sunnyside 0.0.2

data/lib/sunnyside/ledger/edi.rb

@@ -0,0 +1,181 @@
+module Sunnyside
+  def self.edi_parser
+    print "checking for new files...\n"
+    Dir["#{LOCAL_FILES}/835/*.txt"].select { |file| Filelib.where(:filename => file).count == 0 }.each do |file|
+      print "processing #{file}...\n"
+      data  = File.open(file).read.split(/~CLP\*/)
+      edi   = Edi.new(data, file)
+      edi.parse_claim_header
+      Filelib.insert(filename: file, created_at: Time.now, purpose: 'EDI Import', file_type: '835 Remittance')
+      edi.save_payment_to_db
+    end
+  end
+  class Edi
+    attr_reader :header, :claims, :file
+    def initialize(data, file)
+      @header, @claims = data[0], data.drop(1)
+      @file            = file
+    end
+
+    def process_file
+      claims.map { |clm| clm.split(/~(?=SVC)/) }.each do |claim|
+        claim_head = claim[0]
+        services   = claim.select { |section| section =~ /^SVC/ }
+        InvoiceHeader.new(claim_head, services).parse_data
+      end
+    end
+
+    def check_number
+      header[/(?<=~TRN\*\d\*)\w+/, 0]
+    end
+
+    def check_total
+      header[/(?<=~BPR\*\w\*)[0-9\.\-]+/] || 0.0
+    end
+
+    def type
+      if header[/(?<=\*C\*)ACH/] == 'ACH'
+        'Electronic Funds Transfer'
+      elsif header[/(?<=\*C\*)CHK/] == 'CHK'
+        'Physical Check Issued'
+      else
+        'Non Payment'
+      end
+    end
+
+    # not working
+
+    # def check
+    #   if check_number.include?('E') # E for Fidelis
+    #     check_number[/\d+[A-Z]+(\d+)/, 1] 
+    #   else
+    #     check_number
+    #   end
+    # end
+
+    def separate_claims_from_services
+      claims.map {|clm| clm.split(/~(?=SVC)/)}
+    end
+
+    def parse_claim_header
+      separate_claims_from_services.each do |clm|
+        claim_data = clm[0]
+        services   = clm.reject{|x| x !~ /^SVC/}
+        claims     = InvoiceHeader.new(claim_data, check_number)
+        claims.format_data
+        claims.add_to_db(check_number, file)
+        parse_service(services) {|svc| claims.parse_svc(svc, check_number)}
+      end
+    end
+
+    def save_payment_to_db
+      provider = Claim.where(check_number: check_number).get(:provider_id) || 17
+      Payment.insert(provider_id: provider, filelib_id: filelib_id, check_total: check_total, check_number: check_number)
+    end
+
+    def filelib_id
+      Filelib.where(filename: file).get(:id)
+    end
+
+    def parse_service(services)
+      services.map{|x| x.split(/~/).reject{|x| x !~ /CAS|SVC|DTM/}}.each {|svc| yield svc}
+    end
+  end
+
+  class InvoiceHeader < Edi
+    attr_accessor :claim_number, :invoice_number, :response_code, :amt_charged, :amt_paid, :check_number
+    def initialize(claim, check_number)
+      @invoice_number, @response_code, @amt_charged, @amt_paid, @whatever, @claim_number = claim.match(/^([\w\.]+)\*(\d+)\*([0-9\.\-]+)\*([0-9\.\-]+)\*([0-9\.\-]+)?\*+\w+\*(\w+)/).captures
+      @check_number   = check_number
+    end
+
+    def format_data
+      @invoice_number         = invoice_number[/^\w+/].gsub(/[OLD]/, 'O' => '0', 'D' => '8', 'L' => '1').gsub(/^0/, '')[0..5].to_i
+    end
+
+    def claim_id
+      Claim.where(invoice_id: invoice_number, check_number: check_number).get(:id)
+    end
+
+    def parse_svc(service, check_number)
+      if service.length == 2
+        svc = Detail.new(service[0], service[1])
+      elsif service.length > 2
+        svc = Detail.new(service[0], service[1])
+        svc.set_denial(service[2])
+      end
+      svc.display(invoice_number)
+      svc.save_to_db(invoice_number, check_number, claim_id)
+    end
+
+    def prov
