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Finalization

Suggest edit Updated on August 31, 2021

The finalization capabilities of the SCE support any final calculations, for example, surcharge and application of COB savings amounts, along with the update of any accumulators that were used in processing.

CapabilityDescription
COB savings

Benefits that incorporate COB savings programs are identified and if the member has a credit for those programs, those can be applied to the member cost shares.

  • Identify COB savings programs
  • Apply COB savings to member liability
Member liability

The final member liabilities are summed from the cost shares and added to the claim.

  • Calculate final member liability
Surcharge calculations

Claims for states that incorporate surcharges, for example, New York, are identified and the appropriate calculations made to support the provider payments.

  • Identify appropriate surcharges
  • Calculate surcharges
Accumulator updates

Changes to the balances identified during processing to the accumulators are updated for subsequent claims or authorizations.

  • Update accumulators
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