POST api/networkplans
Request Information
URI Parameters
None.
Body Parameters
NetworkPlanModelName | Description | Type | Additional information |
---|---|---|---|
DeductiblesUrl |
Gets or sets the link to the Deductibles resource for the plan |
string |
None. |
PlanIncentivesUrl |
Gets or sets the link to the Plan Incentive resource for the plan |
string |
None. |
PlanPricingGroupsUrl |
Gets or sets the link to the Plan Pricing Groups resource for the plan |
string |
None. |
PlanName |
Gets or sets the name given to represent the Plan |
string |
None. |
Description |
Gets or sets the description given to represent the plan |
string |
None. |
MaxClaimDays |
Gets or sets the maximum number of days the plan allows for submitting a claim based on the date of service |
integer |
None. |
MaxReversalDays |
Gets or sets the maximum number days the plan allows for reversing a claim |
integer |
None. |
DefaultDrugTier |
Gets or sets the the default Tier captured if not specified on the formulary (obsolete) |
byte |
None. |
EnforceFormularyLimits |
Gets or sets the option to enforce formulary limits (obsolete) |
boolean |
None. |
StandardMessage |
Gets or sets the standard message in the claim header |
string |
None. |
ApproveMessage |
Gets or sets the approve message in the claim header when claim is paid |
string |
None. |
RequiredOverrideMessage |
Gets or sets the prior authorization message in the claim header when drug requires a PA |
string |
None. |
NotCoveredMessage |
Gets or sets the not covered message in the claim header when drug is not covered |
string |
None. |
OutOfPocketMessage |
Gets or sets the out of pocket message in the claim header when out of pocket limit has been reached |
string |
None. |
UnknownDispenseFee |
Gets or sets the the catch-all dispense fee for the plan (obsolete) |
decimal number |
None. |
UnknownUseSubmittedDispenseFee |
Gets or sets whether to use the submitted dispense fee for unknown/undefined drugs (obsolete) |
boolean |
None. |
UnknownUseUsualAndCustomary |
Gets or sets whether to use Usual and Customary for unknown/undefined drugs (obsolete) |
boolean |
None. |
UnknownUseGrossAmountDue |
Gets or sets whether to use Gross Amount Due for unknown/undefined drugs (obsolete) |
boolean |
None. |
UnknownCoinsuranceUrl |
Gets or sets the link to the Coinsurance resource for unkown or undefined drugs |
string |
None. |
UnknownCoinsuranceNo |
Gets or sets the identifier for the Copay/Coinsurance used for unknown or undefined drugs |
integer |
None. |
UnknownOutOfPocketCoinsuranceUrl |
Gets or sets the link to the Coinsurance resource for unkown or undefined drugs after out of pocket limits have been reached |
string |
None. |
UnknownOutOfPocketCoinsuranceNo |
Gets or sets the link to the identifier for the Copay/Coinsurance used for unknown or undefined drugs after out of pocket limits have been reached |
integer |
None. |
CompoundPriceSubmittedDrugs |
Gets or sets the whether the plan will price each drug of a compound |
boolean |
None. |
CompoundRequireValidNDC |
Gets or sets whether a valid NDC must be used in a compound claim |
boolean |
None. |
CompoundMinimumDrugsToPrice |
Gets or sets the minimum number of drugs to price in the compound |
byte |
None. |
CompoundMaxDrugsToPrice |
Gets or sets the maximum number of drugs to price in the compound (blank or null means all will be priced) |
byte |
None. |
CompoundMinimumPrice |
Gets or sets the minimum indgredient cost for the compound |
decimal number |
None. |
CompoundDefaultFee |
Gets or sets the default dispense fee to be applied for a compound (level of effort 0) |
decimal number |
None. |
CompoundEffort1Fee |
Gets or sets the dispense fee for level of effort 1 |
decimal number |
None. |
CompoundEffort2Fee |
Gets or sets the dispense fee for level of effort 2 |
decimal number |
None. |
CompoundEffort3Fee |
Gets or sets the dispense fee for level of effort 3 |
decimal number |
None. |
CompoundEffort4Fee |
Gets or sets the dispense fee for level of effort 4 |
