You can update existing benefit sets or use them as the base to replicate new benefit
sets or create new versions of the benefit sets. After selecting the benefit sets, you
determine which target action that you want to apply to your selected benefit sets. For
example, you might select three benefit sets to create new versions.
Pega Product Composer for Healthcare
Pega Product Composer for Healthcare
Pega Product Composer for Healthcare
Pega Product Composer for Healthcare
Pega Product Composer for Healthcare
Pega Product Composer for Healthcare
Pega Product Composer for Healthcare
Pega Product Composer for Healthcare
Pega Product Composer for Healthcare
In the Add benefit sets dialog box, complete the fields as
needed for your search, and then click Search.
For example: You can search for benefit sets by the name of the insurance line such as
Medical or any of the advanced search fields.
In the search results list, select the benefit sets that you want to update,
and then click Submit.
In the header, breadcrumbs guide you along in the process. The green flag
shows your current location, as in the following example:Smart Update breadcrumbs
The colors of the flags are as follows:
Gray - Not started
Green - In progress
Blue - Complete, but not approved
Checkered - Complete and approved
Red - Withdrawn or rejected
Click Continue.
In the Select target action step, in the
Target action list, select an action.
Note: When you choose Update existing as the target
action for your Smart Update case, do not select other target actions in the
same case. The Smart Update flow is slightly different for the
Updating existing target action than it is for the other
target actions. By following this practice, you can more easily navigate
through the Smart Update process.
Select the benefit set, complete the fields that are appropriate for your
business needs, and then click Apply. Based on the
selected target action, other fields are displayed for completion.
For example: You might give your target entity a new name when you update the benefit
set.
When you replicate a benefit set, it requires that you give the benefit
set a new name. After the replication, the replicated benefit set is no
longer connected to the existing downstream entities.
If you select Update existing as a target
action, you cannot have this benefit set approved until you complete the
Smart Update case all the way through to the plan (or to any entity that
was built from this benefit set). For example, if only product templates
have been built from this benefit set, then you must complete the
process through the product template to send the update for approval. To
maintain structural integrity, any structural changes, such as adding a
new benefit, must be followed through to the plan or any entity that is
built from this benefit set.
To select actions for other selected benefit sets, repeat steps 5 and 6.
Review the update information, and then click
Finish.
Reviewing the selected benefit sets
When the system either updates existing entities or creates or replicates new
entities, the algorithm determines whether any errors exist that you must correct before
proceeding, and then checks for warnings that are informational to you. For the warnings,
you can decide when you want to correct the issues.
On the Smart Update page, click
Refresh.
In the Assignments section, click
Begin, and then either correct errors in your entity
selection or create your benefit set.
Create the benefit set
Review each benefit set by clicking the name link in the
Benefit Sets section.
Read-only
information is displayed in the Benefit set
overview and
Structure tabs.
Close the benefit set-specific information window.
Repeat steps 1 and 2 for each benefit set.
Click Submit.
Complete Configuring the benefit sets in this
section.
Correct the benefit set errors
Hover over the Warning icon next to the
benefit set.
Determine whether you want to withdraw or fix the error.
If you do not want to modify the benefit set or you cannot fix
the error, withdraw the Smart Update case. To withdraw the
case:
Click Actions Withdraw.
If Withdraw is not an available
action, on the Actions menu,
click Review, and then click
Actions again.
Withdraw is now an
available option.
If you want to fix the issue later, for example, adding data to
the Market segment field, continue this
Smart Update case, and then add the data during subsequent steps
or later when it is convenient for you.
If you want to correct the error in the straight-through
processing flow, fix the issue, and then return to the Smart
Update flow to continue.
Define the benefit set batch by adding the benefit sets to the batch and then
selecting the metadata options that you want to change. For example, you might create a
benefit set batch that contains two benefit sets each of which has unique configuration
changes. Then you might create another batch that contains three benefit sets with the same
configuration changes.
