View Claim Transaction

This page shows a claims stored in the claim transaction repository (CTR). This page does not allow the user to update, create or delete fields of the displayed claim transaction. It is possible to modify external claims data displayed in the claims header section and financial processing details in section 2 and 4. This page does not show reversal transactions. The retrieval and display of data in this page is subject to restrictions described in the implementation guide for user access.

This page is accessible through any other claim page.

Display and Specifics

This page displays the claim exactly as described in the section on the claim page local area. All dialog boxes are shown in display-only mode.

Header Buttons

The following buttons display on the top right of the local area:

Field	Remark
View Claim Transaction (drop menu)	The drop menu lists all of the claim transactions available for the claim, except the transaction that is currently displayed. The most recent transaction is the default value. Transactions are listed in descending order of version. For each transaction the version number and transaction date is shown.
To View Claim (button)	Opens a new tab for the View Claim page, showing the working copy of the claim that generated the claim transaction.
Save (button)	Saves open changes to external claims data.
Cancel (button)	Rolls back all changes to external claims data.

Displayed Fields to Object Model

Although the View Claim Transaction page presents itself as any other claim page, the object model underneath is not the same. For this reason, the mapping is listed per section in the following paragraphs.

Section 1

Displays the attributes of a single claim in a form based layout. This section also contains dynamic fields that extend the claim table. This section holds the following fields:

Display label	Object field
Process Type	ctrClaim.processType
Code	ctrClaim.code
Version	ctrClaim.version
Transaction Date	ctrClaim.transactionDate
Claim Ref	ctrClaim.providerReference
Claim Set	ctrClaim.claimSetCode
Entity Type	ctrClaim.servicedEntityType
Entity	ctrClaim.servicedEntityCode
+ name	ctrClaim.servicedEntityName
+ date	ctrClaim.servicedEntityDate
Entity Ref	ctrClaim.providerEntityReference
Servicing Provider	ctrClaim.serviceProvCode
+ name	ctrClaim.serviceProvName
Service Facility	ctrClaim.locationProvCode
+ name	ctrClaim.locationProvName
Service Specialty	ctrClaim.serviceSpecialtyCode
Referring Provider	ctrClaim.referralProvCode
Billing Party	ctrClaim.claimantProvCode or ctrClaim.claimantRelCode
+ name	ctrClaim.claimantName
Pay To	ctrClaim.payReceiverProvCode or ctrClaim.payReceiverRelCode
+ name	ctrClaim.payReceiverName
Specification To	ctrClaim.specReceiverProvCode or ctrClaim.specReceiverRelcode
+ name	ctrClaim.specReceiverName
Beneficiary	ctrClaim.payBeneficiaryProvCode or ctrClaim.payBeneficiaryRelCode
+ name	ctrClaim.payBeneficiaryName
Location Type	ctrClaim.locationTypeCode
+ description	ctrClaim.locationTypeDescription
Total Charged	ctrClaim.totalClaimedAmount and ctrClaim.totalClaimedAmountCurr (the currency display code is displayed)
Total Allowed	ctrClaim.totalAllowedAmount and ctrClaim.totalAllowedAmountCurr (the currency display code is displayed)
Total Covered	ctrClaim.totalCoveredAmount and ctrClaim.totalCoveredAmountCurr (the currency display code is displayed)
Payer code	ctrClaim.payerCode
Brand	ctrClaim.brandCode
Access Group	ctrClaim.dataAccessGroupCode
+ name	ctrClaim.referralProvName
Form	ctrClaim.formCode
Classification	ctrClaim.classificationCode
Classification Scheme	ctrClaim.classificationSchemeCode
Type	ctrClaim.type
Due Date	ctrClaim.dueDate
Emergency?	ctrClaim.emergencyIndicator
Manual?	ctrClaim.manualIndicator
Claimed on	ctrClaim.claimDate
Received on	ctrClaim.receiptDate
Priced on	ctrClaim.priceDate
Entered on	ctrClaim.entryDate
Expires on	ctrClaim.expirationDate
Authorization	ctrClaim.authorizationCode
Preceding Payer	ctrClaim.precedingPayerCode
Preceding Payer Paid On	ctrClaim.paidDate
Next Payer	ctrClaim.nextPayerCode

Some roles on the claim transaction are populated based on either a relation or a provider. For these reason, the claim transaction allows up to two codes to store such a role, i.e., a provider code and a relation code. The provider code is shown, unless unavailable, in which case the relation code is displayed. This applies to the Billing Party, Pay To, Specification To and Beneficiary fields.

