Extending portals to enhance the claims processing experience

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Extending portals to enhance the claims processing experience

Description Concepts and considerations for extending claim processing portals.
Version as of 8.5
Application Pega Smart Claims Engine for Healthcare
Capability/Industry Area Healthcare and Life Sciences

Definition and concept[edit]

Pega Smart Claims Engine (SCE) for Healthcare portals are interfaces supplied with the application. They include common roles associated with claims processing systems. Common examples are business analyst, claims examiner, claims manager, and system manager. For a complete listing of portals and their available features, see Pega Smart Claims Engine for Healthcare User Guide.

Each portal provides access to features supporting the role common to processing systems. There is overlap between features, menu items, and functionality between portals. Careful consideration is given to features available in each portal to cover many business needs. You can customize content to display any data integrated into the application. SCE portals come with extension points to support custom user interface requirements.

Key considerations[edit]

When you extend SCE portals, apply the following guidelines:

  • Always use predefined extension points when available. This reduces impact during updates.
  • Use the screen space to maximum effect by focusing on the information required to complete the task at hand. Too much information may slow the screen performance or overwhelm the end user. Too little information will require the user to look to external sources slowing productivity.
  • Review content of the included portals as a starting point. Sections can be added but the recommended approach is to update the extension sections with additional properties.
  • Extension points for specific interface screens can be found by browsing the live UI. For additional instructions, see Pega Smart Claims Engine for Healthcare Implementation Guide.
Portal UI Image.png
  • Rules overridden in the implementation layer will take precedent over updated product rules. Review release notes to identify when new enhancements can be used instead of a custom code.

Use case examples[edit]

The following figures show examples of how you can extend SCE portals:

Adding member information on the main claim display
Adding credentialing data
Adding financial data


Pega Smart Claims Engine for Healthcare Implementation Guide

Extending the application

SCE user guide