   ____ _                              _   _            _ _   _     
  / ___| |__   __ _ _ __   __ _  ___  | | | | ___  __ _| | |_| |__  
 | |   | '_ \ / _` | '_ \ / _` |/ _ \ | |_| |/ _ \/ _` | | __| '_ \ 
 | |___| | | | (_| | | | | (_| |  __/ |  _  |  __/ (_| | | |_| | | |
  \____|_| |_|\__,_|_| |_|\__, |\___| |_| |_|\___|\__,_|_|\__|_| |_|
                          |___/

Ruby API wrapper for Change Health

Installation

Add this line to your application's Gemfile:

gem 'change_health'

And then execute:

$ bundle

Or install it yourself as:

$ gem install change_health

Usage

Setup

Make sure you're configured!

Eligibility

Change Healthcare Eligibility Guide

ChangeHealth::Request::Eligibility.ping # Test your connection

encounter  = ChangeHealth::Models::Eligibility::Encounter.new(date_of_service: Date.current, service_type_codes: ['98'])
provider   = ChangeHealth::Models::Eligibility::Provider.new(npi: '0123456789', last_name: 'Bobson', first_name: 'Bob')
subscriber = ChangeHealth::Models::Eligibility::Subscriber.new(member_id: '0000000000', first_name: 'johnOne', last_name: 'doeOne', date_of_birth: '18800102')

edata = ChangeHealth::Request::Eligibility.new(tradingPartnerServiceId: '000050', provider: provider, subscriber: subscriber, encounter: encounter).query

edata.raw # Raw Hash of JSON response

Benefit(s) objects

Benefits extends Array and provides a query-like interface.

Benefit extends Hash and provides helpers for single-benefit.

edata.benefits # Returns Benefits querying object (extends Array)

edata.benefits.individual # Only benefits matching the 'IND' identifier

edata.benefits.individual.in_network # 'IND' and in-plan-network = 'Y'

edata.benefits.individual(name: 'Co-Payment') # Manually finding "name" == "Co-Payment" in JSON
edata.benefits.individual(customParam: 'hi') # Filter on any params in the API combined with 'IND' type

edata.benefits.where(name: 'Co-Payment', code: 'B', benefitAmount: '30) # Generic 'where' api returns a Benefits querying object for chaining
edata.benefits.find_by(name: 'Co-Payment', code: 'B', benefitAmount: '30) # Generic 'find_by' api returns first object found

Response

Response is EligibilityData object

edata.response
#<HTTParty::Response:0x7fa354c1fbe8>

edata.response.ok?
# true

edata.individual_oop_remaining(service_code: '30')
# 1344.88

edata.raw == edata.response.parsed_response
# true

Trading Partners

# Query trading partners using a wildcard search
# Returns Array of ChangeHealth::Models::TradingPartner Objects
# Query params: term, service_name(default: 'Eligibility'), clearing_house(default: 'npd')
trading_partners = ChangeHealth::Request::TradingPartner.query("Aetna", service_name: 'Eligibility', clearing_house: 'dbq')

trading_partners.first.name
# "Aetna"

trading_partners.first.service_id
# "ABC123"

Claim Submission

Professional Claims

Change Healthcare Professional Claim Submission Guide

ChangeHealth::Request::Claim::Submission.ping # Test your connection

contact_information = ChangeHealth::Models::Claim::ContactInformation.new(
  name: "SUBMITTER CONTACT INFO",
  phone_number: "123456789"
)

submitter = ChangeHealth::Models::Claim::Submitter.new(
  organization_name: "REGIONAL PPO NETWORK",
  contact_information: contact_information
)

receiver = ChangeHealth::Models::Claim::Receiver.new(
  organization_name: "EXTRA HEALTHY INSURANCE"
)

address = ChangeHealth::Models::Claim::Address.new(
  address1: "123 address1",
  city: "city1",
  state: "wa",
  postalCode: "981010000"
)

