hccinfhir 0.2.0__py3-none-any.whl → 0.2.1__py3-none-any.whl

hccinfhir/constants.py

@@ -0,0 +1,240 @@
+"""
+CMS Risk Adjustment Domain Constants
+
+This module contains constants used across the HCC risk adjustment system,
+including dual eligibility codes, OREC/CREC values, and state-specific mappings.
+
+References:
+- CMS Rate Announcement and Call Letter
+- Medicare Advantage Enrollment and Disenrollment Guidance
+- X12 834 Implementation Guides
+"""
+
+from typing import Set, Dict
+
+# =============================================================================
+# DUAL ELIGIBILITY CODES
+# =============================================================================
+# CMS Dual Eligibility Status Codes (Medicare + Medicaid)
+# Used in coefficient prefix selection (CNA_, CFA_, CPA_, etc.)
+
+VALID_DUAL_CODES: Set[str] = {'00', '01', '02', '03', '04', '05', '06', '08'}
+
+# Non-Dual Eligible
+NON_DUAL_CODE: str = '00'
+
+# Full Benefit Dual Eligible (receive both Medicare and full Medicaid benefits)
+# Uses CFA_ (Community, Full Benefit Dual, Aged) or CFD_ (Disabled) prefixes
+FULL_BENEFIT_DUAL_CODES: Set[str] = {
+    '02',  # QMB Plus (Qualified Medicare Beneficiary Plus)
+    '04',  # SLMB Plus (Specified Low-Income Medicare Beneficiary Plus)
+    '08',  # Other Full Benefit Dual Eligible
+}
+
+# Partial Benefit Dual Eligible (Medicare + limited Medicaid)
+# Uses CPA_ (Community, Partial Benefit Dual, Aged) or CPD_ (Disabled) prefixes
+PARTIAL_BENEFIT_DUAL_CODES: Set[str] = {
+    '01',  # QMB Only
+    '03',  # SLMB Only
+    '05',  # QDWI (Qualified Disabled and Working Individual)
+    '06',  # QI (Qualifying Individual)
+}
+
+# =============================================================================
+# OREC - Original Reason for Entitlement Code
+# =============================================================================
+# Determines if beneficiary has ESRD and affects coefficient prefix selection
+
+VALID_OREC_VALUES: Set[str] = {'0', '1', '2', '3'}
+
+OREC_DESCRIPTIONS: Dict[str, str] = {
+    '0': 'Old Age and Survivors Insurance (OASI)',
+    '1': 'Disability Insurance Benefits (DIB)',
+    '2': 'ESRD - End-Stage Renal Disease',
+    '3': 'DIB and ESRD',
+}
+
+# OREC codes indicating ESRD status (per CMS documentation)
+OREC_ESRD_CODES: Set[str] = {'2', '3'}
+
+# =============================================================================
+# CREC - Current Reason for Entitlement Code
+# =============================================================================
+# Current entitlement status (may differ from OREC)
+
+VALID_CREC_VALUES: Set[str] = {'0', '1', '2', '3'}
+
+CREC_DESCRIPTIONS: Dict[str, str] = {
+    '0': 'Old Age and Survivors Insurance (OASI)',
+    '1': 'Disability Insurance Benefits (DIB)',
+    '2': 'ESRD - End-Stage Renal Disease',
+    '3': 'DIB and ESRD',
+}
+
+# CREC codes indicating ESRD status
+CREC_ESRD_CODES: Set[str] = {'2', '3'}
+
+# =============================================================================
+# COEFFICIENT PREFIX GROUPS
+# =============================================================================
+# Used for prefix_override logic in model_demographics.py
+
+# ESRD model prefixes
+ESRD_PREFIXES: Set[str] = {'DI_', 'DNE_', 'GI_', 'GNE_', 'GFPA_', 'GFPN_', 'GNPA_', 'GNPN_'}
+
+# CMS-HCC new enrollee prefixes
+NEW_ENROLLEE_PREFIXES: Set[str] = {'NE_', 'SNPNE_', 'DNE_', 'GNE_'}
+
+# CMS-HCC community prefixes
+COMMUNITY_PREFIXES: Set[str] = {'CNA_', 'CND_', 'CFA_', 'CFD_', 'CPA_', 'CPD_'}
+
+# Institutionalized prefixes
+INSTITUTIONAL_PREFIXES: Set[str] = {'INS_', 'GI_'}
+
+# Full Benefit Dual prefixes
+FULL_BENEFIT_DUAL_PREFIXES: Set[str] = {'CFA_', 'CFD_', 'GFPA_', 'GFPN_'}
+
+# Partial Benefit Dual prefixes
+PARTIAL_BENEFIT_DUAL_PREFIXES: Set[str] = {'CPA_', 'CPD_'}
+
+# Non-Dual prefixes
+NON_DUAL_PREFIXES: Set[str] = {'CNA_', 'CND_', 'GNPA_', 'GNPN_'}
+
+# =============================================================================
+# DEMOGRAPHIC CODES
+# =============================================================================
+
+VALID_SEX_CODES: Set[str] = {'M', 'F'}
+
+# X12 834 Gender Code mappings
+X12_SEX_CODE_MAPPING: Dict[str, str] = {
+    'M': 'M',
+    'F': 'F',
+    '1': 'M',  # X12 numeric code
+    '2': 'F',  # X12 numeric code
+}
+
+# =============================================================================
+# X12 834 MAINTENANCE TYPE CODES
