Financial Hold integration Point

This chapter describes Financial Hold Integration Point messages and how they are used by external interfaces to initiate a hold or to release an existing hold.

External interfaces determine when request messages are sent and what they contain. Each request message can be for one of the following

• Set Claim Financial Hold

• Release Claim Financial Hold

This chapter does not discuss logging, time stamps or other technical aspects. These aspects are covered by the overall messaging framework.

Set Claim Financial Hold

This request enables an external system to apply a financial hold to a claim or a claim transaction. The hold type code in combination with a claim code or a claim code with the claim transaction version number is used. The set financial hold request is considered for a specific claim transaction version of the claim (identified by the claim code) if the request message contains a claim transaction version number. In a request to set the financial hold to a claim, the claim transaction version number should not be supplied.

Request Message

Each request message contains a hold type in the combination with a claim code or a claim code along with the claim transaction version number. The hold can be placed by sending a 'POST' request with the following details.

<claimHold
claimCode=""
claimVersion=""
holdTypeCode=""
remarks=""
autoReleaseOnNewVersion=""
referenceCode=""
transactionSourceCode=""
>
<expirationDateTime>{value}</expirationDateTime>
</claimHold>

The information about the hold start date/time and held by user is populated in the following way:

Field	Description	Auto Populated Value
Start datetime	Date and time the hold is placed	With the date and time of the set claim financial hold call.
Held by user	The user who has placed the hold	With the value for the user

Response Message

Response message is created by Claims in response to the request message received from an external interface.

The set claim financial hold will have the standard response as specified in Response Message.

Error Messages

The following error messages, that are specific to the set claim financial hold, may be returned in the response messages:

Code	Severity	Message
CLA-IP-HOLD-001	Fatal	Hold Type {code} is unknown.
CLA-IP-HOLD-002	Fatal	Claim {code} is unknown.
CLA-IP-HOLD-003	Fatal	Claim transaction version {version} for the claim {code} does not exist.

In addition, functional business rule messages may be returned (refer to the 'Result Messages' section in the HTTP API Integration Points part of the Common Features book).

Release Claim Financial Hold

This request enables an external system to release a financial hold from a claim or a claim transaction. The hold type code in combination with a claim code or a claim code with the claim transaction version number is used. The release financial hold request is considered for a specific claim transaction version of the claim (identified by the claim code) if the request message contains a claim transaction version number. In a request to release the financial hold from a claim, claim transaction version number should not be supplied.

This integration point can only release a financial hold that meets both of the following conditions:

• the financial hold is not released

• the financial hold is not expired

System responds with a fatal message when no hold of the given hold type is found. No informative messages are provided for the holds that were already either released or expired, but if no financial hold can be released at all, a fatal message is issued in the response.

Example 1

Consider that three holds of hold type A are present on a claim

Hold Type	Is Released?	Is Expired?
Hold Type A	Yes	No
Hold Type A	No	Yes
Hold Type A	No	No

If a request to release hold type A is made, then this will result in a success (only the third record will actually be released).

Example 2

Consider that two holds of hold type A are present on a claim

Hold Type	Is Released?	Is Expired?
Hold Type A	Yes	No
Hold Type A	No	Yes

If a request to release hold type A is made, then this will result in a failure as there is no valid hold of the hold type A that can be released.

Request Message

Each request message contains the hold type in combination with claim code or claim code with claim transaction version number. The hold can be released by sending a 'PUT' request with the following details.

<claimHold
claimCode=""
claimVersion=""
holdTypeCode=""
releaseRemarks=""
/>

The information about release date/time and release by the user is populated in the following way:

Field	Description	Auto Populated Value?
Release datetime	Date and time the hold is placed	With the date and time of the release claim financial hold call.
Released by user	The user that released the hold	With the value for the user.

Response Message

The response message is created by Claims in response to the request message received from an external interface.

The release claim financial hold will have the standard response as specified in Response Message.

Error Messages

The following error messages that are specific to the release claim financial hold may be returned in the response message:

Code	Severity	Message
CLA-IP-HOLD-004	Fatal	No financial hold of the type {code} to a claim {code} that can be released is found.
CLA-IP-HOLD-005	Fatal	No financial hold of the type {code} to a claim transaction {version_number} for the claim {code} that can be released is found.

In addition, functional business rule messages may be returned (refer to the 'Result Messages' section in the HTTP API Integration Points part of the Common Features book).