Medplum

// SPDX-FileCopyrightText: Copyright Orangebot, Inc. and Medplum contributors // SPDX-License-Identifier: Apache-2.0 import { CPT, createReference, getReferenceString, ICD10, indexSearchParameterBundle, indexStructureDefinitionBundle, SNOMED, } from '@medplum/core'; import type { MedplumClient } from '@medplum/core'; import { readJson, SEARCH_PARAMETER_BUNDLE_FILES } from '@medplum/definitions'; import type { Bundle, Coverage, Encounter, Patient, SearchParameter } from '@medplum/fhirtypes'; import { DrAliceSmith, MockClient } from '@medplum/mock'; import fetch from 'node-fetch'; import { handler } from './send-to-candid'; vi.mock('node-fetch', () => ({ default: vi.fn(() => ({ json: () => ({}), })), })); describe('Candid Health Tests', () => { beforeAll(() => { indexStructureDefinitionBundle(readJson('fhir/r4/profiles-types.json') as Bundle); indexStructureDefinitionBundle(readJson('fhir/r4/profiles-resources.json') as Bundle); for (const filename of SEARCH_PARAMETER_BUNDLE_FILES) { indexSearchParameterBundle(readJson(filename) as Bundle<SearchParameter>); } }); beforeEach(async (ctx) => { const medplum = new MockClient(); const patient = await medplum.createResource({ resourceType: 'Patient', name: [ { family: 'Kirby901', given: ['John43'], prefix: ['Mr.'], }, ], gender: 'male', birthDate: '1940-09-05', address: [ { line: ['599 Schowalter Promenade'], city: 'West Springfield', state: 'MA', postalCode: '01089', country: 'US', period: { start: '1940-09-05', }, }, ], maritalStatus: { coding: [ { system: 'http://terminology.hl7.org/CodeSystem/v3-MaritalStatus', code: 'M', display: 'M', }, ], text: 'M', }, }); const serviceProvider = await medplum.createResource({ resourceType: 'Organization', name: 'HOLYOKE MEDICAL CENTER', address: [ { line: ['575 BEECH STREET'], city: 'HOLYOKE', state: 'MA', postalCode: '01040-2223', country: 'US', }, ], }); const encounter = await medplum.createResource({ status: 'finished', class: { system: 'http://terminology.hl7.org/CodeSystem/v3-ActCode', code: 'AMB', }, type: [ { coding: [ { system: SNOMED, code: '394701000', display: 'Asthma follow-up', }, { system: CPT, code: '99213', display: 'Established patient office visit, 20-29 minutes', }, ], text: 'Asthma follow-up', }, ], subject: createReference(patient), participant: [ { type: [ { coding: [ { system: 'http://terminology.hl7.org/CodeSystem/v3-ParticipationType', code: 'PPRF', display: 'primary performer', }, ], text: 'primary performer', }, ], period: { start: '2022-02-11T23:33:18.000Z', }, individual: createReference(DrAliceSmith), }, ], period: { start: '2022-02-11T23:33:18.000Z', }, reasonCode: [ { coding: [ { system: SNOMED, code: '195967001', display: 'Asthma', }, { system: ICD10, code: 'J45.5', display: 'Severe persistent asthma', }, ], }, ], serviceProvider: createReference(serviceProvider), resourceType: 'Encounter', } as Encounter); const coverage: Coverage = await medplum.createResource( // start-block exampleCoverage { resourceType: 'Coverage', // Member id identifier: [ { type: { coding: [ { system: 'http://terminology.hl7.org/CodeSystem/v2-0203', code: 'MB', display: 'Member Number', }, ], }, system: 'https://www.acmeinsurance.com/glossary/memberid', value: '102345672-01', assigner: { display: 'Acme Insurance Co', }, }, ], subscriberId: '102345672-01', status: 'active', // Plan type type: { coding: [ { system: 'https://nahdo.org/sopt', code: '512', display: 'Commercial Managed Care - PPO', }, { system: 'http://terminology.hl7.org/CodeSystem/v3-ActCode', code: 'PPO', display: 'preferred provider organization policy', }, ], text: 'health insurance plan policy', }, // Subscriber & Beneficiary subscriber: createReference(patient), beneficiary: createReference(patient), relationship: { coding: [ { system: 'http://terminology.hl7.org/CodeSystem/subscriber-relationship', code: 'self', display: 'Self', }, ], }, period: { start: '2021-01-01', }, // Payor payor: [ { display: 'Acme Insurance Co', }, ], // Classification Codes class: [ { type: { coding: [ { system: 'http://terminology.hl7.org/CodeSystem/coverage-class', code: 'group', }, ], }, value: '993355', name: 'Stars Inc', }, { type: { coding: [ { system: 'http://terminology.hl7.org/CodeSystem/coverage-class', code: 'plan', }, ], }, value: '11461128', name: 'Acme Gold Plus', }, { type: { coding: [ { system: 'http://hl7.org/fhir/us/insurance-card/CodeSystem/C4DICExtendedCoverageClassCS', code: 'division', }, ], }, value: '11', }, { type: { coding: [ { system: 'http://hl7.org/fhir/us/insurance-card/CodeSystem/C4DICExtendedCoverageClassCS', code: 'network', }, ], }, value: '561490', name: 'Acme Gold Plus South', }, { type: { coding: [ { system: 'http://terminology.hl7.org/CodeSystem/coverage-class', code: 'rxbin', }, ], }, value: '100045', }, { type: { coding: [ { system: 'http://terminology.hl7.org/CodeSystem/coverage-class', code: 