feat(sp7): wire _reconcile_pair into manual_match (T21)
manual_match previously only flipped the claim↔remit FK and the
claim state — it never ran line-level reconciliation, so manually-
paired claims surfaced empty line-reconciliation rows to the UI
and skipped CLP-level CAS aggregate recompute.
Refactor reconcile.run() to call a new per-pair helper
_reconcile_pair(session, claim, remittance) that:
- clears any existing LineReconciliation rows for the claim
(idempotent re-run; safe across manual_unmatch + manual_rematch
cycles that may pair the claim with a different remittance),
- reads 837 SV1 lines from Claim.raw_json and 835 SVC rows from
ServiceLinePayment,
- runs match_service_lines() and persists a LineReconciliation row
per side,
- recomputes Remittance.claim_level_adjustment_amount (CLP-level
CAS) and Remittance.adjustment_amount (total CAS).
manual_match now calls this helper after the FK is set and before
commit, mirroring the auto-match path. Reversals are skipped (they
don't have SV1↔SVC line pairs; per §7.3).
Tests (test_store_reconcile.py):
- test_manual_match_populates_line_reconciliation_rows: end-to-end
check that a manual pair writes the expected matched +
unmatched_837_only rows plus zero CAS aggregates.
- test_manual_match_idempotent_line_reconciliation: after
manual_unmatch + manual_rematch + inserting a CLP-level CAS row
directly, the claim has exactly two fresh LineReconciliation rows
(no duplicates) and the remittance aggregate reflects the new CAS.
Smoke tested end-to-end via TestClient: parse co_medicaid_837p.txt
+ co_medicaid_835.txt, auto-matcher skips (PCNs differ), manual
match via POST /api/reconciliation/match, then
GET /api/claims/{id}/line-reconciliation returns 2 rows and
GET /api/inbox/lanes shows matched_remittance.total_lines=2.
Note: matched_lines may be 0 on real 835 fixtures due to a
pre-existing parser bug in _consume_service_payment that swaps
SVC04 (units) and SVC05 (unit-of-measure) when reading units from
the segment. The SP7 strict-match criterion requires units parity,
so the misread produces None on the SVC side and strict-match
never succeeds. Surfaced as a follow-up; the SP7 work itself is
correct (line counts are computed and persisted).
This commit is contained in:
@@ -300,79 +300,21 @@ def run(session, batch_id: str) -> ReconcileResult:
|
|||||||
))
|
))
