// SPDX-FileCopyrightText: Copyright Orangebot, Inc. and Medplum contributors
// SPDX-License-Identifier: Apache-2.0
import type { MedplumClient, WithId } from '@medplum/core';
import { CPT, createReference } from '@medplum/core';
import type {
ChargeItem,
Claim,
ClaimItem,
Coverage,
Encounter,
Patient,
Practitioner,
Reference,
} from '@medplum/fhirtypes';
import { calculateTotalPrice } from './chargeitems';
import { createSelfPayCoverage } from './coverage';
export async function createClaimFromEncounter(
medplum: MedplumClient,
patient: WithId<Patient>,
encounter: WithId<Encounter>,
practitioner: WithId<Practitioner>,
chargeItems: WithId<ChargeItem>[]
): Promise<WithId<Claim> | undefined> {
const coverageResults = await medplum.searchResources('Coverage', `patient=Patient/${patient.id}&status=active`);
let coverage: Coverage = coverageResults[0];
if (!coverage) {
coverage = await createSelfPayCoverage(medplum, patient);
}
const claim: Claim = {
resourceType: 'Claim',
status: 'draft',
type: { coding: [{ code: 'professional' }] },
use: 'claim',
created: new Date().toISOString(),
patient: createReference(patient),
provider: createReference(practitioner),
priority: { coding: [{ code: 'normal' }] },
insurance: [
{
sequence: 1,
focal: true,
coverage: createReference(coverage),
},
],
item: getCptChargeItems(chargeItems, createReference(encounter)),
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 } : {}),
};
});
}
