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1157 lines (1090 loc) · 40.5 KB
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import csv
import random
import sys
from collections import OrderedDict, defaultdict
from enum import StrEnum, auto
from pathlib import Path
from typing import Any
import click
import field_constants as f
import tqdm
from claims_adj import AdjudicatedGeneratorUtil
from claims_other import OtherGeneratorUtil
from claims_pac import PacGeneratorUtil
from claims_static import INSTITUTIONAL_CLAIM_TYPES, PHARMACY_CLM_TYPE_CDS, PROFESSIONAL_CLAIM_TYPES
from claims_util import four_part_key, match_line_num
from generator_util import (
BENE_HSTRY,
CLM,
CLM_ANSI_SGNTR,
CLM_DCMTN,
CLM_DT_SGNTR,
CLM_FISS,
CLM_INSTNL,
CLM_LCTN_HSTRY,
CLM_LINE,
CLM_LINE_DCMTN,
CLM_LINE_INSTNL,
CLM_LINE_PRFNL,
CLM_LINE_RX,
CLM_PRFNL,
CLM_PROD,
CLM_RLT_COND_SGNTR_MBR,
CLM_VAL,
CNTRCT_PBP_NUM,
PRVDR_HSTRY,
GeneratorUtil,
RowAdapter,
adapters_to_dicts,
as_list,
load_file_dict,
partition_rows,
probability,
run_command,
)
_INT_TO_STRING_COLS = [
f.BENE_SK,
f.CLM_TYPE_CD,
f.CLM_NUM_SK,
f.PRVDR_PRSCRBNG_PRVDR_NPI_NUM,
f.PRVDR_RFRG_PRVDR_NPI_NUM,
f.PRVDR_BLG_PRVDR_NPI_NUM,
f.CLM_ATNDG_PRVDR_NPI_NUM,
f.CLM_OPRTG_PRVDR_NPI_NUM,
f.CLM_OTHR_PRVDR_NPI_NUM,
f.CLM_RNDRG_PRVDR_NPI_NUM,
f.CLM_BLG_PRVDR_NPI_NUM,
f.CLM_RFRG_PRVDR_PIN_NUM,
f.PRVDR_ATNDG_PRVDR_NPI_NUM,
f.PRVDR_SRVC_PRVDR_NPI_NUM,
f.PRVDR_OTHR_PRVDR_NPI_NUM,
f.PRVDR_RNDRNG_PRVDR_NPI_NUM,
f.PRVDR_OPRTG_PRVDR_NPI_NUM,
]
"""Columns you want as string without decimal/nan"""
class GeneratePacDataMode(StrEnum):
NO = auto()
IF_NONE = auto()
ALWAYS = auto()
class BeneSkMode(StrEnum):
BENE_HSTRY = auto()
CLM = auto()
BOTH = auto()
class _ClaimsFile(StrEnum):
CLM = (
CLM,
[
f.CLM_DT_SGNTR_SK,
f.CLM_UNIQ_ID,
f.CLM_RLT_COND_SGNTR_SK,
f.CLM_TYPE_CD,
f.CLM_SRC_ID,
f.META_SRC_SK,
f.CLM_FROM_DT,
f.CLM_THRU_DT,
f.CLM_CNTL_NUM,
f.CLM_NUM_SK,
f.CLM_EFCTV_DT,
f.CLM_IDR_LD_DT,
f.CLM_OBSLT_DT,
f.GEO_BENE_SK,
f.BENE_SK,
f.CLM_DISP_CD,
f.CLM_QUERY_CD,
f.CLM_ADJSTMT_TYPE_CD,
f.CLM_BILL_FAC_TYPE_CD,
f.CLM_BILL_CLSFCTN_CD,
f.CLM_BILL_FREQ_CD,
f.CLM_CNTRCTR_NUM,
f.CLM_NCH_PRMRY_PYR_CD,
f.CLM_FINL_ACTN_IND,
f.CLM_LTST_CLM_IND,
f.PRVDR_BLG_PRVDR_NPI_NUM,
f.CLM_ATNDG_PRVDR_NPI_NUM,
f.PRVDR_ATNDG_PRVDR_NPI_NUM,
f.CLM_OPRTG_PRVDR_NPI_NUM,
f.PRVDR_OPRTG_PRVDR_NPI_NUM,
f.CLM_OTHR_PRVDR_NPI_NUM,
f.PRVDR_OTHR_PRVDR_NPI_NUM,
f.CLM_RNDRG_PRVDR_NPI_NUM,
f.PRVDR_RNDRNG_PRVDR_NPI_NUM,
f.CLM_BLG_PRVDR_OSCAR_NUM,
f.CLM_MDCR_COINSRNC_AMT,
f.CLM_BLG_PRVDR_ZIP5_CD,
f.CLM_SBMT_CHRG_AMT,
f.CLM_PMT_AMT,
f.CLM_MDCR_DDCTBL_AMT,
f.CLM_NCVRD_CHRG_AMT,
