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Claims Inquiry

Updated on March 12, 2022

Pega Smart Claims Engine for Healthcare provides the capability to manage Inquiries. Managing Inquiries consist of:

  1. Creating new Inquiries within the System.
  2. Searching for existing Inquiries within the System.
  3. Submitting new Inquiries manually and through using API.
  4. Sending / Receiving a response for the request send.
  5. Resolving existing Inquiries using Smart Claims Engine.

Note: Create a claims inquiry case manually through Examiner portal. The operator with ‘CE:Org_Level_2’ role will have the privilege to create an inquiry case manually.

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