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

Example 86 with Claim

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

the class CarrierClaimTransformerTest method transformSampleARecord.

/**
 * Verifies that {@link
 * gov.cms.bfd.server.war.stu3.providers.CarrierClaimTransformer#transform(Object)} works as
 * expected when run against the {@link StaticRifResource#SAMPLE_A_CARRIER} {@link CarrierClaim}.
 *
 * @throws FHIRException (indicates test failure)
 */
@Test
public void transformSampleARecord() throws FHIRException {
    List<Object> parsedRecords = ServerTestUtils.parseData(Arrays.asList(StaticRifResourceGroup.SAMPLE_A.getResources()));
    CarrierClaim claim = parsedRecords.stream().filter(r -> r instanceof CarrierClaim).map(r -> (CarrierClaim) r).findFirst().get();
    claim.setLastUpdated(Instant.now());
    ExplanationOfBenefit eobWithLastUpdated = CarrierClaimTransformer.transform(new MetricRegistry(), claim, Optional.of(true));
    assertMatches(claim, eobWithLastUpdated, Optional.of(true));
    claim.setLastUpdated(Optional.empty());
    ExplanationOfBenefit eobWithoutLastUpdated = CarrierClaimTransformer.transform(new MetricRegistry(), claim, Optional.of(true));
    assertMatches(claim, eobWithoutLastUpdated, Optional.of(true));
}

Example 87 with Claim

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

the class CarrierClaimTransformerTest method assertMatches.

