feat(sp7): GET /api/claims/{id}/line-reconciliation endpoint

2026-06-20 19:35:17 -06:00
parent c1323c44d0
commit 48d4739864
2 changed files with 309 additions and 0 deletions
@@ -0,0 +1,112 @@
+"""SP7 — endpoint test for GET /api/claims/{id}/line-reconciliation.
+
+Spec §5.1.
+
+Architecture note: 837 service lines live in ``Claim.raw_json``, not a
+separate ORM table, so the test seeds them via the raw_json blob.
+"""
+from datetime import date, datetime, timezone
+from decimal import Decimal
+import json
+import uuid
+
+import pytest
+from fastapi.testclient import TestClient
+from sqlalchemy import select
+
+from cyclone import db
+from cyclone.api import app
+from cyclone.parsers.models_835 import ClaimPayment, ServicePayment
+from cyclone.reconcile import run
+from cyclone.store import _persist_835_remit, _remittance_835_row
+
+
+@pytest.fixture
+def client():
+    return TestClient(app)
+
+
+def _seed(client):
+    """Insert one claim + matching remit + 4 service lines (3 matched, 1 unmatched 837).
+    Returns the claim id."""
+    bid = str(uuid.uuid4())
+    claim_id = "CLM-API-1"
+    svc_lines_json = []
+    # 4 837 service lines: 99213, 99214, 99215, 90837 (last one is 837-only — no SVC)
+    for i, code in enumerate(["99213", "99214", "99215", "90837"], start=1):
+        svc_lines_json.append({
+            "line_number": i,
+            "procedure": {"qualifier": "HC", "code": code, "modifiers": []},
+            "charge": "100.00",
+            "unit_type": "UN",
+            "units": "1",
+            "place_of_service": "11",
+            "service_date": f"2026-06-0{i}",
+            "provider_reference": None,
+        })
+
+    with db.SessionLocal()() as s:
+        s.add(db.Batch(
+            id=bid, kind="835", input_filename="x.835",
+            parsed_at=datetime.now(timezone.utc),
+            totals_json={"total_claims": 1, "total_paid": "240"},
+            validation_json={"passed": True, "warnings": [], "errors": []},
+            raw_result_json={"_": "stub"},
+        ))
+        s.add(db.Claim(
+            id=claim_id,
+            patient_control_number="PCN-API",
+            charge_amount=Decimal("300.00"),
+            provider_npi="1234567890",
+            payer_id="SKCO0",
+            service_date_from=date(2026, 6, 1),
+            service_date_to=date(2026, 6, 4),
+            state="submitted",
+            batch_id=bid,
+            raw_json={"service_lines": svc_lines_json},
+        ))
+        # Remit pays the first 3 lines (line 4 is 837-only)
+        cp = ClaimPayment(
+            payer_claim_control_number="PCN-API",
+            status_code="1",
+            total_charge=Decimal("300.00"),
+            total_paid=Decimal("240.00"),
+            service_payments=[
+                ServicePayment(
+                    line_number=i, procedure_qualifier="HC",
+                    procedure_code=code, charge=Decimal("100.00"),
+                    payment=Decimal("80.00"),
+                    units=Decimal("1"),
+                    service_date=date(2026, 6, i),
+                )
+                for i, code in enumerate(["99213", "99214", "99215"], start=1)
+            ],
+        )
+        remit = _remittance_835_row(cp, bid)
+        s.add(remit)
+        s.flush()
+        _persist_835_remit(s, cp, remit.id)
+        s.commit()
+
+        # Run reconcile so matched_remittance_id gets set + LineReconciliation rows persist
+        run(s, bid)
+        s.commit()
+
+    return claim_id
+
+
+def test_endpoint_returns_documented_shape(client):
+    claim_id = _seed(client)
+    r = client.get(f"/api/claims/{claim_id}/line-reconciliation")
+    assert r.status_code == 200, r.text
+    body = r.json()
+    assert body["claim_id"] == claim_id
+    assert body["summary"]["total_lines"] == 4
+    assert body["summary"]["matched_lines"] == 3
+    statuses = sorted(row["status"] for row in body["lines"])
+    assert statuses == ["matched", "matched", "matched", "unmatched_837_only"]
+
+
+def test_endpoint_404_for_unknown_claim(client):
+    r = client.get("/api/claims/UNKNOWN/line-reconciliation")
+    assert r.status_code == 404