Benefits Eligibility Verification System API - Implementation Template

The Availity application uses the following DataWeave modules to be used in Coverage search

CoverageFHIRTools

CoverageFHIRTools DataWeave library contains functions used for Coverage search
in Availity

Functions

fun createCoverageEligibilityResponse ( coverageResp, activeCoveragesList, amountTypes, networkTypes)

param coverageResp response from Availity
param activeCoveragesList a list of Status Codes for Active Coverages
param amountTypes is a list of amountTypes being mapped
param networkTypes is the types of networks being mapped
return FHIR R4 CoverageEligibilityResponse

Create CoverageEligibilityResponse from Availity Coverage Response

fun createFHIRR4Benefit ( benefit, amtDescription)

param benefit is array of amounts grouped by amountType
param amtDescription is the type of amount
return Return FHIR R4 formatted benefit array

Create benefit array using payload.plans.amounts and amountTypes, and networkTypes

fun getAmountsArray ( benefitArray, amountTypes)

param benefitArray is the input from plans.amounts
param amountTypes
return Filtered list of non empty amounts matching amountTypes

Filter 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 type

Cross 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 code

Cross 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 code

Cross Reference benefit amount type between Availity and FHIR R4

fun coverageStatus ( coverageRespPayload, activeCoveragesList)

param coverageRespPayload is the Availity Coverage Response
param activeCoveragesList is the list of Availity Active Coverage statuses
return A boolean indicating coverage status

Function 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 code

Cross Reference function to convert Availity Coverage Status Code at root level to FHIR outcomes