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

Example 6 with InpatientClaim

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

the class R4ExplanationOfBenefitResourceProviderIT method readEobForExistingInpatientClaim.

/**
 * Verifies that {@link
 * gov.cms.bfd.server.war.r4.providers.ExplanationOfBenefitResourceProvider#read(org.hl7.fhir.r4.model.IdType)}
 * works as expected for an {@link InpatientClaim}-derived {@link ExplanationOfBenefit} that does
 * exist in the DB.
 *
 * @throws FHIRException (indicates test failure)
 */
@Test
public void readEobForExistingInpatientClaim() throws FHIRException {
    List<Object> loadedRecords = ServerTestUtils.get().loadData(Arrays.asList(StaticRifResourceGroup.SAMPLE_A.getResources()));
    IGenericClient fhirClient = ServerTestUtils.get().createFhirClientV2();
    InpatientClaim claim = loadedRecords.stream().filter(r -> r instanceof InpatientClaim).map(r -> (InpatientClaim) r).findFirst().get();
    ExplanationOfBenefit eob = fhirClient.read().resource(ExplanationOfBenefit.class).withId(TransformerUtilsV2.buildEobId(ClaimTypeV2.INPATIENT, claim.getClaimId())).execute();
    assertNotNull(eob);
    // Compare result to transformed EOB
    compareEob(ClaimTypeV2.INPATIENT, eob, loadedRecords);
}

Example 7 with InpatientClaim

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

the class ExplanationOfBenefitResourceProviderIT method searchForEobsByExistingPatientWithPageSizeZero.

/**
 * Verifies that {@link ExplanationOfBenefitResourceProvider#findByPatient} works as expected for
 * a {@link Patient} that does exist in the DB, with paging on a page size of 0.
 *
 * @throws FHIRException (indicates test failure)
 */
@Test
public void searchForEobsByExistingPatientWithPageSizeZero() throws FHIRException {
    List<Object> loadedRecords = ServerTestUtils.get().loadData(Arrays.asList(StaticRifResourceGroup.SAMPLE_A.getResources()));
    IGenericClient fhirClient = ServerTestUtils.get().createFhirClient();
    Beneficiary beneficiary = loadedRecords.stream().filter(r -> r instanceof Beneficiary).map(r -> (Beneficiary) r).findFirst().get();
    /*
     * FIXME: According the the FHIR spec, paging for _count=0 should not return any
     * claim entries in the bundle, but instead just a total for the number of
     * entries that match the search criteria. This functionality does no work
     * currently (see https://github.com/jamesagnew/hapi-fhir/issues/1074) and so
     * for now paging with _count=0 should behave as though paging was not
     * requested.
     */
    Bundle searchResults = fhirClient.search().forResource(ExplanationOfBenefit.class).where(ExplanationOfBenefit.PATIENT.hasId(TransformerUtils.buildPatientId(beneficiary))).count(0).returnBundle(Bundle.class).execute();
    assertNotNull(searchResults);
    /*
     * Verify the bundle contains a key for total and that the value matches the
     * number of entries in the bundle
     */
    assertEquals(loadedRecords.stream().filter(r -> !(r instanceof Beneficiary)).filter(r -> !(r instanceof BeneficiaryHistory)).filter(r -> !(r instanceof MedicareBeneficiaryIdHistory)).count(), searchResults.getTotal());
    /*
     * Verify that no paging links exist in the bundle.
     */
    assertNull(searchResults.getLink(Constants.LINK_NEXT));
    assertNull(searchResults.getLink(Constants.LINK_PREVIOUS));
    assertNull(searchResults.getLink(Constants.LINK_FIRST));
    assertNull(searchResults.getLink(Constants.LINK_LAST));
    /*
     * Verify that each of the expected claims (one for every claim type) is present
     * and looks correct.
     */
    CarrierClaim carrierClaim = loadedRecords.stream().filter(r -> r instanceof CarrierClaim).map(r -> (CarrierClaim) r).findFirst().get();
    assertEquals(1, filterToClaimType(searchResults, ClaimType.CARRIER).size());
    CarrierClaimTransformerTest.assertMatches(carrierClaim, filterToClaimType(searchResults, ClaimType.CARRIER).get(0), Optional.empty());
    DMEClaim dmeClaim = loadedRecords.stream().filter(r -> r instanceof DMEClaim).map(r -> (DMEClaim) r).findFirst().get();
    DMEClaimTransformerTest.assertMatches(dmeClaim, filterToClaimType(searchResults, ClaimType.DME).get(0), Optional.empty());
    HHAClaim hhaClaim = loadedRecords.stream().filter(r -> r instanceof HHAClaim).map(r -> (HHAClaim) r).findFirst().get();
    HHAClaimTransformerTest.assertMatches(hhaClaim, filterToClaimType(searchResults, ClaimType.HHA).get(0));
    HospiceClaim hospiceClaim = loadedRecords.stream().filter(r -> r instanceof HospiceClaim).map(r -> (HospiceClaim) r).findFirst().get();
    HospiceClaimTransformerTest.assertMatches(hospiceClaim, filterToClaimType(searchResults, ClaimType.HOSPICE).get(0));
    InpatientClaim inpatientClaim = loadedRecords.stream().filter(r -> r instanceof InpatientClaim).map(r -> (InpatientClaim) r).findFirst().get();
    InpatientClaimTransformerTest.assertMatches(inpatientClaim, filterToClaimType(searchResults, ClaimType.INPATIENT).get(0));
    OutpatientClaim outpatientClaim = loadedRecords.stream().filter(r -> r instanceof OutpatientClaim).map(r -> (OutpatientClaim) r).findFirst().get();
    OutpatientClaimTransformerTest.assertMatches(outpatientClaim, filterToClaimType(searchResults, ClaimType.OUTPATIENT).get(0));
    PartDEvent partDEvent = loadedRecords.stream().filter(r -> r instanceof PartDEvent).map(r -> (PartDEvent) r).findFirst().get();
    PartDEventTransformerTest.assertMatches(partDEvent, filterToClaimType(searchResults, ClaimType.PDE).get(0));
    SNFClaim snfClaim = loadedRecords.stream().filter(r -> r instanceof SNFClaim).map(r -> (SNFClaim) r).findFirst().get();
    SNFClaimTransformerTest.assertMatches(snfClaim, filterToClaimType(searchResults, ClaimType.SNF).get(0));
}