f.CLM_BLOOD_LBLTY_AMT,
f.CLM_BENE_PMT_COINSRNC_AMT,
f.CLM_BLOOD_CHRG_AMT,
f.CLM_BLOOD_NCVRD_CHRG_AMT,
f.CLM_COB_PTNT_RESP_AMT,
f.CLM_PRVDR_INTRST_PD_AMT,
f.CLM_PRVDR_OTAF_AMT,
f.CLM_PRVDR_RMNG_DUE_AMT,
f.CLM_TOT_CNTRCTL_AMT,
f.CLM_BLOOD_PT_FRNSH_QTY,
f.PRVDR_RFRG_PRVDR_NPI_NUM,
f.CLM_PRVDR_PMT_AMT,
f.CLM_RIC_CD,
f.CLM_BLG_PRVDR_NPI_NUM,
f.CLM_RFRG_PRVDR_PIN_NUM,
f.CLM_OPRTG_FED_PRVDR_SPCLTY_CD,
f.CLM_OPRTG_PRVDR_NAME,
f.CLM_OTHR_FED_PRVDR_SPCLTY_CD,
f.CLM_OTHR_PRVDR_NAME,
f.CLM_RNDRG_FED_PRVDR_SPCLTY_CD,
f.CLM_RNDRG_PRVDR_NAME,
f.CLM_ATNDG_FED_PRVDR_SPCLTY_CD,
f.CLM_ATNDG_PRVDR_NAME,
f.CLM_ALOWD_CHRG_AMT,
f.CLM_BENE_PD_AMT,
f.CLM_BENE_PMT_AMT,
f.CLM_BENE_INTRST_PD_AMT,
f.CLM_ORIG_CNTL_NUM,
f.CLM_SRVC_PRVDR_GNRC_ID_NUM,
f.CLM_PRSBNG_PRVDR_GNRC_ID_NUM,
f.PRVDR_SRVC_ID_QLFYR_CD,
f.PRVDR_PRSBNG_ID_QLFYR_CD,
f.PRVDR_SRVC_PRVDR_NPI_NUM,
f.CLM_PD_DT,
f.PRVDR_PRSCRBNG_PRVDR_NPI_NUM,
f.CLM_SBMT_FRMT_CD,
f.CLM_SBMTR_CNTRCT_NUM,
f.CLM_SBMTR_CNTRCT_PBP_NUM,
f.CLM_OTHR_TP_PD_AMT,
f.CLM_BNFT_ENHNCMT_1_CD,
f.CLM_BNFT_ENHNCMT_2_CD,
f.CLM_BNFT_ENHNCMT_3_CD,
f.CLM_BNFT_ENHNCMT_4_CD,
f.CLM_BNFT_ENHNCMT_5_CD,
f.CLM_NGACO_PBPMT_SW,
f.CLM_NGACO_PDSCHRG_HCBS_SW,
f.CLM_NGACO_SNF_WVR_SW,
f.CLM_NGACO_TLHLTH_SW,
f.CLM_NGACO_CPTATN_SW,
f.CLM_ACO_CARE_MGMT_HCBS_SW,
f.CLM_PD_STUS_CD,
f.IDR_INSRT_TS,
f.IDR_UPDT_TS,
],
)
CLM_ANSI_SGNTR = (
CLM_ANSI_SGNTR,
[
f.CLM_ANSI_SGNTR_SK,
f.CLM_1_REV_CNTR_ANSI_RSN_CD,
f.CLM_2_REV_CNTR_ANSI_RSN_CD,
f.CLM_3_REV_CNTR_ANSI_RSN_CD,
f.CLM_4_REV_CNTR_ANSI_RSN_CD,
f.IDR_INSRT_TS,
f.IDR_UPDT_TS,
],
)
CLM_DCMTN = (
CLM_DCMTN,
[
f.CLM_DT_SGNTR_SK,
f.CLM_NUM_SK,
f.GEO_BENE_SK,
f.CLM_TYPE_CD,
f.CLM_NRLN_RIC_CD,
f.IDR_INSRT_TS,
f.IDR_UPDT_TS,
],
)
CLM_DT_SGNTR = (
CLM_DT_SGNTR,
[
f.CLM_DT_SGNTR_SK,
f.IDR_INSRT_TS,
f.IDR_UPDT_TS,
f.CLM_ACTV_CARE_FROM_DT,
f.CLM_DSCHRG_DT,
f.CLM_MDCR_EXHSTD_DT,
f.CLM_NCVRD_FROM_DT,
f.CLM_NCVRD_THRU_DT,
f.CLM_SUBMSN_DT,
f.CLM_CMS_PROC_DT,
f.CLM_NCH_WKLY_PROC_DT,
f.CLM_ACTV_CARE_THRU_DT,
f.CLM_QLFY_STAY_FROM_DT,
f.CLM_QLFY_STAY_THRU_DT,
],
)
CLM_FISS = (
CLM_FISS,
[
f.CLM_DT_SGNTR_SK,
f.GEO_BENE_SK,
f.CLM_NUM_SK,
f.CLM_TYPE_CD,
f.CLM_CRNT_STUS_CD,
f.IDR_INSRT_TS,
f.IDR_UPDT_TS,
],
)
CLM_INSTNL = (
CLM_INSTNL,
[
f.GEO_BENE_SK,
f.CLM_DT_SGNTR_SK,
f.CLM_TYPE_CD,
f.CLM_NUM_SK,
f.CLM_FI_ACTN_CD,
f.CLM_ADMSN_TYPE_CD,
f.BENE_PTNT_STUS_CD,
f.CLM_MDCR_INSTNL_MCO_PD_SW,
f.CLM_ADMSN_SRC_CD,
f.DGNS_DRG_CD,
f.DGNS_DRG_OUTLIER_CD,
f.CLM_INSTNL_CVRD_DAY_CNT,
f.CLM_MDCR_IP_LRD_USE_CNT,
f.CLM_INSTNL_PER_DIEM_AMT,
f.CLM_HIPPS_UNCOMPD_CARE_AMT,
f.CLM_MDCR_INSTNL_PRMRY_PYR_AMT,
f.CLM_INSTNL_DRG_OUTLIER_AMT,
f.CLM_MDCR_IP_PPS_DSPRPRTNT_AMT,
f.CLM_INSTNL_MDCR_COINS_DAY_CNT,
