Remove from Financial Transaction Set

There are scenarios where if a claim is updated before it has been included in a message, it meets the criteria of a different set and needs to be moved to it. For example, if a claim is rejected, it needs to be moved to a set for immediate refund of copay if it is currently in the set for payment on a specific due date.

Therefore, a way needs to be provided for financial transactions to be removed from a set (without creating financial messages). After that, they can be placed in a different set.

The input parameter of the business operation is the claim code, which identifies the base financial object. As it is not possible that unhandled financial transactions for the same base financial object reside in more than one financial transaction set, there is no need for the financial transaction set as input parameter.

Based on the claim code, the operation will search for the financial transaction set that has one or more unhandled financial transactions for the base financial object. If none exist, then nothing happens. Otherwise, the operation will follow the pattern similar to removal of financial transactions from a set when generating the financial message because of a financial hold:

  • remove all unhandled financial transactions from the financial transaction set (handled financial transactions are left untouched)

Note that - identical to the removal because of a financial hold:

  • supersedes are left untouched

  • BASE FINANCIAL OBJECT.status is left untouched

  • BASE FINANCIAL OBJECT.gen fin proc complete datetime is left untouched

The current functionality already takes care of correct processing when the financial transactions are placed in a different set after which the financial processing takes place (Supersede and Generate Financial Message)

Resource representation of a claim that is to be removed from a financial transaction set:

  ... claim properties ...
 "links": [
    {
      "href": "http://<host>:<port>/api/generic/claims/<id>",
      "rel": "self"
    },
    {
      "href": "http://<host>:<port>/api/claims/<claim id>/removefromset",
      "rel": "claim:removefromset",
      "httpMethod": "POST"
    }
  ]
}

HTTP Status 204 is returned if the claim is found and the operation did not end up in error. HTTP Status 404 is returned if the claim is not found.