GenHealth - Eligibility integration

Evaluate DME Eligibility Policy

Perform Evaluate DME Eligibility Policy through GenHealth - Eligibility.

View as Markdown

eligibility_evaluate_dme_policy

write

Inputs

phase
selectrequired
Phase
Required selected identifier or value.
Default: "post_eligibility"
Options: Before Eligibility Check ("pre_eligibility"), After Eligibility Check ("post_eligibility")
niko_patient_id
expressionrequired
Niko Patient Id
Required literal value or workflow expression.
niko_order_id
expression
Niko Order Id
Optional literal value or workflow expression.
niko_order_display_id
expression
Niko Order Display Id
Optional literal value or workflow expression.
source_types
expression
Source Types
Optional literal value or workflow expression.
service_type
expression
Service Type
Optional literal value or workflow expression.
patient_insurance
expression
Patient Insurance
Optional literal value or workflow expression.
order_insurance
expression
Order Insurance
Optional literal value or workflow expression.
insurance_id
expression
Insurance Id
Optional literal value or workflow expression.
niko_insurance_status
expression
Niko Insurance Status
Optional literal value or workflow expression.
patient
expression
Patient
Optional literal value or workflow expression.
patient_insurances
expression
Patient Insurances
Optional literal value or workflow expression.
payer_key
expression
Payer Key
Optional literal value or workflow expression.
benefit_summary
expression
Benefit Summary
Optional literal value or workflow expression.
niko_eligibility
expression
Niko Eligibility
Optional literal value or workflow expression.
patient_notes
expression
Patient Notes
Optional literal value or workflow expression.
current_order
expression
Current Order
Optional literal value or workflow expression.
current_order_items
expression
Current Order Items
Optional literal value or workflow expression.
patient_orders
expression
Patient Orders
Optional literal value or workflow expression.
dry_run
boolean
Dry Run
Optional true-or-false value.

Outputs

successSuccess
phasePhase
statusStatus
reasonReason
case_keyCase Key
service_typeService Type
payer_keyPayer Key
patient_insurancePatient Insurance
order_insuranceOrder Insurance
insurance_idInsurance Id
requires_eligibility_checkRequires Eligibility Check
dry_runDry Run
side_effects_enabledSide Effects Enabled
side_effects_readySide Effects Ready
niko_eligibility_requestNiko Eligibility Request
benefit_summary_readyBenefit Summary Ready
benefit_summaryBenefit Summary
upfront_feeUpfront Fee
installment_detailsInstallment Details
final_summary_textFinal Summary Text
self_pay_note_textSelf Pay Note Text
network_statusNetwork Status
network_status_detailNetwork Status Detail
patient_note_requestPatient Note Request
task_requestTask Request
patient_tag_requestPatient Tag Request
order_tag_requestOrder Tag Request
required_side_effectsRequired Side Effects
missing_side_effect_settingsMissing Side Effect Settings
diagnosticsDiagnostics
errorError
error_messageError Message

Output schema completeness: best_effort_declared

Safety

External effect: write
Confirmation recommended: No
Retry safe: No
Dry run supported: Yes

Schemas

These schemas are first-pass authoring guidance. Runtime validation remains authoritative.

Input schema

{
  "type": "object",
  "required": [
    "phase",
    "niko_patient_id"
  ],
  "properties": {
    "phase": {
      "enum": [
        "pre_eligibility",
        "post_eligibility"
      ],
      "type": "string",
      "default": "post_eligibility",
      "description": "Required selected identifier or value.",
      "x-workflow-field-type": "select"
    },
    "dry_run": {
      "type": "boolean",
      "description": "Optional true-or-false value.",
      "x-workflow-field-type": "boolean"
    },
    "patient": {
      "description": "Optional literal value or workflow expression.",
      "x-workflow-field-type": "expression"
    },
    "payer_key": {
      "description": "Optional literal value or workflow expression.",
      "x-workflow-field-type": "expression"
    },
    "insurance_id": {
      "description": "Optional literal value or workflow expression.",
      "x-workflow-field-type": "expression"
    },
    "service_type": {
      "description": "Optional literal value or workflow expression.",
      "x-workflow-field-type": "expression"
    },
    "source_types": {
      "description": "Optional literal value or workflow expression.",
      "x-workflow-field-type": "expression"
    },
    "current_order": {
      "description": "Optional literal value or workflow expression.",
      "x-workflow-field-type": "expression"
    },
    "niko_order_id": {
      "description": "Optional literal value or workflow expression.",
      "x-workflow-field-type": "expression"
    },
    "patient_notes": {
      "description": "Optional literal value or workflow expression.",
      "x-workflow-field-type": "expression"
    },
    "patient_orders": {
      "description": "Optional literal value or workflow expression.",
      "x-workflow-field-type": "expression"
    },
    "benefit_summary": {
      "description": "Optional literal value or workflow expression.",
      "x-workflow-field-type": "expression"
    },
    "niko_patient_id": {
      "description": "Required literal value or workflow expression.",
      "x-workflow-field-type": "expression"
    },
    "order_insurance": {
      "description": "Optional literal value or workflow expression.",
      "x-workflow-field-type": "expression"
    },
    "niko_eligibility": {
      "description": "Optional literal value or workflow expression.",
      "x-workflow-field-type": "expression"
    },
    "patient_insurance": {
      "description": "Optional literal value or workflow expression.",
      "x-workflow-field-type": "expression"
    },
    "patient_insurances": {
      "description": "Optional literal value or workflow expression.",
      "x-workflow-field-type": "expression"
    },
    "current_order_items": {
      "description": "Optional literal value or workflow expression.",
      "x-workflow-field-type": "expression"
    },
    "niko_insurance_status": {
      "description": "Optional literal value or workflow expression.",
      "x-workflow-field-type": "expression"
    },
    "niko_order_display_id": {
      "description": "Optional literal value or workflow expression.",
      "x-workflow-field-type": "expression"
    }
  },
  "additionalProperties": false
}

Output schema

{
  "type": "object",
  "properties": {
    "error": {},
    "phase": {},
    "reason": {},
    "status": {},
    "dry_run": {},
    "success": {},
    "case_key": {},
    "payer_key": {},
    "diagnostics": {},
    "upfront_fee": {},
    "insurance_id": {},
    "service_type": {},
    "task_request": {},
    "error_message": {},
    "network_status": {},
    "benefit_summary": {},
    "order_insurance": {},
    "order_tag_request": {},
    "patient_insurance": {},
    "final_summary_text": {},
    "self_pay_note_text": {},
    "side_effects_ready": {},
    "installment_details": {},
    "patient_tag_request": {},
    "patient_note_request": {},
    "side_effects_enabled": {},
    "benefit_summary_ready": {},
    "network_status_detail": {},
    "required_side_effects": {},
    "niko_eligibility_request": {},
    "requires_eligibility_check": {},
    "missing_side_effect_settings": {}
  },
  "additionalProperties": true
}

View all GenHealth - Eligibility actions