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

Example 11 with ExplanationOfBenefit

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

the class InpatientClaimTransformer method transform.

/**
 * @param metricRegistry the {@link MetricRegistry} to use
 * @param claim the CCW {@link InpatientClaim} 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
 *     InpatientClaim}
 */
@Trace
static ExplanationOfBenefit transform(MetricRegistry metricRegistry, Object claim, Optional<Boolean> includeTaxNumbers) {
    Timer.Context timer = metricRegistry.timer(MetricRegistry.name(InpatientClaimTransformer.class.getSimpleName(), "transform")).time();
    if (!(claim instanceof InpatientClaim))
        throw new BadCodeMonkeyException();
    ExplanationOfBenefit eob = transformClaim((InpatientClaim) claim);
    timer.stop();
    return eob;
}

Example 12 with ExplanationOfBenefit

use of org.hl7.fhir.r4.model.ExplanationOfBenefit 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 13 with ExplanationOfBenefit

use of org.hl7.fhir.r4.model.ExplanationOfBenefit 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);
        }
    }
}

Example 14 with ExplanationOfBenefit

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

the class TransformerUtilsV2 method mapEobType.

/**
 * maps a blue button claim type to a FHIR claim type
 *
 * @param eob the {@link CodeableConcept} that will get remapped
 * @param blueButtonClaimType the blue button {@link ClaimTypeV2} we are mapping from
 * @param ccwNearLineRecordIdCode if present, the blue button near line id code {@link
 *     Optional}<{@link Character}> gets remapped to a ccw record id code
 * @param ccwClaimTypeCode if present, the blue button claim type code {@link Optional}<{@link
 *     String}> gets remapped to a nch claim type code
 */
static void mapEobType(ExplanationOfBenefit eob, ClaimTypeV2 blueButtonClaimType, Optional<Character> ccwNearLineRecordIdCode, Optional<String> ccwClaimTypeCode) {
    // NCH_CLM_TYPE_CD => ExplanationOfBenefit.type.coding
    if (ccwClaimTypeCode.isPresent()) {
        eob.getType().addCoding(createCoding(eob, CcwCodebookVariable.NCH_CLM_TYPE_CD, ccwClaimTypeCode));
    }
    // This Coding MUST always be present as it's the only one we can definitely map
    // for all 8 of our claim types.
    // EOB Type => ExplanationOfBenefit.type.coding
    eob.getType().addCoding().setSystem(TransformerConstants.CODING_SYSTEM_BBAPI_EOB_TYPE).setCode(blueButtonClaimType.name());
    // Map a Coding for FHIR's ClaimType coding system, if we can.
    org.hl7.fhir.r4.model.codesystems.ClaimType fhirClaimType;
    switch(blueButtonClaimType) {
        case PDE:
            fhirClaimType = org.hl7.fhir.r4.model.codesystems.ClaimType.PHARMACY;
            break;
        case INPATIENT:
        case OUTPATIENT:
        case HOSPICE:
        case SNF:
        case DME:
            fhirClaimType = org.hl7.fhir.r4.model.codesystems.ClaimType.INSTITUTIONAL;
            break;
        case CARRIER:
        case HHA:
            fhirClaimType = org.hl7.fhir.r4.model.codesystems.ClaimType.PROFESSIONAL;
            break;
        default:
            // All options on ClaimTypeV2 are covered above, but this is there to appease linter
            throw new BadCodeMonkeyException("No match found for ClaimTypeV2");
    }
    // Claim Type => ExplanationOfBenefit.type.coding
    if (fhirClaimType != null) {
        eob.getType().addCoding(new Coding(fhirClaimType.getSystem(), fhirClaimType.toCode(), fhirClaimType.getDisplay()));
    }
    // NCH_NEAR_LINE_REC_IDENT_CD => ExplanationOfBenefit.extension
    if (ccwNearLineRecordIdCode.isPresent()) {
        eob.addExtension(createExtensionCoding(eob, CcwCodebookVariable.NCH_NEAR_LINE_REC_IDENT_CD, ccwNearLineRecordIdCode));
    }
}

Example 15 with ExplanationOfBenefit

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

the class TransformerUtilsV2 method findOrCreateContainedOrg.

/**
 * Looks for an {@link Organization} with the given resource ID in {@link
 * ExplanationOfBenefit#getContained()} or adds one if it doesn't exist
 *
 * @param eob the {@link ExplanationOfBenefit} to modify
 * @param id The resource ID
 * @return The found or new {@link Organization} resource
 */
static Resource findOrCreateContainedOrg(ExplanationOfBenefit eob, String id) {
    Optional<Resource> org = eob.getContained().stream().filter(r -> r.getId() == id).findFirst();
    // If it isn't there, add one
    if (!org.isPresent()) {
        org = Optional.of(new Organization().setId(id));
        org.get().getMeta().addProfile(ProfileConstants.C4BB_ORGANIZATION_URL);
        eob.getContained().add(org.get());
    }
    return org.get();
}