Examples with Resource org.hl7.fhir.r5.model.Resource used on opensource projects

Example 26 with Resource

use of org.hl7.fhir.r5.model.Resource in project beneficiary-fhir-data by CMSgov.

the class R4ExplanationOfBenefitResourceProvider method read.

/**
 * Adds support for the FHIR "read" operation, for {@link ExplanationOfBenefit}s. The {@link Read}
 * annotation indicates that this method supports the read operation.
 *
 * <p>Read operations take a single parameter annotated with {@link IdParam}, and should return a
 * single resource instance.
 *
 * @param eobId The read operation takes one parameter, which must be of type {@link IdType} and
 *     must be annotated with the {@link IdParam} annotation.
 * @param requestDetails the request details for the read
 * @return Returns a resource matching the specified {@link IdDt}, or <code>null</code> if none
 *     exists.
 */
@SuppressWarnings({ "rawtypes", "unchecked" })
@Read(version = false)
@Trace
public ExplanationOfBenefit read(@IdParam IdType eobId, RequestDetails requestDetails) {
    if (eobId == null)
        throw new IllegalArgumentException();
    if (eobId.getVersionIdPartAsLong() != null)
        throw new IllegalArgumentException();
    String eobIdText = eobId.getIdPart();
    if (eobIdText == null || eobIdText.trim().isEmpty())
        throw new IllegalArgumentException();
    Matcher eobIdMatcher = EOB_ID_PATTERN.matcher(eobIdText);
    if (!eobIdMatcher.matches())
        throw new IllegalArgumentException("Unsupported ID pattern: " + eobIdText);
    String eobIdTypeText = eobIdMatcher.group(1);
    Optional<ClaimTypeV2> eobIdType = ClaimTypeV2.parse(eobIdTypeText);
    if (!eobIdType.isPresent())
        throw new ResourceNotFoundException(eobId);
    String eobIdClaimIdText = eobIdMatcher.group(2);
    boolean includeTaxNumbers = returnIncludeTaxNumbers(requestDetails);
    Operation operation = new Operation(Operation.Endpoint.V2_EOB);
    operation.setOption("IncludeTaxNumbers", "" + includeTaxNumbers);
    operation.setOption("by", "id");
    operation.publishOperationName();
    Class<?> entityClass = eobIdType.get().getEntityClass();
    CriteriaBuilder builder = entityManager.getCriteriaBuilder();
    CriteriaQuery criteria = builder.createQuery(entityClass);
    Root root = criteria.from(entityClass);
    eobIdType.get().getEntityLazyAttributes().stream().forEach(a -> root.fetch(a));
    criteria.select(root);
    criteria.where(builder.equal(root.get(eobIdType.get().getEntityIdAttribute()), eobIdClaimIdText));
    Object claimEntity = null;
    Long eobByIdQueryNanoSeconds = null;
    Timer.Context timerEobQuery = metricRegistry.timer(MetricRegistry.name(getClass().getSimpleName(), "query", "eob_by_id")).time();
    try {
        claimEntity = entityManager.createQuery(criteria).getSingleResult();
    } catch (NoResultException e) {
        throw new ResourceNotFoundException(eobId);
    } finally {
        eobByIdQueryNanoSeconds = timerEobQuery.stop();
        TransformerUtilsV2.recordQueryInMdc("eob_by_id", eobByIdQueryNanoSeconds, claimEntity == null ? 0 : 1);
    }
    ExplanationOfBenefit eob = eobIdType.get().getTransformer().transform(metricRegistry, claimEntity, Optional.of(includeTaxNumbers));
    return eob;
}

Example 27 with Resource

use of org.hl7.fhir.r5.model.Resource in project beneficiary-fhir-data by CMSgov.

the class CoverageTransformerV2 method transformPartB.

