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Electronic Verification Scenarios
Explore the different scenarios that occur when your representative raises an electronic verification request. Also, understand the different scenarios of failure and their resolution.
Required Editions
| Available in: Lightning Experience |
| Available in: Enterprise and Unlimited Editions with Life Sciences Cloud or Health Cloud |
When your representative initiates an electronic verification request, an FHIR compliant RTBPC request is sent to the clearing house through MuleSoft. The clearing house sends an acknowledgment as soon as it receives the request. MuleSoft then updates the status of the care benefit verification request to Acknowledged.
The clearing house then connects with various payors and gets the FHIR compliant RTPBC response. This response includes the patient's coverage details such as coverage benefits, coverage benefit items, and coverage benefit item limits. When the clearing house sends the response back to Salesforce through MuleSoft, the status gets updated to Verified, and the relevant benefits summary gets updated with the coverage details.
Different Scenarios for an Electronic Verification Request
Here are the different scenarios and statuses of care benefit verify request that an electronic verification request may go through.
| SCENARIO | Status | STATUS REASON | Resolution | Can Retry Electronic verification? | Can Retry Manual verification? | Can create a new Electronic request? | Can create a new manual request? |
|---|---|---|---|---|---|---|---|
| A verification request is created but can't be sent to the clearing house. This can happen due to multiple reasons, such as MuleSoft or clearing house being unresponsive, or a network issue. | Error | Request could not be sent | Check network connection, connectivity with MuleSoft, or connectivity with clearing house. | Yes | Yes | No | No |
| MuleSoft rejects the application due to invalid credentials. | Error | Bad credential | Review your MuleSoft login credentials and ensure the username and password are correct. | Yes | Yes | No | No |
| The clearing house rejects the application due to invalid credentials. | Error | Bad credential | Review your clearing house login credentials and ensure the username and password are correct. | Yes | Yes | No | No |
| MuleSoft can't send the request to the clearing house because of the invalid request. | Error | Bad request input | Specify the correct values for the fields highlighted in response from the clearing house. | Yes | Yes | No | No |
| MuleSoft can't process the response from clearing house. | Error | Response could not be processed | Review all the coverage details, coverage detail items, coverage detail item limit, and care benefit verification requests records. | Yes | Yes | No | No |
| The clearing house can't process the request and rejects it. | Rejected | Clearing house rejected the request | Contact the clearing house to find out the reason for the rejection. | No | No | Yes | Yes |
| The clearing house can't send the response within 3 hours of sending the request. | Timed Out | Request timed out | Try contacting the clearing house to check whether the response didn't come from payors or there were connectivity issues. You can also customize the request time out in your org. | No | No | Yes | Yes |
