Candid Health

Candid Health Payer Plan Groups API

The Payer Plan Groups API from Candid Health — 2 operation(s) for payer plan groups.

GitHub OpenAPI

Operations 5

GET /api/payer-plan-groups/v1 Get payer plans #
POST /api/payer-plan-groups/v1 Create a payer plan #
GET /api/payer-plan-groups/v1/{payer_plan_group_id} Get payer plan #
PUT /api/payer-plan-groups/v1/{payer_plan_group_id} Update payer plan #
PATCH /api/payer-plan-groups/v1/{payer_plan_group_id} Delete payer plan #

Documentation

📖
Documentation
https://docs.joincandidhealth.com/api-reference/eligibility/v-2
📖
Documentation
https://docs.joincandidhealth.com/api-reference/encounters/v-4
📖
Documentation
https://docs.joincandidhealth.com/api-reference/encounters/v-4/get-all
📖
APIReference
https://docs.joincandidhealth.com/api-reference/encounters/v-4/create
📖
Documentation
https://docs.joincandidhealth.com/api-reference/eligibility/v-2/submit-eligibility-check
📖
APIReference
https://docs.joincandidhealth.com/api-reference/pre-encounter/coverages/v-1/check-eligibility
📖
Documentation
https://docs.joincandidhealth.com/api-reference/charge-capture/v-1/create
📖
Documentation
https://docs.joincandidhealth.com/api-reference/payers/v-3/get
📖
APIReference
https://docs.joincandidhealth.com/api-reference/fee-schedules/v-3/get-match
📖
Documentation
https://docs.joincandidhealth.com/api-reference/insurance-adjudications/v-1/get
📖
Documentation
https://docs.joincandidhealth.com/api-reference/events/v-1/get

Specifications

⚙
OpenAPI
https://raw.githubusercontent.com/api-evangelist/candid-health/refs/heads/main/openapi/candid-health-payer-plan-groups-api-openapi.yml

Other Resources

🔗
PostmanCollection
https://raw.githubusercontent.com/api-evangelist/candid-health/refs/heads/main/collections/candidhealth.postman_collection.json
🔗
OpenCollection
https://raw.githubusercontent.com/api-evangelist/candid-health/refs/heads/main/collections/candidhealth.opencollection.json

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OpenAPI Specification

candid-health-payer-plan-groups-api-openapi.yml Raw ↑ 
openapi: 3.2.0
info:
  title: Reference Payer Plan Groups API
  version: 1.0.0
servers:
- url: https://pre-api.joincandidhealth.com
  description: Production
- url: https://pre-api-staging.joincandidhealth.com
  description: Staging
- url: https://sandbox-pre-api.joincandidhealth.com
  description: CandidSandbox
- url: https://staging-pre-api.joincandidhealth.com
  description: CandidStaging
- url: http://localhost:4000
  description: Local
- url: https://api.joincandidhealth.com
  description: Production
- url: https://api-staging.joincandidhealth.com
  description: Staging
- url: https://sandbox-api.joincandidhealth.com
  description: CandidSandbox
- url: https://staging-api.joincandidhealth.com
  description: CandidStaging
- url: http://localhost:5050
  description: Local
tags:
- name: Payer Plan Groups
paths:
  /api/payer-plan-groups/v1:
    get:
      operationId: getMulti
      summary: Get payer plans
      description: Returns all payer plans matching filter criteria.
      tags:
      - Payer Plan Groups
      parameters:
      - name: plan_group_name
        in: query
        required: false
        schema:
          type: string
      - name: payer_uuid
        in: query
        required: false
        schema:
          $ref: '#/components/schemas/type_payers_v3_PayerUuid'
      - name: payer_id
        in: query
        required: false
        schema:
          $ref: '#/components/schemas/type_payers_v3_PayerId'
      - name: plan_type
        in: query
        required: false
        schema:
          $ref: '#/components/schemas/type_commons_SourceOfPaymentCode'
      - name: is_active
        in: query
        required: false
        schema:
          type: boolean
      - name: payer_plan_group_id
        in: query
        required: false
        schema:
          $ref: '#/components/schemas/type_commons_PayerPlanGroupId'
      - name: limit
        in: query
        description: Defaults to 100. Cannot exc
        required: false
        schema:
          type: integer
      - name: sort_by_similarity
        in: query
        description: 'If this property is passed, the results will be ordered by those that contain a payer_id, payer_name, plan_group_name, or

          payer_address most similar to the value passed. This will take precedence over the sort and sort_direction properties. This

