|
332
|
+
"no", "benefit_amount": {"currency": "USD", "amount": "24956.09"}, "coverage_level":
|
|
333
|
+
"family", "messages": [{"message": "Unlimited Lifetime Benefits"}], "time_period":
|
|
334
|
+
"remaining"}], "level": "employee_and_spouse", "copay": [{"in_plan_network":
|
|
335
|
+
"yes", "service_types": ["professional_physician_visit_office"], "coverage_level":
|
|
336
|
+
"employee_and_spouse", "messages": [{"message": "PRIMARY OFFICE"}]}, {"in_plan_network":
|
|
337
|
+
"not_applicable", "service_types": ["professional_physician_visit_office"],
|
|
338
|
+
"coverage_level": "employee_and_spouse", "messages": [{"message": "GYN OFFICE
|
|
339
|
+
VS"}, {"message": "GYN VISIT"}, {"message": "SPEC OFFICE"}, {"message": "SPEC
|
|
340
|
+
VISIT"}, {"message": "PRIME CARE VST"}, {"message": "Plan Requires PreCert"},
|
|
341
|
+
{"message": "Commercial"}, {"message": "Plan includes NAP"}, {"message": "Pre-Existing
|
|
342
|
+
may apply"}]}], "deductibles": [{"messages": [{"message": "INT MED AND RX,GYN
|
|
343
|
+
OFFICE VS,DED INCLUDED IN OOP,GYN VISIT,SPEC OFFICE,SPEC VISIT,PRIMARY OFFICE,PRIME
|
|
344
|
+
CARE VST"}], "in_plan_network": "yes", "eligibility_date": "2013-01-01", "time_period":
|
|
345
|
+
"calendar_year", "coverage_level": "family", "benefit_amount": {"currency":
|
|
346
|
+
"USD", "amount": "6000"}}, {"in_plan_network": "yes", "time_period": "remaining",
|
|
347
|
+
"coverage_level": "family", "messages": [{"message": "INT MED AND RX"}], "benefit_amount":
|
|
348
|
+
{"currency": "USD", "amount": "5956.09"}}, {"messages": [{"message": "INT
|
|
349
|
+
MED AND RX,GYN OFFICE VS,DED INCLUDED IN OOP,GYN VISIT,SPEC OFFICE,SPEC VISIT,PRIMARY
|
|
350
|
+
OFFICE,PRIME CARE VST"}], "in_plan_network": "yes", "eligibility_date": "2013-01-01",
|
|
351
|
+
"time_period": "calendar_year", "coverage_level": "individual", "benefit_amount":
|
|
352
|
+
{"currency": "USD", "amount": "3000"}}, {"in_plan_network": "yes", "time_period":
|
|
353
|
+
"remaining", "coverage_level": "individual", "messages": [{"message": "INT
|
|
354
|
+
MED AND RX"}], "benefit_amount": {"currency": "USD", "amount": "2983.57"}},
|
|
355
|
+
{"messages": [{"message": "INT MED AND RX,GYN OFFICE VS,DED INCLUDED IN OOP,GYN
|
|
356
|
+
VISIT,SPEC OFFICE,SPEC VISIT,PRIME CARE VST"}], "in_plan_network": "no", "eligibility_date":
|
|
357
|
+
"2013-01-01", "time_period": "calendar_year", "coverage_level": "family",
|
|
358
|
+
"benefit_amount": {"currency": "USD", "amount": "12000"}}, {"in_plan_network":
|
|
359
|
+
"no", "time_period": "remaining", "coverage_level": "family", "messages":
|
|
360
|
+
[{"message": "INT MED AND RX"}], "benefit_amount": {"currency": "USD", "amount":
|
|
361
|
+
"11956.09"}}, {"messages": [{"message": "INT MED AND RX,GYN OFFICE VS,DED
|
|
362
|
+
INCLUDED IN OOP,GYN VISIT,SPEC OFFICE,SPEC VISIT,PRIME CARE VST"}], "in_plan_network":
|
|
363
|
+
"no", "eligibility_date": "2013-01-01", "time_period": "calendar_year", "coverage_level":
|
|
364
|
+
"individual", "benefit_amount": {"currency": "USD", "amount": "6000"}}, {"in_plan_network":
|
|
365
|
+
"no", "time_period": "remaining", "coverage_level": "individual", "messages":
|
|
366
|
+
[{"message": "INT MED AND RX"}], "benefit_amount": {"currency": "USD", "amount":
|
|
367
|
+
"5983.57"}}], "plan_begin_date": "2013-02-15", "eligibility_begin_date": "2012-02-01",
|
|
368
|
+
"coinsurance": [{"benefit_percent": 0.0, "service_types": ["professional_physician_visit_office"],
|
|
369
|
+
"coverage_level": "employee_and_spouse", "messages": [{"message": "GYN OFFICE
|
|
370
|
+
VS"}, {"message": "GYN VISIT"}, {"message": "SPEC OFFICE"}, {"message": "SPEC
|
|
371
|
+
VISIT"}, {"message": "PRIMARY OFFICE"}, {"message": "PRIME CARE VST"}], "in_plan_network":
|
|
372
|
+
"yes"}, {"benefit_percent": 0.5, "service_types": ["professional_physician_visit_office"],
|
|
373
|
+
"coverage_level": "employee_and_spouse", "messages": [{"message": "GYN OFFICE
|
|
374
|
+
VS,COINS APPLIES TO OUT OF POCKET"}, {"message": "GYN VISIT,COINS APPLIES
|
|
375
|
+
TO OUT OF POCKET"}, {"message": "SPEC OFFICE,COINS APPLIES TO OUT OF POCKET"},
|
|
376
|
+
{"message": "SPEC VISIT,COINS APPLIES TO OUT OF POCKET"}, {"message": "PRIME
|
|
377
|
+
CARE VST,COINS APPLIES TO OUT OF POCKET"}], "in_plan_network": "no"}], "group_description":
|
|
378
|
+
"MOCK INDIVIDUAL ADVANTAGE PLAN", "plan_number": "0888188", "service_date":
|
|
379
|
+
"2013-08-10"}, "valid_request": true}, "trading_partner_id": "MOCKPAYER",
|
|
380
|
+
"id": "53bc0d2556c02c0671dde4e6", "transition_path": ["generate", "transmit",
|
|
381
|
+
"wait", "receive", "process", "complete"], "history": [{"record_dt": "2014-07-08T15:24:21.014000",
|
|
382
|
+
"name": "init", "title": "Initializing"}, {"record_dt": "2014-07-08T15:24:21.027000",
|
|
383
|
+
"name": "generating", "title": "Generating X12 transactions"}, {"record_dt":
|
|
384
|
+
"2014-07-08T15:24:21.029000", "name": "transmitting", "title": "Transmitting
|
|
385
|
+
transactions to Trading Partner"}, {"record_dt": "2014-07-08T15:24:21.030000",
|
|
386
|
+
"name": "waiting", "title": "Waiting on Trading Partner Response"}, {"record_dt":
|
|
387
|
+
"2014-07-08T15:24:21.031000", "name": "receiving", "title": "Receiving transactions
|
|
388
|
+
from Trading Partner"}, {"record_dt": "2014-07-08T15:24:21.079000", "name":
|
|
389
|
+
"processing", "title": "Processing X12 transactions"}]}, {"units_of_work":
|
|
390
|
+
1, "name": "providers", "parameters": {"service_types": ["health_benefit_plan_coverage"],
|
|
391
|
+
"trading_partner_id": "MOCKPAYER", "payer": {"id": "MOCKPAYER", "name": "Mockpayer
|
|
392
|
+
For Testing"}, "member": {"birth_date": "1989-06-14", "first_name": "Ezra",
|
|
393
|
+
"last_name": "Volkman", "plan_start_date": "2013-08-10", "id": "353717364"},
|
|
394
|
+
"correlation_id": "0af32807-b1da-4b1f-a42a-3b8570c8ca06", "client_id": "2MBlqahR2xiaBtVSS50n",
|
|
395
|
+
"provider": {"first_name": "Clemens", "last_name": "Windler", "npi": "2583472309"},
|
|
396
|
+
"async": false, "transaction_code": "request"}, "state": {"name": "completed",
|
|
397
|
+
"title": "Completed"}, "result": {"service_types": ["professional_physician_visit_office"],
|
|
398
|
+
"client_id": "2MBlqahR2xiaBtVSS50n", "payer": {"id": "MOCKPAYER", "name":
|
|
399
|
+
"MOCK PAYER INC"}, "subscriber": {"birth_date": "1989-06-14", "first_name":
|
|
400
|
+
"Ezra", "last_name": "Volkman", "id": "353717364", "address": {"city": "SPARTANBURG",
|
|
401
|
+
"state": "SC", "zipcode": "29307", "address_lines": ["123 MAIN ST"]}}, "correlation_id":
|
|
402
|
+
"0af32807-b1da-4b1f-a42a-3b8570c8ca06", "trading_partner_id": "MOCKPAYER",
|
|
403
|
+
"provider": {"first_name": "Clemens", "last_name": "Clemens Windler", "npi":
|
|
404
|
+
"2583472309"}, "coverage": {"service_types": ["professional_physician_visit_office"],
|
|
405
|
+
"group_number": "088818801000013", "out_of_pocket": [{"in_plan_network": "yes",
|
|
406
|
+
"benefit_amount": {"currency": "USD", "amount": "3000"}, "coverage_level":
|
|
407
|
+
"individual"}, {"in_plan_network": "yes", "benefit_amount": {"currency": "USD",
|
|
408
|
+
"amount": "2983.57"}, "coverage_level": "individual", "time_period": "remaining"},
|
|
409
|
+
{"in_plan_network": "yes", "benefit_amount": {"currency": "USD", "amount":
|
|
410
|
+
"6000"}, "coverage_level": "family"}, {"in_plan_network": "yes", "benefit_amount":
|
|
411
|
+
{"currency": "USD", "amount": "5956.09"}, "coverage_level": "family", "time_period":
|
|
412
|
+
"remaining"}, {"in_plan_network": "no", "benefit_amount": {"currency": "USD",
|
|
413
|
+
"amount": "12500"}, "coverage_level": "individual"}, {"in_plan_network": "no",
|
|
414
|
+
"benefit_amount": {"currency": "USD", "amount": "12483.57"}, "coverage_level":
|
|
415
|
+
"individual", "time_period": "remaining"}, {"in_plan_network": "no", "benefit_amount":
|
|
416
|
+
{"currency": "USD", "amount": "25000"}, "coverage_level": "family"}, {"in_plan_network":
|
|
417
|
+
"no", "benefit_amount": {"currency": "USD", "amount": "24956.09"}, "coverage_level":
|
|
418
|
+
"family", "messages": [{"message": "Unlimited Lifetime Benefits"}], "time_period":
|
|
419
|
+
"remaining"}], "level": "employee_and_spouse", "copay": [{"in_plan_network":
|
|
420
|
+
"yes", "service_types": ["professional_physician_visit_office"], "coverage_level":
|
|
421
|
+
"employee_and_spouse", "messages": [{"message": "PRIMARY OFFICE"}]}, {"in_plan_network":
|
|
422
|
+
"not_applicable", "service_types": ["professional_physician_visit_office"],
|
|
423
|
+
"coverage_level": "employee_and_spouse", "messages": [{"message": "GYN OFFICE
|
|
424
|
+
VS"}, {"message": "GYN VISIT"}, {"message": "SPEC OFFICE"}, {"message": "SPEC
|
|
425
|
+
VISIT"}, {"message": "PRIME CARE VST"}, {"message": "Plan Requires PreCert"},
|
|
426
|
+
{"message": "Commercial"}, {"message": "Plan includes NAP"}, {"message": "Pre-Existing
|
|
427
|
+
may apply"}]}], "deductibles": [{"messages": [{"message": "INT MED AND RX,GYN
|
|
428
|
+
OFFICE VS,DED INCLUDED IN OOP,GYN VISIT,SPEC OFFICE,SPEC VISIT,PRIMARY OFFICE,PRIME
|
|
429
|
+
CARE VST"}], "in_plan_network": "yes", "eligibility_date": "2013-01-01", "time_period":
|
|
430
|
+
"calendar_year", "coverage_level": "family", "benefit_amount": {"currency":
|
|
431
|
+
"USD", "amount": "6000"}}, {"in_plan_network": "yes", "time_period": "remaining",
|
|
432
|
+
"coverage_level": "family", "messages": [{"message": "INT MED AND RX"}], "benefit_amount":
|
|
433
|
+
{"currency": "USD", "amount": "5956.09"}}, {"messages": [{"message": "INT
|
|
434
|
+
MED AND RX,GYN OFFICE VS,DED INCLUDED IN OOP,GYN VISIT,SPEC OFFICE,SPEC VISIT,PRIMARY
|
|
435
|
+
OFFICE,PRIME CARE VST"}], "in_plan_network": "yes", "eligibility_date": "2013-01-01",
|
|
436
|
+
"time_period": "calendar_year", "coverage_level": "individual", "benefit_amount":
|
|
437
|
+
{"currency": "USD", "amount": "3000"}}, {"in_plan_network": "yes", "time_period":
|
|
438
|
+
"remaining", "coverage_level": "individual", "messages": [{"message": "INT
|
|
439
|
+
MED AND RX"}], "benefit_amount": {"currency": "USD", "amount": "2983.57"}},
|
|
440
|
+
{"messages": [{"message": "INT MED AND RX,GYN OFFICE VS,DED INCLUDED IN OOP,GYN
|
|
441
|
+
VISIT,SPEC OFFICE,SPEC VISIT,PRIME CARE VST"}], "in_plan_network": "no", "eligibility_date":
|
|
442
|
+
"2013-01-01", "time_period": "calendar_year", "coverage_level": "family",
|
|
443
|
+
"benefit_amount": {"currency": "USD", "amount": "12000"}}, {"in_plan_network":
|
|
444
|
+
"no", "time_period": "remaining", "coverage_level": "family", "messages":
|
|
445
|
+
[{"message": "INT MED AND RX"}], "benefit_amount": {"currency": "USD", "amount":
|
|
446
|
+
"11956.09"}}, {"messages": [{"message": "INT MED AND RX,GYN OFFICE VS,DED
|
|
447
|
+
INCLUDED IN OOP,GYN VISIT,SPEC OFFICE,SPEC VISIT,PRIME CARE VST"}], "in_plan_network":
|
|
448
|
+
"no", "eligibility_date": "2013-01-01", "time_period": "calendar_year", "coverage_level":
|
|
449
|
+
"individual", "benefit_amount": {"currency": "USD", "amount": "6000"}}, {"in_plan_network":
|
|
450
|
+
"no", "time_period": "remaining", "coverage_level": "individual", "messages":
|
|
451
|
+
[{"message": "INT MED AND RX"}], "benefit_amount": {"currency": "USD", "amount":
|
|
452
|
+
"5983.57"}}], "plan_begin_date": "2013-02-15", "eligibility_begin_date": "2012-02-01",
|
|
453
|
+
"coinsurance": [{"benefit_percent": 0.0, "service_types": ["professional_physician_visit_office"],
|
|
454
|
+
"coverage_level": "employee_and_spouse", "messages": [{"message": "GYN OFFICE
|
|
455
|
+
VS"}, {"message": "GYN VISIT"}, {"message": "SPEC OFFICE"}, {"message": "SPEC
|
|
456
|
+
VISIT"}, {"message": "PRIMARY OFFICE"}, {"message": "PRIME CARE VST"}], "in_plan_network":
|
|
457
|
+
"yes"}, {"benefit_percent": 0.5, "service_types": ["professional_physician_visit_office"],
|
|
458
|
+
"coverage_level": "employee_and_spouse", "messages": [{"message": "GYN OFFICE
|
|
459
|
+
VS,COINS APPLIES TO OUT OF POCKET"}, {"message": "GYN VISIT,COINS APPLIES
|
|
460
|
+
TO OUT OF POCKET"}, {"message": "SPEC OFFICE,COINS APPLIES TO OUT OF POCKET"},
|
|
461
|
+
{"message": "SPEC VISIT,COINS APPLIES TO OUT OF POCKET"}, {"message": "PRIME
|
|
462
|
+
CARE VST,COINS APPLIES TO OUT OF POCKET"}], "in_plan_network": "no"}], "group_description":
|
|
463
|
+
"MOCK INDIVIDUAL ADVANTAGE PLAN", "plan_number": "0888188", "service_date":
|
|
464
|
+
"2013-08-10"}, "valid_request": true}, "trading_partner_id": "MOCKPAYER",
|
|
465
|
+
"id": "53bc0d2556c02c0671dde4e9", "transition_path": ["generate", "transmit",
|
|
466
|
+
"wait", "receive", "process", "complete"], "history": [{"record_dt": "2014-07-08T15:24:21.090000",
|
|
467
|
+
"name": "init", "title": "Initializing"}, {"record_dt": "2014-07-08T15:24:21.106000",
|
|
468
|
+
"name": "generating", "title": "Generating X12 transactions"}, {"record_dt":
|
|
469
|
+
"2014-07-08T15:24:21.108000", "name": "transmitting", "title": "Transmitting
|
|
470
|
+
transactions to Trading Partner"}, {"record_dt": "2014-07-08T15:24:21.109000",
|
|
471
|
+
"name": "waiting", "title": "Waiting on Trading Partner Response"}, {"record_dt":
|
|
472
|
+
"2014-07-08T15:24:21.110000", "name": "receiving", "title": "Receiving transactions
|
|
473
|
+
from Trading Partner"}, {"record_dt": "2014-07-08T15:24:21.161000", "name":
|
|
474
|
+
"processing", "title": "Processing X12 transactions"}]}, {"units_of_work":
|
|
475
|
+
1, "name": "insurance_prices", "parameters": {"service_types": ["health_benefit_plan_coverage"],
|
|
476
|
+
"trading_partner_id": "MOCKPAYER", "payer": {"id": "MOCKPAYER", "name": "Mockpayer
|
|
477
|
+
For Testing"}, "member": {"birth_date": "1989-12-12", "first_name": "Alexander",
|
|
478
|
+
"last_name": "Kling", "plan_start_date": "2013-08-10", "id": "199597632"},
|
|
479
|
+
"correlation_id": "1a2b1379-1fb9-4b1c-904b-9653beb20168", "client_id": "2MBlqahR2xiaBtVSS50n",
|
|
480
|
+
"provider": {"first_name": "Luella", "last_name": "Crist", "npi": "9672938575"},
|
|
481
|
+
"async": false, "transaction_code": "request"}, "state": {"name": "completed",
|
|
482
|
+
"title": "Completed"}, "result": {"service_types": ["professional_physician_visit_office"],
|
|
483
|
+
