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Access Roles

Updated on April 12, 2021

The following pre-configured Access Roles are provided for managing access to the processes included in the Pega Foundation for Healthcare:

Pega Foundation for Healthcare Product Overview

Role nameDescription
Core Foundation Application including Codes Management
View_VIP_PII

End user role with access to sample data portal with privileges to view VIP member data and WITHOUT privileges to view Employee member data. (Used to see Member Data Masking)

View_Emp_PII

End user role with access to sample data portal with privileges to view Employees member data and WITHOUT privileges to view VIP member data. (Used to see Member Data Masking)

CodeManager

Code manager role with access to Healthcare Codes Management portal to create and maintain code sets and custom code groupings.

Appeals and Grievances Management Application
AGManagerAGM overall manager role with access to AGM manager portal with visibility into reporting dashboard, team members, and work baskets for all AGM cases. Can perform managerial functions like transferring work from one team member / workbasket to another.
AGCoordinatorAGM Coordinator role with access to AGM user portal to perform AGM case intake.
AGAssistantAGM Assistant role with access to AGM user portal to perform AGM case intake.
CLMCoordinator

AGM Claims Manager role with access to AGM manager portal with visibility into reporting dashboard, team members, and work baskets. Can perform managerial functions like transferring work from one team member/workbasket to another for complaint cases routed for claims review.

MedicalDirectorAGM medical director role with access to AGM manager portal with visibility into cases routed for medical director review.
MRUCoordinatorAGM Member Research role with access to AGM manager portal with visibility intoreporting dashboard, team members, and work baskets. Can perform managerialfunctions like transferring work from one team member/workbasket to another forcomplaint cases routed for member research.
PNSCoordinator

AGM Provider Network Services role with access to AGM manager portal with visibility into reporting dashboard, team members, and work baskets. Can perform managerial functions like transferring work from one team member/workbasket to another for complaint cases routed for provider research.

QICoordinator

AGM Quality Improvement role with access to AGM manager portal with visibility into reporting dashboard, team members, and work baskets. Can perform managerial functions like transferring work from one team member/workbasket to another for complaint cases routed for quality audit.

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