chore: added claim status update and data update to central DB

.irb_history

@@ -0,0 +1,3 @@
+IRB
+IRB.conf
+ls

app/controllers/health_care_provider_controller.rb

@@ -30,7 +30,7 @@ def update_docs_and_send_claim_request
     claim_id = params[:claim_id]
     amount = params[:claims_amount]
     claim_type = params[:claim_type]
-    CentralEntityHelper.add_data_to_health_record(params[:prescriptions], params[:invoices], params[:person_id])
+    CentralEntityHelper.add_data_to_health_record(params[:prescriptions], params[:invoices], null, params[:person_id])
     resp = InsuranceHelper.send_claim_request(claim_id, amount, claim_type)
     render json: resp
   rescue StandardError => e

app/helpers/central_entity_helper.rb

@@ -17,13 +17,19 @@ def get_eligibility(claim_amount, claim_type, customer_id)
       # particular claim_type is under covers
     end
 
-    def add_data_to_health_record(new_prescriptions, new_invoices, customer_id)
+    def add_data_to_health_record(new_prescriptions, new_invoices, new_claims, customer_id)
       health_report = HealthReport.find_by_person_id(customer_id)
       invoices = health_report.invoices
-      invoices.add(new_invoices)
       prescriptions = health_report.prescriptions
-      prescriptions.add(new_prescriptions)
-      health_report.update(invoices: invoices, prescriptions: prescriptions)
+      new_invoices.each do |ninv|
+        invoices.add(Invoice.create(amount: ninv[:amount], health_report: health_report))
+      end
+      new_prescriptions.each do |npr|
+        prescriptions.add(Prescription.create(medicines: npr[:medicines], lab_tests: npr[:lab_tests], health_report: health_report))
+      end
+      claims = health_report.claims
+      claims.add(new_claims)
+      health_report.update(invoices: invoices, prescriptions: prescriptions, claims: claims)
     end
 
   end

app/helpers/insurance_helper.rb

@@ -13,7 +13,7 @@ def process_pre_auth(amount, claim_type, requester_id, customer_id)
         eligibility = CentralEntityHelper.get_eligibility(amount, claim_type, customer_id).with_indifferent_access
         eligible_policy_id = eligibility[:eligible_policy_id]
         claim = Claim.create(status: "pre-auth-approved", person_id: customer_id, insurance_policy_id: eligible_policy_id)
-        return { "success": true, "claim_id": claim.id, msg: "Pre auth claim registered successfully" }
+        return { "success": true, "claim_id": claim.id, "customer_id": customer_id, msg: "Pre auth claim registered successfully" }
       else
         NotificationHelper.send_notification(requester_id, customer_id, "Pre Auth Request")
         # send notification
@@ -37,15 +37,24 @@ def send_claim_request(claim_id, amount, claim_type)
       end
       eligibility = CentralEntityHelper.get_eligibility(amount, claim_type, claim.person_id)
       if eligibility[:is_eligible]
-        claim.update(status: "processing")
-        #todo: call fraud api
-      else
-        new_status = "rejected"
-        ClaimStatusHistory.create(transition_from: claim.status, transition_to: new_status, claim_id: claim.id)
-        claim.update(status: new_status)
-        # todo: create notif & notify customer
+        updateClaimStatus("processing", claim)
+        is_fraud = false # todo: replace with gpt call
+        unless is_fraud
+          updateClaimStatus("approved", claim)
+          CentralEntityHelper.add_data_to_health_record([], [], [claim], claim.person_id)
+          # NotificationHelper.send_notification(claim.insurance_policy.)
+          return
+        end
       end
-      #todo: update claim and max coverage to central DB too
+      self.updateClaimStatus("rejected", claim)
+      # todo: create notif & notify customer
+    end
+
+    private
+
+    def updateClaimStatus(new_status, claim)
+      ClaimStatusHistory.create(transition_from: claim.status, transition_to: new_status, claim_id: claim.id)
+      claim.update(status: new_status)
     end
   end
 end

app/models/health_report.rb

@@ -2,5 +2,6 @@ class HealthReport < ApplicationRecord
   has_many :invoices
   has_many :insurance_policies
   has_many :prescriptions
+  has_many :claims
   belongs_to :person
 end

app/services/fraud_detection_service.rb

@@ -0,0 +1,72 @@
+class FraudDetectionService
+  # TODO: add env variable
+  @@client = OpenAI::Client.new(access_token: ENV.fetch("OPEN_AI_TOKEN"))
+
+  MODEL = "gpt-3.5-turbo"
+
+  PREFIX = "
+Below is a Patient Insurance Claim History, Patient Medical History, Doctor-Patient Transcript, Doctor's Prescription it starts with <PatientMedicalHistory> and ends with </PatientMedicalHistory>
+"
+
+  INSTRUCTION = "
+Based on the Patient Insurance Claim History, Patient Medical History, Doctor-Patient Transcript, Doctor's Prescription provided below, generate a fraud detection response in JSON format:
+{
+  \"approved\": <Yes/No>,
+  \"confidence\": (0,1),
+  \"explanation\": <string>
+}
+"
+
+  TEXT = "
+<PatientMedicalHistory>
+%{medical_history}
+</PatientMedicalHistory>
+"
+
+  def self.detect(medical_history)
+    result = {
+      success: false,
+      approved: nil,
+      confidence: nil,
+      summary: nil,
+      error_message: ""
+    }
+
+    prompt = (PREFIX + "\n" + TEXT + "\n" + INSTRUCTION) % {medical_history: medical_history}
+
+    response = @@client.chat(
+      parameters: {
+        model: MODEL,
+        messages: [{ role: "user", content: prompt}],
+        temperature: 0.7
+      })
+
+    if response.dig("error", "message")
+      result[:error_message] = response.dig("error", "message")
+      return result
+    end
+
+    response_text = response.dig("choices", 0, "message", "content")
+    begin
+      parsed_response = JSON.parse(response_text)
+    rescue StandardError => e
+      puts("ChatGPT Error:", e.message)
+      parsed_response = {}
+    end
+
+    result[:approved] = parsed_response["approved"]
+    result[:confidence] = parsed_response["confidence"]
+    result[:summary] = parsed_response["explanation"]
+
+    result[:success] = !(result[:approved].nil? || result[:confidence].nil? || result[:summary].nil?)
+    return result
+
+    # binding.pry
+    # split_response = response_text.split("\n")
+    # result[:approved] = split_response.second if split_response.first.downcase == "approved:" && split_response.second.to_s.downcase.in?(["yes", "no"])
+    # result[:confidence] = split_response.fourth.to_f if split_response.third.downcase == "confidence:" && split_response.fourth.to_s.to_f.to_s == split_response.fourth
+    # result[:summary] = split_response.last if split_response.fifth.downcase == "explanation:" && split_response.last.to_s == split_response.last
+    # result[:success] = !(result[:approved].nil? || result[:confidence].nil? || result[:summary].nil?)
+    # return result
+  end
+end

config/application.rb

@@ -23,5 +23,6 @@ class Application < Rails::Application
     # Middleware like session, flash, cookies can be added back manually.
     # Skip views, helpers and assets when generating a new resource.
     config.api_only = true
+    config.autoload_paths << "#{Rails.root}/app/services"
   end
 end