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Import Claim Request

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This commit is contained in:
Tb Fajri
2024-02-27 10:47:25 +07:00
parent 40fb595673
commit f043165b15
6 changed files with 148 additions and 119 deletions
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16
Modules/Client/Http/Controllers/Api/ClaimRequestController.php
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@@ -19,7 +19,7 @@ class ClaimRequestController extends Controller
* Display a listing of the resource.
* @return Renderable
*/
private static $code_prefix = 'CP';
private static $code_prefix = 'CLAIM';
public function index()
{
return view('client::index');
@@ -224,10 +224,6 @@ class ClaimRequestController extends Controller
public static function getNextCode()
{
// $last_number = ClaimRequest::max('code');
// $next_number = empty($last_number) ? 1 : ((int) explode('-', $last_number)[2] + 1);
// return self::makeCode($next_number);
$last_numeric_code = ClaimRequest::select(DB::raw('MAX(CAST(SUBSTRING_INDEX(code, "-", -1) AS SIGNED)) as max_numeric_code'))
->whereRaw('SUBSTRING_INDEX(code, "-", -1) REGEXP "^[0-9]+$"')
->value('max_numeric_code');
@@ -247,8 +243,14 @@ class ClaimRequestController extends Controller
{
// Pastikan $next_number adalah integer positif
$next_number = max(1, (int) $next_number);
$requestLogData = RequestLog::where('id', $request_log_id)->first();
$organization = Organization::where(['id' => $requestLogData->organization_id, 'type' => 'hospital'])->first('code');
$provideCode = $organization ? $organization->code : '';
$member = Member::with('currentCorporate')->where(['id' => $requestLogData->member_id])->first();
$sparator = '.';
$date = date('ymd');
// Menghasilkan kode dengan format yang diinginkan
return self::$code_prefix . '-' . str_pad($next_number, 5, '0', STR_PAD_LEFT);
return self::$code_prefix . $sparator. 'H' . $sparator. $provideCode . $sparator. $date. $sparator . $member->currentPolicy->code . $sparator. $member->member_id . $sparator. str_pad($next_number, 6, '0', STR_PAD_LEFT);
}
}

1
Modules/HospitalPortal/Http/Controllers/Api/ClaimRequestController.php
View File

@@ -276,7 +276,6 @@ class ClaimRequestController extends Controller
$date = date('ymd');
// Menghasilkan kode dengan format yang diinginkan
return self::$code_prefix . $sparator. 'H' . $sparator. $provideCode . $sparator. $date. $sparator . $member->currentPolicy->code . $sparator. $member->member_id . $sparator. str_pad($next_number, 5, '0', STR_PAD_LEFT);
return self::$code_prefix . '.' . str_pad($next_number, 6, '0', STR_PAD_LEFT);
}
public function get_claim_requests(Request $request)