|
||||||
applied += 1
|
applied += 1
|
||||||
|
|
||||||
# SP7: line-level reconciliation. For each matched (claim, remit) pair,
|
# SP7: line-level reconciliation + claim-level CAS aggregate. For each
|
||||||
# pair each 837 service line with the first 835 SVC composite that
|
# matched (claim, remit) pair, pair each 837 service line with the first
|
||||||
# matches on (procedure_code, modifiers, service_date, units) and
|
# 835 SVC composite that matches on (procedure_code, modifiers,
|
||||||
# persist a LineReconciliation row per line on either side (matched
|
# service_date, units) and persist a LineReconciliation row per line on
|
||||||
# or explicitly unmatched). See spec §4.4.
|
# either side (matched or explicitly unmatched). Also recompute the
|
||||||
|
# remittance's CLP-level and total CAS aggregates.
|
||||||
#
|
#
|
||||||
# Architecture note: 837 service lines live in ``Claim.raw_json``,
|
# Architecture note: 837 service lines live in ``Claim.raw_json``, not a
|
||||||
# not a separate ORM table. The ``LineReconciliation.claim_service_line_number``
|
# separate ORM table. The ``LineReconciliation.claim_service_line_number``
|
||||||
# column stores the 1-based line index; the SVC side uses
|
# column stores the 1-based line index; the SVC side uses
|
||||||
# ``ServiceLinePayment`` (real ORM rows) so we get an FK to it.
|
# ``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:
|
for m in matches:
|
||||||
if m.is_reversal:
|
if m.is_reversal:
|
||||||
continue # reversals are handled by a separate path (see §7.3)
|
continue # reversals are handled by a separate path (see §7.3)
|
||||||
claim_id = m.claim.id
|
_reconcile_pair(session, m.claim, m.remittance)
|
||||||
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(
|
|
||||||
select(func.sum(CasAdjustment.amount))
|
|
||||||
.where(CasAdjustment.remittance_id == r.id)
|
|
||||||
).scalar_one() or Decimal("0")
|
|
||||||
r.adjustment_amount = total
|
|
||||||
|
|
||||||
# Partition.
|
# Partition.
|
||||||
unmatched_claims_after, unmatched_remits_after = split_unmatched(
|
unmatched_claims_after, unmatched_remits_after = split_unmatched(
|
||||||
@@ -485,6 +427,101 @@ def match_service_lines(
|
|||||||
return matches
|
return matches
|
||||||
|
|
||||||
|
|
||||||
|
def _reconcile_pair(session, claim, remittance) -> None:
|
||||||
|
"""SP7: line-level reconciliation + claim-level CAS aggregate for one pair.
|
||||||
|
|
||||||
|
Idempotent: clears existing ``LineReconciliation`` rows for the
|
||||||
|
claim before inserting fresh ones, and recomputes the aggregate
|
||||||
|
fields on the remittance regardless of prior values. Safe to call
|
||||||
|
across manual_unmatch + manual_rematch cycles.
|
||||||
|
|
||||||
|
Used by both ``reconcile.run()`` (after auto-match) and
|
||||||
|
``store.manual_match()`` (after operator override) so manual matches
|
||||||
|
produce the same per-line audit data as auto matches. See spec §4.4.
|
||||||
|
|
||||||
|
Steps:
|
||||||
|
1. Delete any existing ``LineReconciliation`` rows for the claim.
|
||||||
|
2. Read 837 service lines from ``Claim.raw_json``.
|
||||||
|
3. Read ``ServiceLinePayment`` rows for the remittance.
|
||||||
|
4. Run ``match_service_lines`` (pure) to pair SV1 ↔ SVC.
|
||||||
|
5. Persist ``LineReconciliation`` rows.
|
||||||
|
6. Recompute ``Remittance.claim_level_adjustment_amount`` from CAS
|
||||||
|
rows with ``service_line_payment_id IS NULL`` (CLP-level).
|
||||||
|
7. Recompute ``Remittance.adjustment_amount`` from all CAS rows.
|
||||||
|
|
||||||
|
Does not commit; caller's session controls the transaction.
|
||||||
|
"""
|
||||||
|
from sqlalchemy import select
|
||||||
|
from cyclone.db import (
|
||||||
|
CasAdjustment, LineReconciliation, ServiceLinePayment,
|
||||||
|
)
|
||||||
|
|
||||||
|
# 1: clear stale rows so re-running produces a clean slate. Stale
|
||||||
|
# rows can appear after a manual_unmatch + manual_rematch cycle that
|
||||||
|
# pairs the claim with a *different* remittance, leaving rows whose
|
||||||
|
# ``service_line_payment_id`` references SVC rows no longer paired
|
||||||
|
# with this claim.
|
||||||
|
stale = list(
|
||||||
|
session.execute(
|
||||||
|
select(LineReconciliation)
|
||||||
|
.where(LineReconciliation.claim_id == claim.id)
|
||||||
|
).scalars().all()
|
||||||
|
)
|
||||||
|
for lr in stale:
|
||||||
|
session.delete(lr)
|
||||||
|
|
||||||
|
# 2: read 837 service lines (JSON blob).
|
||||||
|
raw = 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,
|
||||||
|
))
|
||||||
|
|
||||||
|
# 3: read 835 SVC rows (real ORM).
|
||||||
|
svc_payments = list(
|
||||||
|
session.execute(
|
||||||
|
select(ServiceLinePayment)
|
||||||
|
.where(ServiceLinePayment.remittance_id == remittance.id)
|
||||||
|
.order_by(ServiceLinePayment.line_number)
|
||||||
|
).scalars().all()
|
||||||
|
)
|
||||||
|
svc_shims = [_SvcPaymentShim.from_orm(s) for s in svc_payments]
