Merge feat/837p-parser: 837P parser module with CO Medicaid validation

This commit is contained in:
Tyler
2026-06-19 16:13:20 -06:00
25 changed files with 1884 additions and 0 deletions
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__pycache__/
*.py[cod]
*.egg-info/
.pytest_cache/
.ruff_cache/
.venv/
venv/
build/
dist/
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# Cyclone Backend — X12 837P Parser
Python module + CLI for parsing X12 837P professional claim files into one
validated JSON per claim. Output is consumed by the Cyclone Vite/React
frontend (later via a FastAPI service).
## Install
```bash
cd backend
python -m venv .venv
. .venv/bin/activate
pip install -e ".[dev]"
```
## CLI
```bash
python -m cyclone.cli parse-837 path/to/837p.txt --output-dir ./claims
```
Options:
- `--payer {co_medicaid,generic_837p}` — default `co_medicaid`
- `--strict` — promote warnings to errors
- `--max-retries N` — stub in v1 (no auto-fix yet)
- `--include-raw-segments / --no-raw-segments` — default: include
- `--log-level {DEBUG,INFO,WARNING,ERROR}`
Exit codes:
- `0` — every claim parsed
- `2` — file-level failure (no envelope, no claims)
- `1` — unexpected exception
## Output
```
claims/
├── claim-991102977-20260611-CLM001.json # one per claim
├── claim-991102977-20260611-CLM002.json
└── summary.json # batch summary
```
## Programmatic use
```python
from pathlib import Path
from cyclone.parsers.parse_837 import parse
from cyclone.parsers.payer import PayerConfig
from cyclone.parsers.writer import write_outputs
result = parse(Path("input.txt").read_text(), PayerConfig.co_medicaid())
write_outputs(result, Path("./claims"))
print(f"passed={result.summary.passed} failed={result.summary.failed}")
```
## Tests
```bash
pytest -v
```
The CLI smoke test against `docs/prodfiles/837p-from-axiscare/*.txt` is
auto-skipped if no production files are present.
## Spec & plan
- Design: `docs/superpowers/specs/2026-06-19-cyclone-837p-parser-design.md`
- Plan: `docs/superpowers/plans/2026-06-19-cyclone-837p-parser.md`
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[build-system]
requires = ["setuptools>=68", "wheel"]
build-backend = "setuptools.build_meta"
[project]
name = "cyclone"
version = "0.1.0"
description = "Cyclone EDI suite — X12 837P/835 parser"
requires-python = ">=3.11"
dependencies = [
"pydantic>=2.6,<3",
"click>=8.1,<9",
]
[project.optional-dependencies]
dev = [
"pytest>=8.0",
"pytest-cov>=4.1",
]
[project.scripts]
cyclone = "cyclone.cli:main"
[tool.setuptools.packages.find]
where = ["src"]
[tool.pytest.ini_options]
testpaths = ["tests"]
addopts = "-ra --strict-markers"
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__version__ = "0.1.0"
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from cyclone.cli import main
if __name__ == "__main__":
main()
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"""Click-based CLI for the Cyclone 837P parser."""
from __future__ import annotations
import logging
import sys
from pathlib import Path
import click
from cyclone.parsers.exceptions import CycloneParseError, CycloneValidationError
from cyclone.parsers.payer import PayerConfig
from cyclone.parsers.parse_837 import parse
from cyclone.parsers.writer import write_outputs
_PAYER_FACTORIES = {
"co_medicaid": PayerConfig.co_medicaid,
"generic_837p": PayerConfig.generic_837p,
}
def _payer(name: str) -> PayerConfig:
if name not in _PAYER_FACTORIES:
raise click.BadParameter(f"Unknown payer {name!r}. Choose from: {', '.join(_PAYER_FACTORIES)}")
return _PAYER_FACTORIES[name]()
@click.group()
def main() -> None:
"""Cyclone EDI suite — X12 parser."""
@main.command("parse-837")
@click.argument("input_file", type=click.Path(exists=True, dir_okay=False, path_type=Path))
@click.option("--output-dir", required=True, type=click.Path(file_okay=False, path_type=Path))
@click.option("--payer", default="co_medicaid", show_default=True, help="Payer configuration preset")
@click.option("--strict", is_flag=True, help="Promote warnings to errors")
@click.option("--max-retries", default=0, show_default=True, type=int, help="Re-validate failed claims (no fix in v1)")
@click.option("--include-raw-segments / --no-raw-segments", default=True, help="Embed raw segments in output JSON")
@click.option("--log-level", default="INFO", show_default=True, type=click.Choice(["DEBUG", "INFO", "WARNING", "ERROR"]))
def parse_837(
input_file: Path,
output_dir: Path,
payer: str,
strict: bool,
max_retries: int,
include_raw_segments: bool,
log_level: str,
) -> None:
"""Parse an X12 837P file into one JSON per claim."""
logging.basicConfig(level=getattr(logging, log_level))
text = input_file.read_text()
config = _payer(payer)
try:
result = parse(text, config, input_file=str(input_file))
except CycloneParseError as exc:
click.echo(f"PARSE ERROR: {exc}", err=True)
sys.exit(2)
if not result.claims:
raise click.UsageError("No claims found in file") from None
# Strict mode: rewrite reports
if strict:
for claim in result.claims:
promoted = [
issue.model_copy(update={"severity": "error"})
for issue in claim.validation.warnings
]
new_errors = claim.validation.errors + promoted
claim.validation = claim.validation.model_copy(
update={"errors": new_errors, "passed": not new_errors}
)
# Recompute summary
passed = sum(1 for c in result.claims if c.validation.passed)
result.summary = result.summary.model_copy(update={
"passed": passed,
"failed": len(result.claims) - passed,
"failed_claim_ids": [c.claim_id for c in result.claims if not c.validation.passed],
})
# Drop raw_segments if disabled
if not include_raw_segments:
for claim in result.claims:
claim.raw_segments = []
# v1: max_retries is a no-op stub. Surface a log line so users know it's wired.
if max_retries:
logging.info("max-retries=%d (no auto-fix in v1; would re-validate here)", max_retries)
paths = write_outputs(result, output_dir)
result.summary = result.summary.model_copy(update={"output_dir": str(output_dir)})
(output_dir / "summary.json").write_text(result.summary.model_dump_json(indent=2))
click.echo(
f"parsed={result.summary.total_claims} "
f"passed={result.summary.passed} "
f"failed={result.summary.failed} "
f"output={output_dir}"
)
if __name__ == "__main__":
main()
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"""Public re-exports for the 837P parser.
Re-exports are lazy via PEP 562 ``__getattr__`` so that importing a name from
this package (e.g. ``from cyclone.parsers.exceptions import CycloneParseError``)
does not require every referenced module to be importable. Downstream code can
write ``cyclone.parsers.PayerConfig`` and it will be loaded on first access.
"""
from __future__ import annotations
# Eager: only the exceptions module is needed early and unconditionally.
from cyclone.parsers.exceptions import CycloneParseError, CycloneValidationError
_LAZY_EXPORTS: dict[str, str] = {
# exceptions
"CycloneParseError": "cyclone.parsers.exceptions",
"CycloneValidationError": "cyclone.parsers.exceptions",
# models
"Address": "cyclone.parsers.models",
"BatchSummary": "cyclone.parsers.models",
"BillingProvider": "cyclone.parsers.models",
"ClaimHeader": "cyclone.parsers.models",
"ClaimOutput": "cyclone.parsers.models",
"Diagnosis": "cyclone.parsers.models",
"Envelope": "cyclone.parsers.models",
"ParseResult": "cyclone.parsers.models",
"Payer": "cyclone.parsers.models",
"Procedure": "cyclone.parsers.models",
"ServiceLine": "cyclone.parsers.models",
"Subscriber": "cyclone.parsers.models",
"ValidationIssue": "cyclone.parsers.models",
"ValidationReport": "cyclone.parsers.models",
# payer
"PayerConfig": "cyclone.parsers.payer",
# segments
"Delimiters": "cyclone.parsers.segments",
"tokenize": "cyclone.parsers.segments",
# orchestrator
"parse": "cyclone.parsers.parse_837",
"write_outputs": "cyclone.parsers.writer",
}
_cache: dict[str, object] = {}
def __getattr__(name: str) -> object:
module_path = _LAZY_EXPORTS.get(name)
if module_path is None:
raise AttributeError(f"module {__name__!r} has no attribute {name!r}")
if name in _cache:
return _cache[name]
import importlib
mod = importlib.import_module(module_path)
value = getattr(mod, name)
_cache[name] = value
return value
def __dir__() -> list[str]:
return sorted(list(_LAZY_EXPORTS.keys()))
__all__ = sorted(_LAZY_EXPORTS.keys())
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"""Exception types raised by the parser.
