hccinfhir 0.0.1__tar.gz

hccinfhir-0.0.1/.gitignore

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hccinfhir-0.0.1/LICENSE

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hccinfhir-0.0.1/PKG-INFO

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+Metadata-Version: 2.3
+Name: hccinfhir
+Version: 0.0.1
+Summary: HCC Algorithm for FHIR Resources
+Project-URL: Homepage, https://github.com/mimilabs/hccinfhir
+Project-URL: Issues, https://github.com/mimilabs/hccinfhir/issues
+Author-email: Yubin Park <yubin.park@mimilabs.ai>
+Classifier: License :: OSI Approved :: Apache Software License
+Classifier: Operating System :: OS Independent
+Classifier: Programming Language :: Python :: 3
+Requires-Python: >=3.8
+Requires-Dist: pydantic>=2.10.3
+Description-Content-Type: text/markdown
+
+# `hccinfhir` (HCC in FHIR)
+HCC (Hierarchical Condition Category) Algorithm Implementation for FHIR Resources
+
+## Overview
+`hccinfhir` implements the CMS-HCC Risk Adjustment model using FHIR (Fast Healthcare Interoperability Resources) data. It processes Blue Button 2.0 API (BCDA) data to calculate Hierarchical Condition Category (HCC) Risk Adjustment Factors (RAF).
+
+## Why FHIR-Based HCC Processing?
+Risk Adjustment calculations traditionally rely on processed claims data, leading to information loss and reconciliation challenges. `hccinfhir` processes FHIR resources directly because:
+- FHIR represents the source of truth with complete clinical and administrative data
+- Risk Adjustment requires multiple data elements beyond diagnosis codes
+- Direct processing eliminates data transformation errors and simplifies reconciliation
+
+## Data Flexibility
+While built for native FHIR processing, `hccinfhir` works with any data source that can be transformed into the MDE format:
+
+```python
+mde = [{
+    "procedure_code": "99214",
+    "diagnosis_codes": ["E11.9", "I10"],
+    "claim_type": "71",
+    "provider_specialty": "01", 
+    "service_date": "2024-01-15"
+}, ...]
+```
+
+## Components
+
+### 1. Extractor Module
+Processes FHIR ExplanationOfBenefit resources to extract Minimum Data Elements (MDE):
+```python
+from hccinfhir.extractor import extract_mde, extract_mde_list
+
+mde = extract_mde(eob_data)  # Process single EOB
+
+mde_list = extract_mde_list([eob1, eob2])  # Process multiple EOBs
+```
+
+### 2. Logic Module (In Development)
+Implements core HCC calculation logic:
+- Maps diagnosis codes to HCC categories
+- Applies hierarchical rules and interactions
+- Calculates final RAF scores
+- Integrates with standard CMS data files
+
+### 3. Filter Module (In Development)
+Implements claim filtering rules:
+- Inpatient/outpatient criteria
+- Professional service requirements
+- Provider validation
+- Date range filtering
+
+## Installation
+```bash
+pip install hccinfhir
+```
+
+## Usage
+```python
+from hccinfhir import HCCInFHIR
+
+hcc_processor = HCCInFHIR()
+mde_list = hcc_processor.extract_mde_list(eob_list)
+filtered_mde = hcc_processor.apply_filters(mde_list)  # future
+raf_details = hcc_processor.calculate_raf(filtered_mde, demographic_data)  # future
+```
+
+## Dependencies
+- Pydantic >= 2.10.3
+- Standard Python libraries
+
+## Contributing
+Join us at [mimilabs](https://mimilabs.ai/signup). Reference data available in MIMILabs data lakehouse.
+
+## License
+Apache License 2.0

