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Claims – POST (create) claim

Suggest edit Updated on April 26, 2021

Post Claim service rule takes the claim JSON as parameter and returns the created Claim ID in JSON format after adjudicating the claim.

Pega Smart Claims Engine for Healthcare expects external systems to send Post JSON with “processStatus” in Claim JSON as “New” or “”.

URL format
POST https://[hostname:port]/prweb/PRRestService/healthcareapi/v1/Claims
Output

{

"Claim ID": "2017299P0000006000",

"methodStatus": "Good"

}

Key rules
Rule nameRule typeUsage
Class: PegaHC-Int-Claims
PostClaimAPIService activityMethod in REST service to create claim and return claim Id created as response after adjudicating the claim.
ClaimsService RESTREST service rule that identifies the path, parameters, and methods.
MapToEntityWrapperData TransformWrapper DT which calls “MapToEntity” and can be extended for Extension.
MapToEntityData TransformMaps the JSON properties to Claim.
PostClaimAPI_ExtensionActivityMaps claim JSON to Pega claim work object and calls CE_Main_2 workflow to adjudicate the claim as per the orchestration id mentioned in the JSON and returns Claim ID of the newly adjudicated claim.
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