resolved conflicts

app/Http/Controllers/PatientController.php

@@ -542,6 +542,30 @@ class PatientController extends Controller
         return view('app.patient.client-primary-coverages', compact('patient', 'mbPayers'));
     }
 
+    public function primaryCoverage(Request $request, Client $patient) {
+        $mbPayers = MBPayer::all();
+        return view('app.patient.primary-coverage', compact('patient', 'mbPayers'));
+    }
+
+    public function primaryCoverageForm(Request $request, Client $patient) {
+        $mbPayers = MBPayer::all();
+        return view('app.patient.primary-coverage-form', compact('patient', 'mbPayers'));
+    }
+
+    public function primaryCoverageManualDeterminationModal(Request $request, Client $patient) {
+        if($patient->latestClientPrimaryCoverage->plan_type === 'MEDICARE'){
+            return view('app.patient.primary-coverage-manual-determination-medicare-modal', compact('patient'));
+        }
+        if($patient->latestClientPrimaryCoverage->plan_type === 'MEDICAID'){
+            return view('app.patient.primary-coverage-manual-determination-medicaid-modal', compact('patient'));
+        }
+        if($patient->latestClientPrimaryCoverage->plan_type === 'COMMERCIAL'){
+            return view('app.patient.primary-coverage-manual-determination-commercial-modal', compact('patient'));
+        }
+        
+        return "Plan Type is missing!";
+    }
+
     public function mbClaim(Request $request, MBClaim $mbClaim) {
         return view('app.patient.mb-claim-single', compact('mbClaim'));
     }

app/Http/Controllers/PayerController.php

@@ -0,0 +1,28 @@
+<?php
+
+namespace App\Http\Controllers;
+
+use Illuminate\Http\Request;
+use Illuminate\Support\Facades\Validator;
+
+use App\Models\Payer;
+use Illuminate\Support\Facades\DB;
+
+class PayerController extends Controller
+{
+	public function searchPayerV2JSON(Request $request)
+	{
+		$term = $request->input('term') ? trim($request->input('term')) : '';
+		if (empty($term)) return '';
+		$matches = DB::select(
+			"
+			SELECT id, uid, (name || ' (' || COALESCE(availity_payer_id, '--') || ')') as text FROM payer WHERE name ILIKE :term OR memo ILIKE :term", 
+			['term' => '%' . $term . '%']
+		);
+
+		return json_encode([
+			"success" => true,
+			"data" => $matches
+		]);
+	}
+}

app/Models/ClientPrimaryCoverage.php

@@ -55,4 +55,7 @@ class ClientPrimaryCoverage extends Model
         return implode(" ", $parts);
     }
 
+    public function payer(){
+        return $this->hasOne(Payer::class, 'id', 'commercial_payer_id');
+    }
 }

public/css/style.css

@@ -228,6 +228,9 @@ body>nav.navbar {
 [moe][large] form, [moe][large] [url] {
     width: 450px;
 }
+[moe][wide] form, [moe][wide] [url] {
+    width: 550px;
+}
 [moe][bottom] form {
     bottom: 100%;
 }
@@ -1350,6 +1353,11 @@ span.select2-container.select2-container--default.select2-container--open {
     background: #fff !important;
 }
 
+.form-check-label {
+  display: flex;
+  align-items: center;
+}
+
 #stagPdfViewer>form {
     padding: 0;
     background: #eee;
@@ -2098,4 +2106,4 @@ body.in-iframe .main-row > .sidebar {
 }
 [open-in-stag-popup] * {
     pointer-events: none;
-}
+}

public/css/yemi.css

@@ -8,7 +8,7 @@
     position: relative;
 }
 [moe] [url]:not([show]) {
-    z-index: 99999;
+    z-index: 999999;
     position: absolute;
     background-color: white;
     padding: 10px;

resources/views/app/patient/client-primary-coverage-new-with-manual.blade.php

@@ -0,0 +1,468 @@
+<div class="ml-4 d-inline-flex justify-content-center">
+    <span class="mr-2">New w/ Manual:</span>
+    <div moe relative large>
+        <a href="" start show >+ MC</a>
+        <form url="/api/clientPrimaryCoverage/createNewCoverageForMedicareWithManualDetermination" right class="mcp-theme-1">
+            <input type="hidden" name="clientUid" value="{{$patient->uid}}" class="form-control input-sm" />
+            <div class="form-group">
+                <label for="" class="control-label">Subscriber Name First</label>
+                <input type="text" name="subscriberNameFirst" class="form-control input-sm" value="{{$patient->name_first}}"/>
+            </div>
+            <div class="form-group">
+                <label for="" class="control-label">Subscriber Name Last</label>
+                <input type="text" name="subscriberNameLast" class="form-control input-sm" value="{{$patient->name_last}}"/>
+            </div>
+            <div class="form-group">
+                <label for="" class="control-label">Subscriber Dob</label>
+                <input type="date" name="subscriberDob" class="form-control input-sm" value="{{$patient->dob}}"/>
+            </div>
+            <div class="form-group">
+                <label for="" class="control-label">Payer Member Identifier</label>
+                <input type="text" 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" value="{{date('Y-m-d')}}"/>
+            </div>
+            <div class="form-group">
+                <label for="" class="control-label">Manual Determination Strategy</label>
+                <select  name="manualDeterminationStrategy" class="form-control input-sm">
+                    <option value="">--select--</option>
+                    <option value="REVIEWED_ELECTRONIC">Reviewed electronic</option>
+                    <option value="CALLED_PAYER">Called payer</option>
+                </select>
+            </div>
+            <div class="form-group">
+                <label for="" class="control-label">Manual Determination Category</label>
+                <select  name="manualDeterminationCategory" class="form-control input-sm">
+                    <option value="">--select--</option>
+                    <option value="COVERED">Covered</option>
+                    <option value="NOT_COVERED">Not Covered</option>
+                    <option value="INVALID">Invalid</option>
+                    <option value="UNKNOWN">Unknown</option>
+                </select>
+            </div>
+            <div class="form-group">
+                <label for="" class="control-label">Manual Determination Category Memo</label>
+                <input type="text" name="manualDeterminationCategoryMemo" class="form-control input-sm"/>
+            </div>
+            <div class="form-group">
+                <label for="" class="control-label">Manual Detail Json</label>
+                <input type="text" name="manualDetailJson" class="form-control input-sm"/>
+            </div>
+            <div class="form-group">
+                <label for="" class="control-label">Manual Medicare Is Part B Primary</label>
+                <select  name="manualMedicareIsPartBPrimary" class="form-control input-sm">
+                    <option value="">--select--</option>
+                    <option value="YES">Yes</option>
+                    <option value="NO">No</option>
+                    <option value="UNKNOWN">Unknown</option>
+                </select>
+            </div>
+            <div class="form-group">
+                <label for="" class="control-label">Manual Medicare Is Part B Active</label>
+                <select  name="manualMedicareIsPartBActive" class="form-control input-sm">
+                    <option value="">--select--</option>
+                    <option value="YES">Yes</option>
+                    <option value="NO">No</option>
+                    <option value="UNKNOWN">Unknown</option>
+                </select>
+            </div>
+            <div class="form-group">
+                <label for="" class="control-label">Manual Medicare Is Part C Active</label>
+                <select  name="manualMedicareIsPartCActive" class="form-control input-sm">
+                    <option value="">--select--</option>
+                    <option value="YES">Yes</option>
+                    <option value="NO">No</option>
+                    <option value="UNKNOWN">Unknown</option>
+                </select>
+            </div>
+            <div class="form-group">
+                <label for="" class="control-label">Manual Medicare Is Inpatient</label>
+                <select  name="manualMedicareIsInpatient" class="form-control input-sm">
+                    <option value="">--select--</option>
+                    <option value="YES">Yes</option>
+                    <option value="NO">No</option>
+                    <option value="UNKNOWN">Unknown</option>
+                </select>
+            </div>
+            <div class="form-group">
+                <label for="" class="control-label">Manual Medicare Is Hospice Or Home Health</label>
+                <select  name="manualMedicareIsHospiceOrHomeHealth" class="form-control input-sm">
+                    <option value="">--select--</option>
+                    <option value="YES">Yes</option>
+                    <option value="NO">No</option>
+                    <option value="UNKNOWN">Unknown</option>
+                </select>
+            </div>
+            <div class="form-group">
+                <label for="" class="control-label">Manual Medicare Is Msp</label>
+                <select  name="manualMedicareIsMsp" class="form-control input-sm">
+                    <option value="">--select--</option>
+                    <option value="YES">Yes</option>
+                    <option value="NO">No</option>
+                    <option value="UNKNOWN">Unknown</option>
+                </select>
+            </div>
+            <div class="form-group">
+                <label for="" class="control-label">Manual Medicare Msp Memo</label>
+                <select  name="manualMedicareMspMemo" class="form-control input-sm">
+                    <option value="">--select--</option>
+                    <option value="YES">Yes</option>
+                    <option value="NO">No</option>
+                    <option value="UNKNOWN">Unknown</option>
+                </select>
+            </div>
+            <div class="form-group">
+                <label for="" class="control-label">Manual Medicare Mpb Start Date</label>
+                <input type="date" name="manualMedicareMpbStartDate" class="form-control input-sm"/>
+            </div>
+            <div class="form-group">
+                <label for="" class="control-label">Manual Medicare Mpb End Date</label>
+                <input type="date" name="manualMedicareMpbEndDate" class="form-control input-sm"/>
+            </div>
+            <div class="form-group">
+                <label for="" class="control-label">Manual Medicare Mpb Deductible</label>
+                <input type="number" name="manualMedicareMpbDeductible" class="form-control input-sm"/>
+            </div>
+            <div class="form-group">
+                <label for="" class="control-label">Manual Medicare Mpb Remaining</label>
+                <input type="number" name="manualMedicareMpbRemaining" class="form-control input-sm"/>
+            </div>
+            <div class="form-group">
+                <label for="" class="control-label">Manual Medicare Mpb Insurance Type</label>
+                <input type="text" name="manualMedicareMpbInsuranceType" class="form-control input-sm"/>
+            </div>
+            <div class="form-group">
+                <label for="" class="control-label">Manual Medicare Mpb Insurance Type Label</label>
+                <input type="text" name="manualMedicareMpbInsuranceTypeLabel" class="form-control input-sm"/>
+            </div>
+            <div class="form-group">
+                <label for="" class="control-label">Manual Medicare Mpb Coinsurance Percent</label>
+                <input type="number" name="manualMedicareMpbCoinsurancePercent" class="form-control input-sm"/>
+            </div>
+            <div class="form-group">
+                <label for="" class="control-label">Manual Medicare Mpb Info Valid Until</label>
+                <input type="date" name="manualMedicareMpbInfoValidUntil" class="form-control input-sm"/>
+            </div>
+            <div class="form-group">
+                <label for="" class="control-label">Manual Medicare Mpb Info Valid Till</label>
+                <input type="date" name="manualMedicareMpbInfoValidTill" class="form-control input-sm"/>
+            </div>
+            <div class="form-group text-nowrap mb-0">
+                <button class="btn btn-sm btn-primary" submit>Submt</button>
+                <button class="btn btn-sm btn-default border" close>Close</button>
+            </div>
+        </form>
+    </div>
+    <span class="mx-2 text-secondary text-sm">|</span>
+    <div moe relative large>
+        <a href="" start show >+ Medicaid</a>
+        <form url="/api/clientPrimaryCoverage/createNewCoverageForMedicaidWithManualDetermination" right 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">Manual Determination Strategy</label>
+                <select  name="manualDeterminationStrategy" class="form-control input-sm">
+                    <option value="">--select--</option>
+                    <option value="REVIEWED_ELECTRONIC">Reviewed electronic</option>
+                    <option value="CALLED_PAYER">Called payer</option>
+                </select>
+            </div>
+            <div class="form-group">
+                <label for="" class="control-label">Manual Determination Category</label>
+                <select  name="manualDeterminationCategory" class="form-control input-sm">
+                    <option value="">--select--</option>
+                    <option value="COVERED">Covered</option>
+                    <option value="NOT_COVERED">Not Covered</option>
+                    <option value="INVALID">Invalid</option>
+                    <option value="UNKNOWN">Unknown</option>
+                </select>
+            </div>
+            <div class="form-group">
+                <label for="" class="form-control-label">Manual Determination Category Memo</label>
+                <input type="text" name="manualDeterminationCategoryMemo" class="form-control input-sm">
+            </div>
+            <div class="form-group">
+                <label for="" class="control-label">Manual Detail Json</label>
+                <input type="text" name="manualDetailJson" class="form-control input-sm">
+            </div>
+            <div class="form-group text-nowrap mb-0">
+                <button class="btn btn-sm btn-primary" submit>Submt</button>
+                <button class="btn btn-sm btn-default border" close>Close</button>
+            </div>
+        </form>
+    </div>
+    <span class="mx-2 text-secondary text-sm">|</span>
+    <div moe relative large>
+        <a href="" start show >+ Comm.</a>
+        <form url="/api/clientPrimaryCoverage/createNewCoverageForCommercialWithManualDetermination" right 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" value="{{$patient->name_first}}">
+            </div>
+            <div class="form-group">
+                <label class="control-label">Subscriber Name Last</label>
+                <input type="text" name="subscriberNameLast" class="form-control input-sm" value="{{$patient->name_last}}">
+            </div>
+            <div class="form-group">
+                <label class="control-label">Subscriber Dob</label>
+                <input type="date" name="subscriberDob" class="form-control input-sm" value="{{$patient->dob}}">
+            </div>
+            <div class="form-group">
+                <label for="" class="control-label">Subscriber Sex</label>
+                <select  name="subscriberSex" class="form-control input-sm">
+                    <option value="">--select--</option>
+                    <option value="M" {{$patient->sex === 'M' ? 'selected' : ''}}>M</option>
+                    <option value="F" {{$patient->sex === 'F' ? 'selected' : ''}}>F</option>
+                </select>
+            </div>
+            <div class="form-group">
+                <label for="" class="control-label">Payer Name</label>
+                <input type="text" name="payerName" 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" value="{{date('Y-m-d')}}">
+            </div>
+
+            <div class="form-group">
+                <label for="" class="control-label">Manual Determination Strategy</label>
+                <select  name="manualDeterminationStrategy" class="form-control input-sm">
+                    <option value="">--select--</option>
+                    <option value="REVIEWED_ELECTRONIC">Reviewed electronic</option>
+                    <option value="CALLED_PAYER">Called payer</option>
+                </select>
+            </div>
+            <div class="form-group">
+                <label for="" class="control-label">Manual Determination Category</label>
+                <select  name="manualDeterminationCategory" class="form-control input-sm">
+                    <option value="">--select--</option>
+                    <option value="COVERED">Covered</option>
+                    <option value="NOT_COVERED">Not Covered</option>
+                    <option value="INVALID">Invalid</option>
+                    <option value="UNKNOWN">Unknown</option>
+                </select>
+            </div>
+            <div class="form-group">
+                <label for="" class="control-label">Manual Determination Category Memo</label>
+                <textarea name="manualDeterminationCategoryMemo" class="form-control input-sm"></textarea>
+            </div>
+            <div class="form-group">
+                <label for="" class="control-label">Manual Detail Json</label>
+                <textarea name="manualDetailJson" class="form-control input-sm"></textarea>
+            </div>
+            <div class="form-group text-nowrap mb-0">
+                <button class="btn btn-sm btn-primary" submit>Submt</button>
+                <button class="btn btn-sm btn-default border" close>Close</button>
+            </div>
+        </form>
+    </div>
+    <span class="mx-2 text-secondary text-sm">|</span>
+    <div moe relative large>
+        <a href="" start show >+ Mcr Adv.</a>
+        <form url="/api/clientPrimaryCoverage/createNewCoverageForMcrAdvWithManualDetermination" right 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" value="{{$patient->name_first}}">
+            </div>
+            <div class="form-group">
+                <label class="control-label">Subscriber Name Last</label>
+                <input type="text" name="subscriberNameLast" class="form-control input-sm" value="{{$patient->name_last}}">
+            </div>
+            <div class="form-group">
+                <label class="control-label">Subscriber Dob</label>
+                <input type="date" name="subscriberDob" class="form-control input-sm" value="{{$patient->dob}}">
+            </div>
+            <div class="form-group">
+                <label for="" class="control-label">Subscriber Sex</label>
+                <select  name="subscriberSex" class="form-control input-sm">
+                    <option value="">--select--</option>
+                    <option value="M" {{$patient->sex === 'M' ? 'selected' : ''}}>M</option>
+                    <option value="F" {{$patient->sex === 'F' ? 'selected' : ''}}>F</option>
+                </select>
+            </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">Medicare Number</label>
+                <input type="text" name="mcrNumber" 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" value="{{date('Y-m-d')}}">
+            </div>
+
+            <div class="form-group">
+                <label for="" class="control-label">Manual Determination Strategy</label>
+                <select  name="manualDeterminationStrategy" class="form-control input-sm">
+                    <option value="">--select--</option>
+                    <option value="REVIEWED_ELECTRONIC">Reviewed electronic</option>
+                    <option value="CALLED_PAYER">Called payer</option>
+                </select>
+            </div>
+            <div class="form-group">
+                <label for="" class="control-label">Manual Determination Category</label>
+                <select  name="manualDeterminationCategory" class="form-control input-sm">
+                    <option value="">--select--</option>
+                    <option value="COVERED">Covered</option>
+                    <option value="NOT_COVERED">Not Covered</option>
+                    <option value="INVALID">Invalid</option>
+                    <option value="UNKNOWN">Unknown</option>
+                </select>
+            </div>
+            <div class="form-group">
+                <label for="" class="control-label">Manual Determination Category Memo</label>
+                <textarea name="manualDeterminationCategoryMemo" class="form-control input-sm"></textarea>
+            </div>
+            <div class="form-group">
+                <label for="" class="control-label">Manual Detail Json</label>
+                <textarea name="manualDetailJson" class="form-control input-sm"></textarea>
+            </div>
+            <div class="form-group">
+                <label for="" class="control-label">Manual Is Payer Member Identifier Valid</label>
+                <select  name="manualIsPayerMemberIdentifierValid" class="form-control input-sm">
+                    <option value="">--select--</option>
+                    <option value="YES">Yes</option>
+                    <option value="NO">No</option>
+                    <option value="UNKNOWN">Unknown</option>
+                </select>
+            </div>
+
+            <div class="form-group">
+                <label for="" class="control-label">Manual Is Mcr Number Valid</label>
+                <select  name="manualIsMcrNumberValid" class="form-control input-sm">
+                    <option value="">--select--</option>
+                    <option value="YES">Yes</option>
+                    <option value="NO">No</option>
+                    <option value="UNKNOWN">Unknown</option>
+                </select>
+            </div>
+
+            <div class="form-group">
+                <label for="" class="control-label">Manual Is Mcr Part Bprimary</label>
+                <select  name="manualIsMcrPartBPrimary" class="form-control input-sm">
+                    <option value="">--select--</option>
+                    <option value="YES">Yes</option>
+                    <option value="NO">No</option>
+                    <option value="UNKNOWN">Unknown</option>
+                </select>
+            </div>
+
+            <div class="form-group">
+                <label for="" class="control-label">Manual Is Mcr Part C Active</label>
+                <select  name="manualIsMcrPartCActive" class="form-control input-sm">
+                    <option value="">--select--</option>
+                    <option value="YES">Yes</option>
+                    <option value="NO">No</option>
+                    <option value="UNKNOWN">Unknown</option>
+                </select>
+            </div>
+            <div class="form-group text-nowrap mb-0">
+                <button class="btn btn-sm btn-primary" submit>Submt</button>
+                <button class="btn btn-sm btn-default border" close>Close</button>
+            </div>
+        </form>
+    </div>
+
+    <span class="mx-2 text-secondary text-sm">|</span>
+    <div moe relative large>
+        <a href="" start show >+ Mcd Mco.</a>
+        <form url="/api/clientPrimaryCoverage/createNewCoverageForMcdMcoWithManualDetermination" right 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" value="{{$patient->name_first}}">
+            </div>
+            <div class="form-group">
+                <label class="control-label">Subscriber Name Last</label>
+                <input type="text" name="subscriberNameLast" class="form-control input-sm" value="{{$patient->name_last}}">
+            </div>
+            <div class="form-group">
+                <label class="control-label">Subscriber Dob</label>
+                <input type="date" name="subscriberDob" class="form-control input-sm" value="{{$patient->dob}}">
+            </div>
+            <div class="form-group">
+                <label for="" class="control-label">Subscriber Sex</label>
+                <select  name="subscriberSex" class="form-control input-sm">
+                    <option value="">--select--</option>
+                    <option value="M" {{$patient->sex === 'M' ? 'selected' : ''}}>M</option>
+                    <option value="F" {{$patient->sex === 'F' ? 'selected' : ''}}>F</option>
+                </select>
+            </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">Medicaid Number</label>
+                <input type="text" name="mcrNumber" class="form-control input-sm">
+            </div>
+            <div class="form-group">
+                <label class="control-label">Medicaid State</label>
+                <input type="text" name="mcdState" 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" value="{{date('Y-m-d')}}">
+            </div>
+
+            <div class="form-group">
+                <label for="" class="control-label">Manual Determination Strategy</label>
+                <select  name="manualDeterminationStrategy" class="form-control input-sm">
+                    <option value="">--select--</option>
+                    <option value="REVIEWED_ELECTRONIC">Reviewed electronic</option>
+                    <option value="CALLED_PAYER">Called payer</option>
+                </select>
+            </div>
+            <div class="form-group">
+                <label for="" class="control-label">Manual Determination Category</label>
+                <select  name="manualDeterminationCategory" class="form-control input-sm">
+                    <option value="">--select--</option>
+                    <option value="COVERED">Covered</option>
+                    <option value="NOT_COVERED">Not Covered</option>
+                    <option value="INVALID">Invalid</option>
+                    <option value="UNKNOWN">Unknown</option>
+                </select>
+            </div>
+            <div class="form-group">
+                <label for="" class="control-label">Manual Determination Category Memo</label>
+                <textarea name="manualDeterminationCategoryMemo" class="form-control input-sm"></textarea>
+            </div>
+            <div class="form-group">
+                <label for="" class="control-label">Manual Detail Json</label>
+                <textarea name="manualDetailJson" class="form-control input-sm"></textarea>
+            </div>
+            <div class="form-group">
+                <label for="" class="control-label">Manual Is Mcd Number Valid</label>
+                <select  name="manualIsMcdNumberValid" class="form-control input-sm">
+                    <option value="">--select--</option>
+                    <option value="YES">Yes</option>
+                    <option value="NO">No</option>
+                    <option value="UNKNOWN">Unknown</option>
+                </select>
+            </div>
+
+            <div class="form-group">
+                <label for="" class="control-label">Manual Is Mcd Response Mco Active</label>
+                <select  name="manualIsMcdResponseMcoActive" class="form-control input-sm">
+                    <option value="">--select--</option>
+                    <option value="YES">Yes</option>
+                    <option value="NO">No</option>
+                    <option value="UNKNOWN">Unknown</option>
+                </select>
+            </div>
+            <div class="form-group text-nowrap mb-0">
+                <button class="btn btn-sm btn-primary" submit>Submt</button>
+                <button class="btn btn-sm btn-default border" close>Close</button>
+            </div>
+        </form>
+    </div>
+</div>