+      Invoice.where(invoice_number: invoice_number).get(:provider_id)
+    end
+
+    def add_to_db(check, file)
+      Claim.insert(provider_id: prov, invoice_id: invoice_number, billed: amt_charged, paid: amt_paid, check_number: check_number, control_number: claim_number, status: response_code)
+    end
+  end
+
+  class Detail < Edi
+
+    attr_reader :billed, :paid, :denial_reason, :date, :billed, :paid, :units, :service_code
+    def initialize(service, date, denial_reason=nil, denial_code=nil)
+      @service_code, @billed, @paid, @units = service.match(/HC:([A-Z0-9\:]+)\*([0-9\.\-]+)\*([0-9\.\-]+)?\**([0-9\-]+)?/).captures
+      @date = Date.parse(date[/\d+$/])
+    end
+
+    def display(inv)
+      print "#{inv} #{@service_code} #{@date} #{client(inv)} #{denial}\n"
+    end
+
+    def client(inv)
+      Invoice.where(invoice_number: inv).get(:client_name)
+    end
+
+    def denial
+      (billed.to_f - paid.to_f).round(2) if billed > paid
+    end
+
+    def set_denial(denial)
+      @denial_reason = set_code(denial[/\d+/])
+    end
+
+    def save_to_db(invoice, check, claim_id)
+      Service.insert(invoice_id: invoice, service_code: service_code, units: units.to_f, billed: billed.to_f, paid: paid.to_f, denial_reason: denial_reason, dos: date, claim_id: claim_id)
+    end
+
+    def set_code(code)
+      case code
+      when '125' then return 'Submission/billing error(s). At least one Remark Code must be provided'
+      when '140' then return 'Patient/Insured health identification number and name do not match.'
+      when '31'  then return 'INVALID MEMBER ID'
+      when '62'  then return 'PAID AUTHORIZED UNITS'
+      when '96'  then return 'NO AUTHORIZATION FOR DOS'
+      when '146' then return 'DIAGNOSIS WAS INVALID FOR DATES LISTED'
+      when '197' then return 'Precertification/authorization/notification absent'
+      when '198' then return 'Precertification/authorization exceeded'
+      when '199' then return 'Revenue code and Procedure code do not match'
+      when '9'   then return 'DIAGNOSIS ISSUE'
+      when '15'  then return 'AUTHORIZATION MISSING/INVALID'
+      when '18'  then return 'Exact Duplicate Claim/Service'
+      when '19'  then return 'Expenses incurred prior to coverage'
+      when '27'  then return 'Expenses incurred after coverage terminated'
+      when '29'  then return 'Timely Filing'
+      when '39'  then return 'Services denied at the time authorization/pre-certification was requested'
+      when '45'  then return 'Charge exceeds fee schedule/maximum allowable'
+      when '16'  then return 'Claim/service lacks information which is needed for adjudication'
+      when '50'  then return 'These are non-covered services because this is not deemed a medical necessity by the payer'
+      when '192' then return 'Non standard adjustment code from paper remittance'
+      when '181' then return 'Procedure code was invalid on the date of service'
+      when '182' then return 'Procedure modifier was invalid on the date of service'
+      when '204' then return 'This service/equipment/drug is not covered under the patients current benefit plan'
+      when '151' then return '151 Payment adjusted because the payer deems the information submitted does not support this many/frequency of services'
+      when '177' then return 'Patient has not met the required eligibility requirements'
+      when '109' then return 'Claim/service not covered by this payer/contractor. You must send the claim/service to the correct payer/contractor.'
+      else
+        return "#{code} is UNIDENTIFIED"
+      end
+    end
+  end
+end

