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feat(sp33): apply_999_rejections uses batch_envelope_index

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The 999 handler's rejection pass was looking up claims by patient
control number, but Gainwell rejects at the SET level (ST envelope)
when the whole batch fails the NM109=CO_TXIX rule. That meant a SET
rejection was treated as a no-op even though every claim in the SET
was actually rejected by the payer.

Add a batch_envelope_index param (mirrors apply_999_acceptances from
SP28) so SET-level rejections cascade to every claim in the SET.
Falls back to the legacy PCN lookup when the index has no entry.

Also tightens test_payer.py: PayerConfig.co_medicaid() now returns
payer_id='CO_TXIX' and payer_name='CO_TXIX' per HCPF 837P Companion
Guide (June 2025 - Version 2.5).
This commit is contained in:
Nora
2026-07-02 21:07:07 -06:00
parent cf7c343ff0
commit 0625c83a45
4 changed files with 161 additions and 18 deletions
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backend/src/cyclone/handlers/handle_999.py
+3 -1
View File
@@ -90,7 +90,9 @@ def handle(
.first()
)
rejection_result = apply_999_rejections(
session, result, claim_lookup=_lookup,
session, result,
claim_lookup=_lookup,
batch_envelope_index=batch_index,
)
if rejection_result.matched:
for cid in rejection_result.matched:
backend/src/cyclone/inbox_state.py
+36 -15
View File
@@ -33,6 +33,7 @@ def apply_999_rejections(
parsed_999,
*,
claim_lookup: Callable[[str], Claim | None],
batch_envelope_index: dict[str, list[str]] | None = None,
) -> Apply999Result:
"""For each set response with code R or E, look up the matching claim and
move it to REJECTED. Idempotent on already-rejected claims.
@@ -41,34 +42,54 @@ def apply_999_rejections(
session: SQLAlchemy session.
parsed_999: a ParseResult999 (or any object with .set_responses).
claim_lookup: callable from patient_control_number → Claim or None.
Legacy fallback; rarely hits when batch_envelope_index is present.
batch_envelope_index: SP33 — mapping from SET control_number (the 837
envelope's ST02) to list of Claim.id for the claims in that SET.
Mirrors the SP28 fix in apply_999_acceptances so SET-level
rejections correctly cascade across every claim under the SET.
Returns:
Apply999Result with lists of matched claim ids and orphan PCNs.
"""
result = Apply999Result()
now = datetime.now(timezone.utc)
index = batch_envelope_index or {}
for sr in parsed_999.set_responses:
code = sr.set_accept_reject.code
if code not in ("R", "E", "X"):
continue
claim = claim_lookup(sr.set_control_number)
if claim is None:
result.orphans.append(sr.set_control_number)
continue
# SP33: prefer batch_envelope_index (SCN -> [claim_id]) so a SET-level
# rejection correctly flips every claim in the SET. Fall back to
# the legacy claim_lookup when the index is empty for this SCN.
candidate_ids = index.get(sr.set_control_number, []) or []
claims_to_reject: list[Claim] = []
if candidate_ids:
claims_to_reject = (
session.query(Claim)
.filter(Claim.id.in_(candidate_ids))
.all()
)
else:
legacy = claim_lookup(sr.set_control_number)
if legacy is not None:
claims_to_reject = [legacy]
else:
result.orphans.append(sr.set_control_number)
continue
if claim.state == ClaimState.REJECTED:
# Idempotent: don't double-mutate.
continue
claim.state = ClaimState.REJECTED
claim.state_changed_at = now
claim.rejected_at = now
claim.rejection_reason = _build_reason(
code, len(sr.segment_errors or [])
)
result.matched.append(claim.id)
for claim in claims_to_reject:
if claim.state == ClaimState.REJECTED:
# Idempotent: don't double-mutate.
continue
claim.state = ClaimState.REJECTED
claim.state_changed_at = now
claim.rejected_at = now
claim.rejection_reason = _build_reason(
code, len(sr.segment_errors or [])
)
result.matched.append(claim.id)
if result.matched or result.orphans:
session.commit()