|
||||||
|
|
||||||
|
# 4-5: pure pair + persist.
|
||||||
|
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,
|
||||||
|
))
|
||||||
|
|
||||||
|
# 6: claim-level CAS aggregate (CLP-level adjustments, no SLI pointer).
|
||||||
|
cl_total = session.execute(
|
||||||
|
select(func.sum(CasAdjustment.amount))
|
||||||
|
.where(CasAdjustment.remittance_id == remittance.id)
|
||||||
|
.where(CasAdjustment.service_line_payment_id.is_(None))
|
||||||
|
).scalar_one() or Decimal("0")
|
||||||
|
remittance.claim_level_adjustment_amount = cl_total
|
||||||
|
|
||||||
|
# 7: total CAS aggregate.
|
||||||
|
total = session.execute(
|
||||||
|
select(func.sum(CasAdjustment.amount))
|
||||||
|
.where(CasAdjustment.remittance_id == remittance.id)
|
||||||
|
).scalar_one() or Decimal("0")
|
||||||
|
remittance.adjustment_amount = total
|
||||||
|
|
||||||
|
|
||||||
@dataclass
|
@dataclass
|
||||||
class _ClaimLineShim:
|
class _ClaimLineShim:
|
||||||
"""Adapt an 837 service-line dict to the _ClaimLineLike protocol.
|
"""Adapt an 837 service-line dict to the _ClaimLineLike protocol.
|
||||||
|
|||||||
@@ -1948,6 +1948,11 @@ class CycloneStore:
|
|||||||
# we don't rely on T10 to do this.
|
# we don't rely on T10 to do this.
|
||||||
remit.claim_id = claim_id
|
remit.claim_id = claim_id
|
||||||
|
|
||||||
|
# SP7: line-level reconciliation + claim-level CAS aggregate.
|
||||||
|
# Skipped for reversals — they don't have SV1↔SVC line pairs.
|
||||||
|
if not remit.is_reversal:
|
||||||
|
_reconcile._reconcile_pair(s, claim, remit)
|
||||||
|
|
||||||
s.add(ActivityEvent(
|
s.add(ActivityEvent(
|
||||||
ts=now,
|
ts=now,
|
||||||
kind="manual_match",
|
kind="manual_match",
|
||||||
|
|||||||
@@ -260,4 +260,330 @@ def test_manual_match_conflict_raises():
|
|||||||
sess.commit()
|
sess.commit()
|
||||||
|
|
||||||
with pytest.raises(AlreadyMatchedError):
|
with pytest.raises(AlreadyMatchedError):
|
||||||
s.manual_match("CLM-X", "CLP-1:b1xxxxxx")
|
s.manual_match("CLM-X", "CLP-1:b1xxxxxx")
|
||||||
|
|
||||||
|
|
||||||
|
# ---------------------------------------------------------------------------
|
||||||
|
# SP7: manual_match populates LineReconciliation rows + CAS aggregates.
|
||||||
|
# ---------------------------------------------------------------------------
|
||||||
|
|
||||||
|
|
||||||
|
def test_manual_match_populates_line_reconciliation_rows():
|
||||||
|
"""manual_match must run line-level reconciliation, same as auto-match.
|
||||||
|
|
||||||
|
Without this, operators who manually pair claims see no per-line audit
|
||||||
|
data (every line shows up as ``unmatched_837_only`` in the UI). The
|
||||||
|
SP7 fix routes ``manual_match`` through ``reconcile._reconcile_pair``
|
||||||
|
after the claim↔remit FK is set, mirroring the auto-match path.
|
||||||
|
|
||||||
|
Setup:
|
||||||
|
* 837 claim with two SV1 lines (99213 + 99214).
|
||||||
|
* 835 remit with one SVC line (99213) — matches line 1, leaves
|
||||||
|
line 2 unmatched_837_only.
|
||||||
|
* member_id and PCN differ so auto-match doesn't pair them.
|
||||||
|
|
||||||
|
Expected post-match state:
|
||||||
|
* 1 ``matched`` LineReconciliation row (line 1 ↔ SVC 1).
|
||||||
|
* 1 ``unmatched_837_only`` LineReconciliation row (line 2).
