Other enhancements
- Automatic orchestration selection
- The orchestration configuration table enables the flexibility to define the orchestration to be executed. Configurations for claim frequency type code, claim transaction type code, claim payer ID, and claim transaction type code are provided to select the appropriate orchestration, and the table can be extended as necessary to add other columns.
- Reverting to original claims
- Pega Smart Claims Engine for Healthcare provides the ability for claims examiners to restore the claim back to its original state, regardless of the number of times it has been processed or changed. The restore action is reflected appropriately in the claim audit logs.
- Queue processors
- Pega Smart Claims Engine for Healthcare can be configured to use queue processors or agents. Queue processors provide enhanced queue management and asynchronous processing capabilities.
- Line status display
- The claim screen has been modified to show the status of each line along with other key fields.
- Newly added lines
- When a new claim line is added to the claim due to recommendations made by the external editors, the added line is highlighted in SCE by adding a suffix "A" to the line number. This nomenclature next to the line number allows the user to easily distinguish the newly added lines from the original claim lines.
- Service unit count
- SCE 8.6 release is enhanced to set service units to 1 for dental claims when the value is received as blank on the intake. The system also raises an event code if the service units are received as blank for medical claims (SVE-0057) and if zero units are billed (SVE-0058).
- Display line of business
- The line of business associated with the claim, through the members plan, is displayed on the claim header.
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