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

Example 16 with Coverage

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

the class CoverageTransformerV2 method transformPartB.

/**
 * @param metricRegistry the {@link MetricRegistry} to use
 * @param beneficiary the {@link Beneficiary} to generate a {@link MedicareSegment#PART_B} {@link
 *     Coverage} resource for
 * @return {@link MedicareSegment#PART_B} {@link Coverage} resource for the specified {@link
 *     Beneficiary}
 */
private static Coverage transformPartB(MetricRegistry metricRegistry, Beneficiary beneficiary) {
    Timer.Context timer = getTimerContext(metricRegistry, "part_b");
    Coverage coverage = new Coverage();
    coverage.getMeta().addProfile(ProfileConstants.C4BB_COVERAGE_URL);
    coverage.setId(TransformerUtilsV2.buildCoverageId(MedicareSegment.PART_B, beneficiary));
    setCoverageStatus(coverage, beneficiary.getPartBTerminationCode());
    TransformerUtilsV2.setPeriodStart(coverage.getPeriod(), beneficiary.getMedicareCoverageStartDate());
    beneficiary.getMedicareBeneficiaryId().ifPresent(value -> coverage.setSubscriberId(value));
    setTypeAndIssuer(coverage);
    setCoverageRelationship(coverage, SubscriberPolicyRelationship.SELF);
    createCoverageClass(coverage, CoverageClass.GROUP, TransformerConstants.COVERAGE_PLAN, Optional.empty());
    createCoverageClass(coverage, CoverageClass.PLAN, TransformerConstants.COVERAGE_PLAN_PART_B, Optional.empty());
    coverage.setBeneficiary(TransformerUtilsV2.referencePatient(beneficiary));
    addCoverageExtension(coverage, CcwCodebookVariable.MS_CD, beneficiary.getMedicareEnrollmentStatusCode());
    addCoverageCodeExtension(coverage, CcwCodebookVariable.B_TRM_CD, beneficiary.getPartATerminationCode());
    addCoverageDecimalExtension(coverage, CcwCodebookVariable.RFRNC_YR, beneficiary.getBeneEnrollmentReferenceYear());
    // Monthly Medicare-Medicaid dual eligibility codes
    transformEntitlementDualEligibility(coverage, beneficiary);
    // Medicare Entitlement Buy In Indicator
    transformEntitlementBuyInIndicators(coverage, beneficiary);
    // update Coverage.meta.lastUpdated
    TransformerUtilsV2.setLastUpdated(coverage, beneficiary.getLastUpdated());
    timer.stop();
    return coverage;
}

Example 17 with Coverage

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

the class CoverageTransformerV2 method transformPartC.

