pm4py/examples/llm/PET/doc-3.6

When a claim is received , it is first checked whether the claimant is insured by the organization.

If not , the claimant is informed that the claim must be rejected.

Otherwise , the severity of the claim is evaluated.

Based on the outcome ( simple or complex claims ) , relevant forms are sent to the claimant.

Once the forms are returned , they are checked for completeness.

If the forms provide all relevant details , the claim is registered in the Claims Management system , which ends the Claims Notification process.

Otherwise , the claimant is informed to update the forms.

Upon reception of the updated forms , they are checked again .