On the Configure benefit sets page, click the
Configure Metadata tab, and then click Add
benefit set batch.
To rename the default batch name, click the
Edit icon, and then enter a new name.
If you want to copy the batch data from another batch, click the
Copy batch data icon, and then choose an already
configured batch.
Expand the batch.
On the right side of the page, click the Add link.
In the Select benefit sets for batch dialog box, select
the benefit sets for which you want to update the metadata with this batch, and
then click Submit.
Define the metadata for the batch, by clicking Define
metadata.
On the Edit benefit set metadata page, in the list on the
left side of the page, select the option that you want to change, and then
select the action.
For example: You might want to append a line of business.
In the Edit benefit set metadata window, complete the
fields, and then click Submit.
Repeat steps 1 through 8 for each metadata batch.
On the Configure benefit sets page, click
Save.
Configuring content for a single benefit set
To make different changes to several benefit sets, configure the information on this
tab, one benefit set at a time.
On the Assignments page, click
Begin.
On the Configure benefit sets page, click the
Configure content - Individual tab, and then click
Add benefit set.
In the Select benefit sets dialog box, select the check
box for each benefit set that you want to change, and then click
Submit.
On the Configure benefits sets page, at the end of the row
of a benefit set, click the Configure benefit set
icon.
In the Configure the benefit set window, based on your
business needs, make your changes:
To modify benefits or groupers in the Add benefits
and Add groupers sections, select the benefits and
groupers that you want to add, and then click
Add.
Note: You can click the Open this
item for review icon to review the structure of the
benefit or grouper to add. Close the window when you complete the
review.
In the Ranking section, adjust the order of
appearance for the benefits by clicking the up or down links.
In the Benefit set section, click
Remove next to the benefit or grouper that
you want to remove.
Click Submit.
Repeat steps 2 through 6 for each benefit set that you are configuring with
unique changes.
Do one of the following:
To configure benefits sets with the same changes, click
Save, and then go to Configuring
content in batches in this section.
If you do not want to make any further changes, click
Submit, and go to Reviewing updated
benefit sets in this section to complete your
configuration:
Go to the product template.
Get approval.
Reconfigure your benefit sets.
Configuring content in batches
Configure the changes in your benefit sets in batches if the changes that you want to
make are the same for the multiple benefit sets that you have selected. You can conveniently
modify values for multiple benefit sets in one Smart Update case.
For example, you need to add a new benefit for COVID-19 to all your benefit sets. In
one batch, you can choose each benefit set and add the new COVID-19 benefit. As a
result, every benefit set that you choose, is updated to include the COVID-19
benefit.
The new benefit is added at the end of the list of pre-existing benefits in the
ranking order. For example, if there are five benefits, the new benefit is ranked as
the sixth benefit.
On the Assignments page, click
Begin to configure the benefit sets.
On the Configure benefit sets page, click the
Configure content – Batches tab.
Add the batch by clicking Add benefit set batch.
To rename the default batch name, click the
Edit icon, and then enter a new name.
If you want to copy the batch data from another batch, click the
Copy batch data icon, and then choose an already
configured batch.
Click the arrow to the left of the batch name to expand it.
On the right side of the page, click the Add link.
Select the benefit sets, and then click Submit.
Make changes to the content for the selected benefit sets by clicking
Define content.
In the Configure benefit set content dialog box, modify
the list of benefits and groupers:
To add a benefit or grouper to the benefit set, click an item and then
complete the fields.
To remove a benefit or grouper, click the item that you want to delete.
Click Submit.
Repeat steps 3 through 11 for each batch.
Click Submit.
Reviewing updated benefit sets
If you have errors in the updated benefit sets, you need to correct them. Otherwise,
you decide on your next step such as proceeding to approval or product templates.
On the Smart Update page, click
Refresh.
On the Assignments page, click
Begin.
