Differences

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

--- claim_pended [2024/08/20 17:30] – tina.robles
+++ claim_pended [2025/09/18 18:53] (current) – tina.robles
@@ 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}}

Telus TPM Documentation

User Tools

Site Tools

Differences

Page Tools