def build_response_service(self, fhir_claim_response):
service = ClaimResponseItem()
service.sequenceLinkId = 2
service_general_adjudication = ClaimResponseItemAdjudication()
service_general_adjudication.category = ClaimResponseConverter.build_simple_codeable_concept(
Stu3ClaimConfig.get_fhir_claim_item_general_adjudication_code())
item_limitation = Money()
item_limitation.value = self._TEST_SERVICE_LIMITATION_VALUE
service_general_adjudication.amount = item_limitation
service_general_adjudication.reason = ClaimResponseConverter \
.build_codeable_concept(self._TEST_SERVICE_STATUS, Stu3ClaimConfig.get_fhir_claim_item_status_rejected_code())
service_general_adjudication.value = self._TEST_SERVICE_QUANTITY_APPROVED
service.adjudication.append(service_general_adjudication)
item_rejection_adjudication = ClaimResponseItemAdjudication()
item_rejection_adjudication.category = ClaimResponseConverter.build_simple_codeable_concept(
Stu3ClaimConfig.
get_fhir_claim_item_rejected_reason_adjudication_code())
item_rejection_adjudication.reason = ClaimResponseConverter.build_codeable_concept(
self._TEST_SERVICE_REJECTED_REASON)
service.adjudication.append(item_rejection_adjudication)
service.noteNumber = [2]
fhir_claim_response.item.append(service)
item_note = ClaimResponseProcessNote()
item_note.number = 2
item_note.text = self._TEST_SERVICE_JUSTIFICATION
fhir_claim_response.processNote.append(item_note)
def build_response_item(self, fhir_claim_response):
item = ClaimResponseItem()
item.sequenceLinkId = 1
item_general_adjudication = ClaimResponseItemAdjudication()
item_general_adjudication.category = ClaimResponseConverter.build_simple_codeable_concept(
Stu3ClaimConfig.get_fhir_claim_item_general_adjudication_code())
item_limitation = Money()
item_limitation.value = self._TEST_ITEM_LIMITATION_VALUE
item_general_adjudication.amount = item_limitation
item_general_adjudication.reason = ClaimResponseConverter \
.build_codeable_concept(self._TEST_ITEM_STATUS, Stu3ClaimConfig.get_fhir_claim_item_status_passed_code())
item_general_adjudication.value = self._TEST_ITEM_QUANTITY_APPROVED
item.adjudication.append(item_general_adjudication)
item_rejection_adjudication = ClaimResponseItemAdjudication()
item_rejection_adjudication.category = ClaimResponseConverter.build_simple_codeable_concept(
Stu3ClaimConfig.
get_fhir_claim_item_rejected_reason_adjudication_code())
item_rejection_adjudication.reason = ClaimResponseConverter.build_codeable_concept(
self._TEST_ITEM_REJECTED_REASON)
item.adjudication.append(item_rejection_adjudication)
item.noteNumber = [1]
fhir_claim_response.item.append(item)
item_note = ClaimResponseProcessNote()
item_note.number = 1
item_note.text = self._TEST_ITEM_JUSTIFICATION
fhir_claim_response.processNote.append(item_note)
def verify_fhir_instance(self, fhir_obj):
self.assertIsNotNone(fhir_obj.patient.reference)
self.assertEqual(str(self._TEST_UUID), fhir_obj.id)
for identifier in fhir_obj.identifier:
if identifier.type.coding[
0].code == Stu3IdentifierConfig.get_fhir_uuid_type_code():
self.assertEqual(fhir_obj.id, identifier.value)
elif identifier.type.coding[
0].code == Stu3IdentifierConfig.get_fhir_claim_code_type():
self.assertEqual(self._TEST_CODE, identifier.value)
self.assertEqual(self._TEST_DATE_FROM, fhir_obj.billablePeriod.start)
self.assertEqual(self._TEST_DATE_TO, fhir_obj.billablePeriod.end)
for diagnosis in fhir_obj.diagnosis:
type = diagnosis.type[0].text
code = diagnosis.diagnosisCodeableConcept.coding[0].code
if type == ImisClaimIcdTypes.ICD_0.value:
