Merged in bugfix/default_ind_postprocess (pull request #887)

Bugfix/default ind postprocess

* Add logic to standardize UNIT_OF_MEASURE for flat-rate reimbursement methods

- Implemented functionality in `standardize_reimb_method_and_fee_schedule` to set UNIT_OF_MEASURE to blank for rows where DEFAULT_IND is 'Y' and AARETE_DERIVED_REIMB_METHOD is 'flat rate'.
- Added unit tests to verify behavior for various scenarios, including case insensitivity and non-default conditions.
- Ensured that UNIT_OF_MEASURE remains unchanged for non-flat rate methods.

* Enhance child rank handling and ensure column consistency in parent-child mapping

- Added initialization for the `child_rank` column in both parents and children DataFrames to prevent KeyError during concatenation when no children exist.
- Updated `cols_to_keep` in `parent_child_mapping` to filter out columns not present in `pc_df`, ensuring robustness in data processing.

* Ran Black

* made a small change in code_last_check, fixed so it returns string and not single char

* Made changes to make sure that default_ind postprocess only happens to the cc output and not dashboard

* Merged DEV into bugfix/default_ind_postprocess

* Restore deleted AARETE_DERIVED_PAYER_NAME functions

Functions were removed during previous commit. Restored from DEV to fix
AttributeError in prompt_calls.py.

* Simplify code_last_check return logic and add error logging

- Simplified return to single line with fallback
- Added error logging for failed LLM response parsing


