Skip to main content


         This documentation site is for previous versions. Visit our new documentation site for current releases.      
 

Customizing reports

Updated on December 22, 2021

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.

Pega Care Management Implementation Guide Pega Care Management Implementation Guide

To create other reports, see Report categories.

Pega Care Management reports

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:

  • Care Management reports
  • Utilization Management (UM) reports
  • Incident reports
    Note: This category includes reports that are related to incidents. Because incidents are considered quality events, in many cases, you must report them to regulatory agencies. This report helps you to document and report incidents accurately so that you deliver a quality program and avoid regulatory penalties.

Pega Care Management reports

Report nameRule nameDescription
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 typeACTIVEPROGRAMSBYCLINICALTYPEActive programs that are categorized by clinical type
Patient goalsPATIENTGOALSPatient goals and status
Patient alertsPATIENTALERTSActive alerts that are categorized by patient
Count care plan instances grouped by care plan category, statusCAREPLANSBYPROGRAMBYSTATUS ALLPatients that are enrolled in care plans and categorized by care plan, category, and status
Care plans by dateCAREPLANSBYDATECare plans that are categorized by date
Active care plans by programACTIVEPATIENTSBYPROGRAMActive care plans that are categorized by program
Active members by programACTIVEMEMBERSBYPROGRAMActive members that are categorized by program
Active cases by ownerACTIVEADMCASESBYOWNERREPORTActive care management cases that are categorized by owner
Active case by case typeACTIVECMCASESBYCASETYPEActive care management cases that are categorized by case type
Active admissions by case typeACTIVEADMISSIONSBYCASETYPEActive admissions that are categorized by case type

UM Reports

Report nameRule nameReport description
Peer-to-peer reviews by MDPEGAHC-CARE-WORK-AUTHREQUEST!PEERTOPEERREVIEWSBYMD Outcomes as reported by the medical director
Auth denials by MDPEGAHC-CARE-WORK-AUTHREQUEST!DENIEDAUTHSBYMDPercentage of denied authorizations
Auth AdherancePEGAHC-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 MDPEGAHC-AG-WORK-APPEAL!GETOVERTURNDENIALSBYMDPercentage of the overturned denials by the medical director
Auth requests by status – Current yearAUTHREQBYSTATUSAdmission requests and status for the current year
Pending authorization requests by request type & pend statusPENDINGAUTHREQBYREQUESTTYPEPENDSTATUSPending authorization requests that are categorized by the request type and the pend status
Open discharge reviewsOPENDISCHARGEREVIEWSList of open discharge reviews
Open concurrent reviewsOPENCONCURRENTREVIEWSList of open concurrent reviews
Discharge census on daily basisDISCHARGECENSUSFORUMList of discharged patients on a daily basis
Denied auth by auth type and reject reason code – Current yearDENIEDAUTHREQ_CURRENTYEARDenied authorizations that are categorized by the authorization type and the reject reason for the year
Denied admissions by reject reason code – Current yearDENIEDAUTHREQAR_CURRENTYEARDenied admissions that are categorized by the reject reason for the current year
Authorization Requests by Request Type & Status – Current YearAUTHREQBYREQUESTTYPESTATUS_CURRENTYEARAuthorization requests that are categorized by the request type and the status for the current year
Authorization Requests by Request Type & Status – Current MonthAUTHREQBYREQUESTTYPESTATUS_CURRENTMONTHAuthorization requests that are categorized by the request type and the status for the current month
Authorization Requests by Request Type - Current YearAUTHREQBYREQUESTTYPE_CURRENTYEARAuthorization requests that are categorized by the request type for the current year
Authorization Requests by Request Type - Current MonthAUTHORIZATIONREQBYREQUESTTYPE_CURRENTMONTHAuthorization requests that are categorized by the request type for the current month
Approved Admissions – No NotificationAPPROVEDADMISSIONSApproved admissions
Admission census on a daily basisADMISSIONCENSUSONDAILYBASISReported admissions and discharges for today
Admission censusADMISSIONCENSUSReported admissions that are being followed by the organization
Admission auth requests by status - Current yearADMISSIONAUTHREQBYSTATUS_CURRENTYEARAdmission requests and status for the current year

CSR performance reports

Report nameReport ruleDescription
Assessment statusPEGAHC-CARE-WORK-TASK!LISTOFASSESSMENTSTATUS Consolidated list of visits scheduled by the CSR team
Visits scheduled by CSRPEGAHC-CARE-WORK-VISIT!GETVISITSCHEDULEDETAILSFORWIDGET Status of assessments

Incident report

Report nameReport ruleReport description
Incident report by dateGETREPORTSBYDATEIncidents that are categorized by date, including the patient name and the details of the incident

Note: The Incident report category includes reports that are related to incidents. Because incidents are considered quality events, in many cases, you must report them to regulatory agencies. This report helps you to document and report incidents accurately so that you deliver a quality program and avoid regulatory penalties.

Have a question? Get answers now.

Visit the Support Center to ask questions, engage in discussions, share ideas, and help others.

Did you find this content helpful?

Want to help us improve this content?

We'd prefer it if you saw us at our best.

Pega.com is not optimized for Internet Explorer. For the optimal experience, please use:

Close Deprecation Notice
Contact us