resources/views/app/patient/client-primary-coverages.blade.php

@@ -4,31 +4,31 @@
 <div>
     <div class="mb-3 border rounded bg-light p-2">
         <div class="mb-2">
-            Latest Client Primary Coverage: 
+            Latest Client Primary Coverage:
             @if($patient->latestClientPrimaryCoverage)
                 <b>{{$patient->latestClientPrimaryCoverage->plan_type}}</b> (Member ID: {{$patient->latestClientPrimaryCoverage->payer_member_identifier}})
-            @else 
+            @else
                 -
             @endif
         </div>
         <div class="mb-2">Latest New Client Primary Coverage:
             @if($patient->latestNewClientPrimaryCoverage)
                 <b>{{$patient->latestNewClientPrimaryCoverage->plan_type}}</b> (Member ID: {{$patient->latestNewClientPrimaryCoverage->payer_member_identifier}})
-            @else 
+            @else
                 -
             @endif
         </div>
         <div class="mb-2">Latest Auto Refresh Client Primary Coverage:
             @if($patient->latestAutoRefreshClientPrimaryCoverage)
                 <b>{{$patient->latestAutoRefreshClientPrimaryCoverage->plan_type}}</b> (Member ID: {{$patient->latestAutoRefreshClientPrimaryCoverage->payer_member_identifier}})
-            @else 
+            @else
                 -
             @endif
         </div>
         <div class="">Latest Manual Client Primary Coverage:
             @if($patient->latestManualClientPrimaryCoverage)
                 <b>{{$patient->latestManualClientPrimaryCoverage->plan_type}}</b> (Member ID: {{$patient->latestManualClientPrimaryCoverage->payer_member_identifier}})
-            @else 
+            @else
                 -
             @endif
         </div>
@@ -38,7 +38,7 @@
         <div class="ml-auto d-inline-flex justify-content-center">
             <span class="mr-2">New w/o Manual:</span>
             <div moe relative large>
-                <a href="" start show>+ MC</a>
+                <a href="" start show>+ MCR</a>
                 <form url="/api/clientPrimaryCoverage/createNewCoverageForMedicareWithoutManualDetermination" right class="mcp-theme-1">
                     <input type="hidden" name="clientUid" value="{{$patient->uid}}" class="form-control input-sm" />
                     <div class="form-group">
@@ -104,7 +104,7 @@
                         <label for="" class="control-label">Date Of Service</label>
                         <input type="date" name="dateOfService" class="form-control input-sm" value="{{date('Y-m-d')}}">
                     </div>
-                   
+
                     <div class="form-group text-nowrap mb-0">
                         <button class="btn btn-sm btn-primary" submit>Submt</button>
                         <button class="btn btn-sm btn-default border" close>Close</button>
@@ -148,202 +148,51 @@
                         <label class="control-label">Date Of Service</label>
                         <input type="date" name="dateOfService" class="form-control input-sm" value="{{date('Y-m-d')}}">
                     </div>
-                    
+
                     <div class="form-group text-nowrap mb-0">
                         <button class="btn btn-sm btn-primary" submit>Submt</button>
                         <button class="btn btn-sm btn-default border" close>Close</button>
                     </div>
                 </form>
             </div>
-        </div>
-        <div class="ml-4 d-inline-flex justify-content-center">
-            <span class="mr-2">New w/ Manual:</span>
+            <span class="mx-2 text-secondary text-sm">|</span>
             <div moe relative large>
-                <a href="" start show >+ MC</a>
-                <form url="/api/clientPrimaryCoverage/createNewCoverageForMedicareWithManualDetermination" right class="mcp-theme-1">
+                <a href="" start show >+ Mcr Adv.</a>
+                <form url="/api/clientPrimaryCoverage/createNewCoverageForMcrAdvWithoutManualDetermination" right class="mcp-theme-1">
                     <input type="hidden" name="clientUid" value="{{$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" value="{{$patient->name_first}}"/>
-                    </div>
-                    <div class="form-group">
-                        <label for="" class="control-label">Subscriber Name Last</label>
-                        <input type="text" name="subscriberNameLast" class="form-control input-sm" value="{{$patient->name_last}}"/>
-                    </div>
-                    <div class="form-group">
-                        <label for="" class="control-label">Subscriber Dob</label>
-                        <input type="date" name="subscriberDob" class="form-control input-sm" value="{{$patient->dob}}"/>
-                    </div>
-                    <div class="form-group">
-                        <label for="" class="control-label">Payer Member Identifier</label>
-                        <input type="text" 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" value="{{date('Y-m-d')}}"/>
-                    </div>
-                    <div class="form-group">
-                        <label for="" class="control-label">Manual Determination Strategy</label>
-                        <select  name="manualDeterminationStrategy" class="form-control input-sm">
-                            <option value="">--select--</option>
-                            <option value="REVIEWED_ELECTRONIC">Reviewed electronic</option>
-                            <option value="CALLED_PAYER">Called payer</option>
-                        </select>
-                    </div>
-                    <div class="form-group">
-                        <label for="" class="control-label">Manual Determination Category</label>
-                        <select  name="manualDeterminationCategory" class="form-control input-sm">
-                            <option value="">--select--</option>
-                            <option value="COVERED">Covered</option>
-                            <option value="NOT_COVERED">Not Covered</option>
-                            <option value="INVALID">Invalid</option>
-                            <option value="UNKNOWN">Unknown</option>
-                        </select>                        
-                    </div>
-                    <div class="form-group">
-                        <label for="" class="control-label">Manual Determination Category Memo</label>
-                        <input type="text" name="manualDeterminationCategoryMemo" class="form-control input-sm"/>
-                    </div>
-                    <div class="form-group">
-                        <label for="" class="control-label">Manual Detail Json</label>
-                        <input type="text" name="manualDetailJson" class="form-control input-sm"/>
-                    </div>
-                    <div class="form-group">
-                        <label for="" class="control-label">Manual Medicare Is Part B Primary</label>
-                        <select  name="manualMedicareIsPartBPrimary" class="form-control input-sm">
-                            <option value="">--select--</option>
-                            <option value="YES">Yes</option>
-                            <option value="NO">No</option>
-                            <option value="UNKNOWN">Unknown</option>
-                        </select>
-                    </div>
-                    <div class="form-group">
-                        <label for="" class="control-label">Manual Medicare Is Part B Active</label>
-                        <select  name="manualMedicareIsPartBActive" class="form-control input-sm">
-                            <option value="">--select--</option>
-                            <option value="YES">Yes</option>
-                            <option value="NO">No</option>
-                            <option value="UNKNOWN">Unknown</option>
-                        </select>
-                    </div>
-                    <div class="form-group">
-                        <label for="" class="control-label">Manual Medicare Is Part C Active</label>
-                        <select  name="manualMedicareIsPartCActive" class="form-control input-sm">
-                            <option value="">--select--</option>
-                            <option value="YES">Yes</option>
-                            <option value="NO">No</option>
-                            <option value="UNKNOWN">Unknown</option>
-                        </select>
-                    </div>
-                    <div class="form-group">
-                        <label for="" class="control-label">Manual Medicare Is Inpatient</label>
-                        <select  name="manualMedicareIsInpatient" class="form-control input-sm">
-                            <option value="">--select--</option>
-                            <option value="YES">Yes</option>
-                            <option value="NO">No</option>
-                            <option value="UNKNOWN">Unknown</option>
-                        </select>
-                    </div>
-                    <div class="form-group">
-                        <label for="" class="control-label">Manual Medicare Is Hospice Or Home Health</label>
-                        <select  name="manualMedicareIsHospiceOrHomeHealth" class="form-control input-sm">
-                            <option value="">--select--</option>
-                            <option value="YES">Yes</option>
-                            <option value="NO">No</option>
-                            <option value="UNKNOWN">Unknown</option>
-                        </select>
-                    </div>
-                    <div class="form-group">
-                        <label for="" class="control-label">Manual Medicare Is Msp</label>
-                        <select  name="manualMedicareIsMsp" class="form-control input-sm">
-                            <option value="">--select--</option>
-                            <option value="YES">Yes</option>
-                            <option value="NO">No</option>
-                            <option value="UNKNOWN">Unknown</option>
-                        </select>
-                    </div>
-                    <div class="form-group">
-                        <label for="" class="control-label">Manual Medicare Msp Memo</label>
-                        <select  name="manualMedicareMspMemo" class="form-control input-sm">
-                            <option value="">--select--</option>
-                            <option value="YES">Yes</option>
-                            <option value="NO">No</option>
-                            <option value="UNKNOWN">Unknown</option>
-                        </select>
-                    </div>
-                    <div class="form-group">
-                        <label for="" class="control-label">Manual Medicare Mpb Start Date</label>
-                        <input type="date" name="manualMedicareMpbStartDate" class="form-control input-sm"/>
-                    </div>
-                    <div class="form-group">
-                        <label for="" class="control-label">Manual Medicare Mpb End Date</label>
-                        <input type="date" name="manualMedicareMpbEndDate" class="form-control input-sm"/>
-                    </div>
-                    <div class="form-group">
-                        <label for="" class="control-label">Manual Medicare Mpb Deductible</label>
-                        <input type="number" name="manualMedicareMpbDeductible" class="form-control input-sm"/>
-                    </div>
-                    <div class="form-group">
-                        <label for="" class="control-label">Manual Medicare Mpb Remaining</label>
-                        <input type="number" name="manualMedicareMpbRemaining" class="form-control input-sm"/>
-                    </div>
-                    <div class="form-group">
-                        <label for="" class="control-label">Manual Medicare Mpb Insurance Type</label>
-                        <input type="text" name="manualMedicareMpbInsuranceType" class="form-control input-sm"/>
-                    </div>
-                    <div class="form-group">
-                        <label for="" class="control-label">Manual Medicare Mpb Insurance Type Label</label>
-                        <input type="text" name="manualMedicareMpbInsuranceTypeLabel" class="form-control input-sm"/>
-                    </div>
-                    <div class="form-group">
-                        <label for="" class="control-label">Manual Medicare Mpb Coinsurance Percent</label>
-                        <input type="number" name="manualMedicareMpbCoinsurancePercent" class="form-control input-sm"/>
+                        <label class="control-label">Subscriber Name First</label>
+                        <input type="text" name="subscriberNameFirst" class="form-control input-sm" value="{{$patient->name_first}}">
                     </div>
                     <div class="form-group">
-                        <label for="" class="control-label">Manual Medicare Mpb Info Valid Until</label>
-                        <input type="date" name="manualMedicareMpbInfoValidUntil" class="form-control input-sm"/>
+                        <label class="control-label">Subscriber Name Last</label>
+                        <input type="text" name="subscriberNameLast" class="form-control input-sm" value="{{$patient->name_last}}">
                     </div>
                     <div class="form-group">
-                        <label for="" class="control-label">Manual Medicare Mpb Info Valid Till</label>
-                        <input type="date" name="manualMedicareMpbInfoValidTill" class="form-control input-sm"/>
-                    </div>
-                    <div class="form-group text-nowrap mb-0">
-                        <button class="btn btn-sm btn-primary" submit>Submt</button>
-                        <button class="btn btn-sm btn-default border" close>Close</button>
+                        <label class="control-label">Subscriber Dob</label>
+                        <input type="date" name="subscriberDob" class="form-control input-sm" value="{{$patient->dob}}">
                     </div>
-                </form>
-            </div>
-            <span class="mx-2 text-secondary text-sm">|</span>
-            <div moe relative large>
-                <a href="" start show >+ Medicaid</a>
-                <form url="/api/clientPrimaryCoverage/createNewCoverageForMedicaidWithManualDetermination" right class="mcp-theme-1">
-                    <input type="hidden" name="clientUid" value="{{$patient->uid}}" class="form-control input-sm" />
                     <div class="form-group">
-                        <label for="" class="control-label">Manual Determination Strategy</label>
-                        <select  name="manualDeterminationStrategy" class="form-control input-sm">
+                        <label for="" class="control-label">Subscriber Sex</label>
+                        <select  name="subscriberSex" class="form-control input-sm">
                             <option value="">--select--</option>
-                            <option value="REVIEWED_ELECTRONIC">Reviewed electronic</option>
-                            <option value="CALLED_PAYER">Called payer</option>
+                            <option value="M" {{$patient->sex === 'M' ? 'selected' : ''}}>M</option>
+                            <option value="F" {{$patient->sex === 'F' ? 'selected' : ''}}>F</option>
                         </select>
                     </div>
                     <div class="form-group">
-                        <label for="" class="control-label">Manual Determination Category</label>
-                        <select  name="manualDeterminationCategory" class="form-control input-sm">
-                            <option value="">--select--</option>
-                            <option value="COVERED">Covered</option>
-                            <option value="NOT_COVERED">Not Covered</option>
-                            <option value="INVALID">Invalid</option>
-                            <option value="UNKNOWN">Unknown</option>
-                        </select>                        
+                        <label class="control-label">Payer Member Identifier</label>
+                        <input type="text" name="payerMemberIdentifier" class="form-control input-sm">
                     </div>
                     <div class="form-group">
-                        <label for="" class="form-control-label">Manual Determination Category Memo</label>
-                        <input type="text" name="manualDeterminationCategoryMemo" class="form-control input-sm">
+                        <label class="control-label">Medicare Number</label>
+                        <input type="text" name="mcrNumber" class="form-control input-sm">
                     </div>
                     <div class="form-group">
-                        <label for="" class="control-label">Manual Detail Json</label>
-                        <input type="text" name="manualDetailJson" class="form-control input-sm">
+                        <label class="control-label">Date Of Service</label>
+                        <input type="date" name="dateOfService" class="form-control input-sm" value="{{date('Y-m-d')}}">
                     </div>
+
                     <div class="form-group text-nowrap mb-0">
                         <button class="btn btn-sm btn-primary" submit>Submt</button>
                         <button class="btn btn-sm btn-default border" close>Close</button>
@@ -352,8 +201,8 @@
             </div>
             <span class="mx-2 text-secondary text-sm">|</span>
             <div moe relative large>
-                <a href="" start show >+ Comm.</a>
-                <form url="/api/clientPrimaryCoverage/createNewCoverageForCommercialWithManualDetermination" right class="mcp-theme-1">
+                <a href="" start show >+ Mcd Mco.</a>
+                <form url="/api/clientPrimaryCoverage/createNewCoverageForMcdMcoWithoutManualDetermination" right 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>
@@ -375,45 +224,24 @@
                             <option value="F" {{$patient->sex === 'F' ? 'selected' : ''}}>F</option>
                         </select>
                     </div>
-                    <div class="form-group">
-                        <label for="" class="control-label">Payer Name</label>
-                        <input type="text" name="payerName" 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" value="{{date('Y-m-d')}}">
-                    </div>
-                   
-                    <div class="form-group">
-                        <label for="" class="control-label">Manual Determination Strategy</label>
-                        <select  name="manualDeterminationStrategy" class="form-control input-sm">
-                            <option value="">--select--</option>
-                            <option value="REVIEWED_ELECTRONIC">Reviewed electronic</option>
-                            <option value="CALLED_PAYER">Called payer</option>
-                        </select>
-                    </div>
-                    <div class="form-group">
-                        <label for="" class="control-label">Manual Determination Category</label>
-                        <select  name="manualDeterminationCategory" class="form-control input-sm">
-                            <option value="">--select--</option>
-                            <option value="COVERED">Covered</option>
-                            <option value="NOT_COVERED">Not Covered</option>
-                            <option value="INVALID">Invalid</option>
-                            <option value="UNKNOWN">Unknown</option>
-                        </select>                        
+                        <label class="control-label">Medicaid Number</label>
+                        <input type="text" name="mcdNumber" class="form-control input-sm">
                     </div>
                     <div class="form-group">
-                        <label for="" class="control-label">Manual Determination Category Memo</label>
-                        <textarea name="manualDeterminationCategoryMemo" class="form-control input-sm"></textarea>
+                        <label class="control-label">Medicaid State</label>
+                        <input type="text" name="mcdState" class="form-control input-sm">
                     </div>
                     <div class="form-group">
-                        <label for="" class="control-label">Manual Detail Json</label>
-                        <textarea name="manualDetailJson" class="form-control input-sm"></textarea>
+                        <label class="control-label">Date Of Service</label>
+                        <input type="date" name="dateOfService" class="form-control input-sm" value="{{date('Y-m-d')}}">
                     </div>
+
                     <div class="form-group text-nowrap mb-0">
                         <button class="btn btn-sm btn-primary" submit>Submt</button>
                         <button class="btn btn-sm btn-default border" close>Close</button>
@@ -421,99 +249,11 @@
                 </form>
             </div>
         </div>
+
     </div>
 
