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docs: surface SP14 (Payer-Rejected UI + acknowledge) + SP15 (key rotation) #3

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tyler wants to merge 14 commits from docs/sp14-15-readme-sync into main
pull from: docs/sp14-15-readme-sync
merge into: tyler:main
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+415 -366
2 changed files with 415 additions and 366 deletions
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backend/src/cyclone/api.py
+4 -366
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@@ -145,6 +145,7 @@ from cyclone.api_routers import ( # noqa: E402
acks, acks,
activity, activity,
batches, batches,
claims,
clearhouse, clearhouse,
config, config,
health, health,
@@ -160,12 +161,14 @@ app.include_router(clearhouse.router)
app.include_router(config.router) app.include_router(config.router)
app.include_router(activity.router) app.include_router(activity.router)
app.include_router(batches.router) app.include_router(batches.router)
app.include_router(claims.router)
# Backwards-compat re-exports: test_api_stream_live.py imports these # Backwards-compat re-exports: test_api_stream_live.py imports these
# names directly from ``cyclone.api`` to invoke the endpoint coroutines # names directly from ``cyclone.api`` to invoke the endpoint coroutines
# in-process. Re-pointing at the router keeps the public surface stable # in-process. Re-pointing at the router keeps the public surface stable
# while the bodies live in the routers package. # while the bodies live in the routers package.
activity_stream = activity.activity_stream_endpoint activity_stream = activity.activity_stream_endpoint
claims_stream = claims.claims_stream_endpoint
def _resolve_payer(name: str) -> PayerConfig: def _resolve_payer(name: str) -> PayerConfig:
@@ -1164,372 +1167,7 @@ def inbox_export_csv(lane: str):
# --- /api/batches lives in cyclone.api_routers.batches --- # --- /api/batches lives in cyclone.api_routers.batches ---
@app.get("/api/claims") # --- /api/claims lives in cyclone.api_routers.claims ---
def list_claims(
request: Request,
batch_id: str | None = Query(None),
status: str | None = Query(None),
provider_npi: str | None = Query(None),
payer: str | None = Query(None),
date_from: str | None = Query(None),
date_to: str | None = Query(None),
sort: str | None = Query(None),
order: str = Query("desc"),
limit: int = Query(100, ge=1, le=1000),
offset: int = Query(0, ge=0),
) -> Any:
common = dict(
batch_id=batch_id,
status=status,
provider_npi=provider_npi,
payer=payer,
date_from=date_from,
date_to=date_to,
)
items = list(store.iter_claims(
sort=sort, order=order, limit=limit, offset=offset, **common,
))
total = len(list(store.iter_claims(**common)))
returned = len(items)
has_more = total > offset + returned
if _wants_ndjson(request):
return StreamingResponse(
_ndjson_stream_list(items, total, returned, has_more),
media_type="application/x-ndjson",
)
return {
"items": items,
"total": total,
"returned": returned,
"has_more": has_more,
}
# --------------------------------------------------------------------------- #
# Live-tail NDJSON streaming endpoints (Phase 3 — SP5)
# --------------------------------------------------------------------------- #
@app.get("/api/claims/stream")
async def claims_stream(
request: Request,
status: str | None = Query(None),
provider_npi: str | None = Query(None),
payer: str | None = Query(None),
date_from: str | None = Query(None),
date_to: str | None = Query(None),
sort: str | None = Query(None),
order: str = Query("desc"),
limit: int = Query(100, ge=1, le=1000),
) -> StreamingResponse:
"""Stream Claims as NDJSON: snapshot first, then live events.
Wire format:
* ``{"type":"item","data":<claim>}`` per snapshot row, then per
new ``claim_written`` event
* ``{"type":"snapshot_end","data":{"count":N}}`` after the snapshot
* ``{"type":"heartbeat","data":{"ts":<iso>}}`` every
``CYCLONE_TAIL_HEARTBEAT_S`` seconds when idle
Query params mirror :func:`list_claims` so a frontend can swap a
one-shot fetch for a tail with no URL surgery.
