Examples with SupportingInformationComponent org.hl7.fhir.r4.model.Claim.SupportingInformationComponent used on opensource projects

Example 76 with SupportingInformationComponent

use of org.hl7.fhir.r4.model.Claim.SupportingInformationComponent in project beneficiary-fhir-data by CMSgov.

the class InpatientClaimTransformerV2Test method shouldHaveClmDrgCdInfo.

@Test
public void shouldHaveClmDrgCdInfo() {
    SupportingInformationComponent sic = TransformerTestUtilsV2.findSupportingInfoByCode("https://bluebutton.cms.gov/resources/variables/clm_drg_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/clm_drg_cd", "Claim Diagnosis Related Group Code (or MS-DRG Code)")), // Code
    new Coding("https://bluebutton.cms.gov/resources/variables/clm_drg_cd", "695", null));
    assertTrue(compare.equalsDeep(sic));
}

Example 77 with SupportingInformationComponent

use of org.hl7.fhir.r4.model.Claim.SupportingInformationComponent in project beneficiary-fhir-data by CMSgov.

the class InpatientClaimTransformerV2Test method shouldHaveNchPrmryPyrCdSupInfo.

@Test
public void shouldHaveNchPrmryPyrCdSupInfo() {
    SupportingInformationComponent sic = TransformerTestUtilsV2.findSupportingInfoByCode("https://bluebutton.cms.gov/resources/variables/nch_prmry_pyr_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/nch_prmry_pyr_cd", "NCH Primary Payer Code (if not Medicare)")), // Code
    new Coding("https://bluebutton.cms.gov/resources/variables/nch_prmry_pyr_cd", "A", "Employer group health plan (EGHP) insurance for an aged beneficiary"));
    assertTrue(compare.equalsDeep(sic));
}

Example 78 with SupportingInformationComponent

use of org.hl7.fhir.r4.model.Claim.SupportingInformationComponent in project beneficiary-fhir-data by CMSgov.

the class OutpatientClaimTransformerV2Test method shouldHaveTypeOfBillSupInfo.

@Test
public void shouldHaveTypeOfBillSupInfo() {
    SupportingInformationComponent sic = TransformerTestUtilsV2.findSupportingInfoByCode("typeofbill", eob.getSupportingInfo());
    SupportingInformationComponent compare = TransformerTestUtilsV2.createSupportingInfo(// We don't care what the sequence number is here
    sic.getSequence(), // Category
    Arrays.asList(new Coding("http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType", "typeofbill", "Type of Bill")), // Code
    new Coding("https://bluebutton.cms.gov/resources/variables/clm_freq_cd", "1", "Admit thru discharge claim"));
    assertTrue(compare.equalsDeep(sic));
}

Example 79 with SupportingInformationComponent

use of org.hl7.fhir.r4.model.Claim.SupportingInformationComponent in project beneficiary-fhir-data by CMSgov.

the class TransformerTestUtils method assertCommonGroupInpatientSNF.