     <table class="table table-sm table-bordered mt-3 mb-0">
-        <thead>
-            <tr>
-                <th></th>
-                <th>Creation Strategy</th>
-                <th>Auto Refresh Of Client Primary Coverage Id</th>
-                <th>Manual Determination Of Client Primary Coverage Id</th>
-                <th>Plan Type</th>
-                <th>Is Partbprimary</th>
-                <th>Is Manually Determined</th>
-                <th>Is Entry Error</th>
-                <th>Subscriber Name First</th>
-                <th>Subscriber Name Last</th>
-                <th>Subscriber Sex</th>
-                <th>Subscriber Dob</th>
-                <th>Payer Member Identifier</th>
-                <th>Payer Name</th>
-                <th>Date Of Service</th>
-                <th>Auto Is Payer Member Identifier Valid</th>
-                <th>Auto Detail Json</th>
-                <th>Auto Medicare Is Partbprimary</th>
-                <th>Auto Medicare Is Partbactive</th>
-                <th>Auto Medicare Is Partcactive</th>
-                <th>Auto Medicare Is Inpatient</th>
-                <th>Auto Medicare Is Hospice Or Home Health</th>
-                <th>Auto Medicare Is Msp</th>
-                <th>Auto Medicare Msp Memo</th>
-                <th>Auto Medicare Mpb Start Date</th>
-                <th>Auto Medicare Mpb End Date</th>
-                <th>Auto Medicare Mpb Deductible</th>
-                <th>Auto Medicare Mpb Remaining</th>
-                <th>Auto Medicare Mpb Insurance Type</th>
-                <th>Auto Medicare Mpb Insurance Type Label</th>
-                <th>Auto Medicare Mpb Coinsurance Percent</th>
-                <th>Auto Medicare Mpb Info Valid Until</th>
-                <th>Auto Medicare Mpb Info Valid Till</th>
-                <th>Auto Medicare Mpb Last Refreshed At</th>
-                <th>Was Successful</th>
-                <th>Reject Reason Code</th>
-                <th>Reject Reason Description</th>
-                <th>Follow Up Action Code</th>
-                <th>Follow Up Action Description</th>
-                <th>Details</th>
-                <th>Is Mcn Valid Number</th>
-                <th>Address Street Line1</th>
-                <th>Address Street Line2</th>
-                <th>Address City</th>
-                <th>Address State</th>
-                <th>Address Zip</th>
-                <th>Is Hospice</th>
-                <th>Mcn Response Detail</th>
-                <th>Billing Address</th>
-                <th>Reason Not Partb</th>
-                <th>Reason Not Partbmemo</th>
-                <th>Is Medicare Advantage</th>
-                <th>Medicare Advantage Plan</th>
-                <th>Mpb Active</th>
-                <th>Mpb Start Date</th>
-                <th>Mpb End Date</th>
-                <th>Mpb Deductible</th>
-                <th>Mpb Remaining</th>
-                <th>Mpb Insurance Type</th>
-                <th>Mpb Insurance Type Label</th>
-                <th>Mpb Coinsurance Percent</th>
-                <th>Mpb Info Valid Until</th>
-                <th>Mpb Info Valid Till</th>
-                <th>Mpb Last Refreshed At</th>
-                <th>Manual Determination Strategy</th>
-                <th>Manual Determination Category</th>
-                <th>Manual Determination Category Memo</th>
-                <th>Manual Detail Json</th>
-                <th>Manual Medicare Is Partbprimary</th>
-                <th>Manual Medicare Is Partbactive</th>
-                <th>Manual Medicare Is Partcactive</th>
-                <th>Manual Medicare Is Inpatient</th>
-                <th>Manual Medicare Is Hospice Or Home Health</th>
-                <th>Manual Medicare Is Msp</th>
-                <th>Manual Medicare Msp Memo</th>
-                <th>Manual Medicare Mpb Start Date</th>
-                <th>Manual Medicare Mpb End Date</th>
-                <th>Manual Medicare Mpb Deductible</th>
-                <th>Manual Medicare Mpb Remaining</th>
-                <th>Manual Medicare Mpb Insurance Type</th>
-                <th>Manual Medicare Mpb Insurance Type Label</th>
-                <th>Manual Medicare Mpb Coinsurance Percent</th>
-                <th>Manual Medicare Mpb Info Valid Until</th>
-                <th>Manual Medicare Mpb Info Valid Till</th>
-                <th>Manual Medicare Mpb Last Refreshed At</th>
-                <th>Auto Medicare Result Id</th>
-            </tr>
-        </thead>
+
         <tbody>
             @foreach($patient->primaryCoverages as $cpc)
             <tr>
@@ -533,7 +273,7 @@
                             </div>
                         </form>
                     </div>
-
+                    <hr/>
                     <div moe relative large>
                         <a href="" start show class="">Manual Determination</a>
 
@@ -555,7 +295,7 @@
                                     <option value="NOT_COVERED">Not Covered</option>
                                     <option value="INVALID">Invalid</option>
                                     <option value="UNKNOWN">Unknown</option>
-                                </select>                        
+                                </select>
                             </div>
                             <div class="form-group">
                                 <label for="" class="control-label">Manual Determination Category Memo</label>
@@ -670,7 +410,7 @@
                             </div>
                         </form>
                     </div>
-                    @endif 
+                    @endif
                     @if($cpc->plan_type == 'MEDICAID')
                     <div moe relative>
                         <a href="" start show class="">Refresh</a>
@@ -686,6 +426,7 @@
                             </div>
                         </form>
                     </div>
+                    <hr/>
                     <div moe relative large>
                         <a href="" start show class="">Manual Determination</a>
 
@@ -707,7 +448,7 @@
                                     <option value="NOT_COVERED">Not Covered</option>
                                     <option value="INVALID">Invalid</option>
                                     <option value="UNKNOWN">Unknown</option>
-                                </select>                        
+                                </select>
                             </div>
                             <div class="form-group">
                                 <label for="" class="control-label">Manual Determination Category Memo</label>
@@ -717,15 +458,15 @@
                                 <label for="" class="control-label">Manual Detail Json</label>
                                 <input type="text" name="manualDetailJson" class="form-control input-sm"/>
                             </div>
-                           
-                           
+
+
                             <div class="form-group text-nowrap mb-0">
                                 <button class="btn btn-sm btn-primary" submit>Submt</button>
                                 <button class="btn btn-sm btn-default border" close>Close</button>
                             </div>
                         </form>
                     </div>
-                    @endif 
+                    @endif
                     @if($cpc->plan_type == 'COMMERCIAL')
                     <div moe relative>
                         <a href="" start show class="">Refresh</a>
@@ -741,6 +482,7 @@
                             </div>
                         </form>
                     </div>
+                    <hr/>
                     <div moe relative large>
                         <a href="" start show class="">Manual Determination</a>
 
@@ -762,7 +504,7 @@
                                     <option value="NOT_COVERED">Not Covered</option>
                                     <option value="INVALID">Invalid</option>
                                     <option value="UNKNOWN">Unknown</option>
-                                </select>                        
+                                </select>
                             </div>
                             <div class="form-group">
                                 <label for="" class="control-label">Manual Determination Category Memo</label>
@@ -772,104 +514,284 @@
                                 <label for="" class="control-label">Manual Detail Json</label>
                                 <input type="text" name="manualDetailJson" class="form-control input-sm"/>
                             </div>
-                            
-                           
+
+
                             <div class="form-group text-nowrap mb-0">
                                 <button class="btn btn-sm btn-primary" submit>Submt</button>
                                 <button class="btn btn-sm btn-default border" close>Close</button>
                             </div>
                         </form>
                     </div>
-                    @endif 
+                    @endif
+                    @if($cpc->plan_type == 'MCR_ADV')
+                        <div moe relative>
+                            <a href="" start show class="">Refresh</a>
+
+                            <form url="/api/clientPrimaryCoverage/refreshCoverageForMcrAdv" class="mcp-theme-1">
+                                <input type="hidden" name="uid" value="{{$cpc->uid}}" class="form-control input-sm" />
+                                <div class="form-group">
+                                    <p>Refresh?</p>
+                                </div>
+                                <div class="form-group text-nowrap mb-0">
+                                    <button class="btn btn-sm btn-primary" submit>Submt</button>
+                                    <button class="btn btn-sm btn-default border" close>Close</button>
+                                </div>
+                            </form>
+                        </div>
+                        <hr/>
+                        <div moe relative large>
+                            <a href="" start show class="">Manual Determination</a>
+                            <form url="/api/clientPrimaryCoverage/manualDeterminationForMcrAdv" class="mcp-theme-1">
+                                <input type="hidden" name="uid" value="{{$cpc->uid}}" class="form-control input-sm" />
+                                <div class="form-group">
+                                    <label for="" class="control-label">Manual Determination Strategy</label>
+                                    <select  name="manualDeterminationStrategy" class="form-control input-sm">
+                                        <option value="">--select--</option>
+                                        <option value="REVIEWED_ELECTRONIC">Reviewed electronic</option>
+                                        <option value="CALLED_PAYER">Called payer</option>
+                                    </select>
+                                </div>
+                                <div class="form-group">
+                                    <label for="" class="control-label">Manual Determination Category</label>
+                                    <select  name="manualDeterminationCategory" class="form-control input-sm">
+                                        <option value="">--select--</option>
+                                        <option value="COVERED">Covered</option>
+                                        <option value="NOT_COVERED">Not Covered</option>
+                                        <option value="INVALID">Invalid</option>
+                                        <option value="UNKNOWN">Unknown</option>
+                                    </select>
+                                </div>
+                                <div class="form-group">
+                                    <label for="" class="control-label">Manual Determination Category Memo</label>
+                                    <input type="text" name="manualDeterminationCategoryMemo" class="form-control input-sm"/>
+                                </div>
+                                <div class="form-group">
+                                    <label for="" class="control-label">Manual Detail Json</label>
+                                    <input type="text" name="manualDetailJson" class="form-control input-sm"/>
+                                </div>
+
+                                <div class="form-group">
+                                    <label for="" class="control-label">Manual Is Payer Member Identifier Valid</label>
+                                    <select  name="manualIsPayerMemberIdentifierValid" class="form-control input-sm">
+                                        <option value="">--select--</option>
+                                        <option value="YES">Yes</option>
+                                        <option value="NO">No</option>
+                                        <option value="UNKNOWN">Unknown</option>
+                                    </select>
+                                </div>
+
+                                <div class="form-group">
+                                    <label for="" class="control-label">Manual Is Mcr Number Valid</label>
+                                    <select  name="manualIsMcrNumberValid" class="form-control input-sm">
+                                        <option value="">--select--</option>
+                                        <option value="YES">Yes</option>
+                                        <option value="NO">No</option>
+                                        <option value="UNKNOWN">Unknown</option>
+                                    </select>
+                                </div>
+
+                                <div class="form-group">
+                                    <label for="" class="control-label">Manual Is Mcr Part Bprimary</label>
+                                    <select  name="manualIsMcrPartBPrimary" class="form-control input-sm">
+                                        <option value="">--select--</option>
+                                        <option value="YES">Yes</option>
+                                        <option value="NO">No</option>
+                                        <option value="UNKNOWN">Unknown</option>
+                                    </select>
+                                </div>
+
+                                <div class="form-group">
+                                    <label for="" class="control-label">Manual Is Mcr Part C Active</label>
+                                    <select  name="manualIsMcrPartCActive" class="form-control input-sm">
+                                        <option value="">--select--</option>
+                                        <option value="YES">Yes</option>
+                                        <option value="NO">No</option>
+                                        <option value="UNKNOWN">Unknown</option>
+                                    </select>
+                                </div>
+
+                                <div class="form-group text-nowrap mb-0">
+                                    <button class="btn btn-sm btn-primary" submit>Submt</button>
+                                    <button class="btn btn-sm btn-default border" close>Close</button>
+                                </div>
+                            </form>
+                        </div>
+                    @endif
+                    @if($cpc->plan_type == 'MCD_MCO')
+                        <div moe relative>
+                            <a href="" start show class="">Refresh</a>
+
+                            <form url="/api/clientPrimaryCoverage/refreshCoverageForMcdMco" class="mcp-theme-1">
+                                <input type="hidden" name="uid" value="{{$cpc->uid}}" class="form-control input-sm" />
+                                <div class="form-group">
+                                    <p>Refresh?</p>
+                                </div>
+                                <div class="form-group text-nowrap mb-0">
+                                    <button class="btn btn-sm btn-primary" submit>Submt</button>
+                                    <button class="btn btn-sm btn-default border" close>Close</button>
+                                </div>
+                            </form>
+                        </div>
+                        <hr/>
+                        <div moe relative large>
+                            <a href="" start show class="">Manual Determination</a>
+                            <form url="/api/clientPrimaryCoverage/manualDeterminationForMcdMco" class="mcp-theme-1">
+                                <input type="hidden" name="uid" value="{{$cpc->uid}}" class="form-control input-sm" />
+                                <div class="form-group">
+                                    <label for="" class="control-label">Manual Determination Strategy</label>
+                                    <select  name="manualDeterminationStrategy" class="form-control input-sm">
+                                        <option value="">--select--</option>
+                                        <option value="REVIEWED_ELECTRONIC">Reviewed electronic</option>
+                                        <option value="CALLED_PAYER">Called payer</option>
+                                    </select>
+                                </div>
+                                <div class="form-group">
+                                    <label for="" class="control-label">Manual Determination Category</label>
+                                    <select  name="manualDeterminationCategory" class="form-control input-sm">
+                                        <option value="">--select--</option>
+                                        <option value="COVERED">Covered</option>
+                                        <option value="NOT_COVERED">Not Covered</option>
+                                        <option value="INVALID">Invalid</option>
+                                        <option value="UNKNOWN">Unknown</option>
+                                    </select>
+                                </div>
+                                <div class="form-group">
+                                    <label for="" class="control-label">Manual Determination Category Memo</label>
+                                    <input type="text" name="manualDeterminationCategoryMemo" class="form-control input-sm"/>
+                                </div>
+                                <div class="form-group">
+                                    <label for="" class="control-label">Manual Detail Json</label>
+                                    <input type="text" name="manualDetailJson" class="form-control input-sm"/>
+                                </div>
+
+                                <div class="form-group">
+                                    <label for="" class="control-label">Manual Is Mcd Number Valid</label>
+                                    <select  name="manualIsMcdNumberValid" class="form-control input-sm">
+                                        <option value="">--select--</option>
+                                        <option value="YES">Yes</option>
+                                        <option value="NO">No</option>
+                                        <option value="UNKNOWN">Unknown</option>
+                                    </select>
+                                </div>
+
+                                <div class="form-group">
+                                    <label for="" class="control-label">Manual Is Mcd Response Mco Active</label>
+                                    <select  name="manualIsMcdResponseMcoActive" class="form-control input-sm">
+                                        <option value="">--select--</option>
+                                        <option value="YES">Yes</option>
+                                        <option value="NO">No</option>
+                                        <option value="UNKNOWN">Unknown</option>
+                                    </select>
+                                </div>
+
+                                <div class="form-group text-nowrap mb-0">
+                                    <button class="btn btn-sm btn-primary" submit>Submt</button>
+                                    <button class="btn btn-sm btn-default border" close>Close</button>
+                                </div>
+                            </form>
+                        </div>
+                    @endif
+                </td>
+                <td>
+                    <table class="table table-sm table-bordered table-condensed">
+                        <tr><td>creation_strategy</td><td>{{$cpc->creation_strategy}}</td></tr>
+                        <tr><td>auto_refresh_of_client_primary_coverage_id</td><td>{{$cpc->auto_refresh_of_client_primary_coverage_id}}</td></tr>
+                        <tr><td>manual_determination_of_client_primary_coverage_id</td><td>{{$cpc->manual_determination_of_client_primary_coverage_id}}</td></tr>
+                        <tr><td>plan_type</td><td>{{$cpc->plan_type}}</td></tr>
+                        <tr><td>is_partbprimary</td><td>{{$cpc->is_partbprimary}}</td></tr>
+                        <tr><td>is_manually_determined</td><td>{{$cpc->is_manually_determined}}</td></tr>
+                        <tr><td>is_entry_error</td><td>{{$cpc->is_entry_error}}</td></tr>
+                        <tr><td>subscriber_name_first</td><td>{{$cpc->subscriber_name_first}}</td></tr>
+                        <tr><td>subscriber_name_last</td><td>{{$cpc->subscriber_name_last}}</td></tr>
+                        <tr><td>subscriber_sex</td><td>{{$cpc->subscriber_sex}}</td></tr>
+                        <tr><td>subscriber_dob</td><td>{{$cpc->subscriber_dob}}</td></tr>
+                        <tr><td>payer_member_identifier</td><td>{{$cpc->payer_member_identifier}}</td></tr>
+                        <tr><td>payer_name</td><td>{{$cpc->payer_name}}</td></tr>
+                        <tr><td>date_of_service</td><td>{{$cpc->date_of_service}}</td></tr>
+                    </table>
+                </td>
+                <td>
+                    <table class="table table-sm table-bordered table-condensed">
+                        <tr><td>auto_is_payer_member_identifier_valid</td><td>{{$cpc->auto_is_payer_member_identifier_valid}}</td></tr>
+                        <tr><td>auto_medicare_is_partbprimary</td><td>{{$cpc->auto_medicare_is_partbprimary}}</td></tr>
+                        <tr><td>auto_medicare_is_partbactive</td><td>{{$cpc->auto_medicare_is_partbactive}}</td></tr>
+                        <tr><td>auto_medicare_is_partcactive</td><td>{{$cpc->auto_medicare_is_partcactive}}</td></tr>
+                        <tr><td>auto_medicare_is_inpatient</td><td>{{$cpc->auto_medicare_is_inpatient}}</td></tr>
+                        <tr><td>auto_medicare_is_hospice_or_home_health</td><td>{{$cpc->auto_medicare_is_hospice_or_home_health}}</td></tr>
+                        <tr><td>auto_medicare_is_msp</td><td>{{$cpc->auto_medicare_is_msp}}</td></tr>
+                        <tr><td>auto_medicare_msp_memo</td><td>{{$cpc->auto_medicare_msp_memo}}</td></tr>
+                        <tr><td>auto_medicare_mpb_start_date</td><td>{{$cpc->auto_medicare_mpb_start_date}}</td></tr>
+                        <tr><td>auto_medicare_mpb_end_date</td><td>{{$cpc->auto_medicare_mpb_end_date}}</td></tr>
+                        <tr><td>auto_medicare_mpb_deductible</td><td>{{$cpc->auto_medicare_mpb_deductible}}</td></tr>
+                        <tr><td>auto_medicare_mpb_remaining</td><td>{{$cpc->auto_medicare_mpb_remaining}}</td></tr>
+                        <tr><td>auto_medicare_mpb_insurance_type</td><td>{{$cpc->auto_medicare_mpb_insurance_type}}</td></tr>
+                        <tr><td>auto_medicare_mpb_insurance_type_label</td><td>{{$cpc->auto_medicare_mpb_insurance_type_label}}</td></tr>
+                        <tr><td>auto_medicare_mpb_coinsurance_percent</td><td>{{$cpc->auto_medicare_mpb_coinsurance_percent}}</td></tr>
+                        <tr><td>auto_medicare_mpb_info_valid_until</td><td>{{$cpc->auto_medicare_mpb_info_valid_until}}</td></tr>
+                        <tr><td>auto_medicare_mpb_info_valid_till</td><td>{{$cpc->auto_medicare_mpb_info_valid_till}}</td></tr>
+                        <tr><td>auto_medicare_mpb_last_refreshed_at</td><td>{{$cpc->auto_medicare_mpb_last_refreshed_at}}</td></tr>
+                        <tr><td>was_successful</td><td>{{$cpc->was_successful}}</td></tr>
+                        <tr><td>reject_reason_code</td><td>{{$cpc->reject_reason_code}}</td></tr>
+                        <tr><td>reject_reason_description</td><td>{{$cpc->reject_reason_description}}</td></tr>
+                        <tr><td>follow_up_action_code</td><td>{{$cpc->follow_up_action_code}}</td></tr>
+                        <tr><td>follow_up_action_description</td><td>{{$cpc->follow_up_action_description}}</td></tr>
+                        <tr><td>details</td><td>{{$cpc->details}}</td></tr>
+                        <tr><td>is_mcn_valid_number</td><td>{{$cpc->is_mcn_valid_number}}</td></tr>
+                        <tr><td>address_street_line1</td><td>{{$cpc->address_street_line1}}</td></tr>
+                        <tr><td>address_street_line2</td><td>{{$cpc->address_street_line2}}</td></tr>
+                        <tr><td>address_city</td><td>{{$cpc->address_city}}</td></tr>
+                        <tr><td>address_state</td><td>{{$cpc->address_state}}</td></tr>
+                        <tr><td>address_zip</td><td>{{$cpc->address_zip}}</td></tr>
+                        <tr><td>is_hospice</td><td>{{$cpc->is_hospice}}</td></tr>
+                        <tr><td>mcn_response_detail</td><td>{{$cpc->mcn_response_detail}}</td></tr>
+                        <tr><td>billing_address</td><td>{{$cpc->billing_address}}</td></tr>
+                        <tr><td>reason_not_partb</td><td>{{$cpc->reason_not_partb}}</td></tr>
+                        <tr><td>reason_not_partbmemo</td><td>{{$cpc->reason_not_partbmemo}}</td></tr>
+                        <tr><td>is_medicare_advantage</td><td>{{$cpc->is_medicare_advantage}}</td></tr>
+                        <tr><td>medicare_advantage_plan</td><td>{{$cpc->medicare_advantage_plan}}</td></tr>
+                        <tr><td>mpb_active</td><td>{{$cpc->mpb_active}}</td></tr>
+                        <tr><td>mpb_start_date</td><td>{{$cpc->mpb_start_date}}</td></tr>
+                        <tr><td>mpb_end_date</td><td>{{$cpc->mpb_end_date}}</td></tr>
+                        <tr><td>mpb_deductible</td><td>{{$cpc->mpb_deductible}}</td></tr>
+                        <tr><td>mpb_remaining</td><td>{{$cpc->mpb_remaining}}</td></tr>
+                        <tr><td>mpb_insurance_type</td><td>{{$cpc->mpb_insurance_type}}</td></tr>
+                        <tr><td>mpb_insurance_type_label</td><td>{{$cpc->mpb_insurance_type_label}}</td></tr>
+                        <tr><td>mpb_coinsurance_percent</td><td>{{$cpc->mpb_coinsurance_percent}}</td></tr>
+                        <tr><td>mpb_info_valid_until</td><td>{{$cpc->mpb_info_valid_until}}</td></tr>
+                        <tr><td>mpb_info_valid_till</td><td>{{$cpc->mpb_info_valid_till}}</td></tr>
+                        <tr><td>mpb_last_refreshed_at</td><td>{{$cpc->mpb_last_refreshed_at}}</td></tr>
+                        <tr><td>manual_determination_strategy</td><td>{{$cpc->manual_determination_strategy}}</td></tr>
+                        <tr><td>manual_determination_category</td><td>{{$cpc->manual_determination_category}}</td></tr>
+                        <tr><td>manual_determination_category_memo</td><td>{{$cpc->manual_determination_category_memo}}</td></tr>
+                        <tr><td>manual_detail_json</td><td>{{$cpc->manual_detail_json}}</td></tr>
+                        <tr><td>manual_medicare_is_partbprimary</td><td>{{$cpc->manual_medicare_is_partbprimary}}</td></tr>
+                        <tr><td>manual_medicare_is_partbactive</td><td>{{$cpc->manual_medicare_is_partbactive}}</td></tr>
+                        <tr><td>manual_medicare_is_partcactive</td><td>{{$cpc->manual_medicare_is_partcactive}}</td></tr>
+                        <tr><td>manual_medicare_is_inpatient</td><td>{{$cpc->manual_medicare_is_inpatient}}</td></tr>
+                        <tr><td>manual_medicare_is_hospice_or_home_health</td><td>{{$cpc->manual_medicare_is_hospice_or_home_health}}</td></tr>
+                        <tr><td>manual_medicare_is_msp</td><td>{{$cpc->manual_medicare_is_msp}}</td></tr>
+                        <tr><td>manual_medicare_msp_memo</td><td>{{$cpc->manual_medicare_msp_memo}}</td></tr>
+                        <tr><td>manual_medicare_mpb_start_date</td><td>{{$cpc->manual_medicare_mpb_start_date}}</td></tr>
+                        <tr><td>manual_medicare_mpb_end_date</td><td>{{$cpc->manual_medicare_mpb_end_date}}</td></tr>
+                        <tr><td>manual_medicare_mpb_deductible</td><td>{{$cpc->manual_medicare_mpb_deductible}}</td></tr>
+                        <tr><td>manual_medicare_mpb_remaining</td><td>{{$cpc->manual_medicare_mpb_remaining}}</td></tr>
+                        <tr><td>manual_medicare_mpb_insurance_type</td><td>{{$cpc->manual_medicare_mpb_insurance_type}}</td></tr>
+                        <tr><td>manual_medicare_mpb_insurance_type_label</td><td>{{$cpc->manual_medicare_mpb_insurance_type_label}}</td></tr>
+                        <tr><td>manual_medicare_mpb_coinsurance_percent</td><td>{{$cpc->manual_medicare_mpb_coinsurance_percent}}</td></tr>
+                        <tr><td>manual_medicare_mpb_info_valid_until</td><td>{{$cpc->manual_medicare_mpb_info_valid_until}}</td></tr>
+                        <tr><td>manual_medicare_mpb_info_valid_till</td><td>{{$cpc->manual_medicare_mpb_info_valid_till}}</td></tr>
+                        <tr><td>manual_medicare_mpb_last_refreshed_at</td><td>{{$cpc->manual_medicare_mpb_last_refreshed_at}}</td></tr>
+                        <tr><td>auto_medicare_result_id</td><td>{{$cpc->auto_medicare_result_id}}</td></tr>
+                    </table>
+                </td>
+                <td>
+                    <table>
+                        <tr><td>auto_detail_json</td><td><pre>{{$cpc->auto_detail_json}}</pre></td></tr>
+                    </table>
                 </td>
-                <td>{{$cpc->creation_strategy}}</td>
-                <td>{{$cpc->auto_refresh_of_client_primary_coverage_id}}</td>
-                <td>{{$cpc->manual_determination_of_client_primary_coverage_id}}</td>
-                <td>{{$cpc->plan_type}}</td>
-                <td>{{$cpc->is_partbprimary}}</td>
-                <td>{{$cpc->is_manually_determined}}</td>
-                <td>{{$cpc->is_entry_error}}</td>
-                <td>{{$cpc->subscriber_name_first}}</td>
-                <td>{{$cpc->subscriber_name_last}}</td>
-                <td>{{$cpc->subscriber_sex}}</td>
-                <td>{{$cpc->subscriber_dob}}</td>
-                <td>{{$cpc->payer_member_identifier}}</td>
-                <td>{{$cpc->payer_name}}</td>
-                <td>{{$cpc->date_of_service}}</td>
-                <td>{{$cpc->auto_is_payer_member_identifier_valid}}</td>
-                <td>{{$cpc->auto_detail_json}}</td>
-                <td>{{$cpc->auto_medicare_is_partbprimary}}</td>
-                <td>{{$cpc->auto_medicare_is_partbactive}}</td>
-                <td>{{$cpc->auto_medicare_is_partcactive}}</td>
-                <td>{{$cpc->auto_medicare_is_inpatient}}</td>
-                <td>{{$cpc->auto_medicare_is_hospice_or_home_health}}</td>
-                <td>{{$cpc->auto_medicare_is_msp}}</td>
-                <td>{{$cpc->auto_medicare_msp_memo}}</td>
-                <td>{{$cpc->auto_medicare_mpb_start_date}}</td>
-                <td>{{$cpc->auto_medicare_mpb_end_date}}</td>
-                <td>{{$cpc->auto_medicare_mpb_deductible}}</td>
-                <td>{{$cpc->auto_medicare_mpb_remaining}}</td>
-                <td>{{$cpc->auto_medicare_mpb_insurance_type}}</td>
-                <td>{{$cpc->auto_medicare_mpb_insurance_type_label}}</td>
-                <td>{{$cpc->auto_medicare_mpb_coinsurance_percent}}</td>
-                <td>{{$cpc->auto_medicare_mpb_info_valid_until}}</td>
-                <td>{{$cpc->auto_medicare_mpb_info_valid_till}}</td>
-                <td>{{$cpc->auto_medicare_mpb_last_refreshed_at}}</td>
-                <td>{{$cpc->was_successful}}</td>
-                <td>{{$cpc->reject_reason_code}}</td>
-                <td>{{$cpc->reject_reason_description}}</td>
-                <td>{{$cpc->follow_up_action_code}}</td>
-                <td>{{$cpc->follow_up_action_description}}</td>
-                <td>{{$cpc->details}}</td>
-                <td>{{$cpc->is_mcn_valid_number}}</td>
-                <td>{{$cpc->address_street_line1}}</td>
-                <td>{{$cpc->address_street_line2}}</td>
-                <td>{{$cpc->address_city}}</td>
-                <td>{{$cpc->address_state}}</td>
-                <td>{{$cpc->address_zip}}</td>
-                <td>{{$cpc->is_hospice}}</td>
-                <td>{{$cpc->mcn_response_detail}}</td>
-                <td>{{$cpc->billing_address}}</td>
-                <td>{{$cpc->reason_not_partb}}</td>
-                <td>{{$cpc->reason_not_partbmemo}}</td>
-                <td>{{$cpc->is_medicare_advantage}}</td>
-                <td>{{$cpc->medicare_advantage_plan}}</td>
-                <td>{{$cpc->mpb_active}}</td>
-                <td>{{$cpc->mpb_start_date}}</td>
-                <td>{{$cpc->mpb_end_date}}</td>
-                <td>{{$cpc->mpb_deductible}}</td>
-                <td>{{$cpc->mpb_remaining}}</td>
-                <td>{{$cpc->mpb_insurance_type}}</td>
-                <td>{{$cpc->mpb_insurance_type_label}}</td>
-                <td>{{$cpc->mpb_coinsurance_percent}}</td>
-                <td>{{$cpc->mpb_info_valid_until}}</td>
-                <td>{{$cpc->mpb_info_valid_till}}</td>
-                <td>{{$cpc->mpb_last_refreshed_at}}</td>
-                <td>{{$cpc->manual_determination_strategy}}</td>
-                <td>{{$cpc->manual_determination_category}}</td>
-                <td>{{$cpc->manual_determination_category_memo}}</td>
-                <td>{{$cpc->manual_detail_json}}</td>
-                <td>{{$cpc->manual_medicare_is_partbprimary}}</td>
-                <td>{{$cpc->manual_medicare_is_partbactive}}</td>
-                <td>{{$cpc->manual_medicare_is_partcactive}}</td>
-                <td>{{$cpc->manual_medicare_is_inpatient}}</td>
-                <td>{{$cpc->manual_medicare_is_hospice_or_home_health}}</td>
-                <td>{{$cpc->manual_medicare_is_msp}}</td>
-                <td>{{$cpc->manual_medicare_msp_memo}}</td>
-                <td>{{$cpc->manual_medicare_mpb_start_date}}</td>
-                <td>{{$cpc->manual_medicare_mpb_end_date}}</td>
-                <td>{{$cpc->manual_medicare_mpb_deductible}}</td>
-                <td>{{$cpc->manual_medicare_mpb_remaining}}</td>
-                <td>{{$cpc->manual_medicare_mpb_insurance_type}}</td>
-                <td>{{$cpc->manual_medicare_mpb_insurance_type_label}}</td>
-                <td>{{$cpc->manual_medicare_mpb_coinsurance_percent}}</td>
-                <td>{{$cpc->manual_medicare_mpb_info_valid_until}}</td>
-                <td>{{$cpc->manual_medicare_mpb_info_valid_till}}</td>
-                <td>{{$cpc->manual_medicare_mpb_last_refreshed_at}}</td>
-                <td>{{$cpc->auto_medicare_result_id}}</td>
             </tr>
             @endforeach
         </tbody>
     </table>
 </div>
-@endsection
+@endsection