NOTE: registered before ``/api/claims/{claim_id}`` so the literal
``stream`` path segment doesn't get matched as a claim id.
"""
bus: EventBus = request.app.state.event_bus
async def gen() -> AsyncIterator[bytes]:
# 1. Snapshot (eager — iter_claims returns a list already).
rows = store.iter_claims(
status=status, provider_npi=provider_npi, payer=payer,
date_from=date_from, date_to=date_to,
sort=sort or "-submission_date", order=order, limit=limit,
)
for row in rows:
yield _ndjson_line({"type": "item", "data": row})
yield _ndjson_line({"type": "snapshot_end", "data": {"count": len(rows)}})
# 2. Subscribe + heartbeats.
async for chunk in _tail_events(request, bus, ["claim_written"]):
yield chunk
return StreamingResponse(gen(), media_type="application/x-ndjson")
@app.get("/api/claims/{claim_id}")
def get_claim_detail_endpoint(claim_id: str) -> dict:
"""Return one claim with full drawer context (SP4).
Body shape is produced by :meth:`CycloneStore.get_claim_detail`:
header, state, service lines, diagnoses, parties, validation,
raw segments, ``stateHistory`` (most-recent-first, capped at 50),
and a populated ``matchedRemittance`` block when paired.
Path param is ``claim_id`` (matches the SP3 ``/api/acks/{ack_id}``
convention). Returns 404 — never 500 — on a missing claim so the
UI can distinguish "doesn't exist" from a transient fetch error.
"""
body = store.get_claim_detail(claim_id)
if body is None:
raise HTTPException(
status_code=404,
detail={
"error": "Not found",
"detail": f"Claim {claim_id} not found",
},
)
return body
@app.get("/api/claims/{claim_id}/serialize-837")
def serialize_claim_as_837(claim_id: str):
"""Return the claim as a regenerated X12 837P file (SP8).
Loads the ClaimOutput from the persisted ``raw_json`` and runs the
outbound serializer. Returns 404 if the claim doesn't exist, 422 if
the stored payload has no parseable ClaimOutput (data integrity
issue, not a transient failure).
"""
with db.SessionLocal()() as s:
row = s.get(Claim, claim_id)
if row is None:
return JSONResponse(
{"error": "Not found", "detail": f"Claim {claim_id} not found"},
status_code=404,
)
if not row.raw_json:
return JSONResponse(
{
"error": "Unprocessable",
"detail": f"Claim {claim_id} has no raw_json; cannot serialize",
},
status_code=422,
)
try:
claim_obj = ClaimOutput.model_validate(row.raw_json)
except Exception as exc:
return JSONResponse(
{
"error": "Unprocessable",
"detail": f"Claim {claim_id} raw_json is malformed: {exc}",
},
status_code=422,
)
try:
text = serialize_837(claim_obj)
except SerializeError837 as exc:
return JSONResponse(
{"error": "Unprocessable", "detail": str(exc)},
status_code=422,
)
return Response(
content=text,
media_type="text/x12",
headers={
"Content-Disposition": f'attachment; filename="claim-{claim_id}.x12"'
},
)
@app.get("/api/claims/{claim_id}/line-reconciliation")
def get_claim_line_reconciliation(claim_id: str) -> dict:
"""Per-line reconciliation view for the ClaimDrawer tab.
Spec §5.1. Returns the 837 service lines and 835 SVC composites
side-by-side, with per-line CAS adjustments and a summary block.
Architecture note: 837 service lines live in ``Claim.raw_json``
(not a separate ORM table), so the 837-side rows are read from the
JSON blob; the 835-side rows come from ``ServiceLinePayment`` ORM.
``LineReconciliation.claim_service_line_number`` stores the 1-based
line number to join them.
