Coverage for claims\models.py: 100%

1from decimal import Decimal 

2 

3from django.contrib.auth.models import User 

4from django.db import models 

5from django.utils import timezone 

6 

7 

8class Claim(models.Model): 

9 """ 

10 Represents a single insurance claim. 

11 """ 

12 

13 class ClaimStatus(models.TextChoices): 

14 """Defines the possible statuses for a claim.""" 

15 

16 PAID = "PAID", "Paid" 

17 DENIED = "DENIED", "Denied" 

18 UNDER_REVIEW = "UNDER REVIEW", "Under Review" 

19 

20 id = models.IntegerField(primary_key=True, editable=False) 

21 patient_name = models.CharField( 

22 max_length=255, db_index=True, help_text="Full name of the patient." 

23 ) 

24 billed_amount = models.DecimalField( 

25 max_digits=10, 

26 decimal_places=2, 

27 help_text="The amount originally billed to the insurer.", 

28 ) 

29 paid_amount = models.DecimalField( 

30 max_digits=10, decimal_places=2, help_text="The amount paid by the insurer." 

31 ) 

32 status = models.CharField( 

33 max_length=20, 

34 choices=ClaimStatus.choices, 

35 db_index=True, 

36 help_text="The current processing status of the claim.", 

37 ) 

38 insurer_name = models.CharField( 

39 max_length=255, db_index=True, help_text="The name of the insurance company." 

40 ) 

41 discharge_date = models.DateField() 

42 is_flagged = models.BooleanField( 

43 default=False, help_text="Mark this claim for special review or follow-up." 

44 ) 

45 

46 # Auditing fields for tracking who flagged a claim and when. 

47 flagged_by = models.ForeignKey( 

48 User, 

49 on_delete=models.SET_NULL, 

50 null=True, 

51 blank=True, 

52 related_name="flagged_claims", 

53 help_text="The user who flagged this claim.", 

54 ) 

55 flagged_at = models.DateTimeField( 

56 null=True, blank=True, help_text="The timestamp when the claim was flagged." 

57 ) 

58 

59 # Timestamps for record creation and updates. 

60 created_at = models.DateTimeField(auto_now_add=True) 

61 updated_at = models.DateTimeField(auto_now=True) 

62 

63 def __str__(self) -> str: 

64 """String representation of the Claim model.""" 

65 return f"Claim {self.id} for {self.patient_name}" 

66 

67 @property 

68 def underpayment(self) -> Decimal: 

69 """ 

70 Calculates the difference between the billed and paid amounts and get the underpayment value. 

71 """ 

72 return self.billed_amount - self.paid_amount 

73 

74 

75class ClaimDetail(models.Model): 

76 """ 

77 Provides specific, detailed information related to a single claim, 

78 such as medical codes or denial reasons. 

79 """ 

80 

81 # A OneToOneField ensures that a claim can only have one detail record. 

82 claim = models.OneToOneField( 

83 Claim, on_delete=models.CASCADE, related_name="details" 

84 ) 

85 cpt_codes = models.CharField( 

86 max_length=255, 

87 help_text="Comma-separated CPT (Current Procedural Terminology) codes.", 

88 ) 

89 denial_reason = models.TextField( 

90 blank=True, 

91 null=True, 

92 help_text="The reason provided by the insurer for denying the claim.", 

93 ) 

94 

95 def __str__(self) -> str: 

96 """String representation of the ClaimDetail model.""" 

97 return f"Details for Claim {self.claim.id}" 

98 

99 

100class Note(models.Model): 

101 """ 

102 Stores user-generated annotations or notes for a specific claim. 

103 """ 

104 

105 claim = models.ForeignKey(Claim, on_delete=models.CASCADE, related_name="notes") 

106 note = models.TextField(help_text="The content of the note.") 

107 created_at = models.DateTimeField(default=timezone.now) 

108 user = models.ForeignKey( 

109 User, 

110 on_delete=models.SET_NULL, 

111 null=True, 

112 help_text="The user who created this note.", 

113 ) 

114 

115 def __str__(self) -> str: 

116 """ 

117 Provides a truncated preview of the note for display in the admin 

118 or other contexts. 

119 """ 

120 note_preview: str = ( 

121 (self.note[:75] + "...") if len(self.note) > 75 else self.note 

122 ) 

123 return f"Note on {self.claim.id} at {self.created_at.strftime('%Y-%m-%d')}: {note_preview}"