@ampath/esm-dha-workflow-app 4.0.0-next.44 → 4.0.0-next.445

package/src/claims/index.ts

@@ -0,0 +1,365 @@
+export interface ClientSubBenefit {
+  id: number;
+  code: string;
+  name: string;
+  accessPoint: string;
+  fund: string;
+  parentBenefit: string;
+  parentBenefitCode: string;
+}
+
+export interface ClientSubBenefitResults {
+  results: ClientSubBenefit[];
+}
+
+export interface Intervention {
+  id: number;
+  accessPoint: string;
+  name: string;
+  code: string;
+  paymentMechanism: string;
+  needsPreauth: boolean;
+  needsManualPreauthApproval: boolean;
+  overallTariff: string;
+  kephLevelTarriff: string;
+  fund: string;
+  fallBackOverallTariff: string;
+  tariffPerAdditionalKilometer: string;
+  level2Tariff: string;
+  level3Tariff: string;
+  level4Tariff: string;
+  level5Tariff: string;
+  level6Tariff: string;
+  requiresSurgicalPreauth: boolean;
+  requiresRenalPreauth: boolean;
+  requiresOncologyPreauth: boolean;
+  requiresRadiologyPreauth: boolean;
+  requiresOpticalPreauth: boolean;
+  applicableSchemes: string[];
+  requiredPreauthDocumentTypes: string[];
+  applicableDocumentTypes: string[];
+}
+
+export interface InterventionResults {
+  results: Intervention[];
+}
+
+export interface FundUtilizationLimit {
+  fundType: string;
+  utilisedAmount: string;
+  maxAmount: string;
+  availableAmount: string;
+}
+
+export interface IntermediatePeriodUsage {
+  individualUtilisedDuringPeriod: number;
+  individualMaxDuringPeriod: number;
+  period: string;
+  lastUsageDate: string;
+}
+
+export interface ComputationalDetail {
+  individualLimitAvailableCount: number;
+  householdLimitAvailableCount: number;
+  coverageStartDate: string;
+  coverageEndDate: string;
+  limitAvailableAmount: string;
+  nextAvailableDate: string;
+  eligibility: boolean;
+  intermediatePeriodUsage: IntermediatePeriodUsage;
+}
+
+export interface BenefitUtilization {
+  crId: string;
+  code: string;
+  limitScope: string;
+  nextAvailability: string;
+  utilizationDays: number;
+  individualMaxLimit: number;
+  householdMaxLimit: number;
+  individualUtilisedLimit: number;
+  householdUtilisedLimit: number;
+  fundUtilizationLimit: FundUtilizationLimit[];
+  computationalDetail: ComputationalDetail;
+}
+
+export type ServiceType = 'CAPITATION' | 'OUTPATIENT' | 'INPATIENT' | 'EMERGENCY' | 'PER_DIEM';
+
+export type PreauthType = 'NORMAL' | 'SURGICAL' | 'ONCOLOGY' | 'RENAL' | 'IMAGING' | 'OPTICAL';
+
+export type VisitType = 'INPATIENT' | 'OUTPATIENT' | 'EMERGENCY';
+
+// Claim visit
+export interface ClaimIntervention {
+  id: string;
+  intervention_code: string;
+  intervention_name: string;
+  intervention_payment_mechanism: string;
+  keph_level_tarrif: string;
+  accrued_per_diem_amount: string;
+  accrued_per_diem_days: number;
+  workflow_state: string;
+  preauth_exist: boolean;
+  is_switched_intervention: boolean;
+  supported_scheme: string;
+  switched_lines_retained: boolean;
+  sub_benefit_code: string;
+  active_for_uhc: boolean;
+  intervention_fund: string;
+  requires_surgical_preauth: boolean;
+  requires_renal_preauth: boolean;
+  requires_oncology_preauth: boolean;
+  requires_radiology_preauth: boolean;
+  requires_optical_preauth: boolean;
+  optional_document_type: string | null;
+  required_preauth_document_types: string[] | null;
+  optional_preauth_document_types: string[] | null;
+  applicable_document_types: string[];
+  needs_preauth: boolean;
+  needs_manual_preauth: boolean;
+}
+
+export interface PreExistingIntervention {
+  id: number;
+  bill_uuid: string;
+  patient_uuid: string;
+  order_no: string;
+  line_item_uuid: string;
+  sub_benefit_code: string;
+  intervention_code: string;
+  consent_token: string | null;
+  service_type: string | null;
+  requires_preauth: boolean;
+  normal_preauth: boolean;
+  elective_preauth: boolean;
+  preauth_approved: boolean;
+  required_documents: unknown | null;
+  applicable_document_types: unknown | null;
+  required_preauth_document_types: unknown | null;
+  createdAt: string;
+  updatedAt: string;
+}
+
+interface InvoiceLine {
+  [key: string]: unknown;
+}
+
+interface InvoiceDoctor {
+  [key: string]: unknown;
+}
+
+interface InvoiceFlag {
+  [key: string]: unknown;
+}
+
+interface ClaimInvoice {
+  id: string;
+  invoice_number: string;
+  invoice_date: string;
+  dispatch_status: string;
+  workflow_state: string;
+  created_by_name: string;
+  patient_name: string;
+  patient_number: string;
+  provider_name: string;
+  scheme_code: string;
+  scheme_name: string;
+  service_type: ServiceType;
+  total_inv_amount: string;
+  total_inv_net_amount: string;
+  total_inv_copay: string;
+  total_inv_discount: string;
+  lines: InvoiceLine[];
+  doctors: InvoiceDoctor[];
+  invoice_flags: InvoiceFlag[];
+  visit_start: string;
+}
+
+interface ClaimDiagnosis {
+  [key: string]: unknown;
+}
+
+export interface ClaimResult {
+  id: string;
+  payer_code: string;
+  payer_name: string;
+  payer_slade_code: string;
+  provider_slade_code: string;
+  provider_name: string;
+  patient_name: string;
+  patient_number: string;
+  member_number: string;
+  member_number_has_token: boolean;
+  service_type: ServiceType;
+  scheme_code: string;
+  scheme_name: string;
+  currency: string;
+  visit_number: string;
+  visit_start: string;
+  authorization_code: string;
+  authorization_guid: string;
+  beneficiary_id: number;
+  beneficiary_guid: string;
+  beneficiary_is_fuzzy_matched: boolean;
+  workflow_state: string;
+  is_charge_master_mapped: boolean;
+  is_resubmitted: boolean;
+  is_negative: boolean;
+  is_zero: boolean;
+  has_reviewed_claim: boolean;
+  initial_intervention: string;
+  interventions: ClaimIntervention[];
+  invoices: ClaimInvoice[];
+  claim_attachments_count: number;
+  claim_auth_status: string;
+  claim_diagnoses: ClaimDiagnosis[];
+  diagnoses_count: number;
+  invoice_attachments_count: number;
+  invoice_id: string;
+  invoice_number: string;
+  number_of_invoices: number;
+  total_claim_amount: string;
+  total_claim_copay: string;
+  total_claim_discount: string;
+  total_claim_net_amount: string;
+  total_claim_splits: string;
+  retry_count: number;
+  created_by_name: string;
+  updated_by_name: string;
+  notes: string;
+}
+export interface PomsfBalance {
+  memberNumber: string;
+  parentNumber: string;
+  schemeCount: number;
+  policyCount: number;
+  title: string;
+  firstName: string;
+  middleName: string;
+  lastName: string;
+  gender: string;
+  dateOfBirth: string;
+  relationshipType: string;
+  phoneCode: string;
+  phone: string;
+  registeredOn: string;
+  householdId: string;
+  nationalId: string;
+  shaNumber: string;
+  memberPolicies: MemberPolicy[];
+}
+
+export interface Policy {
+  policyId: string;
+  name: string;
+  description: string;
+  type: string;
+  status: string;
+  totalBenefit: number;
+  PolicyYear: string;
+  endDate: string;
+  terminationDate: string;
+  activeDate: string;
+  policyCode: string;
+  companyName: string;
+  schemeName: string;
+  schemeCode: string;
+  policyGroup: string;
+  hasHospitalCodes: boolean;
+  hasIncludeandExclude: boolean;
+  hasICD10Code: boolean;
+  hasImagingServices: boolean;
+  hasLabtests: boolean;
+  hasMedicalprocedures: boolean;
+  hasOpticalServices: boolean;
+  hasMedicines: boolean;
+  iCD10Type: string;
+  medicalproceduresType: string;
+}
+
+interface MemberPolicy {
+  parentMemberNumber: string;
+  policy: Policy;
+  benefit: Benefit[];
+  status: string;
+  joinDate: string;
+  leaveDate: string | null;
+  memberOriginalJoinDate: string;
+  policyJoinDate: string;
+  dependentCount: unknown[];
+  spouseCount: unknown[];
+}
+
+export interface Benefit {
+  benefitId: number;
+  name: string;
+  description: string;
+  type: string;
+  limit: number;
+  benefitShared: any;
+  benefitRelation: any;
+  benefitGender: any;
+  subBenefit: SubBenefit[];
+  balance: MemberBalance[];
+  benefitCode: string;
+}
+
+export interface SubBenefit {
+  subBenefitId: number;
+  name: string;
+  description: string;
+  type: string;
+  limit: number;
+  subBenefitShared: any;
+  subBenefitRelation: any;
+  subBenefitGender: any;
+  subBenefitWaitingPeriod: number | string | null;
