sunnyside 0.1.1 → 0.1.2
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- checksums.yaml +7 -0
- data/bin/sunnyside +5 -5
- data/lib/sunnyside.rb +35 -35
- data/lib/sunnyside/advanced.rb +84 -84
- data/lib/sunnyside/cash_receipts/cash_receipt.rb +14 -11
- data/lib/sunnyside/expiring_auth.rb +0 -0
- data/lib/sunnyside/ftp.rb +0 -0
- data/lib/sunnyside/ledger/auth_report.rb +0 -0
- data/lib/sunnyside/ledger/edi.rb +174 -174
- data/lib/sunnyside/ledger/ledger.rb +189 -188
- data/lib/sunnyside/ledger/private.rb +0 -0
- data/lib/sunnyside/menu.rb +52 -52
- data/lib/sunnyside/models/db_setup.rb +196 -196
- data/lib/sunnyside/models/sequel_classes.rb +13 -13
- data/lib/sunnyside/query/query.rb +46 -28
- data/lib/sunnyside/reports/mco_mltc.rb +41 -41
- data/lib/sunnyside/reports/pdf_report.rb +1 -1
- data/lib/sunnyside/reports/pdf_report_draft.rb +0 -0
- data/lib/sunnyside/reports/private.rb +0 -0
- data/lib/sunnyside/reports/report.rb +0 -0
- data/lib/sunnyside/version.rb +3 -3
- metadata +21 -35
checksums.yaml
ADDED
@@ -0,0 +1,7 @@
|
|
1
|
+
---
|
2
|
+
SHA1:
|
3
|
+
metadata.gz: 8e0f90574f4539e1f9daa2488cbca27d81414ad3
|
4
|
+
data.tar.gz: 12ce71ebb22046f4d41c371ef3b5e984b04a25a4
|
5
|
+
SHA512:
|
6
|
+
metadata.gz: 4cace35d98ac36f145edd1f29c32564fc56195d8711ee6ab4a941e721d4d2ecfcee4070aa7dd2d88ee5b0f119979cbc56d6309508dcfd7d44e1b10aac396bc48
|
7
|
+
data.tar.gz: 0ac9c8a12d46770f952cfc36e3072bad461572c843b0c24ff69d17888ebdd51c9aced11f7e59c5cd78587b2be5f24beca8227816d4e48c4824161a6809d1e88b
|
data/bin/sunnyside
CHANGED
@@ -1,6 +1,6 @@
|
|
1
|
-
#!/usr/bin/env ruby
|
2
|
-
require 'rubygems'
|
3
|
-
require 'sequel'
|
4
|
-
require 'sunnyside'
|
5
|
-
|
1
|
+
#!/usr/bin/env ruby
|
2
|
+
require 'rubygems'
|
3
|
+
require 'sequel'
|
4
|
+
require 'sunnyside'
|
5
|
+
|
6
6
|
Sunnyside::Menu.new.start
|
data/lib/sunnyside.rb
CHANGED
@@ -1,35 +1,35 @@
|
|
1
|
-
require 'prawn'
|
2
|
-
require 'sequel'
|
3
|
-
require 'csv'
|
4
|
-
require 'fileutils'
|
5
|
-
require "sunnyside/version"
|
6
|
-
require 'sunnyside/cash_receipts/cash_receipt'
|
7
|
-
require 'sunnyside/ledger/ledger'
|
8
|
-
require 'sunnyside/ledger/edi'
|
9
|
-
require 'sunnyside/ledger/auth_report'
|
10
|
-
require 'sunnyside/ledger/private'
|
11
|
-
require 'sunnyside/reports/pdf_report'
|
12
|
-
require 'sunnyside/reports/private'
|
13
|
-
require 'sunnyside/reports/report'
|
14
|
-
require 'sunnyside/query/query'
|
15
|
-
require 'sunnyside/ftp'
|
16
|
-
require 'sunnyside/menu'
|
17
|
-
require 'sunnyside/expiring_auth'
|
18
|
-
require 'sunnyside/models/db_setup'
|
19
|
-
require 'sunnyside/advanced'
|
20
|
-
|
21
|
-
module Sunnyside
|
22
|
-
DRIVE = ENV["HOMEDRIVE"]
|
23
|
-
|
24
|
-
Sunnyside.create_folders if !Dir.exist?("#{DRIVE}/sunnyside-files")
|
25
|
-
Dir.chdir("R:/Departments/AR Department")
|
26
|
-
DB = Sequel.connect("sqlite://sunnyside.db")
|
27
|
-
|
28
|
-
if DB.tables.empty?
