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Pega Foundation for Healthcare Implementation Guide

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In release 8.6 significant changes have been made to the Pega Foundation for Healthcare implementation guide to ensure the reader an easier, more focused experience for learning and understanding how to implement the Healthcare foundation. The following changes have been made.

  • Content has been substantially consolidated to include only information specific to the Healthcare foundation. All other information, such as Pega platform or application-related topics and issues, when referenced in this document, are made available to the reader by hyperlink.
  • The Pega Foundation Appeals and Grievances Management implementation guide has also been substantially consolidated, and incorporated into this document as Appendix A.
  • The entire Healthcare Foundation implementation guide, and appendix are now available in HTML format in Pega Community to ensure easier search and navigation.

Built for healthcare organizations, Pega Foundation for Healthcare provides a set of enterprise healthcare assets that include pre-configured data models for commonly referenced healthcare objects and code sets. It also includes assets such as APIs for rapid integration with external systems of records, support for industry-standard electronic data interchange (EDI) and other message and transaction standards including HIPAA X12 5010. These assets provide a platform for rapid configuration and deployment of SmartBPM™ solutions that deliver productivity, spur growth, and ensure compliance.

Healthcare organizations can use Pega Foundation for Healthcare to:

  • Address new market opportunities in a fraction of the time required by more traditional development environments, and accelerate the development of personalized solutions targeting your organization’s biggest challenges across your key domains of marketing, sales and onboarding, customer service, and operations.
  • Develop applications that dramatically extend the capabilities of existing systems such as claims, billing, enrollment, membership, and provider networks.
  • Revitalize legacy applications.
  • Create and maintain your healthcare enterprise foundation layer of shared assets across your Pega application portfolio.

Pega Foundation for Healthcare forms the enterprise foundation for all Pega healthcare solutions.

Pega Foundation for Healthcare comprises the application layers described below. The individual application modules provide flexibility and speed of deployment by allowing you to install and use only the modules that you need, based on your planned use.

The following application bundles are included on your media:

  • Pega HC Core Foundation – The core foundation application that contains the healthcare data model, healthcare codes management, and common object API rules. Installing this application is a pre-requisitie for all the other optional application modules.
  • PegaHC AGM – Contains the rules for managing member complaints, which includes grievances and appeals. For more information, see Appendix A: Implementing the Appeals and Grievances application.
  • Pega X12 5010 – Contains all HIPAA X12 EDI and NCPDP message processing rules.
  • PegaHC FHIR®© – Contains all HL7 FHIR®© REST APIs for integrating with clinical data repositories.
  • Pega HL7 – Provides HL7 V2.2 and V2.3 support for managing Admission/Discharge/Transfer (ADT) inbound messages from third-party systems.
  • PegaHC DDS – Provides drug data search using the RxNorm database.
  • PegaHC – An overarching application that includes all the add-on modules in this list. The modules are referenced as multiple, built-on applications.
  • U+Health Demo – A demo application that helps you explore the default application capabilities. The application provides sample customer data and sample operators.
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