hccinfhir-0.0.1/README.md

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+# `hccinfhir` (HCC in FHIR)
+HCC (Hierarchical Condition Category) Algorithm Implementation for FHIR Resources
+
+## Overview
+`hccinfhir` implements the CMS-HCC Risk Adjustment model using FHIR (Fast Healthcare Interoperability Resources) data. It processes Blue Button 2.0 API (BCDA) data to calculate Hierarchical Condition Category (HCC) Risk Adjustment Factors (RAF).
+
+## Why FHIR-Based HCC Processing?
+Risk Adjustment calculations traditionally rely on processed claims data, leading to information loss and reconciliation challenges. `hccinfhir` processes FHIR resources directly because:
+- FHIR represents the source of truth with complete clinical and administrative data
+- Risk Adjustment requires multiple data elements beyond diagnosis codes
+- Direct processing eliminates data transformation errors and simplifies reconciliation
+
+## Data Flexibility
+While built for native FHIR processing, `hccinfhir` works with any data source that can be transformed into the MDE format:
+
+```python
+mde = [{
+    "procedure_code": "99214",
+    "diagnosis_codes": ["E11.9", "I10"],
+    "claim_type": "71",
+    "provider_specialty": "01", 
+    "service_date": "2024-01-15"
+}, ...]
+```
+
+## Components
+
+### 1. Extractor Module
+Processes FHIR ExplanationOfBenefit resources to extract Minimum Data Elements (MDE):
+```python
+from hccinfhir.extractor import extract_mde, extract_mde_list
+
+mde = extract_mde(eob_data)  # Process single EOB
+
+mde_list = extract_mde_list([eob1, eob2])  # Process multiple EOBs
+```
+
+### 2. Logic Module (In Development)
+Implements core HCC calculation logic:
+- Maps diagnosis codes to HCC categories
+- Applies hierarchical rules and interactions
+- Calculates final RAF scores
+- Integrates with standard CMS data files
+
+### 3. Filter Module (In Development)
+Implements claim filtering rules:
+- Inpatient/outpatient criteria
+- Professional service requirements
+- Provider validation
+- Date range filtering
+
+## Installation
+```bash
+pip install hccinfhir
+```
+
+## Usage
+```python
+from hccinfhir import HCCInFHIR
+
+hcc_processor = HCCInFHIR()
+mde_list = hcc_processor.extract_mde_list(eob_list)
+filtered_mde = hcc_processor.apply_filters(mde_list)  # future
+raf_details = hcc_processor.calculate_raf(filtered_mde, demographic_data)  # future
+```
+
+## Dependencies
+- Pydantic >= 2.10.3
+- Standard Python libraries
+
+## Contributing
+Join us at [mimilabs](https://mimilabs.ai/signup). Reference data available in MIMILabs data lakehouse.
+
+## License
+Apache License 2.0

