# """ # Viewflow workflows for billing app. # Provides medical billing, insurance claims, and payment processing workflows. # """ # # from viewflow import Flow, lock # from viewflow.base import this, flow_func # from viewflow.contrib import celery # from viewflow.decorators import flow_view # from viewflow.fields import CharField, ModelField # from viewflow.forms import ModelForm # from viewflow.views import CreateProcessView, UpdateProcessView # from viewflow.models import Process, Task # from django.contrib.auth.models import User # from django.urls import reverse_lazy # from django.utils import timezone # from django.db import transaction # from django.core.mail import send_mail # # from .models import MedicalBill, InsuranceClaim, Payment, ClaimStatusUpdate # from .views import ( # BillGenerationView, ChargeReviewView, InsuranceVerificationView, # ClaimPreparationView, ClaimSubmissionView, ClaimTrackingView, # PaymentProcessingView, PaymentReconciliationView, DenialManagementView, # AppealPreparationView, CollectionsView # ) # # # class MedicalBillingProcess(Process): # """ # Viewflow process model for medical billing # """ # medical_bill = ModelField(MedicalBill, help_text='Associated medical bill') # # # Process status tracking # charges_captured = models.BooleanField(default=False) # charges_reviewed = models.BooleanField(default=False) # insurance_verified = models.BooleanField(default=False) # bill_generated = models.BooleanField(default=False) # claims_submitted = models.BooleanField(default=False) # payments_processed = models.BooleanField(default=False) # account_reconciled = models.BooleanField(default=False) # billing_completed = models.BooleanField(default=False) # # class Meta: # verbose_name = 'Medical Billing Process' # verbose_name_plural = 'Medical Billing Processes' # # # class MedicalBillingFlow(Flow): # """ # Medical Billing Workflow # # This flow manages the complete revenue cycle from charge capture # through payment processing and account reconciliation. # """ # # process_class = MedicalBillingProcess # # # Flow definition # start = ( # flow_func(this.start_billing) # .Next(this.capture_charges) # ) # # capture_charges = ( # flow_func(this.collect_service_charges) # .Next(this.review_charges) # ) # # review_charges = ( # flow_view(ChargeReviewView) # .Permission('billing.can_review_charges') # .Next(this.verify_insurance) # ) # # verify_insurance = ( # flow_view(InsuranceVerificationView) # .Permission('billing.can_verify_insurance') # .Next(this.generate_bill) # ) # # generate_bill = ( # flow_view(BillGenerationView) # .Permission('billing.can_generate_bills') # .Next(this.parallel_claim_processing) # ) # # parallel_claim_processing = ( # flow_func(this.start_parallel_processing) # .Next(this.submit_primary_claim) # .Next(this.submit_secondary_claim) # .Next(this.patient_billing) # ) # # submit_primary_claim = ( # flow_view(PrimaryClaimSubmissionView) # .Permission('billing.can_submit_claims') # .Next(this.join_claim_processing) # ) # # submit_secondary_claim = ( # flow_view(SecondaryClaimSubmissionView) # .Permission('billing.can_submit_claims') # .Next(this.join_claim_processing) # ) # # patient_billing = ( # flow_view(PatientBillingView) # .Permission('billing.can_bill_patients') # .Next(this.join_claim_processing) # ) # # join_claim_processing = ( # flow_func(this.join_parallel_processing) # .Next(this.process_payments) # ) # # process_payments = ( # flow_view(PaymentProcessingView) # .Permission('billing.can_process_payments') # .Next(this.reconcile_account) # ) # # reconcile_account = ( # flow_view(PaymentReconciliationView) # .Permission('billing.can_reconcile_accounts') # .Next(this.finalize_billing) # ) # # finalize_billing = ( # flow_func(this.complete_billing) # .Next(this.end) # ) # # end = flow_func(this.end_billing) # # # Flow functions # def start_billing(self, activation): # """Initialize the billing process""" # process = activation.process # bill = process.medical_bill # # # Update bill status # bill.status = 'PROCESSING' # bill.save() # # # Send notification to billing staff # self.notify_billing_staff(bill) # # # Check for priority billing # if bill.bill_type in ['EMERGENCY', 'SURGERY']: # self.notify_priority_billing(bill) # # def collect_service_charges(self, activation): # """Collect charges from various service departments""" # process = activation.process # bill = process.medical_bill # # # Collect charges from different departments # charges = self.gather_service_charges(bill) # # if