Examples with PreAdjFissClaim gov.cms.bfd.model.rda.PreAdjFissClaim used on opensource projects

Example 1 with PreAdjFissClaim

use of gov.cms.bfd.model.rda.PreAdjFissClaim in project beneficiary-fhir-data by CMSgov.

the class FissClaimTransformerV2 method transformClaim.

/**
 * @param claimGroup the {@link PreAdjFissClaim} to transform
 * @return a FHIR {@link Claim} resource that represents the specified {@link PreAdjFissClaim}
 */
private static Claim transformClaim(PreAdjFissClaim claimGroup) {
    Claim claim = new Claim();
    boolean isIcd9 = claimGroup.getStmtCovToDate() != null && claimGroup.getStmtCovToDate().isBefore(ICD_9_CUTOFF_DATE);
    claim.setId("f-" + claimGroup.getDcn());
    claim.setContained(List.of(getContainedPatient(claimGroup), getContainedProvider(claimGroup)));
    claim.setIdentifier(getIdentifier(claimGroup));
    claim.setExtension(getExtension(claimGroup));
    claim.setStatus(Claim.ClaimStatus.ACTIVE);
    claim.setType(getType(claimGroup));
    claim.setSupportingInfo(getSupportingInfo(claimGroup));
    claim.setBillablePeriod(getBillablePeriod(claimGroup));
    claim.setUse(Claim.Use.CLAIM);
    claim.setPriority(getPriority());
    claim.setTotal(getTotal(claimGroup));
    claim.setProvider(new Reference("#provider-org"));
    claim.setPatient(new Reference("#patient"));
    claim.setFacility(getFacility(claimGroup));
    claim.setDiagnosis(getDiagnosis(claimGroup, isIcd9));
    claim.setProcedure(getProcedure(claimGroup, isIcd9));
    claim.setInsurance(getInsurance(claimGroup));
    claim.setMeta(new Meta().setLastUpdated(Date.from(claimGroup.getLastUpdated())));
    claim.setCreated(new Date());
    return claim;
}

Example 2 with PreAdjFissClaim

use of gov.cms.bfd.model.rda.PreAdjFissClaim in project beneficiary-fhir-data by CMSgov.

the class FissClaimStreamCallerIT method basicCall.

@Test
public void basicCall() throws Exception {
    RdaServer.InProcessConfig.builder().serverName(getClass().getSimpleName()).fissSourceFactory(sequenceNumber -> WrappedClaimSource.wrapFissClaims(new JsonMessageSource<>(CLAIM_1 + System.lineSeparator() + CLAIM_2, JsonMessageSource::parseFissClaim), clock, sequenceNumber)).build().runWithChannelParam(channel -> {
        final FissClaimStreamCaller caller = new FissClaimStreamCaller();
        assertEquals(RdaService.RDA_PROTO_VERSION, caller.callVersionService(channel, CallOptions.DEFAULT));
        final GrpcResponseStream<FissClaimChange> results = caller.callService(channel, CallOptions.DEFAULT, 0L);
        assertTrue(results.hasNext());
        PreAdjFissClaim claim = transform(results.next());
        assertEquals("63843470", claim.getDcn());
        assertEquals(Long.valueOf(0), claim.getSequenceNumber());
        assertTrue(results.hasNext());
        claim = transform(results.next());
        assertEquals("2643602", claim.getDcn());
        assertEquals(Long.valueOf(1), claim.getSequenceNumber());
        assertFalse(results.hasNext());
    });
}

Example 3 with PreAdjFissClaim

use of gov.cms.bfd.model.rda.PreAdjFissClaim in project beneficiary-fhir-data by CMSgov.

the class FissClaimTransformerTest method basicFieldsTestForInsuredPayerObjectTransformation.

