Add CMS-855 PDF filler + e-sign fulfillment for Medicare revalidation/enrollment
- cms855_pdf_filler.py: fills official CMS-855I/B/O/A AcroForms from intake (name, NPI, DOB, cert-page printed name) and records the signature anchor at the form's official /Sig box so the e-sign stamper lands on the cert line. - npi_provider handlers (revalidation/reactivation/enrollment) now generate the paper CMS-855, upload it to MinIO, request_esign with anchors, and email the signing link. Human completes/verifies + USPS Priority Mails to the MAC. - scripts/Dockerfile: copy the official CMS-855I/B/O/A forms into the image.
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justin
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7 changed files with 359 additions and 2 deletions
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scripts/document_gen/templates/cms855_pdf_filler.py
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scripts/document_gen/templates/cms855_pdf_filler.py
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"""Fill an official CMS-855 enrollment PDF for Medicare revalidation/enrollment.
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We fill the *official* CMS form (downloaded into ``docs/CMS-855X Form.pdf``)
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using its AcroForm fields, mirroring ``mcs150_pdf_filler.py``. The handful of
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fields we can reliably populate from intake are mapped here; the rest are left
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for a human to complete during review before the form is e-signed and mailed.
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After filling we record a signature anchor at the form's official signature box
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(the ``/Sig`` annotation on the certification page) so the e-sign stamper lands
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the provider's signature exactly on the certification line. The signed PDF is
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then printed and mailed USPS Priority Mail to the provider's MAC.
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Supported forms (by slug -> form type):
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npi-revalidation / medicare-enrollment (individual) -> 855I
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medicare-enrollment (group/supplier) -> 855B
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medicare-enrollment (ordering/referring only) -> 855O
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Usage:
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from scripts.document_gen.templates.cms855_pdf_filler import fill_cms855
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pdf_bytes, anchors, missing = fill_cms855("855i", intake, order_number)
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"""
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from __future__ import annotations
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import io
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import logging
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from pathlib import Path
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LOG = logging.getLogger("cms855_pdf_filler")
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# docs/ lives two levels up from scripts/document_gen/templates/
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DOCS_DIR = Path(__file__).resolve().parents[3] / "docs"
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FORM_PATHS = {
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"855i": DOCS_DIR / "CMS-855I Form.pdf",
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"855b": DOCS_DIR / "CMS-855B Form.pdf",
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"855o": DOCS_DIR / "CMS-855O Form.pdf",
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"855a": DOCS_DIR / "CMS-855A Form.pdf",
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}
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# Map intake keys -> AcroForm field names, per form. Field names are taken from
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# the official PDF's AcroForm (verified against each form's /TU tooltips). Only
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# the reliably-derivable identity fields are mapped; a human completes the rest.
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FIELD_MAPS = {
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# 855I — individual practitioner (most common for revalidation)
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"855i": {
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# Section 2A: individual personal identifying info
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"first_name": "5-1",
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"middle_init": "5-2",
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"last_name": "5-3",
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"npi": "5-13",
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"dob": "5-11",
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# Section 15: certification — printed signer name
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"sign_first": "24-1",
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"sign_middle": "24-2",
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"sign_last": "24-3",
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},
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# 855B — clinic/group practice
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"855b": {
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# Org NPI appears in section 4 area; org name fields vary, so we map the
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# ones we can verify and leave the rest for human completion.
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"org_npi": "11-4",
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},
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# 855O — ordering/referring (no billing). Minimal identity fields.
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"855o": {},
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"855a": {},
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}
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# Official signature annotation(s) on the certification page, by form. Recorded
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# from the PDF's /Sig field rects (page index is 0-based). These let the e-sign
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# stamper place the provider's signature on the exact certification line.
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# rect = [llx, lly, urx, ury] in points; page_w/page_h = mediabox dims.
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SIGNATURE_FIELDS = {
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"855i": [
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{"field": "signer", "page": 24, "rect": [44.9, 522.8, 370.7, 541.2], "page_w": 612.0, "page_h": 792.0},
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],
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# 855b/855o/855a signature rects are populated when those flows go live; the
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# filler still works without them (human places signature during review).
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"855b": [],
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"855o": [],
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"855a": [],
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}
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def _split_name(full: str) -> tuple[str, str, str]:
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"""Split 'First Middle Last' into (first, middle_initial, last)."""
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parts = (full or "").split()
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if not parts:
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return "", "", ""
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if len(parts) == 1:
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return parts[0], "", ""
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if len(parts) == 2:
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return parts[0], "", parts[1]
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return parts[0], parts[1][0], " ".join(parts[2:])
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def determine_form_type(slug: str, intake: dict) -> str:
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"""Pick which 855 form applies for the order."""
