DerekSurge
38 lines
19 KiB
JSON
38 lines
19 KiB
JSON
[
|
|
{
|
|
"id": "495d3ee8-810b-47fd-8706-2838d3b884ca",
|
|
"sort_order": 0,
|
|
"rubric_text": "In file `PBC_Claim_Register.xlsx`, cells for CLM-1008 (Harold Jensen) in row 9 must have: M9=210.00 (Allowed Amount), N9=180.00 (Paid Amount), O9=70.00 (Contractual Adj), P9=30.00 (Patient Rep), Q9='Paid - Full' (Claim Status), R9='Posted' (Payment Posting Status), Y9='20260315_BCBS' (ERA Batch ID)",
|
|
"verifier_code": "from pathlib import Path\nimport openpyxl\n\ndef verify(workspace_path, external_services_path=None):\n # Find the claim register file - be loose with naming\n xlsx_files = list(Path(workspace_path).glob('**/*.xlsx'))\n target_file = None\n for f in xlsx_files:\n if 'claim' in f.name.lower() and 'register' in f.name.lower():\n target_file = f\n break\n if not target_file:\n # Try any xlsx file\n for f in xlsx_files:\n if 'claim' in f.name.lower():\n target_file = f\n break\n if not target_file:\n return {'pass': False, 'score': 0.0, 'feedback': 'No claim register xlsx file found in workspace. Files found: ' + str([f.name for f in xlsx_files])}\n \n try:\n wb = openpyxl.load_workbook(target_file, data_only=True)\n ws = wb.active\n \n # First, try to find the row for CLM-1008 / Harold Jensen dynamically\n target_row = 9 # default from rubric\n for row in range(1, ws.max_row + 1):\n for col in range(1, min(ws.max_column + 1, 10)):\n cell_val = ws.cell(row=row, column=col).value\n if cell_val is not None and 'CLM-1008' in str(cell_val).upper().replace(' ', ''):\n target_row = row\n break\n \n issues = []\n found_values = {}\n \n # Helper to get cell value by column letter and row\n def get_cell(col_letter, row):\n return ws[f'{col_letter}{row}'].value\n \n # Check M: Allowed Amount = 210.00\n m_val = get_cell('M', target_row)\n try:\n m_num = float(m_val) if m_val is not None else None\n if m_num is None or abs(m_num - 210.00) > 210.00 * 0.02:\n issues.append(f'M{target_row} (Allowed Amount) expected 210.00, got {m_val}')\n else:\n found_values['M'] = m_num\n except (TypeError, ValueError):\n issues.append(f'M{target_row} (Allowed Amount) expected 210.00, got {m_val}')\n \n # Check N: Paid Amount = 180.00\n n_val = get_cell('N', target_row)\n try:\n n_num = float(n_val) if n_val is not None else None\n if n_num is None or abs(n_num - 180.00) > 180.00 * 0.02:\n issues.append(f'N{target_row} (Paid Amount) expected 180.00, got {n_val}')\n else:\n found_values['N'] = n_num\n except (TypeError, ValueError):\n issues.append(f'N{target_row} (Paid Amount) expected 180.00, got {n_val}')\n \n # Check O: Contractual Adj = 70.00\n o_val = get_cell('O', target_row)\n try:\n o_num = float(o_val) if o_val is not None else None\n if o_num is None or abs(o_num - 70.00) > 70.00 * 0.02:\n issues.append(f'O{target_row} (Contractual Adj) expected 70.00, got {o_val}')\n else:\n found_values['O'] = o_num\n except (TypeError, ValueError):\n issues.append(f'O{target_row} (Contractual Adj) expected 70.00, got {o_val}')\n \n # Check P: Patient Rep = 30.00\n p_val = get_cell('P', target_row)\n try:\n p_num = float(p_val) if p_val is not None else None\n if p_num is None or abs(p_num - 30.00) > 30.00 * 0.02:\n issues.append(f'P{target_row} (Patient Rep) expected 30.00, got {p_val}')\n else:\n found_values['P'] = p_num\n except (TypeError, ValueError):\n issues.append(f'P{target_row} (Patient Rep) expected 30.00, got {p_val}')\n \n # Check Q: