Claims pending reason codes

Each claim pending reason code is designated a two character code which begins with an A, B or a 0.

• The ‘A’ codes are assigned to the header information of the order.
• The ‘B’ codes are assigned to the detail lines of the order.
• The ‘0’ codes are user defined.

The Claims pending system is used for validation against company policy. Certain pending rules are checked when entering a claim, like Outside Returns Policy. Claims that are held as pending can be reviewed by pending code.

The Pending rejections program provides a facility to automatically reject claims based on pending rules via field Auto reject. A pending reason for this purpose must be entered in the Pending Department Definition and flagged as 1-auto reject. Pending checks print R/A’s before rejecting them automatically.

Specific item groups can be set up to bypass the pending check. A control file holds the group codes and a flag to indicate whether or not that group is to be excluded from the pending check. It is not necessary to load all groups, only those to be excluded.

The pending function is available to users that are authorised to review pended claims only. Departments and users within these departments are defined to have the authority to review some or all pended claims, by pending reason code.

Claims that pend can be directed to the appropriate users for approval, based on the division of the Description. If orders have Descriptions from more than one division, the division of the first Description on the order is used.

Departments and users within these departments are defined to the system by Division. The pending review checks these definitions and allows users access to the appropriate claims in the correct divisions.