CMS1500

Ruby gem for printing CMS 1500 forms

Typical Usage

file = File.new('claim.txt', 'w')

form = Cms1500.build_form(output: file) do |f|
  f.build_section(:carrier) do |c|
  end

  f.build_section(:patient) do |p|
    p.first_name = 'Jane'
    p.middle_initial = 'H'
    p.last_name = 'Doe'
    p.date_of_birth = '1900-01-01'
    p.sex = :female
    p.address = '123 Fake Street'
    p.city = 'Springfield'
    p.state = 'OR'
    p.zip_code = 12345
    p.telephone = 1234567890
    p.relationship_to_insured = :self
    p.status = [:single, :employed]
    p.condition = [:employment, :auto]
  end

  f.build_section(:insured) do |i|
    # since patient == insured, person attributes copied from patient
    i.program = :medicare
    i.id_number = 123456789
    i.policy_number = 123456789 # or group or feca number
    i.employer_name = 'Mr Burns' # or school_name
    i.plan_name = 'Insurance Plan' # or program_name
    i.another_plan = true # requires other insured section
  end

  f.build_section(:other_insured) do |i|
    i.policy_number = 1234567890
    i.date_of_birth = '1900-01-01'
    i.sex = :female
    i.employer_name = 'Mr. Burns' # or school_name
    i.plan_name = 'Insurance Plan' # or program_name
  end

  f.build_section(:physician) do |p|
    p.name = 'John Doe'
    p.npi = 1234567890
    p.outside_lab = true
    p.charges = 100.50
    p.diagnosis_1 = 750.1
    p.medicaid_resubmission_code = ''
    p.original_ref_no = ''
    p.prior_authorization_number = ''
    p.federal_tax_id_number = [12345, :ssn]
    p.patient_account_no = 12345
    p.accept_assignment = true
    p.total_charge = 123.45
    p.amount_paid = 56.78
    p.balance_due = 9.99
    p.service_facility_location_information = ''
    p.billing_provider_info = ''
  end

  f.build_line(1) do |l|
    l.date_of_service = {from: '2010-01-01', to: '2010-01-01'}
    l.place_of_service = 'Springfield'
    l.emg = ''
    l.cpt = '80101'
    l.modifier = '59'
    l.diagnosis_pointer = ''
    l.charges = 100.5
    l.units = 1 # or days
    l.epstd_family_plan = ''
    l.rendering_provider_id = ''
  end
end

form.to_text
file.close