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.