BFD-3108: Add new 2024 SAMHSA code (#2095)

apps/bfd-model/bfd-model-rif-samples/src/main/java/gov/cms/bfd/model/rif/samples/StaticRifResource.java

@@ -183,7 +183,35 @@ public enum StaticRifResource {
   SAMPLE_HICN_MULT_BENES_BENEFICIARY_HISTORY(
       resourceUrl("rif-static-samples/sample-hicn-mult-bene-beneficiaryhistory.txt"),
       RifFileType.BENEFICIARY_HISTORY,
-      7);
+      7),
+
+  /** Sample A Carrier static rif. */
+  SAMPLE_A_CARRIER_SAMHSA(
+      resourceUrl("rif-static-samples/samhsa/sample-a-carrier.txt"), RifFileType.CARRIER, 1),
+
+  /** Sample A DME static rif. */
+  SAMPLE_A_DME_SAMHSA(
+      resourceUrl("rif-static-samples/samhsa/sample-a-dme.txt"), RifFileType.DME, 1),
+
+  /** Sample A HHA static rif. */
+  SAMPLE_A_HHA_SAMHSA(
+      resourceUrl("rif-static-samples/samhsa/sample-a-hha.txt"), RifFileType.HHA, 1),
+
+  /** Sample A Hospice static rif. */
+  SAMPLE_A_HOSPICE_SAMHSA(
+      resourceUrl("rif-static-samples/samhsa/sample-a-hospice.txt"), RifFileType.HOSPICE, 1),
+
+  /** Sample A Inpatient static rif. */
+  SAMPLE_A_INPATIENT_SAMHSA(
+      resourceUrl("rif-static-samples/samhsa/sample-a-inpatient.txt"), RifFileType.INPATIENT, 1),
+
+  /** Sample A Outpatient static rif. */
+  SAMPLE_A_OUTPATIENT_SAMHSA(
+      resourceUrl("rif-static-samples/samhsa/sample-a-outpatient.txt"), RifFileType.OUTPATIENT, 1),
+
+  /** Sample A SNF static rif. */
+  SAMPLE_A_SNF_SAMHSA(
+      resourceUrl("rif-static-samples/samhsa/sample-a-snf.txt"), RifFileType.SNF, 1);
 
   /** The Resource URL Supplier for the different RIF files. */
   private final Supplier<URL> resourceUrlSupplier;

apps/bfd-model/bfd-model-rif-samples/src/main/java/gov/cms/bfd/model/rif/samples/StaticRifResourceGroup.java

@@ -31,6 +31,19 @@ public enum StaticRifResourceGroup {
       StaticRifResource.SAMPLE_A_HOSPICE,
       StaticRifResource.SAMPLE_A_SNF,
       StaticRifResource.SAMPLE_A_DME),
+  /** Sample A with various SAMHSA data in each claim. */
+  SAMPLE_A_SAMHSA(
+      StaticRifResource.SAMPLE_A_BENES,
+      StaticRifResource.SAMPLE_A_BENEFICIARY_HISTORY,
+      StaticRifResource.SAMPLE_A_CARRIER_SAMHSA,
+      // PDE has no SAMHSA data
+      StaticRifResource.SAMPLE_A_PDE,
+      StaticRifResource.SAMPLE_A_INPATIENT_SAMHSA,
+      StaticRifResource.SAMPLE_A_OUTPATIENT_SAMHSA,
+      StaticRifResource.SAMPLE_A_HHA_SAMHSA,
+      StaticRifResource.SAMPLE_A_HOSPICE_SAMHSA,
+      StaticRifResource.SAMPLE_A_SNF_SAMHSA,
+      StaticRifResource.SAMPLE_A_DME_SAMHSA),
   /** Sample A Four Character DRG Code Resource Group. */
   SAMPLE_A_FOUR_CHARACTER_DRG_CODE(
       StaticRifResource.SAMPLE_A_BENES,

apps/bfd-model/bfd-model-rif-samples/src/main/resources/rif-static-samples/samhsa/sample-a-carrier.txt