|
29
|
-
Sunnyside.create_tables
|
30
|
-
Sunnyside.add_providers
|
31
|
-
Sunnyside.add_denial_data
|
32
|
-
end
|
33
|
-
|
34
|
-
require 'sunnyside/models/sequel_classes'
|
35
|
-
end
|
1
|
+
require 'prawn'
|
2
|
+
require 'sequel'
|
3
|
+
require 'csv'
|
4
|
+
require 'fileutils'
|
5
|
+
require "sunnyside/version"
|
6
|
+
require 'sunnyside/cash_receipts/cash_receipt'
|
7
|
+
require 'sunnyside/ledger/ledger'
|
8
|
+
require 'sunnyside/ledger/edi'
|
9
|
+
require 'sunnyside/ledger/auth_report'
|
10
|
+
require 'sunnyside/ledger/private'
|
11
|
+
require 'sunnyside/reports/pdf_report'
|
12
|
+
require 'sunnyside/reports/private'
|
13
|
+
require 'sunnyside/reports/report'
|
14
|
+
require 'sunnyside/query/query'
|
15
|
+
require 'sunnyside/ftp'
|
16
|
+
require 'sunnyside/menu'
|
17
|
+
require 'sunnyside/expiring_auth'
|
18
|
+
require 'sunnyside/models/db_setup'
|
19
|
+
require 'sunnyside/advanced'
|
20
|
+
|
21
|
+
module Sunnyside
|
22
|
+
DRIVE = ENV["HOMEDRIVE"]
|
23
|
+
|
24
|
+
Sunnyside.create_folders if !Dir.exist?("#{DRIVE}/sunnyside-files")
|
25
|
+
Dir.chdir("R:/Departments/AR Department")
|
26
|
+
DB = Sequel.connect("sqlite://sunnyside.db")
|
27
|
+
|
28
|
+
if DB.tables.empty?
|
29
|
+
Sunnyside.create_tables
|
30
|
+
Sunnyside.add_providers
|
31
|
+
Sunnyside.add_denial_data
|
32
|
+
end
|
33
|
+
|
34
|
+
require 'sunnyside/models/sequel_classes'
|
35
|
+
end
|
data/lib/sunnyside/advanced.rb
CHANGED
@@ -1,85 +1,85 @@
|
|
1
|
-
module Sunnyside
|
2
|
-
def self.advanced_opts
|
3
|
-
puts "1.) Add new provider"
|
4
|
-
puts "2.) Export A/R denials"
|
5
|
-
|
6
|
-
case gets.chomp
|
7
|
-
when '1'
|
8
|
-
print "Type in the provider name _EXACTLY_ how it appears on the SanData archive report files (e.g. Guildnet is always GUILDNET): "
|
9
|
-
provider = gets.chomp
|
10
|
-
print "Now type in the abbreviation (batch initials - e.g. MetroPlus Health is MPH): "
|
11
|
-
abbrev = gets.chomp
|
12
|
-
print "Now type in the CREDIT account that is used in FUND EZ: "
|
13
|
-
credit = gets.chomp
|
14
|
-
print "Now type in the DEBIT account that is used in FUND EZ: "
|
15
|
-
debit = gets.chomp
|
16
|
-
print "And finally, type in the FUND number that is used in FUND EZ: "
|
17
|
-
fund = gets.chomp
|
18
|
-
review = "--------Name: #{provider}, Credit Account: #{credit}, Debit Account: #{debit}, Fund: #{fund}, Abbreviation: #{abbrev}--------"
|
19
|
-
puts "Please review the below information."
|
20
|
-
puts '-' * review.length
|
21
|
-
puts review
|
22
|
-
puts '-' * review.length
|
23
|
-
print "Is this correct? (Y for yes, N for No): "
|
24
|
-
raise 'You have an empty field! Start over!' if [provider, credit, debit, fund, abbrev].any? { |elem| elem.empty? }
|
25
|
-
if gets.chomp.upcase == 'Y'
|
26
|
-
provider = Provider.insert(name: provider, credit_account: credit, debit_account: debit, fund: fund, abbreviation: abbrev)
|
27
|
-
puts "#{Provider[provider].name} added."
