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Updating benefit sets, product templates, products, and plans by using Smart Update

Suggest edit Updated on September 10, 2021

With the Smart Update feature of Pega Product Composer™ for Healthcare, you can update existing entities, replicate entities, or create new versions of entities at one time. For example, use Smart Update to update benefit sets, product templates, products, and plans for portfolio renewal, implementation of regulatory changes, and error correction. 

This functionality means that you can use Smart Update to change only one setting or you can change many parameters all at one time. For example, if you needed to change the telehealth benefit to have no member cost-sharing across your entire book of business, you can complete that task in one Smart Update case.

When you use Smart Update, you can update benefit sets, product templates, products, and plans in that order or you can update any one of the entities by starting directly with that entity.

Use Smart Update to perform the following tasks:

  • Add new benefits and groupers or new versions of benefits and groupers to existing or new benefit sets or to a new version of a benefit set
  • Create new product templates or create a new version of an existing product template
  • Update benefit and network coverages within the context of the product template, product, or plan

About batches

Smart Update uses batches in the flows. You can use batches to organize your information to apply all related changes at the same time. You can configure your target entities with batches of information for the following content:

  • Benefit set content
  • Benefit set, product template, product, and plan metadata
  • Product template, product, and plan benefit categories
  • Product template, product, and plan coverages

The changes that you specify in the batch are made to all the benefit sets, product templates, products, and plans that you add to the specified batch.

For example, to update 10 products, but change the coverage level on only seven products, you define a product metadata batch by adding the seven products to the batch, and then apply the changes. The changes are applied only to the seven products.

About target actions

During Smart Update, you select target actions for entities, including update existing, replicate, or create new version. The following table shows that the target action of the current entity is based on the target action of the upstream entity. For example, if the target action for benefit set is replicate, then the target action for the product template is replicate. 

Restrictions on target actions
Benefit setProduct templateProduct Plan
Update existingUpdate existingUpdate existingUpdate existing
ReplicateReplicateReplicateReplicate
Create version
  • Create version
  • Replicate
  • Update existing
  • Create version
  • Replicate
  • Update existing
  • Create version
  • Replicate
  • Update existing

 

Smart Update tasks

Discover how to configure and use the Smart Update feature by completing these tasks:

Before you begin:
  1. Download the hotfix. For information about getting the hotfix, see Pega Product Composer for Healthcare hotfixes.
  2. Ensure that you have uploaded all the related hotfixes.

  3. Add new benefits or groupers, or new versions of benefits or groupers by using the standard processing flows.
    For more information about entity creation, see the Pega Product Composer for Healthcare Implementation Guide on the
    Pega Product Composer for Healthcare product page.

    Configuring Smart Update settings

    Configure the stage and status of your approved Smart Update products or plans when you replicate existing products or create new products or plans. The stage and status are associated with your products or plans after they are approved through the Smart Update process.

    For example, you might set the stage to Development and the status to Dev-Approved for your items that are approved by Smart Update.

    1. Log in to Pega Product Composer for Healthcare by entering your administrator credentials.
    2. In the header of Dev Studio, click Configure > Product composer system > Configuration.
    3. On the Product Composer System Configuration page, click the Flow Settings tab.
    4. In the Smart update settings section, in the Smart update stage field, enter the stage for the approved Smart Update entities.
    5. In the Smart update status field, enter the status for the approved Smart Update entities.
    6. Click Actions > Save as system configuration.

    Launching Smart Update

    1. Log in to Pega Product Composer for Healthcare by entering your operator credentials.
      Based on your operator credentials, you might immediately see the Pega Composer for Healthcare portal that you are approved to access, and you can skip this step.
    2. In the header of Dev Studio, click Launch web interface > Product Development.
    3. In the left navigation pane, click Process Entities > Update.
    4. On the Smart Update page, click Smart update.
    5. Based on your needs, click one of the following items, and then click Continue:
    • Benefit set
    • Product template
    • Product
    • Plan
    1. Based on your selection in Step 5, go the section that describes your task:

    Updating benefit sets

    You can update existing benefit sets or use them as the base to replicate new benefit sets or create new versions of the benefit sets. 

    After selecting the benefit sets, you determine which target action that you want to apply to your selected benefit sets. For example, you might select three benefit sets to create new versions.

    Before you begin: Complete the steps in Launching Smart Update

    Selecting benefit sets and target actions

    1. Click Add benefit sets.
    2. In the Add benefit sets dialog box, complete the fields as needed for your search, and then click Search.
      For example, you can search for benefit sets by the name of the insurance line such as Medical or any of the advanced search fields.
    3. In the search results list, select the benefit sets that you want to update, and then click Submit.
      In the header, breadcrumbs guide you along in the process. The green flag shows your current location, as in the following example:

       
      Smart Update breadcrumbs

    The colors of the flags are as follows:

    • Gray - Not started
    • Green - In progress
    • Blue - Complete, but not approved
    • Checkered - Complete and approved
    • Red - Withdrawn or rejected
    1. Click Continue.
    2. In the Select target actionstep, in the Target action list, select an action.
      Note: When you choose Update existing as the target action for your Smart Update case, do not select other target actions in the same case. The Smart Update flow is slightly different for the Updating existing target action than it is for the other target actions. By following this practice, you can more easily navigate through the Smart Update process.
    3. Select the benefit set, complete the fields that are appropriate for your business needs, and then click Apply.
      Based on the selected target action, other fields are displayed for completion. For example, you might give your target entity a new name when you update the benefit set.
    • When you replicate a benefit set, it requires that you give the benefit set a new name. After the replication, the replicated benefit set is no longer connected to the existing downstream entities.
    • If you select Update existing as a target action, you cannot have this benefit set approved until you complete the Smart Update case all the way through to the plan (or to any entity that was built from this benefit set).
      For example, if only product templates have been built from this benefit set, then you must complete the process through the product template to send the update for approval. To maintain structural integrity, any structural changes, such as adding a new benefit, must be followed through to the plan or any entity that is built from this benefit set.
    1. To select actions for other selected benefit sets, repeat steps 5 and 6.
    2. Review the update information, and then click Finish.

    Reviewing the selected benefit sets

    When the system either updates existing entities or creates or replicates new entities, the algorithm determines whether any errors exist that you must correct before proceeding, and then checks for warnings that are informational to you. For the warnings, you can decide when you want to correct the issues.

