diff --git a/app/Controllers/FhplApiController.php b/app/Controllers/FhplApiController.php index b2ec8b1c..d941c757 100644 --- a/app/Controllers/FhplApiController.php +++ b/app/Controllers/FhplApiController.php @@ -1000,6 +1000,7 @@ class FhplApiController extends BaseController 'claim_created_by' => 'TPA', 'created_at' => date('Y-m-d H:i:s'), + 'tpa_claim_push_reference_no' => $row['ClaimID'] ?? null, ]; $this->db->table('ticket_master')->insert($claimData); diff --git a/app/Controllers/HealthIndiaApiController.php b/app/Controllers/HealthIndiaApiController.php index 49a573bd..5e9f79bc 100644 --- a/app/Controllers/HealthIndiaApiController.php +++ b/app/Controllers/HealthIndiaApiController.php @@ -1036,6 +1036,7 @@ class HealthIndiaApiController extends BaseController 'claim_created_by' => 'TPA', 'created_at' => date('Y-m-d H:i:s'), + 'tpa_claim_push_reference_no' => $row['ccn'].'-'.$row['ccN_EXT'] ?? null, ]; $this->db->table('ticket_master')->insert($claimData); diff --git a/app/Controllers/MediAssistApiController.php b/app/Controllers/MediAssistApiController.php index 65a8992a..536015d0 100644 --- a/app/Controllers/MediAssistApiController.php +++ b/app/Controllers/MediAssistApiController.php @@ -503,7 +503,7 @@ class MediAssistApiController extends BaseController } } - public function ClaimDetail($claimId = null) // 585 this id for test + public function ClaimDetailOLD($claimId = null) // 585 this id for test { helper('api'); @@ -523,7 +523,7 @@ class MediAssistApiController extends BaseController tm.tpa_no as memberId, tm.tpa_claim_push_reference_no as claimRefNo, tm.tpa_claim_id,tm.doa, - tm.claim_number, + tm.claim_number,tm.claim_amount, cp.policy_no as policyNo, cp.policy_start_date as startDate, cp.policy_end_date as endDate, @@ -661,7 +661,8 @@ class MediAssistApiController extends BaseController } - if($ticket['doa'] == $this->mediDate($claimData['datE_OF_ADMISSION'] ?? null) || $ticket['claim_number'] == $tpa_claim_no){ + if((isset($ticket['claim_number']) && $ticket['claim_number'] == $tpa_claim_no) || ($ticket['doa'] == $this->mediDate($claimData['datE_OF_ADMISSION'] ?? null) && $ticket['claimRefNo'] == $claimData['clM_COMP_REFNO'])) + { // UPDATE ticket_master $this->db->table('ticket_master')->where('id', $claimId)->update($updateArray); @@ -674,6 +675,210 @@ class MediAssistApiController extends BaseController } return ['status' => true,'message' => 'Claim Status updated.','updated_status' => $currentStatus,'api_response' => $response]; + } + + public function ClaimDetail($claimId = null) // 585 this id for test + { + helper('api'); + + $url = getenv('MEDI_ASSIST_API_BASE_URL_CLAIMSTATUS'); + $method = 'POST'; + + $headers = [ + 'Content-Type: application/json', + 'Username:' . getenv('MEDI_ASSIST_API_USERNAME'), + 'Password:' . getenv('MEDI_ASSIST_API_PASSWORD'), + ]; + + // Fetch ticket master details + $ticket = $this->db->table('ticket_master tm') + ->select(" + tm.id, + tm.tpa_no as memberId, + tm.tpa_claim_push_reference_no as claimRefNo, + tm.tpa_claim_id,tm.doa, + tm.claim_number,tm.claim_amount, + cp.policy_no as policyNo, + cp.policy_start_date as startDate, + cp.policy_end_date as endDate, + e.emp_code as employeeCode + ") + ->join('employees e', 'e.id = tm.emp_id', 'left') + ->join('client_policy cp', 'tm.client_policy_id = cp.id', 'left') + ->where('tm.id', $claimId) + ->get() + ->getRowArray(); + + // print_rr($ticket);die; + if (!