subscriber = ChangeHealth::Models::Claim::Subscriber.new(
  member_id: "0000000001",
  payment_responsibility_level_code: "P",
  first_name: "johnone",
  last_name: "doetwo",
  gender: "M",
  date_of_birth: "02/01/1980",
  address: address
)

dependent = ChangeHealth::Models::Claim::Dependent.new(
  address: address,
  date_of_birth: "02/01/1980",
  first_name: "johnone",
  gender: "M",
  last_name: "doetwo",
  member_id: "0000000001",
  relationship_to_subscriber_code: "01"
)

provider = ChangeHealth::Models::Claim::Provider.new(
  address: address,
  employer_id: "000000000",
  first_name: "johnone",
  last_name: "doetwo",
  npi: "1760854442",
  provider_type: "BillingProvider"
)

diagnosis1 = ChangeHealth::Models::Claim::Diagnosis.new(
  diagnosis_type_code: "ABK",
  diagnosis_code: "S93401A"
)

diagnosis2 = ChangeHealth::Models::Claim::Diagnosis.new(
  diagnosis_type_code: "ABF",
  diagnosis_code: "S72044G"
)

service_line1 = ChangeHealth::Models::Claim::ServiceLine.new(
  service_date: "2018-05-14",
  professional_service: ChangeHealth::Models::Claim::ProfessionalService.new(
    line_item_charge_amount: "25",
    measurement_unit: "UN",
    procedure_code: "E0570",
    procedure_identifier: "HC",
    service_unit_count: "1",
    composite_diagnosis_code_pointers: {
      diagnosisCodePointers: ["1","2"]
    }
  )
)

service_line2 = ChangeHealth::Models::Claim::ServiceLine.new(
  service_date: "20180514",
  service_date_end: "20180514",
  professional_service: ChangeHealth::Models::Claim::ProfessionalService.new(
    line_item_charge_amount: "3.75",
    measurement_unit: "UN",
    procedure_code: "A7003",
    procedure_identifier: "HC",
    service_unit_count: "1",
    composite_diagnosis_code_pointers: {
      diagnosisCodePointers: ["1"]
    }
  )
)

claim_information = ChangeHealth::Models::Claim::ClaimInformation.new(
  benefits_assignment_certification_indicator: "Y",
  claim_charge_amount: "28.75",
  claim_filing_code: "CI",
  claim_frequency_code: "1",
  patient_control_number: "12345",
  place_of_service_code: "11",
  plan_participation_code: "A",
  release_information_code: "Y",
  signature_indicator: "Y",
  health_care_code_information: [diagnosis1, diagnosis2],
  service_lines: [service_line1, service_line2]
)

headers = {
  submitter_id: '111000',
  biller_id: '000111',
  username: '222333hey',
  password: 'builder1'
}

claim_submission = ChangeHealth::Request::Claim::Submission.new(
  claim_information: claim_information,
  dependent: dependent,
  headers: headers,
  pay_to_address: address,
  providers: [provider],
  receiver: receiver,
  submitter: submitter,
  subscriber: subscriber,
  trading_partner_service_id: "9496"
)

claim_submission_data = claim_submission.submission

validation = claim_submission.validation

Institutional Claims

Change Healthcare Institutional Claim Submission Guide

ChangeHealth::Request::Claim::Submission.ping(is_professional: false) # Test your connection

billing_pay_to_address_name = ChangeHealth::Models::Claim::BillingPayToAddressName.new(
  entity_type_qualifier: "2",
  address: address
)

claim_code_information = ChangeHealth::Models::Claim::ClaimCodeInformation.new(
  admission_source_code: "7",
  admission_type_code: "1",
  patient_status_code: "10"
)

other_diagnosis_information_list = [[
  ChangeHealth::Models::Claim::Diagnosis.new(
    other_diagnosis_code: "S72044G",
    qualifier_code: "ABF"
  ),
  ChangeHealth::Models::Claim::Diagnosis.new(
    other_diagnosis_code: "S72044H",
    qualifier_code: "ABF"
  )
]]

