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Purpose of the guide

Updated on December 15, 2021

The Pega Smart Claims Engine for Healthcare user guide provides information on functionality in the system, such as feature use, configuration, and extension points, where appropriate. This guide focuses on the key capabilities of claims processing.

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It provides information supporting each of the main implementation journeys, from initial claims intake, pre-adjudication, business edits and rules, adjudication steps, through to finalization. This guide also provides detailed information on core configurations, personas, and user experience features.

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