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Generating SBC documents for many products and plans at once

Updated on April 12, 2021

You can generate SBC documents for many products and plans at the same time.

For example, you might use the SBC mass generation feature to:

  • Generate SBC documents for products or plans without previously-generated SBC documents.

    In this example, on the Configure SBC page, you select the SBC template, products, or plans. You do not need to select the networks. The document generation process uses the selected SBC template and the networks that are in the respective products or plans.

  • Re-generate the SBC documents for products or plans with previously-generated SBC documents that need to be modified.

    For example, you might you want to change the network name from In Network to Participating Network in the SBC document. You need to select the modified SBC template and configure the network section in the SBC mass generation inputs section on the Document generation page.

  • Re-generate the SBC documents for selected products and plans.

    In this example, you can skip the selection of the SBC template and the networks if the selected products and plans already have an associated template. You might need to re-generate the SBC documents if you implemented cost shares changes such as copay or coinsurance in the plans.

Pega Product Composer for Healthcare
Before you begin:
  • Create an SBC template. For information about creating templates, see Creating an SBC template.
  • Enable SBC. Otherwise, you are unable to generate documents. For more information about enabling SBC, see Enabling SBC operation in the Prerequisites section.
  • Configure the default locale in the operator ID record of the user who initiates the SBC mass generation process. This value determines the currency symbol for the values in an SBC document that is generated by using the SBC mass generation process.
  1. In the header of Dev Studio,click Launch portalProduct Development.
  2. In the left navigation pane, click Process EntitiesUpdate.
  3. On the Update page, click the SBC Generation tab.
  4. Click Generate SBC.
  5. To enter the SBC mass generation parameters, on the Configure SBC page, complete the following steps:
    Note: If you do not perform this step, the system uses the SBC templates that are associated with the individual entities.

    If you do not select an SBC template and the selected product or plan does not have an SBC template, you cannot proceed with document generation.

    1. In the SBC template field, click and enter the name of the approved SBC template that you want to use.
      If you use a resolved or deleted SBC template, and if the template has been resolved or deleted after you configured mass generation and before the document generation, the document generation process continues and entities are updated.
    2. In the Network/In network field, click and enter the name of the network to which you are applying the template.
    3. In the Network Name field, change the name to the text that you want displayed.
    4. For each network to which you want to apply the template, repeat steps 5.b and 5.c
  6. Expand the Products tab, and then click Add products.
  7. In the Add products dialog box, search for your products:

    You must select at least one product or plan.

    1. In the Add products dialog box, enter text in the fields, including the new Last updated on or after and Last updated on or before date fields, to search for your products.
    2. In the search results, select the approved products that you want to update.
      If you use resolved or rejected entities, and if the entities were resolved or rejected after you configured mass generation and before the document generation, the mass generation process is stopped for those entities with errors. You cannot correct those errors because the entities are resolved.

      If you update the SBC template that is associated with a product while the child plan is inflight, and changes were made to the plan, there might data integrity issues. An error is generated.

    3. Display the name of the plan that uses the product by clicking the arrow next to the product name.
      By default, all the child plans are automatically selected. Based on your needs, you can clear the check boxes for plans that you do not want. Selected products and child plans are locked. For more information about locking, see Locking entities.
    4. Click Submit.
  8. To add plans, expand the Plans tab by clicking the arrow, and then click Add plans.
  9. In the Add plans dialog box, search for your plans:

    You must select at least one product or plan.

    1. In the Add plans dialog box, enter text in the fields, including the new Last updated on or after and Last updated on or before date fields, to search for your plans.
    2. Select the approved plans that you want to use.
      Selected plans and parent products are locked. For more information about locking, see Locking entities.
    3. Click Submit.
  10. On the Configure SBC page, review your selections, and then click Save.
    Result: If you have duplicate plans listed in the Product and Plan sections, an error is generated when you submit your work.
  11. Click Submit.
    Result:

    After you submit your work, the case status is Pending-Approval, and the case is routed to the manager work list.

    All selected and dependent entities are locked until the manager performs some action.

    The manager can perform the following actions on the work:

    Approve
    Approves and submits the work for document generation with the provided configuration. All entities continue to be locked.

    If the document generation is approved, the manager enters a note and submits the approval. The status is Pending-Process.

    Send for rework
    Sends it back for rework. Locks on the entities are released.
    Reject
    Rejects the document generation and no further action is taken. Locks on the entities are released.
    Withdraw
    Withdraws the request and no further action is taken. Locks on the entities are released.

Tags

Pega Product Composer for Healthcare 8.6

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