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

Example 91 with Claim

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

the class OutpatientClaimTransformerTest method assertMatches.

/**
 * Verifies that the {@link ExplanationOfBenefit} "looks like" it should, if it were produced from
 * the specified {@link OutpatientClaim}.
 *
 * @param claim the {@link OutpatientClaim} that the {@link ExplanationOfBenefit} was generated
 *     from
 * @param eob the {@link ExplanationOfBenefit} that was generated from the specified {@link
 *     OutpatientClaim}
 * @throws FHIRException (indicates test failure)
 */
static void assertMatches(OutpatientClaim claim, ExplanationOfBenefit eob) throws FHIRException {
    // Test to ensure group level fields between all claim types match
    TransformerTestUtils.assertEobCommonClaimHeaderData(eob, claim.getClaimId(), claim.getBeneficiaryId(), ClaimType.OUTPATIENT, claim.getClaimGroupId().toPlainString(), MedicareSegment.PART_B, 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());
    TransformerTestUtils.assertAdjudicationTotalAmountEquals(CcwCodebookVariable.NCH_BENE_PTB_DDCTBL_AMT, claim.getDeductibleAmount(), eob);
    TransformerTestUtils.assertAdjudicationTotalAmountEquals(CcwCodebookVariable.NCH_PROFNL_CMPNT_CHRG_AMT, claim.getProfessionalComponentCharge(), eob);
    TransformerTestUtils.assertAdjudicationTotalAmountEquals(CcwCodebookVariable.NCH_BENE_PTB_COINSRNC_AMT, claim.getCoinsuranceAmount(), eob);
    TransformerTestUtils.assertAdjudicationTotalAmountEquals(CcwCodebookVariable.CLM_OP_PRVDR_PMT_AMT, claim.getProviderPaymentAmount(), eob);
    TransformerTestUtils.assertAdjudicationTotalAmountEquals(CcwCodebookVariable.CLM_OP_BENE_PMT_AMT, claim.getBeneficiaryPaymentAmount(), eob);
    // 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().get(), claim.getClaimServiceClassificationTypeCode(), claim.getClaimPrimaryPayerCode(), claim.getAttendingPhysicianNpi(), claim.getTotalChargeAmount(), claim.getPrimaryPayerPaidAmount(), claim.getFiscalIntermediaryNumber(), claim.getFiDocumentClaimControlNumber(), claim.getFiOriginalClaimControlNumber());
    assertTrue(countDiagnosisCodes(claim) >= eob.getDiagnosis().size(), "Expect actual diagnosis count is less than or equal to the claim count");
    if (claim.getProcedure1Code().isPresent()) {
        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(claim.getProcedure1Date().get().atStartOfDay(ZoneId.systemDefault()).toInstant(), eob.getProcedure().get(0).getDate().toInstant());
    }
    assertTrue(1 <= eob.getItem().size(), "Expect actual item count is above 0");
    ItemComponent eobItem0 = eob.getItem().get(0);
    OutpatientClaimLine claimLine1 = claim.getLines().get(0);
    assertEquals(new Integer(claimLine1.getLineNumber().intValue()), new Integer(eobItem0.getSequence()));
    assertEquals(claim.getProviderStateCode(), eobItem0.getLocationAddress().getState());
    // TODO re-map as described in CBBF-111
    /*
     * TransformerTestUtils.assertHasCoding(TransformerConstants.CODING_NDC,
     * claimLine1.getNationalDrugCode().get(), eobItem0.getService());
     */
    TransformerTestUtils.assertAdjudicationReasonEquals(CcwCodebookVariable.REV_CNTR_1ST_ANSI_CD, claimLine1.getRevCntr1stAnsiCd(), eobItem0.getAdjudication());
    TransformerTestUtils.assertAdjudicationReasonEquals(CcwCodebookVariable.REV_CNTR_2ND_ANSI_CD, claimLine1.getRevCntr2ndAnsiCd(), eobItem0.getAdjudication());
    TransformerTestUtils.assertAdjudicationReasonEquals(CcwCodebookVariable.REV_CNTR_3RD_ANSI_CD, claimLine1.getRevCntr3rdAnsiCd(), eobItem0.getAdjudication());
