Automatic workflow can be configured for your teams to sign off claims using a streamlined approval process.
Workflow groups are used to group job roles for each step of the approval workflow. Users within a workflow group can only approve a clam if they have been given the read and write permission for trading partners within permission groups.
Claims admin users have access to the Config area and workflow configuration within the Claims app.
This article will guide you through:
Looking for something else?
- Looking to configure the sign off process for trading programs rather than claims? Learn how to configure your trading program approval workflow here.
- Alternatively, see our Help Center for more on Claims.
Approval workflow consists of configured workflow groups for each step of the claim sign-off process. We recommend that you create a workflow group for each job role involved in approving claims.
To create a workflow group:
Step 1: Within the Claims app, click on Config in the green banner at the top of the page.
Step 2: Click on Workflow in the drop-down menu.
Once your workflow groups have been created, you can configure your approval workflow to include a group for each step of the claim sign-off process.
To create an approval workflow:
Step 1: Within the Claims app, click on Config in the green banner at the top of the page.
Step 2: Click on Workflow in the drop-down menu.
Step 3: Click the Create workflow button.
Step 4: Enter a Name for the workflow.
Step 5: Click the ☰ symbol next to Select Workflow Group. Click the Workflow Group… button to choose the group to be used for the draft step, i.e. the group of users who will be creating draft claims. Review the users within the workflow group you have selected, then click the Save button.
Step 6: Click the Create Step button to add additional steps of approval required for the workflow.
Step 7: For each additional step, click on the step number on the left and repeat selecting a workflow group.
Step 8: If you are ready for the approval workflow to be applied to all claims, set the Active toggle.
Step 9: Click the Save button.
Tip: To edit an approval workflow or add additional steps after the workflow has been saved, simply click on the relevant approval workflow in the list within Workflow Configuration and make any required changes using steps 3 to 7 above.
Configuring workflow defaults
Specific workflows can be set for different partners, agreement types and agreement subtype combinations.
To configure workflow defaults:
Step 1: Within the Claims app, click on Config in the green banner at the top of the page.
Step 2: Click on Settings hierarchy in the drop-down menu.
Step 3: Select the applicable Partner, Agreement type, and Agreement subtype. If one of these settings is left unselected, the workflow defaults will apply to all claims that meet the criteria.
Step 4: Within the Claims process section on the right of the page, select from the Approval workflow drop-down list.
Step 5: Click the Save button.
The specific workflow will then be applied when a claim is calculated, and verified by the platform again when the draft step of a claim is approved.
What’s next?
Ready to start the approval process for a claim? Learn how to start the approval workflow and approve a claim here.