Validation Rules

Summary

This enhancement to Validation Rules adds support to trigger a validation based on the notes section on the carrier table or on the raw_results returned in the c_eligibility_response table.

Previously, the carrier notes field was accessible to the validation rules framework by selecting c_visit_x_patient_insurance for the table and l_carrier.XXX where XXX is the name of the field that requires validation. This would check only the insurances that were applied to the current visit, but lacked the ability to pinpoint primary carrier vs secondary carrier.

With this change, the new AdditionalRowFilter validation rule property facilitates targeting the primary carrier and secondary carrier.

The AdditionalRowFilter takes a filter in the form of "columnName = value". If this filter is set, then prior to validating a row or a child condition, the table specified by "DataTable" is examined to see if the current row matches this filter. If the row doesn't match the filter, the logic skips over the row and will only validate other rows that match.

A sample rule that looks for an eligibility response with a coverage status code of 1 for the primary insurance is provided below:

In this example, the rule is first looking in c_visit_x_patient_insurance (so only insurances applied to the visit are considered), then an additional filter is applied to indicate the sequence_id must equal 1 (as is the case for a primary insurance). If any matching rows are found, then the rule examines the c_eligibility_response table (here an implicit join to c_visit_x_patient_insurance is done and only rows that have a matching eligibility_request_key are considered).

Configuration Instructions

No System Administrator actions are necessary to enable this feature.