421 lines
16 KiB
PHP
421 lines
16 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 RcareClaimImportService 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" => "CLInwardNo", "col_index" => 0], "db_column" => "cl_inward_no"],
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["excel_column" => ["col_name" => "Inward Date", "col_index" => 1], "db_column" => "inward_date"],
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["excel_column" => ["col_name" => "Claim Classification", "col_index" => 2], "db_column" => "claim_classification"],
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["excel_column" => ["col_name" => "Policy Name", "col_index" => 3], "db_column" => "policy_name"],
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["excel_column" => ["col_name" => "Policy Number", "col_index" => 4], "db_column" => "policy_number"],
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["excel_column" => ["col_name" => "Policy Start Date", "col_index" => 5], "db_column" => "policy_start_date"],
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["excel_column" => ["col_name" => "Policy End Date", "col_index" => 6], "db_column" => "policy_end_date"],
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["excel_column" => ["col_name" => "UHID", "col_index" => 7], "db_column" => "uhid"],
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["excel_column" => ["col_name" => "Insured Name", "col_index" => 8], "db_column" => "insured_name"],
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["excel_column" => ["col_name" => "Patient Name", "col_index" => 9], "db_column" => "patient_name"],
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["excel_column" => ["col_name" => "Employee/Member Id", "col_index" => 10], "db_column" => "employee_member_id"],
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["excel_column" => ["col_name" => "Grade", "col_index" => 11], "db_column" => "grade"],
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["excel_column" => ["col_name" => "Relation", "col_index" => 12], "db_column" => "relation"],
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["excel_column" => ["col_name" => "Age", "col_index" => 13], "db_column" => "age"],
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["excel_column" => ["col_name" => "Gender", "col_index" => 14], "db_column" => "gender"],
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["excel_column" => ["col_name" => "DF/DNF idenitifcation", "col_index" => 15], "db_column" => "df_dnf_identification"],
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["excel_column" => ["col_name" => "Sum Insured", "col_index" => 16], "db_column" => "sum_insured"],
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["excel_column" => ["col_name" => "DOA/OPD Treatment From", "col_index" => 17], "db_column" => "doa_opd_treatment_from"],
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["excel_column" => ["col_name" => "DOD/OPD Treatment To", "col_index" => 18], "db_column" => "dod_opd_treatment_to"],
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["excel_column" => ["col_name" => "Hospital Name", "col_index" => 19], "db_column" => "hospital_name"],
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["excel_column" => ["col_name" => "Hospital District", "col_index" => 20], "db_column" => "hospital_district"],
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["excel_column" => ["col_name" => "Hospital State", "col_index" => 21], "db_column" => "hospital_state"],
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["excel_column" => ["col_name" => "ICDCode", "col_index" => 22], "db_column" => "icd_code"],
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["excel_column" => ["col_name" => "Disease Category", "col_index" => 23], "db_column" => "disease_category"],
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["excel_column" => ["col_name" => "Final Status", "col_index" => 24], "db_column" => "final_status"],
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["excel_column" => ["col_name" => "Approved Date", "col_index" => 25], "db_column" => "approved_date"],
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["excel_column" => ["col_name" => "Claimed Amount", "col_index" => 26], "db_column" => "claimed_amount"],
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["excel_column" => ["col_name" => "Disallowed Amount", "col_index" => 27], "db_column" => "disallowed_amount"],
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["excel_column" => ["col_name" => "Net Sanct Amt", "col_index" => 28], "db_column" => "net_sanction_amount"],
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["excel_column" => ["col_name" => "Reason For Disallowance", "col_index" => 29], "db_column" => "reason_for_disallowance"],
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["excel_column" => ["col_name" => "External Query Remarks", "col_index" => 30], "db_column" => "external_query_remarks"],
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["excel_column" => ["col_name" => "Rejection Remarks", "col_index" => 31], "db_column" => "rejection_remarks"],
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["excel_column" => ["col_name" => "Cheque/NEFT Number", "col_index" => 32], "db_column" => "cheque_neft_number"],
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["excel_column" => ["col_name" => "Cheque/NEFT Date", "col_index" => 33], "db_column" => "cheque_neft_date"],
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["excel_column" => ["col_name" => "Diagnosis", "col_index" => 34], "db_column" => "diagnosis"],
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["excel_column" => ["col_name" => "Treatment Detail", "col_index" => 35], "db_column" => "treatment_detail"],
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["excel_column" => ["col_name" => "Member Reimbursement CL Type", "col_index" => 36], "db_column" => "member_reimbursement_cl_type"],
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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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'relation' => 'relationship',
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// Policy
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'policy_number' => 'policy_no',
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'policy_start_date' => 'date_of_incep',
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// Claim Dates
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'doa_opd_treatment_from' => 'doa',
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'dod_opd_treatment_to' => 'dod',
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'approved_date' => 'approved_date',
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// Claim Amounts
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'claimed_amount' => 'claim_amount',
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'net_sanction_amount' => 'approved_amount',
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// Status / Remarks
