dixonwhitmire / x12genapp

Integrates a X12 Eligibility Transaction With IBM's General Insurance Application

x12GenApp

Integrates X12 Transactions with IBM's General Insurance Application on Z Systems.

Overview

x12GenApp provides a simple REST based API capable of integrating X12 transactions with the General Insurance Application's APIs. A single endpoint is used to consume x12 transactions. Specific transaction handling is implemented by parsing the transaction's ST segment and to determine the transaction format which selects the rules (eligibility, claims, enrollment, etc) used to parse the transaction set.

The x12 endpoint parses membership data from the x12 transaction for use in a Genapp customer lookup. The lookup executes against a record cache which is built when the application starts. The lookup may be bypassed using the is_passthrough_enabled configuration setting. When the lookup is bypassed, an "affirmative" x12 response is returned based on the input data. For example a 270 transaction submitted when is_passthrough_enabled is True will return a 271 transaction with member coverage information.

The request format consists of a single key, x12, and the corresponding x12 payload.

HTTP 1.1
Accept: application/json
Content-Type: application/json

{
  "x12": "ISA*00*          *00*          *ZZ*890069730      *ZZ*154663145<etc>"
}

The response includes the x12 response transaction with the x12 transaction code.

HTTP 1.1
Content-Type: application/json

{
  "x12": "ISA*00*          *00*          *ZZ*890069730      *ZZ*154663145<etc>",
  "x12_transaction_code": "271"
}

Transaction sets supported include:

• 270/271 for Insurance Eligibility Verification

Configuration

Application settings are defined in a configuration class, AppSettings

Setting	Description	Default
uvicorn_app	Path (python module and attribute) to the FastAPI application	x12genapp.main:app
uvicorn_host	Specifies the host/binding address for the FastAPI application	0.0.0.0
uvicorn_port	The port the FastAPI application's listening port	8080
uvicorn_reload	Set to True to support hot-reload for local debugging	False
is_passthrough_enabled	Set to True to bypass the Genapp Customer lookup, which returns an "affirmative" x12 transaction	False
genapp_base_url	The base Genapp url including protocol, host, port, and app root	http://localhost:9990/Genapp
genapp_customer_lookup	The Genapp customer lookup endpoint	/Customer/Ing
genapp_customer_min_id	Specifies the first record included in the Genapp customer cache	1
genapp_customer_max_id	Specifies the last record included in the Genapp customer cache	5

Settings are configured using FastAPI's implementation which is based on Pydantic's Setting implementation.

Settings are overriden using environment variables prior to launching the application.

export IS_PASSTHROUGH_ENABLED=True
python3 x12genapp/main.py

Endpoints

Endpoint	Description
http://:8080/docs	OpenAPI documentation
http://:8080/x12	The X12 message POST endpoint
http://:8080/customers	Returns cached Genapp customer records

Eligibility Check (270/271) Processing

The eligibility check processing workflow consists of the following steps:

• An API Client submits a X12 270 transaction to the x12GenApp endpoint genapp/x12 [POST]
• The endpoint parses member demographics from the X12 transaction for use in a GenApp Customer Search
• The 271 response transaction returned indicates the member is covered if match is found. Otherwise the member does not have coverage.

Demographics from the X12 270 transaction are returned in the X12 271 transaction to provide a meaningful response.

Installing For Local Development

A local development environment requires Python 3.x or higher.

Create the local development environment within a terminal (Linux based systems) or PowerShell (Windows)

cd <desired project base directory>
git clone <project url>
cd <project directory>
python3 -m venv env

Activate the project's virtual environment . . . On Windows

env\Scripts\activate

On Linux based systems

source env\bin\activate

Link the development code to the virtual environment and run tests

pip3 install --upgrade pip
pip3 install -e .[test]
# note on OS X if zsh is the default shell the command will need to be quoted 
#pip3 install -e '.[test]'

pytest

Container Support

Build and run the container image

docker build -t x12genapp .
docker run --rm --name x12genapp -p 8080:8080 -e IS_PASSTHROUGH_ENABLED=True x12genapp