488 lines
16 KiB
Python
488 lines
16 KiB
Python
"""Tests for the in-memory batch store."""
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from __future__ import annotations
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from datetime import datetime, timezone
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from decimal import Decimal
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from cyclone.parsers.models import (
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BatchSummary,
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BillingProvider,
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ClaimHeader,
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ClaimOutput,
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Envelope,
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Payer,
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ParseResult,
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Subscriber,
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ValidationIssue,
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ValidationReport,
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)
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from cyclone.parsers.models_835 import (
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ClaimAdjustment,
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ClaimPayment,
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FinancialInfo,
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ParseResult835,
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Payer835,
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Payee835,
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ReassociationTrace,
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ServicePayment,
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)
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from cyclone.parsers.payer import PayerConfig835
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from cyclone.store import BatchRecord, InMemoryStore, store
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# ---------------------------------------------------------------------------
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# Stubs (match real model field names)
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# ---------------------------------------------------------------------------
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_PARSED_AT = datetime(2026, 6, 19, 12, 0, 0, tzinfo=timezone.utc)
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def _make_claim(claim_id: str = "CLM-1", *, frequency_code: str = "1") -> ClaimOutput:
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"""Minimal ClaimOutput stub. Real parser not needed here."""
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return ClaimOutput(
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claim_id=claim_id,
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control_number="0001",
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transaction_date="2026-06-19",
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billing_provider=BillingProvider(
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name="Test",
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npi="1234567890",
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tax_id=None,
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address=None,
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),
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subscriber=Subscriber(
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first_name="Jane",
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last_name="Doe",
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member_id="M1",
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dob=None,
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gender=None,
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address=None,
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),
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payer=Payer(name="Test Payer", id="P1"),
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claim=ClaimHeader(
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claim_id=claim_id,
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total_charge=Decimal("0.00"),
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place_of_service="11",
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facility_code_qualifier=None,
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frequency_code=frequency_code,
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provider_signature=None,
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assignment=None,
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release_of_info=None,
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prior_auth=None,
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),
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diagnoses=[],
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service_lines=[],
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validation=ValidationReport(passed=True, errors=[], warnings=[]),
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raw_segments=[],
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)
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def _make_result() -> ParseResult:
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return ParseResult(
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envelope=Envelope(
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sender_id="SENDER",
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receiver_id="RECEIVER",
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control_number="0001",
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transaction_date="2026-06-19",
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transaction_time=None,
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implementation_guide=None,
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),
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claims=[_make_claim("CLM-1")],
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summary=BatchSummary(
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input_file="test.txt",
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control_number="0001",
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transaction_date="2026-06-19",
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total_claims=1,
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passed=1,
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failed=0,
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failed_claim_ids=[],
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issues_by_rule={},
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output_dir=None,
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),
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)
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def _make_remit(
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*,
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status_code: str = "1",
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service_payments: list[ServicePayment] | None = None,
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) -> ClaimPayment:
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return ClaimPayment(
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payer_claim_control_number="PCN-1",
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status_code=status_code,
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status_label=None,
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total_charge=Decimal("100.00"),
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total_paid=Decimal("80.00"),
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patient_responsibility=Decimal("0.00"),
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claim_filing_indicator="MC",
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original_claim_id=None,
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frequency_code=None,
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facility_type=None,
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service_payments=service_payments or [],
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)
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def _make_835_result(claims: list[ClaimPayment] | None = None) -> ParseResult835:
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return ParseResult835(
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envelope=Envelope(
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sender_id="SENDER",
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receiver_id="RECEIVER",
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control_number="0001",
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transaction_date="2026-06-19",
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transaction_time=None,
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implementation_guide=None,
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),
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financial_info=FinancialInfo(
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handling_code="C",
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paid_amount=Decimal("80.00"),
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credit_debit_flag="C",
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payment_method=None,
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payer_tax_id=None,
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payment_date=None,
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),
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trace=ReassociationTrace(
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trace_type_code="1",
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trace_number="TRN1",
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originating_company_id="OC1",
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payer_id=None,
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),
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payer=Payer835(name="CO_TXIX", id="7912900843", address=None, contact_url=None),
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payee=Payee835(name="Acme Clinic", npi="1234567890", address=None),
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claims=claims or [],
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summary=BatchSummary(
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input_file="test.txt",
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control_number="0001",
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transaction_date="2026-06-19",
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total_claims=1,
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passed=1,
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failed=0,
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failed_claim_ids=[],
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issues_by_rule={},
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output_dir=None,
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),
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)
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# ---------------------------------------------------------------------------
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# Task 1: BatchRecord + InMemoryStore
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# ---------------------------------------------------------------------------
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def test_module_singleton_store_exists():
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"""The module-level `store` should be importable and be an InMemoryStore."""
