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sharp_revenue_testing_guide [2025/06/05 20:08] – [Eligibility/Insurance Discovery Products] brad.sharpsharp_revenue_testing_guide [2026/05/05 15:20] (current) – Link to mock scenario intake page brad.sharp
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 ==== Eligibility/Insurance Discovery Products==== ==== Eligibility/Insurance Discovery Products====
 The behavior of the service is largely dependent on the name of the subscriber / guarantor:² The behavior of the service is largely dependent on the name of the subscriber / guarantor:²
-  * **Note Use Payer** Payer Number: 00015 and PayerName:BCBS of Indiana (Anthem) if using the claim payer id use '00630'+  * **Note Use Payer** Payer Number: 00015 and PayerName:BCBS of Indiana (Anthem) if using the claim payer id use '00630' and set the property "isRevenueToolsPayerId" to false
   * **Subscriber first name starts with “H”** – return Active coverage if subscriber id is present, otherwise return an AAA 72 validation (indicating a missing subscriber id).   * **Subscriber first name starts with “H”** – return Active coverage if subscriber id is present, otherwise return an AAA 72 validation (indicating a missing subscriber id).
   * **Subscriber first name starts with “I”** – return Not Found response with an AAA 42 validation (indicating service temporarily unable to respond); a different AAA validation code can be sent if the first name contains a hyphen followed by the code (for example, a first name of “I-41” will cause a AAA 41 to be returned).   * **Subscriber first name starts with “I”** – return Not Found response with an AAA 42 validation (indicating service temporarily unable to respond); a different AAA validation code can be sent if the first name contains a hyphen followed by the code (for example, a first name of “I-41” will cause a AAA 41 to be returned).
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 ² Note: The behavior described above depends on the subscriber/guarantor’s name matching specific conditions. ² Note: The behavior described above depends on the subscriber/guarantor’s name matching specific conditions.
 +
 +
 +===== Mock Scenario Library =====
 +
 +Need a polished, repeatable demo of your EMR's eligibility flow against your **test account**? You can pick a handful of your own production transactions, send ClaimRev a short CSV listing them, and we'll anonymize each one and load it into your test account as a canned scenario. From then on, eligibility requests with matching subscriber id / payer number return the captured (PHI-scrubbed) response every time.
 +
 +See the [[sharp_revenue_mock_scenario_intake|Sharp Revenue Mock Scenario Intake]] page for the CSV format, an example, and step-by-step instructions.
  
sharp_revenue_testing_guide.1749154108.txt.gz · Last modified: by brad.sharp

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