Explanation of Benefit - Read
Explanation of benefit API takes ID (Patient ID) and Claim ID as the parameter to provide policy details. Both are required parameters here. And Patient Id should be related to Claim ID.
Pega Foundation for Healthcare
Below are key rules:
URL format
GET https://[hostname:port]/prweb/api/fhirapi/v1/ExplanationOfBenefit/{ID}/{Claim}
Parameters
Key rules
| Rule Name | Rule Type | Usage |
| Class: Int-Fhir401-ExplanationOfBenefitAPI | ||
| explanationofbenefit_var_var6ff11ae7c7f089 4bff63db3a75686cc8 | Service REST | |
| GetExplanationOfBenefitRead | Activity | Method in REST service to get details related to explanation of benefit. |
| MapFromExplanationOfBenefit | Data Transform | Map results from PFHC Polciy to API Integration object |
| Pre_MapFromEOB_EXT | Data Transform | Pre mapping data transform |
| Post_MapFromEOB_EXT | Data Transform | Post mapping data transform |
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