feat(sp7): GET /api/claims/{id}/line-reconciliation endpoint
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Tyler
@@ -1212,6 +1212,203 @@ def get_claim_detail_endpoint(claim_id: str) -> dict:
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return body
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@app.get("/api/claims/{claim_id}/line-reconciliation")
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def get_claim_line_reconciliation(claim_id: str) -> dict:
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"""Per-line reconciliation view for the ClaimDrawer tab.
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Spec §5.1. Returns the 837 service lines and 835 SVC composites
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side-by-side, with per-line CAS adjustments and a summary block.
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Architecture note: 837 service lines live in ``Claim.raw_json``
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(not a separate ORM table), so the 837-side rows are read from the
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JSON blob; the 835-side rows come from ``ServiceLinePayment`` ORM.
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``LineReconciliation.claim_service_line_number`` stores the 1-based
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line number to join them.
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"""
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from sqlalchemy import select
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from cyclone.db import (
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LineReconciliation, ServiceLinePayment, CasAdjustment,
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)
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import json as _json
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from decimal import Decimal
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with db.SessionLocal()() as s:
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claim = s.get(db.Claim, claim_id)
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if claim is None:
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raise HTTPException(
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status_code=404,
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detail={"error": "Not found", "detail": f"Claim {claim_id} not found"},
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)
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# 837 service lines: from raw_json.
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raw = claim.raw_json or {}
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claim_lines_raw = raw.get("service_lines") or []
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# Normalize to dicts for the response.
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claim_lines = [_claim_line_dict(d) for d in claim_lines_raw]
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# 835 service payments: ORM rows from the matched remit.
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remits = list(
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s.execute(
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select(db.Remittance).where(db.Remittance.claim_id == claim_id)
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).scalars().all()
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)
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svc_payments: list[dict] = []
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svc_ids: list[int] = []
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if remits:
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svc_rows = list(
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s.execute(
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select(ServiceLinePayment).where(
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ServiceLinePayment.remittance_id.in_([r.id for r in remits])
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).order_by(ServiceLinePayment.line_number)
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).scalars().all()
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)
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for svc in svc_rows:
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d = _svc_to_dict(svc)
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svc_payments.append(d)
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svc_ids.append(svc.id)
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# LineReconciliation rows.
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lrs = list(
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s.execute(
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select(LineReconciliation).where(LineReconciliation.claim_id == claim_id)
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).scalars().all()
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)
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# Index by claim_service_line_number and service_line_payment_id.
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lr_by_claim_num: dict[int, LineReconciliation] = {
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lr.claim_service_line_number: lr for lr in lrs if lr.claim_service_line_number is not None
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}
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lr_by_svc: dict[int, LineReconciliation] = {
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lr.service_line_payment_id: lr for lr in lrs if lr.service_line_payment_id is not None
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}
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# CAS rows grouped by svc id.
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cas_by_svc: dict[int, list[CasAdjustment]] = {}
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if svc_ids:
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cas_rows = list(
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s.execute(
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select(CasAdjustment).where(CasAdjustment.service_line_payment_id.in_(svc_ids))
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).scalars().all()
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)
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for c in cas_rows:
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cas_by_svc.setdefault(c.service_line_payment_id, []).append(c)
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# Build output lines array, preserving 837 order then 835-only.
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svc_by_id: dict[int, dict] = {d["id"]: d for d in svc_payments}
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lines_out: list[dict] = []
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billed_total = Decimal("0")
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paid_total = Decimal("0")
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adjustment_total = Decimal("0")
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matched_count = 0
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used_svc_ids: set[int] = set()
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for cl in claim_lines:
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billed_total += Decimal(str(cl["charge"]))
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lr = lr_by_claim_num.get(cl["line_number"])
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if lr is None:
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lines_out.append({
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"claim_service_line": cl,
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"service_line_payment": None,
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"status": "unmatched_837_only",
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"adjustments": [],
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})
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continue
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svc_id = lr.service_line_payment_id
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svc = svc_by_id.get(svc_id) if svc_id else None
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if svc_id is not None:
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used_svc_ids.add(svc_id)
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cas_list = cas_by_svc.get(svc_id, []) if svc_id is not None else []
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cas_total = sum((Decimal(str(c.amount)) for c in cas_list), Decimal("0"))
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if svc:
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paid_total += Decimal(str(svc["payment"]))
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adjustment_total += cas_total
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if lr.status == "matched":
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matched_count += 1
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lines_out.append({
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"claim_service_line": cl,
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"service_line_payment": svc,
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"status": lr.status,
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"adjustments": [
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{"group_code": c.group_code, "reason_code": c.reason_code,
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"amount": str(Decimal(str(c.amount)))}
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for c in cas_list
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],
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})
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# 835-only lines (no claim match).
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for lr in lrs:
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if lr.claim_service_line_number is not None:
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continue
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svc_id = lr.service_line_payment_id
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if svc_id is None:
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continue
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if svc_id in used_svc_ids:
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continue
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svc = svc_by_id.get(svc_id)
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cas_list = cas_by_svc.get(svc_id, [])
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cas_total = sum((Decimal(str(c.amount)) for c in cas_list), Decimal("0"))
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if svc:
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paid_total += Decimal(str(svc["payment"]))
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adjustment_total += cas_total
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lines_out.append({
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"claim_service_line": None,
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"service_line_payment": svc,
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"status": lr.status,
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"adjustments": [
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{"group_code": c.group_code, "reason_code": c.reason_code,
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"amount": str(Decimal(str(c.amount)))}
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for c in cas_list
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],
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})
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return {
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"claim_id": claim_id,
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"summary": {
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"billed_total": str(billed_total),
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"paid_total": str(paid_total),
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"adjustment_total": str(adjustment_total),
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"matched_lines": matched_count,
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"total_lines": len(claim_lines),
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},
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"lines": lines_out,
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}
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def _claim_line_dict(d: dict) -> dict:
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"""Project an 837 service-line dict from ``Claim.raw_json`` to wire shape."""
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from decimal import Decimal
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proc = d.get("procedure") or {}
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charge = d.get("charge")
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units = d.get("units")
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return {
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"line_number": d.get("line_number"),
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"procedure_qualifier": proc.get("qualifier", "HC"),
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"procedure_code": proc.get("code", ""),
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"modifiers": proc.get("modifiers") or [],
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"charge": str(Decimal(str(charge))) if charge is not None else "0",
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"units": str(Decimal(str(units))) if units is not None else None,
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"unit_type": d.get("unit_type"),
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"service_date": d.get("service_date"),
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}
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def _svc_to_dict(svc) -> dict:
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"""Project an ORM ``ServiceLinePayment`` to wire shape."""
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import json as _json
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from decimal import Decimal
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return {
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"id": svc.id,
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"line_number": svc.line_number,
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"procedure_qualifier": svc.procedure_qualifier,
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"procedure_code": svc.procedure_code,
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"modifiers": _json.loads(svc.modifiers_json or "[]"),
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"charge": str(Decimal(str(svc.charge))),
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"payment": str(Decimal(str(svc.payment))),
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"units": str(Decimal(str(svc.units))) if svc.units is not None else None,
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"unit_type": svc.unit_type,
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"service_date": svc.service_date.isoformat() if svc.service_date else None,
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}
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@app.get("/api/reconciliation/unmatched")
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def get_reconciliation_unmatched() -> dict:
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"""Return unmatched Claims (left) and unmatched Remittances (right).
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