Optum Pharmacy Solutions API

components:
  schemas:
    ClaimFormat:
      properties:
        acceptedClaimResponse:
          type: string
        code:
          type: string
        compoundNDCRequired:
          format: int64
          type: integer
        deactivate:
          type: boolean
        description:
          type: string
        errorCode:
          type: string
        lastUpdated:
          type: string
        mode:
          format: int32
          type: integer
        notes:
          type: string
        priceGt9999:
          type: boolean
        printPlanName:
          type: boolean
        qtyGt9999:
          type: boolean
        sendFirstNameIn:
          type: boolean
        state:
          type: string
        transmission:
          items:
            $ref: '#/components/schemas/Transmission'
          type: array
        txsPerCall:
          format: int32
          type: integer
        version:
          type: string
      type: object
    FieldGroup:
      properties:
        allFields:
          items:
            $ref: '#/components/schemas/SegmentField'
          type: array
        field:
          $ref: '#/components/schemas/SegmentField'
          writeOnly: true
        fieldGroup:
          $ref: '#/components/schemas/FieldGroup'
          writeOnly: true
        fields:
          items:
            $ref: '#/components/schemas/SegmentField'
          type: array
        id:
          type: string
        included:
          type: boolean
        mandatory:
          type: boolean
        sendIfNull:
          type: boolean
      type: object
    GetClaimFormatRequest:
      properties:
        billingSequence:
          type: string
          pattern: ^[a-zA-Z0-9]*$
          maxLength: 2
          example: S1
        bin:
          type: string
          pattern: ^[a-zA-Z0-9]*$
          maxLength: 6
          example: A99
        chainID:
          type: string
          pattern: ^[0-9]*$
          maxLength: 38
        code:
          type: string
          pattern: ^[a-zA-Z0-9]*$
          maxLength: 3
          example: DG6
        customer:
          type: string
          pattern: ^[a-zA-Z0-9]*$
          maxLength: 128
          example: customerName
        externalMessageId:
          type: string
          pattern: ^[0-9]*$
        groupCode:
          type: string
          pattern: ^[a-zA-Z0-9]*$
          maxLength: 15
          example: D0
        pcn:
          type: string
          maxLength: 10
          format: ncpdp-alphanumeric
          example: A987
        rems:
          type: string
          maxLength: 1
          example: N
          enum:
          - y
          - n
          - Y
          - N
          - null
        siteCode:
          type: string
          pattern: ^[a-zA-Z0-9]*$
          maxLength: 80
          example: epsxx92qax1e2cz
        sourceSystemId:
          type: string
          pattern: ^[0-9]*$
        transactionCode:
          type: string
      type: object
    GetClaimFormatResponse:
      properties:
        claimFormat:
          $ref: '#/components/schemas/JsonClaimFormat'
      type: object
    JsonClaimFormat:
      properties:
        billingSequence:
          type: string
          pattern: ^[a-zA-Z0-9]*$
          maxLength: 2
          example: S1
        bin:
          type: string
          pattern: ^[a-zA-Z0-9]*$
          maxLength: 6
          example: A99
        chainID:
          type: string
          pattern: ^[0-9]*$
          maxLength: 38
        code:
          type: string
          pattern: ^[a-zA-Z0-9]*$
          maxLength: 3
          example: DG6
        customer:
          type: string
          pattern: ^[a-zA-Z0-9]*$
          maxLength: 128
          example: customerName
        description:
          type: string
          maxLength: 250
          format: ncpdp-alphanumeric
          example: NCPDP D.0 Claim
        effectiveDate:
          type: string
          format: rxn-date
          example: '2025-01-01'
        expirationDate:
          type: string
          format: rxn-date
          example: '2030-01-01'
        externalMessageId:
          type: string
          pattern: ^[0-9]*$
        groupCode:
          type: string
          pattern: ^[a-zA-Z0-9]*$
          maxLength: 15
          example: D0
        pcn:
          type: string
          maxLength: 10
          format: ncpdp-alphanumeric
          example: A987
        rems:
          type: string
          maxLength: 1
          example: N
          enum:
          - y
          - n
          - Y
          - N
          - null
        siteCode:
          type: string
          pattern: ^[a-zA-Z0-9]*$
          maxLength: 80
          example: epsxx92qax1e2cz
        sourceSystemId:
          type: string
          pattern: ^[0-9]*$
        transmissions:
          items:
            $ref: '#/components/schemas/JsonTransmission'
          type: array
