feat(store): get_claim_detail returns full claim context with history + matched remit
This commit is contained in:
@@ -417,6 +417,203 @@ def to_ui_claim_from_orm(
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}
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}
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# Max number of ActivityEvent rows surfaced in the detail drawer's
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# state history. The spec caps it at 50; a higher claim volume (manual
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# match/unmatch thrash) just shows the 50 most recent. Exposed as a
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# module constant so the endpoint layer can pass it through as a
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# default if it ever supports a `?limit=N` query param.
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CLAIM_DETAIL_HISTORY_LIMIT = 50
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def _iso_z(value: datetime | None) -> str:
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"""Format a tz-aware-or-naive UTC datetime as ISO-8601 with trailing Z.
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The DB columns are declared ``DateTime(timezone=True)`` and rows are
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stored UTC at write time, but SQLite drops the tzinfo on read
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(returning a naive ``datetime``). Re-attach UTC for naive values
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so the spec contract holds: every ISO datetime field ends in Z.
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"""
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if value is None:
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return ""
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if value.tzinfo is None:
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value = value.replace(tzinfo=timezone.utc)
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return value.isoformat().replace("+00:00", "Z")
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def _address_to_ui(addr: dict | None) -> dict:
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"""Render a raw ``Address`` dict in the spec's parties address shape.
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Returns an empty dict when the source is missing so the UI can
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branch on the field's presence rather than the value. The spec
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shape is ``{line1, line2|null, city, state, zip}``.
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"""
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if not addr:
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return {}
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return {
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"line1": addr.get("line1") or "",
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"line2": addr.get("line2"),
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"city": addr.get("city") or "",
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"state": addr.get("state") or "",
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"zip": addr.get("zip") or "",
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}
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def _validation_issues_to_ui(issues: list[dict] | None) -> list[dict]:
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"""Project ValidationIssue dicts onto the spec's per-issue shape.
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Source includes ``segment_index`` (a parser debug aid) which the
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spec doesn't surface; we drop it. The endpoint contract is
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``{rule, severity, message}`` per issue.
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"""
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if not issues:
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return []
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return [
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{
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"rule": issue.get("rule", ""),
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"severity": issue.get("severity", "error"),
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"message": issue.get("message", ""),
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}
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for issue in issues
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]
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def to_ui_claim_detail(
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row: Claim,
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*,
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batch_id: str,
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parsed_at: datetime,
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) -> dict:
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"""Map an ORM ``Claim`` row to the SP4 detail-drawer UI shape.
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A superset of :func:`to_ui_claim_from_orm`: same top-level identity
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fields, plus the full parties / validation / service-lines /
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diagnoses / raw-segments / service-date / state-label payload that
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the drawer needs. ``matchedRemittance`` and ``stateHistory`` are
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*not* filled in here — they require extra queries and are stitched
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in by :meth:`CycloneStore.get_claim_detail`.
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The mapper is deliberately a pure function (no DB I/O) so the
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endpoint layer can call it from a worker thread or swap the
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history/remittance sources for tests without re-implementing the
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body.
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"""
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raw = row.raw_json or {}
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bp = raw.get("billing_provider", {}) or {}
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payer_obj = raw.get("payer", {}) or {}
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sub = raw.get("subscriber", {}) or {}
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service_lines = raw.get("service_lines", []) or []
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diagnoses = raw.get("diagnoses", []) or []
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validation = raw.get("validation", {}) or {}
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raw_segments = raw.get("raw_segments", []) or []
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parsed_iso = parsed_at.isoformat().replace("+00:00", "Z")
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state_value = (
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row.state.value if hasattr(row.state, "value") else str(row.state)
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)
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# Service dates come from the dedicated ORM columns (denormalized at
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# ingest in _claim_837_row so the list views can sort/filter on
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# them without a JSON parse). ``isoformat()`` on a ``date`` gives
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# ``YYYY-MM-DD`` — the spec shape.
