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Configuration and details for the Administrative tab

Updated on April 22, 2021

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:

  • Care Teams
  • Incidents
  • Admissions
  • Utilization management Cases
  • Authorizations
  • Declined programs
  • Appeals & grievances
  • Claims
  • Programs
  • Encounters
  • Conversation logs
  • Incidents

Care team

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.

Rules related to the care team members

Rule nameRule typePurpose
GetTeamMembersData transformPre-loading activity of the first layout in the MemberCareTeamContacts section. Fetches all the contact details based on the category.

No parameters

D_CareTeamContactsByCategoryData pageRetrieves contacts based on the category:
  • Internal team
  • Care provider
  • Personal Support

Paramneters are WorkObjectID: .pyCustomer,WorkObjectClass: "PegaHC-Data-Party-Member", ContactClass: "PegaHCCMF-Data-Party-Contact", and Category:"Internal Team" isActive:

CreateCareTeamContactPageDetailsData transformCreates the care team contact page.

Parameter is Category: CaseSpecific: "False"

AddCareTeamContactActivityCreates the new contact and the new link object that associates this contact with the work object.

No parameters

D_GetEligilityForPCMData pageChecks 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.

Parameter is InternalTeamContact: Param.InternalTeamContact

ContactsByCategoryReport definitionFetches all contacts based on a category.

No parameters

AddRelationshipsData transformAdds relationships for the Personal support category for the patient.

No parameters

D_fetchFieldValuesData pageFetches all field values based on the class name and the field name.

Parameters are fieldName: "Relationship" and className: Param.ClassName

D_ContactRolesListData pageFetches a list of contact roles.

Parameter is Category: .Category

PrimaryContactsReport definitionGets the primary contacts for the patient.

Parameters are Category: .Category, WorkObjectID: pyWorkPage.pyCustomer, WorkObjectClass: Declare_CM_ENV.Value (provider_DATA_CLASS), and ContactClass: Declare_CM_ENV.Value (CONTACTLIST_DATA_CLASS)

CheckPHPCasesActivityChecks whether a Pega Care manager already exists for the member and transfers all the PHP cases from the previous manager to the current manager.

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.

Rules to edit, view, activate, or deactivate a patient

Rule nameRule typePurpose
CareTeamContactPageActivityOpens the care team patient and acquires a lock on it
ViewCareTeamContactDetailsFlow actionLaunches the care team profile when the care team patient is selected
ViewCareTeamDetailsSectionDisplays the basic profile of the contact and options to edit, view, deactivate, and remove
EditPersonalContactFlow actionEdits the care team contact
StoreCareTeamContactActivitySaves the existing contact when editing the care team contact
ViewPersonalContactDetailsFlow actionExtension point for viewing the care team contact
DeactivateContactFlow actionExtension point for deactivating a care team contact
ActivateContactFlow actionExtension point for activating a care team contact
UpdateContactStatusActivityExtension point for updating, that is activating or deactivating, a care team contact
RemoveContactFlow actionExtension point for removing a care team contact
RemoveContactActivityDeletes the selected care team contact from the data party contact PegaHCCMF-Data-Party-Contact class when the Remove link is clicked


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.

Rules to display all authorizations

Rule nameRule typePurpose
AddAuthorizationAuditLogActivityDefers the load activity to load authorizations.

No parameters

D_roviderAuthorizationsListData pageFetches the authorization list based on the patient ID.

Parameter is ProviderID: .pyCustomer

CopyPageActivitySets the change stage option for peer review, and reopens an action event.

No parameters

Admissions and Utilization management

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.

Rules to display or add care team patients

Rule nameRule typePurpose
AuditLogTabCasesActivityDefers the load activity to load Admission or Utilization Management cases based on parameters.

Parameters are casepattern: Declare_CM_ENV.Value(ADMISSION_WORK_CLASS) and Declare_CM_ENV.Value(UMCASE_WORK_CLASS); and CasesList: AdmissionCases and UtilizationCases

pyLoadMyCasesNestedWrapperActivityDefers the load activity to load nested cases and all child items in the tree grid.

No parameters

pyLoadMyCasesNestedOneWPReport definitionRetrieves the child cases information based on the parent key.

Parameter is ParentInsHandle

AdmissionAndUMCasesReportReport definitionFetches the admission or UM cases based on the case type object parameter.

No parameters

NewAdmissionNotificationFlowCreates a new admission notification case when the Add admission case button is clicked.

Parameters are MemberID: .pyCustomer and Source: Provider

CreateCaseByTypeActivityIf 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.

No parameters

Declined programs

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).

Rules to display all declined programs

Rule nameRule typePurpose
GetDeclinedProgramsForroviderReport definitionGets the denied programs for the patient within the opt-out days that are indicated on the configuration page.