/**
 * Tests field values of an eob's benefit balance component that are common between the Inpatient
 * and SNF claim types.
 *
 * @param eob the {@link ExplanationOfBenefit} that will be tested by this method
 * @param coinsuranceDayCount BENE_TOT_COINSRNC_DAYS_CNT: a {@link BigDecimal} shared field
 *     representing the coinsurance day count for the claim
 * @param nonUtilizationDayCount CLM_NON_UTLZTN_DAYS_CNT: a {@link BigDecimal} shared field
 *     representing the non-utilization day count for the claim
 * @param deductibleAmount NCH_BENE_IP_DDCTBL_AMT: a {@link BigDecimal} shared field representing
 *     the deductible amount for the claim
 * @param partACoinsuranceLiabilityAmount NCH_BENE_PTA_COINSRNC_LBLTY_AM: a {@link BigDecimal}
 *     shared field representing the part A coinsurance amount for the claim
 * @param bloodPintsFurnishedQty NCH_BLOOD_PNTS_FRNSHD_QTY: a {@link BigDecimal} shared field
 *     representing the blood pints furnished quantity for the claim
 * @param noncoveredCharge NCH_IP_NCVRD_CHRG_AMT: a {@link BigDecimal} shared field representing
 *     the non-covered charge for the claim
 * @param totalDeductionAmount NCH_IP_TOT_DDCTN_AMT: a {@link BigDecimal} shared field
 *     representing the total deduction amount for the claim
 * @param claimPPSCapitalDisproportionateShareAmt CLM_PPS_CPTL_DSPRPRTNT_SHR_AMT: an {@link
 *     Optional}<{@link BigDecimal}> shared field representing the claim PPS capital
 *     disproportionate share amount for the claim
 * @param claimPPSCapitalExceptionAmount CLM_PPS_CPTL_EXCPTN_AMT: an {@link Optional}<{@link
 *     BigDecimal}> shared field representing the claim PPS capital exception amount for the
 *     claim
 * @param claimPPSCapitalFSPAmount CLM_PPS_CPTL_FSP_AMT: an {@link Optional}<{@link
 *     BigDecimal}> shared field representing the claim PPS capital FSP amount for the claim
 * @param claimPPSCapitalIMEAmount CLM_PPS_CPTL_IME_AMT: an {@link Optional}<{@link
 *     BigDecimal}> shared field representing the claim PPS capital IME amount for the claim
 * @param claimPPSCapitalOutlierAmount CLM_PPS_CPTL_OUTLIER_AMT: an {@link Optional}<{@link
 *     BigDecimal}> shared field representing the claim PPS capital outlier amount for the
 *     claim
 * @param claimPPSOldCapitalHoldHarmlessAmount CLM_PPS_OLD_CPTL_HLD_HRMLS_AMT: an {@link
 *     Optional}<{@link BigDecimal}> shared field representing the claim PPS old capital
 *     hold harmless amount for the claim
 * @throws FHIRException Indicates a test failure.
 */
static void assertCommonGroupInpatientSNF(ExplanationOfBenefit eob, BigDecimal coinsuranceDayCount, BigDecimal nonUtilizationDayCount, BigDecimal deductibleAmount, BigDecimal partACoinsuranceLiabilityAmount, BigDecimal bloodPintsFurnishedQty, BigDecimal noncoveredCharge, BigDecimal totalDeductionAmount, Optional<BigDecimal> claimPPSCapitalDisproportionateShareAmt, Optional<BigDecimal> claimPPSCapitalExceptionAmount, Optional<BigDecimal> claimPPSCapitalFSPAmount, Optional<BigDecimal> claimPPSCapitalIMEAmount, Optional<BigDecimal> claimPPSCapitalOutlierAmount, Optional<BigDecimal> claimPPSOldCapitalHoldHarmlessAmount) throws FHIRException {
    BenefitComponent benefit_BENE_TOT_COINSRNC_DAYS_CNT = assertHasBenefitComponent(CcwCodebookVariable.BENE_TOT_COINSRNC_DAYS_CNT, eob);
    assertEquals(coinsuranceDayCount.intValue(), benefit_BENE_TOT_COINSRNC_DAYS_CNT.getUsedUnsignedIntType().getValue().intValue());
    BenefitComponent benefit_CLM_NON_UTLZTN_DAYS_CNT = assertHasBenefitComponent(CcwCodebookVariable.CLM_NON_UTLZTN_DAYS_CNT, eob);
    assertEquals(nonUtilizationDayCount.intValue(), benefit_CLM_NON_UTLZTN_DAYS_CNT.getUsedUnsignedIntType().getValue().intValue());
    TransformerTestUtils.assertAdjudicationTotalAmountEquals(CcwCodebookVariable.NCH_BENE_IP_DDCTBL_AMT, deductibleAmount, eob);
    TransformerTestUtils.assertAdjudicationTotalAmountEquals(CcwCodebookVariable.NCH_BENE_PTA_COINSRNC_LBLTY_AMT, partACoinsuranceLiabilityAmount, eob);
    SupportingInformationComponent nchBloodPntsFrnshdQtyInfo = TransformerTestUtils.assertHasInfo(CcwCodebookVariable.NCH_BLOOD_PNTS_FRNSHD_QTY, eob);
    assertEquals(bloodPintsFurnishedQty.intValueExact(), nchBloodPntsFrnshdQtyInfo.getValueQuantity().getValue().intValueExact());
    TransformerTestUtils.assertAdjudicationTotalAmountEquals(CcwCodebookVariable.NCH_IP_NCVRD_CHRG_AMT, noncoveredCharge, eob);
    TransformerTestUtils.assertAdjudicationTotalAmountEquals(CcwCodebookVariable.NCH_IP_TOT_DDCTN_AMT, totalDeductionAmount, eob);
    if (claimPPSCapitalDisproportionateShareAmt.isPresent()) {
        TransformerTestUtils.assertAdjudicationTotalAmountEquals(CcwCodebookVariable.CLM_PPS_CPTL_DSPRPRTNT_SHR_AMT, claimPPSCapitalDisproportionateShareAmt, eob);
    }
    if (claimPPSCapitalExceptionAmount.isPresent()) {
        TransformerTestUtils.assertAdjudicationTotalAmountEquals(CcwCodebookVariable.CLM_PPS_CPTL_EXCPTN_AMT, claimPPSCapitalExceptionAmount, eob);
    }
    if (claimPPSCapitalFSPAmount.isPresent()) {
        TransformerTestUtils.assertAdjudicationTotalAmountEquals(CcwCodebookVariable.CLM_PPS_CPTL_FSP_AMT, claimPPSCapitalFSPAmount, eob);
    }
    if (claimPPSCapitalIMEAmount.isPresent()) {
        TransformerTestUtils.assertAdjudicationTotalAmountEquals(CcwCodebookVariable.CLM_PPS_CPTL_IME_AMT, claimPPSCapitalIMEAmount, eob);
    }
    if (claimPPSCapitalOutlierAmount.isPresent()) {
        TransformerTestUtils.assertAdjudicationTotalAmountEquals(CcwCodebookVariable.CLM_PPS_CPTL_OUTLIER_AMT, claimPPSCapitalOutlierAmount, eob);
    }
    if (claimPPSOldCapitalHoldHarmlessAmount.isPresent()) {
        TransformerTestUtils.assertAdjudicationTotalAmountEquals(CcwCodebookVariable.CLM_PPS_OLD_CPTL_HLD_HRMLS_AMT, claimPPSOldCapitalHoldHarmlessAmount, eob);
    }
}

