SAIF.Business.Claim.Entry operations and processes¶

This page is the operation catalog and cross-operation hub for SAIF.Business.Claim.Entry. The library exposes sixteen operations covering the core claim-entry lifecycle (create, insert, update, delete, number, and duplicate-claim detection), state-specific entry extensions (county-code resolution, multiple-employer letters, work release), pharmacy eligibility CRUD and reporting, and the Online 801 electronic-submission surface (documents, submissions, submission detail, worker lookup, claim submission, and claim search), which is backed by the PK82538_ONLINE_801_CLAIM Oracle package and two ClaimCenter/CCClaimDataApi REST integrations. Each operation's detailed, step-by-step logic lives in its own page under operations/.

Operation catalog¶

Operation	Intent	Trigger	Inputs	Outputs	Rules	Tables	SQL
Create new claim	Generate a new `CLAIM_ID` from an Oracle sequence and initialize claim defaults	`clsClaimEntry.BeforeCreate` / `AfterCreate` via the data-portal create pipeline	Acting worker ID, jurisdiction code	New in-memory claim object seeded with default status/coverage/flags	None documented*	None	SQL-001
Insert claim	Persist a new claim header to `CL_INJURY_CLAIM` and, for New-status claims, cascade auxiliary status rows	`clsClaimEntry.BeforeInsert` / `AfterInsert` during `Save()` of a new claim	Populated claim fields, injury address, `IsNewStatus`	Inserted `CL_INJURY_CLAIM` row; conditional request-decision, status-activity, type-activity, MCO-eligibility, and policy-history rows	BR-CE-004, BR-CE-011, BR-CE-013	CL_INJURY_CLAIM, CL_CLAIM_REQUEST_DECISION, CL_CLAIM_STATUS_ACTIVITY, CL_CLAIM_TYPE_ACTIVITY, CL_CLAIM_MCO_ELIGIBILITY, CL_CLAIM_POLICY_HISTORY	SQL-010, SQL-005, SQL-006, SQL-007, SQL-008, SQL-009
Update claim	Update all mutable fields on `CL_INJURY_CLAIM` with optimistic concurrency, re-running the New-status cascade	`clsClaimEntry.BeforeUpdate` / `AfterUpdate` during `Save()` of an existing claim	Modified claim fields, `ClaimID`, `UpdateNum`	Updated `CL_INJURY_CLAIM` row; same conditional auxiliary rows as insert	BR-CE-004, BR-CE-011, BR-CE-013	CL_INJURY_CLAIM, CL_CLAIM_REQUEST_DECISION, CL_CLAIM_STATUS_ACTIVITY, CL_CLAIM_TYPE_ACTIVITY, CL_CLAIM_MCO_ELIGIBILITY, CL_CLAIM_POLICY_HISTORY	SQL-022, SQL-005, SQL-006, SQL-007, SQL-008, SQL-009
Delete claim	Remove all tasks for the claim, then delete the `CL_INJURY_CLAIM` row	`clsClaimEntry.BeforeDelete` / `AfterDelete` during `Save()` of a deleted claim	`ClaimID`	Deleted `TASK` rows and `CL_INJURY_CLAIM` row, or a DB contention error	BR-CE-011	CL_INJURY_CLAIM	SQL-027
Number claim / manual claim validation	Assign the next system claim number or validate a manually entered claim number	Caller calls `NumberClaim` or `ValidManualClaim` before save	Current `SaifClaimNum`, or a manually entered claim number	Assigned/validated `SaifClaimNum` and recalculated check digit	BR-CE-003, BR-CE-014	None	SQL-002
Check multiple claims for worker	Detect an existing claim for the same worker within a 14-day injury-date window	Caller calls `CheckForMultipleClaimsForWorker`	`WorkerID`, `ClaimID`, `InjuryDate`	Matching SAIF claim number, or an empty string	BR-CE-012	CL_INJURY_CLAIM	SQL-016
State insert extensions	Resolve the county code from the injury address and, for New-status claims, queue a multiple-employer letter request	`clsStateClaimEntry.BeforeInsert` / `BeforeUpdate`	Injury address state/zip, `MultipleEmprFlag`, `SaifClaimNum`	Resolved `County` on the injury address; conditional `CL_MULT_EMPLOYER_LETTER_REQ` row	BR-CE-007, BR-CE-008, BR-CE-009	ZIP_MCO_COUNTY, CL_MULT_EMPLOYER_LETTER_REQ	SQL-019, SQL-015