|
28
|
-
else
|
29
|
-
Sunnyside.advanced_opts
|
30
|
-
end
|
31
|
-
else
|
32
|
-
exit
|
33
|
-
end
|
34
|
-
end
|
35
|
-
|
36
|
-
def self.rails_server
|
37
|
-
puts "Please wait..."
|
38
|
-
|
39
|
-
Dir.chdir("R:/Departments/AR Department/sunnyside-app")
|
40
|
-
|
41
|
-
%x(rails s)
|
42
|
-
end
|
43
|
-
|
44
|
-
def self.determine_browser
|
45
|
-
if Dir.exist?("#{DRIVE}/Program Files (x86)")
|
46
|
-
Dir.chdir("#{DRIVE}/Program Files (x86)/Mozilla Firefox")
|
47
|
-
else
|
48
|
-
Dir.chdir("#{DRIVE}/Program Files/Mozilla Firefox")
|
49
|
-
end
|
50
|
-
end
|
51
|
-
|
52
|
-
def self.add_provider_to_ftp
|
53
|
-
Provider.all.each { |prov| puts "#{prov.id}: #{prov.name}"}
|
54
|
-
print "Type in the corresponding ID Number for the provider you would like to add to FTP: "
|
55
|
-
|
56
|
-
provider = Provider[gets.chomp].abbreviation
|
57
|
-
|
58
|
-
puts "You've selected #{provider}"
|
59
|
-
|
60
|
-
print "Type in the ftp address now: "
|
61
|
-
site = gets.chomp
|
62
|
-
|
63
|
-
print "Type in the username now: "
|
64
|
-
username = gets.chomp
|
65
|
-
|
66
|
-
print "Type in the password now: "
|
67
|
-
password = gets.chomp
|
68
|
-
|
69
|
-
review = "-------Provider: #{provider}, Site: #{site}, Username: #{username}, Password: #{password}--------------"
|
70
|
-
puts "Please review the following information: "
|
71
|
-
puts '-' * review.length
|
72
|
-
puts review
|
73
|
-
puts '-' * review.length
|
74
|
-
|
75
|
-
puts "Is this correct? Type Y or N."
|
76
|
-
if gets.chomp.downcase == 'y'
|
77
|
-
Login.insert(site: site, username: username, password: password, provider: provider)
|
78
|
-
Dir.mkdir("#{DRIVE}/sunnyside-files/ftp/835/#{provider}")
|
79
|
-
Dir.mkdir("#{DRIVE}/sunnyside-files/ftp/837/#{provider}")
|
80
|
-
else
|
81
|
-
puts 'Please try again.'
|
82
|
-
Sunnyside.add_provider_to_ftp
|
83
|
-
end
|
84
|
-
end
|
1
|
+
module Sunnyside
|
2
|
+
def self.advanced_opts
|
3
|
+
puts "1.) Add new provider"
|
4
|
+
puts "2.) Export A/R denials"
|
5
|
+
|
6
|
+
case gets.chomp
|
7
|
+
when '1'
|
8
|
+
print "Type in the provider name _EXACTLY_ how it appears on the SanData archive report files (e.g. Guildnet is always GUILDNET): "
|
9
|
+
provider = gets.chomp
|
10
|
+
print "Now type in the abbreviation (batch initials - e.g. MetroPlus Health is MPH): "
|
11
|
+
abbrev = gets.chomp
|
12
|
+
print "Now type in the CREDIT account that is used in FUND EZ: "
|
13
|
+
credit = gets.chomp
|
14
|
+
print "Now type in the DEBIT account that is used in FUND EZ: "
|
15
|
+
debit = gets.chomp
|
16
|
+
print "And finally, type in the FUND number that is used in FUND EZ: "
|
17
|
+
fund = gets.chomp
|
18
|
+
review = "--------Name: #{provider}, Credit Account: #{credit}, Debit Account: #{debit}, Fund: #{fund}, Abbreviation: #{abbrev}--------"
|
19
|
+
puts "Please review the below information."
