Plan guardrails API
Pega Sales Automation for Healthcare has a Plan Guardrails REST API integration with Pega
Product Composer for Healthcare. This integration helps to prevent users from entering cost
share values that are outside of the standard ranges. During a custom plan request, Pega Sales Automation for Healthcare makes a call to Pega Product
Composer for Healthcare to get the standard ranges of cost share values from the
matching product template table, and then it populates the custom plan's cost share
fields with those values. A user can still enter a value that is outside of the standard
range, but a non-standard value must be approved before the custom plan request can be
completed. The API sends the plan ID to fetch the plan guardrails from the Pega Product Composer
for Healthcare REST service. When you create a new customer plan request from an existing plan, Pega Sales Automation for Healthcare fetches plan guardrails from Pega Product Composer for
Healthcare to check if the plan-level cost shares and network cost shares are within
the given range. If the cost shares are out of range, then the plan request is
routed to an approval queue so the out of range values can be approved. If plan guardrails exist for a plan, then Pega Product Composer for Healthcare system
sends the plan guardrails in JSON format. The received JSON response is mapped to
the clipboard and has the structure that is detailed in the following image: The following table describes the plan-level cost shares that are available at the
product level: The same cost shares are available at the network level, in the
NetworkNodes property: For each type of cost share, the corresponding page property includes the properties
that are detailed in the following image: Use the following rules to implement the Plan Guardrails API integration: For Product Composer system version 8.5 and above, you need to create an
authentication profile to access data. Fetch the plan guardrails that contain the standard ranges
Receive and process the standard ranges
Plan-level cost shares available at product level
Property Description AnnualMaximumData Annual Max data for Family/Individual CarryOverData Carry over data for Family/Individual CoinsuranceData Coinsurance data for Family/Individual CopaymentData Copay data for Family/Individual DeductibleData Deductible data for Family/Individual LifetimeMaximumData Lifetime maximum data for Family/Individual OutOfPocketData Out of pocket data for Family/Individual Plan Guardrails API Rules
http://10.60.215.7:9080/prweb/PRRestService/healthcarepcsAPI/v1/PlanCostShareRangesService
Creating authentication profile
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