resources/views/app/patient/coverage-status.blade.php

@@ -0,0 +1,147 @@
+<div>
+    @php
+        $coverage = $patient->latestClientPrimaryCoverage;
+    @endphp
+    @if(!$coverage)
+        <span><b>No coverage info!</b></span>
+    @elseif($coverage->plan_type === 'MEDICARE')
+      @if($coverage->creation_strategy == 'NEW' || $coverage->creation_strategy == 'AUTO_REFRESH')
+      <table class="table table-sm table-bordered">
+        <tr>
+          <td class="font-weight-bold">Medicare Part B (Primary)</td>
+          <td>
+            @if($coverage->auto_medicare_is_partbprimary)
+              <span><i class="fas fa-check-circle text-success"></i> (auto)</span>
+            @elseif(!$coverage->auto_medicare_is_match_found)
+              <span><i class="fas fa-times text-danger"></i> record not found (auto)</span>
+            @else
+              <span><i class="fas fa-times text-danger"></i> not primary!</span> <br>
+              <span><i class="fas fa-check-circle text-success"></i> record found</span> <br>
+              <span><b>Part B:</b> {{$coverage->auto_medicare_is_partbactive}}</span> <br>
+              <span><b>Part C:</b> {{$coverage->auto_medicare_is_partcactive}}</span>
+            @endif
+          </td>
+        </tr>
+        @if($coverage->auto_medicare_is_partbactive)
+        <tr>
+          <td class="font-weight-bold">Part B Deductible</td>
+          <td>{{$coverage->auto_medicare_mpb_deductible ?? '-'}}</td>
+        </tr>
+        <tr>
+          <td class="font-weight-bold">Part B Remaining</td>
+          <td>{{$coverage->auto_medicare_mpb_remaining ?? '-'}}</td>
+        </tr>
+        @endif
+      </table>
+      @else
+      <table class="table table-sm table-bordered">
+        <tr>
+          <td class="font-weight-bold">Medicare Part B (Primary)</td>
+          <td>
+            @if($coverage->manual_medicare_is_partbprimary)
+              <span><i class="fas fa-check-circle text-success"></i>  ({{$coverage->manual_determination_strategy}})</span>
+            @elseif(!$coverage->manual_medicare_is_match_found)
+            <span><i class="fas fa-times text-danger"></i> record not found ({{$coverage->manual_determination_strategy}})</span>
+            @else
+            <span><i class="fas fa-times text-danger"></i> not primary! ({{$coverage->manual_determination_strategy}})</span> <br>
+            <span><i class="fas fa-check-circle text-success"></i> record found</span> <br>
+            <span><b>Part B:</b> {{$coverage->manual_medicare_is_partbactive}}</span> <br>
+            <span><b>Part C:</b> {{$coverage->manual_medicare_is_partcactive}}</span>
+            @endif
+          </td>
+        </tr>
+        @if($coverage->auto_medicare_is_partbactive)
+        <tr>
+          <td class="font-weight-bold">Part B Deductible</td>
+          <td>{{$coverage->auto_medicare_mpb_deductible ?? '-'}}</td>
+        </tr>
+        <tr>
+          <td class="font-weight-bold">Part B Remaining</td>
+          <td>{{$coverage->auto_medicare_mpb_remaining ?? '-'}}</td>
+        </tr>
+        @endif
+      </table>
+      @endif
+      <div class="w-50">
+        {{$coverage->manual_determination_category_memo}}
+      </div>
+
+    @elseif($coverage->plan_type === 'MEDICAID')
+      @if($coverage->creation_strategy == 'NEW' || $coverage->creation_strategy == 'AUTO_REFRESH')
+      <table class="table table-sm table-bordered">
+        <tr>
+          <td class="font-weight-bold">Medicaid (Primary):</td>
+          <td>
+            <span><b>{{$coverage->mcd_payer_name ?? '-'}}</b></span> <br>
+            <span><i class="fas fa-hourglass-half text-warning"></i> Pending Validation</span> <br>
+          </td>
+        </tr>
+        <tr>
+          <td class="font-weight-bold">Date Created:</td>
+          <td><span>{{date_format($coverage->created_at, 'm/d/Y')}}</span></td>
+        </tr>
+      </table>
+      @else
+        <table class="table table-sm table-bordered">
+          <tr>
+            <td class="font-weight-bold">Medicaid (Primary):</td>
+            <td>
+              <span><b>{{$coverage->mcd_payer_name ?? '-'}}</b></span> <br>
+              @if($coverage->manual_determination_category == 'COVERED')
+              <span><i class="fas fa-check-circle text-success"></i></span>
+              @elseif($coverage->manual_determination_category == 'NOT_COVERED')
+              <span><i class="fas fa-check-circle text-danger"></i> record found</span> <br>
+              <span><i class="fas fa-times text-danger"></i> not covered ({{$coverage->manual_determination_strategy}})</span>
+              @elseif($coverage->manual_determination_category == 'INVALID')
+              <span><i class="fas fa-times text-danger"></i> record not found ({{$coverage->manual_determination_strategy}})</span>
+              @else
+              <span><i class="fas fa-hourglass-half text-warning"></i> pending ({{$coverage->manual_determination_strategy}})</span>
+              @endif
+            </td>
+          </tr>
+        </table>
+      @endif
+      <div class="w-50">
+        {{$coverage->manual_determination_category_memo}}
+      </div>
+
+    @elseif($coverage->plan_type === 'COMMERCIAL')
+      @if($coverage->creation_strategy == 'NEW' || $coverage->creation_strategy == 'AUTO_REFRESH')
+      <table class="table table-sm table-bordered">
+        <tr>
+          <td class="font-weight-bold">Commercial (Primary):</td>
+          <td>
+            <span><b>{{$coverage->payer->name ?? '-'}}</b></span> <br>
+            <span><i class="fas fa-hourglass-half text-warning"></i> Pending Validation</span> <br>
+          </td>
+        </tr>
+        <tr>
+          <td class="font-weight-bold">Date Created:</td>
+          <td><span>{{date_format($coverage->created_at, 'm/d/Y')}}</span></td>
+        </tr>
+      </table>
+      @else
+        <table class="table table-sm table-bordered">
+          <tr>
+            <td class="font-weight-bold">Commercial (Primary):</td>
+            <td>
+              <span><b>{{$coverage->payer->name ?? '-'}}</b></span> <br>
+              @if($coverage->manual_determination_category == 'COVERED')
+              <span><i class="fas fa-check-circle text-success"></i></span>
+              @elseif($coverage->manual_determination_category == 'NOT_COVERED')
+              <span><i class="fas fa-check-circle text-danger"></i> record found</span> <br>
+              <span><i class="fas fa-times text-danger"></i> not covered ({{$coverage->manual_determination_strategy}})</span>
+              @elseif($coverage->manual_determination_category == 'INVALID')
+              <span><i class="fas fa-times text-danger"></i> record not found ({{$coverage->manual_determination_strategy}})</span>
+              @else
+              <span><i class="fas fa-hourglass-half text-warning"></i> pending ({{$coverage->manual_determination_strategy}})</span>
+              @endif
+            </td>
+          </tr>
+        </table>
+      @endif
+      <div class="w-50">
+        {{$coverage->manual_determination_category_memo}}
+      </div>
+    @endif
+</div>

