SCE provides tools and a platform to manage accumulators associated with the adjudicated claims. Accumulators can be configured to support out-of-pocket cost shares, authorizations, and benefit limits. The history of the accumulators associated to a claim can easily be viewed by claims examiners.
SCE's Accumulator Manager is a repository for use history that can be integrated with Pega healthcare applications, such as the Smart Claims Engine and the Product Composer System. It is a system of record for member benefit use against health plan financial payments and limits, such as deductibles, out of pocket maximums, referral and authorization usage, and visits/units/days.Integration
The accumulator manager provides APIs to integrate the accumulator manager into other applications. The APIs can create, retrieve, or update accumulators that are stored in the application. The accumulator manager provides appropriate error handling based on the outcome of the API action.Management
The accumulator manager provides a series of manual functions. These functions include:
- Viewing accumulators and their history
- Creating new accumulators
- Updating existing accumulators
- Deleting accumulators and their associated transactional details.
The accumulator manager provides a full history of all actions against accumulators showing the appropriate action that was taken against an accumulator and the system performing that action.