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enum_type = (intake.get("enumeration_type") or "").upper()
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if slug == "npi-revalidation":
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# Org NPIs (Type 2) revalidate on 855B; individuals on 855I.
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return "855b" if enum_type in ("NPI-2", "2", "ORGANIZATION") else "855i"
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if slug == "medicare-enrollment":
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return "855b" if enum_type in ("NPI-2", "2", "ORGANIZATION") else "855i"
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return "855i"
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def fill_cms855(form_type: str, intake: dict, order_number: str = "") -> tuple[bytes, list[dict], list[str]]:
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"""Fill the official CMS-855 form.
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Returns (pdf_bytes, signature_anchors, unmapped_fields_note).
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``signature_anchors`` is the list the e-sign stamper consumes.
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``unmapped_fields_note`` lists data we could NOT auto-place, for the human
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reviewer to complete before mailing.
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"""
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try:
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from pypdf import PdfReader, PdfWriter
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except ImportError as exc: # pragma: no cover
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raise RuntimeError("pypdf is required to fill CMS-855 forms") from exc
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form_type = (form_type or "855i").lower()
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form_path = FORM_PATHS.get(form_type)
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if not form_path or not form_path.exists():
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raise FileNotFoundError(f"Official form not found for {form_type}: {form_path}")
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reader = PdfReader(str(form_path))
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writer = PdfWriter()
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writer.append(reader)
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fmap = FIELD_MAPS.get(form_type, {})
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# Derive values from intake.
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provider = intake.get("provider_name", "")
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first, mid, last = _split_name(provider)
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npi = intake.get("npi", "")
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dob = intake.get("dob", "") # MMDDYYYY if provided
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values = {
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"first_name": intake.get("first_name", first),
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"middle_init": intake.get("middle_initial", mid),
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"last_name": intake.get("last_name", last),
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"npi": npi,
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"dob": dob,
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"sign_first": intake.get("first_name", first),
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"sign_middle": intake.get("middle_initial", mid),
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"sign_last": intake.get("last_name", last),
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"org_npi": npi,
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}
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field_updates = {}
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for intake_key, pdf_field in fmap.items():
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v = values.get(intake_key, "")
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if v:
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field_updates[pdf_field] = str(v)
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# Apply to every page that contains these fields.
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for page in writer.pages:
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try:
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writer.update_page_form_field_values(page, field_updates)
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except Exception:
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# update only the fields that exist on this page; ignore the rest
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pass
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# Make filled values render in all viewers.
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try:
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writer.set_need_appearances_writer(True)
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except Exception:
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pass
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buf = io.BytesIO()
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writer.write(buf)
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pdf_bytes = buf.getvalue()
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# Build signature anchors from the official /Sig rects.
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anchors = []
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for sig in SIGNATURE_FIELDS.get(form_type, []):
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llx, lly, urx, ury = sig["rect"]
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anchors.append({
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"field": sig["field"],
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"page": sig["page"],
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"x": float(llx) + 4,
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"y": float(lly) + 1,
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"w": float(urx - llx) - 8,
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"h": max(float(ury - lly), 18.0),
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"page_w": sig["page_w"],
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"page_h": sig["page_h"],
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})
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# What we could not auto-fill (so the human reviewer knows to complete it).
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missing = []
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if not anchors:
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missing.append(f"No signature anchor mapped for {form_type} — place signature manually before mailing.")
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if form_type in ("855b", "855a") or (form_type == "855o"):
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missing.append(f"{form_type.upper()} is partially mapped — verify all sections before signing/mailing.")
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if not intake.get("dob"):
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missing.append("Date of birth not collected — required on the 855; confirm with provider.")
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if not intake.get("practice_state"):
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missing.append("Practice/MAC routing state not collected — needed to address the USPS envelope to the correct MAC.")
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return pdf_bytes, anchors, missing
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if __name__ == "__main__": # quick local render for visual verification
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sample = {
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"provider_name": "Jane Q Smith",
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"npi": "1234567893",
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"dob": "01011980",
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"practice_state": "CA",
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"enumeration_type": "NPI-1",
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}
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pdf, anchors, missing = fill_cms855("855i", sample, "CO-TEST1234")
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with open("/tmp/cms855i_filled.pdf", "wb") as f:
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f.write(pdf)
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print("wrote /tmp/cms855i_filled.pdf")
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print("anchors:", anchors)
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print("missing:", missing)
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