hccinfhir-0.0.1/hccinfhir/__init__.py

@@ -0,0 +1 @@
+

hccinfhir-0.0.1/hccinfhir/data/__init__.py

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+
+

hccinfhir-0.0.1/hccinfhir/data/sample_eob_1.json

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+{
+  "billablePeriod": {
+    "end": "2021-01-01",
+    "start": "2021-01-01"
+  },
+  "careTeam": [
+    {
+      "provider": {
+        "identifier": {
+          "type": {
+            "coding": [
+              {
+                "code": "npi",
+                "display": "National Provider Identifier",
+                "system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBIdentifierType"
+              }
+            ]
+          },
+          "value": "1234567890"
+        }
+      },
+      "qualification": {
+        "coding": [
+          {
+            "code": "50",
+            "display": "Nurse practitioner",
+            "system": "https://bluebutton.cms.gov/resources/variables/prvdr_spclty"
+          }
+        ]
+      },
+      "responsible": true,
+      "role": {
+        "coding": [
+          {
+            "code": "performing",
+            "display": "Performing provider",
+            "system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBClaimCareTeamRole"
+          }
+        ]
+      },
+      "sequence": 1
+    }
+  ],
+  "diagnosis": [
+    {
+      "diagnosisCodeableConcept": {
+        "coding": [
+          {
+            "code": "F411",
+            "display": "GENERALIZED ANXIETY DISORDER",
+            "system": "http://hl7.org/fhir/sid/icd-10-cm"
+          }
+        ]
+      },
+      "sequence": 1,
+      "type": [
+        {
+          "coding": [
+            {
+              "code": "principal",
+              "display": "principal",
+              "system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype"
+            }
+          ]
+        }
+      ]
+    }
+  ],
+  "id": "carrier-28493431905",
+  "item": [
+    {
+      "diagnosisSequence": [
+        1
+      ],
+      "productOrService": {
+        "coding": [
+          {
+            "code": "90792",
+            "system": "https://bluebutton.cms.gov/resources/codesystem/hcpcs"
+          }
+        ]
+      },
+      "quantity": {
+        "value": 1
+      },
+      "sequence": 1,
+      "servicedPeriod": {
+        "end": "2021-01-01",
+        "start": "2021-01-01"
+      }
+    },
+    {
+      "diagnosisSequence": [
+        1
+      ],
+      "productOrService": {
+        "coding": [
+          {
+            "code": "99213",
+            "system": "https://bluebutton.cms.gov/resources/codesystem/hcpcs"
+          }
+        ]
+      },
+      "quantity": {
+        "value": 1
+      },
+      "sequence": 1,
+      "servicedPeriod": {
+        "end": "2021-01-01",
+        "start": "2021-01-01"
+      }
+    }
+  ],
+  "patient": {
+    "reference": "Patient/12345678"
+  },
+  "type": {
+    "coding": [
+      {
+        "code": "71",
+        "display": "Local carrier non-durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) claim",
+        "system": "https://bluebutton.cms.gov/resources/variables/nch_clm_type_cd"
+      },
+      {
+        "code": "CARRIER",
+        "system": "https://bluebutton.cms.gov/resources/codesystem/eob-type"
+      },
+      {
+        "code": "professional",
+        "display": "Professional",
+        "system": "http://terminology.hl7.org/CodeSystem/claim-type"
+      }
+    ]
+  },
+  "resourceType": "ExplanationOfBenefit"
+}

hccinfhir-0.0.1/hccinfhir/data/sample_eob_2.json

@@ -0,0 +1,84 @@
+{
+  "resourceType": "ExplanationOfBenefit",
+  "type": {
+    "coding": [
+      {
+        "system": "https://bluebutton.cms.gov/resources/variables/nch_clm_type_cd",
+        "code": "40"
+      }
+    ]
+  },
+  "diagnosis": [
+    {
+      "sequence": 1,
+      "diagnosisCodeableConcept": {
+        "coding": [
+          {
+            "system": "http://hl7.org/fhir/sid/icd-10-cm",
+            "code": "E11.9"
+          }
+        ]
+      }
+    }
+  ],
+  "careTeam": [
+    {
+      "sequence": 1,
+      "provider": {
+        "identifier": {
+          "type": {
+            "coding": [
+              {
+                "code": "npi",
+                "display": "National Provider Identifier",
+                "system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBIdentifierType"
+              }
+            ]
+          },
+          "value": "1234567890"
+        }
+      },
+      "qualification": {
+        "coding": [
+          {
+            "system": "https://bluebutton.cms.gov/resources/variables/prvdr_spclty",
+            "code": "01"
+          }
+        ]
+      },
+      "role": {
+        "coding": [
+          {
+            "system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBClaimCareTeamRole",
+            "code": "performing"
+          }
+        ]
+      },
+      "responsible": true
+    }
+  ],
+  "billablePeriod": {
+    "start": "2023-01-01",
+    "end": "2023-01-01"
+  },
+  "item": [
+    {
+      "sequence": 1,
+      "productOrService": {
+        "coding": [
+          {
+            "system": "https://bluebutton.cms.gov/resources/codesystem/hcpcs",
+            "code": "99213"
+          }
+        ]
+      },
+      "diagnosisSequence": [
+        1
+      ],
+      "servicedPeriod": {
+        "start": "2023-01-01",
+        "end": "2023-01-01"
+      }
+    }
+  ]
+}

