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Editing the Excluded services tab

Updated on April 12, 2021

You can edit the information in this tab. You can move any one of the default services from excluded services to other services. For example, you might add a service to the other covered services section if a new medical technology became available or if CMS had a new SBC requirement.

Consumers refer to this section of the SBC document to learn about certain services that are not covered by their health plan, as well as some additional services the plan does cover that are not listed in the Common medical events tab.

Excluded services tab

Pega Product Composer for Healthcare Pega Product Composer for Healthcare
  1. On the Excluded services tab of your template, to edit the information, click in the disclosure section below the Excluded Services and Other Covered Services section.
  2. In the Excluded Services & Other Services pane at the right, follow these steps:
    1. To move a specified item that appears in the excluded services (Excl) section to the other services section, click Othr.
    2. To move items that appear in the other covered services (Othr) section to the excluded services section, click Excl.
    3. Click the Delete icon to remove any item.
    4. To add a service to the excluded services section, click Add service and enter text.
      You cannot add items to the Other Covered Services section.
  3. To change the text in each of the disclosure sections that are listed below, follow these steps:
    1. Click the text in the box below the label.
    2. In the right pane, modify the text in the text box.
    3. Click Apply.
    • Your Rights to Continue Coverage
    • Your Grievance and Appeals Rights
    • Does this plan provide Minimum Essential Coverage
    • Does this plan meet Minimum Value Standards
    • Language Access Services
    • Disclosure Notes
  4. Click Save when you are finished.

Optional: Extending rules related to the Excluded services tab

As an administrator, you can extend rules that are related to the Excluded services tab by modifying the data transforms to meet your business needs.

  1. To modify a rule that is listed in the following table, in Dev Studio, enter the rule name in the search box.
  2. Click the rule name.
  3. On the Data Transform page, click Save as and save the rule to your implementation layer.
  4. Make your changes and click Save.
    For more information about data transforms, see Data transforms.
  5. Repeat these steps for each rule that you want to modify.

    ActionRule name
    Override the text for services in the Excluded Services & Other Covered Services section on the Excluded services tab.SetExcludeAndcoveredServicesEXT
    Override the default notes in the disclosure section below Excluded Services & Other Covered Services on the Excluded Services tab. By using this rule, you are making changes for all the templates, and not just one template. SetDataForCoverageNoteEXT

Tags

Pega Product Composer for Healthcare 8.7

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