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Updating benefit sets

Updated on January 26, 2021

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.

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Before you begin:

Selecting benefit sets and target actions

Select your benefit sets and the target actions.

  1. Click Add benefit sets.
  2. 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.
  3. 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    • Red - Withdrawn or rejected
  4. Click Continue.
  5. 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.
  6. 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.
  7. To select actions for other selected benefit sets, repeat steps 5 and 6.
  8. 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.

  1. On the Smart Update page, click Refresh.
  2. In the Assignments section, click Begin, and then either correct errors in your entity selection or create your benefit set.
    Create the benefit set
    1. 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.

    2. Close the benefit set-specific information window.
    3. Repeat steps 1 and 2 for each benefit set.
    4. Click Submit.
    5. Complete Configuring the benefit sets in this section.
    Correct the benefit set errors
    1. Hover over the Warning icon next to the benefit set.
    2. Determine whether you want to withdraw or fix the error.
    3. 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:
      1. Click Actions Withdraw.
      2. If Withdraw is not an available action, on the Actions menu, click Review, and then click Actions again.

        Withdraw is now an available option.

    4. 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.
    5. 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.

      For more information, see Entity configuration.

Configuring metadata for your benefit set

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.

  1. On the Configure benefit sets page, click the Configure Metadata tab, and then click Add benefit set batch.
  2. To rename the default batch name, click the Edit icon, and then enter a new name.
  3. If you want to copy the batch data from another batch, click the Copy batch data icon, and then choose an already configured batch.
  4. Expand the batch.
  5. On the right side of the page, click the Add link.
  6. 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.
  7. 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.
  8. In the Edit benefit set metadata window, complete the fields, and then click Submit.
  9. Repeat steps 1 through 8 for each metadata batch.
  10. 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.

  1. On the Assignments page, click Begin.
  2. On the Configure benefit sets page, click the Configure content - Individual tab, and then click Add benefit set.
  3. In the Select benefit sets dialog box, select the check box for each benefit set that you want to change, and then click Submit.
  4. On the Configure benefits sets page, at the end of the row of a benefit set, click the Configure benefit set icon.
  5. 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.
  6. Click Submit.
  7. Repeat steps 2 through 6 for each benefit set that you are configuring with unique changes.
  8. 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.

  1. On the Assignments page, click Begin to configure the benefit sets.
  2. On the Configure benefit sets page, click the Configure content – Batches tab.
  3. Add the batch by clicking Add benefit set batch.
  4. To rename the default batch name, click the Edit icon, and then enter a new name.
  5. If you want to copy the batch data from another batch, click the Copy batch data icon, and then choose an already configured batch.
  6. Click the arrow to the left of the batch name to expand it.
  7. On the right side of the page, click the Add link.
  8. Select the benefit sets, and then click Submit.
  9. Make changes to the content for the selected benefit sets by clicking Define content.
  10. 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.
  11. Click Submit.
  12. Repeat steps 3 through 11 for each batch.
  13. 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.

  1. On the Smart Update page, click Refresh.
  2. On the Assignments page, click Begin.
  3. 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.

  1. On the Review page, click ActionsApprove benefit sets.
  2. 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.
  3. On the Assignment page, click Begin.
  4. 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 nameClassDescription
ValidateSUBSModelTypeApplicabilityEXTRule-HC-PCS-BenefitSet Use this data transform to validate the applicability of the model type based on the target action and the system configuration.
CreateBenefitSetEXTPegaPCS-HC-USA-Work-SmartUpdateUse this activity to add or copy more properties or include more validations when creating a benefit set
SUBSMetaDataClientConfigurationSUBSMetaDataClientConfigurationUse this section rule to define any implementation-layer metadata properties.
EditSUBSMetadataPostEXTEmbed-HC-PCS-SUBatch Use this data transform to validate and copy any implementation-layer properties for metadata in the benefit set.
ConfigureIndBenefitSetContentPreEXTRule-HC-PCS-BenefitSet Use this activity to add implementation-layer properties to display in the dialog box for the Configure content - individual benefit set.
ConfigureIndBenefitSetContentPostEXTRule-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.
ConfigureBenefitSetContentPostEXTEmbed-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.
ValidateBenefitSetsEXTRule-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_EXTRule-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.

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