Work release management	Create, update, or delete the claim's work-release-status child record to match the caller-supplied code/date	`clsStateClaimEntry.IsValid`, via `UpdateWorkReleaseStatus`	`WorkReleaseCode`, `WorkReleaseDate`, claim deletion state	Created/updated/deleted work-release-status child object	BR-CE-005, BR-CE-015	None in this library*	None in this library*
Pharmacy eligibility CRUD	Insert or update a pharmacy eligibility report record for a claim	`clsPharmacyEligibilityReport.BeforeInsert` / `BeforeUpdate` during `Save()`	`ClaimID`, eligibility status/effective date, transmit dates	Inserted/updated `CL_PHARMACY_ELIGIBILITY_REPORT` row	BR-CE-010, BR-CE-011	CL_PHARMACY_ELIGIBILITY_REPORT	SQL-014, SQL-026
Pharmacy report retrieval	Extract full, delta, and first-fill pharmacy eligibility report sets for downstream transmission	Caller calls `GetEligibilityReports`, `GetEligibilityFFReports`, or `GetFirstFillEligibilityReports`	Full/delta extraction flag	Sorted eligibility-report collections for transmission	BR-CE-016, BR-CE-017, BR-CE-018, BR-CE-019	CL_PHARMACY_ELIGIBILITY_REPORT	Not catalogued in the SQL index — inline queries documented on the operation page*
801 document management	Create, update, and retrieve Online 801 document metadata rows	`cls801Document` CRUD lifecycle and `cls801DocumentCollection` retrieval	`ClaimID`, `ImageSeqNum`, `FileName`, `DocTypeCode`	Persisted `CL_801_DOCUMENT` row, or a retrieved/sorted document collection	BR-CE-011, BR-PROC-003	CL_801_DOCUMENT	SQL-003, SQL-011, SQL-023
801 submission CRUD	Create, update, delete, and retrieve Online 801 submission header rows, including worker-lookup-driven duplicate prevention	`cls801Submission` CRUD lifecycle and retrieval helpers	`PolicyNumber`, `ClaimID`/`SubmissionID`, submission header fields	Persisted `CL_801_SUBMISSION` row; populated or claim-synthesized submission object	BR-CE-011, BR-CE-020, BR-CE-021, BR-PROC-001, BR-PROC-002	CL_801_SUBMISSION	SQL-004, SQL-012, SQL-024, SQL-028
801 submission data CRUD	Create, update, delete, and retrieve Online 801 submission detail rows, including claim/worker prefill	`cls801SubmissionData` CRUD lifecycle and `LoadFromClaim` / `LoadClaimWorker` prefill	Submission ID, claim data, worker DTO/ID, Box-field detail	Persisted `CL_801_SUBMISSION_DATA` row and six contact objects	BR-CE-011, BR-PROC-002	CL_801_SUBMISSION_DATA	SQL-013, SQL-018, SQL-025, SQL-029
Worker lookup via API	Resolve a worker (and, when applicable, an in-progress claim) from CCClaimDataApi before an Online 801 submission	`cls801Submission.FindWorker`, delegating to `clsFindWorkerAPI`	Submission name fields, tax ID, birth date, injury date	Resolved `cls801FindWorkerDTO` worker(s); adopted `ClaimID` on a same-claim match	BR-CE-022	None (REST)	None
Claim submission via API	Submit a completed Online 801 submission to ClaimCenter and adopt the returned `ClaimID`	`cls801Submission.SubmitClaim`, delegating to `clsSubmitClaimByAPI`	Validated submission and submission-data, acting user	ClaimCenter `ClaimID`; updated submission status `Submitted`; `clsSubmissionResult`	BR-CE-023	None (REST)	None
Claim search via API	Search CCClaimDataApi for Online 801 claims matching policy/name/SSN/date criteria	`clsClaimSearchResultCollection.GetResults`, delegating to `clsClaimSearchApi`	`PolicyNum`, name, SSN, claim number, status flags, date ranges	Sorted `clsClaimSearchResult` collection with display-translated claim number/status	BR-CE-024	None (REST)	None

