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pended_claims_resolution

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pended_claims_resolution [2021/10/06 18:47] – lisa.maloneypended_claims_resolution [2024/10/09 11:28] (current) – tina.robles
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 **__Pended Claims Resolution__** **__Pended Claims Resolution__**
  
-To locate pending claims, expand the Claim Menu and select the Pended option from the Claim Views section.  Or you can go to the claim search and search for pending claims.+To locate pending claims, use the Pended claim widget button or expand the Claim Menu and select the Pended option from the Claim Views section.
  
-{{:pasted:20181127-110527.png}}+{{:pasted:20240813-180700.png}}   {{:pasted:20240813-180630.png}}  
 ------ ------
  
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 ----- -----
 +**PENDED CLAIMS RESOLUTION**
  
-The results can be filtered to select pending reasons.  Just type in the text box at the top of the column and click enter.  This will perform a filter that contains the text entered.  To remove the filter, delete the text and click enter.+To locate pending claims, expand the Claim Menu and select the Pended option from the Claim Views section. Or you can go to the claim search and search for pending claims. 
 +The results can be filtered within any column. Just type in the text box at the top of the column and click enter. This will perform a filter that contains the text entered. To remove the filter, click on the x in the filtered field.
  
-{{:pasted:20160128-135644.png}} +{{:pasted:20240813-180959.png}}
------ +
-On the Pending grid, if there are multiple pending reasons, the Pend hyperlink is followed by a count of pending.  To view all pend reasons for a claim, click on the hyperlink. This will open a read-only window displaying all pend reasons.  If a reason is listed multiple times, that pend is on multiple lines on the claim.+
  
-{{:pasted:20160128-142059.png}}+On the Pending grid, if there are multiple pending reasons, the Pend hyperlink is followed by a count of pending. To view all pend reasons for a claim, click on the hyperlink. This will open a read-only window displaying all pend reasons. If a reason is listed multiple times, that pend is on multiple lines on the claim.
  
-__Pended Aged Days__+{{:pasted:20240813-181150.png}} 
 + 
 +Pended Aged Days
  
 The Pended Aged Days column on the grid displays the count of days since the first pending date on the claim till today's date. The Pended Aged Days column on the grid displays the count of days since the first pending date on the claim till today's date.
------ 
- 
  
 **Pended - No Contract** **Pended - No Contract**
  
-To locate a claim pending for No Contract, expand the Claim Menu and Claim Views and select Contractless and filter to Pending status.  (This grid will display claims in both a Draft and Pended status.) To find contractless claims on the Claim Search or Pending grids, these will be claims where the Contract ID is blank.   +To locate a claim pending for No Contract, expand the Claim Menu and Claim Views and select Contractless and filter to Pending status. (This grid will display claims in both a Draft and Pended status.) To find contractless claims on the Claim Search or Pending grids, these will be claims where the Contract ID is blank. Note: Claims in a Draft status have not been completed yet, but a contract can be assigned.
-Note: Claims in a Draft status have not been completed yet, but a contract can be assigned. +
- +
-{{:pasted:20181127-110604.png}}+
  
-__Linking a Contract:__  To Link a Contract to a Claim, click the Link button on the claim in view mode.  This Link can also be used to select a different Contract for a Claim if the currently assigned Contract is incorrect. +{{:pasted:20240813-181252.png}}
  
-{{:pasted:20181127-110759.png}}+Linking a Contract: To Link a Contract to a Claim, click the Link button on the claim in view mode. This Link can also be used to select a different Contract for a Claim if the currently assigned Contract is incorrect.
  
-Clicking Link will open up a Contract Search.+{{:pasted:20240813-181349.png}} 
 +Clicking Link will open the contract search window 
 +{{:pasted:20240813-181507.png}}
  
-{{:pasted:20180410-101141.png}} +There are 2 different search sections with different searching options on the Contract Search. Enter search criteria in any of the 5 search boxes on the left or select search criteria from the drop downs on the right side of the search section. The search criteria available in the drop downs are as follows: Start Date, End Date, Claimable, Contract Version ID, Contract Name, Direct Value, Deviated Value, Product Name and Product Number.
- +
-There are 2 different search sections with different searching options on the Contract Search.  Enter search criteria in any of the 5 search boxes on the left or select search criteria from the drop downs on the right side of the search section. The search criteria available in the drop downs are as follows: Start Date, End Date, Claimable, Contract Version ID, Contract Name, Direct Value, Deviated Value, Product Name and Product Number.+
  
