merge: SP14 5-lane Inbox UI + acknowledge action into main
This commit is contained in:
Tyler
@@ -1105,6 +1105,78 @@ def inbox_dismiss_candidates(body: dict):
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return {"ok": True, "dismissed_count": len(pairs)}
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# ---------------------------------------------------------------------------
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# SP14: Payer-Rejected acknowledge
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#
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# Operator hits "Acknowledge" on the Payer-Rejected Inbox lane to clear
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# the claim from the working surface. We don't delete the rejection
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# (the original payer_rejected_* fields stay for SP11 audit), we just
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# set payer_rejected_acknowledged_at so the lane query filters it out.
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#
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# Idempotent: re-acknowledging an already-acknowledged claim is a noop
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# (the timestamp is not bumped). Returns the count actually transitioned
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# so the UI can show "3 of 5 were already acknowledged".
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# ---------------------------------------------------------------------------
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@app.post("/api/inbox/payer-rejected/acknowledge")
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def inbox_acknowledge_payer_rejected(body: dict):
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"""Mark Payer-Rejected claims as acknowledged by the operator."""
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claim_ids = body.get("claim_ids") or []
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actor = body.get("actor") or "operator"
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if not isinstance(claim_ids, list) or not claim_ids:
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raise HTTPException(400, "claim_ids must be a non-empty list")
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if not all(isinstance(c, str) for c in claim_ids):
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raise HTTPException(400, "claim_ids must be a list of strings")
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with db.SessionLocal()() as session:
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from cyclone.db import Claim
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now = datetime.now(timezone.utc)
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transitioned = 0
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already_acked = 0
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not_found = 0
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not_rejected = 0
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for cid in claim_ids:
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claim = session.get(Claim, cid)
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if claim is None:
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not_found += 1
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continue
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if claim.payer_rejected_at is None:
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not_rejected += 1
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continue
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if claim.payer_rejected_acknowledged_at is not None:
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already_acked += 1
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continue
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claim.payer_rejected_acknowledged_at = now
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claim.payer_rejected_acknowledged_actor = actor
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transitioned += 1
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# SP11: audit event for the acknowledge action.
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try:
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from cyclone.audit_log import append_event, AuditEvent
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append_event(session, AuditEvent(
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event_type="claim.payer_rejected_acknowledged",
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entity_type="claim",
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entity_id=claim.id,
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actor=actor,
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payload={
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"payer_rejected_status_code": claim.payer_rejected_status_code,
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"payer_rejected_by_277ca_id": claim.payer_rejected_by_277ca_id,
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},
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))
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except Exception: # noqa: BLE001
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# Audit append is best-effort; don't block the operator's
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# acknowledge action on an audit-log failure.
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pass
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if transitioned:
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session.commit()
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return {
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"ok": True,
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"transitioned": transitioned,
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"already_acked": already_acked,
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"not_found": not_found,
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"not_rejected": not_rejected,
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}
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@app.post("/api/inbox/rejected/resubmit")
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def inbox_resubmit_rejected(
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request: Request,
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@@ -1202,7 +1274,7 @@ def inbox_resubmit_rejected(
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@app.get("/api/inbox/export.csv")
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def inbox_export_csv(lane: str):
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"""Stream a CSV for a single lane."""
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if lane not in {"rejected", "candidates", "unmatched", "done_today"}:
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if lane not in {"rejected", "candidates", "unmatched", "done_today", "payer_rejected"}:
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raise HTTPException(400, f"unknown lane: {lane}")
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dismissed_pairs = getattr(app.state, "dismissed_pairs", set())
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with db.SessionLocal()() as session:
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@@ -239,6 +239,16 @@ class Claim(Base):
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payer_rejected_by_277ca_id: Mapped[Optional[str]] = mapped_column(
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String(64), nullable=True
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)
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# SP14: when the operator hits "Acknowledge" on the Payer-Rejected
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# lane, we set this timestamp. The lane query filters on it being
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# NULL so acknowledged claims drop out of the working surface. The
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# original payer_rejected_* fields stay intact for audit (SP11).
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payer_rejected_acknowledged_at: Mapped[Optional[datetime]] = mapped_column(
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DateTime(timezone=True), nullable=True
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)
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payer_rejected_acknowledged_actor: Mapped[Optional[str]] = mapped_column(
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String(64), nullable=True
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)
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resubmit_count: Mapped[int] = mapped_column(
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Integer, nullable=False, default=0, server_default=text("0")
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)
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@@ -73,6 +73,12 @@ def _claim_to_row(
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"payer_rejected_reason": c.payer_rejected_reason,
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"payer_rejected_status_code": c.payer_rejected_status_code,
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"payer_rejected_by_277ca_id": c.payer_rejected_by_277ca_id,
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# SP14: acknowledgment tracking. Always null on the lane
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# (we filter acknowledged claims out) but exposed for
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# forward-compat if we later add a "Recently acknowledged"
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# inspector view.
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"payer_rejected_acknowledged_at": _isoformat(c.payer_rejected_acknowledged_at),
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"payer_rejected_acknowledged_actor": c.payer_rejected_acknowledged_actor,
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}
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@@ -192,8 +198,15 @@ def compute_lanes(session: Session, *, dismissed_pairs: Iterable[frozenset]) ->
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# by the payer after we submitted a syntactically-valid file).
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# We don't filter by Claim.state here because the claim may still
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# be in SUBMITTED state — the payer just hasn't paid it yet.
