Medplum

// SPDX-FileCopyrightText: Copyright Orangebot, Inc. and Medplum contributors // SPDX-License-Identifier: Apache-2.0 import { CPT, getReferenceString } from '@medplum/core'; import type { MedplumClient } from '@medplum/core'; import type { ChargeItem, Claim, ClaimItem, Coverage, Encounter, Reference } from '@medplum/fhirtypes'; import { calculateTotalPrice } from './chargeitems'; import { createSelfPayCoverage } from './coverage'; export async function createClaimFromEncounter( medplum: MedplumClient, patientId: string, encounterId: string, practitionerId: string, chargeItems: ChargeItem[] ): Promise<Claim | undefined> { const coverageResults = await medplum.searchResources('Coverage', `patient=Patient/${patientId}&status=active`); let coverage: Coverage = coverageResults[0]; if (!coverage) { coverage = await createSelfPayCoverage(medplum, patientId); } const claim: Claim = { resourceType: 'Claim', status: 'draft', type: { coding: [{ code: 'professional' }] }, use: 'claim', created: new Date().toISOString(), patient: { reference: `Patient/${patientId}` }, provider: { reference: `Practitioner/${practitionerId}`, type: 'Practitioner' }, priority: { coding: [{ code: 'normal' }] }, insurance: [ { sequence: 1, focal: true, coverage: { reference: getReferenceString(coverage) }, }, ], item: getCptChargeItems(chargeItems, { reference: `Encounter/${encounterId}` }), total: { value: calculateTotalPrice(chargeItems) }, }; return medplum.createResource(claim); } export function getCptChargeItems(chargeItems: ChargeItem[], encounter: Reference<Encounter>): ClaimItem[] { const cptChargeItems = chargeItems.filter((item) => item.code?.coding?.some((coding) => coding.system === CPT)); return cptChargeItems.map((chargeItem: ChargeItem, index: number) => { const modifiers = chargeItem.extension ?.filter((ext) => ext.url === 'http://hl7.org/fhir/StructureDefinition/chargeitem-modifier') .map((ext) => { return ext.valueCodeableConcept; }) .filter((modifier) => modifier !== undefined); return { sequence: index + 1, encounter: [encounter], productOrService: { coding: chargeItem.code.coding?.filter((coding) => coding.system === CPT), text: chargeItem.code.text, }, net: chargeItem.priceOverride, ...(modifiers && modifiers.length > 0 ? { modifier: modifiers } : {}), }; }); }