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:
committed by
Siddhant Medar
parent
7571d3e3b1
commit
ddefa2ff30
@@ -489,11 +489,13 @@ def code_last_check(service, filename):
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)
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try:
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llm_answer_final = _parser(llm_answer_raw)
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return llm_answer_final[0]
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except:
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return llm_answer_final if llm_answer_final else "Generic"
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except Exception:
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logging.error(
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"Failed to parse LLM response in code_last_check: %s", llm_answer_raw
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)
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return "Generic"
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def fill_bill_type(
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service,
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answer_dict,
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@@ -743,6 +743,11 @@ def assign_child_ranks(df, grouper_col="grouping_key"):
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parents = df[df["parent"]].copy()
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children = df[~df["parent"]].copy()
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# Ensure child_rank column exists so concat result has it when there are no
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# children (otherwise result["child_rank"].astype(str) raises KeyError).
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parents["child_rank"] = ""
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children["child_rank"] = ""
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# For each child, find their actual parent's identity
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# Then group children by the parent they're actually assigned to
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children["_parent_identity"] = None
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@@ -1096,6 +1101,7 @@ def parent_child_mapping(
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"parent_child_flag",
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"parent_name",
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]
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cols_to_keep = [col for col in cols_to_keep if col in pc_df.columns]
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# Ensure consistent types for merge - convert both to string to avoid datetime/object mismatch
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pc_df["fixed_effective_date"] = pc_df["fixed_effective_date"].astype(str)
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@@ -150,6 +150,9 @@ def contract_config_postprocess(df, constants: Constants):
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if cc_df.shape[0] == 0:
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return cc_df
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# CC only: blank UNIT_OF_MEASURE for default flat-rate rows (not for dashboard).
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cc_df = postprocessing_funcs.blank_uom_for_default_flat_rate_cc(cc_df)
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# Contract Config specific postprocessing steps:
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# Apply json formatting
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cc_df["PAYER_STATE"] = cc_df["PAYER_STATE"].apply(
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@@ -613,6 +613,27 @@ def standardize_reimb_method_and_fee_schedule(
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return df
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def blank_uom_for_default_flat_rate_cc(df: pd.DataFrame) -> pd.DataFrame:
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"""
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CC output only: blank UNIT_OF_MEASURE when DEFAULT_IND='Y' and method is flat rate.
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Ensures default flat-rate reimbursements are not shown as per-unit in CC output.
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Dashboard output is not modified (call this only in contract_config_postprocess).
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"""
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if not all(
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c in df.columns
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for c in ("DEFAULT_IND", "AARETE_DERIVED_REIMB_METHOD", "UNIT_OF_MEASURE")
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):
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return df
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default_ind_y = df["DEFAULT_IND"].astype(str).str.strip().str.upper() == "Y"
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flat_rate_method = (
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df["AARETE_DERIVED_REIMB_METHOD"].astype(str).str.strip().str.lower()
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== "flat rate"
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)
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df.loc[default_ind_y & flat_rate_method, "UNIT_OF_MEASURE"] = ""
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return df
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def process_patient_age_range(df):
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"""
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Process the 'PATIENT_AGE_RANGE' column into 'PATIENT_AGE_MIN' and 'PATIENT_AGE_MAX'.
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@@ -1286,12 +1286,14 @@ Extract explicit procedure, revenue, diagnosis, and other healthcare codes from
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[INSTRUCTIONS]
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- 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.
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- 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.
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- 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.
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- If the text gives a range of codes, without listing each code in the range individually, return the range in the format 'LowestCode-HighestCode'.
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- 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.
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- If the text explicitly says that there is no published or established rate, write "NOT_ESTABLISHED" for the PROCEDURE_CD value.
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- If any of the codes are not found, do not write a list for that field. Simply populate the field with an empty list [].
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- 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.
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- 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.
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[FIELDS]
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Populate a JSON dictionary with the following fields:
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@@ -1456,16 +1458,19 @@ Examples: ["Specific"] or ["Generic"]
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{JSON_LIST_FORMAT_INSTRUCTIONS}"""
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def CODE_LAST_CHECK(service) -> Tuple[str, Callable[[str], list]]:
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def CODE_LAST_CHECK(service) -> Tuple[str, Callable[[str], Any]]:
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"""Call CODE_LAST_CHECK_INSTRUCTION() separately for the cached instruction.
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Returns:
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Tuple of (prompt_string, parser_function) where parser expects JSON list output.
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Uses format-aware list parser with expected_format='str' so single-item list
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(e.g. ['Specific'] or ['Generic']) is normalized to a string. Parser returns str.
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"""
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prompt = f"""[SERVICE TO ANALYZE]
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{service}"""
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return (prompt, _json_list_parser)
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return (
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prompt,
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_create_json_list_parser(field_name="CODE_LAST_CHECK", expected_format="str"),
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)
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def FILL_BILL_TYPE_INSTRUCTION() -> str:
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@@ -2419,7 +2424,7 @@ def AARETE_DERIVED_PAYER_NAME_INSTRUCTION():
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{{"AARETE_DERIVED_PAYER_NAME":"AvMed Health Plans"}}
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[OUTPUT FORMAT]
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Return ONLY the JSON dictionary with no explanatory text. Use "AARETE_DERIVED_PAYER_NAME" as the key.
