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SCE request batch generation

Updated on October 9, 2020

Pega Smart Claims Engine for Healthcare can generate a batch ClaimsXten request file, also referred to as paid feed. The XML request file/paid feed would typically contain more than one claim. The system would generate two files for the batch feed. One file would be the batch paid file containing multiple claims in it. The second file would be an empty control file. ClaimsXten configuration employs a control file methodology that ensures the proper delivery and processing of files. The control file is necessary for files sent to or from ClaimsXten. The control file is a zero-byte, ASCII text file associated with each data file posted in the staging area. The control file is given the same name as its corresponding data file, but with the addition of the suffix “”. The control file would be used to trigger the ClaimsXten file watcher to pick up the batch file and start processing. Each file sent to ClaimsXten would have a unique naming convention.

  1. Claims with the configured status would be included in the batch generation file:

  2. Paid amount and paid date would be on the paid feed if present.
  3. All claims would be sent as history on the paid feed.

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