"""
from sqlalchemy import select
from cyclone.db import (
LineReconciliation, ServiceLinePayment, CasAdjustment,
)
import json as _json
from decimal import Decimal
with db.SessionLocal()() as s:
claim = s.get(db.Claim, claim_id)
if claim is None:
raise HTTPException(
status_code=404,
detail={"error": "Not found", "detail": f"Claim {claim_id} not found"},
)
# 837 service lines: from raw_json.
raw = claim.raw_json or {}
claim_lines_raw = raw.get("service_lines") or []
# Normalize to dicts for the response.
claim_lines = [_claim_line_dict(d) for d in claim_lines_raw]
# 835 service payments: ORM rows from the matched remit.
remits = list(
s.execute(
select(db.Remittance).where(db.Remittance.claim_id == claim_id)
).scalars().all()
)
svc_payments: list[dict] = []
svc_ids: list[int] = []
if remits:
svc_rows = list(
s.execute(
select(ServiceLinePayment).where(
ServiceLinePayment.remittance_id.in_([r.id for r in remits])
).order_by(ServiceLinePayment.line_number)
).scalars().all()
)
for svc in svc_rows:
d = _svc_to_dict(svc)
svc_payments.append(d)
svc_ids.append(svc.id)
# LineReconciliation rows.
lrs = list(
s.execute(
select(LineReconciliation).where(LineReconciliation.claim_id == claim_id)
).scalars().all()
)
# Index by claim_service_line_number and service_line_payment_id.
lr_by_claim_num: dict[int, LineReconciliation] = {
lr.claim_service_line_number: lr for lr in lrs if lr.claim_service_line_number is not None
}
lr_by_svc: dict[int, LineReconciliation] = {
lr.service_line_payment_id: lr for lr in lrs if lr.service_line_payment_id is not None
}
# CAS rows grouped by svc id.
cas_by_svc: dict[int, list[CasAdjustment]] = {}
if svc_ids:
cas_rows = list(
s.execute(
select(CasAdjustment).where(CasAdjustment.service_line_payment_id.in_(svc_ids))
).scalars().all()
)
for c in cas_rows:
cas_by_svc.setdefault(c.service_line_payment_id, []).append(c)
# Build output lines array, preserving 837 order then 835-only.
svc_by_id: dict[int, dict] = {d["id"]: d for d in svc_payments}
lines_out: list[dict] = []
billed_total = Decimal("0")
paid_total = Decimal("0")
adjustment_total = Decimal("0")
matched_count = 0
used_svc_ids: set[int] = set()
for cl in claim_lines:
billed_total += Decimal(str(cl["charge"]))
lr = lr_by_claim_num.get(cl["line_number"])
if lr is None:
lines_out.append({
"claim_service_line": cl,
"service_line_payment": None,
"status": "unmatched_837_only",
"adjustments": [],
})
continue
svc_id = lr.service_line_payment_id
svc = svc_by_id.get(svc_id) if svc_id else None
if svc_id is not None:
used_svc_ids.add(svc_id)
cas_list = cas_by_svc.get(svc_id, []) if svc_id is not None else []
cas_total = sum((Decimal(str(c.amount)) for c in cas_list), Decimal("0"))
if svc:
paid_total += Decimal(str(svc["payment"]))
adjustment_total += cas_total
if lr.status == "matched":
matched_count += 1
lines_out.append({
"claim_service_line": cl,
"service_line_payment": svc,
"status": lr.status,
"adjustments": [
{"group_code": c.group_code, "reason_code": c.reason_code,
"amount": str(Decimal(str(c.amount)))}
for c in cas_list
],
})