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service_date_from_iso = (
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row.service_date_from.isoformat() if row.service_date_from else None
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)
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service_date_to_iso = (
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row.service_date_to.isoformat() if row.service_date_to else None
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)
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return {
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# -- identity + state -----------------------------------------
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"id": row.id,
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"batchId": batch_id,
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"state": state_value,
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"stateLabel": state_value.capitalize(),
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# -- money + dates --------------------------------------------
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"billedAmount": float(row.charge_amount or 0),
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"serviceDateFrom": service_date_from_iso,
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"serviceDateTo": service_date_to_iso,
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"submissionDate": parsed_iso,
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"parsedAt": parsed_iso,
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# -- patient / provider / payer -------------------------------
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"patientName": (
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f"{sub.get('first_name', '')} {sub.get('last_name', '')}".strip()
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),
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"providerNpi": bp.get("npi") or row.provider_npi or "",
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"providerName": bp.get("name") or "",
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"payerName": payer_obj.get("name") or "",
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"payerId": payer_obj.get("id") or row.payer_id or "",
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# -- diagnoses ------------------------------------------------
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"diagnoses": [
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{
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"code": d.get("code", ""),
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"qualifier": d.get("qualifier"),
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}
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for d in diagnoses
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],
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# -- service lines --------------------------------------------
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# ``service_lines[i].procedure`` is a nested dict in the
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# serialized raw_json; the spec flattens it into the line.
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# ``charge`` and ``units`` are stored as Decimal via Pydantic
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# and serialized to string — coerce defensively. ``modifiers``
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# defaults to [] so the UI doesn't have to handle null.
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"serviceLines": [
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{
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"lineNumber": sl.get("line_number"),
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"procedureQualifier": (
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sl.get("procedure", {}).get("qualifier", "") or ""
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),
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"procedureCode": (
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sl.get("procedure", {}).get("code", "") or ""
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),
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"modifiers": list(
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sl.get("procedure", {}).get("modifiers") or []
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),
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"charge": float(sl.get("charge") or 0),
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"units": (
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float(sl["units"])
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if sl.get("units") is not None
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else None
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),
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"unitType": sl.get("unit_type"),
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"serviceDate": sl.get("service_date"),
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}
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for sl in service_lines
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],
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# -- parties --------------------------------------------------
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"parties": {
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"billingProvider": {
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"name": bp.get("name") or "",
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"npi": bp.get("npi") or "",
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"taxId": bp.get("tax_id") or "",
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"address": _address_to_ui(bp.get("address")),
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},
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"subscriber": {
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"firstName": sub.get("first_name") or "",
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"lastName": sub.get("last_name") or "",
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"memberId": sub.get("member_id") or "",
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"dob": sub.get("dob"),
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"gender": sub.get("gender"),
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},
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"payer": {
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"name": payer_obj.get("name") or "",
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"id": payer_obj.get("id") or "",
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},
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},
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# -- validation ----------------------------------------------
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"validation": {
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"passed": bool(validation.get("passed", True)),
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"errors": _validation_issues_to_ui(validation.get("errors")),
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"warnings": _validation_issues_to_ui(validation.get("warnings")),
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},
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# -- raw segments (debug aid) --------------------------------
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"rawSegments": raw_segments,
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# -- matched remittance (filled by get_claim_detail) ---------
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"matchedRemittance": None,
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# -- state history (filled by get_claim_detail) --------------
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"stateHistory": [],
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}
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def to_ui_remittance_from_orm(
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def to_ui_remittance_from_orm(
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row: Remittance,
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row: Remittance,
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*,
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*,
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@@ -852,6 +1049,96 @@ class CycloneStore:
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cas_rows=cas_rows,
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cas_rows=cas_rows,
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)
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)
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def get_claim_detail(self, claim_id: str) -> dict | None:
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"""Return the SP4 detail-drawer shape for one claim, or ``None``.
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Drives ``GET /api/claims/{claim_id}``. Returns the spec-shaped
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dict from :func:`to_ui_claim_detail` (header + state + parties +
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validation + service lines + diagnoses + raw segments) stitched
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with the claim's recent activity history and, if paired, a
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matched-remittance summary.
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Returns ``None`` when ``claim_id`` is not in the DB so the API
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layer can map that to a 404 — the URL-driven drawer
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distinguishes "claim doesn't exist" from "fetch failed" (the
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spec §3.4 calls for a distinct 404 state in the drawer).
