Download OpenAPI specification:Download
A CapitalRx API key consists of 2 parts, a public and a private access key. The public access key is used as part of your request to identify who is making the request, and is not necessarily secret. The private access key is secret and is used to generate the HMAC signature to authenticate requests.
API Keys expire 365 days from the date of creation, and any one identity can only have two (2) active API key pairs at any given moment, to allow for seamless key rotation.
Public Access Keys start with CRX and are always all caps.
Private Access Keys are random strings 58 characters long.
Example Public Access Key:
Example Private Access Key:
The following headers are required or your request will be rejected, even if it contains a valid signature.
All requests should have a Content-Type of application/json and contain a request
body with valid json. Even a request that supplies no information should send an
empty object {}
Requests are signed with an HMAC-SHA256 signature using the private access key. The canonical request needs to be hashed using this algorithm, and the resulting HMAC placed into the X-CRX-SIGNATURE header of the request.
The canonical request is defined as these 4 elements concatenated together:
An example of a canonical request would be:
POST https://adjudication-sts.staging-cap-rx.com/claim/list
1709242510POST/claim/list{}
Below is a Python3 example of an authenticated API call to list claims visible to the user calling the endpoint. Your user must have the appropriate permissions granted to call the endpoint, and if allowed to make the call, must have access to some data in order to not get an empty response.
List Claims:
import hmac
import requests
import time
from requests.auth import AuthBase
class CapitalRxApiAuth(AuthBase):
def __init__(self, access_key, secret_key):
self.access_key = access_key
self.secret_key = secret_key
def __call__(self, request):
timestamp = str(int(time.time()))
canonical_request = timestamp + request.method + request.path_url + (request.body.decode("UTF-8") or '')
signature = hmac.new(self.secret_key.encode("UTF-8"), canonical_request.encode("UTF-8"), 'sha256').hexdigest()
request.headers.update({
'X-CRX-TIMESTAMP': timestamp,
'X-CRX-ACCESS-KEY': self.access_key,
'X-CRX-SIGNATURE': signature,
})
return request
ACCESS_KEY = ""
SECRET_KEY = ""
auth = CapitalRxApiAuth(ACCESS_KEY, SECRET_KEY)
api_url = "https://adjudication-sts.staging-cap-rx.com/claim/list" # or any other endpoint you want to hit.
payload = {}
r = requests.post(
url=api_url,
auth=auth,
json=payload,
headers={
"Content-Type": "application/json",
"User-Agent": "apiexample/1.0",
},
)
print(r.content)
List Drug (search):
import requests
import json
r = requests.post(
url="https://advantage-api.cap-rx.com/drug/list",
json={
"search": "ibuprofen",
"page_number": 2,
},
headers={
"Content-Type": "application/json",
"User-Agent": "apiexample/1.0",
},
)
print(json.dumps(r.json(), indent=2))
Requests are only valid within 5 minutes of the timestamp in the X-CRX-TIMESTAMP header. If more than 5 minutes has elapsed since the request was signed, it will be rejected as expired.
The User-Agent header is required. If not present in the request, it can appear as a failure to authenticate, despite a valid signature being included.
Create an Accumulation Configuration.
| rn | string or null |
| parser_name required | string |
| description | string or null |
| config | any or null |
| bucket_pattern required | string Regex pattern for matching on the bucket. Example: '^example-bucket$ |
| key_pattern required | string Regex pattern for matching on the key. Example: '^ |
| plan_ids required | Array of integers or null <int32> |
| status_report_output_dir | string or null Directory to upload output status report of load. Example: 'vendor/output/' |
| client_ids | Array of strings or null |
| status | string Enum: "active" "inactive" |
| event_handler_type required | string Enum: "lambda" "batch" |
| event_handler_is_enabled required | boolean |
| event_handler_effective_date required | string or null <ArrowDateTime> |
| event_handler_termination_date required | string or null <ArrowDateTime> |
{- "rn": "string",
- "parser_name": "string",
- "description": "string",
- "config": null,
- "bucket_pattern": "string",
- "key_pattern": "string",
- "plan_ids": [
- 0
], - "status_report_output_dir": "string",
- "client_ids": [
- "string"
], - "status": "active",
- "event_handler_type": "lambda",
- "event_handler_is_enabled": true,
- "event_handler_effective_date": "string",
- "event_handler_termination_date": "string"
}{- "rn": "string",
- "parser_mapping_id": 0,
- "parser_name": "string",
- "description": "string",
- "config": null,
- "bucket_pattern": "string",
- "key_pattern": "string",
- "plan_ids": [
- 0
], - "status_report_output_dir": "string",
- "client_ids": [
- "string"
], - "status": "active",
- "event_handler_type": "lambda",
- "event_handler_is_enabled": true,
- "event_handler_effective_date": "string",
- "event_handler_termination_date": "string"
}Get an Accumulation Configuration.
| parser_mapping_id | integer <int32> |
{- "parser_mapping_id": 0
}{- "rn": "string",
- "parser_mapping_id": 0,
- "parser_name": "string",
- "description": "string",
- "config": null,
- "bucket_pattern": "string",
- "key_pattern": "string",
- "plan_ids": [
- 0
], - "status_report_output_dir": "string",
- "client_ids": [
- "string"
], - "status": "active",
- "event_handler_type": "lambda",
- "event_handler_is_enabled": true,
- "event_handler_effective_date": "string",
- "event_handler_termination_date": "string"
}List Accumulation Configurations.
| page_number | integer or null <int32> The page of results you would like to get. For the first page, pass |
| results_per_page | integer or null <int32> The number of results per page. |
| expected_fields | Array of strings or null or null The desired list of fields to be returned. |
| parser_mapping_id | integer or null <int32> |
| parser_name | string or null |
| bucket_pattern | string or null |
| key_pattern | string or null |
| plan_ids | Array of integers or null <int32> |
| client_ids | Array of strings or null |
| status | string Enum: "active" "inactive" |
| description | string or null |
| event_handler_type | string or null |
| event_handler_is_enabled | boolean or null |
| event_handler_effective_date | string or null <ArrowDateTime> |
| event_handler_termination_date | string or null <ArrowDateTime> |
Array of objects or null (OrderBySchema_1764643208.3418279) |
{- "page_number": 0,
- "results_per_page": 0,
- "expected_fields": [
- "string"
], - "parser_mapping_id": 0,
- "parser_name": "string",
- "bucket_pattern": "string",
- "key_pattern": "string",
- "plan_ids": [
- 0
], - "client_ids": [
- "string"
], - "status": "active",
- "description": "string",
- "event_handler_type": "string",
- "event_handler_is_enabled": true,
- "event_handler_effective_date": "string",
- "event_handler_termination_date": "string",
- "order_by": [
- {
- "parser_mapping_id": "string",
- "parser_name": "string",
- "bucket_pattern": "string",
- "key_pattern": "string",
- "plan_ids": "string",
- "client_ids": "string",
- "description": "string",
- "event_handler_type": "string",
- "event_handler_is_enabled": "string",
- "event_handler_effective_date": "string",
- "event_handler_termination_date": "string",
- "status_report_output_dir": "string",
- "status": "string"
}
]
}{- "results": [
- {
- "accumulation_configuration": {
- "rn": "string",
- "parser_mapping_id": 0,
- "parser_name": "string",
- "description": "string",
- "config": null,
- "bucket_pattern": "string",
- "key_pattern": "string",
- "plan_ids": [
- 0
], - "status_report_output_dir": "string",
- "client_ids": [
- "string"
], - "status": "active",
- "event_handler_type": "lambda",
- "event_handler_is_enabled": true,
- "event_handler_effective_date": "string",
- "event_handler_termination_date": "string"
}
}
], - "result_count": "string"
}Manually initiates the load of an accumulations file.
| parser_mapping_id | integer or null <int32> The id of the accumulation configuration used as a base for the load, which may be overridden by other fields |
| inbound_bucket required | string S3 bucket of the accumulations file to be loaded |
| inbound_key required | string S3 key of the accumulations file to be loaded |
| commit_data required | boolean Whether the results of the file load will be committed to the database. When false, reports are generated without commiting changes. |
| override_report_status_folder | string When present, overrides the status_report_output_dir of the base accumulation configuration for this load. |
| override_parser_mapping | string When present, overrides the parser of the base accumulation configuration for this load. |
| override_parser_config | any or null When present, overrides the config object passed to the parser when processing this load. |
| override_plans_mapping | Array of integers <int32> [ items <int32 > ] When present, overrides the file_plan_mapping_id of the base accumulation configuration for this load. |
| override_event_handler_type | string Enum: "batch" "lambda" When present, overrides the event_handler_type of the base accumulation configuration for this load. |
| manual_note | string or null A user-provided note describing details of the load. |
{- "parser_mapping_id": 0,
- "inbound_bucket": "string",
- "inbound_key": "string",
- "commit_data": true,
- "override_report_status_folder": "string",
- "override_parser_mapping": "string",
- "override_parser_config": null,
- "override_plans_mapping": [
- 0
], - "override_event_handler_type": "batch",
- "manual_note": "string"
}{- "message": "string"
}Update an Accumulation Configuration.
| rn | string or null |
| parser_mapping_id | integer <int32> |
| parser_name | string |
| description | string or null |
| config | any or null |
| bucket_pattern | string Regex pattern for matching on the bucket. Example: '^example-bucket$ |
| key_pattern | string Regex pattern for matching on the key. Example: '^ |
| plan_ids | Array of integers or null <int32> |
| status_report_output_dir | string or null Directory to upload output status report of load. Example: 'vendor/output/' |
| client_ids | Array of strings or null |
| status | string Enum: "active" "inactive" |
| event_handler_type | string Enum: "lambda" "batch" |
| event_handler_is_enabled | boolean |
| event_handler_effective_date | string or null <ArrowDateTime> |
| event_handler_termination_date | string or null <ArrowDateTime> |
{- "rn": "string",
- "parser_mapping_id": 0,
- "parser_name": "string",
- "description": "string",
- "config": null,
- "bucket_pattern": "string",
- "key_pattern": "string",
- "plan_ids": [
- 0
], - "status_report_output_dir": "string",
- "client_ids": [
- "string"
], - "status": "active",
- "event_handler_type": "lambda",
- "event_handler_is_enabled": true,
- "event_handler_effective_date": "string",
- "event_handler_termination_date": "string"
}{- "rn": "string",
- "parser_mapping_id": 0,
- "parser_name": "string",
- "description": "string",
- "config": null,
- "bucket_pattern": "string",
- "key_pattern": "string",
- "plan_ids": [
- 0
], - "status_report_output_dir": "string",
- "client_ids": [
- "string"
], - "status": "active",
- "event_handler_type": "lambda",
- "event_handler_is_enabled": true,
- "event_handler_effective_date": "string",
- "event_handler_termination_date": "string"
}| filename required | string |
{- "filename": "string"
}{- "bucket": "string",
- "key": "string",
- "post": {
- "url": "string",
- "fields": null
}
}Get an Accumulation Transaction Datum.
| id required | integer or null <int32> |
{- "id": 0
}{- "result_count": "string",
- "results": [
- {
- "accumulation_transaction_data": {
- "id": 0,
- "created_at": "string",
- "status": "string",
- "status_detail": "string",
- "transaction_id": "string",
- "data": "string",
- "source_bucket": "string",
- "source_key": "string",
- "processor": "string",
- "processed_at": [
- "string"
], - "processed_at_count": 0,
- "processed_at_max": "string",
- "override_client_id": "string",
- "override_external_member_id": "string",
- "override_person_code": "string",
- "override_external_account_id": "string",
- "override_external_group_id": "string",
- "edited_by": "string",
- "edited_at": "string",
- "rn": "string",
- "accumulation_transaction_record_id": 0,
- "accumulation_transaction_created_at": "string",
- "client_id": "string",
- "external_member_id": "string",
- "person_code": "string",
- "date_of_service": "string",
- "accumulation_type": "string",
- "last_processed_at": "string",
- "accumulated_amount": 0
}
}
]
}List Accumulation Transaction Data.
| page_number | integer or null <int32> The page of results you would like to get. For the first page, pass |
| results_per_page | integer or null <int32> The number of results per page. |
| expected_fields | Array of strings or null or null The desired list of fields to be returned. |
| id | integer <int32> |
| created_at | string <ArrowDateTime> |
| status | string |
| status_detail | string |
| transaction_id | string |
| data | string |
| source_bucket | string |
| source_key | string |
| processor | string |
| processed_at | string <ArrowDateTime> |
| override_client_id | string |
| override_external_member_id | string |
| override_person_code | string |
| override_external_account_id | string |
| override_external_group_id | string |
| edited_by | string |
| edited_at | string <ArrowDateTime> |
| accumulation_transaction_record_id | integer <int32> |
| accumulation_transaction_created_at | string <ArrowDateTime> |
| client_id | string |
| external_member_id | string |
| person_code | string |
| accumulation_type | string |
| accumulation_amount | string |
| date_of_service | string <ArrowDateTime> |
Array of objects or null (OrderBySchema_1764643208.3495839) |
{- "page_number": 0,
- "results_per_page": 0,
- "expected_fields": [
- "string"
], - "id": 0,
- "created_at": "string",
- "status": "string",
- "status_detail": "string",
- "transaction_id": "string",
- "data": "string",
- "source_bucket": "string",
- "source_key": "string",
- "processor": "string",
- "processed_at": "string",
- "override_client_id": "string",
- "override_external_member_id": "string",
- "override_person_code": "string",
- "override_external_account_id": "string",
- "override_external_group_id": "string",
- "edited_by": "string",
- "edited_at": "string",
- "accumulation_transaction_record_id": 0,
- "accumulation_transaction_created_at": "string",
- "client_id": "string",
- "external_member_id": "string",
- "person_code": "string",
- "accumulation_type": "string",
- "accumulation_amount": "string",
- "date_of_service": "string",
- "order_by": [
- {
- "id": "string",
- "client_id": "string",
- "external_member_id": "string",
- "person_code": "string",
- "processor": "string",
- "accumulation_type": "string",
- "accumulated_amount": "string",
- "created_at": "string",
- "status": "string",
- "status_detail": "string",
- "transaction_id": "string",
- "source_bucket": "string",
- "source_key": "string",
- "processed_at": "string",
- "override_client_id": "string",
- "override_external_member_id": "string",
- "override_person_code": "string",
- "override_external_account_id": "string",
- "override_external_group_id": "string",
- "edited_by": "string",
- "edited_at": "string",
- "date_of_service": "string"
}
]
}{- "result_count": "string",
- "results": [
- {
- "accumulation_transaction_data": {
- "id": 0,
- "created_at": "string",
- "status": "string",
- "status_detail": "string",
- "transaction_id": "string",
- "data": "string",
- "source_bucket": "string",
- "source_key": "string",
- "processor": "string",
- "processed_at": [
- "string"
], - "processed_at_count": 0,
- "processed_at_max": "string",
- "override_client_id": "string",
- "override_external_member_id": "string",
- "override_person_code": "string",
- "override_external_account_id": "string",
- "override_external_group_id": "string",
- "edited_by": "string",
- "edited_at": "string",
- "rn": "string",
- "accumulation_transaction_record_id": 0,
- "accumulation_transaction_created_at": "string",
- "client_id": "string",
- "external_member_id": "string",
- "person_code": "string",
- "date_of_service": "string",
- "accumulation_type": "string",
- "last_processed_at": "string",
- "accumulated_amount": "string"
}
}
]
}required | Array of objects or null (ProcessorSchema_1764643208.352214) |
{- "processors": [
- {
- "processor": "string",
- "data_ids": [
- 0
], - "bucket": "string",
- "source_key": "string"
}
]
}{- "message": "string"
}Update an Accumulation Transaction Datum.
| id required | integer or null <int32> |
| created_at | string or null <ArrowDateTime> |
| status | string or null |
| status_detail | string or null |
| transaction_id | string or null |
| data | string or null |
| source_bucket | string or null |
| source_key | string or null |
| processor | string or null |
| processed_at | Array of strings or null |
| processed_at_count | integer or null <int32> |
| processed_at_max | string or null |
| override_client_id | string or null |
| override_external_member_id | string or null |
| override_person_code | string or null |
| override_external_account_id | string or null |
| override_external_group_id | string or null |
| edited_by | string or null |
| edited_at | string or null <ArrowDateTime> |
| rn | string or null |
| accumulation_transaction_record_id | integer or null <int32> |
| accumulation_transaction_created_at | string or null <ArrowDateTime> |
| client_id | string or null |
| external_member_id | string or null |
| person_code | string or null |
| date_of_service | string or null <ArrowDateTime> |
| accumulation_type | string or null |
| last_processed_at | string or null <ArrowDateTime> |
| accumulated_amount | number or null |
{- "id": 0,
- "created_at": "string",
- "status": "string",
- "status_detail": "string",
- "transaction_id": "string",
- "data": "string",
- "source_bucket": "string",
- "source_key": "string",
- "processor": "string",
- "processed_at": [
- "string"
], - "processed_at_count": 0,
- "processed_at_max": "string",
- "override_client_id": "string",
- "override_external_member_id": "string",
- "override_person_code": "string",
- "override_external_account_id": "string",
- "override_external_group_id": "string",
- "edited_by": "string",
- "edited_at": "string",
- "rn": "string",
- "accumulation_transaction_record_id": 0,
- "accumulation_transaction_created_at": "string",
- "client_id": "string",
- "external_member_id": "string",
- "person_code": "string",
- "date_of_service": "string",
- "accumulation_type": "string",
- "last_processed_at": "string",
- "accumulated_amount": 0
}{- "id": 0,
- "created_at": "string",
- "status": "string",
- "status_detail": "string",
- "transaction_id": "string",
- "data": "string",
- "source_bucket": "string",
- "source_key": "string",
- "processor": "string",
- "processed_at": [
- "string"
], - "processed_at_count": 0,
- "processed_at_max": "string",
- "override_client_id": "string",
- "override_external_member_id": "string",
- "override_person_code": "string",
- "override_external_account_id": "string",
- "override_external_group_id": "string",
- "edited_by": "string",
- "edited_at": "string",
- "rn": "string",
- "accumulation_transaction_record_id": 0,
- "accumulation_transaction_created_at": "string",
- "client_id": "string",
- "external_member_id": "string",
- "person_code": "string",
- "date_of_service": "string",
- "accumulation_type": "string",
- "last_processed_at": "string",
- "accumulated_amount": 0
}Create an Accumulation Transaction Record.
| transmission_id | integer or null <int32> |
| client_id | string or null |
| external_member_id required | string |
| person_code required | string |
| date_of_service | string <ArrowDateTime> |
| accumulation_types required | Array of strings |
| accumulated_amount required | number or null |
{- "transmission_id": 0,
- "client_id": "string",
- "external_member_id": "string",
- "person_code": "string",
- "date_of_service": "string",
- "accumulation_types": [
- "string"
], - "accumulated_amount": 0
}{- "inserted_ids": [
- 0
]
}| transmission_id | integer or null <int32> |
| client_id | string or null |
| external_member_id required | string |
| person_code required | string |
| date_of_service | string <ArrowDateTime> |
| accumulation_types required | Array of strings |
| accumulated_amount required | number or null |
| external_account_id required | string or null |
| external_group_id required | string or null |
{- "transmission_id": 0,
- "client_id": "string",
- "external_member_id": "string",
- "person_code": "string",
- "date_of_service": "string",
- "accumulation_types": [
- "string"
], - "accumulated_amount": 0,
- "external_account_id": "string",
- "external_group_id": "string"
}{- "inserted_ids": [
- 0
]
}List Accumulation Transaction Records.
| page_number | integer or null <int32> The page of results you would like to get. For the first page, pass |
| results_per_page | integer or null <int32> The number of results per page. |
| expected_fields | Array of strings or null or null The desired list of fields to be returned. |
| id | integer <int32> |
| client_id required | string |
| external_member_id required | string |
| person_code | string |
| accumulation_transaction_data_id | integer or null <int32> |
| external_group_id | string or null |
| external_account_id | string or null |
| accumulation_type | string or null |
| created_at | string <ArrowDateTime> |
| maximum_created_at | string <ArrowDateTime> |
| minimum_created_at | string <ArrowDateTime> |
| date_of_service | string <ArrowDateTime> |
Array of objects or null (OrderBySchema_1764643208.3577526) |
{- "page_number": 0,
- "results_per_page": 0,
- "expected_fields": [
- "string"
], - "id": 0,
- "client_id": "string",
- "external_member_id": "string",
- "person_code": "string",
- "accumulation_transaction_data_id": 0,
- "external_group_id": "string",
- "external_account_id": "string",
- "accumulation_type": "string",
- "created_at": "string",
- "maximum_created_at": "string",
- "minimum_created_at": "string",
- "date_of_service": "string",
- "order_by": [
- {
- "created_at": "string",
- "date_of_service": "string",
- "accumulation_type": "string",
- "accumulated_amount": "string",
- "external_group_id": "string",
- "external_account_id": "string",
- "claim_id": "string",
- "is_adjustment": "string"
}
]
}{- "result_count": "string",
- "results": [
- {
- "accumulation_transaction_record": {
- "id": 0,
- "client_id": "string",
- "external_member_id": "string",
- "person_code": "string",
- "created_at": "string",
- "date_of_service": "string",
- "accumulation_type": "string",
- "accumulated_amount": 0,
- "rn": "string",
- "external_group_id": "string",
- "external_account_id": "string",
- "is_adjustment": true,
- "adjustment_reason": "string",
- "claim_id": 0
}
}
]
}| page_number | integer or null <int32> The page of results you would like to get. For the first page, pass |
| results_per_page | integer or null <int32> The number of results per page. |
| expected_fields | Array of strings or null or null The desired list of fields to be returned. |
| id | integer <int32> |
| client_id required | string |
| external_member_id required | string |
| person_code | string |
| accumulation_transaction_data_id | integer or null <int32> |
| external_group_id required | string or null |
| external_account_id required | string or null |
| accumulation_type | string or null |
| created_at | string <ArrowDateTime> |
| maximum_created_at | string <ArrowDateTime> |
| minimum_created_at | string <ArrowDateTime> |
| date_of_service | string <ArrowDateTime> |
Array of objects or null (OrderBySchema_1764643208.3577526) |
{- "page_number": 0,
- "results_per_page": 0,
- "expected_fields": [
- "string"
], - "id": 0,
- "client_id": "string",
- "external_member_id": "string",
- "person_code": "string",
- "accumulation_transaction_data_id": 0,
- "external_group_id": "string",
- "external_account_id": "string",
- "accumulation_type": "string",
- "created_at": "string",
- "maximum_created_at": "string",
- "minimum_created_at": "string",
- "date_of_service": "string",
- "order_by": [
- {
- "created_at": "string",
- "date_of_service": "string",
- "accumulation_type": "string",
- "accumulated_amount": "string",
- "external_group_id": "string",
- "external_account_id": "string",
- "claim_id": "string",
- "is_adjustment": "string"
}
]
}{- "result_count": "string",
- "results": [
- {
- "accumulation_transaction_record": {
- "id": 0,
- "client_id": "string",
- "external_member_id": "string",
- "person_code": "string",
- "created_at": "string",
- "date_of_service": "string",
- "accumulation_type": "string",
- "accumulated_amount": 0,
- "rn": "string",
- "external_group_id": "string",
- "external_account_id": "string",
- "is_adjustment": true,
- "adjustment_reason": "string",
- "claim_id": 0
}
}
]
}Get an Accumulation Parser Module.
| id | integer or null <int32> |
| name | string or null |
{- "id": 0,
- "name": "string"
}{- "id": 0,
- "name": "string",
- "description": "string",
- "created_at": "string",
- "rn": "string",
- "supported_fields": null,
- "supported_attributes": null,
- "supported_functions": null,
- "supported_operators": null,
- "config_template": null
}List Accumulation Parser Modules.
| page_number | integer or null <int32> The page of results you would like to get. For the first page, pass |
| results_per_page | integer or null <int32> The number of results per page. |
| expected_fields | Array of strings or null or null The desired list of fields to be returned. |
| id | integer or null <int32> |
| name | string or null |
| description | string or null |
Array of objects or null (OrderBySchema_1764643208.3642857) |
{- "page_number": 0,
- "results_per_page": 0,
- "expected_fields": [
- "string"
], - "id": 0,
- "name": "string",
- "description": "string",
- "order_by": [
- {
- "id": 0,
- "name": "string",
- "description": "string"
}
]
}{- "results": [
- {
- "accumulation_parser_module": {
- "id": 0,
- "name": "string",
- "description": "string",
- "created_at": "string",
- "rn": "string",
- "supported_fields": null,
- "supported_attributes": null,
- "supported_functions": null,
- "supported_operators": null,
- "config_template": null
}
}
], - "result_count": "string"
}Get an Accumulation Reconciliation Execution.
| id | integer or null <int32> |
{- "id": 0
}{- "id": 0,
- "client_ids": [
- "string"
], - "status": "string",
- "created_at": "string",
- "start_time": "string",
- "end_time": "string",
- "run_time": 0,
- "balance_files": null,
- "oob_report_files": null,
- "status_files": null,
- "status_data": null,
- "error_message": "string"
}List Accumulation Reconciliation Executions.
| page_number | integer or null <int32> The page of results you would like to get. For the first page, pass |
| results_per_page | integer or null <int32> The number of results per page. |
| expected_fields | Array of strings or null or null The desired list of fields to be returned. |
| status | string or null |
| client_ids | Array of strings or null The client IDs used for the accumulations reconciliation |
Array of objects or null (OrderBySchema_1764643208.3675807) |
{- "page_number": 0,
- "results_per_page": 0,
- "expected_fields": [
- "string"
], - "status": "string",
- "client_ids": [
- "string"
], - "order_by": [
- {
- "id": "string",
- "status": "string",
- "created_at": "string",
- "start_time": "string",
- "run_time": 0
}
]
}{- "results": [
- {
- "execution": {
- "id": 0,
- "client_ids": [
- "string"
], - "status": "string",
- "created_at": "string",
- "start_time": "string",
- "end_time": "string",
- "run_time": 0,
- "balance_files": null,
- "oob_report_files": null,
- "status_files": null,
- "status_data": null,
- "error_message": "string"
}
}
], - "result_count": "string"
}| accumulation_reconciliation_execution_id required | integer <int32> |
| bucket required | string |
| key required | string |
{- "accumulation_reconciliation_execution_id": 0,
- "bucket": "string",
- "key": "string"
}{- "url": "string"
}| file_name required | string |
{- "file_name": "string"
}{- "file_name": "string",
- "bucket": "string",
- "key": "string",
- "post": {
- "url": "string",
- "fields": null
}
}| bucket required | string |
| key required | string |
| file_name required | string |
{- "bucket": "string",
- "key": "string",
- "file_name": "string"
}{- "message": "string"
}| address_line_1 | string |
| birth_date | string |
| city | string |
string | |
| external_member_id | string |
| first_name | string |
| last_name | string |
| phone_number | string |
| state | string |
| zip_code | string |
{- "address_line_1": "string",
- "birth_date": "string",
- "city": "string",
- "email": "string",
- "external_member_id": "string",
- "first_name": "string",
- "last_name": "string",
- "phone_number": "string",
- "state": "string",
- "zip_code": "string"
}{- "result_count": "string",
- "protected_address_result_count": "string",
- "matched_member": {
- "id": 0,
- "rn": "string",
- "external_member_id": "string",
- "client_id": "string",
- "person_code": "string",
- "group_id": 0,
- "test_member": false,
- "created_at": "string",
- "updated_at": "string",
- "start_date": "string",
- "end_date": "string",
- "relationship_code": "string",
- "sex": "string",
- "effective_date": "string",
- "termination_date": "string",
- "first_name": "string",
- "last_name": "string",
- "address_line_1": "string",
- "address_line_2": "string",
- "address_line_3": "string",
- "city": "string",
- "state": "string",
- "zip_code": "string",
- "country": "string",
- "location": "string",
- "birth_date": "string",
- "death_date": "string",
- "multiple_birth_code": 0,
- "phone_number": "string",
- "social_security_number": "string",
- "ppo_name": "string",
- "coverage_type": "string",
- "language_code": "string",
- "email": "string",
- "coverage_status": "string",
- "handicap_indicator": "string",
- "miscellaneous_id": "string",
- "alternate_member_id": "string",
- "is_allocated": true,
- "identity": "string",
- "medicare_indicator": "string",
- "medicare_beneficiary_identifier": "string",
- "low_income_subsidy_level": "string",
- "low_income_subsidy_level_effective_date": "string",
- "low_income_subsidy_level_termination_date": "string",
- "hospice_flag": "string",
- "hospice_flag_effective_date": "string",
- "hospice_flag_termination_date": "string",
- "end_stage_renal_disease_flag": "string",
- "end_stage_renal_disease_flag_effective_date": "string",
- "end_stage_renal_disease_flag_termination_date": "string",
- "transplant_patient_flag": "string",
- "transplant_patient_flag_effective_date": "string",
- "transplant_patient_flag_termination_date": "string",
- "cancer_flag": "string",
- "cancer_flag_effective_date": "string",
- "cancer_flag_termination_date": "string",
- "beneficiary_identifier": "string",
- "action_type": "string",
- "other_payer_member_identification_number": "string",
- "other_payer_group_number": "string",
- "other_payer_bin_number": "string",
- "other_payer_processor_control_number": "string",
- "other_payer_effective_date": "string",
- "other_payer_termination_date": "string",
- "new_enrollee_effective_date": "string",
- "udf_1": "string",
- "udf_1_name": "string",
- "udf_2": "string",
- "udf_2_name": "string",
- "udf_3": "string",
- "udf_3_name": "string",
- "udf_4": "string",
- "udf_4_name": "string",
- "udf_5": "string",
- "udf_5_name": "string",
- "udf_6": "string",
- "udf_6_name": "string",
- "udf_7": "string",
- "udf_7_name": "string",
- "udf_8": "string",
- "udf_8_name": "string",
- "udf_9": "string",
- "udf_9_name": "string",
- "udf_10": "string",
- "udf_10_name": "string",
- "udf_11": "string",
- "udf_11_name": "string",
- "udf_12": "string",
- "udf_12_name": "string",
- "udf_13": "string",
- "udf_13_name": "string",
- "udf_14": "string",
- "udf_14_name": "string",
- "udf_15": "string",
- "udf_15_name": "string",
- "file_lock_start_date": "string",
- "file_lock_end_date": "string",
- "legal_representative_first_name": "string",
- "legal_representative_last_name": "string",
- "legal_representative_address_line_1": "string",
- "legal_representative_address_line_2": "string",
- "legal_representative_city": "string",
- "legal_representative_state": "string",
- "legal_representative_zip_code": "string",
- "legal_representative_country": "string",
- "large_print": true,
- "spans": [
- { }
], - "protected_member_address": "string",
- "phone_number_qualifier": "string",
- "written_language": "string",
- "verbal_language": "string",
- "alternate_written_communication_mode": "string",
- "disenrollment_reason": "string",
- "line_of_business": "string",
- "program": "string",
- "service_area_state": "string",
- "service_area_county": "string",
- "marketplace_metal_level": "string",
- "hios_id_naic": "string",
- "medicaid_id": "string",
- "encounter_member_id": "string",
- "encounter_member_id_qualifier": "string",
- "medicaid_dual_status_code": "string",
- "medicaid_dual_status_code_effective_date": "string",
- "medicaid_dual_status_code_termination_date": "string",
- "is_medical_member": true,
- "medical_group_id": "string"
}
}List all AI endpoints for this service.
:return: List of AI endpoints, their descriptions and schemas.
{ }{- "endpoints": [
- {
- "endpoint": "string",
- "description": "string",
- "methods": [
- "string"
], - "input_schema": { },
- "output_schema": {
- "property1": { },
- "property2": { }
}
}
]
}Get the SQLAlchemy code for the given model names in the given database. If the model name starts with "fdw.", it will be considered as a foreign data wrapper model.
:return: The SQLAlchemy code for the given models
| model_names required | Array of strings List of SQLAlchemy models. |
{- "model_names": [
- "string"
]
}{- "model_codes": [
- "string"
]
}List the SQLAlchemy models for the given database.
:return: List of model names, their descriptions and sample data. Some columns in sample data might be omitted for brevity.
{ }{- "models": {
- "property1": { },
- "property2": { }
}
}Query the database with the given SQLAlchemy 2.0 query.
:param: query: The SQLAlchemy 2.0 query :return: The query results
| query required | string SQLAlchemy 2.0 query in |
{- "query": "string"
}{- "results": [
- { }
]
}Create a Claim Adjustment.
| type required | string Enum: "encounter" "pde" |
| claim_id required | integer <int32> |
| adjustments required | any |
{- "type": "encounter",
- "claim_id": 0,
- "adjustments": null
}{- "id": 0,
- "type": "encounter",
- "claim_id": 0,
- "adjustments": null
}| type required | string Enum: "encounter" "pde" |
| ids required | Array of numbers Claim adjustmet IDs |
{- "type": "encounter",
- "ids": [
- 0
]
}{- "message": "string"
}Get a Claim Adjustment.
| id required | integer <int32> |
| type required | string Enum: "encounter" "pde" |
{- "id": 0,
- "type": "encounter"
}{- "id": 0,
- "type": "encounter",
- "claim_id": 0,
- "adjustments": null
}List Claim Adjustments.
| page_number | integer or null <int32> The page of results you would like to get. For the first page, pass |
| results_per_page | integer or null <int32> The number of results per page. |
| expected_fields | Array of strings or null or null The desired list of fields to be returned. |
| id | integer <int32> |
| type | string Enum: "encounter" "pde" |
| claim_id | integer <int32> |
| adjustments | string |
Array of objects or null (ClaimAdjustmentsOrderBySchema_1764643208.378516) |
{- "page_number": 0,
- "results_per_page": 0,
- "expected_fields": [
- "string"
], - "id": 0,
- "type": "encounter",
- "claim_id": 0,
- "adjustments": "string",
- "order_by": [
- {
- "id": "string",
- "type": "encounter",
- "claim_id": "string",
- "adjustments": "string"
}
]
}{- "results": [
- {
- "claim_adjustment": {
- "id": 0,
- "type": "encounter",
- "claim_id": 0,
- "adjustments": null
}
}
], - "result_count": "string"
}Update a Claim Adjustment.
| id required | integer <int32> |
| type required | string Enum: "encounter" "pde" |
| claim_id | integer <int32> |
| adjustments required | any |
{- "id": 0,
- "type": "encounter",
- "claim_id": 0,
- "adjustments": null
}{- "id": 0,
- "type": "encounter",
- "claim_id": 0,
- "adjustments": null
}| original_name required | string |
{- "original_name": "string"
}{- "bucket": "string",
- "key": "string",
- "post": {
- "url": "string",
- "fields": null
}
}| claim_id_1 required | integer <int32> |
| claim_id_2 required | integer <int32> |
{- "claim_id_1": 0,
- "claim_id_2": 0
}{- "compare_result": [
- {
- "key": "id",
- "values_by_claim_id": {
- "property1": null,
- "property2": null
}
}
]
}Get a Claim.