"client_id": "2MBlqahR2xiaBtVSS50n", "payer": {"id": "MOCKPAYER", "name":
|
|
484
|
+
"MOCK PAYER INC"}, "subscriber": {"birth_date": "1989-12-12", "first_name":
|
|
485
|
+
"Alexander", "last_name": "Kling", "id": "199597632", "address": {"city":
|
|
486
|
+
"SPARTANBURG", "state": "SC", "zipcode": "29307", "address_lines": ["123 MAIN
|
|
487
|
+
ST"]}}, "correlation_id": "1a2b1379-1fb9-4b1c-904b-9653beb20168", "trading_partner_id":
|
|
488
|
+
"MOCKPAYER", "provider": {"first_name": "Luella", "last_name": "Luella Crist",
|
|
489
|
+
"npi": "9672938575"}, "coverage": {"service_types": ["professional_physician_visit_office"],
|
|
490
|
+
"group_number": "088818801000013", "out_of_pocket": [{"in_plan_network": "yes",
|
|
491
|
+
"benefit_amount": {"currency": "USD", "amount": "3000"}, "coverage_level":
|
|
492
|
+
"individual"}, {"in_plan_network": "yes", "benefit_amount": {"currency": "USD",
|
|
493
|
+
"amount": "2983.57"}, "coverage_level": "individual", "time_period": "remaining"},
|
|
494
|
+
{"in_plan_network": "yes", "benefit_amount": {"currency": "USD", "amount":
|
|
495
|
+
"6000"}, "coverage_level": "family"}, {"in_plan_network": "yes", "benefit_amount":
|
|
496
|
+
{"currency": "USD", "amount": "5956.09"}, "coverage_level": "family", "time_period":
|
|
497
|
+
"remaining"}, {"in_plan_network": "no", "benefit_amount": {"currency": "USD",
|
|
498
|
+
"amount": "12500"}, "coverage_level": "individual"}, {"in_plan_network": "no",
|
|
499
|
+
"benefit_amount": {"currency": "USD", "amount": "12483.57"}, "coverage_level":
|
|
500
|
+
"individual", "time_period": "remaining"}, {"in_plan_network": "no", "benefit_amount":
|
|
501
|
+
{"currency": "USD", "amount": "25000"}, "coverage_level": "family"}, {"in_plan_network":
|
|
502
|
+
"no", "benefit_amount": {"currency": "USD", "amount": "24956.09"}, "coverage_level":
|
|
503
|
+
"family", "messages": [{"message": "Unlimited Lifetime Benefits"}], "time_period":
|
|
504
|
+
"remaining"}], "level": "employee_and_spouse", "copay": [{"in_plan_network":
|
|
505
|
+
"yes", "service_types": ["professional_physician_visit_office"], "coverage_level":
|
|
506
|
+
"employee_and_spouse", "messages": [{"message": "PRIMARY OFFICE"}]}, {"in_plan_network":
|
|
507
|
+
"not_applicable", "service_types": ["professional_physician_visit_office"],
|
|
508
|
+
"coverage_level": "employee_and_spouse", "messages": [{"message": "GYN OFFICE
|
|
509
|
+
VS"}, {"message": "GYN VISIT"}, {"message": "SPEC OFFICE"}, {"message": "SPEC
|
|
510
|
+
VISIT"}, {"message": "PRIME CARE VST"}, {"message": "Plan Requires PreCert"},
|
|
511
|
+
{"message": "Commercial"}, {"message": "Plan includes NAP"}, {"message": "Pre-Existing
|
|
512
|
+
may apply"}]}], "deductibles": [{"messages": [{"message": "INT MED AND RX,GYN
|
|
513
|
+
OFFICE VS,DED INCLUDED IN OOP,GYN VISIT,SPEC OFFICE,SPEC VISIT,PRIMARY OFFICE,PRIME
|
|
514
|
+
CARE VST"}], "in_plan_network": "yes", "eligibility_date": "2013-01-01", "time_period":
|
|
515
|
+
"calendar_year", "coverage_level": "family", "benefit_amount": {"currency":
|
|
516
|
+
"USD", "amount": "6000"}}, {"in_plan_network": "yes", "time_period": "remaining",
|
|
517
|
+
"coverage_level": "family", "messages": [{"message": "INT MED AND RX"}], "benefit_amount":
|
|
518
|
+
{"currency": "USD", "amount": "5956.09"}}, {"messages": [{"message": "INT
|
|
519
|
+
MED AND RX,GYN OFFICE VS,DED INCLUDED IN OOP,GYN VISIT,SPEC OFFICE,SPEC VISIT,PRIMARY
|
|
520
|
+
OFFICE,PRIME CARE VST"}], "in_plan_network": "yes", "eligibility_date": "2013-01-01",
|
|
521
|
+
"time_period": "calendar_year", "coverage_level": "individual", "benefit_amount":
|
|
522
|
+
{"currency": "USD", "amount": "3000"}}, {"in_plan_network": "yes", "time_period":
|
|
523
|
+
"remaining", "coverage_level": "individual", "messages": [{"message": "INT
|
|
524
|
+
MED AND RX"}], "benefit_amount": {"currency": "USD", "amount": "2983.57"}},
|
|
525
|
+
{"messages": [{"message": "INT MED AND RX,GYN OFFICE VS,DED INCLUDED IN OOP,GYN
|
|
526
|
+
VISIT,SPEC OFFICE,SPEC VISIT,PRIME CARE VST"}], "in_plan_network": "no", "eligibility_date":
|
|
527
|
+
"2013-01-01", "time_period": "calendar_year", "coverage_level": "family",
|
|
528
|
+
"benefit_amount": {"currency": "USD", "amount": "12000"}}, {"in_plan_network":
|
|
529
|
+
"no", "time_period": "remaining", "coverage_level": "family", "messages":
|
|
530
|
+
[{"message": "INT MED AND RX"}], "benefit_amount": {"currency": "USD", "amount":
|
|
531
|
+
"11956.09"}}, {"messages": [{"message": "INT MED AND RX,GYN OFFICE VS,DED
|
|
532
|
+
INCLUDED IN OOP,GYN VISIT,SPEC OFFICE,SPEC VISIT,PRIME CARE VST"}], "in_plan_network":
|
|
533
|
+
"no", "eligibility_date": "2013-01-01", "time_period": "calendar_year", "coverage_level":
|
|
534
|
+
"individual", "benefit_amount": {"currency": "USD", "amount": "6000"}}, {"in_plan_network":
|
|
535
|
+
"no", "time_period": "remaining", "coverage_level": "individual", "messages":
|
|
536
|
+
[{"message": "INT MED AND RX"}], "benefit_amount": {"currency": "USD", "amount":
|
|
537
|
+
"5983.57"}}], "plan_begin_date": "2013-02-15", "eligibility_begin_date": "2012-02-01",
|
|
538
|
+
"coinsurance": [{"benefit_percent": 0.0, "service_types": ["professional_physician_visit_office"],
|
|
539
|
+
"coverage_level": "employee_and_spouse", "messages": [{"message": "GYN OFFICE
|
|
540
|
+
VS"}, {"message": "GYN VISIT"}, {"message": "SPEC OFFICE"}, {"message": "SPEC
|
|
541
|
+
VISIT"}, {"message": "PRIMARY OFFICE"}, {"message": "PRIME CARE VST"}], "in_plan_network":
|
|
542
|
+
"yes"}, {"benefit_percent": 0.5, "service_types": ["professional_physician_visit_office"],
|
|
543
|
+
"coverage_level": "employee_and_spouse", "messages": [{"message": "GYN OFFICE
|
|
544
|
+
VS,COINS APPLIES TO OUT OF POCKET"}, {"message": "GYN VISIT,COINS APPLIES
|
|
545
|
+
TO OUT OF POCKET"}, {"message": "SPEC OFFICE,COINS APPLIES TO OUT OF POCKET"},
|
|
546
|
+
{"message": "SPEC VISIT,COINS APPLIES TO OUT OF POCKET"}, {"message": "PRIME
|
|
547
|
+
CARE VST,COINS APPLIES TO OUT OF POCKET"}], "in_plan_network": "no"}], "group_description":
|
|
548
|
+
"MOCK INDIVIDUAL ADVANTAGE PLAN", "plan_number": "0888188", "service_date":
|
|
549
|
+
"2013-08-10"}, "valid_request": true}, "trading_partner_id": "MOCKPAYER",
|
|
550
|
+
"id": "53bc0d2556c02c0671dde4ec", "transition_path": ["generate", "transmit",
|
|
551
|
+
"wait", "receive", "process", "complete"], "history": [{"record_dt": "2014-07-08T15:24:21.173000",
|
|
552
|
+
"name": "init", "title": "Initializing"}, {"record_dt": "2014-07-08T15:24:21.187000",
|
|
553
|
+
"name": "generating", "title": "Generating X12 transactions"}, {"record_dt":
|
|
554
|
+
"2014-07-08T15:24:21.188000", "name": "transmitting", "title": "Transmitting
|
|
555
|
+
transactions to Trading Partner"}, {"record_dt": "2014-07-08T15:24:21.189000",
|
|
556
|
+
"name": "waiting", "title": "Waiting on Trading Partner Response"}, {"record_dt":
|
|
557
|
+
"2014-07-08T15:24:21.190000", "name": "receiving", "title": "Receiving transactions
|
|
558
|
+
from Trading Partner"}, {"record_dt": "2014-07-08T15:24:21.241000", "name":
|
|
559
|
+
"processing", "title": "Processing X12 transactions"}]}, {"units_of_work":
|
|
560
|
+
1, "name": "cash_prices", "parameters": {"service_types": ["health_benefit_plan_coverage"],
|
|
561
|
+
"trading_partner_id": "MOCKPAYER", "payer": {"id": "MOCKPAYER", "name": "Mockpayer
|
|
562
|
+
For Testing"}, "member": {"birth_date": "1980-12-12", "first_name": "Vivienne",
|
|
563
|
+
"last_name": "Will", "plan_start_date": "2013-08-10", "id": "553849400"},
|
|
564
|
+
"correlation_id": "491c4eac-df9b-45fa-afc8-b39a5db67a23", "client_id": "2MBlqahR2xiaBtVSS50n",
|
|
565
|
+
"provider": {"first_name": "Luna", "last_name": "Upton", "npi": "9911703279"},
|
|
566
|
+
"async": false, "transaction_code": "request"}, "state": {"name": "completed",
|
|
567
|
+
"title": "Completed"}, "result": {"service_types": ["professional_physician_visit_office"],
|
|
568
|
+
"client_id": "2MBlqahR2xiaBtVSS50n", "payer": {"id": "MOCKPAYER", "name":
|
|
569
|
+
"MOCK PAYER INC"}, "subscriber": {"birth_date": "1980-12-12", "first_name":
|
|
570
|
+
"Vivienne", "last_name": "Will", "id": "553849400", "address": {"city": "SPARTANBURG",
|
|
571
|
+
"state": "SC", "zipcode": "29307", "address_lines": ["123 MAIN ST"]}}, "correlation_id":
|
|
572
|
+
"491c4eac-df9b-45fa-afc8-b39a5db67a23", "trading_partner_id": "MOCKPAYER",
|
|
573
|
+
"provider": {"first_name": "Luna", "last_name": "Luna Upton", "npi": "9911703279"},
|
|
574
|
+
"coverage": {"service_types": ["professional_physician_visit_office"], "group_number":
|
|
575
|
+
"088818801000013", "out_of_pocket": [{"in_plan_network": "yes", "benefit_amount":
|
|
576
|
+
{"currency": "USD", "amount": "3000"}, "coverage_level": "individual"}, {"in_plan_network":
|
|
577
|
+
"yes", "benefit_amount": {"currency": "USD", "amount": "2983.57"}, "coverage_level":
|
|
578
|
+
"individual", "time_period": "remaining"}, {"in_plan_network": "yes", "benefit_amount":
|
|
579
|
+
{"currency": "USD", "amount": "6000"}, "coverage_level": "family"}, {"in_plan_network":
|
|
580
|
+
"yes", "benefit_amount": {"currency": "USD", "amount": "5956.09"}, "coverage_level":
|
|
581
|
+
"family", "time_period": "remaining"}, {"in_plan_network": "no", "benefit_amount":
|
|
582
|
+
{"currency": "USD", "amount": "12500"}, "coverage_level": "individual"}, {"in_plan_network":
|
|
583
|
+
"no", "benefit_amount": {"currency": "USD", "amount": "12483.57"}, "coverage_level":
|
|
584
|
+
"individual", "time_period": "remaining"}, {"in_plan_network": "no", "benefit_amount":
|
|
585
|
+
{"currency": "USD", "amount": "25000"}, "coverage_level": "family"}, {"in_plan_network":
|
|
586
|
+
"no", "benefit_amount": {"currency": "USD", "amount": "24956.09"}, "coverage_level":
|
|
587
|
+
"family", "messages": [{"message": "Unlimited Lifetime Benefits"}], "time_period":
|
|
588
|
+
"remaining"}], "level": "employee_and_spouse", "copay": [{"in_plan_network":
|
|
589
|
+
"yes", "service_types": ["professional_physician_visit_office"], "coverage_level":
|
|
590
|
+
"employee_and_spouse", "messages": [{"message": "PRIMARY OFFICE"}]}, {"in_plan_network":
|
|
591
|
+
"not_applicable", "service_types": ["professional_physician_visit_office"],
|
|
592
|
+
"coverage_level": "employee_and_spouse", "messages": [{"message": "GYN OFFICE
|
|
593
|
+
VS"}, {"message": "GYN VISIT"}, {"message": "SPEC OFFICE"}, {"message": "SPEC
|
|
594
|
+
VISIT"}, {"message": "PRIME CARE VST"}, {"message": "Plan Requires PreCert"},
|
|
595
|
+
{"message": "Commercial"}, {"message": "Plan includes NAP"}, {"message": "Pre-Existing
|
|
596
|
+
may apply"}]}], "deductibles": [{"messages": [{"message": "INT MED AND RX,GYN
|
|
597
|
+
OFFICE VS,DED INCLUDED IN OOP,GYN VISIT,SPEC OFFICE,SPEC VISIT,PRIMARY OFFICE,PRIME
|
|
598
|
+
CARE VST"}], "in_plan_network": "yes", "eligibility_date": "2013-01-01", "time_period":
|
|
599
|
+
"calendar_year", "coverage_level": "family", "benefit_amount": {"currency":
|
|
600
|
+
"USD", "amount": "6000"}}, {"in_plan_network": "yes", "time_period": "remaining",
|
|
601
|
+
"coverage_level": "family", "messages": [{"message": "INT MED AND RX"}], "benefit_amount":
|
|
602
|
+
{"currency": "USD", "amount": "5956.09"}}, {"messages": [{"message": "INT
|
|
603
|
+
MED AND RX,GYN OFFICE VS,DED INCLUDED IN OOP,GYN VISIT,SPEC OFFICE,SPEC VISIT,PRIMARY
|
|
604
|
+
OFFICE,PRIME CARE VST"}], "in_plan_network": "yes", "eligibility_date": "2013-01-01",
|
|
605
|
+
"time_period": "calendar_year", "coverage_level": "individual", "benefit_amount":
|
|
606
|
+
{"currency": "USD", "amount": "3000"}}, {"in_plan_network": "yes", "time_period":
|
|
607
|
+
"remaining", "coverage_level": "individual", "messages": [{"message": "INT
|
|
608
|
+
MED AND RX"}], "benefit_amount": {"currency": "USD", "amount": "2983.57"}},
|
|
609
|
+
{"messages": [{"message": "INT MED AND RX,GYN OFFICE VS,DED INCLUDED IN OOP,GYN
|
|
610
|
+
VISIT,SPEC OFFICE,SPEC VISIT,PRIME CARE VST"}], "in_plan_network": "no", "eligibility_date":
|
|
611
|
+
"2013-01-01", "time_period": "calendar_year", "coverage_level": "family",
|
|
612
|
+
"benefit_amount": {"currency": "USD", "amount": "12000"}}, {"in_plan_network":
|
|
613
|
+
"no", "time_period": "remaining", "coverage_level": "family", "messages":
|
|
614
|
+
[{"message": "INT MED AND RX"}], "benefit_amount": {"currency": "USD", "amount":
|
|
615
|
+
"11956.09"}}, {"messages": [{"message": "INT MED AND RX,GYN OFFICE VS,DED
|
|
616
|
+
INCLUDED IN OOP,GYN VISIT,SPEC OFFICE,SPEC VISIT,PRIME CARE VST"}], "in_plan_network":
|
|
617
|
+
"no", "eligibility_date": "2013-01-01", "time_period": "calendar_year", "coverage_level":
|
|
618
|
+
"individual", "benefit_amount": {"currency": "USD", "amount": "6000"}}, {"in_plan_network":
|
|
619
|
+
"no", "time_period": "remaining", "coverage_level": "individual", "messages":
|
|
620
|
+
[{"message": "INT MED AND RX"}], "benefit_amount": {"currency": "USD", "amount":
|
|
621
|
+
"5983.57"}}], "plan_begin_date": "2013-02-15", "eligibility_begin_date": "2012-02-01",
|
|
622
|
+
"coinsurance": [{"benefit_percent": 0.0, "service_types": ["professional_physician_visit_office"],
|
|
623
|
+
"coverage_level": "employee_and_spouse", "messages": [{"message": "GYN OFFICE
|
|
624
|
+
VS"}, {"message": "GYN VISIT"}, {"message": "SPEC OFFICE"}, {"message": "SPEC
|
|
625
|
+
VISIT"}, {"message": "PRIMARY OFFICE"}, {"message": "PRIME CARE VST"}], "in_plan_network":
|
|
626
|
+
"yes"}, {"benefit_percent": 0.5, "service_types": ["professional_physician_visit_office"],
|
|
627
|
+
"coverage_level": "employee_and_spouse", "messages": [{"message": "GYN OFFICE
|
|
628
|
+
VS,COINS APPLIES TO OUT OF POCKET"}, {"message": "GYN VISIT,COINS APPLIES
|
|
629
|
+
TO OUT OF POCKET"}, {"message": "SPEC OFFICE,COINS APPLIES TO OUT OF POCKET"},
|
|
630
|
+
{"message": "SPEC VISIT,COINS APPLIES TO OUT OF POCKET"}, {"message": "PRIME
|
|
631
|
+
CARE VST,COINS APPLIES TO OUT OF POCKET"}], "in_plan_network": "no"}], "group_description":
|
|
632
|
+
"MOCK INDIVIDUAL ADVANTAGE PLAN", "plan_number": "0888188", "service_date":
|
|
633
|
+
"2013-08-10"}, "valid_request": true}, "trading_partner_id": "MOCKPAYER",
|