resources/views/app/patient/primary-coverage-form.blade.php

@@ -0,0 +1,306 @@
+	<div id="new-coverage-form-{{$patient->uid}}">
+		<div class="p-3">
+			<form :url="url" class="mcp-theme-1" @submit.prevent="submitForm">
+				<input type="hidden" name="clientUid" value="{{$patient->uid}}" class="form-control input-sm" />
+				<div class="row">
+					<div class="form-group col-md-12">
+						<p class="mb-1 font-weight-bold">Type of insurance card:</p>
+						<div class="form-check form-check-inline">
+							<label class="form-check-label"><input class="form-check-input" type="radio" v-model="insuranceCardType" @change="updateUrl" name="insuranceCardType" value="medicare">Medicare Part B (Primary)</label>
+						</div>
+						<div class="form-check form-check-inline">
+							<label class="form-check-label"><input class="form-check-input" type="radio" v-model="insuranceCardType" @change="updateUrl" name="insuranceCardType" value="medicaid">Medicaid (Primary)</label>
+						</div>
+						<div class="form-check form-check-inline">
+							<label class="form-check-label"><input class="form-check-input" type="radio" v-model="insuranceCardType" @change="updateUrl" name="insuranceCardType" value="commercial">Commercial / Third Party (Primary)</label>
+						</div>
+					</div>
+				</div>
+
+				<div class="row" v-show="insuranceCardType == 'commercial'">
+					<div class="form-group col-md-12">
+						<label for="" class="control-label">Commercial Payer</label>
+						<input name="commercialPayerUidSuggest" class="form-control input-sm" value="" stag-suggest stag-suggest-ep="/search-payer/json" />
+						<input type="hidden" name="commercialPayerUid" />
+					</div>
+					<div class="form-group col-md-6">
+						<label class="control-label">Patient Member Identifier</label>
+						<input type="text" name="commercialMemberIdentifier"  class="form-control input-sm">
+					</div>
+					<div class="form-group col-md-6">
+						<label class="control-label">Patient Group Number</label>
+						<input type="text" name="commercialGroupNumber"  class="form-control input-sm">
+					</div>
+				</div>
+
+
+				<div class="row" v-if="insuranceCardType">
+					<div class="col-md-12 bg-light p-3 mb-2">
+						<h5 class="m-0 font-weight-bold">Patient Name / Demographics:</h5>
+					</div>
+					<div class="form-group col-md-4">
+						<label class="control-label">Patient First Name</label>
+						<input type="text" name="patientNameFirst" value="{{$patient->name_first}}" class="form-control input-sm">
+					</div>
+					<div class="form-group col-md-4">
+						<label class="control-label">Patient Middle Name / MI</label>
+						<input type="text" name="patientNameMiddle" value="{{$patient->name_middle}}" class="form-control input-sm">
+					</div>
+					<div class="form-group col-md-4">
+						<label class="control-label">Patient Last Name</label>
+						<input type="text" name="patientNameLast" value="{{$patient->name_last}}" class="form-control input-sm">
+					</div>
+					<div class="form-group col-md-4">
+						<label class="control-label">Patient Suffix</label>
+						<input type="text" name="patientNameSuffix" value="{{$patient->name_suffix}}" class="form-control input-sm">
+					</div>
+					<div class="form-group col-md-4">
+						<label class="control-label">Patient Sex</label>
+						<select class="form-control input-sm" name="patientSex" select2>
+							<option value="">--</option>
+							<option value="M">Male</option>
+							<option value="F">Female</option>
+							<option value="UNKNOWN">Unknown</option>
+						</select>
+					</div>
+					<div class="form-group col-md-4">
+						<label class="control-label">Patient Dob</label>
+						<input type="date" name="patientDob" value="{{$patient->dob}}" class="form-control input-sm">
+					</div>
+					<div class="form-group col-md-6">
+						<label class="control-label">Date Of Service</label>
+						<input type="date" name="dateOfService" value="{{date('Y-m-d')}}" class="form-control input-sm">
+					</div>
+				</div>
+				<div class="row">
+					<div class="form-group col-md-12" v-if="insuranceCardType == 'medicaid' || insuranceCardType == 'commercial'">
+						<p class="mb-1 font-weight-bold">Is Patient The Subscriber?</p>
+						<div class="form-check form-check-inline">
+							<label class="form-check-label"><input class="form-check-input" type="radio" name="isPatientSubscriber" v-model="isPatientSubscriber" value="1">Yes</label>
+						</div>
+						<div class="form-check form-check-inline">
+							<label class="form-check-label"><input class="form-check-input" type="radio" name="isPatientSubscriber" v-model="isPatientSubscriber" value="0">No</label>
+						</div>
+					</div>
+				</div>
+
+				<div v-if="isPatientSubscriber == 0 && (insuranceCardType == 'medicaid' || insuranceCardType == 'commercial')" class="row">
+					<div class="col-md-12 bg-light p-3 mb-2">
+						<h5 class="m-0 font-weight-bold">Subscriber Details:</h5>
+					</div>
+					<div class="form-group col-md-4">
+						<label class="control-label">Subscriber First Name</label>
+						<input type="text" name="subscriberNameFirst" value="{{$patient->name_first}}" class="form-control input-sm">
+					</div>
+					<div class="form-group col-md-4">
+						<label class="control-label">Subscriber Middle Name / MI</label>
+						<input type="text" name="subscriberNameMiddle" value="{{$patient->name_middle}}" class="form-control input-sm">
+					</div>
+					<div class="form-group col-md-4">
+						<label class="control-label">Subscriber Last Name</label>
+						<input type="text" name="subscriberNameLast" value="{{$patient->name_last}}" class="form-control input-sm">
+					</div>
+					<div class="form-group col-md-4">
+						<label class="control-label">Subscriber Suffix</label>
+						<input type="text" name="subscriberNameSuffix" value="{{$patient->name_suffix}}" class="form-control input-sm">
+					</div>
+					<div class="form-group col-md-4">
+						<label class="control-label">Subscriber Sex</label>
+						<select class="form-control input-sm" name="subscriberSex">
+							<option value="">--</option>
+							<option value="M">Male</option>
+							<option value="F">Female</option>
+							<option value="UNKNOWN">Unknown</option>
+						</select>
+					</div>
+					<div class="form-group col-md-4">
+						<label class="control-label">Subscriber Dob</label>
+						<input type="date" name="subscriberDob" value="{{$patient->dob}}" class="form-control input-sm">
+					</div>
+					<div class="form-group col-md-6">
+						<label class="control-label">What is the patient's relationship to the subscriber?</label>
+						<select name="patientRelationshipToSubscriber" class="form-control input-sm">
+							<option value="">--</option>
+							<option value="SPOUSE">Spouse</option>
+							<option value="CHILD">Child</option>
+							<option value="EMPLOYEE">Employee</option>
+							<option value="ORGAN_DONOR">Organ Donor</option>
+							<option value="CADAVER_DONOR">Cadaver Donor</option>
+							<option value="LIFE_PARTNER">Life Partner</option>
+							<option value="OTHER_RELATIONSHIP">Other Relationship</option>
+							<option value="UNKNOWN">Unknown</option>
+						</select>
+					</div>
+				</div>
+				<div class="mb-1" v-if="insuranceCardType == 'commercial'">
+					<p>Does the patient also have either a Medicare or Medicaid #? (optional)</p>
+				</div>
+				<div class="row" v-if="insuranceCardType == 'medicaid' || insuranceCardType == 'commercial'">
+					<div class="col-md-12 bg-light p-3 mb-2">
+						<h5 class="m-0 font-weight-bold">Medicaid Information:</h5>
+					</div>
+					<div class="form-group col-md-6">
+						<label for="" class="control-label">Medicaid State</label>
+						<input class="form-control input-sm" list="mcdPayer" name="mcdPayerUid" id="mcdPayerUid">
+						<datalist id="mcdPayer">
+							<option value="">--</option>
+							<option>MEDICAID ALABAMA</option>
+							<option>MEDICAID ALASKA</option>
+							<option>MEDICAID ARIZONA</option>
+							<option>MEDICAID ARKANSAS</option>
+							<option>MEDICAID CALIFORNIA MEDI-CAL</option>
+							<option>MEDICAID COLORADO</option>
+							<option>MEDICAID CONNECTICUT</option>
+							<option>MEDICAID DELAWARE</option>
+							<option>MEDICAID DISTRICT OF COLUMBIA</option>
+							<option>MEDICAID FLORIDA</option>
+							<option>MEDICAID GEORGIA</option>
+							<option>MEDICAID HAWAII</option>
+							<option>MEDICAID IDAHO</option>
+							<option>MEDICAID ILLINOIS</option>
+							<option>MEDICAID INDIANA</option>
+							<option>MEDICAID IOWA</option>
+							<option>MEDICAID KANSAS</option>
+							<option>MEDICAID KENTUCKY</option>
+							<option>MEDICAID LOUISIANA</option>
+							<option>MEDICAID MAINE</option>
+							<option>MEDICAID MARYLAND</option>
+							<option>MEDICAID MARYLAND DHMH</option>
+							<option>MEDICAID MASSACHUSETTS</option>
+							<option>MEDICAID MICHIGAN</option>
+							<option>MEDICAID MINNESOTA</option>
+							<option>MEDICAID MISSISSIPPI</option>
+							<option>MEDICAID MISSISSIPPI</option>
+							<option>MEDICAID MISSOURI</option>
+							<option>MEDICAID MONTANA</option>
+							<option>MEDICAID NEBRASKA</option>
+							<option>MEDICAID NEVADA</option>
+							<option>MEDICAID NEW HAMPSHIRE</option>
+							<option>MEDICAID NEW JERSEY</option>
+							<option>MEDICAID NEW MEXICO</option>
+							<option>MEDICAID NEW YORK</option>
+							<option>MEDICAID NEW YORK</option>
+							<option>MEDICAID NORTH CAROLINA</option>
+							<option>MEDICAID NORTH DAKOTA</option>
+							<option>MEDICAID OHIO</option>
+							<option>MEDICAID OKLAHOMA</option>
+							<option>MEDICAID OREGON</option>
+							<option>MEDICAID OREGON (DHS OMAP)</option>
+							<option>MEDICAID PENNSYLVANIA</option>
+							<option>MEDICAID RHODE ISLAND</option>
+							<option>MEDICAID SOUTH CAROLINA</option>
+							<option>MEDICAID SOUTH DAKOTA</option>
+							<option>MEDICAID TENNESSEE</option>
+							<option>MEDICAID TEXAS</option>
+							<option>MEDICAID TEXAS AND TEXAS HEALTH STEPS</option>
+							<option>MEDICAID UTAH</option>
+							<option>MEDICAID VERMONT</option>
+							<option>MEDICAID VIRGINIA</option>
+							<option>MEDICAID WASHINGTON (PROVIDER ONE)</option>
+							<option>MEDICAID WEST VIRGINIA</option>
+							<option>MEDICAID WISCONSIN</option>
+							<option>MEDICAID WYOMING</option>
+						</datalist>
+					</div>
+
+					<div class="form-group col-md-6">
+						<label class="control-label">Medicaid Number</label>
+						<input type="text" name="mcdNumber" class="form-control input-sm">
+					</div>
+				</div>
+
+				<div class="row" v-if="insuranceCardType == 'medicare' || insuranceCardType == 'commercial'">
+					<div class="col-md-12 bg-light p-3 mb-2">
+						<h5 class="m-0 font-weight-bold">Medicare Information:</h5>
+					</div>
+					<div class="form-group col-md-6">
+						<label class="control-label">Medicare Number</label>
+						<input type="text" name="mcrNumber" class="form-control input-sm">
+					</div>
+
+				</div>
+
+				<div v-if="response" :class="response.success ? 'alert success' : 'alert alert-danger'">
+					@{{ response.message }}
+				</div>
+
+				<div class="form-group text-nowrap mb-0">
+					<button v-if="!processing" class="btn btn-sm btn-primary" type="submit" :disabled="url == ''">Submt</button>
+					<button v-else class="btn btn-sm btn-primary" type="button"><i class="fas fa-circle-notch fa-spin"></i> Processing...</button>
+				</div>
+			</form>
+		</div>
+	</div>
+	<script>
+		(function() {
+			function init() {
+				new Vue({
+					el: '#new-coverage-form-{{$patient->uid}}',
+					delimiters: ['@{{', '}}'],
+					data: {
+						url: '',
+						insuranceCardType: '',
+						isPatientSubscriber: 1,
+						processing: false,
+						response: null
+					},
+					methods: {
+						updateUrl: function() {
+							if (this.insuranceCardType == 'medicare') {
+								this.url = '/api/clientPrimaryCoverage/createNewCoverageForMedicare';
+							}
+							if (this.insuranceCardType == 'medicaid') {
+								this.url = '/api/clientPrimaryCoverage/createNewCoverageForMedicaid';
+							}
+							if (this.insuranceCardType == 'commercial') {
+								this.url = '/api/clientPrimaryCoverage/createNewCoverageForCommercial';
+							}
+						},
+						onCommercialPayerChange: function() {
+							var input = $('input[name=commercialPayerUidSuggest]');
+							var hiddenInput = $('input[name=commercialPayerUid]');
+							input
+								.off('stag-suggest-selected')
+								.on('stag-suggest-selected', (e, input, _data) => {
+									hiddenInput.val(_data.uid);
+								});
+
+						},
+						submitForm: function(evt) {
+							var self = this;
+							if(self.processing) return;
+							var form = evt.target;
+							var data = $(form).serializeArray();
+							var url = $(form).attr('url');
+							if (!url) {
+								self.response = {
+									success: false,
+									message: 'Invalid url'
+								};
+								return;
+							}
+
+							self.processing = true;
+							$.post(url, data, function(response) {
+								self.processing = false;
+								if (response.success) {
+									closeStagPopup();
+									fastReload();
+								} else {
+									self.response = response;
+								}
+							}, 'json');
+						},
+						init: function() {
+							initStagSuggest();
+							this.onCommercialPayerChange();
+						}
+					},
+					mounted: function() {
+						this.init();
+					}
+				});
+			}
+			addMCInitializer('new-coverage-form-{{$patient->uid}}', init, '#new-coverage-form-{{$patient->uid}}')
+		}).call(window);
+	</script>

resources/views/app/patient/primary-coverage-manual-determination-commercial-modal.blade.php

@@ -0,0 +1,381 @@
+<div id="manual-determination-form-{{$patient->uid}}">
+	@php
+	$cpc = $patient->latestClientPrimaryCoverage;
+	@endphp
+	<div class="p-3">
+		<form @submit.prevent="submitForm" method="post" class="mcp-theme-1">
+			<input type="hidden" name="clientPrimaryCoverageUid" value="{{$cpc->uid}}" class="form-control input-sm" />
+			<div class="row">
+				<div class="form-group col-md-12">
+					<p class="mb-1">How did you manually check coverage?</p>
+					<div class="form-check form-check-inline">
+						<label class="form-check-label"><input class="form-check-input" type="radio" v-model="uiState.manualDeterminationStrategy" name="manualDeterminationStrategy" value="REVIEWED_ELECTRONIC" required>Reviewed Electronically</label>
+					</div>
+					<div class="form-check form-check-inline">
+						<label class="form-check-label"><input class="form-check-input" type="radio" v-model="uiState.manualDeterminationStrategy" name="manualDeterminationStrategy" value="CALLED_PAYER" required>Called Payer</label>
+					</div>
+				</div>
+			</div>
+			<div class="table-responsive">
+				<table class="table table-sm table-bordered table-striped">
+					<thead>
+						<tr>
+							<th></th>
+							<th>Automatic</th>
+							<th>Override</th>
+						</tr>
+					</thead>
+					<tbody>
+						<tr>
+							<td>Record Found?</td>
+							<td>{{$cpc->auto_commercial_is_match_found ? 'YES' : 'NO'}}</td>
+							<td>
+								<div class="form-group">
+									<div class="form-check form-check-inline">
+										<label class="form-check-label"><input class="form-check-input" type="radio" name="manualCommercialIsMatched" value="YES" @change="onInputChange">Yes</label>
+									</div>
+									<div class="form-check form-check-inline">
+										<label class="form-check-label"><input class="form-check-input" type="radio" name="manualCommercialIsMatched" value="NO" @change="onInputChange">No</label>
+									</div>
+								</div>
+							</td>
+						</tr>
+						<tr>
+							<td>Coverage Status?</td>
+							<td>UNKNOWN</td>
+							<td>
+								<select name="manualDeterminationCategory" class="form-control input-sm" @change="onInputChange">
+									<option value="">--select--</option>
+									<option value="COVERED" :selected="uiState.manualCommercialIsMatched == 'YES'">Covered</option>
+									<option value="NOT_COVERED">Not Covered</option>
+									<option value="INVALID" :selected="uiState.manualCommercialIsMatched == 'NO'">Invalid</option>
+									<option value="UNKNOWN">Unknown</option>
+								</select>
+							</td>
+						</tr>
+					</tbody>
+				</table>
+
+				@if($cpc->mcd_number)
+				<h5 class="mt-2 font-weight-bold">Medicaid Information Provided:</h5>
+				<table class="table table-bordered table-striped table-sm">
+					<tbody>
+						<tr>
+							<td>Medicaid Number</td>
+							<td>{{$cpc->mcd_number ?? '-'}}</td>
+						</tr>
+						<tr>
+							<td>Medicaid State</td>
+							<td>{{$cpc->mcd_payer_name ?? '-'}}</td>
+						</tr>
+						<tr>
+							<td>Was Medicaid Record Found?</td>
+							<td>{{$cpc->auto_medicaid_is_match_found ? 'Yes' : 'No'}}</td>
+						</tr>
+					</tbody>
+				</table>
+				@endif
+
+				@if($cpc->mcr_number)
+				<h5 class="mt-2 font-weight-bold">Medicare Information Provided:</h5>
+				<table class="table table-bordered table-striped table-sm">
+					<thead>
+						<tr>
+							<th></th>
+							<th>Automatic</th>
+							<th>Override</th>
+						</tr>
+					</thead>
+					<tbody>
+						<tr>
+							<td>Record Found?</td>
+							<td>{{$cpc->auto_medicare_is_match_found ? 'YES' : 'NO'}}</td>
+							<td>
+								<div class="form-group mb-0">
+									<div class="form-check form-check-inline">
+										<label class="form-check-label"><input class="form-check-input" type="radio" name="manualMedicareIsMatched" value="YES" @click="onInputChange">Yes</label>
+									</div>
+									<div class="form-check form-check-inline">
+										<label class="form-check-label"><input class="form-check-input" type="radio" name="manualMedicareIsMatched" value="NO" @click="onInputChange">No</label>
+									</div>
+								</div>
+							</td>
+						</tr>
+						<tr>
+							<td>Part B Active?</td>
+							<td>{{$cpc->auto_medicare_is_partbactive}}</td>
+							<td>
+								<div class="form-group mb-0">
+									<div class="form-check form-check-inline">
+										<label class="form-check-label"><input class="form-check-input" type="radio" name="manualMedicareIsPartBActive" @click="onInputChange" value="YES">Yes</label>
+									</div>
+									<div class="form-check form-check-inline">
+										<label class="form-check-label"><input class="form-check-input" type="radio" name="manualMedicareIsPartBActive" @click="onInputChange" value="NO">No</label>
+									</div>
+									<div class="form-check form-check-inline">
+										<label class="form-check-label"><input class="form-check-input" type="radio" name="manualMedicareIsPartBActive" @click="onInputChange" value="UNKNOWN">Unknown</label>
+									</div>
+								</div>
+							</td>
+						</tr>
+						<tr>
+							<td>Is Part B Primary?</td>
+							<td>{{$cpc->auto_medicare_is_partbprimary}}</td>
+							<td>
+								<div class="form-group mb-0">
+									<div class="form-check form-check-inline">
+										<label class="form-check-label"><input class="form-check-input" type="radio" name="manualMedicareIsPartBPrimary" @click="onInputChange" value="YES">Yes</label>
+									</div>
+									<div class="form-check form-check-inline">
+										<label class="form-check-label"><input class="form-check-input" type="radio" name="manualMedicareIsPartBPrimary" @click="onInputChange" value="NO">No</label>
+									</div>
+									<div class="form-check form-check-inline">
+										<label class="form-check-label"><input class="form-check-input" type="radio" name="manualMedicareIsPartBPrimary" @click="onInputChange" value="UNKNOWN">Unknown</label>
+									</div>
+								</div>
+							</td>
+						</tr>
+						<tr>
+							<td>Is Part C Active?</td>
+							<td>{{$cpc->auto_medicare_is_partcactive}}</td>
+							<td>
+								<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')">
+									Oops! Patient Medicare Part B Primary is set to <b>Yes</b>.
+								</div>
+								<div class="form-group mb-0">
+									<div class="form-check form-check-inline">
+										<label class="form-check-label"><input class="form-check-input" type="radio" name="manualMedicareIsPartCActive" @click="onInputChange" value="YES">Yes</label>
+									</div>
+									<div class="form-check form-check-inline">
+										<label class="form-check-label"><input class="form-check-input" type="radio" name="manualMedicareIsPartCActive" @click="onInputChange" value="NO">No</label>
+									</div>
+									<div class="form-check form-check-inline">
+										<label class="form-check-label"><input class="form-check-input" type="radio" name="manualMedicareIsPartCActive" @click="onInputChange" value="UNKNOWN">Unknown</label>
+									</div>
+								</div>
+							</td>
+						</tr>
+						<tr>
+							<td>Inpatient?</td>
+							<td>{{$cpc->auto_medicare_is_inpatient}}</td>
+							<td>
+								<div class="form-group mb-0">
+									<div class="form-check form-check-inline">
+										<label class="form-check-label"><input class="form-check-input" type="radio" name="manualMedicareIsInpatient" @click="onInputChange" value="YES">Yes</label>
+									</div>
+									<div class="form-check form-check-inline">
+										<label class="form-check-label"><input class="form-check-input" type="radio" name="manualMedicareIsInpatient" @click="onInputChange" value="NO">No</label>
+									</div>
+									<div class="form-check form-check-inline">
+										<label class="form-check-label"><input class="form-check-input" type="radio" name="manualMedicareIsInpatient" @click="onInputChange" value="UNKNOWN">Unknown</label>
+									</div>
+								</div>
+							</td>
+						</tr>
+						<tr>
+							<td>Hospice?</td>
+							<td>UNKNOWN</td>
+							<td>
+								<div class="form-group mb-0">
+									<div class="form-check form-check-inline">
+										<label class="form-check-label"><input class="form-check-input" type="radio" name="manualMedicareIsHospice" @click="onInputChange" value="YES">Yes</label>
+									</div>
+									<div class="form-check form-check-inline">
+										<label class="form-check-label"><input class="form-check-input" type="radio" name="manualMedicareIsHospice" @click="onInputChange" value="NO">No</label>
+									</div>
+									<div class="form-check form-check-inline">
+										<label class="form-check-label"><input class="form-check-input" type="radio" name="manualMedicareIsHospice" @click="onInputChange" value="UNKNOWN">Unknown</label>
+									</div>
+								</div>
+							</td>
+						</tr>
+						<tr>
+							<td>Home Health?</td>
+							<td>UNKNOWN</td>
+							<td>
+								<div class="form-group mb-0">
+									<div class="form-check form-check-inline">
+										<label class="form-check-label"><input class="form-check-input" type="radio" name="manualMedicareIsHomeHealth" @click="onInputChange" value="YES">Yes</label>
+									</div>
+									<div class="form-check form-check-inline">
+										<label class="form-check-label"><input class="form-check-input" type="radio" name="manualMedicareIsHomeHealth" @click="onInputChange" value="NO">No</label>
+									</div>
+									<div class="form-check form-check-inline">
+										<label class="form-check-label"><input class="form-check-input" type="radio" name="manualMedicareIsHomeHealth" @click="onInputChange" value="UNKNOWN">Unknown</label>
+									</div>
+								</div>
+							</td>
+						</tr>
+						<tr>
+							<td>MSP?</td>
+							<td>{{$cpc->auto_medicare_is_msp}}</td>
+							<td>
+								<div class="form-group mb-0">
+									<div class="form-check form-check-inline">
+										<label class="form-check-label"><input class="form-check-input" type="radio" name="manualMedicareIsMsp" @click="onInputChange" value="YES">Yes</label>
+									</div>
+									<div class="form-check form-check-inline">
+										<label class="form-check-label"><input class="form-check-input" type="radio" name="manualMedicareIsMsp" @click="onInputChange" value="NO">No</label>
+									</div>
+									<div class="form-check form-check-inline">
+										<label class="form-check-label"><input class="form-check-input" type="radio" name="manualMedicareIsMsp" @click="onInputChange" value="UNKNOWN">Unknown</label>
+									</div>
+								</div>
+							</td>
+						</tr>
+					</tbody>
+				</table>
+				@endif
+
+
+			</div>
+			<div class="row">
+				<div class="form-group col-md-12">
+					<label for="" class="control-label">Memo</label>
+					<textarea name="manualDeterminationCategoryMemo" class="form-control"></textarea>
+				</div>
+			</div>
+
+
+			<div v-if="response" :class="response.success ? 'alert success' : 'alert alert-danger'">
+				@{{ response.message }}
+			</div>
+
+			<div class="form-group text-nowrap mb-0">
+				<button v-if="!processing" class="btn btn-sm btn-primary" type="submit" :disabled="url == '' || disabled === true">Submt</button>
+				<button v-else class="btn btn-sm btn-primary" type="button"><i class="fas fa-circle-notch fa-spin"></i> Processing...</button>
+			</div>
+		</form>
+	</div>
+</div>
+<script>
+	(function() {
+			function init() {
+				new Vue({
+						el: '#manual-determination-form-{{$patient->uid}}',
+						delimiters: ['@{{', '}}'],
+						data: {
+							url: '/api/clientPrimaryCoverage/manualDeterminationForCommercial',
+							uiState: {
+								manualCommercialIsMatched: null,
+								manualDeterminationCategory: null,
+								manualMedicareIsPartBActive: null,
+								manualMedicareIsPartBPrimary: null,
+								manualMedicareIsPartCActive: null,
+								manualMedicareIsInpatient: null,
+								manualMedicareIsHospice: null,
+								manualMedicareIsHomeHealth: null,
+								manualMedicareIsMsp: null,
+
+								manualMedicareIsMatched: null,
+
+							},
+							cpc: <?= json_encode($cpc); ?>,
+							processing: false,
+							response: null,
+							disabled: false
+						},
+						methods: {
+							onInputChange: function(evt) {
+								var input = evt.target;
+								var name = input.name;
+								var nameLowerCase = name.toLowerCase();
+								var value = input.value;
+								this.uiState[name] = value;
+
+								if(/medicare/gi.test(nameLowerCase)){
+									if(value === 'YES') this.uiState.manualMedicareIsMatched = 'YES';
+								}
+
+								if (name === 'manualMedicareIsPartBPrimary') {
+									if (value === 'YES') this.uiState.manualMedicareIsPartBActive = 'YES';
+								}
+								if (name === 'manualMedicareIsPartCActive') {
+									if (value === 'YES') this.uiState.manualMedicareIsPartBActive = 'NO';
+								}
+								if (name === 'manualDeterminationCategory') {
+									if (value === 'INVALID' || value === 'UNKNOWN') {
+										this.setUiStateDefaultValue('NO');
+										return;
+									}
+								}
+
+								if (this.uiState.manualMedicareIsMatched === 'NO') {
+									this.setUiStateDefaultValue('NO', 'medicare');
+									return;
+								}
+
+								this.refreshUi();
+							},
+							setUiStateDefaultValue: function(value, type) {
+								var self = this;
+								for (var fieldName in self.uiState) {
+									if (type) {
+										var fieldNameLowerCase = fieldName.toLowerCase();
+										var typeRegex = RegExp(type, 'g');
+										var isMatchFound = typeRegex.test(fieldNameLowerCase);
+										if(isMatchFound){
+											self.uiState[fieldName] = value;
+										}
+										}
+										else {
+											self.uiState[fieldName] = value;
+										}
+									}
+									self.refreshUi();
+								},
+								submitForm: function(evt) {
+										var self = this;
+										if (self.processing) return;
+										var form = evt.target;
+										var data = $(form).serializeArray();
+										var url = self.url;
+										if (!url) {
+											self.response = {
+												success: false,
+												message: 'Invalid url'
+											};
+											return;
+										}
+
+										self.processing = true;
+										$.post(url, data, function(response) {
+											self.processing = false;
+											if (response.success) {
+												closeStagPopup();
+												fastReload();
+											} else {
+												self.response = response;
+											}
+										}, 'json');
+									},
+									refreshUi: function() {
+										var self = this;
+										$("input[type=radio]").prop('checked', false);
+										for (var fieldName in self.uiState) {
+											var value = self.uiState[fieldName];
+											if (value) {
+												$("input[name=" + fieldName + "][type=radio][value=" + value + "]").prop('checked', true);
+											}
+										}
+										self.disabled = (self.cpc.auto_medicare_is_partcactive == 'YES' && self.cpc.auto_medicare_is_partbprimary == 'YES') || (self.uiState.manualMedicareIsPartBPrimary == 'YES' && self.uiState.manualMedicareIsPartCActive == 'YES');
+									},
+							},
+							mounted: function() {
+								if (this.cpc.auto_medicare_is_partbprimary == 'YES') {
+									this.uiState.manualMedicareIsPartBPrimary = 'YES';
+									this.uiState.manualMedicareIsPartCActive = 'NO';
+									this.uiState.manualMedicareIsPartBActive = 'YES';
+								};
+								this.uiState.manualMedicareIsMatched = this.cpc.auto_medicare_is_partbactive;
+								this.uiState.manualCommercialIsMatched = this.cpc.auto_commercial_is_match_found ? 'YES' : 'NO';
+								if (this.cpc.auto_commercial_is_match_found === 'NO') {
+									this.uiState.manualDeterminationCategory = 'INVALID';
+								}
+								this.refreshUi();
+							}
+						});
+				}
+				addMCInitializer('manual-determination-form-{{$patient->uid}}', init, '#manual-determination-form-{{$patient->uid}}')
+			}).call(window);
+</script>

