Eligibility Integration
Explains the backend integration with insurance eligibility vendors used to verify insurance coverage.
Overview
The insurance eligibility verification system allows the platform to validate patient insurance coverage before billing or claim submission.
Currently the system integrates with the Inmediata eligibility verification service.
The integration retrieves coverage details such as:
- Insurance validity
- Copay
- Deductible
- Co-insurance percentage
- Patient details along with corrections
Required Patient Data
Eligibility verification requires several pieces of patient and insurance data.
Required fields include:
- Referring doctor registration number (docRegNo)
- Insurance group number
- Insurance policy number
- Insurance code
- Patient date of birth
If any required information is missing, the eligibility request may fail.
Integration Configuration
Eligibility integration requires configuration entries in the database.
The configuration is stored in the labIntegration table.
The column integrationExtraDetails contains vendor configuration information such as:
- sender_id
- sender_code
- receiver_id
- receiver_code
- request_url
- authentication credentials
These values are used when constructing eligibility requests.