Fix insurance eligibility filtering and deductible calculation

[Copilot]

Insurance eligibility responses were incorrectly processed: copay/deductible amounts showed as unknown despite being present, deductible paid wasn't calculated, and period/benefit filtering was too broad.

Changes

Eligibility response parsing (packages/utils/lib/fhir/billing.ts)

Network classification

• Treat both 'Y' and 'W' as in-network (W = within service area)

Payment considerations filtering
Applied strict criteria to reduce noise and match actual urgent care benefits:

copay = benefitsTemp.filter((benefit) => {
  const isValidCoverageCode = benefit.coverageCode === 'A' || benefit.coverageCode === 'B';
  const isIndividualLevel = benefit.levelCode === 'IND';
  const isCalendarYear = benefit.periodCode === '27';
  const isInNetwork = benefit.inNetwork;
  const isUrgentCare = benefit.code === 'UC';
  
  return isValidCoverageCode && isIndividualLevel && isCalendarYear && isInNetwork && isUrgentCare;
});

Financial details (deductibles/OOP)

• Filter by benefit_period_code=27 (Calendar Year) and individual/family level
• Calculate paid amount when missing: paid = total - remaining
• Use period codes (23=total, 24=paid, 29=remaining) with regex fallback for description matching

Details dialog filtering (apps/ehr/src/features/visits/shared/components/patient/EligibilityDetailsDialog.tsx)

Filter view details popup to show only individual urgent care copays:

const copayBenefits = eligibilityCheck.copay?.filter((benefit) => {
  return benefit.coverageCode === 'B' && benefit.levelCode === 'IND' && benefit.code === 'UC';
}) || [];

Impact

• UHC responses now show correct period information
• Aetna responses populate fields instead of showing blank
• Deductible paid auto-calculates from available data
• Payment suggestions show accurate copay/deductible amounts

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Original prompt

---

This section details on the original issue you should resolve

<issue_title>RCM. EHR - Insurance details and suggested payment details are incorrect</issue_title>
<issue_description>Tested on:

• ENV [Demo], Version [1.24.25]
• Browser [Chrome]

Description

There are actually 4 related items in processing eligibility response:

1. Copay/deductible known, but shows as unknown in suggestions, but is showing correctly in insurance info
2. Deductible paid is shown as unknown when all other values are known. Should be able to calculate if not in the response
3. Period information is missing in insurance details for UHC
4. Aetna eligibility check returns all blank fields

HOST-468</issue_description>

<agent_instructions>in the section for payment considerations, we should filter based on

benefit_coverage_code of B

benefit_level_code of IND

benefit_period_code of 27

inplan_network of either Y or W

benefit_code of UC

in the section of insurance details, filter on the same things as in 1, but, for out of network section look for inplan_network that is not Y or W

in the popup of "view details" show all copays, selecting by:

benefit_coverage_code of B

benefit_level_code of IND

benefit_code of UC </agent_instructions>

Comments on the Issue (you are @copilot in this section)

• Fixes RCM. EHR - Insurance details and suggested payment details are incorrect #5737

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