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alex-dzedaalex-dzeda
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BFD-4832: Ensure practitioner/org synthetic data persists (#3233)
1 parent 31db88d commit cadb8b0

7 files changed

Lines changed: 280 additions & 697 deletions

‎apps/bfd-model-idr/generate_prior_auth_sample.py‎

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Original file line numberDiff line numberDiff line change
@@ -26,6 +26,25 @@ def find_bene_sk(mbi_num: str) -> str:
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return "123456789"
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def ensure_provider_history_exists(npis: set[str]) -> None:
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poc_path = "sample-data/PRVDR_HSTRY_POC.csv"
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synth_path = "out/SYNTHETIC_PRVDR_HSTRY.csv"
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if not os.path.exists(poc_path) or not os.path.exists(synth_path):
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return
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df_poc = pd.read_csv(poc_path, dtype=str, keep_default_na=False)
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existing_npis = set(df_poc["PRVDR_SK"])
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missing_npis = {n for n in npis if n} - existing_npis
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if not missing_npis:
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return
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df_synth = pd.read_csv(synth_path, dtype=str, keep_default_na=False)
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matches = df_synth[df_synth["PRVDR_SK"].isin(missing_npis)]
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if not matches.empty:
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new_rows = matches[df_poc.columns].drop_duplicates(subset=["PRVDR_SK"])
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pd.concat([df_poc, new_rows], ignore_index=True).to_csv(poc_path, index=False)
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def main():
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parser = argparse.ArgumentParser(
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description="Generate a prior auth sample JSON from SYNTHETIC_PRAUC.csv based on UTN."
@@ -58,6 +77,11 @@ def main():
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matching_rows_df["CURRENT_SEGMENT"] = matching_rows_df["CURRENT_SEGMENT"].astype(int)
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matching_rows_df = matching_rows_df.sort_values(by="CURRENT_SEGMENT")
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# Collect provider NPIs and ensure they exist in sample-data/PRVDR_HSTRY_POC.csv
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npi_cols = [c for c in matching_rows_df.columns if "NPI" in c]
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npis = set(matching_rows_df[npi_cols].to_numpy().ravel())
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ensure_provider_history_exists(npis)
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# Get bene_sk
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bene_sk = find_bene_sk(target_mbi)
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‎apps/bfd-model-idr/maps/ExplanationOfBenefit-Base.map‎

Lines changed: 1 addition & 1 deletion
Original file line numberDiff line numberDiff line change
@@ -29,7 +29,7 @@ group createEOBBase(source src: ExplanationOfBenefitBase, target tgt: BFDEOB){
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//CodeSystem -> CLM_TYPE_CD
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src.CLM_TYPE_CD as typeCd -> tgtCC.coding = translate(typeCd,'https://bfd.cms.gov/MappingLanguage/Maps/ExplanationOfBenefit-Helper#CLM_TYPE_CD','coding') "translate code";
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src.CLM_TYPE_CD as typeCd -> tgtCC.coding = c('https://bluebutton.cms.gov/fhir/CodeSystem/CLM-TYPE-CD', typeCd) "Add claim type code";
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src.CLM_TYPE_CD as typeCd -> tgtCC.coding = c("https://bluebutton.cms.gov/fhir/CodeSystem/EOB-TYPE", typeCd) "Add eob-type coding";
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src.CLM_TYPE_CD as typeCd -> tgtCC.coding = translate(typeCd,'https://bfd.cms.gov/MappingLanguage/Maps/ExplanationOfBenefit-Helper#EOB_TYPE','coding') "Add eob-type coding";
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} "Create type";
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src -> tgt.subType = create('CodeableConcept') as tgtCC then {

