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Configuring claim validation rules

Suggest edit Updated on November 3, 2020

A warranty claim is a set of cases and subcases that are managed independently while allowing you to view the entire case structure.

Pega Warranty has a number of pre-configured rules that implement a sample set of business rules. The following are the pre-validation rules:

  • PreValidationForPart - where a certain part number requires an invoice number.
  • PreValidationForMisc - where miscellaneous expense codes require an invoice attached to the claim.
  • PreValidationForLabor - where labor hours cannot exceed the defined amount for a particular labor activity.
  • ProductCheckInDate - where a date cannot be set in the future.
  • OdometerReading - where the odometer reading cannot be less than the last reading on record for the vehicle.
  • CoverageExists - where the claim cannot be entered if there is no valid coverage available.

When these conditions are not met for any line, a warning icon appears.

The ClaimValidation subflow handles all the validations related to the claim in the validate claim step. When a claim passes through this flow, all the exceptions related to the claim are flagged and added to the claim. This subflow also determines the claim disposition as paid, denied, or manually assessed. To review the ClaimsValidation flow steps, enter ClaimsValidation in the Dev Studio header search text field and click it to open.

You can configure the following claim validation rules as per the business requirement.

  • Configuring a coverage validation
  • Initializing exception and disposition flags
  • Configuring AutoPay
  • Configuring BOM validation sub flow rules
  • Configuring duplicate claim validation
  • Adding exceptions to the claim
  • Configuring exceptions ranking and claim disposition
  • Configuring claim assessing routing rules
  • Setting up Pre-Authorization programs
  • Setting up Campaign programs
  • Setting up Dashboards and Reports

 

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