Tyler
2c0afbe9c5
- Add cyclone.parsers.models_277ca + parse_277ca (X12 005010X214)
- Per-Patient HL ClaimStatus with REF*1K (PCN), REF*EJ (tax ID),
STC category code, amount, service date
- STC classifier: A1-A3 accepted, A4/A6/A7 rejected, A8/A9 pended,
P1-P5 paid, anything else unknown
- Multiple STCs per Patient HL: last wins (canonical pattern for
'first pended, then paid' acknowledgments)
- Subscriber-level STCs surface in unscoped_statuses
- Add apply_277ca_rejections — stamps Claim.payer_rejected_* fields on
matching rows (lookup by patient_control_number, mirrors 999 path)
- New /api/parse-277ca, /api/277ca-acks, /api/277ca-acks/{id} endpoints
- New two77ca_acks table + Two77caAck ORM model
- New Claim columns: payer_rejected_at, _reason, _status_code, _by_277ca_id
- New payer_rejected lane in /api/inbox/lanes (distinct from 999
envelope rejected lane)
- New PayerConfig277CA block in config/payers.yaml + Pydantic model
- Migration 0008 bumps user_version to 8
Tests: 654 -> 688 (parser 22 + apply 6 + API 8 + config 6 + adjustments).
All 688 backend tests pass; 1 pre-existing skipped test class unaffected.
62 lines
2.6 KiB
YAML
62 lines
2.6 KiB
YAML
# Cyclone payer configuration
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# SP9 — loaded at boot by cyclone.payers.load_payer_configs()
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# Schema-validated against Pydantic models in cyclone.providers
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# See spec: docs/superpowers/specs/2026-06-20-cyclone-multi-payer-npi-sftp-design.md
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payers:
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# Colorado Medical Assistance Program (FFS) — the user's primary payer
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- payer_id: CO_TXIX
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name: "Colorado Medical Assistance Program"
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receiver_name: "COLORADO MEDICAL ASSISTANCE PROGRAM"
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receiver_id: "COMEDASSISTPROG"
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configs:
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"837P":
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submitter_name: "Dzinesco"
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submitter_contact_name: "Tyler Martinez"
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submitter_contact_email: "tyler@dzinesco.com"
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receiver_name: "COLORADO MEDICAL ASSISTANCE PROGRAM"
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receiver_id_qualifier: "46"
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receiver_id: "COMEDASSISTPROG"
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bht06_allowed: ["CH", "RP"]
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bht06_default: "CH"
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sbr09_default: "MC"
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sbr09_allowed: ["MC", "16", "MA", "MB", "ZZ"]
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payer_id_qualifier: "PI"
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# Per spec: NM1*PR NM109 = "CO_TXIX".
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# Production reality (June 2026): SKCO0 is still being sent in
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# the prod 837P files. SP9 emits CO_TXIX per the CO MAP companion
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# guide. If Gainwell rejects CO_TXIX, set this to "SKCO0".
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payer_id: "CO_TXIX"
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pwk_supported: false
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cas_2320_group_allowed: false
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claim_type_codes:
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"11": "Office"
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"12": "Home"
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"99": "Other"
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"835":
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expected_payer_tax_ids:
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- "81-1725341"
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- "811725341"
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- "84-0644739"
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- "840644739"
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- "1811725341"
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expected_payer_health_plan_id: "7912900843"
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payer_name_pattern: "^CO_(TXIX|BHA)$"
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"277CA":
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# Per X12 005010X214. HCPF sends back 277CAs to acknowledge
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# claims we submit. The parser matches each STC row against our
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# 837 batch via REF*1K (cross-references CLM01 / patient_control_number).
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#
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# rejected_status_codes → claim ends up in the Inbox Payer-Rejected
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# lane. Per HCPF's published STC code set, A4/A6/A7 are rejection,
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# A8/A9 are pended, A1/A2/A3 are accepted, P1-P5 are paid.
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rejected_status_codes: ["A4", "A6", "A7"]
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pended_status_codes: ["A8", "A9"]
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accepted_status_codes: ["A1", "A2", "A3"]
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paid_status_codes: ["P1", "P2", "P3", "P4", "P5"]
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# ST*01 transaction set identifier — HCPF uses "277CA" but the
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# X12 005010X214 spec allows just "277". Both are accepted.
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transaction_set_ids_allowed: ["277", "277CA"]
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# Implementation guide version HCPF sends.
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implementation_guide: "005010X214"
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