pokitdok-ruby 0.4.1 → 0.5.0
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/VERSION +1 -1
- data/lib/pokitdok.rb +14 -2
- data/pokitdok-ruby.gemspec +6 -4
- data/spec/pokitdok_spec.rb +33 -5
- data/vcr_cassettes/activities.yml +118 -1700
- data/vcr_cassettes/auth.yml +6 -6
- data/vcr_cassettes/cash_prices.yml +13 -13
- data/vcr_cassettes/claims.yml +16 -15
- data/vcr_cassettes/claims_status.yml +30 -24
- data/vcr_cassettes/eligibility.yml +36 -26
- data/vcr_cassettes/enrollment.yml +39 -38
- data/vcr_cassettes/files.yml +13 -12
- data/vcr_cassettes/insurance_prices.yml +11 -10
- data/vcr_cassettes/payers.yml +212 -237
- data/vcr_cassettes/providers.yml +19 -57
- data/vcr_cassettes/trading_partners_get.yml +44 -0
- data/vcr_cassettes/trading_partners_index.yml +337 -0
- metadata +44 -42
checksums.yaml
CHANGED
@@ -1,7 +1,7 @@
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---
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SHA1:
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metadata.gz:
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data.tar.gz:
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metadata.gz: ce7c2ae83219ec4443a5e2501581dba614fb6212
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data.tar.gz: 551a4c1278d48004addb74df57f95f30d0ba4309
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SHA512:
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metadata.gz:
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data.tar.gz:
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metadata.gz: 35dd8c1f0cc8555f04c1fc22ee401bf93e23f63c96150bd76e658858bedf91e7070e0bcb92b7569f828a45a4b158a34451df8447691f1492a4949127a6fd7aaa
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data.tar.gz: e5ac558a0269661c13ee936353050c8dfd7409f03046280f7145e3806b864a050a4c384ca174cb4ef052830f56ca0294ac6b322fa5e99b8d84d76cde2ec4ed41
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data/VERSION
CHANGED
@@ -1 +1 @@
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1
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-
0.
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1
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0.5.0
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data/lib/pokitdok.rb
CHANGED
@@ -156,13 +156,25 @@ module PokitDok
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# Invokes the payers endpoint, with an optional Hash of parameters.
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def payers(params = {})
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response = @token.get('payers', headers: headers, params: params)
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response = @token.get('payers/', headers: headers, params: params)
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JSON.parse(response.body)
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end
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# Invokes the providers endpoint, with an optional Hash of parameters.
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def providers(params = {})
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response = @token.get('providers') do |request|
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response = @token.get('providers/') do |request|
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request.params = params
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end
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JSON.parse(response.body)
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end
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# Invokes the trading partners endpoint, with an optional Hash of
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# parameters.
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def trading_partners(params = {})
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trading_partner_id = params.delete :trading_partner_id
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response =
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@token.get("tradingpartners/#{trading_partner_id}") do |request|
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request.params = params
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end
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JSON.parse(response.body)
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data/pokitdok-ruby.gemspec
CHANGED
@@ -2,16 +2,16 @@
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# DO NOT EDIT THIS FILE DIRECTLY
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# Instead, edit Jeweler::Tasks in Rakefile, and run 'rake gemspec'
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# -*- encoding: utf-8 -*-
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# stub: pokitdok-ruby 0.
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# stub: pokitdok-ruby 0.5.0 ruby lib
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Gem::Specification.new do |s|
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s.name = "pokitdok-ruby"
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s.version = "0.
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s.version = "0.5.0"
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s.required_rubygems_version = Gem::Requirement.new(">= 0") if s.respond_to? :required_rubygems_version=
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s.require_paths = ["lib"]
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s.authors = ["John Riney"]
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s.date = "2014-08-
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s.date = "2014-08-12"
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s.description = "Gem for easy access to the PokitDok Platform APIs."
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s.email = "john.riney@pokitdok.com"
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s.extra_rdoc_files = [
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"vcr_cassettes/files.yml",
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"vcr_cassettes/insurance_prices.yml",
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"vcr_cassettes/payers.yml",
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"vcr_cassettes/providers.yml"
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"vcr_cassettes/providers.yml",
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"vcr_cassettes/trading_partners_get.yml",
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"vcr_cassettes/trading_partners_index.yml"
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]
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s.homepage = "http://github.com/pokitdok/pokitdok-ruby"
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s.licenses = ["MIT"]
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data/spec/pokitdok_spec.rb
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require 'spec_helper'
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CLIENT_ID = '
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CLIENT_SECRET = '
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CLIENT_ID = 'oB7rLIqHmdoAXHRAmWtM'
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CLIENT_SECRET = 'ZE8xqtUY5kYqmHIhd8lzdjqD1CPa8sRBPvmF9UuG'
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POKITDOK_TEST_URL = 'http://localhost:5002'
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def check_meta_and_data(result)
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describe 'Insurance Prices endpoint' do
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it 'should expose the insurance prices endpoint' do
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query = { cpt_code: '
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query = { cpt_code: '87799', zip_code: '32218' }
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VCR.use_cassette 'insurance_prices' do
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@prices = @pokitdok.insurance_prices query
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check_meta_and_data @claims_status
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refute_empty @claims_status['data']
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assert_nil @claims_status['errors']
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end
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end
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check_meta_and_data @payers
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refute_nil @payers['data']
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@payers['data'].size.must_equal
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@payers['data'].size.must_equal 229
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end
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end
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@providers['data'].size.must_equal 1
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end
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end
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describe 'Trading Partners endpoint index' do
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it 'should expose the trading partners endpoint (index call)' do
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query = {}
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VCR.use_cassette 'trading_partners_index' do
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@trading_partners = @pokitdok.trading_partners(query)
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end
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check_meta_and_data @trading_partners
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@trading_partners['data'].must_be_instance_of Array
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@trading_partners['data'].length.must_be :>, 1
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end
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end
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describe 'Trading Partners endpoint get' do
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it 'should expose the trading partners endpoint (get call)' do
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query = { trading_partner_id: 'MOCKPAYER' }
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VCR.use_cassette 'trading_partners_get' do
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@trading_partners = @pokitdok.trading_partners(query)
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end
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check_meta_and_data @trading_partners
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@trading_partners['data'].must_be_instance_of Hash
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end
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end
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end
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end
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string: ''
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headers:
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User-Agent:
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- pokitdok-ruby 0.4.1 ruby 2.
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- pokitdok-ruby 0.4.1 ruby 2.0.0p451 (2014-02-24 revision 45167) [x86_64-darwin12.5.0]
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Authorization:
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- Bearer
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- Bearer 88CVCN9YDDAQdTC3GeQMcrMPyDJPErQZ3PECJcln
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Accept-Encoding:
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- gzip;q=1.0,deflate;q=0.6,identity;q=0.3
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Accept:
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- '*/*'
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response:
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status:
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code: 200
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Content-Type:
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Content-Length:
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- '
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- '9065'
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Server:
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- Werkzeug/0.9.4 Python/2.7.3
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Date:
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- Tue,
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- Tue, 12 Aug 2014 15:19:08 GMT
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body:
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encoding: UTF-8
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string: '{"meta": {"
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"no", "benefit_amount": {"currency": "USD", "amount": "24956.09"}, "coverage_level":
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"family", "messages": [{"message": "Unlimited Lifetime Benefits"}], "time_period":
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"remaining"}], "level": "employee_and_spouse", "copay": [{"in_plan_network":
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"yes", "service_types": ["professional_physician_visit_office"], "coverage_level":
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"employee_and_spouse", "messages": [{"message": "PRIMARY OFFICE"}]}, {"in_plan_network":
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"not_applicable", "service_types": ["professional_physician_visit_office"],
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"coverage_level": "employee_and_spouse", "messages": [{"message": "GYN OFFICE
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VS"}, {"message": "GYN VISIT"}, {"message": "SPEC OFFICE"}, {"message": "SPEC
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VISIT"}, {"message": "PRIME CARE VST"}, {"message": "Plan Requires PreCert"},
