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Pega Care Management portals

Updated on February 8, 2021

The Pega Care Management application provides the following pre-configured portals for various user profiles.

  • CMFManager
  • CMFSupport
  • CMFFullfillment
  • CMBusinessAnalyst
  • UMServiceManager
  • UMServiceCoordinator
  • PHPSupport
  • Developer
  • Interaction portal

While the Manager and User portals may look similar, options available on portal left navigation menus are controlled by privileges, as explained in the Pega Care Management 8.2 Implementation Guide on the Pega Care Management product page.

Default Portal

Access Group

Operator ID

CMBusinessAnalyst

CareSample:Configurator

CareTemplateManager

CMFFullfillment

CareSample:FulfillmentCoordinator

CareFullfillmentUser

CMFManager

CareSample:CareManager

CareManager

CMFManager

CareSample:MedicalDirector

MedicalDirector1

CMFSupport

CareSample:CareTriage

CareSupportUser

PHPSupport

CareSample:PHPTriage

CustomerSupportUser

CPMInteractionPortal

CareSample:CareCoordinator

CareCoordinator1

UMServiceCoordinator

CareSample:UMCoordinator

UMServiceCoordinator

UMServiceManager

CareSample:UMManager

UMServiceManager

Developer

PegaCare:Administrator

CMSysAdmin

 

Access the Questionnaire (Assessment) management capability through the Survey
Management portal by clicking Developer Studio > Case Management > Survey menu. The Healthcare Code Set and Code Group management capability is managed through specific portals in Pega Foundation for Healthcare (See the Pega Foundation for Healthcare 8.2 Common Codes Business Use Case Guide on the Pega Foundation for Healthcare product page.

Care Manager portal – Dashboard

This portal is designed for the users responsible for managing care management work.

The default dashboard in this portal offers four different charts with actions available so that the user can see the associated data in grid view. This dashboard gives the user a holistic picture of the work being performed by the user such as assessments handled by them, upcoming scheduled visits, cases resolved within SLA and list of active members enrolled to a program.

The Worklist section in the Care Manager portal is divided into two sections: the upper section is “My Work” and the lower section is for “My Meetings”. “My Work” displays a list of work items the user has been assigned. Clicking the hyperlink for an individual work item opens the respective case for the user to work on. “My Meetings” lists all the meetings where the user is included as a participant. The meetings where a user is a primary participant are marked with an asterisk (*). This user can cancel, reschedule, or conduct the meetings where they are listed as primary participants. Users have view-only access for meetings where they are attendees but not the primary participant.

Care Manager portal – Patients

The Patients tab in the portal allows the application user(s) to search and view member details available in the application. User(s) can perform member search using first name, last name, or member ID. By default, the system displays 10 random members available in the application. “Patient ID” in the search results is a hyperlink that opens the patient 360 view, which contains all the details associated with the record.

Care Manager portal – Tools

The “Tools” tab in the portal header menu has three sub-tabs: Providers, Authorizations, and Bulk print status. The “Providers” tab enables application users to search provider records available in the application. The search can be refined using multiple search parameters and filter criteria to find the exact provider the user is looking for. Each provider record in the search results has an accordion shape in front of it, which, when clicked, gives more details about the provider.

The “Authorizations” and “Bulk print status” tabs are available only to those users that have privileges to access these tabs. The care manager role has access to both. The “Authorizations” tab lets you search and view details of authorizations available in the system.

The “Authorizations” tab also allows the user to select and bulk print the authorizations. The bulk print functionality is available based on the privileges assigned to the user. After the authorizations are sent or scheduled for print in the Authorizations tab, they are associated to the bulk print jobs. These bulk print jobs can be viewed and managed in the “Bulk print status” tab in the Tools portal header menu. Users can only manage the jobs that they initiated. Other jobs will be shown with no actions listed for them.

Care Manager portal – Reports

The Reports screen’s right-hand section in the Case Manager portal displays a list of reports in two categories: Private and Public. Private reports are accessible to a specific user; however, the public reports are visible to all users who have privileges to view reports in the Care Management application. Each category has several reports listed under it. When users click on a report, a graphical representation of the data corresponding to that report appears.

For more information about creating reports refer to:

https://community.pega.com/knowledgebase/capabilities/reporting

Care Management Support User portal

This portal is designed for nurses who are responsible for interacting with the members and complete the tasks assigned by their respective managers. Nurses can communicate among themselves regarding the member health progress.

Care Management Customer Support User portal

This portal is designed for the application user(s) responsible for interacting with members and support them through the process of personalized health planning. Customer support users handle the intake where they are responsible for documenting the member health statistics and route to the appropriate care manager.

Care Management Fulfillment User portal

This portal is designed for the application user(s) that are responsible for sending fulfillments to member(s) participating in care management areas, e.g., sending a welcome kit, a biometric device, or fax.

Care Management Business Analyst portal

The Business analyst portal is designed for application users that are responsible for business configuration(s). The dashboard in this portal shows a list of entities that a business user can configure. The main use of the wizard driven approach is to configure elements pertinent to a Care Plan. Clicking on an entity shows records associated with that category. Users can view the configuration and modify (update/delete) it as required. The configuration changes made in the BA portal are immediately reflected for the new work items in the CM portal.

Additionally, users can make changes to the rules delegated to the business users for real time updates in production. Users can access such rules from the “My rules” section at the bottom of the screen.

Utilization Management Service Manager portal - Dashboard

The left navigation menu for the Utilization Management (UM) portal is similar to that of the CM portal. The fundamental difference between these two types of portals is that CM portals are designed for the application users involved in the care management area of work, whereas UM portals are designed for the application users that are responsible for taking care of the utilization management area of patient care.

The application dashboard in this portal lists four charts related to the utilization management (auth/admission) with the chart actions available.

UM Service Manager portal – Worklist

The Worklist area in the UM portal is also divided into two parts and works the same as in the CM portal. Users can launch their utilization management work from “My work” and work on any meeting from “My Meetings”.

UM Service Manager portal – Reports

The default view in this portal displays reports related to utilization management, but the user could choose another category of report from the right-hand side bar and access reports associated to the category.

UM Service Coordinator portal

The UM Service Coordinator portal is designed for the application users responsible for coordinating utilization management area of patient care such as coordinating reviews, discharge planning, post discharge follow-up, and so on.

Interaction portal

This portal is designed for care coordinators or customer service representatives responsible for handling the customer interactions and is feasible to handle to both Inbound and outbound call. Customer service representatives handle queries, update demographic details, record any complaints or compliments, schedule any appointments, and send correspondence as per the request from patient. CSR’s can also handle calls from practitioners and create referrals for program in the system, which will be routed to care managers for review.

Survey management landing page

The survey management landing page is used to create questionnaire with components, such clinical measurements for creating assessments that can be associated to different types of programs that will be used to evaluate patients or providers. For example, an HRA (Health Risk Assessment) is usually provided to all new enrollees of a health plan. The Survey management landing page can be launched from Dev Studio > Case Management > Survey. This portal allows users to configure assessments, questions, and components to capture the various measurements, associated answers, and questions tree based on business requirements.

Integration and data model Landing Page

The Integration designer is intended to create efficiencies and ease of integrations.  The page provides System of Record information and easy access to the data pages needed for the integration.

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