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Electronic admittance advice (835)

Suggest edit Updated on April 26, 2021

Pega Smart Claims Engine for Healthcare can generate an Electronic Remittance Advice (835). This transaction provides payment or advice updated to the billing providers about the claims that they have submitted to the application.

  1. You can initiate the SearchclaimsToBePaid activity from the Global configuration Page. This Activity collects claim status information for paid claims based on the provider. It also collects all claims from the transaction flag for which the payment extract is not done.
  2. The payment extract file is generated in the \\Transactions\XML\PaymentOut server folder.
  3. This file is picked by the CE_XMLPaymentConfirmation file listener and it generates the 835 XML file.
  4. The file listener calls the CE_ParsePaymentConfirmation activity to generate the 835 file.
  5. A Payment/Advice (835 xml) file is created for each billing provider. It contains the information for all the claims for which payment has been made.
  6. The Generate835XMLAfterPaymentReceipt activity creates a Payment/Advice (835 xml) with a file name derived from parameters as defined in Step 8, highlighted in the following screen.
  7. The Payment/Advice (835) is created in the file location specified in the Destination path field of the PegaX12XML835OutBP connect rule shown below.
  8. The Payment/Advice is now ready to be selected and returned to the provider system.
  9. This function has been added as an agent to the PegaHCCLMEngine agent queue rule as Step 7. This agent is scheduled to run once every week and generates payment information (XML 835) on a weekly basis.
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