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Updating plans

Updated on January 26, 2021

From the Review updated products page, click Continue to plans. Search for the plans that you want to update. You might update the plans that were based on the products that you updated in the Product update section. From the search results, select the plans that you are updating.

Just as in the product updates, you can select one of the following target actions and apply it to the plans that you are updating:

  • Update an existing plan
  • Replicate an existing plan

    Replicating an existing plan means that you are creating a new plan that you copied from an existing plan. After the replication, the replicated plan is no longer connected to the existing plan.

  • Create a new version of an existing plan

Changes that you made in the products are inherited by the plan, except for any value that is overridden in the plan. Then the plan does not inherit the product change. This process follows the current Pega Product Composer for Healthcare inheritance pattern.

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Selecting plans and target actions

Determine which target actions you are applying to your selected plans. For example, you might create a new version for the plans.

  1. Based on the order of tasks that you follow in Smart Update, complete the applicable task.
    Select plans following your product updates
    1. Optional: To add more plans for update after the initial selection, in the Search plans step, click Add plans.
    2. Click Continue to select the target actions.
    Start Smart Update with plans
    1. Open Smart Update. For more information, see Launching Smart Update in the Launching Smart Update section.
    2. In the Select an entity field, click Plan, and then click Continue.
    3. In the Search plan step, click Add plans.
    4. In the Add plans dialog box, complete the fields as needed for your search, and then click Search.

      For example, you can search for plans by the product name.

    5. In the search results list, select the plans that you want to update, and then click Submit.
    6. Optional: To add more plans to update after the initial selection, in the Selected plans section in the Search plans step, click Add plans, search for additional plans, and then click Submit.
    7. Click Continue.
  2. In the Select target action step, in the Target action list, select an action. Select only one action for your plans. Do not mix actions in the case.
  3. Select one or more plans, 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 can give your target entity a new name. When you replicate a plan, it requires that you give the plan a new name because after the replication, the replicated plan is no longer connected to the existing plan.
  4. Review the update information, and then click Finish.

Reviewing selected plans

On the Review created plans page, you can review all the information that is related to your target entity. Note any information that you want to add or modify and any items that you need to reconcile. You can make these changes in Configuring plans in this section.

  • If you are updating versions of plans, you can click the link for the target entity and review existing plan metadata, cost shares, networks, benefits, and benefit categories for the updated versions.
  • When you update a plan, the new plan receives merged information from both the parent plan and the product. In this case, you see the merged information.

Sometimes, Smart Update cannot reconcile the two sources of information because of a conflict or missing information. In that case, you must manually review and reconcile the items. For more information, see Troubleshooting.

If you have items that have conflicts because of the merged data of the product and product template, a Warning icon appears in the Manual review column of the item. Follow these steps:

  1. Click Refresh.
  2. In the Assignments section, click Begin to review your plan.
    No Warning icons displayed next to your planClick Submit.
    A Warning icon is displayed next to the plan with information for your configurationHover over the icon, note the information, and then click Submit.
    A Warning icon is displayed next to the plan with an error message
    1. Hover over the Warning icon next to the plan.
    2. Determine whether you want to withdraw or fix the error.
    3. If you do not want to modify the plan or you cannot fix the error, withdraw the smart update case.
    4. To withdraw the case:
      1. Click Actions Withdraw.
      2. If Withdraw is not an available action, click Review from the Actions menu. Then click Actions again. Withdraw is now an available option
    5. Based on the warning message, if you determine that you will fix the issue later, for example, adding data to the Market segment field, continue this Smart Update case and add the data during subsequent steps or later when it is convenient for you.
    6. If you can correct the error in the straight-through processing flow, do so and then return to the Smart Update flow to continue.
    7. To resolve errors, repeat steps 1 through 6.
  3. After completing your review, submit the entities, and then start the configuration process for Smart Update.

Configuring plans

During configuration, you might perform one or more of these tasks in any order or you might not perform any of the tasks: configure metadata, configure benefit categories, and configure coverages.

