refactor data serailisation

app/controllers/consents_controller.rb

@@ -14,9 +14,9 @@ def show
   end
 
   def approve_consent
-    @consent = Consent.create(consultation_id: params[:consultation_id], person_id: params[:person_id], registered_on: Time.now)
-    notification = Notification.find_by(id: params[:notification_id])
-    notification.update(notification_type: Notification::TYPE["NOTICE"], data: @notification.data + " Approved")
+    @consent = Consent.create(consultation_id: params[:consultation_id].to_i, person_id: params[:person_id].to_i, registered_on: Time.now)
+    # notification = Notification.find_by(id: params[:notification_id].to_i)
+    # notification.update(notification_type: Notification::TYPE["NOTICE"], data: notification.data + "has been Approved by you.")
     render json: @consent
   end
 

app/controllers/health_care_provider_controller.rb

@@ -14,7 +14,7 @@ def check_eligibility
     render json: resp
   rescue StandardError => e
     puts(e.message)
-    render json: {msg: "Bad request"}
+    render json: {msg: "no data available", is_eligible: false}
   end
 
   def send_pre_auth_request
@@ -32,17 +32,17 @@ def send_pre_auth_request
   end
 
   def update_docs_and_send_claim_request
-    claim_id = params[:claim_id]
-    amount = params[:amount]
-    claim_type = params[:claim_type]
+    claim_id = params[:claim_id].to_i
+    amount = params[:amount].to_i
+    claim_type = params[:claim_type].to_s
     health_id = params["health_id"].to_s
     customer = Person.find_by_health_id(health_id)
     eligibility = CentralEntityHelper.get_eligibility(amount, claim_type, customer.id)
     resp = InsuranceHelper.send_claim_request(claim_id, amount, eligibility)
     claim = Claim.find_by(id: claim_id)
-    ConsultationHelper.add_data_to_consultation(params[:prescriptions], params[:invoices], [claim], params[:consultation_id])
+    ConsultationHelper.add_data_to_consultation(params[:prescriptions], params[:invoices], [claim], claim.consultation_id)
     #todo: debug low priority why above line wasn't working
-    consultation = Consultation.find_by(id: params[:consultation_id])
+    consultation = claim.consultation
     CentralEntityHelper.add_data_to_health_record(consultation, customer.id)
     render json: resp
   rescue StandardError => e

app/controllers/notifications_controller.rb

@@ -1,5 +1,5 @@
 class NotificationsController < ApplicationController
-  before_action :set_notification, only: %i[ show update destroy ]
+  before_action :set_notification, only: %i[ show update destroy approve_notification]
 
   # GET /notifications?person_id
   def index
@@ -42,6 +42,18 @@ def destroy
     @notification.destroy
   end
 
+  def approve_notification
+    notification_id = params[:id]
+    approval = params[:approval] # boolean (true/false)
+    consultation = @notification.consultation
+    Consent.create(consultation_id: consultation.id, person_id: @notification.person_id, registered_on: Time.now)
+    if approval
+      @notification.update(notification_type: Notification::TYPE["NOTICE"], data: @notification.data + " Approved")
+    else
+      @notification.update(notification_type: Notification::TYPE["NOTICE"], data: @notification.data + " Rejected")
+    end
+  end
+
   private
     # Use callbacks to share common setup or constraints between actions.
     def set_notification

app/controllers/people_controller.rb

@@ -38,8 +38,6 @@ def destroy
     @person.destroy
   end
 
-
-
   private
     # Use callbacks to share common setup or constraints between actions.
     def set_person

app/helpers/central_entity_helper.rb

@@ -6,10 +6,10 @@ def get_eligibility(claim_amount, claim_type, customer_id)
       return { is_eligible: false } unless health_report
       health_report.insurance_policies.each do |policy|
         if policy.covers.include?(claim_type.downcase) && claim_amount <= policy.coverage.to_i
-          return { eligible_policy_id: policy.id, max_coverage_left: policy.coverage, is_eligible: true }
+          return { eligible_policy_id: policy.id, max_coverage_left: policy.coverage, is_eligible: true, requester: policy.insurer}
         end
       end
-      { is_eligible: false }
+      { is_eligible: false, msg: "claim limit exceeds coverage" }
       # get uhid of customer
       # get health record
       # check insurances and it's active status

app/helpers/consultation_helper.rb

@@ -17,7 +17,7 @@ def add_data_to_consultation(new_prescriptions, new_invoices, new_claims, consul
           claims << nc
         end
       end
-      consultation.update(invoices: invoices, prescriptions: prescriptions, claims: claims)
+      consultation.update(invoices: invoices, prescriptions: prescriptions, claims: claims, status: 'completed')
       return consultation
     end
 

