https://smylen.com/_nuxt/insurance-form-CYmkAwef.js

1
2!function(){try{var e="undefined"!=typeof window?window:"undefined"!=typeof global?global:"undefined"!=typeof globalThis?globalThis:"undefined"!=typeof self?self:{},n=(new e.Error).stack;n&&(e._sentryDebugIds=e._sentryDebugIds||{},e._sentryDebugIds[n]="ad9bd325-ebe1-5702-aa4a-55ee10813d9a")}catch(e){}}();
3import{n as l,h as m}from"./client-DZ-TyKlL.js";import{L as p}from"./LoaderSpinner-C0tWqaCB.js";const c=""+globalThis.__publicAssetsURL("img/airpay-logo.svg"),d={components:{LoaderSpinner:p},layout:"unbranded",head(){return{title:"Update Your insurance Information"}},async asyncData({query:s,$axios:e}){const{code:t}=s;let r,i,a,o,u;try{const n=await e.$get("/PatientInsuranceForms/Get-Subscriber-For-Insurance-Update/".concat(t));r=n.patient,i=n.subscriber,a=n.dentalPlan,o=n.carriers}catch(n){if(n.response.data.error.message==="Link Expired")u=!0;else throw n}return{code:t,patient:r,subscriber:i,dentalPlan:a,patientDob:r?m.utc(r.dob).format("MM/DD/YYYY"):null,patientFirstName:r?r.firstName:a&&a.patientFirstName,patientGender:r&&r.gender||null,patientLastName:r?r.lastName:a&&a.patientLastName,patientMiddleName:r?r.middleName:a&&a.patientMiddleName,subscriberDob:i?m.utc(i.dob).format("MM/DD/YYYY"):null,subscriberFirstName:i?i.firstName:a&&a.subscriberFirstName,subscriberGender:i&&i.gender||null,subscriberLastName:i?i.lastName:a&&a.subscriberLastName,subscriberMiddleName:i?i.middleName:a&&a.subscriberMiddleName,memberId:(a==null?void 0:a.memberId)||"",groupNumber:(a==null?void 0:a.groupNumber)||"",insuranceId:(a==null?void 0:a.insuranceId)||null,carriers:o,genderList:[{key:null,text:"-"},{key:"M",text:"Male"},{key:"F",text:"Female"},{key:"T",text:"Non-binary"}],patientIsDifferentFromSubscriber:!!i,step:"patient",working:!1,isExpired:u,newLinkSuccess:!1,errorMessage:null}},computed:{nextStepText(){return this.step!=="review"?"Next Step":"Verify Insurance"},h2Text(){if(this.step==="patient")return"Patient Information";if(this.step==="subscriber")return"Subscriber Information";if(this.step==="plan")return"Plan Information";if(this.step==="review")return"Confirm Your Information"},h2Step(){if(this.step==="patient")return 1;if(this.step==="subscriber")return 2;if(this.step==="plan")return this.patientIsDifferentFromSubscriber?3:2;if(this.step==="review")return this.patientIsDifferentFromSubscriber?4:3},selectedPayerName(){for(let s of this.carriers)if(s.id===this.insuranceId)return s.name;return null}},methods:{sendUpdatedLink(){this.$axios.post("/PatientInsuranceForms/".concat(this.code,"/Refresh")).then(()=>{this.newLinkSuccess=!0}).catch(s=>{this.$toast.error("Error creating new link")})},formatDate(s){return m(s).format("MM/DD/YYYY")},next(){if(this.step==="patient"&&this.patientIsDifferentFromSubscriber)return this.step="subscriber";if(this.step==="patient"||this.step==="subscriber")return this.step="plan";if(this.step==="plan")return this.step="review";if(this.step==="review")return this.save()},back(){return this.step==="review"?this.step="plan":this.step==="plan"&&this.patientIsDifferentFromSubscriber?this.step="subscriber":this.step="patient"},async save(){this.working=!0;try{await this.