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#
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# SP14: filter out claims the operator has already acknowledged.
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# The original payer_rejected_* fields stay intact for audit;
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# only the working surface (this lane) is filtered.
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payer_rejected_claims = (
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session.query(Claim).filter(Claim.payer_rejected_at.is_not(None)).all()
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session.query(Claim)
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.filter(Claim.payer_rejected_at.is_not(None))
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.filter(Claim.payer_rejected_acknowledged_at.is_(None))
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.all()
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)
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pr_matched, pr_total = _line_count_lookup(session, payer_rejected_claims)
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matched_counts.update(pr_matched)
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@@ -0,0 +1,22 @@
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-- version: 10
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-- SP14: Payer-Rejected lane acknowledge
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-- When the operator reviews a payer-rejected claim, they hit the
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-- "Acknowledge" bulk action. We mark the claim with the timestamp so
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-- the lane query can filter it out (it stays in the DB for audit but
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-- doesn't show up in the operator's working surface).
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--
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-- Why a separate column instead of clearing payer_rejected_at:
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-- * Audit trail: SP11's hash-chained audit_log needs the *original*
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-- rejection event intact. Clearing the timestamp would erase the
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-- evidence of the payer saying "no" — exactly what auditors want
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-- to see.
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-- * Reconciliation: future SPs that match payer-rejected claims
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-- against appeals (e.g. SP17) can still see the original status
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-- code and reason.
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ALTER TABLE claims ADD COLUMN payer_rejected_acknowledged_at TEXT;
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ALTER TABLE claims ADD COLUMN payer_rejected_acknowledged_actor TEXT;
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CREATE INDEX idx_claims_payer_rejected_unack
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ON claims(payer_rejected_at)
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WHERE payer_rejected_acknowledged_at IS NULL;
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@@ -51,18 +51,18 @@ def test_migration_0002_creates_acks_table():
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def test_migration_latest_idempotent_on_fresh_db():
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"""Re-running the migration on the same DB must be a no-op (PRAGMA
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user_version already at the latest version — currently 9 after
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user_version already at the latest version — currently 10 after
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0004-0006 line_reconciliation, 0005 ta1_acks, SP9's 0007
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providers/payers/clearhouse, SP10's 0008 payer_rejected, and
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SP11's 0009 audit_log)."""
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providers/payers/clearhouse, SP10's 0008 payer_rejected,
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SP11's 0009 audit_log, and SP14's 0010 payer_rejected_acknowledged)."""
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with db.engine().begin() as c:
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v1 = c.exec_driver_sql("PRAGMA user_version").scalar() or 0
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assert v1 == 9
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assert v1 == 10
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# A second run should not raise and should not bump the version.
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db_migrate.run(db.engine())
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with db.engine().begin() as c:
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v2 = c.exec_driver_sql("PRAGMA user_version").scalar() or 0
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assert v2 == 9
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assert v2 == 10
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def test_add_ack_persists_row():
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@@ -0,0 +1,105 @@
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"""SP14 — Lane filter drops acknowledged payer-rejected claims.
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The Payer-Rejected Inbox lane must not include claims the operator
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has already acknowledged. This is the working-surface UX: acknowledged
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claims drop out so the operator only sees new rejections.
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"""
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from __future__ import annotations
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from datetime import datetime, timezone
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import pytest
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from cyclone import db
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from cyclone.db import Batch, Claim, ClaimState
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from cyclone.inbox_lanes import compute_lanes
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@pytest.fixture(autouse=True)
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def _setup(tmp_path, monkeypatch):
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monkeypatch.setenv("CYCLONE_DB_URL", f"sqlite:///{tmp_path}/test.db")
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db._reset_for_tests()
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db.init_db()
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def _seed(*, acked: bool = False) -> str:
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now = datetime.now(timezone.utc)
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cid = "C1"
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with db.SessionLocal()() as session:
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batch = Batch(
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id="b-1", kind="837p",
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input_filename="t.x12", parsed_at=now,
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)
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session.add(batch)
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session.flush()
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claim = Claim(
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id=cid, batch_id=batch.id, patient_control_number=cid,
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state=ClaimState.SUBMITTED, charge_amount=100,
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payer_rejected_at=now,
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payer_rejected_status_code="A7",
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payer_rejected_reason="invalid dx",
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)
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if acked:
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claim.payer_rejected_acknowledged_at = now
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claim.payer_rejected_acknowledged_actor = "operator"
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session.add(claim)
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session.commit()
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return cid
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def test_unacknowledged_claim_appears_in_lane():
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_seed(acked=False)
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with db.SessionLocal()() as session:
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lanes = compute_lanes(session, dismissed_pairs=set())
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assert len(lanes.payer_rejected) == 1
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assert lanes.payer_rejected[0]["id"] == "C1"
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def test_acknowledged_claim_drops_out_of_lane():
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_seed(acked=True)
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with db.SessionLocal()() as session:
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lanes = compute_lanes(session, dismissed_pairs=set())
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assert lanes.payer_rejected == []
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def test_mix_of_acked_and_unacked():
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"""Only the unacknowledged one shows up."""