app/helpers/insurance_helper.rb

@@ -8,21 +8,37 @@ class << self
     def process_pre_auth(requester_id, customer_id, eligibility)
       health_report = HealthReport.find_by_person_id(customer_id)
       # create new consultation at time of pre-auth
-      consultation = Consultation.create(health_report: health_report)
-      #todo: stitch some mechanism to create consent when notification is approved or just create consent from seeds
+      existing_consultations = health_report.consultations || []
+      consultation = nil
+      existing_consultations.each do |ec|
+        if ec.status == 'pre-auth-approved'
+          consultation = ec
+          break
+        end
+      end
+      consultation = Consultation.create(health_report: health_report, status: 'pre-auth-approved') if consultation.nil?
       consent = Consent.find_by(person_id: customer_id, consultation_id: consultation.id)
       #todo: comment next line
       # consent = Consent.create(consultation: consultation, person_id: customer_id, registered_on: Time.now)
       # a consent is valid for 2 days
       if consent && (Time.now-1.day..Time.now+2.days).cover?(consent.registered_on)
         # health_report = HealthReport.find_by_person_id(customer_id)
         eligible_policy_id = eligibility[:eligible_policy_id]
-        claim = Claim.create(status: "pre-auth-approved", person_id: customer_id, insurance_policy_id: eligible_policy_id, consultation_id: consultation.id)
+        existing_claims = consultation.claims || []
+        claim = nil
+        existing_claims.each do |ec|
+          if ec.status == 'pre-auth-approved'
+            claim = ec
+            break
+          end
+        end
+        claim = Claim.create(status: "pre-auth-approved", person_id: customer_id, insurance_policy_id: eligible_policy_id, consultation_id: consultation.id) if claim.nil?
         return { "success": true, "claim_id": claim.id, "consultation_id": consultation.id, msg: "Pre auth claim registered successfully" }
       else
         NotificationHelper.send_notification(requester_id, customer_id, "Pre Auth Request", consultation.id, "CONSENT")
         # send notification
-        return { "success": false, "msg": "Consent pending fom customer" }
+        claim = Claim.find_by(consultation_id: consultation.id, status: "pre-auth-approved")
+        return { "success": false, "msg": "Consent pending fom customer", "claim_id": claim&.id, "consultation_id": consultation.id }
       end
     end
 
@@ -40,20 +56,24 @@ def send_claim_request(claim_id, amount, eligibility)
       if !claim || claim.status != 'pre-auth-approved'
         return {"success": false, msg: "customer not authorised, invalid claim status"}
       end
+      fraud_response = nil
       if eligibility[:is_eligible]
         updateClaimStatus("processing", claim)
         insured_policy = InsurancePolicy.find_by_id(eligibility[:eligible_policy_id])
         is_fraud = false # todo: replace with gpt call
-        unless is_fraud
+        medical_report = ClaimReportGenerator.new(claim.person_id).generate
+        fraud_response = FraudDetectionService.detect(medical_report)
+        if fraud_response[:approved] == "Yes"
           updateClaimStatus("approved", claim)
           updated_coverage = insured_policy.coverage - amount
           insured_policy.update(coverage: updated_coverage)
           NotificationHelper.send_notification(insured_policy.insurer, claim.person_id, "Claim of Rs." + (amount.to_s) +" approved", claim.consultation_id, "NOTICE")
-          return {"success": true, "msg": "Claim processed successfully"}
+          return {"success": true, "msg": "Claim processed successfully", fraud_detector_response: fraud_response}
         end
       end
       updateClaimStatus("rejected", claim)
-      NotificationHelper.send_notification(insured_policy.insurer, claim.person_id, "Claim of Rs." + amount +" rejected", claim.consultation_id, "NOTICE")
+      NotificationHelper.send_notification(insured_policy.insurer, claim.person_id, "Claim of Rs." + (amount.to_s) +" rejected", claim.consultation_id, "NOTICE")
+      return {"success": false, "msg": "Claim rejected", fraud_detector_response: (fraud_response || {"summary": "Not eligible for claim"})}
     end
 
     private

app/services/claim_report_generator.rb

@@ -44,9 +44,9 @@ def insurance_claim_history
     @claims.each_with_index do |claim, index|
       claim_data = CLAIM_HISTORY_TEMPLATE % {
         index: index + 1,
-        year_of_claim: claim.date_of_service.year,
+        year_of_claim: claim.date_of_service&.year,
         insurance_provider: claim.insurance_policy.insurer,
-        date_of_claim: claim.date_of_service.strftime("%b %d, %Y"),
+        date_of_claim: claim.date_of_service&.strftime("%b %d, %Y"),
         health_care_provider: claim.provider,
         diagnosis: claim.diagnosis,
         procedure: claim.procedure,

app/services/fraud_detection_service.rb

@@ -1,7 +1,6 @@
 class FraudDetectionService
   # TODO: add env variable
   @@client = OpenAI::Client.new(access_token: ENV.fetch("OPEN_AI_TOKEN"))
-  binding.pry
 
   MODEL = "gpt-3.5-turbo"
 
@@ -70,4 +69,34 @@ def self.detect(medical_history)
     # result[:success] = !(result[:approved].nil? || result[:confidence].nil? || result[:summary].nil?)
     # return result
   end
+
+  def self.mock_response_success(medical_history)
+    return {
+      success: true,
+      approved: "Yes",
+      confidence: "0.99",
+      summary: "This is approved as it is mocked",
+      error_message: ""
+    }
+  end
+
+  def self.mock_response_error(medical_history)
+    return {
+      success: false,
+      approved: nil,
+      confidence: nil,
+      summary: nil,
+      error_message: "Mocked error"
+    }
+  end
+
+  def self.mock_response_fail(medical_history)
+    return {
+      success: true,
+      approved: "No",
+      confidence: "0.99",
+      summary: "This is rejected as it is mocked",
+      error_message: ""
+    }
+  end
 end

config/routes.rb

@@ -19,4 +19,5 @@
   #
   #
   post '/approve_consent', to: "consents#approve_consent"
+  post '/notification/:id/approve', to: "notifications#approve_notification"
 end

db/migrate/20230528035801_add_status_to_consultation.rb

@@ -0,0 +1,5 @@
+class AddStatusToConsultation < ActiveRecord::Migration[7.0]
+  def change
+    add_column :consultations, :status, :string
+  end
+end