# 835-only lines (no claim match).
for lr in lrs:
if lr.claim_service_line_number is not None:
continue
svc_id = lr.service_line_payment_id
if svc_id is None:
continue
if svc_id in used_svc_ids:
continue
svc = svc_by_id.get(svc_id)
cas_list = cas_by_svc.get(svc_id, [])
cas_total = sum((Decimal(str(c.amount)) for c in cas_list), Decimal("0"))
if svc:
paid_total += Decimal(str(svc["payment"]))
adjustment_total += cas_total
lines_out.append({
"claim_service_line": None,
"service_line_payment": svc,
"status": lr.status,
"adjustments": [
{"group_code": c.group_code, "reason_code": c.reason_code,
"amount": str(Decimal(str(c.amount)))}
for c in cas_list
],
})
return {
"claim_id": claim_id,
"summary": {
"billed_total": str(billed_total),
"paid_total": str(paid_total),
"adjustment_total": str(adjustment_total),
"matched_lines": matched_count,
"total_lines": len(claim_lines),
},
"lines": lines_out,
}
def _claim_line_dict(d: dict) -> dict:
"""Project an 837 service-line dict from ``Claim.raw_json`` to wire shape."""
from decimal import Decimal
proc = d.get("procedure") or {}
charge = d.get("charge")
units = d.get("units")
return {
"line_number": d.get("line_number"),
"procedure_qualifier": proc.get("qualifier", "HC"),
"procedure_code": proc.get("code", ""),
"modifiers": proc.get("modifiers") or [],
"charge": str(Decimal(str(charge))) if charge is not None else "0",
"units": str(Decimal(str(units))) if units is not None else None,
"unit_type": d.get("unit_type"),
"service_date": d.get("service_date"),
}
def _svc_to_dict(svc) -> dict:
"""Project an ORM ``ServiceLinePayment`` to wire shape."""
import json as _json
from decimal import Decimal
return {
"id": svc.id,
"line_number": svc.line_number,
"procedure_qualifier": svc.procedure_qualifier,
"procedure_code": svc.procedure_code,
"modifiers": _json.loads(svc.modifiers_json or "[]"),
"charge": str(Decimal(str(svc.charge))),
"payment": str(Decimal(str(svc.payment))),
"units": str(Decimal(str(svc.units))) if svc.units is not None else None,
"unit_type": svc.unit_type,
"service_date": svc.service_date.isoformat() if svc.service_date else None,
}
@app.get("/api/reconciliation/unmatched") @app.get("/api/reconciliation/unmatched")
def get_reconciliation_unmatched() -> dict: def get_reconciliation_unmatched() -> dict:
backend/src/cyclone/api_routers/claims.py
+411
View File
@@ -0,0 +1,411 @@
"""``/api/claims`` — list, live-tail, detail, X12 regenerate, line-reconciliation.
This is the largest single-resource router. Five endpoints:
* ``GET /api/claims`` — paginated list with filters
(status / batch_id / provider_npi / payer / date range / sort).
* ``GET /api/claims/stream`` — NDJSON snapshot + live tail via the
``claim_written`` EventBus kind.
* ``GET /api/claims/{claim_id}`` — drawer detail
(header / state / service lines / diagnoses / parties / validation /
raw segments / stateHistory / matchedRemittance).
* ``GET /api/claims/{claim_id}/serialize-837`` — regenerate X12 for
download (SP8).
* ``GET /api/claims/{claim_id}/line-reconciliation`` — per-line
reconciliation view for the ClaimDrawer tab (spec §5.1).
**Route ordering.** ``/stream`` is declared **before** ``/{claim_id}`` so
FastAPI's first-match routing doesn't swallow the literal ``stream``
segment as a claim id. Same order as the prior inline code.
The two projection helpers ``_claim_line_dict`` / ``_svc_to_dict`` are
private to this router; both only used by the line-reconciliation
endpoint.
