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Example 1 with InpatientClaim

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

the class InpatientClaimTransformer method transform.

/**
 * @param metricRegistry the {@link MetricRegistry} to use
 * @param claim the CCW {@link InpatientClaim} to transform
 * @param includeTaxNumbers whether or not to include tax numbers in the result (see {@link
 *     ExplanationOfBenefitResourceProvider#HEADER_NAME_INCLUDE_TAX_NUMBERS}, defaults to <code>
 *     false</code>)
 * @return a FHIR {@link ExplanationOfBenefit} resource that represents the specified {@link
 *     InpatientClaim}
 */
@Trace
static ExplanationOfBenefit transform(MetricRegistry metricRegistry, Object claim, Optional<Boolean> includeTaxNumbers) {
    Timer.Context timer = metricRegistry.timer(MetricRegistry.name(InpatientClaimTransformer.class.getSimpleName(), "transform")).time();
    if (!(claim instanceof InpatientClaim))
        throw new BadCodeMonkeyException();
    ExplanationOfBenefit eob = transformClaim((InpatientClaim) claim);
    timer.stop();
    return eob;
}
Also used : InpatientClaim(gov.cms.bfd.model.rif.InpatientClaim) Timer(com.codahale.metrics.Timer) BadCodeMonkeyException(gov.cms.bfd.sharedutils.exceptions.BadCodeMonkeyException) ExplanationOfBenefit(org.hl7.fhir.dstu3.model.ExplanationOfBenefit) Trace(com.newrelic.api.agent.Trace)

Example 2 with InpatientClaim

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

the class ClaimTypeV2Test method verifyServiceEndAttributeFunc.

/**
 * Verifies that our service end date function is working as expected. Since we are type casting
 * our claim object, we need to verify that every ClaimType is tested.
 */
@Test
public void verifyServiceEndAttributeFunc() {
    LocalDate start = LocalDate.now();
    LocalDate end = start.plusDays(10);
    CarrierClaim carrierClaim = new CarrierClaim();
    carrierClaim.setDateFrom(start);
    carrierClaim.setDateThrough(end);
    DMEClaim dmeClaim = new DMEClaim();
    dmeClaim.setDateFrom(start);
    dmeClaim.setDateThrough(end);
    HospiceClaim hospiceClaim = new HospiceClaim();
    hospiceClaim.setDateFrom(start);
    hospiceClaim.setDateThrough(end);
    PartDEvent partDEvent = new PartDEvent();
    partDEvent.setPrescriptionFillDate(end);
    InpatientClaim inpatientClaim = new InpatientClaim();
    inpatientClaim.setDateFrom(start);
    inpatientClaim.setDateThrough(end);
    OutpatientClaim outpatientClaim = new OutpatientClaim();
    outpatientClaim.setDateFrom(start);
    outpatientClaim.setDateThrough(end);
    SNFClaim snfClaim = new SNFClaim();
    snfClaim.setDateFrom(start);
    snfClaim.setDateThrough(end);
    HHAClaim hhaClaim = new HHAClaim();
    hhaClaim.setDateFrom(start);
    hhaClaim.setDateThrough(end);
    ImmutableMap.Builder<ClaimTypeV2, Object> builder = ImmutableMap.builder();
    builder.put(ClaimTypeV2.CARRIER, carrierClaim);
    builder.put(ClaimTypeV2.DME, dmeClaim);
    builder.put(ClaimTypeV2.PDE, partDEvent);
    builder.put(ClaimTypeV2.INPATIENT, inpatientClaim);
    builder.put(ClaimTypeV2.OUTPATIENT, outpatientClaim);
    builder.put(ClaimTypeV2.HOSPICE, hospiceClaim);
    builder.put(ClaimTypeV2.SNF, snfClaim);
    builder.put(ClaimTypeV2.HHA, hhaClaim);
    Map<ClaimTypeV2, Object> claimTypeToClaim = builder.build();
    // Verify that we're testing all of the ClaimTypes that are defined
    EnumSet.allOf(ClaimTypeV2.class).stream().forEach(claimType -> assertTrue(claimTypeToClaim.containsKey(claimType), String.format("ClaimType %s not tested", claimType.name())));
    claimTypeToClaim.entrySet().forEach(entry -> assertEquals(end, entry.getKey().getServiceEndAttributeFunction().apply(entry.getValue()), String.format("Claim type %s does not match expectations", entry.getKey().name())));
}
Also used : InpatientClaim(gov.cms.bfd.model.rif.InpatientClaim) OutpatientClaim(gov.cms.bfd.model.rif.OutpatientClaim) CarrierClaim(gov.cms.bfd.model.rif.CarrierClaim) SNFClaim(gov.cms.bfd.model.rif.SNFClaim) LocalDate(java.time.LocalDate) PartDEvent(gov.cms.bfd.model.rif.PartDEvent) ImmutableMap(com.google.common.collect.ImmutableMap) DMEClaim(gov.cms.bfd.model.rif.DMEClaim) HHAClaim(gov.cms.bfd.model.rif.HHAClaim) HospiceClaim(gov.cms.bfd.model.rif.HospiceClaim) Test(org.junit.jupiter.api.Test)

