ecw-charge-validation/tests/test_conditions_dental_payer_check.py

r"""
conditions/dental_payer_check.py — document #13: Dental codes are billed
only to DentaQuest, Delta Dental or CHP+ Dental — on any insurance row,
secondary included. None of them on a claim with a billed Dental code: the
Claim Status is set to Patient (PAT) where the run may write, else Review
"set it by hand"; no payer read: Review (operator, 2026-10-16 / 2026-10-21).

    python tests\test_conditions_dental_payer_check.py

Uses tests/fixtures/dental_claim.html (D0120 row 0, DCONS row 1) for the
run_all case.
"""

import io
import sys
import pathlib
import inspect
import contextlib

ROOT = pathlib.Path(__file__).resolve().parent.parent
sys.path.insert(0, str(ROOT / "src"))

FIXTURE = pathlib.Path(__file__).resolve().parent / "fixtures" / "dental_claim.html"

from ecw_bot.conditions import dental_payer_check as cond      # noqa: E402
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
from ecw_bot.pages import claim_form                            # noqa: E402

CASES = []


def case(fn):
    CASES.append(fn)
    return fn


def _row(code, billed=True, fee="85.00"):
    return {"code": code, "billed": billed, "billed_fee": fee, "units": "1"}


def _claim(payer, *rows):
    return {"insurance": [{"Name": payer}] if payer is not None else [],
            "cpt": list(rows)}


# ── recognition ──────────────────────────────────────────────────────────────

@case
def a_dental_code_is_d_and_four_digits():
    for code in ("D0120", "D1110", " d0274 ", "D9999"):
        assert cond.is_dental_code(code), code
    for code in ("DCONS", "Dscprit", "DPIMP", "D012", "D01200", "99213",
                 "G8510", "", None):
        assert not cond.is_dental_code(code), code


@case
def the_three_payers_are_allowed_and_no_other():
    for payer in ("DentaQuest", "CHP+ DENTAQUEST", "Delta Dental",
                  "Delta Dental of Colorado", "DELTA DENTAL PPO",
                  " delta dental of oregon "):
        assert cond.is_allowed_payer(payer), payer
    for payer in ("Aetna Dental PPO", "Dental Cigna", "MetLife Dental Claims",
                  "Medicaid", "Anthem Blue Cross Blue Shield",
                  "Dental Slide D", "", None):
        assert not cond.is_allowed_payer(payer), payer


# ── needs_review (no browser) ────────────────────────────────────────────────

@case
def allowed_payers_need_nothing():
    for payer in ("DentaQuest", "CHP+ DENTAQUEST", "Delta Dental of Colorado"):
        data = _claim(payer, _row("D0120"), _row("D1110"))
        assert cond.detect("C1", data) is False
        assert cond.needs_review("C1", data) is None, payer


@case
def an_allowed_secondary_payer_is_enough():
    """Operator 2026-10-21: secondary insurance counts."""
    data = _claim("Medicaid", _row("D0120"))
    data["insurance"].append({"Name": "Delta Dental of Colorado"})
    assert cond.detect("C1", data) is False
    assert cond.needs_review("C1", data) is None


@case
def another_payer_is_detected():
    for payer in ("Aetna Dental PPO", "Medicaid", "Cigna HealthCare Of Colorado"):
        data = _claim(payer, _row("D0120"), _row("DCONS"), _row("D1110"))
        assert cond.detect("C1", data) is True, payer
        assert cond.needs_review("C1", data) is None, payer


@case
def no_payer_read_is_review_not_a_status_change():
    for data in (_claim("", _row("D0120")), _claim(None, _row("D0120"))):
        assert cond.detect("C1", data) is False
        why = cond.needs_review("C1", data)
        assert why and "no payer read" in why and "D0120" in why, why


@case
def only_billed_dental_lines_count():
    # Unchecked at 0.00, or checked at 0.00 (zero_fee_uncheck unchecks it):
    # nothing billed, nothing to do.
    for row in (_row("D0120", billed=False, fee="0.00"),
                _row("D0120", billed=True, fee="0.00")):
        assert cond.detect("C1", _claim("Medicaid", row)) is False, row
    # Dummy codes only: not dental codes.
    data = _claim("Medicaid", _row("DCONS"), _row("DPIMP"), _row("99213"))
    assert cond.detect("C1", data) is False


@case
def it_is_registered():
    assert "dental_payer_check" in [m.NAME for m in CONDITIONS]
    assert cs.COMMENTS.get("dental_payer_check")