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assert isinstance(store, InMemoryStore)
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def test_in_memory_store_starts_empty():
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s = InMemoryStore()
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assert s.list() == []
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def test_add_and_get_round_trip():
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s = InMemoryStore()
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result = _make_result()
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rec = BatchRecord(
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id="abc123",
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kind="837p",
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input_filename="test.txt",
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parsed_at=_PARSED_AT,
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result=result,
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)
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s.add(rec)
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assert s.get("abc123") is rec
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assert s.list() == [rec]
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def test_get_missing_returns_none():
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s = InMemoryStore()
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assert s.get("does-not-exist") is None
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def test_batch_record_parsed_at_accepts_datetime():
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"""Spec 6.1: parsed_at is a tz-aware datetime, not a string."""
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rec = BatchRecord(
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id="x",
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kind="837p",
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input_filename="a.txt",
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parsed_at=_PARSED_AT,
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result=_make_result(),
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)
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assert isinstance(rec.parsed_at, datetime)
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assert rec.parsed_at.tzinfo is not None
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# ---------------------------------------------------------------------------
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# Task 2: Mappers
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# ---------------------------------------------------------------------------
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def test_to_ui_claim_maps_status_submitted():
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from cyclone.store import to_ui_claim
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claim = _make_claim("CLM-1") # passed=True, frequency_code="1"
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out = to_ui_claim(claim, batch_id="b1", parsed_at=_PARSED_AT)
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assert out["id"] == "CLM-1"
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assert out["status"] == "submitted"
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assert out["providerNpi"] == "1234567890"
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assert out["batchId"] == "b1"
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assert out["parsedAt"] == "2026-06-19T12:00:00Z"
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def test_to_ui_claim_maps_status_pending_when_warnings_no_freq_one():
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"""passed + warnings + non-1 frequency_code → pending (rule 2)."""
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from cyclone.store import to_ui_claim
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claim = _make_claim("CLM-2", frequency_code="7")
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claim.validation = ValidationReport(
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passed=True, errors=[],
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warnings=[ValidationIssue(rule="W001", severity="warning", message="soft")],
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)
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out = to_ui_claim(claim, batch_id="b1", parsed_at=_PARSED_AT)
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assert out["status"] == "pending"
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def test_to_ui_claim_submitted_takes_precedence_over_pending():
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"""passed + frequency_code=1 + warnings → submitted (rule 1 beats rule 2)."""
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from cyclone.store import to_ui_claim
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claim = _make_claim("CLM-3", frequency_code="1")
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claim.validation = ValidationReport(
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passed=True, errors=[],
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warnings=[ValidationIssue(rule="W001", severity="warning", message="soft")],
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)
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out = to_ui_claim(claim, batch_id="b1", parsed_at=_PARSED_AT)
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assert out["status"] == "submitted"
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def test_to_ui_claim_maps_status_denied_when_failed():
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from cyclone.store import to_ui_claim
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claim = _make_claim("CLM-4")
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claim.validation = ValidationReport(
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passed=False,
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errors=[ValidationIssue(rule="E001", severity="error", message="hard")],
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warnings=[],
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)
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out = to_ui_claim(claim, batch_id="b1", parsed_at=_PARSED_AT)
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assert out["status"] == "denied"
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def test_to_ui_claim_maps_status_draft_when_r050_diagnosis_present():
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"""!passed with an R050_diagnosis_present error → draft (carve-out)."""