Example 80 with SupportingInformationComponent

use of org.hl7.fhir.r4.model.Claim.SupportingInformationComponent in project beneficiary-fhir-data by CMSgov.

the class SNFClaimTransformerTest method assertMatches.

/**
 * Verifies that the {@link ExplanationOfBenefit} "looks like" it should, if it were produced from
 * the specified {@link SNFClaim}.
 *
 * @param claim the {@link SNFClaim} that the {@link ExplanationOfBenefit} was generated from
 * @param eob the {@link ExplanationOfBenefit} that was generated from the specified {@link
 *     SNFClaim}
 * @throws FHIRException (indicates test failure)
 */
static void assertMatches(SNFClaim claim, ExplanationOfBenefit eob) throws FHIRException {
    // Test to ensure group level fields between all claim types match
    TransformerTestUtils.assertEobCommonClaimHeaderData(eob, claim.getClaimId(), claim.getBeneficiaryId(), ClaimType.SNF, claim.getClaimGroupId().toPlainString(), MedicareSegment.PART_A, Optional.of(claim.getDateFrom()), Optional.of(claim.getDateThrough()), Optional.of(claim.getPaymentAmount()), claim.getFinalAction());
    // test the common field provider number is set as expected in the EOB
    TransformerTestUtils.assertProviderNumber(eob, claim.getProviderNumber());
    // test common benefit components between SNF and Inpatient claims are set as expected
    TransformerTestUtils.assertCommonGroupInpatientSNF(eob, claim.getCoinsuranceDayCount(), claim.getNonUtilizationDayCount(), claim.getDeductibleAmount(), claim.getPartACoinsuranceLiabilityAmount(), claim.getBloodPintsFurnishedQty(), claim.getNoncoveredCharge(), claim.getTotalDeductionAmount(), claim.getClaimPPSCapitalDisproportionateShareAmt(), claim.getClaimPPSCapitalExceptionAmount(), claim.getClaimPPSCapitalFSPAmount(), claim.getClaimPPSCapitalIMEAmount(), claim.getClaimPPSCapitalOutlierAmount(), claim.getClaimPPSOldCapitalHoldHarmlessAmount());
    if (claim.getQualifiedStayFromDate().isPresent() || claim.getQualifiedStayThroughDate().isPresent()) {
        SupportingInformationComponent nchQlyfdStayInfo = TransformerTestUtils.assertHasInfo(CcwCodebookVariable.NCH_QLFYD_STAY_FROM_DT, eob);
        TransformerTestUtils.assertPeriodEquals(claim.getQualifiedStayFromDate(), claim.getQualifiedStayThroughDate(), (Period) nchQlyfdStayInfo.getTiming());
    }
    // test common eob information between SNF and Inpatient claims are set as expected
    TransformerTestUtils.assertCommonEobInformationInpatientSNF(eob, claim.getNoncoveredStayFromDate(), claim.getNoncoveredStayThroughDate(), claim.getCoveredCareThroughDate(), claim.getMedicareBenefitsExhaustedDate(), claim.getDiagnosisRelatedGroupCd());
    TransformerTestUtils.assertDateEquals(claim.getClaimAdmissionDate().get(), eob.getHospitalization().getStartElement());
    TransformerTestUtils.assertDateEquals(claim.getBeneficiaryDischargeDate().get(), eob.getHospitalization().getEndElement());
    // test common eob information between Inpatient, HHA, Hospice and SNF claims are set as
    // expected
    TransformerTestUtils.assertEobCommonGroupInpHHAHospiceSNFEquals(eob, claim.getClaimAdmissionDate(), claim.getBeneficiaryDischargeDate(), Optional.of(claim.getUtilizationDayCount()));
    // Test to ensure common group fields between Inpatient, Outpatient and SNF
