Insurance Eligibility

Summary

This enhancement to Insurance Eligibility provides more visible messaging to the end user when the patient’s out-of-pocket maximum has been reached via the Insurance Eligibility Tool Tip and Patient Insurance Policies dialog.

Feature Description

Previously, the Insurance Eligibility Details via the Manage Policies shield would have to be reviewed to locate information regarding the patient’s out-of-pocket maximum.

With this change, when the out-of-pocket maximum is reached a message will be displayed via the Eligibility shield on the tool tip and in the Patient Insurance Policies dialog.

Configuration Instructions

No System Administrator actions are necessary to enable this feature.

Summary

This enhancement to Insurance Eligibility introduces the ability to create validation rules based on the most recent active eligibility response, such as allowing the scheduling workflow to either alert or prevent the user from scheduling when a Location and Carrier combination is not a valid selection.

Background

Previously, although the scheduling workflow would alert users that a site and carrier combination was inappropriate, the desire was to have a more visible ("toast") message appear, or to prevent scheduling from proceeding altogether when they attempted to schedule.

Existing warnings were not visible enough to users.

Feature Description

With this change, a validation rule can now be created to either display a warning dialog message when scheduling, or display the dialog and prevent scheduling from proceeding whenever the Location and Carrier combination is not a valid selection.

The configuration section below provides the specifics for implementing this particular validation rule.

However, this is only one example of the possibilities that are now available with this change to validation rules.

Validation rules may now be created that are based on the most recent active eligibility response. A new _active_flag field was added to the the c_eligibility_response table, which allows RIS administrators to properly write validation rules against the current eligibility response. Previous to this the validation rules against the eligibility response could have matched the response from when the screen was opened or before the most resent carrier change.

Now rules can be written in RIS to where:

AdditionalRowFilter: _active_flag = 'Y'
ExpressionFilter: warning like '%<text shown int he eligibility response warning>%'

Or just using the expression filter:

ExpressionFilter: warning like '%<text shown int he eligibility response warning>%' and _active_flag = 'Y'

Other valuation rules are possible. For example, a rule to warn the users with a popup before saving a screen that has an eligibility response of failed. Failed is any eligibility response with an internal_status of 2 or 4:

ExpressionFilter: interanl_status in (2,4) and _active_flag = 'Y'

Configuration Instructions

System Administrators must complete the following actions to enable this feature:

Validation Rules

To create a validation rule that alerts the user earlier in the workflow when a Location and Carrier combination is not a valid selection:

·         Create a validation rule with as follows: