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

Example 1 with ExplanationOfBenefit

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

the class TransformerUtils method mapEobCommonGroupCarrierDME.

/**
 * Transforms the common group level data elements between the {@link CarrierClaim} and {@link
 * DMEClaim} claim types to FHIR. The method parameter fields from {@link CarrierClaim} and {@link
 * DMEClaim} are listed below and their corresponding RIF CCW fields (denoted in all CAPS below
 * from {@link CarrierClaimColumn} and {@link DMEClaimColumn}).
 *
 * @param eob the {@link ExplanationOfBenefit} to modify
 * @param benficiaryId BEME_ID, *
 * @param carrierNumber CARR_NUM,
 * @param clinicalTrialNumber CLM_CLNCL_TRIL_NUM,
 * @param beneficiaryPartBDeductAmount CARR_CLM_CASH_DDCTBL_APLD_AMT,
 * @param paymentDenialCode CARR_CLM_PMT_DNL_CD,
 * @param referringPhysicianNpi RFR_PHYSN_NPI
 * @param providerAssignmentIndicator CARR_CLM_PRVDR_ASGNMT_IND_SW,
 * @param providerPaymentAmount NCH_CLM_PRVDR_PMT_AMT,
 * @param beneficiaryPaymentAmount NCH_CLM_BENE_PMT_AMT,
 * @param submittedChargeAmount NCH_CARR_CLM_SBMTD_CHRG_AMT,
 * @param allowedChargeAmount NCH_CARR_CLM_ALOWD_AMT,
 */
static void mapEobCommonGroupCarrierDME(ExplanationOfBenefit eob, String beneficiaryId, String carrierNumber, Optional<String> clinicalTrialNumber, BigDecimal beneficiaryPartBDeductAmount, String paymentDenialCode, Optional<String> referringPhysicianNpi, Optional<Character> providerAssignmentIndicator, BigDecimal providerPaymentAmount, BigDecimal beneficiaryPaymentAmount, BigDecimal submittedChargeAmount, BigDecimal allowedChargeAmount, String claimDispositionCode, Optional<String> claimCarrierControlNumber) {
    eob.addExtension(createExtensionIdentifier(CcwCodebookVariable.CARR_NUM, carrierNumber));
    // Carrier Claim Control Number
    if (claimCarrierControlNumber.isPresent()) {
        eob.addExtension(createExtensionIdentifier(CcwCodebookMissingVariable.CARR_CLM_CNTL_NUM, claimCarrierControlNumber.get()));
    }
    eob.addExtension(createExtensionCoding(eob, CcwCodebookVariable.CARR_CLM_PMT_DNL_CD, paymentDenialCode));
    // Claim Disposition Code
    eob.setDisposition(claimDispositionCode);
    /*
     * Referrals are represented as contained resources, since they share the lifecycle and identity
     * of their containing EOB.
     */
    if (referringPhysicianNpi.isPresent()) {
        ReferralRequest referral = new ReferralRequest();
        referral.setStatus(ReferralRequestStatus.COMPLETED);
        referral.setSubject(referencePatient(beneficiaryId));
        referral.setRequester(new ReferralRequestRequesterComponent(referencePractitioner(referringPhysicianNpi.get())));
        referral.addRecipient(referencePractitioner(referringPhysicianNpi.get()));
        // Set the ReferralRequest as a contained resource in the EOB:
        eob.setReferral(new Reference(referral));
    }
    if (providerAssignmentIndicator.isPresent()) {
        eob.addExtension(createExtensionCoding(eob, CcwCodebookVariable.ASGMNTCD, providerAssignmentIndicator));
    }
    if (clinicalTrialNumber.isPresent()) {
        eob.addExtension(createExtensionIdentifier(CcwCodebookVariable.CLM_CLNCL_TRIL_NUM, clinicalTrialNumber));
    }
    addAdjudicationTotal(eob, CcwCodebookVariable.CARR_CLM_CASH_DDCTBL_APLD_AMT, beneficiaryPartBDeductAmount);
    addAdjudicationTotal(eob, CcwCodebookVariable.NCH_CLM_PRVDR_PMT_AMT, providerPaymentAmount);
    addAdjudicationTotal(eob, CcwCodebookVariable.NCH_CLM_BENE_PMT_AMT, beneficiaryPaymentAmount);
    addAdjudicationTotal(eob, CcwCodebookVariable.NCH_CARR_CLM_SBMTD_CHRG_AMT, submittedChargeAmount);
    addAdjudicationTotal(eob, CcwCodebookVariable.NCH_CARR_CLM_ALOWD_AMT, allowedChargeAmount);
}

Example 2 with ExplanationOfBenefit

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

the class TransformerUtils method addCareTeamPractitioner.

