import { PracticeFusionClient, PracticeFusionConfig } from './PracticeFusionClient.js';
// Payer API Types
export interface Payer {
payerGuid: string;
payerName: string;
clearingHouses?: ClearingHouse[];
}
export interface ClearingHouse {
clearingHouseName: string;
payerCode: string;
}
export interface PayersResponse {
payers: Payer[];
meta?: {
totalPages: number;
totalItems: number;
};
}
export interface InsurancePlan {
payerGuid: string;
payerName: string;
planGuid: string;
planName: string;
planType: PlanType;
coverageTypeCode: CoverageTypeCode;
coverageType: CoverageType;
claimsContactInfo?: ContactInformation;
attorneyContactInfo?: ContactInformation;
}
export interface ContactInformation {
address?: Address;
telephoneNumber?: string;
telephoneExtension?: string;
faxNumber?: string;
faxExtension?: string;
}
export interface Address {
streetAddress1: string;
streetAddress2?: string;
city: string;
state: State;
postalCode: string;
}
export type State = 'AL' | 'AK' | 'AS' | 'AZ' | 'AR' | 'CA' | 'CO' | 'CT' | 'DE' | 'DC' | 'FM' | 'FL' | 'GA' | 'GU' | 'HI' | 'ID' | 'IL' | 'IN' | 'IA' | 'KS' | 'KY' | 'LA' | 'ME' | 'MH' | 'MD' | 'MA' | 'MI' | 'MN' | 'MS' | 'MO' | 'MT' | 'NE' | 'NV' | 'NH' | 'NJ' | 'NM' | 'NY' | 'NC' | 'ND' | 'MP' | 'OH' | 'OK' | 'OR' | 'PW' | 'PA' | 'PR' | 'RI' | 'SC' | 'SD' | 'TN' | 'TX' | 'UT' | 'VT' | 'VI' | 'VA' | 'WA' | 'WV' | 'WI' | 'WY';
export type PlanType = 'PPO' | 'HMO' | 'Medicare' | 'HSA' | 'Private' | 'EPO' | 'POS' | 'Medicaid' | 'Dental' | 'Vision' | 'Other' | 'Workers Compensation' | 'Behavioral health' | 'Motor Vehicle' | 'Uninsured';
export type CoverageTypeCode = 'Med' | 'Dental' | 'Other' | 'WC' | 'BH' | 'MV' | 'Unins';
export type CoverageType = 'Medical' | 'Dental' | 'Other' | "Worker's Comp" | 'Behavioral Health' | 'Motor Vehicle' | 'Uninsured';
export type OrderOfBenefits = 'Primary' | 'Secondary' | 'Tertiary' | 'Unknown/None';
export interface InsurancePlansResponse {
insurancePlans: InsurancePlan[];
}
export interface PayerSearchParams {
payerName?: string;
payerCode?: string;
pageNumber?: number;
pageSize?: number;
}
export interface InsurancePlansQueryParams {
restrictToPracticePreferredList?: boolean;
}
export interface PatientInsurancePlan {
patientInsurancePlanGuid?: string;
patientPracticeGuid: string;
relationshipToInsured: 'Self' | 'Spouse' | 'Child' | 'Other';
insuredId: string;
groupNumber?: string;
orderOfBenefits: OrderOfBenefits;
coverageStartDate: string;
coverageEndDate?: string;
nameOfEmployer?: string;
coPayType: 'Fixed' | 'Percentage';
baseCopay: number;
comments?: string;
isActive?: boolean;
claimNumber?: string;
insurancePlan: InsurancePlanSummary;
employerContact?: EmployerContact;
subscriber?: Subscriber;
}
export interface InsurancePlanSummary {
planGuid: string;
payerGuid: string;
coverageType: CoverageType;
planType: PlanType;
}
export interface EmployerContact {
firstName: string;
middleInitial?: string;
lastName: string;
address?: Address;
phoneNumber?: string;
phoneExtension?: string;
faxNumber?: string;
faxExtension?: string;
emailAddress?: string;
}
export interface Subscriber {
firstName: string;
middleInitial?: string;
lastName: string;
socialSecurityNumber?: string;
birthDate?: string;
sex: 'Male' | 'Female' | 'Unknown';
address?: Address;
primaryPhoneNumber?: string;
primaryPhoneExtension?: string;
secondaryPhoneNumber?: string;
secondaryPhoneExtension?: string;
}
export interface PatientInsurancePlansResponse {
patientInsurancePlans: PatientInsurancePlan[];
}
export interface PatientInsurancePlansQueryParams {
coverageType?: string;
planType?: string;
orderOfBenefits?: OrderOfBenefits;
activeOnly?: boolean;
}
export class PayerClient extends PracticeFusionClient {
constructor(config: PracticeFusionConfig) {
super({
...config,
baseUrl: `${config.baseUrl}/ehr/payer/v1`
});
}
