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Pega Customer Service for Healthcare reports
Pega Customer Service for Healthcare includes the core Pega Customer Service reports and the additional reports that are listed in the following tables.
Clinical Services reports
| Report name | Rule name | Report description |
|---|---|---|
| Patient Program Enrollment Requests - Current Month | ProgramEnrollmentsByCategoryForCurrentMonth | For the current month, a breakdown of program enrollment requests during patient interactions that are grouped by by program type. |
| Patient Program Enrollment Requests - Previous Month | ProgramEnrollmentsByCategoryForPreviousMonth | For the previous month, a breakdown of program enrollment requests during patient interactions that are grouped by program type. |
| Provider Authorization Requests - Current Month | AuthorizationRequestsByRequestTypeForCurrentMonth | For the current month, a breakdown of patient program enrollment requests that are grouped by program type. |
| Provider Authorization Requests - Previous Month | AuthorizationRequestsByRequestTypeForPreviousMonth | For the previous month, a breakdown of patient program enrollment requests that are grouped by program type. |
| Provider Program Enrollment Requests - Current Month | ProgramEnrollmentsByCategoryForCurrentMonth | For the current month, a breakdown of program enrollment requests during provider interactions that are grouped by program type. |
| Provider Program Enrollment Requests - Previous Month | ProgramEnrollmentsByCategoryForPreviousMonth | For the previous month, a breakdown of program enrollment requests during provider interactions that are grouped by program type. |
Member Services reports
| Report name | Rule name | Report description |
|---|---|---|
| Benefits Inquiries-Dental-Current Month | BenefitInquiriesByCurrentMonth | For the current month, the number of member eligibility inquiries on dental policies that are grouped by benefit. |
| Benefits Inquiries-Dental-Previous Month | BenefitInquiriesByPreviousMonth | For the previous month, the number of member eligibility inquiries on dental policies that are grouped by benefit. |
| Benefits Inquiries-Medical-Current Month | BenefitInquiriesByCurrentMonth | For the current month, the number of member eligibility inquiries on medical policies that are grouped by benefit. |
| Benefits Inquiries-Medical-Previous Month | BenefitInquiriesByPreviousMonth | For the previous month, the number of member eligibility inquiries on medical policies that are grouped by benefit. |
| Cases By Channel - Add Newborn - Current Month | ServiceCasesByChannelCurrentMonth | For the current month, the number of resolved Add Newborn cases that are grouped by channel. |
| Cases By Channel - Add Newborn - Previous Month | ServiceCasesByChannelPreviousMonth | For the previous month, the number of resolved Add Newborn cases that are grouped by channel. |
| Cases By Channel - Dispute Claim For Member - Current Month | ServiceCasesByChannelCurrentMonth | For the current month, the number of resolved Dispute Claim For Member cases that are grouped by channel. |
| Cases By Channel - Dispute Claim For Member - Previous Month | ServiceCasesByChannelPreviousMonth | For the previous month, the number of resolved Dispute Claim For Member cases that are grouped by channel. |
| Cases By Channel - Find Provider - Current Month | ServiceCasesByChannelCurrentMonth | For the current month, the number of resolved Find Provider cases that are grouped by channel. |
| Cases By Channel - Find Provider - Previous Month | ServiceCasesByChannelPreviousMonth | For the previous month, the number of resolved Find Provider cases that are grouped by channel. |
| Cases By Channel - Order ID Card - Current Month | ServiceCasesByChannelCurrentMonth | For the current month, the number of resolved Order ID Card cases that are grouped by channel. |
| Cases By Channel - Order ID Card - Previous Month | ServiceCasesByChannelPreviousMonth | For the previous month, the number of resolved Order ID Card cases that are grouped by channel. |
| Cases By Channel - Update Member Address - Current Month | ServiceCasesByChannelCurrentMonth | For the current month, the number of resolved Update Member Address cases that are grouped by channel. |
| Cases By Channel - Update Member Address - Previous Month | ServiceCasesByChannelPreviousMonth | For the previous month, the number of resolved Update Member Address cases that are grouped by channel. |
| Cases By Channel - Update PCP - Current Month | ServiceCasesByChannelCurrentMonth | For the current month, the number of resolved Update PCP cases that are grouped by channel. |
| Cases By Channel - Update PCP - Previous Month | ServiceCasesByChannelPreviousMonth | For the previous month, the number of resolved Update PCP cases that are grouped by channel. |
| Cases By Channel - Update Privacy Settings - Current Month | ServiceCasesByChannelCurrentMonth | For the current month, the number of resolved Update Privacy Settings cases that are grouped by channel. |
| Cases By Channel - Update Privacy Settings - Previous Month | ServiceCasesByChannelPreviousMonth | For the previous month, the number of resolved Update Privacy Settings cases that are grouped by channel. |
