|
|
@@ -2,45 +2,43 @@
|
|
|
|
|
|
@section('inner-content')
|
|
|
<div>
|
|
|
- <div class="my-2">
|
|
|
- <div>
|
|
|
+ <div class="mb-3 border rounded bg-light p-2">
|
|
|
+ <div class="mb-2">
|
|
|
Latest Client Primary Coverage:
|
|
|
@if($patient->latestClientPrimaryCoverage)
|
|
|
- {{$patient->latestClientPrimaryCoverage->plan_type}}|{{$patient->latestClientPrimaryCoverage->payer_member_identifier}}
|
|
|
+ <b>{{$patient->latestClientPrimaryCoverage->plan_type}}</b> (Member ID: {{$patient->latestClientPrimaryCoverage->payer_member_identifier}})
|
|
|
@else
|
|
|
- --
|
|
|
+ -
|
|
|
@endif
|
|
|
</div>
|
|
|
- <div>Latest New Client Primary Coverage:
|
|
|
+ <div class="mb-2">Latest New Client Primary Coverage:
|
|
|
@if($patient->latestNewClientPrimaryCoverage)
|
|
|
- {{$patient->latestNewClientPrimaryCoverage->plan_type}}|{{$patient->latestNewClientPrimaryCoverage->payer_member_identifier}}
|
|
|
+ <b>{{$patient->latestNewClientPrimaryCoverage->plan_type}}</b> (Member ID: {{$patient->latestNewClientPrimaryCoverage->payer_member_identifier}})
|
|
|
@else
|
|
|
- --
|
|
|
+ -
|
|
|
@endif
|
|
|
</div>
|
|
|
- <div>Latest Auto Refresh Client Primary Coverage:
|
|
|
+ <div class="mb-2">Latest Auto Refresh Client Primary Coverage:
|
|
|
@if($patient->latestAutoRefreshClientPrimaryCoverage)
|
|
|
- {{$patient->latestAutoRefreshClientPrimaryCoverage->plan_type}}|{{$patient->latestAutoRefreshClientPrimaryCoverage->payer_member_identifier}}
|
|
|
+ <b>{{$patient->latestAutoRefreshClientPrimaryCoverage->plan_type}}</b> (Member ID: {{$patient->latestAutoRefreshClientPrimaryCoverage->payer_member_identifier}})
|
|
|
@else
|
|
|
- --
|
|
|
+ -
|
|
|
@endif
|
|
|
</div>
|
|
|
- <div>Latest Manual Client Primary Coverage:
|
|
|
+ <div class="">Latest Manual Client Primary Coverage:
|
|
|
@if($patient->latestManualClientPrimaryCoverage)
|
|
|
- {{$patient->latestManualClientPrimaryCoverage->plan_type}}|{{$patient->latestManualClientPrimaryCoverage->payer_member_identifier}}
|
|
|
+ <b>{{$patient->latestManualClientPrimaryCoverage->plan_type}}</b> (Member ID: {{$patient->latestManualClientPrimaryCoverage->payer_member_identifier}})
|
|
|
@else
|
|
|
- --
|
|
|
+ -
|
|
|
@endif
|
|
|
</div>
|
|
|
-
|
|
|
</div>
|
|
|
- <div class="d-flex align-items-center">
|
|
|
- <h4 class="font-weight-bold m-0 font-size-16">Client Primary Coverages</h4>
|
|
|
-
|
|
|
- <div class="ml-3">
|
|
|
+ <div class="d-flex align-items-baseline">
|
|
|
+ <h4 class="font-weight-bold m-0 font-size-16 text-nowrap">Client Primary Coverages</h4>
|
|
|
+ <div class="ml-auto d-inline-flex justify-content-center">
|
|
|
+ <span class="mr-2">Auto:</span>
|
|
|
<div moe relative>
|
|
|
- <a href="" start show class="btn btn-sm btn-primary text-white font-weight-bold small">Create New Coverage For Medicare Without Manual Determination</a>
|
|
|
-
|
|
|
+ <a href="" start show>+ MC</a>
|
|
|
<form url="/api/clientPrimaryCoverage/createNewCoverageForMedicareWithoutManualDetermination" class="mcp-theme-1">
|
|
|
<input type="hidden" name="clientUid" value="{{$patient->uid}}" class="form-control input-sm" />
|
|
|
<div class="form-group">
|
|
|
@@ -69,9 +67,105 @@
|
|
|
</div>
|
|
|
</form>
|
|
|
</div>
|
|
|
+ <span class="mx-2 text-secondary text-sm">|</span>
|
|
|
<div moe relative>
|
|
|
- <a href="" start show class="btn btn-sm btn-primary text-white font-weight-bold small">Create New Coverage For Medicare With Manual Determination</a>
|
|
|
-
|
|
|
+ <a href="" start show >+ Medicaid</a>
|
|
|