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{"message": "Commercial"}, {"message": "Plan includes NAP"}, {"message": "Pre-Existing
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may apply"}]}], "deductibles": [{"messages": [{"message": "INT MED AND RX,GYN
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OFFICE VS,DED INCLUDED IN OOP,GYN VISIT,SPEC OFFICE,SPEC VISIT,PRIMARY OFFICE,PRIME
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CARE VST"}], "in_plan_network": "yes", "eligibility_date": "2013-01-01", "time_period":
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"calendar_year", "coverage_level": "family", "benefit_amount": {"currency":
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"USD", "amount": "6000"}}, {"in_plan_network": "yes", "time_period": "remaining",
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"coverage_level": "family", "messages": [{"message": "INT MED AND RX"}], "benefit_amount":
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{"currency": "USD", "amount": "5956.09"}}, {"messages": [{"message": "INT
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MED AND RX,GYN OFFICE VS,DED INCLUDED IN OOP,GYN VISIT,SPEC OFFICE,SPEC VISIT,PRIMARY
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OFFICE,PRIME CARE VST"}], "in_plan_network": "yes", "eligibility_date": "2013-01-01",
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"time_period": "calendar_year", "coverage_level": "individual", "benefit_amount":
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{"currency": "USD", "amount": "3000"}}, {"in_plan_network": "yes", "time_period":
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"remaining", "coverage_level": "individual", "messages": [{"message": "INT
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MED AND RX"}], "benefit_amount": {"currency": "USD", "amount": "2983.57"}},
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{"messages": [{"message": "INT MED AND RX,GYN OFFICE VS,DED INCLUDED IN OOP,GYN
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VISIT,SPEC OFFICE,SPEC VISIT,PRIME CARE VST"}], "in_plan_network": "no", "eligibility_date":
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"2013-01-01", "time_period": "calendar_year", "coverage_level": "family",
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"benefit_amount": {"currency": "USD", "amount": "12000"}}, {"in_plan_network":
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"no", "time_period": "remaining", "coverage_level": "family", "messages":
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[{"message": "INT MED AND RX"}], "benefit_amount": {"currency": "USD", "amount":
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"11956.09"}}, {"messages": [{"message": "INT MED AND RX,GYN OFFICE VS,DED
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INCLUDED IN OOP,GYN VISIT,SPEC OFFICE,SPEC VISIT,PRIME CARE VST"}], "in_plan_network":
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"no", "eligibility_date": "2013-01-01", "time_period": "calendar_year", "coverage_level":
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"individual", "benefit_amount": {"currency": "USD", "amount": "6000"}}, {"in_plan_network":
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"no", "time_period": "remaining", "coverage_level": "individual", "messages":
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[{"message": "INT MED AND RX"}], "benefit_amount": {"currency": "USD", "amount":
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"5983.57"}}], "plan_begin_date": "2013-02-15", "eligibility_begin_date": "2012-02-01",
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"coinsurance": [{"benefit_percent": 0.0, "service_types": ["professional_physician_visit_office"],
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"coverage_level": "employee_and_spouse", "messages": [{"message": "GYN OFFICE
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VS"}, {"message": "GYN VISIT"}, {"message": "SPEC OFFICE"}, {"message": "SPEC
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VISIT"}, {"message": "PRIMARY OFFICE"}, {"message": "PRIME CARE VST"}], "in_plan_network":
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"yes"}, {"benefit_percent": 0.5, "service_types": ["professional_physician_visit_office"],
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"coverage_level": "employee_and_spouse", "messages": [{"message": "GYN OFFICE
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VS,COINS APPLIES TO OUT OF POCKET"}, {"message": "GYN VISIT,COINS APPLIES
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TO OUT OF POCKET"}, {"message": "SPEC OFFICE,COINS APPLIES TO OUT OF POCKET"},
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-
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-
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|
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|
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|
-
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|
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|
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-
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-
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|
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-
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-
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-
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-
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-
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-
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633
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-
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634
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-
"last_name": "Nolan", "plan_start_date": "2013-08-10", "id": "023393527"},
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635
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-
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-
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-
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-
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-
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-
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-
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-
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-
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-
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-
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685
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-
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686
|
-
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-
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-
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-
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-
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-
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|
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-
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-
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|
-
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-
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|
-
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|
-
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|
-
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701
|
-
{"message": "SPEC VISIT,COINS APPLIES TO OUT OF POCKET"}, {"message": "PRIME
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702
|
-
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|
-
"MOCK INDIVIDUAL ADVANTAGE PLAN", "plan_number": "0888188", "service_date":
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|
-
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-
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|
-
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-
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-
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|
-
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710
|
-
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|
711
|
-
"name": "waiting", "title": "Waiting on Trading Partner Response"}, {"record_dt":
|
712
|
-
"2014-07-22T00:04:47.618000", "name": "receiving", "title": "Receiving transactions
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713
|
-
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714
|
-
"processing", "title": "Processing X12 transactions"}]}, {"units_of_work":
|
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|
-
1, "name": "enrollment", "parameters": {"service_types": ["health_benefit_plan_coverage"],
|
716
|
-
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717
|
-
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|
718
|
-
"last_name": "Tremblay", "plan_start_date": "2013-08-10", "id": "039173051"},
|
719
|
-
"correlation_id": "4ca33e09-3f0a-4b84-a52e-8ca2b3ed75fe", "client_id": "7x7nRAotGfxHfy7Llfl3",
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720
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-
"provider": {"first_name": "Dayana", "last_name": "Doyle", "npi": "8369176691"},
|
721
|
-
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|
-
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|
723
|
-
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724
|
-
"MOCK PAYER INC"}, "subscriber": {"birth_date": "1992-01-08", "first_name":
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725
|
-
"Alfonso", "last_name": "Tremblay", "id": "039173051", "address": {"city":
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726
|
-
"SPARTANBURG", "state": "SC", "zipcode": "29307", "address_lines": ["123 MAIN
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727
|
-
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"MOCKPAYER", "provider": {"first_name": "Dayana", "last_name": "Dayana Doyle",
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|
-
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730
|
-
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|
731
|
-
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732
|
-
"individual"}, {"in_plan_network": "yes", "benefit_amount": {"currency": "USD",
|
733
|
-
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|
734
|
-
{"in_plan_network": "yes", "benefit_amount": {"currency": "USD", "amount":
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735
|
-
"6000"}, "coverage_level": "family"}, {"in_plan_network": "yes", "benefit_amount":
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736
|
-
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737
|
-
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|
738
|
-
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739
|
-
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740
|
-
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741
|
-
{"currency": "USD", "amount": "25000"}, "coverage_level": "family"}, {"in_plan_network":
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742
|
-
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|
743
|
-
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744
|
-
"remaining"}], "level": "employee_and_spouse", "copay": [{"in_plan_network":
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|
-
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|
-
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|
-
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|
-
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|
-
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-
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|
-
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|
-
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-
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764
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|
-
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|
766
|
-
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767
|
-
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|
768
|
-
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|
769
|
-
"no", "time_period": "remaining", "coverage_level": "family", "messages":
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770
|
-
[{"message": "INT MED AND RX"}], "benefit_amount": {"currency": "USD", "amount":
|
771
|
-
"11956.09"}}, {"messages": [{"message": "INT MED AND RX,GYN OFFICE VS,DED
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772
|
-
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|
773
|
-
"no", "eligibility_date": "2013-01-01", "time_period": "calendar_year", "coverage_level":
|
774
|
-
"individual", "benefit_amount": {"currency": "USD", "amount": "6000"}}, {"in_plan_network":
|
775
|
-
"no", "time_period": "remaining", "coverage_level": "individual", "messages":
|
776
|
-
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|
777
|
-
"5983.57"}}], "plan_begin_date": "2013-02-15", "eligibility_begin_date": "2012-02-01",
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778
|
-
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|
779
|
-
"coverage_level": "employee_and_spouse", "messages": [{"message": "GYN OFFICE
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780
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-
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781
|
-
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782
|
-
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-
"coverage_level": "employee_and_spouse", "messages": [{"message": "GYN OFFICE
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|
-
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785
|
-
TO OUT OF POCKET"}, {"message": "SPEC OFFICE,COINS APPLIES TO OUT OF POCKET"},
|
786
|
-
{"message": "SPEC VISIT,COINS APPLIES TO OUT OF POCKET"}, {"message": "PRIME
|
787
|
-
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788
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-
"MOCK INDIVIDUAL ADVANTAGE PLAN", "plan_number": "0888188", "service_date":
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789
|
-
