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Table of Contents
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maxLevel7

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  1. Verify Care plan:

    1. It should be in active status

      1. in case of error - return 409 (message: "Invalid care plan status")

    2. Care plan's period end (if exist) should be greater than current date or equal.

      1. in case of error - return 409 (message: “Care plan expired“)

  2. Verify care plan Activity:

    1. It has scheduled, in_progress status

      1. in case of error - return 409 (message: "Invalid activity status")

Validate division

If division_id submitted:

  1. Validate division is active

    1. in case of error - return 409 ("Division is not active")

  2. Validate division belongs to user's legal entity

    1. in case of error - return 409 ("Division does not belong to user's legal entity")

  3. If chart parameter DISPENSE_DIVISION_DLS_VERIFY is on, then validate division is DLS verified (dls_verified=true)

    1. in case of error - return 409 "Division is not verified in DLS"

  4. If chart parameter MEDICAL_PROGRAM_PROVISION_VERIFY, then check division provide each submitted program. For each Medical Program Provision validate following:

    1.  If the medical program has no setting skip_contract_provision_verify or it is equal to false/null:

      1. provision exist and active:

        1. in case of error - return status=INVALID for a program, rejection_reason= "Division does not provide the medical program"

      2. provision relates to the actual reimbursement contract: contract.start_date <= current_date <= contract.end_date, is_active = true, status = VERIFIED.

        1. in case of error - return status=INVALID for a program, rejection_reason="Medical program provision is not related to any actual contract for the current date"

    2. else if skip_contract_provision_verify = true, then skip provision verification for the medical program

Logic for qualify (analyze compliance with programs)

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