    1. On the Smart Update page, click Refresh.
    2. In the Assignments section, click Begin, and then either correct errors in your entity selection or create your benefit set.
    Create the benefit set
    1. Review each benefit set by clicking the name link in the Benefit Sets section.
      Read-only information is displayed in the Benefit set overview and Structure tabs.
    2. Close the benefit set-specific information window.
    3. Repeat steps a and b for each benefit set.
    4. Click Submit.
    5. Complete Configuring the benefit sets.
    Correct the benefit set errors


     
    1. Hover over the Warning icon next to the benefit set.
    2. Determine whether you want to withdraw or fix the error. 
    3. If you do not want to modify the benefit set or you cannot fix the error, withdraw the Smart Update case. To withdraw the case:
      1. Click Actions > Withdraw.
      2. If Withdraw is not an available action, on the Actionsmenu, click Review, and then click Actionsagain. Withdraw is now an available option.
    4. If you want to fix the issue later, for example, adding data to the Market segment field, continue this Smart Update case, and then add the data during subsequent steps or later when it is convenient for you.
    5. If you want to correct the error in the straight-through processing flow, fix the issue, and then return to the Smart Update flow to continue. 
      For more information, see the Product Composer for Healthcare Implementation Guide on the Pega Product Composer for Healthcare product page

    Configuring the benefit sets

    On the Configure benefit sets page, you can complete the following actions:

    • Create one or more batch files to add metadata to benefit sets.
    • Configure content for one benefit set at a time.
    • Create batch files for configuration of multiple benefit sets with the same changes.

    Configuring metadata for your benefit set

    Define the benefit set batch file by adding the benefit sets to the file and then selecting the metadata options that you want to change. 

    For example, you might create a benefit set batch file that contains two benefit sets each of which has unique configuration changes. Then you might create another batch file that contains three benefit sets with the same configuration changes.

    1. On the Configure benefit sets page, click the Configure Metadata tab, and then click Add benefit set batch.
    2. Optional: To rename the default batch file name, click the Edit icon, and then enter a new name.
    3. If you want to copy the batch data from another batch file, click the Copy batch dataicon, and then choose an already configured batch file.
    4. Expand the batch file.
    5. On the right side of the page, click the Add link.
    6. Inthe Select benefit sets for batch dialog box, select the benefit sets for which you want to update the metadata with this batch file, and then click Submit.
    7. Define the metadata for the batch file, by clicking Define metadata.
      On the Edit benefit set metadata page, in the list on the left side of the page, select the option that you want to change, and then select the action. For example, you might want to append a line of business.
    8. In the Edit benefit set metadata window, complete the fields, and then click Submit.
    9. Repeat steps 1 through 6 for each metadata batch file.
    10. On the Configure benefit sets page, click Save.
    What to do next: Based on your business needs, complete one of the following tasks:

    Configuring content for a single benefit set

    If you want to make different changes to several benefit sets, configure the information on this tab, one benefit set at a time. 

    1. On the Assignments page, click Begin.
    2. On the Configure benefit sets page, click the Configure content - Individual tab, and then click Add benefit set
    3. In the Select benefit sets dialog box, select the check box for each benefit set that you want to change, and then click Submit
    4. On the Configure benefits sets page, at the end of the row of a benefit set, click the Configure benefit set icon.
    5. In the Configure the benefit set window, based on your business needs, make your changes:
      • To modify benefits or groupers in the Add benefits and Add grouperssections, select the benefits and groupers that you want to add, and then click Add.
        Note that you can click theOpen this item for review icon to review the structure of the benefit or grouper to add. Close the window when you complete the review.
      • In the Ranking section, adjust the order of appearance for the benefits by clicking the up or downlinks.
      • In the Benefit set section, click Remove next to the benefit or grouper that you want to remove.
    6. Click Submit
    7. Repeat steps 2 through 6 for each benefit set that you are configuring with unique changes. 
    8. Do one of the following:

    Configuring content in batches

    Configure the changes in your benefit sets in batches if the changes that you want to make are the same for the multiple benefit sets that you have selected. You can conveniently modify values for multiple benefit sets in one Smart Update case.

    For example, you need to add a new benefit for COVID-19 to all your benefit sets. In one batch, you can choose each benefit set and add the new COVID-19 benefit. As a result, every benefit set that you choose, is updated to include the COVID-19 benefit.

    The new benefit is added at the end of the list of pre-existing benefits in the ranking order. For example, if there are five benefits, the new benefit is ranked as the sixth benefit.

    1. On the Assignments page, click Begin to configure the benefit sets.
    2. On the Configure benefit sets page, click the Configure content – Batches tab.
    3. Add the batch file by clicking Add benefit set batch.
    4. Optional: To rename the default batch file name, click the Edit icon, and then enter a new name.
    5. If you want to copy the batch data from another batch file, click the Copy batch data icon, and then choose an already configured batch file.
    6. Click the arrow to the left of the batch file name to expand it.
    7. On the right side of the page, click the Add link. 
    8. Select the benefit sets, and then click Submit
    9. Make changes to the content for the selected benefit sets by clicking Define content.
    10. In the Configure benefit set content dialog box, modify the list of benefits and groupers:
    • To add a benefit or grouper to the benefit set, click an item and then complete the fields. 
    • To remove a benefit or grouper, click the item that you want to delete. 
    1. Click Submit
    2. Repeat steps 3 through 9 for each batch file.
    3. Click Submit.

    Reviewing updated benefit sets

    If you have errors in the updated benefit sets, you need to correct them. Otherwise, you decide on your next step such as proceeding to approval or product templates. For more information, see Troubleshooting

    1. On the Smart Update page, click Refresh.
    2. On the Assignments page, click Begin.
    3. On theReview updated benefits sets for correct valuespage, based on your business needs, decide on your next steps:
    • To make more changes to the benefit sets, click Reconfigure benefit sets.
    • To send the benefit sets for approval, click Send for approval, and then go to Approving benefit sets
    • Continue to product templates
      If you updated existing benefit sets, navigate to step in Selecting product templates and target actions and complete the steps in all the sections. Product templates that were created from the benefits sets are listed in the Add product templates dialog box. You cannot add other product templates or remove any of the product templates that are already in the list. If you created a new version or replicated an existing version of the benefit set, you cannot add other product templates, but you can remove product templates from the list.

