Nora
0625c83a45
The 999 handler's rejection pass was looking up claims by patient control number, but Gainwell rejects at the SET level (ST envelope) when the whole batch fails the NM109=CO_TXIX rule. That meant a SET rejection was treated as a no-op even though every claim in the SET was actually rejected by the payer. Add a batch_envelope_index param (mirrors apply_999_acceptances from SP28) so SET-level rejections cascade to every claim in the SET. Falls back to the legacy PCN lookup when the index has no entry. Also tightens test_payer.py: PayerConfig.co_medicaid() now returns payer_id='CO_TXIX' and payer_name='CO_TXIX' per HCPF 837P Companion Guide (June 2025 - Version 2.5).
121 lines
4.2 KiB
Python
121 lines
4.2 KiB
Python
"""SP33: apply_999_rejections must use batch_envelope_index (mirrors
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SP28's apply_999_acceptances fix) so SET-level 999 rejections cascade
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to claim state transitions.
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The pre-SP33 bug: ``claim_lookup(sr.set_control_number)`` passed the
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SET control_number to a PCN-based lookup, so no claim was ever matched
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and rejections silently died. SP33 threads the same
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``batch_envelope_index`` that ``apply_999_acceptances`` already has.
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"""
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from __future__ import annotations
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from types import SimpleNamespace
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from unittest.mock import MagicMock
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from cyclone.db import ClaimState
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from cyclone.inbox_state import apply_999_rejections
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def _mk_set_response(code: str = "R", scn: str = "991102994"):
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"""Build a stand-in for ``ParseResult999.set_responses[0]``."""
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return SimpleNamespace(
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set_accept_reject=SimpleNamespace(code=code),
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set_control_number=scn,
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segment_errors=[],
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)
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def _mk_claim(cid: str = "claim-x", state=ClaimState.SUBMITTED):
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c = MagicMock()
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c.id = cid
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c.state = state
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return c
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def test_set_level_rejection_cascades_via_envelope_index():
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"""When the SET-level 999 has set_control_number=991102994 and the
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batch_envelope_index maps it to a list of 3 claim_ids, all 3 should
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transition to REJECTED.
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"""
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session = MagicMock()
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claims = [_mk_claim(f"c-{i}") for i in range(3)]
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session.query.return_value.filter.return_value.all.return_value = claims
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parsed = SimpleNamespace(set_responses=[_mk_set_response(code="R", scn="991102994")])
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index = {"991102994": [c.id for c in claims]}
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result = apply_999_rejections(
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session, parsed,
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claim_lookup=lambda _pcn: None,
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batch_envelope_index=index,
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)
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assert sorted(result.matched) == sorted(c.id for c in claims)
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assert result.orphans == []
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session.commit.assert_called_once()
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for c in claims:
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# ClaimState.REJECTED is the lowercase 'rejected' string (the enum
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# value stored in the DB column via SQLAlchemy Enum type).
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assert c.state == ClaimState.REJECTED
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def test_set_level_rejection_without_index_still_uses_legacy_lookup():
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"""Backwards compat: when batch_envelope_index is None, the function
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must fall back to claim_lookup (existing behavior preserved).
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"""
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session = MagicMock()
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parsed = SimpleNamespace(set_responses=[_mk_set_response(code="R", scn="991102994")])
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legacy_claim = _mk_claim("legacy-claim")
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result = apply_999_rejections(
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session, parsed,
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claim_lookup=lambda scn: legacy_claim if scn == "991102994" else None,
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)
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assert result.matched == ["legacy-claim"]
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def test_no_envelope_index_no_match_becomes_orphan():
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"""Empty index + empty legacy lookup => the SET becomes an orphan."""
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session = MagicMock()
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parsed = SimpleNamespace(set_responses=[_mk_set_response(code="R", scn="991102999")])
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result = apply_999_rejections(
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session, parsed,
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claim_lookup=lambda _pcn: None,
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batch_envelope_index={}, # empty index
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)
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assert result.matched == []
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assert "991102999" in result.orphans
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def test_accepted_999_does_not_reject():
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"""An 'A' code must not transition any claim to REJECTED."""
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session = MagicMock()
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parsed = SimpleNamespace(set_responses=[_mk_set_response(code="A", scn="991102994")])
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result = apply_999_rejections(
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session, parsed,
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claim_lookup=lambda _pcn: None,
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batch_envelope_index={"991102994": ["claim-x"]},
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)
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assert result.matched == []
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session.query.assert_not_called()
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session.commit.assert_not_called()
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def test_already_rejected_is_idempotent():
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"""Pre-REJECTED claims in the index are left alone (no second commit)."""
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session = MagicMock()
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already = _mk_claim("already-rejected", state=ClaimState.REJECTED)
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session.query.return_value.filter.return_value.all.return_value = [already]
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parsed = SimpleNamespace(set_responses=[_mk_set_response(code="R", scn="991102994")])
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result = apply_999_rejections(
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session, parsed,
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claim_lookup=lambda _pcn: None,
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batch_envelope_index={"991102994": ["already-rejected"]},
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)
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assert result.matched == []
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assert already.state == ClaimState.REJECTED # untouched
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