charges: # # Update bill with collected charges # self.update_bill_charges(bill, charges) # # process.charges_captured = True # process.save() # # def start_parallel_processing(self, activation): # """Start parallel claim and billing processing""" # process = activation.process # # # Create parallel processing tasks # self.create_claim_tasks(process.medical_bill) # # def join_parallel_processing(self, activation): # """Wait for all claim processing to complete""" # process = activation.process # # # Check if all processing is completed # if self.all_claims_processed(process.medical_bill): # # Proceed to payment processing # self.notify_claims_completed(process.medical_bill) # # def complete_billing(self, activation): # """Finalize the billing process""" # process = activation.process # bill = process.medical_bill # # # Update bill status based on payment status # if bill.balance_due <= 0: # bill.status = 'PAID' # elif bill.total_payments > 0: # bill.status = 'PARTIALLY_PAID' # else: # bill.status = 'OUTSTANDING' # # bill.save() # # # Mark process as completed # process.billing_completed = True # process.save() # # # Send completion notifications # self.notify_billing_completion(bill) # # # Update revenue metrics # self.update_revenue_metrics(bill) # # def end_billing(self, activation): # """End the billing workflow""" # process = activation.process # # # Generate billing summary report # self.generate_billing_summary(process.medical_bill) # # # Helper methods # def notify_billing_staff(self, bill): # """Notify billing staff of new bill""" # from django.contrib.auth.models import Group # # billing_staff = User.objects.filter( # groups__name='Billing Staff' # ) # # for staff in billing_staff: # send_mail( # subject=f'New Medical Bill: {bill.bill_number}', # message=f'New medical bill for {bill.patient.get_full_name()} requires processing.', # from_email='billing@hospital.com', # recipient_list=[staff.email], # fail_silently=True # ) # # def notify_priority_billing(self, bill): # """Notify of priority billing""" # billing_managers = User.objects.filter( # groups__name='Billing Managers' # ) # # for manager in billing_managers: # send_mail( # subject=f'PRIORITY Billing: {bill.bill_number}', # message=f'{bill.get_bill_type_display()} bill requires priority processing.', # from_email='billing@hospital.com', # recipient_list=[manager.email], # fail_silently=True # ) # # def gather_service_charges(self, bill): # """Gather charges from service departments""" # # This would collect charges from various departments # return [] # # def update_bill_charges(self, bill, charges): # """Update bill with collected charges""" # # This would update the bill with charges # pass # # def create_claim_tasks(self, bill): # """Create claim processing tasks""" # # This would create tasks for claim processing # pass # # def all_claims_processed(self, bill): # """Check if all claims are processed""" # # This would check claim processing status # return True # # def notify_claims_completed(self, bill): # """Notify that claims processing is completed""" # billing_staff = User.objects.filter( # groups__name='Billing Staff' # ) # # for staff in billing_staff: # send_mail( # subject=f'Claims Processed: {bill.bill_number}', # message=f'All claims have been processed for {bill.patient.get_full_name()}.', # from_email='billing@hospital.com', # recipient_list=[staff.email], # fail_silently=True # ) # # def notify_billing_completion(self, bill): # """Notify billing completion""" # # Notify patient if email available # if bill.patient.email: # send_mail( # subject='Medical Bill Processed', # message=f'Your medical bill {bill.bill_number} has been processed.', # from_email='billing@hospital.com', # recipient_list=[bill.patient.email], # fail_silently=True # ) # # def update_revenue_metrics(self, bill): # """Update revenue cycle metrics""" # # This would update revenue metrics # pass # # def generate_billing_summary(self, bill): # """Generate billing summary report""" # # This would generate a comprehensive billing report # pass # # # class InsuranceClaimProcess(Process): # """ # Viewflow process model for insurance claims # """ # insurance_claim = ModelField(InsuranceClaim, help_text='Associated insurance claim') # # # Process status tracking # claim_prepared = models.BooleanField(default=False) # eligibility_verified = models.BooleanField(default=False) # claim_submitted = models.BooleanField(default=False) # claim_tracked = models.BooleanField(default=False) # response_received = models.BooleanField(default=False) # payment_posted = models.BooleanField(default=False) # denials_managed = models.BooleanField(default=False) # claim_finalized = models.BooleanField(default=False) # # class Meta: # verbose_name = 'Insurance Claim Process' # verbose_name_plural = 'Insurance Claim Processes' # # # class InsuranceClaimFlow(Flow): # """ # Insurance Claim Processing Workflow # # This flow manages insurance claim processing from preparation # through payment posting and denial management. # """ # # process_class = InsuranceClaimProcess # # # Flow definition # start = ( # flow_func(this.start_claim) # .Next(this.prepare_claim) # ) # # prepare_claim = ( # flow_view(ClaimPreparationView) # .Permission('billing.can_prepare_claims') # .Next(this.verify_eligibility) # ) # # verify_eligibility = ( # flow_view(EligibilityVerificationView) # .Permission('billing.can_verify_eligibility') # .Next(this.submit_claim) # ) # # submit_claim = ( # flow_view(ClaimSubmissionView) # .Permission('billing.can_submit_claims') # .Next(this.track_claim) # ) # # track_claim = ( # flow_view(ClaimTrackingView) # .Permission('billing.can_track_claims') # .Next(this.receive_response) # ) # # receive_response = ( # flow_func(this.process_claim_response) # .Next(this.post_payment) # ) # # post_payment = ( # flow_view(PaymentPostingView) # .Permission('billing.can_post_payments') # .Next(this.manage_denials) # ) # # manage_denials = ( # flow_view(DenialManagementView) # .Permission('billing.can_manage_denials') # .Next(this.finalize_claim) # ) # # finalize_claim = ( # flow_func(this.complete_claim) # .Next(this.end) # ) # # end = flow_func(this.end_claim) # # # Flow functions # def start_claim(self, activation): # """Initialize the claim process""" # process = activation.process # claim = process.insurance_claim # # # Update claim status # claim.status = 'PREPARING' # claim.save() # # # Send notification to claims staff # self.notify_claims_staff(claim) # # def process_claim_response(self, activation): # """Process insurance claim response""" # process = activation.process # claim = process.insurance_claim # # # Check for claim response # response = self.check_claim_response(claim) # # if response: # # Update claim with response # self.update_claim_response(claim, response) # # process.response_received = True # process.save() # # # Handle different response types # if response.get('status') == 'DENIED': # self.handle_claim_denial(claim, response) # elif response.get('status') == 'PAID': # self.handle_claim_payment(claim, response) # # def complete_claim(self, activation): # """Finalize the claim process""" # process = activation.process # claim = process.insurance_claim # # # Update claim status based on final outcome # if claim.paid_amount >= claim.billed_amount: # claim.status = 'PAID' # elif claim.paid_amount > 0: # claim.status = 'PARTIALLY_PAID' # elif claim.denial_reason: # claim.status = 'DENIED' # else: # claim.status = 'PENDING' # # claim.save() # # # Mark process as completed # process.claim_finalized = True # process.save() # # # Send completion notifications # self.notify_claim_completion(claim) # # def end_claim(self, activation): # """End the claim workflow""" # process = activation.process # # # Generate claim summary report # self.generate_claim_summary(process.insurance_claim) # # # Helper methods # def notify_claims_staff(self, claim): # """Notify claims staff""" # claims_staff = User.objects.filter( # groups__name='Claims Staff' # ) # # for staff in claims_staff: # send_mail( # subject=f'New Insurance Claim: {claim.claim_number}', # message=f'New insurance claim for {claim.patient.get_full_name()} requires processing.', # from_email='claims@hospital.com', # recipient_list=[staff.email], # fail_silently=True # ) # # def check_claim_response(self, claim): # """Check for claim response from insurance""" # # This would check for insurance responses # return None # # def update_claim_response(self, claim, response): # """Update claim with insurance response""" # # This would update the claim with response data # pass # # def handle_claim_denial(self, claim, response): # """Handle claim denial""" # # Notify claims staff of denial # claims_staff = User.objects.filter( # groups__name='Claims Staff' # ) # # for staff in claims_staff: # send_mail( # subject=f'Claim Denied: {claim.claim_number}', # message=f'Insurance claim has been denied. Reason: {response.get("denial_reason", "Unknown")}', # from_email='claims@hospital.com', # recipient_list=[staff.email], # fail_silently=True # ) # # def handle_claim_payment(self, claim, response): # """Handle claim payment""" # # This would process claim payment # pass # # def notify_claim_completion(self, claim): # """Notify claim completion""" # # This would notify relevant parties # pass # # def generate_claim_summary(self, claim): # """Generate claim summary report""" # # This would generate claim summary # pass # # # class PaymentProcessingProcess(Process): # """ # Viewflow process model for payment processing # """ # payment = ModelField(Payment, help_text='Associated payment') # # # Process status tracking # payment_received = models.BooleanField(default=False) # payment_verified = models.BooleanField(default=False) # payment_processed = models.BooleanField(default=False) # payment_deposited = models.BooleanField(default=False) # account_updated = models.BooleanField(default=False) # receipt_generated = models.BooleanField(default=False) # payment_completed = models.BooleanField(default=False) # # class Meta: # verbose_name = 'Payment Processing Process' # verbose_name_plural = 'Payment Processing Processes' # # # class PaymentProcessingFlow(Flow): # """ # Payment Processing Workflow # # This flow manages payment processing from receipt through # deposit and account reconciliation. # """ # # process_class = PaymentProcessingProcess # # # Flow definition # start = ( # flow_func(this.start_payment) # .Next(this.receive_payment) # ) # # receive_payment = ( # flow_view(PaymentReceiptView) # .Permission('billing.can_receive_payments') # .Next(this.verify_payment) # ) # # verify_payment = ( # flow_view(PaymentVerificationView) # .Permission('billing.can_verify_payments') # .Next(this.process_payment) # ) # # process_payment = ( # flow_view(PaymentProcessingView) # .Permission('billing.can_process_payments') # .Next(this.deposit_payment) # ) # # deposit_payment = ( # flow_view(PaymentDepositView) # .Permission('billing.can_deposit_payments') # .Next(this.update_account) # ) # # update_account = ( # flow_func(this.update_patient_account) # .Next(this.generate_receipt) # ) # # generate_receipt = ( # flow_view(ReceiptGenerationView) # .Permission('billing.can_generate_receipts') # .Next(this.finalize_payment) # ) # # finalize_payment = ( # flow_func(this.complete_payment) # .Next(this.end) # ) # # end = flow_func(this.end_payment) # # # Flow functions # def start_payment(self, activation): # """Initialize the payment process""" # process = activation.process # payment = process.payment # # # Update payment status # payment.status = 'PENDING' # payment.save() # # # Send notification to billing staff # self.notify_payment_received(payment) # # def update_patient_account(self, activation): # """Update patient account with payment""" # process = activation.process # payment = process.payment # # # Update medical bill balance # bill = payment.medical_bill # bill.total_payments += payment.payment_amount # bill.balance_due = bill.total_amount - bill.total_payments # bill.save() # # process.account_updated = True # process.save() # # # Check if bill is fully paid # if bill.balance_due <= 0: # self.notify_account_paid_in_full(bill) # # def complete_payment(self, activation): # """Finalize the payment process""" # process = activation.process # payment = process.payment # # # Update payment status # payment.status = 'PROCESSED' # payment.save() # # # Mark process as completed # process.payment_completed = True # process.save() # # # Send completion notifications # self.notify_payment_completion(payment) # # def end_payment(self, activation): # """End the payment workflow""" # process = activation.process # # # Generate payment summary report # self.generate_payment_summary(process.payment) # # # Helper methods # def notify_payment_received(self, payment): # """Notify billing staff of payment received""" # billing_staff = User.objects.filter( # groups__name='Billing Staff' # ) # # for staff in billing_staff: # send_mail( # subject=f'Payment Received: {payment.payment_number}', # message=f'Payment of ${payment.payment_amount} received for {payment.patient.get_full_name()}.', # from_email='billing@hospital.com', # recipient_list=[staff.email], # fail_silently=True # ) # # def notify_account_paid_in_full(self, bill): # """Notify that account is paid in full""" # # Notify patient # if bill.patient.email: # send_mail( # subject='Account Paid in Full', # message=f'Your account for bill {bill.bill_number} has been paid in