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Updated on February 1, 2022

This connector rule takes PlanBenefitRequest as a parameter which is claim Line details for a claim to fetch the coverage for particular line item.

Pega Foundation for Healthcare

PlanBenefitRequest {

claimLineNumber (string, optional), planID (string, optional), serviceFromDate (date, optional), serviceToDate (date, optional),

revenueCode (string, optional), procedureCode (A00.1, optional),

placeOfService (string, optional), diagnosis (string, optional),

age (string, optional), gender (string, optional), DateOfBirth (date, optional), billType (string, optional),

networkRelationship (string, optional), AdmissionType (string, optional),

IRC (string, optional), Modifier (string, optional), Providerype (string, optional)


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