def build_contract_valued_item(cls, contract_asset, imis_policy):
valued_item = ContractTermAssetValuedItem()
policy_value = Money()
policy_value.value = imis_policy.value
valued_item.net = policy_value
contract_asset.valuedItem.append(valued_item)
return contract_asset
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
if hasattr(core, 'currency'):
unit_price.currency = core.currency
fhir_item.unitPrice = unit_price
fhir_quantity = Quantity()
fhir_quantity.value = item.qty_provided
fhir_item.quantity = fhir_quantity
fhir_item.productOrService = cls.build_simple_codeable_concept(code)
fhir_item.category = cls.build_simple_codeable_concept(item_type)
item_explanation_code = R4ClaimConfig.get_fhir_claim_item_explanation_code(
)
information = cls.build_fhir_string_information(
fhir_claim.supportingInfo, item_explanation_code, item.explanation)
if information:
fhir_item.informationSequence = [information.sequence]
extension = Extension()
if fhir_item.category.text == "item":
medication = cls.build_medication_extension(extension)
fhir_item.extension.append(medication)
elif fhir_item.category.text == "service":
activity_definition = cls.build_activity_definition_extension(
extension)
fhir_item.extension.append(activity_definition)
fhir_claim.item.append(fhir_item)
def build_response_service(self, fhir_claim_response):
service = ClaimResponseItem()
service.itemSequence = 2
service_general_adjudication = ClaimResponseItemAdjudication()
service_general_adjudication.category = ClaimResponseConverter.build_simple_codeable_concept(
R4ClaimConfig.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,
R4ClaimConfig.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(
R4ClaimConfig.
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.itemSequence = 1
item_general_adjudication = ClaimResponseItemAdjudication()
item_general_adjudication.category = ClaimResponseConverter.build_simple_codeable_concept(
R4ClaimConfig.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, R4ClaimConfig.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(
R4ClaimConfig.
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 build_contract_valued_item(self, contract, imis_coverage):
valued_item = ContractTermAssetValuedItem()
policy_value = Money()
policy_value.value = imis_coverage.value
valued_item.net = policy_value
contract.term[0].asset[0].valuedItem[0] = [valued_item]
return contract
def build_fhir_total(cls, fhir_claim, imis_claim):
total_claimed = imis_claim.claimed
if not total_claimed:
total_claimed = 0
fhir_total = Money()
fhir_total.value = total_claimed
if hasattr(core, 'currency'):
fhir_total.currency = core.currency
fhir_claim.total = fhir_total
def build_contract_valued_item(self, contract, imis_coverage):
valued_item = ContractTermAssetValuedItem()
policy_value = Money()
policy_value.value = imis_coverage.value
valued_item.net = policy_value
if contract.term is None:
contract.term = [ContractTerm()]
elif len(contract.term) == 0:
contract.term.append(ContractTerm())
if contract.term[0].asset is None:
contract.term[0].asset = [ContractTermAsset()]
elif len(contract.term[0].asset) == 0:
contract.term[0].asset.append(ContractTermAsset())
contract.term[0].asset[0].valuedItem.append(valued_item)
return contract
def create_test_fhir_instance(self):
fhir_claim = FHIRClaim()
fhir_claim.id = self._TEST_UUID
fhir_claim.patient = PatientConverter.build_fhir_resource_reference(
self._TEST_INSUREE)
claim_code = ClaimConverter.build_fhir_identifier(
self._TEST_CODE,
R4IdentifierConfig.get_fhir_identifier_type_system(),
R4IdentifierConfig.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)
supportingInfo = []
guarantee_id_code = R4ClaimConfig.get_fhir_claim_information_guarantee_id_code(
)
ClaimConverter.build_fhir_string_information(supportingInfo,
guarantee_id_code,
self._TEST_GUARANTEE_ID)
explanation_code = R4ClaimConfig.get_fhir_claim_information_explanation_code(
)
ClaimConverter.build_fhir_string_information(supportingInfo,
explanation_code,
self._TEST_EXPLANATION)
fhir_claim.supportingInfo = supportingInfo
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 = R4ClaimConfig.get_fhir_claim_item_code()
ClaimConverter.build_fhir_item(fhir_claim, self._TEST_ITEM_CODE, type,
self._TEST_ITEM)
type = R4ClaimConfig.get_fhir_claim_service_code()
ClaimConverter.build_fhir_item(fhir_claim, self._TEST_SERVICE_CODE,
type, self._TEST_SERVICE)
return fhir_claim
def build_unit_price_extension(cls, value):
extension = Extension()
money = Money()
extension.url = "unitPrice"
extension.valueMoney = money
extension.valueMoney.value = value
if hasattr(core, 'currency'):
extension.valueMoney.currency = core.currency
return extension
def build_fhir_money_item_benefit(cls, item, allowed_value, used_value):
benefit = cls.build_fhir_generic_item_benefit()
allowed_money_value = Money()
allowed_money_value.value = allowed_value or 0
benefit.allowedMoney = allowed_money_value
used_money_value = Money()
used_money_value.value = used_value or 0
benefit.usedMoney = used_money_value
item.benefit.append(benefit)