@@ -0,0 +1,2 @@
+DML_IND|BENE_ID|CLM_ID|CLM_GRP_ID|FINAL_ACTION|NCH_NEAR_LINE_REC_IDENT_CD|NCH_CLM_TYPE_CD|CLM_FROM_DT|CLM_THRU_DT|NCH_WKLY_PROC_DT|CARR_CLM_ENTRY_CD|CLM_DISP_CD|CARR_NUM|CARR_CLM_PMT_DNL_CD|CLM_PMT_AMT|CARR_CLM_PRMRY_PYR_PD_AMT|RFR_PHYSN_UPIN|RFR_PHYSN_NPI|CARR_CLM_PRVDR_ASGNMT_IND_SW|NCH_CLM_PRVDR_PMT_AMT|NCH_CLM_BENE_PMT_AMT|NCH_CARR_CLM_SBMTD_CHRG_AMT|NCH_CARR_CLM_ALOWD_AMT|CARR_CLM_CASH_DDCTBL_APLD_AMT|CARR_CLM_HCPCS_YR_CD|CARR_CLM_RFRNG_PIN_NUM|PRNCPAL_DGNS_CD|PRNCPAL_DGNS_VRSN_CD|ICD_DGNS_CD1|ICD_DGNS_VRSN_CD1|ICD_DGNS_CD2|ICD_DGNS_VRSN_CD2|ICD_DGNS_CD3|ICD_DGNS_VRSN_CD3|ICD_DGNS_CD4|ICD_DGNS_VRSN_CD4|ICD_DGNS_CD5|ICD_DGNS_VRSN_CD5|ICD_DGNS_CD6|ICD_DGNS_VRSN_CD6|ICD_DGNS_CD7|ICD_DGNS_VRSN_CD7|ICD_DGNS_CD8|ICD_DGNS_VRSN_CD8|ICD_DGNS_CD9|ICD_DGNS_VRSN_CD9|ICD_DGNS_CD10|ICD_DGNS_VRSN_CD10|ICD_DGNS_CD11|ICD_DGNS_VRSN_CD11|ICD_DGNS_CD12|ICD_DGNS_VRSN_CD12|CLM_CLNCL_TRIL_NUM|CARR_CLM_CNTL_NUM|CARR_CLM_BLG_NPI_NUM|LINE_NUM|CARR_PRFRNG_PIN_NUM|PRF_PHYSN_UPIN|PRF_PHYSN_NPI|ORG_NPI_NUM|CARR_LINE_PRVDR_TYPE_CD|TAX_NUM|PRVDR_STATE_CD|PRVDR_ZIP|PRVDR_SPCLTY|PRTCPTNG_IND_CD|CARR_LINE_RDCD_PMT_PHYS_ASTN_C|LINE_SRVC_CNT|LINE_CMS_TYPE_SRVC_CD|LINE_PLACE_OF_SRVC_CD|CARR_LINE_PRCNG_LCLTY_CD|LINE_1ST_EXPNS_DT|LINE_LAST_EXPNS_DT|HCPCS_CD|HCPCS_1ST_MDFR_CD|HCPCS_2ND_MDFR_CD|BETOS_CD|LINE_NCH_PMT_AMT|LINE_BENE_PMT_AMT|LINE_PRVDR_PMT_AMT|LINE_BENE_PTB_DDCTBL_AMT|LINE_BENE_PRMRY_PYR_CD|LINE_BENE_PRMRY_PYR_PD_AMT|LINE_COINSRNC_AMT|LINE_SBMTD_CHRG_AMT|LINE_ALOWD_CHRG_AMT|LINE_PRCSG_IND_CD|LINE_PMT_80_100_CD|LINE_SERVICE_DEDUCTIBLE|CARR_LINE_MTUS_CNT|CARR_LINE_MTUS_CD|LINE_ICD_DGNS_CD|LINE_ICD_DGNS_VRSN_CD|HPSA_SCRCTY_IND_CD|CARR_LINE_RX_NUM|LINE_HCT_HGB_RSLT_NUM|LINE_HCT_HGB_TYPE_CD|LINE_NDC_CD|CARR_LINE_CLIA_LAB_NUM|CARR_LINE_ANSTHSA_UNIT_CNT
+INSERT|567834|9991831999|900|F|O|71|27-OCT-1999|27-OCT-1999|06-NOV-1999|1|1|61026|1|199.99|0|1234534|8765676|A|123.45|888.00|245.04|166.23|777.00|5|K25852|A02|0|A02|0|29189|9|B04|0|B05|0|||||||||||||||||0|74655592568216|1234567890|6|K25555||1923124|0000000000|0|204299999|IL|555558202|41|1|0|1.0|1|11|15|27-OCT-1999|27-OCT-1999|92999|LT||T2D|37.5|0|37.5|0|E|0|9.57|75|47.84|A|0|0|1|3|A52|0|||42.0|R1|000000000|BB889999AA|0

apps/bfd-model/bfd-model-rif-samples/src/main/resources/rif-static-samples/samhsa/sample-a-dme.txt

