Add Blood and Body Fluid Exposure Policy

Encoding/Benefits/Blood and Body Fluid Exposure/berlitz.hdf

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+berlitz(clinical_injury_coverage(C),
+        "The clinical injury coverage applies to $C$")
+
+berlitz(claim_has_injury_coverage(C),
+        "The claim $C$ has injury coverage")
+
+berlitz(claim_requires_treatment(C),
+        "The claim $C$ requires treatment")
+
+berlitz(claim_is_exempt_from_coverage(C),
+        "The claim $C$ is exempt from coverage")
+
+berlitz(clinical_injury_service_type(S),
+        "$S$ is a type of clinical injury service")
+
+berlitz(clinical_injury_location_type(L),
+        "$L$ is a type of clinical injury location")
+
+berlitz(clinical_injury_diagnostic_service(D),
+        "$D$ is a diagnostic service for a clinical injury")
+
+berlitz(patient_is_eligible_for_treatment(P),
+        "The patient $P$ is eligible for treatment under clinical injury coverage")
+
+berlitz(patient_has_exclusion(P),
+        "The patient $P$ has an exclusion from treatment")

Encoding/Benefits/Blood and Body Fluid Exposure/metadata.metadata

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+type(claim, class).
+
+type(claim.patient_dob, attributerelation).
+domain(claim.patient_dob, clinical_related_injury_coverage).
+codomain(claim.patient_dob, date).
+unique(claim.patient_dob, yes).
+total(claim.patient_dob, yes).
+changestyle(claim.patient_dob, datestyle).
+
+type(claim.date_of_injury, attributerelation).
+domain(claim.date_of_injury, clinical_related_injury_coverage).
+codomain(claim.date_of_injury, date).
+unique(claim.date_of_injury, yes).
+total(claim.date_of_injury, yes).
+changestyle(claim.date_of_injury, datestyle).
+
+type(claim.service_type, attributerelation).
+domain(claim.service_type, clinical_related_injury_coverage).
+codomain(claim.service_type, clinical_related_injury_service).
+unique(claim.service_type, yes).
+total(claim.service_type, yes).
+changestyle(claim.service_type, selector).
+
+type(claim.location_of_service, attributerelation).
+domain(claim.location_of_service, clinical_related_injury_coverage).
+codomain(claim.location_of_service, clinical_related_injury_location).
+unique(claim.location_of_service, yes).
+total(claim.location_of_service, yes).
+changestyle(claim.location_of_service, selector).
+
+type(claim.treatment_required, attributerelation).
+domain(claim.treatment_required, clinical_related_injury_coverage).
+codomain(claim.treatment_required, boolean).
+unique(claim.treatment_required, yes).
+total(claim.treatment_required, yes).
+changestyle(claim.treatment_required, checkboxfield).
+
+type(claim.source_patient_diagnostic_services, attributerelation).
+domain(claim.source_patient_diagnostic_services, clinical_related_injury_coverage).
+codomain(claim.source_patient_diagnostic_services, clinical_related_diagnostic_services).
+unique(claim.source_patient_diagnostic_services, yes).
+total(claim.source_patient_diagnostic_services, yes).
+changestyle(claim.source_patient_diagnostic_services, selector).
+
+% General exclusions
+attribute(claim, exclusions).
+
+type(claim.exclusions, attributerelation).
+domain(claim.exclusions, clinical_related_injury_coverage).
+codomain(claim.exclusions, general_exclusion).
+unique(claim.exclusions, yes).
+total(claim.exclusions, yes).
+changestyle(claim.exclusions, checkboxfield).

Encoding/Benefits/Blood and Body Fluid Exposure/rules.hrf

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+eligible_health_services_for_clinical_injury(Claim) :-
+    patient_in_clinical_capacity(Claim) &
+    claim.has_clinical_injury(Claim) &
+    claim.is_treatment_for_wound(Claim).
+
+eligible_health_services_for_wound_treatment(Claim) :-
+    eligible_health_services_for_clinical_injury(Claim) &
+    claim.is_immediate_treatment(Claim) &
+    claim.includes_medications(Claim, prophylactic_medications) &
+    claim.includes_physician_visit(Claim) &
+    claim.includes_specialist_visit(Claim) &
+    claim.includes_outpatient_visit(Claim) &
+    claim.includes_walk_in_clinic_visit(Claim) &
+    claim.includes_urgent_care(Claim) &
+    claim.includes_emergency_services(Claim) &
+    claim.includes_diagnostic_lab_work(Claim) &
+    claim.includes_radiological_services(Claim).
+
+eligible_health_services_for_source_diagnosis(Claim) :-
+    patient_in_clinical_capacity(Claim) &
+    claim.has_clinical_injury(Claim) &
+    claim.is_source_of_injury(Claim) &
+    claim.includes_diagnostic_lab_work(Claim) &
+    claim.includes_radiological_services(Claim).
+
+eligible_health_services_for_illness_treatment(Claim) :-
+    claim.has_illness_due_to_wound(Claim) &
+    eligible_health_services_for_clinical_injury(Claim) &
+    claim.is_treatment_for_illness(Claim) &
+    claim.includes_physician_visit(Claim) &
+    claim.includes_specialist_visit(Claim) &
+    claim.includes_emergency_services(Claim) &
+    claim.includes_outpatient_visit(Claim) &
+    claim.includes_walk_in_clinic_visit(Claim) &
+    claim.includes_urgent_care(Claim) &
+    claim.includes_diagnostic_lab_work(Claim) &
+    claim.includes_radiological_services(Claim).
+
+non_covered_services_for_clinical_injury_illness(Claim) :-
+    claim.has_illness_due_to_wound(Claim) &
+    claim.includes_services_for_illness_not_related_to_wound(Claim).

Encoding/Benefits/Blood and Body Fluid Exposure/world.hdf

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+type(clinical_related_injury, clinical_related_injury_coverage)
+type(treatment_required, clinical_related_injury_coverage)
+type(exclusion_type, general_exclusion)
+type(clinical_injury_service, clinical_related_injury_service)
+type(clinical_injury_location, clinical_related_injury_location)
+type(clinical_related_diagnostic_services, clinical_related_diagnostic_services)
+type(patient_dob, date)
+type(date_of_injury, date)
+
+type(patient_eligibility_for_treatment, boolean)
+type(exclusion_for_treatment, boolean)
+type(patient_has_required_treatment, boolean)