Examples with Diagnosis gov.cms.bfd.server.war.commons.Diagnosis used on opensource projects

Example 16 with Diagnosis

use of gov.cms.bfd.server.war.commons.Diagnosis in project beneficiary-fhir-data by CMSgov.

the class SNFClaimTransformerV2 method transformClaim.

/**
 * @param claimGroup the CCW {@link SNFClaim} to transform
 * @return a FHIR {@link ExplanationOfBenefit} resource that represents the specified {@link
 *     SNFClaim}
 */
private static ExplanationOfBenefit transformClaim(SNFClaim 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
    // 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.SNF, claimGroup.getClaimGroupId().toPlainString(), MedicareSegment.PART_A, Optional.of(claimGroup.getDateFrom()), Optional.of(claimGroup.getDateThrough()), Optional.of(claimGroup.getPaymentAmount()), claimGroup.getFinalAction());
    // NCH_WKLY_PROC_DT => ExplanationOfBenefit.supportinginfo.timingDate
    TransformerUtilsV2.addInformation(eob, TransformerUtilsV2.createInformationRecievedDateSlice(eob, CcwCodebookVariable.NCH_WKLY_PROC_DT, Optional.of(claimGroup.getWeeklyProcessDate())));
    // map eob type codes into FHIR
    // NCH_CLM_TYPE_CD            => ExplanationOfBenefit.type.coding
    // EOB Type                   => ExplanationOfBenefit.type.coding
    // Claim Type (Professional)  => ExplanationOfBenefit.type.coding
    // NCH_NEAR_LINE_REC_IDENT_CD => ExplanationOfBenefit.extension
    TransformerUtilsV2.mapEobType(eob, ClaimTypeV2.SNF, Optional.of(claimGroup.getNearLineRecordIdCode()), Optional.of(claimGroup.getClaimTypeCode()));
    // PRVDR_NUM => ExplanationOfBenefit.provider.identifier
    TransformerUtilsV2.addProviderSlice(eob, C4BBOrganizationIdentifierType.PRN, claimGroup.getProviderNumber(), claimGroup.getLastUpdated());
    // 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.getCoveredCareThroughDate(), claimGroup.getMedicareBenefitsExhaustedDate(), claimGroup.getDiagnosisRelatedGroupCd());
    // 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()));
    // CLM_UTLZTN_DAY_CNT => ExplanationOfBenefit.benefitBalance.financial
    TransformerUtilsV2.addBenefitBalanceFinancialMedicalInt(eob, CcwCodebookVariable.CLM_UTLZTN_DAY_CNT, claimGroup.getUtilizationDayCount());
    // NCH_QLFYD_STAY_THRU_DT => ExplanationOfBenefit.supportingInfo
    if (claimGroup.getQualifiedStayFromDate().isPresent() || claimGroup.getQualifiedStayThroughDate().isPresent()) {
        TransformerUtilsV2.validatePeriodDates(claimGroup.getQualifiedStayFromDate(), claimGroup.getQualifiedStayThroughDate());
        Period period = new Period();
        // NCH_QLFYD_STAY_FROM_DT
        claimGroup.getQualifiedStayFromDate().ifPresent(c -> period.setStart(TransformerUtilsV2.convertToDate(c), TemporalPrecisionEnum.DAY));
        // NCH_QLFYD_STAY_THRU_DT
        claimGroup.getQualifiedStayThroughDate().ifPresent(c -> period.setEnd(TransformerUtilsV2.convertToDate(c), TemporalPrecisionEnum.DAY));
        // Add to EOB
        TransformerUtilsV2.addInformation(eob, CcwCodebookVariable.NCH_QLFYD_STAY_FROM_DT).setTiming(period);
    }
    // CLM_PPS_IND_CODE => ExplanationOfBenefit.supportingInfo
    claimGroup.getProspectivePaymentCode().ifPresent(c -> TransformerUtilsV2.addInformationWithCode(eob, CcwCodebookVariable.CLM_PPS_IND_CD, CcwCodebookVariable.CLM_PPS_IND_CD, c));
    /*
     * 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());
    // 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
    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());
    // ICD_DGNS_E_VRSN_CD(1-12) => diagnosis.diagnosisCodeableConcept
    for (Diagnosis diagnosis : DiagnosisUtilV2.extractDiagnoses(claimGroup)) {
        DiagnosisUtilV2.addDiagnosisCode(eob, diagnosis, ClaimTypeV2.SNF);
    }
    // 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()));
    for (SNFClaimLine line : claimGroup.getLines()) {
        ItemComponent item = eob.addItem();
        // Override the default sequence
        // CLM_LINE_NUM => item.sequence
        item.setSequence(line.getLineNumber().intValue());
        // PRVDR_STATE_CD => item.location
        TransformerUtilsV2.addLocationState(item, claimGroup.getProviderStateCode());
        // HCPCS_CD => ExplanationOfBenefit.item.productOrService
        TransformerUtilsV2.mapHcpcs(eob, item, line.getHcpcsCode(), Optional.empty(), Collections.emptyList());
        // 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());
        // 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;
}

Example 17 with Diagnosis

use of gov.cms.bfd.server.war.commons.Diagnosis in project beneficiary-fhir-data by CMSgov.

the class CarrierClaimTransformer method transformClaim.

