FIX_MEDIASSIT_TPA_API
This commit is contained in:
velz
parent
a06b74da6a
commit
9912aa747f
@ -992,6 +992,7 @@ 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);
|
||||
|
||||
@ -1028,6 +1028,7 @@ 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);
|
||||
|
||||
@ -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']);
|
||||
|
||||
Loading…
Reference in New Issue
Block a user