self.assertEqual(self._TEST_MAIN_ICD_CODE, code)
self.assertEqual(self._TEST_CLAIMED, fhir_obj.total.value)
self.assertEqual(self._TEST_DATE_CLAIMED, fhir_obj.created)
self.assertIsNotNone(fhir_obj.facility.reference)
for information in fhir_obj.information:
if information.category.text == Stu3ClaimConfig.get_fhir_claim_information_explanation_code(
):
self.assertEqual(self._TEST_EXPLANATION,
information.valueString)
elif information.category.text == Stu3ClaimConfig.get_fhir_claim_information_guarantee_id_code(
):
self.assertEqual(self._TEST_GUARANTEE_ID,
information.valueString)
self.assertIsNotNone(fhir_obj.enterer.reference)
self.assertEqual(self._TEST_VISIT_TYPE, fhir_obj.type.text)
for item in fhir_obj.item:
if item.category.text == Stu3ClaimConfig.get_fhir_claim_item_code(
):
self.assertEqual(self._TEST_ITEM_CODE, item.service.text)
self.assertEqual(self._TEST_ITEM_QUANTITY_PROVIDED,
item.quantity.value)
self.assertEqual(self._TEST_ITEM_PRICE_ASKED,
item.unitPrice.value)
self.assertEqual(
self._TEST_ITEM_EXPLANATION,
fhir_obj.information[item.informationLinkId[0] -
1].valueString)
elif item.category.text == Stu3ClaimConfig.get_fhir_claim_service_code(
):
self.assertEqual(self._TEST_SERVICE_CODE, item.service.text)
self.assertEqual(self._TEST_SERVICE_QUANTITY_PROVIDED,
item.quantity.value)
self.assertEqual(self._TEST_SERVICE_PRICE_ASKED,
item.unitPrice.value)
self.assertEqual(
self._TEST_SERVICE_EXPLANATION,
fhir_obj.information[item.informationLinkId[0] -
1].valueString)
def build_fhir_adjudication_reason(cls, item):
status = item.status
text_code = None
if status == 1:
text_code = Stu3ClaimConfig.get_fhir_claim_item_status_passed_code(
)
elif status == 2:
text_code = Stu3ClaimConfig.get_fhir_claim_item_status_rejected_code(
)
return cls.build_codeable_concept(status, text=text_code)
def build_imis_information(cls, imis_claim, fhir_claim):
if fhir_claim.information:
for information in fhir_claim.information:
category = information.category
if category and category.text == Stu3ClaimConfig.get_fhir_claim_information_guarantee_id_code(
):
imis_claim.guarantee_id = information.valueString
elif category and category.text == Stu3ClaimConfig.get_fhir_claim_information_explanation_code(
):
imis_claim.explanation = information.valueString
def build_fhir_information(cls, fhir_claim, imis_claim):
guarantee_id_code = Stu3ClaimConfig.get_fhir_claim_information_guarantee_id_code(
)
cls.build_fhir_string_information(fhir_claim.information,
guarantee_id_code,
imis_claim.guarantee_id)
explanation_code = Stu3ClaimConfig.get_fhir_claim_information_explanation_code(
)
cls.build_fhir_string_information(fhir_claim.information,
explanation_code,
imis_claim.explanation)
def get_status_display_by_code(cls, code):
display = None
if code == 1:
display = Stu3ClaimConfig.get_fhir_claim_status_rejected_code()
elif code == 2:
display = Stu3ClaimConfig.get_fhir_claim_status_entered_code()
elif code == 4:
display = Stu3ClaimConfig.get_fhir_claim_status_checked_code()
elif code == 8:
display = Stu3ClaimConfig.get_fhir_claim_status_processed_code()
elif code == 16:
display = Stu3ClaimConfig.get_fhir_claim_status_valuated_code()
return display
def build_imis_submit_items_and_services(cls, imis_claim, fhir_claim):
imis_items = []
imis_services = []
if fhir_claim.item:
for item in fhir_claim.item:
if item.category:
if item.category.text == Stu3ClaimConfig.get_fhir_claim_item_code(
):
cls.build_imis_submit_item(imis_items, item)
elif item.category.text == Stu3ClaimConfig.get_fhir_claim_service_code(
):
cls.build_imis_submit_service(imis_services, item)
