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@@ -1,302 +0,0 @@
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-<div id="manual-determination-form-{{$patient->uid}}">
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- @php
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- $cpc = $patient->latestClientPrimaryCoverage;
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- @endphp
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- <div class="p-3">
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- <form @submit.prevent="submitForm" method="post" class="mcp-theme-1">
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- <input type="hidden" name="clientPrimaryCoverageUid" value="{{$cpc->uid}}" class="form-control input-sm" />
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- <div class="row">
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- <div class="form-group col-md-12">
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- <p class="mb-1">How did you manually check coverage?</p>
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- <div class="form-check form-check-inline">
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- <label class="form-check-label"><input class="form-check-input" type="radio" v-model="uiState.manualDeterminationStrategy" name="manualDeterminationStrategy" value="REVIEWED_ELECTRONIC">Reviewed Electronically</label>
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- </div>
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- <div class="form-check form-check-inline">
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- <label class="form-check-label"><input class="form-check-input" type="radio" v-model="uiState.manualDeterminationStrategy" name="manualDeterminationStrategy" value="CALLED_PAYER">Called Payer</label>
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- </div>
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- </div>
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- </div>
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- <div class="table-responsive">
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- <table class="table table-bordered table-striped">
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- <thead>
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- <tr>
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- <th></th>
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- <th>Automatic</th>
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- <th>Override</th>
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- </tr>
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- </thead>
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- <tbody>
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- <tr v-if="cpc.plan_type == 'MEDICARE'">
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- <td>Record Found?</td>
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- <td>{{$cpc->auto_medicare_is_match_found ? 'YES' : 'NO'}}</td>
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- <td>
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- <div class="form-group mb-0">
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- <div class="form-check form-check-inline">
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- <label class="form-check-label"><input class="form-check-input" type="radio" :checked="cpc.auto_medicare_is_partbactive == 'YES'" name="manualMedicareIsMatched" value="YES">Yes</label>
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- </div>
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- <div class="form-check form-check-inline">
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- <label class="form-check-label"><input class="form-check-input" type="radio" name="manualMedicareIsMatched" value="NO">No</label>
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- </div>
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- </div>
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- </td>
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- </tr>
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- <tr v-if="cpc.plan_type == 'MEDICAID'">
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- <td>Record Found?</td>
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- <td>{{$cpc->auto_medicaid_is_match_found ? 'YES' : 'NO'}}</td>
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- <td>
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- <div class="form-group">
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- <div class="form-check form-check-inline">
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- <label class="form-check-label"><input class="form-check-input" type="radio" :checked="cpc.auto_medicaid_is_match_found == 'YES'" name="manualMedicaidIsMatched" value="YES">Yes</label>
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- </div>
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- <div class="form-check form-check-inline">
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- <label class="form-check-label"><input class="form-check-input" type="radio" name="manualMedicaidIsMatched" value="NO">No</label>
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- </div>
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- </div>
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- <div class="form-group mb-0">
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- <label for="" class="control-label">Manual Determination Category</label>
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- <select name="manualDeterminationCategory" class="form-control input-sm">
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- <option value="">--select--</option>
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- <option value="COVERED" :selected="cpc.auto_medicaid_is_match_found == 'YES'">Covered</option>
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- <option value="NOT_COVERED">Not Covered</option>
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- <option value="INVALID" :selected="cpc.auto_medicaid_is_match_found == 'NO'">Invalid</option>
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- <option value="UNKNOWN">Unknown</option>
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- </select>
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- </div>
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- </td>
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- </tr>
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- <tr v-if="cpc.plan_type == 'COMMERCIAL'">
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- <td>Record Found?</td>
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- <td>{{$cpc->auto_commercial_is_match_found ? 'YES' : 'NO'}}</td>
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- <td>
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- <div class="form-group mb-0">
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- <label for="" class="control-label">Manual Determination Category</label>
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- <select name="manualDeterminationCategory" class="form-control input-sm">
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- <option value="">--select--</option>
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- <option value="COVERED">Covered</option>
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- <option value="NOT_COVERED">Not Covered</option>
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- <option value="INVALID" :selected="cpc.auto_commercial_is_match_found == 'NO'">Invalid</option>
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- <option value="UNKNOWN">Unknown</option>
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- </select>
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- </div>
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- </td>
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- </tr>
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- <tr v-if="cpc.plan_type == 'COMMERCIAL' && cpc.mcd_number">
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- <td>Medicaid Number</td>
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- <td colspan="2">{{$cpc->mcd_number}}</td>
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- </tr>
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- <tr v-if="cpc.plan_type == 'COMMERCIAL' && cpc.mcd_number">
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- <td>Medicaid State</td>
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- <td colspan="2">{{$cpc->mcd_payer_name}}</td>
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- </tr>
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- <tr v-if="cpc.plan_type == 'COMMERCIAL' && cpc.mcd_number">
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- <td>Was Medicaid Record Found?</td>
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- <td colspan="2">{{$cpc->auto_medicaid_is_match_found}}</td>
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- </tr>
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- <tr v-if="cpc.plan_type == 'COMMERCIAL' && cpc.mcr_number">
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- <td>Medicare Number</td>
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- <td colspan="2">{{$cpc->mcr_number}}</td>
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- </tr>
