Your application includes a set of predefined case types. A case is defined as a Service Case or a Service Request, which is a process that your staff will execute to service your customers. Each case contains one or more processes that will be extended or created to meet your business requirements. If you do not see an existing case type, you can create one during your planning process.

Each case type has one or more processes associated with it. When you define a new case type, you provide stages for that case type. A stage is the first level of organizing work in your case type. Each stage has one or more steps. 

Case Types are used to define the work your customer is asking you to perform. Examples of case types include: Medical Information Request, Sample Management, Patient Adherence and Patient Assist.

The following are the primary case types:

• Medical Information Request (PegaCPMLS-Work-MedicalInfoReq)
• Sample Management (PegaLS-FW-PatientAssist-Work-SampleManagement)
• Patient Adherence (PegaLS-FW-PatientAssist-Work-PatientAdherence)
• Patient Assist (PegaLS-FW-PatientAssist-Work-PatientAssist)
• Edetailing (PegaLS-FW-PatientAssist-Work-EDetailing)

   

Care Management Application includes the capability to manage prior-authorization and pre-certification requests. This includes a manual intake of the request as well processing the X12 278 EDI message.

The following are the primary cases:

• Appeal
• Care Management
• Utilization Management
• Admission
• Personal Health Plan

Updating existing case types

If an existing case type is close to meeting your business requirements, you can modify it and use it.

•  In the explorer panel, click Cases.
• Click the first case type.
• Update the case-wide properties.
• Update the processes associated with the case type.

• Alternatively, you can add processes by using the Case Designer.

• Repeat these steps for all case types.

Adding a new case type

If you require a case type that is not similar to any existing case types, create a new one that meets your business requirements.

• In the explorer panel, click Cases.
• Click Add a case type.
• Provide a name and description for the case.
• Click Next.
• Define the stages for the case type.
• Click Finish.

You will configure the steps for each stage at a later time.

• New Program Enrollment
• Authorization Request

Map case type classes to a database table

When you run the New Application wizard to create your initial case types, a default class group mapping is created for each case type. You can change the class group setting for each case type to ensure that each case is mapped to a table name that conforms to your site's naming conventions.

Mapping a class to a physical database table impacts data storage and security decisions. If you expect the volume of the case types to be low, consider sharing the table with other case types. If access to instances of this case type needs to be restricted, create a separate class group for each case type.

For each class corresponding to the case type:

1. In the explorer panel, click App.
2. Right-click the class name and select Definition.
3. In the Settings section, review the This Class setting.
4. Determine whether the class is a class group or belongs to a class group. If the class belongs to a class group, determine to which class group it belongs.
5. In the Test Connection section, click Test Connection to determine the name of the table currently mapped to this class.
6. Determine the name of your database table.
7. Record your decision in the Case type modifications planning worksheet.