Eligibility Determination and Enrollment
Innovation at the Speed of Business
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The challenge: To meet growing constituent needs while reducing costs, government agencies must be empowered to quickly model, test and deploy their best ideas. Unfortunately, information technology has become an impediment to modernization as innovative ideas end up sitting in a queue for months — if not years — before IT can make them real. Innovators are powerless without the ability to rapidly adjust strategies and processes, making it nearly impossible to deliver new services in a timely, cost-effective manner.
With Pegasystems, the wait is over. Pegasystems puts the power of innovation into the hands of the business owner so that you can rapidly turn business objectives into intelligent, automated processes that are easily adjusted to respond to new regulations and changing constituent expectations. Governmental agencies around the world trust Pegasystems to help them deliver new services in substantially shorter time, transform underperforming areas into high-performance organizations and drive costs for servicing constituents to their lowest level.
- Turn new ideas into new processes. Capture your business goals right into Pega solutions and efficiently manage your portfolio of change initiatives according to key performance indicators.
- Roll out new services faster. Take advantage of business-focused capabilities to simulate planned strategies and determine their impact on constituents, agencies and third parties. Adjust, change and immediately deploy new strategies without burdening IT.
- Implement dynamic offerings for instant response to change. Leverage dynamic processes and business rules that automatically adapt to different contexts, such as geography, program or constituent, to deliver services that are relevant and appropriate.
- Reduce costs for new services. Leverage the assets developed for one application across multiple applications. Quickly add in specialized process steps and rules to account for the specific requirements of each policy and program.
Pegasystems — Delivering Real-World Results
Around the globe, forward-thinking government agencies rely on Pegasystems to power innovation.
- In just 60 days, a government systems integrator delivered an enrollment and payment system for a new drug subsidy program that provides on-line registration, application, verification and payments to constituents. The fully automated, paperless solution includes a multi-channel citizen contact center with an integrated desktop, payment inquiry response, automated correspondence and materials fulfillment. The program issued over $2 billion payments during the first 6 months of operation with a 90 percent resolution rate.
- A national government health program was launched using Pegasystems for citizen inquiries, enrollment processing and exception handling in under 90 days. With Pega’s BPM technology, the systems Integrator grew its Medicare Part-D business from $0 to $1 billion in less than a year; increasing enrollment to over a million members while at the same time earning the #1 ranking in customer service and significantly reducing staffing levels, average call times and training costs.



