Insurance Eligibility

Summary

This enhancement to Insurance Eligibility updates Eligibility SQL filters to allow exclusion of line items based on source and level values, allowing rules to e.g., exclude all "service_type" level co-insurances when performing Amount to Collect calculations.

Feature Description

With this change, the Eligibility Special Conditions Table "Edit SQL" filters now allow exclusion of line items based on:

·         Source - values such as "service_type", "plan"

·         Level - values such as "Family", "Individual", "Employee"

This allows flexibility when creating eligibility special conditions selection criteria e.g., support for including all co_insurance that exists at the plan level or to exclude all the co_insurance that exists in the service_type section, while also supporting combining with other criteria such as the Group Name.

Configuration Instructions

No System Administrator actions are necessary to enable this feature; however, optional configuration is available:

RIS Client

Changes to EligibilitySpecialCondition Lookup Table Settings

·         Update rules as desired by modifying the Matching String logic via the Edit SQL… dialog to add additional Source and Level criteria.