Customizing reports
In addition to the library of Pega Platform reports, your
application provides several pre-configured reports that are customized for the various
work objects, cases, and business processes used in the application. These reports provide you
with real-time insights into case inventories and aging so that you can respond with the agility
that is needed to comply with your internal and external service level agreements as well as
compliance mandates. To create other reports, see Report categories. Your login and persona determine which reports you can view. The application provides
numerous pre-configured reports to monitor case and work inventory as well as monitor
workforce productivity and quality. These standard reports are driven by the case and work
object life-cycle infrastructure as well as the work and assignment-level service level
rules for goals and deadlines used in managing the life cycle of a case. The Pega Care Management application includes four categories of reports. You can view
these reports in the My Reports tab. Categories are Care
management, Utilization Management reports, Customer Service Representative reports,
Performance reports, and Incident reports. For information about additional reports available in all Pega applications, see Report categories. Report categories include:Pega Care Management reports
Pega Care Management reports
Report name Rule name Description Program referral status PEGAHC-CARE-WORK-PROGRAM!GETDECLINEDPROGRAMS Status of programs that are offered and the percentage of the
programs that were denied. Programs by case type ACTIVEPROGRAMSBYCLINICALTYPE Active programs that are categorized by clinical type Patient goals PATIENTGOALS Patient goals and status Patient alerts PATIENTALERTS Active alerts that are categorized by patient Count care plan instances grouped by care plan category,
status CAREPLANSBYPROGRAMBYSTATUS ALL Patients that are enrolled in care plans and categorized by care
plan, category, and status Care plans by date CAREPLANSBYDATE Care plans that are categorized by date Active care plans by program ACTIVEPATIENTSBYPROGRAM Active care plans that are categorized by program Active members by program ACTIVEMEMBERSBYPROGRAM Active members that are categorized by program Active cases by owner ACTIVEADMCASESBYOWNERREPORT Active care management cases that are categorized by owner Active case by case type ACTIVECMCASESBYCASETYPE Active care management cases that are categorized by case
type Active admissions by case type ACTIVEADMISSIONSBYCASETYPE Active admissions that are categorized by case type UM Reports
Report name Rule name Report description Peer-to-peer reviews by MD PEGAHC-CARE-WORK-AUTHREQUEST!PEERTOPEERREVIEWSBYMD
Outcomes as reported by the medical director Auth denials by MD PEGAHC-CARE-WORK-AUTHREQUEST!DENIEDAUTHSBYMD Percentage of denied authorizations Auth Adherance PEGAHC-CARE-WORK-AUTHREQUEST!AUTHREVIEWSWITHINSLA
Authorization reviews that were completed with the service level
agreement (SLA) window Upcoming peer-to-peer reviews PEGAHC-CARE-WORK-AUTHREQUEST!GETUPCOMINGPEERSFORMD
Reviews that are pending for the medical director Appeal overturn denials by MD PEGAHC-AG-WORK-APPEAL!GETOVERTURNDENIALSBYMD Percentage of the overturned denials by the medical director Auth requests by status – Current year AUTHREQBYSTATUS Admission requests and status for the current year Pending authorization requests by request type & pend
status PENDINGAUTHREQBYREQUESTTYPEPENDSTATUS Pending authorization requests that are categorized by the request
type and the pend status Open discharge reviews OPENDISCHARGEREVIEWS List of open discharge reviews Open concurrent reviews OPENCONCURRENTREVIEWS List of open concurrent reviews Discharge census on daily basis DISCHARGECENSUSFORUM List of discharged patients on a daily basis Denied auth by auth type and reject reason code – Current
year DENIEDAUTHREQ_CURRENTYEAR Denied authorizations that are categorized by the authorization type
and the reject reason for the year Denied admissions by reject reason code – Current year DENIEDAUTHREQAR_CURRENTYEAR Denied admissions that are categorized by the reject reason for the
current year Authorization Requests by Request Type & Status – Current
Year AUTHREQBYREQUESTTYPESTATUS_CURRENTYEAR Authorization requests that are categorized by the request type and
the status for the current year Authorization Requests by Request Type & Status – Current
Month AUTHREQBYREQUESTTYPESTATUS_CURRENTMONTH Authorization requests that are categorized by the request type and
the status for the current month Authorization Requests by Request Type - Current Year AUTHREQBYREQUESTTYPE_CURRENTYEAR Authorization requests that are categorized by the request type for
the current year Authorization Requests by Request Type - Current Month AUTHORIZATIONREQBYREQUESTTYPE_CURRENTMONTH Authorization requests that are categorized by the request type for
the current month Approved Admissions – No Notification APPROVEDADMISSIONS Approved admissions Admission census on a daily basis ADMISSIONCENSUSONDAILYBASIS Reported admissions and discharges for today Admission census ADMISSIONCENSUS Reported admissions that are being followed by the
organization Admission auth requests by status - Current year ADMISSIONAUTHREQBYSTATUS_CURRENTYEAR Admission requests and status for the current year CSR performance reports
Report name Report rule Description Assessment status PEGAHC-CARE-WORK-TASK!LISTOFASSESSMENTSTATUS
Consolidated list of visits scheduled by the CSR team Visits scheduled by CSR PEGAHC-CARE-WORK-VISIT!GETVISITSCHEDULEDETAILSFORWIDGET
Status of assessments Incident report
Report name Report rule Report description Incident report by date GETREPORTSBYDATE Incidents that are categorized by date, including the patient name
and the details of the incident
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