These are reserved for unrecoverable, file-level failures (bad envelope, no
ISA segment, malformed delimiters). Per-claim validation issues are not
exceptions — they are accumulated into ``ValidationReport``.
"""
from __future__ import annotations
class CycloneParseError(Exception):
"""Raised when the file itself cannot be parsed (bad envelope, etc.)."""
def __init__(self, message: str, *, segment_index: int | None = None) -> None:
self.segment_index = segment_index
suffix = f" (segment {segment_index})" if segment_index is not None else ""
super().__init__(f"{message}{suffix}")
class CycloneValidationError(Exception):
"""Raised by the CLI for envelope-level validation failures (no claims found)."""
def __init__(self, message: str, *, rule_id: str | None = None, claim_id: str | None = None) -> None:
self.rule_id = rule_id
self.claim_id = claim_id
prefix = f"[{rule_id}] " if rule_id else ""
claim = f" (claim {claim_id})" if claim_id else ""
super().__init__(f"{prefix}{message}{claim}")
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"""Pydantic v2 models for parsed 837P claims.
Models mirror the X12 837P structure (Loop 2000A → 2000B → 2300 → 2400) but
flattened to one ``ClaimOutput`` per CLM segment, suitable for JSON serialization
and consumption by the Cyclone frontend.
"""
from __future__ import annotations
from datetime import date
from decimal import Decimal
from typing import Literal
from pydantic import BaseModel, ConfigDict, Field, model_serializer
class _Base(BaseModel):
model_config = ConfigDict(extra="ignore", str_strip_whitespace=True)
@model_serializer(mode="wrap")
def _serialize(self, handler): # type: ignore[no-untyped-def]
data = handler(self)
for key, value in data.items():
if isinstance(value, date):
data[key] = value.isoformat()
return data
class Address(_Base):
line1: str
line2: str | None = None
city: str
state: str
zip: str
class BillingProvider(_Base):
name: str
npi: str
tax_id: str | None = None
address: Address | None = None
class Subscriber(_Base):
first_name: str
last_name: str
member_id: str
dob: date | None = None
gender: Literal["M", "F", "U"] | None = None
address: Address | None = None
class Payer(_Base):
name: str
id: str
class ClaimHeader(_Base):
claim_id: str
total_charge: Decimal
place_of_service: str | None = None
frequency_code: str | None = None
provider_signature: str | None = None
assignment: str | None = None
release_of_info: str | None = None
prior_auth: str | None = None
class Diagnosis(_Base):
code: str
qualifier: str | None = None
class Procedure(_Base):
qualifier: str
code: str
modifiers: list[str] = Field(default_factory=list)
class ServiceLine(_Base):
line_number: int
procedure: Procedure
charge: Decimal
unit_type: str | None = None
units: Decimal | None = None
place_of_service: str | None = None
service_date: date | None = None
provider_reference: str | None = None
class ValidationIssue(_Base):
rule: str
severity: Literal["error", "warning"]
message: str
segment_index: int | None = None
class ValidationReport(_Base):
passed: bool
errors: list[ValidationIssue] = Field(default_factory=list)
warnings: list[ValidationIssue] = Field(default_factory=list)
class Envelope(_Base):
sender_id: str
receiver_id: str
control_number: str
transaction_date: date
transaction_time: str | None = None
implementation_guide: str | None = None
class BatchSummary(_Base):
input_file: str
control_number: str | None = None
transaction_date: date | None = None
total_claims: int = 0
passed: int = 0
failed: int = 0
failed_claim_ids: list[str] = Field(default_factory=list)
issues_by_rule: dict[str, int] = Field(default_factory=dict)
output_dir: str | None = None
class ClaimOutput(_Base):
claim_id: str
control_number: str
transaction_date: date
billing_provider: BillingProvider
subscriber: Subscriber
payer: Payer
claim: ClaimHeader
diagnoses: list[Diagnosis] = Field(default_factory=list)
service_lines: list[ServiceLine] = Field(default_factory=list)
validation: ValidationReport
raw_segments: list[list[str]] = Field(default_factory=list)
class ParseResult(_Base):
envelope: Envelope | None = None
claims: list[ClaimOutput] = Field(default_factory=list)
summary: BatchSummary
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r"""Orchestrate parsing an X12 837P file into a :class:`ParseResult`.
Single-pass HL walker:
- ``HL*1**20*1`` = Loop 2000A (Billing Provider)
- ``HL*n*1*22*0`` = Loop 2000B (Subscriber), one per subscriber
- Inside each subscriber loop, every CLM segment = one :class:`ClaimOutput`
- Inside each claim, LX/SV1 pairs = :class:`ServiceLine` rows
Errors at the file level raise :class:`CycloneParseError`. Errors at the
claim level are caught and accumulated into ``ClaimOutput.validation``.
"""
from __future__ import annotations
import logging
from datetime import date
from decimal import Decimal
from typing import Any
from cyclone.parsers.exceptions import CycloneParseError
from cyclone.parsers.models import (
Address,
BatchSummary,
BillingProvider,
ClaimHeader,
ClaimOutput,
Diagnosis,
Envelope,
Payer,
ParseResult,
Procedure,
ServiceLine,
Subscriber,
ValidationIssue,
ValidationReport,
)
from cyclone.parsers.payer import PayerConfig
from cyclone.parsers.segments import tokenize
from cyclone.parsers.validator import validate
log = logging.getLogger(__name__)
def _parse_isa_date(yymmdd: str) -> date:
if len(yymmdd) == 8:
# BHT04 uses CCYYMMDD (8 chars); ISA06/GS04 may also.
year = int(yymmdd[0:4])
mm = int(yymmdd[4:6])
dd = int(yymmdd[6:8])
else:
yy = int(yymmdd[0:2])
mm = int(yymmdd[2:4])
dd = int(yymmdd[4:6])
# Pivot year 30: 00-29 = 2000s, 30-99 = 1900s. Reasonable for 837P.
year = 2000 + yy if yy < 30 else 1900 + yy
return date(year, mm, dd)
def _build_envelope(segments: list[list[str]], input_file: str = "") -> tuple[Envelope | None, BatchSummary]:
summary = BatchSummary(input_file=input_file)
envelope: Envelope | None = None
for seg in segments:
if seg[0] == "ISA":
try:
envelope = Envelope(
sender_id=seg[6].strip(),
receiver_id=seg[8].strip(),
control_number=seg[13].strip(),
transaction_date=date(2026, 1, 1), # placeholder; overwritten by BHT
implementation_guide=None,
)
except (IndexError, ValueError) as exc:
raise CycloneParseError(f"Bad ISA: {exc}") from exc
elif seg[0] == "BHT" and envelope is not None:
try:
envelope = envelope.model_copy(update={"transaction_date": _parse_isa_date(seg[4])})
if len(seg) > 5:
envelope = envelope.model_copy(update={"transaction_time": seg[5]})
except (IndexError, ValueError) as exc:
log.warning("Could not parse BHT date: %s", exc)
elif seg[0] == "ST" and envelope is not None:
if len(seg) > 3:
envelope = envelope.model_copy(update={"implementation_guide": seg[3]})
return envelope, summary
def _consume_billing_provider(segments: list[list[str]], idx: int) -> tuple[BillingProvider, int]:
"""Read NM1*85 / N3 / N4 / REF*EI between ``idx`` and the next HL."""
npi = ""
name = ""
tax_id: str | None = None
addr: Address | None = None
while idx < len(segments) and segments[idx][0] != "HL":
seg = segments[idx]
if seg[0] == "NM1" and len(seg) > 8 and seg[1] == "85":
name = seg[3]
for j, qual in enumerate(seg):
if qual == "XX" and j + 1 < len(seg):
npi = seg[j + 1]
break
elif seg[0] == "N3":
line1 = seg[1] if len(seg) > 1 else ""
line2 = seg[2] if len(seg) > 2 else None
addr = (addr or Address(line1=line1, city="", state="", zip="")).model_copy(update={"line1": line1, "line2": line2})
elif seg[0] == "N4":
city = seg[1] if len(seg) > 1 else ""
state = seg[2] if len(seg) > 2 else ""
zip_ = seg[3] if len(seg) > 3 else ""
addr = (addr or Address(line1="", city=city, state=state, zip=zip_)).model_copy(update={"city": city, "state": state, "zip": zip_})
elif seg[0] == "REF" and len(seg) > 2 and seg[1] == "EI":
tax_id = seg[2]
idx += 1
if addr is None:
addr = Address(line1="", city="", state="", zip="")
return BillingProvider(name=name, npi=npi, tax_id=tax_id, address=addr), idx
def _consume_subscriber(segments: list[list[str]], idx: int) -> tuple[Subscriber, int]:
"""Read NM1*IL / N3 / N4 / DMG between ``idx`` and the next HL/CLM."""
first = ""
last = ""
member_id = ""
dob: date | None = None
gender: str | None = None
addr: Address | None = None
while idx < len(segments) and segments[idx][0] not in {"HL", "CLM"}:
seg = segments[idx]
# Stop at the payer (NM1*PR) or patient (NM1*QC) — those belong to the next loop
if seg[0] == "NM1" and len(seg) > 1 and seg[1] in {"PR", "QC"}:
break
if seg[0] == "NM1" and len(seg) > 3 and seg[1] == "IL":
last = seg[3] if len(seg) > 3 else ""
first = seg[4] if len(seg) > 4 else ""
for j, qual in enumerate(seg):
if qual == "MI" and j + 1 < len(seg):
member_id = seg[j + 1]
break
elif seg[0] == "N3":
line1 = seg[1] if len(seg) > 1 else ""
addr = (addr or Address(line1=line1, city="", state="", zip="")).model_copy(update={"line1": line1})
elif seg[0] == "N4":
city = seg[1] if len(seg) > 1 else ""
state = seg[2] if len(seg) > 2 else ""
zip_ = seg[3] if len(seg) > 3 else ""
addr = (addr or Address(line1="", city=city, state=state, zip=zip_)).model_copy(update={"city": city, "state": state, "zip": zip_})
elif seg[0] == "DMG" and len(seg) > 2 and seg[1] == "D8":
try:
dob = _parse_isa_date(seg[2])
except (ValueError, IndexError):
dob = None
gender = seg[3] if len(seg) > 3 else None
idx += 1
if addr is None:
addr = Address(line1="", city="", state="", zip="")
return Subscriber(first_name=first, last_name=last, member_id=member_id, dob=dob, gender=gender, address=addr), idx
def _consume_payer(segments: list[list[str]], idx: int) -> tuple[Payer, int]:
name = ""
pid = ""
while idx < len(segments) and segments[idx][0] not in {"HL", "CLM"}:
seg = segments[idx]
# Stop at patient loop (NM1*QC) — we already have the payer.
if seg[0] == "NM1" and len(seg) > 1 and seg[1] == "QC":
break
if seg[0] == "NM1" and len(seg) > 3 and seg[1] == "PR":
name = seg[3] if len(seg) > 3 else ""
for j, qual in enumerate(seg):
if qual == "PI" and j + 1 < len(seg):
pid = seg[j + 1]
break
idx += 1
return Payer(name=name, id=pid), idx
def _consume_claim(segments: list[list[str]], idx: int) -> tuple[ClaimOutput, int]:
"""Read one CLM and all its child segments up to the next CLM/HL/SE."""
seg = segments[idx]
clm = seg
claim_id = clm[1] if len(clm) > 1 else ""
total_charge = Decimal(clm[2]) if len(clm) > 2 and clm[2] else Decimal("0")
pos = ""
freq = ""
if len(clm) > 5:
clm05 = clm[5].split(":")
if len(clm05) > 0:
pos = clm05[0]
if len(clm05) > 2:
freq = clm05[2]
claim_header = ClaimHeader(
claim_id=claim_id,
total_charge=total_charge,
place_of_service=pos or None,
frequency_code=freq or None,
provider_signature=clm[6] if len(clm) > 6 else None,
assignment=clm[7] if len(clm) > 7 else None,
release_of_info=clm[9] if len(clm) > 9 else None,
)
diagnoses: list[Diagnosis] = []
service_lines: list[ServiceLine] = []
raw: list[list[str]] = [seg]
prior_auth: str | None = None
idx += 1
while idx < len(segments) and segments[idx][0] not in {"HL", "CLM", "SE"}:
s = segments[idx]
raw.append(s)
if s[0] == "REF" and len(s) > 2 and s[1] == "G1":
prior_auth = s[2]
elif s[0] == "HI":
for h in s[1:]:
if not h:
continue
parts = h.split(":")
qualifier = parts[0] if parts else None
for code in parts[1:]:
if code:
diagnoses.append(Diagnosis(code=code, qualifier=qualifier))
elif s[0] == "LX":
line_no = int(s[1]) if len(s) > 1 and s[1].isdigit() else len(service_lines) + 1
# LX is just a separator — the actual service line data is in the next SV1.
# Capture SV1 in the claim's raw_segments, then hand off to the consumer.
if idx + 1 < len(segments) and segments[idx + 1][0] == "SV1":
raw.append(segments[idx + 1])
sl, idx = _consume_service_line(segments, idx + 1, line_no)
else:
# No SV1 after LX — skip the LX and create a stub line.
idx += 1
sl = ServiceLine(
line_number=line_no,
procedure=Procedure(qualifier="", code=""),
charge=Decimal("0"),
)
service_lines.append(sl)
continue # _consume_service_line already advanced idx
idx += 1
claim_header.prior_auth = prior_auth
return (
ClaimOutput(
claim_id=claim_id,
control_number="", # filled in by caller
transaction_date=date(2026, 1, 1), # filled in by caller
billing_provider=BillingProvider(name="", npi=""), # filled in by caller
subscriber=Subscriber(first_name="", last_name="", member_id="", address=Address(line1="", city="", state="", zip="")),
payer=Payer(name="", id=""),
claim=claim_header,
diagnoses=diagnoses,
service_lines=service_lines,
validation=ValidationReport(passed=True, errors=[], warnings=[]),
raw_segments=raw,
),
idx,
)
def _consume_service_line(segments: list[list[str]], idx: int, line_no: int) -> tuple[ServiceLine, int]:
seg = segments[idx]
raw: list[list[str]] = [seg]
qualifier = ""
code = ""
modifiers: list[str] = []
if len(seg) > 1:
sv101 = seg[1].split(":")
if len(sv101) > 0:
qualifier = sv101[0]
if len(sv101) > 1:
code = sv101[1]
modifiers = [m for m in sv101[2:] if m]
charge = Decimal(seg[2]) if len(seg) > 2 and seg[2] else Decimal("0")
unit_type = seg[3] if len(seg) > 3 else None
units: Decimal | None = None
if len(seg) > 4 and seg[4]:
try:
units = Decimal(seg[4])
except Exception:
units = None
place_of_service = seg[5] if len(seg) > 5 else None
service_date: date | None = None
provider_ref: str | None = None
idx += 1
while idx < len(segments) and segments[idx][0] not in {"LX", "HL", "CLM", "SE"}:
s = segments[idx]
raw.append(s)
if s[0] == "DTP" and len(s) > 2 and s[1] == "472":
try:
service_date = _parse_isa_date(s[3]) if len(s) > 3 and s[2] == "D8" and len(s) > 3 else None
except (ValueError, IndexError):
service_date = None
elif s[0] == "REF" and len(s) > 2 and s[1] == "6R":
provider_ref = s[2]
idx += 1
return (
ServiceLine(
line_number=line_no,
procedure=Procedure(qualifier=qualifier, code=code, modifiers=modifiers),
charge=charge,
unit_type=unit_type,
units=units,
place_of_service=place_of_service,
service_date=service_date,
provider_reference=provider_ref,
),
idx,
)
def parse(text: str, payer_config: PayerConfig, input_file: str = "") -> ParseResult:
"""Parse a complete 837P document and return a :class:`ParseResult`."""
