medicafe 0.240716.2__py3-none-any.whl → 0.240809.0__py3-none-any.whl

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MediBot/MediBot.py CHANGED
@@ -262,10 +262,21 @@ if __name__ == "__main__":
262
262
  print("\nNOTE: The following patient(s) already EXIST in the system and \n will be excluded from processing:")
263
263
  # TODO ... not excluded anymore, because charges may need to be added.
264
264
  # So at this point in the processing, we should have already processed the surgery schedules and enriched the data with Charges.
265
+ # Find the corresponding rows in csv_data to get the surgery dates and store them along with patient info
266
+ patient_info = []
265
267
  for patient_id, patient_name in existing_patients:
266
- print("(ID: {0}) {1}".format(patient_id, patient_name))
268
+ surgery_date = next((row.get('Surgery Date', 'Unknown Date') for row in csv_data if row.get(reverse_mapping['Patient ID #2']) == patient_id), 'Unknown Date')
269
+ patient_info.append((surgery_date, patient_name, patient_id))
270
+
271
+ # Sort by surgery date first and then by patient name
272
+ patient_info.sort(key=lambda x: (x[0], x[1]))
273
+
274
+ # Print the sorted patient info
275
+ for index, (surgery_date, patient_name, patient_id) in enumerate(patient_info):
276
+ print("{0:03d}: {3:%m-%d} (ID: {2}) {1} ".format(index + 1, patient_name, patient_id, surgery_date))
277
+
267
278
  # Update csv_data to exclude existing patients
268
- # TODO This now has to be updated to handle patients that exist but need new charges added.
279
+ # TODO This now has to be updated to handle patients that exist but need new charges added.
269
280
  csv_data = [row for row in csv_data if row[reverse_mapping['Patient ID #2']] in patients_to_process]
270
281
  else:
271
282
  print("\nSelected patient(s) are NEW patients and will be processed.")
@@ -124,7 +124,8 @@ def sort_and_deduplicate(csv_data):
124
124
  if patient_id not in unique_patients or row['Surgery Date'] < unique_patients[patient_id]['Surgery Date']:
125
125
  unique_patients[patient_id] = row
126
126
  csv_data[:] = list(unique_patients.values())
127
- # TODO Sorting, now that we're going to have the Surgery Schedules available, should be ordered as the patients show up on the schedule.
127
+ # TODO Sorting, now that we're going to have the Surgery Schedules available, should (or shouldn't??
128
+ # maybe we should build in the option as liek a 'setting' in the config) be ordered as the patients show up on the schedule.
128
129
  # If we don't have that surgery schedule yet for some reason, we should default to the current ordering strategy.
129
130
  csv_data.sort(key=lambda x: (x['Surgery Date'], x.get('Patient Last', '').strip()))
130
131
 
@@ -161,7 +162,16 @@ def update_insurance_ids(csv_data, crosswalk):
161
162
  medisoft_ids = crosswalk['payer_id'][ins1_payer_id].get('medisoft_id', [])
162
163
  if medisoft_ids:
163
164
  medisoft_ids = [int(id) for id in medisoft_ids]
164
- # TODO Try to match OpenPM's Insurance Name to get a better match
165
+ # TODO Try to match OpenPM's Insurance Name to get a better match.
166
+ # Potential approach:
167
+ # 1. Retrieve the insurance name from the current row
168
+ # insurance_name = row.get('Primary Insurnace', '').strip()
169
+ # 2. Check if the insurance name exists in the subset of MAINS names associated with
170
+ # crosswalk medisoft ID values for the given payer ID.
171
+ # 3. If an approximate match is found above a certain confidence, use the corresponding medisoft_id.
172
+ # else: 4. If no match is found, default to the first medisoft_id
173
+ # row['Ins1 Insurance ID'] = medisoft_ids[0]
174
+
165
175
  row['Ins1 Insurance ID'] = medisoft_ids[0]
166
176
  # MediLink_ConfigLoader.log("Ins1 Insurance ID '{}' used for Payer ID {} in crosswalk.".format(row.get('Ins1 Insurance ID', ''), ins1_payer_id))
167
177
  else:
@@ -367,6 +377,8 @@ def load_insurance_data_from_mains(config):
367
377
  # Retrieve MAINS path and slicing information from the configuration
368
378
  # TODO (Low) For secondary insurance, this needs to be pulling from the correct MAINS (there are 2)
369
379
  # TODO (Low) Performance: There probably needs to be a dictionary proxy for MAINS that gets updated.
380
+ # Meh, this just has to be part of the new architecture plan where we make Medisoft a downstream
381
+ # recipient from the db.
370
382
  mains_path = config['MAINS_MED_PATH']
371
383
  mains_slices = crosswalk['mains_mapping']['slices']
372
384
 
