Sample components included with the Pega Customer Relationship Management for Healthcare suite
The distribution media for the Pega® Customer Relationship Management for Healthcare suite of applications has a shared application that includes sample access groups, sample integration rulesets, and Pega Foundation for Healthcare rulesets. It also includes sample applications with sample operators.
Shared applications structure
Pega Customer Service for Healthcare and Pega Sales Automation for Healthcare include an integration ruleset that is built on a shared customer relationship management for healthcare application. To use the Pega Marketing application, install that application separately.
The following image illustrates the rulesets in the Pega Customer Relationship Management for Healthcare suite of applications.
PegaCRMBase is a shared application that contains shared rulesets such as PegaCRMBase, PegaFW-NewsFeed, and MKT-Integration:
- The PegaCRMBase ruleset contains rules such as properties, data pages, when rules, and classes that can be reused by the Pega Customer Service and Pega Sales Automation applications.
- The MKT-Integration integration ruleset contains REST services, data pages, classes, and properties that are used to connect to the Pega Customer Decision Hub application.
- The PegaFW-NewsFeed ruleset contains RSS features that are shared by the Pega Customer Service and Pega Sales Automation applications.
Access groups
In a Pega Customer Relationship Management for Healthcare configuration, applications include the following access groups.
| Access Group | Application rule | Description |
|---|---|---|
| CSHC:SysAdmin | PegaCSHCSample | System Administrator: For Pega Customer Service for Healthcare users with system administrator responsibilities. Provides access to Dev Studio and the Interaction Portal. |
| CSHC:CSR | PegaCSHCSample | Customer Service Representative: For Pega Customer Service for Healthcare users with customer service representative responsibilities. Provides access to the Interaction Portal. |
| CSHC:MGR | PegaCSHCSample | Customer Service Manager: For Pega Customer Service for Healthcare users with customer service manager responsibilities. Provides access to the Interaction Portal. |
| SPMHC:SysAdmin | PegaHCSPM | System Administrator: For Pega Sales Automation for Healthcare users with system administrator responsibilities. Provides access to Dev Studio and the Sales Manager, Sales Rep, and Sales Ops portals. |
| SPMHC:SalesManager | PegaHCSPM | Sales Manager: For Pega Sales Automation for Healthcare users with sales manager responsibilities. Provides access to the Sales Manager portal. |
| SPMHC:SalesRep | PegaHCSPM | Sales Representative: For Pega Sales Automation for Healthcare users with sales representative responsibilities. Provides access to the Sales Rep portal and the Sales Automation Outlook Portal for MS Outlook integration. |
| SPMHC:LocalSalesOp | PegaHCSPM | Sales Operations: For Pega Sales Automation for Healthcare users with sales operation responsibilities. Provides access to the Sales Ops portal. |
| SPMHC:BrokerAdmin | PegaHCSPM | Broker Administrator: For Pega Sales Automation for Healthcare users who administer brokers and agencies. Provides access to the SPM Broker Admin portal. |
| SPMHC:BrokerOps | PegaHCSPM | Sales Broker: For Pega Sales Automation for Healthcare users who are brokers. Provides access to the Broker Admin portal. |
| SPMHC:AssistantOps | PegaHCSPM | Sales Assistant: For Pega Sales Automation for Healthcare users who assist brokers. Provides access to the Broker Admin portal. |
| SPMHC:AgencyOwnerOps | PegaHCSPM | Sales Agency Owner: For Pega Sales Automation for Healthcare users who represent a sales agency. Provides access to the Broker Admin portal. |
| SPMHC:RenewalRep | PegaHCSPM | Renewal Rep: For Pega Sales Automation for Healthcare users with renewal responsibilities. Provides access to the Renewal User portal. |
| SPMHC:FulfillmentUser | PegaHCSPM | Sales Fulfillment users: For Pega Sales Automation for Healthcare users with fulfillment responsibilities. Provides access to the Fulfillment User portal. |
| SPMHC:Underwriter | PegaHCSPM | Sales underwriter: For Pega Sales Automation for Healthcare users with underwriting responsibilities. Provides access to the Underwriting portal. |
Integration rulesets
Pega Customer Service for Healthcare and Pega Sales Automation for Healthcare include the following integration rulesets to support Pega Customer Relationship Management for Healthcare use cases:
- SAHCforCSHC –This ruleset is available in the Pega Customer Service for Healthcare application, and it contains overridden rules from Pega Sales Automation for Healthcare. The overridden rules are harnesses, data transforms, data pages, and sections that are required to present the Pega Sales Automation for Healthcare cases in the Pega Customer Service for Healthcare Interaction Portal.
- CSHCforSAHC – This ruleset is available in the Pega Sales Automation for Healthcare application, and it contains overridden rules from Pega Customer Service for Healthcare. The overridden rules are harnesses, data pages, data transforms, and sections that are required to present the Pega Customer Service for Healthcare cases in the Pega Sales Automation for Healthcare portals.
For information about creating a new integration ruleset, see "Creating integration rulesets" in the Pega Customer Service for Healthcare Implementation Guide on the Pega Customer Service for Healthcare product page and the Pega Sales Automation for Healthcare Implementation Guide on the Pega Sales Automation for Healthcare product page.