34
Modules/Internal/Http/Controllers/Api/ClaimRequestController.php
View File

@@ -25,7 +25,7 @@ use App\Models\Member;
class ClaimRequestController extends Controller
{
private static $code_prefix = 'CRQ-C';
private static $code_prefix = 'CLAIM';
/**
* Display a listing of the resource.
@@ -429,6 +429,7 @@ class ClaimRequestController extends Controller
$import = new ImportService();
$import->read($fileRead);
$import->write($fileWrite, 'xsls');
foreach ($import->sheetsIterator() as $sheetIndex => $sheet) {
if ($sheetIndex == 1) { // Rename First Sheet to Writer
$firstWriterSheet = $import->writer->getCurrentSheet();
@@ -445,6 +446,8 @@ class ClaimRequestController extends Controller
$result_headers = array_merge($result_headers, ['Ingest Code', 'Ingest Note']);
$import->addArrayToRow($result_headers);
$doc_headers_indexes = [];
foreach ($sheet->getRowIterator() as $index => $row) {
if ($index == 1) { // First Row Must be Header
@@ -465,21 +468,20 @@ class ClaimRequestController extends Controller
}
try { // Process the Row Data
$claimRequestService = new ClaimRequestService();
$claimRequestService->handleClaimRequestRow($row_data);
// Write Success Result to File
// $import->read($fileRead);
// $import->write($fileWrite, 'xsls');
$result_headers = array_merge($row_data, ['Ingest Code' =>200, 'Ingest Note' => 'Success']);
// Mengambil tanggal dari objek DateTime
$dateSubmission = Helper::dateParser($result_headers['date_submission']); // Format tanggal sesuai kebutuhan
// Mengubah nilai date_submission menjadi string tanggal
$result_headers['date_submission'] = $dateSubmission;
$import->addArrayToRow($result_headers, $sheet->getName());
} catch (ImportRowException $e) {
// Write Data Validation Error to File
// $import->read($fileRead);
// $import->write($fileWrite, 'xsls');
$import->addArrayToRow(array_merge($row_data, [
'Ingest Code' => $e->getCode(),
'Ingest Note' => $e->getMessage(),
@@ -620,10 +622,6 @@ class ClaimRequestController extends Controller
public static function getNextCode()
{
// $last_number = ClaimRequest::max('code');
// $next_number = empty($last_number) ? 1 : ((int) explode('-', $last_number)[2] + 1);
// return self::makeCode($next_number);
$last_numeric_code = ClaimRequest::select(DB::raw('MAX(CAST(SUBSTRING_INDEX(code, "-", -1) AS SIGNED)) as max_numeric_code'))
->whereRaw('SUBSTRING_INDEX(code, "-", -1) REGEXP "^[0-9]+$"')
->value('max_numeric_code');
@@ -641,11 +639,17 @@ class ClaimRequestController extends Controller
public static function makeCode($next_number)
{
// Pastikan $next_number adalah integer positif
$next_number = max(1, (int) $next_number);
// Menghasilkan kode dengan format yang diinginkan
return self::$code_prefix . '-' . str_pad($next_number, 5, '0', STR_PAD_LEFT);
// Pastikan $next_number adalah integer positif
$next_number = max(1, (int) $next_number);
$requestLogData = RequestLog::where('id', $request_log_id)->first();
$organization = Organization::where(['id' => $requestLogData->organization_id, 'type' => 'hospital'])->first('code');
$provideCode = $organization ? $organization->code : '';
$member = Member::with('currentCorporate')->where(['id' => $requestLogData->member_id])->first();
$sparator = '.';
$date = date('ymd');
// Menghasilkan kode dengan format yang diinginkan
return self::$code_prefix . $sparator. 'H' . $sparator. $provideCode . $sparator. $date. $sparator . $member->currentPolicy->code . $sparator. $member->member_id . $sparator. str_pad($next_number, 6, '0', STR_PAD_LEFT);
}
public function requestFiles(Request $request, $claim_id)

17
app/Helpers/Helper.php
View File

@@ -11,6 +11,7 @@ use Illuminate\Support\Facades\DB;
use App\Models\Member;
use App\Models\User;
use App\Models\Service;
use DateTime;
class Helper
{
@@ -426,4 +427,20 @@ class Helper
ini_set('memory_limit', '256M');
}
public static function dateParser($date_from_row) {
if ($date_from_row instanceof DateTime) {
return $date_from_row->format('Y-m-d');
} else if ($date_from_row != null) {
if (strtotime($date_from_row)){
return date('Y-m-d', strtotime($date_from_row));
} else {
// throw new ImportRowException(__('Format Date Invalid'), 0, null, $date_from_row);
return null;
}
} else {
// throw new ImportRowException(__('Format Date Invalid'), 0, null, $date_from_row);
return null;
}
}
}

