Nora
363 lines
12 KiB
Python
363 lines
12 KiB
Python
"""SP41 — tests for the `cyclone rebill-from-835` CLI.
|
|
|
|
Three smoke tests:
|
|
1. --help renders cleanly and surfaces --window and --override-filing.
|
|
2. --status (with no other args) renders cleanly and exits 0 — the
|
|
option is recognized even when no prior summary.csv exists.
|
|
3. End-to-end run against a 2-row visits CSV (one in-window, one
|
|
ancient) and a zero-SVC 835 fixture produces a summary.csv with
|
|
the in-window visit classified as REBILLED_B.
|
|
|
|
Plus five disposition-coverage tests added during the Task 10 review:
|
|
4. EXCLUDED_CARC: CO-45 on a denied visit → not rebilled.
|
|
5. REBILLED_A: CO-97 on a denied visit → pipeline-a freq-7.
|
|
6. PAID visits are filtered out of the summary.
|
|
7. EXCLUDED_TIMELY_FILING vs REBILLED_B via --override-filing (two runs).
|
|
8. --status on a real summary.csv prints the per-disposition tally.
|
|
"""
|
|
from __future__ import annotations
|
|
|
|
import csv
|
|
from datetime import date as _date
|
|
from decimal import Decimal
|
|
from pathlib import Path
|
|
from unittest import mock
|
|
|
|
from click.testing import CliRunner
|
|
|
|
from cyclone.cli import main
|
|
from cyclone.rebill.parse_835_svc import SvcRow
|
|
from cyclone.rebill.reconcile import VisitRow
|
|
|
|
|
|
def _write_visits_csv(path: Path, rows: list[tuple[str, str, str, str]]) -> Path:
|
|
"""rows: list of (dos_mmddyyyy, member, procedure, billed_str)."""
|
|
with path.open("w", newline="") as f:
|
|
w = csv.writer(f)
|
|
w.writerow(["Visit Date", "Member ID", "Procedure Code", "Billable Amount"])
|
|
for r in rows:
|
|
w.writerow(r)
|
|
return path
|
|
|
|
|
|
def _read_summary(out_dir: Path) -> list[dict[str, str]]:
|
|
with (out_dir / "summary.csv").open(newline="") as f:
|
|
return list(csv.DictReader(f))
|
|
|
|
|
|
def _stub_svc(monkeypatch, svcs: list[SvcRow]) -> None:
|
|
"""Replace cli.parse_835_svc's underlying cyclonic call with a fixed list."""
|
|
# cli.rebill_from_835 imports parse_835_svc locally, so patch the
|
|
# source module's symbol — the local `from ... import parse_835_svc`
|
|
# binds the symbol at call time on each invocation.
|
|
monkeypatch.setattr(
|
|
"cyclone.rebill.parse_835_svc.parse_835_svc",
|
|
lambda path, _svcs=svcs: iter(_svcs),
|
|
)
|
|
|
|
|
|
def _make_835_placeholder(ingest_dir: Path, name: str = "x.835") -> Path:
|
|
"""A real *.835 file present in the glob; parse_835_svc is mocked so content doesn't matter."""
|
|
ingest_dir.mkdir(exist_ok=True)
|
|
p = ingest_dir / name
|
|
p.write_text("ST*835*0001~SE*0*0001~")
|
|
return p
|
|
|
|
|
|
def test_rebill_from_835_help():
|
|
runner = CliRunner()
|
|
result = runner.invoke(main, ["rebill-from-835", "--help"])
|
|
assert result.exit_code == 0, result.output
|
|
assert "--window" in result.output
|
|
assert "--override-filing" in result.output
|
|
|
|
|
|
def test_rebill_from_835_status_help():
|
|
"""Either bare --status or --status --help should exit 0.
|
|
|
|
The spec note: the help-test ensures the option is recognized, so
|
|
even a "no prior runs" 0-exit path is acceptable. We try both
|
|
invocations because click short-circuits --help ahead of any
|
|
required-option check; the bare --status path is the one that
|
|
proves --status works without --visits / --ingest.
