Access Roles
The following pre-configured Access Roles are provided for managing access to the processes included in the Pega Foundation for Healthcare:
| Role name | Description |
| 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 | |
| AGManager | AGM 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. |
| AGCoordinator | AGM Coordinator role with access to AGM user portal to perform AGM case intake. |
| AGAssistant | AGM 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. |
| MedicalDirector | AGM medical director role with access to AGM manager portal with visibility into cases routed for medical director review. |
| MRUCoordinator | AGM 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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