Pega Sales Automation for Healthcare can send account enrollment details to a third-party enrollment system and receive real-time enrollment dates and status information from a third-party enrollment system. This article contains technical details for Lead System Architects who configure the integration.
- Send account and member details to the third-party enrollment system
- Receive enrollment data from the third-party enrollment system
After the Opportunity-Application stage is completed and the opportunity is won, Pega Sales Automation for Healthcare uses a REST API to send account enrollment details in XML format to the third-party enrollment system. The spmUpdateAccountEnrollment activity, which is part of the spmUpdateAccount flow, calls the D_EnrollAccountDetails data page. The D_EnrollAccountDetails data page calls the EnrollAccountDetails connector to send the account enrollment details in XML format.
After the third-party enrollment system completes the member enrollment, the enrollment system sends the enrollment details back to Pega Sales Automation for Healthcare. Pega Sales Automation for Healthcare uses the received enrollment information to track historical enrollment data for the Account, and also to renew an Account when it is about to expire.
Simulated third-party enrollment system
In order to model an integration with a third-party enrollment system, Pega Sales Automation for Healthcare has simulated a response coming from a third-party enrollment system. With the simulation, Pega Sales Automation for Healthcare receives enrollment period details such as enrollment start and end dates, and enrollment IDs. The enrollment ID is unique for each of the account’s plan types, and each plan type can have a different enrollment period.
- Database table that contains simulated data
- Third-party enrollment system extension points
- Data exchange process for sending simulated data to Pega Sales Automation for Healthcare
Pega Sales Automation for Healthcare provides a database table with simulated data as a reference point for your integration with a third-party enrollment system. The spm_data_accountenrollment database table is part of the PegaHCSPM-Data-AccountEnrollment class.
The simulated third-party enrollment system populates the following database table columns:
Pega Sales Automation for Healthcare account case ID of the enrolled account
Enrolled account name
Pega Sales Automation for Healthcare Opportunity case ID
Medical, Dental, or Vision type
Plan enrollment start date
Plan enrollment end date
Pega Sales Automation for Healthcare census ID
Pega Sales Automation for Healthcare partner ID
B2C or B2B
SmallGroup, Individual, LargeGroup, or Medicare
The simulated third-party enrollment system has the following additional extension points:
- Data page: D_EnrollAccountDetails
- REST Connector: EnrollAccountDetails
- REST Service API: EnrollAccountDetails
- Service activity: EnrollAccountDetails
- Pre data transform: EnrollAccountDetailsPRE
- Post data transform: EnrollAccountDetailsPOST
A clipboard page of type Account is used for data exchange. In the pre-data transform of the D_EnrollAccountDetails data page, the simulated third-party system populates the account page with the necessary data and converts it to XML. The simulated third-party system uses a REST call to send the XML. The third-party enrollment system replies, the reply is re-mapped to a clipboard page, and then it is used to generate enrollment records with enrollment dates. Pega Sales Automation for Healthcare attaches the XML data to the account case type as an XML file.