ClaimServices

Provides basic Claim Services. Provides claim-centric lookup, security, authorization, and payment helper methods used across SAIF business workflows.

Purpose

• Provides claim-centric lookup, security, authorization, and payment helper methods used across SAIF business workflows.

Context

• Namespace: SAIF.Business
• Assembly/package: SAIF.Business

Public members

Member	Signature	Purpose
BusinessProcess	Public Enum BusinessProcess	Identifies the Business Processes supported for authorizations
PaymentAuthorizationPurpose	Public Enum PaymentAuthorizationPurpose	Identifies the Authorization Purpose for Payments
ReserveAuthorizationPurpose	Public Enum ReserveAuthorizationPurpose	Identifies the Authorization Purpose for Reserves
ReserveBusinessFunction	Public Enum ReserveBusinessFunction	Identifies the Authorization Purpose for Reserves
PaymentBusinessFunction	Public Enum PaymentBusinessFunction	Identifies the Authorization Purpose for Reserves
ProviderAddressTypes	Public Enum ProviderAddressTypes	Enumerates provider address categories used to request correspondence, physical, or payment addresses.
WorkerAddressTypes	Public Enum WorkerAddressTypes	Enumerates worker address categories used to request mailing, home, or primary addresses.
RunID	Public Property RunID As String	Stores a run identifier for the ClaimServices instance.
getMaxBurialAmt	Public Shared Function getMaxBurialAmt(ByVal inDataPortalInfo As IDataPortalInfo, ByVal inDate As Date) As Decimal	Calculates the max burial payment amount allowed based on passed in date. For reserves the passed in date would be injury date. For payments the passed in date would be the current effective date based on date of death.
GetBeneficiaryAddresses	Public Shared Function GetBeneficiaryAddresses(ByVal inDataPortalInfo As IDataPortalInfo, ByVal inClaimNumber As String, ByVal inPersonId As Decimal) As List(Of clsClaimAddress)	Retrieves beneficiary addresses for the specified claim number and person ID through the claim data API.
GetClaimContacts	Public Shared Function GetClaimContacts(ByVal inDataPortalInfo As IDataPortalInfo, ByVal inClaimNumber As String) As ClaimContacts	Retrieves the claim contacts payload for the specified claim number from the claim data API.
getPersonAddress	Public Shared Function getPersonAddress(ByVal inDataPortalInfo As IDataPortalInfo, ByVal inPersonId As Decimal, ByVal inAddressType As String) As clsClaimAddress	Retrieves a person address for the specified person ID and address type from the worker data API.
GetWorkerAddress	Public Shared Function GetWorkerAddress(ByVal inDataPortalInfo As IDataPortalInfo, ByVal inWorkerId As Decimal, ByVal inAddressType As WorkerAddressTypes) As clsClaimAddress	Retrieves a worker address by worker ID after translating the requested worker address type to its API code.
GetResponsibleAdjuster	Public Shared Function GetResponsibleAdjuster(ByVal inDataPortalInfo As IDataPortalInfo, ByVal inClaimNumber As String) As String	Retrieves the responsible or pseudo adjuster user ID for the specified SAIF claim number.
GetResponsibleAdjuster	Public Shared Function GetResponsibleAdjuster(ByVal inDataPortalInfo As IDataPortalInfo, ByVal inClaimID As Decimal) As String	Retrieves the responsible or pseudo adjuster user ID for the specified claim ID.
CalcCheckDigit	Public Shared Function CalcCheckDigit(ByVal inNumber As String, ByVal inCharacterSet As ChecksumCharacterSet) As String	This Function Returns a Calculated Check Digit. It Requires a CharacterSet of Type "A" or "D" along with string that must have at least one numeric character. If no numeric characters are found or an error occurs in the routine, a "-" is returned.
IsValidClaim	Public Shared Function IsValidClaim(ByVal inDataPortalInfo As IDataPortalInfo, ByVal inClaimID As Decimal, ByVal inClaimNumber As String) As Boolean	Checks whether a claim exists for the supplied claim ID or SAIF claim number.
IsValidResponsibilityCode	Public Shared Function IsValidResponsibilityCode(ByVal inDataPortalInfo As IDataPortalInfo, ByVal inResponsibilityCode As String) As Boolean	Checks whether the supplied claim responsibility code exists in CL_CLAIM_RESPONSIBILITY.