Approved-by: Siddhant Medar
This commit is contained in:
Praneel Panchigar
2026-02-20 21:19:34 +00:00
committed by Siddhant Medar
parent 7571d3e3b1
commit ddefa2ff30
6 changed files with 123 additions and 8 deletions
+5 -3
View File
@@ -489,11 +489,13 @@ def code_last_check(service, filename):
)
try:
llm_answer_final = _parser(llm_answer_raw)
return llm_answer_final[0]
except:
return llm_answer_final if llm_answer_final else "Generic"
except Exception:
logging.error(
"Failed to parse LLM response in code_last_check: %s", llm_answer_raw
)
return "Generic"
def fill_bill_type(
service,
answer_dict,
+6
View File
@@ -743,6 +743,11 @@ def assign_child_ranks(df, grouper_col="grouping_key"):
parents = df[df["parent"]].copy()
children = df[~df["parent"]].copy()
# Ensure child_rank column exists so concat result has it when there are no
# children (otherwise result["child_rank"].astype(str) raises KeyError).
parents["child_rank"] = ""
children["child_rank"] = ""
# For each child, find their actual parent's identity
# Then group children by the parent they're actually assigned to
children["_parent_identity"] = None
@@ -1096,6 +1101,7 @@ def parent_child_mapping(
"parent_child_flag",
"parent_name",
]
cols_to_keep = [col for col in cols_to_keep if col in pc_df.columns]
# Ensure consistent types for merge - convert both to string to avoid datetime/object mismatch
pc_df["fixed_effective_date"] = pc_df["fixed_effective_date"].astype(str)
@@ -150,6 +150,9 @@ def contract_config_postprocess(df, constants: Constants):
if cc_df.shape[0] == 0:
return cc_df
# CC only: blank UNIT_OF_MEASURE for default flat-rate rows (not for dashboard).
cc_df = postprocessing_funcs.blank_uom_for_default_flat_rate_cc(cc_df)
# Contract Config specific postprocessing steps:
# Apply json formatting
cc_df["PAYER_STATE"] = cc_df["PAYER_STATE"].apply(
@@ -613,6 +613,27 @@ def standardize_reimb_method_and_fee_schedule(
return df
def blank_uom_for_default_flat_rate_cc(df: pd.DataFrame) -> pd.DataFrame:
"""
CC output only: blank UNIT_OF_MEASURE when DEFAULT_IND='Y' and method is flat rate.
Ensures default flat-rate reimbursements are not shown as per-unit in CC output.
Dashboard output is not modified (call this only in contract_config_postprocess).
"""
if not all(
c in df.columns
for c in ("DEFAULT_IND", "AARETE_DERIVED_REIMB_METHOD", "UNIT_OF_MEASURE")
):
return df
default_ind_y = df["DEFAULT_IND"].astype(str).str.strip().str.upper() == "Y"
flat_rate_method = (
df["AARETE_DERIVED_REIMB_METHOD"].astype(str).str.strip().str.lower()
== "flat rate"
)
df.loc[default_ind_y & flat_rate_method, "UNIT_OF_MEASURE"] = ""
return df
def process_patient_age_range(df):
"""
Process the 'PATIENT_AGE_RANGE' column into 'PATIENT_AGE_MIN' and 'PATIENT_AGE_MAX'.
+10 -5
View File
@@ -1286,12 +1286,14 @@ Extract explicit procedure, revenue, diagnosis, and other healthcare codes from
[INSTRUCTIONS]
- For each field, return a list of all codes EXPLICITLY written for that field. The code itself must be written, not language that describes the code.
- FIELD ASSIGNMENT: Assign each code to exactly one field that matches its format. Do not put diagnosis codes (ICD-10: letter followed by digits, e.g. Z00.00, A01.1) in PROCEDURE_CD. Do not put procedure codes (CPT 5 digits or HCPCS 1 letter + 4 digits) in DIAG_CD. Revenue codes (3-4 digits, may end in X) belong only in REVENUE_CD. When in doubt, use format: PROCEDURE_CD = CPT/HCPCS only; DIAG_CD = ICD-10 only.
- Note that codes may be present, but not explicitly labeled as codes. For example, you may simply see "J1098", which is a PROCEDURE_CD. You may see "155" which is a REVENUE_CD, etc.
- If the text gives a range of codes, without listing each code in the range individually, return the range in the format 'LowestCode-HighestCode'.
- If the text describes an entire Code Category (not one specific code) based on a start letter, return the Category in the form "Category: X". e.g. "A-Codes" --> "Category: A", "K-Codes" --> "Category K", etc.
- If the text explicitly says that there is no published or established rate, write "NOT_ESTABLISHED" for the PROCEDURE_CD value.
- If any of the codes are not found, do not write a list for that field. Simply populate the field with an empty list [].
- If a standalone 3-digit code appears without explicit labels (e.g., "DRG," "revenue," "Rev code"), analyze the surrounding context for clues. Look for any direct or indirect references—no matter how subtle—that may suggest a connection to either a Revenue Code or a Grouper Code. If any contextual clues imply relevance to either classification, categorize the code accordingly.