resources/views/app/patient/primary-coverage-manual-determination-medicaid-modal.blade.php

@@ -0,0 +1,155 @@
+<div id="manual-determination-form-{{$patient->uid}}">
+	@php
+	$cpc = $patient->latestClientPrimaryCoverage;
+	@endphp
+	<div class="p-3">
+		<form @submit.prevent="submitForm" method="post" class="mcp-theme-1">
+			<input type="hidden" name="clientPrimaryCoverageUid" value="{{$cpc->uid}}" class="form-control input-sm" />
+			<div class="row">
+				<div class="form-group col-md-12">
+					<p class="mb-1">How did you manually check coverage?</p>
+					<div class="form-check form-check-inline">
+						<label class="form-check-label"><input class="form-check-input" type="radio" v-model="uiState.manualDeterminationStrategy" name="manualDeterminationStrategy" value="REVIEWED_ELECTRONIC" required>Reviewed Electronically</label>
+					</div>
+					<div class="form-check form-check-inline">
+						<label class="form-check-label"><input class="form-check-input" type="radio" v-model="uiState.manualDeterminationStrategy" name="manualDeterminationStrategy" value="CALLED_PAYER" required>Called Payer</label>
+					</div>
+				</div>
+			</div>
+			<div class="table-responsive">
+				<table class="table table-sm table-bordered table-striped">
+					<thead>
+						<tr>
+							<th></th>
+							<th>Automatic</th>
+							<th>Override</th>
+						</tr>
+					</thead>
+					<tbody>
+						<tr>
+							<td>Record Found?</td>
+							<td>{{$cpc->auto_medicaid_is_match_found ? 'YES' : 'NO'}}</td>
+							<td>
+								<div class="form-group">
+									<div class="form-check form-check-inline">
+										<label class="form-check-label"><input class="form-check-input" type="radio" name="manualMedicaidIsMatched" value="YES" :checked="uiState.manualMedicaidIsMatched === 'YES'" @change="inputChange">Yes</label>
+									</div>
+									<div class="form-check form-check-inline">
+										<label class="form-check-label"><input class="form-check-input" type="radio" name="manualMedicaidIsMatched" value="NO" :checked="uiState.manualMedicaidIsMatched === 'NO'" @change="inputChange">No</label>
+									</div>
+								</div>
+							</td>
+						</tr>
+						<tr>
+							<td>Coverage Status?</td>
+							<td>UNKNOWN</td>
+							<td>
+								<select name="manualDeterminationCategory" class="form-control input-sm" @change="inputChange">
+									<option value="">--select--</option>
+									<option value="COVERED" :selected="uiState.manualMedicaidIsMatched == 'YES'">Covered</option>
+									<option value="NOT_COVERED">Not Covered</option>
+									<option value="INVALID" :selected="uiState.manualMedicaidIsMatched == 'NO'">Invalid</option>
+									<option value="UNKNOWN">Unknown</option>
+								</select>
+							</td>
+						</tr>
+					</tbody>
+				</table>
+			</div>
+			<div class="row">
+				<div class="form-group col-md-12">
+					<label for="" class="control-label">Memo</label>
+					<textarea name="manualDeterminationCategoryMemo" class="form-control"></textarea>
+				</div>
+			</div>
+
+
+			<div v-if="response" :class="response.success ? 'alert success' : 'alert alert-danger'">
+				@{{ response.message }}
+			</div>
+
+			<div class="form-group text-nowrap mb-0">
+				<button v-if="!processing" class="btn btn-sm btn-primary" type="submit" :disabled="url == ''">Submt</button>
+				<button v-else class="btn btn-sm btn-primary" type="button"><i class="fas fa-circle-notch fa-spin"></i> Processing...</button>
+			</div>
+		</form>
+	</div>
+</div>
+
+<script>
+	(function() {
+		function init() {
+			new Vue({
+				el: '#manual-determination-form-{{$patient->uid}}',
+				delimiters: ['@{{', '}}'],
+				data: {
+					url: '/api/clientPrimaryCoverage/manualDeterminationForMedicaid',
+					uiState: {},
+					cpc: <?= json_encode($cpc); ?>,
+					processing: false,
+					response: null
+				},
+				methods: {
+					inputChange: function(evt){
+						var self = this;
+						var input = evt.target;
+						var name = input.name;
+						var value = input.value;
+						self.uiState[name] = value;
+						if(name == 'manualDeterminationCategory') {
+							if(self.uiState.manualDeterminationCategory === 'COVERED'){
+								self.uiState.manualMedicaidIsMatched = "YES";
+							}
+							if(self.uiState.manualDeterminationCategory === 'INVALID'){
+								self.uiState.manualMedicaidIsMatched = "NO";
+							}
+						}
+
+						if(name === 'manualMedicaidIsMatched'){
+							if(value === 'YES') self.uiState.manualDeterminationCategory = 'COVERED';
+							if(value === 'NO') self.uiState.manualDeterminationCategory = 'INVALID';
+						}
+						self.$forceUpdate();
+
+					},
+					submitForm: function(evt) {
+						var self = this;
+						if (self.processing) return;
+						var form = evt.target;
+						var data = $(form).serializeArray();
+						var url = self.url;
+						if (!url) {
+							self.response = {
+								success: false,
+								message: 'Invalid url'
+							};
+							return;
+						}
+
+						self.processing = true;
+						$.post(url, data, function(response) {
+							self.processing = false;
+							if (response.success) {
+								closeStagPopup();
+								fastReload();
+							} else {
+								self.response = response;
+							}
+						}, 'json');
+					},
+					setDefaultData: function(){
+						var self = this;
+						self.uiState.manualMedicaidIsMatched = this.cpc.auto_medicaid_is_match_found ? 'YES' : 'NO';
+						self.$forceUpdate();
+						console.log({uiState: self.uiState});
+
+					},
+				},
+				mounted: function() {
+					this.setDefaultData();
+				}
+			});
+		}
+		addMCInitializer('manual-determination-form-{{$patient->uid}}', init, '#manual-determination-form-{{$patient->uid}}')
+	}).call(window);
+</script>

resources/views/app/patient/primary-coverage-manual-determination-medicare-modal.blade.php

@@ -0,0 +1,336 @@
+<div id="manual-determination-form-{{$patient->uid}}">
+	@php
+	$cpc = $patient->latestClientPrimaryCoverage;
+	@endphp
+	<div class="p-3">
+		<form @submit.prevent="submitForm" method="post" class="mcp-theme-1">
+			<input type="hidden" name="clientPrimaryCoverageUid" value="{{$cpc->uid}}" class="form-control input-sm" />
+			<div class="row">
+				<div class="form-group col-md-12">
+					<p class="mb-1">How did you manually check coverage?</p>
+					<div class="form-check form-check-inline">
+						<label class="form-check-label"><input class="form-check-input" type="radio" v-model="uiState.manualDeterminationStrategy" name="manualDeterminationStrategy" value="REVIEWED_ELECTRONIC" required>Reviewed Electronically</label>
+					</div>
+					<div class="form-check form-check-inline">
+						<label class="form-check-label"><input class="form-check-input" type="radio" v-model="uiState.manualDeterminationStrategy" name="manualDeterminationStrategy" value="CALLED_PAYER" required>Called Payer</label>
+					</div>
+				</div>
+			</div>
+			<div class="table-responsive">
+				<table class="table table-sm table-bordered table-striped">
+					<thead>
+						<tr>
+							<th></th>
+							<th>Automatic</th>
+							<th>Override</th>
+						</tr>
+					</thead>
+					<tbody>
+						<tr>
+							<td>Record Found?</td>
+							<td>{{$cpc->auto_medicare_is_match_found ? 'YES' : 'NO'}}</td>
+							<td>
+								<div class="form-group mb-0">
+									<div class="form-check form-check-inline">
+										<label class="form-check-label"><input class="form-check-input" type="radio"  name="manualMedicareIsMatched" value="YES" @click="onInputChange">Yes</label>
+									</div>
+									<div class="form-check form-check-inline">
+										<label class="form-check-label"><input class="form-check-input" type="radio" name="manualMedicareIsMatched" value="NO" @click="onInputChange">No</label>
+									</div>
+								</div>
+							</td>
+						</tr>
+
+
+
+						<tr>
+							<td>Part B Active?</td>
+							<td>{{$cpc->auto_medicare_is_partbactive}}</td>
+							<td>
+								<div class="form-group mb-0">
+									<div class="form-check form-check-inline">
+										<label class="form-check-label"><input class="form-check-input" type="radio" name="manualMedicareIsPartBActive" @click="onInputChange" value="YES">Yes</label>
+									</div>
+									<div class="form-check form-check-inline">
+										<label class="form-check-label"><input class="form-check-input" type="radio" name="manualMedicareIsPartBActive" @click="onInputChange" value="NO">No</label>
+									</div>
+									<div class="form-check form-check-inline">
+										<label class="form-check-label"><input class="form-check-input" type="radio" name="manualMedicareIsPartBActive" @click="onInputChange" value="UNKNOWN">Unknown</label>
+									</div>
+								</div>
+							</td>
+						</tr>
+						<tr>
+							<td>Is Part B Primary?</td>
+							<td>{{$cpc->auto_medicare_is_partbprimary}}</td>
+							<td>
+							<input type="hidden" name="manualDeterminationCategory" />
+
+								<div class="form-group mb-0">
+									<div class="form-check form-check-inline">
+										<label class="form-check-label"><input class="form-check-input" type="radio" name="manualMedicareIsPartBPrimary" @click="onInputChange" value="YES">Yes</label>
+									</div>
+									<div class="form-check form-check-inline">
+										<label class="form-check-label"><input class="form-check-input" type="radio" name="manualMedicareIsPartBPrimary" @click="onInputChange" value="NO">No</label>
+									</div>
+									<div class="form-check form-check-inline">
+										<label class="form-check-label"><input class="form-check-input" type="radio" name="manualMedicareIsPartBPrimary" @click="onInputChange" value="UNKNOWN">Unknown</label>
+									</div>
+								</div>
+							</td>
+						</tr>
+						<tr>
+							<td>Is Part C Active?</td>
+							<td>{{$cpc->auto_medicare_is_partcactive}}</td>
+							<td>
+								<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')">
+									Oops! Patient Medicare Part B Primary is set to <b>Yes</b>.
+								</div>
+								<div class="form-group mb-0">
+									<div class="form-check form-check-inline">
+										<label class="form-check-label"><input class="form-check-input" type="radio" name="manualMedicareIsPartCActive" @click="onInputChange" value="YES">Yes</label>
+									</div>
+									<div class="form-check form-check-inline">
+										<label class="form-check-label"><input class="form-check-input" type="radio" name="manualMedicareIsPartCActive" @click="onInputChange" value="NO">No</label>
+									</div>
+									<div class="form-check form-check-inline">
+										<label class="form-check-label"><input class="form-check-input" type="radio" name="manualMedicareIsPartCActive" @click="onInputChange" value="UNKNOWN">Unknown</label>
+									</div>
+								</div>
+							</td>
+						</tr>
+						<tr>
+							<td>Inpatient?</td>
+							<td>{{$cpc->auto_medicare_is_inpatient}}</td>
+							<td>
+								<div class="form-group mb-0">
+									<div class="form-check form-check-inline">
+										<label class="form-check-label"><input class="form-check-input" type="radio" name="manualMedicareIsInpatient" @click="onInputChange" value="YES">Yes</label>
+									</div>
+									<div class="form-check form-check-inline">
+										<label class="form-check-label"><input class="form-check-input" type="radio" name="manualMedicareIsInpatient" @click="onInputChange" value="NO">No</label>
+									</div>
+									<div class="form-check form-check-inline">
+										<label class="form-check-label"><input class="form-check-input" type="radio" name="manualMedicareIsInpatient" @click="onInputChange" value="UNKNOWN">Unknown</label>
+									</div>
+								</div>
+							</td>
+						</tr>
+						<tr>
+							<td>Hospice?</td>
+							<td>UNKNOWN</td>
+							<td>
+								<div class="form-group mb-0">
+									<div class="form-check form-check-inline">
+										<label class="form-check-label"><input class="form-check-input" type="radio" name="manualMedicareIsHospice" @click="onInputChange" value="YES">Yes</label>
+									</div>
+									<div class="form-check form-check-inline">
+										<label class="form-check-label"><input class="form-check-input" type="radio" name="manualMedicareIsHospice" @click="onInputChange" value="NO">No</label>
+									</div>
+									<div class="form-check form-check-inline">
+										<label class="form-check-label"><input class="form-check-input" type="radio" name="manualMedicareIsHospice" @click="onInputChange" value="UNKNOWN">Unknown</label>
+									</div>
+								</div>
+							</td>
+						</tr>
+						<tr>
+							<td>Home Health?</td>
+							<td>UNKNOWN</td>
+							<td>
+								<div class="form-group mb-0">
+									<div class="form-check form-check-inline">
+										<label class="form-check-label"><input class="form-check-input" type="radio" name="manualMedicareIsHomeHealth" @click="onInputChange" value="YES">Yes</label>
+									</div>
+									<div class="form-check form-check-inline">
+										<label class="form-check-label"><input class="form-check-input" type="radio" name="manualMedicareIsHomeHealth" @click="onInputChange" value="NO">No</label>
+									</div>
+									<div class="form-check form-check-inline">
+										<label class="form-check-label"><input class="form-check-input" type="radio" name="manualMedicareIsHomeHealth" @click="onInputChange" value="UNKNOWN">Unknown</label>
+									</div>
+								</div>
+							</td>
+						</tr>
+						<tr>
+							<td>MSP?</td>
+							<td>{{$cpc->auto_medicare_is_msp}}</td>
+							<td>
+								<div class="form-group mb-0">
+									<div class="form-check form-check-inline">
+										<label class="form-check-label"><input class="form-check-input" type="radio" name="manualMedicareIsMsp" @click="onInputChange" value="YES">Yes</label>
+									</div>
+									<div class="form-check form-check-inline">
+										<label class="form-check-label"><input class="form-check-input" type="radio" name="manualMedicareIsMsp" @click="onInputChange" value="NO">No</label>
+									</div>
+									<div class="form-check form-check-inline">
+										<label class="form-check-label"><input class="form-check-input" type="radio" name="manualMedicareIsMsp" @click="onInputChange" value="UNKNOWN">Unknown</label>
+									</div>
+								</div>
+							</td>
+						</tr>
+					</tbody>
+				</table>
+			</div>
+			<div class="row">
+				<div class="form-group col-md-12">
+					<label for="" class="control-label">Memo</label>
+					<textarea name="manualDeterminationCategoryMemo" class="form-control"></textarea>
+				</div>
+			</div>
+
+
+			<div v-if="response" :class="response.success ? 'alert success' : 'alert alert-danger'">
+				@{{ response.message }}
+			</div>
+
+			<div class="form-group text-nowrap mb-0">
+				<button v-if="!processing" class="btn btn-sm btn-primary" type="submit" :disabled="url == '' || disabled === true">Submt</button>
+				<button v-else class="btn btn-sm btn-primary" type="button"><i class="fas fa-circle-notch fa-spin"></i> Processing...</button>
+			</div>
+		</form>
+	</div>
+</div>
+<script>
+	(function() {
+		function init() {
+			new Vue({
+				el: '#manual-determination-form-{{$patient->uid}}',
+				delimiters: ['@{{', '}}'],
+				data: {
+					url: '/api/clientPrimaryCoverage/manualDeterminationForMedicare',
+					uiState: {
+						manualMedicareIsMatched: null,
+						manualMedicareIsPartBActive: null,
+						manualMedicareIsPartBPrimary: null,
+						manualMedicareIsPartCActive: null,
+						manualMedicareIsInpatient: null,
+						manualMedicareIsHospice: null,
+						manualMedicareIsHomeHealth: null,
+						manualMedicareIsMsp: null,
+
+					},
+					cpc: <?= json_encode($cpc); ?>,
+					processing: false,
+					response: null,
+					disabled: false
+				},
+				methods: {
+					onInputChange: function(evt){
+						var input = evt.target;
+						var name = input.name;
+						var value = input.value;
+						this.uiState[name] = value;
+						if(value === 'YES') this.uiState.manualMedicareIsMatched = 'YES';
+
+						if(name === 'manualMedicareIsMatched'){
+							if(value === 'NO') this.setUiStateDefaultValue(value);
+						}
+
+						if(name === 'manualMedicareIsPartBActive'){
+							if(value === 'YES') {
+								this.uiState.manualMedicareIsMatched = 'YES';
+							}
+							if(value === 'NO') this.uiState.manualMedicareIsPartBPrimary = 'NO';
+							if(value === 'UNKNOWN') this.uiState.manualMedicareIsPartBPrimary = 'UNKNOWN';
+						}
+						if(name === 'manualMedicareIsPartBPrimary'){
+							if(value === 'YES') {
+								this.uiState.manualMedicareIsMatched = 'YES';
+								this.uiState.manualMedicareIsPartBActive = 'YES';
+							}
+						}
+
+
+						if(name === 'manualMedicareIsPartCActive'){
+							if(value === 'YES') this.uiState.manualMedicareIsPartBActive = 'NO';
+						}
+
+						if(this.uiState.manualMedicareIsMatched === 'NO') {
+							this.setUiStateDefaultValue('NO');
+							return;
+						}
+
+						this.refreshUi();
+					},
+					setUiStateDefaultValue: function(value){
+						var self = this;
+						for(var fieldName in self.uiState){
+							self.uiState[fieldName] = value;
+						}
+						self.refreshUi();
+					},
+					submitForm: function(evt) {
+						var self = this;
+						if (self.processing) return;
+						var form = evt.target;
+						var data = $(form).serializeArray();
+						var url = self.url;
+						if (!url) {
+							self.response = {
+								success: false,
+								message: 'Invalid url'
+							};
+							return;
+						}
+
+						self.processing = true;
+						$.post(url, data, function(response) {
+							self.processing = false;
+							if (response.success) {
+								closeStagPopup();
+								fastReload();
+							} else {
+								self.response = response;
+							}
+						}, 'json');
+					},
+					setDefaultData: function(){
+						this.uiState.manualMedicareIsMatched = this.cpc.auto_medicare_is_match_found ? 'YES':'NO';
+						this.uiState.manualMedicareIsPartBActive = this.cpc.auto_medicare_is_partbprimary;
+						this.refreshUi();
+					},
+					refreshUi: function(){
+						var self = this;
+						$("input[type=radio]").prop('checked', false);
+						for(var fieldName in self.uiState){
+							var value = self.uiState[fieldName];
+							if(value){
+								$("input[name="+ fieldName +"][type=radio][value=" + value + "]").prop('checked', true);
+							}
+						}
+
+						self.disabled = (self.cpc.auto_medicare_is_partcactive == 'YES' && self.cpc.auto_medicare_is_partbprimary == 'YES') || (self.uiState.manualMedicareIsPartBPrimary == 'YES' && self.uiState.manualMedicareIsPartCActive == 'YES');
+						self.setDefaultValueForManualDeterminationCategory();
+
+					},
+					setDefaultValueForManualDeterminationCategory: function(){
+						var self = this;
+						var input = $('input[name=manualDeterminationCategory]');
+						if(self.uiState.manualMedicareIsMatched === 'NO'){
+							input.val('INVALID');
+							return;
+						}
+						if(self.uiState.manualMedicareIsPartBPrimary === 'YES'){
+							input.val('COVERED');
+							return;
+						}
+						if(self.uiState.manualMedicareIsPartBPrimary === 'NO'){
+							input.val('NOT_COVERED');
+							return;
+						}
+						input.val('UNKNOWN');
+					},
+				},
+				mounted: function() {
+					this.setDefaultData();
+					this.uiState.manualMedicareIsPartBPrimary = this.cpc.auto_medicare_is_partbprimary;
+					if (this.cpc.auto_medicare_is_partbprimary == 'YES') {
+						this.uiState.manualMedicareIsPartCActive = 'NO';
+					};
+					this.refreshUi();
+
+				}
+			});
+		}
+		addMCInitializer('manual-determination-form-{{$patient->uid}}', init, '#manual-determination-form-{{$patient->uid}}')
+	}).call(window);
+</script>

