831 lines
42 KiB
PHP
831 lines
42 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 VidalClaimImportService 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_old = [
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["excel_column" => "TPA Policy Number", "db_column" => "tpa_policy_number"],
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["excel_column" => "Insurer Policy Number", "db_column" => "insurer_policy_number"],
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["excel_column" => "Corporate Name", "db_column" => "corporate_name"],
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["excel_column" => "Proposer Name", "db_column" => "proposer_name"],
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["excel_column" => "Corporate Group ID", "db_column" => "corporate_group_id"],
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["excel_column" => "Policy Start Date", "db_column" => "policy_start_date"],
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["excel_column" => "Policy End date", "db_column" => "policy_end_date"],
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["excel_column" => "Insurance Company Name", "db_column" => "insurance_company_name"],
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["excel_column" => "Employee Number", "db_column" => "employee_number"],
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["excel_column" => "Employee Location", "db_column" => "employee_location"],
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["excel_column" => "Primary Policy Holder Name", "db_column" => "primary_policy_holder_name"],
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["excel_column" => "Primary Policy Holder Card ID", "db_column" => "primary_policy_holder_card_id"],
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["excel_column" => "Employee Grade", "db_column" => "employee_grade"],
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["excel_column" => "Patient Health Card ID", "db_column" => "patient_health_card_id"],
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["excel_column" => "Patient Name", "db_column" => "patient_name"],
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["excel_column" => "Date of Birth", "db_column" => "date_of_birth"],
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["excel_column" => "Age", "db_column" => "age"],
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["excel_column" => "Gender", "db_column" => "gender"],
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["excel_column" => "Relation", "db_column" => "relation"],
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["excel_column" => "Sum Insured", "db_column" => "sum_insured"],
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["excel_column" => "Balance Sum Insured", "db_column" => "balance_sum_insured"],
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["excel_column" => "Top Up Sum Insured", "db_column" => "top_up_sum_insured"],
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["excel_column" => "Enrollment status", "db_column" => "enrollment_status"],
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["excel_column" => "Policy Inception date", "db_column" => "policy_inception_date"],
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["excel_column" => "Policy Exit Date", "db_column" => "policy_exit_date"],
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["excel_column" => "Insurer Risk ID", "db_column" => "insurer_risk_id"],
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["excel_column" => "Claim Preauth Identifier", "db_column" => "claim_preauth_identifier"],
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["excel_column" => "TPA Claim Number", "db_column" => "tpa_claim_number"],
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["excel_column" => "Preauth Number", "db_column" => "preauth_number"],
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["excel_column" => "Insurer Claim Number", "db_column" => "insurer_claim_number"],
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["excel_column" => "Claim Received date", "db_column" => "claim_received_date"],
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["excel_column" => "Date of Admission", "db_column" => "date_of_admission"],
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["excel_column" => "Date of Discharge", "db_column" => "date_of_discharge"],
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["excel_column" => "Hospital Name", "db_column" => "hospital_name"],
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["excel_column" => "Hospital ID", "db_column" => "hospital_id"],
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["excel_column" => "Hospital Address", "db_column" => "hospital_address"],
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["excel_column" => "Hospital City", "db_column" => "hospital_city"],
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["excel_column" => "Hospital State", "db_column" => "hospital_state"],
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["excel_column" => "Hospital Pincode", "db_column" => "hospital_pincode"],
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["excel_column" => "Hospital Network status", "db_column" => "hospital_network_status"],
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["excel_column" => "PPN Hospital Status", "db_column" => "ppn_hospital_status"],
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["excel_column" => "Room Category", "db_column" => "room_category"],
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["excel_column" => "Room Days", "db_column" => "room_days"],
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["excel_column" => "ICU Days", "db_column" => "icu_days"],
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["excel_column" => "Medical Surgical Identifier", "db_column" => "medical_surgical_identifier"],