decimal number |
None. |
CompoundEffort5Fee |
Gets or sets the dispense fee for level of effort 5 |
decimal number |
None. |
CompoundUseSubmittedDispenseFee |
Gets or sets the indicates whether to use the submitted dispense fee from the pharmacy for the compound |
boolean |
None. |
CompoundUseUsualAndCustomary |
Gets or sets the indicates whether to use the submitted Usual and Customary price from the pharmacy for the compound |
boolean |
None. |
CompoundUseGrossAmountDue |
Gets or sets the indicates whether to use the Gross Amount Due price from the pharmacy for the compound |
boolean |
None. |
CompoundCoinsuranceUrl |
Gets or sets the link to the Coinsurance resource for compound drugs |
string |
None. |
CompoundCoinsuranceNo |
Gets or sets the identifier for the Copay/Coinsurance used for compounds |
integer |
None. |
CompoundOutOfPocketCoinsuranceUrl |
Gets or sets the link to the Coinsurance resource for compound drugs after out of pocket limits have been reached |
string |
None. |
CompoundOutOfPocketCoinsuranceNo |
Gets or sets the identifier for the Copay/Coinsurance used for compounds after out of pocket limits have been reached |
integer |
None. |
CompoundDrugPricingUrl |
Gets or sets the link to the Drug Pricing resource for compound drugs |
string |
None. |
CompoundDrugPricingNo |
Gets or sets the identifier of the special drug pricing for a compound. |
integer |
None. |
AltCompoundDrugPricingNo |
Gets or sets the identifier representing the Alternate compound pricing option (If two options are defined, then the lower pricing option will be used) |
integer |
None. |
AltCompoundDrugPricingUrl |
Gets or sets the link to the Alt Drug Pricing resource for compound drugs |
string |
None. |
UnknownDrugPricingUrl |
Gets or sets the link to the Drug Pricing resource for unknown/undefined drugs |
string |
None. |
UnknownDrugPricingNo |
Gets or sets the identifier of the special drug pricing for an unknown/undefined drug. |
integer |
None. |
DURDrugDrugCheck | boolean |
None. |
|
DURDrugDrugLevel | string |
None. |
|
DURDrugDrugMessage | string |
None. |
|
DURDrugDrugActionTypeNo | integer |
None. |
|
MMEActionTypeNo |
Gets or sets the action to take when threshold is exceeded |
integer |
None. |
MMEThresholdCheck |
Gets or sets whether the system will determine if the patient is exceeding the daily dosage threshold for opioid medications |
boolean |
None. |
MMEThreshold |
Gets or sets the daily dosage threshold for opioid medications |
integer |
None. |
MMEResponseMessage |
Gets or sets the message to send in the claim response when MME Threshold is exceeded |
string |
None. |
TemplateOverrideOptions |
Gets or sets whether the plan overrides the template options when deriving from a Group Template |
boolean |
None. |
TemplateOverrideMessages |
Gets or sets whether the plan overrides the template messages when deriving from a Group Template |
boolean |
None. |
TemplateOverridePrescriptionEdits |
Gets or sets whether the plan overrides the template prescription edits when deriving from a Group Template |
boolean |
None. |
TemplateOverrideDUR |
Gets or sets whether the plan overrides the template DUR options when deriving from a Group Template |
boolean |
None. |
TemplateOverrideCompoundPricing |
Gets or sets whether the plan overrides the template compound pricing options when deriving from a Group Template |
boolean |
None. |
TemplateOverrideUnknownPricing |
Gets or sets whether the plan overrides the template unkown/undefined drug pricing options when deriving from a Group Template |
boolean |
None. |
TemplateOverrideFormulary |
Gets or sets whether the plan overrides the template formulary options when deriving from a Group Template |
boolean |
None. |
TemplateOverrideGlobalPricing |
Gets or sets whether the plan overrides the template Location/Global pricing when deriving from a Group Template |
boolean |
None. |
SubscribeToGlobalPricingACI |
Gets or sets whether the plan subscribes to Location/Global ACI pricing |