data/lib/sunnyside/ledger/ledger.rb

@@ -0,0 +1,142 @@
+require 'prawn'
+module Sunnyside
+  # This should be redone.
+  def self.ledger_file
+    Dir["#{LOCAL_FILES}/summary/*.PDF", "#{LOCAL_FILES}/summary/*.pdf"].each {|file| 
+      if Filelib.where(filename: file).count == 0 
+        puts "processing #{file}..."
+        ledger = Ledger.new(file)
+        ledger.process_file
+        Filelib.insert(filename: file, purpose: 'summary')
+      end
+    }
+  end
+  
+  class Ledger
+    attr_reader   :post_date, :file, :pages
+
+    # when Ledger gets initialized, the page variable filters out the VNS clients
+    # and then proceeds to pass the page date onto the PageData class
+
+    def initialize(file)
+      @file      = File.basename(file)
+      @pages     = PDF::Reader.new(file).pages.select { |page| !page.raw_content.include?('VISITING NURSE SERVICE') }
+    end
+
+    def providers
+      pages.map { |page| PageData.new(page.raw_content, file) }
+    end
+
+    def process_file
+      providers.each { |page| page.invoice_data }
+    end
+  end
+
+  # in PageData, the providers name is captured from the PDF::Reader raw_content, and the post date from the file name.
+  # the rest of the data (the invoices) gets split by newlines (filted by those lines that fit the criteria for invoice data)
+  # Then, the data gets finalized (via the InvoiceLine child class of PageData) and inserted into the database. 
+
+  class PageData
+    include Sunnyside
+    attr_reader :page_data, :provider, :post_date
+
+    def initialize(page_data, file, provider = nil)
+      @provider  = page_data[/CUSTOMER:\s+(.+)(?=\)')/, 1]
+      @post_date = Date.parse(file[0..7])
+      @page_data = page_data.split(/\n/).select { |line| line =~ /^\([0-9\/]+\s/ }
+    end
+
+    # Since the source data is somewhat unreliable in the format, there have been two different variations of AMERIGROUP and ELDERSERVE.
+    # This method accounts for the aberrations while still maintaining that any provider not recognized by the DB to be saved as a PRIVATE client.
+
+    def formatted_provider
+      if provider_missing?
+        case provider
+        when 'ELDERSERVEHEALTH'
+          Provider.where(name: 'ELDERSERVE HEALTH').first
+        when 'AMERIGROUP'
+          Provider.where(name: 'AMERIGROUP 2').first
+        else 
+          Provider.where(name: 'PRIVATE').first        
+        end
+      else
+        Provider.where(name: provider).first
+      end
+    end
+
+    def provider_missing?
+      Provider.where(name: provider).count == 0
+    end
+
+    def invoice_lines
+      page_data.map { |line| InvoiceLine.new(line, formatted_provider, post_date) }
+    end
+
+    def invoice_data
+      invoice_lines.each { |inv| inv.finalize }
+      # Invoice.where(post_date: post_date).all.each { |inv| self.payable_csv(inv, post_date, formatted_provider) }
+    end
+
+    # InvoiceLine does all the nitty-gritty parsing of an invoice line into the necessary fields the DB requres.
+
+    class InvoiceLine < PageData
+      attr_accessor :invoice, :rate, :hours, :amount, :client_id, :client_name, :post_date, :provider
+      def initialize(line, provider, post_date)
+        @provider                                               = provider
+        @post_date                                              = post_date
+        @client_name                                            = line.slice!(20..45)
+        @doc_date, @invoice, @client_id, @hours, @rate, @amount = line.split
+      end
+
+      # Some invoice totals exceed $999.99, so the strings need to be parsed into a format, sans comma, that the DB will read correctly. 
+      # Otherwise, the DB will read 1,203.93 as 1.0.
+
+      def amt
+        amount.gsub(/,/, '')
+      end
+
+      # Ocasionally, new clients will appear on the PDF doc. If the DB does not find a client with the client_id, then it executes a method wherein
+      # new client gets saved into the DB with a new FUND EZ ID. It must do this before saving the invoice information.
+
+      def finalize
+        if !client_missing? 
+          add_invoice
+        else 
+          add_client
+          finalize
+        end
+      end
+
+      def client_missing?
+        Client[client_id].nil?
+      end
+
+      def add_client
+        Client.insert(client_number: client_id, client_name: client_name)
+      end
+
+      # rarely there may be an invoice line that contains an invoice number that already exists. This method accounts for it, by merely updating the amount.
+      # There has only been two instances of this happening and both occurred in 2011.
+
+      def add_invoice
+        if invoice_exist?
+          update_invoice
+        else
+          Invoice.insert(invoice_number: invoice, rate: rate, hours: hours, amount: amt, client_id: client_id, post_date: post_date, provider_id: provider.id, client_name: client_name.strip)
+        end
+      end
+
+      def invoice_exist?
+        Invoice.where(invoice_number: invoice).count > 0
+      end
+
+      def update_invoice
+        Invoice.where(invoice_number: invoice).update(amount: amt.to_f)
+      end
+
+      def prev_amt
+        Invoice.where(invoice_number: invoice).get(:amount)
+      end
+    end
+  end
+end

