Mass update
Use the Pega Product Composer for Healthcare Mass Updates wizard to make changes
across multiple entities at one time instead of performing updates on individual entities.
You can add, update, or remove new and existing benefits and groupers within a set of
selected target benefit sets, product templates, products, and plans. Review the information in this section to determine whether you want to perform a mass
update or update entities individually. It describes how the mass update process
handles inheritance and default benefits. You can add or remove groupers and benefits or modify existing groupers and benefits
to change data such as cost shares, copayments, coinsurance, deductibles, and other
data, such as limits and authorization requirements. The data that you change for
the groupers and benefits is propagated to the targeted product templates, products,
or plans that you choose. The inheritance is maintained. For example, a new healthcare regulation requires the
addition of the new healthcare benefit, Telemedicine, to all
small group HMO and preferred provider organization (PPO)
plans. Use the Mass Updates wizard to add the benefit to all
the plans at one time. The benefit inherits the network cost
shares. The inheritance from the parent entity is broken. Changes that you make when performing a mass update overwrite
the data in the targets that you select. This feature does
not maintain the existing data and creates a new version for
the updated data. For example, if you change the copayment for the pediatric
dental benefit from $10 to N/A for a plan during a mass
update, the copayment is overwritten and has the value of
N/A. There is no versioning that maintains the copayment of
$10 prior to performing a mass update. In this case, the
mass update process works successfully if you are using it
to correct errors. However, if you need to maintain the data
from different versions, do not use it. Instead, update the
entitiesindividually. In Pega Product Composer for Healthcare 8.3, the introduction of the default benefit
in a benefit category affects the mass update results. The following table provides
descriptions and examples. The next benefit or grouper in the benefit category becomes the
default. For example, if the magnetic resonance imaging (MRI) benefit is
the default benefit for the Diagnostic services benefit category
in a product template, and you remove it from the product
template during a mass update, the computed axial tomography
(CAT) scan, which is the next benefit in the benefit category,
becomes the default benefit. If it is the only benefit category that is associated with that
benefit, you must have another benefit category available. For example, if you disassociated the MRI benefit from Benefit
Category A, you must add another benefit category, for example,
Benefit Category B, during the mass update. Then the MRI benefit
becomes the default benefit of Benefit Category B. Use the Pega Product Composer for Healthcare Mass Updates wizard to make changes
across multiple entities at one time instead of performing updates on individual
entities. The mass
update feature does not validate the configuration on groupers and their
contained benefits for the following cost shares: Follow these steps to perform mass updates. The following example shows that the MRI benefit for the PPO Full Network
and the Imaging grouper from the Producttemplate4000 (01-01) product
template are the source for the mass update.Inheritance
Action Result Add groupers or benefits Modify existing groupers or benefits Remove an existing benefit or grouper The benefit or grouper is removed from the selected target
benefit sets, product templates, products, and plans. Default benefits
Action Result Add a benefit or grouper The Mass Updates wizard automatically includes the benefit
category that you specified during benefit configuration. Remove a default benefit or grouper from a product template,
product, or plan Update an existing benefit or grouper by disassociating it from a
benefit category Performing a mass update
You can configure these cost shares in either the grouper or the
benefit, but not in both. For example, you cannot have an Ambulance grouper
that contains the Ambulance air benefit that is defined with a deductible
and the Ambulance air benefit that is also defined with a deductible.
Because used or existing benefits in your context might have these cost
shares defined, ensure that the benefits are pushed to a grouper that does
not have the benefits defined.
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