feat(sp7): wire match_service_lines into reconcile.run

This commit is contained in:
Tyler
2026-06-20 19:33:02 -06:00
parent 9626eae5f1
commit c1323c44d0
2 changed files with 243 additions and 0 deletions
+115
View File
@@ -300,6 +300,72 @@ def run(session, batch_id: str) -> ReconcileResult:
))
applied += 1
# SP7: line-level reconciliation. For each matched (claim, remit) pair,
# pair each 837 service line with the first 835 SVC composite that
# matches on (procedure_code, modifiers, service_date, units) and
# persist a LineReconciliation row per line on either side (matched
# or explicitly unmatched). See spec §4.4.
#
# Architecture note: 837 service lines live in ``Claim.raw_json``,
# not a separate ORM table. The ``LineReconciliation.claim_service_line_number``
# column stores the 1-based line index; the SVC side uses
# ``ServiceLinePayment`` (real ORM rows) so we get an FK to it.
from cyclone.db import LineReconciliation, ServiceLinePayment
import json as _json_lm
for m in matches:
if m.is_reversal:
continue # reversals are handled by a separate path (see §7.3)
claim_id = m.claim.id
remit_id = m.remittance.id
# 837 side: read service_lines out of the claim's raw_json blob.
raw = m.claim.raw_json or {}
raw_lines = raw.get("service_lines") or []
claim_lines = []
for d in raw_lines:
proc = d.get("procedure") or {}
claim_lines.append(_ClaimLineShim(
line_number=d.get("line_number"),
procedure_code=proc.get("code", ""),
modifiers=proc.get("modifiers") or [],
service_date=_parse_iso_date(d.get("service_date")),
units=Decimal(str(d["units"])) if d.get("units") is not None else None,
))
# 835 side: real ORM rows.
svc_payments = list(
session.execute(
select(ServiceLinePayment)
.where(ServiceLinePayment.remittance_id == remit_id)
.order_by(ServiceLinePayment.line_number)
).scalars().all()
)
svc_shims = [_SvcPaymentShim.from_orm(s) for s in svc_payments]
line_matches = match_service_lines(claim_lines, svc_shims)
now = datetime.now(timezone.utc)
for lm in line_matches:
session.add(LineReconciliation(
claim_id=claim_id,
claim_service_line_number=lm.claim_line.line_number if lm.claim_line else None,
service_line_payment_id=lm.service_payment.line_id if lm.service_payment else None,
status=lm.status,
reconciled_at=now,
))
# SP7: claim-level adjustment aggregate. Sum CAS rows whose
# service_line_payment_id IS NULL — these are CLP-level adjustments,
# not per-line. Persist on the remit for fast reads.
from sqlalchemy import func as _func
for r in new_remits:
cl_total = session.execute(
select(_func.sum(CasAdjustment.amount))
.where(CasAdjustment.remittance_id == r.id)
.where(CasAdjustment.service_line_payment_id.is_(None))
).scalar_one() or Decimal("0")
r.claim_level_adjustment_amount = cl_total
# Aggregate CAS adjustments per Remittance.
for r in new_remits:
total = session.execute(
@@ -417,3 +483,52 @@ def match_service_lines(
))
return matches
@dataclass
class _ClaimLineShim:
"""Adapt an 837 service-line dict to the _ClaimLineLike protocol.
Used by ``reconcile.run()`` to call ``match_service_lines()`` against
lines that live inside ``Claim.raw_json`` (no ORM table).
"""
line_number: int
procedure_code: str
modifiers: list
service_date: Optional[date]
units: Optional[Decimal]
@dataclass
class _SvcPaymentShim:
"""Adapt an ORM ``ServiceLinePayment`` to the _ServicePaymentLike protocol."""
line_id: int
line_number: int
procedure_code: str
modifiers: list
service_date: Optional[date]
units: Optional[Decimal]
@classmethod
def from_orm(cls, svc) -> "_SvcPaymentShim":
import json as _json
return cls(
line_id=svc.id,
line_number=svc.line_number,
procedure_code=svc.procedure_code,
modifiers=_json.loads(svc.modifiers_json or "[]"),
service_date=svc.service_date,
units=Decimal(str(svc.units)) if svc.units is not None else None,
)
def _parse_iso_date(value) -> Optional[date]:
"""Coerce a date / ISO-8601 string / None to ``datetime.date``."""
if value is None:
return None
if isinstance(value, date):
return value
if isinstance(value, str):
return date.fromisoformat(value)
return None