Examples with CodeableConcept org.hl7.fhir.r4b.model.CodeableConcept used on opensource projects

Example 86 with CodeableConcept

use of org.hl7.fhir.r4b.model.CodeableConcept in project beneficiary-fhir-data by CMSgov.

the class SamhsaMatcherFromClaimTransformerTest method verifySamhsaMatcherForDiagnosisPackage.

/**
 * Verify SAMHSA matcher for package with the given system, code and if the expectation is that
 * there should be a match for this combination.
 *
 * @param system the system value
 * @param code the code
 * @param shouldMatch if the matcher should match on this combination
 */
private void verifySamhsaMatcherForDiagnosisPackage(String system, String code, boolean shouldMatch, ExplanationOfBenefit explanationOfBenefit) {
    ExplanationOfBenefit modifiedEob = explanationOfBenefit.copy();
    // Set diagnosis DRG
    for (ExplanationOfBenefit.DiagnosisComponent diagnosisComponent : modifiedEob.getDiagnosis()) {
        if (diagnosisComponent.getDiagnosisCodeableConcept() != null) {
            diagnosisComponent.getDiagnosisCodeableConcept().setCoding(new ArrayList<>());
        }
        CodeableConcept codeableConcept = new CodeableConcept();
        Coding coding = new Coding(system, code, null);
        codeableConcept.setCoding(Collections.singletonList(coding));
        diagnosisComponent.setPackageCode(codeableConcept);
    }
    // Set procedure to empty so we dont check it for matches
    for (ExplanationOfBenefit.ProcedureComponent diagnosisComponent : modifiedEob.getProcedure()) {
        CodeableConcept codeableConcept = diagnosisComponent.getProcedureCodeableConcept();
        ArrayList<Coding> codingList = new ArrayList<>();
        codeableConcept.setCoding(codingList);
    }
    // Set item coding to non-SAMHSA so we dont check it for matches
    List<Coding> codings = new ArrayList<>();
    Coding coding = new Coding();
    coding.setSystem(TransformerConstants.CODING_SYSTEM_HCPCS);
    coding.setCode(NON_SAMHSA_HCPCS_CODE);
    codings.add(coding);
    modifiedEob.getItem().get(0).getService().setCoding(codings);
    assertEquals(shouldMatch, samhsaMatcher.test(modifiedEob));
}

Example 87 with CodeableConcept

use of org.hl7.fhir.r4b.model.CodeableConcept in project beneficiary-fhir-data by CMSgov.

the class CCWProcedureTest method assertMatches.

static void assertMatches(Character version, String system) {
    Optional<String> code = Optional.of("code");
    Optional<LocalDate> procDate = Optional.of(LocalDate.now());
    Optional<CCWProcedure> diagnosis = CCWProcedure.from(code, Optional.of(version), procDate);
    assertEquals(procDate.get(), diagnosis.get().getProcedureDate().get());
    assertEquals(system, diagnosis.get().getFhirSystem());
    TransformerTestUtils.assertHasCoding(system, code.get(), diagnosis.get().toCodeableConcept().getCoding());
    CodeableConcept codeableConcept = new CodeableConcept();
    Coding coding = codeableConcept.addCoding();
    coding.setSystem(system).setCode(code.get());
    assertTrue(diagnosis.get().isContainedIn(codeableConcept));
}

Example 88 with CodeableConcept

use of org.hl7.fhir.r4b.model.CodeableConcept in project beneficiary-fhir-data by CMSgov.

the class CCWProcedureTest method assertDateNotPresent.

