Skip to main content


         This documentation site is for previous versions. Visit our new documentation site for current releases.      
 

XML claims import

Updated on October 9, 2020

Pega Smart Claims Engine for Healthcare can import specific claim files in XML format and process them through the adjudication flow. The types of files that can be processed are:

  • Professional Healthcare Claims (837P)
  • Institutional Healthcare Claims (837I)
  • Dental Healthcare Claims (837D)

Claims for import must be complete and well-formed XML that conforms to the ACS X12 XML format.

You can drop claims for import into a specified file location at any time of the day. A file listener recognizes the arrival of the file, reads it, and processes it into a claim work object, which is placed into the backlog with a status of New. A scheduled agent processes the new claims at a defined interval, usually daily, off-hours, so as not to impact normal activity in the application.

  • Previous topic Solicited claims status request/response (276/277)
  • Next topic Importing a professional healthcare claim (837P)

Have a question? Get answers now.

Visit the Support Center to ask questions, engage in discussions, share ideas, and help others.

Did you find this content helpful?

Want to help us improve this content?

We'd prefer it if you saw us at our best.

Pega.com is not optimized for Internet Explorer. For the optimal experience, please use:

Close Deprecation Notice
Contact us