+# =============================================================================
+# INS03 - Maintenance Type Code
+
+MAINTENANCE_TYPE_CHANGE: str = '001'
+MAINTENANCE_TYPE_ADD: str = '021'
+MAINTENANCE_TYPE_CANCEL: str = '024'
+MAINTENANCE_TYPE_REINSTATE: str = '025'
+
+MAINTENANCE_TYPE_DESCRIPTIONS: Dict[str, str] = {
+    '001': 'Change',
+    '021': 'Addition',
+    '024': 'Cancellation/Termination',
+    '025': 'Reinstatement',
+}
+
+# =============================================================================
+# STATE-SPECIFIC MAPPINGS
+# =============================================================================
+
+# -----------------------------------------------------------------------------
+# California DHCS Medi-Cal Aid Codes
+# -----------------------------------------------------------------------------
+# Maps California-specific aid codes to CMS dual eligibility codes
+# Source: California DHCS 834 Implementation Guide
+
+MEDI_CAL_AID_CODES: Dict[str, str] = {
+    # Full Benefit Dual (QMB Plus, SLMB Plus)
+    '4N': '02',  # QMB Plus - Aged
+    '4P': '02',  # QMB Plus - Disabled
+    '5B': '04',  # SLMB Plus - Aged
+    '5D': '04',  # SLMB Plus - Disabled
+
+    # Partial Benefit Dual (QMB Only, SLMB Only, QI)
+    '4M': '01',  # QMB Only - Aged
+    '4O': '01',  # QMB Only - Disabled
+    '5A': '03',  # SLMB Only - Aged
+    '5C': '03',  # SLMB Only - Disabled
+    '5E': '06',  # QI - Aged
+    '5F': '06',  # QI - Disabled
+}
+
+# -----------------------------------------------------------------------------
+# Medicare Status Code Mappings
+# -----------------------------------------------------------------------------
+# Maps Medicare status codes (from various sources) to CMS dual eligibility codes
+# Used in X12 834 REF*ABB segment and other payer files
+
+MEDICARE_STATUS_CODE_MAPPING: Dict[str, str] = {
+    # QMB - Qualified Medicare Beneficiary
+    'QMB': '01',         # QMB Only (Partial)
+    'QMBONLY': '01',
+    'QMBPLUS': '02',     # QMB Plus (Full Benefit)
+    'QMB+': '02',
+
+    # SLMB - Specified Low-Income Medicare Beneficiary
+    'SLMB': '03',        # SLMB Only (Partial)
+    'SLMBONLY': '03',
+    'SLMBPLUS': '04',    # SLMB Plus (Full Benefit)
+    'SLMB+': '04',
+
+    # Other dual eligibility programs
+    'QDWI': '05',        # Qualified Disabled and Working Individual
+    'QI': '06',          # Qualifying Individual
+    'QI1': '06',
+    'FBDE': '08',        # Full Benefit Dual Eligible (Other)
+    'OTHERFULL': '08',
+}
+
+# =============================================================================
+# HELPER FUNCTIONS
+# =============================================================================
+
+def is_full_benefit_dual(dual_code: str) -> bool:
+    """Check if dual eligibility code is Full Benefit Dual"""
+    return dual_code in FULL_BENEFIT_DUAL_CODES
+
+def is_partial_benefit_dual(dual_code: str) -> bool:
+    """Check if dual eligibility code is Partial Benefit Dual"""
+    return dual_code in PARTIAL_BENEFIT_DUAL_CODES
+
+def is_esrd_by_orec(orec: str) -> bool:
+    """Check if OREC indicates ESRD status"""
+    return orec in OREC_ESRD_CODES
+
+def is_esrd_by_crec(crec: str) -> bool:
+    """Check if CREC indicates ESRD status"""
+    return crec in CREC_ESRD_CODES
+
+def normalize_medicare_status_code(status: str) -> str:
+    """Normalize Medicare status code (uppercase, no spaces/hyphens)"""
+    if not status:
+        return ''
+    return status.upper().replace(' ', '').replace('-', '')
+
+def map_medicare_status_to_dual_code(status: str) -> str:
+    """Map Medicare status code to dual eligibility code
+
+    Args:
+        status: Medicare status code (e.g., 'QMB Plus', 'SLMB', 'QI')
+
+    Returns:
+        Dual eligibility code ('01'-'08') or '00' if not found
+    """
+    if not status:
+        return NON_DUAL_CODE
+
+    normalized = normalize_medicare_status_code(status)
+    return MEDICARE_STATUS_CODE_MAPPING.get(normalized, NON_DUAL_CODE)
+
+def map_aid_code_to_dual_status(aid_code: str) -> str:
+    """Map California Medi-Cal aid code to dual eligibility code
+
+    Args:
+        aid_code: California aid code (e.g., '4N', '5B')
+
+    Returns:
+        Dual eligibility code ('01'-'08') or '00' if not found
+    """
+    if not aid_code:
+        return NON_DUAL_CODE
+
+    return MEDI_CAL_AID_CODES.get(aid_code, NON_DUAL_CODE)