"2013-08-10"}, "valid_request": true}, "trading_partner_id": "MOCKPAYER",
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790
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-
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-
"wait", "receive", "process", "complete"], "history": [{"record_dt": "2014-07-22T00:04:47.696000",
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-
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793
|
-
"name": "generating", "title": "Generating X12 transactions"}, {"record_dt":
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794
|
-
"2014-07-22T00:04:47.713000", "name": "transmitting", "title": "Transmitting
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795
|
-
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796
|
-
"name": "waiting", "title": "Waiting on Trading Partner Response"}, {"record_dt":
|
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|
-
"2014-07-22T00:04:47.716000", "name": "receiving", "title": "Receiving transactions
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798
|
-
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799
|
-
"processing", "title": "Processing X12 transactions"}]}, {"units_of_work":
|
800
|
-
1, "name": "pokitdok_api", "parameters": {"service_types": ["health_benefit_plan_coverage"],
|
801
|
-
"trading_partner_id": "MOCKPAYER", "payer": {"id": "MOCKPAYER", "name": "Mockpayer
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802
|
-
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|
803
|
-
"last_name": "Green", "plan_start_date": "2013-08-10", "id": "454534266"},
|
804
|
-
"correlation_id": "9ecd6843-a6ef-477b-a531-2978097b0abe", "client_id": "7x7nRAotGfxHfy7Llfl3",
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805
|
-
"provider": {"first_name": "Levi", "last_name": "Price", "npi": "4541551516"},
|
806
|
-
"async": false, "transaction_code": "request"}, "state": {"name": "completed",
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807
|
-
"title": "Completed"}, "result": {"service_types": ["professional_physician_visit_office"],
|
808
|
-
"client_id": "7x7nRAotGfxHfy7Llfl3", "payer": {"id": "MOCKPAYER", "name":
|
809
|
-
"MOCK PAYER INC"}, "subscriber": {"birth_date": "1997-11-28", "first_name":
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810
|
-
"Cleo", "last_name": "Green", "id": "454534266", "address": {"city": "SPARTANBURG",
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811
|
-
"state": "SC", "zipcode": "29307", "address_lines": ["123 MAIN ST"]}}, "correlation_id":
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812
|
-
"9ecd6843-a6ef-477b-a531-2978097b0abe", "trading_partner_id": "MOCKPAYER",
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813
|
-
"provider": {"first_name": "Levi", "last_name": "Levi Price", "npi": "4541551516"},
|
814
|
-
"coverage": {"service_types": ["professional_physician_visit_office"], "group_number":
|
815
|
-
"088818801000013", "out_of_pocket": [{"in_plan_network": "yes", "benefit_amount":
|
816
|
-
{"currency": "USD", "amount": "3000"}, "coverage_level": "individual"}, {"in_plan_network":
|
817
|
-
"yes", "benefit_amount": {"currency": "USD", "amount": "2983.57"}, "coverage_level":
|
818
|
-
"individual", "time_period": "remaining"}, {"in_plan_network": "yes", "benefit_amount":
|
819
|
-
{"currency": "USD", "amount": "6000"}, "coverage_level": "family"}, {"in_plan_network":
|
820
|
-
"yes", "benefit_amount": {"currency": "USD", "amount": "5956.09"}, "coverage_level":
|
821
|
-
"family", "time_period": "remaining"}, {"in_plan_network": "no", "benefit_amount":
|
822
|
-
{"currency": "USD", "amount": "12500"}, "coverage_level": "individual"}, {"in_plan_network":
|
823
|
-
"no", "benefit_amount": {"currency": "USD", "amount": "12483.57"}, "coverage_level":
|
824
|
-
"individual", "time_period": "remaining"}, {"in_plan_network": "no", "benefit_amount":
|
825
|
-
{"currency": "USD", "amount": "25000"}, "coverage_level": "family"}, {"in_plan_network":
|
826
|
-
"no", "benefit_amount": {"currency": "USD", "amount": "24956.09"}, "coverage_level":
|
827
|
-
"family", "messages": [{"message": "Unlimited Lifetime Benefits"}], "time_period":
|
828
|
-
"remaining"}], "level": "employee_and_spouse", "copay": [{"in_plan_network":
|
829
|
-
"yes", "service_types": ["professional_physician_visit_office"], "coverage_level":
|
830
|
-
"employee_and_spouse", "messages": [{"message": "PRIMARY OFFICE"}]}, {"in_plan_network":
|
831
|
-
"not_applicable", "service_types": ["professional_physician_visit_office"],
|
832
|
-
"coverage_level": "employee_and_spouse", "messages": [{"message": "GYN OFFICE
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833
|
-
VS"}, {"message": "GYN VISIT"}, {"message": "SPEC OFFICE"}, {"message": "SPEC
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834
|
-
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835
|
-
{"message": "Commercial"}, {"message": "Plan includes NAP"}, {"message": "Pre-Existing
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836
|
-
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837
|
-
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838
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-
CARE VST"}], "in_plan_network": "yes", "eligibility_date": "2013-01-01", "time_period":
|
839
|
-
"calendar_year", "coverage_level": "family", "benefit_amount": {"currency":
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840
|
-
"USD", "amount": "6000"}}, {"in_plan_network": "yes", "time_period": "remaining",
|
841
|
-
"coverage_level": "family", "messages": [{"message": "INT MED AND RX"}], "benefit_amount":
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842
|
-
{"currency": "USD", "amount": "5956.09"}}, {"messages": [{"message": "INT
|
843
|
-
MED AND RX,GYN OFFICE VS,DED INCLUDED IN OOP,GYN VISIT,SPEC OFFICE,SPEC VISIT,PRIMARY
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|
-
OFFICE,PRIME CARE VST"}], "in_plan_network": "yes", "eligibility_date": "2013-01-01",
|
845
|
-
"time_period": "calendar_year", "coverage_level": "individual", "benefit_amount":
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846
|
-
{"currency": "USD", "amount": "3000"}}, {"in_plan_network": "yes", "time_period":
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847
|
-
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848
|
-
MED AND RX"}], "benefit_amount": {"currency": "USD", "amount": "2983.57"}},
|
849
|
-
{"messages": [{"message": "INT MED AND RX,GYN OFFICE VS,DED INCLUDED IN OOP,GYN
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850
|
-
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|
851
|
-
"2013-01-01", "time_period": "calendar_year", "coverage_level": "family",
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852
|
-
"benefit_amount": {"currency": "USD", "amount": "12000"}}, {"in_plan_network":
|
853
|
-
"no", "time_period": "remaining", "coverage_level": "family", "messages":
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854
|
-
[{"message": "INT MED AND RX"}], "benefit_amount": {"currency": "USD", "amount":
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855
|
-
"11956.09"}}, {"messages": [{"message": "INT MED AND RX,GYN OFFICE VS,DED
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|
-
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|
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|
-
"no", "eligibility_date": "2013-01-01", "time_period": "calendar_year", "coverage_level":
|
858
|
-
"individual", "benefit_amount": {"currency": "USD", "amount": "6000"}}, {"in_plan_network":
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|
-
"no", "time_period": "remaining", "coverage_level": "individual", "messages":
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|
-
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|
861
|
-
"5983.57"}}], "plan_begin_date": "2013-02-15", "eligibility_begin_date": "2012-02-01",
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|
-
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|
-
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864
|
-
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|
-
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|
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|
-
"yes"}, {"benefit_percent": 0.5, "service_types": ["professional_physician_visit_office"],
|
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|
-
"coverage_level": "employee_and_spouse", "messages": [{"message": "GYN OFFICE
|
868
|
-
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|
869
|
-
TO OUT OF POCKET"}, {"message": "SPEC OFFICE,COINS APPLIES TO OUT OF POCKET"},
|
870
|
-
{"message": "SPEC VISIT,COINS APPLIES TO OUT OF POCKET"}, {"message": "PRIME
|
871
|
-
CARE VST,COINS APPLIES TO OUT OF POCKET"}], "in_plan_network": "no"}], "group_description":
|
872
|
-
"MOCK INDIVIDUAL ADVANTAGE PLAN", "plan_number": "0888188", "service_date":
|
873
|
-
"2013-08-10"}, "valid_request": true}, "trading_partner_id": "MOCKPAYER",
|
874
|
-
"id": "53cdaa9f56c02c1cdb7a40b2", "transition_path": ["generate", "transmit",
|
875
|
-
"wait", "receive", "process", "complete"], "history": [{"record_dt": "2014-07-22T00:04:47.799000",
|
876
|
-
"name": "init", "title": "Initializing"}, {"record_dt": "2014-07-22T00:04:47.816000",
|
877
|
-
"name": "generating", "title": "Generating X12 transactions"}, {"record_dt":
|
878
|
-
"2014-07-22T00:04:47.817000", "name": "transmitting", "title": "Transmitting
|
879
|
-
transactions to Trading Partner"}, {"record_dt": "2014-07-22T00:04:47.818000",
|
880
|
-
"name": "waiting", "title": "Waiting on Trading Partner Response"}, {"record_dt":
|
881
|
-
"2014-07-22T00:04:47.819000", "name": "receiving", "title": "Receiving transactions
|
882
|
-
from Trading Partner"}, {"record_dt": "2014-07-22T00:04:47.888000", "name":
|
883
|
-
"processing", "title": "Processing X12 transactions"}]}, {"units_of_work":
|
884
|
-
1, "name": "cash_prices", "parameters": {"service_types": ["health_benefit_plan_coverage"],
|
885
|
-
"trading_partner_id": "MOCKPAYER", "payer": {"id": "MOCKPAYER", "name": "Mockpayer
|
886
|
-
For Testing"}, "member": {"birth_date": "1992-06-26", "first_name": "Enos",
|
887
|
-
"last_name": "Hammes", "plan_start_date": "2013-08-10", "id": "803850921"},
|
888
|
-
"correlation_id": "2c111b0c-2bce-4188-9487-1d173cac2f04", "client_id": "7x7nRAotGfxHfy7Llfl3",
|
889
|
-
"provider": {"first_name": "Edythe", "last_name": "Kertzmann", "npi": "0303839453"},
|
890
|
-
"async": false, "transaction_code": "request"}, "state": {"name": "completed",
|
891
|
-
"title": "Completed"}, "result": {"service_types": ["professional_physician_visit_office"],
|
892
|
-
"client_id": "7x7nRAotGfxHfy7Llfl3", "payer": {"id": "MOCKPAYER", "name":
|
893
|
-
"MOCK PAYER INC"}, "subscriber": {"birth_date": "1992-06-26", "first_name":
|
894
|
-
"Enos", "last_name": "Hammes", "id": "803850921", "address": {"city": "SPARTANBURG",
|
895
|
-
"state": "SC", "zipcode": "29307", "address_lines": ["123 MAIN ST"]}}, "correlation_id":
|
896
|
-
"2c111b0c-2bce-4188-9487-1d173cac2f04", "trading_partner_id": "MOCKPAYER",
|
897
|
-
"provider": {"first_name": "Edythe", "last_name": "Edythe Kertzmann", "npi":
|
898
|
-
"0303839453"}, "coverage": {"service_types": ["professional_physician_visit_office"],
|
899
|
-
"group_number": "088818801000013", "out_of_pocket": [{"in_plan_network": "yes",
|
900
|
-
"benefit_amount": {"currency": "USD", "amount": "3000"}, "coverage_level":
|
901
|
-
"individual"}, {"in_plan_network": "yes", "benefit_amount": {"currency": "USD",
|
902
|
-
"amount": "2983.57"}, "coverage_level": "individual", "time_period": "remaining"},
|
903
|
-
{"in_plan_network": "yes", "benefit_amount": {"currency": "USD", "amount":
|
904
|
-
"6000"}, "coverage_level": "family"}, {"in_plan_network": "yes", "benefit_amount":
|
905
|
-
{"currency": "USD", "amount": "5956.09"}, "coverage_level": "family", "time_period":
|
906
|
-
"remaining"}, {"in_plan_network": "no", "benefit_amount": {"currency": "USD",
|
907
|
-
"amount": "12500"}, "coverage_level": "individual"}, {"in_plan_network": "no",
|
908
|
-
"benefit_amount": {"currency": "USD", "amount": "12483.57"}, "coverage_level":
|
909
|
-
"individual", "time_period": "remaining"}, {"in_plan_network": "no", "benefit_amount":
|
910
|
-
{"currency": "USD", "amount": "25000"}, "coverage_level": "family"}, {"in_plan_network":
|
911
|
-
"no", "benefit_amount": {"currency": "USD", "amount": "24956.09"}, "coverage_level":
|
912
|
-
"family", "messages": [{"message": "Unlimited Lifetime Benefits"}], "time_period":
|
913
|
-
"remaining"}], "level": "employee_and_spouse", "copay": [{"in_plan_network":
|
914
|
-
"yes", "service_types": ["professional_physician_visit_office"], "coverage_level":
|
915
|
-
"employee_and_spouse", "messages": [{"message": "PRIMARY OFFICE"}]}, {"in_plan_network":
|
916
|
-
"not_applicable", "service_types": ["professional_physician_visit_office"],
|
917
|
-
"coverage_level": "employee_and_spouse", "messages": [{"message": "GYN OFFICE
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918
|
-
VS"}, {"message": "GYN VISIT"}, {"message": "SPEC OFFICE"}, {"message": "SPEC
|
919
|
-
VISIT"}, {"message": "PRIME CARE VST"}, {"message": "Plan Requires PreCert"},
|
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|
-
{"message": "Commercial"}, {"message": "Plan includes NAP"}, {"message": "Pre-Existing
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921
|
-
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922
|
-
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923
|
-
CARE VST"}], "in_plan_network": "yes", "eligibility_date": "2013-01-01", "time_period":
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924
|
-
"calendar_year", "coverage_level": "family", "benefit_amount": {"currency":
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925
|
-
"USD", "amount": "6000"}}, {"in_plan_network": "yes", "time_period": "remaining",
|
926
|
-
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927
|
-
{"currency": "USD", "amount": "5956.09"}}, {"messages": [{"message": "INT
|
928
|
-
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929
|
-
