medicafe 0.250711.1__py3-none-any.whl → 0.250720.0__py3-none-any.whl

MediLink/MediLink_837p_encoder.py

@@ -4,6 +4,8 @@ from datetime import datetime
 import MediLink_ConfigLoader
 from MediLink_DataMgmt import parse_fixed_width_data, read_fixed_width_data
 import MediLink_837p_encoder_library
+# TODO (COB ENHANCEMENT): Import COB library when implementing Medicare and secondary claim support
+# import MediLink_837p_cob_library
 #from tqdm import tqdm
 
 def format_single_claim(patient_data, config, endpoint, transaction_set_control_number, crosswalk, client):
@@ -46,7 +48,18 @@ def format_single_claim(patient_data, config, endpoint, transaction_set_control_
     
     # Subscriber information, possibly including endpoint-specific logic
     segments.extend(MediLink_837p_encoder_library.create_hl_subscriber_segment())
+    
+    # TODO (COB ENHANCEMENT): Enhanced SBR segment creation for COB scenarios
+    # Replace the standard SBR segment creation with enhanced COB-aware version
+    # Current: segments.append(MediLink_837p_encoder_library.create_sbr_segment(config, patient_data, endpoint))
+    # Enhanced: 
+    # if patient_data.get('claim_type') == 'secondary':
+    #     enhanced_sbr = MediLink_837p_cob_library.create_enhanced_sbr_segment(patient_data, config, crosswalk)
+    #     segments.append(enhanced_sbr)
+    # else:
+    #     segments.append(MediLink_837p_encoder_library.create_sbr_segment(config, patient_data, endpoint))
     segments.append(MediLink_837p_encoder_library.create_sbr_segment(config, patient_data, endpoint))
+    
     segments.append(MediLink_837p_encoder_library.create_nm1_subscriber_segment(config, patient_data, endpoint))
     segments.extend(MediLink_837p_encoder_library.create_subscriber_address_segments(patient_data))
     segments.append(MediLink_837p_encoder_library.create_dmg_segment(patient_data))
@@ -58,9 +71,36 @@ def format_single_claim(patient_data, config, endpoint, transaction_set_control_
     segments.extend([MediLink_837p_encoder_library.create_2010BB_payer_information_segment(patient_data)])
     #segments.extend(MediLink_837p_encoder_library.create_payer_address_segments(config)) OMITTED
     
+    # TODO (COB ENHANCEMENT): COB processing for secondary claims and Medicare adjudication
+    # See MediLink_837p_cob_library.process_cob_claim() for complete COB implementation
+    # This would include:
+    # - Enhanced SBR segments with Medicare payer types (MB/MA)
+    # - 2320 loop for other subscriber information
+    # - 2330B loop for prior payer (Medicare) information
+    # - 2330C loop when patient != subscriber
+    # - 2430 loop for service-level COB adjudication
+    # - PWK segments for attachment references
+    # 
+    # Integration point for COB processing:
+    # if patient_data.get('claim_type') == 'secondary' or patient_data.get('requires_cob_processing'):
+    #     cob_segments = MediLink_837p_cob_library.process_cob_claim(patient_data, config, crosswalk, client)
+    #     segments.extend(cob_segments)
+    
     # Rendering Provider (2310B Loop)
     segments.extend(MediLink_837p_encoder_library.create_nm1_rendering_provider_segment(config))
     
+    # TODO (COB ENHANCEMENT): Enhanced CLM segment creation for COB claims
+    # Replace standard CLM creation with COB-aware version
+    # Current: segments.extend(MediLink_837p_encoder_library.create_clm_and_related_segments(patient_data, config, crosswalk))
+    # Enhanced:
+    # if patient_data.get('claim_type') == 'secondary':
+    #     enhanced_clm = MediLink_837p_cob_library.create_enhanced_clm_segment(patient_data, config, crosswalk)
+    #     segments.append(enhanced_clm)
+    #     # Add service line segments separately for COB
+    #     segments.extend(MediLink_837p_encoder_library.create_service_line_segments(patient_data, config, crosswalk))
+    # else:
+    #     segments.extend(MediLink_837p_encoder_library.create_clm_and_related_segments(patient_data, config, crosswalk))
+    
     # Claim information 2300, 2310C Service Facility and 2400 loop segments
     segments.extend(MediLink_837p_encoder_library.create_clm_and_related_segments(patient_data, config, crosswalk))
 

