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Create a Decision Matrix for Benefit Service Codes
Create a decision matrix to assign the prior authorization required status for the service codes defined in the Health Cloud objects and also for a few undefined ones.
Required Editions
| Available in: Lightning Experience |
| Available in: Enterprise and Unlimited Editions for clouds that have Business Rules Engine enabled |
| User Permissions Needed | |
|---|---|
| To create, update, and delete decision matrices and matrix versions: | Rule Engine Designer |
| To use decision matrices in Business Rules Engine: | Rule Engine Runtime |
-
From the App Launcher (
), find and select Business Rules Engine.
- Click the app navigation menu, and then select Lookup Tables.
- Click New.
- Select Decision Matrix, and then click Next.
-
Enter these details.
- Name: Benefit Service Code
- Type: Standard
- Save your changes.
Add Columns and Rows
- On the Benefit Service Code decision matrix record page, click the Related tab.
- On the Decision Matrix Versions related list, click the Benefit Service Code V1 decision matrix version.
- On the Matrix tab, click Add Column.
-
Enter these details.
- Column Header: ServiceCode
- Header Type: Input
- Data Type: Text
- Click Add Column.
-
Enter these details for the second column.
- Column Header: PriorAuthorizationRequired
- Header Type: Output
- Data Type: Boolean
- Click Done.
- Click Add Row.
-
In the ServiceCode column, hover over the first row, and click
.
- Enter CPT23456 as the service code.
-
In the PriorAuthorizationRequired column, hover over the first row, and click .
- To ensure prior authorization for the corresponding service code, select the checkbox.
-
Similarly, add the remaining service codes and their prior authorization required
status.
ServiceCode PriorAuthorizationRequired CPT23457
Yes CPT23458
Yes CPT23459
No CPT45678
Yes CPT67890
No - Save your changes.
-
Click
on the top right, and select Activate.
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