New Pegasystems Healthcare Payer Solutions to Improve Service Centers through BPM

CAMBRIDGE, Mass, May 20, 2003 — Smart, Rules-based BPM Software Streamlines Member and Provider Call Center Interactions to Help Increase Personalized Service, Productivity, and Agility


Pegasystems Inc. (NASDAQ: PEGA), a leading provider of smart business process management (BPM) software, today announced PegaHEALTH Service Manager, a new suite of solutions for healthcare payers. The suite, which consists of PegaHEALTH Member Services version 3.2 and PegaHEALTH Provider Services version 2.0, helps healthcare payers create integrated service centers — eliminating existing departmental silos and helping to deliver consistent, high-quality service to both members and providers, across the enterprise. PegaHEALTH Member Services is currently being deployed at Blue Cross Blue Shield of Rhode Island.


PegaHEALTH Service Manager helps healthcare payers service both healthcare plan members as well as healthcare providers, such as physicians and hospitals. Traditionally, healthcare customer service has been delivered through separate contact centers — each with unique processes — and multiple, dedicated toll-free phone numbers. PegaHEALTH Service Manager provides the tools to create a universal service representative which helps to eliminate the need for separate, disparate contact centers and allows for phone line consolidation to help improve service delivery, create process-driven staffing models, and create cross-constituent interactions to improve consistency.


With PegaHEALTH Service Manager, customer service representatives (CSRs) are provided with tailored information to personalize each interaction. The suite allows them to handle both healthcare member and provider inquiries through all customer touch-points. Pegasystems' flexible rules engine helps payers adapt to changing business conditions. This can result in differentiated service that helps to increase member retention, reduce technology support costs and reduce attrition rates.


Released today, PegaHEALTH Provider Services is designed for CSRs to respond to service requests from physicians, hospitals and other direct caregivers. PegaHEALTH Member Services version 3.2, designed to respond to requests directly from healthcare members, adds new functionality with the inclusion of HIPAA compliance features and heightened reporting functionality. Both include pre-configured, provider-specific workflows that help CSRs resolve service transactions — such as patient claim and eligibility inquiries — by connecting directly to and electronically updating a health payer's back-end systems. Both products are able to intelligently guide CSRs through these pre-configured healthcare workflows, helping to drive the work and deliver consolidated customer data where it is needed. The combination of these capabilities with rules-based scripting and routing helps eliminate dependencies on varying service representative skill sets and reduce the need for extended training programs.


"The PegaHEALTH Service Manager Solution Suite is built to simplify how healthcare organizations process service requests from their members and their providers," said Henry Ancona, president and COO, Pegasystems. "Not only can it help CSRs work faster, smarter and more efficiently and provide straight-through processing capabilities, it will also help give healthcare payers a new agility they haven't had before, exceeding the limits of older technology to change as their business changes."


The PegaHEALTH Service Manager suite of solutions will be demonstrated at PegaVISION 2003, Pegasystems' annual user conference, held May 18th to 20th at the Boston Marriott Copley Place in Boston, Mass.


Forward-Looking Statements


Certain statements contained in this press release may be construed as "forward-looking statements" as defined in the Private Securities Litigation Reform Act of 1995. The words "believe," "expect," "hope," "anticipate," "plan" and similar expressions identify forward-looking statements, which speak only as of the date the statement was made. The company does not undertake and specifically disclaims any obligation to publicly update or revise any forward-looking statements, whether as a result of new information, future events or otherwise. These statements are based on current expectations and assumptions and involve various risks and uncertainties, which could cause the Company's actual results to differ from those expressed in such forward-looking statements. These risks and uncertainties include impact of pending regulatory proceedings, difficulty in predicting the completion of product implementations and consequently the timing of revenue recognition, the inability to attract and retain key employees, reliance on key third-party relationships, management of the Company's growth, and other risks and uncertainties. Further information regarding these and other factors which could cause the Company's actual results to differ materially from any forward-looking statements contained in this press release is contained in the Company's Quarterly Report on Form 10Q for the quarter ended March 31, 2003 on file with the Securities and Exchange Commission. Investors are cautioned not to place undue reliance on such forward-looking statements and there are no assurances that the matters contained in such statements will be achieved.


NOTE: Pegasystems is a registered trademark of Pegasystems Inc. Other product and company names may be trademarks of their respective owners.

About Pegasystems

Pegasystems (NASDAQ: PEGA) develops strategic applications for marketing, sales, service, and operations. Pega’s applications streamline critical business operations, connect enterprises to their customers seamlessly in real-time across channels, and adapt to meet rapidly changing requirements. Pega’s Global 3000 customers include many of the world’s most sophisticated and successful enterprises. Pega’s applications, available in the cloud or on-premises, are built on its unified Pega 7 platform, which uses visual tools to easily extend and change applications to meet clients’ strategic business needs. Pega’s clients report that Pega gives them the fastest time to value, extremely rapid deployment, efficient re-use, and global scale. For more information, please visit us at www.pega.com.

All trademarks are the property of their respective owners.

The information contained in this press release is not a commitment, promise, or legal obligation to deliver any material, code or functionality. The development, release and timing of any features or functionality described remains at the sole discretion of Pegasystems, Pegasystems specifically disclaims any liability with respect to this information.

 

Press Kit

 

Media Contacts

Lisa Pintchman Rogers
VP, Corporate Communications
[email protected]
+1 617-866-6022

North America:
Sean Audet
Director, Corporate Communications
[email protected]
+1 617-528-5230

Ilena Ryan
Sr. Manager, Public Relations
[email protected]
+1 617-866-6722

Europe:
Joanna Richardson
Director, Corporate Communications
[email protected]
+44 (0) 118 9651 660

Jon Brigden
PR & Communications Manager
[email protected]
+44 (0) 118 9398 584

Pegasystems Inc.
One Rogers St.
Cambridge, MA 02142
U.S.A.
Phone +1 617-374-9600
Fax +1 617-374-9620