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UCSPA Compliance Verifier

by recued-core v1 44 views

Verifies claim processing timelines against state Unfair Claims Settlement Practices Act deadlines and renders a compliance checklist.

How it works 10 steps

Inspect the data fetches, transforms, gates, and output this recipe runs.

Process (10 steps)
■ days_to_acknowledge date_diff
Calculate days between claim date received and claim date acknowledged
■ days_to_investigate date_diff
Calculate days between claim date received and claim date investigated started
■ days_to_decision date_diff
Calculate days between claim date received and claim date decision
■ state_limits switch
Map claim policyholder state to one of: CA, FL, IL, NY, TX
■ ack_ok compare
Check if days to acknowledge is at most state limits acknowledge days
skip: step.days_to_acknowledge is_null
■ inv_ok compare
Check if days to investigate is at most state limits investigate days
skip: step.days_to_investigate is_null
■ dec_ok compare
Check if days to decision is at most state limits decision days
skip: step.days_to_decision is_null
■ form_sent_ok compare
Check if claim claim form sent date exists
■ denial_ok compare
Check if claim denial reason has data
■ compliance_checklist to_checklist
Format results as an actionable checklist
▼
Output
checklist compliance_checklist

About

Tags

claims-system claimscomplianceucspainsurance

Details

10 steps recipe_id: verify-ucspa-compliance-claims