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Reviewing your Pega Care Management application settings

Updated on January 6, 2022

When you run the New Application wizard to create a new application or implementation, it populates the work class names. You might want to review the settings.

Pega Care Management Implementation Guide Pega Care Management Implementation Guide Pega Care Management Implementation Guide Pega Care Management Implementation Guide Pega Care Management Implementation Guide Pega Care Management Implementation Guide Pega Care Management Implementation Guide Pega Care Management Implementation Guide
  1. In the header of Dev Studio, click ConfigureCare Management Configuration.
  2. Review the class names on the following tabs:
    • Work classes
    • Rule classes
    • Data classes
    • Accelerator classes
  3. If necessary, modify the settings, and then click Save.

Prescribed implementation path

When you implement Pega Care Management, you might want to use the Utilization Management Microjourney or you might want to use the Care Management Microjourney. Based on your organization's needs, this section provides links to the Microjourneys that you might want to configure and use.

Case typeUtilization ManagementCare Management
AuthorizationX
AdmissionX
UM caseX
Task AcceleratorXX
MemberXX
Alert Accelerator XX
Goal Accelerator XX
Problem Accelerator XX
WorkX
Concurrent reviewX
Discharge planX
AppealX
Materials Accelerator XX
Admission notificationX
VisitXX
Intervention AcceleratorXX
Barrier AcceleratorXX
Case conferenceX
Discharge worksheetX
Medication therapy managementXX
Care planX
TaskX
ProblemX
AlertX
MemberX
IncidentX
CarePlan AcceleratorXX
Care gapsX
WorkX
GoalX
Program referralX
BarrierX

Configuring Pega Care Management general application settings

To specify application settings that are required for your organization's needs, use the Care Management Application configuration page. Configure the settings that are listed below.

Other settings are based on whether you selected Care Management or Utilization Management when you set up your implementation layer. For more information, see Prescribed implementation path.

Design Patterns: For more information, see Setting the configuration when building an implementation layer.

Changing your application perspective

When you create your application, you select either payer or provider perspective. However as an organization, you might want to change the perspective.

If a provider organization used an earlier version of the application and did not customize the labels, for example, changing Member to Patient, they might now choose the Provider option. In this case, when changing to the provider perspective, all references to member are automatically changed to patient.

Design Patterns: For more information, see Setting the application perspective to payer or provider in Care Management.
  1. In the header of Dev Studio, click ConfigureCare Management Configuration.
  2. Click the Other settings tab.
  3. In the Application perspective field, click Provider.
  4. Click Save and then click Close.

Configuring the patient verification setting

You can specify whether you want to perform Health Insurance Portability and Accountability Act (HIPAA) verification as part of your Schedule call and Schedule assessment tasks. This compliance activity ensures the protection of member health and identity information.

Because some organizations have other processes to ensure HIPPA compliance, this setting gives an organization the opportunity to remove the verification step from the Schedule call and Schedule assessment tasks.
  1. In the header of Dev Studio, click ConfigureCare Management Configuration.
  2. Click the Other settings tab.
  3. In the Require member verification in task field, click an option to specify whether or not you want to perform member HIPAA verification as part of your tasks.
  4. Click Save.
Result: The HIPAA verification section in the Schedule call or Schedule assessment tasks is displayed based on your configuration.

Adding members to the care team list

During implementation, you might want to add more user roles to the default list of internal care team member roles who interact with the patient. For example, your non-clinical care management representatives might be asked to engage with patients. In this example, you add the role of CM User Rep to the internal care team list.

Before you begin: A user role is not available to be added to the internal care team unless the role is associated with a user profile. Ensure that the user role is associated with a user profile.
  1. In the header of Dev Studio, click ConfigureCare Management Configuration.
  2. Select the Access roles for internal team tab, and then click the Add a row icon below the Access role field.
  3. In the Access role field, select a name from the list.
  4. Click Save.
    An individual must be assigned to the specified access role in order for the access role to be displayed in the Pega CM Care Manager portal. For more information, see Managing access roles.

Setting the default healthcare policy

Set the type of healthcare policy as a default setting for all cases that are supported in the application, for example, set the medical policy as the default setting.

  1. In the header of Dev Studio, click ConfigureCare Management Configuration.
  2. Click the Other Settings tab.
  3. In the Default policy drop-down list, select the type of policy that you want.
  4. Click Save.

Extending the Care Management Configuration page

Based on your organization's needs, you can extend the configuration rules and save them to your application rulesets. For example, you might want to add a new case type or you might want to add the client name in the other settings.

  1. In the header of Dev Studio, click ConfigureCare Management Configuration.
  2. In the following table, use the section rules in the PegaHCCMF-Landing class that correspond to the tab of the configuration page that you want to extend.
    You can use the following extensions to manage additional configurations such as a new case type or work basket configurations through the Care Management Configuration page. The details that you configure on the landing page are accessed through the Declare_CM_ENV data page in the application.
    Tab nameRule name
    Work classesCMAConfigWorkClass_Ext
    Rule classesCMAConfigRuleClass_Ext
    Data classesCMAConfigDataClass_Ext
    Accelerator classesCMAConfigAccelClass_Ext
    Work queuesConfigCMAWorkbaskets_Ext
    Work queuesConfigCMAWorkGroups_Ext
    Work object statusConfigCMAWorkStatus_Ext
    Other settingsConfigCMAOtherSettings_Ext
    Patient identifiersPatientIdentificationsList_Ext
    Access roles for internal teamCareTeamAccessRolesList_Ext
    Access roles for PCMPCMAccessRolesList_Ext
    Patient eventsPatientEvents_Ext
    SDOH categoriesSDOHCategories_Ext

    The details that you configured on the landing page are saved in the PegaHCCMF-Data-Settings instance. Any new configurations that you add on the landing page by using the above extension points should be saved in the PegaHCCMF-Data-Settings data instance so that they are available for use in the application. Use the following extension data transforms to update the new configuration details in the PegaHCCMF-Data-Settings data instance.

    Rule nameRule class
    SetConfigValue_ExtPegaHCCMF-Landing
    SaveApplicationSettings_ExtPegaHCCMF-Landing
    LOAD_CM_ENV_ExtPegaHC-Care-Env

Tags

Pega Care Management 8.7

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