Tyler
126 lines
4.2 KiB
Python
126 lines
4.2 KiB
Python
"""SP7 — pure-function tests for match_service_lines().
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Spec §4.
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"""
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from dataclasses import dataclass
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from datetime import date
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from decimal import Decimal
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from cyclone.reconcile import (
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LineMatch,
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match_service_lines,
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)
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@dataclass
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class FakeLine:
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line_number: int
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procedure_code: str
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modifiers: list
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service_date: date | None
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units: Decimal | None
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payment: Decimal = Decimal("0") # 835 only
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@dataclass
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class FakeClaimLine(FakeLine):
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charge: Decimal = Decimal("0") # 837 only
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def _claim(*lines: FakeClaimLine) -> list:
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return list(lines)
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def _remit(*lines: FakeLine) -> list:
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return list(lines)
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def test_exact_match_on_all_four_criteria():
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claim_lines = _claim(FakeClaimLine(1, "99213", [], date(2026, 6, 1), Decimal("1")))
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remit_lines = _remit(FakeLine(1, "99213", [], date(2026, 6, 1), Decimal("1"), payment=Decimal("80")))
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matches = match_service_lines(claim_lines, remit_lines)
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assert len(matches) == 1
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assert matches[0].claim_line.line_number == 1
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assert matches[0].service_payment.line_number == 1
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assert matches[0].status == "matched"
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def test_procedure_code_mismatch_both_unmatched():
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claim_lines = _claim(FakeClaimLine(1, "99213", [], None, None))
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remit_lines = _remit(FakeLine(1, "99214", [], None, None))
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matches = match_service_lines(claim_lines, remit_lines)
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assert len(matches) == 2
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statuses = sorted(m.status for m in matches)
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assert statuses == ["unmatched_835_only", "unmatched_837_only"]
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def test_modifiers_set_equal_regardless_of_order():
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claim_lines = _claim(FakeClaimLine(1, "99213", ["25", "59"], None, None))
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remit_lines = _remit(FakeLine(1, "99213", ["59", "25"], None, None))
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matches = match_service_lines(claim_lines, remit_lines)
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assert len(matches) == 1
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assert matches[0].status == "matched"
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def test_service_date_mismatch():
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claim_lines = _claim(FakeClaimLine(1, "99213", [], date(2026, 6, 1), None))
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remit_lines = _remit(FakeLine(1, "99213", [], date(2026, 6, 2), None))
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matches = match_service_lines(claim_lines, remit_lines)
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assert len(matches) == 2
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statuses = sorted(m.status for m in matches)
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assert statuses == ["unmatched_835_only", "unmatched_837_only"]
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def test_units_mismatch():
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claim_lines = _claim(FakeClaimLine(1, "99213", [], None, Decimal("1")))
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remit_lines = _remit(FakeLine(1, "99213", [], None, Decimal("2")))
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matches = match_service_lines(claim_lines, remit_lines)
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assert len(matches) == 2
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statuses = sorted(m.status for m in matches)
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assert statuses == ["unmatched_835_only", "unmatched_837_only"]
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def test_procedure_code_case_normalized():
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claim_lines = _claim(FakeClaimLine(1, "99213", [], None, None))
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remit_lines = _remit(FakeLine(1, "99213", [], None, None)) # case irrelevant when both upper
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matches = match_service_lines(claim_lines, remit_lines)
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assert matches[0].status == "matched"
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def test_claim_has_more_lines_than_remit():
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claim_lines = _claim(
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FakeClaimLine(1, "99213", [], None, None),
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FakeClaimLine(2, "99214", [], None, None),
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)
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remit_lines = _remit(FakeLine(1, "99213", [], None, None))
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matches = match_service_lines(claim_lines, remit_lines)
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statuses = sorted(m.status for m in matches)
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assert statuses == ["matched", "unmatched_837_only"]
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def test_remit_has_more_lines_than_claim():
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claim_lines = _claim(FakeClaimLine(1, "99213", [], None, None))
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remit_lines = _remit(
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FakeLine(1, "99213", [], None, None),
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FakeLine(2, "99214", [], None, None),
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)
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matches = match_service_lines(claim_lines, remit_lines)
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statuses = sorted(m.status for m in matches)
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assert statuses == ["matched", "unmatched_835_only"]
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def test_empty_837_lines_no_reconciliation_rows():
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matches = match_service_lines([], _remit(FakeLine(1, "99213", [], None, None)))
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assert len(matches) == 1
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assert matches[0].status == "unmatched_835_only"
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def test_empty_835_lines_no_reconciliation_rows():
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matches = match_service_lines(_claim(FakeClaimLine(1, "99213", [], None, None)), [])
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assert len(matches) == 1
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assert matches[0].status == "unmatched_837_only"
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def test_both_empty():
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assert match_service_lines([], []) == []
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