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Known Issues in Pega Smart Claims Engine for Healthcare 8.7

Updated on June 16, 2021

This section describes the known issues in this version.

IDTitle and Description Suggested Resolution
BUG-583944 When a claim is processed using the preview execution or process immediately options, the ClaimsXten processing information is not displayed immediately on the UX. This information (and all the other information) is displayed correctly in other claim processing options. Closing and reopening the claim will enable the information to be displayed.
BUG-517116 The Mass Adjustment Process by Provider report displays the wrong header count. The details have the correct values, but the header sum is not correct. Viewing the details will display the correct values.
BUG-589522 Cost shares stop accumulating when the deductible is met. Copays and the OOP accumulator should continue to be calculated. The copay should only stop when the OOP has been met. Not available. The SCE needs to be fixed to continue benefit calculations based on the benefit configuration, when the deductible accumulator is met.
BUG-627696 Hotkeys on random audit configurations do not work correctly when multiple tabs are open. For example, if the user is on Claim amount tab and clicks on add new hot key, the claim type tab opens. Select the appropriate tab and action buttons when configuring random audits.
BUG-603894 Delete attachment, attach files, and attach hotkeys do not work while using configuring the event codes. Select the appropriate button will provide the action required.
BUG-668843 Within a report, when a user tries to filter the report, the system shows the selected filter on the grid. However, if the user selects “All”, instead of showing “All” as the selected option, the option shows blank. Consider blank as all.
BUG-616713 Claims go to open error status when a claim file with invalid year in the claim service dates is submitted. For example: 12/11/0231. In this situation, the SCE should update the claim status to error and route it to the error handling work queue for review. Claims with incorrect date years should be corrected before they are loaded in SCE.
BUG-618747 In the Event code screen, a decimal point appears instantaneously next to the version number. For example: version "1" is displayed as version "1.0" while the section is refreshing due to changes to other fields. It shows as "1" after the refresh of section is completed. Users should ignore the decimal point.
BUG-632689 The spacing between the Active today and Inactive today row changes creating a shift in the UX when the user selects one or the other in the event code list. Users should ignore the spacing.
BUG-666348 When a user clicks on the delegated rules and on a heading (not on expand icon), the user gets a box around text for heading,1st text and pencil icon. Users should ignore the box around the text.
BUG-646937 In the SCE TPL edits, the event code STP-0001 is raised if the member has an external payer associated with their policy. This should only be applied if the policy has a higher ranking than the current policy. The STP-0001 event code should be set as informational.
BUG-677460 When a user clicks on “Resolve” during event resolution and then cancel, the claim automatically gets routed to the originator work basket while it should still reside in the destination workbasket. Users should avoid clicking the cancel button. Instead, to return to the process claim screen, users should not select a resolution action and simply click apply.
BUG-687490 Users are not able to see multiple authorizations in the related claims section. To resolve this issue, the Enable paging check box (within the FetchRelatedObjects rule) which restricts the fetching of authorizations to only 50 results needs to be unchecked.
BUG-686806 When a claim matches to more than one valid authorization, the available units (on the second authorization) are not considered for claim adjudication. SCE will need to provide a patch if a resolution is required.
BUG-687807 In the new event code creation flow, when a user reaches the final review screen, and is trying to modify the claim identifier information using modify button, validation errors could occur. When such validation errors occur, the vertical steps shown on the right side of the screen are misaligned. Users should ignore the UI misalignment when editing in the new event code creation flow.
Note: To submit new issues or find out more about known issues, or to request a hotfix, go to the Pega Product Support Community. Look up or subscribe to your Support Requests (INCs) in My Support Portal. Ensure that you refer to the issue ID in all communications.
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