public Stream Transform837ToClaimDocument(Stream input)
{
var service = new ClaimTransformationService();
var document = service.Transform837ToClaimDocument(input);
string xml = document.Serialize();
return(new MemoryStream(Encoding.UTF8.GetBytes(xml)));
}
public void TransToDentalClaim5010()
{
string x12 = @"ISA*00* *00* *01*9012345720000 *01*9088877320000 *020816*1144*U*00401*000000031*1*T*:~
GS*HC*901234572000*908887732000*20070816*1615*31*X*005010X096A1~
ST*837*873501~
BHT*0019*00*0125*19970411*1524*CH~
REF*87*004010X097~
NM1*41*2*DENTAL ASSOCIATES*****46*579999999~
PER*IC*SYDNEY SNOW*TE*2125557987~
NM1*40*2*HEISMAN INSURANCE COMPANY*****46*555667777~
HL*1**20*1~
NM1*85*2*DENTAL ASSOCIATES*****XX*591PD123~
N3*10 1/2 SHOEMAKER STREET~
N4*COBBLER*CA*99997~
REF*TJ*579999999~
HL*2*1*22*1~
SBR*P*****6***LM~
NM1*IL*1*HOWLING*HAL****MI*B99977791G~
NM1*PR*2*HEISMAN INSURANCE COMPANY*****PI*999888777~
HL*3*2*23*0~
PAT*41~
NM1*QC*1*DIMPSON*D*J***34*567324788~
N3*32 BUFFALO RUN~
N4*ROCKING HORSE*CA*99666~
DMG*D8*19480601*M~
REF*Y4*32323232~
CLM*900000032*390***11::1*Y**Y*Y**AA:::CA~
DTP*439*D8*19970201~
DTP*472*D8*19970202~
NM1*82*1*MOGLIE*BRUNO****34*224873702~
PRV*PE*ZZ*122300000N~
LX*1~
SV3*AD:D0330*40****1~
LX*2~
SV3*AD:D5820*350***I*1~
TOO*JP*8~
TOO*JP*9*M~
TOO*JP*13*M:O~
SE*35*873501~
GE*1*31~
IEA*1*000000031~";
var service = new ClaimTransformationService();
var x12Parser = new Parsing.X12Parser();
var document = service.Transform837ToClaimDocument(x12Parser.ParseMultiple(x12).First());
Claim claim = document.Claims.First();
Trace.Write(claim.Serialize());
Assert.AreEqual(3, claim.ServiceLines.Sum(sl => sl.ToothInformations.Count));
}
public void TransformToInstitutionalClaim5010_PayerObjectTest()
{
var service = new ClaimTransformationService();
Stream stream = Assembly.GetExecutingAssembly().GetManifestResourceStream("X12.Hipaa.Tests.Unit.Claims.TestData.InstitutionalClaim5010.txt");
var document = service.Transform837ToClaimDocument(stream);
Claim claim = document.Claims.First();
Assert.AreEqual("PI", claim.Payer.Name.Identification.Qualifier);
Assert.AreEqual("00435", claim.Payer.Name.Identification.Id);
Assert.AreEqual("G2", claim.Payer.Identifications.First().Qualifier);
Assert.AreEqual("330127", claim.Payer.Identifications.First().Id);
}
public void TransformToInstitutionalClaim4010Test()
{
var service = new ClaimTransformationService();
Stream stream = Assembly.GetExecutingAssembly().GetManifestResourceStream("OopFactory.X12.Hipaa.Tests.Unit.Claims.TestData.InstitutionalClaim4010.txt");
var document = service.Transform837ToClaimDocument(stream);
string xml = document.Serialize();
Trace.Write(xml);
Assert.AreEqual(1, document.Claims.Count, "Expected one claim");
Claim claim = document.Claims.First();
// Box 1 - Service Location
Assert.AreEqual("JONES HOSPITAL", claim.ServiceLocation.Name.LastName, "Unexpected Billing Provider Last Name");
Assert.AreEqual("225 MAIN STREET BARKLEY BUILDING", claim.ServiceLocation.Address.Line1, "Unexpected Billing Provider Adddress Line 1");