@@ -0,0 +1,2 @@
+DML_IND|BENE_ID|CLM_ID|CLM_GRP_ID|FINAL_ACTION|NCH_NEAR_LINE_REC_IDENT_CD|NCH_CLM_TYPE_CD|CLM_FROM_DT|CLM_THRU_DT|NCH_WKLY_PROC_DT|CARR_CLM_ENTRY_CD|CLM_DISP_CD|CARR_NUM|CARR_CLM_PMT_DNL_CD|CLM_PMT_AMT|CARR_CLM_PRMRY_PYR_PD_AMT|CARR_CLM_PRVDR_ASGNMT_IND_SW|NCH_CLM_PRVDR_PMT_AMT|NCH_CLM_BENE_PMT_AMT|NCH_CARR_CLM_SBMTD_CHRG_AMT|NCH_CARR_CLM_ALOWD_AMT|CARR_CLM_CASH_DDCTBL_APLD_AMT|CARR_CLM_HCPCS_YR_CD|PRNCPAL_DGNS_CD|PRNCPAL_DGNS_VRSN_CD|ICD_DGNS_CD1|ICD_DGNS_VRSN_CD1|ICD_DGNS_CD2|ICD_DGNS_VRSN_CD2|ICD_DGNS_CD3|ICD_DGNS_VRSN_CD3|ICD_DGNS_CD4|ICD_DGNS_VRSN_CD4|ICD_DGNS_CD5|ICD_DGNS_VRSN_CD5|ICD_DGNS_CD6|ICD_DGNS_VRSN_CD6|ICD_DGNS_CD7|ICD_DGNS_VRSN_CD7|ICD_DGNS_CD8|ICD_DGNS_VRSN_CD8|ICD_DGNS_CD9|ICD_DGNS_VRSN_CD9|ICD_DGNS_CD10|ICD_DGNS_VRSN_CD10|ICD_DGNS_CD11|ICD_DGNS_VRSN_CD11|ICD_DGNS_CD12|ICD_DGNS_VRSN_CD12|RFR_PHYSN_UPIN|RFR_PHYSN_NPI|CLM_CLNCL_TRIL_NUM|CARR_CLM_CNTL_NUM|LINE_NUM|TAX_NUM|PRVDR_SPCLTY|PRTCPTNG_IND_CD|LINE_SRVC_CNT|LINE_CMS_TYPE_SRVC_CD|LINE_PLACE_OF_SRVC_CD|LINE_1ST_EXPNS_DT|LINE_LAST_EXPNS_DT|HCPCS_CD|HCPCS_1ST_MDFR_CD|HCPCS_2ND_MDFR_CD|BETOS_CD|LINE_NCH_PMT_AMT|LINE_BENE_PMT_AMT|LINE_PRVDR_PMT_AMT|LINE_BENE_PTB_DDCTBL_AMT|LINE_BENE_PRMRY_PYR_CD|LINE_BENE_PRMRY_PYR_PD_AMT|LINE_COINSRNC_AMT|LINE_PRMRY_ALOWD_CHRG_AMT|LINE_SBMTD_CHRG_AMT|LINE_ALOWD_CHRG_AMT|LINE_PRCSG_IND_CD|LINE_PMT_80_100_CD|LINE_SERVICE_DEDUCTIBLE|LINE_ICD_DGNS_CD|LINE_ICD_DGNS_VRSN_CD|LINE_DME_PRCHS_PRICE_AMT|PRVDR_NUM|PRVDR_NPI|DMERC_LINE_PRCNG_STATE_CD|PRVDR_STATE_CD|DMERC_LINE_SUPPLR_TYPE_CD|HCPCS_3RD_MDFR_CD|HCPCS_4TH_MDFR_CD|DMERC_LINE_SCRN_SVGS_AMT|DMERC_LINE_MTUS_CNT|DMERC_LINE_MTUS_CD|LINE_HCT_HGB_RSLT_NUM|LINE_HCT_HGB_TYPE_CD|LINE_NDC_CD
+INSERT|567834|2188888888|900|F|M|82|03-FEB-2014|03-FEB-2014|14-FEB-2014|1|01|99999|1|777.75|0|A|666.75|666.66|1752.75|754.79|777.00|3|B04|0|B04|0|A37|0|||||||||||||||||||||I99999|1306849450|0|74655592568216|1|9994931888|A5|1|60|P|12|03-FEB-2014|03-FEB-2014|G0137|YY||D9Z|123.45|11.00|120.00|18.00|E|11.00|20.20|20.29|130.45|129.45|A|0|0|A25|0|82.29|1219966666|1244444444|AL|MO|3|||0.00|60.234|3|44.4|R2|000000000|

apps/bfd-model/bfd-model-rif-samples/src/main/resources/rif-static-samples/samhsa/sample-a-hha.txt

