use of gov.cms.bfd.server.war.commons.CCWProcedure in project beneficiary-fhir-data by CMSgov.
the class TransformerUtils method addProcedureCode.
/**
* @param eob the {@link ExplanationOfBenefit} to (possibly) modify
* @param diagnosis the {@link Diagnosis} to add, if it's not already present
* @return the {@link ProcedureComponent#getSequence()} of the existing or newly-added entry
*/
static int addProcedureCode(ExplanationOfBenefit eob, CCWProcedure procedure) {
Optional<ProcedureComponent> existingProcedure = eob.getProcedure().stream().filter(pc -> pc.getProcedure() instanceof CodeableConcept).filter(pc -> isCodeInConcept((CodeableConcept) pc.getProcedure(), procedure.getFhirSystem(), procedure.getCode())).findAny();
if (existingProcedure.isPresent())
return existingProcedure.get().getSequenceElement().getValue();
ProcedureComponent procedureComponent = new ProcedureComponent().setSequence(eob.getProcedure().size() + 1);
procedureComponent.setProcedure(createCodeableConcept(procedure.getFhirSystem(), null, retrieveProcedureCodeDisplay(procedure.getCode()), procedure.getCode()));
if (procedure.getProcedureDate().isPresent()) {
procedureComponent.setDate(convertToDate(procedure.getProcedureDate().get()));
}
eob.getProcedure().add(procedureComponent);
return procedureComponent.getSequenceElement().getValue();
}
use of gov.cms.bfd.server.war.commons.CCWProcedure in project beneficiary-fhir-data by CMSgov.
the class InpatientClaimTransformer 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();
// Common group level fields between all claim types
TransformerUtils.mapEobCommonClaimHeaderData(eob, claimGroup.getClaimId(), claimGroup.getBeneficiaryId(), ClaimType.INPATIENT, claimGroup.getClaimGroupId().toPlainString(), MedicareSegment.PART_A, Optional.of(claimGroup.getDateFrom()), Optional.of(claimGroup.getDateThrough()), Optional.of(claimGroup.getPaymentAmount()), claimGroup.getFinalAction());
TransformerUtils.mapEobWeeklyProcessDate(eob, claimGroup.getWeeklyProcessDate());
// map eob type codes into FHIR
TransformerUtils.mapEobType(eob, ClaimType.INPATIENT, Optional.of(claimGroup.getNearLineRecordIdCode()), Optional.of(claimGroup.getClaimTypeCode()));
// set the provider number which is common among several claim types
TransformerUtils.setProviderNumber(eob, claimGroup.getProviderNumber());
if (claimGroup.getPatientStatusCd().isPresent()) {
TransformerUtils.addInformationWithCode(eob, CcwCodebookVariable.NCH_PTNT_STUS_IND_CD, CcwCodebookVariable.NCH_PTNT_STUS_IND_CD, claimGroup.getPatientStatusCd());
}
// add EOB information to fields that are common between the Inpatient and SNF claim types
TransformerUtils.addCommonEobInformationInpatientSNF(eob, claimGroup.getAdmissionTypeCd(), claimGroup.getSourceAdmissionCd(), claimGroup.getNoncoveredStayFromDate(), claimGroup.getNoncoveredStayThroughDate(), claimGroup.getCoveredCareThoughDate(), claimGroup.getMedicareBenefitsExhaustedDate(), claimGroup.getDiagnosisRelatedGroupCd());
// Claim Operational Indirect Medical Education Amount
if (claimGroup.getIndirectMedicalEducationAmount().isPresent()) {
TransformerUtils.addAdjudicationTotal(eob, CcwCodebookVariable.IME_OP_CLM_VAL_AMT, claimGroup.getIndirectMedicalEducationAmount());
}
// Claim Operational disproportionate Amount
if (claimGroup.getDisproportionateShareAmount().isPresent()) {
TransformerUtils.addAdjudicationTotal(eob, CcwCodebookVariable.DSH_OP_CLM_VAL_AMT, claimGroup.getDisproportionateShareAmount());
}
// TODO If actually nullable, should be Optional.
