PlanSource API

EOI Processing

Evidence of Insurability, or EOI,is the process of providing health information to an insurance provider in order to receive insurance coverage. There are currently four ways to process pending EOIs within PlanSource:

  1. Manual EOI Processing as Administrator (okay)
  2. Spreadsheet Import as Administrator (good)
  3. Automated Batch Import (better)
  4. EOI API (best)

There are currently six types of action to take when processing pending EOIs within PlanSource:

  1. Approve All
  2. Approve Partial
  3. Approve Partial and Pend Remaining
  4. Approve and Disallow Additional Amounts
  5. Expire
  6. Deny All

Manual EOI Processing as Administrator

When a subscriber elects an EOI required benefit within PlanSource, the client administrator can login to PlanSource's Benefit Admin site and approve the Open EOI after a carrier sends back a report denoting which EOI's were approved and/or denied. The administrator can do this through EOI Processing, a manual process to take action on pending EOI.

To do this as the client administrator, first login to PlanSource's Benefit Admin site.

  1. Click on the Open EOI tab on the admin dashboard.
  2. Select the checkbox next to the pending EOI needing action.
  3. Choose an Action to take for the pending EOI.
  4. Enter an Effective Date for the EOI to take effect.
  5. Click Save to save the configuration.

Spreadsheet Import as Administrator

Another form of processing EOI is by utilizing Spreadsheet Import. The administrator can do this through Spreadsheet Importing, another manual process to take action on pending EOI.

To do this as the client administrator, first login to PlanSource's Benefit Admin site.

  1. Click on the Data tab.

  2. Scroll down to the bottom of the page and select either EOI Decision New (empty) Worksheet or EOI Decision Update Worksheet. Selecting an empty worksheet will open an Excel spreadsheet without any pending EOIs filled in. Choosing the other worksheet will populate the rows with any pending EOIs in the Excel spreadsheet.

  3. After selecting a worksheet (in this example, EOI Decision Update Worksheet was selected), fill in the required data fields (listed below) in the Excel spreadsheet to process the pending EOIs.

  • Action
  • Effective Date

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Instructions

Within the Excel spreadsheet there are two tabs: EOI Decisions and Instructions. The Instructions tab will help give examples of how the data field entries must be entered. There are formats that are required, and if the formats are not followed, the spreadsheet will not be accepted correctly back into PlanSource. Make sure to read over the Instructions tab before inputting data into the required data fields.

  1. Once those required fields have been entered and the file has been saved as .xml, click Choose File and select the .xml file previously saved.
  2. Click Upload, and the EOI should be processed and saved.

Automated Batch Import

For processing EOIs using automated batch import, there is a standardized layout that can be utilized. It accepts fields similar to Data Import (section above), and whenever a batch is imported, an SFTP folder is created to intake the batch. The information from the import will be picked up and processed by PlanSource's system as an automated process. This process requires configuration and setup to be performed by PlanSource before it can be used.

EOI API

Another form of processing EOI is by utilizing the EOI API. A developer can make a PUT call to the endpoint /eoi/decision/{subscriber_id} to process a single subscriber's pending EOI. To do so, there are some required fields that are necessary to processing an EOI:

  • Subscriber ID
    The Subscriber's ID must be added to the URL when making the PUT call to a specific subscriber. The ID refers to the employee's unique ID on the partner's side.
  • Action
    The Action must be filled in to make the decision for the EOI. There are six types of actions that can be used to process an EOI, and they are listed in the next section below.
  • Effective Date
    The Effective Date is needed to mark when the EOI should become effective.

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Different Actions = Different Required Fields

Depending on which action is chosen for the decision on processing an EOI, there may be different required fields that need to be entered as a result. In the next section below, the resulting required fields are listed next to each action that can be taken on an EOI.

Below is an example of processing an EOI with the action to Approve All of the amount requested. First is the PUT call with the URL, next is the body with the parameters, and last is the JSON response with a status of "success".

PUT https://partner-dev-api.plansource.com/v2/eoi/decision/2852117

BODY:
{
  "decisions": [
    {
      "ssn": "123000000",
      "benefit_lookup_code": "subscriber_life",
      "action": "approve_all",
      "approved_amount": 150000,
      "effective_date": "2017-03-31",
      "original_effective_date": ""
    }
  ]
}

RESPONSE:
{
    "status": "success",
    "data": {
        "valid_count": 1,
        "failed_count": 0,
        "failed_rows": []
    }
}

Here is what the approved EOI will look like in PlanSource once the EOI has been processed.

Six Types of Action

Below are the six types of actions that can be taken when processing a pending EOI (and there corresponding API data field labels). Below each type are the data fields that are required to be filled out when processing the pending EOI using PlanSource's API.

Action Type

Action Type Data Field Name

Action Type required data fields

Description

Approve All

approve_all

effective_date

Approve All means to approve the entire amount a subscriber has elected in their benefit.

Approve Partial

approve_part

approved_volume
effective_date

Approve Partial means to approve only a partial amount that a subscriber has elected. The remaining amount that was not approved disappears and cannot be approved at a later time.

Approve Partial and Pend Remaining

pend_remaining

approved_volume
effective_date

Approve Partial and Pend Remaining means to approve only a partial amount that a subscriber has elected and to hold off on the remaining portion until a later date.

Approve and Disallow Additional Amounts

deny_permanently

approved_volume
effective_date

Approve and Disallow Additional Amounts means to approve the entire amount a subscriber has elected and to now allow any more funds be allowed in this benefit at any other time.

Expire

expire_all

effective_date

Expire means to let the subscriber's election expire without any funds being approved.

Deny All

deny_all

effective_date

Deny All means to deny the entire amount a subscriber has elected.

Updated about a year ago

EOI Processing


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