Process flow diagram¶

The following diagram shows how the sixteen operations relate: a claim is created, numbered, and persisted through its core lifecycle; state-specific extensions and pharmacy eligibility hang off the same claim; and the Online 801 surface runs its own parallel lifecycle for documents, submissions, and submission detail, converging on worker lookup and ClaimCenter submission.

flowchart TD
    Start([Caller requests claim entry]) --> Create[Create new claim]
    Create --> Number[Number claim /<br>manual claim validation]
    Number --> Dup{Check multiple claims<br>for worker?}
    Dup -->|Match found| Warn([Caller warned of<br>possible duplicate claim])
    Dup -->|No match| Insert[Insert claim]
    Insert --> StateExt[State insert extensions:<br>county code, multiple-employer letter]
    Insert --> WorkRel[Work release management]
    Insert --> Pharmacy[Pharmacy eligibility CRUD]
    Pharmacy --> PharmReports[Pharmacy report retrieval]
    Create --> Update[Update claim]
    Update --> StateExt
    Update --> WorkRel
    Update --> Pharmacy
    Insert --> Delete{Claim deleted?}
    Update --> Delete
    Delete -->|Yes| DeleteOp[Delete claim]
    Online801Start([Online 801 electronic submission]) --> Search[Claim search via API]
    Online801Start --> WorkerLookup[Worker lookup via API]
    WorkerLookup --> SubCrud[801 submission CRUD]
    SubCrud --> SubDataCrud[801 submission data CRUD]
    SubDataCrud --> DocMgmt[801 document management]
    SubDataCrud --> Submit{Ready to submit?}
    Submit -->|Yes| ClaimSubmit[Claim submission via API]
    ClaimSubmit --> Insert
    Submit -->|No| SubDataCrud

Inherited operations and processes¶

Operations in this section originate from base classes or business objects provided by dependency libraries. They are inherited or delegated, not implemented in this library.

From `clsClaimWorkReleaseStatus` and `clsClaimEmployeeWorkAddress` (`SAIF.Business.Claim`)¶

Operation	Intent	Provided by	Origin	Embedded in
Work status and work release tracking	Create, retrieve, update, and delete the sequence-numbered work-release-status child row	`clsClaimWorkReleaseStatus`	`SAIF.Business.Claim`	Work release management
Claim employee work address management	Maintain the address of the work site where the injury occurred	`clsClaimEmployeeWorkAddress`	`SAIF.Business.Claim`	State insert extensions

Origin: These operations are defined and fully documented in SAIF.Business.Claim, which has been migrated to the current documentation format. See Work status and work release tracking and Claim employee work address management in the SAIF.Business.Claim documentation set.

Database interactions¶

The following table summarizes which operations read from or write to the database. Per-step SQL and table citations live in each operation's detail page under operations/.

Operation	SQL	Tables	Type
Create new claim	SQL-001	DUAL (sequence)	Read
Insert claim	SQL-010, SQL-005, SQL-006, SQL-007, SQL-008, SQL-009	CL_INJURY_CLAIM, CL_CLAIM_REQUEST_DECISION, CL_CLAIM_STATUS_ACTIVITY, CL_CLAIM_TYPE_ACTIVITY, CL_CLAIM_MCO_ELIGIBILITY, CL_CLAIM_POLICY_HISTORY	Write
Update claim	SQL-022, SQL-005, SQL-006, SQL-007, SQL-008, SQL-009	CL_INJURY_CLAIM, CL_CLAIM_REQUEST_DECISION, CL_CLAIM_STATUS_ACTIVITY, CL_CLAIM_TYPE_ACTIVITY, CL_CLAIM_MCO_ELIGIBILITY, CL_CLAIM_POLICY_HISTORY	Read / Write
Delete claim	SQL-027	CL_INJURY_CLAIM	Delete
Number claim / manual claim validation	SQL-002	DUAL (sequence)	Read
Check multiple claims for worker	SQL-016	CL_INJURY_CLAIM	Read
State insert extensions	SQL-019, SQL-015	ZIP_MCO_COUNTY, CL_MULT_EMPLOYER_LETTER_REQ	Read / Write
Pharmacy eligibility CRUD	SQL-014, SQL-026	CL_PHARMACY_ELIGIBILITY_REPORT	Write
Pharmacy report retrieval	Not catalogued*	CL_PHARMACY_ELIGIBILITY_REPORT	Read
801 document management	SQL-003, SQL-011, SQL-023	CL_801_DOCUMENT	Read / Write (stored procedure)
801 submission CRUD	SQL-004, SQL-012, SQL-024, SQL-028	CL_801_SUBMISSION	Read / Write (stored procedure)
801 submission data CRUD	SQL-013, SQL-018, SQL-025, SQL-029	CL_801_SUBMISSION_DATA	Read / Write (stored procedure)
Worker lookup via API	None	None	Read (REST call only)
Claim submission via API	None	None	Write (REST call only)
Claim search via API	None	None	Read (REST call only)

Stored procedure operations¶

Operations implemented in Oracle stored procedures referenced by this library.

