DoseSpot Eligibilities API
The Eligibilities API from DoseSpot — 4 operation(s) for eligibilities.
The Eligibilities API from DoseSpot — 4 operation(s) for eligibilities.
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openapi: 3.2.0
info:
title: Dosespot Eligibilities API
version: '1.0'
description: 'Operations tagged Eligibilities across 2 of this provider''s published API definitions: dosespot-rest-api-full-epcs-v2-swagger.json, dosespot-rest-api-jumpstart-epcs-v2-swagger.json. Each path carries the servers of the definition it was published in.'
servers:
- url: https://virtserver.swaggerhub.com/DoseSpot/dosespot-staging-rest-api-v2/Full_EPCSV2
- url: https://virtserver.swaggerhub.com/DoseSpot/dosespot-staging-rest-api-v2/JumpStart_EPCSV2
tags:
- name: Eligibilities
paths:
/api/patients/{patientId}/eligibilities:
get:
tags:
- Eligibilities
summary: Get patient's insurance information
description: "Retrieves a patientâ\x80\x99s insurance details and payer information"
operationId: Eligibilities_GetPayerInformationV2
parameters:
- name: patientId
in: path
description: Patient ID
required: true
schema:
type: integer
format: int32
responses:
'200':
description: OK
content:
application/json:
schema:
$ref: '#/components/schemas/ListResponse_PayerInformationResponse'
text/json:
schema:
$ref: '#/components/schemas/ListResponse_PayerInformationResponse'
application/problem+json:
schema:
$ref: '#/components/schemas/ListResponse_PayerInformationResponse'
application/xml:
schema:
$ref: '#/components/schemas/ListResponse_PayerInformationResponse'
text/xml:
schema:
$ref: '#/components/schemas/ListResponse_PayerInformationResponse'
servers:
- url: https://virtserver.swaggerhub.com/DoseSpot/dosespot-staging-rest-api-v2/Full_EPCSV2
/api/patients/{patientId}/formulary:
get:
tags:
- Eligibilities
summary: Get patient's medication coverage
description: "Retrieves information of a patientâ\x80\x99s insurance coverage for a specified drug, including copay information, coverage restrictions, and available payer alternatives"
operationId: Eligibilities_GetMedicationCoverageV2
parameters:
- name: patientId
in: path
description: Patient ID
required: true
schema:
type: integer
format: int32
- name: patientEligibilityId
in: query
required: true
schema:
type: integer
format: int32
- name: nDC
in: query
required: true
schema:
type: string
maxLength: 24
minLength: 0
responses:
'200':
description: OK
content:
application/json:
schema:
$ref: '#/components/schemas/ItemResponse_MedicationCoverageResponse'
text/json:
schema:
$ref: '#/components/schemas/ItemResponse_MedicationCoverageResponse'
application/problem+json:
schema:
$ref: '#/components/schemas/ItemResponse_MedicationCoverageResponse'
application/xml:
schema:
$ref: '#/components/schemas/ItemResponse_MedicationCoverageResponse'
text/xml:
schema:
$ref: '#/components/schemas/ItemResponse_MedicationCoverageResponse'
servers:
- url: https://virtserver.swaggerhub.com/DoseSpot/dosespot-staging-rest-api-v2/Full_EPCSV2
/api/patients/{patientId}/prescriptionbenefits:
get:
tags:
- Eligibilities
summary: Get prescription benefits
description: "Retrieves information of a patientâ\x80\x99s insurance coverage for a specified prescription, including copay information, coverage restrictions, and available payer alternatives"
operationId: Eligibilities_GetPrescriptionBenefitsV2
parameters:
- name: patientId
in: path
description: Patient ID
required: true
schema:
type: integer
format: int32
- name: ndc
in: query
required: true
schema:
type: string
maxLength: 24
minLength: 0
- name: pharmacyId
in: query
required: true
schema:
type: integer
format: int32
- name: quantity
in: query
required: true
schema:
type: number
format: double