78
app/Models/ClaimRequest.php
View File

@@ -52,69 +52,27 @@ class ClaimRequest extends Model
];
public static $doc_headers_to_field_map = [
"PAYOR ID" => "payor_id",
"CORPORATE ID" => "corporate_id",
"POLICY NUMBER" => "policy_number",
"MEMBER ID" => "member_id",
"MEMBER NAME" => "member_name",
"RECORD TYPE (P/D)" => "record_type",
"BENEFIT CODE" => "benefit_code",
"BENEFIT DESC" => "benefit_desc",
"CLAIM TYPE" => "claim_type",
"CLAIM PROCESS STATUS" => "status",
"CLIENT CLAIM ID" => "client_claim_id",
"REFERENCE NO" => "reference_no",
"ADMEDIKA CLAIM ID" => "admika_claim_id",
"PROVIDER CODE" => "provider_code",
"ADMISSION DATE" => "admission_date",
"DISCUTRGE DATE" => "discutrge_date",
"DURATION DAYS" => "duration_days",
"COVERAGE TYPE" => "coverage_type",
"PLAN ID" => "plan_id",
"DIAGNOSIS CODE" => "diagnosis_code",
"DIAGNOSIS DESC" => "diagnosis_desc",
"TOT AMT INCURRED" => "tot_amt_insurred",
"TOT AMT APPROVED" => "tot_amt_approved",
"TOT AMT NOT APPROVED" => "tot_amt_not_approved",
"TOT EXCESS PAID" => "tot_excess_paid",
"REMARKS" => "remarks",
"SECONDARY DIAGNOSIS CODE" => "secondary_diagnosis",
"APPROVED DATE" => "approved_date",
"APPROVED BY" => "approved_by",
"DATE RECEIVED" => "data_received",
"HOSPITAL INVOICE DATE" => "hospital_invoice_date",
"Code" => "code",
"Date Submission" => "date_submission",
"Total Billing" => "total_billing",
"Benefit Code" => "benefit_code",
"Amt Incurred" => "amount_incurred",
"Amt Approved" => "amount_apporve",
"Amt Not Approved" => "amount_not_apporve",
"Excess Paid" => "excess_paid",
"QC" => "qc",
];
public static $listing_doc_headers = [
"PAYOR ID",
"CORPORATE ID",
"POLICY NUMBER",
"MEMBER ID",
"MEMBER NAME",
"RECORD TYPE (P/D)",
"CLAIM TYPE",
"CLAIM PROCESS STATUS",
"CLIENT CLAIM ID",
"REFERENCE NO",
"ADMEDIKA CLAIM ID",
"PROVIDER CODE",
"ADMISSION DATE",
"DISCUTRGE DATE",
"DURATION DAYS",
"COVERAGE TYPE",
"PLAN ID",
"DIAGNOSIS CODE",
"DIAGNOSIS DESC",
"TOT AMT INCURRED",
"TOT AMT APPROVED",
"TOT AMT NOT APPROVED",
"TOT EXCESS PAID",
"REMARKS",
"SECONDARY DIAGNOSIS CODE",
"APPROVED DATE",
"APPROVED BY",
"DATE RECEIVED",
"HOSPITAL INVOICE DATE",
"Code",
"Date Submission",
"Total Billing",
"Benefit Code",
"Amt Incurred",
"Amt Approved",
"Amt Not Approved",
"Excess Paid",
"QC",
];

