The claim latency action code is used to identify if the claim has been delayed in submission to the Smart Claims Engine for processing. This can happen if the Smart Claims Engine is implemented between other systems in the payer’s core operations systems. The latency action code compares the difference between the submitted and received dates against the default SLA that is configured for the Smart Claims Engine. If the difference between the days and the default SLA is greater than the threshold configured, then the latency action code (A-417) is applied to the claim. This will enable claims that meet this criterion be given a higher urgency or routed to a specific work queue if they are pended for review. This action code is provided as part of the claim business edits module.

The configuration for this action code is found in the SLA section of the System settings configuration menu. The default SLA applies to all the claims processed in the system and the claim latency % identifies the threshold for when the action code should be applied.

For example, if the difference between the submitted date and received date is 20 days and the system SLA is 30 days, then the latency percentage is (20/30) * 100 = 66%. If the latency configuration is 60, then the action code will be assigned.

• Action codes