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
@@ -3,12 +3,19 @@
 namespace App\Insurance\Controller;

 use App\Auth\Entity\User;
+use App\Clinic\Repository\ClinicRepository;
 use App\Doctor\Repository\DoctorRepository;
 use App\Insurance\Entity\DoctorInsurance;
+use App\Insurance\Entity\EntityInsurancePricing;
 use App\Insurance\Entity\Insurance;
 use App\Insurance\Enum\InsuranceType;
+use App\Insurance\Entity\TenantInsurance;
 use App\Insurance\Repository\DoctorInsuranceRepository;
+use App\Insurance\Repository\EntityInsurancePricingRepository;
 use App\Insurance\Repository\InsuranceRepository;
+use App\Insurance\Repository\TenantInsuranceRepository;
+use App\Insurance\Repository\TenantServiceCoverageRepository;
+use App\Insurance\Service\TenantInsuranceService;
 use App\Shared\Constant\ErrorCodes;
 use App\Shared\Controller\BaseController;
 use App\Shared\Service\FileValidatorService;
@@ -27,10 +34,28 @@ class InsuranceController extends BaseController
        private readonly InsuranceRepository       $insuranceRepo,
        private readonly DoctorInsuranceRepository $doctorInsuranceRepo,
        private readonly DoctorRepository          $doctorRepo,
+        private readonly ClinicRepository          $clinicRepo,
+        private readonly EntityInsurancePricingRepository $pricingRepo,
+        private readonly TenantInsuranceRepository $tenantInsuranceRepo,
+        private readonly TenantServiceCoverageRepository $serviceCoverageRepo,
+        private readonly TenantInsuranceService    $tenantInsuranceService,
        private readonly FileValidatorService      $fileValidator,
        private readonly string                    $projectDir,
    ) {}

+    private function resolveEntity(User $user): array
+    {
+        if ($user->hasRole('ROLE_DOCTOR')) {
+            $doctor = $this->doctorRepo->findByUser($user);
+            return $doctor !== null ? [EntityInsurancePricing::TYPE_DOCTOR, $doctor->getId()] : [EntityInsurancePricing::TYPE_DOCTOR, null];
+        }
+        if ($user->hasRole('ROLE_CLINIC')) {
+            $clinic = $this->clinicRepo->findByUser($user);
+            return $clinic !== null ? [EntityInsurancePricing::TYPE_CLINIC, $clinic->getId()] : [EntityInsurancePricing::TYPE_CLINIC, null];
+        }
+        return ['unknown', null];
+    }
+
    // ── Public list ───────────────────────────────────────────────────────────

    #[Route('/api/v1/insurances', methods: ['GET'])]
@@ -183,6 +208,232 @@ class InsuranceController extends BaseController
        }
    }

