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Healthcare capabilities

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This section provides an overview of Pega Customer Service for Healthcare and shows the application stack.

Pega Customer Service for Healthcare

Pega Customer Service for Healthcare helps reduce service costs and improve customer satisfaction through a process-driven approach that resolves customer issues with context, immediacy, and relevance at the initial point-of-contact.

  • Member Services

    Enables healthcare organizations to service consumers of healthcare services, such as health plan members

  • Provider Services

    Enables healthcare organizations to service medical providers, such as physicians, practice staff, and healthcare system personnel

  • Patient Services

    Provides healthcare organizations with capabilities for patient care and engagement

Built on the Pega Platform, Pega Customer Service for Healthcare automates common service requests through intent-driven processing and anticipates customer and operator needs so that customer service representatives (CSRs) have the necessary tools to deliver personalized and responsive service. The application delivers new value from healthcare organizations’ back-end data and processing silos, provides agility to meet changing business requirements, and facilitates compliance with internal and external regulations.

Pega Customer Service for Healthcare is built on the Pega Customer Service and Pega Foundation for Healthcare applications. It includes multiple components; some components are optional. The healthcare data model and healthcare service processes are provided for you in the Pega Customer Service for Healthcare application.

Pega Customer Service for Healthcare application stack

The Pega Customer Service for Healthcare media includes Pega Sales Automation for Healthcare because they are designed to complement each other through the use of common case types and a unified data model. Each application requires a separate license in order to use it. Pega Care Management is built on Pega Customer Service for Healthcare. For more information about the capabilities that are available by implementing the two applications together, see the Pega Care Management product page. If you are using Pega Customer Decision Hub and Pega Care Management, install those applications separately.

All Pega healthcare applications are built on Pega Foundation for Healthcare, which contains the healthcare data model.
Pega Customer Service Relationship Management for Healthcare application stack

Pega Customer Service for Healthcare sample operators and access groups

Pega Customer Service for Healthcare can be used in different types of healthcare contact centers. As part of installation, you can optionally install the sample application that includes operators and access groups. You use them to access the sample application and review the application's capabilities, copy into your application, or extend to meet your business needs.

The sample application includes operators and access groups for the following types of healthcare contact centers:

  • Member Services and Provider Services
  • Medicare Member Services

Member Services, Patient Services, and Provider Services

Name Description Default access group Default portal
CSHCSysAdmin Systems administrator operator CSHC:SysAdmin Dev Studio
CSHCManager Contact center manager operator CSHC:MGR Interaction Portal
CSHCCSR Contact center representative operator CSHC:CSR Interaction Portal
CSHCAppStudioAdmin Systems administrator operator CSHCAuthor App Studio
CSHCMedicare SysAdmin Systems administrator operator CSHC:MedicareSysAdmin Dev Studio
CSHCMedicare Mgr Contact center manager operator CSHC:MedicareMGR Interaction portal
CSHCMedicareCSR Contact center representative operator CSHC:MedicareCSR Interaction portal
CSHCMedicareAppStudioAdmin Systems administrator operator CSHCMedicareAuthor Dev Studio

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