 On the field search, additional criteria can be added by clicking the Add Field Criteria button. Criteria can be removed by clicking the Remove Criteria button. To clear data from the search criteria, click the X at the beginning of the criteria row. On the field search, additional criteria can be added by clicking the Add Field Criteria button. Criteria can be removed by clicking the Remove Criteria button. To clear data from the search criteria, click the X at the beginning of the criteria row.
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 Refer to the Search Legend for specifics on how to perform And, Or, Not, Prefix, or Grouping searches. Click on the Search Legend hyperlink to open the legend. Refer to the Search Legend for specifics on how to perform And, Or, Not, Prefix, or Grouping searches. Click on the Search Legend hyperlink to open the legend.
  
-{{:pasted:20180410-102440.png}}+{{:pasted:20240813-181556.png}}
  
 The text boxes on the left side of the contract search are a “Full Text” search. Example: If “Approve” is entered in the Header and search, the results will have “Approval”, “Approved” as part of the contract header. The search results can also be filtered by entering text in box at the top of each column and clicking Enter on the keyboard. To clear a filter, delete the text in the column search and click Enter. The text boxes on the left side of the contract search are a “Full Text” search. Example: If “Approve” is entered in the Header and search, the results will have “Approval”, “Approved” as part of the contract header. The search results can also be filtered by entering text in box at the top of each column and clicking Enter on the keyboard. To clear a filter, delete the text in the column search and click Enter.
- 
  
 One thing to note is that field search (on the right side) and normal search (on the left side) work together as a global “and” search. You can enter some criteria into one, and other criteria into another, and it will return the contracts which match BOTH. For example, if you wanted to search for any contracts which contained product “12345” with a direct value that is greater than $0.50, enter both of those criteria into the field search (on the right side). If you were to enter the product criteria into normal search, and direct value into field search, it would pull back any contracts that have product “12345” on them, AND any contracts that have ANY product with a direct value greater than $0.50. Not just contracts with product “12345” whose direct value was greater than $0.50 like you were looking for. One thing to note is that field search (on the right side) and normal search (on the left side) work together as a global “and” search. You can enter some criteria into one, and other criteria into another, and it will return the contracts which match BOTH. For example, if you wanted to search for any contracts which contained product “12345” with a direct value that is greater than $0.50, enter both of those criteria into the field search (on the right side). If you were to enter the product criteria into normal search, and direct value into field search, it would pull back any contracts that have product “12345” on them, AND any contracts that have ANY product with a direct value greater than $0.50. Not just contracts with product “12345” whose direct value was greater than $0.50 like you were looking for.
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 Enter search criteria and select Search or click the Enter key on the keyboard to perform the search. Enter search criteria and select Search or click the Enter key on the keyboard to perform the search.
  
-Select the contract by selecting a row and clicking the Select button, or by double-clicking the row.  This will assign the Contract to the Claim and update the status of the claim and line items.  +Select the contract by selecting a row and clicking the Select button, or by double-clicking the row. This will assign the Contract to the Claim and update the status of the claim and line items.
  
 If the Contract ID hyperlink is clicked, this will open the selected contract in another tab. If the Contract ID hyperlink is clicked, this will open the selected contract in another tab.
  
