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Known Issues in Pega Smart Claims Engine for Healthcare 8.6

Updated on May 14, 2021

This section describes the known issues that might occur in this release.

IDTitle and descriptionSuggested resolution
ISSUE 583944ClaimsXten™ processing information is not displayed on the UX when the claim is processed via the preview execution or process immediately options. This information is displayed correctly in other claim processing options.

Closing and reopening the claim will enable the information to be displayed.

ISSUE 517116The Mass Adjustment Process by Provider report displays the wrong header count. The details have the correct values, but the header sum is not correct.

Viewing the details will display the correct values.

ISSUE 589522Cost shares stop accumulating when the deductible is met. Copays and the OOP accumulator should continue to be calculated. The copay should only stop when the OOP has been met.Not available. The SCE needs to be fixed to continue calculations based on the benefit configuration.
ISSUE 627696Hotkeys on random audit configurations do not work correctly due to the multiple tabs. For example, if the user is on Claim amount tab and clicks on add new hot key, the claim type tab opens.

Select the appropriate tab and action buttons when configuring random audits.

ISSUE 603894

Delete attachment, attach files, and attach hotkeys on event code configurations do not work.

Select the appropriate button will provide the action required.

ISSUE 615233

Claims loaded or keyed manually with a year of 0000 are updated incorrectly to the year 2000.Claims with the invalid years of 0000 should be corrected before they are loaded in SCE.
ISSUE 616713Claims go to open error status when a claim file with invalid year in the claim service dates is submitted. For example: 12/11/0231. In this situation, the SCE should update the claim status to error and route it to the error handling work queue for review.

Claims with incorrect date years should be corrected before they are loaded in SCE.

ISSUE 618747In the Event code screen, a decimal point appears temporarily next to the version number. For example: version "1" is displayed as version "1.0" while the section is refreshing due to change to other fields. It shows as "1" after the refresh of section is completed.Users should ignore the decimal point.

ISSUE 632689

The spacing between the Active today and Inactive today row changes creating a shift in the UX when the user selects one or the other in the event code list. Users should ignore the spacing.

ISSUE 639427

The error message for the ICN entry when creating a claim inquiry is incorrect. The error message states that the user needs to enter a minimum of ten characters for the search. The message should detail that the entire ICN is required for the search.Users should search using the entire ICN while creating the inquiry work object.
ISSUE 646609

In the SCE TPL edits, the event code STP-0001 is raised if the member has an external payer associated with their policy. This should only be applied if the policy has a higher ranking than the current policy.

Set STP-0001 event code to informational.
Note: To submit new issues or find out more about known issues, or to request a hotfix, go to the Pega Product Support Community. Look up or subscribe to your Support Requests (INCs) in My Support Portal. Ensure that you refer to the issue ID in all communications.
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