feat(backend): PayerConfig with co_medicaid and generic factories

2026-06-19 15:40:09 -06:00
parent aa801805ce
commit bb35ecd40c
2 changed files with 81 additions and 0 deletions
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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,
+        )