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

Example 6 with TotalComponent

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

the class R4ExplanationOfBenefitResourceProviderIT method assertEobEquals.

/**
 * Compares two ExplanationOfBenefit objects in detail while working around serialization issues
 * like comparing "0" and "0.0" or creation differences like using "Quantity" vs "SimpleQuantity"
 *
 * @param expected the expected
 * @param actual the actual
 */
private static void assertEobEquals(ExplanationOfBenefit expected, ExplanationOfBenefit actual) {
    // ID in the bundle will have `ExplanationOfBenefit/` in front, so make sure the last bit
    // matches up
    assertTrue(actual.getId().endsWith(expected.getId()));
    // Clean them out so we can do a deep compare later
    actual.setId("");
    expected.setId("");
    // If there are any contained resources, they might have lastupdate times in them too
    assertEquals(expected.getContained().size(), actual.getContained().size());
    for (int i = 0; i < expected.getContained().size(); i++) {
        Resource expectedContained = expected.getContained().get(i);
        Resource actualContained = actual.getContained().get(i);
        expectedContained.getMeta().setLastUpdated(null);
        actualContained.getMeta().setLastUpdated(null);
        // TODO: HAPI seems to be inserting the `#` in the ID of the contained element.
        // This is incorrect according to the FHIR spec:
        // https://build.fhir.org/references.html#contained
        // This works around that problem
        assertEquals("#" + expectedContained.getId(), actualContained.getId());
        expectedContained.setId("");
        actualContained.setId("");
    }
    // Dates are not easy to compare so just make sure they are there
    assertNotNull(actual.getMeta().getLastUpdated());
    // We compared all of meta that we care about so get it out of the way
    expected.getMeta().setLastUpdated(null);
    actual.getMeta().setLastUpdated(null);
    // Created is required, but can't be compared
    assertNotNull(actual.getCreated());
    expected.setCreated(null);
    actual.setCreated(null);
    // Extensions may have `valueMoney` elements
    assertEquals(expected.getExtension().size(), actual.getExtension().size());
    for (int i = 0; i < expected.getExtension().size(); i++) {
        Extension expectedEx = expected.getExtension().get(i);
        Extension actualEx = actual.getExtension().get(i);
        // We have to deal with Money objects separately
        if (expectedEx.hasValue() && expectedEx.getValue() instanceof Money) {
            assertTrue(actualEx.getValue() instanceof Money);
            assertCurrencyEquals((Money) expectedEx.getValue(), (Money) actualEx.getValue());
            // Now remove since we validated so we can compare the rest directly
            expectedEx.setValue(null);
            actualEx.setValue(null);
        }
    }
    // SupportingInfo can have `valueQuantity` that has the 0 vs 0.0 issue
    assertEquals(expected.getSupportingInfo().size(), actual.getSupportingInfo().size());
    for (int i = 0; i < expected.getSupportingInfo().size(); i++) {
        SupportingInformationComponent expectedSup = expected.getSupportingInfo().get(i);
        SupportingInformationComponent actualSup = actual.getSupportingInfo().get(i);
        // We have to deal with Money objects separately
        if (expectedSup.hasValueQuantity()) {
            assertTrue(actualSup.hasValueQuantity());
            assertEquals(expectedSup.getValueQuantity().getValue().floatValue(), actualSup.getValueQuantity().getValue().floatValue(), 0.0);
            // Now remove since we validated so we can compare the rest directly
            expectedSup.setValue(null);
            actualSup.setValue(null);
        }
    }
    // line items
