Talk:Create a Post-Service Appeal in Pega Foundation for Healthcare’s Appeals and Grievances Manager Layer

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I may be off the mark here but this article does not appear to me to meet the definition of “design pattern.” I expect a design pattern show a developer how to solve a common problem using Pega features and capabilities. Instead, this article indicates that Pega has an implementation for addressing a specific need in a specific industry.

  • It’s narrowly focused on using a specific implementation offered in the Pega Foundation for Healthcare product rather than solving a general problem (Appeals) which may occur in other industries.
  • The multiple references to the Appeals and Grievances Manager Implementation Guide indicate that most of the information is found there. It’s not clear that this article adds any value beyond what’s already included in the documentation.
  • The article appears directed at the user rather than the developer. As a developer, I’m less interested in how to use an existing implementation (to create an appeal) and more interested in how to create or modify such a process to meet similar but different requirements. Or, how to create such a process from scratch. Is there a common pattern to implementing an appeals process?

Recommendations for improvement:

  1. I suggest a design pattern that discusses how to create an appeals process in Pega might be more useful to developers. Start with a simple statement that such an implementation already exists in Pega Foundation for Healthcare. As a developer, I would want to know this so I can evaluate that product as a potential solution.
  2. If not using the Healthcare framework, how to I implement an appeals process? Are there common patterns or approaches involved?
  3. Some discussion of appeals processes in general would be useful. I once helped develop an appeals process that used “baseball arbitration” to resolve the appeal (required by the client, not a Healthcare application). Can the Healthcare implementation be modified to accommodate such a requirement?
  4. Some discussion of design assumptions, key decisions, and potential extension points for the existing implementation that would help a developer modify the appeals process to meet different requirements.