carin_for_blue_button_test_kit 0.15.2 → 0.15.3
This diff represents the content of publicly available package versions that have been released to one of the supported registries. The information contained in this diff is provided for informational purposes only and reflects changes between package versions as they appear in their respective public registries.
- checksums.yaml +4 -4
- data/lib/carin_for_blue_button_test_kit/custom_groups/v2.0.0/eob/insurer_same_test.rb +74 -0
- data/lib/carin_for_blue_button_test_kit/custom_groups/v2.0.0/eob/outcome_complete_test.rb +32 -0
- data/lib/carin_for_blue_button_test_kit/custom_groups/v2.0.0/eob/type_data_absent_test.rb +41 -0
- data/lib/carin_for_blue_button_test_kit/generated/v2.0.0/eob_group.rb +6 -0
- data/lib/carin_for_blue_button_test_kit/generator/templates/group.rb.erb +7 -1
- data/lib/carin_for_blue_button_test_kit/requirements/generated/c4bb_v200_requirements_coverage.csv +8 -8
- data/lib/carin_for_blue_button_test_kit/version.rb +2 -2
- metadata +5 -2
checksums.yaml
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---
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SHA256:
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metadata.gz:
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data.tar.gz:
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metadata.gz: 67e7b14eb8555dfd3b698224f6588d8d7697a53d97806dd8edc142ad8ec342ca
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data.tar.gz: 8f8a1bf9dbb75ffb68151e3cd5a7a944cea6568c41932549f26665b959c7be80
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metadata.gz: 865d150b32a6e1bee5bb4af634bf588721ebcafcdd7ad0168d20aaeb1f75535d8435a9f17c7db78112fb68b66b92606c988cfc8f582a65cc3a5d7ea0739dbc18
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data.tar.gz: 78cca118754975e754777beb20e21199f46bda13855350d04ea4031fa68210fe471cf5db9e915eebe6df80c238a8bb0c5affe180278cde9f4e57d816d2505446
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# frozen_string_literal: true
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module CarinForBlueButtonTestKit
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module CARIN4BBV200
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class InsurerSameTest < Inferno::Test
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include CarinSearchTest
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id :c4bb_v200_custom_eob_insurer_same
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title 'ExplanationOfBenefit insurer is properly referenced in insurance list'
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description %(This test confirms that the ExplanationOfBenefit.insurer is equal to the insurance referenced
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in the ExplanationOfBenefit.insurance list with focal=True, and that ExplanationOfBenefit.insurer is not
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equal to any insurance referenced in the ExplanationOfBenefit.insurance list with focal=False.
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)
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verifies_requirements 'hl7.fhir.us.carin-bb_2.0.0@116',
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'hl7.fhir.us.carin-bb_2.0.0@124',
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'hl7.fhir.us.carin-bb_2.0.0@125',
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'hl7.fhir.us.carin-bb_2.0.0@127',
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'hl7.fhir.us.carin-bb_2.0.0@128',
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'hl7.fhir.us.carin-bb_2.0.0@129'
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def resource_type
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'ExplanationOfBenefit'
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end
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def scratch_resources
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scratch[:explanationofbenefit_resources] ||= {}
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end
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def get_reference(reference, type)
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reference_id = resource_id(reference)
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fhir_read(type, reference_id)&.resource
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end
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run do
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resources = scratch_resources[:all]
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skip_if resources.blank?,
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"No #{resource_type} resources were returned"
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skip_if !resources
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.map(&:insurance)
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.flatten
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.map(&:coverage)
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.map { |eob_insurance_coverage| get_reference(eob_insurance_coverage, :coverage) }
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.any?,
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"None of the ExplanationOfBenefit resources has .insurance.coverage."
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resources.each do |eob|
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eob.insurance.each_with_index do |eob_insurance, index|
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eob_insurance_coverage = get_reference(eob_insurance.coverage, :coverage)
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next if eob_insurance_coverage.nil?
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if eob_insurance.focal
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assert resource_id(eob.insurer) == resource_id(eob_insurance_coverage.payor.first),
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<<~ERROR_MESSAGE1
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ExplanationOfBenefit.insurer.reference differs from
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ExplanationOfBenefit.insurance.coverage.reference -> Coverage.payor[0].reference
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when ExplanationOfBenefit.insurance.focal == True. They must be equal.
