Claim Lines Search Result

This page displays the results of an (advanced or quick) search over claims based on data characteristics of claim lines. Once executed, this page shows a list (display only) of the claim lines that meet the search criteria. The user can deep link to other claims pages for specific functions, such as manually price the claim, manually adjust the benefits or simply see an overview of the claim (it depends on the status of the claim which claim page is opened).

A new Claim Lines Search Result tab will open if the user either executes a query using the quick search function in the regional area or clicks on the advanced search button in the regional area. The retrieval and display of data in this page is subject to restrictions described in the implementation guide for user access.

Display and Specifics

The Claim Lines Search Result page provides direct access (using a deep-link) to the other claims pages, based on the status of the claim (as reflected in the navigation model below). Each page represents a specific function on a claim. The direct access that the Claim Lines Search Result page provides may be restricted due to configured user restrictions, e.g., only certain user roles are allowed to do manual benefits.

Advanced Search

The advanced search functionality is located in the upper part of the Claim Lines Search Result local area. The advanced search offers the following fields as search criteria:

Field	Remark
Entity Type Entity Code Entity Name/Description Entity Date	Search on serviced entity, combination of fields Drop down on serviced entity type, e.g. Person, Car etc. (mandatory pick one) - the other Serviced Entity search fields are disabled if no type is chosen Code. Free text field on serviced entity code, LOV on person or object (depending on the type) Name /description. Free text field on serviced person name / serviced object description Date. Date picker on serviced person date of birth / serviced object object date If only value for drop down field is specified, the system searches within the context of the chosen serviced entity type Returns all claim lines where at least one serviced entity matches the specified criteria
Claim Code	Free text
Benefits Provider	LOV on providers
Price Individual provider	LOV on providers
Price Organization provider	LOV on providers
Procedure	LOV on procedures (matched against all three claim line procedures)
Procedure 2	LOV on procedures (matched against all three claim line procedures)
Procedure 3	LOV on procedures (matched against all three claim line procedures)
Diagnosis	LOV on diagnoses (matched against all claim line diagnoses including the diagnoses that are inherited from higher levels)
Message	LOV on messages (matched against all claim line messages including the fatal messages that are inherited from higher levels)
Pend Reason	LOV on pend reasons (matched against all claim line pend reasons)
Service Date between	Date picker
and	Date picker
Charged between	Number field
and	Number field
Allowed between	Number field
and	Number field
Covered between	Number field
and	Number field

Field

Remark

Entity Type

Entity Code

Entity Name/Description

Entity Date

Search on serviced entity, combination of fields

Drop down on serviced entity type, e.g. Person, Car etc. (mandatory pick one) - the other Serviced Entity search fields are disabled if no type is chosen
Code. Free text field on serviced entity code, LOV on person or object (depending on the type)
Name /description. Free text field on serviced person name / serviced object description
Date. Date picker on serviced person date of birth / serviced object object date
If only value for drop down field is specified, the system searches within the context of the chosen serviced entity type
Returns all claim lines where at least one serviced entity matches the specified criteria

Claim Code

Free text

Benefits Provider

LOV on providers

Price Individual provider

LOV on providers

Price Organization provider

LOV on providers

Procedure

LOV on procedures (matched against all three claim line procedures)

Procedure 2

LOV on procedures (matched against all three claim line procedures)

Procedure 3

LOV on procedures (matched against all three claim line procedures)

Diagnosis

LOV on diagnoses (matched against all claim line diagnoses including the diagnoses that are inherited from higher levels)

Message

LOV on messages (matched against all claim line messages including the fatal messages that are inherited from higher levels)

Pend Reason

LOV on pend reasons (matched against all claim line pend reasons)

Service Date between

Date picker

and

Date picker

Charged between

Number field

and

Number field

Allowed between

Number field

and

Number field

Covered between

Number field

and

Number field

Note that non-matched fields are not considered when evaluating whether a claim line meets the search criteria.

To clarify the inheritance from higher levels, consider the following example: the serviced person on the claim line is null, the serviced person on the claim is the person with relation code '1234'. When executing a search with the criterion that the serviced person relation code is 1234, this particular claim line is a valid search result, because the claim line inherits the serviced person as specified on the claim.

The start and end date are evaluated as follows: if the start and end date of the claim line lie within the search period, then the claim line is an eligible search result.

