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

Example 31 with Reference

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

the class CarrierClaimTransformerV2 method transformClaim.

/**
 * @param claimGroup the CCW {@link CarrierClaim} to transform
 * @return a FHIR {@link ExplanationOfBenefit} resource that represents the specified {@link
 *     CarrierClaim}
 */
private static ExplanationOfBenefit transformClaim(CarrierClaim claimGroup, Optional<Boolean> includeTaxNumbers) {
    ExplanationOfBenefit eob = new ExplanationOfBenefit();
    // Required values not directly mapped
    eob.getMeta().addProfile(ProfileConstants.C4BB_EOB_NONCLINICIAN_PROFILE_URL);
    // TODO: ExplanationOfBenefit.outcome is a required field. Needs to be mapped.
    // eob.setOutcome(?)
    // Common group level fields between all claim types
    // Claim Type + Claim ID => ExplanationOfBenefit.id
    // CLM_ID => ExplanationOfBenefit.identifier
    // CLM_GRP_ID => ExplanationOfBenefit.identifier
    // BENE_ID + Coverage Type => ExplanationOfBenefit.insurance.coverage
    // (reference)
    // BENE_ID => ExplanationOfBenefit.patient (reference)
    // FINAL_ACTION => ExplanationOfBenefit.status
    // CLM_FROM_DT => ExplanationOfBenefit.billablePeriod.start
    // CLM_THRU_DT => ExplanationOfBenefit.billablePeriod.end
    // CLM_PMT_AMT => ExplanationOfBenefit.payment.amount
    TransformerUtilsV2.mapEobCommonClaimHeaderData(eob, claimGroup.getClaimId(), claimGroup.getBeneficiaryId(), ClaimTypeV2.CARRIER, claimGroup.getClaimGroupId().toPlainString(), MedicareSegment.PART_B, Optional.of(claimGroup.getDateFrom()), Optional.of(claimGroup.getDateThrough()), Optional.of(claimGroup.getPaymentAmount()), claimGroup.getFinalAction());
    // NCH_WKLY_PROC_DT => ExplanationOfBenefit.supportinginfo.timingDate
    TransformerUtilsV2.addInformation(eob, TransformerUtilsV2.createInformationRecievedDateSlice(eob, CcwCodebookVariable.NCH_WKLY_PROC_DT, Optional.of(claimGroup.getWeeklyProcessDate())));
    // map eob type codes into FHIR
    // NCH_CLM_TYPE_CD            => ExplanationOfBenefit.type.coding
    // EOB Type                   => ExplanationOfBenefit.type.coding
    // Claim Type (Professional)  => ExplanationOfBenefit.type.coding
    // NCH_NEAR_LINE_REC_IDENT_CD => ExplanationOfBenefit.extension
    TransformerUtilsV2.mapEobType(eob, ClaimTypeV2.CARRIER, Optional.of(claimGroup.getNearLineRecordIdCode()), Optional.of(claimGroup.getClaimTypeCode()));
    // CARR_CLM_PRMRY_PYR_PD_AMT => ExplanationOfBenefit.total.amount
    TransformerUtilsV2.addTotal(eob, TransformerUtilsV2.createTotalAdjudicationAmountSlice(eob, CcwCodebookVariable.CLM_TOT_CHRG_AMT, C4BBAdjudication.PRIOR_PAYER_PAID, claimGroup.getPrimaryPayerPaidAmount()));
    // Common group level fields between Carrier and DME
    // BENE_ID =>
    // CARR_NUM                       => ExplanationOfBenefit.extension
    // CLM_CLNCL_TRIL_NUM             => ExplanationOfBenefit.extension
    // CARR_CLM_CASH_DDCTBL_APLD_AMT  => ExplanationOfBenefit.benefitBalance.financial
    // CARR_CLM_PMT_DNL_CD            => ExplanationOfBenefit.extension
    // RFR_PHYSN_NPI                  => ExplanationOfBenefit.referral.identifier