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["excel_column" => "Treatment Type of AYUSH", "db_column" => "treatment_type_of_ayush"],
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["excel_column" => "Package", "db_column" => "package"],
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["excel_column" => "Diagnosis", "db_column" => "diagnosis"],
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["excel_column" => "Illness Details", "db_column" => "illness_details"],
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["excel_column" => "Ailment Grouping", "db_column" => "ailment_grouping"],
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["excel_column" => "Primary ICD Code", "db_column" => "primary_icd_code"],
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["excel_column" => "Secondary ICD Code", "db_column" => "secondary_icd_code"],
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["excel_column" => "Procedure Code", "db_column" => "procedure_code"],
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["excel_column" => "Procedure Description", "db_column" => "procedure_description"],
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["excel_column" => "Procedure Grouping", "db_column" => "procedure_grouping"],
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["excel_column" => "Claim Submission mode", "db_column" => "claim_submission_mode"],
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["excel_column" => "Admission Category", "db_column" => "admission_category"],
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["excel_column" => "Type of Claim", "db_column" => "type_of_claim"],
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["excel_column" => "MainClaim_Prepost type", "db_column" => "mainclaim_prepost_type"],
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["excel_column" => "Type of Hospitalization", "db_column" => "type_of_hospitalization"],
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["excel_column" => "Death Status", "db_column" => "death_status"],
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["excel_column" => "Treatement Given", "db_column" => "treatment_given"],
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["excel_column" => "Claim Amount", "db_column" => "claim_amount"],
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["excel_column" => "Total Billed Amount", "db_column" => "total_billed_amount"],
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["excel_column" => "Claim Consultation Charges", "db_column" => "claim_consultation_charges"],
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["excel_column" => "Claim Investigation Charges", "db_column" => "claim_investigation_charges"],
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["excel_column" => "Claim Medicines", "db_column" => "claim_medicines"],
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["excel_column" => "Claim Nursing", "db_column" => "claim_nursing"],
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["excel_column" => "Claim Room Charges", "db_column" => "claim_room_charges"],
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["excel_column" => "Claim Icu Charges", "db_column" => "claim_icu_charges"],
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["excel_column" => "Claim Stay Charges", "db_column" => "claim_stay_charges"],
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["excel_column" => "Claim Surgeon Charges", "db_column" => "claim_surgeon_charges"],
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["excel_column" => "Claim Surgery Charges", "db_column" => "claim_surgery_charges"],
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["excel_column" => "Claim Miscellaneous Charges", "db_column" => "claim_miscellaneous_charges"],
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["excel_column" => "Claim Other Charges", "db_column" => "claim_other_charges"],
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["excel_column" => "Approved Consultation Charges", "db_column" => "approved_consultation_charges"],
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["excel_column" => "Approved Investigation Charges", "db_column" => "approved_investigation_charges"],
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["excel_column" => "Approved Medicines", "db_column" => "approved_medicines"],
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["excel_column" => "Approved Nursing", "db_column" => "approved_nursing"],
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["excel_column" => "Approved Room Charges", "db_column" => "approved_room_charges"],
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["excel_column" => "Approved Icu Charges", "db_column" => "approved_icu_charges"],
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["excel_column" => "Approved Stay Charges", "db_column" => "approved_stay_charges"],
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["excel_column" => "Approved Surgeon Charges", "db_column" => "approved_surgeon_charges"],
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["excel_column" => "Approved Surgery Charges", "db_column" => "approved_surgery_charges"],
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["excel_column" => "Approved Miscellaneous Charges", "db_column" => "approved_miscellaneous_charges"],
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["excel_column" => "Approved Others Charges", "db_column" => "approved_others_charges"],
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["excel_column" => "Total Disallowed Amount", "db_column" => "total_disallowed_amount"],
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["excel_column" => "Copayment Amount", "db_column" => "copayment_amount"],
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["excel_column" => "Deposit Amount", "db_column" => "deposit_amount"],
