With the de-batch logic in place, Pega Smart Claims Engine for Healthcare has the claims picked and processed by multiple nodes and multiple agents.

The claims will be picked sequentially, one by one, by each of the nodes configured in the decision table.

In the agent management tab of the Designer studio, the user can have the agents for picking up the data objects to create the work objects. The agent which will convert the DO to work object is X12BatchEDIProcessor.

On clicking the agent, the user can also observe the node which is active for processing the DO to work object. There may be multiple nodes configured for a single agent.

There is a discrete decision used table for configuring all the nodes and the agents for picking and processing any step (i.e. for converting the DO’s to work objects). For this step the decision table being used to configure the nodes and agents is DetermineX12BatchAgentNumber.

Based on this decision table configuration the DO’s will be converted to work objects in a sequential order.

Apart from the decision table Pega Smart Claims Engine for Healthcare has a dynamic system setting in place which will determine how many max numbers of agents are to be configured for conversion of DO’s to work objects.

As per this DSS only the configured number of agents will work and convert the objects. The DSS being used for this purpose is NumberofAgentsN837.

In the agent management tab of the Designer studio, the user can have the agents for picking up the actual work objects to adjudicate and create the claims. The agent will create claims from work objects

CE_ProcessNewClaims

On clicking the agent, the user can also observe the node which is active for processing the DO to work object. There may be multiple nodes configured for a single agent.

There is a discrete decision table for configuring all the nodes and the agents for picking and processing any step (i.e. for converting the work objects to claims through adjudication). For this step the decision table being used to configure the nodes and agents is DetermineAdjudicationAgentNumber.

Apart from the decision table, Pega Smart Claims Engine for Healthcare also has a dynamic system setting in place that determines how many max numbers of agents are to be configured for processing or adjudication of claims. This DSS is NumberofAgentsforAdjudication.

As per this DSS the agents will work, and the claims will be adjudicated by the configured number of agents.

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