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The history is capped at :data:`CLAIM_DETAIL_HISTORY_LIMIT`
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(50, per the spec) and ordered ``ts DESC`` so the most recent
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event is first. The status string in ``matchedRemittance``
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follows the same ``reconciled``/``received`` mapping used by
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:func:`to_ui_remittance_from_orm`.
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"""
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# Lazy import — same pattern used throughout this module to
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# avoid a circular store ↔ db import on cold start.
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from cyclone import db as _db
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with _db.SessionLocal()() as s:
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row = s.get(Claim, claim_id)
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if row is None:
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return None
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history_rows = (
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s.query(ActivityEvent)
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.filter(ActivityEvent.claim_id == claim_id)
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.order_by(ActivityEvent.ts.desc())
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.limit(CLAIM_DETAIL_HISTORY_LIMIT)
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.all()
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)
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parsed_at = (
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row.batch.parsed_at
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if row.batch is not None
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else None
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)
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if parsed_at is not None and parsed_at.tzinfo is None:
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parsed_at = parsed_at.replace(tzinfo=timezone.utc)
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detail = to_ui_claim_detail(
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row,
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batch_id=row.batch_id,
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parsed_at=parsed_at,
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)
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detail["stateHistory"] = [
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{
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"kind": ev.kind,
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# SQLite drops tzinfo on read; rows are stored UTC
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# at write time (see ``add`` / ``manual_match``),
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# so re-attach UTC if needed to keep the spec
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# contract that ``ts`` ends in Z.
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"ts": _iso_z(ev.ts),
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"batchId": ev.batch_id,
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"remittanceId": ev.remittance_id,
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}
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for ev in history_rows
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]
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if row.matched_remittance_id is not None:
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remit = s.get(Remittance, row.matched_remittance_id)
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if remit is not None:
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status = (
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"reconciled"
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if remit.status_code in ("21", "22")
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else "received"
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)
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detail["matchedRemittance"] = {
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"id": remit.id,
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"totalPaid": float(remit.total_paid or 0),
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"status": status,
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"receivedAt": _iso_z(remit.received_at),
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}
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# If the remittance was deleted out from under the FK
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# (the FK is ``ON DELETE SET NULL`` so the column is
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# already cleared in normal flow), the matched_remittance_id
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# would be None here and we wouldn't enter this branch.
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# If the FK is non-null but the row is gone (e.g. tests
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# that bypass the cascade), fall through with the
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# default ``None`` — the UI shows "no match" rather
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# than crashing.
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return detail
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def all(self) -> list[BatchRecord]:
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def all(self) -> list[BatchRecord]:
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"""Return every ``BatchRecord``, oldest first (no pagination)."""
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"""Return every ``BatchRecord``, oldest first (no pagination)."""
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with db.SessionLocal()() as s:
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with db.SessionLocal()() as s:
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@@ -0,0 +1,426 @@
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"""Tests for ``CycloneStore.get_claim_detail`` (SP4 Task 1).
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The method is the read path behind the ``GET /api/claims/{id}`` endpoint
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that drives the per-claim detail drawer. The response shape is locked in
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``docs/superpowers/specs/2026-06-20-cyclone-claim-drawer-design.md`` §3.2.
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What this exercises:
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* ``test_get_claim_detail_returns_none_for_missing`` — a claim id that
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isn't in the DB must return ``None`` (the API maps that to 404).
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* ``test_get_claim_detail_happy_path_returns_full_shape`` — a fully
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populated claim (diagnoses, service lines, parties, validation,
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raw segments) round-trips into the spec dict.
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* ``test_get_claim_detail_includes_state_history`` — the
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``stateHistory`` array surfaces ``ActivityEvent`` rows for this
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claim, newest first, with both batch and remittance associations
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preserved.
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* ``test_get_claim_detail_includes_matched_remittance_summary`` — a
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claim that has been paired with a remittance via ``manual_match``
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surfaces a ``matchedRemittance`` summary with id / totalPaid /
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status / receivedAt.
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* ``test_get_claim_detail_no_matched_remittance_returns_null_field``
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— an unmatched claim returns ``matchedRemittance: null`` (not
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missing, not an empty dict).
