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

Example 6 with ExplanationOfBenefit

use of org.hl7.fhir.r4.model.ExplanationOfBenefit 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 7 with ExplanationOfBenefit

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

the class ExplanationOfBenefitResourceProvider method findByPatient.

/**
 * Adds support for the FHIR "search" operation for {@link ExplanationOfBenefit}s, allowing users
 * to search by {@link ExplanationOfBenefit#getPatient()}.
 *
 * <p>The {@link Search} annotation indicates that this method supports the search operation.
 * There may be many different methods annotated with this {@link Search} annotation, to support
 * many different search criteria.
 *
 * @param patient a {@link ReferenceParam} for the {@link ExplanationOfBenefit#getPatient()} to
 *     try and find matches for {@link ExplanationOfBenefit}s
 * @param type a list of {@link ClaimType} to include in the result. Defaults to all types.
 * @param startIndex an {@link OptionalParam} for the startIndex (or offset) used to determine
 *     pagination
 * @param excludeSamhsa an {@link OptionalParam} that, if <code>"true"</code>, will use {@link
 *     Stu3EobSamhsaMatcher} to filter out all SAMHSA-related claims from the results
 * @param lastUpdated an {@link OptionalParam} that specifies a date range for the lastUpdated
 *     field.
 * @param serviceDate an {@link OptionalParam} that specifies a date range for {@link
 *     ExplanationOfBenefit}s that completed
 * @param requestDetails a {@link RequestDetails} containing the details of the request URL, used
 *     to parse out pagination values
 * @return Returns a {@link Bundle} of {@link ExplanationOfBenefit}s, which may contain multiple
 *     matching resources, or may also be empty.
 */
@Search
@Trace
public Bundle findByPatient(@RequiredParam(name = ExplanationOfBenefit.SP_PATIENT) @Description(shortDefinition = "The patient identifier to search for") ReferenceParam patient, @OptionalParam(name = "type") @Description(shortDefinition = "A list of claim types to include") TokenAndListParam type, @OptionalParam(name = "startIndex") @Description(shortDefinition = "The offset used for result pagination") String startIndex, @OptionalParam(name = "excludeSAMHSA") @Description(shortDefinition = "If true, exclude all SAMHSA-related resources") String excludeSamhsa, @OptionalParam(name = "_lastUpdated") @Description(shortDefinition = "Include resources last updated in the given range") DateRangeParam lastUpdated, @OptionalParam(name = "service-date") @Description(shortDefinition = "Include resources that completed in the given range") DateRangeParam serviceDate, RequestDetails requestDetails) {
    /*
     * startIndex is an optional parameter here because it must be declared in the
     * event it is passed in. However, it is not being used here because it is also
     * contained within requestDetails and parsed out along with other parameters
     * later.
     */
    String beneficiaryId = patient.getIdPart();
    Set<ClaimType> claimTypes = parseTypeParam(type);
    Boolean includeTaxNumbers = returnIncludeTaxNumbers(requestDetails);
    OffsetLinkBuilder paging = new OffsetLinkBuilder(requestDetails, "/ExplanationOfBenefit?");
    Operation operation = new Operation(Operation.Endpoint.V1_EOB);
    operation.setOption("by", "patient");
    operation.setOption("types", (claimTypes.size() == ClaimType.values().length) ? "*" : claimTypes.stream().sorted(Comparator.comparing(ClaimType::name)).collect(Collectors.toList()).toString());
    operation.setOption("IncludeTaxNumbers", "" + includeTaxNumbers);
    operation.setOption("pageSize", paging.isPagingRequested() ? "" + paging.getPageSize() : "*");
    operation.setOption("_lastUpdated", Boolean.toString(lastUpdated != null && !lastUpdated.isEmpty()));
    operation.setOption("service-date", Boolean.toString(serviceDate != null && !serviceDate.isEmpty()));
    operation.publishOperationName();
    List<IBaseResource> eobs = new ArrayList<IBaseResource>();
    // Optimize when the lastUpdated parameter is specified and result set is empty
    if (loadedFilterManager.isResultSetEmpty(beneficiaryId, lastUpdated)) {
        return TransformerUtils.createBundle(paging, eobs, loadedFilterManager.getTransactionTime());
    }
    /*
     * The way our JPA/SQL schema is setup, we have to run a separate search for
     * each claim type, then combine the results. It's not super efficient, but it's
     * also not so inefficient that it's worth fixing.
     */
    if (claimTypes.contains(ClaimType.CARRIER))
        eobs.addAll(transformToEobs(ClaimType.CARRIER, findClaimTypeByPatient(ClaimType.CARRIER, beneficiaryId, lastUpdated, serviceDate), Optional.of(includeTaxNumbers)));
    if (claimTypes.contains(ClaimType.DME))
        eobs.addAll(transformToEobs(ClaimType.DME, findClaimTypeByPatient(ClaimType.DME, beneficiaryId, lastUpdated, serviceDate), Optional.of(includeTaxNumbers)));
    if (claimTypes.contains(ClaimType.HHA))
        eobs.addAll(transformToEobs(ClaimType.HHA, findClaimTypeByPatient(ClaimType.HHA, beneficiaryId, lastUpdated, serviceDate), Optional.of(includeTaxNumbers)));
    if (claimTypes.contains(ClaimType.HOSPICE))
        eobs.addAll(transformToEobs(ClaimType.HOSPICE, findClaimTypeByPatient(ClaimType.HOSPICE, beneficiaryId, lastUpdated, serviceDate), Optional.of(includeTaxNumbers)));
    if (claimTypes.contains(ClaimType.INPATIENT))
        eobs.addAll(transformToEobs(ClaimType.INPATIENT, findClaimTypeByPatient(ClaimType.INPATIENT, beneficiaryId, lastUpdated, serviceDate), Optional.of(includeTaxNumbers)));
    if (claimTypes.contains(ClaimType.OUTPATIENT))
        eobs.addAll(transformToEobs(ClaimType.OUTPATIENT, findClaimTypeByPatient(ClaimType.OUTPATIENT, beneficiaryId, lastUpdated, serviceDate), Optional.of(includeTaxNumbers)));
    if (claimTypes.contains(ClaimType.PDE))
        eobs.addAll(transformToEobs(ClaimType.PDE, findClaimTypeByPatient(ClaimType.PDE, beneficiaryId, lastUpdated, serviceDate), Optional.of(includeTaxNumbers)));
    if (claimTypes.contains(ClaimType.SNF))
        eobs.addAll(transformToEobs(ClaimType.SNF, findClaimTypeByPatient(ClaimType.SNF, beneficiaryId, lastUpdated, serviceDate), Optional.of(includeTaxNumbers)));
    if (Boolean.parseBoolean(excludeSamhsa))
        filterSamhsa(eobs);
    eobs.sort(ExplanationOfBenefitResourceProvider::compareByClaimIdThenClaimType);
    // Add bene_id to MDC logs
    TransformerUtils.logBeneIdToMdc(Arrays.asList(beneficiaryId));
    return TransformerUtils.createBundle(paging, eobs, loadedFilterManager.getTransactionTime());
}