|
634
|
+
"id": "53bc0d2556c02c0671dde4ef", "transition_path": ["generate", "transmit",
|
|
635
|
+
"wait", "receive", "process", "complete"], "history": [{"record_dt": "2014-07-08T15:24:21.252000",
|
|
636
|
+
"name": "init", "title": "Initializing"}, {"record_dt": "2014-07-08T15:24:21.267000",
|
|
637
|
+
"name": "generating", "title": "Generating X12 transactions"}, {"record_dt":
|
|
638
|
+
"2014-07-08T15:24:21.268000", "name": "transmitting", "title": "Transmitting
|
|
639
|
+
transactions to Trading Partner"}, {"record_dt": "2014-07-08T15:24:21.269000",
|
|
640
|
+
"name": "waiting", "title": "Waiting on Trading Partner Response"}, {"record_dt":
|
|
641
|
+
"2014-07-08T15:24:21.270000", "name": "receiving", "title": "Receiving transactions
|
|
642
|
+
from Trading Partner"}, {"record_dt": "2014-07-08T15:24:21.318000", "name":
|
|
643
|
+
"processing", "title": "Processing X12 transactions"}]}, {"units_of_work":
|
|
644
|
+
1, "name": "providers", "parameters": {"service_types": ["health_benefit_plan_coverage"],
|
|
645
|
+
"trading_partner_id": "MOCKPAYER", "payer": {"id": "MOCKPAYER", "name": "Mockpayer
|
|
646
|
+
For Testing"}, "member": {"birth_date": "1981-06-16", "first_name": "Giovanny",
|
|
647
|
+
"last_name": "Dare", "plan_start_date": "2013-08-10", "id": "565837735"},
|
|
648
|
+
"correlation_id": "0dee56bf-ee2e-47a0-b080-1dd41c2a5688", "client_id": "2MBlqahR2xiaBtVSS50n",
|
|
649
|
+
"provider": {"first_name": "Coleman", "last_name": "Boehm", "npi": "2148171830"},
|
|
650
|
+
"async": false, "transaction_code": "request"}, "state": {"name": "completed",
|
|
651
|
+
"title": "Completed"}, "result": {"service_types": ["professional_physician_visit_office"],
|
|
652
|
+
"client_id": "2MBlqahR2xiaBtVSS50n", "payer": {"id": "MOCKPAYER", "name":
|
|
653
|
+
"MOCK PAYER INC"}, "subscriber": {"birth_date": "1981-06-16", "first_name":
|
|
654
|
+
"Giovanny", "last_name": "Dare", "id": "565837735", "address": {"city": "SPARTANBURG",
|
|
655
|
+
"state": "SC", "zipcode": "29307", "address_lines": ["123 MAIN ST"]}}, "correlation_id":
|
|
656
|
+
"0dee56bf-ee2e-47a0-b080-1dd41c2a5688", "trading_partner_id": "MOCKPAYER",
|
|
657
|
+
"provider": {"first_name": "Coleman", "last_name": "Coleman Boehm", "npi":
|
|
658
|
+
"2148171830"}, "coverage": {"service_types": ["professional_physician_visit_office"],
|
|
659
|
+
"group_number": "088818801000013", "out_of_pocket": [{"in_plan_network": "yes",
|
|
660
|
+
"benefit_amount": {"currency": "USD", "amount": "3000"}, "coverage_level":
|
|
661
|
+
"individual"}, {"in_plan_network": "yes", "benefit_amount": {"currency": "USD",
|
|
662
|
+
"amount": "2983.57"}, "coverage_level": "individual", "time_period": "remaining"},
|
|
663
|
+
{"in_plan_network": "yes", "benefit_amount": {"currency": "USD", "amount":
|
|
664
|
+
"6000"}, "coverage_level": "family"}, {"in_plan_network": "yes", "benefit_amount":
|
|
665
|
+
{"currency": "USD", "amount": "5956.09"}, "coverage_level": "family", "time_period":
|
|
666
|
+
"remaining"}, {"in_plan_network": "no", "benefit_amount": {"currency": "USD",
|
|
667
|
+
"amount": "12500"}, "coverage_level": "individual"}, {"in_plan_network": "no",
|
|
668
|
+
"benefit_amount": {"currency": "USD", "amount": "12483.57"}, "coverage_level":
|
|
669
|
+
"individual", "time_period": "remaining"}, {"in_plan_network": "no", "benefit_amount":
|
|
670
|
+
{"currency": "USD", "amount": "25000"}, "coverage_level": "family"}, {"in_plan_network":
|
|
671
|
+
"no", "benefit_amount": {"currency": "USD", "amount": "24956.09"}, "coverage_level":
|
|
672
|
+
"family", "messages": [{"message": "Unlimited Lifetime Benefits"}], "time_period":
|
|
673
|
+
"remaining"}], "level": "employee_and_spouse", "copay": [{"in_plan_network":
|
|
674
|
+
"yes", "service_types": ["professional_physician_visit_office"], "coverage_level":
|
|
675
|
+
"employee_and_spouse", "messages": [{"message": "PRIMARY OFFICE"}]}, {"in_plan_network":
|
|
676
|
+
"not_applicable", "service_types": ["professional_physician_visit_office"],
|
|
677
|
+
"coverage_level": "employee_and_spouse", "messages": [{"message": "GYN OFFICE
|
|
678
|
+
VS"}, {"message": "GYN VISIT"}, {"message": "SPEC OFFICE"}, {"message": "SPEC
|
|
679
|
+
VISIT"}, {"message": "PRIME CARE VST"}, {"message": "Plan Requires PreCert"},
|
|
680
|
+
{"message": "Commercial"}, {"message": "Plan includes NAP"}, {"message": "Pre-Existing
|
|
681
|
+
may apply"}]}], "deductibles": [{"messages": [{"message": "INT MED AND RX,GYN
|
|
682
|
+
OFFICE VS,DED INCLUDED IN OOP,GYN VISIT,SPEC OFFICE,SPEC VISIT,PRIMARY OFFICE,PRIME
|
|
683
|
+
CARE VST"}], "in_plan_network": "yes", "eligibility_date": "2013-01-01", "time_period":
|
|
684
|
+
"calendar_year", "coverage_level": "family", "benefit_amount": {"currency":
|
|
685
|
+
"USD", "amount": "6000"}}, {"in_plan_network": "yes", "time_period": "remaining",
|
|
686
|
+
"coverage_level": "family", "messages": [{"message": "INT MED AND RX"}], "benefit_amount":
|
|
687
|
+
{"currency": "USD", "amount": "5956.09"}}, {"messages": [{"message": "INT
|
|
688
|
+
MED AND RX,GYN OFFICE VS,DED INCLUDED IN OOP,GYN VISIT,SPEC OFFICE,SPEC VISIT,PRIMARY
|
|
689
|
+
OFFICE,PRIME CARE VST"}], "in_plan_network": "yes", "eligibility_date": "2013-01-01",
|
|
690
|
+
"time_period": "calendar_year", "coverage_level": "individual", "benefit_amount":
|
|
691
|
+
{"currency": "USD", "amount": "3000"}}, {"in_plan_network": "yes", "time_period":
|
|
692
|
+
"remaining", "coverage_level": "individual", "messages": [{"message": "INT
|
|
693
|
+
MED AND RX"}], "benefit_amount": {"currency": "USD", "amount": "2983.57"}},
|
|
694
|
+
{"messages": [{"message": "INT MED AND RX,GYN OFFICE VS,DED INCLUDED IN OOP,GYN
|
|
695
|
+
VISIT,SPEC OFFICE,SPEC VISIT,PRIME CARE VST"}], "in_plan_network": "no", "eligibility_date":
|
|
696
|
+
"2013-01-01", "time_period": "calendar_year", "coverage_level": "family",
|
|
697
|
+
"benefit_amount": {"currency": "USD", "amount": "12000"}}, {"in_plan_network":
|
|
698
|
+
"no", "time_period": "remaining", "coverage_level": "family", "messages":
|
|
699
|
+
[{"message": "INT MED AND RX"}], "benefit_amount": {"currency": "USD", "amount":
|
|
700
|
+
"11956.09"}}, {"messages": [{"message": "INT MED AND RX,GYN OFFICE VS,DED
|
|
701
|
+
INCLUDED IN OOP,GYN VISIT,SPEC OFFICE,SPEC VISIT,PRIME CARE VST"}], "in_plan_network":
|
|
702
|
+
"no", "eligibility_date": "2013-01-01", "time_period": "calendar_year", "coverage_level":
|
|
703
|
+
"individual", "benefit_amount": {"currency": "USD", "amount": "6000"}}, {"in_plan_network":
|
|
704
|
+
"no", "time_period": "remaining", "coverage_level": "individual", "messages":
|
|
705
|
+
[{"message": "INT MED AND RX"}], "benefit_amount": {"currency": "USD", "amount":
|
|
706
|
+
"5983.57"}}], "plan_begin_date": "2013-02-15", "eligibility_begin_date": "2012-02-01",
|
|
707
|
+
"coinsurance": [{"benefit_percent": 0.0, "service_types": ["professional_physician_visit_office"],
|
|
708
|
+
"coverage_level": "employee_and_spouse", "messages": [{"message": "GYN OFFICE
|
|
709
|
+
VS"}, {"message": "GYN VISIT"}, {"message": "SPEC OFFICE"}, {"message": "SPEC
|
|
710
|
+
VISIT"}, {"message": "PRIMARY OFFICE"}, {"message": "PRIME CARE VST"}], "in_plan_network":
|
|
711
|
+
"yes"}, {"benefit_percent": 0.5, "service_types": ["professional_physician_visit_office"],
|
|
712
|
+
"coverage_level": "employee_and_spouse", "messages": [{"message": "GYN OFFICE
|
|
713
|
+
VS,COINS APPLIES TO OUT OF POCKET"}, {"message": "GYN VISIT,COINS APPLIES
|
|
714
|
+
TO OUT OF POCKET"}, {"message": "SPEC OFFICE,COINS APPLIES TO OUT OF POCKET"},
|
|
715
|
+
{"message": "SPEC VISIT,COINS APPLIES TO OUT OF POCKET"}, {"message": "PRIME
|
|
716
|
+
CARE VST,COINS APPLIES TO OUT OF POCKET"}], "in_plan_network": "no"}], "group_description":
|
|
717
|
+
"MOCK INDIVIDUAL ADVANTAGE PLAN", "plan_number": "0888188", "service_date":
|
|
718
|
+
"2013-08-10"}, "valid_request": true}, "trading_partner_id": "MOCKPAYER",
|
|
719
|
+
"id": "53bc0d2556c02c0671dde4f2", "transition_path": ["generate", "transmit",
|
|
720
|
+
"wait", "receive", "process", "complete"], "history": [{"record_dt": "2014-07-08T15:24:21.331000",
|
|
721
|
+
"name": "init", "title": "Initializing"}, {"record_dt": "2014-07-08T15:24:21.344000",
|
|
722
|
+
"name": "generating", "title": "Generating X12 transactions"}, {"record_dt":
|
|
723
|
+
"2014-07-08T15:24:21.345000", "name": "transmitting", "title": "Transmitting
|
|
724
|
+
transactions to Trading Partner"}, {"record_dt": "2014-07-08T15:24:21.346000",
|
|
725
|
+
"name": "waiting", "title": "Waiting on Trading Partner Response"}, {"record_dt":
|
|
726
|
+
"2014-07-08T15:24:21.347000", "name": "receiving", "title": "Receiving transactions
|
|
727
|
+
from Trading Partner"}, {"record_dt": "2014-07-08T15:24:21.394000", "name":
|
|
728
|
+
"processing", "title": "Processing X12 transactions"}]}, {"units_of_work":
|
|
729
|
+
1, "name": "cash_prices", "parameters": {"service_types": ["health_benefit_plan_coverage"],
|
|
730
|
+
"trading_partner_id": "MOCKPAYER", "payer": {"id": "MOCKPAYER", "name": "Mockpayer
|
|
731
|
+
For Testing"}, "member": {"birth_date": "1996-12-21", "first_name": "Terry",
|
|
732
|
+
"last_name": "Purdy", "plan_start_date": "2013-08-10", "id": "833320093"},
|
|
733
|
+
"correlation_id": "2083290f-4443-4fe4-b3c8-3f65b1e74b75", "client_id": "2MBlqahR2xiaBtVSS50n",
|
|
734
|
+
"provider": {"first_name": "Aurelie", "last_name": "Gorczany", "npi": "2403328124"},
|
|
735
|
+
"async": false, "transaction_code": "request"}, "state": {"name": "completed",
|
|
736
|
+
"title": "Completed"}, "result": {"service_types": ["professional_physician_visit_office"],
|
|
737
|
+
"client_id": "2MBlqahR2xiaBtVSS50n", "payer": {"id": "MOCKPAYER", "name":
|
|
738
|
+
"MOCK PAYER INC"}, "subscriber": {"birth_date": "1996-12-21", "first_name":
|
|
739
|
+
"Terry", "last_name": "Purdy", "id": "833320093", "address": {"city": "SPARTANBURG",
|
|
740
|
+
"state": "SC", "zipcode": "29307", "address_lines": ["123 MAIN ST"]}}, "correlation_id":
|
|
741
|
+
"2083290f-4443-4fe4-b3c8-3f65b1e74b75", "trading_partner_id": "MOCKPAYER",
|
|
742
|
+
"provider": {"first_name": "Aurelie", "last_name": "Aurelie Gorczany", "npi":
|
|
743
|
+
"2403328124"}, "coverage": {"service_types": ["professional_physician_visit_office"],
|
|
744
|
+
"group_number": "088818801000013", "out_of_pocket": [{"in_plan_network": "yes",
|
|
745
|
+
"benefit_amount": {"currency": "USD", "amount": "3000"}, "coverage_level":
|
|
746
|
+
"individual"}, {"in_plan_network": "yes", "benefit_amount": {"currency": "USD",
|
|
747
|
+
"amount": "2983.57"}, "coverage_level": "individual", "time_period": "remaining"},
|
|
748
|
+
{"in_plan_network": "yes", "benefit_amount": {"currency": "USD", "amount":
|
|
749
|
+
"6000"}, "coverage_level": "family"}, {"in_plan_network": "yes", "benefit_amount":
|
|
750
|
+
{"currency": "USD", "amount": "5956.09"}, "coverage_level": "family", "time_period":
|
|
751
|
+
"remaining"}, {"in_plan_network": "no", "benefit_amount": {"currency": "USD",
|
|
752
|
+
"amount": "12500"}, "coverage_level": "individual"}, {"in_plan_network": "no",
|
|
753
|
+
"benefit_amount": {"currency": "USD", "amount": "12483.57"}, "coverage_level":
|
|
754
|
+
"individual", "time_period": "remaining"}, {"in_plan_network": "no", "benefit_amount":
|
|
755
|
+
{"currency": "USD", "amount": "25000"}, "coverage_level": "family"}, {"in_plan_network":
|
|
756
|
+
"no", "benefit_amount": {"currency": "USD", "amount": "24956.09"}, "coverage_level":
|
|
757
|
+
"family", "messages": [{"message": "Unlimited Lifetime Benefits"}], "time_period":
|
|
758
|
+
"remaining"}], "level": "employee_and_spouse", "copay": [{"in_plan_network":
|
|
759
|
+
"yes", "service_types": ["professional_physician_visit_office"], "coverage_level":
|
|
760
|
+
"employee_and_spouse", "messages": [{"message": "PRIMARY OFFICE"}]}, {"in_plan_network":
|
|
761
|
+
"not_applicable", "service_types": ["professional_physician_visit_office"],
|
|
762
|
+
"coverage_level": "employee_and_spouse", "messages": [{"message": "GYN OFFICE
|
|
763
|
+
VS"}, {"message": "GYN VISIT"}, {"message": "SPEC OFFICE"}, {"message": "SPEC
|
|
764
|
+
VISIT"}, {"message": "PRIME CARE VST"}, {"message": "Plan Requires PreCert"},
|
|
765
|
+
{"message": "Commercial"}, {"message": "Plan includes NAP"}, {"message": "Pre-Existing
|
|
766
|
+
may apply"}]}], "deductibles": [{"messages": [{"message": "INT MED AND RX,GYN
|
|
767
|
+
OFFICE VS,DED INCLUDED IN OOP,GYN VISIT,SPEC OFFICE,SPEC VISIT,PRIMARY OFFICE,PRIME
|
|
768
|
+
CARE VST"}], "in_plan_network": "yes", "eligibility_date": "2013-01-01", "time_period":
|
|
769
|
+
"calendar_year", "coverage_level": "family", "benefit_amount": {"currency":
|
|
770
|
+
"USD", "amount": "6000"}}, {"in_plan_network": "yes", "time_period": "remaining",
|
|
771
|
+
"coverage_level": "family", "messages": [{"message": "INT MED AND RX"}], "benefit_amount":
|
|
772
|
+
{"currency": "USD", "amount": "5956.09"}}, {"messages": [{"message": "INT
|
|
773
|
+
MED AND RX,GYN OFFICE VS,DED INCLUDED IN OOP,GYN VISIT,SPEC OFFICE,SPEC VISIT,PRIMARY
|
|
774
|
+
OFFICE,PRIME CARE VST"}], "in_plan_network": "yes", "eligibility_date": "2013-01-01",
|
|
775
|
+
"time_period": "calendar_year", "coverage_level": "individual", "benefit_amount":
|
|
776
|
+
{"currency": "USD", "amount": "3000"}}, {"in_plan_network": "yes", "time_period":
|
|
777
|
+
"remaining", "coverage_level": "individual", "messages": [{"message": "INT
|
|
778
|
+
MED AND RX"}], "benefit_amount": {"currency": "USD", "amount": "2983.57"}},
|
|
779
|
+
{"messages": [{"message": "INT MED AND RX,GYN OFFICE VS,DED INCLUDED IN OOP,GYN
|
|
780
|
+
VISIT,SPEC OFFICE,SPEC VISIT,PRIME CARE VST"}], "in_plan_network": "no", "eligibility_date":
|
|
781
|
+
"2013-01-01", "time_period": "calendar_year", "coverage_level": "family",
|
|
782
|
+
"benefit_amount": {"currency": "USD", "amount": "12000"}}, {"in_plan_network":
|
|
783
|
+
"no", "time_period": "remaining", "coverage_level": "family", "messages":
|
|
784
|
+
[{"message": "INT MED AND RX"}], "benefit_amount": {"currency": "USD", "amount":
|
|
785
|
+
"11956.09"}}, {"messages": [{"message": "INT MED AND RX,GYN OFFICE VS,DED
