MyMealth Corporation wants to use the age of the claim to increase the urgency on the assignment so that claims processors work on the most urgent claims first. The claim assignment urgency increases by 1 each day the claim remains in an unresolved status. At any time. My Health has up to 10,000 claims in process. Claims in the PendingProcessing workbasket are subject to this calculation. The application updates the claim urgency daily before the work day begins. AM claims are processed within 30 days.
MyHealth also processes complaint cases from health plan members. Complaint cases use a service level agreement (SLA) to ensure the customer service representatives respond to complaints within 48 hours. All claims processors work in Los Angeles 9:00 AM-5:OQ PM PST.
Which approach satisfies the claim urgency requirement and provides the best experience for the claims processor?
You need to create custom workspaces for the manager and for the Customer service representative (CSR), Also, you are asked to display some properties in custom formats that arc not supported by Pega.
Which approach satisfies these requirements?
How do you begin your research to diagnose the cause of the reported performance issue?
A health plan application includes a process for surgical procedure requests. Currently, there is an evaluation subprocess in which a physician reviews the diagnosis and enters the recommended procedure and its urgency. The request then advances to a medical director who analyzes the feedback and approves the appropriate procedure. The health care organization has created a new requirement, which states that three physicians can perform the evaluation independently. Only two evaluations are necessary to advance the case to the medical director.
How do you configure the process so that the request can continue to be processed if only two of the three physicians approve the order?
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