|
||||||
|
* ``Remittance.adjustment_amount`` recomputed (0 — no CAS in this test).
|
||||||
|
* ``Remittance.claim_level_adjustment_amount`` recomputed (0).
|
||||||
|
"""
|
||||||
|
from sqlalchemy import select
|
||||||
|
from cyclone.db import LineReconciliation, Remittance
|
||||||
|
from cyclone.store import BatchRecord837, BatchRecord835
|
||||||
|
from cyclone.parsers.models import (
|
||||||
|
BatchSummary as BatchSummary837,
|
||||||
|
BillingProvider, ClaimHeader, ClaimOutput, Envelope,
|
||||||
|
Payer, ParseResult, Procedure, ServiceLine, Subscriber,
|
||||||
|
ValidationReport,
|
||||||
|
)
|
||||||
|
|
||||||
|
s = CycloneStore()
|
||||||
|
|
||||||
|
# 837 claim with two SV1 service lines.
|
||||||
|
co = ClaimOutput(
|
||||||
|
claim_id="CLM-MANUAL",
|
||||||
|
control_number="0001",
|
||||||
|
transaction_date=date(2026, 6, 19),
|
||||||
|
billing_provider=BillingProvider(name="Test", npi="1234567890"),
|
||||||
|
# member_id deliberately ≠ PCN below so auto-match skips this claim.
|
||||||
|
subscriber=Subscriber(first_name="Jane", last_name="Doe",
|
||||||
|
member_id="MANUAL"),
|
||||||
|
payer=Payer(name="Test Payer", id="P1"),
|
||||||
|
claim=ClaimHeader(
|
||||||
|
claim_id="CLM-MANUAL", total_charge=Decimal("200.00"),
|
||||||
|
frequency_code="1", place_of_service="11",
|
||||||
|
),
|
||||||
|
diagnoses=[],
|
||||||
|
service_lines=[
|
||||||
|
ServiceLine(
|
||||||
|
line_number=1,
|
||||||
|
procedure=Procedure(qualifier="HC", code="99213",
|
||||||
|
modifiers=[]),
|
||||||
|
charge=Decimal("100.00"),
|
||||||
|
unit_type="UN",
|
||||||
|
units=Decimal("1"),
|
||||||
|
service_date=date(2026, 6, 19),
|
||||||
|
),
|
||||||
|
ServiceLine(
|
||||||
|
line_number=2,
|
||||||
|
procedure=Procedure(qualifier="HC", code="99214",
|
||||||
|
modifiers=[]),
|
||||||
|
charge=Decimal("100.00"),
|
||||||
|
unit_type="UN",
|
||||||
|
units=Decimal("1"),
|
||||||
|
service_date=date(2026, 6, 19),
|
||||||
|
),
|
||||||
|
],
|
||||||
|
validation=ValidationReport(passed=True, errors=[], warnings=[]),
|
||||||
|
raw_segments=[],
|
||||||
|
)
|
||||||
|
pr837 = ParseResult(
|
||||||
|
envelope=Envelope(
|
||||||
|
sender_id="S", receiver_id="R", control_number="0001",
|
||||||
|
transaction_date=date(2026, 6, 19),
|
||||||
|
),
|
||||||
|
claims=[co],
|
||||||
|
summary=BatchSummary837(
|
||||||
|
input_file="c.txt", control_number="0001",
|
||||||
|
transaction_date=date(2026, 6, 19),
|
||||||
|
total_claims=1, passed=1, failed=0,
|
||||||
|
),
|
||||||
|
)
|
||||||
|
s.add(BatchRecord837(
|
||||||
|
id="b-837-sp7", kind="837p", input_filename="c.txt",
|
||||||
|
parsed_at=datetime(2026, 6, 19, tzinfo=timezone.utc),
|
||||||
|
result=pr837,
|
||||||
|
))
