Post Claim service rule takes the claim JSON as parameter and returns the created Claim ID in JSON format after adjudicating the claim.

Pega Smart Claims Engine for Healthcare expects external systems to send Post JSON with “processStatus” in Claim JSON as “New” or “”.

URL format

POST https://[hostname:port]/prweb/PRRestService/healthcareapi/v1/Claims

Output

{

"Claim ID": "2017299P0000006000",

"methodStatus": "Good"

}

Key rules

Rule name	Rule type	Usage
Class: PegaHC-Int-Claims
PostClaimAPI	Service activity	Method in REST service to create claim and return claim Id created as response after adjudicating the claim.
Claims	Service REST	REST service rule that identifies the path, parameters, and methods.
MapToEntityWrapper	Data Transform	Wrapper DT which calls “MapToEntity” and can be extended for Extension.
MapToEntity	Data Transform	Maps the JSON properties to Claim.
PostClaimAPI_Extension	Activity	Maps claim JSON to Pega claim work object and calls CE_Main_2 workflow to adjudicate the claim as per the orchestration id mentioned in the JSON and returns Claim ID of the newly adjudicated claim.

• Business service APIs