Where a Workflow Engine Fits in the Claim Lifecycle

The claim lifecycle can run for weeks. You submit the 837 and get a 999 back, then a 277CA. There might be a rejection and a resubmission before an 835 tells you what was actually paid.

The systems I have worked with track all of that with status columns, cron jobs, and usually a report of files stuck in PROCESSING. It works until someone asks where a claim is and nobody can say without digging through rows and logs.

For the past few months I have been trying Temporal with its .NET SDK in a personal sandbox. I wanted to find out if a workflow engine could answer that question without the digging.

Workflows fit best between submitting the 837 and getting the 835. That part runs long and a lot can fail along the way. The steps are hours or weeks apart and each one depends on the one before it. Whatever tracks them has to survive restarts, deploys, and outages.

With status columns, every job that wakes up has to rebuild where the claim is from rows in a table. Temporal keeps that state for the workflow. Polling for responses is part of the workflow instead of a separate cron job someone has to know about. When the next payer response comes in, the workflow picks up where it left off.

Real-time 270/271 eligibility and 276/277 claim status are where they don't fit. The provider is waiting on those answers. CAQH CORE allows 20 seconds for the round trip across every hop and a workflow engine adds round trips and persistence the request does not need.

Parsing a large 837 does not belong in a workflow either. The parsing itself is regular code and the workflow handles what happens to the file before and after.

Getting a workflow running in the sandbox did not take long. Most of what I learned came after that.