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:
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
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
response = client.do_inquiry({...})
response.active_coverage_for?(service_type_code = "30") #=> true | false
require 'trizetto/api'
Trizetto::Api.configure do |config|
config.username = 'Not the real username'
config.password = 'Super Top Secret'
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. # => ["Please enter InsuranceNum."]
response.errors.validation_failures.first.affected_fields # => ["InsuranceNum"]
response.errors.validation_failures.first. # => "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. # => nil
coverages.last. # => ["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.
require 'trizetto/api'
Trizetto::Api.configure do |config|
config.username = 'Not the real username'
config.password = 'Super Top Secret'
end
client = Trizetto::Api::Eligibility::Core2.new
client.check_eligibility(payload: )
Ping the Payer List endpoint to see if it is up
require 'trizetto/api'
Trizetto::Api.configure do |config|
config.username = 'Not the real username'
config.password = 'Super Top Secret'
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.
require 'trizetto/api'
Trizetto::Api.configure do |config|
config.username = 'Not the real username'
config.password = 'Super Top Secret'
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.
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 code of conduct.
License
The gem is available as open source under the terms of the MIT License.
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.