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now = datetime.now(timezone.utc)
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with db.SessionLocal()() as session:
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batch = Batch(
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id="b-1", kind="837p",
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input_filename="t.x12", parsed_at=now,
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)
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session.add(batch)
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session.flush()
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for i, acked in enumerate([True, False, True, False]):
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claim = Claim(
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id=f"C{i}", batch_id=batch.id,
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patient_control_number=f"PCN-{i}",
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state=ClaimState.SUBMITTED, charge_amount=100,
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payer_rejected_at=now,
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payer_rejected_status_code="A7",
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)
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if acked:
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claim.payer_rejected_acknowledged_at = now
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session.add(claim)
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session.commit()
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with db.SessionLocal()() as session:
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lanes = compute_lanes(session, dismissed_pairs=set())
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ids = [r["id"] for r in lanes.payer_rejected]
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assert sorted(ids) == ["C1", "C3"]
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def test_lane_row_carries_ack_fields_for_forward_compat():
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"""The row payload still carries the ack fields (all null on the lane)
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so future views that want a 'Recently acknowledged' section don't need
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a schema change."""
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_seed(acked=False)
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with db.SessionLocal()() as session:
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lanes = compute_lanes(session, dismissed_pairs=set())
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row = lanes.payer_rejected[0]
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assert "payer_rejected_acknowledged_at" in row
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assert row["payer_rejected_acknowledged_at"] is None
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assert "payer_rejected_acknowledged_actor" in row
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assert row["payer_rejected_acknowledged_actor"] is None
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@@ -0,0 +1,168 @@
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"""SP14 — Payer-Rejected acknowledge endpoint tests.
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The endpoint marks payer-rejected claims as acknowledged so the
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working-surface lane query filters them out. The original
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payer_rejected_* fields stay intact (SP11 audit).
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"""
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from __future__ import annotations
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import pytest
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from cyclone import db
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from cyclone.db import Claim, ClaimState
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from cyclone.audit_log import verify_chain
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@pytest.fixture(autouse=True)
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def _setup(tmp_path, monkeypatch):
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monkeypatch.setenv("CYCLONE_DB_URL", f"sqlite:///{tmp_path}/test.db")
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db._reset_for_tests()
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db.init_db()
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def _make_claim(claim_id: str, *, payer_rejected: bool = True) -> None:
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"""Insert a minimal claim with optional payer_rejected markers."""
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from datetime import datetime, timezone
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from cyclone.db import Batch
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with db.SessionLocal()() as session:
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batch = Batch(
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id=f"b-{claim_id}",
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kind="837p",
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input_filename="t.x12",
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parsed_at=datetime.now(timezone.utc),
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)
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session.add(batch)
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session.flush()
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claim = Claim(
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id=claim_id,
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batch_id=batch.id,
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patient_control_number=claim_id,
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state=ClaimState.SUBMITTED,
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charge_amount=100,
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)
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if payer_rejected:
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now = datetime.now(timezone.utc)
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claim.payer_rejected_at = now
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claim.payer_rejected_reason = "invalid diagnosis code"
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claim.payer_rejected_status_code = "A7"
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session.add(claim)
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session.commit()
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def test_acknowledge_marks_unacknowledged_claim():
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_make_claim("C1", payer_rejected=True)
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from fastapi.testclient import TestClient
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from cyclone.api import app
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with TestClient(app) as client:
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r = client.post(
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"/api/inbox/payer-rejected/acknowledge",
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json={"claim_ids": ["C1"], "actor": "operator"},
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)
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assert r.status_code == 200, r.text
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body = r.json()
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assert body["ok"] is True
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assert body["transitioned"] == 1
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assert body["already_acked"] == 0
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assert body["not_found"] == 0
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assert body["not_rejected"] == 0
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with db.SessionLocal()() as session:
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c = session.get(Claim, "C1")
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assert c.payer_rejected_acknowledged_at is not None
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assert c.payer_rejected_acknowledged_actor == "operator"
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# Original fields stay intact for audit.
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assert c.payer_rejected_at is not None
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assert c.payer_rejected_status_code == "A7"
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assert c.payer_rejected_reason == "invalid diagnosis code"
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def test_acknowledge_is_idempotent():
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_make_claim("C1", payer_rejected=True)
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from fastapi.testclient import TestClient
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from cyclone.api import app
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with TestClient(app) as client:
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r1 = client.post(
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"/api/inbox/payer-rejected/acknowledge",
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json={"claim_ids": ["C1"]},
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)
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assert r1.json()["transitioned"] == 1
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r2 = client.post(
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"/api/inbox/payer-rejected/acknowledge",
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json={"claim_ids": ["C1"]},
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)
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assert r2.json()["transitioned"] == 0
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assert r2.json()["already_acked"] == 1
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def test_acknowledge_skips_non_payer_rejected_claims():
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_make_claim("C1", payer_rejected=False)
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from fastapi.testclient import TestClient
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from cyclone.api import app
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with TestClient(app) as client:
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r = client.post(
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"/api/inbox/payer-rejected/acknowledge",
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json={"claim_ids": ["C1"]},
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)
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assert r.status_code == 200
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body = r.json()
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assert body["transitioned"] == 0
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assert body["not_rejected"] == 1
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def test_acknowledge_counts_missing_ids():
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from fastapi.testclient import TestClient
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from cyclone.api import app
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with TestClient(app) as client:
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r = client.post(
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"/api/inbox/payer-rejected/acknowledge",
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json={"claim_ids": ["nope"]},
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)
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assert r.status_code == 200
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body = r.json()
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assert body["transitioned"] == 0
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assert body["not_found"] == 1
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def test_acknowledge_empty_claim_ids_400():
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from fastapi.testclient import TestClient
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from cyclone.api import app
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with TestClient(app) as client:
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r = client.post(
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"/api/inbox/payer-rejected/acknowledge",
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json={"claim_ids": []},
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)
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assert r.status_code == 400
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def test_acknowledge_writes_audit_event():
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_make_claim("C1", payer_rejected=True)
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from fastapi.testclient import TestClient
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from cyclone.api import app
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with TestClient(app) as client:
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r = client.post(
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"/api/inbox/payer-rejected/acknowledge",
|
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json={"claim_ids": ["C1"], "actor": "alice"},
|
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)