|
20
|
+
puts '-' * review.length
|
21
|
+
puts review
|
22
|
+
puts '-' * review.length
|
23
|
+
print "Is this correct? (Y for yes, N for No): "
|
24
|
+
raise 'You have an empty field! Start over!' if [provider, credit, debit, fund, abbrev].any? { |elem| elem.empty? }
|
25
|
+
if gets.chomp.upcase == 'Y'
|
26
|
+
provider = Provider.insert(name: provider, credit_account: credit, debit_account: debit, fund: fund, abbreviation: abbrev)
|
27
|
+
puts "#{Provider[provider].name} added."
|
28
|
+
else
|
29
|
+
Sunnyside.advanced_opts
|
30
|
+
end
|
31
|
+
else
|
32
|
+
exit
|
33
|
+
end
|
34
|
+
end
|
35
|
+
|
36
|
+
def self.rails_server
|
37
|
+
puts "Please wait..."
|
38
|
+
|
39
|
+
Dir.chdir("R:/Departments/AR Department/sunnyside-app")
|
40
|
+
|
41
|
+
%x(rails s)
|
42
|
+
end
|
43
|
+
|
44
|
+
def self.determine_browser
|
45
|
+
if Dir.exist?("#{DRIVE}/Program Files (x86)")
|
46
|
+
Dir.chdir("#{DRIVE}/Program Files (x86)/Mozilla Firefox")
|
47
|
+
else
|
48
|
+
Dir.chdir("#{DRIVE}/Program Files/Mozilla Firefox")
|
49
|
+
end
|
50
|
+
end
|
51
|
+
|
52
|
+
def self.add_provider_to_ftp
|
53
|
+
Provider.all.each { |prov| puts "#{prov.id}: #{prov.name}"}
|
54
|
+
print "Type in the corresponding ID Number for the provider you would like to add to FTP: "
|
55
|
+
|
56
|
+
provider = Provider[gets.chomp].abbreviation
|
57
|
+
|
58
|
+
puts "You've selected #{provider}"
|
59
|
+
|
60
|
+
print "Type in the ftp address now: "
|
61
|
+
site = gets.chomp
|
62
|
+
|
63
|
+
print "Type in the username now: "
|
64
|
+
username = gets.chomp
|
65
|
+
|
66
|
+
print "Type in the password now: "
|
67
|
+
password = gets.chomp
|
68
|
+
|
69
|
+
review = "-------Provider: #{provider}, Site: #{site}, Username: #{username}, Password: #{password}--------------"
|
70
|
+
puts "Please review the following information: "
|
71
|
+
puts '-' * review.length
|
72
|
+
puts review
|
73
|
+
puts '-' * review.length
|
74
|
+
|
75
|
+
puts "Is this correct? Type Y or N."
|
76
|
+
if gets.chomp.downcase == 'y'
|
77
|
+
Login.insert(site: site, username: username, password: password, provider: provider)
|
78
|
+
Dir.mkdir("#{DRIVE}/sunnyside-files/ftp/835/#{provider}")
|
79
|
+
Dir.mkdir("#{DRIVE}/sunnyside-files/ftp/837/#{provider}")
|
80
|
+
else
|
81
|
+
puts 'Please try again.'
|
82
|
+
Sunnyside.add_provider_to_ftp
|
83
|
+
end
|
84
|
+
end
|
85
85
|
end
|
@@ -3,14 +3,18 @@ module Sunnyside
|
|
3
3
|
def self.cash_receipt
|
4
4
|
puts "1.) EDI PAYMENT"
|
5
5
|
puts "2.) MANUAL PAYMENT"
|
6
|
-
|
7
|
-
|
8
|
-
|
9
|
-
|
10
|
-
|
11
|
-
|
12
|
-
|
13
|
-
|
6
|
+
puts "3.) RESET A/R SPREADSHEET"
|
7
|
+
case gets.chomp
|
8
|
+
when '1'
|
9
|
+
cash_receipt = CashReceipt.new(:electronic)
|
10
|
+
when '2'
|
11
|
+
cash_receipt = CashReceipt.new(:manual)
|
12
|
+
when '3'
|
13
|
+
CSV.open("#{DRIVE}/sunnyside-files/cash_receipts/EDI-citywide-import.csv", "w") { |row|
|
14
|
+
row << ['Seq','Receipt','post_date','other id','invoice','header memo','batch','doc date','detail memo','fund','account','cc1','cc2','cc3','debit','credit']
|
15
|
+
}
|
16
|
+
end
|
17
|
+
cash_receipt.collate if cash_receipt
|
14
18
|
end
|
15
19
|
|
16
20
|
