Examples with DMEClaim gov.cms.bfd.model.rif.DMEClaim used on opensource projects

Example 11 with DMEClaim

use of gov.cms.bfd.model.rif.DMEClaim in project beneficiary-fhir-data by CMSgov.

the class EndpointJsonResponseComparatorV2IT method eobReadDme.

/**
 * @return the results of the {@link
 *     ExplanationOfBenefitResourceProvider#read(org.hl7.fhir.dstu3.model.IdType)} operation for
 *     DME claims
 */
public static String eobReadDme() {
    List<Object> loadedRecords = ServerTestUtils.get().loadData(Arrays.asList(StaticRifResourceGroup.SAMPLE_A.getResources()));
    IGenericClient fhirClient = createFhirClientAndSetEncoding();
    JsonInterceptor jsonInterceptor = createAndRegisterJsonInterceptor(fhirClient);
    DMEClaim dmeClaim = loadedRecords.stream().filter(r -> r instanceof DMEClaim).map(r -> (DMEClaim) r).findFirst().get();
    fhirClient.read().resource(ExplanationOfBenefit.class).withId(TransformerUtilsV2.buildEobId(ClaimTypeV2.DME, dmeClaim.getClaimId())).execute();
    return jsonInterceptor.getResponse();
}

Example 12 with DMEClaim

use of gov.cms.bfd.model.rif.DMEClaim in project beneficiary-fhir-data by CMSgov.

the class ExplanationOfBenefitResourceProviderIT method adjustDmeRecordForSamhsaDiagnosis.

/**
 * Adjusts the first DME record to support samhsa.
 *
 * @param loadedRecords the loaded records
 * @param entityManager the entity manager
 */
private void adjustDmeRecordForSamhsaDiagnosis(List<Object> loadedRecords, EntityManager entityManager) {
    DMEClaim dmeRifRecord = loadedRecords.stream().filter(r -> r instanceof DMEClaim).map(r -> (DMEClaim) r).findFirst().get();
    entityManager.getTransaction().begin();
    dmeRifRecord = entityManager.find(DMEClaim.class, dmeRifRecord.getClaimId());
    dmeRifRecord.setDiagnosis2Code(Optional.of(Stu3EobSamhsaMatcherTest.SAMPLE_SAMHSA_ICD_9_DIAGNOSIS_CODE));
    dmeRifRecord.setDiagnosis2CodeVersion(Optional.of('9'));
    entityManager.merge(dmeRifRecord);
    entityManager.getTransaction().commit();
}

Example 13 with DMEClaim

use of gov.cms.bfd.model.rif.DMEClaim in project beneficiary-fhir-data by CMSgov.

the class ExplanationOfBenefitResourceProviderIT method readEobForExistingDMEClaim.

/**
 * Verifies that {@link ExplanationOfBenefitResourceProvider#read(IdType, RequestDetails)} works
 * as expected for a {@link DMEClaim}-derived {@link ExplanationOfBenefit} that does exist in the
 * DB.
 *
 * @throws FHIRException (indicates test failure)
 */
@Test
public void readEobForExistingDMEClaim() throws FHIRException {
    List<Object> loadedRecords = ServerTestUtils.get().loadData(Arrays.asList(StaticRifResourceGroup.SAMPLE_A.getResources()));
    IGenericClient fhirClient = ServerTestUtils.get().createFhirClient();
    DMEClaim claim = loadedRecords.stream().filter(r -> r instanceof DMEClaim).map(r -> (DMEClaim) r).findFirst().get();
    ExplanationOfBenefit eob = fhirClient.read().resource(ExplanationOfBenefit.class).withId(TransformerUtils.buildEobId(ClaimType.DME, claim.getClaimId())).execute();
    assertNotNull(eob);
    DMEClaimTransformerTest.assertMatches(claim, eob, Optional.empty());
}

Example 14 with DMEClaim

use of gov.cms.bfd.model.rif.DMEClaim in project beneficiary-fhir-data by CMSgov.

the class RifFilesProcessorTest method process1DMEClaimRecord.

/**
 * Ensures that {@link RifFilesProcessor} can correctly handle {@link
 * StaticRifResource#SAMPLE_A_DME}.
 */
@Test
public void process1DMEClaimRecord() {
    RifFilesEvent filesEvent = new RifFilesEvent(Instant.now(), StaticRifResource.SAMPLE_A_DME.toRifFile());
    RifFilesProcessor processor = new RifFilesProcessor();
    RifFileRecords rifFileRecords = processor.produceRecords(filesEvent.getFileEvents().get(0));
    List<RifRecordEvent<?>> rifEventsList = rifFileRecords.getRecords().collect(Collectors.toList());
    assertEquals(StaticRifResource.SAMPLE_A_DME.getRecordCount(), rifEventsList.size());
    RifRecordEvent<?> rifRecordEvent = rifEventsList.get(0);
    assertEquals(StaticRifResource.SAMPLE_A_DME.getRifFileType(), rifRecordEvent.getFileEvent().getFile().getFileType());
    assertNotNull(rifRecordEvent.getRecord());
    assertTrue(rifRecordEvent.getRecord() instanceof DMEClaim);
    // Verify the claim header.
    DMEClaim claimGroup = (DMEClaim) rifRecordEvent.getRecord();
    assertEquals(RecordAction.INSERT, rifRecordEvent.getRecordAction());
    assertEquals(claimGroup.getBeneficiaryId(), rifRecordEvent.getBeneficiaryId());
    assertEquals("567834", claimGroup.getBeneficiaryId());
    assertEquals("2188888888", claimGroup.getClaimId());
    assertEquals(new BigDecimal(900), claimGroup.getClaimGroupId());
    assertEquals('M', claimGroup.getNearLineRecordIdCode());
    assertEquals("82", claimGroup.getClaimTypeCode());
    assertEquals(LocalDate.of(2014, 02, 03), claimGroup.getDateFrom());
    assertEquals(LocalDate.of(2014, 02, 03), claimGroup.getDateThrough());
    assertEquals(LocalDate.of(2014, 02, 14), claimGroup.getWeeklyProcessDate());
    assertEquals('1', claimGroup.getClaimEntryCode());
    assertEquals("01", claimGroup.getClaimDispositionCode());
    assertEquals("99999", claimGroup.getCarrierNumber());
    assertEquals("1", claimGroup.getPaymentDenialCode());
    assertEquals(new BigDecimal("777.75"), claimGroup.getPaymentAmount());
    assertEquals(new BigDecimal("0"), claimGroup.getPrimaryPayerPaidAmount());
    assertEquals('A', claimGroup.getProviderAssignmentIndicator());
    assertEquals(new BigDecimal("666.75"), claimGroup.getProviderPaymentAmount());
    assertEquals(new BigDecimal("666.66"), claimGroup.getBeneficiaryPaymentAmount());
    assertEquals(new BigDecimal("1752.75"), claimGroup.getSubmittedChargeAmount());
    assertEquals(new BigDecimal("754.79"), claimGroup.getAllowedChargeAmount());
    assertEquals(new BigDecimal("777.00"), claimGroup.getBeneficiaryPartBDeductAmount());
    assertEquals('3', claimGroup.getHcpcsYearCode().get().charValue());
    assertEquals("R5555", claimGroup.getDiagnosis1Code().get());
    assertEquals('0', claimGroup.getDiagnosis1CodeVersion().get().charValue());
    assertEquals("1306849450", claimGroup.getReferringPhysicianNpi().get());
    assertEquals("0", claimGroup.getClinicalTrialNumber().get());
    assertEquals(1, claimGroup.getLines().size());
    assertEquals("74655592568216", claimGroup.getClaimCarrierControlNumber().get());
    // Verify one of the claim lines.
    DMEClaimLine claimLine = claimGroup.getLines().get(0);
    assertEquals(new BigDecimal(1), claimLine.getLineNumber());
    assertEquals("9994931888", claimLine.getProviderTaxNumber());
    assertEquals("A5", claimLine.getProviderSpecialityCode().get());
    assertEquals('1', claimLine.getProviderParticipatingIndCode().get().charValue());
