Class: ChangeHealth::Response::Claim::Report835Data

Inherits:
ReportData show all
Defined in:
lib/change_health/response/claim/report/report_835_data.rb

Overview

Methods only return meaningful data for json reports

Instance Attribute Summary

Attributes inherited from ReportData

#json, #report_name

Attributes inherited from ResponseData

#raw, #response

Instance Method Summary collapse

Methods inherited from ReportData

#edi?, #initialize, #is_277?, is_277?, #is_835?, is_835?, #presence, #report_type, report_type

Methods inherited from ResponseData

#errors, #errors?, #initialize, #recommend_retry?, #server_error

Constructor Details

This class inherits a constructor from ChangeHealth::Response::Claim::ReportData

Instance Method Details

#claims ⇒ Object 



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# File 'lib/change_health/response/claim/report/report_835_data.rb', line 23

def claims
  payments.flat_map(&:claims).compact
end

#payer_identification ⇒ Object 



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# File 'lib/change_health/response/claim/report/report_835_data.rb', line 10

def payer_identification
  transactions&.first&.dig('payer', 'payerIdentificationNumber')
end

#payer_name ⇒ Object

Only one payer per report



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# File 'lib/change_health/response/claim/report/report_835_data.rb', line 15

def payer_name
  transactions&.first&.dig('payer')&.dig('name')
end

#payments ⇒ Object 



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# File 'lib/change_health/response/claim/report/report_835_data.rb', line 27

def payments
  report_payments = []

  transactions&.each do |transaction|
    payment_id = transaction.dig('id')
    check_or_eft_trace_number = transaction.dig('paymentAndRemitReassociationDetails', 'checkOrEFTTraceNumber')
    check_issue_or_eft_effective_date =
      ChangeHealth::Models::PARSE_DATE.call(
        transaction.dig('financialInformation', 'checkIssueOrEFTEffectiveDate')
      )
    payer_identifier = transaction.dig('financialInformation', 'payerIdentifier')
    payment_method_code = transaction.dig('financialInformation', 'paymentMethodCode')
    payer_address = transaction.dig('payer', 'address')
    provider_adjustments = transaction['providerAdjustments']&.map do |provider_adjustment|
      adjustments = provider_adjustment['adjustments']&.map do |adjustment|
        {
          amount: adjustment['providerAdjustmentAmount'],
          identifier: adjustment['providerAdjustmentIdentifier'],
          reason_code: adjustment['adjustmentReasonCode']
        }
      end
      Report835ProviderAdjustment.new(
        adjustments: adjustments,
        fiscal_period_date: ChangeHealth::Models::PARSE_DATE.call(provider_adjustment['fiscalPeriodDate']),
        provider_identifier: provider_adjustment['providerIdentifier']
      )
    end

    report_creation_date = ChangeHealth::Models::PARSE_DATE.call(transaction['productionDate'])
    total_actual_provider_payment_amount =
      transaction.dig('financialInformation', 'totalActualProviderPaymentAmount')
    claims = transaction['detailInfo']&.flat_map do |detail_info|
      claim_id = detail_info.dig('id')
      detail_info['paymentInfo']&.map do |payment_info|
        claim_payment_amount = payment_info.dig('claimPaymentInfo', 'claimPaymentAmount')
        claim_status_code = payment_info.dig('claimPaymentInfo', 'claimStatusCode')
        patient_control_number = payment_info.dig('claimPaymentInfo', 'patientControlNumber')
        patient_first_name = payment_info.dig('patientName', 'firstName')
        patient_last_name = payment_info.dig('patientName', 'lastName')
        patient_member_id =
          presence(payment_info.dig('patientName', 'memberId')) ||
          presence(payment_info.dig('subscriber', 'memberId'))
        payer_claim_control_number = payment_info.dig('claimPaymentInfo', 'payerClaimControlNumber')
        service_provider_npi =
          presence(payment_info.dig('renderingProvider', 'npi')) ||
          presence(detail_info.dig('providerSummaryInformation', 'providerIdentifier')) ||
          presence(transaction.dig('payee', 'npi'))
        total_charge_amount = payment_info.dig('claimPaymentInfo', 'totalClaimChargeAmount')