 NOTE: If there are instances where the Contract Name listed on the Invoice is different that the Contract Name in GoSimple, please send this information to your GoSimple contact so that we can add that to the cheat sheet to avoid future pending claims. NOTE: If there are instances where the Contract Name listed on the Invoice is different that the Contract Name in GoSimple, please send this information to your GoSimple contact so that we can add that to the cheat sheet to avoid future pending claims.
 +
 ----- -----
 +**CONTRACTS WITH PENDING CLAIMS**
 +
 +The purpose of this new screen is so a user can work pendings at a contract level instead of claim by claim.  This screen will show you most pend reasons, all claims, for any given contract.
 +How to find the new pend reason - go into the pended screen by clicking on Pended in the Claims widget or go to Claim, Claim views, Pended
 +
 +Once you get into the pended screen there is a new tab at the top of the screen for this new view. 
 +
 +{{:pasted:20240710-161719.png}}
 +
 +The same visibility rules you have on the older pend screen will apply to this new screen as well.
 +
 +**Pend reasons NOT included in the new window**
 +
 +The below pend reasons will NOT show up in the new contract window and will still have to be worked claim by claim in the old pending screens.  We may be able to work some of these into a later phase of the new pend screens.  
 +1) No contract
 +2) Event date mismatch
 +3) Out of time frame
 +4) Missing line-item distributor
 +5) Missing UOM conversion
 +6) Possible duplicate
 +7) Any pendings tied to a terminated contract
 +
 +**Fields in the new contract pend screen**
 +
 +•**Contract id** – The full contract version id that has pendings against it
 +
 +NOTE:  Contract version missing sku pends will use the most recent version contract id since the sku is not 
 +on the contract and technically does not tie to a specific version
 +     
 +•**Contract title** – Contract title that goes with that id
 +
 +•**Contract creator** – the person that created the contract
 +
 +•**# of pending claims** – The count of claims pending against that contract, this only includes pends related 
 +to the new pend screen.  If it is an excluded pend reason the counts will not show here. 
 +
 +•**# of different pend reasons** – The count of different pend reasons per contract
 +
 +•**Claim pending lines by contract** – The total count of pending lines against that contract
 +
 +•**Invoice $ total pending** – The sum of invoice requested dollars for the invoices that are tied to that contract.  Keep in mind if an invoice has multiple contracts(claims), the invoice amount will duplicate. 
 + 
 +•**Total pending dollars** – this will show you the dollar amount that is pending from the invoice #total dollars. 
 + 
 +You can click on the gear to export the data or change the columns 
 +
 +{{:pasted:20240710-162907.png}}
 +
 +
 +**How to work a pending**
 +
 +Click on the contract id you want to work on
 +
 +{{:pasted:20240710-162958.png}}
 +
 +This will open a new screen showing you all the pend reasons against that contract and the action steps available.     
 +
 +{{:pasted:20240710-163041.png}}
 +
 +**Actions available**
 +
 +Note the actions will vary based off the pending reasons.  Not all options will be available per pend reason.  When you choose an action a box will appear, please read the box as it will give you information on what outcome your action will do. 
 +
 +You can only choose 1 action per line item in the new pend screen.  To choose the action just click the check box in that column for that row. 
 + 
 +•**Reject** – this will mark the pending lines rejected and not allow any monies for those claims.  This will make the claim rebillable if it is a deduction or a short pay if it is a check. 
 +
 +NOTE:  If you have more than one pend reason you will have to perform the reject action once for any lines per pend reason. This is because the reject reason used will be the same as the pend reason. 
 + 
 +•**Amend** – This action will either auto update your contract for you or will open the contract to give the user the ability to update the contract with the changes needed to clear the pending claim(s).  This action will open the contract so the user can amend it.  
 +
 +NOTE:  You must have rights to edit that contract or you will get an error message stating you are not 
 +allowed to update it.  Pay attention to the box that pops up after you hit the amend button, it will let you know when the change will be automatically applied to the contract you are about to open or if you manually need to update your contract.   (few examples below)
 +        
 + {{:pasted:20240716-122437.png}}  
 +
 +  
 +•**Split** – This will remove line items on the claim and move it to a different claim so you can assign a different contract to those lines.
 +
 +The contract search screen will open when you choose this option so you can choose a new contract to apply 
 +to the lines you checked on the pend screen.   This will leave the non-pended lines on the original contract.  
 +        
 +•**Update contract used** – this will change the contract used for the claim.
 +
 +The contract search box will appear for you to be able to find a different contract you want used on those 
 +pending claims.  
 +        
