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Pega Foundation for Healthcare

Healthcare solutions foundation

Pega Foundation for Healthcare forms the enterprise foundation for all Pega healthcare solutions, including Pega Smart Claims Engine™ for Healthcare. 

Pega Foundation for Healthcare provides a set of enterprise healthcare assets utilized by Smart Claims Engine, including:

  • Preconfigured data models for commonly referenced healthcare objects such as claims, member, provider, benefits, and authorizations
  • Code set and code group management that enable industry-standard code set management and creation of associated code groups.
  • APIs for rapid integration with external sources of truth, and support for industry-standard electronic data interchange (EDI) standards

Pega Foundation for Healthcare holds the references to benefit plans, care management authorizations, and provider and member data used by Smart Claims Engine for claims processing. Pega Foundation for Healthcare also provides the data masking needed to obscure personally identifiable information (PII) for sensitive members like VIPs and employees.

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