data/lib/sunnyside/ledger/private.rb

@@ -0,0 +1,70 @@
+module Sunnyside  
+  def self.process_private
+    Dir["#{LOCAL_FILES}/private/*.PDF", "#{LOCAL_FILES}/private/*.pdf"].select { |file| Filelib.where(filename: file).count == 0 }.each do |file|
+      puts "processing #{file}..."
+      PDF::Reader.new(file).pages.each { |inv| 
+        page  = inv.text.split(/\n/)
+        InvoiceParse.new(page).process if page.include?('Remit') 
+      }
+      Filelib.insert(filename: file, purpose: 'private client visit data')
+    end
+  end
+
+  class InvoiceParse
+    attr_reader :invoice_line, :client_line, :service_lines
+    def initialize(page)
+      @invoice_line  = page.select { |line| line =~ /[0-9\/]{8}\s+\d{7}/  }.join
+      @client_line   = page.select { |line| line =~ /[0-9]{7}\s+[0-9]{7}/ }.join
+      @service_lines = page.map    { |line| ServiceLine.new(line) if line =~ /\sHHA\s|\sPCA\s/ }.compact
+    end
+
+    def invoice
+      invoice_line[/(\d{7})$/, 1].gsub(/^0/, '')
+    end
+
+    def client_number
+      client_line[/[0-9]{7}/, 0]
+    end
+
+    def process
+      service_lines.each { |line| line.to_db(invoice, client_number) }
+    end
+  end
+
+  class ServiceLine
+    attr_reader :line
+
+    def initialize(line)
+      @line = line
+    end
+
+    def to_db(invoice, client_number)
+      Visit.insert(invoice_id: invoice, client_id: client_number, dos: Date.strptime(service_date, '%m/%d/%y'), service_code: code, amount: amount)
+    end
+
+    def service_date
+      line[/[0-9\/]{8}/, 0]
+    end
+
+    def code
+      if line =~ / HHA /
+        'HHA'
+      else
+        'PCA'
+      end
+    end
+
+    def line_split
+      line.split 
+    end
+
+    def amount
+      line_split[-1]
+    end
+
+    def rate
+      line_split[-2]
+    end
+  end
+end
+

data/lib/sunnyside/menu.rb

@@ -0,0 +1,41 @@
+module Sunnyside
+  class Menu
+    def start
+      loop do 
+        puts "1.) LEDGER IMPORT"
+        puts "2.) EDI IMPORT"
+        puts "3.) 837 IMPORT"
+        puts "4.) A/R REPORT"
+        puts "5.) CASH RECEIPT IMPORT"
+        puts "6.) ACCESS FTP"
+        puts "7.) EXPIRING AUTHORIZATION REPORT"
+        puts "9.) MCO - MLTC HOURS UPDATE"
+        print "select option: "
+        case gets.chomp
+        when '1' 
+          Sunnyside.ledger_file
+          Sunnyside.process_private
+        when '2' 
+          Sunnyside.edi_parser
+        when '3'
+          Sunnyside.parse_pdf
+        when '4' 
+          Sunnyside::Report.new
+        when '5' 
+          Sunnyside::CashReceipt.new.process
+        when '6'
+          Sunnyside.access_ftp(:download)
+          Sunnyside.access_ftp(:upload)
+        when '7'
+          Sunnyside.show_opts
+        when '8'
+          Sunnyside.process_private
+        when '9'
+          Sunnyside.run_mco_mltc
+        else
+          exit
+        end
+      end
+    end
+  end
+end

