Extending portals to enhance the claims processing experience
|Request to Publish||Yes|
|Description||Concepts and considerations for extending claim processing portals.|
|Version as of||8.5|
|Application||Smart Claims Engine|
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Definition and concept
SCE Portals are interfaces supplied with the application. The include common roles associated with claims processing systems. Common examples are business analyst, claims examiner, claims manager, and system manager. Review the SCE user guide for a more complete listing of portals and available features of each.
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 but there they may not cover all business needs. Content can be customized to display any data integrated into the application. SCE portals come with extension points to support custom user interface requirements.
Always use predefined extension points when available. This reduces impact during upgrade.
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 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. Review the implementation guide for additional instructions.
Rules overridden in the implementation layer will take precedent over updated product rules. Review release notes to identify when new enhancements can be used in lieu of carrying forward custom code.
Use case examples
- Add external system keys from the keyring to the MemberInfoReviewDisplay_EXT display on the member section of the claim screen. Patient and Subscriber ID fields are already present so those should be excluded from the new display section.
- Include provider data from an external credentialing system to the BillingandRenderingProvReviewDisplay_EXT section of the claim screen. The placement keeps relevant data grouped logically for the examiner or reviewer.
- Financial risk or delegation information common to DOFR support can be added to the CE_ClaimLineProfReview_EXT section. This keeps the information near the appropriate claim lines for reference when needed without overloading the existing line display.