Configuration and details for the Administrative tab
The Administrative tab has care team details at the top
which is divided into three sections. Each section displays care team members who are
associated with a category. By default, three care team members for each category are
displayed but you can view all of them at once by clicking the SHOW
MORE link. You can also add a care team member by clicking
Add care team member at the top right corner. Along with the
care team, the Administrative tab in the Patient 360 view
displays multiple sections and allows you to manage multiple types of cases for the
patient. The Administrative tab shows a list of the following items. Each
of the items is described in this topic: The care team that is associated with the patient includes the Internal Team,
Personal Support, and Care Providers. Each category has a primary contact, for example, the
Care Provider category indicates the primary care physician
(PCP). The data class is PegaHCCMF-Data-Party-Contact. The data model for
the care team is maintained through this class. No parameters Paramneters are WorkObjectID: .pyCustomer,WorkObjectClass:
"PegaHC-Data-Party-Member", ContactClass:
"PegaHCCMF-Data-Party-Contact", and Category:"Internal Team"
isActive: Parameter is Category:
CaseSpecific: "False" No parameters Parameter is InternalTeamContact:
Param.InternalTeamContact No parameters No parameters Parameters are fieldName: "Relationship" and className:
Param.ClassName Parameter is Category:
.Category Parameters are Category:
.Category, WorkObjectID: pyWorkPage.pyCustomer, WorkObjectClass:
Declare_CM_ENV.Value (provider_DATA_CLASS), and ContactClass:
Declare_CM_ENV.Value (CONTACTLIST_DATA_CLASS) No parameters The Activate option is available if the care team patient is in a
deactivated state and the Deactivate option is available when the
care team patient is in an activated state. The Remove option is
available if the contact is not a primary care physician and the contact should not be
associated with any case conferences or visit cases. The Authorization section displays cases of active or resolved
statuses. The Peer review action is available for authorizations with
the Resolved-Denied status. The Reopen
action is available for authorizations with the
Resolved-Cancelled status. No parameters Parameter
is ProviderID: .pyCustomer No parameters The Admission section displays all types of cases, either active
or resolved, with the respective child items such as concurrent review, Discharge plan,
Discharge worksheet, and tasks when you expand the tree grid structure. The
Utilization management section displays all the Utilization
management cases either active or resolved. There can be only one active Admission or
Utilization Management case at any given time. Parameters are casepattern:
Declare_CM_ENV.Value(ADMISSION_WORK_CLASS) and
Declare_CM_ENV.Value(UMCASE_WORK_CLASS); and CasesList:
AdmissionCases and UtilizationCases No parameters Parameter is ParentInsHandle No parameters Parameters are
MemberID: .pyCustomer and Source: Provider No parameters The Declined program section displays program referrals that are
declined or rejected. You can re-open or activate the declined programs after a certain
threshold period (days). The Declare_CM_ENV.Value(PROGRAM_OPT_OUT_DAYS rule represents the
threshold period (days) after which you can refer for the declined programs. The
Declare_CM_ENV.Value rule is where you set the workbasket to
which declined programs are routed. (CM_NONPARTICIPATINGPROGRAM_WORKBASKET). Parameter is ProviderID:
.pyCustomer The Appeals and grievances section displays appeals that are requested for the denied
authorizations. As part of the appeal review, if the decision is overturned, then the denied
authorizations is reopened. Parameter is CustomerID: .pyCustomer The Claims section displays all medical, pharmacy, and dental
claims. The data class is PegaHC-Data-Claim. The data model for claims is
maintained through this class. Parameter is ProviderID:
.pyCustomer No parameters Parameter is ClaimID:
.ClaimID Parameter is ClaimID: .ClaimID Parameter is ClaimID: .ClaimID No
parameters The Program section displays a list of the programs in which a
patient is enrolled. Each program offers Opt-in or Opt-out
options. If a program is active, the Opt-out option
is displayed. You must select the comments and the reason for the opt-out to in order to
opt-out of a selected program. If a program is inactive, the
Opt-in option is displayed. A confirmation note to opt-in is