      type: object
    JsonClaimFormatWrapper:
      properties:
        claimFormats:
          items:
            $ref: '#/components/schemas/JsonClaimFormat'
          type: array
      type: object
    JsonFieldGroup:
      properties:
        fieldGroupId:
          format: int64
          type: integer
        fieldIdentifier:
          type: string
          pattern: ^[a-zA-Z0-9]*$
          maxLength: 3
          example: '123'
        fieldNumber:
          type: string
          pattern: ^[a-zA-Z0-9]*$
          maxLength: 4
          example: A1
        groupCode:
          type: string
        maximumCount:
          type: string
          example: '10'
      type: object
    JsonSegment:
      properties:
        segmentFields:
          items:
            $ref: '#/components/schemas/JsonSegmentField'
          type: array
        segmentIdentifier:
          type: string
          pattern: ^[a-zA-Z0-9]*$
          maxLength: 32
          example: HEADER
        sequence:
          format: int32
          type: integer
          example: '2'
        usageCode:
          type: string
          maxLength: 10
          format: ncpdp-alphanumeric
          example: M
      type: object
    JsonSegmentField:
      properties:
        customName:
          type: string
          maxLength: 250
          format: ncpdp-alphanumeric
          example: custom field name
        customProcessingCode:
          type: string
          pattern: ^[a-zA-Z0-9]*$
          maxLength: 10
          example: A1
        description:
          type: string
          maxLength: 250
          format: ncpdp-alphanumeric
          example: field description
        fieldDataType:
          type: string
          maxLength: 250
          format: ncpdp-alphanumeric
          example: Integer
        fieldDataTypeId:
          format: int64
          type: integer
          example: '1'
        fieldGroups:
          items:
            $ref: '#/components/schemas/JsonFieldGroup'
          type: array
          example: []
        fieldIdentifier:
          type: string
          pattern: ^[a-zA-Z0-9]*$
          maxLength: 3
          example: A1
        fieldNumber:
          type: string
          pattern: ^[a-zA-Z0-9]*$
          maxLength: 4
          example: '101'
        fieldType:
          type: string
          pattern: ^[a-zA-Z0-9]*$
          maxLength: 1
          example: I
        includeIfNull:
          type: boolean
          example: 'true'
        mantissaSize:
          format: int32
          type: integer
          example: '1'
        maximumLength:
          format: int32
          type: integer
          example: '10'
        segmentFieldQualifiers:
          items:
            $ref: '#/components/schemas/JsonSegmentFieldQualifier'
          type: array
          example: []
        sequence:
          format: int32
          type: integer
          example: '1'
        usageCode:
          type: string
          maxLength: 10
          format: ncpdp-alphanumeric
          example: M
        useIfNull:
          type: string
          maxLength: 250
          format: ncpdp-alphanumeric
          example: '   '
      type: object
    JsonSegmentFieldQualifier:
      properties:
        qualifierCode:
          type: string
          pattern: ^[a-zA-Z0-9]*$
          maxLength: 10
        qualifierDescription:
          type: string
          maxLength: 250
        sequence:
          format: int32
          type: integer
      type: object
    JsonTransmission:
      properties:
        code:
          type: string
          pattern: ^[a-zA-Z0-9]*$
          maxLength: 10
          example: B1
        segments:
          items:
            $ref: '#/components/schemas/JsonSegment'
          type: array
        standard:
          type: string
          maxLength: 2
          example: D0
          enum:
          - D0
          - ''
        type:
          type: string
          pattern: ^[a-zA-Z0-9]*$
          maxLength: 50
          example: request
      type: object
    N1:
      properties:
        code:
          type: string
        id:
          type: string
        selected:
          type: boolean
        subId:
          format: int32
          type: integer
      type: object
    Prereq:
      properties:
        id:
          type: string
      type: object
    Prereqs:
      properties:
        prereq:
          $ref: '#/components/schemas/Prereq'
      type: object
    SaveClaimFormatRequest:
      properties:
        claimFormat:
          $ref: '#/components/schemas/JsonClaimFormat'
      type: object
    Segment:
      properties:
        allFields:
          items:
            $ref: '#/components/schemas/SegmentField'
          type: array
        field:
          $ref: '#/components/schemas/SegmentField'
          writeOnly: true
        fieldGroup:
          $ref: '#/components/schemas/FieldGroup'
          writeOnly: true
        fieldGroups:
          items:
            $ref: '#/components/schemas/FieldGroup'
          type: array
        fields:
          items:
            $ref: '#/components/schemas/SegmentField'
          type: array
        id:
          type: string
        mandatory:
          type: boolean
      type: object
    SegmentField:
      properties:
        id:
          type: string
        included:
          type: boolean
        mandatory:
          type: boolean
        n1List:
          items:
            $ref: '#/components/schemas/N1'
          type: array
        prereqs:
          $ref: '#/components/schemas/Prereqs'
        sendIfNull:
          type: boolean
      type: object
    SegmentGroup:
      properties:
        mandatory:
          type: boolean
        segment:
          items:
            $ref: '#/components/schemas/Segment'
          type: array
      type: object
    Transmission:
      properties:
        code:
          type: string
        segment:
          items:
            $ref: '#/components/schemas/Segment'
          type: array
        segmentGroup:
          $ref: '#/components/schemas/SegmentGroup'
        type:
          type: string
        version:
          type: string
      type: object
    UpdateClaimFormatRequest:
      properties:
        claimFormat:
          $ref: '#/components/schemas/JsonClaimFormat'
      type: object
  securitySchemes:
    oauth2_security:
      flows:
        clientCredentials:
          scopes: {}
          tokenUrl: https://idx-stage.linkhealth.com/auth/realms/developer-platform/protocol/openid-connect/token
      type: oauth2
externalDocs:
  description: Resource Docs
  url: https://springdoc.org/
info:
  description: API for Formatting Rule
  title: Formatting Rule API
  version: v1
openapi: 3.1.0
paths:
  /v1/standards-based-messaging/services/payer-sheet-service/telecomFormat/fetch:
    post:
      description: This endpoint is used to retrieve existing telecom claim formats based on provided
        criteria (e.g., payer ID, format ID, etc.). It returns the matching claim format(s) from the system
        for viewing or further processing.
      operationId: getClaimFormat
      requestBody:
        content:
          application/json:
            schema:
              properties:
                getClaimFormatRequest:
                  $ref: '#/components/schemas/GetClaimFormatRequest'
              type: object
        required: true
      responses:
        '200':
          content:
            '*/*':
              schema:
                properties:
                  getClaimFormatResponse:
                    $ref: '#/components/schemas/GetClaimFormatResponse'
                type: object
          description: OK
      summary: Fetch Claim Format
      tags:
      - Payersheet
  /v1/standards-based-messaging/services/payer-sheet-service/telecomFormat/save:
    post:
      description: This endpoint is used to save a new telecom claim format. It accepts a payload containing
        the details of the claim format and persists it in the system. Typically used when creating a
        new configuration for telecom-based payer sheets.
      operationId: saveClaimFormat
      parameters:
      - in: query
        name: request
        required: true
        schema:
          properties:
            saveClaimFormatRequest:
              $ref: '#/components/schemas/SaveClaimFormatRequest'
          type: object
      responses:
        '200':
          content:
            '*/*':
              schema:
                type: string
          description: OK
      summary: Save Claim Format
      tags:
      - Payersheet
  /v1/standards-based-messaging/services/payer-sheet-service/telecomFormat/update:
    patch:
      description: This endpoint is used to update an existing telecom claim format. It requires the updated
        format data, including the identifier of the format to be modified. Useful for maintaining or
        correcting claim format configurations.
      operationId: updateClaimFormat
      parameters:
      - in: query
        name: request
        required: true
        schema:
          properties:
            updateClaimFormatRequest:
              $ref: '#/components/schemas/UpdateClaimFormatRequest'
          type: object
      responses:
        '200':
          content:
            '*/*':
              schema:
                type: string
          description: OK
      summary: Update Claim Format
      tags:
      - Payersheet
  /health/formatting-rules:
    get:
      responses:
        '200':
          description: OK
      summary: Health check endpoint for the formatting rule engine
      tags:
      - HealthCheck
security:
- oauth2_security: []
servers:
- description: Generated server url
  url: https://sandbox-apigw.optum.com/rxn/formattingrules
tags:
- description: API to process Payersheet information
  name: Payersheet
x-readme:
  explorer-enabled: true
  proxy-enabled: true