data/lib/sunnyside/models/db_setup.rb

@@ -0,0 +1,158 @@
+module Sunnyside
+  class << self
+    def create_tables
+      DB.create_table :charges do 
+        primary_key   :id
+        foreign_key   :invoice_id, :invoices
+        foreign_key   :provider_id, :providers
+        Date          :dos
+        Float         :amount
+        Float         :units
+        String        :service_code
+        String        :filename
+      end
+
+      DB.create_table :invoices do 
+        Integer       :invoice_number, :primary_key=>true
+        index         :invoice_number
+        Float         :amount
+        Date          :post_date, :default=>Date.today
+        foreign_key   :client_id, :clients
+        foreign_key   :provider_id, :providers
+        foreign_key   :filelib_id, :filelibs
+        String        :client_name
+        Float         :rate
+        Float         :hours
+      end
+
+      DB.create_table :payments do 
+        primary_key   :id 
+        foreign_key   :provider_id, :providers
+        foreign_key   :filelib_id, :filelibs
+        Float         :check_total
+        String        :status
+        Integer       :check_number
+      end
+
+      DB.create_table :claims do 
+        primary_key   :id
+        index         :id
+        String        :control_number
+        foreign_key   :payment_id, :payments
+        foreign_key   :invoice_id, :invoices
+        foreign_key   :client_id, :clients
+        Float         :paid 
+        Float         :billed
+        String        :status
+        String        :recipient_id
+        foreign_key   :provider_id, :providers
+        Date          :post_date
+      end
+
+      DB.create_table :services do 
+        primary_key   :id
+        foreign_key   :claim_id, :claims
+        foreign_key   :payment_id, :payments
+        foreign_key   :invoice_id, :invoices
+        foreign_key   :client_id, :clients
+        String        :service_code
+        Float         :paid
+        Float         :billed
+        String        :denial_reason
+        Float         :units
+        Date          :dos
+      end
+
+      DB.create_table :clients do
+        Integer       :client_number, :primary_key=>true
+        String        :client_name
+        String        :fund_id
+        String        :recipient_id
+      end
+
+      DB.create_table :providers do 
+        primary_key   :id
+        Integer       :credit_account
+        Integer       :fund 
+        Integer       :debit_account
+        String        :name
+        String        :abbreviation
+        String        :type
+        String        :edi_identifier
+      end
+
+      DB.create_table :filelibs do
+        primary_key   :id
+        String        :filename
+        String        :purpose
+        String        :file_type
+        Time          :created_at
+      end
+
+      DB.create_table :visits do 
+        primary_key :id
+        String      :service_code
+        String      :modifier
+        foreign_key :invoice_id, :invoices
+        foreign_key :client_id, :clients
+        Float       :amount
+        Float       :units
+        Date        :dos
+      end
+
+      DB.create_table :denials do 
+        primary_key :denial_code, :primary_key=>true
+        String      :denial_explanation
+      end
+
+      DB[:providers].insert(:credit_account=>1206, :fund=>500, :debit_account=>5005, :name=>"AMERIGROUP 2", :abbreviation=>"AMG", :type=>"MCO")
+      DB[:providers].insert(:credit_account=>1207, :fund=>300, :debit_account=>5007, :name=>"CHILDREN'S AID SOCIETY", :abbreviation=>"CAS", :type=>"MLTC")
+      DB[:providers].insert(:credit_account=>1226, :fund=>300, :debit_account=>5026, :name=>"COMPREHENSIVE CARE MANAGEMENT", :abbreviation=>"CCM", :type=>"MLTC")
+      DB[:providers].insert(:credit_account=>1203, :fund=>300, :debit_account=>5002, :name=>"DOMINICAN SISTERS FAM HLTH", :abbreviation=>"DSF", :type=>"MLTC")
+      DB[:providers].insert(:credit_account=>1209, :fund=>300, :debit_account=>5009, :name=>"ELDERSERVE HEALTH", :abbreviation=>"ELD", :type=>"MLTC")
+      DB[:providers].insert(:credit_account=>1212, :fund=>300, :debit_account=>5012, :name=>"EMBLEM HEALTH", :abbreviation=>"EMB", :type=>"MLTC")
+      DB[:providers].insert(:credit_account=>1201, :fund=>300, :debit_account=>5001, :name=>"GUILDNET", :abbreviation=>"G", :type=>"MLTC")
+      DB[:providers].insert(:credit_account=>1227, :fund=>500, :debit_account=>5027, :name=>"HEALTH CARE PARTNERS", :abbreviation=>"HCP", :type=>"MCO")
+      DB[:providers].insert(:credit_account=>1218, :fund=>500, :debit_account=>5018, :name=>"HEALTH FIRST", :abbreviation=>"HFS", :type=>"MCO")
+      DB[:providers].insert(:credit_account=>1216, :fund=>500, :debit_account=>5016, :name=>"HEALTH INSURANCE PLAN OF NY", :abbreviation=>"HIP", :type=>"MCO")