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["excel_column" => "Exceeds Policy Limit", "db_column" => "exceeds_policy_limit"],
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["excel_column" => "Copay Buffer", "db_column" => "copay_buffer"],
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["excel_column" => "Hospital Discount Amount", "db_column" => "hospital_discount_amount"],
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["excel_column" => "Deductible Amount", "db_column" => "deductible_amount"],
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["excel_column" => "Approved Amount", "db_column" => "approved_amount"],
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["excel_column" => "Total Incurred Amount", "db_column" => "total_incurred_amount"],
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["excel_column" => "Total Buffer Approved", "db_column" => "total_buffer_approved"],
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["excel_column" => "Total Buffer Utlilized", "db_column" => "total_buffer_utilized"],
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["excel_column" => "TDS Amount", "db_column" => "tds_amount"],
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["excel_column" => "Net Amount", "db_column" => "net_amount"],
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["excel_column" => "Claim Decision date", "db_column" => "claim_decision_date"],
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["excel_column" => "Payment Reference Number", "db_column" => "payment_reference_number"],
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["excel_column" => "Payment Reference Date", "db_column" => "payment_reference_date"],
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["excel_column" => "Claim Status", "db_column" => "claim_status"],
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["excel_column" => "Deduction Remarks", "db_column" => "deduction_remarks"],
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["excel_column" => "Rejection Reasons", "db_column" => "rejection_reasons"],
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["excel_column" => "Claim Query Reasons", "db_column" => "claim_query_reasons"],
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["excel_column" => "Insurer Request Sent date", "db_column" => "insurer_request_sent_date"],
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["excel_column" => "Insurer Conf. Received date", "db_column" => "insurer_conf_received_date"],
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["excel_column" => "Claim Reopen Date", "db_column" => "claim_reopen_date"],
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["excel_column" => "First Query Raised date", "db_column" => "first_query_raised_date"],
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["excel_column" => "First Query response date", "db_column" => "first_query_response_date"],
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["excel_column" => "Last Query Raised date", "db_column" => "last_query_raised_date"],
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["excel_column" => "Last Query response date", "db_column" => "last_query_response_date"],
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["excel_column" => "Last Document Received date", "db_column" => "last_document_received_date"],
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];
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protected $mapping = [
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["excel_column" => ["col_name" => "TPA Policy Number", "col_index" => 0], "db_column" => "tpa_policy_number"],
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["excel_column" => ["col_name" => "Insurer Policy Number", "col_index" => 1], "db_column" => "insurer_policy_number"],
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["excel_column" => ["col_name" => "Corporate Name", "col_index" => 2], "db_column" => "corporate_name"],
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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" => "Corporate Group ID", "col_index" => 4], "db_column" => "corporate_group_id"],
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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" => "Insurance Company Name", "col_index" => 7], "db_column" => "insurance_company_name"],
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["excel_column" => ["col_name" => "Employee Number", "col_index" => 8], "db_column" => "employee_number"],
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["excel_column" => ["col_name" => "Employee Location", "col_index" => 9], "db_column" => "employee_location"],
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["excel_column" => ["col_name" => "Primary Policy Holder Name", "col_index" => 10], "db_column" => "primary_policy_holder_name"],
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["excel_column" => ["col_name" => "Primary Policy Holder Card ID", "col_index" => 11], "db_column" => "primary_policy_holder_card_id"],
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["excel_column" => ["col_name" => "Employee Grade", "col_index" => 12], "db_column" => "employee_grade"],
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["excel_column" => ["col_name" => "Patient Health Card ID", "col_index" => 13], "db_column" => "patient_health_card_id"],
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["excel_column" => ["col_name" => "Patient Name", "col_index" => 14], "db_column" => "patient_name"],
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["excel_column" => ["col_name" => "Date of Birth", "col_index" => 15], "db_column" => "date_of_birth"],
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["excel_column" => ["col_name" => "Age", "col_index" => 16], "db_column" => "age"],
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["excel_column" => ["col_name" => "Gender", "col_index" => 17], "db_column" => "gender"],
