# Evaluate DME Eligibility Policy

> Perform Evaluate DME Eligibility Policy through GenHealth - Eligibility.

Source: [https://genhealth.ai/docs/workflows/integrations/gen-health-eligibility/eligibility_evaluate_dme_policy](https://genhealth.ai/docs/workflows/integrations/gen-health-eligibility/eligibility_evaluate_dme_policy)

Integration: [GenHealth - Eligibility](https://genhealth.ai/docs/workflows/integrations/gen-health-eligibility.md)

- Handler: `eligibility_evaluate_dme_policy`

## Inputs

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

## Outputs

- `success` — Success
- `phase` — Phase
- `status` — Status
- `reason` — Reason
- `case_key` — Case Key
- `service_type` — Service Type
- `payer_key` — Payer Key
- `patient_insurance` — Patient Insurance
- `order_insurance` — Order Insurance
- `insurance_id` — Insurance Id
- `requires_eligibility_check` — Requires Eligibility Check
- `dry_run` — Dry Run
- `side_effects_enabled` — Side Effects Enabled
- `side_effects_ready` — Side Effects Ready
- `niko_eligibility_request` — Niko Eligibility Request
- `benefit_summary_ready` — Benefit Summary Ready
- `benefit_summary` — Benefit Summary
- `upfront_fee` — Upfront Fee
- `installment_details` — Installment Details
- `final_summary_text` — Final Summary Text
- `self_pay_note_text` — Self Pay Note Text
- `network_status` — Network Status
- `network_status_detail` — Network Status Detail
- `patient_note_request` — Patient Note Request
- `task_request` — Task Request
- `patient_tag_request` — Patient Tag Request
- `order_tag_request` — Order Tag Request
- `required_side_effects` — Required Side Effects
- `missing_side_effect_settings` — Missing Side Effect Settings
- `diagnostics` — Diagnostics
- `error` — Error
- `error_message` — Error 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

```json
{
  "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

```json
{
  "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
}
```