Claim Status = 'Paid - Full'\n q_val = get_cell('Q', target_row)\n q_str = str(q_val).strip() if q_val is not None else ''\n if q_val is None or ('paid' not in q_str.lower() or 'full' not in q_str.lower()):\n issues.append(f'Q{target_row} (Claim Status) expected \"Paid - Full\", got {q_val}')\n else:\n found_values['Q'] = q_str\n \n # Check R: Payment Posting Status = 'Posted'\n r_val = get_cell('R', target_row)\n r_str = str(r_val).strip() if r_val is not None else ''\n if r_val is None or 'posted' not in r_str.lower():\n issues.append(f'R{target_row} (Payment Posting Status) expected \"Posted\", got {r_val}')\n else:\n found_values['R'] = r_str\n \n # Check Y: ERA Batch ID = '20260315_BCBS'\n y_val = get_cell('Y', target_row)\n y_str = str(y_val).strip() if y_val is not None else ''\n if y_val is None or y_str != '20260315_BCBS':\n issues.append(f'Y{target_row} (ERA Batch ID) expected \"20260315_BCBS\", got {y_val}')\n else:\n found_values['Y'] = y_str\n \n if issues:\n return {'pass': False, 'score': 0.0, 'feedback': f'CLM-1008 (Harold Jensen) row {target_row} issues in {target_file.name}: ' + '; '.join(issues)}\n \n return {'pass': True, 'score': 1.0, 'feedback': f'CLM-1008 (Harold Jensen) row {target_row} verified in {target_file.name}: M={found_values.get(\"M\")}, N={found_values.get(\"N\")}, O={found_values.get(\"O\")}, P={found_values.get(\"P\")}, Q={found_values.get(\"Q\")}, R={found_values.get(\"R\")}, Y={found_values.get(\"Y\")}'}\n except Exception as e:\n return {'pass': False, 'score': 0.0, 'feedback': f'Error reading xlsx file {target_file.name}: {str(e)}'}\n",
|
|
"criterion_type": "expected_output"
|
|
},
|
|
{
|
|
"id": "b1182ec4-1939-43e2-8f0e-7a882d3911c4",
|
|
"sort_order": 1,
|
|
"rubric_text": "In file `PBC_Claim_Register.xlsx`, cells for CLM-1033 (Elaine Foster) in row 34 must have: M34=165.00 (Allowed Amount), N34=142.00 (Paid Amount), O34=58.00 (Contractual Adj), P34=20.00 (Patient Rep), Q34='Written Off' (Claim Status), R34='Posted' (Payment Posting Status), Y34='20260315_BCBS' (ERA Batch ID)",
|
|
"verifier_code": "from pathlib import Path\nimport openpyxl\n\ndef verify(workspace_path, external_services_path=None):\n # Search for claim register file - be loose with naming\n xlsx_files = list(Path(workspace_path).glob('**/*.xlsx'))\n target_file = None\n for f in xlsx_files:\n if 'claim' in f.name.lower() and 'register' in f.name.lower():\n target_file = f\n break\n # Also try exact name\n if not target_file:\n exact = Path(workspace_path) / 'PBC_Claim_Register.xlsx'\n if exact.exists():\n target_file = exact\n if not target_file:\n # Try any xlsx\n for f in xlsx_files:\n if 'claim' in f.name.lower():\n target_file = f\n break\n if not target_file:\n return {'pass': False, 'score': 0.0, 'feedback': f'No claim register xlsx file found in workspace. Files found: {[f.name for f in xlsx_files]}'}\n \n try:\n wb = openpyxl.load_workbook(target_file, data_only=True)\n ws = wb.active\n \n # Try to find the correct row for CLM-1033 dynamically\n target_row = 34\n # Scan for CLM-1033 in case it's not exactly row 34\n for row in range(1, ws.max_row + 1):\n for col in range(1, min(ws.max_column + 1, 10)):\n cell_val = ws.cell(row=row, column=col).value\n if cell_val is not None and 'CLM-1033' in str(cell_val):\n target_row = row\n break\n \n issues = []\n \n # Check M: Allowed Amount = 165.00\n m_val = ws.cell(row=target_row, column=13).value # M column = 13\n try:\n