|
||||||
|
|
||||||
|
# 835 remit with one SVC line that matches claim line 1.
|
||||||
|
cp = ClaimPayment(
|
||||||
|
payer_claim_control_number="CLM-MANUAL", # != member_id "MANUAL"
|
||||||
|
status_code="1",
|
||||||
|
status_label="Primary",
|
||||||
|
total_charge=Decimal("200.00"),
|
||||||
|
total_paid=Decimal("200.00"),
|
||||||
|
service_payments=[
|
||||||
|
ServicePayment(
|
||||||
|
line_number=1, procedure_qualifier="HC",
|
||||||
|
procedure_code="99213",
|
||||||
|
charge=Decimal("100.00"),
|
||||||
|
payment=Decimal("100.00"),
|
||||||
|
units=Decimal("1"),
|
||||||
|
service_date=date(2026, 6, 19),
|
||||||
|
adjustments=[],
|
||||||
|
),
|
||||||
|
],
|
||||||
|
)
|
||||||
|
s.add(BatchRecord835(
|
||||||
|
id="b-835-sp7", kind="835", input_filename="era.txt",
|
||||||
|
parsed_at=datetime(2026, 6, 19, tzinfo=timezone.utc),
|
||||||
|
result=_make_835_result([cp]),
|
||||||
|
))
|
||||||
|
|
||||||
|
# Verify auto-match didn't pair them (they should both be unmatched).
|
||||||
|
out = s.list_unmatched(kind="both")
|
||||||
|
assert len(out["claims"]) == 1
|
||||||
|
assert len(out["remittances"]) == 1
|
||||||
|
claim_id = out["claims"][0]["id"]
|
||||||
|
remit_id = out["remittances"][0]["id"]
|
||||||
|
|
||||||
|
# Manual match — must populate LineReconciliation rows.
|
||||||
|
result = s.manual_match(claim_id, remit_id)
|
||||||
|
assert result["claim"]["state"] == "paid"
|
||||||
|
|
||||||
|
with db.SessionLocal()() as session:
|
||||||
|
lrs = list(
|
||||||
|
session.execute(
|
||||||
|
select(LineReconciliation)
|
||||||
|
.where(LineReconciliation.claim_id == claim_id)
|
||||||
|
.order_by(LineReconciliation.id)
|
||||||
|
).scalars().all()
|
||||||
|
)
|
||||||
|
# Two claim SV1 lines → exactly two LineReconciliation rows
|
||||||
|
# (matched + unmatched_837_only). No SVC-only rows since the
|
||||||
|
# single SVC line pairs with claim line 1.
|
||||||
|
assert len(lrs) == 2, [lr.status for lr in lrs]
|
||||||
|
statuses = sorted(lr.status for lr in lrs)
|
||||||
|
assert statuses == ["matched", "unmatched_837_only"], statuses
|
||||||
|
|
||||||
|
# The matched row references claim line 1 + SVC row 1.
|
||||||
|
matched = next(lr for lr in lrs if lr.status == "matched")
|
||||||
|
assert matched.claim_service_line_number == 1
|
||||||
|
assert matched.service_line_payment_id is not None
|
||||||
|
# The unmatched_837_only row references claim line 2 only.
|
||||||
|
unmatched = next(lr for lr in lrs if lr.status == "unmatched_837_only")
|
||||||
|
assert unmatched.claim_service_line_number == 2
|
||||||
|
assert unmatched.service_line_payment_id is None
|
||||||
|
|
||||||
|
# Remittance aggregates were recomputed (0 CAS in this test).
|
||||||
|
r = session.get(Remittance, remit_id)
|
||||||
|
assert r is not None
|
||||||
|
assert r.adjustment_amount == Decimal("0")
|
||||||
|
assert r.claim_level_adjustment_amount == Decimal("0")
|
||||||
|
|
||||||
|
|
||||||
|
def test_manual_match_idempotent_line_reconciliation():
|
||||||
|
"""Re-running ``manual_match`` semantics on a rematched claim must not
|
||||||
|
duplicate LineReconciliation rows.
|
||||||
|
|
||||||
|
The helper clears stale rows for the claim before inserting fresh
|
||||||
|
ones, so a manual_unmatch → manual_rematch cycle (possibly to a
|
||||||
|
different remittance) produces a clean slate per claim.
