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BFD-4244: Add Part C / D / Dual Coverage mappings (#2774)
1 parent e41edef commit ee9aeff

23 files changed

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‎apps/bfd-model/bfd-model-idr/README.md‎

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@@ -66,6 +66,16 @@ uv run compile_resources.py \
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--test
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```
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Coverage (part C/D):
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```sh
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uv run compile_resources.py \
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-m maps/Coverage-Base.map \
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-i sample-data/Coverage-PartC-Sample.json \
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-o outputs/Coverage.json \
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-r https://bfd.cms.gov/MappingLanguage/Maps/Coverage-Base \
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--test
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```
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Pass along map with -m
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pass along the sample file with -i
@@ -92,6 +102,10 @@ SYNTHETIC_BENE_MDCR_ENTLMT.csv
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SYNTHETIC_BENE_MDCR_STUS.csv
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SYNTHETIC_BENE_TP.csv
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SYNTHETIC_BENE_XREF.csv
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SYNTHETIC_BENE_CMBND_DUAL_MDCR.csv
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SYNTHETIC_BENE_LIS.csv
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SYNTHETIC_BENE_MAPD_ENRLMT_RX.csv
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SYNTHETIC_BENE_MAPD_ENRLMT.csv
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The patient generator creates synthetic beneficiary data with realistic but SYNTHETIC MBIs, coverage information, and historical records. It can generate multiple MBI versions per beneficiary and handles beneficiary cross-references with kill credit switches.
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‎apps/bfd-model/bfd-model-idr/StructureDefinitions/Source/Coverage-Base.json‎

