Member detail walkthrough

Outcome

You can locate any member, read their full record without inadvertently exposing PHI to anyone who shouldn't see it, and edit demographics or coverage with a clean audit trail.

Prerequisites

Scope	What it lets you do
clinical.member.read	Read demographics, coverage, encounters
clinical.member.write	Edit demographics, coverage
clinical.member.read.phi	Read SSN, full DOB

A member already exists in the system. Members typically arrive via an ingestion feed (member roster); a tenant admin can also add one by hand.

The list page

/members shows the roster. The default view excludes terminated members; use the filter to include them.

Filter	Behavior
Search	Last name, first name, MRN, payer member ID. Substring; case-insensitive.
Status	Active, Inactive, Pending.
Coverage	Members with active coverage on a specific payer.
Facility	Members assigned to a specific facility.

The Search field works on every identifier the member carries — typing 12345 matches against MRN, payer member ID, and external system IDs.

The detail page

Click a row to open /members/:id. The page has a header card and tabs.

Header card

The header is always visible. It carries:

Field	Note
Display name	Last, First
MRN	Click to copy.
DOB	Shown as YYYY-MM-DD (full DOB) or XXXX-MM-DD (year masked) depending on your scope.
Status	Active, Inactive, Pending.
Primary coverage	Quick chip; click to jump to Coverage tab.
Dual-eligible badge	Appears if member has both Medicare and Medicaid (see 6.2 — COB & dual-eligibility).

Demographics tab

Field	Editable	Notes
Names	Yes	Aliases preserved as history.
DOB	Yes	Edit triggers an audit row.
SSN	Edit if clinical.member.write.phi	Stored encrypted; never displayed in full unless your scope allows.
Address	Yes	Full history kept.
Contact	Yes	Phone, email, preferred channel.

Every save writes an audit row visible on the Audit tab.

Coverage tab

Lists every coverage policy the member has ever held.

Column	Notes
Payer	Display name + line of business.
Member ID	The ID this payer carries.
Effective from / to	Coverage policy window.
Priority	Primary, Secondary, Tertiary.
Status	Active, Termed.

The COB & dual-eligibility view (6.2) explains how the platform uses coverage priority to drive secondary / tertiary claims.

Authorizations tab

Every auth ever requested for this member, with the standard auth status chip. The 3 most recent are highlighted at the top with utilization meters.

Claims tab

Filterable list of every claim that includes this member. The default sort is most-recent date-of-service first.

Encounters tab

Every service event tied to this member, grouped by date. Group sessions collapse into a single row; individual visits each get their own.

Documents tab

Uploaded clinical or insurance documents. Upload, replace, archive — all audited. PHI scope rules apply: clinical.documents.read.phi is required to view scanned clinical material; without it the row is visible but the preview is blocked with a redaction notice.

Audit tab

Append-only log of every change to this member's record:

Column	Meaning
When	Server timestamp.
Who	The user (or impersonating platform admin) who acted.
What	The mutation (update demographics, add coverage, view PHI).
Before / After	Old and new values for the field.

For a focused audit lookup (HIPAA pull), use 6.3 — Audit log lookup (HIPAA pulls).

Steps to update a member

1. Find the member via search on /members.

2. Open the relevant tab (Demographics for name/DOB; Coverage for insurance changes).

3. Click Edit, change the field, save. The page refreshes; the Audit tab carries a new row.

Validation

Check	Expected
Save returns 200	The detail page reflects the edit immediately.
Audit tab shows the edit	Yes, with your user and the timestamp.
Subsequent claims pick up the change	Yes — the next claim built carries the updated demographics / coverage.

Troubleshooting

Symptom	Cause	Fix
Cannot edit DOB / SSN	Missing clinical.member.write.phi scope	Ask a tenant admin to grant; or hand off to a teammate who has it.
Member not found on search	Filter is excluding terminated members	Toggle the Status filter.
Coverage tab shows two active primaries	Misconfigured ingestion or manual edit	Term one of them; the platform's COB selection picks the most-recent active.
Claims tab empty for a long-term member	Coverage was termed before any claim built	Confirm coverage windows match expected service dates.

Next

6.2 — COB & dual-eligibility