resources/views/app/patient/primary-coverage-manual-determination-view-commercial.blade.php

@@ -0,0 +1,111 @@
+<div id="primaryCoverageManualDeterminationView">
+	<div class="table-responsive">
+	<table class="table table-sm table-bordered table-striped">
+		<thead>
+			<tr>
+				<th></th>
+				<th>Automatic</th>
+				<th>Override</th>
+			</tr>
+		</thead>
+		<tbody>
+			<tr>
+				<td>Record Found?</td>
+				<td>{{$cpc->auto_commercial_is_match_found ? 'YES' : 'NO'}}</td>
+				<td>
+					<div class="form-group">
+						<p class="mb-1 text-secondary">Manual Determination Category</p>
+						<span>{{$cpc->manual_determination_category ?? '-'}}</span>
+					</div>
+				</td>
+			</tr>
+
+			<tr>
+				<td>Part B Active?</td>
+				<td>{{$cpc->auto_medicare_is_partbactive}}</td>
+				<td>
+					<div class="form-group mb-0">
+						<p class="mb-1 text-secondary">Is Part B Active?</p>
+						<span>{{$cpc->manual_medicare_is_partbactive ?? '-'}}</span>
+					</div>
+				</td>
+			</tr>
+			<tr>
+				<td>Part B Primary?</td>
+				<td>{{$cpc->auto_medicare_is_partbprimary}}</td>
+				<td>
+					<div class="form-group">
+						<p class="mb-1 text-secondary">Manual Determination Category</p>
+						<span>{{$cpc->manual_determination_category  ?? '-'}}</span>
+					</div>
+					<div class="form-group mb-0">
+						<p class="mb-1 text-secondary">Is Part B Primary?</p>
+						<span>{{$cpc->manual_medicare_is_partbprimary ?? '-'}}</span>
+					</div>
+				</td>
+			</tr>
+			<tr>
+				<td>Part C Active?</td>
+				<td>{{$cpc->auto_medicare_is_partcactive}}</td>
+				<td>
+					<div class="form-group mb-0">
+						<div class="alert alert-danger" v-if="(cpc.auto_medicare_is_partcactive == 'YES' && cpc.auto_medicare_is_partbprimary == 'YES')">
+							Oops! Patient Medicare Part B Primary is set to <b>Yes</b>.
+						</div>
+						<p class="mb-1 text-secondary">Is Part C Active?</p>
+						<span>{{$cpc->manual_medicare_is_partcactive ?? '-'}}</span>
+					</div>
+				</td>
+			</tr>
+			<tr>
+				<td>Inpatient?</td>
+				<td>{{$cpc->auto_medicare_is_inpatient}}</td>
+				<td>
+					<div class="form-group mb-0">
+						<p class="mb-1 text-secondary">Inpatient?</p>
+						<span>{{$cpc->manual_medicare_is_inpatient ?? '-'}}</span>
+					</div>
+				</td>
+			</tr>
+			<tr>
+				<td>Hospice?</td>
+				<td>UNKNOWN</td>
+				<td>
+					<div class="form-group mb-0">
+						<p class="mb-1 text-secondary">Hospice?</p>
+						<span>UNKNOWN</span>
+					</div>
+				</td>
+			</tr>
+			<tr>
+				<td>Home Health?</td>
+				<td>UNKNOWN</td>
+				<td>
+					<div class="form-group mb-0">
+						<p class="mb-1 text-secondary">Home Health?</p>
+						<span>UNKNOWN</span>
+					</div>
+				</td>
+			</tr>
+			<tr>
+				<td>MSP?</td>
+				<td>{{$cpc->auto_medicare_is_msp}}</td>
+				<td>
+					<div class="form-group mb-0">
+						<p class="mb-1 text-secondary">MSP?</p>
+						<span>{{$cpc->manual_medicare_is_msp ?? '-'}}</span>
+					</div>
+				</td>
+			</tr>
+		</tbody>
+	</table>
+</div>
+</div>
+<script type="text/javascript">
+	var primaryCoverageManualDeterminationView = new Vue({
+		el: '#primaryCoverageManualDeterminationView',
+		data: {
+			cpc: <?= json_encode($cpc); ?>,
+		}
+	})
+</script>

resources/views/app/patient/primary-coverage-manual-determination-view-medicaid.blade.php

@@ -0,0 +1,43 @@
+<div id="primaryCoverageManualDeterminationView">
+	<div class="table-responsive">
+	<table class="table table-sm table-bordered table-striped">
+		<thead>
+			<tr>
+				<th></th>
+				<th>Automatic</th>
+				<th>Override</th>
+			</tr>
+		</thead>
+		<tbody>
+			<tr>
+				<td>Record Found?</td>
+				<td>{{$cpc->auto_medicaid_is_match_found ? 'YES' : 'NO'}}</td>
+				<td>
+					<div class="form-group">
+						<p class="mb-1 text-secondary">Is Matched?</p>
+						<span>{{$cpc->manual_medicaid_is_matched ?? '-'}}</span>
+					</div>
+				</td>
+			</tr>
+			<tr>
+				<td>Coverage Status?</td>
+				<td>UNKNOWN</td>
+				<td>
+					<div class="form-group">
+						<p class="mb-1 text-secondary">Manual Determination Category</p>
+						<span>{{$cpc->manual_determination_category ?? '-'}}</span>
+					</div>
+				</td>
+			</tr>
+		</tbody>
+	</table>
+</div>
+</div>
+<script type="text/javascript">
+	var primaryCoverageManualDeterminationView = new Vue({
+		el: '#primaryCoverageManualDeterminationView',
+		data: {
+			cpc: <?= json_encode($cpc); ?>,
+		}
+	})
+</script>

resources/views/app/patient/primary-coverage-manual-determination-view-medicare.blade.php

@@ -0,0 +1,117 @@
+<div id="primaryCoverageManualDeterminationView">
+	<div class="table-responsive">
+	<table class="table table-sm table-bordered table-striped">
+		<thead>
+			<tr>
+				<th></th>
+				<th>Automatic</th>
+				<th>Override</th>
+			</tr>
+		</thead>
+		<tbody>
+			<tr>
+				<td>Plan Type</td>
+				<td colspan="2">{{$cpc->plan_type}}</td>
+			</tr>
+			<tr>
+				<td>Record Found?</td>
+				<td>{{$cpc->auto_medicare_is_match_found ? 'YES' : 'NO'}}</td>
+				<td>
+					<div class="form-group">
+						<p class="mb-1 text-secondary">Is Matched?</p>
+						<span>{{$cpc->manual_medicare_is_matched ?? '-'}}</span>
+					</div>
+				</td>
+			</tr>
+
+
+			<tr>
+				<td>Part B Active?</td>
+				<td>{{$cpc->auto_medicare_is_partbactive}}</td>
+				<td>
+					<div class="form-group mb-0">
+						<p class="mb-1 text-secondary">Is Part B Active?</p>
+						<span>{{$cpc->manual_medicare_is_partbactive ?? '-'}}</span>
+					</div>
+				</td>
+			</tr>
+			<tr>
+				<td>Part B Primary?</td>
+				<td>{{$cpc->auto_medicare_is_partbprimary}}</td>
+				<td>
+					<div class="form-group">
+						<p class="mb-1 text-secondary">Manual Determination Category</p>
+						<span>{{$cpc->manual_determination_category  ?? '-'}}</span>
+					</div>
+					<div class="form-group mb-0">
+						<p class="mb-1 text-secondary">Is Part B Primary?</p>
+						<span>{{$cpc->manual_medicare_is_partbprimary ?? '-'}}</span>
+					</div>
+				</td>
+			</tr>
+			<tr>
+				<td>Part C Active?</td>
+				<td>{{$cpc->auto_medicare_is_partcactive}}</td>
+				<td>
+					<div class="form-group mb-0">
+						<div class="alert alert-danger" v-if="cpc.auto_medicare_is_partcactive == 'YES' && cpc.auto_medicare_is_partbprimary == 'YES'">
+							Oops! Patient Medicare Part B Primary is set to <b>Yes</b>.
+						</div>
+						<p class="mb-1 text-secondary">Is Part C Active?</p>
+						<span>{{$cpc->manual_medicare_is_partcactive ?? '-'}}</span>
+					</div>
+				</td>
+			</tr>
+			<tr>
+				<td>Inpatient?</td>
+				<td>{{$cpc->auto_medicare_is_inpatient}}</td>
+				<td>
+					<div class="form-group mb-0">
+						<p class="mb-1 text-secondary">Inpatient?</p>
+						<span>{{$cpc->manual_medicare_is_inpatient ?? '-'}}</span>
+					</div>
+				</td>
+			</tr>
+			<tr>
+				<td>Hospice?</td>
+				<td>UNKNOWN</td>
+				<td>
+					<div class="form-group mb-0">
+						<p class="mb-1 text-secondary">Hospice?</p>
+						<span>{{ $cpc->is_hospice }}</span>
+					</div>
+				</td>
+			</tr>
+
+			<tr>
+				<td>Home Health?</td>
+				<td>UNKNOWN</td>
+				<td>
+					<div class="form-group mb-0">
+						<p class="mb-1 text-secondary">Home Health?</p>
+						<span>UNKNOWN</span>
+					</div>
+				</td>
+			</tr>
+			<tr>
+				<td>MSP?</td>
+				<td>{{$cpc->auto_medicare_is_msp}}</td>
+				<td>
+					<div class="form-group mb-0">
+						<p class="mb-1 text-secondary">MSP?</p>
+						<span>{{$cpc->manual_medicare_is_msp ?? '-'}}</span>
+					</div>
+				</td>
+			</tr>
+		</tbody>
+	</table>
+</div>
+</div>
+<script type="text/javascript">
+	var primaryCoverageManualDeterminationView = new Vue({
+		el: '#primaryCoverageManualDeterminationView',
+		data: {
+			cpc: <?= json_encode($cpc); ?>,
+		}
+	})
+</script>

resources/views/app/patient/primary-coverage-new-commercial.blade.php

@@ -0,0 +1,202 @@
+<div moe relative wide>
+	<a href="" start show>
+		+ Commercial
+	</a>
+	<form id="commercialComponent" url="/api/clientPrimaryCoverage/createNewCoverageForCommercial" right class="mcp-theme-1">
+		<input type="hidden" name="clientUid" value="{{$patient->uid}}" class="form-control input-sm" />
+
+		<div class="row">
+			<div class="form-group col-md-12">
+				<label for="" class="control-label">Commercial Payer</label>
+				<select name="commercialPayerUid" id="" class="form-control input-sm">
+					<option value="">--</option>
+				</select>
+			</div>
+			<div class="form-group col-md-6">
+				<label class="control-label">Patient Member Identifier</label>
+				<input type="text" name="commercialMemberIdentifier"  class="form-control input-sm">
+			</div>
+			<div class="form-group col-md-6">
+				<label class="control-label">Patient Group Number</label>
+				<input type="text" name="commercialGroupNumber"  class="form-control input-sm">
+			</div>
+			<div class="form-group col-md-6">
+				<label class="control-label">Patient First Name</label>
+				<input type="text" name="patientNameFirst" value="{{$patient->name_first}}" class="form-control input-sm">
+			</div>
+			<div class="form-group col-md-6">
+				<label class="control-label">Patient Middle Name / MI</label>
+				<input type="text" name="patientNameMiddle" value="{{$patient->name_middle}}" class="form-control input-sm">
+			</div>
+			<div class="form-group col-md-6">
+				<label class="control-label">Patient Last Name</label>
+				<input type="text" name="patientNameLast" value="{{$patient->name_last}}" class="form-control input-sm">
+			</div>
+			<div class="form-group col-md-6">
+				<label class="control-label">Patient Suffix</label>
+				<input type="text" name="patientNameSuffix" value="{{$patient->name_suffix}}" class="form-control input-sm">
+			</div>
+			<div class="form-group col-md-6">
+				<label class="control-label">Patient Dob</label>
+				<input type="date" name="patientDob" value="{{$patient->dob}}" class="form-control input-sm">
+			</div>
+			<div class="form-group col-md-6">
+				<label class="control-label">Patient Sex</label>
+				<select class="form-control input-sm" name="patientSex">
+					<option value="">--</option>
+					<option value="M">Male</option>
+					<option value="F">Female</option>
+					<option value="UNKNOWN">Unknown</option>
+				</select>
+			</div>
+			<div class="form-group col-md-6">
+				<label class="control-label">Date Of Service</label>
+				<input type="date" name="dateOfService" value="{{date('Y-m-d')}}" class="form-control input-sm">
+			</div>
+			<div class="form-group col-md-12">
+				<p class="mb-1">Is Patient The Subscriber?</p>
+				<label class="mr-2">
+					<input type="radio" name="isPatientSubscriber" v-model="isPatientSubscriber" value="1"> Yes
+				</label>
+				<label class="">
+					<input type="radio" name="isPatientSubscriber" v-model="isPatientSubscriber" value="0"> No
+				</label>
+			</div>
+		</div>
+
+		<div v-if="isPatientSubscriber == 0" class="row">
+			<div class="form-group col-md-6">
+				<label class="control-label">Patient Relationship To Subscriber</label>
+				<select name="patientRelationshipToSubscriber" class="form-control input-sm">
+					<option value="">--</option>
+					<option value="SPOUSE">Spouse</option>
+					<option value="CHILD">Child</option>
+					<option value="EMPLOYEE">Employee</option>
+					<option value="ORGAN_DONOR">Organ Donor</option>
+					<option value="CADAVER_DONOR">Cadaver Donor</option>
+					<option value="LIFE_PARTNER">Life Partner</option>
+					<option value="OTHER_RELATIONSHIP">Other Relationship</option>
+					<option value="UNKNOWN">Unknown</option>
+				</select>
+			</div>
+			<div class="form-group col-md-6">
+				<label class="control-label">Subscriber First Name</label>
+				<input type="text" name="subscriberNameFirst" value="{{$patient->name_first}}" class="form-control input-sm">
+			</div>
+			<div class="form-group col-md-6">
+				<label class="control-label">Subscriber Middle Name / MI</label>
+				<input type="text" name="subscriberNameMiddle" value="{{$patient->name_middle}}" class="form-control input-sm">
+			</div>
+			<div class="form-group col-md-6">
+				<label class="control-label">Subscriber Last Name</label>
+				<input type="text" name="subscriberNameLast" value="{{$patient->name_last}}" class="form-control input-sm">
+			</div>
+			<div class="form-group col-md-6">
+				<label class="control-label">Subscriber Suffix</label>
+				<input type="text" name="subscriberNameSuffix" value="{{$patient->name_suffix}}" class="form-control input-sm">
+			</div>
+			<div class="form-group col-md-6">
+				<label class="control-label">Subscriber Sex</label>
+				<select class="form-control input-sm" name="subscriberSex">
+					<option value="">--</option>
+					<option value="MALE">Male</option>
+					<option value="FEMALE">Female</option>
+					<option value="UNKNOWN">Unknown</option>
+				</select>
+			</div>
+			<div class="form-group col-md-6">
+				<label class="control-label">Subscriber Dob</label>
+				<input type="date" name="subscriberDob" value="{{$patient->dob}}" class="form-control input-sm">
+			</div>
+		</div>
+
+		<div class="row">
+			<div class="form-group col-md-6">
+				<label class="control-label">Medicare Number</label>
+				<input type="text" name="mcrNumber" class="form-control input-sm">
+			</div>
+
+			<div class="form-group col-md-6">
+				<label class="control-label">Medicaid Number</label>
+				<input type="text" name="mcdNumber"  class="form-control input-sm">
+			</div>
+
+			<div class="form-group col-md-12">
+				<label for="" class="control-label">Medicaid Payer</label>
+				<select name="mcdPayerName" id="" class="form-control input-sm">
+					<option value="">--</option>
+					<option>MEDICAID ALABAMA</option>
+					<option>MEDICAID ALASKA</option>
+					<option>MEDICAID ARIZONA</option>
+					<option>MEDICAID ARKANSAS</option>
+					<option>MEDICAID CALIFORNIA MEDI-CAL</option>
+					<option>MEDICAID COLORADO</option>
+					<option>MEDICAID CONNECTICUT</option>
+					<option>MEDICAID DELAWARE</option>
+					<option>MEDICAID DISTRICT OF COLUMBIA</option>
+					<option>MEDICAID FLORIDA</option>
+					<option>MEDICAID GEORGIA</option>
+					<option>MEDICAID HAWAII</option>
+					<option>MEDICAID IDAHO</option>
+					<option>MEDICAID ILLINOIS</option>
+					<option>MEDICAID INDIANA</option>
+					<option>MEDICAID IOWA</option>
+					<option>MEDICAID KANSAS</option>
+					<option>MEDICAID KENTUCKY</option>
+					<option>MEDICAID LOUISIANA</option>
+					<option>MEDICAID MAINE</option>
+					<option>MEDICAID MARYLAND</option>
+					<option>MEDICAID MARYLAND DHMH</option>
+					<option>MEDICAID MASSACHUSETTS</option>
+					<option>MEDICAID MICHIGAN</option>
+					<option>MEDICAID MINNESOTA</option>
+					<option>MEDICAID MISSISSIPPI</option>
+					<option>MEDICAID MISSISSIPPI</option>
+					<option>MEDICAID MISSOURI</option>
+					<option>MEDICAID MONTANA</option>
+					<option>MEDICAID NEBRASKA</option>
+					<option>MEDICAID NEVADA</option>
+					<option>MEDICAID NEW HAMPSHIRE</option>
+					<option>MEDICAID NEW JERSEY</option>
+					<option>MEDICAID NEW MEXICO</option>
+					<option>MEDICAID NEW YORK</option>
+					<option>MEDICAID NEW YORK</option>
+					<option>MEDICAID NORTH CAROLINA</option>
+					<option>MEDICAID NORTH DAKOTA</option>
+					<option>MEDICAID OHIO</option>
+					<option>MEDICAID OKLAHOMA</option>
+					<option>MEDICAID OREGON</option>
+					<option>MEDICAID OREGON (DHS OMAP)</option>
+					<option>MEDICAID PENNSYLVANIA</option>
+					<option>MEDICAID RHODE ISLAND</option>
+					<option>MEDICAID SOUTH CAROLINA</option>
+					<option>MEDICAID SOUTH DAKOTA</option>
+					<option>MEDICAID TENNESSEE</option>
+					<option>MEDICAID TEXAS</option>
+					<option>MEDICAID TEXAS AND TEXAS HEALTH STEPS</option>
+					<option>MEDICAID UTAH</option>
+					<option>MEDICAID VERMONT</option>
+					<option>MEDICAID VIRGINIA</option>
+					<option>MEDICAID WASHINGTON (PROVIDER ONE)</option>
+					<option>MEDICAID WEST VIRGINIA</option>
+					<option>MEDICAID WISCONSIN</option>
+					<option>MEDICAID WYOMING</option>
+				</select>
+			</div>
+		</div>
+
+		<div class="form-group text-nowrap mb-0">
+			<button class="btn btn-sm btn-primary" submit>Submt</button>
+			<button class="btn btn-sm btn-default border" cancel>Close</button>
+		</div>
+	</form>
+</div>
+
+<script type="text/javascript">
+	var commercialComponent = new Vue({
+		el: '#commercialComponent',
+		data: {
+			isPatientSubscriber: 1
+		}
+	})
+</script>