hccinfhir-0.0.1/hccinfhir/data/sample_eob_3.json

@@ -0,0 +1,102 @@
+{
+  "resourceType": "ExplanationOfBenefit",
+  "id": "carrier-28527",
+  "type": {
+    "coding": [
+      {
+        "system": "https://bluebutton.cms.gov/resources/variables/nch_clm_type_cd",
+        "code": "71",
+        "display": "Carrier claim"
+      }
+    ]
+  },
+  "billablePeriod": {
+    "start": "2023-03-15",
+    "end": "2023-03-15"
+  },
+  "careTeam": [
+    {
+      "sequence": 1,
+      "provider": {
+        "identifier": {
+          "type": {
+            "coding": [
+              {
+                "code": "npi",
+                "display": "National Provider Identifier",
+                "system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBIdentifierType"
+              }
+            ]
+          },
+          "value": "1234567890"
+        }
+      },
+      "role": {
+        "coding": [
+          {
+            "system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBClaimCareTeamRole",
+            "code": "performing",
+            "display": "Performing"
+          }
+        ]
+      },
+      "qualification": {
+        "coding": [
+          {
+            "system": "https://bluebutton.cms.gov/resources/variables/prvdr_spclty",
+            "code": "11",
+            "display": "Internal Medicine"
+          }
+        ]
+      }
+    }
+  ],
+  "diagnosis": [
+    {
+      "sequence": 1,
+      "diagnosisCodeableConcept": {
+        "coding": [
+          {
+            "system": "http://hl7.org/fhir/sid/icd-10-cm",
+            "code": "E11.9",
+            "display": "Type 2 diabetes mellitus without complications"
+          }
+        ]
+      }
+    },
+    {
+      "sequence": 2,
+      "diagnosisCodeableConcept": {
+        "coding": [
+          {
+            "system": "http://hl7.org/fhir/sid/icd-10-cm",
+            "code": "I10",
+            "display": "Essential (primary) hypertension"
+          }
+        ]
+      }
+    }
+  ],
+  "item": [
+    {
+      "sequence": 1,
+      "servicedPeriod": {
+        "start": "2023-03-15",
+        "end": "2023-03-15"
+      },
+      "productOrService": {
+        "coding": [
+          {
+            "system": "https://bluebutton.cms.gov/resources/codesystem/hcpcs",
+            "code": "99214",
+            "display": "Office/outpatient visit established"
+          }
+        ]
+      },
+      "diagnosisSequence": [
+        1,
+        2
+      ]
+    }
+  ]
+}

