This list is based on the Gherkin scenarios to enable further refinement and discussion.

Submitting a valid claim

TBC

Submitting a partially valid claim

There are many ways to submit an invalid claim. Some of the checks performed by the backend cannot even be performed from the web interface.

Here is a list of possible rejection scenarios:

Invalid family

This validation will fail if the insuree is invalid, or his/her family itself is invalid.

Rejection reason code: 7

Invalid target date

The target date is the “date to” field of the claim or, if unspecified, the “date_from” field.

Rejection reason code: 9

Claim item/service refers to an invalid item/service

Rejection reason code: 1

Claim item/service is not the right pricelist

The claim item/service refers to an item/service that should be listed (price list detail) in a pricelist linked to the claim health facility with the appropriate mask.

Rejection reason code: 2

Submitting a none valid claim

TBC

Submitting multiple claims

TBC