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

Example 1 with IdentifierType

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

the class TransformerUtilsTest method createReferenceForIdentifierTypeTest.

/**
 * Verifies that {@link
 * gov.cms.bfd.server.war.stu3.providers.TransformerUtils#createIdentifierReference
 * (gov.cms.bfd.server.war.stu3.providers.IdentifierType, String)} sets {@link Reference)}
 * correctly.
 */
@Test
public void createReferenceForIdentifierTypeTest() {
    String identifierValue = "identifierValue";
    IdentifierType identifierType = IdentifierType.NPI;
    Reference reference = TransformerUtils.createIdentifierReference(identifierType, identifierValue);
    assertEquals(identifierType.getSystem(), reference.getIdentifier().getSystem());
    assertEquals(identifierValue, reference.getIdentifier().getValue());
    assertEquals(identifierType.getCode(), reference.getIdentifier().getType().getCoding().get(0).getCode());
    assertEquals(identifierType.getDisplay(), reference.getIdentifier().getType().getCoding().get(0).getDisplay());
    assertEquals(identifierType.getSystem(), reference.getIdentifier().getType().getCoding().get(0).getSystem());
}

Example 2 with IdentifierType

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

the class PartDEventTransformer method transformClaim.

/**
 * @param claimGroup the CCW {@link PartDEvent} to transform
 * @return a FHIR {@link ExplanationOfBenefit} resource that represents the specified {@link
 *     PartDEvent}
 */
private static ExplanationOfBenefit transformClaim(PartDEvent claimGroup) {
    ExplanationOfBenefit eob = new ExplanationOfBenefit();
    // Common group level fields between all claim types
    TransformerUtils.mapEobCommonClaimHeaderData(eob, claimGroup.getEventId(), claimGroup.getBeneficiaryId(), ClaimType.PDE, claimGroup.getClaimGroupId().toPlainString(), MedicareSegment.PART_D, Optional.of(claimGroup.getPrescriptionFillDate()), Optional.of(claimGroup.getPrescriptionFillDate()), Optional.empty(), claimGroup.getFinalAction());
    eob.addIdentifier(TransformerUtils.createIdentifier(CcwCodebookVariable.RX_SRVC_RFRNC_NUM, claimGroup.getPrescriptionReferenceNumber().toPlainString()));
    // map eob type codes into FHIR
    TransformerUtils.mapEobType(eob, ClaimType.PDE, Optional.empty(), Optional.empty());
    eob.getInsurance().getCoverage().addExtension(TransformerUtils.createExtensionIdentifier(CcwCodebookVariable.PLAN_CNTRCT_REC_ID, claimGroup.getPlanContractId()));
    eob.getInsurance().getCoverage().addExtension(TransformerUtils.createExtensionIdentifier(CcwCodebookVariable.PLAN_PBP_REC_NUM, claimGroup.getPlanBenefitPackageId()));
    if (claimGroup.getPaymentDate().isPresent()) {
        eob.getPayment().setDate(TransformerUtils.convertToDate(claimGroup.getPaymentDate().get()));
    }
    ItemComponent rxItem = eob.addItem();
    rxItem.setSequence(1);
    ExplanationOfBenefit.DetailComponent detail = new ExplanationOfBenefit.DetailComponent();
    switch(claimGroup.getCompoundCode()) {
        // COMPOUNDED
        case 2:
            /* Pharmacy dispense invoice for a compound */
            detail.getType().addCoding(new Coding().setSystem(V3ActCode.RXCINV.getSystem()).setCode(V3ActCode.RXCINV.toCode()).setDisplay(V3ActCode.RXCINV.getDisplay()));
            break;
        // NOT_COMPOUNDED
        case 1:
            /*
         * Pharmacy dispense invoice not involving a compound
         */
            detail.getType().addCoding(new Coding().setSystem(V3ActCode.RXCINV.getSystem()).setCode(V3ActCode.RXDINV.toCode()).setDisplay(V3ActCode.RXDINV.getDisplay()));
            break;
        // NOT_SPECIFIED
        case 0:
            /*
         * Pharmacy dispense invoice not specified - do not set a value
         */
            break;
        default:
            /*
         * Unexpected value encountered - compound code should be either
         * compounded or not compounded.
         */
            throw new InvalidRifValueException("Unexpected value encountered - compound code should be either compounded or not compounded: " + claimGroup.getCompoundCode());
    }
    rxItem.addDetail(detail);
