Copy the following rules in your ruleset to extend the eligibility lookup and processing:
|ProcessBenefitRequest||Activity||Main activity rule that processes the eligibility information.|
|OpenPolicyByIDNoDisplay||Activity||Searches for member’s policy by Policy Number submitted on the message.|
|CheckPolicyOnServiceDate||Data Transform||Checks to see if the Policy is active on the requested service date in the message.|
|ProcessPlan||Activity||Fetches Plan/Product based on Plan ID associated with Policy.|
|ProcessBenefit||Activity||Fetches Plan Benefits.|
|ProcessBenefitGroup||Activity||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.