f.CLM_INSTNL_NCVRD_DAY_CNT,
f.CLM_MDCR_IP_PPS_DRG_WT_NUM,
f.CLM_MDCR_IP_PPS_EXCPTN_AMT,
f.CLM_MDCR_IP_PPS_CPTL_FSP_AMT,
f.CLM_MDCR_IP_PPS_CPTL_IME_AMT,
f.CLM_MDCR_IP_PPS_OUTLIER_AMT,
f.CLM_MDCR_IP_PPS_CPTL_HRMLS_AMT,
f.CLM_MDCR_IP_PPS_CPTL_TOT_AMT,
f.CLM_MDCR_IP_BENE_DDCTBL_AMT,
f.CLM_PPS_IND_CD,
f.CLM_MDCR_HOSPC_PRD_CNT,
f.CLM_MDCR_NPMT_RSN_CD,
f.CLM_OP_SRVC_TYPE_CD,
f.CLM_INSTNL_PRFNL_AMT,
f.CLM_MDCR_INSTNL_BENE_PD_AMT,
f.CLM_FINL_STDZD_PYMT_AMT,
f.CLM_HHA_RFRL_CD,
f.CLM_MDCR_HHA_TOT_VISIT_CNT,
f.CLM_HIPPS_READMSN_RDCTN_AMT,
f.CLM_HIPPS_VBP_AMT,
f.CLM_INSTNL_LOW_VOL_PMT_AMT,
f.CLM_MDCR_IP_1ST_YR_RATE_AMT,
f.CLM_MDCR_IP_SCND_YR_RATE_AMT,
f.CLM_PPS_MD_WVR_STDZD_VAL_AMT,
f.CLM_HHA_LUP_IND_CD,
f.CLM_HAC_RDCTN_PYMT_AMT,
f.CLM_HIPPS_MODEL_BNDLD_PMT_AMT,
f.CLM_SITE_NTRL_CST_BSD_PYMT_AMT,
f.CLM_SITE_NTRL_IP_PPS_PYMT_AMT,
f.CLM_SS_OUTLIER_STD_PYMT_AMT,
f.IDR_INSRT_TS,
f.IDR_UPDT_TS,
],
)
CLM_LCTN_HSTRY = (
CLM_LCTN_HSTRY,
[
f.CLM_DT_SGNTR_SK,
f.GEO_BENE_SK,
f.CLM_NUM_SK,
f.CLM_TYPE_CD,
f.CLM_LCTN_CD_SQNC_NUM,
f.CLM_AUDT_TRL_STUS_CD,
f.CLM_AUDT_TRL_LCTN_CD, # TODO: Generate this; values in test-samples2 are static
f.IDR_INSRT_TS,
f.IDR_UPDT_TS,
],
)
CLM_LINE_DCMTN = (
CLM_LINE_DCMTN,
[
f.GEO_BENE_SK,
f.CLM_DT_SGNTR_SK,
f.CLM_TYPE_CD,
f.CLM_NUM_SK,
f.CLM_LINE_PA_UNIQ_TRKNG_NUM,
f.CLM_LINE_NUM,
f.IDR_INSRT_TS,
f.IDR_UPDT_TS,
],
)
CLM_LINE_INSTNL = (
CLM_LINE_INSTNL,
[
f.GEO_BENE_SK,
f.CLM_DT_SGNTR_SK,
f.CLM_TYPE_CD,
f.CLM_NUM_SK,
f.CLM_LINE_NUM,
f.CLM_LINE_INSTNL_ADJSTD_AMT,
f.CLM_LINE_INSTNL_RDCD_AMT,
f.CLM_DDCTBL_COINSRNC_CD,
f.CLM_LINE_INSTNL_RATE_AMT,
f.CLM_LINE_INSTNL_MSP1_PD_AMT,
f.CLM_LINE_INSTNL_MSP2_PD_AMT,
f.CLM_LINE_INSTNL_REV_CTR_DT,
f.CLM_REV_DSCNT_IND_CD,
f.CLM_OTAF_ONE_IND_CD,
f.CLM_REV_PACKG_IND_CD,
f.CLM_REV_PMT_MTHD_CD,
f.CLM_REV_CNTR_STUS_CD,
f.CLM_ANSI_SGNTR_SK,
f.CLM_LINE_ADD_ON_PYMT_AMT,
f.CLM_LINE_NON_EHR_RDCTN_AMT,
f.CLM_REV_CNTR_TDAPA_AMT,
f.IDR_INSRT_TS,
f.IDR_UPDT_TS,
],
)
CLM_LINE_PRFNL = (
CLM_LINE_PRFNL,
[
f.GEO_BENE_SK,
f.CLM_DT_SGNTR_SK,
f.CLM_TYPE_CD,
f.CLM_NUM_SK,
f.CLM_LINE_NUM,
f.CLM_BENE_PRMRY_PYR_PD_AMT,
f.CLM_SRVC_DDCTBL_SW,
f.CLM_PRCSG_IND_CD,
f.CLM_PMT_80_100_CD,
f.CLM_MTUS_IND_CD,
f.CLM_LINE_PRFNL_MTUS_CNT,
f.CLM_PHYSN_ASTNT_CD,
f.CLM_LINE_CARR_CLNCL_CHRG_AMT,
f.CLM_LINE_CARR_PSYCH_OT_LMT_AMT,
f.CLM_LINE_PRFNL_INTRST_AMT,
f.CLM_MDCR_PRMRY_PYR_ALOWD_AMT,
f.CLM_LINE_HCT_HGB_TYPE_CD,
f.CLM_LINE_CARR_CLNCL_LAB_NUM,
f.CLM_LINE_DMERC_SCRN_SVGS_AMT,
f.CLM_SUPLR_TYPE_CD,
f.CLM_LINE_PRFNL_DME_PRICE_AMT,
f.CLM_LINE_HCT_HGB_RSLT_NUM, # TODO: not generated yet
f.IDR_INSRT_TS,
f.IDR_UPDT_TS,
],
)
CLM_LINE_RX = (
CLM_LINE_RX,
