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FHIR Claims data - Total amount does not match the sum of the net amounts in the item elements. #1513

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neerajshri78 opened this issue Oct 4, 2024 · 0 comments
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@neerajshri78
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What happened?

I generated FHIR Claims data in JSON format and noticed for majority of data, total amount at the claims header level does not match the sum of the net amounts in the item elements.

I am attaching the claims data in Log file for reference, It will be really helpful if this issue is fixed.

Here is one of the example:-
Details:
Sum of net amounts:
Item 2: $136.00
Item 3: $431.40
Item 4: $32.66
Item 5: $74.58
Item 6: $431.40
Item 7: $431.40
Item 8: $431.40
Calculated Total: $1,968.84

However at the header level its 704.2
"total": {
"value": 704.2,
"currency": "USD"
}

Environment

- OS:
- Java:

Relevant log output

{
    "resourceType": "Claim",
    "id": "17afaf7a-b02a-9d74-4483-7a7a61d59ca6",
    "meta": {
        "versionId": "1",
        "lastUpdated": "2023-04-06T21:52:26.522+00:00"
    },
    "status": "active",
    "type": {
        "coding": [
            {
                "system": "http://terminology.hl7.org/CodeSystem/claim-type",
                "code": "institutional"
            }
        ]
    },
    "use": "claim",
    "patient": {
        "reference": "Patient/b41aa195-572c-5fc5-4315-08401b5044c1",
        "display": "Ahmed109 Emory494 Deckow585"
    },
    "billablePeriod": {
        "start": "2014-04-24T16:40:33+00:00",
        "end": "2014-04-24T16:55:33+00:00"
    },
    "created": "2014-04-24T16:55:33+00:00",
    "provider": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|12567d24-fef1-388d-9586-256c0b8bf783",
        "display": "PCP31309"
    },
    "priority": {
        "coding": [
            {
                "system": "http://terminology.hl7.org/CodeSystem/processpriority",
                "code": "normal"
            }
        ]
    },
    "facility": {
        "reference": "Location?identifier=https://github.com/synthetichealth/synthea|15e2530b-8aad-3697-8476-374abd61d33f",
        "display": "PCP31309"
    },
    "supportingInfo": [
        {
            "sequence": 1,
            "category": {
                "coding": [
                    {
                        "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
                        "code": "info"
                    }
                ]
            },
            "valueReference": {
                "reference": "Immunization/63dc3890-ced3-203a-920e-f4762b609711"
            }
        },
        {
            "sequence": 2,
            "category": {
                "coding": [
                    {
                        "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
                        "code": "info"
                    }
                ]
            }
        }
    ],
    "procedure": [
        {
            "sequence": 1,
            "procedureReference": {
                "reference": "Procedure/104d388d-571f-c054-0c8d-5f71687a810d"
            }
        },
        {
            "sequence": 2,
            "procedureReference": {
                "reference": "Procedure/632a3b85-6229-28b2-a21e-a6467e0f3294"
            }
        },
        {
            "sequence": 3,
            "procedureReference": {
                "reference": "Procedure/b8ba36d5-4304-0793-e84c-196bd91a9c3c"
            }
        },
        {
            "sequence": 4,
            "procedureReference": {
                "reference": "Procedure/c45c2618-783a-638d-8f14-731e3442bebc"
            }
        },
        {
            "sequence": 5,
            "procedureReference": {
                "reference": "Procedure/7dc239aa-afbd-3f69-ea7e-a7c3c63d2125"
            }
        }
    ],
    "insurance": [
        {
            "sequence": 1,
            "focal": true,
            "coverage": {
                "display": "Anthem"
            }
        }
    ],
    "item": [
        {
            "sequence": 1,
            "productOrService": {
                "coding": [
                    {
                        "system": "http://snomed.info/sct",
                        "code": "410620009",
                        "display": "Well child visit (procedure)"
                    }
                ],
                "text": "Well child visit (procedure)"
            },
            "encounter": [
                {
                    "reference": "Encounter/6b38c855-4c39-71d7-c080-75fc7f06fb4e"
                }
            ]
        },
        {
            "sequence": 2,
            "informationSequence": [
                1
            ],
            "productOrService": {
                "coding": [
                    {
                        "system": "http://hl7.org/fhir/sid/cvx",
                        "code": "140",
                        "display": "Influenza, seasonal, injectable, preservative free"
                    }
                ],
                "text": "Influenza, seasonal, injectable, preservative free"
            },
            "net": {
                "value": 136.0,
                "currency": "USD"
            }
        },
        {
            "sequence": 3,
            "procedureSequence": [
                1
            ],
            "productOrService": {
                "coding": [
                    {
                        "system": "http://snomed.info/sct",
                        "code": "171207006",
                        "display": "Depression screening (procedure)"
                    }
                ],
                "text": "Depression screening (procedure)"
            },
            "net": {
                "value": 431.4,
                "currency": "USD"
            }
        },
        {
            "sequence": 4,
            "procedureSequence": [
                2
            ],
            "productOrService": {
                "coding": [
                    {
                        "system": "http://snomed.info/sct",
                        "code": "715252007",
                        "display": "Depression screening using Patient Health Questionnaire Nine Item score (procedure)"
                    }
                ],
                "text": "Depression screening using Patient Health Questionnaire Nine Item score (procedure)"
            },
            "net": {
                "value": 32.66,
                "currency": "USD"
            }
        },
        {
            "sequence": 5,
            "informationSequence": [
                2
            ],
            "productOrService": {
                "coding": [
                    {
                        "system": "http://loinc.org",
                        "code": "89206-7",
                        "display": "Patient Health Questionnaire-9: Modified for Teens [Reported.PHQ.Teen]"
                    }
                ],
                "text": "Patient Health Questionnaire-9: Modified for Teens [Reported.PHQ.Teen]"
            },
            "net": {
                "value": 74.58,
                "currency": "USD"
            }
        },
        {
            "sequence": 6,
            "procedureSequence": [
                3
            ],
            "productOrService": {
                "coding": [
                    {
                        "system": "http://snomed.info/sct",
                        "code": "428211000124100",
                        "display": "Assessment of substance use (procedure)"
                    }
                ],
                "text": "Assessment of substance use (procedure)"
            },
            "net": {
                "value": 431.4,
                "currency": "USD"
            }
        },
        {
            "sequence": 7,
            "procedureSequence": [
                4
            ],
            "productOrService": {
                "coding": [
                    {
                        "system": "http://snomed.info/sct",
                        "code": "868187001",
                        "display": "Assessment using Car, Relax, Alone, Forget, Friends, Trouble Screening Test (procedure)"
                    }
                ],
                "text": "Assessment using Car, Relax, Alone, Forget, Friends, Trouble Screening Test (procedure)"
            },
            "net": {
                "value": 431.4,
                "currency": "USD"
            }
        },
        {
            "sequence": 8,
            "procedureSequence": [
                5
            ],
            "productOrService": {
                "coding": [
                    {
                        "system": "http://snomed.info/sct",
                        "code": "386516004",
                        "display": "Anticipatory guidance (procedure)"
                    }
                ],
                "text": "Anticipatory guidance (procedure)"
            },
            "net": {
                "value": 431.4,
                "currency": "USD"
            }
        }
    ],
    "total": {
        "value": 704.2,
        "currency": "USD"
    }
}
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