Claims functionality

Allow dynamic fields and Multifields configuration for Claims functionality

This feature will expand the current Claims feature capability on OIPA by allowing the user to configure the dynamic fields and Multifields along with the existing Fixed Fields capability. This would enable OIPA to capture more Claims-related information besides ClaimAmount, CurrencyCode, and ClaimEffectiveDate. This feature also enhances OIPA's capability to process or update multiple Claims using Collections.

The following rules have been added to OIPA or modified.

  • A ClaimScreen business rule has been added to define dynamic fields to the Claims entity. This increases the claim information beyond the ClaimAmount, CurrencyCode and Claim EffectiveDate fixed fields.

  • The CreateClaim business rule has expanded capability to persist a multifield structure for a new Claim.

  • The CopyToClaimFields business rule retains the ability to update the Claim's fixed fields and is expanded to update its dynamic fields.

  • UpdateClaimStatus business rule can update the status of multiple Claims through the use of a collection.

Configuration modifications

ClaimScreen business rule

This is a new rule that the system as definition for the Claims entity's dynamic fields. The system does not support a screen display. Configuration follows the common structure for dynamic <Fields> with the exception for a limited set of data types and limited field elements. The description below explains the differences.

XML Syntax Additions
Element Attribute Parent Element Description Element / Attribute Values
<ClaimScreen>     This is the root element for the rule.  
<Fields>   <ClaimScreen>

Required:

See common Fields Elements article under Common Elements topic. DataTypes supported by this rule are Date, Decimal, Integer, Money and Text. Each definition of a <Field> allows <Name>, <Display> and <DataType> element

  
XML Schema - ClaimScreen Business Rule
<ClaimScreen>
      <Fields>
           <Field>
                 <Name>[field name]</Name>
                 <Display>[literal]</Display>
                 <DataType>[Date|Decimal|Integer|Money|Text]</DataType>
           </Field>
           <Field>...</Field>
      </Fields>
</ClaimScreen>

Configuration modifications

CopyToClaimFields business rule

This is an existing rule with the ability to update a claim that may contain multifield structures. The information below explains this new functionality and also provides clarity to the definition of the Claim's fixed fields

XML Syntax Additions
Element Attribute Parent Element Description Element / Attribute Values
<CopyToClaimFields>     provided for context  
<Fields>   <CopyToClaimFields> provided for context  
<Field>   <Fields>

Required, Repeatable:

This structure identifies the fields that will be updated by the business rule.  Fixed and dynamic fields may be identified for update.  The fixed fields that can be updated are:

  • ClaimAmount

  • CurrencyCode

  • ClaimEffectiveDate 

  
<MultiFields>   <CopyToClaimFields>

Optional, Repeatable:

This structure will allow the rule to create one of the multifield structures identified by the NAME attribute.  The element is repeated for each named multifield structure that is expected to be create by this rule.

  
  NAME <MultiFields>

Required:

The attribute identifies the configured name of the multifield structure to update.

  • literal structure name

  • math variable

  • activity field name
  END <MultiFields>

Required:

The attribute provides the total number of multifield instances in the resulting named structure.  The only appropriate value is an integer.

  • literal

  • math variable

  • activity field name
<Field>   <MultiFields>

Required, Repeatable:

This structure identifies one of the multifield fields to create.  This is repeated for each multifield field the rule expects to create.

  
<FromIndexCollection>   <Field>

Required:

This element provides the updated values for multiple multifield instances.  A collection contains multiple sets of key/value pairs where this element expects keys as an index value identifying a multifield instance and values as the updated field values in the multifield instance that is identified by the key.  Multifield indexes start with a value of 1.

  • math variable

    • key = index to multified instance

      • first instance has a value of 1

    • value = update field value
<To>   <Field>

Required:

This element provides the name of the multifield field to update.  The field name must exist in the named multifield configuration.

  • literal field name
XML Schema - CopyToClaimFields Business Rule
<CopyToClaimFields CLAIMGUID="[variable]">
    ...
    <MultiFields NAME="[literal|variable|field]" END="[literal|variable|field]">
        <Field>
            <FromIndexCollection>[variable]</FromIndexCollection>
            <To>[field name]</To>
        </Field>
        <Field>...</Field>
    </MultiFields>
    <MultiFields>...</MultiFields>
    ...
</CopyToClaimFields>

Configuration modifications

UpdateClaimStatus business rule

This is an existing rule with the ability to update multifield structures that a claim may contain. The information below explains this new functionality and also adds clarity to definition of the existing elements in the rule.

