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cyclone/backend/tests/test_validator_835.py
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"""Tests for the 835 ERA validator rules."""
from datetime import date
from decimal import Decimal
from pathlib import Path
import pytest
from cyclone.parsers.models import Address, BatchSummary, Envelope
from cyclone.parsers.models_835 import (
ClaimAdjustment,
ClaimPayment,
FinancialInfo,
ParseResult835,
Payer835,
Payee835,
ReassociationTrace,
ServicePayment,
)
from cyclone.parsers.payer import PayerConfig835
from cyclone.parsers.validator_835 import validate
# --------------------------------------------------------------------------- #
# Builders
# --------------------------------------------------------------------------- #
def _build_result(**overrides) -> ParseResult835:
"""Build a passing CO Medicaid 835 result; override fields to break rules."""
financial = FinancialInfo(
handling_code="C",
paid_amount=Decimal("85.00"),
credit_debit_flag="C",
payment_method="ACH",
payer_tax_id="81-1725341",
payment_date=date(2026, 6, 17),
)
trace = ReassociationTrace(
trace_type_code="1",
trace_number="TPID001",
originating_company_id="TPID001",
payer_id="81-1725341",
)
payer = Payer835(
name="CO_TXIX",
id="7912900843",
address=Address(line1="PO BOX 11000", city="DENVER", state="CO", zip="802110000"),
)
payee = Payee835(
name="TOC, Inc.",
npi="1881068062",
address=Address(line1="1100 East Main St", city="Montrose", state="CO", zip="814014063"),
)
claim = ClaimPayment(
payer_claim_control_number="CLM001",
status_code="1",
status_label="Processed as Primary",
total_charge=Decimal("100.00"),
total_paid=Decimal("85.00"),
patient_responsibility=Decimal("15.00"),
claim_filing_indicator="MC",
original_claim_id="CLM001",
facility_type="12",
frequency_code="1",
per_diem_covered_days=None,
ref_benefit_plan=None,
service_payments=[
ServicePayment(
line_number=1,
procedure_qualifier="HC",
procedure_code="S5130",
modifiers=["U2"],
charge=Decimal("60.00"),
payment=Decimal("50.00"),
units=Decimal("7.73"),
unit_type="UN",
service_date=date(2026, 6, 2),
adjustments=[],
ref_benefit_plan=None,
),
ServicePayment(
line_number=2,
procedure_qualifier="HC",
procedure_code="S5130",
modifiers=["U2"],
charge=Decimal("40.00"),
payment=Decimal("35.00"),
units=Decimal("7.73"),
unit_type="UN",
service_date=date(2026, 6, 3),
adjustments=[],
ref_benefit_plan=None,
),
],
raw_segments=[],
)
summary = BatchSummary(input_file="f", total_claims=1, passed=1, failed=0)
result = ParseResult835(
envelope=Envelope(
sender_id="COMEDASSISTPROG",
receiver_id="TPID001",
control_number="991102984",
transaction_date=date(2026, 6, 17),
),
financial_info=financial,
trace=trace,
payer=payer,
payee=payee,
claims=[claim],
summary=summary,
)
if overrides:
result = result.model_copy(update=overrides)
return result
# --------------------------------------------------------------------------- #
# Sanity: balanced claim passes
# --------------------------------------------------------------------------- #
def test_balanced_claim_passes_all_rules():
cfg = PayerConfig835.co_medicaid_835()
report = validate(_build_result(), cfg)
assert report.passed is True
assert report.errors == []
# --------------------------------------------------------------------------- #
# BPR rules
# --------------------------------------------------------------------------- #
def test_r835_bpr01_handling_code_disallowed():
cfg = PayerConfig835.co_medicaid_835()
result = _build_result(financial_info=_build_result().financial_info.model_copy(update={"handling_code": "Z"}))
report = validate(result, cfg)
assert any(i.rule == "R835_BPR01_handling_code_allowed" for i in report.errors)
assert report.passed is False
def test_r835_bpr02_positive():
cfg = PayerConfig835.co_medicaid_835()
result = _build_result(financial_info=_build_result().financial_info.model_copy(update={"paid_amount": Decimal("0.00")}))
report = validate(result, cfg)
assert any(i.rule == "R835_BPR02_positive" for i in report.errors)
def test_r835_bal_bpr_vs_clp04_unbalanced():
"""BPR02 (85.00) must equal sum of CLP04 (85.00). Off by 0.50 → error."""
