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In case the Event-based activation is activated (event_based_activation=True), the triggering of the Schedule Task will not do anything because all the checked Claims have already been sent during immediately after the Rule Engine execution.
Claims Preparation
In case the Schedule Task activation is used, the time-lapse from when the Claims are submitted and automatically checked by the Rule Engine and when they are adjudicated by the Claim-AI module can be very long. During the time-lapse, the Medical Officers reviewing manually the Claims should not be allowed to select any checked Claim that was not processed by the Claim-AI module. To realize this mechanism, we are adding additional JSON extension (see Models) and additional filter based Claim Adjudication Processon the JSON extension (see Custom Claim Review Search Filters).
Pushing Claims to Claim-AI Module
Build FHIR Claim Bundle
The Claim-AI module is accepting FHIR Claim Bundle resource and respond with FHIR ClaimResponse Bundle resource (see REST API). Before calling the Claim-AI REST API, we are transforming all prepared Claims to FHIR Claim Bundle (see partition Build FHIR-Claim Bundle in AI-based Claim Adjudication Process).
FHIR Contained Resources
FHIR Contained Resources feature (https://www.hl7.org/fhir/references.html#contained) allows to integrate the referred resourced. In our case for FHIR Claim, these are Patient, Condition, Medication, HealthcareService, Practitioner, ActivityDefinition.
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