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Prior approval validation process

Suggest edit Updated on September 10, 2021

Use the Prior approval case type to validate and decide if a repair order has been filled correctly for an exceptional circumstance.

During the repair process, the repair technician might receive a notification that they must approve a repair of a certain type or on a particular part before it is completed. The Prior approval case type eliminates claim data duplication. Once the repair is approved, a claim is created with the entire set of claim data transferred from the prior approval.

The approved bill of material (BOM) line items are marked with a green check mark icon. Any changes that are made to the claim are marked with a yellow warning icon, which indicates that you must manually review the claim.

During the claim validation, if the claim data has not changed since it was approved, it is auto-adjudicated and is automatically paid. If the claim is updated, it is sent for review by an assessor.

Prior approval functionality is implemented in the PegaMfg-AMS-Work-WR-CL.ApproverSubmit data transform when the prior approval request is approved, and in the PegaMfg-Data-ClaimCmp.SetNewLine data transform when the claim is updated.

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