use of org.hl7.fhir.dstu3.model.Coverage in project beneficiary-fhir-data by CMSgov.
the class CarrierClaimTransformerV2 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();
// Required values not directly mapped
eob.getMeta().addProfile(ProfileConstants.C4BB_EOB_NONCLINICIAN_PROFILE_URL);
// TODO: ExplanationOfBenefit.outcome is a required field. Needs to be mapped.
// eob.setOutcome(?)
// 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
// (reference)
// 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.CARRIER, claimGroup.getClaimGroupId().toPlainString(), MedicareSegment.PART_B, 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.CARRIER, Optional.of(claimGroup.getNearLineRecordIdCode()), Optional.of(claimGroup.getClaimTypeCode()));
// CARR_CLM_PRMRY_PYR_PD_AMT => ExplanationOfBenefit.total.amount
TransformerUtilsV2.addTotal(eob, TransformerUtilsV2.createTotalAdjudicationAmountSlice(eob, CcwCodebookVariable.CLM_TOT_CHRG_AMT, C4BBAdjudication.PRIOR_PAYER_PAID, claimGroup.getPrimaryPayerPaidAmount()));
// Common group level fields between Carrier and DME
// BENE_ID =>
// CARR_NUM => ExplanationOfBenefit.extension
// CLM_CLNCL_TRIL_NUM => ExplanationOfBenefit.extension
// CARR_CLM_CASH_DDCTBL_APLD_AMT => ExplanationOfBenefit.benefitBalance.financial
// CARR_CLM_PMT_DNL_CD => ExplanationOfBenefit.extension
// RFR_PHYSN_NPI => ExplanationOfBenefit.referral.identifier
// => ExplanationOfBenefit.careteam.provider
// RFR_PHYSN_UPIN => ExplanationOfBenefit.referral.identifier
// => ExplanationOfBenefit.careteam.provider
// CARR_CLM_PRVDR_ASGNMT_IND_SW => ExplanationOfBenefit.extension
// NCH_CLM_PRVDR_PMT_AMT => ExplanationOfBenefit.benefitBalance.financial
// NCH_CLM_BENE_PMT_AMT => ExplanationOfBenefit.benefitBalance.financial
// NCH_CARR_CLM_SBMTD_CHRG_AMT => ExplanationOfBenefit.benefitBalance.financial
// NCH_CARR_CLM_ALOWD_AMT => ExplanationOfBenefit.benefitBalance.financial
// CLM_DISP_CD => ExplanationOfBenefit.disposition
// CARR_CLM_CNTL_NUM => ExplanationOfBenefit.extension
TransformerUtilsV2.mapEobCommonGroupCarrierDME(eob, claimGroup.getBeneficiaryId(), claimGroup.getCarrierNumber(), claimGroup.getClinicalTrialNumber(), claimGroup.getBeneficiaryPartBDeductAmount(), claimGroup.getPaymentDenialCode(), claimGroup.getReferringPhysicianNpi(), claimGroup.getReferringPhysicianUpin(), claimGroup.getProviderAssignmentIndicator(), claimGroup.getProviderPaymentAmount(), claimGroup.getBeneficiaryPaymentAmount(), claimGroup.getSubmittedChargeAmount(), claimGroup.getAllowedChargeAmount(), claimGroup.getClaimDispositionCode(), claimGroup.getClaimCarrierControlNumber());
// ICD_DGNS_VRSN_CD(1-12) => diagnosis.diagnosisCodeableConcept
for (Diagnosis diagnosis : DiagnosisUtilV2.extractDiagnoses(claimGroup)) {
DiagnosisUtilV2.addDiagnosisCode(eob, diagnosis, ClaimTypeV2.CARRIER);
}
// CARR_CLM_RFRNG_PIN_NUM => ExplanationOfBenefit.careteam.provider
TransformerUtilsV2.addCareTeamMember(eob, C4BBPractitionerIdentifierType.NPI, C4BBClaimProfessionalAndNonClinicianCareTeamRole.REFERRING, Optional.ofNullable(claimGroup.getReferringProviderIdNumber()));
// CARR_CLM_ENTRY_CD => ExplanationOfBenefit.extension
eob.addExtension(TransformerUtilsV2.createExtensionCoding(eob, CcwCodebookVariable.CARR_CLM_ENTRY_CD, claimGroup.getClaimEntryCode()));
// Process line items
for (CarrierClaimLine line : claimGroup.getLines()) {
ItemComponent item = eob.addItem();
