hccinfhir 0.0.3__py3-none-any.whl → 0.0.5__py3-none-any.whl

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.
Files changed (41) hide show
  1. hccinfhir/data/ra_coefficients_2025.csv +6352 -0
  2. hccinfhir/data/ra_dx_to_cc_2025.csv +53952 -0
  3. hccinfhir/data/ra_eligible_cpt_hcpcs_2024.csv +6697 -0
  4. hccinfhir/data/ra_eligible_cpt_hcpcs_2025.csv +6725 -0
  5. hccinfhir/data/ra_hierarchies_2025.csv +487 -0
  6. hccinfhir/datamodels.py +101 -0
  7. hccinfhir/extractor.py +3 -3
  8. hccinfhir/extractor_837.py +1 -2
  9. hccinfhir/extractor_fhir.py +1 -1
  10. hccinfhir/filter.py +3 -5
  11. hccinfhir/hccinfhir.py +149 -0
  12. hccinfhir/model_calculate.py +95 -0
  13. hccinfhir/model_coefficients.py +143 -0
  14. hccinfhir/model_demographics.py +191 -0
  15. hccinfhir/model_dx_to_cc.py +54 -0
  16. hccinfhir/model_hierarchies.py +70 -0
  17. hccinfhir/model_interactions.py +342 -0
  18. hccinfhir/samples/__init__.py +2 -0
  19. hccinfhir/utils.py +51 -0
  20. {hccinfhir-0.0.3.dist-info → hccinfhir-0.0.5.dist-info}/METADATA +147 -9
  21. hccinfhir-0.0.5.dist-info/RECORD +42 -0
  22. hccinfhir/models.py +0 -44
  23. hccinfhir-0.0.3.dist-info/RECORD +0 -28
  24. /hccinfhir/{data → samples}/sample_837_0.txt +0 -0
  25. /hccinfhir/{data → samples}/sample_837_1.txt +0 -0
  26. /hccinfhir/{data → samples}/sample_837_10.txt +0 -0
  27. /hccinfhir/{data → samples}/sample_837_11.txt +0 -0
  28. /hccinfhir/{data → samples}/sample_837_2.txt +0 -0
  29. /hccinfhir/{data → samples}/sample_837_3.txt +0 -0
  30. /hccinfhir/{data → samples}/sample_837_4.txt +0 -0
  31. /hccinfhir/{data → samples}/sample_837_5.txt +0 -0
  32. /hccinfhir/{data → samples}/sample_837_6.txt +0 -0
  33. /hccinfhir/{data → samples}/sample_837_7.txt +0 -0
  34. /hccinfhir/{data → samples}/sample_837_8.txt +0 -0
  35. /hccinfhir/{data → samples}/sample_837_9.txt +0 -0
  36. /hccinfhir/{data → samples}/sample_eob_1.json +0 -0
  37. /hccinfhir/{data → samples}/sample_eob_2.json +0 -0
  38. /hccinfhir/{data → samples}/sample_eob_200.ndjson +0 -0
  39. /hccinfhir/{data → samples}/sample_eob_3.json +0 -0
  40. {hccinfhir-0.0.3.dist-info → hccinfhir-0.0.5.dist-info}/WHEEL +0 -0
  41. {hccinfhir-0.0.3.dist-info → hccinfhir-0.0.5.dist-info}/licenses/LICENSE +0 -0
hccinfhir/data/ra_hierarchies_2025.csv ADDED
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hccinfhir/datamodels.py ADDED
@@ -0,0 +1,101 @@
1
+ from pydantic import BaseModel, Field
2
+ from typing import List, Optional, Literal, Dict, Set, TypedDict
3
+
4
+ # Define Model Name literal type
5
+ ModelName = Literal[
6
+ "CMS-HCC Model V22",
7
+ "CMS-HCC Model V24",
8
+ "CMS-HCC Model V28",
9
+ "CMS-HCC ESRD Model V21",
10
+ "CMS-HCC ESRD Model V24",
11
+ "RxHCC Model V08"
12
+ ]
13
+
14
+ ProcFilteringFilename = Literal[
15
+ "ra_eligible_cpt_hcpcs_2023.csv",
16
+ "ra_eligible_cpt_hcpcs_2024.csv",
17
+ "ra_eligible_cpt_hcpcs_2025.csv"
18
+ ]
19
+
20
+ DxCCMappingFilename = Literal[
21
+ "ra_dx_to_cc_2025.csv"
22
+ ]
23
+
24
+ class ServiceLevelData(BaseModel):
25
+ """
26
+ Represents standardized service-level data extracted from healthcare claims.
27
+
28
+ Attributes:
29
+ claim_id: Unique identifier for the claim
30
+ procedure_code: Healthcare Common Procedure Coding System (HCPCS) code
31
+ ndc: National Drug Code
32
+ linked_diagnosis_codes: ICD-10 diagnosis codes linked to this service
33
+ claim_diagnosis_codes: All diagnosis codes on the claim
34
+ claim_type: Type of claim (e.g., NCH Claim Type Code, or 837I, 837P)
35
+ provider_specialty: Provider taxonomy or specialty code
36
+ performing_provider_npi: National Provider Identifier for performing provider
37
+ billing_provider_npi: National Provider Identifier for billing provider
38
+ patient_id: Unique identifier for the patient
39
+ facility_type: Type of facility where service was rendered
40
+ service_type: Type of service provided (facility type + service type = Type of Bill)
41
+ service_date: Date service was performed (YYYY-MM-DD)
42
+ place_of_service: Place of service code
43
+ quantity: Number of units provided
44
+ quantity_unit: Unit of measure for quantity
45
+ modifiers: List of procedure code modifiers
46
+ allowed_amount: Allowed amount for the service
47
+ """
48
+ claim_id: Optional[str] = None
49
+ procedure_code: Optional[str] = None
50
+ ndc: Optional[str] = None
51
+ linked_diagnosis_codes: List[str] = []
52
+ claim_diagnosis_codes: List[str] = []
53
+ claim_type: Optional[str] = None
54
+ provider_specialty: Optional[str] = None
55
+ performing_provider_npi: Optional[str] = None
56
+ billing_provider_npi: Optional[str] = None
57
+ patient_id: Optional[str] = None
58
+ facility_type: Optional[str] = None
59
+ service_type: Optional[str] = None
60
+ service_date: Optional[str] = None
61
+ place_of_service: Optional[str] = None
62
+ quantity: Optional[float] = None
63
+ modifiers: List[str] = []
64
+ allowed_amount: Optional[float] = None
65
+
66
+ class Demographics(BaseModel):
67
+ """
68
+ Response model for demographic categorization
69
+ """
70
+ age: int = Field(..., description="Beneficiary age")
71
+ sex: Literal['M', 'F', '1', '2'] = Field(..., description="Beneficiary sex")
72
+ dual_elgbl_cd: Literal[None, 'NA', '99', '00', '01', '02', '03', '04', '05', '06', '07', '08', '09', '10'] = Field('NA', description="Dual status code")
73
+ orec: Literal[None, '0', '1', '2', '3'] = Field('0', description="Original reason for entitlement")
74
+ crec: Literal[None, '0', '1', '2', '3'] = Field('0', description="Current reason for entitlement")
75
+ new_enrollee: bool = Field(False, description="True if beneficiary is a new enrollee")
76
+ snp: bool = Field(False, description="True if beneficiary is in SNP")
77
+ version: str = Field("V2", description="Version of categorization used (V2, V4, V6)")
78
+ low_income: bool = Field(False, description="True if beneficiary is in low income; RxHCC only")
79
+ graft_months: Optional[int] = Field(None, description="Number of months since transplant; ESRD Model only")
80
+ category: str = Field(..., description="[derived] Age-sex category code")
81
+ non_aged: bool = Field(False, description="[derived] True if age <= 64")
82
+ orig_disabled: bool = Field(False, description="[derived] True if originally disabled (OREC='1' and not currently disabled)")
83
+ disabled: bool = Field(False, description="[derived] True if currently disabled (age < 65 and OREC != '0')")
84
+ esrd: bool = Field(False, description="[derived] True if ESRD (ESRD Model)")
85
+ lti: bool = Field(False, description="[derived] True if LTI (LTI Model)")
86
+ fbd: bool = Field(False, description="[derived] True if FBD (FBD Model)")
87
+ pbd: bool = Field(False, description="[derived] True if PBD (PBD Model)")
88
+
89
+
90
+ class RAFResult(TypedDict):
91
+ """Type definition for RAF calculation results"""
92
+ risk_score: float
93
+ hcc_list: List[str]
94
+ cc_to_dx: Dict[str, Set[str]]
95
+ coefficients: Dict[str, float]
96
+ interactions: Dict[str, float]
97
+ demographics: Demographics
98
+ model_name: ModelName
99
+ version: str
100
+ diagnosis_codes: List[str]
101
+ service_level_data: Optional[List[ServiceLevelData]]
hccinfhir/extractor.py CHANGED
@@ -1,7 +1,7 @@
1
1
  from typing import Union, List, Literal
2
- from .models import ServiceLevelData
3
- from .extractor_837 import extract_sld_837
4
- from .extractor_fhir import extract_sld_fhir
2
+ from hccinfhir.datamodels import ServiceLevelData
3
+ from hccinfhir.extractor_837 import extract_sld_837
4
+ from hccinfhir.extractor_fhir import extract_sld_fhir
5
5
 
