Import Claim Request

Modules/Client/Http/Controllers/Api/ClaimRequestController.php

@@ -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);
+       
     }
 }

Modules/HospitalPortal/Http/Controllers/Api/ClaimRequestController.php

@@ -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)

Modules/Internal/Http/Controllers/Api/ClaimRequestController.php

@@ -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
+       // Pastikan $next_number adalah integer positif
-        $next_number = max(1, (int) $next_number);
+       $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);
       
-        // Menghasilkan kode dengan format yang diinginkan
-        return self::$code_prefix . '-' . str_pad($next_number, 5, '0', STR_PAD_LEFT);
     }
 
     public function requestFiles(Request $request, $claim_id)

app/Helpers/Helper.php

@@ -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;    
+        }
+    }
+
 }

app/Models/ClaimRequest.php

@@ -52,69 +52,27 @@ class ClaimRequest extends Model
     ];
 
     public static $doc_headers_to_field_map = [
-        "PAYOR ID"                      => "payor_id",
+        "Code"                          => "code",
-        "CORPORATE ID"                  => "corporate_id",
+        "Date Submission"               => "date_submission",
-        "POLICY NUMBER"                 => "policy_number",
+        "Total Billing"                 => "total_billing",
-        "MEMBER ID"                     => "member_id",
+        "Benefit Code"                  => "benefit_code",
-        "MEMBER NAME"                   => "member_name",
+        "Amt Incurred"                  => "amount_incurred",
-        "RECORD TYPE (P/D)"             => "record_type",
+        "Amt Approved"                  => "amount_apporve",
-        "BENEFIT CODE"                  => "benefit_code",
+        "Amt Not Approved"              => "amount_not_apporve",
-        "BENEFIT DESC"                  => "benefit_desc",
+        "Excess Paid"                   => "excess_paid",
-        "CLAIM TYPE"                    => "claim_type",
+        "QC"                            => "qc",
-        "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",
     ];
 
     public static $listing_doc_headers = [
-        "PAYOR ID",
+        "Code",
-        "CORPORATE ID",
+        "Date Submission",
-        "POLICY NUMBER",
+        "Total Billing",
-        "MEMBER ID",
+        "Benefit Code",
-        "MEMBER NAME",
+        "Amt Incurred",
-        "RECORD TYPE (P/D)",
+        "Amt Approved",
-        "CLAIM TYPE",
+        "Amt Not Approved",
-        "CLAIM PROCESS STATUS",
+        "Excess Paid",  
-        "CLIENT CLAIM ID",
+        "QC",  
-        "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",
     ];
     
 

app/Services/ClaimRequestService.php

@@ -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 {
@@ -36,19 +40,48 @@ 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();
 
@@ -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();
+            $requestLog = RequestLog::where('code', $row['code'])->first();
-            if(!$member){
+            if(!$requestLog){
-                throw new ImportRowException(__('Member Tidak ditemukan'), 0, null, $row);
+                throw new ImportRowException(__('LOG Tidak ditemukan'), 0, null, $row);
             };
-            $code = $row['client_claim_id'];
+
-            $organization_id = $row['provider_code'];
+            if ($requestLog->status != 'approved' && $requestLog != 'approved'){
-            $submissionDate = Helper::formatDateDB($row['admission_date']);
+                throw new ImportRowException(__('Request LOG / Final LOG Belum di Approved'), 0, null, $row);
-            $paymentType = $row['claim_type'];
+            }
-            $status = $row['status'];
+            $organization = Organization::where('id', $requestLog->organization_id)->first();
-            $serviceCode = $row['coverage_type'];
+            
+            // 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);
-            $newClaimManangement = $this->storeClaimManagement($row, $member, $newlyCreatedID);
+            // ClaimRequested::dispatch($newClaimRequest);
-            ClaimRequested::dispatch($newClaimRequest);
+            // // Log History
-            // Log History
+            // $newClaimRequest->histories()->create([
-            $newClaimRequest->histories()->create([
+            //     'title' => 'New Claim Requested',
-                'title' => 'New Claim Requested',
+            //     'description' => "Claim Requested for Member : {$member->member_id} - ({$member->full_name})",
-                'description' => "Claim Requested for Member : {$member->member_id} - ({$member->full_name})",
+            //     'type' => 'info',
-                'type' => 'info',
+            //     'system_origin' => 'import-internal-aso'
-                'system_origin' => 'import-internal-aso'
+            // ]);
-            ]);
-
-            $claim_request_data = $row;
-            $this->validatePlanRow($claim_request_data);
-
             return $newClaimRequest;
         } catch (\Exception $e) {
             throw $e;