// LINE_NUM => ExplanationOfBenefit.item.sequence
item.setSequence(line.getLineNumber().intValue());
// PRF_PHYSN_NPI => ExplanationOfBenefit.careTeam.provider
Optional<CareTeamComponent> performing = TransformerUtilsV2.addCareTeamMember(eob, item, C4BBPractitionerIdentifierType.NPI, C4BBClaimProfessionalAndNonClinicianCareTeamRole.PERFORMING, line.getPerformingPhysicianNpi());
// Fall back to UPIN if NPI not present
if (!line.getPerformingPhysicianNpi().isPresent()) {
performing = TransformerUtilsV2.addCareTeamMember(eob, item, C4BBPractitionerIdentifierType.UPIN, C4BBClaimProfessionalAndNonClinicianCareTeamRole.PERFORMING, line.getPerformingPhysicianUpin());
}
// Update the responsible flag
performing.ifPresent(p -> {
p.setResponsible(true);
// PRVDR_SPCLTY => ExplanationOfBenefit.careTeam.qualification
p.setQualification(TransformerUtilsV2.createCodeableConcept(eob, CcwCodebookVariable.PRVDR_SPCLTY, line.getProviderSpecialityCode()));
// CARR_LINE_PRVDR_TYPE_CD => ExplanationOfBenefit.careTeam.extension
p.addExtension(TransformerUtilsV2.createExtensionCoding(eob, CcwCodebookVariable.CARR_LINE_PRVDR_TYPE_CD, line.getProviderTypeCode()));
// PRTCPTNG_IND_CD => ExplanationOfBenefit.careTeam.extension
p.addExtension(TransformerUtilsV2.createExtensionCoding(eob, CcwCodebookVariable.PRTCPTNG_IND_CD, line.getProviderParticipatingIndCode()));
});
// ORG_NPI_NUM => ExplanationOfBenefit.careTeam.provider
TransformerUtilsV2.addCareTeamMember(eob, item, C4BBPractitionerIdentifierType.NPI, C4BBClaimProfessionalAndNonClinicianCareTeamRole.PRIMARY, line.getOrganizationNpi());
// CARR_LINE_RDCD_PMT_PHYS_ASTN_C => ExplanationOfBenefit.item.adjudication
TransformerUtilsV2.addAdjudication(item, TransformerUtilsV2.createAdjudicationDenialReasonSlice(eob, CcwCodebookVariable.CARR_LINE_RDCD_PMT_PHYS_ASTN_C, String.valueOf(line.getReducedPaymentPhysicianAsstCode())));
// HCPCS_CD => ExplanationOfBenefit.item.productOrService
// HCPCS_1ST_MDFR_CD => ExplanationOfBenefit.item.modifier
// HCPCS_2ND_MDFR_CD => ExplanationOfBenefit.item.modifier
// CARR_CLM_HCPCS_YR_CD => ExplanationOfBenefit.item.modifier.version
TransformerUtilsV2.mapHcpcs(eob, item, line.getHcpcsCode(), claimGroup.getHcpcsYearCode(), Arrays.asList(line.getHcpcsInitialModifierCode(), line.getHcpcsSecondModifierCode()));
// tax num should be as a extension
if (includeTaxNumbers.orElse(false)) {
item.addExtension(TransformerUtilsV2.createExtensionCoding(eob, CcwCodebookVariable.TAX_NUM, line.getProviderTaxNumber()));
}
// CARR_LINE_ANSTHSA_UNIT_CNT => ExplanationOfBenefit.item.extension
if (line.getAnesthesiaUnitCount().compareTo(BigDecimal.ZERO) > 0) {
item.addExtension(TransformerUtilsV2.createExtensionQuantity(CcwCodebookVariable.CARR_LINE_ANSTHSA_UNIT_CNT, line.getAnesthesiaUnitCount()));
}
// CARR_LINE_MTUS_CNT => ExplanationOfBenefit.item.extension
if (!line.getMtusCount().equals(BigDecimal.ZERO)) {
item.addExtension(TransformerUtilsV2.createExtensionQuantity(CcwCodebookVariable.CARR_LINE_MTUS_CNT, line.getMtusCount()));
}
// CARR_LINE_MTUS_CD => ExplanationOfBenefit.item.extension
line.getMtusCode().ifPresent(code -> item.addExtension(TransformerUtilsV2.createExtensionCoding(eob, CcwCodebookVariable.CARR_LINE_MTUS_CNT, code)));
// Common item level fields between Carrier and DME
// LINE_SRVC_CNT => ExplanationOfBenefit.item.quantity
// LINE_CMS_TYPE_SRVC_CD => ExplanationOfBenefit.item.category
