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_contract_valued_item(self, contract, imis_coverage):
valued_item = ContractValuedItem()
policy_value = Money()
policy_value.value = imis_coverage.value
valued_item.net = policy_value
contract.valuedItem = [valued_item]
return contract
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_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 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
fhir_claim.total = fhir_total
def build_fhir_money_benefit_balance_financial(cls, benefit_balance,
value):
financial = cls.build_fhir_generic_benefit_balance_financial()
money_value = Money()
money_value.value = value
financial.allowedMoney = money_value
benefit_balance.financial.append(financial)
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 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(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_fhir_money_benefit_balance_financial(cls, benefit_balance,
allowed_value, used_value):
financial = cls.build_fhir_generic_benefit_balance_financial()
allowed_money_value = Money()
allowed_money_value.value = allowed_value or 0
financial.allowedMoney = allowed_money_value
used_money_value = Money()
used_money_value.value = used_value or 0
financial.usedMoney = used_money_value
benefit_balance.financial.append(financial)
def build_fhir_total_benefit(cls, fhir_claim_response, imis_claim):
total_approved = Money()
total_approved.value = imis_claim.approved
fhir_claim_response.totalBenefit = total_approved