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  Status of a Claim/Status of a Subclaim

Definition

Indicates the status of the claim or subclaim at header level.

Note Note

Since the status concept is the same in principle for claim and subclaim, it is described in one document.

End of the note.

Structure

A distinction is made between the database status and the display status of the claim or subclaim.

Database Status

The system contains the following database statuses for the claim or subclaim, for example:

The documentation for this database status also contains information on when which database status is set.

Display Status

The display status is the status of the claim or subclaim that is displayed at run time during claims processing. The claim status is displayed on claim header level in the Status field on the Claim Overview tab page, and the subclaim status is displayed on the relevant subclaim level in the Status field on the Subclaim Overview tab page.

The possible display statuses are defined in the IMG activity Enhance Status (IMG path:   Claims Management  Claim  Business Settings  Status Within a Claim  Enhance Status   .)

You can now use a Business Rule Framework (BRF) expression to define which of these statuses is displayed, and when it is displayed. You can also create new statuses using this BRF expression (in addition to the statuses defined in the IMG activity Enhance Status).

To do so:

  1. Create the expression you require in the BRF.

  2. Store the BRF expression in the IMG activity Configure Internal Claim Types (IMG path:   Claims Management  Claim  Process Control (Internal Claim Types)  Configure Internal Claim Types   ).

    You store the BRF expression on claim header level in the detail view for the version of the internal claim type in the Claim Status VR field (for the claim status) or Subclaim Status VR (for the subclaim status).

Example

For example, you can use a BRF expression of the type Truth Table to determine the display status of a claim. This can be done as follows:

Display Status

BRF Expression

CL201

(Claim Handling Process Active)

BRF Expression

CL401

(Claim Closed)

BRF Expression

CL501

(No Claim Made)

BRF Expression

CL502

(Pending Tasks)

Open

TRUE

FALSE

FALSE

*

Reopened

TRUE

TRUE

FALSE

*

No Claim Made

FALSE

*

TRUE

*

Pending

FALSE

TRUE

FALSE

TRUE

Closed

FALSE

TRUE

FALSE

FALSE

Notes on the above truth table:

  • The possible values in the Display Status column must be defined in the IMG activity Enhance Status .

  • BRF expressions are evaluated in the truth table.

    The individual BRF expressions have the following meaning:

    • The BRF expression CL201 checks whether the Claim Handling Process Active indicator (STHANDLER field) is set in the database table ICLCLAIM.

    • The BRF expression CL401 checks whether the Claim Closed indicator (STCLOSED field) is set in the database table ICLCLAIM.

    • The BRF expression CL501 checks whether the No Claim Made indicator (STNOCLAIM field) is set in the database table ICLCLAIM.

    • The BRF expression CL502 checks whether there are pending tasks in the claim in the sense of activity management .

  • The details TRUE, FALSE,* are the return values of the BRF expression.

    • TRUE means that the BRF expression has returned the value TRUE.

    • FALSE means that the BRF expression has returned the value FALSE.

    • * means that it is unimportant whether the BRF expression has returned the value TRUE or FALSE.

Examples based on the truth table shown above:

  • The system displays the claim status Open if the following conditions are met:

    • The claim handling process is active; meaning that the BRF expression CL201 returns the value TRUE.

    • The claim is not yet closed and is not a no claim made; the BRF expressions CL401 and CL501 return the value FALSE.

    • It is unimportant whether there are still pending tasks in the claim.

  • The system displays the claim status Reopened if the following conditions are met:

    • The claim handling process is active and the claim has already been closed; the BRF expressions CL201 and CL401 return the value TRUE.

    • The claim is not a no claim made; the BRF expression CL501 returns the value FALSE.

    • Here it is also unimportant whether there are still pending tasks in the claim.

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