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Capitation Report Process
- Aleksandr Virny (Unlicensed)
- Iryna Biiovska
- sveta vedmed (Unlicensed)
Overall process
Capitation report starts periodically based on the value of configuration parameter CAPITATION_REPORT_SCHEDULE
Configuration
| Parameter | Description | Value |
|---|---|---|
| CAPITATION_REPORT_SCHEDULE | (Cron Format) How often to run capitation report | `* 1 * * *` for prod
|
| CAPITATION_REPORT_VALIDATE_SIGNATURE | true |
Specification
Prepare dataset
- Determine billing_date
Billing_date - first calendar day of month. Month is equal to the month of report execution date
2. Generate report_id
Report_id - unique report identifier generated for each report execution
3. Find active contracts
Active contract - contract that meets the following conditions:
| Attribute | Condition |
|---|---|
| contract.start_date | < billing_date |
| contract.end_date | >= billing_date |
| contract.status | in (ACTIVE) |
| contract.type | in (capitation) |
4. Find active employees declared in Active contract's
Active employee - employee that meets the following conditions:
| Attribute | Condition |
|---|---|
| contract_employees.start_date | < billing_date |
| contract_employees.end_date | >= billing_date |
5. Find active declarations signed with Active employee
Active Declarations - declaration that meets the following conditions and is signed with active employee
| Attribute | Condition |
|---|---|
| declarations.employee_id | = contract_employees.employee_id |
| declarations.division_id | = contract_employees.division_id |
declaration_status_hstr.status = active declaration_status_hstr.inserted_at | Declaration was active on billing_date |
6. Determine age_group for each declaration
There are following age groups right now:
| Group | Condition |
|---|---|
| 0 - 5 | EXTRACT(YEAR FROM AGE(now(), persons.birth_date)) between 0 and 5 |
| 6 - 17 | EXTRACT(YEAR FROM AGE(now(), persons.birth_date)) between 6 and 17 where persons.id = declarations.person_id |
| 18 - 39 | EXTRACT(YEAR FROM AGE(now(), persons.birth_date)) between 18 and 39 where persons.id = declarations.person_id |
| 40 - 65 | EXTRACT(YEAR FROM AGE(now(), persons.birth_date)) between 40 and 65 where persons.id = declarations.person_id |
| 65 + | EXTRACT(YEAR FROM AGE(now(), persons.birth_date)) > 65 where persons.id = declarations.person_id |
7. (Optional) Validate signed content
In case of error during signed content validation - add record to capitation_report_errors
| Attribute | Description |
|---|---|
| id | Unique record identifier |
| capitation_report_id | Capitation report id generated on step 2 |
| declaration_id | Declaration id that caused error during signed content validation |
| action | Const: SIGNED_CONTENT_VALIDATION |
| message | Error message |
| inserted_at | Inserted at date time |
8. Aggregate and save data to DB
Create report record in capitation_reports. Result with zero values are also saved to report.
- For each contract in billing prepare temporary dataset with zero values for each key (age group | mountain group)
- Update this dataset with real number of declarations for each key
| Attribute | Description |
|---|---|
| id | Generated on Step 2 report_id |
| billing_date | Determined on Step 1 billing_date |
| created_at | Created at date time |
Aggregate result data by:
- legal_entity_id
- capitation_contract_id
- mountain_group
- age_group
| Attribute | Description |
|---|---|
| id | Unique record identifier |
| capitation_report_id | Generated on Step 2 report_id |
| legal_entity_id | contract.legal_entity_id |
| capitation_contract_id | contract.id |
| mountain_group | divisions.mountain_group where division.legal_entity_id = contract.legal_entity_id |
| age_group | Determined on Step 6 age group |
| declarations_count | Number of declaration grouped by legal_entity_id, capitation_contract_id, mountain_group, age_group |
ЕСОЗ - публічна документація