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assert r.status_code == 200
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|
||||
# SP11: the chain is intact and includes the new event.
|
||||
with db.SessionLocal()() as session:
|
||||
result = verify_chain(session)
|
||||
assert result.ok, f"chain broken: {result.reason} at {result.first_bad_id}"
|
||||
|
||||
# And the event itself is queryable.
|
||||
import json as _json
|
||||
from cyclone.db import AuditLog
|
||||
with db.SessionLocal()() as session:
|
||||
events = (
|
||||
session.query(AuditLog)
|
||||
.filter(AuditLog.event_type == "claim.payer_rejected_acknowledged")
|
||||
.all()
|
||||
)
|
||||
assert len(events) == 1
|
||||
e = events[0]
|
||||
assert e.entity_type == "claim"
|
||||
assert e.entity_id == "C1"
|
||||
assert e.actor == "alice"
|
||||
payload = _json.loads(e.payload_json) if e.payload_json else {}
|
||||
assert payload["payer_rejected_status_code"] == "A7"
|
||||
@@ -1,6 +1,6 @@
|
||||
// @vitest-environment happy-dom
|
||||
import { afterEach, describe, expect, it, vi } from "vitest";
|
||||
import { cleanup, render, screen, fireEvent } from "@testing-library/react";
|
||||
import { cleanup, render, fireEvent } from "@testing-library/react";
|
||||
import { BulkBar } from "./BulkBar";
|
||||
|
||||
afterEach(() => cleanup());
|
||||
@@ -12,6 +12,7 @@ describe("BulkBar", () => {
|
||||
lane="rejected"
|
||||
count={3}
|
||||
onResubmit={vi.fn()}
|
||||
onAcknowledge={() => {}}
|
||||
onDismiss={vi.fn()}
|
||||
onExport={vi.fn()}
|
||||
/>,
|
||||
@@ -28,6 +29,7 @@ describe("BulkBar", () => {
|
||||
lane="rejected"
|
||||
count={2}
|
||||
onResubmit={onResubmit}
|
||||
onAcknowledge={() => {}}
|
||||
onDismiss={() => {}}
|
||||
onExport={() => {}}
|
||||
/>,
|
||||
@@ -39,12 +41,36 @@ describe("BulkBar", () => {
|
||||
expect(onResubmit).toHaveBeenCalledOnce();
|
||||
});
|
||||
|
||||
it("SP14: payer_rejected lane shows Acknowledge (not Resubmit/Dismiss)", () => {
|
||||
// Payer-rejected claims are not eligible for resubmit (the payer
|
||||
// already said no); the operator can only acknowledge them as
|
||||
// "I've seen this" and export the row set for follow-up.
|
||||
const onAcknowledge = vi.fn();
|
||||
const { container, getByTestId } = render(
|
||||
<BulkBar
|
||||
lane="payer_rejected"
|
||||
count={4}
|
||||
onResubmit={() => {}}
|
||||
onAcknowledge={onAcknowledge}
|
||||
onDismiss={() => {}}
|
||||
onExport={() => {}}
|
||||
/>,
|
||||
);
|
||||
expect(container.textContent).toMatch(/acknowledge/i);
|
||||
expect(container.textContent).not.toMatch(/re-?submit/i);
|
||||
expect(container.textContent).not.toMatch(/dismiss/i);
|
||||
const ack = getByTestId("payer-rejected-acknowledge");
|
||||
fireEvent.click(ack);
|
||||
expect(onAcknowledge).toHaveBeenCalledOnce();
|
||||
});
|
||||
|
||||
it("hides when count is zero", () => {
|
||||
const { container } = render(
|
||||
<BulkBar
|
||||
lane="rejected"
|
||||
count={0}
|
||||
onResubmit={() => {}}
|
||||
onAcknowledge={() => {}}
|
||||
onDismiss={() => {}}
|
||||
onExport={() => {}}
|
||||
/>,
|
||||
|
||||
@@ -1,13 +1,40 @@
|
||||
// ---------------------------------------------------------------------------
|
||||
// BulkBar
|
||||
//
|
||||
// Per-lane floating action bar. Each Inbox lane has its own BulkBar —
|
||||
// the bar shows when the lane has a selection and exposes the actions
|
||||
// appropriate to that lane:
|
||||
//
|
||||
// * rejected → Re-submit (move back to SUBMITTED)
|
||||
// * payer_rejected → Acknowledge (drop from working surface; SP14)
|
||||
// * candidates → Dismiss (suppress a remit/claim pair)
|
||||
// * unmatched → (no destructive action; just export)
|
||||
// * done_today → (read-only; just export)
|
||||
//
|
||||
// Every lane gets the Export CSV action so the operator can ship
|
||||
// anything actionable to a file for off-system follow-up (appeals,
|
||||
// re-keying, posting to the billing system of record, etc).