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@@ -69,9 +69,9 @@
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]
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},
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{
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"id": "Coverage-Base.DUAL_STUS_CD",
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"path": "Coverage-Base.DUAL_STUS_CD",
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"label": "Medicare/Medicaid Dual Status Code",
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"id": "Coverage-Base.BENE_DUAL_STUS_CD",
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"path": "Coverage-Base.BENE_DUAL_STUS_CD",
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"label": "Beneficiary Dual Status Code",
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"min": 0,
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"max": "1",
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"type": [
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"code": "string"
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}
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]
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},
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{
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"id": "Coverage-Base.BENE_MDCD_ELGBLTY_BGN_DT",
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"path": "Coverage-Base.BENE_MDCD_ELGBLTY_BGN_DT",
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"label": "Medicaid Eligibility Begin Date",
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"min": 0,
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"max": "1",
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"type": [
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{
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"code": "string"
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}
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]
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},
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{
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"id": "Coverage-Base.BENE_MDCD_ELGBLTY_END_DT",
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"path": "Coverage-Base.BENE_MDCD_ELGBLTY_END_DT",
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"label": "Medicaid Eligibility End Date",
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"min": 0,
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"max": "1",
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"type": [
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{
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"code": "string"
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}
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]
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},
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{
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"id": "Coverage-Base.GEO_USPS_STATE_CD",
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"path": "Coverage-Base.GEO_USPS_STATE_CD",
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"label": "Medicaid State Code",
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"min": 0,
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"max": "1",
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"type": [
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{
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"code": "string"
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}
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]
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},
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{
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"id": "Coverage-Base.BENE_ENRLMT_BGN_DT",
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"path": "Coverage-Base.BENE_ENRLMT_BGN_DT",
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"label": "Beneficiary Enrollment Begin Date",
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"min": 0,
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"max": "1",
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"type": [
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{
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"code": "string"
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}
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]
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},
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{
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"id": "Coverage-Base.BENE_ENRLMT_END_DT",
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"path": "Coverage-Base.BENE_ENRLMT_END_DT",
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"label": "Beneficiary Enrollment End Date",
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"min": 0,
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"max": "1",
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"type": [
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{
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"code": "string"
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}
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]
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},
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{
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"id": "Coverage-Base.BENE_CNTRCT_NUM",
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"path": "Coverage-Base.BENE_CNTRCT_NUM",
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"label": "Beneficiary Contract Number",
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"min": 0,
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"max": "1",
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"type": [
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{
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"code": "string"
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}
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]
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},
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{
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"id": "Coverage-Base.BENE_PBP_NUM",
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"path": "Coverage-Base.BENE_PBP_NUM",
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"label": "Beneficiary PBP Number",
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"min": 0,
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"max": "1",
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"type": [
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{
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"code": "string"
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}
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]
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},
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{
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"id": "Coverage-Base.BENE_CVRG_TYPE_CD",
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"path": "Coverage-Base.BENE_CVRG_TYPE_CD",
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"label": "Beneficiary Coverage Type Code",
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"min": 0,
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"max": "1",
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"type": [
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{
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"code": "string"
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}
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]
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},
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{
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"id": "Coverage-Base.CNTRCT_PBP_NAME",
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"path": "Coverage-Base.CNTRCT_PBP_NAME",
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"label": "Contract PBP Name",
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"min": 0,
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"max": "1",
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"type": [
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{
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"code": "string"
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}
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]
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},
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{
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"id": "Coverage-Base.CNTRCT_PLAN_CNTCT_TEL_NUM",
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"path": "Coverage-Base.CNTRCT_PLAN_CNTCT_TEL_NUM",
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"label": "Contract Plan Contact Telephone Number",
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"min": 0,
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"max": "1",
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"type": [
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{
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"code": "string"
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}
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]
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},
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{
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"id": "Coverage-Base.BENE_MAPD_ENRLMT_RX",
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"path": "Coverage-Base.BENE_MAPD_ENRLMT_RX",
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"label": "Beneficiary MAPD Enrollment RX",
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"min": 0,
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"max": "1",
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"type": [
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{
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"code": "string"
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}
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]
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},
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{
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"id": "Coverage-Base.BENE_PDP_ENRLMT_MMBR_ID_NUM",
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"path": "Coverage-Base.BENE_PDP_ENRLMT_MMBR_ID_NUM",
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"label": "Beneficiary PDP Enrollment Member ID Number",
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"min": 0,
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"max": "1",
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"type": [
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{
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"code": "string"
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}
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]
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},
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{
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"id": "Coverage-Base.BENE_PDP_ENRLMT_GRP_NUM",
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"path": "Coverage-Base.BENE_PDP_ENRLMT_GRP_NUM",
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"label": "Beneficiary PDP Enrollment Group Number",
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"min": 0,
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"max": "1",
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"type": [
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{
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"code": "string"
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}
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]
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},
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{
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"id": "Coverage-Base.BENE_PDP_ENRLMT_PRCSR_NUM",
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"path": "Coverage-Base.BENE_PDP_ENRLMT_PRCSR_NUM",
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"label": "Beneficiary PDP Enrollment Processor Number",
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"min": 0,
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"max": "1",
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"type": [
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{
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"code": "string"
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}
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]
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},
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{
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"id": "Coverage-Base.BENE_PDP_ENRLMT_BANK_ID_NUM",
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"path": "Coverage-Base.BENE_PDP_ENRLMT_BANK_ID_NUM",
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"label": "Beneficiary PDP Enrollment Bank ID Number",
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"min": 0,
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"max": "1",
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"type": [
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{
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"code": "string"
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}
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]
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},
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{
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"id": "Coverage-Base.BENE_LIS_EFCTV_CD",
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"path": "Coverage-Base.BENE_LIS_EFCTV_CD",
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"label": "Beneficiary LIS Effective Code",
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"min": 0,
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"max": "1",
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"type": [
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{
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"code": "string"
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}
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]
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},
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{
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"id": "Coverage-Base.BENE_LIS_COPMT_LVL_CD",
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"path": "Coverage-Base.BENE_LIS_COPMT_LVL_CD",
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"label": "Beneficiary LIS Copayment Level Code",
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"min": 0,
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"max": "1",
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"type": [
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{
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"code": "string"
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}
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]
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},
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{
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"id": "Coverage-Base.BENE_LIS_PTD_PRM_PCT",
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"path": "Coverage-Base.BENE_LIS_PTD_PRM_PCT",
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"label": "Beneficiary LIS Part D Premium Percentage",
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"min": 0,
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"max": "1",
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"type": [
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{
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"code": "string"
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}
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]
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}
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]
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}