+  balance: MemberBalance[];
+  subBenefitCode: string;
+}
+
+export interface MemberBalance {
+  member: string;
+  balance: number;
+}
+export interface PreauthRequest {
+  consentToken?: string;
+  patientUuid: string;
+  orderNo: string;
+  subBenefitCode: string;
+  interventionCode: string;
+  serviceType: string;
+  locationUuid: string;
+  billableServiceUuid?: string;
+  priceUuid?: string;
+  encounterUuid?: string;
+  expectedServiceStartDate?: string;
+  requiresPreauth: boolean;
+  normalPreauth: boolean;
+  electivePreauth: boolean;
+  applicableDocumentTypes?: string;
+  requiredPreauthDocumentTypes?: string;
+}
+
+/** Local holding row from GET /pre-auth/request */
+export interface PreAuthRequestRecord {
+  id: number;
+  patientUuid: string;
+  orderNo: string;
+  subBenefitCode: string;
+  interventionCode: string;
+  consentToken?: string | null;
+  encounterUuid?: string | null;
+  expectedServiceStartDate?: string | null;
+  serviceType: string;
+  locationUuid: string;
+  billableServiceUuid?: string | null;
+  priceUuid?: string | null;
+  requiresPreauth?: boolean;
+  normalPreauth?: boolean;
+  electivePreauth?: boolean;
+  applicableDocumentTypes?: string;
+  requiredPreauthDocumentTypes?: string;
+  status?: string;
+  dateCreated?: string;
+}

package/src/claims/interventions.resource.ts

@@ -0,0 +1,131 @@
+import { openmrsFetch } from "@openmrs/esm-framework";
+import { fetchUrl, getHieBaseUrl, getUrl } from "./utils";
+import { ClaimIntervention } from ".";
+
+export async function addIntervention(consentToken: string, interventionCode: string, locationUuid: string) {
+    const { hieBaseUrl } = await getHieBaseUrl();
+    const url = `${hieBaseUrl}/interventions`;
+
+    const payload = {
+        locationUuid,
+        consentToken: consentToken,
+        interventionCode: interventionCode
+    }
+    // return await fetchUrl<any>(url, { method: "POST", payload });
+    const result = await openmrsFetch<ClaimIntervention>(url, {
+        method: 'POST',
+        headers: {
+            'Content-Type': 'application/json',
+        },
+        // signal: abortController.signal,
+        body: payload,
+    }).catch((error) => {
+        const message = error?.responseBody?.message ?? "";
+        if (typeof message === "object") {
+            throw `${message?.join(",")}`;
+        }
+        throw message;
+    });
+
+    if (result?.data && "error" in result.data && "message" in result.data) {
+        const message = result.data.message ?? "";
+        throw message;
+    }
+
+    return result?.data;
+}
+
+export async function checkInterventionExists(consentToken: string, interventionCode: string): Promise<boolean> {
+    const { hieBaseUrl } = await getHieBaseUrl();
+    const url = `${hieBaseUrl}/interventions/check-intervention-exists?consentToken=${encodeURIComponent(consentToken)}&interventionCode=${encodeURIComponent(interventionCode)}`;
+    const response = await openmrsFetch(url);
+    const data = response?.data;
+    if (typeof data === 'boolean') {
+        return data;
+    }
+    if (data && typeof data === 'object' && 'exists' in data) {
+        return Boolean((data as { exists: boolean }).exists);
+    }
+    return Boolean(data);
+}
+
+/**
+ * Ensure the intervention is on the HIE claim visit for this consent token.
+ * Preauth and claim-line both require this — SHA rejects otherwise with
+ * "intervention … is not in the visit for consent token …".
+ */
+export async function ensureInterventionOnVisit(
+    consentToken: string,
+    interventionCode: string,
+    locationUuid: string,
+    options?: { alreadyOnVisit?: boolean },
+): Promise<'added' | 'exists'> {
+    if (!consentToken || !interventionCode || !locationUuid) {
+        throw 'Missing consent token, intervention code, or location.';
+    }
+    if (options?.alreadyOnVisit) {
+        return 'exists';
+    }
+
+    // Local bill-order may already list the code, but HIE visit can still lack it —
+    // always POST add when not confirmed on the visit. Treat "already present" as OK.