/**
 * @param metricRegistry the {@link MetricRegistry} to use
 * @param beneficiary the {@link Beneficiary} to generate a {@link MedicareSegment#PART_C} {@link
 *     Coverage} resource for
 * @return {@link MedicareSegment#PART_C} {@link Coverage} resource for the specified {@link
 *     Beneficiary}
 */
private static Coverage transformPartC(MetricRegistry metricRegistry, Beneficiary beneficiary) {
    Timer.Context timer = getTimerContext(metricRegistry, "part_c");
    Coverage coverage = new Coverage();
    coverage.getMeta().addProfile(ProfileConstants.C4BB_COVERAGE_URL);
    coverage.setId(TransformerUtilsV2.buildCoverageId(MedicareSegment.PART_C, beneficiary));
    coverage.setStatus(CoverageStatus.ACTIVE);
    beneficiary.getMedicareBeneficiaryId().ifPresent(value -> coverage.setSubscriberId(value));
    setTypeAndIssuer(coverage);
    setCoverageRelationship(coverage, SubscriberPolicyRelationship.SELF);
    createCoverageClass(coverage, CoverageClass.GROUP, TransformerConstants.COVERAGE_PLAN, Optional.empty());
    createCoverageClass(coverage, CoverageClass.PLAN, TransformerConstants.COVERAGE_PLAN_PART_C, Optional.empty());
    coverage.setBeneficiary(TransformerUtilsV2.referencePatient(beneficiary));
    // Contract Number
    addCoverageExtension(coverage, CcwCodebookVariable.PTC_CNTRCT_ID_01, beneficiary.getPartCContractNumberJanId());
    addCoverageExtension(coverage, CcwCodebookVariable.PTC_CNTRCT_ID_02, beneficiary.getPartCContractNumberFebId());
    addCoverageExtension(coverage, CcwCodebookVariable.PTC_CNTRCT_ID_03, beneficiary.getPartCContractNumberMarId());
    addCoverageExtension(coverage, CcwCodebookVariable.PTC_CNTRCT_ID_04, beneficiary.getPartCContractNumberAprId());
    addCoverageExtension(coverage, CcwCodebookVariable.PTC_CNTRCT_ID_05, beneficiary.getPartCContractNumberMayId());
    addCoverageExtension(coverage, CcwCodebookVariable.PTC_CNTRCT_ID_06, beneficiary.getPartCContractNumberJunId());
    addCoverageExtension(coverage, CcwCodebookVariable.PTC_CNTRCT_ID_07, beneficiary.getPartCContractNumberJulId());
    addCoverageExtension(coverage, CcwCodebookVariable.PTC_CNTRCT_ID_08, beneficiary.getPartCContractNumberAugId());
    addCoverageExtension(coverage, CcwCodebookVariable.PTC_CNTRCT_ID_09, beneficiary.getPartCContractNumberSeptId());
    addCoverageExtension(coverage, CcwCodebookVariable.PTC_CNTRCT_ID_10, beneficiary.getPartCContractNumberOctId());
    addCoverageExtension(coverage, CcwCodebookVariable.PTC_CNTRCT_ID_11, beneficiary.getPartCContractNumberNovId());
    addCoverageExtension(coverage, CcwCodebookVariable.PTC_CNTRCT_ID_12, beneficiary.getPartCContractNumberDecId());
    // PBP
    addCoverageExtension(coverage, CcwCodebookVariable.PTC_PBP_ID_01, beneficiary.getPartCPbpNumberJanId());
    addCoverageExtension(coverage, CcwCodebookVariable.PTC_PBP_ID_02, beneficiary.getPartCPbpNumberFebId());
    addCoverageExtension(coverage, CcwCodebookVariable.PTC_PBP_ID_03, beneficiary.getPartCPbpNumberMarId());
    addCoverageExtension(coverage, CcwCodebookVariable.PTC_PBP_ID_04, beneficiary.getPartCPbpNumberAprId());
    addCoverageExtension(coverage, CcwCodebookVariable.PTC_PBP_ID_05, beneficiary.getPartCPbpNumberMayId());
    addCoverageExtension(coverage, CcwCodebookVariable.PTC_PBP_ID_06, beneficiary.getPartCPbpNumberJunId());
    addCoverageExtension(coverage, CcwCodebookVariable.PTC_PBP_ID_07, beneficiary.getPartCPbpNumberJulId());
    addCoverageExtension(coverage, CcwCodebookVariable.PTC_PBP_ID_08, beneficiary.getPartCPbpNumberAugId());
    addCoverageExtension(coverage, CcwCodebookVariable.PTC_PBP_ID_09, beneficiary.getPartCPbpNumberSeptId());