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["excel_column" => ["col_name" => "Relation", "col_index" => 18], "db_column" => "relation"],
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["excel_column" => ["col_name" => "Sum Insured", "col_index" => 19], "db_column" => "sum_insured"],
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["excel_column" => ["col_name" => "Balance Sum Insured", "col_index" => 20], "db_column" => "balance_sum_insured"],
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["excel_column" => ["col_name" => "Top Up Sum Insured", "col_index" => 21], "db_column" => "top_up_sum_insured"],
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["excel_column" => ["col_name" => "Enrollment status", "col_index" => 22], "db_column" => "enrollment_status"],
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["excel_column" => ["col_name" => "Policy Inception date", "col_index" => 23], "db_column" => "policy_inception_date"],
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["excel_column" => ["col_name" => "Policy Exit Date", "col_index" => 24], "db_column" => "policy_exit_date"],
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["excel_column" => ["col_name" => "Insurer Risk ID", "col_index" => 25], "db_column" => "insurer_risk_id"],
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["excel_column" => ["col_name" => "Claim Preauth Identifier", "col_index" => 26], "db_column" => "claim_preauth_identifier"],
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["excel_column" => ["col_name" => "TPA Claim Number", "col_index" => 27], "db_column" => "tpa_claim_number"],
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["excel_column" => ["col_name" => "Preauth Number", "col_index" => 28], "db_column" => "preauth_number"],
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["excel_column" => ["col_name" => "Insurer Claim Number", "col_index" => 29], "db_column" => "insurer_claim_number"],
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["excel_column" => ["col_name" => "Claim Received date", "col_index" => 30], "db_column" => "claim_received_date"],
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["excel_column" => ["col_name" => "Date of Admission", "col_index" => 31], "db_column" => "date_of_admission"],
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["excel_column" => ["col_name" => "Date of Discharge", "col_index" => 32], "db_column" => "date_of_discharge"],
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["excel_column" => ["col_name" => "Hospital Name", "col_index" => 33], "db_column" => "hospital_name"],
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["excel_column" => ["col_name" => "Hospital ID", "col_index" => 34], "db_column" => "hospital_id"],
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["excel_column" => ["col_name" => "Hospital Address", "col_index" => 35], "db_column" => "hospital_address"],
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["excel_column" => ["col_name" => "Hospital City", "col_index" => 36], "db_column" => "hospital_city"],
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["excel_column" => ["col_name" => "Hospital State", "col_index" => 37], "db_column" => "hospital_state"],
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["excel_column" => ["col_name" => "Hospital Pincode", "col_index" => 38], "db_column" => "hospital_pincode"],
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["excel_column" => ["col_name" => "Hospital Network status", "col_index" => 39], "db_column" => "hospital_network_status"],
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["excel_column" => ["col_name" => "PPN Hospital Status", "col_index" => 40], "db_column" => "ppn_hospital_status"],
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["excel_column" => ["col_name" => "Room Category", "col_index" => 41], "db_column" => "room_category"],
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["excel_column" => ["col_name" => "Room Days", "col_index" => 42], "db_column" => "room_days"],
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["excel_column" => ["col_name" => "ICU Days", "col_index" => 43], "db_column" => "icu_days"],
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["excel_column" => ["col_name" => "Medical Surgical Identifier", "col_index" => 44], "db_column" => "medical_surgical_identifier"],
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["excel_column" => ["col_name" => "Treatment Type of AYUSH", "col_index" => 45], "db_column" => "treatment_type_of_ayush"],
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["excel_column" => ["col_name" => "Package", "col_index" => 46], "db_column" => "package"],
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["excel_column" => ["col_name" => "Diagnosis", "col_index" => 47], "db_column" => "diagnosis"],
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["excel_column" => ["col_name" => "Illness Details", "col_index" => 48], "db_column" => "illness_details"],
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["excel_column" => ["col_name" => "Ailment Grouping", "col_index" => 49], "db_column" => "ailment_grouping"],
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["excel_column" => ["col_name" => "Primary ICD Code", "col_index" => 50], "db_column" => "primary_icd_code"],
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["excel_column" => ["col_name" => "Secondary ICD Code", "col_index" => 51], "db_column" => "secondary_icd_code"],
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["excel_column" => ["col_name" => "Procedure Code", "col_index" => 52], "db_column" => "procedure_code"],
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["excel_column" => ["col_name" => "Procedure Description", "col_index" => 53], "db_column" => "procedure_description"],
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["excel_column" => ["col_name" => "Procedure Grouping", "col_index" => 54], "db_column" => "procedure_grouping"],
