"""Healthcare / NPI provider compliance handlers. Review-staged: each NPI service generates an admin todo with the provider's NPI + intake details for a human to file in CMS PECOS / NPPES. This mirrors the FCC auto-filing-off safety default — no automated submission to government portals until the Playwright flows are proven. Covers slugs: npi-revalidation Medicare PECOS revalidation (5-yr cycle) npi-reactivation reactivate a deactivated NPI nppes-update NPPES data update / attestation medicare-enrollment new Medicare enrollment via PECOS oig-sam-screening OIG LEIE + SAM exclusion screening (annual) provider-compliance-bundle revalidation watch + screening + NPPES upkeep Intake data needed (collected by the npi-intake wizard step): - npi provider's 10-digit NPI - provider_name legal/provider name - email contact email - pecos_enrollment_id (optional) PECOS enrollment ID - specialty (optional) taxonomy/specialty - practice_state (optional) practice location state """ from __future__ import annotations import json import logging import os LOG = logging.getLogger("workers.services.npi_provider") # Per-slug admin todo metadata: human-readable action + the portal a human uses. _SLUG_META = { "npi-revalidation": { "name": "Medicare PECOS Revalidation Filing", "portal": "https://pecos.cms.hhs.gov/", "action": ( "File the Medicare revalidation in PECOS for this provider. Confirm " "the revalidation due date on the CMS revalidation list, update the " "enrollment record, and submit. Capture the PECOS tracking ID." ), "access": ( "Standard: prepare CMS-855I/B/R, provider signs cert, submit to MAC. Expedited: file in PECOS via CMS I&A surrogate access." ), "priority": "high", }, "npi-reactivation": { "name": "NPI Reactivation", "portal": "https://nppes.cms.hhs.gov/", "action": ( "Reactivate the deactivated NPI in NPPES. Verify the deactivation " "reason, correct any stale data, and re-certify the record." ), "access": ( "NPPES via CMS I&A surrogate access (online-only)." ), "priority": "high", }, "nppes-update": { "name": "NPPES Data Update / Attestation", "portal": "https://nppes.cms.hhs.gov/", "action": ( "Update + re-attest the provider's NPPES record (CMS requires " "updates within 30 days of any change). Apply the requested field " "changes and certify." ), "access": ( "NPPES via CMS I&A surrogate access (online-only)." ), "priority": "normal", }, "medicare-enrollment": { "name": "Medicare Enrollment (PECOS)", "portal": "https://pecos.cms.hhs.gov/", "action": ( "Complete the provider's Medicare enrollment in PECOS (CMS-855). " "Confirm taxonomy, practice location, and authorized official." ), "access": ( "Standard: prepare CMS-855, provider signs cert, submit to MAC. Expedited: file in PECOS via CMS I&A surrogate access." ), "priority": "high", }, "oig-sam-screening": { "name": "OIG/SAM Exclusion Screening (Annual)", "portal": "https://oig.hhs.gov/exclusions/ + https://sam.gov/", "action": ( "Run the provider (and any listed staff) against the OIG LEIE and " "SAM exclusion lists. Produce the screening certificate and flag any " "matches for escalation." ), "access": ( "No client access needed - OIG LEIE + SAM.gov are public. Screen by NPI/name, issue certificate." ), "priority": "normal", }, "provider-compliance-bundle": { "name": "Provider Compliance Bundle (Annual)", "portal": "https://pecos.cms.hhs.gov/ + https://nppes.cms.hhs.gov/", "action": ( "Onboard the provider into the annual compliance bundle: enroll in " "revalidation watch, run OIG/SAM screening, and refresh the NPPES " "record. Set the next revalidation reminder." ), "access": ( "Standard CMS-855 filing for the enrollment/revalidation piece; NPPES + PECOS via CMS I&A surrogate access; screening is public." ), "priority": "high", }, } # Slugs whose fulfilment includes a CMS-855 (auto-filled official form, signed # via the secure e-sign link, then submitted to the provider's MAC). The # bundle's revalidation piece is handled by the dedicated revalidation order it # spawns, so it is not listed here. _STANDARD_FILING_SLUGS = { "npi-revalidation", "npi-reactivation", "medicare-enrollment", } class _BaseNPIHandler: """Shared review-staged behaviour for all NPI services.""" SERVICE_SLUG = "" async def process(self, order_data: dict) -> list[str]: order_number = order_data.get("order_number", order_data.get("name", "")) return await self.handle(order_data, order_number) async def handle(self, order_data: dict, order_number: str) -> list[str]: meta = _SLUG_META[self.SERVICE_SLUG] LOG.info("[%s] Processing %s", order_number, self.SERVICE_SLUG) intake = order_data.get("intake_data") or {} if isinstance(intake, str): intake = json.loads(intake) npi = intake.get("npi", "N/A") provider = intake.get("provider_name", order_data.get("customer_name", "Unknown")) specialty = intake.get("specialty", "") practice_state = intake.get("practice_state", "") pecos_id = intake.get("pecos_enrollment_id", "") customer_email = ( intake.get("email") or order_data.get("customer_email") or order_data.get("email") or "" ) # For PECOS enrollment/revalidation we generate the official CMS-855, # send it for e-signature, then a human submits it to the MAC. filing_note = "" if self.SERVICE_SLUG in _STANDARD_FILING_SLUGS: try: filing_note = self._generate_855_for_signing( order_number, intake, provider, customer_email ) except Exception as exc: # never block the admin todo on PDF issues LOG.error("[%s] CMS-855 generation failed: %s", order_number, exc) filing_note = f"CMS-855 auto-generation FAILED ({exc}); prepare the form manually." description = ( f"{meta['action']}\n\n" f"Provider: {provider}\n" f"NPI: {npi}\n" f"PECOS Enrollment ID: {pecos_id or 'not provided'}\n" f"Specialty: {specialty or 'not provided'}\n" f"Practice state: {practice_state or 'not provided'}\n" f"Portal: {meta['portal']}\n" f"Access model: {meta['access']}\n" + (f"\n{filing_note}\n" if filing_note else "") + "\nReview-staged: complete/verify the form, get it signed, then " "submit it to the provider's MAC (standard), or file in " "PECOS if surrogate access was granted). Mark this order complete." ) self._create_todo( order_number, intake, title=f"{meta['name']} — {provider} (NPI {npi})", description=description, priority=meta["priority"], ) return [] def _generate_855_for_signing(self, order_number, intake, provider, customer_email) -> str: """Generate the official CMS-855, upload it, and request an e-signature. Returns a human-readable note for the admin todo describing what was generated and what still needs manual completion. The signed PDF is submitted to the MAC by the fulfilment team. """ try: from scripts.document_gen.templates.cms855_pdf_filler import ( determine_form_type, fill_cms855, ) except ImportError: from document_gen.templates.cms855_pdf_filler import ( # type: ignore determine_form_type, fill_cms855, ) form_type = determine_form_type(self.SERVICE_SLUG, intake) pdf_bytes, anchors, missing = fill_cms855(form_type, intake, order_number) # Upload the unsigned, partially-filled official form to MinIO. document_key = f"compliance/{order_number}/cms{form_type}_unsigned.pdf" try: import tempfile try: from scripts.document_gen.minio_client import MinioStorage except ImportError: from document_gen.minio_client import MinioStorage # type: ignore storage = MinioStorage() with tempfile.NamedTemporaryFile(suffix=".pdf", delete=True) as tf: tf.write(pdf_bytes) tf.flush() storage.upload(tf.name, document_key, content_type="application/pdf") except Exception as exc: LOG.error("[%s] CMS-855 upload failed: %s", order_number, exc) return f"CMS-{form_type.upper()} generated but upload FAILED ({exc})." # Create the esign record (via the shared helper, which also emails the # signing link) and attach the official signature anchor so the stamper # lands the signature on the certification line. signed = self._create_855_esign_record( order_number, intake, provider, customer_email, form_type, document_key, anchors, ) note_lines = [ f"CMS-{form_type.upper()} generated (official form, auto-filled where possible).", f"Unsigned PDF: {document_key}", ] if signed and customer_email: note_lines.append(f"E-sign link emailed to {customer_email}. After signing, submit to the MAC (standard) or file via PECOS surrogate access (expedited).") else: note_lines.append("No customer email or esign infra — send the form for signature manually.") if missing: note_lines.append("MANUAL COMPLETION NEEDED:") note_lines.extend(f" - {m}" for m in missing) return "\n".join(note_lines) def _create_855_esign_record(self, order_number, intake, provider, customer_email, form_type, document_key, anchors) -> bool: """Create the esign record + email the signing link via the shared helper, then attach the official signature anchors. Returns True on success. """ if not customer_email: return False document_type = f"cms{form_type}" document_title = f"Medicare Enrollment Form (CMS-{form_type.upper()})" try: try: from scripts.workers.services.telecom.esign_helper import request_esign except ImportError: from .telecom.esign_helper import request_esign # type: ignore import psycopg2 conn = psycopg2.connect(os.environ.get("DATABASE_URL", "")) try: esign_id = request_esign( conn=conn, order_number=order_number, document_type=document_type, document_title=document_title, entity_name=provider, customer_email=customer_email, customer_name=provider, document_minio_key=document_key, requires_perjury=True, metadata={"service_slug": self.SERVICE_SLUG, "npi": intake.get("npi", ""), "form_type": form_type}, expires_hours=21 * 24, ) # request_esign does not persist signature anchors; attach them so # the stamper places the signature on the certification line. if esign_id and anchors: with conn.cursor() as cur: cur.execute( "UPDATE esign_records SET signature_anchors = %s, updated_at = NOW() WHERE id = %s", (json.dumps(anchors), esign_id), ) conn.commit() return esign_id is not None finally: conn.close() except Exception as exc: LOG.error("[%s] CMS-855 esign request failed: %s", order_number, exc) return False def _create_todo(self, order_number, intake, title, description, priority="normal"): try: import psycopg2 conn = psycopg2.connect(os.environ.get("DATABASE_URL", "")) with conn.cursor() as cur: cur.execute( """ INSERT INTO admin_todos ( title, category, priority, order_number, service_slug, description, data, status ) VALUES (%s, %s, %s, %s, %s, %s, %s, 'pending') """, ( title, "filing", priority, order_number, self.SERVICE_SLUG, description, json.dumps(intake), ), ) conn.commit() conn.close() except Exception as exc: LOG.error("[%s] Failed to create NPI todo: %s", order_number, exc) class NPIRevalidationHandler(_BaseNPIHandler): SERVICE_SLUG = "npi-revalidation" class NPIReactivationHandler(_BaseNPIHandler): SERVICE_SLUG = "npi-reactivation" class NPPESUpdateHandler(_BaseNPIHandler): SERVICE_SLUG = "nppes-update" class MedicareEnrollmentHandler(_BaseNPIHandler): SERVICE_SLUG = "medicare-enrollment" class OIGSAMScreeningHandler(_BaseNPIHandler): SERVICE_SLUG = "oig-sam-screening" class ProviderComplianceBundleHandler(_BaseNPIHandler): SERVICE_SLUG = "provider-compliance-bundle"