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from cyclone.store import to_ui_claim
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claim = _make_claim("CLM-5")
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claim.validation = ValidationReport(
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passed=False,
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errors=[ValidationIssue(
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rule="R050_diagnosis_present", severity="error",
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message="missing principal diagnosis",
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)],
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warnings=[],
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)
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out = to_ui_claim(claim, batch_id="b1", parsed_at=_PARSED_AT)
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assert out["status"] == "draft"
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def test_to_ui_claim_maps_status_draft_when_passed_no_freq_no_warnings():
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"""passed + non-1 frequency + no warnings → draft."""
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from cyclone.store import to_ui_claim
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claim = _make_claim("CLM-6", frequency_code="7")
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out = to_ui_claim(claim, batch_id="b1", parsed_at=_PARSED_AT)
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assert out["status"] == "draft"
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def test_to_ui_remittance_maps_status_received_for_paid():
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from cyclone.store import to_ui_remittance
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cp = _make_remit(status_code="1")
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out = to_ui_remittance(cp, batch_id="b1", parsed_at=_PARSED_AT)
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assert out["status"] == "received"
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assert out["denialReason"] is None
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assert out["validationWarnings"] == []
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def test_to_ui_remittance_denial_reason_from_cas_for_code_4():
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"""CLP02 == 4 → received with denialReason populated from first CAS."""
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from cyclone.store import to_ui_remittance
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sp = ServicePayment(
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line_number=1,
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procedure_qualifier="HC",
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procedure_code="99213",
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modifiers=[],
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charge=Decimal("100.00"),
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payment=Decimal("0.00"),
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units=None,
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unit_type=None,
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service_date=None,
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adjustments=[
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ClaimAdjustment(
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group_code="CO", reason_code="97",
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amount=Decimal("100.00"), quantity=None,
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),
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],
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)
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cp = _make_remit(status_code="4", service_payments=[sp])
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out = to_ui_remittance(cp, batch_id="b1", parsed_at=_PARSED_AT)
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assert out["status"] == "received"
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assert out["denialReason"] == "CO-97: $100.00"
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def test_to_ui_remittance_denial_reason_none_when_no_cas_for_code_4():
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"""CLP02 == 4 with no CAS segments → denialReason stays None."""
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from cyclone.store import to_ui_remittance
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cp = _make_remit(status_code="4", service_payments=[])
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out = to_ui_remittance(cp, batch_id="b1", parsed_at=_PARSED_AT)
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assert out["status"] == "received"
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assert out["denialReason"] is None
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def test_to_ui_remittance_validation_warning_for_invalid_clp02():
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"""CLP02 outside the allowlist → received + validationWarnings populated."""
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from cyclone.store import to_ui_remittance
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cp = _make_remit(status_code="99") # not in {"1","2","3","4","19","20","21","22","23","25"}
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out = to_ui_remittance(
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cp, batch_id="b1", parsed_at=_PARSED_AT,
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payer_config=PayerConfig835.generic_835(),
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)
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assert out["status"] == "received"
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assert any("99" in w and "allowlist" in w for w in out["validationWarnings"])
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def test_to_ui_remittance_no_warning_for_allowed_clp02():
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"""CLP02 in the allowlist → empty validationWarnings."""
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from cyclone.store import to_ui_remittance
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cp = _make_remit(status_code="1")
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out = to_ui_remittance(
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cp, batch_id="b1", parsed_at=_PARSED_AT,
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payer_config=PayerConfig835.generic_835(),
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)
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assert out["validationWarnings"] == []
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def test_to_ui_remittance_fills_payer_name():
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"""payer_name kwarg flows into the remittance's payerName field."""