class CashReceipt
|
@@ -39,9 +43,9 @@ module Sunnyside
|
|
39
43
|
print "You have typed out #{invoices.length} number of invoices. Do you wish to add more to the same check? (Y or N): "
|
40
44
|
if gets.chomp.upcase == 'Y'
|
41
45
|
more_invoices = gets.chomp.split
|
42
|
-
return (more_invoices + invoices)
|
46
|
+
return (more_invoices + invoices).uniq
|
43
47
|
else
|
44
|
-
return invoices
|
48
|
+
return invoices.uniq
|
45
49
|
end
|
46
50
|
end
|
47
51
|
|
@@ -61,7 +65,6 @@ module Sunnyside
|
|
61
65
|
manual_invoices
|
62
66
|
end
|
63
67
|
end
|
64
|
-
|
65
68
|
end
|
66
69
|
|
67
70
|
def invoices_exist?(invoices)
|
File without changes
|
data/lib/sunnyside/ftp.rb
CHANGED
File without changes
|
File without changes
|
data/lib/sunnyside/ledger/edi.rb
CHANGED
@@ -1,175 +1,175 @@
|
|
1
|
-
module Sunnyside
|
2
|
-
def self.edi_parser
|
3
|
-
print "checking for new files...\n"
|
4
|
-
Dir["#{DRIVE}/sunnyside-files/835/*.txt"].each do |file|
|
5
|
-
|
6
|
-
if Filelib.where(filename: file).count > 0
|
7
|
-
puts "This file has been processed already. File removed."
|
8
|
-
File.delete(file)
|
9
|
-
else
|
10
|
-
print "processing #{file}...\n"
|
11
|
-
file_data = File.open(file)
|
12
|
-
data = file_data.read
|
13
|
-
# Detect to see if the EDI file already has new lines inserted. If so, the newlines are removed before the file gets processed.
|
14
|
-
|
15
|
-
data.gsub!(/\n/, '')
|
16
|
-
|
17
|
-
data = data.split(/~CLP\*/)
|
18
|
-
|
19
|
-
edi_file = EdiReader.new(data)
|
20
|
-
edi_file.parse_claims
|
21
|
-
Filelib.insert(filename: file, purpose: '835')
|
22
|
-
file_data.close
|
23
|
-
FileUtils.mv(file, "#{DRIVE}/sunnyside-files/835/archive/#{File.basename(file)}")
|
24
|
-
end
|
25
|
-
end
|
26
|
-
end
|
27
|
-
|
28
|
-
class EdiReader
|
29
|
-
attr_reader :data
|
30
|
-
|
31
|
-
def initialize(data)
|
32
|
-
@data = data
|
33
|
-
end
|
34
|
-
|
35
|
-
def claims
|
36
|
-
data.select { |clm| clm =~ /^\d+/ }.map { |clm| clm.split(/~(?=SVC)/) }
|
37
|
-
end
|
38
|
-
|
39
|
-
def check_number
|
40
|
-
check = data[0][/(?<=~TRN\*\d\*)\w+/]
|
41
|
-
return check.include?('E') ? check[/\d+$/] : check
|
42
|
-
end
|
43
|
-
|
44
|
-
def check_total
|
45
|
-
data[0][/(?<=~BPR\*\w\*)[0-9\.\-]+/, 0]
|
46
|
-
end
|
47
|
-
|
48
|
-
def parse_claims
|
49
|
-
payment_id = Payment.insert(check_number: check_number, check_total: check_total)
|
50
|
-
claims.each { |claim| ClaimParser.new(claim, payment_id).parse }
|
51
|
-
end
|
52
|
-
end
|
53
|
-
|
54
|
-
class ClaimParser < EdiReader
|
55
|
-
attr_reader :claim_header, :service_data, :payment_id
|
56
|
-
|
57
|
-
def initialize(claim, payment_id)
|
58
|
-
@claim_header = claim[0].split(/\*/)
|
59
|
-
@service_data = claim.select { |clm| clm =~ /^SVC/ }
|
60
|
-
@payment_id = Payment[payment_id]
|
61
|
-
end
|
62
|
-
|
63
|
-
def header
|
64
|
-
{
|
65
|
-
:invoice => claim_header[0],
|
66
|
-
:response_code => claim_header[1],
|
67
|
-
:billed => claim_header[2],
|
68
|
-
:paid => claim_header[3],
|
69
|
-
:units => claim_header[5], # 4 is not used - that is the patient responsibility amount
|
70
|
-
:claim_number => claim_header[6][/^\d+/]
|
71
|
-
}