Assert.AreEqual("CENTERVILLE", claim.ServiceLocation.Address.City, "Unexpected Billing Provider Address City");
Assert.AreEqual("PA", claim.ServiceLocation.Address.StateCode, "Unexpected Billing Provider Address State Code");
Assert.AreEqual("17111", claim.ServiceLocation.Address.PostalCode, "Unexpected Billing Provider Address Postal Code");
// Box 2 - Pay To Provider
Assert.AreEqual(ClaimTypeEnum.Institutional, claim.Type);
Assert.AreEqual("JONES HOSPITAL", claim.PayToProvider.Name.LastName, "Unexpected Billing Provider Last Name");
Assert.AreEqual("225 MAIN STREET BARKLEY BUILDING", claim.PayToProvider.Address.Line1, "Unexpected Billing Provider Adddress Line 1");
Assert.AreEqual("CENTERVILLE", claim.PayToProvider.Address.City, "Unexpected Billing Provider Address City");
Assert.AreEqual("PA", claim.PayToProvider.Address.StateCode, "Unexpected Billing Provider Address State Code");
Assert.AreEqual("17111", claim.PayToProvider.Address.PostalCode, "Unexpected Billing Provider Address Postal Code");
// Box 3a - Patient Control Number
Assert.AreEqual("756048Q", claim.PatientControlNumber, "Unexpected PatientControlNumber");
// Box 3b - Type of Bill
Assert.AreEqual("TEST MEDICAL RECORD NUMBER", claim.MedicalRecordNumber, "Unexpected MedicalRecordNumber");
// Box 4 - Type of Bill
Assert.AreEqual("14", claim.ServiceLocationInfo.FacilityCode, "Unexpected facility code");
Assert.AreEqual("A", claim.ServiceLocationInfo.Qualifier, "Unexpected facility code qualifier");
Assert.AreEqual("1", claim.ServiceLocationInfo.FrequencyTypeCode, "Unexpected frequency type code");
// Box 5 - Federal Tax Number
Assert.AreEqual("123456789", claim.PayToProvider.TaxId, "Unexpected Federal Tax ID");
// Box 6 Statement Covers Period
Assert.AreEqual(DateTime.Parse("1996-9-11"), claim.StatementFromDate, "Unexpected statement from date");
Assert.AreEqual(DateTime.Parse("1996-9-11"), claim.StatementToDate, "Unexpected statement through date");
// Box 7 - Filler
ClaimMember patient = claim.Patient ?? claim.Subscriber;
// Box 8 - Patient Name
Assert.AreEqual("DOE", patient.Name.LastName, "Unexpected patient last name");
Assert.AreEqual("JOHN", patient.Name.FirstName, "Unexpected patient first name");
Assert.AreEqual("T", patient.Name.MiddleName, "Unexpected patient middle name");
Assert.AreEqual("030005074A", patient.MemberId);
// Box 9 Patient Address
Assert.AreEqual("125 CITY AVENUE", patient.Address.Line1, "Unexpected patient address line 1");
Assert.AreEqual("CENTERVILLE", patient.Address.City, "Unexpected patient address city");
Assert.AreEqual("PA", patient.Address.StateCode, "Unexpected patient address state code");
Assert.AreEqual("17111", patient.Address.PostalCode, "Unexpected patient address postal code");
// Box 10 Birthdate
Assert.AreEqual(DateTime.Parse("1926-11-11"), patient.DateOfBirth);
// Box 11 Sex
Assert.AreEqual(GenderEnum.Male, patient.Gender);
// Box 12 & 13 Admission Date and Hour
Assert.AreEqual(DateTime.Parse("1996-09-10 2:02 PM"), claim.AdmissionDate);
// Box 14 Admission Type
// Box 15 Admission Source
