Nora
213 lines
7.9 KiB
Python
213 lines
7.9 KiB
Python
"""Tests for the 835 ERA parser orchestrator."""
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from datetime import date
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from pathlib import Path
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import pytest
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from cyclone.parsers.exceptions import CycloneParseError
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from cyclone.parsers.parse_835 import parse
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from cyclone.parsers.payer import PayerConfig835
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FIXTURE = Path(__file__).parent / "fixtures" / "minimal_835.txt"
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def test_parse_minimal_fixture_returns_one_claim():
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text = FIXTURE.read_text()
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result = parse(text, PayerConfig835.co_medicaid_835())
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assert len(result.claims) == 1
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c = result.claims[0]
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assert c.payer_claim_control_number == "CLM001"
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assert c.status_code == "1"
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assert c.status_label == "Processed as Primary"
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assert c.total_charge == 100.00
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assert c.total_paid == 85.00
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assert c.patient_responsibility == 15.00
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assert c.claim_filing_indicator == "MC"
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assert c.facility_type == "12"
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assert c.frequency_code == "1"
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def test_parse_envelope_captured():
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result = parse(FIXTURE.read_text(), PayerConfig835.co_medicaid_835())
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assert result.envelope is not None
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assert result.envelope.control_number == "991102984"
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assert result.envelope.transaction_date == date(2026, 6, 17)
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assert result.envelope.sender_id == "COMEDASSISTPROG"
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assert result.envelope.implementation_guide == "005010X221A1"
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def test_parse_financial_info():
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result = parse(FIXTURE.read_text(), PayerConfig835.co_medicaid_835())
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f = result.financial_info
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assert f.handling_code == "C"
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assert f.paid_amount == 85.00
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assert f.credit_debit_flag == "C"
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assert f.payment_method == "ACH"
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assert f.payer_tax_id == "81-1725341"
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assert f.payment_date == date(2026, 6, 17)
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def test_parse_trace():
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result = parse(FIXTURE.read_text(), PayerConfig835.co_medicaid_835())
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t = result.trace
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assert t.trace_type_code == "1"
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# X12 standard: TRN02 = Reference Identification (trace number),
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# TRN03 = Originating Company Identifier. The CO guide labels
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# TRN03 as the Payer Tax ID, so for CO Medicaid 835s the
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# originating_company_id is "81-1725341" and the trace number is
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# the provider's TPID.
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assert t.trace_number == "TPID001"
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assert t.originating_company_id == "81-1725341"
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assert t.payer_id is None # TRN04 is not present in this fixture
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def test_parse_payer_and_payee():
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result = parse(FIXTURE.read_text(), PayerConfig835.co_medicaid_835())
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p = result.payer
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assert p.name == "CO_TXIX"
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assert p.id == "7912900843"
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assert p.contact_url == "hcpf.colorado.gov"
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assert p.address is not None
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assert p.address.city == "DENVER"
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pe = result.payee
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assert pe.name == "TOC, Inc."
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assert pe.npi == "1881068062"
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assert pe.address is not None
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assert pe.address.zip == "814014063"
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def test_parse_claim_has_two_service_lines():
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result = parse(FIXTURE.read_text(), PayerConfig835.co_medicaid_835())
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c = result.claims[0]
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assert len(c.service_payments) == 2
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s1, s2 = c.service_payments
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assert s1.line_number == 1
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assert s1.procedure_code == "S5130"
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assert s1.procedure_qualifier == "HC"
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assert s1.modifiers == ["U2"]
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assert s1.payment == 50.00
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assert s1.service_date == date(2026, 6, 2)
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assert s2.line_number == 2
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assert s2.payment == 35.00
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assert s2.service_date == date(2026, 6, 3)
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def test_parse_summary_counts():
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result = parse(FIXTURE.read_text(), PayerConfig835.co_medicaid_835())
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assert result.summary.total_claims == 1
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assert result.summary.input_file == ""
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# The orchestrator sets passed/failed from the validation report.
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# Without running validation it remains 0 — the CLI / API does that.
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assert result.summary.passed == 0
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def test_parse_preserves_raw_segments():
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result = parse(FIXTURE.read_text(), PayerConfig835.co_medicaid_835())
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c = result.claims[0]
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assert any(s[0] == "CLP" for s in c.raw_segments)
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assert any(s[0] == "SVC" for s in c.raw_segments)
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def test_parse_uses_generic_config():
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"""Generic config shouldn't suppress parser errors but accepts any payer."""