|
72
|
-
end
|
73
|
-
|
74
|
-
def parse
|
75
|
-
claim = ClaimEntry.new(header)
|
76
|
-
claim_id = claim.to_db(payment_id)
|
77
|
-
service_data.each { |service| ServiceParser.new(service, claim_id).parse }
|
78
|
-
end
|
79
|
-
end
|
80
|
-
|
81
|
-
class ClaimEntry < EdiReader
|
82
|
-
attr_reader :invoice, :response_code, :billed, :paid, :units, :claim_number
|
83
|
-
|
84
|
-
def initialize(header = {})
|
85
|
-
@invoice = header[:invoice].gsub(/[OLD]/, 'O' => '0', 'D' => '8', 'L' => '1').gsub(/^0/, '')[0..5].to_i # for the corrupt SHP EDI files
|
86
|
-
@response_code = header[:response_code]
|
87
|
-
@billed = header[:billed]
|
88
|
-
@paid = header[:paid]
|
89
|
-
@units = header[:units]
|
90
|
-
@claim_number = header[:claim_number]
|
91
|
-
end
|
92
|
-
|
93
|
-
def to_db(payment)
|
94
|
-
payment.update(provider_id: inv.provider_id) if payment.provider_id.nil?
|
95
|
-
Claim.insert(
|
96
|
-
:invoice_id => invoice,
|
97
|
-
:payment_id => payment.id,
|
98
|
-
:client_id => inv.client_id,
|
99
|
-
:control_number => claim_number,
|
100
|
-
:paid => paid,
|
101
|
-
:billed => billed,
|
102
|
-
:status => response_code,
|
103
|
-
:provider_id => inv.provider_id,
|
104
|
-
:recipient_id => inv.recipient_id
|
105
|
-
)
|
106
|
-
end
|
107
|
-
|
108
|
-
def inv
|
109
|
-
Invoice[invoice]
|
110
|
-
end
|
111
|
-
end
|
112
|
-
|
113
|
-
class ServiceParser < EdiReader
|
114
|
-
attr_reader :service_line, :claim
|
115
|
-
|
116
|
-
def initialize(service_line, claim_id)
|
117
|
-
@service_line = service_line.split(/~/)
|
118
|
-
@claim = Claim[claim_id]
|
119
|
-
end
|
120
|
-
|
121
|
-
def dos
|
122
|
-
service_line.detect { |svc| svc =~ /^DTM/ }[/\w+$/]
|
123
|
-
end
|
124
|
-
|
125
|
-
def service_header
|
126
|
-
line = service_line[0].split(/\*/).drop(1)
|
127
|
-
if line.length == 7 || line[1] != line[2]
|
128
|
-
return line.uniq
|
129
|
-
else
|
130
|
-
return line
|
131
|
-
end
|
132
|
-
end
|
133
|
-
|
134
|
-
def error_codes
|
135
|
-
service_line.find_all { |section| section =~ /^CAS|^SE/ }.map { |code| code[/\w+\*\w+\*(\d+)/, 1] }
|
136
|
-
end
|
137
|
-
|
138
|
-
def parse
|
139
|
-
service = ServiceEntry.new(service_header, dos, error_codes)
|
140
|
-
service.to_db(claim)
|
141
|
-
end
|
142
|
-
end
|
143
|
-
|
144
|
-
class ServiceEntry < EdiReader
|
145
|
-
attr_reader :paid, :billed, :service_code, :units, :res_code, :error_codes, :dos
|
146
|
-
|
147
|
-
def initialize(service_header, dos, error_codes)
|
148
|
-
@service_code, @billed, @paid, @res_code, @units = service_header
|
149
|
-
@dos = Date.parse(dos)
|
150
|
-
@error_codes = error_codes.map { |id| Denial[id].denial_explanation }
|
151
|
-
end
|
152
|
-
|
153
|
-
def to_db(claim)
|
154
|
-
Service.insert(
|
155
|
-
:claim_id => claim.id,
|
156
|
-
:invoice_id => claim.invoice_id,
|
157
|
-
:payment_id => claim.payment_id,
|
158
|
-
:denial_reason => denial_reason,
|
159
|
-
:service_code => service_code.gsub(/HC:/, ''),
|
160
|
-
:paid => paid,
|
161
|
-
:billed => billed,
|
162
|
-
:units => units,
|
163
|
-
:dos => dos
|
164
|
-
)
|
165
|
-
end
|
166
|
-
|
167
|
-
def denial_reason
|
168
|
-
error_codes.join("\n") if denied?