Operation	Description	Source	Link
Retrieve Online 801 submissions	Returns submission rows by submission ID, claim ID, policy number, or retention-date cleanup mode.	`PK82538_ONLINE_801_CLAIM.submission_select`	Details
Persist Online 801 submission headers	Inserts, updates, and deletes Online 801 submission header rows.	`PK82538_ONLINE_801_CLAIM.submission_insert`	Details
Persist Online 801 submission detail	Inserts, updates, retrieves, and deletes Online 801 submission detail rows.	`PK82538_ONLINE_801_CLAIM.submission_data_insert`	Details
Persist Online 801 documents	Retrieves and maintains Online 801 document metadata keyed by claim or image sequence number.	`PK82538_ONLINE_801_CLAIM.document_insert`	Details

Failure and edge-case behavior¶

Every persisting claim-entry, pharmacy, and Online 801 operation checks the affected row count and adds a DB contention error instead of throwing (BR-CE-011). Detailed per-operation behavior is documented on each operation page.
Deleting Online 801 documents is not operational: cls801Document prepares delete parameters, but its criteria class throws InvalidSQLProperty for DeleteSQL, so no document_delete procedure is wired.*
801 submission CRUD retrieval and cleanup paths (submission_select, submission_claim_select, submission_policy_select, submission_cleanup_select, Incomplete_Submission_select) call PK82538_ONLINE_801_CLAIM procedures that are not individually catalogued as SQL-* documents in this run; see the operation page for the traced call sites.*
The Claim submission via API flow unconditionally sets IsSubmitted = True on the result object after the local save attempt, regardless of whether the save actually succeeded, which can mask a failed local persist.*
Claim submission via API's response handling in clsSubmitClaimByAPI.AfterInsert dereferences response(0) in its own empty-response fallback branch, which throws if the API ever returns a zero-length response array.*
Claim search via API does not inspect the wrapper response's status code or handle a missing/empty Data payload before consuming it.*
Warning-versus-error severity for duplicate-claim detection is caller-dependent: CheckForMultipleClaimsForWorker itself only returns a claim number string; historical rule wrappers treated a match as a warning rather than a blocking error.*

Note: Statements marked with * were inferred from code structure, naming conventions, or contextual evidence where direct confirmation was not available in source artifacts.

Sources¶

Business\SAIF.Business.Claim.Entry\clsClaimEntry.vb
Business\SAIF.Business.Claim.Entry\clsClaimEntryBusinessRules.vb
Business\SAIF.Business.Claim.Entry\clsPharmacyEligibility.vb
Business\SAIF.Business.Claim.Entry\clsStateClaimEntry.vb
Business\SAIF.Business.Claim.Entry\enums.vb
Business\SAIF.Business.Claim.Entry\Online801\Submission\cls801Document.vb
Business\SAIF.Business.Claim.Entry\Online801\Submission\cls801Submission.vb
Business\SAIF.Business.Claim.Entry\Online801\Submission\cls801SubmissionData.vb
Business\SAIF.Business.Claim.Entry\Online801\Submission\clsFindWorkerAPI.vb
Business\SAIF.Business.Claim.Entry\Online801\Submission\clsSubmitClaimByAPI.vb
Business\SAIF.Business.Claim.Entry\Online801\Submission\clsGwNameSuffix.vb
Business\SAIF.Business.Claim.Entry\Online801\Submission\cls801FindWorkerDTO.vb
Business\SAIF.Business.Claim.Entry\Online801\Submission\cls801SearchCriteriaDTO.vb
Business\SAIF.Business.Claim.Entry\Online801\Submission\ApiNewClaimModels\clsNewClaimModel.vb
Business\SAIF.Business.Claim.Entry\Online801\Submission\ApiNewClaimModels\Claimant.vb
Business\SAIF.Business.Claim.Entry\Online801\Submission\ApiNewClaimModels\EmploymentData.vb
Business\SAIF.Business.Claim.Entry\Online801\Submission\ApiNewClaimModels\Policy.vb
Business\SAIF.Business.Claim.Entry\Online801\Submission\ApiNewClaimModels\PrimaryAddress.vb
Business\SAIF.Business.Claim.Entry\Online801\Search\clsClaimSearchCriteria.vb
Business\SAIF.Business.Claim.Entry\Online801\Search\clsClaimSearchResult.vb
Business\SAIF.Business.Claim.Entry\Online801\Search\CCClaimDataApi\clsClaimSearchApi.vb
Business\SAIF.Business.Claim.Entry\Online801\Search\CCClaimDataApi\CCClaimDataApiClaimSearchCriteria.vb
Business\SAIF.Business.Claim.Entry\Online801\CCClaimDataAPIResponseData.vb
Business\SAIF.Business.Claim.Entry\Online801\ClaimCenterAPIResponseData.vb
Business\SAIF.Business.Claim.Entry\Online801\clsRecordInfo.vb
Business\SAIF.Business.Claim.Entry\Online801\mdlCodeTables.vb