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
"Claim ID": "2017299P0000006000",
- 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.