class Trizetto::Api::Eligibility::WebService::Client
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', })
@see DoInquiryResponse
References
-
{services.gatewayedi.com/eligibility/service.asmx ServiceDescription}
-
{services.gatewayedi.com/eligibility/service.asmx?WSDL WSDL}
-
{mytools.gatewayedi.com/Help/documents/Eligibility/Realtime%20Eligibility%20Webservice%20Companion%20Guide.pdf Realtime Eligibiliy Webservice Companion Guide}
-
{mytools.gatewayedi.com/Help/documents/Eligibility/Realtime%20Eligibility%20Webservice%20Vendor%20Toolkit.pdf Realtime Eligibiliy Webservice Vendor Toolkit}
-
{mytools.gatewayedi.com/help/documents/Eligibility/Payer%20Specific%20Required%20Data%20Elements-2010.pdf
Eligibility
Companion Guide by Payer}
Public Class Methods
# 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
Public Instance Methods
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 PlanBenefit
Coverage, “General healthcare benefits for the member's policy or contract”
References
-
{services.gatewayedi.com/eligibility/service.asmx?op=DoInquiry Service Description}
-
{www.x12.org/codes/health-care-service-type-codes/ Service Type Codes}
@return DoInquiryResponse
# File lib/trizetto/api/eligibility/web_service.rb, line 118 def do_inquiry(parameters={}) savon_response = @client.call( :do_inquiry, message: { 'Inquiry': { 'ResponseDataType': 'Xml', 'Parameters': { 'MyNameValue': parameters.map { |name, value| {'Name': name, 'Value': value} } } }}) DoInquiryResponse.new(savon_response.body, savon_response.to_xml) end