[
f.CLM_UNIQ_ID,
f.CLM_DT_SGNTR_SK,
f.CLM_NUM_SK,
f.CLM_TYPE_CD,
f.GEO_BENE_SK,
f.CLM_LINE_NUM,
f.CLM_FROM_DT,
f.CLM_DSPNSNG_STUS_CD,
f.CLM_LINE_RX_ORGN_CD,
f.CLM_BRND_GNRC_CD,
f.CLM_PTNT_RSDNC_CD,
f.CLM_PHRMCY_SRVC_TYPE_CD,
f.CLM_LINE_AUTHRZD_FILL_NUM,
f.CLM_LTC_DSPNSNG_MTHD_CD,
f.CLM_CMPND_CD,
f.CLM_LINE_DAYS_SUPLY_QTY,
f.CLM_LINE_RX_FILL_NUM,
f.CLM_DAW_PROD_SLCTN_CD,
f.CLM_DRUG_CVRG_STUS_CD,
f.CLM_CTSTRPHC_CVRG_IND_CD,
f.CLM_LINE_GRS_ABOVE_THRSHLD_AMT,
f.CLM_LINE_GRS_BLW_THRSHLD_AMT,
f.CLM_LINE_LIS_AMT,
f.CLM_LINE_TROOP_TOT_AMT,
f.CLM_LINE_PLRO_AMT,
f.CLM_RPTD_MFTR_DSCNT_AMT,
f.CLM_LINE_INGRDNT_CST_AMT,
f.CLM_LINE_VCCN_ADMIN_FEE_AMT,
f.CLM_LINE_SRVC_CST_AMT,
f.CLM_LINE_SLS_TAX_AMT,
f.CLM_PRCNG_EXCPTN_CD,
f.CLM_CMS_CALCD_MFTR_DSCNT_AMT,
f.CLM_LINE_REBT_PASSTHRU_POS_AMT,
f.CLM_PHRMCY_PRICE_DSCNT_AT_POS_AMT,
f.CLM_LINE_RPTD_GAP_DSCNT_AMT,
f.IDR_INSRT_TS,
f.IDR_UPDT_TS,
],
)
CLM_LINE = (
CLM_LINE,
[
f.CLM_UNIQ_ID,
f.GEO_BENE_SK,
f.CLM_DT_SGNTR_SK,
f.CLM_TYPE_CD,
f.CLM_NUM_SK,
f.CLM_LINE_NUM,
f.CLM_FROM_DT,
f.CLM_LINE_FROM_DT,
f.CLM_LINE_THRU_DT,
f.CLM_LINE_HCPCS_CD,
f.HCPCS_1_MDFR_CD,
f.HCPCS_2_MDFR_CD,
f.HCPCS_3_MDFR_CD,
f.HCPCS_4_MDFR_CD,
f.HCPCS_5_MDFR_CD,
f.CLM_LINE_ANSTHSA_UNIT_CNT, # TODO: generate this
f.CLM_LINE_SRVC_UNIT_QTY,
f.CLM_LINE_REV_CTR_CD,
f.CLM_LINE_BENE_PMT_AMT,
f.CLM_LINE_BENE_PD_AMT,
f.CLM_LINE_ALOWD_CHRG_AMT,
f.CLM_LINE_SBMT_CHRG_AMT,
f.CLM_LINE_CVRD_PD_AMT,
f.CLM_LINE_BLOOD_DDCTBL_AMT,
f.CLM_LINE_MDCR_DDCTBL_AMT,
f.CLM_LINE_PRVDR_PMT_AMT,
f.CLM_LINE_NCVRD_CHRG_AMT,
f.CLM_LINE_FINL_ACTN_IND,
f.CLM_LINE_LTST_CLM_IND,
f.CLM_LINE_OTAF_AMT,
f.CLM_LINE_NDC_CD,
f.CLM_LINE_NDC_QTY,
f.CLM_LINE_NDC_QTY_QLFYR_CD,
f.CLM_RNDRG_PRVDR_TYPE_CD,
f.CLM_LINE_MDCR_COINSRNC_AMT,
f.CLM_LINE_DGNS_CD,
f.CLM_POS_CD,
f.CLM_RNDRG_PRVDR_PRTCPTG_CD,
f.CLM_RNDRG_FED_PRVDR_SPCLTY_CD,
f.CLM_RNDRG_PRVDR_TAX_NUM,
f.CLM_RNDRG_PRVDR_PIN_NUM,
f.PRVDR_RNDRNG_PRVDR_NPI_NUM,
f.CLM_RNDRG_PRVDR_NPI_NUM,
f.CLM_LINE_PMD_UNIQ_TRKNG_NUM,
f.CLM_LINE_NCVRD_PD_AMT,
f.CLM_LINE_RX_NUM,
f.CLM_LINE_GRS_CVRD_CST_TOT_AMT,
f.CLM_LINE_OTHR_TP_PD_AMT,
f.CLM_RNDRNG_PRVDR_NPI_NUM,
f.CLM_LINE_BNFT_ENHNCMT_1_CD,
f.CLM_LINE_BNFT_ENHNCMT_2_CD,
f.CLM_LINE_BNFT_ENHNCMT_3_CD,
f.CLM_LINE_BNFT_ENHNCMT_4_CD,
f.CLM_LINE_BNFT_ENHNCMT_5_CD,
f.CLM_LINE_NGACO_PBPMT_SW,
f.CLM_LINE_NGACO_PDSCHRG_HCBS_SW,
f.CLM_LINE_NGACO_SNF_WVR_SW,
f.CLM_LINE_NGACO_TLHLTH_SW,
f.CLM_LINE_NGACO_CPTATN_SW,
f.CLM_LINE_ACO_CARE_MGMT_HCBS_SW,
f.IDR_INSRT_TS,
f.IDR_UPDT_TS,
],
)
CLM_PRFNL = (
CLM_PRFNL,
[
f.CLM_DT_SGNTR_SK,
f.CLM_NUM_SK,
f.GEO_BENE_SK,
f.CLM_TYPE_CD,
f.CLM_CARR_PMT_DNL_CD,
f.CLM_MDCR_PRFNL_PRMRY_PYR_AMT,