if (claimGroup.getPassThruPerDiemAmount() != null) {
TransformerUtils.addAdjudicationTotal(eob, CcwCodebookVariable.CLM_PASS_THRU_PER_DIEM_AMT, claimGroup.getPassThruPerDiemAmount());
}
// TODO If actually nullable, should be Optional.
if (claimGroup.getProfessionalComponentCharge() != null) {
TransformerUtils.addAdjudicationTotal(eob, CcwCodebookVariable.NCH_PROFNL_CMPNT_CHRG_AMT, claimGroup.getProfessionalComponentCharge());
}
// TODO If actually nullable, should be Optional.
if (claimGroup.getClaimTotalPPSCapitalAmount() != null) {
TransformerUtils.addAdjudicationTotal(eob, CcwCodebookVariable.CLM_TOT_PPS_CPTL_AMT, claimGroup.getClaimTotalPPSCapitalAmount());
}
if (claimGroup.getIndirectMedicalEducationAmount().isPresent()) {
TransformerUtils.addAdjudicationTotal(eob, CcwCodebookVariable.IME_OP_CLM_VAL_AMT, claimGroup.getIndirectMedicalEducationAmount().get());
}
// Claim Uncompensated Care Payment Amount
if (claimGroup.getClaimUncompensatedCareAmount().isPresent()) {
TransformerUtils.addAdjudicationTotal(eob, CcwCodebookVariable.CLM_UNCOMPD_CARE_PMT_AMT, claimGroup.getClaimUncompensatedCareAmount().get());
}
/*
* add field values to the benefit balances that are common between the
* Inpatient and SNF claim types
*/
TransformerUtils.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());
// TODO If this is actually nullable, should be Optional.
if (claimGroup.getDrgOutlierApprovedPaymentAmount() != null) {
TransformerUtils.addAdjudicationTotal(eob, CcwCodebookVariable.NCH_DRG_OUTLIER_APRVD_PMT_AMT, claimGroup.getDrgOutlierApprovedPaymentAmount());
}
// Common group level fields between Inpatient, Outpatient and SNF
TransformerUtils.mapEobCommonGroupInpOutSNF(eob, claimGroup.getBloodDeductibleLiabilityAmount(), claimGroup.getOperatingPhysicianNpi(), claimGroup.getOtherPhysicianNpi(), claimGroup.getClaimQueryCode(), claimGroup.getMcoPaidSw());
// Common group level fields between Inpatient, Outpatient Hospice, HHA and SNF
TransformerUtils.mapEobCommonGroupInpOutHHAHospiceSNF(eob, claimGroup.getOrganizationNpi(), claimGroup.getClaimFacilityTypeCode(), claimGroup.getClaimFrequencyCode(), claimGroup.getClaimNonPaymentReasonCode(), claimGroup.getPatientDischargeStatusCode(), claimGroup.getClaimServiceClassificationTypeCode(), claimGroup.getClaimPrimaryPayerCode(), claimGroup.getAttendingPhysicianNpi(), claimGroup.getTotalChargeAmount(), claimGroup.getPrimaryPayerPaidAmount(), claimGroup.getFiscalIntermediaryNumber(), claimGroup.getFiDocumentClaimControlNumber(), claimGroup.getFiOriginalClaimControlNumber());
// Common group level fields between Inpatient, HHA, Hospice and SNF
TransformerUtils.mapEobCommonGroupInpHHAHospiceSNF(eob, claimGroup.getClaimAdmissionDate(), claimGroup.getBeneficiaryDischargeDate(), Optional.of(claimGroup.getUtilizationDayCount()));
for (Diagnosis diagnosis : extractDiagnoses(claimGroup)) TransformerUtils.addDiagnosisCode(eob, diagnosis);