|
||||
// ---------------------------------------------------------------------------
|
||||
|
||||
type LaneKey =
|
||||
| "rejected"
|
||||
| "payer_rejected"
|
||||
| "candidates"
|
||||
| "unmatched"
|
||||
| "done_today";
|
||||
|
||||
export function BulkBar({
|
||||
lane,
|
||||
count,
|
||||
onResubmit,
|
||||
onAcknowledge,
|
||||
onDismiss,
|
||||
onExport,
|
||||
}: {
|
||||
lane: "rejected" | "candidates" | "unmatched" | "done_today";
|
||||
lane: LaneKey;
|
||||
count: number;
|
||||
onResubmit: () => void;
|
||||
onAcknowledge: () => void;
|
||||
onDismiss: () => void;
|
||||
onExport: () => void;
|
||||
}) {
|
||||
@@ -52,6 +79,16 @@ export function BulkBar({
|
||||
Re-submit ({count})
|
||||
</button>
|
||||
)}
|
||||
{lane === "payer_rejected" && (
|
||||
<button
|
||||
onClick={onAcknowledge}
|
||||
data-testid="payer-rejected-acknowledge"
|
||||
className="px-2.5 py-1 rounded-sm uppercase tracking-[0.12em] transition-colors hover:bg-[color:var(--tt-amber)]/10 focus-visible:outline-none focus-visible:bg-[color:var(--tt-amber)]/10"
|
||||
style={{ color: "var(--tt-ink)", fontWeight: 600 }}
|
||||
>
|
||||
Acknowledge ({count})
|
||||
</button>
|
||||
)}
|
||||
{lane === "candidates" && (
|
||||
<button
|
||||
onClick={onDismiss}
|
||||
|
||||
@@ -1,3 +1,16 @@
|
||||
// ---------------------------------------------------------------------------
|
||||
// InboxHeader
|
||||
//
|
||||
// Compact working-surface header: the day/date, a live clock, and the
|
||||
// two top-line counts ("N items need eyes" and "N done today") that
|
||||
// anchor the operator's day. "Need eyes" is computed by the Inbox
|
||||
// page (sum of actionable lanes) and passed in.
|
||||
//
|
||||
// SP14: payer_rejected (277CA) is now part of the actionable lanes —
|
||||
// it's a working-surface rejection that needs operator follow-up.
|
||||
// The Inbox page sums it into the needEyes count.
|
||||
// ---------------------------------------------------------------------------
|
||||
|
||||
export function InboxHeader({
|
||||
needEyesCount,
|
||||
doneTodayCount,
|
||||
|
||||
@@ -39,6 +39,8 @@ function emptyLanesPayload() {
|
||||
ok: true,
|
||||
json: async () => ({
|
||||
rejected: [],
|
||||
// SP14: payer-rejected lane was added to the working surface.
|
||||
payer_rejected: [],
|
||||
candidates: [],
|
||||
unmatched: [],
|
||||
done_today: [],
|
||||
@@ -74,6 +76,7 @@ describe("useInboxLanes", () => {
|
||||
await waitFor(() => expect(result.current.loading).toBe(false));
|
||||
expect(result.current.lanes).toEqual({
|
||||
rejected: [],
|
||||
payer_rejected: [],
|
||||
candidates: [],
|
||||
unmatched: [],
|
||||
done_today: [],
|
||||
|
||||
@@ -31,6 +31,8 @@ const REFETCH_DEBOUNCE_MS = 250;
|
||||
export function useInboxLanes() {
|
||||
const [lanes, setLanes] = useState<InboxLanes>({
|
||||
rejected: [],
|
||||
// SP14: the 5th working-surface lane (277CA STC A4/A6/A7).
|
||||
payer_rejected: [],
|
||||
candidates: [],
|
||||
unmatched: [],
|
||||
done_today: [],
|
||||
|
||||
+52
-4
@@ -1,9 +1,13 @@
|
||||
// ---------------------------------------------------------------------------
|
||||
// Inbox API client (sub-project 6).
|
||||
//
|
||||
// Mirrors the four-lane working surface: rejected / candidates / unmatched /
|
||||
// done_today. Plus the actions: manual match, dismiss, resubmit, export.
|
||||
// All non-2xx responses throw (so callers can branch on status).
|
||||
// Mirrors the five-lane working surface: rejected / payer_rejected /
|
||||
// candidates / unmatched / done_today. Plus the actions: manual match,
|
||||
// dismiss, resubmit, acknowledge, export. All non-2xx responses throw
|
||||
// (so callers can branch on status).
|
||||
//
|
||||
// SP14: added the `payer_rejected` lane (277CA STC A4/A6/A7) and the
|
||||
// `acknowledge` action — distinct from the 999 envelope `rejected` lane.
|
||||
// ---------------------------------------------------------------------------
|
||||
|
||||
export type ScoreBreakdown = {
|
||||
@@ -39,6 +43,17 @@ export type InboxClaimRow = {
|
||||
matched_lines: number;
|
||||
total_lines: number;
|
||||
} | null;
|
||||
// SP10/SP14: payer-side rejection fields. Populated on the
|
||||
// `payer_rejected` lane with the 277CA STC category, reason,
|
||||
// and source 277CA id. The ack fields are always null on the
|
||||
// lane (we filter acknowledged claims out) but exposed for
|
||||
// forward-compat.
