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
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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.
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
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Not applicable.
- Related Entities
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Not applicable.
Related APIs
The following APIs check for pend resons resolution access
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Pend Resolution Operation
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Claims Update IP