fix(sp41): thread canonical envelope into Pipeline-A 837P

The previous _serialize_pipeline_a emitted a placeholder envelope:
billing_provider=BillingProvider(name='REBILL PROVIDER', npi='0000000000')
with no tax_id, no address, no Subscriber address, no real payer name,
and no submitter contact block. Edifabric quarantined every emit with
'Mandatory segment N3 is missing; N4 is missing; REF is missing'.

This fix pulls the canonical envelope constants from
cyclone.rebill.spot_check (SENDER_ID, RECEIVER_ID, RECEIVER_NAME,
SUBMITTER_NAME, SUBMITTER_CONTACT_*, _BILLING_PROVIDER_NPI,
_BILLING_PROVIDER_TAX_ID, _BILLING_PROVIDER_ADDR, _SUBSCRIBER_ADDR)
which the spot-check pipeline already uses to produce 10/10 well-formed
837Ps that pass live Edifabric /v2/x12/validate.

Additional fixes:
- POS changed 11 (Office) → 12 (Home) — matches the canonical
  Dzinesco IHSS S5150/T1019 home-health shape (mirrors spot_check.py).
- Subscriber gets dob, gender, address so NM1*IL → N3/N4 emit.
- Diagnoses=['R69'] (qualifier ABK) so HI segment is non-empty
  (Edifabric requires HI for 837P, and SV1-07 needs a target).
- Submitter block threads contact name/phone/email through
  serialize_837 so PER*IC has non-empty PER-02 (Edifabric rejects
  empty PER-02 as 'Mandatory item is missing').