$axios.post("/PatientInsuranceForms/Token/".concat(this.code,"/Update"),{patientFirstName:this.patientFirstName,patientMiddleName:this.patientMiddleName,patientLastName:this.patientLastName,patientDob:this.patientDob,patientGender:this.patientGender,subscriberFirstName:this.subscriberFirstName,subscriberMiddleName:this.subscriberMiddleName,subscriberLastName:this.subscriberLastName,subscriberDob:this.subscriberDob,subscriberGender:this.subscriberGender,dentalPlanMemberId:this.memberId,dentalPlanGroupNumber:this.groupNumber,dentalPlanInsuranceId:this.insuranceId}),this.$toast.success("Updated Insurance information successfully"),this.step="done",this.working=!1}catch(s){this.errorMessage="We couldn't verify your insurance with the information provided. Please check your details and try again.",this.$toast.error("Failed to update insurance information"),this.working=!1,this.step="patient"}}}};var b=function(){var e=this,t=e._self._c;return t("div",{staticClass:"container"},[e._m(0),e.newLinkSuccess?[e._m(1)]:e.isExpired?[t("div",{staticClass:"after-form"},[t("i",{staticClass:"fas fa-exclamation-triangle"}),t("h1",[e._v("Your Link Has Expired")]),t("button",{staticClass:"btn btn--lg btn--rounded btn--bolded btn--primary",on:{click:e.sendUpdatedLink}},[e._v(" Click here to send a new link to your email ")])])]:e.step==="done"?[e._m(2)]:e.working?[t("div",{staticClass:"after-form"},[t("LoaderSpinner",{attrs:{test:"Verifying Insurance"}})],1)]:[t("h1",[e._v("Update Your Insurance Information")]),t("p",[e._v("Enter your information below.")]),e.errorMessage&&e.step==="patient"?t("alert",{attrs:{type:"info"}}

3,[e._v(" "+e._s(e.errorMessage)+" ")]):e._e(),t("h2",[t("span",{staticClass:"number"},[e._v(e._s(e.h2Step))]),e._v(" "+e._s(e.h2Text)+" ")]),t("div",{staticClass:"form"},[e.step==="patient"?[t("label",{attrs:{for:"firstName"}},[e._v(" Patient First Name ")]),t("input",{directives:[{name:"model",rawName:"v-model.trim",value:e.patientFirstName,expression:"patientFirstName",modifiers:{trim:!0}},{name:"validate",rawName:"v-validate",value:"required",expression:"'required'"}],ref:"firstName",staticClass:"pure-form__input",attrs:{name:"firstName",id:"first-name-input",type:"text",autocomplete:"off"},domProps:{value:e.patientFirstName},on:{input:function(r){r.target.composing||(e.patientFirstName=r.target.value.trim())},blur:function(r){return e.$forceUpdate()}}}),t("label",{attrs:{for:"middleName"}},[e._v("Patient Middle Name (Optional)")]),t("input",{directives:[{name:"model",rawName:"v-model.trim",value:e.patientMiddleName,expression:"patientMiddleName",modifiers:{trim:!0}}],ref:"middleName",staticClass:"pure-form__input",attrs:{name:"middleName",id:"middle-name-input",type:"text",autocomplete:"off"},domProps:{value:e.patientMiddleName},on:{input:function(r){r.target.composing||(e.patientMiddleName=r.target.value.trim())},blur:function(r){return e.