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

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

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

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

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

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

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

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

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

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

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.
   For more information, see Configuring the advanced options of a when rule.
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