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Pega Customer Service for Healthcare reports

Suggest edit Updated on March 16, 2021

Pega Customer Service for Healthcare includes the Member Services and Provider Services reports described in this section.

For information about the standard customer service reports, see Pega Customer Service reports.

Member Services Reports

Report nameRule nameReport description
Benefits Inquiries-Dental-Current MonthBenefitInquiriesByCurrentMonthFor the current month, the number of member eligibility inquiries on dental policies that are grouped by benefit.
Benefits Inquiries-Dental-Previous MonthBenefitInquiriesByPreviousMonth
Benefits Inquiries-Medical-Current MonthBenefitInquiriesByCurrentMonthFor the current month, the number of member eligibility inquiries on medical policies that are grouped by benefit.
Benefits Inquiries-Medical-Previous MonthBenefitInquiriesByPreviousMonthFor the previous month, the number of member eligibility inquiries on medical policies that are grouped by benefit.
Cases By Channel - Add Newborn - Current MonthServiceCasesByChannelCurrentMonthFor the current month, the number of resolved Add Newborn cases that are grouped by channel.
Cases By Channel - Add Newborn - Previous MonthServiceCasesByChannelPreviousMonthFor the previous month, the number of resolved Add Newborn cases that are grouped by channel.
Cases by Channel - Dispute Claim for Member - Current MonthServiceCasesByChannelCurrentMonthFor the current month, the number of resolved Dispute Claim For Member cases that are grouped by channel.
Cases By Channel - Dispute Claim For Member - Previous MonthServiceCasesByChannelPrevious MonthFor the previous month, the number of resolved Dispute Claim For Member cases that are grouped by channel.
Cases By Channel - Find Provider - Current MonthServiceCasesByChannelCurrentMonthFor the current month, the number of resolved Find Provider cases that are grouped by channel.
Cases By Channel - Find Provider - Previous MonthServiceCasesByChannelPreviousMonthFor the previous month, the number of resolved Find Provider cases that are grouped by channel.
Cases By Channel - Order ID Card - Current MonthServiceCasesByChannelCurrentMonthFor the current month, the number of resolved Order ID Card cases that are grouped by channel.
Cases By Channel - Order ID Card - Previous MonthServiceCasesByChannelPreviousMonthFor the previous month, the number of resolved Order ID Card cases that are grouped by channel.
Cases By Channel - Update Member Address - Current MonthServiceCasesByChannelCurrentMonthFor the current month, the number of resolved Update Member Address cases that are grouped by channel.
Cases By Channel - Update Member Address - Previous MonthServiceCasesByChannelPreviousMonthFor the previous month, the number of resolved Update Member Address cases that are grouped by channel.
Cases By Channel - Update PCP - Current MonthServiceCasesByChannelCurrentMonthFor the current month, the number of resolved Update PCP cases that are grouped by channel.
Cases By Channel - Update PCP - Previous Month ServiceCasesByChannelPreviousMonthFor the previous month, the number of resolved Update PCP cases that are grouped by channel.
Cases By Channel - Update Privacy Settings - Current MonthServiceCasesByChannelPreviousMonthFor the current month, the number of resolved Update Privacy Settings cases that are grouped by channel.
Cases By Channel - Update Privacy Settings - Previous MonthServiceCasesByChannelCurrentMonthFor the current month, the number of resolved View Benefits cases that are grouped by channel.
Cases By Channel - View Benefits - Current MonthServiceCasesByChannelCurrentMonthFor the current month, the number of resolved Update Privacy Settings cases that are grouped by channel.
Cases By Channel - View Benefits - Previous MonthServiceCasesByChannelPreviousMonthFor the previous month, the number of resolved Update Privacy Settings cases that are grouped by channel.
Member Service Cases - Current MonthServiceCasesByChannelCurrentMonthFor the current month, the number of resolved View Benefits cases that are grouped by channel.
My Member Service Cases - Current MonthMyMemberServiceCasesFor the current month, the number of member service cases that were opened by the operator and resolved.
Welcome Member Plan Extras responseWelcomeMemberPlanExtrasResponseDisplays the results of the Promote the plan extras survey and provides insight to managers about the preferences of additional offerings of the plan by targeted new members.
Welcome Member Plan Extras responseWelcomeMemberPlanExtrasResponseDisplays the results of the Review Tools survey and provides insight to managers about the number of new members who have received their ID cards.
Welcome Member Coverage ResponseWelcomeMemberCoverageResponseDisplays the results of the Introduce Plan survey and provides insight to managers about existing health coverage of targeted new members.
Welcome Member Survey CompletionWelcomememberSurveyCompletionProvides insight to managers about the number of targeted new members who completed the Welcome Member survey.

