Claim Edit
To access Claim Edit features, a user must be set up with the Claim Edit Access Role. Certain edit features are available when the claim is in View mode, but this section deals with the claim in Edit.
To access the claim in Edit, click the Edit button in the Actions menu.
Note that the following fields must be edited on the Invoice: Claimant Name, Invoice Number, Invoice Date, Start Date, End Date, Amount Requested and Deduction Number Hint. See the invoice_view_edit section of the help documents for additional information.
Claim Header
In the Claim Header, the Contract Hint field is editable. This field captures the name of the contract as it appears on the invoice and is used as a reference to selecting a contract.
Products
Products can be added, deleted or modified.
Add Products: To add a manufacturer product, search for the product on either the Contract Products (displays products on the specific contract) or Products grid (displays all products) by entering the product number or product name in the grid filters.
Select one to many rows to add to the claim by clicking and highlighting the rows. Multiple lines can be selected by using the ctrl+click or shift+click option. Once the rows are highlighted, drag them to the left and they will display on the claim products grid.
To add products which do not exist in the manufacturer products tab, click the Add Adhoc Product button.
The Product Number, Product Name and Rebate UOM must be entered on the Adhoc product row.
For all products, enter in the Rebate UOM, Date, Requested Quantity, Requested Rate and Requested Total.
Rebate UOM - this will default to the UOM for that product on the contract, or the Default UOM if the product is not on the contract. The dropdown will display the UOM options defined for that product.
Date – the default date displayed is the mid-date between the Start Date and End Date of the claim. This date can be updated to the actual product delivery date, but it must be between the start and end dates of the invoice.
Requested Quantity – enter in the quantity for the product.
Requested Rate – enter in the rate for the product and the Requested Total will auto-populate with the total value. The calculation is quantity x rate.
Requested Total – enter in the total for the product and the rate will auto-populate. The calculation is total ÷ quantity.
NOTE: Quantity and Total can be negative, but Rate must always be positive. It is not necessary to enter both a rate and a total – entering the quantity and either rate or total will calculate and populate the grid for the remaining field. Any calculated (non-entered) values which are rounded in the application will display an approximate symbol (~) and the actual value will display on hover.
Add Distributors: To add line item distributors to the claim, check the box at the beginning of the claim row, then click the Assign Distributor button.
This will open a distributor search. Enter in text in the filter boxes at the top to search for the distributor. Then either double-click the row or click the Select button to add that distributor to the claim lines.
Delete Products: there is also the option to delete products from the grid. Select the checkbox at the beginning of a row by either selecting the individual row or clicking the Select All button. To de-select all rows, click the Select None button. Once the row(s) are selected then click Delete Selected.
After clicking Delete Selected, a confirmation popup will display. To continue with the product delete select Confirm and the popup will close and the selected product(s) will be deleted. Click Cancel to cancel the product delete process.
Swap Product
If there is a claim product that needs to be removed and replaced with a different product, use the Swap Product feature. This action can be performed on adhoc products, manufacturer products, and contract products.
Select the row of the claim product(s) that need to be swapped. One to many product rows can be selected but they will all be replaced with the same product.
After selecting the product(s) to remove and highlighting the product to add, click the Swap Product button.
This will replace the product number and name and the rest of the information on the product row will stay the same except for the Rebate UOM. This column will update to blank and force the user to select a UOM for the product row.
Mass Update
If there are multiple lines that need updates, use the Mass Update feature. In EDIT mode, select the lines that need to be actioned by checking the box next to the line. Click the mass update button and select the items to mass update. Check the box next to the action item and type in the box or use the drop-down box when available. Click APPLY to come the action.
LumpSums
LumpSums can be deleted, added or modified when in Edit mode. To add lumpsums to the claim, select either the Add Contract Lumpsum or Add Lumpsum buttons. Note that the Add Contract Lumpsum button will only be enabled if there are lumpsums available on the contract assigned to the claim.
Select a lumpsum row by checking the box on the lumpsum row. To select all lumpsums to add to the claim, click the Select All button. Multiple lumpsums can be added to the claims. After the rows are selected, click the OK button to close the popup and add the lumpsums to the claim.
The Date and Claim Amount Requested fields are editable for all lumpsum rows. The Date field defaults to the mid-date of the claim start and end dates but can be modified to a specific date. That date must be between the claim start and end dates. The Claim Amount Requested can also be entered or modified.
There are three mass update buttons on the lumpsum tab: mass reject, mass override and mass unhold. Select the lump sum rows, click the mass button and action all selected lines at the same time.
Add Payment Information
To add or modify payment information, click on the Payment Configuration tab. Chose a payment type by selecting one of the options.
If Payment is selected and an Alternate Payee is required, check the Alternate Payee box. This will open the section to select or enter an Alternate Payee. Either click Choose Company to select from a list of active companies for the manufacturer or hand-type the information.
Client Defined Fields
If there are Client Defined Fields set up for Claims, those can be added to the claim in Edit. If a client defined field is required, an error will be returned on Save if a value is not entered.
Resolving Pending Lines
To resolve pending lines while in Edit mode, click the Reason Codes hyperlink for the pending lines on product or lumpsum rows. This will display a Claim Product Reason Codes popup with the Pend reason displayed and Override, Recalc, and Reject options. The options displayed depend on the pend reason, so if the line is pending for Ineligible Sku, the Recalc option will not be enabled.
