402 lines
17 KiB
PHP
402 lines
17 KiB
PHP
<?php
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namespace App\Libraries\TPAClaimsImportServices;
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use App\Models\TicketMasterModel;
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use App\Models\ClientPolicyModel;
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use App\Models\ClientRMModel;
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use App\Models\EmployeeModel;
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use App\Models\ClaimDumpFileModel;
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use App\Models\ClaimsDumpFhplModel;
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class IciciClaimImportService extends BaseTpaClaimImportService
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{
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/**
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* MAPPING ARRAYs
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*/
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protected $mapping = [
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["excel_column" => ["col_name" => "POLICY_NAME", "col_index" => 0], "db_column" => "policy_name"],
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["excel_column" => ["col_name" => "POLICY_NO", "col_index" => 1], "db_column" => "policy_no"],
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["excel_column" => ["col_name" => "UHID", "col_index" => 2], "db_column" => "uhid"],
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["excel_column" => ["col_name" => "INSURED_NAME", "col_index" => 3], "db_column" => "insured_name"],
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["excel_column" => ["col_name" => "MAIN_MEMBER_NAME", "col_index" => 4], "db_column" => "main_member_name"],
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["excel_column" => ["col_name" => "EMPLOYEE_MEMBER_ID", "col_index" => 5], "db_column" => "employee_member_id"],
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["excel_column" => ["col_name" => "GRADE", "col_index" => 6], "db_column" => "grade"],
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["excel_column" => ["col_name" => "RELATION", "col_index" => 7], "db_column" => "relation"],
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["excel_column" => ["col_name" => "AGE", "col_index" => 8], "db_column" => "age"],
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["excel_column" => ["col_name" => "GENDER", "col_index" => 9], "db_column" => "gender"],
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["excel_column" => ["col_name" => "DIAGNOSIS", "col_index" => 10], "db_column" => "diagnosis"],
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["excel_column" => ["col_name" => "CLAIMED_AMOUNT", "col_index" => 11], "db_column" => "claimed_amount"],
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["excel_column" => ["col_name" => "NET_SANCT_AMT", "col_index" => 12], "db_column" => "net_sanct_amt"],
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["excel_column" => ["col_name" => "COPAYMENT_AMT", "col_index" => 13], "db_column" => "copayment_amt"],
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["excel_column" => ["col_name" => "DISALLOWED_AMOUNT", "col_index" => 14], "db_column" => "disallowed_amount"],
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["excel_column" => ["col_name" => "REASON_FOR_DISALLOWANCE", "col_index" => 15], "db_column" => "reason_for_disallowance"],
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["excel_column" => ["col_name" => "PAYMENT_AMOUNT", "col_index" => 16], "db_column" => "payment_amount"],
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["excel_column" => ["col_name" => "SUM_INSURED", "col_index" => 17], "db_column" => "sum_insured"],
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["excel_column" => ["col_name" => "BAL_SUM_INSURED", "col_index" => 18], "db_column" => "bal_sum_insured"],
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["excel_column" => ["col_name" => "TYPE_OF_CLAIM", "col_index" => 19], "db_column" => "type_of_claim"],
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["excel_column" => ["col_name" => "Claim_r_Os_Amt", "col_index" => 20], "db_column" => "claim_r_os_amt"],
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["excel_column" => ["col_name" => "Updated_status", "col_index" => 21], "db_column" => "updated_status"],
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["excel_column" => ["col_name" => "Disease_Category", "col_index" => 22], "db_column" => "disease_category"],
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["excel_column" => ["col_name" => "POLICY_START_DATE", "col_index" => 23], "db_column" => "policy_start_date"],
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["excel_column" => ["col_name" => "POLICY_END_DATE", "col_index" => 24], "db_column" => "policy_end_date"],
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["excel_column" => ["col_name" => "CLAIM_NUMBER", "col_index" => 25], "db_column" => "claim_number"],
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["excel_column" => ["col_name" => "AL_NO", "col_index" => 26], "db_column" => "al_no"],
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["excel_column" => ["col_name" => "HOSPITAL_CODE", "col_index" => 27], "db_column" => "hospital_code"],
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["excel_column" => ["col_name" => "HOSPITAL_ID", "col_index" => 28], "db_column" => "hospital_id"],
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["excel_column" => ["col_name" => "HOSPITAL_NAME", "col_index" => 29], "db_column" => "hospital_name"],
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["excel_column" => ["col_name" => "TREATMENT_TAKEN", "col_index" => 30], "db_column" => "treatment_taken"],
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["excel_column" => ["col_name" => "CF_Utilised_Amounnt", "col_index" => 31], "db_column" => "cf_utilised_amount"],
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["excel_column" => ["col_name" => "DT_OF_DEFICIENCIES_SENT", "col_index" => 32], "db_column" => "dt_of_deficiencies_sent"],
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["excel_column" => ["col_name" => "DT_OF_DEFICIENCIES_RECIEVED", "col_index" => 33], "db_column" => "dt_of_deficiencies_received"],
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["excel_column" => ["col_name" => "PAYMENT_DATE", "col_index" => 34], "db_column" => "payment_date"],
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["excel_column" => ["col_name" => "PAYEE_NAME", "col_index" => 35], "db_column" => "payee_name"],
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["excel_column" => ["col_name" => "PAYMENT_MODE", "col_index" => 36], "db_column" => "payment_mode"],
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["excel_column" => ["col_name" => "CHEQUE_NUMBER", "col_index" => 37], "db_column" => "cheque_number"],
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["excel_column" => ["col_name" => "DOA", "col_index" => 38], "db_column" => "doa"],
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["excel_column" => ["col_name" => "DOD", "col_index" => 39], "db_column" => "dod"],
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["excel_column" => ["col_name" => "HOSPITAL_CITY", "col_index" => 40], "db_column" => "hospital_city"],
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["excel_column" => ["col_name" => "HOSPITAL_STATE", "col_index" => 41], "db_column" => "hospital_state"],