hccinfhir/extractor_834.py

@@ -1,29 +1,23 @@
-from typing import List, Optional, Dict
+from typing import List, Optional, Dict, Any, Tuple
 from pydantic import BaseModel
 from datetime import datetime, date
 from hccinfhir.datamodels import Demographics, EnrollmentData
+from hccinfhir.constants import (
+    VALID_DUAL_CODES,
+    FULL_BENEFIT_DUAL_CODES,
+    PARTIAL_BENEFIT_DUAL_CODES,
+    VALID_OREC_VALUES,
+    VALID_CREC_VALUES,
+    X12_SEX_CODE_MAPPING,
+    NON_DUAL_CODE,
+    map_medicare_status_to_dual_code,
+    map_aid_code_to_dual_status,
+)
 
 TRANSACTION_TYPES = {
     "005010X220A1": "834",  # Benefit Enrollment and Maintenance
 }
 
-# California Medi-Cal Aid Codes mapping to dual eligibility status
-MEDI_CAL_AID_CODES = {
-    # Full Benefit Dual (QMB Plus, SLMB Plus)
-    '4N': '02',  # QMB Plus - Aged
-    '4P': '02',  # QMB Plus - Disabled
-    '5B': '04',  # SLMB Plus - Aged
-    '5D': '04',  # SLMB Plus - Disabled
-
-    # Partial Benefit Dual (QMB Only, SLMB Only, QI)
-    '4M': '01',  # QMB Only - Aged
-    '4O': '01',  # QMB Only - Disabled
-    '5A': '03',  # SLMB Only - Aged
-    '5C': '03',  # SLMB Only - Disabled
-    '5E': '06',  # QI - Aged
-    '5F': '06',  # QI - Disabled
-}
-
 class MemberContext(BaseModel):
     """Tracks member-level data across segments within 834 transaction"""
     # Identifiers
@@ -95,7 +89,7 @@ def is_medicaid_terminated(enrollment: EnrollmentData) -> bool:
     """Check if Medicaid coverage is being terminated (maintenance type 024)"""
     return enrollment.maintenance_type == '024'
 
-def medicaid_status_summary(enrollment: EnrollmentData) -> Dict[str, any]:
+def medicaid_status_summary(enrollment: EnrollmentData) -> Dict[str, Any]:
     """Get summary of Medicaid coverage status for monitoring
 
     Args:
@@ -157,45 +151,28 @@ def get_segment_value(segment: List[str], index: int, default: Optional[str] = N
         pass
     return default
 
-def map_medicare_status_to_dual_code(status: Optional[str]) -> Optional[str]:
-    """Map Medicare status codes to dual eligibility codes
+def parse_composite_ref_value(value: str) -> str:
+    """Parse X12 composite element format: 'qualifier;id;...'
 
