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Claims Inquiry API Details

Suggest edit Updated on April 26, 2021

Pega Smart Claims Engine for Healthcare supports two API’s.

POST Claims Inquiry API: The POST Claims Inquiry API accepts set of claims inquiry search parameters as request json. On receiving the request Smart Claims Engine creates a claim inquiry case with respective claims search criteria results and routes it to claims inquiry work basket with “Pending-review” status. Response includes claims inquiry meta data returned as json.

GET Claims Inquiry API: The GET Claims Inquiry API accepts claims inquiry case ID as input request path parameter and returns claims inquiry meta data.

Signature Details:

Post Claims Inquiry APIGet Claims Inquiry API
http://<<URL>>/prweb/PRRestService/
healthcareapi/v1/ClaimsInquiry/{ID}
http://<<URL>>/prweb/PRRestService/
healthcareapi/v1/ClaimsInquiry/{ID}

Service package: healthcareapi

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