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

Example 71 with AdjudicationComponent

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

the class OutpatientClaimTransformerV2Test method shouldHaveLineItemAdjudicationRevCntrTotChrgAmt.

@Test
public void shouldHaveLineItemAdjudicationRevCntrTotChrgAmt() {
    AdjudicationComponent adjudication = TransformerTestUtilsV2.findAdjudicationByCategory("https://bluebutton.cms.gov/resources/variables/rev_cntr_tot_chrg_amt", eob.getItemFirstRep().getAdjudication());
    AdjudicationComponent compare = new AdjudicationComponent().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/rev_cntr_tot_chrg_amt", "Revenue Center Total Charge Amount")))).setAmount(new Money().setValue(999.85).setCurrency(TransformerConstants.CODED_MONEY_USD));
    assertTrue(compare.equalsDeep(adjudication));
}

Example 72 with AdjudicationComponent

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

the class OutpatientClaimTransformerV2Test method shouldHaveLineItemAdjudicationRevCntrRateAmt.

@Test
public void shouldHaveLineItemAdjudicationRevCntrRateAmt() {
    AdjudicationComponent adjudication = TransformerTestUtilsV2.findAdjudicationByCategory("https://bluebutton.cms.gov/resources/variables/rev_cntr_rate_amt", eob.getItemFirstRep().getAdjudication());
    AdjudicationComponent compare = new AdjudicationComponent().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/rev_cntr_rate_amt", "Revenue Center Rate Amount")))).setAmount(new Money().setValue(5).setCurrency(TransformerConstants.CODED_MONEY_USD));
    assertTrue(compare.equalsDeep(adjudication));
}

Example 73 with AdjudicationComponent

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

the class TransformerTestUtils method assertAdjudicationReasonEquals.

/**
 * @param expectedCategoryCode the {@link CcwCodebookVariable} for the {@link
 *     AdjudicationComponent#getCategory()} to find and verify
 * @param expectedReasonCode the expected {@link Coding#getCode()} of the {@link
 *     AdjudicationComponent#getReason()} to find and verify
 * @param actuals the actual {@link AdjudicationComponent}s to verify
 */
static void assertAdjudicationReasonEquals(CcwCodebookInterface ccwVariable, Optional<?> expectedReasonCode, List<AdjudicationComponent> actuals) {
    CodeableConcept expectedCategory = TransformerUtils.createAdjudicationCategory(ccwVariable);
    Optional<AdjudicationComponent> adjudication = actuals.stream().filter(a -> isCodeInConcept(a.getCategory(), expectedCategory.getCodingFirstRep().getSystem(), expectedCategory.getCodingFirstRep().getCode())).findAny();
    assertEquals(expectedReasonCode.isPresent(), adjudication.isPresent());
    if (expectedReasonCode.isPresent())
        assertHasCoding(ccwVariable, expectedReasonCode, adjudication.get().getReason());
}

Example 74 with AdjudicationComponent

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

the class TransformerTestUtils method assertEobCommonItemCarrierDMEEquals.

