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PATIENT SERVICE
| First or Last Name Contains | Behavior |
|---|---|
Verified | Auto-passes identity verification |
Examples: JohnVerified, JaneVerified Smith
Case-insensitive, matches anywhere in first or last name.
BV
| Patient First Name Contains | Mock Scenario | Description |
|---|---|---|
FullCovered | drugs_covered__prior_auth_required__has_copay | Drugs covered, prior auth required, has copay |
NotCovered | drugs_not_covered__prior_auth_na__no_copay | Drugs not covered, no prior auth, no copay |
Examples: JohnFullCovered, JaneNotCovered
PA
| Patient First Name Contains | Mock Result | Detail Code |
|---|---|---|
PAApproved | Approved | approval |
PADenied | Denied | step_therapy_criteria_not_met |
Examples: JohnPAApproved, JanePADenied
All checks use Contains, so suffixes can be combined in any order:
JohnVerifiedFullCoveredPAApproved— ID verified + BV covered + PA approvedJaneVerifiedPADeniedNotCovered— ID verified + PA denied + BV not covered