/**
 * @param claimGroup the CCW {@link CarrierClaim} to transform
 * @return a FHIR {@link ExplanationOfBenefit} resource that represents the specified {@link
 *     CarrierClaim}
 */
private static ExplanationOfBenefit transformClaim(CarrierClaim claimGroup, Optional<Boolean> includeTaxNumbers) {
    ExplanationOfBenefit eob = new ExplanationOfBenefit();
    // Common group level fields between all claim types
    TransformerUtils.mapEobCommonClaimHeaderData(eob, claimGroup.getClaimId(), claimGroup.getBeneficiaryId(), ClaimType.CARRIER, claimGroup.getClaimGroupId().toPlainString(), MedicareSegment.PART_B, 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.CARRIER, Optional.of(claimGroup.getNearLineRecordIdCode()), Optional.of(claimGroup.getClaimTypeCode()));
    TransformerUtils.addAdjudicationTotal(eob, CcwCodebookVariable.PRPAYAMT, claimGroup.getPrimaryPayerPaidAmount());
    // Common group level fields between Carrier and DME
    TransformerUtils.mapEobCommonGroupCarrierDME(eob, claimGroup.getBeneficiaryId(), claimGroup.getCarrierNumber(), claimGroup.getClinicalTrialNumber(), claimGroup.getBeneficiaryPartBDeductAmount(), claimGroup.getPaymentDenialCode(), claimGroup.getReferringPhysicianNpi(), claimGroup.getProviderAssignmentIndicator(), claimGroup.getProviderPaymentAmount(), claimGroup.getBeneficiaryPaymentAmount(), claimGroup.getSubmittedChargeAmount(), claimGroup.getAllowedChargeAmount(), claimGroup.getClaimDispositionCode(), claimGroup.getClaimCarrierControlNumber());
    for (Diagnosis diagnosis : TransformerUtils.extractDiagnoses1Thru12(claimGroup.getDiagnosisPrincipalCode(), claimGroup.getDiagnosisPrincipalCodeVersion(), claimGroup.getDiagnosis1Code(), claimGroup.getDiagnosis1CodeVersion(), claimGroup.getDiagnosis2Code(), claimGroup.getDiagnosis2CodeVersion(), claimGroup.getDiagnosis3Code(), claimGroup.getDiagnosis3CodeVersion(), claimGroup.getDiagnosis4Code(), claimGroup.getDiagnosis4CodeVersion(), claimGroup.getDiagnosis5Code(), claimGroup.getDiagnosis5CodeVersion(), claimGroup.getDiagnosis6Code(), claimGroup.getDiagnosis6CodeVersion(), claimGroup.getDiagnosis7Code(), claimGroup.getDiagnosis7CodeVersion(), claimGroup.getDiagnosis8Code(), claimGroup.getDiagnosis8CodeVersion(), claimGroup.getDiagnosis9Code(), claimGroup.getDiagnosis9CodeVersion(), claimGroup.getDiagnosis10Code(), claimGroup.getDiagnosis10CodeVersion(), claimGroup.getDiagnosis11Code(), claimGroup.getDiagnosis11CodeVersion(), claimGroup.getDiagnosis12Code(), claimGroup.getDiagnosis12CodeVersion())) TransformerUtils.addDiagnosisCode(eob, diagnosis);
    for (CarrierClaimLine claimLine : claimGroup.getLines()) {
        ItemComponent item = eob.addItem();
        item.setSequence(claimLine.getLineNumber().intValue());
        /*
       * Per Michelle at GDIT, and also Tony Dean at OEDA, the performing provider _should_ always
       * be present. However, we've found some examples in production where it's not for some claim
       * lines. (This is annoying, as it's present on other lines in the same claim, and the data
       * indicates that the same NPI probably applies to the lines where it's not specified. Still,
       * it's not safe to guess at this, so we'll leave it blank.)
       */
        if (claimLine.getPerformingPhysicianNpi().isPresent()) {
            ExplanationOfBenefit.CareTeamComponent performingCareTeamMember = TransformerUtils.addCareTeamPractitioner(eob, item, TransformerConstants.CODING_NPI_US, claimLine.getPerformingPhysicianNpi().get(), ClaimCareteamrole.PRIMARY);
            performingCareTeamMember.setResponsible(true);
            /*
         * The provider's "specialty" and "type" code are equivalent. However, the "specialty" codes
         * are more granular, and seem to better match the example FHIR
         * `http://hl7.org/fhir/ex-providerqualification` code set. Accordingly, we map the
         * "specialty" codes to the `qualification` field here, and stick the "type" code into an
         * extension. TODO: suggest that the spec allows more than one `qualification` entry.
         */
            performingCareTeamMember.setQualification(TransformerUtils.createCodeableConcept(eob, CcwCodebookVariable.PRVDR_SPCLTY, claimLine.getProviderSpecialityCode()));
