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Identify a planned admission

Updated on April 26, 2021

Smart Claims Engine for Healthcare executes the logic for identifying planned admissions that fall into the General Population category from the CE_IsPlannedAdmission collection, which uses decision tables, when rules, and a data transform to drive the end-to-end process illustrated below.

The following data tables (identified below with sample codes) are used to support this process.

  • Readmission planned procedure table

  • Readmission planned diagnosis table

  • Readmission potentially planned procedures table

  • Readmission acute diagnosis table

    For claims that have been identified as planned admissions, according to the end-to-end planned admission review process, Smart Claims Engine for Healthcare displays a note in the claims history indicating the result of the review.

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