claim-validator 0.3.0__tar.gz

claim_validator-0.3.0/.env.example

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+# claim-validator configuration
+# All settings use CLAIM_VALIDATOR_ prefix
+
+# AI Provider Configuration (optional — rule-based works without these)
+# CLAIM_VALIDATOR_AI_PROVIDER=anthropic
+# CLAIM_VALIDATOR_AI_API_KEY=sk-ant-...
+# CLAIM_VALIDATOR_AI_MODEL=claude-sonnet-4-5-20241022
+
+# Pipeline Configuration
+# CLAIM_VALIDATOR_SKIP_AI_ON_RULE_FAILURE=true
+
+# Clearinghouse Configuration (optional — pick ONE provider)
+# --- Waystar ---
+# CLEARINGHOUSE_PROVIDER=waystar
+# CLEARINGHOUSE_API_KEY=your-waystar-api-key          # HMAC key from Settings > Key/Pass
+# CLEARINGHOUSE_SECRET=your-waystar-hmac-secret        # HMAC secret (defaults to API key)
+# CLEARINGHOUSE_USER_ID=your-waystar-user-id           # UserID for eligibility/PA endpoints
+# CLEARINGHOUSE_PASSWORD=your-waystar-password         # Password for eligibility/PA endpoints
+# CLEARINGHOUSE_CUST_ID=your-waystar-customer-id       # Waystar Customer ID (integer)
+# CLEARINGHOUSE_BASE_URL=https://claimsapi.zirmed.com  # Claims History service
+# CLEARINGHOUSE_ELIGIBILITY_BASE_URL=https://eligibilityapi.zirmed.com
+# CLEARINGHOUSE_PRIOR_AUTH_BASE_URL=https://priorauthorizationapi.waystar.com
+#
+# --- Stedi (Bearer token) ---
+# CLEARINGHOUSE_PROVIDER=stedi
+# CLEARINGHOUSE_API_KEY=your-stedi-api-key
+# CLEARINGHOUSE_BASE_URL=https://healthcare.us.stedi.com
+#
+# --- Claim.MD (AccountKey) ---
+# CLEARINGHOUSE_PROVIDER=claimmd
+# CLEARINGHOUSE_API_KEY=your-claimmd-account-key
+# CLEARINGHOUSE_BASE_URL=https://svc.claim.md

claim_validator-0.3.0/.gitignore

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+# Python
+__pycache__/
+*.py[cod]
+*$py.class
+*.so
+
+# Distribution / packaging
+build/
+dist/
+wheels/
+*.egg-info/
+*.egg
+
+# Virtual environments
+.venv/
+venv/
+
+# uv
+uv.lock
+
+# IDE
+.idea/
+.vscode/
+*.swp
+*.swo
+*~
+
+# Testing
+.pytest_cache/
+htmlcov/
+.coverage
+.coverage.*
+coverage.xml
+
+# mypy
+.mypy_cache/
+
+# ruff
+.ruff_cache/
+
+# Environment
+.env
+.env.local
+
+# OS
+.DS_Store
+Thumbs.db

claim_validator-0.3.0/.pre-commit-config.yaml

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+repos:
+  - repo: https://github.com/astral-sh/ruff-pre-commit
+    rev: v0.15.1
+    hooks:
+      - id: ruff
+        args: [--fix]
+      - id: ruff-format

claim_validator-0.3.0/.python-version

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+3.12

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claim_validator-0.3.0/.remember/tmp/save-session.pid

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claim_validator-0.3.0/CHANGELOG.md