            performingCareTeamMember.addExtension(TransformerUtils.createExtensionCoding(eob, CcwCodebookVariable.CARR_LINE_PRVDR_TYPE_CD, claimLine.getProviderTypeCode()));
            performingCareTeamMember.addExtension(TransformerUtils.createExtensionCoding(eob, CcwCodebookVariable.PRTCPTNG_IND_CD, claimLine.getProviderParticipatingIndCode()));
            // addExtensionReference
            if (claimLine.getOrganizationNpi().isPresent()) {
                TransformerUtils.addExtensionCoding(performingCareTeamMember, TransformerConstants.CODING_NPI_US, TransformerConstants.CODING_NPI_US, TransformerUtils.retrieveNpiCodeDisplay(claimLine.getOrganizationNpi().get()), "" + claimLine.getOrganizationNpi().get());
            }
        }
        /*
       * FIXME This value seems to be just a "synonym" for the performing physician NPI and should
       * probably be mapped as an extra identifier with it (if/when that lands in a contained
       * Practitioner resource).
       */
        if (includeTaxNumbers.orElse(false)) {
            ExplanationOfBenefit.CareTeamComponent providerTaxNumber = TransformerUtils.addCareTeamPractitioner(eob, item, IdentifierType.TAX.getSystem(), claimLine.getProviderTaxNumber(), ClaimCareteamrole.OTHER);
            providerTaxNumber.setResponsible(true);
        }
        item.addAdjudication(TransformerUtils.createAdjudicationWithReason(eob, CcwCodebookVariable.CARR_LINE_RDCD_PMT_PHYS_ASTN_C, claimLine.getReducedPaymentPhysicianAsstCode()));
        TransformerUtils.mapHcpcs(eob, item, claimGroup.getHcpcsYearCode(), claimLine.getHcpcsCode(), Arrays.asList(claimLine.getHcpcsInitialModifierCode(), claimLine.getHcpcsSecondModifierCode()));
        if (claimLine.getAnesthesiaUnitCount().compareTo(BigDecimal.ZERO) > 0) {
            item.getService().addExtension(TransformerUtils.createExtensionQuantity(CcwCodebookVariable.CARR_LINE_ANSTHSA_UNIT_CNT, claimLine.getAnesthesiaUnitCount()));
        }
        if (claimLine.getMtusCode().isPresent()) {
            item.addExtension(TransformerUtils.createExtensionCoding(eob, CcwCodebookVariable.CARR_LINE_MTUS_CD, claimLine.getMtusCode()));
        }
        if (!claimLine.getMtusCount().equals(BigDecimal.ZERO)) {
            item.addExtension(TransformerUtils.createExtensionQuantity(CcwCodebookVariable.CARR_LINE_MTUS_CNT, claimLine.getMtusCount()));
        }
        // Common item level fields between Carrier and DME
        TransformerUtils.mapEobCommonItemCarrierDME(item, eob, claimGroup.getClaimId(), claimLine.getServiceCount(), claimLine.getPlaceOfServiceCode(), claimLine.getFirstExpenseDate(), claimLine.getLastExpenseDate(), claimLine.getBeneficiaryPaymentAmount(), claimLine.getProviderPaymentAmount(), claimLine.getBeneficiaryPartBDeductAmount(), claimLine.getPrimaryPayerCode(), claimLine.getPrimaryPayerPaidAmount(), claimLine.getBetosCode(), claimLine.getPaymentAmount(), claimLine.getPaymentCode(), claimLine.getCoinsuranceAmount(), claimLine.getSubmittedChargeAmount(), claimLine.getAllowedChargeAmount(), claimLine.getProcessingIndicatorCode(), claimLine.getServiceDeductibleCode(), claimLine.getDiagnosisCode(), claimLine.getDiagnosisCodeVersion(), claimLine.getHctHgbTestTypeCode(), claimLine.getHctHgbTestResult(), claimLine.getCmsServiceTypeCode(), claimLine.getNationalDrugCode());
        if (claimLine.getProviderStateCode().isPresent()) {
            item.getLocation().addExtension(TransformerUtils.createExtensionCoding(eob, CcwCodebookVariable.PRVDR_STATE_CD, claimLine.getProviderStateCode()));
        }
        if (claimLine.getProviderZipCode().isPresent()) {
            item.getLocation().addExtension(TransformerUtils.createExtensionCoding(eob, CcwCodebookVariable.PRVDR_ZIP, claimLine.getProviderZipCode()));
        }
        item.getLocation().addExtension(TransformerUtils.createExtensionCoding(eob, CcwCodebookVariable.CARR_LINE_PRCNG_LCLTY_CD, claimLine.getLinePricingLocalityCode()));
        if (claimLine.getCliaLabNumber().isPresent()) {
            item.getLocation().addExtension(TransformerUtils.createExtensionIdentifier(CcwCodebookVariable.CARR_LINE_CLIA_LAB_NUM, claimLine.getCliaLabNumber()));
        }
    }
    TransformerUtils.setLastUpdated(eob, claimGroup.getLastUpdated());
    return eob;
}

