cyclone/backend/tests/test_validation_r200_r210.py

"""SP9 — R200-R210 validation rule tests.

These tests use the in-code PAYER_FACTORIES (which include the live
payer_config blocks loaded from YAML) so the rules have a non-empty
cfg_block to read. The live ``cyclone.payers`` registry is the source
of truth for CO_MAP; the rules fall back to the in-code PayerConfig
when the registry is empty.
"""

from __future__ import annotations

from datetime import date
from decimal import Decimal

import pytest

from cyclone import db as db_mod
from cyclone import payers as payer_loader
from cyclone.parsers.models import (
    Address,
    BillingProvider,
    ClaimHeader,
    ClaimOutput,
    Diagnosis,
    Payer,
    Procedure,
    ServiceLine,
    Subscriber,
    ValidationReport,
)
from cyclone.parsers.payer import PayerConfig
from cyclone.parsers.validator import validate
from cyclone.store import store


@pytest.fixture(autouse=True)
def _seed_db(tmp_path, monkeypatch):
    """Seed an in-memory DB with 3 providers + CO_TXIX payer, load YAML."""
    monkeypatch.setenv("CYCLONE_DB_URL", f"sqlite:///{tmp_path}/test.db")
    db_mod._reset_for_tests()
    db_mod.init_db()
    payer_loader.load_payer_configs()
    store.ensure_clearhouse_seeded()
    yield
    db_mod._reset_for_tests()
    payer_loader.reset()


def _co_txix_cfg() -> PayerConfig:
    """Build a PayerConfig matching the live CO_TXIX YAML block."""
    return PayerConfig(
        name="Colorado Medical Assistance Program",
        sbr09_claim_filing="MC",
        allowed_claim_frequencies={1, 7, 8},
        require_ref_g1_for_adjustments=False,
        allowed_bht06={"CH", "RP"},
        payer_id="CO_TXIX",
        payer_name="COHCPF",
        no_patient_loop=True,
        encounter_claim_in_same_batch=False,
    )


def _claim(*, npi="1881068062", sbr09=None, prv_code=None, payer_id="CO_TXIX",
           payer_name="COHCPF", ref_ei="721587149", transaction_type_code="CH",
           has_pwk=False) -> ClaimOutput:
    raw = []
    if sbr09 is not None:
        raw.append(["SBR", "P", "18", "", "", "", "", "", "", sbr09])
    if prv_code is not None:
        raw.append(["PRV", "BI", "PXC", f"PXC{prv_code}"])
    raw.append(["NM1", "85", "2", "TOC, Inc.", "", "", "", "", "XX", npi])
    if ref_ei is not None:
        raw.append(["REF", "EI", ref_ei])
    if has_pwk:
        raw.append(["PWK"])
    return ClaimOutput(
        claim_id="CLM1",
        control_number="0001",
        transaction_date=date(2026, 6, 20),
        billing_provider=BillingProvider(
            name="TOC, Inc.",
            npi=npi,
            tax_id=ref_ei,
            address=Address(line1="1100 East Main St", city="Montrose", state="CO", zip="81401"),
        ),
        subscriber=Subscriber(first_name="John", last_name="Doe", member_id="M1"),
        payer=Payer(name=payer_name, id=payer_id),
        claim=ClaimHeader(
            claim_id="CLM1",
            total_charge=Decimal("100.00"),
            frequency_code="1",
            place_of_service="11",
            facility_code_qualifier="B",
        ),
        transaction_type_code=transaction_type_code,
        diagnoses=[Diagnosis(code="R69")],
        service_lines=[
            ServiceLine(
                line_number=1,
                procedure=Procedure(qualifier="HC", code="99213"),
                charge=Decimal("100.00"),
                units=Decimal("1"),
            ),
        ],
        raw_segments=raw,
        validation=ValidationReport(passed=True, errors=[], warnings=[]),
    )


# ----- R200: BHT06 allowed ------------------------------------------------


def test_r200_passes_for_allowed_bht06():
    c = _claim(transaction_type_code="CH")
    report = validate(c, _co_txix_cfg())
    bad = [i for i in report.errors if i.rule.startswith("R200")]
    assert bad == []


def test_r200_fails_for_disallowed_bht06():
    c = _claim(transaction_type_code="XX")
    report = validate(c, _co_txix_cfg())
    bad = [i for i in report.errors if i.rule == "R200_bht06_allowed"]
    assert len(bad) == 1
    assert "not in" in bad[0].message


def test_r200_skips_when_no_bht06():
    c = _claim(transaction_type_code="")
    report = validate(c, _co_txix_cfg())
    assert not [i for i in report.errors if i.rule == "R200_bht06_allowed"]


