Access Restriction for Claims Jet Pages

Access to all UI pages is protected by access restrictions of type Function. Each page is represented by an access restriction of type function. So a user can only access pages he has been granted access to via one of his roles. Function access is granted on the level of a page. It is not possible to give access to certain parts of a page. For example, when the user has access to the persons page, he can search for persons, he can access all parts of that a view and edit person page like person data, person addresses, person bank accounts and so on.

A user can be granted Retrieve access to a page, and optionally also Create, Update, and/or Delete access. Create access means that new records (objects and its details) can be added. Delete access means that records can be deleted. Dynamic fields and multi-select drop down lists are considered attributes of an entity, if the user has Update access to the page he can add/remove/update such attributes even if he does not have Create or Delete access.

Menu options to which the user does not have access, are not shown. On a page to which the user has access, add / delete / save buttons are hidden if the user does not have access rights for that operation. If the user does not have update access, fields are displayed as read-only.

The pages uses HTTP API/resources and Integration points (generic/specific) to perform special operations, e.g submitting a claim or resolving a pend. Access to these operation must be granted explicitly.

Whenever a page access is provided to a user, access to required IP/API is automatically granted. However, exception to the rules are IP/API that allow user to perform certain restricted operations e.g. submitting a claim or put a claim back to change

The following access requirements apply to the Claims page (Function Code: CL0172). To perform following operations on claims or claim lines, users must have the corresponding FUNC/IP/API/TYPE access restrictions as listed in the following Table 1 Access Restrictions.

Table 1. Access Restrictions
Operation Access Restrictions (FUNC/IP/API/TYPE)

To edit a claim in statuses such as Change, Manual Pricing, Manual Pricing Adjudication, Manual Benefits, and Manual Adjudication, the user must have authorization for the Submit Claim operation and a function access update grant to CL0172.

  • All Statuses - claims.allstatus.submit IP

  • Entry - claims.entry.submit IP

  • Change - claims.change.submit IP

  • Manual Pricing - claims.manualpricing.submit IP

  • Manual Pricing Adjudication - claims.manualpricingadjudication.submit IP

  • Manual Benefits - claims.manualbenefits.submit IP

  • Manual Adjudication - claims.manualadjudication.submit IP

To submit a claim, the user must have authorization for the Submit Claim operation.

claims.submit IP

To edit a large claim in statuses such as, Inprocess and Manual Adjudication, the user must have the appropriate authorization for the Submit Claim Large Claim operation and a function access update grant to CL0172. In addition, further authorizations may be required to perform special operations.

largeclaims.submit IP

To unfinalize a claim, the user must have the appropriate authorization for the Unfinalize Claim operation or the Unfinalize Large Claim operation, along with an access grant of type Claim Unfinalization.

  • claims.unfinalize IP

  • claims.largeclaimunfinalize IP

To set claims back to status Changed, the user must have the appropriate authorization for the Back to Change operation.

claims.tochange IP

To set large claims back to status In Process, the user must have the appropriate authorization for the Back to InProcess operation.

claims.toinprocess IP

To set claims back to Manual Pricing status, the user must have the appropriate authorization for the Back to Manual Pricing operation.

claims.tomanualpricing

To set claims back to the Manual Benefits status, the user must have the appropriate authorization for the Back to Manual Benefits operation.

claims.tomanualbenefits

To resolve pends, the user must have the appropriate authorization for the Resolve Pend Reasons or the Resolve Pend on Multiple Claims operation.

  • claims.resolvepend IP

  • claims.resolvependreason IP

To add messages to multiple claims or claim lines, the user must have the appropriate authorization for the Add Messages operation.

claims.addmessage IP

To add pends to multiple claims or claim lines, the user must have the appropriate authorization for the Add Pends operation.

claims.addpendreason IP

To undo claim line replacements, the user must have the appropriate authorization for the Undo Line Replacement operation.

claims.undolinereplacements IP

To view or edit financial holds, the user must have the appropriate authorization for the Financial Holds generic API.

financialholds API

To settle or unsettle a claim, the user must have the appropriate Claim Settlement authorization and an update grant on the External Claims Data generic API.

  • Type: claimSettlement

  • Update grant on the externalclaimsdata API

To unlock claim lines, the user must have the appropriate authorization for the Unlock Lines operation.

claims.unlocklines IP

To change the skip tags action, the user must have the appropriate authorization for the Update Skip Tags operation.

claims.updateskiptags IP

To view or edit external claims data, the user must have the appropriate authorization for the External Claims Data generic API.

externalclaimsdata API

To restart an errored task, the user must have the appropriate authorization for the Task Processing operation.

taskprocessing IP

To dismiss an errored task, the user must have the appropriate authorization for the Task Processing operation.

tasks IP