Tyler
203 lines
7.4 KiB
Python
203 lines
7.4 KiB
Python
"""Tests for the pure reconciliation functions.
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These tests use lightweight stand-in objects (namedtuples) rather than
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SQLAlchemy ORM instances, so the reconcile module has zero DB dependency.
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"""
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from __future__ import annotations
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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 typing import Optional
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import pytest
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from cyclone import reconcile
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from cyclone.db import ClaimState
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from cyclone.reconcile import Match
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# --- Stand-in types -----------------------------------------------------------
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@dataclass
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class FakeClaim:
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id: str
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patient_control_number: str
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service_date_from: Optional[date]
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state: str = "submitted"
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matched_remittance_id: Optional[str] = None
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@dataclass
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class FakeRemit:
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id: str
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payer_claim_control_number: str
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service_date: Optional[date]
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is_reversal: bool = False
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# --- match() ------------------------------------------------------------------
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def test_match_same_pcn_within_window_matches():
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claims = [FakeClaim("CLM-1", "PCN-A", date(2026, 6, 1))]
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remits = [FakeRemit("CLP-1", "PCN-A", date(2026, 6, 2))]
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matches = reconcile.match(claims, remits, window_days=7)
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assert len(matches) == 1
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assert matches[0].claim.id == "CLM-1"
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assert matches[0].remittance.id == "CLP-1"
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assert matches[0].strategy == "auto"
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def test_match_dates_outside_window_unmatched():
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claims = [FakeClaim("CLM-1", "PCN-A", date(2026, 6, 1))]
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remits = [FakeRemit("CLP-1", "PCN-A", date(2026, 7, 1))] # 30d apart
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matches = reconcile.match(claims, remits, window_days=7)
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assert matches == []
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def test_match_different_pcn_unmatched():
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claims = [FakeClaim("CLM-1", "PCN-A", date(2026, 6, 1))]
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remits = [FakeRemit("CLP-1", "PCN-B", date(2026, 6, 1))]
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matches = reconcile.match(claims, remits)
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assert matches == []
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def test_match_multiple_claims_same_pcn_picks_closest_date():
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claims = [
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FakeClaim("CLM-1", "PCN-A", date(2026, 5, 1)),
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FakeClaim("CLM-2", "PCN-A", date(2026, 6, 1)), # closer
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]
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remits = [FakeRemit("CLP-1", "PCN-A", date(2026, 6, 2))]
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matches = reconcile.match(claims, remits)
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assert len(matches) == 1
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assert matches[0].claim.id == "CLM-2"
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def test_match_multiple_remits_same_pcn_each_gets_own_claim():
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claims = [
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FakeClaim("CLM-1", "PCN-A", date(2026, 6, 1)),
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FakeClaim("CLM-2", "PCN-A", date(2026, 6, 15)),
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]
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remits = [
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FakeRemit("CLP-1", "PCN-A", date(2026, 6, 2)),
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FakeRemit("CLP-2", "PCN-A", date(2026, 6, 16)),
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]
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matches = reconcile.match(claims, remits)
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assert len(matches) == 2
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claim_ids = {m.claim.id for m in matches}
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assert claim_ids == {"CLM-1", "CLM-2"}
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def test_match_skips_already_matched_claims():
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claims = [FakeClaim("CLM-1", "PCN-A", date(2026, 6, 1), matched_remittance_id="OLD")]
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remits = [FakeRemit("CLP-1", "PCN-A", date(2026, 6, 1))]
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matches = reconcile.match(claims, remits)
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assert matches == []
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def test_match_falls_back_to_first_claim_when_no_service_date():
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"""When the remit has no service_date, match the first claim for that PCN."""