'rxpcn', }, ], }, value: '1234000', }, ], // Cost Sharing Provisions costToBeneficiary: [ { type: { coding: [ { system: 'http://hl7.org/fhir/us/insurance-card/CodeSystem/C4DICExtendedCopayTypeCS', code: 'FamOutDed', display: 'Family Out of Network Deductible', }, ], }, valueMoney: { value: 10000, currency: 'USD', }, }, { type: { coding: [ { system: 'http://hl7.org/fhir/us/insurance-card/CodeSystem/C4DICExtendedCopayTypeCS', code: 'FamInDed', display: 'Family In Network Deductible', }, ], }, valueMoney: { value: 8000, currency: 'USD', }, }, { type: { coding: [ { system: 'http://hl7.org/fhir/us/insurance-card/CodeSystem/C4DICExtendedCopayTypeCS', code: 'FamRxOutDed', display: 'Family Pharmacy Out of Network Deductible', }, ], }, valueMoney: { value: 2000, currency: 'USD', }, }, { type: { coding: [ { system: 'http://hl7.org/fhir/us/insurance-card/CodeSystem/C4DICExtendedCopayTypeCS', code: 'FamRxInDed', display: 'Family Pharmacy In Network Deductible', }, ], }, valueMoney: { value: 1500, currency: 'USD', }, }, { type: { coding: [ { system: 'http://hl7.org/fhir/us/insurance-card/CodeSystem/C4DICExtendedCopayTypeCS', code: 'FamOutMax', display: 'Family Out of Network Out of Pocket Maximum', }, ], }, valueMoney: { value: 12000, currency: 'USD', }, }, { type: { coding: [ { system: 'http://hl7.org/fhir/us/insurance-card/CodeSystem/C4DICExtendedCopayTypeCS', code: 'FamInMax', display: 'Family In Network Out of Pocket Maximum', }, ], }, valueMoney: { value: 10000, currency: 'USD', }, }, { type: { coding: [ { system: 'http://hl7.org/fhir/us/insurance-card/CodeSystem/C4DICExtendedCopayTypeCS', code: 'FamRxOutMax', display: 'Family Pharmacy Out of Network Out of Pocket Maximum', }, ], }, valueMoney: { value: 3000, currency: 'USD', }, }, { type: { coding: [ { system: 'http://hl7.org/fhir/us/insurance-card/CodeSystem/C4DICExtendedCopayTypeCS', code: 'FamRxInMax', display: 'Family Pharmacy In Network Out of Pocket Maximum', }, ], }, valueMoney: { value: 2000, currency: 'USD', }, }, { type: { coding: [ { system: 'http://hl7.org/fhir/us/insurance-card/CodeSystem/C4DICExtendedCopayTypeCS', code: 'rx', }, ], }, valueMoney: { extension: [ { url: 'http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-BeneficiaryCostString-extension', valueString: 'DED THEN $10/$40/$70/25%', }, ], }, }, ], } // end-block exampleCoverage ); Object.assign(ctx, { medplum, patient, encounter, coverage }); }); afterEach(() => { vi.resetAllMocks(); }); test('Send to Candid', async (ctx: any) => { const { medplum, patient, encounter } = ctx as { medplum: MedplumClient; patient: Patient; encounter: Encounter }; await handler(medplum, { bot: { reference: 'Bot/123' }, input: encounter, contentType: 'application/fhir+json', secrets: { CANDID_API_KEY: { name: 'CANDID_API_KEY', valueString: '123' }, CANDID_API_SECRET: { name: 'CANDID_API_SECRET', valueString: 'ABC' }, }, }); const body = JSON.parse(vi.mocked(fetch).mock?.lastCall?.[1]?.body as string); expect(body).toMatchObject({ external_id: getReferenceString(encounter), date_of_service: '2022-02-11', patient_authorized_release: true, benefits_assigned_to_provider: true, provider_accepts_assignment: true, appointment_type: 'Asthma follow-up', do_not_bill: false, billing_provider: { first_name: 'Alice', last_name: 'Smith' }, rendering_provider: { first_name: 'Alice', last_name: 'Smith' }, service_facility: { organization_name: 'HOLYOKE MEDICAL CENTER', address: { address1: '575 BEECH STREET', address2: '', city: 'HOLYOKE', state: 'MA', zip_code: '01040', zip_plus_four_code: '2223', }, }, pay_to_address: { address1: '575 BEECH STREET', address2: '', city: 'HOLYOKE', state: 'MA', zip_code: '01040', zip_plus_four_code: '2223', }, patient: { first_name: 'John43', last_name: 'Kirby901', gender: 'male', external_id: getReferenceString(patient), date_of_birth: '1940-09-05', address: { address1: '599 Schowalter Promenade', address2: '', city: 'West Springfield', state: 'MA', zip_code: '01089', }, }, subscriber_primary: { first_name: 'John43', last_name: 'Kirby901', gender: 'male', date_of_birth: '1940-09-05', address: { address1: '599 Schowalter Promenade', address2: '', city: 'West Springfield', state: 'MA', zip_code: '01089', }, patient_relationship_to_subscriber_code: '18', insurance_card: { group_number: '993355', plan_name: 'Stars Inc', plan_type: '12', insurance_type: 'string', member_id: '102345672-01', payer_name: 'string', payer_id: '00019', rx_bin: '100045', rx_pcn: '1234000', image_url_front: 'string', image_url_back: 'string', }, }, diagnoses: [{ code_type: 'ABK', code: 'J45.5', name: 'Severe persistent asthma' }], place_of_service_code: '10', service_lines: [ { procedure_code: '99213', quantity: '1', units: 'MJ', charge_amount_cents: 10000, diagnosis_pointers: [0] }, ], synchronicity: 'Synchronous', }); }); });