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

Example 1 with ItemComponent

use of org.hl7.fhir.r4.model.ExplanationOfBenefit.ItemComponent 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 2 with ItemComponent

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

the class TransformerUtils method mapHcpcs.

/**
 * @param eob the {@link ExplanationOfBenefit} that the HCPCS code is being mapped into
 * @param item the {@link ItemComponent} that the HCPCS code is being mapped into
 * @param hcpcsYear the {@link CcwCodebookVariable#CARR_CLM_HCPCS_YR_CD} identifying the HCPCS
 *     code version in use
 * @param hcpcs the {@link CcwCodebookVariable#HCPCS_CD} to be mapped
 * @param hcpcsModifiers the {@link CcwCodebookVariable#HCPCS_1ST_MDFR_CD}, etc. values to be
 *     mapped (if any)
 */
static void mapHcpcs(ExplanationOfBenefit eob, ItemComponent item, Optional<Character> hcpcsYear, Optional<String> hcpcs, List<Optional<String>> hcpcsModifiers) {
    // Create and map all of the possible CodeableConcepts.
    CodeableConcept hcpcsConcept = hcpcs.isPresent() ? createCodeableConcept(TransformerConstants.CODING_SYSTEM_HCPCS, hcpcs.get()) : null;
    if (hcpcsConcept != null)
        item.setService(hcpcsConcept);
    List<CodeableConcept> hcpcsModifierConcepts = new ArrayList<>(4);
    for (Optional<String> hcpcsModifier : hcpcsModifiers) {
        if (!hcpcsModifier.isPresent())
            continue;
        CodeableConcept hcpcsModifierConcept = createCodeableConcept(TransformerConstants.CODING_SYSTEM_HCPCS, hcpcsModifier.get());
        hcpcsModifierConcepts.add(hcpcsModifierConcept);
        item.addModifier(hcpcsModifierConcept);
    }
    // Set Coding.version for all of the mappings, if it's available.
    Stream.concat(Arrays.asList(hcpcsConcept).stream(), hcpcsModifierConcepts.stream()).forEach(concept -> {
        if (concept == null)
            return;
        if (!hcpcsYear.isPresent())
            return;
        // Note: Only CARRIER and DME claims have the year/version field.
        concept.getCodingFirstRep().setVersion(hcpcsYear.get().toString());
    });
}

Example 3 with ItemComponent

use of org.hl7.fhir.r4.model.ExplanationOfBenefit.ItemComponent 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 4 with ItemComponent

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

the class InpatientClaimTransformer method transformClaim.

