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Merged
saewitz merged 5 commits into from
Dec 4, 2025
Merged

Insurance otr 1373 #5255

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6afd52e
on payment screen, add fee schedule information
saewitz Nov 25, 2025
61cb72d
update comments
saewitz Nov 25, 2025
61f65f3
Merge branch 'insurance-otr-1373' of https://github.com/masslight/ott…
saewitz Dec 2, 2025
ad85f4d
Merge branch 'develop' into insurance-otr-1373
saewitz Dec 2, 2025
5748f1f
Merge branch 'develop' into insurance-otr-1373
saewitz Dec 3, 2025
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94 changes: 94 additions & 0 deletions apps/ehr/src/components/PatientPaymentsList.tsx
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Original file line number Diff line number Diff line change
Expand Up @@ -3,6 +3,8 @@ import {
Box,
Button,
capitalize,
CircularProgress,
Container,
FormControlLabel,
Paper,
Radio,
Expand All @@ -22,13 +24,16 @@ import { DocumentReference, Encounter, Patient } from 'fhir/r4b';
import { DateTime } from 'luxon';
import { enqueueSnackbar } from 'notistack';
import { FC, Fragment, ReactElement, useEffect, useState } from 'react';
import { useOystehrAPIClient } from 'src/features/visits/shared/hooks/useOystehrAPIClient';
import { useApiClients } from 'src/hooks/useAppClients';
import { useGetEncounter } from 'src/hooks/useEncounter';
import { useGetPatientAccount, useGetPatientCoverages } from 'src/hooks/useGetPatient';
import { useGetPatientPaymentsList } from 'src/hooks/useGetPatientPaymentsList';
import {
APIError,
APIErrorCode,
CashOrCardPayment,
FHIR_EXTENSION,
getPaymentVariantFromEncounter,
isApiError,
PatientPaymentDTO,
Expand Down Expand Up @@ -68,6 +73,7 @@ export default function PatientPaymentList({
responsibleParty,
}: PaymentListProps): ReactElement {
const { oystehr, oystehrZambda } = useApiClients();
const apiClient = useOystehrAPIClient();
const theme = useTheme();
const [paymentDialogOpen, setPaymentDialogOpen] = useState(false);
const [sendReceiptByEmailDialogOpen, setSendReceiptByEmailDialogOpen] = useState(false);
Expand All @@ -88,6 +94,16 @@ export default function PatientPaymentList({
encounterId,
disabled: !encounterId || !patient?.id,
});
const { data: insuranceData } = useGetPatientAccount({
apiClient,
patientId: patient?.id ?? null,
});

const { data: insuranceCoverages } = useGetPatientCoverages({
apiClient,
patientId: patient?.id ?? null,
});

const payments = paymentData?.payments ?? []; // Replace with actual payments when available

const stripeCustomerDeletedError =
Expand Down Expand Up @@ -233,6 +249,26 @@ export default function PatientPaymentList({
return null;
})();

const insurance = insuranceCoverages?.coverages?.primary?.identifier?.find(
(temp) => temp.type?.coding?.find((temp) => temp.code === 'MB')
)?.assigner;
const insuranceOrganization = insuranceCoverages?.insuranceOrgs?.find(
(organization) => organization.id === insurance?.reference?.replace('Organization/', '')
);
const insuranceName = insuranceOrganization?.name;
const insuranceNotes = insuranceOrganization?.extension?.find(
(extensionTemp) => extensionTemp.url === FHIR_EXTENSION.InsurancePlan.notes.url
)?.valueString;

const copayAmount = insuranceData?.coverageChecks?.[0]?.copay?.find(
(copay) =>
copay.code === 'UC' && copay.coverageCode === 'B' && copay.levelCode === 'IND' && copay.periodCode === '27'
)?.amountInUSD;
const remainingDeductibleAmount = insuranceData?.coverageChecks?.[0]?.deductible?.find(
(copay) =>
copay.code === '30' && copay.coverageCode === 'C' && copay.levelCode === 'IND' && copay.periodCode === '29'
)?.amountInUSD;

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@ValeriyDyachenko ValeriyDyachenko Nov 28, 2025

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Let's move this to a helper function. It can use useGetPatientAccount and useGetPatientCoverages under the hood to provide a useful abstraction and to avoid using low-level logic in high-level components.

return (
<Paper
sx={{
Expand Down Expand Up @@ -269,6 +305,64 @@ export default function PatientPaymentList({
label="Self-pay"
/>
</RadioGroup>
<Container
style={{
backgroundColor: theme.palette.background.default,
borderRadius: 4,
paddingTop: 10,
paddingBottom: 10,
}}
>
<Typography variant="h5" sx={{ color: theme.palette.primary.dark }}>
Payment Considerations
</Typography>
{insuranceData ? (
<>
<Table style={{ tableLayout: 'fixed' }}>
<TableBody>
<TableRow>
<TableCell style={{ fontSize: '16px' }}>Insurance Carrier</TableCell>
<TableCell style={{ fontSize: '16px', fontWeight: 'bold', textAlign: 'right' }}>
{insuranceName ? insuranceName : 'Unknown'}
</TableCell>
</TableRow>
<TableRow>
<TableCell style={{ fontSize: '16px' }}>Copay</TableCell>
<TableCell style={{ fontSize: '16px', fontWeight: 'bold', textAlign: 'right' }}>
{copayAmount ? `$${copayAmount}` : 'Unknown'}
</TableCell>
</TableRow>
<TableRow sx={{ '&:last-child td': { borderBottom: 'none' } }}>
<TableCell style={{ fontSize: '16px' }}>Remaining Deductible</TableCell>
<TableCell style={{ fontSize: '16px', fontWeight: 'bold', textAlign: 'right' }}>
{remainingDeductibleAmount ? `$${remainingDeductibleAmount}` : 'Unknown'}
</TableCell>
</TableRow>
</TableBody>
</Table>
{insuranceNotes && (
<Container
style={{
backgroundColor: '#2169F514',
borderRadius: 4,
marginTop: 5,
paddingTop: 10,
paddingBottom: 10,
}}
>
<Typography variant="body1" sx={{ color: theme.palette.primary.dark, fontWeight: 'bold' }}>
Notes
</Typography>
<Typography variant="body1" style={{ whiteSpace: 'pre' }}>
{insuranceNotes}
</Typography>
</Container>
)}
</>
) : (
<CircularProgress />
)}
</Container>
{stripeCustomerDeletedError && <StripeErrorAlert />}
{!stripeCustomerDeletedError && (
<>
Expand Down
20 changes: 20 additions & 0 deletions apps/ehr/src/features/visits/telemed/components/telemed-admin/EditInsurance.tsx
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Original file line number Diff line number Diff line change
Expand Up @@ -52,6 +52,7 @@ export type InsuranceData = InsuranceSettingsBooleans & {
active: Organization['active'];
identifier?: Identifier[];
address?: Address[];
notes?: string;
};

type InsuranceForm = Omit<InsuranceData, 'id' | 'active'>;
Expand Down Expand Up @@ -106,6 +107,7 @@ export default function EditInsurance(): JSX.Element {
reset({
payor: insuranceDetails,
displayName: alias || insuranceDetails.name,
notes: insuranceDetails.extension?.find((ext) => ext.url === FHIR_EXTENSION.InsurancePlan.notes.url)?.valueString,
// TODO: uncomment when insurance settings will be applied to patient paperwork step with filling insurance data
// ...settingsMap,
});
Expand All @@ -129,6 +131,7 @@ export default function EditInsurance(): JSX.Element {
const submitSnackbarText = isNew
? `${data.displayName} was successfully created`
: `${data.displayName} was updated successfully`;

try {
const mutateResp = await mutateInsurance(data);
enqueueSnackbar(`${submitSnackbarText}`, {
Expand Down Expand Up @@ -262,6 +265,23 @@ export default function EditInsurance(): JSX.Element {
)}
/>

<Controller
name="notes"
control={control}
render={({ field: { onChange, value } }) => (
<TextField
id="notes"
label="Notes"
value={value || ''}
onChange={onChange}
sx={{ marginTop: 1, marginBottom: 1, width: '100%' }}
multiline
minRows={2}
margin="dense"
/>
)}
/>

{/* TODO: uncomment when insurance settings will be applied to patient paperwork step with filling insurance data */}
{/* <Controller
name={ENABLE_ELIGIBILITY_CHECK_KEY}
Expand Down
24 changes: 24 additions & 0 deletions apps/ehr/src/features/visits/telemed/components/telemed-admin/telemed-admin.queries.tsx
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Original file line number Diff line number Diff line change
Expand Up @@ -151,6 +151,30 @@ export const useInsuranceMutation = (
identifier: insurancePlan?.identifier || data?.identifier,
address: insurancePlan?.address || data?.address,
};

if (data.notes) {
const noteExt = {
url: FHIR_EXTENSION.InsurancePlan.notes.url,
valueString: data.notes,
};

const existingExtIndex = resourceExtensions.findIndex(
(ext) => ext.url === FHIR_EXTENSION.InsurancePlan.notes.url
);
if (existingExtIndex >= 0) {
resourceExtensions[existingExtIndex] = noteExt;
} else {
resourceExtensions.push(noteExt);
}
} else {
const existingExtIndex = resourceExtensions.findIndex(
(ext) => ext.url === FHIR_EXTENSION.InsurancePlan.notes.url
);
if (existingExtIndex >= 0) {
resourceExtensions.splice(existingExtIndex, 1);
}
}

