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NXP integration point

Updated on November 6, 2020

The application integrates with the NXP pricer following the execution of several Smart Claims Engine adjudication sequence modules, including: (a) Process Validation Edits, (b) Member Eligibility, (c) Provider Eligibility, (d) ClaimsXten, and (e) Rate Sheet Selection. However, the sequence of NXP execution is configurable. The integration to NXP is configured to adjudicate both professional and institutional claims, which is an alternative to SCE’s Pricing calculation adjudication module.

You can view the ruleset associated with NXP, using the following steps:

  1. Go to Dev Studio, Claims Engine, and Claims Engine Configuration.
  2. From the Claims Engine Configuration page, select Module configuration.
  3. Navigate to the Module section and click on the CE_ProcessSANP link.

The following graphic of the claim process history represents (a) the by-passing of the standard Price calculation module, and (b) the passing of a claim through the NXP pricing module.

  • Previous topic Smart Claims Engine and NetworX integration
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