Claim Forms Sample Profile Workflow

The route Claim Processor in this profile picks up three sample 837 claims (Professional, Institutional, Dental) from the file system, validates the data, and converts claims to XData 2.0. Depending on the transaction implementation, the route directs each transaction to the corresponding Claim Forms component, and stores the resulting PDF forms filled with the data extracted from the incoming claims in the files system.

Route Structure

Route Components Description

Component Name	Component Type	Description
Claim Intake	FS Inbound	Picks an 837 transaction from the file system.
Claim Processing	XE Native	Validates the incoming claims and converts the data to XData 2.0. For every 837 transaction, the Transaction Implementation (Professional, Institutional, or Dental) value is extracted and set as the XEServer property ClaimVersion.
Router	Router	Checks the XEServer property ClaimVersion and directs the transaction to the corresponding Claim Forms component.
Error Reports	FS Outbound	Stores the validation error reports in the file system.
CMS-1500 Generator	CMS-1500 Generator	Converts the 837 Professional claims from XData to PDF.
UB-04 Generator	UB-04 Generator	Converts the 837 Institutional claims from XData to PDF.
ADA-2012 Generator	ADA-2012 Generator	Converts the 837 Dental Claims from XData to PDF.
Forms PDF Archive	FS Outbound	Stores the resulting PDF files in the file system.