    Approving benefit sets

    You can approve your benefit sets before updating a product template except when your target action is updating existing benefit sets. Perform this task so that your work is reviewed for accuracy.

    1. On the Review page, click Actions > Approve benefit sets.
    2. In the Approval notefield, enter your comments, and then clickSubmit.
      After the approver approves the assignment, you can start the next step. You can get the assignment from your workbasket queue.
    3. On the Assignment page, click Begin.
    4. Click on one of the following options:
    • Based on your business needs, to exit after each entity is completed and approved before you work on the next entity, click Exit Smart Update.
    • For new, replicated or update existing benefit sets, click Continue with the process, and then begin with step 3 in Selecting product templates and target actions.
      Product templates that were created from the benefits sets are listed. You cannot add other product templates or remove any of the product templates that are already in the list.
    Notice: If you select Update existing as your target action, you cannot have this benefit set approved until you complete the Smart Update case all the way through to the plan (or to any entity that was built from this benefit set). For example, if only product templates have been built from this benefit set, then you must complete the process through the product template to send the update for approval. To maintain structural integrity, any structural changes, such as adding a new benefit, must be followed through to the plan or any entity that is built from this benefit set.

    Updating product templates

      When you need to make updates to your product templates, you can use Smart Update for one or multiple changes across many product templates. For example, you might need to add new benefits to your templates for the next year. After you modify the product template, you can automatically update the specified products and plans. 

      During the product template update, you select product templates that you want to change, and then apply one of the following target actions:

      • Update the current version of an existing product template, for example, when you need to correct errors.
      • Replicate an existing product template, for example, when you want to add a new line of business, and most of the other information is the same as an existing product template.
        R
        eplicating an existing product template involves creating a new product template that you copied from an existing product template. After the replication, the replicated product template is no longer connected to the existing product template.
      • Create a new version of an existing product template, for example, to add a new network. 
        The system automatically increments the version of the new product template as either a major version, if you update the effective and end dates, or a minor version if you update parameters other than the dates.
      Before you begin:
      Complete the steps in Launching Smart Update

      Selecting product templates and target actions

      1. In the Select an entity field, click Product template, and then click Continue.
      2. On the Search product templates page, click Add product templates.
      3. In the Add product templates dialog box, complete the fields as needed for your search, and then click Search
        To find the product templates that were built by using the specific benefit sets, you can search by benefit set. For example, you can search for product templates by insurance line or any of the advanced search fields.
      4. In the search results list, select the check boxes for the product templates that you want to update, and then click Submit.
      5. Optional: To add more product templates for update after the initial selection, in the Selected product templates section, click Add product templatesand repeat step 4
      6. Click Continue to select the target actions.
      7. In the Select target action step, in the Target action list, select an action.
        Select only one action for your product templates. 
        To avoid confusion in the Smart Update process, do not mix actions in the Smart Update case.
      8. Select one or more product templates, complete the fields that are appropriate for your business needs, and then click Apply.
        Based on the selected target action, other fields are displayed for completion. For example, you can give your target entity a new name.
        When you replicate a product template, give the product template a new name. After the replication, the replicated product template is no longer connected to the existing product template.
      9. Update the networks, network guardrails, and the selected benefit sets for a product template:
        1. Click the Open product template configuration icon at the end of the product template row.
        2. In the Configure a product template for smart updatedialog box, in the Network list, add a network by selecting a network, and then click Add network.
        3. Based on your business requirements, for each network listed, in the PCP required list, modify the option as needed.
        4. Optional: To delete a network from the product template, click the Delete the network icon. 
        5. In the Network guardrails section, modify or add a guardrail by clicking the Add a rowicon.
        6. Optional: To keep the changes that you already made to other benefits, select the Update only check box.
          If you do not select this option, you lose the changes that you have already made to the product template.
        7. Click Submit
      10. Repeat step 9 for all the product templates.
      11. Review the update information, and then click Finish.

      Reviewing the selected product templates

      When the system either updates existing entities or creates or replicates new entities, it determines if there are errors that you must correct before proceeding or displays warnings that are informational to you. For the warnings, you can make the determination on when is the appropriate time to correct the issues. 

      For more information, see Troubleshooting

      1. Click Refresh.
      2. Based on the task in the Assignments section, click Begin to either correct errors in your product template selection or create your product template by following the steps in the table below. 
      Review the product templates
      1. Review the benefit sets by clicking the name link in the Product Templatessection.
        Read-only information is displayed in thetabs.
      2. Close the product template information window.
      3. In the Review created product templates for correct valuessection, click Submit.
      4. Follow the steps in Configuring Metadata for product templates.
      Correct the product template errors


       
      1. Hover over the Warning icon next to the product template.
      2. Determine whether you want to withdraw or fix the error.
      3. If you do not want to modify the product template or you cannot fix the error, withdraw the Smart Update case. 
        1. Click Actions > Withdraw.
        2. If Withdrawis not an available action, in the Actionsmenu, click Review and then click Actionsagain. Withdraw is now an available option.
      4. If you want to fix the issue later, for example, adding data to the Market segment field, continue this
        Smart Update case, and then add the data during subsequent steps or later when it is convenient for you.
      5. If you want to correct the error in the straight-through processing flow, fix the issue, and then return to the Smart Update flow to continue.
        For more information, see the Product Composer for Healthcare Implementation Guide on the Pega Product Composer for Healthcare product page

      Configuring product templates

      During configuration, you might perform one or more of these tasks in any order or you might not perform any of the following tasks:

      • Configure metadata including the following items:
        • Product line
        • Line of business
        • Coverage level
        • Market segment
        • Exchange level
        • SBC properties
      • Configure benefit categories
      • Configure coverages

      Configuring metadata for product templates

      Define the product template batch file by adding the product templates to the file and then selecting the metadata options that you want to change.

      1. On the Configure product templates page, click the Configure Metadata tab, and then click Add product template batch.
      2. Optional: To rename the default batch file name, click the Edit icon, and then enter the new name.
      3.  If you want to copy the batch data from another batch, click the Copy batch data icon, and then choose an already configured batch file. 
      4. Expand the batch file.
      5. On the right side of the page, click the Add product templates to batch icon.
      6. In the Select product templates for batch dialog box, select the product templates that you want to update with this batch, and then click Submit
        You can use the Filter by fields to display a subset of the selected product templates. For example, you might want to add a market segment of Medium group to only some of the product templates, but not all. Click Define metadata to make your changes to the metadata.

