Eligibility Checking
Eligibility
Key features
Connects to the National Health Security Office for universal coverage checks by national ID
Connects to the Social Security Office for insured status and the registered facility
Connects to the Comptroller General's Department for civil service benefits
Mock mode for demonstration and training — switched by configuration, no code change
Manual verification — staff can enter a result themselves and record its source
Caching with a configurable lifetime, to reduce load on the external services
Automatic refresh before a cached result goes stale
Audit log of every call, with request, response and outcome
Fallback strategy — switches to cache or manual entry when an external service is down
Results attach to the visit automatically and feed the benefit engine
Overview
Before care begins, confirming that the coverage a patient claims is actually valid is the first step in getting the money right. MorLuang connects to all three principal Thai scheme registries, with fallbacks for when the network or the service is unavailable.
Why it matters
A receipt issued on the wrong coverage is painful to correct — either you chase a patient who has already gone home, or you process a refund. Checking eligibility before the visit opens gives the benefit engine correct information from the start and lets staff make the right call at the counter.
Three operating modes
| Mode | Used for | Behaviour |
|---|---|---|
| Live API | Production | Calls the real scheme registries |
| Mock | Demo and training | Uses simulated data, touching nothing real |
| Manual | Outage or special cases | Staff enter the result and record where it came from |
The system switches mode automatically when it hits an error, and logs every fallback.
Caching and audit
Results are cached with a configurable lifetime — for example 24 hours for universal coverage, seven days for social security. That keeps the registration screen fast and reduces load on the external services.
Every request and response is written to the audit log with a timestamp, the user who triggered it, the result, and the adapter version used. That record is what answers an inspector’s question months later about exactly what was asked and what came back.
How it connects
Eligibility runs before the outpatient visit opens. The result attaches to the visit and passes to the benefit engine for coverage calculation at charge capture. The claim centre later uses the same result as supporting evidence on the submission.
Who uses this
Registration staffCoverage officersBilling staff
Hospital information system software, licensed to clinics and hospitals in Thailand.