Section 2

For each of the subsections a 'view only' list of detail records is displayed. These lists show all stored detail records (but not necessarily all fields per record), e.g., if a claim transaction has ten diagnoses then all ten are shown with only priority, type and code. Section 2 becomes scrollable when the accumulated height of all displayed records exceeds that of section 1. In addition to detail records, this section also shows claim transaction attributes that are expected to take up a lot of page real-estate (free form remarks, routing slips).

For some of the subsections a 'view' icon is displayed. Clicking this icon will open up a dialogue that allows to see all the fields on a detail record. This section displays the following claim details and attributes. Note that a detail summary is not displayed in case no details exist. For example, if there are no messages, the detail summary header is not displayed (nor is it possible to open the underlying dialog box).

The subsections are listed in the same sequence as they appear (top to bottom) in section 2:

Header	Displayed Object Fields
Financial Processing	FinancialTransactionProcessData.dueDate Value is prompted by "Due Date"
FinancialTransactionProcessData.financialMessageMandatory Value is prompted by "Message Mandatory?"	Edit button
Transaction Labels	ctrClaim.ctrTransactionLabelList[].labelDateTime
ctrClaim.ctrTransactionLabelList[].labelType	View button
Unfinalize Reasons	ctrClaim.ctrClaimUnfinalizeReasonList[].code
ctrClaim.ctrClaimUnfinalizeReasonList[].sourceReference	Financial Hold status and history
FinancialHoldList[].FinancialHoldType.code	FinancialHoldList[].status
FinancialHoldList[].expirationDatetime	View / Edit button
Messages	ctrClaim.ctrClaimMessageList[].severity
ctrClaim.ctrClaimMessageList[].code	ctrClaim.ctrClaimMessageList[].messageText
View button	Diagnoses
ctrClaim.ctrClaimDiagnosisList[].sequence	ctrClaim.ctrClaimDiagnosisList[].typeDescription
ctrClaim.ctrClaimDiagnosisList[].code	View button
Process Fields	String that displays the name of the process field, followed by a delimiter (" : "), followed by one of: ctrClaim.dueDate
Status, Pend and Callout History	ctrClaim.ctrStatusHistory[].dateTime
ctrClaim.ctrStatusHistory[].status	ctrClaim.ctrStatusHistory[].ctrPendReasonHistoryList[].code
ctrClaim.ctrStatusHistory[].ctrCalloutHistoryList[].definitionCode	ctrClaim.ctrStatusHistory[].ctrCalloutHistoryList[].definitionDescription
View button	Internal Remarks
ctrClaim.internalRemarks	View button
External Remarks	ctrClaim.externalRemarks

Of the listed detail summary items, only the Financial Processing and the Financial Hold status and history items are editable as they are attached to the financial process data, rather than the claim transaction. This means that the summary will show an edit icon.

Clicking the icon on Financial Processing opens the Financial Transactions page. This page shows the financial transaction and financial transaction details for the selected claim transaction.

Clicking the icon on Financial Hold status and history opens the financial hold dialog. Note that the edit icon on financial holds is controlled by access restriction type Financial hold. If the user has Financial hold access rights, an edit icon is displayed, otherwise a view icon is available.

Transaction labels are sorted on date, most recent first. Unfinalize reasons and messages are sorted on code. Messages are sorted on code. Diagnoses are sorted on sequence. Status history is sorted on date. The most recent status transition is listed first.