    addCoverageExtension(coverage, CcwCodebookVariable.PTC_PBP_ID_10, beneficiary.getPartCPbpNumberOctId());
    addCoverageExtension(coverage, CcwCodebookVariable.PTC_PBP_ID_11, beneficiary.getPartCPbpNumberNovId());
    addCoverageExtension(coverage, CcwCodebookVariable.PTC_PBP_ID_12, beneficiary.getPartCPbpNumberDecId());
    // Plan Type
    addCoverageExtension(coverage, CcwCodebookVariable.PTC_PLAN_TYPE_CD_01, beneficiary.getPartCPlanTypeJanCode());
    addCoverageExtension(coverage, CcwCodebookVariable.PTC_PLAN_TYPE_CD_02, beneficiary.getPartCPlanTypeFebCode());
    addCoverageExtension(coverage, CcwCodebookVariable.PTC_PLAN_TYPE_CD_03, beneficiary.getPartCPlanTypeMarCode());
    addCoverageExtension(coverage, CcwCodebookVariable.PTC_PLAN_TYPE_CD_04, beneficiary.getPartCPlanTypeAprCode());
    addCoverageExtension(coverage, CcwCodebookVariable.PTC_PLAN_TYPE_CD_05, beneficiary.getPartCPlanTypeMayCode());
    addCoverageExtension(coverage, CcwCodebookVariable.PTC_PLAN_TYPE_CD_06, beneficiary.getPartCPlanTypeJunCode());
    addCoverageExtension(coverage, CcwCodebookVariable.PTC_PLAN_TYPE_CD_07, beneficiary.getPartCPlanTypeJulCode());
    addCoverageExtension(coverage, CcwCodebookVariable.PTC_PLAN_TYPE_CD_08, beneficiary.getPartCPlanTypeAugCode());
    addCoverageExtension(coverage, CcwCodebookVariable.PTC_PLAN_TYPE_CD_09, beneficiary.getPartCPlanTypeSeptCode());
    addCoverageExtension(coverage, CcwCodebookVariable.PTC_PLAN_TYPE_CD_10, beneficiary.getPartCPlanTypeOctCode());
    addCoverageExtension(coverage, CcwCodebookVariable.PTC_PLAN_TYPE_CD_11, beneficiary.getPartCPlanTypeNovCode());
    addCoverageExtension(coverage, CcwCodebookVariable.PTC_PLAN_TYPE_CD_12, beneficiary.getPartCPlanTypeDecCode());
    // Monthly Medicare Advantage (MA) enrollment indicators:
    addCoverageCodeExtension(coverage, CcwCodebookVariable.HMO_IND_01, beneficiary.getHmoIndicatorJanInd());
    addCoverageCodeExtension(coverage, CcwCodebookVariable.HMO_IND_02, beneficiary.getHmoIndicatorFebInd());
    addCoverageCodeExtension(coverage, CcwCodebookVariable.HMO_IND_03, beneficiary.getHmoIndicatorMarInd());
    addCoverageCodeExtension(coverage, CcwCodebookVariable.HMO_IND_04, beneficiary.getHmoIndicatorAprInd());
    addCoverageCodeExtension(coverage, CcwCodebookVariable.HMO_IND_05, beneficiary.getHmoIndicatorMayInd());
    addCoverageCodeExtension(coverage, CcwCodebookVariable.HMO_IND_06, beneficiary.getHmoIndicatorJunInd());
    addCoverageCodeExtension(coverage, CcwCodebookVariable.HMO_IND_07, beneficiary.getHmoIndicatorJulInd());
    addCoverageCodeExtension(coverage, CcwCodebookVariable.HMO_IND_08, beneficiary.getHmoIndicatorAugInd());
    addCoverageCodeExtension(coverage, CcwCodebookVariable.HMO_IND_09, beneficiary.getHmoIndicatorSeptInd());
    addCoverageCodeExtension(coverage, CcwCodebookVariable.HMO_IND_10, beneficiary.getHmoIndicatorOctInd());
    addCoverageCodeExtension(coverage, CcwCodebookVariable.HMO_IND_11, beneficiary.getHmoIndicatorNovInd());
    addCoverageCodeExtension(coverage, CcwCodebookVariable.HMO_IND_12, beneficiary.getHmoIndicatorDecInd());
    // The reference year of the enrollment data
    addCoverageDecimalExtension(coverage, CcwCodebookVariable.RFRNC_YR, beneficiary.getBeneEnrollmentReferenceYear());
    // Monthly Medicare-Medicaid dual eligibility codes
    transformEntitlementDualEligibility(coverage, beneficiary);
    // update Coverage.meta.lastUpdated
    TransformerUtilsV2.setLastUpdated(coverage, beneficiary.getLastUpdated());
    timer.stop();
    return coverage;
}

