sync tpa claims to nhance database: GWM
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a6d443af38
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c1c0887b2d
@ -767,11 +767,12 @@ $routes->get('claimStatus','VidalApiController::claimStatus');
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$routes->get('EcardRequest','MediAssistApiController::EcardRequest');
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$routes->get('HospitalNetwork','MediAssistApiController::HospitalNetwork');
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$routes->get('GetBenefDetails','MediAssistApiController::GetBenefDetails');
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$routes->get('ClaimDetail','VidalApiController::ClaimDetail');
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$routes->get('ClaimDetail','MediAssistApiController::ClaimDetail');
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$routes->get('SubmitClaim','MediAssistApiController::SubmitClaim');
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$routes->get('IntimateClaim','MediAssistApiController::IntimateClaim');
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$routes->get('IRSubmission','MediAssistApiController::IRSubmission');
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$routes->get('ClaimStatusUpdate','MediAssistApiController::ClaimStatusUpdate');
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$routes->get('syncTpaClaimToNhance','MediAssistApiController::syncTpaClaimToNhance');
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// API service
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@ -6,6 +6,7 @@ use App\Controllers\BaseController;
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use App\Models\BatchFileModel;
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use App\Models\EmployeePolicyModel;
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use App\Models\TpaApiDataModel;
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use App\Models\ClientPolicyModel;
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use CodeIgniter\HTTP\ResponseInterface;
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use CodeIgniter\HTTP\IncomingRequest;
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use CodeIgniter\HTTP\RequestInterface;
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@ -25,6 +26,7 @@ class MediAssistApiController extends BaseController
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}
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public function SubmitClaim ($claimId = null)
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{
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@ -482,7 +484,7 @@ class MediAssistApiController extends BaseController
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}
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}
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public function ClaimDetail($claimId = null) // 585 this id for test
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public function ClaimDetail($claimId = 585) // 585 this id for test
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{
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helper('api');
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@ -545,19 +547,21 @@ class MediAssistApiController extends BaseController
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// dd($body);
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// $body = [
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// "policyNo" => "97000063250400000031",
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// "startDate" => "31/08/2025",
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// "endDate" => "01/09/2025",
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// "employeeCode" => "CITPL120193",
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// "memberID" => "",
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// "claimNo" => "",
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// "claimRefNo" => "HOSP4078102577_16092025111030"
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// ];
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$body = [
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"policyNo" => "97000063250400000031",
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"startDate" => "01/11/2025",
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"endDate" => "05/11/2025",
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"employeeCode" => "",
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"memberID" => "",
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"claimNo" => "",
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"claimRefNo" => ""
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];
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// CALL API
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$response = call_third_party_api($url, $method, $headers, $body);
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dd($response);
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if ($response['status'] != true || empty($response['data']['claimsData'][0])) {
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log_message('error', 'CLAIM STATUS FAILED | for ticket ID: ' . $claimId.' | response: '.json_encode($response));
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@ -616,9 +620,9 @@ class MediAssistApiController extends BaseController
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// Maping tpa claim status with local claim Status
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if (isset($validStatuses[$currentStatus]))
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{
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$updateArray = ['claim_status_id' => $validStatuses[$currentStatus] , 'tpa_claim_status' => $currentStatus , 'tpa_claim_id' => $tpa_claim_no , 'updated_at' => date('Y-m-d H:i:s')];
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$updateArray = ['claim_status_id' => $validStatuses[$currentStatus] , 'tpa_claim_status' => $currentStatus , 'tpa_claim_id' => $tpa_claim_no, 'claim_number' => $tpa_claim_no, 'updated_at' => date('Y-m-d H:i:s')];
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}else{
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$updateArray = ['tpa_claim_status' => $currentStatus , 'tpa_claim_id' => $tpa_claim_no , 'updated_at' => date('Y-m-d H:i:s')];
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$updateArray = ['tpa_claim_status' => $currentStatus , 'tpa_claim_id' => $tpa_claim_no, 'claim_number' => $tpa_claim_no , 'updated_at' => date('Y-m-d H:i:s')];
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}
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// UPDATE ticket_master
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@ -797,7 +801,6 @@ class MediAssistApiController extends BaseController
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// unlink($file_array['json_file_path']); // delete temp json file
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}
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public function ClaimStatusUpdate()
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{
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helper('api');
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@ -928,9 +931,9 @@ class MediAssistApiController extends BaseController