// Find payers with optional filters
async findPayers(params?: PayerSearchParams): Promise<PayersResponse> {
try {
return await this.get<PayersResponse>('/payers', params);
} catch (error) {
this.logger.error('Error finding payers', { params }, error as Error);
throw error;
}
}
// Get a specific payer by GUID
async getPayer(payerGuid: string): Promise<Payer> {
try {
return await this.get<Payer>(`/payers/${payerGuid}`);
} catch (error) {
this.logger.error('Error fetching payer', { payerGuid }, error as Error);
throw error;
}
}
// Get insurance plans for a specific payer
async getInsurancePlans(payerGuid: string, params?: InsurancePlansQueryParams): Promise<InsurancePlansResponse> {
try {
return await this.get<InsurancePlansResponse>(`/payers/${payerGuid}/insurancePlans`, params);
} catch (error) {
this.logger.error('Error fetching insurance plans for payer', { payerGuid }, error as Error);
throw error;
}
}
// Get a specific insurance plan
async getInsurancePlan(payerGuid: string, planGuid: string): Promise<InsurancePlan> {
try {
const response = await this.get<InsurancePlan>(`/payers/${payerGuid}/insurancePlans/${planGuid}`);
return response;
} catch (error) {
this.logger.error('Error fetching insurance plan', { planGuid, payerGuid }, error as Error);
throw error;
}
}
// Get patient insurance plans
async getPatientInsurancePlans(patientPracticeGuid: string, params?: PatientInsurancePlansQueryParams): Promise<PatientInsurancePlansResponse> {
try {
return await this.get<PatientInsurancePlansResponse>(`/patients/${patientPracticeGuid}/patientInsurancePlans`, params);
} catch (error) {
this.logger.error('Error fetching insurance plans for patient', { patientPracticeGuid }, error as Error);
throw error;
}
}
// Get a specific patient insurance plan
async getPatientInsurancePlan(patientPracticeGuid: string, patientInsurancePlanGuid: string): Promise<PatientInsurancePlan> {
try {
const response = await this.get<PatientInsurancePlan>(`/patients/${patientPracticeGuid}/patientInsurancePlans/${patientInsurancePlanGuid}`);
return response;
} catch (error) {
this.logger.error('Error fetching patient insurance plan', { patientInsurancePlanGuid }, error as Error);
throw error;
}
}
// Add a patient insurance plan
async createPatientInsurancePlan(patientPracticeGuid: string, plan: PatientInsurancePlan): Promise<PatientInsurancePlan> {
try {
return await this.post<PatientInsurancePlan>(`/patients/${patientPracticeGuid}/patientInsurancePlans`, plan);
} catch (error) {
this.logger.error('Error creating insurance plan for patient', { patientPracticeGuid }, error as Error);
throw error;
}
}
// Update a patient insurance plan
async updatePatientInsurancePlan(patientPracticeGuid: string, patientInsurancePlanGuid: string, plan: PatientInsurancePlan): Promise<PatientInsurancePlan> {
try {
return await this.put<PatientInsurancePlan>(`/patients/${patientPracticeGuid}/patientInsurancePlans/${patientInsurancePlanGuid}`, plan);
} catch (error) {
this.logger.error('Error updating patient insurance plan', { patientInsurancePlanGuid }, error as Error);
throw error;
}
}
// Deactivate a patient insurance plan
async deactivatePatientInsurancePlan(patientPracticeGuid: string, patientInsurancePlanGuid: string): Promise<void> {
try {
await this.client.delete(`/patients/${patientPracticeGuid}/patientInsurancePlans/${patientInsurancePlanGuid}`);
} catch (error) {
this.logger.error('Error deactivating patient insurance plan', { patientInsurancePlanGuid }, error as Error);
throw error;
}
}
// Get subscriber relationship options
async getSubscriberRelationshipOptions(): Promise<string[]> {
try {
const response = await this.get<string[]>('/subscriberRelationshipOptions');
return response;
} catch (error) {
this.logger.error('Error fetching subscriber relationship options', {}, error as Error);
throw error;
}
}
}