|
||||||
|
"""
|
||||||
|
from sqlalchemy import select
|
||||||
|
from cyclone.db import LineReconciliation
|
||||||
|
from cyclone.store import BatchRecord837, BatchRecord835
|
||||||
|
from cyclone.parsers.models import (
|
||||||
|
BatchSummary as BatchSummary837,
|
||||||
|
BillingProvider, ClaimHeader, ClaimOutput, Envelope,
|
||||||
|
Payer, ParseResult, Procedure, ServiceLine, Subscriber,
|
||||||
|
ValidationReport,
|
||||||
|
)
|
||||||
|
|
||||||
|
s = CycloneStore()
|
||||||
|
|
||||||
|
# 837 with two SV1 lines, member_id="IDEMP" so it doesn't auto-pair.
|
||||||
|
co = ClaimOutput(
|
||||||
|
claim_id="CLM-IDEMP",
|
||||||
|
control_number="0001",
|
||||||
|
transaction_date=date(2026, 6, 19),
|
||||||
|
billing_provider=BillingProvider(name="Test", npi="1234567890"),
|
||||||
|
subscriber=Subscriber(first_name="Jane", last_name="Doe",
|
||||||
|
member_id="IDEMP"),
|
||||||
|
payer=Payer(name="Test Payer", id="P1"),
|
||||||
|
claim=ClaimHeader(
|
||||||
|
claim_id="CLM-IDEMP", total_charge=Decimal("200.00"),
|
||||||
|
frequency_code="1", place_of_service="11",
|
||||||
|
),
|
||||||
|
diagnoses=[],
|
||||||
|
service_lines=[
|
||||||
|
ServiceLine(
|
||||||
|
line_number=1,
|
||||||
|
procedure=Procedure(qualifier="HC", code="99213",
|
||||||
|
modifiers=[]),
|
||||||
|
charge=Decimal("100.00"),
|
||||||
|
unit_type="UN",
|
||||||
|
units=Decimal("1"),
|
||||||
|
service_date=date(2026, 6, 19),
|
||||||
|
),
|
||||||
|
ServiceLine(
|
||||||
|
line_number=2,
|
||||||
|
procedure=Procedure(qualifier="HC", code="99214",
|
||||||
|
modifiers=[]),
|
||||||
|
charge=Decimal("100.00"),
|
||||||
|
unit_type="UN",
|
||||||
|
units=Decimal("1"),
|
||||||
|
service_date=date(2026, 6, 19),
|
||||||
|
),
|
||||||
|
],
|
||||||
|
validation=ValidationReport(passed=True, errors=[], warnings=[]),
|
||||||
|
raw_segments=[],
|
||||||
|
)
|
||||||
|
pr837 = ParseResult(
|
||||||
|
envelope=Envelope(
|
||||||
|
sender_id="S", receiver_id="R", control_number="0001",
|
||||||
|
transaction_date=date(2026, 6, 19),
|
||||||
|
),
|
||||||
|
claims=[co],
|
||||||
|
summary=BatchSummary837(
|
||||||
|
input_file="c.txt", control_number="0001",
|
||||||
|
transaction_date=date(2026, 6, 19),
|
||||||
|
total_claims=1, passed=1, failed=0,
|
||||||
|
),
|
||||||
|
)
|
||||||
|
s.add(BatchRecord837(
|
||||||
|
id="b-837-idemp", kind="837p", input_filename="c.txt",
|
||||||
|
parsed_at=datetime(2026, 6, 19, tzinfo=timezone.utc),
|
||||||
|
result=pr837,
|
||||||
|
))
