Claim entry, correction and editor screens

The claim workspace is built from three host windows that dynamically load a claim-form tab object (one per claim form type) plus shared tabs for adjudication results and payment history. All of them delegate business logic to clmshare/n_cst_claims (data orchestration, save, message handling) and clmshare/n_cst_claim_control (locking / status / security).

Host windows

claims/w_claim_entry — Claims Entry

• Purpose: capture a brand-new claim. Loads the tab object for the selected claim form (of_setform), sized to the form.
• Actions: choose claim form; enter data; Save (claim id generated, status RFCP — see CLM-1/2). Menu m_claim_entry.

claims/w_claim_correction — Claims Correction

• Purpose: work claims that have open error messages. A claim-list DataWindow with a search-criteria panel (ue_search) retrieves claims for the screen's status family; clicking a claim opens it in the embedded editor surface (ue_retrieveclaim).
• Notes: the same window class also serves "show deleted" mode for returned/deleted claims (ue_showdeleted).

claims/w_claim_editor — Open Claim ("Claims editor")

• Purpose: the general claim viewer/editor. Opens in a screen mode that determines title, help text and which actions are enabled: AUDIT (Claims Audit), CORRECTIONS (Claims Corrections), RETURN (Returned Claims), ADJUDICATION (Claims Adjudication), VOID, RFF and default Open Claim (ue_setscreenstatus).
• Layout: claim-id header (dw_claim_id), dynamically loaded claim-form tab (ue_setclaimstab via clmshare/n_cst_claimform), messages grid (dw_messages, shared with n_cst_claims), original-values view (dw_original), action log (dw_action), status text (st_status shows Read Only reasons).
• Actions (menu/toolbar m_claims_correction):
  • Void / Return / Mark-for-Deletion / Reactivate / Hold — all via wf_setstatus + confirmation popup w_setclaimsstatus (info messages 88/87/144/89/86). Void is disabled once the claim has ever been PAID (claim_statuses_history check).
  • Message operations: add / edit / close (close triggers the per-message-number workflows in n_cst_claims.of_closemessage).
  • View: benefit definitions applied (w_claim_lines_benefit_definition), claim lines before code review (w_before_claim_lines via of_viewbeforeclaimlines), status history (w_claims_disp_status_history), original values, notes, associated claims (w_assoc_list), claim letters (ue_issueletters → w_claims_letters), EOB (ue_vieweob), enrollment.
  • Assign provider / subscriber / patient (lookup + assignment events ue_setprovider / ue_setsubscriber / ue_setpatient).
  • Mark claim for Outbound EDI (ue_outbound_edi): checks the claim is not already in outbound_edi_transactions, prompts for a trading partner (w_claims_partners_select), inserts the transaction row and logs message 223.
  • Duplicate viewer (claims/u_duplicate_claim, titled View Duplicates): lists the claim ids from the message-102 DupClaims: comment; double-click opens each candidate in another w_claim_editor sheet (read-only if locked).

Claim form tab objects (clmentry)

clmshare/n_cst_claimform.of_getclaimsobject maps claims.claim_form_type to the tab object; each tab is composed of DataWindows over claim_entries, claim_lines and form-specific tables.

Claim form type	Tab object	Window title	Extra tables
HCFA1500	u_claims_tab_hcfa	HCFA 1500	claims_hcfa_info
HCFA_REPRICE	u_claims_tab_hcfa_reprice	HCFA 1500 Repricing	+ claims_reprice_info
UB92	u_claims_tab_ub92	UB92	claims_ub92_info, conditions/occurrences/procedures/values, itemized
UB92_REPRICE_IN / _OUT	u_claims_tab_ub92_reprice_in / _out	UB92 Inpatient / Outpatient Repricing	+ reprice info/detail
GENERIC_REPRICE	u_claims_tab_generic_reprice	Generic UB92 Repricing	+ reprice info/detail
GENERIC_MEDICAL	u_claims_tab_generic_medical	Generic Medical
DED_SUPPLEMENT	u_claims_tab_dedsupp	Deductible Supplement
SFPI_DENTAL	u_claims_tab_sfpi_dental	SFPI Dental	claims_dental_info, claim_missing_teeth
SFPI_VISION_EXAM	u_claims_tab_sfpi_vision_exam	SFPI Vision Examination	claims_vision_info
SFPI_VISION	u_claims_tab_sfpi_vision_lens	SFPI Vision Lens and Frames	claims_vision_info (lens detail)
SFPI_HCR	u_claims_tab_sfpi_hcr	SFPI Healthcare Reimbursement	claims_reimb_info
SFPI_DEPENDENT	u_claims_tab_sfpi_dependent	SFPI Dependent Care	claims_reimb_info
SFPI_WDI	u_claims_tab_sfpi_wdi	SFPI Weekly Income Benefits	claims_wdi_info, claim_wdi_lines
SFPI_INELIGIBLE	u_claims_tab_sfpi_ineligible	SFPI Ineligible Benefit
DRUG	u_claims_tab_drug	Prescription Drug	line-level refill_ind (New/Refill)
SSO	u_claims_tab_sso	Second Surgical Opinion	claims_sso_info + diagnosis/procedure sections

Common header/entry fields (clmentry/d_claim_entries_common and per-form variants)

Grouped summary — the DataWindows carry 80–100 columns each; do not enumerate in migration UI specs, map from the claim_entries table:

• Receipt: received-from (Provider / HCN / Subscriber), received method, received/entered dates.
• Subscriber: name, address, phone, gender, birth date, SSN/member id, employer (group) name & address.
• Patient: name, gender, birth date, relationship (Self/Spouse/Child/Other), marital status (Single/Married/Other), student status (Full/Part/None), employment status.
• Claim classification: claim type (Medicare / Medicaid / Champus / Champva / Group plan / FECA / Other — HCFA box 1), accident indicators (auto / employment / other), COB indicator, operative-notes and attachment indicators, QMCSO flag.
• Provider: billing/attending/facility provider name, address, TIN + TIN type (SSN/EIN), degree, signature/assignment indicators (accept_assignment_ind, outside_lab_ind on HCFA).
• Payee: initial_payee — Subscriber or Provider (clmentry/d_claims_infoa).
• Repricing forms only: HCN (network), Member Not on File and Provider Out of Network checkboxes (drive conversion message 104 / whole-claim-pricing eligibility).

Claim lines

Line grids (clmentry/d_claim_lines_*, master clmshare/d_claim_lines_master) capture per service line: from/thru dates, place of service, procedure code + type + modifiers, revenue code (UB), diagnosis reference, units, claimed amount; and display system results: allowed amount, considered, allowed-after-copay/deductible/coinsurance, benefit amount, payable amount, line status (REJECT/HOLD), duplicate indicator, reject reason, assigned benefit definition and package. Line sequence numbers are auto-incremented (n_cst_claims.of_incrementsequence); deleting a line forces reprocessing (CLM-18).

Adjudication tab — clmentry/u_adjudication

• Top grid: the claim's lines (select a line to filter the panels).
• Benefit Rules Currently Applied to Claim Line (clmshare/d_claim_line_rules_master): rule code, type, reason, retained amount/qty, editable exclude flag; users may manually add a rule from the pricing-rules grid (duplicate rule keys prevented; new rows get keys from ALL_PURPOSE_SEQ).
• Pricing Rules Applied to Claim Line (clmshare/d_claim_line_pricing_rules_master).
• Line adjudication amounts (d_claim_lines_adjudication) with buttons Select (opens claims/w_select_benefit_definition to pick a benefit definition) and Clear (clears the definition, recording the change).
• Rule totals summary (d_claim_line_rules_totals, excludes rows flagged exclude_ind='Y').

Payment tab — clmentry/u_payment

• Fund-register activity for the claim (clmentry/d_claim_history): applied/paid dates, amounts, paid/void/backout/hold/waiver/check-cleared indicators; default filter shows applied activity only, with a Show All Activity checkbox.
• For Aetna electronic claims (id prefix EAET) shows "Sent to Aetna: date" from ext_output_transactions.

Message-resolution and utility popups

Window	Purpose / behavior
claims/w_setclaimsstatus	Confirmation for Void/Return/Delete/Reactivate/Hold; writes the matching info message; Return currently redirected to Delete (CLM-11)
claims/w_setstatusfromaudit	Close audit hold (msg 151/171): blocks if other messages open; choose Return to Corrections (RFCP) or Proceed to Funding (RFF, REXOUT if electronically paid); comment required
claims/w_setstatusfrompreadj	Close pre-adjudication hold (msg 167): choose RFCP or advance to Dupe Check (RFDC)
claims/w_claim_message_duplicate	Disposition duplicate message 102: mark Not A Duplicate or keep/adjust the duplicate-claim list
claims/w_claim_message_multiple_benefit	Resolve msg 40 — pick the coverage (type_of_claim) when multiple benefits could apply
claims/w_claim_message_select_package	Resolve msg 109 — pick the benefit package for a claim line
claims/w_claim_message_claim_line_hold	Resolve msg 124 (benefit-rule HOLD): Accept or Deny the held amount with reason
claims/w_claim_message_cm_hold	Resolve internal-CM messages 225/226/227: Accept / Deny (reason) / Not-a-service
claims/w_claims_message_wizard (2 steps, u_wizard_user_message1/2)	Add and route a user-defined claim message
claims/w_claims_message_edit	Edit a claim message
claims/w_claims_select_reason_code	Pick a reject/denial reason code
claims/w_comment_prompt	Free-text comment prompt used by status flows
clmentry/w_anesthesia_popup	Anesthesia units: start/end time, elapsed/total time, base + time + modifier units, unit conversion → total units (claims_anesthesia)
claims/w_select_benefit_definition	Search/select a benefit definition for a claim line (manual assignment, msg 128)
claims/w_claim_lines_benefit_definition	Read-only view of the definition applied to each line (includes duplicate flag)
claims/w_claim_line_pricing_rules	Record manually entered pricing data for a line
claims/w_claim_lines_remove_modifiers	Change/remove procedure modifiers on claim lines
claims/w_before_claim_lines	Side-by-side current lines vs lines before code review (claim_lines_before)
claims/w_convert_to_reprice_form / w_select_reprice_form	Convert a standard claim to a repricing form / choose UB92 reprice in-vs-out form
claims/w_claims_hcn_list	Choose the HCN (network) for a repricing claim
claims/w_add_claim_to_internal_cm	Attach the claim to an internal case-management case (um_case_mgt_claims)
claims/w_claims_unlock	Supervisor: clear a stuck claim lock
claims/w_claim_search_by_claim_id	Open a claim directly by claim id
clmshare/w_cm_select	Case-management case picker (shared)