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// Maping tpa claim status with local claim Status
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if (isset($validStatuses[$currentStatus]))
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{
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$updateArray = ['claim_status_id' => $validStatuses[$currentStatus] , 'tpa_claim_status' => $currentStatus , 'tpa_claim_id' => $tpa_claim_no , 'updated_at' => date('Y-m-d H:i:s')];
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$updateArray = ['claim_status_id' => $validStatuses[$currentStatus] , 'tpa_claim_status' => $currentStatus , 'tpa_claim_id' => $tpa_claim_no , 'claim_number' => $tpa_claim_no , 'updated_at' => date('Y-m-d H:i:s')];
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}else{
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$updateArray = ['tpa_claim_status' => $currentStatus , 'tpa_claim_id' => $tpa_claim_no , 'updated_at' => date('Y-m-d H:i:s')];
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$updateArray = ['tpa_claim_status' => $currentStatus , 'tpa_claim_id' => $tpa_claim_no , 'claim_number' => $tpa_claim_no, 'updated_at' => date('Y-m-d H:i:s')];
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}
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// UPDATE ticket_master
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@ -952,6 +955,328 @@ class MediAssistApiController extends BaseController
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]);
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}
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public function syncTpaClaimToNhance()
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{
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helper(['api', 'date']);
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$url = getenv('MEDI_ASSIST_API_BASE_URL_CLAIMSTATUS');
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$method = 'POST';
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$headers = [
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'Content-Type: application/json',
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'Username:' . getenv('MEDI_ASSIST_API_USERNAME'),
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'Password:' . getenv('MEDI_ASSIST_API_PASSWORD'),
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];
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// REQUEST DATES
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$reqStartDate = $this->request->getGet('start_date');
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$reqEndDate = $this->request->getGet('end_date');
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// If start_date OR end_date is missing → last 7 days
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if (empty($reqStartDate) || empty($reqEndDate)) {
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$endDateObj = new \DateTime(); // today
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$startDateObj = (clone $endDateObj)->modify('-6 days');
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} else {
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$startDateObj = new \DateTime($reqStartDate);
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$endDateObj = new \DateTime($reqEndDate);
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}
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// Final usable variables
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$reqStartDate = $startDateObj->format('Y-m-d');
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$reqEndDate = $endDateObj->format('Y-m-d');
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// Final usable variables
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$reqStartDate = new \DateTime($reqStartDate);
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$reqEndDate = new \DateTime($reqEndDate);
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// FETCH POLICY DATA
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$policies = $this->db->table('client_policy cp')
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->select("
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cp.policy_no AS policyNo,
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cp.policy_start_date AS policyStartDate,
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cp.policy_end_date AS policyEndDate
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")
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->where('cp.is_active', 1)
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->where('cp.policy_type_id', 2)
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->where('cp.policy_status', 1)
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// ->where('cp.policy_no', '97000063250400000031')
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->where('cp.tpa_id', $this->mediAssistTpaId)
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->get()
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->getResultArray();
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if (empty($policies)) {
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log_message('error', 'No policies found for claim sync');
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return $this->response->setJSON([
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'status' => false,
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'message' => 'Policies not found'
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]);
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}
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$finalResult = [];
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$errorData = [];
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// LOOP POLICIES
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foreach ($policies as $policy) {
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$policyStart = new \DateTime($policy['policyStartDate']);
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$policyEnd = new \DateTime($policy['policyEndDate']);
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// ADJUST DATE RANGE (inside policy period)
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$startDate = max($reqStartDate, $policyStart);
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$endDate = min($reqEndDate, $policyEnd);
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if ($startDate > $endDate) {
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continue; // No valid range for this policy
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}
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// SPLIT INTO 7-DAY CHUNKS
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$chunkStart = clone $startDate;
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while ($chunkStart <= $endDate) {
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$chunkEnd = clone $chunkStart;
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$chunkEnd->modify('+6 days');
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if ($chunkEnd > $endDate) {
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$chunkEnd = clone $endDate;
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}
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// PREPARE BODY
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$body = [