 +•**Recalc** – this will short pay the lines and only pay the allowed dollar amounts. 
 + 
 +This will make the claim rebillable if it is a deduction or a short pay if it is a check. 
 +
 +•**Override** – This will allow a one-time exception to allow the requested amount for the pending lines
 +
 +•**Swap** – this will allow the user to choose a different product id for the pending lines.
 +
 +        
 +Depending on the action you take on the claim the pending may or may not clear immediately. 
 + 
 +For example, if you had to amend the contract the pendings will not clear until the contract is approved.  
 +
 +You can only take 1 action at a time.  If the action you took clears the pend the lines will disappear.  
 +
 +If you choose the check box on the line that has the pend reason it will select ALL lines for that pend reason for that action. 
 +
 +{{:pasted:20240710-163548.png}}
 +
 +As you choose a line to action it will add the – on the pend reason line under that action name, see below I chose the first three actions.
 +
 +{{:pasted:20240710-163631.png}}
 +
 +Also, the boxes at the bottom will show as you choose each action.  Reminder, you have to do each action separately.  
 +
 +{{:pasted:20240710-163729.png}}
 +
 +When you choose the action button it will show you some details and ask you to confirm the action you chose.  In the example below I chose reject. 
 +
 +{{:pasted:20240710-163811.png}}
 +
 +Once you hit yes it ask you to commit the changes.  Because reject the reason is always the same as the pend reason there is no need to choose a reason here, just hit the commit button to complete the action on the claim lines selected.  
 +
 +{{:pasted:20240710-163851.png}}
 +
 +The pending screen will update and remove those lines you actioned. 
 + 
 +Recalc are the same steps listed above as Reject.  Details provided, yes button.  Then commit button.  
 +
 +NOTE:  If you see an error about a claim being locked up that means either someone else has that claim open or the hourly process in the TELUS side that clears pends is running against the claim at that time.  Even though the error appears the claim will show be cleared but not until the claim id is released.  
 +
 +
 +**Amend action – updates made to the contract**
 +
 +Below describes when you choose the amend option to clear a pending what action will take place on the contract per pend reason.  This information also appears in a pop box box when you choose amend in the new pending screen.  
 +
 +•Calculated rate zero 
 +-No changes will be made to the contract.  
 +-The contract will have to be updated manually to clear this pend reason.  
 +
 +•Contract version missing sku
 +-The pending skus will be added to the contract, you will have to update the pricing for these new skus.  
 +
 +{{:pasted:20240710-164107.png}}
 +
 +•Explicit contract rate zero
 +-The pricing will be updated only if the contract is setup as a Rebate Direct Value and it is setup with a 
 +-Rebate Direct Type of Fixed Rate and a Rebate direct value type of numeric. 
 +         
 +All others contract types will have to be manually updated. 
 +
 +SPECIAL NOTE:  If your contract is setup with product groups you will have to manually update the value
 +
 +{{:pasted:20240710-164212.png}}
 +
 +•Ineligible event
 +-The pending event and dollar amount will be added to the contract.  If all is good all you have to do is 
 +save and submit the changes.  
 +        
 +{{:pasted:20240710-164305.png}}        
 +        
 +•Ineligible claimant
 +-No changes will be made to the contract. 
 +
 +The contract will have to be updated manually to clear this pend reason.  
 +
 +•Ineligible Distributor
 +-The line-item distributors pending on claim will be added to the distributor tab on the newly amended contract.         
 +        
 +{{:pasted:20240710-164413.png}}
 +
 +SPECIAL NOTE:  If the contract is setup with a direct rebate only no change will be made to the contract and you will see the below error message.
 +
 +{{:pasted:20240710-164501.png}}
 +
 +•Ineligible sku
 +-The pending skus will be added to the contract 
 +
 +You will have to update the pricing for these new skus.
 +
 +{{:pasted:20240710-165542.png}}
 +
 +•Missing price 
 +-No changes will be made to the contract. 
 +
 +The contract will have to be updated manually to clear this pend reason.  
 +
 +{{:pasted:20240710-165633.png}}
 +
 +•Negative Rates 
 +-No changes will be made to the contract.  
 +
 +The contract will have to be updated manually to clear this pend reason.  
 +
 +•Overspent event
 +
 +•Requested Greater than allowed
 +-The pricing will be updated only if the contract is setup as a Rebate Direct Value and it is setup with a Rebate Direct Type of Fixed Rate and a Rebate direct value type of numeric. 
 +                 
 +-All others contract types will have to be manually updated.
 +
 +-SPECIAL NOTE:  If your contract is setup with product groups you will have to manually update the value.
 +
 +{{:pasted:20240710-165802.png}}      
 +        
 +
 +A new option added to the Pended claims>Claim pended tab is the Clear from Contract option. This gives you the ability to remove the contract from one to many claims within the pending screen.  This will move any claims selected to a no contract pending.  
 +
 +{{:pasted:20241009-112523.png}}
 +
 +-----
 +**PENDED CLAIM REASONS**
  