- name: daysSupply
in: query
required: true
schema:
type: integer
format: int32
- name: dispenseUnitTypeID
in: query
required: true
schema:
type: integer
format: int32
- name: patientEligibilityId
in: query
required: false
schema:
type: integer
format: int32
responses:
'200':
description: OK
content:
application/json:
schema:
$ref: '#/components/schemas/ItemResponse_GetPrescriptionBenefitResponse'
text/json:
schema:
$ref: '#/components/schemas/ItemResponse_GetPrescriptionBenefitResponse'
application/problem+json:
schema:
$ref: '#/components/schemas/ItemResponse_GetPrescriptionBenefitResponse'
application/xml:
schema:
$ref: '#/components/schemas/ItemResponse_GetPrescriptionBenefitResponse'
text/xml:
schema:
$ref: '#/components/schemas/ItemResponse_GetPrescriptionBenefitResponse'
servers:
- url: https://virtserver.swaggerhub.com/DoseSpot/dosespot-staging-rest-api-v2/Full_EPCSV2
/api/patients/{patientId}/insurance:
post:
tags:
- Eligibilities
summary: Add custom insurance info
description: Add custom insurance to a patient provided the clinic allows it.
operationId: Eligibilities_CustomInsuranceInfoV2
parameters:
- name: patientId
in: path
description: ''
required: true
schema:
type: integer
format: int32
responses:
'200':
description: OK
content:
application/json:
schema:
$ref: '#/components/schemas/IdentifierResponse'
text/json:
schema:
$ref: '#/components/schemas/IdentifierResponse'
application/problem+json:
schema:
$ref: '#/components/schemas/IdentifierResponse'
application/xml:
schema:
$ref: '#/components/schemas/IdentifierResponse'
text/xml:
schema:
$ref: '#/components/schemas/IdentifierResponse'
requestBody:
content:
application/json:
schema:
$ref: '#/components/schemas/CustomInsuranceRequest'
text/json:
schema:
$ref: '#/components/schemas/CustomInsuranceRequest'
application/problem+json:
schema:
$ref: '#/components/schemas/CustomInsuranceRequest'
application/xml:
schema:
$ref: '#/components/schemas/CustomInsuranceRequest'
text/xml:
schema:
$ref: '#/components/schemas/CustomInsuranceRequest'
application/x-www-form-urlencoded:
schema:
$ref: '#/components/schemas/CustomInsuranceRequest'
required: true
servers:
- url: https://virtserver.swaggerhub.com/DoseSpot/dosespot-staging-rest-api-v2/Full_EPCSV2
components:
schemas:
FormularyInfo:
type: object
properties:
ProductId:
type: integer
format: int32
Ndc:
type: string
FormularyStatusId:
type: integer
format: int32
FormularyAbbreviation:
type: string
FormularyStatusMessage:
type: string
OrderRank:
type: integer
format: int32
IsGeneric:
type: boolean
IsRx:
type: boolean
Result:
type: object
required:
- ResultCode
properties:
ResultCode:
type: string
description: The result code of the operation.
ResultDescription:
type: string
description: A description of the result, if there were errors.
description: Represents the result of a service operation.
ItemResponse_GetPrescriptionBenefitResponse:
type: object
properties:
Item:
description: The response object.
$ref: '#/components/schemas/GetPrescriptionBenefitResponse'
Result:
description: The result of the operation.
$ref: '#/components/schemas/Result'
description: Represents a generic response containing a single object.
PrescriptionBenefitsPharmacy:
type: object
properties:
PharmacyType:
type: string
enum:
- Retail
- Mail
- Item90DayAtRetail
- Specialty
- LongTermCare
Identifications:
type: object
additionalProperties:
type: string
PharmacistLastName:
type: string
PharmacistFirstName:
type: string
PharmacistMiddleName:
type: string
PharmacistSuffix:
type: string
PharmacistPrefix:
type: string
Email:
type: string
DistanceFromRequestedPharmacy:
type: number
format: double
PharmacyId:
type: integer
format: int32
description: The pharmacy identifier.