/**
 * Basic smoke test for transformation of insured payer objects prior to all of the individual
 * field tests.
 */
@Test
public void basicFieldsTestForInsuredPayerObjectTransformation() {
    claimBuilder.setDcn("dcn").setHicNo("hicn").setCurrStatusEnum(FissClaimStatus.CLAIM_STATUS_MOVE).setCurrLoc1Enum(FissProcessingType.PROCESSING_TYPE_MANUAL).setCurrLoc2Enum(FissCurrentLocation2.CURRENT_LOCATION_2_FINAL).addFissPayers(FissPayer.newBuilder().setInsuredPayer(FissInsuredPayer.newBuilder().setPayersIdEnum(FissPayersCode.PAYERS_CODE_BLACK_LUNG).setPayersName("payers-name").setRelIndEnum(FissReleaseOfInformation.RELEASE_OF_INFORMATION_NO_RELEASE_ON_FILE).setAssignIndEnum(FissAssignmentOfBenefitsIndicator.ASSIGNMENT_OF_BENEFITS_INDICATOR_BENEFITS_ASSIGNED).setProviderNumber("provider-num").setAdjDcnIcn("dcn-icn").setPriorPmt("123.45").setEstAmtDue("234.56").setInsuredRelEnum(FissPatientRelationshipCode.PATIENT_RELATIONSHIP_CODE_EMPLOYEE).setInsuredName("insured-name").setInsuredSsnHic("ssn-hic").setInsuredGroupName("group-name").setInsuredGroupNbr("group-num").setTreatAuthCd("auth-code").setInsuredSexEnum(FissBeneficiarySex.BENEFICIARY_SEX_MALE).setInsuredRelX12Enum(FissPatientRelationshipCode.PATIENT_RELATIONSHIP_CODE_GRANDCHILD).setInsuredDobText("11222021").setInsuredDob("2021-11-22").build()).build());
    claim.setDcn("dcn");
    claim.setHicNo("hicn");
    claim.setCurrStatus('M');
    claim.setCurrLoc1('M');
    claim.setCurrLoc2("9997");
    claim.setLastUpdated(clock.instant());
    PreAdjFissPayer payer = new PreAdjFissPayer();
    payer.setDcn("dcn");
    payer.setPriority((short) 0);
    payer.setPayerType(PreAdjFissPayer.PayerType.Insured);
    payer.setPayersId("H");
    payer.setPayersName("payers-name");
    payer.setRelInd("N");
    payer.setAssignInd("Y");
    payer.setProviderNumber("provider-num");
    payer.setAdjDcnIcn("dcn-icn");
    payer.setPriorPmt(new BigDecimal("123.45"));
    payer.setEstAmtDue(new BigDecimal("234.56"));
    payer.setInsuredRel("08");
    payer.setInsuredName("insured-name");
    payer.setInsuredSsnHic("ssn-hic");
    payer.setInsuredGroupName("group-name");
    payer.setInsuredGroupNbr("group-num");
    payer.setTreatAuthCd("auth-code");
    payer.setInsuredSex("M");
    payer.setInsuredRelX12("13");
    payer.setInsuredDob(LocalDate.of(2021, 11, 22));
    payer.setInsuredDobText("11222021");
    payer.setLastUpdated(claim.getLastUpdated());
    claim.getPayers().add(payer);
    changeBuilder.setSeq(MIN_SEQUENCE_NUM).setChangeType(ChangeType.CHANGE_TYPE_UPDATE).setClaim(claimBuilder.build());
    PreAdjFissClaim transformed = transformer.transformClaim(changeBuilder.build()).getClaim();
    assertThat(transformed, samePropertyValuesAs(claim));
    TransformerTestUtils.assertListContentsHaveSamePropertyValues(claim.getPayers(), transformed.getPayers(), PreAdjFissPayer::getPriority);
}

Example 4 with PreAdjFissClaim

use of gov.cms.bfd.model.rda.PreAdjFissClaim in project beneficiary-fhir-data by CMSgov.

the class FissClaimTransformerTest method basicFieldsTestForAuditTrailObjectTransformation.