MediLink/MediLink.py CHANGED
@@ -58,7 +58,7 @@ def enrich_with_insurance_type(detailed_patient_data, patient_insurance_type_map
58
58
  TODO: Implement a function to provide `patient_insurance_mapping` from a reliable source.
59
59
  """
60
60
  if patient_insurance_type_mapping is None:
61
- MediLink_ConfigLoader.log("No Patient:Insurance-Type mapping available.")
61
+ MediLink_ConfigLoader.log("No Patient:Insurance-Type mapping available.", level="WARNING")
62
62
  patient_insurance_type_mapping = {}
63
63
 
64
64
  for data in detailed_patient_data:
@@ -86,7 +86,7 @@ def extract_and_suggest_endpoint(file_path, config, crosswalk):
86
86
 
87
87
  # Load insurance data from MAINS to create a mapping from insurance names to their respective IDs
88
88
  insurance_to_id = load_insurance_data_from_mains(config)
89
- MediLink_ConfigLoader.log("Insurance data loaded from MAINS. {} insurance providers found.".format(len(insurance_to_id)))
89
+ MediLink_ConfigLoader.log("Insurance data loaded from MAINS. {} insurance providers found.".format(len(insurance_to_id)), level="INFO")
90
90
 
91
91
  for personal_info, insurance_info, service_info, service_info_2, service_info_3 in MediLink_DataMgmt.read_fixed_width_data(file_path):
92
92
  parsed_data = MediLink_DataMgmt.parse_fixed_width_data(personal_info, insurance_info, service_info, service_info_2, service_info_3, config.get('MediLink_Config', config))
@@ -148,13 +148,13 @@ def check_for_new_remittances(config):
148
148
  try:
149
149
  ERA_path = MediLink_Down.main(desired_endpoint=endpoint_key)
150
150
  processed_endpoints.append((endpoint_info['name'], ERA_path))
151
- MediLink_ConfigLoader.log("Results for {} saved to: {}".format(endpoint_info['name'], ERA_path))
151
+ MediLink_ConfigLoader.log("Results for {} saved to: {}".format(endpoint_info['name'], ERA_path), level="DEBUG")
152
152
  # TODO (Low SFTP - Download side) This needs to check to see if this actually worked maybe winscplog before saying it completed successfully
153
153
  # Check if there is commonality with the upload side so we can use the same validation function.
154
154
  except Exception as e:
155
155
  print("An error occurred while checking remittances for {}: {}".format(endpoint_info['name'], e))
156
156
  else:
157
- MediLink_ConfigLoader.log("Skipping endpoint '{}' as it does not have 'remote_directory_down' configured.".format(endpoint_info['name']))
157
+ MediLink_ConfigLoader.log("Skipping endpoint '{}' as it does not have 'remote_directory_down' configured.".format(endpoint_info['name']), level="WARNING")
158
158
  else:
159
159
  print("Error: Endpoint config is not a 'dictionary' as expected.")
160
160
  # Check if all ERA paths are the same
@@ -77,33 +77,27 @@ def format_single_claim(patient_data, config, endpoint, transaction_set_control_
77
77
 
78
78
  return formatted_837p
79
79
 
80
- def write_output_file(document_segments, output_directory, endpoint_key, input_file_path, config):
80
+ def write_output_file(document_segments, output_directory, endpoint_key, input_file_path, config, suffix=""):
81
81
  """
82
82
  Writes formatted 837P document segments to an output file with a dynamically generated name.
83
-
84
- Development Roadmap:
85
- - Ensure input `document_segments` is a non-empty list to avoid creating empty files.
86
- - Verify `output_directory` exists and is writable before proceeding. Create the directory if it does not exist.
87
- - Consider parameterizing the file naming convention or providing options for customization to accommodate different organizational needs.
88
- - Implement error handling to gracefully manage file writing failures, potentially returning a status or error message alongside the file path.
89
- - Incorporate logging directly within the function, accepting an optional `config` or `logger` parameter to facilitate tracking of the file writing process and outcomes.
90
- - Update the return value to include both the path to the output file and any relevant status information (e.g., success flag, error message) to enhance downstream error handling and user feedback.
91
-
83
+
92
84
  Parameters:
93
85
  - document_segments: List of strings, where each string is a segment of the 837P document to be written.
94
86
  - output_directory: String specifying the directory where the output file will be saved.
95
87
  - endpoint_key: String specifying the endpoint for which the claim is processed, used in naming the output file.
96
88
  - input_file_path: String specifying the path to the input file being processed, used in naming the output file.
97
-
89
+ - config: Configuration settings for logging and other purposes.
90
+ - suffix: Optional string to differentiate filenames, useful for single-patient processing.
91
+
98
92
  Returns:
99
- - String specifying the path to the successfully created output file. Consider returning a tuple (path, status) for enhanced error handling.
93
+ - String specifying the path to the successfully created output file, or None if an error occurred.
100
94
  """
101
- # Check if document segments are empty
95
+ # Ensure the document segments are not empty
102
96
  if not document_segments:
103
97
  MediLink_ConfigLoader.log("Error: Empty document segments provided. No output file created.", config, level="ERROR")
104
98
  return None
105
99
 