        On the Edit template metadata page, select the option that you want to change from the list on the left, and then select the action from the list on the right side of the page. For example, you might want to add a new coverage level, such as Employee + Children, to some product templates.

        If you make a market segment change that applies to all 10 product templates, for example, a change from Large Group to Medium Group, define a product template metadata batch, select all the product templates, and remove the Large Group market segment. Then define another product template metadata batch, select the same product templates, and add the Medium Group market segment. These changes apply to all 10 product templates.

        Some fields allow for selection of multiple values, for example Coverage level, and have the following options:

      Append - The value that you select is added to the existing values

      Replace - The value that you select replaces the existing values

      Remove - The value that you select is removed

      Other fields where you can select only one option, for example Product line, have the actions Replace or No changeNo change means that the existing value remains. The Exchange level field shows the actions of No changeReplace, or Remove.

      1. Complete the fields on the Edit product template metadata page, and then click Submit.
      2. Confirm your changes by clicking Save, and then proceed to configure the other tabs of information. 

      Configuring benefit categories

      Define the benefit category batch file by adding the product templates to the file, defining the benefit categories, and then adding benefits. For more information about benefit categories, see Pega Product Composer for Healthcare Implementation Guide on the Pega Product Composer for Healthcare product page

      Important: If you change the benefit category within the Smart Update feature, Smart Update only updates existing benefit categories that come from the existing or the new product template, per your  configuration in the batch files.
      1. On the Configure product template page, click Begin
      2. On the Configure product template page, click the Configure Benefit Categories tab.
      3. Click the Add benefit category batch.
      4. Optional: To rename the default batch file name, click the Edit icon, and then enter a new name.
      5. If you want to copy the batch data from another batch file, click the Copy batch dataicon, and then choose an already configured batch file.
      6. Click the Add product templates to batch icon.
      7. In the Select product templates for batch dialog box, select the product templates that you want to update with this batch, and click Submit
      8. Click Define benefit categories.
      9. In the product template benefit categories dialog box, click Add benefit category.
      10. In the Name list, select an item, and click OK.
      11. Repeat steps 7 and 8 for each benefit category that you want to add.
      12. Click Submit.
      13. Click Save.

      Configuring coverages

      Define the coverage batch by selecting the entity for which you want to update coverage. Then select the product templates and networks to which the updated coverage applies. For more information about coverage, see the Pega Product Composer for Healthcare Implementation Guide on the Pega Product Composer for Healthcare product page

      For example, based on world conditions, you might want to add a new benefit, such as Home Delivery of Meals during a flu epidemic, to your product templates for the current year. You create the benefit by using the links in the navigation pane of Pega Product Composer for Healthcare. You can then use Smart Update to add the benefit to the benefit set and product template. You can then update the coverage for the current year to add cost shares, limits, or inheritance of those coverages.

      Another example of product template coverage configuration is when you want to change the deductibles and out-of-pocket values at the network level for your product templates.

      Note: If you want to change the deductibles and out-of-pocket values at the network level, the product templates in the coverages batch must have the same calculation method. For information on calculation methods, see the Pega Product Composer for Healthcare Implementation Guide on the Pega Product Composer for Healthcare product page.

      If you need to change the calculation method for a product template, on the Configure Coverages tab, select Product template, and then add the product templates for which you want changes. Then change the calculation method and define the values. 

      1. On the Assignments page, click Begin.
      2. On the Configure Product templates page, click the Configure Coverages tab. 
      3. Click the Add product template batch.
      4. Optional: To rename the default batch file name, click the Edit icon, and then enter the new name.
      5.  If you want to copy the batch data from another batch, click the Copy batch data icon, and then choose an already configured batch file.
      6. Expand the batch file.
      7. In the Coverage applies to list, select the entity for which you want to update coverage within the context of the product template, for example, Benefit. 
      8. Optional: To change network coverage, on the Configure Coverages tab, select Network, and then add the networks for which you want changes.
      9. Expand the Select benefits section of the page, and then click the Add icon to add the benefits.
      10. In the Add benefits dialog box, complete the fields for your search, select the benefits that you want to update, and then click Submit.
      11. Expand the Select product templates section of the page, and then click the Add icon.
      12. In the Add product templates dialog box, complete fields for your search, select the product templates that you want to update with the benefit change, and then click Submit.
      13. Expand the Select networks section of the page, and then click the Add icon.
      14. In the Add networks dialog box, select the network names, and then click Submit.
      15. Click Define coverage.
      16. On the Configure coverage page, complete the updates to the coverage fields, and then click Submit.
        The default configuration provides the following values:
        No ChangeThe entity has the pre-existing value and the value does not change.
        Restore inheritance - The coverage value follows normal inheritance rules. If the value was previously overridden, this action restores inheritance.
        Update coverage - The value that you enter overwrites the value on the product template.

        Clicking the Copy to other networksbuttons allows you to copy
        a coverage to another network.

        For additional information about configuring these fields, see the Pega Product Composer for Healthcare Implementation Guide on the Pega Product Composer for Healthcare product page.
         
      17. On the Configure product templates page, click Submit.

      Reviewing product templates

      The algorithm determines whether any errors exist that you must correct before proceeding, and then checks for warnings that are informational to you. For warnings, you can decide when you want to correct the issues.

      For more information, see Troubleshooting

      1. On the Smart Updatepage, click Refresh.
      2. On the Assignments page, click Begin.
      3. On the Review updated product templates for correct values page, based on your business needs, do one of following: 
      • Reconfigure product templates
        Click this button if you need to make more changes to the product templates.
      • Send for approval
        Click this button and follow the steps in
        Approving product templates. If you are updating existing product templates, you are not able to send for approval now. You must continue through the product.
      • Continue to products 
        Click this button and go to Updating products

      If you updated existing product templates, navigate to step 3 in Selecting products and target actions and follow the steps in all the sections. Products that were created from the product templates are listed. You cannot add other products or remove any of the products already in the list. 

      Approving product templates

      You can approve your product templates before updating products except when your target action is Updating existing.

      1. On the Review page, click Actions > Approve product templates.
      2. In the Approval notefield, enter text, and then clickSubmit.
        After the approver has approved the assignment, you can start the next step. You can get the assignment from your workbasket queue.
      3. On the Assignment page, click Begin.
      4. Click on one of the following options:
      • Exit Smart Update
      • Continue with the process
        For new or replicated product templates, follow the steps in Updating products.

