Examples with C4BBOrganizationIdentifierType gov.cms.bfd.server.war.commons.carin.C4BBOrganizationIdentifierType used on opensource projects

Example 1 with C4BBOrganizationIdentifierType

use of gov.cms.bfd.server.war.commons.carin.C4BBOrganizationIdentifierType in project beneficiary-fhir-data by CMSgov.

the class PartDEventTransformerV2 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();
    eob.getMeta().addProfile(ProfileConstants.C4BB_EOB_PHARMACY_PROFILE_URL);
    // Common group level fields between all claim types
    // Claim Type + Claim ID
    // => ExplanationOfBenefit.id
    // PDE_ID           => ExplanationOfBenefit.identifier
    // CLM_GRP_ID       => ExplanationOfBenefit.identifier
    // BENE_ID + Coverage Type
    // => ExplanationOfBenefit.insurance.coverage (reference)
    // BENE_ID          => ExplanationOfBenefit.patient (reference)
    // FINAL_ACTION     => ExplanationOfBenefit.status
    // SRVC_DT          => ExplanationOfBenefit.billablePeriod.start
    // SRVC_DT          => ExplanationOfBenefit.billablePeriod.end
    TransformerUtilsV2.mapEobCommonClaimHeaderData(eob, claimGroup.getEventId(), claimGroup.getBeneficiaryId(), ClaimTypeV2.PDE, claimGroup.getClaimGroupId().toPlainString(), MedicareSegment.PART_D, Optional.of(claimGroup.getPrescriptionFillDate()), Optional.of(claimGroup.getPrescriptionFillDate()), Optional.empty(), claimGroup.getFinalAction());
    // RX_SRVC_RFRNC_NUM => ExplanationOfBenefit.identifier
    eob.addIdentifier(TransformerUtilsV2.createClaimIdentifier(CcwCodebookVariable.RX_SRVC_RFRNC_NUM, claimGroup.getPrescriptionReferenceNumber().toPlainString()));
    // map eob type codes into FHIR
    // EOB Type               => ExplanationOfBenefit.type.coding
    // Claim Type  (pharmacy) => ExplanationOfBenefit.type.coding
    TransformerUtilsV2.mapEobType(eob, ClaimTypeV2.PDE, Optional.empty(), Optional.empty());
    // Coverage object is not optional, and we want to add extensions to it. This is safe.
    // PLAN_CNTRCT_REC_ID => ExplanationOfBenefit.insurance.coverage.extension
    eob.getInsuranceFirstRep().getCoverage().addExtension(TransformerUtilsV2.createExtensionIdentifier(CcwCodebookVariable.PLAN_CNTRCT_REC_ID, claimGroup.getPlanContractId()));
    // PLAN_PBP_REC_NUM => ExplanationOfBenefit.insurance.coverage.extension
    eob.getInsuranceFirstRep().getCoverage().addExtension(TransformerUtilsV2.createExtensionIdentifier(CcwCodebookVariable.PLAN_PBP_REC_NUM, claimGroup.getPlanBenefitPackageId()));
    // PD_DT => ExplanationOfBenefit.payment.date
    if (claimGroup.getPaymentDate().isPresent()) {
        eob.getPayment().setDate(TransformerUtilsV2.convertToDate(claimGroup.getPaymentDate().get()));
    }
    ItemComponent rxItem = eob.addItem();
    // 1 => ExplanationOfBenefit.item.sequence
    rxItem.setSequence(1);
    // CMPND_CD => ExplanationOfBenefit.item.programCode
    switch(claimGroup.getCompoundCode()) {
        // COMPOUNDED
        case 2:
            /* Pharmacy dispense invoice for a compound */
            TransformerUtilsV2.addInformationSlice(eob, C4BBSupportingInfoType.COMPOUND_CODE).setCode(new CodeableConcept().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
         */
            TransformerUtilsV2.addInformationSlice(eob, C4BBSupportingInfoType.COMPOUND_CODE).setCode(new CodeableConcept().addCoding(new Coding().setSystem(V3ActCode.RXDINV.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());
    }
    // SRVC_DT => ExplanationOfBenefit.item.servicedDate
    rxItem.setServiced(new DateType().setValue(TransformerUtilsV2.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. CARING Slicing and CARING Adjudication Value Sets.
