openapi: 3.0.3
info:
  title: Real Dental Pre-Care Eligibility API
  description: 'API to perform pre-service eligibility checks for dental/medical coverage. This endpoint
    accepts a GraphQL-style request payload over HTTP POST.

    '
  version: 1.0.0
servers:
- url: https://sandbox-apigw.optum.com
paths:
  /oihub/dental/eligibility/preservice/v1:
    post:
      summary: Pre-Care Eligibility Check
      description: Performs eligibility verification for a member and provider.
      operationId: checkEligibility
      security:
      - bearerAuth: []
      tags:
      - Eligibility
      parameters:
      - name: environment
        in: header
        required: true
        schema:
          type: string
          example: sandbox
        description: Target environment
      - name: providerTaxId
        in: header
        required: true
        schema:
          type: string
          pattern: ^\d{9}$
          example: '123456789'
        description: 9-digit provider tax identifier
      requestBody:
        required: true
        content:
          application/json:
            schema:
              $ref: '#/components/schemas/GraphQLRequest'
            example:
              query: "query CheckEligibility($input: EligibilityInput!) {\n  checkEligibility(input: $input)\
                \ {\n    eligibility {\n      eligibilityInfo {\n        trnId\n        policyStatus\n\
                \      }\n    }\n  }\n}\n"
              variables:
                input:
                  memberId: '0001234567'
                  firstName: ABC
                  lastName: EFGH
                  dateOfBirth: '1980-01-01'
                  serviceStartDate: '2024-01-01'
                  serviceEndDate: '2024-12-31'
                  coverageTypes:
                  - Medical
                  payerId: '87726'
                  providerFirstName: QWERT
                  providerLastName: XYZ
                  providerNPI: '1234567890'
      responses:
        '200':
          description: Eligibility response successfully processed
          content:
            application/json:
              schema:
                $ref: '#/components/schemas/EligibilityResponse'
        '400':
          description: Invalid or missing request fields
        '401':
          description: Missing or invalid access token
        '403':
          description: Token lacks required scopes
        '500':
          description: Optum backend error
  /oihub/dental/eligibility/preservice/v1/healthcheck:
    get:
      summary: Health check
      description: Returns API health status.
      responses:
        '200':
          description: Service is healthy
      operationId: get_oihub_dental_eligibility_preservice_v1_healthcheck
      security:
      - bearerAuth: []
components:
  schemas:
    GraphQLRequest:
      type: object
      required:
      - query
      - variables
      properties:
        query:
          type: string
          description: GraphQL query string
        variables:
          type: object
          required:
          - input
          properties:
            input:
              $ref: '#/components/schemas/EligibilityInput'
    EligibilityInput:
      type: object
      required:
      - memberId
      - firstName
      - lastName
      - dateOfBirth
      - serviceStartDate
      - serviceEndDate
      - coverageTypes
      - payerId
      - providerFirstName
      - providerLastName
      - providerNPI
      properties:
        memberId:
          type: string
        firstName:
          type: string
        lastName:
          type: string
        dateOfBirth:
          type: string
          format: date
        serviceStartDate:
          type: string
          format: date
        serviceEndDate:
          type: string
          format: date
        coverageTypes:
          type: array
          items:
            type: string
        payerId:
          type: string
        providerFirstName:
          type: string
        providerLastName:
          type: string
        providerNPI:
          type: string
          pattern: ^\d{10}$
    EligibilityResponse:
      type: object
      properties:
        data:
          type: object
          properties:
            checkEligibility:
              type: object
              properties:
                eligibility:
                  type: array
                  items:
                    $ref: '#/components/schemas/EligibilityRecord'
    EligibilityRecord:
      type: object
      properties:
        eligibilityInfo:
          $ref: '#/components/schemas/EligibilityInfo'
    EligibilityInfo:
      type: object
      properties:
        trnId:
          type: string
          nullable: true
        member:
          $ref: '#/components/schemas/Member'
        contact:
          $ref: '#/components/schemas/Contact'
        insuranceInfo:
          $ref: '#/components/schemas/InsuranceInfo'
        associatedIds:
          $ref: '#/components/schemas/AssociatedIds'
        planLevels:
          type: array
          items:
            $ref: '#/components/schemas/PlanLevel'
        delegatedInfo:
          type: array
          items:
            $ref: '#/components/schemas/DelegatedInfo'
    Member:
      type: object
      properties:
        memberId:
          type: string
        firstName:
          type: string
        middleName:
          type: string
        lastName:
          type: string
        suffix:
          type: string
        dateOfBirth:
          type: string
          format: date
        gender:
          type: string
        relationshipCode:
          type: string
        dependentSequenceNumber:
          type: string
        individualRelationship:
          $ref: '#/components/schemas/CodeDescription'
        relationshipType:
          $ref: '#/components/schemas/CodeDescription'
    CodeDescription:
      type: object
      properties:
        code:
          type: string
        description:
          type: string
    Contact:
      type: object
      properties:
        addresses:
          type: array
          items:
            $ref: '#/components/schemas/Address'
    Address:
      type: object
      properties:
        type:
          type: string
        street1:
          type: string
        street2:
          type: string
        city:
          type: string
        state:
          type: string
        country:
          type: string
        zip:
          type: string
        zip4:
          type: string
    InsuranceInfo:
      type: object
      properties:
        policyNumber:
          type: string
        eligibilityStartDate:
          type: string
          format: date
        eligibilityEndDate:
          type: string
          format: date
        planStartDate:
          type: string
          format: date
        planEndDate:
          type: string
          format: date
        policyStatus:
          type: string
        planTypeDescription:
          type: string
        groupName:
          type: string
        address:
          $ref: '#/components/schemas/Address'
        stateOfIssueCode:
          type: string
        productType:
          type: string
        productCode:
          type: string
        payerId:
          type: string
        lineOfBusinessCode:
          type: string
        governmentProgramCode:
          type: string
        coverageType:
          type: string
        insuranceTypeCode:
          type: string
        insuranceType:
          type: string
    AssociatedIds:
      type: object
      properties:
        alternateId:
          type: string
        subscriberId:
          type: string
        mbiNumber:
          type: string
        healthInsuranceExchangeId:
          type: string
    PlanLevel:
      type: object
      properties:
        level:
          type: string
        family:
          type: array
          items:
            $ref: '#/components/schemas/PlanAmount'
        individual:
          type: array
          items:
            $ref: '#/components/schemas/PlanAmount'
    PlanAmount:
      type: object
      properties:
        networkStatus:
          type: string
        planAmount:
          type: number
          format: decimal
        remainingAmount:
          type: number
          format: decimal
    DelegatedInfo:
      type: object
      properties:
        entity:
          type: string
        contact:
          type: object
          properties:
            phone:
              type: string
        addresses:
          type: array
          items:
            $ref: '#/components/schemas/Address'
  securitySchemes:
    bearerAuth:
      type: http
      scheme: bearer
      bearerFormat: JWT
      description: Enter a Bearer access token. The API Explorer applies the Bearer scheme.
security:
- bearerAuth: []
x-readme:
  explorer-enabled: true
  proxy-enabled: true