Copy the following rules in your ruleset to extend the eligibility lookup and processing:
|Main activity rule that processes the eligibility information.
|Searches for member’s policy by Policy Number submitted on the message.
|Checks to see if the Policy is active on the requested service date in the message.
|Fetches Plan/Product based on Plan ID associated with Policy.
|Fetches Plan Benefits.
|Searches for matching benefit coverage based on submitted service type code on the message.
For additional information, refer to the Healthcare X12 EDI Message Management Technical Specifications on the Pega Foundation for Healthcare product page.