Set Up Claim Coverage Verification AI

Set up the Claim Coverage Verification AI module

After installing the Claim Coverage Verification AI add-on module, you need to set it up before using it with the Connected Claims Base application.

This guide walks you through the incorporation steps required to utilize the full functionality of the Claim Coverage Verification AI. Implementers are free to customize the security, display names, and other aspects of the application to best suit their needs. These steps include:

• Required incorporation.
  • Update Claim Coverage Verification on claim creation.
  • Update Claim Coverage Verification on updating loss details.
• Testing and validation.

Prerequisites

Before setting up Claim Coverage Verification AI, ensure you have:

• Connected Claims Management Base Application v1.2 installed and configured
• Claim Coverage Verification AI Add-On v1.1 installed
• Appropriate user permissions for AI functionality
• Claims data available for coverage verification

Required incorporation

The following steps are the bare minimum incorporation steps required to utilize the full functionality of the Claim Coverage Verification AI. Implementers are free to customize the security, display names, and other aspects of the application to best suit their needs.

To incorporate the add-on to the Appian Connected Claims Management Base Application, perform the following steps.

Update Claim Coverage Verification on claim creation

1. In the target environment, log in as the deployment user.
2. Navigate to the Appian Designer.
3. Navigate to Connected Claims Management Base Application.
4. Search for process model CCM_SUB_SubmitClaim_ParallelProcesses.

5. Add a sub process after the Send Email node.

   

6. Under the setup tab, set up the subprocess in the following way:

   

7. For the claimId input variable, pass in the following:

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   pv!claimId
   

Update Claim Coverage Verification on updating loss details

1. In the target environment, log in as the deployment user.
2. Navigate to the Appian Designer.
3. Navigate to Connected Claims Management Base Application.
4. Search for process model CCM_Claim_UpdateLossDetails.
5. Add a sub process after the Automation Evaluation node.
6. Under the setup tab, set up the subprocess in the same way as the claim creation process.

7. For the claimId input variable, pass in the following:

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   pv!claimId
   

Configure Summary Page

1. In the target environment, log in as the deployment user.
2. Navigate to the Appian Designer.
3. Navigate to Connected Claims Management Base Application.
4. Search for expression rule CCM_Claim_ClaimSummary.

5. Add the following code above the Details cardLayout:

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   rule!CCM_CCVAI_displayCliamCoverageVerification(
     claimId: ri!claim['recordType!{d81cdd0e-c54d-4b8e-beec-b7ae37fefe7f-ccm}CCM_Claim.fields.{f4bdff4d-4087-4519-bf34-34a1139e5c3d-ccm}claimId']
   ),
   

Testing and validation

1. Create test claims to verify coverage verification functionality
2. Update loss details on existing claims to test the verification process
3. Verify that coverage verification results appear on the claim summary page
4. Test AI accuracy with various claim scenarios

Next steps

Now that you have set up the Claim Coverage Verification AI module, you can automatically verify claim coverage details and receive AI-powered analysis of coverage verification for all new claims and loss detail updates in Connected Claims.

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