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-
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- <tr v-if="(cpc.plan_type == 'MEDICARE') || (cpc.plan_type == 'COMMERCIAL' && cpc.mcr_number)">
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- <td>Part B Active?</td>
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- <td>{{$cpc->auto_medicare_is_partbactive}}</td>
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- <td>
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- <div class="form-group mb-0">
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- <div class="form-check form-check-inline">
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- <label class="form-check-label"><input class="form-check-input" type="radio" :checked="cpc.auto_medicare_is_partbprimary == 'YES'" name="manualMedicareIsPartBActive" value="YES">Yes</label>
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- </div>
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- <div class="form-check form-check-inline">
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- <label class="form-check-label"><input class="form-check-input" type="radio" name="manualMedicareIsPartBActive" value="NO">No</label>
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- </div>
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- </div>
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- </td>
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- </tr>
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- <tr v-if="(cpc.plan_type == 'MEDICARE') || (cpc.plan_type == 'COMMERCIAL' && cpc.mcr_number)">
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- <td>Is Part B Primary?</td>
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- <td>{{$cpc->auto_medicare_is_partbprimary}}</td>
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- <td>
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- <input v-if="cpc.plan_type == 'MEDICARE'" type="hidden" name="manualDeterminationCategory" :value="
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- !cpc.auto_medicare_is_match_found ? 'INVALID' :
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- cpc.auto_medicare_is_partbprimary == 'YES' ? 'COVERED' :
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- cpc.auto_medicare_is_partbprimary == 'NO' ? 'NOT_COVERED' : 'UNKNOWN'
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- ">
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- <div class="form-group mb-0">
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- <div class="form-check form-check-inline">
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- <label class="form-check-label"><input class="form-check-input" type="radio" name="manualMedicareIsPartBPrimary" v-model="uiState.manualMedicareIsPartBPrimary" value="YES">Yes</label>
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- </div>
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- <div class="form-check form-check-inline">
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- <label class="form-check-label"><input class="form-check-input" type="radio" name="manualMedicareIsPartBPrimary" v-model="uiState.manualMedicareIsPartBPrimary" value="NO">No</label>
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- </div>
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- </div>
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- </td>
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- </tr>
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- <tr v-if="(cpc.plan_type == 'MEDICARE') || (cpc.plan_type == 'COMMERCIAL' && cpc.mcr_number)">
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- <td>Is Part C Active?</td>
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- <td>{{$cpc->auto_medicare_is_partcactive}}</td>
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- <td>
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- <div class="alert alert-danger" v-if="(cpc.auto_medicare_is_partcactive == 'YES' && cpc.auto_medicare_is_partbprimary == 'YES') || (uiState.manualMedicareIsPartBPrimary == 'YES' && uiState.manualMedicareIsPartCActive == 'YES')">
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- Oops! Patient Medicare Part B Primary is set to <b>Yes</b>.
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- </div>
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- <div class="form-group mb-0">
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- <div class="form-check form-check-inline">
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- <label class="form-check-label"><input class="form-check-input" type="radio" name="manualMedicareIsPartCActive" v-model="uiState.manualMedicareIsPartCActive" value="YES">Yes</label>
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- </div>
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- <div class="form-check form-check-inline">
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- <label class="form-check-label"><input class="form-check-input" type="radio" name="manualMedicareIsPartCActive" v-model="uiState.manualMedicareIsPartCActive" value="NO">No</label>
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- </div>
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- </div>
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- </td>
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- </tr>
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- <tr v-if="(cpc.plan_type == 'MEDICARE') || (cpc.plan_type == 'COMMERCIAL' && cpc.mcr_number)">
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- <td>Inpatient?</td>
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- <td>{{$cpc->auto_medicare_is_inpatient}}</td>
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- <td>
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- <div class="form-group mb-0">
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- <div class="form-check form-check-inline">
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- <label class="form-check-label"><input class="form-check-input" type="radio" name="manualMedicareIsInpatient" value="YES">Yes</label>
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- </div>
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- <div class="form-check form-check-inline">
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- <label class="form-check-label"><input class="form-check-input" type="radio" name="manualMedicareIsInpatient" value="NO">No</label>
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- </div>
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- <div class="form-check form-check-inline">
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- <label class="form-check-label"><input class="form-check-input" type="radio" name="manualMedicareIsInpatient" value="UNKNOWN">Unknown</label>
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- </div>
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- </div>
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- </td>
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- </tr>
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- <tr v-if="(cpc.plan_type == 'MEDICARE') || (cpc.plan_type == 'COMMERCIAL' && cpc.mcr_number)">
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- <td>Hospice?</td>
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- <td>UNKNOWN</td>
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- <td>
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- <div class="form-group mb-0">
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- <div class="form-check form-check-inline">
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- <label class="form-check-label"><input class="form-check-input" type="radio" name="manualMedicareIsHospice" value="YES">Yes</label>
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- </div>
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- <div class="form-check form-check-inline">
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- <label class="form-check-label"><input class="form-check-input" type="radio" name="manualMedicareIsHospice" value="NO">No</label>
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- </div>
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- <div class="form-check form-check-inline">
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- <label class="form-check-label"><input class="form-check-input" type="radio" name="manualMedicareIsHospice" value="UNKNOWN">Unknown</label>
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- </div>
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- </div>
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- </td>
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- </tr>
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- <tr v-if="(cpc.plan_type == 'MEDICARE') || (cpc.plan_type == 'COMMERCIAL' && cpc.mcr_number)">
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- <td>Home Health?</td>
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- <td>UNKNOWN</td>
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- <td>
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- <div class="form-group mb-0">
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- <div class="form-check form-check-inline">
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- <label class="form-check-label"><input class="form-check-input" type="radio" name="manualMedicareIsHomeHealth" value="YES">Yes</label>
