Commit Graph

12 Commits

Author SHA1 Message Date
Nora ee1a397bd5 fix(sp41): 2010BB payer loop ordering + patient loop structure + visits table
**The bug.** The 837P X12 005010X222A1 IG requires the Payer Name
loop (2010BB / NM1*PR) to live INSIDE 2000B, AFTER the subscriber's
DMG and BEFORE 2000C (HL*3, the patient loop). The previous
serializer emitted NM1*PR AFTER the patient loop, which pyX12 caught
as 'Mandatory loop 2010BB missing' on round-trip. The 10/10 spot-check
files were therefore structurally invalid per the IG even though they
round-tripped through our own parser (which silently swallowed the
misplaced NM1*PR).

**The fix.**
1. Move 2010BB into 2000B in `_build_subscriber_block` so the order
   is now: HL*2 → SBR → NM1*IL → N3 → N4 → DMG → NM1*PR → HL*3
   → PAT → NM1*QC → N3 → N4 → DMG → CLM.
2. Add `_consume_patient_loop` to `parse_837.py` so the 2000B
   subscriber iteration skips past the 2000C patient loop and
   finds loop 2300 (CLM) — the parser was previously relying on
   the (invalid) old ordering.
3. Strip NM108/NM109 from NM1*QC (the IG marks these as 'Not Used')
   via the QC branch of `_build_nm1`.
4. Add PAT*01 segment (PAT is required whenever 2000C is emitted).
5. Add `include_patient_loop` flag so callers can opt out (e.g.
   Patient==Subscriber cases that don't need a 2000C loop at all).
6. Bump HL*2 child count to 1 when 2000C is emitted (was 0 or 1
   inconsistently).

**Visits table (gap #3).** Migration 0023 adds a `visits` table
holding the AxisCare visits export rows. The previous spot-check
driver read the CSV in-memory; persisting the roster makes the
source-of-truth reviewable via SQL. `cyclone.rebill.visits_store`
provides `load_visits_csv` (with UNIQUE-key dedup) and
`query_visits` (filterable read-back). 8 new unit tests pin the
contract.

**Misc.**
- guard `s.svc_date is not None` in `reconcile.run` against 835
  rows that lack DTP*472.
- `.gitignore`: dev/rebills/ (the 355k generated 837P files from
  pipeline-A runs) so they no longer pollute 'git status'.
- Bump migration-head assertions in test_db_migrate / test_acks /
  test_migration_0020 from 22 → 23.

**Verification (post-fix).**
- 1568/1568 unit tests pass (10s)
- 20/20 spot-check files pass pyX12 v4.0.0 (BSD-licensed local X12
  validator; the Edifabric live API is still quota-blocked)
- 10/10 batch-1 + 10/10 batch-2 files have all required segment
  classes (NM1*41, NM1*40, NM1*QC, NM1*IL, CLM*, SV1*HC:, DTP*472)
- spot-check.json + spot-check-summary.txt refreshed from
  pyX12 (was 10/10 stale 403 errors; now 20/20 PASS)

Refs: SP41 inwindow-rebill-pipeline, plan step 3 (10 well-formed 837P
files with NM1*QC patient/subscriber loop) + plan step 4 (Edifabric /
v2/x12/validate).
2026-07-08 03:15:21 -06:00
Nora 0e130579b4 feat(sp41): claim-id dedup at SFTP pre-flight (30-day window, configurable) 2026-07-07 22:02:46 -06:00
Nora 353adfc08b feat(sp39): Resubmission model + migration 0021 + idempotency tests 2026-07-07 17:21:24 -06:00
sp37 bot 0067ecc5da feat(sp37): add batches.transaction_set_control_number column
Migration 0020 adds the column additively (nullable, no default) and
backfills from raw_result_json.envelope.transaction_set_control_number
for any existing batch rows that already carry it. Required for the
SP37 join-key update so 999 acks can resolve by ST02 (the source 837's
transaction set control number) instead of just ISA13.
2026-07-07 10:13:00 -06:00
Nora 1b2f6c6b21 test(sp32): bump migration version assertions to 19 2026-07-02 17:18:16 -06:00
Nora b094231995 feat(sp28): store.claim_acks facade + batch_envelope_index + to_ui_claim_ack serializer
The persistence layer for the SP28 join table lands in
cyclone/store/claim_acks.py:

- add_claim_ack — insert + publish 'claim_ack_written' on the bus
  (mirrors the publish-from-store pattern used by the ACKs paths)
- list_acks_for_claim / list_claims_for_ack — read helpers for the
  two list endpoints
- find_ack_orphans — Inbox ack-orphans lane source: every ack row
  whose ack_id has no ClaimAck row tied to it
- remove_claim_ack — unlink + publish 'claim_ack_dropped'
- batch_envelope_index — D10 in-memory map of
  {envelope.control_number: batch.id}, called once per ingest (cost
  is ~16 lookups today; trivially cheap)

Plus the to_ui_claim_ack serializer in store/ui.py mirroring
to_ui_ack shape — single source of truth for the wire format so the
live-tail event payload matches the list endpoint byte-for-byte.
Includes a single SELECT against claims for the claim_state field
(TA1 batch-level rows return 'n/a').

The CycloneStore facade in store/__init__.py re-exports all six
methods (add_claim_ack, list_acks_for_claim, list_claims_for_ack,
find_ack_orphans, remove_claim_ack, batch_envelope_index) plus
to_ui_claim_ack from the ui module.

Migration-version assertions in test_acks.py and test_db_migrate.py
bumped 17 → 18 to match the new migration head.

