Benefits Eligibility Verification System API - Implementation Template
Developer guide
The Availity application uses the following DataWeave modules to be used in Coverage search
Module | Description |
---|---|
CoverageFHIRTools | CoverageFHIRTools DataWeave library contains functions used for Coverage search in Availity |
CoverageFHIRTools
CoverageFHIRTools DataWeave library contains functions used for Coverage search
in Availity
Functions
fun createCoverageEligibilityResponse
( coverageResp, activeCoveragesList, amountTypes, networkTypes)
param
coverageResp
response from Availity
paramactiveCoveragesList
a list of Status Codes for Active Coverages
paramamountTypes
is a list of amountTypes being mapped
paramnetworkTypes
is the types of networks being mapped
return FHIR R4 CoverageEligibilityResponseCreate CoverageEligibilityResponse from Availity Coverage Response
fun createFHIRR4Benefit
( benefit, amtDescription)
param
benefit
is array of amounts grouped by amountType
paramamtDescription
is the type of amount
return Return FHIR R4 formatted benefit arrayCreate benefit array using payload.plans.amounts and amountTypes, and networkTypes
fun getAmountsArray
( benefitArray, amountTypes)
param
benefitArray
is the input from plans.amounts
paramamountTypes
return Filtered list of non empty amounts matching amountTypesFilter amounts from Availity to include only amounts that are present
fun benTypeCrossRef
( benefitType)
param
benefitType
is the Availity benefit type
return Benefit Type and Name for FHIR R4 using Availity benefit typeCross Reference benefits types between Availity and FHIR R4
fun termCodeLookup
( termCode)
param
termCode
is the Availity term code
return FHIR R4 term code using Availity term codeCross Reference term types between Availity and FHIR R4
fun bnftPayableLookup
( bnftCode, bnftUnit)
param
benifitType
is the Availity benefitType (coPayment,coInsurance,deductible
return FHIR R4 term code using Availity term codeCross Reference benefit amount type between Availity and FHIR R4
fun coverageStatus
( coverageRespPayload, activeCoveragesList)
param
coverageRespPayload
is the Availity Coverage Response
paramactiveCoveragesList
is the list of Availity Active Coverage statuses
return A boolean indicating coverage statusFunction to lookup plan status from activeCoverageList and set coverage status at root level
fun outcomeLookup
( availityStatusCode)
param
availityStatusCode
is the status code from Availity
return FHIR R4 Outcome looked up from Availity Coverage Status codeCross Reference function to convert Availity Coverage Status Code at root level to FHIR outcomes