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Pega Customer Service for Healthcare reports

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Pega Customer Service for Healthcare includes the Member Services and Provider Services reports described in this section.

For information about the standard customer service reports, see Pega Customer Service reports.

Member Services Reports

Report name Rule name Report description
Benefits Inquiries-Dental-Current Month BenefitInquiriesByCurrentMonth For the current month, the number of member eligibility inquiries on dental policies that are grouped by benefit.
Benefits Inquiries-Dental-Previous Month BenefitInquiriesByPreviousMonth
Benefits Inquiries-Medical-Current Month BenefitInquiriesByCurrentMonth For the current month, the number of member eligibility inquiries on medical policies that are grouped by benefit.
Benefits Inquiries-Medical-Previous Month BenefitInquiriesByPreviousMonth For the previous month, the number of member eligibility inquiries on medical policies that are grouped by benefit.
Cases By Channel - Add Newborn - Current Month ServiceCasesByChannelCurrentMonth For the current month, the number of resolved Add Newborn cases that are grouped by channel.
Cases By Channel - Add Newborn - Previous Month ServiceCasesByChannelPreviousMonth For the previous month, the number of resolved Add Newborn cases that are grouped by channel.
Cases by Channel - Dispute Claim for Member - Current Month ServiceCasesByChannelCurrentMonth For the current month, the number of resolved Dispute Claim For Member cases that are grouped by channel.
Cases By Channel - Dispute Claim For Member - Previous Month ServiceCasesByChannelPrevious Month For the previous month, the number of resolved Dispute Claim For Member cases that are grouped by channel.
Cases By Channel - Find Provider - Current Month ServiceCasesByChannelCurrentMonth For the current month, the number of resolved Find Provider cases that are grouped by channel.
Cases By Channel - Find Provider - Previous Month ServiceCasesByChannelPreviousMonth For the previous month, the number of resolved Find Provider cases that are grouped by channel.
Cases By Channel - Order ID Card - Current Month ServiceCasesByChannelCurrentMonth For the current month, the number of resolved Order ID Card cases that are grouped by channel.
Cases By Channel - Order ID Card - Previous Month ServiceCasesByChannelPreviousMonth For the previous month, the number of resolved Order ID Card cases that are grouped by channel.
Cases By Channel - Update Member Address - Current Month ServiceCasesByChannelCurrentMonth For the current month, the number of resolved Update Member Address cases that are grouped by channel.
Cases By Channel - Update Member Address - Previous Month ServiceCasesByChannelPreviousMonth For the previous month, the number of resolved Update Member Address cases that are grouped by channel.
Cases By Channel - Update PCP - Current Month ServiceCasesByChannelCurrentMonth For the current month, the number of resolved Update PCP cases that are grouped by channel.
Cases By Channel - Update PCP - Previous Month ServiceCasesByChannelPreviousMonth For the previous month, the number of resolved Update PCP cases that are grouped by channel.
Cases By Channel - Update Privacy Settings - Current Month ServiceCasesByChannelPreviousMonth For the current month, the number of resolved Update Privacy Settings cases that are grouped by channel.
Cases By Channel - Update Privacy Settings - Previous Month ServiceCasesByChannelCurrentMonth For the current month, the number of resolved View Benefits cases that are grouped by channel.
Cases By Channel - View Benefits - Current Month ServiceCasesByChannelCurrentMonth For the current month, the number of resolved Update Privacy Settings cases that are grouped by channel.
Cases By Channel - View Benefits - Previous Month ServiceCasesByChannelPreviousMonth For the previous month, the number of resolved Update Privacy Settings cases that are grouped by channel.
Member Service Cases - Current Month ServiceCasesByChannelCurrentMonth For the current month, the number of resolved View Benefits cases that are grouped by channel.
My Member Service Cases - Current Month MyMemberServiceCases For the current month, the number of member service cases that were opened by the operator and resolved.
Welcome Member Plan Extras response WelcomeMemberPlanExtrasResponse Displays the results of the Promote the plan extras survey and provides insight to managers about the preferences of additional offerings of the plan by targeted new members.
Welcome Member Plan Extras response WelcomeMemberPlanExtrasResponse Displays the results of the Review Tools survey and provides insight to managers about the number of new members who have received their ID cards.
Welcome Member Coverage Response WelcomeMemberCoverageResponse Displays the results of the Introduce Plan survey and provides insight to managers about existing health coverage of targeted new members.
Welcome Member Survey Completion WelcomememberSurveyCompletion Provides insight to managers about the number of targeted new members who completed the Welcome Member survey.

