244 lines
9.9 KiB
PHP
Executable File
244 lines
9.9 KiB
PHP
Executable File
<?php
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namespace App\Services;
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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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use App\Models\Member;
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use Carbon\Carbon;
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use App\Exceptions\ImportRowException;
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use Box\Spout\Writer\Common\Creator\WriterEntityFactory;
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use DB;
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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', $organization_code = null)
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{
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// try {
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$organization = False;
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if($organization_code){
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$organization = Organization::where('code', $organization_code)->first();
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if (!$organization){
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throw new ImportRowException(__('Code Provider Tidak ditemukan', [
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'attribute' => 'provider_code',
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'code' => $row['provider_code']
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]), 403, null, $row);
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}
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}
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DB::beginTransaction();
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if ($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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$statusClaim = null;
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}
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if (count($row)>0){
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if($row['total_billing']) {
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$data = [
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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 ? $organization->id : 0,
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];
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} else {
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$data = [];
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}
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$claimRequest = ClaimRequest::updateOrCreate(['request_log_id' => $requestLogID],$data);
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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' => $row['excess_paid'],
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]);
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} else { // input from hospital portal
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$data = [
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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::updateOrCreate(['request_log_id' => $requestLogID],$data);
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}
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DB::commit();
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return $claimRequest;
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// } catch (\Exception $error) {
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// DB::rollBack();
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// throw new \Exception($error);
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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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if($row['provider_code']){
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$organization = Organization::where('code', $row['provider_code'])->first();
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if (!$organization){
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throw new ImportRowException(__('Provider Tidak ditemukan'), 0, null, $row);
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}
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};
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if(!$member){
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throw new ImportRowException(__('Member Tidak ditemukan'), 0, null, $row);
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};
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DB::beginTransaction();
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$data = [
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'member_id' => $member->id,
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'currency' => 'IDR',
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'plan_id' => $member->currentPlan->id,
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'total_claim' => $row['tot_amt_insurred'] ? $row['tot_amt_insurred'] : 0,
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'benefit_code' => $row['benefit_code'] ? $row['benefit_code'] : '-',
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'benefit_desc' => $row['benefit_desc'] ? $row['benefit_desc'] : '-',
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'amount_incurred' => $row['tot_amt_insurred'] ? $row['tot_amt_insurred'] : 0,
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'amount_approved' => $row['tot_amt_approved'] ? $row['tot_amt_approved'] : 0,
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'amount_not_approved' => $row['tot_amt_not_approved'] ? $row['tot_amt_not_approved'] :0,
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'excess_paid' => $row['tot_excess_paid'] ? $row['tot_excess_paid'] : 0,
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'claim_request_id' => $claim_request_id,
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'organization_id' => $organization ? $organization->id : NULL,
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'status' => 'requested'
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];
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$claimManagement = Claim::create($data);
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// update client id di claim request
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ClaimRequest::where('id', $claim_request_id)->update([
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'claim_id' => $claimManagement->id,
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]);
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DB::commit();
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return $claimManagement;
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} catch (\Exception $error) {
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DB::rollBack();
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throw new \Exception($error);
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}
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}
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public static function updateClaimRequest($reason, $submission_date, $claim_request_id){
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try {
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$claimRequest = ClaimRequest::find($claim_request_id);
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if (!$claimRequest) {
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throw new \Exception("Claim request not found");
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}
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$claimRequest->submission_date = $submission_date;
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$claimRequest->reason = $reason;
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$claimRequest->save();
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return $claimRequest;
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} catch (\Exception $error) {
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throw new \Exception($error->getMessage());
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}
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}
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public function handleClaimRequestRow($row)
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{
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try {
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$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, $row);
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};
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if ($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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$submissionDate = Helper::dateParser($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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code: $code,
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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: $organization->code
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);
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$newlyCreatedID = $newClaimRequest->id;
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return $newClaimRequest;
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} catch (\Exception $e) {
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throw $e;
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}
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}
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}
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