Workflow:
The below diagram provides a high-level overview of the PayOrDeny processing flow. A customer or business user initiates a request either in real-time through the API Endpoint for immediate processing, or in bulk via a Queue when handling high volumes of requests. Regardless of the submission path, the system validates the member's eligibility and determines their primary coverage by cross-referencing account details and member information. Based on the outcome, the request is either Pay or Deny, and the corresponding claim decision is returned to the requester.
