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Overview

Suggest edit Updated on April 26, 2021

Smart Claims Engine action codes allow business policy to alter processing. Action codes are rules that you define to override events, assign work to a specific work queue, change the urgency on an event, and bypass modules. Action codes can also be reported on a claim to show specific actions that may have been taken, for example splitting lines or adding new lines. You can report an action code anywhere in Smart Claims Engine to support the appropriate claims processing scenario. Smart Claims Engine is delivered with a set of action codes that support several key business scenarios:

  • Identification of a natural catastrophe
  • Claim latency
  • Priority handling

Other action codes assigned in the Smart Claims Engine, for example: adding a new line based on a response from ClaimsXten or identification of a transplant claim, are detailed in their appropriate chapter in the user guide.

Action codes, when assigned in the Smart Claims Engine, are seen in the Action codes section of the Claim tab accessed through the View claim history item in the Actions menu on the claim.

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