Definition Type: SimpleType
Name: ClaimStatus
Namespace: http://www.eclaimlink.ae/DHD/ValidationSchema
Containing Schema: CommonTypes_20191113.xsd
Documentation:
-	ClaimStatus describes the processing status of the Claim, from the time the provider submits the Claim to the time until the provider considers it settled.
-	ClaimStatus is empty, until the Provider has submitted a Claim
-	The Provider considers ClaimStatus to be:
-   In Process with the Payer from the time the Claim has been submitted until the Payer either asks for clarification (ClaimStatus is then Pending), settles the Claim and the settlement is received by the Provider (ClaimStatus is then PayerSettled), or the Payer chooses to actively withhold payment and has communicated this to the provider (ClaimStatus is then Withheld).
-   Pending with the provider from the time the provider has received a request for clarification from the Payer until the Provider has replied to the Payer. (ClaimStatus is then In Process)
-   Withheld from the time the Payer has communicated that payment is Withheld, until the Payer settles the Claim (ClaimStatus is then PayerSettled)
-   PayerSettled from the time the provider receives notice of settlement, either through receipt of a settlement amount or notification that the settlement amount is 0.
-   ProviderSettled as and when the Provider considers the Claim to be settled.
-	The Payer considers ClaimStatus to be
-   In Process with the Payer from the time the Claim has received until the Payer either asks for clarification (ClaimStatus is then Pending), settles the Claim and the settlement is received by the Provider (ClaimStatus is then PayerSettled), or the Payer may choose to actively withhold payment and has communicated this to the provider (ClaimStatus is then Withheld).
-   Pending with the provider from the time the Payer has made a request for clarification from the Provider until the Provider has replied to the Payer. (ClaimStatus is then In Process)
-   Withheld if the Payer has fully processed the Claim to the point that it is ready to be settled, but that the Payer chooses (for a reason unrelated to the specific Claim in question) to withhold payment and has communicated this to the provider. ClaimStatus remains Withheld until the Payer settles the Claim (ClaimStatus is then PayerSettled)
-   PayerSettled from the time the Payer has settled the Claim.
-   ProviderSettled as and when the Payer has received notification that the Provider considers the Claim to be settled
-	Example:
-   A provider submits a Claim C1 to an insurer in a batch.
-   The insurer processes the Claim and is ready to settle it.
-   Some other Claims in the batch are still pending with the provider, however.
-   The insurer decides to wait for payment of the entire batch, until all Claims have been processed.
-   The Claim C1 would have ClaimStatus Withheld.
-	If for any reason the Payer or the Provider is unable to differentiate between
-   In Process and Pending, ClaimStatus should be (InProcess or Pending)
-   In Process and Withheld, ClaimStatus should be (InProcess or Withheld)
-   Pending and Withheld, ClaimStatus should be (Pending or Withheld)
-   In Process, Pending and Withheld, ClaimStatus should be (Pending, In Process or Withheld)
-	Restrictions: If ClaimDateSubmitted is empty, ClaimStatus needs to be empty; only values allowed are
-   1 = In Process with Payer
-   2 = Pending at Provider
-   3 = Withheld by Payer
-   4 = PayerSettled
-   5 = ProviderSettled
-   6 = In Process or Pending
-   7 = In Process or Withheld
-   8 = Pending or Withheld
-   9 = Pending, In Process or Withheld.
Collapse XSD Schema Diagram:
XSD Diagram of ClaimStatus
Collapse XSD Schema Code:
<xs:simpleType name="ClaimStatus">
    <xs:annotation>
        <xs:documentation>
        -	ClaimStatus describes the processing status of the Claim, from the time the provider submits the Claim to the time until the provider considers it settled.
        -	ClaimStatus is empty, until the Provider has submitted a Claim
        -	The Provider considers ClaimStatus to be:
        -   In Process with the Payer from the time the Claim has been submitted until the Payer either asks for clarification (ClaimStatus is then Pending), settles the Claim and the settlement is received by the Provider (ClaimStatus is then PayerSettled), or the Payer chooses to actively withhold payment and has communicated this to the provider (ClaimStatus is then Withheld).
        -   Pending with the provider from the time the provider has received a request for clarification from the Payer until the Provider has replied to the Payer. (ClaimStatus is then In Process)
        -   Withheld from the time the Payer has communicated that payment is Withheld, until the Payer settles the Claim (ClaimStatus is then PayerSettled)
        -   PayerSettled from the time the provider receives notice of settlement, either through receipt of a settlement amount or notification that the settlement amount is 0.
        -   ProviderSettled as and when the Provider considers the Claim to be settled.
        -	The Payer considers ClaimStatus to be
        -   In Process with the Payer from the time the Claim has received until the Payer either asks for clarification (ClaimStatus is then Pending), settles the Claim and the settlement is received by the Provider (ClaimStatus is then PayerSettled), or the Payer may choose to actively withhold payment and has communicated this to the provider (ClaimStatus is then Withheld).
        -   Pending with the provider from the time the Payer has made a request for clarification from the Provider until the Provider has replied to the Payer. (ClaimStatus is then In Process)
        -   Withheld if the Payer has fully processed the Claim to the point that it is ready to be settled, but that the Payer chooses (for a reason unrelated to the specific Claim in question) to withhold payment and has communicated this to the provider. ClaimStatus remains Withheld until the Payer settles the Claim (ClaimStatus is then PayerSettled)
        -   PayerSettled from the time the Payer has settled the Claim.
        -   ProviderSettled as and when the Payer has received notification that the Provider considers the Claim to be settled
        -	Example:
        -   A provider submits a Claim C1 to an insurer in a batch.
        -   The insurer processes the Claim and is ready to settle it.
        -   Some other Claims in the batch are still pending with the provider, however.
        -   The insurer decides to wait for payment of the entire batch, until all Claims have been processed.
        -   The Claim C1 would have ClaimStatus Withheld.
        -	If for any reason the Payer or the Provider is unable to differentiate between
        -   In Process and Pending, ClaimStatus should be (InProcess or Pending)
        -   In Process and Withheld, ClaimStatus should be (InProcess or Withheld)
        -   Pending and Withheld, ClaimStatus should be (Pending or Withheld)
        -   In Process, Pending and Withheld, ClaimStatus should be (Pending, In Process or Withheld)
        -	Restrictions: If ClaimDateSubmitted is empty, ClaimStatus needs to be empty; only values allowed are
        -   1 = In Process with Payer
        -   2 = Pending at Provider
        -   3 = Withheld by Payer
        -   4 = PayerSettled
        -   5 = ProviderSettled
        -   6 = In Process or Pending
        -   7 = In Process or Withheld
        -   8 = Pending or Withheld
        -   9 = Pending, In Process or Withheld.
      </xs:documentation>
    </xs:annotation>
    <xs:restriction base="xs:integer">
        <xs:enumeration value="1" />
        <xs:enumeration value="2" />
        <xs:enumeration value="3" />
        <xs:enumeration value="4" />
        <xs:enumeration value="5" />
        <xs:enumeration value="6" />
        <xs:enumeration value="7" />
        <xs:enumeration value="8" />
        <xs:enumeration value="9" />
    </xs:restriction>
</xs:simpleType>
Collapse Facets:
Facet Value
Enumeration 1
Enumeration 2
Enumeration 3
Enumeration 4
Enumeration 5
Enumeration 6
Enumeration 7
Enumeration 8
Enumeration 9