CaseTypes, DocTypes, and Status Events
Valid Status Events depend on the caseType and docType applied. Follow the caseType tables bellow to know what docTypes can be configured for what caseTypes, and what Statuses Events are relevant for each docType.
Note
All status events need a Success/Failed scenario configured. Example: if "Received" is a valid event, the applied statuses in the shovel operations are ReceivedSuccess and ReceivedFailed
CaseFile
caseType | docType | Status Events | Definition |
|---|---|---|---|
CaseFile | CaseFile | ReceivedSuccess ReceivedFailed | MH received the file |
ValidatedSuccess ValidatedFailed | MH has performed EDI validations and additional custom validations on the file | ||
AcknowledgedSentSuccess AcknowledgedSentFailed | MH has sent the corresponding Ack file for the file | ||
GeneratedSuccess GeneratedFailed | MH has generated an outgoing file and it is ready to be sent (queued) | ||
SentSuccess SentFailed | MH has sent the file | ||
AcknowledgedReceivedSuccess AcknowledgedReceivedFailed | The outgoing file has been acknowledged by the receiver |
Claim
Note
In general, we assume that if a file containing a claim is received or sent, that the claim is also received or sent.
caseType | docType | Status Events | Definition |
|---|---|---|---|
Claim | AdjudicationRequest (typically 837) | ValidatedSuccess ValidatedFailed | The claim has passed EDI validations and additional custom validation rules |
AcknowledgeReceiveSuccess AcknowledgeReceiveFailed | MH has acknowledged the receipt of the claim | ||
ProcessedSuccess ProcessedFailed | MH has decided on how the claim must be processed. Options are potentially to filter it out of the outgoing file, close it altogether or send to various SFTP destinations. Optional: Halted (applied if filtered out of outgoing file) Optional: Voided, Adjusted, Closed, (applied at user's discretion) | ||
TransformedSuccess TransformedFailed | The claim has had all relevant mapping rules applied to it | ||
GeneratedSuccess GeneratedFailed | The claim is lined up and ready to send, if required | ||
AcknowledgedReceiveSuccess AcknowledgedReceiveFailed | From the file we send, the claim has been sent and acknowledged by the receiving party | ||
AdjudicationResponse (typically 835) | ValidatedSuccess ValidatedFailed | The claim has passed EDI validations and additional custom validation rules | |
AcknowledgedReceiveSuccess AcknowledgedReceiveFailed | MH has acknowledged the receipt of the claim | ||
ProcessedSuccess ProcessedFailed | MH has decided on how the claim must be processed. Options are potentially to filter it out of the outgoing file, close it altogether or send to various SFTP destinations. Optional: Halted (applied if filtered out of outgoing file) Optional: Voided, Adjusted, Closed, (applied at user's discretion) | ||
TransformedSuccess TransformedFailed | The claim has had all relevant mapping rules applied to it | ||
GeneratedSuccess GeneratedFailed | The claim is lined up and ready to send, if required | ||
AcknowledgedReceivedSuccess AcknowledgedReceivedFailed | From the file we sent, the claim has been sent and acknowledged by the receiving party |
Enrollment
Note
In general, we assume that if a file containing an enrollment is received or sent, that the enrollment is also received or sent.
caseType | docType | Status Events | Description |
|---|---|---|---|
Enrollment | incomingEnrollments | ValidatedSuccess ValidatedFailed | The enrollment has passed EDI validations and additional custom validation rules |
AcknowledgedSuccess AcknowledgedFailed | MH has acknowledged the receipt of the enrollment | ||
ProcessedSuccess ProcessedFailed | MH has decided on how the enrollment must be processed. Options are potentially to filter it out of the outgoing file, or void the enrollment if it doesn't meet certain criteria Optional: Halted (applied if filtered out of outgoing file) Optional: Voided (applied at user's discretion) | ||
TransformedSuccess TransformedFailed | MH has applied the necessary data transformations on the enrollment | ||
outgoingEnrollments | GeneratedSuccess GeneratedFailed | The enrollment is ready to be sent | |
AcknowledgedSuccess AcknowledgedFailed | The enrollment was sent and acknowledged by the receiving party |