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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 Claims Engine
Recognize some user capabilities in Smart Claims Engine

Available in the following mission:

Pega Smart Claims Engine Foundation v1

Topics

Claims adjudication process

10 mins

Event codes

5 mins

User capabilities in Pega Smart Claims Engine

10 mins

Module Quiz

5 mins

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