# added additional attributes which will be used to create ClaimRequest in serializer
imis_claim.submit_items = imis_items
imis_claim.submit_services = imis_services
def create_test_fhir_instance(self):
fhir_claim = FHIRClaim()
fhir_claim.id = self._TEST_CODE
fhir_claim.patient = PatientConverter.build_fhir_resource_reference(
self._TEST_INSUREE)
claim_code = ClaimConverter.build_fhir_identifier(
self._TEST_CODE,
Stu3IdentifierConfig.get_fhir_identifier_type_system(),
Stu3IdentifierConfig.get_fhir_claim_code_type())
fhir_claim.identifier = [claim_code]
billable_period = Period()
billable_period.start = self._TEST_DATE_FROM
billable_period.end = self._TEST_DATE_TO
fhir_claim.billablePeriod = billable_period
diagnoses = []
ClaimConverter.build_fhir_diagnosis(diagnoses,
self._TEST_DIAGNOSIS_CODE.code,
ImisClaimIcdTypes.ICD_0.value)
fhir_claim.diagnosis = diagnoses
total = Money()
total.value = self._TEST_CLAIMED
fhir_claim.total = total
fhir_claim.created = self._TEST_DATE_CLAIMED
fhir_claim.facility = LocationConverter.build_fhir_resource_reference(
self._TEST_HF)
information = []
guarantee_id_code = Stu3ClaimConfig.get_fhir_claim_information_guarantee_id_code(
)
ClaimConverter.build_fhir_string_information(information,
guarantee_id_code,
self._TEST_GUARANTEE_ID)
explanation_code = Stu3ClaimConfig.get_fhir_claim_information_explanation_code(
)
ClaimConverter.build_fhir_string_information(information,
explanation_code,
self._TEST_EXPLANATION)
fhir_claim.information = information
fhir_claim.enterer = PractitionerConverter.build_fhir_resource_reference(
self._TEST_CLAIM_ADMIN)
fhir_claim.type = ClaimConverter.build_simple_codeable_concept(
self._TEST_VISIT_TYPE)
type = Stu3ClaimConfig.get_fhir_claim_item_code()
ClaimConverter.build_fhir_item(fhir_claim, self._TEST_ITEM_CODE, type,
self._TEST_ITEM)
type = Stu3ClaimConfig.get_fhir_claim_service_code()
ClaimConverter.build_fhir_item(fhir_claim, self._TEST_SERVICE_CODE,
type, self._TEST_SERVICE)
return fhir_claim
def build_fhir_item_rejected_reason_adjudication(cls, claim_response_item,
rejection_reason):
item_adjudication = ClaimResponseItemAdjudication()
item_adjudication.category = \
cls.build_simple_codeable_concept(Stu3ClaimConfig.get_fhir_claim_item_rejected_reason_adjudication_code())
item_adjudication.reason = cls.build_codeable_concept(rejection_reason)
claim_response_item.adjudication.append(item_adjudication)
def create_test_fhir_instance(self):
fhir_claim_response = ClaimResponse()
fhir_claim_response.id = self._TEST_CODE
pk_id = ClaimResponseConverter.build_fhir_identifier(
self._TEST_ID,
Stu3IdentifierConfig.get_fhir_identifier_type_system(),
Stu3IdentifierConfig.get_fhir_id_type_code())
claim_code = ClaimResponseConverter.build_fhir_identifier(
self._TEST_CODE,
Stu3IdentifierConfig.get_fhir_identifier_type_system(),
Stu3IdentifierConfig.get_fhir_claim_code_type())
fhir_claim_response.identifier = [pk_id, claim_code]
display = Stu3ClaimConfig.get_fhir_claim_status_rejected_code()
fhir_claim_response.outcome = ClaimResponseConverter.build_codeable_concept(
self._TEST_STATUS, system=None, text=display)
fhir_payment = ClaimResponsePayment()
fhir_payment.adjustmentReason = ClaimResponseConverter.build_simple_codeable_concept(
self._TEST_ADJUSTMENT)
fhir_payment.date = self._TEST_DATE_PROCESSED
fhir_claim_response.payment = fhir_payment
total_approved = Money()
total_approved.value = self._TEST_APPROVED
fhir_claim_response.totalBenefit = total_approved
fhir_error = ClaimResponseError()
