["col_name" => "POLICY_NAME", "col_index" => 0], "db_column" => "policy_name"], ["excel_column" => ["col_name" => "POLICY_NO", "col_index" => 1], "db_column" => "policy_no"], ["excel_column" => ["col_name" => "UHID", "col_index" => 2], "db_column" => "uhid"], ["excel_column" => ["col_name" => "INSURED_NAME", "col_index" => 3], "db_column" => "insured_name"], ["excel_column" => ["col_name" => "MAIN_MEMBER_NAME", "col_index" => 4], "db_column" => "main_member_name"], ["excel_column" => ["col_name" => "EMPLOYEE_MEMBER_ID", "col_index" => 5], "db_column" => "employee_member_id"], ["excel_column" => ["col_name" => "GRADE", "col_index" => 6], "db_column" => "grade"], ["excel_column" => ["col_name" => "RELATION", "col_index" => 7], "db_column" => "relation"], ["excel_column" => ["col_name" => "AGE", "col_index" => 8], "db_column" => "age"], ["excel_column" => ["col_name" => "GENDER", "col_index" => 9], "db_column" => "gender"], ["excel_column" => ["col_name" => "DIAGNOSIS", "col_index" => 10], "db_column" => "diagnosis"], ["excel_column" => ["col_name" => "CLAIMED_AMOUNT", "col_index" => 11], "db_column" => "claimed_amount"], ["excel_column" => ["col_name" => "NET_SANCT_AMT", "col_index" => 12], "db_column" => "net_sanct_amt"], ["excel_column" => ["col_name" => "COPAYMENT_AMT", "col_index" => 13], "db_column" => "copayment_amt"], ["excel_column" => ["col_name" => "DISALLOWED_AMOUNT", "col_index" => 14], "db_column" => "disallowed_amount"], ["excel_column" => ["col_name" => "REASON_FOR_DISALLOWANCE", "col_index" => 15], "db_column" => "reason_for_disallowance"], ["excel_column" => ["col_name" => "PAYMENT_AMOUNT", "col_index" => 16], "db_column" => "payment_amount"], ["excel_column" => ["col_name" => "SUM_INSURED", "col_index" => 17], "db_column" => "sum_insured"], ["excel_column" => ["col_name" => "BAL_SUM_INSURED", "col_index" => 18], "db_column" => "bal_sum_insured"], ["excel_column" => ["col_name" => "TYPE_OF_CLAIM", "col_index" => 19], "db_column" => "type_of_claim"], ["excel_column" => ["col_name" => "Claim_r_Os_Amt", "col_index" => 20], "db_column" => "claim_r_os_amt"], ["excel_column" => ["col_name" => "Updated_status", "col_index" => 21], "db_column" => "updated_status"], ["excel_column" => ["col_name" => "Disease_Category", "col_index" => 22], "db_column" => "disease_category"], ["excel_column" => ["col_name" => "POLICY_START_DATE", "col_index" => 23], "db_column" => "policy_start_date"], ["excel_column" => ["col_name" => "POLICY_END_DATE", "col_index" => 24], "db_column" => "policy_end_date"], ["excel_column" => ["col_name" => "CLAIM_NUMBER", "col_index" => 25], "db_column" => "claim_number"], ["excel_column" => ["col_name" => "AL_NO", "col_index" => 26], "db_column" => "al_no"], ["excel_column" => ["col_name" => "HOSPITAL_CODE", "col_index" => 27], "db_column" => "hospital_code"], ["excel_column" => ["col_name" => "HOSPITAL_ID", "col_index" => 28], "db_column" => "hospital_id"], ["excel_column" => ["col_name" => "HOSPITAL_NAME", "col_index" => 29], "db_column" => "hospital_name"], ["excel_column" => ["col_name" => "TREATMENT_TAKEN", "col_index" => 30], "db_column" => "treatment_taken"], ["excel_column" => ["col_name" => "CF_Utilised_Amounnt", "col_index" => 31], "db_column" => "cf_utilised_amount"], ["excel_column" => ["col_name" => "DT_OF_DEFICIENCIES_SENT", "col_index" => 32], "db_column" => "dt_of_deficiencies_sent"], ["excel_column" => ["col_name" => "DT_OF_DEFICIENCIES_RECIEVED", "col_index" => 33], "db_column" => "dt_of_deficiencies_received"], ["excel_column" => ["col_name" => "PAYMENT_DATE", "col_index" => 34], "db_column" => "payment_date"], ["excel_column" => ["col_name" => "PAYEE_NAME", "col_index" => 35], "db_column" => "payee_name"], ["excel_column" => ["col_name" => "PAYMENT_MODE", "col_index" => 36], "db_column" => "payment_mode"], ["excel_column" => ["col_name" => "CHEQUE_NUMBER", "col_index" => 37], "db_column" => "cheque_number"], ["excel_column" => ["col_name" => "DOA", "col_index" => 38], "db_column" => "doa"], ["excel_column" => ["col_name" => "DOD", "col_index" => 39], "db_column" => "dod"], ["excel_column" => ["col_name" => "HOSPITAL_CITY", "col_index" => 40], "db_column" => "hospital_city"], ["excel_column" => ["col_name" => "HOSPITAL_STATE", "col_index" => 41], "db_column" => "hospital_state"], ["excel_column" => ["col_name" => "REJECTED_QUERY_REASON", "col_index" => 