RL6:Claims File Lifecycle

RL6:Claims can be used in a variety of ways based on how your organization wishes to track claim data. The ultimate goal is that the claim is researched and documented completely so that it can be made available to decision makers through reports and graphs. Once claims have been fully documented, appropriate decisions can be made.

The file lifecycle contains the following steps:

1. Import FilesThe electronic record created when a user submits an incident report, such as a fall or medication error, or when a patient provides feedback. Some organizations refer to files as events, reports, or cases. – the file submitter searches for and imports a file created in another RL6 module to complete some of the details (Completing the Event Details Section).
2. Incomplete – the file submitter can save an Incomplete version (Submission Form Buttons) and then finish and submit the file later.
3. New – once the file has been submitted (Submitting a File), it goes into the state New. More details may be added at this point.
4. In-Progress – once the file has been opened in management mode, it enters the state In-Progress. During this state, the claims manager researches, documents, and manages the file. Follow-up details (Adding a Follow-up Action), Parties, Insurance, and Transactions may be added.
5. Closed – for some organizations, the end of the file lifecycle is when the file gets closed. Closed files can be reopened, if necessary (Management Form Buttons).
6. Deleted – claims managers may delete files (Management Form Buttons) that are invalid, duplicate reports or don’t provide sufficient details. This is a “soft” delete, meaning the file is still in the database and can be undeleted.