Import Claim Request
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@@ -11,6 +11,7 @@ use Illuminate\Support\Facades\DB;
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use App\Models\Member;
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use App\Models\User;
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use App\Models\Service;
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use DateTime;
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class Helper
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{
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@@ -426,4 +427,20 @@ class Helper
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ini_set('memory_limit', '256M');
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}
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public static function dateParser($date_from_row) {
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if ($date_from_row instanceof DateTime) {
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return $date_from_row->format('Y-m-d');
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} else if ($date_from_row != null) {
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if (strtotime($date_from_row)){
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return date('Y-m-d', strtotime($date_from_row));
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} else {
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// throw new ImportRowException(__('Format Date Invalid'), 0, null, $date_from_row);
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return null;
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}
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} else {
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// throw new ImportRowException(__('Format Date Invalid'), 0, null, $date_from_row);
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return null;
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}
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}
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}
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@@ -52,69 +52,27 @@ class ClaimRequest extends Model
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];
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public static $doc_headers_to_field_map = [
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"PAYOR ID" => "payor_id",
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"CORPORATE ID" => "corporate_id",
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"POLICY NUMBER" => "policy_number",
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"MEMBER ID" => "member_id",
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"MEMBER NAME" => "member_name",
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"RECORD TYPE (P/D)" => "record_type",
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"BENEFIT CODE" => "benefit_code",
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"BENEFIT DESC" => "benefit_desc",
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"CLAIM TYPE" => "claim_type",
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"CLAIM PROCESS STATUS" => "status",
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"CLIENT CLAIM ID" => "client_claim_id",
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"REFERENCE NO" => "reference_no",
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"ADMEDIKA CLAIM ID" => "admika_claim_id",
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"PROVIDER CODE" => "provider_code",
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"ADMISSION DATE" => "admission_date",
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"DISCUTRGE DATE" => "discutrge_date",
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"DURATION DAYS" => "duration_days",
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"COVERAGE TYPE" => "coverage_type",
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"PLAN ID" => "plan_id",
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"DIAGNOSIS CODE" => "diagnosis_code",
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"DIAGNOSIS DESC" => "diagnosis_desc",
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"TOT AMT INCURRED" => "tot_amt_insurred",
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"TOT AMT APPROVED" => "tot_amt_approved",
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"TOT AMT NOT APPROVED" => "tot_amt_not_approved",
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"TOT EXCESS PAID" => "tot_excess_paid",
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"REMARKS" => "remarks",
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"SECONDARY DIAGNOSIS CODE" => "secondary_diagnosis",
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"APPROVED DATE" => "approved_date",
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"APPROVED BY" => "approved_by",
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"DATE RECEIVED" => "data_received",
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"HOSPITAL INVOICE DATE" => "hospital_invoice_date",
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"Code" => "code",
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"Date Submission" => "date_submission",
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"Total Billing" => "total_billing",
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"Benefit Code" => "benefit_code",
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"Amt Incurred" => "amount_incurred",
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"Amt Approved" => "amount_apporve",
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"Amt Not Approved" => "amount_not_apporve",
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"Excess Paid" => "excess_paid",
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"QC" => "qc",
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];
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public static $listing_doc_headers = [
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"PAYOR ID",
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"CORPORATE ID",
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"POLICY NUMBER",
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"MEMBER ID",
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"MEMBER NAME",
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"RECORD TYPE (P/D)",
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"CLAIM TYPE",
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"CLAIM PROCESS STATUS",
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"CLIENT CLAIM ID",
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"REFERENCE NO",
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"ADMEDIKA CLAIM ID",
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"PROVIDER CODE",
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"ADMISSION DATE",
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"DISCUTRGE DATE",
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"DURATION DAYS",
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"COVERAGE TYPE",
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"PLAN ID",
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"DIAGNOSIS CODE",
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"DIAGNOSIS DESC",
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"TOT AMT INCURRED",
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"TOT AMT APPROVED",
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"TOT AMT NOT APPROVED",
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"TOT EXCESS PAID",
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"REMARKS",
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"SECONDARY DIAGNOSIS CODE",
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"APPROVED DATE",
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"APPROVED BY",
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"DATE RECEIVED",
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"HOSPITAL INVOICE DATE",
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"Code",
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"Date Submission",
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"Total Billing",
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"Benefit Code",
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"Amt Incurred",
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"Amt Approved",
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"Amt Not Approved",
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"Excess Paid",
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"QC",
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];
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@@ -6,6 +6,9 @@ use App\Events\ClaimApproved;
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use App\Events\ClaimRequested;
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use App\Models\Claim;
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use App\Models\ClaimRequest;
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use App\Models\RequestLog;
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use App\Models\Benefit;
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use App\Models\RequestLogBenefit;
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use App\Models\Organization;
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use App\Helpers\Helper;
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use App\Models\Icd;
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@@ -20,6 +23,7 @@ use Str;
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class ClaimRequestService{
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private static $code_prefix = 'CLAIM';
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public static function storeClaimRequest($row = null, $code, $member, $paymentType, $serviceCode, $requestLogID = null, $submissionDate = null, $status = 'requested', $organization_code = null)
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{
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// try {
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@@ -36,20 +40,49 @@ class ClaimRequestService{
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DB::beginTransaction();
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if ($status == 'submission'){
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$claimManagement = 1;
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$submissionDateClaimManagement = $submissionDate;
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$submissionByClaimManagement = auth()->user()->id;
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$statusClaim = 'received';
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} else {
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$claimManagement = 0;
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$submissionDateClaimManagement = null;
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$submissionByClaimManagement = null;
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$statusClaim = null;
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}
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$claimRequestData = [
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'code' => $code,
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'request_log_id' => $requestLogID ?? 0,
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'member_id' => $member->id,