     */
    if (claimGroup.getDrugCoverageStatusCode() == 'C') {
        // CVRD_D_PLAN_PD_AMT => ExplanationOfBenefit.item.adjudication.amount
        TransformerUtilsV2.addAdjudication(rxItem, TransformerUtilsV2.createAdjudicationAmtSlice(CcwCodebookVariable.CVRD_D_PLAN_PD_AMT, C4BBAdjudication.BENEFIT, claimGroup.getPartDPlanCoveredPaidAmount()));
    } else {
        // NCVRD_PLAN_PD_AMT => ExplanationOfBenefit.item.adjudication.amount
        TransformerUtilsV2.addAdjudication(rxItem, TransformerUtilsV2.createAdjudicationAmtSlice(CcwCodebookVariable.CVRD_D_PLAN_PD_AMT, C4BBAdjudication.NONCOVERED, claimGroup.getPartDPlanNonCoveredPaidAmount()));
    }
    // GDC_BLW_OOPT_AMT => ExplanationOfBenefit.item.adjudication.amount
    TransformerUtilsV2.addAdjudication(rxItem, TransformerUtilsV2.createAdjudicationAmtSlice(CcwCodebookVariable.GDC_BLW_OOPT_AMT, C4BBAdjudication.COINSURANCE, claimGroup.getGrossCostBelowOutOfPocketThreshold()));
    // GDC_ABV_OOPT_AMT => ExplanationOfBenefit.item.adjudication.amount
    TransformerUtilsV2.addAdjudication(rxItem, TransformerUtilsV2.createAdjudicationAmtSlice(CcwCodebookVariable.GDC_ABV_OOPT_AMT, C4BBAdjudication.COINSURANCE, claimGroup.getGrossCostAboveOutOfPocketThreshold()));
    // PTNT_PAY_AMT => ExplanationOfBenefit.item.adjudication.amount
    TransformerUtilsV2.addAdjudication(rxItem, TransformerUtilsV2.createAdjudicationAmtSlice(CcwCodebookVariable.PTNT_PAY_AMT, C4BBAdjudication.PAID_BY_PATIENT, claimGroup.getPatientPaidAmount()));
    // OTHR_TROOP_AMT => ExplanationOfBenefit.item.adjudication.amount
    TransformerUtilsV2.addAdjudication(rxItem, TransformerUtilsV2.createAdjudicationAmtSlice(CcwCodebookVariable.OTHR_TROOP_AMT, C4BBAdjudication.PRIOR_PAYER_PAID, claimGroup.getOtherTrueOutOfPocketPaidAmount()));
    // LICS_AMT => ExplanationOfBenefit.item.adjudication.amount
    TransformerUtilsV2.addAdjudication(rxItem, TransformerUtilsV2.createAdjudicationAmtSlice(CcwCodebookVariable.LICS_AMT, C4BBAdjudication.DISCOUNT, claimGroup.getLowIncomeSubsidyPaidAmount()));
    // PLRO_AMT => ExplanationOfBenefit.item.adjudication.amount
    TransformerUtilsV2.addAdjudication(rxItem, TransformerUtilsV2.createAdjudicationAmtSlice(CcwCodebookVariable.PLRO_AMT, C4BBAdjudication.PRIOR_PAYER_PAID, claimGroup.getPatientLiabilityReductionOtherPaidAmount()));
    // TOT_RX_CST_AMT => ExplanationOfBenefit.item.adjudication.amount
    TransformerUtilsV2.addAdjudication(rxItem, TransformerUtilsV2.createAdjudicationAmtSlice(CcwCodebookVariable.TOT_RX_CST_AMT, C4BBAdjudication.DRUG_COST, claimGroup.getTotalPrescriptionCost()));
    // RPTD_GAP_DSCNT_NUM => ExplanationOfBenefit.item.adjudication.amount
    TransformerUtilsV2.addAdjudication(rxItem, TransformerUtilsV2.createAdjudicationAmtSlice(CcwCodebookVariable.RPTD_GAP_DSCNT_NUM, C4BBAdjudication.DISCOUNT, claimGroup.getGapDiscountAmount()));
    // Validate PRESCRBR_ID
    if (claimGroup.getPrescriberIdQualifierCode() == null || !claimGroup.getPrescriberIdQualifierCode().equalsIgnoreCase("01")) {
        throw new InvalidRifValueException("Prescriber ID Qualifier Code is invalid: " + claimGroup.getPrescriberIdQualifierCode());