| id required | integer <int32> |
| client_id | string or null |
| external_account_id | string or null |
| external_group_id | string or null |
| external_member_id | string or null |
| person_code | string or null |
| include_raw_request_parsed | boolean or null |
| include_raw_response_parsed | boolean or null |
{- "id": 0,
- "client_id": "string",
- "external_account_id": "string",
- "external_group_id": "string",
- "external_member_id": "string",
- "person_code": "string",
- "include_raw_request_parsed": true,
- "include_raw_response_parsed": true
}{- "id": 0,
- "rn": "string",
- "reversal_id": 0,
- "reverses_id": 0,
- "original_claim_id": 0,
- "client_id": "string",
- "external_account_id": "string",
- "external_group_id": "string",
- "provider_agreement_id": 0,
- "coverage_strategy_id": "string",
- "date_of_service": "string",
- "claim_submission_date": "string",
- "claim_payment_cycle_end_date": "string",
- "claim_reimbursement_cycle_end_date": "string",
- "claim_status": "string",
- "claim_count": 0,
- "received_at": "string",
- "source": "string",
- "external_member_id": "string",
- "person_code": "string",
- "first_name": "string",
- "last_name": "string",
- "coverage_strategy_type": "string",
- "plan_benefit_id": 0,
- "formulary_id": 0,
- "network_id": 0,
- "benefit_network": "string",
- "gpi": "string",
- "pharmacy_nabp": "string",
- "pharmacy_name": "string",
- "pharmacy_channel": "string",
- "version_release_number": "string",
- "request_transaction_code": "string",
- "bin_number": "string",
- "processor_control_number": "string",
- "transaction_count": "string",
- "service_provider_id_qualifier": "string",
- "service_provider_id": "string",
- "software_vendor_certification_id": "string",
- "submitted_cardholder_id": "string",
- "cardholder_first_name": "string",
- "cardholder_last_name": "string",
- "plan_id": "string",
- "eligibility_clarification_code": "string",
- "group_id": "string",
- "submitted_person_code": "string",
- "patient_relationship_code": "string",
- "medigap_id": "string",
- "medicaid_indicator": "string",
- "provider_accept_assignment_indicator": "string",
- "cms_part_d_defined_qualified_facility": "string",
- "medicaid_id_number": "string",
- "patient_id_qualifier": "string",
- "patient_id": "string",
- "date_of_birth": "string",
- "patient_gender_code": "string",
- "patient_first_name": "string",
- "patient_last_name": "string",
- "patient_street_address": "string",
- "patient_street_address_line_1": "string",
- "patient_street_address_line_2": "string",
- "patient_city_address": "string",
- "patient_state_province_address": "string",
- "patient_zip_postal_code": "string",
- "patient_country_code": "string",
- "patient_telephone_number": "string",
- "place_of_service": "string",
- "employer_id": "string",
- "pregnancy_indicator": "string",
- "patient_email_address": "user@example.com",
- "patient_residence": "string",
- "prescription_service_reference_number_qualifier": "string",
- "prescription_service_reference_number": "string",
- "product_service_id_qualifier": "string",
- "ndc": "string",
- "associated_prescription_service_reference_number": "string",
- "associated_prescription_service_date": "string",
- "procedure_modifier_code_1": "string",
- "procedure_modifier_code_2": "string",
- "procedure_modifier_code_3": "string",
- "procedure_modifier_code_4": "string",
- "procedure_modifier_code_5": "string",
- "procedure_modifier_code_6": "string",
- "procedure_modifier_code_7": "string",
- "procedure_modifier_code_8": "string",
- "procedure_modifier_code_9": "string",
- "procedure_modifier_code_10": "string",
- "quantity_dispensed": "string",
- "fill_number": 0,
- "days_supply": 0,
- "compound_code": "string",
- "daw": "string",
- "date_prescription_written": "string",
- "number_of_refills_authorized": 0,
- "prescription_origin_code": "string",
- "submission_clarification_code_1": "string",
- "submission_clarification_code_2": "string",
- "submission_clarification_code_3": "string",
- "submission_clarification_code_4": "string",
- "submission_clarification_code_5": "string",
- "submission_clarification_code_pde": "string",
- "submission_type_code_1": "string",
- "submission_type_code_2": "string",
- "submission_type_code_3": "string",
- "submission_type_code_4": "string",
- "submission_type_code_5": "string",
- "quantity_prescribed": "string",
- "multiple_prescription_service_order_group_id": "string",
- "multiple_prescription_service_order_group_reason_code": "string",
- "total_prescribed_quantity_remaining": "string",
- "other_coverage_code": "string",
- "special_packaging_indicator": "string",
- "originally_prescribed_product_service_id_qualifier": "string",
- "originally_prescribed_product_service_code": "string",
- "originally_prescribed_quantity": "string",
- "scheduled_prescription_id_number": "string",
- "unit_of_measure": "string",
- "level_of_service": "string",
- "prior_authorization_type_code": "string",
- "prior_authorization_id_submitted": "string",
- "dispensing_status": "string",
- "quantity_intended_to_be_dispensed": "string",
- "days_supply_intended_to_be_dispensed": 0,
- "delay_reason_code": "string",
- "patient_assignment_indicator": "string",
- "route_of_administration": "string",
- "compound_type": "string",
- "preparation_environment_type": "string",
- "preparation_environment_event_code": "string",
- "pharmacy_service_type": "string",
- "associated_prescription_service_reference_number_qualifier": "string",
- "associated_prescription_service_fill_number": 0,
- "original_manufacturer_product_id_qualifier": "string",
- "original_manufacturer_product_id": "string",
- "ltpac_dispense_frequency": "string",
- "ltpac_billing_methodology": "string",
- "number_of_ltpac_dispensing_events": 0,
- "do_not_dispense_before_date": "string",
- "ingredient_cost_submitted": "string",
- "dispensing_fee_submitted": "string",
- "patient_pay_amount_reported": "string",
- "incentive_amount_submitted": "string",
- "other_amount_claimed_submitted_qualifier_1": "string",
- "other_amount_claimed_submitted_1": "string",
- "other_amount_claimed_submitted_qualifier_2": "string",
- "other_amount_claimed_submitted_2": "string",
- "other_amount_claimed_submitted_qualifier_3": "string",
- "other_amount_claimed_submitted_3": "string",
- "regulatory_fee_type_code_submitted_1": "string",
- "regulatory_fee_amount_submitted_1": "string",
- "regulatory_fee_type_code_submitted_2": "string",
- "regulatory_fee_amount_submitted_2": "string",
- "regulatory_fee_type_code_submitted_3": "string",
- "regulatory_fee_amount_submitted_3": "string",
- "percentage_tax_amount_submitted": "string",
- "percentage_tax_rate_submitted": "string",
- "percentage_tax_basis_submitted": "string",
- "usual_and_customary_charge": "string",
- "gross_amount_due": "string",
- "basis_of_cost_determination": "string",
- "provider_id_qualifier": "string",
- "provider_id": "string",
- "provider_first_name": "string",
- "provider_last_name": "string",
- "prescriber_id_qualifier": "string",
- "prescriber_id": "string",
- "prescriber_last_name": "string",
- "prescriber_telephone_number": "string",
- "prescriber_telephone_number_extension": "string",
- "primary_care_provider_id_qualifier": "string",
- "primary_care_provider_id": "string",
- "primary_care_provider_last_name": "string",
- "prescriber_first_name": "string",
- "prescriber_street_address": "string",
- "prescriber_street_address_line_1": "string",
- "prescriber_street_address_line_2": "string",
- "prescriber_city_address": "string",
- "prescriber_state_province_address": "string",
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- "amount_applied_to_deductible_phase": "string",
- "amount_applied_to_gross_covered_drug_cost": "string",
- "amount_applied_to_initial_coverage_phase": "string",
- "amount_applied_to_true_out_of_pocket": "string",
- "accumulated_deductible_phase_amount": "string",
- "accumulated_gross_covered_drug_cost_amount": "string",
- "accumulated_true_out_of_pocket_amount": "string",
- "accumulated_part_b_deductible_amount": "string",
- "accumulated_part_b_maximum_out_of_pocket_amount": "string",
- "accumulated_part_b_deductible_out_of_network_amount": "string",
- "accumulated_part_b_out_of_pocket_out_of_network": "string",
- "amount_applied_to_part_b_deductible_out_of_network": "string",
- "amount_applied_to_part_b_out_of_pocket_out_of_network": "string",
- "amount_exceeding_periodic_category_deductible_1": 0,
- "amount_exceeding_periodic_overall_deductible": "string",
- "birth_date": "string",
- "coordination_of_benefits_other_payments_count": 0,
- "dispensing_fee_charged_level_1": "string",
- "dispensing_fee_charged_level_2": "string",
- "dispensing_fee_charged_level_3": "string",
- "ingredient_cost_charged_level_1": "string",
- "ingredient_cost_charged_level_2": "string",
- "ingredient_cost_charged_level_3": "string",
- "mac_list_dispensing_fee": "string",
- "pricing_category_mac_list_unit_price_adjustment_percentage": 0,
- "mac_list_id": 0,
- "mac_list_name": "string",
- "other_payer_amount_paid_1": "string",
- "other_payer_amount_paid_2": "string",
- "other_payer_amount_paid_3": "string",
- "other_payer_amount_paid_4": "string",
- "other_payer_amount_paid_5": "string",
- "other_payer_amount_paid_6": "string",
- "other_payer_amount_paid_7": "string",
- "other_payer_amount_paid_8": "string",
- "other_payer_amount_paid_9": "string",
- "other_payer_amount_paid_count": 0,
- "other_payer_amount_paid_qualifier_1": "string",
- "other_payer_amount_paid_qualifier_2": "string",
- "other_payer_amount_paid_qualifier_3": "string",
- "other_payer_amount_paid_qualifier_4": "string",
- "other_payer_amount_paid_qualifier_5": "string",
- "other_payer_amount_paid_qualifier_6": "string",
- "other_payer_amount_paid_qualifier_7": "string",
- "other_payer_amount_paid_qualifier_8": "string",
- "other_payer_amount_paid_qualifier_9": "string",
- "other_payer_coverage_type_1": "string",
- "other_payer_coverage_type_2": "string",
- "other_payer_coverage_type_3": "string",
- "other_payer_coverage_type_4": "string",
- "other_payer_coverage_type_5": "string",
- "other_payer_coverage_type_6": "string",
- "other_payer_coverage_type_7": "string",
- "other_payer_coverage_type_8": "string",
- "other_payer_coverage_type_9": "string",
- "other_payer_id_1": "string",
- "other_payer_id_2": "string",
- "other_payer_id_3": "string",
- "other_payer_id_4": "string",
- "other_payer_id_5": "string",
- "other_payer_id_6": "string",
- "other_payer_id_7": "string",
- "other_payer_id_8": "string",
- "other_payer_id_9": "string",
- "other_payer_id_qualifier_1": "string",
- "other_payer_id_qualifier_2": "string",
- "other_payer_id_qualifier_3": "string",
- "other_payer_id_qualifier_4": "string",
- "other_payer_id_qualifier_5": "string",
- "other_payer_id_qualifier_6": "string",
- "other_payer_id_qualifier_7": "string",
- "other_payer_id_qualifier_8": "string",
- "other_payer_id_qualifier_9": "string",
- "other_payer_patient_responsibility_amount_1": "string",
- "other_payer_patient_responsibility_amount_2": "string",
- "other_payer_patient_responsibility_amount_3": "string",
- "other_payer_patient_responsibility_amount_4": "string",
- "other_payer_patient_responsibility_amount_5": "string",
- "other_payer_patient_responsibility_amount_6": "string",
- "other_payer_patient_responsibility_amount_7": "string",
- "other_payer_patient_responsibility_amount_8": "string",
- "other_payer_patient_responsibility_amount_9": "string",
- "other_payer_patient_responsibility_amount_count": 0,
- "other_payer_patient_responsibility_amount_qualifier_1": "string",
- "other_payer_patient_responsibility_amount_qualifier_2": "string",
- "other_payer_patient_responsibility_amount_qualifier_3": "string",
- "other_payer_patient_responsibility_amount_qualifier_4": "string",
- "other_payer_patient_responsibility_amount_qualifier_5": "string",
- "other_payer_patient_responsibility_amount_qualifier_6": "string",
- "other_payer_patient_responsibility_amount_qualifier_7": "string",
- "other_payer_patient_responsibility_amount_qualifier_8": "string",
- "other_payer_patient_responsibility_amount_qualifier_9": "string",
- "other_payer_reject_code_1": "string",
- "other_payer_reject_code_2": "string",
- "other_payer_reject_code_3": "string",
- "other_payer_reject_code_4": "string",
- "other_payer_reject_code_5": "string",
- "other_payer_reject_count": 0,
- "pay_amount_level_1": "string",
- "pay_amount_level_2": "string",
- "pay_amount_level_3": "string",
- "prescriber_npi": "string",
- "professional_service_code_1": "string",
- "professional_service_code_2": "string",
- "professional_service_code_3": "string",
- "professional_service_code_4": "string",
- "professional_service_code_5": "string",
- "professional_service_code_6": "string",
- "professional_service_code_7": "string",
- "professional_service_code_8": "string",
- "professional_service_code_9": "string",
- "remaining_category_deductible_1_amount": "string",
- "remaining_overall_deductible_amount": "string",
- "request_reason_for_service_code_1": "string",
- "request_reason_for_service_code_2": "string",
- "request_reason_for_service_code_3": "string",
- "request_reason_for_service_code_4": "string",
- "request_reason_for_service_code_5": "string",
- "request_reason_for_service_code_6": "string",
- "request_reason_for_service_code_7": "string",
- "request_reason_for_service_code_8": "string",
- "request_reason_for_service_code_9": "string",
- "result_of_service_code_1": "string",
- "result_of_service_code_2": "string",
- "result_of_service_code_3": "string",
- "result_of_service_code_4": "string",
- "result_of_service_code_5": "string",
- "result_of_service_code_6": "string",
- "result_of_service_code_7": "string",
- "result_of_service_code_8": "string",
- "result_of_service_code_9": "string",
- "specialty_list_dispensing_fee": "string",
- "specialty_list_id": 0,
- "specialty_list_name": "string",
- "dmr_pay_to_city_address": "string",
- "dmr_pay_to_country_code": "string",
- "dmr_pay_to_name": "string",
- "dmr_pay_to_state_province_address": "string",
- "dmr_pay_to_street_address_line_1": "string",
- "dmr_pay_to_street_address_line_2": "string",
- "dmr_pay_to_tax_id": "string",
- "dmr_pay_to_vendor_id": "string",
- "dmr_pay_to_zip_postal_code": "string",
- "dmr_pay_to_check_eft_number": "string",
- "dmr_pay_to_date": "string",
- "tax_id_number": "string",
- "reasons_for_rejection": [
- "string"
], - "reasons_for_adjudication": [
- "string"
], - "reasons_for_adjudication_sections": null,
- "patient_pay_reduction_due_to_point_of_service_rebate": 0,
- "plan_pay_reduction_due_to_point_of_service_rebate": 0,
- "point_of_service_rebate_amount": 0,
- "low_income_subsidy_level": "string",
- "senior_savings_model_cost_share_reduction_gap": 0,
- "senior_savings_model_cost_share_reduction_non_gap": 0,
- "senior_savings_model_indicator": "string",
- "inflation_reduction_act_subsidy_amount": 0,
- "inflation_reduction_act_covered_vaccine": "string",
- "inflation_reduction_act_covered_insulin": "string",
- "other_true_out_of_pocket_amount_indicator": "string",
- "medicare_amounts_id": 0,
- "low_income_subsidy_amounts_id": 0,
- "medicare_medicaid_dsnp_co_administered_plan": "string",
- "dsnp_fee_for_service_or_capitation": 0,
- "dsnp_medicaid_cost_share_reduction_amount_part_d": 0,
- "dsnp_medicaid_cost_share_reduction_amount_part_b": 0,
- "dsnp_medicaid_cost_share_covered_excluded_reduction_amount": 0,
- "is_340b": true,
- "medicare_administrative_claim": "string",
- "controlled_substance_code": "string",
- "desi_code": "string",
- "batch_test_claims_file_id": 0,
- "reprocessing_id": 0,
- "reprocessing_type": "string",
- "reprocessing_patient_pay_difference": "string",
- "reprocessing_pharmacy_pay_amount": "string",
- "reprocessing_plan_pay_amount": "string",
- "reprocessing_goes_to_835": true,
- "reprocessing_goes_to_invoice": true,
- "reprocessing_is_member_recoupment": true,
- "nx_other_payers_total_amount": "string",
- "reprocessing_nx_amount_applied_to_patient_pay": "string",
- "reprocessing_excess_nx_amount_total": "string",
- "reprocessing_patient_pay_net_nx": "string",
- "reprocessing_member_refund_amount": "string",
- "reprocessing_member_recoupment_amount": "string",
- "reprocessing_is_recoup_ltc_pharmacy": true,
- "notes": "string",
- "first_claim_id": 0,
- "next_claim_id": 0,
- "include_raw_request_parsed": true,
- "include_raw_response_parsed": true,
- "manufacturer_discount_amount": 0,
- "is_manufacturer_discount_drug": true,
- "is_maximum_fair_price_selected_drug": true,
- "maximum_fair_price_ndc_11_package_price": 0,
- "maximum_fair_price_ndc_9_unit_price": 0,
- "maximum_fair_price_selected_drug_subsidy": 0,
- "maximum_fair_price_thiry_day_equivalent": 0,
- "claim_number": "string",
- "claim_sequence_number": "string",
- "medicare_prescription_payment_plan_indicator": "string",
- "medicare_prescription_payment_plan_original_claim_id": 0,
- "pharmacy_transaction_fee": 0,
- "vbid_cost_share_reduction_amount_part_d": 0,
- "vbid_model_indicator": "string",
- "pricing_level_ids": [
- 0
], - "is_parallel_validation": true,
- "calculated_spread_data": null,
- "level_1_basis_of_reimbursement": "string",
- "level_2_basis_of_reimbursement": "string",
- "level_3_basis_of_reimbursement": "string",
- "primary_plan_original_claim_id": 0,
- "is_wrap_benefit": true,
- "column_masks": null,
- "global_management_program_ids": [
- 0
], - "originator": "string",
- "benefit_categories": [
- "string"
], - "drug_lists": null,
- "brand_name_code": "string",
- "drug_descriptor_id": "string",
- "dosage": "string",
- "dosage_form": "string",
- "dosage_form_packaging": "string",
- "drug_name": "string",
- "drug_type": "string",
- "group_name": "string",
- "provider_phone": "string",
- "most_expensive_compound_ingredient_ndc": "string",
- "multi_source": "string",
- "name_type_code": "string",
- "rx_otc_indicator_code": "string",
- "strength": "string",
- "strength_unit_of_measure": "string",
- "pde_record_id": "string",
- "pde_claim_control_number": "string",
- "pde_plan_benefit_package_id": "string",
- "medicare_prescription_payment_plan_claim_id": 0,
- "medicare_prescription_payment_plan_claim_amount": 0,
- "claim_gpi": "string",
- "identity": "string",
- "over_reimbursement_indicator": true,
- "accumulation_adjustment_ids": [
- 0
]
}| claim_number required | string or null Unique number generated when claim is submitted for given clientid, external_member_id , person_code, date_of_service, service_provider_id, prescription_service_reference_number and fill_number |
| claim_sequence_number required | string or null Sequence number assigned for a given claim_number and the operation resulting in claim with paid or rejected status |
{- "claim_number": "string",
- "claim_sequence_number": "string"
}{- "id": 0,
- "rn": "string",
- "reversal_id": 0,
- "reverses_id": 0,
- "original_claim_id": 0,
- "client_id": "string",
- "external_account_id": "string",
- "external_group_id": "string",
- "provider_agreement_id": 0,
- "coverage_strategy_id": "string",
- "date_of_service": "string",
- "claim_submission_date": "string",
- "claim_payment_cycle_end_date": "string",
- "claim_reimbursement_cycle_end_date": "string",
- "claim_status": "string",
- "claim_count": 0,
- "received_at": "string",
- "source": "string",
- "external_member_id": "string",
- "person_code": "string",
- "first_name": "string",
- "last_name": "string",
- "coverage_strategy_type": "string",
- "plan_benefit_id": 0,
- "formulary_id": 0,
- "network_id": 0,
- "benefit_network": "string",
- "gpi": "string",
- "pharmacy_nabp": "string",
- "pharmacy_name": "string",
- "pharmacy_channel": "string",
- "version_release_number": "string",
- "request_transaction_code": "string",
- "bin_number": "string",
- "processor_control_number": "string",
- "transaction_count": "string",
- "service_provider_id_qualifier": "string",
- "service_provider_id": "string",
- "software_vendor_certification_id": "string",
- "submitted_cardholder_id": "string",
- "cardholder_first_name": "string",
- "cardholder_last_name": "string",
- "plan_id": "string",
- "eligibility_clarification_code": "string",
- "group_id": "string",
- "submitted_person_code": "string",
- "patient_relationship_code": "string",
- "medigap_id": "string",
- "medicaid_indicator": "string",
- "provider_accept_assignment_indicator": "string",
- "cms_part_d_defined_qualified_facility": "string",
- "medicaid_id_number": "string",
- "patient_id_qualifier": "string",
- "patient_id": "string",
- "date_of_birth": "string",
- "patient_gender_code": "string",
- "patient_first_name": "string",
- "patient_last_name": "string",
- "patient_street_address": "string",
- "patient_street_address_line_1": "string",
- "patient_street_address_line_2": "string",
- "patient_city_address": "string",
- "patient_state_province_address": "string",
- "patient_zip_postal_code": "string",
- "patient_country_code": "string",
- "patient_telephone_number": "string",
- "place_of_service": "string",
- "employer_id": "string",
- "pregnancy_indicator": "string",
- "patient_email_address": "user@example.com",
- "patient_residence": "string",
- "prescription_service_reference_number_qualifier": "string",
- "prescription_service_reference_number": "string",
- "product_service_id_qualifier": "string",
- "ndc": "string",
- "associated_prescription_service_reference_number": "string",
- "associated_prescription_service_date": "string",
- "procedure_modifier_code_1": "string",
- "procedure_modifier_code_2": "string",
- "procedure_modifier_code_3": "string",
- "procedure_modifier_code_4": "string",
- "procedure_modifier_code_5": "string",
- "procedure_modifier_code_6": "string",
- "procedure_modifier_code_7": "string",
- "procedure_modifier_code_8": "string",
- "procedure_modifier_code_9": "string",
- "procedure_modifier_code_10": "string",
- "quantity_dispensed": "string",
- "fill_number": 0,
- "days_supply": 0,
- "compound_code": "string",
- "daw": "string",
- "date_prescription_written": "string",
- "number_of_refills_authorized": 0,
- "prescription_origin_code": "string",
- "submission_clarification_code_1": "string",
- "submission_clarification_code_2": "string",
- "submission_clarification_code_3": "string",
- "submission_clarification_code_4": "string",
- "submission_clarification_code_5": "string",
- "submission_clarification_code_pde": "string",
- "submission_type_code_1": "string",
- "submission_type_code_2": "string",
- "submission_type_code_3": "string",
- "submission_type_code_4": "string",
- "submission_type_code_5": "string",
- "quantity_prescribed": "string",
- "multiple_prescription_service_order_group_id": "string",
- "multiple_prescription_service_order_group_reason_code": "string",
- "total_prescribed_quantity_remaining": "string",
- "other_coverage_code": "string",
- "special_packaging_indicator": "string",
- "originally_prescribed_product_service_id_qualifier": "string",
- "originally_prescribed_product_service_code": "string",
- "originally_prescribed_quantity": "string",
- "scheduled_prescription_id_number": "string",
- "unit_of_measure": "string",
- "level_of_service": "string",
- "prior_authorization_type_code": "string",
- "prior_authorization_id_submitted": "string",
- "dispensing_status": "string",
- "quantity_intended_to_be_dispensed": "string",
- "days_supply_intended_to_be_dispensed": 0,
- "delay_reason_code": "string",
- "patient_assignment_indicator": "string",
- "route_of_administration": "string",
- "compound_type": "string",
- "preparation_environment_type": "string",
- "preparation_environment_event_code": "string",
- "pharmacy_service_type": "string",
- "associated_prescription_service_reference_number_qualifier": "string",
- "associated_prescription_service_fill_number": 0,
- "original_manufacturer_product_id_qualifier": "string",
- "original_manufacturer_product_id": "string",
- "ltpac_dispense_frequency": "string",
- "ltpac_billing_methodology": "string",
- "number_of_ltpac_dispensing_events": 0,
- "do_not_dispense_before_date": "string",
- "ingredient_cost_submitted": "string",
- "dispensing_fee_submitted": "string",
- "patient_pay_amount_reported": "string",
- "incentive_amount_submitted": "string",
- "other_amount_claimed_submitted_qualifier_1": "string",
- "other_amount_claimed_submitted_1": "string",
- "other_amount_claimed_submitted_qualifier_2": "string",
- "other_amount_claimed_submitted_2": "string",
- "other_amount_claimed_submitted_qualifier_3": "string",
- "other_amount_claimed_submitted_3": "string",
- "regulatory_fee_type_code_submitted_1": "string",
- "regulatory_fee_amount_submitted_1": "string",
- "regulatory_fee_type_code_submitted_2": "string",
- "regulatory_fee_amount_submitted_2": "string",
- "regulatory_fee_type_code_submitted_3": "string",
- "regulatory_fee_amount_submitted_3": "string",
- "percentage_tax_amount_submitted": "string",
- "percentage_tax_rate_submitted": "string",
- "percentage_tax_basis_submitted": "string",
- "usual_and_customary_charge": "string",
- "gross_amount_due": "string",
- "basis_of_cost_determination": "string",
- "provider_id_qualifier": "string",
- "provider_id": "string",
- "provider_first_name": "string",
- "provider_last_name": "string",
- "prescriber_id_qualifier": "string",
- "prescriber_id": "string",
- "prescriber_last_name": "string",
- "prescriber_telephone_number": "string",
- "prescriber_telephone_number_extension": "string",
- "primary_care_provider_id_qualifier": "string",
- "primary_care_provider_id": "string",
- "primary_care_provider_last_name": "string",
- "prescriber_first_name": "string",
- "prescriber_street_address": "string",
- "prescriber_street_address_line_1": "string",
- "prescriber_street_address_line_2": "string",
- "prescriber_city_address": "string",
- "prescriber_state_province_address": "string",
- "prescriber_zip_postal_code": "string",
- "prescriber_country_code": "string",
- "prescriber_dea_number": "string",
- "prescriber_place_of_service": "string",
- "compound_prices": null,
- "compound_dosage_form_description_code": "string",
- "compound_dispensing_unit_form_indicator": "string",
- "compound_ingredient_component_count": 0,
- "compound_product_id_qualifier_1": "string",
- "compound_product_id_1": "string",
- "compound_ingredient_quantity_1": "string",
- "compound_product_id_qualifier_2": "string",
- "compound_product_id_2": "string",
- "compound_ingredient_quantity_2": "string",
- "compound_product_id_qualifier_3": "string",
- "compound_product_id_3": "string",
- "compound_ingredient_quantity_3": "string",
- "compound_product_id_qualifier_4": "string",
- "compound_product_id_4": "string",
- "compound_ingredient_quantity_4": "string",
- "compound_product_id_qualifier_5": "string",
- "compound_product_id_5": "string",
- "compound_ingredient_quantity_5": "string",
- "compound_product_id_qualifier_6": "string",
- "compound_product_id_6": "string",
- "compound_ingredient_quantity_6": "string",
- "compound_product_id_qualifier_7": "string",
- "compound_product_id_7": "string",
- "compound_ingredient_quantity_7": "string",
- "compound_product_id_qualifier_8": "string",
- "compound_product_id_8": "string",
- "compound_ingredient_quantity_8": "string",
- "compound_product_id_qualifier_9": "string",
- "compound_product_id_9": "string",
- "compound_ingredient_quantity_9": "string",
- "compound_product_id_qualifier_10": "string",
- "compound_product_id_10": "string",
- "compound_ingredient_quantity_10": "string",
- "compound_product_id_qualifier_11": "string",
- "compound_product_id_11": "string",
- "compound_ingredient_quantity_11": "string",
- "compound_product_id_qualifier_12": "string",
- "compound_product_id_12": "string",
- "compound_ingredient_quantity_12": "string",
- "compound_product_id_qualifier_13": "string",
- "compound_product_id_13": "string",
- "compound_ingredient_quantity_13": "string",
- "compound_product_id_qualifier_14": "string",
- "compound_product_id_14": "string",
- "compound_ingredient_quantity_14": "string",
- "compound_product_id_qualifier_15": "string",
- "compound_product_id_15": "string",
- "compound_ingredient_quantity_15": "string",
- "compound_product_id_qualifier_16": "string",
- "compound_product_id_16": "string",
- "compound_ingredient_quantity_16": "string",
- "compound_product_id_qualifier_17": "string",
- "compound_product_id_17": "string",
- "compound_ingredient_quantity_17": "string",
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- "other_payer_coverage_type_8": "string",
- "other_payer_coverage_type_9": "string",
- "other_payer_id_1": "string",
- "other_payer_id_2": "string",
- "other_payer_id_3": "string",
- "other_payer_id_4": "string",
- "other_payer_id_5": "string",
- "other_payer_id_6": "string",
- "other_payer_id_7": "string",
- "other_payer_id_8": "string",
- "other_payer_id_9": "string",
- "other_payer_id_qualifier_1": "string",
- "other_payer_id_qualifier_2": "string",
- "other_payer_id_qualifier_3": "string",
- "other_payer_id_qualifier_4": "string",
- "other_payer_id_qualifier_5": "string",
- "other_payer_id_qualifier_6": "string",
- "other_payer_id_qualifier_7": "string",
- "other_payer_id_qualifier_8": "string",
- "other_payer_id_qualifier_9": "string",
- "other_payer_patient_responsibility_amount_1": "string",
- "other_payer_patient_responsibility_amount_2": "string",
- "other_payer_patient_responsibility_amount_3": "string",
- "other_payer_patient_responsibility_amount_4": "string",
- "other_payer_patient_responsibility_amount_5": "string",
- "other_payer_patient_responsibility_amount_6": "string",
- "other_payer_patient_responsibility_amount_7": "string",
- "other_payer_patient_responsibility_amount_8": "string",
- "other_payer_patient_responsibility_amount_9": "string",
- "other_payer_patient_responsibility_amount_count": 0,
- "other_payer_patient_responsibility_amount_qualifier_1": "string",
- "other_payer_patient_responsibility_amount_qualifier_2": "string",
- "other_payer_patient_responsibility_amount_qualifier_3": "string",
- "other_payer_patient_responsibility_amount_qualifier_4": "string",
- "other_payer_patient_responsibility_amount_qualifier_5": "string",
- "other_payer_patient_responsibility_amount_qualifier_6": "string",
- "other_payer_patient_responsibility_amount_qualifier_7": "string",
- "other_payer_patient_responsibility_amount_qualifier_8": "string",
- "other_payer_patient_responsibility_amount_qualifier_9": "string",
- "other_payer_reject_code_1": "string",
- "other_payer_reject_code_2": "string",
- "other_payer_reject_code_3": "string",
- "other_payer_reject_code_4": "string",
- "other_payer_reject_code_5": "string",
- "other_payer_reject_count": 0,
- "pay_amount_level_1": "string",
- "pay_amount_level_2": "string",
- "pay_amount_level_3": "string",
- "prescriber_npi": "string",
- "professional_service_code_1": "string",
- "professional_service_code_2": "string",
- "professional_service_code_3": "string",
- "professional_service_code_4": "string",
- "professional_service_code_5": "string",
- "professional_service_code_6": "string",
- "professional_service_code_7": "string",
- "professional_service_code_8": "string",
- "professional_service_code_9": "string",
- "remaining_category_deductible_1_amount": "string",
- "remaining_overall_deductible_amount": "string",
- "request_reason_for_service_code_1": "string",
- "request_reason_for_service_code_2": "string",
- "request_reason_for_service_code_3": "string",
- "request_reason_for_service_code_4": "string",
- "request_reason_for_service_code_5": "string",
- "request_reason_for_service_code_6": "string",
- "request_reason_for_service_code_7": "string",
- "request_reason_for_service_code_8": "string",
- "request_reason_for_service_code_9": "string",
- "result_of_service_code_1": "string",
- "result_of_service_code_2": "string",
- "result_of_service_code_3": "string",
- "result_of_service_code_4": "string",
- "result_of_service_code_5": "string",
- "result_of_service_code_6": "string",
- "result_of_service_code_7": "string",
- "result_of_service_code_8": "string",
- "result_of_service_code_9": "string",
- "specialty_list_dispensing_fee": "string",
- "specialty_list_id": 0,
- "specialty_list_name": "string",
- "dmr_pay_to_city_address": "string",
- "dmr_pay_to_country_code": "string",
- "dmr_pay_to_name": "string",
- "dmr_pay_to_state_province_address": "string",
- "dmr_pay_to_street_address_line_1": "string",
- "dmr_pay_to_street_address_line_2": "string",
- "dmr_pay_to_tax_id": "string",
- "dmr_pay_to_vendor_id": "string",
- "dmr_pay_to_zip_postal_code": "string",
- "dmr_pay_to_check_eft_number": "string",
- "dmr_pay_to_date": "string",
- "tax_id_number": "string",
- "reasons_for_rejection": [
- "string"
], - "reasons_for_adjudication": [
- "string"
], - "reasons_for_adjudication_sections": null,
- "patient_pay_reduction_due_to_point_of_service_rebate": 0,
- "plan_pay_reduction_due_to_point_of_service_rebate": 0,
- "point_of_service_rebate_amount": 0,
- "low_income_subsidy_level": "string",
- "senior_savings_model_cost_share_reduction_gap": 0,
- "senior_savings_model_cost_share_reduction_non_gap": 0,
- "senior_savings_model_indicator": "string",
- "inflation_reduction_act_subsidy_amount": 0,
- "inflation_reduction_act_covered_vaccine": "string",
- "inflation_reduction_act_covered_insulin": "string",
- "other_true_out_of_pocket_amount_indicator": "string",
- "medicare_amounts_id": 0,
- "low_income_subsidy_amounts_id": 0,
- "medicare_medicaid_dsnp_co_administered_plan": "string",
- "dsnp_fee_for_service_or_capitation": 0,
- "dsnp_medicaid_cost_share_reduction_amount_part_d": 0,
- "dsnp_medicaid_cost_share_reduction_amount_part_b": 0,
- "dsnp_medicaid_cost_share_covered_excluded_reduction_amount": 0,
- "is_340b": true,
- "medicare_administrative_claim": "string",
- "controlled_substance_code": "string",
- "desi_code": "string",
- "batch_test_claims_file_id": 0,
- "reprocessing_id": 0,
- "reprocessing_type": "string",
- "reprocessing_patient_pay_difference": "string",
- "reprocessing_pharmacy_pay_amount": "string",
- "reprocessing_plan_pay_amount": "string",
- "reprocessing_goes_to_835": true,
- "reprocessing_goes_to_invoice": true,
- "reprocessing_is_member_recoupment": true,
- "nx_other_payers_total_amount": "string",
- "reprocessing_nx_amount_applied_to_patient_pay": "string",
- "reprocessing_excess_nx_amount_total": "string",
- "reprocessing_patient_pay_net_nx": "string",
- "reprocessing_member_refund_amount": "string",
- "reprocessing_member_recoupment_amount": "string",
- "reprocessing_is_recoup_ltc_pharmacy": true,
- "notes": "string",
- "first_claim_id": 0,
- "next_claim_id": 0,
- "include_raw_request_parsed": true,
- "include_raw_response_parsed": true,
- "manufacturer_discount_amount": 0,
- "is_manufacturer_discount_drug": true,
- "is_maximum_fair_price_selected_drug": true,
- "maximum_fair_price_ndc_11_package_price": 0,
- "maximum_fair_price_ndc_9_unit_price": 0,
- "maximum_fair_price_selected_drug_subsidy": 0,
- "maximum_fair_price_thiry_day_equivalent": 0,
- "claim_number": "string",
- "claim_sequence_number": "string",
- "medicare_prescription_payment_plan_indicator": "string",
- "medicare_prescription_payment_plan_original_claim_id": 0,
- "pharmacy_transaction_fee": 0,
- "vbid_cost_share_reduction_amount_part_d": 0,
- "vbid_model_indicator": "string",
- "pricing_level_ids": [
- 0
], - "is_parallel_validation": true,
- "calculated_spread_data": null,
- "level_1_basis_of_reimbursement": "string",
- "level_2_basis_of_reimbursement": "string",
- "level_3_basis_of_reimbursement": "string",
- "primary_plan_original_claim_id": 0,
- "is_wrap_benefit": true,
- "column_masks": null,
- "global_management_program_ids": [
- 0
], - "originator": "string",
- "benefit_categories": [
- "string"
], - "drug_lists": null,
- "brand_name_code": "string",
- "drug_descriptor_id": "string",
- "dosage": "string",
- "dosage_form": "string",
- "dosage_form_packaging": "string",
- "drug_name": "string",
- "drug_type": "string",
- "group_name": "string",
- "provider_phone": "string",
- "most_expensive_compound_ingredient_ndc": "string",
- "multi_source": "string",
- "name_type_code": "string",
- "rx_otc_indicator_code": "string",
- "strength": "string",
- "strength_unit_of_measure": "string",
- "pde_record_id": "string",
- "pde_claim_control_number": "string",
- "pde_plan_benefit_package_id": "string",
- "medicare_prescription_payment_plan_claim_id": 0,
- "medicare_prescription_payment_plan_claim_amount": 0,
- "claim_gpi": "string",
- "identity": "string",
- "over_reimbursement_indicator": true,
- "accumulation_adjustment_ids": [
- 0
]
}List Claims.
| page_number | integer or null <int32> The page of results you would like to get. For the first page, pass |
| results_per_page | integer or null <int32> The number of results per page. |
| expected_fields | Array of strings or null or null The desired list of fields to be returned. |
Array of objects or null (OrderBySchema_1764643208.4167695) | |
| id | integer or null <int32> The internal ID of a claim. Cannot be set during create nor subsequently changed. |
| client_id | string or null |
| external_member_id | string or null |
| person_code | string or null |
| external_account_id | string or null |
| external_group_id | string or null |
| submitted_carholder_id | string or null |
| first_name | string or null |
| last_name | string or null |
| full_text_search | string or null The full text search for claims by product_service_description, date of service, and pharmacy name |
| claim_status | string or null |
| date_type | string or null |
| prescription_service_reference_number | string or null A field on NCPDP D.0 that is also referred to as the 'prescription number' or 'Rx number'. This number is assigned by the pharmacy to represent a specific prescription, inclusive of all refills for that prescription (via fill number). Rx numbers are ONLY unique to pharmacies, and are NOT globally unique. |
| pharmacy_nabp | string or null |
| prescriber_id | string or null |
| ndc | string or null |
| service_provider_id | string or null A field in NCPDP D.0 which in our system is ALWAYS the NPI of the pharmacy for paid or accepted claims (rejected claims may submit other values, causing us to reject the claim). NPI is the national provider identifier, essentially every entity in healthcare has an NPI, which includes pharmacies, doctors, hospitals, and pharmacists themselves. |
| start_date | string or null <ArrowDateTime> |
| end_date | string or null <ArrowDateTime> |
| minimum_claim_submission_date | string or null <ArrowDateTime> |
| maximum_claim_submission_date | string or null <ArrowDateTime> |
| is_340b | boolean or null Return claims matching the given is_340b value. |
| reject_codes | string or null A string of reject codes, with multiple reject codes separated by commas. |
| paid_claims_only | boolean or null Boolean to show paid claims only, ignoring reversed and rejected. Defaults to false. |
| claim_sources | Array of strings or null or null Enum: "admin" "app" "batch-test" "historical" "migrated" "pharmacy" "switch" "test" "vendor" "web" |
| get_dependent_claims | boolean or null Boolean to return dependent claims. |
| month | integer or null <int32> Month to filter by as integer |
| year | integer or null <int32> Year to filter by as integer |
| year_to_date | boolean or null Should filter by year to date. |
| gpi | string or null Drug gpi to search. |
| gpi_operator | string or null Search field using =, STARTSWITH, CONTAINS |
| drug_name | string or null |
| excluded_gpi_list | Array of strings or null or null |
| client_ids | Array of strings or null or null |
| add_pharmacy_data | boolean or null Boolean to return pharmacy details from ncpdp_providers |
| only_fields | Array of strings or null or null |
| formulary_tier | string or null A string of formulary tiers, with multiple tiers separated by commas. |
| first_claim_id | integer or null <int32> |
| basis_of_cost_determination | string or null |
| custom_filters | Array of strings or null or null |
| medicare_prescription_payment_plan_indicator | string or null |
| coverage_strategy_type | string or null |
| claim_number | string or null |
| claim_sequence_number | string or null |
{- "page_number": 0,
- "results_per_page": 0,
- "expected_fields": [
- "string"
], - "order_by": [
- {
- "id": "string",
- "client_id": "string",
- "external_group_id": "string",
- "date_of_service": "string",
- "claim_submission_date": "string",
- "claim_status": "string",
- "received_at": "string",
- "source": "string",
- "external_member_id": "string",
- "person_code": "string",
- "first_name": "string",
- "last_name": "string",
- "plan_benefit_id": "string",
- "formulary_id": "string",
- "network_id": "string",
- "service_provider_id": "string",
- "pharmacy_nabp": "string",
- "cardholder_first_name": "string",
- "cardholder_last_name": "string",
- "plan_id": "string",
- "group_id": "string",
- "date_of_birth": "string",
- "patient_first_name": "string",
- "patient_last_name": "string",
- "prescription_service_reference_number": "string",
- "ndc": "string",
- "quantity_dispensed": "string",
- "fill_number": "string",
- "days_supply": "string",
- "compound_code": "string",
- "daw": "string",
- "prior_authorization_type_code": "string",
- "prior_authorization_id_submitted": "string",
- "pharmacy_service_type": "string",
- "ingredient_cost_submitted": "string",
- "dispensing_fee_submitted": "string",
- "patient_pay_amount_reported": "string",
- "incentive_amount_submitted": "string",
- "other_amount_claimed_submitted_1": "string",
- "other_amount_claimed_submitted_2": "string",
- "other_amount_claimed_submitted_3": "string",
- "regulatory_fee_type_code_submitted_1": "string",
- "regulatory_fee_amount_submitted_1": "string",
- "regulatory_fee_type_code_submitted_2": "string",
- "regulatory_fee_amount_submitted_2": "string",
- "regulatory_fee_type_code_submitted_3": "string",
- "regulatory_fee_amount_submitted_3": "string",
- "percentage_tax_amount_submitted": "string",
- "percentage_tax_rate_submitted": "string",
- "percentage_tax_basis_submitted": "string",
- "usual_and_customary_charge": "string",
- "gross_amount_due": "string",
- "basis_of_cost_determination": "string",
- "provider_id": "string",
- "provider_last_name": "string",
- "prescriber_id": "string",
- "prescriber_last_name": "string",
- "header_response_status": "string",
- "response_transaction_code": "string",
- "transaction_response_status": "string",
- "reject_code_1": "string",
- "reject_code_2": "string",
- "reject_code_3": "string",
- "reject_code_4": "string",
- "reject_code_5": "string",
- "next_available_fill_date": "string",
- "ingredient_cost_charged_to_plan": "string",
- "dispensing_fee_charged_to_plan": "string",
- "product_service_classification": "string",
- "product_service_description": "string",
- "total_amount_paid": "string",
- "patient_pay_amount": "string",
- "patient_pay_component_amount_1": "string",
- "patient_pay_component_amount_2": "string",
- "patient_pay_component_amount_3": "string",
- "plan_pay_amount": "string",
- "amount_applied_to_periodic_deductible": "string",
- "amount_applied_to_periodic_maximum_benefit": "string",
- "amount_applied_to_periodic_maximum_out_of_pocket": "string",
- "amount_applied_to_periodic_maximum_fertility": "string",
- "amount_exceeding_periodic_fertility_maximum": "string",
- "amount_attributed_to_product_selection_brand_drug": "string",
- "amount_attributed_to_percentage_tax": "string",
- "amount_exceeding_periodic_benefit_maximum": "string",
- "amount_of_copay": "string",
- "amount_of_coinsurance": "string",
- "amount_attributed_to_product_selection_non_preferred": "string",
- "amount_attributed_to_health_plan_assistance": "string",
- "amount_attributed_to_provider_network_selection": "string",
- "amount_attributed_to_product_selection_brand_non_preferred": "string",
- "amount_attributed_to_coverage_gap": "string",
- "amount_attributed_to_processor_fee": "string",
- "amount_attributed_to_grace_period": "string",
- "amount_attributed_to_catastrophic_benefit": "string",
- "amount_attributed_to_regulatory_fee": "string",
- "ingredient_cost_paid": "string",
- "dispensing_fee_paid": "string",
- "percentage_tax_exempt_indicator": "string",
- "regulatory_fee_amount_paid_1": "string",
- "regulatory_fee_amount_paid_2": "string",
- "regulatory_fee_amount_paid_3": "string",
- "percentage_tax_amount_paid": "string",
- "percentage_tax_rate_paid": "string",
- "other_amount_paid_qualifier_1": "string",
- "other_amount_paid_1": "string",
- "other_amount_paid_qualifier_2": "string",
- "other_amount_paid_2": "string",
- "other_amount_paid_qualifier_3": "string",
- "other_amount_paid_3": "string",
- "other_payer_amount_recognized": "string",
- "basis_of_reimbursement_determination": "string",
- "basis_of_calculation_dispensing_fee": "string",
- "basis_of_calculation_copay": "string",
- "basis_of_calculation_coinsurance": "string",
- "basis_of_calculation_regulatory_fee": "string",
- "basis_of_calculation_percentage_tax": "string",
- "basis_of_days_supply_determination": "string",
- "accumulated_deductible_amount": "string",
- "remaining_deductible_amount": "string",
- "remaining_benefit_amount": "string",
- "patient_percentage_tax_amount": "string",
- "patient_regulatory_fee_amount": "string",
- "estimated_generic_savings": "string",
- "reason_for_service_code_1": "string",
- "previous_date_of_fill_1": "string",
- "quantity_of_previous_fill_1": "string",
- "reason_for_service_code_2": "string",
- "previous_date_of_fill_2": "string",
- "quantity_of_previous_fill_2": "string",
- "reason_for_service_code_3": "string",
- "previous_date_of_fill_3": "string",
- "quantity_of_previous_fill_3": "string",
- "direct_member_reimbursement_indicator": "string",
- "drug_name": "string",
- "pharmacy_name": "string",
- "reprocessing_id": "string",
- "original_claim_id": "string",
- "first_claim_id": "string",
- "claim_number": "string",
- "claim_sequence_number": "string"
}
], - "id": 0,
- "client_id": "string",
- "external_member_id": "string",
- "person_code": "string",
- "external_account_id": "string",
- "external_group_id": "string",
- "submitted_carholder_id": "string",
- "first_name": "string",
- "last_name": "string",
- "full_text_search": "string",
- "claim_status": "string",
- "date_type": "string",
- "prescription_service_reference_number": "string",
- "pharmacy_nabp": "string",
- "prescriber_id": "string",
- "ndc": "string",
- "service_provider_id": "string",