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+# Changelog
+
+All notable changes to this project will be documented in this file.
+
+The format is based on [Keep a Changelog](https://keepachangelog.com/).
+
+## [0.2.0] — 2026-04-01
+
+### Added
+
+- **Institutional validators**: PlaceOfServiceValidator, TaxonomyValidator, ModifierCompatibilityValidator, ConditionCodeValidator, ValueCodeValidator
+- **Institutional API**: `validate_institutional()` for UB-04 / 837I claim validation
+- **Async / batch API**: `validate_async()`, `validate_batch()`, `validate_batch_async()` with concurrency control and stop-on-first-error
+- **Expanded code tables**: ICD-10-CM (2,554 codes), expanded HCPCS/CPT, Taxonomy (624 codes)
+- **Timely filing**: expanded payer table from 11 to 58 US payers covering major insurers, regional plans, and marketplace carriers
+- **AI confidence scores**: `confidence` field exposed in `Finding.context` for CoverageCheckAI and PriorAuthAI outputs
+
+### Improved
+
+- **AI validator prompts**: CodeValidationAI now checks mutually exclusive diagnoses, sequencing errors, and placeholder/unspecified codes; CoverageCheckAI checks frequency limitations and site-of-service concerns; PriorAuthAI checks step therapy requirements and quantity/duration limits
+
+## [Unreleased]
+
+### Added
+
+- Project scaffolding with src layout, hatchling build backend, and hatch-vcs versioning
+- Package skeleton with all subpackage stubs
+- Development tooling: ruff, mypy, pytest configuration

claim_validator-0.3.0/LICENSE

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+MIT License
+
+Copyright (c) 2026 aniket
+
+Permission is hereby granted, free of charge, to any person obtaining a copy
+of this software and associated documentation files (the "Software"), to deal
+in the Software without restriction, including without limitation the rights
+to use, copy, modify, merge, publish, distribute, sublicense, and/or sell
+copies of the Software, and to permit persons to whom the Software is
+furnished to do so, subject to the following conditions:
+
+The above copyright notice and this permission notice shall be included in all
+copies or substantial portions of the Software.
+
+THE SOFTWARE IS PROVIDED "AS IS", WITHOUT WARRANTY OF ANY KIND, EXPRESS OR
+IMPLIED, INCLUDING BUT NOT LIMITED TO THE WARRANTIES OF MERCHANTABILITY,
+FITNESS FOR A PARTICULAR PURPOSE AND NONINFRINGEMENT. IN NO EVENT SHALL THE
+AUTHORS OR COPYRIGHT HOLDERS BE LIABLE FOR ANY CLAIM, DAMAGES OR OTHER
+LIABILITY, WHETHER IN AN ACTION OF CONTRACT, TORT OR OTHERWISE, ARISING FROM,
+OUT OF OR IN CONNECTION WITH THE SOFTWARE OR THE USE OR OTHER DEALINGS IN THE
+SOFTWARE.