106
- # Check if the output directory exists and is writable
100
+ # Verify the output directory exists and is writable, create if necessary
107
101
  if not os.path.exists(output_directory):
108
102
  try:
109
103
  os.makedirs(output_directory)
@@ -114,13 +108,13 @@ def write_output_file(document_segments, output_directory, endpoint_key, input_f
114
108
  MediLink_ConfigLoader.log("Error: Output directory is not writable.", config, level="ERROR")
115
109
  return None
116
110
 
117
- # Generate new output file path
111
+ # Generate the new output file path
118
112
  base_name = os.path.splitext(os.path.basename(input_file_path))[0]
119
113
  timestamp = datetime.now().strftime("%m%d%H%M")
120
- new_output_file_name = "{}_{}_{}.txt".format(base_name, endpoint_key.lower(), timestamp)
114
+ new_output_file_name = "{}_{}_{}{}.txt".format(base_name, endpoint_key.lower(), timestamp, suffix)
121
115
  new_output_file_path = os.path.join(output_directory, new_output_file_name)
122
116
 
123
- # Write formatted 837P document to the output file
117
+ # Write the document to the output file
124
118
  try:
125
119
  with open(new_output_file_path, 'w') as output_file:
126
120
  output_file.write('\n'.join(document_segments))
@@ -335,7 +329,7 @@ def main():
335
329
  parser.add_argument(
336
330
  "-e", "--endpoint",
337
331
  required=True,
338
- choices=["AVAILITY", "OPTUMEDI", "PNT_DATA"],
332
+ choices=["AVAILITY", "OPTUMEDI", "PNT_DATA", "UHCAPI"],
339
333
  help="Specify the endpoint for which the conversion is intended."
340
334
  )
341
335
  parser.add_argument(
@@ -388,9 +382,9 @@ if __name__ == "__main__":
388
382
  #######################################################################################
389
383
 
390
384
  def convert_files_for_submission(detailed_patient_data, config):
391
- """
385
+ """
392
386
  Processes detailed patient data for submission based on their confirmed endpoints,
393
- generating a separate 837P file for each endpoint.
387
+ generating separate 837P files for each endpoint according to the configured submission type.
394
388
 
395
389
  Parameters:
396
390
  - detailed_patient_data: A list containing detailed patient data with endpoint information.
@@ -398,73 +392,93 @@ def convert_files_for_submission(detailed_patient_data, config):
398
392
 
399
393
  Returns:
400
394
  - A list of paths to the converted files ready for submission.
395
+
396
+ Note:
397
+ - This function currently supports batch and single-patient submissions based on the configuration.
398
+ - Future implementation may include progress tracking using tools like `tqdm`.
401
399
  """
402
400
 
403
401
  # Initialize a dictionary to hold patient data segregated by confirmed endpoints
404
402
  data_by_endpoint = {}
405
-
406
- # Populate the dictionary with patient data
403
+
404
+ # Group patient data by endpoint
407
405
  for data in detailed_patient_data:
408
- endpoint = data['confirmed_endpoint']
409
- if endpoint not in data_by_endpoint:
410
- data_by_endpoint[endpoint] = []
411
- data_by_endpoint[endpoint].append(data)
406
+ endpoint = data.get('confirmed_endpoint')
407
+ if endpoint:
408
+ if endpoint not in data_by_endpoint:
409
+ data_by_endpoint[endpoint] = []
410
+ data_by_endpoint[endpoint].append(data)
412
411
 
413
412
  # List to store paths of converted files for each endpoint
414
413
  converted_files_paths = []
415
414
 
