Eligibility fix

.github/workflows/dbt_v1.4.6_bigquery_build_full_refresh.yml

@@ -19,17 +19,17 @@ jobs:
       - uses: actions/checkout@v2
 
       - name: dbt-deps
-        uses: mwhitaker/dbt-action@v1.4.6
+        uses: mwhitaker/dbt-action@v1.6.3
         with:
           dbt_command: "dbt deps --profiles-dir ./integration_tests/profiles/bigquery"
 
       - name: dbt-debug
-        uses: mwhitaker/dbt-action@v1.4.6
+        uses: mwhitaker/dbt-action@v1.6.3
         with:
           dbt_command: "dbt debug --profiles-dir ./integration_tests/profiles/bigquery"
 
       - name: dbt-build
-        uses: mwhitaker/dbt-action@v1.4.6
+        uses: mwhitaker/dbt-action@v1.6.3
         with:
           dbt_command: 'dbt build --full-refresh --profiles-dir ./integration_tests/profiles/bigquery  --vars {"tuva_database":"dev-ci-testing","input_database":"dev-ci-testing","input_schema":"lds","tuva_schema_prefix":"lds"}'
 

.github/workflows/dbt_v1.4.6_redshift_build_full_refresh.yml

@@ -22,18 +22,18 @@ jobs:
       - uses: actions/checkout@v2
 
       - name: dbt-deps
-        uses: mwhitaker/dbt-action@v1.4.6
+        uses: mwhitaker/dbt-action@v1.6.3
         with:
           dbt_command: "dbt deps --profiles-dir ./integration_tests/profiles/redshift"
 
 
       - name: dbt-debug
-        uses: mwhitaker/dbt-action@v1.4.6
+        uses: mwhitaker/dbt-action@v1.6.3
         with:
           dbt_command: "dbt debug --profiles-dir ./integration_tests/profiles/redshift"
 
       - name: dbt-build
-        uses: mwhitaker/dbt-action@v1.4.6
+        uses: mwhitaker/dbt-action@v1.6.3
         with:
           dbt_command: 'dbt build --full-refresh --profiles-dir ./integration_tests/profiles/redshift --vars {"tuva_database":"dev_ci_testing","input_database":"dev_ci_testing","input_schema":"saf","tuva_schema_prefix":"saf"}'
 

.github/workflows/dbt_v1.4.6_snowflake_build_full_refresh.yml

@@ -22,18 +22,18 @@ jobs:
       - uses: actions/checkout@v2
 
       - name: dbt-deps
-        uses: mwhitaker/dbt-action@v1.4.6
+        uses: mwhitaker/dbt-action@v1.6.3
         with:
           dbt_command: "dbt deps --profiles-dir ./integration_tests/profiles/snowflake"
 
 
       - name: dbt-debug
-        uses: mwhitaker/dbt-action@v1.4.6
+        uses: mwhitaker/dbt-action@v1.6.3
         with:
           dbt_command: "dbt debug --profiles-dir ./integration_tests/profiles/snowflake"
 
       - name: dbt-build
-        uses: mwhitaker/dbt-action@v1.4.6
+        uses: mwhitaker/dbt-action@v1.6.3
         with:
           dbt_command: 'dbt build --full-refresh --profiles-dir ./integration_tests/profiles/snowflake --vars {"tuva_database":"dev_ci_testing","input_database":"dev_ci_testing","input_schema":"saf","tuva_schema_prefix":"saf"}'
 

.gitignore

@@ -2,3 +2,4 @@
 target/
 dbt_packages/
 logs/
+package-lock.yml

macros/generate_schema_name.sql

@@ -3,8 +3,11 @@
     See https://docs.getdbt.com/docs/building-a-dbt-project/building-models/using-custom-schemas for the original macro.
 #}
 