    TransformerTestUtils.assertAdjudicationReasonEquals(CcwCodebookVariable.REV_CNTR_4TH_ANSI_CD, claimLine1.getRevCntr4thAnsiCd(), eobItem0.getAdjudication());
    TransformerTestUtils.assertHcpcsCodes(eobItem0, claimLine1.getHcpcsCode(), claimLine1.getHcpcsInitialModifierCode(), claimLine1.getHcpcsSecondModifierCode(), Optional.empty(), 0);
    TransformerTestUtils.assertExtensionCodingEquals(CcwCodebookVariable.REV_CNTR_IDE_NDC_UPC_NUM, claimLine1.getNationalDrugCode(), eobItem0.getService());
    TransformerTestUtils.assertAdjudicationAmountEquals(CcwCodebookVariable.REV_CNTR_BLOOD_DDCTBL_AMT, claimLine1.getBloodDeductibleAmount(), eobItem0.getAdjudication());
    TransformerTestUtils.assertAdjudicationAmountEquals(CcwCodebookVariable.REV_CNTR_CASH_DDCTBL_AMT, claimLine1.getCashDeductibleAmount(), eobItem0.getAdjudication());
    TransformerTestUtils.assertAdjudicationAmountEquals(CcwCodebookVariable.REV_CNTR_COINSRNC_WGE_ADJSTD_C, claimLine1.getWageAdjustedCoinsuranceAmount(), eobItem0.getAdjudication());
    TransformerTestUtils.assertAdjudicationAmountEquals(CcwCodebookVariable.REV_CNTR_RDCD_COINSRNC_AMT, claimLine1.getReducedCoinsuranceAmount(), eobItem0.getAdjudication());
    TransformerTestUtils.assertAdjudicationAmountEquals(CcwCodebookVariable.REV_CNTR_1ST_MSP_PD_AMT, claimLine1.getFirstMspPaidAmount(), eobItem0.getAdjudication());
    TransformerTestUtils.assertAdjudicationAmountEquals(CcwCodebookVariable.REV_CNTR_1ST_MSP_PD_AMT, claimLine1.getSecondMspPaidAmount(), eobItem0.getAdjudication());
    TransformerTestUtils.assertAdjudicationAmountEquals(CcwCodebookVariable.REV_CNTR_PRVDR_PMT_AMT, claimLine1.getProviderPaymentAmount(), eobItem0.getAdjudication());
    TransformerTestUtils.assertAdjudicationAmountEquals(CcwCodebookVariable.REV_CNTR_BENE_PMT_AMT, claimLine1.getBenficiaryPaymentAmount(), eobItem0.getAdjudication());
    TransformerTestUtils.assertAdjudicationAmountEquals(CcwCodebookVariable.REV_CNTR_PTNT_RSPNSBLTY_PMT, claimLine1.getPatientResponsibilityAmount(), eobItem0.getAdjudication());
    String claimControlNumber = "0000000000";
    // Test to ensure item level fields between Inpatient, Outpatient, HHA, Hopsice
    // and SNF match
    TransformerTestUtils.assertEobCommonItemRevenueEquals(eobItem0, eob, claimLine1.getRevenueCenterCode(), claimLine1.getRateAmount(), claimLine1.getTotalChargeAmount(), claimLine1.getNonCoveredChargeAmount(), claimLine1.getUnitCount(), claimControlNumber, claimLine1.getNationalDrugCodeQuantity(), claimLine1.getNationalDrugCodeQualifierCode(), claimLine1.getRevenueCenterRenderingPhysicianNPI(), 1);
    // Test to ensure item level fields between Outpatient, HHA and Hospice match
    TransformerTestUtils.assertEobCommonItemRevenueOutHHAHospice(eobItem0, claimLine1.getRevenueCenterDate(), claimLine1.getPaymentAmount());
    // verify {@link
    // TransformerUtils#mapEobType(CodeableConcept,ClaimType,Optional,Optional)}
    // method worked as expected for this claim type
    TransformerTestUtils.assertMapEobType(eob.getType(), ClaimType.OUTPATIENT, Optional.of(org.hl7.fhir.dstu3.model.codesystems.ClaimType.PROFESSIONAL), Optional.of(claim.getNearLineRecordIdCode()), Optional.of(claim.getClaimTypeCode()));
    TransformerTestUtils.assertExtensionCodingEquals(CcwCodebookVariable.REV_CNTR_STUS_IND_CD, claimLine1.getStatusCode(), eobItem0.getRevenue());
    // Test lastUpdated
    TransformerTestUtils.assertLastUpdatedEquals(claim.getLastUpdated(), eob);
}

Example 92 with Claim

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

the class SNFClaimTransformerV2Test method shouldHavePrpayamtFinancial.

