Healthcare: Featured Solutions
Pega Frameworks and Featured Solutions accelerate the delivery of industry-specific applications by providing pre-defined data models, workflows, decision tables, user interfaces and industry components. Leveraging Pega's powerful process and rules management capabilities, these solutions enable you to capitalize on the strength, extensibility and agility of Pega technology while rapidly achieving significant return on investment.
| Care Management | Pega’s care management capabilities enable healthcare payers to efficiently develop and manage high-touch programs for diverse populations, customizing and delivering individualized plans through a unified portal for utilization, disease and case management as well as health and wellness programs. |
| Claims | Pega optimizes high-volume, high-cost claims processes from streamlining product configuration and benefits management to increasing first-pass rates by automatically repairing problematic claims. Pega also increases claims operator productivity for finalizing pended claims, bringing end-to-end visibility and intelligent control to claims management organizations. View: |
| Customer Relationship Management (CRM) | Pega CRM makes it easy to provide consistent, personalized service by turning best practices into intent-led processes that tailor each interaction to the member or provider, situation, channel and care setting. View: Customer Process Manager for Member Services Customer Process Manager for Provider Services |
| Sales Process Management | With Pega, payers can rapidly design and implement compelling acquisition strategies for groups and individuals, facilitating best-practice sales, rating and underwriting processes while streamlining product selection and enrollment processing. |
| Healthcare Industry Foundation | A foundation including healthcare data model, templates, data structures, solution design models, and HIPAA components to accelerate the development of Pega solutions for healthcare organizations. |
| Product Configuration Framework | Best practice rule-forms and administrative tools for creating and maintaining products. Creates products at component level including rules for eligibility, pricing, data entry and display for speedy product deployment and simplified modification. |
| Revenue Cycle Management | This revenue cycle management solution uses intelligent automation to bridge organizational silos, automate manual processes and increase billing accuracy by improving the ‘First Pass’ clean bill rate. |
| ICD-10 | Pega facilitates accurate ICD-10 coding with intent-led processes that guide users through the steps for determining the right code. Combined with conversion tables, reverse mapping, translation rule creation and ICD reporting and modeling, Pega helps healthcare organizations rapidly complete successful conversions from ICD-9. |
| Medicare/Medicaid | Pega’s intelligent automation drives efficiency, consistency and agility into the complex processes required to execute and manage Medicare and Medicaid programs, enabling error-free processing and immediate adjustment to changing regulations. |