-{% macro generate_schema_name(custom_schema_name, node) -%}
-
-    {{ custom_schema_name }}
-
+{% macro default__generate_schema_name(custom_schema_name, node) -%}
+    {%- set default_schema = target.schema -%}
+    {%- if custom_schema_name is not none -%}
+        {{ custom_schema_name | trim }}
+    {%- else -%}
+        {{ default_schema }}
+    {%- endif -%}
 {%- endmacro %}

models/_models.yml

@@ -7,35 +7,35 @@ models:
     description: Member eligibility at the month grain
     config:
       schema: |
-        {%- if var('tuva_schema_prefix',None) != None -%}_{{var('tuva_schema_prefix')}}_tuva_claims{% else %}_tuva_claims{%- endif -%}
+        {%- if var('tuva_schema_prefix',None) != None -%}_{{var('tuva_schema_prefix')}}input_layer{% else %}input_layer{%- endif -%}
       materialized: table
 
   - name: medical_claim
     description: Claim line details of all claim types
     config:
       schema: |
-        {%- if var('tuva_schema_prefix',None) != None -%}_{{var('tuva_schema_prefix')}}_tuva_claims{% else %}_tuva_claims{%- endif -%}
+        {%- if var('tuva_schema_prefix',None) != None -%}_{{var('tuva_schema_prefix')}}_input_layer{% else %}input_layer{%- endif -%}
       materialized: table
 
   - name: pharmacy_claim
     description: Claim line details of all claim types
     config:
       schema: |
-        {%- if var('tuva_schema_prefix',None) != None -%}_{{var('tuva_schema_prefix')}}_tuva_claims{% else %}_tuva_claims{%- endif -%}
+        {%- if var('tuva_schema_prefix',None) != None -%}_{{var('tuva_schema_prefix')}}_input_layer{% else %}input_layer{%- endif -%}
       materialized: table
 
 ### intermediate
   - name: carrier_claim
     description: Claim line details of carrier claims
     config:
       schema: |
-        {%- if var('tuva_schema_prefix',None) != None -%}_{{var('tuva_schema_prefix')}}_tuva_claims{% else %}_tuva_claims{%- endif -%}
+        {%- if var('tuva_schema_prefix',None) != None -%}_{{var('tuva_schema_prefix')}}_input_layer{% else %}input_layer{%- endif -%}
 
   - name: dme_claim
     description: Claim line details of durable medical equipment claims
     config:
       schema: |
-        {%- if var('tuva_schema_prefix',None) != None -%}_{{var('tuva_schema_prefix')}}_tuva_claims{% else %}_tuva_claims{%- endif -%}
+        {%- if var('tuva_schema_prefix',None) != None -%}_{{var('tuva_schema_prefix')}}_input_layer{% else %}input_layer{%- endif -%}
 
   - name: eligibility_unpivot
     description: >
@@ -44,34 +44,40 @@ models:
       of eligibility.
     config:
       schema: |
-        {%- if var('tuva_schema_prefix',None) != None -%}_{{var('tuva_schema_prefix')}}_tuva_claims{% else %}_tuva_claims{%- endif -%}
+        {%- if var('tuva_schema_prefix',None) != None -%}_{{var('tuva_schema_prefix')}}_input_layer{% else %}input_layer{%- endif -%}
 
   - name: home_health_claim
     description: Claim line details of home health claims
     config:
       schema: |
-        {%- if var('tuva_schema_prefix',None) != None -%}_{{var('tuva_schema_prefix')}}_tuva_claims{% else %}_tuva_claims{%- endif -%}
+        {%- if var('tuva_schema_prefix',None) != None -%}_{{var('tuva_schema_prefix')}}_input_layer{% else %}input_layer{%- endif -%}
 
   - name: hospice_claim
     description: Claim line details of hospice claims
     config:
       schema: |
-        {%- if var('tuva_schema_prefix',None) != None -%}_{{var('tuva_schema_prefix')}}_tuva_claims{% else %}_tuva_claims{%- endif -%}
+        {%- if var('tuva_schema_prefix',None) != None -%}_{{var('tuva_schema_prefix')}}_input_layer{% else %}input_layer{%- endif -%}
 