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claims = [
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FakeClaim("CLM-1", "PCN-A", None),
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FakeClaim("CLM-2", "PCN-A", None),
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]
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remits = [FakeRemit("CLP-1", "PCN-A", None)]
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matches = reconcile.match(claims, remits)
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assert len(matches) == 1
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assert matches[0].claim.id == "CLM-1"
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def test_match_reversal_flag_propagates():
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claims = [FakeClaim("CLM-1", "PCN-A", date(2026, 6, 1))]
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remits = [FakeRemit("CLP-1", "PCN-A", date(2026, 6, 1), is_reversal=True)]
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matches = reconcile.match(claims, remits)
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assert matches[0].is_reversal is True
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# ApplyIntent + apply_payment / apply_reversal / split_unmatched ----------------
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def test_apply_payment_full_amount_returns_paid():
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claim = FakeClaim("CLM-1", "PCN-A", None, state=ClaimState.SUBMITTED.value)
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remit = FakeRemit("CLP-1", "PCN-A", None)
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intent = reconcile.apply_payment(claim, remit, charge=Decimal("100"), paid=Decimal("100"))
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assert intent.new_state == ClaimState.PAID
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assert intent.activity_kind == "reconcile"
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assert intent.skipped is False
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def test_apply_payment_partial_amount_returns_partial():
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claim = FakeClaim("CLM-1", "PCN-A", None, state=ClaimState.SUBMITTED.value)
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remit = FakeRemit("CLP-1", "PCN-A", None)
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intent = reconcile.apply_payment(claim, remit, charge=Decimal("100"), paid=Decimal("60"))
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assert intent.new_state == ClaimState.PARTIAL
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def test_apply_payment_zero_paid_returns_received():
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claim = FakeClaim("CLM-1", "PCN-A", None, state=ClaimState.SUBMITTED.value)
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remit = FakeRemit("CLP-1", "PCN-A", None)
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intent = reconcile.apply_payment(claim, remit, charge=Decimal("100"), paid=Decimal("0"))
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assert intent.new_state == ClaimState.RECEIVED
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def test_apply_payment_status_4_returns_denied():
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claim = FakeClaim("CLM-1", "PCN-A", None, state=ClaimState.SUBMITTED.value)
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remit = FakeRemit("CLP-1", "PCN-A", None)
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intent = reconcile.apply_payment(claim, remit, charge=Decimal("100"), paid=Decimal("0"),
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status_code="4")
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assert intent.new_state == ClaimState.DENIED
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def test_apply_payment_already_paid_is_noop():
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claim = FakeClaim("CLM-1", "PCN-A", None, state=ClaimState.PAID.value)
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remit = FakeRemit("CLP-1", "PCN-A", None)
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intent = reconcile.apply_payment(claim, remit, charge=Decimal("100"), paid=Decimal("100"))
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assert intent.skipped is True
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assert intent.activity_kind == "invalid_state"
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assert intent.new_state is None
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def test_apply_reversal_of_paid_returns_reversed_with_prior_state():
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claim = FakeClaim("CLM-1", "PCN-A", None, state=ClaimState.PAID.value)
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remit = FakeRemit("CLP-1", "PCN-A", None, is_reversal=True)
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intent = reconcile.apply_reversal(claim, remit)
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assert intent.new_state == ClaimState.REVERSED
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assert intent.prior_claim_state == ClaimState.PAID
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assert intent.activity_kind == "reversal"
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assert intent.skipped is False
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def test_apply_reversal_of_partial_works_same_way():
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claim = FakeClaim("CLM-1", "PCN-A", None, state=ClaimState.PARTIAL.value)
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remit = FakeRemit("CLP-1", "PCN-A", None, is_reversal=True)
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intent = reconcile.apply_reversal(claim, remit)
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assert intent.new_state == ClaimState.REVERSED
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assert intent.prior_claim_state == ClaimState.PARTIAL
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def test_apply_reversal_of_denied_is_noop():
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claim = FakeClaim("CLM-1", "PCN-A", None, state=ClaimState.DENIED.value)
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remit = FakeRemit("CLP-1", "PCN-A", None, is_reversal=True)
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intent = reconcile.apply_reversal(claim, remit)
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assert intent.skipped is True
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assert intent.activity_kind == "reversal_skipped"
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def test_apply_reversal_of_already_reversed_is_noop():
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claim = FakeClaim("CLM-1", "PCN-A", None, state=ClaimState.REVERSED.value)
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remit = FakeRemit("CLP-1", "PCN-A", None, is_reversal=True)
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intent = reconcile.apply_reversal(claim, remit)
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assert intent.skipped is True
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def test_split_unmatched_partitions_by_match_set():
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claims = [FakeClaim("CLM-1", "A", None), FakeClaim("CLM-2", "B", None)]
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remits = [FakeRemit("CLP-1", "A", None), FakeRemit("CLP-2", "C", None)]
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matches = [Match(claim=claims[0], remittance=remits[0], strategy="auto", is_reversal=False)]
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unmatched_claims, unmatched_remits = reconcile.split_unmatched(claims, remits, matches)
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assert [c.id for c in unmatched_claims] == ["CLM-2"]
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assert [r.id for r in unmatched_remits] == ["CLP-2"]
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