+ <form url="/api/clientPrimaryCoverage/createNewCoverageForMedicaidWithoutManualDetermination" class="mcp-theme-1">
|
|
|
+ <input type="hidden" name="clientUid" value="{{$patient->uid}}" class="form-control input-sm" />
|
|
|
+ <div class="form-group">
|
|
|
+ <label for="" class="control-label">Subscriber Name First</label>
|
|
|
+ <input type="text" name="subscriberNameFirst" class="form-control input-sm">
|
|
|
+ </div>
|
|
|
+ <div class="form-group">
|
|
|
+ <label for="" class="control-label">Subscriber Name Last</label>
|
|
|
+ <input type="text" name="subscriberNameLast" class="form-control input-sm">
|
|
|
+ </div>
|
|
|
+ <div class="form-group">
|
|
|
+ <label for="" class="control-label">Subscriber Dob</label>
|
|
|
+ <input type="date" name="subscriberDob" class="form-control input-sm">
|
|
|
+ </div>
|
|
|
+ <div class="form-group">
|
|
|
+ <label for="" class="control-label">Payer Member Identifier</label>
|
|
|
+ <input type="String" name="payerMemberIdentifier" class="form-control input-sm">
|
|
|
+ </div>
|
|
|
+ <div class="form-group">
|
|
|
+ <label for="" class="control-label">Date Of Service</label>
|
|
|
+ <input type="date" name="dateOfService" class="form-control input-sm">
|
|
|
+ </div>
|
|
|
+ <div class="form-group">
|
|
|
+ <label for="" class="control-label">Subscriber Sex</label>
|
|
|
+ <select name="subscriberSex" class="form-control input-sm">
|
|
|
+ <option value="">--select--</option>
|
|
|
+ <option value="M">M</option>
|
|
|
+ <option value="F">F</option>
|
|
|
+ </select>
|
|
|
+ </div>
|
|
|
+ <div class="form-group">
|
|
|
+ <label for="" class="control-label">Plan Name</label>
|
|
|
+ <input type="text" name="planName" class="form-control input-sm">
|
|
|
+ </div>
|
|
|
+ <div class="form-group">
|
|
|
+ <label for="" class="control-label">Plan Identifier</label>
|
|
|
+ <input type="text" name="planIdentifier" class="form-control input-sm">
|
|
|
+ </div>
|
|
|
+ <div class="form-group">
|
|
|
+ <button class="btn btn-sm" submit>Submt</button>
|
|
|
+ <button class="btn btn-sm" close>Close</button>
|
|
|
+ </div>
|
|
|
+ </form>
|
|
|
+ </div>
|
|
|
+ <span class="mx-2 text-secondary text-sm">|</span>
|
|
|
+ <div moe relative>
|
|
|
+ <a href="" start show >+ Comm.</a>
|
|
|
+ <form url="/api/clientPrimaryCoverage/createNewCoverageForCommercialWithoutManualDetermination" class="mcp-theme-1">
|
|
|
+ <input type="hidden" name="clientUid" value="{{$patient->uid}}" class="form-control input-sm" />
|
|
|
+ <div class="form-group">
|
|
|
+ <label class="control-label">Subscriber Name First</label>
|
|
|
+ <input type="text" name="subscriberNameFirst" class="form-control input-sm">
|
|
|
+ </div>
|
|
|
+ <div class="form-group">
|
|
|
+ <label class="control-label">Subscriber Name Last</label>
|
|
|
+ <input type="text" name="subscriberNameLast" class="form-control input-sm">
|
|
|
+ </div>
|
|
|
+ <div class="form-group">
|
|
|
+ <label class="control-label">Subscriber Dob</label>
|
|
|
+ <input type="date" name="subscriberDob" class="form-control input-sm">
|
|
|
+ </div>
|
|
|
+ <div class="form-group">
|
|
|
+ <label class="control-label">Payer Member Identifier</label>
|
|
|
+ <input type="text" name="payerMemberIdentifier" class="form-control input-sm">
|
|
|
+ </div>
|
|
|
+ <div class="form-group">
|
|
|
+ <label class="control-label">Date Of Service</label>
|
|
|
+ <input type="date" name="dateOfService" class="form-control input-sm">
|
|
|
+ </div>
|
|
|
+ <div class="form-group">
|
|
|
+ <label for="" class="control-label">Subscriber Sex</label>
|
|
|
+ <select name="subscriberSex" class="form-control input-sm">
