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Auto Payment Approval

Auto Payment Approval

Introduction

Auto Payment Approval process allows claim payment transactions automatically approved right after it’s created without human intervention based on configured rule. This helps your company to speed up claim processing.

Auto Payment Approval Process

Every payment after being saved, system will check if it’s within user’s auto approval limit. See Limit Groups

  1. If it’s within the user’s auto approval limit, the payment will be evaluated if it can be auto approved by determining the chance it gets auto approval. See https://contemi.atlassian.net/wiki/spaces/SHC/pages/1795326031/Auto+Payment+Approval#Random-check-on-auto-approval-payments

    1. If the payment has a chance, the payment will be auto approved. Approver is the user who creates payment transaction.

    2. Otherwise the payment needs to be manually approved. System will determine the approver for the payment based on the rule in Manual Payment Approval

  2. If the payment amount exceeds the user’s auto approval limit, the payment needs to be manually approved. System will determine the approver for the payment based on the rule in Manual Payment Approval

  3. If Auto approval process is failed, payment will go to manual approval process. See Manual Payment Approval

Random check on auto approval payments

To minimize the risks of fraud or auto-approval mistakes, there is configuration to control random check and route some auto-approved payments to someone with sufficient authority to manually approve.

In Claim Settings, tab General, go to section Payment Approval, specify “% of payment that will be auto approved” as a number from 0 to 100.

For ex:

  1. If you specify 90, it means maximum 90 out of 100 payments (90%) will be auto approved, only 10 out of 100 payments (10%) will need manual approval.

  2. If you specify 0, it means no payments (0%) will be auto approved, all payments (100%) will need manual approval.

  3. If you specify 100, it means all payments (100%) will be auto approved, no manual approval.

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