API InsPlans
See Insurance Plans for more information.
InsPlans GET (single)
Version Added: 24.2.11
Gets a single insplan.
PlanNum: Required in URL.
Example Request:
GET /insplans/6
Example Response:
{
"PlanNum": 6,
"GroupName": "United States Post Office",
"GroupNum": "PB181863",
"PlanNote": "Mostly covered.",
"FeeSched": 54,
"PlanType": "p",
"ClaimFormNum": 1,
"ClaimsUseUCR": "false",
"CopayFeeSched": 0,
"EmployerNum": 23,
"CarrierNum": 10,
"IsMedical": "false",
"FilingCode": 4,
"ShowBaseUnits": "false",
"CodeSubstNone": "true",
"IsHidden": "false",
"MonthRenew": 0,
"FilingCodeSubtype": 0,
"CobRule": "Standard",
"SecUserNumEntry": 0,
"SecDateEntry": "2023-01-21",
"SecDateTEdit": "2023-01-21 06:47:00",
"BillingType": 40,
"ExclusionFeeRule": "PracticeDefault",
"IsBlueBookEnabled": "false",
"InsPlansZeroWriteOffsOnAnnualMaxOverride": "Default",
"InsPlansZeroWriteOffsOnFreqOrAgingOverride": "Default"
}
200 OK
404 NotFound (with explanation)
InsPlans GET (multiple)
Version Added: 22.3.30
Gets a list of insplans.
Parameters: All optional.
PlanType: (Added in version 24.2.11) Must be one of the following: "percentage" (Percentage), "p" (PPO Percentage), "f" (Flat Copay), or "c" (Capitation). Percentage PlanTypes are stored as blank in the database.
CarrierNum: (Added in version 24.2.11) FK to carrier.CarrierNum.
Example Request:
GET /insplans
GET /insplans?PlanType=p
GET /insplans?CarrierNum=10
Example Response:
[
{
"PlanNum": 6,
"GroupName": "United States Post Office",
"GroupNum": "PB181863",
"PlanNote": "Mostly covered.",
"FeeSched": 54,
"PlanType": "p",
"ClaimFormNum": 1,
"ClaimsUseUCR": "true",
"CopayFeeSched": 0,
"EmployerNum": 23,
"CarrierNum": 10,
"IsMedical": "false",
"FilingCode": 0,
"ShowBaseUnits": "false",
"CodeSubstNone": "true",
"IsHidden": "false",
"MonthRenew": 0,
"FilingCodeSubtype": 0,
"CobRule": "Basic",
"SecUserNumEntry": 0,
"SecDateEntry": "2023-01-21",
"SecDateTEdit": "2023-01-21 06:47:00",
"BillingType": 313,
"ExclusionFeeRule": "UseUcrFee",
"IsBlueBookEnabled": "false",
"InsPlansZeroWriteOffsOnAnnualMaxOverride": "Default",
"InsPlansZeroWriteOffsOnFreqOrAgingOverride": "Default"
},
{
"PlanNum": 14,
"GroupName": "REI",
"GroupNum": "G189614",
"PlanNote": "",
"FeeSched": 0,
"PlanType": "c",
"ClaimFormNum": 1,
"ClaimsUseUCR": "false",
"CopayFeeSched": 56,
"EmployerNum": 23,
"CarrierNum": 10,
"IsMedical": "false",
"FilingCode": 23,
"ShowBaseUnits": "true",
"CodeSubstNone": "false",
"IsHidden": "true",
"MonthRenew": 6,
"FilingCodeSubtype": 41,
"CobRule": "Standard",
"SecUserNumEntry": 34,
"SecDateEntry": "2023-12-07",
"SecDateTEdit": "2023-12-04 09:15:00",
"BillingType": 315,
"ExclusionFeeRule": "DoNothing",
"IsBlueBookEnabled": "false",
"InsPlansZeroWriteOffsOnAnnualMaxOverride": "No",
"InsPlansZeroWriteOffsOnFreqOrAgingOverride": "No"
},
etc...
]
200 OK
400 BadRequest (with explanation)
InsPlans POST
Version Added: 22.4.24
Creates a new insplan.
CarrierNum: Required. FK to carrier.CarrierNum.
GroupName: Optional. Typically the same as the employer. Used to identify difference in plans.
GroupNum: Optional. The Plan Number in Canada.
PlanNote: Optional. Note for this plan. Same for all subscribers.
FeeSched: Optional. FK to feesched.FeeSchedNum. Default 0.
