Pega Smart Claims Engine for Healthcare has the ability to create a unique ICN (Internal Control Number) number for a claim that allows the users not only to identify the claim but lets them know other properties such as whether the Claim is submitted electronic vs paper, date of the submission of the claim with respect to Smart Claims Engine, or type of business (i.e. Government, Commercial, Medicare, Medicaid and so on.)

• ICN number is an 18-digit unique identifier for Claim.

  ICN = CCYYJJJMSSSSSSSSXX

  • CC = Century
  • YY = Year
  • JJJ = Julian Day
  • M = Media Type (P – Paper, E-Electronic Batch, V – VAN POS, W – Web-POS)
  • SSSSSSSS = Sequence Number support for up to 99,999,999 claims per day
  • XX = Version (00 – Original, 01-99 – Version update via adjustment/split)

  ICN can be input from

  • 837xml
  • 837EDI
  • Manual entry
  • Automatically assigned by system
  • API
• ICN Number is the Primary ID. The ICN Number will be the Primary ID On the UI. The TST or CLM ID would be still being Visible, just not in the primary place.
• The ability to enter ICN Number manually. By default a new ICN Number should be assigned for a new claim.
• The following edits are in place:
  • “ICN already exist” would show if a user tries to enter a new claim with an existing ICN Number.
  • “No ICN Number” would show if a user would try to enter a new Claim without an ICN Number. (Or if the user purposely deletes the existing ICN Number).
  • The Edits would now allow a user to change ICN Number once assigned to a Claim.

The Ability to Generate ICN Number automatically using an Auto Generate Button is also available to the users.

• ICN