The Hippo library is an attempt at creating a simple DSL to generate and parse HIPAA transaction sets. HIPAA or the Health Insurance Portability Accountability Act is a series of regulations which place restrictions and requirements on the way transaction sets (ie. Claims, Remittances, Eligibility, Claim Status, etc.) must be formatted.
The HIPAA required transactions sets are created by the X12 organization. The current production version (as of 2011/02/05) is 4010A1, but effective 2012/01/01 all organizations must be migrated to using version 5010.
To obtain copies of the implementation guides you must purchase them from the X12 organization. The implementation data is also available in tabular format (CSV). The transaction sets, loops, and segments in Hippo were created from the X12 CSV Table Data.
More information can be found at the following sites:
gem install hippo
This is very straight forward. Basically, create an instance of the transaction set that you will be working with, and start filling in the loops, segments, and fields. For a complete example from the 222A1 (837-P) implementation guide please review test/test_hipaa_837.rb.
Below is a small sample of how to create a transaction set.
ts = Hippo::TransactionSets::HIPAA_837::Base.new
ts.ST do |st|
st.TransactionSetControlNumber = '0021'
st.ImplementationConventionReference = '005010X222A1'
end
ts.BHT do |bht|
bht.TransactionSetPurposeCode = '00'
bht.ReferenceIdentification = '244579'
bht.Date = '20061015'
bht.Time = '1023'
bht.TransactionTypeCode = 'CH'
end
ts.L1000A do |l1000a|
l1000a.NM1 do |nm1|
nm1.EntityTypeQualifier = '2'
nm1.NameLastOrOrganizationName = 'PREMIER BILLING SERVICE'
nm1.IdentificationCode = 'TGJ23'
end
l1000a.PER do |per|
per.Name = 'JERRY'
per.CommunicationNumberQualifier_01 = 'TE'
per.CommunicationNumber_01 = '3055552222'
per.CommunicationNumberQualifier_02 = 'EX'
per.CommunicationNumber_02 = '231'
end
end
puts ts.to_s
=> "ST*837*0021*005010X222A1~BHT*0019*00*244579*20061015*1023*CH~NM1*41*2*PREMIER BILLING SERVICE*****46*TGJ23~PER*IC*JERRY*TE*3055552222*EX*231~"Transaction Sets/Loops and Segments are defined with a very straight forward DSL.
module Hippo::Segments
class TestSimpleSegment < Hippo::Segments::Base
segment_identifier 'TSS'
field :name => 'Field1'
field :name => 'Field2'
field :name => 'Field3'
field :name => 'Field4'
field :name => 'CommonName'
field :name => 'CommonName'
end
class TestCompoundSegment < Hippo::Segments::Base
segment_identifier 'TCS'
composite_field 'CompositeField' do
field :name => 'Field1'
field :name => 'Field2'
field :name => 'Field3'
field :name => 'CompositeCommonName'
end
composite_field 'CompositeField' do
field :name => 'Field4'
field :name => 'Field5'
field :name => 'Field6'
field :name => 'CompositeCommonName'
end
field :name => 'Field7'
end
end
module Hippo::TransactionSets
module Test
class Base < Hippo::TransactionSets::Base
segment Hippo::Segments::TestSimpleSegment,
:name => 'Test Simple Segment #1',
:minimum => 1,
:maximum => 5,
:position => 50,
:defaults => {
'TSS01' => 'Blah'
}
segment Hippo::Segments::TestCompoundSegment,
:name => 'Test Compound Segment #2',
:minimum => 1,
:maximum => 1,
:position => 100,
:defaults => {
'Field7' => 'Preset Field 7'
}
segment Hippo::Segments::TestSimpleSegment,
:name => 'Test Simple Segment #3',
:minimum => 1,
:maximum => 1,
:position => 50,
:defaults => {
'TSS01' => 'Last Segment'
}
end
end
endUsing the simple transaction set and segments defined above, here are a few ways to access the fields.
To create a transaction set simple choose the set you want and call new on it's Base class.
ts = Hippo::TransactionSets::Test::Base.newThe segments can be accessed directly from the created transaction set using the segment identifier.
ts.TCSSince the TSS segment can be repeated we must call #build to generate a new instance for each repeat. (You will be returned the first instance each time if you do not call #build.)
ts.TSS.buildThe code above produces the following string output (notice how the values from :defaults are prefilled, and the output is automatically sorted based on the order that the segments were declared):
# ts.to_s => 'TSS*Blah~TCS***Preset Field 7~'To set field values on a given segment you can access it either by calling the field directly on the segment or by passing a block to the segment.
# this is one way to populate the fields
ts.TCS.Field1 = 'Foo'
ts.TSS.Field2 = 'Bar'
# this is another way
ts.TCS do |tcs|
tcs.Field1 = 'Foo'
end
ts.TSS do |tss|
tss.Field2 = 'Bar'
end
# both of the mechanisms above have the same string representation:
#
# ts.to_s => 'TSS*Blah*Bar~TCS*Foo**Preset Field 7~'If you read the transaction set declaration from above you will notice that the TSS segment can be set in two different sequences (with different preset values). By default (as you can see from the previous example) when we call TSS we are referring to the first segment, but if you need to access the second instance of TSS in the transaction set you would specify TSS_02 instead.
ts.TCS.Field1 = 'Foo'
ts.TSS.Field2 = 'Bar'
ts.TSS_02.Field2 = 'Baz'
# ts.to_s => 'TSS*Blah*Bar~TCS*Foo**Preset Field 7~TSS*Last Segment*Baz~'The same technique can be used to reference fields within a segment that have the same name.
ts.TSS.CommonName = 'Value1'
ts.TSS.CommonName_02 = 'Value2'
# ts.to_s => 'TSS*Blah*Bar***Value1*Value2~TCS*Foo**Preset Field 7~TSS*Last Segment*Baz~'For more example please review the test suite.