|
|
786
|
+
INCLUDED IN OOP,GYN VISIT,SPEC OFFICE,SPEC VISIT,PRIME CARE VST"}], "in_plan_network":
|
|
787
|
+
"no", "eligibility_date": "2013-01-01", "time_period": "calendar_year", "coverage_level":
|
|
788
|
+
"individual", "benefit_amount": {"currency": "USD", "amount": "6000"}}, {"in_plan_network":
|
|
789
|
+
"no", "time_period": "remaining", "coverage_level": "individual", "messages":
|
|
790
|
+
[{"message": "INT MED AND RX"}], "benefit_amount": {"currency": "USD", "amount":
|
|
791
|
+
"5983.57"}}], "plan_begin_date": "2013-02-15", "eligibility_begin_date": "2012-02-01",
|
|
792
|
+
"coinsurance": [{"benefit_percent": 0.0, "service_types": ["professional_physician_visit_office"],
|
|
793
|
+
"coverage_level": "employee_and_spouse", "messages": [{"message": "GYN OFFICE
|
|
794
|
+
VS"}, {"message": "GYN VISIT"}, {"message": "SPEC OFFICE"}, {"message": "SPEC
|
|
795
|
+
VISIT"}, {"message": "PRIMARY OFFICE"}, {"message": "PRIME CARE VST"}], "in_plan_network":
|
|
796
|
+
"yes"}, {"benefit_percent": 0.5, "service_types": ["professional_physician_visit_office"],
|
|
797
|
+
"coverage_level": "employee_and_spouse", "messages": [{"message": "GYN OFFICE
|
|
798
|
+
VS,COINS APPLIES TO OUT OF POCKET"}, {"message": "GYN VISIT,COINS APPLIES
|
|
799
|
+
TO OUT OF POCKET"}, {"message": "SPEC OFFICE,COINS APPLIES TO OUT OF POCKET"},
|
|
800
|
+
{"message": "SPEC VISIT,COINS APPLIES TO OUT OF POCKET"}, {"message": "PRIME
|
|
801
|
+
CARE VST,COINS APPLIES TO OUT OF POCKET"}], "in_plan_network": "no"}], "group_description":
|
|
802
|
+
"MOCK INDIVIDUAL ADVANTAGE PLAN", "plan_number": "0888188", "service_date":
|
|
803
|
+
"2013-08-10"}, "valid_request": true}, "trading_partner_id": "MOCKPAYER",
|
|
804
|
+
"id": "53bc0d2556c02c0671dde4f5", "transition_path": ["generate", "transmit",
|
|
805
|
+
"wait", "receive", "process", "complete"], "history": [{"record_dt": "2014-07-08T15:24:21.408000",
|
|
806
|
+
"name": "init", "title": "Initializing"}, {"record_dt": "2014-07-08T15:24:21.421000",
|
|
807
|
+
"name": "generating", "title": "Generating X12 transactions"}, {"record_dt":
|
|
808
|
+
"2014-07-08T15:24:21.422000", "name": "transmitting", "title": "Transmitting
|
|
809
|
+
transactions to Trading Partner"}, {"record_dt": "2014-07-08T15:24:21.424000",
|
|
810
|
+
"name": "waiting", "title": "Waiting on Trading Partner Response"}, {"record_dt":
|
|
811
|
+
"2014-07-08T15:24:21.425000", "name": "receiving", "title": "Receiving transactions
|
|
812
|
+
from Trading Partner"}, {"record_dt": "2014-07-08T15:24:21.471000", "name":
|
|
813
|
+
"processing", "title": "Processing X12 transactions"}]}, {"units_of_work":
|
|
814
|
+
1, "name": "insurance_prices", "parameters": {"service_types": ["health_benefit_plan_coverage"],
|
|
815
|
+
"trading_partner_id": "MOCKPAYER", "payer": {"id": "MOCKPAYER", "name": "Mockpayer
|
|
816
|
+
For Testing"}, "member": {"birth_date": "1993-05-27", "first_name": "Hollis",
|
|
817
|
+
"last_name": "Schoen", "plan_start_date": "2013-08-10", "id": "133016101"},
|
|
818
|
+
"correlation_id": "fbfa8078-61f0-4b6b-ab2a-bdebc08441c8", "client_id": "2MBlqahR2xiaBtVSS50n",
|
|
819
|
+
"provider": {"first_name": "Savannah", "last_name": "Feil", "npi": "5876189598"},
|
|
820
|
+
"async": false, "transaction_code": "request"}, "state": {"name": "completed",
|
|
821
|
+
"title": "Completed"}, "result": {"service_types": ["professional_physician_visit_office"],
|
|
822
|
+
"client_id": "2MBlqahR2xiaBtVSS50n", "payer": {"id": "MOCKPAYER", "name":
|
|
823
|
+
"MOCK PAYER INC"}, "subscriber": {"birth_date": "1993-05-27", "first_name":
|
|
824
|
+
"Hollis", "last_name": "Schoen", "id": "133016101", "address": {"city": "SPARTANBURG",
|
|
825
|
+
"state": "SC", "zipcode": "29307", "address_lines": ["123 MAIN ST"]}}, "correlation_id":
|
|
826
|
+
"fbfa8078-61f0-4b6b-ab2a-bdebc08441c8", "trading_partner_id": "MOCKPAYER",
|
|
827
|
+
"provider": {"first_name": "Savannah", "last_name": "Savannah Feil", "npi":
|
|
828
|
+
"5876189598"}, "coverage": {"service_types": ["professional_physician_visit_office"],
|
|
829
|
+
"group_number": "088818801000013", "out_of_pocket": [{"in_plan_network": "yes",
|
|
830
|
+
"benefit_amount": {"currency": "USD", "amount": "3000"}, "coverage_level":
|
|
831
|
+
"individual"}, {"in_plan_network": "yes", "benefit_amount": {"currency": "USD",
|
|
832
|
+
"amount": "2983.57"}, "coverage_level": "individual", "time_period": "remaining"},
|
|
833
|
+
{"in_plan_network": "yes", "benefit_amount": {"currency": "USD", "amount":
|
|
834
|
+
"6000"}, "coverage_level": "family"}, {"in_plan_network": "yes", "benefit_amount":
|
|
835
|
+
{"currency": "USD", "amount": "5956.09"}, "coverage_level": "family", "time_period":
|
|
836
|
+
"remaining"}, {"in_plan_network": "no", "benefit_amount": {"currency": "USD",
|
|
837
|
+
"amount": "12500"}, "coverage_level": "individual"}, {"in_plan_network": "no",
|
|
838
|
+
"benefit_amount": {"currency": "USD", "amount": "12483.57"}, "coverage_level":
|
|
839
|
+
"individual", "time_period": "remaining"}, {"in_plan_network": "no", "benefit_amount":
|
|
840
|
+
{"currency": "USD", "amount": "25000"}, "coverage_level": "family"}, {"in_plan_network":
|
|
841
|
+
"no", "benefit_amount": {"currency": "USD", "amount": "24956.09"}, "coverage_level":
|
|
842
|
+
"family", "messages": [{"message": "Unlimited Lifetime Benefits"}], "time_period":
|
|
843
|
+
"remaining"}], "level": "employee_and_spouse", "copay": [{"in_plan_network":
|
|
844
|
+
"yes", "service_types": ["professional_physician_visit_office"], "coverage_level":
|
|
845
|
+
"employee_and_spouse", "messages": [{"message": "PRIMARY OFFICE"}]}, {"in_plan_network":
|
|
846
|
+
"not_applicable", "service_types": ["professional_physician_visit_office"],
|
|
847
|
+
"coverage_level": "employee_and_spouse", "messages": [{"message": "GYN OFFICE
|
|
848
|
+
VS"}, {"message": "GYN VISIT"}, {"message": "SPEC OFFICE"}, {"message": "SPEC
|
|
849
|
+
VISIT"}, {"message": "PRIME CARE VST"}, {"message": "Plan Requires PreCert"},
|
|
850
|
+
{"message": "Commercial"}, {"message": "Plan includes NAP"}, {"message": "Pre-Existing
|
|
851
|
+
may apply"}]}], "deductibles": [{"messages": [{"message": "INT MED AND RX,GYN
|
|
852
|
+
OFFICE VS,DED INCLUDED IN OOP,GYN VISIT,SPEC OFFICE,SPEC VISIT,PRIMARY OFFICE,PRIME
|
|
853
|
+
CARE VST"}], "in_plan_network": "yes", "eligibility_date": "2013-01-01", "time_period":
|
|
854
|
+
"calendar_year", "coverage_level": "family", "benefit_amount": {"currency":
|
|
855
|
+
"USD", "amount": "6000"}}, {"in_plan_network": "yes", "time_period": "remaining",
|
|
856
|
+
"coverage_level": "family", "messages": [{"message": "INT MED AND RX"}], "benefit_amount":
|
|
857
|
+
{"currency": "USD", "amount": "5956.09"}}, {"messages": [{"message": "INT
|
|
858
|
+
MED AND RX,GYN OFFICE VS,DED INCLUDED IN OOP,GYN VISIT,SPEC OFFICE,SPEC VISIT,PRIMARY
|
|
859
|
+
OFFICE,PRIME CARE VST"}], "in_plan_network": "yes", "eligibility_date": "2013-01-01",
|
|
860
|
+
"time_period": "calendar_year", "coverage_level": "individual", "benefit_amount":
|
|
861
|
+
{"currency": "USD", "amount": "3000"}}, {"in_plan_network": "yes", "time_period":
|
|
862
|
+
"remaining", "coverage_level": "individual", "messages": [{"message": "INT
|
|
863
|
+
MED AND RX"}], "benefit_amount": {"currency": "USD", "amount": "2983.57"}},
|
|
864
|
+
{"messages": [{"message": "INT MED AND RX,GYN OFFICE VS,DED INCLUDED IN OOP,GYN
|
|
865
|
+
VISIT,SPEC OFFICE,SPEC VISIT,PRIME CARE VST"}], "in_plan_network": "no", "eligibility_date":
|
|
866
|
+
"2013-01-01", "time_period": "calendar_year", "coverage_level": "family",
|
|
867
|
+
"benefit_amount": {"currency": "USD", "amount": "12000"}}, {"in_plan_network":
|
|
868
|
+
"no", "time_period": "remaining", "coverage_level": "family", "messages":
|
|
869
|
+
[{"message": "INT MED AND RX"}], "benefit_amount": {"currency": "USD", "amount":
|
|
870
|
+
"11956.09"}}, {"messages": [{"message": "INT MED AND RX,GYN OFFICE VS,DED
|
|
871
|
+
INCLUDED IN OOP,GYN VISIT,SPEC OFFICE,SPEC VISIT,PRIME CARE VST"}], "in_plan_network":
|
|
872
|
+
"no", "eligibility_date": "2013-01-01", "time_period": "calendar_year", "coverage_level":
|
|
873
|
+
"individual", "benefit_amount": {"currency": "USD", "amount": "6000"}}, {"in_plan_network":
|
|
874
|
+
"no", "time_period": "remaining", "coverage_level": "individual", "messages":
|
|
875
|
+
[{"message": "INT MED AND RX"}], "benefit_amount": {"currency": "USD", "amount":
|
|
876
|
+
"5983.57"}}], "plan_begin_date": "2013-02-15", "eligibility_begin_date": "2012-02-01",
|
|
877
|
+
"coinsurance": [{"benefit_percent": 0.0, "service_types": ["professional_physician_visit_office"],
|
|
878
|
+
"coverage_level": "employee_and_spouse", "messages": [{"message": "GYN OFFICE
|
|
879
|
+
VS"}, {"message": "GYN VISIT"}, {"message": "SPEC OFFICE"}, {"message": "SPEC
|
|
880
|
+
VISIT"}, {"message": "PRIMARY OFFICE"}, {"message": "PRIME CARE VST"}], "in_plan_network":
|
|
881
|
+
"yes"}, {"benefit_percent": 0.5, "service_types": ["professional_physician_visit_office"],
|
|
882
|
+
"coverage_level": "employee_and_spouse", "messages": [{"message": "GYN OFFICE
|
|
883
|
+
VS,COINS APPLIES TO OUT OF POCKET"}, {"message": "GYN VISIT,COINS APPLIES
|
|
884
|
+
TO OUT OF POCKET"}, {"message": "SPEC OFFICE,COINS APPLIES TO OUT OF POCKET"},
|
|
885
|
+
{"message": "SPEC VISIT,COINS APPLIES TO OUT OF POCKET"}, {"message": "PRIME
|
|
886
|
+
CARE VST,COINS APPLIES TO OUT OF POCKET"}], "in_plan_network": "no"}], "group_description":
|
|
887
|
+
"MOCK INDIVIDUAL ADVANTAGE PLAN", "plan_number": "0888188", "service_date":
|
|
888
|
+
"2013-08-10"}, "valid_request": true}, "trading_partner_id": "MOCKPAYER",
|
|
889
|
+
"id": "53bc0d2556c02c0671dde4f8", "transition_path": ["generate", "transmit",
|
|
890
|
+
"wait", "receive", "process", "complete"], "history": [{"record_dt": "2014-07-08T15:24:21.483000",
|
|
891
|
+
"name": "init", "title": "Initializing"}, {"record_dt": "2014-07-08T15:24:21.497000",
|
|
892
|
+
"name": "generating", "title": "Generating X12 transactions"}, {"record_dt":
|
|
893
|
+
"2014-07-08T15:24:21.499000", "name": "transmitting", "title": "Transmitting
|
|
894
|
+
transactions to Trading Partner"}, {"record_dt": "2014-07-08T15:24:21.500000",
|
|
895
|
+
"name": "waiting", "title": "Waiting on Trading Partner Response"}, {"record_dt":
|
|
896
|
+
"2014-07-08T15:24:21.502000", "name": "receiving", "title": "Receiving transactions
|
|
897
|
+
from Trading Partner"}, {"record_dt": "2014-07-08T15:24:21.549000", "name":
|
|
898
|
+
"processing", "title": "Processing X12 transactions"}]}, {"units_of_work":
|
|
899
|
+
1, "name": "providers", "parameters": {"service_types": ["health_benefit_plan_coverage"],
|
|
900
|
+
"trading_partner_id": "MOCKPAYER", "payer": {"id": "MOCKPAYER", "name": "Mockpayer
|
|
901
|
+
For Testing"}, "member": {"birth_date": "1997-08-30", "first_name": "Shayne",
|
|
902
|
+
"last_name": "Osinski", "plan_start_date": "2013-08-10", "id": "236880972"},
|
|
903
|
+
"correlation_id": "2a0ea494-616b-42c4-88cb-f7df84f351a3", "client_id": "2MBlqahR2xiaBtVSS50n",
|
|
904
|
+
"provider": {"first_name": "Rodger", "last_name": "Roberts", "npi": "2848872459"},
|
|
905
|
+
"async": false, "transaction_code": "request"}, "state": {"name": "completed",
|
|
906
|
+
"title": "Completed"}, "result": {"service_types": ["professional_physician_visit_office"],
|
|
907
|
+
"client_id": "2MBlqahR2xiaBtVSS50n", "payer": {"id": "MOCKPAYER", "name":
|
|
908
|
+
"MOCK PAYER INC"}, "subscriber": {"birth_date": "1997-08-30", "first_name":
|
|
909
|
+
"Shayne", "last_name": "Osinski", "id": "236880972", "address": {"city": "SPARTANBURG",
|
|
910
|
+
"state": "SC", "zipcode": "29307", "address_lines": ["123 MAIN ST"]}}, "correlation_id":
|
|
911
|
+
"2a0ea494-616b-42c4-88cb-f7df84f351a3", "trading_partner_id": "MOCKPAYER",
|
|
912
|
+
"provider": {"first_name": "Rodger", "last_name": "Rodger Roberts", "npi":
|
|
913
|
+
"2848872459"}, "coverage": {"service_types": ["professional_physician_visit_office"],
|
|
914
|
+
"group_number": "088818801000013", "out_of_pocket": [{"in_plan_network": "yes",
|
|
915
|
+
"benefit_amount": {"currency": "USD", "amount": "3000"}, "coverage_level":
|
|
916
|
+
"individual"}, {"in_plan_network": "yes", "benefit_amount": {"currency": "USD",
|
|
917
|
+
"amount": "2983.57"}, "coverage_level": "individual", "time_period": "remaining"},
|
|
918
|
+
{"in_plan_network": "yes", "benefit_amount": {"currency": "USD", "amount":
|
|
919
|
+
"6000"}, "coverage_level": "family"}, {"in_plan_network": "yes", "benefit_amount":
|
|
920
|
+
{"currency": "USD", "amount": "5956.09"}, "coverage_level": "family", "time_period":
|
|
921
|
+
"remaining"}, {"in_plan_network": "no", "benefit_amount": {"currency": "USD",
|
|
922
|
+
"amount": "12500"}, "coverage_level": "individual"}, {"in_plan_network": "no",
|
|
923
|
+
"benefit_amount": {"currency": "USD", "amount": "12483.57"}, "coverage_level":
|
|
924
|
+
"individual", "time_period": "remaining"}, {"in_plan_network": "no", "benefit_amount":
|
|
925
|
+
{"currency": "USD", "amount": "25000"}, "coverage_level": "family"}, {"in_plan_network":
|
|
926
|
+
"no", "benefit_amount": {"currency": "USD", "amount": "24956.09"}, "coverage_level":
|
|
927
|
+
"family", "messages": [{"message": "Unlimited Lifetime Benefits"}], "time_period":
|
|
928
|
+
"remaining"}], "level": "employee_and_spouse", "copay": [{"in_plan_network":
|
|
929
|
+
"yes", "service_types": ["professional_physician_visit_office"], "coverage_level":
|
|
930
|
+
"employee_and_spouse", "messages": [{"message": "PRIMARY OFFICE"}]}, {"in_plan_network":
|
|
931
|
+
"not_applicable", "service_types": ["professional_physician_visit_office"],
|
|
932
|
+
"coverage_level": "employee_and_spouse", "messages": [{"message": "GYN OFFICE
|
|
933
|
+
VS"}, {"message": "GYN VISIT"}, {"message": "SPEC OFFICE"}, {"message": "SPEC
|
|
934
|
+
VISIT"}, {"message": "PRIME CARE VST"}, {"message": "Plan Requires PreCert"},
|
|
935
|
+
{"message": "Commercial"}, {"message": "Plan includes NAP"}, {"message": "Pre-Existing
|
|
936
|
+
may apply"}]}], "deductibles": [{"messages": [{"message": "INT MED AND RX,GYN