$forceUpdate()}}}),t("label",{attrs:{for:"lastName"}},[e._v(" Patient Last Name ")]),t("input",{directives:[{name:"model",rawName:"v-model.trim",value:e.patientLastName,expression:"patientLastName",modifiers:{trim:!0}},{name:"validate",rawName:"v-validate",value:"required",expression:"'required'"}],ref:"lastName",staticClass:"pure-form__input",attrs:{name:"lastName",id:"first-name-input",type:"text",autocomplete:"off"},domProps:{value:e.patientLastName},on:{input:function(r){r.target.composing||(e.patientLastName=r.target.value.trim())},blur:function(r){return e.$forceUpdate()}}}),t("label",{attrs:{for:"dob"}},[e._v("Patient Date of Birth")]),t("v-date-picker",{staticClass:"dobInput__calendar",attrs:{name:"dob",popover:{visibility:"click"}},scopedSlots:e._u([{key:"default",fn:function({inputValue:r,inputEvents:i}){return[t("input",e._g({ref:"dob",staticClass:"pure-form__input",attrs:{autocomplete:"off",placeholder:"MM/DD/YYYY",name:"dob-input"},domProps:{value:r}},i))]}}],null,!1,3429121421),model:{value:e.patientDob,callback:function(r){e.patientDob=r},expression:"patientDob"}}),t("label",{attrs:{for:"gender"}},[e._v("Patient Gender")]),t("select",{directives:[{name:"model",rawName:"v-model",value:e.patientGender,expression:"patientGender"}],ref:"gender",staticClass:"pure-form__input",attrs:{name:"gender"},on:{change:function(r){var i=Array.prototype.filter.call(r.target.options,function(a){return a.selected}).map(function(a){var o="_value"in a?a._value:a.value;return o});e.patientGender=r.target.multiple?i:i[0]}}},e._l(e.genderList,function(r){return t("option",{key:r.key||"unknown",domProps:{value:r.key}},[e._v(" "+e._s(r.text)+" ")])}),0),t("span",[t("input",{directives:[{name:"model",rawName:"v-model",value:e.patientIsDifferentFromSubscriber,expression:"patientIsDifferentFromSubscriber"}],attrs:{type:"checkbox"},domProps:{checked:Array.isArray(e.patientIsDifferentFromSubscriber)?e._i(e.patientIsDifferentFromSubscriber,null)>-1:e.patientIsDifferentFromSubscriber},on:{change:function(r){var i=e.patientIsDifferentFromSubscriber,a=r.target,o=!!a.checked;if(Array.isArray(i)){var u=null,n=e._i(i,u);a.checked?n<0&&(e.patientIsDifferentFromSubscriber=i.concat([u])):n>-1&&(e.patientIsDifferentFromSubscriber=i.slice(0,n).concat(i.slice(n+1)))}else e.patientIsDifferentFromSubscriber=o}}}),e._v(" Patient is different from the subscriber ")])]:e._e(),e.step==="subscriber"?[t("label",{attrs:{for:"firstName"}},[e._v(" Subscriber First Name ")]),t("input",{directives:[{name:"model",rawName:"v-model.trim",value:e.subscriberFirstName,expression:"subscriberFirstName",modifiers:{trim:!0}},{name:"validate",rawName:"v-validate",value:"required",expression:"'required'"}],ref:"firstName",staticClass:"pure-form__input",attrs:{name:"firstName",id:"first-name-input",type:"text",autocomplete:"off"},domProps:{value:e.subscriberFirstName},on:{input:function(r){r.target.composing||(e.subscriberFirstName=r.target.value.trim())},blur:function(r){return e.$forceUpdate()}}}),t("label",{attrs:{for:"middleName"}},[e._v("Subscriber Middle Name (Optional)")]),t("input",{directives:[{name:"model",rawName:"v-model.trim",value:e.subscriberMiddleName,expression:"subscriberMiddleName",modifiers:{trim:!0}}],ref:"middleName",staticClass:"pure-form__input",attrs:{name:"middleName",id:"middle-name-input",type:"text",autocomplete:"off"},domProps:{value:e.subscriberMiddleName},on:{input:function(r){r.target.composing||(e.subscriberMiddleName=r.target.value.trim())},blur:function(r){return e.