@@ -0,0 +1,2 @@
+DML_IND|BENE_ID|CLM_ID|CLM_GRP_ID|FINAL_ACTION|NCH_NEAR_LINE_REC_IDENT_CD|NCH_CLM_TYPE_CD|CLM_FROM_DT|CLM_THRU_DT|NCH_WKLY_PROC_DT|FI_CLM_PROC_DT|PRVDR_NUM|CLM_FAC_TYPE_CD|CLM_SRVC_CLSFCTN_TYPE_CD|CLM_FREQ_CD|FI_NUM|CLM_MDCR_NON_PMT_RSN_CD|CLM_PMT_AMT|NCH_PRMRY_PYR_CLM_PD_AMT|NCH_PRMRY_PYR_CD|PRVDR_STATE_CD|ORG_NPI_NUM|AT_PHYSN_UPIN|AT_PHYSN_NPI|PTNT_DSCHRG_STUS_CD|CLM_PPS_IND_CD|CLM_TOT_CHRG_AMT|PRNCPAL_DGNS_CD|PRNCPAL_DGNS_VRSN_CD|ICD_DGNS_CD1|ICD_DGNS_VRSN_CD1|ICD_DGNS_CD2|ICD_DGNS_VRSN_CD2|ICD_DGNS_CD3|ICD_DGNS_VRSN_CD3|ICD_DGNS_CD4|ICD_DGNS_VRSN_CD4|ICD_DGNS_CD5|ICD_DGNS_VRSN_CD5|ICD_DGNS_CD6|ICD_DGNS_VRSN_CD6|ICD_DGNS_CD7|ICD_DGNS_VRSN_CD7|ICD_DGNS_CD8|ICD_DGNS_VRSN_CD8|ICD_DGNS_CD9|ICD_DGNS_VRSN_CD9|ICD_DGNS_CD10|ICD_DGNS_VRSN_CD10|ICD_DGNS_CD11|ICD_DGNS_VRSN_CD11|ICD_DGNS_CD12|ICD_DGNS_VRSN_CD12|ICD_DGNS_CD13|ICD_DGNS_VRSN_CD13|ICD_DGNS_CD14|ICD_DGNS_VRSN_CD14|ICD_DGNS_CD15|ICD_DGNS_VRSN_CD15|ICD_DGNS_CD16|ICD_DGNS_VRSN_CD16|ICD_DGNS_CD17|ICD_DGNS_VRSN_CD17|ICD_DGNS_CD18|ICD_DGNS_VRSN_CD18|ICD_DGNS_CD19|ICD_DGNS_VRSN_CD19|ICD_DGNS_CD20|ICD_DGNS_VRSN_CD20|ICD_DGNS_CD21|ICD_DGNS_VRSN_CD21|ICD_DGNS_CD22|ICD_DGNS_VRSN_CD22|ICD_DGNS_CD23|ICD_DGNS_VRSN_CD23|ICD_DGNS_CD24|ICD_DGNS_VRSN_CD24|ICD_DGNS_CD25|ICD_DGNS_VRSN_CD25|FST_DGNS_E_CD|FST_DGNS_E_VRSN_CD|ICD_DGNS_E_CD1|ICD_DGNS_E_VRSN_CD1|ICD_DGNS_E_CD2|ICD_DGNS_E_VRSN_CD2|ICD_DGNS_E_CD3|ICD_DGNS_E_VRSN_CD3|ICD_DGNS_E_CD4|ICD_DGNS_E_VRSN_CD4|ICD_DGNS_E_CD5|ICD_DGNS_E_VRSN_CD5|ICD_DGNS_E_CD6|ICD_DGNS_E_VRSN_CD6|ICD_DGNS_E_CD7|ICD_DGNS_E_VRSN_CD7|ICD_DGNS_E_CD8|ICD_DGNS_E_VRSN_CD8|ICD_DGNS_E_CD9|ICD_DGNS_E_VRSN_CD9|ICD_DGNS_E_CD10|ICD_DGNS_E_VRSN_CD10|ICD_DGNS_E_CD11|ICD_DGNS_E_VRSN_CD11|ICD_DGNS_E_CD12|ICD_DGNS_E_VRSN_CD12|CLM_HHA_LUPA_IND_CD|CLM_HHA_RFRL_CD|CLM_HHA_TOT_VISIT_CNT|CLM_ADMSN_DT|FI_DOC_CLM_CNTL_NUM|FI_ORIG_CLM_CNTL_NUM|CLAIM_QUERY_CODE|CLM_LINE_NUM|REV_CNTR|REV_CNTR_DT|REV_CNTR_1ST_ANSI_CD|REV_CNTR_APC_HIPPS_CD|HCPCS_CD|HCPCS_1ST_MDFR_CD|HCPCS_2ND_MDFR_CD|REV_CNTR_PMT_MTHD_IND_CD|REV_CNTR_UNIT_CNT|REV_CNTR_RATE_AMT|REV_CNTR_PMT_AMT_AMT|REV_CNTR_TOT_CHRG_AMT|REV_CNTR_NCVRD_CHRG_AMT|REV_CNTR_DDCTBL_COINSRNC_CD|REV_CNTR_STUS_IND_CD|REV_CNTR_NDC_QTY|REV_CNTR_NDC_QTY_QLFR_CD|RNDRNG_PHYSN_UPIN|RNDRNG_PHYSN_NPI
+INSERT|567834|2925555555|900|F|W|10|23-JUN-2015|23-JUN-2015|06-NOV-2015|30-OCT-2015|45645|3|2|1|15999|P|188.00|11.00|A|UT|0000000000||2222222222|30|2|199.99|53081|9|53081|9|B01|0|||||||||||||||||||||||||||||||||||||||||||||||B05|0|29189|9|B30|0|||||||||||||||||||||L|1|3|23-JUN-2015|08683096577486|10493204767560565|3|1|0023|23-JUN-2015|CO120|0|2GGGG|KO||3|1|0|26.00|25.00|24.00|4|A|666|DD||345345345|