Example 8 with InpatientClaim

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

the class ExplanationOfBenefitResourceProviderIT method adjustInpatientRecordForSamhsaDiagnosis.

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

Example 9 with InpatientClaim

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

the class RifFilesProcessorTest method process1InpatientClaimRecord.

/**
 * Ensures that {@link RifFilesProcessor} can correctly handle {@link
 * StaticRifResource#SAMPLE_A_INPATIENT}.
 */
@Test
public void process1InpatientClaimRecord() {
    RifFilesEvent filesEvent = new RifFilesEvent(Instant.now(), StaticRifResource.SAMPLE_A_INPATIENT.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_INPATIENT.getRecordCount(), rifEventsList.size());
    RifRecordEvent<?> rifRecordEvent = rifEventsList.get(0);
    assertEquals(StaticRifResource.SAMPLE_A_INPATIENT.getRifFileType(), rifRecordEvent.getFileEvent().getFile().getFileType());
    assertNotNull(rifRecordEvent.getRecord());
    assertTrue(rifRecordEvent.getRecord() instanceof InpatientClaim);
    // Verify the claim header.
    InpatientClaim claimGroup = (InpatientClaim) rifRecordEvent.getRecord();
    assertEquals(RecordAction.INSERT, rifRecordEvent.getRecordAction());
    assertEquals(claimGroup.getBeneficiaryId(), rifRecordEvent.getBeneficiaryId());
    assertEquals("567834", claimGroup.getBeneficiaryId());
    assertEquals("333333222222", claimGroup.getClaimId());
    assertEquals(new BigDecimal(900), claimGroup.getClaimGroupId());
    assertEquals('V', claimGroup.getNearLineRecordIdCode());
    assertEquals("60", claimGroup.getClaimTypeCode());
    assertEquals(LocalDate.of(2016, 01, 15), claimGroup.getDateFrom());
    assertEquals(LocalDate.of(2016, 01, 27), claimGroup.getDateThrough());
    assertEquals('3', claimGroup.getClaimQueryCode());
    assertEquals("777776", claimGroup.getProviderNumber());
    assertEquals('1', claimGroup.getClaimServiceClassificationTypeCode());
    assertTrue(claimGroup.getClaimNonPaymentReasonCode().isPresent());
    assertEquals(new BigDecimal("7699.48"), claimGroup.getPaymentAmount());
    assertEquals(new BigDecimal("11.00"), claimGroup.getPrimaryPayerPaidAmount());
    assertEquals("IA", claimGroup.getProviderStateCode());
    assertEquals("5555553305", claimGroup.getOrganizationNpi().get());
    assertEquals("161999999", claimGroup.getAttendingPhysicianNpi().get());
    assertEquals("3333444555", claimGroup.getOperatingPhysicianNpi().get());
    assertEquals("161943433", claimGroup.getOtherPhysicianNpi().get());
    assertEquals("51", claimGroup.getPatientDischargeStatusCode());
    assertEquals(new BigDecimal("84999.37"), claimGroup.getTotalChargeAmount());
    assertEquals(LocalDate.of(2016, 1, 15), claimGroup.getClaimAdmissionDate().get());
    assertEquals('1', claimGroup.getAdmissionTypeCd());
    assertEquals(new Character('4'), claimGroup.getSourceAdmissionCd().get());
    assertEquals(new BigDecimal("10.00"), claimGroup.getPassThruPerDiemAmount());
    assertEquals(new BigDecimal("112.00"), claimGroup.getDeductibleAmount());