    assertEquals(expected.getItem().size(), actual.getItem().size());
    for (int i = 0; i < expected.getItem().size(); i++) {
        ItemComponent expectedItem = expected.getItem().get(i);
        ItemComponent actualItem = actual.getItem().get(i);
        // Compare value directly because SimpleQuantity vs Quantity can't be compared
        assertEquals(expectedItem.getQuantity().getValue().floatValue(), actualItem.getQuantity().getValue().floatValue(), 0.0);
        expectedItem.setQuantity(null);
        actualItem.setQuantity(null);
        assertEquals(expectedItem.getAdjudication().size(), actualItem.getAdjudication().size());
        for (int j = 0; j < expectedItem.getAdjudication().size(); j++) {
            AdjudicationComponent expectedAdj = expectedItem.getAdjudication().get(j);
            AdjudicationComponent actualAdj = actualItem.getAdjudication().get(j);
            // Here is where we start getting into trouble with "0" vs "0.0", so we do this manually
            if (expectedAdj.hasAmount()) {
                assertNotNull(actualAdj.getAmount());
                assertCurrencyEquals(expectedAdj.getAmount(), actualAdj.getAmount());
            } else {
                // If expected doesn't have an amount, actual shouldn't
                assertFalse(actualAdj.hasAmount());
            }
            // We just checked manually, so null them out and check the rest of the fields
            expectedAdj.setAmount(null);
            actualAdj.setAmount(null);
        }
    }
    // Total has the same problem with values
    assertEquals(expected.getTotal().size(), actual.getTotal().size());
    for (int i = 0; i < expected.getTotal().size(); i++) {
        TotalComponent expectedTot = expected.getTotal().get(i);
        TotalComponent actualTot = actual.getTotal().get(i);
        if (expectedTot.hasAmount()) {
            assertNotNull(actualTot.getAmount());
            assertCurrencyEquals(expectedTot.getAmount(), actualTot.getAmount());
        } else {
            // If expected doesn't have an amount, actual shouldn't
            assertFalse(actualTot.hasAmount());
        }
        expectedTot.setAmount(null);
        actualTot.setAmount(null);
    }
    // Benefit Balance Financial components
    assertEquals(expected.getBenefitBalance().size(), actual.getBenefitBalance().size());
    for (int i = 0; i < expected.getBenefitBalance().size(); i++) {
        BenefitBalanceComponent expectedBen = expected.getBenefitBalance().get(i);
        BenefitBalanceComponent actualBen = actual.getBenefitBalance().get(i);
        assertEquals(expectedBen.getFinancial().size(), actualBen.getFinancial().size());
        for (int j = 0; j < expectedBen.getFinancial().size(); j++) {
            BenefitComponent expectedFinancial = expectedBen.getFinancial().get(j);
            BenefitComponent actualFinancial = actualBen.getFinancial().get(j);
            // Are we dealing with Money?
            if (expectedFinancial.hasUsedMoney()) {
                assertNotNull(actualFinancial.getUsedMoney());
                assertCurrencyEquals(expectedFinancial.getUsedMoney(), actualFinancial.getUsedMoney());
                // Clean up
                expectedFinancial.setUsed(null);
                actualFinancial.setUsed(null);
            }
        }
    }
    // As does payment
    if (expected.hasPayment()) {
        assertTrue(actual.hasPayment());
        assertCurrencyEquals(expected.getPayment().getAmount(), actual.getPayment().getAmount());
    } else {
        // If expected doesn't have an amount, actual shouldn't
        assertFalse(actual.hasPayment());
    }
    expected.getPayment().setAmount(null);
    actual.getPayment().setAmount(null);
    // Now for the grand finale, we can do an `equalsDeep` on the rest
    assertTrue(expected.equalsDeep(actual));
}