/**
 * Verifies that a procedure date isn't present even though there is a procedure code present
 */
static void assertDateNotPresent(Character version, String system) {
    Optional<String> code = Optional.of("code");
    Optional<LocalDate> procDate = Optional.empty();
    Optional<CCWProcedure> diagnosis = CCWProcedure.from(code, Optional.of(version), procDate);
    assertEquals(Optional.empty(), diagnosis.get().getProcedureDate());
    assertEquals(system, diagnosis.get().getFhirSystem());
    TransformerTestUtils.assertHasCoding(system, code.get(), diagnosis.get().toCodeableConcept().getCoding());
    CodeableConcept codeableConcept = new CodeableConcept();
    Coding coding = codeableConcept.addCoding();
    coding.setSystem(system).setCode(code.get());
    assertTrue(diagnosis.get().isContainedIn(codeableConcept));
}

Example 89 with CodeableConcept

use of org.hl7.fhir.r4b.model.CodeableConcept in project beneficiary-fhir-data by CMSgov.

the class CarrierClaimTransformerTest method assertMatches.

/**
 * Verifies that the {@link ExplanationOfBenefit} "looks like" it should, if it were produced from
 * the specified {@link CarrierClaim}.
 *
 * @param claim the {@link CarrierClaim} that the {@link ExplanationOfBenefit} was generated from
 * @param eob the {@link ExplanationOfBenefit} that was generated from the specified {@link
 *     CarrierClaim}
 * @param includedTaxNumbers whether or not to include tax numbers are expected to be included in
 *     the result (see {@link
 *     ExplanationOfBenefitResourceProvider#HEADER_NAME_INCLUDE_TAX_NUMBERS}, defaults to <code>
 *     false</code>)
 * @throws FHIRException (indicates test failure)
 */
static void assertMatches(CarrierClaim claim, ExplanationOfBenefit eob, Optional<Boolean> includedTaxNumbers) throws FHIRException {
    // Test to ensure group level fields between all claim types match
    TransformerTestUtils.assertEobCommonClaimHeaderData(eob, claim.getClaimId(), claim.getBeneficiaryId(), ClaimType.CARRIER, claim.getClaimGroupId().toPlainString(), MedicareSegment.PART_B, Optional.of(claim.getDateFrom()), Optional.of(claim.getDateThrough()), Optional.of(claim.getPaymentAmount()), claim.getFinalAction());
    // Test to ensure common group fields between Carrier and DME match
    TransformerTestUtils.assertEobCommonGroupCarrierDMEEquals(eob, claim.getBeneficiaryId(), claim.getCarrierNumber(), claim.getClinicalTrialNumber(), claim.getBeneficiaryPartBDeductAmount(), claim.getPaymentDenialCode(), claim.getReferringPhysicianNpi(), claim.getProviderAssignmentIndicator(), claim.getProviderPaymentAmount(), claim.getBeneficiaryPaymentAmount(), claim.getSubmittedChargeAmount(), claim.getAllowedChargeAmount());
    assertEquals(5, eob.getDiagnosis().size());
    assertEquals(1, eob.getItem().size());
    TransformerTestUtils.assertAdjudicationTotalAmountEquals(CcwCodebookVariable.PRPAYAMT, claim.getPrimaryPayerPaidAmount(), eob);
    CarrierClaimLine claimLine1 = claim.getLines().get(0);
    ItemComponent eobItem0 = eob.getItem().get(0);
    assertEquals(claimLine1.getLineNumber(), new BigDecimal(eobItem0.getSequence()));
    TransformerTestUtils.assertCareTeamEquals(claimLine1.getPerformingPhysicianNpi().get(), ClaimCareteamrole.PRIMARY, eob);
    CareTeamComponent performingCareTeamEntry = TransformerTestUtils.findCareTeamEntryForProviderNpi(claimLine1.getPerformingPhysicianNpi().get(), eob.getCareTeam());
    TransformerTestUtils.assertHasCoding(CcwCodebookVariable.PRVDR_SPCLTY, claimLine1.getProviderSpecialityCode(), performingCareTeamEntry.getQualification());
    TransformerTestUtils.assertExtensionCodingEquals(CcwCodebookVariable.CARR_LINE_PRVDR_TYPE_CD, claimLine1.getProviderTypeCode(), performingCareTeamEntry);
