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Business Rules Engine
Create a Decision Matrix for Benefit Service Codes

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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
  1. From the App Launcher (App Launcher), find and select Business Rules Engine.
  2. Click the app navigation menu, and then select Lookup Tables.
  3. Click New.
  4. Select Decision Matrix, and then click Next.
  5. Enter these details.
    • Name: Benefit Service Code
    • Type: Standard
  6. Save your changes.

Add Columns and Rows

  1. On the Benefit Service Code decision matrix record page, click the Related tab.
  2. On the Decision Matrix Versions related list, click the Benefit Service Code V1 decision matrix version.
  3. On the Matrix tab, click Add Column.
  4. Enter these details.
    • Column Header: ServiceCode
    • Header Type: Input
    • Data Type: Text
  5. Click Add Column.
  6. Enter these details for the second column.
    • Column Header: PriorAuthorizationRequired
    • Header Type: Output
    • Data Type: Boolean
    Add Column
  7. Click Done.
  8. Click Add Row.
  9. In the ServiceCode column, hover over the first row, and click Edit field pencil icon.
  10. Enter CPT23456 as the service code.
  11. In the PriorAuthorizationRequired column, hover over the first row, and click Edit field pencil icon.
  12. To ensure prior authorization for the corresponding service code, select the checkbox.
  13. Similarly, add the remaining service codes and their prior authorization required status.
    ServiceCode PriorAuthorizationRequired

    CPT23457

    		 Yes

    CPT23458

    		 Yes

    CPT23459

    		 No

    CPT45678

    		 Yes

    CPT67890

    		 No
  14. Save your changes.
  15. Click Dropdown Button on the top right, and select Activate.
 
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