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["excel_column" => ["col_name" => "REJECTED_QUERY_REASON", "col_index" => 42], "db_column" => "rejected_query_reason"],
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["excel_column" => ["col_name" => "REJECTED_QUERY_DESC", "col_index" => 43], "db_column" => "rejected_query_desc"],
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["excel_column" => ["col_name" => "REJECTED_QUERY_CLOSED_DATE", "col_index" => 44], "db_column" => "rejected_query_closed_date"],
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["excel_column" => ["col_name" => "REJREOPEN_CLOSURE_DATE", "col_index" => 45], "db_column" => "rejreopen_closure_date"],
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["excel_column" => ["col_name" => "CLAIM_CLASSIFICATION", "col_index" => 46], "db_column" => "claim_classification"],
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["excel_column" => ["col_name" => "TAGGED_INWARD_NO", "col_index" => 47], "db_column" => "tagged_inward_no"],
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["excel_column" => ["col_name" => "INWARD_DATE", "col_index" => 48], "db_column" => "inward_date"],
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["excel_column" => ["col_name" => "ICD_ID_L3", "col_index" => 49], "db_column" => "icd_id_l3"],
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["excel_column" => ["col_name" => "Incidence_Count", "col_index" => 50], "db_column" => "incidence_count"],
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["excel_column" => ["col_name" => "FLEXI_OPTION", "col_index" => 51], "db_column" => "flexi_option"],
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["excel_column" => ["col_name" => "Base_TopUp_Option", "col_index" => 52], "db_column" => "base_topup_option"],
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["excel_column" => ["col_name" => "POLICY_GROUP_NAME", "col_index" => 53], "db_column" => "policy_group_name"],
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["excel_column" => ["col_name" => "Relation_Group", "col_index" => 54], "db_column" => "relation_group"],
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["excel_column" => ["col_name" => "Age_Band", "col_index" => 55], "db_column" => "age_band"],
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["excel_column" => ["col_name" => "Work_Location", "col_index" => 56], "db_column" => "work_location"],
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["excel_column" => ["col_name" => "ILTC_TAG", "col_index" => 57], "db_column" => "iltc_tag"],
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];
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protected $ticketMasterMapping = [
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// Employee / Member
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'employee_member_id' => 'emp_code',
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// Claim
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'claim_number' => 'claim_number',
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'claimed_amount' => 'claim_amount',
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'claim_status' => 'tpa_claim_status',
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// Dates
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'doa' => 'doa',
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'dod' => 'dod',
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'payment_date' => 'settled_date',
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// Hospital
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'hospital_name' => 'hospital_name',
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'hospital_city' => 'hospital_city',
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'hospital_state' => 'hospital_state',
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'cheque_number' => 'utr_details',
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'uhid' => 'tpa_no',
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'rejected_query_desc' => 'claim_description',
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'type_of_claim' => 'tpa_claim_type',
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];
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protected $statusMapping = [
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'PAID' => 11,
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'REJECTED' => 8,
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];
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protected $dateColumns = [
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'policy_start_date',
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'policy_end_date',
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'dt_of_deficiencies_sent',
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'dt_of_deficiencies_received',
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'payment_date',
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'doa',
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'dod',
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'rejected_query_closed_date',
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'rejreopen_closure_date',
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];
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/**
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* ABSTRACT FUNCTIONs
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*/
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public function bulkInsertTPATable(array $data): bool
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{
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if (empty($data)) {
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return false;
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}
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$builder = $this->db->table('claims_dump_icici');
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return $builder->insertBatch($data);
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}
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public function importClaimMaster(array $data): bool
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{
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if (empty($data)) {
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return false;
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}
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$ticketMasterModel = new TicketMasterModel();
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return $ticketMasterModel->insertBatch($data);
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}
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public function updateTicketIdInTPATable(): bool
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{
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if (empty($data)) {
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return false;
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}
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$builder = $this->db->table('claims_dump_icici');
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return $builder->upsertBatch($data, 'id');
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}
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public function updateTicketMasterRejectedReasonInTPATable($data): bool
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{
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if (empty($data)) {