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"""
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from __future__ import annotations
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from datetime import date, datetime, timezone
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from decimal import Decimal
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import pytest
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from cyclone import db
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from cyclone.parsers.models import (
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Address,
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BatchSummary,
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BillingProvider,
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ClaimHeader,
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ClaimOutput,
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Diagnosis,
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Envelope,
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Payer,
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ParseResult,
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Procedure,
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ServiceLine,
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Subscriber,
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ValidationIssue,
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ValidationReport,
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)
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from cyclone.parsers.models_835 import (
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ClaimAdjustment,
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ClaimPayment,
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Envelope as Envelope835,
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FinancialInfo,
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ParseResult835,
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Payer835,
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Payee835,
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ReassociationTrace,
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ServicePayment,
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BatchSummary as BatchSummary835,
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)
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from cyclone.store import BatchRecord837, BatchRecord835, CycloneStore
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# ---------------------------------------------------------------------------
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# Fixtures
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|
# ---------------------------------------------------------------------------
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|
|
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|
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@pytest.fixture(autouse=True)
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def _setup(tmp_path, monkeypatch):
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|
"""Per-test DB init — matches the pattern in test_store_reconcile.py.
|
||||||
|
|
||||||
|
Defensive: conftest.py already provides an autouse fixture, but we
|
||||||
|
declare it here too so this file is self-contained and matches the
|
||||||
|
convention used by the other store-level test modules.
|
||||||
|
"""
|
||||||
|
monkeypatch.setenv("CYCLONE_DB_URL", f"sqlite:///{tmp_path}/test.db")
|
||||||
|
db._reset_for_tests()
|
||||||
|
db.init_db()
|
||||||
|
yield
|
||||||
|
db._reset_for_tests()
|
||||||
|
|
||||||
|
|
||||||
|
# ---------------------------------------------------------------------------
|
||||||
|
# Builders
|
||||||
|
