["col_name" => "ABHI Claim No", "col_index" => 0], "db_column" => "abhi_claim_no"], ["excel_column" => ["col_name" => "New ABHI Claim No With Extension", "col_index" => 1], "db_column" => "new_abhi_claim_no_with_extension"], ["excel_column" => ["col_name" => "Unique Count", "col_index" => 2], "db_column" => "unique_count"], ["excel_column" => ["col_name" => "Proposer Name", "col_index" => 3], "db_column" => "proposer_name"], ["excel_column" => ["col_name" => "Patient Name", "col_index" => 4], "db_column" => "patient_name"], ["excel_column" => ["col_name" => "Family ID", "col_index" => 5], "db_column" => "family_id"], ["excel_column" => ["col_name" => "Member Code", "col_index" => 6], "db_column" => "member_code"], ["excel_column" => ["col_name" => "Patient Age", "col_index" => 7], "db_column" => "patient_age"], ["excel_column" => ["col_name" => "Relation", "col_index" => 8], "db_column" => "relation"], ["excel_column" => ["col_name" => "Gender", "col_index" => 9], "db_column" => "gender"], ["excel_column" => ["col_name" => "Certificate No", "col_index" => 10], "db_column" => "certificate_no"], ["excel_column" => ["col_name" => "Master Policy No", "col_index" => 11], "db_column" => "master_policy_no"], ["excel_column" => ["col_name" => "Policy Number", "col_index" => 12], "db_column" => "policy_number"], ["excel_column" => ["col_name" => "Policy From", "col_index" => 13], "db_column" => "policy_from"], ["excel_column" => ["col_name" => "Policy Upto", "col_index" => 14], "db_column" => "policy_upto"], ["excel_column" => ["col_name" => "Product Name", "col_index" => 15], "db_column" => "product_name"], ["excel_column" => ["col_name" => "Product Name 1", "col_index" => 16], "db_column" => "product_name_1"], ["excel_column" => ["col_name" => "Sub - Product", "col_index" => 17], "db_column" => "sub_product"], ["excel_column" => ["col_name" => "Policy Category", "col_index" => 18], "db_column" => "policy_category"], ["excel_column" => ["col_name" => "Policy Category (Carry Forward till Q3 18-19)+(New Q4 18-19 Onward)", "col_index" => 19], "db_column" => "policy_category_cf_q3_q4"], ["excel_column" => ["col_name" => "Sum Insured", "col_index" => 20], "db_column" => "sum_insured"], ["excel_column" => ["col_name" => "Bonus", "col_index" => 21], "db_column" => "bonus"], ["excel_column" => ["col_name" => "Intimation Date", "col_index" => 22], "db_column" => "intimation_date"], ["excel_column" => ["col_name" => "Date Of Doc Rec", "col_index" => 23], "db_column" => "date_of_doc_rec"], ["excel_column" => ["col_name" => "Intimation Final Month", "col_index" => 24], "db_column" => "intimation_final_month"], ["excel_column" => ["col_name" => "Reported Year", "col_index" => 25], "db_column" => "reported_year"], ["excel_column" => ["col_name" => "Reported Qurter", "col_index" => 26], "db_column" => "reported_quarter"], ["excel_column" => ["col_name" => "Hospital Name", "col_index" => 27], "db_column" => "hospital_name"], ["excel_column" => ["col_name" => "Hospital City", "col_index" => 28], "db_column" => "hospital_city"], ["excel_column" => ["col_name" => "Hospital State", "col_index" => 29], "db_column" => "hospital_state"], ["excel_column" => ["col_name" => "Diagnosis", "col_index" => 30], "db_column" => "diagnosis"], ["excel_column" => ["col_name" => "ICD Chapter", "col_index" => 31], "db_column" => "icd_chapter"], ["excel_column" => ["col_name" => "ICD Block", "col_index" => 32], "db_column" => "icd_block"], ["excel_column" => ["col_name" => "ICD Level1", "col_index" => 33], "db_column" => "icd_level1"], ["excel_column" => ["col_name" => "ICD Level2", "col_index" => 34], "db_column" => "icd_level2"], ["excel_column" => ["col_name" => "Procedure Description", "col_index" => 35], "db_column" => "procedure_description"], ["excel_column" => ["col_name" => "PCS Description", "col_index" => 36], "db_column" => "pcs_description"], ["excel_column" => ["col_name" => "DOA", "col_index" => 37], "db_column" => "doa"], ["excel_column" => ["col_name" => "DOD", "col_index" => 