Pega Smart Claims Engine for Healthcare supports two API’s.

POST Claims Inquiry API: The POST Claims Inquiry API accepts set of claims inquiry search parameters as request json. On receiving the request Smart Claims Engine creates a claim inquiry case with respective claims search criteria results and routes it to claims inquiry work basket with “Pending-review” status. Response includes claims inquiry meta data returned as json.

GET Claims Inquiry API: The GET Claims Inquiry API accepts claims inquiry case ID as input request path parameter and returns claims inquiry meta data.

Signature Details:

http://<<URL>>/prweb/PRRestService/
healthcareapi/v1/ClaimsInquiry/{ID}

http://<<URL>>/prweb/PRRestService/
healthcareapi/v1/ClaimsInquiry/{ID}

Service package: healthcareapi

• Claims Inquiry