      Updating products

      During the product update, you select products to apply one of the following target actions:

      • Update an existing product
      • Replicate an existing product
        Replicating an existing product involves creating a new product that you copy from an existing product. After the replication, the replicated product is no longer connected to the existing product.
      • Create a new version of an existing product
        The system automatically increments the version of the new product as either a major or minor version based on whether you changed the effective and end dates. 

      When you update a product, the product receives merged information from the existing product and the parent product template. This data includes metadata, benefit categories, coverage ranges, and coverage values.

      Before you begin:
       Complete the steps in Launching Smart Update

      Selecting products and target actions

      1. In the Select an entity field, click Product, and then click Continue.
      2. On the Search product templates page, click Add products.
      3. In the Add products dialog box, complete the fields as needed for your search, and then click Search.
        For example, you can search for products by the product name or by the product template name on which products were built.
      4. In the search results list, select the products that you want to update, and then click Submit.
      5. Optional: To add more products to update after the initial selection, in the Selected products section, click Add products, and complete steps 3 and 4
      6. Click Continue to select the target actions.
      7. Determine which target actions you are applying to your selected products. For example, you might update the selected products.
      8. In the Select target action step, in the Target action list, select an action.
        Select only one action for your products. Do not mix actions in the case.
      9. Select one or more products, complete the fields that are appropriate for your business needs, and then click Apply.
        Based on the selected target action, other fields are displayed for completion. For example, you can give your target entity a new name or select another version of the product template on which the target entity is built, if another version is available and applicable. 
        When you replicate a product, you must give the product a new name because after the replication, the replicated product is no longer connected to the existing product.
      10. Review the information, and then click Submit.
      11. Click Refresh.
      12. In the Assignments section, click Begin to review your product.

      Reviewing the selected products

      On the Review created products page, you can review all the information that is related to your target entity. Note any information that you want to add or modify and any items that you need to reconcile. You can make these changes in Configuring products.

      For updates to products, you can click the link for the target entity and review existing product metadata, cost shares, networks, benefits, and benefit categories for the updated versions. When you update a product, the new product receives merged information from both the parent product and the product template. In this case, you see the merged information.

      For more information, see Troubleshooting

      No Warning icons are displayed next to your product Click Submit.
       
      Warning icon is displayed next to the product with information for your configurationHover over the icon, note the information, and then click Submit.
      Warning icon is displayed next to your product with an error message
      1. Hover over the Warning icon next to your product. 
      2. Determine whether you want to withdraw or fix the error. 
      3. If you do not want to modify the product or you cannot fix the error, withdraw the Smart Update case. 
         
        1. Click Actions > Withdraw.
        2. If Withdraw is not an available action, on the Actions menu click Review, and then click Actions again.
          Withdraw is now an available option
      4. Based on the warning message, if you determine that you will fix the issue later, for example, adding data to the Market segment field, continue this Smart Update case and add the data during subsequent steps or later when convenient for you.
      5. If you want to correct the error in the straight-through processing flow, fix the issue, and then return to the Smart Update flow. 
        For more information, see the Pega Product Composer for Healthcare Implementation Guide on the 
        Pega Product Composer for Healthcare product page.
      6. To resolve other errors, repeat steps a through d.

      Warning icon appears in the Manual review column of the item because you have items that have conflicts due to the merged data of the product and product template

      1. Hover over the icon to display the warning.
      2. Note the items that are indicated in the warning.
        During product configuration, you can make changes in any of the three tabs of metadata, benefit categories, and coverages information. For more information, see 
        Configuring products.
      3. Click Begin.
        The second review screen is displayed.
      4. Click Submit

        Example: 
        The following list shows items that you might need to reconcile. You can reconcile these items on the Configure Coverages page:
      • If a copayment for an existing product is not available (N/A) and the copayment for the new product is not available (N/A), but the product template has a range of copayments from $10 to $50.
      • If a product shows not available for deductibles, but the product template has a range of values.
      • If a product uses the embedded calculation type for deductible and out-of-pocket values and the product template uses the policy type calculation method.
      • If a conflict exists between the coverage for a stand-alone benefit and the coverage for the same benefit within a grouper.

      Configuring products

      During configuration, you might perform one or more of these tasks in any order or you might not perform any of the tasks:

      • Configure metadata including the following items:
        • Product line
        • Line of business
        • Coverage level
        • Market segment
        • Exchange level
        • SBC properties
      • Configure benefit categories
      • Configure coverages

      Configuring product metadata

      Define the product metadata batch file by adding the products to the batch file and then selecting the metadata options that you are changing.

      1. On the Configure products page, click the Configure Metadata tab, and then click the Add product batch link.
      2. Optional: To rename the default batch file name, click the Edit icon, and then enter the new name.
      3. If you want to copy the batch data from another batch, click the Copy batch data icon, and then choose an already configured batch file.
      4. Expand the batch file.
      5. Click the Add products to batch link.
      6. In the Select products for batch dialog box, select the products that you want to update with this batch, and click Submit.
        You can use the Filter by fields to display a subset of the selected products. For example, if you select ten products for update, but want to change the coverage only for Small group products, filter by Market Segment and select only those products for this batch.
      7. Click Submit.
      8. Click Define metadata to make your changes to the metadata.
      9. In the list on the left side of the Edit product metadata page, select the option that you want to change, and then select the action in the list on the right side of the page.
        For example, you might want to add a new coverage level, such as Employee + Children, to some products and plans.


        If you make a market segment change that applies to all 10 products, for example, a change from Large group to Medium group, define a product metadata batch, select all the products, and then remove the Large group market segment. Then define another product metadata batch, select the same products, and add the Medium group market segment. These changes apply to all 10 products.

        Some fields where you can select multiple options, for example Coverage level, have the following options:

      Append - The value that you select is added to the existing values

      Replace - The value that you select replaces the existing value

      Remove - The value that you select is removed

      Other fields where you can select only one option, for example Product line, have the actions Replace or No changeNo change means that the existing value remains. The Exchange level field shows the actions of No changeReplace, or Remove.

      1. Complete the fields on the Edit product metadata page, and then click Submit.
      2. On theConfigure products page, click Save.
      3. Do one of the following:

      Configuring product benefit categories

      Define the benefit category batch file by adding the products to the file and then defining the benefit categories and adding benefits.