for (CCWProcedure procedure : TransformerUtils.extractCCWProcedures(claimGroup.getProcedure1Code(), claimGroup.getProcedure1CodeVersion(), claimGroup.getProcedure1Date(), claimGroup.getProcedure2Code(), claimGroup.getProcedure2CodeVersion(), claimGroup.getProcedure2Date(), claimGroup.getProcedure3Code(), claimGroup.getProcedure3CodeVersion(), claimGroup.getProcedure3Date(), claimGroup.getProcedure4Code(), claimGroup.getProcedure4CodeVersion(), claimGroup.getProcedure4Date(), claimGroup.getProcedure5Code(), claimGroup.getProcedure5CodeVersion(), claimGroup.getProcedure5Date(), claimGroup.getProcedure6Code(), claimGroup.getProcedure6CodeVersion(), claimGroup.getProcedure6Date(), claimGroup.getProcedure7Code(), claimGroup.getProcedure7CodeVersion(), claimGroup.getProcedure7Date(), claimGroup.getProcedure8Code(), claimGroup.getProcedure8CodeVersion(), claimGroup.getProcedure8Date(), claimGroup.getProcedure9Code(), claimGroup.getProcedure9CodeVersion(), claimGroup.getProcedure9Date(), claimGroup.getProcedure10Code(), claimGroup.getProcedure10CodeVersion(), claimGroup.getProcedure10Date(), claimGroup.getProcedure11Code(), claimGroup.getProcedure11CodeVersion(), claimGroup.getProcedure11Date(), claimGroup.getProcedure12Code(), claimGroup.getProcedure12CodeVersion(), claimGroup.getProcedure12Date(), claimGroup.getProcedure13Code(), claimGroup.getProcedure13CodeVersion(), claimGroup.getProcedure13Date(), claimGroup.getProcedure14Code(), claimGroup.getProcedure14CodeVersion(), claimGroup.getProcedure14Date(), claimGroup.getProcedure15Code(), claimGroup.getProcedure15CodeVersion(), claimGroup.getProcedure15Date(), claimGroup.getProcedure16Code(), claimGroup.getProcedure16CodeVersion(), claimGroup.getProcedure16Date(), claimGroup.getProcedure17Code(), claimGroup.getProcedure17CodeVersion(), claimGroup.getProcedure17Date(), claimGroup.getProcedure18Code(), claimGroup.getProcedure18CodeVersion(), claimGroup.getProcedure18Date(), claimGroup.getProcedure19Code(), claimGroup.getProcedure19CodeVersion(), claimGroup.getProcedure19Date(), claimGroup.getProcedure20Code(), claimGroup.getProcedure20CodeVersion(), claimGroup.getProcedure20Date(), claimGroup.getProcedure21Code(), claimGroup.getProcedure21CodeVersion(), claimGroup.getProcedure21Date(), claimGroup.getProcedure22Code(), claimGroup.getProcedure22CodeVersion(), claimGroup.getProcedure22Date(), claimGroup.getProcedure23Code(), claimGroup.getProcedure23CodeVersion(), claimGroup.getProcedure23Date(), claimGroup.getProcedure24Code(), claimGroup.getProcedure24CodeVersion(), claimGroup.getProcedure24Date(), claimGroup.getProcedure25Code(), claimGroup.getProcedure25CodeVersion(), claimGroup.getProcedure25Date())) TransformerUtils.addProcedureCode(eob, procedure);
for (InpatientClaimLine claimLine : claimGroup.getLines()) {
ItemComponent item = eob.addItem();
item.setSequence(claimLine.getLineNumber().intValue());
TransformerUtils.mapHcpcs(eob, item, Optional.empty(), claimLine.getHcpcsCode(), Collections.emptyList());
item.setLocation(new Address().setState((claimGroup.getProviderStateCode())));
// Common item level fields between Inpatient, Outpatient, HHA, Hospice and SNF
TransformerUtils.mapEobCommonItemRevenue(item, eob, claimLine.getRevenueCenter(), claimLine.getRateAmount(), claimLine.getTotalChargeAmount(), claimLine.getNonCoveredChargeAmount(), claimLine.getUnitCount(), claimLine.getNationalDrugCodeQuantity(), claimLine.getNationalDrugCodeQualifierCode(), claimLine.getRevenueCenterRenderingPhysicianNPI());
// Common group level field coinsurance between Inpatient, HHA, Hospice and SNF
TransformerUtils.mapEobCommonGroupInpHHAHospiceSNFCoinsurance(eob, item, claimLine.getDeductibleCoinsuranceCd());
}
TransformerUtils.setLastUpdated(eob, claimGroup.getLastUpdated());
return eob;
}
use of gov.cms.bfd.server.war.commons.CCWProcedure in project beneficiary-fhir-data by CMSgov.