StoreName:
type: string
description: The pharmacy store name.
Address1:
type: string
description: The pharmacy address.
Address2:
type: string
description: The pharmacy address.
City:
type: string
description: The pharmacy city.
State:
type: string
description: The pharmacy state.
ZipCode:
type: string
description: The pharmacy zip code.
PrimaryPhone:
type: string
description: The pharmacy primary phone number.
PrimaryPhoneType:
type: string
description: The pharmacy primary phone type.
enum:
- Undefined
- Beeper
- Cell
- Fax
- Home
- Work
- Night
- Primary
PrimaryFax:
type: string
description: The pharmacy primary fax number.
PhoneAdditional1:
type: string
description: Additional phone number.
PhoneAdditionalType1:
type: string
description: Additional phone type.
enum:
- Undefined
- Beeper
- Cell
- Fax
- Home
- Work
- Night
- Primary
PhoneAdditional2:
type: string
description: Additional phone number.
PhoneAdditionalType2:
type: string
description: Additional phone type.
enum:
- Undefined
- Beeper
- Cell
- Fax
- Home
- Work
- Night
- Primary
PhoneAdditional3:
type: string
description: Additional phone number.
PhoneAdditionalType3:
type: string
description: Additional phone type.
enum:
- Undefined
- Beeper
- Cell
- Fax
- Home
- Work
- Night
- Primary
PharmacySpecialties:
type: array
description: The pharmacy specialties.
items:
type: string
ServiceLevel:
type: integer
format: int32
description: The pharmacy service level.
Latitude:
type: number
format: double
description: The pharmacy Latitude.
Longitude:
type: number
format: double
description: The pharmacy Longitude.
NCPDPID:
type: string
TherapeuticAlternatives:
type: object
properties:
Ndc:
type: string
FormularyStatus:
type: string
Copay:
$ref: '#/components/schemas/PayerCopay'
DisplayName:
type: string
FormularyInfo:
$ref: '#/components/schemas/FormularyInfo'
FullDisplayString:
type: string
DisplayStrength:
type: string
DefaultDispenseUnitID:
type: integer
format: int32
DispensableDrugId:
type: integer
format: int32
Schedule:
type: integer
format: int32
IsDetox:
type: boolean
HasGHB:
type: boolean
RxCUI:
type: integer
format: int32
PharmacyEligibility:
type: object
properties:
PharmacyType:
type: string
enum:
- Any
- FaxPharmacy
- EPCS
- TwentyFourHourPharmacy
- LongTermCarePharmacy
- MailOrder
- Retail
- SpecialtyPharmacy
EligibilityStatus:
type: string
enum:
- Covered
- NotCovered
- OutOfPocket
- Unknown
- UnableToProcess
Name:
type: string
PayerCopay:
type: object
properties:
IsDrugSpecific:
type: boolean
PharmacyType:
type: string
enum:
- Any
- FaxPharmacy
- EPCS
- TwentyFourHourPharmacy
- LongTermCarePharmacy
- MailOrder
- Retail
- SpecialtyPharmacy
FlatCopayAmount:
type: number
format: double
PercentCopayAmount:
type: number
format: double
FlatCopayAmountFirst:
type: boolean
MinimumCopayAmount:
type: number
format: double
MaximumCopayAmount:
type: number
format: double
DaysSupply:
type: integer
format: int32
CopayTier:
type: integer
format: int32
MaximumCopayTier:
type: integer
format: int32
OutOfPocketMinimum:
type: number
format: double
OutOfPocketMaximum:
type: number
format: double
StepMedicationRestriction:
type: object
properties:
Ndc:
type: string
StepDrugType:
type: string
enum:
- Unknown
- SpecificMedication
- PharmacologicalClass
StepOrder:
type: integer
format: int32
DisplayName:
type: string
RxCUI:
type: integer
format: int32
DispensableDrugId:
type: integer
format: int32
PricingCoverageFactorsCoverageAlerts:
type: object
properties:
ReferenceCode:
type: string
enum:
- AgeLimits
- DaysSupplyExceeded
- DrugExclusion
- ExcessiveUtilization
- FullCostNotCovered
- GenderLimits
- MandatoryGeneric
- MedicalNecessity
- NotOnFormulary
- PharmacyOutOfNetwork
- PlanLimitExclusion
- QuantityLimits
- QuantityLimitExceeded
- QuantityNotValid
- ResourceLink
- StepTherapy
- TextMessage
ReferenceText:
type: string
CoverageMessage:
type: object
properties:
Message:
type: string
LongMessage:
type: string
PrescriptionBenefitPayerAlternativeDetail:
type: object
properties:
PatientSpecificPricingCoverages:
type: array
items:
$ref: '#/components/schemas/PatientSpecificPricingCoverage'
Ndc:
type: string
DisplayName:
type: string
RxCUI:
type: integer
format: int32
DispensableDrugId:
type: integer
format: int32
Coverage:
$ref: '#/components/schemas/MedicationCoverage'
PatientSpecificPricingCoverage:
type: object
properties:
Pharmacy:
description: Pricing for each pharmacy available
$ref: '#/components/schemas/PrescriptionBenefitsPharmacy'
PricingCoverage:
description: Contains PMBC pricing for original medication requested.
$ref: '#/components/schemas/PricingCoverageFactors'
QuantityLimitRestriction:
type: object
properties:
MaximumAmount:
type: number
format: double
AmountUnit:
type: string
enum:
- DollarAmount
- DaysSupply
- Fills
- Quantity
TimePeriodUnit:
type: string
enum:
- Days
- Lifetime
- PerDispensing
- SpecificDateRange
- CalendarYear
- CalendarQuarter
- CalendarMonth
StartDate:
type: string
format: date-time
EndDate:
type: string
format: date-time
MaximumTimePeriodUnits:
type: integer
format: int32
PayerInformationResponse:
type: object
properties:
PatientEligibilityId:
type: integer
format: int32
PayerName:
type: string
PharmacyEligibilities:
type: array
items:
$ref: '#/components/schemas/PharmacyEligibility'
PlanName:
type: string
CoverageId:
type: string
PayerId:
type: string
BIN:
type: string
PCN:
type: string
FormularyId:
type: string
AlternativesId:
type: string
CopayId:
type: string
DemographicChanges:
type: boolean
Demographics:
$ref: '#/components/schemas/PayerDemographics'
ErrorMessage:
type: string
InfoMessage:
type: string
MemberId:
type: string
GetPrescriptionBenefitResponse:
type: object
properties:
PatientFormularyId:
type: integer
format: int32
Brand:
type: boolean
Otc:
type: boolean
Alternatives:
type: array
items:
$ref: '#/components/schemas/PayerAlternativeAPI'
RealTimeFormularyRequestStatus:
type: integer
format: int32
PatientSpecificPricingCoverages:
type: array
items:
$ref: '#/components/schemas/PatientSpecificPricingCoverage'
OptionalPharmacy:
$ref: '#/components/schemas/PrescriptionBenefitsPharmacy'
PayerAlternativeDetail:
type: object
properties:
Ndc:
type: string
Coverage:
$ref: '#/components/schemas/MedicationCoverage'
CoverageRestrictions:
type: object
properties:
IsExcluded:
type: boolean
HasMedicalNecessity:
type: boolean
HasPriorAuthorization:
type: boolean
HasStepTherapy:
type: boolean
HasQuantityLimit:
type: boolean
HasAgeLimit:
type: boolean
AgeLimitRestrictions:
type: array
items:
$ref: '#/components/schemas/AgeLimitRestriction'
GenderRestriction:
type: string
enum:
- Male
- Female
- Unknown
QuantityLimitRestrictions:
type: array
items:
$ref: '#/components/schemas/QuantityLimitRestriction'
StepMedicationRestrictions:
type: array
items:
$ref: '#/components/schemas/StepMedicationRestriction'
Messages:
type: array
items:
$ref: '#/components/schemas/CoverageMessage'
DrugResources:
type: array
items:
$ref: '#/components/schemas/CoverageResource'
SummaryResources:
type: array
items:
$ref: '#/components/schemas/CoverageResource'
PayerDemographics:
type: object
properties:
LastName:
type: string
FirstName:
type: string
MiddleName:
type: string
Suffix:
type: string
DateOfBirth:
type: string
format: date-time
Gender:
type: string
enum:
- Male
- Female
- Unknown
Address:
$ref: '#/components/schemas/PayerAddress'
PayerAlternative:
type: object
properties:
Ndc:
type: string
Details:
type: array
items:
$ref: '#/components/schemas/PayerAlternativeDetail'
RepresentitiveFormularyCoverage:
type: object
properties:
CopayFactors:
type: array
items:
$ref: '#/components/schemas/PayerCopay'
FormularyStatus:
type: string
FormularyStatusText:
type: string
RealTimeFormularyCoverageRestrictions:
$ref: '#/components/schemas/RealTimeFormularyCoverageRestrictions'
AgeLimitRestriction:
type: object
properties:
MinimumAge:
type: integer
format: int32
MinimumAgeUnit:
type: string
enum:
- Days
- Years
MaximumAge:
type: integer
format: int32
MaximumAgeUnit:
type: string
enum:
- Days
- Years
PricingCoverageFactors:
type: object
properties:
DrugStatusCode:
type: string
DrugStatus:
type: string
QuantityPricedValue:
type: string
QuantityPricedCodeListQualifier:
type: string
enum:
- Item38
- Item40
- Item87
- QS
- CF
- UQ
QuantityPricedUnitOfMeasureType:
type: string
QuantityPricedUnitOfMeasureTypeId:
type: integer
format: int32
DaysSupplyPriced:
type: string
PlanPayAmount:
type: string
EstimatedPatientPayAmount:
type: string
OOPAppliedAmount:
type: string
OOPRemainingAmount:
type: string
DeductibleAppliedAmount:
type: string
DeductibleRemainingAmount:
type: string
CoverageAlerts:
type: array
items:
$ref: '#/components/schemas/PricingCoverageFactorsCoverageAlerts'
FormularyStatus:
type: string
description: 'U = Unknown
0 = Not Reimbursable 1 = Non Formulary
2 = On Formulary (Not Preferred)
3 = Preferred Level 1
4 = Preferred Level 2
5 = Preferred Level 3
Preferred Levels up to 99 are allowed.'
PriorAuthRequired:
type: boolean
description: 'Y- PA required
N - PA Not required'
ListResponse_PayerInformationResponse:
type: object
properties:
Items:
type: array
description: The list of elements to return.
items:
$ref: '#/components/schemas/PayerInformationResponse'
Result:
description: The result of the operation.
$ref: '#/components/schemas/Result'
description: Represents a generic response containing a list of objects.
MedicationCoverageResponse:
type: object
properties:
FormularyStatus:
type: string
Brand:
type: boolean
Otc:
type: boolean
Copays:
type: array
items:
$ref: '#/components/schemas/PayerCopay'
Alternatives:
type: array
items:
$ref: '#/components/schemas/PayerAlternativeAPI'
TherapeuticAlternatives:
type: array
items:
$ref: '#/components/schemas/TherapeuticAlternatives'
Restrictions:
$ref: '#/components/schemas/CoverageRestrictions'
RealTimeFormularyRequestStatus:
type: integer
format: int32
CoverageResource:
type: object
properties:
Url:
type: string
ResourceType:
type: string
enum:
- AgeLimits
- ProductCoverageExclusion
- GenderLimits
- MedicalNecessity
- PriorAuthorization
- QuantityLimits
- StepTherapy
- General
- Copay
- Formulary
PayerAddress:
type: object
properties:
AddressLine1:
type: string
AddressLine2:
type: string
City:
type: string
State:
type: string
ZipCode:
type: string
CustomEligibilityInfo:
type: object
properties:
CustomEligibilityInfoType:
type: string
enum:
- PCN
- CardholderID
- GroupID
CustomEligibilityInfoValue:
type: string
IdentifierResponse:
type: object
properties:
Id:
type: integer
format: int32
description: The entity identifier.