segments = tokenize(text)
envelope, summary = _build_envelope(segments, input_file=input_file)
if envelope is None:
raise CycloneParseError("No ISA / BHT envelope found")
claims: list[ClaimOutput] = []
issues_by_rule: dict[str, int] = {}
i = 0
while i < len(segments):
seg = segments[i]
if seg[0] == "HL" and len(seg) > 3 and seg[3] == "20":
# Billing provider HL
provider, i = _consume_billing_provider(segments, i + 1)
continue
if seg[0] == "HL" and len(seg) > 3 and seg[3] == "22":
# Subscriber HL
try:
subscriber, i = _consume_subscriber(segments, i + 1)
except Exception as exc: # pragma: no cover - safety net
log.warning("Subscriber parse failed at segment %d: %s", i, exc)
i += 1
continue
try:
payer, i = _consume_payer(segments, i)
except Exception as exc: # pragma: no cover
log.warning("Payer parse failed at segment %d: %s", i, exc)
payer = Payer(name="", id="")
# Consume all CLMs in this subscriber loop
while i < len(segments) and segments[i][0] != "HL":
if segments[i][0] == "CLM":
try:
claim, i = _consume_claim(segments, i)
except Exception as exc:
log.warning("Claim parse failed at segment %d: %s", i, exc)
i += 1
continue
# Fill in envelope-bound fields
claim = claim.model_copy(update={
"control_number": envelope.control_number,
"transaction_date": envelope.transaction_date,
"billing_provider": provider,
"subscriber": subscriber,
"payer": payer,
})
# Run validation
report = validate(claim, payer_config)
# Structural check not covered by the validator rules: subscriber
# member id (NM109/MI) must be present. The validator's
# `R040_member_id_present` style rule lives here as a guard
# so a truncated MI segment does not silently produce a
# "passed" claim.
if not claim.subscriber.member_id:
extra = ValidationIssue(
rule="R040_member_id_present",
severity="error",
message="Subscriber member id (NM109/MI) is empty",
)
report = report.model_copy(update={
"errors": report.errors + [extra],
"passed": False,
})
claim = claim.model_copy(update={"validation": report})
for issue in report.errors + report.warnings:
issues_by_rule[issue.rule] = issues_by_rule.get(issue.rule, 0) + 1
claims.append(claim)
else:
i += 1
continue
i += 1
passed = sum(1 for c in claims if c.validation.passed)
failed = len(claims) - passed
failed_ids = [c.claim_id for c in claims if not c.validation.passed]
summary = summary.model_copy(update={
"control_number": envelope.control_number,
"transaction_date": envelope.transaction_date,
"total_claims": len(claims),
"passed": passed,
"failed": failed,
"failed_claim_ids": failed_ids,
"issues_by_rule": issues_by_rule,
})
return ParseResult(envelope=envelope, claims=claims, summary=summary)
+59
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"""Payer-specific configuration for the 837P parser.
The same parser module can ingest 837P files from any payer, but the
validation rules differ. ``PayerConfig`` carries the differences so
``validator.validate(claim, config)`` can be payer-aware without branching
in the parser.
"""
from __future__ import annotations
from pydantic import BaseModel, ConfigDict, Field
class PayerConfig(BaseModel):
model_config = ConfigDict(frozen=True)
name: str
sbr09_claim_filing: str = "MC"
allowed_claim_frequencies: set[int] = Field(default_factory=lambda: {1, 7, 8})
require_ref_g1_for_adjustments: bool = False
allowed_bht06: set[str] = Field(default_factory=lambda: {"CH"})
payer_id: str = ""
payer_name: str = ""
no_patient_loop: bool = False
encounter_claim_in_same_batch: bool = False
@classmethod
def co_medicaid(cls) -> "PayerConfig":
"""Defaults for Colorado Medical Assistance Program (FFS).
Source: ``docs/companionguides/837p.md``.
"""
return cls(
name="Colorado Medical Assistance Program",
sbr09_claim_filing="MC",
allowed_claim_frequencies={1, 7, 8},
# Lenient in v1 — see spec §9 R031.
require_ref_g1_for_adjustments=False,
allowed_bht06={"CH"},
payer_id="SKCO0",
payer_name="COHCPF",
no_patient_loop=True,
encounter_claim_in_same_batch=False,
)
@classmethod
def generic_837p(cls) -> "PayerConfig":
"""Relaxed defaults for an unknown payer. Structural rules only."""
return cls(
name="Generic 837P",
sbr09_claim_filing="",
allowed_claim_frequencies={1, 2, 3, 4, 5, 6, 7, 8, 9},
require_ref_g1_for_adjustments=False,
allowed_bht06={"CH", "RP"},
payer_id="",
payer_name="",
no_patient_loop=False,
encounter_claim_in_same_batch=True,
)
+80
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"""X12 segment tokenizer.
The ISA segment is a fixed 106-character record (101 + segment terminator) that
declares the four delimiters used in the rest of the file:
- element separator (3rd char, 0-indexed)
- repetition separator (82nd char, 0-indexed; ISA11)
- component separator (104th char, 0-indexed; ISA16)
- segment terminator (105th char, 0-indexed)
We do not split components here — that is left to the caller, since most X12
elements are simple and splitting unconditionally would corrupt data.
"""
from __future__ import annotations
from dataclasses import dataclass
from cyclone.parsers.exceptions import CycloneParseError
@dataclass(frozen=True)
class Delimiters:
element: str # usually "*"
repetition: str # usually "^"
component: str # usually ":"
segment: str # usually "~"
def _detect_delimiters(isa_segment: str) -> Delimiters:
"""Pull the four delimiters from the fixed-width ISA segment.
The ISA segment must be exactly 106 characters (including the terminator).
"""
if len(isa_segment) < 106:
raise CycloneParseError(
f"ISA segment too short: expected 106 chars, got {len(isa_segment)}"
)
return Delimiters(
element=isa_segment[3],
repetition=isa_segment[82],
component=isa_segment[104],
segment=isa_segment[105],
)
def tokenize(text: str) -> list[list[str]]:
"""Split a raw X12 document into a list of segments (each a list of elements).
The first segment must be an ISA. Raises :class:`CycloneParseError` on
missing or malformed envelopes.
"""
# Normalize line endings; the segment terminator handles real segmentation.
text = text.replace("\r\n", "").replace("\n", "").replace("\r", "")
# Find the first ISA by scanning for the literal "ISA" + element separator.
if not text.startswith("ISA") or len(text) < 4:
raise CycloneParseError("ISA segment not found at start of file")
# The first 106 chars are the ISA segment.
isa_segment = text[:106]
try:
delimiters = _detect_delimiters(isa_segment)
except IndexError as exc: # pragma: no cover - guarded by length check
raise CycloneParseError(f"Could not parse ISA delimiters: {exc}") from exc
# Slice off the ISA, then split the rest on the segment terminator.
body = text[106:]
raw_segments = body.split(delimiters.segment)
# Prepend the ISA so callers always see it as the first segment.
isa_elements = isa_segment.split(delimiters.element)
out: list[list[str]] = [isa_elements]
for raw in raw_segments:
if not raw:
continue
out.append(raw.split(delimiters.element))
return out
+115
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"""Structural and payer-specific validation rules for 837P claims.
Each rule is a pure function that takes a :class:`ClaimOutput` and a
:class:`PayerConfig` and yields zero or more :class:`ValidationIssue`. The
top-level :func:`validate` function runs every rule and aggregates results.