Example 3 with InpatientClaim

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

the class InpatientClaimTransformerV2Test method generateClaim.

/**
 * Generates the Claim object to be used in multiple tests
 *
 * @return
 * @throws FHIRException
 */
public InpatientClaim generateClaim() throws FHIRException {
    List<Object> parsedRecords = ServerTestUtils.parseData(Arrays.asList(StaticRifResourceGroup.SAMPLE_A.getResources()));
    InpatientClaim claim = parsedRecords.stream().filter(r -> r instanceof InpatientClaim).map(r -> (InpatientClaim) r).findFirst().get();
    claim.setLastUpdated(Instant.now());
    return claim;
}
Also used : Assertions.assertNotNull(org.junit.jupiter.api.Assertions.assertNotNull) BeforeEach(org.junit.jupiter.api.BeforeEach) Arrays(java.util.Arrays) DateTimeType(org.hl7.fhir.r4.model.DateTimeType) ExplanationOfBenefitStatus(org.hl7.fhir.r4.model.ExplanationOfBenefit.ExplanationOfBenefitStatus) Identifier(org.hl7.fhir.r4.model.Identifier) SimpleDateFormat(java.text.SimpleDateFormat) CodeableConcept(org.hl7.fhir.r4.model.CodeableConcept) BenefitComponent(org.hl7.fhir.r4.model.ExplanationOfBenefit.BenefitComponent) Use(org.hl7.fhir.r4.model.ExplanationOfBenefit.Use) InpatientClaim(gov.cms.bfd.model.rif.InpatientClaim) ProfileConstants(gov.cms.bfd.server.war.commons.ProfileConstants) Reference(org.hl7.fhir.r4.model.Reference) Disabled(org.junit.jupiter.api.Disabled) ProcedureComponent(org.hl7.fhir.r4.model.ExplanationOfBenefit.ProcedureComponent) PaymentComponent(org.hl7.fhir.r4.model.ExplanationOfBenefit.PaymentComponent) Money(org.hl7.fhir.r4.model.Money) Address(org.hl7.fhir.r4.model.Address) FhirContext(ca.uhn.fhir.context.FhirContext) Assertions.assertFalse(org.junit.jupiter.api.Assertions.assertFalse) SupportingInformationComponent(org.hl7.fhir.r4.model.ExplanationOfBenefit.SupportingInformationComponent) UnsignedIntType(org.hl7.fhir.r4.model.UnsignedIntType) Assertions.assertEquals(org.junit.jupiter.api.Assertions.assertEquals) StaticRifResourceGroup(gov.cms.bfd.model.rif.samples.StaticRifResourceGroup) ServerTestUtils(gov.cms.bfd.server.war.ServerTestUtils) Quantity(org.hl7.fhir.r4.model.Quantity) CareTeamComponent(org.hl7.fhir.r4.model.ExplanationOfBenefit.CareTeamComponent) DecimalType(org.hl7.fhir.r4.model.DecimalType) IParser(ca.uhn.fhir.parser.IParser) MetricRegistry(com.codahale.metrics.MetricRegistry) DateType(org.hl7.fhir.r4.model.DateType) Period(org.hl7.fhir.r4.model.Period) InsuranceComponent(org.hl7.fhir.r4.model.ExplanationOfBenefit.InsuranceComponent) Instant(java.time.Instant) Test(org.junit.jupiter.api.Test) AdjudicationComponent(org.hl7.fhir.r4.model.ExplanationOfBenefit.AdjudicationComponent) List(java.util.List) TransformerConstants(gov.cms.bfd.server.war.commons.TransformerConstants) Coding(org.hl7.fhir.r4.model.Coding) ExplanationOfBenefit(org.hl7.fhir.r4.model.ExplanationOfBenefit) Assertions.assertTrue(org.junit.jupiter.api.Assertions.assertTrue) Optional(java.util.Optional) FHIRException(org.hl7.fhir.exceptions.FHIRException) Extension(org.hl7.fhir.r4.model.Extension) DiagnosisComponent(org.hl7.fhir.r4.model.ExplanationOfBenefit.DiagnosisComponent) TotalComponent(org.hl7.fhir.r4.model.ExplanationOfBenefit.TotalComponent) InpatientClaim(gov.cms.bfd.model.rif.InpatientClaim)