      Important:

      If you change the benefit category within the Smart Update feature, Smart Update updates only the existing benefit categories that come from the existing or the new product, per your configuration in the batch files.

      1. On the Smart Update page, click Begin.
      2. On the Configure product template page, click the Configure Benefit Categoriestab.
      3. Click the Add product batch link.
      4. Optional: To rename the default batch file name, click the Edit icon, and then enter the new value.
      5. To copy the batch data from another file, click the Copy batch data icon, and then choose an already configured batch file.
      6. On the Configure products page, click the Configure Benefit Categories tab, and then on the right side of the window, click the Add products to batch link.
      7. In the Select products for batch dialog box, select the products that you want to update with this batch, and then click Submit.
      8. On the right side of the window, click Define benefit categories, and then configure the categories:
        1. In the Define benefit categories dialog box, click Add benefit category.
        2. In the Benefit category list, enter a benefit category name, and then select an item.
        3. In the Update type field, select an option that describes the change that you want to make, for example, Add.
        4. In the Benefits and Groupers section, click the Add link and select Benefit or Grouper
        5. In the Benefits and Grouperssection, enter a benefit or grouper name, and then click the item that you want to update.
        6. To add other benefits or groupers, repeat steps c through e,
        7. Next to the benefit that you want to make the default benefit of the benefit category, click the Set as default display icon.
        8. Click OK.
      9. In the Define benefit categories dialog box, expand the benefit category name, and click Add.
      10. Select Benefit.
      11. In the Benefits and Groupers list, enter a benefit name, and then select the benefit that you want to update.
      12. Optional: To make the benefit the default benefit in the category, click the Set as default display icon to the right of the benefit.
        You must set one benefit in each benefit category as the default benefit.
      13. Click Submit.
      14. To define additional benefit categories and benefits, repeat steps 3 through 13
      15. After completing your product configuration, click Submit, and then view the Review page.
      What to do next: Save your configuration. Go to Configuring coverages for your products

      Configuring coverages for your products

      Define the coverage batch by selecting the entity to which you want to update coverage. Then select the products and networks to which the updated coverage will apply.

      For example, based on world conditions, you might want to add a new benefit, such as Home Delivery of Meals during a flu epidemic, to your products for the current year. You create the benefit by using the links in the navigation pane of Pega Product Composer for Healthcare. You can then use Smart Update to add the benefit to the benefit set, product template, product, and plan and update the coverage.

      You also configure product coverage if you want to change the deductibles and out-of-pocket values at the network level for your products.

      Notice: If you are changing the deductibles and out-of-pocket values at the network level, the products in the coverages batch must have the same calculation method. For information on calculation methods, see the Pega Product Composer for Healthcare Implementation Guide on the Pega Product Composer for Healthcare product page. If you need to change the calculation method for a product, on the Configure Coverages tab, select Product, and then add the products for which you want changes. Then change the calculation method and define values.
      1. On the Smart Update page, click Begin.
      2. On the Configure products page, click the Configure Coverages tab, and then click Add product batch.
      3. Optional: To rename the default batch file name, click the Edit icon, and then enter the new name.
      4.  If you want to copy the batch data from another batch, click the Copy batch data icon, and then choose an already configured batch file.
      5. Expand the batch file name.
      6. In the Coverage applies to list, select the entity for which you are updating coverage within the context of the product. Based on the selection in this list, different sections are displayed on this page.
        For this example, select Benefit.
        If you are changing network coverage, on the Configure Coverages tab, select Network, and then add the networks for which you want changes. Then you can define the coverage.
      7. Expand the Select benefits section of the page, and then click the Click to add benefitsicon to add the benefits.
      8. In the Add benefits dialog box, complete fields for your search, select the benefits that you are updating, and then click Submit.
      9. Expand the Select products section of the page, and then click the Click to add products icon to add the products.
      10. In the Add products dialog box, complete fields for your search, select the products that you are updating with the benefit change, and then click Submit.
      11. Expand the Select networks section of the page, and then click the Click to add networks icon to add the network names.
      12. Select the network names, and then click Submit.
      13. Click Define coverage.
      14. On the Configure coverage page, complete the updates to the coverage fields, and then click Submit.
        The following are the default values:
        No ChangeThe entity has the inherited values and the values do not change.
        Restore inheritance - The coverage value follows normal inheritance rules. 
        Update coverage - The value that you enter overwrites the value on the product.
        ​​​​You can also copy values of one network to another network on this page.
        For additional information about configuring these fields, see the Pega Product Composer for Healthcare Implementation Guide on the 
        Pega Product Composer for Healthcare product page. 
      15. On the Configure products page, click Submit.

      Reviewing updated products

      You can review the updated products by clicking on the items under the Products and Configuration tabs.

      1. Click Refresh.
      2. Click Begin.
      3. Based on your selections, do one of the following

      Reconfiguring products

      Modify some values, for example, for a product or network, or fix some errors that you noted when you reviewed the products.

      1. Click Reconfigure products.
      2. On the Configure products page, create new batch files.
      3. You add new batch files (ongoing batch files) for any changes that you want to make. You cannot modify the batch files that you previously created because they have been submitted and processed by the system before the review. They are called processed batch files.
      4. After you complete your changes to information on any of the three tabs, click Submit, and then review the products again.
      What to do next:  Based on your business, determine your next step:

      Sending the product updates for approval

      1. From the Review updated product page, click Send for Approval.
        The approval request is routed to the manager.
      2. As the manager, in the Pega Case Manager portal, click Actions > Approve products.
      3. On the Approve products page, in the text box, enter an approval note, and then click Submit.
        After the background process is completed, the product is now available in the stage and with the status that you specify in your configuration settings.

      Updating plans

      From the Review updated products page, click Continue to plans. Search for the plans that you want to update. You might update the plans that were based on the products that you updated in the Product update section. From the search results, select the plans that you are updating. Just as in the product updates, you can select one of the following target actions and apply it to the plans that you are updating:

      • Updating an existing plan
      • Replicating an existing plan
        Replicating an existing plan means that you are creating a new plan that you copied from an existing plan. After the replication, the replicated plan is no longer connected to the existing plan.
      • Creating a new version of an existing plan

      Changes that you made in the products are inherited by the plan, except for any value that is overridden in the plan. Then the plan does not inherit the product change. This process follows the current Pega Product Composer for Healthcare inheritance pattern. For more information about inheritance, see the Pega Product Composer for Healthcare Implementation Guide on the Pega Product Composer for Healthcare product page.

      Selecting plans and target actions

      Determine which target actions you are applying to your selected plans. For example, you might create a new version for the plans.

      1. Based on the order of tasks that you follow in Smart Update, complete the applicable task. 
        Select plans following your product updates
        1. Optional: To add more plans for update after the initial selection, in the Search plans step, click Add plans.
        2. Click Continue to select the target actions.
        Start Smart Update with plans

         

        1. Open Smart Update. For more information, see Launching Smart Update
        2. In the Select an entity field, click Plan, and then click Continue.
        3. In the Search plan step, click Add plans.
        4. In the Add plandialog box, complete the fields as needed for your search, and then click Search. For example, you can search for plans by the product name.
        5. In the search results list, select the plans that you want to update, and then click Submit.
        6. Optional: To add more plans to update after the initial selection, in the Selected plans section in the Search plans step, click Add plans, search for additional plans, and then click Submit.
        7. Click Continue.
      2. In the Select target action step, in the Target action list, select an action.
        Select only one action for your product templates. Do not mix actions in the case.
      3. Select one or more plans, complete the fields that are appropriate for your business needs, and then click Apply.
        Based on the selected target action, other fields are displayed for completion. For example, you can give your target entity a new name.
        When you replicate a plan, it requires that you give the plan a new name because after the replication, the replicated plan is no longer connected to the existing plan.
      4. Review the update information, and then click Finish.

      Reviewing selected plans

      On the Review created products page, you can review all the information that is related to your target entity. Note any information that you want to add or modify and any items that you need to reconcile. You can make these changes in Configuring plans.

      • If you are updating versions of plans, you can click the link for the target entity and review existing plan metadata, cost shares, networks, benefits, and benefit categories for the updated versions. 
      • When you update a plan, the new plan receives merged information from both the parent plan and the product. In this case, you see the merged information.

      Sometimes, Smart Update cannot reconcile the two sources of information because of a conflict or missing information. In that case, you must manually review and reconcile the items. 

      For more information, see Troubleshooting

      If you have items that have conflicts because of the merged data of the product and product template, a Warning icon appears in the Manual review column of the item. Follow these steps.

      1. Click Refresh
      2. In the Assignments section, click Begin to review your plan.
      No Warning icons displayed next to your plan Click Submit.
       
      Warning icon is displayed next to the plan with information for your configurationHover over the icon, note the information, and then click Submit.
      Warning icon is displayed next to the plan with an error message
      1. Hover over the Warning icon next to the plan.
      2. Determine whether you want to withdraw or fix the error.
      3. If you do not want to modify the plan or you cannot fix the error, withdraw the smart update case. 
      4. To withdraw the case:
         
        1. Click Actions > Withdraw.
        2. If Withdrawis not an available action, click Reviewfrom the Actionsmenu. Then click Actions again. Withdraw is now an available option
      5. Based on the warning message, if you determine that you will fix the issue later, for example, adding data to the Market segment field, continue this Smart Update case and add the data during subsequent steps or later when it is convenient for you.
      6. If you can correct the error in the straight-through processing flow, do so and then return to the Smart Update flow to continue.
      7. To resolve errors, repeat steps a through f
      1. After completing your review, submit the entities, and then start the configuration process for Smart Update.

      Configuring plans

      During configuration, you might perform one or more of these tasks in any order or you might not perform any of the tasks:

      • Configure metadata including the following items:
        • Line of business
        • Coverage level
        • Market segment
        • Exchange level
        • SBC properties
      • Configure benefit categories
      • Configure coverages
      Before you begin: Review Batches.

      Configuring plan metadata

      Define the plan metadata batch file by adding the plans to the file and then selecting the metadata options that you are changing.

      1. On the Configure products page, click the Configure Metadata tab, and then click Add plan batch.
      2. Optional: To rename the default batch file name, click the Edit icon, and then enter a new name.
      3. If you want to copy the batch data from another batch file, click the Copy batch data icon, and then choose an already configured batch file.
      4. Expand the batch file.
      5. Click the Add plans to batch icon.
      6. In the Select plans for batch dialog box, select the plans that you want to update with this batch, and then click Submit.
        You can use the Filter by fields to display a subset of the selected plans. For example, if you select ten plans for update, but want to change the coverage only for Small group plans, filter by Market Segment and select only those plans for this batch.
      7. Click Define metadata to make your changes to the metadata.
        On the Edit plan metadata page, select the option that you want to change from the list on the left, and then select the action from the list on the right side of the page.
        For example, you might want to add a new coverage level, such as Employee + Children, to some plans.
        Another example is if you make a market segment change that applies to your 10 selected plans, for example, a change from Large Group to Small Group, you define a plan metadata batch, select all the plans, and remove the Large Group market segment. Then define another plan metadata batch, select the same plans, and add the Small Group market segment. These changes apply to all 10 plans.
        Some fields that where you can select multiple options, for example Coverage level, have the actions of AppendRemove, and Replace

      Append - The value that you select is added to the existing values

      Replace - The value that you select replaces the existing value

      Remove - The value that you select is removed

      The Exchange level field shows the actions of No changeReplace, or Remove.

      1. Complete the fields on the Edit plan metadata page, and then click Submit.

      Configuring plan benefit categories

      Define the benefit category batch file by adding the plans to the file and then defining the benefit categories and adding benefits.

      Important: If you change the benefit category within the Smart Update feature, Smart Update updates only existing benefit categories that come from the existing or the new plan, per your configuration in the batch files.
      1. On the Configure plans page, click the Configure benefit categories tab, and then click Add plan batch.
      2. You can rename the default batch file name by clicking the Edit icon.
      3. Expand the batch file by clicking the arrow.
      4. Click the Add plans to batch icon.
      5. In the Select plans for batch dialog box, select the plans that you want to update with this batch, and then click Submit.
      6. Click Define benefit categories.
         
        1. In the Define plan benefit categories dialog box, click Add benefit category.
        2. Enter and select a benefit category from the Benefit category list, and then click OK.
        3. In the Define benefit categories dialog box, expand the benefit category name, and then click Add.
        4. Select Benefit.
        5. Enter and select a benefit from the Benefits and Groupers list.
        6. To make the benefit the default benefit in the category, click the Set as default display icon to the right of the benefit.
          You must set one benefit in each benefit category as the default benefit.
        7. Click Submit.
        8. Repeat these steps to define additional benefit categories and benefits.
        9. When you are finished, click Submit.