OFFICE,PRIME CARE VST"}], "in_plan_network": "yes", "eligibility_date": "2013-01-01",
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930
|
-
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931
|
-
{"currency": "USD", "amount": "3000"}}, {"in_plan_network": "yes", "time_period":
|
932
|
-
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933
|
-
MED AND RX"}], "benefit_amount": {"currency": "USD", "amount": "2983.57"}},
|
934
|
-
{"messages": [{"message": "INT MED AND RX,GYN OFFICE VS,DED INCLUDED IN OOP,GYN
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935
|
-
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|
936
|
-
"2013-01-01", "time_period": "calendar_year", "coverage_level": "family",
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937
|
-
"benefit_amount": {"currency": "USD", "amount": "12000"}}, {"in_plan_network":
|
938
|
-
"no", "time_period": "remaining", "coverage_level": "family", "messages":
|
939
|
-
[{"message": "INT MED AND RX"}], "benefit_amount": {"currency": "USD", "amount":
|
940
|
-
"11956.09"}}, {"messages": [{"message": "INT MED AND RX,GYN OFFICE VS,DED
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941
|
-
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|
942
|
-
"no", "eligibility_date": "2013-01-01", "time_period": "calendar_year", "coverage_level":
|
943
|
-
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944
|
-
"no", "time_period": "remaining", "coverage_level": "individual", "messages":
|
945
|
-
[{"message": "INT MED AND RX"}], "benefit_amount": {"currency": "USD", "amount":
|
946
|
-
"5983.57"}}], "plan_begin_date": "2013-02-15", "eligibility_begin_date": "2012-02-01",
|
947
|
-
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|
948
|
-
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949
|
-
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950
|
-
VISIT"}, {"message": "PRIMARY OFFICE"}, {"message": "PRIME CARE VST"}], "in_plan_network":
|
951
|
-
"yes"}, {"benefit_percent": 0.5, "service_types": ["professional_physician_visit_office"],
|
952
|
-
"coverage_level": "employee_and_spouse", "messages": [{"message": "GYN OFFICE
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953
|
-
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|
954
|
-
TO OUT OF POCKET"}, {"message": "SPEC OFFICE,COINS APPLIES TO OUT OF POCKET"},
|
955
|
-
{"message": "SPEC VISIT,COINS APPLIES TO OUT OF POCKET"}, {"message": "PRIME
|
956
|
-
CARE VST,COINS APPLIES TO OUT OF POCKET"}], "in_plan_network": "no"}], "group_description":
|
957
|
-
"MOCK INDIVIDUAL ADVANTAGE PLAN", "plan_number": "0888188", "service_date":
|
958
|
-
"2013-08-10"}, "valid_request": true}, "trading_partner_id": "MOCKPAYER",
|
959
|
-
"id": "53cdaa9f56c02c1cdb7a40b5", "transition_path": ["generate", "transmit",
|
960
|
-
"wait", "receive", "process", "complete"], "history": [{"record_dt": "2014-07-22T00:04:47.901000",
|
961
|
-
"name": "init", "title": "Initializing"}, {"record_dt": "2014-07-22T00:04:47.938000",
|
962
|
-
"name": "generating", "title": "Generating X12 transactions"}, {"record_dt":
|
963
|
-
"2014-07-22T00:04:47.939000", "name": "transmitting", "title": "Transmitting
|
964
|
-
transactions to Trading Partner"}, {"record_dt": "2014-07-22T00:04:47.940000",
|
965
|
-
"name": "waiting", "title": "Waiting on Trading Partner Response"}, {"record_dt":
|
966
|
-
"2014-07-22T00:04:47.942000", "name": "receiving", "title": "Receiving transactions
|
967
|
-
from Trading Partner"}, {"record_dt": "2014-07-22T00:04:48.020000", "name":
|
968
|
-
"processing", "title": "Processing X12 transactions"}]}, {"units_of_work":
|
969
|
-
1, "name": "providers", "parameters": {"service_types": ["health_benefit_plan_coverage"],
|
970
|
-
"trading_partner_id": "MOCKPAYER", "payer": {"id": "MOCKPAYER", "name": "Mockpayer
|
971
|
-
For Testing"}, "member": {"birth_date": "1985-06-30", "first_name": "Elian",
|
972
|
-
"last_name": "Larson", "plan_start_date": "2013-08-10", "id": "431585370"},
|
973
|
-
"correlation_id": "62fc1541-69a2-4377-9eb9-dd6b391ca0bd", "client_id": "7x7nRAotGfxHfy7Llfl3",
|
974
|
-
"provider": {"first_name": "Tomasa", "last_name": "Cronin", "npi": "0826932801"},
|
975
|
-
"async": false, "transaction_code": "request"}, "state": {"name": "completed",
|
976
|
-
"title": "Completed"}, "result": {"service_types": ["professional_physician_visit_office"],
|
977
|
-
"client_id": "7x7nRAotGfxHfy7Llfl3", "payer": {"id": "MOCKPAYER", "name":
|
978
|
-
"MOCK PAYER INC"}, "subscriber": {"birth_date": "1985-06-30", "first_name":
|
979
|
-
"Elian", "last_name": "Larson", "id": "431585370", "address": {"city": "SPARTANBURG",
|
980
|
-
"state": "SC", "zipcode": "29307", "address_lines": ["123 MAIN ST"]}}, "correlation_id":
|
981
|
-
"62fc1541-69a2-4377-9eb9-dd6b391ca0bd", "trading_partner_id": "MOCKPAYER",
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982
|
-
"provider": {"first_name": "Tomasa", "last_name": "Tomasa Cronin", "npi":
|
983
|
-
"0826932801"}, "coverage": {"service_types": ["professional_physician_visit_office"],
|
984
|
-
"group_number": "088818801000013", "out_of_pocket": [{"in_plan_network": "yes",
|
985
|
-
"benefit_amount": {"currency": "USD", "amount": "3000"}, "coverage_level":
|
986
|
-
"individual"}, {"in_plan_network": "yes", "benefit_amount": {"currency": "USD",
|
987
|
-
"amount": "2983.57"}, "coverage_level": "individual", "time_period": "remaining"},
|
988
|
-
{"in_plan_network": "yes", "benefit_amount": {"currency": "USD", "amount":
|
989
|
-
"6000"}, "coverage_level": "family"}, {"in_plan_network": "yes", "benefit_amount":
|
990
|
-
{"currency": "USD", "amount": "5956.09"}, "coverage_level": "family", "time_period":
|
991
|
-
"remaining"}, {"in_plan_network": "no", "benefit_amount": {"currency": "USD",
|
992
|
-
"amount": "12500"}, "coverage_level": "individual"}, {"in_plan_network": "no",
|
993
|
-
"benefit_amount": {"currency": "USD", "amount": "12483.57"}, "coverage_level":
|
994
|
-
"individual", "time_period": "remaining"}, {"in_plan_network": "no", "benefit_amount":
|
995
|
-
{"currency": "USD", "amount": "25000"}, "coverage_level": "family"}, {"in_plan_network":
|
996
|
-
"no", "benefit_amount": {"currency": "USD", "amount": "24956.09"}, "coverage_level":
|
997
|
-
"family", "messages": [{"message": "Unlimited Lifetime Benefits"}], "time_period":
|
998
|
-
"remaining"}], "level": "employee_and_spouse", "copay": [{"in_plan_network":
|
999
|
-
"yes", "service_types": ["professional_physician_visit_office"], "coverage_level":
|
1000
|
-
"employee_and_spouse", "messages": [{"message": "PRIMARY OFFICE"}]}, {"in_plan_network":
|
1001
|
-
"not_applicable", "service_types": ["professional_physician_visit_office"],
|
1002
|
-
"coverage_level": "employee_and_spouse", "messages": [{"message": "GYN OFFICE
|
1003
|
-
VS"}, {"message": "GYN VISIT"}, {"message": "SPEC OFFICE"}, {"message": "SPEC
|
1004
|
-
VISIT"}, {"message": "PRIME CARE VST"}, {"message": "Plan Requires PreCert"},
|
1005
|
-
{"message": "Commercial"}, {"message": "Plan includes NAP"}, {"message": "Pre-Existing
|
1006
|
-
may apply"}]}], "deductibles": [{"messages": [{"message": "INT MED AND RX,GYN
|
1007
|
-
OFFICE VS,DED INCLUDED IN OOP,GYN VISIT,SPEC OFFICE,SPEC VISIT,PRIMARY OFFICE,PRIME
|
1008
|
-
CARE VST"}], "in_plan_network": "yes", "eligibility_date": "2013-01-01", "time_period":
|
1009
|
-
"calendar_year", "coverage_level": "family", "benefit_amount": {"currency":
|
1010
|
-
"USD", "amount": "6000"}}, {"in_plan_network": "yes", "time_period": "remaining",
|
1011
|
-
"coverage_level": "family", "messages": [{"message": "INT MED AND RX"}], "benefit_amount":
|
1012
|
-
{"currency": "USD", "amount": "5956.09"}}, {"messages": [{"message": "INT
|
1013
|
-
MED AND RX,GYN OFFICE VS,DED INCLUDED IN OOP,GYN VISIT,SPEC OFFICE,SPEC VISIT,PRIMARY
|
1014
|
-
OFFICE,PRIME CARE VST"}], "in_plan_network": "yes", "eligibility_date": "2013-01-01",
|
1015
|
-
"time_period": "calendar_year", "coverage_level": "individual", "benefit_amount":
|
1016
|
-
{"currency": "USD", "amount": "3000"}}, {"in_plan_network": "yes", "time_period":
|
1017
|
-
"remaining", "coverage_level": "individual", "messages": [{"message": "INT
|
1018
|
-
MED AND RX"}], "benefit_amount": {"currency": "USD", "amount": "2983.57"}},
|
1019
|
-
{"messages": [{"message": "INT MED AND RX,GYN OFFICE VS,DED INCLUDED IN OOP,GYN
|
1020
|
-
VISIT,SPEC OFFICE,SPEC VISIT,PRIME CARE VST"}], "in_plan_network": "no", "eligibility_date":
|
1021
|
-
"2013-01-01", "time_period": "calendar_year", "coverage_level": "family",
|
1022
|
-
"benefit_amount": {"currency": "USD", "amount": "12000"}}, {"in_plan_network":
|
1023
|
-
"no", "time_period": "remaining", "coverage_level": "family", "messages":
|
1024
|
-
[{"message": "INT MED AND RX"}], "benefit_amount": {"currency": "USD", "amount":
|
1025
|
-
"11956.09"}}, {"messages": [{"message": "INT MED AND RX,GYN OFFICE VS,DED
|
1026
|
-
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|
1027
|
-
"no", "eligibility_date": "2013-01-01", "time_period": "calendar_year", "coverage_level":
|
1028
|
-
"individual", "benefit_amount": {"currency": "USD", "amount": "6000"}}, {"in_plan_network":
|
1029
|
-
"no", "time_period": "remaining", "coverage_level": "individual", "messages":
|
1030
|
-
[{"message": "INT MED AND RX"}], "benefit_amount": {"currency": "USD", "amount":
|
1031
|
-
"5983.57"}}], "plan_begin_date": "2013-02-15", "eligibility_begin_date": "2012-02-01",
|
1032
|
-
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|
1033
|
-
"coverage_level": "employee_and_spouse", "messages": [{"message": "GYN OFFICE
|
1034
|
-
VS"}, {"message": "GYN VISIT"}, {"message": "SPEC OFFICE"}, {"message": "SPEC
|
1035
|
-
VISIT"}, {"message": "PRIMARY OFFICE"}, {"message": "PRIME CARE VST"}], "in_plan_network":
|
1036
|
-
"yes"}, {"benefit_percent": 0.5, "service_types": ["professional_physician_visit_office"],
|
1037
|
-
"coverage_level": "employee_and_spouse", "messages": [{"message": "GYN OFFICE
|
1038
|
-
VS,COINS APPLIES TO OUT OF POCKET"}, {"message": "GYN VISIT,COINS APPLIES
|
1039
|
-
TO OUT OF POCKET"}, {"message": "SPEC OFFICE,COINS APPLIES TO OUT OF POCKET"},
|
1040
|
-
{"message": "SPEC VISIT,COINS APPLIES TO OUT OF POCKET"}, {"message": "PRIME
|
1041
|
-
CARE VST,COINS APPLIES TO OUT OF POCKET"}], "in_plan_network": "no"}], "group_description":
|
1042
|
-
"MOCK INDIVIDUAL ADVANTAGE PLAN", "plan_number": "0888188", "service_date":
|
1043
|
-
"2013-08-10"}, "valid_request": true}, "trading_partner_id": "MOCKPAYER",
|
1044
|
-
"id": "53cdaaa056c02c1cdb7a40b8", "transition_path": ["generate", "transmit",
|
1045
|
-
"wait", "receive", "process", "complete"], "history": [{"record_dt": "2014-07-22T00:04:48.035000",
|
1046
|
-
"name": "init", "title": "Initializing"}, {"record_dt": "2014-07-22T00:04:48.063000",
|
1047
|
-
"name": "generating", "title": "Generating X12 transactions"}, {"record_dt":
|
1048
|
-
"2014-07-22T00:04:48.065000", "name": "transmitting", "title": "Transmitting
|
1049
|
-
transactions to Trading Partner"}, {"record_dt": "2014-07-22T00:04:48.066000",
|
1050
|
-
"name": "waiting", "title": "Waiting on Trading Partner Response"}, {"record_dt":
|
1051
|
-
"2014-07-22T00:04:48.067000", "name": "receiving", "title": "Receiving transactions
|
1052
|
-
from Trading Partner"}, {"record_dt": "2014-07-22T00:04:48.138000", "name":
|
1053
|
-
"processing", "title": "Processing X12 transactions"}]}, {"units_of_work":
|
1054
|
-
1, "name": "cash_prices", "parameters": {"service_types": ["health_benefit_plan_coverage"],
|
1055
|
-
"trading_partner_id": "MOCKPAYER", "payer": {"id": "MOCKPAYER", "name": "Mockpayer
|
1056
|
-
For Testing"}, "member": {"birth_date": "1990-02-13", "first_name": "Gordon",
|
1057
|
-
"last_name": "Berge", "plan_start_date": "2013-08-10", "id": "781167793"},
|
1058
|
-
"correlation_id": "7f7185e5-d7a0-47fd-b0a0-38ac8642e393", "client_id": "7x7nRAotGfxHfy7Llfl3",
|
1059
|
-
"provider": {"first_name": "Joana", "last_name": "Herzog", "npi": "7669802604"},
|
1060
|
-
"async": false, "transaction_code": "request"}, "state": {"name": "completed",
|
1061
|
-
"title": "Completed"}, "result": {"service_types": ["professional_physician_visit_office"],
|
1062
|
-
"client_id": "7x7nRAotGfxHfy7Llfl3", "payer": {"id": "MOCKPAYER", "name":
|
1063
|
-
"MOCK PAYER INC"}, "subscriber": {"birth_date": "1990-02-13", "first_name":
|
1064
|
-
"Gordon", "last_name": "Berge", "id": "781167793", "address": {"city": "SPARTANBURG",
|
1065
|
-
"state": "SC", "zipcode": "29307", "address_lines": ["123 MAIN ST"]}}, "correlation_id":
|
1066
|
-
"7f7185e5-d7a0-47fd-b0a0-38ac8642e393", "trading_partner_id": "MOCKPAYER",
|
1067
|
-
"provider": {"first_name": "Joana", "last_name": "Joana Herzog", "npi": "7669802604"},
|
1068
|
-
"coverage": {"service_types": ["professional_physician_visit_office"], "group_number":
|
1069
|
-
"088818801000013", "out_of_pocket": [{"in_plan_network": "yes", "benefit_amount":
|
1070
|
-
{"currency": "USD", "amount": "3000"}, "coverage_level": "individual"}, {"in_plan_network":
|
1071
|
-
"yes", "benefit_amount": {"currency": "USD", "amount": "2983.57"}, "coverage_level":
|
1072
|
-
"individual", "time_period": "remaining"}, {"in_plan_network": "yes", "benefit_amount":
|
1073
|
-
{"currency": "USD", "amount": "6000"}, "coverage_level": "family"}, {"in_plan_network":
|
1074
|
-
"yes", "benefit_amount": {"currency": "USD", "amount": "5956.09"}, "coverage_level":
|
1075
|
-
"family", "time_period": "remaining"}, {"in_plan_network": "no", "benefit_amount":
|
1076
|
-
{"currency": "USD", "amount": "12500"}, "coverage_level": "individual"}, {"in_plan_network":
|
1077
|
-
"no", "benefit_amount": {"currency": "USD", "amount": "12483.57"}, "coverage_level":
|
1078
|
-
"individual", "time_period": "remaining"}, {"in_plan_network": "no", "benefit_amount":
|
1079
|
-
{"currency": "USD", "amount": "25000"}, "coverage_level": "family"}, {"in_plan_network":
|
1080
|
-
"no", "benefit_amount": {"currency": "USD", "amount": "24956.09"}, "coverage_level":
|
1081
|
-
"family", "messages": [{"message": "Unlimited Lifetime Benefits"}], "time_period":
|
1082
|
-
"remaining"}], "level": "employee_and_spouse", "copay": [{"in_plan_network":
|
1083
|
-
