Business Partner Roles in the Claims Management System

Definition

In the Claims Management system a distinction is made between the following roles:

Participant role

The participant role describes the relationship of the business partner to the claimin which it is participating.

Participant roles include:
- Claimant
- Prescriber
Business partner role

Every business partner that participates in the claim has a role in SAP Business Partner, namely the business partner role. The business partner role is not connected to the participant role in any way.

Use

In Customizing, you must assign a business partner role to every participant role (IMG path: Start of the navigation path Claims Management Next navigation step Claim Business Settings Participants Define Characteristics of Participant Roles End of the navigation path ).

When you create a new participant in the relevant role in claims processing, the assignment that you make in this activity specifies the business partner role that the participant must have.

Example Example

A participant with the participant role of Insurer must exist in the business partner role of Insurance Company .

End of the example.

Structure

The Claims Management system requires the existence of some business partners in certain business partner roles. For example, a payee must exist in the Contract Partner (MCI) role, because the SAP Collections & Disbursements system (FS-CD) can only make payments to contract partners. With most claim participants, it is sufficient that they exist as a General Business Partner (000000) , or that they can be created in this business partner role. However, some specific business partner roles are required (such as Policyholder ).

The following business partner roles from SAP Business Partner are used in the Claims Management system:

Business partner role	Key in SAP Business Partner	Description
Business partner (general)	000000	Business Partner (General)
Contract Partners	MKK	Every claim participant that is also a payee must also have the role of Contract Partner in addition to the existing business partner role, so that FS-CD is able to make payments to this claim participant. If necessary, the system creates this business partner role with Direct Input, as soon as the payment is transferred to FS-CD.
Policyholder	ICL000	Participant who can assume the participant role of policyholder as well as the business partner role of policyholder . You can use the Policyholder business partner role to manage data for the business partner, independent of the claim, the contract, or the policy product.
Insurance company	ICL004
External services: Repair Shop Rental Car Company External Appraiser Towing Service Retaile r	ICL001 ICL002 ICL003 ICL005 ICL010	External services are business partners. You can save specific additional data for these business partners, such as customer satisfaction.

Integration

The business partner roles that are used in the Claims Management system are created in SAP Business Partner.