Files
clinicpro/src/Billing/Service/ClaimService.php
T
hamed e6267080b2 feat: Enhance insurance billing system to support supplementary insurance
- Updated CoverageRule and related entities to include franchise_percent instead of franchise_rials.
- Modified Appointment entity to carry supplementary insurance ID alongside base insurance.
- Implemented SessionBillingService to ensure finalized invoices for insured patient sessions.
- Created InvoiceFinalized event to trigger claims creation upon invoice finalization.
- Added BackfillMissingClaimsCommand to generate claims for finalized invoices without existing claims.
- Developed tests to validate the new functionality for supplementary insurance handling in appointments and claims.
2026-07-29 19:57:02 +03:30

191 lines
7.2 KiB
PHP

<?php
namespace App\Billing\Service;
use App\Billing\Contract\ClaimSubmitterInterface;
use App\Billing\Entity\Claim;
use App\Billing\Entity\ClaimItem;
use App\Billing\Entity\Invoice;
use App\Billing\Entity\ClaimStatusLog;
use App\Billing\Repository\ClaimRepository;
use App\Billing\Repository\ClaimStatusLogRepository;
use App\Auth\Entity\User;
use App\Shared\Constant\ErrorCodes;
use App\Shared\Exception\AppException;
class ClaimService
{
public function __construct(
private readonly ClaimRepository $claimRepo,
private readonly ClaimSubmitterInterface $submitter,
private readonly ClaimStatusLogRepository $statusLogRepo,
) {}
/**
* ساخت مطالبات از یک صورتحساب نهایی‌شده.
* یک Claim برای بیمه‌ی پایه و یک Claim برای بیمه‌ی مکمل (در صورت وجود سهم).
* @return Claim[]
*/
public function createFromInvoice(Invoice $invoice): array
{
if ($invoice->getStatus() !== Invoice::STATUS_FINALIZED) {
throw new AppException(ErrorCodes::ERR_VALIDATION_001, 'فقط از صورتحساب نهایی‌شده می‌توان مطالبه ساخت', 422);
}
if ($invoice->getId() !== null && $this->claimRepo->existsForInvoice($invoice->getId())) {
throw new AppException(ErrorCodes::ERR_VALIDATION_001, 'برای این صورتحساب قبلاً مطالبه ثبت شده است', 422);
}
$claims = [];
$baseId = $invoice->getBaseInsuranceId();
if ($baseId !== null) {
$claim = $this->buildClaim($invoice, $baseId, Claim::KIND_BASE);
if ($claim !== null) {
$claims[] = $claim;
}
}
$suppId = $invoice->getSupplementaryInsuranceId();
if ($suppId !== null) {
$claim = $this->buildClaim($invoice, $suppId, Claim::KIND_SUPPLEMENTARY);
if ($claim !== null) {
$claims[] = $claim;
}
}
if ($claims === []) {
throw new AppException(ErrorCodes::ERR_VALIDATION_001, 'سهم بیمه‌ای برای این صورتحساب وجود ندارد', 422);
}
foreach ($claims as $claim) {
$this->claimRepo->save($claim, false);
}
$this->claimRepo->getEntityManager()->flush();
// بعد از flush تا id مطالبه موجود باشد.
foreach ($claims as $claim) {
$this->logTransition($claim, null, $claim->getStatus(), 'ایجاد مطالبه', null);
}
$this->claimRepo->getEntityManager()->flush();
return $claims;
}
/**
* مطالبات جاافتاده‌ی یک صورتحساب نهایی‌شده را می‌سازد و مطالبات موجود را دست نمی‌زند.
* برخلاف createFromInvoice که یک عملِ کاربر است و با خطا جواب می‌دهد، این متد
* روی رویدادِ نهایی‌شدن صدا زده می‌شود و «کاری برای انجام نبود» حالت عادی‌اش است.