   - name: inpatient_claim
     description: Claim line details of inpatient claims
     config:
       schema: |
-        {%- if var('tuva_schema_prefix',None) != None -%}_{{var('tuva_schema_prefix')}}_tuva_claims{% else %}_tuva_claims{%- endif -%}
+        {%- if var('tuva_schema_prefix',None) != None -%}_{{var('tuva_schema_prefix')}}_input_layer{% else %}input_layer{%- endif -%}
+
+  - name: _int_medical_claim
+    description: union of all medical claim tables
+    config:
+      schema: |
+        {%- if var('tuva_schema_prefix',None) != None -%}_{{var('tuva_schema_prefix')}}_input_layer{% else %}input_layer{%- endif -%}
 
   - name: outpatient_claim
     description: Claim line details of outpatient claims
     config:
       schema: |
-        {%- if var('tuva_schema_prefix',None) != None -%}_{{var('tuva_schema_prefix')}}_tuva_claims{% else %}_tuva_claims{%- endif -%}
+        {%- if var('tuva_schema_prefix',None) != None -%}_{{var('tuva_schema_prefix')}}_input_layer{% else %}input_layer{%- endif -%}
 
   - name: snf_claim
     description: Claim line details of skilled nursing facility claims
     config:
       schema: |
-        {%- if var('tuva_schema_prefix',None) != None -%}_{{var('tuva_schema_prefix')}}_tuva_claims{% else %}_tuva_claims{%- endif -%}
+        {%- if var('tuva_schema_prefix',None) != None -%}_{{var('tuva_schema_prefix')}}_input_layer{% else %}input_layer{%- endif -%}

models/final/eligibility.sql

@@ -15,7 +15,7 @@ with eligibility_unpivot as (
 
 medicare_state_fips as (
 
-    select * from {{ ref('terminology__ssa_fips_state') }}
+    select * from {{ ref('reference_data__ssa_fips_state') }}
 
 ),
 
@@ -29,8 +29,9 @@ add_row_num as (
             order by enrollment_date
           ) as row_num
         , case
-            when medicare_status in (null, '00')
-            and dual_status in (null, '00', '99', 'NA') then 1
+            when medicare_status in (null, '00') and dual_status in (null, '00', '99', 'NA') then 1
+            when hmo_status <> '0' then 1 --  MA coverage
+            when entitlement not in ('3','C') then 1 --Doesn't have both Part A and B
             else 0
           end as disenrolled_flag
     from eligibility_unpivot
@@ -128,7 +129,8 @@ joined as (
 
     select
           cast(enrollment_span.desy_sort_key as {{ dbt.type_string() }} ) as patient_id
-        , cast(NULL as {{ dbt.type_string() }} ) as member_id
+        , cast(enrollment_span.desy_sort_key as {{ dbt.type_string() }} ) as member_id
+        , cast(enrollment_span.desy_sort_key as {{ dbt.type_string() }} ) as subscriber_id
         , case eligibility_unpivot.sex_code
                when '0' then 'unknown'
                when '1' then 'male'
@@ -159,12 +161,18 @@ joined as (
         , cast(eligibility_unpivot.medicare_status as {{ dbt.type_string() }} ) as medicare_status_code
         , cast(NULL as {{ dbt.type_string() }} ) as first_name
         , cast(NULL as {{ dbt.type_string() }} ) as last_name
+        , cast(NULL as {{ dbt.type_string() }} ) as social_security_number
+        , 'self' as subscriber_relation
         , cast(NULL as {{ dbt.type_string() }} ) as address
         , cast(NULL as {{ dbt.type_string() }} ) as city
         , cast(medicare_state_fips.ssa_fips_state_name as {{ dbt.type_string() }} ) as state
         , cast(NULL as {{ dbt.type_string() }} ) as zip_code
         , cast(NULL as {{ dbt.type_string() }} ) as phone
         , 'medicare_lds' as data_source
+        , 'master_beneficiary_summary' as file_name
+        , cast(NULL as date ) as ingest_datetime
+
+
     from enrollment_span
          left join eligibility_unpivot
             on enrollment_span.desy_sort_key = eligibility_unpivot.desy_sort_key