Example 7 with TotalComponent

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

the class SNFClaimTransformerV2Test method shouldHaveClmTotChrgAmtTotal.

@Test
public void shouldHaveClmTotChrgAmtTotal() {
    // Only one so just pull it directly and compare
    TotalComponent total = eob.getTotalFirstRep();
    TotalComponent compare = new TotalComponent().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/clm_tot_chrg_amt", "Claim Total Charge Amount")))).setAmount(new Money().setValue(5555.03).setCurrency(TransformerConstants.CODED_MONEY_USD));
    assertTrue(compare.equalsDeep(total));
}

Example 8 with TotalComponent

use of org.hl7.fhir.r4.model.ExplanationOfBenefit.TotalComponent in project synthea by synthetichealth.

the class FhirR4 method explanationOfBenefit.

/**
 * Create an explanation of benefit resource for each claim, detailing insurance
 * information.
 *
 * @param personEntry Entry for the person
 * @param bundle The Bundle to add to
 * @param encounterEntry The current Encounter
 * @param claimEntry the Claim object
 * @param person the person the health record belongs to
 * @param encounter the current Encounter as an object
 * @return the added entry
 */
private static BundleEntryComponent explanationOfBenefit(BundleEntryComponent personEntry, Bundle bundle, BundleEntryComponent encounterEntry, Person person, BundleEntryComponent claimEntry, Encounter encounter) {
    ExplanationOfBenefit eob = new ExplanationOfBenefit();
    eob.setStatus(org.hl7.fhir.r4.model.ExplanationOfBenefit.ExplanationOfBenefitStatus.ACTIVE);
    eob.setType(new CodeableConcept().addCoding(new Coding().setSystem("http://terminology.hl7.org/CodeSystem/claim-type").setCode("professional").setDisplay("Professional")));
    eob.setUse(Use.CLAIM);
    eob.setOutcome(RemittanceOutcome.COMPLETE);
    org.hl7.fhir.r4.model.Encounter encounterResource = (org.hl7.fhir.r4.model.Encounter) encounterEntry.getResource();
    // according to CMS guidelines claims have 12 months to be
    // billed, so we set the billable period to 1 year after
    // services have ended (the encounter ends).
    Calendar cal = Calendar.getInstance();
    cal.setTime(encounterResource.getPeriod().getEnd());
    cal.add(Calendar.YEAR, 1);
    Period billablePeriod = new Period().setStart(encounterResource.getPeriod().getEnd()).setEnd(cal.getTime());
    eob.setBillablePeriod(billablePeriod);
    // cost is hardcoded to be USD in claim so this should be fine as well
    Money totalCost = new Money();
    totalCost.setCurrency("USD");
    totalCost.setValue(encounter.claim.getTotalClaimCost());
    TotalComponent total = eob.addTotal();
    total.setAmount(totalCost);
    Code submitted = new Code("http://terminology.hl7.org/CodeSystem/adjudication", "submitted", "Submitted Amount");
    total.setCategory(mapCodeToCodeableConcept(submitted, "http://terminology.hl7.org/CodeSystem/adjudication"));
    // Set References
    eob.setPatient(new Reference(personEntry.getFullUrl()));
    if (USE_US_CORE_IG) {
        eob.setFacility(encounterResource.getLocationFirstRep().getLocation());
    }
    ServiceRequest referral = (ServiceRequest) new ServiceRequest().setStatus(ServiceRequest.ServiceRequestStatus.COMPLETED).setIntent(ServiceRequest.ServiceRequestIntent.ORDER).setSubject(new Reference(personEntry.getFullUrl())).setId("referral");
    CodeableConcept primaryCareRole = new CodeableConcept().addCoding(new Coding().setCode("primary").setSystem("http://terminology.hl7.org/CodeSystem/claimcareteamrole").setDisplay("Primary Care Practitioner"));
    Reference providerReference = new Reference().setDisplay("Unknown");
    if (encounter.clinician != null) {
        String practitionerFullUrl = TRANSACTION_BUNDLE ? ExportHelper.buildFhirNpiSearchUrl(encounter.clinician) : findPractitioner(encounter.clinician, bundle);
        if (practitionerFullUrl != null) {
            providerReference = new Reference(practitionerFullUrl);
        }
    } else if (encounter.provider != null) {
        String providerUrl = TRANSACTION_BUNDLE ? ExportHelper.buildFhirSearchUrl("Location", encounter.provider.getResourceLocationID()) : findProviderUrl(encounter.provider, bundle);
        if (providerUrl != null) {
            providerReference = new Reference(providerUrl);
        }
    }
    eob.setProvider(providerReference);
    eob.addCareTeam(new ExplanationOfBenefit.CareTeamComponent().setSequence(1).setProvider(providerReference).setRole(primaryCareRole));
    referral.setRequester(providerReference);
    referral.addPerformer(providerReference);
    eob.addContained(referral);
    eob.setReferral(new Reference().setReference("#referral"));
    // Get the insurance info at the time that the encounter occurred.
    Payer payer = encounter.claim.payer;
    Coverage coverage = new Coverage();
    coverage.setId("coverage");
    coverage.setStatus(CoverageStatus.ACTIVE);
