Pega Smart Claims Engine (SCE) for Healthcare 8.6 enhanced the management and assignment of event codes within claims processing.

Event code versioning

The SCE 8.6 release allows users to configure (and maintain) multiple versions of SCE event codes, each with their own non-overlapping active period. This provides clients with more flexibility in the configuration and supports a historical view of changes made to an event code. Claims are adjudicated against the appropriate version based on the processing date and the version status.

Event code dashboard and management capabilities

The SCE 8.6 release allows users to manage event codes by providing the following system capabilities through the new management screens:

• Add new event codes
• Edit event codes
• Deactivate event codes
• Copy event codes
• View event code versions

The improved user interface and workflow enhancements allow easy creation, editing and viewing of event codes. The UX enhancements include:

• Enhanced event code dashboard with filter capabilities
• Hover over capabilities for users to easily view the event code descriptions
• Expandable and collapsible event code disposition sections
• Easily accessible event code actions
  • Inactivate an event code
  • Activate an event code
  • Edit an event code

Ignore disposition

With the 8.6 release, users can configure an “Ignore” disposition. The “ignore” disposition enables event codes to be disabled or ignored at the disposition level. This provides a more granular configuration for handling event codes.

Event code reports

SCE 8.6 now has new reports to provide visibility on the event codes in the system. You can:

• View which event codes are active/inactive – via event code list
• View all versions of a single event code
• View the entire approval history of the event code

Revised event code names and descriptions

The names and descriptions of existing and new event codes are standardized to enable a clearer understanding of the event codes.