Configure Financial Workflows with Claim Payment Actions

A flexible framework supports standard and custom financial workflows based on the status of claim payments. Use the framework to provide a full slate of financial actions to claims adjusters, from initial payments, through approval processes and payment issuance, to payment cancellations.

Administrators can:

• Configure payment detail status values: Open, Pending Authority, Authority Approved, Ex Gratia Approved, and Paid.

• Configure relevant payment actions to show users for each payment detail status: Edit, Delete, Pay, Request Financial Authority, Request Ex Gratia Approval, and Cancel Payment.

• Launch a back-end process or user interface when users click a specific payment action. For example, an integration procedure can change a payment detail status to Pending Authority, and then invoke an approval process.

• Seamlessly embed workflows into the existing Claim Financials user interface.

After everything is configured, claims adjusters can choose from a list of payment actions tailored for each status. Approval requests and payment cancellation processes kick off automatically.

Where: Available in Spring '22 and later releases.

Why: Folding your financial processes into the claims workflow can reduce project implementation costs, tighten financial controls, and improve user adoption of claims financial tools.

How: Configure payment detail statuses and payment actions for each status. Then configure processes to run when users click a specific payment action.

Claims adjusters see the appropriate payment actions for each payment detail. If a user selects several payment details, the only actions available to click are those that apply to all selected payment details based on status.