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--- claim_pended [2024/07/11 14:37] – tina.robles
+++ claim_pended [2025/09/18 18:53] (current) – tina.robles
@@ Line 3: / Line 3: @@
 The Claims Pended screen can be accessed by clicking Pended in the Claim -> Claim View menu.
-{{:pasted:20181128-194309.png}}
+{{:pasted:20240820-170051.png}}
 The Claims Pended grid displays all claims in a Pended status and a option to view claims by Reason Code.
@@ Line 15: / Line 15: @@
 This column displays the Grouping Description hierarchy for the group which has visibility to the claim based on Claimant. This column can be filtered to a group by entering the text in the column filter and clicking enter.
-{{:pasted:20160919-093105.png}}
+{{:pasted:20240820-170218.png}}
 __Visibility Indicator__
@@ Line 26: / Line 26: @@
 In the screenshot below, the user is in both the hierarchy2 and level A groups, but not the level 2 group.  To view all pended claims the user is responsible for, simply filter the Visible Indicator column to True.
-{{:pasted:20160919-093424.png}}
+{{:pasted:20240820-170235.png}}
 -----
@@ Line 33: / Line 33: @@
 This displays the date of the oldest Pend reason for the Claim.  Use this column to sort by the oldest Pended Claims.
-{{:pasted:20160423-200003.png}}
+{{:pasted:20240820-170257.png}}
 -----
@@ Line 40: / Line 40: @@
 Clicking the Contract ID will open a new tab for the contract selected.  Clicking the Contract ID Hyperlink for a contract not resolved to a specific version will direct the user to the Contract Search screen.  The Contract ID will be populated in the search criteria and generate results automatically.
-{{:pasted:20160423-204749.png}}
+{{:pasted:20240820-170339.png}}
 -----
 **Contract Creator**
@@ Line 46: / Line 46: @@
 The Contract Creator First Name and Last Name display on the Pending grid.  These columns will be blank if the Contract has not resolved to a specific version, or if there is no Contract assigned to the claim.
-{{:pasted:20160817-094753.png}}
+{{:pasted:20240820-170406.png}}
 -----
@@ Line 63: / Line 63: @@
 **Column Filters**
-All columns have a filter option.  Enter text into the field below the column label and click enter to filter the data.  To remove a filter, clear the text in the field and click Enter.  In the screenshot below, the grid is filtered to pended claims with "09" in the Invoice Number.
+All columns have a filter option.  Enter text into the field below the column label and click enter to filter the data.  To remove a filter, clear the text in the field and click Enter.  In the screenshot below, the grid is filtered to pended claims with "123" in the Invoice Number.
-{{:pasted:20160919-094012.png}}
+{{:pasted:20240820-171135.png}}
 -----
 **Filter Reason Codes**
@@ Line 73: / Line 73: @@
 In the below screenshot, 9.87% of claims are pending for Missing manufacturer sku.  Clicking on this row in the Filter Reason Codes grid automatically filters by this reason code.
-{{:pasted:20160423-201625.png}}
+{{:pasted:20240820-171359.png}}
 -----
 NOTE: Claims and line items can pend for multiple reasons.  When PEND (#) is displayed, click on the hyperlink to view all pendings for that claim.
-{{:pasted:20160423-201810.png}}
+{{:pasted:20240820-171505.png}}
 -----
 **Multi-Claim Assign Contract**
@@ Line 118: / Line 118: @@
 Click the Generate button.  Excel is the only Export Type available for this report.
-{{:pasted:20161007-124430.png}}
+{{:pasted:20240820-172010.png}}
 A wait message will display while the report is being generated.
-{{:pasted:20161007-124119.png}}
+{{:pasted:20240820-172040.png}}
 To open the report, click the hyperlink in the Generated Reports section.
-{{:pasted:20161007-124110.png}}
+{{:pasted:20240820-172057.png}}
 -----
@@ Line 134: / Line 134: @@
 There is a Chart that displays a visual representation of Pendings by Reason Code.
-{{:pasted:20161207-110519.png}}
+{{:pasted:20240820-172132.png}}
 To view the claims pending for a specific reason, click on that portion of the chart and the data will display in the grid on the left.
@@ Line 140: / Line 140: @@
 The count related to each reason will display on hover over that reason.
-Data can be removed/added to the chart by clicking the reasons listed below the chart.  Reasons with a strike-through are not displaying in the chart.
+Data can be removed/added to the chart by clicking the reasons listed below the chart.  Reasons will be greyed out that are not displaying in the chart.
-{{:pasted:20161207-110826.png}}
+{{:pasted:20240820-174331.png}}
+**Enhanced Claim Line Item Status Classification**
+A new pending reason designation has been implemented to improve claim processing accuracy. Claims associated with
+terminated contract versions will now display a specific Terminated Contract status indicator, replacing the previous Out of Time Frame designation. This enhancement provides more precise identification of claim status rationale.
+{{: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}}

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