    TransformerTestUtils.assertEobCommonGroupInpOutSNFEquals(eob, claim.getBloodDeductibleLiabilityAmount(), claim.getOperatingPhysicianNpi(), claim.getOtherPhysicianNpi(), claim.getClaimQueryCode(), claim.getMcoPaidSw());
    // Test to ensure common group fields between Inpatient, Outpatient HHA, Hospice
    // and SNF match
    TransformerTestUtils.assertEobCommonGroupInpOutHHAHospiceSNFEquals(eob, claim.getOrganizationNpi(), claim.getClaimFacilityTypeCode(), claim.getClaimFrequencyCode(), claim.getClaimNonPaymentReasonCode(), claim.getPatientDischargeStatusCode(), claim.getClaimServiceClassificationTypeCode(), claim.getClaimPrimaryPayerCode(), claim.getAttendingPhysicianNpi(), claim.getTotalChargeAmount(), claim.getPrimaryPayerPaidAmount(), claim.getFiscalIntermediaryNumber(), claim.getFiDocumentClaimControlNumber(), claim.getFiOriginalClaimControlNumber());
    assertEquals(6, eob.getDiagnosis().size());
    CCWProcedure ccwProcedure = new CCWProcedure(claim.getProcedure1Code(), claim.getProcedure1CodeVersion(), claim.getProcedure1Date());
    TransformerTestUtils.assertHasCoding(ccwProcedure.getFhirSystem().toString(), claim.getProcedure1Code().get(), eob.getProcedure().get(0).getProcedureCodeableConcept().getCoding());
    assertEquals(TransformerUtils.convertToDate(claim.getProcedure1Date().get()), eob.getProcedure().get(0).getDate());
    assertEquals(1, eob.getItem().size());
    SNFClaimLine claimLine1 = claim.getLines().get(0);
    ItemComponent eobItem0 = eob.getItem().get(0);
    assertEquals(claimLine1.getLineNumber(), new BigDecimal(eobItem0.getSequence()));
    assertEquals(claim.getProviderStateCode(), eobItem0.getLocationAddress().getState());
    TransformerTestUtils.assertHasCoding(CcwCodebookVariable.REV_CNTR, claimLine1.getRevenueCenter(), eobItem0.getRevenue());
    TransformerTestUtils.assertHcpcsCodes(eobItem0, claimLine1.getHcpcsCode(), Optional.empty(), Optional.empty(), Optional.empty(), 0);
    // Test to ensure common group field coinsurance between Inpatient, HHA, Hospice and SNF match
    TransformerTestUtils.assertEobCommonGroupInpHHAHospiceSNFCoinsuranceEquals(eobItem0, claimLine1.getDeductibleCoinsuranceCd());
    String claimControlNumber = "0000000000";
    // Test to ensure item level fields between Inpatient, Outpatient, HHA, Hopsice
    // and SNF match
    TransformerTestUtils.assertEobCommonItemRevenueEquals(eobItem0, eob, claimLine1.getRevenueCenter(), claimLine1.getRateAmount(), claimLine1.getTotalChargeAmount(), claimLine1.getNonCoveredChargeAmount(), BigDecimal.valueOf(claimLine1.getUnitCount()), claimControlNumber, claimLine1.getNationalDrugCodeQuantity(), claimLine1.getNationalDrugCodeQualifierCode(), claimLine1.getRevenueCenterRenderingPhysicianNPI(), 1);
    // verify {@link
    // TransformerUtils#mapEobType(CodeableConcept,ClaimType,Optional,Optional)}
    // method worked as expected for this claim type
    TransformerTestUtils.assertMapEobType(eob.getType(), ClaimType.SNF, Optional.of(org.hl7.fhir.dstu3.model.codesystems.ClaimType.INSTITUTIONAL), Optional.of(claim.getNearLineRecordIdCode()), Optional.of(claim.getClaimTypeCode()));
    // Test lastUpdated
    TransformerTestUtils.assertLastUpdatedEquals(claim.getLastUpdated(), eob);
}