{ "$schema": "http://json-schema.org/draft-07/schema#", "$id": "https://github.com/CMSgov/price-transparency-guide/blob/master/schemas/allowed-amounts/allowed-amounts.json", "definitions": { "out_of_network": { "type": "object", "properties": { "name": { "type": "string", "minLength": 1 }, "billing_code_type": { "enum": [ "CPT", "HCPCS", "ICD", "MS-DRG", "R-DRG", "S-DRG", "APS-DRG", "AP-DRG", "APR-DRG", "APC", "NDC", "HIPPS", "LOCAL", "EAPG", "CDT", "RC" ] }, "billing_code_type_version": { "type": "string", "minLength": 1 }, "billing_code": { "type": "string", "minLength": 1 }, "description": { "type": "string", "minLength": 1 }, "allowed_amounts": { "type": "array", "items": { "$ref": "#/definitions/allowed_amounts" }, "default": [] } }, "required": [ "name", "billing_code_type", "billing_code_type_version", "billing_code", "allowed_amounts", "description" ] }, "allowed_amounts": { "type": "object", "properties": { "tin": { "type": "object", "properties": { "type": { "type": "string", "enum": [ "ein", "npi" ] }, "value": { "type": "string", "minLength": 1 } } }, "service_code": { "type": "array", "items": { "type": "string", "pattern": "^([1-9][0-9]|[0-9][1-9])$" }, "uniqueItems": true }, "billing_class": { "enum": [ "professional", "institutional" ] }, "payments": { "type": "array", "items": { "$ref": "#/definitions/payments" }, "default": [], "minItems": 1 } }, "required": [ "tin", "billing_class", "payments" ], "if": { "properties": { "billing_class": { "const": "professional" } } }, "then": { "required": [ "service_code" ] } }, "payments": { "type": "object", "properties": { "allowed_amount": { "type": "number", "minimum": 0 }, "billing_code_modifier": { "type": "array", "items": { "type": "string", "minLength": 1 }, "uniqueItems": true, "default": [], "minItems": 1 }, "providers": { "type": "array", "items": { "$ref": "#/definitions/providers" }, "default": [], "minItems": 1 } }, "required": [ "allowed_amount", "providers" ] }, "providers": { "type": "object", "properties": { "billed_charge": { "type": "number", "minimum": 0 }, "npi": { "type": "array", "items": { "type": "integer" }, "default": [], "uniqueItems": true, "minItems": 1 } }, "required": [ "billed_charge", "npi" ] } }, "type": "object", "properties": { "reporting_entity_name": { "type": "string", "minLength": 1 }, "reporting_entity_type": { "type": "string", "minLength": 1 }, "plan_name": { "type": "string", "minLength": 1 }, "issuer_name": { "type": "string", "minLength": 1 }, "plan_sponsor_name": { "type": "string", "minLength": 1 }, "plan_id_type": { "enum": [ "ein", "hios" ] }, "plan_id": { "type": "string", "minLength": 1 }, "plan_market_type": { "enum": [ "group", "individual" ] }, "last_updated_on": { "type": "string", "format": "date", "description": "This is a date format of YYYY-MM-DD", "minLength": 10, "maxLength": 10 }, "version": { "type": "string" }, "out_of_network": { "type": "array", "items": { "$ref": "#/definitions/out_of_network" }, "default": [] } }, "if": { "properties": { "plan_id_type": { "enum": [ "ein" ] } }, "required": [ "plan_id_type" ] }, "then": { "required": [ "plan_sponsor_name" ] }, "required": [ "reporting_entity_name", "reporting_entity_type", "last_updated_on", "out_of_network", "version" ], "dependentRequired": { "plan_name": [ "plan_id_type", "plan_id", "plan_market_type", "issuer_name" ], "plan_id_type": [ "plan_name", "plan_id", "plan_market_type", "issuer_name" ], "plan_id": [ "plan_name", "plan_id_type", "plan_market_type", "issuer_name" ], "plan_market_type": [ "plan_name", "plan_id_type", "plan_id", "issuer_name" ], "issuer_name": [ "plan_name", "plan_id_type", "plan_market_type", "plan_id" ] } }