Centene

Centene Product Mapping V2 API

Resolves Centene plan networks and counties for a given address — the geography layer behind plan shopping and eligibility. Supports authorization_code, PKCE and client_credentials grants with audience ewsext.

Documentation GitHub OpenAPI

Operations 4

GET /network A GET that fetches the Network Data for a given Network Code #

POST /query Search for a particular set of active networks and retrieve their names and identifiers. streetAddress is optional, all other fields are required #

POST /v2/query Search for a particular set of active networks and retrieve their names and identifiers. streetAddress and includeProviderProgramCodesAggs are are optional, all other fields are re #

POST /countiesForAddress Determine the list of counties that apply for a given address and address type #

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OpenAPI Specification

openapi: 3.0.1
info:
  title: Product Mapping V2
  description: Application to get network data and active networks based on location.
  version: 2.0.0
servers:
  - url: https://dev-int-api-gw.centene.com/productmapping/v2/
    description: Dev Internal
  - url: https://prod.api.centene.com/incoming/dev/productmapping/v2
    description: Dev DMZ External
  - url: https://test-int-api-gw.centene.com/productmapping/v2/
    description: Test Internal
  - url: https://prod.api.centene.com/incoming/test/productmapping/v2
    description: Test DMZ External
  - url: https://api-gateway-01.centene.com/productmapping/v2/
    description: Prod Internal
  - url:  https://prod.api.centene.com/incoming/productmapping/v2
    description: Prod DMZ External
security:
  - basicAuth: []
paths:
  /network:
    get:
      tags:
        - network
      summary: A GET that fetches the Network Data for a given Network Code
      operationId: getNetwork
      parameters:
        - name: fapNetworkIdentifier
          in: query
          description: code
          required: true
          schema:
            type: string
            default: "9001"
      responses:
        '200':
          description: "OK"
          content:
            application/json:
              schema:
                $ref: '#/components/schemas/fapNetworkServiceArea'
  /query:
    post:
      tags:
        - query
      summary: Search for a particular set of active networks and retrieve their names and identifiers. streetAddress is optional, all other fields are required
      operationId: postQueryNetworks
      requestBody:
        description: Accepted parameters.
        content:
          'application/json':
            schema:
              anyOf:
                - $ref: '#/components/schemas/query'
                - $ref: '#/components/schemas/queryWithAddress'
            examples:
              Network Query:
                description: "Query legacy Centene plans without county code restrictions."
                value:
                  url: "cahealthwellness.com"
                  displayDate: "2020-12-02"
              Network with Address Query:
                description: 'Query legacy Centene plans WITH county code restrictions.'
                value:
                  url: "cahealthwellness.com"
                  displayDate: "2020-12-02"
                  streetAddress: "1 infinite loop"
                  city: "cupertino"
                  state: "CA"
                  zip: "95014"
        required: false
      responses:
        200:
          description: successful operation
          content:
            application/json:
              schema:
                $ref: '#/components/schemas/queryResponseObject'
  /v2/query:
    post:
      tags:
        - query v2
      summary: Search for a particular set of active networks and retrieve their names and identifiers. streetAddress and includeProviderProgramCodesAggs are are optional, all other fields are required
      operationId: postQueryV2Networks
      requestBody:
        description: Accepted parameters.
        content:
          'application/json':
            schema:
              anyOf:
                - $ref: '#/components/schemas/query'
                - $ref: '#/components/schemas/queryWithAddress'
                - $ref: '#/components/schemas/queryWithFapNetworkTypeCode'
                - $ref: '#/components/schemas/queryV2ResponseNetworkObject'
            examples:
              Network Query:
                description: "Query legacy Centene plans without county code restrictions."
                value:
                  url: "cahealthwellness.com"
                  displayDate: "2020-12-02"
              Network with Address Query:
                description: 'Query legacy Centene plans WITH county code restrictions.'
                value:
                  url: "cahealthwellness.com"
                  displayDate: "2020-12-02"
                  streetAddress: "1 infinite loop"
                  city: "cupertino"
                  state: "CA"
                  zip: "95014"
              Network with fapNetworkTypeCode Query:
                description: 'Query legacy Centene plans WITH fapNetworkTypeCode restrictions.'
                value:
                  url: "https://healthnetcalifornia.com"
                  city: "Santa Clara"
                  zip: "95050"
                  state: "CA"
                  effectiveDate: "2020-08-01"
                  countyFIPSCode: "06011"
                  fapNetworkTypeCode: "Commercial Group Off Exchange"
              Network with includeProviderProgramCodesAggs Query:
                description: 'Query legacy Centene plans to include Provider Program Codes.'
                value:
                  url: "https://healthnetcalifornia.com"
                  city: "Santa Clara"
                  zip: "95050"
                  state: "CA"
