class Institutional_ClaimDetails(ClaimDetails):
"""Institutional Claim Details from the 2300 Loop."""
fmt = ElementAccess("DTP", 2)
stmtDts = ElementAccess("DTP", 3, qualifier=(1, "434"))
admsDt = ElementAccess("DTP", 3, qualifier=(1, "435"))
dischHr = ElementAccess("DTP", 3, qualifier=(1, "096"))
billNote = ElementAccess("NTE", 2, qualifier=(1, "ADD"))
# Non-"ADD" "NTE" segments are claim notes -- legacy uses an array of up to 10.
# Only for institutional claims.
claimNotes = ElementSequenceAccess("NTE",
2,
qualPos=1,
notInList=("ADD", ))
# DR Composite (Diagnosis Related Group (DRG) Information)
drg = CompositeAccess("HI", "DR", 1)
# BP/BR Composite (Principal Procedure Information)
prinProcCode = CompositeAccess("HI", ("BR", "BP"), 1)
# BF Composite (Diagnosis) can have a number of attributes
diagCode = CompositeSequenceAccess("HI", "BF")
# BG Composite (Condition Information) can have a number of attributes
condCode = CompositeSequenceAccess("HI", "BG")
# BK Composite (Principal Diagnosis) is split into two attributes
prinDiagCode = CompositeAccess("HI", "BK", 1)
admitDiagCd = CompositeAccess("HI", "BK", 2)
# BO/BQ Composite (Other Procedure Information) has a number of attributes
procCode = CompositeSequenceAccess("HI", ("BQ", "BO"))
# BH Composite (Occurrence Information) has a number of attributes
occrCode = CompositeSequenceAccess("HI", "BH")
# BE Composite (Value Information) has a number of attributes
valueCode = CompositeSequenceAccess("HI", "BE")
class EligibilityOrBenefitInformation(X12SegmentBridge):
"""Eligibility Information."""
information_type = ElementAccess("EB", 1, x12type=enum(
eligibility_or_benefit_code))
coverage_level = ElementAccess("EB", 2, x12type=enum(
coverage_level))
service_type = ElementAccess("EB", 3, x12type=enum(
service_type_codes))
insurance_type = ElementAccess("EB", 4, x12type=enum(
insurance_type))
description = ElementAccess("EB", 5)
time_period_type = ElementAccess("EB", 6,
x12type=enum(time_period_qualifier))
benefit_amount = ElementAccess("EB", 7, x12type=Money)
benefit_percent = ElementAccess("EB", 8, x12type=XDecimal)
quantity_type = ElementAccess("EB", 9, x12type=enum(quantity_qualifier))
quantity = ElementAccess("EB", 10)
authorization_or_certification = ElementAccess("EB", 11,
x12type=boolean("Y"))
in_plan_network = ElementAccess("EB", 12, x12type=boolean("Y"))
both_in_out_network = ElementAccess("EB", 12, x12type=boolean("W"))
ada_code = CompositeAccess("EB", "AD", 13)
cpt_code = CompositeAccess("EB", "CJ", 13)
hcpcs_code = CompositeAccess("EB", "HC", 13)
icd_9_cm_code = CompositeAccess("EB", "ID", 13)
ndc_code = CompositeAccess("EB", "ND", 13)
zz_code = CompositeAccess("EB", "ZZ", 13)
class EligibilityOrBenefitInquiry(X12SegmentBridge):
service_type = ElementAccess("EQ", 1, x12type=enum(service_type_codes))
ada_code = CompositeAccess("EQ", "AD", 2)
cpt_code = CompositeAccess("EQ", "CJ", 2)
hcpcs_code = CompositeAccess("EQ", "HC", 2)
icd_9_cm_code = CompositeAccess("EQ", "ID", 2)
hiec_code = CompositeAccess("EQ", "IV", 2)
ndc_code = CompositeAccess("EQ", "ND", 2)
zz_code = CompositeAccess("EQ", "ZZ", 2)
coverage_level = ElementAccess("EQ", 3, x12type=enum(coverage_level))
insurance_type = ElementAccess("EQ", 4, x12type=enum(insurance_type))
class EligibilityOrBenefitAdditionalInformation(X12LoopBridge):
additional_information = CompositeAccess("III", "ZZ", 2, x12type=enum(place_of_service))
class _ServiceInfo(X12LoopBridge):
""" Oh jeez, I'm so sorry about this mess.
Each claim has several nested 2110 loops that have additional
information pertaining to a claim. This is usually when the
insurance company doesn't want to pay the whole amount billed.
The only way I could think of to implement this is to do this
mess of multiple inheritance.
Rest assured I did not come to this decision lightly."""
loopName = "2110"
hcpcs_code = CompositeAccess("SVC", "HC", 1)
charge = ElementAccess("SVC", 2, x12type=Money)
payment = ElementAccess("SVC", 3, x12type=Money)
quantity = ElementAccess("SVC", 5)
start_date = ElementAccess("DTM", 2, qualifier=(1, "150"), x12type=D8)
end_date = ElementAccess("DTM", 2, qualifier=(1, "151"), x12type=D8)
service_date = ElementAccess("DTM",
2,
qualifier=(1, "472"),
x12type=D8)
# Identification
apg_number = ElementAccess("REF", 2, qualifier=(1, "1S"))
provider_control_number = ElementAccess("REF", 2, qualifier=(1, "6R"))
authorization_number = ElementAccess("REF", 2, qualifier=(1, "BB"))
attachment_code = ElementAccess("REF", 2, qualifier=(1, "E9"))
prior_authorization_number = ElementAccess("REF",
2,
qualifier=(1, "G1"))
predetermination_of_benefits_id = ElementAccess("REF",
2,
qualifier=(1, "G3"))
location_number = ElementAccess("REF", 2, qualifier=(1, "LU"))
rate_code_number = ElementAccess("REF", 2, qualifier=(1, "RB"))
# TODO: Rendering provider info?
# Line-item claim amounts
allowed_amount = ElementAccess("AMT",
2,
qualifier=(1, "B6"),
x12type=Money)
per_day_limit = ElementAccess("AMT",
2,
qualifier=(1, "DY"),
x12type=Money)
deduction_amount = ElementAccess("AMT",
2,
qualifier=(1, "KH"),
x12type=Money)
tax_amount = ElementAccess("AMT", 2, qualifier=(1, "T"), x12type=Money)
total_claim_before_taxes = ElementAccess("AMT",
2,
qualifier=(1, "T2"),
x12type=Money)
not_covered_quantity = ElementAccess("QTY", 2, qualifier=(1, "NE"))
notes = ElementSequenceAccess("LQ",
2,
qualPos=1,
inList=("HE", ),
x12type=enum(remittance_advice_codes,
raw_unknowns=True))
def __init__(self, anX12Message, *args, **kwargs):
super(Claim._ServiceInfo, self).__init__(anX12Message, *args,
**kwargs)
self.claim_adjustments = Claim._ClaimAdjustments(anX12Message)
def get_actual_allowed_amount(self):
if self.allowed_amount == Decimal('0.00'):
# Actually means that the allowed amount is the full billed amt
return self.charge
return self.allowed_amount
def get_actual_deductible(self):
return (self.claim_adjustments.patient_responsibility.total_amount(
'1'))
def get_actual_coinsurance(self):
return (self.claim_adjustments.patient_responsibility.total_amount(
'2'))
def get_actual_copayment(self):
return (self.claim_adjustments.patient_responsibility.total_amount(
'3'))