feat: insurance & medical billing system (6 phases)

Multi-tenant insurance contracts, service coverage, versioned tariffs, invoice calculation, and insurance claims with debt reporting. - TenantInsurance: per-tenant insurance contracts (coverage/franchise/ceiling, versioning, soft-deactivate) + active guard - ServiceItem.insuranceCovered + TenantServiceCoverage per-service overrides - Tariff: versioned yearly tariffs with fallback to ServiceItem price - Billing domain: Money/ShareBreakdown VOs, BillingCalculator (unit-tested), Invoice/InvoiceItem aggregate, InvoiceService.createFromSession - Claim/ClaimItem with state machine (pending->submitted->approved/rejected->paid), ClaimService, insurance-debt report - ClaimSubmitterInterface + ManualClaimSubmitter (future insurance API ready) - Admin UI: insurance-pricing page, claims page, service tariff modal, service insurance toggle; routes + sidebar entries - Architecture doc + billing/insurance/clinic-services API docs Co-Authored-By: Claude Opus 4.8 <noreply@anthropic.com>
2026-06-23 15:05:24 +03:30
parent 5b1dfe9b40
commit 89191eee57
54 changed files with 4233 additions and 10 deletions
@@ -0,0 +1,53 @@
+<?php
+
+namespace App\Billing\Service;
+
+use App\Billing\ValueObject\Money;
+use App\Billing\ValueObject\ShareBreakdown;
+use App\Insurance\ValueObject\CoverageRule;
+
+class BillingCalculator
+{
+    /**
+     * محاسبه‌ی سهم برای یک آیتم.
+     * ترتیب: کل → پوشش پایه (با سقف) → باقیمانده → پوشش مکمل روی باقیمانده (با سقف) → فرانشیز سهم بیمار.
+     */
+    public function calculateItem(
+        Money $total,
+        ?CoverageRule $base,
+        ?CoverageRule $supplementary,
+    ): ShareBreakdown {
+        $baseShare = Money::zero();
+        $remaining = $total;
+
+        if ($base !== null && $base->covered) {
+            $baseShare = $total->percent($base->coveragePercent);
+            if ($base->ceilingRials !== null) {
+                $baseShare = $baseShare->min(new Money($base->ceilingRials));
+            }
+            $remaining = $total->sub($baseShare);
+        }
+
+        $suppShare = Money::zero();
+        if ($supplementary !== null && $supplementary->covered) {
+            $suppShare = $remaining->percent($supplementary->coveragePercent);
+            if ($supplementary->ceilingRials !== null) {
+                $suppShare = $suppShare->min(new Money($supplementary->ceilingRials));
+            }
+            $remaining = $remaining->sub($suppShare);
+        }
+
+        // فرانشیز سهم بیمار است؛ از سهم بیمه کم نمی‌کند ولی سهم بیمار از کل بیشتر نمی‌شود.
+        $franchise = new Money(
+            ($base?->franchiseRials ?? 0) + ($supplementary?->franchiseRials ?? 0)
+        );
+        $patient = $remaining->add($franchise)->min($total);
+
+        return new ShareBreakdown(
+            totalRials:         $total->rials,
+            baseInsuranceRials: $baseShare->rials,
+            supplementaryRials: $suppShare->rials,
+            patientRials:       $patient->rials,
+        );
+    }
+}