Insurance Eligibility

Feature #35124 – Include Out Of Network values in JSON

Summary

This enhancement to Insurance Eligibility updates JSON encoding to include financials for out-of-network values, necessary for calculating the patient financial responsibility amount.

Background

Previously, an under-collection would occur on exams where a higher out of network copay was the accurate amount to collect. This was due to RIS not recognizing the copay amount which returns as an "N" in the JSON and XML.

Feature Description

This enhancement to Insurance Eligibility updates the X12 271 to JSON transformation to include financials for out-of-network values (i.e., where EB12 = N).

Configuration Instructions

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

RIS Client

Changes to SystemConfig Lookup Table Values

· Requires the existing system config Enable271AnalyticsDataStorage = True

Setting	Default	Purpose
Enable271AnalyticsDataStorage	Value = Boolean, Default = [False]	When True, 271 details are parsed and logged to the tables c_eligibility_json_provider, c_eligibility_json_additional_insurance, and c_eligibility_json_financial for reporting and analytics. Updated by #34398