/**
 * Basic smoke test for transformation of audit trail objects prior to all of the individual field
 * tests.
 */
@Test
public void basicFieldsTestForAuditTrailObjectTransformation() {
    claimBuilder.setDcn("dcn").setHicNo("hicn").setCurrStatusEnum(FissClaimStatus.CLAIM_STATUS_MOVE).setCurrLoc1Enum(FissProcessingType.PROCESSING_TYPE_MANUAL).setCurrLoc2Enum(FissCurrentLocation2.CURRENT_LOCATION_2_FINAL).addFissAuditTrail(FissAuditTrail.newBuilder().setBadtStatusEnum(FissClaimStatus.CLAIM_STATUS_MOVE).setBadtLoc("1").setBadtOperId("2").setBadtReas("3").setBadtCurrDateCymd("2021-12-03").build());
    claim.setDcn("dcn");
    claim.setHicNo("hicn");
    claim.setCurrStatus('M');
    claim.setCurrLoc1('M');
    claim.setCurrLoc2("9997");
    claim.setLastUpdated(clock.instant());
    PreAdjFissAuditTrail auditTrail = new PreAdjFissAuditTrail();
    auditTrail.setDcn("dcn");
    auditTrail.setPriority((short) 0);
    auditTrail.setBadtStatus("M");
    auditTrail.setBadtLoc("1");
    auditTrail.setBadtOperId("2");
    auditTrail.setBadtReas("3");
    auditTrail.setBadtCurrDate(LocalDate.of(2021, 12, 3));
    auditTrail.setLastUpdated(claim.getLastUpdated());
    claim.getAuditTrail().add(auditTrail);
    changeBuilder.setSeq(MIN_SEQUENCE_NUM).setChangeType(ChangeType.CHANGE_TYPE_UPDATE).setClaim(claimBuilder.build());
    PreAdjFissClaim transformed = transformer.transformClaim(changeBuilder.build()).getClaim();
    assertThat(transformed, samePropertyValuesAs(claim));
    TransformerTestUtils.assertListContentsHaveSamePropertyValues(claim.getAuditTrail(), transformed.getAuditTrail(), PreAdjFissAuditTrail::getPriority);
}

Example 5 with PreAdjFissClaim

use of gov.cms.bfd.model.rda.PreAdjFissClaim in project beneficiary-fhir-data by CMSgov.

the class RdaLoadJobIT method fissClaimsTest.

@Test
public void fissClaimsTest() throws Exception {
    RdaPipelineTestUtils.runTestWithTemporaryDb(RdaLoadJobIT.class, clock, (appState, entityManager) -> {
        assertTablesAreEmpty(entityManager);
        RdaServer.LocalConfig.builder().fissSourceFactory(fissJsonSource(fissClaimJson)).build().runWithPortParam(port -> {
            final RdaLoadOptions config = createRdaLoadOptions(port);
            final PipelineJob<?> job = config.createFissClaimsLoadJob(appState);
            job.call();
        });
        final ImmutableList<FissClaimChange> expectedClaims = JsonMessageSource.parseAll(fissClaimJson, JsonMessageSource::parseFissClaimChange);
        List<PreAdjFissClaim> claims = getPreAdjFissClaims(entityManager);
        assertEquals(expectedClaims.size(), claims.size());
        for (PreAdjFissClaim resultClaim : claims) {
            FissClaim expected = findMatchingFissClaim(expectedClaims, resultClaim);
            assertNotNull(expected);
            assertEquals(expected.getHicNo(), resultClaim.getHicNo());
            assertEquals(expected.getPracLocCity(), Strings.nullToEmpty(resultClaim.getPracLocCity()));
            assertEquals(expected.getFissProcCodesCount(), resultClaim.getProcCodes().size());
            assertEquals(expected.getFissDiagCodesCount(), resultClaim.getDiagCodes().size());
        }
    });
}