Eclaim Processes

This section of help will explain how to load an eclaim using the eclaim template, and the checks the system performs to prevent duplicate eclaim loads.

Another feature of the eclaim process is the ability to have eclaims Auto Submit and/or Auto Approve. This setting is done at the company level and companies with this setting enabled will flow through the eclaim process automatically.

Auto Submit: if a company has this enabled, any eclaim loaded for this claimant will move from draft to submitted and then into a Pend, Hold, Evaluation status.

Auto Approve: if a company has this enabled, any eclaim loaded for this claimant will be auto approved once the claim is submitted (either via auto submit or manually).

Settings at the company level:


Eclaim Template Procedures

Purpose of the Eclaim Template

This template gives any user the ability to take data from an invoice and turn it into an eclaim. This can be used by copying/pasting data from the original submission into this template or even manually typing the data into this spreadsheet.

One to many invoices can go into one template document. NOTE: If you use this template for more than 1 invoice that is what will appear on the claim as the claim attachment backup.

Worksheets

There are 3 worksheets within this template that have fields that need to be filled out.

  1. Invoice_header – this one contains fields required to fill out the invoice header, like the first entry screen when you create a new invoice.
  2. Invoice_product – this one is used for the sku level detail
  3. Invoice_lumpsum – this one is used if there are flat fee lump sum lines that are required for a claim

Fields Defined

Required fields are in bold, italicized and underlined.

Fields where one or the other are required are in bold.

Use a 4-digit year for all dates.

Invoice_header:

Invoice_product: (the below required fields are only if the invoice is sku based)

invoice_lumpsum: (the below required fields are only if the invoice is lumpsum)


Process to name the file and save it to the FTP

Once the file is created save it as “1072_inbound_ claim_(manufacturer name)_(initials and date file is being saved to the ftp)

Save the template to the specific clients FTP under the from Files\Inbound\From Distributors.

Manufacturer name use: MFG (Manufacturer) where MFG is the 3 letter abbreviation followed by manufacturer name

If you create more than one file a day then add a _1 at the end of the file name, increasing the number by 1 each time.

IMPORTANT: Also, save the original documents to the FTP as well. Make sure to save then with the exact file name noted in the File_name field on the excel document so the process can match it up to the claim created. FTP Login choose your client

FTP Login choose your client

FTP save under Files, Inbound, From_Distributor


Eclaim Load Duplicate Checking

Process to determine duplicates - Eclaim Load:

1. Check for possible Duplicate based on Header information (checks against both what is in the eclaim import tables and what is in the system for claims)

2. Check line level for duplicates for those header rows that have been determined to be possible duplicates

3. Exact Duplicates are tagged and ignored preventing the load of the invoice from progressing any further

Recap: If we load (2) files they contain the same invoice, but they are not exact matches at the header level, they will not be flagged as a possible duplicate, add into that the change of the claimant to the invoice that you are doing, the second file would not see a possible duplicate in the system either because the claimant being loaded is not the one on the invoice that it should see as a duplicate. Everything for eclaim is based at INVOICE level not claim level.