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Configuration settings for the SBC template

Updated on January 26, 2021

These are the out-of-the-box configuration settings that can be delegated to managers who access the Product manager portal for the purpose of controlling the operation of SBC document generation.

To modify these settings, you must delegate the rules. For more information, see Delegating a rule in this section.

Pega Product Composer for Healthcare Pega Product Composer for Healthcare Pega Product Composer for Healthcare Pega Product Composer for Healthcare
Rule nameApplies toPurpose
SBCGlossaryItemToURLMappingsCode-Pega-ListThis decision table holds the mapping of the text tokens to the corresponding URLs in the CMS glossary web page. The mappings can be added or modified to synchronize with the changes made in the CMS glossary site.
SBCPolicyTypeRankingEmbed-HC-PCS-Method-ContentThis decision table rule specifies the ranking of the policy types to be considered for the deductible.
SetRoundOffForCoverageExamplesEmbed-HC-PCS-CoverageExample-IllustrationThis decision table includes the “Round off to nearest” information in 10's or 100's as specified for the auto-calculated cost-share values of coverage examples. For values other than 10 or 100, no rounding occurs.
SetTotalExampleCostValuesRule-HC-PCS-Doc-DataThis decision table holds the total cost values for each example with effective and end dates. The values are mapped in SBC according to the matching of SBC template effective and end dates.
SBCFirstPageFooterRule-HC-PCS-Doc-TemplateThis paragraph rule indicates the footer text that appears on the first page of the generated SBC PDF document.
SBCLastPageFooterRule-HC-PCS-Doc-TemplateThis paragraph rule indicates the footer text that appears on the last page of the generated SBC PDF document.
SBCMiddlePagesFooterRule-HC-PCS-Doc-TemplateThis paragraph rule indicates the footer text that appears on all the pages other than the first and last pages of the generated SBC PDF document.
SBC sample care costs

[Class: PegaPCS-Data-SBCSampleCareCosts]

N/AThis data type includes the CMS-specified sample care costs that are used as part of the auto-calculation of the final cost share values that are displayed in the various examples in the SBC document. The data type holds the service line data for each example as specified by CMS.

Delegating a rule

Delegate the rules to the appropriate managers so that they can modify settings for the operation of SBC document generation.

Members of the access group who modify the delegated rules should have the PegaRULES:WorkMgr4 role or equivalent role so that they can edit the delegated rules.

  1. Create a production ruleset in the implementation layer.
    For more information, see Creating a ruleset and a ruleset version.
  2. Add the ruleset to the access groups of the users who work on the delegated rules and to the application rule.
  3. For each rule that you want to delegate:
    1. Open the rule form from the source ruleset.
    2. Click Save as and save the rule to production ruleset.
    3. In the rule that you saved, click ActionsDelegate.
    4. From the dialog box that displays, follow the steps in Delegating a rule or data type.

Modifying the settings for the SBC rules

If you have the appropriate access role, you can configure the settings for the SBC rules.

Before you begin: You need to delegate the rules before you can modify the settings. For more information, see Delegating a rule in this section.
  1. In the header of Dev Studio, click Launch portalProduct Manager.
  2. In the left navigation pane, click Configuration.
  3. In the list of delegated rules, click Edit next to the rule that you are changing, and make your changes.

Optional: Viewing the rules in sample data

You can view the rules for reference by using the sample data.

Before you begin: For this task, you must have a reference server that is separate from the server where the current implementation layer is created.
  1. Import PCS sample data into the reference server.
    For more information, see "Importing Pega Product Composer for Healthcare sample application" in the Pega Product Composer for Healthcare Installation Guide on the Pega Product Composer for Healthcare product page.
  2. Create an operator with the HC-USA-PCS-Sample:ProductManager access group.
  3. Log in as the operator that you created in step 2.
  4. In the Case manager portal, in the left navigation pane, click Configuration.
    Result: The list of the delegated rules is displayed.
  5. For each delegated rule that you want to modify:
    1. Click Edit next to the item that you want to change.
    2. Click Check out, make the changes, and then click Save.
    3. Check in the modified rule.

Tags

Pega Product Composer for Healthcare 8.5

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