Access Claims Data in the Policy Module

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A Data Source configuration is available to import claims data from the claims module into the policy module, making this information available to users managing the policy life cycle. This is of particular use to Underwriter users, who may wish to view this information as a rating factor.

This is achieved using a Data Source configured with the Claims Lookup Web Service. The LookupDataSourceToGrid() function is then used in a Calculated Field to inject the results of the Claims Lookup service into an output grid configured within the submission workflow.

This section provides instructions to complete this configuration.

Example:  

At the conclusion of this tutorial, the following output grid will be displayed in the policy submission workflow.

This is a Claims Lookup output grid configured to display four columns of claim records. For each record returned by the Claims Lookup, a row will be added to the grid containing the returned values for each claim. The number of results returned is limited to 1000.

Clicking a link in the first column opens grid row detail window.

Data Source Configuration

  1. Review the core claim fields that are available to be returned by the Claims Lookup Web Service to identify which fields will be included in the final output grid. A list of these fields is provided in the Claims Lookup section of the Managing Data Sources section.

    Notes:  

    In addition to core fields from the claims module, top-level fields can be made available to the Claim Lookup Web Service.

    If importing claim payment records (Expense, Indemnity, Salvage, Recovery), top-level Calculated Fields must be created in the claims module to aggregate the sum of all payments per claim.

    All custom fields must be indexed in order to be available to the policy module. For additional information, see the Field Indexing section.

    Example:  

    Sum([[ClaimPayment.Amount]] Where [[ClaimPayment.TypeCode]] = 'TypeCode' and [[ClaimPayment.CoverageCode]] = 'CoverageCode' and [[ClaimPayment.CategoryCode]] = 'CategoryCode' and [[ClaimPayment.StatusCode]] = 'Approved')

    Where the value for TypeCode is either Expense, Indemnity, Salvage, or Recovery, the value of CoverageCode is the Coverage code of the Premium Type, and the value of CategoryCode is the claim payment type Category code.

  2. In the policy submission workflow, create a corresponding field for each result of the Claims Lookup service that will be exposed in the final output grid.

    3. For the purpose of this tutorial, four grid column fields have been created to capture the following claims data.

    • Claim Number
    • Claim Status
    • Claim Date of Loss
    • Claim Loss Amount

    These Columns are available by default through the Claims Lookup service.

  3. Configure a grid within the submission workflow that contains a column for each of the fields configured in step 2. For information on creating a grid, see the Managing Grids section.

    For the purpose of this tutorial, this grid is called Claims Lookup Service Output Grid with the corresponding ClaimsLookupServiceOutputGrid system code. This grid has four columns with the labels Claim Number, Claim Status, Reported Claim Amount, and Date of Loss.

    Note: By default, each panel is open, visible, and editable at all stages and statuses of the transaction. To prevent user input, it is recommended to use a Panel Behavior Override to display the output grid as Read-Only.

  4. Navigate to the Workflow Container Menu widget, open the Lookups group and select Data Sources. The Data Source Configurations page opens with a list of all available data sources within the current container and any shared containers.

  5. Click Add to add a new data source. The Data Source Configuration Management page opens. Enter the information requested in the General Information panel.

    For the purpose of this tutorial, the data source is named Claims Lookup Service Data Source with the corresponding ClaimsLookupServiceDataSource system code.

  6. Proceed to the Attributes panel.

    1. In the Data Source Type drop-down field, select Web Service.
    2. In the Data Source drop-down field, select Claims Lookup.
    3. Check the Output Results to a Grid checkbox field.

    4. Click Save.

      Note: When Output Results to a Grid is checked, the options to assign the Primary Display Column, Key Column Rule, and Display Columns are not available.

  7. Skipping the Filters panel for the moment, navigate to the Output To Fields panel.

    • In the Grid drop-down field, select the grid configured in step 2.

      For the purpose of this tutorial, the Claims Lookup Service Output Grid is selected.

      Note: The option to Select New Grid is available to select a new output grid. Note that any existing output field configurations will be deleted as part of this action.

    • Continuing in the Output To Fields panel, click Add.The Add Output to Field window opens.

      • The Column drop-down field contains a list of all fields available to be returned through the Claims Lookup service.
      • The Output Field drop-down field contains a list of all column fields configured within the Claims Lookup Service grid.
    • For each Column returned by the Claims Lookup service that will be displayed in the output grid, select a corresponding Output Field. This step maps the results of the Claims Lookup to the appropriate grid columns.