42], "db_column" => "rejected_query_reason"], ["excel_column" => ["col_name" => "REJECTED_QUERY_DESC", "col_index" => 43], "db_column" => "rejected_query_desc"], ["excel_column" => ["col_name" => "REJECTED_QUERY_CLOSED_DATE", "col_index" => 44], "db_column" => "rejected_query_closed_date"], ["excel_column" => ["col_name" => "REJREOPEN_CLOSURE_DATE", "col_index" => 45], "db_column" => "rejreopen_closure_date"], ["excel_column" => ["col_name" => "CLAIM_CLASSIFICATION", "col_index" => 46], "db_column" => "claim_classification"], ["excel_column" => ["col_name" => "TAGGED_INWARD_NO", "col_index" => 47], "db_column" => "tagged_inward_no"], ["excel_column" => ["col_name" => "INWARD_DATE", "col_index" => 48], "db_column" => "inward_date"], ["excel_column" => ["col_name" => "ICD_ID_L3", "col_index" => 49], "db_column" => "icd_id_l3"], ["excel_column" => ["col_name" => "Incidence_Count", "col_index" => 50], "db_column" => "incidence_count"], ["excel_column" => ["col_name" => "FLEXI_OPTION", "col_index" => 51], "db_column" => "flexi_option"], ["excel_column" => ["col_name" => "Base_TopUp_Option", "col_index" => 52], "db_column" => "base_topup_option"], ["excel_column" => ["col_name" => "POLICY_GROUP_NAME", "col_index" => 53], "db_column" => "policy_group_name"], ["excel_column" => ["col_name" => "Relation_Group", "col_index" => 54], "db_column" => "relation_group"], ["excel_column" => ["col_name" => "Age_Band", "col_index" => 55], "db_column" => "age_band"], ["excel_column" => ["col_name" => "Work_Location", "col_index" => 56], "db_column" => "work_location"], ["excel_column" => ["col_name" => "ILTC_TAG", "col_index" => 57], "db_column" => "iltc_tag"], ]; protected $ticketMasterMapping = [ // Employee / Member 'employee_member_id' => 'emp_code', // Claim 'claim_number' => 'claim_number', 'claimed_amount' => 'claim_amount', 'updated_status' => 'tpa_claim_status', // Dates 'doa' => 'doa', 'dod' => 'dod', 'payment_date' => 'settled_date', // Hospital 'hospital_name' => 'hospital_name', 'hospital_city' => 'hospital_city', 'hospital_state' => 'hospital_state', 'cheque_number' => 'utr_details', 'uhid' => 'tpa_no', 'rejected_query_desc' => 'claim_description', 'type_of_claim' => 'tpa_claim_type', 'diagnosis' => 'tpa_ailments', ]; /** * Extra dump → claim_report fields beyond ticketMasterMapping. protected $statusMapping = [ 'PAID' => 11, 'SETTLED' => 11, 'REJECTED' => 8, 'APPROVED' => 9, 'CLOSED' => 12, 'QUERY' => 4, 'REQUIRED INFORMATION' => 4, 'IN-PROGRESS' => 5, ]; protected $dateColumns = [ 'policy_start_date', 'policy_end_date', 'dt_of_deficiencies_sent', 'dt_of_deficiencies_received', 'payment_date', 'doa', 'dod', 'rejected_query_closed_date', 'rejreopen_closure_date', ]; /** * ABSTRACT FUNCTIONs */ public function bulkInsertTPATable(array $data): bool { if (empty($data)) { return false; } $builder = $this->db->table('claims_dump_icici'); 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_icici 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 $this->db->table('claims_dump_icici')->updateBatch($updateData, 'id') !== false; } public function updateTicketMasterRejectedReasonInTPATable($data): bool { if (empty($data)) { return false; } $builder = $this->db->table('claims_dump_icici'); 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] = $value; } foreach ($this->dateColumns as $key => $value) { $item[$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_icici', ['file_id' => $file_id]); if (empty($tpaClaimDumpData)) { return $this->emptyClaimMasterMappingResponse('claims_dump_icici', (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['employee_member_id'] ?? null, 'claim_amount' => $row['claimed_amount'] ?? null, 'tpa_no' => $row['uhid'] ?? null, 'client_id' => $file_data['client_id'] ?? null, 'client_policy_id' => $file_data['client_policy_id'] ?? null, ]; $newStatusId = $this->resolveClaimStatusId( $this->statusMapping, $row['updated_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'] ?? ''); $employee_data = $this->getEmployeeDetails($file_data['client_id'], $file_data['client_policy_id'], $row['employee_member_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['claim_dump_ref_id'] = $row['id']; $item['file_id'] = $file_id; $item['claim_dump_date'] = $file_data['claim_dump_date'] ?? null; $item['created_by'] = $file_data['created_by'] ?? 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 } }