+      DB[:providers].insert(:credit_account=>1223, :fund=>300, :debit_account=>5023, :name=>"HHH LONG TERM HOME HLTH CARE", :abbreviation=>"HHH", :type=>"MLTC")
+      DB[:providers].insert(:credit_account=>1228, :fund=>300, :debit_account=>5028, :name=>"INDEPENDENCE CARE SYSTEMS", :abbreviation=>"ICS", :type=>"MLTC")
+      DB[:providers].insert(:credit_account=>1217, :fund=>500, :debit_account=>5017, :name=>"METROPLUS HEALTH", :abbreviation=>"MPH", :type=>"MCO")
+      DB[:providers].insert(:credit_account=>1219, :fund=>500, :debit_account=>5019, :name=>"NEIGHBORHOOD HEALTH PROVIDERS", :abbreviation=>"NHP", :type=>"MCO")
+      DB[:providers].insert(:credit_account=>1221, :fund=>500, :debit_account=>5021, :name=>"NYS CATHOLIC/FIDELIS", :abbreviation=>"FID", :type=>"MCO")
+      DB[:providers].insert(:credit_account=>1200, :fund=>300, :debit_account=>5000, :name=>"PRIVATE", :abbreviation=>"P", :type=>"MLTC")
+      DB[:providers].insert(:credit_account=>1204, :fund=>300, :debit_account=>5004, :name=>"SENIOR HEALTH PARTNERS", :abbreviation=>"SHP", :type=>"MLTC")
+      DB[:providers].insert(:credit_account=>1202, :fund=>300, :debit_account=>5003, :name=>"SUNNYSIDE COMMUNITY SERVICES", :abbreviation=>"SCS", :type=>"MLTC")
+      DB[:providers].insert(:credit_account=>1213, :fund=>500, :debit_account=>5013, :name=>"UNITED HEALTH CARE", :abbreviation=>"UHC", :type=>"MCO")
+      DB[:providers].insert(:credit_account=>1229, :fund=>500, :debit_account=>5029, :name=>"VNSNY CHOICE SELECT HEALTH", :abbreviation=>"VCS", :type=>"MCO")
+      DB[:providers].insert(:credit_account=>1224, :fund=>500, :debit_account=>5024, :name=>"WELCARE OF NEW YORK, INC.", :abbreviation=>"WEL", :type=>"MCO")
+      DB[:providers].insert(:credit_account=>1310, :fund=>300, :debit_account=>5030, :name=>"VILLAGE CARE MAX", :abbreviation=>"VIL", :type=>"MLTC")
+      DB[:providers].insert(:credit_account=>1222, :fund=>500, :debit_account=>5022, :name=>"AFFINITY HEALTH PLUS", :abbreviation=>"AFF", :type=>"MCO")
+      DB[:providers].insert(:credit_account=>1218, :fund=>500, :debit_account=>5018, :name=>"HEALTH PLUS PHSP,INC", :abbreviation=>"HFS", :type=>"MCO")
+
+    end
+  end
+end
+
+# DB[:denials].insert(denial_code: 1, denial_explanation: 'not implemented yet')
+# DB[:denials].insert(denial_code: 96, denial_explanation: "NO AUTHORIZATION FOR DOS")
+# DB[:denials].insert(denial_code: 197, denial_explanation: "Precertification/authorization/notification absent")
+# DB[:denials].insert(denial_code: 198, denial_explanation: "Precertification/authorization exceeded")
+# DB[:denials].insert(denial_code: 199, denial_explanation: "Revenue code and Procedure code do not match")
+# DB[:denials].insert(denial_code: 9, denial_explanation: "DIAGNOSIS ISSUE")
+# DB[:denials].insert(denial_code: 15, denial_explanation: "AUTHORIZATION MISSING/INVALID")
+# DB[:denials].insert (denial_code: 18, denial_explanation: "Exact Duplicate Claim/Service")
+# DB[:denials].insert(denial_code: 19, denial_explanation: "Expenses incurred prior to coverage")
+# DB[:denials].insert(denial_code: 27, denial_explanation: "Expenses incurred after coverage terminated")
+# DB[:denials].insert(denial_code: 29, denial_explanation: "Timely Filing")
+# DB[:denials].insert(denial_code: 39, denial_explanation: "Services denied at the time authorization/pre-certification was requested")
+# DB[:denials].insert(denial_code: 45, denial_explanation: "Charge exceeds fee schedule/maximum allowable")
+# DB[:denials].insert(denial_code: 16, denial_explanation: "Claim/service lacks information which is needed for adjudication")
+# DB[:denials].insert(denial_code: 50, denial_explanation: "These are non-covered services because this is not deemed a 'medical necessity' by the payer")
+# DB[:denials].insert(denial_code: 192, denial_explanation: "Non standard adjustment code from paper remittance")
+# DB[:denials].insert(denial_code: 181, denial_explanation: "Procedure code was invalid on the date of service")
+# DB[:denials].insert(denial_code: 182, denial_explanation: "Procedure modifier was invalid on the date of service")
+# DB[:denials].insert(denial_code: 204, denial_explanation: "This service/equipment/drug is not covered under the patients current benefit plan")
+# DB[:denials].insert(denial_code: 151, denial_explanation: "151 Payment adjusted because the payer deems the information submitted does not support this many/frequency of services")
+# DB[:denials].insert(denial_code: 177, denial_explanation: "Patient has not met the required eligibility requirements")
+# DB[:denials].insert(denial_code: 109, denial_explanation: "Claim/service not covered by this payer/contractor. You must send the claim/service to the correct payer/contractor.")