cfg = PayerConfig835.co_medicaid_835()
result = _build_result(financial_info=_build_result().financial_info.model_copy(update={"paid_amount": Decimal("85.50")}))
report = validate(result, cfg)
assert any(i.rule == "R835_BAL_BPR_vs_CLP04" for i in report.errors)
assert report.passed is False
def test_r835_bal_bpr_vs_clp04_within_tolerance_passes():
cfg = PayerConfig835.co_medicaid_835()
result = _build_result(financial_info=_build_result().financial_info.model_copy(update={"paid_amount": Decimal("85.005")}))
report = validate(result, cfg)
# 0.005 difference is below tolerance (0.01) — no error.
assert not any(i.rule == "R835_BAL_BPR_vs_CLP04" for i in report.errors)
# --------------------------------------------------------------------------- #
# CLP rules
# --------------------------------------------------------------------------- #
def test_r835_bal_clp04_vs_svc03_unbalanced():
cfg = PayerConfig835.co_medicaid_835()
# The default fixture has CLP04=85.00 and SVC03 sum = 50+35 = 85.00.
# Change one SVC payment to 40 → sum = 40+35 = 75, off by 10.
base = _build_result()
svc = base.claims[0].service_payments[0].model_copy(update={"payment": Decimal("40.00")})
result = base.model_copy(update={"claims": [base.claims[0].model_copy(update={"service_payments": [svc, base.claims[0].service_payments[1]]})]})
report = validate(result, cfg)
assert any(i.rule == "R835_BAL_CLP04_vs_SVC03" for i in report.errors)
assert "CLM001" in [i.message for i in report.errors if i.rule == "R835_BAL_CLP04_vs_SVC03"][0]
def test_r835_clp01_present():
cfg = PayerConfig835.co_medicaid_835()
result = _build_result(claims=[_build_result().claims[0].model_copy(update={"payer_claim_control_number": ""})])
report = validate(result, cfg)
assert any(i.rule == "R835_CLP01_present" for i in report.errors)
def test_r835_clp02_status_disallowed():
cfg = PayerConfig835.co_medicaid_835()
result = _build_result(claims=[_build_result().claims[0].model_copy(update={"status_code": "9", "status_label": None})])
report = validate(result, cfg)
assert any(i.rule == "R835_CLP02_status_allowed" for i in report.errors)
def test_r835_clp03_present():
cfg = PayerConfig835.co_medicaid_835()
result = _build_result(claims=[_build_result().claims[0].model_copy(update={"total_charge": Decimal("0.00")})])
report = validate(result, cfg)
assert any(i.rule == "R835_CLP03_present" for i in report.errors)
# --------------------------------------------------------------------------- #
# Payer / payee rules
# --------------------------------------------------------------------------- #
def test_r835_payer_tax_id_mismatch_warning():
cfg = PayerConfig835.co_medicaid_835()
result = _build_result(financial_info=_build_result().financial_info.model_copy(update={"payer_tax_id": "99-9999999"}))
report = validate(result, cfg)
assert any(i.rule == "R835_PAYER_TAX_ID_matches" and i.severity == "warning" for i in report.warnings)
# Warning only — report still passes.
assert report.passed is True
def test_r835_payer_tax_id_skipped_when_set_empty():
cfg = PayerConfig835.co_medicaid_835()
result = _build_result(financial_info=_build_result().financial_info.model_copy(update={"payer_tax_id": None}))
report = validate(result, cfg)
# When BPR10 is empty, the rule is skipped silently (per spec wording).
assert not any(i.rule == "R835_PAYER_TAX_ID_matches" for i in report.errors + report.warnings)
def test_r835_payer_health_plan_id_mismatch_warning():
cfg = PayerConfig835.co_medicaid_835()
result = _build_result(payer=_build_result().payer.model_copy(update={"id": "12345"}))
report = validate(result, cfg)
assert any(i.rule == "R835_PAYER_HEALTH_PLAN_ID_matches" and i.severity == "warning" for i in report.warnings)
assert report.passed is True
def test_r835_payee_npi_format():
cfg = PayerConfig835.co_medicaid_835()
result = _build_result(payee=_build_result().payee.model_copy(update={"npi": "12345"}))
report = validate(result, cfg)
assert any(i.rule == "R835_PAYEE_NPI_format" for i in report.errors)
assert report.passed is False
def test_r835_trn02_originating_company_id_present():
cfg = PayerConfig835.co_medicaid_835()
result = _build_result(trace=_build_result().trace.model_copy(update={"originating_company_id": ""}))
report = validate(result, cfg)
assert any(i.rule == "R835_REGN01_trn02_present" for i in report.errors)
# --------------------------------------------------------------------------- #
# Optional: warnings don't fail the report
# --------------------------------------------------------------------------- #
def test_warnings_do_not_set_passed_false():
cfg = PayerConfig835.co_medicaid_835()
# A wrong payer tax id is a warning; report should still pass.
result = _build_result(financial_info=_build_result().financial_info.model_copy(update={"payer_tax_id": "BAD"}))
report = validate(result, cfg)
assert report.passed is True
assert any(i.severity == "warning" for i in report.warnings)
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