["col_name"=>"Requesttype","col_index"=>0],"db_column"=>"request_type"], ["excel_column"=>["col_name"=>"Intimation ID","col_index"=>1],"db_column"=>"intimation_id"], ["excel_column"=>["col_name"=>"Intimation Date","col_index"=>2],"db_column"=>"intimation_date"], ["excel_column"=>["col_name"=>"claimid","col_index"=>3],"db_column"=>"claim_id"], ["excel_column"=>["col_name"=>"slno","col_index"=>4],"db_column"=>"sl_no"], ["excel_column"=>["col_name"=>"UHIDNO","col_index"=>5],"db_column"=>"uhid_no"], ["excel_column"=>["col_name"=>"Membername","col_index"=>6],"db_column"=>"member_name"], ["excel_column"=>["col_name"=>"Main Memuhidno","col_index"=>7],"db_column"=>"main_member_uhid_no"], ["excel_column"=>["col_name"=>"Main Memname","col_index"=>8],"db_column"=>"main_member_name"], ["excel_column"=>["col_name"=>"Gender","col_index"=>9],"db_column"=>"gender"], ["excel_column"=>["col_name"=>"DOB","col_index"=>10],"db_column"=>"dob"], ["excel_column"=>["col_name"=>"Yrs","col_index"=>11],"db_column"=>"years"], ["excel_column"=>["col_name"=>"relationship","col_index"=>12],"db_column"=>"relationship"], ["excel_column"=>["col_name"=>"employeeid","col_index"=>13],"db_column"=>"employee_id"], ["excel_column"=>["col_name"=>"Mobile","col_index"=>14],"db_column"=>"mobile"], ["excel_column"=>["col_name"=>"Email","col_index"=>15],"db_column"=>"email"], ["excel_column"=>["col_name"=>"Policy No","col_index"=>16],"db_column"=>"policy_no"], ["excel_column"=>["col_name"=>"Policy Start Date","col_index"=>17],"db_column"=>"policy_start_date"], ["excel_column"=>["col_name"=>"Policy Commencing Date","col_index"=>18],"db_column"=>"policy_commencing_date"], ["excel_column"=>["col_name"=>"Policy Expiry Date","col_index"=>19],"db_column"=>"policy_expiry_date"], ["excel_column"=>["col_name"=>"Organisationname","col_index"=>20],"db_column"=>"organisation_name"], ["excel_column"=>["col_name"=>"Claimreceiveddate","col_index"=>21],"db_column"=>"claim_received_date"], ["excel_column"=>["col_name"=>"Admdate","col_index"=>22],"db_column"=>"admission_date"], ["excel_column"=>["col_name"=>"Dis Date","col_index"=>23],"db_column"=>"discharge_date"], ["excel_column"=>["col_name"=>"Diagnosis","col_index"=>24],"db_column"=>"diagnosis"], ["excel_column"=>["col_name"=>"Service Type","col_index"=>25],"db_column"=>"service_type"], ["excel_column"=>["col_name"=>"Service Sub Type","col_index"=>26],"db_column"=>"service_sub_type"], ["excel_column"=>["col_name"=>"icdcode First Level","col_index"=>27],"db_column"=>"icd_code_first_level"], ["excel_column"=>["col_name"=>"icdcode Second Level","col_index"=>28],"db_column"=>"icd_code_second_level"], ["excel_column"=>["col_name"=>"icdcode Third Level","col_index"=>29],"db_column"=>"icd_code_third_level"], ["excel_column"=>["col_name"=>"Claim Type","col_index"=>30],"db_column"=>"claim_type"], ["excel_column"=>["col_name"=>"Providername","col_index"=>31],"db_column"=>"provider_name"], ["excel_column"=>["col_name"=>"provideraddress","col_index"=>32],"db_column"=>"provider_address"], ["excel_column"=>["col_name"=>"providerplace","col_index"=>33],"db_column"=>"provider_place"], ["excel_column"=>["col_name"=>"providerstate","col_index"=>34],"db_column"=>"provider_state"], ["excel_column"=>["col_name"=>"Provider Pincode","col_index"=>35],"db_column"=>"provider_pincode"], ["excel_column"=>["col_name"=>"PROVIDERTYPE","col_index"=>36],"db_column"=>"provider_type"], ["excel_column"=>["col_name"=>"Provider Identification","col_index"=>37],"db_column"=>"provider_identification"], ["excel_column"=>["col_name"=>"coverageamount","col_index"=>38],"db_column"=>"coverage_amount"], ["excel_column"=>["col_name"=>"claimamount","col_index"=>39],"db_column"=>"claim_amount"], ["excel_column"=>["col_name"=>"billedamount","col_index"=>40],"db_column"=>"billed_amount"], ["excel_column"=>["col_name"=>"Disallowed Amount","col_index"=>41],"db_column"=>"disallowed_amount"], ["excel_column"=>["col_name"=>"Dis