full.', # from_email='billing@hospital.com', # recipient_list=[bill.patient.email], # fail_silently=True # ) # # def notify_payment_completion(self, payment): # """Notify payment completion""" # # This would notify relevant parties # pass # # def generate_payment_summary(self, payment): # """Generate payment summary report""" # # This would generate payment summary # pass # # # class DenialManagementProcess(Process): # """ # Viewflow process model for denial management # """ # insurance_claim = ModelField(InsuranceClaim, help_text='Associated denied claim') # # # Process status tracking # denial_analyzed = models.BooleanField(default=False) # appeal_prepared = models.BooleanField(default=False) # appeal_submitted = models.BooleanField(default=False) # appeal_tracked = models.BooleanField(default=False) # appeal_resolved = models.BooleanField(default=False) # account_adjusted = models.BooleanField(default=False) # denial_completed = models.BooleanField(default=False) # # class Meta: # verbose_name = 'Denial Management Process' # verbose_name_plural = 'Denial Management Processes' # # # class DenialManagementFlow(Flow): # """ # Denial Management Workflow # # This flow manages insurance claim denials including analysis, # appeal preparation, submission, and resolution. # """ # # process_class = DenialManagementProcess # # # Flow definition # start = ( # flow_func(this.start_denial_management) # .Next(this.analyze_denial) # ) # # analyze_denial = ( # flow_view(DenialAnalysisView) # .Permission('billing.can_analyze_denials') # .Next(this.prepare_appeal) # ) # # prepare_appeal = ( # flow_view(AppealPreparationView) # .Permission('billing.can_prepare_appeals') # .Next(this.submit_appeal) # ) # # submit_appeal = ( # flow_view(AppealSubmissionView) # .Permission('billing.can_submit_appeals') # .Next(this.track_appeal) # ) # # track_appeal = ( # flow_view(AppealTrackingView) # .Permission('billing.can_track_appeals') # .Next(this.resolve_appeal) # ) # # resolve_appeal = ( # flow_func(this.process_appeal_resolution) # .Next(this.adjust_account) # ) # # adjust_account = ( # flow_view(AccountAdjustmentView) # .Permission('billing.can_adjust_accounts') # .Next(this.finalize_denial) # ) # # finalize_denial = ( # flow_func(this.complete_denial_management) # .Next(this.end) # ) # # end = flow_func(this.end_denial_management) # # # Flow functions # def start_denial_management(self, activation): # """Initialize the denial management process""" # process = activation.process # claim = process.insurance_claim # # # Send notification to denial management staff # self.notify_denial_staff(claim) # # def process_appeal_resolution(self, activation): # """Process appeal resolution""" # process = activation.process # claim = process.insurance_claim # # # Check appeal status # appeal_result = self.check_appeal_status(claim) # # if appeal_result: # # Update claim with appeal result # self.update_appeal_result(claim, appeal_result) # # process.appeal_resolved = True # process.save() # # def complete_denial_management(self, activation): # """Finalize the denial management process""" # process = activation.process # claim = process.insurance_claim # # # Mark process as completed # process.denial_completed = True # process.save() # # # Send completion notifications # self.notify_denial_completion(claim) # # def end_denial_management(self, activation): # """End the denial management workflow""" # process = activation.process # # # Generate denial management summary # self.generate_denial_summary(process.insurance_claim) # # # Helper methods # def notify_denial_staff(self, claim): # """Notify denial management staff""" # denial_staff = User.objects.filter( # groups__name='Denial Management' # ) # # for staff in denial_staff: # send_mail( # subject=f'Claim Denial: {claim.claim_number}', # message=f'Insurance claim has been denied and requires review.', # from_email='denials@hospital.com', # recipient_list=[staff.email], # fail_silently=True # ) # # def check_appeal_status(self, claim): # """Check appeal status""" # # This would check appeal status # return None # # def update_appeal_result(self, claim, result): # """Update claim with appeal result""" # # This would update the claim with appeal result # pass # # def notify_denial_completion(self, claim): # """Notify denial management completion""" # # This would notify relevant parties # pass # # def generate_denial_summary(self, claim): # """Generate denial management summary""" # # This would generate denial summary # pass # # # class CollectionsProcess(Process): # """ # Viewflow process model for collections # """ # medical_bill = ModelField(MedicalBill, help_text='Associated medical bill') # # # Process status tracking # account_reviewed = models.BooleanField(default=False) # patient_contacted = models.BooleanField(default=False) # payment_plan_offered = models.BooleanField(default=False) # collection_actions_taken = models.BooleanField(default=False) # external_agency_assigned = models.BooleanField(default=False) # collections_resolved = models.BooleanField(default=False) # # class Meta: # verbose_name = 'Collections Process' # verbose_name_plural = 'Collections Processes' # # # class CollectionsFlow(Flow): # """ # Collections Workflow # # This flow manages collections activities for overdue accounts # including patient contact, payment plans, and external collections. # """ # # process_class = CollectionsProcess # # # Flow definition # start = ( # flow_func(this.start_collections) # .Next(this.review_account) # ) # # review_account = ( # flow_view(AccountReviewView) # .Permission('billing.can_review_collections') # .Next(this.contact_patient) # ) # # contact_patient = ( # flow_view(PatientContactView) # .Permission('billing.can_contact_patients') # .Next(this.offer_payment_plan) # ) # # offer_payment_plan = ( # flow_view(PaymentPlanView) # .Permission('billing.can_offer_payment_plans') # .Next(this.collection_actions) # ) # # collection_actions = ( # flow_view(CollectionActionsView) # .Permission('billing.can_take_collection_actions') # .Next(this.external_collections) # ) # # external_collections = ( # flow_view(ExternalCollectionsView) # .Permission('billing.can_assign_external_collections') # .Next(this.resolve_collections) # ) # # resolve_collections = ( # flow_func(this.complete_collections) # .Next(this.end) # ) # # end = flow_func(this.end_collections) # # # Flow functions # def start_collections(self, activation): # """Initialize the collections process""" # process = activation.process # bill = process.medical_bill # # # Send notification to collections staff # self.notify_collections_staff(bill) # # def complete_collections(self, activation): # """Finalize the collections process""" # process = activation.process # bill = process.medical_bill # # # Mark process as completed # process.collections_resolved = True # process.save() # # # Send completion notifications # self.notify_collections_completion(bill) # # def end_collections(self, activation): # """End the collections workflow""" # process = activation.process # # # Generate collections summary # self.generate_collections_summary(process.medical_bill) # # # Helper methods # def notify_collections_staff(self, bill): # """Notify collections staff""" # collections_staff = User.objects.filter( # groups__name='Collections Staff' # ) # # for staff in collections_staff: # send_mail( # subject=f'Collections Account: {bill.bill_number}', # message=f'Account for {bill.patient.get_full_name()} requires collections action.', # from_email='collections@hospital.com', # recipient_list=[staff.email], # fail_silently=True # ) # # def notify_collections_completion(self, bill): # """Notify collections completion""" # # This would notify relevant parties # pass # # def generate_collections_summary(self, bill): # """Generate collections summary""" # # This would generate collections summary # pass # # # # Celery tasks for background processing # @celery.job # def auto_generate_bills(): # """Background task to automatically generate bills""" # try: # # This would generate bills for completed services # return True # except Exception: # return False # # # @celery.job # def monitor_claim_status(): # """Background task to monitor insurance claim status""" # try: # # This would check claim status with insurance companies # return True # except Exception: # return False # # # @celery.job # def generate_billing_reports(): # """Background task to generate billing reports""" # try: # # This would generate daily billing reports # return True # except Exception: # return False # # # @celery.job # def auto_post_insurance_payments(): # """Background task to automatically post insurance payments""" # try: # # This would post insurance payments from EDI files # return True # except Exception: # return False # # # @celery.job # def identify_collection_accounts(): # """Background task to identify accounts for collections""" # try: # # This would identify overdue accounts # return True # except Exception: # return False #