    coverage.setType(new CodeableConcept().setText(payer.getName()));
    coverage.setBeneficiary(new Reference(personEntry.getFullUrl()));
    coverage.addPayor(new Reference().setDisplay(payer.getName()));
    eob.addContained(coverage);
    ExplanationOfBenefit.InsuranceComponent insuranceComponent = new ExplanationOfBenefit.InsuranceComponent();
    insuranceComponent.setFocal(true);
    insuranceComponent.setCoverage(new Reference("#coverage").setDisplay(payer.getName()));
    eob.addInsurance(insuranceComponent);
    eob.setInsurer(new Reference().setDisplay(payer.getName()));
    org.hl7.fhir.r4.model.Claim claim = (org.hl7.fhir.r4.model.Claim) claimEntry.getResource();
    eob.addIdentifier().setSystem("https://bluebutton.cms.gov/resources/variables/clm_id").setValue(claim.getId());
    // Hardcoded group id
    eob.addIdentifier().setSystem("https://bluebutton.cms.gov/resources/identifier/claim-group").setValue("99999999999");
    eob.setClaim(new Reference().setReference(claimEntry.getFullUrl()));
    eob.setCreated(encounterResource.getPeriod().getEnd());
    eob.setType(claim.getType());
    List<ExplanationOfBenefit.DiagnosisComponent> eobDiag = new ArrayList<>();
    for (org.hl7.fhir.r4.model.Claim.DiagnosisComponent claimDiagnosis : claim.getDiagnosis()) {
        ExplanationOfBenefit.DiagnosisComponent diagnosisComponent = new ExplanationOfBenefit.DiagnosisComponent();
        diagnosisComponent.setDiagnosis(claimDiagnosis.getDiagnosis());
        diagnosisComponent.getType().add(new CodeableConcept().addCoding(new Coding().setCode("principal").setSystem("http://terminology.hl7.org/CodeSystem/ex-diagnosistype")));
        diagnosisComponent.setSequence(claimDiagnosis.getSequence());
        diagnosisComponent.setPackageCode(claimDiagnosis.getPackageCode());
        eobDiag.add(diagnosisComponent);
    }
    eob.setDiagnosis(eobDiag);
    List<ExplanationOfBenefit.ProcedureComponent> eobProc = new ArrayList<>();
    for (ProcedureComponent proc : claim.getProcedure()) {
        ExplanationOfBenefit.ProcedureComponent p = new ExplanationOfBenefit.ProcedureComponent();
        p.setDate(proc.getDate());
        p.setSequence(proc.getSequence());
        p.setProcedure(proc.getProcedure());
    }
    eob.setProcedure(eobProc);
    List<ExplanationOfBenefit.ItemComponent> eobItem = new ArrayList<>();
    double totalPayment = 0;
    // Get all the items info from the claim
    for (ItemComponent item : claim.getItem()) {
        ExplanationOfBenefit.ItemComponent itemComponent = new ExplanationOfBenefit.ItemComponent();
        itemComponent.setSequence(item.getSequence());
        itemComponent.setQuantity(item.getQuantity());
        itemComponent.setUnitPrice(item.getUnitPrice());
        itemComponent.setCareTeamSequence(item.getCareTeamSequence());
        itemComponent.setDiagnosisSequence(item.getDiagnosisSequence());
        itemComponent.setInformationSequence(item.getInformationSequence());
        itemComponent.setNet(item.getNet());
        itemComponent.setEncounter(item.getEncounter());
        itemComponent.setServiced(encounterResource.getPeriod());
        itemComponent.setCategory(new CodeableConcept().addCoding(new Coding().setSystem("https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd").setCode("1").setDisplay("Medical care")));
        itemComponent.setProductOrService(item.getProductOrService());
        // Location of service, can use switch statement based on
        // encounter type
        String code;
        String display;
        CodeableConcept location = new CodeableConcept();
        EncounterType encounterType = EncounterType.fromString(encounter.type);
        switch(encounterType) {
            case AMBULATORY:
                code = "21";
                display = "Inpatient Hospital";
                break;
            case EMERGENCY:
                code = "20";
                display = "Urgent Care Facility";
                break;
            case INPATIENT:
                code = "21";
                display = "Inpatient Hospital";
                break;
            case URGENTCARE:
                code = "20";
                display = "Urgent Care Facility";
                break;
            case WELLNESS:
                code = "19";
                display = "Off Campus-Outpatient Hospital";
                break;
            default:
                code = "21";
                display = "Inpatient Hospital";
        }
        location.addCoding().setCode(code).setSystem("http://terminology.hl7.org/CodeSystem/ex-serviceplace").setDisplay(display);
        itemComponent.setLocation(location);
        // Adjudication
        if (item.hasNet()) {
            // Assume that the patient has already paid deductible and
            // has 20/80 coinsurance
            ExplanationOfBenefit.AdjudicationComponent coinsuranceAmount = new ExplanationOfBenefit.AdjudicationComponent();