|
||||||
|
|
||||||
|
# 835 with two SVC lines — auto-match won't pair (PCN="CLM-IDEMP" ≠
|
||||||
|
# member_id="IDEMP"), so manual_match has work to do.
|
||||||
|
cp = ClaimPayment(
|
||||||
|
payer_claim_control_number="CLM-IDEMP",
|
||||||
|
status_code="1",
|
||||||
|
status_label="Primary",
|
||||||
|
total_charge=Decimal("200.00"),
|
||||||
|
total_paid=Decimal("200.00"),
|
||||||
|
service_payments=[
|
||||||
|
ServicePayment(
|
||||||
|
line_number=1, procedure_qualifier="HC",
|
||||||
|
procedure_code="99213",
|
||||||
|
charge=Decimal("100.00"),
|
||||||
|
payment=Decimal("100.00"),
|
||||||
|
units=Decimal("1"),
|
||||||
|
service_date=date(2026, 6, 19),
|
||||||
|
adjustments=[],
|
||||||
|
),
|
||||||
|
ServicePayment(
|
||||||
|
line_number=2, procedure_qualifier="HC",
|
||||||
|
procedure_code="99214",
|
||||||
|
charge=Decimal("100.00"),
|
||||||
|
payment=Decimal("100.00"),
|
||||||
|
units=Decimal("1"),
|
||||||
|
service_date=date(2026, 6, 19),
|
||||||
|
adjustments=[],
|
||||||
|
),
|
||||||
|
],
|
||||||
|
)
|
||||||
|
s.add(BatchRecord835(
|
||||||
|
id="b-835-idemp", kind="835", input_filename="era.txt",
|
||||||
|
parsed_at=datetime(2026, 6, 19, tzinfo=timezone.utc),
|
||||||
|
result=_make_835_result([cp]),
|
||||||
|
))
|
||||||
|
|
||||||
|
out = s.list_unmatched(kind="both")
|
||||||
|
claim_id = out["claims"][0]["id"]
|
||||||
|
remit_id = out["remittances"][0]["id"]
|
||||||
|
|
||||||
|
# First match — creates LineReconciliation rows.
|
||||||
|
s.manual_match(claim_id, remit_id)
|
||||||
|
with db.SessionLocal()() as session:
|
||||||
|
first_count = len(list(
|
||||||
|
session.execute(
|
||||||
|
select(LineReconciliation)
|
||||||
|
.where(LineReconciliation.claim_id == claim_id)
|
||||||
|
).scalars().all()
|
||||||
|
))
|
||||||
|
assert first_count == 2
|
||||||
|
|
||||||
|
# Unmatch — clears FK but leaves LineReconciliation rows in place.
|
||||||
|
s.manual_unmatch(claim_id)
|
||||||
|
|
||||||
|
# Insert a CLP-level CAS row directly so we can verify aggregate
|
||||||
|
# recompute on the rematch. This simulates a forward-compat CLP CAS
|
||||||
|
# (today's parser doesn't produce these, see _persist_835_remit).
|
||||||
|
from cyclone.db import CasAdjustment
|
||||||
|
with db.SessionLocal()() as session:
|
||||||
|
session.add(CasAdjustment(
|
||||||
|
remittance_id=remit_id,
|
||||||
|
group_code="CO", reason_code="45",
|
||||||
|
amount=Decimal("20.00"),
|
||||||
|
quantity=None,
|
||||||
|
service_line_payment_id=None, # CLP-level
|
||||||
|
))
|
||||||
|
session.commit()
|
||||||
|
|
||||||
|
# Rematch — _reconcile_pair clears stale rows and inserts fresh ones.
|
||||||
|
s.manual_match(claim_id, remit_id)
|
||||||
|
with db.SessionLocal()() as session:
|
||||||
|
second = list(
|
||||||
|
session.execute(
|
||||||
|
select(LineReconciliation)
|
||||||
|
.where(LineReconciliation.claim_id == claim_id)
|
||||||
|
.order_by(LineReconciliation.id)
|
||||||
|
).scalars().all()
|
||||||
|
)
|
||||||
|
# Still exactly 2 rows — stale rows from the first match were
|
||||||
|
# deleted before the new ones were inserted.
|
||||||
|
assert len(second) == 2, [lr.status for lr in second]
|
||||||
|
statuses = sorted(lr.status for lr in second)
|
||||||
|
assert statuses == ["matched", "matched"], statuses
|
||||||
|
|
||||||
|
# CLP-level CAS aggregate now reflects the inserted row.
|
||||||
|
from cyclone.db import Remittance
|
||||||
|
r = session.get(Remittance, remit_id)
|
||||||
|
assert r is not None
|
||||||
|
assert r.adjustment_amount == Decimal("20.00")
|
||||||
|
assert r.claim_level_adjustment_amount == Decimal("20.00")
|
||||||
Reference in New Issue
Block a user