boolean |
None. |
SubscribeToGlobalPricingAcqCost |
Gets or sets whether the plan subscribes to Location/Global acquisition pricing |
boolean |
None. |
SubscribeToGlobalPricingCustomMAC |
Gets or sets whether the plan subscribes to Location/Global Custom MAC pricing |
boolean |
None. |
SubscribeToGlobalPricingRefPrice |
Gets or sets whether the plan subscribes to Location/Global reference pricing |
boolean |
None. |
PrescriberGraceDays |
Gets or sets the Prescriber Grace Days to be used in conjuction with prescriber effective dates in rules. If a prescriber's effective date has expired, but the grace period has not been exceeded, the claim will continue processing. |
integer |
None. |
EligibilityRejectMessage |
Get or sets the message for eligibility rejects |
string |
None. |
PrescriptionWrittenMaxDays |
Maximum number of days a prescription is valid from the date written |
integer |
None. |
RejectClaimIfNoCustomPrice |
Gets or sets whether claims should reject if there is no custom pricing |
boolean |
None. |
PlanTemplateNo |
Gets or sets the Plan Template from which this plan inherits |
integer |
None. |
PlanTemplateUrl |
Gets or sets the link to the Plan Template resource for this plan |
string |
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. |
Request Formats
application/json, text/json, application/json-patch+json
{ "url": "sample string 23", "id": 24, "deductiblesUrl": "sample string 1", "planIncentivesUrl": "sample string 2", "planPricingGroupsUrl": "sample string 3", "planName": "sample string 4", "description": "sample string 5", "maxClaimDays": 1, "maxReversalDays": 1, "defaultDrugTier": 64, "enforceFormularyLimits": true, "standardMessage": "sample string 6", "approveMessage": "sample string 7", "requiredOverrideMessage": "sample string 8", "notCoveredMessage": "sample string 9", "outOfPocketMessage": "sample string 10", "unknownDispenseFee": 1.0, "unknownUseSubmittedDispenseFee": true, "unknownUseUsualAndCustomary": true, "unknownUseGrossAmountDue": true, "unknownCoinsuranceUrl": "sample string 11", "unknownCoinsuranceNo": 1, "unknownOutOfPocketCoinsuranceUrl": "sample string 12", "unknownOutOfPocketCoinsuranceNo": 1, "compoundPriceSubmittedDrugs": true, "compoundRequireValidNDC": true, "compoundMinimumDrugsToPrice": 64, "compoundMaxDrugsToPrice": 64, "compoundMinimumPrice": 1.0, "compoundDefaultFee": 1.0, "compoundEffort1Fee": 1.0, "compoundEffort2Fee": 1.0, "compoundEffort3Fee": 1.0, "compoundEffort4Fee": 1.0, "compoundEffort5Fee": 1.0, "compoundUseSubmittedDispenseFee": true, "compoundUseUsualAndCustomary": true, "compoundUseGrossAmountDue": true, "compoundCoinsuranceUrl": "sample string 13", "compoundCoinsuranceNo": 1, "compoundOutOfPocketCoinsuranceUrl": "sample string 14", "compoundOutOfPocketCoinsuranceNo": 1, "compoundDrugPricingUrl": "sample string 15", "compoundDrugPricingNo": 1, "altCompoundDrugPricingNo": 1, "altCompoundDrugPricingUrl": "sample string 16", "unknownDrugPricingUrl": "sample string 17", "unknownDrugPricingNo": 1, "durDrugDrugCheck": true, "durDrugDrugLevel": "sample string 18", "durDrugDrugMessage": "sample string 19", "durDrugDrugActionTypeNo": 1, "mmeActionTypeNo": 1, "mmeThresholdCheck": true, "mmeThreshold": 1, "mmeResponseMessage": "sample string 20", "templateOverrideOptions": true, "templateOverrideMessages": true, "templateOverridePrescriptionEdits": true, "templateOverrideDUR": true, "templateOverrideCompoundPricing": true, "templateOverrideUnknownPricing": true, "templateOverrideFormulary": true, "templateOverrideGlobalPricing": true, "subscribeToGlobalPricingACI": true, "subscribeToGlobalPricingAcqCost": true, "subscribeToGlobalPricingCustomMAC": true, "subscribeToGlobalPricingRefPrice": true, "prescriberGraceDays": 1, "eligibilityRejectMessage": "sample string 21", "prescriptionWrittenMaxDays": 1, "rejectClaimIfNoCustomPrice": true, "planTemplateNo": 1, "planTemplateUrl": "sample string 22" }
application/x-www-form-urlencoded
Sample not available.
