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

Example 1 with BenefitComponent

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

the class HHAClaimTransformer 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();
    // Common group level fields between all claim types
    TransformerUtils.mapEobCommonClaimHeaderData(eob, claimGroup.getClaimId(), claimGroup.getBeneficiaryId(), ClaimType.HHA, claimGroup.getClaimGroupId().toPlainString(), MedicareSegment.PART_B, Optional.of(claimGroup.getDateFrom()), Optional.of(claimGroup.getDateThrough()), Optional.of(claimGroup.getPaymentAmount()), claimGroup.getFinalAction());
    TransformerUtils.mapEobWeeklyProcessDate(eob, claimGroup.getWeeklyProcessDate());
    // map eob type codes into FHIR
    TransformerUtils.mapEobType(eob, ClaimType.HHA, Optional.of(claimGroup.getNearLineRecordIdCode()), Optional.of(claimGroup.getClaimTypeCode()));
    // set the provider number which is common among several claim types
    TransformerUtils.setProviderNumber(eob, claimGroup.getProviderNumber());
    // Common group level fields between Inpatient, Outpatient Hospice, HHA and SNF
    TransformerUtils.mapEobCommonGroupInpOutHHAHospiceSNF(eob, claimGroup.getOrganizationNpi(), claimGroup.getClaimFacilityTypeCode(), claimGroup.getClaimFrequencyCode(), claimGroup.getClaimNonPaymentReasonCode(), claimGroup.getPatientDischargeStatusCode(), claimGroup.getClaimServiceClassificationTypeCode(), claimGroup.getClaimPrimaryPayerCode(), claimGroup.getAttendingPhysicianNpi(), claimGroup.getTotalChargeAmount(), claimGroup.getPrimaryPayerPaidAmount(), claimGroup.getFiscalIntermediaryNumber(), claimGroup.getFiDocumentClaimControlNumber(), claimGroup.getFiOriginalClaimControlNumber());
    for (Diagnosis diagnosis : TransformerUtils.extractDiagnoses1Thru12(claimGroup.getDiagnosisPrincipalCode(), claimGroup.getDiagnosisPrincipalCodeVersion(), claimGroup.getDiagnosis1Code(), claimGroup.getDiagnosis1CodeVersion(), claimGroup.getDiagnosis2Code(), claimGroup.getDiagnosis2CodeVersion(), claimGroup.getDiagnosis3Code(), claimGroup.getDiagnosis3CodeVersion(), claimGroup.getDiagnosis4Code(), claimGroup.getDiagnosis4CodeVersion(), claimGroup.getDiagnosis5Code(), claimGroup.getDiagnosis5CodeVersion(), claimGroup.getDiagnosis6Code(), claimGroup.getDiagnosis6CodeVersion(), claimGroup.getDiagnosis7Code(), claimGroup.getDiagnosis7CodeVersion(), claimGroup.getDiagnosis8Code(), claimGroup.getDiagnosis8CodeVersion(), claimGroup.getDiagnosis9Code(), claimGroup.getDiagnosis9CodeVersion(), claimGroup.getDiagnosis10Code(), claimGroup.getDiagnosis10CodeVersion(), claimGroup.getDiagnosis11Code(), claimGroup.getDiagnosis11CodeVersion(), claimGroup.getDiagnosis12Code(), claimGroup.getDiagnosis12CodeVersion())) TransformerUtils.addDiagnosisCode(eob, diagnosis);
    for (Diagnosis diagnosis : TransformerUtils.extractDiagnoses13Thru25(claimGroup.getDiagnosis13Code(), claimGroup.getDiagnosis13CodeVersion(), claimGroup.getDiagnosis14Code(), claimGroup.getDiagnosis14CodeVersion(), claimGroup.getDiagnosis15Code(), claimGroup.getDiagnosis15CodeVersion(), claimGroup.getDiagnosis16Code(), claimGroup.getDiagnosis16CodeVersion(), claimGroup.getDiagnosis17Code(), claimGroup.getDiagnosis17CodeVersion(), claimGroup.getDiagnosis18Code(), claimGroup.getDiagnosis18CodeVersion(), claimGroup.getDiagnosis19Code(), claimGroup.getDiagnosis19CodeVersion(), claimGroup.getDiagnosis20Code(), claimGroup.getDiagnosis20CodeVersion(), claimGroup.getDiagnosis21Code(), claimGroup.getDiagnosis21CodeVersion(), claimGroup.getDiagnosis22Code(), claimGroup.getDiagnosis22CodeVersion(), claimGroup.getDiagnosis23Code(), claimGroup.getDiagnosis23CodeVersion(), claimGroup.getDiagnosis24Code(), claimGroup.getDiagnosis24CodeVersion(), claimGroup.getDiagnosis25Code(), claimGroup.getDiagnosis25CodeVersion())) TransformerUtils.addDiagnosisCode(eob, diagnosis);