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result = parse(FIXTURE.read_text(), PayerConfig835.generic_835())
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assert len(result.claims) == 1
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def test_parse_no_bpr_raises():
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text = (
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"ISA*00* *00* *ZZ*COMEDASSISTPROG*ZZ*TPID001 *260617*1937*^*00501*991102990*1*P*:~"
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"ST*835*991102990*005010X221A1~"
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"SE*1*991102990~"
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"GE*1*991102990~"
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"IEA*1*991102990~"
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)
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with pytest.raises(CycloneParseError, match="No BPR"):
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parse(text, PayerConfig835.co_medicaid_835())
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def test_parse_service_payment_units_and_unit_type():
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"""X12 005010X221A1: SVC04 = unit-of-measure, SVC05 = service unit count.
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Bug history: the parser previously read SVC04 as ``units`` and SVC05
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as ``unit_type`` (with the comment stating the opposite of the spec).
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On real-world 835s — and the canonical minimal fixture — this left
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``units=None`` because SVC04 carries the string "UN" (which fails
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``Decimal`` parsing) and SVC05 (a count like "7.73") got assigned to
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``unit_type``.
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This test pins down the correct mapping so SP7's line-level matcher
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can compare units on the SVC side against the claim side.
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"""
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from decimal import Decimal
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result = parse(FIXTURE.read_text(), PayerConfig835.co_medicaid_835())
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c = result.claims[0]
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s1, s2 = c.service_payments
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# minimal_835.txt fixture: SVC*HC:S5130:U2*60.00*50.00*UN*7.73*date*
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assert s1.units == Decimal("7.73"), s1.units
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assert s1.unit_type == "UN"
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assert s2.units == Decimal("7.73"), s2.units
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assert s2.unit_type == "UN"
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def test_parse_service_payment_units_default_unit_type_to_un():
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"""If SVC04 is empty but SVC05 carries a count, default unit_type to UN.
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Some payers omit the unit-of-measure code when the units are obvious
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(e.g. always "UN"). The parser should still parse the units and
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surface a reasonable default for ``unit_type`` so downstream
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consumers (validation, SP7 line matcher) have a non-None value.
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"""
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from decimal import Decimal
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base = FIXTURE.read_text()
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text = (
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base
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.replace(
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"SVC*HC:S5130:U2*60.00*50.00*UN*7.73*20260602~",
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"SVC*HC:S5130:U2*60.00*50.00**3*20260602~",
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)
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.replace(
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"SVC*HC:S5130:U2*40.00*35.00*UN*7.73*20260603~",
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"SVC*HC:S5130:U2*40.00*35.00**4*20260603~",
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)
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)
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result = parse(text, PayerConfig835.co_medicaid_835())
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s1, s2 = result.claims[0].service_payments
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assert s1.units == Decimal("3"), s1.units
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assert s2.units == Decimal("4"), s2.units
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# Default to UN when SVC04 missing but units present.
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assert s1.unit_type == "UN", s1.unit_type
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assert s2.unit_type == "UN", s2.unit_type
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def test_parse_835_extracts_service_provider_npi_from_nm1_1p():
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"""SP32: NM1*1P in Loop 2100 populates ClaimPayment.service_provider_npi."""
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from cyclone.parsers.parse_835 import parse as parse_835
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text = (
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"ISA*00* *00* *ZZ*RECEIVERID *ZZ*SENDERID *250101*1200*^*00501*000000001*0*P*:~"
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"GS*HP*RECEIVER*SENDER*20250101*1200*1*X*005010X221A1~"
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"ST*835*0001~"
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"BPR*I*85.40*C*NON*****01*021000021*DA*123456*1511111**01*031302955*DA*9876543~"
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"TRN*1*1511111*1511111~"
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"DTM*405*20250101~"
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"N1*PR*COLORADO MEDICAID*XV*CO MEDICAID~"
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"N3*PO BOX 1100*~"
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"N4*DENVER*CO*80203~"
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"REF*2U*12345~"
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"PER*BL*SUPPORT*TE*8005551212~"
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"N1*PE*ACME CLINIC*XX*1111111111~"
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"LX*1~"
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"CLP*CLM001*1*85.40*85.40*0.00*MC*CLM001*11*1~"
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"CAS*PR*1*0.00~"
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"NM1*1P*2*RENDERING PROVIDER*****XX*2222222222~"
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"SVC*HC:99213*85.40*85.40**1~"
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"DTM*472*20250101~"
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"SE*18*0001~"
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"GE*1*1~"
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"IEA*1*000000001~"
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)
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result = parse_835(text, payer_config=None) # type: ignore[arg-type]
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assert len(result.claims) == 1
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assert result.claims[0].service_provider_npi == "2222222222"
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