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SIMG_VC_TICL005_PM - Configure Permitted Subclaim Types

SIMG_VC_TICL005_PM - Configure Permitted Subclaim Types

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Use

In this IMG activity you configure the permitted subclaim types. You can make the configuration for either an existing claim type or for a new claim type.

  • To configure the permitted subclaim types for an existing claim type, select the claim type.
  • To configure the permitted subclaim types for a new claim type, enter a key that does not yet exist and a name for the new claim type.

At the level of Version you can define the name of a version of the claim type and also the timepoint from which it is to be valid.

At the level of Permitted Subclaim Types you can define how many subclaims may be created for each subclaim type.

At the level of Permitted Subclaim Complexities, you can store those subclaim complexities that have been defined in IMG activity Define Claim/Subclaim Complexities. The claim complexity selected by the performer controls further processing of the claim. For example, if the claim handler flags a subclaim as being complex, only certain claim handlers are permitted to process the subclaim further.

At the level of Permitted Claim Item Rejection Reasons, you can store those reasons that have been defined in IMG activity Define Reasons for Rejecting a Claim Item.

At the level of Permitted Subclaim Status Reasonsyou can store the reasons for changing the subclaim status that have been defined in IMG activity Define Reasons for Changing Claim/Subclaim Status.

At the level of Permitted Manual Tasks/Log Entries you can define which tasks or log entries the user may create manually during claims processing. All tasks/log entries must have been defined previously in IMG activity Configure Tasks/Log Entries and Activities.

At the level of Permitted Manual Coverage Referrals you can store the coverage referrals that the user may enter manually during claims processing. All coverage referrals must have been defined previously in IMG activity Define Coverage Referrals.

At the level of Permitted Methods of Settlement, you can store those methods of settlement that have been defined in IMG activity Define Methods of Settlement.

At the level of Permitted Reserve Types, you can store those reserve types that have been defined in IMG activity Define Reserve Types.

At the level of Permitted Manual Documents you can store the claim documents that the user may place manually into document dispatch. All claim documents must have been defined previously in IMG activity Define Claim Documents.

At the level of Permitted Benefits/Services/Fees Catalogs, you can store those benefits/services/fees catalogs that have been defined in IMG activity. Define Benefit Catalogs. If you define several benefits, services, and fees catalogs, you can mark one of them as being the default catalog.

Requirements

Standard settings

Activities

Example






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