API FamilyModules

See API Specification

FamilyModules GET Insurance

Version Added: 21.4

Gets the insurance information for a patient similarly to how it shows in the Family Module. Will typically return between 0 and 2 rows, one row for each insurance for the patient. Coverage percentages are not returned here, but must be obtained separately (currently with a query). This area of the Family Module also shows discount plans, which are obtained through DiscountPlanSubs GET.

PatNum: Required in the URL.

Returned fields are detailed below:

InsSubNum:inssub.InsSubNum. Primary key to insurance subscriber.
Subscriber: inssub.Subscriber. The PatNum of the subscriber.
subscriber: First and last name of Subscriber from patient table.
SubscriberID: inssub.SubscriberID. Number assigned by insurance company, may be Medicaid ID.
SubscNote: inssub.SubscNote. Stores any other information that affects coverage.
PatPlanNum: patplan.PatPlanNum. Primary key to patient plan.
Ordinal: patplan.Ordinal. Numerical representation of the patient's insurance order. 1, 2, 3, etc.
ordinal: Description of Ordinal. Primary, Secondary, Medical, or Other insurance.
IsPending: patplan.IsPending. Informational only. true or false. Identifies insurance information that is incomplete or unverified.
Relationship: patplan.Relationship to subscriber. Self, Spouse, Child, Employee, HandicapDep, SignifOther, InjuredPlaintiff, LifePartner, or Dependant.
PatID: patplan.PatID. Optional patient ID which overrides Subscriber ID on eclaims.
CarrierNum: carrier.CarrierNum. Primary key to the carrier.
CarrierName: carrier.CarrierName. Full name of carrier.
PlanNum: insplan.PlanNum. Primary key to the insurance plan.
GroupName: insplan.GroupName. Each plan has a group name, typically similar to employer.
GroupNum: insplan.GroupNum. Issued by the carrier.
PlanNote: insplan.PlanNote. Notes specific to the subscriber and associated family members.
FeeSched: insplan.FeeSched, foreign key to feesched.FeeSchedNum.
feeschedule: feesched.Description of the fee schedule.
PlanType: insplan.PlanType. ""=percentage, "p"=ppo percentage, "f"=flat copay, "c"=capitation.
planType: Description of PlanType. Category Percentage, PPO Fixed Benefit, PPO Percentage, Medicaid or Flat Co-pay, or Capitation.
CopayFeeSched: insplan.CopayFeeSched, foreign key to feesched.FeeSchedNum.
EmployerNum: insplan.EmployerNum, foreign key to employer.EmployerNum.
employer: employer.EmpName. Description of EmployerNum.
IsMedical: insplan.IsMedical. True if this is medical insurance rather than dental insurance.

Example Request:
GET /familymodules/13/Insurance

Example Response:
"PatNum": 13,
"InsSubNum": 7,
"Subscriber": 10,
"subscriber": "Eve Wilkins",
"SubscriberID": "541147842",
"SubscNote": "",
"PatPlanNum": 17,
"Ordinal": 1,
"ordinal": "Primary",
"IsPending": "false",
"Relationship": "LifePartner",
"PatID": "",
"CarrierNum": 8,
"CarrierName": "BCBS",
"PlanNum": 7,
"GroupName": "",
"GroupNum": "",
"PlanNote": "",
"FeeSched": 53,
"feeSchedule": "Standard",
"PlanType": "",
"planType": "Category Percentage",
"CopayFeeSched": 0,
"EmployerNum": 0,
"employer": "",
"IsMedical": "false"
"PatNum": 13,
"InsSubNum": 16,
"Subscriber": 13,
"subscriber": "John Wilkins",
"SubscriberID": "987654",
"SubscNote": "",
"PatPlanNum": 18,
"Ordinal": 2,
"ordinal": "Secondary",
"IsPending": "false",
"Relationship": "Self",
"PatID": "",
"CarrierNum": 9,
"CarrierName": "Metlife Dental",
"PlanNum": 11,
"GroupName": "",
"GroupNum": "",
"PlanNote": "Insurance plan note.",
"FeeSched": 0,
"feeSchedule": "",
"PlanType": "p",
"planType": "PPO Percentage",
"CopayFeeSched": 0,
"EmployerNum": 2,
"employer": "Happy Dental",
"IsMedical": "false"

200 OK
400 Bad Request (with explanation)
404 Not Found (with explanation)