Allowence Reason1","col_index"=>42],"db_column"=>"dis_allowance_reason_1"], ["excel_column"=>["col_name"=>"Dis Allowence Reason2","col_index"=>43],"db_column"=>"dis_allowance_reason_2"], ["excel_column"=>["col_name"=>"settledamt","col_index"=>44],"db_column"=>"settled_amount"], ["excel_column"=>["col_name"=>"Incurred Amount","col_index"=>45],"db_column"=>"incurred_amount"], ["excel_column"=>["col_name"=>"Discountamount","col_index"=>46],"db_column"=>"discount_amount"], ["excel_column"=>["col_name"=>"TDSAmount","col_index"=>47],"db_column"=>"tds_amount"], ["excel_column"=>["col_name"=>"Net Amount Paid","col_index"=>48],"db_column"=>"net_amount_paid"], ["excel_column"=>["col_name"=>"Co Payment","col_index"=>49],"db_column"=>"co_payment"], ["excel_column"=>["col_name"=>"Current Claim Status","col_index"=>50],"db_column"=>"current_claim_status"], ["excel_column"=>["col_name"=>"Balance Suminsured","col_index"=>51],"db_column"=>"balance_sum_insured"], ["excel_column"=>["col_name"=>"Chequeno","col_index"=>52],"db_column"=>"cheque_no"], ["excel_column"=>["col_name"=>"chequedate","col_index"=>53],"db_column"=>"cheque_date"], ["excel_column"=>["col_name"=>"Claim Passed Date","col_index"=>54],"db_column"=>"claim_passed_date"], ["excel_column"=>["col_name"=>"Settled Date","col_index"=>55],"db_column"=>"settled_date"], ["excel_column"=>["col_name"=>"Pending Remarks","col_index"=>56],"db_column"=>"pending_remarks"], ["excel_column"=>["col_name"=>"Ir Investigation","col_index"=>57],"db_column"=>"ir_investigation"], ["excel_column"=>["col_name"=>"Date of IR","col_index"=>58],"db_column"=>"ir_date"], ["excel_column"=>["col_name"=>"Date of IRretrieval Date","col_index"=>59],"db_column"=>"ir_retrieval_date"], ["excel_column"=>["col_name"=>"first Reminder","col_index"=>60],"db_column"=>"first_reminder"], ["excel_column"=>["col_name"=>"Second Reminder","col_index"=>61],"db_column"=>"second_reminder"], ["excel_column"=>["col_name"=>"Rejection Remarks","col_index"=>62],"db_column"=>"rejection_remarks"], ["excel_column"=>["col_name"=>"Payee name","col_index"=>63],"db_column"=>"payee_name"], ["excel_column"=>["col_name"=>"Treatment Type","col_index"=>64],"db_column"=>"treatment_type"], ["excel_column"=>["col_name"=>"roomdays","col_index"=>65],"db_column"=>"room_days"], ["excel_column"=>["col_name"=>"icudays","col_index"=>66],"db_column"=>"icu_days"], ["excel_column"=>["col_name"=>"totalstay","col_index"=>67],"db_column"=>"total_stay"], ["excel_column"=>["col_name"=>"Room Rent Claimed","col_index"=>68],"db_column"=>"room_rent_claimed"], ["excel_column"=>["col_name"=>"ICU Claimed","col_index"=>69],"db_column"=>"icu_claimed"], ["excel_column"=>["col_name"=>"ICU Related","col_index"=>70],"db_column"=>"icu_related"], ["excel_column"=>["col_name"=>"Nursing Claimed","col_index"=>71],"db_column"=>"nursing_claimed"], ["excel_column"=>["col_name"=>"Nursing Charges","col_index"=>72],"db_column"=>"nursing_charges"], ["excel_column"=>["col_name"=>"Room Rent Related","col_index"=>73],"db_column"=>"room_rent_related"], ["excel_column"=>["col_name"=>"Professional Charges","col_index"=>74],"db_column"=>"professional_charges"], ["excel_column"=>["col_name"=>"Drugs Medication Consumables Investigationsetc","col_index"=>75],"db_column"=>"drugs_medication_consumables"], ["excel_column"=>["col_name"=>"Investigations Procedures IP","col_index"=>76],"db_column"=>"investigations_procedures_ip"], ["excel_column"=>["col_name"=>"Domicillary Hospitalization","col_index"=>77],"db_column"=>"domicillary_hospitalization"], ["excel_column"=>["col_name"=>"Maternity","col_index"=>78],"db_column"=>"maternity"], ["excel_column"=>["col_name"=>"Day Care","col_index"=>79],"db_column"=>"day_care"], ["excel_column"=>["col_name"=>"Operation Theatre","col_index"=>80],"db_column"=>"operation_theatre"], ["excel_column"=>["col_name"=>"Organ Donar","col_index"=>81],"db_column"=>"organ_donor"], ["excel_column"=>["col_name"=>"Ancilliary