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