489 lines
21 KiB
PHP
489 lines
21 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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class AbhiClaimImportService 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" => "ABHI Claim No", "col_index" => 0], "db_column" => "abhi_claim_no"],
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["excel_column" => ["col_name" => "New ABHI Claim No With Extension", "col_index" => 1], "db_column" => "new_abhi_claim_no_with_extension"],
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["excel_column" => ["col_name" => "Unique Count", "col_index" => 2], "db_column" => "unique_count"],
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["excel_column" => ["col_name" => "Proposer Name", "col_index" => 3], "db_column" => "proposer_name"],
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["excel_column" => ["col_name" => "Patient Name", "col_index" => 4], "db_column" => "patient_name"],
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["excel_column" => ["col_name" => "Family ID", "col_index" => 5], "db_column" => "family_id"],
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["excel_column" => ["col_name" => "Member Code", "col_index" => 6], "db_column" => "member_code"],
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["excel_column" => ["col_name" => "Patient Age", "col_index" => 7], "db_column" => "patient_age"],
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["excel_column" => ["col_name" => "Relation", "col_index" => 8], "db_column" => "relation"],
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["excel_column" => ["col_name" => "Gender", "col_index" => 9], "db_column" => "gender"],
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["excel_column" => ["col_name" => "Certificate No", "col_index" => 10], "db_column" => "certificate_no"],
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["excel_column" => ["col_name" => "Master Policy No", "col_index" => 11], "db_column" => "master_policy_no"],
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["excel_column" => ["col_name" => "Policy Number", "col_index" => 12], "db_column" => "policy_number"],
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["excel_column" => ["col_name" => "Policy From", "col_index" => 13], "db_column" => "policy_from"],
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["excel_column" => ["col_name" => "Policy Upto", "col_index" => 14], "db_column" => "policy_upto"],
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["excel_column" => ["col_name" => "Product Name", "col_index" => 15], "db_column" => "product_name"],
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["excel_column" => ["col_name" => "Product Name 1", "col_index" => 16], "db_column" => "product_name_1"],
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["excel_column" => ["col_name" => "Sub - Product", "col_index" => 17], "db_column" => "sub_product"],
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["excel_column" => ["col_name" => "Policy Category", "col_index" => 18], "db_column" => "policy_category"],
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["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"],
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["excel_column" => ["col_name" => "Sum Insured", "col_index" => 20], "db_column" => "sum_insured"],
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["excel_column" => ["col_name" => "Bonus", "col_index" => 21], "db_column" => "bonus"],
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["excel_column" => ["col_name" => "Intimation Date", "col_index" => 22], "db_column" => "intimation_date"],
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["excel_column" => ["col_name" => "Date Of Doc Rec", "col_index" => 23], "db_column" => "date_of_doc_rec"],
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["excel_column" => ["col_name" => "Intimation Final Month", "col_index" => 24], "db_column" => "intimation_final_month"],
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["excel_column" => ["col_name" => "Reported Year", "col_index" => 25], "db_column" => "reported_year"],
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["excel_column" => ["col_name" => "Reported Qurter", "col_index" => 26], "db_column" => "reported_quarter"],
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["excel_column" => ["col_name" => "Hospital Name", "col_index" => 27], "db_column" => "hospital_name"],
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["excel_column" => ["col_name" => "Hospital City", "col_index" => 28], "db_column" => "hospital_city"],
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["excel_column" => ["col_name" => "Hospital State", "col_index" => 29], "db_column" => "hospital_state"],
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["excel_column" => ["col_name" => "Diagnosis", "col_index" => 30], "db_column" => "diagnosis"],
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["excel_column" => ["col_name" => "ICD Chapter", "col_index" => 31], "db_column" => "icd_chapter"],
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["excel_column" => ["col_name" => "ICD Block", "col_index" => 32], "db_column" => "icd_block"],
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["excel_column" => ["col_name" => "ICD Level1", "col_index" => 33], "db_column" => "icd_level1"],
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["excel_column" => ["col_name" => "ICD Level2", "col_index" => 34], "db_column" => "icd_level2"],
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["excel_column" => ["col_name" => "Procedure Description", "col_index" => 35], "db_column" => "procedure_description"],
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["excel_column" => ["col_name" => "PCS Description", "col_index" => 36], "db_column" => "pcs_description"],
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["excel_column" => ["col_name" => "DOA", "col_index" => 37], "db_column" => "doa"],
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["excel_column" => ["col_name" => "DOD", "col_index" => 38], "db_column" => "dod"],