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"policyNo" => $policy['policyNo'],
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"startDate" => $chunkStart->format('d/m/Y'),
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"endDate" => $chunkEnd->format('d/m/Y'),
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"employeeCode" => "",
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"memberID" => "",
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"claimNo" => "",
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"claimRefNo" => "",
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];
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// CALL TPA API
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$response = call_third_party_api($url, $method, $headers, $body);
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if (empty($response['status']) || empty($response['data']['claimsData'])) {
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log_message('error','CLAIM STATUS FAILED | ' .'policyNo: ' . $policy['policyNo'] .' | ' . $chunkStart->format('Y-m-d') .' to ' . $chunkEnd->format('Y-m-d') .' | response: ' . json_encode($response) );
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$errorData[] = [
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'policy_no' => $policy['policyNo'],
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'start' => $chunkStart->format('Y-m-d'),
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'end' => $chunkEnd->format('Y-m-d'),
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];
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} else {
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$finalResult = array_merge($finalResult,$response['data']['claimsData']);
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}
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// Move to next chunk
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$chunkStart->modify('+7 days');
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}
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}
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// 5️⃣ FINAL RESPONSE
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foreach ($finalResult as $key => $value) {
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$relationship = strtolower(trim($value['relation'] ?? ''));
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if ($relationship === 'employee') {
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$relationship = 'self';
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}
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$ticket = $this->db->table('ticket_master tm')->select("tm.id")
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->where('tm.policy_no', $value['policY_NUMBER'])
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->where('tm.emp_code', $value['employeE_NO'])
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->where('tm.claim_number', $value['tpA_CLAIM_NO'])
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->get()
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->getRowArray();
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if(!$ticket)
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{
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// VALID STATUS LIST
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$validStatuses = [
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"Claim Received" => 1,
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"In Progress" => 5,
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"Processed" => 11,
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"Claim Paid" => 11,
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"Denied" => 13,
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"Cancelled" => 13,
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"Information Awaited" => 4,
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"Confirmation Awaited" => 4,
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"Information Awaited Reminder" => 4,
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"Information Awaited Final Reminder" => 4,
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"Insurer Concurrence Awaited" => 6,
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"Closed" => 12,
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"Physical Documents Awaited" => 9,
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"Processed - Payment Initiated" => 10,
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"Processed - Transaction Failed" => 10,
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"Processed - Account Details Updated" => 10,
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"Processed - Debit Note Raised With Insurer for Payment"=> 10,
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"Processed - Payment Initiated by Insurer" => 10,
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"Payment - Refunded to Insurer" => 14,
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"Processed - Processing Payment" => 10,
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"Processed - Physical Documents Awaited" => 9,
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// Extra Mappings (based on your DB list)
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"NON ID" => 1,
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"ID NOT GENERATED" => 2,
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"CDA" => 3,
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"REJECTED" => 8,
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"APPROVED" => 9,
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"PAYMENT INITIATED" => 10,
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"SETTLED" => 11,
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"RETURNED" => 14,
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"UNDER PROCESS - TPA" => 61,
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"DENIAL REVIEW AWAITED" => 66,
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];
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$currentStatus = trim($value['claim_Current_Status'] ?? '');
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$claimStatusId = $validStatuses[$currentStatus] ?? null;
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if (!$claimStatusId) {
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log_message('error', 'Unknown claim status: '.$currentStatus);
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continue;
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}
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$clientpolicy = $this->db->table('client_policy cp')
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->select("
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cp.id as client_policy_id,
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cp.client_id ,
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cp.insurer_id ,
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cp.tpa_id ,
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client_rm.id as acm_id
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")
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->join('client_rm', 'client_rm.client_id = cp.client_id AND client_rm.level = 3', 'left')
