The SCE typically integrates with the NetworX following the execution of several Smart Claims Engine adjudication sequence modules, including: Process validation edits, Member match, Member validations, Policy selection and eligibility, Provider eligibility, third party clinical editing systems, and Rate sheet selection.
These are used to ensure that the appropriate data is available and correct prior to pricing the claim. This information can be populated by customized extensions and configurations as necessary without utilizing the SCE for those functions.
NetworX integration into the SCE orchestration is configurable. The NetworX Pricer is configured to adjudicate both professional and institutional claims. Once the pre-conditions to the NetworX call are met, the data from the claim object and the rate sheet identifier information are copied to the Request XML file for NetworX processing.