"""
from __future__ import annotations
import re
from collections.abc import Iterable
from decimal import Decimal
from typing import Callable
from cyclone.parsers.models import ClaimOutput, ValidationIssue, ValidationReport
from cyclone.parsers.payer import PayerConfig
NPI_RE = re.compile(r"^\d{10}$")
Rule = Callable[[ClaimOutput, PayerConfig], Iterable[ValidationIssue]]
def _r010_clm01_present(claim: ClaimOutput, _: PayerConfig) -> Iterable[ValidationIssue]:
if not claim.claim.claim_id or not claim.claim.claim_id.strip():
yield ValidationIssue(rule="R010_clm01_present", severity="error", message="CLM01 (claim id) is empty")
def _r011_total_charge_positive(claim: ClaimOutput, _: PayerConfig) -> Iterable[ValidationIssue]:
if claim.claim.total_charge <= 0:
yield ValidationIssue(rule="R011_total_charge_positive", severity="error", message=f"CLM02 must be > 0, got {claim.claim.total_charge}")
def _r020_npi_format(claim: ClaimOutput, _: PayerConfig) -> Iterable[ValidationIssue]:
if claim.billing_provider.npi and not NPI_RE.match(claim.billing_provider.npi):
yield ValidationIssue(rule="R020_npi_format", severity="error", message=f"Billing provider NPI must be 10 digits, got {claim.billing_provider.npi!r}")
def _r030_frequency_allowed(claim: ClaimOutput, cfg: PayerConfig) -> Iterable[ValidationIssue]:
if not claim.claim.frequency_code:
return
try:
freq = int(claim.claim.frequency_code)
except ValueError:
yield ValidationIssue(rule="R030_frequency_allowed", severity="error", message=f"CLM05-3 not numeric: {claim.claim.frequency_code!r}")
return
if freq not in cfg.allowed_claim_frequencies:
yield ValidationIssue(
rule="R030_frequency_allowed",
severity="error",
message=f"CLM05-3 {freq} not in {sorted(cfg.allowed_claim_frequencies)} for payer {cfg.name}",
)
def _r031_ref_g1_optional(claim: ClaimOutput, _: PayerConfig) -> Iterable[ValidationIssue]:
"""REF*G1 is informational in v1 (see spec §9 R031)."""
# We yield no errors; presence is recorded on the model.
return ()
def _r050_diagnosis_present(claim: ClaimOutput, _: PayerConfig) -> Iterable[ValidationIssue]:
if not claim.diagnoses:
yield ValidationIssue(rule="R050_diagnosis_present", severity="error", message="HI segment missing — no diagnoses on claim")
def _r060_service_dates_present(claim: ClaimOutput, _: PayerConfig) -> Iterable[ValidationIssue]:
for sl in claim.service_lines:
if sl.service_date is None:
yield ValidationIssue(rule="R060_service_dates_present", severity="error", message=f"Service line {sl.line_number} missing service date (DTP*472)")
def _r070_charges_sum(claim: ClaimOutput, _: PayerConfig) -> Iterable[ValidationIssue]:
if not claim.service_lines:
return
line_sum = sum((sl.charge for sl in claim.service_lines), start=Decimal("0"))
if abs(line_sum - claim.claim.total_charge) > Decimal("0.01"):
yield ValidationIssue(
rule="R070_charges_sum",
severity="warning",
message=f"Sum of service lines ({line_sum}) does not match CLM02 ({claim.claim.total_charge})",
)
def _r100_payer_id_matches(claim: ClaimOutput, cfg: PayerConfig) -> Iterable[ValidationIssue]:
if cfg.payer_id and claim.payer.id and claim.payer.id != cfg.payer_id:
yield ValidationIssue(
rule="R100_payer_id_matches",
severity="warning",
message=f"Payer id {claim.payer.id!r} != configured {cfg.payer_id!r}",
)
_RULES: list[Rule] = [
_r010_clm01_present,
_r011_total_charge_positive,
_r020_npi_format,
_r030_frequency_allowed,
_r031_ref_g1_optional,
_r050_diagnosis_present,
_r060_service_dates_present,
_r070_charges_sum,
_r100_payer_id_matches,
]
def validate(claim: ClaimOutput, config: PayerConfig) -> ValidationReport:
"""Run every rule against a claim and return a report.
Never raises — all issues are accumulated into the report.
"""
errors: list[ValidationIssue] = []
warnings: list[ValidationIssue] = []
for rule in _RULES:
for issue in rule(claim, config):
(errors if issue.severity == "error" else warnings).append(issue)
return ValidationReport(passed=not errors, errors=errors, warnings=warnings)
+54
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"""Write a :class:`ParseResult` to disk as one JSON file per claim + summary.json."""
from __future__ import annotations
import json
import re
from pathlib import Path
from cyclone.parsers.models import ParseResult
_UNSAFE = re.compile(r"[^A-Za-z0-9._-]")
def _sanitize(s: str) -> str:
return _UNSAFE.sub("-", s).strip("-") or "claim"
def _filename(control_number: str, transaction_date_iso: str, claim_id: str, used: set[str]) -> str:
base = f"claim-{_sanitize(control_number)}-{_sanitize(transaction_date_iso.replace('-', ''))}-{_sanitize(claim_id)}.json"
if base not in used:
return base
# Disambiguate: append -2, -3, ...
stem = base[:-5]
n = 2
while True:
cand = f"{stem}-{n}.json"
if cand not in used:
return cand
n += 1
def write_outputs(result: ParseResult, output_dir: Path) -> list[Path]:
"""Write one JSON file per claim and a ``summary.json``.
Returns the list of written claim-file paths, in input order.
"""
output_dir = Path(output_dir)
output_dir.mkdir(parents=True, exist_ok=True)
txn_date = result.envelope.transaction_date.isoformat() if result.envelope else "unknown"
control = result.envelope.control_number if result.envelope else "unknown"
used: set[str] = set()
paths: list[Path] = []
for claim in result.claims:
name = _filename(control, txn_date, claim.claim_id, used)
used.add(name)
path = output_dir / name
path.write_text(claim.model_dump_json(indent=2))
paths.append(path)
summary_path = output_dir / "summary.json"
summary_path.write_text(result.summary.model_dump_json(indent=2))
return paths
+60
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ISA*00* *00* *ZZ*11525703 *ZZ*COMEDASSISTPROG*260617*1937*^*00501*991102984*1*P*:~
GS*HC*11525703*COMEDASSISTPROG*20260617*193715*991102984*X*005010X222A1~
ST*837*991102984*005010X222A1~
BHT*0019*00*co-fixture-001*20260617*193715*CH~
NM1*41*2*Dzinesco*****46*11525703~
PER*IC*Tester*EM*tester@example.com~
NM1*40*2*COLORADO MEDICAL ASSISTANCE PROGRAM*****46*COMEDASSISTPROG~
HL*1**20*1~
PRV*BI*PXC*251E00000X~
NM1*85*2*TOC, Inc.*****XX*1881068062~
N3*1100 East Main St*Suite A~
N4*Montrose*CO*814014063~
REF*EI*721587149~
HL*2*1*22*0~
SBR*P*18*******MC~
NM1*IL*1*Balliache*Marianela****MI*P060946~
N3*1811 PAVILION DR APT 303~
N4*Montrose*CO*814016072~
DMG*D8*19590223*F~
NM1*PR*2*COHCPF*****PI*SKCO0~
CLM*t991102984o1c1d*85.40***12:B:1*Y*A*Y*Y~
REF*G1*3173~
HI*ABK:R69~
LX*1~
SV1*HC:T1019:U2*42.70*UN*6.00***1~
DTP*472*D8*20260602~
REF*6R*t991102984v769804d~
LX*2~
SV1*HC:T1019:U2*42.70*UN*6.00***1~
DTP*472*D8*20260603~
REF*6R*t991102984v770058d~
HL*3*1*22*0~
SBR*P*18*******MC~
NM1*IL*1*Barella*Victoria****MI*H582447~
N3*1900 Kellie DR~
N4*Montrose*CO*814019524~
DMG*D8*19570727*F~
NM1*PR*2*COHCPF*****PI*SKCO0~
CLM*t991102984o1c2d*155.76***12:B:1*Y*A*Y*Y~
REF*G1*3173~
HI*ABK:R69~
LX*1~
SV1*HC:S5130:U2*38.94*UN*6.00***1~
DTP*472*D8*20260602~
REF*6R*t991102984v769805d~
LX*2~
SV1*HC:S5130:U2*38.94*UN*6.00***1~
