Claim Line Locking Scenarios

Locked claim lines cannot be updated and they will not be again processed when the claim that they belong to is reprocessed (all results on the locked claim lines will be kept). Claim lines can be locked when unfinalizing a claim or when pending a claim. The two different scenarios are described below.

Unfinalizing

Locking claim lines when unfinalizing a claim supports the scenario of appeals on specific claim lines instead of the entire claim. To be able to lock claim lines when unfinalizing a claim, an unfinalize reason with a checked Lock Claim Lines indicator has to be configured. If such an unfinalize reason is used to unfinalize a claim, all claim lines of the claim will automatically be locked. The claim lines that have to be reprocessed (because they are appealed) have to be unlocked. This can be done in the Claims In and Claims Update integration points, by setting the indUnlock attribute in the request message to Y for the applicable claim lines. This can also be done in the Change Claim page by selecting the applicable claim lines and clicking on the Unlock Line(s) button. Note that this button is only displayed for users that have an access restriction (with read and update grants) of type 'Claim Line Unlocking'. When the claim is submitted, only the claim lines that are unlocked will be reprocessed; the results on the locked claim lines will be kept.

Pending

Locking claim lines when pending a claim supports the scenario of building up a claim gradually by adding new claim lines and keeping the results on the existing claim lines. To be able to lock claim lines when pending a claim or specific claim lines, an external intervention rule with a checked Lock Claim Lines indicator has to be configured. Note that only external intervention rules for steps Manual Pricing Adjudication and Manual Adjudication can be configured to lock claim lines. If a claim is pended by such an external intervention rule, all claim lines of the claim will automatically be locked. If a specific claim line is pended by such an external intervention rule, then only that specific claim line will automatically be locked. New claim lines can be added through the Claims In and Claims Update integration points or in the Change Claim page. When the claim is submitted, only the new claim lines will be processed; the results on the existing (locked) claim lines will be kept.