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- </div>
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- <div class="form-check form-check-inline">
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- <label class="form-check-label"><input class="form-check-input" type="radio" name="manualMedicareIsHomeHealth" value="NO">No</label>
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- </div>
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- <div class="form-check form-check-inline">
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- <label class="form-check-label"><input class="form-check-input" type="radio" name="manualMedicareIsHomeHealth" value="UNKNOWN">Unknown</label>
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- </div>
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- </div>
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- </td>
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- </tr>
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- <tr v-if="(cpc.plan_type == 'MEDICARE') || (cpc.plan_type == 'COMMERCIAL' && cpc.mcr_number)">
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- <td>MSP?</td>
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- <td>{{$cpc->auto_medicare_is_msp}}</td>
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- <td>
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- <div class="form-group mb-0">
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- <div class="form-check form-check-inline">
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- <label class="form-check-label"><input class="form-check-input" type="radio" name="manualMedicareIsMsp" value="YES">Yes</label>
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- </div>
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- <div class="form-check form-check-inline">
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- <label class="form-check-label"><input class="form-check-input" type="radio" name="manualMedicareIsMsp" value="NO">No</label>
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- </div>
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- <div class="form-check form-check-inline">
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- <label class="form-check-label"><input class="form-check-input" type="radio" name="manualMedicareIsMsp" value="UNKNOWN">Unknown</label>
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- </div>
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- </div>
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- </td>
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- </tr>
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- </tbody>
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- </table>
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- </div>
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- <div class="row">
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- <div class="form-group col-md-12">
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- <label for="" class="control-label">Memo</label>
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- <textarea name="manualMedicareMemo" class="form-control"></textarea>
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- </div>
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- </div>
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-
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-
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- <div v-if="response" :class="response.success ? 'alert success' : 'alert alert-danger'">
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- @{{ response.message }}
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- </div>
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-
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- <div class="form-group text-nowrap mb-0">
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- <button v-if="!processing" class="btn btn-sm btn-primary" type="submit" :disabled="url == ''">Submt</button>
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- <button v-else class="btn btn-sm btn-primary" type="button"><i class="fas fa-circle-notch fa-spin"></i> Processing...</button>
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- </div>
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- </form>
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-</div>
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-</div>
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-<script>
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- (function() {
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- function init() {
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- new Vue({
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- el: '#manual-determination-form-{{$patient->uid}}',
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- delimiters:['@{{','}}'],
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- data: {
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- url: '',
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- uiState: {
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- manualMedicareIsPartBPrimary: '',
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- manualMedicareIsPartCActive: ''
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- },
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- cpc: <?= json_encode($cpc); ?>,
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- processing: false,
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- response: null
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- },
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- methods: {
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- submitForm: function(evt) {
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- var self = this;
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- if(self.processing) return;
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- var form = evt.target;
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- var data = $(form).serializeArray();
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- var url = self.url;
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- if (!url) {
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- self.response = {
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- success: false,
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- message: 'Invalid url'
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- };
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- return;
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- }
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-
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- self.processing = true;
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- $.post(url, data, function(response) {
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- self.processing = false;
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- if (response.success) {
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- closeStagPopup();
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- fastReload();
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- } else {
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- self.response = response;
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- }
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- }, 'json');
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- },
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- },
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- mounted: function() {
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- if(this.cpc.auto_medicare_is_partbprimary == 'YES') {
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- this.uiState.manualMedicareIsPartBPrimary = 'YES';
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- this.uiState.manualMedicareIsPartCActive = 'NO';
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- };
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- if(this.cpc.plan_type == 'MEDICARE') {
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- this.url = '/api/clientPrimaryCoverage/manualDeterminationForMedicare';
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- };
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- if(this.cpc.plan_type == 'MEDICAID') {
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- this.url = '/api/clientPrimaryCoverage/manualDeterminationForMedicaid';
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- };
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- if(this.cpc.plan_type == 'COMMERCIAL') {
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- this.url = '/api/clientPrimaryCoverage/manualDeterminationForCommercial';
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- };
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- }
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- });
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- }
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- addMCInitializer('manual-determination-form-{{$patient->uid}}', init, '#manual-determination-form-{{$patient->uid}}')
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- }).call(window);
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-</script>
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