- "start_date": "string",
- "end_date": "string",
- "minimum_claim_submission_date": "string",
- "maximum_claim_submission_date": "string",
- "is_340b": true,
- "reject_codes": "string",
- "paid_claims_only": true,
- "claim_sources": [
- "admin"
], - "get_dependent_claims": true,
- "month": 0,
- "year": 0,
- "year_to_date": true,
- "gpi": "string",
- "gpi_operator": "string",
- "drug_name": "string",
- "excluded_gpi_list": [
- "string"
], - "client_ids": [
- "string"
], - "add_pharmacy_data": true,
- "only_fields": [
- "string"
], - "formulary_tier": "string",
- "first_claim_id": 0,
- "basis_of_cost_determination": "string",
- "custom_filters": [
- "string"
], - "medicare_prescription_payment_plan_indicator": "string",
- "coverage_strategy_type": "string",
- "claim_number": "string",
- "claim_sequence_number": "string"
}{- "results": [
- {
- "claim": {
- "id": 0,
- "rn": "string",
- "reversal_id": 0,
- "reverses_id": 0,
- "original_claim_id": 0,
- "client_id": "string",
- "external_account_id": "string",
- "external_group_id": "string",
- "provider_agreement_id": 0,
- "coverage_strategy_id": "string",
- "date_of_service": "string",
- "claim_submission_date": "string",
- "claim_payment_cycle_end_date": "string",
- "claim_reimbursement_cycle_end_date": "string",
- "claim_status": "string",
- "claim_count": 0,
- "received_at": "string",
- "source": "string",
- "external_member_id": "string",
- "person_code": "string",
- "first_name": "string",
- "last_name": "string",
- "coverage_strategy_type": "string",
- "plan_benefit_id": 0,
- "formulary_id": 0,
- "network_id": 0,
- "benefit_network": "string",
- "gpi": "string",
- "pharmacy_nabp": "string",
- "pharmacy_name": "string",
- "pharmacy_channel": "string",
- "version_release_number": "string",
- "request_transaction_code": "string",
- "bin_number": "string",
- "processor_control_number": "string",
- "transaction_count": "string",
- "service_provider_id_qualifier": "string",
- "service_provider_id": "string",
- "software_vendor_certification_id": "string",
- "submitted_cardholder_id": "string",
- "cardholder_first_name": "string",
- "cardholder_last_name": "string",
- "plan_id": "string",
- "eligibility_clarification_code": "string",
- "group_id": "string",
- "submitted_person_code": "string",
- "patient_relationship_code": "string",
- "medigap_id": "string",
- "medicaid_indicator": "string",
- "provider_accept_assignment_indicator": "string",
- "cms_part_d_defined_qualified_facility": "string",
- "medicaid_id_number": "string",
- "patient_id_qualifier": "string",
- "patient_id": "string",
- "date_of_birth": "string",
- "patient_gender_code": "string",
- "patient_first_name": "string",
- "patient_last_name": "string",
- "patient_street_address": "string",
- "patient_street_address_line_1": "string",
- "patient_street_address_line_2": "string",
- "patient_city_address": "string",
- "patient_state_province_address": "string",
- "patient_zip_postal_code": "string",
- "patient_country_code": "string",
- "patient_telephone_number": "string",
- "place_of_service": "string",
- "employer_id": "string",
- "pregnancy_indicator": "string",
- "patient_email_address": "user@example.com",
- "patient_residence": "string",
- "prescription_service_reference_number_qualifier": "string",
- "prescription_service_reference_number": "string",
- "product_service_id_qualifier": "string",
- "ndc": "string",
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- "dur_pps_level_of_effort_4": "string",
- "dur_pps_level_of_effort_5": "string",
- "dur_pps_level_of_effort_6": "string",
- "dur_pps_level_of_effort_7": "string",
- "dur_pps_level_of_effort_8": "string",
- "dur_pps_level_of_effort_9": "string",
- "aws_region": "string",
- "log_group_name": "string",
- "log_stream_name": "string",
- "aws_request_id": "string",
- "log_key": "string",
- "raw_request": "string",
- "raw_response": "string",
- "raw_request_parsed": null,
- "raw_response_parsed": null,
- "relationship_code": "string",
- "overrides": [
- 0
], - "prior_authorizations": [
- 0
], - "tags": [
- 0
], - "finance_835_record_id": 0,
- "finished_at": "string",
- "formulary_name": "string",
- "formulary_tier": "string",
- "nadac_per_unit": 0,
- "nadac_plus_ndc": "string",
- "nadac_plus_per_unit": 0,
- "relationship_id": "string",
- "ncpdp_relationship_id": "string",
- "affiliation_relationship_id": "string",
- "parent_organization_id": "string",
- "remit_and_reconciliation_id": "string",
- "payment_center_id": "string",
- "rx_cap_flag": "string",
- "rx_cap_plus_flag": "string",
- "total_mac_list": 0,
- "total_nadac": 0,
- "total_nadac_plus": 0,
- "total_specialty_list": 0,
- "external_invoice_id": 0,
- "pde_id": 0,
- "pde_status": "string",
- "pde_cms_calculated_gap_discount": 0,
- "pde_plan_benefit_package_id_of_record": "string",
- "pde_alternate_service_provider_id_qualifier": "string",
- "pde_alternate_service_provider_id": "string",
- "pde_original_submitting_contract": "string",
- "pde_plan_to_plan_contract_of_record": "string",
- "pde_corrected_medicare_beneficiary_identifier": "string",
- "pde_error_count": 0,
- "pde_error_1": "string",
- "pde_error_2": "string",
- "pde_error_3": "string",
- "pde_error_4": "string",
- "pde_error_5": "string",
- "pde_error_6": "string",
- "pde_error_7": "string",
- "pde_error_8": "string",
- "pde_error_9": "string",
- "pde_error_10": "string",
- "pde_exclusion_reason_code": "string",
- "pde_adjustment_deletion_code": "string",
- "programs": [
- "string"
], - "plan_additional_covered_amount": 0,
- "nsde_drug_application_type": "string",
- "drug_application_type": "string",
- "non_standard_format_code": "string",
- "drug_status_code": "string",
- "part_b": "string",
- "part_d": "string",
- "contract_number": "string",
- "plan_benefit_package_id": "string",
- "clinical_rules": [
- { }
], - "pharmacy_quality_alliance": [
- { }
], - "formulary_attributes": { },
- "callback_overrides": [
- { }
], - "performance": { },
- "adjustments": [
- null
], - "plan_type": "string",
- "medicare_beneficiary_identifier": "string",
- "gross_covered_drug_cost_before_adjudication": "string",
- "reported_gap_discount": "string",
- "beginning_benefit_phase": "string",
- "ending_benefit_phase": "string",
- "formulary_code": "string",
- "true_out_of_pocket_before_adjudication": "string",
- "gross_drug_cost_above": "string",
- "gross_drug_cost_below": "string",
- "total_claim_covered_plan_pay": "string",
- "total_claim_non_covered_plan_pay": "string",
- "amount_applied_to_low_income_subsidy": "string",
- "amount_applied_to_low_income_subsidy_deductible": "string",
- "amount_applied_to_part_b_deductible": "string",
- "amount_applied_to_part_b_maximum_out_of_pocket": "string",
- "adjustment_reason_code": "string",
- "adjustment_reason_code_qualifier": "string",
- "estimated_rebate_at_point_of_service": "string",
- "other_true_out_of_pocket_amount": "string",
- "part_d_model_indicator": "string",
- "pricing_exception_code": "string",
- "pricing_custom_id": 0,
- "patient_liability_reduction_due_to_other_payer_amount": "string",
- "patient_liability_reduction_due_to_the_employer_amount": "string",
- "accumulated_category_deductible_1_amount": "string",
- "accumulations_applied": null,
- "alternate_benefit_cost_share": null,
- "amount_applied_to_deductible_phase": "string",
- "amount_applied_to_gross_covered_drug_cost": "string",
- "amount_applied_to_initial_coverage_phase": "string",
- "amount_applied_to_true_out_of_pocket": "string",
- "accumulated_deductible_phase_amount": "string",
- "accumulated_gross_covered_drug_cost_amount": "string",
- "accumulated_true_out_of_pocket_amount": "string",
- "accumulated_part_b_deductible_amount": "string",
- "accumulated_part_b_maximum_out_of_pocket_amount": "string",
- "accumulated_part_b_deductible_out_of_network_amount": "string",
- "accumulated_part_b_out_of_pocket_out_of_network": "string",
- "amount_applied_to_part_b_deductible_out_of_network": "string",
- "amount_applied_to_part_b_out_of_pocket_out_of_network": "string",
- "amount_exceeding_periodic_category_deductible_1": 0,
- "amount_exceeding_periodic_overall_deductible": "string",
- "birth_date": "string",
- "coordination_of_benefits_other_payments_count": 0,
- "dispensing_fee_charged_level_1": "string",
- "dispensing_fee_charged_level_2": "string",
- "dispensing_fee_charged_level_3": "string",
- "ingredient_cost_charged_level_1": "string",
- "ingredient_cost_charged_level_2": "string",
- "ingredient_cost_charged_level_3": "string",
- "mac_list_dispensing_fee": "string",
- "pricing_category_mac_list_unit_price_adjustment_percentage": 0,
- "mac_list_id": 0,
- "mac_list_name": "string",
- "other_payer_amount_paid_1": "string",
- "other_payer_amount_paid_2": "string",
- "other_payer_amount_paid_3": "string",
- "other_payer_amount_paid_4": "string",
- "other_payer_amount_paid_5": "string",
- "other_payer_amount_paid_6": "string",
- "other_payer_amount_paid_7": "string",
- "other_payer_amount_paid_8": "string",
- "other_payer_amount_paid_9": "string",
- "other_payer_amount_paid_count": 0,
- "other_payer_amount_paid_qualifier_1": "string",
- "other_payer_amount_paid_qualifier_2": "string",
- "other_payer_amount_paid_qualifier_3": "string",
- "other_payer_amount_paid_qualifier_4": "string",
- "other_payer_amount_paid_qualifier_5": "string",
- "other_payer_amount_paid_qualifier_6": "string",
- "other_payer_amount_paid_qualifier_7": "string",
- "other_payer_amount_paid_qualifier_8": "string",
- "other_payer_amount_paid_qualifier_9": "string",
- "other_payer_coverage_type_1": "string",
- "other_payer_coverage_type_2": "string",
- "other_payer_coverage_type_3": "string",
- "other_payer_coverage_type_4": "string",
- "other_payer_coverage_type_5": "string",
- "other_payer_coverage_type_6": "string",
- "other_payer_coverage_type_7": "string",
- "other_payer_coverage_type_8": "string",
- "other_payer_coverage_type_9": "string",
- "other_payer_id_1": "string",
- "other_payer_id_2": "string",
- "other_payer_id_3": "string",
- "other_payer_id_4": "string",
- "other_payer_id_5": "string",
- "other_payer_id_6": "string",
- "other_payer_id_7": "string",
- "other_payer_id_8": "string",
- "other_payer_id_9": "string",
- "other_payer_id_qualifier_1": "string",
- "other_payer_id_qualifier_2": "string",
- "other_payer_id_qualifier_3": "string",
- "other_payer_id_qualifier_4": "string",
- "other_payer_id_qualifier_5": "string",
- "other_payer_id_qualifier_6": "string",
- "other_payer_id_qualifier_7": "string",
- "other_payer_id_qualifier_8": "string",
- "other_payer_id_qualifier_9": "string",
- "other_payer_patient_responsibility_amount_1": "string",
- "other_payer_patient_responsibility_amount_2": "string",
- "other_payer_patient_responsibility_amount_3": "string",
- "other_payer_patient_responsibility_amount_4": "string",
- "other_payer_patient_responsibility_amount_5": "string",
- "other_payer_patient_responsibility_amount_6": "string",
- "other_payer_patient_responsibility_amount_7": "string",
- "other_payer_patient_responsibility_amount_8": "string",
- "other_payer_patient_responsibility_amount_9": "string",
- "other_payer_patient_responsibility_amount_count": 0,
- "other_payer_patient_responsibility_amount_qualifier_1": "string",
- "other_payer_patient_responsibility_amount_qualifier_2": "string",
- "other_payer_patient_responsibility_amount_qualifier_3": "string",
- "other_payer_patient_responsibility_amount_qualifier_4": "string",
- "other_payer_patient_responsibility_amount_qualifier_5": "string",
- "other_payer_patient_responsibility_amount_qualifier_6": "string",
- "other_payer_patient_responsibility_amount_qualifier_7": "string",
- "other_payer_patient_responsibility_amount_qualifier_8": "string",
- "other_payer_patient_responsibility_amount_qualifier_9": "string",
- "other_payer_reject_code_1": "string",
- "other_payer_reject_code_2": "string",
- "other_payer_reject_code_3": "string",
- "other_payer_reject_code_4": "string",
- "other_payer_reject_code_5": "string",
- "other_payer_reject_count": 0,
- "pay_amount_level_1": "string",
- "pay_amount_level_2": "string",
- "pay_amount_level_3": "string",
- "prescriber_npi": "string",
- "professional_service_code_1": "string",
- "professional_service_code_2": "string",
- "professional_service_code_3": "string",
- "professional_service_code_4": "string",
- "professional_service_code_5": "string",
- "professional_service_code_6": "string",
- "professional_service_code_7": "string",
- "professional_service_code_8": "string",
- "professional_service_code_9": "string",
- "remaining_category_deductible_1_amount": "string",
- "remaining_overall_deductible_amount": "string",
- "request_reason_for_service_code_1": "string",
- "request_reason_for_service_code_2": "string",
- "request_reason_for_service_code_3": "string",
- "request_reason_for_service_code_4": "string",
- "request_reason_for_service_code_5": "string",
- "request_reason_for_service_code_6": "string",
- "request_reason_for_service_code_7": "string",
- "request_reason_for_service_code_8": "string",
- "request_reason_for_service_code_9": "string",
- "result_of_service_code_1": "string",
- "result_of_service_code_2": "string",
- "result_of_service_code_3": "string",
- "result_of_service_code_4": "string",
- "result_of_service_code_5": "string",
- "result_of_service_code_6": "string",
- "result_of_service_code_7": "string",
- "result_of_service_code_8": "string",
- "result_of_service_code_9": "string",
- "specialty_list_dispensing_fee": "string",
- "specialty_list_id": 0,
- "specialty_list_name": "string",
- "dmr_pay_to_city_address": "string",
- "dmr_pay_to_country_code": "string",
- "dmr_pay_to_name": "string",
- "dmr_pay_to_state_province_address": "string",
- "dmr_pay_to_street_address_line_1": "string",
- "dmr_pay_to_street_address_line_2": "string",
- "dmr_pay_to_tax_id": "string",
- "dmr_pay_to_vendor_id": "string",
- "dmr_pay_to_zip_postal_code": "string",
- "dmr_pay_to_check_eft_number": "string",
- "dmr_pay_to_date": "string",
- "tax_id_number": "string",
- "reasons_for_rejection": [
- "string"
], - "reasons_for_adjudication": [
- "string"
], - "reasons_for_adjudication_sections": null,
- "patient_pay_reduction_due_to_point_of_service_rebate": 0,
- "plan_pay_reduction_due_to_point_of_service_rebate": 0,
- "point_of_service_rebate_amount": 0,
- "low_income_subsidy_level": "string",
- "senior_savings_model_cost_share_reduction_gap": 0,
- "senior_savings_model_cost_share_reduction_non_gap": 0,
- "senior_savings_model_indicator": "string",
- "inflation_reduction_act_subsidy_amount": 0,
- "inflation_reduction_act_covered_vaccine": "string",
- "inflation_reduction_act_covered_insulin": "string",
- "other_true_out_of_pocket_amount_indicator": "string",
- "medicare_amounts_id": 0,
- "low_income_subsidy_amounts_id": 0,
- "medicare_medicaid_dsnp_co_administered_plan": "string",
- "dsnp_fee_for_service_or_capitation": 0,
- "dsnp_medicaid_cost_share_reduction_amount_part_d": 0,
- "dsnp_medicaid_cost_share_reduction_amount_part_b": 0,
- "dsnp_medicaid_cost_share_covered_excluded_reduction_amount": 0,
- "is_340b": true,
- "medicare_administrative_claim": "string",
- "controlled_substance_code": "string",
- "desi_code": "string",
- "batch_test_claims_file_id": 0,
- "reprocessing_id": 0,
- "reprocessing_type": "string",
- "reprocessing_patient_pay_difference": "string",
- "reprocessing_pharmacy_pay_amount": "string",
- "reprocessing_plan_pay_amount": "string",
- "reprocessing_goes_to_835": true,
- "reprocessing_goes_to_invoice": true,
- "reprocessing_is_member_recoupment": true,
- "nx_other_payers_total_amount": "string",
- "reprocessing_nx_amount_applied_to_patient_pay": "string",
- "reprocessing_excess_nx_amount_total": "string",
- "reprocessing_patient_pay_net_nx": "string",
- "reprocessing_member_refund_amount": "string",
- "reprocessing_member_recoupment_amount": "string",
- "reprocessing_is_recoup_ltc_pharmacy": true,
- "notes": "string",
- "first_claim_id": 0,
- "next_claim_id": 0,
- "include_raw_request_parsed": true,
- "include_raw_response_parsed": true,
- "manufacturer_discount_amount": 0,
- "is_manufacturer_discount_drug": true,
- "is_maximum_fair_price_selected_drug": true,
- "maximum_fair_price_ndc_11_package_price": 0,
- "maximum_fair_price_ndc_9_unit_price": 0,
- "maximum_fair_price_selected_drug_subsidy": 0,
- "maximum_fair_price_thiry_day_equivalent": 0,
- "claim_number": "string",
- "claim_sequence_number": "string",
- "medicare_prescription_payment_plan_indicator": "string",
- "medicare_prescription_payment_plan_original_claim_id": 0,
- "pharmacy_transaction_fee": 0,
- "vbid_cost_share_reduction_amount_part_d": 0,
- "vbid_model_indicator": "string",
- "pricing_level_ids": [
- 0
], - "is_parallel_validation": true,
- "calculated_spread_data": null,
- "level_1_basis_of_reimbursement": "string",
- "level_2_basis_of_reimbursement": "string",
- "level_3_basis_of_reimbursement": "string",
- "primary_plan_original_claim_id": 0,
- "is_wrap_benefit": true,
- "column_masks": null,
- "global_management_program_ids": [
- 0
], - "originator": "string",
- "benefit_categories": [
- "string"
], - "drug_lists": null,
- "brand_name_code": "string",
- "drug_descriptor_id": "string",
- "dosage": "string",
- "dosage_form": "string",
- "dosage_form_packaging": "string",
- "drug_name": "string",
- "drug_type": "string",
- "group_name": "string",
- "provider_phone": "string",
- "most_expensive_compound_ingredient_ndc": "string",
- "multi_source": "string",
- "name_type_code": "string",
- "rx_otc_indicator_code": "string",
- "strength": "string",
- "strength_unit_of_measure": "string",
- "pde_record_id": "string",
- "pde_claim_control_number": "string",
- "pde_plan_benefit_package_id": "string",
- "medicare_prescription_payment_plan_claim_id": 0,
- "medicare_prescription_payment_plan_claim_amount": 0,
- "claim_gpi": "string",
- "identity": "string",
- "over_reimbursement_indicator": true,
- "accumulation_adjustment_ids": [
- 0
]
}
}
], - "result_count": "string"
}| page_number | integer or null <int32> The page of results you would like to get. For the first page, pass |
| results_per_page | integer or null <int32> The number of results per page. |
| expected_fields | Array of strings or null or null The desired list of fields to be returned. |
required | Array of objects (MemberIdentifierSchema_1764643208.4262812) |
| claim_statuses required | Array of strings or null or null Enum: "P" "R" |
| claim_sources | Array of strings or null or null |
| start_date_of_service | string or null <ArrowDateTime> Date of service to filter (inclusive >=) |
| end_date_of_service | string or null <ArrowDateTime> Date of service to filter (inclusive <=) |
| month | integer or null <int32> Month to filter by as integer |
| year | integer or null <int32> Year to filter by as integer |
| year_to_date | boolean or null Should filter by year to date. |
| add_pharmacy_data | boolean or null Boolean to return pharmacy details from ncpdp_providers |
| only_fields | Array of strings or null or null |
| custom_filters | Array of strings or null or null |
| full_text_search | string or null The full text search for claims by product_service_description, date of service, and pharmacy name |
| reject_codes | Array of strings or null or null |
Array of objects or null (OrderBySchema_1764643208.4167695) |
{- "page_number": 0,
- "results_per_page": 0,
- "expected_fields": [
- "string"
], - "member_list": [
- {
- "client_id": "string",
- "external_member_id": "string",
- "person_code": "string",
- "external_group_id": "string",
- "external_account_id": "string"
}
], - "claim_statuses": [
- "P"
], - "claim_sources": [
- "string"
], - "start_date_of_service": "string",
- "end_date_of_service": "string",
- "month": 0,
- "year": 0,
- "year_to_date": true,
- "add_pharmacy_data": true,
- "only_fields": [
- "string"
], - "custom_filters": [
- "string"
], - "full_text_search": "string",
- "reject_codes": [
- "string"
], - "order_by": [
- {
- "id": "string",
- "client_id": "string",
- "external_group_id": "string",
- "date_of_service": "string",
- "claim_submission_date": "string",
- "claim_status": "string",
- "received_at": "string",
- "source": "string",
- "external_member_id": "string",
- "person_code": "string",
- "first_name": "string",
- "last_name": "string",
- "plan_benefit_id": "string",
- "formulary_id": "string",
- "network_id": "string",
- "service_provider_id": "string",
- "pharmacy_nabp": "string",
- "cardholder_first_name": "string",
- "cardholder_last_name": "string",
- "plan_id": "string",
- "group_id": "string",
- "date_of_birth": "string",
- "patient_first_name": "string",
- "patient_last_name": "string",
- "prescription_service_reference_number": "string",
- "ndc": "string",
- "quantity_dispensed": "string",
- "fill_number": "string",
- "days_supply": "string",
- "compound_code": "string",
- "daw": "string",
- "prior_authorization_type_code": "string",
- "prior_authorization_id_submitted": "string",
- "pharmacy_service_type": "string",
- "ingredient_cost_submitted": "string",
- "dispensing_fee_submitted": "string",
- "patient_pay_amount_reported": "string",
- "incentive_amount_submitted": "string",
- "other_amount_claimed_submitted_1": "string",
- "other_amount_claimed_submitted_2": "string",
- "other_amount_claimed_submitted_3": "string",
- "regulatory_fee_type_code_submitted_1": "string",
- "regulatory_fee_amount_submitted_1": "string",
- "regulatory_fee_type_code_submitted_2": "string",
- "regulatory_fee_amount_submitted_2": "string",
- "regulatory_fee_type_code_submitted_3": "string",
- "regulatory_fee_amount_submitted_3": "string",
- "percentage_tax_amount_submitted": "string",
- "percentage_tax_rate_submitted": "string",
- "percentage_tax_basis_submitted": "string",
- "usual_and_customary_charge": "string",
- "gross_amount_due": "string",
- "basis_of_cost_determination": "string",
- "provider_id": "string",
- "provider_last_name": "string",
- "prescriber_id": "string",
- "prescriber_last_name": "string",
- "header_response_status": "string",
- "response_transaction_code": "string",
- "transaction_response_status": "string",
- "reject_code_1": "string",
- "reject_code_2": "string",
- "reject_code_3": "string",
- "reject_code_4": "string",
- "reject_code_5": "string",
- "next_available_fill_date": "string",
- "ingredient_cost_charged_to_plan": "string",
- "dispensing_fee_charged_to_plan": "string",
- "product_service_classification": "string",
- "product_service_description": "string",
- "total_amount_paid": "string",
- "patient_pay_amount": "string",
- "patient_pay_component_amount_1": "string",
- "patient_pay_component_amount_2": "string",
- "patient_pay_component_amount_3": "string",
- "plan_pay_amount": "string",
- "amount_applied_to_periodic_deductible": "string",
- "amount_applied_to_periodic_maximum_benefit": "string",
- "amount_applied_to_periodic_maximum_out_of_pocket": "string",
- "amount_applied_to_periodic_maximum_fertility": "string",
- "amount_exceeding_periodic_fertility_maximum": "string",
- "amount_attributed_to_product_selection_brand_drug": "string",
- "amount_attributed_to_percentage_tax": "string",
- "amount_exceeding_periodic_benefit_maximum": "string",
- "amount_of_copay": "string",
- "amount_of_coinsurance": "string",
- "amount_attributed_to_product_selection_non_preferred": "string",
- "amount_attributed_to_health_plan_assistance": "string",
- "amount_attributed_to_provider_network_selection": "string",
- "amount_attributed_to_product_selection_brand_non_preferred": "string",
- "amount_attributed_to_coverage_gap": "string",
- "amount_attributed_to_processor_fee": "string",
- "amount_attributed_to_grace_period": "string",
- "amount_attributed_to_catastrophic_benefit": "string",
- "amount_attributed_to_regulatory_fee": "string",
- "ingredient_cost_paid": "string",
- "dispensing_fee_paid": "string",
- "percentage_tax_exempt_indicator": "string",
- "regulatory_fee_amount_paid_1": "string",
- "regulatory_fee_amount_paid_2": "string",
- "regulatory_fee_amount_paid_3": "string",
- "percentage_tax_amount_paid": "string",
- "percentage_tax_rate_paid": "string",
- "other_amount_paid_qualifier_1": "string",
- "other_amount_paid_1": "string",
- "other_amount_paid_qualifier_2": "string",
- "other_amount_paid_2": "string",
- "other_amount_paid_qualifier_3": "string",
- "other_amount_paid_3": "string",
- "other_payer_amount_recognized": "string",
- "basis_of_reimbursement_determination": "string",
- "basis_of_calculation_dispensing_fee": "string",
- "basis_of_calculation_copay": "string",
- "basis_of_calculation_coinsurance": "string",
- "basis_of_calculation_regulatory_fee": "string",
- "basis_of_calculation_percentage_tax": "string",
- "basis_of_days_supply_determination": "string",
- "accumulated_deductible_amount": "string",
- "remaining_deductible_amount": "string",
- "remaining_benefit_amount": "string",
- "patient_percentage_tax_amount": "string",
- "patient_regulatory_fee_amount": "string",
- "estimated_generic_savings": "string",
- "reason_for_service_code_1": "string",
- "previous_date_of_fill_1": "string",
- "quantity_of_previous_fill_1": "string",
- "reason_for_service_code_2": "string",
- "previous_date_of_fill_2": "string",
- "quantity_of_previous_fill_2": "string",
- "reason_for_service_code_3": "string",
- "previous_date_of_fill_3": "string",
- "quantity_of_previous_fill_3": "string",
- "direct_member_reimbursement_indicator": "string",
- "drug_name": "string",
- "pharmacy_name": "string",
- "reprocessing_id": "string",
- "original_claim_id": "string",
- "first_claim_id": "string",
- "claim_number": "string",
- "claim_sequence_number": "string"
}
]
}{- "results": [
- {
- "claim": {
- "id": 0,
- "rn": "string",
- "reversal_id": 0,
- "reverses_id": 0,
- "original_claim_id": 0,
- "client_id": "string",
- "external_account_id": "string",
- "external_group_id": "string",
- "provider_agreement_id": 0,
- "coverage_strategy_id": "string",
- "date_of_service": "string",
- "claim_submission_date": "string",
- "claim_payment_cycle_end_date": "string",
- "claim_reimbursement_cycle_end_date": "string",
- "claim_status": "string",
- "claim_count": 0,
- "received_at": "string",
- "source": "string",
- "external_member_id": "string",
- "person_code": "string",
- "first_name": "string",
- "last_name": "string",
- "coverage_strategy_type": "string",
- "plan_benefit_id": 0,
- "formulary_id": 0,
- "network_id": 0,
- "benefit_network": "string",
- "gpi": "string",
- "pharmacy_nabp": "string",
- "pharmacy_name": "string",
- "pharmacy_channel": "string",
- "version_release_number": "string",
- "request_transaction_code": "string",
- "bin_number": "string",
- "processor_control_number": "string",
- "transaction_count": "string",
- "service_provider_id_qualifier": "string",
- "service_provider_id": "string",
- "software_vendor_certification_id": "string",
- "submitted_cardholder_id": "string",
- "cardholder_first_name": "string",
- "cardholder_last_name": "string",
- "plan_id": "string",
- "eligibility_clarification_code": "string",
- "group_id": "string",
- "submitted_person_code": "string",
- "patient_relationship_code": "string",
- "medigap_id": "string",
- "medicaid_indicator": "string",
- "provider_accept_assignment_indicator": "string",
- "cms_part_d_defined_qualified_facility": "string",
- "medicaid_id_number": "string",
- "patient_id_qualifier": "string",
- "patient_id": "string",
- "date_of_birth": "string",
- "patient_gender_code": "string",
- "patient_first_name": "string",
- "patient_last_name": "string",
- "patient_street_address": "string",
- "patient_street_address_line_1": "string",
- "patient_street_address_line_2": "string",
- "patient_city_address": "string",
- "patient_state_province_address": "string",
- "patient_zip_postal_code": "string",
- "patient_country_code": "string",
- "patient_telephone_number": "string",
- "place_of_service": "string",
- "employer_id": "string",
- "pregnancy_indicator": "string",
- "patient_email_address": "user@example.com",
- "patient_residence": "string",
- "prescription_service_reference_number_qualifier": "string",
- "prescription_service_reference_number": "string",
- "product_service_id_qualifier": "string",
- "ndc": "string",
- "associated_prescription_service_reference_number": "string",
- "associated_prescription_service_date": "string",
- "procedure_modifier_code_1": "string",
- "procedure_modifier_code_2": "string",
- "procedure_modifier_code_3": "string",
- "procedure_modifier_code_4": "string",
- "procedure_modifier_code_5": "string",
- "procedure_modifier_code_6": "string",
- "procedure_modifier_code_7": "string",
- "procedure_modifier_code_8": "string",
- "procedure_modifier_code_9": "string",
- "procedure_modifier_code_10": "string",
- "quantity_dispensed": "string",
- "fill_number": 0,
- "days_supply": 0,
- "compound_code": "string",
- "daw": "string",
- "date_prescription_written": "string",
- "number_of_refills_authorized": 0,
- "prescription_origin_code": "string",
- "submission_clarification_code_1": "string",
- "submission_clarification_code_2": "string",
- "submission_clarification_code_3": "string",
- "submission_clarification_code_4": "string",
- "submission_clarification_code_5": "string",
- "submission_clarification_code_pde": "string",
- "submission_type_code_1": "string",
- "submission_type_code_2": "string",
- "submission_type_code_3": "string",
- "submission_type_code_4": "string",
- "submission_type_code_5": "string",
- "quantity_prescribed": "string",
- "multiple_prescription_service_order_group_id": "string",
- "multiple_prescription_service_order_group_reason_code": "string",
- "total_prescribed_quantity_remaining": "string",
- "other_coverage_code": "string",
- "special_packaging_indicator": "string",
- "originally_prescribed_product_service_id_qualifier": "string",
- "originally_prescribed_product_service_code": "string",
- "originally_prescribed_quantity": "string",
- "scheduled_prescription_id_number": "string",
- "unit_of_measure": "string",
- "level_of_service": "string",
- "prior_authorization_type_code": "string",
- "prior_authorization_id_submitted": "string",
- "dispensing_status": "string",
- "quantity_intended_to_be_dispensed": "string",
- "days_supply_intended_to_be_dispensed": 0,
- "delay_reason_code": "string",
- "patient_assignment_indicator": "string",
- "route_of_administration": "string",
- "compound_type": "string",
- "preparation_environment_type": "string",
- "preparation_environment_event_code": "string",
- "pharmacy_service_type": "string",
- "associated_prescription_service_reference_number_qualifier": "string",
- "associated_prescription_service_fill_number": 0,
- "original_manufacturer_product_id_qualifier": "string",
- "original_manufacturer_product_id": "string",
- "ltpac_dispense_frequency": "string",
- "ltpac_billing_methodology": "string",
- "number_of_ltpac_dispensing_events": 0,
- "do_not_dispense_before_date": "string",
- "ingredient_cost_submitted": "string",
- "dispensing_fee_submitted": "string",
- "patient_pay_amount_reported": "string",
- "incentive_amount_submitted": "string",
- "other_amount_claimed_submitted_qualifier_1": "string",
- "other_amount_claimed_submitted_1": "string",
- "other_amount_claimed_submitted_qualifier_2": "string",
- "other_amount_claimed_submitted_2": "string",
- "other_amount_claimed_submitted_qualifier_3": "string",
- "other_amount_claimed_submitted_3": "string",
- "regulatory_fee_type_code_submitted_1": "string",
- "regulatory_fee_amount_submitted_1": "string",
- "regulatory_fee_type_code_submitted_2": "string",
- "regulatory_fee_amount_submitted_2": "string",
- "regulatory_fee_type_code_submitted_3": "string",
- "regulatory_fee_amount_submitted_3": "string",
- "percentage_tax_amount_submitted": "string",
- "percentage_tax_rate_submitted": "string",
- "percentage_tax_basis_submitted": "string",
- "usual_and_customary_charge": "string",
- "gross_amount_due": "string",
- "basis_of_cost_determination": "string",
- "provider_id_qualifier": "string",
- "provider_id": "string",
- "provider_first_name": "string",
- "provider_last_name": "string",
- "prescriber_id_qualifier": "string",
- "prescriber_id": "string",
- "prescriber_last_name": "string",
- "prescriber_telephone_number": "string",
- "prescriber_telephone_number_extension": "string",
- "primary_care_provider_id_qualifier": "string",
- "primary_care_provider_id": "string",
- "primary_care_provider_last_name": "string",
- "prescriber_first_name": "string",
- "prescriber_street_address": "string",
- "prescriber_street_address_line_1": "string",
- "prescriber_street_address_line_2": "string",
- "prescriber_city_address": "string",
- "prescriber_state_province_address": "string",
- "prescriber_zip_postal_code": "string",
- "prescriber_country_code": "string",
- "prescriber_dea_number": "string",
- "prescriber_place_of_service": "string",
- "compound_prices": null,
- "compound_dosage_form_description_code": "string",
- "compound_dispensing_unit_form_indicator": "string",
- "compound_ingredient_component_count": 0,
- "compound_product_id_qualifier_1": "string",
- "compound_product_id_1": "string",
- "compound_ingredient_quantity_1": "string",
- "compound_product_id_qualifier_2": "string",
- "compound_product_id_2": "string",
- "compound_ingredient_quantity_2": "string",
- "compound_product_id_qualifier_3": "string",
- "compound_product_id_3": "string",
- "compound_ingredient_quantity_3": "string",
- "compound_product_id_qualifier_4": "string",
- "compound_product_id_4": "string",
- "compound_ingredient_quantity_4": "string",
- "compound_product_id_qualifier_5": "string",
- "compound_product_id_5": "string",
- "compound_ingredient_quantity_5": "string",
- "compound_product_id_qualifier_6": "string",
- "compound_product_id_6": "string",
- "compound_ingredient_quantity_6": "string",
- "compound_product_id_qualifier_7": "string",
- "compound_product_id_7": "string",
- "compound_ingredient_quantity_7": "string",
- "compound_product_id_qualifier_8": "string",
- "compound_product_id_8": "string",
- "compound_ingredient_quantity_8": "string",
- "compound_product_id_qualifier_9": "string",
- "compound_product_id_9": "string",
- "compound_ingredient_quantity_9": "string",
- "compound_product_id_qualifier_10": "string",
- "compound_product_id_10": "string",
- "compound_ingredient_quantity_10": "string",
- "compound_product_id_qualifier_11": "string",
- "compound_product_id_11": "string",
- "compound_ingredient_quantity_11": "string",
- "compound_product_id_qualifier_12": "string",
- "compound_product_id_12": "string",
- "compound_ingredient_quantity_12": "string",
- "compound_product_id_qualifier_13": "string",
- "compound_product_id_13": "string",
- "compound_ingredient_quantity_13": "string",
- "compound_product_id_qualifier_14": "string",
- "compound_product_id_14": "string",
- "compound_ingredient_quantity_14": "string",
- "compound_product_id_qualifier_15": "string",
- "compound_product_id_15": "string",
- "compound_ingredient_quantity_15": "string",
- "compound_product_id_qualifier_16": "string",
- "compound_product_id_16": "string",
- "compound_ingredient_quantity_16": "string",
- "compound_product_id_qualifier_17": "string",
- "compound_product_id_17": "string",
- "compound_ingredient_quantity_17": "string",
- "compound_product_id_qualifier_18": "string",
- "compound_product_id_18": "string",
- "compound_ingredient_quantity_18": "string",
- "compound_product_id_qualifier_19": "string",
- "compound_product_id_19": "string",
- "compound_ingredient_quantity_19": "string",
- "compound_product_id_qualifier_20": "string",
- "compound_product_id_20": "string",
- "compound_ingredient_quantity_20": "string",
- "compound_product_id_qualifier_21": "string",
- "compound_product_id_21": "string",
- "compound_ingredient_quantity_21": "string",
- "compound_product_id_qualifier_22": "string",
- "compound_product_id_22": "string",
- "compound_ingredient_quantity_22": "string",
- "compound_product_id_qualifier_23": "string",
- "compound_product_id_23": "string",
- "compound_ingredient_quantity_23": "string",
- "compound_product_id_qualifier_24": "string",
- "compound_product_id_24": "string",
- "compound_ingredient_quantity_24": "string",
- "compound_product_id_qualifier_25": "string",
- "compound_product_id_25": "string",
- "compound_ingredient_quantity_25": "string",
- "diagnosis_code_qualifier_1": "string",
- "diagnosis_code_1": "string",
- "diagnosis_code_qualifier_2": "string",
- "diagnosis_code_2": "string",
- "diagnosis_code_qualifier_3": "string",
- "diagnosis_code_3": "string",
- "diagnosis_code_qualifier_4": "string",
- "diagnosis_code_4": "string",
- "diagnosis_code_qualifier_5": "string",
- "diagnosis_code_5": "string",
- "header_response_status": "string",
- "response_transaction_code": "string",
- "response_message": "string",
- "response_group_id": "string",
- "response_plan_id": "string",
- "response_cob": null,
- "network_reimbursement_id": "string",
- "external_provider_agreement_id": "string",
- "payer_health_plan_id_qualifier": "string",
- "payer_health_plan_id": "string",
- "payer_health_plan_id_qualifier_1": "string",
- "payer_health_plan_id_1": "string",
- "payer_health_plan_id_qualifier_2": "string",
- "payer_health_plan_id_2": "string",
- "payer_health_plan_id_qualifier_3": "string",
- "payer_health_plan_id_3": "string",
- "transaction_response_status": "string",
- "authorization_number": "string",
- "reconciliation_id": "string",
- "reject_code_1": "string",
- "reject_code_2": "string",
- "reject_code_3": "string",
- "reject_code_4": "string",
- "reject_code_5": "string",
- "approved_message_code_1": "string",
- "approved_message_code_2": "string",
- "approved_message_code_3": "string",
- "approved_message_code_4": "string",
- "approved_message_code_5": "string",
- "additional_message_count": 0,
- "additional_message_information_qualifier_1": "string",
- "additional_message_information_1": "string",
- "additional_message_information_continuity_1": "string",
- "additional_message_information_qualifier_2": "string",
- "additional_message_information_2": "string",
- "additional_message_information_continuity_2": "string",
- "additional_message_information_qualifier_3": "string",
- "additional_message_information_3": "string",
- "additional_message_information_continuity_3": "string",
- "additional_message_information_qualifier_4": "string",
- "additional_message_information_4": "string",
- "additional_message_information_continuity_4": "string",
- "additional_message_information_qualifier_5": "string",
- "additional_message_information_5": "string",
- "additional_message_information_continuity_5": "string",
- "additional_message_information_qualifier_6": "string",
- "additional_message_information_6": "string",
- "additional_message_information_continuity_6": "string",
- "additional_message_information_qualifier_7": "string",
- "additional_message_information_7": "string",
- "additional_message_information_continuity_7": "string",
- "additional_message_information_qualifier_8": "string",
- "additional_message_information_8": "string",
- "additional_message_information_continuity_8": "string",
- "additional_message_information_qualifier_9": "string",
- "additional_message_information_9": "string",
- "additional_message_information_continuity_9": "string",
- "additional_message_information_qualifier_10": "string",
- "additional_message_information_10": "string",
- "additional_message_information_continuity_10": "string",
- "additional_message_information_qualifier_11": "string",
- "additional_message_information_11": "string",
- "additional_message_information_continuity_11": "string",
- "additional_message_information_qualifier_12": "string",
- "additional_message_information_12": "string",
- "additional_message_information_continuity_12": "string",
- "additional_message_information_qualifier_13": "string",
- "additional_message_information_13": "string",
- "additional_message_information_continuity_13": "string",
- "additional_message_information_qualifier_14": "string",
- "additional_message_information_14": "string",
- "additional_message_information_continuity_14": "string",
- "additional_message_information_qualifier_15": "string",
- "additional_message_information_15": "string",
- "additional_message_information_continuity_15": "string",
- "additional_message_information_qualifier_16": "string",
- "additional_message_information_16": "string",
- "additional_message_information_continuity_16": "string",
- "additional_message_information_qualifier_17": "string",
- "additional_message_information_17": "string",
- "additional_message_information_continuity_17": "string",
- "additional_message_information_qualifier_18": "string",
- "additional_message_information_18": "string",
- "additional_message_information_continuity_18": "string",
- "additional_message_information_qualifier_19": "string",
- "additional_message_information_19": "string",
- "additional_message_information_continuity_19": "string",
- "additional_message_information_qualifier_20": "string",
- "additional_message_information_20": "string",
- "additional_message_information_continuity_20": "string",
- "internal_control_number": "string",
- "adjudicated_program_type": "string",
- "next_available_fill_date": "string",
- "formulary_alternative_product_count": 0,
- "formulary_alternative_plan_benefit_tier_1": "string",
- "formulary_alternative_reason_code_1": "string",
- "formulary_alternative_id_qualifier_1": "string",
- "formulary_alternative_id_1": "string",
- "formulary_alternative_incentive_1": "string",
- "formulary_alternative_cost_share_incentive_1": "string",
- "formulary_alternative_description_1": "string",
- "formulary_alternative_plan_benefit_tier_2": "string",
- "formulary_alternative_reason_code_2": "string",
- "formulary_alternative_id_qualifier_2": "string",
- "formulary_alternative_id_2": "string",
- "formulary_alternative_incentive_2": "string",
- "formulary_alternative_cost_share_incentive_2": "string",
- "formulary_alternative_description_2": "string",
- "formulary_alternative_plan_benefit_tier_3": "string",
- "formulary_alternative_reason_code_3": "string",
- "formulary_alternative_id_qualifier_3": "string",
- "formulary_alternative_id_3": "string",
- "formulary_alternative_incentive_3": "string",
- "formulary_alternative_cost_share_incentive_3": 0,
- "formulary_alternative_description_3": "string",
- "plan_benefit_override_indicator": "string",
- "plan_benefit_override_value_1": "string",
- "plan_benefit_override_value_2": "string",
- "plan_benefit_override_value_3": "string",
- "plan_benefit_override_value_4": "string",
- "plan_benefit_override_value_5": "string",
- "plan_benefit_override_value_6": "string",
- "plan_benefit_override_value_7": "string",
- "plan_benefit_override_value_8": "string",
- "plan_benefit_override_value_9": "string",
- "maximum_age_qualifier": "string",
- "maximum_age": 0,
- "minimum_age_qualifier": "string",
- "minimum_age": 0,
- "minimum_amount_qualifier": "string",
- "minimum_amount": "string",
- "maximum_amount_qualifier": "string",
- "maximum_amount": "string",
- "maximum_amount_time_period": "string",
- "maximum_amount_time_period_end_date": "string",
- "maximum_amount_time_period_start_date": "string",
- "maximum_amount_time_period_units": "string",
- "remaining_amount_qualifier": "string",
- "remaining_amount": "string",
- "benefit_type_opportunity_count": 0,
- "benefit_type_opportunity_1": "string",
- "benefit_type_opportunity_2": "string",
- "benefit_type_opportunity_3": "string",
- "direct_member_reimbursement_indicator": "string",
- "ingredient_cost_charged_to_plan": "string",
- "dispensing_fee_charged_to_plan": "string",
- "product_service_classification": "string",
- "product_service_specialty_indication": "string",
- "product_service_description": "string",
- "mac_price_per_unit": "string",
- "specialty_price_per_unit": "string",
- "awp_per_unit": "string",
- "total_awp": "string",
- "wac_per_unit": "string",
- "total_wac": "string",
- "total_amount_paid": "string",
- "patient_pay_amount": "string",
- "patient_pay_component_qualifier_1": "string",
- "patient_pay_component_amount_1": "string",
- "patient_pay_component_qualifier_2": "string",
- "patient_pay_component_amount_2": "string",
- "patient_pay_component_qualifier_3": "string",
- "patient_pay_component_amount_3": "string",
- "plan_pay_amount": "string",
- "amount_exceeding_periodic_deductible": "string",
- "remaining_out_of_pocket_maximum_amount": "string",
- "amount_exceeding_periodic_maximum_out_of_pocket": "string",
- "remaining_category_out_of_pocket_maximum_amount_1": "string",
- "amount_exceeding_periodic_maximum_category_out_of_pocket_1": "string",
- "amount_applied_to_periodic_deductible": "string",
- "amount_applied_to_periodic_overall_deductible": "string",
- "amount_applied_to_periodic_category_deductible_1": "string",
- "amount_applied_to_periodic_maximum_benefit": "string",
- "amount_applied_to_periodic_maximum_out_of_pocket": "string",
- "amount_applied_to_periodic_maximum_category_out_of_pocket_1": "string",
- "amount_applied_to_periodic_maximum_fertility": "string",
- "amount_exceeding_periodic_fertility_maximum": "string",
- "amount_attributed_to_product_selection_brand_drug": "string",
- "amount_attributed_to_percentage_tax": "string",
- "amount_exceeding_periodic_benefit_maximum": "string",
- "amount_applied_to_cob_plan_maximum": "string",
- "remaining_cob_plan_maximum_amount": "string",
- "amount_exceeding_cob_plan_maximum": "string",
- "amount_of_coinsurance_exceeding_cob_plan_maximum": "string",
- "amount_of_manufacturer_assistance": "string",
- "anti_accumulation_indicator": "string",
- "copay_maximizer_standard_benefit_patient_pay_amount": "string",
- "amount_of_copay": "string",
- "amount_of_coinsurance": "string",
- "amount_attributed_to_product_selection_non_preferred": "string",
- "amount_attributed_to_health_plan_assistance": "string",
- "amount_attributed_to_provider_network_selection": "string",
- "amount_attributed_to_product_selection_brand_non_preferred": "string",
- "amount_attributed_to_coverage_gap": "string",
- "amount_attributed_to_processor_fee": "string",
- "amount_attributed_to_grace_period": "string",
- "amount_attributed_to_catastrophic_benefit": "string",
- "amount_attributed_to_regulatory_fee": "string",
- "ingredient_cost_paid": "string",
- "dispensing_fee_paid": "string",
- "percentage_tax_exempt_indicator": "string",
- "regulatory_fee_amount_paid": "string",