MediLink/MediLink_837p_encoder_library.py

@@ -159,7 +159,7 @@ def create_1000A_submitter_name_segment(patient_data, config, endpoint):
     
     # Construct PER segment for the submitter's contact information
     per_segment = "PER*IC*{}*TE*{}~".format(contact_name, contact_telephone_number)
-
+    
     return [nm1_segment, per_segment]
 
 # Constructs the NM1 segment for the receiver (1000B).
@@ -539,6 +539,12 @@ def create_sbr_segment(config, parsed_data, endpoint):
     # Insurance Type Code
     insurance_type_code = insurance_type_selection(parsed_data)
 
+    # TODO (COB ENHANCEMENT): Enhanced SBR segment for Medicare and COB support
+    # For Medicare Part B: SBR09 = "MB"
+    # For Medicare Advantage: SBR09 = "MA" 
+    # For secondary claims: SBR01 = "S"
+    # See MediLink_837p_cob_library.create_enhanced_sbr_segment() for implementation
+
     # Construct the SBR segment using the determined codes
     sbr_segment = "SBR*{responsibility_code}*18*******{insurance_type_code}~".format(
         responsibility_code=responsibility_code,
@@ -591,6 +597,12 @@ def insurance_type_selection(parsed_data):
     # Retrieve insurance options with codes and descriptions
     config, _ = MediLink_ConfigLoader.load_configuration()
     insurance_options = config['MediLink_Config'].get('insurance_options')
+    
+    # TODO (COB ENHANCEMENT): Enhanced insurance options for Medicare support
+    # See MediLink_837p_cob_library.get_enhanced_insurance_options() for Medicare codes:
+    # - MB: Medicare Part B
+    # - MA: Medicare Advantage  
+    # - MC: Medicare Part C
 
     def prompt_display_insurance_options():
         # Prompt to display full list
@@ -705,6 +717,14 @@ def create_clm_and_related_segments(parsed_data, config, crosswalk):
     Service Line Information (2400 Loop):
     Verify that the service line number (LX), professional service (SV1), and service date (DTP) segments contain
     accurate information and are formatted according to the claim's details.
+    
+    TODO (COB ENHANCEMENT): This function needs enhancement for COB scenarios:
+    1. Enhanced CLM segment with proper claim frequency (CLM05-3)
+    2. Support for service-level COB adjudication (2430 loop)
+    3. Integration with 835-derived adjudication data
+    4. PWK segment support for attachments
+    
+    See MediLink_837p_cob_library.create_enhanced_clm_segment() for enhanced implementation.
     """
     
     segments = []
@@ -715,15 +735,22 @@ def create_clm_and_related_segments(parsed_data, config, crosswalk):
     formatted_claim_number = format_claim_number(chart_number, date_of_service)
         
     # CLM - Claim Information
-    segments.append("CLM*{}*{}***{}:B:1*Y*A*Y*Y~".format(
+    # TODO (COB ENHANCEMENT): Enhanced claim frequency handling
+    # For COB claims, CLM05-3 should be "1" (original) unless replacement logic applies
+    claim_frequency = "1"  # Default to original
+    # if parsed_data.get('claim_type') == 'secondary':
+    #     claim_frequency = "1"  # Original for secondary claims
+    
+    segments.append("CLM*{}*{}***{}:B:{}*Y*A*Y*Y~".format(
         formatted_claim_number,
         parsed_data['AMOUNT'],
-        parsed_data['TOS']))
+        parsed_data['TOS'],
+        claim_frequency))
     
