Eligibility Checker Automation

Health Cloud

This page contains details on how to trigger Eligibility by creating Member Plan and and refresh Member Plan over a period of time :

1. Required fields to create Member Plan

2. How to refresh Member Plan

Below is the list Of Fields that are required to Create a Member Plan Record –

Sample Apex Code Snippet to Create a Member Plan Record

MemberPlan oMemberPlan = new MemberPlan();
oMemberPlan.Name = 'Primary-CIGNA(62308)';
oMemberPlan.medicalcoverage__First_Name__c = ‘First Name’;
oMemberPlan.medicalcoverage__Last_Name__c = ‘Last Name’;
oMemberPlan.medicalcoverage__Birth_Date__c = Date.parse('9/7/1986') ;
oMemberPlan.MemberNumber  = ‘Member#’;
oMemberPlan.medicalcoverage__Payer_Name__c = ‘Payer Name’;
oMemberPlan.medicalcoverage__Payer_Id__c  = ‘Payer ID’;
oMemberPlan.medicalcoverage__NPI__c   = '1578505947';
oMemberPlan.MemberId = ‘Member Id’;
oMemberPlan.medicalcoverage__API_Status__c = 'Processing';
oMemberPlan.medicalcoverage__As_of_Date__c = System.today();
insert oMemberPlan;   

Apex Class - InvocableMemberPlanRefresh

Method - runMemberPlanRefresh

Parameter - List<Id> lstMemberPlanRecordId

Please make sure that you update the BELOW 2 FIELDS ON THE MEMBER PLAN before calling the class to refresh

medicalcoverage__As_of_Date__c - As of date on the Member Plan to today’s date (else it will update the Member Plan with the existing As of Date) -

medicalcoverage__Coverage_ID__c – set Coverage ID to null