"""
from __future__ import annotations
from decimal import Decimal
from typing import Any, AsyncIterator
from fastapi import APIRouter, HTTPException, Query, Request
from fastapi.responses import JSONResponse, Response, StreamingResponse
from cyclone import db
from cyclone.api_helpers import (
ndjson_line,
ndjson_stream_list,
tail_events,
wants_ndjson,
)
from cyclone.db import Claim
from cyclone.parsers.models import ClaimOutput
from cyclone.parsers.serialize_837 import SerializeError as SerializeError837, serialize_837
from cyclone.pubsub import EventBus
from cyclone.store import store
router = APIRouter()
@router.get("/api/claims")
def list_claims_endpoint(
request: Request,
batch_id: str | None = Query(None),
status: str | None = Query(None),
provider_npi: str | None = Query(None),
payer: str | None = Query(None),
date_from: str | None = Query(None),
date_to: str | None = Query(None),
sort: str | None = Query(None),
order: str = Query("desc"),
limit: int = Query(100, ge=1, le=1000),
offset: int = Query(0, ge=0),
) -> Any:
"""Paginated claims list with filters; supports NDJSON streaming.
``has_more`` is computed as ``total > offset + returned`` so paginating
forward keeps returning true until the last page is reached.
"""
common = dict(
batch_id=batch_id,
status=status,
provider_npi=provider_npi,
payer=payer,
date_from=date_from,
date_to=date_to,
)
items = list(store.iter_claims(
sort=sort, order=order, limit=limit, offset=offset, **common,
))
total = len(list(store.iter_claims(**common)))
returned = len(items)
has_more = total > offset + returned
if wants_ndjson(request):
return StreamingResponse(
ndjson_stream_list(items, total, returned, has_more),
media_type="application/x-ndjson",
)
return {
"items": items,
"total": total,
"returned": returned,
"has_more": has_more,
}
@router.get("/api/claims/stream")
async def claims_stream_endpoint(
request: Request,
status: str | None = Query(None),
provider_npi: str | None = Query(None),
payer: str | None = Query(None),
date_from: str | None = Query(None),
date_to: str | None = Query(None),
sort: str | None = Query(None),
order: str = Query("desc"),
limit: int = Query(100, ge=1, le=1000),
) -> StreamingResponse:
"""Stream Claims as NDJSON: snapshot first, then live events.
Wire format:
* ``{"type":"item","data":<claim>}`` per snapshot row, then per
new ``claim_written`` event
* ``{"type":"snapshot_end","data":{"count":N}}`` after the snapshot
* ``{"type":"heartbeat","data":{"ts":<iso>}}`` every
``CYCLONE_TAIL_HEARTBEAT_S`` seconds when idle
Query params mirror :func:`list_claims_endpoint` so a frontend can
swap a one-shot fetch for a tail with no URL surgery.
NOTE: registered before ``/api/claims/{claim_id}`` so the literal
``stream`` path segment doesn't get matched as a claim id.
"""
bus: EventBus = request.app.state.event_bus
async def gen() -> AsyncIterator[bytes]:
# 1. Snapshot (eager — iter_claims returns a list already).
rows = store.iter_claims(
status=status, provider_npi=provider_npi, payer=payer,
date_from=date_from, date_to=date_to,
sort=sort or "-submission_date", order=order, limit=limit,
)
for row in rows:
yield ndjson_line({"type": "item", "data": row})
yield ndjson_line({"type": "snapshot_end", "data": {"count": len(rows)}})
# 2. Subscribe + heartbeats.
async for chunk in tail_events(request, bus, ["claim_written"]):
yield chunk
return StreamingResponse(gen(), media_type="application/x-ndjson")
@router.get("/api/claims/{claim_id}")
def get_claim_detail_endpoint(claim_id: str) -> dict:
"""Return one claim with full drawer context (SP4).
Body shape is produced by :meth:`CycloneStore.get_claim_detail`:
header, state, service lines, diagnoses, parties, validation,
raw segments, ``stateHistory`` (most-recent-first, capped at 50),
and a populated ``matchedRemittance`` block when paired.
Returns 404 — never 500 — on a missing claim so the UI can
distinguish "doesn't exist" from a transient fetch error.
"""
body = store.get_claim_detail(claim_id)
if body is None:
raise HTTPException(
status_code=404,
detail={
"error": "Not found",
"detail": f"Claim {claim_id} not found",
},
)
return body
@router.get("/api/claims/{claim_id}/serialize-837")
def serialize_claim_as_837(claim_id: str):
"""Return the claim as a regenerated X12 837P file (SP8).