On the Review updated benefits sets for correct values
page, based on your business needs, decide your next steps:
To make more changes to the benefit sets, click Reconfigure
benefit sets.
To send the benefit sets for approval, click Send for
approval, and then go to Approving benefit
sets in this section.
Continue to product templates.
Note: If you updated existing benefit
sets, navigate to step 3 in Selecting product templates and
target actions in the Updating product templates section, and complete the
steps in all the sections. Product templates that were created from
the benefits sets are listed in the Add product templates
dialog box.
You cannot add other product templates or
remove any of the product templates that are already in the
list. If you created a new version or replicated an existing
version of the benefit set, you cannot add other product
templates, but you can remove product templates from the
list.
Approving benefit sets
You can approve your benefit sets before updating a product template except when your
target action is updating existing benefit sets. Perform this task so that your work is
reviewed for accuracy.
On the Review page, click ActionsApprove benefit sets.
In the Approval note field, enter your comments, and
then click Submit.
After the approver approves the assignment, you can start the next step. You
can get the assignment from your workbasket queue.
On the Assignment page, click
Begin.
Click one of the following options:
Based on your business needs, to exit after each entity is completed and
approved before you work on the next entity, click Exit Smart
Update.
For new, replicated or update existing benefit sets, click
Continue with the process, and then begin
with step 3 in Selecting product templates and target
actions in the Updating product templates
section. Product templates that were created from the benefits sets are
listed. You cannot add other product templates or remove any of the
product templates that are already in the list.
Note:
If you select Update existing as your target
action, you cannot have this benefit set approved until you complete the
Smart Update case all the way through to the plan (or to any entity that
was built from this benefit set). For example, if only product templates
have been built from this benefit set, then you must complete the
process through the product template to send the update for approval. To
maintain structural integrity, any structural changes, such as adding a
new benefit, must be followed through to the plan or any entity that is
built from this benefit set.
Benefit set extension rules
Use these rules to extend the benefit sets to meet your business needs.
Rule name
Class
Description
ValidateSUBSModelTypeApplicabilityEXT
Rule-HC-PCS-BenefitSet
Use this data transform to validate the applicability of the model
type based on the target action and the system configuration.
CreateBenefitSetEXT
PegaPCS-HC-USA-Work-SmartUpdate
Use this activity to add or copy more properties or include more
validations when creating a benefit set
SUBSMetaDataClientConfiguration
SUBSMetaDataClientConfiguration
Use this section rule to define any implementation-layer metadata
properties.
EditSUBSMetadataPostEXT
Embed-HC-PCS-SUBatch
Use this data transform to validate and copy any implementation-layer
properties for metadata in the benefit set.
ConfigureIndBenefitSetContentPreEXT
Rule-HC-PCS-BenefitSet
Use this activity to add implementation-layer properties to display
in the dialog box for the Configure content - individual benefit
set.
ConfigureIndBenefitSetContentPostEXT
Rule-HC-PCS-BenefitSet
Use this activity to save the changes that you made in the above rule
in the dialog box for the individual benefit set.
ConfigureBenefitSetContentPreEXT
Embed-HC-PCS-SUBatch
Use this data transform to add implementation-layer properties for
display in the dialog box for the batch benefit set content.
ConfigureBenefitSetContentPostEXT
Embed-HC-PCS-SUBatch
Use this data transform to save the changes that you made in the
above rule in the dialog box for all the benefit sets in the
batch.
UpdateBSMetadataEXT
Rule-HC-PCS-BenefitSet
Use this data transform to define any implementation-layer metadata
properties.
ValidateBenefitSetsEXT
Rule-HC-PCS-BenefitSet
Use this data transform to add more validations to the benefit sets,
for example, restriction of Vision benefits to a Medical benefit set.
UpdateBaseBSWithCloneBS_EXT
Rule-HC-PCS-BenefitSet
When your target action is Update existing
version, use this data transform to save the values (any
implementation-layer properties) on the actual or base benefit
set.