File: /home/imensosw/www/imenso.co/dev/revspring/index.html
<!DOCTYPE html>
<html>
<head>
<meta charset="utf-8">
<meta name="viewport" content="width=device-width, initial-scale=1">
<script src="https://code.jquery.com/jquery-3.6.0.min.js" integrity="sha256-/xUj+3OJU5yExlq6GSYGSHk7tPXikynS7ogEvDej/m4=" crossorigin="anonymous"></script>
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<title>RevSpring</title>
</head>
<body>
<!-- <div class="container p-4">
<div class="text-center">
<h2>Eligibility Verification</h2>
</div>
<div >
<div class="row mt-3">
<div class="col-6">
<label for="firstName">First Name</label><span class="text-danger"> *</span><br>
<input class="form-control" placeholder="First Name" type="text" id="firstName" name="firstName">
</div>
<div class="col-6">
<label for="lastName">Last Name</label><span class="text-danger"> *</span><br>
<input class="form-control" placeholder="Last Name" type="text" id="lastName" name="lastName">
</div>
</div>
<div class="row mt-3">
<div class="col-6">
<label for="dateOfBirth">Date of Birth</label><span class="text-danger"> *</span><br>
<input class="form-control" type="date" id="dateOfBirth" name="dateOfBirth">
</div>
<div class="col-6">
<label for="memberId">Member Id</label><span class="text-danger"> *</span><br>
<input class="form-control" placeholder="Member Id" type="text" id="memberId" name="memberId">
</div>
</div>
<div class="row mt-3">
<div class="col-6">
<label for="serviceDate">Service Date</label><br>
<input class="form-control" type="date" id="serviceDate" name="serviceDate">
</div>
<div class="col-6">
<label for="payerId">Payer Id</label><span class="text-danger"> *</span><br>
<input class="form-control" placeholder="Payer Id" type="text" id="payerId" name="payerId">
</div>
</div>
<div class="row mt-3">
<div class="col-6">
<label for="transactionId">Transaction Id</label><br>
<input class="form-control" placeholder="Transaction Id" type="text" id="transactionId" name="transactionId">
</div>
<div class="col-6">
<label for="npi">NPI</label><span class="text-danger"> *</span><br>
<input class="form-control" placeholder="NPI" type="text" id="npi" name="npi">
</div>
</div>
<div class="row mt-3">
<div class="col-6">
<label for="payerProviderId">Payer Provider Id</label><span class="text-danger"> *</span><br>
<input class="form-control" placeholder="Payer Provider Id" type="text" id="payerProviderId" name="payerProviderId">
</div>
<div class="col-6">
<label for="organizationName">Organization Name</label><span class="text-danger"> *</span><br>
<input class="form-control" placeholder="Organization Name" type="text" id="organizationName" name="organizationName">
</div>
</div>
<div class="row mt-3">
<div class="col-6">
<label for="receiverorganizationName">Receiver Organization Name</label><span class="text-danger"> *</span><br>
<input class="form-control" placeholder="Receiver Organization Name" type="text" id="receiverorganizationName" name="receiverorganizationName">
</div>
</div>
</div>
<div class="text-center mt-4">
<button type="button" class="btn btn-primary" id="submitButton" onclick="submitRequest()"> Submit </button>
</div>
<div id="responseDiv" class="mt-5" style="display: none;">
<h5>Response: </h5>
<div id="showResponse" class="mt-2">
</div>
</div>
</div> -->
<div class="container p-4">
<div class="text-center">
<h2>Verify Insurance Eligibility</h2>
</div>
<div class="mt-5">
<div class="row justify-content-center" id="idForm">
<div class="col-6">
<label for="visitid">Visit ID</label><span class="text-danger"> *</span><br>
<input class="form-control" placeholder="Visit ID" type="text" id="visitId" name="visitId">
</div>
<div class="col-2 mt-auto">
<button type="button" class="btn btn-primary" id="getDetailsButton" onclick="getDetails()"> Get Details </button>
<button class="btn btn-primary" type="button" disabled id="loader" style="display:none;">
<span class="spinner-border spinner-border-sm" role="status" aria-hidden="true"></span>
Loading...
</button>
</div>
</div>
</div>
<!-- <div class="text-center mt-5">
<button type="button" class="btn btn-primary" id="getTokenButton" onclick="getToken()"> Verify Your Eligibility </button>
</div> -->
<div id="responseDiv" class="px-5 mt-5" style="display: none;">
<h5>Response: </h5>
<div id="showResponse" class="mt-2">
</div>
</div>
</div>
</body>
</html>
<script type="text/javascript">
// function getToken() {
// //var type = $('#type').val();
// $.ajax({
// type: "POST",
// url: 'GetToken.php',
// success: function(response)
// {
// var responseData = JSON.parse(response);
// if(responseData.access_token !== undefined) {
// $('#token').val(responseData.access_token);
// $('#getTokenButton').hide();
// $('#idForm').show();
// }
// }
// });
// }
function getDetails() {
$('#getDetailsButton').hide();
$('#loader').show();
var visitId = $('#visitId').val();
var token = $('#token').val();
$.ajax({
type: "POST",
url: 'GetDetails.php',
data: {'visitId': visitId, 'token': token},
success: function(response)
{
$('#showResponse').html(response);
$('#responseDiv').show();
$('#getDetailsButton').show();
$('#loader').hide();
// var responseData = JSON.parse(response);
// if(responseData.access_token !== undefined) {
// $('#getTokenButton').hide();
// $('#idForm').show();
// }
}
});
}
</script>