Class: Trizetto::Api::Eligibility::WebService::Client

Inherits:
WebService
  • Object
show all
Defined in:
lib/trizetto/api/eligibility/web_service.rb

Overview

Ruby Wrapper for the Eligibility Web Service

Performs a real time eligibility check using the non-CORE II Web Service

The webservice provides 3 eligibility checks:

  • DoInquiry

  • DoInquiryByX12Data

  • DoInquiryByX12DataWith271Response

This API, currently, only uses the DoInquiry check. For X12 requests the CORE II client is recommended instead.

Example

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

response = client.do_inquiry({
  'ProviderLastName': 'YOUR COMPANY NAME HERE',
  'NPI':              'YOUR NPI HERE',
  'InsuredFirstName': 'Mickey',
  'InsuredLastName':  'Mouse',
  'InsuredDob':       '19281118',
  'GediPayerId':      'N4222',
})

References

See Also:

Instance Method Summary collapse

Constructor Details

#initialize(options = {}) ⇒ Client

Returns a new instance of Client.



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# File 'lib/trizetto/api/eligibility/web_service.rb', line 63

def initialize(options={})
  super(
    options.merge(
      {
        wsdl:        File.join( File.dirname(__FILE__), 'web_service.wsdl' ),
        endpoint:    Trizetto::Api.configuration.eligibiltiy_webservice_endpoint,
      }
  ))
end

Instance Method Details

#do_inquiry(parameters = {}) ⇒ Object Also known as: check_eligibility

Performs an eligibility check using the trizetto eligibility SOAP API

In this request, your company is the Provider, you are providing services to an individual. For the ProviderLastName, you should use you company’s name. For the NPI, you should use your company’s National Provider Identifier.

The GediPayerId is the insurance company. You want them to pay for the service you have or will provide. You will need to get these values from Trizetto.

Required and optional fields will depend on the Payer being checked. Some payers require additional information than those listed below. Refer to the companion guide for the required additional parameters. A valid inquiry submitted to those payers must also account for the additional payer specific parameters. InsuranceNum in particular, is not a required field for all transactions, but is required by almost all payers.

Always Required Fields

  • GediPayerId - The Gateway EDI specific payer identifier

  • ProviderLastName - Provider Last Name/Organization Name.

  • NPI - National Provider Identifier

Situational Fields

  • ProviderFirstName - Provider First Name

  • InsuredFirstName - Subscriber First Name

  • InsuredLastName - Subscriber Last Name

  • InsuranceNum - Subscriber Id

  • InsuredDob - Subscriber DOB

  • InsuredGender - Subscriber Gender

  • DependentFirstName - Dependent First Name

  • DependentLastName - Dependent Last Name

  • DependentDob - Dependent DOB

  • DependentGender - Dependent Gender

  • GroupNumber -

  • ServiceTypeCode - What type of provider service. 30 is Health Plan Benefit Coverage, “General healthcare benefits for the member’s policy or contract”

References

Returns:

  • DoInquiryResponse



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# File 'lib/trizetto/api/eligibility/web_service.rb', line 118

def do_inquiry(parameters={})
  DoInquiryResponse.new(
    @client.call( :do_inquiry, message: { 'Inquiry': {
      'ResponseDataType': 'Xml',
      'Parameters': {
        'MyNameValue': parameters.map { |name, value|
           {'Name': name, 'Value': value}
         }
      }
    }})
  )
end