Provider Services reports

Report nameRule nameReport description
Benefits Inquiries-Dental-Current MonthBenefitInquiriesByCurrentMonthFor the current month, the number of provider eligibility inquiries on dental policies that are grouped by benefit.
Benefits Inquiries-Dental-Previous MonthBenefitInquiriesByPreviousMonthFor the previous month, the number of provider eligibility inquiries on dental policies that are grouped by benefit.
Benefits Inquiries-Medical-Current MonthBenefitInquiriesByCurrentMonthFor the current month, the number of provider eligibility inquiries on medical policies that are grouped by benefit.
Benefits Inquiries-Medical-Previous MonthBenefitInquiriesByPreviousMonthFor the previous month, the number of provider eligibility inquiries on medical policies that are grouped by benefit.
Cases By Channel-Appeal Prior Auth-Previous MonthServiceCasesByChannelPreviousMonthFor the previous month, the number of resolved Appeal Prior Authorization cases that are grouped by channel.
Cases By Channel-Determine Medicare Primacy-Current MonthServiceCasesByChannelCurrentMonthFor the current month, the number of resolved Determine Medicare Primacy cases that are grouped by channel.
Cases By Channel-Determine Medicare Primacy-Previous MonthServiceCasesByChannelPreviousMonthFor the previous month, the number of resolved Determine Medicare Primacy cases that are grouped by channel.
Cases By Channel-Dispute Claim Payment/Denial-Current MonthServiceCasesByChannelCurrentMonthFor the current month, the number of resolved Dispute Claim Payment/Denial cases that are grouped by channel.
Cases By Channel-DisputeClaimPayment/Denial-Previous MonthServiceCasesByChannelPreviousMonthFor the previous month, the number of resolved Dispute Claim Payment/Denial cases that are grouped by channel.
Cases By Channel-Request Prior Authorization-Current MonthServiceCasesByChannelCurrentMonthFor the current month, the number of resolved Request Prior Authorization cases that are grouped by channel.
Cases By Channel-Request Prior Authorization-Previous MonthServiceCasesByChannelPreviousMonthFor the previous month, the number of resolved Request Prior Authorization cases that are grouped by channel.
Cases By Channel-Review Member Benefits-Current MonthServiceCasesByChannelCurrentMonthFor the current month, the number of resolved Review Member Benefits cases that are grouped by channel.
Cases By Channel-Review Member Benefits-Previous MonthServiceCasesByChannelPreviousMonthFor the previous month, the number of resolved Review Member Benefits cases that are grouped by channel.
Cases By Channel-Update Address-Current MonthServiceCasesByChannelCurrentMonthFor the current month, the number of resolved Update Address cases that are grouped by channel.
Cases By Channel-Update Address-Previous MonthServiceCasesByChannelPreviousMonthFor the previous month, the number of resolved Update Address cases that are grouped by channel.
Cases By Channel-Update Prac Credentials-Current MonthServiceCasesByChannelCurrentMonthFor the current month, the number of resolved Update Practitioner Credentials cases that are grouped by channel.
Cases By Channel-Update Prac Credentials-Previous MonthServiceCasesByChannelPreviousMonthFor the previous month, the number of resolved Update Practitioner Credentials cases that are grouped by channel.
Cases By Channel-Update Prac NPI-Current MonthServiceCasesByChannelCurrentMonthFor the current month, the number of resolved Update Practitioner NPI cases that are grouped by channel.
Cases By Channel-Update Prac NPI-Previous MonthServiceCasesByChannelPreviousMonthFor the previous month, the number of resolved Update Practitioner NPI cases that are grouped by channel.
Cases By Channel -Appeal Prior Auth- Current MonthServiceCasesByChannelCurrentMonthFor the current month, the number of resolved Appeal Prior Authorization cases that are grouped by channel.
My Provider Service Cases - Current MonthProviderServiceCasesCurrentMonthFor the current month, the number of resolved provider service cases.
Provider Service Cases - Current MonthMyProviderServiceCasesFor the current month, the number of provider service cases that were opened by the operator and resolved.
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