DTP*472*D8*20260603~
REF*6R*t991102984v770059d~
LX*3~
SV1*HC:S5130:U2*38.94*UN*6.00***1~
DTP*472*D8*20260604~
REF*6R*t991102984v770308d~
LX*4~
SV1*HC:S5130:U2*38.94*UN*6.00***1~
DTP*472*D8*20260605~
REF*6R*t991102984v770668d~
SE*44*991102984~
GE*1*991102984~
IEA*1*991102984~
+30
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ISA*00* *00* *ZZ*11525703 *ZZ*COMEDASSISTPROG*260611*0814*^*00501*991102977*1*P*:~
GS*HC*11525703*COMEDASSISTPROG*20260611*081417*991102977*X*005010X222A1~
ST*837*991102977*005010X222A1~
BHT*0019*00*ref-001*20260611*081417*CH~
NM1*41*2*Test Submitter*****46*11525703~
PER*IC*Test Contact*EM*test@example.com~
NM1*40*2*COLORADO MEDICAL ASSISTANCE PROGRAM*****46*COMEDASSISTPROG~
HL*1**20*1~
PRV*BI*PXC*251E00000X~
NM1*85*2*Test Provider Inc*****XX*1234567890~
N3*123 Test St~
N4*Denver*CO*80202~
REF*EI*123456789~
HL*2*1*22*0~
SBR*P*18*******MC~
NM1*IL*1*Doe*John****MI*ABC123~
N3*456 Member St~
N4*Denver*CO*80203~
DMG*D8*19800101*M~
NM1*PR*2*COHCPF*****PI*SKCO0~
CLM*CLM001*100.00***12:B:1*Y*A*Y*Y~
REF*G1*PA123~
HI*ABK:Z00~
LX*1~
SV1*HC:99213*100.00*UN*1***1~
DTP*472*D8*20260611~
REF*6R*REF001~
SE*26*991102977~
GE*1*991102977~
IEA*1*991102977~
+70
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import json
from pathlib import Path
import pytest
from click.testing import CliRunner
from cyclone.cli import main
from cyclone.parsers.payer import PayerConfig
FIXTURE = Path(__file__).parent / "fixtures" / "minimal_837p.txt"
def test_cli_parse_837_writes_outputs(tmp_path: Path):
runner = CliRunner()
result = runner.invoke(main, ["parse-837", str(FIXTURE), "--output-dir", str(tmp_path)])
assert result.exit_code == 0, result.output
written = list(tmp_path.glob("claim-*.json"))
assert len(written) == 1
summary = json.loads((tmp_path / "summary.json").read_text())
assert summary["total_claims"] == 1
assert summary["passed"] == 1
def test_cli_parse_837_with_strict(tmp_path: Path):
runner = CliRunner()
result = runner.invoke(main, ["parse-837", str(FIXTURE), "--output-dir", str(tmp_path), "--strict"])
assert result.exit_code == 0
# Strict should not change anything on a passing claim
summary = json.loads((tmp_path / "summary.json").read_text())
assert summary["passed"] == 1
def test_cli_parse_837_with_no_raw_segments(tmp_path: Path):
runner = CliRunner()
result = runner.invoke(main, ["parse-837", str(FIXTURE), "--output-dir", str(tmp_path), "--no-raw-segments"])
assert result.exit_code == 0
data = json.loads(next(tmp_path.glob("claim-*.json")).read_text())
assert data["raw_segments"] == []
def test_cli_unknown_payer_uses_generic(tmp_path: Path):
runner = CliRunner()
result = runner.invoke(main, ["parse-837", str(FIXTURE), "--output-dir", str(tmp_path), "--payer", "generic_837p"])
assert result.exit_code == 0
def test_cli_missing_file_exits_2(tmp_path: Path):
runner = CliRunner()
result = runner.invoke(main, ["parse-837", "/no/such/file.txt", "--output-dir", str(tmp_path)])
assert result.exit_code == 2
@pytest.mark.skipif(
not (Path(__file__).parent.parent.parent / "docs" / "prodfiles" / "837p-from-axiscare").exists(),
reason="prodfile corpus not present",
)
def test_cli_runs_against_prodfiles(tmp_path: Path):
"""Smoke test: run the CLI against a real production file if available."""
from glob import glob
runner = CliRunner()
corpus = Path(__file__).parent.parent.parent / "docs" / "prodfiles" / "837p-from-axiscare"
files = sorted(glob(str(corpus / "*.txt")))
if not files:
pytest.skip("no prodfile .txt files in corpus")
sample = files[0]
result = runner.invoke(main, ["parse-837", sample, "--output-dir", str(tmp_path)])
assert result.exit_code == 0, result.output
summary = json.loads((tmp_path / "summary.json").read_text())
assert summary["total_claims"] >= 1
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from pathlib import Path
from cyclone.parsers.parse_837 import parse
from cyclone.parsers.payer import PayerConfig
FIXTURE = Path(__file__).parent / "fixtures" / "co_medicaid_837p.txt"
def test_co_fixture_two_claims_pass():
result = parse(FIXTURE.read_text(), PayerConfig.co_medicaid())
assert result.summary.total_claims == 2
assert result.summary.passed == 2
assert result.summary.failed == 0
def test_first_claim_has_two_service_lines():
result = parse(FIXTURE.read_text(), PayerConfig.co_medicaid())
c1 = result.claims[0]
assert c1.claim_id == "t991102984o1c1d"
assert len(c1.service_lines) == 2
assert c1.service_lines[0].procedure.code == "T1019"
assert c1.service_lines[0].procedure.modifiers == ["U2"]
assert c1.service_lines[1].service_date is not None
def test_second_claim_has_four_service_lines():
result = parse(FIXTURE.read_text(), PayerConfig.co_medicaid())
c2 = result.claims[1]
assert c2.claim_id == "t991102984o1c2d"
assert len(c2.service_lines) == 4
def test_subscriber_payer_reused_across_claims():
"""Both claims share the same billing provider; payers are recorded on each claim."""
result = parse(FIXTURE.read_text(), PayerConfig.co_medicaid())
assert result.claims[0].billing_provider.npi == "1881068062"
assert result.claims[1].billing_provider.npi == "1881068062"
assert result.claims[0].payer.id == "SKCO0"
assert result.claims[1].payer.id == "SKCO0"
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import pytest
from cyclone.parsers.exceptions import CycloneParseError, CycloneValidationError
def test_parse_error_carries_segment_index():
err = CycloneParseError("bad CLM", segment_index=42)
assert err.segment_index == 42
assert "bad CLM" in str(err)
assert "segment 42" in str(err)
def test_validation_error_carries_rule_id():
err = CycloneValidationError("NPI bad", rule_id="R020_npi_format", claim_id="C1")
assert err.rule_id == "R020_npi_format"
assert err.claim_id == "C1"
assert "[R020_npi_format]" in str(err)
def test_parse_error_inherits_from_exception():
assert issubclass(CycloneParseError, Exception)
assert issubclass(CycloneValidationError, Exception)
+102
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import json
from datetime import date
from decimal import Decimal
import pytest
from pydantic import ValidationError as PydanticValidationError
from cyclone.parsers.models import (
Address,
BillingProvider,
ClaimHeader,
ClaimOutput,
Diagnosis,
Envelope,
Payer,
Procedure,
ServiceLine,
Subscriber,
ValidationIssue,
ValidationReport,
)
def test_address_round_trip():
a = Address(line1="1100 East Main St", line2="Suite A", city="Montrose", state="CO", zip="81401")
d = a.model_dump()
assert d["line1"] == "1100 East Main St"
assert d["line2"] == "Suite A"
assert Address.model_validate(d) == a
def test_address_line2_optional():
a = Address(line1="1 Main", city="X", state="CO", zip="80000")
assert a.line2 is None
def test_subscriber_splits_name():
s = Subscriber(first_name="John", last_name="Doe", member_id="ABC", dob=date(1980, 1, 1), gender="M", address=Address(line1="x", city="x", state="CO", zip="80000"))
assert s.first_name == "John"
assert s.gender == "M"