principal_diagnosis = ChangeHealth::Models::Claim::Diagnosis.new(
  principal_diagnosis_code: "S93401A",
  qualifier_code: "ABK"
)

service_line1 = ChangeHealth::Models::Claim::ServiceLine.new(
  assigned_number: "1",
  institutional_service: ChangeHealth::Models::Claim::InstitutionalService.new(
    line_item_charge_amount: "25",
    measurement_unit: "UN",
    procedure_code: "E0570",
    procedure_identifier: "HC",
    service_line_revenue_code: "X",
    service_unit_count: "1",
  )
)

service_line2 = ChangeHealth::Models::Claim::ServiceLine.new(
  assigned_number: "2",
  institutional_service: ChangeHealth::Models::Claim::InstitutionalService.new(
    line_item_charge_amount: "3.75",
    measurement_unit: "UN",
    procedure_code: "A7003",
    procedure_identifier: "HC",
    service_line_revenue_code: "Y",
    service_unit_count: "1",
  )
)

claim_information = ChangeHealth::Models::Claim::ClaimInformation.new(
  benefits_assignment_certification_indicator: "Y",
  claim_charge_amount: "28.75",
  claim_code_information: claim_code_information,
  claim_filing_code: "CI",
  claim_frequency_code: "1",
  other_diagnosis_information_list: other_diagnosis_information_list,
  patient_control_number: "12345",
  place_of_service_code: "11",
  plan_participation_code: "A",
  principal_diagnosis: principal_diagnosis,
  release_information_code: "Y",
  signature_indicator: "Y",
  service_lines: [service_line1, service_line2]
)

headers = {
  submitter_id: '111000',
  biller_id: '000111',
  username: '222333hey',
  password: 'builder1'
}

address = ChangeHealth::Models::Claim::Address.new(
  address1: "123 address1",
  city: "city1",
  state: "wa",
  postalCode: "981010000"
)

provider = ChangeHealth::Models::Claim::Provider.new(
  address: address,
  employer_id: "000000000",
  first_name: "johnone",
  last_name: "doetwo",
  npi: "1760854442",
  organization_name: "EXTRA HEALTHY INSURANCE",
  provider_type: "BillingProvider"
)

receiver = ChangeHealth::Models::Claim::Receiver.new(
  organization_name: "EXTRA HEALTHY INSURANCE"
)

contact_information = ChangeHealth::Models::Claim::ContactInformation.new(
  name: "SUBMITTER CONTACT INFO",
  phone_number: "123456789"
)

submitter = ChangeHealth::Models::Claim::Submitter.new(
  organization_name: "REGIONAL PPO NETWORK",
  contact_information: contact_information
)

subscriber = ChangeHealth::Models::Claim::Subscriber.new(
  member_id: "0000000001",
  payment_responsibility_level_code: "P",
  first_name: "johnone",
  last_name: "doetwo",
  gender: "M",
  date_of_birth: "02/01/1980",
  address: address
)

claim_submission = ChangeHealth::Request::Claim::Submission.new(
  claim_information: claim_information,
  headers: headers,
  providers: [provider],
  receiver: receiver,
  submitter: submitter,
  subscriber: subscriber,
  trading_partner_service_id: "9496",
  billing_pay_to_address_name: billing_pay_to_address_name
)

claim_supplemental_information = ChangeHealth::Models::Claim::ClaimSupplementalInformation.new(
  claim_control_number: 'claimControlNumber',
  demo_project_identifier: 'demoProjectIdentifier',
  prior_authorization_number: 'priorAuthorizationNumber',
  referral_number: 'referralNumber',
  report_information: 'reportInformation'
)

claim_submission_data = claim_submission.submission(is_professional: false)

validation = claim_submission.validation(is_professional: false)