416
- # Determine the total number of unique endpoints for progress bar
417
- # total_endpoints = len(data_by_endpoint)
418
-
419
415
  # Iterate over each endpoint and process its corresponding patient data
420
416
  for endpoint, patient_data_list in data_by_endpoint.items():
421
- # tqdm(data_by_endpoint.items(), desc="Creating 837p(s)", total=total_endpoints, ascii=True)
422
- # Each endpoint might have multiple patients' data to be processed into a single 837P file
423
- if patient_data_list:
424
- converted_path = process_claim(config['MediLink_Config'], endpoint, patient_data_list)
417
+ # Retrieve submission type from config; default to "batch" if not specified
418
+ submission_type = config.get('MediLink_Config', {}).get('endpoints', {}).get(endpoint, {}).get('submission_type', 'batch')
419
+
420
+ if submission_type == 'single':
421
+ # Process each patient's data individually for single-patient submissions
422
+ for patient_data in patient_data_list:
423
+ # Generate a unique suffix for each patient, e.g., using a truncated chart number
424
+ chart_number = patient_data.get('CHART', 'UNKNOWN')#[:5] truncation might cause collisions.
425
+ suffix = "_{}".format(chart_number)
426
+ # Process and convert each patient's data to a separate file
427
+ converted_path = process_claim(config, endpoint, [patient_data], suffix)
428
+ if converted_path:
429
+ converted_files_paths.append(converted_path)
430
+ else:
431
+ # Process all patient data together for batch submissions
432
+ converted_path = process_claim(config, endpoint, patient_data_list)
425
433
  if converted_path:
426
434
  converted_files_paths.append(converted_path)
427
-
435
+
428
436
  return converted_files_paths
429
437
 
430
- def process_claim(config, endpoint, patient_data_list):
438
+ def process_claim(config, endpoint, patient_data_list, suffix=""):
431
439
  """
432
440
  Processes patient data for a specified endpoint, converting it into the 837P format.
433
- Generates a separate 837P file for each endpoint based on detailed patient data.
441
+ Can handle both batch and single-patient submissions.
434
442
 
435
443
  Parameters:
436
444
  - config: Configuration settings loaded from a JSON file.
437
- - endpoint_key: The key representing the endpoint for which the data is being processed.
445
+ - endpoint: The key representing the endpoint for which the data is being processed.
438
446
  - patient_data_list: A list of dictionaries, each containing detailed patient data.
447
+ - suffix: An optional suffix to differentiate filenames for single-patient processing.
439
448
 
440
449
  Returns:
441
450
  - Path to the converted file, or None if an error occurs.
442
-
443
- TODO (LOW) Why are there duplicated interchange flows? Because the arg if we're doing a .dat directory or not.
444
- Although, that shouldn't be making duplicates of these interchange headers. That's still confusing and could end up making
445
- duplicate interchange headers because processing .dat in batch might be fast enough to be a problem.
446
451
  """
452
+ # Ensure we're accessing the correct configuration key
453
+ config = config.get('MediLink_Config', config)
454
+
455
+ # Retrieve the output directory from the configuration
447
456
  output_directory = MediLink_837p_encoder_library.get_output_directory(config)
448
457
  if not output_directory:
449
458
  return None
450
459
 
451
- # Initialize the transaction set control number and document segments
452
460
  transaction_set_control_number = 1
453
461
  document_segments = []
454
462
 
455
- # Process each patient's data in the list
456
463
  for patient_data in patient_data_list:
457
- # Validate each patient's data
464
+ # Validate each patient's data before processing
458
465
  is_valid, validation_errors = validate_claim_data(patient_data, config)
459
466
  if is_valid:
460
- # Format the claim if data is valid
467
+ # Format the claim into 837P segments
461
468
  formatted_claim = format_single_claim(patient_data, config, endpoint, transaction_set_control_number)
462
469
  document_segments.append(formatted_claim)
463
470
  transaction_set_control_number += 1
464
471
  else:
472
+ # Log any validation errors encountered
473
+ MediLink_ConfigLoader.log("Validation errors for patient data: {}".format(validation_errors), config, level="ERROR")
465
474
  if MediLink_837p_encoder_library.handle_validation_errors(transaction_set_control_number, validation_errors, config):
466
475
  continue # Skip the current patient
467
476
 