PlanType: Optional. Must be one of the following: "" (Percentage), "p" (PPO Percentage), "f" (Flat Copay), or "c" (Capitation). Default is "" (Percentage).
ClaimsUseUCR: (Added in version 25.1.20) Optional. Either "true" or "false". Default is "true" if the preference InsDefaultShowUCRonClaims is enabled and the PlanType is "" (Percentage), otherwise "false".
CopayFeeSched: (Added in version 23.3.17) Optional. FK to feesched.FeeSchedNum when FeeSchedType is CoPay. Typically only used for capitation or copay plans. Default 0.
EmployerNum: Optional. FK to employer.EmployerNum. Default 0.
IsMedical: (Added in version 24.4.34) Optional. Either "true" or "false". Default "false".
FilingCode: (Added in version 25.1.20) Optional. FK to insfilingcode.InsFilingCodeNum. Default 0.
ShowBaseUnits: (Added in version 25.1.20) Optional. Either "true" or "false". Default "false".
CodeSubstNone: (Added in version 22.4.31) Optional. Either "true" or "false". Set "true" if this Insurance Plan should ignore any Substitution Codes. Default "false".
IsHidden: (Added in version 22.4.31) Optional. Either "true" or "false". Default "false".
MonthRenew: Optional. The month, 1-12, when the insurance plan renews. It will renew on the first of the month. Default 0 to indicate calendar year.
FilingCodeSubtype: (Added in version 25.1.20) Optional. FK to insfilingcodesubtype.InsFilingCodeSubtypeNum. Default 0.
CobRule: (Added in version 25.1.20) Optional. Either "Basic", "Standard", "CarveOut" or "SecondaryMedicaid". Defaults to the InsDefaultCobRule preference.
BillingType: (Added in version 25.1.20) Optional. FK to definition.DefNum where definition.Category=4. Default 0.
ExclusionFeeRule: (Added in version 25.1.20) Optional. Either "PracticeDefault", "DoNothing" or "UseUcrFee". Default is "PracticeDefault".
IsBlueBookEnabled: Optional. Determines if the plan utilizes BlueBook or not. Cannot be set to true if PlanType is set to anything other than "" (Percentage). Defaults to true if AllowedFeeSchedsAutomate is set to BlueBook, otherwise defaults to false.
InsPlansZeroWriteOffsOnAnnualMaxOverride: (Added in version 25.1.20) Optional. Either "Default", "Yes" or "No". Default is "Default".
InsPlansZeroWriteOffsOnFreqOrAgingOverride: (Added in version 25.1.20) Optional. Either "Default", "Yes" or "No". Default is "Default".
POST /insplans
{
"CarrierNum": 10
}
or
{
"GroupName": "Walmart",
"GroupNum": "W4875",
"PlanNote": "Copayments",
"FeeSched": 56,
"PlanType": "f",
"ClaimsUseUCR": "false",
"CopayFeeSched": 172,
"EmployerNum": 23,
"CarrierNum": 10,
"IsMedical": "false",
"ShowBaseUnits": "true",
"CodeSubstNone": "false",
"IsHidden": "false",
"MonthRenew": 12,
"CobRule": "Basic",
"BillingType": 313,
"ExclusionFeeRule": "DoNothing",
"IsBlueBookEnabled": "false"
}
Example Response:
{
"PlanNum": 16,
"GroupName": "Walmart",
"GroupNum": "W4875",
"PlanNote": "Copayments",
"FeeSched": 56,
"PlanType": "f",
"ClaimFormNum": 1,
"ClaimsUseUCR": "false",
"CopayFeeSched": 172,
"EmployerNum": 23,
"CarrierNum": 10,
"IsMedical": "false",
"FilingCode": 0,
"ShowBaseUnits": "true",
"CodeSubstNone": "false",
"IsHidden": "false",
"MonthRenew": 12,
"FilingCodeSubtype": 0,
"CobRule": "Basic",
"SecUserNumEntry": 0,
"SecDateEntry": "2023-01-21",
"SecDateTEdit": "2023-01-21 06:47:00",
"BillingType": 313,
"ExclusionFeeRule": "DoNothing",
"IsBlueBookEnabled": "false",
"InsPlansZeroWriteOffsOnAnnualMaxOverride": "Default",
"InsPlansZeroWriteOffsOnFreqOrAgingOverride": "Default"
}
200 OK
400 BadRequest (with explanation)
404 NotFound (with explanation)
InsPlans PUT
Version Added: 22.3.30
Updates an insplan.
PlanNum: Required in the URL.
GroupName: Optional. Typically the same as the employer. Used to identify difference in plans.