the class CCWProcedureTest method assertMatches.
static void assertMatches(Character version, String system) {
Optional<String> code = Optional.of("code");
Optional<LocalDate> procDate = Optional.of(LocalDate.now());
Optional<CCWProcedure> diagnosis = CCWProcedure.from(code, Optional.of(version), procDate);
assertEquals(procDate.get(), diagnosis.get().getProcedureDate().get());
assertEquals(system, diagnosis.get().getFhirSystem());
TransformerTestUtils.assertHasCoding(system, code.get(), diagnosis.get().toCodeableConcept().getCoding());
CodeableConcept codeableConcept = new CodeableConcept();
Coding coding = codeableConcept.addCoding();
coding.setSystem(system).setCode(code.get());
assertTrue(diagnosis.get().isContainedIn(codeableConcept));
}
use of gov.cms.bfd.server.war.commons.CCWProcedure in project beneficiary-fhir-data by CMSgov.
the class CCWProcedureTest method assertDateNotPresent.
/**
* Verifies that a procedure date isn't present even though there is a procedure code present
*/
static void assertDateNotPresent(Character version, String system) {
Optional<String> code = Optional.of("code");
Optional<LocalDate> procDate = Optional.empty();
Optional<CCWProcedure> diagnosis = CCWProcedure.from(code, Optional.of(version), procDate);
assertEquals(Optional.empty(), diagnosis.get().getProcedureDate());
assertEquals(system, diagnosis.get().getFhirSystem());
TransformerTestUtils.assertHasCoding(system, code.get(), diagnosis.get().toCodeableConcept().getCoding());
CodeableConcept codeableConcept = new CodeableConcept();
Coding coding = codeableConcept.addCoding();
coding.setSystem(system).setCode(code.get());
assertTrue(diagnosis.get().isContainedIn(codeableConcept));
}
use of gov.cms.bfd.server.war.commons.CCWProcedure in project beneficiary-fhir-data by CMSgov.
the class OutpatientClaimTransformerTest method assertMatches.
/**
* Verifies that the {@link ExplanationOfBenefit} "looks like" it should, if it were produced from
* the specified {@link OutpatientClaim}.
*
* @param claim the {@link OutpatientClaim} that the {@link ExplanationOfBenefit} was generated
* from
* @param eob the {@link ExplanationOfBenefit} that was generated from the specified {@link
* OutpatientClaim}
* @throws FHIRException (indicates test failure)
*/
static void assertMatches(OutpatientClaim claim, ExplanationOfBenefit eob) throws FHIRException {
// Test to ensure group level fields between all claim types match
TransformerTestUtils.assertEobCommonClaimHeaderData(eob, claim.getClaimId(), claim.getBeneficiaryId(), ClaimType.OUTPATIENT, claim.getClaimGroupId().toPlainString(), MedicareSegment.PART_B, Optional.of(claim.getDateFrom()), Optional.of(claim.getDateThrough()), Optional.of(claim.getPaymentAmount()), claim.getFinalAction());
// test the common field provider number is set as expected in the EOB
TransformerTestUtils.assertProviderNumber(eob, claim.getProviderNumber());
TransformerTestUtils.assertAdjudicationTotalAmountEquals(CcwCodebookVariable.NCH_BENE_PTB_DDCTBL_AMT, claim.getDeductibleAmount(), eob);
TransformerTestUtils.assertAdjudicationTotalAmountEquals(CcwCodebookVariable.NCH_PROFNL_CMPNT_CHRG_AMT, claim.getProfessionalComponentCharge(), eob);