def build_fhir_total_reinsured(cls, imis_claim):
fhir_total = ClaimResponseTotal()
money = Money()
fhir_total.amount = money
if imis_claim.reinsured is not None:
fhir_total.category = CodeableConcept()
coding = Coding()
coding.code = "R"
coding.system = "http://terminology.hl7.org/CodeSystem/adjudication.html"
coding.display = "Reinsured"
fhir_total.category.coding.append(coding)
fhir_total.category.text = "Valuated < Reinsured < Approved < Claimed"
fhir_total.amount.value = imis_claim.reinsured
if hasattr(core, 'currency'):
fhir_total.amount.currency = core.currency
return fhir_total
def build_fhir_money_item_benefit(cls, item, value):
benefit = cls.build_fhir_generic_item_benefit()
money_value = Money()
money_value.value = value
benefit.allowedMoney = money_value
item.benefit.append(benefit)
def build_fhir_item_adjudication(cls, item, rejected_reason, imis_claim):
item_adjudication_asked = ClaimResponseItemAdjudication()
item_adjudication_adjusted = ClaimResponseItemAdjudication()
item_adjudication_approved = ClaimResponseItemAdjudication()
item_adjudication_valuated = ClaimResponseItemAdjudication()
price_asked = Money()
price_asked.value = item.price_asked
price_adjusted = Money()
price_adjusted.value = item.price_adjusted
price_approved = Money()
price_approved.value = item.price_approved
price_valuated = Money()
price_valuated.value = item.price_valuated
if hasattr(core, 'currency'):
price_asked.currency = core.currency
price_adjusted.currency = core.currency
price_valuated.currency = core.currency
price_approved.currency = core.currency
value = None
if rejected_reason == 0:
value = item.qty_approved
else:
value = item.qty_provided
item_adjudication_asked.reason = cls.build_fhir_adjudication_reason(
item, rejected_reason)
item_adjudication_asked.amount = price_asked
item_adjudication_adjusted.reason = cls.build_fhir_adjudication_reason(
item, rejected_reason)
if price_adjusted.value is not None and price_adjusted.value != 0.0:
item_adjudication_adjusted.amount = price_adjusted
item_adjudication_approved.reason = cls.build_fhir_adjudication_reason(
item, rejected_reason)
if price_approved.value is not None and price_approved.value != 0.0:
item_adjudication_approved.amount = price_approved
item_adjudication_valuated.reason = cls.build_fhir_adjudication_reason(
item, rejected_reason)
if price_valuated.value is not None and price_valuated.value != 0.0:
item_adjudication_valuated.amount = price_valuated
if imis_claim.status == 1:
item_adjudication_asked.category = \
cls.build_codeable_concept(1, text="rejected")
item_adjudication_asked.value = item.qty_provided
return [item_adjudication_asked]
if imis_claim.status == 2:
item_adjudication_asked.category = \
cls.build_codeable_concept(2, text="entered")
item_adjudication_asked.value = item.qty_provided
return [item_adjudication_asked]
if imis_claim.status == 4:
item_adjudication_asked.category = \
cls.build_codeable_concept(2, text="entered")
item_adjudication_adjusted.category = \
cls.build_codeable_concept(4, text="checked")
item_adjudication_asked.value = item.qty_provided
if item.qty_approved is not None and item.qty_approved != 0.0:
value = item.qty_approved
else:
value = item.qty_provided
item_adjudication_adjusted.value = value
return [item_adjudication_asked, item_adjudication_adjusted]
if imis_claim.status == 8:
item_adjudication_asked.category = \
cls.build_codeable_concept(2, text="entered")
item_adjudication_adjusted.category = \
cls.build_codeable_concept(4, text="checked")
item_adjudication_approved.category = \
cls.build_codeable_concept(8, text="processed")
item_adjudication_asked.value = item.qty_provided
if item.qty_approved is not None and item.qty_approved != 0.0:
value = item.qty_approved
else:
value = item.qty_provided
item_adjudication_adjusted.value = value
item_adjudication_approved.value = value
return [
item_adjudication_asked, item_adjudication_adjusted,
item_adjudication_approved
]
if imis_claim.status == 16:
item_adjudication_asked.category = \
cls.build_codeable_concept(2, text="entered")
item_adjudication_adjusted.category = \
cls.build_codeable_concept(4, text="checked")
item_adjudication_approved.category = \
cls.build_codeable_concept(8, text="processed")
item_adjudication_valuated.category = \
cls.build_codeable_concept(16, text="valuated")
item_adjudication_asked.value = item.qty_provided
if item.qty_approved is not None and item.qty_approved != 0.0:
value = item.qty_approved
else:
value = item.qty_provided
item_adjudication_adjusted.value = value
item_adjudication_approved.value = value
item_adjudication_valuated.value = value
return [
item_adjudication_asked, item_adjudication_adjusted,
item_adjudication_approved, item_adjudication_valuated
]
if rejected_reason != 0:
item_adjudication_asked.reason = cls.build_fhir_adjudication_reason(
item, rejected_reason)
item_adjudication_asked.amount = price_asked
item_adjudication_asked.category = \
cls.build_codeable_concept(1, text="rejected")
item_adjudication_asked.value = item.qty_provided
return [item_adjudication_asked]