SAIF.Business.UnitStat.Claim operations and processes

This page is the operation catalog and cross-operation hub for SAIF.Business.UnitStat.Claim. The library exposes seven operations covering Part A/B coverage-combination linkage, NCCI-derived current-loss retrieval, loss-summary header CRUD with derived financial totals, cost-category and offset breakdown maintenance, the central loss-valuation orchestration that layers correction offsets over live claim data, a set of thin Oracle-package date/flag helpers, and the claim-financial API adapter that most of the above depend on. 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
Coverage combination management	Create, retrieve, and delete Part A/B claim coverage-combination rows and expose part-A/part-B membership lookups	clsCoverageCombination.NewCoverageCombination / GetCoverageCombination / clsCoverageCombinationCollection.GetCoverageCombinationCollection, followed by Save() or Delete()	PartAClaimID, PartBClaimID, ClaimID	Persisted or retrieved US_COVERAGE_COMBINATION row(s); boolean part-A/part-B membership results	BR-004	US_COVERAGE_COMBINATION, DUAL	SQL-001, SQL-002, SQL-003, SQL-017, SQL-018, SQL-022, SQL-023
Current loss and NCCI record retrieval	Retrieve NCCI-mapped current-loss data valued for Unit Stat reporting, including a live current-claim enrichment call	clsCurrentLoss.NewCurrentLoss / GetCurrentLoss / clsCurrentLossCollection.GetCurrentLosses / GetTemporaryCurrentLosses, and the explicit LoadCurrentClaimInfo(dpi) call	ClaimID, PolicyUnitSeqNum, ReportValuationNumber	Populated clsCurrentLoss / clsCurrentLossCollection rows with derived NCCI claim-type, loss-act, loss-type, settlement, and fraud codes	BR-001, BR-002, BR-003	us_policy_unit, us_claim_unit, cl_injury_claim, cl_injury_source_code, cl_injury_nature_code, cl_body_part_code, us_unit_report, us_report_batch, us_reported_loss, us_catastrophic_claim, us_catastrophe	SQL-007
Loss summary maintenance	Create, retrieve, update, and delete Unit Stat loss-summary header rows, deriving and persisting incurred/paid medical and indemnity totals	clsLossSummary.NewLossSummary / GetLossSummary (by sequence or natural key) / clsLossSummaryCollection.GetLossSummaries, followed by property edits and Save()	ClaimID, PolicyUnitSeqNum, ReportValuationNumber, ReportTypeCode, AdjustmentSeqNum	Persisted US_LOSS_SUMMARY row with derived totals; loaded LossCategories child collection	BR-006, BR-007	US_LOSS_SUMMARY, DUAL	SQL-006, SQL-011, SQL-021, SQL-026
Loss category and offset maintenance	Create, retrieve, update, and delete cost-category and offset breakdown rows under a loss summary, including offset-type metadata lookups	clsLossValuation.GetLossCategory / GetLossCategoryOffset or clsLossSummary.LossCategories lazy load, followed by Save()	LossSummarySeqNum, ClaimCostCategoryCode, LossCategorySeqNum, OffsetTypeCode, OffsetAmount	Persisted US_LOSS_CATEGORY / US_LOSS_CATEGORY_OFFSET rows; resolved offset-type metadata	None registered*	US_LOSS_CATEGORY, US_LOSS_CATEGORY_OFFSET	SQL-004, SQL-005, SQL-019, SQL-020, SQL-024, SQL-025
Loss valuation orchestration	Value a loss summary from live claim-system data by computing category cost basis and layering fraud, refund, third-party-prediction, ND-reimbursement, or voided-claim offsets	Higher-level report/valuation manager calls clsLossValuation.ValueLossSummary(dataPortalInfo, lossSummary, claimUnit)	clsLossSummary, clsClaimUnit, current claim data	Mutated loss summary and its LossCategories/offsets; boolean success	BR-008	—	SQL-012, SQL-014, SQL-015, SQL-016
Denial, fraud, and refund date helpers	Retrieve discrete denial, fraud-recovery, and refund derivation values from PK73304_LOSS_SUMMARY for non-compensable and reporting logic	Caller invokes clsDeniedFinal.GetDeniedFinalFlag / clsFinalDenial.GetFinalDenialDate / clsFraudRecovery.GetFraudRecoveryDate / clsRefund.GetRefundDates directly	ClaimID (plus a valuation date for final denial)	Denied-final flag; final-denial date; fraud-recovery date; refund date ranges	BR-005	—	SQL-008, SQL-009, SQL-010, SQL-013
Claim financial aggregation	Adapt claim-financial API responses (payments, reserves, recoveries) into a shape consumed by unit-stat reporting logic	Any loss-summary or valuation class calls ClaimFinancialData.GetClaimFinancialsData	IDataPortalInfo, ClaimID	FinancialsData (payments, reserves, recoveries)	None registered*	—	—

