Universal API Implementation Guide - Local Development build (v1.1.19). See the Directory of published versions

Validation Rules

Validation rules have been implemented to ensure that enrollments have the minimum required information to process enrollments.

If an enrollment is missing any of the listed resources and/or data elements, the enrollment is rejected, meaning the bundle is not processed by Access Solutions / Patient Foundation. Our external partner will receive a message indicating that an error has occurred and information on what data is missing. If multiple resources/data elements are missing, the error message will list all missing resources/fields. The external partner will be responsible for resubmitting enrollment with the missing information in order for enrollment to be processed.

Required Resources

The following Resources are required for all Service Types:

• Patient
• MedicationRequest
• Condition
• ServiceRequest
• Practitioner
  
  
  

List of Required Data Elements by Service Type

Resource	Data Element	When Service Type = BIPA, CoPay, Appeals or Starter SR	When Service Type = Patient Foundation SR
Patient	Patient First Name	Required	Required
Patient	Patient Last Name	Required	Required
Patient	Date of Birth	Required	Required
Patient	Street Address	Required	Required
Patient	City	Required	Required
Patient	State	Required	Required
Patient	Zip	Required	Required
Patient	Phone	Required	Required
Patient	Phone Type	Required	Required
Patient	Preferred Language	Required	Required
MedicationRequest	Product	Required	Required
Condition	Diagnosis Code	Required	Required
ServiceRequest	ServiceRequest Type	Required	Required
Practioner	Prescriber First Name	Required	Required
Practioner	Prescriber Last Name	Required	Required
Practioner	Prescriber NPI#	Required	Required
Organization	Prescriber Street Address	Required	Required
Organization	Prescriber City	Required	Required
Organization	Prescriber State	Required	Required
Organization	Prescriber Zip	Required	Required
Organization	Practice Name	Required	Reqiured
Organization	Practice Contact First Name	Required	Required
Organization	Practice Contact Last Name	Required	Required
Organization	Practice Contact Phone#	Required	Required
Organization	Payer Name	Required	Optional
Coverage	Subscriber ID	Required	Optional
Coverage	First Name	Required	if patient is insured
Coverage	Last Name	Required	if patient is insured
Provenance	Prescriber signature	Conditional, based on product & Service Request Type*	Required
Consent	Patient consent (type)	Required if Patient Consent is included in bundle	Required if Patient Consent is included in bundle

*Refer to Business Rules - Products Specifics tab

List of Possible Validation Error Messages that Can be Received

Error Message Description	Expression
Missing required resource: Condition	Condition
Too many Condition resources found in the bundle, should be just one	Condition
Missing ICD10 code in Condition resource	Condition.code.coding.code
Missing Patient Authorization Signature Consent	Consent
Missing required resource: Coverage	Coverage
Missing payor references	Coverage.payor
Missing subscriber reference	Coverage.subscriber
Missing reference for Patient	Coverage.subscriber.reference
Missing Patient reference for	Coverage.subscriber.reference
Missing reference for RelatedPerson	Coverage.subscriber.reference
Missing Related Person reference for + reference	Coverage.subscriber.reference
Wrong subscriber type	Coverage.subscriber.type
Missing required field: subscriberId for Coverage: + coverageId	Coverage.subscriberId
Missing required resource: MedicationRequest	MedicationRequest
Missing Prescription information on MedicationRequest	MedicationRequest.note
Missing required resource: Organization	Organization
Organization referenced under Coverage.payor is not provided in the bundle	Organization
Missing required resource: Organization	Organization
Missing Organization address	Organization.address
Missing Organization city	Organization.address.city
Missing Organization country	Organization.address.country
Missing Organization address line	Organization.address.line
Missing Organization address line, only Organization Address.Apt/Unit found	Organization.address.line
Missing Organization postal code	Organization.address.postalCode
Missing Organization state	Organization.address.state
Wrong Organization state	Organization.address.state
Missing required field: contact	Organization.contact
Wrong amount of contact fields in Organization resource, should be 1	Organization.contact
Missing Organization.contact’s LastName	Organization.contact.name.family
Missing Organization.contact’s FirstName	Organization.contact.name.given
Patient.managingOrganization.reference doesn’t match Organization FullURL	Organization.FullURL
Missing required field: Payer name	Organization.Name
Missing Organization fax number	Organization.telecom.value
Wrong fax number format	Organization.telecom.value
Missing Organization phone number	Organization.telecom.value
Wrong Organization phone number format	Organization.telecom.value
Missing Patients	Patient
Missing required resource: Patient	Patient
Too many Patient resources found in Bundle: + numberOfPatients + , required only 1	Patient
Missing Patient address	Patient.address
Missing Patient city	Patient.address.city
Missing Patient country	Patient.address.country
Missing Patient address line	Patient.address.line
Missing Patient address line, only Patient Address.Apt/Unit found	Patient.address.line
Missing Patient postal code	Patient.address.postalCode
Missing Patient state	Patient.address.state
Wrong Patient state	Patient.address.state
Missing required field: birthDate	Patient.birthDate
Patient’s date of birth should be in the past	Patient.birthDate
Missing required reference to Practitioner	Patient.generalPractitioner.reference
Missing required reference to Organization	Patient.managingOrganization.reference
Missing required fields: FirstName, LastName	Patient.name
Missing required fields: FirstName, LastName	Patient.name
Missing Patient’s LastName	Patient.name.family
Missing Patient’s FirstName	Patient.name.given
Missing Patient phone number	Patient.telecom.value
Wrong Patient phone number format	Patient.telecom.value
Missing required resource: Practitioner	Practitioner
Too many Practitioner resources found in Bundle: ‘ + bundle.practitioners.size() + ‘, required only 1	Practitioner
Patient.generalPractitioner.reference doesn’t match Practitioner FullURL	Practitioner.FullURL
Missing required field: Identifier	Practitioner.identifier
Missing appropriate Practitioner’s identifier type, required: ‘National Provider Identifier’	Practitioner.identifier.type
Practitioner’s NPI number doesn’t have correct number of digits: ‘ + singleIdentifier.value.length() + ‘, required 10	Practitioner.identifier.value
Practitioner’s NPI number requires only digits, letters are forbidden	Practitioner.identifier.value
Missing Practitioner’s NPI number	Practitioner.identifier.value
Missing required fields: FirstName, LastName	Practitioner.name
Missing Practitioner’s LastName	Practitioner.name.family
Missing Practitioner’s FirstName	Practitioner.name.given
Missing required resource: Provenance	Provenance
Missing Prescriber signature	Provenance.signature
Missing required values: + One or two missing links	Questionnaire/QuestionnaireResponse
Missing Related person	RelatedPerson
Missing required fields: FirstName, LastName	RelatedPerson.name
Missing Related Person’s FirstName	RelatedPerson.name.given
Missing Related Person’s LastName	RelatedPerson.name.family