WebApr 26, 2024 · Pega Smart Claims Engine for Healthcare uses Pega Foundation for Healthcare, which contains a rich set of standard-based healthcare data models such as x12, HL7, ICD, and HIPAA compliance rules. This layer functions as the backbone of the system and enables integration with other systems. WebOct 9, 2024 · Process validation edits. Updated on October 9, 2024. Pega Smart Claims Engine for Healthcare provides a framework for performing basic validations before the claim goes through benefit and pricing adjudication. These validations support the claim-header and claim-line level edits for Professional, Institutional and Dental claim.
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WebSmart Data Solutions monitors each claim out with the networks, tracking it every step of the way to ensure full reconciliation. If a claim is out with a PPO for longer than expected, automated reconciliation alerts are sent out to highlight the aging claim and to speed its resolution. Get Started. 791,000+. transactions routed per month. WebMyAflac is your dashboard to help you file and track claims, understand the details of your policy, and do it all quickly and easily. Login to learn more. Aflac provides supplemental … WebSmart Claims Engine also supports adjustments, splitting of claims and claim lines, routing for suspended claims, claim status updates, claim balancing, and application of … razer keyboard with screen