    assertEquals(new BigDecimal("60"), claimLine.getServiceCount());
    assertEquals('P', claimLine.getCmsServiceTypeCode());
    assertEquals("12", claimLine.getPlaceOfServiceCode());
    assertEquals(LocalDate.of(2014, 02, 03), claimLine.getFirstExpenseDate().get());
    assertEquals(LocalDate.of(2014, 02, 03), claimLine.getLastExpenseDate().get());
    assertEquals("345", claimLine.getHcpcsCode().get());
    assertFalse(claimLine.getHcpcsSecondModifierCode().isPresent());
    assertFalse(claimLine.getHcpcsThirdModifierCode().isPresent());
    assertFalse(claimLine.getHcpcsFourthModifierCode().isPresent());
    assertEquals("D9Z", claimLine.getBetosCode().get());
    assertEquals(new BigDecimal("123.45"), claimLine.getPaymentAmount());
    assertEquals(new BigDecimal("11.00"), claimLine.getBeneficiaryPaymentAmount());
    assertEquals(new BigDecimal("120.00"), claimLine.getProviderPaymentAmount());
    assertEquals(new BigDecimal("18.00"), claimLine.getBeneficiaryPartBDeductAmount());
    assertTrue(claimLine.getPrimaryPayerCode().isPresent());
    assertEquals(new BigDecimal("11.00"), claimLine.getPrimaryPayerPaidAmount());
    assertEquals(new BigDecimal("20.20"), claimLine.getCoinsuranceAmount());
    assertEquals(new BigDecimal("20.29"), claimLine.getPrimaryPayerAllowedChargeAmount());
    assertEquals(new BigDecimal("130.45"), claimLine.getSubmittedChargeAmount());
    assertEquals(new BigDecimal("129.45"), claimLine.getAllowedChargeAmount());
    assertEquals("A", claimLine.getProcessingIndicatorCode().get());
    assertEquals('0', claimLine.getPaymentCode().get().charValue());
    assertEquals('0', claimLine.getServiceDeductibleCode().get().charValue());
    assertEquals(new BigDecimal("82.29"), claimLine.getPurchasePriceAmount());
    assertEquals("1244444444", claimLine.getProviderNPI().get());
    assertEquals("AL", claimLine.getPricingStateCode().get());
    assertEquals("MO", claimLine.getProviderStateCode());
    assertEquals(new Character('3'), claimLine.getSupplierTypeCode().get());
    assertEquals(new BigDecimal("0.00"), claimLine.getScreenSavingsAmount().get());
    assertEquals(new BigDecimal("60"), claimLine.getMtusCount());
    assertEquals('3', claimLine.getMtusCode().get().charValue());
    assertEquals(new BigDecimal("44.4"), claimLine.getHctHgbTestResult());
    assertEquals("R2", claimLine.getHctHgbTestTypeCode().get());
    assertEquals("500904610", claimLine.getNationalDrugCode().get());
}

Example 15 with DMEClaim

use of gov.cms.bfd.model.rif.DMEClaim in project beneficiary-fhir-data by CMSgov.

the class RifFilesProcessor method buildDMEClaimEvent.

/**
 * @param fileEvent the {@link RifFileEvent} being processed
 * @param csvRecords the {@link CSVRecord}s to be mapped, which must be from a {@link
 *     RifFileType#DME} {@link RifFile}
 * @return a {@link RifRecordEvent} built from the specified {@link CSVRecord}s
 */
private static RifRecordEvent<DMEClaim> buildDMEClaimEvent(RifFileEvent fileEvent, List<CSVRecord> csvRecords) {
    if (LOGGER.isTraceEnabled())
        LOGGER.trace(csvRecords.toString());
    CSVRecord firstCsvRecord = csvRecords.get(0);
    RecordAction recordAction = RecordAction.match(firstCsvRecord.get("DML_IND"));
    DMEClaim claim = DMEClaimParser.parseRif(csvRecords);
    return new RifRecordEvent<DMEClaim>(fileEvent, csvRecords, recordAction, claim.getBeneficiaryId(), claim);
}