|
|
"""
|
|
runner = CliRunner()
|
|
result_help = runner.invoke(main, ["rebill-from-835", "--status", "--help"])
|
|
assert result_help.exit_code == 0, result_help.output
|
|
|
|
result_bare = runner.invoke(main, ["rebill-from-835", "--status"])
|
|
assert result_bare.exit_code == 0, result_bare.output
|
|
|
|
|
|
def test_rebill_from_835_runs(tmp_path: Path):
|
|
"""End-to-end: 1 in-window visit + 1 ancient visit + zero-SVC 835 → REBILLED_B for the in-window row."""
|
|
visits_path = tmp_path / "visits.csv"
|
|
visits_path.write_text(
|
|
"Visit Date,Member ID,Procedure Code,Billable Amount\n"
|
|
"06/27/2026,J813715,T1019,$2.32\n"
|
|
"01/01/2020,ANCIENT,T1019,$2.32\n"
|
|
)
|
|
|
|
ingest_dir = tmp_path / "ingest"
|
|
ingest_dir.mkdir()
|
|
(ingest_dir / "x.835").write_text("ST*835*0001~SE*0*0001~")
|
|
|
|
out_dir = tmp_path / "out"
|
|
|
|
runner = CliRunner()
|
|
result = runner.invoke(main, [
|
|
"rebill-from-835",
|
|
"--visits", str(visits_path),
|
|
"--ingest", str(ingest_dir),
|
|
"--out", str(out_dir),
|
|
"--as-of", "2026-07-07",
|
|
])
|
|
assert result.exit_code == 0, (
|
|
f"CLI exited {result.exit_code}, output={result.output!r}, "
|
|
f"exception={result.exception!r}"
|
|
)
|
|
|
|
summary_path = out_dir / "summary.csv"
|
|
assert summary_path.exists(), summary_path
|
|
|
|
rows = _read_summary(out_dir)
|
|
# Two visits in, two summary rows out (one REBILLED_B, one
|
|
# EXCLUDED_TIMELY_FILING). PAID outcomes would be dropped, but
|
|
# neither of these is PAID — the 835 has no SVCs.
|
|
assert len(rows) == 2, rows
|
|
|
|
by_member = {r["member_id"]: r for r in rows}
|
|
in_window = by_member["J813715"]
|
|
assert in_window["disposition"] == "REBILLED_B", in_window
|
|
assert in_window["dos"] == "2026-06-27", in_window
|
|
|
|
ancient = by_member["ANCIENT"]
|
|
assert ancient["disposition"] == "EXCLUDED_TIMELY_FILING", ancient
|
|
assert ancient["dos"] == "2020-01-01", ancient
|
|
|
|
|
|
# ---------------------------------------------------------------------------
|
|
# Disposition coverage (Task 10 review)
|
|
# ---------------------------------------------------------------------------
|
|
|
|
def test_rebill_carc_excluded_visit_landed_as_excluded_carc(tmp_path: Path, monkeypatch):
|
|
"""A denied visit whose CAS list contains CO-45 (excluded) must land as EXCLUDED_CARC, not REBILLED_A."""
|
|
visits = _write_visits_csv(tmp_path / "visits.csv", [
|
|
("06/27/2026", "J813715", "T1019", "$16.24"),
|
|
])
|
|
ingest = tmp_path / "ingest"
|
|
_make_835_placeholder(ingest)
|
|
out_dir = tmp_path / "out"
|
|
|
|
# A denied SVC for the visit (paid == 0) with CO-45 in CAS.
|
|
svc = SvcRow(
|
|
src_file="x.835",
|
|
claim_id="T1",
|
|
member_id="J813715",
|
|
status="4", # denied
|
|
procedure="T1019",
|
|
modifiers="",
|
|
charge=Decimal("16.24"),
|
|
paid=Decimal("0"),
|
|
units=Decimal("1"),
|
|
svc_date=_date(2026, 6, 27),
|
|
cas_reasons=("CO-45",),
|
|
pay_date=None,
|
|
)
|
|
_stub_svc(monkeypatch, [svc])
|
|
|
|
runner = CliRunner()
|
|
result = runner.invoke(main, [
|
|
"rebill-from-835",
|
|
"--visits", str(visits),
|
|
"--ingest", str(ingest),
|
|
"--out", str(out_dir),
|
|
"--as-of", "2026-07-07",
|
|
])
|
|
assert result.exit_code == 0, (result.output, result.exception)
|
|
rows = _read_summary(out_dir)
|
|
assert len(rows) == 1, rows
|
|
assert rows[0]["disposition"] == "EXCLUDED_CARC"
|
|
assert rows[0]["member_id"] == "J813715"
|
|
assert "CO-45" in rows[0]["cas_reasons"]
|
|
|
|
|
|
def test_rebill_denied_rebill_visit_landed_as_rebilled_a(tmp_path: Path, monkeypatch):
|
|
"""A denied visit whose CAS list contains CO-97 (rebillable) must land as REBILLED_A."""