Example 4 with InpatientClaim

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

the class InpatientClaimTransformerV2 method transformClaim.

/**
 * @param claimGroup the CCW {@link InpatientClaim} to transform
 * @return a FHIR {@link ExplanationOfBenefit} resource that represents the specified {@link
 *     InpatientClaim}
 */
private static ExplanationOfBenefit transformClaim(InpatientClaim claimGroup) {
    ExplanationOfBenefit eob = new ExplanationOfBenefit();
    // Required values not directly mapped
    eob.getMeta().addProfile(ProfileConstants.C4BB_EOB_INPATIENT_PROFILE_URL);
    // Common group level fields between all claim types
    // Claim Type + Claim ID    => ExplanationOfBenefit.id
    // CLM_ID                   => ExplanationOfBenefit.identifier
    // CLM_GRP_ID               => ExplanationOfBenefit.identifier
    // BENE_ID + Coverage Type  => ExplanationOfBenefit.insurance.coverage (reference)
    // BENE_ID                  => ExplanationOfBenefit.patient (reference)
    // FINAL_ACTION             => ExplanationOfBenefit.status
    // CLM_FROM_DT              => ExplanationOfBenefit.billablePeriod.start
    // CLM_THRU_DT              => ExplanationOfBenefit.billablePeriod.end
    // CLM_PMT_AMT              => ExplanationOfBenefit.payment.amount
    TransformerUtilsV2.mapEobCommonClaimHeaderData(eob, claimGroup.getClaimId(), claimGroup.getBeneficiaryId(), ClaimTypeV2.INPATIENT, claimGroup.getClaimGroupId().toPlainString(), MedicareSegment.PART_A, Optional.of(claimGroup.getDateFrom()), Optional.of(claimGroup.getDateThrough()), Optional.of(claimGroup.getPaymentAmount()), claimGroup.getFinalAction());
    // map eob type codes into FHIR
    // NCH_CLM_TYPE_CD              => ExplanationOfBenefit.type.coding
    // EOB Type                     => ExplanationOfBenefit.type.coding
    // Claim Type  (institutional)  => ExplanationOfBenefit.type.coding
    // NCH_NEAR_LINE_REC_IDENT_CD   => ExplanationOfBenefit.extension
    TransformerUtilsV2.mapEobType(eob, ClaimTypeV2.INPATIENT, Optional.of(claimGroup.getNearLineRecordIdCode()), Optional.of(claimGroup.getClaimTypeCode()));
    // set the provider number which is common among several claim types
    // PRVDR_NUM => ExplanationOfBenefit.provider.identifier
    TransformerUtilsV2.addProviderSlice(eob, C4BBOrganizationIdentifierType.PRN, claimGroup.getProviderNumber(), claimGroup.getLastUpdated());
    // NCH_PTNT_STUS_IND_CD => ExplanationOfBenefit.supportingInfo.code
    claimGroup.getPatientStatusCd().ifPresent(c -> TransformerUtilsV2.addInformationWithCode(eob, CcwCodebookVariable.NCH_PTNT_STUS_IND_CD, CcwCodebookVariable.NCH_PTNT_STUS_IND_CD, c));
    // CLM_ADMSN_DT       => ExplanationOfBenefit.supportingInfo:admissionperiod
    // NCH_BENE_DSCHRG_DT => ExplanationOfBenefit.supportingInfo:admissionperiod
    TransformerUtilsV2.addInformation(eob, TransformerUtilsV2.createInformationAdmPeriodSlice(eob, claimGroup.getClaimAdmissionDate(), claimGroup.getBeneficiaryDischargeDate()));
    // add EOB information to fields that are common between the Inpatient and SNF claim types
