Universal API Implementation Guide - Local Development build (v1.1.20) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

Release 2024 August 5

Changes as of 8/5/24

Copay Enrollment - Questionnaire Validations for Hemlibra

The Copay administrator for the Hemlibra Copay program implemented validation checks on medicare-related QuestionnaireResponses.

Previously, if Hemlibra questionnaireResponse indicated that patient had 'federal state funded insurance', it would result in error message 'Eligibility Question(s) Failed'. Validation has been changed so if patient has 'federal or state funded insurance' regardless if patient has a medicare card or not, then the Copay enrollment will automatically be denied. Patients are advised to contact RisRx Customer Support at [phone number to be provided] to further investigate the reason for their enrollment denial.

Below are medicare questionnaireResponses scenarios and resulting enrollment response:

Hemlibra Scenario	Response
"linkId": "federal-state-funded-insurance" = Yes "linkId": "have-medicare-card" = No "linkId":"enter-medicare-number" = linkId excluded from bundle	enrollment denied
"linkId": "federal-state-funded-insurance" = Yes "linkId": "have-medicare-card" = Yes "linkId": "enter-medicare-number" = value provided	enrollment denied
"linkId": "federal-state-funded-insurance" = Yes "linkId": "have-medicare-card" = Yes "linkId": "enter-medicare-number" = linkId excluded from bundle	enrollment denied
"federal-state-funded-insurance" = No (assumes all other criteria are met)	enrollment approved