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BFD-4244: Add Part C / D / Dual Coverage mappings #2774

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Merged
alex-dzeda merged 4 commits into from
Aug 15, 2025
Merged

BFD-4244: Add Part C / D / Dual Coverage mappings #2774

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176f096
incorporate part c/d/dual mappings
alex-dzeda Aug 7, 2025
34b33f6
update sample data generation and mappings
alex-dzeda Aug 7, 2025
3670d2d
update readme
alex-dzeda Aug 7, 2025
b7da379
update map to add member num
alex-dzeda Aug 7, 2025
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14 changes: 14 additions & 0 deletions apps/bfd-model/bfd-model-idr/README.md
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Original file line number Diff line number Diff line change
Expand Up @@ -66,6 +66,16 @@ uv run compile_resources.py \
--test
```

Coverage (part C/D):
```sh
uv run compile_resources.py \
-m maps/Coverage-Base.map \
-i sample-data/Coverage-PartC-Sample.json \
-o outputs/Coverage.json \
-r https://bfd.cms.gov/MappingLanguage/Maps/Coverage-Base \
--test
```


Pass along map with -m
pass along the sample file with -i
Expand All @@ -92,6 +102,10 @@ SYNTHETIC_BENE_MDCR_ENTLMT.csv
SYNTHETIC_BENE_MDCR_STUS.csv
SYNTHETIC_BENE_TP.csv
SYNTHETIC_BENE_XREF.csv
SYNTHETIC_BENE_CMBND_DUAL_MDCR.csv
SYNTHETIC_BENE_LIS.csv
SYNTHETIC_BENE_MAPD_ENRLMT_RX.csv
SYNTHETIC_BENE_MAPD_ENRLMT.csv

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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222 changes: 219 additions & 3 deletions apps/bfd-model/bfd-model-idr/StructureDefinitions/Source/Coverage-Base.json
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Expand Up @@ -69,9 +69,9 @@
]
},
{
"id": "Coverage-Base.DUAL_STUS_CD",
"path": "Coverage-Base.DUAL_STUS_CD",
"label": "Medicare/Medicaid Dual Status Code",
"id": "Coverage-Base.BENE_DUAL_STUS_CD",
"path": "Coverage-Base.BENE_DUAL_STUS_CD",
"label": "Beneficiary Dual Status Code",
"min": 0,
"max": "1",
"type": [
Expand Down Expand Up @@ -188,6 +188,222 @@
"code": "string"
}
]
},
{
"id": "Coverage-Base.BENE_MDCD_ELGBLTY_BGN_DT",
"path": "Coverage-Base.BENE_MDCD_ELGBLTY_BGN_DT",
"label": "Medicaid Eligibility Begin Date",
"min": 0,
"max": "1",
"type": [
{
"code": "string"
}
]
},
{
"id": "Coverage-Base.BENE_MDCD_ELGBLTY_END_DT",
"path": "Coverage-Base.BENE_MDCD_ELGBLTY_END_DT",
"label": "Medicaid Eligibility End Date",
"min": 0,
"max": "1",
"type": [
{
"code": "string"
}
]
},
{
"id": "Coverage-Base.GEO_USPS_STATE_CD",
"path": "Coverage-Base.GEO_USPS_STATE_CD",
"label": "Medicaid State Code",
"min": 0,
"max": "1",
"type": [
{
"code": "string"
}
]
},
{
"id": "Coverage-Base.BENE_ENRLMT_BGN_DT",
"path": "Coverage-Base.BENE_ENRLMT_BGN_DT",
"label": "Beneficiary Enrollment Begin Date",
"min": 0,
"max": "1",
"type": [
{
"code": "string"
}
]
},
{
"id": "Coverage-Base.BENE_ENRLMT_END_DT",
"path": "Coverage-Base.BENE_ENRLMT_END_DT",
"label": "Beneficiary Enrollment End Date",
"min": 0,
"max": "1",
"type": [
{
"code": "string"
}
]
},
{
"id": "Coverage-Base.BENE_CNTRCT_NUM",
"path": "Coverage-Base.BENE_CNTRCT_NUM",
"label": "Beneficiary Contract Number",
"min": 0,
"max": "1",
"type": [
{
"code": "string"
}
]
},
{
"id": "Coverage-Base.BENE_PBP_NUM",
"path": "Coverage-Base.BENE_PBP_NUM",
"label": "Beneficiary PBP Number",
"min": 0,
"max": "1",
"type": [
{
"code": "string"
}
]
},
{
"id": "Coverage-Base.BENE_CVRG_TYPE_CD",
"path": "Coverage-Base.BENE_CVRG_TYPE_CD",
"label": "Beneficiary Coverage Type Code",
"min": 0,
"max": "1",
"type": [
{
"code": "string"
}
]
},
{
"id": "Coverage-Base.CNTRCT_PBP_NAME",
"path": "Coverage-Base.CNTRCT_PBP_NAME",
"label": "Contract PBP Name",
"min": 0,
"max": "1",
"type": [
{
"code": "string"
}
]
},
{
"id": "Coverage-Base.CNTRCT_PLAN_CNTCT_TEL_NUM",
"path": "Coverage-Base.CNTRCT_PLAN_CNTCT_TEL_NUM",
"label": "Contract Plan Contact Telephone Number",
"min": 0,
"max": "1",
"type": [
{
"code": "string"
}
]
},
{
"id": "Coverage-Base.BENE_MAPD_ENRLMT_RX",
"path": "Coverage-Base.BENE_MAPD_ENRLMT_RX",
"label": "Beneficiary MAPD Enrollment RX",
"min": 0,
"max": "1",
"type": [
{
"code": "string"
}
]
},
{
"id": "Coverage-Base.BENE_PDP_ENRLMT_MMBR_ID_NUM",
"path": "Coverage-Base.BENE_PDP_ENRLMT_MMBR_ID_NUM",
"label": "Beneficiary PDP Enrollment Member ID Number",
"min": 0,
"max": "1",
"type": [
{
"code": "string"
}
]
},
{
"id": "Coverage-Base.BENE_PDP_ENRLMT_GRP_NUM",
"path": "Coverage-Base.BENE_PDP_ENRLMT_GRP_NUM",
"label": "Beneficiary PDP Enrollment Group Number",
"min": 0,
"max": "1",
"type": [
{
"code": "string"
}
]
},
{
"id": "Coverage-Base.BENE_PDP_ENRLMT_PRCSR_NUM",
"path": "Coverage-Base.BENE_PDP_ENRLMT_PRCSR_NUM",
"label": "Beneficiary PDP Enrollment Processor Number",
"min": 0,
"max": "1",
"type": [
{
"code": "string"
}
]
},
{
"id": "Coverage-Base.BENE_PDP_ENRLMT_BANK_ID_NUM",
"path": "Coverage-Base.BENE_PDP_ENRLMT_BANK_ID_NUM",
"label": "Beneficiary PDP Enrollment Bank ID Number",
"min": 0,
"max": "1",
"type": [
{
"code": "string"
}
]
},
{
"id": "Coverage-Base.BENE_LIS_EFCTV_CD",
"path": "Coverage-Base.BENE_LIS_EFCTV_CD",
"label": "Beneficiary LIS Effective Code",
"min": 0,
"max": "1",
"type": [
{
"code": "string"
}
]
},
{
"id": "Coverage-Base.BENE_LIS_COPMT_LVL_CD",
"path": "Coverage-Base.BENE_LIS_COPMT_LVL_CD",
"label": "Beneficiary LIS Copayment Level Code",
"min": 0,
"max": "1",
"type": [
{
"code": "string"
}
]
},
{
"id": "Coverage-Base.BENE_LIS_PTD_PRM_PCT",
"path": "Coverage-Base.BENE_LIS_PTD_PRM_PCT",
"label": "Beneficiary LIS Part D Premium Percentage",
"min": 0,
"max": "1",
"type": [
{
"code": "string"
}
]
}
]
}
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124 changes: 124 additions & 0 deletions apps/bfd-model/bfd-model-idr/dictionary-support-files/Coverage.yaml
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Expand Up @@ -97,3 +97,127 @@
sourceView: V2_MDCR_BENE_MDCR_STUS_CD
sourceColumn: BENE_DSBLD_STUS_ID
nameOverride: Beneficiary Disabled Status Code
- inputPath: Coverage-Base.BENE_DUAL_STUS_CD
appliesTo:
- DUAL
fhirPath: Coverage.extension.where(url='https://bluebutton.cms.gov/fhir/StructureDefinition/BENE-DUAL-STUS-CD').value.code
referenceTable: BENE_DUAL_STUS_CD
sourceView: V2_MDCR_BENE_CMBND_DUAL_MDCR
sourceColumn: BENE_DUAL_STUS_CD
- inputPath: Coverage-Base.BENE_DUAL_TYPE_CD
appliesTo:
- DUAL
fhirPath: Coverage.extension.where(url='https://bluebutton.cms.gov/fhir/StructureDefinition/BENE-DUAL-TYPE-CD').value.code
referenceTable: BENE_DUAL_TYPE_CD
sourceView: V2_MDCR_BENE_CMBND_DUAL_MDCR
sourceColumn: BENE_DUAL_TYPE_CD
- inputPath: Coverage-Base.GEO_USPS_STATE_CD
appliesTo:
- DUAL
fhirPath: Coverage.extension.where(url='https://bluebutton.cms.gov/fhir/StructureDefinition/MEDICAID-STATE-CD').value.code
sourceView: V2_MDCR_BENE_CMBND_DUAL_MDCR
sourceColumn: GEO_USPS_STATE_CD
- inputPath: Coverage-Base.BENE_MDCD_ELGBLTY_BGN_DT
appliesTo:
- DUAL
fhirPath: Coverage.period.start
sourceView: V2_MDCR_BENE_CMBND_DUAL_MDCR
sourceColumn: BENE_MDCD_ELGBLTY_BGN_DT
- inputPath: Coverage-Base.BENE_MDCD_ELGBLTY_END_DT
appliesTo:
- DUAL
fhirPath: Coverage.period.end
sourceView: V2_MDCR_BENE_CMBND_DUAL_MDCR
sourceColumn: BENE_MDCD_ELGBLTY_END_DT
- inputPath: Coverage-Base.BENE_ENRLMT_BGN_DT
appliesTo:
- PartC
- PartD
fhirPath: Coverage.period.start
sourceView: V2_MDCR_BENE_MAPD_ENRLMT
sourceColumn: BENE_ENRLMT_BGN_DT
- inputPath: Coverage-Base.BENE_ENRLMT_END_DT
appliesTo:
- PartC
- PartD
fhirPath: Coverage.period.end
sourceView: V2_MDCR_BENE_MAPD_ENRLMT
sourceColumn: BENE_ENRLMT_END_DT
- inputPath: Coverage-Base.BENE_CNTRCT_NUM
appliesTo:
- PartC
- PartD
fhirPath: Coverage.extension.where(url='https://bluebutton.cms.gov/fhir/StructureDefinition/BENE-CNTRCT-NUM').value
sourceView: V2_MDCR_BENE_MAPD_ENRLMT
sourceColumn: BENE_CNTRCT_NUM
- inputPath: Coverage-Base.BENE_PBP_NUM
appliesTo:
- PartC
- PartD