Parameter is ProviderID: .pyCustomer

Appeals and grievances

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.

Rules to display all appeals and grievances

Rule nameRule typePurpose
AppealsGrievancesListsReport definitionFetches all the appeals' details based on the customer ID.

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.

Rules to display all claims

Rule nameRule typePurpose
D_Claims_Provider360Data pageFetches claims based on the patient ID.

Parameter is ProviderID: .pyCustomer

MaMemberClaimsData transformSets the service date and claim classifications based on the claim type, that is Medical, Professional, Institutional, or Pharmacy claims.

No parameters

D_ClaimData pageFetches claim details based on the claim ID.

Parameter is ClaimID: .ClaimID

D_ClaimHistoryListData pageFetches the list of history records regarding actions performed on each claim.

Parameter is ClaimID: .ClaimID

SetClaimDetailsData transformPopulates the claims history depending on the actions performed.

Parameter is ClaimID: .ClaimID

MaMemberDetailsUnderClaimData transformMaps the properties of a claim with patient details.

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.

Rules to display program enrollment history and options

Rule nameRule typePurpose
D_MemberrEnrollmentHistoryData pageFetches the patient program enrollment history based on the patient ID.

Parameter is PatientID: .pyCustomer

OptOutPatientFromAllProgramFlowOpts-out for all programs.

No parameters

OptOutPatientFromProgramFlowOpts-out for a selected program.

Parameter is SelectedProgram: .Program

D_GetFieldValuesData pageSource for the Opt-out reason drop-down list.

Parameters are pyClassName: Declare_CM_ENV.Value (CAREPLAN_WORK_CLASS), pyPropertyName: StatusReason, and SortByLocalizedValue: true

InitiateOptInBackEndProcessActivityOpts-in the patient to a selected program by using the backend queue processors.

No parameters

D_GetOpenCPCasesForProgramData pageFetches the care plans for a selected program.

Parameters are Program: .Program, PatientID: pyWorkPage.pyCustomer, and ObjClass: Declare_CM_ENV.Value (CAREPLAN_WORK_CLASS)

ResetExistingRegistryEntriesAsInactiveActivityResets or inactivates an existing registry list under a selected program.

Parameters are PatientID: pyWorkPage.pyCustomer and Program: .Program

getAllRegistryEntriesForPatientActivityFetches the registry list under a selected program.

Parameters are PatientID: and program

ReopenCareplanElementsQueue processor - Activity Reopens the care plan elements during an opt-in to the 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.

Rules to display encounters

Rule nameRule typePurpose
D_PatientEncounterDetailsData pageFetches the Patient encounter history based on the patient ID.

Parameter is PatientID: .pyCustomer

Extending patient encounter details in the Patient 360

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.

The patient encounter details appear in the Administrative tab of the Patient 360 profile if this information is available in your application.
Before you begin: Ensure that you have the encounter data available either in your application or by integrating with a third-party application. For more information about FHIR, see the Pega Foundation for Healthcare product page.
  1. In the header of Dev Studio, enter ShowEncounterDetails, and press Enter.
  2. Click the ShowEncounterDetails section rule.
  3. On the Section Encounter details page, on the Design tab, in the properties panel, edit or add the fields that you want to extend.
    For more information, see Sections.
  4. Repeat step 3 for each field that you want to add or edit.
  5. Click Save.
    Result: The additional details are displayed in the Encounter dialog box in the profile for the specified patient.


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.

Data pages for patient conversation logs display

Rule nameRule typePurpose
D_PatientConversationsData pageFetches the patient conversation logs, for example, Pulse and Summary notes, based on the patient ID.

Parameter is PatientID: .pyCustomer

D_GetPatientNotesData pageFetches the patient summary notes based on the patient ID.

Parameter is PatientID: .pyCustomer

D_GetConversationLogData pageFetches the Pulse notes for the patient.

Parameter is PatientID: .pyCustomer

D_GetWO Data pageFetches the work object details based on the work object ID.

Parameter is pyID: .WorkID

Extending fields for conversation details in the Patient 360

You can add or modify the fields that provide the details in the Context Information dialog box during patient conversations.

  1. In the header of Dev Studio, enter ShowContextInfo, and then press Enter.
  2. Click the Section rule.
  3. On the Section page, on the Design tab, use the controls in the right pane to edit the existing fields or add new fields.
    For example: You might want to add a field for an assessment, a phone call, or the next visit.
  4. Click Save.


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.

Data page for incidents

Rule nameRule typePurpose
D_FetchIncidentsData pageFetches incidents based on the patient ID.

Parameter is PatientID: .pyCustomer

  • Previous topic Configuration and details for the History tab
  • Next topic Configuration and details for the Appointments tab

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