Pega developed Pega Smart Claims Engine for Healthcare as an orchestration layer that guides a raw XML, EDI, API, test claim created from UI from import to adjudication using guided processes, or modules, defined by our customers. Each module is a distinct function that communicates with Smart Claims Engine and directs the claim through the adjudication process using event codes which influence next best actions for the claim.

Pega Smart Claims Engine for Healthcare is a Pega-provided product that you can use for demonstration and training purposes. It is based on the Pega Foundation for Healthcare application to take full advantage of the data and object models already available.

• What is already set up