API Benefits
Benefits GET
Version Added: 22.3.27
Gets all Benefits for a given Insurance Plan or Patient Plan. Empty Percent and MonetaryAmt values are indicated by -1 .
PlanNum: (Optional after version 23.2.62) FK to InsPlan.PlanNum.
PatPlanNum: (Optional after version 23.2.62) FK to PatPlan.PatPlanNum.
Example Requests:
GET /benefits?PlanNum=12
GET /benefits?PatPlanNum=30
Example Response:
[
{
"BenefitNum": 236,
"PlanNum": 12,
"PatPlanNum": 0,
"CovCatNum": 3,
"BenefitType": "CoInsurance",
"Percent": 30,
"MonetaryAmt": -1.0,
"TimePeriod": "None",
"QuantityQualifier": "Visits",
"Quantity": 2,
"CodeNum": 0,
"procCode": "",
"CoverageLevel": "None",
"SecDateTEntry": "2021-06-21 10:03:08",
"SecDateTEdit": "2021-06-21 10:03:08",
"CodeGroupNum": 0
},
{
"BenefitNum": 243,
"PlanNum": 12,
"PatPlanNum": 0,
"CovCatNum": 0,
"BenefitType": "WaitingPeriod",
"Percent": -1,
"MonetaryAmt": -1.0,
"TimePeriod": "ServiceYear",
"QuantityQualifier": "Months",
"Quantity": 3,
"CodeNum": 150,
"procCode": "D0486",
"CoverageLevel": "Family",
"SecDateTEntry": "2021-06-21 10:03:08",
"SecDateTEdit": "2021-06-21 10:03:08",
"CodeGroupNum": 0
},
{
"BenefitNum": 245,
"PlanNum": 12,
"PatPlanNum": 0,
"CovCatNum": 12,
"BenefitType": "Limitations",
"Percent": -1,
"MonetaryAmt": 1000.0,
"TimePeriod": "Lifetime",
"QuantityQualifier": "None",
"Quantity": 0,
"CodeNum": 0,
"procCode": "",
"CoverageLevel": "Individual",
"SecDateTEntry": "2021-06-21 10:03:08",
"SecDateTEdit": "2021-06-21 10:03:08",
"CodeGroupNum": 0
},
etc...
]
200 OK
400 BadRequest (with explanation)
404 NotFound (with explanation)
Benefits POST (create)
Version Added: 22.3.17
Creates a new benefit for a given Insurance Plan or Patient Plan. For more information, see Edit Benefits - Row View.
PlanNum: This or PatPlanNum is required. FK to InsPlan.PlanNum.
PatPlanNum: This or PlanNum is required. FK to PatPlan.PlanNum.
BenefitType: Required. Either "ActiveCoverage", "CoInsurance", "Deductible", "CoPayment", "Exclusions", "Limitations", or "WaitingPeriod".
CoverageLevel: Required. Either "None", "Individual", or "Family".
CovCatNum: Optional. FK to covcat.CovCatNum.
Percent: Optional. Only allowed if BenefitType is "CoInsurance". Must be a value between 0 and 100. Default -1 (Indicating empty).
MonetaryAmt: Optional. Only used if BenefitType is "CoPayment", "Limitations", or "Deductible". Default -1.0 (Indicating empty).
TimePeriod: Optional. Either "None", "ServiceYear", "CalendarYear", "Lifetime", "Years", or "NumberInLast12Months". Default "CalendarYear".
QuantityQualifier: Optional. Either "None", "NumberOfServices", "AgeLimit", "Visits", "Years", or "Months". Default "None". Must be "Months" or "Years" if BenefitType is "WaitingPeriod".
Quantity: Optional. Must be a value between 0 and 100. Default 0. Must be a value greater than 0 if QuantityQualifier is "AgeLimit".
CodeNum: Optional. FK to procedurecode.CodeNum. Only allowed if CovCatNum is 0. Will be used over procCode if both are specified. Default 0.
procCode: Optional. FK to procedurecode.ProcCode. Only allowed if CovCatNum is 0. Default empty string.
CodeGroupNum: Optional. (Added in version 23.2.62) FK to codegroup.CodeGroupNum. The group of procedure codes that apply to this Frequency Limitation benefit.
