Aetna

Aetna Insurance Plan API

The Insurance Plan API from Aetna — 1 operation(s) for insurance plan.

Documentation GitHub OpenAPI

Operations 1

GET /InsurancePlan Retrieve InsurancePlan resource based on Coverage Area (Coverage area is a… #

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OpenAPI Specification

openapi: 3.2.0
info:
  contact:
    name: Interoperability Developer Support
    email: InteroperabilityDeveloperSupport@aetna.com
  description: 'Retrieve Insurance Plan resource based on Coverage Area (Coverage area is a 2-digit state abbreviation).

    Both Provider and Pharmacy data are available on this resource.'
  x-ibm-name: v1providerdirectoryinsuranceplan
  title: /v1/providerdirectory/ Insurance Plan API
  version: 1.0.0
servers:
- url: https://apif1.aetna.com/fhir/v1/providerdirectory
security:
- FHIR_Application_Oauth:
  - Public
- FHIR_Application_Oauth:
  - NonPII
- FHIR_User_AccessCode_Oauth:
  - patient/Patient.read
- FHIR_User_AccessCode_Oauth:
  - patient/Patient.*
- FHIR_User_AccessCode_Oauth:
  - patient/*.read
- FHIR_User_AccessCode_Oauth:
  - patient/*.*
tags:
- name: Insurance Plan
paths:
  /InsurancePlan:
    get:
      summary: Retrieve InsurancePlan resource based on Coverage Area (Coverage area is a…
      description: Returns insurance plans and network keys for a specific state
      operationId: GET
      responses:
        '200':
          description: This response returns a Bundle of InsurancePlan(s) information based on the input received.
          content:
            application/json:
              schema:
                $ref: '#/components/schemas/Bundle'
              example:
                entry:
                - search:
                    mode: match
                  resource:
                    identifier:
                    - system: http://terminology.hl7.org/CodeSystem/v2-0203
                      use: official
                      assigner:
                        display: Aetna Better Health of New Jersey
                      type:
                        coding:
                        - system: http://terminology.hl7.org/CodeSystem/v2-0203
                          code: XV
                          display: Health Plan Identifier
                      value: Aetna Better Health of New Jersey - NJ
                    period:
                      start: '2020-01-01T00:00:00Z'
                      end: '2020-12-31T23:59:59Z'
                    language: en
                    type:
                    - coding:
                      - system: http://hl7.org/fhir/us/davinci-pdex-plan-net/CodeSystem/InsuranceProductTypeCS
                        code: medihmo
                        display: Medicaid HMO
                    administeredBy:
                      display: Aetna Better Health of New Jersey
                    network:
                    - reference: Organization/0000000000000212937
                      display: Aetna Better Health of New Jersey
                    - reference: Organization/0000000000000212938
                      display: Aetna Assure Premier Plus (HMO D-SNP)
                    - reference: Organization/0000000000000212939
                      display: Aetna Assure Premier Plus (HMO D-SNP)
                    meta:
                      lastUpdated: '2020-10-23T00:00:00.000+00:00'
                      versionId: 4.0.1
                      profile:
                      - http://hl7.org/fhir/us/davinci-pdex-plan-net/StructureDefinition/plannet-InsurancePlan
                    contact:
                    - address:
                        city: Princeton
                        line:
                        - 3 Independence Way
                        - Suite 400
                        postalCode: 08540-6626
                        state: NJ
                      name:
                        use: official
                        text: ABH New Jersey
                      telecom:
                      - system: phone
                        use: work
                        value: 1-855-232-3596
                    name: Aetna Better Health of New Jersey
                    id: 0000000000000212936
                    ownedBy:
                      display: Aetna Better Health of New Jersey
                    resourceType: InsurancePlan
                    status: active
                    coverageArea:
                    - display: NJ
                  fullUrl: https://apif1.aetna.com/fhir/v1/providerdirectory/InsurancePlan/0000000000000212936
                total: 1
                link:
                - url: https://apif1.aetna.com/fhir/v1/providerdirectory/InsurancePlan?address-state=nj&page=1
                  relation: self
                id: 32ed03f463dd540f05fbb9f1
                type: searchset
                resourceType: Bundle
        '400':
          description: A required parameter isn’t provided, or an unknown parameter is provided.
          content:
            application/json:
              schema:
                $ref: '#/components/schemas/OperationOutcome'
              example:
                issue:
                - severity: error
                  code: required
                  details:
                    coding:
                    - system: http://hl7.org/fhir/ValueSet/operation-outcome
                      code: MSG_RESOURCE_ID_MISSING
                      display: Resource Id Missing
                id: 14c27ea91f91d8f01234
                resourceType: OperationOutcome
        '500':
          description: Internal Server Error. Failures on the server side.
          content:
            application/json:
              schema:
                $ref: '#/components/schemas/OperationOutcome'
              example:
                issue:
                - severity: fatal
                  diagnostics: Backend service failure
                  code: exception
                  details:
                    coding:
                    - system: http://hl7.org/fhir/ValueSet/operation-outcome
                      code: MSG_SVC_FAILURE
                      display: Error occurred while processing response
                id: 53c27ea45fd8f0ff0af91f91
                resourceType: OperationOutcome
      parameters:
      - in: query
        name: address-state
        description: 'The state code of the InsurancePlan''s coverage