data/lib/sunnyside/models/sequel_classes.rb

@@ -0,0 +1,12 @@
+module Sunnyside
+  class Auth < Sequel::Model; end
+  class Charge < Sequel::Model; end
+  class Invoice < Sequel::Model; end
+  class Filelib < Sequel::Model; end
+  class Payment < Sequel::Model; end
+  class Claim < Sequel::Model; end
+  class Client < Sequel::Model; end
+  class Service < Sequel::Model; end
+  class Provider < Sequel::Model; end
+  class Visit < Sequel::Model; end
+end

data/lib/sunnyside/reports/mco_mltc.rb

@@ -0,0 +1,43 @@
+module Sunnyside
+  def self.run_mco_mltc
+    print "Type in post date (YYYY-MM-DD): "
+    post_date = gets.chomp
+    Provider.map(:name).each do |provider|
+      ReportMCO.new(provider, post_date).run
+    end
+  end
+
+  class ReportMCO
+    attr_reader :provider, :post_date, :clients
+    # attr_accessor :mco_total, :mltc_total
+
+    def initialize(provider, post_date)
+      @provider   = provider
+      @post_date  = post_date 
+      @clients    = Client.where(provider: provider)
+      # @mco_total  = 0.0
+      # @mltc_total = 0.0
+    end
+
+    def run
+      mco_total = 0.0
+      mltc_total = 0.0
+      invoices.each do |inv|
+        if inv[:type] == 'MCO'
+          mco_total += inv[:hours]
+          # mco_total  += inv.hours
+        elsif inv[:type] == 'MLTC'  
+          mltc_total += inv[:hours]
+        end
+      end
+      puts "#{provider}: MCO => #{mco_total} MLTC => #{mltc_total}"
+    end
+
+    def invoices
+      Invoice.where(provider: provider, post_date: post_date).all.map { |invoice| 
+        { :type  => Client.where(med_id: invoice.service_number).exclude(type: nil).get(:type),
+          :hours => invoice.hours }
+      }
+    end
+  end
+end