    }
    // PRSCRBR_ID => ExplanationOfBenefit.careTeam.provider
    TransformerUtilsV2.addCareTeamMember(eob, rxItem, C4BBPractitionerIdentifierType.NPI, C4BBClaimPharmacyTeamRole.PRESCRIBING, Optional.ofNullable(claimGroup.getPrescriberId()));
    // This can't use TransformerUtilsV2.addNationalDrugCode because it maps differently
    // PROD_SRVC_ID => ExplanationOfBenefit.item.productOrService
    rxItem.setProductOrService(TransformerUtilsV2.createCodeableConcept(TransformerConstants.CODING_NDC, null, TransformerUtilsV2.retrieveFDADrugCodeDisplay(claimGroup.getNationalDrugCode()), claimGroup.getNationalDrugCode()));
    // QTY_DSPNSD_NUM => ExplanationOfBenefit.item.quantity
    rxItem.setQuantity(new SimpleQuantity().setValue(claimGroup.getQuantityDispensed()));
    // FILL_NUM => ExplanationOfBenefit.item.quantity.extension
    TransformerUtilsV2.addInformationSlice(eob, C4BBSupportingInfoType.REFILL_NUM).setValue(new SimpleQuantity().setValue(claimGroup.getFillNumber()));
    // DAYS_SUPLY_NUM => ExplanationOfBenefit.item.quantity.extension
    TransformerUtilsV2.addInformationSlice(eob, C4BBSupportingInfoType.DAYS_SUPPLY).setValue(new SimpleQuantity().setValue(claimGroup.getDaysSupply()));
    /*
     * This chart is to display the different code values for the different service provider id qualifier
     * 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
     */
    C4BBOrganizationIdentifierType identifierType;
    if (!claimGroup.getServiceProviderId().isEmpty()) {
        switch(claimGroup.getServiceProviderIdQualiferCode()) {
            case "01":
                identifierType = C4BBOrganizationIdentifierType.NPI;
                break;
            case "06":
                identifierType = C4BBOrganizationIdentifierType.UPIN;
                break;
            case "07":
                identifierType = C4BBOrganizationIdentifierType.NCPDP;
                break;
            case "08":
                identifierType = C4BBOrganizationIdentifierType.SL;
                break;
            case "11":
                identifierType = C4BBOrganizationIdentifierType.TAX;
                break;
            default:
                identifierType = null;
                break;
        }
        // SRVC_PRVDR_ID => ExplanationOfBenefit.facility
        if (identifierType != null) {
            eob.setFacility(TransformerUtilsV2.createIdentifierReference(identifierType, claimGroup.getServiceProviderId()));
        }
    }
    /*
     * Storing code values in EOB.information below
     */
    // DRUG_CVRG_STUS_CD => ExplanationOfBenefit.supportingInfo.code
    TransformerUtilsV2.addInformationWithCode(eob, CcwCodebookVariable.DRUG_CVRG_STUS_CD, CcwCodebookVariable.DRUG_CVRG_STUS_CD, claimGroup.getDrugCoverageStatusCode());
    // DAW_PROD_SLCTN_CD => ExplanationOfBenefit.supportingInfo.code
    TransformerUtilsV2.addInformationWithCode(eob, CcwCodebookVariable.DAW_PROD_SLCTN_CD, CcwCodebookVariable.DAW_PROD_SLCTN_CD, claimGroup.getDispenseAsWrittenProductSelectionCode());
    // DAW_PROD_SLCTN_CD => ExplanationOfBenefit.supportingInfo.code
