Unresolve Pend Reasons

During manual intervention in health insurance claims processing, an operator can resolve a pend reason on a claim or claim line. The unresolve operation allows undoing this resolution for a specific pend on a specific claim or claim line reverting it to pending status and clearing its resolution details in history.

This is a single-level operation (claim or claim line only), bulk unresolve is not supported.

  • Access restrictions protect pend reasons. HTTP API operations always enforce those access restrictions.

    • HTTP 403 Forbidden is returned if the current user does not have the access rights to unresolve the pend. Error code: CLA-IP-CLAI-038 You do not have the privileges to unresolve the pend is returned in the response.

    • If any rights are missing, no change is made to the claim or any of its details.

  • Pend unresolve is discoverable: When a pend reason is resolved and eligible for unresolve, an unresolve link is added to the resource representation.

Unresolve a Specific Pend Reason on Claim Level

This operation is available on the claimpendreasons and claimlineperndreson resource.

When a claim pend reason is resolved and not removed, an unresolve link is added like this:

{
  ... claim pend reason properties
  "resolved": true,
  "links": [
    {
      "href": "http://[hostName]:[portNumber]/[api-context-root]/generic/claimpendreasons/{id}",
      "rel": "self"
    },
    {
      "href": "http://[hostName]:[portNumber]/[api-context-root]/claimpendreasons/{id}/unresolve",
      "rel": "claimpendreason:unresolve"
      "httpMethod": "POST"
    }
  ]
}

Success Response

The pend reason is marked as unresolved (resolved: false), and the resolvedBy and resolvedDateTime are cleared from the pend reason history (for the claim status) for the specific pend reason.

HTTP 200 OK after the operation is completed successfully.

Unresolve a Specific Pend Reason on Claim Line Level

This works exactly identical to unresolving a pend reason on the claim level. The only difference is that the claimlinependreason resource is involved.

{
  ... claim pend reason properties
  "resolved": true,
  "links": [
    {
      "href": "http://[hostName]:[portNumber]/[api-context-root]/generic/claimpendreasons/{id}",
      "rel": "self"
    },
    {
      "href": "http://[hostName]:[portNumber]/[api-context-root]/claimpendreasons/{id}/unresolve",
      "rel": "claimlinependreason:unresolve"
      "httpMethod": "POST"
    }
  ]
}

Authorization

All operations in this section are protected by access restriction claims.unresolvepend IP.

Response Messages

For full error codes and handling, see Response Messages.