        claim_payment_remark_codes = []
        claim_payment_remark_codes_index = 1

        loop do
          current_claim_payment_remark_code = payment_info
                                              .dig(
                                                'outpatientAdjudication',
                                                "claimPaymentRemarkCode#{claim_payment_remark_codes_index}"
                                              )
          break unless presence(current_claim_payment_remark_code)

          claim_payment_remark_codes << current_claim_payment_remark_code
          claim_payment_remark_codes_index += 1
        end

        claim_adjustments = adjustments(payment_info['claimAdjustments'])

        service_date_begin = nil
        service_date_end = nil
        service_lines = payment_info['serviceLines']&.map do |service_line|
          service_line_date = ChangeHealth::Models::PARSE_DATE.call(service_line['serviceDate'])
          unless service_line_date.nil?
            if service_date_begin.nil? || service_line_date < service_date_begin
              service_date_begin = service_line_date
            end
            if service_date_end.nil? || service_date_end < service_line_date
              service_date_end = service_line_date
            end
          end

          adjudicated_procedure_code = service_line.dig('servicePaymentInformation', 'adjudicatedProcedureCode')
          allowed_actual = service_line.dig('serviceSupplementalAmounts', 'allowedActual')
          line_item_charge_amount = service_line.dig('servicePaymentInformation', 'lineItemChargeAmount')
          line_item_provider_payment_amount = service_line.dig('servicePaymentInformation',
                                                               'lineItemProviderPaymentAmount')

          service_adjustments = adjustments(service_line['serviceAdjustments'])

          health_care_check_remark_codes = presence(service_line['healthCareCheckRemarkCodes']&.filter_map do |health_care_check_remark_code|
            remark_code = health_care_check_remark_code['remarkCode']
            next unless presence(remark_code)

            Report835HealthCareCheckRemarkCode.new(
              code_list_qualifier_code: health_care_check_remark_code['codeListQualifierCode'],
              code_list_qualifier_code_value: health_care_check_remark_code['codeListQualifierCodeValue'],
              remark_code: remark_code
            )
          end)

          Report835ServiceLine.new(
            adjudicated_procedure_code: adjudicated_procedure_code,
            allowed_actual: allowed_actual,
            line_item_charge_amount: line_item_charge_amount,
            line_item_provider_payment_amount: line_item_provider_payment_amount,
            service_adjustments: service_adjustments,
            health_care_check_remark_codes: health_care_check_remark_codes
          )
        end

        if service_date_begin.nil? && service_date_end.nil?
          service_date_begin = ChangeHealth::Models::PARSE_DATE.call(payment_info['claimStatementPeriodStart'])
          service_date_end = ChangeHealth::Models::PARSE_DATE.call(payment_info['claimStatementPeriodEnd'])
        end

        Report835Claim.new(
          claim_adjustments: claim_adjustments,
          claim_payment_amount: claim_payment_amount,
          claim_payment_remark_codes: claim_payment_remark_codes,
          claim_status_code: claim_status_code,
          id: claim_id,
          patient_control_number: patient_control_number,
          patient_first_name: patient_first_name,
          patient_last_name: patient_last_name,
          patient_member_id: patient_member_id,
          payer_claim_control_number: payer_claim_control_number,
          payer_identification: payer_identification,
          payer_name: payer_name,
          report_creation_date: report_creation_date,
          report_name: report_name,
          service_date_begin: service_date_begin,
          service_date_end: service_date_end,
          service_lines: service_lines,
          service_provider_npi: service_provider_npi,
          total_charge_amount: total_charge_amount
        )
      end
    end
    report_payments << Report835Payment.new(
      check_issue_or_eft_effective_date: check_issue_or_eft_effective_date,
      check_or_eft_trace_number: check_or_eft_trace_number,
      claims: claims,
      id: payment_id,
      payer_identifier: payer_identifier,
      payer_name: payer_name,
      payer_address: payer_address,
      payment_method_code: payment_method_code,
      provider_adjustments: provider_adjustments,
      report_creation_date: report_creation_date,
      report_name: report_name,
      total_actual_provider_payment_amount: total_actual_provider_payment_amount
    )
  end

  report_payments
end

#report_creation_date ⇒ Object 



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# File 'lib/change_health/response/claim/report/report_835_data.rb', line 19

def report_creation_date
  payments.map(&:report_creation_date).min
end

#transactions ⇒ Object 



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# File 'lib/change_health/response/claim/report/report_835_data.rb', line 6

def transactions
  @raw['transactions']
end