|
|
|
+ <option value="">--select--</option>
|
|
|
+ <option value="M">M</option>
|
|
|
+ <option value="F">F</option>
|
|
|
+ </select>
|
|
|
+ </div>
|
|
|
+ <div class="form-group">
|
|
|
+ <label class="control-label">Plan Name</label>
|
|
|
+ <input type="text" name="planName" class="form-control input-sm">
|
|
|
+ </div>
|
|
|
+ <div class="form-group">
|
|
|
+ <label class="control-label">Plan Identifier</label>
|
|
|
+ <input type="text" name="planIdentifier" class="form-control input-sm">
|
|
|
+ </div>
|
|
|
+ <div class="form-group">
|
|
|
+ <button class="btn btn-sm" submit>Submt</button>
|
|
|
+ <button class="btn btn-sm" close>Close</button>
|
|
|
+ </div>
|
|
|
+ </form>
|
|
|
+ </div>
|
|
|
+ </div>
|
|
|
+ <div class="ml-4 d-inline-flex justify-content-center">
|
|
|
+ <span class="mr-2">Manual:</span>
|
|
|
+ <div moe relative>
|
|
|
+ <a href="" start show >+ MC</a>
|
|
|
<form url="/api/clientPrimaryCoverage/createNewCoverageForMedicareWithManualDetermination" class="mcp-theme-1">
|
|
|
<input type="hidden" name="clientUid" value="{{$patient->uid}}" class="form-control input-sm" />
|
|
|
<div class="form-group">
|
|
|
@@ -225,56 +319,9 @@
|
|
|
</div>
|
|
|
</form>
|
|
|
</div>
|
|
|
+ <span class="mx-2 text-secondary text-sm">|</span>
|
|
|
<div moe relative>
|
|
|
- <a href="" start show class="btn btn-sm btn-primary text-white font-weight-bold small">Create New Coverage For Medicaid Without Manual Determination</a>
|
|
|
-
|
|
|
- <form url="/api/clientPrimaryCoverage/createNewCoverageForMedicaidWithoutManualDetermination" class="mcp-theme-1">
|
|
|
- <input type="hidden" name="clientUid" value="{{$patient->uid}}" class="form-control input-sm" />
|
|
|
- <div class="form-group">
|
|
|
- <label for="" class="control-label">Subscriber Name First</label>
|
|
|
- <input type="text" name="subscriberNameFirst" class="form-control input-sm">
|
|
|
- </div>
|
|
|
- <div class="form-group">
|
|
|
- <label for="" class="control-label">Subscriber Name Last</label>
|
|
|
- <input type="text" name="subscriberNameLast" class="form-control input-sm">
|
|
|
- </div>
|
|
|
- <div class="form-group">
|
|
|
- <label for="" class="control-label">Subscriber Dob</label>
|
|
|
- <input type="date" name="subscriberDob" class="form-control input-sm">
|
|
|
- </div>
|
|
|
- <div class="form-group">
|
|
|
- <label for="" class="control-label">Payer Member Identifier</label>
|
|
|
- <input type="String" name="payerMemberIdentifier" class="form-control input-sm">
|
|
|
- </div>
|
|
|
- <div class="form-group">
|
|
|
- <label for="" class="control-label">Date Of Service</label>
|
|
|
- <input type="date" name="dateOfService" class="form-control input-sm">
|
|
|
- </div>
|
|
|
- <div class="form-group">
|
|
|
- <label for="" class="control-label">Subscriber Sex</label>
|
|
|
- <select name="subscriberSex" class="form-control input-sm">
|
|
|
- <option value="">--select--</option>
|
|
|
- <option value="M">M</option>
|
|
|
- <option value="F">F</option>
|
|
|
- </select>
|
|
|
- </div>
|
|
|
- <div class="form-group">
|
|
|
- <label for="" class="control-label">Plan Name</label>
|
|
|
- <input type="text" name="planName" class="form-control input-sm">
|
|
|
- </div>
|
|
|
- <div class="form-group">
|
|
|
- <label for="" class="control-label">Plan Identifier</label>
|
|
|
- <input type="text" name="planIdentifier" class="form-control input-sm">
|
|
|
- </div>
|
|
|
- <div class="form-group">
|
|
|
- <button class="btn btn-sm" submit>Submt</button>
|
|
|
- <button class="btn btn-sm" close>Close</button>