Claim Reports

Change Healthcare Claim Responses and Reports Guide

Get Reports

ChangeHealth::Request::Claim::Report.ping # Test your connection

report_headers = {
  username: '111000john',
  password: 'WeInfuse1'
}

report_list = ChangeHealth::Request::Claim::Report.report_list(headers: report_headers)

report_list.report_names
# ["X3000000.XX", "R5000000.XY", "R5000000.XX", "X3000000.AB", "X3000000.AC", "X3000000.ZZ", "R5000000.XZ", "R5000000.YZ", "R5000000.WA", "R5000000.WB", "R5000000.WC"]

report0_edi = ChangeHealth::Request::Claim::Report.get_report(report_list.report_names.first, as_json_report: false)
# Report in edi format

report0_json = ChangeHealth::Request::Claim::Report.get_report(report_list.report_names.first, as_json_report: true)
# Report in json format

reports_json = report_list.report_names.map {|report_name| ChangeHealth::Request::Claim::Report.get_report(report_name, headers: report_headers)}
# all reports in json format

reports_edi = report_list.report_names.map {|report_name| ChangeHealth::Request::Claim::Report.get_report(report_name, as_json_report: false, headers: report_headers)}
# all reports in edi format

Inspect Reports

Currently only works for json 277 reports and json 835 reports. Not for EDI reports

From a report, you can get an array of claims

Report 277

report277_data = ChangeHealth::Request::Claim::Report.get_report("X3000000.AB", as_json_report: true)

report277_data.payer_name
# "PREMERA"

report277_data.report_creation_date
# Tue, 01 Dec 2020

claim277 = report277_data.claims.first
claim277.payer_name
# "PREMERA"

claim277.report_name
# "X3000000.AB"

claim277.patient_first_name
# "JOHNONE"

claim277.report_creation_date
# Tue, 01 Dec 2020

# Report 277 specific below
claim277.latest_status_category_codes
# ["F1"]

claim277.total_charge_amount
# "100"

claim277.procedure_codes
# ["97161"]

Report 835

report835_data = ChangeHealth::Request::Claim::Report.get_report("R5000000.XY", as_json_report: true)

payment835 = report835_data.payments.first

payment835.payment_method_code
# "ACH"

payment835.total_actual_provider_payment_amount
# "2563.13"

claim835 = payment835.claims.first
claim835.payer_name
# "NATIONAL GOVERNMENT SERVICES, INC."

claim835.patient_first_name
# "JANE"

claim835.patient_member_id
# "7SL5RA7XR19"

claim835.report_creation_date
# Wed, 22 Apr 2020

claim835.procedure_codes
# ["21210", "21026", "21208", "30580"]

claim835.service_lines.map(&:line_item_charge_amount)
# ["3600", "1890", "1836", "1680"]

claim835.claim_status_code
# "19"

Delete Reports

Delete Endpoint FAQ

Delete Endpoint API Reference

ChangeHealth::Request::Claim::Report.delete_report("R5000000.XY")

Configuration

ChangeHealth.configure do |c|
  c.client_id     = ENV['CHANGE_HEALTH_CLIENT_ID']
  c.client_secret = ENV['CHANGE_HEALTH_SECRET']
  c.grant_type    = 'client_credentials' # Defaults to client_credentials
  c.api_endpoint  = 'https://sandbox.apigw.changehealthcare.com' # Defaults to Change Health Sandbox endpoint
end

Development

After checking out the repo, run bin/setup to install dependencies. Then, run rake test 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.

Contributing

Bug reports and pull requests are welcome on GitHub at https://github.com/WeInfuse/change_health.

change_health

Development

Runtime

Installation

Usage

Setup

Eligibility

Benefit(s) objects

Response

Trading Partners

Claim Submission

Professional Claims

Institutional Claims

Claim Reports

Get Reports

Inspect Reports

Report 277

Report 835

Delete Reports

Configuration

Development

Contributing