Medplum

// SPDX-FileCopyrightText: Copyright Orangebot, Inc. and Medplum contributors // SPDX-License-Identifier: Apache-2.0 import type { Account, Organization, RelatedPerson } from '@medplum/fhirtypes'; import { mapFhirToCcdaDate } from '../../datetime'; import { OID_COVERAGE_ACTIVITY, OID_COVERED_PARTY_PARTICIPANT, OID_LOINC_CODE_SYSTEM, OID_PAYER_PERFORMER, OID_POLICY_ACTIVITY, OID_POLICY_HOLDER_PARTICIPANT, } from '../../oids'; import { INSURANCE_COVERAGE_TYPE_MAPPER } from '../../systems'; import type { CcdaEntry, CcdaEntryRelationship, CcdaId, CcdaParticipant } from '../../types'; import type { FhirToCcdaConverter } from '../convert'; import { createTextFromExtensions, mapFhirAddressArrayToCcdaAddressArray, mapIdentifiers, mapNames, mapTelecom, } from '../utils'; export function createInsuranceEntry(converter: FhirToCcdaConverter, account: Account): CcdaEntry | undefined { const entryRelationship: CcdaEntryRelationship[] = []; if (account.coverage) { for (const accountCoverage of account.coverage) { const coverage = converter.findResourceByReference(accountCoverage.coverage); if (coverage?.resourceType !== 'Coverage') { continue; } const coveragePlan = coverage.class?.find((c) => c.type?.coding?.[0]?.code === 'plan'); const payor = converter.findResourceByReference(coverage.payor?.[0]) as Organization | undefined; const policyHolder = converter.findResourceByReference(coverage.policyHolder) as RelatedPerson | undefined; entryRelationship.push({ '@_typeCode': 'COMP', sequenceNumber: { '@_xsi:type': 'INT', '@_value': entryRelationship.length.toString() }, act: [ { '@_classCode': 'ACT', '@_moodCode': 'EVN', templateId: [ { '@_root': OID_POLICY_ACTIVITY, '@_extension': '2015-08-01' }, { '@_root': OID_POLICY_ACTIVITY }, ], id: mapIdentifiers(coverage.id, coverage.identifier) as CcdaId[], code: { '@_code': INSURANCE_COVERAGE_TYPE_MAPPER.mapFhirToCcdaWithDefault( coverage.type?.coding?.[0]?.code, '9999' ), '@_displayName': coverage.type?.coding?.[0]?.display || 'Unknown', '@_codeSystemName': 'Source of Payment Typology (PHDSC)', '@_codeSystem': '2.16.840.1.113883.3.221.5', }, statusCode: { '@_code': 'completed' }, text: createTextFromExtensions(coverage.extension), performer: [ { '@_typeCode': 'PRF', templateId: [{ '@_root': OID_PAYER_PERFORMER }], assignedEntity: { id: [{ '@_root': '2.16.840.1.113883.6.300', '@_extension': '999999' }], code: { '@_code': 'PAYOR', '@_codeSystem': '2.16.840.1.113883.5.110', '@_codeSystemName': 'HL7 RoleCode', '@_displayName': 'invoice payor', }, addr: mapFhirAddressArrayToCcdaAddressArray(payor?.address), telecom: mapTelecom(payor?.telecom), representedOrganization: { name: payor?.name ? [payor.name] : undefined, telecom: mapTelecom(payor?.telecom), addr: mapFhirAddressArrayToCcdaAddressArray(payor?.address), }, }, }, ], participant: [ { '@_typeCode': 'COV', templateId: [{ '@_root': OID_COVERED_PARTY_PARTICIPANT }], participantRole: { '@_classCode': 'PAT', id: [ { '@_root': '2.16.840.1.113883.6.300', '@_extension': policyHolder?.identifier?.[0]?.value || '88800933502', }, ], code: { '@_code': 'FAMDEP', '@_codeSystem': '2.16.840.1.113883.5.111', '@_displayName': policyHolder ? 'self' : 'dependent', }, addr: mapFhirAddressArrayToCcdaAddressArray(policyHolder?.address), playingEntity: { '@_classCode': 'PSN', name: mapNames(policyHolder?.name), 'sdtc:birthTime': policyHolder?.birthDate ? { '@_value': mapFhirToCcdaDate(policyHolder.birthDate) } : undefined, }, }, }, policyHolder ? { '@_typeCode': 'HLD', templateId: [{ '@_root': OID_POLICY_HOLDER_PARTICIPANT }], participantRole: { id: [ { '@_root': '2.16.840.1.113883.6.300', '@_extension': policyHolder.identifier?.[0]?.value || '888009335', }, ], addr: mapFhirAddressArrayToCcdaAddressArray(policyHolder.address), playingEntity: { name: mapNames(policyHolder.name), }, }, } : undefined, ].filter(Boolean) as CcdaParticipant[], entryRelationship: [ { '@_typeCode': 'REFR', act: [ { '@_classCode': 'ACT', '@_moodCode': 'DEF', id: mapIdentifiers(coverage.id, coverage.identifier) as CcdaId[], code: { '@_code': 'PAYOR', '@_codeSystem': '2.16.840.1.113883.5.110', '@_codeSystemName': 'HL7 RoleCode', '@_displayName': 'invoice payor', }, text: coveragePlan?.value ? { '#text': coveragePlan.value } : undefined, }, ], }, ], }, ], }); } } return { act: [ { '@_classCode': 'ACT', '@_moodCode': 'EVN', templateId: [ { '@_root': OID_COVERAGE_ACTIVITY, '@_extension': '2015-08-01' }, { '@_root': OID_COVERAGE_ACTIVITY }, ], id: mapIdentifiers(account.id, account.identifier), code: { '@_code': '48768-6', '@_codeSystem': OID_LOINC_CODE_SYSTEM, '@_codeSystemName': 'LOINC', '@_displayName': 'Payment Sources', }, statusCode: { '@_code': 'completed' }, entryRelationship, }, ], }; }