    • Once all Column and Output Field associations have been made, click Save & Close.

      • Note: Click Select New Grid to select a new output grid. Note that existing output field configurations will be deleted as part of this action.

  8. Continuing with the values specific to this tutorial, the Output To Fields panel now contains the following configuration.

  9. Once the Claims Lookup service results have been mapped to the appropriate Output Fields, filters can be optionally added to the Claims Lookup Service grid.

    Navigate to the Filters panel and click Add. The Add Filter window opens.

    There are four filters available for the Claims Lookup service, each requiring a specific configuration.

    Filter Column Filter By Field
    Client Code Client Code Field InsuredCode
    Policy Number Policy Number Field [Policy] Policy Number
    Policy Term Policy Term Resource Id Field Policy Term Resource ID
    Policy Transaction Policy Transaction Resource Id Field Policy Transaction Resource ID

    Continuing with the tutorial, and assuming that all four filters are being used, the Filters panel now looks like this.

    Note: The filter fields are core system fields, and do not require indexing through a Cross-Policy Data Configuration. For additional information, see the Cross-Policy Data Configurations section.

    This concludes the Data Source configuration.

Workflow Configuration

To continue the configuration, a Calculated Field and Field Evaluation Rules must be added to the submission workflow to inject the results of the Claims Lookup into the final output grid.

  1. Configure a Calculated Field containing the LookupDataSourceToGrid() function. It is recommended that the field be set to Read-Only. For information on creating a field, see the Managing Fields section.

    The LookupDataSourceToGrid() function takes the code of the data source configuration and performs a lookup using the filters selected in the Filters panel of the Data Source Configuration Management page. It returns the count for the number of results that meet the criteria and populates the grid fields specified in the Output To Fields panel. The number of results returned is limited to 1000.

    Tip: The LookupDataSourceToGrid() function inserts new rows to the designated output grid each time it is evaluated. To avoid creating duplicate records in the grid, the ClearGrid() function can be used.

    Example:  

    Using the system codes generated within this tutorial, the calculated field formula looks like this.

    ClearGrid(ClaimsLookupServiceOutputGrid)

    LookupDataSourceToGrid(ClaimsLookupServiceDataSource)

  2. A Field Evaluation Rule is required to evaluate the Calculated Field at specific points within the submission workflow. This prevents unnecessary calculations that may impact system performance.

    For the purposes of this tutorial, we will evaluate the Calculated Field upon the Save event.

    • In the Workflow Container Menu widget, open the Rules group and select Field Evaluation Rules. The Field Evaluation Rules page opens with a list of all available rules within the current container and any shared containers.
    • Click Add. The Field Evaluation Rule Management page opens. Enter the information requested in the General Information panel.

    • Navigate to the Fields panel, and select the Calculated Field created in step 1 from the drop-down list.

    • Navigate to the Availability / Trigger Conditions panel and apply the appropriate settings according to your business requirements.

      A Trigger can be selected to control whether the rule will be applied or not when all other conditions are met. This can further help prevent unnecessary calculations that may impact system performance. The field will not be evaluated if the trigger evaluates to False.

      For the purposes of this tutorial, the following settings are applied.

      Field Values
      Type Policy
      Events Save
      Policy Transaction Types All
      Policy Transaction Statuses All
      Security Roles All
      Screens All
      Trigger None
    • Publish the Workflow.

Automatic Field Evaluation Rule (Optional)

An Automatic Field Evaluation rule can be configured to evaluate the Calculated Field on a daily basis, ensuring that the Claims Lookup output grid in the submission workflow is regularly updated.

  • With the master cover selected, click the Automatic Processing item in the Screens widget. Navigate to the Automatic Field Evaluations panel. For instructions on finding and viewing a master cover, see the Viewing and Modifying a Master Cover section.

  • In the Field Evaluation Rule field, select the Field Evaluation Rule configured in step 2 of the Workflow Configuration section described above.

  • In the Trigger field, select a Trigger to define the conditions under which the field will be evaluated.

    Notes:  

    Though not enforced through the UI, a Trigger must be selected to ensure that the Field Evaluation Rule is evaluated daily.

    Since the trigger is evaluated outside of the context of the policy, all fields referenced in the trigger must be indexed in a Cross-Policy Data Configuration. For additional information, see the Cross-Policy Data Configurations section.