    // => ExplanationOfBenefit.careteam.provider
    // RFR_PHYSN_UPIN                 => ExplanationOfBenefit.referral.identifier
    // => ExplanationOfBenefit.careteam.provider
    // CARR_CLM_PRVDR_ASGNMT_IND_SW   => ExplanationOfBenefit.extension
    // NCH_CLM_PRVDR_PMT_AMT          => ExplanationOfBenefit.benefitBalance.financial
    // NCH_CLM_BENE_PMT_AMT           => ExplanationOfBenefit.benefitBalance.financial
    // NCH_CARR_CLM_SBMTD_CHRG_AMT    => ExplanationOfBenefit.benefitBalance.financial
    // NCH_CARR_CLM_ALOWD_AMT         => ExplanationOfBenefit.benefitBalance.financial
    // CLM_DISP_CD                    => ExplanationOfBenefit.disposition
    // CARR_CLM_CNTL_NUM              => ExplanationOfBenefit.extension
    TransformerUtilsV2.mapEobCommonGroupCarrierDME(eob, claimGroup.getBeneficiaryId(), claimGroup.getCarrierNumber(), claimGroup.getClinicalTrialNumber(), claimGroup.getBeneficiaryPartBDeductAmount(), claimGroup.getPaymentDenialCode(), claimGroup.getReferringPhysicianNpi(), claimGroup.getReferringPhysicianUpin(), claimGroup.getProviderAssignmentIndicator(), claimGroup.getProviderPaymentAmount(), claimGroup.getBeneficiaryPaymentAmount(), claimGroup.getSubmittedChargeAmount(), claimGroup.getAllowedChargeAmount(), claimGroup.getClaimDispositionCode(), claimGroup.getClaimCarrierControlNumber());
    // ICD_DGNS_VRSN_CD(1-12) => diagnosis.diagnosisCodeableConcept
    for (Diagnosis diagnosis : DiagnosisUtilV2.extractDiagnoses(claimGroup)) {
        DiagnosisUtilV2.addDiagnosisCode(eob, diagnosis, ClaimTypeV2.CARRIER);
    }
    // CARR_CLM_RFRNG_PIN_NUM => ExplanationOfBenefit.careteam.provider
    TransformerUtilsV2.addCareTeamMember(eob, C4BBPractitionerIdentifierType.NPI, C4BBClaimProfessionalAndNonClinicianCareTeamRole.REFERRING, Optional.ofNullable(claimGroup.getReferringProviderIdNumber()));
    // CARR_CLM_ENTRY_CD => ExplanationOfBenefit.extension
    eob.addExtension(TransformerUtilsV2.createExtensionCoding(eob, CcwCodebookVariable.CARR_CLM_ENTRY_CD, claimGroup.getClaimEntryCode()));
    // Process line items
    for (CarrierClaimLine line : claimGroup.getLines()) {
        ItemComponent item = eob.addItem();
        // LINE_NUM => ExplanationOfBenefit.item.sequence
        item.setSequence(line.getLineNumber().intValue());
        // PRF_PHYSN_NPI => ExplanationOfBenefit.careTeam.provider
        Optional<CareTeamComponent> performing = TransformerUtilsV2.addCareTeamMember(eob, item, C4BBPractitionerIdentifierType.NPI, C4BBClaimProfessionalAndNonClinicianCareTeamRole.PERFORMING, line.getPerformingPhysicianNpi());
        // Fall back to UPIN if NPI not present
        if (!line.getPerformingPhysicianNpi().isPresent()) {
            performing = TransformerUtilsV2.addCareTeamMember(eob, item, C4BBPractitionerIdentifierType.UPIN, C4BBClaimProfessionalAndNonClinicianCareTeamRole.PERFORMING, line.getPerformingPhysicianUpin());
        }
        // Update the responsible flag
        performing.ifPresent(p -> {
            p.setResponsible(true);
            // PRVDR_SPCLTY => ExplanationOfBenefit.careTeam.qualification
            p.setQualification(TransformerUtilsV2.createCodeableConcept(eob, CcwCodebookVariable.PRVDR_SPCLTY, line.getProviderSpecialityCode()));