- "regulatory_fee_type_code_1": "string",
- "regulatory_fee_exempt_indicator_1": "string",
- "regulatory_fee_amount_paid_1": "string",
- "regulatory_fee_type_code_2": "string",
- "regulatory_fee_exempt_indicator_2": "string",
- "regulatory_fee_amount_paid_2": "string",
- "regulatory_fee_type_code_3": "string",
- "regulatory_fee_exempt_indicator_3": "string",
- "regulatory_fee_amount_paid_3": "string",
- "percentage_tax_amount_paid": "string",
- "percentage_tax_rate_paid": "string",
- "percentage_tax_basis_paid": "string",
- "incentive_amount_paid": "string",
- "professional_service_fee_paid": "string",
- "other_amount_paid_qualifier_1": "string",
- "other_amount_paid_1": 0,
- "other_amount_paid_qualifier_2": "string",
- "other_amount_paid_2": 0,
- "other_amount_paid_qualifier_3": "string",
- "other_amount_paid_3": 0,
- "other_payer_amount_recognized": "string",
- "basis_of_reimbursement_determination": "string",
- "benefit_stage_qualifier_1": "string",
- "benefit_stage_qualifier_2": "string",
- "benefit_stage_qualifier_3": "string",
- "benefit_stage_qualifier_4": "string",
- "benefit_stage_amount_1": "string",
- "benefit_stage_amount_2": "string",
- "benefit_stage_amount_3": "string",
- "benefit_stage_amount_4": "string",
- "basis_of_calculation_dispensing_fee": "string",
- "basis_of_calculation_copay": "string",
- "basis_of_calculation_coinsurance": "string",
- "basis_of_calculation_regulatory_fee": "string",
- "basis_of_calculation_percentage_tax": "string",
- "basis_of_days_supply_determination": "string",
- "accumulated_deductible_amount": "string",
- "remaining_deductible_amount": "string",
- "remaining_benefit_amount": "string",
- "spending_account_amount_remaining": "string",
- "patient_percentage_tax_amount": "string",
- "patient_regulatory_fee_amount": "string",
- "estimated_generic_savings": "string",
- "ingredient_cost_contracted_reimbursable_amount": "string",
- "dispensing_fee_contracted_reimbursable_amount": "string",
- "reason_for_service_code_1": "string",
- "clinical_significance_code_1": "string",
- "other_pharmacy_indicator_1": "string",
- "previous_date_of_fill_1": "string",
- "quantity_of_previous_fill_1": "string",
- "database_indicator_1": "string",
- "other_prescriber_indicator_1": "string",
- "dur_free_text_message_1": "string",
- "dur_additional_text_1": "string",
- "reason_for_service_code_2": "string",
- "clinical_significance_code_2": "string",
- "other_pharmacy_indicator_2": "string",
- "previous_date_of_fill_2": "string",
- "quantity_of_previous_fill_2": "string",
- "database_indicator_2": "string",
- "other_prescriber_indicator_2": "string",
- "dur_free_text_message_2": "string",
- "dur_additional_text_2": "string",
- "reason_for_service_code_3": "string",
- "reason_for_service_code_4": "string",
- "reason_for_service_code_5": "string",
- "reason_for_service_code_6": "string",
- "reason_for_service_code_7": "string",
- "reason_for_service_code_8": "string",
- "reason_for_service_code_9": "string",
- "clinical_significance_code_3": "string",
- "other_pharmacy_indicator_3": "string",
- "previous_date_of_fill_3": "string",
- "quantity_of_previous_fill_3": "string",
- "database_indicator_3": "string",
- "other_prescriber_indicator_3": "string",
- "dur_free_text_message_3": "string",
- "dur_additional_text_3": "string",
- "dur_pps_level_of_effort_1": "string",
- "dur_pps_level_of_effort_2": "string",
- "dur_pps_level_of_effort_3": "string",
- "dur_pps_level_of_effort_4": "string",
- "dur_pps_level_of_effort_5": "string",
- "dur_pps_level_of_effort_6": "string",
- "dur_pps_level_of_effort_7": "string",
- "dur_pps_level_of_effort_8": "string",
- "dur_pps_level_of_effort_9": "string",
- "aws_region": "string",
- "log_group_name": "string",
- "log_stream_name": "string",
- "aws_request_id": "string",
- "log_key": "string",
- "raw_request": "string",
- "raw_response": "string",
- "raw_request_parsed": null,
- "raw_response_parsed": null,
- "relationship_code": "string",
- "overrides": [
- 0
], - "prior_authorizations": [
- 0
], - "tags": [
- 0
], - "finance_835_record_id": 0,
- "finished_at": "string",
- "formulary_name": "string",
- "formulary_tier": "string",
- "nadac_per_unit": 0,
- "nadac_plus_ndc": "string",
- "nadac_plus_per_unit": 0,
- "relationship_id": "string",
- "ncpdp_relationship_id": "string",
- "affiliation_relationship_id": "string",
- "parent_organization_id": "string",
- "remit_and_reconciliation_id": "string",
- "payment_center_id": "string",
- "rx_cap_flag": "string",
- "rx_cap_plus_flag": "string",
- "total_mac_list": 0,
- "total_nadac": 0,
- "total_nadac_plus": 0,
- "total_specialty_list": 0,
- "external_invoice_id": 0,
- "pde_id": 0,
- "pde_status": "string",
- "pde_cms_calculated_gap_discount": 0,
- "pde_plan_benefit_package_id_of_record": "string",
- "pde_alternate_service_provider_id_qualifier": "string",
- "pde_alternate_service_provider_id": "string",
- "pde_original_submitting_contract": "string",
- "pde_plan_to_plan_contract_of_record": "string",
- "pde_corrected_medicare_beneficiary_identifier": "string",
- "pde_error_count": 0,
- "pde_error_1": "string",
- "pde_error_2": "string",
- "pde_error_3": "string",
- "pde_error_4": "string",
- "pde_error_5": "string",
- "pde_error_6": "string",
- "pde_error_7": "string",
- "pde_error_8": "string",
- "pde_error_9": "string",
- "pde_error_10": "string",
- "pde_exclusion_reason_code": "string",
- "pde_adjustment_deletion_code": "string",
- "programs": [
- "string"
], - "plan_additional_covered_amount": 0,
- "nsde_drug_application_type": "string",
- "drug_application_type": "string",
- "non_standard_format_code": "string",
- "drug_status_code": "string",
- "part_b": "string",
- "part_d": "string",
- "contract_number": "string",
- "plan_benefit_package_id": "string",
- "clinical_rules": [
- { }
], - "pharmacy_quality_alliance": [
- { }
], - "formulary_attributes": { },
- "callback_overrides": [
- { }
], - "performance": { },
- "adjustments": [
- null
], - "plan_type": "string",
- "medicare_beneficiary_identifier": "string",
- "gross_covered_drug_cost_before_adjudication": "string",
- "reported_gap_discount": "string",
- "beginning_benefit_phase": "string",
- "ending_benefit_phase": "string",
- "formulary_code": "string",
- "true_out_of_pocket_before_adjudication": "string",
- "gross_drug_cost_above": "string",
- "gross_drug_cost_below": "string",
- "total_claim_covered_plan_pay": "string",
- "total_claim_non_covered_plan_pay": "string",
- "amount_applied_to_low_income_subsidy": "string",
- "amount_applied_to_low_income_subsidy_deductible": "string",
- "amount_applied_to_part_b_deductible": "string",
- "amount_applied_to_part_b_maximum_out_of_pocket": "string",
- "adjustment_reason_code": "string",
- "adjustment_reason_code_qualifier": "string",
- "estimated_rebate_at_point_of_service": "string",
- "other_true_out_of_pocket_amount": "string",
- "part_d_model_indicator": "string",
- "pricing_exception_code": "string",
- "pricing_custom_id": 0,
- "patient_liability_reduction_due_to_other_payer_amount": "string",
- "patient_liability_reduction_due_to_the_employer_amount": "string",
- "accumulated_category_deductible_1_amount": "string",
- "accumulations_applied": null,
- "alternate_benefit_cost_share": null,
- "amount_applied_to_deductible_phase": "string",
- "amount_applied_to_gross_covered_drug_cost": "string",
- "amount_applied_to_initial_coverage_phase": "string",
- "amount_applied_to_true_out_of_pocket": "string",
- "accumulated_deductible_phase_amount": "string",
- "accumulated_gross_covered_drug_cost_amount": "string",
- "accumulated_true_out_of_pocket_amount": "string",
- "accumulated_part_b_deductible_amount": "string",
- "accumulated_part_b_maximum_out_of_pocket_amount": "string",
- "accumulated_part_b_deductible_out_of_network_amount": "string",
- "accumulated_part_b_out_of_pocket_out_of_network": "string",
- "amount_applied_to_part_b_deductible_out_of_network": "string",
- "amount_applied_to_part_b_out_of_pocket_out_of_network": "string",
- "amount_exceeding_periodic_category_deductible_1": 0,
- "amount_exceeding_periodic_overall_deductible": "string",
- "birth_date": "string",
- "coordination_of_benefits_other_payments_count": 0,
- "dispensing_fee_charged_level_1": "string",
- "dispensing_fee_charged_level_2": "string",
- "dispensing_fee_charged_level_3": "string",
- "ingredient_cost_charged_level_1": "string",
- "ingredient_cost_charged_level_2": "string",
- "ingredient_cost_charged_level_3": "string",
- "mac_list_dispensing_fee": "string",
- "pricing_category_mac_list_unit_price_adjustment_percentage": 0,
- "mac_list_id": 0,
- "mac_list_name": "string",
- "other_payer_amount_paid_1": "string",
- "other_payer_amount_paid_2": "string",
- "other_payer_amount_paid_3": "string",
- "other_payer_amount_paid_4": "string",
- "other_payer_amount_paid_5": "string",
- "other_payer_amount_paid_6": "string",
- "other_payer_amount_paid_7": "string",
- "other_payer_amount_paid_8": "string",
- "other_payer_amount_paid_9": "string",
- "other_payer_amount_paid_count": 0,
- "other_payer_amount_paid_qualifier_1": "string",
- "other_payer_amount_paid_qualifier_2": "string",
- "other_payer_amount_paid_qualifier_3": "string",
- "other_payer_amount_paid_qualifier_4": "string",
- "other_payer_amount_paid_qualifier_5": "string",
- "other_payer_amount_paid_qualifier_6": "string",
- "other_payer_amount_paid_qualifier_7": "string",
- "other_payer_amount_paid_qualifier_8": "string",
- "other_payer_amount_paid_qualifier_9": "string",
- "other_payer_coverage_type_1": "string",
- "other_payer_coverage_type_2": "string",
- "other_payer_coverage_type_3": "string",
- "other_payer_coverage_type_4": "string",
- "other_payer_coverage_type_5": "string",
- "other_payer_coverage_type_6": "string",
- "other_payer_coverage_type_7": "string",
- "other_payer_coverage_type_8": "string",
- "other_payer_coverage_type_9": "string",
- "other_payer_id_1": "string",
- "other_payer_id_2": "string",
- "other_payer_id_3": "string",
- "other_payer_id_4": "string",
- "other_payer_id_5": "string",
- "other_payer_id_6": "string",
- "other_payer_id_7": "string",
- "other_payer_id_8": "string",
- "other_payer_id_9": "string",
- "other_payer_id_qualifier_1": "string",
- "other_payer_id_qualifier_2": "string",
- "other_payer_id_qualifier_3": "string",
- "other_payer_id_qualifier_4": "string",
- "other_payer_id_qualifier_5": "string",
- "other_payer_id_qualifier_6": "string",
- "other_payer_id_qualifier_7": "string",
- "other_payer_id_qualifier_8": "string",
- "other_payer_id_qualifier_9": "string",
- "other_payer_patient_responsibility_amount_1": "string",
- "other_payer_patient_responsibility_amount_2": "string",
- "other_payer_patient_responsibility_amount_3": "string",
- "other_payer_patient_responsibility_amount_4": "string",
- "other_payer_patient_responsibility_amount_5": "string",
- "other_payer_patient_responsibility_amount_6": "string",
- "other_payer_patient_responsibility_amount_7": "string",
- "other_payer_patient_responsibility_amount_8": "string",
- "other_payer_patient_responsibility_amount_9": "string",
- "other_payer_patient_responsibility_amount_count": 0,
- "other_payer_patient_responsibility_amount_qualifier_1": "string",
- "other_payer_patient_responsibility_amount_qualifier_2": "string",
- "other_payer_patient_responsibility_amount_qualifier_3": "string",
- "other_payer_patient_responsibility_amount_qualifier_4": "string",
- "other_payer_patient_responsibility_amount_qualifier_5": "string",
- "other_payer_patient_responsibility_amount_qualifier_6": "string",
- "other_payer_patient_responsibility_amount_qualifier_7": "string",
- "other_payer_patient_responsibility_amount_qualifier_8": "string",
- "other_payer_patient_responsibility_amount_qualifier_9": "string",
- "other_payer_reject_code_1": "string",
- "other_payer_reject_code_2": "string",
- "other_payer_reject_code_3": "string",
- "other_payer_reject_code_4": "string",
- "other_payer_reject_code_5": "string",
- "other_payer_reject_count": 0,
- "pay_amount_level_1": "string",
- "pay_amount_level_2": "string",
- "pay_amount_level_3": "string",
- "prescriber_npi": "string",
- "professional_service_code_1": "string",
- "professional_service_code_2": "string",
- "professional_service_code_3": "string",
- "professional_service_code_4": "string",
- "professional_service_code_5": "string",
- "professional_service_code_6": "string",
- "professional_service_code_7": "string",
- "professional_service_code_8": "string",
- "professional_service_code_9": "string",
- "remaining_category_deductible_1_amount": "string",
- "remaining_overall_deductible_amount": "string",
- "request_reason_for_service_code_1": "string",
- "request_reason_for_service_code_2": "string",
- "request_reason_for_service_code_3": "string",
- "request_reason_for_service_code_4": "string",
- "request_reason_for_service_code_5": "string",
- "request_reason_for_service_code_6": "string",
- "request_reason_for_service_code_7": "string",
- "request_reason_for_service_code_8": "string",
- "request_reason_for_service_code_9": "string",
- "result_of_service_code_1": "string",
- "result_of_service_code_2": "string",
- "result_of_service_code_3": "string",
- "result_of_service_code_4": "string",
- "result_of_service_code_5": "string",
- "result_of_service_code_6": "string",
- "result_of_service_code_7": "string",
- "result_of_service_code_8": "string",
- "result_of_service_code_9": "string",
- "specialty_list_dispensing_fee": "string",
- "specialty_list_id": 0,
- "specialty_list_name": "string",
- "dmr_pay_to_city_address": "string",
- "dmr_pay_to_country_code": "string",
- "dmr_pay_to_name": "string",
- "dmr_pay_to_state_province_address": "string",
- "dmr_pay_to_street_address_line_1": "string",
- "dmr_pay_to_street_address_line_2": "string",
- "dmr_pay_to_tax_id": "string",
- "dmr_pay_to_vendor_id": "string",
- "dmr_pay_to_zip_postal_code": "string",
- "dmr_pay_to_check_eft_number": "string",
- "dmr_pay_to_date": "string",
- "tax_id_number": "string",
- "reasons_for_rejection": [
- "string"
], - "reasons_for_adjudication": [
- "string"
], - "reasons_for_adjudication_sections": null,
- "patient_pay_reduction_due_to_point_of_service_rebate": 0,
- "plan_pay_reduction_due_to_point_of_service_rebate": 0,
- "point_of_service_rebate_amount": 0,
- "low_income_subsidy_level": "string",
- "senior_savings_model_cost_share_reduction_gap": 0,
- "senior_savings_model_cost_share_reduction_non_gap": 0,
- "senior_savings_model_indicator": "string",
- "inflation_reduction_act_subsidy_amount": 0,
- "inflation_reduction_act_covered_vaccine": "string",
- "inflation_reduction_act_covered_insulin": "string",
- "other_true_out_of_pocket_amount_indicator": "string",
- "medicare_amounts_id": 0,
- "low_income_subsidy_amounts_id": 0,
- "medicare_medicaid_dsnp_co_administered_plan": "string",
- "dsnp_fee_for_service_or_capitation": 0,
- "dsnp_medicaid_cost_share_reduction_amount_part_d": 0,
- "dsnp_medicaid_cost_share_reduction_amount_part_b": 0,
- "dsnp_medicaid_cost_share_covered_excluded_reduction_amount": 0,
- "is_340b": true,
- "medicare_administrative_claim": "string",
- "controlled_substance_code": "string",
- "desi_code": "string",
- "batch_test_claims_file_id": 0,
- "reprocessing_id": 0,
- "reprocessing_type": "string",
- "reprocessing_patient_pay_difference": "string",
- "reprocessing_pharmacy_pay_amount": "string",
- "reprocessing_plan_pay_amount": "string",
- "reprocessing_goes_to_835": true,
- "reprocessing_goes_to_invoice": true,
- "reprocessing_is_member_recoupment": true,
- "nx_other_payers_total_amount": "string",
- "reprocessing_nx_amount_applied_to_patient_pay": "string",
- "reprocessing_excess_nx_amount_total": "string",
- "reprocessing_patient_pay_net_nx": "string",
- "reprocessing_member_refund_amount": "string",
- "reprocessing_member_recoupment_amount": "string",
- "reprocessing_is_recoup_ltc_pharmacy": true,
- "notes": "string",
- "first_claim_id": 0,
- "next_claim_id": 0,
- "include_raw_request_parsed": true,
- "include_raw_response_parsed": true,
- "manufacturer_discount_amount": 0,
- "is_manufacturer_discount_drug": true,
- "is_maximum_fair_price_selected_drug": true,
- "maximum_fair_price_ndc_11_package_price": 0,
- "maximum_fair_price_ndc_9_unit_price": 0,
- "maximum_fair_price_selected_drug_subsidy": 0,
- "maximum_fair_price_thiry_day_equivalent": 0,
- "claim_number": "string",
- "claim_sequence_number": "string",
- "medicare_prescription_payment_plan_indicator": "string",
- "medicare_prescription_payment_plan_original_claim_id": 0,
- "pharmacy_transaction_fee": 0,
- "vbid_cost_share_reduction_amount_part_d": 0,
- "vbid_model_indicator": "string",
- "pricing_level_ids": [
- 0
], - "is_parallel_validation": true,
- "calculated_spread_data": null,
- "level_1_basis_of_reimbursement": "string",
- "level_2_basis_of_reimbursement": "string",
- "level_3_basis_of_reimbursement": "string",
- "primary_plan_original_claim_id": 0,
- "is_wrap_benefit": true,
- "column_masks": null,
- "global_management_program_ids": [
- 0
], - "originator": "string",
- "benefit_categories": [
- "string"
], - "drug_lists": null,
- "brand_name_code": "string",
- "drug_descriptor_id": "string",
- "dosage": "string",
- "dosage_form": "string",
- "dosage_form_packaging": "string",
- "drug_name": "string",
- "drug_type": "string",
- "group_name": "string",
- "provider_phone": "string",
- "most_expensive_compound_ingredient_ndc": "string",
- "multi_source": "string",
- "name_type_code": "string",
- "rx_otc_indicator_code": "string",
- "strength": "string",
- "strength_unit_of_measure": "string",
- "pde_record_id": "string",
- "pde_claim_control_number": "string",
- "pde_plan_benefit_package_id": "string",
- "medicare_prescription_payment_plan_claim_id": 0,
- "medicare_prescription_payment_plan_claim_amount": 0,
- "claim_gpi": "string",
- "identity": "string",
- "over_reimbursement_indicator": true,
- "accumulation_adjustment_ids": [
- 0
]
}
}
], - "result_count": "string"
}| page_number | integer or null <int32> The page of results you would like to get. For the first page, pass |
| results_per_page | integer or null <int32> The number of results per page. |
| expected_fields | Array of strings or null or null The desired list of fields to be returned. |
Array of objects or null (OrderBySchema_1764643208.4167695) | |
| id | integer or null <int32> The internal ID of a claim. Cannot be set during create nor subsequently changed. |
| client_id | string or null |
| external_member_id | string or null |
| person_code | string or null |
| external_account_id required | string or null |
| external_group_id required | string or null |
| submitted_carholder_id | string or null |
| first_name | string or null |
| last_name | string or null |
| full_text_search | string or null The full text search for claims by product_service_description, date of service, and pharmacy name |
| claim_status | string or null |
| date_type | string or null |
| prescription_service_reference_number | string or null A field on NCPDP D.0 that is also referred to as the 'prescription number' or 'Rx number'. This number is assigned by the pharmacy to represent a specific prescription, inclusive of all refills for that prescription (via fill number). Rx numbers are ONLY unique to pharmacies, and are NOT globally unique. |
| pharmacy_nabp | string or null |
| prescriber_id | string or null |
| ndc | string or null |
| service_provider_id | string or null A field in NCPDP D.0 which in our system is ALWAYS the NPI of the pharmacy for paid or accepted claims (rejected claims may submit other values, causing us to reject the claim). NPI is the national provider identifier, essentially every entity in healthcare has an NPI, which includes pharmacies, doctors, hospitals, and pharmacists themselves. |
| start_date | string or null <ArrowDateTime> |
| end_date | string or null <ArrowDateTime> |
| minimum_claim_submission_date | string or null <ArrowDateTime> |
| maximum_claim_submission_date | string or null <ArrowDateTime> |
| is_340b | boolean or null Return claims matching the given is_340b value. |
| reject_codes | string or null A string of reject codes, with multiple reject codes separated by commas. |
| paid_claims_only | boolean or null Boolean to show paid claims only, ignoring reversed and rejected. Defaults to false. |
| claim_sources | Array of strings or null or null Enum: "admin" "app" "batch-test" "historical" "migrated" "pharmacy" "switch" "test" "vendor" "web" |
| get_dependent_claims | boolean or null Boolean to return dependent claims. |
| month | integer or null <int32> Month to filter by as integer |
| year | integer or null <int32> Year to filter by as integer |
| year_to_date | boolean or null Should filter by year to date. |
| gpi | string or null Drug gpi to search. |
| gpi_operator | string or null Search field using =, STARTSWITH, CONTAINS |
| drug_name | string or null |
| excluded_gpi_list | Array of strings or null or null |
| client_ids | Array of strings or null or null |
| add_pharmacy_data | boolean or null Boolean to return pharmacy details from ncpdp_providers |
| only_fields | Array of strings or null or null |
| formulary_tier | string or null A string of formulary tiers, with multiple tiers separated by commas. |
| first_claim_id | integer or null <int32> |
| basis_of_cost_determination | string or null |
| custom_filters | Array of strings or null or null |
| medicare_prescription_payment_plan_indicator | string or null |
| coverage_strategy_type | string or null |
| claim_number | string or null |
| claim_sequence_number | string or null |
{- "page_number": 0,
- "results_per_page": 0,
- "expected_fields": [
- "string"
], - "order_by": [
- {
- "id": "string",
- "client_id": "string",
- "external_group_id": "string",
- "date_of_service": "string",
- "claim_submission_date": "string",
- "claim_status": "string",
- "received_at": "string",
- "source": "string",
- "external_member_id": "string",
- "person_code": "string",
- "first_name": "string",
- "last_name": "string",
- "plan_benefit_id": "string",
- "formulary_id": "string",
- "network_id": "string",
- "service_provider_id": "string",
- "pharmacy_nabp": "string",
- "cardholder_first_name": "string",
- "cardholder_last_name": "string",
- "plan_id": "string",
- "group_id": "string",
- "date_of_birth": "string",
- "patient_first_name": "string",
- "patient_last_name": "string",
- "prescription_service_reference_number": "string",
- "ndc": "string",
- "quantity_dispensed": "string",
- "fill_number": "string",
- "days_supply": "string",
- "compound_code": "string",
- "daw": "string",
- "prior_authorization_type_code": "string",
- "prior_authorization_id_submitted": "string",
- "pharmacy_service_type": "string",
- "ingredient_cost_submitted": "string",
- "dispensing_fee_submitted": "string",
- "patient_pay_amount_reported": "string",
- "incentive_amount_submitted": "string",
- "other_amount_claimed_submitted_1": "string",
- "other_amount_claimed_submitted_2": "string",
- "other_amount_claimed_submitted_3": "string",
- "regulatory_fee_type_code_submitted_1": "string",
- "regulatory_fee_amount_submitted_1": "string",
- "regulatory_fee_type_code_submitted_2": "string",
- "regulatory_fee_amount_submitted_2": "string",
- "regulatory_fee_type_code_submitted_3": "string",
- "regulatory_fee_amount_submitted_3": "string",
- "percentage_tax_amount_submitted": "string",
- "percentage_tax_rate_submitted": "string",
- "percentage_tax_basis_submitted": "string",
- "usual_and_customary_charge": "string",
- "gross_amount_due": "string",
- "basis_of_cost_determination": "string",
- "provider_id": "string",
- "provider_last_name": "string",
- "prescriber_id": "string",
- "prescriber_last_name": "string",
- "header_response_status": "string",
- "response_transaction_code": "string",
- "transaction_response_status": "string",
- "reject_code_1": "string",
- "reject_code_2": "string",
- "reject_code_3": "string",
- "reject_code_4": "string",
- "reject_code_5": "string",
- "next_available_fill_date": "string",
- "ingredient_cost_charged_to_plan": "string",
- "dispensing_fee_charged_to_plan": "string",
- "product_service_classification": "string",
- "product_service_description": "string",
- "total_amount_paid": "string",
- "patient_pay_amount": "string",
- "patient_pay_component_amount_1": "string",
- "patient_pay_component_amount_2": "string",
- "patient_pay_component_amount_3": "string",
- "plan_pay_amount": "string",
- "amount_applied_to_periodic_deductible": "string",
- "amount_applied_to_periodic_maximum_benefit": "string",
- "amount_applied_to_periodic_maximum_out_of_pocket": "string",
- "amount_applied_to_periodic_maximum_fertility": "string",
- "amount_exceeding_periodic_fertility_maximum": "string",
- "amount_attributed_to_product_selection_brand_drug": "string",
- "amount_attributed_to_percentage_tax": "string",
- "amount_exceeding_periodic_benefit_maximum": "string",
- "amount_of_copay": "string",
- "amount_of_coinsurance": "string",
- "amount_attributed_to_product_selection_non_preferred": "string",
- "amount_attributed_to_health_plan_assistance": "string",
- "amount_attributed_to_provider_network_selection": "string",
- "amount_attributed_to_product_selection_brand_non_preferred": "string",
- "amount_attributed_to_coverage_gap": "string",
- "amount_attributed_to_processor_fee": "string",
- "amount_attributed_to_grace_period": "string",
- "amount_attributed_to_catastrophic_benefit": "string",
- "amount_attributed_to_regulatory_fee": "string",
- "ingredient_cost_paid": "string",
- "dispensing_fee_paid": "string",
- "percentage_tax_exempt_indicator": "string",
- "regulatory_fee_amount_paid_1": "string",
- "regulatory_fee_amount_paid_2": "string",
- "regulatory_fee_amount_paid_3": "string",
- "percentage_tax_amount_paid": "string",
- "percentage_tax_rate_paid": "string",
- "other_amount_paid_qualifier_1": "string",
- "other_amount_paid_1": "string",
- "other_amount_paid_qualifier_2": "string",
- "other_amount_paid_2": "string",
- "other_amount_paid_qualifier_3": "string",
- "other_amount_paid_3": "string",
- "other_payer_amount_recognized": "string",
- "basis_of_reimbursement_determination": "string",
- "basis_of_calculation_dispensing_fee": "string",
- "basis_of_calculation_copay": "string",
- "basis_of_calculation_coinsurance": "string",
- "basis_of_calculation_regulatory_fee": "string",
- "basis_of_calculation_percentage_tax": "string",
- "basis_of_days_supply_determination": "string",
- "accumulated_deductible_amount": "string",
- "remaining_deductible_amount": "string",
- "remaining_benefit_amount": "string",
- "patient_percentage_tax_amount": "string",
- "patient_regulatory_fee_amount": "string",
- "estimated_generic_savings": "string",
- "reason_for_service_code_1": "string",
- "previous_date_of_fill_1": "string",
- "quantity_of_previous_fill_1": "string",
- "reason_for_service_code_2": "string",
- "previous_date_of_fill_2": "string",
- "quantity_of_previous_fill_2": "string",
- "reason_for_service_code_3": "string",
- "previous_date_of_fill_3": "string",
- "quantity_of_previous_fill_3": "string",
- "direct_member_reimbursement_indicator": "string",
- "drug_name": "string",
- "pharmacy_name": "string",
- "reprocessing_id": "string",
- "original_claim_id": "string",
- "first_claim_id": "string",
- "claim_number": "string",
- "claim_sequence_number": "string"
}
], - "id": 0,
- "client_id": "string",
- "external_member_id": "string",
- "person_code": "string",
- "external_account_id": "string",
- "external_group_id": "string",
- "submitted_carholder_id": "string",
- "first_name": "string",
- "last_name": "string",
- "full_text_search": "string",
- "claim_status": "string",
- "date_type": "string",
- "prescription_service_reference_number": "string",
- "pharmacy_nabp": "string",
- "prescriber_id": "string",
- "ndc": "string",
- "service_provider_id": "string",
- "start_date": "string",
- "end_date": "string",
- "minimum_claim_submission_date": "string",
- "maximum_claim_submission_date": "string",
- "is_340b": true,
- "reject_codes": "string",
- "paid_claims_only": true,
- "claim_sources": [
- "admin"
], - "get_dependent_claims": true,
- "month": 0,
- "year": 0,
- "year_to_date": true,
- "gpi": "string",
- "gpi_operator": "string",
- "drug_name": "string",
- "excluded_gpi_list": [
- "string"
], - "client_ids": [
- "string"
], - "add_pharmacy_data": true,
- "only_fields": [
- "string"
], - "formulary_tier": "string",
- "first_claim_id": 0,
- "basis_of_cost_determination": "string",
- "custom_filters": [
- "string"
], - "medicare_prescription_payment_plan_indicator": "string",
- "coverage_strategy_type": "string",
- "claim_number": "string",
- "claim_sequence_number": "string"
}{- "results": [
- {
- "claim": {
- "id": 0,
- "rn": "string",
- "reversal_id": 0,
- "reverses_id": 0,
- "original_claim_id": 0,
- "client_id": "string",
- "external_account_id": "string",
- "external_group_id": "string",
- "provider_agreement_id": 0,
- "coverage_strategy_id": "string",
- "date_of_service": "string",
- "claim_submission_date": "string",
- "claim_payment_cycle_end_date": "string",
- "claim_reimbursement_cycle_end_date": "string",
- "claim_status": "string",
- "claim_count": 0,
- "received_at": "string",
- "source": "string",
- "external_member_id": "string",
- "person_code": "string",
- "first_name": "string",
- "last_name": "string",
- "coverage_strategy_type": "string",
- "plan_benefit_id": 0,
- "formulary_id": 0,
- "network_id": 0,
- "benefit_network": "string",
- "gpi": "string",
- "pharmacy_nabp": "string",
- "pharmacy_name": "string",
- "pharmacy_channel": "string",
- "version_release_number": "string",
- "request_transaction_code": "string",
- "bin_number": "string",
- "processor_control_number": "string",
- "transaction_count": "string",
- "service_provider_id_qualifier": "string",
- "service_provider_id": "string",
- "software_vendor_certification_id": "string",
- "submitted_cardholder_id": "string",
- "cardholder_first_name": "string",
- "cardholder_last_name": "string",
- "plan_id": "string",
- "eligibility_clarification_code": "string",
- "group_id": "string",
- "submitted_person_code": "string",
- "patient_relationship_code": "string",
- "medigap_id": "string",
- "medicaid_indicator": "string",
- "provider_accept_assignment_indicator": "string",
- "cms_part_d_defined_qualified_facility": "string",
- "medicaid_id_number": "string",
- "patient_id_qualifier": "string",
- "patient_id": "string",
- "date_of_birth": "string",
- "patient_gender_code": "string",
- "patient_first_name": "string",
- "patient_last_name": "string",
- "patient_street_address": "string",
- "patient_street_address_line_1": "string",
- "patient_street_address_line_2": "string",
- "patient_city_address": "string",
- "patient_state_province_address": "string",
- "patient_zip_postal_code": "string",
- "patient_country_code": "string",
- "patient_telephone_number": "string",
- "place_of_service": "string",
- "employer_id": "string",
- "pregnancy_indicator": "string",
- "patient_email_address": "user@example.com",
- "patient_residence": "string",
- "prescription_service_reference_number_qualifier": "string",
- "prescription_service_reference_number": "string",
- "product_service_id_qualifier": "string",
- "ndc": "string",
- "associated_prescription_service_reference_number": "string",
- "associated_prescription_service_date": "string",
- "procedure_modifier_code_1": "string",
- "procedure_modifier_code_2": "string",
- "procedure_modifier_code_3": "string",
- "procedure_modifier_code_4": "string",
- "procedure_modifier_code_5": "string",
- "procedure_modifier_code_6": "string",
- "procedure_modifier_code_7": "string",
- "procedure_modifier_code_8": "string",
- "procedure_modifier_code_9": "string",
- "procedure_modifier_code_10": "string",
- "quantity_dispensed": "string",
- "fill_number": 0,
- "days_supply": 0,
- "compound_code": "string",
- "daw": "string",
- "date_prescription_written": "string",
- "number_of_refills_authorized": 0,
- "prescription_origin_code": "string",
- "submission_clarification_code_1": "string",
- "submission_clarification_code_2": "string",
- "submission_clarification_code_3": "string",
- "submission_clarification_code_4": "string",
- "submission_clarification_code_5": "string",
- "submission_clarification_code_pde": "string",
- "submission_type_code_1": "string",
- "submission_type_code_2": "string",
- "submission_type_code_3": "string",
- "submission_type_code_4": "string",
- "submission_type_code_5": "string",
- "quantity_prescribed": "string",
- "multiple_prescription_service_order_group_id": "string",
- "multiple_prescription_service_order_group_reason_code": "string",
- "total_prescribed_quantity_remaining": "string",
- "other_coverage_code": "string",
- "special_packaging_indicator": "string",
- "originally_prescribed_product_service_id_qualifier": "string",
- "originally_prescribed_product_service_code": "string",
- "originally_prescribed_quantity": "string",
- "scheduled_prescription_id_number": "string",
- "unit_of_measure": "string",
- "level_of_service": "string",
- "prior_authorization_type_code": "string",
- "prior_authorization_id_submitted": "string",
- "dispensing_status": "string",
- "quantity_intended_to_be_dispensed": "string",
- "days_supply_intended_to_be_dispensed": 0,
- "delay_reason_code": "string",
- "patient_assignment_indicator": "string",
- "route_of_administration": "string",
- "compound_type": "string",
- "preparation_environment_type": "string",
- "preparation_environment_event_code": "string",
- "pharmacy_service_type": "string",
- "associated_prescription_service_reference_number_qualifier": "string",
- "associated_prescription_service_fill_number": 0,
- "original_manufacturer_product_id_qualifier": "string",
- "original_manufacturer_product_id": "string",
- "ltpac_dispense_frequency": "string",
- "ltpac_billing_methodology": "string",
- "number_of_ltpac_dispensing_events": 0,
- "do_not_dispense_before_date": "string",
- "ingredient_cost_submitted": "string",
- "dispensing_fee_submitted": "string",
- "patient_pay_amount_reported": "string",
- "incentive_amount_submitted": "string",
- "other_amount_claimed_submitted_qualifier_1": "string",
- "other_amount_claimed_submitted_1": "string",
- "other_amount_claimed_submitted_qualifier_2": "string",
- "other_amount_claimed_submitted_2": "string",
- "other_amount_claimed_submitted_qualifier_3": "string",
- "other_amount_claimed_submitted_3": "string",
- "regulatory_fee_type_code_submitted_1": "string",
- "regulatory_fee_amount_submitted_1": "string",
- "regulatory_fee_type_code_submitted_2": "string",
- "regulatory_fee_amount_submitted_2": "string",
- "regulatory_fee_type_code_submitted_3": "string",
- "regulatory_fee_amount_submitted_3": "string",
- "percentage_tax_amount_submitted": "string",
- "percentage_tax_rate_submitted": "string",
- "percentage_tax_basis_submitted": "string",
- "usual_and_customary_charge": "string",
- "gross_amount_due": "string",
- "basis_of_cost_determination": "string",
- "provider_id_qualifier": "string",
- "provider_id": "string",
- "provider_first_name": "string",
- "provider_last_name": "string",
- "prescriber_id_qualifier": "string",
- "prescriber_id": "string",
- "prescriber_last_name": "string",
- "prescriber_telephone_number": "string",
- "prescriber_telephone_number_extension": "string",
- "primary_care_provider_id_qualifier": "string",
- "primary_care_provider_id": "string",
- "primary_care_provider_last_name": "string",
- "prescriber_first_name": "string",
- "prescriber_street_address": "string",
- "prescriber_street_address_line_1": "string",
- "prescriber_street_address_line_2": "string",
- "prescriber_city_address": "string",
- "prescriber_state_province_address": "string",
- "prescriber_zip_postal_code": "string",
- "prescriber_country_code": "string",
- "prescriber_dea_number": "string",
- "prescriber_place_of_service": "string",
- "compound_prices": null,
- "compound_dosage_form_description_code": "string",
- "compound_dispensing_unit_form_indicator": "string",
- "compound_ingredient_component_count": 0,
- "compound_product_id_qualifier_1": "string",
- "compound_product_id_1": "string",
- "compound_ingredient_quantity_1": "string",
- "compound_product_id_qualifier_2": "string",
- "compound_product_id_2": "string",
- "compound_ingredient_quantity_2": "string",
- "compound_product_id_qualifier_3": "string",
- "compound_product_id_3": "string",
- "compound_ingredient_quantity_3": "string",
- "compound_product_id_qualifier_4": "string",
- "compound_product_id_4": "string",
- "compound_ingredient_quantity_4": "string",
- "compound_product_id_qualifier_5": "string",
- "compound_product_id_5": "string",
- "compound_ingredient_quantity_5": "string",
- "compound_product_id_qualifier_6": "string",
- "compound_product_id_6": "string",
- "compound_ingredient_quantity_6": "string",
- "compound_product_id_qualifier_7": "string",
- "compound_product_id_7": "string",
- "compound_ingredient_quantity_7": "string",
- "compound_product_id_qualifier_8": "string",
- "compound_product_id_8": "string",
- "compound_ingredient_quantity_8": "string",
- "compound_product_id_qualifier_9": "string",
- "compound_product_id_9": "string",
- "compound_ingredient_quantity_9": "string",
- "compound_product_id_qualifier_10": "string",
- "compound_product_id_10": "string",
- "compound_ingredient_quantity_10": "string",
- "compound_product_id_qualifier_11": "string",
- "compound_product_id_11": "string",
- "compound_ingredient_quantity_11": "string",
- "compound_product_id_qualifier_12": "string",
- "compound_product_id_12": "string",
- "compound_ingredient_quantity_12": "string",
- "compound_product_id_qualifier_13": "string",
- "compound_product_id_13": "string",
- "compound_ingredient_quantity_13": "string",
- "compound_product_id_qualifier_14": "string",
- "compound_product_id_14": "string",
- "compound_ingredient_quantity_14": "string",
- "compound_product_id_qualifier_15": "string",
- "compound_product_id_15": "string",
- "compound_ingredient_quantity_15": "string",
- "compound_product_id_qualifier_16": "string",
- "compound_product_id_16": "string",
- "compound_ingredient_quantity_16": "string",
- "compound_product_id_qualifier_17": "string",
- "compound_product_id_17": "string",
- "compound_ingredient_quantity_17": "string",
- "compound_product_id_qualifier_18": "string",
- "compound_product_id_18": "string",
- "compound_ingredient_quantity_18": "string",
- "compound_product_id_qualifier_19": "string",
- "compound_product_id_19": "string",
- "compound_ingredient_quantity_19": "string",
- "compound_product_id_qualifier_20": "string",
- "compound_product_id_20": "string",
- "compound_ingredient_quantity_20": "string",
- "compound_product_id_qualifier_21": "string",
- "compound_product_id_21": "string",
- "compound_ingredient_quantity_21": "string",
- "compound_product_id_qualifier_22": "string",
- "compound_product_id_22": "string",
- "compound_ingredient_quantity_22": "string",
- "compound_product_id_qualifier_23": "string",
- "compound_product_id_23": "string",
- "compound_ingredient_quantity_23": "string",
- "compound_product_id_qualifier_24": "string",
- "compound_product_id_24": "string",
- "compound_ingredient_quantity_24": "string",
- "compound_product_id_qualifier_25": "string",
- "compound_product_id_25": "string",
- "compound_ingredient_quantity_25": "string",
- "diagnosis_code_qualifier_1": "string",
- "diagnosis_code_1": "string",
- "diagnosis_code_qualifier_2": "string",
- "diagnosis_code_2": "string",
- "diagnosis_code_qualifier_3": "string",
- "diagnosis_code_3": "string",
- "diagnosis_code_qualifier_4": "string",
- "diagnosis_code_4": "string",
- "diagnosis_code_qualifier_5": "string",
- "diagnosis_code_5": "string",
- "header_response_status": "string",
- "response_transaction_code": "string",
- "response_message": "string",
- "response_group_id": "string",
- "response_plan_id": "string",
- "response_cob": null,
- "network_reimbursement_id": "string",
- "external_provider_agreement_id": "string",
- "payer_health_plan_id_qualifier": "string",
- "payer_health_plan_id": "string",
- "payer_health_plan_id_qualifier_1": "string",
- "payer_health_plan_id_1": "string",
- "payer_health_plan_id_qualifier_2": "string",
- "payer_health_plan_id_2": "string",
- "payer_health_plan_id_qualifier_3": "string",
- "payer_health_plan_id_3": "string",
- "transaction_response_status": "string",
- "authorization_number": "string",
- "reconciliation_id": "string",
- "reject_code_1": "string",
- "reject_code_2": "string",
- "reject_code_3": "string",
- "reject_code_4": "string",
- "reject_code_5": "string",
- "approved_message_code_1": "string",
- "approved_message_code_2": "string",
- "approved_message_code_3": "string",
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- "professional_service_code_6": "string",
- "professional_service_code_7": "string",
- "professional_service_code_8": "string",
- "professional_service_code_9": "string",
- "remaining_category_deductible_1_amount": "string",
- "remaining_overall_deductible_amount": "string",
- "request_reason_for_service_code_1": "string",
- "request_reason_for_service_code_2": "string",
- "request_reason_for_service_code_3": "string",
- "request_reason_for_service_code_4": "string",
- "request_reason_for_service_code_5": "string",
- "request_reason_for_service_code_6": "string",
- "request_reason_for_service_code_7": "string",
- "request_reason_for_service_code_8": "string",
- "request_reason_for_service_code_9": "string",
- "result_of_service_code_1": "string",
- "result_of_service_code_2": "string",
- "result_of_service_code_3": "string",
- "result_of_service_code_4": "string",
- "result_of_service_code_5": "string",
- "result_of_service_code_6": "string",
- "result_of_service_code_7": "string",
- "result_of_service_code_8": "string",
- "result_of_service_code_9": "string",
- "specialty_list_dispensing_fee": "string",
- "specialty_list_id": 0,
- "specialty_list_name": "string",
- "dmr_pay_to_city_address": "string",
- "dmr_pay_to_country_code": "string",
- "dmr_pay_to_name": "string",
- "dmr_pay_to_state_province_address": "string",
- "dmr_pay_to_street_address_line_1": "string",
- "dmr_pay_to_street_address_line_2": "string",
- "dmr_pay_to_tax_id": "string",
- "dmr_pay_to_vendor_id": "string",
- "dmr_pay_to_zip_postal_code": "string",
- "dmr_pay_to_check_eft_number": "string",
- "dmr_pay_to_date": "string",
- "tax_id_number": "string",
- "reasons_for_rejection": [
- "string"
], - "reasons_for_adjudication": [
- "string"
], - "reasons_for_adjudication_sections": null,
- "patient_pay_reduction_due_to_point_of_service_rebate": 0,
- "plan_pay_reduction_due_to_point_of_service_rebate": 0,
- "point_of_service_rebate_amount": 0,
- "low_income_subsidy_level": "string",
- "senior_savings_model_cost_share_reduction_gap": 0,
- "senior_savings_model_cost_share_reduction_non_gap": 0,
- "senior_savings_model_indicator": "string",
- "inflation_reduction_act_subsidy_amount": 0,
- "inflation_reduction_act_covered_vaccine": "string",
- "inflation_reduction_act_covered_insulin": "string",
- "other_true_out_of_pocket_amount_indicator": "string",
- "medicare_amounts_id": 0,
- "low_income_subsidy_amounts_id": 0,
- "medicare_medicaid_dsnp_co_administered_plan": "string",
- "dsnp_fee_for_service_or_capitation": 0,
- "dsnp_medicaid_cost_share_reduction_amount_part_d": 0,
- "dsnp_medicaid_cost_share_reduction_amount_part_b": 0,
- "dsnp_medicaid_cost_share_covered_excluded_reduction_amount": 0,
- "is_340b": true,
- "medicare_administrative_claim": "string",
- "controlled_substance_code": "string",
- "desi_code": "string",
- "batch_test_claims_file_id": 0,
- "reprocessing_id": 0,
- "reprocessing_type": "string",
- "reprocessing_patient_pay_difference": "string",
- "reprocessing_pharmacy_pay_amount": "string",
- "reprocessing_plan_pay_amount": "string",
- "reprocessing_goes_to_835": true,
- "reprocessing_goes_to_invoice": true,
- "reprocessing_is_member_recoupment": true,
- "nx_other_payers_total_amount": "string",
- "reprocessing_nx_amount_applied_to_patient_pay": "string",
- "reprocessing_excess_nx_amount_total": "string",
- "reprocessing_patient_pay_net_nx": "string",
- "reprocessing_member_refund_amount": "string",
- "reprocessing_member_recoupment_amount": "string",
- "reprocessing_is_recoup_ltc_pharmacy": true,
- "notes": "string",
- "first_claim_id": 0,
- "next_claim_id": 0,
- "include_raw_request_parsed": true,
- "include_raw_response_parsed": true,
- "manufacturer_discount_amount": 0,
- "is_manufacturer_discount_drug": true,
- "is_maximum_fair_price_selected_drug": true,
- "maximum_fair_price_ndc_11_package_price": 0,
- "maximum_fair_price_ndc_9_unit_price": 0,
- "maximum_fair_price_selected_drug_subsidy": 0,
- "maximum_fair_price_thiry_day_equivalent": 0,
- "claim_number": "string",
- "claim_sequence_number": "string",
- "medicare_prescription_payment_plan_indicator": "string",
- "medicare_prescription_payment_plan_original_claim_id": 0,
- "pharmacy_transaction_fee": 0,
- "vbid_cost_share_reduction_amount_part_d": 0,
- "vbid_model_indicator": "string",
- "pricing_level_ids": [
- 0
], - "is_parallel_validation": true,
- "calculated_spread_data": null,
- "level_1_basis_of_reimbursement": "string",
- "level_2_basis_of_reimbursement": "string",
- "level_3_basis_of_reimbursement": "string",
- "primary_plan_original_claim_id": 0,
- "is_wrap_benefit": true,
- "column_masks": null,
- "global_management_program_ids": [
- 0
], - "originator": "string",
- "benefit_categories": [
- "string"
], - "drug_lists": null,
- "brand_name_code": "string",
- "drug_descriptor_id": "string",
- "dosage": "string",
- "dosage_form": "string",
- "dosage_form_packaging": "string",
- "drug_name": "string",
- "drug_type": "string",
- "group_name": "string",
- "provider_phone": "string",
- "most_expensive_compound_ingredient_ndc": "string",
- "multi_source": "string",
- "name_type_code": "string",
- "rx_otc_indicator_code": "string",
- "strength": "string",
- "strength_unit_of_measure": "string",
- "pde_record_id": "string",
- "pde_claim_control_number": "string",
- "pde_plan_benefit_package_id": "string",
- "medicare_prescription_payment_plan_claim_id": 0,
- "medicare_prescription_payment_plan_claim_amount": 0,
- "claim_gpi": "string",
- "identity": "string",
- "over_reimbursement_indicator": true,
- "accumulation_adjustment_ids": [
- 0
]
}
}
], - "result_count": "string"
}Update a Claim.
