Medplum

// SPDX-FileCopyrightText: Copyright Orangebot, Inc. and Medplum contributors // SPDX-License-Identifier: Apache-2.0 import { getReferenceString } from '@medplum/core'; import type { BotEvent, MedplumClient } from '@medplum/core'; import type { Coding, CoverageEligibilityRequest, CoverageEligibilityResponse } from '@medplum/fhirtypes'; /** * This bot is designed to be executed whenever a `CoverageEligibilityRequest` is created. It will take the request and initiate an * insurance eligibility check process, ultimately creating a `CoverageEligibilityResponse` resource with the results. For more * details on insurance eligibility checks see https://www.medplum.com/docs/billing/insurance-eligibility-checks * * NOTE: This Bot only illustrates the relevant workflow. To implement the process, you will need to choose a coverage clearinghouse * to work with and modify the code to query that clearinghouse. * * @param medplum - MedplumClient * @param event - BotEvent<CoverageEligibilityRequest> * @returns the CoverageEligibilityResponse */ export async function handler( medplum: MedplumClient, event: BotEvent<CoverageEligibilityRequest> ): Promise<CoverageEligibilityResponse> { // Get the request from the input const request = event.input as CoverageEligibilityRequest; const serviceType = request.item?.[0].category?.coding?.[0]; // Process the request. This is a dummy function that represents sending the request to a coverage clearinghouse const response = processRequest(request, serviceType); // Make sure that a response is returned if (!response) { throw new Error('Invalid request submitted.'); } // If you receive a valid response, create and return `CoverageEligibilityResponse` resource return medplum.createResource(response); } function processRequest( request: CoverageEligibilityRequest, serviceType?: Coding ): CoverageEligibilityResponse | undefined { const coverage = request.insurance?.[0].coverage; // Make sure that the request has a linked coverage resource. if (!coverage) { console.log('This request has no linked coverage'); return undefined; } // Build a response based on the request const response: CoverageEligibilityResponse = { resourceType: 'CoverageEligibilityResponse', status: 'active', purpose: request.purpose, patient: request.patient, created: new Date().toISOString(), request: { reference: getReferenceString(request), }, outcome: 'complete', insurer: request.insurer, insurance: [ { inforce: true, coverage, item: [ { // For simplicity, this demo only provides coverage for X12 Service Type Code 30 - Plan Coverage and General Benefits. // For more details see https://www.medplum.com/docs/billing/insurance-eligibility-checks#use-cases excluded: serviceType?.code === '30', category: { coding: [serviceType || { code: '30' }], }, benefit: [ { type: { coding: [ { code: 'room', }, ], }, allowedString: 'shared', }, { type: { coding: [ { code: 'benefit', }, ], }, allowedMoney: { value: 600, currency: 'USD', }, }, ], }, ], }, ], }; return response; }