-    California Medi-Cal uses these status codes:
-    - QMB = Qualified Medicare Beneficiary
-    - QMBPLUS = QMB Plus (Full Benefit)
-    - SLMB = Specified Low-Income Medicare Beneficiary
-    - SLMBPLUS = SLMB Plus (Full Benefit)
-    - QI = Qualifying Individual
-    - QDWI = Qualified Disabled Working Individual
+    X12 uses semicolons to separate sub-elements within a composite data element.
+    Example: REF*23*9;20061234; where 9 is the ID type qualifier
+
+    Args:
+        value: Raw REF segment value (e.g., '9;20061234;' or '20061234')
+
+    Returns:
+        The last non-empty sub-element (the actual ID)
     """
-    if not status:
-        return None
+    if not value:
+        return value
 
-    status_upper = status.upper().replace(' ', '').replace('-', '')
-
-    mapping = {
-        'QMB': '01',         # QMB Only (Partial)
-        'QMBONLY': '01',
-        'QMBPLUS': '02',     # QMB Plus (Full Benefit)
-        'QMB+': '02',
-        'SLMB': '03',        # SLMB Only (Partial)
-        'SLMBONLY': '03',
-        'SLMBPLUS': '04',    # SLMB Plus (Full Benefit)
-        'SLMB+': '04',
-        'QDWI': '05',
-        'QI': '06',
-        'QI1': '06',
-        'FBDE': '08',        # Full Benefit Dual Eligible (Other)
-        'OTHERFULL': '08',
-    }
+    if ';' in value:
+        # Split by semicolon and filter out empty parts
+        parts = [p for p in value.split(';') if p]
+        return parts[-1] if parts else value
 
-    return mapping.get(status_upper)
+    return value
 
-def map_aid_code_to_dual_status(aid_code: Optional[str]) -> Optional[str]:
-    """Map California Medi-Cal aid code to dual eligibility status"""
-    if not aid_code:
-        return None
-    return MEDI_CAL_AID_CODES.get(aid_code)
 
 def determine_dual_status(member: MemberContext) -> str:
     """Intelligently derive dual eligibility code from available data
@@ -208,19 +185,19 @@ def determine_dual_status(member: MemberContext) -> str:
     5. Default to non-dual ('00')
     """
     # Priority 1: Explicit dual_elgbl_cd
-    if member.dual_elgbl_cd and member.dual_elgbl_cd in ['01','02','03','04','05','06','08']:
+    if member.dual_elgbl_cd and member.dual_elgbl_cd in VALID_DUAL_CODES:
         return member.dual_elgbl_cd
 
     # Priority 2: California aid code mapping
     if member.medi_cal_aid_code:
         dual_code = map_aid_code_to_dual_status(member.medi_cal_aid_code)
-        if dual_code:
+        if dual_code != NON_DUAL_CODE:
             return dual_code
 
     # Priority 3: Medicare status code
     if member.medicare_status_code:
         dual_code = map_medicare_status_to_dual_code(member.medicare_status_code)
-        if dual_code:
+        if dual_code != NON_DUAL_CODE:
             return dual_code
 
     # Priority 4: Both Medicare and Medicaid coverage present
@@ -229,9 +206,9 @@ def determine_dual_status(member: MemberContext) -> str:
         return '08'
 
     # Default: Non-dual
-    return '00'
+    return NON_DUAL_CODE
 
-def classify_dual_benefit_level(dual_code: str) -> tuple[bool, bool]:
+def classify_dual_benefit_level(dual_code: str) -> Tuple[bool, bool]:
     """Classify as Full Benefit Dual (FBD) or Partial Benefit Dual (PBD)
 
     Full Benefit Dual codes: 02, 04, 08
@@ -242,11 +219,8 @@ def classify_dual_benefit_level(dual_code: str) -> tuple[bool, bool]:
     - Uses CPA_ (Community, Partial Benefit Dual, Aged) prefix
     - Uses CPD_ (Community, Partial Benefit Dual, Disabled) prefix
     """
-    full_benefit_codes = {'02', '04', '08'}
-    partial_benefit_codes = {'01', '03', '05', '06'}
-
-    is_fbd = dual_code in full_benefit_codes
-    is_pbd = dual_code in partial_benefit_codes
+    is_fbd = dual_code in FULL_BENEFIT_DUAL_CODES
+    is_pbd = dual_code in PARTIAL_BENEFIT_DUAL_CODES
 
     return is_fbd, is_pbd
 
@@ -284,7 +258,7 @@ def parse_834_enrollment(segments: List[List[str]]) -> List[EnrollmentData]:
     enrollments = []
     member = MemberContext()
 