| id required | integer <int32> |
| is_340b | boolean or null |
| external_account_id | string or null |
| external_group_id | string or null |
| dmr_pay_to_check_eft_number | string or null |
| dmr_pay_to_date | string or null <ArrowDateTime> |
{- "id": 0,
- "is_340b": true,
- "external_account_id": "string",
- "external_group_id": "string",
- "dmr_pay_to_check_eft_number": "string",
- "dmr_pay_to_date": "string"
}{- "id": 0,
- "rn": "string",
- "reversal_id": 0,
- "reverses_id": 0,
- "original_claim_id": 0,
- "client_id": "string",
- "external_account_id": "string",
- "external_group_id": "string",
- "provider_agreement_id": 0,
- "coverage_strategy_id": "string",
- "date_of_service": "string",
- "claim_submission_date": "string",
- "claim_payment_cycle_end_date": "string",
- "claim_reimbursement_cycle_end_date": "string",
- "claim_status": "string",
- "claim_count": 0,
- "received_at": "string",
- "source": "string",
- "external_member_id": "string",
- "person_code": "string",
- "first_name": "string",
- "last_name": "string",
- "coverage_strategy_type": "string",
- "plan_benefit_id": 0,
- "formulary_id": 0,
- "network_id": 0,
- "benefit_network": "string",
- "gpi": "string",
- "pharmacy_nabp": "string",
- "pharmacy_name": "string",
- "pharmacy_channel": "string",
- "version_release_number": "string",
- "request_transaction_code": "string",
- "bin_number": "string",
- "processor_control_number": "string",
- "transaction_count": "string",
- "service_provider_id_qualifier": "string",
- "service_provider_id": "string",
- "software_vendor_certification_id": "string",
- "submitted_cardholder_id": "string",
- "cardholder_first_name": "string",
- "cardholder_last_name": "string",
- "plan_id": "string",
- "eligibility_clarification_code": "string",
- "group_id": "string",
- "submitted_person_code": "string",
- "patient_relationship_code": "string",
- "medigap_id": "string",
- "medicaid_indicator": "string",
- "provider_accept_assignment_indicator": "string",
- "cms_part_d_defined_qualified_facility": "string",
- "medicaid_id_number": "string",
- "patient_id_qualifier": "string",
- "patient_id": "string",
- "date_of_birth": "string",
- "patient_gender_code": "string",
- "patient_first_name": "string",
- "patient_last_name": "string",
- "patient_street_address": "string",
- "patient_street_address_line_1": "string",
- "patient_street_address_line_2": "string",
- "patient_city_address": "string",
- "patient_state_province_address": "string",
- "patient_zip_postal_code": "string",
- "patient_country_code": "string",
- "patient_telephone_number": "string",
- "place_of_service": "string",
- "employer_id": "string",
- "pregnancy_indicator": "string",
- "patient_email_address": "user@example.com",
- "patient_residence": "string",
- "prescription_service_reference_number_qualifier": "string",
- "prescription_service_reference_number": "string",
- "product_service_id_qualifier": "string",
- "ndc": "string",
- "associated_prescription_service_reference_number": "string",
- "associated_prescription_service_date": "string",
- "procedure_modifier_code_1": "string",
- "procedure_modifier_code_2": "string",
- "procedure_modifier_code_3": "string",
- "procedure_modifier_code_4": "string",
- "procedure_modifier_code_5": "string",
- "procedure_modifier_code_6": "string",
- "procedure_modifier_code_7": "string",
- "procedure_modifier_code_8": "string",
- "procedure_modifier_code_9": "string",
- "procedure_modifier_code_10": "string",
- "quantity_dispensed": "string",
- "fill_number": 0,
- "days_supply": 0,
- "compound_code": "string",
- "daw": "string",
- "date_prescription_written": "string",
- "number_of_refills_authorized": 0,
- "prescription_origin_code": "string",
- "submission_clarification_code_1": "string",
- "submission_clarification_code_2": "string",
- "submission_clarification_code_3": "string",
- "submission_clarification_code_4": "string",
- "submission_clarification_code_5": "string",
- "submission_clarification_code_pde": "string",
- "submission_type_code_1": "string",
- "submission_type_code_2": "string",
- "submission_type_code_3": "string",
- "submission_type_code_4": "string",
- "submission_type_code_5": "string",
- "quantity_prescribed": "string",
- "multiple_prescription_service_order_group_id": "string",
- "multiple_prescription_service_order_group_reason_code": "string",
- "total_prescribed_quantity_remaining": "string",
- "other_coverage_code": "string",
- "special_packaging_indicator": "string",
- "originally_prescribed_product_service_id_qualifier": "string",
- "originally_prescribed_product_service_code": "string",
- "originally_prescribed_quantity": "string",
- "scheduled_prescription_id_number": "string",
- "unit_of_measure": "string",
- "level_of_service": "string",
- "prior_authorization_type_code": "string",
- "prior_authorization_id_submitted": "string",
- "dispensing_status": "string",
- "quantity_intended_to_be_dispensed": "string",
- "days_supply_intended_to_be_dispensed": 0,
- "delay_reason_code": "string",
- "patient_assignment_indicator": "string",
- "route_of_administration": "string",
- "compound_type": "string",
- "preparation_environment_type": "string",
- "preparation_environment_event_code": "string",
- "pharmacy_service_type": "string",
- "associated_prescription_service_reference_number_qualifier": "string",
- "associated_prescription_service_fill_number": 0,
- "original_manufacturer_product_id_qualifier": "string",
- "original_manufacturer_product_id": "string",
- "ltpac_dispense_frequency": "string",
- "ltpac_billing_methodology": "string",
- "number_of_ltpac_dispensing_events": 0,
- "do_not_dispense_before_date": "string",
- "ingredient_cost_submitted": "string",
- "dispensing_fee_submitted": "string",
- "patient_pay_amount_reported": "string",
- "incentive_amount_submitted": "string",
- "other_amount_claimed_submitted_qualifier_1": "string",
- "other_amount_claimed_submitted_1": "string",
- "other_amount_claimed_submitted_qualifier_2": "string",
- "other_amount_claimed_submitted_2": "string",
- "other_amount_claimed_submitted_qualifier_3": "string",
- "other_amount_claimed_submitted_3": "string",
- "regulatory_fee_type_code_submitted_1": "string",
- "regulatory_fee_amount_submitted_1": "string",
- "regulatory_fee_type_code_submitted_2": "string",
- "regulatory_fee_amount_submitted_2": "string",
- "regulatory_fee_type_code_submitted_3": "string",
- "regulatory_fee_amount_submitted_3": "string",
- "percentage_tax_amount_submitted": "string",
- "percentage_tax_rate_submitted": "string",
- "percentage_tax_basis_submitted": "string",
- "usual_and_customary_charge": "string",
- "gross_amount_due": "string",
- "basis_of_cost_determination": "string",
- "provider_id_qualifier": "string",
- "provider_id": "string",
- "provider_first_name": "string",
- "provider_last_name": "string",
- "prescriber_id_qualifier": "string",
- "prescriber_id": "string",
- "prescriber_last_name": "string",
- "prescriber_telephone_number": "string",
- "prescriber_telephone_number_extension": "string",
- "primary_care_provider_id_qualifier": "string",
- "primary_care_provider_id": "string",
- "primary_care_provider_last_name": "string",
- "prescriber_first_name": "string",
- "prescriber_street_address": "string",
- "prescriber_street_address_line_1": "string",
- "prescriber_street_address_line_2": "string",
- "prescriber_city_address": "string",
- "prescriber_state_province_address": "string",
- "prescriber_zip_postal_code": "string",
- "prescriber_country_code": "string",
- "prescriber_dea_number": "string",
- "prescriber_place_of_service": "string",
- "compound_prices": null,
- "compound_dosage_form_description_code": "string",
- "compound_dispensing_unit_form_indicator": "string",
- "compound_ingredient_component_count": 0,
- "compound_product_id_qualifier_1": "string",
- "compound_product_id_1": "string",
- "compound_ingredient_quantity_1": "string",
- "compound_product_id_qualifier_2": "string",
- "compound_product_id_2": "string",
- "compound_ingredient_quantity_2": "string",
- "compound_product_id_qualifier_3": "string",
- "compound_product_id_3": "string",
- "compound_ingredient_quantity_3": "string",
- "compound_product_id_qualifier_4": "string",
- "compound_product_id_4": "string",
- "compound_ingredient_quantity_4": "string",
- "compound_product_id_qualifier_5": "string",
- "compound_product_id_5": "string",
- "compound_ingredient_quantity_5": "string",
- "compound_product_id_qualifier_6": "string",
- "compound_product_id_6": "string",
- "compound_ingredient_quantity_6": "string",
- "compound_product_id_qualifier_7": "string",
- "compound_product_id_7": "string",
- "compound_ingredient_quantity_7": "string",
- "compound_product_id_qualifier_8": "string",
- "compound_product_id_8": "string",
- "compound_ingredient_quantity_8": "string",
- "compound_product_id_qualifier_9": "string",
- "compound_product_id_9": "string",
- "compound_ingredient_quantity_9": "string",
- "compound_product_id_qualifier_10": "string",
- "compound_product_id_10": "string",
- "compound_ingredient_quantity_10": "string",
- "compound_product_id_qualifier_11": "string",
- "compound_product_id_11": "string",
- "compound_ingredient_quantity_11": "string",
- "compound_product_id_qualifier_12": "string",
- "compound_product_id_12": "string",
- "compound_ingredient_quantity_12": "string",
- "compound_product_id_qualifier_13": "string",
- "compound_product_id_13": "string",
- "compound_ingredient_quantity_13": "string",
- "compound_product_id_qualifier_14": "string",
- "compound_product_id_14": "string",
- "compound_ingredient_quantity_14": "string",
- "compound_product_id_qualifier_15": "string",
- "compound_product_id_15": "string",
- "compound_ingredient_quantity_15": "string",
- "compound_product_id_qualifier_16": "string",
- "compound_product_id_16": "string",
- "compound_ingredient_quantity_16": "string",
- "compound_product_id_qualifier_17": "string",
- "compound_product_id_17": "string",
- "compound_ingredient_quantity_17": "string",
- "compound_product_id_qualifier_18": "string",
- "compound_product_id_18": "string",
- "compound_ingredient_quantity_18": "string",
- "compound_product_id_qualifier_19": "string",
- "compound_product_id_19": "string",
- "compound_ingredient_quantity_19": "string",
- "compound_product_id_qualifier_20": "string",
- "compound_product_id_20": "string",
- "compound_ingredient_quantity_20": "string",
- "compound_product_id_qualifier_21": "string",
- "compound_product_id_21": "string",
- "compound_ingredient_quantity_21": "string",
- "compound_product_id_qualifier_22": "string",
- "compound_product_id_22": "string",
- "compound_ingredient_quantity_22": "string",
- "compound_product_id_qualifier_23": "string",
- "compound_product_id_23": "string",
- "compound_ingredient_quantity_23": "string",
- "compound_product_id_qualifier_24": "string",
- "compound_product_id_24": "string",
- "compound_ingredient_quantity_24": "string",
- "compound_product_id_qualifier_25": "string",
- "compound_product_id_25": "string",
- "compound_ingredient_quantity_25": "string",
- "diagnosis_code_qualifier_1": "string",
- "diagnosis_code_1": "string",
- "diagnosis_code_qualifier_2": "string",
- "diagnosis_code_2": "string",
- "diagnosis_code_qualifier_3": "string",
- "diagnosis_code_3": "string",
- "diagnosis_code_qualifier_4": "string",
- "diagnosis_code_4": "string",
- "diagnosis_code_qualifier_5": "string",
- "diagnosis_code_5": "string",
- "header_response_status": "string",
- "response_transaction_code": "string",
- "response_message": "string",
- "response_group_id": "string",
- "response_plan_id": "string",
- "response_cob": null,
- "network_reimbursement_id": "string",
- "external_provider_agreement_id": "string",
- "payer_health_plan_id_qualifier": "string",
- "payer_health_plan_id": "string",
- "payer_health_plan_id_qualifier_1": "string",
- "payer_health_plan_id_1": "string",
- "payer_health_plan_id_qualifier_2": "string",
- "payer_health_plan_id_2": "string",
- "payer_health_plan_id_qualifier_3": "string",
- "payer_health_plan_id_3": "string",
- "transaction_response_status": "string",
- "authorization_number": "string",
- "reconciliation_id": "string",
- "reject_code_1": "string",
- "reject_code_2": "string",
- "reject_code_3": "string",
- "reject_code_4": "string",
- "reject_code_5": "string",
- "approved_message_code_1": "string",
- "approved_message_code_2": "string",
- "approved_message_code_3": "string",
- "approved_message_code_4": "string",
- "approved_message_code_5": "string",
- "additional_message_count": 0,
- "additional_message_information_qualifier_1": "string",
- "additional_message_information_1": "string",
- "additional_message_information_continuity_1": "string",
- "additional_message_information_qualifier_2": "string",
- "additional_message_information_2": "string",
- "additional_message_information_continuity_2": "string",
- "additional_message_information_qualifier_3": "string",
- "additional_message_information_3": "string",
- "additional_message_information_continuity_3": "string",
- "additional_message_information_qualifier_4": "string",
- "additional_message_information_4": "string",
- "additional_message_information_continuity_4": "string",
- "additional_message_information_qualifier_5": "string",
- "additional_message_information_5": "string",
- "additional_message_information_continuity_5": "string",
- "additional_message_information_qualifier_6": "string",
- "additional_message_information_6": "string",
- "additional_message_information_continuity_6": "string",
- "additional_message_information_qualifier_7": "string",
- "additional_message_information_7": "string",
- "additional_message_information_continuity_7": "string",
- "additional_message_information_qualifier_8": "string",
- "additional_message_information_8": "string",
- "additional_message_information_continuity_8": "string",
- "additional_message_information_qualifier_9": "string",
- "additional_message_information_9": "string",
- "additional_message_information_continuity_9": "string",
- "additional_message_information_qualifier_10": "string",
- "additional_message_information_10": "string",
- "additional_message_information_continuity_10": "string",
- "additional_message_information_qualifier_11": "string",
- "additional_message_information_11": "string",
- "additional_message_information_continuity_11": "string",
- "additional_message_information_qualifier_12": "string",
- "additional_message_information_12": "string",
- "additional_message_information_continuity_12": "string",
- "additional_message_information_qualifier_13": "string",
- "additional_message_information_13": "string",
- "additional_message_information_continuity_13": "string",
- "additional_message_information_qualifier_14": "string",
- "additional_message_information_14": "string",
- "additional_message_information_continuity_14": "string",
- "additional_message_information_qualifier_15": "string",
- "additional_message_information_15": "string",
- "additional_message_information_continuity_15": "string",
- "additional_message_information_qualifier_16": "string",
- "additional_message_information_16": "string",
- "additional_message_information_continuity_16": "string",
- "additional_message_information_qualifier_17": "string",
- "additional_message_information_17": "string",
- "additional_message_information_continuity_17": "string",
- "additional_message_information_qualifier_18": "string",
- "additional_message_information_18": "string",
- "additional_message_information_continuity_18": "string",
- "additional_message_information_qualifier_19": "string",
- "additional_message_information_19": "string",
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- "other_true_out_of_pocket_amount_indicator": "string",
- "medicare_amounts_id": 0,
- "low_income_subsidy_amounts_id": 0,
- "medicare_medicaid_dsnp_co_administered_plan": "string",
- "dsnp_fee_for_service_or_capitation": 0,
- "dsnp_medicaid_cost_share_reduction_amount_part_d": 0,
- "dsnp_medicaid_cost_share_reduction_amount_part_b": 0,
- "dsnp_medicaid_cost_share_covered_excluded_reduction_amount": 0,
- "is_340b": true,
- "medicare_administrative_claim": "string",
- "controlled_substance_code": "string",
- "desi_code": "string",
- "batch_test_claims_file_id": 0,
- "reprocessing_id": 0,
- "reprocessing_type": "string",
- "reprocessing_patient_pay_difference": "string",
- "reprocessing_pharmacy_pay_amount": "string",
- "reprocessing_plan_pay_amount": "string",
- "reprocessing_goes_to_835": true,
- "reprocessing_goes_to_invoice": true,
- "reprocessing_is_member_recoupment": true,
- "nx_other_payers_total_amount": "string",
- "reprocessing_nx_amount_applied_to_patient_pay": "string",
- "reprocessing_excess_nx_amount_total": "string",
- "reprocessing_patient_pay_net_nx": "string",
- "reprocessing_member_refund_amount": "string",
- "reprocessing_member_recoupment_amount": "string",
- "reprocessing_is_recoup_ltc_pharmacy": true,
- "notes": "string",
- "first_claim_id": 0,
- "next_claim_id": 0,
- "include_raw_request_parsed": true,
- "include_raw_response_parsed": true,
- "manufacturer_discount_amount": 0,
- "is_manufacturer_discount_drug": true,
- "is_maximum_fair_price_selected_drug": true,
- "maximum_fair_price_ndc_11_package_price": 0,
- "maximum_fair_price_ndc_9_unit_price": 0,
- "maximum_fair_price_selected_drug_subsidy": 0,
- "maximum_fair_price_thiry_day_equivalent": 0,
- "claim_number": "string",
- "claim_sequence_number": "string",
- "medicare_prescription_payment_plan_indicator": "string",
- "medicare_prescription_payment_plan_original_claim_id": 0,
- "pharmacy_transaction_fee": 0,
- "vbid_cost_share_reduction_amount_part_d": 0,
- "vbid_model_indicator": "string",
- "pricing_level_ids": [
- 0
], - "is_parallel_validation": true,
- "calculated_spread_data": null,
- "level_1_basis_of_reimbursement": "string",
- "level_2_basis_of_reimbursement": "string",
- "level_3_basis_of_reimbursement": "string",
- "primary_plan_original_claim_id": 0,
- "is_wrap_benefit": true,
- "column_masks": null,
- "global_management_program_ids": [
- 0
], - "originator": "string",
- "benefit_categories": [
- "string"
], - "drug_lists": null,
- "brand_name_code": "string",
- "drug_descriptor_id": "string",
- "dosage": "string",
- "dosage_form": "string",
- "dosage_form_packaging": "string",
- "drug_name": "string",
- "drug_type": "string",
- "group_name": "string",
- "provider_phone": "string",
- "most_expensive_compound_ingredient_ndc": "string",
- "multi_source": "string",
- "name_type_code": "string",
- "rx_otc_indicator_code": "string",
- "strength": "string",
- "strength_unit_of_measure": "string",
- "pde_record_id": "string",
- "pde_claim_control_number": "string",
- "pde_plan_benefit_package_id": "string",
- "medicare_prescription_payment_plan_claim_id": 0,
- "medicare_prescription_payment_plan_claim_amount": 0,
- "claim_gpi": "string",
- "identity": "string",
- "over_reimbursement_indicator": true,
- "accumulation_adjustment_ids": [
- 0
]
}| id required | integer <int32> |
| is_340b | boolean or null |
| external_account_id required | string or null |
| external_group_id required | string or null |
| dmr_pay_to_check_eft_number | string or null |
| dmr_pay_to_date | string or null <ArrowDateTime> |
{- "id": 0,
- "is_340b": true,
- "external_account_id": "string",
- "external_group_id": "string",
- "dmr_pay_to_check_eft_number": "string",
- "dmr_pay_to_date": "string"
}{- "id": 0,
- "rn": "string",
- "reversal_id": 0,
- "reverses_id": 0,
- "original_claim_id": 0,
- "client_id": "string",
- "external_account_id": "string",
- "external_group_id": "string",
- "provider_agreement_id": 0,
- "coverage_strategy_id": "string",
- "date_of_service": "string",
- "claim_submission_date": "string",
- "claim_payment_cycle_end_date": "string",
- "claim_reimbursement_cycle_end_date": "string",
- "claim_status": "string",
- "claim_count": 0,
- "received_at": "string",
- "source": "string",
- "external_member_id": "string",
- "person_code": "string",
- "first_name": "string",
- "last_name": "string",
- "coverage_strategy_type": "string",
- "plan_benefit_id": 0,
- "formulary_id": 0,
- "network_id": 0,
- "benefit_network": "string",
- "gpi": "string",
- "pharmacy_nabp": "string",
- "pharmacy_name": "string",
- "pharmacy_channel": "string",
- "version_release_number": "string",
- "request_transaction_code": "string",
- "bin_number": "string",
- "processor_control_number": "string",
- "transaction_count": "string",
- "service_provider_id_qualifier": "string",
- "service_provider_id": "string",
- "software_vendor_certification_id": "string",
- "submitted_cardholder_id": "string",
- "cardholder_first_name": "string",
- "cardholder_last_name": "string",
- "plan_id": "string",
- "eligibility_clarification_code": "string",
- "group_id": "string",
- "submitted_person_code": "string",
- "patient_relationship_code": "string",
- "medigap_id": "string",
- "medicaid_indicator": "string",
- "provider_accept_assignment_indicator": "string",
- "cms_part_d_defined_qualified_facility": "string",
- "medicaid_id_number": "string",
- "patient_id_qualifier": "string",
- "patient_id": "string",
- "date_of_birth": "string",
- "patient_gender_code": "string",
- "patient_first_name": "string",
- "patient_last_name": "string",
- "patient_street_address": "string",
- "patient_street_address_line_1": "string",
- "patient_street_address_line_2": "string",
- "patient_city_address": "string",
- "patient_state_province_address": "string",
- "patient_zip_postal_code": "string",
- "patient_country_code": "string",
- "patient_telephone_number": "string",
- "place_of_service": "string",
- "employer_id": "string",
- "pregnancy_indicator": "string",
- "patient_email_address": "user@example.com",
- "patient_residence": "string",
- "prescription_service_reference_number_qualifier": "string",
- "prescription_service_reference_number": "string",
- "product_service_id_qualifier": "string",
- "ndc": "string",
- "associated_prescription_service_reference_number": "string",
- "associated_prescription_service_date": "string",
- "procedure_modifier_code_1": "string",
- "procedure_modifier_code_2": "string",
- "procedure_modifier_code_3": "string",
- "procedure_modifier_code_4": "string",
- "procedure_modifier_code_5": "string",
- "procedure_modifier_code_6": "string",
- "procedure_modifier_code_7": "string",
- "procedure_modifier_code_8": "string",
- "procedure_modifier_code_9": "string",
- "procedure_modifier_code_10": "string",
- "quantity_dispensed": "string",
- "fill_number": 0,
- "days_supply": 0,
- "compound_code": "string",
- "daw": "string",
- "date_prescription_written": "string",
- "number_of_refills_authorized": 0,
- "prescription_origin_code": "string",
- "submission_clarification_code_1": "string",
- "submission_clarification_code_2": "string",
- "submission_clarification_code_3": "string",
- "submission_clarification_code_4": "string",
- "submission_clarification_code_5": "string",
- "submission_clarification_code_pde": "string",
- "submission_type_code_1": "string",
- "submission_type_code_2": "string",
- "submission_type_code_3": "string",
- "submission_type_code_4": "string",
- "submission_type_code_5": "string",
- "quantity_prescribed": "string",
- "multiple_prescription_service_order_group_id": "string",
- "multiple_prescription_service_order_group_reason_code": "string",
- "total_prescribed_quantity_remaining": "string",
- "other_coverage_code": "string",
- "special_packaging_indicator": "string",
- "originally_prescribed_product_service_id_qualifier": "string",
- "originally_prescribed_product_service_code": "string",
- "originally_prescribed_quantity": "string",
- "scheduled_prescription_id_number": "string",
- "unit_of_measure": "string",
- "level_of_service": "string",
- "prior_authorization_type_code": "string",
- "prior_authorization_id_submitted": "string",
- "dispensing_status": "string",
- "quantity_intended_to_be_dispensed": "string",
- "days_supply_intended_to_be_dispensed": 0,
- "delay_reason_code": "string",
- "patient_assignment_indicator": "string",
- "route_of_administration": "string",
- "compound_type": "string",
- "preparation_environment_type": "string",
- "preparation_environment_event_code": "string",
- "pharmacy_service_type": "string",
- "associated_prescription_service_reference_number_qualifier": "string",
- "associated_prescription_service_fill_number": 0,
- "original_manufacturer_product_id_qualifier": "string",
- "original_manufacturer_product_id": "string",
- "ltpac_dispense_frequency": "string",
- "ltpac_billing_methodology": "string",
- "number_of_ltpac_dispensing_events": 0,
- "do_not_dispense_before_date": "string",
- "ingredient_cost_submitted": "string",
- "dispensing_fee_submitted": "string",
- "patient_pay_amount_reported": "string",
- "incentive_amount_submitted": "string",
- "other_amount_claimed_submitted_qualifier_1": "string",
- "other_amount_claimed_submitted_1": "string",
- "other_amount_claimed_submitted_qualifier_2": "string",
- "other_amount_claimed_submitted_2": "string",
- "other_amount_claimed_submitted_qualifier_3": "string",
- "other_amount_claimed_submitted_3": "string",
- "regulatory_fee_type_code_submitted_1": "string",
- "regulatory_fee_amount_submitted_1": "string",
- "regulatory_fee_type_code_submitted_2": "string",
- "regulatory_fee_amount_submitted_2": "string",
- "regulatory_fee_type_code_submitted_3": "string",
- "regulatory_fee_amount_submitted_3": "string",
- "percentage_tax_amount_submitted": "string",
- "percentage_tax_rate_submitted": "string",
- "percentage_tax_basis_submitted": "string",
- "usual_and_customary_charge": "string",
- "gross_amount_due": "string",
- "basis_of_cost_determination": "string",
- "provider_id_qualifier": "string",
- "provider_id": "string",
- "provider_first_name": "string",
- "provider_last_name": "string",
- "prescriber_id_qualifier": "string",
- "prescriber_id": "string",
- "prescriber_last_name": "string",
- "prescriber_telephone_number": "string",
- "prescriber_telephone_number_extension": "string",
- "primary_care_provider_id_qualifier": "string",
- "primary_care_provider_id": "string",
- "primary_care_provider_last_name": "string",
- "prescriber_first_name": "string",
- "prescriber_street_address": "string",
- "prescriber_street_address_line_1": "string",
- "prescriber_street_address_line_2": "string",
- "prescriber_city_address": "string",
- "prescriber_state_province_address": "string",
- "prescriber_zip_postal_code": "string",
- "prescriber_country_code": "string",
- "prescriber_dea_number": "string",
- "prescriber_place_of_service": "string",
- "compound_prices": null,
- "compound_dosage_form_description_code": "string",
- "compound_dispensing_unit_form_indicator": "string",
- "compound_ingredient_component_count": 0,
- "compound_product_id_qualifier_1": "string",
- "compound_product_id_1": "string",
- "compound_ingredient_quantity_1": "string",
- "compound_product_id_qualifier_2": "string",
- "compound_product_id_2": "string",
- "compound_ingredient_quantity_2": "string",
- "compound_product_id_qualifier_3": "string",
- "compound_product_id_3": "string",
- "compound_ingredient_quantity_3": "string",
- "compound_product_id_qualifier_4": "string",
- "compound_product_id_4": "string",
- "compound_ingredient_quantity_4": "string",
- "compound_product_id_qualifier_5": "string",
- "compound_product_id_5": "string",
- "compound_ingredient_quantity_5": "string",
- "compound_product_id_qualifier_6": "string",
- "compound_product_id_6": "string",
- "compound_ingredient_quantity_6": "string",
- "compound_product_id_qualifier_7": "string",
- "compound_product_id_7": "string",
- "compound_ingredient_quantity_7": "string",
- "compound_product_id_qualifier_8": "string",
- "compound_product_id_8": "string",
- "compound_ingredient_quantity_8": "string",
- "compound_product_id_qualifier_9": "string",
- "compound_product_id_9": "string",
- "compound_ingredient_quantity_9": "string",
- "compound_product_id_qualifier_10": "string",
- "compound_product_id_10": "string",
- "compound_ingredient_quantity_10": "string",
- "compound_product_id_qualifier_11": "string",
- "compound_product_id_11": "string",
- "compound_ingredient_quantity_11": "string",
- "compound_product_id_qualifier_12": "string",
- "compound_product_id_12": "string",
- "compound_ingredient_quantity_12": "string",
- "compound_product_id_qualifier_13": "string",
- "compound_product_id_13": "string",
- "compound_ingredient_quantity_13": "string",
- "compound_product_id_qualifier_14": "string",
- "compound_product_id_14": "string",
- "compound_ingredient_quantity_14": "string",
- "compound_product_id_qualifier_15": "string",
- "compound_product_id_15": "string",
- "compound_ingredient_quantity_15": "string",
- "compound_product_id_qualifier_16": "string",
- "compound_product_id_16": "string",
- "compound_ingredient_quantity_16": "string",
- "compound_product_id_qualifier_17": "string",
- "compound_product_id_17": "string",
- "compound_ingredient_quantity_17": "string",
- "compound_product_id_qualifier_18": "string",
- "compound_product_id_18": "string",
- "compound_ingredient_quantity_18": "string",
- "compound_product_id_qualifier_19": "string",
- "compound_product_id_19": "string",
- "compound_ingredient_quantity_19": "string",
- "compound_product_id_qualifier_20": "string",
- "compound_product_id_20": "string",
- "compound_ingredient_quantity_20": "string",
- "compound_product_id_qualifier_21": "string",
- "compound_product_id_21": "string",
- "compound_ingredient_quantity_21": "string",
- "compound_product_id_qualifier_22": "string",
- "compound_product_id_22": "string",
- "compound_ingredient_quantity_22": "string",
- "compound_product_id_qualifier_23": "string",
- "compound_product_id_23": "string",
- "compound_ingredient_quantity_23": "string",
- "compound_product_id_qualifier_24": "string",
- "compound_product_id_24": "string",
- "compound_ingredient_quantity_24": "string",
- "compound_product_id_qualifier_25": "string",
- "compound_product_id_25": "string",
- "compound_ingredient_quantity_25": "string",
- "diagnosis_code_qualifier_1": "string",
- "diagnosis_code_1": "string",
- "diagnosis_code_qualifier_2": "string",
- "diagnosis_code_2": "string",
- "diagnosis_code_qualifier_3": "string",
- "diagnosis_code_3": "string",
- "diagnosis_code_qualifier_4": "string",
- "diagnosis_code_4": "string",
- "diagnosis_code_qualifier_5": "string",
- "diagnosis_code_5": "string",
- "header_response_status": "string",
- "response_transaction_code": "string",
- "response_message": "string",
- "response_group_id": "string",
- "response_plan_id": "string",
- "response_cob": null,
- "network_reimbursement_id": "string",
- "external_provider_agreement_id": "string",
- "payer_health_plan_id_qualifier": "string",
- "payer_health_plan_id": "string",
- "payer_health_plan_id_qualifier_1": "string",
- "payer_health_plan_id_1": "string",
- "payer_health_plan_id_qualifier_2": "string",
- "payer_health_plan_id_2": "string",
- "payer_health_plan_id_qualifier_3": "string",
- "payer_health_plan_id_3": "string",
- "transaction_response_status": "string",
- "authorization_number": "string",
- "reconciliation_id": "string",
- "reject_code_1": "string",
- "reject_code_2": "string",
- "reject_code_3": "string",
- "reject_code_4": "string",
- "reject_code_5": "string",
- "approved_message_code_1": "string",
- "approved_message_code_2": "string",
- "approved_message_code_3": "string",
- "approved_message_code_4": "string",
- "approved_message_code_5": "string",
- "additional_message_count": 0,
- "additional_message_information_qualifier_1": "string",
- "additional_message_information_1": "string",
- "additional_message_information_continuity_1": "string",
- "additional_message_information_qualifier_2": "string",
- "additional_message_information_2": "string",
- "additional_message_information_continuity_2": "string",
- "additional_message_information_qualifier_3": "string",
- "additional_message_information_3": "string",
- "additional_message_information_continuity_3": "string",
- "additional_message_information_qualifier_4": "string",
- "additional_message_information_4": "string",
- "additional_message_information_continuity_4": "string",
- "additional_message_information_qualifier_5": "string",
- "additional_message_information_5": "string",
- "additional_message_information_continuity_5": "string",
- "additional_message_information_qualifier_6": "string",
- "additional_message_information_6": "string",
- "additional_message_information_continuity_6": "string",
- "additional_message_information_qualifier_7": "string",
- "additional_message_information_7": "string",
- "additional_message_information_continuity_7": "string",
- "additional_message_information_qualifier_8": "string",
- "additional_message_information_8": "string",
- "additional_message_information_continuity_8": "string",
- "additional_message_information_qualifier_9": "string",
- "additional_message_information_9": "string",
- "additional_message_information_continuity_9": "string",
- "additional_message_information_qualifier_10": "string",
- "additional_message_information_10": "string",
- "additional_message_information_continuity_10": "string",
- "additional_message_information_qualifier_11": "string",
- "additional_message_information_11": "string",
- "additional_message_information_continuity_11": "string",
- "additional_message_information_qualifier_12": "string",
- "additional_message_information_12": "string",
- "additional_message_information_continuity_12": "string",
- "additional_message_information_qualifier_13": "string",
- "additional_message_information_13": "string",
- "additional_message_information_continuity_13": "string",
- "additional_message_information_qualifier_14": "string",
- "additional_message_information_14": "string",
- "additional_message_information_continuity_14": "string",
- "additional_message_information_qualifier_15": "string",
- "additional_message_information_15": "string",
- "additional_message_information_continuity_15": "string",
- "additional_message_information_qualifier_16": "string",
- "additional_message_information_16": "string",
- "additional_message_information_continuity_16": "string",
- "additional_message_information_qualifier_17": "string",
- "additional_message_information_17": "string",
- "additional_message_information_continuity_17": "string",
- "additional_message_information_qualifier_18": "string",
- "additional_message_information_18": "string",
- "additional_message_information_continuity_18": "string",
- "additional_message_information_qualifier_19": "string",
- "additional_message_information_19": "string",
- "additional_message_information_continuity_19": "string",
- "additional_message_information_qualifier_20": "string",
- "additional_message_information_20": "string",
- "additional_message_information_continuity_20": "string",
- "internal_control_number": "string",
- "adjudicated_program_type": "string",
- "next_available_fill_date": "string",
- "formulary_alternative_product_count": 0,
- "formulary_alternative_plan_benefit_tier_1": "string",
- "formulary_alternative_reason_code_1": "string",
- "formulary_alternative_id_qualifier_1": "string",
- "formulary_alternative_id_1": "string",
- "formulary_alternative_incentive_1": "string",
- "formulary_alternative_cost_share_incentive_1": "string",
- "formulary_alternative_description_1": "string",
- "formulary_alternative_plan_benefit_tier_2": "string",
- "formulary_alternative_reason_code_2": "string",
- "formulary_alternative_id_qualifier_2": "string",
- "formulary_alternative_id_2": "string",
- "formulary_alternative_incentive_2": "string",
- "formulary_alternative_cost_share_incentive_2": "string",
- "formulary_alternative_description_2": "string",
- "formulary_alternative_plan_benefit_tier_3": "string",
- "formulary_alternative_reason_code_3": "string",
- "formulary_alternative_id_qualifier_3": "string",
- "formulary_alternative_id_3": "string",
- "formulary_alternative_incentive_3": "string",
- "formulary_alternative_cost_share_incentive_3": 0,
- "formulary_alternative_description_3": "string",
- "plan_benefit_override_indicator": "string",
- "plan_benefit_override_value_1": "string",
- "plan_benefit_override_value_2": "string",
- "plan_benefit_override_value_3": "string",
- "plan_benefit_override_value_4": "string",
- "plan_benefit_override_value_5": "string",
- "plan_benefit_override_value_6": "string",
- "plan_benefit_override_value_7": "string",
- "plan_benefit_override_value_8": "string",
- "plan_benefit_override_value_9": "string",
- "maximum_age_qualifier": "string",
- "maximum_age": 0,
- "minimum_age_qualifier": "string",
- "minimum_age": 0,
- "minimum_amount_qualifier": "string",
- "minimum_amount": "string",
- "maximum_amount_qualifier": "string",
- "maximum_amount": "string",
- "maximum_amount_time_period": "string",
- "maximum_amount_time_period_end_date": "string",
- "maximum_amount_time_period_start_date": "string",
- "maximum_amount_time_period_units": "string",
- "remaining_amount_qualifier": "string",
- "remaining_amount": "string",
- "benefit_type_opportunity_count": 0,
- "benefit_type_opportunity_1": "string",
- "benefit_type_opportunity_2": "string",
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], - "drug_lists": null,
- "brand_name_code": "string",
- "drug_descriptor_id": "string",
- "dosage": "string",
- "dosage_form": "string",
- "dosage_form_packaging": "string",
- "drug_name": "string",
- "drug_type": "string",
- "group_name": "string",
- "provider_phone": "string",
- "most_expensive_compound_ingredient_ndc": "string",
- "multi_source": "string",
- "name_type_code": "string",
- "rx_otc_indicator_code": "string",
- "strength": "string",
- "strength_unit_of_measure": "string",
- "pde_record_id": "string",
- "pde_claim_control_number": "string",
- "pde_plan_benefit_package_id": "string",
- "medicare_prescription_payment_plan_claim_id": 0,
- "medicare_prescription_payment_plan_claim_amount": 0,
- "claim_gpi": "string",
- "identity": "string",
- "over_reimbursement_indicator": true,
- "accumulation_adjustment_ids": [
- 0
]
}Get a Claim Reprocessing.
| id required | integer <int32> |
{- "id": 0
}{- "id": 0,
- "created_at": "string",
- "identity": "string",
- "description": "string",
- "data_source": "string",
- "bucket": "string",
- "key": "string",
- "original_name": "string",
- "data": "string",
- "type": "string",
- "kind": "string",
- "status": "string",
- "status_bucket": "string",
- "status_key": "string",
- "rn": "string",
- "reprocessing_type": "string",
- "reprocessing_kind": "string",
- "total_rows": 0,
- "rows_processed": 0,
- "display_status": "string",
- "updated_at": "string"
}List Claim Reprocessings.
| page_number | integer or null <int32> The page of results you would like to get. For the first page, pass |
| results_per_page | integer or null <int32> The number of results per page. |
| expected_fields | Array of strings or null or null The desired list of fields to be returned. |
Array of objects or null (OrderBySchema_1764643208.462241) | |
| created_at_from | string or null <ArrowDateTime> |
| created_at_to | string or null <ArrowDateTime> |
| kind | string or null Enum: "test" "final" |
| initiated_by | string or null |
| original_name | string or null |
| type | string or null |
| status | string or null |
| id | string or null |
{- "page_number": 0,
- "results_per_page": 0,
- "expected_fields": [
- "string"
], - "order_by": [
- {
- "created_at": "string",
- "key": "string",
- "type": "string",
- "kind": "string",
- "identity": "string",
- "original_name": "string",
- "status": "string",
- "updated_at": "string",
- "id": "string"
}
], - "created_at_from": "string",
- "created_at_to": "string",
- "kind": "test",
- "initiated_by": "string",
- "original_name": "string",
- "type": "string",
- "status": "string",
- "id": "string"
}{- "results": [
- {
- "claim_reprocessing": {
- "id": 0,
- "created_at": "string",
- "identity": "string",
- "description": "string",
- "data_source": "string",
- "bucket": "string",
- "key": "string",
- "original_name": "string",
- "data": "string",
- "type": "string",
- "kind": "string",
- "status": "string",
- "status_bucket": "string",
- "status_key": "string",
- "rn": "string",
- "reprocessing_type": "string",
- "reprocessing_kind": "string",
- "total_rows": 0,
- "rows_processed": 0,
- "display_status": "string",
- "updated_at": "string"
}
}
], - "result_count": "string"
}Reprocesses claims as a test.
| id required | integer <int32> |
| reprocessing_type | string |
{- "id": 0,
- "reprocessing_type": "string"
}{- "message": "string"
}| original_name | string or null |
| reprocessing_type | string |
{- "original_name": "string",
- "reprocessing_type": "string"
}{- "id": 0,
- "created_at": "string",
- "identity": "string",
- "description": "string",
- "data_source": "string",
- "bucket": "string",
- "key": "string",
- "original_name": "string",
- "data": "string",
- "type": "string",
- "kind": "string",
- "status": "string",
- "status_bucket": "string",
- "status_key": "string",
- "rn": "string",
- "reprocessing_type": "string",
- "reprocessing_kind": "string",
- "total_rows": 0,
- "rows_processed": 0,
- "display_status": "string",
- "updated_at": "string",
- "post": {
- "url": "string",
- "fields": null
}
}Create a Client Management.
| id | integer <int32> A unique ID which represents a client payment configuration |
| client_id required | string or null An identifier for the client |
| rn | string or null A unique resource identifier string used for IAM |
| created_at | string <ArrowDateTime> Timestamp when the payment configuration was created |
| deleted_at | string or null <ArrowDateTime> Timestamp when the payment configuration was soft deleted |
| client_payment_configuration_id | integer <int32> Foreign key reference to the parent configuration |
| client_payment_configuration_version_id | integer <int32> ID of the current active version |
| name required | string or null Full name of the client |
| first_name | string or null First name of the client contact person |
| last_name | string or null Last name of the client contact person |
| phone_number | string or null Contact phone number for client inquiries |
| email_address | string or null Contact email address for client communications |
| days_of_week | Array of strings or null List of days |
| week_of_month | string[first|second|third|fourth|last] Week of the month the reimbursement will be in effect. For monthly cadences only. |
| frequency | string Enum: "daily" "weekly" "biweekly" "monthly" Claim reimbursement cadence. |
| mode | string Enum: "asap" "alap" Payment mode: 'asap' (as soon as possible) or 'alap' (as late as possible) |
| holding_duration_hours | integer or null <int32> Client specified holding period for moving funds to ADAC account |
| bank_name | string or null Name of the bank for the client's account |
| bank_address_line_1 | string or null Primary street address of the client's bank |
| bank_address_line_2 | string or null Secondary address information (suite, floor, etc.) for the client's bank |
| bank_address_city | string or null City for the client's bank |
| bank_address_state | string or null State where client's bank is located |
| bank_address_zip_code | string or null Zip code of the client's bank |
| bank_contact_first_name | string or null First name of the contact person at the client's bank |
| bank_contact_last_name | string or null Last name of the contact person at the client's bank |
| bank_contact_phone_number | string or null Phone number for the contact at the client's bank |
| bank_contact_fax_number | string or null Fax number for the contact at the client's bank |
| bank_account_name | string or null Account name on the client's bank account |
| bank_account_number | string or null Bank account number for the client to send money from |
| bank_routing_number | string or null Routing number for the bank where the client sends money from |
| bank_account_type | string or null Type of bank account (checking, savings) the client uses to send money |
| funding_bank_name | string or null Name of the bank for the client's funding/holding account with Judi Health |
| funding_bank_address_line_1 | string or null Address of the client's bank for the funding/holding account |
| funding_bank_address_line_2 | string or null Secondary address of the client's bank for the funding/holding account |
| funding_bank_address_city | string or null City where the client's bank funding/holding account is located |
| funding_bank_address_state | string or null State where the client's bank funding/holding account is located |
| funding_bank_address_zip_code | string or null Zip code of the client's funding/holding account bank |
| funding_bank_contact_first_name | string or null First name of the contact person at the client's bank for the funding/holding account |
| funding_bank_contact_last_name | string or null Last name of the contact person at the client's bank for the funding/holding account |
| funding_bank_contact_phone_number | string or null Phone number for the contact at the client's funding/holding account bank |
| funding_bank_contact_fax_number | string or null Fax number for the contact at the client's funding/holding account bank |
| funding_bank_account_name | string or null Account name for the client's funding/holding account |
| funding_bank_account_number | string or null Account number for the client's funding/holding account |
| funding_bank_routing_number | string or null Routing number for the client's funding/holding account |
| funding_bank_account_type | string or null Type of the client's funding account (checking, savings) |
| start_date | string <ArrowDateTime> Date when the client payment cycle begins |
| end_date | string <ArrowDateTime> Date when the client payment cycle ends |
| effective_date | string <ArrowDateTime> Date when the client configuration becomes active |
| termination_date | string <ArrowDateTime> Date when the client configuration is terminated |
| notes | string or null Additional notes or comments about the client payment configuration |
| identity | string or null Identifier for the person who created or updated the version |
{- "id": 0,
- "client_id": "string",
- "rn": "string",
- "created_at": "string",
- "deleted_at": "string",
- "client_payment_configuration_id": 0,
- "client_payment_configuration_version_id": 0,
- "name": "string",
- "first_name": "string",
- "last_name": "string",
- "phone_number": "string",
- "email_address": "string",
- "days_of_week": [
- "string"
], - "week_of_month": "string",
- "frequency": "daily",
- "mode": "asap",
- "holding_duration_hours": 0,
- "bank_name": "string",
- "bank_address_line_1": "string",
- "bank_address_line_2": "string",
- "bank_address_city": "string",
- "bank_address_state": "string",
- "bank_address_zip_code": "string",
- "bank_contact_first_name": "string",
- "bank_contact_last_name": "string",
- "bank_contact_phone_number": "string",
- "bank_contact_fax_number": "string",
- "bank_account_name": "string",
- "bank_account_number": "string",
- "bank_routing_number": "string",
- "bank_account_type": "string",
- "funding_bank_name": "string",
- "funding_bank_address_line_1": "string",
- "funding_bank_address_line_2": "string",
- "funding_bank_address_city": "string",
- "funding_bank_address_state": "string",
- "funding_bank_address_zip_code": "string",
- "funding_bank_contact_first_name": "string",
- "funding_bank_contact_last_name": "string",
- "funding_bank_contact_phone_number": "string",
- "funding_bank_contact_fax_number": "string",
- "funding_bank_account_name": "string",
- "funding_bank_account_number": "string",
- "funding_bank_routing_number": "string",
- "funding_bank_account_type": "string",
- "start_date": "string",
- "end_date": "string",
- "effective_date": "string",
- "termination_date": "string",
- "notes": "string",
- "identity": "string"
}{- "id": 0,
- "client_id": "string",
- "rn": "string",
- "created_at": "string",
- "deleted_at": "string",
- "client_payment_configuration_id": 0,
- "client_payment_configuration_version_id": 0,
- "name": "string",
- "first_name": "string",
- "last_name": "string",
- "phone_number": "string",
- "email_address": "string",
- "days_of_week": [
- "string"
], - "week_of_month": "string",
- "frequency": "daily",
- "mode": "asap",
- "holding_duration_hours": 0,
- "bank_name": "string",
- "bank_address_line_1": "string",
- "bank_address_line_2": "string",
- "bank_address_city": "string",
- "bank_address_state": "string",
- "bank_address_zip_code": "string",
- "bank_contact_first_name": "string",
- "bank_contact_last_name": "string",
- "bank_contact_phone_number": "string",
- "bank_contact_fax_number": "string",
- "bank_account_name": "string",
- "bank_account_number": "string",
- "bank_routing_number": "string",
- "bank_account_type": "string",
- "funding_bank_name": "string",
- "funding_bank_address_line_1": "string",
- "funding_bank_address_line_2": "string",
- "funding_bank_address_city": "string",
- "funding_bank_address_state": "string",
- "funding_bank_address_zip_code": "string",
- "funding_bank_contact_first_name": "string",
- "funding_bank_contact_last_name": "string",
- "funding_bank_contact_phone_number": "string",
- "funding_bank_contact_fax_number": "string",
- "funding_bank_account_name": "string",
- "funding_bank_account_number": "string",
- "funding_bank_routing_number": "string",
- "funding_bank_account_type": "string",
- "start_date": "string",
- "end_date": "string",
- "effective_date": "string",
- "termination_date": "string",
- "notes": "string",
- "identity": "string"
}Get a Client Management.
