It supports a wide variety of claim processing requirements, including business rules-driven edits and processing, adjustments, claims splitting, intelligent work routing, claim status updates, balancing, and surcharges. Seamless integration within a healthcare payer's technology and existing application ecosystem in order to support true end-to-end business and system workflow is possible because:

• The SCE architecture utilizes Pega's industry-leading technology such as business process management, case management, and workflow technologies.

• Standards-based integration unites Pega processes with enterprise systems to maximize existing investments and reduce data inconsistencies and redundancies.

• Standalone, modular, or cloud implementations provide the flexibility to fit within an organization's technology infrastructure.

• Rules-driven controls define how each processing step is managed internally and called from external sources.

• SCE incorporates the Pega Foundation for Healthcare, a rich set of standard-based healthcare data models and tools which support X12, HL7, ICD, and HIPAA compliance rules. This layer functions as the backbone of the system and simplifies integration with other systems.