477
+ if not document_segments:
478
+ # If no valid segments were created, log the issue and return None
479
+ MediLink_ConfigLoader.log("No valid document segments created.", config, level="ERROR")
480
+ return None
481
+
468
482
  # Create interchange elements with the final transaction set control number
469
483
  isa_header, gs_header, ge_trailer, iea_trailer = MediLink_837p_encoder_library.create_interchange_elements(config, endpoint, transaction_set_control_number - 1)
470
484
 
@@ -473,5 +487,8 @@ def process_claim(config, endpoint, patient_data_list):
473
487
  document_segments.insert(0, isa_header)
474
488
  document_segments.extend([ge_trailer, iea_trailer])
475
489
 
476
- # Write the complete 837P document to an output file and return its path
477
- return write_output_file(document_segments, output_directory, endpoint, patient_data_list[0]['file_path'], config)
490
+ # Use the first patient's file path as a reference for output file naming
491
+ input_file_path = patient_data_list[0].get('file_path', 'UNKNOWN')
492
+ # Write the complete 837P document to an output file
493
+ converted_file_path = write_output_file(document_segments, output_directory, endpoint, input_file_path, config, suffix)
494
+ return converted_file_path
@@ -288,7 +288,7 @@ def resolve_payer_name(payer_id, config, primary_endpoint, insurance_name, parse
288
288
  MediLink_ConfigLoader.log("API Resolved to standard insurance name: {} for corrected payer ID: {}".format(resolved_name, corrected_payer_id), config, level="INFO")
289
289
 
290
290
  confirmation = input("Is the standard insurance name '{}' correct? (yes/no): ".format(resolved_name)).strip().lower()
291
-
291
+ # BUG There is duplication of code here.
292
292
  if confirmation in ['yes', 'y']:
293
293
  if MediBot_Crosswalk_Library.update_crosswalk_with_corrected_payer_id(payer_id, corrected_payer_id):
294
294
  return resolved_name
@@ -309,11 +309,16 @@ def resolve_payer_name(payer_id, config, primary_endpoint, insurance_name, parse
309
309
 
310
310
  def prompt_user_for_payer_id(insurance_name):
311
311
  """
312
- Prompts the user to input the payer ID manually.
312
+ Prompts the user to input the payer ID manually and ensures that a valid ID is provided.
313
313
  """
314
- print("Manual intervention required: No payer ID found for insurance name '{}'.".format(insurance_name))
315
- payer_id = input("Please enter the payer ID manually: ").strip()
316
- return payer_id
314
+ while True:
315
+ print("Manual intervention required: No payer ID found for insurance name '{}'.".format(insurance_name))
316
+ payer_id = input("Please enter the payer ID manually: ").strip()
317
+
318
+ if payer_id:
319
+ return payer_id
320
+ else:
321
+ print("Error: Payer ID cannot be empty. Please try again.")
317
322
 
318
323
  def build_nm1_segment(payer_name, payer_id):
319
324
  # Step 1: Build NM1 segment using payer name and ID
@@ -407,7 +412,7 @@ def handle_missing_payer_id(insurance_name, config):
407
412
 
408
413
  # Ask for user confirmation
409
414
  confirmation = input("Is the standard insurance name '{}' correct? (yes/no): ".format(standard_insurance_name)).strip().lower() or 'yes'
410
-
415
+ # BUG There is duplication of code here.
411
416
  if confirmation in ['yes', 'y']:
412
417
  # Update the crosswalk with the new payer ID and insurance name mapping
413
418
  MediBot_Crosswalk_Library.update_crosswalk_with_new_payer_id(insurance_name, payer_id, config)
@@ -847,10 +852,17 @@ def winscp_validate_output_directory(output_directory):
847
852
 
848
853
  def get_output_directory(config):
849
854
  # Retrieve desired default output file path from config
850
- output_directory = config.get('outputFilePath', '')
855
+ output_directory = config.get('outputFilePath', '').strip()
851
856
  # BUG (Low SFTP) Add WinSCP validation because of the mishandling of spaces in paths. (This shouldn't need to exist.)
857
+ if not output_directory:
858
+ print("Output file path is not specified in the configuration.")
859
+ output_directory = input("Please enter a valid output directory path: ").strip()
860
+
861
+ # Validate the directory path (checks for spaces and existence)
852
862
  output_directory = winscp_validate_output_directory(output_directory)
863
+
853
864
  if not os.path.isdir(output_directory):
854
- print("Output directory does not exist. Please check the configuration.")
865
+ print("Output directory does not exist or is not accessible. Please check the configuration.")
855
866
  return None
867
+
856
868
  return output_directory
@@ -9,6 +9,14 @@ try:
9
9
  except ImportError:
10
10
  import MediLink_ConfigLoader
11
11
 