# ---------------------------------------------------------------------------
|
||||||
|
|
||||||
|
|
||||||
|
def _make_rich_claim_837(claim_id: str = "CLM-1") -> ClaimOutput:
|
||||||
|
"""Build a ClaimOutput with every section populated.
|
||||||
|
|
||||||
|
Drives the happy-path test: the detail mapper should round-trip
|
||||||
|
diagnoses, service lines (with procedure+modifiers+charge+units),
|
||||||
|
parties (billing_provider with address, subscriber with dob+gender,
|
||||||
|
payer with id), validation issues, and raw_segments.
|
||||||
|
"""
|
||||||
|
bp_addr = Address(
|
||||||
|
line1="123 Main St", line2="Suite 400",
|
||||||
|
city="Denver", state="CO", zip="80202",
|
||||||
|
)
|
||||||
|
sub_addr = Address(
|
||||||
|
line1="456 Oak Ave", line2=None,
|
||||||
|
city="Boulder", state="CO", zip="80301",
|
||||||
|
)
|
||||||
|
return ClaimOutput(
|
||||||
|
claim_id=claim_id,
|
||||||
|
control_number="0001",
|
||||||
|
transaction_date=date(2026, 6, 11),
|
||||||
|
billing_provider=BillingProvider(
|
||||||
|
name="Test Provider", npi="1234567890",
|
||||||
|
tax_id="99-1234567", address=bp_addr,
|
||||||
|
),
|
||||||
|
subscriber=Subscriber(
|
||||||
|
first_name="John", last_name="Doe", member_id="M-001",
|
||||||
|
dob=date(1980, 1, 1), gender="M", address=sub_addr,
|
||||||
|
),
|
||||||
|
payer=Payer(name="COHCPF", id="SKCO0"),
|
||||||
|
claim=ClaimHeader(
|
||||||
|
claim_id=claim_id, total_charge=Decimal("100.00"),
|
||||||
|
frequency_code="1", place_of_service="11",
|
||||||
|
),
|
||||||
|
diagnoses=[Diagnosis(code="Z00", qualifier="ABK")],
|
||||||
|
service_lines=[
|
||||||
|
ServiceLine(
|
||||||
|
line_number=1,
|
||||||
|
procedure=Procedure(
|
||||||
|
qualifier="HC", code="99213",
|
||||||
|
modifiers=["25"],
|
||||||
|
),
|
||||||
|
charge=Decimal("80.00"),
|
||||||
|
unit_type="UN",
|
||||||
|
units=Decimal("1.0"),
|
||||||
|
service_date=date(2026, 6, 11),
|
||||||
|
),
|
||||||
|
ServiceLine(
|
||||||
|
line_number=2,
|
||||||
|
procedure=Procedure(qualifier="HC", code="85025"),
|
||||||
|
charge=Decimal("20.00"),
|
||||||
|
unit_type="UN",
|
||||||
|
units=Decimal("1.0"),
|
||||||
|
service_date=date(2026, 6, 11),
|
||||||
|
),
|
||||||
|
],
|
||||||
|
validation=ValidationReport(
|
||||||
|
passed=False,
|
||||||
|
errors=[
|
||||||
|
ValidationIssue(
|
||||||
|
rule="R050_diagnosis_present",
|
||||||
|
severity="error",
|
||||||
|
message="At least one diagnosis code is required",
|
||||||
|
),
|
||||||
|
],
|
||||||
|
warnings=[],
|
||||||
|
),
|
||||||
|
raw_segments=[["ISA", "*00*"], ["CLM", claim_id, "*100***"]],
|
||||||
|
)
|
||||||
|
|
||||||
|
|
||||||
|
def _add_837_with_claim(s: CycloneStore, claim_id: str = "CLM-1") -> str:
|
||||||
|
"""Add a single 837 claim via the store. Returns the batch id."""
|
||||||
|
co = _make_rich_claim_837(claim_id)
|
||||||
|
parsed_at = datetime(2026, 6, 11, 12, 0, tzinfo=timezone.utc)
|
||||||
|
pr = ParseResult(
|
||||||
|
envelope=Envelope(
|
||||||
|
sender_id="S", receiver_id="R", control_number="0001",
|
||||||
|
transaction_date=date(2026, 6, 11),
|
||||||
|
),
|
||||||
|
claims=[co],
|
||||||
|
summary=BatchSummary(
|
||||||
|
input_file="c.txt", control_number="0001",
|
||||||
|
transaction_date=date(2026, 6, 11),
|
||||||
|
total_claims=1, passed=0, failed=1,
|
||||||
|
),
|
||||||
|
)
|
||||||
|
batch_id = f"b-837-{claim_id}"
|
||||||
|
s.add(BatchRecord837(
|
||||||
|
id=batch_id, kind="837p", input_filename="c.txt",
|
||||||
|
parsed_at=parsed_at, result=pr,
|
||||||
|
))
|
||||||
|
return batch_id
|
||||||
|
|
||||||
|
|
||||||
|
def _add_835_with_remit(
|
||||||
|
s: CycloneStore,
|
||||||
|
pcn: str,
|
||||||
|
charge: str = "100",
|
||||||
|
paid: str = "100",
|
||||||
|
status: str = "1",
|
||||||
|
) -> str:
|
||||||
|
"""Add a single 835 remittance. Returns the batch id."""
