In Pega Product Composer for Healthcare, you can use groupers to accumulate visits,
units, and dollars assigned to each healthcare benefit and configure limits that span the
dependent benefits. You also use groupers to organize these items across benefit
A grouper contains benefits and organizes them in common medical areas. For example, all
Surgery benefits can be organized under a Surgery grouper. When there are limits on the
benefits, you define the limit in the benefit accumulator. For example, Mental Health group
counseling and inpatient Psychiatrist visits are two separate benefits, but they can have a
limit of 20 total visits in any combination of the two.
Use a benefit grouper to configure
cost shares that are reused for the benefits. For example, if a Physician Services grouper
is configured with a $10 copayment, each of the dependent benefits automatically inherits
the $10 copayment. To change one of the benefits to a $20 copayment, you must manually
configure that benefit.
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.
To extend your grouper, see Extending union data for groupers in the
Extending union data section.
Pega Product Composer for Healthcare
Before you begin: Ensure that you have set up your benefits. For additional
information, see Configuring a benefit.
What to do next: Configure a benefit set. For additional information, see Configuring a benefit set.
- In the header of Dev Studio, click .
- In the left navigation panel of your workspace, click .
- Enter information to configure a new grouper or copy an existing grouper.
- If you select Copy existing, select a grouper from the list.
- Optional: To
modify the grouper selection, click the Edit icon and select
another grouper from the list.
- Enter text in the fields, select options from lists, and enter dates to describe your
benefit. Ensure that you complete all required fields as you perform the steps in the
- Click Save to complete your grouper at a later date or
- In the Benefit list, select a benefit and then click
- Repeat step 6 for each benefit that
you are adding.
- Click Save and click Finish.