12
+ """
13
+ TODO At some point it might make sense to test their acknoledgment endpoint. body is transactionId.
14
+ This API is used to extract the claim acknowledgement details for the given transactionid which was
15
+ generated for 837 requests in claim submission process. Claims Acknowledgement (277CA) will provide
16
+ a status of claim-level acknowledgement of all claims received in the front-end processing system and
17
+ adjudication system.
18
+ """
19
+
12
20
  class ConfigLoader:
13
21
  @staticmethod
14
22
  def load_configuration(config_path=os.path.join(os.path.dirname(__file__), '..', 'json', 'config.json'),
@@ -175,7 +183,7 @@ def fetch_payer_name_from_api(payer_id, config, primary_endpoint='AVAILITY'):
175
183
  raise ValueError(error_message)
176
184
 
177
185
  def get_claim_summary_by_provider(client, tin, first_service_date, last_service_date, payer_id, get_standard_error='false'):
178
- endpoint_name = 'UHCApi'
186
+ endpoint_name = 'UHCAPI'
179
187
  url_extension = client.config['MediLink_Config']['endpoints'][endpoint_name]['additional_endpoints']['claim_summary_by_provider']
180
188
  headers = {
181
189
  'tin': tin,
@@ -188,7 +196,7 @@ def get_claim_summary_by_provider(client, tin, first_service_date, last_service_
188
196
  return client.make_api_call(endpoint_name, 'GET', url_extension, params=None, data=None, headers=headers)
189
197
 
190
198
  def get_eligibility(client, payer_id, provider_last_name, search_option, date_of_birth, member_id, npi):
191
- endpoint_name = 'UHCApi'
199
+ endpoint_name = 'UHCAPI'
192
200
  url_extension = client.config['MediLink_Config']['endpoints'][endpoint_name]['additional_endpoints']['eligibility']
193
201
  url_extension = url_extension + '?payerID={}&providerLastName={}&searchOption={}&dateOfBirth={}&memberId={}&npi={}'.format(
194
202
  payer_id, provider_last_name, search_option, date_of_birth, member_id, npi)
@@ -210,7 +218,7 @@ def get_eligibility_v3(client, payer_id, provider_last_name, search_option, date
210
218
  if payer_id not in valid_payer_ids:
211
219
  raise ValueError("Invalid payer_id: {}. Must be one of: {}".format(payer_id, ", ".join(valid_payer_ids)))
212
220
 
213
- endpoint_name = 'UHCApi'
221
+ endpoint_name = 'UHCAPI'
214
222
  url_extension = client.config['MediLink_Config']['endpoints'][endpoint_name]['additional_endpoints']['eligibility_v3']
215
223
 
216
224
  # Construct request body
@@ -253,6 +261,90 @@ def get_eligibility_v3(client, payer_id, provider_last_name, search_option, date
253
261
 
254
262
  return client.make_api_call(endpoint_name, 'POST', url_extension, params=None, data=body)
255
263
 
