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            Connect to a Benefits Verification Service

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            Connect to a Benefits Verification Service

            Connect Health Cloud to each external service that contains benefit coverage information for members and patients.

            Required Editions

            Available in: Lightning Experience

            Available in: Enterprise and Unlimited Editions with Health Cloud or Life Sciences Cloud
            User Permissions Needed
            To create code set records:

            Health Cloud Starter (for Life Sciences Cloud) permission set

            OR

            Health Cloud Foundation (for Health Cloud) permission set
            To view exernal credentials: View Setup and Configuration
            To create, edit, or delete external credentials: Manage Named Credentials or Customize Applications

            Before you begin:

            • Create an Apex class to connect to your verification service. Visit the See Also links for details about the Verify Benefits API and implementing Apex for the verification of benefits,
            • Create a named credential to support authenticated callouts. A named credential specifies the URL of a callout endpoint and its required authentication parameters in one definition. To simplify the setup of authenticated callouts, specify a named credential as the callout endpoint. Visit the See Also link to learn how to create a named credential.
            1. Populate the Code Set object with the Service Type Codes you need.
              You can have up to 180 codes. See the X12 Service Type Codes reference for a full list.
              1. In the Code Set object, add a value to the Code Set Type picklist field for service type codes. Give the value a name such as Service Type Codes for Benefit Verification.
              2. Create service type codes by selecting the picklist value in the Code Set Type field.
            2. From Setup, search for and select Care Benefit Verification Settings.
            3. Click New Care Benefit Verification Settings.
            4. Give this connection a meaningful label.
              For example, indicate which specific service is verifying benefits to distinguish these settings from settings for other verification services.
            5. Specify the Apex class you created to connect to your verification service.
            6. In Care Benefit Verification URI Path, provide a link to the endpoint where Health Cloud can access the verification service data.
            7. If these settings are for the default service, select Default.
              If your organization supports multiple payers, you can have different benefit verification services. One of them must be the default so that all verification requests work.
            8. In Service Type Source System, specify the external EHR system where this verification stores its service type codes.
            9. In Care Benefit Verification Service Named Credential, provide the login information that authorizes Health Cloud to connect to the external system.
            10. Enter the name of the organization that's issuing the verification request.
            11. Specify the National Provider Identifier number that identifies your organization in benefits verification requests.
              Your NPI is recorded in the NPPES NPI Registry.
            12. For Code Set Type, enter the grouping of service type codes that this configuration supports.
            13. In General Plan Service Type Code, specify the code that describes the plan benefits as a whole.
              Tip
              Tip This code is usually 30, which stands for plan coverage and general benefits for the member's policy or contract.

            See Also

             
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