Example 18 with Diagnosis

use of gov.cms.bfd.server.war.commons.Diagnosis in project beneficiary-fhir-data by CMSgov.

the class DMEClaimTransformer method transformClaim.

/**
 * @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
 *     DMEClaim}
 */
private static ExplanationOfBenefit transformClaim(DMEClaim claimGroup, Optional<Boolean> includeTaxNumbers) {
    ExplanationOfBenefit eob = new ExplanationOfBenefit();
    // Common group level fields between all claim types
    TransformerUtils.mapEobCommonClaimHeaderData(eob, claimGroup.getClaimId(), claimGroup.getBeneficiaryId(), ClaimType.DME, claimGroup.getClaimGroupId().toPlainString(), MedicareSegment.PART_B, 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.DME, Optional.of(claimGroup.getNearLineRecordIdCode()), Optional.of(claimGroup.getClaimTypeCode()));
    // TODO is this column nullable? If so, why isn't it Optional?
    if (claimGroup.getPrimaryPayerPaidAmount() != null) {
        TransformerUtils.addAdjudicationTotal(eob, CcwCodebookVariable.PRPAYAMT, claimGroup.getPrimaryPayerPaidAmount());
    }
    // Common group level fields between Carrier and DME
    TransformerUtils.mapEobCommonGroupCarrierDME(eob, claimGroup.getBeneficiaryId(), claimGroup.getCarrierNumber(), claimGroup.getClinicalTrialNumber(), claimGroup.getBeneficiaryPartBDeductAmount(), claimGroup.getPaymentDenialCode(), claimGroup.getReferringPhysicianNpi(), Optional.of(claimGroup.getProviderAssignmentIndicator()), claimGroup.getProviderPaymentAmount(), claimGroup.getBeneficiaryPaymentAmount(), claimGroup.getSubmittedChargeAmount(), claimGroup.getAllowedChargeAmount(), claimGroup.getClaimDispositionCode(), claimGroup.getClaimCarrierControlNumber());
    for (Diagnosis diagnosis : TransformerUtils.extractDiagnoses1Thru12(claimGroup.getDiagnosisPrincipalCode(), claimGroup.getDiagnosisPrincipalCodeVersion(), claimGroup.getDiagnosis1Code(), claimGroup.getDiagnosis1CodeVersion(), claimGroup.getDiagnosis2Code(), claimGroup.getDiagnosis2CodeVersion(), claimGroup.getDiagnosis3Code(), claimGroup.getDiagnosis3CodeVersion(), claimGroup.getDiagnosis4Code(), claimGroup.getDiagnosis4CodeVersion(), claimGroup.getDiagnosis5Code(), claimGroup.getDiagnosis5CodeVersion(), claimGroup.getDiagnosis6Code(), claimGroup.getDiagnosis6CodeVersion(), claimGroup.getDiagnosis7Code(), claimGroup.getDiagnosis7CodeVersion(), claimGroup.getDiagnosis8Code(), claimGroup.getDiagnosis8CodeVersion(), claimGroup.getDiagnosis9Code(), claimGroup.getDiagnosis9CodeVersion(), claimGroup.getDiagnosis10Code(), claimGroup.getDiagnosis10CodeVersion(), claimGroup.getDiagnosis11Code(), claimGroup.getDiagnosis11CodeVersion(), claimGroup.getDiagnosis12Code(), claimGroup.getDiagnosis12CodeVersion())) TransformerUtils.addDiagnosisCode(eob, diagnosis);
    for (DMEClaimLine claimLine : claimGroup.getLines()) {
        ItemComponent item = eob.addItem();
        item.setSequence(claimLine.getLineNumber().intValue());
        /*
       * add an extension for the provider billing number as there is not a good place
       * to map this in the existing FHIR specification
       */
        if (claimLine.getProviderBillingNumber().isPresent()) {
            item.addExtension(TransformerUtils.createExtensionIdentifier(CcwCodebookVariable.SUPLRNUM, claimLine.getProviderBillingNumber()));
        }
        /*
       * Per Michelle at GDIT, and also Tony Dean at OEDA, the performing provider
       * _should_ always be present. However, we've found some examples in production
       * where it's not for some claim lines. (This is annoying, as it's present on
       * other lines in the same claim, and the data indicates that the same NPI
       * probably applies to the lines where it's not specified. Still, it's not safe
       * to guess at this, so we'll leave it blank.)
       */
        if (claimLine.getProviderNPI().isPresent()) {
            ExplanationOfBenefit.CareTeamComponent performingCareTeamMember = TransformerUtils.addCareTeamPractitioner(eob, item, TransformerConstants.CODING_NPI_US, claimLine.getProviderNPI().get(), ClaimCareteamrole.PRIMARY);
            performingCareTeamMember.setResponsible(true);
            /*
         * The provider's "specialty" and "type" code are equivalent.
         * However, the "specialty" codes are more granular, and seem to
         * better match the example FHIR
         * `http://hl7.org/fhir/ex-providerqualification` code set.
         * Accordingly, we map the "specialty" codes to the