displayed and the post-submission selected program is opted-in at the backend. An
Opt-out of all programs button is also available. After each
opt-out or opt-in action, a new row is added in Program enrollment
history with the date that the action was performed. Parameter is PatientID: .pyCustomer No parameters Parameter is SelectedProgram:
.Program Parameters are pyClassName: Declare_CM_ENV.Value
(CAREPLAN_WORK_CLASS), pyPropertyName: StatusReason, and
SortByLocalizedValue: true No parameters Parameters are
Program: .Program, PatientID: pyWorkPage.pyCustomer, and ObjClass:
Declare_CM_ENV.Value (CAREPLAN_WORK_CLASS) Parameters are PatientID: pyWorkPage.pyCustomer and
Program: .Program Parameters are
PatientID: and program No
parameters The Encounter section displays all the interactions between a
patient and healthcare providers for the purpose of providing healthcare services or
assessing the health status of a patient. Parameter is PatientID: .pyCustomer If you use the Fast Healthcare Interoperability Resource (FHIR) API for
Encounter, you can extend the details for a patient encounter to meet your business
needs. For example, you can include a listing of the providers that were involved in the
encounter or describe a diagnosis. Conversations are logged for tasks, alerts, goals, barriers, and interventions during
case resolution and also when a medication is added or updated. If you customize the
ShowContextInfo section with the necessary properties, when you
click Context, further details are displayed. This extension is
applicable for all conversation logs except Medications. Because look-up data pages do not support dynamic class referencing, you need to save the
D_GetWO rule in the appropriate implementation-layer class
context so that the data page can fetch the implementation-layer specific data.
Otherwise, the look-up fails and the data page does not return any data. Parameter is PatientID:
.pyCustomer Parameter is PatientID: .pyCustomer Parameter is PatientID:
.pyCustomer Parameter is pyID: .WorkID You can add or modify the fields that provide the details in the Context
Information dialog box during patient conversations. The Incident section displays all types of incidents that are
stored in PegaHC-Data-Incident class. When you click the Incident ID,
the respective case or work object opens. To add more details in the Review
Incident content section, you can customize the
ReviewIncidentContent section itself. Parameter is PatientID:
.pyCustomerCare team
Rules related to the care team members
Rule name Rule type Purpose GetTeamMembers Data transform Pre-loading activity of the first layout in the
MemberCareTeamContacts section. Fetches all the
contact details based on the category. D_CareTeamContactsByCategory Data page Retrieves contacts based on the category: CreateCareTeamContactPageDetails Data transform Creates the care team contact page. AddCareTeamContact Activity Creates the new contact and the new link object that associates this
contact with the work object. D_GetEligilityForPCM Data page Checks if the operator has the eligibility to become a Pega Care
Manager. Accepts an operator as a parameter and returns a boolean value
as output. ContactsByCategory Report definition Fetches all contacts based on a category. AddRelationships Data transform Adds relationships for the Personal support category for the
patient. D_fetchFieldValues Data page Fetches all field values based on the class name and the field
name. D_ContactRolesList Data page Fetches a list of contact roles. PrimaryContacts Report definition Gets the primary contacts for the patient. CheckPHPCases Activity Checks whether a Pega Care manager already exists for the member and
transfers all the PHP cases from the previous manager to the current
manager. PickAssignedOperator Activity Activity Rules to edit, view, activate, or deactivate a patient
Rule name Rule type Purpose CareTeamContactPage Activity Opens the care team patient and acquires a lock on it ViewCareTeamContactDetails Flow action Launches the care team profile when the care team patient is selected
ViewCareTeamDetails Section Displays the basic profile of the contact and options to edit, view,
deactivate, and remove EditPersonalContact Flow action Edits the care team contact StoreCareTeamContact Activity Saves the existing contact when editing the care team contact ViewPersonalContactDetails Flow action Extension point for viewing the care team contact DeactivateContact Flow action Extension point for deactivating a care team contact ActivateContact Flow action Extension point for activating a care team contact UpdateContactStatus Activity Extension point for updating, that is activating or deactivating, a
