Pend Reason Resolution

This feature provides for restriction of the resolution of configured pend reasons. Some pend reasons, like 'High Dollar Amount' and 'Fraud and Abuse' may only be resolved by a select group of operators.

If a pend reason is restricted, then only users with a role that has a grant for that access restriction can resolve the pend reason. If a pend reason is not restricted, then all users may resolve that pend reason. The access restriction has no impact whatsoever on the use of Integration Points, by means of which pend reasons can also be resolved.

There are no restrictions on viewing pend reasons or pend reason history.

Example

User Bob is granted access restriction FRAUD_ABUSE. No access restrictions have been granted to user Pete. The following table shows which pend reasons they can resolve.

Table 1. Example

Pend Reason	Pend Reason Access Restriction	Can Pend Reason be Resolved by Bob?	Can Pend Reason be Resolved by Pete?
FRAUD	FRAUD_ABUSE	yes	no
ABUSE	FRAUD_ABUSE	yes	no
DUPL	empty	yes	yes

Inference Prevention

Not applicable.

Related Entities

Not applicable.

Related APIs

The following APIs check for pend resons resolution access

• Pend Resolution Operation

• Claims Update IP