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["excel_column" => ["col_name" => "Claim Submission mode", "col_index" => 55], "db_column" => "claim_submission_mode"],
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["excel_column" => ["col_name" => "Admission Category", "col_index" => 56], "db_column" => "admission_category"],
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["excel_column" => ["col_name" => "Type of Claim", "col_index" => 57], "db_column" => "type_of_claim"],
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["excel_column" => ["col_name" => "MainClaim_Prepost type", "col_index" => 58], "db_column" => "mainclaim_prepost_type"],
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["excel_column" => ["col_name" => "Type of Hospitalization", "col_index" => 59], "db_column" => "type_of_hospitalization"],
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["excel_column" => ["col_name" => "Death Status", "col_index" => 60], "db_column" => "death_status"],
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["excel_column" => ["col_name" => "Treatement Given", "col_index" => 61], "db_column" => "treatment_given"],
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["excel_column" => ["col_name" => "Claim Amount", "col_index" => 62], "db_column" => "claim_amount"],
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["excel_column" => ["col_name" => "Total Billed Amount", "col_index" => 63], "db_column" => "total_billed_amount"],
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["excel_column" => ["col_name" => "Claim Consultation Charges", "col_index" => 64], "db_column" => "claim_consultation_charges"],
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["excel_column" => ["col_name" => "Claim Investigation Charges", "col_index" => 65], "db_column" => "claim_investigation_charges"],
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["excel_column" => ["col_name" => "Claim Medicines", "col_index" => 66], "db_column" => "claim_medicines"],
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["excel_column" => ["col_name" => "Claim Nursing", "col_index" => 67], "db_column" => "claim_nursing"],
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["excel_column" => ["col_name" => "Claim Room Charges", "col_index" => 68], "db_column" => "claim_room_charges"],
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["excel_column" => ["col_name" => "Claim Icu Charges", "col_index" => 69], "db_column" => "claim_icu_charges"],
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["excel_column" => ["col_name" => "Claim Stay Charges", "col_index" => 70], "db_column" => "claim_stay_charges"],
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["excel_column" => ["col_name" => "Claim Surgeon Charges", "col_index" => 71], "db_column" => "claim_surgeon_charges"],
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["excel_column" => ["col_name" => "Claim Surgery Charges", "col_index" => 72], "db_column" => "claim_surgery_charges"],
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["excel_column" => ["col_name" => "Claim Miscellaneous Charges", "col_index" => 73], "db_column" => "claim_miscellaneous_charges"],
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["excel_column" => ["col_name" => "Claim Other Charges", "col_index" => 74], "db_column" => "claim_other_charges"],
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["excel_column" => ["col_name" => "Approved Consultation Charges", "col_index" => 75], "db_column" => "approved_consultation_charges"],
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["excel_column" => ["col_name" => "Approved Investigation Charges", "col_index" => 76], "db_column" => "approved_investigation_charges"],
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["excel_column" => ["col_name" => "Approved Medicines", "col_index" => 77], "db_column" => "approved_medicines"],
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["excel_column" => ["col_name" => "Approved Nursing", "col_index" => 78], "db_column" => "approved_nursing"],
|
|
["excel_column" => ["col_name" => "Approved Room Charges", "col_index" => 79], "db_column" => "approved_room_charges"],
|
|
["excel_column" => ["col_name" => "Approved Icu Charges", "col_index" => 80], "db_column" => "approved_icu_charges"],
|
|
["excel_column" => ["col_name" => "Approved Stay Charges", "col_index" => 81], "db_column" => "approved_stay_charges"],
|
|
["excel_column" => ["col_name" => "Approved Surgeon Charges", "col_index" => 82], "db_column" => "approved_surgeon_charges"],
|
|
["excel_column" => ["col_name" => "Approved Surgery Charges", "col_index" => 83], "db_column" => "approved_surgery_charges"],
|
|
["excel_column" => ["col_name" => "Approved Miscellaneous Charges", "col_index" => 84], "db_column" => "approved_miscellaneous_charges"],
|
|
["excel_column" => ["col_name" => "Approved Others Charges", "col_index" => 85], "db_column" => "approved_others_charges"],
|
|
|
|
["excel_column" => ["col_name" => "Total Disallowed Amount", "col_index" => 86], "db_column" => "total_disallowed_amount"],
|
|
["excel_column" => ["col_name" => "Copayment Amount", "col_index" => 87], "db_column" => "copayment_amount"],
|
|
["excel_column" => ["col_name" => "Deposit Amount", "col_index" => 88], "db_column" => "deposit_amount"],
|
|
|
|
["excel_column" => ["col_name" => "Exceeds Policy Limit", "col_index" => 89], "db_column" => "exceeds_policy_limit"],
|
|
["excel_column" => ["col_name" => "Copay Buffer", "col_index" => 90], "db_column" => "copay_buffer"],
|
|
["excel_column" => ["col_name" => "Hospital Discount Amount", "col_index" => 91], "db_column" => "hospital_discount_amount"],
|
|
["excel_column" => ["col_name" => "Deductible Amount", "col_index" => 92], "db_column" => "deductible_amount"],
|
|
|
|