hccinfhir-0.0.1/hccinfhir/extractor.py

@@ -0,0 +1,122 @@
+from pydantic import BaseModel, ConfigDict
+from typing import List, Optional, Literal
+from datetime import date
+
+SYSTEMS = {
+    'dx': 'http://hl7.org/fhir/sid/icd-10-cm',
+    'pr': 'https://bluebutton.cms.gov/resources/codesystem/hcpcs',
+    'specialty': 'https://bluebutton.cms.gov/resources/variables/prvdr_spclty',
+    'role': 'http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBClaimCareTeamRole',
+    'claim_type': 'https://bluebutton.cms.gov/resources/variables/nch_clm_type_cd'
+}
+
+# Models
+class Coding(BaseModel):
+    system: Optional[str] = None
+    code: Optional[str] = None
+    display: Optional[str] = None
+
+class CodeableConcept(BaseModel):
+    coding: Optional[List[Coding]] = []
+
+class Period(BaseModel):
+    start: Optional[date] = None
+    end: Optional[date] = None
+
+class Diagnosis(BaseModel):
+    sequence: Optional[int] = None
+    diagnosisCodeableConcept: Optional[CodeableConcept] = None
+
+class CareTeamMember(BaseModel):
+    role: Optional[CodeableConcept] = None
+    qualification: Optional[CodeableConcept] = None
+
+class EoBItem(BaseModel):
+    productOrService: Optional[CodeableConcept] = None
+    diagnosisSequence: Optional[List[int]] = None
+    servicedPeriod: Optional[Period] = None
+
+class ExplanationOfBenefit(BaseModel):
+    model_config = ConfigDict(frozen=True)
+    resourceType: Literal["ExplanationOfBenefit"] = "ExplanationOfBenefit"
+    type: Optional[CodeableConcept] = None
+    diagnosis: Optional[List[Diagnosis]] = []
+    item: Optional[List[EoBItem]] = []
+    careTeam: Optional[List[CareTeamMember]] = []
+    billablePeriod: Optional[Period] = None
+
+def extract_mde(eob_data: dict) -> List[dict]:
+    """Extract medical data elements from FHIR ExplanationOfBenefit data."""
+    try:
+        eob = ExplanationOfBenefit.model_validate(eob_data)
+        
+        # Get codes from CodeableConcept
+        get_code = lambda concept, system: next((
+            c.code for c in (concept.coding or [])
+            if c and c.system == system and c.code
+        ), None)
+        
+        # Get date from Period
+        get_date = lambda period: (
+            period.end.isoformat() if period and period.end
+            else period.start.isoformat() if period and period.start
+            else None
+        )
+        
+        # Create diagnosis lookup
+        dx_lookup = {
+            d.sequence: get_code(d.diagnosisCodeableConcept, SYSTEMS['dx'])
+            for d in (eob.diagnosis or [])
+            if d.sequence is not None and d.diagnosisCodeableConcept
+        }
+        
+        # Get claim-level data
+        claim_type = get_code(eob.type, SYSTEMS['claim_type'])
+        
+        # Get provider specialty
+        specialty = next((
+            get_code(m.qualification, SYSTEMS['specialty'])
+            for m in (eob.careTeam or [])
+            if m.role and m.qualification
+            and get_code(m.role, SYSTEMS['role']) in {'performing', 'rendering'}
+        ), None)
+        
+        results = []
+        for item in (eob.item or []):
+            if not item.productOrService:
+                continue
+                
+            pr_code = get_code(item.productOrService, SYSTEMS['pr'])
+            if not pr_code:
+                continue
+            
+            # Get associated data
+            dos = get_date(item.servicedPeriod) or get_date(eob.billablePeriod)
+            dx_codes = [dx_lookup[seq] for seq in (item.diagnosisSequence or [])
+                       if seq in dx_lookup]
+            
+            # Build result
+            result = {k: v for k, v in {
+                'procedure_code': pr_code,
+                'diagnosis_codes': dx_codes,
+                'claim_type': claim_type,
+                'provider_specialty': specialty,
+                'service_date': dos
+            }.items()}
+            
+            results.append(result)
+            
+        return results
+        
+    except Exception as e:
+        raise ValueError(f"Error processing EOB: {str(e)}")
+
+def extract_mde_list(eob_data_list: List[dict]) -> List[dict]:
+    """Process a list of EOB data dictionaries."""
+    results = []
+    for eob_data in eob_data_list:
+        try:
+            results.extend(extract_mde(eob_data))
+        except ValueError as e:
+            print(f"Warning: Skipping invalid EOB: {str(e)}")
+    return results

hccinfhir-0.0.1/pyproject.toml

@@ -0,0 +1,53 @@
+[build-system]
+requires = ["hatchling"]
+build-backend = "hatchling.build"
+
+[project]
+name = "hccinfhir"
+version = "0.0.1"
+authors = [
+  { name="Yubin Park", email="yubin.park@mimilabs.ai" },
+]
+description = "HCC Algorithm for FHIR Resources"
+readme = "README.md"
+requires-python = ">=3.8"
+classifiers = [
+    "Programming Language :: Python :: 3",
+    "License :: OSI Approved :: Apache Software License",
+    "Operating System :: OS Independent",
+]
+dependencies = ["pydantic>=2.10.3"]
+
+[project.urls]
+Homepage = "https://github.com/mimilabs/hccinfhir"
+Issues = "https://github.com/mimilabs/hccinfhir/issues"
+
+[tool.hatch.build]
+packages = ["src/hccinfhir"]
+include = [
+    "*.py",
+    "*.json",
+    "*.csv"
+]
+
+[tool.hatch.build.targets.wheel]
+packages = ["src/hccinfhir"]
+
+[tool.coverage.run]
+source_pkgs = ["hccinfhir"]
+branch = true
+parallel = true
+omit = [
+  "src/hccinfhir/__about__.py",
+]
+
+[tool.coverage.paths]
+hccinfhir = ["src/hccinfhir", "*/hccinfhir/src/hccinfhir"]
+tests = ["tests", "*/hccinfhir/tests"]
+
+[tool.coverage.report]
+exclude_lines = [
+  "no cov",
+  "if __name__ == .__main__.:",
+  "if TYPE_CHECKING:",
+]