      Configuring plan coverages

      Define the coverage batch file by adding the plans to the file and then defining the changes. You might want to change the deductibles and out-of-pocket values at the network level for your plans.

      Notice: If you are changing the deductibles and out-of-pocket values at the network level, the plans in the coverages batch must have the same calculation method. If you need to change the calculation method for a plan, on the Configure Coverages tab, select Plan and then add the plans for which you want to make changes. Then you can change the calculation method and define values.

      To configure coverages, follow these steps:

      1. On the Configure products page, click the Configure Coverages tab, and then click Add plan batch.
        You can rename the default batch file name by clicking the Edit icon.
      2. Optional: To rename the default batch file name, click the Edit icon, and then enter a new name.
      3. If you want to copy the batch data from another batch file, click the Copy batch data icon, and then choose an already configured batch file.
      4. Expand the batch file name by clicking the arrow.
        1. In the Coverage applies to list, select the entity for which you are updating coverage within the context of the plan. Based on the selection in this list, different sections are displayed on this page.
        2. For this example, select Benefit.
          Note: If you are changing network coverage, on the Configure Coverages tab, select Network, and then add the networks for which you want changes. Then you can define the coverage.
      5. Expand the Select plans section of the page, and then click the Add icon to add the plans.
      6. In the Add plans dialog box, complete fields for your search, select the plans that you are updating, and then click Submit.
      7. Expand the Select plans section of the page, and then click the Add icon to add the plans.
      8. In the Add plans dialog box, complete fields for your search, select the plans that you are updating with the benefit change, and then click Submit.
      9. Expand the Select networks section of the page, and then click the Add icon to add the network names.
      10. Select the network names, and then click Submit.
      11. Click Define coverage.
      12. On the Configure coverage page, complete the updates to the coverage fields, and then click Submit.
        The default values are No Change. This means that the entity
        keeps the values that are already in the plan. You can also copy values of one network to another network on this page.
        For additional information about configuring these fields, see the Pega Product Composer for Healthcare Implementation Guide on the 
        Pega Product Composer for Healthcare product page.
      13. On the Configure plans page, click Submit.
        If there are errors, fix the errors, and then submit them.
      14. Click Refresh.
      15. Click Begin.

      Reviewing errors

      If your plans have errors, they are displayed on the Review errors page.

      1. On the Review errors page, analyze the problems, and then click Submit.
      2. Fix the errors by creating new batch files and configuring plans.
        For more information, see 
        Configuring plans.

      Reviewing updated plans

      You can perform a review on the updated plans, for example, if you need to modify some values for a product or network or fix some errors. For more information, see Troubleshooting

      1. Click Reconfigure products
      2. On the Configure plans page, create new batch files.
        You add new batch files (ongoing batch files) for any changes that you want to make. You cannot modify the batch files that you previously created because they have been submitted and processed by the system before the review. They are called processed batch files.
      3. Optional: To review your existing batch file values, click Review metadata.
      4. After you complete your changes to information on any of the three tabs, click Submitand then review the plans again.
      What to do next: Send the plan updates for approval.

      Sending the plan updates for approval

      1. On the Review updated product page, click Send for Approval.
        The approval request is routed to the manager.
      2. As the manager, on the Pega Case Manager portal, click Actions > Approve plans.
      3. On the Approve plans page, in the text box, enter an approval note in the text box, and then click Submit.
        After the background process is completed, the plan is now available in the stage that you specify in your configuration settings. 

      Withdrawing a Smart Update entity

      A manager can withdraw a Smart Update entity from the system by using the Actions > Withdraw menu item. This action undoes everything that was done in the Smart Update case, including the creation of any new versions of benefit sets, product templates, products, or plans.

      If you want to withdraw a Smart Update case but the Withdraw option is not available in the Actions menu, click on Review, then click again on the Actions menu, and the Withdraw option is available.

      Troubleshooting

      Error messageDescription and Action

      This <entity type> cannot be updated as it is not in an approved state.

      <entity type> includes benefit set, product template, product, and plan. 

      This occurs when you have an entity that is being updated in straight-processing and you attempt to perform Smart Update on it.

      Complete the straight flow and then return to the Smart Update.

      <Entity name>: Minor version of this entity cannot be created because version ’01-01’, in ‘Development’ stage (which is ‘Updatable’ by configuration), can only be updated.

       

      <entity type> includes benefit set, product template, product, and plan. 

      This occurs when you attempt to create a new version, without changing the effective and end dates, and the entity is in a stage that you can update. Another minor version cannot be created.

      Which stages are available for update is controlled by the settings on the PCS Configuration page. If you are unsure how this is set, contact your administrator. 

      Update the same version or create another version record with different effective or end dates or both.

       <Individual Deductible> of <product name> Benefit in <benefit name> network is missing

      <Individual Deductible> includes any cost share. 

      This occurs when a benefit or grouper does not have the cost share value but has the ranges (low and high). This error can occur for all cost shares in both product and plan.

      Configure a batch file in the product or plan Smart Update and define the cost share for the benefit that is reported.
      <benefit set name> cannot be consumed in the template <product template name>, as it does not have overlapping dates 

      Do one of the following:

      • Change the dates of the product template to overlap with that of the benefit set.
      • Select another benefit or version that overlaps with the product template’s dates.
      A similar error occurs when the dates of the upstream entity, benefit set, product template, or product do not overlap with the dates of the downstream entity, product template, product and plan, respectively.
      Product template <product template name>: Metadata: At least one Line of Business is required

      This occurs when there are no values configured for the line of business in a product template.

      Configure a metadata batch for the product template and select one of more values for the line of business for the product template.

      Similar errors occur when there are no values for market segment and coverage levels.
      At least one benefit or grouper must be added to the benefit set '<benefit set name> '

      This occurs when all the benefits and groupers are removed from a benefit set. This leaves the benefit set with no constituent entities.

      Add a batch file to the Smart Update and add benefits or groupers, or both, to the benefit set.
      The model type cannot be applied based on the configurationCheck the settings in the Stage actions allowed section of the Product Composer System Configuration page (Configure>Product composer>Configuration)

       

       

      • Previous topic Removal of properties from the default display in Pega Product Composer for Healthcare
      • Next topic Pega Product Composer for Healthcare reports
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