// LINE_PLACE_OF_SRVC_CD => ExplanationOfBenefit.item.location
// BETOS_CD => ExplanationOfBenefit.item.extension
// LINE_1ST_EXPNS_DT => ExplanationOfBenefit.item.servicedPeriod
// LINE_LAST_EXPNS_DT => ExplanationOfBenefit.item.servicedPeriod
// LINE_NCH_PMT_AMT => ExplanationOfBenefit.item.adjudication
// LINE_PMT_80_100_CD => ExplanationOfBenefit.item.adjudication.extension
// PAID_TO_PATIENT => ExplanationOfBenefit.item.adjudication
// LINE_PRVDR_PMT_AMT => ExplanationOfBenefit.item.adjudication
// LINE_BENE_PTB_DDCTBL_AMT => ExplanationOfBenefit.item.adjudication
// LINE_BENE_PRMRY_PYR_CD => ExplanationOfBenefit.item.extension
// LINE_BENE_PRMRY_PYR_PD_AMT => ExplanationOfBenefit.item.adjudication
// LINE_COINSRNC_AMT => ExplanationOfBenefit.item.adjudication
// LINE_SBMTD_CHRG_AMT => ExplanationOfBenefit.item.adjudication
// LINE_ALOWD_CHRG_AMT => ExplanationOfBenefit.item.adjudication
// LINE_BENE_PRMRY_PYR_CD => ExplanationOfBenefit.item.extension
// LINE_SERVICE_DEDUCTIBLE => ExplanationOfBenefit.item.extension
// LINE_HCT_HGB_TYPE_CD => Observation.code
// LINE_HCT_HGB_RSLT_NUM => Observation.value
// LINE_NDC_CD => ExplanationOfBenefit.item.productOrService
TransformerUtilsV2.mapEobCommonItemCarrierDME(item, eob, claimGroup.getClaimId(), item.getSequence(), line.getServiceCount(), line.getPlaceOfServiceCode(), line.getFirstExpenseDate(), line.getLastExpenseDate(), line.getBeneficiaryPaymentAmount(), line.getProviderPaymentAmount(), line.getBeneficiaryPartBDeductAmount(), line.getPrimaryPayerCode(), line.getPrimaryPayerPaidAmount(), line.getBetosCode(), line.getPaymentAmount(), line.getPaymentCode(), line.getCoinsuranceAmount(), line.getSubmittedChargeAmount(), line.getAllowedChargeAmount(), line.getProcessingIndicatorCode(), line.getServiceDeductibleCode(), line.getHctHgbTestTypeCode(), line.getHctHgbTestResult(), line.getCmsServiceTypeCode(), line.getNationalDrugCode());
// LINE_ICD_DGNS_CD => ExplanationOfBenefit.item.diagnosisSequence
// LINE_ICD_DGNS_VRSN_CD => ExplanationOfBenefit.item.diagnosisSequence
DiagnosisUtilV2.addDiagnosisLink(eob, item, Diagnosis.from(line.getDiagnosisCode(), line.getDiagnosisCodeVersion(), DiagnosisLabel.OTHER), ClaimTypeV2.CARRIER);
// PRVDR_STATE_CD => ExplanationOfBenefit.item.location.extension
line.getProviderStateCode().ifPresent(code -> item.getLocation().addExtension(TransformerUtilsV2.createExtensionCoding(eob, CcwCodebookVariable.PRVDR_STATE_CD, code)));
// PRVDR_ZIP => ExplanationOfBenefit.item.location.extension
line.getProviderZipCode().ifPresent(code -> item.getLocation().addExtension(TransformerUtilsV2.createExtensionCoding(eob, CcwCodebookVariable.PRVDR_ZIP, code)));
// CARR_LINE_PRCNG_LCLTY_CD => ExplanationOfBenefit.item.location.extension
item.getLocation().addExtension(TransformerUtilsV2.createExtensionCoding(eob, CcwCodebookVariable.CARR_LINE_PRCNG_LCLTY_CD, line.getLinePricingLocalityCode()));
// CARR_LINE_CLIA_LAB_NUM => ExplanationOfBenefit.item.location.extension
line.getCliaLabNumber().ifPresent(num -> item.getLocation().addExtension(TransformerUtilsV2.createExtensionIdentifier(CcwCodebookVariable.CARR_LINE_CLIA_LAB_NUM, num)));
}
TransformerUtilsV2.setLastUpdated(eob, claimGroup.getLastUpdated());
return eob;
}
use of org.hl7.fhir.dstu3.model.Coverage in project beneficiary-fhir-data by CMSgov.
the class CoverageResourceProviderIT method readCoveragesForExistingBeneficiary.