Assert.AreEqual(2, claim.ServiceLines.Count, "Unexpected number of service lines.");
ServiceLine line = claim.ServiceLines[0];
Assert.AreEqual("305", line.RevenueCode);
Assert.AreEqual("85025", line.Procedure.ProcedureCode);
}
public void TransformToInstitutionalClaim5010Test()
{
var service = new ClaimTransformationService();
Stream stream = Assembly.GetExecutingAssembly().GetManifestResourceStream("OopFactory.X12.Hipaa.Tests.Unit.Claims.TestData.InstitutionalClaim5010.txt");
var document = service.Transform837ToClaimDocument(stream);
string xml = document.Serialize();
Assert.AreEqual(1, document.Claims.Count, "Expected one claim");
Claim claim = document.Claims.First();
Trace.Write(claim.Serialize());
Assert.AreEqual(ClaimTypeEnum.Institutional, claim.Type);
// Box 1 - Service Location
Assert.AreEqual("JONES HOSPITAL", claim.ServiceLocation.Name.LastName, "Unexpected Billing Provider Last Name");
Assert.AreEqual("225 MAIN STREET BARKLEY BUILDING", claim.ServiceLocation.Address.Line1, "Unexpected Billing Provider Adddress Line 1");
Assert.AreEqual("CENTERVILLE", claim.ServiceLocation.Address.City, "Unexpected Billing Provider Address City");
Assert.AreEqual("PA", claim.ServiceLocation.Address.StateCode, "Unexpected Billing Provider Address State Code");
Assert.AreEqual("17111", claim.ServiceLocation.Address.PostalCode, "Unexpected Billing Provider Address Postal Code");
// Box 2 - Pay To Provider
Assert.AreEqual("JONES HOSPITAL", claim.PayToProvider.Name.LastName, "Unexpected Billing Provider Last Name");
Assert.AreEqual("225 MAIN STREET BARKLEY BUILDING", claim.PayToProvider.Address.Line1, "Unexpected Billing Provider Adddress Line 1");
Assert.AreEqual("CENTERVILLE", claim.PayToProvider.Address.City, "Unexpected Billing Provider Address City");
Assert.AreEqual("PA", claim.PayToProvider.Address.StateCode, "Unexpected Billing Provider Address State Code");
Assert.AreEqual("17111", claim.PayToProvider.Address.PostalCode, "Unexpected Billing Provider Address Postal Code");
// Box 3a - Patient Control Number
Assert.AreEqual("756048Q", claim.PatientControlNumber, "Unexpected PatientControlNumber");
// Box 3b - Type of Bill
Assert.AreEqual("TEST MEDICAL RECORD NUMBER", claim.MedicalRecordNumber, "Unexpected MedicalRecordNumber");
// Box 4 - Type of Bill
Assert.AreEqual("14", claim.ServiceLocationInfo.FacilityCode, "Unexpected facility code");
Assert.AreEqual("A", claim.ServiceLocationInfo.Qualifier, "Unexpected facility code qualifier");
Assert.AreEqual("1", claim.ServiceLocationInfo.FrequencyTypeCode, "Unexpected frequency type code");
// Box 5 - Federal Tax Number
Assert.AreEqual("567891234", claim.PayToProvider.TaxId, "Unexpected Federal Tax ID");
// Box 6 Statement Covers Period
Assert.AreEqual(DateTime.Parse("1996-9-11"), claim.StatementFromDate, "Unexpected statement from date");
Assert.AreEqual(DateTime.Parse("1996-9-11"), claim.StatementToDate, "Unexpected statement through date");
// Box 7 - Filler
ClaimMember patient = claim.Patient ?? claim.Subscriber;
// Box 8 - Patient Name
Assert.AreEqual("DOE", patient.Name.LastName, "Unexpected patient last name");