Process flow diagram

The following diagram shows how the seven operations relate: coverage combinations link Part A/B claims, current-loss retrieval surfaces NCCI-mapped reporting data, and the loss-summary/category/offset operations converge on the central valuation orchestration, which pulls claim-financial data and layers correction offsets before the summary is saved.

flowchart TD
    Start([Report cycle or caller requests unit-stat data]) --> Combo[Coverage combination management]
    Start --> Current[Current loss and NCCI record retrieval]
    Start --> Summary[Loss summary maintenance]
    Summary --> Categories[Loss category and offset maintenance]
    Start --> Valuation[Loss valuation orchestration]
    Valuation --> Basis[Load category cost basis<br>from claim reserves]
    Valuation --> Helpers[Denial, fraud, and<br>refund date helpers]
    Valuation --> Financial[Claim financial aggregation]
    Basis --> Financial
    Helpers --> Financial
    Valuation --> Offsets{Claim status = Void?}
    Offsets -->|Yes| Voided[Apply single voided-claim<br>reversal offset]
    Offsets -->|No| Stack[Layer fraud, refund,<br>third-party, ND-reimbursement offsets]
    Voided --> Categories
    Stack --> Categories
    Categories --> SaveSummary[Save loss summary<br>and child categories/offsets]
    Combo --> Summary
    Current --> Summary
    SaveSummary --> Done([Valued loss summary persisted])

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
Coverage combination management	SQL-001, SQL-002, SQL-003, SQL-017, SQL-018, SQL-022, SQL-023	US_COVERAGE_COMBINATION, DUAL	Read / Write
Current loss and NCCI record retrieval	SQL-007	us_policy_unit, us_claim_unit, cl_injury_claim, us_unit_report, us_report_batch, us_reported_loss	Read
Loss summary maintenance	SQL-006, SQL-011, SQL-021, SQL-026	US_LOSS_SUMMARY, DUAL	Read / Write
Loss category and offset maintenance	SQL-004, SQL-005, SQL-019, SQL-020, SQL-024, SQL-025	US_LOSS_CATEGORY, US_LOSS_CATEGORY_OFFSET	Read / Write
Loss valuation orchestration	SQL-012, SQL-014, SQL-015, SQL-016	—	Read
Denial, fraud, and refund date helpers	SQL-008, SQL-009, SQL-010, SQL-013	—	Read

Inherited operations and processes

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

From clsBusinessBase / clsBusinessCollectionBase (SAIF.BOF.Framework)

Operation	Intent	Provided by	Origin	Embedded in
Business object edit and save lifecycle	Provide BOF create, retrieve, update, delete orchestration, dirty-tracking, and child-save cascade for business objects.*	clsBusinessBase, clsBusinessCollectionBase	SAIF.BOF.Framework	Coverage combination management, Current loss and NCCI record retrieval, Loss summary maintenance, Loss category and offset maintenance

Origin: This flow is defined in SAIF.BOF.Framework / clsBusinessBase and inherited by this library's business objects. SAIF.BOF.Framework is documented in the previous format, so no per-operation page exists.