Services","col_index"=>82],"db_column"=>"ancillary_services"], ["excel_column"=>["col_name"=>"Dental","col_index"=>83],"db_column"=>"dental"], ["excel_column"=>["col_name"=>"Out Patient Coverage","col_index"=>84],"db_column"=>"out_patient_coverage"], ["excel_column"=>["col_name"=>"Personal Accident","col_index"=>85],"db_column"=>"personal_accident"], ["excel_column"=>["col_name"=>"Critical Illness","col_index"=>86],"db_column"=>"critical_illness"], ["excel_column"=>["col_name"=>"Health Check Up","col_index"=>87],"db_column"=>"health_check_up"], ["excel_column"=>["col_name"=>"Spectacles Contact Lenses Hearing Aid","col_index"=>88],"db_column"=>"spectacles_contact_lenses_hearing_aid"], ["excel_column"=>["col_name"=>"Notes","col_index"=>89],"db_column"=>"notes"], ["excel_column"=>["col_name"=>"Buffer Amount","col_index"=>90],"db_column"=>"buffer_amount"], ["excel_column"=>["col_name"=>"tertiaryamount","col_index"=>91],"db_column"=>"tertiary_amount"], ["excel_column"=>["col_name"=>"insurancename","col_index"=>92],"db_column"=>"insurance_name"], ["excel_column"=>["col_name"=>"Roname","col_index"=>93],"db_column"=>"ro_name"], ["excel_column"=>["col_name"=>"Class Of Accommodation","col_index"=>94],"db_column"=>"class_of_accommodation"], ["excel_column"=>["col_name"=>"claimcreateddatetime","col_index"=>95],"db_column"=>"claim_created_datetime"], ["excel_column"=>["col_name"=>"Insurer Claim ID","col_index"=>96],"db_column"=>"insurer_claim_id"], ["excel_column"=>["col_name"=>"Gipsa","col_index"=>97],"db_column"=>"gipsa"], ["excel_column"=>["col_name"=>"Date Of Joining","col_index"=>98],"db_column"=>"date_of_joining"], ["excel_column"=>["col_name"=>"GIPSAHospital","col_index"=>99],"db_column"=>"gipsa_hospital"], ["excel_column"=>["col_name"=>"Package","col_index"=>100],"db_column"=>"package"], ["excel_column"=>["col_name"=>"Is NIDB","col_index"=>101],"db_column"=>"is_nidb"], ["excel_column"=>["col_name"=>"NIDB Removed Date","col_index"=>102],"db_column"=>"nidb_removed_date"], ["excel_column"=>["col_name"=>"Investigationdate","col_index"=>103],"db_column"=>"investigation_date"], ["excel_column"=>["col_name"=>"Investigation Retrieval Date","col_index"=>104],"db_column"=>"investigation_retrieval_date"], ["excel_column"=>["col_name"=>"Reopeneddate","col_index"=>105],"db_column"=>"reopened_date"], ["excel_column"=>["col_name"=>"Referto Insurer Date","col_index"=>106],"db_column"=>"refer_to_insurer_date"], ["excel_column"=>["col_name"=>"Receiveddatefrom Insurer","col_index"=>107],"db_column"=>"received_date_from_insurer"], ["excel_column"=>["col_name"=>"Rejection Category","col_index"=>108],"db_column"=>"rejection_category"], ["excel_column"=>["col_name"=>"Referto Insurer Reasons","col_index"=>109],"db_column"=>"refer_to_insurer_reasons"], ["excel_column"=>["col_name"=>"Is VIP","col_index"=>110],"db_column"=>"is_vip"], ["excel_column"=>["col_name"=>"Main Claim Status","col_index"=>111],"db_column"=>"main_claim_status"], ["excel_column"=>["col_name"=>"Main Claimtype","col_index"=>112],"db_column"=>"main_claim_type"], ["excel_column"=>["col_name"=>"icd Third Level Code","col_index"=>113],"db_column"=>"icd_third_level_code"], ["excel_column"=>["col_name"=>"Benefit Plan Name","col_index"=>114],"db_column"=>"benefit_plan_name"], ["excel_column"=>["col_name"=>"zone","col_index"=>115],"db_column"=>"zone"], ["excel_column"=>["col_name"=>"Grade","col_index"=>116],"db_column"=>"grade"], ["excel_column"=>["col_name"=>"Last Modified Date","col_index"=>117],"db_column"=>"last_modified_date"], ["excel_column"=>["col_name"=>"Temp MOU","col_index"=>118],"db_column"=>"temp_mou"], ]; protected $ticketMasterMapping = [ // Claim / Reference 'claim_id' => 'claim_number', // Employee / Member 'employee_id' => 'emp_code', // Claim Dates 'admission_date' => 'doa', 'discharge_date' => 'dod', 'claim_received_date' => 'date_of_intimat', 'claim_passed_date' => 'approved_date', 'settled_date' => 