-    for i, segment in enumerate(segments):
+    for segment in segments:
         if len(segment) < 2:
             continue
 
@@ -330,11 +304,11 @@ def parse_834_enrollment(segments: List[List[str]]) -> List[EnrollmentData]:
 
             # Medicaid Identifiers
             elif qualifier == '1D':  # Medicaid/Recipient ID
-                member.medicaid_id = value
+                member.medicaid_id = parse_composite_ref_value(value)
                 member.has_medicaid = True
             elif qualifier == '23':  # Medicaid Recipient ID (alternative)
                 if not member.medicaid_id:
-                    member.medicaid_id = value
+                    member.medicaid_id = parse_composite_ref_value(value)
                 member.has_medicaid = True
 
             # California Medi-Cal Specific
@@ -345,13 +319,13 @@ def parse_834_enrollment(segments: List[List[str]]) -> List[EnrollmentData]:
 
             # Custom dual eligibility indicators
             elif qualifier == 'F5':  # Dual Eligibility Code (custom)
-                if value in ['01','02','03','04','05','06','08']:
+                if value in VALID_DUAL_CODES:
                     member.dual_elgbl_cd = value
             elif qualifier == 'DX':  # OREC (custom)
-                if value in ['0','1','2','3']:
+                if value in VALID_OREC_VALUES:
                     member.orec = value
             elif qualifier == 'DY':  # CREC (custom)
-                if value in ['0','1','2','3']:
+                if value in VALID_CREC_VALUES:
                     member.crec = value
             elif qualifier == 'EJ':  # Low Income Subsidy indicator
                 member.low_income = (value.upper() in ['Y', 'YES', '1', 'TRUE'])
@@ -376,8 +350,8 @@ def parse_834_enrollment(segments: List[List[str]]) -> List[EnrollmentData]:
 
             # DMG03 = Gender Code
             sex = get_segment_value(segment, 3)
-            if sex in ['M', 'F', '1', '2']:
-                member.sex = 'M' if sex in ['M', '1'] else 'F'
+            if sex in X12_SEX_CODE_MAPPING:
+                member.sex = X12_SEX_CODE_MAPPING[sex]
 
         # ===== DTP - Date Time Periods =====
         elif seg_id == 'DTP' and len(segment) >= 4:
@@ -440,6 +414,13 @@ def parse_834_enrollment(segments: List[List[str]]) -> List[EnrollmentData]:
                     member.has_medicare = True
                     member.has_medicaid = True
 
+            # Detect LTI (Long Term Institutionalized)
+            if any(keyword in combined for keyword in [
+                'LTC', 'LONG TERM CARE', 'LONG-TERM CARE', 'NURSING HOME',
+                'SKILLED NURSING', 'SNF', 'INSTITUTIONALIZED'
+            ]):
+                member.lti = True
+
     # Don't forget last member
     if member.member_id or member.has_medicare or member.has_medicaid:
         enrollments.append(create_enrollment_data(member))

hccinfhir/extractor_837.py

@@ -1,4 +1,4 @@
-from typing import List, Optional, Dict
+from typing import List, Optional, Dict, Tuple
 from pydantic import BaseModel
 from hccinfhir.datamodels import ServiceLevelData
 
@@ -65,7 +65,7 @@ def parse_diagnosis_codes(segment: List[str]) -> Dict[str, str]:
             dx_lookup[str(pos)] = code
     return dx_lookup
 
-def process_service_line(segments: List[List[str]], start_index: int) -> tuple[Optional[str], Optional[str]]:
+def process_service_line(segments: List[List[str]], start_index: int) -> Tuple[Optional[str], Optional[str]]:
     """Extract NDC and service date from service line segments"""
     ndc = None
     service_date = None

hccinfhir/model_coefficients.py

@@ -1,4 +1,4 @@
-from typing import Dict, Tuple, Optional
+from typing import Dict, Tuple, Optional, Set
 from hccinfhir.datamodels import ModelName, Demographics, PrefixOverride
 
 def get_coefficent_prefix(demographics: Demographics, 
@@ -65,7 +65,7 @@ def get_coefficent_prefix(demographics: Demographics,
 
