Skip to main content


         This documentation site is for previous versions. Visit our new documentation site for current releases.      
 

Priority handling action code

Updated on April 26, 2021

The priority handling action code is used to see if a specific member, policy, contract or billing provider is listed in the priority handling configuration tables. If they are reported, then the priority handling action code (A-416) is reported on the claim. The primary use case for this action code is to route claims for specific members, providers, contracts or policies to a specialized work queue or to change the minimum urgency on the claim if they suspend. This will enable these claims to be handled differently to other claims that have been submitted to the Smart Claims Engine. This action code is provided as part of the claim business edits module. The decision tables controlling this are:

AM_Priority_Member – Validates the member’s ID on the claim for priority handling.

AM_Priority_Policy – Validates the member’s policy ID for priority handling

AM_Priority_Contract – Validates the membership contract for priority handling.

AM_Priority_BillingProvider – Validates the billing provider’s tax ID for priority handling.

Have a question? Get answers now.

Visit the Support Center to ask questions, engage in discussions, share ideas, and help others.

Did you find this content helpful?

Want to help us improve this content?

We'd prefer it if you saw us at our best.

Pega.com is not optimized for Internet Explorer. For the optimal experience, please use:

Close Deprecation Notice
Contact us