Result:
description: The result of the operation.
$ref: '#/components/schemas/Result'
description: Represents a generic response containing an entity identifier.
MedicationCoverage:
type: object
properties:
FormularyStatus:
type: string
Copays:
type: array
items:
$ref: '#/components/schemas/PayerCopay'
Alternatives:
type: array
items:
$ref: '#/components/schemas/PayerAlternative'
Restrictions:
$ref: '#/components/schemas/CoverageRestrictions'
GenderLimitRestriction:
type: object
properties:
GenderAbbreviation:
type: string
GenderDescription:
type: string
PayerAlternativeAPI:
type: object
properties:
Ndc:
type: string
DisplayName:
type: string
RxCUI:
type: integer
format: int32
DispensableDrugId:
type: integer
format: int32
Brand:
type: boolean
Otc:
type: boolean
Details:
type: array
items:
$ref: '#/components/schemas/PrescriptionBenefitPayerAlternativeDetail'
RepresentativeFormularyCoverage:
$ref: '#/components/schemas/RepresentitiveFormularyCoverage'
PatientSpecificPricingCoverages:
type: array
items:
$ref: '#/components/schemas/PatientSpecificPricingCoverage'
ItemResponse_MedicationCoverageResponse:
type: object
properties:
Item:
description: The response object.
$ref: '#/components/schemas/MedicationCoverageResponse'
Result:
description: The result of the operation.
$ref: '#/components/schemas/Result'
description: Represents a generic response containing a single object.
RealTimeFormularyCoverageRestrictions:
type: object
properties:
HasCoverageRestrictions:
type: boolean
IsExcluded:
type: boolean
HasMedicalNecessity:
type: boolean
HasPriorAuthorization:
type: boolean
HasStepTherapy:
type: boolean
AgeLimitRestrictions:
type: array
items:
$ref: '#/components/schemas/AgeLimitRestriction'
GenderLimitRestrictions:
type: array
items:
$ref: '#/components/schemas/GenderLimitRestriction'
QuantityLimitRestrictions:
type: array
items:
$ref: '#/components/schemas/QuantityLimitRestriction'
StepMedicationRestrictions:
type: array
items:
$ref: '#/components/schemas/StepMedicationRestriction'
Messages:
type: array
items:
$ref: '#/components/schemas/CoverageMessage'
DrugResources:
type: array
items:
$ref: '#/components/schemas/CoverageResource'
SummaryResources:
type: array
items:
$ref: '#/components/schemas/CoverageResource'
CustomInsuranceRequest:
type: object
required:
- PatientInsuranceIdentifier
- PatientInsuranceIdentifierType
properties:
PatientInsuranceIdentifierType:
type: string
enum:
- PayerID
- ProcessorIdentificationNumber
- NAICCode
- MutuallyDefined
- StandardUniqueHealthPlanIdentifier
- IINNumber
PatientInsuranceIdentifier:
type: string
minLength: 0
maxLength: 35
PersonCode:
type: string
minLength: 0
maxLength: 2
PayerName:
type: string
CustomEligibilityDetails:
type: array
items:
$ref: '#/components/schemas/CustomEligibilityInfo'
x-refined-from:
- dosespot-rest-api-full-epcs-v2-swagger.json
- dosespot-rest-api-jumpstart-epcs-v2-swagger.json