["excel_column" => ["col_name" => "Approved Amount", "col_index" => 93], "db_column" => "approved_amount"],
|
|
["excel_column" => ["col_name" => "Total Incurred Amount", "col_index" => 94], "db_column" => "total_incurred_amount"],
|
|
["excel_column" => ["col_name" => "Total Buffer Approved", "col_index" => 95], "db_column" => "total_buffer_approved"],
|
|
["excel_column" => ["col_name" => "Total Buffer Utlilized", "col_index" => 96], "db_column" => "total_buffer_utilized"],
|
|
|
|
["excel_column" => ["col_name" => "TDS Amount", "col_index" => 97], "db_column" => "tds_amount"],
|
|
["excel_column" => ["col_name" => "Net Amount", "col_index" => 98], "db_column" => "net_amount"],
|
|
|
|
["excel_column" => ["col_name" => "Claim Decision date", "col_index" => 99], "db_column" => "claim_decision_date"],
|
|
["excel_column" => ["col_name" => "Payment Reference Number", "col_index" => 100], "db_column" => "payment_reference_number"],
|
|
["excel_column" => ["col_name" => "Payment Reference Date", "col_index" => 101], "db_column" => "payment_reference_date"],
|
|
|
|
["excel_column" => ["col_name" => "Claim Status", "col_index" => 102], "db_column" => "claim_status"],
|
|
["excel_column" => ["col_name" => "Deduction Remarks", "col_index" => 103], "db_column" => "deduction_remarks"],
|
|
["excel_column" => ["col_name" => "Rejection Reasons", "col_index" => 104], "db_column" => "rejection_reasons"],
|
|
["excel_column" => ["col_name" => "Claim Query Reasons", "col_index" => 105], "db_column" => "claim_query_reasons"],
|
|
|
|
["excel_column" => ["col_name" => "Insurer Request Sent date", "col_index" => 106], "db_column" => "insurer_request_sent_date"],
|
|
["excel_column" => ["col_name" => "Insurer Conf. Received date", "col_index" => 107], "db_column" => "insurer_conf_received_date"],
|
|
["excel_column" => ["col_name" => "Claim Reopen Date", "col_index" => 108], "db_column" => "claim_reopen_date"],
|
|
|
|
["excel_column" => ["col_name" => "First Query Raised date", "col_index" => 109], "db_column" => "first_query_raised_date"],
|
|
["excel_column" => ["col_name" => "First Query response date", "col_index" => 110], "db_column" => "first_query_response_date"],
|
|
["excel_column" => ["col_name" => "Last Query Raised date", "col_index" => 111], "db_column" => "last_query_raised_date"],
|
|
["excel_column" => ["col_name" => "Last Query response date", "col_index" => 112], "db_column" => "last_query_response_date"],
|
|
["excel_column" => ["col_name" => "Last Document Received date", "col_index" => 113], "db_column" => "last_document_received_date"],
|
|
];
|
|
|
|
protected $ticketMasterMapping = [
|
|
|
|
// Policy / Claim identifiers
|
|
'insurer_claim_number' => 'claim_number',
|
|
'tpa_claim_number' => 'tpa_claim_id',
|
|
|
|
// Employee / Insured details
|
|
'employee_number' => 'emp_code',
|
|
'primary_policy_holder_name' => 'emp_name',
|
|
'patient_name' => 'insured_name',
|
|
|
|
// Dates
|
|
'date_of_admission' => 'doa',
|
|
'date_of_discharge' => 'dod',
|
|
'date_of_birth' => 'dob',
|
|
'claim_received_date' => 'registration_date',
|
|
|
|
// Claim details
|
|
'claim_amount' => 'claim_amount',
|
|
'approved_amount' => 'approved_amount',
|
|
'sum_insured' => 'si_amt',
|
|
'claim_status' => 'tpa_claim_status',
|
|
|
|
// Hospital details
|
|
'hospital_name' => 'hospital_name',
|
|
'hospital_address' => 'hospital_address',
|
|
'hospital_city' => 'hospital_city',
|
|
'hospital_state' => 'hospital_state',
|
|
'hospital_pincode' => 'hospital_pin_code',
|
|
|
|
// Meta
|
|
'file_id' => 'file_id',
|
|
'type_of_claim' => 'tpa_claim_type',
|
|
'diagnosis' => 'tpa_ailments',
|
|
|
|
];
|
|
|
|
protected $statusMapping = [
|
|
'Settled' => 11,
|
|
'Rejected' => 8,
|
|
'Paid' => 11,
|
|
'Denied' => 8,
|
|
'Cancelled' => 13,
|
|
'Processed' => 61,
|
|
'Information Awaited' => 4,
|
|
'Denied Letter Sent' => 66,
|
|
'Cashless Document Awaited' => 3,
|
|
'Approved' => 9,
|
|
'Closed' => 12,
|
|
];
|
|
|
|
|
|
/**
|
|
* ABSTRACT FUNCTIONs
|
|
*/
|
|
public function bulkInsertTPATable(array $data): bool
|
|
{
|
|
if (empty($data)) {
|
|
return false;
|
|
}
|
|
|
|
$builder = $this->db->table('claims_dump_vidal');
|
|
return $builder->insertBatch($data);
|
|
|
|
}
|
|
|
|
|
|
public function importClaimMaster(array $data): bool
|
|
{
|
|
if (empty($data)) {
|
|
return false;
|
|
}
|
|
|
|
$ticketMasterModel = new TicketMasterModel();
|
|
return $ticketMasterModel->insertBatch($data);
|
|
}
|
|
|
|
|
|
public function updateTicketIdInTPATable(int $fileId): bool
|
|
{
|
|
$rows = $this->db->table('claims_dump_vidal cd')
|
|
->select('cd.id, tm.id AS ticket_id')
|
|
->join('ticket_master tm', 'tm.claim_dump_ref_id = cd.id AND tm.file_id = cd.file_id', 'inner')
|
|
->where('cd.is_active', 1)
|
|
->where('cd.file_id', $fileId)
|
|
->where('cd.ticket_id IS NULL')
|
|
->get()
|
|
->getResultArray();
|
|
|
|
if (empty($rows)) {
|
|
return true;
|
|
}
|
|
|
|
$updateData = [];
|
|
foreach ($rows as $row) {
|
|
$updateData[] = [
|
|
'id' => $row['id'],
|
|
'ticket_id' => $row['ticket_id'],
|
|
];
|
|
}
|
|
|
|
return $this->db->table('claims_dump_vidal')->updateBatch($updateData, 'id') !== false;
|
|
}
|
|
|
|
|
|
public function updateTicketMasterRejectedReasonInTPATable($data): bool
|
|
{
|
|
if (empty($data)) {
|
|
return false;
|
|
}
|
|
|
|
$builder = $this->db->table('claims_dump_vidal');
|
|
return $builder->updateBatch($data, 'id');
|
|
}
|
|
|
|
|
|
/**
|
|
* MAPPING FUNCTIONs
|
|
*/
|
|
|
|
public function mapTPAData(array $rows, $file_id): array
|
|
{
|
|
$ClientPolicyModel = new ClaimDumpFileModel();
|
|
$file_data = $ClientPolicyModel->where('id', $file_id)->first();
|
|
|
|
$mapped = [];
|
|
|
|
foreach ($rows as $row) {
|
|
|
|
$item = [];
|
|
|
|
foreach ($this->mapping as $map) {
|
|
$excelColumn = $map['excel_column']['col_name'];
|
|
$dbColumn = $map['db_column'];
|
|
|
|
$value = $row[$excelColumn] ?? null;
|
|
|
|
if ($this->isDateValue($value)) {
|
|
$value = $this->normalizeDate($value);
|
|
}
|