fhir_error.code = ClaimResponseConverter.build_codeable_concept(
self._TEST_REJECTION_REASON)
fhir_claim_response.error = [fhir_error]
feedback = Feedback()
feedback.id = self._TEST_FEEDBACK_ID
fhir_claim_response.communicationRequest = \
[CommunicationRequestConverter.build_fhir_resource_reference(feedback)]
self.build_response_item(fhir_claim_response)
self.build_response_service(fhir_claim_response)
return fhir_claim_response
def build_fhir_items(cls, fhir_claim_response, imis_claim):
for claim_item in cls.generate_fhir_claim_items(imis_claim):
type = claim_item.category.text
code = claim_item.service.text
if type == Stu3ClaimConfig.get_fhir_claim_item_code():
serviced = cls.get_imis_claim_item_by_code(code, imis_claim.id)
elif type == Stu3ClaimConfig.get_fhir_claim_service_code():
serviced = cls.get_service_claim_item_by_code(
code, imis_claim.id)
else:
raise FHIRRequestProcessException([
'Could not assign category {} for claim_item: {}'.format(
type, claim_item)
])
cls._build_response_items(fhir_claim_response, claim_item,
serviced, serviced.rejection_reason)
def build_fhir_item_general_adjudication(cls, claim_response_item, item):
item_adjudication = ClaimResponseItemAdjudication()
item_adjudication.category = \
cls.build_simple_codeable_concept(Stu3ClaimConfig.get_fhir_claim_item_general_adjudication_code())
item_adjudication.reason = cls.build_fhir_adjudication_reason(item)
item_adjudication.value = item.qty_approved
limitation_value = Money()
limitation_value.value = item.limitation_value
item_adjudication.amount = limitation_value
claim_response_item.adjudication.append(item_adjudication)
def build_fhir_items(cls, fhir_claim_response, imis_claim):
for claim_item in cls.generate_fhir_claim_items(imis_claim):
type = claim_item.category.text
code = claim_item.service.text
if type == Stu3ClaimConfig.get_fhir_claim_item_code():
imis_item = cls.get_imis_claim_item_by_code(
code, imis_claim.id)
cls.build_fhir_item(fhir_claim_response,
claim_item,
imis_item,
rejected_reason=imis_item.rejection_reason)
elif type == Stu3ClaimConfig.get_fhir_claim_service_code():
imis_service = cls.get_service_claim_item_by_code(
code, imis_claim.id)
cls.build_fhir_item(
fhir_claim_response,
claim_item,
imis_service,
rejected_reason=imis_service.rejection_reason)
def build_fhir_item(cls, fhir_claim, code, item_type, item):
fhir_item = FHIRClaimItem()
fhir_item.sequence = FhirUtils.get_next_array_sequential_id(
fhir_claim.item)
unit_price = Money()
unit_price.value = item.price_asked
fhir_item.unitPrice = unit_price
fhir_quantity = Quantity()
fhir_quantity.value = item.qty_provided
fhir_item.quantity = fhir_quantity
fhir_item.service = cls.build_simple_codeable_concept(code)
fhir_item.category = cls.build_simple_codeable_concept(item_type)
item_explanation_code = Stu3ClaimConfig.get_fhir_claim_item_explanation_code(
)
information = cls.build_fhir_string_information(
fhir_claim.information, item_explanation_code, item.explanation)
if information:
fhir_item.informationLinkId = [information.sequence]
fhir_claim.item.append(fhir_item)
def build_items_for_imis_services(cls, fhir_claim, imis_claim):
for service in cls.get_imis_services_for_claim(imis_claim):
if service.service:
type = Stu3ClaimConfig.get_fhir_claim_service_code()
cls.build_fhir_item(fhir_claim, service.service.code, type,
service)
def build_items_for_imis_item(cls, fhir_claim, imis_claim):
for item in cls.get_imis_items_for_claim(imis_claim):
if item.item:
type = Stu3ClaimConfig.get_fhir_claim_item_code()
cls.build_fhir_item(fhir_claim, item.item.code, type, item)