Loads the ClaimOutput from the persisted ``raw_json`` and runs the
outbound serializer. Returns 404 if the claim doesn't exist, 422 if
the stored payload has no parseable ClaimOutput (data integrity
issue, not a transient failure).
"""
with db.SessionLocal()() as s:
row = s.get(Claim, claim_id)
if row is None:
return JSONResponse(
{"error": "Not found", "detail": f"Claim {claim_id} not found"},
status_code=404,
)
if not row.raw_json:
return JSONResponse(
{
"error": "Unprocessable",
"detail": f"Claim {claim_id} has no raw_json; cannot serialize",
},
status_code=422,
)
try:
claim_obj = ClaimOutput.model_validate(row.raw_json)
except Exception as exc:
return JSONResponse(
{
"error": "Unprocessable",
"detail": f"Claim {claim_id} raw_json is malformed: {exc}",
},
status_code=422,
)
try:
text = serialize_837(claim_obj)
except SerializeError837 as exc:
return JSONResponse(
{"error": "Unprocessable", "detail": str(exc)},
status_code=422,
)
return Response(
content=text,
media_type="text/x12",
headers={
"Content-Disposition": f'attachment; filename="claim-{claim_id}.x12"'
},
)
@router.get("/api/claims/{claim_id}/line-reconciliation")
def get_claim_line_reconciliation(claim_id: str) -> dict:
"""Per-line reconciliation view for the ClaimDrawer tab.
Spec §5.1. Returns the 837 service lines and 835 SVC composites
side-by-side, with per-line CAS adjustments and a summary block.
Architecture note: 837 service lines live in ``Claim.raw_json``
(not a separate ORM table), so the 837-side rows are read from the
JSON blob; the 835-side rows come from ``ServiceLinePayment`` ORM.
``LineReconciliation.claim_service_line_number`` stores the 1-based
line number to join them.
"""
from sqlalchemy import select
from cyclone.db import (
CasAdjustment,
LineReconciliation,
ServiceLinePayment,
)
with db.SessionLocal()() as s:
claim = s.get(db.Claim, claim_id)
if claim is None:
raise HTTPException(
status_code=404,
detail={"error": "Not found", "detail": f"Claim {claim_id} not found"},
)
# 837 service lines: from raw_json.
raw = claim.raw_json or {}
claim_lines_raw = raw.get("service_lines") or []
# Normalize to dicts for the response.
claim_lines = [_claim_line_dict(d) for d in claim_lines_raw]
# 835 service payments: ORM rows from the matched remit.
remits = list(
s.execute(
select(db.Remittance).where(db.Remittance.claim_id == claim_id)
).scalars().all()
)
svc_payments: list[dict] = []
svc_ids: list[int] = []
if remits:
svc_rows = list(
s.execute(
select(ServiceLinePayment).where(
ServiceLinePayment.remittance_id.in_([r.id for r in remits])
).order_by(ServiceLinePayment.line_number)
).scalars().all()
)
for svc in svc_rows:
d = _svc_to_dict(svc)
svc_payments.append(d)
svc_ids.append(svc.id)
# LineReconciliation rows.
lrs = list(
s.execute(
select(LineReconciliation).where(LineReconciliation.claim_id == claim_id)
).scalars().all()
)
# Index by claim_service_line_number and service_line_payment_id.
lr_by_claim_num: dict[int, LineReconciliation] = {
lr.claim_service_line_number: lr for lr in lrs if lr.claim_service_line_number is not None
}
lr_by_svc: dict[int, LineReconciliation] = {
lr.service_line_payment_id: lr for lr in lrs if lr.service_line_payment_id is not None