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ERROR_MESSAGE1
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else
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assert resource_id(eob.insurer) != resource_id(eob_insurance_coverage.payor.first),
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<<~ERROR_MESSAGE2
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ExplanationOfBenefit.insurer.reference equals
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ExplanationOfBenefit.insurance.coverage.reference -> Coverage.payor[0].reference
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when ExplanationOfBenefit.insurance.focal == False. They must differ.
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ERROR_MESSAGE2
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end
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end
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end
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end
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end
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end
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end
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# frozen_string_literal: true
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module CarinForBlueButtonTestKit
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module CARIN4BBV200
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class OutcomeCompleteTest < Inferno::Test
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id :c4bb_v200_custom_eob_outcome_complete
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title 'ExplanationOfBenefit.outcome has value "complete"'
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description %(ExplanationOfBenefit.outcome has value "complete")
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verifies_requirements 'hl7.fhir.us.carin-bb_2.0.0@117'
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def resource_type
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'ExplanationOfBenefit'
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end
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def scratch_resources
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scratch[:explanationofbenefit_resources] ||= {}
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end
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run do
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resources = scratch_resources[:all]
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skip_if resources.blank?,
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"No #{resource_type} resources were returned"
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resources.each do |resource|
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assert resource.outcome == 'complete', "ExplanationOfBenefit.outcome was '#{resource.outcome}'. Expected 'complete'."
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end
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end
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end
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end
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end
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# frozen_string_literal: true
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module CarinForBlueButtonTestKit
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module CARIN4BBV200
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class TypeDataAbsentTest < Inferno::Test
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id :c4bb_v200_custom_eob_type_data_absent
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title 'ExplanationOfBenefit.type does not use a data absent reason'
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description %(
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ExplanationOfBenefit.type SHALL NOT use a data absent reason.
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)
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verifies_requirements 'hl7.fhir.us.carin-bb_2.0.0@115'
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DAR_CODE_SYSTEM_URL = 'http://terminology.hl7.org/CodeSystem/data-absent-reason'
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def resource_type
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'ExplanationOfBenefit'
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end
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def scratch_resources
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scratch[:explanationofbenefit_resources] ||= {}
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end
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run do
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resources = scratch_resources[:all]
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skip_if resources.blank?,
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"No #{resource_type} resources were returned"
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resources.each do |resource|
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resource.type&.coding&.each do |coding|