| id | integer <int32> A unique ID which represents a client payment configuration |
{- "id": 0
}{- "id": 0,
- "client_id": "string",
- "rn": "string",
- "created_at": "string",
- "deleted_at": "string",
- "client_payment_configuration_id": 0,
- "client_payment_configuration_version_id": 0,
- "name": "string",
- "first_name": "string",
- "last_name": "string",
- "phone_number": "string",
- "email_address": "string",
- "days_of_week": [
- "string"
], - "week_of_month": "string",
- "frequency": "daily",
- "mode": "asap",
- "holding_duration_hours": 0,
- "bank_name": "string",
- "bank_address_line_1": "string",
- "bank_address_line_2": "string",
- "bank_address_city": "string",
- "bank_address_state": "string",
- "bank_address_zip_code": "string",
- "bank_contact_first_name": "string",
- "bank_contact_last_name": "string",
- "bank_contact_phone_number": "string",
- "bank_contact_fax_number": "string",
- "bank_account_name": "string",
- "bank_account_number": "string",
- "bank_routing_number": "string",
- "bank_account_type": "string",
- "funding_bank_name": "string",
- "funding_bank_address_line_1": "string",
- "funding_bank_address_line_2": "string",
- "funding_bank_address_city": "string",
- "funding_bank_address_state": "string",
- "funding_bank_address_zip_code": "string",
- "funding_bank_contact_first_name": "string",
- "funding_bank_contact_last_name": "string",
- "funding_bank_contact_phone_number": "string",
- "funding_bank_contact_fax_number": "string",
- "funding_bank_account_name": "string",
- "funding_bank_account_number": "string",
- "funding_bank_routing_number": "string",
- "funding_bank_account_type": "string",
- "start_date": "string",
- "end_date": "string",
- "effective_date": "string",
- "termination_date": "string",
- "notes": "string",
- "identity": "string"
}| columns required | Array of strings Items Enum: "client_id" "name" "frequency" "identity" list of columns to fetch dropdown options for |
{- "columns": [
- "client_id"
]
}{- "client_id": [
- "string"
], - "name": [
- "string"
], - "frequency": [
- "string"
], - "identity": [
- "string"
], - "effective_date": "string",
- "termination_date": "string",
- "created_at": "string",
- "start_date": "string"
}List Client Managements.
| page_number | integer or null <int32> The page of results you would like to get. For the first page, pass |
| results_per_page | integer or null <int32> The number of results per page. |
| expected_fields | Array of strings or null or null The desired list of fields to be returned. |
| client_id | any |
| name | any |
| frequency | string |
| effective_date | string <ArrowDateTime> |
| termination_date | string <ArrowDateTime> |
| created_at | string <ArrowDateTime> |
| start_date | string <ArrowDateTime> |
| identity | any or null Identifier for the person who created or updated the version |
Array of objects (ClientManagementListSearchOrderBySchema_1764643208.472832) |
{- "page_number": 0,
- "results_per_page": 0,
- "expected_fields": [
- "string"
], - "client_id": null,
- "name": null,
- "frequency": "string",
- "effective_date": "string",
- "termination_date": "string",
- "created_at": "string",
- "start_date": "string",
- "identity": null,
- "order_by": [
- {
- "client_id": "string",
- "name": "string",
- "frequency": "string",
- "effective_date": "string",
- "termination_date": "string",
- "created_at": "string",
- "start_date": "string",
- "identity": "string"
}
]
}{- "results": [
- {
- "client_management": {
- "id": 0,
- "client_id": "string",
- "rn": "string",
- "created_at": "string",
- "deleted_at": "string",
- "client_payment_configuration_id": 0,
- "client_payment_configuration_version_id": 0,
- "name": "string",
- "first_name": "string",
- "last_name": "string",
- "phone_number": "string",
- "email_address": "string",
- "days_of_week": [
- "string"
], - "week_of_month": "string",
- "frequency": "daily",
- "mode": "asap",
- "holding_duration_hours": 0,
- "bank_name": "string",
- "bank_address_line_1": "string",
- "bank_address_line_2": "string",
- "bank_address_city": "string",
- "bank_address_state": "string",
- "bank_address_zip_code": "string",
- "bank_contact_first_name": "string",
- "bank_contact_last_name": "string",
- "bank_contact_phone_number": "string",
- "bank_contact_fax_number": "string",
- "bank_account_name": "string",
- "bank_account_number": "string",
- "bank_routing_number": "string",
- "bank_account_type": "string",
- "funding_bank_name": "string",
- "funding_bank_address_line_1": "string",
- "funding_bank_address_line_2": "string",
- "funding_bank_address_city": "string",
- "funding_bank_address_state": "string",
- "funding_bank_address_zip_code": "string",
- "funding_bank_contact_first_name": "string",
- "funding_bank_contact_last_name": "string",
- "funding_bank_contact_phone_number": "string",
- "funding_bank_contact_fax_number": "string",
- "funding_bank_account_name": "string",
- "funding_bank_account_number": "string",
- "funding_bank_routing_number": "string",
- "funding_bank_account_type": "string",
- "start_date": "string",
- "end_date": "string",
- "effective_date": "string",
- "termination_date": "string",
- "notes": "string",
- "identity": "string"
}
}
], - "result_count": "string"
}Update a Client Management.
| id | integer <int32> A unique ID which represents a client payment configuration |
| client_id | string or null An identifier for the client |
| rn | string or null A unique resource identifier string used for IAM |
| created_at | string <ArrowDateTime> Timestamp when the payment configuration was created |
| deleted_at | string or null <ArrowDateTime> Timestamp when the payment configuration was soft deleted |
| client_payment_configuration_id | integer <int32> Foreign key reference to the parent configuration |
| client_payment_configuration_version_id | integer <int32> ID of the current active version |
| name | string or null Full name of the client |
| first_name | string or null First name of the client contact person |
| last_name | string or null Last name of the client contact person |
| phone_number | string or null Contact phone number for client inquiries |
| email_address | string or null Contact email address for client communications |
| days_of_week | Array of strings or null List of days |
| week_of_month | string[first|second|third|fourth|last] Week of the month the reimbursement will be in effect. For monthly cadences only. |
| frequency | string Enum: "daily" "weekly" "biweekly" "monthly" Claim reimbursement cadence. |
| mode | string Enum: "asap" "alap" Payment mode: 'asap' (as soon as possible) or 'alap' (as late as possible) |
| holding_duration_hours | integer or null <int32> Client specified holding period for moving funds to ADAC account |
| bank_name | string or null Name of the bank for the client's account |
| bank_address_line_1 | string or null Primary street address of the client's bank |
| bank_address_line_2 | string or null Secondary address information (suite, floor, etc.) for the client's bank |
| bank_address_city | string or null City for the client's bank |
| bank_address_state | string or null State where client's bank is located |
| bank_address_zip_code | string or null Zip code of the client's bank |
| bank_contact_first_name | string or null First name of the contact person at the client's bank |
| bank_contact_last_name | string or null Last name of the contact person at the client's bank |
| bank_contact_phone_number | string or null Phone number for the contact at the client's bank |
| bank_contact_fax_number | string or null Fax number for the contact at the client's bank |
| bank_account_name | string or null Account name on the client's bank account |
| bank_account_number | string or null Bank account number for the client to send money from |
| bank_routing_number | string or null Routing number for the bank where the client sends money from |
| bank_account_type | string or null Type of bank account (checking, savings) the client uses to send money |
| funding_bank_name | string or null Name of the bank for the client's funding/holding account with Judi Health |
| funding_bank_address_line_1 | string or null Address of the client's bank for the funding/holding account |
| funding_bank_address_line_2 | string or null Secondary address of the client's bank for the funding/holding account |
| funding_bank_address_city | string or null City where the client's bank funding/holding account is located |
| funding_bank_address_state | string or null State where the client's bank funding/holding account is located |
| funding_bank_address_zip_code | string or null Zip code of the client's funding/holding account bank |
| funding_bank_contact_first_name | string or null First name of the contact person at the client's bank for the funding/holding account |
| funding_bank_contact_last_name | string or null Last name of the contact person at the client's bank for the funding/holding account |
| funding_bank_contact_phone_number | string or null Phone number for the contact at the client's funding/holding account bank |
| funding_bank_contact_fax_number | string or null Fax number for the contact at the client's funding/holding account bank |
| funding_bank_account_name | string or null Account name for the client's funding/holding account |
| funding_bank_account_number | string or null Account number for the client's funding/holding account |
| funding_bank_routing_number | string or null Routing number for the client's funding/holding account |
| funding_bank_account_type | string or null Type of the client's funding account (checking, savings) |
| start_date | string <ArrowDateTime> Date when the client payment cycle begins |
| end_date | string <ArrowDateTime> Date when the client payment cycle ends |
| effective_date | string <ArrowDateTime> Date when the client configuration becomes active |
| termination_date | string <ArrowDateTime> Date when the client configuration is terminated |
| notes | string or null Additional notes or comments about the client payment configuration |
| identity | string or null Identifier for the person who created or updated the version |
{- "id": 0,
- "client_id": "string",
- "rn": "string",
- "created_at": "string",
- "deleted_at": "string",
- "client_payment_configuration_id": 0,
- "client_payment_configuration_version_id": 0,
- "name": "string",
- "first_name": "string",
- "last_name": "string",
- "phone_number": "string",
- "email_address": "string",
- "days_of_week": [
- "string"
], - "week_of_month": "string",
- "frequency": "daily",
- "mode": "asap",
- "holding_duration_hours": 0,
- "bank_name": "string",
- "bank_address_line_1": "string",
- "bank_address_line_2": "string",
- "bank_address_city": "string",
- "bank_address_state": "string",
- "bank_address_zip_code": "string",
- "bank_contact_first_name": "string",
- "bank_contact_last_name": "string",
- "bank_contact_phone_number": "string",
- "bank_contact_fax_number": "string",
- "bank_account_name": "string",
- "bank_account_number": "string",
- "bank_routing_number": "string",
- "bank_account_type": "string",
- "funding_bank_name": "string",
- "funding_bank_address_line_1": "string",
- "funding_bank_address_line_2": "string",
- "funding_bank_address_city": "string",
- "funding_bank_address_state": "string",
- "funding_bank_address_zip_code": "string",
- "funding_bank_contact_first_name": "string",
- "funding_bank_contact_last_name": "string",
- "funding_bank_contact_phone_number": "string",
- "funding_bank_contact_fax_number": "string",
- "funding_bank_account_name": "string",
- "funding_bank_account_number": "string",
- "funding_bank_routing_number": "string",
- "funding_bank_account_type": "string",
- "start_date": "string",
- "end_date": "string",
- "effective_date": "string",
- "termination_date": "string",
- "notes": "string",
- "identity": "string"
}{- "id": 0,
- "client_id": "string",
- "rn": "string",
- "created_at": "string",
- "deleted_at": "string",
- "client_payment_configuration_id": 0,
- "client_payment_configuration_version_id": 0,
- "name": "string",
- "first_name": "string",
- "last_name": "string",
- "phone_number": "string",
- "email_address": "string",
- "days_of_week": [
- "string"
], - "week_of_month": "string",
- "frequency": "daily",
- "mode": "asap",
- "holding_duration_hours": 0,
- "bank_name": "string",
- "bank_address_line_1": "string",
- "bank_address_line_2": "string",
- "bank_address_city": "string",
- "bank_address_state": "string",
- "bank_address_zip_code": "string",
- "bank_contact_first_name": "string",
- "bank_contact_last_name": "string",
- "bank_contact_phone_number": "string",
- "bank_contact_fax_number": "string",
- "bank_account_name": "string",
- "bank_account_number": "string",
- "bank_routing_number": "string",
- "bank_account_type": "string",
- "funding_bank_name": "string",
- "funding_bank_address_line_1": "string",
- "funding_bank_address_line_2": "string",
- "funding_bank_address_city": "string",
- "funding_bank_address_state": "string",
- "funding_bank_address_zip_code": "string",
- "funding_bank_contact_first_name": "string",
- "funding_bank_contact_last_name": "string",
- "funding_bank_contact_phone_number": "string",
- "funding_bank_contact_fax_number": "string",
- "funding_bank_account_name": "string",
- "funding_bank_account_number": "string",
- "funding_bank_routing_number": "string",
- "funding_bank_account_type": "string",
- "start_date": "string",
- "end_date": "string",
- "effective_date": "string",
- "termination_date": "string",
- "notes": "string",
- "identity": "string"
}For given client_id/report_type/report_period/report_year/sheet, return presigned URL for corresponding JSON.
By using "url" key of returned JSON, user get temporary access to JSON stored on S3.
| client_id required | string |
| report_period required | string |
| report_year required | string |
| report_type required | string |
| sheet required | string |
{- "client_id": "string",
- "report_period": "string",
- "report_year": "string",
- "report_type": "string",
- "sheet": "string"
}{- "url": "string"
}| client_id required | string |
| override | boolean or null |
| report_period required | string |
| report_year required | string |
| report_type required | string |
{- "client_id": "string",
- "override": true,
- "report_period": "string",
- "report_year": "string",
- "report_type": "string"
}{- "message": "string"
}| client_id required | string |
| report_period required | string |
| report_year required | string |
| report_type required | string |
{- "client_id": "string",
- "report_period": "string",
- "report_year": "string",
- "report_type": "string"
}{- "url": "string"
}List Reportings.
| page_number | integer or null <int32> The page of results you would like to get. For the first page, pass |
| results_per_page | integer or null <int32> The number of results per page. |
| expected_fields | Array of strings or null or null The desired list of fields to be returned. |
| client_id required | string The client ID for desired reports |
Array of objects or null (OrderBySchema_1764643208.4789388) |
{- "page_number": 0,
- "results_per_page": 0,
- "expected_fields": [
- "string"
], - "client_id": "string",
- "order_by": [
- {
- "client_id": "string",
- "report_type": "string",
- "report_date": "string",
- "updated_at": "string",
- "status": "string"
}
]
}{- "results": [
- {
- "client_utilization_report": {
- "rn": "string",
- "created_at": "string",
- "updated_at": "string",
- "client_id": "string",
- "report_type": "string",
- "report_date": "string",
- "status": "string",
- "failure_reason": "string",
- "bucket": "string",
- "key": "string"
}
}
], - "result_count": "string"
}Get a Configurable Realtime Module.
| id | integer or null <int32> |
| name | string or null |
{- "id": 0,
- "name": "string"
}{- "id": 0,
- "name": "string",
- "message_type": "string",
- "description": "string",
- "created_at": "string",
- "supported_attributes": null,
- "supported_fields": null,
- "supported_functions": null,
- "supported_operators": null
}List Configurable Realtime Modules.
| page_number | integer or null <int32> The page of results you would like to get. For the first page, pass |
| results_per_page | integer or null <int32> The number of results per page. |
| expected_fields | Array of strings or null or null The desired list of fields to be returned. |
| id | integer or null <int32> |
| name | string or null |
| description | string or null |
Array of objects or null (OrderBySchema_1764643208.4821684) |
{- "page_number": 0,
- "results_per_page": 0,
- "expected_fields": [
- "string"
], - "id": 0,
- "name": "string",
- "description": "string",
- "order_by": [
- {
- "id": 0,
- "name": "string",
- "description": "string"
}
]
}{- "results": [
- {
- "configurable_realtime_module": {
- "id": 0,
- "name": "string",
- "message_type": "string",
- "description": "string",
- "created_at": "string",
- "supported_attributes": null,
- "supported_fields": null,
- "supported_functions": null,
- "supported_operators": null
}
}
], - "result_count": 0
}Get a Continuation Of Therapy.
| id required | integer <int32> The internal ID of the continuation of therapy. Cannot be set during create nor subsequently changed. |
{- "id": 0
}{- "id": 0,
- "plan_benefit_id": 0,
- "rn": "string",
- "continuation_types": [
- "string"
], - "intent": "string",
- "drug_type": "string",
- "drug_use": "string",
- "only_applies_to_categories": [
- "string"
], - "only_applies_to_tags": [
- 0
], - "does_not_apply_to_tags": [
- 0
], - "only_applies_to_carve_out": [
- "string"
], - "does_not_apply_to_carve_out": [
- "string"
], - "utilizer_type": [
- "string"
], - "use_continuation_of_therapy_effective_date": true,
- "use_new_enrollee_effective_date": true,
- "lookback_days": 0,
- "existing_utilizer_cutoff_date": "string",
- "existing_utilizer_cutoff_date_source": "string",
- "network_types": [
- "string"
], - "duration": 0,
- "number_of_fills": 0,
- "cumulative_days_supply": 0,
- "effective_date": "string",
- "termination_date": "string",
- "continuation_of_therapy_id": 0,
- "cot_formulary_exclusion_tier_placement": [
- {
- "multi_source": [
- "string"
], - "specialty": "string",
- "new_tier": "string"
}
]
}Update a Continuation Of Therapy.
| id required | integer <int32> The continuation of therapy ID to update |
| plan_benefit_id | integer or null <int32> The internal ID of the associated plan benefit. Should not be changed. |
| rn | string or null |
| continuation_types | Array of strings or null |
| intent | string or null |
| drug_type | string or null |
| drug_use | string or null |
| only_applies_to_categories | Array of strings or null |
| only_applies_to_tags | Array of integers or null <int32> |
| does_not_apply_to_tags | Array of integers or null <int32> |
| only_applies_to_carve_out | Array of strings or null |
| does_not_apply_to_carve_out | Array of strings or null |
| utilizer_type | Array of strings or null |
| use_continuation_of_therapy_effective_date | boolean or null |
| use_new_enrollee_effective_date | boolean or null |
| lookback_days | integer or null <int32> |
| existing_utilizer_cutoff_date | string or null <ArrowDateTime> |
| existing_utilizer_cutoff_date_source | string or null |
| network_types | Array of strings or null |
| duration | integer or null <int32> |
| number_of_fills | integer or null <int32> |
| cumulative_days_supply | integer or null <int32> |
| effective_date | string <ArrowDateTime> |
| termination_date | string <ArrowDateTime> |
| continuation_of_therapy_id | integer or null <int32> |
Array of objects or null (FormularyExclusionTierPlacement_1764643208.4848669) |
{- "id": 0,
- "plan_benefit_id": 0,
- "rn": "string",
- "continuation_types": [
- "string"
], - "intent": "string",
- "drug_type": "string",
- "drug_use": "string",
- "only_applies_to_categories": [
- "string"
], - "only_applies_to_tags": [
- 0
], - "does_not_apply_to_tags": [
- 0
], - "only_applies_to_carve_out": [
- "string"
], - "does_not_apply_to_carve_out": [
- "string"
], - "utilizer_type": [
- "string"
], - "use_continuation_of_therapy_effective_date": true,
- "use_new_enrollee_effective_date": true,
- "lookback_days": 0,
- "existing_utilizer_cutoff_date": "string",
- "existing_utilizer_cutoff_date_source": "string",
- "network_types": [
- "string"
], - "duration": 0,
- "number_of_fills": 0,
- "cumulative_days_supply": 0,
- "effective_date": "string",
- "termination_date": "string",
- "continuation_of_therapy_id": 0,
- "cot_formulary_exclusion_tier_placement": [
- {
- "multi_source": [
- "string"
], - "specialty": "string",
- "new_tier": "string"
}
]
}{- "id": 0,
- "plan_benefit_id": 0,
- "rn": "string",
- "continuation_types": [
- "string"
], - "intent": "string",
- "drug_type": "string",
- "drug_use": "string",
- "only_applies_to_categories": [
- "string"
], - "only_applies_to_tags": [
- 0
], - "does_not_apply_to_tags": [
- 0
], - "only_applies_to_carve_out": [
- "string"
], - "does_not_apply_to_carve_out": [
- "string"
], - "utilizer_type": [
- "string"
], - "use_continuation_of_therapy_effective_date": true,
- "use_new_enrollee_effective_date": true,
- "lookback_days": 0,
- "existing_utilizer_cutoff_date": "string",
- "existing_utilizer_cutoff_date_source": "string",
- "network_types": [
- "string"
], - "duration": 0,
- "number_of_fills": 0,
- "cumulative_days_supply": 0,
- "effective_date": "string",
- "termination_date": "string",
- "continuation_of_therapy_id": 0,
- "cot_formulary_exclusion_tier_placement": [
- {
- "multi_source": [
- "string"
], - "specialty": "string",
- "new_tier": "string"
}
]
}Create a Continuation Of Therapy.
| plan_benefit_id | integer or null <int32> The internal ID of the associated plan benefit. Should not be changed. |
| rn | string or null |
| continuation_types | Array of strings or null |
| intent | string or null |
| drug_type | string or null |
| drug_use | string or null |
| only_applies_to_categories | Array of strings or null |
| only_applies_to_tags | Array of integers or null <int32> |
| does_not_apply_to_tags | Array of integers or null <int32> |
| only_applies_to_carve_out | Array of strings or null |
| does_not_apply_to_carve_out | Array of strings or null |
| utilizer_type | Array of strings or null |
| use_continuation_of_therapy_effective_date | boolean or null |
| use_new_enrollee_effective_date | boolean or null |
| lookback_days | integer or null <int32> |
| existing_utilizer_cutoff_date | string or null <ArrowDateTime> |
| existing_utilizer_cutoff_date_source | string or null |
| network_types | Array of strings or null |
| duration | integer or null <int32> |
| number_of_fills | integer or null <int32> |
| cumulative_days_supply | integer or null <int32> |
| effective_date | string <ArrowDateTime> |
| termination_date | string <ArrowDateTime> |
| continuation_of_therapy_id | integer or null <int32> |
Array of objects or null (FormularyExclusionTierPlacement_1764643208.4848669) |
{- "plan_benefit_id": 0,
- "rn": "string",
- "continuation_types": [
- "string"
], - "intent": "string",
- "drug_type": "string",
- "drug_use": "string",
- "only_applies_to_categories": [
- "string"
], - "only_applies_to_tags": [
- 0
], - "does_not_apply_to_tags": [
- 0
], - "only_applies_to_carve_out": [
- "string"
], - "does_not_apply_to_carve_out": [
- "string"
], - "utilizer_type": [
- "string"
], - "use_continuation_of_therapy_effective_date": true,
- "use_new_enrollee_effective_date": true,
- "lookback_days": 0,
- "existing_utilizer_cutoff_date": "string",
- "existing_utilizer_cutoff_date_source": "string",
- "network_types": [
- "string"
], - "duration": 0,
- "number_of_fills": 0,
- "cumulative_days_supply": 0,
- "effective_date": "string",
- "termination_date": "string",
- "continuation_of_therapy_id": 0,
- "cot_formulary_exclusion_tier_placement": [
- {
- "multi_source": [
- "string"
], - "specialty": "string",
- "new_tier": "string"
}
]
}{- "id": 0,
- "plan_benefit_id": 0,
- "rn": "string",
- "continuation_types": [
- "string"
], - "intent": "string",
- "drug_type": "string",
- "drug_use": "string",
- "only_applies_to_categories": [
- "string"
], - "only_applies_to_tags": [
- 0
], - "does_not_apply_to_tags": [
- 0
], - "only_applies_to_carve_out": [
- "string"
], - "does_not_apply_to_carve_out": [
- "string"
], - "utilizer_type": [
- "string"
], - "use_continuation_of_therapy_effective_date": true,
- "use_new_enrollee_effective_date": true,
- "lookback_days": 0,
- "existing_utilizer_cutoff_date": "string",
- "existing_utilizer_cutoff_date_source": "string",
- "network_types": [
- "string"
], - "duration": 0,
- "number_of_fills": 0,
- "cumulative_days_supply": 0,
- "effective_date": "string",
- "termination_date": "string",
- "continuation_of_therapy_id": 0,
- "cot_formulary_exclusion_tier_placement": [
- {
- "multi_source": [
- "string"
], - "specialty": "string",
- "new_tier": "string"
}
]
}List Continuation Of Therapies.
| page_number | integer or null <int32> The page of results you would like to get. For the first page, pass |
| results_per_page | integer or null <int32> The number of results per page. |
| expected_fields | Array of strings or null or null The desired list of fields to be returned. |
| plan_benefit_id required | integer <int32> The internal ID of the associated plan benefit. Should not be changed. |
Array of objects or null (OrderBySchema_1764643208.4908361) |
{- "page_number": 0,
- "results_per_page": 0,
- "expected_fields": [
- "string"
], - "plan_benefit_id": 0,
- "order_by": [
- {
- "id": "string",
- "continuation_types": "string",
- "intent": "string",
- "termination_date": "string"
}
]
}{- "results": [
- {
- "continuation_of_therapy": {
- "id": 0,
- "plan_benefit_id": 0,
- "rn": "string",
- "continuation_types": [
- "string"
], - "intent": "string",
- "drug_type": "string",
- "drug_use": "string",
- "only_applies_to_categories": [
- "string"
], - "only_applies_to_tags": [
- 0
], - "does_not_apply_to_tags": [
- 0
], - "only_applies_to_carve_out": [
- "string"
], - "does_not_apply_to_carve_out": [
- "string"
], - "utilizer_type": [
- "string"
], - "use_continuation_of_therapy_effective_date": true,
- "use_new_enrollee_effective_date": true,
- "lookback_days": 0,
- "existing_utilizer_cutoff_date": "string",
- "existing_utilizer_cutoff_date_source": "string",
- "network_types": [
- "string"
], - "duration": 0,
- "number_of_fills": 0,
- "cumulative_days_supply": 0,
- "effective_date": "string",
- "termination_date": "string",
- "continuation_of_therapy_id": 0,
- "cot_formulary_exclusion_tier_placement": [
- {
- "multi_source": [
- "string"
], - "specialty": "string",
- "new_tier": "string"
}
]
}
}
], - "result_count": "string"
}Get a Continuation Of Therapy Draft.
| id required | integer <int32> The ID of the group that was just updated. |
{- "id": 0
}{- "id": 0,
- "plan_benefit_id": 0,
- "rn": "string",
- "continuation_types": [
- "string"
], - "intent": "string",
- "drug_type": "string",
- "drug_use": "string",
- "only_applies_to_categories": [
- "string"
], - "only_applies_to_tags": [
- 0
], - "does_not_apply_to_tags": [
- 0
], - "only_applies_to_carve_out": [
- "string"
], - "does_not_apply_to_carve_out": [
- "string"
], - "utilizer_type": [
- "string"
], - "use_continuation_of_therapy_effective_date": true,
- "use_new_enrollee_effective_date": true,
- "lookback_days": 0,
- "existing_utilizer_cutoff_date": "string",
- "existing_utilizer_cutoff_date_source": "string",
- "network_types": [
- "string"
], - "duration": 0,
- "number_of_fills": 0,
- "cumulative_days_supply": 0,
- "effective_date": "string",
- "termination_date": "string",
- "continuation_of_therapy_id": 0,
- "cot_formulary_exclusion_tier_placement": [
- {
- "multi_source": [
- "string"
], - "specialty": "string",
- "new_tier": "string"
}
]
}Update a Continuation Of Therapy Draft.
| id required | integer <int32> The ID of the group that was just updated. |
| plan_benefit_id | integer or null <int32> The internal ID of the associated plan benefit. Should not be changed. |
| rn | string or null |
| continuation_types | Array of strings or null |
| intent | string or null |
| drug_type | string or null |
| drug_use | string or null |
| only_applies_to_categories | Array of strings or null |
| only_applies_to_tags | Array of integers or null <int32> |
| does_not_apply_to_tags | Array of integers or null <int32> |
| only_applies_to_carve_out | Array of strings or null |
| does_not_apply_to_carve_out | Array of strings or null |
| utilizer_type | Array of strings or null |
| use_continuation_of_therapy_effective_date | boolean or null |
| use_new_enrollee_effective_date | boolean or null |
| lookback_days | integer or null <int32> |
| existing_utilizer_cutoff_date | string or null <ArrowDateTime> |
| existing_utilizer_cutoff_date_source | string or null |
| network_types | Array of strings or null |
| duration | integer or null <int32> |
| number_of_fills | integer or null <int32> |
| cumulative_days_supply | integer or null <int32> |
| effective_date | string <ArrowDateTime> |
| termination_date | string <ArrowDateTime> |
| continuation_of_therapy_id | integer or null <int32> |
Array of objects or null (FormularyExclusionTierPlacement_1764643208.4848669) |
{- "id": 0,
- "plan_benefit_id": 0,
- "rn": "string",
- "continuation_types": [
- "string"
], - "intent": "string",
- "drug_type": "string",
- "drug_use": "string",
- "only_applies_to_categories": [
- "string"
], - "only_applies_to_tags": [
- 0
], - "does_not_apply_to_tags": [
- 0
], - "only_applies_to_carve_out": [
- "string"
], - "does_not_apply_to_carve_out": [
- "string"
], - "utilizer_type": [
- "string"
], - "use_continuation_of_therapy_effective_date": true,
- "use_new_enrollee_effective_date": true,
- "lookback_days": 0,
- "existing_utilizer_cutoff_date": "string",
- "existing_utilizer_cutoff_date_source": "string",
- "network_types": [
- "string"
], - "duration": 0,
- "number_of_fills": 0,
- "cumulative_days_supply": 0,
- "effective_date": "string",
- "termination_date": "string",
- "continuation_of_therapy_id": 0,
- "cot_formulary_exclusion_tier_placement": [
- {
- "multi_source": [
- "string"
], - "specialty": "string",
- "new_tier": "string"
}
]
}{- "id": 0,
- "plan_benefit_id": 0,
- "rn": "string",
- "continuation_types": [
- "string"
], - "intent": "string",
- "drug_type": "string",
- "drug_use": "string",
- "only_applies_to_categories": [
- "string"
], - "only_applies_to_tags": [
- 0
], - "does_not_apply_to_tags": [
- 0
], - "only_applies_to_carve_out": [
- "string"
], - "does_not_apply_to_carve_out": [
- "string"
], - "utilizer_type": [
- "string"
], - "use_continuation_of_therapy_effective_date": true,
- "use_new_enrollee_effective_date": true,
- "lookback_days": 0,
- "existing_utilizer_cutoff_date": "string",
- "existing_utilizer_cutoff_date_source": "string",
- "network_types": [
- "string"
], - "duration": 0,
- "number_of_fills": 0,
- "cumulative_days_supply": 0,
- "effective_date": "string",
- "termination_date": "string",
- "continuation_of_therapy_id": 0,
- "cot_formulary_exclusion_tier_placement": [
- {
- "multi_source": [
- "string"
], - "specialty": "string",
- "new_tier": "string"
}
]
}Create a Continuation Of Therapy Draft.
| plan_benefit_id | integer or null <int32> The internal ID of the associated plan benefit. Should not be changed. |
| rn | string or null |
| continuation_types | Array of strings or null |
| intent | string or null |
| drug_type | string or null |
| drug_use | string or null |
| only_applies_to_categories | Array of strings or null |
| only_applies_to_tags | Array of integers or null <int32> |
| does_not_apply_to_tags | Array of integers or null <int32> |
| only_applies_to_carve_out | Array of strings or null |
| does_not_apply_to_carve_out | Array of strings or null |
| utilizer_type | Array of strings or null |
| use_continuation_of_therapy_effective_date | boolean or null |
| use_new_enrollee_effective_date | boolean or null |
| lookback_days | integer or null <int32> |
| existing_utilizer_cutoff_date | string or null <ArrowDateTime> |
| existing_utilizer_cutoff_date_source | string or null |
| network_types | Array of strings or null |
| duration | integer or null <int32> |
| number_of_fills | integer or null <int32> |
| cumulative_days_supply | integer or null <int32> |
| effective_date | string <ArrowDateTime> |
| termination_date | string <ArrowDateTime> |
| continuation_of_therapy_id | integer or null <int32> |
Array of objects or null (FormularyExclusionTierPlacement_1764643208.4848669) |
{- "plan_benefit_id": 0,
- "rn": "string",
- "continuation_types": [
- "string"
], - "intent": "string",
- "drug_type": "string",
- "drug_use": "string",
- "only_applies_to_categories": [
- "string"
], - "only_applies_to_tags": [
- 0
], - "does_not_apply_to_tags": [
- 0
], - "only_applies_to_carve_out": [
- "string"
], - "does_not_apply_to_carve_out": [
- "string"
], - "utilizer_type": [
- "string"
], - "use_continuation_of_therapy_effective_date": true,
- "use_new_enrollee_effective_date": true,
- "lookback_days": 0,
- "existing_utilizer_cutoff_date": "string",
- "existing_utilizer_cutoff_date_source": "string",
- "network_types": [
- "string"
], - "duration": 0,
- "number_of_fills": 0,
- "cumulative_days_supply": 0,
- "effective_date": "string",
- "termination_date": "string",
- "continuation_of_therapy_id": 0,
- "cot_formulary_exclusion_tier_placement": [
- {
- "multi_source": [
- "string"
], - "specialty": "string",
- "new_tier": "string"
}
]
}{- "id": 0,
- "plan_benefit_id": 0,
- "rn": "string",
- "continuation_types": [
- "string"
], - "intent": "string",
- "drug_type": "string",
- "drug_use": "string",
- "only_applies_to_categories": [
- "string"
], - "only_applies_to_tags": [
- 0
], - "does_not_apply_to_tags": [
- 0
], - "only_applies_to_carve_out": [
- "string"
], - "does_not_apply_to_carve_out": [
- "string"
], - "utilizer_type": [
- "string"
], - "use_continuation_of_therapy_effective_date": true,
- "use_new_enrollee_effective_date": true,
- "lookback_days": 0,
- "existing_utilizer_cutoff_date": "string",
- "existing_utilizer_cutoff_date_source": "string",
- "network_types": [
- "string"
], - "duration": 0,
- "number_of_fills": 0,
- "cumulative_days_supply": 0,
- "effective_date": "string",
- "termination_date": "string",
- "continuation_of_therapy_id": 0,
- "cot_formulary_exclusion_tier_placement": [
- {
- "multi_source": [
- "string"
], - "specialty": "string",
- "new_tier": "string"
}
]
}List Continuation Of Therapy Drafts.
| page_number | integer or null <int32> The page of results you would like to get. For the first page, pass |
| results_per_page | integer or null <int32> The number of results per page. |
| expected_fields | Array of strings or null or null The desired list of fields to be returned. |
| plan_benefit_id required | integer <int32> The internal ID of the associated plan benefit. Should not be changed. |
Array of objects or null (OrderBySchema_1764643208.4908361) |
{- "page_number": 0,
- "results_per_page": 0,
- "expected_fields": [
- "string"
], - "plan_benefit_id": 0,
- "order_by": [
- {
- "id": "string",
- "continuation_types": "string",
- "intent": "string",
- "termination_date": "string"
}
]
}{- "results": [
- {
- "continuation_of_therapy": {
- "id": 0,
- "plan_benefit_id": 0,
- "rn": "string",
- "continuation_types": [
- "string"
], - "intent": "string",
- "drug_type": "string",
- "drug_use": "string",
- "only_applies_to_categories": [
- "string"
], - "only_applies_to_tags": [
- 0
], - "does_not_apply_to_tags": [
- 0
], - "only_applies_to_carve_out": [
- "string"
], - "does_not_apply_to_carve_out": [
- "string"
], - "utilizer_type": [
- "string"
], - "use_continuation_of_therapy_effective_date": true,
- "use_new_enrollee_effective_date": true,
- "lookback_days": 0,
- "existing_utilizer_cutoff_date": "string",
- "existing_utilizer_cutoff_date_source": "string",
- "network_types": [
- "string"
], - "duration": 0,
- "number_of_fills": 0,
- "cumulative_days_supply": 0,
- "effective_date": "string",
- "termination_date": "string",
- "continuation_of_therapy_id": 0,
- "cot_formulary_exclusion_tier_placement": [
- {
- "multi_source": [
- "string"
], - "specialty": "string",
- "new_tier": "string"
}
]
}
}
], - "result_count": "string"
}Get a Coupon File.
| id | integer or null <int32> |
{- "id": 0
}{- "id": 0,
- "created_at": "string",
- "file_name": "string",
- "source_bucket": "string",
- "source_key": "string",
- "record_count": 0,
- "identity": "string",
- "last_exception": "string",
- "status": "string",
- "rn": "string",
- "unique_claim_count": 0,
- "accumulator_adjustment_count": 0
}List Coupon Files.
| page_number | integer or null <int32> The page of results you would like to get. For the first page, pass |
| results_per_page | integer or null <int32> The number of results per page. |
| expected_fields | Array of strings or null or null The desired list of fields to be returned. |
| id | integer or null <int32> |
| created_at | string or null <ArrowDateTime> |
| file_name | string or null |
| source_bucket | string or null |
| source_key | string or null |
| record_count | integer or null <int32> |
| identity | string or null |
| last_exception | string or null |
| status | string or null |
| rn | string or null |
| unique_claim_count | integer or null <int32> |
| accumulator_adjustment_count | integer or null <int32> |
Array of objects or null (OrderBySchema_1764643208.5005226) |
{- "page_number": 0,
- "results_per_page": 0,
- "expected_fields": [
- "string"
], - "id": 0,
- "created_at": "string",
- "file_name": "string",
- "source_bucket": "string",
- "source_key": "string",
- "record_count": 0,
- "identity": "string",
- "last_exception": "string",
- "status": "string",
- "rn": "string",
- "unique_claim_count": 0,
- "accumulator_adjustment_count": 0,
- "order_by": [
- {
- "id": "string",
- "created_at": "string",
- "file_name": "string",
- "source_bucket": "string",
- "source_key": "string",
- "record_count": "string",
- "identity": "string",
- "last_exception": "string",
- "status": "string",
- "unique_claim_count": "string",
- "accumulator_adjustment_count": "string"
}
]
}{- "results": [
- {
- "coupon_file": {
- "id": 0,
- "created_at": "string",
- "file_name": "string",
- "source_bucket": "string",
- "source_key": "string",
- "record_count": 0,
- "identity": "string",
- "last_exception": "string",
- "status": "string",
- "rn": "string",
- "unique_claim_count": 0,
- "accumulator_adjustment_count": 0
}
}
], - "result_count": "string"
}Get a Coupon File Record.
| id | integer or null <int32> |
{- "id": 0
}{- "id": 0,
- "patient_first_name": "string",
- "patient_last_name": "string",
- "external_patient_id": "string",
- "external_member_id": "string",
- "date_of_birth": "string",
- "ndc": "string",
- "drug_name": "string",
- "date_of_service": "string",
- "ship_date": "string",
- "coupon_submission_date": "string",
- "copay_assistance_description": "string",
- "accounts_receivable_date": "string",
- "transaction_id": "string",
- "patient_pay_amount": 0,
- "adjustment_amount": 0,
- "original_copay_amount": 0,
- "contract_fee": 0,
- "prescription_service_reference_number": "string",
- "fill_number": 0,
- "coupon_status": "string",
- "coupon_type": "string",
- "service_provider_id": "string",
- "coupon_file_id": 0,
- "claim_id": 0,
- "file_name": "string",
- "associated_accumulation_transaction_records": null,
- "created_at": "string",
- "claim_status": "string"
}List Coupon File Records.
| page_number | integer or null <int32> The page of results you would like to get. For the first page, pass |
| results_per_page | integer or null <int32> The number of results per page. |
| expected_fields | Array of strings or null or null The desired list of fields to be returned. |
| id | integer or null <int32> |
| patient_first_name | string or null |
| patient_last_name | string or null |
| external_patient_id | string or null |
| external_member_id | string or null |
| date_of_birth | string or null <ArrowDateTime> |
| ndc | string or null |
| drug_name | string or null |
| date_of_service | string or null <ArrowDateTime> |
| ship_date | string or null <ArrowDateTime> |
| coupon_submission_date | string or null <ArrowDateTime> |
| copay_assistance_description | string or null |
| accounts_receivable_date | string or null <ArrowDateTime> |
| transaction_id | string or null |
| patient_pay_amount | number or null |
| adjustment_amount | number or null |
| original_copay_amount | number or null |
| contract_fee | number or null |
| prescription_service_reference_number | string or null |
| fill_number | integer or null <int32> |
| coupon_status | string or null |
| coupon_type | string or null |
| service_provider_id | string or null |
| coupon_file_id | integer or null <int32> |
| claim_id | integer or null <int32> |
Array of objects or null (OrderBySchema_1764643208.5046642) | |
| created_at | string or null <ArrowDateTime> |
| claim_status | string or null |
{- "page_number": 0,
- "results_per_page": 0,
- "expected_fields": [
- "string"
], - "id": 0,
- "patient_first_name": "string",
- "patient_last_name": "string",
- "external_patient_id": "string",
- "external_member_id": "string",
- "date_of_birth": "string",
- "ndc": "string",
- "drug_name": "string",
- "date_of_service": "string",
- "ship_date": "string",
- "coupon_submission_date": "string",
- "copay_assistance_description": "string",
- "accounts_receivable_date": "string",
- "transaction_id": "string",
- "patient_pay_amount": 0,
- "adjustment_amount": 0,
- "original_copay_amount": 0,
- "contract_fee": 0,
- "prescription_service_reference_number": "string",
- "fill_number": 0,
- "coupon_status": "string",
- "coupon_type": "string",
- "service_provider_id": "string",
- "coupon_file_id": 0,
- "claim_id": 0,
- "order_by": [
- {
- "id": "string",
- "patient_first_name": "string",
- "patient_last_name": "string",
- "external_patient_id": "string",
- "external_member_id": "string",
- "date_of_birth": "string",
- "drug_name": "string",
- "date_of_service": "string",
- "ship_date": "string",
- "coupon_submission_date": "string",
- "copay_assistance_description": "string",
- "accounts_receivable_date": "string",
- "transaction_id": "string",
- "patient_pay_amount": "string",
- "adjustment_amount": "string",
- "original_copay_amount": "string",
- "contract_fee": "string",
- "prescription_service_reference_number": "string",
- "fill_number": "string",
- "coupon_status": "string",
- "coupon_type": "string",
- "service_provider_id": "string",
- "coupon_file_id": "string",
- "claim_id": "string",
- "created_at": "string",
- "claim_status": "string",
- "file_name": "string"
}
], - "created_at": "string",
- "claim_status": "string"
}{- "results": [
- {
- "coupon_file_record": {
- "id": 0,
- "patient_first_name": "string",
- "patient_last_name": "string",
- "external_patient_id": "string",
- "external_member_id": "string",
- "date_of_birth": "string",
- "ndc": "string",
- "drug_name": "string",
- "date_of_service": "string",
- "ship_date": "string",
- "coupon_submission_date": "string",
- "copay_assistance_description": "string",
- "accounts_receivable_date": "string",
- "transaction_id": "string",
- "patient_pay_amount": 0,
- "adjustment_amount": 0,
- "original_copay_amount": 0,
- "contract_fee": 0,
- "prescription_service_reference_number": "string",
- "fill_number": 0,
- "coupon_status": "string",
- "coupon_type": "string",
- "service_provider_id": "string",
- "coupon_file_id": 0,
- "claim_id": 0,
- "file_name": "string",
- "associated_accumulation_transaction_records": null,
- "created_at": "string",
- "claim_status": "string"
}
}
], - "result_count": "string"
}Create a Medical Custom Code.
| code required | string <TrimmedString> |
| description required | string <TrimmedString> |
| type required | string Enum: "procedure" "diagnosis" "place_of_service" |
| client_id required | string |
| identity | string or null |
| rn | string |
| effective_date required | string <ArrowDateTime> |
| termination_date | string or null <ArrowDateTime> |
{- "code": "string",
- "description": "string",
- "type": "procedure",
- "client_id": "string",
- "identity": "string",
- "rn": "string",
- "effective_date": "string",
- "termination_date": "string"
}{- "id": 0,
- "code": "string",
- "description": "string",
- "type": "procedure",
- "client_id": "string",
- "identity": "string",
- "rn": "string",
- "effective_date": "string",
- "termination_date": "string",
- "start_date": "string",
- "end_date": "string"
}Get a Medical Custom Code.
| id required | integer <int32> |
{- "id": 0
}{- "id": 0,
- "code": "string",
- "description": "string",
- "type": "procedure",
- "client_id": "string",
- "identity": "string",
- "rn": "string",
- "effective_date": "string",
- "termination_date": "string",
- "start_date": "string",
- "end_date": "string"
}List Medical Custom Codes.
| page_number | integer or null <int32> The page of results you would like to get. For the first page, pass |
| results_per_page | integer or null <int32> The number of results per page. |
| expected_fields | Array of strings or null or null The desired list of fields to be returned. |
| code | string or null |
| description | string or null |
| code_or_description | string or null |
| custom_codes | Array of strings or null |
| client_id | string or null |
Array of objects or null (OrderBySchema_1764643208.5093465) | |
| type | string or null |
{- "page_number": 0,
- "results_per_page": 0,
- "expected_fields": [
- "string"
], - "code": "string",
- "description": "string",
- "code_or_description": "string",
- "custom_codes": [
- "string"
], - "client_id": "string",
- "order_by": [
- {
- "id": "string",
- "code": "string",
- "code_or_description": "string",
- "type": "string",
- "effective_date": "string",
- "termination_date": "string",
- "client_id": "string"
}
], - "type": "string"
}{- "results": [
- {
- "medical_custom_code": {
- "id": 0,
- "code": "string",
- "description": "string",
- "type": "procedure",
- "client_id": "string",
- "identity": "string",
- "rn": "string",
- "effective_date": "string",
- "termination_date": "string",
- "start_date": "string",
- "end_date": "string"
}
}
], - "result_count": "string"
}Update a Medical Custom Code.