    // CLM_IP_ADMSN_TYPE_CD             => ExplanationOfBenefit.supportingInfo.code
    // CLM_SRC_IP_ADMSN_CD              => ExplanationOfBenefit.supportingInfo.code
    // NCH_VRFD_NCVRD_STAY_FROM_DT      => ExplanationOfBenefit.supportingInfo.timingPeriod
    // NCH_VRFD_NCVRD_STAY_THRU_DT      => ExplanationOfBenefit.supportingInfo.timingPeriod
    // NCH_ACTV_OR_CVRD_LVL_CARE_THRU   => ExplanationOfBenefit.supportingInfo.timingDate
    // NCH_BENE_MDCR_BNFTS_EXHTD_DT_I   => ExplanationOfBenefit.supportingInfo.timingDate
    // CLM_DRG_CD                       => ExplanationOfBenefit.supportingInfo.code
    TransformerUtilsV2.addCommonEobInformationInpatientSNF(eob, claimGroup.getAdmissionTypeCd(), claimGroup.getSourceAdmissionCd(), claimGroup.getNoncoveredStayFromDate(), claimGroup.getNoncoveredStayThroughDate(), claimGroup.getCoveredCareThoughDate(), claimGroup.getMedicareBenefitsExhaustedDate(), claimGroup.getDiagnosisRelatedGroupCd());
    // IME_OP_CLM_VAL_AMT => ExplanationOfBenefit.extension
    TransformerUtilsV2.addAdjudicationTotal(eob, CcwCodebookVariable.IME_OP_CLM_VAL_AMT, claimGroup.getIndirectMedicalEducationAmount());
    // DSH_OP_CLM_VAL_AMT => ExplanationOfBenefit.extension
    TransformerUtilsV2.addAdjudicationTotal(eob, CcwCodebookVariable.DSH_OP_CLM_VAL_AMT, claimGroup.getDisproportionateShareAmount());
    // CLM_PASS_THRU_PER_DIEM_AMT => ExplanationOfBenefit.benefitBalance.financial
    TransformerUtilsV2.addBenefitBalanceFinancialMedicalAmt(eob, CcwCodebookVariable.CLM_PASS_THRU_PER_DIEM_AMT, Optional.ofNullable(claimGroup.getPassThruPerDiemAmount()));
    // NCH_PROFNL_CMPNT_CHRG_AMT => ExplanationOfBenefit.benefitBalance.financial
    TransformerUtilsV2.addBenefitBalanceFinancialMedicalAmt(eob, CcwCodebookVariable.NCH_PROFNL_CMPNT_CHRG_AMT, Optional.ofNullable(claimGroup.getProfessionalComponentCharge()));
    // CLM_TOT_PPS_CPTL_AMT => ExplanationOfBenefit.benefitBalance.financial
    TransformerUtilsV2.addBenefitBalanceFinancialMedicalAmt(eob, CcwCodebookVariable.CLM_TOT_PPS_CPTL_AMT, claimGroup.getClaimTotalPPSCapitalAmount());
    /*
     * add field values to the benefit balances that are common between the
     * Inpatient and SNF claim types
     */
    // BENE_TOT_COINSRNC_DAYS_CNT       => ExplanationOfBenefit.benefitBalance.financial
    // CLM_NON_UTLZTN_DAYS_CNT          => ExplanationOfBenefit.benefitBalance.financial
    // NCH_BENE_IP_DDCTBL_AMT           => ExplanationOfBenefit.benefitBalance.financial
    // NCH_BENE_PTA_COINSRNC_LBLTY_AMT  => ExplanationOfBenefit.benefitBalance.financial
    // NCH_BLOOD_PNTS_FRNSHD_QTY        => ExplanationOfBenefit.supportingInfo.valueQuantity
    // NCH_IP_NCVRD_CHRG_AMT            => ExplanationOfBenefit.benefitBalance.financial
    // NCH_IP_TOT_DDCTN_AMT             => ExplanationOfBenefit.benefitBalance.financial
    // CLM_PPS_CPTL_DSPRPRTNT_SHR_AMT   => ExplanationOfBenefit.benefitBalance.financial
    // CLM_PPS_CPTL_EXCPTN_AMT          => ExplanationOfBenefit.benefitBalance.financial
    // CLM_PPS_CPTL_FSP_AMT             => ExplanationOfBenefit.benefitBalance.financial