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if coding.system
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assert coding.system != DAR_CODE_SYSTEM_URL,
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'ExplanationOfBenefit.type uses a data absent reason. It must not.'
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end
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end
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end
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end
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end
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end
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end
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require_relative 'eob_pharmacy/must_support_test'
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require_relative 'eob_professional_non_clinician/validation_test'
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require_relative 'eob_professional_non_clinician/must_support_test'
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require_relative '../../custom_groups/v2.0.0/eob/type_data_absent_test'
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require_relative '../../custom_groups/v2.0.0/eob/insurer_same_test'
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require_relative '../../custom_groups/v2.0.0/eob/outcome_complete_test'
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module CarinForBlueButtonTestKit
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module CARIN4BBV200
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test from: :c4bb_v200_eob_pharmacy_must_support_test
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test from: :c4bb_v200_eob_professional_non_clinician_validation_test
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test from: :c4bb_v200_eob_professional_non_clinician_must_support_test
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test from: :c4bb_v200_custom_eob_type_data_absent
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test from: :c4bb_v200_custom_eob_insurer_same
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test from: :c4bb_v200_custom_eob_outcome_complete
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end
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end
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end
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<% test_file_list.each do |file_name| %>require_relative '<%= file_name %>'
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<% end %><% if module_name== 'CARIN4BBV200' && class_name == 'EobGroup' %>require_relative '../../custom_groups/v2.0.0/eob/type_data_absent_test'
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require_relative '../../custom_groups/v2.0.0/eob/insurer_same_test'
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require_relative '../../custom_groups/v2.0.0/eob/outcome_complete_test'
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<% end %>
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module CarinForBlueButtonTestKit
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module <%= module_name %>
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@metadata ||= Generator::GroupMetadata.new(YAML.load_file(File.join(__dir__, '<%= profile_identifier %>', 'metadata.yml'), aliases: true))
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end
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<% test_id_list.each do |id| %>
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test from: :<%= id %><% end %>
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test from: :<%= id %><% end %><% if module_name == 'CARIN4BBV200' && class_name == 'EobGroup' %>
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test from: :c4bb_v200_custom_eob_type_data_absent
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test from: :c4bb_v200_custom_eob_insurer_same
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test from: :c4bb_v200_custom_eob_outcome_complete<% end %>
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end
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end
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end
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data/lib/carin_for_blue_button_test_kit/requirements/generated/c4bb_v200_requirements_coverage.csv
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@@ -118,9 +118,9 @@ hl7.fhir.us.carin-bb_2.0.0,111,http://hl7.org/fhir/us/carin-bb/STU2/StructureDef
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hl7.fhir.us.carin-bb_2.0.0,112,http://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-ExplanationOfBenefit.html#notes-on-fields,".meta.lastUpdated: Payers SHALL provide the last time the data was updated or the date of creation in the payer’s system of record, whichever comes last.",SHALL,Health Plan,false,,,2.3.17,c4bb_v200-Group02-c4bb_v200_eob-c4bb_v200_eob_validation_test
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hl7.fhir.us.carin-bb_2.0.0,113,http://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-ExplanationOfBenefit.html#notes-on-fields,".status: value =Expected values are active or cancelled. To comply with the CMS rule, draft EOBs are not required.",SHOULD,Health Plan,false,,,"",""