Pega Foundation for Healthcare application
Pega Foundation for Healthcare is a shared application that contains the following application layers and rulesets.
| Layer | Ruleset | Description |
|---|---|---|
| PegaHC — Healthcare Foundation application layer | ||
PegaHC-API Healthcare API ruleset | This ruleset contains rules that are related to the healthcare REST APIs, which are available in the foundation. For additional details, see the Healthcare API Technical Specifications on the Pega Foundation for Healthcare product page. | |
| PegaHCLP – Healthcare Foundation Landing Pages | This ruleset contains rules that are associated with the landing page, which is available with the foundation. The landing page provides access to custom configuration settings that are specific to the foundation. Use this landing page to indicate the name and version of the ruleset that is created to hold instances of custom code groups. For more information about code groups, see the Healthcare Common Codes Business Use Case Guide on the Pega Foundation for Healthcare product page. | |
PegaHC-PCS-Foundation Healthcare Product Benefit Foundation ruleset | This ruleset contains all foundational rules (classes, properties, and accelerator work objects) that are associated with the healthcare plan, product, and benefit infrastructure that was enhanced in Pega Product Composer System. | |
PegaPCS-Foundation Healthcare Product Benefit Foundation ruleset | This ruleset contains generic rules for generic products. | |
PegaHCEDI HIPAA X12 EDI Message Solution ruleset | This layer contains the rules for processing two paired request-response X12 messages for Eligibility Request and Response (270/271) and Claim Status Request and Response (276/277). It uses the X12 processing layer for accepting and parsing an inbound X12 270 and 276 messages. The functionality supports the new 5010 version of the X12 EDI Standard. | |
PegaHCAGM Appeals and Grievance Management | This layer manages complaints that are received from members and other interested parties (authorized representatives, providers, and third parties such as independent review entities). It provides the capability to create, manage, and resolve new cases for both appeals and grievances. | |
PegaHC Healthcare Foundation Layer | This ruleset contains the main healthcare object model that provides the enterprise foundation for Pega healthcare solutions. | |
PegaHC-EWS Healthcare Exchange Web Services Integration ruleset | This ruleset contains the rules that support the integration with Microsoft Outlook Exchange Web Services for creating and maintaining Microsoft Outlook appointments. | |
PegaHL7 HL7 Message Processing ruleset | PegaHL7 ruleset supports v2.2 and 2.3 of the messaging standard and is configured to support the real-time and batch intake of Admission Discharge Transfer (ADT) messages (events) and map the different events to a work object for processing. The system also generates an acknowledgment message for each event. | |
PegaHC-FV Language Localization Field Values ruleset | This ruleset contains field value rules that support language localization. | |
| PegaX125010 – HIPAA X12 5010 Messaging Application Layer | PegaX125010 HIPAA X12 5010 Messaging ruleset | This ruleset contains rules that support the intake and parsing of HIPAA X12 5010 transactions. |
PegaX12 X12 Messaging Common ruleset | This ruleset contains common rules that support X12 message transactions. | |
PegaX125010-FV Language Localization Field Values ruleset | This ruleset contains field value rules that support language localization. | |
| PegaHealthCodes – Healthcare Code Set Management Application Layer | ||
PegaHealthCodeGroups Healthcare Custom Code Group Management ruleset | This ruleset contains rules and instances of custom code groups that are created by using the codes management capability in the foundation. | |
PegaHealthCodes Healthcare Common Code Set Management ruleset | This ruleset contains rules to maintain common healthcare code sets. | |
HCIF-UI Pega Healthcare Applications Common UI Foundation Layer | This ruleset contains the UI skin and other rules that support healthcare applications. | |
UI Kit Pega 7 Common UI Foundation ruleset | This ruleset contains common UI foundation rules of the Pega Platform. | |
PegaHealthCodes-FV Language Localization Field Values ruleset | This ruleset contains field value rules that support language localization. |
Sample applications
Pega Customer Service for Healthcare and Pega Sales Automation for Healthcare include sample applications. The sample application for Pega Customer Service for Healthcare has the Customer Relationship Management for Healthcare stub rules overridden to support Customer Relationship Management for Healthcare use cases. It contains sample data such as dialogs and data transforms for demonstration purposes. The sample application for Pega Sales Automation for Healthcare allows you to demonstrate the features of the application. The sample application package contains sample operators for each role types (sales manager, sales reps, brokers, underwriters, and brokers). It also includes sample data for you to easily test different features of the application.
Sample operators
In previous releases of Pega Customer Relationship Management for Healthcare, the applications included the sample operators that are listed below. In Pega Customer Relationship Management for Healthcare 8.1, operators are no longer shipped with the products.
| Login/password | Default application | Usage |
|---|---|---|
Ronald Vaughan/install | PegaCSHCSample | A Pega Customer Service for Healthcare user with permission to switch between Pega Sales Automation for Healthcare and Pega Customer Service for Healthcare |
CSHCCSR/install | PegaCSHCSample | A customer service representative with access to the Interaction Portal |
CSHCSysAdmin/install | PegaCSHCSample | A Pega Customer Service for Healthcare system administrator with access to Dev Studio, Interaction, Account Manager, and Back Office Operations portals |
CSHCMgr/install | PegaCSHCSample | A Pega Customer Service for Healthcare manager with access to the Interaction Portal |
TerryAlbert | SPMHC_Sample:Underwriter | An underwriter with access to the Underwriting portal |
| MeganMoore | SPMHC_Sample:SalesRep | A sales representative with access to the Sales Rep portal and Marketing functions to manage campaigns |
| KarenFoster | SPMHC_Sample:SalesRep | A sales representative with access to the Sales Rep portal |
| PaulSimmons | SPMHC_Sample:SalesManager | A sales operations manager with access to the Sales Manager portal |
| TomRiddle | SPMHC_Sample:RenewalRep | A renewal representative with access to the Renewal User portal |
LauraGrant | SPMHC_Sample:LocalSalesOps | A sales operations manager with access to the Sales Ops portal |
CristyBoyer | SPMHC_Sample:BrokerOps | A broker user with access to the New Broker portal |
ThomasCollard | SPMHC_Sample:BrokerAdmin | A broker administrative user with access to the Broker Admin portal |
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