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->where('cp.policy_no', $value['policY_NUMBER'])
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->get()
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->getRowArray();
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$employee = $this->db->table('employees e')
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->select("
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e.id as emp_id,
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e.emp_code ,
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e2.id as insured_emp_id,
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")
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->join(
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'employees e2',
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"e2.emp_code = e.emp_code AND e2.relationship = ".$this->db->escape($relationship),
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'left'
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)
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->where('e.emp_code', $value['employeE_NO'])
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->where('e.relationship', 'self')
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->get()
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->getRowArray();
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$claimData = [
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// Core
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'ticket_type_id' => 1,
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'claim_status_id' => $claimStatusId,
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'policy_no' => $value['policY_NUMBER'] ?? null,
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'claim_number' => $value['tpA_CLAIM_NO'] ?? null,
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'tpa_claim_id' => $value['tpA_CLAIM_NO'] ?? null,
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// local promary id
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'tpa_id' => $clientpolicy['tpa_id'] ?? null,
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'insurer_id' => $clientpolicy['insurer_id'] ?? null,
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'client_policy_id' => $clientpolicy['client_policy_id'] ?? null,
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'client_id' => $clientpolicy['client_id'] ?? null,
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'acm_id' => $clientpolicy['acm_id'] ?? null,
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// Employee / Insured
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'emp_id' => $employee['emp_id'] ?? null,
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'insured_emp_id' => $employee['insured_emp_id'] ?? null,
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'emp_code' => $value['employeE_NO'] ?? null,
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'emp_name' => $value['employeE_NAME'] ?? null,
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'insured_name' => $value['beneficiarY_NAME'] ?? null,
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'relationship' => $relationship,
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'emp_mobile' => $value['mobile'] ?? null,
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'emp_mail' => $value['email'] ?? null,
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// Claim info
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'claim_type' => 1,
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'mode_of_intimation' => 5,
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'claim_amount' => $value['estimateD_CLAIM_AMOUNT']
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?? $value['finaL_BILL_AMOUNT']
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?? null,
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'approved_amount' => $value['claiM_APPROVED_AMOUNT'] ?? null,
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// Dates
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'dob' => $this->mediDate($value['datE_OF_BIRTH'] ?? null),
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'doa' => $this->mediDate($value['datE_OF_ADMISSION'] ?? null),
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'dod' => $this->mediDate($value['datE_OF_DISCHARGE'] ?? null),
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'raised_date' => $this->mediDate($value['claiM_REGISTERED_DATE'] ?? null),
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'approved_date' => $this->mediDate($value['approved_Date'] ?? null),
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'settled_date' => $this->mediDate($value['paiD_DATE'] ?? null),
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// Hospital
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'hospital_name' => $value['hospitaL_NAME'] ?? null,
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'hospital_address' => $value['hospitaL_ADDRESS'] ?? null,
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'hospital_state' => $value['hospitaL_STATE'] ?? null,
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'hospital_city' => $value['hospitaL_CITY'] ?? null,
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'hospital_pin_code'=> $value['hosP_PINCODE'] ?? null,
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// Payment
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'utr_details' => $value['banK_CHEQUE_NO'] ?? null,
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'settle_letter' => $value['settlement_LetterLink'] ?? null,
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];
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$this->db->table('ticket_master')->insert($claimData);
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log_message(
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'info',
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'New claim created | Policy: '.$claimData['policy_no'].
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' | Claim: '.$claimData['claim_number']
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);
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}
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}
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return $this->response->setJSON([
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'status' => true,
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'message' => 'TPA claim status sync completed',
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'total_records' => count($finalResult),
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'result' => $finalResult,
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'errors' => $errorData
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]);
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}
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public function mediDate($date)
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{
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if (empty($date)) return null;
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$dt = \DateTime::createFromFormat('d/m/Y H:i:s', $date);
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return $dt ? $dt->format('Y-m-d') : null;
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}
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