Assert.AreEqual("JOHN", patient.Name.FirstName, "Unexpected patient first name");
Assert.AreEqual("T", patient.Name.MiddleName, "Unexpected patient middle name");
Assert.AreEqual("030005074A", patient.MemberId);
// Box 9 Patient Address
Assert.AreEqual("125 CITY AVENUE", patient.Address.Line1, "Unexpected patient address line 1");
Assert.AreEqual("CENTERVILLE", patient.Address.City, "Unexpected patient address city");
Assert.AreEqual("PA", patient.Address.StateCode, "Unexpected patient address state code");
Assert.AreEqual("17111", patient.Address.PostalCode, "Unexpected patient address postal code");
// Box 10 Birthdate
Assert.AreEqual(DateTime.Parse("1926-11-11"), patient.DateOfBirth);
// Box 11 Sex
Assert.AreEqual(GenderEnum.Male, patient.Gender);
// Box 12 & 13 Admission Date and Hour
Assert.AreEqual(DateTime.Parse("1996-09-11 2:02 PM"), claim.AdmissionDate);
// Box 14 Admission Type
// Box 15 Admission Source
// Box 16 Discharge Hour
// Box 17 Discharge Status
// Box 18 through 28 Condition Codes
Assert.AreEqual(14, claim.Conditions.Count);
Assert.AreEqual("01", claim.Conditions[0].Code);
Assert.AreEqual("02", claim.Conditions[1].Code);
Assert.AreEqual("03", claim.Conditions[2].Code);
Assert.AreEqual("04", claim.Conditions[3].Code);
Assert.AreEqual("05", claim.Conditions[4].Code);
Assert.AreEqual("06", claim.Conditions[5].Code);
Assert.AreEqual("07", claim.Conditions[6].Code);
Assert.AreEqual("08", claim.Conditions[7].Code);
Assert.AreEqual("09", claim.Conditions[8].Code);
Assert.AreEqual("10", claim.Conditions[9].Code);
Assert.AreEqual("11", claim.Conditions[10].Code);
// Box 29
// Box 30
// Box 31 through 34 - Occurrences
Assert.AreEqual(8, claim.Occurrences.Count);
Assert.AreEqual("A1", claim.Occurrences[0].Code);
Assert.AreEqual(DateTime.Parse("1926-11-11"), claim.Occurrences[0].Date);
Assert.AreEqual("A2", claim.Occurrences[1].Code);
Assert.AreEqual(DateTime.Parse("1991-11-01"), claim.Occurrences[1].Date);
Assert.AreEqual("B1", claim.Occurrences[2].Code);
Assert.AreEqual(DateTime.Parse("1926-11-11"), claim.Occurrences[2].Date);
Assert.AreEqual("B2", claim.Occurrences[3].Code);
Assert.AreEqual(DateTime.Parse("1987-1-1"), claim.Occurrences[3].Date);
Assert.AreEqual("C1", claim.Occurrences[4].Code);
Assert.AreEqual(DateTime.Parse("1926-11-11"), claim.Occurrences[4].Date);
Assert.AreEqual("C2", claim.Occurrences[5].Code);
Assert.AreEqual(DateTime.Parse("1991-11-1"), claim.Occurrences[5].Date);
Assert.AreEqual("D1", claim.Occurrences[6].Code);
Assert.AreEqual(DateTime.Parse("1926-11-11"), claim.Occurrences[6].Date);
Assert.AreEqual("D2", claim.Occurrences[7].Code);
Assert.AreEqual(DateTime.Parse("1987-1-1"), claim.Occurrences[7].Date);
// Box 35 through 36 - Occurrence Spans
Assert.AreEqual(4, claim.OccurrenceSpans.Count);
Assert.AreEqual("A1", claim.OccurrenceSpans[0].Code);
Assert.AreEqual(DateTime.Parse("1926-11-11"), claim.OccurrenceSpans[0].FromDate);
Assert.AreEqual(DateTime.Parse("1927-12-31"), claim.OccurrenceSpans[0].ThroughDate);
// Box 37 - Filler
// Box 38 - Responsible Party
