Set Up Claim Coverage Verification AI

Prepare for setup

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.

Prerequisites

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

• Appian platform running version 26.6 or greater.

• A supported version of MariaDB as a business data source.

  Instructions below are for MariaDB databases. For use with other databases, the SQL script will need to be modified.

• A supported web browser.
• Connected Claims Management Base Application v2.0 installed and configured.
• Claim Coverage Verification AI Add-On v1.2 installed.
• Appropriate user permissions for AI functionality.
• Claims data available for coverage verification.

Incorporate the add-on module

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 Claim Coverage Verification AI add-on into the Connected Claims Management Base application, complete the following sections.

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_Claim_Create.

5. Add a Start process after the Dummy node node.

   

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

   

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

   

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 following way:

   

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

   

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']
   ),
   

   

Test coverage verification

To test the Claim Coverage Verification AI module:

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.

Use the module after setup

After you 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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