|
|
|
$item[$dbColumn] = $value;
|
|
}
|
|
|
|
$params = [
|
|
'date_of_admission' => change_date_format($item['date_of_admission'] ?? '') ?? null,
|
|
'employee_number' => $item['employee_number'] ?? null,
|
|
'claim_amount' => $item['claim_amount'] ?? null,
|
|
'primary_policy_holder_card_id' => $item['primary_policy_holder_card_id'] ?? null
|
|
];
|
|
|
|
$is_duplicate = $this->checkDuplicateTpaClaim('claims_dump_vidal', $params);
|
|
|
|
if ($is_duplicate) {
|
|
$item = [];
|
|
continue;
|
|
}
|
|
|
|
$item['file_id'] = $file_id ?? null;
|
|
$item['client_id'] = $file_data['client_id'] ?? null;
|
|
$item['client_policy_id'] = $file_data['client_policy_id'] ?? null;
|
|
$item['created_by'] = $file_data['created_by'] ?? null;
|
|
|
|
$mapped[] = $item;
|
|
}
|
|
|
|
return $mapped;
|
|
}
|
|
|
|
public function mapClaimMasterData($file_id): array
|
|
{
|
|
|
|
$ClientPolicyModel = new ClaimDumpFileModel();
|
|
$file_data = $ClientPolicyModel->where('id', $file_id)->first();
|
|
|
|
$tpaClaimDumpData = $this->getTpaClaimDumpData('claims_dump_vidal', ['file_id' => $file_id]);
|
|
|
|
if (empty($tpaClaimDumpData)) {
|
|
return ['status' => false, 'message' => "No data to insert in TICKET MASTER"];
|
|
}
|
|
|
|
|
|
$ClientPolicyModel = new ClientPolicyModel();
|
|
$client_policy_data = $ClientPolicyModel
|
|
->select("
|
|
client_policy.*,
|
|
(
|
|
SELECT id
|
|
FROM client_rm
|
|
WHERE is_active = 1
|
|
AND level = 3
|
|
AND client_id = client_policy.client_id
|
|
ORDER BY id ASC
|
|
LIMIT 1
|
|
) AS acm_id
|
|
")
|
|
->where('client_policy.id', $file_data['client_policy_id'])
|
|
->where('client_policy.is_active', 1)
|
|
->first();
|
|
|
|
try {
|
|
|
|
$mapped = [];
|
|
$rejecetd_reason = [];
|
|
|
|
foreach ($tpaClaimDumpData as $row) {
|
|
|
|
$params = [
|
|
'doa' => change_date_format($row['date_of_admission'] ?? '') ?? null,
|
|
'emp_code' => $row['employee_number'] ?? null,
|
|
'claim_amount' => $row['claim_amount'] ?? null,
|
|
'tpa_no' => $row['primary_policy_holder_card_id'] ?? null
|
|
];
|
|
|
|
$isduplicate = $this->checkDublicateTicketMasterClaim($params);
|
|
|
|
if ($isduplicate) {
|
|
$reason = "This claim already exists in our system.";
|
|
$rejecetd_reason[] = ["id" => $row['id'], "master_reject_reason" => $reason];
|
|
continue;
|
|
}
|
|
|
|
$item = [];
|
|
|
|
$item['client_id'] = $client_policy_data['client_id'] ?? null;
|
|
$item['client_policy_id'] = $client_policy_data['id'] ?? null;
|
|
$item['insurer_id'] = $client_policy_data['insurer_id'] ?? null;
|
|
$item['tpa_id'] = $client_policy_data['tpa_id'] ?? null;
|
|
$item['acm_id'] = $client_policy_data['acm_id'] ?? null;
|
|
$item['policy_no'] = $client_policy_data['policy_no'] ?? null;
|
|
$item['relationship'] = $this->convertRelation($row['relation'] ?? null, $row['gender'] ?? null);
|
|
|
|
$employee_data = $this->getEmployeeDetails($file_data['client_id'], $file_data['client_policy_id'], $row['employee_number'], $item['relationship']);
|
|
|
|
if (!empty($employee_data)) {
|
|
$item['emp_id'] = $employee_data['id'] ?? null;
|
|
$item['emp_name'] = $employee_data['name'] ?? null;
|
|
$item['emp_mail'] = $employee_data['email_corporate'] ?? null;
|
|
$item['emp_code'] = $employee_data['emp_code'] ?? null;
|
|
$item['emp_mobile'] = $employee_data['mobile'] ?? null;
|
|
$item['insured_emp_id'] = $employee_data['insured_emp_id'] ?? null;
|
|
$item['insured_name'] = $employee_data['insured_name'] ?? null;
|
|
} else {
|
|
|
|
$reason = 'This employee not exist in our system.';
|
|
$rejecetd_reason[] = ["id" => $row['id'], "master_reject_reason" => $reason];
|
|
continue;
|
|
}
|
|
|
|
foreach ($this->ticketMasterMapping as $tpaKey => $ticketMasterKey) {
|
|
$item[$ticketMasterKey] = array_key_exists($tpaKey, $row) ? $row[$tpaKey] : null;
|
|
}
|
|
|
|
// Meta fields
|
|
$item['claim_status_id'] = $this->checkStatusMapping($this->statusMapping, $row['claim_status']) ?? 61;
|
|
$item['file_id'] = $file_id;
|
|
$item['claim_dump_ref_id'] = $row['id'];
|
|
$item['claim_dump_date'] = $file_data['claim_dump_date'] ?? null;
|
|
$item['created_by'] = $file_data['created_by'] ?? null;
|
|
$item['claim_type'] = isset($row['mainclaim_prepost_type']) && !empty($row['mainclaim_prepost_type']) && strtolower($row['mainclaim_prepost_type']) == 'normal' ? 1 : 3;
|
|
$item['priority'] = 1;
|
|
$item['mode_of_intimation'] = 5;
|
|
$item['ticket_type_id'] = 1;
|
|
$item['claim_created_by'] = 'DUMP_TPA';
|
|
|
|
$mapped[] = $item;
|
|
}
|
|
|
|
return ['status' => true, 'mapped_array' => $mapped, 'rejected_reason_array' => $rejecetd_reason];
|
|
|
|
} catch (\Throwable $th) {
|
|
|
|
$errorData = [
|
|
'message' => $th->getMessage(),
|
|
'file' => $th->getFile(),
|
|
'line' => $th->getLine(),
|
|
'code' => $th->getCode(),
|
|
'trace' => $th->getTraceAsString(),
|
|
'trace_array' => $th->getTrace(), // full array version (optional)
|
|
'function' => $th->getTrace()[0]['function'] ?? null,
|
|
'class' => $th->getTrace()[0]['class'] ?? null,
|
|
];
|
|
|
|
return ['status' => false, "message" => $errorData['message'], 'error_data' => $errorData];
|
|
}
|
|
}
|
|
|
|
public function mapClaimMasterDataOld($file_id): array
|
|
{
|
|
$claimDumpFileModel = new ClaimDumpFileModel();
|
|
$file_data = $claimDumpFileModel->where('id', $file_id)->first();
|
|
|
|
$tpaClaimDumpData = $this->db
|
|
->table('claims_dump_vidal')
|
|
->where('is_active', 1)
|
|
->where('file_id', $file_id)
|
|
->where('ticket_id IS NULL')
|
|
->get()
|
|
->getResultArray();
|
|
|
|
if (empty($tpaClaimDumpData)) {
|
|
return [];
|
|
}
|
|
|
|
$ClientPolicyModel = new ClientPolicyModel();
|
|
$client_policy_data = $ClientPolicyModel->where('is_active', 1)->findAll();
|
|
|
|
$mapped = [];
|
|
$rejecetd_reason = [];
|
|
|
|
foreach ($tpaClaimDumpData as $row) {
|
|
|
|
$item = [];
|
|
|
|
if(isset($row['insurer_policy_number']) && !empty($row['insurer_policy_number'])){
|
|
|
|