     # HI - Health Care Diagnosis Code
     # Hardcoding "ABK" for ICD-10 codes as they are the only ones used now.
     medisoft_code = ''.join(filter(str.isalnum, parsed_data['DIAG']))
-    diagnosis_code = next((key for key, value in crosswalk.get('diagnosis_to_medisoft', {}).items() if value == medisoft_code), None) 
+    diagnosis_code = next((key for key, value in crosswalk.get('diagnosis_to_medisoft', {}).items() if value == medisoft_code), None)
     
     if diagnosis_code is None:
         error_message = "Diagnosis code is empty for chart number: {}. Please verify. Medisoft code is {}".format(chart_number, medisoft_code)
@@ -743,8 +770,21 @@ def create_clm_and_related_segments(parsed_data, config, crosswalk):
     segments.extend(create_service_facility_location_npi_segment(config))
     
     # For future reference, SBR - (Loop 2320: OI, NM1 (2330A), N3, N4, NM1 (2330B)) - Other Subscriber Information goes here.
-    
-    # LX - Service Line Number
+    # TODO (COB ENHANCEMENT): COB loops for secondary claims and Medicare adjudication
+    # See MediLink_837p_cob_library for implementation of:
+    # - create_2320_other_subscriber_segments() for secondary payer info
+    # - create_2330B_prior_payer_segments() for Medicare prior payer
+    # - create_2430_service_line_cob_segments() for service-level adjudication
+    # - create_2330C_other_subscriber_name_segments() when patient != subscriber
+    # TODO (COB ENHANCEMENT): Optional attachment references (PWK) for non-electronic EOB handling
+    # See MediLink_837p_cob_library.create_pwk_attachment_segment() for implementation
+    # Example: PWK*EB*FX*123456~ for attachment control number
+    # if parsed_data.get('requires_attachment'):
+    #     pwk_segment = MediLink_837p_cob_library.create_pwk_attachment_segment(parsed_data, config)
+    #     if pwk_segment:
+    #         segments.append(pwk_segment)
+    
+    # LX - Service Line Counter
     segments.append("LX*1~")
     
     # SV1 - Professional Service
@@ -762,6 +802,14 @@ def create_clm_and_related_segments(parsed_data, config, crosswalk):
     # 6R - Provider Control Number (Number assigned by information provider company for tracking and billing purposes)
     # 1 - Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier
     
+
+    # TODO (COB ENHANCEMENT): Service-level COB adjudication (2430 loop)
+    # See MediLink_837p_cob_library.create_2430_service_line_cob_segments() for implementation
+    # This would include SVD, CAS, and DTP*573 segments for service-level adjudication
+    # if parsed_data.get('service_adjudications'):
+    #     cob_segments = MediLink_837p_cob_library.create_2430_service_line_cob_segments(parsed_data, config, crosswalk)
+    #     segments.extend(cob_segments)
+    
     return segments
 
 def get_endpoint_config(config, endpoint):

MediLink/MediLink_ClaimStatus.py

@@ -21,9 +21,10 @@ start_date_str = start_date.strftime('%m/%d/%Y')
 billing_provider_tin = config['MediLink_Config'].get('billing_provider_tin')
 
 # Define the list of payer_id's to iterate over
-payer_ids = ['87726']  # Default value, getting a bad request error when trying to get all payer_ids.
-# Allowed payer id's for UHC
-# payer_ids = ['87726', '03432', '96385', '95467', '86050', '86047', '95378', '06111', '37602']
+payer_ids = ['87726'] # Default Value
+# Allowed payer id's for UHC 87726, 03432, 96385, 95467, 86050, 86047, 95378, 37602. This api does not support payerId 06111.
+# payer_ids = ['87726', '03432', '96385', '95467', '86050', '86047', '95378', '37602']
+# Oddly enough, the API is completely ignoring the payerId parameter and returning the exact same dataset for all payer IDs. 
 
 # Initialize the API client
 client = MediLink_API_v3.APIClient()