Programs, Tasks, and Requests
Programs, tasks, and requests are foundational entities in the Medecision Platform that drive member-centric workflow execution across clinical, utilization, engagement, and compliance domains. These three components interact dynamically to form a flexible framework that supports both guided and automated processes.
Overview of Entities
Entity | Description |
Program | A structured container for activities tied to a clinical or administrative objective (e.g., Chronic Care Management, Transition of Care, Appeals Processing) |
Task | A unit of work assigned to a user, role, or system to fulfill part of a workflow. Tasks can be automated or require manual resolution. |
Request | A formal submission (e.g., prior authorization, appeal, grievance) that typically has TAT rules, compliance deadlines, and resolution outcomes. |
These entities are tightly linked: programs consist of tasks, tasks can relate to requests, and requests can trigger or be managed within programs.
Programs
Programs define the structure, objectives, and tracking mechanisms for multi-step member journeys.
Key Features
Auto-enrollment based on rules (e.g., diagnoses, age, admission event)
Defined stages and goals with configurable progression logic
Associated assessments, outreach, and tasks
Start and completion criteria driven by business rules
Examples
Program Name | Trigger | Goal |
Transition of Care | IP Discharge + CHF Dx | Outreach within 2 days + HRA complete |
Diabetes Care Management | HEDIS gap + Risk Score > 6 | Schedule PCP + Close HbA1c gap |
Appeals Processing | Appeal Submission | Review, resolution, member letter |
Builder Tools Used:
Program Builder: Defines eligibility, stages, tasks, completion criteria
Rules Builder: Sets auto-enrollment logic
Journey Builder: Optionally orchestrates digital components of the program
Program Attributes
Program Type (Clinical, UM, Engagement, A\&G)
Assigned Team or Queue
SLA Target or Regulatory Deadline (if applicable)
Tasks
Tasks are atomic work items generated by the system or manually assigned to staff. They are the primary units of action for users.
Key Features
Configurable by program, request type, or standalone
Role-based assignment rules
Escalation and overdue tracking
Can trigger follow-up actions or assessments
Task Examples
Task Name | Trigger | Assignee |
Review Clinicals | UM Request received with missing documentation | Clinical Reviewer |
Outreach to Member | Auto-enrolled in TOC program | RN Care Manager |
Complete Assessment | Auto-task on program stage start | Care Coordinator |
Generate Letter | Appeal resolved | Correspondence Team |
Task Configuration Options
Duration estimates and due dates
Required vs optional
Repeatable vs one-time
Linked correspondence or attachments
Requests
Requests are structured records for prior authorizations, appeals, grievances, and other regulatory or clinical submissions. They often represent the starting point of a workflow.
Key Features
Guided intake interface or FHIR API submission
Multi-stage review: intake, nurse review, MD review, resolution
Auto-decisioning via rules or AI/ML
SLA tracking and CMS-compliant turnaround monitoring
Request Types
Utilization Management: Pre-cert, referral, concurrent review
Appeals: Clinical, non-clinical, expedited
Grievances: Member complaints and feedback
Clinical Requests: Internal documentation, referrals, escalations
Request Lifecycle
Intake (manual or automated)
Eligibility & coverage validation
Clinical review
Determination (approve/deny/partial)
Correspondence
Closure and audit trail
Attributes
Request type, subtype
Origin (portal, fax, API)
Associated program and tasks
Linked documentation and assessments
Interactions Between Entities
These entities operate independently but are tightly integrated in workflows:
Example Scenarios
A UM Request for DME triggers creation of a Program for post-discharge follow-up and assigns a Task to verify equipment setup.
Completion of a Task (e.g., complete PHQ-9) updates the member’s program stage and triggers a new Request (e.g., behavioral health referral).
A Program nearing its SLA deadline escalates an open Task to a supervisor and generates a follow-up Request for peer review.
Audit & Timeline Integration
All actions taken within programs, tasks, and requests are recorded on the member timeline
Each item contains a full audit trail (created by, timestamps, resolution notes)
Linked artifacts (assessments, letters, notes) are accessible inline
Configuration and Versioning
Each of these components is configured using builder tools and maintained through:
Version control (with rollback support)
Environment promotion workflows (staging → production)
Role-based editing permissions
Governance processes ensure that updates to program structures or task logic are tested and approved before go-live.
Reporting and Analytics
Programs, tasks, and requests feed into dashboards and data exports:
Task completion rates and overdue counts
Program enrollment and outcome metrics
Request volumes by type, status, TAT compliance
Staff productivity and workload distribution
Analytics are accessible via embedded dashboards or exported to BigQuery and other BI platforms.
This document provides a detailed reference for how Programs, Tasks, and Requests function across the Medecision Platform. For technical implementation, refer to Builder Guides and API Docs.