|
||||
payer_rejected_at?: string | null;
|
||||
payer_rejected_reason?: string | null;
|
||||
payer_rejected_status_code?: string | null;
|
||||
payer_rejected_by_277ca_id?: string | null;
|
||||
payer_rejected_acknowledged_at?: string | null;
|
||||
payer_rejected_acknowledged_actor?: string | null;
|
||||
};
|
||||
|
||||
export type InboxCandidateRow = {
|
||||
@@ -59,6 +74,8 @@ export type InboxCandidateRow = {
|
||||
|
||||
export type InboxLanes = {
|
||||
rejected: InboxClaimRow[];
|
||||
/** SP14: 277CA STC A4/A6/A7 — payer-side rejection, distinct from 999. */
|
||||
payer_rejected: InboxClaimRow[];
|
||||
candidates: InboxCandidateRow[];
|
||||
unmatched: InboxClaimRow[];
|
||||
done_today: InboxClaimRow[];
|
||||
@@ -173,7 +190,38 @@ export async function resubmitRejectedWithDownload(
|
||||
}
|
||||
|
||||
export function exportInboxCsvUrl(
|
||||
lane: "rejected" | "candidates" | "unmatched" | "done_today",
|
||||
lane:
|
||||
| "rejected"
|
||||
| "payer_rejected"
|
||||
| "candidates"
|
||||
| "unmatched"
|
||||
| "done_today",
|
||||
): string {
|
||||
return joinUrl(`/api/inbox/export.csv?lane=${lane}`);
|
||||
}
|
||||
|
||||
// ---------------------------------------------------------------------------
|
||||
// SP14: Payer-Rejected acknowledge
|
||||
//
|
||||
// Marks the listed claims as acknowledged by the operator. Acknowledged
|
||||
// claims drop out of the Payer-Rejected Inbox lane. The original 277CA
|
||||
// rejection event stays in the audit log (SP11) — we only flip a
|
||||
// working-surface flag.
|
||||
// ---------------------------------------------------------------------------
|
||||
export type AcknowledgeResult = {
|
||||
ok: boolean;
|
||||
transitioned: number;
|
||||
already_acked: number;
|
||||
not_found: number;
|
||||
not_rejected: number;
|
||||
};
|
||||
|
||||
export async function acknowledgePayerRejected(
|
||||
claimIds: string[],
|
||||
actor: string = "operator",
|
||||
): Promise<AcknowledgeResult> {
|
||||
return postJson<AcknowledgeResult>(
|
||||
"/api/inbox/payer-rejected/acknowledge",
|
||||
{ claim_ids: claimIds, actor },
|
||||
);
|
||||
}
|
||||
|
||||
+111
-1
@@ -12,13 +12,17 @@ afterEach(() => {
|
||||
});
|
||||
|
||||
describe("Inbox page", () => {
|
||||
it("renders the four lane headers", async () => {
|
||||
it("renders the five lane headers", async () => {
|
||||
// SP14: the Payer-Rejected lane was added (277CA STC A4/A6/A7).
|
||||
// The Inbox now renders 5 lanes: REJECTED, PAYER REJECTED,
|
||||
// CANDIDATES, UNMATCHED, DONE.
|
||||
vi.stubGlobal(
|
||||
"fetch",
|
||||
vi.fn().mockResolvedValue({
|
||||
ok: true,
|
||||
json: async () => ({
|
||||
rejected: [],
|
||||
payer_rejected: [],
|
||||
candidates: [],
|
||||
unmatched: [],
|
||||
done_today: [],
|
||||
@@ -28,12 +32,117 @@ describe("Inbox page", () => {
|
||||
const { container } = render(<Inbox />);
|
||||
await waitFor(() => {
|
||||
expect(container.textContent).toContain("REJECTED");
|
||||
expect(container.textContent).toContain("PAYER REJECTED");
|
||||
expect(container.textContent).toContain("CANDIDATES");
|
||||
expect(container.textContent).toContain("UNMATCHED");
|
||||
expect(container.textContent).toContain("DONE");
|
||||
});
|
||||
});
|
||||
|
||||
it("SP14: payer-rejected row count rolls up into the need-eyes header", async () => {
|
||||
// The "need eyes" total in the header is the operator's
|
||||
// anchor for the day. Payer-rejected claims are actionable
|
||||
// (operator must acknowledge or follow up), so they count
|
||||
// toward the need-eyes total alongside 999 rejected, candidates,
|
||||
// and unmatched.
|
||||
vi.stubGlobal(
|
||||
"fetch",
|
||||
vi.fn().mockResolvedValue({
|
||||
ok: true,
|
||||
json: async () => ({
|
||||
rejected: [],
|
||||
payer_rejected: [
|
||||
{ id: "PR1", kind: "claim", patient_control_number: "PR1",
|
||||
charge_amount: 250, payer_id: "CO_TXIX", provider_npi: "1881068062",
|
||||
state: "submitted", rejection_reason: "A7 invalid dx",
|
||||
service_date_from: null, payer_rejected_status_code: "A7",
|
||||
payer_rejected_reason: "invalid diagnosis",
|
||||
payer_rejected_at: "2026-06-20T10:00:00Z" },
|
||||
],
|
||||
candidates: [],
|
||||
unmatched: [],
|
||||
done_today: [],
|
||||
}),
|
||||
}),
|
||||
);
|
||||
const { container } = render(<Inbox />);
|
||||
await waitFor(() => {
|
||||
expect(container.textContent).toContain("1");
|
||||
expect(container.textContent).toContain("items need eyes");
|
||||
});
|
||||
});
|
||||
|
||||
it("SP14: acknowledging selected payer-rejected claims calls the API and refetches", async () => {
|
||||
// The user selects a payer-rejected claim, hits Acknowledge, and
|
||||
// the inbox calls /api/inbox/payer-rejected/acknowledge with the
|
||||
// claim id, then refetches the lane payload.