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["excel_column" => ["col_name" => "Claim Type", "col_index" => 39], "db_column" => "claim_type"],
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["excel_column" => ["col_name" => "Claim Category", "col_index" => 40], "db_column" => "claim_category"],
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["excel_column" => ["col_name" => "Disc Datails", "col_index" => 41], "db_column" => "disc_details"],
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["excel_column" => ["col_name" => "Disc Date", "col_index" => 42], "db_column" => "disc_date"],
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["excel_column" => ["col_name" => "Hospital Code", "col_index" => 43], "db_column" => "hospital_code"],
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["excel_column" => ["col_name" => "Claim Status", "col_index" => 44], "db_column" => "claim_status"],
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["excel_column" => ["col_name" => "Final ABHI Status-Current Month", "col_index" => 45], "db_column" => "final_abhi_status_current_month"],
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["excel_column" => ["col_name" => "Claimed Amount", "col_index" => 46], "db_column" => "claimed_amount"],
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["excel_column" => ["col_name" => "ABHI Amount Less Coins - Current Month", "col_index" => 47], "db_column" => "abhi_amount_less_coins_current_month"],
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["excel_column" => ["col_name" => "Repudiation Date", "col_index" => 48], "db_column" => "repudiation_date"],
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["excel_column" => ["col_name" => "Settled Date", "col_index" => 49], "db_column" => "settled_date"],
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["excel_column" => ["col_name" => "Settled Month", "col_index" => 50], "db_column" => "settled_month"],
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["excel_column" => ["col_name" => "Settled Year", "col_index" => 51], "db_column" => "settled_year"],
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["excel_column" => ["col_name" => "Settled Quarter", "col_index" => 52], "db_column" => "settled_quarter"],
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["excel_column" => ["col_name" => "Rejection Category", "col_index" => 53], "db_column" => "rejection_category"],
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["excel_column" => ["col_name" => "Rejection Category - Level 1", "col_index" => 54], "db_column" => "rejection_category_level_1"],
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["excel_column" => ["col_name" => "Rejection Category - Level 2", "col_index" => 55], "db_column" => "rejection_category_level_2"],
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["excel_column" => ["col_name" => "COVID tagging - Current Month", "col_index" => 56], "db_column" => "covid_tagging_current_month"],
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["excel_column" => ["col_name" => "EXPECTED DOA", "col_index" => 57], "db_column" => "expected_doa"],
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["excel_column" => ["col_name" => "EXPECTED DOD", "col_index" => 58], "db_column" => "expected_dod"],
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["excel_column" => ["col_name" => "AGENT/BROKER CODE", "col_index" => 59], "db_column" => "agent_broker_code"],
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["excel_column" => ["col_name" => "AGENT/BROKER NAME", "col_index" => 60], "db_column" => "agent_broker_name"],
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["excel_column" => ["col_name" => "HEALTHCARD_ID", "col_index" => 61], "db_column" => "healthcard_id"],
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["excel_column" => ["col_name" => "ABHI_NETWORK_NON_NETWORK", "col_index" => 62], "db_column" => "abhi_network_non_network"],
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["excel_column" => ["col_name" => "CORPORATE_EMPLOYEE_CODE", "col_index" => 63], "db_column" => "corporate_employee_code"],
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];
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protected $ticketMasterMapping = [
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// Employee / Member details
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'member_code' => 'emp_code',
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'abhi_claim_no' => 'claim_number',
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// Dates
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'doa' => 'doa',
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'dod' => 'dod',
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'intimation_date' => 'date_of_intimat',
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// Claim info
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'claim_status' => 'tpa_claim_status',
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'claimed_amount' => 'claim_amount',
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// Hospital details
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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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// Settlement / decision
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'repudiation_date' => 'denial_date',
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'settled_date' => 'settled_date',
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'rejection_category' => 'denial_reason',
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// Misc
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'healthcard_id' => 'tpa_no',
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'claim_type' => 'tpa_claim_type',
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];
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/**
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* Extra dump → claim_report fields beyond ticketMasterMapping.
