SOURCE: Pegasystems


November 19, 2013 10:00 ET

Fallon Community Health Plan Deploys Pegasystems to Address and Go Beyond Affordable Care Act Mandates

Top-Ranked Health Plan in the United States Implements Pega Technology in Five Months With Innovative Programs to Help Address Government Regulatory Changes

CAMBRIDGE, MA--(Marketwired - Nov 19, 2013) -  Pegasystems Inc. (NASDAQ: PEGA), the leader in Business Process Management (BPM) and a leading provider of Customer Relationship Management (CRM), today announced that Fallon Community Health Plan (FCHP) has implemented Pegasystems to help meet requirements of the Affordable Care Act (ACA).

By using Pega, FCHP was able to turn the October 1, 2013 federal deadline into an opportunity to improve business operations and provide better service. FCHP used Pega to help comply with ACA's mandates for member-level rating and execute Health Insurance Exchange requirements. They successfully exchanged HIPAA-based electronic information with the Massachusetts Health Connector within four months of selecting Pega, and released a new broker portal called QuoteNow, just one month later. While consumers across the country have experienced difficulties using sales and enrollment portals for the Federal Exchange,, FCHP has been accepting applications and enrolling members, since open enrollment officially started. QuoteNow streamlines health insurance application and enrollment activities, provides best practice quoting, rating and underwriting and offers many new features to FCHP's broker community.

Fallon Community Health Plan is a nationally-recognized, not-for-profit health care services organization. In addition to being the highest-ranked Medicaid health plan in the U.S., FCHP's commercial and senior products are in the top 10% in the country (according to NCQA's 2013-2014 rankings).

Pega is used cross-functionally across the healthcare enterprise by five Fortune 50 healthcare companies, 18 of the 25 largest U.S. health payers, more than 65% of the Blues network, many leading provider organizations and most of the largest pharmacy benefit managers.

Quotes & Commentary:

"The scope of the Affordable Care Act is so immense that the glitches which have arisen so far are not a surprise. Fallon Community Health Plan's approach, embracing Pega's technology to use the changes as an opportunity to help improve their business operations, has been brilliant," said Susan Taylor, VP and Business Line Leader, Healthcare for Pegasystems. "Fallon Community Health Plan embodies how an agile organization can adapt for growth when using the benefits of Pega."

"FCHP takes seriously our obligation to be a part of the solution when it comes to health care reform," said David Przesiek, Senior Vice President and Chief Sales Officer at Fallon Community Health Plan. "Realizing that there are tremendous opportunities to work more efficiently and improve workflow, we've partnered with Pegasystems not only to work smarter, but to promptly respond to the needs of our external customers including brokers, employers and individual consumers. Through Pega technology, we're able to enhance our customers' experience and exceed their expectations for service."

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Pegasystems Build for Change® technology is the heart of better business software. It delivers business agility and empowers leading organizations to rapidly close execution gaps and seize new opportunities. Pegasystems is the recognized leader in business process management and is also ranked as a leader in customer relationship management software by leading industry analysts. For more information, please visit us at

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