| id required | integer <int32> |
| code required | string <TrimmedString> |
| description required | string <TrimmedString> |
| type required | string Enum: "procedure" "diagnosis" "place_of_service" |
| client_id required | string |
| identity | string or null |
| rn | string |
| effective_date required | string <ArrowDateTime> |
| termination_date required | string or null <ArrowDateTime> |
{- "id": 0,
- "code": "string",
- "description": "string",
- "type": "procedure",
- "client_id": "string",
- "identity": "string",
- "rn": "string",
- "effective_date": "string",
- "termination_date": "string"
}{- "id": 0,
- "code": "string",
- "description": "string",
- "type": "procedure",
- "client_id": "string",
- "identity": "string",
- "rn": "string",
- "effective_date": "string",
- "termination_date": "string",
- "start_date": "string",
- "end_date": "string"
}Create a Data Report.
| rn | string or null |
| module_name required | string |
| consumes required | string |
| output_bucket required | string |
| output_key required | string |
| description | string or null |
| exchange_type | string or null |
| plan_ids required | Array of numbers or null |
| plan_filters | any or null |
| cron_schedule | string or null |
| sftp_delivery_target_id required | integer or null <int32> |
| ftps_delivery_target_id required | integer or null <int32> |
| email_delivery_target_id required | integer or null <int32> |
| s3_delivery_target_id required | integer or null <int32> |
| on_error_email_addresses | string or null List of recipient emails (comma separated). |
| send_error_email_if_no_results | boolean |
| effective_date | string or null <ArrowDateTime> |
| termination_date | string or null <ArrowDateTime> |
| min_data_date | string or null <ArrowDateTime> |
| max_data_date | string or null <ArrowDateTime> |
| allow_consumption | boolean |
| allow_delivery | boolean |
| override_output_key | boolean |
| inclusive_start_date | string or null <ArrowDateTime> |
| exclusive_end_date | string or null <ArrowDateTime> |
| config | any or null |
| claims_or_filters_file | file xlsx file upload containing claim_id column or member etc id filter criteria. |
| status | string or null |
{- "rn": "string",
- "module_name": "string",
- "consumes": "string",
- "output_bucket": "string",
- "output_key": "string",
- "description": "string",
- "exchange_type": "string",
- "plan_ids": [
- 0
], - "plan_filters": null,
- "cron_schedule": "string",
- "sftp_delivery_target_id": 0,
- "ftps_delivery_target_id": 0,
- "email_delivery_target_id": 0,
- "s3_delivery_target_id": 0,
- "on_error_email_addresses": "string",
- "send_error_email_if_no_results": true,
- "effective_date": "string",
- "termination_date": "string",
- "min_data_date": "string",
- "max_data_date": "string",
- "allow_consumption": true,
- "allow_delivery": true,
- "override_output_key": true,
- "inclusive_start_date": "string",
- "exclusive_end_date": "string",
- "config": null,
- "claims_or_filters_file": null,
- "status": "string"
}{- "id": 0,
- "rn": "string",
- "module_name": "string",
- "consumes": "string",
- "output_bucket": "string",
- "output_key": "string",
- "description": "string",
- "exchange_type": "string",
- "plan_ids": [
- 0
], - "plan_filters": null,
- "cron_schedule": "string",
- "sftp_delivery_target_id": 0,
- "ftps_delivery_target_id": 0,
- "email_delivery_target_id": 0,
- "s3_delivery_target_id": 0,
- "on_error_email_addresses": "string",
- "send_error_email_if_no_results": true,
- "effective_date": "string",
- "termination_date": "string",
- "min_data_date": "string",
- "max_data_date": "string",
- "allow_consumption": true,
- "allow_delivery": true,
- "override_output_key": true,
- "inclusive_start_date": "string",
- "exclusive_end_date": "string",
- "config": null,
- "claims_or_filters_file": null,
- "status": "string"
}Get a Data Report.
| id | integer <int32> |
{- "id": 0
}{- "id": 0,
- "rn": "string",
- "module_name": "string",
- "consumes": "string",
- "output_bucket": "string",
- "output_key": "string",
- "description": "string",
- "exchange_type": "string",
- "plan_ids": [
- 0
], - "plan_filters": null,
- "cron_schedule": "string",
- "sftp_delivery_target_id": 0,
- "ftps_delivery_target_id": 0,
- "email_delivery_target_id": 0,
- "s3_delivery_target_id": 0,
- "on_error_email_addresses": "string",
- "send_error_email_if_no_results": true,
- "effective_date": "string",
- "termination_date": "string",
- "min_data_date": "string",
- "max_data_date": "string",
- "allow_consumption": true,
- "allow_delivery": true,
- "override_output_key": true,
- "inclusive_start_date": "string",
- "exclusive_end_date": "string",
- "config": null,
- "claims_or_filters_file": null,
- "status": "string"
}List Data Reports.
| page_number | integer or null <int32> The page of results you would like to get. For the first page, pass |
| results_per_page | integer or null <int32> The number of results per page. |
| expected_fields | Array of strings or null or null The desired list of fields to be returned. |
| id | integer or null <int32> |
| plan_ids | Array of strings or null or null |
| module_name | string or null |
| description | string or null |
| config | any |
| has_delivery_target | boolean |
| has_cron_schedule | boolean |
| output_key | string or null |
| exchange_type | string |
| effective_date | string or null <ArrowDateTime> |
| termination_date | string or null <ArrowDateTime> |
| status | string Enum: "active" "inactive" |
| full_text_search | string or null |
Array of objects or null (OrderBySchema_1764643208.515885) |
{- "page_number": 0,
- "results_per_page": 0,
- "expected_fields": [
- "string"
], - "id": 0,
- "plan_ids": [
- "string"
], - "module_name": "string",
- "description": "string",
- "config": null,
- "has_delivery_target": true,
- "has_cron_schedule": true,
- "output_key": "string",
- "exchange_type": "string",
- "effective_date": "string",
- "termination_date": "string",
- "status": "active",
- "full_text_search": "string",
- "order_by": [
- {
- "id": "string",
- "module_name": "string",
- "output_key": "string",
- "description": "string",
- "plan_ids": "string",
- "effective_date": "string",
- "termination_date": "string",
- "exchange_type": "string"
}
]
}{- "results": [
- {
- "data_report": {
- "id": 0,
- "rn": "string",
- "module_name": "string",
- "consumes": "string",
- "output_bucket": "string",
- "output_key": "string",
- "description": "string",
- "exchange_type": "string",
- "plan_ids": [
- 0
], - "plan_filters": null,
- "cron_schedule": "string",
- "sftp_delivery_target_id": 0,
- "ftps_delivery_target_id": 0,
- "email_delivery_target_id": 0,
- "s3_delivery_target_id": 0,
- "on_error_email_addresses": "string",
- "send_error_email_if_no_results": true,
- "effective_date": "string",
- "termination_date": "string",
- "min_data_date": "string",
- "max_data_date": "string",
- "allow_consumption": true,
- "allow_delivery": true,
- "override_output_key": true,
- "inclusive_start_date": "string",
- "exclusive_end_date": "string",
- "config": null,
- "claims_or_filters_file": null,
- "status": "string"
}
}
], - "result_count": "string"
}| id required | integer <int32> |
| allow_consumption required | boolean |
| allow_delivery required | boolean |
| override_output_key required | boolean |
| output_key | string |
| inclusive_start_date | string or null <ArrowDateTime> |
| exclusive_end_date | string or null <ArrowDateTime> |
| claims_or_filters_file | file xlsx file upload containing claim_id column or member etc id filter criteria. |
{- "id": 0,
- "allow_consumption": true,
- "allow_delivery": true,
- "override_output_key": true,
- "output_key": "string",
- "inclusive_start_date": "string",
- "exclusive_end_date": "string",
- "claims_or_filters_file": null
}{- "report_execution_id": 0,
- "message": "string"
}Update a Data Report.
| id | integer <int32> |
| rn | string or null |
| module_name | string |
| consumes | string |
| output_bucket | string |
| output_key | string |
| description | string or null |
| exchange_type | string or null |
| plan_ids | Array of numbers or null |
| plan_filters | any or null |
| cron_schedule | string or null |
| sftp_delivery_target_id | integer or null <int32> |
| ftps_delivery_target_id | integer or null <int32> |
| email_delivery_target_id | integer or null <int32> |
| s3_delivery_target_id | integer or null <int32> |
| on_error_email_addresses | string or null List of recipient emails (comma separated). |
| send_error_email_if_no_results | boolean |
| effective_date | string or null <ArrowDateTime> |
| termination_date | string or null <ArrowDateTime> |
| min_data_date | string or null <ArrowDateTime> |
| max_data_date | string or null <ArrowDateTime> |
| allow_consumption | boolean |
| allow_delivery | boolean |
| override_output_key | boolean |
| inclusive_start_date | string or null <ArrowDateTime> |
| exclusive_end_date | string or null <ArrowDateTime> |
| config | any or null |
| claims_or_filters_file | file xlsx file upload containing claim_id column or member etc id filter criteria. |
| status | string or null |
{- "id": 0,
- "rn": "string",
- "module_name": "string",
- "consumes": "string",
- "output_bucket": "string",
- "output_key": "string",
- "description": "string",
- "exchange_type": "string",
- "plan_ids": [
- 0
], - "plan_filters": null,
- "cron_schedule": "string",
- "sftp_delivery_target_id": 0,
- "ftps_delivery_target_id": 0,
- "email_delivery_target_id": 0,
- "s3_delivery_target_id": 0,
- "on_error_email_addresses": "string",
- "send_error_email_if_no_results": true,
- "effective_date": "string",
- "termination_date": "string",
- "min_data_date": "string",
- "max_data_date": "string",
- "allow_consumption": true,
- "allow_delivery": true,
- "override_output_key": true,
- "inclusive_start_date": "string",
- "exclusive_end_date": "string",
- "config": null,
- "claims_or_filters_file": null,
- "status": "string"
}{- "id": 0,
- "rn": "string",
- "module_name": "string",
- "consumes": "string",
- "output_bucket": "string",
- "output_key": "string",
- "description": "string",
- "exchange_type": "string",
- "plan_ids": [
- 0
], - "plan_filters": null,
- "cron_schedule": "string",
- "sftp_delivery_target_id": 0,
- "ftps_delivery_target_id": 0,
- "email_delivery_target_id": 0,
- "s3_delivery_target_id": 0,
- "on_error_email_addresses": "string",
- "send_error_email_if_no_results": true,
- "effective_date": "string",
- "termination_date": "string",
- "min_data_date": "string",
- "max_data_date": "string",
- "allow_consumption": true,
- "allow_delivery": true,
- "override_output_key": true,
- "inclusive_start_date": "string",
- "exclusive_end_date": "string",
- "config": null,
- "claims_or_filters_file": null,
- "status": "string"
}List Data Report Consumed Dates.
| page_number | integer or null <int32> The page of results you would like to get. For the first page, pass |
| results_per_page | integer or null <int32> The number of results per page. |
| expected_fields | Array of strings or null or null The desired list of fields to be returned. |
| data_report_id required | integer <int32> |
Array of objects (OrderBySchema_1764643208.5203543) |
{- "page_number": 0,
- "results_per_page": 0,
- "expected_fields": [
- "string"
], - "data_report_id": 0,
- "order_by": [
- {
- "data_report_id": "string",
- "end_date": "string",
- "start_date": "string",
- "created_at": "string"
}
]
}{- "results": [
- {
- "data_report_consumed_dates": {
- "data_report_id": 0,
- "start_date": "string",
- "end_date": "string",
- "created_at": "string"
}
}
], - "result_count": "string"
}List Data Report Consumed Id Sequences.
| page_number | integer or null <int32> The page of results you would like to get. For the first page, pass |
| results_per_page | integer or null <int32> The number of results per page. |
| expected_fields | Array of strings or null or null The desired list of fields to be returned. |
| data_report_id required | integer <int32> |
Array of objects (OrderBySchema_1764643208.5241432) |
{- "page_number": 0,
- "results_per_page": 0,
- "expected_fields": [
- "string"
], - "data_report_id": 0,
- "order_by": [
- {
- "data_report_id": "string",
- "minimum_id": "string",
- "maximum_id": "string",
- "created_at": "string"
}
]
}{- "results": [
- {
- "data_report_consumed_id_sequence": {
- "data_report_id": 0,
- "minimum_id": 0,
- "maximum_id": 0,
- "created_at": "string"
}
}
], - "result_count": "string"
}Get a Data Report Execution.
| id | integer <int32> |
{- "id": 0
}{- "id": 0,
- "rn": "string",
- "data_report_id": 0,
- "client_id": "string",
- "output_key": "string",
- "created_at": "string",
- "updated_at": "string",
- "report_started_at": "string",
- "report_ended_at": "string",
- "status": "string",
- "message": "string",
- "error_message": "string",
- "event": null,
- "config": null,
- "report_consumes": "string",
- "min_consumed_id": 0,
- "max_consumed_id": 0,
- "min_consumed_date": "string",
- "max_consumed_date": "string",
- "raw_sql": "string",
- "total_seconds_runtime": 0,
- "total_rows_count": 0,
- "total_files_uploaded": 0,
- "output_files": null,
- "type": "manual",
- "created_by": "string",
- "review_status": "in_review",
- "review_message": "string",
- "reviewed_by": "string",
- "reviewed_at": "string"
}List Data Report Executions.
| page_number | integer or null <int32> The page of results you would like to get. For the first page, pass |
| results_per_page | integer or null <int32> The number of results per page. |
| expected_fields | Array of strings or null or null The desired list of fields to be returned. |
| id | integer <int32> |
| data_report_id | integer <int32> |
| exchange_type | string |
| config | any |
| has_delivery_target | boolean |
| has_cron_schedule | boolean |
| created_at | string <ArrowDateTime> |
| updated_at | string <ArrowDateTime> |
| data_report_output_key | string |
| status | string |
| review_status | string Enum: "in_review" "resolved" "open" |
| type | string Enum: "manual" "scheduled" |
| plan_ids | Array of integers or null <int32> |
Array of objects or null (DataReportExecutionOrderBySchema_1764643208.528879) | |
| created_by | string or null |
{- "page_number": 0,
- "results_per_page": 0,
- "expected_fields": [
- "string"
], - "id": 0,
- "data_report_id": 0,
- "exchange_type": "string",
- "config": null,
- "has_delivery_target": true,
- "has_cron_schedule": true,
- "created_at": "string",
- "updated_at": "string",
- "data_report_output_key": "string",
- "status": "string",
- "review_status": "in_review",
- "type": "manual",
- "plan_ids": [
- 0
], - "order_by": [
- {
- "id": "string",
- "data_report_id": "string",
- "created_at": "string",
- "updated_at": "string",
- "output_key": "string",
- "status": "string",
- "type": "string"
}
], - "created_by": "string"
}{- "results": [
- {
- "data_report_execution": {
- "id": 0,
- "rn": "string",
- "data_report_id": 0,
- "output_key": "string",
- "module_name": "string",
- "description": "string",
- "created_at": "string",
- "updated_at": "string",
- "report_started_at": "string",
- "report_ended_at": "string",
- "status": "string",
- "review_status": "in_review",
- "report_consumes": "string",
- "total_seconds_runtime": 0,
- "total_rows_count": 0,
- "total_files_uploaded": 0,
- "type": "manual",
- "created_by": "string"
}
}
], - "result_count": "string"
}Update a Data Report Execution.
| id required | integer <int32> |
| review_status | string Enum: "in_review" "resolved" "open" |
| review_message | string or null |
{- "id": 0,
- "review_status": "in_review",
- "review_message": "string"
}{- "id": 0,
- "rn": "string",
- "data_report_id": 0,
- "client_id": "string",
- "output_key": "string",
- "created_at": "string",
- "updated_at": "string",
- "report_started_at": "string",
- "report_ended_at": "string",
- "status": "string",
- "message": "string",
- "error_message": "string",
- "event": null,
- "config": null,
- "report_consumes": "string",
- "min_consumed_id": 0,
- "max_consumed_id": 0,
- "min_consumed_date": "string",
- "max_consumed_date": "string",
- "raw_sql": "string",
- "total_seconds_runtime": 0,
- "total_rows_count": 0,
- "total_files_uploaded": 0,
- "output_files": null,
- "type": "manual",
- "created_by": "string",
- "review_status": "in_review",
- "review_message": "string",
- "reviewed_by": "string",
- "reviewed_at": "string"
}| data_report_execution_id required | integer <int32> |
| bucket required | string |
| key required | string |
{- "data_report_execution_id": 0,
- "bucket": "string",
- "key": "string"
}{- "url": "string"
}Get a Data Report Module.
| id | integer or null <int32> |
| name | string or null |
{- "id": 0,
- "name": "string"
}{- "id": 0,
- "name": "string",
- "description": "string",
- "consumes": "dates",
- "supported_options": [
- "string"
], - "supported_attributes": null,
- "supported_fields": null,
- "supported_functions": null,
- "supported_report_info": null,
- "supported_operators": null
}List Data Report Modules.
| page_number | integer or null <int32> The page of results you would like to get. For the first page, pass |
| results_per_page | integer or null <int32> The number of results per page. |
| expected_fields | Array of strings or null or null The desired list of fields to be returned. |
| id | integer or null <int32> |
| name | string or null |
| description | string or null |
| consumes | string or null Enum: "dates" "ids" |
| supported_options | Array of strings or null |
Array of objects or null (OrderBySchema_1764643208.5350583) |
{- "page_number": 0,
- "results_per_page": 0,
- "expected_fields": [
- "string"
], - "id": 0,
- "name": "string",
- "description": "string",
- "consumes": "dates",
- "supported_options": [
- "string"
], - "order_by": [
- {
- "id": 0,
- "name": "string",
- "description": "string",
- "consumes": "string",
- "status": "dates"
}
]
}{- "results": [
- {
- "data_report_module": {
- "id": 0,
- "name": "string",
- "description": "string",
- "consumes": "dates",
- "supported_options": [
- "string"
], - "supported_attributes": null,
- "supported_fields": null,
- "supported_functions": null,
- "supported_report_info": null,
- "supported_operators": null
}
}
], - "result_count": 0
}| rn | string or null |
| source_bucket required | string S3 bucket containing file to be delivered. Sample: sftp-cap-rx-com |
| source_key required | string S3 key for file to be delivered. Sample: vendor/outbound/some_file.txt |
| source_app required | string It defaults to manual_delivery but recommended that applications send service:app. Sample: data_exchange:data_reports |
| protocol required | string Enum: "email" "ftps" "sftp" "s3" |
| target_id required | integer <int32> ID of target to send file. This field is used together with protocol to find proper delivery target |
| encrypted required | boolean True if file already encrypted to ignore target settings. Otherwise False to encrypt or not based on target configuration |
| skip_batch_forwarding | boolean Skip process that forward large files to AWS Batch |
| forward_to_batch | boolean Forward to AWS Batch even if not large file |
{- "rn": "string",
- "source_bucket": "string",
- "source_key": "string",
- "source_app": "string",
- "protocol": "email",
- "target_id": 0,
- "encrypted": true,
- "skip_batch_forwarding": true,
- "forward_to_batch": true
}{- "message": "string"
}Create a Dental Group.
| rn | string or null |
| external_dental_group_id required | string or null The external group ID of the group. |
| plan_id required | integer or null <int32> The ID of the affiliated plan |
| start_date | string <ArrowDateTime> The start date of the group. |
| end_date | string <ArrowDateTime> The end date of the group. |
| effective_date required | string <ArrowDateTime> |
| termination_date | string or null <ArrowDateTime> |
| coverage_effective_date | string or null <ArrowDateTime> |
| group_number | string or null |
| deleted_at | string or null <ArrowDateTime> |
| identity | string or null |
| dental_benefit_id required | string |
| name | string |
{- "rn": "string",
- "external_dental_group_id": "string",
- "plan_id": 0,
- "start_date": "string",
- "end_date": "string",
- "effective_date": "string",
- "termination_date": "string",
- "coverage_effective_date": "string",
- "group_number": "string",
- "deleted_at": "string",
- "identity": "string",
- "dental_benefit_id": "string",
- "name": "string"
}{- "id": 0,
- "rn": "string",
- "external_dental_group_id": "string",
- "plan_id": 0,
- "start_date": "string",
- "end_date": "string",
- "created_at": "string",
- "effective_date": "string",
- "termination_date": "string",
- "coverage_effective_date": "string",
- "group_number": "string",
- "deleted_at": "string",
- "identity": "string",
- "dental_benefit_id": "string",
- "name": "string"
}Get a Dental Group.
| id required | integer <int32> The ID of the group. |
{- "id": 0
}{- "id": 0,
- "rn": "string",
- "external_dental_group_id": "string",
- "plan_id": 0,
- "start_date": "string",
- "end_date": "string",
- "created_at": "string",
- "effective_date": "string",
- "termination_date": "string",
- "coverage_effective_date": "string",
- "group_number": "string",
- "deleted_at": "string",
- "identity": "string",
- "dental_benefit_id": "string",
- "name": "string"
}List Dental Groups.
| page_number | integer or null <int32> The page of results you would like to get. For the first page, pass |
| results_per_page | integer or null <int32> The number of results per page. |
| expected_fields | Array of strings or null or null The desired list of fields to be returned. |
| plan_id | integer or null <int32> |
| external_dental_group_id | string or null |
| start_effective_date | string or null <ArrowDateTime> |
| end_effective_date | string or null <ArrowDateTime> |
| start_termination_date | string or null <ArrowDateTime> |
| end_termination_date | string or null <ArrowDateTime> |
| dental_benefit_id | string or null |
| full_text_search | string or null |
Array of objects or null (OrderBySchema_1764643208.5403485) | |
| name | string or null |
| active_status | string or null |
| only_current_records | boolean or null |
| show_version_history | boolean or null |
{- "page_number": 0,
- "results_per_page": 0,
- "expected_fields": [
- "string"
], - "plan_id": 0,
- "external_dental_group_id": "string",
- "start_effective_date": "string",
- "end_effective_date": "string",
- "start_termination_date": "string",
- "end_termination_date": "string",
- "dental_benefit_id": "string",
- "full_text_search": "string",
- "order_by": [
- {
- "client_id": "string",
- "external_dental_group_id": "string",
- "name": "string",
- "effective_date": "string",
- "termination_date": "string",
- "dental_benefit_id": "string",
- "start_date": "string"
}
], - "name": "string",
- "active_status": "string",
- "only_current_records": true,
- "show_version_history": true
}{- "results": [
- {
- "plan": {
- "id": 0,
- "rn": "string",
- "name": "string",
- "client_id": "string",
- "bin_number": "string",
- "processor_control_number": "string",
- "group_number": "string",
- "medical_group_number": "string",
- "has_group_matching_required": true,
- "claim_payment_cycle": "semi_monthly",
- "address_line_1": "string",
- "address_line_2": "string",
- "city": "string",
- "state": "string",
- "zip_code": "string",
- "effective_date": "string",
- "created_at": "string",
- "updated_at": "string",
- "status": "string",
- "groups_status": "string",
- "eligibility_status": "string",
- "member_documents_status": "string",
- "absence_method": "do_nothing",
- "absence_boundary": "plan",
- "absence_method_terminate_date_option": "file_date",
- "absence_method_group": "do_nothing",
- "absence_method_group_terminate_date_option": "file_date",
- "eligibility_reject_failure_threshold": 0,
- "eligibility_change_failure_threshold": 0,
- "accumulation_load_failure_threshold": 0,
- "external_member_id_format": "string",
- "person_code_length": 0,
- "customer_service_phone_number": "string",
- "help_desk_phone": "string",
- "plan_additional_covered_type": "string",
- "plan_additional_covered_standard_deductible": "string",
- "plan_additional_covered_standard_plan_max": "string",
- "plan_additional_covered_standard_category_plan_max": "string",
- "plan_additional_covered_percentage_amount": 0,
- "plan_additional_covered_dollar_amount": 0,
- "pricing_status": "string",
- "pharmacy_service_fee_enabled": true,
- "strategic_partner_fee": 0,
- "plan_type": "string",
- "has_automatic_enrollment": true,
- "automatic_enrollment_type": "string",
- "routing_configuration": "string",
- "print_system": "string",
- "custom_accumulation_types": null,
- "is_address_required": true,
- "termination_date": "string",
- "external_member_id_pattern": "string",
- "external_member_id_length": 0,
- "bin_number_medicare_prescription_payment_plan": "string",
- "processor_control_number_medicare_prescription_payment_plan": "string",
- "group_number_medicare_prescription_payment_plan": "string",
- "medicare_prescription_payment_plan_allowed_payment_methods": "string",
- "medicare_prescription_payment_plan_invoice_print_window": "string",
- "payment_vendor_account_id": "string",
- "has_feature_use_group_version_ddb": true,
- "has_feature_member_eligibility_gap": true,
- "care_navigation_client_id": "string",
- "reconciliation_type": "string"
}, - "group": {
- "id": 0,
- "rn": "string",
- "external_dental_group_id": "string",
- "plan_id": 0,
- "start_date": "string",
- "end_date": "string",
- "created_at": "string",
- "effective_date": "string",
- "termination_date": "string",
- "coverage_effective_date": "string",
- "group_number": "string",
- "deleted_at": "string",
- "identity": "string",
- "dental_benefit_id": "string",
- "name": "string"
}
}
], - "result_count": "string"
}Update a Dental Group.
| id required | integer <int32> The ID of the group to update. |
| rn | string or null |
| external_dental_group_id | string or null The external group ID of the group. |
| plan_id | integer or null <int32> The ID of the affiliated plan |
| start_date | string <ArrowDateTime> The start date of the group. |
| end_date | string <ArrowDateTime> The end date of the group. |
| created_at | string <ArrowDateTime> |
| effective_date | string <ArrowDateTime> |
| termination_date | string or null <ArrowDateTime> |
| coverage_effective_date | string or null <ArrowDateTime> |
| group_number | string or null |
| deleted_at | string or null <ArrowDateTime> |
| identity | string or null |
| dental_benefit_id | string |
| name | string |
{- "id": 0,
- "rn": "string",
- "external_dental_group_id": "string",
- "plan_id": 0,
- "start_date": "string",
- "end_date": "string",
- "created_at": "string",
- "effective_date": "string",
- "termination_date": "string",
- "coverage_effective_date": "string",
- "group_number": "string",
- "deleted_at": "string",
- "identity": "string",
- "dental_benefit_id": "string",
- "name": "string"
}{- "id": 0,
- "rn": "string",
- "external_dental_group_id": "string",
- "plan_id": 0,
- "start_date": "string",
- "end_date": "string",
- "created_at": "string",
- "effective_date": "string",
- "termination_date": "string",
- "coverage_effective_date": "string",
- "group_number": "string",
- "deleted_at": "string",
- "identity": "string",
- "dental_benefit_id": "string",
- "name": "string"
}Create a Dental Plan Benefit.
| rn | string or null |
| dental_benefit_id required | string or null The external ID of the benefit. |
| plan_id required | integer or null <int32> The ID of the associated plan. |
| created_at | string or null <ArrowDateTime> When the dental plan benefit was created. |
| deleted_at | string or null <ArrowDateTime> When the dental plan benefit was deleted. |
| deleted_by | string or null <ArrowDateTime> Who deleted the dental plan benefit. |
| effective_date required | string or null <ArrowDateTime> When the dental plan benefit goes into effect. |
| termination_date | string or null <ArrowDateTime> When the dental plan benefit ends. |
| benefit_type | string or null |
| dental_plan_benefit_id | integer or null <int32> The ID of the associated dental plan benefit. |
| start_date | string or null <ArrowDateTime> When the dental plan benefit starts. |
| end_date | string or null <ArrowDateTime> When the dental plan benefit ends. |
| name | string or null |
| identity | string or null |
| pend_rules | any or null |
| auto_adjudication_rules | any or null |
| accumulations | any or null |
| networks | any or null |
| preventive | any or null |
| services | any or null |
| claim_validation_checks | any or null |
| service_maximums | any or null |
{- "rn": "string",
- "dental_benefit_id": "string",
- "plan_id": 0,
- "created_at": "string",
- "deleted_at": "string",
- "deleted_by": "string",
- "effective_date": "string",
- "termination_date": "string",
- "benefit_type": "string",
- "dental_plan_benefit_id": 0,
- "start_date": "string",
- "end_date": "string",
- "name": "string",
- "identity": "string",
- "pend_rules": null,
- "auto_adjudication_rules": null,
- "accumulations": null,
- "networks": null,
- "preventive": null,
- "services": null,
- "claim_validation_checks": null,
- "service_maximums": null
}{- "id": 0,
- "rn": "string",
- "dental_benefit_id": "string",
- "plan_id": 0,
- "created_at": "string",
- "deleted_at": "string",
- "deleted_by": "string",
- "effective_date": "string",
- "termination_date": "string",
- "benefit_type": "string",
- "dental_plan_benefit_id": 0,
- "start_date": "string",
- "end_date": "string",
- "name": "string",
- "identity": "string",
- "pend_rules": null,
- "auto_adjudication_rules": null,
- "accumulations": null,
- "networks": null,
- "preventive": null,
- "services": null,
- "claim_validation_checks": null,
- "service_maximums": null
}List Dental Plan Benefits.
| page_number | integer or null <int32> The page of results you would like to get. For the first page, pass |
| results_per_page | integer or null <int32> The number of results per page. |
| expected_fields | Array of strings or null or null The desired list of fields to be returned. |
| dental_benefit_id | string or null The ID of the coverage strategy for the plan benefit. |
| dental_benefit_ids | Array of strings or null Multiple benefit_ids for group search |
| plan_id | integer or null <int32> The ID of the associated plan. |
| created_at | string or null When the plan benefit was created. |
| deleted_at | string or null When the plan benefit was deleted. |
| effective_date | string or null When the plan goes into effect. |
| termination_date | string or null When the plan ceases to be in effect. |
Array of objects or null (OrderBySchema_1764643208.5476284) | |
| current_coverage | boolean or null Select boolean for whether to display only currently active plan benefits. |
| name | string or null |
| benefit_type | string or null |
| only_fields | Array of strings or null or null |
| group_by_dental_benefit_id | boolean or null If this is set to true only one entry will be displayed per benefit id using the closest date range |
| exact_dental_benefit_id_match | boolean or null If this is set to true only benefit IDs matching the benefit_id field exactly will be returned |
{- "page_number": 0,
- "results_per_page": 0,
- "expected_fields": [
- "string"
], - "dental_benefit_id": "string",
- "dental_benefit_ids": [
- "string"
], - "plan_id": 0,
- "created_at": "string",
- "deleted_at": "string",
- "effective_date": "string",
- "termination_date": "string",
- "order_by": [
- {
- "id": "string",
- "dental_benefit_id": "string",
- "plan_id": "string",
- "created_at": "string",
- "deleted_at": "string",
- "effective_date": "string",
- "termination_date": "string",
- "benefit_type": "string",
- "name": "string"
}
], - "current_coverage": true,
- "name": "string",
- "benefit_type": "string",
- "only_fields": [
- "string"
], - "group_by_dental_benefit_id": true,
- "exact_dental_benefit_id_match": true
}{- "results": [
- {
- "dental_plan_benefit": {
- "id": 0,
- "rn": "string",
- "dental_benefit_id": "string",
- "plan_id": 0,
- "created_at": "string",
- "deleted_at": "string",
- "deleted_by": "string",
- "effective_date": "string",
- "termination_date": "string",
- "benefit_type": "string",
- "dental_plan_benefit_id": 0,
- "start_date": "string",
- "end_date": "string",
- "name": "string",
- "identity": "string",
- "pend_rules": null,
- "auto_adjudication_rules": null,
- "accumulations": null,
- "networks": null,
- "preventive": null,
- "services": null,
- "claim_validation_checks": null,
- "service_maximums": null
}
}
], - "result_count": "string"
}Update a Dental Plan Benefit.
| id required | integer <int32> The ID of the dental plan benefit to update. |
| rn | string or null |
| dental_benefit_id | string or null The external ID of the benefit. |
| plan_id | integer or null <int32> The ID of the associated plan. |
| created_at | string or null <ArrowDateTime> When the dental plan benefit was created. |
| deleted_at | string or null <ArrowDateTime> When the dental plan benefit was deleted. |
| deleted_by | string or null <ArrowDateTime> Who deleted the dental plan benefit. |
| effective_date | string or null <ArrowDateTime> When the dental plan benefit goes into effect. |
| termination_date | string or null <ArrowDateTime> When the dental plan benefit ends. |
| benefit_type | string or null |
| dental_plan_benefit_id | integer or null <int32> The ID of the associated dental plan benefit. |
| start_date | string or null <ArrowDateTime> When the dental plan benefit starts. |
| end_date | string or null <ArrowDateTime> When the dental plan benefit ends. |
| name | string or null |
| identity | string or null |
| pend_rules | any or null |
| auto_adjudication_rules | any or null |
| accumulations | any or null |
| networks | any or null |
| preventive | any or null |
| services | any or null |
| claim_validation_checks | any or null |
| service_maximums | any or null |
{- "id": 0,
- "rn": "string",
- "dental_benefit_id": "string",
- "plan_id": 0,
- "created_at": "string",
- "deleted_at": "string",
- "deleted_by": "string",
- "effective_date": "string",
- "termination_date": "string",
- "benefit_type": "string",
- "dental_plan_benefit_id": 0,
- "start_date": "string",
- "end_date": "string",
- "name": "string",
- "identity": "string",
- "pend_rules": null,
- "auto_adjudication_rules": null,
- "accumulations": null,
- "networks": null,
- "preventive": null,
- "services": null,
- "claim_validation_checks": null,
- "service_maximums": null
}{- "id": 0,
- "rn": "string",
- "dental_benefit_id": "string",
- "plan_id": 0,
- "created_at": "string",
- "deleted_at": "string",
- "deleted_by": "string",
- "effective_date": "string",
- "termination_date": "string",
- "benefit_type": "string",
- "dental_plan_benefit_id": 0,
- "start_date": "string",
- "end_date": "string",
- "name": "string",
- "identity": "string",
- "pend_rules": null,
- "auto_adjudication_rules": null,
- "accumulations": null,
- "networks": null,
- "preventive": null,
- "services": null,
- "claim_validation_checks": null,
- "service_maximums": null
}required | Array of objects (DentalPlanBenefitDateInfoSchema_1764643208.551847) |
| dental_benefit_id required | string |
{- "dates": [
- {
- "id": 0,
- "new_effective_date": "string",
- "new_termination_date": "string"
}
], - "dental_benefit_id": "string"
}{- "message": "string"
}Get a Dental Plan Benefit.
| id required | integer <int32> The ID of the dental plan benefit that was just updated. |
{- "id": 0
}{- "id": 0,
- "rn": "string",
- "dental_benefit_id": "string",
- "plan_id": 0,
- "created_at": "string",
- "deleted_at": "string",
- "deleted_by": "string",
- "effective_date": "string",
- "termination_date": "string",
- "benefit_type": "string",
- "dental_plan_benefit_id": 0,
- "start_date": "string",
- "end_date": "string",
- "name": "string",
- "identity": "string",
- "pend_rules": null,
- "auto_adjudication_rules": null,
- "accumulations": null,
- "networks": null,
- "preventive": null,
- "services": null,
- "claim_validation_checks": null,
- "service_maximums": null
}Create a Dental Plan Benefit Draft.
| dental_plan_benefit_id required | integer or null <int32> The ID of the associated dental plan benefit. |
{- "dental_plan_benefit_id": 0
}{- "id": 0,
- "rn": "string",
- "dental_benefit_id": "string",
- "plan_id": 0,
- "created_at": "string",
- "deleted_at": "string",
- "deleted_by": "string",
- "effective_date": "string",
- "termination_date": "string",
- "benefit_type": "string",
- "dental_plan_benefit_id": 0,
- "start_date": "string",
- "end_date": "string",
- "name": "string",
- "identity": "string",
- "pend_rules": null,
- "auto_adjudication_rules": null,
- "accumulations": null,
- "networks": null,
- "preventive": null,
- "services": null,
- "claim_validation_checks": null,
- "service_maximums": null
}| id | integer <int32> The ID of the dental plan benefit that was just updated. |
| rn | string or null |
| dental_benefit_id | string or null The external ID of the benefit. |
| plan_id | integer or null <int32> The ID of the associated plan. |
| created_at | string or null <ArrowDateTime> When the dental plan benefit was created. |
| deleted_at | string or null <ArrowDateTime> When the dental plan benefit was deleted. |
| deleted_by | string or null <ArrowDateTime> Who deleted the dental plan benefit. |
| effective_date | string or null <ArrowDateTime> When the dental plan benefit goes into effect. |
| termination_date | string or null <ArrowDateTime> When the dental plan benefit ends. |
| benefit_type | string or null |
| dental_plan_benefit_id required | integer or null <int32> The ID of the associated dental plan benefit. |
| start_date | string or null <ArrowDateTime> When the dental plan benefit starts. |
| end_date | string or null <ArrowDateTime> When the dental plan benefit ends. |
| name | string or null |
| identity | string or null |
| pend_rules | any or null |
| auto_adjudication_rules | any or null |
| accumulations | any or null |
| networks | any or null |
| preventive | any or null |
| services | any or null |
| claim_validation_checks | any or null |
| service_maximums | any or null |
{- "id": 0,
- "rn": "string",
- "dental_benefit_id": "string",
- "plan_id": 0,
- "created_at": "string",
- "deleted_at": "string",
- "deleted_by": "string",
- "effective_date": "string",
- "termination_date": "string",
- "benefit_type": "string",
- "dental_plan_benefit_id": 0,
- "start_date": "string",
- "end_date": "string",
- "name": "string",
- "identity": "string",
- "pend_rules": null,
- "auto_adjudication_rules": null,
- "accumulations": null,
- "networks": null,
- "preventive": null,
- "services": null,
- "claim_validation_checks": null,
- "service_maximums": null
}{- "message": "string"
}Get a Dental Plan Benefit Draft.
| dental_plan_benefit_id | integer or null <int32> The ID of the associated dental plan benefit. |
{- "dental_plan_benefit_id": 0
}{- "id": 0,
- "rn": "string",
- "dental_benefit_id": "string",
- "plan_id": 0,
- "created_at": "string",
- "deleted_at": "string",
- "deleted_by": "string",
- "effective_date": "string",
- "termination_date": "string",
- "benefit_type": "string",
- "dental_plan_benefit_id": 0,
- "start_date": "string",
- "end_date": "string",
- "name": "string",
- "identity": "string",
- "pend_rules": null,
- "auto_adjudication_rules": null,
- "accumulations": null,
- "networks": null,
- "preventive": null,
- "services": null,
- "claim_validation_checks": null,
- "service_maximums": null
}List Dental Plan Benefit Drafts.
| page_number | integer or null <int32> The page of results you would like to get. For the first page, pass |
| results_per_page | integer or null <int32> The number of results per page. |
| expected_fields | Array of strings or null or null The desired list of fields to be returned. |
| dental_benefit_id required | string or null The ID of the dental benefit. |
Array of objects or null (OrderBySchema_1764643208.5579093) |
{- "page_number": 0,
- "results_per_page": 0,
- "expected_fields": [
- "string"
], - "dental_benefit_id": "string",
- "order_by": [
- {
- "id": "string",
- "effective_date": "string",
- "termination_date": "string"
}
]
}{- "results": [
- {
- "dental_plan_benefit_draft": {
- "id": 0,
- "rn": "string",
- "dental_benefit_id": "string",
- "plan_id": 0,
- "created_at": "string",
- "deleted_at": "string",
- "deleted_by": "string",
- "effective_date": "string",
- "termination_date": "string",
- "benefit_type": "string",
- "dental_plan_benefit_id": 0,
- "start_date": "string",
- "end_date": "string",
- "name": "string",
- "identity": "string",
- "pend_rules": null,
- "auto_adjudication_rules": null,
- "accumulations": null,
- "networks": null,
- "preventive": null,
- "services": null,
- "claim_validation_checks": null,
- "service_maximums": null
}
}
], - "result_count": "string"
}| id | integer <int32> The ID of the dental plan benefit that was just updated. |
| rn | string or null |
| dental_benefit_id | string or null The external ID of the benefit. |
| plan_id | integer or null <int32> The ID of the associated plan. |
| created_at | string or null <ArrowDateTime> When the dental plan benefit was created. |
| deleted_at | string or null <ArrowDateTime> When the dental plan benefit was deleted. |
| deleted_by | string or null <ArrowDateTime> Who deleted the dental plan benefit. |
| effective_date | string or null <ArrowDateTime> When the dental plan benefit goes into effect. |
| termination_date | string or null <ArrowDateTime> When the dental plan benefit ends. |
| benefit_type | string or null |
| dental_plan_benefit_id required | integer or null <int32> The ID of the associated dental plan benefit. |
| start_date | string or null <ArrowDateTime> When the dental plan benefit starts. |
| end_date | string or null <ArrowDateTime> When the dental plan benefit ends. |
| name | string or null |
| identity | string or null |
| pend_rules | any or null |
| auto_adjudication_rules | any or null |
| accumulations | any or null |
| networks | any or null |
| preventive | any or null |
| services | any or null |
| claim_validation_checks | any or null |
| service_maximums | any or null |
{- "id": 0,
- "rn": "string",
- "dental_benefit_id": "string",
- "plan_id": 0,
- "created_at": "string",
- "deleted_at": "string",
- "deleted_by": "string",
- "effective_date": "string",
- "termination_date": "string",
- "benefit_type": "string",
- "dental_plan_benefit_id": 0,
- "start_date": "string",
- "end_date": "string",
- "name": "string",
- "identity": "string",
- "pend_rules": null,
- "auto_adjudication_rules": null,
- "accumulations": null,
- "networks": null,
- "preventive": null,
- "services": null,
- "claim_validation_checks": null,
- "service_maximums": null
}{- "id": 0,
- "rn": "string",
- "dental_benefit_id": "string",
- "plan_id": 0,
- "created_at": "string",
- "deleted_at": "string",
- "deleted_by": "string",
- "effective_date": "string",
- "termination_date": "string",
- "benefit_type": "string",
- "dental_plan_benefit_id": 0,
- "start_date": "string",
- "end_date": "string",
- "name": "string",
- "identity": "string",
- "pend_rules": null,
- "auto_adjudication_rules": null,
- "accumulations": null,
- "networks": null,
- "preventive": null,
- "services": null,
- "claim_validation_checks": null,
- "service_maximums": null
}Update a Dental Plan Benefit Draft.