    assertEquals(new BigDecimal("5.00"), claimGroup.getPartACoinsuranceLiabilityAmount());
    assertEquals(new BigDecimal("6.00"), claimGroup.getBloodDeductibleLiabilityAmount());
    assertEquals(new BigDecimal("4.00"), claimGroup.getProfessionalComponentCharge());
    assertEquals(new BigDecimal("33.00"), claimGroup.getNoncoveredCharge());
    assertEquals(new BigDecimal("14.00"), claimGroup.getTotalDeductionAmount());
    assertEquals(new BigDecimal("646.23"), claimGroup.getClaimTotalPPSCapitalAmount().get());
    assertEquals(new BigDecimal("552.56"), claimGroup.getClaimPPSCapitalFSPAmount().get());
    assertEquals(new BigDecimal("0"), claimGroup.getClaimPPSCapitalOutlierAmount().get());
    assertEquals(new BigDecimal("68.58"), claimGroup.getClaimPPSCapitalIMEAmount().get());
    assertEquals(new BigDecimal("0"), claimGroup.getClaimPPSCapitalExceptionAmount().get());
    assertEquals(new BigDecimal("0"), claimGroup.getClaimPPSOldCapitalHoldHarmlessAmount().get());
    assertEquals(new BigDecimal(12), claimGroup.getUtilizationDayCount());
    assertEquals(new BigDecimal(0), claimGroup.getCoinsuranceDayCount());
    assertEquals(new BigDecimal(0), claimGroup.getNonUtilizationDayCount());
    assertEquals(new BigDecimal(19), claimGroup.getBloodPintsFurnishedQty());
    assertEquals(LocalDate.of(2016, 1, 27), claimGroup.getBeneficiaryDischargeDate().get());
    assertEquals(new BigDecimal("23.99"), claimGroup.getDrgOutlierApprovedPaymentAmount().get());
    assertEquals("R4444", claimGroup.getDiagnosisAdmittingCode().get());
    assertEquals('0', claimGroup.getDiagnosisAdmittingCodeVersion().get().charValue());
    assertEquals("R5555", claimGroup.getDiagnosisPrincipalCode().get());
    assertEquals('0', claimGroup.getDiagnosisPrincipalCodeVersion().get().charValue());
    assertEquals("R5555", claimGroup.getDiagnosis1Code().get());
    assertEquals('0', claimGroup.getDiagnosis1CodeVersion().get().charValue());
    assertEquals('Y', claimGroup.getDiagnosis1PresentOnAdmissionCode().get().charValue());
    assertEquals("0TCDDEE", claimGroup.getProcedure1Code().get());
    assertEquals('0', claimGroup.getProcedure1CodeVersion().get().charValue());
    assertEquals(LocalDate.of(2016, 1, 16), claimGroup.getProcedure1Date().get());
    assertEquals(new BigDecimal("120.56"), claimGroup.getClaimUncompensatedCareAmount().get());
    assertEquals("28486613848", claimGroup.getFiDocumentClaimControlNumber().get());
    assertEquals("261660474641024", claimGroup.getFiOriginalClaimControlNumber().get());
    assertEquals(1, claimGroup.getLines().size());
    // Verify one of the claim lines.
    InpatientClaimLine claimLine = claimGroup.getLines().get(0);
    assertEquals(new BigDecimal("84888.88"), claimLine.getTotalChargeAmount());
    assertEquals(new BigDecimal("3699.00"), claimLine.getNonCoveredChargeAmount());
    assertEquals("345345345", claimLine.getRevenueCenterRenderingPhysicianNPI().get());
}

Example 10 with InpatientClaim

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

the class ExplanationOfBenefitResourceProviderIT method searchForEobsWithLargePageSizesOnFewerResults.