    TransformerTestUtils.assertExtensionCodingEquals(CcwCodebookVariable.PRTCPTNG_IND_CD, claimLine1.getProviderParticipatingIndCode(), performingCareTeamEntry);
    TransformerTestUtils.assertExtensionCodingEquals(performingCareTeamEntry, TransformerConstants.CODING_NPI_US, TransformerConstants.CODING_NPI_US, "" + claimLine1.getOrganizationNpi().get());
    CareTeamComponent taxNumberCareTeamEntry = TransformerTestUtils.findCareTeamEntryForProviderTaxNumber(claimLine1.getProviderTaxNumber(), eob.getCareTeam());
    if (includedTaxNumbers.orElse(false)) {
        assertNotNull(taxNumberCareTeamEntry);
    } else {
        assertNull(taxNumberCareTeamEntry);
    }
    TransformerTestUtils.assertExtensionCodingEquals(CcwCodebookVariable.PRVDR_STATE_CD, claimLine1.getProviderStateCode(), eobItem0.getLocation());
    TransformerTestUtils.assertExtensionCodingEquals(CcwCodebookVariable.PRVDR_STATE_CD, claimLine1.getProviderStateCode(), eobItem0.getLocation());
    TransformerTestUtils.assertExtensionCodingEquals(CcwCodebookVariable.CARR_LINE_PRCNG_LCLTY_CD, claimLine1.getLinePricingLocalityCode(), eobItem0.getLocation());
    TransformerTestUtils.assertHasCoding(TransformerConstants.CODING_SYSTEM_HCPCS, "" + claim.getHcpcsYearCode().get(), null, claimLine1.getHcpcsCode().get(), eobItem0.getService().getCoding());
    assertEquals(1, eobItem0.getModifier().size());
    TransformerTestUtils.assertHcpcsCodes(eobItem0, claimLine1.getHcpcsCode(), claimLine1.getHcpcsInitialModifierCode(), claimLine1.getHcpcsSecondModifierCode(), claim.getHcpcsYearCode(), 0);
    if (claimLine1.getAnesthesiaUnitCount().compareTo(BigDecimal.ZERO) > 0) {
        TransformerTestUtils.assertExtensionQuantityEquals(CcwCodebookVariable.CARR_LINE_ANSTHSA_UNIT_CNT, claimLine1.getAnesthesiaUnitCount(), eobItem0.getService());
    }
    TransformerTestUtils.assertExtensionCodingEquals(CcwCodebookVariable.CARR_LINE_MTUS_CD, claimLine1.getMtusCode(), eobItem0);
    TransformerTestUtils.assertExtensionQuantityEquals(CcwCodebookVariable.CARR_LINE_MTUS_CNT, claimLine1.getMtusCount(), eobItem0);
    TransformerTestUtils.assertAdjudicationReasonEquals(CcwCodebookVariable.CARR_LINE_RDCD_PMT_PHYS_ASTN_C, claimLine1.getReducedPaymentPhysicianAsstCode(), eobItem0.getAdjudication());
    TransformerTestUtils.assertExtensionIdentifierEquals(CcwCodebookVariable.CARR_LINE_CLIA_LAB_NUM, claimLine1.getCliaLabNumber(), eobItem0.getLocation());
    // verify {@link
    // TransformerUtils#mapEobType(CodeableConcept,ClaimType,Optional,Optional)}
    // method worked as expected for this claim type
    TransformerTestUtils.assertMapEobType(eob.getType(), ClaimType.CARRIER, Optional.of(org.hl7.fhir.dstu3.model.codesystems.ClaimType.PROFESSIONAL), Optional.of(claim.getNearLineRecordIdCode()), Optional.of(claim.getClaimTypeCode()));
    // Test to ensure common item fields between Carrier and DME match
    TransformerTestUtils.assertEobCommonItemCarrierDMEEquals(eobItem0, eob, claimLine1.getServiceCount(), claimLine1.getPlaceOfServiceCode(), claimLine1.getFirstExpenseDate(), claimLine1.getLastExpenseDate(), claimLine1.getBeneficiaryPaymentAmount(), claimLine1.getProviderPaymentAmount(), claimLine1.getBeneficiaryPartBDeductAmount(), claimLine1.getPrimaryPayerCode(), claimLine1.getPrimaryPayerPaidAmount(), claimLine1.getBetosCode(), claimLine1.getPaymentAmount(), claimLine1.getPaymentCode(), claimLine1.getCoinsuranceAmount(), claimLine1.getSubmittedChargeAmount(), claimLine1.getAllowedChargeAmount(), claimLine1.getProcessingIndicatorCode(), claimLine1.getServiceDeductibleCode(), claimLine1.getDiagnosisCode(), claimLine1.getDiagnosisCodeVersion(), claimLine1.getHctHgbTestTypeCode(), claimLine1.getHctHgbTestResult(), claimLine1.getCmsServiceTypeCode(), claimLine1.getNationalDrugCode());
    // Test lastUpdated
    TransformerTestUtils.assertLastUpdatedEquals(claim.getLastUpdated(), eob);
}

