PharmacyEligibilityService

Implements IPharmacyEligibility, the extract job that identifies claims eligible for pharmacy benefits (and claims newly ineligible after their first fill) and writes a fixed-format ODS extract file consumed downstream by the MedImpact pharmacy vendor. It depends on IUnitOfWork for persistence and eligibility-report queries, IUserProfileService, IClaimQueryProvider and IWorkerQueryProvider for claim/worker lookups, ICCClaimApiService and IClaimDataApiClient for building Claim aggregates, and a locally constructed WindowsEnvironmentService. It writes the extract to a hardcoded local path (OdsExtractFileName), archiving the previous file before overwriting it.

Purpose

• Processes the full pharmacy-eligibility extract run: reads eligible claims, writes their extract records, reads and processes newly-ineligible first-fill claims, appends a trailer record, and returns run-level counts.
• Filters eligibility reports to claims that are not already marked ineligible or major-is-pilot, and separately to first-fill claims whose MedImpact transmit date is set but whose regular transmit date is not.
• Validates that a claim resolved successfully and is not void or denied before it is written to the extract, logging a warning otherwise.
• Formats and appends a fixed-width pharmacy-eligibility record per eligible worker, substituting a SAIF-owned mailing address for workers with a foreign address.
• Flips a first-fill claim's eligibility status to Ineligible and stamps update audit fields once its extract record has been written.
• Archives the existing extract file (timestamped copy) before the current run overwrites it.

Context

• Namespace: SAIF.Services.Claims.PharmacyElilgbility
• Assembly/package: SAIF.Services (packaged inside the SAIF.SAIFCode.Core NuGet package)

Public members

Member	Signature	Purpose
PharmacyEligibilityService	public PharmacyEligibilityService(IUnitOfWork uow, IUserProfileService ups, IClaimQueryProvider claimQueryProvider, IWorkerQueryProvider workerQueryProvider, ICCClaimApiService claimApiService, IClaimDataApiClient gwClaimDataApiClient)	Wires the persistence and claim/worker lookup collaborators and initializes the run's PharmacyEligibilityResults counters to zero.
ProcessEligibilityExtract	public PharmacyEligibilityResults ProcessEligibilityExtract(ILogWriter warningReport, ILogWriter addressReport)	Runs the full extract: processes eligible claims, processes first-fill claims, writes the trailer record, and commits the unit of work; returns the accumulated result counts.
GetEligibleClaims	public bool GetEligibleClaims()	Loads pharmacy-eligibility reports excluding Ineligible and MajorisPilot status codes into the internal report collection; returns whether any were found.
ProcessEligibilityReports	public PharmacyEligibilityResults ProcessEligibilityReports(ILogWriter warningReport, ILogWriter addressReport)	For each loaded eligibility report, verifies the claim exists and is in a writable status, then writes its extract record; increments the reports-read counter for every claim examined.
GetFirstFillClaims	public bool GetFirstFillClaims()	Loads pharmacy-eligibility reports that are Ineligible with a set MedImpact transmit date but no regular transmit date yet, into the internal report collection; returns whether any were found.
ProcessFirstFillReports	public PharmacyEligibilityResults ProcessFirstFillReports(ILogWriter warningReport, ILogWriter addressReport)	Marks each loaded report as FirstFill status, writes its extract record if the claim is valid, and on success flips it back to Ineligible via UpdatePharmElig; tracks first-fill and reports-read counts.
GetClaimData	public Claim GetClaimData(long claimId)	Constructs a Claim aggregate for the given claim ID using the service's unit-of-work, user-profile, claim/worker query providers, and claim API collaborators.
VerifyClaimNotNull	public bool VerifyClaimNotNull(Claim claimData, long claimId, ILogWriter warningReport)	Confirms the claim resolved to non-null data and identifier; logs a "retrieval failed" warning and returns false otherwise.
VerifyClaim	public bool VerifyClaim(Claim claimData, long claimId, ILogWriter warningReport)	Confirms the claim's latest status is not Void or Denied, logging the corresponding warning message and returning false when it is.
VerifyWorker	public bool VerifyWorker(Worker worker, Claim claimData, long claimId, ILogWriter addressReport, Address address)	Confirms the eligibility report, worker, and claim identifier all resolved, and logs an address exception when the worker has no usable address or a foreign address (still returning true for a foreign address after logging).
UpdatePharmElig	public bool UpdatePharmElig(long claimId)	Reverts a first-fill claim's eligibility status to Ineligible, recording the previous status/effective date and stamping the transmit date and audit fields; returns false if the report can no longer be found.
GetWorkerAddress	public Address GetWorkerAddress(Claim claim, Worker worker)	Resolves and builds the worker's mailing address from the claim person's addresses via IClaimQueryProvider.GetClaimPersonAddresses.
WriteExtract	public bool WriteExtract(long claimId, Claim claimData, Worker worker, ILogWriter addressReport)	Builds a fixed-format PharmacyEligibilityExtract record (status, group ID mapped from eligibility status, demographic and address fields — substituting a SAIF-owned address for foreign addresses) and appends it to the in-memory extract collection; returns false if the eligibility report or worker verification fails.
WriteExtractTrailer	public void WriteExtractTrailer()	Archives the existing extract file, writes a fixed-width trailer record containing the total eligible-report count, and writes the accumulated extract records to the ODS extract file.
ArchiveExistingExtract	public void ArchiveExistingExtract()	Copies the current extract file to a timestamped archive name, deleting any pre-existing file at that archive path first.
WriteWarningMessage	public void WriteWarningMessage(ILogWriter warningReport, string inMessage)	Writes a message to the warning log and increments the run's warning count.
WriteAddressMessage	public void WriteAddressMessage(ILogWriter addressReport, string inMessage)	Writes a message to the address-exception log and increments the run's address-exceptions count.
WriteLog	public void WriteLog(ILogWriter reportLog, string inMessage)	Writes a single line to the supplied log writer.

Behavioral notes

• ProcessEligibilityExtract wraps the entire run in IUnitOfWork.Begin()/Commit().
• The extract file path is a hardcoded local filesystem path (c:\downloads\CMN0008_ExtractPharmEligibility\SAIFODSPharmacyEligibility) marked in source as needing to become configuration.
• Group ID assignment in WriteExtract is driven by a fixed switch over eligibility-status codes (FirstFill→001, Extended→002, Limited→003, Majoris→010, CMC→011, CMCLimited→012, MajorisLimited→013, default→blank).
• Foreign-address workers receive a substituted SAIF department mailing address (constants Saifaddressline1/2, city, state, zip) instead of their actual address in the extract.

Sources

• Services/SAIF.Services/Claims/PharmacyElilgbility/PharmacyEligibilityService.cs