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Step 4: Defining common codes management requirements

Suggest edit Updated on September 18, 2020

Pega Foundation for Healthcare provides a comprehensive code set management solution for you to maintain your enterprise repository of standard code sets in Pega. Although not required, managing your code sets in Pega has the advantage of leveraging Pega rules and business processes for efficient use of your licensed code sets across your applications. If you choose not to maintain code sets in Pega Foundation for Healthcare, skip this step.

You must make an inventory of all code sets (standard as well as custom) that you chose to maintain in the Common Codes solution in Pega Foundation for Healthcare. The Common Codes solution comes pre-configured with capability to manage the following code sets.

You can also extend the capabilities in the Common Codes solution to manage custom code sets not listed below.

  • Admission Type
  • Bill Type
  • CDT®
  • CPT®
  • Condition codes
  • DRG
  • DSM
  • Event Codes
  • Facility
  • Field Qualifier
  • Frequency
  • GCN
  • ICD 10 to 9 Dx
  • ICD 10 to 9 Pcs
  • ICD 9 to 10 Dx
  • ICD 9 to 10 Pcs
  • ICD 9 Dx
  • ICD 9 Pcs
  • ICD 10 Dx
  • ICD 9 Pcs
  • Modifier
  • NDC – Product/Package
  • Occurrence Date
  • Occurrence Span
  • Patient Relation
  • Patient Status
  • Place of Service
  • Point of Origin
  • Provider Specialty
  • Provider Taxonomy
  • Provider Type
  • Revenue
  • Service Types
  • Value Codes

Note: The above code sets do not come pre-loaded with data. You are required to upload your own licensed code set data using the upload capabilities provided in the solution.

For additional information, see the Healthcare Common Codes Business Use Case Guide and the Healthcare Common Codes Supported File Formats documents on the Pega Foundation for Healthcare product page.

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