Claim Submission Data Flow
Explains how claim submission is processed and how claim records are created in the database.
Overview
When a claim is submitted, the system creates several records in the database to capture a snapshot of the claim at the time of submission.
These records ensure that claim data remains consistent even if billing data changes later.
Step 1 — Create InsuranceClaim
The first step in claim submission is creating a record in the InsuranceClaim table.
This table stores claim-level information including:
- Bill reference
- Patient details
- Insurance information
- Total claim amount
- Claim status
Step 2 — Store Provider Information
Provider information is stored in the ClaimProviderInfo table.
This table contains the insurance provider details applicable at the time of claim submission.
Step 3 — Store Test-Level Details
Each test included in the claim is stored in the ClaimTestRelation table.
This table captures:
- Test amount
- Copay
- Deductible
- Insurance coverage amount
Step 4 — Create BillClaimRelation
The BillClaimRelation table stores the relationship between bills and claims.
This allows a single bill to have multiple claims when partial submissions occur.