claim_validator-0.3.0/PKG-INFO

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+Metadata-Version: 2.4
+Name: claim-validator
+Version: 0.3.0
+Summary: Open-source healthcare claim validation library with rule-based and AI-powered checks
+Project-URL: Homepage, https://github.com/aniketsdev/claim-validator
+Project-URL: Repository, https://github.com/aniketsdev/claim-validator
+Project-URL: Documentation, https://github.com/aniketsdev/claim-validator#readme
+Project-URL: Issues, https://github.com/aniketsdev/claim-validator/issues
+Author-email: Aniket Sinare <aniketsinare.dev@gmail.com>
+License-Expression: MIT
+License-File: LICENSE
+Classifier: Development Status :: 4 - Beta
+Classifier: Intended Audience :: Developers
+Classifier: License :: OSI Approved :: MIT License
+Classifier: Programming Language :: Python :: 3.11
+Classifier: Programming Language :: Python :: 3.12
+Classifier: Programming Language :: Python :: 3.13
+Classifier: Topic :: Software Development :: Libraries :: Python Modules
+Classifier: Typing :: Typed
+Requires-Python: >=3.11
+Requires-Dist: pydantic-settings<3.0,>=2.0
+Requires-Dist: pydantic<3.0,>=2.0
+Provides-Extra: ai
+Requires-Dist: anthropic>=0.40; extra == 'ai'
+Requires-Dist: httpx>=0.27; extra == 'ai'
+Requires-Dist: openai>=1.50; extra == 'ai'
+Provides-Extra: all
+Requires-Dist: anthropic>=0.40; extra == 'all'
+Requires-Dist: django>=4.2; extra == 'all'
+Requires-Dist: fastapi>=0.110; extra == 'all'
+Requires-Dist: httpx>=0.27; extra == 'all'
+Requires-Dist: langchain-anthropic<0.3,>=0.2; extra == 'all'
+Requires-Dist: langchain-community<0.4,>=0.3; extra == 'all'
+Requires-Dist: langchain-core<0.4,>=0.3; extra == 'all'
+Requires-Dist: langchain-groq<0.3,>=0.2; extra == 'all'
+Requires-Dist: langchain-openai<0.3,>=0.2; extra == 'all'
+Requires-Dist: openai>=1.50; extra == 'all'
+Requires-Dist: psycopg[binary]>=3.1; extra == 'all'
+Requires-Dist: redis>=5.0; extra == 'all'
+Requires-Dist: tenacity>=8.2; extra == 'all'
+Requires-Dist: uvicorn[standard]>=0.30; extra == 'all'
+Provides-Extra: all-clearinghouses
+Requires-Dist: httpx>=0.27; extra == 'all-clearinghouses'
+Requires-Dist: tenacity>=8.2; extra == 'all-clearinghouses'
+Provides-Extra: anthropic
+Requires-Dist: anthropic>=0.40; extra == 'anthropic'
+Requires-Dist: httpx>=0.27; extra == 'anthropic'
+Provides-Extra: availity
+Requires-Dist: httpx>=0.27; extra == 'availity'
+Provides-Extra: change
+Requires-Dist: httpx>=0.27; extra == 'change'
+Provides-Extra: claimmd
+Requires-Dist: httpx>=0.27; extra == 'claimmd'
+Provides-Extra: dev
+Requires-Dist: factory-boy>=3.3; extra == 'dev'
+Requires-Dist: mypy>=1.10; extra == 'dev'
+Requires-Dist: pytest-cov; extra == 'dev'
+Requires-Dist: pytest>=8.0; extra == 'dev'
+Requires-Dist: ruff>=0.5; extra == 'dev'
+Provides-Extra: django
+Requires-Dist: django>=4.2; extra == 'django'
+Provides-Extra: fastapi
+Requires-Dist: fastapi>=0.110; extra == 'fastapi'
+Provides-Extra: langchain
+Requires-Dist: langchain-anthropic<0.3,>=0.2; extra == 'langchain'
+Requires-Dist: langchain-community<0.4,>=0.3; extra == 'langchain'
+Requires-Dist: langchain-core<0.4,>=0.3; extra == 'langchain'
+Requires-Dist: langchain-groq<0.3,>=0.2; extra == 'langchain'
+Requires-Dist: langchain-openai<0.3,>=0.2; extra == 'langchain'
+Provides-Extra: memory-postgres
+Requires-Dist: psycopg[binary]>=3.1; extra == 'memory-postgres'
+Provides-Extra: memory-redis
+Requires-Dist: redis>=5.0; extra == 'memory-redis'
+Provides-Extra: openai
+Requires-Dist: httpx>=0.27; extra == 'openai'
+Requires-Dist: openai>=1.50; extra == 'openai'
+Provides-Extra: resilience
+Requires-Dist: tenacity>=8.2; extra == 'resilience'
+Provides-Extra: server
+Requires-Dist: fastapi>=0.110; extra == 'server'
+Requires-Dist: uvicorn[standard]>=0.30; extra == 'server'
+Provides-Extra: stedi
+Requires-Dist: httpx>=0.27; extra == 'stedi'
+Provides-Extra: waystar
+Requires-Dist: httpx>=0.27; extra == 'waystar'
+Description-Content-Type: text/markdown
+
+# claim-validator
+
+Open-source healthcare claim validation library for Python 3.11+.
+
+Rule-based and AI-powered validation for CMS-1500 / 837P claims.
+
+## Installation
+
+```bash
+pip install claim-validator
+```
+
+## Quick Start
+
+```python
+from claim_validator import validate
+
+result = validate({
+    "billing_provider_npi": "1234567893",
+    "diagnosis_codes": [{"code": "J06.9"}],
+    "lines": [{"procedure_code": "99213", "charge_amount": 150.00}],
+})
+print(result.passed, result.findings)
+```
+
+## License
+
+MIT