The Smart Claims Engine has preconfigured action codes for use as examples. They are found in the Action Codes screen and include, but are not limited to the following:
- Catastrophe Action Code (A-418)
This configuration allows a region to be associated with a natural catastrophe. If the claim meets the criteria associated with a catastrophe, the action code A-418 is reported in Smart Claims Engine.
- Priority Handling Action Code (A-416)
This configuration checks if the member, policy, contract or billing provider listed in the claim is listed in a decision table. If they are reported in the table, the action code A-416 is reported in Smart Claims Engine.
- Latency Action Code (A-417)
This configuration compares the difference between the submitted and received dates. If the dates exceed the threshold in the configuration, the action code A-417 is reported in Smart Claims Engine.
- ClaimsXten Bypassing (A1 & A2)
These configurations enable ClaimsXten to be bypassed, so that it is not called a second time.
- Pricing Module Bypass (AUP1)
This configuration enables the Pricing Module to be bypassed.
- Split Line Action Codes (SP-101, SP-102)
These configurations detail that the claim line has been split.
- SANP Manual Pricing (SANP-101)
This configuration details that Manual Pricing needs to occur for SANP, and as such call the SANP pricing module differently.
- Member Special Handling (VIP1, EMP1)
These configurations enable employee and VIP claims to be routed to specific work queues.
- Manually Priced Claim Line (MPCL)
This action code is set when the user manually re-prices a claim line, either through guided event resolution or claims adjustment/correction workflows. This action code is designed to allow the user to alter the existing pricing logic to ensure that the manual price takes precedence over all other pricing sources.