hasCollectionActivity	Public Shared Function hasCollectionActivity(ByVal inDataPortalInfo As IDataPortalInfo, ByVal inClaimNum As String) As Boolean	Used to determine if a claim has ever had a legal collection case.
InvestigationRequestdate	Public Shared Function InvestigationRequestdate(ByVal inDataPortalInfo As IDataPortalInfo, ByVal inClaimId As Decimal) As Date	Used to get the first date an investigation was requested.
HasCollateralAccess	Public Overloads Shared Function HasCollateralAccess(ByVal isHealthIssue As Boolean) As Boolean	Returns True if the current user has access to a Collateral Health Claim.
HasExistingBenefitPayment	Public Shared Function HasExistingBenefitPayment(ByVal inDataPortalInfo As IDataPortalInfo, ByVal inClaimID As Decimal, ByVal inBenefitType As String, Optional ByVal inFullPartialCode As String = clsConstants.Blank, Optional ByVal inIssueDate As String = clsConstants.Blank, Optional ByVal inTotalAmt As Decimal = 0) As Boolean	Used to determine if a claim has an existing payment of a particular benefit type in payment history.
SQL1	Const SQL1 As String = " select count(*) " &	Exposes shared constant values.
SQL2	Const SQL2 As String = " AND exists (select 1 from cl_financial_trans_dtl dtl " &	Exposes shared constant values.
SQL3	Const SQL3 As String = " AND dtl.payment_category_code = :PaymentCategory) "	Exposes shared constant values.
WhereForDCSFull	Const WhereForDCSFull As String = " AND settlement_full_part_code = 'F'"	Exposes shared constant values.
WhereForDCSPartial	Const WhereForDCSPartial As String = " AND settlement_full_part_code = 'P' " &	Exposes shared constant values.
WhereForLegalOrder	Const WhereForLegalOrder As String = " AND addition_to_computation_code = 'Y' "	Exposes shared constant values.
hasReleasedScheduledPayment	Public Shared Function hasReleasedScheduledPayment(ByVal inDataPortalInfo As IDataPortalInfo, ByVal inClaimID As Decimal, ByVal inBenePaySeqNum As Decimal) As Boolean	Used to determine if a claim and benefit payment sequence number has a released payment.
hasReleasedFederalScheduledPayment	Public Shared Function hasReleasedFederalScheduledPayment(ByVal inDataPortalInfo As IDataPortalInfo, ByVal inClaimID As Decimal, ByVal inBenePaySeqNum As Decimal) As Boolean	Used to determine if a claim and benefit payment sequence number has a released payment.
HasReleasedFederalAwardPayment	Public Shared Function HasReleasedFederalAwardPayment(ByVal inDataPortalInfo As IDataPortalInfo, ByVal inClaimID As Decimal) As Boolean	Used to determine if a claim has a released federal award payment to the worker.
HasReleasedPaymentToWorker	Public Shared Function HasReleasedPaymentToWorker(ByVal inDataPortalInfo As IDataPortalInfo, ByVal inClaimID As Decimal) As Boolean	Used to determine if a claim has a released payment to the worker.
HasCollateralAccess	Public Overloads Shared Function HasCollateralAccess(ByVal isHealthIssue As Boolean, ByVal inMailid As String) As Boolean	Returns True if System User has access to a Collateral Health Claim
HasCollateralAccessCached	Public Overloads Shared Function HasCollateralAccessCached(ByVal isHealthIssue As Boolean, ByVal inMailid As String) As Boolean	Returns True if the system user has access to a Collateral Health Claim - Cached Data Store
HasConflictAccess	Public Overloads Shared Function HasConflictAccess(ByVal isConflict As Boolean) As Boolean	Returns True if the current user has access to a Conflict Claim.
HasConflictAccess	Public Overloads Shared Function HasConflictAccess(ByVal isConflict As Boolean, ByVal inMailid As String) As Boolean	Returns True if the System User has access to a Conflict Claim.
HasConflictAccessCached	Public Overloads Shared Function HasConflictAccessCached(ByVal isConflict As Boolean, ByVal inMailid As String) As Boolean	Returns True if the System User has access to a Conflict Claim - From Cached Datasource.
HasExposureAccess	Public Overloads Shared Function HasExposureAccess(ByVal isExposure As Boolean) As Boolean	Returns True if the current user has access to an Exposure Claim.
