Pend Reasons

This entity represents a reason that explains why a claim pended. When a claim pends, one or more pend reasons are attached to the claim, bills or claim line(s). Pend reasons are removed when a claim is re-submitted for processing. A pend reason has the following attributes:

Table 1. Pend Reasons

Field	Description
Code	Identifying code.
Description	Description that is displayed in the list of values.
Priority	Number that represents the priority of the pend reason. The priority is sent in the work flow event and can be used to differentiate between tasks and putting them in different work flow queues.
External Code	External code which is sent in the work flow task start message.
Publish Message?	If checked, Claims sends out a work flow event when a claim pends for this reason.
Non Clean?	If checked, attaching this pend reason to a claim marks the claim as non clean.
Re-attach?	If unchecked, this reason is attached, that is, does not cause the claim to pend if the claim(line)'s history shows that the same pend reason has been attached in the past. If checked, then any pend history is ignored when attaching this pend reason.
Adjudication Only?	If checked, this pend reason is only enforced (meaning that it needs to be resolved before the claim can be re-submitted for processing) in the Pricing Manual Adjudication status (for external benefits) or the Manual Adjudication status (for internal benefits).
Reprocess?	If checked, the claim is re-processed automatically without manual intervention.
Claim Fields	Dynamic function produces a list of name value pairs that are included in the workflow message.
Bill Fields	Dynamic function produces a list of name value pairs that are included in the workflow message.
Claim Line Fields	Dynamic function produces a list of name value pairs that are included in the workflow message.
External Text Alternative	An alternative text to be in the external output. Note that the use of placeholders is not supported
External Text Provider	The text as presented in external output for the provider. Note that the use of placeholders is not supported.
Access Restriction	The access restriction restricting access to the pend reason.

The Non Clean? indicator is not tied to any hard logic in the application, but can be used in dynamic logic. For example, consider a dynamic check that determines whether a claim line is within the filing limit period.