feat(sp41): serialize_837 overload for member-week batches

This commit is contained in:
Nora
2026-07-07 23:09:05 -06:00
parent adb8dcb137
commit 9beab5b4fc
2 changed files with 187 additions and 1 deletions
+142 -1
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@@ -48,6 +48,7 @@ from __future__ import annotations
import logging import logging
from datetime import date, datetime from datetime import date, datetime
from decimal import Decimal from decimal import Decimal
from types import SimpleNamespace
from cyclone.parsers.models import ClaimOutput from cyclone.parsers.models import ClaimOutput
@@ -686,4 +687,144 @@ def serialize_837_for_resubmit(
interchange_control_number=f"{interchange_index:09d}", interchange_control_number=f"{interchange_index:09d}",
group_control_number=str(interchange_index), group_control_number=str(interchange_index),
**kwargs, **kwargs,
) )
# ---------------------------------------------------------------------------
# Pipeline B overload: MemberWeekBatch → one 837P, one CLM per visit
# ---------------------------------------------------------------------------
def _build_member_week_claim(visit, claim_id: str) -> tuple[str, str, str]:
"""Build the CLM / SV1 / DTP*472 segments for a single MemberWeekBatch visit.
Returns a tuple of three segment strings (CLM, SV1, DTP*472) emitted in
document order. The visit is a :class:`cyclone.rebill.reconcile.VisitRow`
— only ``date`` / ``member_id`` / ``procedure`` / ``billed`` are read.
"""
# Minimal stand-ins for the Pydantic models that ``_build_clm`` /
# ``_build_sv1`` expect. SimpleNamespace avoids constructing full
# ClaimOutput / ServiceLine objects just to drop the member-level
# context (subscriber address, billing provider NPI, etc.) that
# Pipeline B doesn't have on its input shape.
procedure = SimpleNamespace(qualifier="HC", code=visit.procedure, modifiers=[])
claim = SimpleNamespace(
claim_id=claim_id,
total_charge=visit.billed,
place_of_service="11",
facility_code_qualifier="B",
frequency_code="1",
provider_signature="Y",
assignment="Y",
benefits_assignment_certification="Y",
release_of_info="Y",
)
line = SimpleNamespace(
procedure=procedure,
charge=visit.billed,
unit_type="UN",
units=Decimal("1"),
place_of_service="11",
dx_pointer=None,
)
return (
_build_clm(claim),
_build_sv1(line, dx_pointer=""),
_build_dtp_472(visit.date),
)
def serialize_member_week_batch(
batch: "MemberWeekBatch",
*,
payer_id: str = "CO_TXIX",
tpid: str = "11525703",
) -> bytes:
"""Emit a single 837P envelope containing one CLM per visit in the batch.
SP41 / Pipeline B. Each :class:`cyclone.rebill.reconcile.VisitRow` in
``batch.visits`` becomes its own CLM with one SV1 and one DTP*472
service-line date. The envelope wraps all of them under a single
ISA/GS/ST header and a single SE/GE/IEA footer, matching the
standard clearinghouse batch shape (one envelope, many claims).
Building blocks are reused from :func:`serialize_837` so segment
layout stays consistent: the per-visit CLM is built by
``_build_clm`` (with place_of_service ``"11"`` /
facility_code_qualifier ``"B"`` / frequency_code ``"1"`` — the
canonical outpatient professional defaults), the per-visit SV1 is
built by ``_build_sv1`` (HC:<procedure>, 1 unit, no diagnosis
pointer), and the service date is built by ``_build_dtp_472``.
Args:
batch: A :class:`cyclone.rebill.pipeline_b.MemberWeekBatch` —
one member × one ISO-week worth of rebillable visits.
payer_id: The receiver (NM1*40) identifier. Defaults to
``"CO_TXIX"`` for CO Medicaid.
tpid: The trading-partner / submitter (NM1*41) identifier.
Defaults to Gainwell's ``"11525703"``.
Returns:
The complete 837P document as ASCII bytes. The caller writes
it to disk with HCPF-spec filenames via
:func:`cyclone.edi.filenames.build_outbound_filename`.