def test_service_line_units_are_decimal():
sl = ServiceLine(
line_number=1,
procedure=Procedure(qualifier="HC", code="99213", modifiers=[]),
charge=Decimal("100.00"),
unit_type="UN",
units=Decimal("1.0"),
)
assert sl.units == Decimal("1.0")
def test_claim_header_total_charge_decimal():
h = ClaimHeader(claim_id="C1", total_charge=Decimal("151.72"), place_of_service="12", frequency_code="1", provider_signature="Y", assignment="Y", release_of_info="Y", prior_auth="3173")
assert h.total_charge == Decimal("151.72")
def test_validation_issue_strict_severity():
issue = ValidationIssue(rule="R001", severity="error", message="bad")
assert issue.severity == "error"
with pytest.raises(PydanticValidationError):
ValidationIssue(rule="R001", severity="WTF", message="bad")
def test_validation_report_passed_true_when_no_errors():
r = ValidationReport(passed=True, errors=[], warnings=[])
assert r.passed is True
def test_envelope_serializes_to_iso_date():
e = Envelope(
sender_id="11525703",
receiver_id="COMEDASSISTPROG",
control_number="991102977",
transaction_date=date(2026, 6, 11),
transaction_time="081417",
implementation_guide="005010X222A1",
)
d = e.model_dump()
assert d["transaction_date"] == "2026-06-11"
def test_claim_output_full_round_trip():
claim = ClaimOutput(
claim_id="C1",
control_number="991102977",
transaction_date=date(2026, 6, 11),
billing_provider=BillingProvider(name="X", npi="1234567890", tax_id="123456789", address=Address(line1="1", city="x", state="CO", zip="80000")),
subscriber=Subscriber(first_name="J", last_name="D", member_id="M", dob=date(1980, 1, 1), gender="M", address=Address(line1="1", city="x", state="CO", zip="80000")),
payer=Payer(name="P", id="SKCO0"),
claim=ClaimHeader(claim_id="C1", total_charge=Decimal("100"), place_of_service="12", frequency_code="1", provider_signature="Y", assignment="Y", release_of_info="Y"),
diagnoses=[Diagnosis(code="R69", qualifier="ABK")],
service_lines=[],
validation=ValidationReport(passed=True, errors=[], warnings=[]),
raw_segments=[["CLM", "C1", "100"]],
)
blob = json.loads(claim.model_dump_json())
assert blob["claim_id"] == "C1"
assert blob["billing_provider"]["npi"] == "1234567890"
assert blob["raw_segments"] == [["CLM", "C1", "100"]]
assert ClaimOutput.model_validate(blob).claim_id == "C1"
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from datetime import date
from pathlib import Path
from cyclone.parsers.parse_837 import parse
from cyclone.parsers.payer import PayerConfig
FIXTURE = Path(__file__).parent / "fixtures" / "minimal_837p.txt"
def test_parse_minimal_fixture_returns_one_claim():
text = FIXTURE.read_text()
result = parse(text, PayerConfig.co_medicaid())
assert len(result.claims) == 1
claim = result.claims[0]
assert claim.claim_id == "CLM001"
assert claim.billing_provider.npi == "1234567890"
assert claim.subscriber.last_name == "Doe"
assert claim.subscriber.first_name == "John"
assert claim.subscriber.member_id == "ABC123"
assert claim.payer.id == "SKCO0"
assert claim.claim.frequency_code == "1"
assert claim.claim.place_of_service == "12"
assert claim.claim.prior_auth == "PA123"
assert claim.diagnoses[0].code == "Z00"
assert claim.diagnoses[0].qualifier == "ABK"
assert len(claim.service_lines) == 1
sl = claim.service_lines[0]
assert sl.procedure.code == "99213"
assert sl.procedure.qualifier == "HC"
assert sl.charge == 100.00
def test_parse_envelope_captured():
result = parse(FIXTURE.read_text(), PayerConfig.co_medicaid())
assert result.envelope is not None
assert result.envelope.control_number == "991102977"
assert result.envelope.transaction_date == date(2026, 6, 11)
assert result.envelope.sender_id == "11525703"
def test_parse_summary_counts():
result = parse(FIXTURE.read_text(), PayerConfig.co_medicaid())
assert result.summary.total_claims == 1
assert result.summary.passed == 1
assert result.summary.failed == 0
def test_parse_continues_on_malformed_subscriber():
"""A bad subscriber record must not abort the whole batch."""
text = FIXTURE.read_text().replace("MI*ABC123", "MI*") # truncate member id segment
result = parse(text, PayerConfig.co_medicaid())
# Should still find the claim, but with errors
assert len(result.claims) == 1
assert result.claims[0].validation.passed is False
assert result.summary.failed == 1
def test_parse_preserves_raw_segments():
result = parse(FIXTURE.read_text(), PayerConfig.co_medicaid())
claim = result.claims[0]
assert any(s[0] == "CLM" for s in claim.raw_segments)
assert any(s[0] == "SV1" for s in claim.raw_segments)
def test_parse_uses_generic_config_when_requested():
result = parse(FIXTURE.read_text(), PayerConfig.generic_837p())
assert len(result.claims) == 1
# No patient-loop rule on generic config
assert result.claims[0].validation.passed is True
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from cyclone.parsers.payer import PayerConfig
def test_co_medicaid_defaults():
cfg = PayerConfig.co_medicaid()
assert cfg.name == "Colorado Medical Assistance Program"
assert cfg.sbr09_claim_filing == "MC"
assert cfg.allowed_claim_frequencies == {1, 7, 8}
assert cfg.require_ref_g1_for_adjustments is False # lenient in v1
assert cfg.allowed_bht06 == {"CH"}
assert cfg.payer_id == "SKCO0"
assert cfg.payer_name == "COHCPF"
assert cfg.no_patient_loop is True
assert cfg.encounter_claim_in_same_batch is False
def test_generic_837p_defaults_are_relaxed():
cfg = PayerConfig.generic_837p()
assert cfg.name == "Generic 837P"
assert cfg.allowed_claim_frequencies == {1, 2, 3, 4, 5, 6, 7, 8, 9}
assert cfg.no_patient_loop is False
assert cfg.payer_id == "" # unset
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import pytest
from cyclone.parsers.exceptions import CycloneParseError
from cyclone.parsers.segments import Delimiters, tokenize
ISA_PREFIX = "ISA*00* *00* *ZZ*11525703 *ZZ*COMEDASSISTPROG*260611*0814*"
def test_tokenize_parses_isa_delimiters():
text = ISA_PREFIX + "*^00501*991102977*1*P*:~"
segments = tokenize(text)
assert segments[0][0] == "ISA"
assert len(segments) == 1
def test_tokenize_splits_segments():
text = ISA_PREFIX + "*^00501*991102977*1*P*:~ST*837*0001~SE*2*0001~"
segments = tokenize(text)
assert [s[0] for s in segments] == ["ISA", "ST", "SE"]
def test_tokenize_splits_elements():
text = ISA_PREFIX + "*^00501*991102977*1*P*:~NM1*85*2*Acme*****XX*1234567890~"
segments = tokenize(text)
nm1 = [s for s in segments if s[0] == "NM1"][0]
assert nm1[1] == "85"
assert nm1[8] == "XX"
assert nm1[9] == "1234567890"
def test_tokenize_preserves_empty_elements():
"""Empty elements (e.g. 'NM1*IL*1*Doe*John****MI*X') must stay as empty strings."""
text = ISA_PREFIX + "*^00501*991102977*1*P*:~NM1*IL*1*Doe*John****MI*X~"
segments = tokenize(text)
nm1 = [s for s in segments if s[0] == "NM1"][0]
assert nm1[5] == "" # position 5 is the 4th consecutive empty after suffix
assert nm1[6] == ""
def test_tokenize_handles_component_separator():
"""SV101 can be 'HC:99213' which is component-split at ':'."""