"yes", "service_types": ["professional_physician_visit_office"], "coverage_level":
|
1084
|
-
"employee_and_spouse", "messages": [{"message": "PRIMARY OFFICE"}]}, {"in_plan_network":
|
1085
|
-
"not_applicable", "service_types": ["professional_physician_visit_office"],
|
1086
|
-
"coverage_level": "employee_and_spouse", "messages": [{"message": "GYN OFFICE
|
1087
|
-
VS"}, {"message": "GYN VISIT"}, {"message": "SPEC OFFICE"}, {"message": "SPEC
|
1088
|
-
VISIT"}, {"message": "PRIME CARE VST"}, {"message": "Plan Requires PreCert"},
|
1089
|
-
{"message": "Commercial"}, {"message": "Plan includes NAP"}, {"message": "Pre-Existing
|
1090
|
-
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|
1091
|
-
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|
1092
|
-
CARE VST"}], "in_plan_network": "yes", "eligibility_date": "2013-01-01", "time_period":
|
1093
|
-
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|
1094
|
-
"USD", "amount": "6000"}}, {"in_plan_network": "yes", "time_period": "remaining",
|
1095
|
-
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|
1096
|
-
{"currency": "USD", "amount": "5956.09"}}, {"messages": [{"message": "INT
|
1097
|
-
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1098
|
-
OFFICE,PRIME CARE VST"}], "in_plan_network": "yes", "eligibility_date": "2013-01-01",
|
1099
|
-
"time_period": "calendar_year", "coverage_level": "individual", "benefit_amount":
|
1100
|
-
{"currency": "USD", "amount": "3000"}}, {"in_plan_network": "yes", "time_period":
|
1101
|
-
"remaining", "coverage_level": "individual", "messages": [{"message": "INT
|
1102
|
-
MED AND RX"}], "benefit_amount": {"currency": "USD", "amount": "2983.57"}},
|
1103
|
-
{"messages": [{"message": "INT MED AND RX,GYN OFFICE VS,DED INCLUDED IN OOP,GYN
|
1104
|
-
VISIT,SPEC OFFICE,SPEC VISIT,PRIME CARE VST"}], "in_plan_network": "no", "eligibility_date":
|
1105
|
-
"2013-01-01", "time_period": "calendar_year", "coverage_level": "family",
|
1106
|
-
"benefit_amount": {"currency": "USD", "amount": "12000"}}, {"in_plan_network":
|
1107
|
-
"no", "time_period": "remaining", "coverage_level": "family", "messages":
|
1108
|
-
[{"message": "INT MED AND RX"}], "benefit_amount": {"currency": "USD", "amount":
|
1109
|
-
"11956.09"}}, {"messages": [{"message": "INT MED AND RX,GYN OFFICE VS,DED
|
1110
|
-
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|
1111
|
-
"no", "eligibility_date": "2013-01-01", "time_period": "calendar_year", "coverage_level":
|
1112
|
-
"individual", "benefit_amount": {"currency": "USD", "amount": "6000"}}, {"in_plan_network":
|
1113
|
-
"no", "time_period": "remaining", "coverage_level": "individual", "messages":
|
1114
|
-
[{"message": "INT MED AND RX"}], "benefit_amount": {"currency": "USD", "amount":
|
1115
|
-
"5983.57"}}], "plan_begin_date": "2013-02-15", "eligibility_begin_date": "2012-02-01",
|
1116
|
-
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|
1117
|
-
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|
1118
|
-
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|
1119
|
-
VISIT"}, {"message": "PRIMARY OFFICE"}, {"message": "PRIME CARE VST"}], "in_plan_network":
|
1120
|
-
"yes"}, {"benefit_percent": 0.5, "service_types": ["professional_physician_visit_office"],
|
1121
|
-
"coverage_level": "employee_and_spouse", "messages": [{"message": "GYN OFFICE
|
1122
|
-
VS,COINS APPLIES TO OUT OF POCKET"}, {"message": "GYN VISIT,COINS APPLIES
|
1123
|
-
TO OUT OF POCKET"}, {"message": "SPEC OFFICE,COINS APPLIES TO OUT OF POCKET"},
|
1124
|
-
{"message": "SPEC VISIT,COINS APPLIES TO OUT OF POCKET"}, {"message": "PRIME
|
1125
|
-
CARE VST,COINS APPLIES TO OUT OF POCKET"}], "in_plan_network": "no"}], "group_description":
|
1126
|
-
"MOCK INDIVIDUAL ADVANTAGE PLAN", "plan_number": "0888188", "service_date":
|
1127
|
-
"2013-08-10"}, "valid_request": true}, "trading_partner_id": "MOCKPAYER",
|
1128
|
-
"id": "53cdaaa056c02c1cdb7a40bb", "transition_path": ["generate", "transmit",
|
1129
|
-
"wait", "receive", "process", "complete"], "history": [{"record_dt": "2014-07-22T00:04:48.154000",
|
1130
|
-
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|
1131
|
-
"name": "generating", "title": "Generating X12 transactions"}, {"record_dt":
|
1132
|
-
"2014-07-22T00:04:48.181000", "name": "transmitting", "title": "Transmitting
|
1133
|
-
transactions to Trading Partner"}, {"record_dt": "2014-07-22T00:04:48.183000",
|
1134
|
-
"name": "waiting", "title": "Waiting on Trading Partner Response"}, {"record_dt":
|
1135
|
-
"2014-07-22T00:04:48.184000", "name": "receiving", "title": "Receiving transactions
|
1136
|
-
from Trading Partner"}, {"record_dt": "2014-07-22T00:04:48.251000", "name":
|
1137
|
-
"processing", "title": "Processing X12 transactions"}]}, {"units_of_work":
|
1138
|
-
1, "name": "enrollment", "parameters": {"service_types": ["health_benefit_plan_coverage"],
|
1139
|
-
"trading_partner_id": "MOCKPAYER", "payer": {"id": "MOCKPAYER", "name": "Mockpayer
|
1140
|
-
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1141
|
-
"last_name": "Hessel", "plan_start_date": "2013-08-10", "id": "869808195"},
|
1142
|
-
"correlation_id": "ef2befe5-5498-400e-b282-3211744fc7dd", "client_id": "7x7nRAotGfxHfy7Llfl3",
|
1143
|
-
"provider": {"first_name": "Armand", "last_name": "Kulas", "npi": "1287623786"},
|
1144
|
-
"async": false, "transaction_code": "request"}, "state": {"name": "completed",
|
1145
|
-
"title": "Completed"}, "result": {"service_types": ["professional_physician_visit_office"],
|
1146
|
-
"client_id": "7x7nRAotGfxHfy7Llfl3", "payer": {"id": "MOCKPAYER", "name":
|
1147
|
-
"MOCK PAYER INC"}, "subscriber": {"birth_date": "1997-07-19", "first_name":
|
1148
|
-
"Bernita", "last_name": "Hessel", "id": "869808195", "address": {"city": "SPARTANBURG",
|
1149
|
-
"state": "SC", "zipcode": "29307", "address_lines": ["123 MAIN ST"]}}, "correlation_id":
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1150
|
-
"ef2befe5-5498-400e-b282-3211744fc7dd", "trading_partner_id": "MOCKPAYER",
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|
-
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1152
|
-
"coverage": {"service_types": ["professional_physician_visit_office"], "group_number":
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1153
|
-
"088818801000013", "out_of_pocket": [{"in_plan_network": "yes", "benefit_amount":
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1154
|
-
{"currency": "USD", "amount": "3000"}, "coverage_level": "individual"}, {"in_plan_network":
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|
-
"yes", "benefit_amount": {"currency": "USD", "amount": "2983.57"}, "coverage_level":
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|
-
"individual", "time_period": "remaining"}, {"in_plan_network": "yes", "benefit_amount":
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1157
|
-
{"currency": "USD", "amount": "6000"}, "coverage_level": "family"}, {"in_plan_network":
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|
-
"yes", "benefit_amount": {"currency": "USD", "amount": "5956.09"}, "coverage_level":
|
1159
|
-
"family", "time_period": "remaining"}, {"in_plan_network": "no", "benefit_amount":
|
1160
|
-
{"currency": "USD", "amount": "12500"}, "coverage_level": "individual"}, {"in_plan_network":
|
1161
|
-
"no", "benefit_amount": {"currency": "USD", "amount": "12483.57"}, "coverage_level":
|
1162
|
-
"individual", "time_period": "remaining"}, {"in_plan_network": "no", "benefit_amount":
|
1163
|
-
{"currency": "USD", "amount": "25000"}, "coverage_level": "family"}, {"in_plan_network":
|
1164
|
-
"no", "benefit_amount": {"currency": "USD", "amount": "24956.09"}, "coverage_level":
|
1165
|
-
"family", "messages": [{"message": "Unlimited Lifetime Benefits"}], "time_period":
|
1166
|
-
"remaining"}], "level": "employee_and_spouse", "copay": [{"in_plan_network":
|
1167
|
-
"yes", "service_types": ["professional_physician_visit_office"], "coverage_level":
|
1168
|
-
"employee_and_spouse", "messages": [{"message": "PRIMARY OFFICE"}]}, {"in_plan_network":
|
1169
|
-
"not_applicable", "service_types": ["professional_physician_visit_office"],
|
1170
|
-
"coverage_level": "employee_and_spouse", "messages": [{"message": "GYN OFFICE
|
1171
|
-
VS"}, {"message": "GYN VISIT"}, {"message": "SPEC OFFICE"}, {"message": "SPEC
|
1172
|
-
VISIT"}, {"message": "PRIME CARE VST"}, {"message": "Plan Requires PreCert"},
|
1173
|
-
{"message": "Commercial"}, {"message": "Plan includes NAP"}, {"message": "Pre-Existing
|
1174
|
-
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|
1175
|
-
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|
1176
|
-
CARE VST"}], "in_plan_network": "yes", "eligibility_date": "2013-01-01", "time_period":
|
1177
|
-
"calendar_year", "coverage_level": "family", "benefit_amount": {"currency":
|
1178
|
-
"USD", "amount": "6000"}}, {"in_plan_network": "yes", "time_period": "remaining",
|
1179
|
-
"coverage_level": "family", "messages": [{"message": "INT MED AND RX"}], "benefit_amount":
|
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|
-
{"currency": "USD", "amount": "5956.09"}}, {"messages": [{"message": "INT
|
1181
|
-
MED AND RX,GYN OFFICE VS,DED INCLUDED IN OOP,GYN VISIT,SPEC OFFICE,SPEC VISIT,PRIMARY
|
1182
|
-
OFFICE,PRIME CARE VST"}], "in_plan_network": "yes", "eligibility_date": "2013-01-01",
|
1183
|
-
"time_period": "calendar_year", "coverage_level": "individual", "benefit_amount":
|
1184
|
-
{"currency": "USD", "amount": "3000"}}, {"in_plan_network": "yes", "time_period":
|
1185
|
-
"remaining", "coverage_level": "individual", "messages": [{"message": "INT
|
1186
|
-
MED AND RX"}], "benefit_amount": {"currency": "USD", "amount": "2983.57"}},
|
1187
|
-
{"messages": [{"message": "INT MED AND RX,GYN OFFICE VS,DED INCLUDED IN OOP,GYN
|
1188
|
-
VISIT,SPEC OFFICE,SPEC VISIT,PRIME CARE VST"}], "in_plan_network": "no", "eligibility_date":
|
1189
|
-
"2013-01-01", "time_period": "calendar_year", "coverage_level": "family",
|
1190
|
-
"benefit_amount": {"currency": "USD", "amount": "12000"}}, {"in_plan_network":
|
1191
|
-
"no", "time_period": "remaining", "coverage_level": "family", "messages":
|
1192
|
-
[{"message": "INT MED AND RX"}], "benefit_amount": {"currency": "USD", "amount":
|
1193
|
-
"11956.09"}}, {"messages": [{"message": "INT MED AND RX,GYN OFFICE VS,DED
|
1194
|
-
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|
1195
|
-
"no", "eligibility_date": "2013-01-01", "time_period": "calendar_year", "coverage_level":
|
1196
|
-
"individual", "benefit_amount": {"currency": "USD", "amount": "6000"}}, {"in_plan_network":
|
1197
|
-
"no", "time_period": "remaining", "coverage_level": "individual", "messages":
|
1198
|
-
[{"message": "INT MED AND RX"}], "benefit_amount": {"currency": "USD", "amount":
|
1199
|
-
"5983.57"}}], "plan_begin_date": "2013-02-15", "eligibility_begin_date": "2012-02-01",
|
1200
|
-
"coinsurance": [{"benefit_percent": 0.0, "service_types": ["professional_physician_visit_office"],
|
1201
|
-
"coverage_level": "employee_and_spouse", "messages": [{"message": "GYN OFFICE
|
1202
|
-
VS"}, {"message": "GYN VISIT"}, {"message": "SPEC OFFICE"}, {"message": "SPEC
|
1203
|
-
VISIT"}, {"message": "PRIMARY OFFICE"}, {"message": "PRIME CARE VST"}], "in_plan_network":
|
1204
|
-
"yes"}, {"benefit_percent": 0.5, "service_types": ["professional_physician_visit_office"],
|
1205
|
-
"coverage_level": "employee_and_spouse", "messages": [{"message": "GYN OFFICE
|
1206
|
-
VS,COINS APPLIES TO OUT OF POCKET"}, {"message": "GYN VISIT,COINS APPLIES
|
1207
|
-
TO OUT OF POCKET"}, {"message": "SPEC OFFICE,COINS APPLIES TO OUT OF POCKET"},
|
1208
|
-
{"message": "SPEC VISIT,COINS APPLIES TO OUT OF POCKET"}, {"message": "PRIME
|
1209
|
-
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|
1210
|
-
"MOCK INDIVIDUAL ADVANTAGE PLAN", "plan_number": "0888188", "service_date":
|
1211
|
-
"2013-08-10"}, "valid_request": true}, "trading_partner_id": "MOCKPAYER",
|
1212
|
-
"id": "53cdaaa056c02c1cdb7a40be", "transition_path": ["generate", "transmit",
|
1213
|
-
"wait", "receive", "process", "complete"], "history": [{"record_dt": "2014-07-22T00:04:48.268000",
|
1214
|
-
"name": "init", "title": "Initializing"}, {"record_dt": "2014-07-22T00:04:48.284000",
|
1215
|
-
"name": "generating", "title": "Generating X12 transactions"}, {"record_dt":
|
1216
|
-
"2014-07-22T00:04:48.285000", "name": "transmitting", "title": "Transmitting
|
1217
|
-
transactions to Trading Partner"}, {"record_dt": "2014-07-22T00:04:48.286000",
|
1218
|
-
"name": "waiting", "title": "Waiting on Trading Partner Response"}, {"record_dt":
|
1219
|
-
"2014-07-22T00:04:48.288000", "name": "receiving", "title": "Receiving transactions
|
1220
|
-
from Trading Partner"}, {"record_dt": "2014-07-22T00:04:48.347000", "name":
|
1221
|
-
"processing", "title": "Processing X12 transactions"}]}, {"units_of_work":
|
1222
|
-
1, "name": "providers", "parameters": {"service_types": ["health_benefit_plan_coverage"],
|
1223
|
-
"trading_partner_id": "MOCKPAYER", "payer": {"id": "MOCKPAYER", "name": "Mockpayer
|
1224
|
-
For Testing"}, "member": {"birth_date": "1997-10-31", "first_name": "Filiberto",
|
1225
|
-
"last_name": "Robel", "plan_start_date": "2013-08-10", "id": "950795427"},
|
1226
|
-
"correlation_id": "8e95d79d-d09d-4034-94f9-d3a367c10b18", "client_id": "7x7nRAotGfxHfy7Llfl3",
|
1227
|
-
"provider": {"first_name": "Judy", "last_name": "Strosin", "npi": "3462453852"},
|
1228
|
-
"async": false, "transaction_code": "request"}, "state": {"name": "completed",
|
1229
|
-
"title": "Completed"}, "result": {"service_types": ["professional_physician_visit_office"],
|
1230
|
-
"client_id": "7x7nRAotGfxHfy7Llfl3", "payer": {"id": "MOCKPAYER", "name":
|
1231
|
-
"MOCK PAYER INC"}, "subscriber": {"birth_date": "1997-10-31", "first_name":
|
1232
|
-
"Filiberto", "last_name": "Robel", "id": "950795427", "address": {"city":
|
1233
|
-
"SPARTANBURG", "state": "SC", "zipcode": "29307", "address_lines": ["123 MAIN
|
1234
|
-
ST"]}}, "correlation_id": "8e95d79d-d09d-4034-94f9-d3a367c10b18", "trading_partner_id":
|
1235
|
-
"MOCKPAYER", "provider": {"first_name": "Judy", "last_name": "Judy Strosin",
|
1236
|
-
