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Action management edits

Updated on April 26, 2021
  • In the 2nd step of the main collection, ProcessActionManagementEdits would be called to raise action codes, in the events of Catastrophe, Claim latency and Priority handling.

  • The first step is to set the audit message for entry of the module
  • In the second step, CE_CheckCatastrophe is called to check for the catastrophic events.
  • The catastrophe is decided by using decision tables that are called in the activity.

  • The decision table is used here AM_Catastrophe_Dates

  • This decision table in turn calls another decision table to check the catastrophe name depending on state, zip code etc.

  • AM_Catastrophe_Dates determines whether to check for diagnosis code, provided and member, which in turn call decision tables to determine the catastrophe affected.
  • If the catastrophe is matched, then in the action code A-418 is raised
  • Similarly, Priority handling and Claim latency are determined in the respective activities using decision tables and A-416 is raised for priority handling and A-417 is raise for Claim latency.

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