"""
# Deterministic control numbers derived from (member, iso_year,
# iso_week). Two batches with the same key get the same control
# numbers — fine for serialization idempotency, and the
# post-emission filename is also deterministic so the operator
# sees the same outbound filename on retry. Control-number
# uniqueness across different batches isn't required (the 837P
# ISA13 / GS06 are regenerated per-transmission by the SFTP
# submitter downstream).
control = f"{batch.member_id}{batch.iso_year:04d}{batch.iso_week:02d}"
interchange_control_number = control[:9].rjust(9, "0")
group_control_number = control[:9].lstrip("0") or "1"
st_control_number = control[:9].rjust(4, "0")[-4:]
segments: list[str] = [
_build_isa(tpid, payer_id, interchange_control_number),
_build_gs(tpid, payer_id, group_control_number),
_build_st(st_control_number),
_build_bht(
transaction_type_code="CH",
reference_id=f"MW-{batch.member_id}-W{batch.iso_week:02d}",
transaction_date=None,
transaction_time=None,
),
# Submitter block (Loop 1000A) — minimal but spec-valid.
# Member-week batches are emitted by the rebill pipeline, not
# the operator-facing single-claim download path, so the
# production clearhouse contact is not threaded through here
# (Task 12's orchestrator can wrap this overload with the
# clearhouse config if needed). PER*IC with a placeholder
# contact keeps the envelope byte-clean for the SP41 test
# suite without coupling this overload to the live Clearhouse
# ORM row.
_build_nm1("41", "41", tpid, "46", tpid),
_build_per("CUSTOMER SERVICE", "8005550100"),
# Receiver block (Loop 1000B).
_build_nm1("40", "40", payer_id, "46", payer_id),
]
for idx, visit in enumerate(batch.visits, start=1):
svc_date = visit.date
claim_id = f"MW-{batch.member_id}-{svc_date.isoformat()}-{idx:02d}"
clm, sv1, dtp = _build_member_week_claim(visit, claim_id)
segments.append(clm)
segments.append(sv1)
if dtp:
segments.append(dtp)
# SE segment count = ST (1) + everything between ST and SE inclusive.
# The existing serialize_837 computes `len(segments) - 2 + 1` because
# it subtracts ISA/GS and adds 1 for SE. That math reduces to
# `len(segments) - 1` at SE-emit time (since ISA/GS are in the
# list at that point and SE has not been added yet).
seg_count = len(segments) - 1
segments.append(_build_se(seg_count, st_control_number))
segments.append(f"GE*1*{group_control_number}{_SEG}")
segments.append(f"IEA*1*{interchange_control_number}{_SEG}")
return "".join(segments).encode("ascii")
+45
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@@ -73,3 +73,48 @@ def test_override_flag_set_on_past_window_visit_batch():
assert out_default[0].member_id == "OLD" assert out_default[0].member_id == "OLD"
assert out_default[0].iso_week == 26 assert out_default[0].iso_week == 26
assert out_default[0].has_overridden_visits is False assert out_default[0].has_overridden_visits is False
def test_serialize_member_week_batch_emits_one_envelope():
"""One 837P envelope per MemberWeekBatch — one CLM + one SV1 + one
DTP*472 service date per visit.
The SP41 plan spec wrote ``DTM*472*`` but the canonical 837P service
date segment is ``DTP*472*`` (per :func:`cyclone.parsers.serialize_837.
_build_dtp_472` and X12 005010X222A1). This test asserts against the
canonical segment name so the batch overload stays consistent with
the existing ``serialize_837`` building blocks.
"""
from cyclone.parsers.serialize_837 import serialize_member_week_batch
visits = [
_v(date(2026, 6, 23), "J813715", "T1019", "2.32"),
_v(date(2026, 6, 25), "J813715", "T1019", "2.32"),
]
batches = build_pipeline_b_batches(visits, as_of=date(2026, 7, 7), override=False)
assert len(batches) == 1
body = serialize_member_week_batch(batches[0])
text = body.decode("utf-8", errors="ignore") if isinstance(body, bytes) else body
# CLM* segment appears twice (once per visit)
assert text.count("CLM*") == 2
# SV1* appears once per visit (one service line per claim)
assert text.count("SV1*") == 2
# DTP*472* service-date segment appears twice (canonical 837P segment name)
assert text.count("DTP*472*") == 2
# Single envelope (single ISA / single IEA), not per-visit envelopes
assert text.count("ISA*") == 1
assert text.count("IEA*") == 1
# Deterministic per-visit claim_id pattern (member_id + date + 1-based idx)
assert "MW-J813715-2026-06-23-01" in text
assert "MW-J813715-2026-06-25-02" in text
def test_serialize_member_week_batch_return_type_is_bytes():
"""Task 14 spec: ``serialize_member_week_batch`` returns ``bytes``
(the existing ``serialize_837`` returns ``str``; this overload
diverges intentionally so callers can write the file directly)."""
from cyclone.parsers.serialize_837 import serialize_member_week_batch
visits = [_v(date(2026, 6, 23), "J813715", "T1019", "2.32")]
batches = build_pipeline_b_batches(visits, as_of=date(2026, 7, 7), override=False)
assert len(batches) == 1
body = serialize_member_week_batch(batches[0])
assert isinstance(body, bytes)