264
+ def is_test_mode(client, body, endpoint_type):
265
+ """
266
+ Checks if Test Mode is enabled in the client's configuration and simulates the response if it is.
267
+
268
+ :param client: An instance of APIClient
269
+ :param body: The intended request body
270
+ :param endpoint_type: The type of endpoint being accessed ('claim_submission' or 'claim_details')
271
+ :return: A dummy response simulating the real API call if Test Mode is enabled, otherwise None
272
+ """
273
+ if client.config.get("MediLink_Config", {}).get("TestMode", True):
274
+ print("Test Mode is enabled! API Call not executed.")
275
+ print("\nIntended request body:", body)
276
+ MediLink_ConfigLoader.log("Test Mode is enabled! Simulating API response for {}.".format(endpoint_type), level="INFO")
277
+ MediLink_ConfigLoader.log("Intended request body: {}".format(body), level="INFO")
278
+
279
+ if endpoint_type == 'claim_submission':
280
+ dummy_response = {
281
+ "transactionId": "CS07180420240328013411240", # This is the tID for the sandbox Claim Acknowledgement endpoint.
282
+ "x12ResponseData": "ISA*00* *00* *ZZ*TEST1234567890 *33*TEST *210101*0101*^*00501*000000001*0*P*:~GS*HC*TEST1234567890*TEST*20210101*0101*1*X*005010X222A1~ST*837*000000001*005010X222A1~BHT*0019*00*00001*20210101*0101*CH~NM1*41*2*TEST SUBMITTER*****46*TEST~PER*IC*TEST CONTACT*TE*1234567890~NM1*40*2*TEST RECEIVER*****46*TEST~HL*1**20*1~NM1*85*2*TEST PROVIDER*****XX*1234567890~N3*TEST ADDRESS~N4*TEST CITY*TEST STATE*12345~REF*EI*123456789~PER*IC*TEST PROVIDER*TE*1234567890~NM1*87*2~N3*TEST ADDRESS~N4*TEST CITY*TEST STATE*12345~HL*2*1*22*0~SBR*P*18*TEST GROUP******CI~NM1*IL*1*TEST PATIENT****MI*123456789~N3*TEST ADDRESS~N4*TEST CITY*TEST STATE*12345~DMG*D8*19800101*M~NM1*PR*2*TEST INSURANCE*****PI*12345~CLM*TESTCLAIM*100***12:B:1*Y*A*Y*Y*P~REF*D9*TESTREFERENCE~HI*ABK:TEST~NM1*DN*1*TEST DOCTOR****XX*1234567890~LX*1~SV1*HC:TEST*100*UN*1***1~DTP*472*RD8*20210101-20210101~REF*6R*TESTREFERENCE~SE*30*000000001~GE*1*1~IEA*1*000000001~",
283
+ "responseType": "dummy_response_837999",
284
+ "message": "Test Mode: Claim validated and sent for further processing"
285
+ }
286
+ elif endpoint_type == 'claim_details':
287
+ dummy_response = {
288
+ "responseType": "dummy_response_277CA-CH",
289
+ "x12ResponseData": "ISA*00* *00* *ZZ*841162764 *ZZ*UB920086 *240318*0921*^*00501*000165687*0*T*:~GS*HN*841162764*UB920086*20240318*0921*0165687*X*005010X214~ST*277*000000006*005010X214~…………….. SE*116*000000006~GE*1*0165687~IEA*1*000165687~",
290
+ "statuscode": "000",
291
+ "message:": ""
292
+ }
293
+ return dummy_response
294
+ return None
295
+
296
+ def submit_uhc_claim(client, x12_request_data):
297
+ """
298
+ Submits a UHC claim and retrieves the claim acknowledgement details.
299
+
300
+ This function first submits the claim using the provided x12 837p data. If the client is in Test Mode,
301
+ it returns a simulated response. If Test Mode is not enabled, it submits the claim and then retrieves
302
+ the claim acknowledgement details using the transaction ID from the initial response.
303
+
304
+ :param client: An instance of APIClient
305
+ :param x12_request_data: The x12 837p data as a string
306
+ :return: The final response containing the claim acknowledgement details or a dummy response if in Test Mode
307
+ """
308
+ endpoint_name = 'UHCAPI'
309
+ claim_submission_url = client.config['MediLink_Config']['endpoints'][endpoint_name]['additional_endpoints']['claim_submission']
310
+ claim_details_url = client.config['MediLink_Config']['endpoints'][endpoint_name]['additional_endpoints']['claim_details']
311
+
312
+ # Headers for the request
313
+ headers = {'Content-Type': 'application/json'}
314
+
315
+ # Request body for claim submission
316
+ claim_body = {'x12RequestData': x12_request_data}
317
+
318
+ # Check if Test Mode is enabled and return simulated response if so
319
+ test_mode_response = is_test_mode(client, claim_body, 'claim_submission')
320
+ if test_mode_response:
321
+ return test_mode_response
322
+
323
+ # Make the API call to submit the claim
324
+ try:
325
+ submission_response = client.make_api_call(endpoint_name, 'POST', claim_submission_url, data=claim_body, headers=headers)
326
+
327
+ # Extract the transaction ID from the submission response
328
+ transaction_id = submission_response.get('transactionId')
329
+ if not transaction_id:
330
+ raise ValueError("transactionId not found in the submission response")
331
+
332
+ # Prepare the request body for the claim acknowledgement retrieval
333
+ acknowledgement_body = {'transactionId': transaction_id}
334
+
335
+ # Check if Test Mode is enabled and return simulated response if so
336
+ test_mode_response = is_test_mode(client, acknowledgement_body, 'claim_details')
337
+ if test_mode_response:
338
+ return test_mode_response
339
+
340
+ # Make the API call to retrieve the claim acknowledgement details
341
+ acknowledgement_response = client.make_api_call(endpoint_name, 'POST', claim_details_url, data=acknowledgement_body, headers=headers)
342
+ return acknowledgement_response
343
+
344
+ except Exception as e:
345
+ print("Error during claim processing: {}".format(e))
346
+ raise
347
+
256
348
  if __name__ == "__main__":
257
349
  client = APIClient()
258
350
 
