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The Build FHIR ClaimResponse sections section show the different attributes that are modified by the Claim-AI module. Based on the response, the Claim-AI Quality modulewill update the following fields in the DB:
Claim.ReviewStatus: updated to “Selected for Review” (value 4) if the ClaimResponse contains rejected items
ClaimItem.Status: updated to “rejected” (value 2) for each ClaimResponse.item where adjudication.category equal to 1
json_ext.claim_ai_quality.was_categorized: updated to True
json_ext.claim_ai_quality.ai_result: updated to ClaimResponse.item.adjudication.category + 1 (DB values 1-Accepted, 2-Rejected)
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