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'submission_date' => $submissionDate ?? now(),
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'status' => $status,
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'claim_management' => $claimManagement,
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'status_claim_management' => $statusClaim,
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'submission_date_claim_management' => $submissionDateClaimManagement,
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'submission_by_claim_management' => $submissionByClaimManagement,
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'payment_type' => $paymentType,
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'service_code' => $serviceCode,
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'policy_id' => $member->currentPolicy->id ?? null,
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'organization_id' => $organization ? $organization->id : 0,
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];
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$claimRequest = ClaimRequest::create($claimRequestData);
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$claimRequest = ClaimRequest::updateOrCreate(['request_log_id' => $requestLogID],$claimRequestData);
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$benefitData = Benefit::where('code', $row['benefit_code'])->first();
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$requestLogData = RequestLogBenefit::updateOrCreate(
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[
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'request_log_id' => $requestLogID,
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'benefit_id' => $benefitData->id,
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],[
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'request_log_id' => $requestLogID,
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'benefit_id' => $benefitData->id,
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'amount_incurred' => $row['amount_incurred'],
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'amount_approved' => $row['amount_apporve'],
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'amount_not_approved' => $row['amount_not_apporve'],
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'excess_paid' => $row['excess_paid'],
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]);
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DB::commit();
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return $claimRequest;
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@@ -60,8 +93,6 @@ class ClaimRequestService{
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// }
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}
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public static function storeClaimManagement($row, $member, $claim_request_id){
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try {
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$organization = 0;
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@@ -130,26 +161,49 @@ class ClaimRequestService{
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}
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}
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protected function validatePlanRow($row)
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{
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if (empty($row['member_id'])) {
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throw new ImportRowException(__('Member ID Required'), 0, null, $row);
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}
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}
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public function handleClaimRequestRow($row)
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{
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try {
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$member = Member::where('member_id', $row['member_id'])->with(['currentPlan'])->first();
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if(!$member){
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throw new ImportRowException(__('Member Tidak ditemukan'), 0, null, $row);
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$requestLog = RequestLog::where('code', $row['code'])->first();
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if(!$requestLog){
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throw new ImportRowException(__('LOG Tidak ditemukan'), 0, null, $row);
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};
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$code = $row['client_claim_id'];
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$organization_id = $row['provider_code'];
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$submissionDate = Helper::formatDateDB($row['admission_date']);
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$paymentType = $row['claim_type'];
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$status = $row['status'];
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$serviceCode = $row['coverage_type'];
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if ($requestLog->status != 'approved' && $requestLog != 'approved'){
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throw new ImportRowException(__('Request LOG / Final LOG Belum di Approved'), 0, null, $row);
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}
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$organization = Organization::where('id', $requestLog->organization_id)->first();
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// Create Code
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$last_numeric_code = ClaimRequest::select(DB::raw('MAX(CAST(SUBSTRING_INDEX(code, ".", -1) AS SIGNED)) as max_numeric_code'))
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->whereRaw('SUBSTRING_INDEX(code, ".", -1) REGEXP "^[0-9]+$"')
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->value('max_numeric_code');
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// $next_number = 1;
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if ($last_numeric_code) {
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// // Jika ada kode sebelumnya, pecah kode dan tambahkan 1 ke angka terakhir
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// $parts = explode('-', $last_code);
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// $last_number = (int) end($parts);
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$next_number = $last_numeric_code + 1;
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} else {
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$next_number = 1;
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}
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// make code
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$member = Member::with('currentCorporate')->where(['id' => $requestLog->member_id])->first();
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$sparator = '.';
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$date = date('ymd');
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// Menghasilkan kode dengan format yang diinginkan
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$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);
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// $code = $row['client_claim_id'];
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// dd($row['date_submission']);
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$submissionDate = Helper::dateParser($row['date_submission']);
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$paymentType = $requestLog->payment_type;
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if ($row['qc'] == 'Y'){
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$status = 'submission';
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} else {
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$status = 'requested';
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}
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$serviceCode = $requestLog->service_code;
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$newClaimRequest = $this->storeClaimRequest(
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row: $row,
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@@ -157,26 +211,21 @@ class ClaimRequestService{
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member: $member,
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paymentType: $paymentType,
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serviceCode: $serviceCode,
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requestLogID: $requestLog->id,
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submissionDate: $submissionDate,
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status: $status,
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organization_code: $organization_id
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organization_code: $organization->code
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);
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$newlyCreatedID = $newClaimRequest->id;
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$newClaimManangement = $this->storeClaimManagement($row, $member, $newlyCreatedID);
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ClaimRequested::dispatch($newClaimRequest);
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// Log History
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$newClaimRequest->histories()->create([
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'title' => 'New Claim Requested',
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'description' => "Claim Requested for Member : {$member->member_id} - ({$member->full_name})",
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'type' => 'info',
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'system_origin' => 'import-internal-aso'
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]);
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$claim_request_data = $row;
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$this->validatePlanRow($claim_request_data);
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// $newClaimManangement = $this->storeClaimManagement($row, $member, $newlyCreatedID);
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// ClaimRequested::dispatch($newClaimRequest);
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// // Log History
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// $newClaimRequest->histories()->create([
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// 'title' => 'New Claim Requested',
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// 'description' => "Claim Requested for Member : {$member->member_id} - ({$member->full_name})",
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// 'type' => 'info',
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// 'system_origin' => 'import-internal-aso'
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// ]);
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return $newClaimRequest;
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} catch (\Exception $e) {
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throw $e;
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