Intercom integration with Claim Engine

New conversation

The claim engine creates a new conversation when:

• a reimbursement request (including quote) is submitted
• a reimbursement request (including quote) is unblocked
• a reimbursement request is released (after being on hold waiting for flexben info)
• a new medical document is uploaded
• a new hospitalization declaration is submitted
• a new hospitalization declaration is unblocked
• a new hospitalization invoice is received from AssurCard
• an eBVAC can not be processed automatically and needs manual intervention
• an eBVAC is released (after being on hold waiting for flexben info)

Format of the conversation

The conversation is created with the following format:

• Header: the user info, the barcode, the AssurCard member and employer info
• Content: depending on the event creating the conversation
• Footer: if the user is sensitive profile, there is a warning message "Sensitive profile: should not be handled by external operators"

Tags

Name	Description
Oxygen claim	Deprecated, used to mark claim handled by Oxygen
External claim	Used to mark claim handled by external operators
Parsed Assurcard Invoice	Used to mark AssurCard hospitalization invoice
Autoparsing - oxygen	Used to mark conversation sent to external autoparsing service
Autoprocessing failed	Used to mark conversation where autoprocessing failed
Childbirth	Used to mark conversation related to hospitalization declaration for childbirth
Flexben unblocked Claim	Used to mark conversation related to a claim released after receiving flexben info
Block?	Used to mark conversation where eBVAC could be blocked
Reclassified by Alan classifier	Used to mark conversation reclassified by Alan classifier
Sensitive profile claim	Used to mark conversation where the user is sensitive profile

Autoparsing

When a document is autoparsed, the claim engine uses the existing conversation to inform claim operators of the result.

Reclassification

🗄️ When a document is reclassified,

• the conversation is tagged with Reclassified by Alan classifier
• a message is added to the conversation with the new classification
• the conversation is tagged with External claim if needed
• the conversation is re-assigned to a queue depending on care act type

External Autoparsing

📤 When the document is sent to an external autoparsing service,

• the conversation is tagged with Autoparsing - oxygen
• the conversation is snoozed until we received a response

🤔 When the document sent returns an error or can not be sent (e.g. not supported document format),

• a message is added to the conversation with the reason

📥 When the response is received,

• a message is added to the conversation with the result (including the list of errors if any)
• if errors can be handled by external operators ⧉, the conversation is tagged with External claim and re-assigned to a queue depending on care act type

Autoprocessing

When a document is successfully autoparsed, the claim engine triggered the autoprocessing and uses the existing conversation to inform claim operators of the result.

💥 If the autoprocessing fails,

• the conversation is tagged with Autoprocessing failed
• a message is added to the conversation with a link to processus status tool

🤖 If the autoprocessing is successful,

• the conversation is closed automatically with a message "Conversation closed automatically..."

Internal Controls

The claim engine uses the existing conversation to alert claim operators on doing internal controls.

👮‍When the internal control is created,

• the conversation is re-opened with a message including a link to the tool

👌 When the internal control is done,

• the conversation is closed automatically with a message "The internal control was submitted..."