---
schema_version: "1"
id: dc50d165033b63ed7da542c9622f7c07a72b57e8a5a8b3771b77197bd6ce8468
title: Create an Expression Set for Prior Authorization Determination
collection: admin
version: current
locale: en-us
portal_url: https://docs.salesforce.com/admin/current/en-us/ind/264-0-0/bre_hc_create_expression_set.md
canonical_url: https://help.salesforce.com/s/articleView?id=ind.bre_hc_create_expression_set.htm&release=264.0.0&type=5
source_site: help.salesforce.com
content_type: documentation
content_hash: ed5868aba6341dc44cd4b4fec6c42608c647e8c9529ada58b87ea804f91e2ee4
description: Use an expression set to create a rule to determine the prior authorization and member plan status of a service. Add a List Group element in the expression set to fetch the Health Cloud object fields from the context definition that you created earlier. Based on the prior authorization and member plan status, calculate the coverage benefit associated with the service and its approval status.
products:
  - Industry Solutions
  - Cross Cloud
release: "264"
---
# Create an Expression Set for Prior Authorization Determination

Use an expression set to create a rule to determine the prior authorization and member plan status of a service. Add a List Group element in the expression set to fetch the Health Cloud object fields from the context definition that you created earlier. Based on the prior authorization and member plan status, calculate the coverage benefit associated with the service and its approval status.

### Required Editions

<table class="slds-table slds-table_bordered slds-max-medium-table_stacked slds-m-bottom_small edition"><colgroup><col style="width:100%"></colgroup><tbody><tr class=""><td class="slds-cell-wrap" style="vertical-align:top;">Available in: Lightning Experience</td></tr><tr class=""><td class="slds-cell-wrap" style="vertical-align:top;">Available in: <strong>Enterprise</strong> and <strong>Unlimited</strong> Editions for clouds that have Business Rules Engine enabled</td></tr></tbody></table>

<table class="slds-table slds-table_bordered slds-max-medium-table_stacked slds-m-bottom_small permission">
        <colgroup>
          <col style="width:50%">
          <col style="width:50%">
        </colgroup>
        <thead class="slds-text-title_caps ">
          <tr class="">
            <th scope="colgroup" class="slds-cell-wrap" colspan="2" style="text-align:center;vertical-align:top;" id="d33711e67">User Permissions
              Needed</th>
          </tr>
        </thead>
        <tbody>
          <tr class="">
            <td data-label="User Permissions Needed" class="slds-cell-wrap" style="vertical-align:top;" headers="d33711e67 ">To create, update, and delete expression sets</td>

            <td class="slds-cell-wrap" style="vertical-align:top;" headers="d33711e67 ">Rule Engine Designer</td>

          </tr>
          <tr class="">
            <td data-label="User Permissions Needed" class="slds-cell-wrap" style="vertical-align:top;" headers="d33711e67 ">To run expression sets in Business Rules Engine</td>

            <td class="slds-cell-wrap" style="vertical-align:top;" headers="d33711e67 ">Rule Engine Runtime</td>

          </tr>
        </tbody>
      </table>

1. From the App Launcher ![App Launcher](https://sf-zdocs-cdn-prod.zoominsoftware.com/tdta-ind-business_rules_engine-264-0-0-production-enus/b2d6dd5c-c231-428b-abbf-3dd2cd51a11f/resources-global/_corporate/images/app_launcher_icon.png), find and select **Expression Sets**.
2. Click **New**.
3. Enter Member Plan Status Check as the name of the new expression set.
4. Select **Default** as the usage type.
5. Select **Get\_MemberPlan\_Details** as the context definition.
6. Save your changes.

## Create Resources

1. On the Member Plan Status Check expression set record page, click the **Member Plan Status Check V1** expression set version to open it in Expression Set Builder.
2. In the Expression Set Builder, open Resource Manager by clicking ![Resource Manager Icon](https://sf-zdocs-cdn-prod.zoominsoftware.com/tdta-ind-business_rules_engine-264-0-0-production-enus/b2d6dd5c-c231-428b-abbf-3dd2cd51a11f/business_rules_engine/images/bre_resource_manager_icon.png).
3. Click **Add Resource**.
4. To create the Date of Service variable, enter these details.
    - Resource Type: Variable
    - Resource Name: DateOfService
    - Data Type: Date
5. Click **Done**.
6. Similarly, create these variables.
    
    | Resource Type | Resource Name | Data Type |
    | --- | --- | --- |
    | Variable | MemberNumberInput | Text |
    | Variable | MemberPlanStatus | Boolean |
    | Variable | PriorAuthDetermination | Text |
7. Save your changes.