apps/bfd-model/bfd-model-rif-samples/src/main/resources/rif-static-samples/samhsa/sample-a-hospice.txt

@@ -0,0 +1,2 @@
+DML_IND|BENE_ID|CLM_ID|CLM_GRP_ID|FINAL_ACTION|NCH_NEAR_LINE_REC_IDENT_CD|NCH_CLM_TYPE_CD|CLM_FROM_DT|CLM_THRU_DT|NCH_WKLY_PROC_DT|FI_CLM_PROC_DT|PRVDR_NUM|CLM_FAC_TYPE_CD|CLM_SRVC_CLSFCTN_TYPE_CD|CLM_FREQ_CD|FI_NUM|CLM_MDCR_NON_PMT_RSN_CD|CLM_PMT_AMT|NCH_PRMRY_PYR_CLM_PD_AMT|NCH_PRMRY_PYR_CD|PRVDR_STATE_CD|ORG_NPI_NUM|AT_PHYSN_UPIN|AT_PHYSN_NPI|PTNT_DSCHRG_STUS_CD|CLM_TOT_CHRG_AMT|NCH_PTNT_STATUS_IND_CD|CLM_UTLZTN_DAY_CNT|NCH_BENE_DSCHRG_DT|PRNCPAL_DGNS_CD|PRNCPAL_DGNS_VRSN_CD|ICD_DGNS_CD1|ICD_DGNS_VRSN_CD1|ICD_DGNS_CD2|ICD_DGNS_VRSN_CD2|ICD_DGNS_CD3|ICD_DGNS_VRSN_CD3|ICD_DGNS_CD4|ICD_DGNS_VRSN_CD4|ICD_DGNS_CD5|ICD_DGNS_VRSN_CD5|ICD_DGNS_CD6|ICD_DGNS_VRSN_CD6|ICD_DGNS_CD7|ICD_DGNS_VRSN_CD7|ICD_DGNS_CD8|ICD_DGNS_VRSN_CD8|ICD_DGNS_CD9|ICD_DGNS_VRSN_CD9|ICD_DGNS_CD10|ICD_DGNS_VRSN_CD10|ICD_DGNS_CD11|ICD_DGNS_VRSN_CD11|ICD_DGNS_CD12|ICD_DGNS_VRSN_CD12|ICD_DGNS_CD13|ICD_DGNS_VRSN_CD13|ICD_DGNS_CD14|ICD_DGNS_VRSN_CD14|ICD_DGNS_CD15|ICD_DGNS_VRSN_CD15|ICD_DGNS_CD16|ICD_DGNS_VRSN_CD16|ICD_DGNS_CD17|ICD_DGNS_VRSN_CD17|ICD_DGNS_CD18|ICD_DGNS_VRSN_CD18|ICD_DGNS_CD19|ICD_DGNS_VRSN_CD19|ICD_DGNS_CD20|ICD_DGNS_VRSN_CD20|ICD_DGNS_CD21|ICD_DGNS_VRSN_CD21|ICD_DGNS_CD22|ICD_DGNS_VRSN_CD22|ICD_DGNS_CD23|ICD_DGNS_VRSN_CD23|ICD_DGNS_CD24|ICD_DGNS_VRSN_CD24|ICD_DGNS_CD25|ICD_DGNS_VRSN_CD25|FST_DGNS_E_CD|FST_DGNS_E_VRSN_CD|ICD_DGNS_E_CD1|ICD_DGNS_E_VRSN_CD1|ICD_DGNS_E_CD2|ICD_DGNS_E_VRSN_CD2|ICD_DGNS_E_CD3|ICD_DGNS_E_VRSN_CD3|ICD_DGNS_E_CD4|ICD_DGNS_E_VRSN_CD4|ICD_DGNS_E_CD5|ICD_DGNS_E_VRSN_CD5|ICD_DGNS_E_CD6|ICD_DGNS_E_VRSN_CD6|ICD_DGNS_E_CD7|ICD_DGNS_E_VRSN_CD7|ICD_DGNS_E_CD8|ICD_DGNS_E_VRSN_CD8|ICD_DGNS_E_CD9|ICD_DGNS_E_VRSN_CD9|ICD_DGNS_E_CD10|ICD_DGNS_E_VRSN_CD10|ICD_DGNS_E_CD11|ICD_DGNS_E_VRSN_CD11|ICD_DGNS_E_CD12|ICD_DGNS_E_VRSN_CD12|CLM_HOSPC_START_DT_ID|BENE_HOSPC_PRD_CNT|FI_DOC_CLM_CNTL_NUM|FI_ORIG_CLM_CNTL_NUM|CLAIM_QUERY_CODE|CLM_LINE_NUM|REV_CNTR|REV_CNTR_DT|HCPCS_CD|HCPCS_1ST_MDFR_CD|HCPCS_2ND_MDFR_CD|REV_CNTR_UNIT_CNT|REV_CNTR_RATE_AMT|REV_CNTR_PRVDR_PMT_AMT|REV_CNTR_BENE_PMT_AMT|REV_CNTR_PMT_AMT_AMT|REV_CNTR_TOT_CHRG_AMT|REV_CNTR_NCVRD_CHRG_AMT|REV_CNTR_DDCTBL_COINSRNC_CD|REV_CNTR_NDC_QTY|REV_CNTR_NDC_QTY_QLFR_CD|RNDRNG_PHYSN_UPIN|RNDRNG_PHYSN_NPI
+INSERT|567834|9992223422|900|F|V|50|01-JAN-2014|30-JAN-2014|10-OCT-2014|07-OCT-2014|12345|8|1|1|6666|P|130.32|0|A|AZ|0000000000||8888888888|30|199.99|C|30|29-JUN-2015|72761|9|72761|9|B30|0|||||||||||||||||||||||||||||||||||||||||||||||29189|9|B01|0|A52|0|||||||||||||||||||||06-JUL-2014|2|2718813985998|38875439343923937|3|1|651|01-SEP-2014|A5C|Q9999||||29.00|28.00|26.00|2555.00|300.00|0|5454|B|0|345345345|