|
169
|
-
end
|
170
|
-
|
171
|
-
def denied?
|
172
|
-
paid != billed
|
173
|
-
end
|
174
|
-
end
|
1
|
+
module Sunnyside
|
2
|
+
def self.edi_parser
|
3
|
+
print "checking for new files...\n"
|
4
|
+
Dir["#{DRIVE}/sunnyside-files/835/*.txt"].each do |file|
|
5
|
+
|
6
|
+
if Filelib.where(filename: file).count > 0
|
7
|
+
puts "This file has been processed already. File removed."
|
8
|
+
File.delete(file)
|
9
|
+
else
|
10
|
+
print "processing #{file}...\n"
|
11
|
+
file_data = File.open(file)
|
12
|
+
data = file_data.read
|
13
|
+
# Detect to see if the EDI file already has new lines inserted. If so, the newlines are removed before the file gets processed.
|
14
|
+
|
15
|
+
data.gsub!(/\n/, '')
|
16
|
+
|
17
|
+
data = data.split(/~CLP\*/)
|
18
|
+
|
19
|
+
edi_file = EdiReader.new(data)
|
20
|
+
edi_file.parse_claims
|
21
|
+
Filelib.insert(filename: File.basename(file), purpose: '835')
|
22
|
+
file_data.close
|
23
|
+
FileUtils.mv(file, "#{DRIVE}/sunnyside-files/835/archive/#{File.basename(file)}")
|
24
|
+
end
|
25
|
+
end
|
26
|
+
end
|
27
|
+
|
28
|
+
class EdiReader
|
29
|
+
attr_reader :data
|
30
|
+
|
31
|
+
def initialize(data)
|
32
|
+
@data = data
|
33
|
+
end
|
34
|
+
|
35
|
+
def claims
|
36
|
+
data.select { |clm| clm =~ /^\d+/ }.map { |clm| clm.split(/~(?=SVC)/) }
|
37
|
+
end
|
38
|
+
|
39
|
+
def check_number
|
40
|
+
check = data[0][/(?<=~TRN\*\d\*)\w+/]
|
41
|
+
return check.include?('E') ? check[/\d+$/] : check
|
42
|
+
end
|
43
|
+
|
44
|
+
def check_total
|
45
|
+
data[0][/(?<=~BPR\*\w\*)[0-9\.\-]+/, 0]
|
46
|
+
end
|
47
|
+
|
48
|
+
def parse_claims
|
49
|
+
payment_id = Payment.insert(check_number: check_number, check_total: check_total)
|
50
|
+
claims.each { |claim| ClaimParser.new(claim, payment_id).parse }
|
51
|
+
end
|
52
|
+
end
|
53
|
+
|
54
|
+
class ClaimParser < EdiReader
|
55
|
+
attr_reader :claim_header, :service_data, :payment_id
|
56
|
+
|
57
|
+
def initialize(claim, payment_id)
|
58
|
+
@claim_header = claim[0].split(/\*/)
|
59
|
+
@service_data = claim.select { |clm| clm =~ /^SVC/ }
|
60
|
+
@payment_id = Payment[payment_id]
|
61
|
+
end
|
62
|
+
|
63
|
+
def header
|
64
|
+
{
|
65
|
+
:invoice => claim_header[0],
|
66
|
+
:response_code => claim_header[1],
|
67
|
+
:billed => claim_header[2],
|
68
|
+
:paid => claim_header[3],
|
69
|
+
:units => claim_header[5], # 4 is not used - that is the patient responsibility amount
|
70
|
+
:claim_number => claim_header[6][/^\d+/]
|
71
|
+
}
|
72
|
+
end
|
73
|
+
|
74
|
+
def parse
|
75
|
+
claim = ClaimEntry.new(header)
|
76
|
+
claim_id = claim.to_db(payment_id)
|
77
|
+
service_data.each { |service| ServiceParser.new(service, claim_id).parse }
|
78
|
+
end
|
79
|
+
end
|
80
|
+
|
81
|
+
class ClaimEntry < EdiReader
|
82
|
+
attr_reader :invoice, :response_code, :billed, :paid, :units, :claim_number
|
83
|
+
|
84
|
+
def initialize(header = {})
|
85
|
+
@invoice = header[:invoice].gsub(/[OLD]/, 'O' => '0', 'D' => '8', 'L' => '1').gsub(/^0/, '')[0..5].to_i # for the corrupt SHP EDI files
|
86
|
+
@response_code = header[:response_code]
|
87
|
+
@billed = header[:billed]
|
88
|
+
@paid = header[:paid]
|
89
|
+
@units = header[:units]
|
90
|
+
@claim_number = header[:claim_number]
|
91
|
+
end
|
92
|
+
|
93
|
+
def to_db(payment)
|
94
|
+
payment.update(provider_id: inv.provider_id) if payment.provider_id.nil?