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hl7.fhir.us.carin-bb_2.0.0,114,http://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-ExplanationOfBenefit.html#notes-on-fields,.type Defines the Claims profiles. Values from Claim Type Codes are required;,SHALL,Health Plan,false,,,2.3.17,c4bb_v200-Group02-c4bb_v200_eob-c4bb_v200_eob_validation_test
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hl7.fhir.us.carin-bb_2.0.0,115,http://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-ExplanationOfBenefit.html#notes-on-fields,.type Defines the Claims profiles…. .type SHALL NOT use a data absent reason.,SHALL NOT,Health Plan,false,,,3.3.03,c4bb_v200-c4bb_server_v200_visual_inspection_and_attestation-c4bb_eob-carin_server_requirement_115_attestation
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hl7.fhir.us.carin-bb_2.0.0,116,http://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-ExplanationOfBenefit.html#notes-on-fields,.insurer Same as insurance.coverage.organization. Party responsible for reimbursing the provider,SHALL,Health Plan,false,,,3.3.04,c4bb_v200-c4bb_server_v200_visual_inspection_and_attestation-c4bb_eob-carin_server_requirement_116_117_attestation
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hl7.fhir.us.carin-bb_2.0.0,117,http://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-ExplanationOfBenefit.html#notes-on-fields,.outcome: value = complete,SHALL,Health Plan,false,,,3.3.04,c4bb_v200-c4bb_server_v200_visual_inspection_and_attestation-c4bb_eob-carin_server_requirement_116_117_attestation
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hl7.fhir.us.carin-bb_2.0.0,115,http://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-ExplanationOfBenefit.html#notes-on-fields,.type Defines the Claims profiles…. .type SHALL NOT use a data absent reason.,SHALL NOT,Health Plan,false,,,"2.3.29, 3.3.03","c4bb_v200-Group02-c4bb_v200_eob-c4bb_v200_custom_eob_type_data_absent, c4bb_v200-c4bb_server_v200_visual_inspection_and_attestation-c4bb_eob-carin_server_requirement_115_attestation"
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hl7.fhir.us.carin-bb_2.0.0,116,http://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-ExplanationOfBenefit.html#notes-on-fields,.insurer Same as insurance.coverage.organization. Party responsible for reimbursing the provider,SHALL,Health Plan,false,,,"2.3.30, 3.3.04","c4bb_v200-Group02-c4bb_v200_eob-c4bb_v200_custom_eob_insurer_same, c4bb_v200-c4bb_server_v200_visual_inspection_and_attestation-c4bb_eob-carin_server_requirement_116_117_attestation"
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hl7.fhir.us.carin-bb_2.0.0,117,http://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-ExplanationOfBenefit.html#notes-on-fields,.outcome: value = complete,SHALL,Health Plan,false,,,"2.3.31, 3.3.04","c4bb_v200-Group02-c4bb_v200_eob-c4bb_v200_custom_eob_outcome_complete, c4bb_v200-c4bb_server_v200_visual_inspection_and_attestation-c4bb_eob-carin_server_requirement_116_117_attestation"
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hl7.fhir.us.carin-bb_2.0.0,118,http://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-ExplanationOfBenefit.html#notes-on-fields,".related:
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If the current adjusts a prior ExplanationOfBenefit, .related.reference = the prior ExplanationOfBenefit identifier and related.relationship value = 'prior'.",SHALL,Health Plan,true,,,3.3.05,c4bb_v200-c4bb_server_v200_visual_inspection_and_attestation-c4bb_eob-carin_server_requirement_118_attestation
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ExplanationOfBenefit.insurer MAY have a boolean value = 'True'",MAY,Health Plan,false,,,"",""
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hl7.fhir.us.carin-bb_2.0.0,124,http://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-ExplanationOfBenefit.html#notes-on-fields,".insurance:
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.insurance occurring other than ExplanationOfBenefit.insurer SHALL NOT have a boolean value = 'True'",SHALL NOT,Health Plan,false,,,3.3.08,c4bb_v200-c4bb_server_v200_visual_inspection_and_attestation-c4bb_eob-carin_server_requirement_124_125_127_128_129_attestation
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.insurance occurring other than ExplanationOfBenefit.insurer SHALL NOT have a boolean value = 'True'",SHALL NOT,Health Plan,false,,,"2.3.30, 3.3.08","c4bb_v200-Group02-c4bb_v200_eob-c4bb_v200_custom_eob_insurer_same, c4bb_v200-c4bb_server_v200_visual_inspection_and_attestation-c4bb_eob-carin_server_requirement_124_125_127_128_129_attestation"
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hl7.fhir.us.carin-bb_2.0.0,125,http://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-ExplanationOfBenefit.html#notes-on-fields,".insurance.focal:
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If there is an occurrence, with focal = true, EOB.insurance.coverage.payor = EOB.insurer",SHALL,Health Plan,true,,,3.3.08,c4bb_v200-c4bb_server_v200_visual_inspection_and_attestation-c4bb_eob-carin_server_requirement_124_125_127_128_129_attestation
