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Smart Claims Engine and NetworX integration

Updated on November 6, 2020

Through the integration of NetworX Pricer® (NXP) with Smart Claims Engine, data is automatically passed back and forth between the two systems during the claims adjudication process. Per the flow indicated below, the application’s orchestration layer interfaces with NXP as a stand-alone rule set that is executed in a discrete adjudication sequence module. During adjudication, the application identifies those claims that meet the criteria for NXP pricing, prepares those identified claims for pricing, and then submits the required data (i.e., claims data and rate sheet information) to the NetworX Pricer® application via Application Programming Interface (API). NXP then calculates pricing on a claim line-by-line basis by applying pricing rules according to configured provider contracts. Following those calculations, NXP applies configured routing rules, and returns the pricing information back to the application, where the data is used to update the claim work object and UI, prior to the execution of subsequent application adjudication sequence modules.

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