Data model for the Pega Customer Relationship Management for Healthcare suite

Pega® Customer Service for Healthcare and Pega Sales Automation for Healthcare use their native data models for contact, organization, and other data entities. Because the data models are different in both of these applications, the synchronization of data for contact or organization entities is accomplished by using stub rules.

Data synchronization between the applications of the Pega Customer Relationship Management for Healthcare suite

Each application can view the rulesets of the other application. Synchronizing the common attribute value is carried out by using stub rules. Each stub rule is overridden in the topmost ruleset to add the appropriate logic to perform data synchronization.

The following tables list the overridden stub rules for both applications.

Overridden stub rules for Pega Customer Service for Healthcare

Rule name Applies to Rule type Description
CRMUpdateContactData PegaCA-Work-UpdateContactName Data transform This data transform is used to override a CRM entity contact.
CRMUpdateContactData PegaCPMHC-Work-UpdateContactName Activity This utility is used to update contacts.

Overridden stub rules for Pega Sales Automation for Healthcare

Rule name Applies to Rule type Description

CPMLoadOpenServiceCases

Code-Pega-List Data transform This data transform is used to map the Pega Sales Automation for Healthcare contact to the Pega Customer Service for Healthcare member details and load the open service cases for the Pega Sales Automation for Healthcare contact.
SetSearchStrings PegaCPMHC-Work Data transform This data transform is used to set the specific dynamic class referencing (DCR) values for the Pega Customer Service for Healthcare plan and zip code details.
MapExternalEntity PegaCA-Work Data transform

This data transform is used to map the HC Contact/Member ID of Pega Customer Service for Healthcare to the Contact ID of Pega Sales Automation for Healthcare.

CSNewDefaultsExtension Work- Activity This extension activity is used to set the implementation-specific logic to initiate the default values and initialize supporting properties of Pega Customer Service for Healthcare.
CreateUpdateContact PegaHC-Data-Party-Member Activity This activity is used to create or update the Pega Customer Service for Healthcare member details and calls the Pega Customer Service for Healthcare activity to update the information in the Dependents table during the enrollment process.
CPMOnChargeGetContactData PegaCA-Work Activity This activity is used to set the contact details as work parties to support the Pega Customer Service for Healthcare flows.
Stub rules from both applications contain stubbed steps to integrate the applications seamlessly. Resave these rules into the appropriate ruleset of the implementation layer and update them to meet your integration requirements.

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