                  effectiveDate: "2020-08-01"
                  countyFIPSCode: "06011"
                  fapNetworkTypeCode: "Commercial Group Off Exchange"
                  includeProviderProgramCodesAggs: "Y"
        required: false
      responses:
        200:
          description: successful operation
          content:
            application/json:
              schema:
                $ref: '#/components/schemas/networkResults'
  /countiesForAddress:
    post:
      tags:
        - Geo
      summary: Determine the list of counties that apply for a given address and address type
      operationId: determineCounties
      requestBody:
        description: Accepted parameters.
        content:
          'application/json':
            schema:
              anyOf:
                - $ref: '#/components/schemas/countiesRequest'
            examples:
              County:
                description: "Determine if the address is a valid county"
                value:
                  value: "Sacramento, CA"
                  addressType: "county"
              City:
                description: "Determine the counties the city is in"
                value:
                  value: "San Francisco, CA"
                  addressType: "city"
              Street Address:
                description: "Determine the counties for the address"
                value:
                  value: "105 NW 13th Ave, Portland, OR 97209"
                  addressType: "street_address"
              Postal Code:
                description: "Determine the counties for the postal code"
                value:
                  value: "75001"
                  addressType: "postal"
        required: false
      responses:
        200:
          description: "OK"
          content:
            application/json:
              schema:
                $ref: '#/components/schemas/countiesResponseObject'
components:
  schemas:
    fapNetworkServiceAreaWithoutMemberOrProvider:
      type: object
      properties:
        dataSourceIdentifier:
          type: string
          example: 259
        fapNetworkCode:
          type: string
          example: 558103
        fapNetworkDisplayEndDate:
          type: string
          example: "4000-01-01"
        fapNetworkDisplayStartDate:
          type: string
          format: date
          example: "2020-07-01"
        fapNetworkEndDate:
          type: string
          example: "4000-01-01"
        fapNetworkStartDate:
          type: string
          format: date
          example: "2020-07-01"
        fapNetworkIdentifier:
          type: string
          example: 558103
        fapNetworkName:
          type: string
          example: Seniority Plus Sapphire Premier II (HMO)
        fapNetworkStatusCode:
          type: string
          example: ACTIVE
        fapNetworkTypeCode:
          type: string
          example: Medicaid
        fapNetworkURLText:
          type: string
          example: healthnetadvantage.com
        serviceAreaRestrictionFlag:
          type: string
          example: Y
        ppgIndicator:
          type: string
          example: Y
        noteText:
          type: string
          example: Initial Load 07282020
        stateCode:
          type: string
          example: CA
    fapNetworkServiceArea:
      type: object
      properties:
        dataSourceIdentifier:
          type: string
          example: 259
        fapNetworkCode:
          type: string
          example: 558103
        fapNetworkDisplayEndDate:
          type: string
          example: "4000-01-01"
        fapNetworkDisplayStartDate:
          type: string
          format: date
          example: "2020-07-01"
        fapNetworkEndDate:
          type: string
          example: "4000-01-01"
        fapNetworkStartDate:
          type: string
          format: date
          example: "2020-07-01"
        fapNetworkIdentifier:
          type: string
          example: 558103
        fapNetworkName:
          type: string
          example: Seniority Plus Sapphire Premier II (HMO)
        fapNetworkStatusCode:
          type: string
          example: ACTIVE
        fapNetworkTypeCode:
          type: string
          example: Medicaid
        fapNetworkURLText:
          type: string
          example: healthnetadvantage.com
        memberAttributes:
          type: array
          items:
            type: object
            properties:
              counties:
                type: array
                items:
                  type: object
                  properties:
                    countyName:
                      type: string
                      example: Alameda
                    dataSourceidentifier:
                      type: string
                      example: 259
                    fipsCountyCode:
                      type: string
                      example: 06001
                    stateCode:
                      type: string
                      example: CA
              memberAttributeCode:
                type: string
                example: 1731
              memberAttributeDescription:
                type: string
                example: Migrated Member
              memberAttributeIdentifier:
                type: string
                example: 333622
              memberAttributeName:
                type: string
                example: Seniority Plus Sapphire Premier II (HMO)
              memberAttributeType:
                type: string
                example: Benefit Package Code
        providerPrograms:
          type: array
          items:
            type: object
            properties:
              dataSourceIdentifier:
                type: string
                example: 259
              providerProgramCode:
                type: string
                example: 5581