TransformerTestUtils.assertAdjudicationTotalAmountEquals(CcwCodebookVariable.NCH_BENE_PTB_COINSRNC_AMT, claim.getCoinsuranceAmount(), eob);
TransformerTestUtils.assertAdjudicationTotalAmountEquals(CcwCodebookVariable.CLM_OP_PRVDR_PMT_AMT, claim.getProviderPaymentAmount(), eob);
TransformerTestUtils.assertAdjudicationTotalAmountEquals(CcwCodebookVariable.CLM_OP_BENE_PMT_AMT, claim.getBeneficiaryPaymentAmount(), eob);
// Test to ensure common group fields between Inpatient, Outpatient and SNF
TransformerTestUtils.assertEobCommonGroupInpOutSNFEquals(eob, claim.getBloodDeductibleLiabilityAmount(), claim.getOperatingPhysicianNpi(), claim.getOtherPhysicianNpi(), claim.getClaimQueryCode(), claim.getMcoPaidSw());
// Test to ensure common group fields between Inpatient, Outpatient HHA, Hospice
// and SNF match
TransformerTestUtils.assertEobCommonGroupInpOutHHAHospiceSNFEquals(eob, claim.getOrganizationNpi(), claim.getClaimFacilityTypeCode(), claim.getClaimFrequencyCode(), claim.getClaimNonPaymentReasonCode(), claim.getPatientDischargeStatusCode().get(), claim.getClaimServiceClassificationTypeCode(), claim.getClaimPrimaryPayerCode(), claim.getAttendingPhysicianNpi(), claim.getTotalChargeAmount(), claim.getPrimaryPayerPaidAmount(), claim.getFiscalIntermediaryNumber(), claim.getFiDocumentClaimControlNumber(), claim.getFiOriginalClaimControlNumber());
assertTrue(countDiagnosisCodes(claim) >= eob.getDiagnosis().size(), "Expect actual diagnosis count is less than or equal to the claim count");
if (claim.getProcedure1Code().isPresent()) {
CCWProcedure ccwProcedure = new CCWProcedure(claim.getProcedure1Code(), claim.getProcedure1CodeVersion(), claim.getProcedure1Date());
TransformerTestUtils.assertHasCoding(ccwProcedure.getFhirSystem().toString(), claim.getProcedure1Code().get(), eob.getProcedure().get(0).getProcedureCodeableConcept().getCoding());
assertEquals(claim.getProcedure1Date().get().atStartOfDay(ZoneId.systemDefault()).toInstant(), eob.getProcedure().get(0).getDate().toInstant());
}
assertTrue(1 <= eob.getItem().size(), "Expect actual item count is above 0");
ItemComponent eobItem0 = eob.getItem().get(0);
OutpatientClaimLine claimLine1 = claim.getLines().get(0);
assertEquals(new Integer(claimLine1.getLineNumber().intValue()), new Integer(eobItem0.getSequence()));
assertEquals(claim.getProviderStateCode(), eobItem0.getLocationAddress().getState());
// TODO re-map as described in CBBF-111
/*
* TransformerTestUtils.assertHasCoding(TransformerConstants.CODING_NDC,
* claimLine1.getNationalDrugCode().get(), eobItem0.getService());
*/
TransformerTestUtils.assertAdjudicationReasonEquals(CcwCodebookVariable.REV_CNTR_1ST_ANSI_CD, claimLine1.getRevCntr1stAnsiCd(), eobItem0.getAdjudication());
TransformerTestUtils.assertAdjudicationReasonEquals(CcwCodebookVariable.REV_CNTR_2ND_ANSI_CD, claimLine1.getRevCntr2ndAnsiCd(), eobItem0.getAdjudication());
TransformerTestUtils.assertAdjudicationReasonEquals(CcwCodebookVariable.REV_CNTR_3RD_ANSI_CD, claimLine1.getRevCntr3rdAnsiCd(), eobItem0.getAdjudication());
TransformerTestUtils.assertAdjudicationReasonEquals(CcwCodebookVariable.REV_CNTR_4TH_ANSI_CD, claimLine1.getRevCntr4thAnsiCd(), eobItem0.getAdjudication());