+    // ── Entity insurance pricing (visit price by insurance) ───────────────────
+
+    #[Route('/api/v1/insurance-pricing', methods: ['GET'])]
+    #[IsGranted('IS_AUTHENTICATED_FULLY')]
+    public function getInsurancePricing(#[CurrentUser] User $user): JsonResponse
+    {
+        [$entityType, $entityId] = $this->resolveEntity($user);
+        if ($entityId === null) {
+            return $this->error(ErrorCodes::ERR_FORBIDDEN_001, 'پروفایل یافت نشد', 403);
+        }
+
+        $rows = $this->pricingRepo->findByEntity($entityType, $entityId);
+
+        $freeVisitPriceRials = 0;
+        $perInsurance = [];
+        foreach ($rows as $row) {
+            if ($row->isFreeVisit()) {
+                $freeVisitPriceRials = $row->getPatientShareRials();
+            } else {
+                $perInsurance[$row->getInsuranceId()] = $row->getPatientShareRials();
+            }
+        }
+
+        $insurances = array_map(function (Insurance $i) use ($perInsurance) {
+            return [
+                'insurance_id'        => $i->getId(),
+                'insurance_name'      => $i->getName(),
+                'type'                => $i->getType()->value,
+                'patient_share_rials' => $perInsurance[$i->getId()] ?? null,
+            ];
+        }, $this->insuranceRepo->findActive(null));
+
+        return $this->success([
+            'entity_type'            => $entityType,
+            'entity_id'              => $entityId,
+            'free_visit_price_rials' => $freeVisitPriceRials,
+            'insurances'             => $insurances,
+        ]);
+    }
+
+    #[Route('/api/v1/insurance-pricing', methods: ['PUT'])]
+    #[IsGranted('IS_AUTHENTICATED_FULLY')]
+    public function saveInsurancePricing(Request $request, #[CurrentUser] User $user): JsonResponse
+    {
+        [$entityType, $entityId] = $this->resolveEntity($user);
+        if ($entityId === null) {
+            return $this->error(ErrorCodes::ERR_FORBIDDEN_001, 'پروفایل یافت نشد', 403);
+        }
+
+        $data = json_decode($request->getContent(), true) ?? [];
+
+        if (array_key_exists('free_visit_price_rials', $data)) {
+            $this->upsertPricing($entityType, $entityId, null, (int) $data['free_visit_price_rials']);
+        }
+
+        foreach (($data['insurances'] ?? []) as $row) {
+            $insuranceId = isset($row['insurance_id']) ? (int) $row['insurance_id'] : null;
+            if ($insuranceId === null) {
+                continue;
+            }
+            if (!array_key_exists('patient_share_rials', $row) || $row['patient_share_rials'] === null) {
+                $existing = $this->pricingRepo->findOneForInsurance($entityType, $entityId, $insuranceId);
+                if ($existing !== null) {
+                    $this->pricingRepo->remove($existing, false);
+                }
+                continue;
+            }
+            $this->upsertPricing($entityType, $entityId, $insuranceId, (int) $row['patient_share_rials']);
+        }
+
+        $this->pricingRepo->getEntityManager()->flush();
+
+        return $this->getInsurancePricing($user);
+    }
+
+    private function upsertPricing(string $entityType, int $entityId, ?int $insuranceId, int $shareRials): void
+    {
+        $row = $this->pricingRepo->findOneForInsurance($entityType, $entityId, $insuranceId);
+        if ($row === null) {
+            $row = new EntityInsurancePricing($entityType, $entityId, $insuranceId, $shareRials);
+        } else {
+            $row->setPatientShareRials($shareRials);
+        }
+        $this->pricingRepo->save($row, false);
+    }
+
+    // ── TenantInsurance — قراردادهای بیمه‌ی tenant ─────────────────────────────
+
+    #[Route('/api/v1/billing/tenant-insurances', methods: ['GET'])]
+    #[IsGranted('IS_AUTHENTICATED_FULLY')]
+    public function listTenantInsurances(#[CurrentUser] User $user): JsonResponse
+    {
+        [$entityType, $entityId] = $this->resolveEntity($user);
+        if ($entityId === null) {
+            return $this->error(ErrorCodes::ERR_FORBIDDEN_001, 'پروفایل یافت نشد', 403);
+        }
+
+        $contracts = $this->tenantInsuranceRepo->findActiveByTenant($entityType, $entityId);
+
+        $byId = [];
+        foreach ($this->insuranceRepo->findActive(null) as $ins) {
+            $byId[$ins->getId()] = ['name' => $ins->getName(), 'type' => $ins->getType()->value];
+        }
+
+        $data = array_map(function (TenantInsurance $c) use ($byId) {
+            $row = $c->toArray();
+            $row['insurance_name'] = $byId[$c->getInsuranceId()]['name'] ?? null;
+            $row['insurance_kind'] = $byId[$c->getInsuranceId()]['type'] ?? null;
+            return $row;
+        }, $contracts);
+
+        return $this->success(['data' => $data]);
+    }
+
+    #[Route('/api/v1/billing/tenant-insurances', methods: ['POST'])]
+    #[IsGranted('IS_AUTHENTICATED_FULLY')]
+    public function activateTenantInsurance(Request $request, #[CurrentUser] User $user): JsonResponse
+    {
+        [$entityType, $entityId] = $this->resolveEntity($user);
+        if ($entityId === null) {
+            return $this->error(ErrorCodes::ERR_FORBIDDEN_001, 'پروفایل یافت نشد', 403);
+        }
+
+        $data        = json_decode($request->getContent(), true) ?? [];