/**
 * @param claimGroup the CCW {@link InpatientClaim} to transform
 * @return a FHIR {@link ExplanationOfBenefit} resource that represents the specified {@link
 *     InpatientClaim}
 */
private static ExplanationOfBenefit transformClaim(InpatientClaim claimGroup) {
    ExplanationOfBenefit eob = new ExplanationOfBenefit();
    // Common group level fields between all claim types
    TransformerUtils.mapEobCommonClaimHeaderData(eob, claimGroup.getClaimId(), claimGroup.getBeneficiaryId(), ClaimType.INPATIENT, claimGroup.getClaimGroupId().toPlainString(), MedicareSegment.PART_A, 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.INPATIENT, Optional.of(claimGroup.getNearLineRecordIdCode()), Optional.of(claimGroup.getClaimTypeCode()));
    // set the provider number which is common among several claim types
    TransformerUtils.setProviderNumber(eob, claimGroup.getProviderNumber());
    if (claimGroup.getPatientStatusCd().isPresent()) {
        TransformerUtils.addInformationWithCode(eob, CcwCodebookVariable.NCH_PTNT_STUS_IND_CD, CcwCodebookVariable.NCH_PTNT_STUS_IND_CD, claimGroup.getPatientStatusCd());
    }
    // add EOB information to fields that are common between the Inpatient and SNF claim types
    TransformerUtils.addCommonEobInformationInpatientSNF(eob, claimGroup.getAdmissionTypeCd(), claimGroup.getSourceAdmissionCd(), claimGroup.getNoncoveredStayFromDate(), claimGroup.getNoncoveredStayThroughDate(), claimGroup.getCoveredCareThoughDate(), claimGroup.getMedicareBenefitsExhaustedDate(), claimGroup.getDiagnosisRelatedGroupCd());
    // Claim Operational Indirect Medical Education Amount
    if (claimGroup.getIndirectMedicalEducationAmount().isPresent()) {
        TransformerUtils.addAdjudicationTotal(eob, CcwCodebookVariable.IME_OP_CLM_VAL_AMT, claimGroup.getIndirectMedicalEducationAmount());
    }
    // Claim Operational disproportionate Amount
    if (claimGroup.getDisproportionateShareAmount().isPresent()) {
        TransformerUtils.addAdjudicationTotal(eob, CcwCodebookVariable.DSH_OP_CLM_VAL_AMT, claimGroup.getDisproportionateShareAmount());
    }
    // TODO If actually nullable, should be Optional.
    if (claimGroup.getPassThruPerDiemAmount() != null) {
        TransformerUtils.addAdjudicationTotal(eob, CcwCodebookVariable.CLM_PASS_THRU_PER_DIEM_AMT, claimGroup.getPassThruPerDiemAmount());
    }
    // TODO If actually nullable, should be Optional.
    if (claimGroup.getProfessionalComponentCharge() != null) {
        TransformerUtils.addAdjudicationTotal(eob, CcwCodebookVariable.NCH_PROFNL_CMPNT_CHRG_AMT, claimGroup.getProfessionalComponentCharge());
    }
    // TODO If actually nullable, should be Optional.
    if (claimGroup.getClaimTotalPPSCapitalAmount() != null) {
        TransformerUtils.addAdjudicationTotal(eob, CcwCodebookVariable.CLM_TOT_PPS_CPTL_AMT, claimGroup.getClaimTotalPPSCapitalAmount());
    }
    if (claimGroup.getIndirectMedicalEducationAmount().isPresent()) {
        TransformerUtils.addAdjudicationTotal(eob, CcwCodebookVariable.IME_OP_CLM_VAL_AMT, claimGroup.getIndirectMedicalEducationAmount().get());
    }
    // Claim Uncompensated Care Payment Amount
    if (claimGroup.getClaimUncompensatedCareAmount().isPresent()) {
        TransformerUtils.addAdjudicationTotal(eob, CcwCodebookVariable.CLM_UNCOMPD_CARE_PMT_AMT, claimGroup.getClaimUncompensatedCareAmount().get());
    }
    /*
     * add field values to the benefit balances that are common between the
     * Inpatient and SNF claim types
     */
    TransformerUtils.addCommonGroupInpatientSNF(eob, claimGroup.getCoinsuranceDayCount(), claimGroup.getNonUtilizationDayCount(), claimGroup.getDeductibleAmount(), claimGroup.getPartACoinsuranceLiabilityAmount(), claimGroup.getBloodPintsFurnishedQty(), claimGroup.getNoncoveredCharge(), claimGroup.getTotalDeductionAmount(), claimGroup.getClaimPPSCapitalDisproportionateShareAmt(), claimGroup.getClaimPPSCapitalExceptionAmount(), claimGroup.getClaimPPSCapitalFSPAmount(), claimGroup.getClaimPPSCapitalIMEAmount(), claimGroup.getClaimPPSCapitalOutlierAmount(), claimGroup.getClaimPPSOldCapitalHoldHarmlessAmount());
    // TODO If this is actually nullable, should be Optional.
    if (claimGroup.getDrgOutlierApprovedPaymentAmount() != null) {
        TransformerUtils.addAdjudicationTotal(eob, CcwCodebookVariable.NCH_DRG_OUTLIER_APRVD_PMT_AMT, claimGroup.getDrgOutlierApprovedPaymentAmount());
    }
    // Common group level fields between Inpatient, Outpatient and SNF
    TransformerUtils.mapEobCommonGroupInpOutSNF(eob, claimGroup.getBloodDeductibleLiabilityAmount(), claimGroup.getOperatingPhysicianNpi(), claimGroup.getOtherPhysicianNpi(), claimGroup.getClaimQueryCode(), claimGroup.getMcoPaidSw());
    // 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());
    // Common group level fields between Inpatient, HHA, Hospice and SNF
    TransformerUtils.mapEobCommonGroupInpHHAHospiceSNF(eob, claimGroup.getClaimAdmissionDate(), claimGroup.getBeneficiaryDischargeDate(), Optional.of(claimGroup.getUtilizationDayCount()));
    for (Diagnosis diagnosis : extractDiagnoses(claimGroup)) TransformerUtils.addDiagnosisCode(eob, diagnosis);
    for (CCWProcedure procedure : TransformerUtils.extractCCWProcedures(claimGroup.getProcedure1Code(), claimGroup.getProcedure1CodeVersion(), claimGroup.getProcedure1Date(), claimGroup.getProcedure2Code(), claimGroup.getProcedure2CodeVersion(), claimGroup.getProcedure2Date(), claimGroup.getProcedure3Code(), claimGroup.getProcedure3CodeVersion(), claimGroup.getProcedure3Date(), claimGroup.getProcedure4Code(), claimGroup.getProcedure4CodeVersion(), claimGroup.getProcedure4Date(), claimGroup.getProcedure5Code(), claimGroup.getProcedure5CodeVersion(), claimGroup.getProcedure5Date(), claimGroup.getProcedure6Code(), claimGroup.getProcedure6CodeVersion(), claimGroup.getProcedure6Date(), claimGroup.getProcedure7Code(), claimGroup.getProcedure7CodeVersion(), claimGroup.getProcedure7Date(), claimGroup.getProcedure8Code(), claimGroup.getProcedure8CodeVersion(), claimGroup.getProcedure8Date(), claimGroup.getProcedure9Code(), claimGroup.getProcedure9CodeVersion(), claimGroup.getProcedure9Date(), claimGroup.getProcedure10Code(), claimGroup.getProcedure10CodeVersion(), claimGroup.getProcedure10Date(), claimGroup.getProcedure11Code(), claimGroup.getProcedure11CodeVersion(), claimGroup.getProcedure11Date(), claimGroup.getProcedure12Code(), claimGroup.getProcedure12CodeVersion(), claimGroup.getProcedure12Date(), claimGroup.getProcedure13Code(), claimGroup.getProcedure13CodeVersion(), claimGroup.getProcedure13Date(), claimGroup.getProcedure14Code(), claimGroup.getProcedure14CodeVersion(), claimGroup.getProcedure14Date(), claimGroup.getProcedure15Code(), claimGroup.getProcedure15CodeVersion(), claimGroup.getProcedure15Date(), claimGroup.getProcedure16Code(), claimGroup.getProcedure16CodeVersion(), claimGroup.getProcedure16Date(), claimGroup.getProcedure17Code(), claimGroup.getProcedure17CodeVersion(), claimGroup.getProcedure17Date(), claimGroup.getProcedure18Code(), claimGroup.getProcedure18CodeVersion(), claimGroup.getProcedure18Date(), claimGroup.getProcedure19Code(), claimGroup.getProcedure19CodeVersion(), claimGroup.getProcedure19Date(), claimGroup.getProcedure20Code(), claimGroup.getProcedure20CodeVersion(), claimGroup.getProcedure20Date(), claimGroup.getProcedure21Code(), claimGroup.getProcedure21CodeVersion(), claimGroup.getProcedure21Date(), claimGroup.getProcedure22Code(), claimGroup.getProcedure22CodeVersion(), claimGroup.getProcedure22Date(), claimGroup.getProcedure23Code(), claimGroup.getProcedure23CodeVersion(), claimGroup.getProcedure23Date(), claimGroup.getProcedure24Code(), claimGroup.getProcedure24CodeVersion(), claimGroup.getProcedure24Date(), claimGroup.getProcedure25Code(), claimGroup.getProcedure25CodeVersion(), claimGroup.getProcedure25Date())) TransformerUtils.addProcedureCode(eob, procedure);
    for (InpatientClaimLine claimLine : claimGroup.getLines()) {
        ItemComponent item = eob.addItem();
        item.setSequence(claimLine.getLineNumber().intValue());
        TransformerUtils.mapHcpcs(eob, item, Optional.empty(), claimLine.getHcpcsCode(), Collections.emptyList());
        item.setLocation(new Address().setState((claimGroup.getProviderStateCode())));
        // Common item level fields between Inpatient, Outpatient, HHA, Hospice and SNF
        TransformerUtils.mapEobCommonItemRevenue(item, eob, claimLine.getRevenueCenter(), claimLine.getRateAmount(), claimLine.getTotalChargeAmount(), claimLine.getNonCoveredChargeAmount(), claimLine.getUnitCount(), claimLine.getNationalDrugCodeQuantity(), claimLine.getNationalDrugCodeQualifierCode(), claimLine.getRevenueCenterRenderingPhysicianNPI());
        // Common group level field coinsurance between Inpatient, HHA, Hospice and SNF
        TransformerUtils.mapEobCommonGroupInpHHAHospiceSNFCoinsurance(eob, item, claimLine.getDeductibleCoinsuranceCd());
    }
    TransformerUtils.setLastUpdated(eob, claimGroup.getLastUpdated());
    return eob;
}

