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Healthcare 8.5 enhancements

Suggest edit Updated on April 16, 2021

Pega Customer Service for Healthcare 8.5 includes the product enhancements that are described in this section.

For information about all Pega Customer Service enhancements, see Pega Customer Service 8.5 enhancements.

FeatureDescription
New View Benefits Microjourney

With the new View Benefits Microjourney, health plan CSRs can easily and consistently address the high volume of plan benefit questions that they receive. Successful resolution of these inquiries is critical to improving customer satisfaction and first-call resolution rates. Agents can easily access needed information, whether it is a simple eligibility check or a complex scenario touching on multiple types of coverage information, such as cost share responsibilities, claims, and limits.

This new Microjourney replaces the Review Member Benefits case type, which has been marked as deprecated. Although it remains available, it will be removed in an upcoming release.

For more information about this Microjourney, see View Benefits Microjourney on the Pega Customer Service for Healthcare product page.

Enhanced Order an ID Card Microjourney

The Order an ID Card Microjourney now includes an extensible deflection step and is quicker and easier to implement and configure. By extending the deflection step, healthcare organizations can educate customers about accessing ID cards in self-service channels which in turn avoids unnecessary and costly print runs. In addition, new App Studio configurations have been enabled to make updates easier and quicker. For example, business analysts can now update screen layouts or business logic directly in App Studio. The Microjourney is also available to developers in Dev Studio.

For more information about this Microjourney, see Order an ID Card Microjourney on the Pega Customer Service for Healthcare product page.

For more information about editing Microjourneys in App Studio, see "Customizing the user interface of service requests" in Implementing case types and attributes.

Enhanced Add Child Dependents Microjourney

The Add Child Dependent Microjourney, previously named Add a Newborn, now includes the ability to submit information about adopted child dependents. This reduces implementation time by providing a more complete microjourney out-of-the-box. In addition, new App Studio configurations have been enabled to make updates easier and quicker. For example, business analysts can now update screen layouts or business logic directly in App Studio. The Add Child Dependents Microjourney is also available to developers in Dev Studio.

For more information about this Microjourney, see Add Child Dependents Microjourney on the Pega Customer Service for Healthcare product page.

For more information about editing microjourneys in App Studio, see "Customizing the user interface of service requests" in Implementing case types and attributes.

Support of member ID-re-use

Pega Customer Service for Healthcare now supports the re-use of members’ IDs from their older plans, even when there is a gap between the benefit years. For example, a returning Medicaid member from two years ago can use the same member ID even if they were not subscribed last year. This both simplifies and adds consistency to the customer experience of welcoming back returning members, which is especially important in individual plans types with high churn rates.

Relevant application features have been updated, such as the composites and the Claims Inquiry and Order an ID card Microjourneys, by leveraging the PegaHC-Data-Party-Subscriber class in the Pega Foundation for Healthcare, upon which Customer Service for Healthcare is built.

For more information, see the Pega Foundation for Healthcare documentation on the Pega Foundation for Healthcare product page.

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