The finalization capabilities of the SCE support any final calculations, for example, surcharge and application of COB savings amounts, along with the update of any accumulators that were used in processing.
Benefits that incorporate COB savings programs are identified and if the member has a credit for those programs, those can be applied to the member cost shares.
The final member liabilities are summed from the cost shares and added to the claim.
Claims for states that incorporate surcharges, for example, New York, are identified and the appropriate calculations made to support the provider payments.
Changes to the balances identified during processing to the accumulators are updated for subsequent claims or authorizations.