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https://github.com/goodmeasuresllc/trizetto-api

Ruby wrapper for Trizetto APIs
https://github.com/goodmeasuresllc/trizetto-api

insurance-eligibility ruby soap-client x12

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Ruby wrapper for Trizetto APIs

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README 

        
# Trizetto::Api



[![Build Status](https://travis-ci.org/GoodMeasuresLLC/trizetto-api.svg?branch=master)](https://travis-ci.org/GoodMeasuresLLC/trizetto-api)



Ruby wrapper for Trizetto APIs for Ruby 2.3 and above.



## Installation



Requires Ruby 2.3 or above



Add this line, and maybe some others, to your application's Gemfile:



```ruby

gem 'trizetto-api'



# Savon-multipart is used in the CORE II API. savon-multipart 2.1.1 has the

# mail gem, pinned to exactly 2.5.4.  As of Jan 18, 2018, there is an

# unreleased version that uses ~> 2.6.  Depending on your existing gems

# you may need to add an explicit dependency on savon-multipart if bundle

# install fails with a mail gem dependency.

#

# You can savon-multipart, or use git diretly with one of the below

#

# savon-multipart as of Jan 18, 2018:

# gem 'savon-multipart', git: "[email protected]:savonrb/savon-multipart.git", ref: 'd9a138b6c166cd7c30c28e8888ff19011f8ec071'

#

# live on the edge

# gem 'savon-multipart', git: "[email protected]:savonrb/savon-multipart.git", branch: :master

#

# Your fork?

# gem 'savon-multipart', git: "[email protected]:YOU/savon-multipart.git"

```



And then execute:



    $ bundle



Or install it yourself as:



    $ gem install trizetto-api



## Usage



### Use the Eligibility Web Service with an XML payload to check eligibility in realtime



#### Fields



The Eligibility Web Service is poorly documented in the [Eligibility Web Service Companion Guide](https://mytools.gatewayedi.com/Help/documents/Eligibility/Realtime%20Eligibility%20Webservice%20Companion%20Guide.pdf).



The fields listed below are copied from the documentation and can be used to perform eligibility checks.



|Field| Description | Requirement |

|--|--|--|

| `GediPayerID` | The GEDI specific payer identifier | Always |

| `ProviderFirstName`  | Provider First Name | Required when individual provider name is sent in the inquiry |

| `ProviderLastName`   | Provider Last Name/Organization Name | |

| `NPI`                | National Provider Identifier  | |

| `InsuredFirstName`   | Subscriber First Name | Required when the patient is the subscriber or if the Payer requires this information to identify the patient. |

| `InsuredLastName`    | Subscriber Last Name | Required when the patient is the subscriber or if the Payer requires this information to identify the patient |

| `InsuranceNum`       |  | Required when the payer needs this information to identify patient. |

| `InsuredDob`         | Subscriber Date of birth (YYYYMMDD) | Required when the payer needs this information to identify patient. |

| `InsuredGender`      | Subscriber Gender (M) or (F) | Required when the payer needs this information to identify patient. |

| `ServiceTypeCode`    | Health Care Financing Administration Common Procedural Coding System Code | |

| `DependentFirstName` | Dependent First Name | |

| `DependentLastName`  | Dependent Last Name | |

| `DependentDob`       | Dependent Date of Birth (YYYYMMDD) | |

| `DependentGender`    | Dependent Gender (M) or (F) | |

| `DateOfService`      | Date of service to check for eligibiltiy (YYYYMMDD). **This field is not documented**  | |



#### Example

This uses name/value pairs in a request and returns an XML docunment as a response.



To simply check if the patient is covered by a health plan



```ruby

response = client.do_inquiry({...})

response.active_coverage_for?(service_type_code = "30")  #=> true | false