From clsLossBase (SAIF.Business.UnitStat)

Operation	Intent	Provided by	Origin	Embedded in
Calculate derived reporting values	Compute reserve, reportability, and copy helpers shared by DCI and Unit Stat NCCI loss records.*	clsLossBase	SAIF.Business.UnitStat	Current loss and NCCI record retrieval

Origin: This logic is defined in SAIF.Business.UnitStat / clsLossBase and inherited by clsNCCILossRecord. That library is documented in the previous format, so no per-operation page exists; see Calculate derived reporting values in the SAIF.Business.UnitStat documentation set.

Failure and edge-case behavior

• A rows-affected value other than 1 on insert, update, or delete is treated as a contention or insert failure across every CRUD operation in this library, and is added as an error message rather than raised as an exception.
• ClaimFinancialData.GetClaimFinancialsData silently swallows any API exception and returns an empty FinancialsData, so downstream offset calculations see zero payments/reserves/recoveries rather than a propagated error.*
• Several offset-builder classes (clsFraudRecovery) contain an always-true early-return guard on clmData.PolicyNumber, which makes their full/partial fraudulent-offset logic effectively unreachable as written.*
• AddBusinessRules() is empty across all business objects in this library; no framework-level property validation rules are registered anywhere in this library.*

Related documentation

• Index
• Overview
• Architecture
• Dependencies
• Business rules
• Database tables
• SQL catalog
• Procedures
• API reference

Note: Statements marked with * were inferred from code structure, naming conventions, or contextual evidence where direct confirmation was not available in source artifacts. Statements marked with ** could not be confirmed; treat as unknown until verified.

Sources

• Business\SAIF.Business.UnitStat.Claim\Coverage Combination\clsCoverageCombination.vb
• Business\SAIF.Business.UnitStat.Claim\Coverage Combination\clsCoverageCombinationCollection.vb
• Business\SAIF.Business.UnitStat.Claim\Current Loss\clsCurrentLoss.vb
• Business\SAIF.Business.UnitStat.Claim\Current Loss\clsCurrentLossCollection.vb
• Business\SAIF.Business.UnitStat.Claim\Current Loss\clsNCCILossRecord.vb
• Business\SAIF.Business.UnitStat.Claim\Loss Summary\clsLossSummary.vb
• Business\SAIF.Business.UnitStat.Claim\Loss Summary\clsLossSummaryCollection.vb
• Business\SAIF.Business.UnitStat.Claim\Loss Summary\clsLossCategory.vb
• Business\SAIF.Business.UnitStat.Claim\Loss Summary\clsLossCategoryCollection.vb
• Business\SAIF.Business.UnitStat.Claim\Loss Summary\clsLossCategoryOffset.vb
• Business\SAIF.Business.UnitStat.Claim\Loss Summary\clsLossCategoryOffsetCollection.vb
• Business\SAIF.Business.UnitStat.Claim\Loss Summary\clsOffsetTypeCode.vb
• Business\SAIF.Business.UnitStat.Claim\Loss Summary\clsOffsetTypeCodeCollection.vb
• Business\SAIF.Business.UnitStat.Claim\Loss Summary\clsLossValuation.vb
• Business\SAIF.Business.UnitStat.Claim\Loss Summary\clsDeniedFinal.vb
• Business\SAIF.Business.UnitStat.Claim\Loss Summary\clsFinalDenial.vb
• Business\SAIF.Business.UnitStat.Claim\Loss Summary\clsFraudRecovery.vb
• Business\SAIF.Business.UnitStat.Claim\Loss Summary\clsRefund.vb
• Business\SAIF.Business.UnitStat.Claim\Loss Summary\clsThirdPartyPrediction.vb
• Business\SAIF.Business.UnitStat.Claim\Loss Summary\clsNDReimbursement.vb
• Business\SAIF.Business.UnitStat.Claim\Loss Summary\clsVoidedClaimOffsets.vb
• Business\SAIF.Business.UnitStat.Claim\ClaimFinancialData.vb
• Business\SAIF.Business.UnitStat.Claim\ClaimFinancials.vb

Stored procedure operations

Operations implemented in Oracle stored procedures referenced by this library.

Operation	Description	Source	Link
Loss-summary package derivations	Package-backed retrieval, save, or derivation logic used by loss valuation and the denial/fraud/refund helpers.	PK73304_LOSS_SUMMARY	Details