Tyler
129 lines
4.2 KiB
Python
129 lines
4.2 KiB
Python
"""SP7 — integration test: reconcile.run() persists LineReconciliation rows.
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Spec §4.4.
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Architecture note: 837 service lines are stored inside
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``Claim.raw_json["service_lines"]`` keyed by ``line_number`` (1-based).
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The ``LineReconciliation`` table therefore stores
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``claim_service_line_number`` (int), not a FK to a separate service_lines
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table.
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"""
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from datetime import date, datetime, timezone
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from decimal import Decimal
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import json
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import uuid
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from sqlalchemy import select
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from cyclone.db import (
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Batch,
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Claim,
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LineReconciliation,
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SessionLocal,
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)
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from cyclone.reconcile import run
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from cyclone.store import _persist_835_remit, _remittance_835_row
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from cyclone.parsers.models_835 import ClaimPayment, ServicePayment
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def _setup_db() -> tuple:
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"""Build a minimal 837 claim + 835 remit that share PCN. Returns (claim_id, batch_id)."""
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bid = str(uuid.uuid4())
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claim_id = "CLM-T1"
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service_lines_json = [
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{
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"line_number": 1,
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"procedure": {"qualifier": "HC", "code": "99213", "modifiers": []},
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"charge": "100.00",
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"unit_type": "UN",
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"units": "1",
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"place_of_service": "11",
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"service_date": "2026-06-01",
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"provider_reference": None,
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},
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{
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"line_number": 2,
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"procedure": {"qualifier": "HC", "code": "99214", "modifiers": []},
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"charge": "100.00",
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"unit_type": "UN",
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"units": "1",
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"place_of_service": "11",
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"service_date": "2026-06-01",
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"provider_reference": None,
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},
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]
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with SessionLocal()() as s:
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# 1. Batch
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s.add(Batch(
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id=bid, kind="835", input_filename="x.835",
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parsed_at=datetime.now(timezone.utc),
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totals_json={"total_claims": 1, "total_paid": "150"},
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validation_json={"passed": True, "warnings": [], "errors": []},
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raw_result_json={"_": "stub"},
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))
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# 2. Claim with two service lines (in raw_json)
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s.add(Claim(
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id=claim_id,
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patient_control_number="PCN-1",
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charge_amount=Decimal("200.00"),
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provider_npi="1234567890",
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payer_id="SKCO0",
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service_date_from=date(2026, 6, 1),
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service_date_to=date(2026, 6, 1),
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state="submitted",
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batch_id=bid,
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raw_json={"service_lines": service_lines_json},
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))
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# 3. Remit with two SVC composites — line 1 matches 99213, line 2
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# is 90837 (no claim match).
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cp = ClaimPayment(
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payer_claim_control_number="PCN-1",
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status_code="1",
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total_charge=Decimal("200.00"),
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total_paid=Decimal("150.00"),
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service_payments=[
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ServicePayment(
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line_number=1, procedure_qualifier="HC",
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procedure_code="99213",
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charge=Decimal("100.00"),
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payment=Decimal("80.00"),
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units=Decimal("1"),
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service_date=date(2026, 6, 1),
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),
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ServicePayment(
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line_number=2, procedure_qualifier="HC",
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procedure_code="90837",
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charge=Decimal("100.00"),
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payment=Decimal("70.00"),
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units=Decimal("1"),
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service_date=date(2026, 6, 1),
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),
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],
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)
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remit = _remittance_835_row(cp, bid)
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s.add(remit)
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s.flush()
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_persist_835_remit(s, cp, remit.id)
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s.commit()
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return claim_id, bid
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def test_run_persists_line_reconciliation_rows():
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claim_id, bid = _setup_db()
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with SessionLocal()() as s:
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result = run(s, bid)
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s.commit()
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assert result.matched == 1
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lrs = list(
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s.execute(
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select(LineReconciliation).where(LineReconciliation.claim_id == claim_id)
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).scalars().all()
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)
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# Expect 3 rows: 99213 matched, 99214 unmatched_837_only, 90837 unmatched_835_only
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assert len(lrs) == 3
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by_status = {lr.status for lr in lrs}
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assert by_status == {"matched", "unmatched_837_only", "unmatched_835_only"}
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