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Eligible

Ruby bindings for the Eligible API

Installation

Add this line to your application's Gemfile:

gem 'eligible'

And then execute:

$ bundle

Or install it yourself with:

$ gem install eligible

Important notes

Payer List for Eligibility

the parameter payer_id, required for most of the api calls, is provided by EligibleAPI from its website, in xml and json format, which you can embed into your applications.

https://eligibleapi.com/resources/information-sources.xml https://eligibleapi.com/resources/information-sources.json

Payer List for Claims

the parameter payer_id, required for claims, is provided by EligibleAPI from its website, in xml and json format, which you can embed into your applications.

https://eligibleapi.com/resources/claims-payer.xml https://eligibleapi.com/resources/claims-payer.json

Service Type Codes

the parameter service_type, required on the api calls, is provided by EligibleAPI from its website, in xml and json format, which you can embed into your applications. https://eligibleapi.com/resources/service-codes.xml https://eligibleapi.com/resources/service-codes.json](ttps://eligibleapi.com/resources/service-codes.json)

Place of Service

https://eligibleapi.com/resources/place_of_service.json

Health Care Provider Taxonomy

https://eligibleapi.com/resources/health-care-provider-taxonomy-code-set.json

Usage

Setup

    require 'eligible'
    Eligible.api_key = 'YOUR_KEY'

Test

Eligible.test = true

Parameters overwrite

On each api call, you can overwrite the api key or the test parameter, i.e.

   Eligible::Demographic.get({:api_key => 'NEW_KEY', :test => false})

Response Format

By default, all the responses came in JSON, but you can request raw access to X12 by adding is as a parameter on the api call.

   Eligible::Demographic.get({:format => "x12"})

Api Call Results

On all the results, you can check for errors in result.error, you can get get the raw json format in a has by using result.to_hash.

demographic = Eligible::Demographic.get(params)
demographic.error
demographic.to_hash

Coverage

Reference

https://eligibleapi.com/rest-api-v1-1/coverage-all#apiCoverageInfo

Retrieve eligibility & benefit information

params = {
  :service_type => "33",
  :network => "OUT",
  :payer_id   => "000001",
  :provider_last_name => "Last",
  :provider_first_name => "First",
  :provider_npi => "12345678",
  :member_id => "12345678",
  :member_last_name => "Austen",
  :member_first_name => "Jane",
  :member_dob => "1955-12-14"
}

coverage = Eligible::Coverage.get(params)
coverage.to_hash # returns all coverage info for the request
coverage.error   # return error, if any

Demographic

Reference

https://eligibleapi.com/rest-api-v1-1/demographic-all#apiDemographics

Fetch demographics for a patient

params = {
  :payer_name => "Aetna",
  :payer_id   => "000001",
  :provider_last_name => "Last",
  :provider_first_name => "First",
  :provider_npi => "12345678",
  :member_id => "12345678",
  :member_last_name => "Austen",
  :member_first_name => "Jane",
  :member_dob => "1955-12-14"
}

demographic = Eligible::Demographic.get(params)
demographic.to_hash # returns all coverage info for the request
demographic.error   # return error, if any

Medicare

Reference

https://github.com/EligibleAPI/tools/wiki/Medicare

Retrieve eligibility & benefit information from CMS Medicare for a patient.

params = {
  :payer_id   => "000001",
  :provider_last_name => "Last",
  :provider_first_name => "First",
  :provider_npi => "12345678",
  :member_id => "12345678",
  :member_last_name => "Austen",
  :member_first_name => "Jane",
  :member_dob => "1955-12-14"
}
medicare = Eligible::Medicare.get(params)
medicare.to_hash # returns all coverage info for the request
medicare.error   # return error, if any

Batch API

Reference

https://github.com/EligibleAPI/tools/wiki/Batch-Api

Its important to notice that all the batch api calls, will notify the results by a webhook.

You can setup a webhook in your Dashboard.

All the batch api calls, returns a reference_id value and the number_of_items submitted.

Coverage Batch API

params = {
    "api_key"=>"81ef98e5-4584-19fb-0d8c-6e987b95d695",
    "parameters"=>[
        {
            "id"=>1,
            "payer_name"=>"UnitedHealthCare",
            "payer_id"=>"00112",
            "service_provider_npi"=>"12341234",
            "subscriber_id"=>"98769876",
            "subscriber_first_name"=>"Jane",
            "subscriber_last_name"=>"Austen",
            "service_provider_last_name"=>"Gaurav",
            "service_provider_first_name"=>"Gupta",
            "subscriber_dob"=>"1947-10-07"
        },
        {
            "id"=>2,
            "payer_name"=>"UnitedHealthCare",
            "payer_id"=>"00112",
            "service_provider_npi"=>"67676767",
            "subscriber_id"=>"98989898",
            "subscriber_first_name"=>"Gaurav",
            "subscriber_last_name"=>"Gupta",
            "service_provider_last_name"=>"Jane",
            "service_provider_first_name"=>"Austen",
            "subscriber_dob"=>"1947-08-15"
        }
    ]
}

result = Eligible::Coverage.batch_post(params)
result.to_hash # returns the api call results
result.error   # return error, if any