This section also contains dynamic records of external claims data, they are displayed below the other information of this section.

Section 3

Displays the attributes of a claim line in a table based layout. The following fields are displayed in table columns:

Display label	Entity field
Seq	ctrClaimLine.sequence
Start date	ctrClaimLine.startDate
Qty	ctrClaimLine.claimedNumberOfUnits
(Procedure display name)	ctrClaimLine.procedureCode
+ description	ctrClaimLine.procedureDescription
(Procedure2 display name)	ctrClaimLine.procedure2Code
+ description	ctrClaimLine.procedure2Description
(Procedure3 display name)	ctrClaimLine.procedure3Code
+ description	ctrClaimLine.procedure3Description
Modifiers	ctrClaimLine.ctrClaimLineModifierList[].code
Charged	ctrClaimLine.claimedAmount and ctrClaimLine.claimedAmountCurr (the currency display code is displayed)
Allowed	ctrClaimLine.allowedAmount and ctrClaimLine.allowedAmountCurr (the currency display code is displayed)
Allowed #	ctrClaimLine.allowedNumberOfUnits
Covered	ctrClaimLine.coveredAmount and ctrClaimLine.coveredAmountCurr (the currency display code is displayed)
Covered #	ctrClaimLine.coveredNumberOfUnits
Encounter?	ctrClaimLine.encounterIndicator
Status	ctrClaimLine.status
Code	ctrClaimLine.code

The following fields are available in the inline overflow area:

Field	Entity field
Line Ref	ctrClaimLine.providerReference
Authorization	ctrClaimLine.authorizationCode
Auth Exception	ctrClaimLine.authorizationExceptionType
Emergency?	ctrClaimLine.emergencyIndicator
Process as IN	ctrClaimLine.processAsIn
Family	ctrClaimLine.familyCode
End Date	ctrClaimLine.endDate
Payer Paid	ctrClaimLine.precedingPayerPaidAmount and ctrClaimLine.precedingPayerPaidAmountCurr (the currency display code is displayed)
Entity Type	ctrClaimLine.servicedEntityType
Entity	ctrClaimLine.servicedEntityCode
+ name	ctrClaimLine.servicedEntityName
+ date	ctrClaimLine.servicedEntityDate
Entity Ref	ctrClaimLine.providerEntityReference
Servicing Provider	ctrClaimLine.serviceProvCode
+ name	ctrClaimLine.serviceRelName
Service Specialty	ctrClaimLine.serviceSpecialtyCode
Service Facility	ctrClaimLine.locationProvCode
+ name	ctrClaimLine.locationRelName
Referring Provider	ctrClaimLine.referralProvCode
+ name	ctrClaimLine.referralRelName
Pay To	ctrClaimLine.payReceiverProvCode or ctrClaimLine.payReceiverRelCode
+ name	ctrClaimLine.payReceiverRelName
Funding Arrangement	ctrClaimLine.fundingArrangementCode
Product Family	ctrClaimLine.productFamilyCode
Product Line	ctrClaimLine.productLineCode
Subscription Date	ctrClaimLine.subscriptionDate
Product (benefits)	ctrClaimLine.productCode
Coverage Regime	ctrClaimLine.coverageRegimeCode
Coverage Regime (no auth)	ctrClaimLine.coverageRegimeNoAuthCode
Authorization Regime	ctrClaimLine.authorizationRegimeCode
Waiting Period Regime	ctrClaimLine.waitingPeriodRegimeCode
Post Benefit Regime	ctrClaimLine.postBenefitRegimeCode
Coverage Specification	ctrClaimLine.coverageSpecificationCode
Classification	ctrClaimLine.classificationCode
Classification Auth	ctrClaimLine.classAuthorizationCode
Location Type	ctrClaimLine.locationTypeCode
+ description	ctrClaimLine.locationTypeDescription

Claim lines that are replaced are visible but grayed out. The modifiers are displayed in a single table column cell, even though a claim line may have multiple modifiers.