f.CLM_MDCR_PRFNL_PRVDR_ASGNMT_SW,
f.CLM_CLNCL_TRIL_NUM,
f.CLM_PRVDR_ACNT_RCVBL_OFST_AMT,
f.IDR_INSRT_TS,
f.IDR_UPDT_TS,
],
)
CLM_PROD = (
CLM_PROD,
[
f.CLM_PROD_TYPE_CD,
f.CLM_PRCDR_CD,
f.CLM_DGNS_PRCDR_ICD_IND,
f.CLM_PRCDR_PRFRM_DT,
f.CLM_VAL_SQNC_NUM,
f.CLM_DT_SGNTR_SK,
f.CLM_NUM_SK,
f.GEO_BENE_SK,
f.CLM_TYPE_CD,
f.CLM_DGNS_CD,
f.CLM_POA_IND,
f.IDR_INSRT_TS,
f.IDR_UPDT_TS,
],
)
CLM_RLT_COND_SGNTR_MBR = (
CLM_RLT_COND_SGNTR_MBR,
[
f.CLM_RLT_COND_SGNTR_SK,
f.CLM_RLT_COND_SGNTR_SQNC_NUM,
f.CLM_RLT_COND_CD,
f.IDR_INSRT_TS,
f.IDR_UPDT_TS,
# HACK: See generation function for justification. This is not a real field of this
# table
f.CLM_UNIQ_ID,
],
)
CLM_VAL = (
CLM_VAL,
[
f.CLM_DT_SGNTR_SK,
f.CLM_NUM_SK,
f.GEO_BENE_SK,
f.CLM_TYPE_CD,
f.CLM_VAL_CD,
f.CLM_VAL_AMT,
f.CLM_VAL_SQNC_NUM,
f.IDR_INSRT_TS,
f.IDR_UPDT_TS,
],
)
PRVDR_HSTRY = (
PRVDR_HSTRY,
[
f.PRVDR_SK,
f.PRVDR_HSTRY_EFCTV_DT,
f.PRVDR_HSTRY_OBSLT_DT,
f.PRVDR_1ST_NAME,
f.PRVDR_MDL_NAME,
f.PRVDR_LAST_NAME,
f.PRVDR_NAME,
f.PRVDR_LGL_NAME,
f.PRVDR_NPI_NUM,
f.PRVDR_EMPLR_ID_NUM,
f.PRVDR_OSCAR_NUM,
f.PRVDR_TXNMY_CMPST_CD,
f.PRVDR_TYPE_CD,
f.META_SK,
f.META_LST_UPDT_SK,
],
)
def __init__(
self,
value: str,
ordered_headers: list[str],
) -> None:
self.ordered_headers = ordered_headers
self.out_path = Path(f"out/{value}.csv")
def __new__(
cls: type["_ClaimsFile"],
value: str,
ordered_headers: list[str],
) -> "_ClaimsFile":
obj = str.__new__(cls, value)
obj._value_ = value
obj.ordered_headers = ordered_headers
return obj
def _save_claims_data(files: dict[_ClaimsFile, list[RowAdapter]]):
Path("out").mkdir(exist_ok=True)
print("Exporting finished synthetic claims to ./out...")
with tqdm.tqdm(files.items()) as t:
for claims_file, data in t:
t.set_postfix(file=str(claims_file.out_path)) # type: ignore
_write_claims_file(claims_file=claims_file, data=data)
print("Finished exporting generated claims")
def _write_claims_file(
claims_file: _ClaimsFile,
data: list[RowAdapter],
):
cleaned_data = _clean_int_columns(adapters_to_dicts(data), _INT_TO_STRING_COLS)
with Path(claims_file.out_path).open("w") as csv_file:
writer = csv.DictWriter(
csv_file, fieldnames=claims_file.ordered_headers, restval="", quoting=csv.QUOTE_MINIMAL
)
writer.writeheader()
writer.writerows(cleaned_data)
def _clean_int_columns(rows: list[dict[str, Any]], cols: list[str]):
for col in cols:
for row in rows:
if col in row:
row[col] = str(row[col])
return rows
@click.command
@click.option(
"--sushi/--no-sushi",
envvar="SUSHI",
default=False,
show_default=True,
help=(
"Generate new StructureDefinitions. Use when testing locally if new .fsh files have been "
"added."