            // CARR_LINE_PRVDR_TYPE_CD => ExplanationOfBenefit.careTeam.extension
            p.addExtension(TransformerUtilsV2.createExtensionCoding(eob, CcwCodebookVariable.CARR_LINE_PRVDR_TYPE_CD, line.getProviderTypeCode()));
            // PRTCPTNG_IND_CD => ExplanationOfBenefit.careTeam.extension
            p.addExtension(TransformerUtilsV2.createExtensionCoding(eob, CcwCodebookVariable.PRTCPTNG_IND_CD, line.getProviderParticipatingIndCode()));
        });
        // ORG_NPI_NUM => ExplanationOfBenefit.careTeam.provider
        TransformerUtilsV2.addCareTeamMember(eob, item, C4BBPractitionerIdentifierType.NPI, C4BBClaimProfessionalAndNonClinicianCareTeamRole.PRIMARY, line.getOrganizationNpi());
        // CARR_LINE_RDCD_PMT_PHYS_ASTN_C => ExplanationOfBenefit.item.adjudication
        TransformerUtilsV2.addAdjudication(item, TransformerUtilsV2.createAdjudicationDenialReasonSlice(eob, CcwCodebookVariable.CARR_LINE_RDCD_PMT_PHYS_ASTN_C, String.valueOf(line.getReducedPaymentPhysicianAsstCode())));
        // HCPCS_CD               => ExplanationOfBenefit.item.productOrService
        // HCPCS_1ST_MDFR_CD      => ExplanationOfBenefit.item.modifier
        // HCPCS_2ND_MDFR_CD      => ExplanationOfBenefit.item.modifier
        // CARR_CLM_HCPCS_YR_CD   => ExplanationOfBenefit.item.modifier.version
        TransformerUtilsV2.mapHcpcs(eob, item, line.getHcpcsCode(), claimGroup.getHcpcsYearCode(), Arrays.asList(line.getHcpcsInitialModifierCode(), line.getHcpcsSecondModifierCode()));
        // tax num should be as a extension
        if (includeTaxNumbers.orElse(false)) {
            item.addExtension(TransformerUtilsV2.createExtensionCoding(eob, CcwCodebookVariable.TAX_NUM, line.getProviderTaxNumber()));
        }
        // CARR_LINE_ANSTHSA_UNIT_CNT => ExplanationOfBenefit.item.extension
        if (line.getAnesthesiaUnitCount().compareTo(BigDecimal.ZERO) > 0) {
            item.addExtension(TransformerUtilsV2.createExtensionQuantity(CcwCodebookVariable.CARR_LINE_ANSTHSA_UNIT_CNT, line.getAnesthesiaUnitCount()));
        }
        // CARR_LINE_MTUS_CNT => ExplanationOfBenefit.item.extension
        if (!line.getMtusCount().equals(BigDecimal.ZERO)) {
            item.addExtension(TransformerUtilsV2.createExtensionQuantity(CcwCodebookVariable.CARR_LINE_MTUS_CNT, line.getMtusCount()));
        }
        // CARR_LINE_MTUS_CD => ExplanationOfBenefit.item.extension
        line.getMtusCode().ifPresent(code -> item.addExtension(TransformerUtilsV2.createExtensionCoding(eob, CcwCodebookVariable.CARR_LINE_MTUS_CNT, code)));
        // Common item level fields between Carrier and DME
        // LINE_SRVC_CNT            => ExplanationOfBenefit.item.quantity
        // LINE_CMS_TYPE_SRVC_CD    => ExplanationOfBenefit.item.category
        // LINE_PLACE_OF_SRVC_CD    => ExplanationOfBenefit.item.location
        // BETOS_CD                 => ExplanationOfBenefit.item.extension
        // LINE_1ST_EXPNS_DT        => ExplanationOfBenefit.item.servicedPeriod
        // LINE_LAST_EXPNS_DT       => ExplanationOfBenefit.item.servicedPeriod
        // LINE_NCH_PMT_AMT         => ExplanationOfBenefit.item.adjudication