|
|
|
- </div>
|
|
|
- </form>
|
|
|
- </div>
|
|
|
- <div moe relative>
|
|
|
- <a href="" start show class="btn btn-sm btn-primary text-white font-weight-bold small">Create New Coverage For Medicaid With Manual Determination</a>
|
|
|
-
|
|
|
+ <a href="" start show >+ Medicaid</a>
|
|
|
<form url="/api/clientPrimaryCoverage/createNewCoverageForMedicaidWithManualDetermination" class="mcp-theme-1">
|
|
|
<input type="hidden" name="clientUid" value="{{$patient->uid}}" class="form-control input-sm" />
|
|
|
<div class="form-group">
|
|
|
@@ -309,56 +356,9 @@
|
|
|
</div>
|
|
|
</form>
|
|
|
</div>
|
|
|
+ <span class="mx-2 text-secondary text-sm">|</span>
|
|
|
<div moe relative>
|
|
|
- <a href="" start show class="btn btn-sm btn-primary text-white font-weight-bold small">Create New Coverage For Commercial Without Manual Determination</a>
|
|
|
-
|
|
|
- <form url="/api/clientPrimaryCoverage/createNewCoverageForCommercialWithoutManualDetermination" class="mcp-theme-1">
|
|
|
- <input type="hidden" name="clientUid" value="{{$patient->uid}}" class="form-control input-sm" />
|
|
|
- <div class="form-group">
|
|
|
- <label class="control-label">Subscriber Name First</label>
|
|
|
- <input type="text" name="subscriberNameFirst" class="form-control input-sm">
|
|
|
- </div>
|
|
|
- <div class="form-group">
|
|
|
- <label class="control-label">Subscriber Name Last</label>
|
|
|
- <input type="text" name="subscriberNameLast" class="form-control input-sm">
|
|
|
- </div>
|
|
|
- <div class="form-group">
|
|
|
- <label class="control-label">Subscriber Dob</label>
|
|
|
- <input type="date" name="subscriberDob" class="form-control input-sm">
|
|
|
- </div>
|
|
|
- <div class="form-group">
|
|
|
- <label class="control-label">Payer Member Identifier</label>
|
|
|
- <input type="text" name="payerMemberIdentifier" class="form-control input-sm">
|
|
|
- </div>
|
|
|
- <div class="form-group">
|
|
|
- <label class="control-label">Date Of Service</label>
|
|
|
- <input type="date" name="dateOfService" class="form-control input-sm">
|
|
|
- </div>
|
|
|
- <div class="form-group">
|
|
|
- <label for="" class="control-label">Subscriber Sex</label>
|
|
|
- <select name="subscriberSex" class="form-control input-sm">
|
|
|
- <option value="">--select--</option>
|
|
|
- <option value="M">M</option>
|
|
|
- <option value="F">F</option>
|
|
|
- </select>
|
|
|
- </div>
|
|
|
- <div class="form-group">
|
|
|
- <label class="control-label">Plan Name</label>
|
|
|
- <input type="text" name="planName" class="form-control input-sm">
|
|
|
- </div>
|
|
|
- <div class="form-group">
|
|
|
- <label class="control-label">Plan Identifier</label>
|
|
|
- <input type="text" name="planIdentifier" class="form-control input-sm">
|
|
|
- </div>
|
|
|
- <div class="form-group">
|
|
|
- <button class="btn btn-sm" submit>Submt</button>
|
|
|
- <button class="btn btn-sm" close>Close</button>
|
|
|
- </div>
|
|
|
- </form>
|
|
|
- </div>
|
|
|
- <div moe relative>
|
|
|
- <a href="" start show class="btn btn-sm btn-primary text-white font-weight-bold small">Create New Coverage For Commercial With Manual Determination</a>
|
|
|
-
|
|
|
+ <a href="" start show >+ Comm.</a>
|
|
|
<form url="/api/clientPrimaryCoverage/createNewCoverageForCommercialWithManualDetermination" class="mcp-theme-1">
|
|
|
<input type="hidden" name="clientUid" value="{{$patient->uid}}" class="form-control input-sm" />
|
|
|
<div class="form-group">
|
|
|
@@ -429,7 +429,6 @@
|
|
|
</div>
|
|
|
</form>
|
|
|
</div>
|
|
|
-
|
|
|
</div>
|
|
|
</div>
|
|
|
|
