This section provides an overview of Pega Customer Service for Healthcare and shows the application stack.
Pega Customer Service for Healthcare
Pega Customer Service for Healthcare is purpose-built for the following types of contact centers:
- Member Services
Enables healthcare organizations to service health plan members. They can access case types to update contact and member information, find a provider or update the member PCP, view member benefits, and record member information for use in coordination of benefits.
- Provider Services
Enables healthcare organizations to service medical providers, such as physicians, practice staff, and healthcare system personnel. They can access case types to update practitioner information and hospital admittance privileges, handle authorization requests and denials, and answer claims questions.
- Patient Services
Enables healthcare organizations with capabilities for patient care and engagement. They can access case types to schedule and manage medical appointments, remind patients of their medical appointments, and assist patients who are having difficulty with their medical expenses.
When you create your application by running the New Application wizard, you have the option to select one or more of three bundles based on your implementation of contact centers. You select the bundle that matches the contact center type for which you are implementing Pega Customer for Healthcare. Based on your selection, you can access different case types, display different composites, and have different default access groups. After you run the New Application wizard and select Patient Services, for example, you get operators based on the default access group that is related to Patient Services.
Pega Customer Service for Healthcare application stack
All Pega healthcare applications are built on Pega Foundation for Healthcare, which contains the healthcare data model.