// TODO: uncomment when insurance settings will be applied to patient paperwork step with filling insurance data
// if (!requirementSettingsExistingExtensions) {
// resourceExtensions?.push({
Expand Down
19 changes: 8 additions & 11 deletions packages/utils/lib/fhir/billing.ts
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Original file line number Diff line number Diff line change
Expand Up @@ -121,11 +121,15 @@ export const parseCoverageEligibilityResponse = (
(e) => e.url === 'https://extensions.fhir.oystehr.com/raw-response'
)?.valueString;
let copay: PatientPaymentBenefit[] | undefined;
let deductible: PatientPaymentBenefit[] | undefined;
if (fullBenefitJSON) {
try {
// cSpell:disable-next eligibility
const benefitList = JSON.parse(fullBenefitJSON)?.elig?.benefit;
copay = parseObjectsToCopayBenefits(benefitList);
copay = parseObjectsToCopayBenefits(benefitList).filter(
(benefit) => benefit.coverageCode === 'A' || benefit.coverageCode === 'B'
);
deductible = parseObjectsToCopayBenefits(benefitList).filter((benefit) => benefit.coverageCode === 'C');
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@ValeriyDyachenko ValeriyDyachenko Nov 28, 2025

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We can use a const to calculate parseObjectsToCopayBenefits(benefitList) once, and use an IIFE or reduce to filter data within one iteration.

} catch (error) {
console.error('Error parsing fullBenefitJSON', error);
}
Expand All @@ -134,6 +138,7 @@ export const parseCoverageEligibilityResponse = (
status: InsuranceEligibilityCheckStatus.eligibilityConfirmed,
dateISO,
copay,
deductible,
errors: coverageResponse.error,
};
} else {
Expand All @@ -154,17 +159,9 @@ export const parseCoverageEligibilityResponse = (
};

export const parseObjectsToCopayBenefits = (input: any[]): PatientPaymentBenefit[] => {
const filteredInputs = input.filter((item) => {
return (
item &&
typeof item === 'object' &&
(item['benefit_coverage_code'] === 'B' || item['benefit_coverage_code'] === 'A')
);
});

return filteredInputs
return input
.map((item) => {
const benefitCoverageCode = item['benefit_coverage_code'] as 'A' | 'B';
const benefitCoverageCode = item['benefit_coverage_code'] as 'A' | 'B' | 'C';
const CP: PatientPaymentBenefit = {
amountInUSD: item['benefit_amount'] ?? 0,
percentage: item['benefit_percent'] ?? 0,
Expand Down
3 changes: 3 additions & 0 deletions packages/utils/lib/fhir/constants.ts
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Expand Up @@ -123,6 +123,9 @@ export const FHIR_EXTENSION = {
insuranceRequirements: {
url: `${PUBLIC_EXTENSION_BASE_URL}/insurance-requirements`,
},
notes: {
url: `${PRIVATE_EXTENSION_BASE_URL}/notes`,
},
},
QuestionnaireResponse: {
ipAddress: {
Expand Down
10 changes: 7 additions & 3 deletions packages/utils/lib/types/data/telemed/eligibility.types.ts
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Expand Up @@ -188,17 +188,21 @@ export interface CoverageBenefitInfo {

inNetwork: boolean;
}
export interface CoinsuranceBenefit extends CoverageBenefitInfo {
coverageCode: 'A';
}
export interface CopayBenefit extends CoverageBenefitInfo {
coverageCode: 'B';
}
export interface CoinsuranceBenefit extends CoverageBenefitInfo {
coverageCode: 'A';
export interface DeductibleBenefit extends CoverageBenefitInfo {
coverageCode: 'C';
}
export type PatientPaymentBenefit = CopayBenefit | CoinsuranceBenefit;
export type PatientPaymentBenefit = CopayBenefit | CoinsuranceBenefit | DeductibleBenefit;
export interface InsuranceCheckStatusWithDate {
status: InsuranceEligibilityCheckStatus;
dateISO: string;
copay?: PatientPaymentBenefit[];
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@imbenham imbenham Dec 3, 2025

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Don't you have stronger types you can use here? There is a "CopayBenefit" in the union type "PatientPaymentBenefit", and likewise with "DeductibleBenefit", but then the "copay" and "deductible" fields can both include their titular type, plus any others in the union. If there is a good reason for this it would be nice to have a comment because this was all reading very clearly to me until i got to this last interface.

deductible?: PatientPaymentBenefit[];
errors?: { code: CodeableConcept }[];
}

Expand Down