}
# CAS rows grouped by svc id.
cas_by_svc: dict[int, list[CasAdjustment]] = {}
if svc_ids:
cas_rows = list(
s.execute(
select(CasAdjustment).where(CasAdjustment.service_line_payment_id.in_(svc_ids))
).scalars().all()
)
for c in cas_rows:
cas_by_svc.setdefault(c.service_line_payment_id, []).append(c)
# Build output lines array, preserving 837 order then 835-only.
svc_by_id: dict[int, dict] = {d["id"]: d for d in svc_payments}
lines_out: list[dict] = []
billed_total = Decimal("0")
paid_total = Decimal("0")
adjustment_total = Decimal("0")
matched_count = 0
used_svc_ids: set[int] = set()
for cl in claim_lines:
billed_total += Decimal(str(cl["charge"]))
lr = lr_by_claim_num.get(cl["line_number"])
if lr is None:
lines_out.append({
"claim_service_line": cl,
"service_line_payment": None,
"status": "unmatched_837_only",
"adjustments": [],
})
continue
svc_id = lr.service_line_payment_id
svc = svc_by_id.get(svc_id) if svc_id else None
if svc_id is not None:
used_svc_ids.add(svc_id)
cas_list = cas_by_svc.get(svc_id, []) if svc_id is not None else []
cas_total = sum((Decimal(str(c.amount)) for c in cas_list), Decimal("0"))
if svc:
paid_total += Decimal(str(svc["payment"]))
adjustment_total += cas_total
if lr.status == "matched":
matched_count += 1
lines_out.append({
"claim_service_line": cl,
"service_line_payment": svc,
"status": lr.status,
"adjustments": [
{"group_code": c.group_code, "reason_code": c.reason_code,
"amount": str(Decimal(str(c.amount)))}
for c in cas_list
],
})
# 835-only lines (no claim match).
for lr in lrs:
if lr.claim_service_line_number is not None:
continue
svc_id = lr.service_line_payment_id
if svc_id is None:
continue
if svc_id in used_svc_ids:
continue
svc = svc_by_id.get(svc_id)
cas_list = cas_by_svc.get(svc_id, [])
cas_total = sum((Decimal(str(c.amount)) for c in cas_list), Decimal("0"))
if svc:
paid_total += Decimal(str(svc["payment"]))
adjustment_total += cas_total
lines_out.append({
"claim_service_line": None,
"service_line_payment": svc,
"status": lr.status,
"adjustments": [
{"group_code": c.group_code, "reason_code": c.reason_code,
"amount": str(Decimal(str(c.amount)))}
for c in cas_list
],
})
return {
"claim_id": claim_id,
"summary": {
"billed_total": str(billed_total),
"paid_total": str(paid_total),
"adjustment_total": str(adjustment_total),
"matched_lines": matched_count,
"total_lines": len(claim_lines),
},
"lines": lines_out,
}
def _claim_line_dict(d: dict) -> dict:
"""Project an 837 service-line dict from ``Claim.raw_json`` to wire shape."""
proc = d.get("procedure") or {}
charge = d.get("charge")
units = d.get("units")
return {
"line_number": d.get("line_number"),
"procedure_qualifier": proc.get("qualifier", "HC"),
"procedure_code": proc.get("code", ""),
"modifiers": proc.get("modifiers") or [],
"charge": str(Decimal(str(charge))) if charge is not None else "0",
"units": str(Decimal(str(units))) if units is not None else None,
"unit_type": d.get("unit_type"),
"service_date": d.get("service_date"),
}
def _svc_to_dict(svc) -> dict:
"""Project an ORM ``ServiceLinePayment`` to wire shape."""
import json as _json
return {
"id": svc.id,
"line_number": svc.line_number,
"procedure_qualifier": svc.procedure_qualifier,
"procedure_code": svc.procedure_code,
"modifiers": _json.loads(svc.modifiers_json or "[]"),
"charge": str(Decimal(str(svc.charge))),
"payment": str(Decimal(str(svc.payment))),
"units": str(Decimal(str(svc.units))) if svc.units is not None else None,
"unit_type": svc.unit_type,
"service_date": svc.service_date.isoformat() if svc.service_date else None,
}