$ticket) { + return ['status' => false,'message' => 'Invalid Claim ID' ]; + } + + + // REQUEST BODY + if($ticket['claimRefNo'] != null) + { + $body = [ + "policyNo" => $ticket['policyNo'] ?? "", + "startDate" => "", + "endDate" => "", + "employeeCode" => $ticket['employeeCode'] ?? "", + "memberID" => "", + "claimNo" => "", + "claimRefNo" => $ticket['claimRefNo'] ?? "", + ]; + + }else{ + + $body = [ + "policyNo" => $ticket['policyNo'] ?? "", + "startDate" => "", + "endDate" => "", + "employeeCode" => $ticket['employeeCode'] ?? "", + "memberID" => "", + "claimNo" => "", + "claimRefNo" => "", + ]; + + } + + // $body = [ + // "policyNo" => "97000063250400000031", + // "startDate" => "01/11/2025", + // "endDate" => "05/11/2025", + // "employeeCode" => "", + // "memberID" => "", + // "claimNo" => "", + // "claimRefNo" => "" + // ]; + + // CALL API + $response = call_third_party_api($url, $method, $headers, $body); + + + + if ($response['status'] != true || empty($response['data']['claimsData'][0])) { + log_message('error','MEDI_ASSIST - Claim Status FAILED | for ticket ID: ' . $claimId.' | response: '.json_encode($response)); + + return ['status' => false,'message' => 'API call failed.','data' => $response ]; + } + + // Extract Claim Status + $allClaimData = $response['data']['claimsData']; + + $matched = false; // 🔥 Track if anything matched + + foreach ($allClaimData as $claimData) { + + $currentStatus = $claimData['claim_Current_Status'] ?? ''; + $tpa_claim_no = $claimData['tpA_CLAIM_NO'] ?? ''; + $tpa_claim_type = $claimData['typE_OF_CLAIM'] ?? ''; + $tpa_ailments = ($claimData['ailment'] ?? '') . ' - ' . ($claimData['ailmenT_DESC'] ?? ''); + + $claimRefNo = $claimData['clM_COMP_REFNO'] ?? ''; + $doa = $this->mediDate($claimData['datE_OF_ADMISSION'] ?? null); + + $isMatch = false; + + // ------------------------------- + // ✅ Matching Logic + // ------------------------------- + + // Case 1: Claim number exists → match by claim number + if (!empty($ticket['claim_number'])) { + if ($ticket['claim_number'] == $tpa_claim_no) { + $isMatch = true; + } + } + // Case 2: No claim number → match by DOA + claimRefNo + else { + if ( + $ticket['claimRefNo'] == $claimRefNo && + $ticket['doa'] == $doa + ) { + $isMatch = true; + } + } + + if (!$isMatch) { + continue; + } + + // ✅ Mark matched + $matched = true; + + // ------------------------------- + // ✅ Prepare update + // ------------------------------- + $updateArray = [ + 'tpa_claim_status' => $currentStatus, + 'updated_at' => date('Y-m-d H:i:s'), + 'last_updated_by' => 'API', + ]; + + if (isset($validStatuses[$currentStatus])) { + $updateArray['claim_status_id'] = $validStatuses[$currentStatus]; + } + + // Set claim number when first received + if (empty($ticket['claim_number']) && !empty($tpa_claim_no)) { + $updateArray['claim_number'] = $tpa_claim_no; + $updateArray['tpa_claim_id'] = $tpa_claim_no; + } + + if (!empty($tpa_claim_type)) { + $updateArray['tpa_claim_type'] = $tpa_claim_type; + } + + if (!empty($tpa_ailments)) { + $updateArray['tpa_ailments'] = $tpa_ailments; + } + + // ------------------------------- + // ✅ Update DB + // ------------------------------- + $this->db->table('ticket_master') + ->where('id', $claimId) + ->update($updateArray); + + log_message( + 'error', + "MEDI_ASSIST Claim Status SUCCESS | Updated ticket ID ={$claimId} | Status={$currentStatus} | ClaimNo={$tpa_claim_no} | RefNo={$claimRefNo}" + ); + + // Stop after first valid match + break; + } + + if ($matched) { + return [ + 'status' => true, + 'message' => 'Claim Status updated.', + 'updated_status' => $currentStatus, + 'api_response' => $response + ]; + } + + // ----------------------------------- + // ❌ If nothing matched → log failure + // ----------------------------------- + if (!