Example 90 with CodeableConcept

use of org.hl7.fhir.r4b.model.CodeableConcept in project beneficiary-fhir-data by CMSgov.

the class OutpatientClaimTransformerTest method assertMatches.

/**
 * Verifies that the {@link ExplanationOfBenefit} "looks like" it should, if it were produced from
 * the specified {@link OutpatientClaim}.
 *
 * @param claim the {@link OutpatientClaim} that the {@link ExplanationOfBenefit} was generated
 *     from
 * @param eob the {@link ExplanationOfBenefit} that was generated from the specified {@link
 *     OutpatientClaim}
 * @throws FHIRException (indicates test failure)
 */
static void assertMatches(OutpatientClaim claim, ExplanationOfBenefit eob) throws FHIRException {
    // Test to ensure group level fields between all claim types match
    TransformerTestUtils.assertEobCommonClaimHeaderData(eob, claim.getClaimId(), claim.getBeneficiaryId(), ClaimType.OUTPATIENT, claim.getClaimGroupId().toPlainString(), MedicareSegment.PART_B, Optional.of(claim.getDateFrom()), Optional.of(claim.getDateThrough()), Optional.of(claim.getPaymentAmount()), claim.getFinalAction());
    // test the common field provider number is set as expected in the EOB
    TransformerTestUtils.assertProviderNumber(eob, claim.getProviderNumber());
    TransformerTestUtils.assertAdjudicationTotalAmountEquals(CcwCodebookVariable.NCH_BENE_PTB_DDCTBL_AMT, claim.getDeductibleAmount(), eob);
    TransformerTestUtils.assertAdjudicationTotalAmountEquals(CcwCodebookVariable.NCH_PROFNL_CMPNT_CHRG_AMT, claim.getProfessionalComponentCharge(), eob);
    TransformerTestUtils.assertAdjudicationTotalAmountEquals(CcwCodebookVariable.NCH_BENE_PTB_COINSRNC_AMT, claim.getCoinsuranceAmount(), eob);
    TransformerTestUtils.assertAdjudicationTotalAmountEquals(CcwCodebookVariable.CLM_OP_PRVDR_PMT_AMT, claim.getProviderPaymentAmount(), eob);
    TransformerTestUtils.assertAdjudicationTotalAmountEquals(CcwCodebookVariable.CLM_OP_BENE_PMT_AMT, claim.getBeneficiaryPaymentAmount(), eob);
    // Test to ensure common group fields between Inpatient, Outpatient and SNF
    TransformerTestUtils.assertEobCommonGroupInpOutSNFEquals(eob, claim.getBloodDeductibleLiabilityAmount(), claim.getOperatingPhysicianNpi(), claim.getOtherPhysicianNpi(), claim.getClaimQueryCode(), claim.getMcoPaidSw());
    // Test to ensure common group fields between Inpatient, Outpatient HHA, Hospice
    // and SNF match
    TransformerTestUtils.assertEobCommonGroupInpOutHHAHospiceSNFEquals(eob, claim.getOrganizationNpi(), claim.getClaimFacilityTypeCode(), claim.getClaimFrequencyCode(), claim.getClaimNonPaymentReasonCode(), claim.getPatientDischargeStatusCode().get(), claim.getClaimServiceClassificationTypeCode(), claim.getClaimPrimaryPayerCode(), claim.getAttendingPhysicianNpi(), claim.getTotalChargeAmount(), claim.getPrimaryPayerPaidAmount(), claim.getFiscalIntermediaryNumber(), claim.getFiDocumentClaimControlNumber(), claim.getFiOriginalClaimControlNumber());
