def test_submit_claim_dedrem_limit_delivery(self): # Given insuree = create_test_insuree() self.assertIsNotNone(insuree) service = create_test_service("D", custom_props={}) item = create_test_item("D", custom_props={}) product = create_test_product("BCUL0001", custom_props={ "name": "Basic Cover Ultha", "lump_sum": 10_000, "max_amount_delivery": 55, }) product_service = create_test_product_service(product, service) product_item = create_test_product_item(product, item) policy = create_test_policy(product, insuree, link=True) pricelist_detail1 = add_service_to_hf_pricelist(service) pricelist_detail2 = add_item_to_hf_pricelist(item) # The insuree has a patient_category of 6, not matching the service category claim1 = create_test_claim({"insuree_id": insuree.id}) service1 = create_test_claimservice( claim1, custom_props={"service_id": service.id}) item1 = create_test_claimitem(claim1, "D", custom_props={"item_id": item.id}) errors = validate_claim(claim1, True) errors += validate_assign_prod_to_claimitems_and_services(claim1) errors += process_dedrem(claim1, -1, True) self.assertEqual(len(errors), 0)
def test_submit_claim_dedrem(self): # When the insuree already reaches his limit of visits # Given insuree = create_test_insuree() self.assertIsNotNone(insuree) product = create_test_product("VISIT", custom_props={}) policy = create_test_policy(product, insuree, link=True) service = create_test_service("V", custom_props={}) item = create_test_item("D", custom_props={}) product_service = create_test_product_service(product, service) product_item = create_test_product_item(product, item) pricelist_detail1 = add_service_to_hf_pricelist(service) pricelist_detail2 = add_item_to_hf_pricelist(item) claim1 = create_test_claim({"insuree_id": insuree.id}) service1 = create_test_claimservice( claim1, custom_props={"service_id": service.id}) item1 = create_test_claimitem(claim1, "D", custom_props={"item_id": item.id}) errors = validate_claim(claim1, True) errors += validate_assign_prod_to_claimitems_and_services(claim1) errors += process_dedrem(claim1, -1, True) self.assertEqual(len(errors), 0) # Then claim1.refresh_from_db() item1.refresh_from_db() service1.refresh_from_db() self.assertEqual(len(errors), 0) self.assertEqual(item1.price_adjusted, 100) self.assertEqual(item1.price_valuated, 700) self.assertEqual(item1.deductable_amount, 0) self.assertEqual(item1.exceed_ceiling_amount, 0) self.assertIsNone(item1.exceed_ceiling_amount_category) self.assertEqual(item1.remunerated_amount, 700) self.assertEqual(claim1.status, Claim.STATUS_VALUATED) self.assertEqual(claim1.audit_user_id_process, -1) self.assertIsNotNone(claim1.process_stamp) self.assertIsNotNone(claim1.date_processed) dedrem_qs = ClaimDedRem.objects.filter(claim=claim1) self.assertEqual(dedrem_qs.count(), 1) dedrem1 = dedrem_qs.first() self.assertEqual(dedrem1.policy_id, item1.policy_id) self.assertEqual(dedrem1.insuree_id, claim1.insuree_id) self.assertEqual(dedrem1.audit_user_id, -1) self.assertEqual(dedrem1.ded_g, 0) self.assertEqual(dedrem1.rem_g, 1400) self.assertEqual(dedrem1.rem_op, 1400) self.assertIsNone(dedrem1.rem_ip) self.assertEqual(dedrem1.rem_surgery, 0) self.assertEqual(dedrem1.rem_consult, 0) self.assertEqual(dedrem1.rem_hospitalization, 0) self.assertIsNotNone(claim1.validity_from) self.assertIsNone(claim1.validity_to) # tearDown dedrem_qs.delete() service1.delete() item1.delete() claim1.delete() policy.insuree_policies.first().delete() policy.delete() product_item.delete() product_service.delete() pricelist_detail1.delete() pricelist_detail2.delete() service.delete() item.delete() product.delete()
def test_review_reject_delete_dedrem(self): """ This test creates a claim, submits it so that it gets dedrem entries, then submits a review rejecting part of it, then process the claim. It should not be processed (which was ok) but the dedrem should be deleted. """ # Given insuree = create_test_insuree() self.assertIsNotNone(insuree) service = create_test_service("A", custom_props={"name": "test_review_reject_delete_dedrem"}) item = create_test_item("A", custom_props={"name": "test_review_reject_delete_dedrem"}) product = create_test_product("BCUL0001", custom_props={ "name": "Basic Cover Ultha deldedrem", "lump_sum": 10_000, }) product_service = create_test_product_service(product, service) product_item = create_test_product_item(product, item) policy = create_test_policy(product, insuree, link=True) pricelist_detail1 = add_service_to_hf_pricelist(service) pricelist_detail2 = add_item_to_hf_pricelist(item) claim1 = create_test_claim({"insuree_id": insuree.id}) service1 = create_test_claimservice( claim1, custom_props={"service_id": service.id, "qty_provided": 2}) item1 = create_test_claimitem( claim1, "A", custom_props={"item_id": item.id, "qty_provided": 3}) errors = validate_claim(claim1, True) errors += validate_assign_prod_to_claimitems_and_services(claim1) errors += process_dedrem(claim1, -1, False) self.assertEqual(len(errors), 0) # Make sure that the dedrem was generated dedrem = ClaimDedRem.objects.filter(claim=claim1).first() self.assertIsNotNone(dedrem) self.assertEquals(dedrem.rem_g, 500) # 100*2 + 100*3 # Review the claim and reject all of it # A partial rejection would still trigger the process_dedrem and be fine item1.qty_approved = 0 item1.price_approved = 0 item1.status = ClaimItem.STATUS_REJECTED item1.rejection_reason = -1 item1.audit_user_id_review = -1 item1.justification = "Review comment item" item1.save() service1.qty_approved = 0 service1.price_approved = 0 service1.status = ClaimItem.STATUS_REJECTED service1.rejection_reason = -1 service1.audit_user_id_review = -1 service1.justification = "Review comment svc" service1.save() claim1.refresh_from_db() item1.refresh_from_db() service1.refresh_from_db() set_claims_status([claim1.uuid], "review_status", Claim.REVIEW_DELIVERED) update_claims_dedrems([claim1.uuid], User.objects.first()) errors = validate_claim(claim1, True) if len(errors) == 0: errors += validate_assign_prod_to_claimitems_and_services(claim1) errors += process_dedrem(claim1, -1, False) # The claim should be globally rejected since the review rejected all items/svc claim1.refresh_from_db() item1.refresh_from_db() service1.refresh_from_db() self.assertEquals(claim1.status, Claim.STATUS_REJECTED) self.assertEquals(claim1.rejection_reason, REJECTION_REASON_INVALID_ITEM_OR_SERVICE) self.assertEquals(item1.status, ClaimDetail.STATUS_REJECTED) self.assertEquals(item1.rejection_reason, -1) self.assertEquals(service1.status, ClaimDetail.STATUS_REJECTED) self.assertEquals(service1.rejection_reason, -1) # Then dedrem should have been deleted dedrem = ClaimDedRem.objects.filter(claim=claim1).first() self.assertIsNone(dedrem) # tearDown # dedrem.delete() # already done if the test passed delete_claim_with_itemsvc_dedrem_and_history(claim1) policy.insuree_policies.first().delete() policy.delete() product_item.delete() product_service.delete() pricelist_detail1.delete() pricelist_detail2.delete() service.delete() item.delete() product.delete()