Pega Foundation for Healthcare features
Pega Foundation for Healthcare (PFHC), which forms the enterprise foundation for all Pega healthcare solutions, provides a set of enterprise healthcare assets including preconfigured data models for commonly referenced healthcare objects and code sets, APIs for rapid integration with external sources of truth, and support for industry-standard electronic data interchange (EDI) standards including HIPAA X12 5010, NCPDP D.0, and HL7 FHIR. These assets along with Pega’s platform provide you an alternative for rapid configuration and deployment of CRM solutions that deliver productivity, spur growth, and ensure compliance.
The following sections describe key capabilities and features of the application that you can use as-is or extend to meet your business needs.
- Healthcare object model
- Healthcare enterprise organization structure
- Healthcare portals
- Healthcare sample data
- Healthcare object search and retrieval
- Healthcare object layouts
- Member data masking
- Member data management
- Provider data management
- Healthcare code set management
- Healthcare code group management
- Healthcare Appeals and Grievances management
- HIPAA X12 EDI message support
- Common integration REST APIs
- Common integration FHIR REST APIs
- Integration Data Pages
- EDI Eligibility Request management
- EDI Claim Status Request management
- EDI NCPDP message support
- HL7 ADT Transactions
- RxNorm Drug Data Search
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