HasExposureAccess	Public Overloads Shared Function HasExposureAccess(ByVal isExposure As Boolean, ByVal inMailid As String) As Boolean	Returns True if the system user has access to an Exposure Claim.
HasExposureAccessCached	Public Overloads Shared Function HasExposureAccessCached(ByVal isExposure As Boolean, ByVal inMailid As String) As Boolean	Returns True if the system user has access to an Exposure Claim. - From a cached Datasource.
HasImageAccess	Public Overloads Shared Function HasImageAccess(ByVal isImageSecure As Boolean) As Boolean	Returns True if the current user has access Image access.
HasImageAccess	Public Overloads Shared Function HasImageAccess(ByVal isImageSecure As Boolean, ByVal inMailid As String) As Boolean	Returns True if the System User has access to Image.
HasImageAccessCached	Public Overloads Shared Function HasImageAccessCached(ByVal isImageSecure As Boolean, ByVal inMailid As String) As Boolean	Returns True if the System User has access to Image. - From a Cached Datasource.
HasSecureAccess	Public Overloads Shared Function HasSecureAccess(ByVal isHostileWorker As Boolean) As Boolean	Returns True if the Current User has access to a Secure Claim.
HasSecureAccess	Public Overloads Shared Function HasSecureAccess(ByVal isHostileWorker As Boolean, ByVal inMailid As String) As Boolean	Returns True if the System User has access to a Secure Claim.
HasSecureAccessCached	Public Overloads Shared Function HasSecureAccessCached(ByVal isHostileWorker As Boolean, ByVal inMailid As String) As Boolean	Returns True if the System User has access to a Secure Claim. - From a Cached Datasource.
HasUnpostedPaymentsOrAdjustments	Public Shared Function HasUnpostedPaymentsOrAdjustments(ByVal inDataPortalInfo As IDataPortalInfo, ByVal inClaimId As Decimal) As Boolean	Returns True if there are pending payments or adjustments (payment tran stat code != 5)
HasAccessToClaim	Public Overloads Shared Function HasAccessToClaim(ByVal inDataPortalInfo As IDataPortalInfo, ByVal inClaimNum As String, ByVal inMailid As String) As Boolean	Returns True if the System User has access to a Claim.
HasAccessToClaim	Public Overloads Shared Function HasAccessToClaim(ByVal IsWorkerConflict As Boolean, ByVal IsExposure As Boolean, ByVal IsHealthIssue As Boolean, ByVal IsHostileWorker As Boolean, ByVal inMailid As String) As Boolean	Returns True if the System User has access to a Claim.
HasAccessToClaimCached	Public Overloads Shared Function HasAccessToClaimCached(ByVal inDataPortalInfo As IDataPortalInfo, ByVal inClaimNum As String, ByVal inMailid As String) As Boolean	Returns True if the System User has access to a Claim. - From a cached Datasource.
HasAccessToClaimCached	Public Overloads Shared Function HasAccessToClaimCached(ByVal IsWorkerConflict As Boolean, ByVal IsExposure As Boolean, ByVal IsHealthIssue As Boolean, ByVal IsHostileWorker As Boolean, ByVal inMailid As String) As Boolean	Returns True if the System User has access to a Claim. - From a cached Datasource.
HasOverrideAcess	Public Shared Function HasOverrideAcess(ByVal inDataPortalInfo As IDataPortalInfo, inClaimID As Decimal, ByVal inMailid As String) As Boolean	Returns whether the specified mail ID currently has an active security override for the claim.
LegalCaseExists	Public Function LegalCaseExists(ByVal inDataPortalInfo As IDataPortalInfo, ByVal inClaimID As Decimal) As Boolean	Returns whether the claim has any LEGAL_CASE records.
IncurredCostsExist	Public Function IncurredCostsExist(ByVal inDataPortalInfo As IDataPortalInfo, ByVal inClaimID As Decimal) As Boolean	Returns whether the claim has a positive incurred cost total on its latest incurred cost history.
HasNonPostedPaymentforClaim	Public Shared Function HasNonPostedPaymentforClaim(ByVal inDataPortalInfo As IDataPortalInfo, ByVal inClaimID As Decimal) As Boolean	Returns whether the claim has any payment transactions that are not yet posted.
SupportOrderExists	Public Function SupportOrderExists(ByVal inDataPortalInfo As IDataPortalInfo, ByVal inClaimID As Decimal) As Boolean	Returns whether the claim is linked to any support order connection records.