         * `qualification` field here, and stick the "type" code into an
         * extension. TODO: suggest that the spec allows more than one
         * `qualification` entry.
         */
            performingCareTeamMember.setQualification(TransformerUtils.createCodeableConcept(eob, CcwCodebookVariable.PRVDR_SPCLTY, claimLine.getProviderSpecialityCode()));
            performingCareTeamMember.addExtension(TransformerUtils.createExtensionCoding(eob, CcwCodebookVariable.PRTCPTNG_IND_CD, claimLine.getProviderParticipatingIndCode()));
        }
        TransformerUtils.mapHcpcs(eob, item, claimGroup.getHcpcsYearCode(), claimLine.getHcpcsCode(), Arrays.asList(claimLine.getHcpcsInitialModifierCode(), claimLine.getHcpcsSecondModifierCode(), claimLine.getHcpcsThirdModifierCode(), claimLine.getHcpcsFourthModifierCode()));
        /*
       * FIXME This value seems to be just a "synonym" for the performing physician NPI and should
       * probably be mapped as an extra identifier with it (if/when that lands in a contained
       * Practitioner resource).
       */
        if (includeTaxNumbers.orElse(false)) {
            ExplanationOfBenefit.CareTeamComponent providerTaxNumber = TransformerUtils.addCareTeamPractitioner(eob, item, IdentifierType.TAX.getSystem(), claimLine.getProviderTaxNumber(), ClaimCareteamrole.OTHER);
            providerTaxNumber.setResponsible(true);
        }
        item.addAdjudication().setCategory(TransformerUtils.createAdjudicationCategory(CcwCodebookVariable.LINE_PRMRY_ALOWD_CHRG_AMT)).setAmount(TransformerUtils.createMoney(claimLine.getPrimaryPayerAllowedChargeAmount()));
        item.addAdjudication().setCategory(TransformerUtils.createAdjudicationCategory(CcwCodebookVariable.LINE_DME_PRCHS_PRICE_AMT)).setAmount(TransformerUtils.createMoney(claimLine.getPurchasePriceAmount()));
        if (claimLine.getScreenSavingsAmount().isPresent()) {
            // TODO should this be an adjudication?
            item.addExtension(TransformerUtils.createExtensionQuantity(CcwCodebookVariable.DMERC_LINE_SCRN_SVGS_AMT, claimLine.getScreenSavingsAmount()));
        }
        Extension mtusQuantityExtension = TransformerUtils.createExtensionQuantity(CcwCodebookVariable.DMERC_LINE_MTUS_CNT, claimLine.getMtusCount());
        item.addExtension(mtusQuantityExtension);
        if (claimLine.getMtusCode().isPresent()) {
            Quantity mtusQuantity = (Quantity) mtusQuantityExtension.getValue();
            TransformerUtils.setQuantityUnitInfo(CcwCodebookVariable.DMERC_LINE_MTUS_CD, claimLine.getMtusCode(), eob, mtusQuantity);
        }
        // Common item level fields between Carrier and DME
        TransformerUtils.mapEobCommonItemCarrierDME(item, eob, claimGroup.getClaimId(), claimLine.getServiceCount(), claimLine.getPlaceOfServiceCode(), claimLine.getFirstExpenseDate(), claimLine.getLastExpenseDate(), claimLine.getBeneficiaryPaymentAmount(), claimLine.getProviderPaymentAmount(), claimLine.getBeneficiaryPartBDeductAmount(), claimLine.getPrimaryPayerCode(), claimLine.getPrimaryPayerPaidAmount(), claimLine.getBetosCode(), claimLine.getPaymentAmount(), claimLine.getPaymentCode(), claimLine.getCoinsuranceAmount(), claimLine.getSubmittedChargeAmount(), claimLine.getAllowedChargeAmount(), claimLine.getProcessingIndicatorCode(), claimLine.getServiceDeductibleCode(), claimLine.getDiagnosisCode(), claimLine.getDiagnosisCodeVersion(), claimLine.getHctHgbTestTypeCode(), claimLine.getHctHgbTestResult(), claimLine.getCmsServiceTypeCode(), claimLine.getNationalDrugCode());
        if (!claimLine.getProviderStateCode().isEmpty()) {
            // FIXME Should this be pulled to a common mapping method?
            item.getLocation().addExtension(TransformerUtils.createExtensionCoding(eob, CcwCodebookVariable.PRVDR_STATE_CD, claimLine.getProviderStateCode()));
        }
        if (claimLine.getPricingStateCode().isPresent()) {
            item.getLocation().addExtension(TransformerUtils.createExtensionCoding(eob, CcwCodebookVariable.DMERC_LINE_PRCNG_STATE_CD, claimLine.getPricingStateCode()));
        }
        if (claimLine.getSupplierTypeCode().isPresent()) {
            // TODO should this be elsewhere; does it item.location make sense?
            item.getLocation().addExtension(TransformerUtils.createExtensionCoding(eob, CcwCodebookVariable.DMERC_LINE_SUPPLR_TYPE_CD, claimLine.getSupplierTypeCode()));
        }
    }
    TransformerUtils.setLastUpdated(eob, claimGroup.getLastUpdated());
    return eob;
}