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If there is an occurrence, with focal = true, EOB.insurance.coverage.payor = EOB.insurer",SHALL,Health Plan,true,,,"2.3.30, 3.3.08","c4bb_v200-Group02-c4bb_v200_eob-c4bb_v200_custom_eob_insurer_same, c4bb_v200-c4bb_server_v200_visual_inspection_and_attestation-c4bb_eob-carin_server_requirement_124_125_127_128_129_attestation"
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hl7.fhir.us.carin-bb_2.0.0,126,http://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-ExplanationOfBenefit.html#notes-on-fields,".insurance.focal:
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There can be 0 or * occurrences with focal = false",MAY,Health Plan,false,,,"",""
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hl7.fhir.us.carin-bb_2.0.0,127,http://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-ExplanationOfBenefit.html#notes-on-fields,".insurance.coverage:
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…
|
147
|
-
When focal = true, Coverage.payer--> Organization.identifier.",SHALL,Health Plan,true,,,3.3.08,c4bb_v200-c4bb_server_v200_visual_inspection_and_attestation-c4bb_eob-carin_server_requirement_124_125_127_128_129_attestation
|
147
|
+
When focal = true, Coverage.payer--> Organization.identifier.",SHALL,Health Plan,true,,,"2.3.30, 3.3.08","c4bb_v200-Group02-c4bb_v200_eob-c4bb_v200_custom_eob_insurer_same, c4bb_v200-c4bb_server_v200_visual_inspection_and_attestation-c4bb_eob-carin_server_requirement_124_125_127_128_129_attestation"
|
148
148
|
hl7.fhir.us.carin-bb_2.0.0,128,http://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-ExplanationOfBenefit.html#notes-on-fields,".insurance.coverage:
|
149
149
|
…
|
150
|
-
When focal = false, EOB.insurance.coverage.display = [name of other carrier]",SHALL,Health Plan,true,,,3.3.08,c4bb_v200-c4bb_server_v200_visual_inspection_and_attestation-c4bb_eob-carin_server_requirement_124_125_127_128_129_attestation
|
151
|
-
hl7.fhir.us.carin-bb_2.0.0,129,http://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-ExplanationOfBenefit.html#notes-on-fields,insurance.coverage: Same as insurance.coverage.organization.,SHALL,Health Plan,false,,,3.3.08,c4bb_v200-c4bb_server_v200_visual_inspection_and_attestation-c4bb_eob-carin_server_requirement_124_125_127_128_129_attestation
|
150
|
+
When focal = false, EOB.insurance.coverage.display = [name of other carrier]",SHALL,Health Plan,true,,,"2.3.30, 3.3.08","c4bb_v200-Group02-c4bb_v200_eob-c4bb_v200_custom_eob_insurer_same, c4bb_v200-c4bb_server_v200_visual_inspection_and_attestation-c4bb_eob-carin_server_requirement_124_125_127_128_129_attestation"
|
151
|
+
hl7.fhir.us.carin-bb_2.0.0,129,http://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-ExplanationOfBenefit.html#notes-on-fields,insurance.coverage: Same as insurance.coverage.organization.,SHALL,Health Plan,false,,,"2.3.30, 3.3.08","c4bb_v200-Group02-c4bb_v200_eob-c4bb_v200_custom_eob_insurer_same, c4bb_v200-c4bb_server_v200_visual_inspection_and_attestation-c4bb_eob-carin_server_requirement_124_125_127_128_129_attestation"
|
152
152
|
hl7.fhir.us.carin-bb_2.0.0,130,http://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-ExplanationOfBenefit-Inpatient-Institutional.html#notes-on-fields,"CPCDS data elements
|
153
153
|
…
|
154
154
|
If a Payer does not have line item amounts, provide the claim amounts and amount types in the EOB header data elements.",SHALL,Health Plan,true,,,3.4.01,c4bb_v200-c4bb_server_v200_visual_inspection_and_attestation-c4bb_eob_inpatient-carin_server_requirement_130_attestation
|
metadata
CHANGED
@@ -1,14 +1,14 @@
|
|
1
1
|
--- !ruby/object:Gem::Specification
|
2
2
|
name: carin_for_blue_button_test_kit
|
3
3
|
version: !ruby/object:Gem::Version
|
4
|
-
version: 0.15.
|
4
|
+
version: 0.15.3
|
5
5
|
platform: ruby
|
6
6
|
authors:
|
7
7
|
- John Morrison
|
8
8
|
autorequire:
|
9
9
|
bindir: bin
|
10
10
|
cert_chain: []
|
11
|
-
date: 2025-07-
|
11
|
+
date: 2025-07-03 00:00:00.000000000 Z
|
12
12
|
dependencies:
|
13
13
|
- !ruby/object:Gem::Dependency
|
14
14
|
name: inferno_core
|
@@ -172,6 +172,9 @@ files:
|
|
172
172
|
- lib/carin_for_blue_button_test_kit/custom_groups/v2.0.0/c4bb_smart_launch/smart_scopes_test.rb
|
173
173
|
- lib/carin_for_blue_button_test_kit/custom_groups/v2.0.0/c4bb_smart_launch/well_known_capabilities_test.rb
|
174
174
|
- lib/carin_for_blue_button_test_kit/custom_groups/v2.0.0/c4bb_smart_launch_group.rb
|
175
|
+
- lib/carin_for_blue_button_test_kit/custom_groups/v2.0.0/eob/insurer_same_test.rb
|
176
|
+
- lib/carin_for_blue_button_test_kit/custom_groups/v2.0.0/eob/outcome_complete_test.rb
|
177
|
+
- lib/carin_for_blue_button_test_kit/custom_groups/v2.0.0/eob/type_data_absent_test.rb
|
175
178
|
- lib/carin_for_blue_button_test_kit/custom_groups/visual_inspection_and_attestation/v200_client.rb
|
176
179
|
- lib/carin_for_blue_button_test_kit/custom_groups/visual_inspection_and_attestation/v200_client/authentication.rb
|
177
180
|
- lib/carin_for_blue_button_test_kit/custom_groups/visual_inspection_and_attestation/v200_client/last_updated.rb
|