    for (Diagnosis diagnosis : TransformerUtils.extractExternalDiagnoses1Thru12(claimGroup.getDiagnosisExternalFirstCode(), claimGroup.getDiagnosisExternalFirstCodeVersion(), claimGroup.getDiagnosisExternal1Code(), claimGroup.getDiagnosisExternal1CodeVersion(), claimGroup.getDiagnosisExternal2Code(), claimGroup.getDiagnosisExternal2CodeVersion(), claimGroup.getDiagnosisExternal3Code(), claimGroup.getDiagnosisExternal3CodeVersion(), claimGroup.getDiagnosisExternal4Code(), claimGroup.getDiagnosisExternal4CodeVersion(), claimGroup.getDiagnosisExternal5Code(), claimGroup.getDiagnosisExternal5CodeVersion(), claimGroup.getDiagnosisExternal6Code(), claimGroup.getDiagnosisExternal6CodeVersion(), claimGroup.getDiagnosisExternal7Code(), claimGroup.getDiagnosisExternal7CodeVersion(), claimGroup.getDiagnosisExternal8Code(), claimGroup.getDiagnosisExternal8CodeVersion(), claimGroup.getDiagnosisExternal9Code(), claimGroup.getDiagnosisExternal9CodeVersion(), claimGroup.getDiagnosisExternal10Code(), claimGroup.getDiagnosisExternal10CodeVersion(), claimGroup.getDiagnosisExternal11Code(), claimGroup.getDiagnosisExternal11CodeVersion(), claimGroup.getDiagnosisExternal12Code(), claimGroup.getDiagnosisExternal12CodeVersion())) TransformerUtils.addDiagnosisCode(eob, diagnosis);
    if (claimGroup.getClaimLUPACode().isPresent()) {
        TransformerUtils.addInformationWithCode(eob, CcwCodebookVariable.CLM_HHA_LUPA_IND_CD, CcwCodebookVariable.CLM_HHA_LUPA_IND_CD, claimGroup.getClaimLUPACode());
    }
    if (claimGroup.getClaimReferralCode().isPresent()) {
        TransformerUtils.addInformationWithCode(eob, CcwCodebookVariable.CLM_HHA_RFRL_CD, CcwCodebookVariable.CLM_HHA_RFRL_CD, claimGroup.getClaimReferralCode());
    }
    BenefitComponent clmHhaTotVisitCntFinancial = TransformerUtils.addBenefitBalanceFinancial(eob, BenefitCategory.MEDICAL, CcwCodebookVariable.CLM_HHA_TOT_VISIT_CNT);
    clmHhaTotVisitCntFinancial.setUsed(new UnsignedIntType(claimGroup.getTotalVisitCount().intValue()));
    // Common group level fields between Inpatient, HHA, Hospice and SNF
    TransformerUtils.mapEobCommonGroupInpHHAHospiceSNF(eob, claimGroup.getCareStartDate(), Optional.empty(), Optional.empty());
    for (HHAClaimLine claimLine : claimGroup.getLines()) {
        ItemComponent item = eob.addItem();
        item.setSequence(claimLine.getLineNumber().intValue());
        item.setLocation(new Address().setState((claimGroup.getProviderStateCode())));
        if (claimLine.getRevCntr1stAnsiCd().isPresent()) {
            item.addAdjudication().setCategory(TransformerUtils.createAdjudicationCategory(CcwCodebookVariable.REV_CNTR_1ST_ANSI_CD)).setReason(TransformerUtils.createCodeableConcept(eob, CcwCodebookVariable.REV_CNTR_1ST_ANSI_CD, claimLine.getRevCntr1stAnsiCd()));
        }
        TransformerUtils.mapHcpcs(eob, item, Optional.empty(), claimLine.getHcpcsCode(), Arrays.asList(claimLine.getHcpcsInitialModifierCode(), claimLine.getHcpcsSecondModifierCode()));
        // Common item level fields between Inpatient, Outpatient, HHA, Hospice and SNF
        TransformerUtils.mapEobCommonItemRevenue(item, eob, claimLine.getRevenueCenterCode(), claimLine.getRateAmount(), claimLine.getTotalChargeAmount(), claimLine.getNonCoveredChargeAmount(), claimLine.getUnitCount(), claimLine.getNationalDrugCodeQuantity(), claimLine.getNationalDrugCodeQualifierCode(), claimLine.getRevenueCenterRenderingPhysicianNPI());
        // Common item level fields between Outpatient, HHA and Hospice
        TransformerUtils.mapEobCommonItemRevenueOutHHAHospice(item, claimLine.getRevenueCenterDate(), claimLine.getPaymentAmount());
        // set revenue center status indicator codes for the claim
        item.getRevenue().addExtension(TransformerUtils.createExtensionCoding(eob, CcwCodebookVariable.REV_CNTR_STUS_IND_CD, claimLine.getStatusCode()));
        // Common group level fields between Inpatient, HHA, Hospice and SNF
        TransformerUtils.mapEobCommonGroupInpHHAHospiceSNFCoinsurance(eob, item, claimLine.getDeductibleCoinsuranceCd());
    }
    TransformerUtils.setLastUpdated(eob, claimGroup.getLastUpdated());
    return eob;
}