# ----- R201: BHT06 no mixed batch ------------------------------------------


def test_r201_is_a_per_claim_noop():
    # Batch-level rule; per-claim the rule yields nothing
    c = _claim(transaction_type_code="CH")
    report = validate(c, _co_txix_cfg())
    assert not [i for i in report.errors if i.rule == "R201_bht06_no_mixed_batch"]


# ----- R202: SBR09 allowed ------------------------------------------------


def test_r202_passes_for_mc():
    c = _claim(sbr09="MC")
    report = validate(c, _co_txix_cfg())
    assert not [i for i in report.errors if i.rule == "R202_sbr09_allowed"]


def test_r202_fails_for_unknown():
    c = _claim(sbr09="AB")
    report = validate(c, _co_txix_cfg())
    bad = [i for i in report.errors if i.rule == "R202_sbr09_allowed"]
    assert len(bad) == 1


def test_r202_passes_for_zz_mco_encounter():
    c = _claim(sbr09="ZZ")
    report = validate(c, _co_txix_cfg())
    assert not [i for i in report.errors if i.rule == "R202_sbr09_allowed"]


# ----- R203: PRV matches provider ----------------------------------------


def test_r203_passes_when_prv_matches_provider_taxonomy():
    c = _claim(prv_code="251E00000X")
    report = validate(c, _co_txix_cfg())
    assert not [i for i in report.errors if i.rule == "R203_prv_matches_provider"]


def test_r203_fails_when_prv_mismatch():
    c = _claim(prv_code="999Z00000X")
    report = validate(c, _co_txix_cfg())
    bad = [i for i in report.errors if i.rule == "R203_prv_matches_provider"]
    assert len(bad) == 1


# ----- R204: NPI in providers table --------------------------------------


def test_r204_passes_for_known_npi():
    c = _claim(npi="1881068062")
    report = validate(c, _co_txix_cfg())
    assert not [i for i in report.errors if i.rule == "R204_npi_in_providers_table"]


def test_r204_fails_for_unknown_npi():
    c = _claim(npi="9999999999")
    report = validate(c, _co_txix_cfg())
    bad = [i for i in report.errors if i.rule == "R204_npi_in_providers_table"]
    assert len(bad) == 1


# ----- R205: REF*EI matches provider --------------------------------------


def test_r205_passes_when_ref_ei_matches():
    c = _claim(ref_ei="721587149")
    report = validate(c, _co_txix_cfg())
    assert not [i for i in report.errors if i.rule == "R205_ref_ei_matches_provider"]


def test_r205_fails_when_ref_ei_mismatch():
    c = _claim(ref_ei="000000000")
    report = validate(c, _co_txix_cfg())
    bad = [i for i in report.errors if i.rule == "R205_ref_ei_matches_provider"]
    assert len(bad) == 1


# ----- R206: Payer ID matches ---------------------------------------------


def test_r206_passes_for_co_txix():
    c = _claim(payer_id="CO_TXIX")
    report = validate(c, _co_txix_cfg())
    assert not [i for i in report.errors if i.rule == "R206_payer_id_matches"]


def test_r206_fails_for_wrong_payer_id():
    c = _claim(payer_id="ZZZZZZ")
    report = validate(c, _co_txix_cfg())
    bad = [i for i in report.errors if i.rule == "R206_payer_id_matches"]
    assert len(bad) == 1


# ----- R207: no PWK segment ----------------------------------------------


def test_r207_passes_when_no_pwk():
    c = _claim(has_pwk=False)
    report = validate(c, _co_txix_cfg())
    assert not [i for i in report.errors if i.rule == "R207_no_pwk_segment"]


def test_r207_fails_when_pwk_present():
    c = _claim(has_pwk=True)
    report = validate(c, _co_txix_cfg())
    bad = [i for i in report.errors if i.rule == "R207_no_pwk_segment"]
    assert len(bad) == 1


# ----- R208: 2320 CAS*PI* group ------------------------------------------


def test_r208_is_a_per_claim_noop():
    c = _claim()
    report = validate(c, _co_txix_cfg())
    assert not [i for i in report.errors if i.rule == "R208_cas_2320_group"]


# ----- R209, R210: filename rules (validate at submit / parse time) ----


def test_r209_r210_per_claim_noop():
    # These run at file-routing time, not per-claim validate
    c = _claim()
    report = validate(c, _co_txix_cfg())
    assert not [i for i in report.errors if i.rule in ("R209_outbound_filename", "R210_inbound_filename")]