GET api/memberclaims/{memberid}/{id}

Retrieves a member claim.

Request Information

URI Parameters

NameDescriptionTypeAdditional information
memberid

The unique identifier of the member. This can be retrieved from the members or groupmembers endpoint in the ID property. This value is sometimes known as the RxCPersonID.

 integer

Required
id

The identifier of the claim.

 integer

Required

Body Parameters

None.

Response Information

Resource Description

The details of the member claim.

MemberClaimModel
NameDescriptionTypeAdditional information
OriginalClaimNo

Gets or sets Original Claim Number

 integer

None.
TransactionResponseStatus

Gets or sets the claim's transaction response status

 string

None.
TransactionCode

Gets or sets the claim's transaction code (e.g. B1 or B2)

 string

None.
RxCPatientID

Gets or sets the patient's RxClearinghouse ID

 integer

None.
DateOfBirth

date

None.
Bin

Gets or sets the claim's Bin

 string

None.
PCN

Gets or sets the claim's PCN

 string

None.
GroupID

Gets or sets the claim's Group ID

 string

None.
PrescriptionReferenceNumber

Gets or sets the claim's Rx Number

 string

None.
FillNumber

Gets or sets the claim's Fill Number

 byte

None.
DAWCode

Gets or sets the claim's Dispense as Written code

 string

None.
SubmissionClarificationCode

Gets or sets the claim's Submission Clarification Code

 string

None.
ClaimDate

Gets or sets the claim's date received by processor

 date

None.
Reversed

Gets or sets the claim's Reversed status flag

 boolean

None.
ReversedDate

Gets or sets the claim's reversed date if it has been reversed

 date

None.
DateOfService

Gets or sets the claim's Date of Service

 date

None.
DatePrescriptionWritten

Gets or sets the claim's Date Prescription Written

 date

None.
QuantityDispensed

Gets or sets the claim's Quantity Dispensed

 decimal number

None.
DaysSupply

Gets or sets the claim's Days Supply

 integer

None.
DrugName

Gets or sets claim's drug name

 string

None.
GenericName

Gets or sets the drug's generic drug name

 string

None.
StrengthDescription

Gets or sets the drug's strength and description (e.g. 0.50 MG - TABS)

 string

None.
DosageFormDescription

Gets or sets the drug's dosage form description (e.g. Tablet)

 string

None.
RouteOfAdministrationDescription

Gets or sets the drug's route of adminisration (e.g. Oral)

 string

None.
GenericProductIdentifier

Gets or sets the drug's Generic Product Identifier (GPI)

 string

None.
IsMultiSourced

Gets or sets whether the drug on the claim is multi-sourced

 boolean

None.
MultiSourceCode

Gets or sets the drug's multi-source code

 string

None.
DEAClassCode

Gets or sets the drug's DEA class code

 string

None.
IsRx

Gets or sets whether the drug requires written prescription

 boolean

None.
NDC

Gets or sets the drug's NDC

 string

None.
IngredientCostPaid

Gets or sets the claim's ingredient cost paid according to plan

 decimal number

None.
DispensingFeePaid

Gets or sets the claim's dispensing fee paid according to plan

 decimal number

None.
IncentiveAmountPaid

Gets or sets the claim's incentive amount paid accourding to plan

 decimal number

None.
ProfessionalServiceFeePaid

Gets or sets the claim's professional service fee paid according to plan

 decimal number

None.
FlatSalesTaxAmountPaid

Gets or sets the claim's flat sales tax amount paid

 decimal number

None.
PercentageSalesTaxAmountPaid

Gets or sets the claim's percentage sales tax amount paid

 decimal number

None.
PercentageSalesTaxRatePaid

Gets or sets the claim's percentage sales tax rate

 decimal number

None.
PharmacyPrice

Gets or sets the claim's pharmcy price

 decimal number

None.
AmountOfCoPay

Gets or sets the claim's Copay according to plan

 decimal number

None.
AmountOfCoInsurance

Gets or sets the claim's Coinsurance according to plan

 decimal number

None.
DrugSelectionPenalty

Gets or sets the claim's drug selection penalty

 decimal number

None.
AmountExceedingPeriodicBenefitMaximum

Gets or sets the claim's amount that exceeded periodic benefit maximum according to plan