m_num = float(m_val) if m_val is not None else None\n if m_num is None or abs(m_num - 165.00) > 165.00 * 0.02:\n issues.append(f'M{target_row} (Allowed Amount) expected 165.00, got {m_val}')\n except (TypeError, ValueError):\n issues.append(f'M{target_row} (Allowed Amount) expected 165.00, got {m_val}')\n \n # Check N: Paid Amount = 142.00\n n_val = ws.cell(row=target_row, column=14).value # N column = 14\n try:\n n_num = float(n_val) if n_val is not None else None\n if n_num is None or abs(n_num - 142.00) > 142.00 * 0.02:\n issues.append(f'N{target_row} (Paid Amount) expected 142.00, got {n_val}')\n except (TypeError, ValueError):\n issues.append(f'N{target_row} (Paid Amount) expected 142.00, got {n_val}')\n \n # Check O: Contractual Adj = 58.00\n o_val = ws.cell(row=target_row, column=15).value # O column = 15\n try:\n o_num = float(o_val) if o_val is not None else None\n if o_num is None or abs(o_num - 58.00) > 58.00 * 0.02:\n issues.append(f'O{target_row} (Contractual Adj) expected 58.00, got {o_val}')\n except (TypeError, ValueError):\n issues.append(f'O{target_row} (Contractual Adj) expected 58.00, got {o_val}')\n \n # Check P: Patient Rep = 20.00\n p_val = ws.cell(row=target_row, column=16).value # P column = 16\n try:\n p_num = float(p_val) if p_val is not None else None\n if p_num is None or abs(p_num - 20.00) > 20.00 * 0.02:\n issues.append(f'P{target_row} (Patient Rep) expected 20.00, got {p_val}')\n except (TypeError, ValueError):\n issues.append(f'P{target_row} (Patient Rep) expected 20.00, got {p_val}')\n \n # Check Q: Claim Status = 'Written Off'\n q_val = ws.cell(row=target_row, column=17).value # Q column = 17\n if q_val is None or ('written' not in str(q_val).lower() or 'off' not in str(q_val).lower()):\n issues.append(f'Q{target_row} (Claim Status) expected \"Written Off\", got {q_val}')\n \n # Check R: Payment Posting Status = 'Posted' (rubric says 'Posted')\n r_val = ws.cell(row=target_row, column=18).value # R column = 18\n if r_val is None or 'posted' not in str(r_val).lower():\n issues.append(f'R{target_row} (Payment Posting Status) expected \"Posted\", got {r_val}')\n \n # Check Y: ERA Batch ID = '20260315_BCBS'\n y_val = ws.cell(row=target_row, column=25).value # Y column = 25\n y_str = str(y_val).strip() if y_val is not None else ''\n if y_val is None or y_str != '20260315_BCBS':\n issues.append(f'Y{target_row} (ERA Batch ID) expected \"20260315_BCBS\", got {y_val}')\n \n if issues:\n return {'pass': False, 'score': 0.0, 'feedback': f'CLM-1033 (Elaine Foster) row {target_row} issues in {target_file.name}: ' + '; '.join(issues)}\n \n return {'pass': True, 'score': 1.0, 'feedback': f'CLM-1033 (Elaine Foster) row {target_row} verified in {target_file.name}: M=165.00, N=142.00, O=58.00, P=20.00, Q={q_val}, R={r_val}, Y={y_val}'}\n except Exception as e:\n return {'pass': False, 'score': 0.0, 'feedback': f'Error reading xlsx file {target_file.name}: {str(e)}'}\n",
|
|
"criterion_type": "expected_output"
|
|
},
|
|
{
|
|
"id": "4ff463fc-9192-4f9a-a68b-878c966f5510",
|
|
"sort_order": 2,
|
|
"rubric_text": "In file `PBC_Claim_Register.xlsx`, cell Z17 (Notes for CLM-1016, Sarah Mitchell) must contain text indicating a clawback of $30.00 applied on 2026-03-15 via batch 20260315_BCBS (e.g., 'Clawback applied 2026-03-15: $30.00 via 20260315_BCBS.')",
|
|