|
||||
const fetchMock = vi.fn().mockImplementation(async (url: string) => {
|
||||
if (url.includes("/api/inbox/lanes")) {
|
||||
return {
|
||||
ok: true,
|
||||
json: async () => ({
|
||||
rejected: [],
|
||||
payer_rejected: [
|
||||
{ id: "PR1", kind: "claim", patient_control_number: "PR1",
|
||||
charge_amount: 250, payer_id: "CO_TXIX", provider_npi: "1881068062",
|
||||
state: "submitted", rejection_reason: "A7 invalid dx",
|
||||
service_date_from: null, payer_rejected_status_code: "A7",
|
||||
payer_rejected_reason: "invalid diagnosis",
|
||||
payer_rejected_at: "2026-06-20T10:00:00Z" },
|
||||
],
|
||||
candidates: [],
|
||||
unmatched: [],
|
||||
done_today: [],
|
||||
}),
|
||||
};
|
||||
}
|
||||
if (url.includes("/api/inbox/payer-rejected/acknowledge")) {
|
||||
return {
|
||||
ok: true,
|
||||
json: async () => ({
|
||||
ok: true,
|
||||
transitioned: 1,
|
||||
already_acked: 0,
|
||||
not_found: 0,
|
||||
not_rejected: 0,
|
||||
}),
|
||||
};
|
||||
}
|
||||
return { ok: true, json: async () => ({}) };
|
||||
});
|
||||
vi.stubGlobal("fetch", fetchMock);
|
||||
|
||||
const { container, getByTestId } = render(<Inbox />);
|
||||
await waitFor(() => {
|
||||
expect(container.textContent).toContain("PR1");
|
||||
});
|
||||
|
||||
// Select the PR1 claim via its checkbox.
|
||||
const checkbox = container.querySelector(
|
||||
'input[type="checkbox"][aria-label="Select PR1"]',
|
||||
) as HTMLInputElement;
|
||||
expect(checkbox).toBeTruthy();
|
||||
await act(async () => {
|
||||
checkbox.click();
|
||||
});
|
||||
|
||||
// Hit Acknowledge. The bulk action bar button is wired to the
|
||||
// /api/inbox/payer-rejected/acknowledge endpoint.
|
||||
const ackButton = getByTestId("payer-rejected-acknowledge");
|
||||
await act(async () => {
|
||||
ackButton.click();
|
||||
});
|
||||
|
||||
// The mock was called with the acknowledge URL.
|
||||
const ackCall = fetchMock.mock.calls.find(
|
||||
(c) => typeof c[0] === "string" && c[0].includes("/api/inbox/payer-rejected/acknowledge"),
|
||||
);
|
||||
expect(ackCall).toBeTruthy();
|
||||
expect(ackCall).toBeDefined();
|
||||
const ackBody = JSON.parse(ackCall![1].body);
|
||||
expect(ackBody.claim_ids).toEqual(["PR1"]);
|
||||
});
|
||||
|
||||
it("SP8: multi-select resubmit opens bundle modal; Resubmit + Download triggers api + downloadBlob", async () => {
|
||||
// Two rejected claims → user selects both → Re-submit → modal appears
|
||||
// → user clicks Resubmit + Download → backend is hit with
|
||||
@@ -53,6 +162,7 @@ describe("Inbox page", () => {
|
||||
state: "rejected", rejection_reason: "old", service_date: null,
|
||||
score: null },
|
||||
],
|
||||
payer_rejected: [],
|
||||
candidates: [],
|
||||
unmatched: [],
|
||||
done_today: [],
|
||||
|
||||
+61
-4
@@ -1,9 +1,15 @@
|
||||
// ---------------------------------------------------------------------------
|
||||
// Inbox page (sub-project 6).
|
||||
// Inbox page (sub-project 6, SP14).
|
||||
//
|
||||
// Full-bleed dark working surface for the four-lane triage workflow.
|
||||
// Full-bleed dark working surface for the five-lane triage workflow.
|
||||
// Wires useInboxLanes + Lane + InboxHeader + BulkBar. Bulk actions call
|
||||
// the inbox API client and refetch on completion.
|
||||
//
|
||||
// SP14: added the `payer_rejected` lane (277CA STC A4/A6/A7) and the
|
||||
// Acknowledge bulk action. The Payer-Rejected lane sits between
|
||||
// `rejected` (envelope) and `candidates` (recon opportunities) so the
|
||||
// operator's eye flow is: envelope problems → payer problems →
|
||||
// auto-recon opportunities → claims still in flight → done today.