          will always sort in order of most similar to least similar.'
        required: false
        schema:
          type: string
      - name: sort
        in: query
        description: Defaults to plan_group_name. If sort_by_similarity is passed, that sort will takes precedence over this property.
        required: false
        schema:
          $ref: '#/components/schemas/type_payer-plan-groups_v1_PayerPlanGroupSortField'
      - name: sort_direction
        in: query
        description: Sort direction. Defaults to ascending order if not provided.
        required: false
        schema:
          $ref: '#/components/schemas/type_commons_SortDirection'
      - name: page_token
        in: query
        required: false
        schema:
          $ref: '#/components/schemas/type_commons_PageToken'
      - name: organization_id
        in: query
        description: Filter to a specific organization's payer plans. If not provided, defaults to the requesting user's organization.
        required: false
        schema:
          $ref: '#/components/schemas/type_commons_OrganizationId'
      - name: Authorization
        in: header
        description: OAuth authentication
        required: true
        schema:
          type: string
      responses:
        '200':
          description: Response with status 200
          content:
            application/json:
              schema:
                $ref: '#/components/schemas/type_payer-plan-groups_v1_PayerPlanGroupPage'
        '403':
          description: Error response with status 403
          content:
            application/json:
              schema:
                type: object
                properties:
                  errorName:
                    type: string
                    enum:
                    - UnauthorizedError
                  content:
                    $ref: '#/components/schemas/type_commons_UnauthorizedErrorMessage'
                required:
                - errorName
                - content
        '422':
          description: Error response with status 422
          content:
            application/json:
              schema:
                type: object
                properties:
                  errorName:
                    type: string
                    enum:
                    - UnprocessableEntityError
                  content:
                    $ref: '#/components/schemas/type_commons_UnprocessableEntityErrorMessage'
                required:
                - errorName
                - content
    post:
      operationId: create
      summary: Create a payer plan
      tags:
      - Payer Plan Groups
      parameters:
      - name: Authorization
        in: header
        description: OAuth authentication
        required: true
        schema:
          type: string
      responses:
        '200':
          description: Response with status 200
          content:
            application/json:
              schema:
                $ref: '#/components/schemas/type_payer-plan-groups_v1_PayerPlanGroup'
        '404':
          description: Error response with status 404
          content:
            application/json:
              schema:
                type: object
                properties:
                  errorName:
                    type: string
                    enum:
                    - EntityNotFoundError
                  content:
                    $ref: '#/components/schemas/type_commons_EntityNotFoundErrorMessage'
                required:
                - errorName
                - content
        '422':
          description: Error response with status 422
          content:
            application/json:
              schema:
                type: object
                properties:
                  errorName:
                    type: string
                    enum:
                    - PayerPlanGroupAlreadyExistsHttpError
                  content:
                    $ref: '#/components/schemas/type_payer-plan-groups_v1_PayerPlanGroupAlreadyExistsError'
                required:
                - errorName
                - content
      requestBody:
        content:
          application/json:
            schema:
              $ref: '#/components/schemas/type_payer-plan-groups_v1_MutablePayerPlanGroup'
  /api/payer-plan-groups/v1/{payer_plan_group_id}:
    get:
      operationId: get
      summary: Get payer plan
      description: Return a payer plan with a given ID.
      tags:
      - Payer Plan Groups
      parameters:
      - name: payer_plan_group_id
        in: path
        required: true
        schema:
          $ref: '#/components/schemas/type_commons_PayerPlanGroupId'
      - name: Authorization
        in: header
        description: OAuth authentication
        required: true
        schema:
          type: string
      responses:
        '200':
          description: Response with status 200
          content:
            application/json:
              schema:
                $ref: '#/components/schemas/type_payer-plan-groups_v1_PayerPlanGroup'
        '403':
          description: Error response with status 403
          content:
            application/json:
              schema:
                type: object
                properties:
                  errorName:
                    type: string
                    enum:
                    - UnauthorizedError
                  content:
                    $ref: '#/components/schemas/type_commons_UnauthorizedErrorMessage'
                required:
                - errorName
                - content
        '404':
          description: Error response with status 404
          content:
            application/json:
              schema:
                type: object
                properties:
                  errorName:
                    type: string
                    enum:
                    - EntityNotFoundError
                  content:
                    $ref: '#/components/schemas/type_commons_EntityNotFoundErrorMessage'
                required:
                - errorName
                - content
    put:
      operationId: update
      summary: Update payer plan
      description: Update any of the fields on a payer plan
      tags:
      - Payer Plan Groups
      parameters:
      - name: payer_plan_group_id
        in: path
        required: true
        schema:
          $ref: '#/components/schemas/type_commons_PayerPlanGroupId'
      - name: Authorization
        in: header
        description: OAuth authentication
        required: true
        schema:
          type: string
      responses:
        '200':
          description: Response with status 200
          content:
            application/json:
              schema:
                $ref: '#/components/schemas/type_payer-plan-groups_v1_PayerPlanGroup'
        '403':
          description: Error response with status 403
          content:
            application/json:
              schema:
                type: object
                properties:
                  errorName:
                    type: string
                    enum:
                    - UnauthorizedError
                  content:
                    $ref: '#/components/schemas/type_commons_UnauthorizedErrorMessage'
                required:
                - errorName
                - content
        '404':
          description: Error response with status 404
          content:
            application/json:
              schema:
                type: object
                properties:
                  errorName:
                    type: string
                    enum:
                    - EntityNotFoundError
                  content:
                    $ref: '#/components/schemas/type_commons_EntityNotFoundErrorMessage'
                required:
                - errorName
                - content
        '422':
          description: Error response with status 422
          content:
            application/json:
              schema:
                type: object
                properties:
                  errorName:
                    type: string
                    enum:
                    - PayerPlanGroupAlreadyExistsHttpError
                  content:
                    $ref: '#/components/schemas/type_payer-plan-groups_v1_PayerPlanGroupAlreadyExistsError'
                required:
                - errorName
                - content
      requestBody:
        content:
          application/json:
            schema:
              $ref: '#/components/schemas/type_payer-plan-groups_v1_MutablePayerPlanGroup'
    patch:
      operationId: deactivate
      summary: Delete payer plan
      description: Marks the payer plan as deactivated
      tags:
      - Payer Plan Groups
      parameters:
      - name: payer_plan_group_id
        in: path
        required: true
        schema:
          $ref: '#/components/schemas/type_commons_PayerPlanGroupId'
      - name: Authorization
        in: header
        description: OAuth authentication
        required: true
        schema:
          type: string
      responses:
        '200':
          description: Response with status 200
          content:
            application/json:
              schema:
                $ref: '#/components/schemas/type_payer-plan-groups_v1_PayerPlanGroup'
        '403':
          description: Error response with status 403
          content:
            application/json:
              schema:
                type: object
                properties:
                  errorName:
                    type: string
                    enum:
                    - UnauthorizedError
                  content:
                    $ref: '#/components/schemas/type_commons_UnauthorizedErrorMessage'
                required:
                - errorName
                - content
        '404':
          description: Error response with status 404
          content:
            application/json:
              schema:
                type: object
                properties:
                  errorName:
                    type: string
                    enum:
                    - EntityNotFoundError
                  content:
                    $ref: '#/components/schemas/type_commons_EntityNotFoundErrorMessage'
                required:
                - errorName
                - content
components:
  schemas:
    type_commons_EntityNotFoundErrorMessage:
      type: object
      properties:
        id:
          type: string
      required:
      - id
      title: EntityNotFoundErrorMessage
    type_commons_PageToken:
      type: string
      title: PageToken
    type_commons_PayerPlanGroupId:
      type: string
      format: uuid
      title: PayerPlanGroupId
    type_commons_UnauthorizedErrorMessage:
      type: object
      properties:
        message:
          type: string
      title: UnauthorizedErrorMessage
    type_commons_OrganizationId:
      type: string
      format: uuid
      title: OrganizationId
    type_commons_StreetAddressLongZip:
      type: object
      properties:
        address1:
          type: string
        address2:
          type: string
        city:
          type: string
        state:
          $ref: '#/components/schemas/type_commons_State'
        zip_code:
          type: string
          description: 5-digit zip code
        zip_plus_four_code:
          type: string
          description: 4-digit zip add-on code https://en.wikipedia.org/wiki/ZIP_Code#ZIP+4
      required:
      - address1
      - city
      - state
      - zip_code
      - zip_plus_four_code
      title: StreetAddressLongZip
    type_payer-plan-groups_v1_PayerPlanGroupAlreadyExistsError:
      type: object
      properties:
        message:
          type: string
        id:
          $ref: '#/components/schemas/type_commons_PayerPlanGroupId'
      required:
      - message
      - id
      title: PayerPlanGroupAlreadyExistsError
    type_payer-plan-groups_v1_PayerPlanGroup:
      type: object
      properties:
        plan_group_name:
          type: string
        payer_uuid:
          $ref: '#/components/schemas/type_payers_v3_PayerUuid'
        plan_type:
          $ref: '#/components/schemas/type_commons_SourceOfPaymentCode'
        payer_plan_group_id:
          $ref: '#/components/schemas/type_commons_PayerPlanGroupId'
        payer:
          $ref: '#/components/schemas/type_payers_v3_Payer'
        is_active:
          type: boolean
        organization_id:
          $ref: '#/components/schemas/type_commons_OrganizationId'
      required:
      - plan_group_name
      - payer_uuid
      - plan_type
      - payer_plan_group_id
      - payer
      - is_active
      - organization_id
      title: PayerPlanGroup
    type_commons_SourceOfPaymentCode:
      type: string
      enum:
      - 09
      - '11'
      - '12'
      - '13'
      - '14'
      - '15'
      - '16'
      - '17'
      - AM
      - BL
      - CH
      - CI
      - DS
      - FI
      - HM
      - LM
      - MA
      - MB
      - MC
      - OF
      - TV
      - VA
      - WC
      - ZZ
      title: SourceOfPaymentCode
    type_payer-plan-groups_v1_PayerPlanGroupPage:
      type: object
      properties:
        prev_page_token:
          $ref: '#/components/schemas/type_commons_PageToken'
        next_page_token:
          $ref: '#/components/schemas/type_commons_PageToken'
        items:
          type: array
          items:
            $ref: '#/components/schemas/type_payer-plan-groups_v1_PayerPlanGroup'
      required:
      - items
      title: PayerPlanGroupPage
    type_payers_v3_Payer:
      type: object
      properties:
        payer_uuid:
          $ref: '#/components/schemas/type_payers_v3_PayerUuid'
          description: Auto-generated ID set on creation.
        payer_id:
          type: string
          description: The primary national payer ID of the payer.
        payer_name:
          type: string
          description: The primary display name of the payer.
        availity_payer_name:
          type: string
          description: The name of the payer as it appears in Availity.
        availity_claims_payer_id:
          type: string
          description: The ID of the payer as it appears in Availity.
        availity_eligibility_id:
          type: string
          description: The eligibility ID of the payer as it appears in Availity.
        availity_remittance_payer_id:
          type: string
          description: The remittance ID of the payer as it appears in Availity.
        street_address:
          $ref: '#/components/schemas/type_commons_StreetAddressLongZip'
      required:
      - payer_uuid
      - payer_id
      - payer_name
      title: Payer
    type_payers_v3_PayerUuid:
      type: string
      format: uuid
      title: PayerUuid
    type_payer-plan-groups_v1_PayerPlanGroupSortField:
      type: string
      enum:
      - plan_group_name
      - plan_type
      - created_at
      title: PayerPlanGroupSortField
    type_payer-plan-groups_v1_MutablePayerPlanGroup:
      type: object
      properties:
        plan_group_name:
          type: string
        payer_uuid:
          $ref: '#/components/schemas/type_payers_v3_PayerUuid'
        plan_type:
          $ref: '#/components/schemas/type_commons_SourceOfPaymentCode'
      required:
      - plan_group_name
      - payer_uuid
      - plan_type
      title: MutablePayerPlanGroup
    type_payers_v3_PayerId:
      type: string
      title: PayerId
    type_commons_State:
      type: string
      enum:
      - AA
      - AE
      - AP
      - AL
      - AK
      - AS
      - AZ
      - AR
      - CA
      - CO
      - CT
      - DC
      - DE
      - FL
      - FM
      - GA
      - GU
      - HI
      - ID
      - IL
      - IN
      - IA
      - KS
      - KY
      - LA
      - ME
      - MD
      - MA
      - MH
      - MI
      - MN
      - MP
      - MS
      - MO
      - MT
      - NE
      - NV
      - NH
      - NJ
      - NM
      - NY
      - NC
      - ND
      - OH
      - OK
      - OR
      - PA
      - PR
      - PW
      - RI
      - SC
      - SD
      - TN
      - TX
      - UT
      - VI
      - VT
      - VA
      - WA
      - WV
      - WI
      - WY
      title: State
    type_commons_SortDirection:
      type: string
      enum:
      - asc
      - desc
      title: SortDirection
    type_commons_UnprocessableEntityErrorMessage:
      type: object
      properties:
        message:
          type: string
      title: UnprocessableEntityErrorMessage
  securitySchemes:
    OAuthScheme:
      type: http
      scheme: bearer
      description: OAuth 2.0 authentication