‎apps/bfd-model/bfd-model-idr/dictionary-support-files/Coverage.yaml‎

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sourceView: V2_MDCR_BENE_MDCR_STUS_CD
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sourceColumn: BENE_DSBLD_STUS_ID
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nameOverride: Beneficiary Disabled Status Code
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- inputPath: Coverage-Base.BENE_DUAL_STUS_CD
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appliesTo:
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- DUAL
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fhirPath: Coverage.extension.where(url='https://bluebutton.cms.gov/fhir/StructureDefinition/BENE-DUAL-STUS-CD').value.code
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referenceTable: BENE_DUAL_STUS_CD
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sourceView: V2_MDCR_BENE_CMBND_DUAL_MDCR
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sourceColumn: BENE_DUAL_STUS_CD
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- inputPath: Coverage-Base.BENE_DUAL_TYPE_CD
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appliesTo:
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- DUAL
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fhirPath: Coverage.extension.where(url='https://bluebutton.cms.gov/fhir/StructureDefinition/BENE-DUAL-TYPE-CD').value.code
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referenceTable: BENE_DUAL_TYPE_CD
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sourceView: V2_MDCR_BENE_CMBND_DUAL_MDCR
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sourceColumn: BENE_DUAL_TYPE_CD
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- inputPath: Coverage-Base.GEO_USPS_STATE_CD
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appliesTo:
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- DUAL
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fhirPath: Coverage.extension.where(url='https://bluebutton.cms.gov/fhir/StructureDefinition/MEDICAID-STATE-CD').value.code
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sourceView: V2_MDCR_BENE_CMBND_DUAL_MDCR
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sourceColumn: GEO_USPS_STATE_CD
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- inputPath: Coverage-Base.BENE_MDCD_ELGBLTY_BGN_DT
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appliesTo:
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- DUAL
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fhirPath: Coverage.period.start
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sourceView: V2_MDCR_BENE_CMBND_DUAL_MDCR
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sourceColumn: BENE_MDCD_ELGBLTY_BGN_DT
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- inputPath: Coverage-Base.BENE_MDCD_ELGBLTY_END_DT
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appliesTo:
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- DUAL
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fhirPath: Coverage.period.end
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sourceView: V2_MDCR_BENE_CMBND_DUAL_MDCR
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sourceColumn: BENE_MDCD_ELGBLTY_END_DT
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- inputPath: Coverage-Base.BENE_ENRLMT_BGN_DT
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appliesTo:
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- PartC
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- PartD
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fhirPath: Coverage.period.start
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sourceView: V2_MDCR_BENE_MAPD_ENRLMT
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sourceColumn: BENE_ENRLMT_BGN_DT
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- inputPath: Coverage-Base.BENE_ENRLMT_END_DT
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appliesTo:
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- PartC
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- PartD
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fhirPath: Coverage.period.end
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sourceView: V2_MDCR_BENE_MAPD_ENRLMT
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sourceColumn: BENE_ENRLMT_END_DT
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- inputPath: Coverage-Base.BENE_CNTRCT_NUM
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appliesTo:
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- PartC
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- PartD
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fhirPath: Coverage.extension.where(url='https://bluebutton.cms.gov/fhir/StructureDefinition/BENE-CNTRCT-NUM').value
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sourceView: V2_MDCR_BENE_MAPD_ENRLMT
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sourceColumn: BENE_CNTRCT_NUM
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- inputPath: Coverage-Base.BENE_PBP_NUM
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appliesTo:
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- PartC
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- PartD
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fhirPath: Coverage.extension.where(url='https://bluebutton.cms.gov/fhir/StructureDefinition/BENE-PBP-NUM').value
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sourceView: V2_MDCR_BENE_MAPD_ENRLMT
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sourceColumn: BENE_PBP_NUM
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- inputPath: Coverage-Base.BENE_CVRG_TYPE_CD
