Functional Flow of ClaimGenie

Claim Book Data, Bank Transaction Data, Bill Data:

Users will initially upload these datasets into the system using a specialized data entry form called the File Upload Doctype. This ensures that all required data types are imported into the system in a structured format, ready for further processing.

Settlement Advice Data:

This data can be uploaded in two ways:

1.      Automatically by a Settlement Advice Bot: A bot can automate the upload process.

2.      Manually by Users: Users can manually upload the data.

Once uploaded, the system categorizes the data into three types:

1.      New: New records not previously present in the system.

2.      Update: Existing records that have undergone value changes.

3.      Skip: Records already in the system with no changes.

Processing Bank Transaction Data

Upload to Staging:

The Bank Transaction file is first uploaded into a storage area known as the bank transaction staging. This allows for initial processing and tagging before it is moved to the main storage.

Tagging:

The system tags relevant transactions:

1.      Insurance Payments: Transactions identified as insurance payments are tagged.

2.      Payer Tagging: The system identifies and tags the payer for each transaction.

Movement to Main Storage:

Only transactions tagged as insurance payments are moved from the staging area to the Bank Transaction Doctype, which is the main storage for processed transactions.

Processing Settlement Advice Data

Upload to Staging:

The Settlement Advice file is uploaded into a temporary storage area called the Settlement Advice staging.

UTR Revision:

The system performs a revision of the Unique Transaction Reference (UTR) numbers to ensure accuracy and consistency.

Movement to Main Storage:

After revision, the data is moved to the Settlement Advice Doctype, where it is stored for further reconciliation processes.

Processing Claim Book and Bill Data

Claim Book:

When processing Claim Book data, a new Claim Book document is created. This document contains all the necessary claim details extracted from the uploaded data.

Bill Data:

Similarly, when processing Bill Data, the system creates a Sales Invoice. This invoice contains billing details derived from the uploaded bill data.

Reconciliation Process

Reconciliation Methods:

In total, there are 17 matching types listed below:

Creating Payment Entries

Final Payment Entry:

After successful matching, the system creates a Payment Entry for the matched documents. This updates the status of the sales invoice and other relevant documents to indicate they are settled or paid. This step is crucial for maintaining accurate financial records and ensuring that all transactions are properly accounted for.

Dashboard Reporting

Comprehensive Reporting:

A Detailed report is generated on the dashboard, providing a clear view of the financial status. The report includes:

1.      Reconciled Numbers: Summary of successfully reconciled transactions.

2.      Open Bills Amount (OB): Remaining balances yet to be settled.

3.      Open Receipt Amount (OR): Receivables that are still pending.