|
|
937
|
+
OFFICE VS,DED INCLUDED IN OOP,GYN VISIT,SPEC OFFICE,SPEC VISIT,PRIMARY OFFICE,PRIME
|
|
938
|
+
CARE VST"}], "in_plan_network": "yes", "eligibility_date": "2013-01-01", "time_period":
|
|
939
|
+
"calendar_year", "coverage_level": "family", "benefit_amount": {"currency":
|
|
940
|
+
"USD", "amount": "6000"}}, {"in_plan_network": "yes", "time_period": "remaining",
|
|
941
|
+
"coverage_level": "family", "messages": [{"message": "INT MED AND RX"}], "benefit_amount":
|
|
942
|
+
{"currency": "USD", "amount": "5956.09"}}, {"messages": [{"message": "INT
|
|
943
|
+
MED AND RX,GYN OFFICE VS,DED INCLUDED IN OOP,GYN VISIT,SPEC OFFICE,SPEC VISIT,PRIMARY
|
|
944
|
+
OFFICE,PRIME CARE VST"}], "in_plan_network": "yes", "eligibility_date": "2013-01-01",
|
|
945
|
+
"time_period": "calendar_year", "coverage_level": "individual", "benefit_amount":
|
|
946
|
+
{"currency": "USD", "amount": "3000"}}, {"in_plan_network": "yes", "time_period":
|
|
947
|
+
"remaining", "coverage_level": "individual", "messages": [{"message": "INT
|
|
948
|
+
MED AND RX"}], "benefit_amount": {"currency": "USD", "amount": "2983.57"}},
|
|
949
|
+
{"messages": [{"message": "INT MED AND RX,GYN OFFICE VS,DED INCLUDED IN OOP,GYN
|
|
950
|
+
VISIT,SPEC OFFICE,SPEC VISIT,PRIME CARE VST"}], "in_plan_network": "no", "eligibility_date":
|
|
951
|
+
"2013-01-01", "time_period": "calendar_year", "coverage_level": "family",
|
|
952
|
+
"benefit_amount": {"currency": "USD", "amount": "12000"}}, {"in_plan_network":
|
|
953
|
+
"no", "time_period": "remaining", "coverage_level": "family", "messages":
|
|
954
|
+
[{"message": "INT MED AND RX"}], "benefit_amount": {"currency": "USD", "amount":
|
|
955
|
+
"11956.09"}}, {"messages": [{"message": "INT MED AND RX,GYN OFFICE VS,DED
|
|
956
|
+
INCLUDED IN OOP,GYN VISIT,SPEC OFFICE,SPEC VISIT,PRIME CARE VST"}], "in_plan_network":
|
|
957
|
+
"no", "eligibility_date": "2013-01-01", "time_period": "calendar_year", "coverage_level":
|
|
958
|
+
"individual", "benefit_amount": {"currency": "USD", "amount": "6000"}}, {"in_plan_network":
|
|
959
|
+
"no", "time_period": "remaining", "coverage_level": "individual", "messages":
|
|
960
|
+
[{"message": "INT MED AND RX"}], "benefit_amount": {"currency": "USD", "amount":
|
|
961
|
+
"5983.57"}}], "plan_begin_date": "2013-02-15", "eligibility_begin_date": "2012-02-01",
|
|
962
|
+
"coinsurance": [{"benefit_percent": 0.0, "service_types": ["professional_physician_visit_office"],
|
|
963
|
+
"coverage_level": "employee_and_spouse", "messages": [{"message": "GYN OFFICE
|
|
964
|
+
VS"}, {"message": "GYN VISIT"}, {"message": "SPEC OFFICE"}, {"message": "SPEC
|
|
965
|
+
VISIT"}, {"message": "PRIMARY OFFICE"}, {"message": "PRIME CARE VST"}], "in_plan_network":
|
|
966
|
+
"yes"}, {"benefit_percent": 0.5, "service_types": ["professional_physician_visit_office"],
|
|
967
|
+
"coverage_level": "employee_and_spouse", "messages": [{"message": "GYN OFFICE
|
|
968
|
+
VS,COINS APPLIES TO OUT OF POCKET"}, {"message": "GYN VISIT,COINS APPLIES
|
|
969
|
+
TO OUT OF POCKET"}, {"message": "SPEC OFFICE,COINS APPLIES TO OUT OF POCKET"},
|
|
970
|
+
{"message": "SPEC VISIT,COINS APPLIES TO OUT OF POCKET"}, {"message": "PRIME
|
|
971
|
+
CARE VST,COINS APPLIES TO OUT OF POCKET"}], "in_plan_network": "no"}], "group_description":
|
|
972
|
+
"MOCK INDIVIDUAL ADVANTAGE PLAN", "plan_number": "0888188", "service_date":
|
|
973
|
+
"2013-08-10"}, "valid_request": true}, "trading_partner_id": "MOCKPAYER",
|
|
974
|
+
"id": "53bc0d2556c02c0671dde4fb", "transition_path": ["generate", "transmit",
|
|
975
|
+
"wait", "receive", "process", "complete"], "history": [{"record_dt": "2014-07-08T15:24:21.562000",
|
|
976
|
+
"name": "init", "title": "Initializing"}, {"record_dt": "2014-07-08T15:24:21.575000",
|
|
977
|
+
"name": "generating", "title": "Generating X12 transactions"}, {"record_dt":
|
|
978
|
+
"2014-07-08T15:24:21.576000", "name": "transmitting", "title": "Transmitting
|
|
979
|
+
transactions to Trading Partner"}, {"record_dt": "2014-07-08T15:24:21.577000",
|
|
980
|
+
"name": "waiting", "title": "Waiting on Trading Partner Response"}, {"record_dt":
|
|
981
|
+
"2014-07-08T15:24:21.579000", "name": "receiving", "title": "Receiving transactions
|
|
982
|
+
from Trading Partner"}, {"record_dt": "2014-07-08T15:24:21.625000", "name":
|
|
983
|
+
"processing", "title": "Processing X12 transactions"}]}, {"units_of_work":
|
|
984
|
+
1, "name": "insurance_prices", "parameters": {"service_types": ["health_benefit_plan_coverage"],
|
|
985
|
+
"trading_partner_id": "MOCKPAYER", "payer": {"id": "MOCKPAYER", "name": "Mockpayer
|
|
986
|
+
For Testing"}, "member": {"birth_date": "1982-06-17", "first_name": "Juanita",
|
|
987
|
+
"last_name": "Tillman", "plan_start_date": "2013-08-10", "id": "305262907"},
|
|
988
|
+
"correlation_id": "78284f5a-1316-44ae-97c0-b1346644b374", "client_id": "2MBlqahR2xiaBtVSS50n",
|
|
989
|
+
"provider": {"first_name": "Alanna", "last_name": "Maggio", "npi": "9082293984"},
|
|
990
|
+
"async": false, "transaction_code": "request"}, "state": {"name": "completed",
|
|
991
|
+
"title": "Completed"}, "result": {"service_types": ["professional_physician_visit_office"],
|
|
992
|
+
"client_id": "2MBlqahR2xiaBtVSS50n", "payer": {"id": "MOCKPAYER", "name":
|
|
993
|
+
"MOCK PAYER INC"}, "subscriber": {"birth_date": "1982-06-17", "first_name":
|
|
994
|
+
"Juanita", "last_name": "Tillman", "id": "305262907", "address": {"city":
|
|
995
|
+
"SPARTANBURG", "state": "SC", "zipcode": "29307", "address_lines": ["123 MAIN
|
|
996
|
+
ST"]}}, "correlation_id": "78284f5a-1316-44ae-97c0-b1346644b374", "trading_partner_id":
|
|
997
|
+
"MOCKPAYER", "provider": {"first_name": "Alanna", "last_name": "Alanna Maggio",
|
|
998
|
+
"npi": "9082293984"}, "coverage": {"service_types": ["professional_physician_visit_office"],
|
|
999
|
+
"group_number": "088818801000013", "out_of_pocket": [{"in_plan_network": "yes",
|
|
1000
|
+
"benefit_amount": {"currency": "USD", "amount": "3000"}, "coverage_level":
|
|
1001
|
+
"individual"}, {"in_plan_network": "yes", "benefit_amount": {"currency": "USD",
|
|
1002
|
+
"amount": "2983.57"}, "coverage_level": "individual", "time_period": "remaining"},
|
|
1003
|
+
{"in_plan_network": "yes", "benefit_amount": {"currency": "USD", "amount":
|
|
1004
|
+
"6000"}, "coverage_level": "family"}, {"in_plan_network": "yes", "benefit_amount":
|
|
1005
|
+
{"currency": "USD", "amount": "5956.09"}, "coverage_level": "family", "time_period":
|
|
1006
|
+
"remaining"}, {"in_plan_network": "no", "benefit_amount": {"currency": "USD",
|
|
1007
|
+
"amount": "12500"}, "coverage_level": "individual"}, {"in_plan_network": "no",
|
|
1008
|
+
"benefit_amount": {"currency": "USD", "amount": "12483.57"}, "coverage_level":
|
|
1009
|
+
"individual", "time_period": "remaining"}, {"in_plan_network": "no", "benefit_amount":
|
|
1010
|
+
{"currency": "USD", "amount": "25000"}, "coverage_level": "family"}, {"in_plan_network":
|
|
1011
|
+
"no", "benefit_amount": {"currency": "USD", "amount": "24956.09"}, "coverage_level":
|
|
1012
|
+
"family", "messages": [{"message": "Unlimited Lifetime Benefits"}], "time_period":
|
|
1013
|
+
"remaining"}], "level": "employee_and_spouse", "copay": [{"in_plan_network":
|
|
1014
|
+
"yes", "service_types": ["professional_physician_visit_office"], "coverage_level":
|
|
1015
|
+
"employee_and_spouse", "messages": [{"message": "PRIMARY OFFICE"}]}, {"in_plan_network":
|
|
1016
|
+
"not_applicable", "service_types": ["professional_physician_visit_office"],
|
|
1017
|
+
"coverage_level": "employee_and_spouse", "messages": [{"message": "GYN OFFICE
|
|
1018
|
+
VS"}, {"message": "GYN VISIT"}, {"message": "SPEC OFFICE"}, {"message": "SPEC
|
|
1019
|
+
VISIT"}, {"message": "PRIME CARE VST"}, {"message": "Plan Requires PreCert"},
|
|
1020
|
+
{"message": "Commercial"}, {"message": "Plan includes NAP"}, {"message": "Pre-Existing
|
|
1021
|
+
may apply"}]}], "deductibles": [{"messages": [{"message": "INT MED AND RX,GYN
|
|
1022
|
+
OFFICE VS,DED INCLUDED IN OOP,GYN VISIT,SPEC OFFICE,SPEC VISIT,PRIMARY OFFICE,PRIME
|
|
1023
|
+
CARE VST"}], "in_plan_network": "yes", "eligibility_date": "2013-01-01", "time_period":
|
|
1024
|
+
"calendar_year", "coverage_level": "family", "benefit_amount": {"currency":
|
|
1025
|
+
"USD", "amount": "6000"}}, {"in_plan_network": "yes", "time_period": "remaining",
|
|
1026
|
+
"coverage_level": "family", "messages": [{"message": "INT MED AND RX"}], "benefit_amount":
|
|
1027
|
+
{"currency": "USD", "amount": "5956.09"}}, {"messages": [{"message": "INT
|
|
1028
|
+
MED AND RX,GYN OFFICE VS,DED INCLUDED IN OOP,GYN VISIT,SPEC OFFICE,SPEC VISIT,PRIMARY
|
|
1029
|
+
OFFICE,PRIME CARE VST"}], "in_plan_network": "yes", "eligibility_date": "2013-01-01",
|
|
1030
|
+
"time_period": "calendar_year", "coverage_level": "individual", "benefit_amount":
|
|
1031
|
+
{"currency": "USD", "amount": "3000"}}, {"in_plan_network": "yes", "time_period":
|
|
1032
|
+
"remaining", "coverage_level": "individual", "messages": [{"message": "INT
|
|
1033
|
+
MED AND RX"}], "benefit_amount": {"currency": "USD", "amount": "2983.57"}},
|
|
1034
|
+
{"messages": [{"message": "INT MED AND RX,GYN OFFICE VS,DED INCLUDED IN OOP,GYN
|
|
1035
|
+
VISIT,SPEC OFFICE,SPEC VISIT,PRIME CARE VST"}], "in_plan_network": "no", "eligibility_date":
|
|
1036
|
+
"2013-01-01", "time_period": "calendar_year", "coverage_level": "family",
|
|
1037
|
+
"benefit_amount": {"currency": "USD", "amount": "12000"}}, {"in_plan_network":
|
|
1038
|
+
"no", "time_period": "remaining", "coverage_level": "family", "messages":
|
|
1039
|
+
[{"message": "INT MED AND RX"}], "benefit_amount": {"currency": "USD", "amount":
|
|
1040
|
+
"11956.09"}}, {"messages": [{"message": "INT MED AND RX,GYN OFFICE VS,DED
|
|
1041
|
+
INCLUDED IN OOP,GYN VISIT,SPEC OFFICE,SPEC VISIT,PRIME CARE VST"}], "in_plan_network":
|
|
1042
|
+
"no", "eligibility_date": "2013-01-01", "time_period": "calendar_year", "coverage_level":
|
|
1043
|
+
"individual", "benefit_amount": {"currency": "USD", "amount": "6000"}}, {"in_plan_network":
|
|
1044
|
+
"no", "time_period": "remaining", "coverage_level": "individual", "messages":
|
|
1045
|
+
[{"message": "INT MED AND RX"}], "benefit_amount": {"currency": "USD", "amount":
|
|
1046
|
+
"5983.57"}}], "plan_begin_date": "2013-02-15", "eligibility_begin_date": "2012-02-01",
|
|
1047
|
+
"coinsurance": [{"benefit_percent": 0.0, "service_types": ["professional_physician_visit_office"],
|
|
1048
|
+
"coverage_level": "employee_and_spouse", "messages": [{"message": "GYN OFFICE
|
|
1049
|
+
VS"}, {"message": "GYN VISIT"}, {"message": "SPEC OFFICE"}, {"message": "SPEC
|
|
1050
|
+
VISIT"}, {"message": "PRIMARY OFFICE"}, {"message": "PRIME CARE VST"}], "in_plan_network":
|
|
1051
|
+
"yes"}, {"benefit_percent": 0.5, "service_types": ["professional_physician_visit_office"],
|
|
1052
|
+
"coverage_level": "employee_and_spouse", "messages": [{"message": "GYN OFFICE
|
|
1053
|
+
VS,COINS APPLIES TO OUT OF POCKET"}, {"message": "GYN VISIT,COINS APPLIES
|
|
1054
|
+
TO OUT OF POCKET"}, {"message": "SPEC OFFICE,COINS APPLIES TO OUT OF POCKET"},
|
|
1055
|
+
{"message": "SPEC VISIT,COINS APPLIES TO OUT OF POCKET"}, {"message": "PRIME
|
|
1056
|
+
CARE VST,COINS APPLIES TO OUT OF POCKET"}], "in_plan_network": "no"}], "group_description":
|
|
1057
|
+
"MOCK INDIVIDUAL ADVANTAGE PLAN", "plan_number": "0888188", "service_date":
|
|
1058
|
+
"2013-08-10"}, "valid_request": true}, "trading_partner_id": "MOCKPAYER",
|
|
1059
|
+
"id": "53bc0d2556c02c0671dde4fe", "transition_path": ["generate", "transmit",
|
|
1060
|
+
"wait", "receive", "process", "complete"], "history": [{"record_dt": "2014-07-08T15:24:21.638000",
|
|
1061
|
+
"name": "init", "title": "Initializing"}, {"record_dt": "2014-07-08T15:24:21.652000",
|
|
1062
|
+
"name": "generating", "title": "Generating X12 transactions"}, {"record_dt":
|
|
1063
|
+
"2014-07-08T15:24:21.653000", "name": "transmitting", "title": "Transmitting
|
|
1064
|
+
transactions to Trading Partner"}, {"record_dt": "2014-07-08T15:24:21.654000",
|
|
1065
|
+
"name": "waiting", "title": "Waiting on Trading Partner Response"}, {"record_dt":
|
|
1066
|
+
"2014-07-08T15:24:21.655000", "name": "receiving", "title": "Receiving transactions
|
|
1067
|
+
from Trading Partner"}, {"record_dt": "2014-07-08T15:24:21.703000", "name":
|
|
1068
|
+
"processing", "title": "Processing X12 transactions"}]}, {"units_of_work":
|
|
1069
|
+
1, "name": "insurance_prices", "parameters": {"service_types": ["health_benefit_plan_coverage"],
|
|
1070
|
+
"trading_partner_id": "MOCKPAYER", "payer": {"id": "MOCKPAYER", "name": "Mockpayer
|
|
1071
|
+
For Testing"}, "member": {"birth_date": "1980-02-19", "first_name": "Jace",
|
|
1072
|
+
"last_name": "Cartwright", "plan_start_date": "2013-08-10", "id": "405764353"},
|
|
1073
|
+
"correlation_id": "79913210-ca13-42b6-af4e-25f64ce94e9d", "client_id": "2MBlqahR2xiaBtVSS50n",
|
|
1074
|
+
"provider": {"first_name": "Shanon", "last_name": "Swaniawski", "npi": "3657619269"},
|
|
1075
|
+
"async": false, "transaction_code": "request"}, "state": {"name": "completed",
|
|
1076
|
+
"title": "Completed"}, "result": {"service_types": ["professional_physician_visit_office"],
|
|
1077
|
+
"client_id": "2MBlqahR2xiaBtVSS50n", "payer": {"id": "MOCKPAYER", "name":
|
|
1078
|
+
"MOCK PAYER INC"}, "subscriber": {"birth_date": "1980-02-19", "first_name":
|
|
1079
|
+
"Jace", "last_name": "Cartwright", "id": "405764353", "address": {"city":
|
|
1080
|
+
"SPARTANBURG", "state": "SC", "zipcode": "29307", "address_lines": ["123 MAIN
|
|
1081
|
+
ST"]}}, "correlation_id": "79913210-ca13-42b6-af4e-25f64ce94e9d", "trading_partner_id":
|
|
1082
|
+
"MOCKPAYER", "provider": {"first_name": "Shanon", "last_name": "Shanon Swaniawski",
|
|
1083
|
+
"npi": "3657619269"}, "coverage": {"service_types": ["professional_physician_visit_office"],
|
|
1084
|
+
"group_number": "088818801000013", "out_of_pocket": [{"in_plan_network": "yes",
|
|
1085
|
+
"benefit_amount": {"currency": "USD", "amount": "3000"}, "coverage_level":
|
|
1086
|
+
"individual"}, {"in_plan_network": "yes", "benefit_amount": {"currency": "USD",
|
|
1087
|