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return false;
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}
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$builder = $this->db->table('claims_dump_icici');
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return $builder->updateBatch($data, 'id');
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}
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/**
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* MAPPING FUNCTIONs
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*/
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public function mapTPAData(array $rows, $file_id): array
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{
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$ClientPolicyModel = new ClaimDumpFileModel();
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$file_data = $ClientPolicyModel->where('id', $file_id)->first();
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$mapped = [];
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foreach ($rows as $row) {
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$item = [];
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foreach ($this->mapping as $map) {
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$excelColumn = $map['excel_column']['col_name'];
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$dbColumn = $map['db_column'];
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$value = $row[$excelColumn] ?? null;
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$item[$dbColumn] = $value;
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}
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foreach ($this->dateColumns as $key => $value) {
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$item[$value] = change_date_format($item[$value] ?? null);
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}
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$params = [
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'doa' => change_date_format($item['doa'] ?? '') ?? null,
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'employee_member_id' => $item['employee_member_id'] ?? null,
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'claimed_amount' => $item['claimed_amount'] ?? null,
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'uhid' => $item['uhid'] ?? null
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];
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$is_duplicate = $this->checkDuplicateTpaClaim('claims_dump_icici', $params);
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if ($is_duplicate) {
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$item = [];
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continue;
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}
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$item['file_id'] = $file_id ?? null;
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$item['client_id'] = $file_data['client_id'] ?? null;
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$item['client_policy_id'] = $file_data['client_policy_id'] ?? null;
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$item['created_by'] = $file_data['created_by'] ?? null;
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$mapped[] = $item;
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}
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return $mapped;
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}
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public function mapClaimMasterData($file_id): array
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{
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$ClientPolicyModel = new ClaimDumpFileModel();
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$file_data = $ClientPolicyModel->where('id', $file_id)->first();
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$tpaClaimDumpData = $this->getTpaClaimDumpData('claims_dump_icici', ['file_id' => $file_id]);
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if (empty($tpaClaimDumpData)) {
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return ['status' => false, 'message' => "No data to insert in TICKET MASTER"];
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}
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$ClientPolicyModel = new ClientPolicyModel();
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$client_policy_data = $ClientPolicyModel
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->select("
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client_policy.*,
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(
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SELECT id
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FROM client_rm
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WHERE is_active = 1
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AND level = 3
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AND client_id = client_policy.client_id
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ORDER BY id ASC
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LIMIT 1
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) AS acm_id
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")
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->where('client_policy.id', $file_data['client_policy_id'])
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->where('client_policy.is_active', 1)
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->first();
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try {
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$mapped = [];
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$rejecetd_reason = [];
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foreach ($tpaClaimDumpData as $row) {
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$params = [
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'doa' => change_date_format($row['doa'] ?? '') ?? null,
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'emp_code' => $row['employee_member_id'] ?? null,
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'claim_amount' => $row['claim_amount'] ?? null,
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'tpa_no' => $row['uhid'] ?? null
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];
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$isduplicate = $this->checkDublicateTicketMasterClaim($params);
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if ($isduplicate) {
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$reason = "This claim already exists in our system.";
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$rejecetd_reason[] = ["id" => $row['id'], "master_reject_reason" => $reason];
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continue;
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}
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$item = [];
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$item['client_id'] = $client_policy_data['client_id'] ?? null;
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$item['client_policy_id'] = $client_policy_data['id'] ?? null;
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$item['insurer_id'] = $client_policy_data['insurer_id'] ?? null;
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$item['tpa_id'] = $client_policy_data['tpa_id'] ?? null;
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$item['acm_id'] = $client_policy_data['acm_id'] ?? null;