              providerProgramIdentifier:
                type: string
                example: 220091
              providerProgramName:
                type: string
                example: 5581
              providerProgramTypeCode:
                type: string
                example: MED
              providerProgramDescription:
                type: string
                example: Some Description
        serviceAreaRestrictionFlag:
          type: string
          example: Y
        sites:
          type: array
          items:
            type: object
            properties:
              domainUrl:
                type: string
                example: "findaprovider.superiorhealthplan.com/something_else"
              root_url:
                type: string
                example: "sfindaprovider.superiorhealthplan.com"
              tag:
                type: string
                example: "someTag"
              modes:
                type: array
                items:
                  type: object
                  properties:
                    mode:
                      type: string
                      example: "someMode"
        ppgIndicator:
          type: string
          example: Y
        noteText:
          type: string
          example: Initial Load 07282020
        stateCode:
          type: string
          example: CA
    queryWithAddress:
      type: object
      properties:
        streetAddress:
          type: string
          example: 1261 W 76th St
        url:
          type: string
          example: sunshinehealth.com
        city:
          type: string
          example: Los Angeles
        state:
          type: string
          example: CA
        zip:
          type: string
          example: 90044
        effectiveDate:
          type: string
          format: date
          example: "2020-09-01"
    queryWithCounty:
      type: object
      properties:
        countyFIPSCode:
          type: string
          example: 48113
        url:
          type: string
          example: sunshinehealth.com
        effectiveDate:
          type: string
          format: date
          example: "2020-09-01"
    queryWithFapNetworkTypeCode:
      type: object
      required:
      - url
      - city
      - state
      - zip
      - effectiveDate
      - countyFIPSCode
      - fapNetworkTypeCode
      properties:
        url:
          type: string
          example: https://healthnetcalifornia.com
        city:
          type: string
          example: Santa Clara
        state:
          type: string
          example: CA
        zip:
          type: string
          example: 95050
        effectiveDate:
          type: string
          format: date
          example: "2020-08-01"
        countyFIPSCode:
          type: string
          example: 06011
        fapNetworkTypeCode:
          type: string
          example: Commercial Group Off Exchange
        includeProviderProgramCodesAggs:
          type: string
          enum: ["Y", "N"]
          example: "Y"
    query:
      type: object
      properties:
        streetAddress:
          type: string
          example: 1261 W 76th St
        url:
          type: string
          example: sunshinehealth.com
    queryResponseObject:
      type: array
      items:
        $ref: '#/components/schemas/fapNetworkServiceAreaWithoutMemberOrProvider'
      properties:
        "7001":
          type: string
          example: Medicaid Plan
        "37803":
          type: string
          example: Allwell Dual Medicare HMO SNP
        "37804":
          type: string
          example: Allwell Dual Medicare HMO SNP
        "65601":
          type: string
          example: Florida Long Term Care
        "343703":
          type: string
          example: Allwell Medicare HMO MAPD
        "343704":
          type: string
          example: Allwell Medicare HMO MAPD
        "803601":
          type: string
          example: Child Welfare Specialty Plan
    queryV2ResponseNetworkObject:
      $ref: '#/components/schemas/fapNetworkServiceAreaWithoutMemberOrProvider'
    providerProgramCodes:
      type: object
      properties:
        providerProgramCode:
          type: string
          example: 1234
        fapNetworkIdentifier:
          type: string
          example: ["123401", "123402", "123403"]
    networkResults:
      type: object
      properties:
        network:
          items:
            $ref: '#/components/schemas/queryV2ResponseNetworkObject'
        providerProgramCodes:
          items:
            $ref: '#/components/schemas/providerProgramCodes'
    countiesRequest:
      type: object
      properties:
        streetAddress:
          type: string
          example: 1261 W 76th St
        url:
          type: string
          example: county
    countiesResponseObject:
      type: array
      items:
        $ref: '#/components/schemas/countyResult'
      properties:
        "7001":
          type: string
          example: Medicaid Plan
        "37803":
          type: string
          example: Allwell Dual Medicare HMO SNP
        "37804":
          type: string
          example: Allwell Dual Medicare HMO SNP
        "65601":
          type: string
          example: Florida Long Term Care
        "343703":
          type: string
          example: Allwell Medicare HMO MAPD
        "343704":
          type: string
          example: Allwell Medicare HMO MAPD
        "803601":
          type: string
          example: Child Welfare Specialty Plan
    countyResult:
      type: object
      properties:
        countyName:
          type: string
          example: King
        countyFIPSCode:
          type: string
          example: 53033
        state:
          type: string
          example: WA
  securitySchemes:
    basicAuth:
      type: http
      scheme: basic