    assertTrue(countDiagnosisCodes(claim) >= eob.getDiagnosis().size(), "Expect actual diagnosis count is less than or equal to the claim count");
    if (claim.getProcedure1Code().isPresent()) {
        CCWProcedure ccwProcedure = new CCWProcedure(claim.getProcedure1Code(), claim.getProcedure1CodeVersion(), claim.getProcedure1Date());
        TransformerTestUtils.assertHasCoding(ccwProcedure.getFhirSystem().toString(), claim.getProcedure1Code().get(), eob.getProcedure().get(0).getProcedureCodeableConcept().getCoding());
        assertEquals(claim.getProcedure1Date().get().atStartOfDay(ZoneId.systemDefault()).toInstant(), eob.getProcedure().get(0).getDate().toInstant());
    }
    assertTrue(1 <= eob.getItem().size(), "Expect actual item count is above 0");
    ItemComponent eobItem0 = eob.getItem().get(0);
    OutpatientClaimLine claimLine1 = claim.getLines().get(0);
    assertEquals(new Integer(claimLine1.getLineNumber().intValue()), new Integer(eobItem0.getSequence()));
    assertEquals(claim.getProviderStateCode(), eobItem0.getLocationAddress().getState());
    // TODO re-map as described in CBBF-111
    /*
     * TransformerTestUtils.assertHasCoding(TransformerConstants.CODING_NDC,
     * claimLine1.getNationalDrugCode().get(), eobItem0.getService());
     */
    TransformerTestUtils.assertAdjudicationReasonEquals(CcwCodebookVariable.REV_CNTR_1ST_ANSI_CD, claimLine1.getRevCntr1stAnsiCd(), eobItem0.getAdjudication());
    TransformerTestUtils.assertAdjudicationReasonEquals(CcwCodebookVariable.REV_CNTR_2ND_ANSI_CD, claimLine1.getRevCntr2ndAnsiCd(), eobItem0.getAdjudication());
    TransformerTestUtils.assertAdjudicationReasonEquals(CcwCodebookVariable.REV_CNTR_3RD_ANSI_CD, claimLine1.getRevCntr3rdAnsiCd(), eobItem0.getAdjudication());
    TransformerTestUtils.assertAdjudicationReasonEquals(CcwCodebookVariable.REV_CNTR_4TH_ANSI_CD, claimLine1.getRevCntr4thAnsiCd(), eobItem0.getAdjudication());
    TransformerTestUtils.assertHcpcsCodes(eobItem0, claimLine1.getHcpcsCode(), claimLine1.getHcpcsInitialModifierCode(), claimLine1.getHcpcsSecondModifierCode(), Optional.empty(), 0);
    TransformerTestUtils.assertExtensionCodingEquals(CcwCodebookVariable.REV_CNTR_IDE_NDC_UPC_NUM, claimLine1.getNationalDrugCode(), eobItem0.getService());
    TransformerTestUtils.assertAdjudicationAmountEquals(CcwCodebookVariable.REV_CNTR_BLOOD_DDCTBL_AMT, claimLine1.getBloodDeductibleAmount(), eobItem0.getAdjudication());
