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Importing Pega Product Composer for Healthcare entities

Updated on May 11, 2021

With Pega Product Composer for Healthcare, you can import data for each of the following entities: benefit, grouper, benefit set, network, policy term, and policy. With this feature, you define the required benefits data in a Microsoft Excel template that is included in the application.

For example, you might define a benefit plan with 80 medical benefits, and then you import the Excel template into the Pega Product Composer for Healthcare application. The application creates benefits in the system that are subject to approval. By using this feature, you can bring benefit and plan configuration enterprise data into Pega Product Composer for Healthcare and thereby support the delivery of accurate coverage rules, cost shares, and authorization requirements.

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The example in this task describes the creation of five benefits by using the Excel template that is provided with the Pega Product Composer for Healthcare application. After you import the benefits into the application, you can use them as building blocks for creating other components, for example, a benefit set.

To add benefits information to the template, follow these steps. Ensure that you complete each field in the Excel template that displays an asterisk (*), which indicates a required field. Otherwise, an error message displays.

  1. Log in to Pega Product Composer for Healthcare by entering your administrator credentials.
  2. In Dev Studio, click Launch portalProduct Development.
  3. In the navigation panel of your work area, click Process EntitiesImport.
  4. Click Run PCS Import.
  5. On the Import PCS Entities page, enter a name for the entity.
    For example: Benefits
  6. In the Select entity to import field, select an entity.
    Pega Product Composer for Healthcare supports the Development, Implementation, and Production stages. For example, if you click Development, the uploaded entities are routed to the Dev-Approved work queue with the Dev-Approved status.
  7. Click Download Benefit Template and open the template.
    You can also modify this template to meet your business needs.
  8. In your benefit Microsoft Excel template, click the Instructions tab, and then click the Excel document icon for information about completing the fields in the Excel template.
    The Instructions worksheet provides help in completing the fields in the Template worksheet. The Data Validation worksheet lists the fields that are validated by Pega Product Composer for Healthcare. You can add other fields to suit your business.
    For additional information, see Extending data validation activities. If you are importing a benefit set, ensure that you enter all the benefits of the set in one cell of the template spreadsheet.
  9. Click the Template tab.
    1. In the Name column, enter the name of each of the five benefits.
    2. In the Category column, enter the category name, for example, Medical.
    3. In the Line of Business column, enter text describing the business, for example, Commercial.
    4. In the Effective Date column, enter the start date of this benefit, for example, 01/01/2017.
    5. In the End Date column, enter the end date of the benefit.
    6. In the Base Rate column, enter the rate for the benefit.
    7. In the Version Note column, enter text describing the version of the benefit.
  10. For this example, to provide other information about the benefit, complete the following fields. Although these fields are not required, when defining benefits, complete the description to provide more information about the benefit and to specify these other benefit mapping options.
    • Description
    • Service codes – HCPCS
    • Service codes – A CPT
    • Place Of Service Codes
  11. Save the file.
    The following image shows a completed example. All unused fields are hidden in the Excel template.
    Example with five benefits
    The work object for the imported benefit displays in the application in the specified stage with a status of Open. If an error message displays, report it to your system administrator to get help for the validation. For information about validation fields, see Extending data validation activity rules for PCS Import in the Extending the Pega Product Composer for Healthcare application section.
  12. Use the benefit entities to create your products, product templates, or benefit sets.

Modifying values for separator delimiters in the PCS Import template 

When using the Microsoft Excel templates with the PCS Import feature, you can change the default values of the four delimiters that separate the values in the template.

The first, third, and fourth delimiters are parsed delimited rule types. For additional information, see Parse Delimited rules. They separate items in a list of similar items that appear in the template. For example, the first delimiter can separate a list of benefits in a benefit set. The second delimiter is not a parsed delimiter rule type. It separates attributes in a group that appears in the template. For example, the second delimiter separates the rank of a benefit in a benefit set.

Tip: You cannot use any special characters such as % or @.  All the delimiters must have unique values.
  1. In the header of Dev Studio, click ConfigureProduct composer systemConfiguration.
  2. Click the Flow settings tab.
  3. In the Delimiters section, to modify the value of the second delimiter, change the value in the Second delimiter field. Then skip to step 7.
  4. To modify the values of the first, third, or fourth delimiters, in the appropriate field, change the value.
  5. Click the link below the delimiter field to parse the delimiter rule.
    For additional information, see Parse Delimited rules.
  6. Repeat steps 4 and 5 for each of the parsed delimited rule types that you are changing.
  7. Based on your business needs, click ActionsSave as personal configuration or ActionsSave as system configuration.  
    Saving the settings as personal configuration saves the changes only for the logged in user. To save the configuration as system settings, save the settings as system configuration.
  8. Change the delimiter values in the Microsoft Excel template.

