Implementing search for current and history claims

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Configuring search in Pega Smart Claims Engine / This is the approved revision of this page, as well as being the most recent.
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Implementing search for current and history claims

Description Configuring search fields in Pega Smart Claims Engine
Version as of 8.5
Application Smart Claims Engine
Capability/Industry Area Claims Search



Definition and concept[edit]

Pega Smart Claims Engine (SCE) allows you to search for an existing claim or Mass adjustments cycle. The data returned and the way that it is sorted can be configured for each user.

General guidelines[edit]

Searching for a claim[edit]

From the Business Analyst portal, click Claims. A search screen will be shown. Enter your search criteria and click Search. When you have your results, you can further narrow the search by selecting an option, such as Billing provider tax ID, Member ID, Subscriber ID, Claim ID, or Contract ID, and then narrow further the results by selecting additional options. 

Searching for mass adjustment cycles[edit]

From the Business Analyst portal, click Menu > Mass Processing > Mass Adjustments. A search screen will be shown. Enter your search criteria and click Search.

Choosing the search grid fields[edit]

A configurable repeating grid allows the end user to show or hide columns in a particular grid, as well as specify the order of the visible columns. After the user configures (hides/reorders) the columns and applies the changes, the grid refreshes and the configuration is persisted, so that when the user logs in again, the columns appear as previously configured by that user.

A User can choose the search fields that they want to use by clicking configuration icon in the top-right corner of the screen. This will display a list of columns. The columns to be hidden need to be un-checked and any new column that you want to see needs to be checked. The order of the fields can be also changed as desired by dragging and dropping the fields using the handle to the left of the field name.

Columns List Configuration

The list of available columns can be configured by extending the SearchClaimsCommon Report Definition and adding the new column source data and name to the Query tab of the extended report definition.

Reference materials on Community[edit]

For more information, see https://community.pega.com/knowledgebase/documents/pega-smart-claims-engine-healthcare-85-user-guide