    TransformerTestUtils.assertAdjudicationAmountEquals(CcwCodebookVariable.REV_CNTR_CASH_DDCTBL_AMT, claimLine1.getCashDeductibleAmount(), eobItem0.getAdjudication());
    TransformerTestUtils.assertAdjudicationAmountEquals(CcwCodebookVariable.REV_CNTR_COINSRNC_WGE_ADJSTD_C, claimLine1.getWageAdjustedCoinsuranceAmount(), eobItem0.getAdjudication());
    TransformerTestUtils.assertAdjudicationAmountEquals(CcwCodebookVariable.REV_CNTR_RDCD_COINSRNC_AMT, claimLine1.getReducedCoinsuranceAmount(), eobItem0.getAdjudication());
    TransformerTestUtils.assertAdjudicationAmountEquals(CcwCodebookVariable.REV_CNTR_1ST_MSP_PD_AMT, claimLine1.getFirstMspPaidAmount(), eobItem0.getAdjudication());
    TransformerTestUtils.assertAdjudicationAmountEquals(CcwCodebookVariable.REV_CNTR_1ST_MSP_PD_AMT, claimLine1.getSecondMspPaidAmount(), eobItem0.getAdjudication());
    TransformerTestUtils.assertAdjudicationAmountEquals(CcwCodebookVariable.REV_CNTR_PRVDR_PMT_AMT, claimLine1.getProviderPaymentAmount(), eobItem0.getAdjudication());
    TransformerTestUtils.assertAdjudicationAmountEquals(CcwCodebookVariable.REV_CNTR_BENE_PMT_AMT, claimLine1.getBenficiaryPaymentAmount(), eobItem0.getAdjudication());
    TransformerTestUtils.assertAdjudicationAmountEquals(CcwCodebookVariable.REV_CNTR_PTNT_RSPNSBLTY_PMT, claimLine1.getPatientResponsibilityAmount(), eobItem0.getAdjudication());
    String claimControlNumber = "0000000000";
    // Test to ensure item level fields between Inpatient, Outpatient, HHA, Hopsice
    // and SNF match
    TransformerTestUtils.assertEobCommonItemRevenueEquals(eobItem0, eob, claimLine1.getRevenueCenterCode(), claimLine1.getRateAmount(), claimLine1.getTotalChargeAmount(), claimLine1.getNonCoveredChargeAmount(), claimLine1.getUnitCount(), claimControlNumber, claimLine1.getNationalDrugCodeQuantity(), claimLine1.getNationalDrugCodeQualifierCode(), claimLine1.getRevenueCenterRenderingPhysicianNPI(), 1);
    // Test to ensure item level fields between Outpatient, HHA and Hospice match
    TransformerTestUtils.assertEobCommonItemRevenueOutHHAHospice(eobItem0, claimLine1.getRevenueCenterDate(), claimLine1.getPaymentAmount());
    // verify {@link
    // TransformerUtils#mapEobType(CodeableConcept,ClaimType,Optional,Optional)}
    // method worked as expected for this claim type
    TransformerTestUtils.assertMapEobType(eob.getType(), ClaimType.OUTPATIENT, Optional.of(org.hl7.fhir.dstu3.model.codesystems.ClaimType.PROFESSIONAL), Optional.of(claim.getNearLineRecordIdCode()), Optional.of(claim.getClaimTypeCode()));
    TransformerTestUtils.assertExtensionCodingEquals(CcwCodebookVariable.REV_CNTR_STUS_IND_CD, claimLine1.getStatusCode(), eobItem0.getRevenue());
    // Test lastUpdated
    TransformerTestUtils.assertLastUpdatedEquals(claim.getLastUpdated(), eob);
}