Configuring values for version delimiters in the PCS Import template

In the Microsoft Excel template that you use when you import entities, you can use the version delimiter left and version delimiter right to define the version of an entity.

Tip: You cannot use any special characters such as % or @. All the delimiters must have unique values.
  1. In the header of Dev Studio, click ConfigureProduct composer systemConfiguration.
  2. Click the Flow settings tab.
  3. In the Delimiters section, in the Version delimiter left and Version delimiter right fields, modify the values.
    For example: Change a square bracket ([) to a curly bracket ({).
  4. Based on your business needs, click ActionsSave as personal configuration or ActionsSave as system configuration.  
    Saving the settings as personal configuration saves the changes only for the logged in user. To save the configuration as system settings, save the settings as system configuration.
  5. Ensure that you change the delimiter values in the Microsoft Excel template.
What to do next: Based on your organization's needs, you might want to add data to the import template. For additional information, see Modifying the benefit mapping in the Import template in this section.

Modifying the benefit mapping in the Import template

When you add configure benefit mapping on the configuration page to meet your organization's needs, also add it to the Import template. For example, if you add Zip code to the configuration page, it is displayed in the application, but it is not in the Microsoft Excel template that you use for the PCS Import feature.

  1. In the header of Dev Studio, click Configure Product composer systemConfiguration.
  2. Click the Flow settings tab.
  3. Scroll to the PCS import templates section.
  4. Click the entity for which you want to modify the template.
  5. Click Download file to download the template.
  6. Open the file, modify the fields, and save the file.
    Note: If you change the template names in the Microsoft Excel templates section on the Product Composer System Configuration page, you also need to modify the name of your template.
  7. Click Upload file to upload the modified template.
  8. In the Upload File dialog box, click choose the file and click Upload file.
Result: When you download the template again, you will see your modifications.

Adding properties to the PCS Import template

When you bulk upload information by using the PCS Import feature, in some cases, the data that you want to import includes different fields. When this occurs, add the properties to the Microsoft Excel template that is used with PCS Import before importing. For example, if you have a different property for a benefit, add the property to the Benefit template.

Before you begin: Check your application for other properties than those that are included in Pega Product Composer for Healthcare.
  1. In the header of Dev Studio, click Configure Product composer systemConfiguration.
  2. Click the Flow settings tab.
  3. Scroll to the PCS import settings section.
  4. In the Microsoft Excel templates section, copy the name of the template that you want to modify.
  5. In the header of Dev Studio, paste the copied template name into the search field.
  6. In the search results, click the file name next to Binary File and then click Download file.
  7. Open the template for editing in Microsoft Excel:
    1. Add a column for the additional property in the appropriate location.
    2. In the first row of the new column, enter the label name to which the additional property corresponds.
      For example: Enter Client Benefit Name.
    3. Copy the text from the second row of an adjacent column.
    4. Paste the text into the second row of the new column.
    5. Replace the copied property name with the property name that you are adding.
      Ensure that you precede the name with a period.
      For example: If you copied {.pxResults().AliasName input} replace .AliasName with .ClientBenefitName in the pasted text.
    6. Repeat these steps for additional properties that you want to add to a template.
    7. Save the file.
  8. On the BinaryFile page, click Upload file.
  9. Repeat steps 4 through 8 for additional properties that belong to different templates.

Adding extended properties to data transforms for PCS Import

When you are bulk uploading entity data but your data includes additional properties that you already added to the Microsoft Excel template, map those properties by using the data transforms that are listed below. For example, if your application has the ClientBenefitName property, to import this property, you need to extend the data transform and set the corresponding property.

Before you begin: Add your properties to the PCS Import template. For additional information, see Adding properties to the PCS Import in this section.
The following data transforms are provided for the mapping:
  • SetBenefitPropertiesForImportExt
  • SetBenefitsetPropertiesForImportExt
  • SetNetworkPropertiesForImportExt
  • SetGrouperPropertiesForImportExt
  1. In the header of Dev Studio, enter and search for SetBenefitPropertiesForImportExt.
  2. On the Data transform page, click the Add a row icon.
  3. In the Action field, click Set.
  4. In the Target field, enter the implementation-layer property.
    For example: Enter ClientBenefitName.
  5. In the Relation field, enter equal to.
  6. In the Source field, enter and click the corresponding property from the Microsoft Excel template, for example, AliasName.
  7. Click Save as and save to your ruleset.
  8. Repeat these steps for properties that are related to the data transforms that are listed above.
  • Previous topic Implementing custom validation in the Bulk Renewal feature
  • Next topic Generating a flattened structure for plan and product data

Tags

Pega Product Composer for Healthcare 8.7

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