ManikandanandClaude Opus 5.5
ba15a574ab
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>
138 lines
7.1 KiB
Markdown
138 lines
7.1 KiB
Markdown
# Dental claims run every applicable condition — design
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Date: 2026-10-07. Status: approved in chat (operator, 2026-10-07);
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implemented 2026-10-12 (operator: "this is our number one condition").
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## 2026-10-12 update (as built)
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- The rule now also covers #12 (H codes: BH payer → modifier removed;
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any other payer → line unchecked + fee 0) and #14 (Medicare: G8510 /
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G8431 unchecked + fee 0, #6 not run). Both run on Dental claims like
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every other condition; #12's BH path has no modifier column to read on
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the Dental grid, so it never fires there.
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- A fix the Dental screen cannot hold → **Review** (operator): a condition
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module declares `DENTAL_UNSUPPORTED = "<reason>"` and `run_all` records
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that reason instead of applying it on a `screen == "dental"` read —
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telehealth, medicare_telehealth, vaccine_admin_codes.
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- Dental claims are **never saved** in this change (operator), whatever
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`SAVE_CORRECTIONS` says; the review-before-close box still shows.
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- A Dental claim is read and run through the conditions even with
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CHECK_HIGH_RISK and CHECK_SLIDING_FEE both off (it used to come back
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blank).
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- The Charge Summary applies the same claim-level checks (note read, CPT /
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ICD rows read, conditions run) to a Dental read as to UB/HCFA.
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- Row selectors gained a third (Dental) alternative, scoped to the Dental
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window on screen (`:visible`); `extract()` returns `screen`
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("ub" / "hcfa" / "dental").
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- Not live-verified yet: the first live run should be SAVE-off on a few
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Dental claims (one with DCONS or Dscprit).
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## Rule (operator, 2026-10-07)
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Every claim is checked against **every condition whose Payer column is
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"All" / "All payers"**, **plus** every condition specific to that claim's
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payer (Medicare, Medicaid, Dental payers, ...). This holds for every payer
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and every claim screen — UB, HCFA and Dental alike.
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UB and HCFA claims already work this way: each claim runs the whole
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registry (`conditions/__init__.py` `CONDITIONS`) and each condition's own
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`detect()` decides from the claim's codes and payer. **The gap is Dental:** a
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Dental claim today runs only #15 high risk and #8 sliding fee and never
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reaches `run_all`. So, for example, `dummy_codes` (DCONS/Dscprit, which are
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Dental codes) can never fire on any claim.
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## What a Dental claim will run
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| Doc # | Condition | Payer (document) | Module |
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|---|---|---|---|
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| 5 | J2930/J2001 uncheck + fee 0 | ALL | `j2930_j2001_update` |
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| 6 | Depression DX pointer | All | `depression_dx_pointer` |
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| 7 | Zero-fee uncheck / priced line check | ALL | `zero_fee_uncheck`, `priced_line_check` |
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| 21 | Telehealth POS 2 + modifier | All | `telehealth` |
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| 22 | Medicare telehealth G2025 | Medicare | `medicare_telehealth` |
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| 18 | Vaccine admin codes | All except Medicare | `vaccine_admin_codes` |
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| 8 | DCONS/Dscprit uncheck + fee 0 | All Dental Payer | `dummy_codes` |
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| 8 | Sliding fee date check | All Dental Payer | `pages/sliding_fee` (unchanged) |
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| 15 | High risk in Billing Notes | Dental Payers | `pages/dental_notes` (unchanged) |
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No condition gains a form-type check: each still decides from codes and
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payer only. A condition whose codes are not on the claim does nothing.
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## Dental screen facts (from Dom.txt, claim screen `.modal[id^="dentalClaim"]`)
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- CPT/CDT grid `table[id^="claimCPTCodesTable"]`; real rows are
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`tr[ng-repeat^="CPT in CPTCodes"]` (no `CPTROW_` id).
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- Per row: checkbox `[ng-click*="updateBillToIns("]` (same as UB/HCFA), code
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`[data-fieldname="web_cptcode"]`, pointers `web_icd1`..`web_icd4`, units
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`web_units`, fee `web_billedFee` (blur runs `editCPTRow('BILLED_FEE')`),
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DOS `DentalClaimCPTSDOS`.