/**
 * Verifies that the {@link ExplanationOfBenefit} "looks like" it should, if it were produced from
 * the specified {@link CarrierClaim}.
 *
 * @param claim the {@link CarrierClaim} that the {@link ExplanationOfBenefit} was generated from
 * @param eob the {@link ExplanationOfBenefit} that was generated from the specified {@link
 *     CarrierClaim}
 * @param includedTaxNumbers whether or not to include tax numbers are expected to be included in
 *     the result (see {@link
 *     ExplanationOfBenefitResourceProvider#HEADER_NAME_INCLUDE_TAX_NUMBERS}, defaults to <code>
 *     false</code>)
 * @throws FHIRException (indicates test failure)
 */
static void assertMatches(CarrierClaim claim, ExplanationOfBenefit eob, Optional<Boolean> includedTaxNumbers) throws FHIRException {
    // Test to ensure group level fields between all claim types match
    TransformerTestUtils.assertEobCommonClaimHeaderData(eob, claim.getClaimId(), claim.getBeneficiaryId(), ClaimType.CARRIER, claim.getClaimGroupId().toPlainString(), MedicareSegment.PART_B, Optional.of(claim.getDateFrom()), Optional.of(claim.getDateThrough()), Optional.of(claim.getPaymentAmount()), claim.getFinalAction());
    // Test to ensure common group fields between Carrier and DME match
    TransformerTestUtils.assertEobCommonGroupCarrierDMEEquals(eob, claim.getBeneficiaryId(), claim.getCarrierNumber(), claim.getClinicalTrialNumber(), claim.getBeneficiaryPartBDeductAmount(), claim.getPaymentDenialCode(), claim.getReferringPhysicianNpi(), claim.getProviderAssignmentIndicator(), claim.getProviderPaymentAmount(), claim.getBeneficiaryPaymentAmount(), claim.getSubmittedChargeAmount(), claim.getAllowedChargeAmount());
    assertEquals(5, eob.getDiagnosis().size());
    assertEquals(1, eob.getItem().size());
    TransformerTestUtils.assertAdjudicationTotalAmountEquals(CcwCodebookVariable.PRPAYAMT, claim.getPrimaryPayerPaidAmount(), eob);
    CarrierClaimLine claimLine1 = claim.getLines().get(0);
    ItemComponent eobItem0 = eob.getItem().get(0);
    assertEquals(claimLine1.getLineNumber(), new BigDecimal(eobItem0.getSequence()));
    TransformerTestUtils.assertCareTeamEquals(claimLine1.getPerformingPhysicianNpi().get(), ClaimCareteamrole.PRIMARY, eob);
    CareTeamComponent performingCareTeamEntry = TransformerTestUtils.findCareTeamEntryForProviderNpi(claimLine1.getPerformingPhysicianNpi().get(), eob.getCareTeam());
    TransformerTestUtils.assertHasCoding(CcwCodebookVariable.PRVDR_SPCLTY, claimLine1.getProviderSpecialityCode(), performingCareTeamEntry.getQualification());
    TransformerTestUtils.assertExtensionCodingEquals(CcwCodebookVariable.CARR_LINE_PRVDR_TYPE_CD, claimLine1.getProviderTypeCode(), performingCareTeamEntry);
    TransformerTestUtils.assertExtensionCodingEquals(CcwCodebookVariable.PRTCPTNG_IND_CD, claimLine1.getProviderParticipatingIndCode(), performingCareTeamEntry);
    TransformerTestUtils.assertExtensionCodingEquals(performingCareTeamEntry, TransformerConstants.CODING_NPI_US, TransformerConstants.CODING_NPI_US, "" + claimLine1.getOrganizationNpi().get());
    CareTeamComponent taxNumberCareTeamEntry = TransformerTestUtils.findCareTeamEntryForProviderTaxNumber(claimLine1.getProviderTaxNumber(), eob.getCareTeam());
    if (includedTaxNumbers.orElse(false)) {
        assertNotNull(taxNumberCareTeamEntry);
    } else {
        assertNull(taxNumberCareTeamEntry);
    }
    TransformerTestUtils.assertExtensionCodingEquals(CcwCodebookVariable.PRVDR_STATE_CD, claimLine1.getProviderStateCode(), eobItem0.getLocation());
    TransformerTestUtils.assertExtensionCodingEquals(CcwCodebookVariable.PRVDR_STATE_CD, claimLine1.getProviderStateCode(), eobItem0.getLocation());
    TransformerTestUtils.assertExtensionCodingEquals(CcwCodebookVariable.CARR_LINE_PRCNG_LCLTY_CD, claimLine1.getLinePricingLocalityCode(), eobItem0.getLocation());
    TransformerTestUtils.assertHasCoding(TransformerConstants.CODING_SYSTEM_HCPCS, "" + claim.getHcpcsYearCode().get(), null, claimLine1.getHcpcsCode().get(), eobItem0.getService().getCoding());
    assertEquals(1, eobItem0.getModifier().size());
    TransformerTestUtils.assertHcpcsCodes(eobItem0, claimLine1.getHcpcsCode(), claimLine1.getHcpcsInitialModifierCode(), claimLine1.getHcpcsSecondModifierCode(), claim.getHcpcsYearCode(), 0);
    if (claimLine1.getAnesthesiaUnitCount().compareTo(BigDecimal.ZERO) > 0) {
        TransformerTestUtils.assertExtensionQuantityEquals(CcwCodebookVariable.CARR_LINE_ANSTHSA_UNIT_CNT, claimLine1.getAnesthesiaUnitCount(), eobItem0.getService());
    }
    TransformerTestUtils.assertExtensionCodingEquals(CcwCodebookVariable.CARR_LINE_MTUS_CD, claimLine1.getMtusCode(), eobItem0);
    TransformerTestUtils.assertExtensionQuantityEquals(CcwCodebookVariable.CARR_LINE_MTUS_CNT, claimLine1.getMtusCount(), eobItem0);
    TransformerTestUtils.assertAdjudicationReasonEquals(CcwCodebookVariable.CARR_LINE_RDCD_PMT_PHYS_ASTN_C, claimLine1.getReducedPaymentPhysicianAsstCode(), eobItem0.getAdjudication());
    TransformerTestUtils.assertExtensionIdentifierEquals(CcwCodebookVariable.CARR_LINE_CLIA_LAB_NUM, claimLine1.getCliaLabNumber(), eobItem0.getLocation());
    // verify {@link
    // TransformerUtils#mapEobType(CodeableConcept,ClaimType,Optional,Optional)}
    // method worked as expected for this claim type
    TransformerTestUtils.assertMapEobType(eob.getType(), ClaimType.CARRIER, Optional.of(org.hl7.fhir.dstu3.model.codesystems.ClaimType.PROFESSIONAL), Optional.of(claim.getNearLineRecordIdCode()), Optional.of(claim.getClaimTypeCode()));
    // Test to ensure common item fields between Carrier and DME match
    TransformerTestUtils.assertEobCommonItemCarrierDMEEquals(eobItem0, eob, claimLine1.getServiceCount(), claimLine1.getPlaceOfServiceCode(), claimLine1.getFirstExpenseDate(), claimLine1.getLastExpenseDate(), claimLine1.getBeneficiaryPaymentAmount(), claimLine1.getProviderPaymentAmount(), claimLine1.getBeneficiaryPartBDeductAmount(), claimLine1.getPrimaryPayerCode(), claimLine1.getPrimaryPayerPaidAmount(), claimLine1.getBetosCode(), claimLine1.getPaymentAmount(), claimLine1.getPaymentCode(), claimLine1.getCoinsuranceAmount(), claimLine1.getSubmittedChargeAmount(), claimLine1.getAllowedChargeAmount(), claimLine1.getProcessingIndicatorCode(), claimLine1.getServiceDeductibleCode(), claimLine1.getDiagnosisCode(), claimLine1.getDiagnosisCodeVersion(), claimLine1.getHctHgbTestTypeCode(), claimLine1.getHctHgbTestResult(), claimLine1.getCmsServiceTypeCode(), claimLine1.getNationalDrugCode());
    // Test lastUpdated
    TransformerTestUtils.assertLastUpdatedEquals(claim.getLastUpdated(), eob);
}