6
6
  def extract_sld(
7
7
  data: Union[str, dict],
hccinfhir/extractor_837.py CHANGED
@@ -1,7 +1,6 @@
1
1
  from typing import List, Optional, Dict
2
2
  from pydantic import BaseModel
3
- from datetime import date
4
- from .models import ServiceLevelData
3
+ from hccinfhir.datamodels import ServiceLevelData
5
4
 
6
5
  CLAIM_TYPES = {
7
6
  "005010X222A1": "837P", # Professional
hccinfhir/extractor_fhir.py CHANGED
@@ -1,7 +1,7 @@
1
1
  from pydantic import BaseModel, ConfigDict, Field, AliasChoices
2
2
  from typing import List, Optional, Literal, Dict
3
3
  from datetime import date
4
- from .models import ServiceLevelData
4
+ from hccinfhir.datamodels import ServiceLevelData
5
5
 
6
6
  SYSTEMS = {
7
7
  'diagnosis': {
hccinfhir/filter.py CHANGED
@@ -1,12 +1,10 @@
1
1
  from typing import List, Set
2
- from .models import ServiceLevelData
3
- import importlib.resources
2
+ from hccinfhir.datamodels import ServiceLevelData
3
+ from hccinfhir.utils import load_proc_filtering
4
4
 
5
5
  # use import importlib.resources to load the professional_cpt_fn file as a list of strings
6
6
  professional_cpt_default_fn = 'ra_eligible_cpt_hcpcs_2023.csv'
7
- professional_cpt_default = []
8
- with importlib.resources.open_text('hccinfhir.data', professional_cpt_default_fn) as f:
9
- professional_cpt_default = set(f.read().splitlines())
7
+ professional_cpt_default = load_proc_filtering(professional_cpt_default_fn)
10
8
 
11
9
  def apply_filter(
12
10
  data: List[ServiceLevelData],