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- **No per-row POS and no modifier columns.** POS is claim-level
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(`ng-model="ClaimData.pos"`).
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- Prog. Notes button `button[ng-click="viewProgNote()"]`
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(`dentalClaimProgressNoteBtn…`) — the existing `SEL_PROGRESS_NOTES` matches.
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- Insurance grid: `#DentalClaimTbl2` (Bill To, Ins Id, Name, ...).
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- Billing Notes: `#dentalClaimNotes` (already read by high risk).
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None of the row fields has been exercised live yet; Dom.txt is one capture.
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## Design
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1. **Selectors** (`selectors/claim_form.py`): add the Dental alternative to
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each row selector the helpers already use — `SEL_CPT_ROWS`,
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`SEL_CPT_CODE`, `SEL_CPT_ICD1..4`, `SEL_CPT_BILLED_FEE`, `SEL_CPT_UNITS`.
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The Dental row selector is scoped under `.modal[id^="dentalClaim"]` so it
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cannot match a grid on another screen. Within one row only one alternative
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ever matches, the same contract the UB/HCFA pairs rely on.
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2. **Reader** (`pages/claim_form.py` `_EXTRACT_JS`): read Dental rows into the
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same `cpt` row shape (`code`, `icd1..4`, `units`, `billed_fee`, `billed`,
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`sdos`; `pos`/`mod1..4` empty), insurance from `#DentalClaimTbl2`, the
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Dental claim number, ICD list, and `notes` from `#dentalClaimNotes`.
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One `extract()` for all three screens.
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3. **Flow** (`flows/export_medcor_ready.py`): a Dental claim runs high risk +
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sliding fee first (unchanged, read-only), then the same path as UB/HCFA:
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`extract()`, Prog. Notes (when `OPEN_PROGRESS_NOTES`), `run_all`, per-claim
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box, Charge Summary. The Dental results stay on the claim's data so the box
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and the summary show both.
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4. **A fix the Dental screen cannot make** — e.g. telehealth needs a row
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modifier and the Dental grid has none, or POS is claim-level: the condition
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returns `declined(...)` with the reason ("Dental screen has no modifier
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column"), so the claim is **Review** in the Charge Summary. Never a silent
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skip, never a guess.
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5. **Charge Summary**: one row per claim combining condition comments with the
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Dental findings (HIGH RISK, sliding fee). Category: Review beats Fail beats
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Pass, as today.
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6. **Saving**: Dental claims are **never saved** in this change, whatever
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`SAVE_CORRECTIONS` says. Their corrections are shown and listed as
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"Corrections pending (not saved)". Dental save is enabled only after a live
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verification-mode run confirms the row writes.
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## Error handling
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- Dental form not loaded (`wait_claim_loaded`): conditions skipped, claim is
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Review — same as HCFA today.
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- A Dental row field missing (fee or checkbox not found): the existing helpers
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already treat a missing field as unknown, not as zero/unchecked.
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- High risk / sliding fee failures keep their current Review handling.
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## Testing
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- Grow `tests/fixtures/dental_claim.html` from Dom.txt's real Dental grid
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(rows, checkbox, fee, pointers, insurance grid, Prog. Notes button) with no
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patient data.
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- `extract()` on the Dental fixture returns the expected `cpt` and `insurance`.
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- Per condition, a Dental case: dummy codes (DCONS/Dscprit) uncheck + zero;
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J2001 uncheck + zero; zero-fee uncheck; priced line check; depression
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pointer retag on `web_icd*`; telehealth on Dental → declined/Review.
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- Flow: a Dental claim gets high risk + sliding fee **and** condition results
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in one summary row; never offered Save.
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- Full suite stays green.
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- Live: one SAVE-off run on Dental test claims (with a DCONS or Dscprit line)
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before Dental save is considered.
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## Out of scope
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- New document conditions not yet built (#3, #4, #9-#14, #16, #19, #20,
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#23-#55).
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- Saving Dental claims.
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- "Special programs" half of #8.
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