"npi": "3462453852"}, "coverage": {"service_types": ["professional_physician_visit_office"],
|
1237
|
-
"group_number": "088818801000013", "out_of_pocket": [{"in_plan_network": "yes",
|
1238
|
-
"benefit_amount": {"currency": "USD", "amount": "3000"}, "coverage_level":
|
1239
|
-
"individual"}, {"in_plan_network": "yes", "benefit_amount": {"currency": "USD",
|
1240
|
-
"amount": "2983.57"}, "coverage_level": "individual", "time_period": "remaining"},
|
1241
|
-
{"in_plan_network": "yes", "benefit_amount": {"currency": "USD", "amount":
|
1242
|
-
"6000"}, "coverage_level": "family"}, {"in_plan_network": "yes", "benefit_amount":
|
1243
|
-
{"currency": "USD", "amount": "5956.09"}, "coverage_level": "family", "time_period":
|
1244
|
-
"remaining"}, {"in_plan_network": "no", "benefit_amount": {"currency": "USD",
|
1245
|
-
"amount": "12500"}, "coverage_level": "individual"}, {"in_plan_network": "no",
|
1246
|
-
"benefit_amount": {"currency": "USD", "amount": "12483.57"}, "coverage_level":
|
1247
|
-
"individual", "time_period": "remaining"}, {"in_plan_network": "no", "benefit_amount":
|
1248
|
-
{"currency": "USD", "amount": "25000"}, "coverage_level": "family"}, {"in_plan_network":
|
1249
|
-
"no", "benefit_amount": {"currency": "USD", "amount": "24956.09"}, "coverage_level":
|
1250
|
-
"family", "messages": [{"message": "Unlimited Lifetime Benefits"}], "time_period":
|
1251
|
-
"remaining"}], "level": "employee_and_spouse", "copay": [{"in_plan_network":
|
1252
|
-
"yes", "service_types": ["professional_physician_visit_office"], "coverage_level":
|
1253
|
-
"employee_and_spouse", "messages": [{"message": "PRIMARY OFFICE"}]}, {"in_plan_network":
|
1254
|
-
"not_applicable", "service_types": ["professional_physician_visit_office"],
|
1255
|
-
"coverage_level": "employee_and_spouse", "messages": [{"message": "GYN OFFICE
|
1256
|
-
VS"}, {"message": "GYN VISIT"}, {"message": "SPEC OFFICE"}, {"message": "SPEC
|
1257
|
-
VISIT"}, {"message": "PRIME CARE VST"}, {"message": "Plan Requires PreCert"},
|
1258
|
-
{"message": "Commercial"}, {"message": "Plan includes NAP"}, {"message": "Pre-Existing
|
1259
|
-
may apply"}]}], "deductibles": [{"messages": [{"message": "INT MED AND RX,GYN
|
1260
|
-
OFFICE VS,DED INCLUDED IN OOP,GYN VISIT,SPEC OFFICE,SPEC VISIT,PRIMARY OFFICE,PRIME
|
1261
|
-
CARE VST"}], "in_plan_network": "yes", "eligibility_date": "2013-01-01", "time_period":
|
1262
|
-
"calendar_year", "coverage_level": "family", "benefit_amount": {"currency":
|
1263
|
-
"USD", "amount": "6000"}}, {"in_plan_network": "yes", "time_period": "remaining",
|
1264
|
-
"coverage_level": "family", "messages": [{"message": "INT MED AND RX"}], "benefit_amount":
|
1265
|
-
{"currency": "USD", "amount": "5956.09"}}, {"messages": [{"message": "INT
|
1266
|
-
MED AND RX,GYN OFFICE VS,DED INCLUDED IN OOP,GYN VISIT,SPEC OFFICE,SPEC VISIT,PRIMARY
|
1267
|
-
OFFICE,PRIME CARE VST"}], "in_plan_network": "yes", "eligibility_date": "2013-01-01",
|
1268
|
-
"time_period": "calendar_year", "coverage_level": "individual", "benefit_amount":
|
1269
|
-
{"currency": "USD", "amount": "3000"}}, {"in_plan_network": "yes", "time_period":
|
1270
|
-
"remaining", "coverage_level": "individual", "messages": [{"message": "INT
|
1271
|
-
MED AND RX"}], "benefit_amount": {"currency": "USD", "amount": "2983.57"}},
|
1272
|
-
{"messages": [{"message": "INT MED AND RX,GYN OFFICE VS,DED INCLUDED IN OOP,GYN
|
1273
|
-
VISIT,SPEC OFFICE,SPEC VISIT,PRIME CARE VST"}], "in_plan_network": "no", "eligibility_date":
|
1274
|
-
"2013-01-01", "time_period": "calendar_year", "coverage_level": "family",
|
1275
|
-
"benefit_amount": {"currency": "USD", "amount": "12000"}}, {"in_plan_network":
|
1276
|
-
"no", "time_period": "remaining", "coverage_level": "family", "messages":
|
1277
|
-
[{"message": "INT MED AND RX"}], "benefit_amount": {"currency": "USD", "amount":
|
1278
|
-
"11956.09"}}, {"messages": [{"message": "INT MED AND RX,GYN OFFICE VS,DED
|
1279
|
-
INCLUDED IN OOP,GYN VISIT,SPEC OFFICE,SPEC VISIT,PRIME CARE VST"}], "in_plan_network":
|
1280
|
-
"no", "eligibility_date": "2013-01-01", "time_period": "calendar_year", "coverage_level":
|
1281
|
-
"individual", "benefit_amount": {"currency": "USD", "amount": "6000"}}, {"in_plan_network":
|
1282
|
-
"no", "time_period": "remaining", "coverage_level": "individual", "messages":
|
1283
|
-
[{"message": "INT MED AND RX"}], "benefit_amount": {"currency": "USD", "amount":
|
1284
|
-
"5983.57"}}], "plan_begin_date": "2013-02-15", "eligibility_begin_date": "2012-02-01",
|
1285
|
-
"coinsurance": [{"benefit_percent": 0.0, "service_types": ["professional_physician_visit_office"],
|
1286
|
-
"coverage_level": "employee_and_spouse", "messages": [{"message": "GYN OFFICE
|
1287
|
-
VS"}, {"message": "GYN VISIT"}, {"message": "SPEC OFFICE"}, {"message": "SPEC
|
1288
|
-
VISIT"}, {"message": "PRIMARY OFFICE"}, {"message": "PRIME CARE VST"}], "in_plan_network":
|
1289
|
-
"yes"}, {"benefit_percent": 0.5, "service_types": ["professional_physician_visit_office"],
|
1290
|
-
"coverage_level": "employee_and_spouse", "messages": [{"message": "GYN OFFICE
|
1291
|
-
VS,COINS APPLIES TO OUT OF POCKET"}, {"message": "GYN VISIT,COINS APPLIES
|
1292
|
-
TO OUT OF POCKET"}, {"message": "SPEC OFFICE,COINS APPLIES TO OUT OF POCKET"},
|
1293
|
-
{"message": "SPEC VISIT,COINS APPLIES TO OUT OF POCKET"}, {"message": "PRIME
|
1294
|
-
CARE VST,COINS APPLIES TO OUT OF POCKET"}], "in_plan_network": "no"}], "group_description":
|
1295
|
-
"MOCK INDIVIDUAL ADVANTAGE PLAN", "plan_number": "0888188", "service_date":
|
1296
|
-
"2013-08-10"}, "valid_request": true}, "trading_partner_id": "MOCKPAYER",
|
1297
|
-
"id": "53cdaaa056c02c1cdb7a40c1", "transition_path": ["generate", "transmit",
|
1298
|
-
"wait", "receive", "process", "complete"], "history": [{"record_dt": "2014-07-22T00:04:48.360000",
|
1299
|
-
"name": "init", "title": "Initializing"}, {"record_dt": "2014-07-22T00:04:48.375000",
|
1300
|
-
"name": "generating", "title": "Generating X12 transactions"}, {"record_dt":
|
1301
|
-
"2014-07-22T00:04:48.376000", "name": "transmitting", "title": "Transmitting
|
1302
|
-
transactions to Trading Partner"}, {"record_dt": "2014-07-22T00:04:48.378000",
|
1303
|
-
"name": "waiting", "title": "Waiting on Trading Partner Response"}, {"record_dt":
|
1304
|
-
"2014-07-22T00:04:48.379000", "name": "receiving", "title": "Receiving transactions
|
1305
|
-
from Trading Partner"}, {"record_dt": "2014-07-22T00:04:48.434000", "name":
|
1306
|
-
"processing", "title": "Processing X12 transactions"}]}, {"units_of_work":
|
1307
|
-
1, "name": "providers", "parameters": {"service_types": ["health_benefit_plan_coverage"],
|
1308
|
-
"trading_partner_id": "MOCKPAYER", "payer": {"id": "MOCKPAYER", "name": "Mockpayer
|
1309
|
-
For Testing"}, "member": {"birth_date": "1986-09-19", "first_name": "Kobe",
|
1310
|
-
"last_name": "Konopelski", "plan_start_date": "2013-08-10", "id": "966447696"},
|
1311
|
-
"correlation_id": "2e063c46-c744-4a58-81d2-7eed19707545", "client_id": "7x7nRAotGfxHfy7Llfl3",
|
1312
|
-
"provider": {"first_name": "Dasia", "last_name": "Jones", "npi": "9845281621"},
|
1313
|
-
"async": false, "transaction_code": "request"}, "state": {"name": "completed",
|
1314
|
-
"title": "Completed"}, "result": {"service_types": ["professional_physician_visit_office"],
|
1315
|
-
"client_id": "7x7nRAotGfxHfy7Llfl3", "payer": {"id": "MOCKPAYER", "name":
|
1316
|
-
"MOCK PAYER INC"}, "subscriber": {"birth_date": "1986-09-19", "first_name":
|
1317
|
-
"Kobe", "last_name": "Konopelski", "id": "966447696", "address": {"city":
|
1318
|
-
"SPARTANBURG", "state": "SC", "zipcode": "29307", "address_lines": ["123 MAIN
|
1319
|
-
ST"]}}, "correlation_id": "2e063c46-c744-4a58-81d2-7eed19707545", "trading_partner_id":
|
1320
|
-
"MOCKPAYER", "provider": {"first_name": "Dasia", "last_name": "Dasia Jones",
|
1321
|
-
"npi": "9845281621"}, "coverage": {"service_types": ["professional_physician_visit_office"],
|
1322
|
-
"group_number": "088818801000013", "out_of_pocket": [{"in_plan_network": "yes",
|
1323
|
-
"benefit_amount": {"currency": "USD", "amount": "3000"}, "coverage_level":
|
1324
|
-
"individual"}, {"in_plan_network": "yes", "benefit_amount": {"currency": "USD",
|
1325
|
-
"amount": "2983.57"}, "coverage_level": "individual", "time_period": "remaining"},
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|
-
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1327
|
-
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1328
|
-
{"currency": "USD", "amount": "5956.09"}, "coverage_level": "family", "time_period":
|
1329
|
-
"remaining"}, {"in_plan_network": "no", "benefit_amount": {"currency": "USD",
|
1330
|
-
"amount": "12500"}, "coverage_level": "individual"}, {"in_plan_network": "no",
|
1331
|
-
"benefit_amount": {"currency": "USD", "amount": "12483.57"}, "coverage_level":
|
1332
|
-
"individual", "time_period": "remaining"}, {"in_plan_network": "no", "benefit_amount":
|
1333
|
-
{"currency": "USD", "amount": "25000"}, "coverage_level": "family"}, {"in_plan_network":
|
1334
|
-
"no", "benefit_amount": {"currency": "USD", "amount": "24956.09"}, "coverage_level":
|
1335
|
-
"family", "messages": [{"message": "Unlimited Lifetime Benefits"}], "time_period":
|
1336
|
-
"remaining"}], "level": "employee_and_spouse", "copay": [{"in_plan_network":
|
1337
|
-
"yes", "service_types": ["professional_physician_visit_office"], "coverage_level":
|
1338
|
-
"employee_and_spouse", "messages": [{"message": "PRIMARY OFFICE"}]}, {"in_plan_network":
|
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|
-
"not_applicable", "service_types": ["professional_physician_visit_office"],
|
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|
-
"coverage_level": "employee_and_spouse", "messages": [{"message": "GYN OFFICE
|
1341
|
-
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|
1342
|
-
VISIT"}, {"message": "PRIME CARE VST"}, {"message": "Plan Requires PreCert"},
|
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|
-
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|
1344
|
-
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|
1345
|
-
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|
1346
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-
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|
1347
|
-
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1348
|
-
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|
1349
|
-
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|
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|
-
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|
1351
|
-
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|
1352
|
-
OFFICE,PRIME CARE VST"}], "in_plan_network": "yes", "eligibility_date": "2013-01-01",
|
1353
|
-
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1354
|
-
{"currency": "USD", "amount": "3000"}}, {"in_plan_network": "yes", "time_period":
|
1355
|
-
"remaining", "coverage_level": "individual", "messages": [{"message": "INT
|
1356
|
-
MED AND RX"}], "benefit_amount": {"currency": "USD", "amount": "2983.57"}},
|
1357
|
-
{"messages": [{"message": "INT MED AND RX,GYN OFFICE VS,DED INCLUDED IN OOP,GYN
|
1358
|
-
VISIT,SPEC OFFICE,SPEC VISIT,PRIME CARE VST"}], "in_plan_network": "no", "eligibility_date":
|
1359
|
-
"2013-01-01", "time_period": "calendar_year", "coverage_level": "family",
|
1360
|
-
"benefit_amount": {"currency": "USD", "amount": "12000"}}, {"in_plan_network":
|
1361
|
-
"no", "time_period": "remaining", "coverage_level": "family", "messages":
|
1362
|
-
[{"message": "INT MED AND RX"}], "benefit_amount": {"currency": "USD", "amount":
|
1363
|
-
"11956.09"}}, {"messages": [{"message": "INT MED AND RX,GYN OFFICE VS,DED
|
1364
|
-
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|
1365
|
-
"no", "eligibility_date": "2013-01-01", "time_period": "calendar_year", "coverage_level":
|
1366
|
-
"individual", "benefit_amount": {"currency": "USD", "amount": "6000"}}, {"in_plan_network":
|
1367
|
-
"no", "time_period": "remaining", "coverage_level": "individual", "messages":
|
1368
|
-
[{"message": "INT MED AND RX"}], "benefit_amount": {"currency": "USD", "amount":
|
1369
|
-
"5983.57"}}], "plan_begin_date": "2013-02-15", "eligibility_begin_date": "2012-02-01",
|
1370
|
-
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|
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|
-
"coverage_level": "employee_and_spouse", "messages": [{"message": "GYN OFFICE
|
1372
|
-
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|
1373
|
-
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|
1374
|
-
"yes"}, {"benefit_percent": 0.5, "service_types": ["professional_physician_visit_office"],
|
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|
-
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|
1376
|
-
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|
1377
|
-
TO OUT OF POCKET"}, {"message": "SPEC OFFICE,COINS APPLIES TO OUT OF POCKET"},
|
1378
|
-
{"message": "SPEC VISIT,COINS APPLIES TO OUT OF POCKET"}, {"message": "PRIME
|
1379
|
-
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|
1380
|
-
"MOCK INDIVIDUAL ADVANTAGE PLAN", "plan_number": "0888188", "service_date":
|
1381
|
-
"2013-08-10"}, "valid_request": true}, "trading_partner_id": "MOCKPAYER",
|
1382
|
-
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|
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|
-
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|
-
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|
1385
|
-
"name": "generating", "title": "Generating X12 transactions"}, {"record_dt":
|
1386
|
-
"2014-07-22T00:04:48.467000", "name": "transmitting", "title": "Transmitting
|
1387
|
-
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|
1388
|
-
"name": "waiting", "title": "Waiting on Trading Partner Response"}, {"record_dt":
|
1389
|
-
"2014-07-22T00:04:48.471000", "name": "receiving", "title": "Receiving transactions
|
1390
|
-
from Trading Partner"}, {"record_dt": "2014-07-22T00:04:48.533000", "name":
|
1391
|
-
"processing", "title": "Processing X12 transactions"}]}, {"units_of_work":
|
1392
|
-
1, "name": "insurance_prices", "parameters": {"service_types": ["health_benefit_plan_coverage"],