+
"amount": "2983.57"}, "coverage_level": "individual", "time_period": "remaining"},
|
|
1088
|
+
{"in_plan_network": "yes", "benefit_amount": {"currency": "USD", "amount":
|
|
1089
|
+
"6000"}, "coverage_level": "family"}, {"in_plan_network": "yes", "benefit_amount":
|
|
1090
|
+
{"currency": "USD", "amount": "5956.09"}, "coverage_level": "family", "time_period":
|
|
1091
|
+
"remaining"}, {"in_plan_network": "no", "benefit_amount": {"currency": "USD",
|
|
1092
|
+
"amount": "12500"}, "coverage_level": "individual"}, {"in_plan_network": "no",
|
|
1093
|
+
"benefit_amount": {"currency": "USD", "amount": "12483.57"}, "coverage_level":
|
|
1094
|
+
"individual", "time_period": "remaining"}, {"in_plan_network": "no", "benefit_amount":
|
|
1095
|
+
{"currency": "USD", "amount": "25000"}, "coverage_level": "family"}, {"in_plan_network":
|
|
1096
|
+
"no", "benefit_amount": {"currency": "USD", "amount": "24956.09"}, "coverage_level":
|
|
1097
|
+
"family", "messages": [{"message": "Unlimited Lifetime Benefits"}], "time_period":
|
|
1098
|
+
"remaining"}], "level": "employee_and_spouse", "copay": [{"in_plan_network":
|
|
1099
|
+
"yes", "service_types": ["professional_physician_visit_office"], "coverage_level":
|
|
1100
|
+
"employee_and_spouse", "messages": [{"message": "PRIMARY OFFICE"}]}, {"in_plan_network":
|
|
1101
|
+
"not_applicable", "service_types": ["professional_physician_visit_office"],
|
|
1102
|
+
"coverage_level": "employee_and_spouse", "messages": [{"message": "GYN OFFICE
|
|
1103
|
+
VS"}, {"message": "GYN VISIT"}, {"message": "SPEC OFFICE"}, {"message": "SPEC
|
|
1104
|
+
VISIT"}, {"message": "PRIME CARE VST"}, {"message": "Plan Requires PreCert"},
|
|
1105
|
+
{"message": "Commercial"}, {"message": "Plan includes NAP"}, {"message": "Pre-Existing
|
|
1106
|
+
may apply"}]}], "deductibles": [{"messages": [{"message": "INT MED AND RX,GYN
|
|
1107
|
+
OFFICE VS,DED INCLUDED IN OOP,GYN VISIT,SPEC OFFICE,SPEC VISIT,PRIMARY OFFICE,PRIME
|
|
1108
|
+
CARE VST"}], "in_plan_network": "yes", "eligibility_date": "2013-01-01", "time_period":
|
|
1109
|
+
"calendar_year", "coverage_level": "family", "benefit_amount": {"currency":
|
|
1110
|
+
"USD", "amount": "6000"}}, {"in_plan_network": "yes", "time_period": "remaining",
|
|
1111
|
+
"coverage_level": "family", "messages": [{"message": "INT MED AND RX"}], "benefit_amount":
|
|
1112
|
+
{"currency": "USD", "amount": "5956.09"}}, {"messages": [{"message": "INT
|
|
1113
|
+
MED AND RX,GYN OFFICE VS,DED INCLUDED IN OOP,GYN VISIT,SPEC OFFICE,SPEC VISIT,PRIMARY
|
|
1114
|
+
OFFICE,PRIME CARE VST"}], "in_plan_network": "yes", "eligibility_date": "2013-01-01",
|
|
1115
|
+
"time_period": "calendar_year", "coverage_level": "individual", "benefit_amount":
|
|
1116
|
+
{"currency": "USD", "amount": "3000"}}, {"in_plan_network": "yes", "time_period":
|
|
1117
|
+
"remaining", "coverage_level": "individual", "messages": [{"message": "INT
|
|
1118
|
+
MED AND RX"}], "benefit_amount": {"currency": "USD", "amount": "2983.57"}},
|
|
1119
|
+
{"messages": [{"message": "INT MED AND RX,GYN OFFICE VS,DED INCLUDED IN OOP,GYN
|
|
1120
|
+
VISIT,SPEC OFFICE,SPEC VISIT,PRIME CARE VST"}], "in_plan_network": "no", "eligibility_date":
|
|
1121
|
+
"2013-01-01", "time_period": "calendar_year", "coverage_level": "family",
|
|
1122
|
+
"benefit_amount": {"currency": "USD", "amount": "12000"}}, {"in_plan_network":
|
|
1123
|
+
"no", "time_period": "remaining", "coverage_level": "family", "messages":
|
|
1124
|
+
[{"message": "INT MED AND RX"}], "benefit_amount": {"currency": "USD", "amount":
|
|
1125
|
+
"11956.09"}}, {"messages": [{"message": "INT MED AND RX,GYN OFFICE VS,DED
|
|
1126
|
+
INCLUDED IN OOP,GYN VISIT,SPEC OFFICE,SPEC VISIT,PRIME CARE VST"}], "in_plan_network":
|
|
1127
|
+
"no", "eligibility_date": "2013-01-01", "time_period": "calendar_year", "coverage_level":
|
|
1128
|
+
"individual", "benefit_amount": {"currency": "USD", "amount": "6000"}}, {"in_plan_network":
|
|
1129
|
+
"no", "time_period": "remaining", "coverage_level": "individual", "messages":
|
|
1130
|
+
[{"message": "INT MED AND RX"}], "benefit_amount": {"currency": "USD", "amount":
|
|
1131
|
+
"5983.57"}}], "plan_begin_date": "2013-02-15", "eligibility_begin_date": "2012-02-01",
|
|
1132
|
+
"coinsurance": [{"benefit_percent": 0.0, "service_types": ["professional_physician_visit_office"],
|
|
1133
|
+
"coverage_level": "employee_and_spouse", "messages": [{"message": "GYN OFFICE
|
|
1134
|
+
VS"}, {"message": "GYN VISIT"}, {"message": "SPEC OFFICE"}, {"message": "SPEC
|
|
1135
|
+
VISIT"}, {"message": "PRIMARY OFFICE"}, {"message": "PRIME CARE VST"}], "in_plan_network":
|
|
1136
|
+
"yes"}, {"benefit_percent": 0.5, "service_types": ["professional_physician_visit_office"],
|
|
1137
|
+
"coverage_level": "employee_and_spouse", "messages": [{"message": "GYN OFFICE
|
|
1138
|
+
VS,COINS APPLIES TO OUT OF POCKET"}, {"message": "GYN VISIT,COINS APPLIES
|
|
1139
|
+
TO OUT OF POCKET"}, {"message": "SPEC OFFICE,COINS APPLIES TO OUT OF POCKET"},
|
|
1140
|
+
{"message": "SPEC VISIT,COINS APPLIES TO OUT OF POCKET"}, {"message": "PRIME
|
|
1141
|
+
CARE VST,COINS APPLIES TO OUT OF POCKET"}], "in_plan_network": "no"}], "group_description":
|
|
1142
|
+
"MOCK INDIVIDUAL ADVANTAGE PLAN", "plan_number": "0888188", "service_date":
|
|
1143
|
+
"2013-08-10"}, "valid_request": true}, "trading_partner_id": "MOCKPAYER",
|
|
1144
|
+
"id": "53bc0d2556c02c0671dde501", "transition_path": ["generate", "transmit",
|
|
1145
|
+
"wait", "receive", "process", "complete"], "history": [{"record_dt": "2014-07-08T15:24:21.717000",
|
|
1146
|
+
"name": "init", "title": "Initializing"}, {"record_dt": "2014-07-08T15:24:21.731000",
|
|
1147
|
+
"name": "generating", "title": "Generating X12 transactions"}, {"record_dt":
|
|
1148
|
+
"2014-07-08T15:24:21.732000", "name": "transmitting", "title": "Transmitting
|
|
1149
|
+
transactions to Trading Partner"}, {"record_dt": "2014-07-08T15:24:21.733000",
|
|
1150
|
+
"name": "waiting", "title": "Waiting on Trading Partner Response"}, {"record_dt":
|
|
1151
|
+
"2014-07-08T15:24:21.734000", "name": "receiving", "title": "Receiving transactions
|
|
1152
|
+
from Trading Partner"}, {"record_dt": "2014-07-08T15:24:21.781000", "name":
|
|
1153
|
+
"processing", "title": "Processing X12 transactions"}]}, {"units_of_work":
|
|
1154
|
+
1, "name": "insurance_prices", "parameters": {"service_types": ["health_benefit_plan_coverage"],
|
|
1155
|
+
"trading_partner_id": "MOCKPAYER", "payer": {"id": "MOCKPAYER", "name": "Mockpayer
|
|
1156
|
+
For Testing"}, "member": {"birth_date": "1996-11-30", "first_name": "Florencio",
|
|
1157
|
+
"last_name": "Hyatt", "plan_start_date": "2013-08-10", "id": "651801172"},
|
|
1158
|
+
"correlation_id": "2870b141-df2c-4b9e-ad1e-232938367af8", "client_id": "2MBlqahR2xiaBtVSS50n",
|
|
1159
|
+
"provider": {"first_name": "Lessie", "last_name": "Balistreri", "npi": "7521099306"},
|
|
1160
|
+
"async": false, "transaction_code": "request"}, "state": {"name": "completed",
|
|
1161
|
+
"title": "Completed"}, "result": {"service_types": ["professional_physician_visit_office"],
|
|
1162
|
+
"client_id": "2MBlqahR2xiaBtVSS50n", "payer": {"id": "MOCKPAYER", "name":
|
|
1163
|
+
"MOCK PAYER INC"}, "subscriber": {"birth_date": "1996-11-30", "first_name":
|
|
1164
|
+
"Florencio", "last_name": "Hyatt", "id": "651801172", "address": {"city":
|
|
1165
|
+
"SPARTANBURG", "state": "SC", "zipcode": "29307", "address_lines": ["123 MAIN
|
|
1166
|
+
ST"]}}, "correlation_id": "2870b141-df2c-4b9e-ad1e-232938367af8", "trading_partner_id":
|
|
1167
|
+
"MOCKPAYER", "provider": {"first_name": "Lessie", "last_name": "Lessie Balistreri",
|
|
1168
|
+
"npi": "7521099306"}, "coverage": {"service_types": ["professional_physician_visit_office"],
|
|
1169
|
+
"group_number": "088818801000013", "out_of_pocket": [{"in_plan_network": "yes",
|
|
1170
|
+
"benefit_amount": {"currency": "USD", "amount": "3000"}, "coverage_level":
|
|
1171
|
+
"individual"}, {"in_plan_network": "yes", "benefit_amount": {"currency": "USD",
|
|
1172
|
+
"amount": "2983.57"}, "coverage_level": "individual", "time_period": "remaining"},
|
|
1173
|
+
{"in_plan_network": "yes", "benefit_amount": {"currency": "USD", "amount":
|
|
1174
|
+
"6000"}, "coverage_level": "family"}, {"in_plan_network": "yes", "benefit_amount":
|
|
1175
|
+
{"currency": "USD", "amount": "5956.09"}, "coverage_level": "family", "time_period":
|
|
1176
|
+
"remaining"}, {"in_plan_network": "no", "benefit_amount": {"currency": "USD",
|
|
1177
|
+
"amount": "12500"}, "coverage_level": "individual"}, {"in_plan_network": "no",
|
|
1178
|
+
"benefit_amount": {"currency": "USD", "amount": "12483.57"}, "coverage_level":
|
|
1179
|
+
"individual", "time_period": "remaining"}, {"in_plan_network": "no", "benefit_amount":
|
|
1180
|
+
{"currency": "USD", "amount": "25000"}, "coverage_level": "family"}, {"in_plan_network":
|
|
1181
|
+
"no", "benefit_amount": {"currency": "USD", "amount": "24956.09"}, "coverage_level":
|
|
1182
|
+
"family", "messages": [{"message": "Unlimited Lifetime Benefits"}], "time_period":
|
|
1183
|
+
"remaining"}], "level": "employee_and_spouse", "copay": [{"in_plan_network":
|
|
1184
|
+
"yes", "service_types": ["professional_physician_visit_office"], "coverage_level":
|
|
1185
|
+
"employee_and_spouse", "messages": [{"message": "PRIMARY OFFICE"}]}, {"in_plan_network":
|
|
1186
|
+
"not_applicable", "service_types": ["professional_physician_visit_office"],
|
|
1187
|
+
"coverage_level": "employee_and_spouse", "messages": [{"message": "GYN OFFICE
|
|
1188
|
+
VS"}, {"message": "GYN VISIT"}, {"message": "SPEC OFFICE"}, {"message": "SPEC
|
|
1189
|
+
VISIT"}, {"message": "PRIME CARE VST"}, {"message": "Plan Requires PreCert"},
|
|
1190
|
+
{"message": "Commercial"}, {"message": "Plan includes NAP"}, {"message": "Pre-Existing
|
|
1191
|
+
may apply"}]}], "deductibles": [{"messages": [{"message": "INT MED AND RX,GYN
|
|
1192
|
+
OFFICE VS,DED INCLUDED IN OOP,GYN VISIT,SPEC OFFICE,SPEC VISIT,PRIMARY OFFICE,PRIME
|
|
1193
|
+
CARE VST"}], "in_plan_network": "yes", "eligibility_date": "2013-01-01", "time_period":
|
|
1194
|
+
"calendar_year", "coverage_level": "family", "benefit_amount": {"currency":
|
|
1195
|
+
"USD", "amount": "6000"}}, {"in_plan_network": "yes", "time_period": "remaining",
|
|
1196
|
+
"coverage_level": "family", "messages": [{"message": "INT MED AND RX"}], "benefit_amount":
|
|
1197
|
+
{"currency": "USD", "amount": "5956.09"}}, {"messages": [{"message": "INT
|
|
1198
|
+
MED AND RX,GYN OFFICE VS,DED INCLUDED IN OOP,GYN VISIT,SPEC OFFICE,SPEC VISIT,PRIMARY
|
|
1199
|
+
OFFICE,PRIME CARE VST"}], "in_plan_network": "yes", "eligibility_date": "2013-01-01",
|
|
1200
|
+
"time_period": "calendar_year", "coverage_level": "individual", "benefit_amount":
|
|
1201
|
+
{"currency": "USD", "amount": "3000"}}, {"in_plan_network": "yes", "time_period":
|
|
1202
|
+
"remaining", "coverage_level": "individual", "messages": [{"message": "INT
|
|
1203
|
+
MED AND RX"}], "benefit_amount": {"currency": "USD", "amount": "2983.57"}},
|
|
1204
|
+
{"messages": [{"message": "INT MED AND RX,GYN OFFICE VS,DED INCLUDED IN OOP,GYN
|
|
1205
|
+
VISIT,SPEC OFFICE,SPEC VISIT,PRIME CARE VST"}], "in_plan_network": "no", "eligibility_date":
|
|
1206
|
+
"2013-01-01", "time_period": "calendar_year", "coverage_level": "family",
|
|
1207
|
+
"benefit_amount": {"currency": "USD", "amount": "12000"}}, {"in_plan_network":
|
|
1208
|
+
"no", "time_period": "remaining", "coverage_level": "family", "messages":
|
|
1209
|
+
[{"message": "INT MED AND RX"}], "benefit_amount": {"currency": "USD", "amount":
|
|
1210
|
+
"11956.09"}}, {"messages": [{"message": "INT MED AND RX,GYN OFFICE VS,DED
|
|
1211
|
+
INCLUDED IN OOP,GYN VISIT,SPEC OFFICE,SPEC VISIT,PRIME CARE VST"}], "in_plan_network":
|
|
1212
|
+
"no", "eligibility_date": "2013-01-01", "time_period": "calendar_year", "coverage_level":
|
|
1213
|
+
"individual", "benefit_amount": {"currency": "USD", "amount": "6000"}}, {"in_plan_network":
|
|
1214
|
+
"no", "time_period": "remaining", "coverage_level": "individual", "messages":
|
|
1215
|
+
[{"message": "INT MED AND RX"}], "benefit_amount": {"currency": "USD", "amount":
|
|
1216
|
+
"5983.57"}}], "plan_begin_date": "2013-02-15", "eligibility_begin_date": "2012-02-01",
|
|
1217
|
+
"coinsurance": [{"benefit_percent": 0.0, "service_types": ["professional_physician_visit_office"],
|
|
1218
|
+
"coverage_level": "employee_and_spouse", "messages": [{"message": "GYN OFFICE
|
|
1219
|
+
VS"}, {"message": "GYN VISIT"}, {"message": "SPEC OFFICE"}, {"message": "SPEC
|
|
1220
|
+
VISIT"}, {"message": "PRIMARY OFFICE"}, {"message": "PRIME CARE VST"}], "in_plan_network":
|
|
1221
|
+
"yes"}, {"benefit_percent": 0.5, "service_types": ["professional_physician_visit_office"],
|
|
1222
|
+
"coverage_level": "employee_and_spouse", "messages": [{"message": "GYN OFFICE
|
|
1223
|
+
VS,COINS APPLIES TO OUT OF POCKET"}, {"message": "GYN VISIT,COINS APPLIES
|
|
1224
|
+
TO OUT OF POCKET"}, {"message": "SPEC OFFICE,COINS APPLIES TO OUT OF POCKET"},
|
|
1225
|
+
{"message": "SPEC VISIT,COINS APPLIES TO OUT OF POCKET"}, {"message": "PRIME
|
|
1226
|
+
CARE VST,COINS APPLIES TO OUT OF POCKET"}], "in_plan_network": "no"}], "group_description":
|
|
1227
|
+
"MOCK INDIVIDUAL ADVANTAGE PLAN", "plan_number": "0888188", "service_date":
|
|
1228
|
+
"2013-08-10"}, "valid_request": true}, "trading_partner_id": "MOCKPAYER",
|
|
1229
|
+
"id": "53bc0d2556c02c0671dde504", "transition_path": ["generate", "transmit",
|
|
1230
|
+
"wait", "receive", "process", "complete"], "history": [{"record_dt": "2014-07-08T15:24:21.794000",
|
|
1231
|
+
"name": "init", "title": "Initializing"}, {"record_dt": "2014-07-08T15:24:21.808000",
|
|
1232
|
+
"name": "generating", "title": "Generating X12 transactions"}, {"record_dt":
|
|
1233
|
+
"2014-07-08T15:24:21.810000", "name": "transmitting", "title": "Transmitting
|
|
1234
|
+
transactions to Trading Partner"}, {"record_dt": "2014-07-08T15:24:21.811000",
|
|
1235
|
+
"name": "waiting", "title": "Waiting on Trading Partner Response"}, {"record_dt":
|
|
1236
|
+
"2014-07-08T15:24:21.812000", "name": "receiving", "title": "Receiving transactions