Example 18 with Coverage

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

the class DMEClaimTransformerV2 method transformClaim.

/**
 * @param claimGroup the CCW {@link DMEClaim} to transform
 * @return a FHIR {@link ExplanationOfBenefit} resource that represents the specified {@link
 *     DMEClaim}
 */
private static ExplanationOfBenefit transformClaim(DMEClaim claimGroup, Optional<Boolean> includeTaxNumbers) {
    ExplanationOfBenefit eob = new ExplanationOfBenefit();
    // Required values not directly mapped
    eob.getMeta().addProfile(ProfileConstants.C4BB_EOB_INPATIENT_PROFILE_URL);
    // 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
    // BENE_ID                  => ExplanationOfBenefit.patient (reference)pwd
    // 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.DME, claimGroup.getClaimGroupId().toPlainString(), MedicareSegment.PART_A, Optional.of(claimGroup.getDateFrom()), Optional.of(claimGroup.getDateThrough()), Optional.of(claimGroup.getPaymentAmount()), claimGroup.getFinalAction());
    // 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.DME, 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()));
    // NCH_WKLY_PROC_DT => ExplanationOfBenefit.supportinginfo.timingDate
    TransformerUtilsV2.addInformation(eob, TransformerUtilsV2.createInformationRecievedDateSlice(eob, CcwCodebookVariable.NCH_WKLY_PROC_DT, Optional.of(claimGroup.getWeeklyProcessDate())));
    // 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(), Optional.of(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.DME);
    }
    // CARR_CLM_ENTRY_CD => ExplanationOfBenefit.extension
    eob.addExtension(TransformerUtilsV2.createExtensionCoding(eob, CcwCodebookVariable.CARR_CLM_ENTRY_CD, claimGroup.getClaimEntryCode()));
    handleClaimLines(claimGroup, eob, includeTaxNumbers);
    TransformerUtilsV2.setLastUpdated(eob, claimGroup.getLastUpdated());
    return eob;
}

Example 19 with Coverage

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

the class HHAClaimTransformerV2 method transformClaim.