    rxItem.setServiced(new DateType().setValue(TransformerUtils.convertToDate(claimGroup.getPrescriptionFillDate())));
    /*
     * Create an adjudication for either CVRD_D_PLAN_PD_AMT or NCVRD_PLAN_PD_AMT,
     * depending on the value of DRUG_CVRG_STUS_CD. Stick DRUG_CVRG_STUS_CD into the
     * adjudication.reason field.
     */
    CodeableConcept planPaidAmountAdjudicationCategory;
    BigDecimal planPaidAmountAdjudicationValue;
    if (claimGroup.getDrugCoverageStatusCode() == 'C') {
        planPaidAmountAdjudicationCategory = TransformerUtils.createAdjudicationCategory(CcwCodebookVariable.CVRD_D_PLAN_PD_AMT);
        planPaidAmountAdjudicationValue = claimGroup.getPartDPlanCoveredPaidAmount();
    } else {
        planPaidAmountAdjudicationCategory = TransformerUtils.createAdjudicationCategory(CcwCodebookVariable.NCVRD_PLAN_PD_AMT);
        planPaidAmountAdjudicationValue = claimGroup.getPartDPlanNonCoveredPaidAmount();
    }
    rxItem.addAdjudication().setCategory(planPaidAmountAdjudicationCategory).setReason(TransformerUtils.createCodeableConcept(eob, CcwCodebookVariable.DRUG_CVRG_STUS_CD, claimGroup.getDrugCoverageStatusCode())).setAmount(TransformerUtils.createMoney(planPaidAmountAdjudicationValue));
    rxItem.addAdjudication().setCategory(TransformerUtils.createAdjudicationCategory(CcwCodebookVariable.GDC_BLW_OOPT_AMT)).setAmount(TransformerUtils.createMoney(claimGroup.getGrossCostBelowOutOfPocketThreshold()));
    rxItem.addAdjudication().setCategory(TransformerUtils.createAdjudicationCategory(CcwCodebookVariable.GDC_ABV_OOPT_AMT)).setAmount(TransformerUtils.createMoney(claimGroup.getGrossCostAboveOutOfPocketThreshold()));
    rxItem.addAdjudication().setCategory(TransformerUtils.createAdjudicationCategory(CcwCodebookVariable.PTNT_PAY_AMT)).setAmount(TransformerUtils.createMoney(claimGroup.getPatientPaidAmount()));
    rxItem.addAdjudication().setCategory(TransformerUtils.createAdjudicationCategory(CcwCodebookVariable.OTHR_TROOP_AMT)).setAmount(TransformerUtils.createMoney(claimGroup.getOtherTrueOutOfPocketPaidAmount()));
    rxItem.addAdjudication().setCategory(TransformerUtils.createAdjudicationCategory(CcwCodebookVariable.LICS_AMT)).setAmount(TransformerUtils.createMoney(claimGroup.getLowIncomeSubsidyPaidAmount()));
    rxItem.addAdjudication().setCategory(TransformerUtils.createAdjudicationCategory(CcwCodebookVariable.PLRO_AMT)).setAmount(TransformerUtils.createMoney(claimGroup.getPatientLiabilityReductionOtherPaidAmount()));
    rxItem.addAdjudication().setCategory(TransformerUtils.createAdjudicationCategory(CcwCodebookVariable.TOT_RX_CST_AMT)).setAmount(TransformerUtils.createMoney(claimGroup.getTotalPrescriptionCost()));
    rxItem.addAdjudication().setCategory(TransformerUtils.createAdjudicationCategory(CcwCodebookVariable.RPTD_GAP_DSCNT_NUM)).setAmount(TransformerUtils.createMoney(claimGroup.getGapDiscountAmount()));
    if (claimGroup.getPrescriberIdQualifierCode() == null || !claimGroup.getPrescriberIdQualifierCode().equalsIgnoreCase("01"))
        throw new InvalidRifValueException("Prescriber ID Qualifier Code is invalid: " + claimGroup.getPrescriberIdQualifierCode());
    if (claimGroup.getPrescriberId() != null) {
        TransformerUtils.addCareTeamPractitioner(eob, rxItem, TransformerConstants.CODING_NPI_US, claimGroup.getPrescriberId(), ClaimCareteamrole.PRIMARY);
    }
    rxItem.setService(TransformerUtils.createCodeableConcept(TransformerConstants.CODING_NDC, null, TransformerUtils.retrieveFDADrugCodeDisplay(claimGroup.getNationalDrugCode()), claimGroup.getNationalDrugCode()));
    SimpleQuantity quantityDispensed = new SimpleQuantity();
    quantityDispensed.setValue(claimGroup.getQuantityDispensed());
    rxItem.setQuantity(quantityDispensed);
    rxItem.getQuantity().addExtension(TransformerUtils.createExtensionQuantity(CcwCodebookVariable.FILL_NUM, claimGroup.getFillNumber()));
    rxItem.getQuantity().addExtension(TransformerUtils.createExtensionQuantity(CcwCodebookVariable.DAYS_SUPLY_NUM, claimGroup.getDaysSupply()));
    /*
     * This chart is to dosplay the different code values for the different service provider id qualifer
     * codes below
