fix(store): spec compliance fixes per review
This commit is contained in:
Tyler
@@ -16,6 +16,7 @@ from pydantic import BaseModel, ConfigDict, Field
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from cyclone.parsers.models import ClaimOutput, ParseResult
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from cyclone.parsers.models_835 import ClaimPayment, ParseResult835
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from cyclone.parsers.payer import PayerConfig835
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BatchKind = Literal["837p", "835"]
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@@ -29,7 +30,7 @@ class BatchRecord(BaseModel):
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id: str
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kind: BatchKind
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input_filename: str
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parsed_at: str # ISO 8601 UTC, e.g. "2026-06-19T12:00:00Z"
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parsed_at: datetime # tz-aware UTC
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result: ParseResult | ParseResult835 = Field(discriminator=None)
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@@ -121,6 +122,7 @@ class InMemoryStore:
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for cp in result.claims:
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all_remits.append(to_ui_remittance(
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cp, batch_id=b.id, parsed_at=b.parsed_at,
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payer_name=result.payer.name,
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))
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if payer is not None:
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all_remits = [r for r in all_remits if r.get("payerName") == payer]
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@@ -187,9 +189,9 @@ class InMemoryStore:
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store = InMemoryStore()
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def utcnow_iso() -> str:
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"""ISO 8601 UTC timestamp, second precision, suffixed with 'Z'."""
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return datetime.now(timezone.utc).strftime("%Y-%m-%dT%H:%M:%SZ")
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def utcnow() -> datetime:
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"""tz-aware UTC `datetime` (replaces the old `utcnow_iso` string helper)."""
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return datetime.now(timezone.utc)
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# ---------------------------------------------------------------------------
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@@ -203,26 +205,29 @@ def to_ui_claim(
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claim: ClaimOutput,
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*,
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batch_id: str,
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parsed_at: str,
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parsed_at: datetime,
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) -> dict:
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"""Map a 837P ClaimOutput to the UI's `Claim` shape.
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Status rules (per spec section 6.2, evaluated in priority order):
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- !passed → denied
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- passed and any warnings → pending
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- passed and frequency_code == "1" → submitted
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- otherwise → draft
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Status rules (per spec section 6.2, first-match-wins):
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- !passed and any R050_diagnosis_present error → draft
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- !passed → denied
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- passed and frequency_code == "1" → submitted
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- passed and any warnings → pending
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- otherwise → draft
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"""
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v = claim.validation
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if not v.passed:
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status = "denied"
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elif v.warnings:
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status = "pending"
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has_r050 = any(e.rule == "R050_diagnosis_present" for e in v.errors)
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status = "draft" if has_r050 else "denied"
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elif claim.claim.frequency_code == "1":
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status = "submitted"
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elif v.warnings:
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status = "pending"
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else:
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status = "draft"
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parsed_iso = parsed_at.isoformat().replace("+00:00", "Z")
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return {
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"id": claim.claim_id,
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"patientName": f"{claim.subscriber.first_name} {claim.subscriber.last_name}".strip(),
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@@ -237,9 +242,9 @@ def to_ui_claim(
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"receivedAmount": 0.0,
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"status": status,
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"denialReason": None,
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"submissionDate": parsed_at,
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"submissionDate": parsed_iso,
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"batchId": batch_id,
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"parsedAt": parsed_at,
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"parsedAt": parsed_iso,
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}
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@@ -247,13 +252,17 @@ def to_ui_remittance(
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cp: ClaimPayment,
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*,
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batch_id: str,
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parsed_at: str,
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parsed_at: datetime,
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payer_config: PayerConfig835 | None = None,
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payer_name: str = "",
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) -> dict:
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"""Map an 835 ClaimPayment to the UI's `Remittance` shape.
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Status mapping (per spec section 6.3):
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- status_code 21/22 → reconciled (reversal/correction)
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- otherwise → received
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Status mapping (per spec section 6.2):
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- status_code 21/22 → reconciled (reversal/correction)
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- status_code 4 → received + denialReason from CAS
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- status_code outside allowlist → received + validationWarning
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- otherwise → received
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"""
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code = cp.status_code
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if code in {"21", "22"}:
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@@ -261,17 +270,35 @@ def to_ui_remittance(
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else:
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status = "received"
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denial_reason: str | None = None
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if code == "4" and cp.service_payments:
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sp = cp.service_payments[0]
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if sp.adjustments:
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adj = sp.adjustments[0]
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denial_reason = (
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f"{adj.group_code}-{adj.reason_code}: ${float(adj.amount):.2f}"
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)
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cfg = payer_config if payer_config is not None else PayerConfig835.generic_835()
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validation_warnings: list[str] = []
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if code not in cfg.allowed_status_codes:
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validation_warnings.append(
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f"CLP02 code {code} not in payer allowlist"
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)
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parsed_iso = parsed_at.isoformat().replace("+00:00", "Z")
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return {
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"id": cp.payer_claim_control_number,
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"claimId": cp.original_claim_id or "",
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"payerName": "",
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"payerName": payer_name,
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"paidAmount": float(cp.total_paid or 0.0),
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"adjustmentAmount": 0.0,
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"status": status,
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"denialReason": None,
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"receivedDate": parsed_at,
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"denialReason": denial_reason,
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"validationWarnings": validation_warnings,
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"receivedDate": parsed_iso,
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"batchId": batch_id,
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"parsedAt": parsed_at,
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"parsedAt": parsed_iso,
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}
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@@ -307,7 +334,7 @@ def to_activity_event(
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id: str,
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kind: str,
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message: str,
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timestamp: str,
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timestamp: datetime,
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npi: str | None = None,
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amount: float | None = None,
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) -> dict:
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@@ -315,7 +342,7 @@ def to_activity_event(
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"id": id,
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"kind": kind,
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"message": message,
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"timestamp": timestamp,
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"timestamp": timestamp.isoformat().replace("+00:00", "Z"),
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"npi": npi,
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"amount": amount,
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}
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