Executing the Real-Time Claims Adjudication Solution Scenario

The Real-Time Claims Adjudication Solution Scenario can be executed in Business Space. You can view the end-to-end execution, view reports, and also view the transaction state using the different forms and reports in Business Space.
Before you begin
Ensure that the following prerequisites are complete before you execute the Solution Scenario.
About this task
A provider can execute the Real-Time Claims Adjudication Solution Scenario in Business Space by logging on to Business Space, initiating a request, providing claim details using forms, and submitting the data for processing. If successfully executed, the provider is informed of the claim amount to be paid by the patient, incase of an error the claim is directed to a supervisor for correction. The supervisor can then correct and resubmit the claim using Business Space.
Note: Some of the fields, used in the forms, for this Solution Scenario are programmed using basic validations. You can verify the validation for the field by moving the mouse pointer over the field.

The fields in which data is required are labeled with a * and have a different color. The Submit button in the form is disabled until you provide a value in all such fields in a form.

You can start the Solution Scenario in Business Space to view the Getting Started Widget. The Getting Started Widget lists the assets and the steps for using the Solution Scenario.

Table 1. Widgets to roles mapping
Roles Create Task Task Definition List All dashboard Process Instance / Process Check
Provider Yes Yes N/A N/A
Supervisor N/A Yes N/A N/A
LOB Manager N/A N/A Yes N/A
Provider Administrator N/A N/A N/A Yes
Procedure
  1. Open the Business Space portal.
  2. Create a claim.
    1. Log on to Business Space with the user ID as Adam.
    2. Open the Real-Time Claims Adjudication space and verify that the following pages are displayed.
      • Getting Started
      • My Tasks
      • Real-Time Claims Adjudication Process
      • Real-Time Claims Adjudication Process Check
      • Real-Time Claims Adjudication Dashboard
      • Real-Time Claims Adjudication Analysis
      • Real-Time Claims Adjudication Reports
      Note: This Solution Scenario is configured to display the Real-Time Claims Adjudication space by default. For more information about configuring the Solution Scenario, see Configuring the Real-Time Claims Adjudication Solution Scenario.
    3. Open the My Tasks page.
    4. In the Task Definitions List widget, select the Submit Claims check box and click the Create an instance of this task definition icon Create an instance of this task definition icon. The Submit Claims form is displayed in the Task Information widget.
    5. Provide the member details in the form provided and click Next.
    6. Provide the claim details and click Submit.
  3. View the claim response.
    1. Open the My Tasks page from the Real-Time Claims Adjudication space.
    2. Select the check box for the claim from the My Tasks widget, and click the Open the task icon Open the task icon.
    3. View the transaction status in the form displayed to verify that the transaction is successful or for errors in the transaction and click Submit.
  4. Validate the claim.
    1. Log on to Business Space using the user ID and password for a supervisor, that is Jay.
    2. Open the My Tasks page from the Real-Time Claims Adjudication space.
    3. Select the check box for the claim from the My Tasks widget, and click the Open the task icon Open the task icon. The Claims Correction form is displayed in the Task Information widget.
    4. Correct the claim details and click Submit.
  5. View the dashboards on the following pages.
    • Real-Time Claims Adjudication Dashboard
    • Real-Time Claims Adjudication Analysis
    • Real-Time Claims Adjudication Report
  6. View the Real-Time Claims Adjudication Process on the following pages.
    • Real-Time Claims Adjudication Process
    • Real-Time Claims Adjudication Process Check