Example 5 with ItemComponent

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

the class TransformerUtilsV2 method mapHcpcs.

/**
 * @param eob the {@link ExplanationOfBenefit} that the HCPCS code is being mapped into
 * @param item the {@link ItemComponent} that the HCPCS code is being mapped into
 * @param year the {@link CcwCodebookVariable#CARR_CLM_HCPCS_YR_CD} identifying the HCPCS code
 *     version in use
 * @param modifiers the {@link CcwCodebookVariable#HCPCS_1ST_MDFR_CD}, etc. values to be mapped
 *     (if any)
 */
static void mapHcpcs(ExplanationOfBenefit eob, ItemComponent item, Optional<String> hcpcsCode, Optional<Character> year, List<Optional<String>> modifiers) {
    hcpcsCode.ifPresent(code -> item.setProductOrService(createCodeableConcept(TransformerConstants.CODING_SYSTEM_HCPCS, code)));
    for (Optional<String> hcpcsModifier : modifiers) {
        if (hcpcsModifier.isPresent()) {
            CodeableConcept modifier = createCodeableConcept(TransformerConstants.CODING_SYSTEM_HCPCS, hcpcsModifier.get());
            // Set Coding.version for all of the mappings, if it's available.
            if (year.isPresent()) {
                // Note: Only CARRIER and DME claims have the year/version field.
                modifier.getCodingFirstRep().setVersion(year.get().toString());
            }
            item.addModifier(modifier);
        }
    }
}