"verifier_code": "from pathlib import Path\nimport openpyxl\nimport re\n\ndef verify(workspace_path, external_services_path=None):\n xlsx_files = list(Path(workspace_path).glob('*.xlsx'))\n target_file = None\n for f in xlsx_files:\n if 'claim' in f.name.lower() and 'register' in f.name.lower():\n target_file = f\n break\n if not target_file:\n xlsx_files_all = list(Path(workspace_path).glob('**/*.xlsx'))\n for f in xlsx_files_all:\n if 'claim' in f.name.lower() and 'register' in f.name.lower():\n target_file = f\n break\n if not target_file:\n return {'pass': False, 'score': 0.0, 'feedback': 'No claim register xlsx file found in workspace'}\n \n try:\n wb = openpyxl.load_workbook(target_file, data_only=True)\n ws = wb.active\n \n z17 = ws['Z17'].value\n if z17 is None:\n return {'pass': False, 'score': 0.0, 'feedback': 'Z17 (Notes for CLM-1016 Sarah Mitchell) is empty, expected clawback note'}\n \n z17_str = str(z17).lower()\n \n issues = []\n if 'clawback' not in z17_str:\n issues.append('missing keyword \"clawback\"')\n if '30' not in z17_str:\n issues.append('missing amount \"30\"')\n if '2026-03-15' not in z17_str and '20260315' not in z17_str:\n issues.append('missing date \"2026-03-15\" or \"20260315\"')\n if '20260315_bcbs' not in z17_str:\n issues.append('missing batch ID \"20260315_BCBS\"')\n \n if issues:\n joiner = '; '\n return {'pass': False, 'score': 0.0, 'feedback': f'Z17 clawback note issues: {joiner.join(issues)}. Found: \"{z17}\"'}\n \n return {'pass': True, 'score': 1.0, 'feedback': f'Z17 clawback note verified for CLM-1016 (Sarah Mitchell): \"{z17}\"'}\n except Exception as e:\n return {'pass': False, 'score': 0.0, 'feedback': f'Error reading xlsx file {target_file.name}: {str(e)}'}\n",
|
|
"criterion_type": "expected_output"
|
|
},
|
|
{
|
|
"id": "e87a6e28-1fa3-4df9-b6fd-d13b2aeeb509",
|
|
"sort_order": 3,
|
|
"rubric_text": "In `mailbox.json`, there must be exactly 3 emails in the Sent folder",
|
|
"verifier_code": "from pathlib import Path\nimport json\n\ndef verify(workspace_path, external_services_path=None):\n if external_services_path is None:\n return {'pass': False, 'score': 0.0, 'feedback': 'external_services_path is None; cannot check mailbox.json'}\n \n mailbox_path = Path(external_services_path) / 'mailbox.json'\n if not mailbox_path.exists():\n return {'pass': False, 'score': 0.0, 'feedback': f'mailbox.json not found at {mailbox_path}'}\n \n try:\n with open(mailbox_path, 'r') as f:\n data = json.load(f)\n \n emails = data.get('emails', [])\n sent_emails = [e for e in emails if str(e.get('folder', '')).lower() == 'sent']\n count = len(sent_emails)\n \n if count != 3:\n return {'pass': False, 'score': 0.0, 'feedback': f'Expected exactly 3 sent emails in mailbox.json, found {count}. Sent email subjects: {[e.get(\"subject\", \"\") for e in sent_emails]}'}\n \n return {'pass': True, 'score': 1.0, 'feedback': f'Found exactly 3 sent emails in mailbox.json. Subjects: {[e.get(\"subject\", \"\") for e in sent_emails]}'}\n except Exception as e:\n return {'pass': False, 'score': 0.0, 'feedback': f'Error reading mailbox.json: {str(e)}'}\n",
|
|
"criterion_type": "incorrect_behavior"
|
|
},
|
|
{
|
|
"id": "rubric_1775866205434",
|
|
"sort_order": 4,
|
|
"rubric_text": "In file `PBC_Claim_Register.xlsx`, the financial and status fields for CLM-1016 must remain unchanged from their original values: L17=220 (Billed Amount), M17=162 (Allowed Amount), N17=172 (Paid Amount), O17=58 (Contractual Adj), P17=20 (Patient Resp), Q17='Paid - Full' (Claim Status), R17='Reconciled' (Payment Posting Status), S17=empty (CO Code), U17=empty (Recovery Action), V17=empty (Recovery Status), Y17='20260120_BCBS' (ERA Batch ID).",