Some roles on the claim transaction are populated based on either a relation or a provider. For these reason, the claim transaction allows up to two codes to store such a role, i.e., a provider code and a relation code. The provider code is shown, unless unavailable, in which case the relation code is displayed. On the line level, this applies only to the Pay To field.

Section 4

For each of the subsections a 'view only' list of detail records is displayed. These lists show all stored detail records, e.g., if a claim line has ten diagnoses, then all ten are shown. For some of the subsections a 'view' button is displayed. Clicking this button will open up a dialog that allows a user to view all available information on the detail items.

Note that a detail summary is not displayed in case no details exist. For example, if there are no claim line messages, the detail summary header is not displayed (nor is it possible to open the underlying dialog box).

This section displays the following claim line details.

Header	Remark
Messages	ctrClaimLine.ctrClaimLineMessageList[].severity
ctrClaimLine.ctrClaimLineMessageList[].code	ctrClaimLine.ctrClaimLineMessageList[].messageText
View Button	Financial Details
ctrClaimLine.ctrClaimLineCoverageList[].FinancialTransactionDetailList[].amount and ctrClaimLine.ctrClaimLineCoverageList[].FinancialTransactionDetailList[].amountCurr (the currency display code is displayed)	ctrClaimLine.ctrClaimLineCoverageList[].FinancialTransactionDetailList[].componentCode
Edit Button	Claim Line Coverages
ctrClaimLine.ctrClaimLineCoverageList[].amount and ctrClaimLine.ctrClaimLineCoverageList[].amountCurr (the currency display code is displayed)	ctrClaimLine.ctrClaimLineCoverageList[].action
ctrClaimLine.ctrClaimLineCoverageList[].coverageLabelCode ctrClaimLine.ctrClaimLineCoverageList[].displayName	View Button
Diagnoses	ctrClaimLine.ctrClaimLineDiagnosisList[].sequence
ctrClaimLine.ctrClaimLineDiagnosisList[].typeDescription	ctrClaimLine.ctrClaimLineDiagnosisList[].code
View Button	Process Fields
String that displays the name of the process field, followed by a delimiter (" : "), followed by one of: ctrClaimLine.priceIndProvCode ctrClaimLine.priceOrgProvCode ctrClaimLine.priceInputDate ctrClaimLine.priceInputNumberOfUnits ctrClaimLine.pricePrincipalProc1Ind () ctrClaimLine.pricePrincipalProc2Ind () ctrClaimLine.pricePrincipalProc3Ind () ctrClaimLine.benefitsProvCode ctrClaimLine.benefitsInputAmount and ctrClaimLine.benefitsInputAmountCurr (the currency display code is displayed) ctrClaimLine.benefitsInputDate ctrClaimLine.benefitsAgeInputDate ctrClaimLine.waitingPeriodInputDate () The price principal procedure indicators are shown as one label 'Price Principal Procedure' followed by the procedure codes beneath each other plus a mark whether they are principal or not. As an example, if procedure1 'A' is marked as principal and procedure2 'B' is not marked as principal, then this subsection would be shown as: Price Principal Procedure Y A N B null procedures are not shown.	Sublines
ctrClaimLine.ctrClaimSubLineList[].sequence	ctrClaimLine.ctrClaimSubLineList[].numberOfClaimedUnits
ctrClaimLine.ctrClaimSubLineList[].procedureCode	View Button
Replaced	String that lists the code(s) of the claim line(s) that replace this line.
Replacement	String that lists the code(s) of the claim line(s) that are replaced by this line.
Reservation	The code of the reservation and reservation line that the claim line refers to Example: Code : RES0001 Line Code : RESLN001

Messages are sorted on code. Diagnoses, claim line coverages and sublines are sorted on sequence.

Of the listed detail summary items, only the Financial Details item is editable as it is attached to the financial process data, rather than the claim line transaction. This means that the summary will show an edit icon. Clicking the icon on Financial Details opens the Financial Transactions page. This page shows the financial transaction and financial transaction details for the selected claim line transaction.