```



```ruby

require 'trizetto/api'



Trizetto::Api.configure do |config|

  config.username = ENV['TRIZETTO_USERNAME']

  config.password = ENV['TRIZETTO_PASSWORD']

end



client = Trizetto::Api::Eligibility::WebService::Client.new({

  # You probably don't want logging enable unless you are being very careful to protect PHI in logs

  # pretty_print_xml: true,

  # log: true,

  # log_level: :debug,

})



response = client.do_inquiry({

  'ProviderLastName': 'YOUR_COMPANY_NAME',

  'NPI':              'YOUR NPI HERE',

  'InsuredFirstName': 'Mickey',

  'InsuredLastName':  'Mouse',

  'InsuredDob':       '19281118',

  'GediPayerId':      'N4222',

})



# Were there validation errors with the request?

response.success?                                          # => false

response.success_code                                      # => "ValidationFailure"

response.errors.messages                                   # => ["Please enter InsuranceNum."]

response.errors.validation_failures.first.affected_fields  # => ["InsuranceNum"]

response.errors.validation_failures.first.message          # => "Please enter InsuranceNum."



# Did we successfully get back an eligibility response from the payer.

response.success?                   # => true

response.success_code               # => "Success"

response.transaction_id             # => "c6eb40c5584f0496be3f3a48d0ddfd"

response.trace_number               # => "88213481"

response.payer_name                 # => "BLUE CROSS BLUE SHIELD OF MASSACHUSETTS"

response.active_coverage_for?("30") # => true



# Did the response have group number for the subscriber or dependent?

response.subscriber&.group_number || response.dependent&.group_number  # => "999999999A6AG999"



# What is the subscriber's member number?

response.subscriber.id  # => "XXP123456789"



# Was the response rejected? We got back an eligibility response, but probably the patient wasn't found

response.success?                          # => true

response.success_code                      # => "Success"

response.active_coverage_for?("30")        # => false

response.rejected?                         # => true

response.rejections.count                  # => 1

response.rejections.first.reason           # => "Patient Birth Date Does Not Match That for the Patient on the Database"

response.rejections.first.follow_up_action # => "Please Correct and Resubmit"



# What active insurance coverages of service_type_code=30 does this patient have?

coverages = response.patient.benefits.select {|benefit| benefit.active_coverage? && benefit.service_type_codes.include?("30")}

coverages.count                # => 2

coverages.first.insurance_type # => "Preferred Provider Organization (PPO)"

coverages.last.insurance_type  # => "Medicare Part A"

coverages.first.messages       # => nil

coverages.last.messages        # => ["BCBSMA IS PRIME"]



# Find all the benefit information for service_type_code=30

benefits = response.patient.benefits.select {|benefit| benefit.service_type_codes.include?("30")}



benefits.map(&:info).uniq # => ["Active Coverage", "Deductible", "Coverage Basis", "Out of Pocket (Stop Loss)", "Services Restricted to Following Provider"]



```



### Use the CORE2 API with an X12 payload to check eligibility in realtime



This returns an X12/271 response.  You will need to understand how to build

X12/270 requests and parse X12/271 responses.



```ruby



require 'trizetto/api'



Trizetto::Api.configure do |config|

  config.username = ENV['TRIZETTO_USERNAME']

  config.password = ENV['TRIZETTO_PASSWORD']

end



client = Trizetto::Api::Eligibility::Core2.new

client.check_eligibility(payload: x12_message)

```



### Ping the Payer List endpoint to see if it is up



```ruby

require 'trizetto/api'



Trizetto::Api.configure do |config|

  config.username = ENV['TRIZETTO_USERNAME']

  config.password = ENV['TRIZETTO_PASSWORD']

end



client = Trizetto::Api::PayerList::WebService.new({

  pretty_print_xml: true,

  log: true,

  log_level: :debug,

})



response = client.ping

```



### Fetch the Payer List



**This API times out or errors out on the Trizetto server**.  But you may get it to work.



```ruby

require 'trizetto/api'



Trizetto::Api.configure do |config|

  config.username = ENV['TRIZETTO_USERNAME']

  config.password = ENV['TRIZETTO_PASSWORD']

end



client = Trizetto::Api::PayerList::WebService.new({

  pretty_print_xml: true,

  log: true,

  log_level: :debug,

  read_timeout: 60*5 # 5 minutes

})



response = client.payer_list



```



## Development



After checking out the repo, run `bin/setup` to install dependencies. Then, run `rake spec` to run the tests. You can also run `bin/console` for an interactive prompt that will allow you to experiment.



To install this gem onto your local machine, run `bundle exec rake install`. To release a new version, update the version number in `version.rb`, and then run `bundle exec rake release`, which will create a git tag for the version, push git commits and tags, and push the `.gem` file to [rubygems.org](https://rubygems.org).



## Contributing



Bug reports and pull requests are welcome on GitHub at https://github.com/GoodMeasuresLLC/trizetto-api. This project is intended to be a safe, welcoming space for collaboration, and contributors are expected to adhere to the [Contributor Covenant](http://contributor-covenant.org) code of conduct.



## License



The gem is available as open source under the terms of the [MIT License](https://opensource.org/licenses/MIT).



## Code of Conduct



Everyone interacting in the Trizetto::Api project’s codebases, issue trackers, chat rooms and mailing lists is expected to follow the [code of conduct](https://github.com/GoodMeasuresLLC/trizetto-api/blob/master/CODE_OF_CONDUCT.md).