// Box 39 through 41 - Value Codes
Assert.AreEqual(14, claim.Values.Count);
Assert.AreEqual("A2", claim.Values[0].Code);
Assert.AreEqual(15.31m, claim.Values[0].Amount);
Assert.AreEqual("N2", claim.Values[13].Code);
Assert.AreEqual(28.31m, claim.Values[13].Amount);
// Box 42 through 49 - Service Lines
Assert.AreEqual(2, claim.ServiceLines.Count, "Unexpected number of service lines.");
ServiceLine line = claim.ServiceLines[0];
Assert.AreEqual("0305", line.RevenueCode);
Assert.AreEqual("85025", line.Procedure.ProcedureCode);
Assert.AreEqual(13.39m, line.ChargeAmount);
Assert.AreEqual(1, line.Quantity);
Assert.AreEqual(DateTime.Parse("1996-9-11"), line.ServiceDateFrom);
Assert.IsNull(line.OperatingPhysician);
line = claim.ServiceLines[1];
Assert.AreEqual("0730", line.RevenueCode);
Assert.AreEqual("93005", line.Procedure.ProcedureCode);
Assert.AreEqual("AA", line.Procedure.Modifier1);
Assert.AreEqual("BB", line.Procedure.Modifier2);
Assert.AreEqual("CC", line.Procedure.Modifier3);
Assert.AreEqual("DD", line.Procedure.Modifier4);
Assert.AreEqual("Test Procedure", line.Procedure.Description);
Assert.AreEqual(76.54m, line.ChargeAmount);
Assert.AreEqual(3, line.Quantity);
Assert.AreEqual(11.15m, line.NonCoveredChargeAmount);
Assert.AreEqual(DateTime.Parse("1996-9-11"), line.ServiceDateFrom);
Assert.AreEqual(1, line.Notes.Count);
Assert.AreEqual("TPO", line.Notes[0].Code);
Assert.IsNotNull(line.OperatingPhysician);
Assert.AreEqual("JONES", line.OperatingPhysician.Name.LastName);
Assert.AreEqual("JOHN", line.OperatingPhysician.Name.FirstName);
Assert.AreEqual("B99937", line.OperatingPhysician.Npi);
Assert.AreEqual("363LP0200N", line.OperatingPhysician.ProviderInfo.Id);
// Box 50 through 55 - Payers
// Box 56 - NPI
// Box 57 - Other Provider ID
// Box 68 through 62 - Insured
// Box 63 through 65 - Authorizations
// Box 66 - Diagnosis Version
// Box 67 - Diagnosis
Assert.AreEqual("3669", claim.Diagnoses.First(d => d.DiagnosisType == DiagnosisTypeEnum.Principal).Code);
// Box 68
// Box 69 - Admitting Diagnosis
// Box 70 - Patient Reason Diagnosis
// Box 71 - PPS Code
// Box 72 - ECI
// Box 73
// Box 74 - Procedures
Assert.AreEqual(3, claim.Procedures.Count);
var principal = claim.Procedures.FirstOrDefault(p => p.IsPrincipal);
Assert.IsNotNull(principal);
Assert.AreEqual("BBR", principal.Qualifier);
Assert.AreEqual("0B110F5", principal.Code);
Assert.AreEqual(DateTime.Parse("2005-3-21"), principal.Date);
// Box 75 - Blank
// Box 76 - Attending Physician
Assert.IsNotNull(claim.AttendingProvider);
Assert.AreEqual("JOHN", claim.AttendingProvider.Name.FirstName);
Assert.AreEqual("1G", claim.AttendingProvider.Identifications[0].Qualifier);
Assert.AreEqual("B99937A", claim.AttendingProvider.Identifications[0].Id);
// Box 77 - Operating Physician
Assert.IsNotNull(claim.OperatingPhysician);
Assert.AreEqual("JANE", claim.OperatingPhysician.Name.FirstName);
// Box 78 - Other
Assert.IsNotNull(claim.OtherOperatingPhysician);
Assert.AreEqual("JOE", claim.OtherOperatingPhysician.Name.FirstName);
// Box 79 - Other
// Box 80 - Remarks
// Box 81CC
}