Before you begin: Review About batches in the Batches and target actions section.

Configuring plan metadata

Define the plan metadata batch by adding the plans to the batch and then selecting the metadata options that you are changing.

  1. On the Configure products page, click the Configure Metadata tab, and then click Add plan batch.
  2. Optional: 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. Click the Add plans to batch icon.
  6. In the Select plans for batch dialog box, select the plans that you want to update with this batch, and then click Submit. You can use the Filter by fields to display a subset of the selected plans. For example, if you select ten plans for update, but want to change the coverage only for Small group plans, filter by Market Segment and select only those plans for this batch.
  7. Click Define metadata to make your changes to the metadata.
    On the Edit plan metadata page, select the option that you want to change from the list on the left, and then select the action from the list on the right side of the page.

    For example, you might want to add a new coverage level, such as Employee + Children, to some plans. Another example is if you make a market segment change that applies to your 10 selected plans, for example, a change from Large Group to Small Group, you define a plan metadata batch, select all the plans, and remove the Large Group market segment. Then define another plan metadata batch, select the same plans, and add the Small Group market segment. These changes apply to all 10 plans. Some fields that where you can select multiple options, for example Coverage level, have the actions of Append, Remove, and Replace.

    Append - The value that you select is added to the existing values

    Replace - The value that you select replaces the existing value

    Remove - The value that you select is removed

  8. Complete the fields on the Edit plan metadata page, and then click Submit.

Configuring plan benefit categories

Define the benefit category batch by adding the plans to the batch and then defining the benefit categories and adding benefits.

If you change the benefit category within the Smart Update feature, Smart Update updates only existing benefit categories that come from the existing or the new plan, per your configuration in the batches.
  1. On the Configure plans page, click the Configure benefit categories tab, and then click Add plan batch.
  2. To rename the default batch name, click the Edit icon, and then enter a new name.
  3. Expand the batch by clicking the arrow.
  4. Click the Add plans to batch icon.
  5. In the Select plans for batch dialog box, select the plans that you want to update with this batch, and then click Submit.
  6. Click Define benefit categories.
    1. In the Define plan benefit categories dialog box, click Add benefit category.
    2. Enter and select a benefit category from the Benefit category list, and then click OK.
    3. In the Define benefit categories dialog box, expand the benefit category name, and then click Add.
    4. Select Benefit.
    5. Enter and select a benefit from the Benefits and Groupers list.
    6. To make the benefit the default benefit in the category, click the Set as default display icon to the right of the benefit.
      You must set one benefit in each benefit category as the default benefit.
    7. Click Submit.
    8. Repeat these steps to define additional benefit categories and benefits.
    9. When you are finished, click Submit.

Configuring plan coverages

Define the coverage batch by adding the plans to the batch and then defining the changes. You might want to change the deductibles and out-of-pocket values at the network level for your plans.

If you are changing the deductibles and out-of-pocket values at the network level, the plans in the coverages batch must have the same calculation method. If you need to change the calculation method for a plan, on the Configure Coverages tab, select Plan and then add the plans for which you want to make changes. Then you can change the calculation method and define values.
  1. On the Configure products page, click the Configure Coverages tab, and then click Add plan 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 name by clicking the arrow.
    1. In the Coverage applies to list, select the entity for which you are updating coverage within the context of the plan.
      Based on the selection in this list, different sections are displayed on this page.
    2. For this example, select Benefit.
      Note: If you are changing network coverage, on the Configure Coverages tab, select Network, and then add the networks for which you want changes. Then you can define the coverage.
  5. Expand the Select plans section of the page, and then click the Add icon to add the plans.
  6. In the Add plans dialog box, complete fields for your search, select the plans that you are updating, and then click Submit.
  7. Expand the Select plans section of the page, and then click the Add icon to add the plans.
  8. In the Add plans dialog box, complete fields for your search, select the plans that you are updating with the benefit change, and then click Submit.
  9. Expand the Select networks section of the page, and then click the Add icon to add the network names.
  10. Select the network names, and then click Submit.
  11. Click Define coverage.
  12. On the Configure coverage page, complete the updates to the coverage fields, and then click Submit.
    The default values are No Change. This means that the entity keeps the values that are already in the plan. You can also copy values of one network to another network on this page.
  13. On the Configure plans page, click Submit.
    If there are errors, fix the errors, and then submit them.
  14. Click Refresh.
  15. Click Begin.

