Parse and print output from a HIPAA 277CA file.

parse_277.rb

require 'pp'
require 'pry'
require 'hippo'

def wrap_text(text, max_width, wrap_string = "\n")
  if text.length <= max_width
    text
  else
    text.scan(/.{1,#{max_width}}/).join(wrap_string)
  end
end

category_codes = Hippo::CodeLists::ClaimStatusCategoryCodes
status_codes   = Hippo::CodeLists::ClaimStatusCodes

parser = Hippo::Parser.new
transaction_sets = parser.parse_file('sample_files/082627.EDI')

transaction_sets.each do |ts|
  puts ''
  puts '=' * 120
  puts 'Confirmation for 837 transaction on ' + ts.L2000A.L2200A.DTP.DTP03 + " with a batch control number of '#{ts.L2000B.L2200B.TRN.TRN02}'."
  puts "  #{ts.L2000A.L2100A.NM1.NameLastOrOrganizationName}(#{ts.L2000A.L2100A.NM1.EntityIdentifierCode}) "

  if ts.L2000B.L2200B.STC.STC03 == 'U'
    puts "  Entire batch REJECTED!!!!"
  else
    puts "  Accepted: #{ts.L2000B.L2200B.find_by_name('Total Accepted Quantity').QTY02.to_s.rjust(4)}(#{ts.L2000B.L2200B.find_by_name('Total Accepted Amount').AMT02.to_s.rjust(9)}) " +
    "Rejected: #{ts.L2000B.L2200B.find_by_name('Total Rejected Quantity').QTY02.to_s.rjust(4)}(#{ts.L2000B.L2200B.find_by_name('Total Rejected Amount').AMT02.to_s.rjust(9)})"
  end

  ts.L2000C.each do |l2000c|
    puts '-----------------------------------------------------------------------------------------------------------------------'
    puts "    Billing Provider: #{l2000c.L2100C.NM1.NM103}(#{l2000c.L2100C.NM1.NM109})"
    puts "    Accepted: #{l2000c.L2200C.find_by_name('Total Accepted Quantity').QTY02.to_s.rjust(4)}(#{l2000c.L2200C.find_by_name('Total Accepted Amount').AMT02.to_s.rjust(9)}) " +
    "Rejected: #{l2000c.L2200C.find_by_name('Total Rejected Quantity').QTY02.to_s.rjust(4)}(#{l2000c.L2200C.find_by_name('Total Rejected Amount').AMT02.to_s.rjust(9)})"

    #TODO: need to handle/print out Provider level STC if present

    l2000c.L2000D.each do |l2000d|
      claim_number      = ''
      patient_name      = ''
      date_of_service   = ''
      claim_status      = ''
      claim_status_text = []
      services          = []

      patient_name = (l2000d.L2100D.NM1.NM103 + ', '  + l2000d.L2100D.NM1.NM104)[0,30].ljust(30)

      l2000d.L2200D.each do |l2200d|
        claim_number    = l2200d.TRN.TRN02
        date_of_service = l2200d.DTP.DTP03

        # claim level
        claim_status = l2200d.STC.any?{|stc| stc.STC03 == 'U'} ? 'REJECTED' : 'ACCEPTED'
        claim_status_text = []

        l2200d.STC.each do |stc|
          next if stc.STC03 != 'U'
          claim_status_text << "Cat: #{stc.STC01_01} Stat: #{code = stc.STC01_02} - #{wrap_text(status_codes[code][:description], 65)}"
          claim_status_text << "#{stc.STC12}" if stc.STC12
        end

        l2200d.L2220D.each do |l2220d|
          next unless l2220d.STC.STC03 != 'U'

          service_status_text = []
          l2220d.STC.each do |stc|
            next if stc.STC03 != 'U'

            service_status_text << "Cat: #{stc.STC01_01} Stat: #{code = stc.STC01_02} - #{wrap_text(status_codes[code][:description], 65)}"
            service_status_text << "#{stc.STC12}" if stc.STC12
          end

          services << {
            :date_of_service => l2220d.DTP.DTP03,
            :procedure_code => l2220d.SVC.SVC01_02,
            :modifier_1 => l2220d.SVC.SVC01_03,
            :modifier_2 => l2220d.SVC.SVC01_04,
            :service_status_text => service_status_text
          }

        end

        puts "      CLM# #{claim_number} - #{patient_name} #{claim_status}"
        puts "        #{claim_status_text.join("\n        ")}\n" if claim_status_text.length > 0
        puts "" if claim_status == 'REJECTED'
        services.each do |s|
          puts "        SVC - REJECTED DOS: #{s[:date_of_service]} - CPT: #{s[:procedure_code]}"
          puts "          #{s[:service_status_text].join("\n        ")}" if s[:service_status_text].length > 0
          puts ""
        end
      end   #l2000d.L2200D.each
    end #l2000c.L2000D.each
  end #ts.L2000C.each
end

script_output.txt

========================================================================================================================
Confirmation for 837 transaction on 20111222 with a batch control number of 'FX2LL9TCRD'.
  FIRST COAST SERVICE OPTIONS(PR) 
  Accepted:   92( 63834.93) Rejected:    5(  6525.01)
------------------------------------------------------------------------------------------------------------------------
    Billing Provider: RANDOM CORPORATION NAME(1234567890)
    Accepted:   10(  2380.05) Rejected:     (         )
      CLM# 3635196 - FORD, CAROL                    ACCEPTED
      CLM# 3635197 - FORD, CAROL                    ACCEPTED
      CLM# 3635208 - WALKIN, JAMES                  ACCEPTED
      CLM# 3635209 - WALKIN, JAMES                  ACCEPTED
      CLM# 3635252 - STEWART, MARTHA                ACCEPTED
      CLM# 3635253 - STEWART, MARTHA                ACCEPTED
      CLM# 3635254 - WHITE, HORSE                   ACCEPTED
      CLM# 3635255 - WHITE, HORSE                   ACCEPTED
      CLM# 3635306 - ZICKSON, ROGER                 ACCEPTED
      CLM# 3635307 - ZICKSON, ROGER                 ACCEPTED
------------------------------------------------------------------------------------------------------------------------
    Billing Provider: TERRIBLY SPECIFIC CORPORATION(0987654321)
    Accepted:    3(  3068.51) Rejected:     (         )
      CLM# 3634956 - JACKSON, BERNADINE             ACCEPTED
      CLM# 3634949 - SMITH, RUBY                    ACCEPTED
      CLM# 3634958 - RODRIGUEZ, LINDA               ACCEPTED