Table of Contents

Introduction

Below is the manual payment approval process in Seamless.

1. After a payment is created.

2. System will determine which user can act as an approver for the payment. This auto selection will be based on some criteria (See https://seamlessinsure.atlassian.net/wiki/spaces/SHC/pages/8290483/Manual+Payment+Approval#Auto-approver-selection-process). There will be only one user will be chosen as an approver.

3. If the user is determined, the payment will be assigned to that user.

4. The user will see all pending payments for his/her approvals. See the workflow below.

5. The user will review and decide to approve, reject, or hold a payment.

6. Approved payments will continue to Payment Integration process. See Claim Accounting Integration

Prerequisites

Users who join in claim payment approvals are required to have “Approval payments” permission and approval limits configured in Limit Groups.

Users who have “Approve payments” permission but are not configured in Limit Groups will not be able to approve payments. See Limit Groups

Auto approver selection process

1. Once a payment is saved successfully, system will initialize the random approver selection process. The user is selected randomly by system as an approver based on:

   1. The user has “Approve payments” permission. (Must have)

   2. The user has a suitable Approval Limit on a specific product which is obtained from Claim Settings - Limit group. (Must have)

   3. The user is in the same organization as the user who creates the payment. (Must have)

   4. If more than one user satisfies all the above criteria, select the user who has the least number of currently assigned payments pending for approval.

   5. If more than one user satisfies all the above criteria, select the user who has the nearest higher approval limit, compared to the payment transaction amount.

   6. If more than one user satisfies all the above criteria, select randomly.

   7. Notes: system won’t evaluate users in the parent organization if cannot find any user in the same organization as the user who creates the payment (point 1.d).

2. If no qualified approvers are selected for a transaction, "To be approved by" column in Pending Payments list will show "N/A" and Action column will have a Reassign button. Reassign action will initialize the approver selection process in point 1 above.

3. If a user has roles that have been added to several limit groups, the user will get the highest limit.

4. If the approval assignment is done successfully, a toast message will pop up “Payment <ref. no.> has been assigned to <user name> for approval.”

5. If the approval assignment is failed, a toast message will pop up “Cannot find the approver for Payment <ref. no.>.”

Pending Payments

Pending Payments lists all the payments waiting for approvals. To access the list, go to CLAIMS menu and click on Pending Payments.

You can switch between the list of all pending payments in the system and the ones that are waiting for your approval. The default view is “Payments that need my approval”.

Actions on payments

Approve a Payment

To approve a payment, on Pending Payments list, click Approve to approve the payment.

After the payment is approved, it will disappear from Pending Payments list.

Reject a Payment

To reject a payment, on Pending Payments list, click Reject to reject the payment.

After the payment is rejected, it will disappear from Pending Payments list and there will be a notification sent to payment’s creator.

To see the notification, click on the Bell icon on the top menu to see.

Payment <payment ref. no.> in Claims case <claim ref. no.> has been rejected.

Hold a Payment

To hold a payment, on Pending Payments list, click Hold to hold the payment and enter the reason.

After the payment is held, it will be highlighted in the Pending Payments list.

And there will be a notification sent to the payment’s creator. To see the notification, click on the Bell icon on the main menu to see.

Payment <payment ref. no.> in Claims case <claim ref. no.> has been held.

Reassign Payment Approval

If a payment is not assigned to anyone for approval and you have “Manual Assign Payment Approver” permission, you can trigger finding a new assignment for a pending payment. To do this, click Reassign on the payment in Pending Payments list.

If an assignee can be found, the payment will be updated with the new assignee.

And there will be a notification sent to the new assignee if Pending Payment Approval Notification setting is enabled (See https://seamlessinsure.atlassian.net/wiki/spaces/SHC/pages/8303880/General+Claim+Settings#Pending-Payment-Approval-Notification). To see the notification, click on the Bell icon on the top menu to see.

Payment <payment ref. no.> has been waiting for your approval in Claims case <claim ref. no.>. Please review and take action.

The reminders will be triggered if Pending Payment Approval Reminder setting is enabled. See https://seamlessinsure.atlassian.net/wiki/spaces/SHC/pages/8303880/General+Claim+Settings#Pending-Payment-Approval-Reminder

Payment details after approval

After a payment is done approval process, the payment status, approver name, approval timestamp, held/rejected reason will be reflected on the payment details.