Pegasystems Inc.
Sign in English French,  Spanish,  German
Build For Change®
SmartBPM
for Healthcare
Customer Success
Featured Solutions
Frameworks

Solutions Across the Enterprise…

  • Product Creation & Maintenance
  • RFP Response
  • Underwriting
  • Rating & Quoting
  • Proposal Generation
  • Broker & Agency Management
  • Broker Commissions
  • Value Based Benefits

 

New Business

New Business

 

Frameworks

Solutions Across the Enterprise…

  • Member Services
  • Pharmacy Services
  • Self-Service
  • Cross-Sell, Up-Sell
  • Appeals & Grievances
  • Provider Services
  • Employer Services
  • Consumer Directed Health

 

CRM

Customer Relationship Management

 

Frameworks

Solutions Across the Enterprise…

  • Claims Accumulators
  • Claims Intake
  • Claims Adjudication
  • Claims Exceptions
  • Coordination of Benefits
  • Provider Contracting
  • Premium Reconciliation
  • Medication Therapy Management

 

Servicing Backbone

Servicing Backbone

 

Frameworks

Solutions Across the Enterprise…

  • Subrogation
  • Medicare/Medicaid Fraud
  • Security & Privacy
  • Dosage Calculations
  • MTM Pharmacy Requirements
  • Blues MTM Performance Requirements
  • Provider Fraud
  • ICD – 10

 

Risk, Fraud & Compliance

Risk, Fraud & Compliance

 

Frameworks

Solutions Across the Enterprise…

  • Sales Force Automation
  • Opportunity Management
  • Marketing
  • Individual Sales
  • Pharmacy Program Creation
  • Enrollment
  • Group Set Up
  • Medicare / Part D Sales

New Business

New Business

 

Frameworks

Solutions Across the Enterprise…

  • Billing
  • Utilization Management
  • Disease Management
  • Case Management
  • Wellness
  • Prior-Authorization
  • Formulary Management

Servicing Backbone

Woman Drawing Flow Chart

 

Frameworks

Solutions Across the Enterprise…

  • Provider Network Affiliation & Contracting
  • Admissions (pre-admits, admits, scheduling)
  • Utilization Management
  • Discharge Management
  • EHR Meaningful Use
  • Charge Management & Reconciliation
  • RAC Audit Prevention

Healthcare Providers

Customer Relationship Management

 

Frameworks
 

Featured Solutions

Contact Us

See how Build for Change™ technology can work for you

Request a Demo

Learn more about the Build for Change Advantage

 

Community Library

Find the latest thought leadership from respected analysts as well as case studies, articles and other resources.

• Healthcare Industry Framework
• Pegasystems Review and Roadmap: Healthcare Solutions October 2009
• Accelerating Advancements in Healthcare Through Business Agility
• SmartBPM® for Healthcare Fraud, Waste and Abuse Management
• Care Management Solution Framework

View All Healthcare

The recognized leader in BPM, Pegasystems has helped the largest healthcare organizations in the world address some of their most complex business issues. Whether in customer acquisition and enrollment for new business; customer relationship management; servicing backbone; or risk, fraud, and compliance, Pegasystems’ Build for Change® technology has delivered agile solutions across the enterprise — from payers to providers, pharmacy benefit managers, regulatory agencies, hospital systems and physician groups.

Learn more about Pegasystems’ specialized solutions in healthcare organizations

 

 

 

Pega Blog
Perspectives, Newsletter
Copyright 2010 Pegasystems Inc.