resources/views/app/patient/primary-coverage-new-medicaid.blade.php

@@ -0,0 +1,120 @@
+<div moe relative wide>
+	<a href="" start show>
+		+ Medicaid
+	</a>
+	<form url="/api/clientPrimaryCoverage/createNewCoverageForMedicaid" right class="mcp-theme-1">
+		<input type="hidden" name="clientUid" value="{{$patient->uid}}" class="form-control input-sm" />
+
+		<div class="row">
+			<div class="form-group col-md-6">
+				<label class="control-label">Patient First Name</label>
+				<input type="text" name="patientNameFirst" value="{{$patient->name_first}}" class="form-control input-sm">
+			</div>
+			<div class="form-group col-md-6">
+				<label class="control-label">Patient Middle Name / MI</label>
+				<input type="text" name="patientNameMiddle" value="{{$patient->name_middle}}" class="form-control input-sm">
+			</div>
+			<div class="form-group col-md-6">
+				<label class="control-label">Patient Last Name</label>
+				<input type="text" name="patientNameLast" value="{{$patient->name_last}}" class="form-control input-sm">
+			</div>
+			<div class="form-group col-md-6">
+				<label class="control-label">Patient Suffix</label>
+				<input type="text" name="patientNameSuffix" value="{{$patient->name_suffix}}" class="form-control input-sm">
+			</div>
+			<div class="form-group col-md-6">
+				<label class="control-label">Patient Sex</label>
+				<select class="form-control input-sm" name="patientSex">
+					<option value="">--</option>
+					<option value="M">Male</option>
+					<option value="F">Female</option>
+					<option value="UNKNOWN">Unknown</option>
+				</select>
+			</div>
+			<div class="form-group col-md-6">
+				<label class="control-label">Patient Dob</label>
+				<input type="date" name="patientDob" value="{{$patient->dob}}" class="form-control input-sm">
+			</div>
+
+			<div class="form-group col-md-6">
+				<label for="" class="control-label">Medicaid Payer</label>
+				<select name="mcdPayerName" id="" class="form-control input-sm">
+					<option value="">--</option>
+					<option>MEDICAID ALABAMA</option>
+					<option>MEDICAID ALASKA</option>
+					<option>MEDICAID ARIZONA</option>
+					<option>MEDICAID ARKANSAS</option>
+					<option>MEDICAID CALIFORNIA MEDI-CAL</option>
+					<option>MEDICAID COLORADO</option>
+					<option>MEDICAID CONNECTICUT</option>
+					<option>MEDICAID DELAWARE</option>
+					<option>MEDICAID DISTRICT OF COLUMBIA</option>
+					<option>MEDICAID FLORIDA</option>
+					<option>MEDICAID GEORGIA</option>
+					<option>MEDICAID HAWAII</option>
+					<option>MEDICAID IDAHO</option>
+					<option>MEDICAID ILLINOIS</option>
+					<option>MEDICAID INDIANA</option>
+					<option>MEDICAID IOWA</option>
+					<option>MEDICAID KANSAS</option>
+					<option>MEDICAID KENTUCKY</option>
+					<option>MEDICAID LOUISIANA</option>
+					<option>MEDICAID MAINE</option>
+					<option>MEDICAID MARYLAND</option>
+					<option>MEDICAID MARYLAND DHMH</option>
+					<option>MEDICAID MASSACHUSETTS</option>
+					<option>MEDICAID MICHIGAN</option>
+					<option>MEDICAID MINNESOTA</option>
+					<option>MEDICAID MISSISSIPPI</option>
+					<option>MEDICAID MISSISSIPPI</option>
+					<option>MEDICAID MISSOURI</option>
+					<option>MEDICAID MONTANA</option>
+					<option>MEDICAID NEBRASKA</option>
+					<option>MEDICAID NEVADA</option>
+					<option>MEDICAID NEW HAMPSHIRE</option>
+					<option>MEDICAID NEW JERSEY</option>
+					<option>MEDICAID NEW MEXICO</option>
+					<option>MEDICAID NEW YORK</option>
+					<option>MEDICAID NEW YORK</option>
+					<option>MEDICAID NORTH CAROLINA</option>
+					<option>MEDICAID NORTH DAKOTA</option>
+					<option>MEDICAID OHIO</option>
+					<option>MEDICAID OKLAHOMA</option>
+					<option>MEDICAID OREGON</option>
+					<option>MEDICAID OREGON (DHS OMAP)</option>
+					<option>MEDICAID PENNSYLVANIA</option>
+					<option>MEDICAID RHODE ISLAND</option>
+					<option>MEDICAID SOUTH CAROLINA</option>
+					<option>MEDICAID SOUTH DAKOTA</option>
+					<option>MEDICAID TENNESSEE</option>
+					<option>MEDICAID TEXAS</option>
+					<option>MEDICAID TEXAS AND TEXAS HEALTH STEPS</option>
+					<option>MEDICAID UTAH</option>
+					<option>MEDICAID VERMONT</option>
+					<option>MEDICAID VIRGINIA</option>
+					<option>MEDICAID WASHINGTON (PROVIDER ONE)</option>
+					<option>MEDICAID WEST VIRGINIA</option>
+					<option>MEDICAID WISCONSIN</option>
+					<option>MEDICAID WYOMING</option>
+				</select>
+			</div>
+
+			<div class="form-group col-md-6">
+				<label class="control-label">Medicaid Number</label>
+				<input type="text" name="mcdNumber"  class="form-control input-sm">
+			</div>
+
+			<div class="form-group col-md-6">
+				<label class="control-label">Date Of Service</label>
+				<input type="date" name="dateOfService" value="{{date('Y-m-d')}}" class="form-control input-sm">
+			</div>
+
+		</div>
+
+
+		<div class="form-group text-nowrap mb-0">
+			<button class="btn btn-sm btn-primary" submit>Submt</button>
+			<button class="btn btn-sm btn-default border" cancel>Close</button>
+		</div>
+	</form>
+</div>

resources/views/app/patient/primary-coverage-new-medicare.blade.php

@@ -0,0 +1,45 @@
+<div moe relative wide>
+	<a href="" start show>
+		+ Medicare Part B (Primary)
+	</a>
+	<form url="/api/clientPrimaryCoverage/createNewCoverageForMedicare" right class="mcp-theme-1">
+		<input type="hidden" name="clientUid" value="{{$patient->uid}}" class="form-control input-sm" />
+		<div class="row">
+			<div class="form-group col-md-6">
+				<label class="control-label">Patient First Name</label>
+				<input type="text" name="patientNameFirst" value="{{$patient->name_first}}" class="form-control input-sm">
+			</div>
+			<div class="form-group col-md-6">
+				<label class="control-label">Patient Middle Name / MI</label>
+				<input type="text" name="patientNameMiddle" value="{{$patient->name_middle}}" class="form-control input-sm">
+			</div>
+			<div class="form-group col-md-6">
+				<label class="control-label">Patient Last Name</label>
+				<input type="text" name="patientNameLast" value="{{$patient->name_last}}" class="form-control input-sm">
+			</div>
+			<div class="form-group col-md-6">
+				<label class="control-label">Patient Suffix</label>
+				<input type="text" name="patientNameSuffix" value="{{$patient->name_suffix}}" class="form-control input-sm">
+			</div>
+			<div class="form-group col-md-6">
+				<label class="control-label">Patient Dob</label>
+				<input type="date" name="patientDob" value="{{$patient->dob}}" class="form-control input-sm">
+			</div>
+
+			<div class="form-group col-md-6">
+				<label class="control-label">Medicare Number</label>
+				<input type="text" name="mcrNumber" class="form-control input-sm">
+			</div>
+
+			<div class="form-group col-md-6">
+				<label class="control-label">Date Of Service</label>
+				<input type="date" name="dateOfService" value="{{date('Y-m-d')}}" class="form-control input-sm">
+			</div>
+		</div>
+
+		<div class="form-group text-nowrap mb-0">
+			<button class="btn btn-sm btn-primary" submit>Submt</button>
+			<button class="btn btn-sm btn-default border" cancel>Close</button>
+		</div>
+	</form>
+</div>

resources/views/app/patient/primary-coverage-refresh.blade.php

@@ -0,0 +1,14 @@
+<div moe relative>
+	<a href="" start show class=""><i class="fas fa-sync"></i></a>
+
+	<form url="/api/clientPrimaryCoverage/{{$endpoint}}" class="mcp-theme-1">
+		<input type="hidden" name="uid" value="{{$cpc->uid}}" class="form-control input-sm" />
+		<div class="form-group">
+			<p>Refresh?</p>
+		</div>
+		<div class="form-group text-nowrap mb-0">
+			<button class="btn btn-sm btn-primary" submit>Submt</button>
+			<button class="btn btn-sm btn-default border" cancel>Close</button>
+		</div>
+	</form>
+</div>

resources/views/app/patient/primary-coverage-view.blade.php

@@ -0,0 +1,121 @@
+<h4 class="font-weight-bold">Patient Name / Demographics</h4>
+<div class="table-responsive">
+	<table class="table table-sm table-bordered table-striped">
+		<tbody>
+			<tr>
+				<td>Patient First Name</td>
+				<td>{{$cpc->patient_name_first}}</td>
+			</tr>
+			<tr>
+				<td>Patient Middle Name / MI</td>
+				<td>{{$cpc->patient_name_middle}}</td>
+			</tr>
+			<tr>
+				<td>Patient Last Name</td>
+				<td>{{$cpc->patient_name_last}}</td>
+			</tr>
+			<tr>
+				<td>Patient Suffix</td>
+				<td>{{$cpc->patient_name_suffix}}</td>
+			</tr>
+			<tr>
+				<td>Patient Dob</td>
+				<td>{{$cpc->patient_dob ? date_format(date_create($cpc->patient_dob), 'm/d/Y') : '-'}}</td>
+			</tr>
+			<tr>
+				<td>Patient Sex</td>
+				<td>{{$cpc->patient_sex ?? '-'}}</td>
+			</tr>
+		</tbody>
+	</table>
+</div>
+
+<h4 class="font-weight-bold">Primary Coverage Information</h4>
+<div id="primaryCoverageLatestCoverage">
+	<div class="table-responsive">
+	<table class="table table-sm table-bordered table-striped">
+		<tbody>
+			<tr>
+				<td>Plan Type</td>
+				<td>{{$cpc->plan_type}}</td>
+			</tr>
+			<tr v-if="cpc.plan_type == 'COMMERCIAL'">
+				<td>Commercial Payer</td>
+				<td>{{$cpc->commercial_payer_id ? $cpc->payer->name : '-'}}</td>
+			</tr>
+			<tr v-if="cpc.plan_type == 'COMMERCIAL'">
+				<td>Patient Member Identifier</td>
+				<td>{{$cpc->commercial_member_identifier ?? '-'}}</td>
+			</tr>
+			<tr v-if="cpc.plan_type == 'COMMERCIAL'">
+				<td>Patient Group Name</td>
+				<td>{{$cpc->commercial_group_number ?? '-'}}</td>
+			</tr>
+			<tr>
+				<td>Date of Service</td>
+				<td>{{$cpc->date_of_service ? date_format(date_create($cpc->date_of_service), 'm/d/Y') : '-'}}</td>
+			</tr>
+			<tr v-if="cpc.plan_type == 'COMMERCIAL' || cpc.plan_type == 'MEDICAID'">
+				<td colspan="2">
+					<h5 class="font-weight-bold">Subscriber Details</h5>
+					<table class="table table-bordered table-striped">
+						<tbody>
+							<tr>
+								<td>Is Patient the subscriber?</td>
+								<td>{{$cpc->is_patient_subscriber ? 'Yes' : 'No'}}</td>
+							</tr>
+							@if(!$cpc->is_patient_subscriber)
+							<tr>
+								<td>First Name</td>
+								<td>{{$cpc->subscriber_name_first ?? '-'}}</td>
+							</tr>
+							<tr>
+								<td>Middle Name / MI</td>
+								<td>{{$cpc->subscriber_name_middle ?? '-'}}</td>
+							</tr>
+							<tr>
+								<td>Last Name</td>
+								<td>{{$cpc->subscriber_name_last ?? '-'}}</td>
+							</tr>
+							<tr>
+								<td>Suffix</td>
+								<td>{{$cpc->subscriber_name_suffix ?? '-'}}</td>
+							</tr>
+							<tr>
+								<td>Sex</td>
+								<td>{{$cpc->subscriber_sex ?? '-'}}</td>
+							</tr>
+							<tr>
+								<td>Dob</td>
+								<td>{{$cpc->subscriber_dob ? date_format(date_create($cpc->subscriber_dob), 'm/d/Y') : '-'}}</td>
+							</tr>
+							@endif
+						</tbody>
+					</table>
+				</td>
+			</tr>
+
+			<tr v-if="cpc.plan_type == 'MEDICAID' || (cpc.plan_type == 'COMMERCIAL' && cpc.mcd_number)">
+				<td>Medicaid State</td>
+				<td>{{$cpc->mcd_payer_id ?? '-'}}</td>
+			</tr>
+			<tr v-if="cpc.plan_type == 'MEDICAID' || (cpc.plan_type == 'COMMERCIAL' && cpc.mcd_number)">
+				<td>Medicaid Number</td>
+				<td>{{$cpc->mcd_number ?? '-'}}</td>
+			</tr>
+			<tr v-if="cpc.plan_type == 'MEDICARE' || (cpc.plan_type == 'COMMERCIAL' && cpc.mcr_number)">
+				<td>Medicare Number</td>
+				<td>{{$cpc->mcr_number ?? '-'}}</td>
+			</tr>
+		</tbody>
+	</table>
+</div>
+</div>
+<script type="text/javascript">
+	var primaryCoverageLatestCoverage = new Vue({
+		el: '#primaryCoverageLatestCoverage',
+		data: {
+			cpc: <?= json_encode($cpc); ?>,
+		}
+	})
+</script>

resources/views/app/patient/primary-coverage.blade.php

@@ -0,0 +1,98 @@
+@extends ('layouts.patient')
+
+@section('inner-content')
+<div class="d-flex align-items-baseline">
+    <h4 class="font-weight-bold m-0 font-size-16 text-nowrap">Client Latest Coverage</h4>
+    <div class="ml-4 d-inline-flex justify-content-center">
+        <a native target="_blank"
+           open-in-stag-popup
+           mc-initer="new-coverage-form-{{$patient->uid}}"
+           title="New Primary Insurance Card"
+           href="/patients/view/primary-coverage-form/{{$patient->uid}}">
+            + New Primary Insurance Card
+        </a>
+    </div>
+</div>
+
+<div class="mt-2 pt-2">
+    @php
+        $cpc = $patient->latestClientPrimaryCoverage;
+    @endphp
+</div>
+    @if(!$cpc)
+        <div class="alert alert-info">No coverage for this client</div>
+    @else
+        @php
+            $cpc->auto_detail_json = json_decode($cpc->auto_detail_json);
+        @endphp
+        <div class="d-flex mb-2">
+            @if($cpc->plan_type == 'MEDICARE')
+                @include('app.patient.primary-coverage-refresh', ['endpoint'=>'refreshCoverageForMedicare'])
+                <span class="mx-2 text-secondary text-sm">|</span>
+                <a native target="_blank"
+                   open-in-stag-popup
+                   mc-initer="manual-determination-form-{{$patient->uid}}"
+                   title="Medicare Part B (Primary)"
+                   href="/patients/view/primary-coverage-manual-determination-modal/{{$patient->uid}}">
+                    Manual Determination for Medicare Part B (Primary)
+                </a>
+            @endif
+            @if($cpc->plan_type == 'MEDICAID')
+                @include('app.patient.primary-coverage-refresh', ['endpoint'=>'refreshCoverageForMedicaid'])
+                <span class="mx-2 text-secondary text-sm">|</span>
+                <a native target="_blank"
+                   open-in-stag-popup
+                   mc-initer="manual-determination-form-{{$patient->uid}}"
+                   title="Medicaid (Primary)"
+                   href="/patients/view/primary-coverage-manual-determination-modal/{{$patient->uid}}">
+                    Manual Determination for Medicaid (Primary)
+                </a>
+            @endif
+            @if($cpc->plan_type == 'COMMERCIAL')
+                @include('app.patient.primary-coverage-refresh', ['endpoint'=>'refreshCoverageForCommercial'])
+                <span class="mx-2 text-secondary text-sm">|</span>
+                <a native target="_blank"
+                   open-in-stag-popup
+                   mc-initer="manual-determination-form-{{$patient->uid}}"
+                   title="Commercial (Primary)"
+                   href="/patients/view/primary-coverage-manual-determination-modal/{{$patient->uid}}">
+                    Manual Determination for Commercial (Primary)
+                </a>
+            @endif
+        </div>
+
+        <div class="mt-4">
+          <div class="row">
+            <div class="col-md-9">
+
+              @include('app.patient.primary-coverage-view')
+
+              <h4 class="font-weight-bold">Manual Determination Information</h4>
+              @if($cpc->plan_type == 'MEDICARE')
+                @include('app.patient.primary-coverage-manual-determination-view-medicare')
+              @elseif($cpc->plan_type == 'MEDICAID')
+              @include('app.patient.primary-coverage-manual-determination-view-medicaid')
+              @elseif($cpc->plan_type == 'COMMERCIAL')
+              @include('app.patient.primary-coverage-manual-determination-view-commercial')
+              @else
+                No plan Type specified.
+              @endif
+            </div>
+          </div>
+          
+            @php
+            dump(json_decode($cpc->toJson(JSON_PRETTY_PRINT | JSON_UNESCAPED_UNICODE | JSON_UNESCAPED_SLASHES)));
+            @endphp
+           
+        </div>
+
+        <div>
+            {{--
+              @php
+                  dump($cpc->auto_detail_json);
+              @endphp
+              --}}
+        </div>
+    @endif
+</div>
+@endsection

resources/views/app/patients.blade.php

@@ -181,6 +181,7 @@
                             @if($coverage)
                                 {{$coverage->toString()}}
                             @endif
+                            @include('app.patient.coverage-status')
                         </td>
                         <td>
                             {{ $patient->mcp ? $patient->mcp->displayName() : '-' }}

routes/web.php

@@ -276,6 +276,9 @@ Route::middleware('pro.auth')->group(function () {
         Route::get('patients/view/eligible-refreshes/{patient}', 'PatientController@eligibleRefreshes')->name('patients.view.eligible-refreshes');
         Route::get('patients/view/insurance-coverage/{patient}', 'PatientController@insuranceCoverage')->name('patients.view.insurance-coverage');
         Route::get('patients/view/client-primarycoverages/{patient}', 'PatientController@clientPrimaryCoverages')->name('patients.view.client-primary-coverages');
+        Route::get('patients/view/primary-coverage/{patient}', 'PatientController@primaryCoverage')->name('patients.view.primary-coverage');
+        Route::get('patients/view/primary-coverage-form/{patient}', 'PatientController@primaryCoverageForm')->name('patients.view.primary-coverage-form');
+        Route::get('patients/view/primary-coverage-manual-determination-modal/{patient}', 'PatientController@primaryCoverageManualDeterminationModal')->name('patients.view.primary-coverage-manual-determination-modal');
     });
 
     Route::name('patients.view.')->prefix('patients/view/{patient}')->group(function () {
@@ -481,6 +484,8 @@ Route::middleware('pro.auth')->group(function () {
     Route::any('/fdb-drug-coadministration', 'FDBPGController@drugCoadministration');
     Route::any('/fdb-duplicate-therapy', 'FDBPGController@duplicateTherapy');
 
+    Route::get('/search-payer/json', 'PayerController@searchPayerV2JSON')->name('searchPayerV2JSON');
+
 });
 
 Route::post("/process_form_submit", 'NoteController@processFormSubmit')->name('process_form_submit');