/**
 * @param metricRegistry the {@link MetricRegistry} to use
 * @param beneficiary the {@link Beneficiary} to generate a {@link MedicareSegment#PART_B} {@link
 *     Coverage} resource for
 * @return {@link MedicareSegment#PART_B} {@link Coverage} resource for the specified {@link
 *     Beneficiary}
 */
private static Coverage transformPartB(MetricRegistry metricRegistry, Beneficiary beneficiary) {
    Timer.Context timer = getTimerContext(metricRegistry, "part_b");
    Coverage coverage = new Coverage();
    coverage.getMeta().addProfile(ProfileConstants.C4BB_COVERAGE_URL);
    coverage.setId(TransformerUtilsV2.buildCoverageId(MedicareSegment.PART_B, beneficiary));
    setCoverageStatus(coverage, beneficiary.getPartBTerminationCode());
    TransformerUtilsV2.setPeriodStart(coverage.getPeriod(), beneficiary.getMedicareCoverageStartDate());
    beneficiary.getMedicareBeneficiaryId().ifPresent(value -> coverage.setSubscriberId(value));
    setTypeAndIssuer(coverage);
    setCoverageRelationship(coverage, SubscriberPolicyRelationship.SELF);
    createCoverageClass(coverage, CoverageClass.GROUP, TransformerConstants.COVERAGE_PLAN, Optional.empty());
    createCoverageClass(coverage, CoverageClass.PLAN, TransformerConstants.COVERAGE_PLAN_PART_B, Optional.empty());
    coverage.setBeneficiary(TransformerUtilsV2.referencePatient(beneficiary));
    addCoverageExtension(coverage, CcwCodebookVariable.MS_CD, beneficiary.getMedicareEnrollmentStatusCode());
    addCoverageCodeExtension(coverage, CcwCodebookVariable.B_TRM_CD, beneficiary.getPartATerminationCode());
    addCoverageDecimalExtension(coverage, CcwCodebookVariable.RFRNC_YR, beneficiary.getBeneEnrollmentReferenceYear());
    // Monthly Medicare-Medicaid dual eligibility codes
    transformEntitlementDualEligibility(coverage, beneficiary);
    // Medicare Entitlement Buy In Indicator
    transformEntitlementBuyInIndicators(coverage, beneficiary);
    // update Coverage.meta.lastUpdated
    TransformerUtilsV2.setLastUpdated(coverage, beneficiary.getLastUpdated());
    timer.stop();
    return coverage;
}

Example 28 with Resource

use of org.hl7.fhir.r5.model.Resource in project beneficiary-fhir-data by CMSgov.

the class CoverageTransformerV2 method transformPartC.

