RX-CLAIMS_INTEGRATION

Introduction

This repository contains the source code for the RX Claims integration module.

This service exposes some methods and functions for communication with RX Claims .

Language and tools

The service is developed using NodeJS and NestJS

Additionally, the project is written using ES6/ES7 features and follows a recommended folder structure as follows:

.

├── src                             # Contains all service logic
│   ├── common                      # Contains scommon files
|   |   ├──enums
|   |   ├──constants.ts
│   ├── config                      # Contains configs for service
│   │   ├── config.ts
│   └── helpers                     # Contains helpers files                   
│   │    ├── addItemToClaim.ts
│   │    ├── deleteClaimItem.ts
│   │    ├── generateClaimNumber.ts
│   │    ├── getDiagnosisList.ts
│   │    ├── getInsuranceList.ts
│   │    ├── getItemsList.ts
│   │    └── getMembershipStatus.ts
│   │    └── getUsersList.ts
│   │    └── submitClaim.ts
│   │    └── updateClaim.ts
│   └── modules                      # Contains all rx claims modules               
│   │    ├── addItemToClaim.ts
│   │    ├── deleteClaimItem.ts
│   │    ├── generateClaimNumber.ts
│   │    ├── getDiagnosisList.ts
│   │    ├── getInsuranceList.ts
│   │    ├── getItemsList.ts
│   │    └── getMembershipStatus.ts
│   │    └── getUsersList.ts
│   │    └── submitClaim.ts
│   │    └── updateClaim.ts
│   ├── schema      
│   │    ├── addItemToClaim.ts
│   │    ├── deleteClaimItem.ts
│   │    ├── generateClaimNumber.ts
│   │    ├── getDiagnosisList.ts
│   │    ├── getInsuranceList.ts
│   │    ├── getItemsList.ts
│   │    └── getMembershipStatus.ts
│   │    └── getUsersList.ts
│   │    └── submitClaim.ts
│   │    └── updateClaim.ts             
│   ├── tests                            # Contains all tests for the service and fixtures definition
│   │    ├── addItemToClaim.ts
│   │    ├── deleteClaimItem.ts
│   │    ├── generateClaimNumber.ts
│   │    ├── getDiagnosisList.ts
│   │    ├── getInsuranceList.ts
│   │    ├── getItemsList.ts
│   │    └── getMembershipStatus.ts
│   │    └── getUsersList.ts
│   │    └── submitClaim.ts
│   │    └── updateClaim.ts               # Folder structure follows the one of the src/ folder
│   |    └── mocks
│            └── fixtures.js
│   ├── utils      
│   │    ├── errors.ts
│   │    ├── joi.ts
│   │    ├── readme.ts
│   │    ├── responses.ts
│   ├── index.ts 
├── .babelrc
├── .eslintrc.js
├── .gitignore
├── .prettierrc
├── CHANGELOG.MD
├── nestjs-cli.json
├── package.json
├── package-lock.json
|── README.md
|── tsconfig.build.json
└── README.json

Installation

On developemnt using npm

The following environment requires the usage of the following:

1. NodeJS 20.5.1

For installing dependencies npm is used. The dependencies used in this project can be found in the package.json file. In order to install them use npm ci.

Then run npm run npm run start:dev.

On production

  npm install @unumed/rx-claim-integration

Usage

import {  getMemberStatus,generateClaimNumber,addItemToClaim} from '@unumed/rx-claim-integration';

const response = await getMemberStatus({

})

Tests

All tests are collected in the src/test/ project folder.

Documentation

Documentation for the project can be generated using the JSDoc annotations within the code. To generate the documentation issue the command npm docs. The docs generated will be available in HTML format in the .docs/ folder.

Functions and methods

getMemberStatus

Member Status Request Fields

|Field |Type |Description | | - | - | - | |METHOD |String |(Required) Must be MEMBERSTATUS. | |APIKEY |String |(Required) This a special unique key given to any service provider that wants to use the RxClaims API to make request to our webservers. | |USERNAME |String |(Required) It is the username that is associated with the APIKEY | |PASSWORD |String |(Required) It is the password that is associated with the APIKEY | |PROVIDERID |String |(Required) The unique ID of the Service Provider given to the provider from the RxClaim System. | |USERID |String |(Required) It is the unique id of the individual making the request. | |INSCOMPANYCODE |String |(Required) The unique ID of the insurance company as known by the RxClaim System. | |MEMBERSHIPID |String |(Required) The membership ID of a patient. | |ATTENDINGOFFICER| String |(Required) The full name of the individual making the request.* | |RESPONSETYPE |String |(Optional) This indicates the format in which the response data should be returned by our servers to your servers. There are three values for this. These are XML and JSON. If omitted the results will be returned in JSON format. |

Member Status Response Fields

|Field ||Description | | - | :- | - | |STATUSCODE ||A code representing the status of the response. It is may be one of the following: - 001 – Login Failed. Please Contact your IT administrator. - 002 – Authorization Permitted but Member Data not found. Please Contact your IT administrator. - 002 – Provide User's Id - 002 – Provide Attending Officer's - 002 – Invalid User's Id - 003 –Authorization Permitted. Member Data Found. | |STATUSMSG ||A message which interprets the status code in the response | |INSCOMPANYCODE ||The unique ID of the Health Insurance Institution of the MEMBER.* | |MEMBERSHIPID ||The membership ID number of the MEMBER. | |MEMBERPLAN ||The insurance plan of the MEMBER. | |SURNAME ||The surname of the MEMBER. | |OTHERNAMES ||The othernames of the MEMBER. | |FIRSTNAME ||The first name of the MEMBER | |DATEOFBIRTH || This date of birth of the MEMBER. | |SEX ||The gender of the MEMBER. | |EMPLOYER ||This company name of the EMPLOYER to which the MEMBER belongs to. | |EXPIRYDATE ||The card expiry date of the MEMBER | |MEMBERSTATUS ||This indicates the current status of the MEMBER (This can be either ACTIVE, INACTIVE). | |PLANSTATUS ||This indicates whether the current plan is active on the provider’s system (This can be either ACTIVE, INACTIVE). |

generateClaimNumber

deleteClaimItem

getInsuranceList

getDiagnosisList

getItemsList

getUsersList

submitClaim

updateClaimItem

addClaimItem