+    try {
+        await addIntervention(consentToken, interventionCode, locationUuid);
+        return 'added';
+    } catch (err) {
+        const msg = String(err ?? '').toLowerCase();
+        if (
+            msg.includes('already') ||
+            msg.includes('exist') ||
+            msg.includes('duplicate')
+        ) {
+            return 'exists';
+        }
+        // If local check says it exists, continue — caller can still fail later with a clear HIE error
+        try {
+            if (await checkInterventionExists(consentToken, interventionCode)) {
+                return 'exists';
+            }
+        } catch {
+            // ignore
+        }
+        throw err;
+    }
+}
+
+export async function switchIntervention(consentToken: string, existingInterventionCode: string, newInterventionCode: string) {
+    const endPoint = `/claims/interventions/switch`;
+    const url = getUrl() + endPoint;
+
+    const payload = {
+        consent_token: consentToken,
+        existing_intervention_code: existingInterventionCode,
+        new_intervention_code: newInterventionCode,
+        retain_bill_items: false,
+        bill_from: "", // Date from - Optional depending on whether retain_bill_items is true
+        bill_to: ""// Date to - Optional depending on whether retain_bill_items is true
+    }
+    return await fetchUrl<any>(url, { method: "POST", payload });
+}
+
+export async function restoreIntervention(consentToken: string, interventionCode: string) {
+    const endPoint = `/claims/interventions/restore`;
+    const url = getUrl() + endPoint;
+
+    const payload = {
+        consent_token: consentToken,
+        intervention_code: interventionCode
+    }
+    return await fetchUrl<any>(url, { method: "POST", payload });
+}
+
+export async function retireIntervention(consentToken: string, interventionCode: string) {
+    const endPoint = `/claims/interventions/retire`;
+    const url = getUrl() + endPoint;
+
+    const payload = {
+        consent_token: consentToken,
+        intervention_code: interventionCode
+    }
+    return await fetchUrl<any>(url, { method: "POST", payload });
+}

package/src/claims/utils.ts

@@ -0,0 +1,64 @@
+import { getConfig, useConfig, useSession } from "@openmrs/esm-framework";
+
+export const getUrl = () => {
+    const baseUrl = "https://ilm-dev.dha.go.ke/uat-middleware";
+    const version = "/api/v1"
+    return `${baseUrl}${version}`;
+}
+
+export async function fetchUrl<T>(url: string, { method = "GET", headers, payload, isFormData = false }: { method?: string, headers?: Record<string, any>, payload?: unknown, isFormData?: boolean } = {}): Promise<T> {
+    // Temporarily
+    const authToken = "eyJhbGciOiJSUzI1NiIsInR5cCIgOiAiSldUIiwia2lkIiA6ICJRRzhsY1ZKeG5jS0pCY1hveWVNbmRZWWRaNHdSV2lXY1lBWVppLWlCalBNIn0.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.JXb07V9Qdx0yvnbT6_8bAhqXbDHRtK8XaW2C6Hm04mAZbuTkjB5By9rIrAbeSX6hbiMfZOwrNdWT9Jz473QX6kTde6GxAkjguFNpQ51UrM1g5NUb9IAqSqQsHlYuSSpmK254jMNYocJNEzry9W1gzjs0Q5TPkppF6xASHtyDq6gb1TpYeYzKEwvzvO9nq0VA6ZHRLQ87ZDEvqmxPcOVvHIhZaiNLMZ_UviDmaz2zMuXuioCJftQMMIxzpLP4XFzlkPt7jVdLqhsymAr6NxpNS9KI2irTiMqpS9jRnqU07h1Fsl38ss37boQJAo0rosLrmJBWcYMG0WSNcU9wZFEpRw";
+    // const myHeaders = new Headers();
+    // myHeaders.append("Content-Type", "multipart/form-data");
+
+    headers = {
+        ...headers,
+        Authorization: `Bearer ${authToken}`,
+        'X-Facility-Id': 'FID-27-114387-5',
+        'X-Facility-Id-Type': 'fr-code'
+    }
+
+    if (isFormData) {
+        headers["Content-Type"] = "multipart/form-data";
+        headers["Accept"] = "application/json";
+    } else {
+        headers["Content-Type"] = "application/json";
+    }
+
+    let request = {
+        method: method,
+        headers: { ...headers },
+        ...{ method },
+    }
+
+    if (method === "POST" && payload) {
+        request["body"] = isFormData ? payload : JSON.stringify(payload)
+    }
+
+    const response = await fetch(url, request);
+
+    if (!response.ok) {
+        const errorText = await response.text();
+        throw new Error(`Request failed with ${response.status}: ${errorText}`);
+    }
+
+    return response.json() as Promise<T>;
+}
+
+export const useHie = () => {
+    const { hieBaseUrl } = useConfig({
+        externalModuleName: '@ampath/esm-dha-workflow-app',
+    });
+    const { sessionLocation } = useSession();
+
+    return {
+        hieBaseUrl,
+        locationUuid: sessionLocation?.uuid
+    }
+}
+
+export async function getHieBaseUrl() {
+    const { hieBaseUrl } = await getConfig('@ampath/esm-dha-workflow-app');
+    return { hieBaseUrl: hieBaseUrl ?? null };
+}