Audit type
To determine the Audit type:
- The system would parse the outbound XML response. Based on the fields received on the response, SCE would determine the audit type using the DetermineAuditType decision table.
- Once the audit type is determined the system would refer to the CXTResponsetoSCECode table. The event code would be a mapped based on certainty, current claim line action, rule acronym, rule type, case action, audit type and customer adjustment code.
- DetermineAuditType Collection added to ProcessClaimLineAction collection helps identify audit type based on the response received from ClaimsXten.
- DetermineAudit Type collection has DetermineAuditType data transform which holds case line action on current claim and another to hold the case line action for history claims.
- DetermineAuditType decision table will be configured to calculate the audit type
based on below parameters:
- Rule Acronym.
- Rule Type.
- Case Action.
- Claim Line Action
- Any Other SUPPORT action (Current Claim Line)
- Any Other DENY action (Current Claim Line)
- Any Other ADD action (Current Claim Line)
- Any Other SUPPORT action (History Claim Line)
- Any Other DENY action (History Claim Line)
- Any Other ADD action (History Claim Line)
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