|
||||||
|
cp = ClaimPayment(
|
||||||
|
payer_claim_control_number=pcn,
|
||||||
|
status_code=status,
|
||||||
|
status_label="Primary",
|
||||||
|
total_charge=charge, total_paid=paid,
|
||||||
|
service_payments=[
|
||||||
|
ServicePayment(
|
||||||
|
line_number=1, procedure_qualifier="HC",
|
||||||
|
procedure_code="99213",
|
||||||
|
charge=charge, payment=paid,
|
||||||
|
adjustments=[],
|
||||||
|
),
|
||||||
|
],
|
||||||
|
)
|
||||||
|
parsed_at = datetime(2026, 6, 12, 10, 0, tzinfo=timezone.utc)
|
||||||
|
batch_id = f"b-835-{pcn}"
|
||||||
|
s.add(BatchRecord835(
|
||||||
|
id=batch_id, kind="835", input_filename="era.txt",
|
||||||
|
parsed_at=parsed_at,
|
||||||
|
result=ParseResult835(
|
||||||
|
envelope=Envelope835(
|
||||||
|
sender_id="P", receiver_id="R", control_number="0002",
|
||||||
|
transaction_date=date(2026, 6, 12),
|
||||||
|
),
|
||||||
|
financial_info=FinancialInfo(
|
||||||
|
handling_code="C", paid_amount=Decimal("0"),
|
||||||
|
credit_debit_flag="C", payment_method=None,
|
||||||
|
),
|
||||||
|
trace=ReassociationTrace(
|
||||||
|
trace_type_code="1", trace_number="0001",
|
||||||
|
originating_company_id="P",
|
||||||
|
),
|
||||||
|
payer=Payer835(name="COHCPF", id="SKCO0"),
|
||||||
|
payee=Payee835(name="Test Provider", npi="1234567890"),
|
||||||
|
claims=[cp],
|
||||||
|
summary=BatchSummary835(
|
||||||
|
input_file="era.txt", control_number="0002",
|
||||||
|
transaction_date=date(2026, 6, 12),
|
||||||
|
total_claims=1, passed=1, failed=0,
|
||||||
|
),
|
||||||
|
),
|
||||||
|
))
|
||||||
|
return batch_id
|
||||||
|
|
||||||
|
|
||||||
|
# ---------------------------------------------------------------------------
|
||||||
|
# Tests
|
||||||
|
# ---------------------------------------------------------------------------
|
||||||
|
|
||||||
|
|
||||||
|
def test_get_claim_detail_returns_none_for_missing():
|
||||||
|
"""An unknown claim id must return ``None`` (not raise, not empty dict)."""
|
||||||
|
s = CycloneStore()
|
||||||
|
assert s.get_claim_detail("CLM-DOES-NOT-EXIST") is None
|
||||||
|
|
||||||
|
|
||||||
|
def test_get_claim_detail_happy_path_returns_full_shape():
|
||||||
|
"""A fully populated claim round-trips into the spec-shaped dict."""
|
||||||
|
s = CycloneStore()
|
||||||
|
batch_id = _add_837_with_claim(s, "CLM-1")
|
||||||
|
parsed_at = datetime(2026, 6, 11, 12, 0, tzinfo=timezone.utc)
|
||||||
|
|
||||||
|
out = s.get_claim_detail("CLM-1")
|
||||||
|
assert out is not None
|
||||||
|
|
||||||
|
# -- top-level identity -----------------------------------------
|
||||||
|
assert out["id"] == "CLM-1"
|
||||||
|
assert out["batchId"] == batch_id
|
||||||
|
# SP1 ingest stamps every claim as submitted; detail shape preserves it.
|
||||||
|
assert out["state"] == "submitted"
|
||||||
|
# stateLabel is a human-readable capitalization of state.
|
||||||
|
assert out["stateLabel"] == "Submitted"
|
||||||
|
|
||||||
|
# -- money + dates ----------------------------------------------
|
||||||
|
assert out["billedAmount"] == 100.0
|
||||||
|
assert isinstance(out["billedAmount"], float)
|
||||||
|
assert out["submissionDate"] == "2026-06-11T12:00:00Z"
|
||||||
|
assert out["parsedAt"] == "2026-06-11T12:00:00Z"
|
||||||
|
assert out["serviceDateFrom"] == "2026-06-11"
|
||||||
|
assert out["serviceDateTo"] == "2026-06-11"
|
||||||
|
|
||||||
|
# -- patient + provider + payer ---------------------------------
|
||||||
|
assert out["patientName"] == "John Doe"
|
||||||
|
assert out["providerNpi"] == "1234567890"
|
||||||
|
assert out["providerName"] == "Test Provider"
|
||||||
|
assert out["payerName"] == "COHCPF"
|
||||||
|
assert out["payerId"] == "SKCO0"
|
||||||
|
|
||||||
|
# -- diagnoses --------------------------------------------------
|
||||||
|
assert out["diagnoses"] == [{"code": "Z00", "qualifier": "ABK"}]
|
||||||
|
|
||||||
|
# -- service lines (procedure.flattened shape) ------------------
|
||||||
|
assert len(out["serviceLines"]) == 2
|
||||||
|
sl1 = out["serviceLines"][0]
|
||||||
|
assert sl1["lineNumber"] == 1
|
||||||
|
assert sl1["procedureQualifier"] == "HC"
|
||||||
|
assert sl1["procedureCode"] == "99213"
|
||||||
|
assert sl1["modifiers"] == ["25"]
|
||||||
|
assert sl1["charge"] == 80.0
|
||||||
|
assert sl1["units"] == 1.0
|
||||||
|
assert sl1["unitType"] == "UN"
|
||||||
|
assert sl1["serviceDate"] == "2026-06-11"