),
)
@click.option(
"--min-claims",
envvar="MIN_CLAIMS",
type=int,
default=5,
show_default=True,
help="Minimum number of claims to generate per person",
)
@click.option(
"--max-claims",
envvar="MAX_CLAIMS",
type=int,
default=5,
show_default=True,
help="Maximum number of claims to generate per person",
)
@click.option(
"--enable-samhsa/--disable-samhsa",
envvar="ENABLE_SAMHSA",
type=bool,
default=True,
show_default=True,
help="Enables generation of SAMHSA-related data",
)
@click.option(
"--pac-gen",
envvar="PAC_GEN",
type=click.Choice(GeneratePacDataMode, case_sensitive=False),
default=GeneratePacDataMode.IF_NONE,
show_default=True,
help=(
"Generate new partially-adjudicated claims data based on choice. 'no' will never generate "
"pac data, 'if_none' will generate if the input claims data has no pac CLMs, and "
"'always' will force the generation always"
),
)
@click.option(
"--bene-sk-mode",
envvar="BENE_SK_MODE",
type=click.Choice(BeneSkMode, case_sensitive=False),
default=BeneSkMode.BOTH,
show_default=True,
help=(
"Sets the mode for which input files from which distinct BENE_SKs are read. 'bene_hstry' "
f"indicates that BENE_SKs are only loaded from {BENE_HSTRY}, 'clm' indicates loading from "
f"only from {CLM}. 'both' indicates loading from both"
),
)
@click.argument("paths", nargs=-1, type=click.Path(exists=True))
def generate(
sushi: bool,
min_claims: int,
max_claims: int,
enable_samhsa: bool,
pac_gen: GeneratePacDataMode,
bene_sk_mode: BeneSkMode,
paths: tuple[Path, ...],
):
"""Generate synthetic claims data. Provided file PATHS will be updated with new fields."""
if min_claims > max_claims:
print(
f"error: min claims value of {min_claims} is greater than "
f"max claims value of {max_claims}"
)
sys.exit(1)
gen_utils = GeneratorUtil()
if sushi:
print("Running sushi build")
_, stderr = run_command(["sushi", "build"], cwd="./sushi")
if stderr:
print("SUSHI errors:")
print(stderr)
files: dict[str, list[RowAdapter]] = {
BENE_HSTRY: [],
CLM: [],
CLM_LINE: [],
CLM_LINE_DCMTN: [],
CLM_VAL: [],
CLM_DT_SGNTR: [],
CLM_PROD: [],
CLM_INSTNL: [],
CLM_LINE_INSTNL: [],
CLM_DCMTN: [],
CLM_LCTN_HSTRY: [],
CLM_FISS: [],
CLM_PRFNL: [],
CLM_LINE_PRFNL: [],
CLM_LINE_RX: [],
CLM_RLT_COND_SGNTR_MBR: [],
PRVDR_HSTRY: [],
CNTRCT_PBP_NUM: [],
}
load_file_dict(files=files, paths=list(paths))
gen_utils.cntrct_pbp_num = [row.kv for row in files[CNTRCT_PBP_NUM]]
out_tables: dict[str, list[RowAdapter]] = {k: [] for k in files}
if not files[BENE_HSTRY] and not files[CLM] and not files[CNTRCT_PBP_NUM]:
print(
f"{BENE_HSTRY} and {CNTRCT_PBP_NUM} and/or {CLM} must be provided for "
f"claims data generation to proceed"
)
sys.exit(1)
other_util = OtherGeneratorUtil()
out_tables[PRVDR_HSTRY].extend(
other_util.gen_provider_history(amount=14, init_provider_historys=files[PRVDR_HSTRY])
)
# This table is special in that its data is mostly static and read from a static file, so we
# don't need to do anything fancy with it
out_tables[CLM_ANSI_SGNTR] = other_util.gen_synthetic_clm_ansi_sgntr()
# An operator could provide a BENE_HSTRY with new beneficiaries that have no corresponding CLMs,
# so we need to resolve the unique union of BENE_SKs from both files here. Below we will check
# whether a given BENE_SK has CLMs rows already and either regenerate them or generate new ones
# correspondingly. Additionally, we need to preserve the order of the bene_sks from the source
# files, else there will be drift in the order of generated rows
clm_bene_sks = (
[int(row[f.BENE_SK]) for row in files[CLM]]
if bene_sk_mode == BeneSkMode.CLM or bene_sk_mode == BeneSkMode.BOTH
else []
)
bene_hstry_bene_sks = (
[int(row[f.BENE_SK]) for row in files[BENE_HSTRY]]
if bene_sk_mode == BeneSkMode.BENE_HSTRY or bene_sk_mode == BeneSkMode.BOTH
else []
)
all_bene_sks = clm_bene_sks + bene_hstry_bene_sks # We take the order of CLM first
ordered_bene_sks = list(OrderedDict.fromkeys(x for x in all_bene_sks))
