feat(sp7): wire match_service_lines into reconcile.run

2026-06-20 19:33:02 -06:00
parent 9626eae5f1
commit c1323c44d0
2 changed files with 243 additions and 0 deletions
@@ -0,0 +1,128 @@
+"""SP7 — integration test: reconcile.run() persists LineReconciliation rows.
+
+Spec §4.4.
+
+Architecture note: 837 service lines are stored inside
+``Claim.raw_json["service_lines"]`` keyed by ``line_number`` (1-based).
+The ``LineReconciliation`` table therefore stores
+``claim_service_line_number`` (int), not a FK to a separate service_lines
+table.
+"""
+from datetime import date, datetime, timezone
+from decimal import Decimal
+import json
+import uuid
+
+from sqlalchemy import select
+
+from cyclone.db import (
+    Batch,
+    Claim,
+    LineReconciliation,
+    SessionLocal,
+)
+from cyclone.reconcile import run
+from cyclone.store import _persist_835_remit, _remittance_835_row
+from cyclone.parsers.models_835 import ClaimPayment, ServicePayment
+
+
+def _setup_db() -> tuple:
+    """Build a minimal 837 claim + 835 remit that share PCN. Returns (claim_id, batch_id)."""
+    bid = str(uuid.uuid4())
+    claim_id = "CLM-T1"
+    service_lines_json = [
+        {
+            "line_number": 1,
+            "procedure": {"qualifier": "HC", "code": "99213", "modifiers": []},
+            "charge": "100.00",
+            "unit_type": "UN",
+            "units": "1",
+            "place_of_service": "11",
+            "service_date": "2026-06-01",
+            "provider_reference": None,
+        },
+        {
+            "line_number": 2,
+            "procedure": {"qualifier": "HC", "code": "99214", "modifiers": []},
+            "charge": "100.00",
+            "unit_type": "UN",
+            "units": "1",
+            "place_of_service": "11",
+            "service_date": "2026-06-01",
+            "provider_reference": None,
+        },
+    ]
+
+    with SessionLocal()() as s:
+        # 1. Batch
+        s.add(Batch(
+            id=bid, kind="835", input_filename="x.835",
+            parsed_at=datetime.now(timezone.utc),
+            totals_json={"total_claims": 1, "total_paid": "150"},
+            validation_json={"passed": True, "warnings": [], "errors": []},
+            raw_result_json={"_": "stub"},
+        ))
+        # 2. Claim with two service lines (in raw_json)
+        s.add(Claim(
+            id=claim_id,
+            patient_control_number="PCN-1",
+            charge_amount=Decimal("200.00"),
+            provider_npi="1234567890",
+            payer_id="SKCO0",
+            service_date_from=date(2026, 6, 1),
+            service_date_to=date(2026, 6, 1),
+            state="submitted",
+            batch_id=bid,
+            raw_json={"service_lines": service_lines_json},
+        ))
+        # 3. Remit with two SVC composites — line 1 matches 99213, line 2
+        #    is 90837 (no claim match).
+        cp = ClaimPayment(
+            payer_claim_control_number="PCN-1",
+            status_code="1",
+            total_charge=Decimal("200.00"),
+            total_paid=Decimal("150.00"),
+            service_payments=[
+                ServicePayment(
+                    line_number=1, procedure_qualifier="HC",
+                    procedure_code="99213",
+                    charge=Decimal("100.00"),
+                    payment=Decimal("80.00"),
+                    units=Decimal("1"),
+                    service_date=date(2026, 6, 1),
+                ),
+                ServicePayment(
+                    line_number=2, procedure_qualifier="HC",
+                    procedure_code="90837",
+                    charge=Decimal("100.00"),
+                    payment=Decimal("70.00"),
+                    units=Decimal("1"),
+                    service_date=date(2026, 6, 1),
+                ),
+            ],
+        )
+        remit = _remittance_835_row(cp, bid)
+        s.add(remit)
+        s.flush()
+        _persist_835_remit(s, cp, remit.id)
+        s.commit()
+
+    return claim_id, bid
+
+
+def test_run_persists_line_reconciliation_rows():
+    claim_id, bid = _setup_db()
+    with SessionLocal()() as s:
+        result = run(s, bid)
+        s.commit()
+        assert result.matched == 1
+
+        lrs = list(
+            s.execute(
+                select(LineReconciliation).where(LineReconciliation.claim_id == claim_id)
+            ).scalars().all()
+        )
+        # Expect 3 rows: 99213 matched, 99214 unmatched_837_only, 90837 unmatched_835_only
+        assert len(lrs) == 3
+        by_status = {lr.status for lr in lrs}
+        assert by_status == {"matched", "unmatched_837_only", "unmatched_835_only"}