 **Pended - Out of Time Frame** **Pended - Out of Time Frame**
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 A claim will pend for Out of Time Frame if the products or lumpsums are outside the start and end date of any claimable version of the contract. A claim will pend for Out of Time Frame if the products or lumpsums are outside the start and end date of any claimable version of the contract.
  
-To resolve a Pending for Out of Time Frame, extend the Contract Dates or Renew the Contract.  The claim process will automatically resolve that pending.+To resolve a Pending for Out of Time Frame, extend the Contract Dates or Renew the Contract.  The claim process will automatically resolve that pending once the contract is approved. 
  
------ 
 **Pended - Ineligible Claimant** **Pended - Ineligible Claimant**
  
-To resolve a Pending for Ineligible Claimant where the claimant is a Distributor, add the Distributor to the Contract.  The claim process will automatically resolve that pending.+To resolve a Pending for Ineligible Claimant where the claimant is a Distributor, add the Distributor to the Contract.  The claim process will automatically resolve that pending once the contract is approved.
 ----- -----
  
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 **Pended Line - Ineligible Distributor** **Pended Line - Ineligible Distributor**
  
-To resolve an Ineligible Distributor pending, add the Distributor to the contract.+To resolve an Ineligible Distributor pending, add the Distributor to the contract.  The pending will be resolved once the contract is approved.
 ----- -----
 **Pended Line - Missing Line Item Distributor** **Pended Line - Missing Line Item Distributor**
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 **Pended Line - Ineligible Sku** **Pended Line - Ineligible Sku**
  
-To resolve an Ineligible Sku pending, either add the product to the contract, or reject the line item.  The claim process will automatically resolve that pending once the sku is added to the contract.+To resolve an Ineligible Sku pending, either add the product to the contract, or reject the line item.  The claim process will automatically resolve that pending once the sku is added to the contract, and the contract is approved.
 ----- -----
 **Pended Line - Missing Price** **Pended Line - Missing Price**
  
-If the Default Price is missing and there is no sales data for a product, the line will pend for Missing Price.  To resolve this pending reason, update the default pricing. +If the Default Price is missing and there is no sales data for a product, the line will pend for Missing Price.  
 ----- -----
 **Pended Line - Missing Manufacturer Sku** **Pended Line - Missing Manufacturer Sku**
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 **Hold Line - Duplicate Item Submitted** **Hold Line - Duplicate Item Submitted**
  
-If a line is a possible duplicate to another line in the system based on the same Claimant, Time Frame, and Product, the line will Hold for Duplicate Item Submitted.  These lines will be worked by GoSimple personnel. +If a line is a possible duplicate to another line in the system based on the same Claimant, Time Frame, and Product, the line will Hold for Duplicate Item Submitted.  
 ----- -----
 **Pended Line - Ineligible Event** **Pended Line - Ineligible Event**
  
-To resolve this pending reason, add the LumpSum Event to the Contract to auto clear.+To resolve this pending reason, add the LumpSum Event to the Contract to auto clear.  The pending will resolve once the contract is approved.
 ----- -----
 **Pended Line - Overspent Event** **Pended Line - Overspent Event**
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 **Pended Line - Multiple Events** **Pended Line - Multiple Events**
  
-A lumpsum will pend with this reason when more than one lumpsum exists for the assigned lumpsum on the current claimable version.  This happens when a contract is applied to a lumpsum claim and the lumpsum needs to be updated.  This is an internal pend reason and will be resolved by GoSimple. +A lumpsum will pend with this reason when more than one lumpsum exists for the assigned lumpsum on the current claimable version.  This happens when a contract is applied to a lumpsum claim and the lumpsum needs to be updated.  
pended_claims_resolution.1633546065.txt.gz · Last modified: 2021/10/06 18:47 by lisa.maloney

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