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$item['policy_no'] = $client_policy_data['policy_no'] ?? null;
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$item['relationship'] = $this->convertRelation($row['relation_group'] ?? '');
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$employee_data = $this->getEmployeeDetails($file_data['client_id'], $file_data['client_policy_id'], $row['employee_member_id'], $item['relationship']);
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if (!empty($employee_data)) {
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$item['emp_id'] = $employee_data['id'] ?? null;
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$item['emp_name'] = $employee_data['name'] ?? null;
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$item['emp_code'] = $employee_data['emp_code'] ?? null;
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$item['emp_mail'] = $employee_data['email_corporate'] ?? null;
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$item['emp_mobile'] = $employee_data['mobile'] ?? null;
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if (!empty($employee_data['insured_emp_id'])) {
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$item['insured_emp_id'] = $employee_data['insured_emp_id'] ?? null;
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$item['insured_name'] = $employee_data['insured_name'] ?? null;
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}else{
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$reason = 'This Dependent employee not exist in our system.';
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$rejecetd_reason[] = ["id" => $row['id'], "master_reject_reason" => $reason];
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continue;
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}
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} else {
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$reason = 'This employee not exist in our system.';
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$rejecetd_reason[] = ["id" => $row['id'], "master_reject_reason" => $reason];
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continue;
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}
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foreach ($this->ticketMasterMapping as $tpaKey => $ticketMasterKey) {
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$item[$ticketMasterKey] = array_key_exists($tpaKey, $row) ? $row[$tpaKey] : null;
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}
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// Meta fields
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$item['claim_status_id'] = $statusMapping[$row['updated_status']] ?? 61;
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$item['claim_dump_ref_id'] = $row['id'];
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$item['file_id'] = $file_id;
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$item['created_by'] = $file_data['created_by'] ?? null;
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$item['claim_type'] = 1;
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$item['priority'] = 1;
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$item['mode_of_intimation'] = 5;
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$item['ticket_type_id'] = 1;
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$mapped[] = $item;
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}
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return ['status' => true, 'mapped_array' => $mapped, 'rejected_reason_array' => $rejecetd_reason];
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} catch (\Throwable $th) {
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$errorData = [
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'message' => $th->getMessage(),
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'file' => $th->getFile(),
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'line' => $th->getLine(),
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'code' => $th->getCode(),
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'trace' => $th->getTraceAsString(),
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'trace_array' => $th->getTrace(), // full array version (optional)
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'function' => $th->getTrace()[0]['function'] ?? null,
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'class' => $th->getTrace()[0]['class'] ?? null,
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];
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return ['status' => false, "message" => $errorData['message'], 'error_data' => $errorData];
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}
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}
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/**
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* HELPER FUNCTIONs
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*/
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public function convertRelation(?string $relation): ?string
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{
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if (empty($relation)) {
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return null;
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}
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$relation = strtolower($relation);
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if (str_contains($relation, 'self')) {
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return 'self';
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}
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if (str_contains($relation, 'spouse') || str_contains($relation, 'wife') || str_contains($relation, 'husband')) {
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return 'spouse';
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}
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if (str_contains($relation, 'daughter')) {
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return 'daughter';
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}
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if (str_contains($relation, 'son')) {
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return 'son';
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}
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if (str_contains($relation, 'father in law') || str_contains($relation, 'father-in-law')) {
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return 'father-in-law';
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}
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if (str_contains($relation, 'mother in law') || str_contains($relation, 'mother-in-law')) {
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return 'mother-in-law';
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}
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if (str_contains($relation, 'father')) {
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return 'father';
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}
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if (str_contains($relation, 'mother')) {
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return 'mother';
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}
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return null; // unmatched case
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}
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}
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