Initial import: eCW Charge Validation bot and results Portal

Snapshot of the working project as of 2026-10-23 (local 2d4d4fc), one
commit with no earlier history: the tracked files were de-identified
first (synthetic claim ids and patient data only; see Context.md
section 7). Credentials, run logs, screenshots, claim reports and client
workbooks are gitignored and not included.

Co-Authored-By: Claude Opus 5.5 <noreply@anthropic.com>

tests/test_conditions_medicare_pps_code.py

@@ -0,0 +1,380 @@
+r"""
+conditions/medicare_pps_code.py — document #25: a PPS Payer's UB claim must
+carry the PPS Code its billed Qualifying Codes map to on the client's
+Medicare G code crosswalk (G0466–G0470; operator, 2026-10-23, spec EEWA-34).
+
+    python tests\test_conditions_medicare_pps_code.py
+
+Terms (GLOSSARY.md): PPS Code, Qualifying Code, PPS Payer. Claim numbers
+here are made up.
+"""
+
+import io
+import sys
+import pathlib
+import inspect
+import contextlib
+
+ROOT = pathlib.Path(__file__).resolve().parent.parent
+sys.path.insert(0, str(ROOT / "src"))
+
+from ecw_bot.conditions import medicare_pps_code as pps            # noqa: E402
+
+CASES = []
+
+
+def case(fn):
+    CASES.append(fn)
+    return fn
+
+
+def _quiet(fn, *a, **k):
+    with contextlib.redirect_stdout(io.StringIO()) as out:
+        result = fn(*a, **k)
+    return result, out.getvalue()
+
+
+def _row(code, billed=True, fee="120.00"):
+    return {"code": code, "billed": billed, "billed_fee": fee, "units": "1"}
+
+
+def _data(codes, payer="Medicare", screen="ub"):
+    cpt = [c if isinstance(c, dict) else _row(c) for c in codes]
+    return {"cpt": cpt, "screen": screen,
+            "insurance": [{"Name": payer}] if payer is not None else []}
+
+
+# ── decisions (no browser) ───────────────────────────────────────────────────
+
+@case
+def an_office_visit_without_its_pps_code_is_detected():
+    fired, _ = _quiet(pps.detect, "C1", _data(["99213"]))
+    assert fired is True
+
+
+def _adds(data):
+    return [pps_code for pps_code, _ in pps.decide(data)["add"]]
+
+
+@case
+def each_visit_kind_maps_to_its_pps_code():
+    for codes, want in ((["99203"], "G0466"), (["92002"], "G0466"),
+                        (["99341"], "G0466H"), (["99213"], "G0467"),
+                        (["Q0091"], "G0467"), (["99309"], "G0467NH"),
+                        (["99318"], "G0467NH"), (["99348"], "G0467H"),
+                        (["99336"], "G0467"), (["G0439"], "G0468")):
+        assert _adds(_data(codes)) == [want], (codes, pps.decide(_data(codes)))
+    assert pps.decide(_data(["99203"]))["add"] == [("G0466", ["99203"])]
+
+
+@case
+def an_awv_or_ippe_takes_g0468_even_with_an_office_visit():
+    assert _adds(_data(["99213", "G0438"])) == ["G0468"]
+
+
+@case
+def the_right_pps_code_already_billed_needs_nothing():
+    for codes in (["99213", "G0467"], ["99203", "G0466"],
+                  ["99309", "G0467NH"], ["G0439", "G0468"]):
+        data = _data(codes)
+        fired, _ = _quiet(pps.detect, "C1", data)
+        assert fired is False, codes
+        assert pps.needs_review("C1", data) is None, codes
+
+
+@case
+def a_code_that_does_not_end_billed_does_not_qualify():