@Test
public void shouldHavePrpayamtFinancial() {
    BenefitComponent benefit = TransformerTestUtilsV2.findFinancial("https://bluebutton.cms.gov/resources/variables/prpayamt", eob.getBenefitBalanceFirstRep().getFinancial());
    BenefitComponent compare = new BenefitComponent().setType(new CodeableConcept().setCoding(Arrays.asList(new Coding("https://bluebutton.cms.gov/resources/codesystem/benefit-balance", "https://bluebutton.cms.gov/resources/variables/prpayamt", "NCH Primary Payer (if not Medicare) Claim Paid Amount")))).setUsed(new Money().setValueElement(new DecimalType("11.00")).setCurrency(TransformerConstants.CODED_MONEY_USD));
    assertTrue(compare.equalsDeep(benefit));
}

Example 93 with Claim

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

the class SNFClaimTransformerV2Test method shouldHaveClmPpsCptlFspAmtFinancial.

@Test
public void shouldHaveClmPpsCptlFspAmtFinancial() {
    BenefitComponent benefit = TransformerTestUtilsV2.findFinancial("https://bluebutton.cms.gov/resources/variables/clm_pps_cptl_fsp_amt", eob.getBenefitBalanceFirstRep().getFinancial());
    BenefitComponent compare = new BenefitComponent().setType(new CodeableConcept().setCoding(Arrays.asList(new Coding("https://bluebutton.cms.gov/resources/codesystem/benefit-balance", "https://bluebutton.cms.gov/resources/variables/clm_pps_cptl_fsp_amt", "Claim PPS Capital Federal Specific Portion (FSP) Amount")))).setUsed(new Money().setValueElement(new DecimalType("9.00")).setCurrency(TransformerConstants.CODED_MONEY_USD));
    assertTrue(compare.equalsDeep(benefit));
}

Example 94 with Claim

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

the class SNFClaimTransformerV2Test method shouldHaveClmTotChrgAmtTotal.

@Test
public void shouldHaveClmTotChrgAmtTotal() {
    // Only one so just pull it directly and compare
    TotalComponent total = eob.getTotalFirstRep();
    TotalComponent compare = new TotalComponent().setCategory(new CodeableConcept().setCoding(Arrays.asList(new Coding("http://terminology.hl7.org/CodeSystem/adjudication", "submitted", "Submitted Amount"), new Coding("https://bluebutton.cms.gov/resources/codesystem/adjudication", "https://bluebutton.cms.gov/resources/variables/clm_tot_chrg_amt", "Claim Total Charge Amount")))).setAmount(new Money().setValue(5555.03).setCurrency(TransformerConstants.CODED_MONEY_USD));
    assertTrue(compare.equalsDeep(total));
}

Example 95 with Claim

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

the class SamhsaMatcherR4FromClaimTransformerV2Test method verifyNoItemCodingsTriggersSamhsaFiltering.

/**
 * Verifies that a claim with no samhsa diagnosis, procedure, or item-level HCPCS codes does
 * trigger filtering because the code array is empty and therefore does not contain known systems.
 *
 * @param expectMatch if the test is expecting a filtering match
 * @param explanationOfBenefit the loaded benefit to use for the test
 */
private void verifyNoItemCodingsTriggersSamhsaFiltering(ExplanationOfBenefit explanationOfBenefit, boolean expectMatch) {
    ExplanationOfBenefit modifiedEob = explanationOfBenefit.copy();
    // Set Top level diagnosis and package code to null and coding to empty
    for (ExplanationOfBenefit.DiagnosisComponent diagnosisComponent : modifiedEob.getDiagnosis()) {
        diagnosisComponent.getDiagnosisCodeableConcept().setCoding(new ArrayList<>());
        diagnosisComponent.setPackageCode(null);
    }
    // Set procedure to empty
    modifiedEob.setProcedure(new ArrayList<>());
    // Set item level codings to non-SAMHSA
    modifiedEob.getItem().get(0).setProductOrService(null);
    // When
    boolean isMatch = samhsaMatcherV2.test(modifiedEob);
    // Then
    assertEquals(expectMatch, isMatch);
}