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'final_status' => 'tpa_claim_status',
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'reason_for_disallowance' => 'denial_reason',
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'rejection_remarks' => 'return_remark',
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// Hospital
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'hospital_name' => 'hospital_name',
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'hospital_state' => 'hospital_state',
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'hospital_district' => 'hospital_city',
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'diagnosis' => 'claim_description',
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// Payment
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'cheque_neft_number' => 'utr_details',
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'cheque_neft_date' => 'settled_date',
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// References
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'cl_inward_no' => 'claim_number',
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];
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protected $statusMapping = [
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'Settled' => 11,
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'Rejected' => 8,
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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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];
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protected $dateColumns = [
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'inward_date',
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'policy_start_date',
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'policy_end_date',
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'doa_opd_treatment_from',
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'dod_opd_treatment_to',
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'approved_date',
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'cheque_neft_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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try {
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$builder = $this->db->table('claims_dump_reliance');
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$builder->insertBatch($data);
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return true;
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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' => $th->getTrace()[0]['class'] ?? null,
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];
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dd($errorData);
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return false;
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}
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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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$ticketMasterModel = new TicketMasterModel();
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$ticketMasterModel->insertBatch($data);
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return true;
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}
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public function updateTicketIdInTPATable(): bool
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{
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if (empty($data)) {
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return false;
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}
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$builder = $this->db->table('claims_dump_reliance');
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$builder->insertBatch($data);
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return true;
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}
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public function updateTicketMasterRejectedReasonInTPATable($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 = $this->db->table('claims_dump_reliance');
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$builder->insertBatch($data);
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return true;
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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[$value] ?? null, 'd-M-y', 'Y-m-d');
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}
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$params = [
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'doa_opd_treatment_from' => $item['doa_opd_treatment_from'] ?? 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_reliance', $params);
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if ($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_reliance', ['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_opd_treatment_from'] ?? '') ?? null,
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'emp_code' => $row['employee_member_id'] ?? null,
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'claim_amount' => $row['claimed_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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$rejecetd_reason[$row['id']] = ["ticket_master_insert_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'] ?? null);
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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_mail'] = $employee_data['email_corporate'] ?? null;
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$item['emp_mobile'] = $employee_data['mobile'] ?? null;
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$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 = sprintf(
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'The policy number "%s" does not exist in our system. ' .
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'Details - Client ID: %s, Client Policy ID: %s, Employee Number: %s, Relationship: %s',
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$row['insurer_policy_number'],
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$file_data['client_id'],
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$file_data['client_policy_id'],
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$row['employee_number'],
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$item['relationship']
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);
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$rejecetd_reason[$row['id']] = ["ticket_master_insert_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['final_status']] ?? 61;
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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_dump_ref_id'] = $row['id'];
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$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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