# Regenerating existing data implies that we need a way to uniquely address a single row/set of
# rows for each claims table per-CLM. We could do this via list comprehensions/scanning each
# table during generation, but that would take _far_ too long. Instead, the block below sets up
# precomputed lookup tables for each claims table so that per-CLM regeneration of claims tables
# does not take an exceedingly long time versus generation of entirely new data.
clms_per_bene_sk = partition_rows(llist=files[CLM], part_by=lambda x: int(x[f.BENE_SK]))
# HACK: See generation function for justification. CLM_UNIQ_ID is not a field of this table
sgntr_mbr_per_clm_uniq_id = {
str(row[f.CLM_UNIQ_ID]): row
for row in files[CLM_RLT_COND_SGNTR_MBR]
if row.get(f.CLM_UNIQ_ID)
}
rx_clm_line_per_clm_uniq_id = {
str(x[f.CLM_UNIQ_ID]): x for x in files[CLM_LINE] if x.get(f.CLM_LINE_RX_NUM)
}
norm_clm_lines_per_clm_uniq_id = partition_rows(
llist=files[CLM_LINE],
part_by=lambda x: str(x[f.CLM_UNIQ_ID]),
filter_by=lambda x: not x.get(f.CLM_LINE_RX_NUM),
)
clm_line_rx_per_clm_uniq_id = {str(row[f.CLM_UNIQ_ID]): row for row in files[CLM_LINE_RX]}
clm_dcmtns_per_fpk = partition_rows(
llist=files[CLM_DCMTN],
part_by=four_part_key,
)
dsprtnt_clm_val_per_fpk = {
four_part_key(x): x for x in files[CLM_VAL] if int(x[f.CLM_VAL_CD]) == 18
}
ime_clm_val_per_fpk = {
four_part_key(x): x for x in files[CLM_VAL] if int(x[f.CLM_VAL_CD]) == 19
}
proc_clm_prod_per_fpk = partition_rows(
llist=files[CLM_PROD],
part_by=four_part_key,
filter_by=lambda x: x[f.CLM_PROD_TYPE_CD] == "S",
)
diag_clm_prod_per_fpk = partition_rows(
llist=files[CLM_PROD],
part_by=four_part_key,
filter_by=lambda x: x[f.CLM_PROD_TYPE_CD] != "S",
)
clm_dt_sgntr_per_sk = {str(row[f.CLM_DT_SGNTR_SK]): row for row in files[CLM_DT_SGNTR]}
clm_instnl_per_fpk = {four_part_key(row): row for row in files[CLM_INSTNL]}
clm_prfnls_per_fpk = partition_rows(
llist=files[CLM_PRFNL],
part_by=four_part_key,
)
clm_line_instnls_per_fpk = partition_rows(
llist=files[CLM_LINE_INSTNL], part_by=four_part_key
)
clm_line_prfnls_per_fpk = partition_rows(
llist=files[CLM_LINE_PRFNL], part_by=four_part_key
)
clm_fiss_per_fpk = {four_part_key(row): row for row in files[CLM_FISS]}
clm_lctn_hstry_per_fpk = {four_part_key(row): row for row in files[CLM_LCTN_HSTRY]}
clm_line_dcmtns_per_clk = partition_rows(
llist=files[CLM_LINE_DCMTN], part_by=four_part_key
)
# pac CLM generation is random per-generation iteration, so the number of pac CLMs rows is
# unstable regardless of whether we provide existing CLMs or not. We need a switch to ensure pac
# claims data is not generated if it already exists, only regenerated, so this checks if there's
# any pac CLMs in the provided FILEs or if the --force-pac-claims flag is disable and disables
# _new_ pac claim data generation if so
any_pac_clms = any(int(x[f.CLM_TYPE_CD]) >= 1011 for x in files[CLM])
gen_new_pac_clms = pac_gen == GeneratePacDataMode.ALWAYS or (
not any_pac_clms and pac_gen == GeneratePacDataMode.IF_NONE
)
print("Generating synthetic claims data for provided BENE_SKs...")
adj_util = AdjudicatedGeneratorUtil(enable_samhsa=enable_samhsa)
pac_util = PacGeneratorUtil()
for pt_bene_sk in tqdm.tqdm(ordered_bene_sks):
existing_clms = clms_per_bene_sk.get(pt_bene_sk, [])
existing_adj_clms = [x for x in existing_clms if int(x[f.CLM_TYPE_CD]) < 1011]
existing_pac_clms = [x for x in existing_clms if int(x[f.CLM_TYPE_CD]) >= 1011]
init_adj_clms = (
existing_adj_clms
if existing_adj_clms or existing_pac_clms
else [RowAdapter({}) for _ in range(random.randint(min_claims, max_claims))]
)
# This is dumb, but fresh pac claims are derived/generated from adjudicated claims generated
# here, so we need a way to provide those claims to the pac-generation logic in the next
# loop
all_adj_clms_tbls: list[dict[str, list[RowAdapter]]] = []
for init_adj_clm in init_adj_clms:
# Store this iteration's generated claims-related tables (list[RowAdapter]) for use in
# pac generation
adj_clms_tbls: dict[str, list[RowAdapter]] = defaultdict(list)
clm_from_dt_min = "2018-01-01"
clm = adj_util.gen_clm(
gen_utils=gen_utils,
bene_sk=str(pt_bene_sk),
init_clm=init_adj_clm,
min_date=clm_from_dt_min,
)
adj_clms_tbls[CLM].append(clm)
