Do not merge - awaiting feedback

README.md

@@ -56,4 +56,4 @@ Before your bot runs in production you will need to publish it. Publishing only
 * Go to the `Editor` tab
 * Click on the `Publish` button
 
-After a few seconds your bot will be published and run in production.
+After a few seconds your bot will be published and run in production.

src/eligibility-check-opkit.test.ts

@@ -0,0 +1,34 @@
+import { createReference } from '@medplum/core';
+import { Coverage, Organization, Patient } from '@medplum/fhirtypes';
+import { MockClient } from '@medplum/mock';
+import { expect, test } from 'vitest';
+import { handler } from './eligibility-check-opkit';
+
+
+const contentType = 'application/fhir+json';
+
+// To run this test only: npm t -- src/eligibility-check-opkit.test.ts
+test('Success', async () => {
+ const medplum = new MockClient();
+ const patient = await medplum.createResource<Patient>({
+ resourceType: 'Patient',
+ name:[{given:['John'],family:'Doe'}],
+ birthDate:'1994-07-21',
+ gender:'male'
+ })
+
+ const org = await medplum.createResource<Organization>({
+ resourceType: 'Organization',
+ name: 'DMERC - Region B (formerly MR031)'
+ });
+ const input: Coverage = {
+ resourceType: 'Coverage',
+ beneficiary: createReference(patient),
+ subscriber: createReference(patient),
+ payor: [createReference(org)],
+ subscriberId: '123456789100',
+ status: 'active',
+ };
+ const result = await handler(medplum, { input, contentType });
+ expect(result).toBe(true);
+});