Example 88 with Claim

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

the class ExplanationOfBenefitResourceProviderIT method readEobForExistingOutpatientClaim.

/**
 * Verifies that {link ExplanationOfBenefitResourceProvider#read(IdType, RequestDetails)} works as
 * expected for an {@link OutpatientClaim}-derived {@link ExplanationOfBenefit} that does exist in
 * the DB.
 *
 * @throws FHIRException (indicates test failure)
 */
@Test
public void readEobForExistingOutpatientClaim() throws FHIRException {
    List<Object> loadedRecords = ServerTestUtils.get().loadData(Arrays.asList(StaticRifResourceGroup.SAMPLE_A.getResources()));
    IGenericClient fhirClient = ServerTestUtils.get().createFhirClient();
    OutpatientClaim claim = loadedRecords.stream().filter(r -> r instanceof OutpatientClaim).map(r -> (OutpatientClaim) r).findFirst().get();
    ExplanationOfBenefit eob = fhirClient.read().resource(ExplanationOfBenefit.class).withId(TransformerUtils.buildEobId(ClaimType.OUTPATIENT, claim.getClaimId())).execute();
    assertNotNull(eob);
    OutpatientClaimTransformerTest.assertMatches(claim, eob);
}

Example 89 with Claim

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

the class ExplanationOfBenefitResourceProviderIT method readEobForExistingDMEClaim.

/**
 * Verifies that {@link ExplanationOfBenefitResourceProvider#read(IdType, RequestDetails)} works
 * as expected for a {@link DMEClaim}-derived {@link ExplanationOfBenefit} that does exist in the
 * DB.
 *
 * @throws FHIRException (indicates test failure)
 */
@Test
public void readEobForExistingDMEClaim() throws FHIRException {
    List<Object> loadedRecords = ServerTestUtils.get().loadData(Arrays.asList(StaticRifResourceGroup.SAMPLE_A.getResources()));
    IGenericClient fhirClient = ServerTestUtils.get().createFhirClient();
    DMEClaim claim = loadedRecords.stream().filter(r -> r instanceof DMEClaim).map(r -> (DMEClaim) r).findFirst().get();
    ExplanationOfBenefit eob = fhirClient.read().resource(ExplanationOfBenefit.class).withId(TransformerUtils.buildEobId(ClaimType.DME, claim.getClaimId())).execute();
    assertNotNull(eob);
    DMEClaimTransformerTest.assertMatches(claim, eob, Optional.empty());
}

Example 90 with Claim

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

the class OutpatientClaimTransformerTest method transformSyntheticRecord.

/**
 * Verifies that {@link
 * gov.cms.bfd.server.war.stu3.providers.OutpatientClaimTransformer#transform(Object)} works as
 * expected when run against the {@link StaticRifResource#SYNTHETIC_OUTPATIENT_1999_1999} {@link
 * OutpatientClaim}.
 *
 * <p>Note: This test is normally disabled like other synthetic data tests
 *
 * @throws FHIRException (indicates test failure)
 */
@Disabled
@Test
public void transformSyntheticRecord() throws FHIRException {
    List<Object> parsedRecords = ServerTestUtils.parseData(Arrays.asList(StaticRifResource.SYNTHETIC_OUTPATIENT_1999_1999));
    OutpatientClaim claim = parsedRecords.stream().filter(r -> r instanceof OutpatientClaim).map(r -> (OutpatientClaim) r).findFirst().get();
    ExplanationOfBenefit eob = OutpatientClaimTransformer.transform(new MetricRegistry(), claim, Optional.empty());
    assertMatches(claim, eob);
}