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Technical details for developers extending the healthcare plan renewal features

Developers can extend the Pega Sales Automation for Healthcare renewals feature with this additional functionality:

  • Renewals for large group and Medicare accounts
  • Renewals for accounts from an external system of record

In addition, developers can use the Live UI feature to change the Renewals interfaces, such as changing the filters used for manual batch creation. For information about editing renewals interfaces, see Editing with Live UI.

Internal and external accounts

An external account is an account that uses a third-party application as the system of record. By default, Pega Sales Automation for Healthcare supports renewals for internal accounts only, but you can extend the renewals feature to work with external accounts. For information about extending renewals for external accounts, see Extensions for external account renewals.

For information about extending renewals for internal accounts, see the following topics:

Extensions for internal account renewals

Data page and data transform

The D_GetRenewalAccounts data page displays the Renewal Batch cases (case ID prefix of RB-) in the system. The data page calls the ListofRenewalAccounts report definition. For the response, extend the MapGetRenewalAccountsResponse data transform.

Renewal batch extensions

The spmCreate flow calls the CreateQuoteRequestWrapper activity, which sets the required values for creating a renewal quote and then calls the queue processor. The queue processor calls the spmCreateRenewal flow in the QuoteRequest class. For each Renewal Batch case, the CreateQuoteRequestWrapper activity creates a new Quote Request case with a case ID prefix of QRSG- or QRIND-.

Extend the spmGetBatchRenewalParameters data transform to add custom parameters for renewals processing.

Renewal job scheduler for automatic batch creation

For automatic batch creation, the CreateRenewalBatch job scheduler creates Renewal Batch (RB-) and Quote Request (QR-) cases in the background, and it sets the status of the Renewal Batch case to Pending-BackgroundAgent until the background process is complete.

Renewal quote processing for unchanged census data

The quote renewal process for "as–is" (unchanged) census data assumes that nothing has changed with the account. The renewal process skips the Census Data screen and instead goes to the quote creation process. After the quote creation process is completed, the effective date and close date are updated on the new Quote Request item and a corresponding new opportunity is created.

Renewal quote processing for modified census data

If the user chooses to update final census during quote renewal, the alternate path is triggered. In this case, the Census Data screen opens so the user can upload or edit census details. Then, the renewal process continues with the quote creation process.

Extensions for external account renewals

An external account is an account that does not use Pega Sales Automation for Healthcare as the system of record. When you renew an external account, the account is imported to Pega Sales Automation for Healthcare and the account uses Pega Sales Automation for Healthcare as the system of record going forward.

Data transforms to extend for external accounts

Configure the following settings in the crmAPPExtModel data transform that is defined in PegaHSCSPM-Data-AppExt:

  • Set CensusFromExternal to true
  • Set AccountsFromExternal to true
  • Set Param.ServerURL to the external server URL

Data pages to extend

Extend the following data pages by configuring the end point URL:

  • D_GetRenewalAccountsExternal – Retrieves a list of accounts
  • D_GetAccountAPIData – Retrieves the account and organization information
  • D_GetRenewalObjects – Retrieves the quote, opportunity, and plan details
  • D_SpmGetCensusData – Retrieves the census data

Endpoint URLs to configure

To connect to external accounts to get renewal data, enter values for the following endpoint URLs:

  • Connector Rule – HCSPMAccountList
  • Data Transform – crmAppExtModel in PegaHCSPM-Data-AppExt

API rules

Account API

Rule name

Rule type

Class

D_GetAccountAPIData

Data page

 

GetRenewalByAccID

Data Transform

PegaHCSPM-Int-Renewal

MapRenewalData

Data Transform

PegaHCSPM-Work-Census

LoadAccountData

Activity

PegaHCSPM-Work-Census

Census API

Rule name

Rule type

Class

D_SpmGetCensusData

Data page

 

GetCensusByContractID

Data Transform

PegaHCSPM-Int-Renewal

MapCensusData

Data Transform

PegaHCSPM-Work-Census

LoadCensusData

Activity

PegaHCSPM-Work-Census

Renewals API

Rule name

Rule type

Class

D_GetRenewalObjects

Data page

 

GetRenewalByAccID

Data Transform

PegaHCSPM-Int-Account

MapRenewalData

Data Transform

PegaHCSPM-Work-Account

LoadRenewalData

Activity

PegaHCSPM-Work-Account

Renewals external account list

Rule name

Rule type

Class

D_GetRenewalAccountsExternal

Data Page

 

RequestAccountList

Data Transform

PegaHCSPM-Int-Account

ResponseAccountList

Data Transform

PegaHCSPM-Work-Account

PostLoadGetRenewalAccounts

Activity

PegaHCSPM-Work-Account

Published February 9, 2018 — Updated March 22, 2019

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