For example, consider the following claim lines for person 123:

Claim Line 1, with service dates 01-01-2012 through 01-15-2012
Claim Line 2, with service dates 01-10-2012 through 01-30-2012
Claim Line 3, with service date 02-05-2012

Consider the following search periods for claim lines for person 123 and the search results:

From <empty> through <empty> returns 1, 2 and 3
From 01-01-2012 through <empty> returns 1, 2 and 3
From <empty> through 01-20-2012 returns 1
From 01-01-2012 through 01-20-2012 returns 1
From 01-08-2012 through 02-08-2012 returns 2 and 3
From 01-10-2012 through 01-20-2012 returns nothing

Search Results

Once the search is executed and processed, the search results will display in the lower section of the page. The header of this section shows the number of returned search results.

The fields are all display only fields:

Column	Remark
Claim Code	Code of the claim. Deep links to a claim page, depending on the status of the claim: Entry → Enter Claim page Change → Change Claim page Manual Pricing → Manual Pricing page Manual Pricing Adjudication → Manual Pricing Adjudication page Manual Benefits → Manual Benefits page Manual Adjudication → Manual Adjudication page any other status → View Claim page (also opened when the user has no access to the above mentioned pages)
Claim Status	Status of the claim (note that this column is not displayed in the mock-up).
Sequence	Sequence of the claim line.
Start Date	Start date of the claim line.
Procedures	Claim line procedures (comma separated).
Entity Type	Entity type singular display name
Entity Code	Person or object code
Benefits Provider	Code of the benefits provider.
Price Individual Provider	Code of the price individual provider (note that this column is not displayed in the mock-up).
Price Organization Provider	Code of the price organization provider (note that this column is not displayed in the mock-up).
Charged	Charged amount and currency display code.
Allowed	Allowed amount and currency display code.
Covered	Covered amount and currency display code.
Primary Fatal Message	Code of the fatal message with the highest priority (lowest priority field value). If more than one message qualifies, an alphabetic sort on the code determines which message is displayed. Note that fatal messages inherited from higher levels are also taken into account.
Primary Fatal Message Text	Text of the fatal message.
Primary Diagnosis	Code of the primary diagnosis (inherited from higher levels if not specified on claim line).
Primary Pend Reason	Code of the pend reason with the highest priority (lowest priority field value). If more than one pend reason qualifies, an alphabetic sort on the code determines which pend reason is displayed.
Claim Line Status	Status of the claim line

Column

Remark

Claim Code

Code of the claim. Deep links to a claim page, depending on the status of the claim:

Entry → Enter Claim page
Change → Change Claim page
Manual Pricing → Manual Pricing page
Manual Pricing Adjudication → Manual Pricing Adjudication page
Manual Benefits → Manual Benefits page
Manual Adjudication → Manual Adjudication page
any other status → View Claim page (also opened when the user has no access to the above mentioned pages)

Claim Status

Status of the claim (note that this column is not displayed in the mock-up).

Sequence

Sequence of the claim line.

Start Date

Start date of the claim line.

Procedures

Claim line procedures (comma separated).

Entity Type

Entity type singular display name

Entity Code

Person or object code

Benefits Provider

Code of the benefits provider.

Price Individual Provider

Code of the price individual provider (note that this column is not displayed in the mock-up).

Price Organization Provider

Code of the price organization provider (note that this column is not displayed in the mock-up).

Charged

Charged amount and currency display code.

Allowed

Allowed amount and currency display code.

Covered

Covered amount and currency display code.

Primary Fatal Message

Code of the fatal message with the highest priority (lowest priority field value). If more than one message qualifies, an alphabetic sort on the code determines which message is displayed. Note that fatal messages inherited from higher levels are also taken into account.

Primary Fatal Message Text

Text of the fatal message.

Primary Diagnosis

Code of the primary diagnosis (inherited from higher levels if not specified on claim line).

Primary Pend Reason

Code of the pend reason with the highest priority (lowest priority field value). If more than one pend reason qualifies, an alphabetic sort on the code determines which pend reason is displayed.

Claim Line Status

Status of the claim line

The search results are ordered by claim code (first) and claim line sequence (second). All results are shown in a single table. The user can go through the search results by using the (search result) table scroll bar. When a search yields more than the maximum results that can be displayed in the page, the user is warned by a warning message in the header of the section.