clm_rlt_cond_sgntr_mbr = adj_util.gen_clm_rlt_cond_sgntr_mbr(
clm=clm,
init_clm_rlt_cond_sgntr_mbr=sgntr_mbr_per_clm_uniq_id.get(clm[f.CLM_UNIQ_ID]),
)
adj_clms_tbls[CLM_RLT_COND_SGNTR_MBR].append(clm_rlt_cond_sgntr_mbr)
clm_type_cd = int(clm[f.CLM_TYPE_CD])
if clm_type_cd in PHARMACY_CLM_TYPE_CDS:
pharm_clm_line = adj_util.gen_pharm_clm_line(
clm=clm,
init_clm_line=rx_clm_line_per_clm_uniq_id.get(clm[f.CLM_UNIQ_ID]),
)
pharm_clm_line_rx = adj_util.gen_pharm_clm_line_rx(
gen_utils=gen_utils,
clm=clm,
init_clm_line_rx=clm_line_rx_per_clm_uniq_id.get(clm[f.CLM_UNIQ_ID]),
)
adj_clms_tbls[CLM_LINE].append(pharm_clm_line)
adj_clms_tbls[CLM_LINE_RX].append(pharm_clm_line_rx)
clm_dcmtns = [
adj_util.gen_clm_dcmtn(clm=clm, init_clm_dcmtn=x)
for x in clm_dcmtns_per_fpk.get(four_part_key(clm), [RowAdapter({})])
]
adj_clms_tbls[CLM_DCMTN].extend(clm_dcmtns)
if clm_type_cd in (20, 40, 60, 61, 62, 63, 64):
dsprtnt_clm_val = adj_util.gen_dsprtnt_clm_val(
clm=clm,
init_clm_val=dsprtnt_clm_val_per_fpk.get(four_part_key(clm)),
)
adj_clms_tbls[CLM_VAL].append(dsprtnt_clm_val)
ime_clm_val = adj_util.gen_ime_clm_val(
clm=clm,
init_clm_val=ime_clm_val_per_fpk.get(four_part_key(clm)),
)
adj_clms_tbls[CLM_VAL].append(ime_clm_val)
if clm_type_cd in (10, 20, 30, 40, 50, 60, 61, 62, 63, 64):
init_procs = proc_clm_prod_per_fpk.get(four_part_key(clm)) or [
RowAdapter({}) for _ in range(random.randint(1, 5))
]
for proc_idx, proc in enumerate(init_procs):
_proc = adj_util.gen_proc_clm_prod(
clm=clm, clm_val_sqnc_num=proc_idx, init_clm_prod=proc
)
adj_clms_tbls[CLM_PROD].append(_proc)
diagnoses = adj_util.gen_diag_clm_prod_list(
clm=clm, init_diagnoses=diag_clm_prod_per_fpk.get(four_part_key(clm))
)
adj_clms_tbls[CLM_PROD].extend(diagnoses)
clm_dt_sgntr = adj_util.gen_clm_dt_sgntr(
clm=clm, init_clm_dt_sgntr=clm_dt_sgntr_per_sk.get(clm[f.CLM_DT_SGNTR_SK])
)
adj_clms_tbls[CLM_DT_SGNTR].append(clm_dt_sgntr)
clm_instnl = None
if clm_type_cd in INSTITUTIONAL_CLAIM_TYPES:
clm_instnl = adj_util.gen_clm_instnl(
gen_utils=gen_utils,
clm=clm,
init_clm_instnl=clm_instnl_per_fpk.get(four_part_key(clm)),
)
adj_clms_tbls[CLM_INSTNL].append(clm_instnl)
if clm_type_cd in PROFESSIONAL_CLAIM_TYPES:
clm_prfnls = [
adj_util.gen_clm_prfnl(
gen_utils=gen_utils,
clm=clm,
init_clm_prfnl=x,
)
for x in clm_prfnls_per_fpk.get(four_part_key(clm), [RowAdapter({})])
]
adj_clms_tbls[CLM_PRFNL].extend(clm_prfnls)
init_clm_lines = norm_clm_lines_per_clm_uniq_id.get(clm[f.CLM_UNIQ_ID]) or [
RowAdapter({}) for _ in range(random.randint(1, 15))
]
for idx, init_clm_line in enumerate(init_clm_lines, start=1):
if clm_type_cd in PHARMACY_CLM_TYPE_CDS:
continue
clm_line = adj_util.gen_clm_line(
gen_utils=gen_utils,
clm=clm,
clm_line_num=int(init_clm_line[f.CLM_LINE_NUM])
if init_clm_line.get(f.CLM_LINE_NUM)
else idx,
diagnoses=diagnoses,
init_clm_line=init_clm_line,
)
adj_clms_tbls[CLM_LINE].append(clm_line)
line_num = int(clm_line[f.CLM_LINE_NUM])
fpk = four_part_key(clm)
if clm_type_cd >= 10 and clm_type_cd <= 65:
clm_line_instnl = adj_util.gen_clm_line_instnl(
gen_utils=gen_utils,
clm=clm,
clm_line_num=line_num,
init_clm_line_instnl=match_line_num(
clm_lines=clm_line_instnls_per_fpk.get(fpk),
clm_line_num=line_num,
),
)
adj_clms_tbls[CLM_LINE_INSTNL].append(clm_line_instnl)
elif clm_type_cd >= 71 and clm_type_cd <= 82:
clm_line_prfnl = adj_util.gen_clm_line_prfnl(
gen_utils=gen_utils,
clm=clm,
clm_line_num=line_num,
init_clm_line_prfnl=match_line_num(
clm_lines=clm_line_prfnls_per_fpk.get(fpk),
clm_line_num=line_num,
),
)
adj_clms_tbls[CLM_LINE_PRFNL].append(clm_line_prfnl)
for k, v in adj_clms_tbls.items():
out_tables[k].extend(v)
all_adj_clms_tbls.append(adj_clms_tbls)
# Looks awful, but this is essentially equivalent to looking up each table's row(s)
# sequentially in the generation algorithm (as we do for adjudicated claims data above). We
# "pre-lookup" these row(s) so that a BENE_SK with no pac CLMs can have pac claims data
# generated for it from the freshly-generated adjudicated claims data above
# ("all_adj_clms_tbls")
pac_clms_tbls_from_file = [
{
CLM: as_list(file_pac_clm), # as_list ensures None values return empty list
CLM_FISS: as_list(clm_fiss_per_fpk.get(four_part_key(file_pac_clm))),