Skip to main content


         This documentation site is for previous versions. Visit our new documentation site for current releases.      
 

About processing Reporting claims

Updated on April 26, 2021

After Pega Smart Claims Engine for Healthcare processes a reporting claim, it edits the claim just as it does for a chargeable claim, except that it sets these values:

  • Paid Amount = 0

    The reporting claim goes through the adjudication process, calculates values for the Allowed amount, Copay, and Coinsurance, similar to a chargeable claim. However, it sets the Paid Amount to 0.

  • Paid Date = Claim Process Date
  • Final status of the Reporting claim = Resolved - Completed, assuming that the Reporting claim did not meet any event code criteria.

Have a question? Get answers now.

Visit the Support Center to ask questions, engage in discussions, share ideas, and help others.

Did you find this content helpful?

Want to help us improve this content?

We'd prefer it if you saw us at our best.

Pega.com is not optimized for Internet Explorer. For the optimal experience, please use:

Close Deprecation Notice
Contact us