apps/bfd-model/bfd-model-rif-samples/src/main/resources/rif-static-samples/samhsa/sample-a-inpatient.txt

@@ -0,0 +1,2 @@
+DML_IND|BENE_ID|CLM_ID|CLM_GRP_ID|FINAL_ACTION|NCH_NEAR_LINE_REC_IDENT_CD|NCH_CLM_TYPE_CD|CLM_FROM_DT|CLM_THRU_DT|NCH_WKLY_PROC_DT|FI_CLM_PROC_DT|CLAIM_QUERY_CODE|PRVDR_NUM|CLM_FAC_TYPE_CD|CLM_SRVC_CLSFCTN_TYPE_CD|CLM_FREQ_CD|FI_NUM|CLM_MDCR_NON_PMT_RSN_CD|CLM_PMT_AMT|NCH_PRMRY_PYR_CLM_PD_AMT|NCH_PRMRY_PYR_CD|FI_CLM_ACTN_CD|PRVDR_STATE_CD|ORG_NPI_NUM|AT_PHYSN_UPIN|AT_PHYSN_NPI|OP_PHYSN_UPIN|OP_PHYSN_NPI|OT_PHYSN_UPIN|OT_PHYSN_NPI|CLM_MCO_PD_SW|PTNT_DSCHRG_STUS_CD|CLM_PPS_IND_CD|CLM_TOT_CHRG_AMT|CLM_ADMSN_DT|CLM_IP_ADMSN_TYPE_CD|CLM_SRC_IP_ADMSN_CD|NCH_PTNT_STATUS_IND_CD|CLM_PASS_THRU_PER_DIEM_AMT|NCH_BENE_IP_DDCTBL_AMT|NCH_BENE_PTA_COINSRNC_LBLTY_AM|NCH_BENE_BLOOD_DDCTBL_LBLTY_AM|NCH_PROFNL_CMPNT_CHRG_AMT|NCH_IP_NCVRD_CHRG_AMT|NCH_IP_TOT_DDCTN_AMT|CLM_TOT_PPS_CPTL_AMT|CLM_PPS_CPTL_FSP_AMT|CLM_PPS_CPTL_OUTLIER_AMT|CLM_PPS_CPTL_DSPRPRTNT_SHR_AMT|CLM_PPS_CPTL_IME_AMT|CLM_PPS_CPTL_EXCPTN_AMT|CLM_PPS_OLD_CPTL_HLD_HRMLS_AMT|CLM_PPS_CPTL_DRG_WT_NUM|CLM_UTLZTN_DAY_CNT|BENE_TOT_COINSRNC_DAYS_CNT|BENE_LRD_USED_CNT|CLM_NON_UTLZTN_DAYS_CNT|NCH_BLOOD_PNTS_FRNSHD_QTY|NCH_VRFD_NCVRD_STAY_FROM_DT|NCH_VRFD_NCVRD_STAY_THRU_DT|NCH_ACTV_OR_CVRD_LVL_CARE_THRU|NCH_BENE_MDCR_BNFTS_EXHTD_DT_I|NCH_BENE_DSCHRG_DT|CLM_DRG_CD|CLM_DRG_OUTLIER_STAY_CD|NCH_DRG_OUTLIER_APRVD_PMT_AMT|ADMTG_DGNS_CD|ADMTG_DGNS_VRSN_CD|PRNCPAL_DGNS_CD|PRNCPAL_DGNS_VRSN_CD|ICD_DGNS_CD1|ICD_DGNS_VRSN_CD1|CLM_POA_IND_SW1|ICD_DGNS_CD2|ICD_DGNS_VRSN_CD2|CLM_POA_IND_SW2|ICD_DGNS_CD3|ICD_DGNS_VRSN_CD3|CLM_POA_IND_SW3|ICD_DGNS_CD4|ICD_DGNS_VRSN_CD4|CLM_POA_IND_SW4|ICD_DGNS_CD5|ICD_DGNS_VRSN_CD5|CLM_POA_IND_SW5|ICD_DGNS_CD6|ICD_DGNS_VRSN_CD6|CLM_POA_IND_SW6|ICD_DGNS_CD7|ICD_DGNS_VRSN_CD7|CLM_POA_IND_SW7|ICD_DGNS_CD8|ICD_DGNS_VRSN_CD8|CLM_POA_IND_SW8|ICD_DGNS_CD9|ICD_DGNS_