{ "$schema": "http://json-schema.org/draft-07/schema#", "definitions": { "out_of_network": { "type": "object", "properties": { "name": { "type": "string" }, "billing_code_type": { "enum": [ "CPT", "HCPCS", "ICD", "MS-DRG", "R-DRG", "S-DRG", "APS-DRG", "AP-DRG", "APR-DRG", "APC", "NDC", "HIPPS", "LOCAL", "EAPG", "CDT", "RC" ] }, "billing_code_type_version": { "type": "string" }, "billing_code": { "type": "string" }, "description": { "type": "string" }, "allowed_amounts": { "type": "array", "items": { "$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" } } }, "service_code": { "type": "array", "items": { "type": "string", "enum":["01","02","03","04","05","06","07","08","09","10","11","12","13","14","15","16","17","18","19","20","21","22","23","24","25","26","27","28","29","30","31","32","33","34","35","36","37","38","39","40","41","42","43","44","45","46","47","48","49","50","51","52","53","54","55","56","57","58","59","60","61","62","63","64","65","66","67","68","69","70","71","72","73","74","75","76","77","78","79","80","81","82","83","84","85","86","87","88","89","90","91","92","93","94","95","96","97","98","99"] }, "uniqueItems": true }, "billing_class": { "enum": [ "professional", "institutional" ] }, "payments": { "type": "array", "items": { "$ref": "#/definitions/payments" }, "default": [] } }, "required": [ "tin", "billing_class", "payments" ], "if": { "properties": { "billing_class": { "const": "professional" } } }, "then": { "required": [ "service_code" ] } }, "payments": { "type": "object", "properties": { "allowed_amount": { "type": "number" }, "billing_code_modifier": { "type": "array", "items": { "type": "string" }, "uniqueItems": true, "default": [] }, "providers": { "type": "array", "items": { "$ref": "#/definitions/providers" }, "default": [] } }, "required": [ "allowed_amount", "providers" ] }, "providers": { "type": "object", "properties": { "billed_charge": { "type": "number" }, "npi": { "type": "array", "items": { "type": "number" }, "default": [], "uniqueItems": true } }, "required": [ "billed_charge", "npi" ] } }, "type": "object", "properties": { "reporting_entity_name": { "type": "string" }, "reporting_entity_type": { "type": "string" }, "plan_name": { "type": "string" }, "plan_id_type": { "type": "string" }, "plan_id": { "type": "string" }, "plan_market_type": { "enum": [ "group", "individual" ] }, "last_updated_on": { "type": "string" }, "version": { "type": "string" }, "out_of_network": { "type": "array", "items": { "$ref": "#/definitions/out_of_network" }, "default": [] } }, "required": ["reporting_entity_name", "reporting_entity_type", "last_updated_on", "version"], "dependentRequired": { "plan_name": ["plan_id_type", "plan_id", "plan_market_type"], "plan_id_type": ["plan_name", "plan_id", "plan_market_type"], "plan_id": ["plan_name","plan_id_type", "plan_market_type"], "plan_market_type": ["plan_name", "plan_id_type", "plan_id"] } }