"""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." ), "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." ), "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." ), "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." ), "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." ), "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." ), "priority": "high", }, } 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", "") 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\n" f"Review-staged: file manually, then mark this order complete." ) self._create_todo( order_number, intake, title=f"{meta['name']} — {provider} (NPI {npi})", description=description, priority=meta["priority"], ) return [] 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"