Applied provider pricing clauses

Applied provider pricing clauses are not shown in section 4. However, a button is shown to reach the detail dialog were they can be viewed (see below). This button is only available if at least one record exists in (one of the blocks of) the detail dialog.

Detail Dialog Boxes

The displayed detail dialog boxes are identical to the dialog boxes described in the section on dialog boxes, with the exception that they are strictly view only when opened from the View claim page. The dialog boxes for claim line coverages, claim transaction labels, claim/bill/claim line messages, applied provider pricing clauses and status and pend history are an exception. They are specified below:

Transaction Labels

Displays the attributes in a table based layout. All information is display only. The following fields are displayed in table columns:

Field	Object.field
Date	ctrTransactionLabel.labelDateTime
Type	ctrTransactionLabel.labelType

The inline overflow area has no fixed fields. It is used to display any configured dynamic fields. The following image is a mockup of the dialog box.

Claim Line Coverages

Displays the attributes in a table based layout. All information is display only. The following fields are displayed in table columns:

Field	Object.field
Coverage Amount (Amount and Currency)	ctrClaimLineCoverage.amount and ctrClaimLineCoverage.amountCurr (the currency display code is displayed)
Units	ctrClaimLineCoverage.numberOfUnits
Action	ctrClaimLineCoverage.action
Coverage Label	ctrClaimLineCoverage.coverageLabelCode
Display Name	ctrClaimLineCoverage.displayName
Product	ctrClaimLineCoverage.productCode
Brand	ctrClaimLineCoverage.productBrandCode

Applied Provider Pricing Clauses

Displays the attributes in a table based layout. All information is display only. The following fields are displayed in table columns:

Field	Object.field
Order	ctrClaimLineProviderPricingClause.sequence
Type	ctrClaimLineProviderPricingClause.methodRuleType
Description	ctrClaimLineProviderPricingClause.providerPricingClauseDescr
Quantifier	ctrClaimLineProviderPricingClause.quantifier
Code of Reimbursement Method / Pricing Rule	ctrClaimLineProviderPricingClause.methodRuleCode
Mark	ctrClaimLineProviderPricingClause.mark
Difference (Amount and Currency)	ctrClaimLineProviderPricingClause.amount and ctrClaimLineProviderPricingClause.amountCurr (the currency display code is displayed)

The following image is a mockup of the dialog box.

Financial Hold status and history

The dialog box is identical to the dialog box described in the section on dialog boxes.

Status, Pend and Callout History

The dialog consists of several sections: a master showing the claim status history with details showing the pend reason history and callout history. All sections are display only and show the attributes in a table based layout.

The following fields are displayed in table columns:

Status History

Field	Type
Entity, field	Date time
Label	ctrStatusHistory.statusDateTime
Status	Label

Pend Reason History

Field	Type
Entity, field	Code
Label	ctrPendReasonHistory.code
Claim Line Code	Label
ctrPendReasonHistory.claimLineCode	Resolved By
Label	ctrPendReasonHistory.userLoginName
External Code (in overflow)	Label
ctrPendReasonHistory.externalCode	Alternative Text (in overflow)
Label	ctrPendReasonHistory.alternativeText
Provider Text (in overflow)	Label

Callout History

Field	Type
Entity, field	Definition
Label	ctrCalloutHistory.definitionCode
Description	Label
ctrCalloutHistory.definitionDescription	Request Sent Datetime
Label	ctrCalloutHistory.requestSentDatetime
Response Received Datetime	Label

Claim/Claim Line Messages

The dialog box is identical to the dialog box described in the section on dialog boxes, with the exception that it is strictly view only, there is no 'OHI Specific?' column and there are extra fields displayed in the overflow area:

Field	Object.field
External Code	ctrClaimLineMessage.externalCode
Alternative Message	ctrClaimLineMessage.alternativeMessageText
Provider Message	ctrClaimLineMessage.providerMessageText