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XML claims import

Suggest edit Updated on April 26, 2021

Pega Smart Claims Engine for Healthcare can import specific claim files in XML format and process them through the adjudication flow. The types of files that can be processed are:

  • Professional Healthcare Claims (837P)
  • Institutional Healthcare Claims (837I)
  • Dental Healthcare Claims (837D)

Claims for import must be complete and well-formed XML that conforms to the ACS X12 XML format.

You can drop claims for import into a specified file location at any time of the day. A file listener recognizes the arrival of the file, reads it, and processes it into a claim work object, which is placed into the backlog with a status of New. A scheduled agent processes the new claims at a defined interval, usually daily, off-hours, so as not to impact normal activity in the application.

  • Previous topic Solicited claims status request/response (276/277)
  • Next topic Importing a professional healthcare claim (837P)
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