            coinsuranceAmount.getCategory().getCoding().add(new Coding().setCode("https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt").setSystem("https://bluebutton.cms.gov/resources/codesystem/adjudication").setDisplay("Line Beneficiary Coinsurance Amount"));
            coinsuranceAmount.getAmount().setValue(// 20% coinsurance
            0.2 * item.getNet().getValue().doubleValue()).setCurrency("USD");
            ExplanationOfBenefit.AdjudicationComponent lineProviderAmount = new ExplanationOfBenefit.AdjudicationComponent();
            lineProviderAmount.getCategory().getCoding().add(new Coding().setCode("https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt").setSystem("https://bluebutton.cms.gov/resources/codesystem/adjudication").setDisplay("Line Provider Payment Amount"));
            lineProviderAmount.getAmount().setValue(0.8 * item.getNet().getValue().doubleValue()).setCurrency("USD");
            // assume the allowed and submitted amounts are the same for now
            ExplanationOfBenefit.AdjudicationComponent submittedAmount = new ExplanationOfBenefit.AdjudicationComponent();
            submittedAmount.getCategory().getCoding().add(new Coding().setCode("https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt").setSystem("https://bluebutton.cms.gov/resources/codesystem/adjudication").setDisplay("Line Submitted Charge Amount"));
            submittedAmount.getAmount().setValue(item.getNet().getValue()).setCurrency("USD");
            ExplanationOfBenefit.AdjudicationComponent allowedAmount = new ExplanationOfBenefit.AdjudicationComponent();
            allowedAmount.getCategory().getCoding().add(new Coding().setCode("https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt").setSystem("https://bluebutton.cms.gov/resources/codesystem/adjudication").setDisplay("Line Allowed Charge Amount"));
            allowedAmount.getAmount().setValue(item.getNet().getValue()).setCurrency("USD");
            ExplanationOfBenefit.AdjudicationComponent indicatorCode = new ExplanationOfBenefit.AdjudicationComponent();
            indicatorCode.getCategory().getCoding().add(new Coding().setCode("https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd").setSystem("https://bluebutton.cms.gov/resources/codesystem/adjudication").setDisplay("Line Processing Indicator Code"));
            // assume deductible is 0
            ExplanationOfBenefit.AdjudicationComponent deductibleAmount = new ExplanationOfBenefit.AdjudicationComponent();
            deductibleAmount.getCategory().getCoding().add(new Coding().setCode("https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt").setSystem("https://bluebutton.cms.gov/resources/codesystem/adjudication").setDisplay("Line Beneficiary Part B Deductible Amount"));
            deductibleAmount.getAmount().setValue(0).setCurrency("USD");
            List<ExplanationOfBenefit.AdjudicationComponent> adjudicationComponents = new ArrayList<>();
            adjudicationComponents.add(coinsuranceAmount);
            adjudicationComponents.add(lineProviderAmount);
            adjudicationComponents.add(submittedAmount);
            adjudicationComponents.add(allowedAmount);
            adjudicationComponents.add(deductibleAmount);
            adjudicationComponents.add(indicatorCode);
            itemComponent.setAdjudication(adjudicationComponents);
            // the total payment is what the insurance ends up paying
            totalPayment += 0.8 * item.getNet().getValue().doubleValue();
        }
        eobItem.add(itemComponent);
    }
    eob.setItem(eobItem);
    // This will throw a validation error no matter what.  The
    // payment section is required, and it requires a value.
    // The validator will complain that if there is a value, the payment
    // needs a code, but it will also complain if there is a code.
    // There is no way to resolve this error.
    Money payment = new Money();
    payment.setValue(totalPayment).setCurrency("USD");
    eob.setPayment(new ExplanationOfBenefit.PaymentComponent().setAmount(payment));
    return newEntry(person, bundle, eob);
}

Example 9 with TotalComponent

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

the class CarrierClaimTransformerV2Test method shouldHaveClmTotChrgAmtTotal.

@Test
public void shouldHaveClmTotChrgAmtTotal() {
    // Only one so just pull it directly and compare
    TotalComponent total = eob.getTotalFirstRep();
    TotalComponent compare = new TotalComponent().setCategory(new CodeableConcept().setCoding(Arrays.asList(new Coding("http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudication", "priorpayerpaid", "Prior payer paid"), new Coding("https://bluebutton.cms.gov/resources/codesystem/adjudication", "https://bluebutton.cms.gov/resources/variables/clm_tot_chrg_amt", "Claim Total Charge Amount")))).setAmount(new Money().setValue(0).setCurrency(TransformerConstants.CODED_MONEY_USD));
    assertTrue(compare.equalsDeep(total));
}