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

Example 1 with Resource

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

the class TransformerUtils method mapEobCommonGroupCarrierDME.

/**
 * Transforms the common group level data elements between the {@link CarrierClaim} and {@link
 * DMEClaim} claim types to FHIR. The method parameter fields from {@link CarrierClaim} and {@link
 * DMEClaim} are listed below and their corresponding RIF CCW fields (denoted in all CAPS below
 * from {@link CarrierClaimColumn} and {@link DMEClaimColumn}).
 *
 * @param eob the {@link ExplanationOfBenefit} to modify
 * @param benficiaryId BEME_ID, *
 * @param carrierNumber CARR_NUM,
 * @param clinicalTrialNumber CLM_CLNCL_TRIL_NUM,
 * @param beneficiaryPartBDeductAmount CARR_CLM_CASH_DDCTBL_APLD_AMT,
 * @param paymentDenialCode CARR_CLM_PMT_DNL_CD,
 * @param referringPhysicianNpi RFR_PHYSN_NPI
 * @param providerAssignmentIndicator CARR_CLM_PRVDR_ASGNMT_IND_SW,
 * @param providerPaymentAmount NCH_CLM_PRVDR_PMT_AMT,
 * @param beneficiaryPaymentAmount NCH_CLM_BENE_PMT_AMT,
 * @param submittedChargeAmount NCH_CARR_CLM_SBMTD_CHRG_AMT,
 * @param allowedChargeAmount NCH_CARR_CLM_ALOWD_AMT,
 */
static void mapEobCommonGroupCarrierDME(ExplanationOfBenefit eob, String beneficiaryId, String carrierNumber, Optional<String> clinicalTrialNumber, BigDecimal beneficiaryPartBDeductAmount, String paymentDenialCode, Optional<String> referringPhysicianNpi, Optional<Character> providerAssignmentIndicator, BigDecimal providerPaymentAmount, BigDecimal beneficiaryPaymentAmount, BigDecimal submittedChargeAmount, BigDecimal allowedChargeAmount, String claimDispositionCode, Optional<String> claimCarrierControlNumber) {
    eob.addExtension(createExtensionIdentifier(CcwCodebookVariable.CARR_NUM, carrierNumber));
    // Carrier Claim Control Number
    if (claimCarrierControlNumber.isPresent()) {
        eob.addExtension(createExtensionIdentifier(CcwCodebookMissingVariable.CARR_CLM_CNTL_NUM, claimCarrierControlNumber.get()));
    }
    eob.addExtension(createExtensionCoding(eob, CcwCodebookVariable.CARR_CLM_PMT_DNL_CD, paymentDenialCode));
    // Claim Disposition Code
    eob.setDisposition(claimDispositionCode);
    /*
     * Referrals are represented as contained resources, since they share the lifecycle and identity
     * of their containing EOB.
     */
    if (referringPhysicianNpi.isPresent()) {
        ReferralRequest referral = new ReferralRequest();
        referral.setStatus(ReferralRequestStatus.COMPLETED);
        referral.setSubject(referencePatient(beneficiaryId));
        referral.setRequester(new ReferralRequestRequesterComponent(referencePractitioner(referringPhysicianNpi.get())));
        referral.addRecipient(referencePractitioner(referringPhysicianNpi.get()));
        // Set the ReferralRequest as a contained resource in the EOB:
        eob.setReferral(new Reference(referral));
    }
    if (providerAssignmentIndicator.isPresent()) {
        eob.addExtension(createExtensionCoding(eob, CcwCodebookVariable.ASGMNTCD, providerAssignmentIndicator));
    }
    if (clinicalTrialNumber.isPresent()) {
        eob.addExtension(createExtensionIdentifier(CcwCodebookVariable.CLM_CLNCL_TRIL_NUM, clinicalTrialNumber));
    }
    addAdjudicationTotal(eob, CcwCodebookVariable.CARR_CLM_CASH_DDCTBL_APLD_AMT, beneficiaryPartBDeductAmount);
    addAdjudicationTotal(eob, CcwCodebookVariable.NCH_CLM_PRVDR_PMT_AMT, providerPaymentAmount);
    addAdjudicationTotal(eob, CcwCodebookVariable.NCH_CLM_BENE_PMT_AMT, beneficiaryPaymentAmount);
    addAdjudicationTotal(eob, CcwCodebookVariable.NCH_CARR_CLM_SBMTD_CHRG_AMT, submittedChargeAmount);
    addAdjudicationTotal(eob, CcwCodebookVariable.NCH_CARR_CLM_ALOWD_AMT, allowedChargeAmount);
}

Example 2 with Resource

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

the class TransformerUtils method addResourcesToBundle.

/**
 * @param bundle a {@link Bundle} to add the list of {@link ExplanationOfBenefit} resources to.
 * @param resources a list of either {@link ExplanationOfBenefit}s, {@link Coverage}s, or {@link
 *     Patient}s, of which a portion will be added to the bundle based on the paging values
 * @return Returns a {@link Bundle} of {@link ExplanationOfBenefit}s, {@link Coverage}s, or {@link
 *     Patient}s, which may contain multiple matching resources, or may also be empty.
 */
public static Bundle addResourcesToBundle(Bundle bundle, List<IBaseResource> resources) {
    Set<String> beneIds = new HashSet<String>();
    for (IBaseResource res : resources) {
        BundleEntryComponent entry = bundle.addEntry();
        entry.setResource((Resource) res);
        if (entry.getResource().getResourceType() == ResourceType.ExplanationOfBenefit) {
            ExplanationOfBenefit eob = ((ExplanationOfBenefit) entry.getResource());
            if (eob != null && eob.getPatient() != null && !Strings.isNullOrEmpty(eob.getPatient().getReference())) {
                String reference = eob.getPatient().getReference().replace("Patient/", "");
                if (!Strings.isNullOrEmpty(reference)) {
                    beneIds.add(reference);
                }
            }
        } else if (entry.getResource().getResourceType() == ResourceType.Patient) {
            Patient patient = ((Patient) entry.getResource());
            if (patient != null && !Strings.isNullOrEmpty(patient.getId())) {
                beneIds.add(patient.getId());
            }
        } else if (entry.getResource().getResourceType() == ResourceType.Coverage) {
            Coverage coverage = ((Coverage) entry.getResource());
            if (coverage != null && coverage.getBeneficiary() != null && !Strings.isNullOrEmpty(coverage.getBeneficiary().getReference())) {
                String reference = coverage.getBeneficiary().getReference().replace("Patient/", "");
                if (!Strings.isNullOrEmpty(reference)) {
                    beneIds.add(reference);
                }
            }
        }
    }
    logBeneIdToMdc(beneIds);
    return bundle;
}

Example 3 with Resource

use of org.hl7.fhir.r4b.model.Resource 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 4 with Resource

use of org.hl7.fhir.r4b.model.Resource 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;
}

Example 5 with Resource

use of org.hl7.fhir.r4b.model.Resource 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;
}