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Return ONLY the JSON dictionary with no explanatory text. Use "AARETE_DERIVED_PAYER_NAME" as the key.
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{JSON_DICT_FORMAT_INSTRUCTIONS}
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"""
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@@ -7,6 +7,7 @@ from unittest.mock import MagicMock, patch
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import pandas as pd
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import pytest
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from src.pipelines.shared.postprocessing.postprocessing_funcs import (
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blank_uom_for_default_flat_rate_cc,
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clean_na_values,
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deduplicate_provider_columns,
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fill_claim_type_from_title,
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@@ -21,6 +22,7 @@ from src.pipelines.shared.postprocessing.postprocessing_funcs import (
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remove_hyphens,
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remove_redundant_reimb_info,
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rename_columns,
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standardize_reimb_method_and_fee_schedule,
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validate_and_reformat_date,
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)
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from src.pipelines.shared.postprocessing.postprocess import standard_postprocess
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@@ -920,6 +922,82 @@ class TestPostprocessFunctions(unittest.TestCase):
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self.assertEqual(result_df.loc[1, "CONTRACT_TITLE"], "Another Valid")
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class TestStandardizeReimbMethodAndFeeScheduleUOM(unittest.TestCase):
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"""Tests for UNIT_OF_MEASURE post-processing when DEFAULT_IND='Y' and flat rate."""
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def test_cc_default_flat_rate_uom_blank(self):
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"""CC only: DEFAULT_IND='Y' and Flat Rate -> UNIT_OF_MEASURE blank."""
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df = pd.DataFrame(
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{
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"DEFAULT_IND": ["Y"],
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"AARETE_DERIVED_REIMB_METHOD": ["Flat Rate"],
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"UNIT_OF_MEASURE": ["Per Unit"],
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}
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)
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result = blank_uom_for_default_flat_rate_cc(df)
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self.assertEqual(result.loc[0, "UNIT_OF_MEASURE"], "")
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def test_cc_default_flat_rate_case_insensitive(self):
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"""CC only: DEFAULT_IND='Y' and 'flat rate' (lowercase) -> UNIT_OF_MEASURE blank."""
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df = pd.DataFrame(
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{
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"DEFAULT_IND": ["Y"],
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"AARETE_DERIVED_REIMB_METHOD": ["flat rate"],
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"UNIT_OF_MEASURE": ["Per Visit"],
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}
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)
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result = blank_uom_for_default_flat_rate_cc(df)
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self.assertEqual(result.loc[0, "UNIT_OF_MEASURE"], "")
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def test_standardize_does_not_blank_default_flat_rate(self):
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"""Shared path: default flat rate keeps UOM (blanking is CC-only)."""
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constants = Constants()
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df = pd.DataFrame(
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{
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"DEFAULT_IND": ["Y"],
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"AARETE_DERIVED_REIMB_METHOD": ["Flat Rate"],
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"UNIT_OF_MEASURE": ["Per Unit"],
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"REIMB_TERM": [""],
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}
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)
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result = standardize_reimb_method_and_fee_schedule(
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df, constants.VALID_UNIT_OF_MEASURE
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)
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self.assertEqual(result.loc[0, "UNIT_OF_MEASURE"], "Per Unit")
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def test_non_default_flat_rate_uom_per_unit(self):
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"""DEFAULT_IND='N', flat rate, empty UOM -> UNIT_OF_MEASURE becomes Per Unit."""
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constants = Constants()
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df = pd.DataFrame(
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{
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"DEFAULT_IND": ["N"],
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"AARETE_DERIVED_REIMB_METHOD": ["Flat Rate"],
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"UNIT_OF_MEASURE": [""],
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"REIMB_TERM": [""],
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}
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)
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result = standardize_reimb_method_and_fee_schedule(
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df, constants.VALID_UNIT_OF_MEASURE
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)
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self.assertEqual(result.loc[0, "UNIT_OF_MEASURE"], "Per Unit")
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def test_default_non_flat_rate_uom_unchanged(self):
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"""DEFAULT_IND='Y' and Fee Schedule -> UNIT_OF_MEASURE unchanged."""
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constants = Constants()
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df = pd.DataFrame(
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{
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"DEFAULT_IND": ["Y"],
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"AARETE_DERIVED_REIMB_METHOD": ["Fee Schedule"],
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"UNIT_OF_MEASURE": ["Per Visit"],
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"REIMB_TERM": [""],
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}
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)
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result = standardize_reimb_method_and_fee_schedule(
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df, constants.VALID_UNIT_OF_MEASURE
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)
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self.assertEqual(result.loc[0, "UNIT_OF_MEASURE"], "Per Visit")
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class TestOutputFileStructure(unittest.TestCase):
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"""Test that the new output file structure is generated correctly."""
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