$matched) { + + log_message( + 'error', + "MEDI_ASSIST | Fetch Claim Status | Claim Status NOT UPDATED | | TicketID={$claimId} | TicketDOA={$ticket['doa']} | ClaimDOA={$claimData['datE_OF_ADMISSION']} | Status={$currentStatus}" + ); + + return [ + 'status' => true, + 'message' => 'No matching claim found.', + 'updated_status' => null, + 'api_response' => $response + ]; + } + + + } public function IRSubmission($claimId = null) // 585 this id for test @@ -860,7 +1065,7 @@ class MediAssistApiController extends BaseController // unlink($file_array['json_file_path']); // delete temp json file } - public function ClaimStatusUpdate() + public function ClaimStatusUpdateOLD() { helper('api'); @@ -879,7 +1084,7 @@ class MediAssistApiController extends BaseController tm.id, tm.tpa_no as memberId, tm.tpa_claim_push_reference_no as claimRefNo, - tm.doa,tm.claim_no, + tm.doa,tm.claim_number, cp.policy_no as policyNo, cp.policy_start_date as startDate, cp.policy_end_date as endDate, @@ -1026,7 +1231,8 @@ class MediAssistApiController extends BaseController $updateArray['tpa_ailments'] = $tpa_ailments; } - if($ticket['doa'] == $this->mediDate($claimData['datE_OF_ADMISSION'] ?? null) || $ticket['claim_number'] == $tpa_claim_no){ + if((isset($ticket['claim_number']) && $ticket['claim_number'] == $tpa_claim_no) || ($ticket['doa'] == $this->mediDate($claimData['datE_OF_ADMISSION'] ?? null) && $ticket['claimRefNo'] == $claimData['clM_COMP_REFNO'])) + { // UPDATE ticket_master $this->db->table('ticket_master')->where('id', $claimId)->update($updateArray); $status_updated_count ++; @@ -1051,6 +1257,227 @@ class MediAssistApiController extends BaseController ]); } + public function ClaimStatusUpdate() + { + helper('api'); + + $url = getenv('MEDI_ASSIST_API_BASE_URL_CLAIMSTATUS'); + $method = 'POST'; + + $headers = [ + 'Content-Type: application/json', + 'Username:' . getenv('MEDI_ASSIST_API_USERNAME'), + 'Password:' . getenv('MEDI_ASSIST_API_PASSWORD'), + ]; + + $TicketData = $this->db->table('ticket_master tm') + ->select(" + tm.id, + tm.tpa_no as memberId, + tm.tpa_claim_push_reference_no as claimRefNo, + tm.doa, + tm.claim_number, + tm.tpa_claim_id, + cp.policy_no as policyNo, + cp.policy_start_date as startDate, + cp.policy_end_date as endDate, + e.emp_code as employeeCode + ") + ->join('employees e', 'e.id = tm.emp_id', 'left') + ->join('client_policy cp', 'tm.client_policy_id = cp.id', 'left') + ->where('tm.tpa_claim_push_reference_no IS NOT NULL') + ->where('tm.is_active', 1) + ->whereNotIn('tm.claim_status_id', [8, 11, 12, 13, 66, 22, 24, 47, 49, 32, 34, 53, 55, 42, 44, 58, 60]) + ->where('tm.tpa_id', $this->mediAssistTpaId) + ->get() + ->getResultArray(); + + log_message('error','MEDI_ASSIST - Claim Status started | for ticket count: ' . count($TicketData)); + + if (!$TicketData) { + log_message('error',"MEDI_ASSIST - Claims not found to update Claim Status"); + return $this->response->setJSON([ + 'status' => false, + 'message' => 'Claims not found' + ]); + } + + $error_data = []; + $status_updated_count = 0; + + // ✅ Move outside loop (performance) + $validStatuses = [ + "Claim Received" => 1, + "In Progress" => 5, + "Processed" => 11, + "Claim Paid" => 11, + "Denied" => 13, + "Cancelled" => 13, + "Information Awaited" => 4, + "Confirmation Awaited" => 4, + "Information Awaited Reminder" => 4, + "Information Awaited Final Reminder" => 4, + "Insurer Concurrence Awaited" => 7, + "Closed" => 12, + "Physical Documents Awaited" => 9, + "Processed - Payment Initiated" => 10, + "Processed - Transaction Failed" => 10, + "Processed - Account Details Updated" => 10, + "Processed - Debit Note Raised With Insurer for Payment" => 10, + "Processed - Payment Initiated by Insurer" => 10, + "Payment - Refunded to Insurer" => 14, + "Processed - Processing Payment" => 10, + "Processed - Physical Documents Awaited" => 9, + "NON ID" => 1, + "ID NOT GENERATED" => 2, + "CDA" => 3, + "REJECTED" => 8, + "APPROVED" => 9, + "PAYMENT INITIATED" => 10, + "SETTLED" => 11, + "RETURNED" => 14, + "UNDER PROCESS - TPA" => 61, + "DENIAL REVIEW AWAITED" => 66, + ]; + + foreach ($TicketData as $ticket) { + + $claimId = $ticket['id']; + $matched = false; + + $body = [ + "policyNo" => $ticket['policyNo'] ?? "", + "startDate" => "", + "endDate" => "", + "employeeCode" => $ticket['employeeCode'] ?? "", + "memberID" => "", + "claimNo" => "", + "claimRefNo" => $ticket['claimRefNo'] ?? "", + ]; + + $response = call_third_party_api($url, $method, $headers, $body); + + log_message('error','MEDI_ASSIST - 2 hours Claim Status API Response: ' . json_encode($response)); + + if ($response['status'] != true || empty($response['data']['claimsData'])) { + log_message('error','MEDI_ASSIST - Claim Status FAILED | for ticket ID: ' . $claimId.' | response: '.json_encode($response)); + $error_data[$claimId] = [ + 'response' => $response, + 'body' => $body + ]; + continue; + } + + $allClaimData = $response['data']['claimsData']; + + foreach ($allClaimData as $claimData) { + + $currentStatus = $claimData['claim_Current_Status'] ?? ''; + $tpa_claim_no = $claimData['tpA_CLAIM_NO'] ?? ''; + $tpa_claim_type = $claimData['typE_OF_CLAIM'] ?? ''; + $tpa_ailments = ($claimData['ailment'] ?? '') . ' - ' . ($claimData['ailmenT_DESC'] ?? ''); + $claimRefNo = $claimData['clM_COMP_REFNO'] ?? ''; + + // ✅ Normalize dates (critical fix) + $claimDOA = !empty($claimData['datE_OF_ADMISSION']) + ? date('Y-m-d', strtotime($claimData['datE_OF_ADMISSION'])) + : null; + + $ticketDOA = !empty($ticket['doa']) + ? date('Y-m-d', strtotime($ticket['doa'])) + : null; + + $isMatch = false; + + // ================================ + // ✅ STRICT MATCHING (NO LOOPHOLE) + // ================================ + + // Case 1: claim number exists → ONLY match by claim number + if (!empty($ticket['claim_number'])) { + + if ($ticket['claim_number'] == $tpa_claim_no) { + $isMatch = true; + } + + } + // Case 2: claim number empty → match by DOA + claimRefNo ONLY + else { + + if ( + !empty($ticket['claimRefNo']) && + $ticket['claimRefNo'] == $claimRefNo && + $ticketDOA == $claimDOA + ) { + $isMatch = true; + } + } + + // ❌ No fallback allowed + + if (!$isMatch) { + continue; + } + + // ================================ + // ✅ MATCH FOUND + // ================================ + $matched = true; + + $updateArray = [ + 'tpa_claim_status' => $currentStatus, + 'updated_at' => date('Y-m-d H:i:s'), + 'last_updated_by' => 'API', + ]; + + if (isset($validStatuses[$currentStatus])) { + $updateArray['claim_status_id'] = $validStatuses[$currentStatus]; + } + + // Set claim number only if empty + if (empty($ticket['claim_number']) && !empty($tpa_claim_no)) { + $updateArray['claim_number'] = $tpa_claim_no; + $updateArray['tpa_claim_id'] = $tpa_claim_no; + } + + if (!empty($tpa_claim_type)) { + $updateArray['tpa_claim_type'] = $tpa_claim_type; + } + + if (!empty($tpa_ailments)) { + $updateArray['tpa_ailments'] = $tpa_ailments; + } + + // UPDATE DB + $this->db->table('ticket_master') + ->where('id', $claimId) + ->update($updateArray); + + $status_updated_count++; + + log_message('error',"MEDI_ASSIST - Claim Status SUCCESS | Updated ticket ID $claimId with Claim Status: $currentStatus"); + + break; // ✅ only inner loop + } + + // ================================ + // ❌ UNMATCHED LOG (once per ticket) + // ================================ + if (!$matched) { + log_message('error', "MEDI_ASSIST | 2 hours | Claim Status NOT UPDATED | TicketID={$claimId} | TicketDOA={$ticket['doa']} | ClaimRefNo={$ticket['claimRefNo']}"); + } + } + + log_message('error',"MEDI_ASSIST - Claim Status ENDED | 2 hours | Total Tickets={".count($TicketData)."} | Status Updated={$status_updated_count} | Errors={".count($error_data)."}"); + + return $this->response->setJSON([ + 'status' => true, + 'message' => 'Claim Status updated.', + 'count' => $status_updated_count, + 'error_data' => $error_data, + ]); + } + public function syncTpaClaimToNhance() { helper(['api', 'date']);