@@ -261,7 +353,8 @@ if __name__ == "__main__":
261
353
  'test_fetch_payer_name': False,
262
354
  'test_claim_summary': False,
263
355
  'test_eligibility': False,
264
- 'test_eligibility_v3': True,
356
+ 'test_eligibility_v3': False,
357
+ 'test_claim_submission': True,
265
358
  }
266
359
 
267
360
  try:
@@ -321,5 +414,16 @@ if __name__ == "__main__":
321
414
  except Exception as e:
322
415
  print("Error in getting eligibility for {}: {}".format(patient['provider_last_name'], e))
323
416
  """
417
+ # Test 5: UHC Claim Submission
418
+ if test_config.get('test_claim_submission', False):
419
+ try:
420
+ x12_request_data = (
421
+ "ISA*00* *00* *ZZ*BRT219991205 *33*87726 *170417*1344*^*00501*019160001*0*P*:~GS*HC*BRT219991205*B2BRTA*20170417*134455*19160001*X*005010X222A1~ST*837*000000001*005010X222A1~BHT*0019*00*00001*20170417*134455*CH~NM1*41*2*B00099999819*****46*BB2B~PER*IC*NO NAME*TE*1234567890~NM1*40*2*TIGER*****46*87726~HL*1**20*1~NM1*85*2*XYZ ADDRESS*****XX*1073511762~N3*123 CITY#680~N4*STATE*TG*98765~REF*EI*943319804~PER*IC*XYZ ADDRESS*TE*8008738385*TE*9142862043*FX*1234567890~NM1*87*2~N3*PO BOX 277500~N4*STATE*TS*303847000~HL*2*1*22*0~SBR*P*18*701648******CI~NM1*IL*1*FNAME*LNAME****MI*00123456789~N3*2020 CITY~N4*STATE*TG*80001~DMG*D8*19820220*M~NM1*PR*2*PROVIDER XYZ*****PI*87726~\nCLM*TOSRTA-SPL1*471***12:B:1*Y*A*Y*Y*P~REF*D9*H4HZMH0R4P0104~HI*ABK:Z12~NM1*DN*1*DN*SKO****XX*1255589300~LX*1~SV1*HC:73525*471*UN*1***1~DTP*472*RD8*0190701-20190701~REF*6R*2190476543Z1~SE*30*000000001~GE*1*19160001~IEA*1*019160001~"
422
+ )
423
+ response = submit_uhc_claim(client, x12_request_data)
424
+ print("\nTEST API: Claim Submission Response:\n", response)
425
+ except Exception as e:
426
+ print("\nTEST API: Error in Claim Submission Test:\n", e)
427
+
324
428
  except Exception as e:
325
- print("TEST API: Unexpected Error: {}".format(e))
429
+ print("TEST API: Unexpected Error: {}".format(e))
@@ -17,7 +17,7 @@ def load_configuration(config_path=os.path.join(os.path.dirname(__file__), '..',
17
17
  Returns: A tuple containing dictionaries with configuration settings for the main config and crosswalk.
18
18
  """
19
19
  # TODO (Low Config Upgrade) The Medicare / Private differentiator flag probably needs to be pulled or passed to this.
20
- # BUG Hardcode sucks.
20
+ # BUG Hardcode sucks. This should probably be some local env variable.
21
21
  # Detect the operating system
22
22
  if platform.system() == 'Windows' and platform.release() == 'XP':
23
23
  # Use F: paths for Windows XP
@@ -219,11 +219,11 @@ def operate_winscp(operation_type, files, endpoint_config, local_storage_path, c
219
219
  except KeyError as e:
220
220
  # Log the missing key information
221
221
  missing_key = str(e)
222
- message = "KeyError: Endpoint config is missing key: {}".format(missing_key)
222
+ message = "Critical Error: Endpoint config is missing key: {}".format(missing_key)
223
223
  MediLink_ConfigLoader.log(message)
224
- # Set default values or handle the situation accordingly
225
- session_name = ''
226
- remote_directory = ''
224
+ # Raise an exception to halt execution
225
+ raise RuntimeError("Configuration error: The endpoint configuration is missing definitions for the required remote directories. Please check the configuration and try again.")
226
+
227
227
  # Command building
228
228
  command = [
229
229
  winscp_path,