    // CLM_PPS_CPTL_IME_AMT             => ExplanationOfBenefit.benefitBalance.financial
    // CLM_PPS_CPTL_OUTLIER_AMT         => ExplanationOfBenefit.benefitBalance.financial
    // CLM_PPS_OLD_CPTL_HLD_HRMLS_AMT   => ExplanationOfBenefit.benefitBalance.financial
    TransformerUtilsV2.addCommonGroupInpatientSNF(eob, claimGroup.getCoinsuranceDayCount(), claimGroup.getNonUtilizationDayCount(), claimGroup.getDeductibleAmount(), claimGroup.getPartACoinsuranceLiabilityAmount(), claimGroup.getBloodPintsFurnishedQty(), claimGroup.getNoncoveredCharge(), claimGroup.getTotalDeductionAmount(), claimGroup.getClaimPPSCapitalDisproportionateShareAmt(), claimGroup.getClaimPPSCapitalExceptionAmount(), claimGroup.getClaimPPSCapitalFSPAmount(), claimGroup.getClaimPPSCapitalIMEAmount(), claimGroup.getClaimPPSCapitalOutlierAmount(), claimGroup.getClaimPPSOldCapitalHoldHarmlessAmount());
    // NCH_DRG_OUTLIER_APRVD_PMT_AMT => ExplanationOfBenefit.extension
    TransformerUtilsV2.addBenefitBalanceFinancialMedicalAmt(eob, CcwCodebookVariable.NCH_DRG_OUTLIER_APRVD_PMT_AMT, claimGroup.getDrgOutlierApprovedPaymentAmount());
    // Map care team
    // AT_PHYSN_NPI     => ExplanationOfBenefit.careTeam.provider (Primary)
    // AT_PHYSN_UPIN    => ExplanationOfBenefit.careTeam.provider
    // OP_PHYSN_NPI     => ExplanationOfBenefit.careTeam.provider (Assisting)
    // OP_PHYSN_NPI     => ExplanationOfBenefit.careTeam.provider
    // OT_PHYSN_NPI     => ExplanationOfBenefit.careTeam.provider (Other)
    // OT_PHYSN_UPIN    => ExplanationOfBenefit.careTeam.provider
    TransformerUtilsV2.mapCareTeam(eob, claimGroup.getAttendingPhysicianNpi(), claimGroup.getOperatingPhysicianNpi(), claimGroup.getOtherPhysicianNpi(), claimGroup.getAttendingPhysicianUpin(), claimGroup.getOperatingPhysicianUpin(), claimGroup.getOtherPhysicianUpin());
    // Common group level fields between Inpatient, Outpatient and SNF
    // NCH_BENE_BLOOD_DDCTBL_LBLTY_AM   => ExplanationOfBenefit.benefitBalance.financial
    // CLAIM_QUERY_CODE                 => ExplanationOfBenefit.billablePeriod.extension
    // CLM_MCO_PD_SW                    => ExplanationOfBenefit.supportingInfo.code
    TransformerUtilsV2.mapEobCommonGroupInpOutSNF(eob, claimGroup.getBloodDeductibleLiabilityAmount(), claimGroup.getClaimQueryCode(), claimGroup.getMcoPaidSw());
    // Common group level fields between Inpatient, Outpatient Hospice, HHA and SNF
    // ORG_NPI_NUM              => ExplanationOfBenefit.provider
    // CLM_FAC_TYPE_CD          => ExplanationOfBenefit.facility.extension
    // CLM_FREQ_CD              => ExplanationOfBenefit.supportingInfo
    // CLM_MDCR_NON_PMT_RSN_CD  => ExplanationOfBenefit.extension
    // PTNT_DSCHRG_STUS_CD      => ExplanationOfBenefit.supportingInfo
    // CLM_SRVC_CLSFCTN_TYPE_CD => ExplanationOfBenefit.extension
    // NCH_PRMRY_PYR_CD         => ExplanationOfBenefit.supportingInfo
    // CLM_TOT_CHRG_AMT         => ExplanationOfBenefit.total.amount
    // NCH_PRMRY_PYR_CLM_PD_AMT => ExplanationOfBenefit.benefitBalance.financial (PRPAYAMT)