/**
 * Ensures that the specified {@link ExplanationOfBenefit} has the specified {@link
 * CareTeamComponent}, and links the specified {@link ItemComponent} to that {@link
 * CareTeamComponent} (via {@link ItemComponent#addCareTeamLinkId(int)}).
 *
 * @param eob the {@link ExplanationOfBenefit} that the {@link CareTeamComponent} should be part
 *     of
 * @param eobItem the {@link ItemComponent} that should be linked to the {@link CareTeamComponent}
 * @param practitionerIdSystem the {@link Identifier#getSystem()} of the practitioner to reference
 *     in {@link CareTeamComponent#getProvider()}
 * @param practitionerIdValue the {@link Identifier#getValue()} of the practitioner to reference
 *     in {@link CareTeamComponent#getProvider()}
 * @param careTeamRole the {@link ClaimCareteamrole} to use for the {@link
 *     CareTeamComponent#getRole()}
 * @return the {@link CareTeamComponent} that was created/linked
 */
static CareTeamComponent addCareTeamPractitioner(ExplanationOfBenefit eob, ItemComponent eobItem, String practitionerIdSystem, String practitionerIdValue, ClaimCareteamrole careTeamRole) {
    // Try to find a matching pre-existing entry.
    CareTeamComponent careTeamEntry = eob.getCareTeam().stream().filter(ctc -> ctc.getProvider().hasIdentifier()).filter(ctc -> practitionerIdSystem.equals(ctc.getProvider().getIdentifier().getSystem()) && practitionerIdValue.equals(ctc.getProvider().getIdentifier().getValue())).filter(ctc -> ctc.hasRole()).filter(ctc -> careTeamRole.toCode().equals(ctc.getRole().getCodingFirstRep().getCode()) && careTeamRole.getSystem().equals(ctc.getRole().getCodingFirstRep().getSystem())).findAny().orElse(null);
    // If no match was found, add one to the EOB.
    if (careTeamEntry == null) {
        careTeamEntry = eob.addCareTeam();
        careTeamEntry.setSequence(eob.getCareTeam().size() + 1);
        careTeamEntry.setProvider(createIdentifierReference(practitionerIdSystem, practitionerIdValue));
        CodeableConcept careTeamRoleConcept = createCodeableConcept(ClaimCareteamrole.OTHER.getSystem(), careTeamRole.toCode());
        careTeamRoleConcept.getCodingFirstRep().setDisplay(careTeamRole.getDisplay());
        careTeamEntry.setRole(careTeamRoleConcept);
    }
    // care team entry is at eob level so no need to create item link id
    if (eobItem == null) {
        return careTeamEntry;
    }
    // Link the EOB.item to the care team entry (if it isn't already).
    final int careTeamEntrySequence = careTeamEntry.getSequence();
    if (eobItem.getCareTeamLinkId().stream().noneMatch(id -> id.getValue() == careTeamEntrySequence)) {
        eobItem.addCareTeamLinkId(careTeamEntrySequence);
    }
    return careTeamEntry;
}

Example 3 with ExplanationOfBenefit

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

the class TransformerUtils method addDiagnosisCode.

/**
 * @param eob the {@link ExplanationOfBenefit} to (possibly) modify
 * @param diagnosis the {@link Diagnosis} to add, if it's not already present
 * @return the {@link DiagnosisComponent#getSequence()} of the existing or newly-added entry
 */
static int addDiagnosisCode(ExplanationOfBenefit eob, Diagnosis diagnosis) {
    Optional<DiagnosisComponent> existingDiagnosis = eob.getDiagnosis().stream().filter(d -> d.getDiagnosis() instanceof CodeableConcept).filter(d -> diagnosis.isContainedIn((CodeableConcept) d.getDiagnosis())).findAny();
    if (existingDiagnosis.isPresent())
        return existingDiagnosis.get().getSequenceElement().getValue();
    DiagnosisComponent diagnosisComponent = new DiagnosisComponent().setSequence(eob.getDiagnosis().size() + 1);
    diagnosisComponent.setDiagnosis(diagnosis.toCodeableConcept());
    for (DiagnosisLabel diagnosisLabel : diagnosis.getLabels()) {
        CodeableConcept diagnosisTypeConcept = createCodeableConcept(diagnosisLabel.getSystem(), diagnosisLabel.toCode());
        diagnosisTypeConcept.getCodingFirstRep().setDisplay(diagnosisLabel.getDisplay());
        diagnosisComponent.addType(diagnosisTypeConcept);
    }
    if (diagnosis.getPresentOnAdmission().isPresent()) {
        diagnosisComponent.addExtension(createExtensionCoding(eob, CcwCodebookVariable.CLM_POA_IND_SW1, diagnosis.getPresentOnAdmission()));
    }
    eob.getDiagnosis().add(diagnosisComponent);
    return diagnosisComponent.getSequenceElement().getValue();
}

Example 4 with ExplanationOfBenefit

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

the class TransformerUtils 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;
}

Example 5 with ExplanationOfBenefit

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

the class TransformerUtils method addProcedureCode.

/**
 * @param eob the {@link ExplanationOfBenefit} to (possibly) modify
 * @param diagnosis the {@link Diagnosis} to add, if it's not already present
 * @return the {@link ProcedureComponent#getSequence()} of the existing or newly-added entry
 */
static int addProcedureCode(ExplanationOfBenefit eob, CCWProcedure procedure) {
    Optional<ProcedureComponent> existingProcedure = eob.getProcedure().stream().filter(pc -> pc.getProcedure() instanceof CodeableConcept).filter(pc -> isCodeInConcept((CodeableConcept) pc.getProcedure(), procedure.getFhirSystem(), procedure.getCode())).findAny();
    if (existingProcedure.isPresent())
        return existingProcedure.get().getSequenceElement().getValue();
    ProcedureComponent procedureComponent = new ProcedureComponent().setSequence(eob.getProcedure().size() + 1);
    procedureComponent.setProcedure(createCodeableConcept(procedure.getFhirSystem(), null, retrieveProcedureCodeDisplay(procedure.getCode()), procedure.getCode()));
    if (procedure.getProcedureDate().isPresent()) {
        procedureComponent.setDate(convertToDate(procedure.getProcedureDate().get()));
    }
    eob.getProcedure().add(procedureComponent);
    return procedureComponent.getSequenceElement().getValue();
}