Demographic Batch API

params = {
    "parameters"=>[
        {
            "id"=>1,
            "payer_name"=>"UnitedHealthCare",
            "payer_id"=>"00112",
            "service_provider_npi"=>"12341234",
            "subscriber_id"=>"98769876",
            "subscriber_first_name"=>"Jane",
            "subscriber_last_name"=>"Austen",
            "service_provider_last_name"=>"Gaurav",
            "service_provider_first_name"=>"Gupta",
            "subscriber_dob"=>"1947-10-07"
        },
        {
            "id"=>2,
            "payer_name"=>"UnitedHealthCare",
            "payer_id"=>"00112",
            "service_provider_npi"=>"67676767",
            "subscriber_id"=>"98989898",
            "subscriber_first_name"=>"Gaurav",
            "subscriber_last_name"=>"Gupta",
            "service_provider_last_name"=>"Jane",
            "service_provider_first_name"=>"Austen",
            "subscriber_dob"=>"1947-08-15"
        }
    ]
}
result = Eligible::Demographic.batch_post(params)
result.to_hash # returns the api call results
result.error   # return error, if any

Medicare Batch API

params = {
    "parameters"=>[
        {
            "id"=>1,
            "service_provider_npi"=>"12341234",
            "subscriber_id"=>"98769876",
            "subscriber_first_name"=>"Jane",
            "subscriber_last_name"=>"Austen",
            "service_provider_last_name"=>"Gaurav",
            "service_provider_first_name"=>"Gupta",
            "subscriber_dob"=>"1947-10-07"
        },
        {
            "id"=>2,
            "service_provider_npi"=>"67676767",
            "subscriber_id"=>"98989898",
            "subscriber_first_name"=>"Gaurav",
            "subscriber_last_name"=>"Gupta",
            "service_provider_last_name"=>"Jane",
            "service_provider_first_name"=>"Austen",
            "subscriber_dob"=>"1947-08-15"
        }
    ]
}

Eligible::Coverage.batch_medicare_post params
result.to_hash # returns the api call results
result.error   # return error, if any

Enrollment

Reference

https://github.com/EligibleAPI/tools/wiki/Enrollments

Its important to notice than an Enrollment Request can have multiple Enrollment NPIs, and that the API has been designed in a way that you can repeat the enrollment for a NPI multiple times across different Enrollment request.

Create an Enrollment Request

params = {
  "service_provider_list" => [
      {
        "facility_name" => "Quality",
        "provider_name" => "Jane Austen",
               "tax_id" => "12345678",
              "address" => "125 Snow Shoe Road",
                 "city" => "Sacramento",
                "state" => "CA",
                  "zip" => "94107",
                 "ptan" => "54321",
                  "npi" => "987654321"
      },
      {
        "facility_name" => "Aetna",
        "provider_name" => "Jack Austen",
               "tax_id" => "12345678",
              "address" => "985 Snow Shoe Road",
                 "city" => "Menlo Park",
                "state" => "CA",
                  "zip" => "94107",
                 "ptan" => "54321",
                  "npi" => "987654321"
      }
    ],
    "payer_ids" => [
      "00431",
      "00282"
    ]
}
result = Eligible::Enrollment.post(params)
result.to_hash # returns the api call results
result.error   # return error, if any

Retrieve an Enrollment Request

params = { :enrollment_request_id => 123 }
enrollment = Eligible::Enrollment.get(params)
enrollment.to_hash # return the api call results
enrollment.error  # return error, if any
enrollment.enrollment_npis # quick access to the enrollment npis within the enrollment request object

params = { :npis => %w(123 456 789).join(',') }
enrollment = Eligible::Enrollment.get(params)

Claims

Reference

https://github.com/EligibleAPI/tools/wiki/Claims

Create Claim object

params = {
    "receiver" => {
        "name" => "AETNA",
        "id" => "60054"
    },
    "billing_provider" => {
        "taxonomy_code" => "332B00000X",
        "practice_name" => "Jane Austen Practice",
        "npi" => "1922222222",
        "address" => {
            "street_line_1" => "419 Fulton",
            "street_line_2" => "",
            "city" => "San Francisco",
            "state" => "CA",
            "zip" => "94102"
        },
        "tin" => "43291023"
    },
    "subscriber" => {
        "last_name" => "Franklin",
        "first_name" => "Benjamin",
        "member_id" => "12312312",
        "group_id" => "455716",
        "group_name" => "",
        "dob" => "1734-05-04",
        "gender" => "M",
        "address" => {
            "street_line_1" => "435 Sugar Lane",
            "street_line_2" => "",
            "city" => "Sweet",
            "state" => "OH",
            "zip" => "436233127"
        }
    },
    "payer" => {
        "name" => "AETNA",
        "id" => "60054",
        "address" => {
            "street_line_1" => "Po Box 981106",
            "street_line_2" => "",
            "city" => "El Paso",
            "state" => "TX",
            "zip" => "799981222"
        }
    },
    "claim" => {
        "total_charge_amount" => "275",
        "claim_frequency" => "1",
        "patient_signature_on_file" => "Y",
        "provider_plan_participation" => "A",
        "direct_payment_authorized" => "Y",
        "release_of_information" => "I",
        "service_lines" => [
            {
                "line_number" => "1",
                "service_start" => "2013-03-07",
                "service_end" => "2013-03-07",
                "place_of_service" => "11",
                "charge_amount" => "275",
                "product_service" => "99213",
                "qualifier" => "HC",
                "diagnosis_1" => "32723"
            }
        ]
    }
}