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appliesTo:
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- PartC
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- PartD
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fhirPath: Coverage.extension.where(url='https://bluebutton.cms.gov/fhir/StructureDefinition/BENE-CVRG-TYPE-CD').value.code
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referenceTable: BENE_CVRG_TYPE_CD
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sourceView: V2_MDCR_BENE_MAPD_ENRLMT
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sourceColumn: BENE_CVRG_TYPE_CD
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- inputPath: Coverage-Base.CNTRCT_PBP_NAME
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appliesTo:
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- PartC
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- PartD
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fhirPath: Coverage.contained.where(resourceType='Organization').name
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sourceView: V2_MDCR_CNTRCT_PBP_NUM
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sourceColumn: CNTRCT_PBP_NAME
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- inputPath: Coverage-Base.CNTRCT_PLAN_CNTCT_TEL_NUM
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appliesTo:
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- PartC
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- PartD
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fhirPath: Coverage.contained.where(resourceType='Organization').contact.telecom.where(system='phone').value
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sourceView: V2_MDCR_CNTRCT_PBP_CNTCT
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sourceColumn: CNTRCT_PLAN_CNTCT_TEL_NUM
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- inputPath: Coverage-Base.BENE_PDP_ENRLMT_MMBR_ID_NUM
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appliesTo:
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- PartD
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fhirPath: Coverage.class.where(type.coding.code='rxid').value
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sourceView: V2_MDCR_BENE_MAPD_ENRLMT_RX
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sourceColumn: BENE_PDP_ENRLMT_MMBR_ID_NUM
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- inputPath: Coverage-Base.BENE_PDP_ENRLMT_GRP_NUM
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appliesTo:
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- PartD
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fhirPath: Coverage.class.where(type.coding.code='rxgroup').value
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sourceView: V2_MDCR_BENE_MAPD_ENRLMT_RX
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sourceColumn: BENE_PDP_ENRLMT_GRP_NUM
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- inputPath: Coverage-Base.BENE_PDP_ENRLMT_PRCSR_NUM
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appliesTo:
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- PartD
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fhirPath: Coverage.class.where(type.coding.code='rxpcn').value
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sourceView: V2_MDCR_BENE_MAPD_ENRLMT_RX
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sourceColumn: BENE_PDP_ENRLMT_PRCSR_NUM
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- inputPath: Coverage-Base.BENE_PDP_ENRLMT_BANK_ID_NUM
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appliesTo:
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- PartD
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fhirPath: Coverage.class.where(type.coding.code='rxbin').value
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sourceView: V2_MDCR_BENE_MAPD_ENRLMT_RX
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sourceColumn: BENE_PDP_ENRLMT_BANK_ID_NUM
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- inputPath: Coverage-Base.BENE_LIS_EFCTV_CD
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appliesTo:
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- PartD
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fhirPath: Coverage.extension.where(url='https://bluebutton.cms.gov/fhir/StructureDefinition/BENE-LIS-EFCTV-CD').value.code
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sourceView: V2_MDCR_BENE_LIS
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sourceColumn: BENE_LIS_EFCTV_CD
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- inputPath: Coverage-Base.BENE_LIS_COPMT_LVL_CD
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appliesTo:
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- PartD
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fhirPath: Coverage.extension.where(url='https://bluebutton.cms.gov/fhir/StructureDefinition/BENE-LIS-COPMT-LVL-CD').value.code
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sourceView: V2_MDCR_BENE_LIS
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sourceColumn: BENE_LIS_COPMT_LVL_CD
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- inputPath: Coverage-Base.BENE_LIS_PTD_PRM_PCT
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appliesTo:
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- PartD
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fhirPath: Coverage.extension.where(url='https://bluebutton.cms.gov/fhir/StructureDefinition/BENE-LIS-PTD-PRM-PCT').value
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sourceView: V2_MDCR_BENE_LIS
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sourceColumn: BENE_LIS_PTD_PRM_PCT

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