models/final/medical_claim.sql

@@ -1,13 +1,34 @@
-select * from {{ ref('carrier_claim')}}
-union all
-select * from {{ ref('dme_claim')}}
-union all
-select * from {{ ref('home_health_claim')}}
-union all
-select * from {{ ref('hospice_claim')}}
-union all
-select * from {{ ref('inpatient_claim')}}
-union all
-select * from {{ ref('outpatient_claim')}}
-union all
-select * from {{ ref('snf_claim')}}
+
+with month_start_and_end_dates as (
+  select distinct 
+      year as year_nbr
+      ,month as month_nbr
+      ,first_day_of_month
+      ,last_day_of_month
+  from {{ ref('reference_data__calendar')}}
+)
+
+,member_months as (
+select distinct
+    a.patient_id
+  , year_nbr
+  , month_nbr
+  , a.payer
+  , a.plan
+  , data_source
+from {{ ref('eligibility') }} a
+inner join month_start_and_end_dates b
+  on a.enrollment_start_date <= b.last_day_of_month
+  and a.enrollment_end_date >= b.first_day_of_month
+)
+
+-- limit claims to only enrolled members, removing claims for members that we only have partial claims data for.
+select c.*
+,cast(null as {{ dbt.type_string() }} ) as rendering_tin
+,cast(null as {{ dbt.type_string() }} ) as billing_tin
+from {{ ref('_int_medical_claim') }} c
+inner join member_months mm on c.patient_id = mm.patient_id
+and
+extract(year from c.claim_start_date) = mm.year_nbr
+and
+extract(month from c.claim_start_date) = mm.month_nbr

models/final/pharmacy_claim.sql

@@ -13,10 +13,14 @@ select
     ,cast(null as int) as DAYS_SUPPLY
     ,cast(null as int) as REFILLS
     ,cast(null as date) as PAID_DATE
+    ,cast(null as numeric) as CHARGE_AMOUNT
     ,cast(null as numeric) as PAID_AMOUNT
     ,cast(null as numeric) as ALLOWED_AMOUNT
     ,cast(null as numeric) as COPAYMENT_AMOUNT
     ,cast(null as numeric) as COINSURANCE_AMOUNT
     ,cast(null as numeric) as DEDUCTIBLE_AMOUNT
     ,cast(null as {{ dbt.type_string() }}) as DATA_SOURCE
+    ,cast(null as numeric) as in_network_flag
+    ,cast(null as {{ dbt.type_string() }}) as file_name
+    ,cast(NULL as date ) as ingest_datetime
 limit 0

models/intermediate/_int_medical_claim.sql

@@ -0,0 +1,5 @@
+{{ dbt_utils.union_relations(
+    relations=[ref('carrier_claim'), ref('dme_claim'), ref('home_health_claim'), ref('hospice_claim')
+        , ref('inpatient_claim'), ref('outpatient_claim'), ref('snf_claim')],
+    exclude=["_DBT_SOURCE_RELATION"]
+) }}

models/intermediate/carrier_claim.sql

@@ -8,6 +8,14 @@ with carrier_base_claim as (
 
 )
 