UpdatePharmacyEligibilityToIneligible	Public Shared Function UpdatePharmacyEligibilityToIneligible(ByVal inDataPortalInfo As IDataPortalInfo, ByVal inClaimID As Decimal, ByVal inUpdateUser As String) As Decimal	Updates Pharmacy Eligibility to ineligible for a claim. Returns Number of records updated.
HasReserveAuthorization	Public Shared Function HasReserveAuthorization(ByVal inDataPortalInfo As IDataPortalInfo, ByVal inUserId As String, ByVal inAuthPurpose As ReserveAuthorizationPurpose, ByVal inFunction As ReserveBusinessFunction, ByVal inAmount As Decimal) As Boolean	Returns True if user authorized to initiate or approve payment
HasPaymentAuthorization	Public Shared Function HasPaymentAuthorization(ByVal inDataPortalInfo As IDataPortalInfo, ByVal inUserId As String, ByVal inAuthPurpose As PaymentAuthorizationPurpose, ByVal inFunction As PaymentBusinessFunction, ByVal inAmount As Decimal) As Boolean	Returns True if user authorized to initiate or approve payment
HasActiveWorkerEFTAuth	Public Shared Function HasActiveWorkerEFTAuth(ByVal inDataPortalInfo As IDataPortalInfo, ByVal inClaimID As Decimal, ByVal inDate As Date) As Boolean	Determine if the worker has active eft authorization for the claim id
HasActiveWorkerEFTAuth	Public Shared Function HasActiveWorkerEFTAuth(ByVal inDataPortalInfo As IDataPortalInfo, ByVal inClaimNum As String, ByVal inDate As Date) As Boolean	Determine if the worker has active eft authorization for the claim num
HasActiveClmPersonEFTAuth	Public Shared Function HasActiveClmPersonEFTAuth(ByVal inDataPortalInfo As IDataPortalInfo, ByVal inClaimNum As String, ByVal inPersonID As Decimal, ByVal inDate As Date) As Boolean	Determine if the person has active eft authorization for the claim num
HasActiveClmPersonEFTAuth	Public Shared Function HasActiveClmPersonEFTAuth(ByVal inDataPortalInfo As IDataPortalInfo, ByVal inClaimID As Decimal, ByVal inPersonID As Decimal, ByVal inDate As Date) As Boolean	Determine if the person has active eft authorization for the claim id
HasActiveBeneEFTAuth	Public Shared Function HasActiveBeneEFTAuth(ByVal inDataPortalInfo As IDataPortalInfo, ByVal inBeneficiaryID As Decimal, ByVal inDate As Date) As Boolean	Determine if a beneficiary has any active eft authorizations on any claim
UpdateIssueDate	Public Shared Function UpdateIssueDate(ByVal inDPI As IDataPortalInfo, ByVal inPaymentType As PaymentTransactionTypes, ByVal inIssueDate As Date, ByVal inUpdateUser As String) As Boolean	Updates the Issue date for a Payment Type.
IsClaimAvailableExternalView	Public Shared Function IsClaimAvailableExternalView(dpi As IDataPortalInfo, claimID As Int64) As Boolean	Returns whether the claim is flagged as externally viewable in CL_INJURY_CLAIM.
Fill	Public Function Fill(ByVal address As clsClaimAddress) As clsClaimAddress	Copies values from the supplied clsClaimAddress into a new clsClaimAddress instance and returns it.
Routes	Public Enum Routes	Defines the API route keys used for person address, worker address, beneficiary address, and claim contact lookups.
New	Public Sub New(ByVal inDataPortalInfo As IDataPortalInfo, Optional inPersonId As Decimal = 0, Optional inAddressType As String = "")	Initializes the claim-service criteria helper with the data portal context used to configure API routes.
Public Class ApiResult(Of T)	Public Class ApiResult(Of T)	Wraps an API response status code together with its typed data payload.

Behavioral notes

• Many public members are Shared helpers that expect an IDataPortalInfo instance and then execute inline Oracle SQL or stored procedure calls.
• The type exposes nested authorization enums that are reused when claim payment and reserve authorization checks are performed.

Constraints and usage notes

• Callers must supply the claim, mail ID, or person identifiers required by the specific helper method.
• Methods that execute Oracle routines rely on the surrounding data-access framework to create requests and bind parameters.

Sources

• Business\SAIF.Business\ClaimServices.vb