| Healthcare Patterns | Application | Description | Version |
|---|
| Authoring questionnaires through the BA portal | Pega Care Management | How to author questionnaires by using the BA portal | 8.6 |
| Configuring elements on the patient timeline in Care Management | Pega Care Management | Configuring elements on the Care Management patient 360 timeline | 8.6 |
| Extending the Prior Authorization request Microjourney | Pega Care Management | Identify and add extension points in the Prior Authorization request Microjourney | 8.5 |
| Features and functions of the Task case in Care Management | Pega Care Management | Using and extending the Task case | 8.6 |
| Setting the application perspective to payer or provider in Care Management | Pega Care Management | Customizing data collection for various healthcare uses. | 8.5 |
| Setting the configuration when building an implementation layer | Pega Care Management | Instructions for updating the configuration page in Pega Care Management | 8.5 |
| Extend Add Child Dependent Microjourney | Pega Customer Service | Learn how to extend the Add Child Dependent Microjourney | 8.5 |
| Extending View Benefits Microjourney | Pega Customer Service | Learn how to extend View Benefits Microjourney. | 8.5 |
| Implementing Claims Inquiry for Pega Case Management Edition | Pega Customer Service | Learn how to use Pega's case management capabilities in an external desktop. | 8.7 |
| Implementing Patient Assistance for Pega Care Management Edition | Pega Customer Service | Learn how to implement the Patient Assistance case type in an external desktop by using Pega's Digital Experience APIs | 8.7 |
| Create a Custom Code Group in Pega Foundation for Healthcare | Pega Foundation for Healthcare | Learn how to create code groups to support multi-faceted transactions in Pega Foundation for Healthcare. | 8.1 |
| Create a Post-Service Appeal in Pega Foundation for Healthcare’s Appeals and Grievances Manager Layer | Pega Foundation for Healthcare | Learn how to create and handle appeals claims in Pega Foundation for Healthcare’s Appeals and Grievances manager layer. | 8.1 |
| Dynamically Driving Appeals, Grievances, & Organization Determination Sub-Cases from a Complaint Case | Pega Foundation for Healthcare | How to create complaint category and reason combinations to drive appeals, grievances, and OD sub-cases. | 8.7 |
| Extending the Healthcare Foundation Data Model | Pega Foundation for Healthcare | How to extend PFHC's data model | 8.7 |
| Prescription plan data model | Pega Foundation for Healthcare | Understanding the prescription drug plan data model | 8.6 |
| Understanding RxNorm drug database | Pega Foundation for Healthcare | A brief introduction to the RxNorm drug database, and the Pega Foundation for Healthcare's RxNorm search and display feature. | 8.6 |
| Understanding the Medical Dictionary for Regulatory Activities | Pega Foundation for Healthcare | The Medical Dictionary for Regulatory Activities, or MedDRA is an international system of medical codes and terminology used to help manage regulatory approval processes. | 8.6 |
| Adding new properties to PCS entities | Pega Product Composer for Healthcare | Adding new properties to PCS entities | 8.7 |
| Benefit and plan lifecycle management and configuration | Pega Product Composer for Healthcare | Benefit and plan lifecycle management and configuration | 8.7 |
| Benefit design in PCS | Pega Product Composer for Healthcare | Benefit design with PCS | 8.6 |
| Configuring and extending stages, statuses, and work queues | Pega Product Composer for Healthcare | Design inputs and details for configuring and extending stages, statuses, and work queues | 8.5 |
| Design inputs for extracting data for reporting, QC, and downstream integration | Pega Product Composer for Healthcare | Design inputs for extracting data for reporting, QC, and downstream integration | 8.5 |
| Extending and leveraging data extract report | Pega Product Composer for Healthcare | Extending and leveraging data extract reports | 8.7 |
| Extending coverage data to leverage inheritance | Pega Product Composer for Healthcare | Details for extending coverage data in PCS | 8.5 |
| Extending the document generation feature | Pega Product Composer for Healthcare | Leveraging document generation feature in PCS | 8.7 |
| Implementing and using product and plan flattening feature | Pega Product Composer for Healthcare | Details about implementing and using the product and plan flattening feature in PCS | 8.5 |
| Implementing the Summary of Benefits and coverage (SBC) feature | Pega Product Composer for Healthcare | Implementing the Summary of Benefits and coverage (SBC) feature | 8.5 |
| Implementing versioning | Pega Product Composer for Healthcare | Design inputs while implementing versioning in PCS | 8.5 |
| Loading and extending reusable entities in PCS | Pega Product Composer for Healthcare | Design inputs to consider while loading and extending the reusable entities in PCS | 8.5 |
| Search configuration and extension | Pega Product Composer for Healthcare | Search configuration and extension | 8.5 |
| Creating and extending sequences to customize adjudication | Pega Smart Claims Engine for Healthcare | Description and use of sequences in the Smart Claims Engine application. | 8.5 |
| Creating guided event flows using UI patterns | Pega Smart Claims Engine for Healthcare | Learning about the Smart Claims Engine (SCE) guided event resolution flow | 8.5 |
| Creating new event codes for claim adjudication | Pega Smart Claims Engine for Healthcare | Describes the pattern behind adding new event codes | 8.5 |
| Creating new, extending existing and bypassing modules | Pega Smart Claims Engine for Healthcare | Optimizing modules for the Smart Claims Engine for Healthcare | 8.5 |
| Creating orchestrations to control claim processing | Pega Smart Claims Engine for Healthcare | Describes the role of orchestrations and how they can be used for complex processing scenarios | 8.5 |
| Extending healthcare claims API | Pega Smart Claims Engine for Healthcare | Guidelines for extending Healthcare Claims API to accommodate external information | 8.7 |
| Extending portals to enhance the claims processing experience | Pega Smart Claims Engine for Healthcare | Concepts and considerations for extending claim processing portals. | 8.5 |
| Extending processing flows with action codes | Pega Smart Claims Engine for Healthcare | Guidelines for extending processing flows by using action codes | 8.5 |
| Healthcare - Extending the 837 | Pega Smart Claims Engine for Healthcare | Guidelines for extending 837 to accommodate external information. | 8.7 |
| Implementing error handling for new and existing modules | Pega Smart Claims Engine for Healthcare | Implementing error handling for new and existing modules | 8.5 |
| Implementing search for current and history claims | Pega Smart Claims Engine for Healthcare | Configuring search fields in Pega Smart Claims Engine | 8.5 |
| Mass reprocessing, event groups, and event recycle | Pega Smart Claims Engine for Healthcare | When to use a mass reprocess/adjustment, an event group or an event code recycle | 8.5 |
| SCE orchestration design patterns | Pega Smart Claims Engine for Healthcare | SCE orchestration design patterns | 8.7 |
| Smart Claims Engine personas and portals | Pega Smart Claims Engine for Healthcare | SCE access groups, roles and portals summary | 8.7 |