TransformerTestUtils.assertHcpcsCodes(eobItem0, claimLine1.getHcpcsCode(), claimLine1.getHcpcsInitialModifierCode(), claimLine1.getHcpcsSecondModifierCode(), Optional.empty(), 0);
TransformerTestUtils.assertExtensionCodingEquals(CcwCodebookVariable.REV_CNTR_IDE_NDC_UPC_NUM, claimLine1.getNationalDrugCode(), eobItem0.getService());
TransformerTestUtils.assertAdjudicationAmountEquals(CcwCodebookVariable.REV_CNTR_BLOOD_DDCTBL_AMT, claimLine1.getBloodDeductibleAmount(), eobItem0.getAdjudication());
TransformerTestUtils.assertAdjudicationAmountEquals(CcwCodebookVariable.REV_CNTR_CASH_DDCTBL_AMT, claimLine1.getCashDeductibleAmount(), eobItem0.getAdjudication());
TransformerTestUtils.assertAdjudicationAmountEquals(CcwCodebookVariable.REV_CNTR_COINSRNC_WGE_ADJSTD_C, claimLine1.getWageAdjustedCoinsuranceAmount(), eobItem0.getAdjudication());
TransformerTestUtils.assertAdjudicationAmountEquals(CcwCodebookVariable.REV_CNTR_RDCD_COINSRNC_AMT, claimLine1.getReducedCoinsuranceAmount(), eobItem0.getAdjudication());
TransformerTestUtils.assertAdjudicationAmountEquals(CcwCodebookVariable.REV_CNTR_1ST_MSP_PD_AMT, claimLine1.getFirstMspPaidAmount(), eobItem0.getAdjudication());
TransformerTestUtils.assertAdjudicationAmountEquals(CcwCodebookVariable.REV_CNTR_1ST_MSP_PD_AMT, claimLine1.getSecondMspPaidAmount(), eobItem0.getAdjudication());
TransformerTestUtils.assertAdjudicationAmountEquals(CcwCodebookVariable.REV_CNTR_PRVDR_PMT_AMT, claimLine1.getProviderPaymentAmount(), eobItem0.getAdjudication());
TransformerTestUtils.assertAdjudicationAmountEquals(CcwCodebookVariable.REV_CNTR_BENE_PMT_AMT, claimLine1.getBenficiaryPaymentAmount(), eobItem0.getAdjudication());
TransformerTestUtils.assertAdjudicationAmountEquals(CcwCodebookVariable.REV_CNTR_PTNT_RSPNSBLTY_PMT, claimLine1.getPatientResponsibilityAmount(), eobItem0.getAdjudication());
String claimControlNumber = "0000000000";
// Test to ensure item level fields between Inpatient, Outpatient, HHA, Hopsice
// and SNF match
TransformerTestUtils.assertEobCommonItemRevenueEquals(eobItem0, eob, claimLine1.getRevenueCenterCode(), claimLine1.getRateAmount(), claimLine1.getTotalChargeAmount(), claimLine1.getNonCoveredChargeAmount(), claimLine1.getUnitCount(), claimControlNumber, claimLine1.getNationalDrugCodeQuantity(), claimLine1.getNationalDrugCodeQualifierCode(), claimLine1.getRevenueCenterRenderingPhysicianNPI(), 1);
// Test to ensure item level fields between Outpatient, HHA and Hospice match
TransformerTestUtils.assertEobCommonItemRevenueOutHHAHospice(eobItem0, claimLine1.getRevenueCenterDate(), claimLine1.getPaymentAmount());
// verify {@link
// TransformerUtils#mapEobType(CodeableConcept,ClaimType,Optional,Optional)}
// method worked as expected for this claim type
TransformerTestUtils.assertMapEobType(eob.getType(), ClaimType.OUTPATIENT, Optional.of(org.hl7.fhir.dstu3.model.codesystems.ClaimType.PROFESSIONAL), Optional.of(claim.getNearLineRecordIdCode()), Optional.of(claim.getClaimTypeCode()));
TransformerTestUtils.assertExtensionCodingEquals(CcwCodebookVariable.REV_CNTR_STUS_IND_CD, claimLine1.getStatusCode(), eobItem0.getRevenue());
// Test lastUpdated
TransformerTestUtils.assertLastUpdatedEquals(claim.getLastUpdated(), eob);
}
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