Add Pend

This synchronous integration point allows the user to add a specific pend reason on multiple claims and claim lines by performing the following POST request with the payload:

http://[hostName]:[portNumber]/[api-context-root]/claims/addpendreason

{
    "pendReasonCode": "PEND_001",
    "level": "claim",
    "claimList": [
        {
            "id": 123,
            "claimLineList": [
                {
                    "id": 456
                },
                {
                    "code": "CLAIM_LINE_001 "
                }
            ]
        },
        {
            "code": "CLAIM_001",
            "claimLineList": [
                {
                    "id": 345
                },
                {
                    "code": "CLAIM_LINE_002"
                }
            ]
        }
    ]
}

Details

• It is mandatory to pass the Pend Reason Code and Claim id/code..

• It is possible to add Pend Reasons to claims only when a claim is in the following statuses:

  • In Process

  • Change

  • Manual Pricing

  • Manual Benefits

  • Manual Pricing Adjudication

  • Manual Adjudication

• When the level is not specified, it is considered as claim.

• Add pend reason at claim level:

  • When level is set as claim, the pend reason is added at the claim level.

• Add pend reason at claim line level:

  • When level is set as claim line, the pend reason is added at the claim line level.

    • When claim line details are passed in the payload, the system adds the pend reason only to those specified claim lines.

    • If no claim line details are passed on to the payload, then the pend reason is added to all the claim lines that belong to the claim.

    • NOTE: Adding pend reason at the claim line level is not applicable when the claim code’s process category is Large Claim System.

• After successful processing, the system creates a related entry in the pend reason history.

Authorization

A user authorization configuration protects access to this feature. The relevant access restriction is claims.addpend IP.

HTTP status 403 is returned if the current user has no access rights to resolve pend

Response Messages

Success

HTTP 200 (Ok) after the operation is completed successfully.

Failure

The potential failure responses that a user may encounter are as follows:

Table 1. Response Messages

Code	Severity	Message
CLA-IP-APND-001	Fatal	Claim {id/code} is unknown.
CLA-IP-APND-002	Fatal	Claim Line {id/code} is unknown
CLA-IP-APND-003	Fatal	Pend Reason {Code} is unknown
CLA-IP-APND-004	Fatal	It is not possible to add a pend reason on claim {id/code} with status {claim status}
CLA-IP-APND-005	Fatal	Atleast one claim id or code is not specified
CLA-IP-APND-006	Fatal	Claim line {id/code} does not belong to Claim {id/code}
CLA-IP-APND-007	Fatal	Level cannot be Claim Line for the Claim {id/code} as the process category is Large Claim.
CLA-IP-APND-008	Fatal	Level can only be either claim or claim line
CLA-IP-APND-009	Fatal	Pend reason code is not specified

The response can also contain generic error messages not specific to this web service. See Response Messages for more details.