/**
 * @param claimGroup the CCW {@link HHAClaim} to transform
 * @return a FHIR {@link ExplanationOfBenefit} resource that represents the specified {@link
 *     HHAClaim}
 */
private static ExplanationOfBenefit transformClaim(HHAClaim claimGroup) {
    ExplanationOfBenefit eob = new ExplanationOfBenefit();
    // Required values not directly mapped
    eob.getMeta().addProfile(ProfileConstants.C4BB_EOB_NONCLINICIAN_PROFILE_URL);
    // 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
    // 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.HHA, 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                 => ExplanationOfBenefit.type.coding
    // NCH_NEAR_LINE_REC_IDENT_CD => ExplanationOfBenefit.extension
    TransformerUtilsV2.mapEobType(eob, ClaimTypeV2.HHA, Optional.of(claimGroup.getNearLineRecordIdCode()), Optional.of(claimGroup.getClaimTypeCode()));
    // PRVDR_NUM => ExplanationOfBenefit.provider.identifier
    TransformerUtilsV2.addProviderSlice(eob, C4BBOrganizationIdentifierType.PRN, claimGroup.getProviderNumber(), claimGroup.getLastUpdated());
    // Common group level fields between Inpatient, Outpatient Hospice, HHA and SNF
    // ORG_NPI_NUM              => ExplanationOfBenefit.provider
    // CLM_FAC_TYPE_CD          => ExplanationOfBenefit.facility.extension
    // CLM_FREQ_CD              => ExplanationOfBenefit.supportingInfo
    // CLM_MDCR_NON_PMT_RSN_CD  => ExplanationOfBenefit.extension
    // PTNT_DSCHRG_STUS_CD      => ExplanationOfBenefit.supportingInfo
    // CLM_SRVC_CLSFCTN_TYPE_CD => ExplanationOfBenefit.extension
    // NCH_PRMRY_PYR_CD         => ExplanationOfBenefit.supportingInfo
    // CLM_TOT_CHRG_AMT         => ExplanationOfBenefit.total.amount
    // NCH_PRMRY_PYR_CLM_PD_AMT => ExplanationOfBenefit.benefitBalance.financial
    TransformerUtilsV2.mapEobCommonGroupInpOutHHAHospiceSNF(eob, claimGroup.getOrganizationNpi(), claimGroup.getClaimFacilityTypeCode(), claimGroup.getClaimFrequencyCode(), claimGroup.getClaimNonPaymentReasonCode(), claimGroup.getPatientDischargeStatusCode(), claimGroup.getClaimServiceClassificationTypeCode(), claimGroup.getClaimPrimaryPayerCode(), claimGroup.getTotalChargeAmount(), claimGroup.getPrimaryPayerPaidAmount(), claimGroup.getFiscalIntermediaryNumber(), claimGroup.getLastUpdated());
    // CLM_PPS_IND_CODE => ExplanationOfBenefit.supportingInfo
    TransformerUtilsV2.addInformationWithCode(eob, CcwCodebookVariable.CLM_PPS_IND_CD, CcwCodebookVariable.CLM_PPS_IND_CD, claimGroup.getProspectivePaymentCode());
    // ICD_DGNS_E_VRSN_CD(1-12) => diagnosis.diagnosisCodeableConcept
    for (Diagnosis diagnosis : DiagnosisUtilV2.extractDiagnoses(claimGroup)) {
        DiagnosisUtilV2.addDiagnosisCode(eob, diagnosis, ClaimTypeV2.HHA);
    }
    // Map care team
    // AT_PHYSN_NPI     => ExplanationOfBenefit.careTeam.provider
    // AT_PHYSN_UPIN    => ExplanationOfBenefit.careTeam.provider
    TransformerUtilsV2.mapCareTeam(eob, claimGroup.getAttendingPhysicianNpi(), Optional.empty(), Optional.empty(), claimGroup.getAttendingPhysicianUpin(), Optional.empty(), Optional.empty());
    // CLM_HHA_LUPA_IND_CD => ExplanationOfBenefit.supportinginfo.code
    claimGroup.getClaimLUPACode().ifPresent(c -> TransformerUtilsV2.addInformationWithCode(eob, CcwCodebookVariable.CLM_HHA_LUPA_IND_CD, CcwCodebookVariable.CLM_HHA_LUPA_IND_CD, c));
    // CLM_HHA_RFRL_CD => ExplanationOfBenefit.supportinginfo.code
    claimGroup.getClaimReferralCode().ifPresent(c -> TransformerUtilsV2.addInformationWithCode(eob, CcwCodebookVariable.CLM_HHA_RFRL_CD, CcwCodebookVariable.CLM_HHA_RFRL_CD, c));
    // CLM_HHA_TOT_VISIT_CNT => ExplanationOfBenefit.supportinginfo.value[x]
    TransformerUtilsV2.addInformation(eob, CcwCodebookVariable.CLM_HHA_TOT_VISIT_CNT).setValue(new Quantity(claimGroup.getTotalVisitCount().intValue()));
    // CLM_ADMSN_DT => ExplanationOfBenefit.supportingInfo:admissionperiod
    TransformerUtilsV2.addInformation(eob, TransformerUtilsV2.createInformationAdmPeriodSlice(eob, claimGroup.getCareStartDate(), Optional.empty()));
    for (HHAClaimLine line : claimGroup.getLines()) {
        ItemComponent item = eob.addItem();
        // Override the default sequence
        // CLM_LINE_NUM => item.sequence
        item.setSequence(line.getLineNumber().intValue());
        // PRVDR_STATE_CD => item.location
        TransformerUtilsV2.addLocationState(item, claimGroup.getProviderStateCode());
        // HCPCS_CD           => ExplanationOfBenefit.item.productOrService
        // HCPCS_1ST_MDFR_CD  => ExplanationOfBenefit.item.modifier
        // HCPCS_2ND_MDFR_CD  => ExplanationOfBenefit.item.modifier
        TransformerUtilsV2.mapHcpcs(eob, item, line.getHcpcsCode(), Optional.empty(), Arrays.asList(line.getHcpcsInitialModifierCode(), line.getHcpcsSecondModifierCode()));
        // REV_CNTR_1ST_ANSI_CD => ExplanationOfBenefit.item.adjudication
        TransformerUtilsV2.addAdjudication(item, TransformerUtilsV2.createAdjudicationDenialReasonSlice(eob, CcwCodebookVariable.REV_CNTR_1ST_ANSI_CD, line.getRevCntr1stAnsiCd()));
        // REV_CNTR                   => ExplanationOfBenefit.item.revenue
        // REV_CNTR_RATE_AMT          => ExplanationOfBenefit.item.adjudication
        // REV_CNTR_TOT_CHRG_AMT      => ExplanationOfBenefit.item.adjudication
        // REV_CNTR_NCVRD_CHRG_AMT    => ExplanationOfBenefit.item.adjudication
        // REV_CNTR_NDC_QTY           => ExplanationOfBenefit.item.quantity
        // REV_CNTR_NDC_QTY_QLFR_CD   => ExplanationOfBenefit.modifier
        TransformerUtilsV2.mapEobCommonItemRevenue(item, eob, line.getRevenueCenterCode(), line.getRateAmount(), line.getTotalChargeAmount(), Optional.of(line.getNonCoveredChargeAmount()), line.getNationalDrugCodeQuantity(), line.getNationalDrugCodeQualifierCode());
        // Common item level fields between Outpatient, HHA and Hospice
        // REV_CNTR_DT              => ExplanationOfBenefit.item.servicedDate
        // REV_CNTR_PMT_AMT_AMT     => ExplanationOfBenefit.item.adjudication
        TransformerUtilsV2.mapEobCommonItemRevenueOutHHAHospice(item, line.getRevenueCenterDate(), line.getPaymentAmount());
        // REV_CNTR_DDCTBL_COINSRNC_CD => item.revenue
        TransformerUtilsV2.addItemRevenue(item, eob, CcwCodebookVariable.REV_CNTR_DDCTBL_COINSRNC_CD, line.getDeductibleCoinsuranceCd());
        // RNDRNG_PHYSN_UPIN => ExplanationOfBenefit.careTeam.provider
        TransformerUtilsV2.addCareTeamMember(eob, item, C4BBPractitionerIdentifierType.UPIN, C4BBClaimProfessionalAndNonClinicianCareTeamRole.PERFORMING, line.getRevenueCenterRenderingPhysicianUPIN());
        // RNDRNG_PHYSN_NPI => ExplanationOfBenefit.careTeam.provider
        TransformerUtilsV2.addCareTeamMember(eob, item, C4BBPractitionerIdentifierType.NPI, C4BBClaimProfessionalAndNonClinicianCareTeamRole.PERFORMING, line.getRevenueCenterRenderingPhysicianNPI());
        // REV_CNTR_STUS_IND_CD => ExplanationOfBenefit.item.revenue.extension
        TransformerUtilsV2.mapEobCommonItemRevenueStatusCode(item, eob, line.getStatusCode());
    }
    TransformerUtilsV2.setLastUpdated(eob, claimGroup.getLastUpdated());
    return eob;
}

