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.

• Claim business edits
• Claim business audits
• Third party liability edits
• Split claims
• Episode processing

• Pega Smart Claims Engine User Guide