Example 19 with Diagnosis

use of gov.cms.bfd.server.war.commons.Diagnosis in project beneficiary-fhir-data by CMSgov.

the class HospiceClaimTransformer method transformClaim.

/**
 * @param claimGroup the CCW {@link HospiceClaim} to transform
 * @return a FHIR {@link ExplanationOfBenefit} resource that represents the specified {@link
 *     HospiceClaim}
 */
private static ExplanationOfBenefit transformClaim(HospiceClaim claimGroup) {
    ExplanationOfBenefit eob = new ExplanationOfBenefit();
    // Common group level fields between all claim types
    TransformerUtils.mapEobCommonClaimHeaderData(eob, claimGroup.getClaimId(), claimGroup.getBeneficiaryId(), ClaimType.HOSPICE, 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.HOSPICE, 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());
    }
    // Common group level fields between Inpatient, HHA, Hospice and SNF
    TransformerUtils.mapEobCommonGroupInpHHAHospiceSNF(eob, claimGroup.getClaimHospiceStartDate(), claimGroup.getBeneficiaryDischargeDate(), Optional.of(claimGroup.getUtilizationDayCount()));
    if (claimGroup.getHospicePeriodCount().isPresent()) {
        eob.getHospitalization().addExtension(TransformerUtils.createExtensionQuantity(CcwCodebookVariable.BENE_HOSPC_PRD_CNT, claimGroup.getHospicePeriodCount()));
    }
    // 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());
    for (Diagnosis diagnosis : TransformerUtils.extractDiagnoses1Thru12(claimGroup.getDiagnosisPrincipalCode(), claimGroup.getDiagnosisPrincipalCodeVersion(), claimGroup.getDiagnosis1Code(), claimGroup.getDiagnosis1CodeVersion(), claimGroup.getDiagnosis2Code(), claimGroup.getDiagnosis2CodeVersion(), claimGroup.getDiagnosis3Code(), claimGroup.getDiagnosis3CodeVersion(), claimGroup.getDiagnosis4Code(), claimGroup.getDiagnosis4CodeVersion(), claimGroup.getDiagnosis5Code(), claimGroup.getDiagnosis5CodeVersion(), claimGroup.getDiagnosis6Code(), claimGroup.getDiagnosis6CodeVersion(), claimGroup.getDiagnosis7Code(), claimGroup.getDiagnosis7CodeVersion(), claimGroup.getDiagnosis8Code(), claimGroup.getDiagnosis8CodeVersion(), claimGroup.getDiagnosis9Code(), claimGroup.getDiagnosis9CodeVersion(), claimGroup.getDiagnosis10Code(), claimGroup.getDiagnosis10CodeVersion(), claimGroup.getDiagnosis11Code(), claimGroup.getDiagnosis11CodeVersion(), claimGroup.getDiagnosis12Code(), claimGroup.getDiagnosis12CodeVersion())) TransformerUtils.addDiagnosisCode(eob, diagnosis);
    for (Diagnosis diagnosis : TransformerUtils.extractDiagnoses13Thru25(claimGroup.getDiagnosis13Code(), claimGroup.getDiagnosis13CodeVersion(), claimGroup.getDiagnosis14Code(), claimGroup.getDiagnosis14CodeVersion(), claimGroup.getDiagnosis15Code(), claimGroup.getDiagnosis15CodeVersion(), claimGroup.getDiagnosis16Code(), claimGroup.getDiagnosis16CodeVersion(), claimGroup.getDiagnosis17Code(), claimGroup.getDiagnosis17CodeVersion(), claimGroup.getDiagnosis18Code(), claimGroup.getDiagnosis18CodeVersion(), claimGroup.getDiagnosis19Code(), claimGroup.getDiagnosis19CodeVersion(), claimGroup.getDiagnosis20Code(), claimGroup.getDiagnosis20CodeVersion(), claimGroup.getDiagnosis21Code(), claimGroup.getDiagnosis21CodeVersion(), claimGroup.getDiagnosis22Code(), claimGroup.getDiagnosis22CodeVersion(), claimGroup.getDiagnosis23Code(), claimGroup.getDiagnosis23CodeVersion(), claimGroup.getDiagnosis24Code(), claimGroup.getDiagnosis24CodeVersion(), claimGroup.getDiagnosis25Code(), claimGroup.getDiagnosis25CodeVersion())) TransformerUtils.addDiagnosisCode(eob, diagnosis);
    for (Diagnosis diagnosis : TransformerUtils.extractExternalDiagnoses1Thru12(claimGroup.getDiagnosisExternalFirstCode(), claimGroup.getDiagnosisExternalFirstCodeVersion(), claimGroup.getDiagnosisExternal1Code(), claimGroup.getDiagnosisExternal1CodeVersion(), claimGroup.getDiagnosisExternal2Code(), claimGroup.getDiagnosisExternal2CodeVersion(), claimGroup.getDiagnosisExternal3Code(), claimGroup.getDiagnosisExternal3CodeVersion(), claimGroup.getDiagnosisExternal4Code(), claimGroup.getDiagnosisExternal4CodeVersion(), claimGroup.getDiagnosisExternal5Code(), claimGroup.getDiagnosisExternal5CodeVersion(), claimGroup.getDiagnosisExternal6Code(), claimGroup.getDiagnosisExternal6CodeVersion(), claimGroup.getDiagnosisExternal7Code(), claimGroup.getDiagnosisExternal7CodeVersion(), claimGroup.getDiagnosisExternal8Code(), claimGroup.getDiagnosisExternal8CodeVersion(), claimGroup.getDiagnosisExternal9Code(), claimGroup.getDiagnosisExternal9CodeVersion(), claimGroup.getDiagnosisExternal10Code(), claimGroup.getDiagnosisExternal10CodeVersion(), claimGroup.getDiagnosisExternal11Code(), claimGroup.getDiagnosisExternal11CodeVersion(), claimGroup.getDiagnosisExternal12Code(), claimGroup.getDiagnosisExternal12CodeVersion())) TransformerUtils.addDiagnosisCode(eob, diagnosis);
    for (HospiceClaimLine claimLine : claimGroup.getLines()) {
        ItemComponent item = eob.addItem();
        item.setSequence(claimLine.getLineNumber().intValue());
        item.setLocation(new Address().setState((claimGroup.getProviderStateCode())));
        TransformerUtils.mapHcpcs(eob, item, Optional.empty(), claimLine.getHcpcsCode(), Arrays.asList(claimLine.getHcpcsInitialModifierCode(), claimLine.getHcpcsSecondModifierCode()));
        item.addAdjudication().setCategory(TransformerUtils.createAdjudicationCategory(CcwCodebookVariable.REV_CNTR_PRVDR_PMT_AMT)).setAmount(TransformerUtils.createMoney(claimLine.getProviderPaymentAmount()));
        item.addAdjudication().setCategory(TransformerUtils.createAdjudicationCategory(CcwCodebookVariable.REV_CNTR_BENE_PMT_AMT)).setAmount(TransformerUtils.createMoney(claimLine.getBenficiaryPaymentAmount()));
        // Common item level fields between Inpatient, Outpatient, HHA, Hospice and SNF
        TransformerUtils.mapEobCommonItemRevenue(item, eob, claimLine.getRevenueCenterCode(), claimLine.getRateAmount(), claimLine.getTotalChargeAmount(), claimLine.getNonCoveredChargeAmount().get(), claimLine.getUnitCount(), claimLine.getNationalDrugCodeQuantity(), claimLine.getNationalDrugCodeQualifierCode(), claimLine.getRevenueCenterRenderingPhysicianNPI());
        // Common item level fields between Outpatient, HHA and Hospice
        TransformerUtils.mapEobCommonItemRevenueOutHHAHospice(item, claimLine.getRevenueCenterDate(), claimLine.getPaymentAmount());
        // Common group level field coinsurance between Inpatient, HHA, Hospice and SNF
        TransformerUtils.mapEobCommonGroupInpHHAHospiceSNFCoinsurance(eob, item, claimLine.getDeductibleCoinsuranceCd());
    }
    TransformerUtils.setLastUpdated(eob, claimGroup.getLastUpdated());
    return eob;
}