|
1393
|
-
"trading_partner_id": "MOCKPAYER", "payer": {"id": "MOCKPAYER", "name": "Mockpayer
|
1394
|
-
For Testing"}, "member": {"birth_date": "1983-03-07", "first_name": "Rodger",
|
1395
|
-
"last_name": "Koss", "plan_start_date": "2013-08-10", "id": "190345307"},
|
1396
|
-
"correlation_id": "b886a354-28a5-4dd7-a645-7bd1e6c1b09b", "client_id": "7x7nRAotGfxHfy7Llfl3",
|
1397
|
-
"provider": {"first_name": "Reed", "last_name": "O''Keefe", "npi": "0228483630"},
|
1398
|
-
"async": false, "transaction_code": "request"}, "state": {"name": "completed",
|
1399
|
-
"title": "Completed"}, "result": {"service_types": ["professional_physician_visit_office"],
|
1400
|
-
"client_id": "7x7nRAotGfxHfy7Llfl3", "payer": {"id": "MOCKPAYER", "name":
|
1401
|
-
"MOCK PAYER INC"}, "subscriber": {"birth_date": "1983-03-07", "first_name":
|
1402
|
-
"Rodger", "last_name": "Koss", "id": "190345307", "address": {"city": "SPARTANBURG",
|
1403
|
-
"state": "SC", "zipcode": "29307", "address_lines": ["123 MAIN ST"]}}, "correlation_id":
|
1404
|
-
"b886a354-28a5-4dd7-a645-7bd1e6c1b09b", "trading_partner_id": "MOCKPAYER",
|
1405
|
-
"provider": {"first_name": "Reed", "last_name": "Reed O''Keefe", "npi": "0228483630"},
|
1406
|
-
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|
1407
|
-
"088818801000013", "out_of_pocket": [{"in_plan_network": "yes", "benefit_amount":
|
1408
|
-
{"currency": "USD", "amount": "3000"}, "coverage_level": "individual"}, {"in_plan_network":
|
1409
|
-
"yes", "benefit_amount": {"currency": "USD", "amount": "2983.57"}, "coverage_level":
|
1410
|
-
"individual", "time_period": "remaining"}, {"in_plan_network": "yes", "benefit_amount":
|
1411
|
-
{"currency": "USD", "amount": "6000"}, "coverage_level": "family"}, {"in_plan_network":
|
1412
|
-
"yes", "benefit_amount": {"currency": "USD", "amount": "5956.09"}, "coverage_level":
|
1413
|
-
"family", "time_period": "remaining"}, {"in_plan_network": "no", "benefit_amount":
|
1414
|
-
{"currency": "USD", "amount": "12500"}, "coverage_level": "individual"}, {"in_plan_network":
|
1415
|
-
"no", "benefit_amount": {"currency": "USD", "amount": "12483.57"}, "coverage_level":
|
1416
|
-
"individual", "time_period": "remaining"}, {"in_plan_network": "no", "benefit_amount":
|
1417
|
-
{"currency": "USD", "amount": "25000"}, "coverage_level": "family"}, {"in_plan_network":
|
1418
|
-
"no", "benefit_amount": {"currency": "USD", "amount": "24956.09"}, "coverage_level":
|
1419
|
-
"family", "messages": [{"message": "Unlimited Lifetime Benefits"}], "time_period":
|
1420
|
-
"remaining"}], "level": "employee_and_spouse", "copay": [{"in_plan_network":
|
1421
|
-
"yes", "service_types": ["professional_physician_visit_office"], "coverage_level":
|
1422
|
-
"employee_and_spouse", "messages": [{"message": "PRIMARY OFFICE"}]}, {"in_plan_network":
|
1423
|
-
"not_applicable", "service_types": ["professional_physician_visit_office"],
|
1424
|
-
"coverage_level": "employee_and_spouse", "messages": [{"message": "GYN OFFICE
|
1425
|
-
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|
1426
|
-
VISIT"}, {"message": "PRIME CARE VST"}, {"message": "Plan Requires PreCert"},
|
1427
|
-
{"message": "Commercial"}, {"message": "Plan includes NAP"}, {"message": "Pre-Existing
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1428
|
-
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|
1429
|
-
OFFICE VS,DED INCLUDED IN OOP,GYN VISIT,SPEC OFFICE,SPEC VISIT,PRIMARY OFFICE,PRIME
|
1430
|
-
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|
1431
|
-
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|
1432
|
-
"USD", "amount": "6000"}}, {"in_plan_network": "yes", "time_period": "remaining",
|
1433
|
-
"coverage_level": "family", "messages": [{"message": "INT MED AND RX"}], "benefit_amount":
|
1434
|
-
{"currency": "USD", "amount": "5956.09"}}, {"messages": [{"message": "INT
|
1435
|
-
MED AND RX,GYN OFFICE VS,DED INCLUDED IN OOP,GYN VISIT,SPEC OFFICE,SPEC VISIT,PRIMARY
|
1436
|
-
OFFICE,PRIME CARE VST"}], "in_plan_network": "yes", "eligibility_date": "2013-01-01",
|
1437
|
-
"time_period": "calendar_year", "coverage_level": "individual", "benefit_amount":
|
1438
|
-
{"currency": "USD", "amount": "3000"}}, {"in_plan_network": "yes", "time_period":
|
1439
|
-
"remaining", "coverage_level": "individual", "messages": [{"message": "INT
|
1440
|
-
MED AND RX"}], "benefit_amount": {"currency": "USD", "amount": "2983.57"}},
|
1441
|
-
{"messages": [{"message": "INT MED AND RX,GYN OFFICE VS,DED INCLUDED IN OOP,GYN
|
1442
|
-
VISIT,SPEC OFFICE,SPEC VISIT,PRIME CARE VST"}], "in_plan_network": "no", "eligibility_date":
|
1443
|
-
"2013-01-01", "time_period": "calendar_year", "coverage_level": "family",
|
1444
|
-
"benefit_amount": {"currency": "USD", "amount": "12000"}}, {"in_plan_network":
|
1445
|
-
"no", "time_period": "remaining", "coverage_level": "family", "messages":
|
1446
|
-
[{"message": "INT MED AND RX"}], "benefit_amount": {"currency": "USD", "amount":
|
1447
|
-
"11956.09"}}, {"messages": [{"message": "INT MED AND RX,GYN OFFICE VS,DED
|
1448
|
-
INCLUDED IN OOP,GYN VISIT,SPEC OFFICE,SPEC VISIT,PRIME CARE VST"}], "in_plan_network":
|
1449
|
-
"no", "eligibility_date": "2013-01-01", "time_period": "calendar_year", "coverage_level":
|
1450
|
-
"individual", "benefit_amount": {"currency": "USD", "amount": "6000"}}, {"in_plan_network":
|
1451
|
-
"no", "time_period": "remaining", "coverage_level": "individual", "messages":
|
1452
|
-
[{"message": "INT MED AND RX"}], "benefit_amount": {"currency": "USD", "amount":
|
1453
|
-
"5983.57"}}], "plan_begin_date": "2013-02-15", "eligibility_begin_date": "2012-02-01",
|
1454
|
-
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|
1455
|
-
"coverage_level": "employee_and_spouse", "messages": [{"message": "GYN OFFICE
|
1456
|
-
VS"}, {"message": "GYN VISIT"}, {"message": "SPEC OFFICE"}, {"message": "SPEC
|
1457
|
-
VISIT"}, {"message": "PRIMARY OFFICE"}, {"message": "PRIME CARE VST"}], "in_plan_network":
|
1458
|
-
"yes"}, {"benefit_percent": 0.5, "service_types": ["professional_physician_visit_office"],
|
1459
|
-
"coverage_level": "employee_and_spouse", "messages": [{"message": "GYN OFFICE
|
1460
|
-
VS,COINS APPLIES TO OUT OF POCKET"}, {"message": "GYN VISIT,COINS APPLIES
|
1461
|
-
TO OUT OF POCKET"}, {"message": "SPEC OFFICE,COINS APPLIES TO OUT OF POCKET"},
|
1462
|
-
{"message": "SPEC VISIT,COINS APPLIES TO OUT OF POCKET"}, {"message": "PRIME
|
1463
|
-
CARE VST,COINS APPLIES TO OUT OF POCKET"}], "in_plan_network": "no"}], "group_description":
|
1464
|
-
"MOCK INDIVIDUAL ADVANTAGE PLAN", "plan_number": "0888188", "service_date":
|
1465
|
-
"2013-08-10"}, "valid_request": true}, "trading_partner_id": "MOCKPAYER",
|
1466
|
-
"id": "53cdaaa056c02c1cdb7a40c7", "transition_path": ["generate", "transmit",
|
1467
|
-
"wait", "receive", "process", "complete"], "history": [{"record_dt": "2014-07-22T00:04:48.551000",
|
1468
|
-
"name": "init", "title": "Initializing"}, {"record_dt": "2014-07-22T00:04:48.572000",
|
1469
|
-
"name": "generating", "title": "Generating X12 transactions"}, {"record_dt":
|
1470
|
-
"2014-07-22T00:04:48.573000", "name": "transmitting", "title": "Transmitting
|
1471
|
-
transactions to Trading Partner"}, {"record_dt": "2014-07-22T00:04:48.575000",
|
1472
|
-
"name": "waiting", "title": "Waiting on Trading Partner Response"}, {"record_dt":
|
1473
|
-
"2014-07-22T00:04:48.578000", "name": "receiving", "title": "Receiving transactions
|
1474
|
-
from Trading Partner"}, {"record_dt": "2014-07-22T00:04:48.645000", "name":
|
1475
|
-
"processing", "title": "Processing X12 transactions"}]}, {"units_of_work":
|
1476
|
-
1, "name": "providers", "parameters": {"service_types": ["health_benefit_plan_coverage"],
|
1477
|
-
"trading_partner_id": "MOCKPAYER", "payer": {"id": "MOCKPAYER", "name": "Mockpayer
|
1478
|
-
For Testing"}, "member": {"birth_date": "1978-04-04", "first_name": "Gianni",
|
1479
|
-
"last_name": "Cassin", "plan_start_date": "2013-08-10", "id": "178975927"},
|
1480
|
-
"correlation_id": "fbca5ddc-0a37-483a-9fc9-4fd1ecc98715", "client_id": "7x7nRAotGfxHfy7Llfl3",
|
1481
|
-
"provider": {"first_name": "Margarete", "last_name": "Dicki", "npi": "7954513966"},
|
1482
|
-
"async": false, "transaction_code": "request"}, "state": {"name": "completed",
|
1483
|
-
"title": "Completed"}, "result": {"service_types": ["professional_physician_visit_office"],
|
1484
|
-
"client_id": "7x7nRAotGfxHfy7Llfl3", "payer": {"id": "MOCKPAYER", "name":
|
1485
|
-
"MOCK PAYER INC"}, "subscriber": {"birth_date": "1978-04-04", "first_name":
|
1486
|
-
"Gianni", "last_name": "Cassin", "id": "178975927", "address": {"city": "SPARTANBURG",
|
1487
|
-
"state": "SC", "zipcode": "29307", "address_lines": ["123 MAIN ST"]}}, "correlation_id":
|
1488
|
-
"fbca5ddc-0a37-483a-9fc9-4fd1ecc98715", "trading_partner_id": "MOCKPAYER",
|
1489
|
-
"provider": {"first_name": "Margarete", "last_name": "Margarete Dicki", "npi":
|
1490
|
-
"7954513966"}, "coverage": {"service_types": ["professional_physician_visit_office"],
|
1491
|
-
"group_number": "088818801000013", "out_of_pocket": [{"in_plan_network": "yes",
|
1492
|
-
"benefit_amount": {"currency": "USD", "amount": "3000"}, "coverage_level":
|
1493
|
-
"individual"}, {"in_plan_network": "yes", "benefit_amount": {"currency": "USD",
|
1494
|
-
"amount": "2983.57"}, "coverage_level": "individual", "time_period": "remaining"},
|
1495
|
-
{"in_plan_network": "yes", "benefit_amount": {"currency": "USD", "amount":
|
1496
|
-
"6000"}, "coverage_level": "family"}, {"in_plan_network": "yes", "benefit_amount":
|
1497
|
-
{"currency": "USD", "amount": "5956.09"}, "coverage_level": "family", "time_period":
|
1498
|
-
"remaining"}, {"in_plan_network": "no", "benefit_amount": {"currency": "USD",
|
1499
|
-
"amount": "12500"}, "coverage_level": "individual"}, {"in_plan_network": "no",
|
1500
|
-
"benefit_amount": {"currency": "USD", "amount": "12483.57"}, "coverage_level":
|
1501
|
-
"individual", "time_period": "remaining"}, {"in_plan_network": "no", "benefit_amount":
|
1502
|
-
{"currency": "USD", "amount": "25000"}, "coverage_level": "family"}, {"in_plan_network":
|
1503
|
-
"no", "benefit_amount": {"currency": "USD", "amount": "24956.09"}, "coverage_level":
|
1504
|
-
"family", "messages": [{"message": "Unlimited Lifetime Benefits"}], "time_period":
|
1505
|
-
"remaining"}], "level": "employee_and_spouse", "copay": [{"in_plan_network":
|
1506
|
-
"yes", "service_types": ["professional_physician_visit_office"], "coverage_level":
|
1507
|
-
"employee_and_spouse", "messages": [{"message": "PRIMARY OFFICE"}]}, {"in_plan_network":
|
1508
|
-
"not_applicable", "service_types": ["professional_physician_visit_office"],
|
1509
|
-
"coverage_level": "employee_and_spouse", "messages": [{"message": "GYN OFFICE
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1510
|
-
VS"}, {"message": "GYN VISIT"}, {"message": "SPEC OFFICE"}, {"message": "SPEC
|
1511
|
-
VISIT"}, {"message": "PRIME CARE VST"}, {"message": "Plan Requires PreCert"},
|
1512
|
-
{"message": "Commercial"}, {"message": "Plan includes NAP"}, {"message": "Pre-Existing
|
1513
|
-
may apply"}]}], "deductibles": [{"messages": [{"message": "INT MED AND RX,GYN
|
1514
|
-
OFFICE VS,DED INCLUDED IN OOP,GYN VISIT,SPEC OFFICE,SPEC VISIT,PRIMARY OFFICE,PRIME
|
1515
|
-
CARE VST"}], "in_plan_network": "yes", "eligibility_date": "2013-01-01", "time_period":
|
1516
|
-
"calendar_year", "coverage_level": "family", "benefit_amount": {"currency":
|
1517
|
-
"USD", "amount": "6000"}}, {"in_plan_network": "yes", "time_period": "remaining",
|
1518
|
-
"coverage_level": "family", "messages": [{"message": "INT MED AND RX"}], "benefit_amount":
|
1519
|
-
{"currency": "USD", "amount": "5956.09"}}, {"messages": [{"message": "INT
|
1520
|
-
MED AND RX,GYN OFFICE VS,DED INCLUDED IN OOP,GYN VISIT,SPEC OFFICE,SPEC VISIT,PRIMARY
|
1521
|
-
OFFICE,PRIME CARE VST"}], "in_plan_network": "yes", "eligibility_date": "2013-01-01",
|
1522
|
-
"time_period": "calendar_year", "coverage_level": "individual", "benefit_amount":
|
1523
|
-
{"currency": "USD", "amount": "3000"}}, {"in_plan_network": "yes", "time_period":
|
1524
|
-
"remaining", "coverage_level": "individual", "messages": [{"message": "INT
|
1525
|
-
MED AND RX"}], "benefit_amount": {"currency": "USD", "amount": "2983.57"}},
|
1526
|
-
{"messages": [{"message": "INT MED AND RX,GYN OFFICE VS,DED INCLUDED IN OOP,GYN
|
1527
|
-
VISIT,SPEC OFFICE,SPEC VISIT,PRIME CARE VST"}], "in_plan_network": "no", "eligibility_date":
|
1528
|
-
"2013-01-01", "time_period": "calendar_year", "coverage_level": "family",
|
1529
|
-
"benefit_amount": {"currency": "USD", "amount": "12000"}}, {"in_plan_network":
|
1530
|
-
"no", "time_period": "remaining", "coverage_level": "family", "messages":
|
1531
|
-
[{"message": "INT MED AND RX"}], "benefit_amount": {"currency": "USD", "amount":
|
1532
|
-
"11956.09"}}, {"messages": [{"message": "INT MED AND RX,GYN OFFICE VS,DED
|
1533
|
-
INCLUDED IN OOP,GYN VISIT,SPEC OFFICE,SPEC VISIT,PRIME CARE VST"}], "in_plan_network":
|
1534
|
-
"no", "eligibility_date": "2013-01-01", "time_period": "calendar_year", "coverage_level":
|
1535
|
-
"individual", "benefit_amount": {"currency": "USD", "amount": "6000"}}, {"in_plan_network":
|
1536
|
-
"no", "time_period": "remaining", "coverage_level": "individual", "messages":
|
1537
|
-
[{"message": "INT MED AND RX"}], "benefit_amount": {"currency": "USD", "amount":
|
1538
|
-
"5983.57"}}], "plan_begin_date": "2013-02-15", "eligibility_begin_date": "2012-02-01",
|
1539
|
-
"coinsurance": [{"benefit_percent": 0.0, "service_types": ["professional_physician_visit_office"],
|
1540
|
-
"coverage_level": "employee_and_spouse", "messages": [{"message": "GYN OFFICE
|
1541
|
-
VS"}, {"message": "GYN VISIT"}, {"message": "SPEC OFFICE"}, {"message": "SPEC
|
1542
|
-
VISIT"}, {"message": "PRIMARY OFFICE"}, {"message": "PRIME CARE VST"}], "in_plan_network":
|
1543
|
-
"yes"}, {"benefit_percent": 0.5, "service_types": ["professional_physician_visit_office"],
|
1544
|
-
"coverage_level": "employee_and_spouse", "messages": [{"message": "GYN OFFICE
|
1545
|
-
