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Settings Requirements for Pega Smart Claims Engine for Healthcare 8.3 on Pega Platform 8.4

Updated on November 19, 2020

Elastic search prefix

The search URL must be updated to support the externalized Elastic search functionality and resolve a platform bug.

Platform bug in Pega 8.4:

  • BUG-524603 : getIndexHelperAPI().getSearchPrefix() returns no prefix.

Changes required in Implementation layer:

  1. Override data transform LoadHCSettings_Extension with the following changes:
    • Fetch DSS value for “prconfig/database/databases/pegasearch/searchendpoint/default” (Step 4 shown in screenshot)
    • Conditionally set prefix for Elastic search based on above value (Step 5.1 shown in screenshot)
      "Updated data transform LoadHCSettings_Extension"
      Updated data transform LoadHCSettings_Extension
  2. In overridden data transform LoadHCSettings_Extension, copy the following resource settings, after setting the ES prefix in above step:
    "LoadHCSettings_Extension"
  3. Override D_HCSettings in the implementation layer. It is a node level data page with Access Group specific to Pega Claims Application.

 

Adjustment claim submissions

An original claim will not be found when a dental adjustment is submitted. The underlying issue is default Boolean values stored as false instead of null.

Platform bug in Pega 8.4:

  • BUG-571524: DT bool parameter assigned false if any empty property is set.

A work-around is available using the @PropertyExists function prior to setting the parameter. Though not included in these instructions, it is a best practice recommendation to add a comment preceding the logic update.

  1. Override the SearchClaimToAdjust data transform with the following changes:
    • Add a When condition for the Param.IsPBClaim step 20 .
      • Action value of “When”
      • Target value of “@PropertyExists(.Claim.IsPBClaim)”
      • Make Target value in the subsequent Set step “Param.IsPBClaim”
      • Relation value of “equal to”
      • Source value “.Claim.IsPBClaim”
"Original SearchClaimToAdjust Data Transform"
Original SearchClaimToAdjust Data Transform

 

"Revised SearchClaimToAdjust Data Transform"
Revised SearchClaimToAdjust Data Transform

 

Note: These issues are addressed in Pega Smart Claims Engine for Healthcare 8.5. 

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