Rejecting all items and services rejects the claim without delivering the review

Description

This is an example:

Claim

ClaimID

InsureeID

ClaimCode

DateFrom

DateTo

ICDID

ClaimStatus

ReviewStatus

Entered

39

1

RejByass

11/09/2020 00:00

NULL

4

2

1

Checked

39

1

RejByass

11/09/2020 00:00

NULL

4

4

1

Selected

39

1

RejByass

11/09/2020 00:00

NULL

4

4

4

Reviewed

39

1

RejByass

11/09/2020 00:00

NULL

4

1

4

Claim Item

ClaimItemID

ClaimID

ItemID

ProdID

ClaimItemStatus

RejectionReason

Entered

30

39

1

NULL

1

NULL

Checked

30

39

1

4

1

0

Selected

30

39

1

4

1

0

Reviewed

30

39

1

4

2

-1

If all items and services are rejected from the claim, when saving the claim (before delivering the review), the claim is set in rejected status and is not editable anymore. If the review and deliver is done in 2 steps (I wanted to do a rejection and bypass the review delivering), I would expect the claim is rejected after the deliver of the claim and not after the save of the review (this is the flow in the legacy), meaning a junior doctor is rejecting all items and services, saves the review and wants to check with the senior if he reviewed correctly.

Delivering or processing a saved Claim with all items and services rejected will mark the Claim as rejected.

To be confirmed with .

Environment

None

Activity

Show:
Siddharth Srivastava
September 21, 2020, 2:51 PM

- reference for the behaviour should be like in legacy. Once saved by a reviewer the claim should not move forward. The save is for reviewer to save their changes while waiting for clarification from a facility. Only the review button should mean the review decision from the medical reviewer is delivered.

Assignee

Xavier Gillmann

Reporter

Dragos Dobre

Labels

None

Components

Priority

Medium
Configure