|
|
visits = _write_visits_csv(tmp_path / "visits.csv", [
|
|
("06/27/2026", "J813715", "T1019", "$16.24"),
|
|
])
|
|
ingest = tmp_path / "ingest"
|
|
_make_835_placeholder(ingest)
|
|
out_dir = tmp_path / "out"
|
|
|
|
svc = SvcRow(
|
|
src_file="x.835",
|
|
claim_id="T1",
|
|
member_id="J813715",
|
|
status="4", # denied
|
|
procedure="T1019",
|
|
modifiers="",
|
|
charge=Decimal("16.24"),
|
|
paid=Decimal("0"),
|
|
units=Decimal("1"),
|
|
svc_date=_date(2026, 6, 27),
|
|
cas_reasons=("CO-97",), # rebillable (not in EXCLUDED_CARCS or REVIEW_CARCS)
|
|
pay_date=None,
|
|
)
|
|
_stub_svc(monkeypatch, [svc])
|
|
|
|
runner = CliRunner()
|
|
result = runner.invoke(main, [
|
|
"rebill-from-835",
|
|
"--visits", str(visits),
|
|
"--ingest", str(ingest),
|
|
"--out", str(out_dir),
|
|
"--as-of", "2026-07-07",
|
|
])
|
|
assert result.exit_code == 0, (result.output, result.exception)
|
|
rows = _read_summary(out_dir)
|
|
assert len(rows) == 1, rows
|
|
assert rows[0]["disposition"] == "REBILLED_A"
|
|
assert rows[0]["file_path"] == "pipeline-a/"
|
|
assert "CO-97" in rows[0]["cas_reasons"]
|
|
|
|
|
|
def test_rebill_paid_visit_excluded_from_summary(tmp_path: Path, monkeypatch):
|
|
"""PAID visits (paid >= 95% of billed) must not appear in summary.csv — only NOT_IN_835 should."""
|
|
visits = _write_visits_csv(tmp_path / "visits.csv", [
|
|
("06/27/2026", "PAID-MEMBER", "T1019", "$100.00"),
|
|
("06/27/2026", "MISSING-MEMBER", "T1019", "$2.32"),
|
|
])
|
|
ingest = tmp_path / "ingest"
|
|
_make_835_placeholder(ingest)
|
|
out_dir = tmp_path / "out"
|
|
|
|
# One fully-paid SVC for PAID-MEMBER; nothing matches MISSING-MEMBER.
|
|
paid_svc = SvcRow(
|
|
src_file="x.835",
|
|
claim_id="T1",
|
|
member_id="PAID-MEMBER",
|
|
status="1",
|
|
procedure="T1019",
|
|
modifiers="",
|
|
charge=Decimal("100.00"),
|
|
paid=Decimal("100.00"),
|
|
units=Decimal("1"),
|
|
svc_date=_date(2026, 6, 27),
|
|
cas_reasons=(),
|
|
pay_date=None,
|
|
)
|
|
_stub_svc(monkeypatch, [paid_svc])
|
|
|
|
runner = CliRunner()
|
|
result = runner.invoke(main, [
|
|
"rebill-from-835",
|
|
"--visits", str(visits),
|
|
"--ingest", str(ingest),
|
|
"--out", str(out_dir),
|
|
"--as-of", "2026-07-07",
|
|
])
|
|
assert result.exit_code == 0, (result.output, result.exception)
|
|
rows = _read_summary(out_dir)
|
|
assert len(rows) == 1, rows
|
|
assert rows[0]["member_id"] == "MISSING-MEMBER"
|
|
assert rows[0]["disposition"] == "REBILLED_B"
|
|
|
|
|
|
def test_rebill_override_filing_makes_ancient_visit_rebilled_b(tmp_path: Path, monkeypatch):
|
|
"""A 2020 visit without --override-filing → EXCLUDED_TIMELY_FILING; with it → REBILLED_B."""