VS,COINS APPLIES TO OUT OF POCKET"}, {"message": "GYN VISIT,COINS APPLIES
|
1546
|
-
TO OUT OF POCKET"}, {"message": "SPEC OFFICE,COINS APPLIES TO OUT OF POCKET"},
|
1547
|
-
{"message": "SPEC VISIT,COINS APPLIES TO OUT OF POCKET"}, {"message": "PRIME
|
1548
|
-
CARE VST,COINS APPLIES TO OUT OF POCKET"}], "in_plan_network": "no"}], "group_description":
|
1549
|
-
"MOCK INDIVIDUAL ADVANTAGE PLAN", "plan_number": "0888188", "service_date":
|
1550
|
-
"2013-08-10"}, "valid_request": true}, "trading_partner_id": "MOCKPAYER",
|
1551
|
-
"id": "53cdaaa056c02c1cdb7a40ca", "transition_path": ["generate", "transmit",
|
1552
|
-
"wait", "receive", "process", "complete"], "history": [{"record_dt": "2014-07-22T00:04:48.660000",
|
1553
|
-
"name": "init", "title": "Initializing"}, {"record_dt": "2014-07-22T00:04:48.675000",
|
1554
|
-
"name": "generating", "title": "Generating X12 transactions"}, {"record_dt":
|
1555
|
-
"2014-07-22T00:04:48.677000", "name": "transmitting", "title": "Transmitting
|
1556
|
-
transactions to Trading Partner"}, {"record_dt": "2014-07-22T00:04:48.679000",
|
1557
|
-
"name": "waiting", "title": "Waiting on Trading Partner Response"}, {"record_dt":
|
1558
|
-
"2014-07-22T00:04:48.681000", "name": "receiving", "title": "Receiving transactions
|
1559
|
-
from Trading Partner"}, {"record_dt": "2014-07-22T00:04:48.741000", "name":
|
1560
|
-
"processing", "title": "Processing X12 transactions"}]}, {"units_of_work":
|
1561
|
-
1, "name": "pokitdok_api", "parameters": {"service_types": ["health_benefit_plan_coverage"],
|
1562
|
-
"trading_partner_id": "MOCKPAYER", "payer": {"id": "MOCKPAYER", "name": "Mockpayer
|
1563
|
-
For Testing"}, "member": {"birth_date": "1984-01-19", "first_name": "Jaleel",
|
1564
|
-
"last_name": "Hilll", "plan_start_date": "2013-08-10", "id": "513952516"},
|
1565
|
-
"correlation_id": "4bd99d75-4db1-4546-8e87-baf2b3ab082a", "client_id": "7x7nRAotGfxHfy7Llfl3",
|
1566
|
-
"provider": {"first_name": "Gerald", "last_name": "Lehner", "npi": "1126688385"},
|
1567
|
-
"async": false, "transaction_code": "request"}, "state": {"name": "completed",
|
1568
|
-
"title": "Completed"}, "result": {"service_types": ["professional_physician_visit_office"],
|
1569
|
-
"client_id": "7x7nRAotGfxHfy7Llfl3", "payer": {"id": "MOCKPAYER", "name":
|
1570
|
-
"MOCK PAYER INC"}, "subscriber": {"birth_date": "1984-01-19", "first_name":
|
1571
|
-
"Jaleel", "last_name": "Hilll", "id": "513952516", "address": {"city": "SPARTANBURG",
|
1572
|
-
"state": "SC", "zipcode": "29307", "address_lines": ["123 MAIN ST"]}}, "correlation_id":
|
1573
|
-
"4bd99d75-4db1-4546-8e87-baf2b3ab082a", "trading_partner_id": "MOCKPAYER",
|
1574
|
-
"provider": {"first_name": "Gerald", "last_name": "Gerald Lehner", "npi":
|
1575
|
-
"1126688385"}, "coverage": {"service_types": ["professional_physician_visit_office"],
|
1576
|
-
"group_number": "088818801000013", "out_of_pocket": [{"in_plan_network": "yes",
|
1577
|
-
"benefit_amount": {"currency": "USD", "amount": "3000"}, "coverage_level":
|
1578
|
-
"individual"}, {"in_plan_network": "yes", "benefit_amount": {"currency": "USD",
|
1579
|
-
"amount": "2983.57"}, "coverage_level": "individual", "time_period": "remaining"},
|
1580
|
-
{"in_plan_network": "yes", "benefit_amount": {"currency": "USD", "amount":
|
1581
|
-
"6000"}, "coverage_level": "family"}, {"in_plan_network": "yes", "benefit_amount":
|
1582
|
-
{"currency": "USD", "amount": "5956.09"}, "coverage_level": "family", "time_period":
|
1583
|
-
"remaining"}, {"in_plan_network": "no", "benefit_amount": {"currency": "USD",
|
1584
|
-
"amount": "12500"}, "coverage_level": "individual"}, {"in_plan_network": "no",
|
1585
|
-
"benefit_amount": {"currency": "USD", "amount": "12483.57"}, "coverage_level":
|
1586
|
-
"individual", "time_period": "remaining"}, {"in_plan_network": "no", "benefit_amount":
|
1587
|
-
{"currency": "USD", "amount": "25000"}, "coverage_level": "family"}, {"in_plan_network":
|
1588
|
-
"no", "benefit_amount": {"currency": "USD", "amount": "24956.09"}, "coverage_level":
|
1589
|
-
"family", "messages": [{"message": "Unlimited Lifetime Benefits"}], "time_period":
|
1590
|
-
"remaining"}], "level": "employee_and_spouse", "copay": [{"in_plan_network":
|
1591
|
-
"yes", "service_types": ["professional_physician_visit_office"], "coverage_level":
|
1592
|
-
"employee_and_spouse", "messages": [{"message": "PRIMARY OFFICE"}]}, {"in_plan_network":
|
1593
|
-
"not_applicable", "service_types": ["professional_physician_visit_office"],
|
1594
|
-
"coverage_level": "employee_and_spouse", "messages": [{"message": "GYN OFFICE
|
1595
|
-
VS"}, {"message": "GYN VISIT"}, {"message": "SPEC OFFICE"}, {"message": "SPEC
|
1596
|
-
VISIT"}, {"message": "PRIME CARE VST"}, {"message": "Plan Requires PreCert"},
|
1597
|
-
{"message": "Commercial"}, {"message": "Plan includes NAP"}, {"message": "Pre-Existing
|
1598
|
-
may apply"}]}], "deductibles": [{"messages": [{"message": "INT MED AND RX,GYN
|
1599
|
-
OFFICE VS,DED INCLUDED IN OOP,GYN VISIT,SPEC OFFICE,SPEC VISIT,PRIMARY OFFICE,PRIME
|
1600
|
-
CARE VST"}], "in_plan_network": "yes", "eligibility_date": "2013-01-01", "time_period":
|
1601
|
-
"calendar_year", "coverage_level": "family", "benefit_amount": {"currency":
|
1602
|
-
"USD", "amount": "6000"}}, {"in_plan_network": "yes", "time_period": "remaining",
|
1603
|
-
"coverage_level": "family", "messages": [{"message": "INT MED AND RX"}], "benefit_amount":
|
1604
|
-
{"currency": "USD", "amount": "5956.09"}}, {"messages": [{"message": "INT
|
1605
|
-
MED AND RX,GYN OFFICE VS,DED INCLUDED IN OOP,GYN VISIT,SPEC OFFICE,SPEC VISIT,PRIMARY
|
1606
|
-
OFFICE,PRIME CARE VST"}], "in_plan_network": "yes", "eligibility_date": "2013-01-01",
|
1607
|
-
"time_period": "calendar_year", "coverage_level": "individual", "benefit_amount":
|
1608
|
-
{"currency": "USD", "amount": "3000"}}, {"in_plan_network": "yes", "time_period":
|
1609
|
-
"remaining", "coverage_level": "individual", "messages": [{"message": "INT
|
1610
|
-
MED AND RX"}], "benefit_amount": {"currency": "USD", "amount": "2983.57"}},
|
1611
|
-
{"messages": [{"message": "INT MED AND RX,GYN OFFICE VS,DED INCLUDED IN OOP,GYN
|
1612
|
-
VISIT,SPEC OFFICE,SPEC VISIT,PRIME CARE VST"}], "in_plan_network": "no", "eligibility_date":
|
1613
|
-
"2013-01-01", "time_period": "calendar_year", "coverage_level": "family",
|
1614
|
-
"benefit_amount": {"currency": "USD", "amount": "12000"}}, {"in_plan_network":
|
1615
|
-
"no", "time_period": "remaining", "coverage_level": "family", "messages":
|
1616
|
-
[{"message": "INT MED AND RX"}], "benefit_amount": {"currency": "USD", "amount":
|
1617
|
-
"11956.09"}}, {"messages": [{"message": "INT MED AND RX,GYN OFFICE VS,DED
|
1618
|
-
INCLUDED IN OOP,GYN VISIT,SPEC OFFICE,SPEC VISIT,PRIME CARE VST"}], "in_plan_network":
|
1619
|
-
"no", "eligibility_date": "2013-01-01", "time_period": "calendar_year", "coverage_level":
|
1620
|
-
"individual", "benefit_amount": {"currency": "USD", "amount": "6000"}}, {"in_plan_network":
|
1621
|
-
"no", "time_period": "remaining", "coverage_level": "individual", "messages":
|
1622
|
-
[{"message": "INT MED AND RX"}], "benefit_amount": {"currency": "USD", "amount":
|
1623
|
-
"5983.57"}}], "plan_begin_date": "2013-02-15", "eligibility_begin_date": "2012-02-01",
|
1624
|
-
"coinsurance": [{"benefit_percent": 0.0, "service_types": ["professional_physician_visit_office"],
|
1625
|
-
"coverage_level": "employee_and_spouse", "messages": [{"message": "GYN OFFICE
|
1626
|
-
VS"}, {"message": "GYN VISIT"}, {"message": "SPEC OFFICE"}, {"message": "SPEC
|
1627
|
-
VISIT"}, {"message": "PRIMARY OFFICE"}, {"message": "PRIME CARE VST"}], "in_plan_network":
|
1628
|
-
"yes"}, {"benefit_percent": 0.5, "service_types": ["professional_physician_visit_office"],
|
1629
|
-
"coverage_level": "employee_and_spouse", "messages": [{"message": "GYN OFFICE
|
1630
|
-
VS,COINS APPLIES TO OUT OF POCKET"}, {"message": "GYN VISIT,COINS APPLIES
|
1631
|
-
TO OUT OF POCKET"}, {"message": "SPEC OFFICE,COINS APPLIES TO OUT OF POCKET"},
|
1632
|
-
{"message": "SPEC VISIT,COINS APPLIES TO OUT OF POCKET"}, {"message": "PRIME
|
1633
|
-
CARE VST,COINS APPLIES TO OUT OF POCKET"}], "in_plan_network": "no"}], "group_description":
|
1634
|
-
"MOCK INDIVIDUAL ADVANTAGE PLAN", "plan_number": "0888188", "service_date":
|
1635
|
-
"2013-08-10"}, "valid_request": true}, "trading_partner_id": "MOCKPAYER",
|
1636
|
-
"id": "53cdaaa056c02c1cdb7a40cd", "transition_path": ["generate", "transmit",
|
1637
|
-
"wait", "receive", "process", "complete"], "history": [{"record_dt": "2014-07-22T00:04:48.755000",
|
1638
|
-
"name": "init", "title": "Initializing"}, {"record_dt": "2014-07-22T00:04:48.770000",
|
1639
|
-
"name": "generating", "title": "Generating X12 transactions"}, {"record_dt":
|
1640
|
-
"2014-07-22T00:04:48.772000", "name": "transmitting", "title": "Transmitting
|
1641
|
-
transactions to Trading Partner"}, {"record_dt": "2014-07-22T00:04:48.773000",
|
1642
|
-
"name": "waiting", "title": "Waiting on Trading Partner Response"}, {"record_dt":
|
1643
|
-
"2014-07-22T00:04:48.774000", "name": "receiving", "title": "Receiving transactions
|
1644
|
-
from Trading Partner"}, {"record_dt": "2014-07-22T00:04:48.830000", "name":
|
1645
|
-
"processing", "title": "Processing X12 transactions"}]}, {"units_of_work":
|
1646
|
-
1, "name": "pokitdok_api", "parameters": {"service_types": ["health_benefit_plan_coverage"],
|
1647
|
-
"trading_partner_id": "MOCKPAYER", "payer": {"id": "MOCKPAYER", "name": "Mockpayer
|
1648
|
-
For Testing"}, "member": {"birth_date": "1977-01-12", "first_name": "Lorine",
|
1649
|
-
"last_name": "Nolan", "plan_start_date": "2013-08-10", "id": "152238613"},
|
1650
|
-
"correlation_id": "6a5571a2-7ee3-4cfd-bcc5-ea0c945140fe", "client_id": "7x7nRAotGfxHfy7Llfl3",
|
1651
|
-
"provider": {"first_name": "Humberto", "last_name": "Casper", "npi": "6223440922"},
|
1652
|
-
"async": false, "transaction_code": "request"}, "state": {"name": "completed",
|
1653
|
-
"title": "Completed"}, "result": {"service_types": ["professional_physician_visit_office"],
|
1654
|
-
"client_id": "7x7nRAotGfxHfy7Llfl3", "payer": {"id": "MOCKPAYER", "name":
|
1655
|
-
"MOCK PAYER INC"}, "subscriber": {"birth_date": "1977-01-12", "first_name":
|
1656
|
-
"Lorine", "last_name": "Nolan", "id": "152238613", "address": {"city": "SPARTANBURG",
|
1657
|
-
"state": "SC", "zipcode": "29307", "address_lines": ["123 MAIN ST"]}}, "correlation_id":
|
1658
|
-
"6a5571a2-7ee3-4cfd-bcc5-ea0c945140fe", "trading_partner_id": "MOCKPAYER",
|
1659
|
-
"provider": {"first_name": "Humberto", "last_name": "Humberto Casper", "npi":
|
1660
|
-
"6223440922"}, "coverage": {"service_types": ["professional_physician_visit_office"],
|
1661
|
-
"group_number": "088818801000013", "out_of_pocket": [{"in_plan_network": "yes",
|
1662
|
-
"benefit_amount": {"currency": "USD", "amount": "3000"}, "coverage_level":
|
1663
|
-
"individual"}, {"in_plan_network": "yes", "benefit_amount": {"currency": "USD",
|
1664
|
-
"amount": "2983.57"}, "coverage_level": "individual", "time_period": "remaining"},
|
1665
|
-
{"in_plan_network": "yes", "benefit_amount": {"currency": "USD", "amount":
|
1666
|
-
"6000"}, "coverage_level": "family"}, {"in_plan_network": "yes", "benefit_amount":
|
1667
|
-
{"currency": "USD", "amount": "5956.09"}, "coverage_level": "family", "time_period":
|
1668
|
-
"remaining"}, {"in_plan_network": "no", "benefit_amount": {"currency": "USD",
|
1669
|
-
"amount": "12500"}, "coverage_level": "individual"}, {"in_plan_network": "no",
|
1670
|
-
"benefit_amount": {"currency": "USD", "amount": "12483.57"}, "coverage_level":
|
1671
|
-
"individual", "time_period": "remaining"}, {"in_plan_network": "no", "benefit_amount":
|
1672
|
-
{"currency": "USD", "amount": "25000"}, "coverage_level": "family"}, {"in_plan_network":
|
1673
|
-
"no", "benefit_amount": {"currency": "USD", "amount": "24956.09"}, "coverage_level":
|
1674
|
-
"family", "messages": [{"message": "Unlimited Lifetime Benefits"}], "time_period":
|
1675
|
-
"remaining"}], "level": "employee_and_spouse", "copay": [{"in_plan_network":
|
1676
|
-
"yes", "service_types": ["professional_physician_visit_office"], "coverage_level":
|
1677
|
-
"employee_and_spouse", "messages": [{"message": "PRIMARY OFFICE"}]}, {"in_plan_network":
|
1678
|
-
"not_applicable", "service_types": ["professional_physician_visit_office"],
|
1679
|
-
"coverage_level": "employee_and_spouse", "messages": [{"message": "GYN OFFICE
|
1680
|
-
VS"}, {"message": "GYN VISIT"}, {"message": "SPEC OFFICE"}, {"message": "SPEC
|
1681
|
-
VISIT"}, {"message": "PRIME CARE VST"}, {"message": "Plan Requires PreCert"},
|
1682
|
-
{"message": "Commercial"}, {"message": "Plan includes NAP"}, {"message": "Pre-Existing
|
1683
|
-
may apply"}]}], "deductibles": [{"messages": [{"message": "INT MED AND RX,GYN
|
1684
|
-
OFFICE VS,DED INCLUDED IN OOP,GYN VISIT,SPEC OFFICE,SPEC VISIT,PRIMARY OFFICE,PRIME
|
1685
|
-
CARE VST"}], "in_plan_network": "yes", "eligibility_date": "2013-01-01", "time_period":
|
1686
|
-
"calendar_year", "coverage_level": "family", "benefit_amount": {"currency":
|
1687
|
-
"USD", "amount": "6000"}}, {"in_plan_network": "yes", "time_period": "remaining",
|
1688
|
-
"coverage_level": "family", "messages": [{"message": "INT MED AND RX"}], "benefit_amount":
|
1689
|
-
{"currency": "USD", "amount": "5956.09"}}, {"messages": [{"message": "INT
|
1690
|
-
MED AND RX,GYN OFFICE VS,DED INCLUDED IN OOP,GYN VISIT,SPEC OFFICE,SPEC VISIT,PRIMARY
|
1691
|
-
OFFICE,PRIME CARE VST"}], "in_plan_network": "yes", "eligibility_date": "2013-01-01",
|
1692
|
-
"time_period": "calendar_year", "coverage_level": "individual", "benefit_amount":
|
1693
|
-
{"currency": "USD", "amount": "3000"}}, {"in_plan_network": "yes", "time_period":
|
1694
|
-
"remaining", "coverage_level": "individual", "messages": [{"message": "INT
|
1695
|
-
MED AND RX"}], "benefit_amount": {"currency": "USD", "amount": "2983.57"}},
|
1696
|
-
{"messages": [{"message": "INT MED AND RX,GYN OFFICE VS,DED INCLUDED IN OOP,GYN
|
1697
|
-
VISIT,SPEC OFFICE,SPEC VISIT,PRIME CARE VST"}], "in_plan_network": "no", "eligibility_date":
|
1698
|
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