|
|
1237
|
+
from Trading Partner"}, {"record_dt": "2014-07-08T15:24:21.860000", "name":
|
|
1238
|
+
"processing", "title": "Processing X12 transactions"}]}, {"units_of_work":
|
|
1239
|
+
1, "name": "prices", "parameters": {"cpt_code": "12345", "zip_code": "75201"},
|
|
1240
|
+
"state": {"name": "completed", "title": "Completed"}, "trading_partner_id":
|
|
1241
|
+
"PokitDok", "id": "53bc1b9b56c02c08ce81adfd", "transition_path": ["process",
|
|
1242
|
+
"complete"], "history": [{"record_dt": "2014-07-08T16:26:03.008000", "name":
|
|
1243
|
+
"init", "title": "Initializing"}, {"record_dt": "2014-07-08T16:26:03.009000",
|
|
131
1244
|
"name": "processing", "title": "Processing X12 transactions"}]}, {"units_of_work":
|
|
132
|
-
1, "name": "providers", "parameters": {"
|
|
133
|
-
"
|
|
134
|
-
|
|
135
|
-
"
|
|
136
|
-
"
|
|
137
|
-
"
|
|
138
|
-
"
|
|
139
|
-
|
|
140
|
-
|
|
141
|
-
"
|
|
142
|
-
"
|
|
143
|
-
|
|
144
|
-
"
|
|
145
|
-
"
|
|
146
|
-
"
|
|
147
|
-
"
|
|
148
|
-
|
|
149
|
-
|
|
150
|
-
"
|
|
151
|
-
|
|
152
|
-
"
|
|
153
|
-
|
|
154
|
-
"
|
|
155
|
-
|
|
156
|
-
"
|
|
157
|
-
"
|
|
158
|
-
"
|
|
159
|
-
"
|
|
160
|
-
|
|
161
|
-
|
|
162
|
-
|
|
163
|
-
|
|
164
|
-
"
|
|
165
|
-
"
|
|
166
|
-
"
|
|
167
|
-
"
|
|
168
|
-
|
|
169
|
-
"
|
|
170
|
-
|
|
171
|
-
|
|
172
|
-
"
|
|
173
|
-
"
|
|
174
|
-
"
|
|
175
|
-
"
|
|
176
|
-
|
|
177
|
-
"
|
|
178
|
-
"
|
|
179
|
-
"
|
|
180
|
-
|
|
181
|
-
|
|
182
|
-
"
|
|
183
|
-
"
|
|
184
|
-
"
|
|
185
|
-
"
|
|
186
|
-
"
|
|
187
|
-
"
|
|
188
|
-
|
|
189
|
-
|
|
190
|
-
|
|
191
|
-
"
|
|
192
|
-
"
|
|
193
|
-
"
|
|
194
|
-
|
|
195
|
-
|
|
196
|
-
|
|
197
|
-
"
|
|
198
|
-
|
|
199
|
-
"
|
|
200
|
-
"
|
|
201
|
-
|
|
202
|
-
|
|
203
|
-
"
|
|
204
|
-
|
|
205
|
-
|
|
206
|
-
"
|
|
207
|
-
"
|
|
208
|
-
"
|
|
209
|
-
"
|
|
210
|
-
"
|
|
211
|
-
"
|
|
212
|
-
|
|
213
|
-
"
|
|
214
|
-
"
|
|
215
|
-
|
|
216
|
-
"
|
|
217
|
-
|
|
218
|
-
"
|
|
219
|
-
|
|
220
|
-
"
|
|
221
|
-
"
|
|
222
|
-
"
|
|
223
|
-
"
|
|
224
|
-
|
|
225
|
-
"
|
|
226
|
-
|
|
227
|
-
"
|
|
228
|
-
"
|
|
229
|
-
"
|
|
230
|
-
"
|
|
231
|
-
"
|
|
232
|
-
"
|
|
233
|
-
|
|
234
|
-
"
|
|
235
|
-
"
|
|
236
|
-
"
|
|
237
|
-
"
|
|
238
|
-
"
|
|
239
|
-
"
|
|
240
|
-
|
|
241
|
-
"
|
|
242
|
-
"
|
|
243
|
-
"
|
|
244
|
-
"
|
|
245
|
-
"
|
|
246
|
-
"
|
|
247
|
-
"
|
|
248
|
-
"
|
|
249
|
-
"
|
|
250
|
-
"
|
|
251
|
-
"
|
|
252
|
-
"
|
|
253
|
-
"
|
|
254
|
-
|
|
255
|
-
|
|
256
|
-
"
|
|
257
|
-
|
|
258
|
-
"
|
|
259
|
-
|
|
260
|
-
"
|
|
261
|
-
|
|
262
|
-
"
|
|
263
|
-
|
|
264
|
-
|
|
265
|
-
|
|
266
|
-
"
|
|
267
|
-
|
|
268
|
-
|
|
269
|
-
"
|
|
270
|
-
|
|
271
|
-
"
|
|
272
|
-
"
|
|
273
|
-
"
|
|
274
|
-
|
|
275
|
-
|
|
276
|
-
"
|
|
277
|
-
"
|
|
278
|
-
[{"
|
|
279
|
-
|
|
280
|
-
"
|
|
281
|
-
"
|
|
282
|
-
"
|
|
283
|
-
|
|
284
|
-
"
|
|
285
|
-
"
|
|
286
|
-
|
|
287
|
-
|
|
288
|
-
|
|
289
|
-
|
|
290
|
-
"
|
|
291
|
-
"
|
|
292
|
-
"
|
|
293
|
-
|
|
294
|
-
|
|
295
|
-
"
|
|
296
|
-
"
|
|
297
|
-
|
|
298
|
-
"
|
|
299
|
-
"
|
|
300
|
-
"
|
|
301
|
-
"
|
|
302
|
-
|
|
303
|
-
|
|
304
|
-
|
|
305
|
-
|
|
306
|
-
"correlation_id": "
|
|
307
|
-
|
|
308
|
-
"
|
|
309
|
-
|
|
310
|
-
"
|
|
311
|
-
"
|
|
312
|
-
"
|
|
313
|
-
"
|
|
314
|
-
|
|
315
|
-
|
|
316
|
-
"
|
|
317
|
-
"
|
|
318
|
-
{"
|
|
319
|
-
"
|
|
320
|
-
"
|
|
321
|
-
|
|
322
|
-
"
|
|
323
|
-
"
|
|
324
|
-
"
|
|
325
|
-
"
|
|
326
|
-
"
|
|
327
|
-
"
|
|
328
|
-
"
|
|
329
|
-
"
|
|
330
|
-
"
|
|
331
|
-
|
|
332
|
-
|
|
333
|
-
"
|
|
334
|
-
|
|
335
|
-
"
|
|
336
|
-
|
|
337
|
-
"
|
|
338
|
-
{"
|
|
339
|
-
|
|
340
|
-
|
|
341
|
-
"
|
|
342
|
-
"
|
|
343
|
-
|
|
344
|
-
|
|
345
|
-
"
|
|
346
|
-
|
|
347
|
-
|
|
348
|
-
"
|
|
349
|
-
"
|
|
350
|
-
|
|
351
|
-
"
|
|
352
|
-
"
|
|
353
|
-
"
|
|
354
|
-
"
|
|
355
|
-
"
|
|
356
|
-
"
|
|
357
|
-
"
|
|
358
|
-
"
|
|
359
|
-
|
|
360
|
-
|
|
361
|
-
|
|
362
|
-
"
|
|
363
|
-
|
|
364
|
-
"
|
|
365
|
-
|
|
366
|
-
"
|
|
367
|
-
{"
|
|
368
|
-
"
|
|
369
|
-
"
|
|
370
|
-
"
|
|
371
|
-
|
|
372
|
-
|
|
373
|
-
{"
|
|
374
|
-
|
|
375
|
-
"
|
|
376
|
-
"
|
|
377
|
-
"
|
|
378
|
-
"
|
|
1245
|
+
1, "name": "providers", "parameters": {"service_types": ["health_benefit_plan_coverage"],
|
|
1246
|
+
"trading_partner_id": "MOCKPAYER", "payer": {"id": "MOCKPAYER", "name": "Mockpayer
|
|
1247
|
+
For Testing"}, "member": {"birth_date": "1991-03-29", "first_name": "Eva",
|
|
1248
|
+
"last_name": "Anderson", "plan_start_date": "2013-08-10", "id": "537703858"},
|
|
1249
|
+
"correlation_id": "0bec8ea0-c2a6-4ca2-8555-57268780900a", "client_id": "2MBlqahR2xiaBtVSS50n",
|
|
1250
|
+
"provider": {"first_name": "Colby", "last_name": "Rosenbaum", "npi": "8837483554"},
|
|
1251
|
+
"async": false, "transaction_code": "request"}, "state": {"name": "completed",
|
|
1252
|
+
"title": "Completed"}, "result": {"service_types": ["professional_physician_visit_office"],
|
|
1253
|
+
"client_id": "2MBlqahR2xiaBtVSS50n", "payer": {"id": "MOCKPAYER", "name":
|
|
1254
|
+
"MOCK PAYER INC"}, "subscriber": {"birth_date": "1991-03-29", "first_name":
|
|
1255
|
+
"Eva", "last_name": "Anderson", "id": "537703858", "address": {"city": "SPARTANBURG",
|
|
1256
|
+
"state": "SC", "zipcode": "29307", "address_lines": ["123 MAIN ST"]}}, "correlation_id":
|
|
1257
|
+
"0bec8ea0-c2a6-4ca2-8555-57268780900a", "trading_partner_id": "MOCKPAYER",
|
|
1258
|
+
"provider": {"first_name": "Colby", "last_name": "Colby Rosenbaum", "npi":
|
|
1259
|
+
"8837483554"}, "coverage": {"service_types": ["professional_physician_visit_office"],
|
|
1260
|
+
"group_number": "088818801000013", "out_of_pocket": [{"in_plan_network": "yes",
|
|
1261
|
+
"benefit_amount": {"currency": "USD", "amount": "3000"}, "coverage_level":
|
|
1262
|
+
"individual"}, {"in_plan_network": "yes", "benefit_amount": {"currency": "USD",
|
|
1263
|
+
"amount": "2983.57"}, "coverage_level": "individual", "time_period": "remaining"},
|
|
1264
|
+
{"in_plan_network": "yes", "benefit_amount": {"currency": "USD", "amount":
|
|
1265
|
+
"6000"}, "coverage_level": "family"}, {"in_plan_network": "yes", "benefit_amount":
|
|
1266
|
+
{"currency": "USD", "amount": "5956.09"}, "coverage_level": "family", "time_period":
|
|
1267
|
+
"remaining"}, {"in_plan_network": "no", "benefit_amount": {"currency": "USD",
|
|
1268
|
+
"amount": "12500"}, "coverage_level": "individual"}, {"in_plan_network": "no",
|
|
1269
|
+
"benefit_amount": {"currency": "USD", "amount": "12483.57"}, "coverage_level":
|
|
1270
|
+
"individual", "time_period": "remaining"}, {"in_plan_network": "no", "benefit_amount":
|
|
1271
|
+
{"currency": "USD", "amount": "25000"}, "coverage_level": "family"}, {"in_plan_network":
|
|
1272
|
+
"no", "benefit_amount": {"currency": "USD", "amount": "24956.09"}, "coverage_level":
|
|
1273
|
+
"family", "messages": [{"message": "Unlimited Lifetime Benefits"}], "time_period":
|
|
1274
|
+
"remaining"}], "level": "employee_and_spouse", "copay": [{"in_plan_network":
|
|
1275
|
+
"yes", "service_types": ["professional_physician_visit_office"], "coverage_level":
|
|
1276
|
+
"employee_and_spouse", "messages": [{"message": "PRIMARY OFFICE"}]}, {"in_plan_network":
|
|
1277
|
+
"not_applicable", "service_types": ["professional_physician_visit_office"],
|
|
1278
|
+
"coverage_level": "employee_and_spouse", "messages": [{"message": "GYN OFFICE
|
|
1279
|
+
VS"}, {"message": "GYN VISIT"}, {"message": "SPEC OFFICE"}, {"message": "SPEC
|
|
1280
|
+
VISIT"}, {"message": "PRIME CARE VST"}, {"message": "Plan Requires PreCert"},
|
|
1281
|
+
{"message": "Commercial"}, {"message": "Plan includes NAP"}, {"message": "Pre-Existing
|
|
1282
|
+
may apply"}]}], "deductibles": [{"messages": [{"message": "INT MED AND RX,GYN
|
|
1283
|
+
OFFICE VS,DED INCLUDED IN OOP,GYN VISIT,SPEC OFFICE,SPEC VISIT,PRIMARY OFFICE,PRIME
|
|
1284
|
+
CARE VST"}], "in_plan_network": "yes", "eligibility_date": "2013-01-01", "time_period":
|
|
1285
|
+
"calendar_year", "coverage_level": "family", "benefit_amount": {"currency":
|
|
1286
|
+
"USD", "amount": "6000"}}, {"in_plan_network": "yes", "time_period": "remaining",
|
|
1287
|
+
"coverage_level": "family", "messages": [{"message": "INT MED AND RX"}], "benefit_amount":
|
|
1288
|
+
{"currency": "USD", "amount": "5956.09"}}, {"messages": [{"message": "INT
|
|
1289
|
+
MED AND RX,GYN OFFICE VS,DED INCLUDED IN OOP,GYN VISIT,SPEC OFFICE,SPEC VISIT,PRIMARY
|
|
1290
|
+
OFFICE,PRIME CARE VST"}], "in_plan_network": "yes", "eligibility_date": "2013-01-01",
|
|
1291
|
+
"time_period": "calendar_year", "coverage_level": "individual", "benefit_amount":
|
|
1292
|
+
{"currency": "USD", "amount": "3000"}}, {"in_plan_network": "yes", "time_period":
|
|
1293
|
+
"remaining", "coverage_level": "individual", "messages": [{"message": "INT
|
|
1294
|
+
MED AND RX"}], "benefit_amount": {"currency": "USD", "amount": "2983.57"}},
|
|
1295
|
+
{"messages": [{"message": "INT MED AND RX,GYN OFFICE VS,DED INCLUDED IN OOP,GYN
|
|
1296
|
+
VISIT,SPEC OFFICE,SPEC VISIT,PRIME CARE VST"}], "in_plan_network": "no", "eligibility_date":
|
|
1297
|
+
"2013-01-01", "time_period": "calendar_year", "coverage_level": "family",
|
|
1298
|
+
"benefit_amount": {"currency": "USD", "amount": "12000"}}, {"in_plan_network":
|
|
1299
|
+
"no", "time_period": "remaining", "coverage_level": "family", "messages":
|
|
1300
|
+
[{"message": "INT MED AND RX"}], "benefit_amount": {"currency": "USD", "amount":
|
|
1301
|
+
"11956.09"}}, {"messages": [{"message": "INT MED AND RX,GYN OFFICE VS,DED
|
|
1302
|
+
INCLUDED IN OOP,GYN VISIT,SPEC OFFICE,SPEC VISIT,PRIME CARE VST"}], "in_plan_network":
|
|
1303
|
+
"no", "eligibility_date": "2013-01-01", "time_period": "calendar_year", "coverage_level":
|
|
1304
|
+
"individual", "benefit_amount": {"currency": "USD", "amount": "6000"}}, {"in_plan_network":
|
|
1305
|
+
"no", "time_period": "remaining", "coverage_level": "individual", "messages":
|
|
1306
|
+
[{"message": "INT MED AND RX"}], "benefit_amount": {"currency": "USD", "amount":
|
|
1307
|
+
"5983.57"}}], "plan_begin_date": "2013-02-15", "eligibility_begin_date": "2012-02-01",
|
|
1308
|
+
"coinsurance": [{"benefit_percent": 0.0, "service_types": ["professional_physician_visit_office"],
|
|
1309
|
+
"coverage_level": "employee_and_spouse", "messages": [{"message": "GYN OFFICE
|
|
1310
|
+
VS"}, {"message": "GYN VISIT"}, {"message": "SPEC OFFICE"}, {"message": "SPEC
|
|
1311
|
+
VISIT"}, {"message": "PRIMARY OFFICE"}, {"message": "PRIME CARE VST"}], "in_plan_network":
|
|
1312
|
+
"yes"}, {"benefit_percent": 0.5, "service_types": ["professional_physician_visit_office"],
|
|
1313
|
+
"coverage_level": "employee_and_spouse", "messages": [{"message": "GYN OFFICE
|
|
1314
|
+
VS,COINS APPLIES TO OUT OF POCKET"}, {"message": "GYN VISIT,COINS APPLIES
|
|
1315
|
+
TO OUT OF POCKET"}, {"message": "SPEC OFFICE,COINS APPLIES TO OUT OF POCKET"},
|
|
1316
|
+
{"message": "SPEC VISIT,COINS APPLIES TO OUT OF POCKET"}, {"message": "PRIME
|
|
1317
|
+
CARE VST,COINS APPLIES TO OUT OF POCKET"}], "in_plan_network": "no"}], "group_description":
|
|
1318
|
+
"MOCK INDIVIDUAL ADVANTAGE PLAN", "plan_number": "0888188", "service_date":
|
|
1319
|
+
"2013-08-10"}, "valid_request": true}, "trading_partner_id": "MOCKPAYER",
|
|
1320
|
+
"id": "53bc0d2556c02c0671dde507", "transition_path": ["generate", "transmit",
|
|
1321
|
+
"wait", "receive", "process", "complete"], "history": [{"record_dt": "2014-07-08T15:24:21.872000",
|
|
1322
|
+
"name": "init", "title": "Initializing"}, {"record_dt": "2014-07-08T15:24:21.885000",
|
|
1323
|
+
"name": "generating", "title": "Generating X12 transactions"}, {"record_dt":
|
|
1324
|
+
"2014-07-08T15:24:21.886000", "name": "transmitting", "title": "Transmitting
|
|
1325
|
+
transactions to Trading Partner"}, {"record_dt": "2014-07-08T15:24:21.888000",
|
|
1326
|
+
"name": "waiting", "title": "Waiting on Trading Partner Response"}, {"record_dt":
|
|
1327
|
+
"2014-07-08T15:24:21.889000", "name": "receiving", "title": "Receiving transactions
|
|
1328
|
+
from Trading Partner"}, {"record_dt": "2014-07-08T15:24:21.936000", "name":
|
|
1329
|
+
"processing", "title": "Processing X12 transactions"}]}, {"units_of_work":
|
|
1330
|
+
1, "name": "providers", "parameters": {"service_types": ["health_benefit_plan_coverage"],
|
|
1331
|
+
"trading_partner_id": "MOCKPAYER", "payer": {"id": "MOCKPAYER", "name": "Mockpayer
|
|
1332
|
+
For Testing"}, "member": {"birth_date": "1994-01-07", "first_name": "Monserrat",
|
|
1333
|
+
"last_name": "Spinka", "plan_start_date": "2013-08-10", "id": "134414490"},
|
|
1334
|
+
"correlation_id": "9f0c7feb-b70b-49c0-ac31-a3dd08235ccf", "client_id": "2MBlqahR2xiaBtVSS50n",
|
|
1335
|
+
"provider": {"first_name": "Maybelle", "last_name": "Mayer", "npi": "8102799827"},
|
|
1336
|
+
"async": false, "transaction_code": "request"}, "state": {"name": "completed",
|
|
1337
|
+
"title": "Completed"}, "result": {"service_types": ["professional_physician_visit_office"],
|
|
1338
|
+
"client_id": "2MBlqahR2xiaBtVSS50n", "payer": {"id": "MOCKPAYER", "name":
|
|
1339
|
+
"MOCK PAYER INC"}, "subscriber": {"birth_date": "1994-01-07", "first_name":
|
|
1340
|
+
"Monserrat", "last_name": "Spinka", "id": "134414490", "address": {"city":
|
|
1341
|
+
"SPARTANBURG", "state": "SC", "zipcode": "29307", "address_lines": ["123 MAIN
|
|
1342
|
+
ST"]}}, "correlation_id": "9f0c7feb-b70b-49c0-ac31-a3dd08235ccf", "trading_partner_id":
|
|
1343
|
+
"MOCKPAYER", "provider": {"first_name": "Maybelle", "last_name": "Maybelle
|
|
1344
|
+
Mayer", "npi": "8102799827"}, "coverage": {"service_types": ["professional_physician_visit_office"],
|
|
1345
|
+
"group_number": "088818801000013", "out_of_pocket": [{"in_plan_network": "yes",
|
|
1346
|
+
"benefit_amount": {"currency": "USD", "amount": "3000"}, "coverage_level":
|
|
1347
|
+
"individual"}, {"in_plan_network": "yes", "benefit_amount": {"currency": "USD",
|
|
1348
|
+
"amount": "2983.57"}, "coverage_level": "individual", "time_period": "remaining"},
|
|
1349
|
+
{"in_plan_network": "yes", "benefit_amount": {"currency": "USD", "amount":
|
|
1350
|
+
"6000"}, "coverage_level": "family"}, {"in_plan_network": "yes", "benefit_amount":
|
|
1351
|
+
