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Ingest recovery process

Updated on October 9, 2020

Pega Smart Claims Engine for Healthcare has a separate portal for the ingest recovery process called Ingest Recovery Process Portal.

Whenever exceptions are found, or duplicates identified for the N837 files, those files can be checked, corrected and resubmitted by the Claims examiner. For example, consider a file whose status is updated as -2, considering there is an existing file with 0 or 1 status.

The examiner can check this file, correct it and resubmit it. When resubmitted, if there are any exceptions found in the file, the status of the file will be updated as -1. If no exceptions are found and if the file is processed successfully the file status will be updated as 1.

The search for exceptions can be done in this portal, and it can be based on the file name or exception age. Once the user selects any exception then submits it, that record will be placed into a queue for reprocessing.

The recovery process handles the exceptions logged during the flow “data object to Work object creation” only. Also, when the ingest file is correct and system design is issue. The recovery process provided is for rule-level changes only and will not address issues due to invalid data in the file. If the ingest file has data issues (that led to the exception), it is then expected to correct the claim in the ingest file, and to manually reload to folder.

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