Adjudication
Adjudication in the SCE encompasses the final calculations to identify the members cost shares based on the benefit configuration and existing accumulations.
Pega Marketing User Guide
The SCE provides COB models to reduce the payment based on the other payer’s adjudication results.
| Capability | Description |
| Cost share calculations | The SCE calculates the appropriate cost shares based on the rules defined in the benefit. The SCE utilizes any current accumulator balances in the calculations of the cost shares to identify the members liability.
|
| COB deductions | The SCE uses COB models to reduce the payment based on the other payer’s adjudication results.
|
Previous topic Pricing Next topic Finalization