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

Example 1 with ClaimType

use of org.hl7.fhir.r4.model.codesystems.ClaimType 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 2 with ClaimType

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

the class ExplanationOfBenefitResourceProvider method findClaimTypeByPatient.

/**
 * @param claimType the {@link ClaimType} to find
 * @param patientId the {@link Beneficiary#getBeneficiaryId()} to filter by
 * @param lastUpdated the update time to filter by
 * @return the matching claim/event entities
 */
@SuppressWarnings({ "rawtypes", "unchecked" })
@Trace
private <T> List<T> findClaimTypeByPatient(ClaimType claimType, String patientId, DateRangeParam lastUpdated, DateRangeParam serviceDate) {
    CriteriaBuilder builder = entityManager.getCriteriaBuilder();
    CriteriaQuery criteria = builder.createQuery((Class) claimType.getEntityClass());
    Root root = criteria.from(claimType.getEntityClass());
    claimType.getEntityLazyAttributes().stream().forEach(a -> root.fetch(a));
    criteria.select(root).distinct(true);
    // Search for a beneficiary's records. Use lastUpdated if present
    Predicate wherePredicate = builder.equal(root.get(claimType.getEntityBeneficiaryIdAttribute()), patientId);
    if (lastUpdated != null && !lastUpdated.isEmpty()) {
        Predicate predicate = QueryUtils.createLastUpdatedPredicate(builder, root, lastUpdated);
        wherePredicate = builder.and(wherePredicate, predicate);
    }
    criteria.where(wherePredicate);
    List<T> claimEntities = null;
    Long eobsByBeneIdQueryNanoSeconds = null;
    Timer.Context timerEobQuery = metricRegistry.timer(MetricRegistry.name(metricRegistry.getClass().getSimpleName(), "query", "eobs_by_bene_id", claimType.name().toLowerCase())).time();
    try {
        claimEntities = entityManager.createQuery(criteria).getResultList();
    } finally {
        eobsByBeneIdQueryNanoSeconds = timerEobQuery.stop();
        TransformerUtils.recordQueryInMdc(String.format("eobs_by_bene_id.%s", claimType.name().toLowerCase()), eobsByBeneIdQueryNanoSeconds, claimEntities == null ? 0 : claimEntities.size());
    }
    if (claimEntities != null && serviceDate != null && !serviceDate.isEmpty()) {
        final Instant lowerBound = serviceDate.getLowerBoundAsInstant() != null ? serviceDate.getLowerBoundAsInstant().toInstant() : null;
        final Instant upperBound = serviceDate.getUpperBoundAsInstant() != null ? serviceDate.getUpperBoundAsInstant().toInstant() : null;
        final java.util.function.Predicate<LocalDate> lowerBoundCheck = lowerBound == null ? (date) -> true : (date) -> compareLocalDate(date, lowerBound.atZone(ZoneId.systemDefault()).toLocalDate(), serviceDate.getLowerBound().getPrefix());
        final java.util.function.Predicate<LocalDate> upperBoundCheck = upperBound == null ? (date) -> true : (date) -> compareLocalDate(date, upperBound.atZone(ZoneId.systemDefault()).toLocalDate(), serviceDate.getUpperBound().getPrefix());
        return claimEntities.stream().filter(entity -> lowerBoundCheck.test(claimType.getServiceEndAttributeFunction().apply(entity)) && upperBoundCheck.test(claimType.getServiceEndAttributeFunction().apply(entity))).collect(Collectors.toList());
    }
    return claimEntities;
}

Example 3 with ClaimType

use of org.hl7.fhir.r4.model.codesystems.ClaimType 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 4 with ClaimType

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

the class DiagnosisUtilV2 method addDiagnosisCode.

/**
 * @param eob the {@link ExplanationOfBenefit} to (possibly) modify
 * @param diagnosis the {@link Diagnosis} to add, if it's not already present
 * @return the {@link DiagnosisComponent#getSequence()} of the existing or newly-added entry
 */
static int addDiagnosisCode(ExplanationOfBenefit eob, Diagnosis diagnosis, ClaimTypeV2 claimType) {
    // Filter out if the diagnosis is already contained in the document
    Optional<DiagnosisComponent> existingDiagnosis = eob.getDiagnosis().stream().filter(d -> d.getDiagnosis() instanceof CodeableConcept).filter(d -> containedIn(diagnosis, (CodeableConcept) d.getDiagnosis())).findAny();
    // If we already have a match, we are done
    if (existingDiagnosis.isPresent()) {
        return existingDiagnosis.get().getSequenceElement().getValue();
    }
    // Set diagnosisCodeableConcept
    DiagnosisComponent diagnosisComponent = new DiagnosisComponent().setSequence(eob.getDiagnosis().size() + 1);
    diagnosisComponent.setDiagnosis(toCodeableConcept(diagnosis));
    // Set Type
    diagnosisComponent.addType(translateLabels(diagnosis.getLabels(), claimType));
    if (diagnosis.getPresentOnAdmission().isPresent() && diagnosis.getPresentOnAdmissionCode().isPresent()) {
        diagnosisComponent.addExtension(TransformerUtilsV2.createExtensionCoding(eob, diagnosis.getPresentOnAdmissionCode().get(), diagnosis.getPresentOnAdmission()));
    }
    eob.getDiagnosis().add(diagnosisComponent);
    return diagnosisComponent.getSequenceElement().getValue();
}

Example 5 with ClaimType

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

the class R4ExplanationOfBenefitResourceProviderIT method searchForSamhsaEobsWithExcludeSamhsaTrue.

/**
 * Verifies that {@link
 * gov.cms.bfd.server.war.r4.providers.R4ExplanationOfBenefitResourceProvider#findByPatient} with
 * <code>excludeSAMHSA=true</code> properly filters out SAMHSA-related claims.
 *
 * @throws FHIRException (indicates test failure)
 */
@Test
public void searchForSamhsaEobsWithExcludeSamhsaTrue() throws FHIRException {
    Beneficiary beneficiary = loadSampleAWithSamhsa();
    IGenericClient fhirClient = ServerTestUtils.get().createFhirClientV2();
    Bundle searchResults = fhirClient.search().forResource(ExplanationOfBenefit.class).where(ExplanationOfBenefit.PATIENT.hasId(TransformerUtilsV2.buildPatientId(beneficiary.getBeneficiaryId()))).and(new StringClientParam(EXCLUDE_SAMHSA_PARAM).matches().value("true")).returnBundle(Bundle.class).execute();
    assertNotNull(searchResults);
    for (ClaimTypeV2 claimType : ClaimTypeV2.values()) {
        /*
       * SAMHSA fields are present on all claim types except for PDE so we should not
       * get any claims back in the results except for PDE.
       */
        if (claimType == ClaimTypeV2.PDE) {
            assertEquals(1, filterToClaimType(searchResults, claimType).size());
        } else {
            assertEquals(0, filterToClaimType(searchResults, claimType).size());
        }
    }
}