src/eligibility-check-opkit.ts

@@ -0,0 +1,195 @@
+import { BotEvent, createReference, MedplumClient } from '@medplum/core';
+import { Coverage, Organization, Patient, Reference } from '@medplum/fhirtypes';
+import fetch from 'node-fetch';
+
+export async function handler(medplum: MedplumClient, event: BotEvent): Promise<any> {
+ // Because this bot is triggered by a subscription, the resource that comes in is a Coverage object
+ const coverage = event.input as Coverage;
+ const patient = await medplum.readReference(coverage.subscriber as Reference<Patient>);
+ const organization = await medplum.readReference(coverage.payor?.[0] as Reference<Organization>);
+
+ if (!coverage) {
+ console.log('No coverage object found');
+ return true;
+ }
+
+ if (!patient) {
+ console.log('No patient found');
+ return true;
+ }
+
+ if (!organization) {
+ console.log('No payor found');
+ return true;
+ }
+
+ const providerNpi = '1235137563'; // Surprised this is an NPI and not some kind of org identifier
+ const serviceTypes = ['health_benefit_plan_coverage'];
+ const opkitKey = '<opkit-api-key>';
+
+ const opkitRequest = {
+ provider_npi: providerNpi,
+ payer_id: organization.identifier?.find(
+ (identifier) => identifier.system === 'https://docs.opkit.co/reference/getpayers'
+ )?.value,
+ subscriber: {
+ first_name: patient.name?.[0]?.given?.[0],
+ last_name: patient.name?.[0]?.family,
+ member_id: coverage.subscriberId,
+ date_of_birth: patient.birthDate,
+ email: '[email protected]',
+ },
+ services: serviceTypes,
+ };
+ console.log(JSON.stringify(opkitRequest, null, 2));
+
+ const result = await fetch('https://api.opkit.co/v1/eligibility_inquiries', {
+ method: 'POST',
+ body: JSON.stringify(opkitRequest),
+ headers: {
+ Authorization: 'Basic ' + opkitKey,
+ 'Content-Type': 'application/json',
+ Accept: 'application/json',
+ },
+ }).then((response) => response.json());
+ console.log(JSON.stringify(result));
+
+ const serviceToCategoryDisplayMap: Record<string, string> = {
+ health_benefit_plan_coverage: 'Health Benefit Plan Coverage',
+ };
+
+ const serviceToCategoryCodeMap: Record<string, string> = {
+ health_benefit_plan_coverage: '30',
+ };
+
+ const networkToCode: Record<string, string> = {
+ out_of_network: 'out',
+ in_network: 'in',
+ };
+
+ const generateItem = (opkitResponse: any) => {
+ const item: any = [];
+ const benefits = opkitResponse.plan.benefits;
+ const networkSet = new Set<string>(benefits.map((benefit: any) => benefit.network));
+ const unitSet = new Set<string>(benefits.map((benefit: any) => benefit.coverage));
+ const categorySet = new Set<string>(benefits.map((benefit: any) => benefit.service as string));
+
+ categorySet.forEach((category: string) => {
+ networkSet.forEach((network: string) => {
+ unitSet.forEach((unit: string) => {
+ const fhirBenefit = [];
+ const filteredRemainingDeductible = benefits.find(
+ (benefit: any) =>
+ benefit.network === network &&
+ benefit.service === category &&
+ benefit.coverage === unit &&
+ benefit.type === 'deductible' &&
+ benefit.period === 'remaining'
+ );
+
+ const filteredDeductible = benefits.find(
+ (benefit: any) =>
+ benefit.network === network &&
+ benefit.service === category &&
+ benefit.coverage === unit &&
+ benefit.type === 'deductible' &&
+ benefit.period === 'service_year'
+ );
+
+ if (filteredDeductible && filteredRemainingDeductible) {
+ fhirBenefit.push({
+ type: {
+ coding: [
+ {
+ code: 'deductible',
+ },
+ ],
+ },
+ allowedMoney: {
+ value: filteredDeductible.values[0].value || 0,
+ currency: 'USD',
+ },
+ usedMoney: {
+ value: filteredRemainingDeductible.values[0].value || 0,
+ currency: 'USD',
+ },
+ });
+ }
+
+ item.push({
+ category: {
+ coding: [
+ {
+ system: 'https://terminology.hl7.org/CodeSystem/ex-benefitcategory',
+ code: serviceToCategoryCodeMap[category],
+ display: serviceToCategoryDisplayMap[category],
+ },
+ ],
+ },
+ network: {
+ coding: [
+ {
+ system: 'https://terminology.hl7.org/CodeSystem/benefit-network',
+ code: networkToCode[network],
+ },
+ ],
+ },
+ unit: {
+ coding: [
+ {
+ system: 'https://terminology.hl7.org/CodeSystem/benefit-unit',
+ code: unit,
+ },
+ ],
+ },
+ benefit: fhirBenefit,
+ });
+ });
+ });
+ });
+
+ return item;
+ };
+
+ const coverageEligibilityRequest = await medplum.createResource({
+ resourceType: 'CoverageEligibilityRequest',
+ identifier: [{
+ system: 'www.opkit.co/id', //You should choose this
+ value: 'opkit-identifier1234' //Ideally something like opkitRequest.subscriber?
+ }],
+ insurer: createReference(organization),
+ patient: createReference(patient),
+ insurance: [
+ {
+ focal: true,
+ coverage: createReference(coverage),
+ businessArrangement: 'opkit-identifier1234' //If there is some kind of contract number?
+ }
+ ],
+ item: generateItem(result)
+ });
+
+ const coverageEligibilityResponse = await medplum.createResource({
+ resourceType: 'CoverageEligibilityResponse',
+ status: 'active',
+ outcome: 'complete',
+ purpose: ['validation', 'benefits'],
+ request: createReference(coverageEligibilityRequest),
+ disposition: 'Policy is currently in-force.', //Won't this come from opkit?
+ patient: createReference(patient),
+ insurer: createReference(organization),
+ insurance: [
+ {
+ coverage: createReference(coverage),
+ inforce: true, //Won't this come from Opkit as well?
+ item: generateItem(result),
+ },
+ ],
+ });
+
+ console.log(
+ JSON.stringify({
+ coverageEligibilityResponse,
+ })
+ );
+}