    TransformerUtilsV2.mapEobCommonGroupInpOutHHAHospiceSNF(eob, claimGroup.getOrganizationNpi(), claimGroup.getClaimFacilityTypeCode(), claimGroup.getClaimFrequencyCode(), claimGroup.getClaimNonPaymentReasonCode(), claimGroup.getPatientDischargeStatusCode(), claimGroup.getClaimServiceClassificationTypeCode(), claimGroup.getClaimPrimaryPayerCode(), claimGroup.getTotalChargeAmount(), claimGroup.getPrimaryPayerPaidAmount(), claimGroup.getFiscalIntermediaryNumber(), claimGroup.getLastUpdated());
    // CLM_UTLZTN_DAY_CNT => ExplanationOfBenefit.benefitBalance.financial
    TransformerUtilsV2.addBenefitBalanceFinancialMedicalInt(eob, CcwCodebookVariable.CLM_UTLZTN_DAY_CNT, Optional.of(claimGroup.getUtilizationDayCount()));
    // CLM_E_POA_IND_SW(1-12)   => diagnosis.type
    for (Diagnosis diagnosis : DiagnosisUtilV2.extractDiagnoses(claimGroup)) {
        DiagnosisUtilV2.addDiagnosisCode(eob, diagnosis, ClaimTypeV2.INPATIENT);
    }
    // Handle Procedures
    // ICD_PRCDR_CD(1-25)        => ExplanationOfBenefit.procedure.procedureCodableConcept
    // ICD_PRCDR_VRSN_CD(1-25)   => ExplanationOfBenefit.procedure.procedureCodableConcept
    // PRCDR_DT(1-25)            => ExplanationOfBenefit.procedure.date
    final int FIRST_PROCEDURE = 1;
    final int LAST_PROCEDURE = 25;
    IntStream.range(FIRST_PROCEDURE, LAST_PROCEDURE + 1).mapToObj(i -> TransformerUtilsV2.extractCCWProcedure(i, claimGroup)).filter(p -> p.isPresent()).forEach(p -> TransformerUtilsV2.addProcedureCode(eob, p.get()));
    // NCH_WKLY_PROC_DT => ExplanationOfBenefit.supportinginfo.timingDate
    TransformerUtilsV2.addInformation(eob, TransformerUtilsV2.createInformationRecievedDateSlice(eob, CcwCodebookVariable.NCH_WKLY_PROC_DT, Optional.of(claimGroup.getWeeklyProcessDate())));
    // CLM_PPS_CPTL_DRG_WT_NUM => ExplanationOfBenefit.benefitBalance.financial
    TransformerUtilsV2.addBenefitBalanceFinancialMedicalInt(eob, CcwCodebookVariable.CLM_PPS_CPTL_DRG_WT_NUM, claimGroup.getClaimPPSCapitalDrgWeightNumber());
    // BENE_LRD_USED_CNT => ExplanationOfBenefit.benefitBalance.financial
    TransformerUtilsV2.addBenefitBalanceFinancialMedicalInt(eob, CcwCodebookVariable.BENE_LRD_USED_CNT, claimGroup.getLifetimeReservedDaysUsedCount());
    // ClaimLine => ExplanationOfBenefit.item
    for (InpatientClaimLine line : claimGroup.getLines()) {
        ItemComponent item = TransformerUtilsV2.addItem(eob);
        // Override the default sequence
        // CLM_LINE_NUM => item.sequence
        item.setSequence(line.getLineNumber().intValue());
        // PRVDR_STATE_CD => item.location
        TransformerUtilsV2.addLocationState(item, claimGroup.getProviderStateCode());
        // REV_CNTR                   => ExplanationOfBenefit.item.revenue
        // REV_CNTR_RATE_AMT          => ExplanationOfBenefit.item.adjudication
        // REV_CNTR_TOT_CHRG_AMT      => ExplanationOfBenefit.item.adjudication
        // REV_CNTR_NCVRD_CHRG_AMT    => ExplanationOfBenefit.item.adjudication
        // REV_CNTR_NDC_QTY           => ExplanationOfBenefit.item.quantity
        // REV_CNTR_NDC_QTY_QLFR_CD   => ExplanationOfBenefit.modifier
