[WIP] Change Check Coverage Appointment

app/Http/Controllers/Api/OLDLMS/ClaimController.php

@@ -6,6 +6,7 @@ use App\Helpers\Helper;
 use App\Http\Controllers\Controller;
 use App\Models\Icd;
 use App\Models\Member;
+use App\Models\Speciality;
 use App\Services\ClaimService;
 use Illuminate\Http\Request;
 
@@ -16,19 +17,23 @@ class ClaimController extends Controller
         $request->validate([
             'member_id' => 'required',
             'user_id' => 'required',
-            'type' => 'required|in:consultation-gp,consultation-specialist,medicine',
+            'type' => 'required|in:consultation,teleconsultation,medicine',
+            'speciality_code' => 'required',
             'total_claim' => 'required',
             'detail' => 'required',
         ]);
+
+        $currentSpeciality = Speciality::where('code', $request->speciality_code)->first();
         
-        if ($request->type == 'consultation-gp') {
+        $gpSpecialityName = config('aso.general_practitioner_speciality_name', 'Umum');
-            $benefitCode = 'OPCONS1';
+        $isGp = $gpSpecialityName == ($currentSpeciality ? $currentSpeciality->name : false);
-        }
+
-        if ($request->type == 'consultation-specialist') {
-            $benefitCode = 'OPCONS2';
-        }
         if ($request->type == 'medicine') {
             $benefitCode = 'OPMEDI1';
+        } else if ($isGp) {
+            $benefitCode = 'OPCONS1';
+        } else {
+            $benefitCode = 'OPCONS2';
         }
 
         $member = Member::query()
@@ -38,8 +43,7 @@ class ClaimController extends Controller
                         ])
                         ->firstOrFail();
         $benefit = $member->currentPlan->benefits()->where('code', $benefitCode)->first();
-        // $diagnosis = Icd::first();
+        
-
         $claim = ClaimService::storeClaim($member, null, $request->total_claim, $benefit, 'requested');
         $claim->status = 'approved';
         $claim->save();

app/Http/Controllers/Api/OLDLMS/MembershipController.php

@@ -11,7 +11,7 @@ use Illuminate\Http\Request;
 class MembershipController extends Controller
 {
     //
-    public function check(Request $request) 
+    public function check(Request $request)
     {
         $request->validate([
             'member_id' => 'required',
@@ -25,7 +25,7 @@ class MembershipController extends Controller
         }
 
         if (!$member->active) {
-            return Helper::responseJson(statusCode: 406, message: 'The Member '.$request->member_id.' is Inactive.', status: 'error');
+            return Helper::responseJson(statusCode: 406, message: 'The Member ' . $request->member_id . ' is Inactive.', status: 'error');
         }
 
         return Helper::responseJson(data: $member, message: 'Member Found');
@@ -35,68 +35,30 @@ class MembershipController extends Controller
     {
         $request->validate([
             'member_id' => 'required',
-            'type' => 'required|in:consultation-gp,consultation-specialist,medicine',
+            'type' => 'required|in:consultation,teleconsultation,medicine',
             // 'speciality_code' => 'sometimes'
         ]);
 
-        if ($request->type == 'consultation-gp') {
+        $member = Member::query()
-            $benefitCode = 'OPCONS1';
+            ->where('member_id', $request->member_id)
-        }
+            ->with(['currentCorporate', 'currentPolicy', 'currentPlan', 'postponedClaims'])
-        if ($request->type == 'consultation-specialist') {
+            ->first();
-            $benefitCode = 'OPCONS2';
-        }
-        if ($request->type == 'medicine') {
-            $benefitCode = 'OPMEDI1';
-        }
 
-        $member = Member::where('member_id', $request->member_id)->with(['currentCorporate', 'currentPolicy', 'currentPlan', 'postponedClaims'])->first();
+        $corporateService = $member->currentCorporate->corporateServices()
-        
-        $limits = ClaimService::showMemberBenefitLimit($member, $benefitCode);
-        $limits['postponed_claims'] = $member->postponedClaims;
-        $limits['postponed_claims_payment_url'] = route('postpone-pay', $member->member_id);
-        $limits['postponed_claims_unpaid_total'] = $member->postponedClaims->sum('total_claim');
-
-        $corporateService = $member->currentCorporate
-            ->corporateServices()
             ->active()
             ->where('service_code', 'OP')
             ->with([
                 'configs',
                 'specialities' => function ($speciality) use ($request) {
-                    $speciality->where('code', $request->speciality_code)
+                    $speciality->where('code', $request->speciality_code ?? null)
-                            ->wherePivot('active', 1);
+                        ->wherePivot('active', 1);
-                }])
+                }
+            ])
             ->first();
-        
-        $configs = $corporateService->configs->mapWithKeys(function ($config) {
-            return [$config->name => $config];
-        });
 
