d24340c47a
core/rules.py format-tolerant readers + stable registry (R001-R004 plan-scoped, R100-R102 universal per LCD L33822). payer_rules.json wrapped in the same commit as both engine readers (coupling hazard closed). Every DocItem now cites the rule that decided it; NOT_EVALUATED cites nothing. Independent audit: SHIP (registry-drift test added per its L2 finding). 138 tests green. Co-Authored-By: Claude Fable 5 <noreply@anthropic.com>
52 lines
1.8 KiB
Python
52 lines
1.8 KiB
Python
"""
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rules.py
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Signal — STTIL Solutions
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Format-tolerant readers for payer_rules.json plus the stable rule-ID registry
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(build plan 02, item P2; design: readiness-model-design-phase2 section 3.1).
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A rule value may be FLAT (legacy: `"visit_renewal_days": 180`) or WRAPPED with
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its citation (`"visit_renewal_days": {"value": 180, "rule_id": "R001"}`).
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Both engines read through these helpers so the JSON format can carry citation
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IDs without breaking either reader.
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RULE IDS ARE STABLE — never change an ID after shipping. The ID names the rule
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KIND; the plan type plus the value together are the citation.
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"""
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from __future__ import annotations
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from typing import Optional
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# Universal claim/coverage requirements per LCD L33822, independent of plan
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# type. They live in code (no plan-type dependency) but carry rule IDs for
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# citation consistency.
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UNIVERSAL_RULE_IDS = {"swo": "R100", "visit": "R101", "diagnosis": "R102"}
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# Plan-scoped keys in payer_rules.json and their registry IDs.
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PLAN_KEY_RULE_IDS = {
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"visit_renewal_days": "R001",
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"refill_window_days": "R002",
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"pa_required": "R003",
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"pecos_required": "R004",
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}
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def rule_value(cfg: Optional[dict], key: str, default=None):
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"""Read a rule value, accepting flat (180) and wrapped
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({'value': 180, 'rule_id': 'R001'}) formats."""
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if not cfg:
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return default
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raw = cfg.get(key, default)
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if isinstance(raw, dict) and "value" in raw:
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return raw["value"]
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return raw
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def rule_id_for(cfg: Optional[dict], key: str) -> Optional[str]:
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"""The citation ID for a plan-scoped rule: from the wrapped config when
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present, else the registry default for that key."""
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raw = cfg.get(key) if cfg else None
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if isinstance(raw, dict) and "rule_id" in raw:
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return raw["rule_id"]
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return PLAN_KEY_RULE_IDS.get(key)
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