fhirPath: Coverage.extension.where(url='https://bluebutton.cms.gov/fhir/StructureDefinition/BENE-PBP-NUM').value
sourceView: V2_MDCR_BENE_MAPD_ENRLMT
sourceColumn: BENE_PBP_NUM
- inputPath: Coverage-Base.BENE_CVRG_TYPE_CD
appliesTo:
- PartC
- PartD
fhirPath: Coverage.extension.where(url='https://bluebutton.cms.gov/fhir/StructureDefinition/BENE-CVRG-TYPE-CD').value.code
referenceTable: BENE_CVRG_TYPE_CD
sourceView: V2_MDCR_BENE_MAPD_ENRLMT
sourceColumn: BENE_CVRG_TYPE_CD
- inputPath: Coverage-Base.CNTRCT_PBP_NAME
appliesTo:
- PartC
- PartD
fhirPath: Coverage.contained.where(resourceType='Organization').name
sourceView: V2_MDCR_CNTRCT_PBP_NUM
sourceColumn: CNTRCT_PBP_NAME
- inputPath: Coverage-Base.CNTRCT_PLAN_CNTCT_TEL_NUM
appliesTo:
- PartC
- PartD
fhirPath: Coverage.contained.where(resourceType='Organization').contact.telecom.where(system='phone').value
sourceView: V2_MDCR_CNTRCT_PBP_CNTCT
sourceColumn: CNTRCT_PLAN_CNTCT_TEL_NUM
- inputPath: Coverage-Base.BENE_PDP_ENRLMT_MMBR_ID_NUM
appliesTo:
- PartD
fhirPath: Coverage.class.where(type.coding.code='rxid').value
sourceView: V2_MDCR_BENE_MAPD_ENRLMT_RX
sourceColumn: BENE_PDP_ENRLMT_MMBR_ID_NUM
- inputPath: Coverage-Base.BENE_PDP_ENRLMT_GRP_NUM
appliesTo:
- PartD
fhirPath: Coverage.class.where(type.coding.code='rxgroup').value
sourceView: V2_MDCR_BENE_MAPD_ENRLMT_RX
sourceColumn: BENE_PDP_ENRLMT_GRP_NUM
- inputPath: Coverage-Base.BENE_PDP_ENRLMT_PRCSR_NUM
appliesTo:
- PartD
fhirPath: Coverage.class.where(type.coding.code='rxpcn').value
sourceView: V2_MDCR_BENE_MAPD_ENRLMT_RX
sourceColumn: BENE_PDP_ENRLMT_PRCSR_NUM
- inputPath: Coverage-Base.BENE_PDP_ENRLMT_BANK_ID_NUM
appliesTo:
- PartD
fhirPath: Coverage.class.where(type.coding.code='rxbin').value
sourceView: V2_MDCR_BENE_MAPD_ENRLMT_RX
sourceColumn: BENE_PDP_ENRLMT_BANK_ID_NUM
- inputPath: Coverage-Base.BENE_LIS_EFCTV_CD
appliesTo:
- PartD
fhirPath: Coverage.extension.where(url='https://bluebutton.cms.gov/fhir/StructureDefinition/BENE-LIS-EFCTV-CD').value.code
sourceView: V2_MDCR_BENE_LIS
sourceColumn: BENE_LIS_EFCTV_CD
- inputPath: Coverage-Base.BENE_LIS_COPMT_LVL_CD
appliesTo:
- PartD
fhirPath: Coverage.extension.where(url='https://bluebutton.cms.gov/fhir/StructureDefinition/BENE-LIS-COPMT-LVL-CD').value.code
sourceView: V2_MDCR_BENE_LIS
sourceColumn: BENE_LIS_COPMT_LVL_CD
- inputPath: Coverage-Base.BENE_LIS_PTD_PRM_PCT
appliesTo:
- PartD
fhirPath: Coverage.extension.where(url='https://bluebutton.cms.gov/fhir/StructureDefinition/BENE-LIS-PTD-PRM-PCT').value
sourceView: V2_MDCR_BENE_LIS
sourceColumn: BENE_LIS_PTD_PRM_PCT
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