|
|
# No SVCs at all — both visits fall into NOT_IN_835.
|
|
visits = _write_visits_csv(tmp_path / "visits.csv", [
|
|
("01/01/2020", "ANCIENT", "T1019", "$2.32"),
|
|
])
|
|
ingest = tmp_path / "ingest"
|
|
_make_835_placeholder(ingest)
|
|
out_dir = tmp_path / "out"
|
|
|
|
# Stub the (local) parse_835_svc import with an empty generator so
|
|
# the CLI sees no SVCs and every visit is NOT_IN_835.
|
|
monkeypatch.setattr(
|
|
"cyclone.rebill.parse_835_svc.parse_835_svc",
|
|
lambda path: iter([]),
|
|
)
|
|
|
|
runner = CliRunner()
|
|
|
|
# Run 1: as-of 2026-07-07 minus 2020-01-01 = ~6.5 years > 120 days → EXCLUDED.
|
|
r1 = runner.invoke(main, [
|
|
"rebill-from-835",
|
|
"--visits", str(visits),
|
|
"--ingest", str(ingest),
|
|
"--out", str(out_dir),
|
|
"--as-of", "2026-07-07",
|
|
])
|
|
assert r1.exit_code == 0, (r1.output, r1.exception)
|
|
rows1 = _read_summary(out_dir)
|
|
assert len(rows1) == 1, rows1
|
|
assert rows1[0]["disposition"] == "EXCLUDED_TIMELY_FILING", rows1
|
|
|
|
# Run 2: --override-filing bypasses the 120-day gate → REBILLED_B.
|
|
r2 = runner.invoke(main, [
|
|
"rebill-from-835",
|
|
"--visits", str(visits),
|
|
"--ingest", str(ingest),
|
|
"--out", str(out_dir),
|
|
"--as-of", "2026-07-07",
|
|
"--override-filing",
|
|
])
|
|
assert r2.exit_code == 0, (r2.output, r2.exception)
|
|
rows2 = _read_summary(out_dir)
|
|
assert len(rows2) == 1, rows2
|
|
assert rows2[0]["disposition"] == "REBILLED_B", rows2
|
|
assert rows2[0]["file_path"] == "pipeline-b/"
|
|
|
|
|
|
def test_rebill_status_with_real_summary_prints_tally(tmp_path: Path):
|
|
"""--status against a real summary.csv must print both REBILLED_B and EXCLUDED_TIMELY_FILING rows."""
|
|
from cyclone.rebill.reconcile import VisitRow
|
|
from cyclone.rebill.summary import (
|
|
EXCLUDED_TIMELY_FILING,
|
|
REBILLED_B,
|
|
SummaryRow,
|
|
write_summary_csv,
|
|
)
|
|
|
|
out_dir = tmp_path / "dev" / "rebills" / "2026-07-07"
|
|
out_dir.mkdir(parents=True, exist_ok=True)
|
|
summary_path = out_dir / "summary.csv"
|
|
|
|
rows = [
|
|
SummaryRow(
|
|
visit=VisitRow(
|
|
date=_date(2026, 6, 27), member_id="MEM-A",
|
|
procedure="T1019", billed=Decimal("2.32"),
|
|
),
|
|
disposition=REBILLED_B,
|
|
unpaid=Decimal("2.32"),
|
|
cas_reasons=(),
|
|
file_path="pipeline-b/",
|
|
),
|
|
SummaryRow(
|
|
visit=VisitRow(
|
|
date=_date(2026, 6, 27), member_id="MEM-B",
|
|
procedure="T1019", billed=Decimal("2.32"),
|
|
),
|
|
disposition=EXCLUDED_TIMELY_FILING,
|
|
unpaid=Decimal("2.32"),
|
|
cas_reasons=(),
|
|
file_path="",
|
|
),
|
|
]
|
|
write_summary_csv(rows, summary_path)
|
|
|
|
runner = CliRunner()
|
|
result = runner.invoke(main, [
|
|
"rebill-from-835",
|
|
"--status",
|
|
"--out", str(out_dir),
|
|
])
|
|
assert result.exit_code == 0, (result.output, result.exception)
|
|
assert "REBILLED_B" in result.output
|
|
assert "EXCLUDED_TIMELY_FILING" in result.output
|
|
assert "TOTAL" in result.output |