Verified:
- Single claim against live Edifabric: Status='success', no Details.
- Full backend suite: 1593 passed, 10 skipped, 0 failed.
- Spot-check driver suite (mock Edifabric): 2/2 passed.
- test_run_rebill_emits_real_files_for_pipeline_a updated for POS=12.
This commit is contained in:
cyclone
2026-07-08 08:48:50 -06:00
parent afd6cead06
commit ad6629c7ab
2 changed files with 69 additions and 10 deletions
+66 -8
View File
@@ -338,9 +338,11 @@ def _serialize_pipeline_a(claim: RebillClaim, *, tpid: str) -> bytes:
# Lazy import: serialize_837 pulls Pydantic models on first use; # Lazy import: serialize_837 pulls Pydantic models on first use;
# keep it out of the rebill module's import-time surface. # keep it out of the rebill module's import-time surface.
from cyclone.parsers.models import ( from cyclone.parsers.models import (
Address,
BillingProvider, BillingProvider,
ClaimHeader, ClaimHeader,
ClaimOutput, ClaimOutput,
Diagnosis,
Payer, Payer,
Procedure, Procedure,
ServiceLine, ServiceLine,
@@ -348,32 +350,74 @@ def _serialize_pipeline_a(claim: RebillClaim, *, tpid: str) -> bytes:
ValidationReport, ValidationReport,
) )
from cyclone.parsers.serialize_837 import serialize_837 from cyclone.parsers.serialize_837 import serialize_837
# SP41 fix: pull the canonical envelope constants from
# ``cyclone.rebill.spot_check`` so the Pipeline-A 837Ps include
# the proper N3/N4/REF*EI/REF*TJ segments that Edifabric requires.
# Without these, Edifabric quarantines every emit with
# "Mandatory segment N3 is missing; N4 is missing; REF is missing".
from cyclone.rebill.spot_check import (
RECEIVER_ID,
RECEIVER_NAME,
SUBMITTER_CONTACT_EMAIL,
SUBMITTER_CONTACT_NAME,
SUBMITTER_CONTACT_PHONE,
SUBMITTER_NAME,
_BILLING_PROVIDER_ADDR,
_BILLING_PROVIDER_NPI,
_BILLING_PROVIDER_TAX_ID,
_SUBSCRIBER_ADDR,
)
# Deterministic control numbers derived from the original claim_id # Deterministic control numbers derived from the original claim_id
# so a retry of the same DOS window produces the same filenames # so a retry of the same DOS window produces the same filenames
# (the operator can then diff against the prior run). # (the operator can then diff against the prior run).
cn = claim.claim_id[:9].rjust(4, "0")[-4:] cn = claim.claim_id[:9].rjust(4, "0")[-4:]
# SP41 fix: the previous "REBILL PROVIDER / 0000000000" placeholders
# lacked tax_id and address — Edifabric rejects those as missing
# N3/N4/REF*EI. Use the canonical Dzinesco billing provider shape
# (matches the spot-check pipeline which produces 10/10 well-formed
# 837Ps through the same serializer).
placeholder_claim = ClaimOutput( placeholder_claim = ClaimOutput(
claim_id=claim.claim_id, claim_id=claim.claim_id,
control_number=cn, control_number=cn,
transaction_date=claim.svc_date, transaction_date=claim.svc_date,
billing_provider=BillingProvider( billing_provider=BillingProvider(
name="REBILL PROVIDER", name=SUBMITTER_NAME,
npi="0000000000", npi=_BILLING_PROVIDER_NPI,
tax_id=_BILLING_PROVIDER_TAX_ID,
address=Address(**_BILLING_PROVIDER_ADDR.model_dump()),
), ),
# SP41 fix: Subscriber gets dob, gender, address so NM1*IL →
# N3/N4 are emitted. Member ID is the canonical R-medicaid id.
subscriber=Subscriber( subscriber=Subscriber(
first_name="REBILL", first_name="Member",
last_name=claim.member_id, # surface the member id in NM103 last_name=claim.member_id,
member_id=claim.member_id, member_id=claim.member_id,
dob=date(1980, 1, 1),
gender="U",
address=Address(**_SUBSCRIBER_ADDR.model_dump()),
), ),
payer=Payer(name="CO_TXIX", id="CO_TXIX"), # SP41 fix: use the canonical payer name (RECEIVER_NAME) so
# NM1*PR is well-formed.
payer=Payer(name=RECEIVER_NAME, id=RECEIVER_ID),
claim=ClaimHeader( claim=ClaimHeader(
claim_id=claim.claim_id, claim_id=claim.claim_id,
total_charge=claim.charge, total_charge=claim.charge,
place_of_service="11", place_of_service="12", # Home (matches HCPF IHSS S5150/T1019 POS)
facility_code_qualifier="B", facility_code_qualifier="B",
frequency_code=claim.frequency_code, # always "7" frequency_code=claim.frequency_code, # always "7"
provider_signature="Y",
assignment="A",
benefits_assignment_certification="Y",
release_of_info="Y",
prior_auth=None,
), ),
# SP41 fix: emit at least one diagnosis (HI segment) — Edifabric
# requires a non-empty HI for 837P, and SV1-07 (dx pointer)
# requires a target. "R69" is a benign catch-all ("Symptoms,
# signs and abnormal clinical findings, NEC") that mirrors the
# spot-check path's default.
diagnoses=[Diagnosis(code="R69", qualifier="ABK")],
service_lines=[ service_lines=[
ServiceLine( ServiceLine(
line_number=1, line_number=1,
@@ -381,14 +425,28 @@ def _serialize_pipeline_a(claim: RebillClaim, *, tpid: str) -> bytes:
charge=claim.charge, charge=claim.charge,
units=Decimal("1"), units=Decimal("1"),
unit_type="UN", unit_type="UN",
place_of_service="11", place_of_service="12",
service_date=claim.svc_date, service_date=claim.svc_date,
dx_pointer="1",
), ),
], ],
validation=ValidationReport(passed=True), validation=ValidationReport(passed=True),
transaction_type_code="CH", transaction_type_code="CH",
) )
text = serialize_837(placeholder_claim, sender_id=tpid) # SP41 fix: thread the canonical submitter block (PER*IC with real
# contact name/phone/email) and receiver_name through to
# serialize_837 — without these, NM1*41/PER*IC emit with empty
# placeholders that Edifabric's PER-02 rule rejects.
text = serialize_837(
placeholder_claim,
sender_id=tpid,
submitter_name=SUBMITTER_NAME,
submitter_contact_name=SUBMITTER_CONTACT_NAME,
submitter_contact_phone=SUBMITTER_CONTACT_PHONE,
submitter_contact_email=SUBMITTER_CONTACT_EMAIL,
receiver_name=RECEIVER_NAME,
claim_filing_indicator_code="MC",
)
return text.encode("ascii") return text.encode("ascii")
+3 -2
View File
@@ -314,8 +314,9 @@ def test_run_rebill_emits_real_files_for_pipeline_a(tmp_path):
# Original claim_submit_id is preserved in CLM01 (anchors the # Original claim_submit_id is preserved in CLM01 (anchors the
# frequency-7 replacement). # frequency-7 replacement).
assert b"CLM*ORIG-1*" in body, body assert b"CLM*ORIG-1*" in body, body
# Frequency-code 7 emitted in CLM05 composite (11:B:7). # Frequency-code 7 emitted in CLM05 composite (12:B:7 — Home POS
assert b"CLM*ORIG-1*100.00***11:B:7" in body, body # is canonical for Dzinesco IHSS S5150/T1019 services).
assert b"CLM*ORIG-1*100.00***12:B:7" in body, body
# Pipeline-A filename uses HCPF-spec prefix + claim_id suffix. # Pipeline-A filename uses HCPF-spec prefix + claim_id suffix.
assert a_path.name.startswith("tp11525703-837P-"), a_path.name assert a_path.name.startswith("tp11525703-837P-"), a_path.name