User Tools

Site Tools


claim_pended

Differences

This shows you the differences between two versions of the page.

Link to this comparison view

Both sides previous revisionPrevious revision
claim_pended [2024/12/20 20:17] tina.roblesclaim_pended [2025/09/18 18:53] (current) tina.robles
Line 151: Line 151:
 {{:pasted:20241220-201730.png}} {{:pasted:20241220-201730.png}}
 ----- -----
 +
 +**Automated Claims Rejection Enhancement**
 +
 +Contract Hint Mapping - NPGS Integration
 +
 +Feature Overview
 +An intelligent automated rejection system has been implemented to streamline claims processing for contracts designated as "Not Paid at GoSimple" (NPGS). This enhancement eliminates manual intervention requirements and significantly reduces processing overhead.
 +
 +__Functional Specifications__
 +
 +**Trigger Mechanism**
 +  * Contract Hint Mapping: When a contract hint is configured with NPGS - Not paid at GoSimple designation
 +  * Automatic Processing: Claims associated with NPGS-mapped contracts undergo immediate automated rejection upon creation
 +  * Real-Time Execution: Rejection occurs instantaneously during the claim creation workflow
 +
 +**Process Automation**
 +  * Elimination of Manual Tasks: Removes requirement for manual claim rejection activities
 +  * Processing Efficiency: Significantly reduces time-to-resolution for NPGS-designated claims
 +  * Workflow Optimization: Streamlines overall claims processing pipeline
 +
 +__System Behavior__
 +
 +**Automated Actions**
 +  - Claim Creation Detection: System identifies newly created claims
 +  - Contract Hint Validation: Evaluates associated contract hint mappings
 +  - NPGS Status Check: Determines if contract is designated as "Not paid at GoSimple"
 +  - Automatic Rejection: Executes immediate claim rejection for NPGS-mapped contracts
 +  - Documentation: Appends standardized notation to claim record
 +
 +**Audit & Documentation**
 +  * Automated Notation: System-generated notes clearly identify claims rejected through NPGS automation
 +  * Process Transparency: Distinguishes automated rejections from manual processing actions
 +  * Audit Trail: Maintains comprehensive record of all automated rejection activities
 +
 +__Business Benefits__
 +
 +**Operational Efficiency**
 +  * Time Reduction: Eliminates manual processing time for NPGS-designated claims
 +  * Resource Optimization: Frees staff capacity for higher-value claims processing activities
 +  * Consistency: Ensures uniform handling of NPGS claims across all processing scenarios
 +
 +**Process Improvements**
 +  * Error Reduction: Minimizes human error in NPGS claim identification and rejection
 +  * Standardization: Implements consistent rejection methodology organization-wide
 +  * Scalability: Accommodates increased claim volumes without proportional resource increases
 +
 +**Technical Implementation**
 +  * Integration Point: Seamless integration with existing contract hint mapping infrastructure
 +  * Performance Impact: Minimal system overhead with real-time processing capabilities
 +  * Configuration Management: Centralized NPGS designation management through contract hint interface
 +
 +**Quality Assurance**
 +  * Validation Logic: Robust validation ensures accurate NPGS identification
 +  * Exception Handling: Comprehensive error management for edge cases
 +  * Monitoring: Automated tracking of rejection volumes and processing metrics
 +
 +{{:pasted:20250918-185248.png}}
 +
 +
claim_pended.txt · Last modified: 2025/09/18 18:53 by tina.robles