NHC - Eligibility Checker Automation

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

 

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

cloudmaven_ec2__First_Name__c

Last Name

cloudmaven_ec2__Last_Name__c

Birth Date

cloudmaven_ec2__Birth_Date__c

Member Number

cloudmaven_ec2__MemberNumber__c

Payer Name

cloudmaven_ec2__Payer_Name__c

Payer Id

cloudmaven_ec2__Payer_Id__c 

NPI

cloudmaven_ec2__NPI__c  

API Status

cloudmaven_ec2__API_Status__c

As Of Date

cloudmaven_ec2__As_of_Date__c

Member

cloudmaven_ec2__MemberId__c

Sample Apex Code Snippet to Create a Member Plan Record

cloudmaven_ec2__MemberPlan__c oMemberPlan = new cloudmaven_ec2__MemberPlan__c(); oMemberPlan.Name = 'Primary-CIGNA(62308)'; oMemberPlan.cloudmaven_ec2__First_Name__c = ‘First Name’; oMemberPlan.cloudmaven_ec2__Last_Name__c = ‘Last Name’; oMemberPlan.cloudmaven_ec2__Birth_Date__c = Date.parse('9/7/1986') ; oMemberPlan.cloudmaven_ec2__MemberNumber__c = ‘Member#’; oMemberPlan.cloudmaven_ec2__Payer_Name__c = ‘Payer Name’; oMemberPlan.cloudmaven_ec2__Payer_Id__c = ‘Payer ID’; oMemberPlan.cloudmaven_ec2__NPI__c = '1578505947'; oMemberPlan.cloudmaven_ec2__MemberId__c = ‘Member Id’; //Lookup Account oMemberPlan.cloudmaven_ec2__API_Status__c = 'Processing'; oMemberPlan.cloudmaven_ec2__As_of_Date__c = System.today(); 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

cloudmaven_ec2__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) -

cloudmaven_ec2__Coverage_ID__c – set Coverage ID to null