The system setting screen available on the portal provides a business analyst or systems manager with the capability to view and update key system configurations. Each configuration has an effective and end date and goes through the standard approval flow before the configuration is active. The system settings screen shows the last updated user and date in the banner. Audit and system settings history are available from the UX.

The following table shows the list of fields in the system settings screen and the descriptions. More information on some of these settings will be detailed in the SCE capabilities where they are utilized.

Note: there must be an active system setting for the current processing date. If no active system setting is available, then event code SGB-0023 is applied to the claim.

To update the system settings, select the Edit system settings button on the System configuration screen. The System configuration screen will then be editable for the user to make any appropriate changes. Once changes have been made, select the Done Editing button. Once the system settings are valid and are configured to be effective today, or a date in the future, comments for the approver have been made, the changes can be submitted for approval by selecting Submit. Once the changes have been submitted, the user will be notified that the requested settings have been sent for approval, along with the task ID. At any time during the editing, the user can discard the changes, but selecting the Discard button and return to the previous version.

Key items to consider when making system configuration changes:

• Smart Claims Engine allows the user to create and store system settings instances that have a future effective date. In this situation, the current settings remain in effect until the user-defined start date of the new instance.
• When the user creates a new system setting instance that will become effective in the future, Smart Claims Engine automatically changes the end date of the current instance to the day prior to the start date of the future instance.
• All future system settings are displayed in the audit history in chronological order with the most current instance on top.
• SCE will display a validation error if the system settings are configured for a past date.
• Smart Claims Engine also ensures that system settings run concurrently and, therefore, does not allow gaps in system settings, or overlapping dates. A validation error is displayed if a configuration has been created with a gap.

Both the history of each individual system setting instance, and the history of all system configuration changes in Smart Claims Engine may be viewed from the System configuration screen by clicking on the Actions button in the top right-hand corner and then selecting the desired view.

When the user selects Setting instances, a text box is displayed showing, in list form, all previous (and future scheduled) system setting instances, including a unique ID number for each individual setting, effective and end dates, and other key data.

Selecting the Sys config ID in this screen will show the full view of the corresponding system configuration page in read-only mode.

When the user selects the Audit history, a text box is displayed that includes in list form all changes to the individual setting instance, including operator name and ID, edit date, and any comments that were associated to the changes.

Dev studio SCE configuration settings

The SCE provides some configurations in the dev studio. To access these configuration settings, select the Claims Engine Configuration from the Claims Engine item on the Configure menu.

The top portion of this tab describes the major settings for the configuration of this application.

Application configuration tab

The application configuration tab contains many of the application level settings. These global level settings define how the claim is processed and are required by the application.

This section enables the creation and management of modules, sequences and orchestrations that support the processing of claims. More information is found in the section on Modules, sequences, and orchestrations in this section.

The claim edits tab controls the key information needed for specific claim types, as well as the configurations for the duplicate claim rules. The duplicate claim rules are detailed in the section for duplicate claim edits. This section will cover the key fields used to configure claim types in the system.

The claim type is defined based on a series of parameters. The Claim Type Identification link below the parameters displays the configuration for the claim type. The Type indicates the form type (Institutional, Professional, Pharmacy and Dental). The facility type and bill classification come from the fields on the institutional form to classify institutional claims into different claim types. Changes may be made to the configuration on the IdentifyClaimType decision table.

The claim transaction type is also broken down into three types based on the claim frequency code. You can access this table through the Claim Submission Type Mapping link on the Claim Edits tab. Changes may be made to the configuration on the ClaimSubmissionType decision table.

To configure the system to support on un-support the specific claim type, you can select +Add item, or X Delete. You can also copy an existing claim type configuration by selecting Copy claim type. To edit an existing type, double click on the claim type to be modified.

Each claim identifier selected for processing will create a separate configuration for the history retrieval, the claim submission types and the duplicate edit configuration.

History retrieval – This allows the system to consider multiple claim types when retrieving history for the purposes of system audits. Clicking on a claim type will add it to the selected section. Clicking it in the selected section will remove it from consideration.

Duplicate Claim Edits – This provides the ability to select the fields and appropriate weights for exact and suspect duplicate edits. More information can be found in the section on Duplicate Edit section of Business edits.

Submission type – This defines the submission types that can be processed for this claim type and claim identifier. If a submission type is not configured and a claim meeting that criteria as defined in the ClaimSubmissionType decision table, SVE-0011 will be set.

The configuration settings can be changed easily in the developer studio. Once the changes have been performed, press Save Configuration, enter comments in the popup box and press Submit. Selecting Cancel will return to the configuration screen. Selecting Close on the main screen will close the configuration screen without saving the changes.