result = Eligible::Claim.post(params)
enrollment.to_hash # return the api call results
enrollment.error  # return error, if any

Retrieve all Claim objects/acknowledgments

claims = Eligible::Claim.all # returns acknowlegdement information for all claims that have been submitted with the API key

Retrieve individual Claim object/acknowledgment

params = { 
  :reference_id => "12345"
}

claim = Eligible::Claim.get(params) # returns acknoweldement information on an individual claim identified by its reference_id

Payment Status

Reference

https://eligibleapi.com/rest-api-v1-1/beta/payment-status#apiPaymentStatus

Retrieve Payment status

params = { :payer_id => '00001',
           :provider_tax_id => '4373208923',
           :provider_npi => '1234567890',
           :provider_first_name => 'Thomas',
           :provider_first_name => 'Thomas',
           :member_id => '123',
           :member_first_name => 'Benjamin',
           :member_last_name => 'Franklin',
           :member_dob => '01-01-1980',
           :charge_amount => '100.00',
           :start_date => '2013-03-25',
           :end_date => '2013-03-25' }

result = Eligible::Payment.get(params)
result.to_hash   # return the api call results
result.error     # return error, if any

X12

Reference

https://github.com/EligibleAPI/tools/wiki/X12

X12 post

params = { :x12 => "ISA*00*          *00*          *ZZ*SENDERID       *ZZ*ELIGIB         *130610*0409*^*00501*100000001*0*T*:~GS*HS*SENDERID*ELIGIB*20130610*0409*1*X*005010X279A1~ST*270*0001*005010X279A1~BHT*0022*13*137083739083716126837*20130610*0409~HL*1**20*1~NM1*PR*2*UnitedHealthCare*****PI*112~HL*2*1*21*1~NM1*1P*1*AUSTEN*JANE****XX*1222494919~HL*3*2*22*0~TRN*1*1*1453915417~NM1*IL*1*FRANKLIN*BENJAMIN****MI*23412342~DMG*D8*17371207~DTP*291*D8*20130610~EQ*30~SE*13*0001~GE*1*1~IEA*1*100000001~" }

result = Eligible::X12.post(params)

Tickets

Reference

https://github.com/EligibleAPI/tools/wiki/Tickets

Create a ticket

params = {:priority => 'normal',
          :title => 'TITLE',
          :notification_email => '[email protected]',
          :body => 'Your comment'}
result = Eligible::Ticket.create params
result.to_hash # return the api call results
enrollment.error  # return error, if any

Get a ticket

ticket = Eligible::Ticket.get(:id => 1)
ticket.to_hash # return the api call result
ticket.error   # return error, if any

Update a ticket

params = { :id => 1,
           :priority => 'normal',
           :title => 'TITLE',
           :notification_email => '[email protected]',
           :body => 'Your comment'}
result = Eligible::Ticket.update(params)
result.to_hash # return the api call results
enrollment.error  # return error, if any

Get comments for a ticket

comments = Eligible::Ticket.get(:id => 1)
comments.to_hash # return the api call result
comments.error   # return error, if any

Delete a ticket

result = Eligible::Ticket.delete(:id => 1)
comments.to_hash # return the api call result
comments.error   # return error, if any

Get all tickets

Eligible::Ticket.all

Tests

You can run tests with

rake test

If you do send a pull request, please add passing tests for the new feature/fix.

Contributing

  1. Fork it
  2. Create your feature branch (git checkout -b my-new-feature)
  3. Commit your changes (git commit -am 'Add some feature')
  4. Run tests (see above)
  5. Push to the branch (git push origin my-new-feature)
  6. Create new Pull Request

Changelog

2.4

  • Refactoring Code
  • More test cases
  • Removed legacy endpoint for plans, coverage should be used instead.
  • Removed legacy endpoint for services, coverage should be used instead.
  • List of contributors and documentation updated.
  • Gemfile updated, dependencies updated as well.
  • Removed json gem in favor of multi_json
  • Fixed the code to let the users make x12 requests at anytime.
  • New endpoint for Tickets

2.3

  • New endpoint for Batch

2.2

  • New endpoint for x12 POST

2.1

  • New endpoint for payment status

2.0

  • Additional endpoints for claims, enrollments, and coverage

1.1

  • Additional endpoints for service/general and service/list
  • Support x12 format in params

1.0

  • Initial release

eligible-ruby's People

Contributors

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Watchers

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