feat(sp7): persist ServiceLinePayment + link CAS rows on 835 ingest

2026-06-20 19:27:24 -06:00
parent 0dd6d39424
commit 8442bf91ce
2 changed files with 236 additions and 3 deletions
@@ -0,0 +1,168 @@
+"""SP7 — 835 ingest persists ServiceLinePayment rows + links CAS rows.
+
+Spec §3.1, §3.3, T6.
+"""
+from datetime import date, datetime, timezone
+from decimal import Decimal
+import uuid
+
+from sqlalchemy import select
+
+from cyclone.db import (
+    Batch,
+    CasAdjustment,
+    Remittance,
+    ServiceLinePayment,
+    SessionLocal,
+)
+from cyclone.parsers.models_835 import (
+    ClaimAdjustment,
+    ClaimPayment,
+    ServicePayment,
+)
+from cyclone.store import _persist_835_remit, _remittance_835_row
+
+
+def _make_batch() -> str:
+    bid = str(uuid.uuid4())
+    with SessionLocal()() as s:
+        s.add(Batch(
+            id=bid, kind="835", input_filename="x.835",
+            parsed_at=datetime.now(timezone.utc),
+            totals_json={"total_claims": 1, "total_paid": "0"},
+            validation_json={"passed": True, "warnings": [], "errors": []},
+            raw_result_json={"_": "stub"},
+        ))
+        s.commit()
+    return bid
+
+
+def test_persist_835_creates_one_service_line_payment_per_svc_composite():
+    bid = _make_batch()
+    cp = ClaimPayment(
+        payer_claim_control_number="PCN-SLP-1",
+        status_code="1",
+        total_charge=Decimal("200.00"),
+        total_paid=Decimal("150.00"),
+        service_payments=[
+            ServicePayment(
+                line_number=1, procedure_qualifier="HC",
+                procedure_code="99213", charge=Decimal("100.00"),
+                payment=Decimal("80.00"),
+                service_date=date(2026, 6, 1),
+                adjustments=[ClaimAdjustment(group_code="CO", reason_code="45", amount=Decimal("20.00"))],
+            ),
+            ServicePayment(
+                line_number=2, procedure_qualifier="HC",
+                procedure_code="99214", charge=Decimal("100.00"),
+                payment=Decimal("70.00"),
+                service_date=date(2026, 6, 1),
+                adjustments=[],
+            ),
+        ],
+    )
+    with SessionLocal()() as s:
+        remit = _remittance_835_row(cp, bid)
+        s.add(remit)
+        s.flush()
+        _persist_835_remit(s, cp, remit.id)
+        s.commit()
+
+        slps = list(
+            s.execute(
+                select(ServiceLinePayment).order_by(ServiceLinePayment.line_number)
+            ).scalars().all()
+        )
+        assert len(slps) == 2
+        assert slps[0].procedure_code == "99213"
+        assert slps[0].payment == Decimal("80.00")
+        assert slps[1].procedure_code == "99214"
+        assert slps[1].payment == Decimal("70.00")
+        assert slps[0].remittance_id == remit.id
+
+
+def test_svc_level_cas_adjustments_link_to_service_line_payment():
+    """CAS rows that follow an SVC composite must point at the SLP."""
+    bid = _make_batch()
+    cp = ClaimPayment(
+        payer_claim_control_number="PCN-SLP-2",
+        status_code="1",
+        total_charge=Decimal("100.00"),
+        total_paid=Decimal("80.00"),
+        service_payments=[
+            ServicePayment(
+                line_number=1, procedure_qualifier="HC",
+                procedure_code="99213", charge=Decimal("100.00"),
+                payment=Decimal("80.00"),
+                adjustments=[ClaimAdjustment(group_code="CO", reason_code="45", amount=Decimal("20.00"))],
+            ),
+        ],
+    )
+    with SessionLocal()() as s:
+        remit = _remittance_835_row(cp, bid)
+        s.add(remit)
+        s.flush()
+        _persist_835_remit(s, cp, remit.id)
+        s.commit()
+
+        cas = list(s.execute(select(CasAdjustment)).scalars().all())
+        assert len(cas) == 1
+        assert cas[0].service_line_payment_id is not None
+
+        slp = s.execute(
+            select(ServiceLinePayment).where(
+                ServiceLinePayment.id == cas[0].service_line_payment_id
+            )
+        ).scalar_one()
+        assert slp.procedure_code == "99213"
+
+
+def test_modifiers_persisted_as_json_array():
+    bid = _make_batch()
+    cp = ClaimPayment(
+        payer_claim_control_number="PCN-SLP-3",
+        status_code="1",
+        total_charge=Decimal("100.00"),
+        total_paid=Decimal("80.00"),
+        service_payments=[
+            ServicePayment(
+                line_number=1, procedure_qualifier="HC",
+                procedure_code="99213", modifiers=["25", "59"],
+                charge=Decimal("100.00"), payment=Decimal("80.00"),
+                adjustments=[],
+            ),
+        ],
+    )
+    with SessionLocal()() as s:
+        remit = _remittance_835_row(cp, bid)
+        s.add(remit)
+        s.flush()
+        _persist_835_remit(s, cp, remit.id)
+        s.commit()
+
+        slp = s.execute(select(ServiceLinePayment)).scalar_one()
+        import json as _json
+        assert _json.loads(slp.modifiers_json) == ["25", "59"]
+
+
+def test_empty_service_payments_is_noop():
+    """A 835 with no SVC composites produces no ServiceLinePayment rows."""
+    bid = _make_batch()
+    cp = ClaimPayment(
+        payer_claim_control_number="PCN-SLP-4",
+        status_code="1",
+        total_charge=Decimal("0.00"),
+        total_paid=Decimal("0.00"),
+        service_payments=[],
+    )
+    with SessionLocal()() as s:
+        remit = _remittance_835_row(cp, bid)
+        s.add(remit)
+        s.flush()
+        _persist_835_remit(s, cp, remit.id)
+        s.commit()
+
+        slps = list(s.execute(select(ServiceLinePayment)).scalars().all())
+        assert slps == []
+        cas = list(s.execute(select(CasAdjustment)).scalars().all())
+        assert cas == []