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Claim pre-adjudication

Updated on December 15, 2021

The Smart Claims Engine performs a series of tasks as part of the pre-adjudication of claims during processing. These tasks include validating codes, system configurations, and key data on the claim; performing a member match, retrieving the appropriate policy and validating eligibility, and validating provider information.

Pega Marketing User Guide

This section will detail those processes and provide information on appropriate configurations and extensions.

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