QC Process Technical Workflows

When adjudicating a claim the following steps are executed:

• The UI pulls the web service address from the database
• It then sends a Simple Object Access Protocol (SOAP) message to the web service which will then contact the adjudication workflow
• The adjudication workflow will send an MSMQ message to the adjudication service itself.
• The service will read data from the database, calculate how the claim should process, and finally write the results to the database.

When clearing a claim, the following steps are executed:

• The UI will pull the web service address from the database
• It then sends a SOAP message to the webservice, which will then contact clear adjudication service. 
• This service will read data from the database, calculate how the claim should process, and finally write the results to the database. 

When moving to Accounting, the following steps are executed:

• User sets a schedule in the UI and this is saved in the schedule_form table of the database.
• The Scheduler Service pings the table every minute to determine if something should be executed.
• When that time comes, the scheduler sends a message to the Accounting Web Service, which will contact the appropriate Accounting service. 

When calculating Premium Billing the following steps are executed:

• User sets a schedule in the UI and this is saved in the schedule_form table of the database.
• The Scheduler Service pings the table every minute to determine if something should be executed.
• When that time comes, the scheduler sends a message to the Premium Billing Web Service, which will contact the Premium Billing Process Batch Service.