{"currency": "USD", "amount": "5956.09"}, "coverage_level": "family", "time_period":
|
|
1352
|
+
"remaining"}, {"in_plan_network": "no", "benefit_amount": {"currency": "USD",
|
|
1353
|
+
"amount": "12500"}, "coverage_level": "individual"}, {"in_plan_network": "no",
|
|
1354
|
+
"benefit_amount": {"currency": "USD", "amount": "12483.57"}, "coverage_level":
|
|
1355
|
+
"individual", "time_period": "remaining"}, {"in_plan_network": "no", "benefit_amount":
|
|
1356
|
+
{"currency": "USD", "amount": "25000"}, "coverage_level": "family"}, {"in_plan_network":
|
|
1357
|
+
"no", "benefit_amount": {"currency": "USD", "amount": "24956.09"}, "coverage_level":
|
|
1358
|
+
"family", "messages": [{"message": "Unlimited Lifetime Benefits"}], "time_period":
|
|
1359
|
+
"remaining"}], "level": "employee_and_spouse", "copay": [{"in_plan_network":
|
|
1360
|
+
"yes", "service_types": ["professional_physician_visit_office"], "coverage_level":
|
|
1361
|
+
"employee_and_spouse", "messages": [{"message": "PRIMARY OFFICE"}]}, {"in_plan_network":
|
|
1362
|
+
"not_applicable", "service_types": ["professional_physician_visit_office"],
|
|
1363
|
+
"coverage_level": "employee_and_spouse", "messages": [{"message": "GYN OFFICE
|
|
1364
|
+
VS"}, {"message": "GYN VISIT"}, {"message": "SPEC OFFICE"}, {"message": "SPEC
|
|
1365
|
+
VISIT"}, {"message": "PRIME CARE VST"}, {"message": "Plan Requires PreCert"},
|
|
1366
|
+
{"message": "Commercial"}, {"message": "Plan includes NAP"}, {"message": "Pre-Existing
|
|
1367
|
+
may apply"}]}], "deductibles": [{"messages": [{"message": "INT MED AND RX,GYN
|
|
1368
|
+
OFFICE VS,DED INCLUDED IN OOP,GYN VISIT,SPEC OFFICE,SPEC VISIT,PRIMARY OFFICE,PRIME
|
|
1369
|
+
CARE VST"}], "in_plan_network": "yes", "eligibility_date": "2013-01-01", "time_period":
|
|
1370
|
+
"calendar_year", "coverage_level": "family", "benefit_amount": {"currency":
|
|
1371
|
+
"USD", "amount": "6000"}}, {"in_plan_network": "yes", "time_period": "remaining",
|
|
1372
|
+
"coverage_level": "family", "messages": [{"message": "INT MED AND RX"}], "benefit_amount":
|
|
1373
|
+
{"currency": "USD", "amount": "5956.09"}}, {"messages": [{"message": "INT
|
|
1374
|
+
MED AND RX,GYN OFFICE VS,DED INCLUDED IN OOP,GYN VISIT,SPEC OFFICE,SPEC VISIT,PRIMARY
|
|
1375
|
+
OFFICE,PRIME CARE VST"}], "in_plan_network": "yes", "eligibility_date": "2013-01-01",
|
|
1376
|
+
"time_period": "calendar_year", "coverage_level": "individual", "benefit_amount":
|
|
1377
|
+
{"currency": "USD", "amount": "3000"}}, {"in_plan_network": "yes", "time_period":
|
|
1378
|
+
"remaining", "coverage_level": "individual", "messages": [{"message": "INT
|
|
1379
|
+
MED AND RX"}], "benefit_amount": {"currency": "USD", "amount": "2983.57"}},
|
|
1380
|
+
{"messages": [{"message": "INT MED AND RX,GYN OFFICE VS,DED INCLUDED IN OOP,GYN
|
|
1381
|
+
VISIT,SPEC OFFICE,SPEC VISIT,PRIME CARE VST"}], "in_plan_network": "no", "eligibility_date":
|
|
1382
|
+
"2013-01-01", "time_period": "calendar_year", "coverage_level": "family",
|
|
1383
|
+
"benefit_amount": {"currency": "USD", "amount": "12000"}}, {"in_plan_network":
|
|
1384
|
+
"no", "time_period": "remaining", "coverage_level": "family", "messages":
|
|
1385
|
+
[{"message": "INT MED AND RX"}], "benefit_amount": {"currency": "USD", "amount":
|
|
1386
|
+
"11956.09"}}, {"messages": [{"message": "INT MED AND RX,GYN OFFICE VS,DED
|
|
1387
|
+
INCLUDED IN OOP,GYN VISIT,SPEC OFFICE,SPEC VISIT,PRIME CARE VST"}], "in_plan_network":
|
|
1388
|
+
"no", "eligibility_date": "2013-01-01", "time_period": "calendar_year", "coverage_level":
|
|
1389
|
+
"individual", "benefit_amount": {"currency": "USD", "amount": "6000"}}, {"in_plan_network":
|
|
1390
|
+
"no", "time_period": "remaining", "coverage_level": "individual", "messages":
|
|
1391
|
+
[{"message": "INT MED AND RX"}], "benefit_amount": {"currency": "USD", "amount":
|
|
1392
|
+
"5983.57"}}], "plan_begin_date": "2013-02-15", "eligibility_begin_date": "2012-02-01",
|
|
1393
|
+
"coinsurance": [{"benefit_percent": 0.0, "service_types": ["professional_physician_visit_office"],
|
|
1394
|
+
"coverage_level": "employee_and_spouse", "messages": [{"message": "GYN OFFICE
|
|
1395
|
+
VS"}, {"message": "GYN VISIT"}, {"message": "SPEC OFFICE"}, {"message": "SPEC
|
|
1396
|
+
VISIT"}, {"message": "PRIMARY OFFICE"}, {"message": "PRIME CARE VST"}], "in_plan_network":
|
|
1397
|
+
"yes"}, {"benefit_percent": 0.5, "service_types": ["professional_physician_visit_office"],
|
|
1398
|
+
"coverage_level": "employee_and_spouse", "messages": [{"message": "GYN OFFICE
|
|
1399
|
+
VS,COINS APPLIES TO OUT OF POCKET"}, {"message": "GYN VISIT,COINS APPLIES
|
|
1400
|
+
TO OUT OF POCKET"}, {"message": "SPEC OFFICE,COINS APPLIES TO OUT OF POCKET"},
|
|
1401
|
+
{"message": "SPEC VISIT,COINS APPLIES TO OUT OF POCKET"}, {"message": "PRIME
|
|
1402
|
+
CARE VST,COINS APPLIES TO OUT OF POCKET"}], "in_plan_network": "no"}], "group_description":
|
|
1403
|
+
"MOCK INDIVIDUAL ADVANTAGE PLAN", "plan_number": "0888188", "service_date":
|
|
1404
|
+
"2013-08-10"}, "valid_request": true}, "trading_partner_id": "MOCKPAYER",
|
|
1405
|
+
"id": "53bc0d2556c02c0671dde50a", "transition_path": ["generate", "transmit",
|
|
1406
|
+
"wait", "receive", "process", "complete"], "history": [{"record_dt": "2014-07-08T15:24:21.948000",
|
|
1407
|
+
"name": "init", "title": "Initializing"}, {"record_dt": "2014-07-08T15:24:21.964000",
|
|
1408
|
+
"name": "generating", "title": "Generating X12 transactions"}, {"record_dt":
|
|
1409
|
+
"2014-07-08T15:24:21.965000", "name": "transmitting", "title": "Transmitting
|
|
1410
|
+
transactions to Trading Partner"}, {"record_dt": "2014-07-08T15:24:21.966000",
|
|
1411
|
+
"name": "waiting", "title": "Waiting on Trading Partner Response"}, {"record_dt":
|
|
1412
|
+
"2014-07-08T15:24:21.967000", "name": "receiving", "title": "Receiving transactions
|
|
1413
|
+
from Trading Partner"}, {"record_dt": "2014-07-08T15:24:22.015000", "name":
|
|
1414
|
+
"processing", "title": "Processing X12 transactions"}]}, {"units_of_work":
|
|
1415
|
+
1, "name": "cash_prices", "parameters": {"service_types": ["health_benefit_plan_coverage"],
|
|
1416
|
+
"trading_partner_id": "MOCKPAYER", "payer": {"id": "MOCKPAYER", "name": "Mockpayer
|
|
1417
|
+
For Testing"}, "member": {"birth_date": "1981-07-29", "first_name": "Jamie",
|
|
1418
|
+
"last_name": "Kihn", "plan_start_date": "2013-08-10", "id": "982549789"},
|
|
1419
|
+
"correlation_id": "fe5fcc98-c92a-411e-a5ea-38a585197111", "client_id": "2MBlqahR2xiaBtVSS50n",
|
|
1420
|
+
"provider": {"first_name": "Clemens", "last_name": "Dicki", "npi": "2581219600"},
|
|
1421
|
+
"async": false, "transaction_code": "request"}, "state": {"name": "completed",
|
|
1422
|
+
"title": "Completed"}, "result": {"service_types": ["professional_physician_visit_office"],
|
|
1423
|
+
"client_id": "2MBlqahR2xiaBtVSS50n", "payer": {"id": "MOCKPAYER", "name":
|
|
1424
|
+
"MOCK PAYER INC"}, "subscriber": {"birth_date": "1981-07-29", "first_name":
|
|
1425
|
+
"Jamie", "last_name": "Kihn", "id": "982549789", "address": {"city": "SPARTANBURG",
|
|
1426
|
+
"state": "SC", "zipcode": "29307", "address_lines": ["123 MAIN ST"]}}, "correlation_id":
|
|
1427
|
+
"fe5fcc98-c92a-411e-a5ea-38a585197111", "trading_partner_id": "MOCKPAYER",
|
|
1428
|
+
"provider": {"first_name": "Clemens", "last_name": "Clemens Dicki", "npi":
|
|
1429
|
+
"2581219600"}, "coverage": {"service_types": ["professional_physician_visit_office"],
|
|
1430
|
+
"group_number": "088818801000013", "out_of_pocket": [{"in_plan_network": "yes",
|
|
1431
|
+
"benefit_amount": {"currency": "USD", "amount": "3000"}, "coverage_level":
|
|
1432
|
+
"individual"}, {"in_plan_network": "yes", "benefit_amount": {"currency": "USD",
|
|
1433
|
+
"amount": "2983.57"}, "coverage_level": "individual", "time_period": "remaining"},
|
|
1434
|
+
{"in_plan_network": "yes", "benefit_amount": {"currency": "USD", "amount":
|
|
1435
|
+
"6000"}, "coverage_level": "family"}, {"in_plan_network": "yes", "benefit_amount":
|
|
1436
|
+
{"currency": "USD", "amount": "5956.09"}, "coverage_level": "family", "time_period":
|
|
1437
|
+
"remaining"}, {"in_plan_network": "no", "benefit_amount": {"currency": "USD",
|
|
1438
|
+
"amount": "12500"}, "coverage_level": "individual"}, {"in_plan_network": "no",
|
|
1439
|
+
"benefit_amount": {"currency": "USD", "amount": "12483.57"}, "coverage_level":
|
|
1440
|
+
"individual", "time_period": "remaining"}, {"in_plan_network": "no", "benefit_amount":
|
|
1441
|
+
{"currency": "USD", "amount": "25000"}, "coverage_level": "family"}, {"in_plan_network":
|
|
1442
|
+
"no", "benefit_amount": {"currency": "USD", "amount": "24956.09"}, "coverage_level":
|
|
1443
|
+
"family", "messages": [{"message": "Unlimited Lifetime Benefits"}], "time_period":
|
|
1444
|
+
"remaining"}], "level": "employee_and_spouse", "copay": [{"in_plan_network":
|
|
1445
|
+
"yes", "service_types": ["professional_physician_visit_office"], "coverage_level":
|
|
1446
|
+
"employee_and_spouse", "messages": [{"message": "PRIMARY OFFICE"}]}, {"in_plan_network":
|
|
1447
|
+
"not_applicable", "service_types": ["professional_physician_visit_office"],
|
|
1448
|
+
"coverage_level": "employee_and_spouse", "messages": [{"message": "GYN OFFICE
|
|
1449
|
+
VS"}, {"message": "GYN VISIT"}, {"message": "SPEC OFFICE"}, {"message": "SPEC
|
|
1450
|
+
VISIT"}, {"message": "PRIME CARE VST"}, {"message": "Plan Requires PreCert"},
|
|
1451
|
+
{"message": "Commercial"}, {"message": "Plan includes NAP"}, {"message": "Pre-Existing
|
|
1452
|
+
may apply"}]}], "deductibles": [{"messages": [{"message": "INT MED AND RX,GYN
|
|
1453
|
+
OFFICE VS,DED INCLUDED IN OOP,GYN VISIT,SPEC OFFICE,SPEC VISIT,PRIMARY OFFICE,PRIME
|
|
1454
|
+
CARE VST"}], "in_plan_network": "yes", "eligibility_date": "2013-01-01", "time_period":
|
|
1455
|
+
"calendar_year", "coverage_level": "family", "benefit_amount": {"currency":
|
|
1456
|
+
"USD", "amount": "6000"}}, {"in_plan_network": "yes", "time_period": "remaining",
|
|
1457
|
+
"coverage_level": "family", "messages": [{"message": "INT MED AND RX"}], "benefit_amount":
|
|
1458
|
+
{"currency": "USD", "amount": "5956.09"}}, {"messages": [{"message": "INT
|
|
1459
|
+
MED AND RX,GYN OFFICE VS,DED INCLUDED IN OOP,GYN VISIT,SPEC OFFICE,SPEC VISIT,PRIMARY
|
|
1460
|
+
OFFICE,PRIME CARE VST"}], "in_plan_network": "yes", "eligibility_date": "2013-01-01",
|
|
1461
|
+
"time_period": "calendar_year", "coverage_level": "individual", "benefit_amount":
|
|
1462
|
+
{"currency": "USD", "amount": "3000"}}, {"in_plan_network": "yes", "time_period":
|
|
1463
|
+
"remaining", "coverage_level": "individual", "messages": [{"message": "INT
|
|
1464
|
+
MED AND RX"}], "benefit_amount": {"currency": "USD", "amount": "2983.57"}},
|
|
1465
|
+
{"messages": [{"message": "INT MED AND RX,GYN OFFICE VS,DED INCLUDED IN OOP,GYN
|
|
1466
|
+
VISIT,SPEC OFFICE,SPEC VISIT,PRIME CARE VST"}], "in_plan_network": "no", "eligibility_date":
|
|
1467
|
+
"2013-01-01", "time_period": "calendar_year", "coverage_level": "family",
|
|
1468
|
+
"benefit_amount": {"currency": "USD", "amount": "12000"}}, {"in_plan_network":
|
|
1469
|
+
"no", "time_period": "remaining", "coverage_level": "family", "messages":
|
|
1470
|
+
[{"message": "INT MED AND RX"}], "benefit_amount": {"currency": "USD", "amount":
|
|
1471
|
+
"11956.09"}}, {"messages": [{"message": "INT MED AND RX,GYN OFFICE VS,DED
|
|
1472
|
+
INCLUDED IN OOP,GYN VISIT,SPEC OFFICE,SPEC VISIT,PRIME CARE VST"}], "in_plan_network":
|
|
1473
|
+
"no", "eligibility_date": "2013-01-01", "time_period": "calendar_year", "coverage_level":
|
|
1474
|
+
"individual", "benefit_amount": {"currency": "USD", "amount": "6000"}}, {"in_plan_network":
|
|
1475
|
+
"no", "time_period": "remaining", "coverage_level": "individual", "messages":
|
|
1476
|
+
[{"message": "INT MED AND RX"}], "benefit_amount": {"currency": "USD", "amount":
|
|
1477
|
+
"5983.57"}}], "plan_begin_date": "2013-02-15", "eligibility_begin_date": "2012-02-01",
|
|
1478
|
+
"coinsurance": [{"benefit_percent": 0.0, "service_types": ["professional_physician_visit_office"],
|
|
1479
|
+
"coverage_level": "employee_and_spouse", "messages": [{"message": "GYN OFFICE
|
|
1480
|
+
VS"}, {"message": "GYN VISIT"}, {"message": "SPEC OFFICE"}, {"message": "SPEC
|
|
1481
|
+
VISIT"}, {"message": "PRIMARY OFFICE"}, {"message": "PRIME CARE VST"}], "in_plan_network":
|
|
1482
|
+
"yes"}, {"benefit_percent": 0.5, "service_types": ["professional_physician_visit_office"],
|
|
1483
|
+
"coverage_level": "employee_and_spouse", "messages": [{"message": "GYN OFFICE
|
|
1484
|
+
VS,COINS APPLIES TO OUT OF POCKET"}, {"message": "GYN VISIT,COINS APPLIES
|
|
1485
|
+
TO OUT OF POCKET"}, {"message": "SPEC OFFICE,COINS APPLIES TO OUT OF POCKET"},
|
|
1486
|
+
{"message": "SPEC VISIT,COINS APPLIES TO OUT OF POCKET"}, {"message": "PRIME
|
|
1487
|
+
CARE VST,COINS APPLIES TO OUT OF POCKET"}], "in_plan_network": "no"}], "group_description":
|
|
1488
|
+
"MOCK INDIVIDUAL ADVANTAGE PLAN", "plan_number": "0888188", "service_date":
|
|
1489
|
+
"2013-08-10"}, "valid_request": true}, "trading_partner_id": "MOCKPAYER",
|
|
1490
|
+
"id": "53bc0d2656c02c0671dde50d", "transition_path": ["generate", "transmit",
|
|
1491
|
+
"wait", "receive", "process", "complete"], "history": [{"record_dt": "2014-07-08T15:24:22.030000",
|
|
1492
|
+
"name": "init", "title": "Initializing"}, {"record_dt": "2014-07-08T15:24:22.043000",
|
|
1493
|
+
"name": "generating", "title": "Generating X12 transactions"}, {"record_dt":
|
|
1494
|
+
"2014-07-08T15:24:22.045000", "name": "transmitting", "title": "Transmitting
|
|
1495
|
+
transactions to Trading Partner"}, {"record_dt": "2014-07-08T15:24:22.046000",
|
|
1496
|
+
"name": "waiting", "title": "Waiting on Trading Partner Response"}, {"record_dt":
|
|
1497
|
+
"2014-07-08T15:24:22.047000", "name": "receiving", "title": "Receiving transactions
|
|
1498
|
+
from Trading Partner"}, {"record_dt": "2014-07-08T15:24:22.095000", "name":
|
|
1499
|
+
"processing", "title": "Processing X12 transactions"}]}]}'
|
|
379
1500
|
http_version:
|
|
380
|
-
recorded_at:
|
|
1501
|
+
recorded_at: Tue, 08 Jul 2014 16:27:12 GMT
|
|
381
1502
|
recorded_with: VCR 2.9.2
|