 
 def apply_coefficients(demographics: Demographics,
-                      hcc_set: set[str],
+                      hcc_set: Set[str],
                       interactions: dict,
                       model_name: ModelName,
                       coefficients: Dict[Tuple[str, ModelName], float],

hccinfhir/model_demographics.py

@@ -1,5 +1,18 @@
 from typing import Union, Optional
 from hccinfhir.datamodels import Demographics, PrefixOverride
+from hccinfhir.constants import (
+    FULL_BENEFIT_DUAL_CODES,
+    PARTIAL_BENEFIT_DUAL_CODES,
+    OREC_ESRD_CODES,
+    CREC_ESRD_CODES,
+    ESRD_PREFIXES,
+    NEW_ENROLLEE_PREFIXES,
+    COMMUNITY_PREFIXES,
+    INSTITUTIONAL_PREFIXES,
+    FULL_BENEFIT_DUAL_PREFIXES,
+    PARTIAL_BENEFIT_DUAL_PREFIXES,
+    NON_DUAL_PREFIXES,
+)
     
 def categorize_demographics(age: Union[int, float],
                        sex: str,
@@ -75,56 +88,40 @@ def categorize_demographics(age: Union[int, float],
     disabled = age < 65 and (orec is not None and orec != "0")
     orig_disabled = (orec is not None and orec == '1') and not disabled
 
-    # Reference: https://resdac.org/cms-data/variables/medicare-medicaid-dual-eligibility-code-january 
-    # Full benefit dual codes
-    fbd_codes = {'02', '04', '08'}
-    
-    # Partial benefit dual codes
-    pbd_codes = {'01', '03', '05', '06'}
-    
-    is_fbd = dual_elgbl_cd in fbd_codes
-    is_pbd = dual_elgbl_cd in pbd_codes
+    # Reference: https://resdac.org/cms-data/variables/medicare-medicaid-dual-eligibility-code-january
+    is_fbd = dual_elgbl_cd in FULL_BENEFIT_DUAL_CODES
+    is_pbd = dual_elgbl_cd in PARTIAL_BENEFIT_DUAL_CODES
 
-    esrd_orec = orec in {'2', '3', '6'}
-    esrd_crec = crec in {'2', '3'} if crec else False
+    # ESRD detection from OREC/CREC (CMS official codes: 2=ESRD, 3=DIB+ESRD)
+    esrd_orec = orec in OREC_ESRD_CODES
+    esrd_crec = crec in CREC_ESRD_CODES if crec else False
     esrd = esrd_orec or esrd_crec
 
     # Override demographics based on prefix_override
     if prefix_override:
-        # ESRD model prefixes
-        esrd_prefixes = {'DI_', 'DNE_', 'GI_', 'GNE_', 'GFPA_', 'GFPN_', 'GNPA_', 'GNPN_'}
-        # CMS-HCC new enrollee prefixes
-        new_enrollee_prefixes = {'NE_', 'SNPNE_', 'DNE_', 'GNE_'}
-        # CMS-HCC community prefixes
-        community_prefixes = {'CNA_', 'CND_', 'CFA_', 'CFD_', 'CPA_', 'CPD_'}
-        # Institutionalized prefix
-        institutional_prefixes = {'INS_', 'GI_'}
-        
-        # TODO: RxHCC prefixes
-
         # Set esrd flag
-        if prefix_override in esrd_prefixes:
+        if prefix_override in ESRD_PREFIXES:
             esrd = True
 
         # Set new_enrollee flag
-        if prefix_override in new_enrollee_prefixes:
+        if prefix_override in NEW_ENROLLEE_PREFIXES:
             new_enrollee = True
-        elif prefix_override in community_prefixes or prefix_override in institutional_prefixes:
+        elif prefix_override in COMMUNITY_PREFIXES or prefix_override in INSTITUTIONAL_PREFIXES:
             new_enrollee = False
 
         # Set dual eligibility flags based on prefix
-        if prefix_override in {'CFA_', 'CFD_', 'GFPA_', 'GFPN_'}:
+        if prefix_override in FULL_BENEFIT_DUAL_PREFIXES:
             is_fbd = True
             is_pbd = False
-        elif prefix_override in {'CPA_', 'CPD_'}:
+        elif prefix_override in PARTIAL_BENEFIT_DUAL_PREFIXES:
             is_fbd = False
             is_pbd = True
-        elif prefix_override in {'CNA_', 'CND_', 'GNPA_', 'GNPN_'}:
+        elif prefix_override in NON_DUAL_PREFIXES:
             is_fbd = False
             is_pbd = False
 