Reviewing errors

If your plans have errors, they are displayed on the Review errors page.

  1. On the Review errors page, analyze the problems, and then click Submit.
  2. Fix the errors by creating new batches and configuring plans.

Reviewing updated plans

You can perform a review on the updated plans, for example, if you need to modify some values for a product or network or fix some errors.

For more information, see Troubleshooting.
  1. Click Reconfigure products.
  2. On the Configure plans page, create new batches.
    You add new batches (ongoing batches) for any changes that you want to make. You cannot modify the batches that you previously created because they have been submitted and processed by the system before the review. They are called processed batches.
  3. To review your existing batch values, click Review metadata.
  4. After you complete your changes to information on any of the three tabs, click Submit, and then review the plans again.

Sending the plan updates for approval

  1. On the Review updated product page, click Send for Approval.
    The approval request is routed to the manager.
  2. As the manager, on the Pega Case Manager portal, click ActionsApprove plans.
  3. On the Approve plans page, in the text box, enter an approval note in the text box, and then click Submit.
    After the background process is completed, the plan is now available in the stage that you specify in your configuration settings.

Plan extension rules

Rule nameClass
ValidateSUPlanAliasNamePegaPCS-Data-PlanUse this data transform rule to validate the AliasName for a plan. You need to have extended the rule, for example, if you want to restrict alias name across versions.
ValidateAndPopulateSUPlanVersionPegaPCS-Data-PlanUse this data transform rule to extend the out-of-the-box versioning feature for a plan.
SetvaluesonPlannodeUnionDataandBstEXTRule-HC-PCS-ProductUse this data transform rule to synchronize coverages for the display on the plan cost shares pages.
SetvalueswhenPRDandPThascoverageEXTRule-HC-PCS-NetworkUse this data transform rule to synchronize coverages or variations at the network level union data when the source and target both have union data. If the target is plan, then the source is product. If the target is product, then the source is product template.
SetvalueswhenPRDandPThascoverageforBenorGrpEXTRule-HC-PCS-Use this data transform rule to synchronize coverages or variations at the benefit- or grouper-level union data when the source and target both have union data.

If the target is plan, then the source is product. If the target is product, then the source is product template.

SyncPlnMetadataWithPrdExtPegaPCS-Data-PlanUse this data transform rule to synchronize the plan metadata with that of the product.

Use this page information for the synchronization.

PTPage refers to the product that was used in the smart update of the plan.

PlanData refers to the plan page.

ValidatePlanMetadataAfterSyncExtPegaPCS-Data-PlanUse this data transform rule to add validation to the metadata after the plan is synchronized.
ValidateInvalidBenefitCategoryContentExtPegaPCS-HC-USA-Work-SmartUpdateUse this data transform rule to add any validations to the benefit category.

BenCatBatchList is the page that holds the benefit categories.

SetProductInheritanceFlagsForPlan

InSmartUpdate_EXT

Rule-HC-PCS-If the HasActualOrgPRDRef parameter is true, use this data transform rule (this is only for plan) to copy the inheritance flags from the ActualOrgPRDPageRef product page to the Primary plan page.
SmartUpdatePlanCoverageExtensionRule-HC-PCS-ProductUse this data transform rule to extend plan level coverages by initializing the coverage page so that it displays on the page. All the initialized pages will be in the ProductPlanData page.
SUPlanCoverageEXTForNWBenGrpBenInGrpRule-HC-PCS-NetworkUse this data transform rule to extend network, benefit, grouper, or benefit within grouper-level coverages by initializing the coverage page so that it displays on the page.

This page will be the TargetNetworkList page.

Tags

Pega Product Composer for Healthcare 8.5

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