Example Requests:
POST /benefits
{
"PlanNum": 12,
"CoverageLevel": "None",
"BenefitType": "CoInsurance",
"Percent": 30,
"QuantityQualifier": "Visits",
"Quantity": 2,
"CovCatNum": 3,
"TimePeriod": "None"
}
or
{
"PatPlanNum": 29,
"CoverageLevel": "Individual",
"BenefitType": "Deductible",
"MonetaryAmt": 500,
"CodeNum": 158,
"QuantityQualifier": "AgeLimit",
"Quantity": "15",
"TimePeriod": "Years"
}
or
{
"PlanNum": 19,
"CoverageLevel": "Family",
"BenefitType": "WaitingPeriod",
"QuantityQualifier": "Months",
"Quantity": "6",
"procCode": "D1110",
"TimePeriod": "ServiceYear"
}
or
{
"PlanNum":25,
"BenefitType":"Limitations",
"CoverageLevel":"None",
"Percent":-1,
"MonetaryAmt":-1,
"TimePeriod": "None",
"QuantityQualifier":"AgeLimit",
"Quantity":12,
"CodeGroupNum":1
}
Example Responses:
{
"BenefitNum": 236,
"PlanNum": 12,
"PatPlanNum": 0,
"CovCatNum": 3,
"BenefitType": CoInsurance,
"Percent": 30,
"MonetaryAmt": -1.0,
"TimePeriod": None,
"QuantityQualifier": "Visits",
"Quantity": 2,
"CodeNum": 0,
"procCode": "",
"CoverageLevel": "None",
"SecDateTEntry": "2021-06-21 10:03:08",
"SecDateTEdit": "2021-06-21 10:03:08",
"CodeGroupNum": 0
}
or
{
"BenefitNum": 245,
"PlanNum": 0,
"PatPlanNum": 29,
"CovCatNum": 0,
"BenefitType": "Deductible",
"Percent": -1,
"MonetaryAmt": 500.0,
"TimePeriod": "Years",
"QuantityQualifier": "AgeLimit",
"Quantity": 15,
"CodeNum": 158,
"procCode": "D1120",
"CoverageLevel": "Individual",
"SecDateTEntry": "2021-06-21 10:03:08",
"SecDateTEdit": "2021-06-21 10:03:08",
"CodeGroupNum": 0
}
or
{
"BenefitNum": 246,
"PlanNum": 19,
"PatPlanNum": 0,
"CovCatNum": 0,
"BenefitType": "WaitingPeriod",
"Percent": -1,
"MonetaryAmt": -1.0,
"TimePeriod": "ServiceYear",
"QuantityQualifier": "Months",
"Quantity": 6,
"CodeNum": 157,
"procCode": "D1110",
"CoverageLevel": "Family",
"SecDateTEntry": "2021-06-21 10:03:08",
"SecDateTEdit": "2021-06-21 10:03:08",
"CodeGroupNum": 0
}
or
{
"BenefitNum": 323,
"PlanNum": 25,
"PatPlanNum": 0,
"CovCatNum": 0,
"BenefitType": "Limitations",
"Percent": -1,
"MonetaryAmt": -1.0,
"TimePeriod": "None",
"QuantityQualifier": "AgeLimit",
"Quantity": 12,
"CodeNum": 0,
"procCode": "",
"CoverageLevel": "None",
"SecDateTEntry": "2024-02-13 14:45:19",
"SecDateTEdit": "2024-02-13 14:45:19",
"CodeGroupNum": 1
}
201 Created
400 BadRequest (with explanation)
404 NotFound (with explanation)
Benefits PUT (update)
Version Added: 22.4.7
Updates an existing benefit by BenefitNum. For more information, see Edit Benefits - Row View.
BenefitNum: Required in URL.
CovCatNum: Optional. FK to covcat.CovCatNum.
BenefitType: Optional. Either "ActiveCoverage", "CoInsurance", "Deductible", "CoPayment", "Exclusions", "Limitations", or "WaitingPeriod".
Percent: Optional. Only allowed if BenefitType is "CoInsurance". Must be a value between 0 and 100. Use -1 to indicate empty.
MonetaryAmt: Optional. Only used if BenefitType is "CoPayment", "Limitations", or "Deductible". Use -1 to indicate empty.
TimePeriod: Optional. Either "None", "ServiceYear", "CalendarYear", "Lifetime", "Years", or "NumberInLast12Months".
QuantityQualifier: Optional. Either "None", "NumberOfServices", "AgeLimit", "Visits", "Years", or "Months". Must be "Months" or "Years" if BenefitType is "WaitingPeriod".
Quantity: Optional. Must be a value between 0 and 100. Must be a value greater than 0 if QuantityQualifier is "AgeLimit".
CodeNum: Optional. FK to procedurecode.CodeNum. Only allowed if CovCatNum is 0. Will be used over procCode if both are specified.
procCode: Optional. FK to procedurecode.ProcCode. Only allowed if CovCatNum is 0.
CoverageLevel: Optional. Either "None", "Individual", or "Family".
Example Requests:
PUT /benefits/75
PUT /benefits/323
{
"Percent": 70,
"QuantityQualifier": "Visits",
"Quantity": 2
}
or
{
"CovCatNum": 0,
"BenefitType": "ActiveCoverage",
"Percent": -1,
"MonetaryAmt": 499.99,
"TimePeriod": "ServiceYear",
"QuantityQualifier": "AgeLimit",
"Quantity": 13,
"CodeNum": 156,
"procCode": "D1110",
"CoverageLevel": "Individual"
}
or
{
"Quantity":18
}
Example Response:
{
"BenefitNum": 75,
"PlanNum": 10,
"PatPlanNum": 0,
"CovCatNum": 0,
"BenefitType": "ActiveCoverage",
"Percent": -1,
"MonetaryAmt": 499.99,
"TimePeriod": "ServiceYear",
"QuantityQualifier": "AgeLimit",
"Quantity": 13,
"CodeNum": 156,
"procCode": "D0999",
"CoverageLevel": "Individual",
"SecDateTEntry": "2021-05-25 13:27:52",
"SecDateTEdit": "2021-05-25 13:27:52",
"CodeGroupNum": 0
}
or
{
"BenefitNum": 323,
"PlanNum": 25,
"PatPlanNum": 0,
"CovCatNum": 0,
"BenefitType": "Limitations",
"Percent": -1,
"MonetaryAmt": -1.0,
"TimePeriod": "None",
"QuantityQualifier": "AgeLimit",
"Quantity": 18,
"CodeNum": 0,
"procCode": "",
"CoverageLevel": "None",
"SecDateTEntry": "2024-02-13 14:45:19",
"SecDateTEdit": "2024-02-13 14:45:19",
"CodeGroupNum": 1
}
200 OK
400 BadRequest (with explanation)
404 NotFound (with explanation)
Benefits DELETE
Version Added: 22.4.7
Deletes an existing benefit by BenefitNum.
BenefitNum: Required in URL.
Example Request:
DELETE /benefits/75
Example Response:
200 OK
400 BadRequest (with explanation)
404 NotFound (with explanation)