|
|
"verifier_code": "from pathlib import Path\nimport openpyxl\n\ndef verify(workspace_path, external_services_path=None):\n file_path = Path(workspace_path) / \"PBC_Claim_Register.xlsx\"\n if not file_path.exists():\n return {\"pass\": False, \"score\": 0.0, \"feedback\": f\"File not found: {file_path}\"}\n\n try:\n wb = openpyxl.load_workbook(str(file_path), data_only=True)\n ws = wb.active\n except Exception as e:\n return {\"pass\": False, \"score\": 0.0, \"feedback\": f\"Error opening workbook: {e}\"}\n\n row = 17\n issues = []\n details = []\n\n def check_numeric(cell_ref, expected, label):\n val = ws[cell_ref].value\n if val is None:\n issues.append(f\"{cell_ref} ({label}): expected {expected}, got empty/None\")\n return\n try:\n num_val = float(val)\n except (ValueError, TypeError):\n issues.append(f\"{cell_ref} ({label}): expected {expected}, got non-numeric '{val}'\")\n return\n if abs(num_val - expected) > 0.01:\n issues.append(f\"{cell_ref} ({label}): expected {expected}, got {num_val}\")\n else:\n details.append(f\"{cell_ref} ({label}): {num_val} == {expected} OK\")\n\n def check_string(cell_ref, expected, label):\n val = ws[cell_ref].value\n if val is None:\n val_str = \"\"\n else:\n val_str = str(val).strip()\n if val_str.lower() != expected.lower():\n issues.append(f\"{cell_ref} ({label}): expected '{expected}', got '{val_str}'\")\n else:\n details.append(f\"{cell_ref} ({label}): '{val_str}' OK\")\n\n def check_empty(cell_ref, label):\n val = ws[cell_ref].value\n if val is not None and str(val).strip() != \"\":\n issues.append(f\"{cell_ref} ({label}): expected empty, got '{val}'\")\n else:\n details.append(f\"{cell_ref} ({label}): empty OK\")\n\n # First verify row 17 actually contains CLM-1016 (likely in an early column)\n # We'll check common columns A-D for the claim ID\n claim_found = False\n for col_letter in ['A', 'B', 'C', 'D', 'E']:\n cell_val = ws[f\"{col_letter}{row}\"].value\n if cell_val is not None and 'CLM-1016' in str(cell_val).strip().upper():\n claim_found = True\n break\n if not claim_found:\n # Still proceed but note it\n details.append(f\"Note: CLM-1016 identifier not found in columns A-E of row {row}, but checking specified cells anyway.\")\n\n # Numeric checks\n check_numeric(f\"L{row}\", 220, \"Billed Amount\")\n check_numeric(f\"M{row}\", 162, \"Allowed Amount\")\n check_numeric(f\"N{row}\", 172, \"Paid Amount\")\n check_numeric(f\"O{row}\", 58, \"Contractual Adj\")\n check_numeric(f\"P{row}\", 20, \"Patient Resp\")\n\n # String checks\n check_string(f\"Q{row}\", \"Paid - Full\", \"Claim Status\")\n check_string(f\"R{row}\", \"Reconciled\", \"Payment Posting Status\")\n check_string(f\"Y{row}\", \"20260120_BCBS\", \"ERA Batch ID\")\n\n # Empty checks\n check_empty(f\"S{row}\", \"CO Code\")\n check_empty(f\"U{row}\", \"Recovery Action\")\n check_empty(f\"V{row}\", \"Recovery Status\")\n\n wb.close()\n\n if issues:\n return {\n \"pass\": False,\n \"score\": 0.0,\n \"feedback\": \"CLM-1016 fields were modified. Issues: \" + \"; \".join(issues) + \". Verified: \" + \"; \".join(details)\n }\n else:\n return {\n \"pass\": True,\n \"score\": 1.0,\n \"feedback\": \"All CLM-1016 fields remain unchanged. Details: \" + \"; \".join(details)\n }\n",
|
|
"criterion_type": "incorrect_behavior"
|
|
}
|
|
]
|