Universal API Implementation Guide
1.1.20 - ci-build
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
The Copay administrator for the following Copay programs implemented validation checks on QuestionnaireResponses to help prescreen for eligibility. If criteria are not met, an error will be generated, and the Copay enrollment will not be processed. To proceed, correct the error and resend the enrollment bundle.
| linkId | Value Resulting in an Error | Validation Error Message |
|---|---|---|
| consent-to-enroll | Null value or any other value other than 'Yes' | The expected response for the survey must include 'Yes' for the consent |
| 18-years-or-older | Null value or any other value other than 'Yes' | The expected response for the survey must include 'Yes' for the ageCheck18 |
| 18-years-or-older (Evrysdi Only) | Null value or any other value other than 'Yes' | DOB is not valid for the enrollment |
| (product)-fda-approved-indications | None of the Above none of the above None of the above Not Sure not sure Not sure Unsure unsure |
The expected response for the survey cannot include 'None of the Above' or 'Unsure' or 'Not sure' for the indicationCheck. |
| commercial-private-insurance | Null value or any other value other than 'Yes' | The expected response for the survey must include 'Yes' for the commericalInsuranceCheck |
| federal-state-funded-insurance have-medicare-card | federal-state-funded-insurance = 'Yes' have-medicare-card = 'No' | The expected response for the survey must include 'No' for the governmentInsuranceCheck and/or medicare red white and blue card 'Yes' |
| residence-state | Null value | The expected response for the survey cannot be null for stateCheck |
| receiving-medication-from-gpf | Null value or any other value other than 'No' | The expected response for the survey must include 'No' for the patientAssistanceCheck |
| receiving-assistance-from-charitable-organization | Null value or any other value other than 'No' | The expected response for the survey must include 'No' for the patientOutofPocketCheck |
| agree-to-genentech-privacy-policy | Null value or any other value other than 'Agree' | The expected response for the survey must include 'Agree' for the disclosureCheck |
| agree-to-copay-program-terms | Null value or any other value other than 'Agree' | The expected response for the survey must include 'Agree' for the patientAgreement |
| agree-to-admin-copay-program-terms | Applicable only for those products that have an Admin Copay program: Null value or any other value other than 'Agree' |
The expected response for the survey must include 'Agree' for the patientAgreement |
The Copay administrator for the XOLAIR Copay program implemented validation checks on medicare-related QuestionnaireResponses.
Previously, if Xolair 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 to further investigate the reason for their enrollment denial.
Below are medicare questionnaireResponses scenarios and resulting enrollment response:
| Xolair 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 |