-        $coverage = [
+        $currentSpeciality = $corporateService->specialities->first();
-            'benefit' => false,
-            'admin_fee' => false,
-            'medicine_benefit' => true, // TODO Make this into setting ?
-            'medicine_delivery_fee' => false
-        ];
-        $coverage['medicine_delivery_fee'] = (($configs['delivery_fee']['value'] ?? 1) == 1);
-        $coverage['gp_benefit'] = (($configs['gp_internal_doctor_online']['value'] ?? 1) == 1);
-        $coverage['gp_admin_fee'] = (($configs['general_practitioner_fee']['value'] ?? 1) == 1);
-        $coverage['sp_benefit'] = (($configs['sp_internal_doctor_online']['value'] ?? 1) == 1);
-        $coverage['sp_admin_fee'] = (($configs['specialist_practitioner_fee']['value'] ?? 1) == 1);
 
-        if ($request->has('speciality_code') && !empty($request->speciality_code)) {
+        if ($currentSpeciality) {
-            
-            if (empty($corporateService) || empty($corporateService->specialities)) {
-                $coverage['benefit'] = false;
-                $coverage['admin_fee'] = false;
-                $limits['coverage'] = $coverage;
-
-                return Helper::responseJson(data: $limits);
-            }
-
-            $currentSpeciality = $corporateService->specialities->first();
-            
-            // Load the Relation Data after speciality check is supported
             $corporateService->load([
                 'corporateServiceSpecialities' => function ($corporateServiceSpeciality) use ($currentSpeciality) {
                     $corporateServiceSpeciality->where('speciality_id', $currentSpeciality->id);
@@ -106,94 +68,101 @@ class MembershipController extends Controller
                 },
                 'corporateServiceSpecialities.exclusions.rules'
             ]);
-
-            $serviceSpeciality = $corporateService->corporateServiceSpecialities->first() ?? null;
-            $serviceSpecialityRules = $serviceSpeciality->exclusions->first()->rules ?? collect([]);
-            $serviceSpecialityRules = $serviceSpecialityRules->mapWithKeys(function ($rule) {
-                return [$rule->name => $rule];
-            });
-
-            $gpSpecialityName = config('aso.general_practitioner_speciality_name', 'Umum');
-
-            if ($gpSpecialityName == $currentSpeciality->name) {
-                // To General Practitioner
-                if (($configs['gp_internal_doctor_online']['value'] ?? 1) == 1) {
-                    $coverage['benefit'] = true;
-                }
-
-                if (($configs['general_practitioner_fee']['value'] ?? 1) == 1) {
-                    $coverage['admin_fee'] = true;
-                }
-
-                if ($serviceSpeciality->active == 1) {
-                    $coverage['benefit'] = true;
-                }
-
-            } else {
-                // To Specialist
-                if (($configs['sp_internal_doctor_online']['value'] ?? 1) == 1) {
-                    $coverage['benefit'] = true;
-                }
-                // dd($configs['specialist_practitioner_fee']['value'], $configs['specialist_practitioner_fee']['value'] ?? 1, ($configs['specialist_practitioner_fee']['value'] ?? 1) == 1);
-
-                if (($configs['specialist_practitioner_fee']['value'] ?? 1) == 1) {
-                    $coverage['admin_fee'] = true;
-                }
-
-                if ($serviceSpeciality->active == 1) {
-                    $coverage['benefit'] = true;
-                }
-            }
-
-            
-            // TODO THIS EXCLUSION IS USED AS INCLUSION NOW, MUST BE CHANGE TO USED AS EXCLUSION AND MAYBE MOVE THE TABLE
-            $excluded = [];
-            foreach ($serviceSpecialityRules as $ruleName => $rule) {
-                if ($ruleName == 'msc') {
-                    $values = explode(',', $rule->values);
-                    if (!in_array(strtolower($member->marital_status), $values)) {
-                        $excluded[] = $rule;
-                    }
-                }
-
-                if ($ruleName == 'gender') {
-                    $values = explode(',', $rule->values);
-                    if (!in_array(strtolower($member->gender), $values)) {
-                        $excluded[] = $rule;
-                    }
-                }
-
-                if ($ruleName == 'min_age') {
-                    if (!empty($rule->values) && $member->age < $rule->values) {
-                        $excluded[] = $rule;
-                    }
-                }
-
-                if ($ruleName == 'max_age') {
-                    if (!empty($rule->values) && $member->age > $rule->values) {
-                        $excluded[] = $rule;
-                    }
-                }
-
-                if ($ruleName == 'plan') {
-                    $values = explode(',', $rule->values);
-                    if (!in_array($member->currentPlan->code, $values)) {
-                        $excluded[] = $rule;
-                    }
-                }
-            }
-
-            if ( count($excluded) ) {
-                $coverage['benefit'] = false;
-                $coverage['benefit_exclusion'] = $excluded;
-            } else {
-                $coverage['benefit'] = true;
-            }
-
         }
-        
+
+        $corporateServiceSpeciality = $corporateService->corporateServiceSpecialities->first() ?? null;
+
+        $serviceSpecialityRules = $corporateServiceSpeciality->exclusions->first()->rules ?? collect([]);
+        $serviceSpecialityRules = $serviceSpecialityRules->mapWithKeys(function ($rule) {
+            return [$rule->name => $rule];
+        });
+
+        $configs = $corporateService->configs->mapWithKeys(function ($config) {
+            return [$config->name => $config];
+        });
+
+        $gpSpecialityName = config('aso.general_practitioner_speciality_name', 'Umum');
+        $isGp = $gpSpecialityName == ($currentSpeciality ? $currentSpeciality->name : false);
+
+        if ($request->type == 'medicine') {
+            $benefitCode = 'OPMEDI1';
+        } else if ($isGp) {
+            $benefitCode = 'OPCONS1';
+        } else {
+            $benefitCode = 'OPCONS2';
+        }
+
+        $limits = ClaimService::showMemberBenefitLimit($member, $benefitCode);
+        $limits['postponed_claims'] = $member->postponedClaims;
+        $limits['postponed_claims_payment_url'] = route('postpone-pay', $member->member_id);
+        $limits['postponed_claims_unpaid_total'] = $member->postponedClaims->sum('total_claim');
+
+        $coverage['medicine_benefit'] = $benefitCode == 'OPMEDI1'; // TODO Make this into setting ?
+        $coverage['medicine_delivery_fee'] = (($configs['delivery_fee']['value'] ?? 1) == 1);
+
+        if ($currentSpeciality) {
+            $xCoverage['sp_consultation_benefit'] = (($configs['sp_internal_doctor_offline']['value'] ?? 1) == 1);
+            $xCoverage['sp_teleconsultation_benefit'] = (($configs['sp_internal_doctor_online']['value'] ?? 1) == 1);
+            $xCoverage['gp_consultation_benefit'] = (($configs['gp_internal_doctor_offline']['value'] ?? 1) == 1);
+            $xCoverage['gp_teleconsultation_benefit'] = (($configs['gp_internal_doctor_online']['value'] ?? 1) == 1);
+            $coverage['consultation_benefit'] = ($isGp)
+                ? $xCoverage['gp_consultation_benefit']
+                : $xCoverage['sp_consultation_benefit'];
+            $coverage['teleconsultation_benefit'] = ($isGp)
+                ? $xCoverage['gp_teleconsultation_benefit']
+                : $xCoverage['sp_teleconsultation_benefit'];
+
+            $xCoverage['sp_admin_fee'] = (($configs['specialist_practitioner_fee']['value'] ?? 1) == 1);
+            $xCoverage['gp_admin_fee'] = (($configs['general_practitioner_fee']['value'] ?? 1) == 1);
+            $coverage['admin_fee'] = ($isGp)
+                ? $xCoverage['gp_admin_fee']
+                : $xCoverage['sp_admin_fee'];
+        } else {
+            // Not Supported
+            $coverage['consultation_benefit'] = false;
+            $coverage['teleconsultation_benefit'] = false;
+            $coverage['admin_fee'] = false;
+        }
+
         $limits['coverage'] = $coverage;
 
