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Claim Financials Setup
Claims admins manage the entire setup process to operationalize the claims financials system.
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- Map payment status: Claim admins start by mapping the non-configurable CCPD static status to org-specific CCPD dynamic status. This alignment ensures that the correct user interface buttons and API automations are activated at the right times. It enforces both standard and custom actions on the claim financial UI and supports many-to-one mapping, allowing many dynamic enums to map to one static enum. See Configurable Status to Action Mapping for Claim Payments.
- Map prebuilt or custom payment details actions: Next, claim admins map both pre-built and custom payment detail actions to the relevant statuses. These actions include creating, canceling, deleting, and paying claims. In addition, admins can expose custom actions that enforce specific status-based functionalities. See Configure Manageable Actions.
- Attribute Scopes for Limit Tracking: Claim admins then map attribute scopes to policy or coverage attributes. This step is crucial for maintaining accurate balances and ensuring that data is audit-ready. By correctly mapping these attributes, limits and adjustments are posted to the appropriate categories for accurate and compliant financial records. See Product Attribute Scope Mapping.
- Extend Limit Tracking Logic: Finally, admins can extend the limit tracking logic by attaching expression sets or integration procedures. This enables the calculation of adjustments and the processing of limits using custom algorithms. This extension preserves standardized, audit-ready outputs while providing the flexibility to accommodate the organization's unique needs. The result is a no-code configuration that empowers claim adjusters with the right actions, ensuring they can efficiently and accurately manage claims. See Custom Setup for Calculating Adjustments and Processing Limits.
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