          State will be 2 letter abbreviation.'
        required: true
        schema:
          type: string
      servers:
      - url: https://apif1.aetna.com/fhir/v1/providerdirectory
      tags:
      - Insurance Plan
components:
  schemas:
    InsurancePlan:
      description: 'See the appropriate Implementation Guide for proper documentation to use


        This is the HL7 FHIR Release 4.0.1 InsurancePlan resource.

        Full Documentation is available at: http://hl7.org/fhir/insuranceplan.html


        For the DaVinci PDEX Plan Net 1.0.0 InsurancePlan resource documentation is available at:

        http://hl7.org/fhir/us/davinci-pdex-plan-net/STU1/StructureDefinition-plannet-InsurancePlan.html


        For the DaVinci PDEX Plan Net 1.1.0 InsurancePlan resource documentation is available at:

        http://hl7.org/fhir/us/davinci-pdex-plan-net/STU1.1/StructureDefinition-plannet-InsurancePlan.html'
      type: object
    Bundle:
      description: 'See the appropriate Implementation Guide for proper documentation to use


        This is the HL7 FHIR Release 4.0.1 Bundle resource.

        Full Documentation is available at: http://hl7.org/fhir/bundle.html'
      type: object
      properties:
        entry:
          type: array
          items:
            $ref: '#/components/schemas/Entry'
    Entry:
      description: An entry in a bundle resource - will contain a resource(s) returned in the bundle
      type: object
      properties:
        resource:
          $ref: '#/components/schemas/InsurancePlan'
    OperationOutcome:
      description: 'See the appropriate Implementation Guide for proper documentation to use


        This is the HL7 FHIR Release 4.0.1 OperationOutcome resource.

        Full Documentation is available at: http://hl7.org/fhir/operationoutcome.html'
      type: object
  securitySchemes:
    FHIR_User_AccessCode_Oauth:
      type: oauth2
      flows:
        authorizationCode:
          scopes:
            patient/Patient.*: ''
            patient/Patient.read: ''
            patient/*.read: ''
            patient/*.*: ''
          authorizationUrl: /Authorize
          tokenUrl: /Token
    FHIR_Application_Oauth:
      type: oauth2
      flows:
        clientCredentials:
          scopes:
            NonPII: ''
            Public: ''
          tokenUrl: /Token
externalDocs:
  description: HTTP Common Error Codes
  url: https://eaintegrationgovernance.github.io/APIC-Common-Error-Codes.github.io/
x-ibm-configuration:
  phase: realized
  enforced: true
  testable: true
x-ibm-endpoints:
- endpointUrl: https://qahapi.aetna.com/fhir/qapath3
  type:
  - production
  - development
- endpointUrl: https://qaehapi.aetna.com/fhir/qapath3
  type:
  - production
  - development