Enter electronic claims into claims system

Trigger: Receipt of an electronic claim file from a healthcare provider or clearinghouse.

1. Receive electronic claim files from providers or clearinghouses
2. Acknowledge receipt of the electronic transmission
3. Parse file data into standardized claim fields
4. Validate structural integrity and compliance with data standards
5. Reject and return files with critical structural errors
6. Load accepted claims into the core claims administration system

Outcome: Claims are validated, parsed, and successfully loaded into the core claims adjudication system.