Steps 3.1/3.2/3.3/3.4 of the SP28 implementation plan.
2026-07-02 11:31:29 -06:00
Nora d8841834dc fix(sp27): Claim.patient_control_number populated from CLM01 (claim_id), not 2010BA NM109 (member_id)
The 837 ingest path (_claim_837_row in store.py:194) populated
Claim.patient_control_number from claim.subscriber.member_id — the
subscriber's 2010BA NM109 Medicaid ID — instead of from
claim.claim_id (CLM01, the claim submitter's identifier the 837
actually sent).

That silently broke every downstream join that uses this column as a
cross-reference key:

  * reconcile.match() (reconcile.py:74) — joins
    Claim.patient_control_number against
    Remittance.payer_claim_control_number (which is parsed from CLP01,
    the 835's echo of CLM01 per X12 spec). Member_id never matches
    CLP01, so auto-match always fails.
  * apply_999_rejections — same lookup, same broken key.
  * apply_277ca_rejections — same lookup, same broken key.
  * scoring.score_pair — same broken key.

Live DB probe (1,739 remits, 337 claims):
  * Claim.id == Remit.payer_claim_control_number    → 0 matches
  * Claim.patient_control_number == Remit.payer_claim_control_number
    → 9 matches (substring coincidences; synthetic PCN strings share
    alphanumeric characters with the human-readable member_ids)
  * Claim.matched_remittance_id NOT NULL             → 0 claims

This commit changes _claim_837_row to write
Claim.patient_control_number = claim.claim_id (= CLM01). The
reconcile matcher's existing join now hits the row the 835 echoes
back. Companion migration 0017 backfills the 337 pre-fix rows so
they're on equal footing with new ingests (UPDATE claims SET
patient_control_number = id WHERE patient_control_number IS DISTINCT
FROM id — idempotent).

Tests:
  * 2 new RED→GREEN tests in test_store_reconcile.py:
    - test_837_ingest_populates_patient_control_number_from_claim_id
      pins the field semantics directly
    - test_837_then_835_with_echoed_pcn_auto_pairs proves the full
      end-to-end auto-match now fires
  * 3 existing manual_match tests that relied on the bug (had setup
    using member_id != claim_id to deliberately prevent auto-match)
    updated to use distinct PCNs explicitly so the tests still
    exercise the manual-match path with a real orphan pair.
  * 3 store_claim_detail / api_gets tests adjusted for the same
    reason.

Verified: 1,176 / 1,177 backend tests pass; the one failure is the
pre-existing flake in test_provider_extended_response.py noted before
this work started.

Caveat for the existing dev DB: the 1,739 remits already in the DB
were ingested from 835 fixtures whose CLP01 is a different synthetic
identifier than the 837's CLM01 (the test fixtures never echoed
CLM01 — a fixture-data limitation, not a code bug). After this fix,
new 837+835 ingest pairs whose payer echoes CLM01 in CLP01 will
auto-match as expected. The pre-existing 1,739 remits will continue
to land in the unmatched bucket; that can only be fixed by
regenerating the test fixtures (out of scope for this SP).
2026-06-29 14:32:10 -06:00
Nora f5d119fbe7 feat(sp27): pin Claim↔Remit matched-pair invariant + startup drift audit
Add check_matched_pair_drift() at module level in store.py — read-only
audit of the Claim.matched_remittance_id ↔ Remittance.claim_id FK pair.
Logs WARNING on drift with up to 5 examples of each of two cases
(claim-side and remit-side), returns the count of drifted rows. Wired
into api.py::lifespan right after db.init_db() and ensure_clearhouse_seeded(),
wrapped in try/except so a query failure logs but doesn't crash boot.

The symmetric-write + symmetric-clear invariants on
manual_match / manual_unmatch were already correct; this commit pins
them with focused regression tests in test_store_match_invariant.py
(8 tests covering both directions, both happy-path, rollback pin, and
drift-check unit behavior). PCN asymmetry in the fixture prevents the
auto-match inside CycloneStore.add (Task 10) from pre-pairing, so
manual_match is the only writer.

Migration 0016 adds the missing ix_claims_matched_remittance_id index —
the drift check scans WHERE matched_remittance_id IS NOT NULL on every
boot and would become a full-table scan past ~10k claims. Symmetric
with ix_remittances_claim_id (added in 0007). Migration tests bumped
from head=15 to head=16.
2026-06-29 12:21:34 -06:00
Tyler 2194d35ea1 fix(sp22): correct test fixtures in SP22 migration tests
- test_migration_latest_idempotent_on_fresh_db now uses the pytest
  tmp_path fixture instead of a literal /tmp path that did not exist,
  so sqlite can create the test DB.
- test_drop_claims_unique_constraint_migration now inserts the NOT
  NULL batches.kind / input_filename / parsed_at columns when seeding
  the parent row for the two same-PCN claims.
2026-06-23 16:18:01 -06:00
Tyler 4fd55dc33e feat(sp22): migration 0015 — drop inline UNIQUE on claims, add tests
Adds migration 0015_drop_claims_unique_constraint.sql that recreates the
claims table without the inline UNIQUE(batch_id, patient_control_number)
constraint, plus tests proving the migration runs cleanly and the
constraint is not re-introduced.
2026-06-23 16:11:42 -06:00
Tyler 934d623d3a feat(backend): harden db_migrate — rollback test, non-sql filter test, doc convention 2026-06-19 21:25:15 -06:00
Tyler 1bd2334e40 feat(backend): add PRAGMA user_version migration runner + 0001_initial 2026-06-19 21:19:43 -06:00