| id | integer <int32> The ID of the dental plan benefit that was just updated. |
| rn | string or null |
| dental_benefit_id | string or null The external ID of the benefit. |
| plan_id | integer or null <int32> The ID of the associated plan. |
| created_at | string or null <ArrowDateTime> When the dental plan benefit was created. |
| deleted_at | string or null <ArrowDateTime> When the dental plan benefit was deleted. |
| deleted_by | string or null <ArrowDateTime> Who deleted the dental plan benefit. |
| effective_date | string or null <ArrowDateTime> When the dental plan benefit goes into effect. |
| termination_date | string or null <ArrowDateTime> When the dental plan benefit ends. |
| benefit_type | string or null |
| dental_plan_benefit_id required | integer or null <int32> The ID of the associated dental plan benefit. |
| start_date | string or null <ArrowDateTime> When the dental plan benefit starts. |
| end_date | string or null <ArrowDateTime> When the dental plan benefit ends. |
| name | string or null |
| identity | string or null |
| pend_rules | any or null |
| auto_adjudication_rules | any or null |
| accumulations | any or null |
| networks | any or null |
| preventive | any or null |
| services | any or null |
| claim_validation_checks | any or null |
| service_maximums | any or null |
{- "id": 0,
- "rn": "string",
- "dental_benefit_id": "string",
- "plan_id": 0,
- "created_at": "string",
- "deleted_at": "string",
- "deleted_by": "string",
- "effective_date": "string",
- "termination_date": "string",
- "benefit_type": "string",
- "dental_plan_benefit_id": 0,
- "start_date": "string",
- "end_date": "string",
- "name": "string",
- "identity": "string",
- "pend_rules": null,
- "auto_adjudication_rules": null,
- "accumulations": null,
- "networks": null,
- "preventive": null,
- "services": null,
- "claim_validation_checks": null,
- "service_maximums": null
}{- "id": 0,
- "rn": "string",
- "dental_benefit_id": "string",
- "plan_id": 0,
- "created_at": "string",
- "deleted_at": "string",
- "deleted_by": "string",
- "effective_date": "string",
- "termination_date": "string",
- "benefit_type": "string",
- "dental_plan_benefit_id": 0,
- "start_date": "string",
- "end_date": "string",
- "name": "string",
- "identity": "string",
- "pend_rules": null,
- "auto_adjudication_rules": null,
- "accumulations": null,
- "networks": null,
- "preventive": null,
- "services": null,
- "claim_validation_checks": null,
- "service_maximums": null
}| sendTimeStamp | string or null |
| messageId | string or null |
| messageType | string or null |
| totalNbrOfTxns | integer or null <int32> |
| transactionData | any or null List of objects of arbitrary shape; specific to the type of request. |
{- "sendTimeStamp": "string",
- "messageId": "string",
- "messageType": "string",
- "totalNbrOfTxns": 0,
- "transactionData": null
}{- "message": "string"
}| ndc required | string |
| service_provider_id required | string |
| days_supply required | number |
| quantity_dispensed required | number |
| group_number | string or null |
{- "ndc": "string",
- "service_provider_id": "string",
- "days_supply": 0,
- "quantity_dispensed": 0,
- "group_number": "string"
}{- "patient_pay_amount": 0
}| gender required | string Enum: "M" "F" Must be 'M' or 'F' |
| first_name required | string |
| last_name required | string |
| date_of_birth required | string <ArrowDateTime> |
| external_member_id | string or null |
| group_number | string or null |
{- "gender": "M",
- "first_name": "string",
- "last_name": "string",
- "date_of_birth": "string",
- "external_member_id": "string",
- "group_number": "string"
}{- "member": {
- "id": 0,
- "rn": "string",
- "external_member_id": "string",
- "client_id": "string",
- "person_code": "string",
- "group_id": 0,
- "test_member": false,
- "created_at": "string",
- "updated_at": "string",
- "start_date": "string",
- "end_date": "string",
- "relationship_code": "string",
- "sex": "string",
- "effective_date": "string",
- "termination_date": "string",
- "first_name": "string",
- "last_name": "string",
- "address_line_1": "string",
- "address_line_2": "string",
- "address_line_3": "string",
- "city": "string",
- "state": "string",
- "zip_code": "string",
- "country": "string",
- "location": "string",
- "birth_date": "string",
- "death_date": "string",
- "multiple_birth_code": 0,
- "phone_number": "string",
- "social_security_number": "string",
- "ppo_name": "string",
- "coverage_type": "string",
- "language_code": "string",
- "email": "string",
- "coverage_status": "string",
- "handicap_indicator": "string",
- "miscellaneous_id": "string",
- "alternate_member_id": "string",
- "is_allocated": true,
- "identity": "string",
- "medicare_indicator": "string",
- "medicare_beneficiary_identifier": "string",
- "low_income_subsidy_level": "string",
- "low_income_subsidy_level_effective_date": "string",
- "low_income_subsidy_level_termination_date": "string",
- "hospice_flag": "string",
- "hospice_flag_effective_date": "string",
- "hospice_flag_termination_date": "string",
- "end_stage_renal_disease_flag": "string",
- "end_stage_renal_disease_flag_effective_date": "string",
- "end_stage_renal_disease_flag_termination_date": "string",
- "transplant_patient_flag": "string",
- "transplant_patient_flag_effective_date": "string",
- "transplant_patient_flag_termination_date": "string",
- "cancer_flag": "string",
- "cancer_flag_effective_date": "string",
- "cancer_flag_termination_date": "string",
- "beneficiary_identifier": "string",
- "action_type": "string",
- "other_payer_member_identification_number": "string",
- "other_payer_group_number": "string",
- "other_payer_bin_number": "string",
- "other_payer_processor_control_number": "string",
- "other_payer_effective_date": "string",
- "other_payer_termination_date": "string",
- "new_enrollee_effective_date": "string",
- "udf_1": "string",
- "udf_1_name": "string",
- "udf_2": "string",
- "udf_2_name": "string",
- "udf_3": "string",
- "udf_3_name": "string",
- "udf_4": "string",
- "udf_4_name": "string",
- "udf_5": "string",
- "udf_5_name": "string",
- "udf_6": "string",
- "udf_6_name": "string",
- "udf_7": "string",
- "udf_7_name": "string",
- "udf_8": "string",
- "udf_8_name": "string",
- "udf_9": "string",
- "udf_9_name": "string",
- "udf_10": "string",
- "udf_10_name": "string",
- "udf_11": "string",
- "udf_11_name": "string",
- "udf_12": "string",
- "udf_12_name": "string",
- "udf_13": "string",
- "udf_13_name": "string",
- "udf_14": "string",
- "udf_14_name": "string",
- "udf_15": "string",
- "udf_15_name": "string",
- "file_lock_start_date": "string",
- "file_lock_end_date": "string",
- "legal_representative_first_name": "string",
- "legal_representative_last_name": "string",
- "legal_representative_address_line_1": "string",
- "legal_representative_address_line_2": "string",
- "legal_representative_city": "string",
- "legal_representative_state": "string",
- "legal_representative_zip_code": "string",
- "legal_representative_country": "string",
- "large_print": true,
- "spans": [
- { }
], - "protected_member_address": "string",
- "phone_number_qualifier": "string",
- "written_language": "string",
- "verbal_language": "string",
- "alternate_written_communication_mode": "string",
- "disenrollment_reason": "string",
- "line_of_business": "string",
- "program": "string",
- "service_area_state": "string",
- "service_area_county": "string",
- "marketplace_metal_level": "string",
- "hios_id_naic": "string",
- "medicaid_id": "string",
- "encounter_member_id": "string",
- "encounter_member_id_qualifier": "string",
- "medicaid_dual_status_code": "string",
- "medicaid_dual_status_code_effective_date": "string",
- "medicaid_dual_status_code_termination_date": "string",
- "is_medical_member": true,
- "medical_group_id": "string"
}, - "plan": {
- "id": 0,
- "rn": "string",
- "name": "string",
- "client_id": "string",
- "bin_number": "string",
- "processor_control_number": "string",
- "group_number": "string",
- "medical_group_number": "string",
- "has_group_matching_required": true,
- "claim_payment_cycle": "semi_monthly",
- "address_line_1": "string",
- "address_line_2": "string",
- "city": "string",
- "state": "string",
- "zip_code": "string",
- "effective_date": "string",
- "created_at": "string",
- "updated_at": "string",
- "status": "string",
- "groups_status": "string",
- "eligibility_status": "string",
- "member_documents_status": "string",
- "absence_method": "do_nothing",
- "absence_boundary": "plan",
- "absence_method_terminate_date_option": "file_date",
- "absence_method_group": "do_nothing",
- "absence_method_group_terminate_date_option": "file_date",
- "eligibility_reject_failure_threshold": 0,
- "eligibility_change_failure_threshold": 0,
- "accumulation_load_failure_threshold": 0,
- "external_member_id_format": "string",
- "person_code_length": 0,
- "customer_service_phone_number": "string",
- "help_desk_phone": "string",
- "plan_additional_covered_type": "string",
- "plan_additional_covered_standard_deductible": "string",
- "plan_additional_covered_standard_plan_max": "string",
- "plan_additional_covered_standard_category_plan_max": "string",
- "plan_additional_covered_percentage_amount": 0,
- "plan_additional_covered_dollar_amount": 0,
- "pricing_status": "string",
- "pharmacy_service_fee_enabled": true,
- "strategic_partner_fee": 0,
- "plan_type": "string",
- "has_automatic_enrollment": true,
- "automatic_enrollment_type": "string",
- "routing_configuration": "string",
- "print_system": "string",
- "custom_accumulation_types": null,
- "is_address_required": true,
- "termination_date": "string",
- "external_member_id_pattern": "string",
- "external_member_id_length": 0,
- "bin_number_medicare_prescription_payment_plan": "string",
- "processor_control_number_medicare_prescription_payment_plan": "string",
- "group_number_medicare_prescription_payment_plan": "string",
- "medicare_prescription_payment_plan_allowed_payment_methods": "string",
- "medicare_prescription_payment_plan_invoice_print_window": "string",
- "payment_vendor_account_id": "string",
- "has_feature_use_group_version_ddb": true,
- "has_feature_member_eligibility_gap": true,
- "care_navigation_client_id": "string",
- "reconciliation_type": "string"
}
}| id | integer <int32> |
| rn | string or null <SanitizedString> |
| documents required | Array of integers <int32> [ items <int32 > ] |
| coverage_strategy_id | string or null <SanitizedString> |
| plan_id | integer or null <int32> |
| destination | string Enum: "member_portal" "enrollment" |
| order | integer <int32> |
{- "id": 0,
- "rn": "string",
- "documents": [
- 0
], - "coverage_strategy_id": "string",
- "plan_id": 0,
- "destination": "member_portal",
- "order": 0
}{- "message": "string"
}Create a Document.
| id | integer <int32> |
| rn | string or null <SanitizedString> |
| file_name required | string <SanitizedString> |
| name required | string <SanitizedString> |
| description required | string <SanitizedString> |
| created_at | string or null <SanitizedString> |
| updated_at | string or null <SanitizedString> |
| bucket | string <SanitizedString> |
| prefix | string <SanitizedString> |
| key | string <SanitizedString> |
object or null | |
| destination | string or null |
| order | integer <int32> |
{- "id": 0,
- "rn": "string",
- "file_name": "string",
- "name": "string",
- "description": "string",
- "created_at": "string",
- "updated_at": "string",
- "bucket": "string",
- "prefix": "string",
- "key": "string",
- "post": {
- "url": "string",
- "fields": null
}, - "destination": "string",
- "order": 0
}{- "id": 0,
- "rn": "string",
- "file_name": "string",
- "name": "string",
- "description": "string",
- "created_at": "string",
- "updated_at": "string",
- "bucket": "string",
- "prefix": "string",
- "key": "string",
- "post": {
- "url": "string",
- "fields": null
}, - "destination": "string",
- "order": 0
}| id required | string |
| external_document_id required | string |
| person_code required | string |
| external_member_id required | string |
| client_id required | string |
{- "id": "string",
- "external_document_id": "string",
- "person_code": "string",
- "external_member_id": "string",
- "client_id": "string"
}{- "url": "string"
}| id | integer <int32> |
| rn | string or null <SanitizedString> |
| documents required | Array of integers <int32> [ items <int32 > ] |
| coverage_strategy_id | string or null <SanitizedString> |
| plan_id | integer or null <int32> |
| destination | string Enum: "member_portal" "enrollment" |
| order | integer <int32> |
{- "id": 0,
- "rn": "string",
- "documents": [
- 0
], - "coverage_strategy_id": "string",
- "plan_id": 0,
- "destination": "member_portal",
- "order": 0
}{- "message": "string"
}List Documents.
| page_number | integer or null <int32> The page of results you would like to get. For the first page, pass |
| results_per_page | integer or null <int32> The number of results per page. |
| expected_fields | Array of strings or null or null The desired list of fields to be returned. |
| id | integer <int32> |
| plan_id | integer or null <int32> |
| coverage_strategy_id | string or null <SanitizedString> |
| client_id | string or null <SanitizedString> |
| destination | string or null Enum: "member_portal" "enrollment" |
Array of objects or null (OrderBySchema_1764643208.5746896) |
{- "page_number": 0,
- "results_per_page": 0,
- "expected_fields": [
- "string"
], - "id": 0,
- "plan_id": 0,
- "coverage_strategy_id": "string",
- "client_id": "string",
- "destination": "member_portal",
- "order_by": [
- {
- "file_name": "string",
- "name": "string",
- "destination": "string",
- "created_at": "string",
- "updated_at": "string"
}
]
}{- "results": [
- {
- "document": {
- "id": 0,
- "rn": "string",
- "file_name": "string",
- "name": "string",
- "description": "string",
- "created_at": "string",
- "updated_at": "string",
- "bucket": "string",
- "prefix": "string",
- "key": "string",
- "post": {
- "url": "string",
- "fields": null
}, - "destination": "string",
- "order": 0
}
}
], - "result_count": "string"
}Update a Document.
| id required | integer <int32> |
| name | string <SanitizedString> |
| description | string <SanitizedString> |
| file_name | string <SanitizedString> |
{- "id": 0,
- "name": "string",
- "description": "string",
- "file_name": "string"
}{- "id": 0,
- "rn": "string",
- "file_name": "string",
- "name": "string",
- "description": "string",
- "created_at": "string",
- "updated_at": "string",
- "bucket": "string",
- "prefix": "string",
- "key": "string",
- "post": {
- "url": "string",
- "fields": null
}, - "destination": "string",
- "order": 0
}| id required | integer <int32> |
| user_target | string or null Enum: "download" "view" The desired end user action |
{- "id": 0,
- "user_target": "download"
}{- "url": "string"
}{- "id": 0
}{- "id": 0,
- "rn": "string",
- "file_name": "string",
- "name": "string",
- "description": "string",
- "created_at": "string",
- "updated_at": "string",
- "bucket": "string",
- "prefix": "string",
- "key": "string",
- "post": {
- "url": "string",
- "fields": null
}, - "destination": "string",
- "order": 0
}| document_id required | integer <int32> |
| plan_id required | integer <int32> |
| destination required | string Enum: "enrollment" "member_portal" |
| new_order required | integer <int32> |
{- "document_id": 0,
- "plan_id": 0,
- "destination": "enrollment",
- "new_order": 0
}{ }| coverage_strategy_id required | string or null Final plan benefit code |
| date_of_service required | string or null <ArrowDateTime> Date of service |
| client_id | string or null The client ID is an external-facing identifier used on eligibility feeds and other information to tie the data to this specific plan. |
| drug_descriptor_id | string or null The Drug Descriptor Identifier from Medi-Span |
| ndc | string or null NDC of the product |
| is_generic | boolean or null Filter by generic (true) or branded (false) drugs. Multi_source = Y is classified as generic. Multi_source <> Y is classified as branded. |
| benefit_reset_date | string or null <ArrowDateTime> Group accumulations/benefit reset date |
| package_size | number Size of mddb generic product pack |
{- "coverage_strategy_id": "string",
- "date_of_service": "string",
- "client_id": "string",
- "drug_descriptor_id": "string",
- "ndc": "string",
- "is_generic": true,
- "benefit_reset_date": "string",
- "package_size": 0
}{- "ndc": "string",
- "coverage_status": "string",
- "awp_price": 0,
- "is_on_formulary": true,
- "package_size": 0,
- "tee_code": "string",
- "formulary_attributes": { }
}Create a Drug Management Program Lockin.
| client_id required | string |
| external_member_id required | string The external member ID of the member. |
| external_lockin_id | integer or null <int32> |
| person_code required | string The person code of the member. |
| drug_management_program_lockin_id | integer or null <int32> |
| start_date | string or null <ArrowDateTime> |
| end_date | string or null <ArrowDateTime> |
| effective_date | string or null <ArrowDateTime> |
| termination_date | string or null <ArrowDateTime> |
| pharmacy_lockin_level | string or null |
| prescriber_npis | Array of strings or null |
| prescriber_lockin_level | string or null |
| pharmacy_nabps | Array of integers or null <int32> NABP Pharmacy ID |
| pharmacy_npis | Array of strings or null Pharmacy NPIs |
| allowed_gpis | Array of strings or null |
| disallowed_gpis | Array of strings or null |
| exempt_gpis | Array of strings or null |
| allowed_ndcs | Array of strings or null |
| disallowed_ndcs | Array of strings or null |
| exempt_ndcs | Array of strings or null |
| custom_drug_limits | Array of any or null |
| external_group_id | string or null |
| external_account_id | string or null |
{- "client_id": "string",
- "external_member_id": "string",
- "external_lockin_id": 0,
- "person_code": "string",
- "drug_management_program_lockin_id": 0,
- "start_date": "string",
- "end_date": "string",
- "effective_date": "string",
- "termination_date": "string",
- "pharmacy_lockin_level": "string",
- "prescriber_npis": [
- "string"
], - "prescriber_lockin_level": "string",
- "pharmacy_nabps": [
- 0
], - "pharmacy_npis": [
- "string"
], - "allowed_gpis": [
- "string"
], - "disallowed_gpis": [
- "string"
], - "exempt_gpis": [
- "string"
], - "allowed_ndcs": [
- "string"
], - "disallowed_ndcs": [
- "string"
], - "exempt_ndcs": [
- "string"
], - "custom_drug_limits": [
- null
], - "external_group_id": "string",
- "external_account_id": "string"
}{- "id": 0,
- "client_id": "string",
- "external_member_id": "string",
- "external_lockin_id": 0,
- "person_code": "string",
- "drug_management_program_lockin_id": 0,
- "start_date": "string",
- "end_date": "string",
- "effective_date": "string",
- "termination_date": "string",
- "pharmacy_lockin_level": "string",
- "prescriber_npis": [
- "string"
], - "prescriber_lockin_level": "string",
- "pharmacy_nabps": [
- 0
], - "pharmacy_npis": [
- "string"
], - "allowed_gpis": [
- "string"
], - "disallowed_gpis": [
- "string"
], - "exempt_gpis": [
- "string"
], - "allowed_ndcs": [
- "string"
], - "disallowed_ndcs": [
- "string"
], - "exempt_ndcs": [
- "string"
], - "custom_drug_limits": [
- null
], - "external_group_id": "string",
- "external_account_id": "string"
}| client_id required | string |
| external_member_id required | string The external member ID of the member. |
| external_lockin_id | integer or null <int32> |
| person_code required | string The person code of the member. |
| drug_management_program_lockin_id | integer or null <int32> |
| start_date | string or null <ArrowDateTime> |
| end_date | string or null <ArrowDateTime> |
| effective_date | string or null <ArrowDateTime> |
| termination_date | string or null <ArrowDateTime> |
| pharmacy_lockin_level | string or null |
| prescriber_npis | Array of strings or null |
| prescriber_lockin_level | string or null |
| pharmacy_nabps | Array of integers or null <int32> NABP Pharmacy ID |
| pharmacy_npis | Array of strings or null Pharmacy NPIs |
| allowed_gpis | Array of strings or null |
| disallowed_gpis | Array of strings or null |
| exempt_gpis | Array of strings or null |
| allowed_ndcs | Array of strings or null |
| disallowed_ndcs | Array of strings or null |
| exempt_ndcs | Array of strings or null |
| custom_drug_limits | Array of any or null |
| external_group_id required | string or null |
| external_account_id required | string or null |
{- "client_id": "string",
- "external_member_id": "string",
- "external_lockin_id": 0,
- "person_code": "string",
- "drug_management_program_lockin_id": 0,
- "start_date": "string",
- "end_date": "string",
- "effective_date": "string",
- "termination_date": "string",
- "pharmacy_lockin_level": "string",
- "prescriber_npis": [
- "string"
], - "prescriber_lockin_level": "string",
- "pharmacy_nabps": [
- 0
], - "pharmacy_npis": [
- "string"
], - "allowed_gpis": [
- "string"
], - "disallowed_gpis": [
- "string"
], - "exempt_gpis": [
- "string"
], - "allowed_ndcs": [
- "string"
], - "disallowed_ndcs": [
- "string"
], - "exempt_ndcs": [
- "string"
], - "custom_drug_limits": [
- null
], - "external_group_id": "string",
- "external_account_id": "string"
}{- "id": 0,
- "client_id": "string",
- "external_member_id": "string",
- "external_lockin_id": 0,
- "person_code": "string",
- "drug_management_program_lockin_id": 0,
- "start_date": "string",
- "end_date": "string",
- "effective_date": "string",
- "termination_date": "string",
- "pharmacy_lockin_level": "string",
- "prescriber_npis": [
- "string"
], - "prescriber_lockin_level": "string",
- "pharmacy_nabps": [
- 0
], - "pharmacy_npis": [
- "string"
], - "allowed_gpis": [
- "string"
], - "disallowed_gpis": [
- "string"
], - "exempt_gpis": [
- "string"
], - "allowed_ndcs": [
- "string"
], - "disallowed_ndcs": [
- "string"
], - "exempt_ndcs": [
- "string"
], - "custom_drug_limits": [
- null
], - "external_group_id": "string",
- "external_account_id": "string"
}Get a Drug Management Program Lockin.
| id required | integer <int32> |
| client_id | string |
| external_member_id | string The external member ID of the member. |
| external_lockin_id | integer or null <int32> |
| person_code | string The person code of the member. |
| drug_management_program_lockin_id | integer or null <int32> |
| start_date | string or null <ArrowDateTime> |
| end_date | string or null <ArrowDateTime> |
| effective_date | string or null <ArrowDateTime> |
| termination_date | string or null <ArrowDateTime> |
| pharmacy_lockin_level | string or null |
| prescriber_npis | Array of strings or null |
| prescriber_lockin_level | string or null |
| pharmacy_nabps | Array of integers or null <int32> NABP Pharmacy ID |
| pharmacy_npis | Array of strings or null Pharmacy NPIs |
| allowed_gpis | Array of strings or null |
| disallowed_gpis | Array of strings or null |
| exempt_gpis | Array of strings or null |
| allowed_ndcs | Array of strings or null |
| disallowed_ndcs | Array of strings or null |
| exempt_ndcs | Array of strings or null |
| custom_drug_limits | Array of any or null |
| external_group_id | string or null |
| external_account_id | string or null |
{- "id": 0,
- "client_id": "string",
- "external_member_id": "string",
- "external_lockin_id": 0,
- "person_code": "string",
- "drug_management_program_lockin_id": 0,
- "start_date": "string",
- "end_date": "string",
- "effective_date": "string",
- "termination_date": "string",
- "pharmacy_lockin_level": "string",
- "prescriber_npis": [
- "string"
], - "prescriber_lockin_level": "string",
- "pharmacy_nabps": [
- 0
], - "pharmacy_npis": [
- "string"
], - "allowed_gpis": [
- "string"
], - "disallowed_gpis": [
- "string"
], - "exempt_gpis": [
- "string"
], - "allowed_ndcs": [
- "string"
], - "disallowed_ndcs": [
- "string"
], - "exempt_ndcs": [
- "string"
], - "custom_drug_limits": [
- null
], - "external_group_id": "string",
- "external_account_id": "string"
}{- "id": 0,
- "client_id": "string",
- "external_member_id": "string",
- "external_lockin_id": 0,
- "person_code": "string",
- "drug_management_program_lockin_id": 0,
- "start_date": "string",
- "end_date": "string",
- "effective_date": "string",
- "termination_date": "string",
- "pharmacy_lockin_level": "string",
- "prescriber_npis": [
- "string"
], - "prescriber_lockin_level": "string",
- "pharmacy_nabps": [
- 0
], - "pharmacy_npis": [
- "string"
], - "allowed_gpis": [
- "string"
], - "disallowed_gpis": [
- "string"
], - "exempt_gpis": [
- "string"
], - "allowed_ndcs": [
- "string"
], - "disallowed_ndcs": [
- "string"
], - "exempt_ndcs": [
- "string"
], - "custom_drug_limits": [
- null
], - "external_group_id": "string",
- "external_account_id": "string"
}List Drug Management Program Lockins.
| page_number | integer or null <int32> The page of results you would like to get. For the first page, pass |
| results_per_page | integer or null <int32> The maximum number of results per page. Cannot be set higher than 1000. |
| expected_fields | Array of strings or null or null The desired list of fields to be returned. |
| client_id required | string |
| external_member_id required | string |
| person_code required | string |
| only_current | boolean or null |
Array of objects or null (OrderBySchema_1764643208.588689) | |
| external_group_id | string or null |
| external_account_id | string or null |
| effective_date | string or null <date-time> |
| pharmacy_lockin_level | string or null |
| termination_date | string or null <date-time> |
| pharmacy_npis | Array of strings or null |
| pharmacy_nabps | Array of strings or null |
object or null An object containing allowed GPIs and/or NDCs. |
{- "page_number": 0,
- "results_per_page": 0,
- "expected_fields": [
- "string"
], - "client_id": "string",
- "external_member_id": "string",
- "person_code": "string",
- "only_current": true,
- "order_by": [
- {
- "id": "string",
- "effective_date": "string",
- "termination_date": "string",
- "external_group_id": "string",
- "external_account_id": "string"
}
], - "external_group_id": "string",
- "external_account_id": "string",
- "effective_date": "2019-08-24T14:15:22Z",
- "pharmacy_lockin_level": "string",
- "termination_date": "2019-08-24T14:15:22Z",
- "pharmacy_npis": [
- "string"
], - "pharmacy_nabps": [
- "string"
], - "custom_drug_limits": {
- "allowed_gpis": [
- "string"
], - "allowed_ndcs": [
- "string"
]
}
}{- "results": [
- {
- "lock_in": {
- "id": 0,
- "client_id": "string",
- "external_member_id": "string",
- "external_lockin_id": 0,
- "person_code": "string",
- "drug_management_program_lockin_id": 0,
- "start_date": "string",
- "end_date": "string",
- "effective_date": "string",
- "termination_date": "string",
- "pharmacy_lockin_level": "string",
- "prescriber_npis": [
- "string"
], - "prescriber_lockin_level": "string",
- "pharmacy_nabps": [
- 0
], - "pharmacy_npis": [
- "string"
], - "allowed_gpis": [
- "string"
], - "disallowed_gpis": [
- "string"
], - "exempt_gpis": [
- "string"
], - "allowed_ndcs": [
- "string"
], - "disallowed_ndcs": [
- "string"
], - "exempt_ndcs": [
- "string"
], - "custom_drug_limits": [
- null
], - "external_group_id": "string",
- "external_account_id": "string"
}
}
], - "result_count": "string"
}| page_number | integer or null <int32> The page of results you would like to get. For the first page, pass |
| results_per_page | integer or null <int32> The maximum number of results per page. Cannot be set higher than 1000. |
| expected_fields | Array of strings or null or null The desired list of fields to be returned. |
| client_id required | string |
| external_member_id required | string |
| person_code required | string |
| only_current | boolean or null |
Array of objects or null (OrderBySchema_1764643208.588689) | |
| external_group_id required | string or null |
| external_account_id required | string or null |
| effective_date | string or null <date-time> |
| pharmacy_lockin_level | string or null |
| termination_date | string or null <date-time> |
| pharmacy_npis | Array of strings or null |
| pharmacy_nabps | Array of strings or null |
object or null An object containing allowed GPIs and/or NDCs. |
{- "page_number": 0,
- "results_per_page": 0,
- "expected_fields": [
- "string"
], - "client_id": "string",
- "external_member_id": "string",
- "person_code": "string",
- "only_current": true,
- "order_by": [
- {
- "id": "string",
- "effective_date": "string",
- "termination_date": "string",
- "external_group_id": "string",
- "external_account_id": "string"
}
], - "external_group_id": "string",
- "external_account_id": "string",
- "effective_date": "2019-08-24T14:15:22Z",
- "pharmacy_lockin_level": "string",
- "termination_date": "2019-08-24T14:15:22Z",
- "pharmacy_npis": [
- "string"
], - "pharmacy_nabps": [
- "string"
], - "custom_drug_limits": {
- "allowed_gpis": [
- "string"
], - "allowed_ndcs": [
- "string"
]
}
}{- "results": [
- {
- "lock_in": {
- "id": 0,
- "client_id": "string",
- "external_member_id": "string",
- "external_lockin_id": 0,
- "person_code": "string",
- "drug_management_program_lockin_id": 0,
- "start_date": "string",
- "end_date": "string",
- "effective_date": "string",
- "termination_date": "string",
- "pharmacy_lockin_level": "string",
- "prescriber_npis": [
- "string"
], - "prescriber_lockin_level": "string",
- "pharmacy_nabps": [
- 0
], - "pharmacy_npis": [
- "string"
], - "allowed_gpis": [
- "string"
], - "disallowed_gpis": [
- "string"
], - "exempt_gpis": [
- "string"
], - "allowed_ndcs": [
- "string"
], - "disallowed_ndcs": [
- "string"
], - "exempt_ndcs": [
- "string"
], - "custom_drug_limits": [
- null
], - "external_group_id": "string",
- "external_account_id": "string"
}
}
], - "result_count": "string"
}Update a Drug Management Program Lockin.
| id required | integer <int32> The ID of the lockin to update. |
| client_id | string |
| external_member_id | string The external member ID of the member. |
| external_lockin_id | integer or null <int32> |
| person_code | string The person code of the member. |
| drug_management_program_lockin_id | integer or null <int32> |
| start_date | string or null <ArrowDateTime> |
| end_date | string or null <ArrowDateTime> |
| effective_date | string or null <ArrowDateTime> |
| termination_date | string or null <ArrowDateTime> |
| pharmacy_lockin_level | string or null |
| prescriber_npis | Array of strings or null |
| prescriber_lockin_level | string or null |
| pharmacy_nabps | Array of integers or null <int32> NABP Pharmacy ID |
| pharmacy_npis | Array of strings or null Pharmacy NPIs |
| allowed_gpis | Array of strings or null |
| disallowed_gpis | Array of strings or null |
| exempt_gpis | Array of strings or null |
| allowed_ndcs | Array of strings or null |
| disallowed_ndcs | Array of strings or null |
| exempt_ndcs | Array of strings or null |
| custom_drug_limits | Array of any or null |
| external_group_id | string or null |
| external_account_id | string or null |
{- "id": 0,
- "client_id": "string",
- "external_member_id": "string",
- "external_lockin_id": 0,
- "person_code": "string",
- "drug_management_program_lockin_id": 0,
- "start_date": "string",
- "end_date": "string",
- "effective_date": "string",
- "termination_date": "string",
- "pharmacy_lockin_level": "string",
- "prescriber_npis": [
- "string"
], - "prescriber_lockin_level": "string",
- "pharmacy_nabps": [
- 0
], - "pharmacy_npis": [
- "string"
], - "allowed_gpis": [
- "string"
], - "disallowed_gpis": [
- "string"
], - "exempt_gpis": [
- "string"
], - "allowed_ndcs": [
- "string"
], - "disallowed_ndcs": [
- "string"
], - "exempt_ndcs": [
- "string"
], - "custom_drug_limits": [
- null
], - "external_group_id": "string",
- "external_account_id": "string"
}{- "id": 0,
- "client_id": "string",
- "external_member_id": "string",
- "external_lockin_id": 0,
- "person_code": "string",
- "drug_management_program_lockin_id": 0,
- "start_date": "string",
- "end_date": "string",
- "effective_date": "string",
- "termination_date": "string",
- "pharmacy_lockin_level": "string",
- "prescriber_npis": [
- "string"
], - "prescriber_lockin_level": "string",
- "pharmacy_nabps": [
- 0
], - "pharmacy_npis": [
- "string"
], - "allowed_gpis": [
- "string"
], - "disallowed_gpis": [
- "string"
], - "exempt_gpis": [
- "string"
], - "allowed_ndcs": [
- "string"
], - "disallowed_ndcs": [
- "string"
], - "exempt_ndcs": [
- "string"
], - "custom_drug_limits": [
- null
], - "external_group_id": "string",
- "external_account_id": "string"
}| id required | integer <int32> The ID of the lockin to update. |
| client_id | string |
| external_member_id | string The external member ID of the member. |
| external_lockin_id | integer or null <int32> |
| person_code | string The person code of the member. |
| drug_management_program_lockin_id | integer or null <int32> |
| start_date | string or null <ArrowDateTime> |
| end_date | string or null <ArrowDateTime> |
| effective_date | string or null <ArrowDateTime> |
| termination_date | string or null <ArrowDateTime> |
| pharmacy_lockin_level | string or null |
| prescriber_npis | Array of strings or null |
| prescriber_lockin_level | string or null |
| pharmacy_nabps | Array of integers or null <int32> NABP Pharmacy ID |
| pharmacy_npis | Array of strings or null Pharmacy NPIs |
| allowed_gpis | Array of strings or null |
| disallowed_gpis | Array of strings or null |
| exempt_gpis | Array of strings or null |
| allowed_ndcs | Array of strings or null |
| disallowed_ndcs | Array of strings or null |
| exempt_ndcs | Array of strings or null |
| custom_drug_limits | Array of any or null |
| external_group_id required | string or null |
| external_account_id required | string or null |
{- "id": 0,
- "client_id": "string",
- "external_member_id": "string",
- "external_lockin_id": 0,
- "person_code": "string",
- "drug_management_program_lockin_id": 0,
- "start_date": "string",
- "end_date": "string",
- "effective_date": "string",
- "termination_date": "string",
- "pharmacy_lockin_level": "string",
- "prescriber_npis": [
- "string"
], - "prescriber_lockin_level": "string",
- "pharmacy_nabps": [
- 0
], - "pharmacy_npis": [
- "string"
], - "allowed_gpis": [
- "string"
], - "disallowed_gpis": [
- "string"
], - "exempt_gpis": [
- "string"
], - "allowed_ndcs": [
- "string"
], - "disallowed_ndcs": [
- "string"
], - "exempt_ndcs": [
- "string"
], - "custom_drug_limits": [
- null
], - "external_group_id": "string",
- "external_account_id": "string"
}{- "id": 0,
- "client_id": "string",
- "external_member_id": "string",
- "external_lockin_id": 0,
- "person_code": "string",
- "drug_management_program_lockin_id": 0,
- "start_date": "string",
- "end_date": "string",
- "effective_date": "string",
- "termination_date": "string",
- "pharmacy_lockin_level": "string",
- "prescriber_npis": [
- "string"
], - "prescriber_lockin_level": "string",
- "pharmacy_nabps": [
- 0
], - "pharmacy_npis": [
- "string"
], - "allowed_gpis": [
- "string"
], - "disallowed_gpis": [
- "string"
], - "exempt_gpis": [
- "string"
], - "allowed_ndcs": [
- "string"
], - "disallowed_ndcs": [
- "string"
], - "exempt_ndcs": [
- "string"
], - "custom_drug_limits": [
- null
], - "external_group_id": "string",
- "external_account_id": "string"
}List Drug Lists.
| page_number | integer or null <int32> The page of results you would like to get. For the first page, pass |
| results_per_page | integer or null <int32> The maximum number of results per page. Cannot be set higher than 1000. |
| expected_fields | Array of strings or null or null The desired list of fields to be returned. |
| external_drug_list_ids | Array of strings or null |
| id | integer <int32> |
| name | string or null Name of the drug list |
| drug_identifier | string or null Search the list that contains a drug_record with the provided identifier |
| ids | Array of integers or null <int32> |
| excluded_drug_list_ids | Array of integers or null <int32> |
Array of objects or null (OrderBySchema_1764643208.5997896) | |
| plan_benefit_id | integer <int32> |
| external_drug_list_id | string or null |
| plan_benefit_attachable_drug_lists_only | boolean or null |
| type | string or null |
| product | string or null |
| client_ids | Array of strings or null or null |
{- "page_number": 0,
- "results_per_page": 0,
- "expected_fields": [
- "string"
], - "external_drug_list_ids": [
- "string"
], - "id": 0,
- "name": "string",
- "drug_identifier": "string",
- "ids": [
- 0
], - "excluded_drug_list_ids": [
- 0
], - "order_by": [
- {
- "id": "string",
- "name": "string",
- "created_at": "string",
- "external_drug_list_id": "string",
- "type": "string",
- "product": "string",
- "client_ids": "string"
}
], - "plan_benefit_id": 0,
- "external_drug_list_id": "string",
- "plan_benefit_attachable_drug_lists_only": true,
- "type": "string",
- "product": "string",
- "client_ids": [
- "string"
]
}{- "results": [
- {
- "drug_list": {
- "id": 0,
- "external_drug_list_id": "string",
- "type": "string",
- "client_ids": [
- "string"
], - "name": "string",
- "notes": "string",
- "created_at": "string",
- "rn": "string"
}
}
], - "result_count": "string"
}| drug_list_id | integer <int32> |
| attributes | Array of strings |
| drug_list_record_id | integer or null <int32> |
| attribute_keys | Array of strings |
| attribute_values | Array of strings |
Array of objects or null (OrderBySchema_1764643208.6022453) |
{- "drug_list_id": 0,
- "attributes": [
- "string"
], - "drug_list_record_id": 0,
- "attribute_keys": [
- "string"
], - "attribute_values": [
- "string"
], - "order_by": [
- {
- "effective_date": "string",
- "termination_date": "string",
- "start_date": "string",
- "end_date": "string",
- "updated_by": "string",
- "identifier_type": "string"
}
]
}{- "attributes": [
- "string"
]
}List Drug List Records.
| page_number | integer or null <int32> The page of results you would like to get. For the first page, pass |
| results_per_page | integer or null <int32> The maximum number of results per page. Cannot be set higher than 1000. |
| expected_fields | Array of strings or null or null The desired list of fields to be returned. |
| drug_list_id | integer <int32> |
| attributes | Array of strings or null |
| show_latest_versions_only | boolean or null |
Array of objects or null (OrderBySchema_1764643208.6022453) | |
| identifier | string |
| identifier_type | string |
| minimum_effective_date | string or null <ArrowDateTime> |
| maximum_effective_date | string or null <ArrowDateTime> |
| minimum_termination_date | string or null <ArrowDateTime> |
| maximum_termination_date | string or null <ArrowDateTime> |
| minimum_start_date | string or null <ArrowDateTime> |
| maximum_start_date | string or null <ArrowDateTime> |
| minimum_end_date | string or null <ArrowDateTime> |
| maximum_end_date | string or null <ArrowDateTime> |
| drug_list_record_id | integer <int32> |
{- "page_number": 0,
- "results_per_page": 0,
- "expected_fields": [
- "string"
], - "drug_list_id": 0,
- "attributes": [
- "string"
], - "show_latest_versions_only": true,
- "order_by": [
- {
- "effective_date": "string",
- "termination_date": "string",
- "start_date": "string",
- "end_date": "string",
- "updated_by": "string",
- "identifier_type": "string"
}
], - "identifier": "string",
- "identifier_type": "string",
- "minimum_effective_date": "string",
- "maximum_effective_date": "string",
- "minimum_termination_date": "string",
- "maximum_termination_date": "string",
- "minimum_start_date": "string",
- "maximum_start_date": "string",
- "minimum_end_date": "string",
- "maximum_end_date": "string",
- "drug_list_record_id": 0
}{- "results": [
- {
- "drug_list_record": {
- "id": 0,
- "drug_list_id": 0,
- "drug_list_file_id": 0,
- "identifier": "string",
- "identifier_type": "string",
- "effective_date": "string",
- "termination_date": "string",
- "start_date": "string",
- "end_date": "string",
- "multi_source": [
- "string"
], - "attributes": null,
- "notes": "string",
- "created_at": "string",
- "created_by": "string",
- "updated_at": "string",
- "updated_by": "string",
- "rn": "string"
}
}
], - "result_count": "string"
}| drug_list_id | integer <int32> |
| attributes | Array of strings |
| drug_list_record_id required | integer or null <int32> |
| attribute_keys | Array of strings |
| attribute_values | Array of strings |
Array of objects or null (OrderBySchema_1764643208.6022453) |
{- "drug_list_id": 0,
- "attributes": [
- "string"
], - "drug_list_record_id": 0,
- "attribute_keys": [
- "string"
], - "attribute_values": [
- "string"
], - "order_by": [
- {
- "effective_date": "string",
- "termination_date": "string",
- "start_date": "string",
- "end_date": "string",
- "updated_by": "string",
- "identifier_type": "string"
}
]
}{- "result_count": "string",
- "results": [
- {
- "key": "string",
- "value": "string"
}
]
}Create an Email Delivery Target.
| rn | string or null |
| action | string or null |
| description | string or null |
| from_address required | string |
| to_addresses required | Array of strings |
| reply_to required | string or null |
| subject required | string or null |
| body_plain required | string or null |
| body_html required | string or null |
| encryption_setting_id | integer or null <int32> |
| effective_date | string or null <ArrowDateTime> |
| termination_date | string or null <ArrowDateTime> |
object or null |
{- "rn": "string",
- "action": "string",
- "description": "string",
- "from_address": "string",
- "to_addresses": [
- "string"
], - "reply_to": "string",
- "subject": "string",
- "body_plain": "string",
- "body_html": "string",
- "encryption_setting_id": 0,
- "effective_date": "string",
- "termination_date": "string",
- "email_notification_config": {
- "property1": [
- "string"
], - "property2": [
- "string"
]
}
}{- "id": 0,
- "rn": "string",
- "action": "string",
- "description": "string",
- "from_address": "string",
- "to_addresses": [
- "string"
], - "reply_to": "string",
- "subject": "string",
- "body_plain": "string",
- "body_html": "string",
- "encryption_setting_id": 0,
- "effective_date": "string",
- "termination_date": "string",
- "email_notification_config": {
- "property1": [
- "string"
], - "property2": [
- "string"
]
}
}Get an Email Delivery Target.
| id | integer <int32> |
{- "id": 0
}{- "id": 0,
- "rn": "string",
- "action": "string",
- "description": "string",
- "from_address": "string",
- "to_addresses": [
- "string"
], - "reply_to": "string",
- "subject": "string",
- "body_plain": "string",
- "body_html": "string",
- "encryption_setting_id": 0,
- "effective_date": "string",
- "termination_date": "string",
- "email_notification_config": {
- "property1": [
- "string"
], - "property2": [
- "string"
]
}
}List Email Delivery Targets.
| page_number | integer or null <int32> The page of results you would like to get. For the first page, pass |
| results_per_page | integer or null <int32> The maximum number of results per page. Cannot be set higher than 1000. |
| expected_fields | Array of strings or null or null The desired list of fields to be returned. |
| id | integer or null <int32> |
| description | string or null |
| subject | string or null |
| from_address | string or null |
| to_addresses | string or null |
| reply_to | string or null |
| effective_date | string or null <ArrowDateTime> |
Array of objects or null (OrderBySchema_1764643208.6102765) |
{- "page_number": 0,
- "results_per_page": 0,
- "expected_fields": [
- "string"
], - "id": 0,
- "description": "string",
- "subject": "string",
- "from_address": "string",
- "to_addresses": "string",
- "reply_to": "string",
- "effective_date": "string",
- "order_by": [
- {
- "id": "string",
- "from_address": "string",
- "subject": "string",
- "description": "string",
- "reply_to": "string",
- "effective_date": "string"
}
]
}{- "results": [
- {
- "email_delivery_target": {
- "id": 0,
- "rn": "string",
- "action": "string",
- "description": "string",
- "from_address": "string",
- "to_addresses": [
- "string"
], - "reply_to": "string",
- "subject": "string",
- "body_plain": "string",
- "body_html": "string",
- "encryption_setting_id": 0,
- "effective_date": "string",
- "termination_date": "string",
- "email_notification_config": {
- "property1": [
- "string"
], - "property2": [
- "string"
]
}
}
}
], - "result_count": "string"
}Update an Email Delivery Target.
| id | integer <int32> |
| rn | string or null |
| action | string or null |
| description | string or null |
| from_address | string |
| to_addresses | Array of strings |
| reply_to | string or null |
| subject | string or null |
| body_plain | string or null |
| body_html | string or null |
| encryption_setting_id | integer or null <int32> |
| effective_date | string or null <ArrowDateTime> |
| termination_date | string or null <ArrowDateTime> |
object or null |
{- "id": 0,
- "rn": "string",
- "action": "string",
- "description": "string",
- "from_address": "string",
- "to_addresses": [
- "string"
], - "reply_to": "string",
- "subject": "string",
- "body_plain": "string",
- "body_html": "string",
- "encryption_setting_id": 0,
- "effective_date": "string",
- "termination_date": "string",
- "email_notification_config": {
- "property1": [
- "string"
], - "property2": [
- "string"
]
}
}{- "id": 0,
- "rn": "string",
- "action": "string",
- "description": "string",
- "from_address": "string",
- "to_addresses": [
- "string"
], - "reply_to": "string",
- "subject": "string",
- "body_plain": "string",
- "body_html": "string",
- "encryption_setting_id": 0,
- "effective_date": "string",
- "termination_date": "string",
- "email_notification_config": {
- "property1": [
- "string"
], - "property2": [
- "string"
]
}
}Create an Eligibility Configuration.
| rn | string or null |
| parser_name required | string |
| description | string or null |
| config | any or null |
| client_thresholds | any or null |
| eligibility_created_failure_threshold | integer or null <int32> |
| eligibility_tba_failure_threshold | integer or null <int32> |
| eligibility_updated_failure_threshold | integer or null <int32> |
| bucket_pattern required | string |
| key_pattern required | string |
| plan_ids required | Array of integers or null <int32> |
| client_ids | Array of strings or null |
| status | string Enum: "active" "inactive" |
| event_handler_type required | string Enum: "batch" "lambda" |
| event_handler_is_enabled required | boolean |
| event_handler_effective_date required | string or null <ArrowDateTime> |
| event_handler_termination_date required | string or null <ArrowDateTime> |
| event_handler_is_group_eligibility | boolean In conjunction with |
| event_handler_is_member_flags_eligibility | boolean In conjunction with |
{- "rn": "string",
- "parser_name": "string",
- "description": "string",
- "config": null,
- "client_thresholds": null,
- "eligibility_created_failure_threshold": 0,
- "eligibility_tba_failure_threshold": 0,
- "eligibility_updated_failure_threshold": 0,
- "bucket_pattern": "string",
- "key_pattern": "string",
- "plan_ids": [
- 0
], - "client_ids": [
- "string"
], - "status": "active",
- "event_handler_type": "batch",
- "event_handler_is_enabled": true,
- "event_handler_effective_date": "string",
- "event_handler_termination_date": "string",
- "event_handler_is_group_eligibility": true,
- "event_handler_is_member_flags_eligibility": true
}{- "rn": "string",
- "parser_mapping_id": 0,
- "parser_name": "string",
- "description": "string",
- "config": null,
- "client_thresholds": null,
- "eligibility_created_failure_threshold": 0,
- "eligibility_tba_failure_threshold": 0,
- "eligibility_updated_failure_threshold": 0,
- "bucket_pattern": "string",
- "key_pattern": "string",
- "plan_ids": [
- 0
], - "client_ids": [
- "string"
], - "status": "active",
- "event_handler_type": "batch",
- "event_handler_is_enabled": true,
- "event_handler_effective_date": "string",
- "event_handler_termination_date": "string",
- "event_handler_is_group_eligibility": true,
- "event_handler_is_member_flags_eligibility": true
}Get an Eligibility Configuration.
| parser_mapping_id | integer <int32> |
{- "parser_mapping_id": 0
}{- "rn": "string",
- "parser_mapping_id": 0,
- "parser_name": "string",
- "description": "string",
- "config": null,
- "client_thresholds": null,
- "eligibility_created_failure_threshold": 0,
- "eligibility_tba_failure_threshold": 0,
- "eligibility_updated_failure_threshold": 0,