        TransformerUtilsV2.mapEobCommonItemRevenue(item, eob, line.getRevenueCenter(), line.getRateAmount(), line.getTotalChargeAmount(), Optional.of(line.getNonCoveredChargeAmount()), line.getNationalDrugCodeQuantity(), line.getNationalDrugCodeQualifierCode());
        // REV_CNTR_DDCTBL_COINSRNC_CD => item.revenue
        TransformerUtilsV2.addItemRevenue(item, eob, CcwCodebookVariable.REV_CNTR_DDCTBL_COINSRNC_CD, line.getDeductibleCoinsuranceCd());
        // HCPCS_CD => item.productOrService
        line.getHcpcsCode().ifPresent(c -> item.setProductOrService(new CodeableConcept().setCoding(Arrays.asList(new Coding().setSystem(CCWUtils.calculateVariableReferenceUrl(CcwCodebookVariable.HCPCS_CD)).setCode(c), new Coding().setSystem(TransformerConstants.CODING_SYSTEM_HCPCS).setCode(c)))));
        // RNDRNG_PHYSN_UPIN => ExplanationOfBenefit.careTeam.provider
        TransformerUtilsV2.addCareTeamMember(eob, item, C4BBPractitionerIdentifierType.UPIN, C4BBClaimInstitutionalCareTeamRole.PERFORMING, line.getRevenueCenterRenderingPhysicianUPIN());
        // RNDRNG_PHYSN_NPI => ExplanationOfBenefit.careTeam.provider
        TransformerUtilsV2.addCareTeamMember(eob, item, C4BBPractitionerIdentifierType.NPI, C4BBClaimInstitutionalCareTeamRole.PERFORMING, line.getRevenueCenterRenderingPhysicianNPI());
    }
    // Last Updated => ExplanationOfBenefit.meta.lastUpdated
    TransformerUtilsV2.setLastUpdated(eob, claimGroup.getLastUpdated());
    return eob;
}
Also used : IntStream(java.util.stream.IntStream) Arrays(java.util.Arrays) MetricRegistry(com.codahale.metrics.MetricRegistry) C4BBPractitionerIdentifierType(gov.cms.bfd.server.war.commons.carin.C4BBPractitionerIdentifierType) Trace(com.newrelic.api.agent.Trace) BadCodeMonkeyException(gov.cms.bfd.sharedutils.exceptions.BadCodeMonkeyException) MedicareSegment(gov.cms.bfd.server.war.commons.MedicareSegment) CodeableConcept(org.hl7.fhir.r4.model.CodeableConcept) InpatientClaim(gov.cms.bfd.model.rif.InpatientClaim) ProfileConstants(gov.cms.bfd.server.war.commons.ProfileConstants) InpatientClaimLine(gov.cms.bfd.model.rif.InpatientClaimLine) C4BBClaimInstitutionalCareTeamRole(gov.cms.bfd.server.war.commons.carin.C4BBClaimInstitutionalCareTeamRole) CCWUtils(gov.cms.bfd.server.war.commons.CCWUtils) TransformerConstants(gov.cms.bfd.server.war.commons.TransformerConstants) C4BBOrganizationIdentifierType(gov.cms.bfd.server.war.commons.carin.C4BBOrganizationIdentifierType) ItemComponent(org.hl7.fhir.r4.model.ExplanationOfBenefit.ItemComponent) Coding(org.hl7.fhir.r4.model.Coding) ExplanationOfBenefit(org.hl7.fhir.r4.model.ExplanationOfBenefit) CcwCodebookVariable(gov.cms.bfd.model.codebook.data.CcwCodebookVariable) Timer(com.codahale.metrics.Timer) Optional(java.util.Optional) Diagnosis(gov.cms.bfd.server.war.commons.Diagnosis) Coding(org.hl7.fhir.r4.model.Coding) ItemComponent(org.hl7.fhir.r4.model.ExplanationOfBenefit.ItemComponent) Diagnosis(gov.cms.bfd.server.war.commons.Diagnosis) ExplanationOfBenefit(org.hl7.fhir.r4.model.ExplanationOfBenefit) InpatientClaimLine(gov.cms.bfd.model.rif.InpatientClaimLine) CodeableConcept(org.hl7.fhir.r4.model.CodeableConcept)

