Accumulator manager key functions
The Accumulator Manager’s key functions are comprised of several discrete workflows that enable the retrieval, update, and deletion of existing accumulators, and the creation of new accumulators. These functions are primarily automated and are executed during the claims auto-adjudication process through integration with Smart Claims Engine. The accumulator manager accommodates these functions manually if you choose. The sections below describe each discrete workflow.
Retrieval of accumulatorsOnce a claim has entered the Smart Claims Engine gateway for
adjudication, the claim processes through several validation steps (for example,
member match and provider eligibility), benefit matching, and edits. During the
coverages, accumulator, and payments process, the application sends a request to the
accumulator manager repository, using the Retrieve for Update API, for all existing
accumulators that match to the benefits identified on the claim. The accumulator
manager returns all existing accumulators that meet the parameters identified in the
Retrieve for Update API.
Upon the retrieval of existing accumulators using the Retrieve for Update API, Smart Claims Engine performs all required calculations against the identified accumulators. Then the claim navigates through its final approval step for adjudication. The results of the calculations are posted to an accumulator structure located on the clipboard. Approval and subsequent adjudication of the claim initiates the Update API, where the results of the calculations are transferred from the clipboard page to the selected accumulators. Once the updates are posted to the accumulator manager, the Update API returns a message indicating whether the posting was successful or unsuccessful.
Creation of new accumulatorsAfter the execution of the
Retrieve for Update API, if no accumulators matching the benefit data generated from
the claim are returned, an accumulator record is auto-generated and the transaction
history for that accumulator is transferred from the clipboard page to the new
accumulator. The accumulator is then posted to the accumulator manager using the
Update API, which returns a message indicating the success or failure of that
posting.
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