- Return only valid codes that match the stated format (e.g. CPT exactly 5 digits, HCPCS 1 letter + 4 digits); do not invent or guess codes.
[FIELDS]
Populate a JSON dictionary with the following fields:
@@ -1456,16 +1458,19 @@ Examples: ["Specific"] or ["Generic"]
{JSON_LIST_FORMAT_INSTRUCTIONS}"""
def CODE_LAST_CHECK(service) -> Tuple[str, Callable[[str], list]]:
def CODE_LAST_CHECK(service) -> Tuple[str, Callable[[str], Any]]:
"""Call CODE_LAST_CHECK_INSTRUCTION() separately for the cached instruction.
Returns:
Tuple of (prompt_string, parser_function) where parser expects JSON list output.
Uses format-aware list parser with expected_format='str' so single-item list
(e.g. ['Specific'] or ['Generic']) is normalized to a string. Parser returns str.
"""
prompt = f"""[SERVICE TO ANALYZE]
{service}"""
return (prompt, _json_list_parser)
return (
prompt,
_create_json_list_parser(field_name="CODE_LAST_CHECK", expected_format="str"),
)
def FILL_BILL_TYPE_INSTRUCTION() -> str:
@@ -2419,7 +2424,7 @@ def AARETE_DERIVED_PAYER_NAME_INSTRUCTION():
{{"AARETE_DERIVED_PAYER_NAME":"AvMed Health Plans"}}
[OUTPUT FORMAT]
Return ONLY the JSON dictionary with no explanatory text. Use "AARETE_DERIVED_PAYER_NAME" as the key.
Return ONLY the JSON dictionary with no explanatory text. Use "AARETE_DERIVED_PAYER_NAME" as the key.
{JSON_DICT_FORMAT_INSTRUCTIONS}
"""
+78
View File
@@ -7,6 +7,7 @@ from unittest.mock import MagicMock, patch
import pandas as pd
import pytest
from src.pipelines.shared.postprocessing.postprocessing_funcs import (
blank_uom_for_default_flat_rate_cc,
clean_na_values,
deduplicate_provider_columns,
fill_claim_type_from_title,
@@ -21,6 +22,7 @@ from src.pipelines.shared.postprocessing.postprocessing_funcs import (
remove_hyphens,
remove_redundant_reimb_info,
rename_columns,
standardize_reimb_method_and_fee_schedule,
validate_and_reformat_date,
)
from src.pipelines.shared.postprocessing.postprocess import standard_postprocess
@@ -920,6 +922,82 @@ class TestPostprocessFunctions(unittest.TestCase):
self.assertEqual(result_df.loc[1, "CONTRACT_TITLE"], "Another Valid")
class TestStandardizeReimbMethodAndFeeScheduleUOM(unittest.TestCase):
"""Tests for UNIT_OF_MEASURE post-processing when DEFAULT_IND='Y' and flat rate."""
def test_cc_default_flat_rate_uom_blank(self):
"""CC only: DEFAULT_IND='Y' and Flat Rate -> UNIT_OF_MEASURE blank."""
df = pd.DataFrame(
{
"DEFAULT_IND": ["Y"],
"AARETE_DERIVED_REIMB_METHOD": ["Flat Rate"],
"UNIT_OF_MEASURE": ["Per Unit"],
}
)
result = blank_uom_for_default_flat_rate_cc(df)
self.assertEqual(result.loc[0, "UNIT_OF_MEASURE"], "")
def test_cc_default_flat_rate_case_insensitive(self):
"""CC only: DEFAULT_IND='Y' and 'flat rate' (lowercase) -> UNIT_OF_MEASURE blank."""
df = pd.DataFrame(
{
"DEFAULT_IND": ["Y"],
"AARETE_DERIVED_REIMB_METHOD": ["flat rate"],
"UNIT_OF_MEASURE": ["Per Visit"],
}
)
result = blank_uom_for_default_flat_rate_cc(df)
self.assertEqual(result.loc[0, "UNIT_OF_MEASURE"], "")
def test_standardize_does_not_blank_default_flat_rate(self):
"""Shared path: default flat rate keeps UOM (blanking is CC-only)."""
constants = Constants()
df = pd.DataFrame(
{
"DEFAULT_IND": ["Y"],
"AARETE_DERIVED_REIMB_METHOD": ["Flat Rate"],
"UNIT_OF_MEASURE": ["Per Unit"],
"REIMB_TERM": [""],
}
)
result = standardize_reimb_method_and_fee_schedule(
df, constants.VALID_UNIT_OF_MEASURE
)
self.assertEqual(result.loc[0, "UNIT_OF_MEASURE"], "Per Unit")
def test_non_default_flat_rate_uom_per_unit(self):
"""DEFAULT_IND='N', flat rate, empty UOM -> UNIT_OF_MEASURE becomes Per Unit."""
constants = Constants()
df = pd.DataFrame(
{
"DEFAULT_IND": ["N"],
"AARETE_DERIVED_REIMB_METHOD": ["Flat Rate"],
"UNIT_OF_MEASURE": [""],
"REIMB_TERM": [""],
}
)
result = standardize_reimb_method_and_fee_schedule(
df, constants.VALID_UNIT_OF_MEASURE
)
self.assertEqual(result.loc[0, "UNIT_OF_MEASURE"], "Per Unit")
def test_default_non_flat_rate_uom_unchanged(self):
"""DEFAULT_IND='Y' and Fee Schedule -> UNIT_OF_MEASURE unchanged."""
constants = Constants()
df = pd.DataFrame(
{
"DEFAULT_IND": ["Y"],
"AARETE_DERIVED_REIMB_METHOD": ["Fee Schedule"],
"UNIT_OF_MEASURE": ["Per Visit"],
"REIMB_TERM": [""],
}
)
result = standardize_reimb_method_and_fee_schedule(
df, constants.VALID_UNIT_OF_MEASURE
)
self.assertEqual(result.loc[0, "UNIT_OF_MEASURE"], "Per Visit")
class TestOutputFileStructure(unittest.TestCase):
"""Test that the new output file structure is generated correctly."""