Claim items changes on historized record (instead of live)

Description

When submitting a claim, a copy in performed (with validity_to,...).
... but later updates in the items (and services?) are done on the 'historized' record (not the 'live' ones)

Example:

ClaimItemID

ClaimID

ItemID

ProdID

ClaimItemStatus

QtyProvided

QtyApproved

PriceAsked

PriceAdjusted

PriceApproved

PriceValuated

Explanation

Justification

RejectionReason

ValidityFrom

ValidityTo

LegacyID

AuditUserID

1025

1030

182

NULL

1

2

NULL

10

NULL

NULL

NULL

NULL

NULL

NULL

38:33.7

NULL

NULL

1

1026

1030

11

NULL

1

3

NULL

40

NULL

NULL

NULL

NULL

NULL

NULL

38:33.7

NULL

NULL

1

1027

1030

182

NULL

1

2

NULL

10

NULL

NULL

NULL

NULL

NULL

NULL

38:33.7

48:18.5

1025

1

1028

1030

11

NULL

1

3

NULL

40

NULL

NULL

NULL

NULL

NULL

NULL

38:33.7

48:18.5

1026

1

1029

1029

182

4

2

2

NULL

10

NULL

NULL

NULL

pain killer

Not accepted

-1

48:18.6

NULL

NULL

1

1030

1029

11

4

1

3

2

40

NULL

NULL

NULL

antibiotic

Too many

0

48:18.6

NULL

NULL

1

1031

1032

182

NULL

1

2

NULL

10

NULL

NULL

NULL

pain killer

NULL

NULL

48:18.6

49:04.8

1029

1

1032

1032

11

NULL

1

3

NULL

40

NULL

NULL

NULL

antibiotic

NULL

NULL

48:18.6

49:04.8

1030

1

1033

1033

182

4

1

2

NULL

10

NULL

NULL

NULL

pain killer

NULL

0

48:18.6

00:52.9

1029

1

1034

1033

11

4

1

3

NULL

40

NULL

NULL

NULL

antibiotic

NULL

0

48:18.6

00:52.9

1030

1

1025 and 1026 are the 2 initial items from a claim. When submitting, 1027-1030 are created and then everything is related to 1029 and 1030.

Activity

Show:
Xavier Gillmann
September 10, 2020, 8:56 AM

Ok, so in fact, when we update a claim, we create a copy of the claim for auditing purpose. That copy has a ClaimID > intial ClaimID… and the validityto set.

This way, the ‘live’ claim remains the smallest claimid (in the example 1029).

BUT: the items and services (in current implementation) don’t get ‘systematically’ copied: we only ‘historize’ them if they have change.

This explains why we don’t have ClaimItems pointing to ClaimID 1031 : the claim got submitted (status updated)… which doesn’t affect the claim items ‘details’.

The claim got validated… and items got accepted (rejection reason = 0)… so the items got ‘historized’… so that, at the end, the “live” version of the claim (1029) points correctly to the ‘live' version of the items… but in a misleading way because claimitems historization is not following the usual behaviour: ‘smallest id is the live version’.

Proposal: when a clailm is historized, always create historized versions of its items/services (even if they didn’t change), following the ‘usual’ historization pattern (smallest id is the live). ok for you?

Dragos Dobre
September 10, 2020, 11:46 AM

Your proposal is exactly how it is done (if I understand correctly). The ClaimServices is working like this. But The ClaimItems, after the review, a copy is made for historization and all further changes are done on this last copy and not the smallest id. In the end, in ClaimItems you will have for the same claim with same item two rows with ValidityTo NULL (see example 1025 and 1029 are the same ClaimItem: 1025 after submit and 1029 after review when 1025 should have the changed values).

Assignee

Xavier Gillmann

Reporter

Xavier Gillmann

Labels

None

Priority

Medium
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