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Configuring SLAs

Updated on April 23, 2021

The goal time and deadline time of the AGM cases is dependent on the line of business for the member associated to the case or parent case. The line of business is selected when a plan is selected for the member during the complaint creation. When the line of business is Medicare, Medicaid or Federal programs, the SLAs for CMS case types will be used and when the line of business is any other (for example, commercial, individual), the SLAs for Commercial case types will be used according to the table below.

Pega Foundation for Healthcare

UpdateSLAByLOB decision table defines which decision table to be called based on the Line of business. If the LOB is Medicare, “SetSLAForCMScaseType” gets executed, and if the LOB is related to commercial case type, “SetSLAForCommcaseType” will be called. These decision tables have the actual days configured. Based on the values returned from these decision tables, the goals and deadline are then calculated in “UpdateSLAByLOB” data transform based on the "True organization received date"(date on which Payer received the complete complaint details) which is captured from UI.

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