 decimal number

None.
TotalAmountPaid

Gets or sets the claim's total amount paid

 decimal number

None.
PatientPayAmount

Gets or sets the claim's patient pay amount

 decimal number

None.
GrossAmountDue

Gets or sets the gross amount due supplied in the claim

 decimal number

None.
SecondaryPayer

Gets or sets whether claim is secondary payer

 boolean

None.
COBAmount

Gets or sets the coordination of benefit amount

 decimal number

None.
DeductibleDescription

Gets or sets the claim's deductible description set by plan

 string

None.
MOOPDescription

Gets or sets the claims max out of pocket description set by plan

 string

None.
PlanIncentiveDescription

Gets or sets the plan incentive description set by plan

 string

None.
BenefitCodeDescription

Gets or sets the benefit code description set by plan

 string

None.
PharmacyNPI

Gets or sets the NPI of the pharmacy

 string

None.
PharmacyLocationName

Gets or sets the name of the pharmacy

 string

None.
PrescriberID

Gets or set the ID of the prescriber submitted in the claim

 string

None.
PrescriberName

Gets or sets the name of the prescriber

 string

None.
AmountAppliedToPeriodicDeductible

Gets or sets the amount applied to periodic deductible

 decimal number

None.
PricingMethod

Gets or sets the pricing method used when the claim was processed

 string

None.
PricingMethodDetail

Gets or sets the pricing method detail used when the claim was processed

 string

None.
TherapeuticClass02

Gets or sets the Therapeutic class (level 2)

 string

None.
TherapeuticClass04

Gets or sets the Therapeutic class (level 4)

 string

None.
TherapeuticClass06

Gets or sets the Therapeutic class (level 6)

 string

None.
TherapeuticClass08

Gets or sets the Therapeutic class (level 8)

 string

None.
TherapeuticClass10

Gets or sets the Therapeutic class (level 10)

 string

None.
TherapeuticClass12

Gets or sets the Therapeutic class (level 12)

 string

None.
TherapeuticClass14

Gets or sets the Therapeutic class (level 14)

 string

None.
BrandNameCode

Gets or sets the brand name code of the drug (B/G/T)

 string

None.
PlanPricingGroup

Gets or sets the plan pricing group used for processing

 string

None.
EnforcedRules

Gets or sets a delimited (^) list of enforced rules

 string

None.
PrimaryRules

Gets or sets the list of rules that were examined during adjudication

 Collection of MemberClaimRuleModel

None.
SecondaryRules

Get or sets the secondary list of rules that were examined during adjudication (secondary rules may be plan specific if template level rules were applied earlier)

 Collection of MemberClaimRuleModel

None.
AdditionalMessageInfo

Gets or sets the list of additional messages that were supplied in the claim response

 Collection of MessageInfoModel

None.
RejectInfo

Gets or sets the list of reject messages and descriptions that were supplied in the claim response

 Collection of RejectInfoModel

None.
IsManualClaim

Gets or sets the value indicating whether this claim is a manual claim

 boolean

None.
Url

Gets or sets the link representing a link back to the resource

 string

None.
ID

Gets or sets the identifier for the resource

 integer

None.