38], "db_column" => "dod"], ["excel_column" => ["col_name" => "Claim Type", "col_index" => 39], "db_column" => "claim_type"], ["excel_column" => ["col_name" => "Claim Category", "col_index" => 40], "db_column" => "claim_category"], ["excel_column" => ["col_name" => "Disc Datails", "col_index" => 41], "db_column" => "disc_details"], ["excel_column" => ["col_name" => "Disc Date", "col_index" => 42], "db_column" => "disc_date"], ["excel_column" => ["col_name" => "Hospital Code", "col_index" => 43], "db_column" => "hospital_code"], ["excel_column" => ["col_name" => "Claim Status", "col_index" => 44], "db_column" => "claim_status"], ["excel_column" => ["col_name" => "Final ABHI Status-Current Month", "col_index" => 45], "db_column" => "final_abhi_status_current_month"], ["excel_column" => ["col_name" => "Claimed Amount", "col_index" => 46], "db_column" => "claimed_amount"], ["excel_column" => ["col_name" => "ABHI Amount Less Coins - Current Month", "col_index" => 47], "db_column" => "abhi_amount_less_coins_current_month"], ["excel_column" => ["col_name" => "Repudiation Date", "col_index" => 48], "db_column" => "repudiation_date"], ["excel_column" => ["col_name" => "Settled Date", "col_index" => 49], "db_column" => "settled_date"], ["excel_column" => ["col_name" => "Settled Month", "col_index" => 50], "db_column" => "settled_month"], ["excel_column" => ["col_name" => "Settled Year", "col_index" => 51], "db_column" => "settled_year"], ["excel_column" => ["col_name" => "Settled Quarter", "col_index" => 52], "db_column" => "settled_quarter"], ["excel_column" => ["col_name" => "Rejection Category", "col_index" => 53], "db_column" => "rejection_category"], ["excel_column" => ["col_name" => "Rejection Category - Level 1", "col_index" => 54], "db_column" => "rejection_category_level_1"], ["excel_column" => ["col_name" => "Rejection Category - Level 2", "col_index" => 55], "db_column" => "rejection_category_level_2"], ["excel_column" => ["col_name" => "COVID tagging - Current Month", "col_index" => 56], "db_column" => "covid_tagging_current_month"], ["excel_column" => ["col_name" => "EXPECTED DOA", "col_index" => 57], "db_column" => "expected_doa"], ["excel_column" => ["col_name" => "EXPECTED DOD", "col_index" => 58], "db_column" => "expected_dod"], ["excel_column" => ["col_name" => "AGENT/BROKER CODE", "col_index" => 59], "db_column" => "agent_broker_code"], ["excel_column" => ["col_name" => "AGENT/BROKER NAME", "col_index" => 60], "db_column" => "agent_broker_name"], ["excel_column" => ["col_name" => "HEALTHCARD_ID", "col_index" => 61], "db_column" => "healthcard_id"], ["excel_column" => ["col_name" => "ABHI_NETWORK_NON_NETWORK", "col_index" => 62], "db_column" => "abhi_network_non_network"], ["excel_column" => ["col_name" => "CORPORATE_EMPLOYEE_CODE", "col_index" => 63], "db_column" => "corporate_employee_code"], ]; protected $ticketMasterMapping = [ // Employee / Member details 'member_code' => 'emp_code', 'abhi_claim_no' => 'claim_number', // Dates 'doa' => 'doa', 'dod' => 'dod', 'intimation_date' => 'date_of_intimat', // Claim info 'claim_status' => 'tpa_claim_status', 'claimed_amount' => 'claim_amount', // Hospital details 'hospital_name' => 'hospital_name', 'hospital_city' => 'hospital_city', 'hospital_state' => 'hospital_state', // Settlement / decision 'repudiation_date' => 'denial_date', 'settled_date' => 'settled_date', 'rejection_category' => 'denial_reason', // Misc 'healthcard_id' => 'tpa_no', 'claim_type' => 'tpa_claim_type', ]; protected $statusMapping = [ 'Settled' => 11, 'Rejected' => 8, 'Cancelled' => 13, 'Approved' => 9, 'Closed' => 12, 'Query' => 4, 'Required Information' => 4, 'In-Progress' => 5, 'Paid' => 11, 'Denied' => 8, 'Cancelled' => 13, 'Processed' => 61, 'Information Awaited' => 4, 'Denied Letter Sent' => 66, 'Cashless Document Awaited' => 3, 'RI Cancelled' => 13, ]; protected $dateColumns = [ 'policy_from', 'policy_upto', 'intimation_date', 'date_of_doc_rec', 'doa', 'dod', 'repudiation_date', 'settled_date', 'expected_doa', 'expected_dod', ]; /** * ABSTRACT