$basic_claim_data = $this->getClientPolicyDataBypolicyNo($client_policy_data, $row['insurer_policy_number']);
|
|
if(empty($basic_claim_data)){
|
|
$reason = " This policy no ( " . $row['insurer_policy_number'] ." ) does not exist in our system";
|
|
$rejecetd_reason[$row['id']] = ["ticket_master_insert_reject_reason" => $reason];
|
|
continue;
|
|
}
|
|
|
|
$item['client_id'] = $basic_claim_data['client_id'] ?? null;
|
|
$item['client_policy_id'] = $basic_claim_data['id'] ?? null;
|
|
$item['insurer_id'] = $basic_claim_data['insurer_id'] ?? null;
|
|
$item['tpa_id'] = $basic_claim_data['tpa_id'] ?? null;
|
|
$item['acm_id'] = $basic_claim_data['acm_id'] ?? null;
|
|
$item['policy_no'] = $basic_claim_data['policy_no'] ?? null;
|
|
$item['relationship'] = $this->convertRelation($row['relation'] ?? null, $row['gender'] ?? null);
|
|
|
|
$employee_data = $this->getEmployeeDetails($item['client_id'], $item['client_policy_id'], $row['employee_number'], $item['relationship']);
|
|
if(!empty($employee_data)){
|
|
$item['emp_id'] = $employee_data['client_id'] ?? null;
|
|
$item['emp_name'] = $employee_data['id'] ?? null;
|
|
$item['emp_mail'] = $employee_data['insurer_id'] ?? null;
|
|
$item['emp_mobile'] = $employee_data['tpa_id'] ?? null;
|
|
if (!empty($employee_data['insured_emp_id'])) {
|
|
$item['insured_emp_id'] = $employee_data['insured_emp_id'] ?? null;
|
|
$item['insured_name'] = $employee_data['insured_name'] ?? null;
|
|
}else{
|
|
$reason = 'This Dependent employee not exist in our system.';
|
|
$rejecetd_reason[] = ["id" => $row['id'], "master_reject_reason" => $reason];
|
|
continue;
|
|
}
|
|
}else{
|
|
$reason = " This policy no ( " . $row['insurer_policy_number'] ." ) does not exist in our system";
|
|
$rejecetd_reason[$row['id']] = ["ticket_master_insert_reject_reason" => $reason];
|
|
continue;
|
|
}
|
|
|
|
}else{
|
|
$reason = " Policy Number is empty";
|
|
$rejecetd_reason[$row['id']] = ["ticket_master_insert_reject_reason" => $reason];
|
|
continue;
|
|
}
|
|
|
|
foreach ($this->ticketMasterMapping as $tpaKey => $ticketMasterKey) {
|
|
$item[$ticketMasterKey] = array_key_exists($tpaKey, $row)
|
|
? $row[$tpaKey]
|
|
: null;
|
|
}
|
|
|
|
$isduplicate = checkDuplicateClaim([
|
|
'doa' => change_date_format($item['doa'] ?? '') ?? null,
|
|
'emp_code' => $item['emp_code'] ?? null,
|
|
'claim_amount' => $item['claim_amount'] ?? null,
|
|
'policy_no' => $item['policy_no'] ?? null
|
|
]);
|
|
|
|
if($isduplicate){
|
|
$reason = " This claim ( " . $row['insurer_policy_number'] ." ) does not exist in our system";
|
|
$rejecetd_reason[$row['id']] = ["ticket_master_insert_reject_reason" => $reason];
|
|
continue;
|
|
}
|
|
|
|
// Meta fields
|
|
$item['file_id'] = $file_id;
|
|
$item['claim_dump_date'] = $file_data['claim_dump_date'] ?? null;
|
|
$item['created_by'] = get_session_userid() ?? null;
|
|
$item['claim_type'] = isset($row['mainclaim_prepost_type']) && !empty($row['mainclaim_prepost_type']) && strtolower($row['mainclaim_prepost_type']) == 'normal' ? 1 : 3;
|
|
$item['claim_created_by'] = 'DUMP_TPA';
|
|
|
|
$mapped[] = $item;
|
|
|
|
}
|
|
|
|
return ['mapped_array' => $mapped, 'rejected_reason_array' => $rejecetd_reason];
|
|
}
|
|
|
|
|
|
/**
|
|
* HELPER FUNCTIONs
|
|
*/
|
|
|
|
public function isDateValue($value): bool
|
|
{
|
|
if (empty($value)) {
|
|
return false;
|
|
}
|
|
|
|
// Excel numeric date (e.g. 44927)
|
|
if (is_numeric($value) && $value > 30000) {
|
|
return true;
|
|
}
|
|
|
|
// Common date formats
|
|
return preg_match(
|
|
'/^\d{1,2}[\/\-]\d{1,2}[\/\-]\d{2,4}$|^\d{4}[\/\-]\d{1,2}[\/\-]\d{1,2}$/',
|
|
(string) $value
|
|
) === 1;
|
|
}
|
|
|
|
|
|
public function normalizeDate($value): ?string
|
|
{
|
|
try {
|
|
// Excel numeric date
|
|
if (is_numeric($value)) {
|
|
return date('Y-m-d', \PhpOffice\PhpSpreadsheet\Shared\Date::excelToTimestamp($value));
|
|
}
|
|
|
|
// String date
|
|
return date('Y-m-d', strtotime(str_replace('/', '-', $value)));
|
|
} catch (\Throwable $e) {
|
|
return null;
|
|
}
|
|
}
|
|
|
|
|
|
public function looksLikeDate($value): bool
|
|
{
|
|
if (empty($value)) {
|
|
return false;
|
|
}
|
|
|
|
// Excel numeric date
|
|
if (is_numeric($value) && $value > 30000) {
|
|
return true;
|
|
}
|
|
|
|
return preg_match(
|
|
'/\d{1,2}[\/\-]\d{1,2}[\/\-]\d{2,4}|
|
|
\d{4}[\/\-]\d{1,2}[\/\-]\d{1,2}|
|
|
\d{1,2}\s?[A-Za-z]{3,}\s?\d{2,4}|
|
|
\d{8}/x',
|
|
(string) $value
|
|
) === 1;
|
|
}
|
|
|
|
|
|
public function convertRelation(string $relation, string $gender): ?string
|
|
{
|
|
if (empty($relation)) {
|
|
return null;
|
|
}
|
|
|
|
$relation = strtolower($relation);
|
|
$gender = strtolower($gender);
|
|
|
|
if ($relation == 'self') {
|
|
return $relation;
|
|
}
|
|
|
|
if ($relation == 'spouse') {
|
|
return $relation;
|
|
}
|
|
|
|
if ($relation == 'child' && $gender == 'male') {
|
|
return 'son';
|
|
}
|
|
|
|
if ($relation == 'child' && $gender == 'female') {
|
|
return 'daughter';
|
|
}
|
|
|
|
if ($relation == 'parents' && $gender == 'male') {
|
|
return 'father';
|
|
}
|
|
|
|
if ($relation == 'parents' && $gender == 'female') {
|
|
return 'mother';
|
|
}
|
|
|
|
if ($relation == 'parents-in-law' && $gender == 'male') {
|
|
return 'father-in-law';
|
|
}
|
|
|
|
if ($relation == 'parents-in-law' && $gender == 'female') {
|
|
return 'mother-in-law';
|
|
}
|
|
|
|
return null;
|
|
}
|
|
|
|
|
|
public function getClientPolicyDataBypolicyNo(array $client_policy_data, string $policy_number): array
|
|
{
|
|
$matched_data = [];
|
|
foreach ($client_policy_data as $key => $value) {
|
|
if(trim($value) == trim($policy_number)){
|
|
$matched_data = $value;
|
|
}
|
|
}
|
|
|
|
if(!empty($matched_data)){
|
|
$ClientRMModel = new ClientRMModel();
|
|
$acm_data = $ClientRMModel->where('is_active', 1)->where('level', 3)->where('client_id', $matched_data['client_id'])->orderBy('id', 'asc')->first();
|
|
if(!empty($acm_data)){
|
|
$matched_data['acm_id'] = $acm_data['id'] ?? null;
|
|
}
|
|
}
|
|
|
|
return $matched_data;
|
|
}
|
|
|
|
}
|