Provider Credentialing Workflow

import ComplianceGrid from "@compliancegrid/sdk";

const cg = new ComplianceGrid({
  apiKey: process.env.COMPLIANCEGRID_API_KEY,
});

// Verify a provider's DEA registration
const dea = await cg.pharma.deaLookup({
  deaNumber: "AB1234567",
});

console.log("Registrant:", dea.data.name);
console.log("DEA Number:", dea.data.deaNumber);
console.log("Status:", dea.data.status); // "ACTIVE" | "EXPIRED" | "REVOKED"
console.log("Schedules:", dea.data.schedules); // ["II", "IIN", "III", "IIIN", "IV", "V"]
console.log("Business Activity:", dea.data.businessActivity);
console.log("Expiration:", dea.data.expirationDate);

if (dea.data.status !== "ACTIVE") {
  console.error("DEA registration is NOT active — cannot handle controlled substances");
}

// Screen against OIG List of Excluded Individuals/Entities
const oig = await cg.legal.oigLeieSearch({
  lastName: "Smith",
  firstName: "John",
  // Or search by NPI, UPIN, or business name
});

if (oig.data.totalResults > 0) {
  console.error("EXCLUDED — provider found on OIG LEIE");
  for (const match of oig.data.results) {
    console.log(`  Name: ${match.lastName}, ${match.firstName}`);
    console.log(`  Exclusion Type: ${match.exclusionType}`);
    console.log(`  Exclusion Date: ${match.exclusionDate}`);
    console.log(`  Specialty: ${match.specialty}`);
    console.log(`  State: ${match.state}`);
  }
} else {
  console.log("CLEAR — no OIG LEIE exclusions found");
}

// Also check by NPI if available
const oigByNpi = await cg.legal.oigLeieSearch({
  npi: "1234567890",
});

// Check SAM.gov for entity exclusions/debarments
const sam = await cg.business.samSearch({
  legalBusinessName: "Smith Medical Group LLC",
});

const entity = sam.data.results[0];
if (entity) {
  console.log("Entity:", entity.legalBusinessName);
  console.log("UEI:", entity.uniqueEntityId);
  console.log("Registration Status:", entity.registrationStatus);

  if (entity.hasExclusions) {
    console.error("SAM.gov EXCLUSION — entity is debarred or excluded");
    for (const ex of entity.exclusions) {
      console.log(`  Type: ${ex.type}`);
      console.log(`  Agency: ${ex.agency}`);
      console.log(`  Effective: ${ex.effectiveDate}`);
    }
  } else {
    console.log("No SAM.gov exclusions — entity in good standing");
  }
}

// Search FDA drug database
const drug = await cg.pharma.fdaDrugSearch({
  brandName: "Lipitor",
});

console.log("Drug:", drug.data.results[0].brandName);
console.log("Generic:", drug.data.results[0].genericName);
console.log("NDC:", drug.data.results[0].ndcCode);
console.log("Labeler:", drug.data.results[0].labelerName);
console.log("DEA Schedule:", drug.data.results[0].deaSchedule || "Not scheduled");

// Check for drug shortages
const shortage = await cg.pharma.drugShortageCheck({
  ndcCode: drug.data.results[0].ndcCode,
});

if (shortage.data.isShortage) {
  console.warn("SHORTAGE ALERT:", shortage.data.shortageDetails);
  console.log("Alternatives:", shortage.data.alternatives);
}

interface CredentialingResult {
  provider: string;
  timestamp: string;
  deaStatus: "ACTIVE" | "EXPIRED" | "REVOKED" | "NOT_FOUND";
  oigExcluded: boolean;
  samExcluded: boolean;
  sanctionsHit: boolean;
  overallStatus: "APPROVED" | "REVIEW_REQUIRED" | "DENIED";
  details: Record<string, any>;
}

async function credentialProvider(
  firstName: string,
  lastName: string,
  deaNumber?: string,
  npi?: string,
  orgName?: string
): Promise<CredentialingResult> {
  const result: CredentialingResult = {
    provider: `${firstName} ${lastName}`,
    timestamp: new Date().toISOString(),
    deaStatus: "NOT_FOUND",
    oigExcluded: false,
    samExcluded: false,
    sanctionsHit: false,
    overallStatus: "APPROVED",
    details: {},
  };

  // Run all checks in parallel for speed
  const [deaResult, oigResult, samResult, screenResult] = await Promise.all([
    deaNumber
      ? cg.pharma.deaLookup({ deaNumber }).catch(() => null)
      : Promise.resolve(null),
    cg.legal.oigLeieSearch({ firstName, lastName, npi }).catch(() => null),
    orgName
      ? cg.business.samSearch({ legalBusinessName: orgName }).catch(() => null)
      : Promise.resolve(null),
    cg.compliance.screenParties([
      { name: `${firstName} ${lastName}`, country: "US", type: "INDIVIDUAL" },
    ]).catch(() => null),
  ]);

  // Evaluate DEA
  if (deaResult?.data) {
    result.deaStatus = deaResult.data.status;
    result.details.dea = deaResult.data;
    if (deaResult.data.status !== "ACTIVE") {
      result.overallStatus = "REVIEW_REQUIRED";
    }
  }

  // Evaluate OIG
  if (oigResult?.data?.totalResults > 0) {
    result.oigExcluded = true;
    result.details.oig = oigResult.data;
    result.overallStatus = "DENIED"; // Mandatory exclusion
  }

  // Evaluate SAM.gov
  if (samResult?.data?.results?.[0]?.hasExclusions) {
    result.samExcluded = true;
    result.details.sam = samResult.data;
    result.overallStatus = "DENIED";
  }

  // Evaluate sanctions
  if (screenResult?.data?.overallResult === "HIT") {
    result.sanctionsHit = true;
    result.details.sanctions = screenResult.data;
    result.overallStatus = "DENIED";
  }

  return result;
}

// Usage
const cred = await credentialProvider("John", "Smith", "AB1234567", "1234567890", "Smith Medical Group");
console.log(`Status: ${cred.overallStatus}`);
if (cred.overallStatus === "DENIED") {
  console.log("Reason:", cred.oigExcluded ? "OIG excluded" : cred.samExcluded ? "SAM excluded" : "Sanctions hit");
}