'settled_date', 'current_claim_status' => 'tpa_claim_status', // Amounts 'claim_amount' => 'claim_amount', 'disallowed_amount' => 'denial_reason', 'coverage_amount' => 'si_amt', // Hospital 'provider_name' => 'hospital_name', 'provider_address' => 'hospital_address', 'provider_state' => 'hospital_state', 'provider_place' => 'hospital_city', 'provider_pincode' => 'hospital_pin_code', // Remarks / Description 'rejection_remarks' => 'return_remark', // Payment 'cheque_no' => 'utr_details', 'uhid_no' => 'tpa_no', 'claim_type' => 'tpa_claim_type', ]; /** * Extra dump → claim_report fields beyond ticketMasterMapping. protected $statusMapping = [ 'Settled' => 11, 'Rejected' => 8, 'Paid' => 11, 'Approved' => 9, 'Closed' => 12, 'Under Process' => 5, 'Query' => 4, 'Required Information' => 4, 'In-Progress' => 5, ]; protected $dateColumns = [ 'intimation_date', 'policy_start_date', 'policy_commencing_date', 'policy_expiry_date', 'claim_received_date', 'admission_date', 'discharge_date', 'cheque_date', 'claim_passed_date', 'settled_date', 'ir_date', 'ir_retrieval_date', 'first_reminder', 'second_reminder', 'date_of_joining', 'nidb_removed_date', 'investigation_date', 'investigation_retrieval_date', 'reopened_date', 'refer_to_insurer_date', 'received_date_from_insurer', 'claim_created_datetime', 'last_modified_date' ]; /** * ABSTRACT FUNCTIONs */ public function bulkInsertTPATable(array $data): bool { if (empty($data)) { return false; } $builder = $this->db->table('claims_dump_fhpl'); 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 { // Join ticket_master with FHPL staging on file_id + claim_dump_ref_id -> id $rows = $this->db->table('claims_dump_fhpl 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 $this->db->table('claims_dump_fhpl')->updateBatch($updateData, 'id') !== false; } public function updateTicketMasterRejectedReasonInTPATable($data): bool { if (empty($data)) { return false; } $builder = $this->db->table('claims_dump_fhpl'); 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) { // Auto-detect source format (Excel may be Y-m-d or d-M-y). $item[$value] = change_date_format($item[$value] ?? null); } $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_fhpl', ['file_id' => $file_id]); if (empty($tpaClaimDumpData)) { return $this->emptyClaimMasterMappingResponse('claims_dump_fhpl', (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['admission_date'] ?? '') ?? null, 'emp_code' => $row['employee_id'] ?? null, 'claim_amount' => $row['claim_amount'] ?? null, 'tpa_no' => $row['uhid_no'] ?? null, 'client_id' => $file_data['client_id'] ?? null, 'client_policy_id' => $file_data['client_policy_id'] ?? null, ]; $newStatusId = $this->resolveClaimStatusId( $this->statusMapping, $row['current_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['relationship'] ?? null); $employee_data = $this->getEmployeeDetails($file_data['client_id'], $file_data['client_policy_id'], $row['employee_id'], $item['relationship']); if (!empty($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; $item['claim_type'] = 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 convertRelation(?string $relation): ?string { if (empty($relation)) { return null; } $relation = strtolower($relation); if (str_contains($relation, 'self')) { return 'self'; } if (str_contains($relation, 'spouse') || str_contains($relation, 'wife') || str_contains($relation, 'husband')) { return 'spouse'; } if (str_contains($relation, 'daughter')) { return 'daughter'; } if (str_contains($relation, 'son')) { return 'son'; } if (str_contains($relation, 'father in law') || str_contains($relation, 'father-in-law')) { return 'father-in-law'; } if (str_contains($relation, 'mother in law') || str_contains($relation, 'mother-in-law')) { return 'mother-in-law'; } if (str_contains($relation, 'father')) { return 'father'; } if (str_contains($relation, 'mother')) { return 'mother'; } return null; // unmatched case } }