/**
* Verifies that {@link
* gov.cms.bfd.server.war.stu3.providers.CoverageResourceProvider#read(org.hl7.fhir.dstu3.model.IdType)}
* works as expected for {@link Beneficiary}-derived {@link Coverage}s that do exist in the DB.
*
* @throws FHIRException (indicates test failure)
*/
@Test
public void readCoveragesForExistingBeneficiary() throws FHIRException {
List<Object> loadedRecords = ServerTestUtils.get().loadData(Arrays.asList(StaticRifResourceGroup.SAMPLE_A.getResources()));
IGenericClient fhirClient = ServerTestUtils.get().createFhirClient();
Beneficiary beneficiary = loadedRecords.stream().filter(r -> r instanceof Beneficiary).map(r -> (Beneficiary) r).findFirst().get();
Coverage partACoverage = fhirClient.read().resource(Coverage.class).withId(TransformerUtils.buildCoverageId(MedicareSegment.PART_A, beneficiary)).execute();
CoverageTransformerTest.assertPartAMatches(beneficiary, partACoverage);
Coverage partBCoverage = fhirClient.read().resource(Coverage.class).withId(TransformerUtils.buildCoverageId(MedicareSegment.PART_B, beneficiary)).execute();
CoverageTransformerTest.assertPartBMatches(beneficiary, partBCoverage);
Coverage partDCoverage = fhirClient.read().resource(Coverage.class).withId(TransformerUtils.buildCoverageId(MedicareSegment.PART_D, beneficiary)).execute();
CoverageTransformerTest.assertPartDMatches(beneficiary, partDCoverage);
}
use of org.hl7.fhir.dstu3.model.Coverage in project beneficiary-fhir-data by CMSgov.
the class CoverageResourceProviderIT method searchByExistingBeneficiaryWithPaging.
/**
* Verifies that {@link
* gov.cms.bfd.server.war.stu3.providers.CoverageResourceProvider#searchByBeneficiary(ca.uhn.fhir.rest.param.ReferenceParam)}
* works as expected for a {@link Beneficiary} that does exist in the DB, with paging.
*
* @throws FHIRException (indicates test failure)
*/
@Test
public void searchByExistingBeneficiaryWithPaging() throws FHIRException {
List<Object> loadedRecords = ServerTestUtils.get().loadData(Arrays.asList(StaticRifResourceGroup.SAMPLE_A.getResources()));
IGenericClient fhirClient = ServerTestUtils.get().createFhirClient();
Beneficiary beneficiary = loadedRecords.stream().filter(r -> r instanceof Beneficiary).map(r -> (Beneficiary) r).findFirst().get();
Bundle searchResults = fhirClient.search().forResource(Coverage.class).where(Coverage.BENEFICIARY.hasId(TransformerUtils.buildPatientId(beneficiary))).count(4).returnBundle(Bundle.class).execute();
assertNotNull(searchResults);
assertEquals(MedicareSegment.values().length, searchResults.getTotal());
/*
* Verify that only the first and last paging links exist, since there should
* only be one page.
*/
assertNotNull(searchResults.getLink(Constants.LINK_FIRST));
assertNull(searchResults.getLink(Constants.LINK_NEXT));
assertNull(searchResults.getLink(Constants.LINK_PREVIOUS));
assertNotNull(searchResults.getLink(Constants.LINK_LAST));
/*
* Verify that each of the expected Coverages (one for every MedicareSegment) is
* present and looks correct.
*/
Coverage partACoverageFromSearchResult = searchResults.getEntry().stream().filter(e -> e.getResource() instanceof Coverage).map(e -> (Coverage) e.getResource()).filter(c -> TransformerConstants.COVERAGE_PLAN_PART_A.equals(c.getGrouping().getSubPlan())).findFirst().get();
CoverageTransformerTest.assertPartAMatches(beneficiary, partACoverageFromSearchResult);
Coverage partBCoverageFromSearchResult = searchResults.getEntry().stream().filter(e -> e.getResource() instanceof Coverage).map(e -> (Coverage) e.getResource()).filter(c -> TransformerConstants.COVERAGE_PLAN_PART_B.equals(c.getGrouping().getSubPlan())).findFirst().get();
CoverageTransformerTest.assertPartBMatches(beneficiary, partBCoverageFromSearchResult);
Coverage partDCoverageFromSearchResult = searchResults.getEntry().stream().filter(e -> e.getResource() instanceof Coverage).map(e -> (Coverage) e.getResource()).filter(c -> TransformerConstants.COVERAGE_PLAN_PART_D.equals(c.getGrouping().getSubPlan())).findFirst().get();
CoverageTransformerTest.assertPartDMatches(beneficiary, partDCoverageFromSearchResult);
}
use of org.hl7.fhir.dstu3.model.Coverage in project beneficiary-fhir-data by CMSgov.
the class PartDEventTransformerV2Test method shouldHaveDrugCvrgStusCdSupInfo.
