Claim business rules and edits
The Smart Claims Engine provides a series of out of the box edits and pre-adjudication updates that can be configured for use within adjudication.
These are provided through a variety of modules:
- SBE – Claim business edits
- SBA – Claim business audits
- STP – TPL/COB edits
- SSP – Split claims
- SEP – Episode processing
Each of these modules can easily be extended by adding a new custom collection of edits or pre-adjudication logic to the module initialization or finalization steps.
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