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 Generating Subrogation/Recovery Receivables from Payment Items of Subclaims

Use

You can automatically generate the items of a subrogation/recovery receivable from the payment items of the assigned subclaims. You have the following options:

  • You can search for specific payment items of the assigned subclaims and select these manually as items of the subrogation/recovery receivable.

  • You can automatically generate all payment items of the assigned subclaims as items of the subrogation/recovery receivable.

Prerequisites

In claims processing

  • You have assigned the required subclaims to the collective subrogation/recovery. In these subclaims the system has already posted payments to the collections and disbursements system.

  • You have posted no other subrogation/recovery receivable for this settlement (see Posting Subrogation/Recovery Receivables).

  • You have created a settlement in collective subrogation/recovery and are on the Settlements tab page.

Customizing

The payments of the assigned subclaims contain recoverable items.

This means that the payment items must be valid. You determine this validity by means of the Customizing settings for the Search Framework that you define for the search by payment item.

The following criteria are used in delivery Customizing:

  • Single fields from tables (such as subclaim, payment, payment item),

    Example of such a single field from the table Payment ICLPAY): Record Type of Payment (field ICL_PAYCAT)

  • Conditions defined in the coding of the search function module.

    The following conditions are particularly important here:

    • Recoverability in the true sense:

      In other words, the indicator Subrogation/Recovery Possible has been set for the benefit type in the benefits type tree (IMG path: Claims Management -> Claim -> Product Configuration -> Benefit Types -> Configure Benefit Type Trees , level of Permitted Benefit Types ).

    • Reference to selection period:

      This means that the system compares the settlement data in the fields Payments From and Payments To with the payment item data in the fields Valid From and Valid To.

    • Prevention of multiple subrogation/recovery:

      Per payer and per claim bundle subtype you may only use each payment item once as the subrogation/recovery item.

You can change the Customizing settings for the search for payment items. For more information, see Customizing Settings for Collective Subrogation/Recovery in the section '“Settings in Search Framework for Search by Payment Item”.

Selecting Specific Payment Items

  1. Choose with the quick info text Choose Payment Items .

    The Payment Items of Assigned Claims/Subclaims dialog screen appears.

    Note Note

    If you have not assigned any subclaim, or if there are no valid payment items in any of the assigned subclaims, the system does not display this dialog screen. Instead the system outputs a corresponding error message in the status bar.

    End of the note.
  2. On the dialog screen, mark the lines with the required payment items.

  3. Choose Continue.

  4. Save your entries.

    Caution Caution

    Before you save, be sure whether you want to post the subrogation/recovery receivable immediately, or if you just want to park it for the time being (see “Posting Subrogation/Recovery Receivables”). If you want to post the subrogation/recovery receivable immediatelym you cannot enter any more items. In this case, do not save until you have entered all items.

    End of the caution.

Assign All Payment Items

Choose Assign All Payment Items (Assign All Payment Items).

Result

The following points are valid for both the “Select Specific Payment Items” procedure and the “Assign All Payment Items” procedure.

  • The system converts all transferred payment items into corresponding receivable items.

    The system displays these receivable items in the Subrogation/Recovery Receivable section, with the following details for example:

    • Subcoverage type

    • Benefit type

      Note Note

      The system replaces the original coverage and benefit types of the payment items with standard values from Customizing of the dummy claim (see “Customizing Settings for Collective Subrogation/Recovery”, section “Settings for Dummy Claim for Posting Subrogation/Recovery Receivables”).

      End of the note.
    • Amount requested

      The system enters the payment amount of the payment item as being the amount requested.

    • Key of original payment item

      In the Payment Item field the system displays the compound key of the original payment items: claim number - subclaim number - payment number - payment item number

    If you want to access this conversion directly, you must implement the Business Add-In (BAdI) BADI_ICLE_BULKSUBRO.

    • BAdI method “MODIFY_REQUESTITEM” (Change Receivable Items)

      You can use this method to do the following, for example:

      • You can compare the coverage and benefit types of the original subclaims with the coverage and benefit types of the subclaims of the dummy claim

      • You can change the amounts of the receivables.

    • BAdI method REQUESTITEM_ASSIGNED_PAYITEM ( Provide Link Data for Payment Items )

      You can use this method to access data on the link between the original payment item and the receivable item created from this. You can save this link data temporarily if you wish. Once you then create and save a subrogation/recovery for a payment item, you can forward this information to other claim subobjects (such as claim item groupings).

    You can find this BAdI in the SAP Customizing Implementation Guide (IMG) under SAP InsuranceClaims ManagementClaim BundleBusiness SettingsCollective Subrogation/RecoveryBAdI: Change and Link of Subrogation/Recovery Receivable Items ).

    For more information, see the documentation for the BAdI and for the two methods.

  • As long as the subrogation/recovery receivable has not yet been posted, you can:

  • Manually change the coverage type, benefit type, and amount requested

  • Manually delete single items

    To do so, mark the line with the item and then choose with the quick info text Delete Subrogation/Receivable Item.

  • Manually add more items (see Creating Subrogation/Recovery Receivables Manually)

  • In the last line, highlighted yellow, the system displays the total of all requested items.