    if (claimGroup.getDispensingStatusCode().isPresent()) {
        TransformerUtilsV2.addInformationWithCode(eob, CcwCodebookVariable.DSPNSNG_STUS_CD, CcwCodebookVariable.DSPNSNG_STUS_CD, claimGroup.getDispensingStatusCode());
    }
    // DRUG_CVRG_STUS_CD => ExplanationOfBenefit.supportingInfo.code
    TransformerUtilsV2.addInformationWithCode(eob, CcwCodebookVariable.DRUG_CVRG_STUS_CD, CcwCodebookVariable.DRUG_CVRG_STUS_CD, claimGroup.getDrugCoverageStatusCode());
    // ADJSTMT_DLTN_CD => => ExplanationOfBenefit.supportingInfo.code
    if (claimGroup.getAdjustmentDeletionCode().isPresent()) {
        TransformerUtilsV2.addInformationWithCode(eob, CcwCodebookVariable.ADJSTMT_DLTN_CD, CcwCodebookVariable.ADJSTMT_DLTN_CD, claimGroup.getAdjustmentDeletionCode());
    }
    // NSTD_FRMT_CD => ExplanationOfBenefit.supportingInfo.code
    if (claimGroup.getNonstandardFormatCode().isPresent()) {
        TransformerUtilsV2.addInformationWithCode(eob, CcwCodebookVariable.NSTD_FRMT_CD, CcwCodebookVariable.NSTD_FRMT_CD, claimGroup.getNonstandardFormatCode());
    }
    // PRCNG_EXCPTN_CD => ExplanationOfBenefit.supportingInfo.code
    if (claimGroup.getPricingExceptionCode().isPresent()) {
        TransformerUtilsV2.addInformationWithCode(eob, CcwCodebookVariable.PRCNG_EXCPTN_CD, CcwCodebookVariable.PRCNG_EXCPTN_CD, claimGroup.getPricingExceptionCode());
    }
    // CTSTRPHC_CVRG_CD => ExplanationOfBenefit.supportingInfo.code
    if (claimGroup.getCatastrophicCoverageCode().isPresent()) {
        TransformerUtilsV2.addInformationWithCode(eob, CcwCodebookVariable.CTSTRPHC_CVRG_CD, CcwCodebookVariable.CTSTRPHC_CVRG_CD, claimGroup.getCatastrophicCoverageCode());
    }
    // RX_ORGN_CD => ExplanationOfBenefit.supportingInfo:rxorigincode
    TransformerUtilsV2.addInformationSliceWithCode(eob, C4BBSupportingInfoType.RX_ORIGIN_CODE, CcwCodebookVariable.RX_ORGN_CD, CcwCodebookVariable.RX_ORGN_CD, claimGroup.getPrescriptionOriginationCode());
    // BRND_GNRC_CD => ExplanationOfBenefit.supportingInfo:brandgenericcode
    TransformerUtilsV2.addInformationSliceWithCode(eob, C4BBSupportingInfoType.BRAND_GENERIC_CODE, CcwCodebookVariable.BRND_GNRC_CD, CcwCodebookVariable.BRND_GNRC_CD, claimGroup.getBrandGenericCode());
    // PHRMCY_SRVC_TYPE_CD => ExplanationOfBenefit.facility.extension
    eob.getFacility().addExtension(TransformerUtilsV2.createExtensionCoding(eob, CcwCodebookVariable.PHRMCY_SRVC_TYPE_CD, claimGroup.getPharmacyTypeCode()));
    // PTNT_RSDNC_CD => ExplanationOfBenefit.supportingInfo.code
    TransformerUtilsV2.addInformationWithCode(eob, CcwCodebookVariable.PTNT_RSDNC_CD, CcwCodebookVariable.PTNT_RSDNC_CD, claimGroup.getPatientResidenceCode());
    // SUBMSN_CLR_CD => ExplanationOfBenefit.supportingInfo.code
    if (claimGroup.getSubmissionClarificationCode().isPresent()) {
        TransformerUtilsV2.addInformationWithCode(eob, CcwCodebookVariable.SUBMSN_CLR_CD, CcwCodebookVariable.SUBMSN_CLR_CD, claimGroup.getSubmissionClarificationCode());
    }
    // Last Updated => ExplanationOfBenefit.meta.lastUpdated
    TransformerUtilsV2.setLastUpdated(eob, claimGroup.getLastUpdated());
    return eob;
}