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protected $statusMapping = [
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'Settled' => 11,
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'Rejected' => 8,
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'Cancelled' => 13,
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'Approved' => 9,
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'Closed' => 12,
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'Query' => 4,
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'Required Information' => 4,
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'In-Progress' => 5,
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'Paid' => 11,
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'Denied' => 8,
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'Cancelled' => 13,
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'Processed' => 61,
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'Information Awaited' => 4,
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'Denied Letter Sent' => 66,
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'Cashless Document Awaited' => 3,
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'RI Cancelled' => 13,
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];
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protected $dateColumns = [
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'policy_from',
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'policy_upto',
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'intimation_date',
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'date_of_doc_rec',
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'doa',
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'dod',
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'repudiation_date',
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'settled_date',
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'expected_doa',
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'expected_dod',
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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_abhi');
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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(int $fileId): bool
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{
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$rows = $this->db->table('claims_dump_abhi cd')
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->select('cd.id, tm.id AS ticket_id')
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->join('ticket_master tm', 'tm.claim_dump_ref_id = cd.id AND tm.file_id = cd.file_id', 'inner')
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->where('cd.is_active', 1)
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->where('cd.file_id', $fileId)
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->where('cd.ticket_id IS NULL')
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->get()
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->getResultArray();
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if (empty($rows)) {
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return true;
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}
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$updateData = [];
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foreach ($rows as $row) {
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$updateData[] = [
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'id' => $row['id'],
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'ticket_id' => $row['ticket_id'],
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];
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}
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return $this->db->table('claims_dump_abhi')->updateBatch($updateData, 'id') !== false;
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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_abhi');
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return $builder->updateBatch($data, 'id') !== false;
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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 === null ? null : trim((string) $value);
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}
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foreach ($this->dateColumns as $key => $value) {
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$item[$value] = change_date_format($item[$value] ?? null, 'm/d/Y h:i:s A', 'Y-m-d');
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}
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$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_abhi', ['file_id' => $file_id]);
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if (empty($tpaClaimDumpData)) {
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return $this->emptyClaimMasterMappingResponse('claims_dump_abhi', (int) $file_id);
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}
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$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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$rejecetd_reason = [];
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$status_update_array = [];
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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['member_code'] ?? null,
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'claim_amount' => $row['claimed_amount'] ?? null,
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'tpa_no' => $row['healthcard_id'] ?? null,
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'client_id' => $file_data['client_id'] ?? null,
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'client_policy_id' => $file_data['client_policy_id'] ?? null,
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];
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$newStatusId = $this->resolveClaimStatusId(
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$this->statusMapping,
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$row['claim_status'] ?? '',
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(int) $row['id'],
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$rejecetd_reason
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);
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if ($newStatusId === null) {
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continue;
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}
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$existingTicket = $this->getExistingTicketMasterClaim($params);
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if ($this->handleExistingTicketStatusUpdate(
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$existingTicket,
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$newStatusId,
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(int) $row['id'],
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$status_update_array,
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$rejecetd_reason
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)) {
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continue;
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}
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$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'] ?? null);
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$employee_data = $this->getEmployeeDetails($file_data['client_id'], $file_data['client_policy_id'], $row['member_code'], $item['relationship']);
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if (!empty($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'] = $employee_data['emp_mail'] ?? null;
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$item['emp_mobile'] = $employee_data['emp_mobile'] ?? null;
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if (!empty($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'] = $newStatusId;
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$item['file_id'] = $file_id;
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$item['claim_dump_ref_id'] = $row['id'];
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$item['claim_dump_date'] = $file_data['claim_dump_date'] ?? null;
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$item['created_by'] = $file_data['created_by'] ?? null;
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$item['claim_description'] = $row['diagnosis'] ?? null;
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$item['tpa_ailments'] = $row['diagnosis'] ?? null;
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$claimTypeRaw = strtolower(trim((string) ($row['claim_type'] ?? '')));
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$item['claim_type'] = (str_contains($claimTypeRaw, 'pre') || str_contains($claimTypeRaw, 'post')) ? 3 : 1;
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$item['priority'] = 1;
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$item['mode_of_intimation'] = 5;
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$item['ticket_type_id'] = 1;
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$item['claim_created_by'] = 'DUMP_TPA';
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$mapped[] = $item;
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}
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return [
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'status' => true,
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'mapped_array' => $mapped,
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'rejected_reason_array' => $rejecetd_reason,
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'status_update_array' => $status_update_array,
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];
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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,
|
|
];
|
|
|
|
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;
|
|
}
|
|
|
|
}
|