FUNCTIONs */ public function bulkInsertTPATable(array $data): bool { if (empty($data)) { return false; } $builder = $this->db->table('claims_dump_abhi'); return $builder->insertBatch($data); } public function importClaimMaster(array $data): bool { if (empty($data)) { return false; } $ticketMasterModel = new TicketMasterModel(); return $ticketMasterModel->insertBatch($data); } public function updateTicketIdInTPATable(int $fileId): bool { $rows = $this->db->table('claims_dump_abhi cd') ->select('cd.id, tm.id AS ticket_id') ->join('ticket_master tm', 'tm.claim_dump_ref_id = cd.id AND tm.file_id = cd.file_id', 'inner') ->where('cd.is_active', 1) ->where('cd.file_id', $fileId) ->where('cd.ticket_id IS NULL') ->get() ->getResultArray(); if (empty($rows)) { return true; } $updateData = []; foreach ($rows as $row) { $updateData[] = [ 'id' => $row['id'], 'ticket_id' => $row['ticket_id'], ]; } return $this->db->table('claims_dump_abhi')->updateBatch($updateData, 'id') !== false; } public function updateTicketMasterRejectedReasonInTPATable($data): bool { if (empty($data)) { return false; } $builder = $this->db->table('claims_dump_abhi'); return $builder->updateBatch($data, 'id') !== false; } /** * MAPPING FUNCTIONs */ public function mapTPAData(array $rows, $file_id): array { $ClientPolicyModel = new ClaimDumpFileModel(); $file_data = $ClientPolicyModel->where('id', $file_id)->first(); $mapped = []; foreach ($rows as $row) { $item = []; foreach ($this->mapping as $map) { $excelColumn = $map['excel_column']['col_name']; $dbColumn = $map['db_column']; $value = $row[$excelColumn] ?? null; $item[$dbColumn] = $value === null ? null : trim((string) $value); } foreach ($this->dateColumns as $key => $value) { $item[$value] = change_date_format($item[$value] ?? null, 'm/d/Y h:i:s A', 'Y-m-d'); } $item['file_id'] = $file_id ?? null; $item['client_id'] = $file_data['client_id'] ?? null; $item['client_policy_id'] = $file_data['client_policy_id'] ?? null; $item['created_by'] = $file_data['created_by'] ?? null; $mapped[] = $item; } return $mapped; } public function mapClaimMasterData($file_id): array { $ClientPolicyModel = new ClaimDumpFileModel(); $file_data = $ClientPolicyModel->where('id', $file_id)->first(); $tpaClaimDumpData = $this->getTpaClaimDumpData('claims_dump_abhi', ['file_id' => $file_id]); if (empty($tpaClaimDumpData)) { return $this->emptyClaimMasterMappingResponse('claims_dump_abhi', (int) $file_id); } $ClientPolicyModel = new ClientPolicyModel(); $client_policy_data = $ClientPolicyModel ->select(" client_policy.*, ( SELECT id FROM client_rm WHERE is_active = 1 AND level = 3 AND client_id = client_policy.client_id ORDER BY id ASC LIMIT 1 ) AS acm_id ") ->where('client_policy.id', $file_data['client_policy_id']) ->where('client_policy.is_active', 1) ->first(); try { $mapped = []; $rejecetd_reason = []; $status_update_array = []; foreach ($tpaClaimDumpData as $row) { $params = [ 'doa' => change_date_format($row['doa'] ?? '') ?? null, 'emp_code' => $row['member_code'] ?? null, 'claim_amount' => $row['claimed_amount'] ?? null, 'tpa_no' => $row['healthcard_id'] ?? null, 'client_id' => $file_data['client_id'] ?? null, 'client_policy_id' => $file_data['client_policy_id'] ?? null, ]; $newStatusId = $this->resolveClaimStatusId( $this->statusMapping, $row['claim_status'] ?? '', (int) $row['id'], $rejecetd_reason ); if ($newStatusId === null) { continue; } $existingTicket = $this->getExistingTicketMasterClaim($params); if ($this->handleExistingTicketStatusUpdate( $existingTicket, $newStatusId, (int) $row['id'], $status_update_array, $rejecetd_reason )) { continue; } $item = []; $item['client_id'] = $client_policy_data['client_id'] ?? null; $item['client_policy_id'] = $client_policy_data['id'] ?? null; $item['insurer_id'] = $client_policy_data['insurer_id'] ?? null; $item['tpa_id'] = $client_policy_data['tpa_id'] ?? null; $item['acm_id'] = $client_policy_data['acm_id'] ?? null; $item['policy_no'] = $client_policy_data['policy_no'] ?? null; $item['relationship'] = $this->convertRelation($row['relation'] ?? null); $employee_data = $this->getEmployeeDetails($file_data['client_id'], $file_data['client_policy_id'], $row['member_code'], $item['relationship']); if (!empty($employee_data)) { $item['emp_id'] = $employee_data['id'] ?? null; $item['emp_name'] = $employee_data['name'] ?? null; $item['emp_code'] = $employee_data['emp_code'] ?? null; $item['emp_mail'] = $employee_data['emp_mail'] ?? null; $item['emp_mobile'] = $employee_data['emp_mobile'] ?? null; if (!empty($employee_data['insured_emp_id'])) { $item['insured_emp_id'] = $employee_data['insured_emp_id'] ?? null; $item['insured_name'] = $employee_data['insured_name'] ?? null; }else{ $reason = 'This Dependent employee not exist in our system.'; $rejecetd_reason[] = ["id" => $row['id'], "master_reject_reason" => $reason]; continue; } } else { $reason = 'This employee not exist in our system.'; $rejecetd_reason[] = ["id" => $row['id'], "master_reject_reason" => $reason]; continue; } foreach ($this->ticketMasterMapping as $tpaKey => $ticketMasterKey) { $item[$ticketMasterKey] = array_key_exists($tpaKey, $row) ? $row[$tpaKey] : null; } // Meta fields $item['claim_status_id'] = $newStatusId; $item['file_id'] = $file_id; $item['claim_dump_ref_id'] = $row['id']; $item['claim_dump_date'] = $file_data['claim_dump_date'] ?? null; $item['created_by'] = $file_data['created_by'] ?? null; $item['claim_description'] = $row['diagnosis'] ?? null; $item['tpa_ailments'] = $row['diagnosis'] ?? null; $claimTypeRaw = strtolower(trim((string) ($row['claim_type'] ?? ''))); $item['claim_type'] = (str_contains($claimTypeRaw, 'pre') || str_contains($claimTypeRaw, 'post')) ? 3 : 1; $item['priority'] = 1; $item['mode_of_intimation'] = 5; $item['ticket_type_id'] = 1; $item['claim_created_by'] = 'DUMP_TPA'; $mapped[] = $item; } return [ 'status' => true, 'mapped_array' => $mapped, 'rejected_reason_array' => $rejecetd_reason, 'status_update_array' => $status_update_array, ]; } catch (\Throwable $th) { $errorData = [ 'message' => $th->getMessage(), 'file' => $th->getFile(), 'line' => $th->getLine(), 'code' => $th->getCode(), 'trace' => $th->getTraceAsString(), 'trace_array' => $th->getTrace(), // full array version (optional) 'function' => $th->getTrace()[0]['function'] ?? null, 'class' => $th->getTrace()[0]['class'] ?? null, ]; return ['status' => false, "message" => $errorData['message'], 'error_data' => $errorData]; } } /** * HELPER FUNCTIONs */ public function isDateValue($value): bool { if (empty($value)) { return false; } // Excel numeric date if (is_numeric($value) && $value > 30000) { return true; } return strtotime(str_replace('/', '-', $value)) !== false; } public function normalizeDate($value): ?string { try { if (empty($value)) { return null; } // Excel numeric date if (is_numeric($value)) { return date( 'Y-m-d', \PhpOffice\PhpSpreadsheet\Shared\Date::excelToTimestamp($value) ); } $value = trim((string) $value); // Replace / with - for strtotime compatibility $value = str_replace('/', '-', $value); $timestamp = strtotime($value); if ($timestamp === false) { return null; } return date('Y-m-d', $timestamp); } catch (\Throwable $e) { return null; } } public function convertRelation(?string $relation): ?string { if (empty($relation)) { return null; } // trim removes whitespace, strtolower handles case sensitivity $relation = strtolower(trim($relation)); // Mapping specific keywords to standardized outputs // ORDER MATTERS: Specific phrases (in-law) must come before general ones (father) $map = [ 'father-in-law' => ['father in law', 'father-in-law', 'fil'], 'mother-in-law' => ['mother in law', 'mother-in-law', 'mil'], 'father' => ['father', 'papa', 'dad'], 'mother' => ['mother', 'mom', 'mummy'], 'spouse' => ['spouse', 'wife', 'husband', 'hubby'], 'daughter' => ['daughter', 'daug'], 'son' => ['son'], 'self' => ['self', 'employee', 'main'], ]; foreach ($map as $standard => $keywords) { foreach ($keywords as $keyword) { if (str_contains($relation, $keyword)) { return $standard; } } } return null; } }