+    assert _adds(_data([_row("99213", billed=False, fee="0.00")])) == []
+    assert _adds(_data([_row("99213", fee="0.00")])) == []
+    assert _adds(_data(["36415"])) == [], "not on the crosswalk"
+
+
+def _review(codes, **kw):
+    data = _data(codes, **kw)
+    fired, _ = _quiet(pps.detect, "C1", data)
+    assert fired is False, (codes, pps.decide(data))
+    return pps.needs_review("C1", data) or ""
+
+
+@case
+def codes_on_both_lists_only_are_review_new_or_established():
+    for codes in (["G0444"], ["97802"], ["G0444", "G0101"]):
+        why = _review(codes)
+        assert "new or established" in why and "G0466" in why \
+            and "G0467" in why and codes[0] in why, (codes, why)
+
+
+@case
+def a_code_on_one_list_settles_the_ones_on_both():
+    assert _adds(_data(["99213", "G0444"])) == ["G0467"]
+    assert pps.decide(_data(["99213", "G0444"]))["add"] == \
+        [("G0467", ["99213"])]
+
+
+@case
+def conflicting_visit_codes_are_review_and_nothing_is_added():
+    for codes, a, b in ((["99203", "99213"], "G0466", "G0467"),
+                        (["99213", "99348"], "G0467", "G0467H")):
+        why = _review(codes)
+        assert "conflicting" in why and a in why and b in why, (codes, why)
+        assert _adds(_data(codes)) == [], codes
+
+
+@case
+def conflicting_codes_stay_review_with_one_of_their_pps_codes_billed():
+    why = _review(["99203", "99213", "G0467"])
+    assert "conflicting" in why and "G0466" in why, why
+
+
+@case
+def a_different_pps_code_billed_is_review_and_not_changed():
+    why = _review(["99203", "G0467"])
+    assert "G0467 billed" in why and "G0466" in why, why
+
+
+@case
+def a_different_pps_code_next_to_the_right_one_is_review_too():
+    why = _review(["99213", "G0467", "G0466"])
+    assert "G0466 billed" in why and "crosswalk says G0467" in why, why
+    why = _review(["G0439", "G0468", "G0467"])
+    assert "G0467 billed" in why and "crosswalk says G0468" in why, why
+
+
+@case
+def mental_health_is_review_until_the_client_rules():
+    why = _review(["90834"])
+    assert "G0469 or G0470" in why and "90834" in why, why
+    for billed in ("G0469", "G0470"):
+        data = _data(["90834", billed])
+        assert pps.needs_review("C1", data) is None, billed
+
+
+@case
+def hcfa_is_review_by_hand_and_dental_is_skipped():
+    why = _review(["99213"], screen="hcfa")
+    assert "by hand" in why and "PPS" in why and "G0467" in why, why
+    why = _review(["99213", "G0467"], screen="hcfa")
+    assert "hcfa" in why and "99213" in why and "by hand" in why, \
+        "the wrong form is caught with the PPS code there too"
+    assert _review(["36415"], screen="hcfa") == "", "no Qualifying Code"
+    data = _data(["99213"], screen="dental")
+    assert _quiet(pps.detect, "C1", data)[0] is False
+    assert pps.needs_review("C1", data) is None
+
+
+@case
+def g0468_on_a_payer_whose_history_is_never_checked_is_review():
+    """Operator, 2026-10-23: the Cigna plans are Commercial for #27–#29,
+    so their preventive visit history is never read — Review, not an add.
+    On Medicare #27–#29 reads it first, so the claim still fires."""