/**
 * @param metricRegistry the {@link MetricRegistry} to use
 * @param beneficiary the {@link Beneficiary} to generate a {@link MedicareSegment#PART_C} {@link
 *     Coverage} resource for
 * @return {@link MedicareSegment#PART_C} {@link Coverage} resource for the specified {@link
 *     Beneficiary}
 */
private static Coverage transformPartC(MetricRegistry metricRegistry, Beneficiary beneficiary) {
    Timer.Context timer = getTimerContext(metricRegistry, "part_c");
    Coverage coverage = new Coverage();
    coverage.getMeta().addProfile(ProfileConstants.C4BB_COVERAGE_URL);
    coverage.setId(TransformerUtilsV2.buildCoverageId(MedicareSegment.PART_C, beneficiary));
    coverage.setStatus(CoverageStatus.ACTIVE);
    beneficiary.getMedicareBeneficiaryId().ifPresent(value -> coverage.setSubscriberId(value));
    setTypeAndIssuer(coverage);
    setCoverageRelationship(coverage, SubscriberPolicyRelationship.SELF);
    createCoverageClass(coverage, CoverageClass.GROUP, TransformerConstants.COVERAGE_PLAN, Optional.empty());
    createCoverageClass(coverage, CoverageClass.PLAN, TransformerConstants.COVERAGE_PLAN_PART_C, Optional.empty());
    coverage.setBeneficiary(TransformerUtilsV2.referencePatient(beneficiary));
    // Contract Number
    addCoverageExtension(coverage, CcwCodebookVariable.PTC_CNTRCT_ID_01, beneficiary.getPartCContractNumberJanId());
    addCoverageExtension(coverage, CcwCodebookVariable.PTC_CNTRCT_ID_02, beneficiary.getPartCContractNumberFebId());
    addCoverageExtension(coverage, CcwCodebookVariable.PTC_CNTRCT_ID_03, beneficiary.getPartCContractNumberMarId());
    addCoverageExtension(coverage, CcwCodebookVariable.PTC_CNTRCT_ID_04, beneficiary.getPartCContractNumberAprId());
    addCoverageExtension(coverage, CcwCodebookVariable.PTC_CNTRCT_ID_05, beneficiary.getPartCContractNumberMayId());
    addCoverageExtension(coverage, CcwCodebookVariable.PTC_CNTRCT_ID_06, beneficiary.getPartCContractNumberJunId());
    addCoverageExtension(coverage, CcwCodebookVariable.PTC_CNTRCT_ID_07, beneficiary.getPartCContractNumberJulId());
    addCoverageExtension(coverage, CcwCodebookVariable.PTC_CNTRCT_ID_08, beneficiary.getPartCContractNumberAugId());
    addCoverageExtension(coverage, CcwCodebookVariable.PTC_CNTRCT_ID_09, beneficiary.getPartCContractNumberSeptId());
    addCoverageExtension(coverage, CcwCodebookVariable.PTC_CNTRCT_ID_10, beneficiary.getPartCContractNumberOctId());
    addCoverageExtension(coverage, CcwCodebookVariable.PTC_CNTRCT_ID_11, beneficiary.getPartCContractNumberNovId());
    addCoverageExtension(coverage, CcwCodebookVariable.PTC_CNTRCT_ID_12, beneficiary.getPartCContractNumberDecId());
    // PBP
    addCoverageExtension(coverage, CcwCodebookVariable.PTC_PBP_ID_01, beneficiary.getPartCPbpNumberJanId());
    addCoverageExtension(coverage, CcwCodebookVariable.PTC_PBP_ID_02, beneficiary.getPartCPbpNumberFebId());
    addCoverageExtension(coverage, CcwCodebookVariable.PTC_PBP_ID_03, beneficiary.getPartCPbpNumberMarId());
    addCoverageExtension(coverage, CcwCodebookVariable.PTC_PBP_ID_04, beneficiary.getPartCPbpNumberAprId());
    addCoverageExtension(coverage, CcwCodebookVariable.PTC_PBP_ID_05, beneficiary.getPartCPbpNumberMayId());
    addCoverageExtension(coverage, CcwCodebookVariable.PTC_PBP_ID_06, beneficiary.getPartCPbpNumberJunId());
    addCoverageExtension(coverage, CcwCodebookVariable.PTC_PBP_ID_07, beneficiary.getPartCPbpNumberJulId());
    addCoverageExtension(coverage, CcwCodebookVariable.PTC_PBP_ID_08, beneficiary.getPartCPbpNumberAugId());
    addCoverageExtension(coverage, CcwCodebookVariable.PTC_PBP_ID_09, beneficiary.getPartCPbpNumberSeptId());
    addCoverageExtension(coverage, CcwCodebookVariable.PTC_PBP_ID_10, beneficiary.getPartCPbpNumberOctId());
    addCoverageExtension(coverage, CcwCodebookVariable.PTC_PBP_ID_11, beneficiary.getPartCPbpNumberNovId());
    addCoverageExtension(coverage, CcwCodebookVariable.PTC_PBP_ID_12, beneficiary.getPartCPbpNumberDecId());
    // Plan Type
    addCoverageExtension(coverage, CcwCodebookVariable.PTC_PLAN_TYPE_CD_01, beneficiary.getPartCPlanTypeJanCode());
    addCoverageExtension(coverage, CcwCodebookVariable.PTC_PLAN_TYPE_CD_02, beneficiary.getPartCPlanTypeFebCode());
    addCoverageExtension(coverage, CcwCodebookVariable.PTC_PLAN_TYPE_CD_03, beneficiary.getPartCPlanTypeMarCode());
    addCoverageExtension(coverage, CcwCodebookVariable.PTC_PLAN_TYPE_CD_04, beneficiary.getPartCPlanTypeAprCode());
    addCoverageExtension(coverage, CcwCodebookVariable.PTC_PLAN_TYPE_CD_05, beneficiary.getPartCPlanTypeMayCode());
    addCoverageExtension(coverage, CcwCodebookVariable.PTC_PLAN_TYPE_CD_06, beneficiary.getPartCPlanTypeJunCode());
    addCoverageExtension(coverage, CcwCodebookVariable.PTC_PLAN_TYPE_CD_07, beneficiary.getPartCPlanTypeJulCode());
    addCoverageExtension(coverage, CcwCodebookVariable.PTC_PLAN_TYPE_CD_08, beneficiary.getPartCPlanTypeAugCode());
    addCoverageExtension(coverage, CcwCodebookVariable.PTC_PLAN_TYPE_CD_09, beneficiary.getPartCPlanTypeSeptCode());
    addCoverageExtension(coverage, CcwCodebookVariable.PTC_PLAN_TYPE_CD_10, beneficiary.getPartCPlanTypeOctCode());
    addCoverageExtension(coverage, CcwCodebookVariable.PTC_PLAN_TYPE_CD_11, beneficiary.getPartCPlanTypeNovCode());
    addCoverageExtension(coverage, CcwCodebookVariable.PTC_PLAN_TYPE_CD_12, beneficiary.getPartCPlanTypeDecCode());
    // Monthly Medicare Advantage (MA) enrollment indicators:
    addCoverageCodeExtension(coverage, CcwCodebookVariable.HMO_IND_01, beneficiary.getHmoIndicatorJanInd());
    addCoverageCodeExtension(coverage, CcwCodebookVariable.HMO_IND_02, beneficiary.getHmoIndicatorFebInd());
    addCoverageCodeExtension(coverage, CcwCodebookVariable.HMO_IND_03, beneficiary.getHmoIndicatorMarInd());
    addCoverageCodeExtension(coverage, CcwCodebookVariable.HMO_IND_04, beneficiary.getHmoIndicatorAprInd());
    addCoverageCodeExtension(coverage, CcwCodebookVariable.HMO_IND_05, beneficiary.getHmoIndicatorMayInd());
    addCoverageCodeExtension(coverage, CcwCodebookVariable.HMO_IND_06, beneficiary.getHmoIndicatorJunInd());
    addCoverageCodeExtension(coverage, CcwCodebookVariable.HMO_IND_07, beneficiary.getHmoIndicatorJulInd());
    addCoverageCodeExtension(coverage, CcwCodebookVariable.HMO_IND_08, beneficiary.getHmoIndicatorAugInd());
    addCoverageCodeExtension(coverage, CcwCodebookVariable.HMO_IND_09, beneficiary.getHmoIndicatorSeptInd());
    addCoverageCodeExtension(coverage, CcwCodebookVariable.HMO_IND_10, beneficiary.getHmoIndicatorOctInd());
    addCoverageCodeExtension(coverage, CcwCodebookVariable.HMO_IND_11, beneficiary.getHmoIndicatorNovInd());
    addCoverageCodeExtension(coverage, CcwCodebookVariable.HMO_IND_12, beneficiary.getHmoIndicatorDecInd());
    // The reference year of the enrollment data
    addCoverageDecimalExtension(coverage, CcwCodebookVariable.RFRNC_YR, beneficiary.getBeneEnrollmentReferenceYear());
    // Monthly Medicare-Medicaid dual eligibility codes
    transformEntitlementDualEligibility(coverage, beneficiary);
    // update Coverage.meta.lastUpdated
    TransformerUtilsV2.setLastUpdated(coverage, beneficiary.getLastUpdated());
    timer.stop();
    return coverage;
}