VRSN_CD9|CLM_POA_IND_SW9|ICD_DGNS_CD10|ICD_DGNS_VRSN_CD10|CLM_POA_IND_SW10|ICD_DGNS_CD11|ICD_DGNS_VRSN_CD11|CLM_POA_IND_SW11|ICD_DGNS_CD12|ICD_DGNS_VRSN_CD12|CLM_POA_IND_SW12|ICD_DGNS_CD13|ICD_DGNS_VRSN_CD13|CLM_POA_IND_SW13|ICD_DGNS_CD14|ICD_DGNS_VRSN_CD14|CLM_POA_IND_SW14|ICD_DGNS_CD15|ICD_DGNS_VRSN_CD15|CLM_POA_IND_SW15|ICD_DGNS_CD16|ICD_DGNS_VRSN_CD16|CLM_POA_IND_SW16|ICD_DGNS_CD17|ICD_DGNS_VRSN_CD17|CLM_POA_IND_SW17|ICD_DGNS_CD18|ICD_DGNS_VRSN_CD18|CLM_POA_IND_SW18|ICD_DGNS_CD19|ICD_DGNS_VRSN_CD19|CLM_POA_IND_SW19|ICD_DGNS_CD20|ICD_DGNS_VRSN_CD20|CLM_POA_IND_SW20|ICD_DGNS_CD21|ICD_DGNS_VRSN_CD21|CLM_POA_IND_SW21|ICD_DGNS_CD22|ICD_DGNS_VRSN_CD22|CLM_POA_IND_SW22|ICD_DGNS_CD23|ICD_DGNS_VRSN_CD23|CLM_POA_IND_SW23|ICD_DGNS_CD24|ICD_DGNS_VRSN_CD24|CLM_POA_IND_SW24|ICD_DGNS_CD25|ICD_DGNS_VRSN_CD25|CLM_POA_IND_SW25|FST_DGNS_E_CD|FST_DGNS_E_VRSN_CD|ICD_DGNS_E_CD1|ICD_DGNS_E_VRSN_CD1|CLM_E_POA_IND_SW1|ICD_DGNS_E_CD2|ICD_DGNS_E_VRSN_CD2|CLM_E_POA_IND_SW2|ICD_DGNS_E_CD3|ICD_DGNS_E_VRSN_CD3|CLM_E_POA_IND_SW3|ICD_DGNS_E_CD4|ICD_DGNS_E_VRSN_CD4|CLM_E_POA_IND_SW4|ICD_DGNS_E_CD5|ICD_DGNS_E_VRSN_CD5|CLM_E_POA_IND_SW5|ICD_DGNS_E_CD6|ICD_DGNS_E_VRSN_CD6|CLM_E_POA_IND_SW6|ICD_DGNS_E_CD7|ICD_DGNS_E_VRSN_CD7|CLM_E_POA_IND_SW7|ICD_DGNS_E_CD8|ICD_DGNS_E_VRSN_CD8|CLM_E_POA_IND_SW8|ICD_DGNS_E_CD9|ICD_DGNS_E_VRSN_CD9|CLM_E_POA_IND_SW9|ICD_DGNS_E_CD10|ICD_DGNS_E_VRSN_CD10|CLM_E_POA_IND_SW10|ICD_DGNS_E_CD11|ICD_DGNS_E_VRSN_CD11|CLM_E_POA_IND_SW11|ICD_DGNS_E_CD12|ICD_DGNS_E_VRSN_CD12|CLM_E_POA_IND_SW12|ICD_PRCDR_CD1|ICD_PRCDR_VRSN_CD1|PRCDR_DT1|ICD_PRCDR_CD2|ICD_PRCDR_VRSN_CD2|PRCDR_DT2|ICD_PRCDR_CD3|ICD_PRCDR_VRSN_CD3|PRCDR_DT3|ICD_PRCDR_CD4|ICD_PRCDR_VRSN_CD4|PRCDR_DT4|ICD_PRCDR_CD5|ICD_PRCDR_VRSN_CD5|PRCDR_DT5|ICD_PRCDR_CD6|ICD_PRCDR_VRSN_CD6|PRCDR_DT6|ICD_PRCDR_CD7|ICD_PRCDR_VRSN_CD7|PRCDR_DT7|ICD_PRCDR_CD8|ICD_PRCDR_VRSN_CD8|PRCDR_DT8|ICD_PRCDR_CD9|ICD_PRCDR_VRSN_CD9|PRCDR_DT9|ICD_PRCDR_CD10|ICD_PRCDR_VRSN_CD10|PRCDR_DT10|ICD_PRCDR_CD11|ICD_PRCDR_VRSN_CD11|PRCDR_DT11|ICD_PRCDR_CD12|ICD_PRCDR_VRSN_CD12|PRCDR_DT12|ICD_PRCDR_CD13|ICD_PRCDR_VRSN_CD13|PRCDR_DT13|ICD_PRCDR_CD14|ICD_PRCDR_VRSN_CD14|PRCDR_DT14|ICD_PRCDR_CD15|ICD_PRCDR_VRSN_CD15|PRCDR_DT15|ICD_PRCDR_CD16|ICD_PRCDR_VRSN_CD16|PRCDR_DT16|ICD_PRCDR_CD17|ICD_PRCDR_VRSN_CD17|PRCDR_DT17|ICD_PRCDR_CD18|ICD_PRCDR_VRSN_CD18|PRCDR_DT18|ICD_PRCDR_CD19|ICD_PRCDR_VRSN_CD19|PRCDR_DT19|ICD_PRCDR_CD20|ICD_PRCDR_VRSN_CD20|PRCDR_DT20|ICD_PRCDR_CD21|ICD_PRCDR_VRSN_CD21|PRCDR_DT21|ICD_PRCDR_CD22|ICD_PRCDR_VRSN_CD22|PRCDR_DT22|ICD_PRCDR_CD23|ICD_PRCDR_VRSN_CD23|PRCDR_DT23|ICD_PRCDR_CD24|ICD_PRCDR_VRSN_CD24|PRCDR_DT24|ICD_PRCDR_CD25|ICD_PRCDR_VRSN_CD25|PRCDR_DT25|IME_OP_CLM_VAL_AMT|DSH_OP_CLM_VAL_AMT|CLM_UNCOMPD_CARE_PMT_AMT|FI_DOC_CLM_CNTL_NUM|FI_ORIG_CLM_CNTL_NUM|CLM_LINE_NUM|REV_CNTR|HCPCS_CD|REV_CNTR_UNIT_CNT|REV_CNTR_RATE_AMT|REV_CNTR_TOT_CHRG_AMT|REV_CNTR_NCVRD_CHRG_AMT|REV_CNTR_DDCTBL_COINSRNC_CD|REV_CNTR_NDC_QTY|REV_CNTR_NDC_QTY_QLFR_CD|RNDRNG_PHYSN_UPIN|RNDRNG_PHYSN_NPI
+INSERT|567834|333333222222|900|F|V|60|15-JAN-2016|27-JAN-2016|26-FEB-2016|19-FEB-2016|3|777776|1|1|1|8299|A|7699.48|11.00|A|1|IA|0000000000||161999999||3333444555||161943433|0|51|2|84999.37|15-JAN-2016|1|4|A|10.00|112.00|5.00|6.00|4.00|33.00|14.00|646.23|552.56|0|25.09|68.58|0|0|1.2494|12|0|0|0|19|||||27-JAN-2016|695|0|23.99|A37|0|A40|0|A40|0|Y|A52|0|N|29189|9|N|A15|0|N|B01|0|N|||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||A01|0|A01|0|N|A02|0|Y|||||||||||||||||||||||||||||||BQ0HZZZ|0|16-JAN-2016|CD1YYZZ|0|16-JAN-2016|2W52X6Z|0|15-JAN-2016|BP17ZZZ|0|17-JAN-2016|D9YD8ZZ|0|24-JAN-2016|F00ZCKZ|0|24-JAN-2016||||||||||||||||||||||||||||||||||||||||||||||||||||||||||66125.51|25|120.56|28486613848|261660474641024|1|6767|M55|0|0|84888.88|3699.00|A|77|GG||345345345|