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Module

Smart Claims Engine product overview

3 Topics

30 mins

Visible to all users
Beginner Healthcare Healthcare Payer English

This module reviews the claims adjudication process and introduces the concept of event codes in Pega Smart Claims Engine™ for Healthcare. It also presents some of the user capabilities that are available in Smart Claim Engine.

After completing this module, you should be able to:

Describe the high-level claims adjudication process
Explain the claims adjudication goals of healthcare payers
Describe fallout and event codes in Smart Claim Engine
Recognize some user capabilities in Smart Claim Engine

Available in the following mission:

Pega Smart Claims Engine Foundation

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