Example 5 with InpatientClaim

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

the class RifFilesProcessor method buildInpatientClaimEvent.

/**
 * @param fileEvent the {@link RifFileEvent} being processed that is being processed
 * @param csvRecords the {@link CSVRecord}s to be mapped, which must be from a {@link
 *     RifFileType#INPATIENT} {@link RifFile}
 * @return a {@link RifRecordEvent} built from the specified {@link CSVRecord}s
 */
private static RifRecordEvent<InpatientClaim> buildInpatientClaimEvent(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"));
    InpatientClaim claim = InpatientClaimParser.parseRif(csvRecords);
    return new RifRecordEvent<InpatientClaim>(fileEvent, csvRecords, recordAction, claim.getBeneficiaryId(), claim);
}
Also used : InpatientClaim(gov.cms.bfd.model.rif.InpatientClaim) RifRecordEvent(gov.cms.bfd.model.rif.RifRecordEvent) CSVRecord(org.apache.commons.csv.CSVRecord) RecordAction(gov.cms.bfd.model.rif.RecordAction)

Aggregations

InpatientClaim (gov.cms.bfd.model.rif.InpatientClaim)19 Arrays (java.util.Arrays)13 Optional (java.util.Optional)13 Test (org.junit.jupiter.api.Test)13 CarrierClaim (gov.cms.bfd.model.rif.CarrierClaim)12 DMEClaim (gov.cms.bfd.model.rif.DMEClaim)12 HHAClaim (gov.cms.bfd.model.rif.HHAClaim)12 HospiceClaim (gov.cms.bfd.model.rif.HospiceClaim)12 OutpatientClaim (gov.cms.bfd.model.rif.OutpatientClaim)12 PartDEvent (gov.cms.bfd.model.rif.PartDEvent)12 SNFClaim (gov.cms.bfd.model.rif.SNFClaim)12 StaticRifResourceGroup (gov.cms.bfd.model.rif.samples.StaticRifResourceGroup)12 ServerTestUtils (gov.cms.bfd.server.war.ServerTestUtils)12 TransformerConstants (gov.cms.bfd.server.war.commons.TransformerConstants)12 List (java.util.List)12 Assertions.assertEquals (org.junit.jupiter.api.Assertions.assertEquals)12 IGenericClient (ca.uhn.fhir.rest.client.api.IGenericClient)10 Beneficiary (gov.cms.bfd.model.rif.Beneficiary)10 PipelineTestUtils (gov.cms.bfd.pipeline.sharedutils.PipelineTestUtils)10 CommonHeaders (gov.cms.bfd.server.war.commons.CommonHeaders)10