## Add Elements

1. In the Expression Set Builder canvas, click ![Add Elements Icon](https://sf-zdocs-cdn-prod.zoominsoftware.com/tdta-ind-business_rules_engine-264-0-0-production-enus/b2d6dd5c-c231-428b-abbf-3dd2cd51a11f/business_rules_engine/images/bre_add_elements.png).
2. Find and select **Lookup Table**.
3. In the Lookup Table Details field, find and select the **Benefit Service Code** decision matrix.
4. Save your changes.
    
    ![Benefit Service Code](https://sf-zdocs-cdn-prod.zoominsoftware.com/tdta-ind-business_rules_engine-264-0-0-production-enus/b2d6dd5c-c231-428b-abbf-3dd2cd51a11f/business_rules_engine/images/bre_sg_hc_benefit_service_code.png)
5. Click ![Add Elements Icon](https://sf-zdocs-cdn-prod.zoominsoftware.com/tdta-ind-business_rules_engine-264-0-0-production-enus/b2d6dd5c-c231-428b-abbf-3dd2cd51a11f/business_rules_engine/images/bre_add_elements.png) after the Benefit Service Code lookup table element.
6. Find and select **List Group**.
7. Add these details in the List Filter element.
    1. Rename the List Filter element as Check Member Plan Status.
    2. In Filter Condition Requirements, select **All Conditions Are Met (AND)**.
    3. Select **MemberNumber** as the resource.
    4. Select **Equals** as the operator. Select **MemberNumberInput** as the value.
    5. Click **Add Condition**.
    6. Select **PlanStatus** as the resource.
    7. Select **Equals** as the operator.
    8. Enter Active as the value.
    9. Click **Add Condition**.
    10. Select **EffectiveDateFrom** as the resource.
    11. Select **Less Than** as the operator.
    12. Select **DateOfService** as the value.
    13. Click **Add Condition**.
    14. Select **EffectiveDateTo** as the resource.
    15. Select **Greater Than** as the operator.
    16. Select **DateOfService** as the value.
8. Click ![Add Elements Icon](https://sf-zdocs-cdn-prod.zoominsoftware.com/tdta-ind-business_rules_engine-264-0-0-production-enus/b2d6dd5c-c231-428b-abbf-3dd2cd51a11f/business_rules_engine/images/bre_add_elements.png) inside the List Group box.
9. Find and select **Calculation**.
10. Add these details in the calculation element.
    1. Rename the Calculation element as Member Plan Active.
    2. Enter true as the formula.
    3. Select **isMemberPlanActive** as the output variable.
11. Click ![Add Elements Icon](https://sf-zdocs-cdn-prod.zoominsoftware.com/tdta-ind-business_rules_engine-264-0-0-production-enus/b2d6dd5c-c231-428b-abbf-3dd2cd51a11f/business_rules_engine/images/bre_add_elements.png) inside the List Group box.
12. Find and select **Calculation**.
13. Add these details in the calculation element.
    1. Rename the Calculation element as Member Plan Status.
    2. Select **isMemberPlanActive** as the formula.
    3. Select **MemberPlanStatus** as the output variable.
14. Save your changes.
    
    ![List Group 1](https://sf-zdocs-cdn-prod.zoominsoftware.com/tdta-ind-business_rules_engine-264-0-0-production-enus/b2d6dd5c-c231-428b-abbf-3dd2cd51a11f/business_rules_engine/images/bre_sg_hc_list_group1.png)
15. Click ![Add Elements Icon](https://sf-zdocs-cdn-prod.zoominsoftware.com/tdta-ind-business_rules_engine-264-0-0-production-enus/b2d6dd5c-c231-428b-abbf-3dd2cd51a11f/business_rules_engine/images/bre_add_elements.png) outside the List Group box.
16. Find and select **List Group**.
17. Add these details in the List Filter element.
    1. Rename the List Filter element as Check Requested Code with Plan Condition 1.
    2. In Filter Condition Requirements, select **Any Condition Is Met (OR)**.
    3. Select **IsPreauthorizationRequired** as the resource.
    4. Select **Equals** as the operator.
    5. Enter false as the value.
    6. Click **Add Condition**, and add two more conditions with these details.
        