121
app/Services/ClaimRequestService.php
View File

@@ -6,6 +6,9 @@ use App\Events\ClaimApproved;
use App\Events\ClaimRequested;
use App\Models\Claim;
use App\Models\ClaimRequest;
use App\Models\RequestLog;
use App\Models\Benefit;
use App\Models\RequestLogBenefit;
use App\Models\Organization;
use App\Helpers\Helper;
use App\Models\Icd;
@@ -20,6 +23,7 @@ use Str;
class ClaimRequestService{
private static $code_prefix = 'CLAIM';
public static function storeClaimRequest($row = null, $code, $member, $paymentType, $serviceCode, $requestLogID = null, $submissionDate = null, $status = 'requested', $organization_code = null)
{
// try {
@@ -36,20 +40,49 @@ class ClaimRequestService{
DB::beginTransaction();
if ($status == 'submission'){
$claimManagement = 1;
$submissionDateClaimManagement = $submissionDate;
$submissionByClaimManagement = auth()->user()->id;
$statusClaim = 'received';
} else {
$claimManagement = 0;
$submissionDateClaimManagement = null;
$submissionByClaimManagement = null;
$statusClaim = null;
}
$claimRequestData = [
'code' => $code,
'request_log_id' => $requestLogID ?? 0,
'member_id' => $member->id,
'submission_date' => $submissionDate ?? now(),
'status' => $status,
'claim_management' => $claimManagement,
'status_claim_management' => $statusClaim,
'submission_date_claim_management' => $submissionDateClaimManagement,
'submission_by_claim_management' => $submissionByClaimManagement,
'payment_type' => $paymentType,
'service_code' => $serviceCode,
'policy_id' => $member->currentPolicy->id ?? null,
'organization_id' => $organization ? $organization->id : 0,
];
$claimRequest = ClaimRequest::create($claimRequestData);
$claimRequest = ClaimRequest::updateOrCreate(['request_log_id' => $requestLogID],$claimRequestData);
$benefitData = Benefit::where('code', $row['benefit_code'])->first();
$requestLogData = RequestLogBenefit::updateOrCreate(
[
'request_log_id' => $requestLogID,
'benefit_id' => $benefitData->id,
],[
'request_log_id' => $requestLogID,
'benefit_id' => $benefitData->id,
'amount_incurred' => $row['amount_incurred'],
'amount_approved' => $row['amount_apporve'],
'amount_not_approved' => $row['amount_not_apporve'],
'excess_paid' => $row['excess_paid'],
]);
DB::commit();
return $claimRequest;
@@ -60,8 +93,6 @@ class ClaimRequestService{
// }
}
public static function storeClaimManagement($row, $member, $claim_request_id){
try {
$organization = 0;
@@ -130,26 +161,49 @@ class ClaimRequestService{
}
}
protected function validatePlanRow($row)
{
if (empty($row['member_id'])) {
throw new ImportRowException(__('Member ID Required'), 0, null, $row);
}
}
public function handleClaimRequestRow($row)
{
try {
$member = Member::where('member_id', $row['member_id'])->with(['currentPlan'])->first();
if(!$member){
throw new ImportRowException(__('Member Tidak ditemukan'), 0, null, $row);
$requestLog = RequestLog::where('code', $row['code'])->first();
if(!$requestLog){
throw new ImportRowException(__('LOG Tidak ditemukan'), 0, null, $row);
};
$code = $row['client_claim_id'];
$organization_id = $row['provider_code'];
$submissionDate = Helper::formatDateDB($row['admission_date']);
$paymentType = $row['claim_type'];
$status = $row['status'];
$serviceCode = $row['coverage_type'];
if ($requestLog->status != 'approved' && $requestLog != 'approved'){
throw new ImportRowException(__('Request LOG / Final LOG Belum di Approved'), 0, null, $row);
}
$organization = Organization::where('id', $requestLog->organization_id)->first();
// Create Code
$last_numeric_code = ClaimRequest::select(DB::raw('MAX(CAST(SUBSTRING_INDEX(code, ".", -1) AS SIGNED)) as max_numeric_code'))
->whereRaw('SUBSTRING_INDEX(code, ".", -1) REGEXP "^[0-9]+$"')
->value('max_numeric_code');
// $next_number = 1;
if ($last_numeric_code) {
// // Jika ada kode sebelumnya, pecah kode dan tambahkan 1 ke angka terakhir
// $parts = explode('-', $last_code);
// $last_number = (int) end($parts);
$next_number = $last_numeric_code + 1;
} else {
$next_number = 1;
}
// make code
$member = Member::with('currentCorporate')->where(['id' => $requestLog->member_id])->first();
$sparator = '.';
$date = date('ymd');
// Menghasilkan kode dengan format yang diinginkan
$code = 'CLAIM' . $sparator. 'I' . $sparator. $organization->code . $sparator. $date. $sparator . $member->currentPolicy->code . $sparator. $member->member_id . $sparator. str_pad($next_number, 5, '0', STR_PAD_LEFT);
// $code = $row['client_claim_id'];
// dd($row['date_submission']);
$submissionDate = Helper::dateParser($row['date_submission']);
$paymentType = $requestLog->payment_type;
if ($row['qc'] == 'Y'){
$status = 'submission';
} else {
$status = 'requested';
}
$serviceCode = $requestLog->service_code;
$newClaimRequest = $this->storeClaimRequest(
row: $row,
@@ -157,26 +211,21 @@ class ClaimRequestService{
member: $member,
paymentType: $paymentType,
serviceCode: $serviceCode,
requestLogID: $requestLog->id,
submissionDate: $submissionDate,
status: $status,
organization_code: $organization_id
organization_code: $organization->code
);
$newlyCreatedID = $newClaimRequest->id;
$newClaimManangement = $this->storeClaimManagement($row, $member, $newlyCreatedID);
ClaimRequested::dispatch($newClaimRequest);
// Log History
$newClaimRequest->histories()->create([
'title' => 'New Claim Requested',
'description' => "Claim Requested for Member : {$member->member_id} - ({$member->full_name})",
'type' => 'info',
'system_origin' => 'import-internal-aso'
]);
$claim_request_data = $row;
$this->validatePlanRow($claim_request_data);
// $newClaimManangement = $this->storeClaimManagement($row, $member, $newlyCreatedID);
// ClaimRequested::dispatch($newClaimRequest);
// // Log History
// $newClaimRequest->histories()->create([
// 'title' => 'New Claim Requested',
// 'description' => "Claim Requested for Member : {$member->member_id} - ({$member->full_name})",
// 'type' => 'info',
// 'system_origin' => 'import-internal-aso'
// ]);
return $newClaimRequest;
} catch (\Exception $e) {
throw $e;