Example 29 with Resource

use of org.hl7.fhir.r5.model.Resource in project beneficiary-fhir-data by CMSgov.

the class DMEClaimTransformerV2 method transform.

/**
 * @param metricRegistry the {@link MetricRegistry} to use
 * @param claim the CCW {@link DMEClaim} to transform
 * @return a FHIR {@link ExplanationOfBenefit} resource that represents the specified {@link
 *     DMEClaim}
 */
@Trace
static ExplanationOfBenefit transform(MetricRegistry metricRegistry, Object claim, Optional<Boolean> includeTaxNumbers) {
    Timer.Context timer = metricRegistry.timer(MetricRegistry.name(DMEClaimTransformerV2.class.getSimpleName(), "transform")).time();
    if (!(claim instanceof DMEClaim)) {
        throw new BadCodeMonkeyException();
    }
    ExplanationOfBenefit eob = transformClaim((DMEClaim) claim, includeTaxNumbers);
    timer.stop();
    return eob;
}

Example 30 with Resource

use of org.hl7.fhir.r5.model.Resource in project beneficiary-fhir-data by CMSgov.

the class DMEClaimTransformerV2 method transformClaim.

/**
 * @param claimGroup the CCW {@link DMEClaim} to transform
 * @return a FHIR {@link ExplanationOfBenefit} resource that represents the specified {@link
 *     DMEClaim}
 */
private static ExplanationOfBenefit transformClaim(DMEClaim claimGroup, Optional<Boolean> includeTaxNumbers) {
    ExplanationOfBenefit eob = new ExplanationOfBenefit();
    // Required values not directly mapped
    eob.getMeta().addProfile(ProfileConstants.C4BB_EOB_INPATIENT_PROFILE_URL);
    // 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
    // BENE_ID                  => ExplanationOfBenefit.patient (reference)pwd
    // 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.DME, claimGroup.getClaimGroupId().toPlainString(), MedicareSegment.PART_A, Optional.of(claimGroup.getDateFrom()), Optional.of(claimGroup.getDateThrough()), Optional.of(claimGroup.getPaymentAmount()), claimGroup.getFinalAction());
    // 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.DME, 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()));
    // NCH_WKLY_PROC_DT => ExplanationOfBenefit.supportinginfo.timingDate
    TransformerUtilsV2.addInformation(eob, TransformerUtilsV2.createInformationRecievedDateSlice(eob, CcwCodebookVariable.NCH_WKLY_PROC_DT, Optional.of(claimGroup.getWeeklyProcessDate())));
    // 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(), Optional.of(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.DME);
    }
    // CARR_CLM_ENTRY_CD => ExplanationOfBenefit.extension
    eob.addExtension(TransformerUtilsV2.createExtensionCoding(eob, CcwCodebookVariable.CARR_CLM_ENTRY_CD, claimGroup.getClaimEntryCode()));
    handleClaimLines(claimGroup, eob, includeTaxNumbers);
    TransformerUtilsV2.setLastUpdated(eob, claimGroup.getLastUpdated());
    return eob;
}