XML Syntax Additions
Element Attribute Parent Element Description Element / Attribute Values
<UpdateClaimStatus>     provided for context  
  CLAIMGUID <UpdateClaimStatus>

Optional:

This attribute provides identity to the Claim that will be updated. 

This attribute is required when the rule does not contain the <FromCollection> element.  When configured with the <FromCollection> element, the <FromCollection> element will take priority.

  • math variable

    • valid value is a ClaimGUID
<Update>   <UpdateClaimStatus>

Optional:

This element determines when the Claim's status will change dependent on the evaluation of the IFF attribute.  The value of this element is optional, but when provided it takes priority over the evaluation of the IFF attribute if that attribute is also configured.  At the very least, one of the two configurable options must be provided:  this element contains a value or the IFF attribute is configured. 

This element is required when the <FromCollection> element is not configured.  When configured with the <FromCollection> element, the latter element will take priority and this element will be ignored. 

  • Yes

    • the Claim's status will be updated to a new status value

  • No

    • the Claim's status will not be updated
  IFF <Update>

Optional:

This attribute's provides a condition that the system will evaluate to determine a change to the Claim's status value. 

If this attribute is configured when the parent element is provided a Yes or No value, the parent element's value takes priority.  At the very least, one of the two configurable options must be provided:  the parent has a configured value or this attribute is configured.

  • conditional statement
<To-StatusCode>   <UpdateClaimStatus>

Optional:

This element provides one of the Claim's status code values that the Claim will be updated to.

This element is required when <FromCollection> element is not configured.

  • code value

    • valid value is from AsCodeClaimStatus
<FromCollection>   <UpdateClaimStatus>

Optional:

This element allows the rule to update multiple Claims from one activity. It provides the identity to one or more Claims to update associated to a status code value that Claim status will be updated to.  Each Claim can be updated to a different status.

This element takes priority when configured with the <Update> element.

  • math variable

    • key = ClaimGUID

    • value = code value

      • valid value is from AsCodeClaimStatus
XML Schema - UpdateClaimStatus Business Rule
<UpdateClaimStatus CLAIMGUID="[variable]">
    <Update>[Yes | No]</Update>
    <To-StatusCode>[code]</To-StatusCode>
</UpdateClaimStatus>
 
OR
 
<UpdateClaimStatus CLAIMGUID="[variable]">
    <Update IFF="[condition]"></Update>
    <To-StatusCode>[code]</To-StatusCode>
</UpdateClaimStatus>
 
OR
 
<UpdateClaimStatus>
    <FromCollection>[variable]</FromCollection>
</UpdateClaimStatus>

Configuration modifications

CreateClaim business rule

This is an existing rule with the ability to create a claim with multifield structures. The information below explains this new elements.

XML Syntax Additions
Element Attribute Parent Element Description Element / Attribute Values
<CreateClaim>     provided for context  
<Claims>   <CreateClaim> provided for context  
<Claim>   <Claims> provided for context  
<MultiFields>   <Claim>

Optional, Repeatable:

This structure will allow the rule to create one of the multifield structures identified by the NAME attribute.  The element is repeated for each named multifield structure that is expected to be create by this rule.

  
  NAME <MultiFields>

Required:

The attribute identifies the configured name of the multifield structure to update.

  • literal structure name

  • math variable

  • activity field name
  END <MultiFields>

Required:

The attribute provides the total number of multifield instances in the resulting named structure.  The only appropriate value is an integer.

  • literal

  • math variable

  • activity field name
<Field>   <MultiFields>

Required, Repeatable:

This structure identifies one of the multifield fields to create.  This is repeated for each multifield field the rule expects to create.

  
<FromIndexCollection>    

Required:

This element provides the updated values for multiple multifield instances.  A collection contains multiple sets of key/value pairs where this element expects keys as an index value identifying a multifield instance and values as the updated field values in the multifield instance that is identified by the key.  Multifield indexes start with a value of 1.

  • math variable

    • key = index to multified instance

      • first instance has a value of 1

    • value = update field value
<To>    

Required:

This element provides the name of the multifield field to update.  The field name must exist in the named multifield configuration.

  • literal field name
XML Schema - CreateClaim Business Rule
<CreateClaim>
    <Claims>
        <Claim>
            ...
            <MultiFields NAME="[literal|variable|field]" END="[literal|variable|field]">
                <Field>
                    <FromIndexCollection>[variable]</FromIndexCollection>
                    <To>[field name]</To>
                </Field>
                <Field>...</Field>
            </MultiFields>
            <MultiFields>...</MultiFields>
            ...
        </Claim>
        <Claim>...</Claim>
        ...
    </Claims>
</CreateClaim>