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Configuring a network

Updated on April 12, 2021

In Pega Product Composer for Healthcare, a network groups one or more provider networks, which includes hospitals, doctors, laboratories, and other healthcare centers that have a contract with a healthcare payer. When you configure a healthcare plan, you can configure a network to have high-level cost shares and variations, for example, authorizations and limits, that are inherited by the groupers and benefits in that network.

In addition to configuring a new network, you can import networks from a third-party source by using a service. For additional information, see Integration systems.

Based on your organization's needs, you can extend the metadata, as described in Extending entity metadata in the Extending the Pega Product Composer for Healthcare application section.

If needed for your business, you can add options to the network. For additional information, see Extending union data for networks in the Extending the Pega Product Composer for Healthcare application section.

Pega Product Composer for Healthcare
Before you begin: Ensure that you have configured the provider networks in Pega Foundation for Healthcare. For additional information, see the documentation on the Pega Foundation for Healthcare product page.

Also ensure that you configured benefits, benefit sets, and groupers as needed. For additional information, see Configuring a benefit, Configuring a benefit set, and Setting up a grouper.

  1. In the header of Dev Studio, click Launch portalProduct Development.
  2. In the left navigation panel of your work area, click NewNetwork.
  3. Enter a name for the network and select options from the Category list. Complete all the required fields in this step of the wizard.
    Network
    You can customize the Enter details page by configuring additional properties. For additional information, see Adding new properties to entities in the Extending the Pega Product Composer for Healthcare application section.
  4. Click Save to complete your network at a later time or Continue.
  5. In the Provider networks step, click the Add a row icon for each network that you want to add and then select it from the list.
  6. Click Save to complete your network at a later time or Continue.
  7. In the Network notes step, enter the appropriate information in the fields, and click Finish.
Result: The system forwards the case to a product manager for approval. Once the manager approves, the system creates the new network.

Tags

Pega Product Composer for Healthcare 8.6

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