With the Add Child Dependent Microjourney™, customer service representatives (CSRs) can enter and process information about newborns and adopted children that customers want to add to their healthcare plans.
Because the Add Child Dependent Microjourney is App Studio-compliant with updated stages and steps, it is easy to implement and use. Additionally, this Microjourney can be extended to meet your organization's specific needs as described in Extending the Microjourney.
The following table shows the personas and channels for each use case in this Microjourney.
|Channel and type
|Customer service representative
|Customer service representative handles customer questions or requests in a contact center through assisted channels, for example, telephone, email, and chat and messaging
|Agents intake and process the information and route it appropriately
|Subscriber to the health plan
Members can request enrollment of newborns and children
The following figure shows the stages and steps in the Add Child Dependent case type for this Microjourney. The project team can modify and extend most areas of this Microjourney in App Studio, thereby enabling healthcare organizations to Build for Change®. However, there are some exceptions in which you must extend the rules in Dev Studio.
Use the Data model page in App Studio to quickly view and understand the relationship between all data objects in the application. You can add, update, and delete data objects without exiting the visual data model. For information about the Data model page, see Data modeling. For information about connecting to external data entities, see Managing data and integrations with the Integration Designer.
The following figure shows the entity relationship diagram (ERD) for this Microjourney. For each data object, the ERD shows only the properties that apply to this Microjourney.
To open the Add Child Dependent Microjourney in App Studio, click, and then click . Extension points that must be updated in Dev Studio are noted below.
Stage 1 - Verify
In this stage, use the Capture event process only when Cassandra is used as the data store for the customer timeline gadget in the member composite, which requires a license for Pega Customer Decision Hub.
Additionally, the Check authorized contact and Plan check processes have been deprecated. These processes include business logic for which members can be serviced with this Microjourney, for example, by enabling subscribers to add child dependents, but not dependents. Pega recommends that clients extend the ShowAddNewborn when rule, which has the added benefit of only displaying the Microjourney in the menu when appropriate. Clients who are upgrading may continue to use the deprecated rules for now, but they will be removed in a future release.
An extension point has been provided so that you can modify the enrollment periods for plans. The date of birth for a newborn and the date of placement for an adopted child drive whether the dependent falls in the enrollment time limit range. You might want to extend this step to include another plan, that has a longer enrollment time limit, such as 90 days. For example, Tricare, a healthcare plan for uniformed service members, retirees, and their families around the world, has a longer enrollment time limit such as 90 days.
- In the navigation pane of Dev Studio, click .
- In the search box, enter PegaCPMHC-Work-AddNewborn.
- Update the ChildDependentEnrollmentLimit decision table to set time limits on when members can add new child dependents to their plans.
For more information about modifying the decision table, see About decision tables.
- Click the icon to the left of the Send Email step.
- In the pane on the right, complete the fields.
For example, you can configure the list of recipients who receive the acknowledgement, use a template for the acknowledgement, or customize the actual message content according to your needs. For more information, click the View contextual help icon or see Sending automatic emails from cases.
- Click .
Stage 3 - Process information
The Send correspondence process is deprecated. Pega recommends that clients extend the Send acknowledgement process in Stage 2. Clients who are upgrading may continue to use the deprecated rules for now, but they will be removed in a future release. For more information, see the Send Email step in Stage 2.
You can also modify the Assign to child dependent enrollment step in App Studio.
- Click the Assignment icon to the left of the Assign to child dependent enrollment step.
- In the right pane, click Open in Dev Studio.
- Update your flow.
For more information, see Flows.
Stage 4 - Update system of record
You can extend the Update SOR step to save data from this Microjourney to a system of record.
- Click the Utility icon to the left of the Update SOR step.
- In the right pane, click Open process, and update the flow to save your system of record in Dev Studio.
For more information, see Flows.
- Click .