To override this line, click the Override tab and select the checkbox for the pend reason. In the instance a line is pending for more than one reason, only one checkbox can be selected. A Note can also be entered and is recommended to explain the reason for the override.
Click the Select button to perform the action selected. Click Revert to undo the action and close the popup.
If the action selected is Recalc, the Allowed Total will be recalculated using the quantity times the calculated amount for that product row.
If the action selected is Reject, the product row will be rejected and the Allowed Total will be updated to $0.00. It is recommended that a Note be entered when a row is rejected – the detail provided in the note will be used on the reject letters as well as the deduction rebill letters.
After resolving the pendings, click the Save button in the Actions section on the top right of the claim. Click Revert to cancel the updates and the claim will return to the state it was in prior to any updates.
Resolving Hold Lines
If a product or lumpsum row is on Hold for Duplicate Item Submitted, click the reason hyperlink and expand the Note column to see the claim ID with the potential duplicate lines. Compare the lines on both claims to determine if the row is a duplicate. If it is not a duplicate, uncheck the box and click OK to remove the hold from the line. The state of the line will be updated to cleared or pended. If the line is a duplicate, uncheck the hold box and then on the Reject tab, click the box to reject the line as a duplicate.
Edits in View Mode
There are also many updates which can be made to a claim while it is in View mode if the user has Claim Edit rights.
Claim Header
The Contract Family can be modified when the claim is in view mode. More on this below.
The Contractee Name and Contract Family are hyperlinks. Click the name or contract ID to view the Company and Contract Information.
Contract Family
The Contract Family field has 2 edit options - Clear and Link.
Clear
If the Contract selected on the claim is incorrect, but there isn’t a correct contract to assign to that claim, click the Clear option. A Confirmation popup will display. To continue with deleting the linked contract, click Yes. To close the popup and keep the current contract click No.
Note that clearing a contract from a claim will update the Claim State to Pending with Claim State Reason of No Contract.
Link
To assign a contract to claim pending for No Contract or to select a different contract click the Link option. This will open up the Contract Search popup. Enter search criteria and click Search or click the Enter key on the keyboard. To select a contract, either double-click the contract row or highlight the row and click Select. After selecting a different contract, the claim will run through the calculate claim process. This could result in claim header states resolving and/or line items resolving and clearing.
Product and LumpSum Mass Updates
There are six mass update options available: Recalc, Reject, Override, UnHold, Mass update, & Assign Distributor
These options are available when in claim view mode for users who have claim edit rights. To perform any of these actions, select the checkboxes on the individual rows or use the Select All option. Click Select None to un-check all the boxes.
Note that when performing these mass pending/hold updates to selected lines that ONLY lines with the selected reasons will be affected.
Scenario 1: there are 3 lines pending for the following reasons: 2 lines for Ineligible Sku and 1 line for Requested Greater than Calculated. Check the boxes for the 2 Ineligible Sku lines and click to Reject with reason code of Ineligible Sku – this will reject ONLY the 2 lines pending for Ineligible Sku.
Scenario 2: there are 4 lines pending for the following reasons: 1 line for Ineligible Sku, 1 line for Requested Greater than Calculated, and 2 lines for Calculated Rate Zero. If ALL rows are selected and then the Mass Override option is selected with reason code Requested Greater than Calculated, ONLY the 1 row pending for that reason will be updated to Override. The other rows will remain pending even though the product rows were checked since they were not pending for the reason code selected.
Mass Recalc
Select this option to recalc lines pending for Requested Greater than Calculated. This is the only pend reason that can be resolved using the Recalc option.
Select the Reason Code and optionally update the text in the claim reason note. Click Commit to update the lines to Recalc for Requested Greater than Calculated. The Allowed Total for the selected rows will be updated to the calculated value times the quantity.
Mass Reject
Select this option to reject any line for any of the pending reasons. The Reason Code dropdown contains a list of all pending reasons – either scroll through the list or start typing in the reason code box to search for the correct reason.
Select the Reason Code and optionally update the text in the claim reason note. Click Commit to update the line to Rejected for the selected reason. The Allowed Total for the rejected rows will update to $0.00.
Mass Override
Select this reason to override the selected lines for the reason code selected. The Reason Code dropdown contains a list of all pending reasons – either scroll through the list or start typing in the reason code box to search for the correct reason.
Select the Reason Code and optionally update the text in the claim reason note. Click Commit to update the lines to Override for the selected reason. The Allowed Total will be updated to equal the Requested Total for the selected lines.
Mass UnHold
Select this option to remove the Hold from any lines pending for Duplicate Item Submitted. Prior to removing the hold, click the reason code hyperlink for the possible duplicate lines and verify that the claim ID(s) listed are not duplicates to the current claim line. The only Reason Code available is Duplicate Item Submitted.
Click Commit to remove the hold from the selected lines. These claim will run through the update process and the lines will be updated to either cleared or pended.
Assign Distributor
Select this option to Add or Change the line item distributor on a product row. The Distributor Assignment popup will display. Enter text in the filter boxes at the top of the grid to find the distributor record, then either double-click the selected row or select a row and click Commit to add that distributor to the line.