|
95
|
+
Claim.insert(
|
96
|
+
:invoice_id => invoice,
|
97
|
+
:payment_id => payment.id,
|
98
|
+
:client_id => inv.client_id,
|
99
|
+
:control_number => claim_number,
|
100
|
+
:paid => paid,
|
101
|
+
:billed => billed,
|
102
|
+
:status => response_code,
|
103
|
+
:provider_id => inv.provider_id,
|
104
|
+
:recipient_id => inv.recipient_id
|
105
|
+
)
|
106
|
+
end
|
107
|
+
|
108
|
+
def inv
|
109
|
+
Invoice[invoice]
|
110
|
+
end
|
111
|
+
end
|
112
|
+
|
113
|
+
class ServiceParser < EdiReader
|
114
|
+
attr_reader :service_line, :claim
|
115
|
+
|
116
|
+
def initialize(service_line, claim_id)
|
117
|
+
@service_line = service_line.split(/~/)
|
118
|
+
@claim = Claim[claim_id]
|
119
|
+
end
|
120
|
+
|
121
|
+
def dos
|
122
|
+
service_line.detect { |svc| svc =~ /^DTM/ }[/\w+$/]
|
123
|
+
end
|
124
|
+
|
125
|
+
def service_header
|
126
|
+
line = service_line[0].split(/\*/).drop(1)
|
127
|
+
if line.length == 7 || line[1] != line[2]
|
128
|
+
return line.uniq
|
129
|
+
else
|
130
|
+
return line
|
131
|
+
end
|
132
|
+
end
|
133
|
+
|
134
|
+
def error_codes
|
135
|
+
service_line.find_all { |section| section =~ /^CAS|^SE/ }.map { |code| code[/\w+\*\w+\*(\d+)/, 1] }
|
136
|
+
end
|
137
|
+
|
138
|
+
def parse
|
139
|
+
service = ServiceEntry.new(service_header, dos, error_codes)
|
140
|
+
service.to_db(claim)
|
141
|
+
end
|
142
|
+
end
|
143
|
+
|
144
|
+
class ServiceEntry < EdiReader
|
145
|
+
attr_reader :paid, :billed, :service_code, :units, :res_code, :error_codes, :dos
|
146
|
+
|
147
|
+
def initialize(service_header, dos, error_codes)
|
148
|
+
@service_code, @billed, @paid, @res_code, @units = service_header
|
149
|
+
@dos = Date.parse(dos)
|
150
|
+
@error_codes = error_codes.map { |id| Denial[id].denial_explanation }
|
151
|
+
end
|
152
|
+
|
153
|
+
def to_db(claim)
|
154
|
+
Service.insert(
|
155
|
+
:claim_id => claim.id,
|
156
|
+
:invoice_id => claim.invoice_id,
|
157
|
+
:payment_id => claim.payment_id,
|
158
|
+
:denial_reason => denial_reason,
|
159
|
+
:service_code => service_code.gsub(/HC:/, ''),
|
160
|
+
:paid => paid,
|
161
|
+
:billed => billed,
|
162
|
+
:units => units,
|
163
|
+
:dos => dos
|
164
|
+
)
|
165
|
+
end
|
166
|
+
|
167
|
+
def denial_reason
|
168
|
+
error_codes.join("\n") if denied?
|
169
|
+
end
|
170
|
+
|
171
|
+
def denied?
|
172
|
+
paid != billed
|
173
|
+
end
|
174
|
+
end
|
175
175
|
end
|