*
* @return Claim[] مطالبات تازه‌ساخته‌شده
*/
public function syncFromInvoice(Invoice $invoice): array
{
if ($invoice->getStatus() !== Invoice::STATUS_FINALIZED || $invoice->getId() === null) {
return [];
}
$existingKinds = $this->claimRepo->kindsForInvoice($invoice->getId());
$claims = [];
foreach ([
Claim::KIND_BASE => $invoice->getBaseInsuranceId(),
Claim::KIND_SUPPLEMENTARY => $invoice->getSupplementaryInsuranceId(),
] as $kind => $insuranceId) {
if ($insuranceId === null || in_array($kind, $existingKinds, true)) {
continue;
}
$claim = $this->buildClaim($invoice, $insuranceId, $kind);
if ($claim !== null) {
$claims[] = $claim;
}
}
if ($claims === []) {
return [];
}
foreach ($claims as $claim) {
$this->claimRepo->save($claim, false);
}
$this->claimRepo->getEntityManager()->flush();
foreach ($claims as $claim) {
$this->logTransition($claim, null, $claim->getStatus(), 'ایجاد مطالبه', null);
}
$this->claimRepo->getEntityManager()->flush();
return $claims;
}
private function buildClaim(Invoice $invoice, int $insuranceId, string $kind): ?Claim
{
$claim = new Claim($invoice->getEntityType(), $invoice->getEntityId(), $insuranceId, $kind);
$hasShare = false;
foreach ($invoice->getItems() as $item) {
$share = $kind === Claim::KIND_BASE
? $item->getBaseInsuranceRials()
: $item->getSupplementaryRials();
if ($share > 0) {
$claim->addItem(new ClaimItem($claim, $item->getId(), $share));
$hasShare = true;
}
}
return $hasShare ? $claim : null;
}
public function transition(Claim $claim, string $target, array $opts = [], ?User $actor = null): void
{
if (!$claim->canTransitionTo($target)) {
throw new AppException(
ErrorCodes::ERR_VALIDATION_001,
sprintf('انتقال از «%s» به «%s» مجاز نیست', $claim->getStatus(), $target),
422
);
}
if ($target === Claim::STATUS_REJECTED && trim((string) ($opts['reason'] ?? '')) === '') {
throw new AppException(ErrorCodes::ERR_VALIDATION_001, 'دلیل رد الزامی است', 422, 'reason');
}
$from = $claim->getStatus();
match ($target) {
Claim::STATUS_SUBMITTED => $this->doSubmit($claim, $opts['tracking_number'] ?? null),
Claim::STATUS_APPROVED => $claim->approve($opts['approved_rials'] ?? null),
Claim::STATUS_REJECTED => $claim->reject($opts['reason'] ?? ''),
Claim::STATUS_PAID => $claim->pay($opts['paid_rials'] ?? null),
default => throw new AppException(ErrorCodes::ERR_VALIDATION_001, 'وضعیت نامعتبر', 422),
};
$this->claimRepo->save($claim, false);
$this->logTransition($claim, $from, $target, $opts['note'] ?? $opts['reason'] ?? null, $actor);
$this->claimRepo->getEntityManager()->flush();
}
private function logTransition(Claim $claim, ?string $from, string $to, ?string $note, ?User $actor): void
{
$log = (new ClaimStatusLog((int) $claim->getId(), $from, $to))
->setNote($note)
->setActor($actor?->getId(), $actor?->getRealName() ?? $actor?->getMobileNumber());
$this->statusLogRepo->save($log, false);
}
private function doSubmit(Claim $claim, ?string $trackingNumber): void
{
$result = $this->submitter->submit($claim);
if (!$result->success) {
throw new AppException(ErrorCodes::ERR_VALIDATION_001, $result->errorMessage ?? 'ارسال مطالبه ناموفق بود', 422);
}
$claim->submit();
if ($trackingNumber !== null) {
$claim->setTrackingNumber((string) $trackingNumber);
}
}
}