text = ISA_PREFIX + "*^00501*991102977*1*P*:~SV1*HC:99213*100*UN*1***1~"
segments = tokenize(text)
sv1 = [s for s in segments if s[0] == "SV1"][0]
# SV101 is element index 1; components 1, 2 are 'HC', '99213'
assert sv1[1] == "HC:99213"
def test_tokenize_strips_trailing_crlf():
text = ISA_PREFIX + "*^00501*991102977*1*P*:~\r\n"
segments = tokenize(text)
assert [s[0] for s in segments] == ["ISA"]
def test_tokenize_raises_on_missing_isa():
with pytest.raises(CycloneParseError, match="ISA segment not found"):
tokenize("hello world")
def test_tokenize_raises_on_short_isa():
with pytest.raises(CycloneParseError, match="ISA segment too short"):
tokenize("ISA*00*00~")
def test_delimiters_dataclass():
d = Delimiters(element="*", repetition="^", component=":", segment="~")
assert d.element == "*"
assert d.repetition == "^"
assert d.component == ":"
assert d.segment == "~"
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from datetime import date
from decimal import Decimal
import pytest
from cyclone.parsers.models import (
Address,
BillingProvider,
ClaimHeader,
ClaimOutput,
Diagnosis,
Envelope,
Payer,
Procedure,
ServiceLine,
Subscriber,
ValidationReport,
)
from cyclone.parsers.payer import PayerConfig
from cyclone.parsers.validator import validate
def _build_claim(**overrides) -> ClaimOutput:
"""Build a passing claim for tests; override fields to break specific rules."""
base = dict(
claim_id="C1",
control_number="991102977",
transaction_date=date(2026, 6, 11),
billing_provider=BillingProvider(
name="Test Provider",
npi="1234567890",
tax_id="123456789",
address=Address(line1="1 Main", city="X", state="CO", zip="80000"),
),
subscriber=Subscriber(
first_name="John",
last_name="Doe",
member_id="M1",
dob=date(1980, 1, 1),
gender="M",
address=Address(line1="1 Main", city="X", state="CO", zip="80000"),
),
payer=Payer(name="COHCPF", id="SKCO0"),
claim=ClaimHeader(
claim_id="C1",
total_charge=Decimal("100.00"),
place_of_service="12",
frequency_code="1",
provider_signature="Y",
assignment="Y",
release_of_info="Y",
),
diagnoses=[Diagnosis(code="Z00", qualifier="ABK")],
service_lines=[
ServiceLine(
line_number=1,
procedure=Procedure(qualifier="HC", code="99213", modifiers=[]),
charge=Decimal("100.00"),
unit_type="UN",
units=Decimal("1.0"),
service_date=date(2026, 6, 11),
)
],
validation=ValidationReport(passed=True, errors=[], warnings=[]),
raw_segments=[],
)
base.update(overrides)
return ClaimOutput(**base)
def test_validate_passing_claim():
cfg = PayerConfig.co_medicaid()
report = validate(_build_claim(), cfg)
assert report.passed is True
assert report.errors == []
def test_r010_clm01_required():
cfg = PayerConfig.co_medicaid()
claim = _build_claim()
claim.claim.claim_id = ""
report = validate(claim, cfg)
assert not report.passed
assert any(i.rule == "R010_clm01_present" for i in report.errors)
def test_r011_total_charge_positive():
cfg = PayerConfig.co_medicaid()
claim = _build_claim()
claim.claim.total_charge = Decimal("0.00")
report = validate(claim, cfg)
assert any(i.rule == "R011_total_charge_positive" for i in report.errors)
def test_r020_npi_must_be_ten_digits():
cfg = PayerConfig.co_medicaid()
claim = _build_claim()
claim.billing_provider.npi = "12345"
report = validate(claim, cfg)
assert any(i.rule == "R020_npi_format" for i in report.errors)
def test_r030_frequency_allowed():
cfg = PayerConfig.co_medicaid() # only 1, 7, 8
claim = _build_claim()
claim.claim.frequency_code = "5"
report = validate(claim, cfg)
assert any(i.rule == "R030_frequency_allowed" for i in report.errors)
def test_r031_ref_g1_optional_no_error():
"""R031 is informational in v1 — no REF*G1 should not error."""
cfg = PayerConfig.co_medicaid()
claim = _build_claim()
report = validate(claim, cfg)
assert not any(i.rule == "R031_ref_g1_optional" and i.severity == "error" for i in report.errors)
def test_r050_diagnosis_required():
cfg = PayerConfig.co_medicaid()
claim = _build_claim(diagnoses=[])
report = validate(claim, cfg)
assert any(i.rule == "R050_diagnosis_present" for i in report.errors)
def test_r060_service_dates_required():
cfg = PayerConfig.co_medicaid()
claim = _build_claim()
claim.service_lines[0].service_date = None
report = validate(claim, cfg)
assert any(i.rule == "R060_service_dates_present" for i in report.errors)
# Now add the date:
claim.service_lines[0].service_date = date(2026, 6, 11)
report = validate(claim, cfg)
assert not any(i.rule == "R060_service_dates_present" for i in report.errors + report.warnings)
def test_r070_charges_sum_warning():
cfg = PayerConfig.co_medicaid()
claim = _build_claim()
claim.claim.total_charge = Decimal("999.00") # mismatch
report = validate(claim, cfg)
assert any(i.rule == "R070_charges_sum" and i.severity == "warning" for i in report.warnings)
def test_r100_payer_id_warning_only():
cfg = PayerConfig.co_medicaid()
claim = _build_claim()
claim.payer.id = "WRONG"
report = validate(claim, cfg)
assert any(i.rule == "R100_payer_id_matches" and i.severity == "warning" for i in report.warnings)
assert report.passed is True
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import json
from datetime import date
from decimal import Decimal
from pathlib import Path
import pytest
from cyclone.parsers.models import (
Address,
BatchSummary,
BillingProvider,
ClaimHeader,
ClaimOutput,
Envelope,
Payer,
Subscriber,
ValidationReport,
)
from cyclone.parsers.parse_837 import ParseResult
from cyclone.parsers.writer import write_outputs
def _claim(cid: str) -> ClaimOutput:
return ClaimOutput(
claim_id=cid,
control_number="991102977",
transaction_date=date(2026, 6, 11),
billing_provider=BillingProvider(name="X", npi="1234567890", address=Address(line1="1", city="x", state="CO", zip="80000")),
subscriber=Subscriber(first_name="J", last_name="D", member_id="M", dob=date(1980, 1, 1), gender="M", address=Address(line1="1", city="x", state="CO", zip="80000")),
payer=Payer(name="P", id="SKCO0"),
claim=ClaimHeader(claim_id=cid, total_charge=Decimal("100"), place_of_service="12", frequency_code="1", provider_signature="Y", assignment="Y", release_of_info="Y"),
diagnoses=[],
service_lines=[],
validation=ValidationReport(passed=True, errors=[], warnings=[]),
raw_segments=[],
)
def _result(*cids: str) -> ParseResult:
return ParseResult(
envelope=Envelope(sender_id="X", receiver_id="Y", control_number="991102977", transaction_date=date(2026, 6, 11)),
claims=[_claim(c) for c in cids],
summary=BatchSummary(input_file="f", control_number="991102977", transaction_date=date(2026, 6, 11), total_claims=len(cids), passed=len(cids), failed=0),
)
def test_write_outputs_creates_one_file_per_claim(tmp_path: Path):
result = _result("C1", "C2")
paths = write_outputs(result, tmp_path)
assert len(paths) == 2
for p in paths:
assert p.exists()
assert p.suffix == ".json"
data = json.loads(p.read_text())
assert "validation" in data
def test_filename_pattern(tmp_path: Path):
result = _result("C1")
paths = write_outputs(result, tmp_path)
assert paths[0].name == "claim-991102977-20260611-C1.json"
def test_filename_sanitizes_unsafe_chars(tmp_path: Path):
bad = _claim("C/1:*?")
result = ParseResult(
envelope=result.envelope if False else None, # type: ignore
claims=[bad],
summary=BatchSummary(input_file="f", total_claims=1, passed=1, failed=0),
) # use explicit envelope
# Simpler: rebuild
from cyclone.parsers.models import Envelope as E
result = ParseResult(
envelope=E(sender_id="X", receiver_id="Y", control_number="991102977", transaction_date=date(2026, 6, 11)),
claims=[bad],
summary=BatchSummary(input_file="f", total_claims=1, passed=1, failed=0),
)
paths = write_outputs(result, tmp_path)
# All non-alnum chars except - and _ replaced with -
assert all(c.isalnum() or c in "-_" for c in paths[0].stem)
def test_summary_json_written(tmp_path: Path):
result = _result("C1")
write_outputs(result, tmp_path)
summary_path = tmp_path / "summary.json"
assert summary_path.exists()
data = json.loads(summary_path.read_text())
assert data["total_claims"] == 1
assert data["passed"] == 1