+        // TODO THIS EXCLUSION IS USED AS INCLUSION NOW, MUST BE CHANGE TO USED AS EXCLUSION AND MAYBE MOVE THE TABLE
+        $excluded = [];
+        foreach ($serviceSpecialityRules as $ruleName => $rule) {
+            if ($ruleName == 'msc') {
+                $values = explode(',', $rule->values);
+                if (!in_array(strtolower($member->marital_status), $values)) {
+                    $excluded[] = $rule;
+                }
+            }
+
+            if ($ruleName == 'gender') {
+                $values = explode(',', $rule->values);
+                if (!in_array(strtolower($member->gender), $values)) {
+                    $excluded[] = $rule;
+                }
+            }
+
+            if ($ruleName == 'min_age') {
+                if (!empty($rule->values) && $member->age < $rule->values) {
+                    $excluded[] = $rule;
+                }
+            }
+
+            if ($ruleName == 'max_age') {
+                if (!empty($rule->values) && $member->age > $rule->values) {
+                    $excluded[] = $rule;
+                }
+            }
+
+            if ($ruleName == 'plan') {
+                $values = explode(',', $rule->values);
+                if (!in_array($member->currentPlan->code, $values)) {
+                    $excluded[] = $rule;
+                }
+            }
+        }
+
         return Helper::responseJson(data: $limits);
     }
 }

frontend/dashboard/src/pages/Corporates/Services/Create.tsx

@@ -88,7 +88,7 @@ export default function Divisions() {
   // console.log('specialities', specialities);
 
   useEffect(() => {
-    axios.get('/corporate/' + corporate_id + '/services/' + service_code).then((res) => {
+    axios.get('/corporates/' + corporate_id + '/services/' + service_code).then((res) => {
       setService(res.data.service);
       setPlans(
         res.data.corporate.plans.map((item: any) => ({
@@ -135,7 +135,7 @@ export default function Divisions() {
   const handleConfigChange = (event: ChangeEvent<HTMLInputElement>, service: any) => {
     axios
       .put(`/corporates/${corporate_id}/services`, {
-        service_code: service.service_code,
+        service_code: service_code,
         config_name: event.target.name,
         config_value: event.target.checked,
       })