Example 20 with Diagnosis

use of gov.cms.bfd.server.war.commons.Diagnosis in project beneficiary-fhir-data by CMSgov.

the class OutpatientClaimTransformer method transformClaim.

/**
 * @param claimGroup the CCW {@link OutpatientClaim} to transform
 * @return a FHIR {@link ExplanationOfBenefit} resource that represents the specified {@link
 *     OutpatientClaim}
 */
private static ExplanationOfBenefit transformClaim(OutpatientClaim claimGroup) {
    ExplanationOfBenefit eob = new ExplanationOfBenefit();
    // Common group level fields between all claim types
    TransformerUtils.mapEobCommonClaimHeaderData(eob, claimGroup.getClaimId(), claimGroup.getBeneficiaryId(), ClaimType.OUTPATIENT, claimGroup.getClaimGroupId().toPlainString(), MedicareSegment.PART_B, 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.OUTPATIENT, Optional.of(claimGroup.getNearLineRecordIdCode()), Optional.of(claimGroup.getClaimTypeCode()));
    // set the provider number which is common among several claim types
    TransformerUtils.setProviderNumber(eob, claimGroup.getProviderNumber());
    // TODO If this is actually nullable, should be Optional.
    if (claimGroup.getProfessionalComponentCharge() != null) {
        TransformerUtils.addAdjudicationTotal(eob, CcwCodebookVariable.NCH_PROFNL_CMPNT_CHRG_AMT, claimGroup.getProfessionalComponentCharge());
    }
    // TODO If this is actually nullable, should be Optional.
    if (claimGroup.getDeductibleAmount() != null) {
        TransformerUtils.addAdjudicationTotal(eob, CcwCodebookVariable.NCH_BENE_PTB_DDCTBL_AMT, claimGroup.getDeductibleAmount());
    }
    // TODO If this is actually nullable, should be Optional.
    if (claimGroup.getCoinsuranceAmount() != null) {
        TransformerUtils.addAdjudicationTotal(eob, CcwCodebookVariable.NCH_BENE_PTB_COINSRNC_AMT, claimGroup.getCoinsuranceAmount());
    }
    // TODO If this is actually nullable, should be Optional.
    if (claimGroup.getProviderPaymentAmount() != null) {
        TransformerUtils.addAdjudicationTotal(eob, CcwCodebookVariable.CLM_OP_PRVDR_PMT_AMT, claimGroup.getProviderPaymentAmount());
    }
    // TODO If this is actually nullable, should be Optional.
    if (claimGroup.getBeneficiaryPaymentAmount() != null) {
        TransformerUtils.addAdjudicationTotal(eob, CcwCodebookVariable.CLM_OP_BENE_PMT_AMT, claimGroup.getBeneficiaryPaymentAmount());
    }
    // 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().get(), claimGroup.getClaimServiceClassificationTypeCode(), claimGroup.getClaimPrimaryPayerCode(), claimGroup.getAttendingPhysicianNpi(), claimGroup.getTotalChargeAmount(), claimGroup.getPrimaryPayerPaidAmount(), claimGroup.getFiscalIntermediaryNumber(), claimGroup.getFiDocumentClaimControlNumber(), claimGroup.getFiOriginalClaimControlNumber());
    for (Diagnosis diagnosis : TransformerUtils.extractDiagnoses1Thru12(claimGroup.getDiagnosisPrincipalCode(), claimGroup.getDiagnosisPrincipalCodeVersion(), claimGroup.getDiagnosis1Code(), claimGroup.getDiagnosis1CodeVersion(), claimGroup.getDiagnosis2Code(), claimGroup.getDiagnosis2CodeVersion(), claimGroup.getDiagnosis3Code(), claimGroup.getDiagnosis3CodeVersion(), claimGroup.getDiagnosis4Code(), claimGroup.getDiagnosis4CodeVersion(), claimGroup.getDiagnosis5Code(), claimGroup.getDiagnosis5CodeVersion(), claimGroup.getDiagnosis6Code(), claimGroup.getDiagnosis6CodeVersion(), claimGroup.getDiagnosis7Code(), claimGroup.getDiagnosis7CodeVersion(), claimGroup.getDiagnosis8Code(), claimGroup.getDiagnosis8CodeVersion(), claimGroup.getDiagnosis9Code(), claimGroup.getDiagnosis9CodeVersion(), claimGroup.getDiagnosis10Code(), claimGroup.getDiagnosis10CodeVersion(), claimGroup.getDiagnosis11Code(), claimGroup.getDiagnosis11CodeVersion(), claimGroup.getDiagnosis12Code(), claimGroup.getDiagnosis12CodeVersion())) TransformerUtils.addDiagnosisCode(eob, diagnosis);
    for (Diagnosis diagnosis : TransformerUtils.extractDiagnoses13Thru25(claimGroup.getDiagnosis13Code(), claimGroup.getDiagnosis13CodeVersion(), claimGroup.getDiagnosis14Code(), claimGroup.getDiagnosis14CodeVersion(), claimGroup.getDiagnosis15Code(), claimGroup.getDiagnosis15CodeVersion(), claimGroup.getDiagnosis16Code(), claimGroup.getDiagnosis16CodeVersion(), claimGroup.getDiagnosis17Code(), claimGroup.getDiagnosis17CodeVersion(), claimGroup.getDiagnosis18Code(), claimGroup.getDiagnosis18CodeVersion(), claimGroup.getDiagnosis19Code(), claimGroup.getDiagnosis19CodeVersion(), claimGroup.getDiagnosis20Code(), claimGroup.getDiagnosis20CodeVersion(), claimGroup.getDiagnosis21Code(), claimGroup.getDiagnosis21CodeVersion(), claimGroup.getDiagnosis22Code(), claimGroup.getDiagnosis22CodeVersion(), claimGroup.getDiagnosis23Code(), claimGroup.getDiagnosis23CodeVersion(), claimGroup.getDiagnosis24Code(), claimGroup.getDiagnosis24CodeVersion(), claimGroup.getDiagnosis25Code(), claimGroup.getDiagnosis25CodeVersion())) TransformerUtils.addDiagnosisCode(eob, diagnosis);
    for (Diagnosis diagnosis : TransformerUtils.extractExternalDiagnoses1Thru12(claimGroup.getDiagnosisExternalFirstCode(), claimGroup.getDiagnosisExternalFirstCodeVersion(), claimGroup.getDiagnosisExternal1Code(), claimGroup.getDiagnosisExternal1CodeVersion(), claimGroup.getDiagnosisExternal2Code(), claimGroup.getDiagnosisExternal2CodeVersion(), claimGroup.getDiagnosisExternal3Code(), claimGroup.getDiagnosisExternal3CodeVersion(), claimGroup.getDiagnosisExternal4Code(), claimGroup.getDiagnosisExternal4CodeVersion(), claimGroup.getDiagnosisExternal5Code(), claimGroup.getDiagnosisExternal5CodeVersion(), claimGroup.getDiagnosisExternal6Code(), claimGroup.getDiagnosisExternal6CodeVersion(), claimGroup.getDiagnosisExternal7Code(), claimGroup.getDiagnosisExternal7CodeVersion(), claimGroup.getDiagnosisExternal8Code(), claimGroup.getDiagnosisExternal8CodeVersion(), claimGroup.getDiagnosisExternal9Code(), claimGroup.getDiagnosisExternal9CodeVersion(), claimGroup.getDiagnosisExternal10Code(), claimGroup.getDiagnosisExternal10CodeVersion(), claimGroup.getDiagnosisExternal11Code(), claimGroup.getDiagnosisExternal11CodeVersion(), claimGroup.getDiagnosisExternal12Code(), claimGroup.getDiagnosisExternal12CodeVersion())) TransformerUtils.addDiagnosisCode(eob, diagnosis);
