Calculate or Recalculate Adjustments (POST, PATCH)

This API uses the default Expression Set Executable Template to perform the calculation and applies the standard policy rules, such as deductibles, co-pays, co-insurance, and limits to an initial claimed amount. You can either extend the executable template to create a custom Expression Set or create an Integration Procedure to include custom calculations.

The API uses the claimedAmount, claimId, and claimCoverageId as input, and returns the final adjustedAmount along with the generated data for Claim Coverage Payment Adjustments (CCPAs) and Insurance Policy Limit Tracking (IPLT) records. This API only returns the data; it doesn't save them in database.

Resource

1/connect/insurance/claims/claimId/coverages/coverageId/calculate-adjustments

Resource example

1https://yourInstance.salesforce.com/services/data/v66.0/connect/insurance/claims/0Zkxx000000001dEAA/coverages/0kPxx000000002fEAA/calculate-adjustments

Available version

65.0

PATCH is available in version 66.0 and later.

HTTP methods

POST, PATCH

Path parameter for POST and PATCH

Parameter Name	Type	Description	Required or Optional	Available Version
claimId	String	ID of the claim for which the payment adjustments must be calculated.	Required	65.0
coverageId	String	ID of the claim coverage record.	Required	65.0

Request body for POST

Calculate adjustments during the creation of a Loss item.

JSON example

1{
2  "benefitName": "Car Rental",
3  "claimedAmount": 1500
4}

Properties

Name	Type	Description	Required or Optional	Available Version
benefitName	String	Name of the specific benefit or sub-coverage that's associated with the coverage, as defined in the product attribute mapping.	Optional	66.0
claimedAmount	Double	Amount requested by the claimant when submitting the loss.	Required	65.0

Response body for POST

Calculate Adjustments

Request body for PATCH

Recalculate adjustments for an existing payment detail.

JSON example

1{
2  "claimedAmount": 1200.00,
3  "paymentDetailId": "0l2xx0000000001CAA"
4}

Properties

Name	Type	Description	Required or Optional	Available Version
claimedAmount	Double	Amount requested by the claimant when submitting the loss.	Optional	66.0
paymentDetailId	String	ID of the claim coverage payment detail for recalculating adjustments.	Optional	66.0

Response body for PATCH

Calculate Adjustments