@section('page-title', 'Claim Details')

Claim {{ $claim->claim_number }}

{{ ucfirst($claim->claim_type) }} | {{ $claim->service_date->format('d M Y') }}

@if(in_array($claim->status, ['received', 'processing']))
@csrf
@endif @can('manage_finance') @if(in_array($claim->status, ['approved', 'adjudicated'])) @endif @feature('claim_reversals') @if($claim->status === 'paid') @endif @if(in_array($claim->status, ['approved', 'adjudicated', 'partially_approved'])) @endif @endfeature @endcan @can('process_claims') @if(in_array($claim->status, ['approved', 'adjudicated', 'paid']) && !$claim->health263_reference)
@csrf
@endif @if($claim->health263_reference) H263: {{ $claim->health263_reference }} @endif @endcan Back

Claim Summary

Status
{{ ucfirst(str_replace('_', ' ', $claim->status)) }}
Currency
{{ $claim->currency }}
Total Billed
${{ number_format($claim->total_billed_cents / 100, 2) }}
Total Awarded
${{ number_format($claim->total_awarded_cents / 100, 2) }}
Shortfall (Patient Pays)
${{ number_format($claim->total_shortfall_cents / 100, 2) }}
Source
{{ $claim->source }}
@if($claim->rejection_reason)
Rejection Reason
{{ $claim->rejection_reason }}
@endif @if($claim->waiting_period_override)
Waiting Period Override
Overridden by {{ $claim->waitingPeriodOverrideBy->name ?? 'Unknown' }} on {{ $claim->waiting_period_override_at?->format('d M Y H:i') }}
Reason: {{ $claim->waiting_period_override_reason }}
@endif
@feature('waiting_period_enforcement') @if($claim->status === 'rejected' && str_contains($claim->rejection_reason ?? '', 'W01') && !$claim->waiting_period_override) @can('process_claims')

Waiting Period Rejection

This claim was rejected because services fall within the member's waiting period. As an assessor, you can override this rejection with a valid reason.

@csrf
@endcan @endif @endfeature @if($claim->status === 'paid')

Payment Details

Reference
{{ $claim->payment_reference }}
Method
{{ $claim->payment_method }}
Paid At
{{ $claim->paid_at?->format('d M Y H:i') }}
@if($claim->batch_number)
Batch
{{ $claim->batch_number }}
@endif
@endif

Member

{{ $claim->member->full_name }}

{{ $claim->member->member_number }} | {{ $claim->member->policy->name ?? '' }}

Provider

{{ $claim->provider->name }}

{{ $claim->provider->practice_number }} | {{ ucfirst(str_replace('_', ' ', $claim->provider->network_status)) }}
@if($fraudAlerts->count() > 0)

Fraud Alerts ({{ $fraudAlerts->count() }})

@foreach($fraudAlerts as $alert)
{{ ucfirst($alert->severity) }}

{{ $alert->description }}

@endforeach
@endif

Claim Lines

@foreach($claim->lines as $line) @endforeach
Tariff ICD-10 Description Qty Billed AHFoZ Awarded Shortfall Status
{{ $line->tariff_code_ref ?? '-' }} {{ $line->icd10_code ?? '-' }} {{ $line->description }} {{ $line->quantity }} ${{ number_format($line->billed_amount_cents / 100, 2) }} ${{ number_format($line->ahfoz_rate_cents / 100, 2) }} ${{ number_format($line->awarded_amount_cents / 100, 2) }} ${{ number_format($line->shortfall_cents / 100, 2) }} {{ ucfirst($line->status) }} @if($line->rejection_reason)

{{ $line->rejection_reason }}

@endif
@feature('claim_reversals') @if($claim->reversals->count() > 0)

Reversal History ({{ $claim->reversals->count() }})

@foreach($claim->reversals as $reversal)

Reversed by {{ $reversal->reversedBy->name ?? 'Unknown' }}

{{ $reversal->reversed_at->format('d M Y H:i') }}

Original Status

{{ ucfirst(str_replace('_', ' ', $reversal->original_status)) }}

Original Awarded Amount

${{ number_format($reversal->original_awarded_cents / 100, 2) }}

Reason

{{ $reversal->reason }}

@endforeach
@endif @endfeature

Documents ({{ $documents->count() }})

@if($documents->count() > 0)
@foreach($documents as $doc)

{{ $doc->original_name }}

{{ $doc->file_size_formatted }} | Uploaded by {{ $doc->uploader->name ?? 'Unknown' }} | {{ $doc->created_at->format('d M Y') }}

Download
@csrf @method('DELETE')
@endforeach
@endif
@csrf
@can('manage_finance') @feature('claim_reversals') @endfeature @endcan