The Pega Smart Claims Engine for Healthcare has a separate portal to identify claims that failed the load and need to be reprocessed. This portal is the Ingest Recovery Process portal.

If exceptions are found, or duplicates identified in the files, those files can be checked, corrected, and resubmitted. Once resubmitted, and there are exceptions found in the file, the status of the file will be again updated to -1 and listed back in the portal. If no exceptions are found and if the file is processed successfully the file status will be updated as 1.

The user can search for exceptions in this portal, using the file name or exception age. Once the user selects any exception then submits it, that record will be placed into a queue for reprocessing.

The recovery process handles the exceptions logged during the flow “data object to Work object creation” only. Also, when the ingest file is correct and system design is issue. The recovery process provided is for rule-level changes only and will not address issues due to invalid data in the file. If the ingest file has data issues (that led to the exception), it is then expected to correct the claim in the ingest file, and to manually reload to folder.

• Interfaces