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Claim business rules and edits

Updated on September 29, 2021

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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