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.

Once 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.

After 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.