GenHealth - Eligibility integration

Prepare Reviewed VOB Benefits

Perform Prepare Reviewed VOB Benefits through GenHealth - Eligibility.

View as Markdown

eligibility_prepare_reviewed_vob_benefits

write

Inputs

record_id
expression
Record Id
Optional literal value or workflow expression.
record_link_id
expression
Record Link Id
Optional literal value or workflow expression.
payer_id
expression
Payer Id
Optional literal value or workflow expression.
payer_name
expression
Payer Name
Optional literal value or workflow expression.
member_id
expressionrequired
Member Id
Required literal value or workflow expression.
patient_first_name
expressionrequired
Patient First Name
Required literal value or workflow expression.
patient_middle_name
expression
Patient Middle Name
Optional literal value or workflow expression.
patient_last_name
expressionrequired
Patient Last Name
Required literal value or workflow expression.
patient_birth_date
expressionrequired
Patient Birth Date
Required literal value or workflow expression.
subscriber_relationship
expression
Subscriber Relationship
Optional literal value or workflow expression.
identity_basis
text
Identity Basis
Optional text value.
Default: "self"
registered_subscriber_member_id
expression
Registered Subscriber Member Id
Optional literal value or workflow expression.
registered_subscriber_first_name
expression
Registered Subscriber First Name
Optional literal value or workflow expression.
registered_subscriber_last_name
expression
Registered Subscriber Last Name
Optional literal value or workflow expression.
registered_subscriber_birth_date
expression
Registered Subscriber Birth Date
Optional literal value or workflow expression.
card_identity_artifact_ref
json
Card Identity Artifact Ref
Optional JSON value.
expected_field_values
json
Expected Field Values
Optional JSON value.
card_extraction_prompt
textarea
Card Extraction Prompt
Optional text value.
Default: "Extract only the printed cardholder name and exact member ID from these card pages. Do not infer whether the cardholder is the patient or subscriber. Do not add, remove, or normalize member ID characters. If the card explicitly labels Prefix, Identification #, and Suffix as separate components, return each exact component and its exact source quote. Otherwise return the complete printed ID and its exact quote. Return unresolved when a field is missing, ambiguous, or not supported by a direct quote."
card_extraction_model
text
Card Extraction Model
Optional text value.
card_extraction_timeout_seconds
number
Card Extraction Timeout Seconds
Optional numeric value.
Default: 45
general_coverage_id
expressionrequired
General Coverage Id
Required literal value or workflow expression.
pre_test_coverage_id
expression
Pre Test Coverage Id
Optional literal value or workflow expression.
sleep_coverage_id
expression
Sleep Coverage Id
Optional literal value or workflow expression.
post_test_coverage_id
expression
Post Test Coverage Id
Optional literal value or workflow expression.
as_of_date
date
As Of Date
Optional date in YYYY-MM-DD format.
rates
json
Rates
Optional JSON value.
reviewed_document_rules
json
Reviewed Document Rules
Optional JSON value.
reviewed_cost_share_rules
json
Reviewed Cost Share Rules
Optional JSON value.
card
json
Card
Optional JSON value.
automatic_write_enabled
boolean
Automatic Write Enabled
Optional true-or-false value.
Default: false

Outputs

successSuccess
errorError
failure_categoryFailure Category
statusStatus
write_evidenceWrite Evidence
reasonReason
field_valuesField Values
allowed_field_link_namesAllowed Field Link Names
withheld_field_link_namesWithheld Field Link Names
fallback_servicesFallback Services
model_callsModel Calls
source_hashesSource Hashes
request_sha256Request Sha256
preparation_sha256Preparation Sha256
estimate_sha256Estimate Sha256
note_sha256Note Sha256
report_titleReport Title