        // LINE_PMT_80_100_CD       => ExplanationOfBenefit.item.adjudication.extension
        // PAID_TO_PATIENT          => ExplanationOfBenefit.item.adjudication
        // LINE_PRVDR_PMT_AMT       => ExplanationOfBenefit.item.adjudication
        // LINE_BENE_PTB_DDCTBL_AMT => ExplanationOfBenefit.item.adjudication
        // LINE_BENE_PRMRY_PYR_CD   => ExplanationOfBenefit.item.extension
        // LINE_BENE_PRMRY_PYR_PD_AMT => ExplanationOfBenefit.item.adjudication
        // LINE_COINSRNC_AMT        => ExplanationOfBenefit.item.adjudication
        // LINE_SBMTD_CHRG_AMT      => ExplanationOfBenefit.item.adjudication
        // LINE_ALOWD_CHRG_AMT      => ExplanationOfBenefit.item.adjudication
        // LINE_BENE_PRMRY_PYR_CD   => ExplanationOfBenefit.item.extension
        // LINE_SERVICE_DEDUCTIBLE  => ExplanationOfBenefit.item.extension
        // LINE_HCT_HGB_TYPE_CD     => Observation.code
        // LINE_HCT_HGB_RSLT_NUM    => Observation.value
        // LINE_NDC_CD              => ExplanationOfBenefit.item.productOrService
        TransformerUtilsV2.mapEobCommonItemCarrierDME(item, eob, claimGroup.getClaimId(), item.getSequence(), line.getServiceCount(), line.getPlaceOfServiceCode(), line.getFirstExpenseDate(), line.getLastExpenseDate(), line.getBeneficiaryPaymentAmount(), line.getProviderPaymentAmount(), line.getBeneficiaryPartBDeductAmount(), line.getPrimaryPayerCode(), line.getPrimaryPayerPaidAmount(), line.getBetosCode(), line.getPaymentAmount(), line.getPaymentCode(), line.getCoinsuranceAmount(), line.getSubmittedChargeAmount(), line.getAllowedChargeAmount(), line.getProcessingIndicatorCode(), line.getServiceDeductibleCode(), line.getHctHgbTestTypeCode(), line.getHctHgbTestResult(), line.getCmsServiceTypeCode(), line.getNationalDrugCode());
        // LINE_ICD_DGNS_CD      => ExplanationOfBenefit.item.diagnosisSequence
        // LINE_ICD_DGNS_VRSN_CD => ExplanationOfBenefit.item.diagnosisSequence
        DiagnosisUtilV2.addDiagnosisLink(eob, item, Diagnosis.from(line.getDiagnosisCode(), line.getDiagnosisCodeVersion(), DiagnosisLabel.OTHER), ClaimTypeV2.CARRIER);
        // PRVDR_STATE_CD => ExplanationOfBenefit.item.location.extension
        line.getProviderStateCode().ifPresent(code -> item.getLocation().addExtension(TransformerUtilsV2.createExtensionCoding(eob, CcwCodebookVariable.PRVDR_STATE_CD, code)));
        // PRVDR_ZIP => ExplanationOfBenefit.item.location.extension
        line.getProviderZipCode().ifPresent(code -> item.getLocation().addExtension(TransformerUtilsV2.createExtensionCoding(eob, CcwCodebookVariable.PRVDR_ZIP, code)));
        // CARR_LINE_PRCNG_LCLTY_CD => ExplanationOfBenefit.item.location.extension
        item.getLocation().addExtension(TransformerUtilsV2.createExtensionCoding(eob, CcwCodebookVariable.CARR_LINE_PRCNG_LCLTY_CD, line.getLinePricingLocalityCode()));
        // CARR_LINE_CLIA_LAB_NUM => ExplanationOfBenefit.item.location.extension
        line.getCliaLabNumber().ifPresent(num -> item.getLocation().addExtension(TransformerUtilsV2.createExtensionIdentifier(CcwCodebookVariable.CARR_LINE_CLIA_LAB_NUM, num)));
    }
    TransformerUtilsV2.setLastUpdated(eob, claimGroup.getLastUpdated());
    return eob;
}

Example 32 with Reference

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

the class TransformerUtilsTest method createReferenceForIdentifierTypeTest.

/**
 * Verifies that {@link
 * gov.cms.bfd.server.war.stu3.providers.TransformerUtils#createIdentifierReference
 * (gov.cms.bfd.server.war.stu3.providers.IdentifierType, String)} sets {@link Reference)}
 * correctly.
 */
@Test
public void createReferenceForIdentifierTypeTest() {
    String identifierValue = "identifierValue";
    IdentifierType identifierType = IdentifierType.NPI;
    Reference reference = TransformerUtils.createIdentifierReference(identifierType, identifierValue);
    assertEquals(identifierType.getSystem(), reference.getIdentifier().getSystem());
    assertEquals(identifierValue, reference.getIdentifier().getValue());
    assertEquals(identifierType.getCode(), reference.getIdentifier().getType().getCoding().get(0).getCode());
    assertEquals(identifierType.getDisplay(), reference.getIdentifier().getType().getCoding().get(0).getDisplay());
    assertEquals(identifierType.getSystem(), reference.getIdentifier().getType().getCoding().get(0).getSystem());
}

Example 33 with Reference

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

the class TransformerUtilsTest method createReferenceTest.

/**
 * Verifies that {@link
 * gov.cms.bfd.server.war.stu3.providers.TransformerUtils#createIdentifierReference(String,
 * String)} sets {@link Reference)} correctly.
 */
@Test
public void createReferenceTest() {
    String identifierSystem = "identifierSystem";
    String identifierValue = "identifierValue";
    Reference reference = TransformerUtils.createIdentifierReference(identifierSystem, identifierValue);
    assertEquals(identifierSystem, reference.getIdentifier().getSystem());
    assertEquals(identifierValue, reference.getIdentifier().getValue());
    assertTrue(isCodingListNullOrEmpty(reference.getIdentifier().getType().getCoding()));
}

Example 34 with Reference

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

the class PatientResourceProviderIT method searchByPartDContractWithoutYear.