     *   Code	    Code value
     *   01        National Provider Identifier (NPI)
     *   06        Unique Physician Identification Number (UPIN)
     *   07        National Council for Prescription Drug Programs (NCPDP) provider identifier
     *   08        State license number
     *   11        Federal tax number
     *   99        Other
     */
    IdentifierType identifierType;
    if (!claimGroup.getServiceProviderId().isEmpty()) {
        switch(claimGroup.getServiceProviderIdQualiferCode()) {
            case "01":
                identifierType = IdentifierType.NPI;
                break;
            case "06":
                identifierType = IdentifierType.UPIN;
                break;
            case "07":
                identifierType = IdentifierType.NCPDP;
                break;
            case "08":
                identifierType = IdentifierType.SL;
                break;
            case "11":
                identifierType = IdentifierType.TAX;
                break;
            default:
                identifierType = null;
                break;
        }
        if (identifierType != null) {
            eob.setOrganization(TransformerUtils.createIdentifierReference(identifierType, claimGroup.getServiceProviderId()));
            eob.setFacility(TransformerUtils.createIdentifierReference(identifierType, claimGroup.getServiceProviderId()));
        }
        eob.getFacility().addExtension(TransformerUtils.createExtensionCoding(eob, CcwCodebookVariable.PHRMCY_SRVC_TYPE_CD, claimGroup.getPharmacyTypeCode()));
    }
    /*
     * Storing code values in EOB.information below
     */
    TransformerUtils.addInformationWithCode(eob, CcwCodebookVariable.DAW_PROD_SLCTN_CD, CcwCodebookVariable.DAW_PROD_SLCTN_CD, claimGroup.getDispenseAsWrittenProductSelectionCode());
    if (claimGroup.getDispensingStatusCode().isPresent())
        TransformerUtils.addInformationWithCode(eob, CcwCodebookVariable.DSPNSNG_STUS_CD, CcwCodebookVariable.DSPNSNG_STUS_CD, claimGroup.getDispensingStatusCode());
    TransformerUtils.addInformationWithCode(eob, CcwCodebookVariable.DRUG_CVRG_STUS_CD, CcwCodebookVariable.DRUG_CVRG_STUS_CD, claimGroup.getDrugCoverageStatusCode());
    if (claimGroup.getAdjustmentDeletionCode().isPresent())
        TransformerUtils.addInformationWithCode(eob, CcwCodebookVariable.ADJSTMT_DLTN_CD, CcwCodebookVariable.ADJSTMT_DLTN_CD, claimGroup.getAdjustmentDeletionCode());
    if (claimGroup.getNonstandardFormatCode().isPresent())
        TransformerUtils.addInformationWithCode(eob, CcwCodebookVariable.NSTD_FRMT_CD, CcwCodebookVariable.NSTD_FRMT_CD, claimGroup.getNonstandardFormatCode());
    if (claimGroup.getPricingExceptionCode().isPresent())
        TransformerUtils.addInformationWithCode(eob, CcwCodebookVariable.PRCNG_EXCPTN_CD, CcwCodebookVariable.PRCNG_EXCPTN_CD, claimGroup.getPricingExceptionCode());
    if (claimGroup.getCatastrophicCoverageCode().isPresent())
        TransformerUtils.addInformationWithCode(eob, CcwCodebookVariable.CTSTRPHC_CVRG_CD, CcwCodebookVariable.CTSTRPHC_CVRG_CD, claimGroup.getCatastrophicCoverageCode());
    if (claimGroup.getPrescriptionOriginationCode().isPresent())
        TransformerUtils.addInformationWithCode(eob, CcwCodebookVariable.RX_ORGN_CD, CcwCodebookVariable.RX_ORGN_CD, claimGroup.getPrescriptionOriginationCode());
    if (claimGroup.getBrandGenericCode().isPresent())
        TransformerUtils.addInformationWithCode(eob, CcwCodebookVariable.BRND_GNRC_CD, CcwCodebookVariable.BRND_GNRC_CD, claimGroup.getBrandGenericCode());
    TransformerUtils.addInformationWithCode(eob, CcwCodebookVariable.PHRMCY_SRVC_TYPE_CD, CcwCodebookVariable.PHRMCY_SRVC_TYPE_CD, claimGroup.getPharmacyTypeCode());
    TransformerUtils.addInformationWithCode(eob, CcwCodebookVariable.PTNT_RSDNC_CD, CcwCodebookVariable.PTNT_RSDNC_CD, claimGroup.getPatientResidenceCode());
    if (claimGroup.getSubmissionClarificationCode().isPresent())
        TransformerUtils.addInformationWithCode(eob, CcwCodebookVariable.SUBMSN_CLR_CD, CcwCodebookVariable.SUBMSN_CLR_CD, claimGroup.getSubmissionClarificationCode());
    TransformerUtils.setLastUpdated(eob, claimGroup.getLastUpdated());
    return eob;
}