| Cases By Channel - View Benefits - Current Month | ServiceCasesByChannelCurrentMonth | For the current month, the number of resolved View Benefits cases that are grouped by channel. |
| Cases By Channel - View Benefits - Previous Month | ServiceCasesByChannelPreviousMonth | For the previous month, the number of resolved View Benefits cases that are grouped by channel. |
| Member Service Cases - Current Month | MemberServiceCasesCurrentMonth | For the current month, the number of member service cases that were resolved. |
| My Member Service Cases - Current Month | MyMemberServiceCases | For the current month, the number of member service cases that were opened by the operator and resolved. |
Provider Services reports
| Report name | Rule name | Report description |
|---|---|---|
| Benefits Inquiries-Dental-Current Month | BenefitInquiriesByCurrentMonth | For the current month, the number of provider eligibility inquiries on dental policies that are grouped by benefit. |
| Benefits Inquiries-Dental-Previous Month | BenefitInquiriesByPreviousMonth | For the previous month, the number of provider eligibility inquiries on dental policies that are grouped by benefit. |
| Benefits Inquiries-Medical-Current Month | BenefitInquiriesByCurrentMonth | For the current month, the number of provider eligibility inquiries on medical policies that are grouped by benefit. |
| Benefits Inquiries-Medical-Previous Month | BenefitInquiriesByPreviousMonth | For the previous month, the number of provider eligibility inquiries on medical policies that are grouped by benefit. |
| Cases By Channel-Appeal Prior Auth-Previous Month | ServiceCasesByChannelPreviousMonth | For the previous month, the number of resolved Appeal Prior Authorization cases that are grouped by channel. |
| Cases By Channel-Determine Medicare Primacy-Current Month | ServiceCasesByChannelCurrentMonth | For the current month, the number of resolved Determine Medicare Primacy cases that are grouped by channel. |
| Cases By Channel-Determine Medicare Primacy-Previous Month | ServiceCasesByChannelPreviousMonth | For the previous month, the number of resolved Determine Medicare Primacy cases that are grouped by channel. |
| Cases By Channel-Dispute Claim Payment/Denial-Current Month | ServiceCasesByChannelCurrentMonth | For the current month, the number of resolved Dispute Claim Payment/Denial cases that are grouped by channel. |
| Cases By Channel-DisputeClaimPayment/Denial-Previous Month | ServiceCasesByChannelPreviousMonth | For the previous month, the number of resolved Dispute Claim Payment/Denial cases that are grouped by channel. |
| Cases By Channel-Request Prior Authorization-Current Month | ServiceCasesByChannelCurrentMonth | For the current month, the number of resolved Request Prior Authorization cases that are grouped by channel. |
| Cases By Channel-Request Prior Authorization-Previous Month | ServiceCasesByChannelPreviousMonth | For the previous month, the number of resolved Request Prior Authorization cases that are grouped by channel. |
| Cases By Channel-Review Member Benefits-Current Month | ServiceCasesByChannelCurrentMonth | For the current month, the number of resolved Review Member Benefits cases that are grouped by channel. |
| Cases By Channel-Review Member Benefits-Previous Month | ServiceCasesByChannelPreviousMonth | For the previous month, the number of resolved Review Member Benefits cases that are grouped by channel. |
| Cases By Channel-Update Address-Current Month | ServiceCasesByChannelCurrentMonth | For the current month, the number of resolved Update Address cases that are grouped by channel. |
| Cases By Channel-Update Address-Previous Month | ServiceCasesByChannelPreviousMonth | For the previous month, the number of resolved Update Address cases that are grouped by channel. |
| Cases By Channel-Update Prac Credentials-Current Month | ServiceCasesByChannelCurrentMonth | For the current month, the number of resolved Update Practitioner Credentials cases that are grouped by channel. |
| Cases By Channel-Update Prac Credentials-Previous Month | ServiceCasesByChannelPreviousMonth | For the previous month, the number of resolved Update Practitioner Credentials cases that are grouped by channel. |
| Cases By Channel-Update Prac NPI-Current Month | ServiceCasesByChannelCurrentMonth | For the current month, the number of resolved Update Practitioner NPI cases that are grouped by channel. |
| Cases By Channel-Update Prac NPI-Previous Month | ServiceCasesByChannelPreviousMonth | For the previous month, the number of resolved Update Practitioner NPI cases that are grouped by channel. |
| Cases By Channel -Appeal Prior Auth- Current Month | ServiceCasesByChannelCurrentMonth | For the current month, the number of resolved Appeal Prior Authorization cases that are grouped by channel. |
| My Provider Service Cases - Current Month | ProviderServiceCasesCurrentMonth | For the current month, the number of resolved provider service cases. |
| Provider Service Cases - Current Month | MyProviderServiceCases | For the current month, the number of provider service cases that were opened by the operator and resolved. |