Response Formats

application/json, text/json, application/json-patch+json

Sample: 
{
  "url": "sample string 42",
  "id": 43,
  "originalClaimNo": 1,
  "transactionResponseStatus": "sample string 2",
  "transactionCode": "sample string 3",
  "rxCPatientID": 4,
  "dateOfBirth": "2025-05-30T21:24:24.0152978-05:00",
  "bin": "sample string 5",
  "pcn": "sample string 6",
  "groupID": "sample string 7",
  "prescriptionReferenceNumber": "sample string 8",
  "fillNumber": 64,
  "dawCode": "sample string 9",
  "submissionClarificationCode": "sample string 10",
  "claimDate": "2025-05-30T21:24:24.0152978-05:00",
  "reversed": true,
  "reversedDate": "2025-05-30T21:24:24.0152978-05:00",
  "dateOfService": "2025-05-30T21:24:24.0152978-05:00",
  "datePrescriptionWritten": "2025-05-30T21:24:24.0152978-05:00",
  "quantityDispensed": 1.0,
  "daysSupply": 1,
  "drugName": "sample string 12",
  "genericName": "sample string 13",
  "strengthDescription": "sample string 14",
  "dosageFormDescription": "sample string 15",
  "routeOfAdministrationDescription": "sample string 16",
  "genericProductIdentifier": "sample string 17",
  "isMultiSourced": true,
  "multiSourceCode": "sample string 18",
  "deaClassCode": "sample string 19",
  "isRx": true,
  "ndc": "sample string 20",
  "ingredientCostPaid": 1.0,
  "dispensingFeePaid": 1.0,
  "incentiveAmountPaid": 1.0,
  "professionalServiceFeePaid": 1.0,
  "flatSalesTaxAmountPaid": 1.0,
  "percentageSalesTaxAmountPaid": 1.0,
  "percentageSalesTaxRatePaid": 1.0,
  "pharmacyPrice": 1.0,
  "amountOfCoPay": 1.0,
  "amountOfCoInsurance": 1.0,
  "drugSelectionPenalty": 1.0,
  "amountExceedingPeriodicBenefitMaximum": 1.0,
  "totalAmountPaid": 1.0,
  "patientPayAmount": 1.0,
  "grossAmountDue": 1.0,
  "secondaryPayer": true,
  "cobAmount": 1.0,
  "deductibleDescription": "sample string 21",
  "moopDescription": "sample string 22",
  "planIncentiveDescription": "sample string 23",
  "benefitCodeDescription": "sample string 24",
  "pharmacyNPI": "sample string 25",
  "pharmacyLocationName": "sample string 26",
  "prescriberID": "sample string 27",
  "prescriberName": "sample string 28",
  "amountAppliedToPeriodicDeductible": 1.0,
  "pricingMethod": "sample string 29",
  "pricingMethodDetail": "sample string 30",
  "therapeuticClass02": "sample string 31",
  "therapeuticClass04": "sample string 32",
  "therapeuticClass06": "sample string 33",
  "therapeuticClass08": "sample string 34",
  "therapeuticClass10": "sample string 35",
  "therapeuticClass12": "sample string 36",
  "therapeuticClass14": "sample string 37",
  "brandNameCode": "sample string 38",
  "planPricingGroup": "sample string 39",
  "enforcedRules": "sample string 40",
  "primaryRules": [
    {
      "ruleType": "sample string 1",
      "description": "sample string 2",
      "ruleActionType": "sample string 3",
      "enforced": true,
      "usedDAW": true,
      "overriden": true,
      "processingEnded": true,
      "note": "sample string 7",
      "sortKey": 8
    },
    {
      "ruleType": "sample string 1",
      "description": "sample string 2",
      "ruleActionType": "sample string 3",
      "enforced": true,
      "usedDAW": true,
      "overriden": true,
      "processingEnded": true,
      "note": "sample string 7",
      "sortKey": 8
    }
  ],
  "secondaryRules": [
    {
      "ruleType": "sample string 1",
      "description": "sample string 2",
      "ruleActionType": "sample string 3",
      "enforced": true,
      "usedDAW": true,
      "overriden": true,
      "processingEnded": true,
      "note": "sample string 7",
      "sortKey": 8
    },
    {
      "ruleType": "sample string 1",
      "description": "sample string 2",
      "ruleActionType": "sample string 3",
      "enforced": true,
      "usedDAW": true,
      "overriden": true,
      "processingEnded": true,
      "note": "sample string 7",
      "sortKey": 8
    }
  ],
  "additionalMessageInfo": [
    {
      "messageInfo": "sample string 1"
    },
    {
      "messageInfo": "sample string 1"
    }
  ],
  "rejectInfo": [
    {
      "rejectCode": "sample string 1",
      "messageInfo": "sample string 2"
    },
    {
      "rejectCode": "sample string 1",
      "messageInfo": "sample string 2"
    }
  ],
  "isManualClaim": true
}