Example 8 with ExplanationOfBenefit

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

the class ExplanationOfBenefitResourceProvider method compareByClaimIdThenClaimType.

/*
   * @param eob1 an {@link ExplanationOfBenefit} to be compared
   *
   * @param eob2 an {@link ExplanationOfBenefit} to be compared
   */
private static int compareByClaimIdThenClaimType(IBaseResource res1, IBaseResource res2) {
    /*
     * In order for paging to be meaningful (and stable), the claims have to be
     * consistently sorted across different app server instances (in case page 1
     * comes from Server A but page 2 comes from Server B). Right now, we don't have
     * anything "useful" to sort by, so we just sort by claim ID (subsorted by claim
     * type). TODO once we have metadata from BLUEBUTTON-XXX on when each claim was
     * first loaded into our DB, we should sort by that.
     */
    ExplanationOfBenefit eob1 = (ExplanationOfBenefit) res1;
    ExplanationOfBenefit eob2 = (ExplanationOfBenefit) res2;
    if (TransformerUtils.getUnprefixedClaimId(eob1) == TransformerUtils.getUnprefixedClaimId(eob2)) {
        return TransformerUtils.getClaimType(eob1).compareTo(TransformerUtils.getClaimType(eob2));
    } else {
        return TransformerUtils.getUnprefixedClaimId(eob1).compareTo(TransformerUtils.getUnprefixedClaimId(eob2));
    }
}

Example 9 with ExplanationOfBenefit

use of org.hl7.fhir.r4.model.ExplanationOfBenefit 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 10 with ExplanationOfBenefit

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

the class HospiceClaimTransformer method transform.

/**
 * @param metricRegistry the {@link MetricRegistry} to use
 * @param claim the CCW {@link HospiceClaim} to transform
 * @param includeTaxNumbers whether or not to include tax numbers in the result (see {@link
 *     ExplanationOfBenefitResourceProvider#HEADER_NAME_INCLUDE_TAX_NUMBERS}, defaults to <code>
 *     false</code>)
 * @return a FHIR {@link ExplanationOfBenefit} resource that represents the specified {@link
 *     HospiceClaim}
 */
@Trace
static ExplanationOfBenefit transform(MetricRegistry metricRegistry, Object claim, Optional<Boolean> includeTaxNumbers) {
    Timer.Context timer = metricRegistry.timer(MetricRegistry.name(HospiceClaimTransformer.class.getSimpleName(), "transform")).time();
    if (!(claim instanceof HospiceClaim))
        throw new BadCodeMonkeyException();
    ExplanationOfBenefit eob = transformClaim((HospiceClaim) claim);
    timer.stop();
    return eob;
}