+, claim_start_date as (
+
+  select l.claim_no
+  ,min(l.line_last_expns_dt) as claim_start_date
+  from {{ source('medicare_lds','carrier_claim_line') }} l
+  group by l.claim_no
+)
+
 select
       /* Claim ID is not unique across claim types.  Concatenating original claim ID, claim year, and claim type. */
       cast(b.claim_no as {{ dbt.type_string() }} )
@@ -20,10 +28,10 @@ select
     , cast(b.desy_sort_key as {{ dbt.type_string() }} ) as member_id
     , cast('medicare' as {{ dbt.type_string() }} ) as payer
     , cast('medicare' as {{ dbt.type_string() }} ) as plan
-    , date(NULL) as claim_start_date
-    , {{try_to_cast_date('b.clm_thru_dt', 'YYYYMMDD')}} as claim_end_date
-    , date(NULL) as claim_line_start_date
-    , {{ try_to_cast_date('l.clm_thru_dt', 'YYYYMMDD') }} as claim_line_end_date
+    , {{ try_to_cast_date('c.claim_start_date', 'YYYYMMDD') }} as claim_start_date
+    , {{ try_to_cast_date('b.clm_thru_dt', 'YYYYMMDD') }} as claim_end_date
+    , {{ try_to_cast_date('l.line_last_expns_dt', 'YYYYMMDD') }} as claim_line_start_date
+    , {{ try_to_cast_date('l.line_last_expns_dt', 'YYYYMMDD') }} as claim_line_end_date
     , date(NULL) as admission_date
     , date(NULL) as discharge_date
     , cast(NULL as {{ dbt.type_string() }} ) as admit_source_code
@@ -164,6 +172,11 @@ select
     , date(NULL) as procedure_date_24
     , date(NULL) as procedure_date_25
     , 'medicare_lds' as data_source
+    , 1 as in_network_flag
+    , 'carrier_claim' as file_name
+    , cast(NULL as date ) as ingest_datetime
+
 from carrier_base_claim as b
 inner join {{ source('medicare_lds','carrier_claim_line') }} as l
     on b.claim_no = l.claim_no
+inner join claim_start_date c on b.claim_no = c.claim_no

models/intermediate/dme_claim.sql

@@ -7,6 +7,14 @@ with dme_base_claim as (
     /** filter out denied claims **/
 )
 
+, claim_start_date as (
+
+  select l.claim_no
+  ,min(l.line_last_expns_dt) as claim_start_date
+  from {{ source('medicare_lds','dme_claim_line') }} l
+  group by l.claim_no
+)
+
 select
       /* Claim ID is not unique across claim types.  Concatenating original claim ID, claim year, and claim type. */
       cast(b.claim_no as {{ dbt.type_string() }} )
@@ -19,10 +27,10 @@ select
     , cast(b.desy_sort_key as {{ dbt.type_string() }} ) as member_id
     , cast('medicare' as {{ dbt.type_string() }} ) as payer
     , cast('medicare' as {{ dbt.type_string() }} ) as plan
-    , date(NULL) as claim_start_date
+    , {{ try_to_cast_date('c.claim_start_date', 'YYYYMMDD') }} as claim_start_date
     , {{ try_to_cast_date('b.clm_thru_dt', 'YYYYMMDD') }} as claim_end_date
-    , date(NULL) as claim_line_start_date
-    , {{ try_to_cast_date('l.clm_thru_dt', 'YYYYMMDD') }} as claim_line_end_date
+    , {{ try_to_cast_date('l.line_last_expns_dt', 'YYYYMMDD') }} as claim_line_start_date
+    , {{ try_to_cast_date('l.line_last_expns_dt', 'YYYYMMDD') }} as claim_line_end_date
     , date(NULL) as admission_date
     , date(NULL) as discharge_date
     , cast(NULL as {{ dbt.type_string() }} ) as admit_source_code
@@ -163,6 +171,10 @@ select
     , date(NULL) as procedure_date_24
     , date(NULL) as procedure_date_25
     , 'medicare_lds' as data_source
+    , 1 as in_network_flag
+    , 'dme_claim' as file_name
+    , cast(NULL as date ) as ingest_datetime    
 from dme_base_claim as b
 inner join {{ source('medicare_lds','dme_claim_line') }} as l
     on b.claim_no = l.claim_no
+inner join claim_start_date c on b.claim_no = c.claim_no