@Test
public void shouldHaveDrugCvrgStusCdSupInfo() {
SupportingInformationComponent sic = TransformerTestUtilsV2.findSupportingInfoByCode("https://bluebutton.cms.gov/resources/variables/drug_cvrg_stus_cd", eob.getSupportingInfo());
SupportingInformationComponent compare = TransformerTestUtilsV2.createSupportingInfo(// We don't care what the sequence number is here
sic.getSequence(), // Category
Arrays.asList(new Coding("http://terminology.hl7.org/CodeSystem/claiminformationcategory", "info", "Information"), new Coding("https://bluebutton.cms.gov/resources/codesystem/information", "https://bluebutton.cms.gov/resources/variables/drug_cvrg_stus_cd", "Drug Coverage Status Code")), // Code
new Coding("https://bluebutton.cms.gov/resources/variables/drug_cvrg_stus_cd", "C", "Covered"));
assertTrue(compare.equalsDeep(sic));
}
use of org.hl7.fhir.dstu3.model.Coverage in project beneficiary-fhir-data by CMSgov.
the class R4CoverageResourceProviderIT method searchByExistingBeneficiaryWithPaging.
/**
* Verifies that {@link
* gov.cms.bfd.server.war.stu3.providers.CoverageResourceProvider#searchByBeneficiary(ca.uhn.fhir.rest.param.ReferenceParam)}
* works as expected for a {@link Beneficiary} that does exist in the DB, with paging.
*
* @throws FHIRException (indicates test failure)
*/
@Test
public void searchByExistingBeneficiaryWithPaging() throws FHIRException {
List<Object> loadedRecords = ServerTestUtils.get().loadData(Arrays.asList(StaticRifResourceGroup.SAMPLE_A.getResources()));
IGenericClient fhirClient = ServerTestUtils.get().createFhirClientV2();
Beneficiary beneficiary = loadedRecords.stream().filter(r -> r instanceof Beneficiary).map(r -> (Beneficiary) r).findFirst().get();
Bundle searchResults = fhirClient.search().forResource(Coverage.class).where(Coverage.BENEFICIARY.hasId(TransformerUtilsV2.buildPatientId(beneficiary))).count(4).returnBundle(Bundle.class).execute();
assertNotNull(searchResults);
assertEquals(MedicareSegment.values().length, searchResults.getTotal());
/*
* Verify that only the first and last paging links exist, since there should
* only be one page.
*/
assertNotNull(searchResults.getLink(Constants.LINK_FIRST));
assertNull(searchResults.getLink(Constants.LINK_NEXT));
assertNull(searchResults.getLink(Constants.LINK_PREVIOUS));
assertNotNull(searchResults.getLink(Constants.LINK_LAST));
/*
* Verify that each of the expected Coverages (one for every MedicareSegment) is
* present and looks correct.
*/
Coverage partACoverageFromSearchResult = searchResults.getEntry().stream().filter(e -> e.getResource() instanceof Coverage).map(e -> (Coverage) e.getResource()).filter(c -> c.getClass_().stream().filter(cl -> TransformerConstants.COVERAGE_PLAN_PART_A.equals(cl.getValue())).findAny().isPresent()).findFirst().get();
CoverageTransformerV2Test.assertPartAMatches(beneficiary, partACoverageFromSearchResult);
Coverage partBCoverageFromSearchResult = searchResults.getEntry().stream().filter(e -> e.getResource() instanceof Coverage).map(e -> (Coverage) e.getResource()).filter(c -> c.getClass_().stream().filter(cl -> TransformerConstants.COVERAGE_PLAN_PART_B.equals(cl.getValue())).findAny().isPresent()).findFirst().get();
CoverageTransformerV2Test.assertPartBMatches(beneficiary, partBCoverageFromSearchResult);
Coverage partDCoverageFromSearchResult = searchResults.getEntry().stream().filter(e -> e.getResource() instanceof Coverage).map(e -> (Coverage) e.getResource()).filter(c -> c.getClass_().stream().filter(cl -> TransformerConstants.COVERAGE_PLAN_PART_D.equals(cl.getValue())).findAny().isPresent()).findFirst().get();
CoverageTransformerV2Test.assertPartDMatches(beneficiary, partDCoverageFromSearchResult);
}
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