/**
 * Verifies that {@link
 * PatientResourceProvider#searchByCoverageContract(ca.uhn.fhir.rest.param.TokenParam,
 * ca.uhn.fhir.rest.param.TokenParam, String, ca.uhn.fhir.rest.api.server.RequestDetails)} works
 * as expected, when no year is specified (hopefully causing it to substitute the current year).
 */
@Test
public void searchByPartDContractWithoutYear() {
    /*
     * TODO Once AB2D has switched to always specifying the year, this needs to become an invalid
     * request and this test will need to be updated to reflect that, then.
     */
    List<Object> loadedRecords = ServerTestUtils.get().loadData(Arrays.asList(StaticRifResource.SAMPLE_A_BENES));
    IGenericClient fhirClient = createFhirClientWithIncludeIdentifiersMbi();
    // First, adjust the bene's reference year in the DB.
    ServerTestUtils.get().doTransaction((entityManager) -> {
        CriteriaBuilder builder = entityManager.getCriteriaBuilder();
        CriteriaQuery<BeneficiaryMonthly> select = builder.createQuery(BeneficiaryMonthly.class);
        select.from(BeneficiaryMonthly.class);
        List<BeneficiaryMonthly> beneMonthlys = entityManager.createQuery(select).getResultList();
        for (BeneficiaryMonthly beneMonthly : beneMonthlys) {
            LocalDate yearMonth = beneMonthly.getYearMonth();
            CriteriaUpdate<BeneficiaryMonthly> update = builder.createCriteriaUpdate(BeneficiaryMonthly.class);
            Root<BeneficiaryMonthly> beneMonthlyRoot = update.from(BeneficiaryMonthly.class);
            update.set(BeneficiaryMonthly_.yearMonth, LocalDate.of(Year.now().getValue(), yearMonth.getMonthValue(), yearMonth.getDayOfMonth()));
            update.where(builder.equal(beneMonthlyRoot.get(BeneficiaryMonthly_.parentBeneficiary), beneMonthly.getParentBeneficiary()), builder.equal(beneMonthlyRoot.get(BeneficiaryMonthly_.yearMonth), yearMonth));
            entityManager.createQuery(update).executeUpdate();
        }
    });
    // Should return a single match
    Bundle searchResults = fhirClient.search().forResource(Patient.class).where(new TokenClientParam("_has:Coverage.extension").exactly().systemAndIdentifier(CCWUtils.calculateVariableReferenceUrl(CcwCodebookVariable.PTDCNTRCT01), "S4607")).returnBundle(Bundle.class).execute();
    // Verify that it found the expected bene.
    assertNotNull(searchResults);
    assertEquals(1, searchResults.getEntry().size());
    Patient patientFromSearchResult = (Patient) searchResults.getEntry().get(0).getResource();
    Beneficiary expectedBene = (Beneficiary) loadedRecords.get(0);
    assertEquals(expectedBene.getBeneficiaryId(), patientFromSearchResult.getIdElement().getIdPart());
}

Example 35 with Reference

use of org.hl7.fhir.r4.model.Reference in project kindling by HL7.

the class Publisher method loadValueSets1.

private void loadValueSets1() throws Exception {
    page.log(" ...vocab #1", LogMessageType.Process);
    generateCodeSystemsPart1();
    generateValueSetsPart1();
    for (BindingSpecification cd : page.getDefinitions().getUnresolvedBindings()) {
        String ref = cd.getReference();
        if (ref.startsWith("http://hl7.org/fhir")) {
            // we expect to be able to resolve this
            ValueSet vs = page.getDefinitions().getValuesets().get(ref);
            if (vs == null)
                vs = page.getDefinitions().getExtraValuesets().get(ref);
            if (vs == null)
                vs = page.getWorkerContext().fetchResource(ValueSet.class, ref);
            if (vs == null) {
                if (page.getDefinitions().getBoundValueSets().containsKey(ref))
                    throw new Exception("Unable to resolve the value set reference " + ref + " but found it in load list");
                throw new Exception("Unable to resolve the value set reference " + ref);
            }
            cd.setValueSet(vs);
        } else {
            ValueSet vs = page.getWorkerContext().fetchResource(ValueSet.class, ref);
            if (vs != null)
                cd.setValueSet(vs);
            else if (!ref.startsWith("http://loinc.org/vs/LL"))
                System.out.println("Unresolved value set reference: " + ref);
        }
    }
    for (ImplementationGuideDefn ig : page.getDefinitions().getSortedIgs()) {
        for (BindingSpecification cd : ig.getUnresolvedBindings()) {
            String ref = cd.getReference();
            if (ref.contains("|"))
                ref = ref.substring(0, ref.indexOf("|"));
            ValueSet vs = page.getDefinitions().getValuesets().get(ref);
            if (vs == null)
                vs = ig.getValueSet(ref);
            if (vs == null)
                vs = page.getWorkerContext().fetchResource(ValueSet.class, ref);
            if (vs == null)
                throw new Exception("unable to resolve value set " + ref);
            cd.setValueSet(vs);
        }
    }
}