+    for payer in ("Cigna Healthspring", "Cigna Health Spring/ Bravo"):
+        why = _review(["G0439"], payer=payer)
+        assert "G0468 not added" in why and "history not checked" in why \
+            and "G0439" in why, (payer, why)
+    assert _adds(_data(["G0439"])) == ["G0468"]
+
+
+@case
+def only_pps_payers_by_their_exact_names_cigna_healthspring_included():
+    for payer in ("Medicare", "Medicare-Novitas", "HCFA Medicare Novitas",
+                  "Humana Medicare", "Devoted MCR UB", "Cigna Healthspring",
+                  "Cigna Health Spring/ Bravo", " medicare "):
+        fired, _ = _quiet(pps.detect, "C1", _data(["99213"], payer=payer))
+        assert fired is True, payer
+    for payer in ("Medicaid", "Cigna Medicare Access Plan", "Devoted",
+                  "Humana Claims", "", None):
+        data = _data(["99213"], payer=payer)
+        fired, _ = _quiet(pps.detect, "C1", data)
+        assert fired is False, payer
+        assert pps.needs_review("C1", data) is None, payer
+
+
+# ── apply (browser) ─────────────────────────────────────────────────────────
+
+FIXTURE = pathlib.Path(__file__).resolve().parent / "fixtures" / "vaccine_claim.html"
+
+from ecw_bot import settings as cfg                                 # noqa: E402
+from ecw_bot.conditions.base import ConditionResult                 # noqa: E402
+from ecw_bot.pages import claim_form                                # noqa: E402
+
+_VISIT = [{"code": "99213", "title": "OFFICE VISIT EST LEVEL 3", "fee": "120.00"}]
+
+
+def _fresh(page, rows, payer="Medicare"):
+    page.goto(FIXTURE.as_uri())
+    page.evaluate("rows => window.seedCptRows(rows)", rows)
+    data = claim_form.extract(page)
+    data["insurance"] = [{"Name": payer}]
+    return data
+
+
+def _rows_for(page, code):
+    return [r for r in claim_form.extract(page)["cpt"] if r["code"] == code]
+
+
+@case
+def verify_adds_nothing_and_says_which_pps_code_to_add_by_hand(page):
+    data = _fresh(page, _VISIT)
+    saved = cfg.SAVE_CORRECTIONS
+    cfg.SAVE_CORRECTIONS = False
+    try:
+        result, _ = _quiet(pps.apply, page, "C1", data)
+    finally:
+        cfg.SAVE_CORRECTIONS = saved
+    assert isinstance(result, ConditionResult)
+    assert result.changed is False, result
+    assert "G0467" in result.review and "99213" in result.review \
+        and "by hand" in result.review, result.review
+    assert _rows_for(page, "G0467") == []
+
+
+@case
+def live_write_adds_the_pps_code_once_with_units_1(page):
+    result, out = _quiet(pps.apply, page, "C1", _fresh(page, _VISIT))
+    assert result.changed is True and result.review == "", (result, out)
+    added = _rows_for(page, "G0467")
+    assert len(added) == 1 and added[0]["units"] == "1", added
+    assert len(claim_form.extract(page)["cpt"]) == 2, "nothing else changed"
+    assert pps.summary_comment(result) == \
+        "CPT Code Missing (PPS code G0467 added (99213))", \
+        pps.summary_comment(result)
+    text = pps.describe(result)
+    assert "G0467" in text and "99213" in text and "Added" in text, text
+
+
+@case
+def a_pps_code_the_picker_cannot_find_is_review_add_by_hand(page):
+    data = _fresh(page, [{"code": "99348", "title": "HOME VISIT EST",
+                          "fee": "130.00"}])
+    result, _ = _quiet(pps.apply, page, "C1", data)
+    assert result.changed is False, result
+    assert "G0467H could not be added" in result.review \
+        and "99348" in result.review, result.review
+    assert _rows_for(page, "G0467H") == []
+
+
+from ecw_bot.conditions import CONDITIONS                           # noqa: E402
+from ecw_bot.conditions.base import run_all                         # noqa: E402
+from ecw_bot.core import charge_summary as cs                       # noqa: E402
+
+
+def _outcome(page, data, live_write):
+    data["progress_notes"] = {"opened": "modal", "text": "Office visit."}
+    saved = cfg.SAVE_CORRECTIONS
+    cfg.SAVE_CORRECTIONS = live_write
+    try:
+        report = {}
+        results, out = _quiet(run_all, page, "C1", data, report=report)
+    finally:
+        cfg.SAVE_CORRECTIONS = saved
+    data["_conditions"] = {"fired": [r.condition_name for r in results],
+                           "saved": False, "failed": report["failed"],
+                           "review": report["review"],
+                           "comments": report["comments"]}
+    return cs.claim_outcome(True, data), report, out
+
+
+@case
+def it_is_registered_after_the_wellness_history_and_before_priced_line_check():
+    names = [m.NAME for m in CONDITIONS]
+    i = names.index("medicare_pps_code")
+    assert names.index("medicare_wellness_history") < i < names.index(
+        "priced_line_check"), names
+
+
+@case
+def a_verify_run_makes_the_claim_review_naming_the_pps_code(page):
+    outcome, report, out = _outcome(page, _fresh(page, _VISIT), False)
+    assert outcome["Category"] == "Review", (outcome, out)
+    mine = [r for r in report["review"] if r["name"] == "medicare_pps_code"]
+    assert mine and "G0467" in mine[0]["reason"], report["review"]
+    assert "G0467" in outcome["Comments"], outcome
+
+
+@case
+def a_live_write_run_adds_it_and_the_claim_is_fail_saying_so(page):
+    outcome, report, out = _outcome(page, _fresh(page, _VISIT), True)
+    assert outcome["Category"] == "Fail", (outcome, out)
+    assert "PPS code G0467 added (99213)" in outcome["Comments"], outcome
+    assert not [r for r in report["review"]
+                if r["name"] == "medicare_pps_code"], report["review"]
+    assert len(_rows_for(page, "G0467")) == 1
+
+
+@case
+def g0468_is_held_back_when_the_wellness_history_found_a_problem(page):
+    awv = [{"code": "G0439", "title": "ANNUAL WELLNESS VISIT SUBSEQ",
+            "fee": "160.00"}]
+    for verdict, words in (
+            ({"read": True, "conflicts": [
+                "G0439 already billed on 01/05/2026 (claim 9000001) — once "
+                "a year"]}, "already billed"),
+            ({"read": False, "conflicts": []}, "history not read")):
+        data = _fresh(page, awv)
+        data["_wellness_history"] = verdict
+        result, _ = _quiet(pps.apply, page, "C1", data)
+        assert result.changed is False, (verdict, result)
+        assert "G0468 not added" in result.review and words in \
+            result.review, result.review
+        assert _rows_for(page, "G0468") == [], verdict
+    data = _fresh(page, awv)
+    data["_wellness_history"] = {"read": True, "conflicts": []}
+    result, _ = _quiet(pps.apply, page, "C1", data)
+    assert result.changed is True and _rows_for(page, "G0468"), result
+
+
+@case
+def g0468_with_no_wellness_verdict_by_apply_is_not_added(page):
+    """#27–#29 raised or never reached the claim: its history is unchecked."""
+    data = _fresh(page, [{"code": "G0439", "title": "ANNUAL WELLNESS VISIT "
+                          "SUBSEQ", "fee": "160.00"}])
+    result, _ = _quiet(pps.apply, page, "C1", data)
+    assert result.changed is False, result
+    assert "G0468 not added" in result.review, result.review
+    assert _rows_for(page, "G0468") == []
+
+
+def _run_cases() -> int:
+    from playwright.sync_api import sync_playwright
+
+    failures = 0
+    with sync_playwright() as pw:
+        browser = pw.chromium.launch(headless=True)
+        page = browser.new_page()
+        for fn in CASES:
+            name = fn.__name__.replace("_", " ")
+            try:
+                if len(inspect.signature(fn).parameters) == 0:
+                    fn()
+                else:
+                    fn(page)
+                print(f"  ok    {name}")
+            except AssertionError as exc:
+                print(f"  FAIL  {name}: {exc}")
+                failures += 1
+            except Exception as exc:
+                print(f"  ERROR {name}: {type(exc).__name__}: {exc}")
+                failures += 1
+        browser.close()
+
+    print(f"\n{len(CASES) - failures}/{len(CASES)} passed")
+    return 1 if failures else 0
+
+
+def main() -> int:
+    """shot() writes into the operator's Screenshots\\ folder; not here.
+    The add cases run as LIVE-WRITE, the way a run that adds does."""
+    import tempfile
+    from ecw_bot import settings as _cfg
+    orig = (_cfg.SCREENSHOTS, _cfg.SAVE_CORRECTIONS)
+    with tempfile.TemporaryDirectory() as tmp:
+        _cfg.SCREENSHOTS = pathlib.Path(tmp)
+        _cfg.SAVE_CORRECTIONS = True
+        try:
+            return _run_cases()
+        finally:
+            _cfg.SCREENSHOTS, _cfg.SAVE_CORRECTIONS = orig
+
+
+if __name__ == "__main__":
+    sys.exit(main())