Example 2 with BenefitComponent

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

the class OutpatientClaimTransformerV2Test 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 3 with BenefitComponent

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

the class DMEClaimTransformerV2Test method shouldHaveCarrClmCashDdctblAmtFinancial.

@Test
public void shouldHaveCarrClmCashDdctblAmtFinancial() {
    BenefitComponent benefit = TransformerTestUtilsV2.findFinancial("https://bluebutton.cms.gov/resources/variables/carr_clm_cash_ddctbl_apld_amt", eob.getBenefitBalanceFirstRep().getFinancial());
    // Need to maintain trailing 0s in USD amount
    BigDecimal amt = new BigDecimal(777.00);
    amt = amt.setScale(2, RoundingMode.HALF_DOWN);
    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/carr_clm_cash_ddctbl_apld_amt", "Carrier Claim Cash Deductible Applied Amount (sum of all line-level deductible amounts)")))).setUsed(new Money().setValue(amt).setCurrency(TransformerConstants.CODED_MONEY_USD));
    assertTrue(compare.equalsDeep(benefit));
}

Example 4 with BenefitComponent

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

the class DMEClaimTransformerV2Test method shouldHaveNchCarrClmAlwdAmtFinancial.

@Test
public void shouldHaveNchCarrClmAlwdAmtFinancial() {
    BenefitComponent benefit = TransformerTestUtilsV2.findFinancial("https://bluebutton.cms.gov/resources/variables/nch_carr_clm_alowd_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/nch_carr_clm_alowd_amt", "NCH Carrier Claim Allowed Charge Amount (sum of all line-level allowed charges)")))).setUsed(new Money().setValue(754.79).setCurrency(TransformerConstants.CODED_MONEY_USD));
    assertTrue(compare.equalsDeep(benefit));
}

Example 5 with BenefitComponent

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

the class InpatientClaimTransformerV2Test method shouldHaveTotCoinsrncDaysCntFinancial.

@Test
public void shouldHaveTotCoinsrncDaysCntFinancial() {
    BenefitComponent benefit = TransformerTestUtilsV2.findFinancial("https://bluebutton.cms.gov/resources/variables/bene_tot_coinsrnc_days_cnt", 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/bene_tot_coinsrnc_days_cnt", "Beneficiary Total Coinsurance Days Count")))).setUsed(new UnsignedIntType(0));
    assertTrue(compare.equalsDeep(benefit));
}