Claim Event Flow

This document was designed to show our Claim Administrators several scenarios that may occur throughout the life of a claim and what EDI transactions would be required for each scenario. This document covers the following:

  1. Claim Event Flow (as defined by the IAIABC)
  2. Establish or Acquire Claim
  3. Initial Payment or Equivalent
  4. Partial Suspension
  5. Suspension of all Indemnity Benefits
  6. Resumption of Benefits
  7. Suspension of Resumed Benefits
  8. File Any Time After First Report