/**
 * Test the transformation of the item level data elements between the {@link CarrierClaimLine}
 * and {@link DMEClaimLine} claim types to FHIR. The method parameter fields from {@link
 * CarrierClaimLine} and {@link DMEClaimLine} are listed below and their corresponding RIF CCW
 * fields (denoted in all CAPS below from {@link CarrierClaimColumn} and {@link DMEClaimColumn}).
 *
 * @param item the {@ ItemComponent} to test
 * @param eob the {@ ExplanationOfBenefit} to test
 * @param serviceCount LINE_SRVC_CNT,
 * @param placeOfServiceCode LINE_PLACE_OF_SRVC_CD,
 * @param firstExpenseDate LINE_1ST_EXPNS_DT,
 * @param lastExpenseDate LINE_LAST_EXPNS_DT,
 * @param beneficiaryPaymentAmount LINE_BENE_PMT_AMT,
 * @param providerPaymentAmount LINE_PRVDR_PMT_AMT,
 * @param beneficiaryPartBDeductAmount LINE_BENE_PTB_DDCTBL_AMT,
 * @param primaryPayerCode LINE_BENE_PRMRY_PYR_CD,
 * @param primaryPayerPaidAmount LINE_BENE_PRMRY_PYR_PD_AMT,
 * @param betosCode BETOS_CD,
 * @param paymentAmount LINE_NCH_PMT_AMT,
 * @param paymentCode LINE_PMT_80_100_CD,
 * @param coinsuranceAmount LINE_COINSRNC_AMT,
 * @param submittedChargeAmount LINE_SBMTD_CHRG_AMT,
 * @param allowedChargeAmount LINE_ALOWD_CHRG_AMT,
 * @param processingIndicatorCode LINE_PRCSG_IND_CD,
 * @param serviceDeductibleCode LINE_SERVICE_DEDUCTIBLE,
 * @param diagnosisCode LINE_ICD_DGNS_CD,
 * @param diagnosisCodeVersion LINE_ICD_DGNS_VRSN_CD,
 * @param hctHgbTestTypeCode LINE_HCT_HGB_TYPE_CD
 * @param hctHgbTestResult LINE_HCT_HGB_RSLT_NUM,
 * @param cmsServiceTypeCode LINE_CMS_TYPE_SRVC_CD,
 * @param nationalDrugCode LINE_NDC_CD
 * @throws FHIRException
 */
static void assertEobCommonItemCarrierDMEEquals(ItemComponent item, ExplanationOfBenefit eob, BigDecimal serviceCount, String placeOfServiceCode, Optional<LocalDate> firstExpenseDate, Optional<LocalDate> lastExpenseDate, BigDecimal beneficiaryPaymentAmount, BigDecimal providerPaymentAmount, BigDecimal beneficiaryPartBDeductAmount, Optional<Character> primaryPayerCode, BigDecimal primaryPayerPaidAmount, Optional<String> betosCode, BigDecimal paymentAmount, Optional<Character> paymentCode, BigDecimal coinsuranceAmount, BigDecimal submittedChargeAmount, BigDecimal allowedChargeAmount, Optional<String> processingIndicatorCode, Optional<Character> serviceDeductibleCode, Optional<String> diagnosisCode, Optional<Character> diagnosisCodeVersion, Optional<String> hctHgbTestTypeCode, BigDecimal hctHgbTestResult, char cmsServiceTypeCode, Optional<String> nationalDrugCode) throws FHIRException {
    assertEquals(serviceCount, item.getQuantity().getValue());
    assertHasCoding(CcwCodebookVariable.LINE_CMS_TYPE_SRVC_CD, cmsServiceTypeCode, item.getCategory());
    assertHasCoding(CcwCodebookVariable.LINE_PLACE_OF_SRVC_CD, placeOfServiceCode, item.getLocationCodeableConcept());
    assertExtensionCodingEquals(CcwCodebookVariable.BETOS_CD, betosCode, item);
    assertDateEquals(firstExpenseDate.get(), item.getServicedPeriod().getStartElement());
    assertDateEquals(lastExpenseDate.get(), item.getServicedPeriod().getEndElement());
    AdjudicationComponent adjudicationForPayment = assertAdjudicationAmountEquals(CcwCodebookVariable.LINE_NCH_PMT_AMT, paymentAmount, item.getAdjudication());
    assertExtensionCodingEquals(CcwCodebookVariable.LINE_PMT_80_100_CD, paymentCode, adjudicationForPayment);
    assertAdjudicationAmountEquals(CcwCodebookVariable.LINE_BENE_PMT_AMT, beneficiaryPaymentAmount, item.getAdjudication());
    assertAdjudicationAmountEquals(CcwCodebookVariable.LINE_PRVDR_PMT_AMT, providerPaymentAmount, item.getAdjudication());
    assertAdjudicationAmountEquals(CcwCodebookVariable.LINE_BENE_PTB_DDCTBL_AMT, beneficiaryPartBDeductAmount, item.getAdjudication());
    assertExtensionCodingEquals(CcwCodebookVariable.LINE_BENE_PRMRY_PYR_CD, primaryPayerCode, item);
    assertAdjudicationAmountEquals(CcwCodebookVariable.LINE_BENE_PRMRY_PYR_PD_AMT, primaryPayerPaidAmount, item.getAdjudication());
    assertAdjudicationAmountEquals(CcwCodebookVariable.LINE_COINSRNC_AMT, coinsuranceAmount, item.getAdjudication());
    assertAdjudicationAmountEquals(CcwCodebookVariable.LINE_SBMTD_CHRG_AMT, submittedChargeAmount, item.getAdjudication());
    assertAdjudicationAmountEquals(CcwCodebookVariable.LINE_ALOWD_CHRG_AMT, allowedChargeAmount, item.getAdjudication());
    assertAdjudicationReasonEquals(CcwCodebookVariable.LINE_PRCSG_IND_CD, processingIndicatorCode, item.getAdjudication());
    assertExtensionCodingEquals(CcwCodebookVariable.LINE_SERVICE_DEDUCTIBLE, serviceDeductibleCode, item);
    assertDiagnosisLinkPresent(Diagnosis.from(diagnosisCode, diagnosisCodeVersion), eob, item);
    List<Extension> hctHgbObservationExtension = item.getExtensionsByUrl(CCWUtils.calculateVariableReferenceUrl(CcwCodebookVariable.LINE_HCT_HGB_RSLT_NUM));
    assertEquals(1, hctHgbObservationExtension.size());
    assertTrue(hctHgbObservationExtension.get(0).getValue() instanceof Reference);
    Reference hctHgbReference = (Reference) hctHgbObservationExtension.get(0).getValue();
    assertTrue(hctHgbReference.getResource() instanceof Observation);
    Observation hctHgbObservation = (Observation) hctHgbReference.getResource();
    assertHasCoding(CcwCodebookVariable.LINE_HCT_HGB_TYPE_CD, hctHgbTestTypeCode, hctHgbObservation.getCode());
    assertEquals(hctHgbTestResult, hctHgbObservation.getValueQuantity().getValue());
    assertExtensionCodingEquals(item, TransformerConstants.CODING_NDC, TransformerConstants.CODING_NDC, nationalDrugCode.get());
}

Example 75 with AdjudicationComponent

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

the class TransformerTestUtils method assertAdjudicationAmountEquals.

/**
 * @param ccwVariable the {@link CcwCodebookVariable} for the {@link
 *     AdjudicationComponent#getCategory()} to find and verify
 * @param expectedAmount the expected {@link AdjudicationComponent#getAmount()}
 * @param actuals the actual {@link AdjudicationComponent}s to verify
 * @return the {@link AdjudicationComponent} that was found and verified
 */
static AdjudicationComponent assertAdjudicationAmountEquals(CcwCodebookInterface ccwVariable, BigDecimal expectedAmount, List<AdjudicationComponent> actuals) {
    CodeableConcept expectedCategory = TransformerUtils.createAdjudicationCategory(ccwVariable);
    Optional<AdjudicationComponent> adjudication = actuals.stream().filter(a -> isCodeInConcept(a.getCategory(), expectedCategory.getCodingFirstRep().getSystem(), expectedCategory.getCodingFirstRep().getCode())).findAny();
    assertTrue(adjudication.isPresent());
    assertEquivalent(expectedAmount, adjudication.get().getAmount().getValue());
    return adjudication.get();
}