         # Set lti flag based on prefix
-        if prefix_override in institutional_prefixes:
+        if prefix_override in INSTITUTIONAL_PREFIXES:
             lti = True
 
     result_dict = {

hccinfhir/model_interactions.py

@@ -1,7 +1,7 @@
 from hccinfhir.datamodels import Demographics, ModelName
-from typing import Optional
+from typing import Optional, List, Set, Dict
 
-def has_any_hcc(hcc_list: list[str], hcc_set: set[str]) -> int:
+def has_any_hcc(hcc_list: List[str], hcc_set: Set[str]) -> int:
     """Returns 1 if any HCC in the list is present, 0 otherwise"""
     return int(bool(set(hcc_list) & hcc_set))
 
@@ -81,7 +81,7 @@ def create_dual_interactions(demographics: Demographics) -> dict:
         
     return interactions
 
-def create_hcc_counts(hcc_set: set[str]) -> dict:
+def create_hcc_counts(hcc_set: Set[str]) -> Dict:
     """Creates HCC count variables"""
     counts = {}
     hcc_count = len(hcc_set)
@@ -95,7 +95,7 @@ def create_hcc_counts(hcc_set: set[str]) -> dict:
 
     return counts
 
-def get_diagnostic_categories(model_name: ModelName, hcc_set: set[str]) -> dict:
+def get_diagnostic_categories(model_name: ModelName, hcc_set: Set[str]) -> Dict:
     """Creates disease categories based on model version"""
     categories = {}
     
@@ -343,9 +343,9 @@ def create_disease_interactions(model_name: ModelName,
     
     return interactions
 
-def apply_interactions(demographics: Demographics, 
-                      hcc_set: set[str], 
-                      model_name: ModelName = "CMS-HCC Model V28") -> dict:
+def apply_interactions(demographics: Demographics,
+                      hcc_set: Set[str],
+                      model_name: ModelName = "CMS-HCC Model V28") -> Dict:
     """
     Calculate HCC interactions across CMS models. Handles CMS-HCC, ESRD, and RxHCC models.
     """

{hccinfhir-0.2.0.dist-info → hccinfhir-0.2.1.dist-info}/METADATA

@@ -1,6 +1,6 @@
 Metadata-Version: 2.3
 Name: hccinfhir
-Version: 0.2.0
+Version: 0.2.1
 Summary: HCC Algorithm for FHIR Resources
 Project-URL: Homepage, https://github.com/mimilabs/hccinfhir
 Project-URL: Issues, https://github.com/mimilabs/hccinfhir/issues