care team contact RemoveContact Flow action Extension point for removing a care team contact RemoveContact Activity Deletes the selected care team contact from the data party contact
PegaHCCMF-Data-Party-Contact class when the
Remove link is clicked Authorizations
Rules to display all authorizations
Rule name Rule type Purpose AddAuthorizationAuditLog Activity Defers the load activity to load authorizations. D_roviderAuthorizationsList Data page Fetches the authorization list based on the patient ID. CopyPage Activity Sets the change stage option for peer review, and reopens an action
event. Admissions and Utilization management
Rules to display or add care team patients
Rule name Rule type Purpose AuditLogTabCases Activity Defers the load activity to load Admission or Utilization Management
cases based on parameters. pyLoadMyCasesNestedWrapper Activity Defers the load activity to load nested cases and all child items in
the tree grid. pyLoadMyCasesNestedOneWP Report definition Retrieves the child cases information based on the parent
key. AdmissionAndUMCasesReport Report definition Fetches the admission or UM cases based on the case type object
parameter. NewAdmissionNotification Flow Creates a new admission notification case when the Add
admission case button is clicked. CreateCaseByType Activity If this is a new case, it creates a new case. If the new case is
added to an existing case, it creates a new case and then adds it to the
existing case. Declined programs
Rules to display all declined programs
Rule name Rule type Purpose GetDeclinedProgramsForrovider Report definition Gets the denied programs for the patient within the opt-out days that
are indicated on the configuration page. Appeals and grievances
Rules to display all appeals and grievances
Rule name Rule type Purpose AppealsGrievancesLists Report definition Fetches all the appeals' details based on the customer
ID. Claims
Rules to display all claims
Rule name Rule type Purpose D_Claims_Provider360 Data page Fetches claims based on the patient ID. MaMemberClaims Data transform Sets the service date and claim classifications based on the claim
type, that is Medical, Professional, Institutional, or Pharmacy
claims. D_Claim Data page Fetches claim details based on the claim ID. D_ClaimHistoryList Data page Fetches the list of history records regarding actions performed on
each claim. SetClaimDetails Data transform Populates the claims history depending on the actions performed.
MaMemberDetailsUnderClaim Data transform Maps the properties of a claim with patient details. Programs
Rules to display program enrollment history and options
Rule name Rule type Purpose D_MemberrEnrollmentHistory Data page Fetches the patient program enrollment history based on the patient
ID. OptOutPatientFromAllProgram Flow Opts-out for all programs. OptOutPatientFromProgram Flow Opts-out for a selected program. D_GetFieldValues Data page Source for the Opt-out reason drop-down list.
InitiateOptInBackEndProcess Activity Opts-in the patient to a selected program by using the backend queue
processors. D_GetOpenCPCasesForProgram Data page Fetches the care plans for a selected program. ResetExistingRegistryEntriesAsInactive Activity Resets or inactivates an existing registry list under a selected
program. getAllRegistryEntriesForPatient Activity Fetches the registry list under a selected program. ReopenCareplanElements Queue processor - Activity Reopens the care plan elements during an opt-in to the program. Encounters
Rules to display encounters
Rule name Rule type Purpose D_PatientEncounterDetails Data page Fetches the Patient encounter history based on the patient
ID. Extending patient encounter details in the Patient 360
Conversations
Data pages for patient conversation logs display
Rule name Rule type Purpose D_PatientConversations Data page Fetches the patient conversation logs, for example, Pulse and Summary
notes, based on the patient ID. D_GetPatientNotes Data page Fetches the patient summary notes based on the patient ID.
D_GetConversationLog Data page Fetches the Pulse notes for the patient. D_GetWO Data page Fetches the work object details based on the work object ID.
Extending fields for conversation details in the Patient 360
Incidents
Data page for incidents
Rule name Rule type Purpose D_FetchIncidents Data page Fetches incidents based on the patient ID.
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