Importance of versioning in auditing

The representation of facts about an entity at a specific time is essential in auditing. With versioning, the facts or history about a version are preserved. This facilitates traceability at any point in time. Using the versioning feature provides a story about the evolution of an entity over a period of time and offers valuable insights to the following questions:

• Why do some entities change more frequently and what caused these changes?
• Why do some entities remain unchanged over a long period of time?
• Why is a particular version of an entity typically used in some plans or products?
• Which kind of healthcare benefit or plan data most commonly undergoes changes?
• Why do some entities have versions that have never been used?

Entity versioning

Pega Product Composer for Healthcare automatically versions the following entities:

• Benefit
• Grouper
• Benefit set
• Network
• Product template
• Product
• Plan

A version has two components. The first number is the major or base version, and the second number is the minor version. The application automatically creates the first version as 01-01.

Major and minor versions

The stage and status of the entity determine the actions that can take place during the stage:

Resume or update the current version of the entity

This action launches the update of the workflow process of the existing version.

Save the entity as a new version

This action saves the entity as a new version and launches the new version creation workflow process. Some of the fields are read-only when you create a new version to keep the core business data integrity between versions.

Pega Product Composer for Healthcare creates a major version of an entity when you change the effective date or the end date, or both, if there is no matching version in production with the changed dates.

The application creates a minor version of the existing major version when you make changes other than changes to the effective date or the end date. For example, if you add a place of service to the list of places of service, the application creates a minor version of the entity.

Configuration settings for versioning

The application settings drive the creation or update of major and minor versions in the stages of the entity. To view and configure these settings, in Dev Studio, click ConfigureProduct Composer System Configuration.

The following figure shows the default settings for versioning:

Create version: Selecting the Create version check box drives the creation of major versions for entities in the specified stage.

Update version: Selecting the Update version check box drives the creation of minor versions:

• If the Update version check box is selected, the entity can be updated, and the version number does not change. No new minor version is created.
• If the Update version check box is not selected, if updates are made to the current entity, then a minor version is created. However, if you made changes to the entity’s effective date or end date, or both, and the Create version check box is also selected, a new major version is created.

For example, in the default Pega Product Composer for Healthcare configuration settings shown above, the Update version check box is selected for the Development stage. This means that you can update the current versions of the entity in the Development stage, but no minor version is created. In this same example, an entity can only be reworked in the same stage after the manager’s approval.

Further in this example, you can create versions in all stages except for the Rejection stage. The creation of minor versions is allowed only in the Production stage. In other words, you can keep updating the entities in Development and Implementation stages without creating minor versions, but for any change or update made in the Production stage, a new version is created.

Benefit versioning example in the application

1. User A creates a new Ambulance benefit. Version 01-01 is assigned by the application.
2. User A moves the benefit to the Dev-Approved status. The benefit is now in the Dev Approved work queue and is available in the application’s search list with the Dev-Approved work status.
3. Later, User A opens the entity in the application, and clicks Save as new version.
   • If User A clicks Next without changing the effective date or end date or both, the next minor version, 01-02, is assigned to the Ambulance benefit.
   • If User A clicks Next after changing the effective date or end date or both, the next major version, 02-01, is assigned if there are no existing versions in the system with the new dates that were entered.