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from cyclone.store import to_ui_remittance
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cp = _make_remit(status_code="1")
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out = to_ui_remittance(
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cp, batch_id="b1", parsed_at=_PARSED_AT, payer_name="CO_TXIX",
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)
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assert out["payerName"] == "CO_TXIX"
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def test_to_ui_provider_aggregates_claims():
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from cyclone.store import to_ui_provider
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out = to_ui_provider(
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npi="1234567890", name="Acme Clinic", tax_id="99-9999999",
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address="1 Main", city="Denver", state="CO", zip="80202", phone="303-555-0100",
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claim_count=5, outstanding_ar=250.0,
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)
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assert out["npi"] == "1234567890"
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assert out["claimCount"] == 5
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def test_to_activity_event_serializes_datetime_to_iso_z():
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from cyclone.store import to_activity_event
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out = to_activity_event(
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id="a1", kind="claim_submitted",
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message="Claim CLM-1 submitted",
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timestamp=_PARSED_AT,
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npi="1234567890", amount=100.0,
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)
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assert out["id"] == "a1"
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assert out["kind"] == "claim_submitted"
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assert out["amount"] == 100.0
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assert out["timestamp"] == "2026-06-19T12:00:00Z"
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# ---------------------------------------------------------------------------
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# Task 3: Iterators
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# ---------------------------------------------------------------------------
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def test_iter_claims_filters_by_status():
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s = InMemoryStore()
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result = _make_result()
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a = _make_claim("A", frequency_code="1") # passed + freq=1 → submitted
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b = _make_claim("B", frequency_code="7")
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b.validation = ValidationReport(
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passed=True, errors=[],
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warnings=[ValidationIssue(rule="W1", severity="warning", message="x")],
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) # passed + freq=7 + warnings → pending
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result.claims = [a, b]
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s.add(BatchRecord(
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id="1", kind="837p", input_filename="a.txt",
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parsed_at=_PARSED_AT, result=result,
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))
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out = list(s.iter_claims(status="submitted"))
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assert all(c["status"] == "submitted" for c in out)
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assert any(c["id"] == "A" for c in out)
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out_pending = list(s.iter_claims(status="pending"))
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assert all(c["status"] == "pending" for c in out_pending)
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assert any(c["id"] == "B" for c in out_pending)
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def test_iter_claims_filters_by_batch_id():
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s = InMemoryStore()
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s.add(BatchRecord(
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id="b1", kind="837p", input_filename="a.txt",
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parsed_at=_PARSED_AT, result=_make_result(),
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))
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out = list(s.iter_claims(batch_id="b1"))
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assert all(c["batchId"] == "b1" for c in out)
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def test_iter_claims_sorts_by_billed_amount_desc():
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s = InMemoryStore()
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result = _make_result()
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result.claims = [
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_make_claim("cheap"),
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_make_claim("expensive"),
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]
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result.claims[0].claim.total_charge = Decimal("50.00")
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result.claims[1].claim.total_charge = Decimal("500.00")
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s.add(BatchRecord(
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id="b1", kind="837p", input_filename="a.txt",
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parsed_at=_PARSED_AT, result=result,
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))
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out = list(s.iter_claims(sort="billedAmount", order="desc"))
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assert out[0]["id"] == "expensive"
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assert out[1]["id"] == "cheap"
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def test_distinct_providers_aggregates_claims():
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s = InMemoryStore()
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result = _make_result()
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result.claims = [_make_claim("A"), _make_claim("B")]
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s.add(BatchRecord(
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id="b1", kind="837p", input_filename="a.txt",
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parsed_at=_PARSED_AT, result=result,
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))
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out = s.distinct_providers()
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assert len(out) == 1
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assert out[0]["npi"] == "1234567890"
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assert out[0]["claimCount"] == 2
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def test_recent_activity_returns_newest_first():
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older = datetime(2026, 6, 19, 11, 0, 0, tzinfo=timezone.utc)
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s = InMemoryStore()
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s.add(BatchRecord(
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id="b1", kind="837p", input_filename="a.txt",
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parsed_at=older, result=_make_result(),
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))
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s.add(BatchRecord(
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id="b2", kind="837p", input_filename="b.txt",
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parsed_at=_PARSED_AT, result=_make_result(),
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))
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out = s.recent_activity(limit=10)
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assert out[0]["timestamp"] == "2026-06-19T12:00:00Z"
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assert out[1]["timestamp"] == "2026-06-19T11:00:00Z"
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def test_iter_remittances_fills_payer_name_from_batch():
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"""iter_remittances should populate payerName from ParseResult835.payer.name."""
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s = InMemoryStore()
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cp = _make_remit(status_code="1")
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s.add(BatchRecord(
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id="835-1", kind="835", input_filename="a.txt",
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parsed_at=_PARSED_AT, result=_make_835_result(claims=[cp]),
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))
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out = list(s.iter_remittances())
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assert len(out) == 1
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assert out[0]["payerName"] == "CO_TXIX"
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