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 :

Required fields to create Member Plan
How to refresh Member Plan

Required Fields to Create Member Plan

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

Field Name	Field API Name
Name	Name
First Name	medicalcoverage__First_Name__c
Last Name	medicalcoverage__Last_Name__c
Birth Date	medicalcoverage__Birth_Date__c
Member Number	MemberNumber
Payer Name	medicalcoverage__Payer_Name__c
Payer Id	medicalcoverage__Payer_Id__c
NPI	medicalcoverage__NPI__c
API Status	medicalcoverage__API_Status__c
As Of Date	medicalcoverage__As_of_Date__c
PrimarySecondary Tertiary	medicalcoverage__PrimarySecondaryTertiary__c

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();
oMemberPlan.medicalcoverage__PrimarySecondaryTertiary__c = 'Primary';
insert oMemberPlan;

How to Refresh Member Plan Record

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