# ── run_all on the Dental screen (browser) ──────────────────────────────────

def _dental_read(page, payer):
    data = claim_form.extract(page)
    data["screen"] = "dental"
    data["insurance"] = [{"Name": payer}]
    data["progress_notes"] = {"opened": "tab", "text": "Routine dental visit."}
    return data


def _outcome(page, payer):
    page.goto(FIXTURE.as_uri())
    data = _dental_read(page, payer)
    report = {}
    with contextlib.redirect_stdout(io.StringIO()):
        results = run_all(page, "C1", data, report=report)
    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


@case
def a_dental_claim_to_aetna_dental_is_review_set_by_hand(page):
    # The Dental screen is never written (claims not saved): Review.
    outcome, report = _outcome(page, "Aetna Dental PPO")
    notes = [r["reason"] for r in report["review"]
             if r["name"] == "dental_payer_check"]
    assert len(notes) == 1 and "D0120" in notes[0], report["review"]
    assert "set it to Patient by hand" in notes[0], notes
    assert outcome["Category"] == "Review", outcome
    assert "Patient" in outcome["Comments"], outcome


# ── the Claim Status dropdown (browser) ─────────────────────────────────────

_STATUS = """
<select id="status" ng-model="claimRP.claimRPStatus">
  <option value="A">Active</option><option value="PAT">Not this one</option>
</select>
<select id="claimStatusSel1" ng-model="ClaimData.ClaimStatus"
        ng-change="ClaimStautsChange('ChangeEvent')">
  <option value=""></option>
  <option value="string:CMC">Ready to Submit (Electronic)</option>
  <option value="string:PAT">Patient</option>
  <option value="string:108ME" selected>Medcor Ready</option>
</select>
"""


def _write(page, html, data, save=True):
    from ecw_bot import settings as _cfg
    page.set_content(html)
    orig = _cfg.SAVE_CORRECTIONS
    _cfg.SAVE_CORRECTIONS = save
    try:
        with contextlib.redirect_stdout(io.StringIO()):
            return cond.apply(page, "C1", data)
    finally:
        _cfg.SAVE_CORRECTIONS = orig


def _value(page, selector):
    return page.locator(selector).input_value()


@case
def live_write_sets_the_claim_status_to_patient(page):
    data = _claim("Aetna Dental PPO", _row("D0120"))
    result = _write(page, _STATUS, data)
    assert result.changed is True and result.review == "", result
    assert _value(page, "#claimStatusSel1") == "string:PAT"
    assert _value(page, "#status") == "A", "the other status field untouched"
    c = result.changes[0]
    assert (c["before"], c["after"], c["label"]) == ("108ME", "PAT", "Patient")
    assert cond.summary_comment(result) == (
        "Dental code(s) D0120 billed to Aetna Dental PPO — not DentaQuest / "
        "Delta Dental / CHP+ Dental - Claim Status set to Patient")
    assert "108ME -> PAT (Patient)" in cond.describe(result)


@case
def the_ub_dropdown_with_plain_values_works_too(page):
    html = ('<select id="claimStatusSel2" ng-model="selectedClaimStatusCodes">'
            '<option value="108ME" selected>Medcor Ready</option>'
            '<option value="PAT">Patient</option></select>')
    result = _write(page, html, _claim("Medicaid", _row("D1110")))
    assert result.changed and _value(page, "#claimStatusSel2") == "PAT"


@case
def verify_changes_nothing_and_says_set_it_by_hand(page):
    result = _write(page, _STATUS, _claim("Medicaid", _row("D0120")),
                    save=False)
    assert result.changed is False
    assert "set it to Patient by hand" in result.review, result.review
    assert _value(page, "#claimStatusSel1") == "string:108ME"


@case
def no_patient_option_or_no_dropdown_is_review(page):
    html = ('<select ng-model="ClaimData.ClaimStatus">'
            '<option value="108ME" selected>Medcor Ready</option></select>')
    result = _write(page, html, _claim("Medicaid", _row("D0120")))
    assert result.changed is False and "set it by hand" in result.review
    result = _write(page, "<p>no form</p>", _claim("Medicaid", _row("D0120")))
    assert result.changed is False and "no Claim Status box" in result.review


@case
def a_dental_claim_to_dentaquest_gets_no_payer_review(page):
    _, report = _outcome(page, "DentaQuest")
    assert not [r for r in report["review"]
                if r["name"] == "dental_payer_check"], report["review"]


def main() -> 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


if __name__ == "__main__":
    sys.exit(main())