$forceUpdate()}}}),t("label",{attrs:{for:"lastName"}},[e._v(" Subscriber Last Name ")]),t("input",{directives:[{name:"model",rawName:"v-model.trim",value:e.subscriberLastName,expression:"subscriberLastName",modifiers:{trim:!0}},{name:"validate",rawName:"v-validate",value:"required",expression:"'required'"}],ref:"lastName",staticClass:"pure-form__input",attrs:{name:"lastName",id:"first-name-input",type:"text",autocomplete:"off"},domProps:{value:e.subscriberLastName},on:{input:function(r){r.target.composing||(e.subscriberLastName=r.target.value.trim())},blur:function(r){return e.$forceUpdate()}}}),t("label",{attrs:{for:"dob"}},[e._v("Subscriber Date of Birth")]),t("v-date-picker",{staticClass:"dobInput__calendar",attrs:{name:"dob",popover:{visibility:"click"}},scopedSlots:e._u([{key:"default",fn:function({inputValue:r,inputEvents:i}){return[t("input",e._g({ref:"dob",staticClass:"pure-form__input",attrs:{autocomplete:"off",placeholder:"MM/DD/YYYY",name:"dob-input"},domProps:{value:r}},i))]}}],null,!1,3429121421),model:{value:e.subscriberDob,callback:function(r){e.subscriberDob=r},expression:"subscriberDob"}}),t("label",{attrs:{for:"gender"}},[e._v("Subscriber Gender")]),t("select",{directives:[{name:"model",rawName:"v-model",value:e.subscriberGender,expression:"subscriberGender"}],ref:"gender",staticClass:"pure-form__input",attrs:{name:"gender"},on:{change:function(r){var i=Array.prototype.filter.call(r.target.options,function(a){return a.selected}).map(function(a){var o="_value"in a?a._value:a.value;return o}

3);e.subscriberGender=r.target.multiple?i:i[0]}}},e._l(e.genderList,function(r){return t("option",{key:r.key||"unknown",domProps:{value:r.key}},[e._v(" "+e._s(r.text)+" ")])}),0)]:e._e(),e.step==="plan"?[t("label",{attrs:{for:"payer"}},[e._v("Payer")]),t("select",{directives:[{name:"model",rawName:"v-model.trim",value:e.insuranceId,expression:"insuranceId",modifiers:{trim:!0}}],ref:"payer",staticClass:"pure-form__input",attrs:{name:"payer"},on:{change:function(r){var i=Array.prototype.filter.call(r.target.options,function(a){return a.selected}).map(function(a){var o="_value"in a?a._value:a.value;return o});e.insuranceId=r.target.multiple?i:i[0]}}},e._l(e.carriers,function(r){return t("option",{key:r.id,domProps:{value:r.id}},[e._v(" "+e._s(r.name)+" ")])}),0),t("label",{attrs:{for:"memberId"}},[e._v("Member ID")]),t("input",{directives:[{name:"model",rawName:"v-model.trim",value:e.memberId,expression:"memberId",modifiers:{trim:!0}},{name:"validate",rawName:"v-validate",value:"required",expression:"'required'"}],ref:"memberId",staticClass:"pure-form__input",attrs:{name:"memberId",id:"first-name-input",type:"text",autocomplete:"off"},domProps:{value:e.memberId},on:{input:function(r){r.target.composing||(e.memberId=r.target.value.trim())},blur:function(r){return e.$forceUpdate()}}}),t("label",{attrs:{for:"groupNumber"}},[e._v("Group Number")]),t("input",{directives:[{name:"model",rawName:"v-model.trim",value:e.groupNumber,expression:"groupNumber",modifiers:{trim:!0}},{name:"validate",rawName:"v-validate",value:"required",expression:"'required'"}],ref:"groupNumber",staticClass:"pure-form__input",attrs:{name:"groupNumber",id:"first-name-input",type:"text",autocomplete:"off"},domProps:{value:e.groupNumber},on:{input:function(r){r.target.composing||(e.groupNumber=r.target.value.trim())},blur:function(r){return e.