/**
 * Verifies that {@link ExplanationOfBenefitResourceProvider#findByPatient} works as expected for
 * a {@link Patient} that does exist in the DB, with a page size of 50 with fewer (8) results.
 *
 * @throws FHIRException (indicates test failure)
 */
@Test
public void searchForEobsWithLargePageSizesOnFewerResults() throws FHIRException {
    List<Object> loadedRecords = ServerTestUtils.get().loadData(Arrays.asList(StaticRifResourceGroup.SAMPLE_A.getResources()));
    IGenericClient fhirClient = ServerTestUtils.get().createFhirClient();
    Beneficiary beneficiary = loadedRecords.stream().filter(r -> r instanceof Beneficiary).map(r -> (Beneficiary) r).findFirst().get();
    Bundle searchResults = fhirClient.search().forResource(ExplanationOfBenefit.class).where(ExplanationOfBenefit.PATIENT.hasId(TransformerUtils.buildPatientId(beneficiary))).count(50).returnBundle(Bundle.class).execute();
    assertNotNull(searchResults);
    /*
     * Verify the bundle contains a key for total and that the value matches the
     * number of entries in the bundle
     */
    assertEquals(loadedRecords.stream().filter(r -> !(r instanceof Beneficiary)).filter(r -> !(r instanceof BeneficiaryHistory)).filter(r -> !(r instanceof MedicareBeneficiaryIdHistory)).count(), searchResults.getTotal());
    /*
     * Verify that only the first and last links exist as there are no previous or
     * next pages.
     */
    assertNotNull(searchResults.getLink(Constants.LINK_FIRST));
    assertNotNull(searchResults.getLink(Constants.LINK_LAST));
    assertNull(searchResults.getLink(Constants.LINK_NEXT));
    assertNull(searchResults.getLink(Constants.LINK_PREVIOUS));
    /*
     * Verify that each of the expected claims (one for every claim type) is present
     * and looks correct.
     */
    CarrierClaim carrierClaim = loadedRecords.stream().filter(r -> r instanceof CarrierClaim).map(r -> (CarrierClaim) r).findFirst().get();
    assertEquals(1, filterToClaimType(searchResults, ClaimType.CARRIER).size());
    CarrierClaimTransformerTest.assertMatches(carrierClaim, filterToClaimType(searchResults, ClaimType.CARRIER).get(0), Optional.empty());
    DMEClaim dmeClaim = loadedRecords.stream().filter(r -> r instanceof DMEClaim).map(r -> (DMEClaim) r).findFirst().get();
    DMEClaimTransformerTest.assertMatches(dmeClaim, filterToClaimType(searchResults, ClaimType.DME).get(0), Optional.empty());
    HHAClaim hhaClaim = loadedRecords.stream().filter(r -> r instanceof HHAClaim).map(r -> (HHAClaim) r).findFirst().get();
    HHAClaimTransformerTest.assertMatches(hhaClaim, filterToClaimType(searchResults, ClaimType.HHA).get(0));
    HospiceClaim hospiceClaim = loadedRecords.stream().filter(r -> r instanceof HospiceClaim).map(r -> (HospiceClaim) r).findFirst().get();
    HospiceClaimTransformerTest.assertMatches(hospiceClaim, filterToClaimType(searchResults, ClaimType.HOSPICE).get(0));
    InpatientClaim inpatientClaim = loadedRecords.stream().filter(r -> r instanceof InpatientClaim).map(r -> (InpatientClaim) r).findFirst().get();
    InpatientClaimTransformerTest.assertMatches(inpatientClaim, filterToClaimType(searchResults, ClaimType.INPATIENT).get(0));
    OutpatientClaim outpatientClaim = loadedRecords.stream().filter(r -> r instanceof OutpatientClaim).map(r -> (OutpatientClaim) r).findFirst().get();
    OutpatientClaimTransformerTest.assertMatches(outpatientClaim, filterToClaimType(searchResults, ClaimType.OUTPATIENT).get(0));
    PartDEvent partDEvent = loadedRecords.stream().filter(r -> r instanceof PartDEvent).map(r -> (PartDEvent) r).findFirst().get();
    PartDEventTransformerTest.assertMatches(partDEvent, filterToClaimType(searchResults, ClaimType.PDE).get(0));
    SNFClaim snfClaim = loadedRecords.stream().filter(r -> r instanceof SNFClaim).map(r -> (SNFClaim) r).findFirst().get();
    SNFClaimTransformerTest.assertMatches(snfClaim, filterToClaimType(searchResults, ClaimType.SNF).get(0));
}