+        $insuranceId = isset($data['insurance_id']) ? (int) $data['insurance_id'] : 0;
+        if ($insuranceId <= 0) {
+            return $this->error(ErrorCodes::ERR_VALIDATION_001, 'insurance_id الزامی است', 422);
+        }
+
+        $contract = $this->tenantInsuranceService->activate(
+            $entityType,
+            $entityId,
+            $insuranceId,
+            (float) ($data['coverage_percent'] ?? 0),
+            (int) ($data['franchise_rials'] ?? 0),
+            isset($data['annual_ceiling_rials']) && $data['annual_ceiling_rials'] !== null
+                ? (int) $data['annual_ceiling_rials'] : null,
+        );
+
+        return $this->success(['data' => $contract->toArray()], 201);
+    }
+
+    #[Route('/api/v1/billing/tenant-insurances/{uuid}', methods: ['PATCH'])]
+    #[IsGranted('IS_AUTHENTICATED_FULLY')]
+    public function updateTenantInsurance(string $uuid, Request $request, #[CurrentUser] User $user): JsonResponse
+    {
+        [$entityType, $entityId] = $this->resolveEntity($user);
+        $contract = $this->tenantInsuranceRepo->findByUuid($uuid);
+        if ($contract === null || $contract->getEntityType() !== $entityType || $contract->getEntityId() !== $entityId) {
+            return $this->error(ErrorCodes::ERR_NOT_FOUND_001, 'قرارداد یافت نشد', 404);
+        }
+
+        $data = json_decode($request->getContent(), true) ?? [];
+        if (array_key_exists('coverage_percent', $data)) {
+            $contract->setCoveragePercent((float) $data['coverage_percent']);
+        }
+        if (array_key_exists('franchise_rials', $data)) {
+            $contract->setFranchiseRials((int) $data['franchise_rials']);
+        }
+        if (array_key_exists('annual_ceiling_rials', $data)) {
+            $contract->setAnnualCeilingRials($data['annual_ceiling_rials'] !== null ? (int) $data['annual_ceiling_rials'] : null);
+        }
+
+        $this->tenantInsuranceRepo->save($contract);
+
+        return $this->success(['data' => $contract->toArray()]);
+    }
+
+    #[Route('/api/v1/billing/tenant-insurances/{uuid}', methods: ['DELETE'])]
+    #[IsGranted('IS_AUTHENTICATED_FULLY')]
+    public function deactivateTenantInsurance(string $uuid, #[CurrentUser] User $user): JsonResponse
+    {
+        [$entityType, $entityId] = $this->resolveEntity($user);
+        $contract = $this->tenantInsuranceRepo->findByUuid($uuid);
+        if ($contract === null || $contract->getEntityType() !== $entityType || $contract->getEntityId() !== $entityId) {
+            return $this->error(ErrorCodes::ERR_NOT_FOUND_001, 'قرارداد یافت نشد', 404);
+        }
+
+        $this->tenantInsuranceService->deactivate($contract);
+
+        return $this->success(['message' => 'قرارداد بیمه غیرفعال شد']);
+    }
+
+    #[Route('/api/v1/billing/tenant-insurances/{uuid}/service-coverage', methods: ['GET'])]
+    #[IsGranted('IS_AUTHENTICATED_FULLY')]
+    public function listServiceCoverage(string $uuid, #[CurrentUser] User $user): JsonResponse
+    {
+        [$entityType, $entityId] = $this->resolveEntity($user);
+        $contract = $this->tenantInsuranceRepo->findByUuid($uuid);
+        if ($contract === null || $contract->getEntityType() !== $entityType || $contract->getEntityId() !== $entityId) {
+            return $this->error(ErrorCodes::ERR_NOT_FOUND_001, 'قرارداد یافت نشد', 404);
+        }
+
+        $rows = $this->serviceCoverageRepo->findByContract($contract->getId());
+
+        return $this->success(['data' => array_map(fn($r) => $r->toArray(), $rows)]);
+    }
+
+    #[Route('/api/v1/billing/tenant-insurances/{uuid}/service-coverage', methods: ['PUT'])]
+    #[IsGranted('IS_AUTHENTICATED_FULLY')]
+    public function setServiceCoverage(string $uuid, Request $request, #[CurrentUser] User $user): JsonResponse
+    {
+        [$entityType, $entityId] = $this->resolveEntity($user);
+        $contract = $this->tenantInsuranceRepo->findByUuid($uuid);
+        if ($contract === null || $contract->getEntityType() !== $entityType || $contract->getEntityId() !== $entityId) {
+            return $this->error(ErrorCodes::ERR_NOT_FOUND_001, 'قرارداد یافت نشد', 404);
+        }
+
+        $data          = json_decode($request->getContent(), true) ?? [];
+        $serviceItemId = isset($data['service_item_id']) ? (int) $data['service_item_id'] : 0;
+        if ($serviceItemId <= 0) {
+            return $this->error(ErrorCodes::ERR_VALIDATION_001, 'service_item_id الزامی است', 422);
+        }
+
+        $this->tenantInsuranceService->setServiceCoverage(
+            $contract,
+            $serviceItemId,
+            (bool) ($data['covered'] ?? true),
+            isset($data['coverage_percent']) && $data['coverage_percent'] !== null ? (float) $data['coverage_percent'] : null,
+            isset($data['franchise_rials']) && $data['franchise_rials'] !== null ? (int) $data['franchise_rials'] : null,
+            isset($data['ceiling_rials']) && $data['ceiling_rials'] !== null ? (int) $data['ceiling_rials'] : null,
+        );
+
+        return $this->success(['message' => 'پوشش خدمت ذخیره شد']);
+    }
+
    // ── DoctorInsurance CRUD ──────────────────────────────────────────────────

    #[Route('/api/v1/insurance/', methods: ['POST'])]