Output schema completeness: best_effort_declared

Safety

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

Schemas

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

Input schema

{
  "type": "object",
  "required": [
    "member_id",
    "patient_first_name",
    "patient_last_name",
    "patient_birth_date",
    "general_coverage_id"
  ],
  "properties": {
    "card": {
      "description": "Optional JSON value.",
      "x-workflow-field-type": "json"
    },
    "rates": {
      "description": "Optional JSON value.",
      "x-workflow-field-type": "json"
    },
    "payer_id": {
      "description": "Optional literal value or workflow expression.",
      "x-workflow-field-type": "expression"
    },
    "member_id": {
      "description": "Required literal value or workflow expression.",
      "x-workflow-field-type": "expression"
    },
    "record_id": {
      "description": "Optional literal value or workflow expression.",
      "x-workflow-field-type": "expression"
    },
    "as_of_date": {
      "type": "string",
      "format": "date",
      "description": "Optional date in YYYY-MM-DD format.",
      "x-workflow-field-type": "date"
    },
    "payer_name": {
      "description": "Optional literal value or workflow expression.",
      "x-workflow-field-type": "expression"
    },
    "identity_basis": {
      "type": "string",
      "default": "self",
      "description": "Optional text value.",
      "x-workflow-field-type": "text"
    },
    "record_link_id": {
      "description": "Optional literal value or workflow expression.",
      "x-workflow-field-type": "expression"
    },
    "patient_last_name": {
      "description": "Required literal value or workflow expression.",
      "x-workflow-field-type": "expression"
    },
    "sleep_coverage_id": {
      "description": "Optional literal value or workflow expression.",
      "x-workflow-field-type": "expression"
    },
    "patient_birth_date": {
      "description": "Required literal value or workflow expression.",
      "x-workflow-field-type": "expression"
    },
    "patient_first_name": {
      "description": "Required literal value or workflow expression.",
      "x-workflow-field-type": "expression"
    },
    "general_coverage_id": {
      "description": "Required literal value or workflow expression.",
      "x-workflow-field-type": "expression"
    },
    "patient_middle_name": {
      "description": "Optional literal value or workflow expression.",
      "x-workflow-field-type": "expression"
    },
    "pre_test_coverage_id": {
      "description": "Optional literal value or workflow expression.",
      "x-workflow-field-type": "expression"
    },
    "card_extraction_model": {
      "type": "string",
      "description": "Optional text value.",
      "x-workflow-field-type": "text"
    },
    "expected_field_values": {
      "description": "Optional JSON value.",
      "x-workflow-field-type": "json"
    },
    "post_test_coverage_id": {
      "description": "Optional literal value or workflow expression.",
      "x-workflow-field-type": "expression"
    },
    "card_extraction_prompt": {
      "type": "string",
      "default": "Extract only the printed cardholder name and exact member ID from these card pages. Do not infer whether the cardholder is the patient or subscriber. Do not add, remove, or normalize member ID characters. If the card explicitly labels Prefix, Identification #, and Suffix as separate components, return each exact component and its exact source quote. Otherwise return the complete printed ID and its exact quote. Return unresolved when a field is missing, ambiguous, or not supported by a direct quote.",
      "description": "Optional text value.",
      "x-workflow-field-type": "textarea"
    },
    "automatic_write_enabled": {
      "type": "boolean",
      "default": false,
      "description": "Optional true-or-false value.",
      "x-workflow-field-type": "boolean"
    },
    "reviewed_document_rules": {
      "description": "Optional JSON value.",
      "x-workflow-field-type": "json"
    },
    "subscriber_relationship": {
      "description": "Optional literal value or workflow expression.",
      "x-workflow-field-type": "expression"
    },
    "reviewed_cost_share_rules": {
      "description": "Optional JSON value.",
      "x-workflow-field-type": "json"
    },
    "card_identity_artifact_ref": {
      "description": "Optional JSON value.",
      "x-workflow-field-type": "json"
    },
    "card_extraction_timeout_seconds": {
      "type": "number",
      "default": 45,
      "description": "Optional numeric value.",
      "x-workflow-field-type": "number"
    },
    "registered_subscriber_last_name": {
      "description": "Optional literal value or workflow expression.",
      "x-workflow-field-type": "expression"
    },
    "registered_subscriber_member_id": {
      "description": "Optional literal value or workflow expression.",
      "x-workflow-field-type": "expression"
    },
    "registered_subscriber_birth_date": {
      "description": "Optional literal value or workflow expression.",
      "x-workflow-field-type": "expression"
    },
    "registered_subscriber_first_name": {
      "description": "Optional literal value or workflow expression.",
      "x-workflow-field-type": "expression"
    }
  },
  "additionalProperties": false
}

Output schema

{
  "type": "object",
  "properties": {
    "error": {},
    "reason": {},
    "status": {},
    "success": {},
    "model_calls": {},
    "note_sha256": {},
    "field_values": {},
    "report_title": {},
    "source_hashes": {},
    "request_sha256": {},
    "write_evidence": {},
    "estimate_sha256": {},
    "failure_category": {},
    "fallback_services": {},
    "preparation_sha256": {},
    "allowed_field_link_names": {},
    "withheld_field_link_names": {}
  },
  "additionalProperties": true
}

View all GenHealth - Eligibility actions