pega

JSON twin: https://www.healthaidb.com/software/pega.json

Company Name

Pegasystems

Product URL

https://www.pega.com/industries/healthcare

Company URL

https://www.pega.com

Categories

Summary

Pega is an enterprise low-code platform that delivers workflow automation, real-time AI decisioning and case/care management solutions for payers, providers, life sciences and government healthcare organizations.

Description

Pegasystems (Pega) provides a commercial, cloud-capable low-code platform and prebuilt healthcare solutions (Pega Care Management, Product Composer for Healthcare, life‑sciences orchestration, PBM automation) that combine case management, business rules, real‑time AI decisioning, orchestration and integrations to automate care coordination, benefits administration, member/patient engagement and clinical trial processes at enterprise scale.

Api Available

yes

Certifications

Company Founding

1983

Company Offices

Compliance

Customers

Data Residency

Pega Cloud regional hosting (US and EU regions) or customer-managed / on-prem deployment for local residency control

Data Standards

Deployment Model

Features

Id

P1266

Integration Partners

Integrations

Languages Supported

Last Updated

2025-09-07

License

commercial / proprietary

Links

Market Segment

Optional Modules

Os Platforms

Pricing Details

Pricing is commercial / enterprise‑quoted based on modules, users, and cloud/hosting; contact vendor for quote. Platform trial/guided tour available via Pega website.

Pricing Model

enterprise_quote

Privacy Features

Ratings

Regions Available

Release Year

1983

Security Features

Specialties

Support Channels

System Requirements

Pega Platform runtime (Java application server), supported browsers Chrome/Firefox/Edge, optional Elasticsearch; (on-prem: Linux/Windows servers, Java, database supported by Pega); Pega Cloud available