{hccinfhir-0.2.0.dist-info → hccinfhir-0.2.1.dist-info}/RECORD

@@ -1,18 +1,19 @@
 hccinfhir/__init__.py,sha256=CKpYTUSzZdP3s1eB74w5JTe9OS3MtcvuUkv6ymgSyic,1085
+hccinfhir/constants.py,sha256=C4Vyjtzgyd4Jm2I2X6cTYQZLe-jAMC8boUcy-7OXQDQ,8473
 hccinfhir/datamodels.py,sha256=NULDYb57R61v4EklOI_AAIuC1-OkLFH1InbAad48dZM,10601
 hccinfhir/defaults.py,sha256=tMNym0R6Nr6ibKTqOu6N1vLcdekL0ZmHyDNIOCOMsP4,1292
 hccinfhir/extractor.py,sha256=xL9c2VT-e2I7_c8N8j4Og42UEgVuCzyn9WFp3ntM5Ro,1822
-hccinfhir/extractor_834.py,sha256=vODcD53iU5ZwQsSbBE8Gix9D-0fz-EhwkmjqRO6LML8,19541
-hccinfhir/extractor_837.py,sha256=D60gUFtMk2S0NrJ0iq3ENo35yIwBmBQvF5TurJgRIa8,15327
+hccinfhir/extractor_834.py,sha256=dIqovUOWm_7k_c6sUqTIzQua_kTQ8dLGy3-4-LECW3Y,18855
+hccinfhir/extractor_837.py,sha256=fGsvBTWIj9dsHLGGR67AdlYDSsFi5qnSVlTgwkL1f-E,15334
 hccinfhir/extractor_fhir.py,sha256=wUN3vTm1oTZ-KvfcDebnpQMxAC-7YlRKv12Wrv3p85A,8490
 hccinfhir/filter.py,sha256=j_yD2g6RBXVUV9trKkWzsQ35x3fRvfKUPvEXKUefI64,2007
 hccinfhir/hccinfhir.py,sha256=rCnExvxZGKi1vLD4cHQ0nzPAGV6e-8C15MtJ2p7zAAk,11160
 hccinfhir/model_calculate.py,sha256=KSeZjKYBCfBYYIWOIckDg941OC8050MX2F7BZ2l3V8g,7663
-hccinfhir/model_coefficients.py,sha256=--8Gh5gYJez1v0cBA1ZqDn0QI6On-ia1-wPr-mqbRFs,4680
-hccinfhir/model_demographics.py,sha256=CR4WC8XVq-CI1nYJoVFc5-KXTw-pKoVlHkHqfnXlnj0,9121
+hccinfhir/model_coefficients.py,sha256=5n3QzHX6FJ3MlO0cV9NS7Bqt-lxzVvT_M3zFaWq6Gng,4685
+hccinfhir/model_demographics.py,sha256=nImKtJCq1HkR9w2GU8aikybJFgow71CPufBRV8Jn7fM,8932
 hccinfhir/model_dx_to_cc.py,sha256=Yjc6xKI-jMXsbOzS_chc4NI15Bwagb7BwZZ8cKQaTbk,1540
 hccinfhir/model_hierarchies.py,sha256=cboUnSHZZfOxA8QZKV4QIE-32duElssML32OqYT-65g,1542
-hccinfhir/model_interactions.py,sha256=xdsTuc3ii8U_MaPpYv0SnR4eR_w72eHKUJn1mwmZHm4,21379
+hccinfhir/model_interactions.py,sha256=g6jK27Xu8RQUHS3lk4sk2v6w6wqd52mdbGn0BsnR7Pk,21394
 hccinfhir/samples.py,sha256=2VSWS81cv9EnaHqK7sd6CjwG6FUI9E--5wHgD000REI,9952
 hccinfhir/utils.py,sha256=9ki4o1wXyAYYr8BR9Skkz0PKL_1H_HYNV4LalEsASE0,8260
 hccinfhir/data/__init__.py,sha256=SGiSkpGrnxbvtEFMMlk82NFHOE50hFXcgKwKUSuVZUg,45
@@ -47,7 +48,7 @@ hccinfhir/sample_files/sample_eob_1.json,sha256=_NGSVR2ysFpx-DcTvyga6dFCzhQ8Vi9f
 hccinfhir/sample_files/sample_eob_2.json,sha256=FcnJcx0ApOczxjJ_uxVLzCep9THfNf4xs9Yf7hxk8e4,1769
 hccinfhir/sample_files/sample_eob_200.ndjson,sha256=CxpjeQ1DCMUzZILaM68UEhfxO0p45YGhDDoCZeq8PxU,1917986
 hccinfhir/sample_files/sample_eob_3.json,sha256=4BW4wOMBEEU9RDfJR15rBEvk0KNHyuMEh3e055y87Hc,2306
-hccinfhir-0.2.0.dist-info/METADATA,sha256=bRJ_IYdfpYNRnKLYeqyhVlKTob5K69SeCiC7FGzX8vM,31674
-hccinfhir-0.2.0.dist-info/WHEEL,sha256=C2FUgwZgiLbznR-k0b_5k3Ai_1aASOXDss3lzCUsUug,87
-hccinfhir-0.2.0.dist-info/licenses/LICENSE,sha256=xx0jnfkXJvxRnG63LTGOxlggYnIysveWIZ6H3PNdCrQ,11357
-hccinfhir-0.2.0.dist-info/RECORD,,
+hccinfhir-0.2.1.dist-info/METADATA,sha256=FrzAPidGEXS8l-1vO_QRlemPZegXavDpn--TkmwQBxY,31674
+hccinfhir-0.2.1.dist-info/WHEEL,sha256=C2FUgwZgiLbznR-k0b_5k3Ai_1aASOXDss3lzCUsUug,87
+hccinfhir-0.2.1.dist-info/licenses/LICENSE,sha256=xx0jnfkXJvxRnG63LTGOxlggYnIysveWIZ6H3PNdCrQ,11357
+hccinfhir-0.2.1.dist-info/RECORD,,