|
||||||
|
# Second line has no modifiers — must be an empty list, not None.
|
||||||
|
sl2 = out["serviceLines"][1]
|
||||||
|
assert sl2["modifiers"] == []
|
||||||
|
assert sl2["procedureCode"] == "85025"
|
||||||
|
assert sl2["charge"] == 20.0
|
||||||
|
|
||||||
|
# -- parties ----------------------------------------------------
|
||||||
|
bp = out["parties"]["billingProvider"]
|
||||||
|
assert bp["name"] == "Test Provider"
|
||||||
|
assert bp["npi"] == "1234567890"
|
||||||
|
assert bp["taxId"] == "99-1234567"
|
||||||
|
assert bp["address"] == {
|
||||||
|
"line1": "123 Main St",
|
||||||
|
"line2": "Suite 400",
|
||||||
|
"city": "Denver",
|
||||||
|
"state": "CO",
|
||||||
|
"zip": "80202",
|
||||||
|
}
|
||||||
|
sub = out["parties"]["subscriber"]
|
||||||
|
assert sub["firstName"] == "John"
|
||||||
|
assert sub["lastName"] == "Doe"
|
||||||
|
assert sub["memberId"] == "M-001"
|
||||||
|
assert sub["dob"] == "1980-01-01"
|
||||||
|
assert sub["gender"] == "M"
|
||||||
|
payer = out["parties"]["payer"]
|
||||||
|
assert payer == {"name": "COHCPF", "id": "SKCO0"}
|
||||||
|
|
||||||
|
# -- validation -------------------------------------------------
|
||||||
|
v = out["validation"]
|
||||||
|
assert v["passed"] is False
|
||||||
|
assert len(v["errors"]) == 1
|
||||||
|
err = v["errors"][0]
|
||||||
|
assert err["rule"] == "R050_diagnosis_present"
|
||||||
|
assert err["severity"] == "error"
|
||||||
|
assert "diagnosis" in err["message"].lower()
|
||||||
|
assert v["warnings"] == []
|
||||||
|
|
||||||
|
# -- raw segments ----------------------------------------------
|
||||||
|
assert out["rawSegments"] == [
|
||||||
|
["ISA", "*00*"],
|
||||||
|
["CLM", "CLM-1", "*100***"],
|
||||||
|
]
|
||||||
|
|
||||||
|
# -- unmatched (this test doesn't pair anything) ---------------
|
||||||
|
assert out["matchedRemittance"] is None
|
||||||
|
|
||||||
|
# -- state history: at minimum the claim_submitted event -------
|
||||||
|
history = out["stateHistory"]
|
||||||
|
assert isinstance(history, list)
|
||||||
|
assert any(ev["kind"] == "claim_submitted" for ev in history), history
|
||||||
|
# The submitted event must carry the batch id, not a remittance id.
|
||||||
|
submitted = next(ev for ev in history if ev["kind"] == "claim_submitted")
|
||||||
|
assert submitted["batchId"] == batch_id
|
||||||
|
assert submitted["remittanceId"] is None
|
||||||
|
# ts is ISO Z.
|
||||||
|
assert submitted["ts"].endswith("Z")
|
||||||
|
|
||||||
|
|
||||||
|
def test_get_claim_detail_includes_state_history():
|
||||||
|
"""``stateHistory`` must include the manual_match event after pairing."""
