The Smart Claims Engine has preconfigured action codes for use as examples. They are found in the Action Codes screen and include, but are not limited to the following:

• Catastrophe Action Code (A-418)

  This configuration allows a region to be associated with a natural catastrophe. If the claim meets the criteria associated with a catastrophe, the action code A-418 is reported in Smart Claims Engine.

• Priority Handling Action Code (A-416)

  This configuration checks if the member, policy, contract or billing provider listed in the claim is listed in a decision table. If they are reported in the table, the action code A-416 is reported in Smart Claims Engine.

• Latency Action Code (A-417)

  This configuration compares the difference between the submitted and received dates. If the dates exceed the threshold in the configuration, the action code A-417 is reported in Smart Claims Engine.

• ClaimsXten Bypassing (A1 & A2)

  These configurations enable ClaimsXten to be bypassed, so that it is not called a second time.

• Pricing Module Bypass (AUP1)

  This configuration enables the Pricing Module to be bypassed.

• Split Line Action Codes (SP-101, SP-102)

  These configurations detail that the claim line has been split.

• SANP Manual Pricing (SANP-101)

  This configuration details that Manual Pricing needs to occur for SANP, and as such call the SANP pricing module differently.

• Member Special Handling (VIP1, EMP1)

  These configurations enable employee and VIP claims to be routed to specific work queues.

• Manually Priced Claim Line (MPCL)

This action code is set when the user manually re-prices a claim line, either through guided event resolution or claims adjustment/correction workflows. This action code is designed to allow the user to alter the existing pricing logic to ensure that the manual price takes precedence over all other pricing sources.

• Action codes