Target Users

Training Options

Type

product

User Reviews

Version

1.0

Canonical JSON

{
  "company_name": "Pegasystems",
  "company_url": "https://www.pega.com",
  "company_offices": [
    "United States",
    "Canada",
    "United Kingdom",
    "France",
    "Germany",
    "Netherlands",
    "Australia",
    "India",
    "China",
    "Japan"
  ],
  "company_founding": "1983",
  "product_url": "https://www.pega.com/industries/healthcare",
  "categories": [
    "administrative",
    "care management",
    "patient-facing",
    "workflow automation",
    "analytics",
    "life sciences"
  ],
  "market_segment": [
    "enterprise"
  ],
  "links": [
    "https://www.pega.com/industries/healthcare",
    "https://www.pega.com/industries/healthcare/care-management",
    "https://www.pega.com/trust",
    "https://docs.pega.com",
    "https://www.pega.com/about/office-locations",
    "https://www.pega.com/customers",
    "https://support.pega.com",
    "https://www.pega.com/insights/resources/pega-foundation-healthcare",
    "https://www.g2.com/products/pega-platform/reviews",
    "https://www.capterra.com/p/136889/Pega-Platform/"
  ],
  "summary": "Pega is an enterprise low-code platform that delivers workflow automation, real-time AI decisioning and case/care management solutions for payers, providers, life sciences and government healthcare organizations.",
  "description": "Pegasystems (Pega) provides a commercial, cloud-capable low-code platform and prebuilt healthcare solutions (Pega Care Management, Product Composer for Healthcare, life‑sciences orchestration, PBM automation) that combine case management, business rules, real‑time AI decisioning, orchestration and integrations to automate care coordination, benefits administration, member/patient engagement and clinical trial processes at enterprise scale.",
  "target_users": [
    "health plan administrators",
    "care managers",
    "clinicians",
    "population health teams",
    "pharmacy benefit managers",
    "life‑sciences/R&D teams",
    "IT/automation engineers",
    "customer service/CRM agents",
    "government healthcare administrators"
  ],
  "specialties": [
    "care management / case management",
    "care coordination",
    "population health",
    "pharmacy benefit management (PBM) automation",
    "health plan product configuration",
    "member/patient engagement",
    "clinical trials orchestration",
    "utilization management",
    "prior authorization workflows",
    "customer service automation"
  ],
  "regions_available": [
    "United States",
    "Canada",
    "United Kingdom",
    "European Union",
    "Australia",
    "India",
    "Japan",
    "Brazil",
    "Global"
  ],
  "languages_supported": [
    "English",
    "French",
    "German",
    "Italian",
    "Japanese",
    "Portuguese (pt-BR)",
    "Spanish"
  ],
  "pricing_model": "enterprise_quote",
  "pricing_details": "Pricing is commercial / enterprise‑quoted based on modules, users, and cloud/hosting; contact vendor for quote. Platform trial/guided tour available via Pega website.",
  "license": "commercial / proprietary",
  "deployment_model": [
    "SaaS (Pega Cloud)",
    "on_prem",
    "hybrid",
    "cloud-managed (customer cloud)"
  ],
  "os_platforms": [
    "Web (browser)",
    "iOS (via Pega Mobile Client)",
    "Android (via Pega Mobile Client)",
    "Windows (server/desktop)",
    "Linux (server)",
    "macOS (desktop)"
  ],
  "features": [
    "Case management / workflow automation",
    "Care management and care plans",
    "FHIR REST APIs (pre-configured) and FHIR resource support (R4 v4.0.1)",
    "HL7 v2 and X12 5010 EDI processing (eligibility, claim status, claims)",
    "Pre-configured healthcare data model (members, providers, plans, contracts)",
    "Pre-built portals and role-based dashboards",
    "Provider directory and Provider 360",
    "Appeals & Grievances management",
    "Document management and document reference APIs",
    "RxNorm drug search integration",
    "Search & reporting (Elasticsearch integration, SRS)",
    "Pre-configured REST connectors and extensible API mappings",
    "Business decisioning / real-time AI integration",
    "Audit trails and data masking for PII",
    "Pre-built Insights / analytics and reporting",
    "X12 and NCPDP message support and mapping",
    "Code set and code group management (ICD10/CPT/HCPCS/MEDDRA)",
    "Integration patterns and connectors (MapToEntity, data pages)",
    "OAuth and configurable authentication for APIs",
    "Extensible API/service testing tooling"
  ],
  "optional_modules": [
    "Pega Foundation for Healthcare (FHIR module)",
    "Pega Care Management",
    "Appeals & Grievances Manager",
    "X12 EDI/X12 837 processing module",
    "Code Manager / Code Sets management",
    "Provider 360 / Provider data management",
    "Elasticsearch integration (search/reporting)",
    "RxNorm / MedDRA data loaders",
    "FHIR API testing & OAuth configuration components",
    "Pega Mobile Client"
  ],
  "integrations": [
    "Epic (FHIR sandbox referenced / Epic FHIR)",
    "HAPI FHIR (test server)",
    "EMR/EHR systems (via FHIR REST APIs)",
    "X12 EDI trading partners (payer/clearinghouse integrations)",
    "NCPDP (pharmacy messages)",
    "RxNorm drug database",
    "PACS/DICOM imaging metadata (ImagingStudy FHIR resource)",
    "Billing / claims systems (837/277/276 workflows)",
    "CMS interfaces (coverage/eligibility/explanation of benefits APIs)",
    "Identity providers (SAML/OAuth/OpenID Connect)",
    "Elasticsearch (search & reporting)",
    "Third‑party clinical data repositories (FHIR servers)",
    "Directory / Provider registries",
    "Robotic process automation connectors (Pega RPA)"
  ],
  "data_standards": [
    "FHIR R4 (v4.0.1)",
    "HL7 v2",
    "X12 5010 (HIPAA EDI)",
    "NCPDP",
    "DICOM",
    "RxNorm",
    "ICD-10",
    "CPT/HCPCS",
    "SNOMED CT"
  ],
  "api_available": "yes",
  "system_requirements": "Pega Platform runtime (Java application server), supported browsers Chrome/Firefox/Edge, optional Elasticsearch; (on-prem: Linux/Windows servers, Java, database supported by Pega); Pega Cloud available",
  "compliance": [
    "HIPAA (supports HIPAA policies)",
    "HITECH (controls for health data)",
    "GDPR (data protection features)",
    "SOC 2 (Pega Cloud attestation)",
    "ISO/IEC 27001 (information security)"
  ],
  "certifications": [
    "SOC 2 (Pega Cloud)",
    "ISO/IEC 27001"
  ],
  "security_features": [
    "OAuth 2.0 support for APIs",
    "SSO / SAML / OpenID Connect",
    "Role-based access control (RBAC)",
    "Encryption in transit (TLS)",
    "Encryption at rest (configurable)",
    "Audit logging / audit trails",
    "PII data masking",
    "Configurable authentication profiles"
  ],
  "privacy_features": [
    "HIPAA support and configuration (BAA available via Pega Cloud agreements)",
    "PII/member data masking",
    "Consent management patterns (configurable)",
    "Anonymization / pseudonymization patterns"
  ],
  "data_residency": "Pega Cloud regional hosting (US and EU regions) or customer-managed / on-prem deployment for local residency control",
  "customers": [
    "Anthem (now Elevance Health)",
    "UnitedHealthcare",
    "DAK Gesundheit",
    "HCA Healthcare",
    "Pfizer",
    "Highmark"
  ],
  "user_reviews": [],
  "ratings": [
    "G2: 4.2/5 (Pega Platform)"
  ],
  "support_channels": [
    "email",
    "phone",
    "chat",
    "ticketing",
    "community",
    "knowledgebase",
    "24x7"
  ],
  "training_options": [
    "documentation",
    "webinars",
    "live_online",
    "onsite",
    "certification",
    "Pega Academy"
  ],
  "release_year": "1983",
  "integration_partners": [
    "Accenture",
    "Deloitte",
    "IBM",
    "AWS",
    "Microsoft",
    "Google Cloud",
    "Cognizant",
    "Capgemini",
    "Infosys",
    "Tata Consultancy Services (TCS)",
    "Wipro",
    "NTT DATA",
    "KPMG",
    "HCL Technologies",
    "EPAM Systems"
  ],
  "id": "P1266",
  "slug": "pega",
  "type": "product",
  "version": "1.0",
  "last_updated": "2025-09-07",
  "links_json": {
    "self": "https://www.healthaidb.com/software/pega.json"
  }
}