|
||||
// ---------------------------------------------------------------------------
|
||||
|
||||
import { useState } from "react";
|
||||
@@ -16,10 +22,16 @@ import {
|
||||
dismissCandidates,
|
||||
resubmitRejected,
|
||||
resubmitRejectedWithDownload,
|
||||
acknowledgePayerRejected,
|
||||
} from "@/lib/inbox-api";
|
||||
import { downloadBlob } from "@/lib/download";
|
||||
|
||||
type LaneKey = "rejected" | "candidates" | "unmatched" | "done_today";
|
||||
type LaneKey =
|
||||
| "rejected"
|
||||
| "payer_rejected"
|
||||
| "candidates"
|
||||
| "unmatched"
|
||||
| "done_today";
|
||||
|
||||
function rowKey(row: LaneRow): string {
|
||||
return row.kind === "remit" ? (row as { payer_claim_control_number: string }).payer_claim_control_number : row.id;
|
||||
@@ -29,6 +41,7 @@ export default function Inbox() {
|
||||
const { lanes, loading, error, refetch } = useInboxLanes();
|
||||
const [selected, setSelected] = useState<Record<LaneKey, string[]>>({
|
||||
rejected: [],
|
||||
payer_rejected: [],
|
||||
candidates: [],
|
||||
unmatched: [],
|
||||
done_today: [],
|
||||
@@ -127,6 +140,18 @@ export default function Inbox() {
|
||||
}
|
||||
}
|
||||
|
||||
async function onAcknowledge() {
|
||||
// SP14: drop selected payer-rejected claims from the working
|
||||
// surface. The backend persists an `acknowledged_at` timestamp;
|
||||
// the original 277CA rejection (status code, reason, source 277CA
|
||||
// id) stays intact for the SP11 audit log.
|
||||
const ids = selected.payer_rejected;
|
||||
if (ids.length === 0) return;
|
||||
await acknowledgePayerRejected(ids);
|
||||
setSelected((prev) => ({ ...prev, payer_rejected: [] }));
|
||||
await refetch();
|
||||
}
|
||||
|
||||
function onExport(lane: LaneKey) {
|
||||
if (selected[lane].length === 0) return;
|
||||
window.open(exportInboxCsvUrl(lane), "_blank");
|
||||
@@ -162,8 +187,15 @@ export default function Inbox() {
|
||||
);
|
||||
}
|
||||
|
||||
// SP14: payer_rejected is also actionable — a 277CA rejection that
|
||||
// needs operator follow-up. Without it, payer-side rejections would
|
||||
// hide behind the 999 envelope "rejected" lane and the operator
|
||||
// could miss a high-value denial.
|
||||
const needEyes =
|
||||
lanes.rejected.length + lanes.candidates.length + lanes.unmatched.length;
|
||||
lanes.rejected.length +
|
||||
lanes.payer_rejected.length +
|
||||
lanes.candidates.length +
|
||||
lanes.unmatched.length;
|
||||
|
||||
return (
|
||||
<div
|
||||
@@ -179,6 +211,19 @@ export default function Inbox() {
|
||||
onRowClick={() => {}}
|
||||
onSelectionChange={(ids) => setLaneSelected("rejected", ids)}
|
||||
/>
|
||||
{/*
|
||||
SP14: payer-rejected (277CA STC A4/A6/A7). Distinct accent
|
||||
from the 999 envelope rejected lane — the operator's eye
|
||||
flow is: 999 problems → payer problems → reconciliation
|
||||
opportunities → claims still in flight → done today.
|
||||
*/}
|
||||
<Lane
|
||||
name="PAYER REJECTED"
|
||||
accent="oxblood"
|
||||
rows={lanes.payer_rejected}
|
||||
onRowClick={() => {}}
|
||||
onSelectionChange={(ids) => setLaneSelected("payer_rejected", ids)}
|
||||
/>
|
||||
<Lane
|
||||
name="CANDIDATES"
|
||||
accent="amber"
|
||||
@@ -207,13 +252,23 @@ export default function Inbox() {
|
||||
lane="rejected"
|
||||
count={selected.rejected.length}
|
||||
onResubmit={onResubmit}
|
||||
onAcknowledge={() => {}}
|
||||
onDismiss={() => {}}
|
||||
onExport={() => onExport("rejected")}
|
||||
/>
|
||||
<BulkBar
|
||||
lane="payer_rejected"
|
||||
count={selected.payer_rejected.length}
|
||||
onResubmit={() => {}}
|
||||
onAcknowledge={onAcknowledge}
|
||||
onDismiss={() => {}}
|
||||
onExport={() => onExport("payer_rejected")}
|
||||
/>
|
||||
<BulkBar
|
||||
lane="candidates"
|
||||
count={selected.candidates.length}
|
||||
onResubmit={() => {}}
|
||||
onAcknowledge={() => {}}
|
||||
onDismiss={onDismiss}
|
||||
onExport={() => onExport("candidates")}
|
||||
/>
|
||||
@@ -221,6 +276,7 @@ export default function Inbox() {
|
||||
lane="unmatched"
|
||||
count={selected.unmatched.length}
|
||||
onResubmit={() => {}}
|
||||
onAcknowledge={() => {}}
|
||||
onDismiss={() => {}}
|
||||
onExport={() => onExport("unmatched")}
|
||||
/>
|
||||
@@ -228,6 +284,7 @@ export default function Inbox() {
|
||||
lane="done_today"
|
||||
count={selected.done_today.length}
|
||||
onResubmit={() => {}}
|
||||
onAcknowledge={() => {}}
|
||||
onDismiss={() => {}}
|
||||
onExport={() => onExport("done_today")}
|
||||
/>
|
||||
|
||||
Reference in New Issue
Block a user