|
||||||
|
s = CycloneStore()
|
||||||
|
_add_837_with_claim(s, "CLM-1")
|
||||||
|
# 835 with PCN that intentionally differs from the 837's member id so
|
||||||
|
# reconcile doesn't auto-pair on ingest — we want manual_match to do it.
|
||||||
|
_add_835_with_remit(s, pcn="CLM-1", paid="100", status="1")
|
||||||
|
s.manual_match("CLM-1", "CLM-1")
|
||||||
|
|
||||||
|
out = s.get_claim_detail("CLM-1")
|
||||||
|
assert out is not None
|
||||||
|
history = out["stateHistory"]
|
||||||
|
kinds = [ev["kind"] for ev in history]
|
||||||
|
# manual_match must appear; claim_submitted must also appear.
|
||||||
|
assert "manual_match" in kinds, history
|
||||||
|
assert "claim_submitted" in kinds, history
|
||||||
|
# Ordering: ts DESC — manual_match was inserted after the submitted
|
||||||
|
# event, so it must come first.
|
||||||
|
assert kinds.index("manual_match") < kinds.index("claim_submitted"), (
|
||||||
|
f"stateHistory not ordered DESC by ts: {history}"
|
||||||
|
)
|
||||||
|
# The manual_match event must carry the remittanceId. It also
|
||||||
|
# carries the remittance's batch_id (per the manual_match
|
||||||
|
# implementation) — the mapper passes through whatever is in the
|
||||||
|
# ActivityEvent row, which is correct per the spec's
|
||||||
|
# ``{kind, ts, batchId|null, remittanceId|null}`` contract.
|
||||||
|
mm = next(ev for ev in history if ev["kind"] == "manual_match")
|
||||||
|
assert mm["remittanceId"] == "CLM-1"
|
||||||
|
assert mm["batchId"] is not None
|
||||||
|
assert mm["ts"].endswith("Z")
|
||||||
|
|
||||||
|
# The claim_submitted event has no remittance_id (only a batch id),
|
||||||
|
# which is the opposite of manual_match.
|
||||||
|
submitted = next(ev for ev in history if ev["kind"] == "claim_submitted")
|
||||||
|
assert submitted["remittanceId"] is None
|
||||||
|
assert submitted["batchId"] is not None
|
||||||
|
|
||||||
|
|
||||||
|
def test_get_claim_detail_includes_matched_remittance_summary():
|
||||||
|
"""A paired claim surfaces a ``matchedRemittance`` summary block."""
|
||||||
|
s = CycloneStore()
|
||||||
|
_add_837_with_claim(s, "CLM-1")
|
||||||
|
_add_835_with_remit(s, pcn="CLM-1", paid="100", status="1")
|
||||||
|
s.manual_match("CLM-1", "CLM-1")
|
||||||
|
|
||||||
|
out = s.get_claim_detail("CLM-1")
|
||||||
|
assert out is not None
|
||||||
|
mr = out["matchedRemittance"]
|
||||||
|
assert mr is not None
|
||||||
|
assert mr["id"] == "CLM-1"
|
||||||
|
assert mr["totalPaid"] == 100.0
|
||||||
|
assert isinstance(mr["totalPaid"], float)
|
||||||
|
# status_code "1" → "received" (per to_ui_remittance_from_orm mapping).
|
||||||
|
assert mr["status"] == "received"
|
||||||
|
# receivedAt is ISO Z (the remit's received_at is tz-aware UTC).
|
||||||
|
assert mr["receivedAt"].endswith("Z")
|
||||||
|
# Sanity: the receivedAt parses back to a real timestamp.
|
||||||
|
parsed = datetime.fromisoformat(mr["receivedAt"].replace("Z", "+00:00"))
|
||||||
|
assert parsed.tzinfo is not None
|
||||||
|
|
||||||
|
|
||||||
|
def test_get_claim_detail_no_matched_remittance_returns_null_field():
|
||||||
|
"""An unmatched claim has ``matchedRemittance: null`` (not missing, not {})."""
|
||||||
|
s = CycloneStore()
|
||||||
|
_add_837_with_claim(s, "CLM-1")
|
||||||
|
# No 835 added — claim is unmatched.
|
||||||
|
|
||||||
|
out = s.get_claim_detail("CLM-1")
|
||||||
|
assert out is not None
|
||||||
|
# Key must exist; value must be None. A 404 endpoint would have
|
||||||
|
# removed the field, but the spec keeps the key with a null value so
|
||||||
|
# the UI can branch on `matchedRemittance == null` cleanly.
|
||||||
|
assert "matchedRemittance" in out
|
||||||
|
assert out["matchedRemittance"] is None
|
||||||
Reference in New Issue
Block a user