$forceUpdate()}}})]:e._e(),e.step==="review"?[t("label",{attrs:{for:"firstName"}},[e._v(" Patient First Name ")]),t("p",[e._v(" "+e._s(e.patientFirstName)+" ")]),t("label",{attrs:{for:"middleName"}},[e._v("Patient Middle Name (Optional)")]),t("p",[e._v(" "+e._s(e.patientMiddleName)+" ")]),t("label",{attrs:{for:"lastName"}},[e._v(" Patient Last Name ")]),t("p",[e._v(" "+e._s(e.patientLastName)+" ")]),t("label",{attrs:{for:"dob"}},[e._v("Patient Date of Birth")]),t("p",[e._v(" "+e._s(e.formatDate(e.patientDob))+" ")]),t("label",{attrs:{for:"gender"}},[e._v("Patient Gender")]),t("p",[e._v(" "+e._s(e.patientGender)+" ")]),e.patientIsDifferentFromSubscriber?t("p",[e._v(" Patient is different from the subscriber ")]):t("p",[e._v("Patient is same as subscriber")]),e.patientIsDifferentFromSubscriber?[t("label",{attrs:{for:"firstName"}},[e._v(" Subscriber First Name ")]),t("p",[e._v(" "+e._s(e.subscriberFirstName)+" ")]),t("label",{attrs:{for:"middleName"}},[e._v("Subscriber Middle Name (Optional)")]),t("p",[e._v(" "+e._s(e.subscriberMiddleName)+" ")]),t("label",{attrs:{for:"lastName"}},[e._v(" Subscriber Last Name ")]),t("p",[e._v(" "+e._s(e.subscriberLastName)+" ")]),t("label",{attrs:{for:"dob"}},[e._v("Subscriber Date of Birth")]),t("p",[e._v(" "+e._s(e.formatDate(e.subscriberDob))+" ")]),t("label",{attrs:{for:"gender"}},[e._v("Subscriber Gender")]),t("p",[e._v(" "+e._s(e.subscriberGender)+" ")])]:e._e(),t("label",{attrs:{for:"payer"}},[e._v("Payer")]),t("p",[e._v(" "+e._s(e.selectedPayerName)+" ")]),t("label",{attrs:{for:"memberId"}},[e._v("Member ID")]),t("p",[e._v(" "+e._s(e.memberId)+" ")]),t("label",{attrs:{for:"groupNumber"}},[e._v("Group Number")]),t("p",[e._v(" "+e._s(e.groupNumber)+" ")])]:e._e()],2),t("div",{staticClass:"buttons"},[e.step!=="patient"?t("span",{staticClass:"blank-hidden"}):e._e(),t("button",{staticClass:"btn btn--primary btn--rounded btn--bolded next-btn",on:{click:e.next}},[e._v(" "+e._s(e.nextStepText)+" ")]),e.step!=="patient"?t("button",{staticClass:"back",on:{click:e.back}},[e._v("Back")]):e._e()])]],2)},f=[function(){var s=this,e=s._self._c;return e("div",{staticClass:"header"},[e("span",[s._v(" Powered By "),e("img",{staticClass:"siteNavbar__brandLogoImage",attrs:{alt:"airpay logo",src:c,height:"30"}})])])},function(){var s=this,e=s._self._c;return e("div",{staticClass:"after-form"},[e("i",{staticClass:"fas fa-check-circle"}),e("h1",[s._v("Your New Link Has Been Sent")]),e("h1",[s._v("Please check your email. It may take few minutes for your email to arrive.")])])},function(){var s=this,e=s._self._c;return e("div",{staticClass:"after-form"},[e("i",{staticClass:"fas fa-check-circle"}),e("h1",[s._v("Success!")]),e("h1",[s._v("Your insurance has been verified.")])])}],v=l(d,b,f,!1,null,"d73bca70");const h=v.exports;export{h as default};
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5//# debugId=ad9bd325-ebe1-5702-aa4a-55ee10813d9a