Provider Services reports

Report name Rule name Report description
Benefits Inquiries-Dental-Current Month BenefitInquiriesByCurrentMonth For the current month, the number of provider eligibility inquiries on dental policies that are grouped by benefit.
Benefits Inquiries-Dental-Previous Month BenefitInquiriesByPreviousMonth For the previous month, the number of provider eligibility inquiries on dental policies that are grouped by benefit.
Benefits Inquiries-Medical-Current Month BenefitInquiriesByCurrentMonth For the current month, the number of provider eligibility inquiries on medical policies that are grouped by benefit.
Benefits Inquiries-Medical-Previous Month BenefitInquiriesByPreviousMonth For the previous month, the number of provider eligibility inquiries on medical policies that are grouped by benefit.
Cases By Channel-Appeal Prior Auth-Previous Month ServiceCasesByChannelPreviousMonth For the previous month, the number of resolved Appeal Prior Authorization cases that are grouped by channel.
Cases By Channel-Determine Medicare Primacy-Current Month ServiceCasesByChannelCurrentMonth For the current month, the number of resolved Determine Medicare Primacy cases that are grouped by channel.
Cases By Channel-Determine Medicare Primacy-Previous Month ServiceCasesByChannelPreviousMonth For the previous month, the number of resolved Determine Medicare Primacy cases that are grouped by channel.
Cases By Channel-Dispute Claim Payment/Denial-Current Month ServiceCasesByChannelCurrentMonth For the current month, the number of resolved Dispute Claim Payment/Denial cases that are grouped by channel.
Cases By Channel-DisputeClaimPayment/Denial-Previous Month ServiceCasesByChannelPreviousMonth For the previous month, the number of resolved Dispute Claim Payment/Denial cases that are grouped by channel.
Cases By Channel-Request Prior Authorization-Current Month ServiceCasesByChannelCurrentMonth For the current month, the number of resolved Request Prior Authorization cases that are grouped by channel.
Cases By Channel-Request Prior Authorization-Previous Month ServiceCasesByChannelPreviousMonth For the previous month, the number of resolved Request Prior Authorization cases that are grouped by channel.
Cases By Channel-Review Member Benefits-Current Month ServiceCasesByChannelCurrentMonth For the current month, the number of resolved Review Member Benefits cases that are grouped by channel.
Cases By Channel-Review Member Benefits-Previous Month ServiceCasesByChannelPreviousMonth For the previous month, the number of resolved Review Member Benefits cases that are grouped by channel.
Cases By Channel-Update Address-Current Month ServiceCasesByChannelCurrentMonth For the current month, the number of resolved Update Address cases that are grouped by channel.
Cases By Channel-Update Address-Previous Month ServiceCasesByChannelPreviousMonth For the previous month, the number of resolved Update Address cases that are grouped by channel.
Cases By Channel-Update Prac Credentials-Current Month ServiceCasesByChannelCurrentMonth For the current month, the number of resolved Update Practitioner Credentials cases that are grouped by channel.
Cases By Channel-Update Prac Credentials-Previous Month ServiceCasesByChannelPreviousMonth For the previous month, the number of resolved Update Practitioner Credentials cases that are grouped by channel.
Cases By Channel-Update Prac NPI-Current Month ServiceCasesByChannelCurrentMonth For the current month, the number of resolved Update Practitioner NPI cases that are grouped by channel.
Cases By Channel-Update Prac NPI-Previous Month ServiceCasesByChannelPreviousMonth For the previous month, the number of resolved Update Practitioner NPI cases that are grouped by channel.
Cases By Channel -Appeal Prior Auth- Current Month ServiceCasesByChannelCurrentMonth For the current month, the number of resolved Appeal Prior Authorization cases that are grouped by channel.
My Provider Service Cases - Current Month ProviderServiceCasesCurrentMonth For the current month, the number of resolved provider service cases.
Provider Service Cases - Current Month MyProviderServiceCases For the current month, the number of provider service cases that were opened by the operator and resolved.
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