‎apps/bfd-model-idr/maps/ExplanationOfBenefit-Helper.map‎

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Original file line numberDiff line numberDiff line change
@@ -297,6 +297,132 @@ conceptmap "subtype" {
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s:2041 == t:"inpatient"
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}
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conceptmap "EOB_TYPE" {
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prefix s = "https://hl7.org/fhir/string"
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prefix t = "https://bluebutton.cms.gov/fhir/CodeSystem/EOB-TYPE"
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s:1 == t:"PDE"
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s:2 == t:"PDE"
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s:3 == t:"PDE"
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s:4 == t:"PDE"
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s:10 == t:"HHA"
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s:1032 == t:"HHA"
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s:1033 == t:"HHA"
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s:1039 == t:"HHA"
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s:1042 == t:"HHA"
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s:1066 == t:"HHA"
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s:1092 == t:"HHA"
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s:2032 == t:"HHA"
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s:2033 == t:"HHA"
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s:2039 == t:"HHA"
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s:2042 == t:"HHA"
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s:2066 == t:"HHA"
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s:2092 == t:"HHA"
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s:20 == t:"SNF"
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s:30 == t:"SNF"
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s:1018 == t:"SNF"
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s:1021 == t:"SNF"
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s:2018 == t:"SNF"
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s:2021 == t:"SNF"
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s:40 == t:"OUTPATIENT"
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s:1000 == t:"OUTPATIENT"
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s:1012 == t:"OUTPATIENT"
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s:1013 == t:"OUTPATIENT"
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s:1014 == t:"OUTPATIENT"
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s:1022 == t:"OUTPATIENT"
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s:1023 == t:"OUTPATIENT"
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s:1028 == t:"OUTPATIENT"
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s:1034 == t:"OUTPATIENT"
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s:1043 == t:"OUTPATIENT"
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s:1049 == t:"OUTPATIENT"
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s:1065 == t:"OUTPATIENT"
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s:1071 == t:"OUTPATIENT"
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s:1072 == t:"OUTPATIENT"
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s:1073 == t:"OUTPATIENT"
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s:1074 == t:"OUTPATIENT"
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s:1075 == t:"OUTPATIENT"
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s:1076 == t:"OUTPATIENT"
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s:1077 == t:"OUTPATIENT"
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s:1078 == t:"OUTPATIENT"
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s:1079 == t:"OUTPATIENT"
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s:1083 == t:"OUTPATIENT"
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s:1084 == t:"OUTPATIENT"
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s:1085 == t:"OUTPATIENT"
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s:1086 == t:"OUTPATIENT"
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s:1087 == t:"OUTPATIENT"
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s:1088 == t:"OUTPATIENT"
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s:1089 == t:"OUTPATIENT"
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s:1093 == t:"OUTPATIENT"
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s:1094 == t:"OUTPATIENT"
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s:1095 == t:"OUTPATIENT"
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s:1096 == t:"OUTPATIENT"
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s:1097 == t:"OUTPATIENT"
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s:1099 == t:"OUTPATIENT"
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s:2000 == t:"OUTPATIENT"
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s:2012 == t:"OUTPATIENT"
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s:2013 == t:"OUTPATIENT"
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s:2014 == t:"OUTPATIENT"
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s:2022 == t:"OUTPATIENT"
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s:2023 == t:"OUTPATIENT"
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s:2028 == t:"OUTPATIENT"
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s:2034 == t:"OUTPATIENT"
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s:2043 == t:"OUTPATIENT"
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s:2049 == t:"OUTPATIENT"
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s:2065 == t:"OUTPATIENT"
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s:2071 == t:"OUTPATIENT"
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s:2072 == t:"OUTPATIENT"
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s:2073 == t:"OUTPATIENT"
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s:2074 == t:"OUTPATIENT"
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s:2075 == t:"OUTPATIENT"
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s:2076 == t:"OUTPATIENT"
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s:2077 == t:"OUTPATIENT"
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s:2078 == t:"OUTPATIENT"
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s:2079 == t:"OUTPATIENT"
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s:2083 == t:"OUTPATIENT"
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s:2084 == t:"OUTPATIENT"
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s:2085 == t:"OUTPATIENT"
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s:2086 == t:"OUTPATIENT"
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s:2087 == t:"OUTPATIENT"
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s:2088 == t:"OUTPATIENT"
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s:2089 == t:"OUTPATIENT"
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s:2093 == t:"OUTPATIENT"
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s:2094 == t:"OUTPATIENT"
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s:2095 == t:"OUTPATIENT"
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s:2096 == t:"OUTPATIENT"
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s:2097 == t:"OUTPATIENT"
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s:2099 == t:"OUTPATIENT"
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s:50 == t:"HOSPICE"
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s:1081 == t:"HOSPICE"
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s:1082 == t:"HOSPICE"
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s:1091 == t:"HOSPICE"
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s:1098 == t:"HOSPICE"
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s:1900 == t:"HOSPICE"
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s:2081 == t:"HOSPICE"
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s:2082 == t:"HOSPICE"
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s:2091 == t:"HOSPICE"
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s:2098 == t:"HOSPICE"
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s:2900 == t:"HOSPICE"
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s:60 == t:"INPATIENT"
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s:61 == t:"INPATIENT"
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s:62 == t:"INPATIENT"
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s:63 == t:"INPATIENT"
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s:64 == t:"INPATIENT"
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s:1011 == t:"INPATIENT"
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s:1041 == t:"INPATIENT"
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s:1069 == t:"INPATIENT"
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s:2011 == t:"INPATIENT"
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s:2041 == t:"INPATIENT"
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s:2069 == t:"INPATIENT"
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s:71 == t:"CARRIER"
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s:72 == t:"CARRIER"
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s:1700 == t:"CARRIER"
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s:2700 == t:"CARRIER"
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s:81 == t:"DME"
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s:82 == t:"DME"
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s:1800 == t:"DME"
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s:2800 == t:"DME"
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}
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conceptmap "CLM_SRC_ID" {
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prefix s = "https://hl7.org/fhir/string"
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prefix t = "https://hl7.org/fhir/string"

‎apps/bfd-model-idr/maps/ExplanationOfBenefit-Pharmacy.map‎

Lines changed: 1 addition & 1 deletion
Original file line numberDiff line numberDiff line change
@@ -24,7 +24,7 @@ group createEOBPharmacy(source src: ExplanationOfBenefitPharmacy, target tgt: BF
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src -> tgt.type = create('CodeableConcept') as tgtCC then {
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src.CLM_TYPE_CD as typeCd -> tgtCC.coding = translate(typeCd,'https://bfd.cms.gov/MappingLanguage/Maps/ExplanationOfBenefit-Helper#CLM_TYPE_CD','coding') "translate code";
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src.CLM_TYPE_CD as typeCd -> tgtCC.coding = c('https://bluebutton.cms.gov/fhir/CodeSystem/CLM-TYPE-CD', typeCd) "Add claim type code";
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src -> tgtCC.coding = c('https://bluebutton.cms.gov/fhir/CodeSystem/EOB-TYPE', 'PDE') "Add eob-type coding";
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src.CLM_TYPE_CD as typeCd -> tgtCC.coding = translate(typeCd,'https://bfd.cms.gov/MappingLanguage/Maps/ExplanationOfBenefit-Helper#EOB_TYPE','coding') "Add eob-type coding";
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} "Create type";
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src -> tgt.patient = create('Reference') as tgtReference then {

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