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SCE request generation

Updated on October 9, 2020

Pega Smart Claims Engine for Healthcare request XML can be generated using the CXT_BuildInboundXML collection present under CE_CXTRequestandResponse collection. The activity shows how history is considered before the actual XML generation. It also shows the location of where the XML file is placed.

The PegaHC-DATA-CXT-TppClaimSet actually refers to the data class which mimics the structure of the request XML.

During the request generation, the CXT_DT_ClaimsData_Regfeed would be the data transform where a user would be able to see the header level mapping. The CXT_DT_GetClaimLineDataforTPPClaimSet_RegFeed would be the data transform which would show the mapping at the line level.

The complex data transforms CXT_DT_ClaimHeaderTppClaimSet_RegFeed, XT_DT_GetClaimLineDataforTPPClaimSet_RegFeed has been divided into multiple DTs:

  • CXT_DT_ClaimHeaderTppClaimSet_RegFeed_Adj
  • CXT_DT_ClaimHeaderTppClaimSet_RegFeed_Admission
  • CXT_DT_ClaimHeaderTppClaimSet_RegFeed_BillingProv
  • CXT_DT_ClaimHeaderTppClaimSet_RegFeed_Miscellaneous
  • CXT_DT_ClaimHeaderTppClaimSet_RegFeed_Other
  • CXT_DT_ClaimHeaderTppClaimSet_RegFeed_Condition
  • CXT_DT_ClaimHeaderTppClaimSet_RegFeed_Diag
  • CXT_DT_ClaimHeaderTppClaimSet_RegFeed_ECI
  • CXT_DT_ClaimHeaderTppClaimSet_RegFeed_ICDCode
  • CXT_DT_ClaimHeaderTppClaimSet_RegFeed_Member
  • CXT_DT_ClaimHeaderTppClaimSet_RegFeed_Occurence
  • CXT_DT_ClaimHeaderTppClaimSet_RegFeed_ValueCode
  • CXT_DT_ClaimHeaderTppClaimSet_RegFeed_ServProv
  • CXT_DT_GetClaimLineDataforTPPClaimSet_RegFeed_Amount
  • CXT_DT_GetClaimLineDataforTPPClaimSet_RegFeed_Adj
  • CXT_DT_GetClaimLineDataforTPPClaimSet_RegFeed_History
  • CXT_DT_GetClaimLineDataforTPPClaimSet_RegFeed_Proc
  • CXT_DT_GetClaimLineDataforTPPClaimSet_RegFeed_Miscellaneous
  • CXT_DT_GetClaimLineDataforTPPClaimSet_RegFeed_DiagInfo
  • CXT_DT_GetClaimLineDataforTPPClaimSet_RegFeed_ProviderProf
  • CXT_DT_GetClaimLineDataforTPPClaimSet_RegFeed_ProviderInst

The clients can use data transforms and the associated mapping in them to extend the request if required.

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