        | Resource | Operator | Value |
        | --- | --- | --- |
        | Benefit\_Service\_Code\_\_PriorAuthorizationRequired | Equals | false |
        | ServiceTypeCode | Not Equals | ServiceCode |
18. Click ![Add Elements Icon](https://sf-zdocs-cdn-prod.zoominsoftware.com/tdta-ind-business_rules_engine-264-0-0-production-enus/b2d6dd5c-c231-428b-abbf-3dd2cd51a11f/business_rules_engine/images/bre_add_elements.png) inside the List Group box.
19. Find and select **Calculation**.
20. Add these details in the calculation element.
    1. Rename the Calculation element as Prior Authorization Not Required.
    2. Enter ServiceCode + " " + CoverageBenefitItemName + " - Administrative Not Approved, PriorAuth Not Required or Service Code is not covered for Benefit." as the formula.
    3. Select **PriorAuthDetermination** as the output variable.
21. Save your changes.
    
    ![List group 2](https://sf-zdocs-cdn-prod.zoominsoftware.com/tdta-ind-business_rules_engine-264-0-0-production-enus/b2d6dd5c-c231-428b-abbf-3dd2cd51a11f/business_rules_engine/images/bre_sg_hc_list_group2.png)
22. Click ![Add Elements Icon](https://sf-zdocs-cdn-prod.zoominsoftware.com/tdta-ind-business_rules_engine-264-0-0-production-enus/b2d6dd5c-c231-428b-abbf-3dd2cd51a11f/business_rules_engine/images/bre_add_elements.png) outside the List Group box.
23. Find and select **List Group**.
24. Add these details in the List Filter element.
    1. Rename the List Filter element as Check Requested Code with Plan Condition 2.
    2. In Filter Condition Requirements, select **Custom Condition Logic is Met**. For Custom Condition Logic, enter (1 OR 2) AND 3.
    3. Select **IsPreauthorizationRequired** as the resource.
    4. Select **Equals** as the operator.
    5. Enter true as the value.
    6. Click **Add Condition**, and add two more conditions with these details.
        
        | Resource | Operator | Value |
        | --- | --- | --- |
        | Benefit\_Service\_Code\_\_PriorAuthorizationRequired | Equals | true |
        | ServiceTypeCode | Equals | ServiceCode |
25. Click ![Add Elements Icon](https://sf-zdocs-cdn-prod.zoominsoftware.com/tdta-ind-business_rules_engine-264-0-0-production-enus/b2d6dd5c-c231-428b-abbf-3dd2cd51a11f/business_rules_engine/images/bre_add_elements.png) inside the List Group box.
26. Find and select **Calculation**.
27. Add these details in the calculation element.
    1. Rename the Calculation element as Prior Authorization Approval.
    2. Enter ServiceCode + " " + CoverageBenefitItemName + " - Administrative Approved" as the formula.
    3. Select **PriorAuthDetermination** as the output variable.
28. Save your changes.
    
    ![List Group 3](https://sf-zdocs-cdn-prod.zoominsoftware.com/tdta-ind-business_rules_engine-264-0-0-production-enus/b2d6dd5c-c231-428b-abbf-3dd2cd51a11f/business_rules_engine/images/bre_sg_hc_list_group3.png)
29. Click ![Settings Icon](https://sf-zdocs-cdn-prod.zoominsoftware.com/tdta-ind-business_rules_engine-264-0-0-production-enus/b2d6dd5c-c231-428b-abbf-3dd2cd51a11f/business_rules_engine/images/bre_settings_icon.png) in the Expression Set Builder page.
30. Enter 1 as the rank.
31. Select the **Prior Authorization Approval** element.
32. Click ![Expression Set Builder Icon](https://sf-zdocs-cdn-prod.zoominsoftware.com/tdta-ind-business_rules_engine-264-0-0-production-enus/b2d6dd5c-c231-428b-abbf-3dd2cd51a11f/business_rules_engine/images/bre_builder_icon.png) in the Expression Set Builder page.
33. Select **Include in Output**.
34. Similarly, select **Include in Output** for all the calculation elements and lookup table element in the expression set.
35. Save your changes.
36. Click **Activate**.
User Permissions Needed
To create, update, and delete expression sets	Rule Engine Designer
To run expression sets in Business Rules Engine	Rule Engine Runtime