Example 20 with Coverage

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

the class TransformerUtilsV2 method addResourcesToBundle.

/**
 * @param bundle a {@link Bundle} to add the list of {@link ExplanationOfBenefit} resources to.
 * @param resources a list of either {@link ExplanationOfBenefit}s, {@link Coverage}s, or {@link
 *     Patient}s, of which a portion will be added to the bundle based on the paging values
 * @return Returns a {@link Bundle} of {@link ExplanationOfBenefit}s, {@link Coverage}s, or {@link
 *     Patient}s, which may contain multiple matching resources, or may also be empty.
 */
public static Bundle addResourcesToBundle(Bundle bundle, List<IBaseResource> resources) {
    Set<String> beneIds = new HashSet<String>();
    for (IBaseResource res : resources) {
        BundleEntryComponent entry = bundle.addEntry();
        entry.setResource((Resource) res);
        if (entry.getResource().getResourceType() == ResourceType.ExplanationOfBenefit) {
            ExplanationOfBenefit eob = ((ExplanationOfBenefit) entry.getResource());
            if (eob != null && eob.getPatient() != null && !Strings.isNullOrEmpty(eob.getPatient().getReference())) {
                String reference = eob.getPatient().getReference().replace("Patient/", "");
                if (!Strings.isNullOrEmpty(reference)) {
                    beneIds.add(reference);
                }
            }
        } else if (entry.getResource().getResourceType() == ResourceType.Patient) {
            Patient patient = ((Patient) entry.getResource());
            if (patient != null && !Strings.isNullOrEmpty(patient.getId())) {
                beneIds.add(patient.getId());
            }
        } else if (entry.getResource().getResourceType() == ResourceType.Coverage) {
            Coverage coverage = ((Coverage) entry.getResource());
            if (coverage != null && coverage.getBeneficiary() != null && !Strings.isNullOrEmpty(coverage.getBeneficiary().getReference())) {
                String reference = coverage.getBeneficiary().getReference().replace("Patient/", "");
                if (!Strings.isNullOrEmpty(reference)) {
                    beneIds.add(reference);
                }
            }
        }
    }
    logBeneIdToMdc(beneIds);
    return bundle;
}