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: "git@github.com:savonrb/savon-multipart.git", ref: 'd9a138b6c166cd7c30c28e8888ff19011f8ec071'
#
# live on the edge
# gem 'savon-multipart', git: "git@github.com:savonrb/savon-multipart.git", branch: :master
#
# Your fork?
# gem 'savon-multipart', git: "git@github.com: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

Fields

The Eligibility Web Service is poorly documented in the Eligibility Web Service Companion Guide.

The fields listed below are copied from the documentation and can be used to perform eligibility checks.

Field	Description	Requirement
GediPayerID	The GEDI specific payer identifier	Always
ProviderFirstName	Provider First Name	Required when individual provider name is sent in the inquiry
ProviderLastName	Provider Last Name/Organization Name
NPI	National Provider Identifier
InsuredFirstName	Subscriber First Name	Required when the patient is the subscriber or if the Payer requires this information to identify the patient.
InsuredLastName	Subscriber Last Name	Required when the patient is the subscriber or if the Payer requires this information to identify the patient
InsuranceNum		Required when the payer needs this information to identify patient.
InsuredDob	Subscriber Date of birth (YYYYMMDD)	Required when the payer needs this information to identify patient.
InsuredGender	Subscriber Gender (M) or (F)	Required when the payer needs this information to identify patient.
ServiceTypeCode	Health Care Financing Administration Common Procedural Coding System Code
DependentFirstName	Dependent First Name
DependentLastName	Dependent Last Name
DependentDob	Dependent Date of Birth (YYYYMMDD)
DependentGender	Dependent Gender (M) or (F)
DateOfService	Date of service to check for eligibiltiy (YYYYMMDD). This field is not documented

Example

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 = ENV['TRIZETTO_USERNAME']
  config.password = ENV['TRIZETTO_PASSWORD']
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.messages                                   # => ["Please enter InsuranceNum."]
response.errors.validation_failures.first.affected_fields  # => ["InsuranceNum"]
response.errors.validation_failures.first.message          # => "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.messages       # => nil
coverages.last.messages        # => ["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 = ENV['TRIZETTO_USERNAME']
  config.password = ENV['TRIZETTO_PASSWORD']
end


client = Trizetto::Api::Eligibility::Core2.new
client.check_eligibility(payload: x12_message)

Ping the Payer List endpoint to see if it is up

require 'trizetto/api'

Trizetto::Api.configure do |config|
  config.username = ENV['TRIZETTO_USERNAME']
  config.password = ENV['TRIZETTO_PASSWORD']
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 = ENV['TRIZETTO_USERNAME']
  config.password = ENV['TRIZETTO_PASSWORD']
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.