GroupNum: Optional. The Plan Number in Canada.
PlanNote: Optional. Note for this plan. Same for all subscribers.
FeeSched: Optional. FK to feesched.FeeSchedNum.
PlanType: Optional. Must be one of the following: "" (Percentage), "p" (PPO Percentage), "f" (Flat Copay), or "c" (Capitation).
ClaimsUseUCR: (Added in version 25.1.20) Optional. Either "true" or "false".
CopayFeeSched: (Added in version 23.3.17) Optional. FK to feesched.FeeSchedNum when FeeSchedType is CoPay. Typically only used for capitation or copay plans.
EmployerNum: (Added in version 22.4.24) Optional. FK to employer.EmployerNum.
CarrierNum: (Added in version 22.4.24) Optional. FK to carrier.CarrierNum.
IsMedical: (Added in version 24.4.34) Optional. Either "true" or "false".
FilingCode: (Added in version 25.1.20) Optional. FK to insfilingcode.InsFilingCodeNum.
ShowBaseUnits: (Added in version 25.1.20) Optional. Either "true" or "false".
CodeSubstNone: (Added in version 22.4.31) Optional. Either "true" or "false". Set "true" if this Insurance Plan should ignore any Substitution Codes.
IsHidden: (Added in version 22.4.31) Optional. Either "true" or "false".
MonthRenew: Optional. The month, 1-12, when the insurance plan renews. It will renew on the first of the month. Use 0 to indicate calendar year.
FilingCodeSubtype: (Added in version 25.1.20) Optional. FK to insfilingcodesubtype.InsFilingCodeSubtypeNum.
CobRule: (Added in version 25.1.20) Optional. Either "Basic", "Standard", "CarveOut" or "SecondaryMedicaid".
BillingType: (Added in version 25.1.20) Optional. FK to definition.DefNum where definition.Category=4.
ExclusionFeeRule: (Added in version 25.1.20) Optional. Either "PracticeDefault", "DoNothing" or "UseUcrFee".
IsBlueBookEnabled: (Added in version 22.4.24) Optional. Determines if the plan utilizes BlueBook or not. Cannot be set to true if PlanType is set to anything other than "" (Percentage).
InsPlansZeroWriteOffsOnAnnualMaxOverride: (Added in version 25.1.20) Optional. Either "Default", "Yes" or "No".
InsPlansZeroWriteOffsOnFreqOrAgingOverride: (Added in version 25.1.20) Optional. Either "Default", "Yes" or "No".
PUT /insplans/15
{
"FeeSched": 0,
"PlanType": "",
"MonthRenew": 0
}
or
{
"GroupName": "Pixar",
"GroupNum": "Y4845",
"PlanNote": "Copayments",
"FeeSched": 56,
"PlanType": "f",
"ClaimsUseUCR": "false",
"CopayFeeSched": 172,
"EmployerNum": 12,
"CarrierNum": 8,
"IsMedical": "false",
"FilingCode": 21,
"CodeSubstNone": "false",
"IsHidden": "false",
"MonthRenew": 12
"FilingCodeSubtype": 3,
"CobRule": "CarveOut",
"BillingType": 314,
"ExclusionFeeRule": "PracticeDefault",
"IsBlueBookEnabled": "false",
"InsPlansZeroWriteOffsOnAnnualMaxOverride": "No",
"InsPlansZeroWriteOffsOnFreqOrAgingOverride": "Yes"
}
Example Response:
{
"PlanNum": 15,
"GroupName": "Pixar",
"GroupNum": "Y4845",
"PlanNote": "Copayments",
"FeeSched": 56,
"PlanType": "f",
"ClaimFormNum": 1,
"ClaimsUseUCR": "false",
"CopayFeeSched": 172,
"EmployerNum": 12,
"CarrierNum": 8,
"IsMedical": "false",
"FilingCode": 21,
"ShowBaseUnits": "false",
"CodeSubstNone": "false",
"IsHidden": "false",
"MonthRenew": 12
"FilingCodeSubtype": 3,
"CobRule": "CarveOut",
"SecUserNumEntry": 0,
"SecDateEntry": "2023-01-21",
"SecDateTEdit": "2023-01-21 06:47:00",
"BillingType": 314,
"ExclusionFeeRule": "PracticeDefault",
"IsBlueBookEnabled": "false",
"InsPlansZeroWriteOffsOnAnnualMaxOverride": "No",
"InsPlansZeroWriteOffsOnFreqOrAgingOverride": "Yes"
}
200 OK
400 BadRequest (with explanation)
404 NotFound (with explanation)