    if (claimGroup.getDiagnosisAdmission1Code().isPresent())
        TransformerUtils.addDiagnosisCode(eob, Diagnosis.from(claimGroup.getDiagnosisAdmission1Code(), claimGroup.getDiagnosisAdmission1CodeVersion(), DiagnosisLabel.REASONFORVISIT).get());
    if (claimGroup.getDiagnosisAdmission2Code().isPresent())
        TransformerUtils.addDiagnosisCode(eob, Diagnosis.from(claimGroup.getDiagnosisAdmission2Code(), claimGroup.getDiagnosisAdmission2CodeVersion(), DiagnosisLabel.REASONFORVISIT).get());
    if (claimGroup.getDiagnosisAdmission3Code().isPresent())
        TransformerUtils.addDiagnosisCode(eob, Diagnosis.from(claimGroup.getDiagnosisAdmission3Code(), claimGroup.getDiagnosisAdmission3CodeVersion(), DiagnosisLabel.REASONFORVISIT).get());
    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 (OutpatientClaimLine claimLine : claimGroup.getLines()) {
        ItemComponent item = eob.addItem();
        item.setSequence(claimLine.getLineNumber().intValue());
        item.setLocation(new Address().setState((claimGroup.getProviderStateCode())));
        if (claimLine.getRevCntr1stAnsiCd().isPresent()) {
            item.addAdjudication().setCategory(TransformerUtils.createAdjudicationCategory(CcwCodebookVariable.REV_CNTR_1ST_ANSI_CD)).setReason(TransformerUtils.createCodeableConcept(eob, CcwCodebookVariable.REV_CNTR_1ST_ANSI_CD, claimLine.getRevCntr1stAnsiCd()));
        }
        if (claimLine.getRevCntr2ndAnsiCd().isPresent()) {
            item.addAdjudication().setCategory(TransformerUtils.createAdjudicationCategory(CcwCodebookVariable.REV_CNTR_2ND_ANSI_CD)).setReason(TransformerUtils.createCodeableConcept(eob, CcwCodebookVariable.REV_CNTR_2ND_ANSI_CD, claimLine.getRevCntr2ndAnsiCd()));
        }
        if (claimLine.getRevCntr3rdAnsiCd().isPresent()) {
            item.addAdjudication().setCategory(TransformerUtils.createAdjudicationCategory(CcwCodebookVariable.REV_CNTR_3RD_ANSI_CD)).setReason(TransformerUtils.createCodeableConcept(eob, CcwCodebookVariable.REV_CNTR_3RD_ANSI_CD, claimLine.getRevCntr3rdAnsiCd()));
        }
        if (claimLine.getRevCntr4thAnsiCd().isPresent()) {
            item.addAdjudication().setCategory(TransformerUtils.createAdjudicationCategory(CcwCodebookVariable.REV_CNTR_4TH_ANSI_CD)).setReason(TransformerUtils.createCodeableConcept(eob, CcwCodebookVariable.REV_CNTR_4TH_ANSI_CD, claimLine.getRevCntr4thAnsiCd()));
        }
        TransformerUtils.mapHcpcs(eob, item, Optional.empty(), claimLine.getHcpcsCode(), Arrays.asList(claimLine.getHcpcsInitialModifierCode(), claimLine.getHcpcsSecondModifierCode()));
        if (claimLine.getNationalDrugCode().isPresent()) {
            item.getService().addExtension(TransformerUtils.createExtensionCoding(eob, CcwCodebookVariable.REV_CNTR_IDE_NDC_UPC_NUM, claimLine.getNationalDrugCode()));
        }
        item.addAdjudication().setCategory(TransformerUtils.createAdjudicationCategory(CcwCodebookVariable.REV_CNTR_BLOOD_DDCTBL_AMT)).setAmount(TransformerUtils.createMoney(claimLine.getBloodDeductibleAmount()));
        item.addAdjudication().setCategory(TransformerUtils.createAdjudicationCategory(CcwCodebookVariable.REV_CNTR_CASH_DDCTBL_AMT)).setAmount(TransformerUtils.createMoney(claimLine.getCashDeductibleAmount()));
        item.addAdjudication().setCategory(TransformerUtils.createAdjudicationCategory(CcwCodebookVariable.REV_CNTR_COINSRNC_WGE_ADJSTD_C)).setAmount(TransformerUtils.createMoney(claimLine.getWageAdjustedCoinsuranceAmount()));
        item.addAdjudication().setCategory(TransformerUtils.createAdjudicationCategory(CcwCodebookVariable.REV_CNTR_RDCD_COINSRNC_AMT)).setAmount(TransformerUtils.createMoney(claimLine.getReducedCoinsuranceAmount()));
        item.addAdjudication().setCategory(TransformerUtils.createAdjudicationCategory(CcwCodebookVariable.REV_CNTR_1ST_MSP_PD_AMT)).setAmount(TransformerUtils.createMoney(claimLine.getFirstMspPaidAmount()));
        item.addAdjudication().setCategory(TransformerUtils.createAdjudicationCategory(CcwCodebookVariable.REV_CNTR_2ND_MSP_PD_AMT)).setAmount(TransformerUtils.createMoney(claimLine.getSecondMspPaidAmount()));
        item.addAdjudication().setCategory(TransformerUtils.createAdjudicationCategory(CcwCodebookVariable.REV_CNTR_PRVDR_PMT_AMT)).setAmount(TransformerUtils.createMoney(claimLine.getProviderPaymentAmount()));
        item.addAdjudication().setCategory(TransformerUtils.createAdjudicationCategory(CcwCodebookVariable.REV_CNTR_BENE_PMT_AMT)).setAmount(TransformerUtils.createMoney(claimLine.getBenficiaryPaymentAmount()));
        item.addAdjudication().setCategory(TransformerUtils.createAdjudicationCategory(CcwCodebookVariable.REV_CNTR_PTNT_RSPNSBLTY_PMT)).setAmount(TransformerUtils.createMoney(claimLine.getPatientResponsibilityAmount()));
        // Common item level fields between Outpatient, HHA and Hospice
        TransformerUtils.mapEobCommonItemRevenueOutHHAHospice(item, claimLine.getRevenueCenterDate(), claimLine.getPaymentAmount());
        // Common item level fields between Inpatient, Outpatient, HHA, Hospice and SNF
        TransformerUtils.mapEobCommonItemRevenue(item, eob, claimLine.getRevenueCenterCode(), claimLine.getRateAmount(), claimLine.getTotalChargeAmount(), claimLine.getNonCoveredChargeAmount(), claimLine.getUnitCount(), claimLine.getNationalDrugCodeQuantity(), claimLine.getNationalDrugCodeQualifierCode(), claimLine.getRevenueCenterRenderingPhysicianNPI());
        // Dt: 6-18-20 Handling for optional status code claim line: BFD-252
        if (claimLine.getStatusCode().isPresent()) {
            item.getRevenue().addExtension(TransformerUtils.createExtensionCoding(eob, CcwCodebookVariable.REV_CNTR_STUS_IND_CD, claimLine.getStatusCode()));
        }
    }
    TransformerUtils.setLastUpdated(eob, claimGroup.getLastUpdated());
    return eob;
}