Table of Contents

Performing a mass update in Pega Product Composer for Healthcare

Use the Pega Product Composer for Healthcare™ Mass Updates wizard to make changes across multiple entities at one time instead of performing updates on individual entities. You can add, update, or remove new and existing benefits and groupers within a set of selected target benefit sets, product templates, products, and plans.

Criteria for choosing a mass update

Review the information in this section to determine whether you want to perform a mass update or update entities individually. It describes how the the mass update process handles inheritance and default benefits.

Inheritance

You can add or remove groupers and benefits or modify existing groupers and benefits to change data such as cost shares, copayments, coinsurance, deductibles, and other data, such as limits and authorization requirements. The data that you change for the groupers and benefits is propagated to the targeted product templates, products, or plans that you choose.

Action Result
Adding groupers or benefits

The inheritance is maintained.

For example, a new healthcare regulation requires the addition of the new healthcare benefit, Telemedicine, to all small group HMO and preferred provider organization (PPO) plans. Use the Mass Updates wizard to add the benefit to all the plans at one time. The benefit inherits the network cost shares.

Modifying existing groupers or benefits

The inheritance from the parent entity is broken.

Changes that you make when performing a mass update overwrite the data in the targets that you select. This feature does not maintain the existing data and creates a new version for the updated data.

For example, if you change the copayment for the pediatric dental benefit from $10 to N/A for a plan during a mass update, the copayment is overwritten and has the value of N/A. There is no versioning that maintains the copayment of $10 prior to performing a mass update. In this case, the mass update process works successfully if you are using it to correct errors. However, if you need to maintain the data from different versions, do not use it. Instead, update the entities individually.

Removing an existing benefit or grouper The benefit or grouper is removed from the selected target benefit sets, product templates, products, and plans.

Default benefits

In Pega Product Composer for Healthcare 8.3, the introduction of the default benefit in a benefit category affects the mass update results. The following table provides descriptions and examples.

Action Result
Adding a benefit or grouper The Mass Updates wizard automatically includes the benefit category that you specified during benefit configuration.
Removing a default benefit or grouper from a product template, product, or plan

The next benefit or grouper in the benefit category becomes the default.

For example, if the magnetic resonance imaging (MRI) benefit is the default benefit for the Diagnostic services benefit category in a product template, and you remove it from the product template during a mass update, the computed axial tomography (CAT) scan, which is the next benefit in the benefit category, becomes the default benefit.

Updating an existing benefit or grouper by disassociating it from a benefit category

If it is the only benefit category that is associated with that benefit, you must have another benefit category available.

For example, if you disassociated the MRI benefit from Benefit Category A, you must add another benefit category, for example, Benefit Category B, during the mass update. Then the MRI benefit becomes the default benefit of Benefit Category B.

Before you begin

  1. You must have the HC_USA_Product_Composer:MassUpdate access role assigned to your access group.
    By default, the Pega Product Composer for Healthcare administrator is assigned this access role.
  2. Using the following information, check your configuration before you perform a mass update so that you avoid an error message during the process.

    The mass update feature does not validate the configuration on groupers and their contained benefits for the following cost shares:
  • Lifetime maximum
  • Out-of-pocket maximum
  • Annual maximum
  • Deductible
  • Limit
  • Eligibility

You can configure these cost shares in either the grouper or the benefit, but not in both. For example, you cannot have an Ambulance grouper that contains the Ambulance air benefit that is defined with a deductible and the Ambulance air benefit that is also defined with a deductible. Because used or existing benefits in your context might have these cost shares defined, ensure that the benefits are pushed to a grouper that does not have the benefits defined.

  1. Ensure that you read Criteria for choosing a mass update.

Procedure

  1. In the header of Dev Studio, click Launch web interface > Product Development.
  2. In the navigation panel of your work area, click Process Entities > Update.
  3. Click Run mass updates and select the entity that you are updating, for example, Product Template.
    This selection determines the context for the application to select source benefits or groupers and the targets that receive the update.
  4. In the Benefit/Grouper list, select either the benefit or grouper as the source of data for the update.
    For this example, Benefit is selected.
  5. In the Add list, select an option to indicate whether you are adding, updating, or removing information.
    For this example, Add is selected.
  6. In the New/Used list, select one of the following:
  • New. Then select the benefit or grouper from the list.
    All benefits and groupers are available for selection. During a mass update, the new benefit or grouper is inserted into the product template so that it inherits cost shares, deductibles, or visit limits.
  • Used. Select the product template that uses the benefit or grouper, and then select options from the Network, Grouper, or Benefits lists.

    The following example shows that the MRI benefit for the PPO Full Network and the Imaging grouper from the Producttemplate4000 (01-01) product template are the source for the mass update.
    Selections in the Mass Updates wizard
    Selections in the Mass Updates wizard
  1. Click Continue.
  • If you selected New in step 6, a message indicates that the benefit or grouper inherits the cost shares information. You cannot edit the values.
  • If you selected Used in step 6, the data is loaded from the selected product template in this example and is available for editing.
  • If you are performing a mass update on a benefit set, this step shows information that the benefit or grouper is being added or removed.
  1. Click Continue to specify the search criteria for your target entities and network.
    1. Complete the fields to specifiy your entity targets.
    2. Select the network.
    3. Click Select targets.
    4. In the Select Targets dialog box, select only the check boxes for the target entities that you want to update.
    5. Click Submit.
  2. Click Finish.
  3. On the Mass update page, select Actions > Approve mass update changes.
  4. Optional: Enter text that describes which entities were updated and click Submit.
  5. On the Mass update the targets page in the Target tree section, click Run mass update, and then click Submit.
    Your mass update has a status of Resolved-Completed.
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