Response Information
Resource Description
NetworkPlanModelName | Description | Type | Additional information |
---|---|---|---|
DeductiblesUrl |
Gets or sets the link to the Deductibles resource for the plan |
string |
None. |
PlanIncentivesUrl |
Gets or sets the link to the Plan Incentive resource for the plan |
string |
None. |
PlanPricingGroupsUrl |
Gets or sets the link to the Plan Pricing Groups resource for the plan |
string |
None. |
PlanName |
Gets or sets the name given to represent the Plan |
string |
None. |
Description |
Gets or sets the description given to represent the plan |
string |
None. |
MaxClaimDays |
Gets or sets the maximum number of days the plan allows for submitting a claim based on the date of service |
integer |
None. |
MaxReversalDays |
Gets or sets the maximum number days the plan allows for reversing a claim |
integer |
None. |
DefaultDrugTier |
Gets or sets the the default Tier captured if not specified on the formulary (obsolete) |
byte |
None. |
EnforceFormularyLimits |
Gets or sets the option to enforce formulary limits (obsolete) |
boolean |
None. |
StandardMessage |
Gets or sets the standard message in the claim header |
string |
None. |
ApproveMessage |
Gets or sets the approve message in the claim header when claim is paid |
string |
None. |
RequiredOverrideMessage |
Gets or sets the prior authorization message in the claim header when drug requires a PA |
string |
None. |
NotCoveredMessage |
Gets or sets the not covered message in the claim header when drug is not covered |
string |
None. |
OutOfPocketMessage |
Gets or sets the out of pocket message in the claim header when out of pocket limit has been reached |
string |
None. |
UnknownDispenseFee |
Gets or sets the the catch-all dispense fee for the plan (obsolete) |
decimal number |
None. |
UnknownUseSubmittedDispenseFee |
Gets or sets whether to use the submitted dispense fee for unknown/undefined drugs (obsolete) |
boolean |
None. |
UnknownUseUsualAndCustomary |
Gets or sets whether to use Usual and Customary for unknown/undefined drugs (obsolete) |
boolean |
None. |
UnknownUseGrossAmountDue |
Gets or sets whether to use Gross Amount Due for unknown/undefined drugs (obsolete) |
boolean |
None. |
UnknownCoinsuranceUrl |
Gets or sets the link to the Coinsurance resource for unkown or undefined drugs |
string |
None. |
UnknownCoinsuranceNo |
Gets or sets the identifier for the Copay/Coinsurance used for unknown or undefined drugs |
integer |
None. |
UnknownOutOfPocketCoinsuranceUrl |
Gets or sets the link to the Coinsurance resource for unkown or undefined drugs after out of pocket limits have been reached |
string |
None. |
UnknownOutOfPocketCoinsuranceNo |
Gets or sets the link to the identifier for the Copay/Coinsurance used for unknown or undefined drugs after out of pocket limits have been reached |
integer |
None. |
CompoundPriceSubmittedDrugs |
Gets or sets the whether the plan will price each drug of a compound |
boolean |
None. |
CompoundRequireValidNDC |
Gets or sets whether a valid NDC must be used in a compound claim |
boolean |
None. |
CompoundMinimumDrugsToPrice |
Gets or sets the minimum number of drugs to price in the compound |
byte |
None. |
CompoundMaxDrugsToPrice |
Gets or sets the maximum number of drugs to price in the compound (blank or null means all will be priced) |
byte |
None. |
CompoundMinimumPrice |
Gets or sets the minimum indgredient cost for the compound |
decimal number |
None. |
CompoundDefaultFee |
Gets or sets the default dispense fee to be applied for a compound (level of effort 0) |
decimal number |
None. |
CompoundEffort1Fee |
Gets or sets the dispense fee for level of effort 1 |
decimal number |
None. |
CompoundEffort2Fee |
Gets or sets the dispense fee for level of effort 2 |
decimal number |
None. |
CompoundEffort3Fee |
Gets or sets the dispense fee for level of effort 3 |
decimal number |
None. |
CompoundEffort4Fee |
Gets or sets the dispense fee for level of effort 4 |
decimal number |
None. |
CompoundEffort5Fee |
Gets or sets the dispense fee for level of effort 5 |
decimal number |
None. |
CompoundUseSubmittedDispenseFee |
Gets or sets the indicates whether to use the submitted dispense fee from the pharmacy for the compound |
boolean |
None. |
CompoundUseUsualAndCustomary |
Gets or sets the indicates whether to use the submitted Usual and Customary price from the pharmacy for the compound |
boolean |
None. |
CompoundUseGrossAmountDue |
Gets or sets the indicates whether to use the Gross Amount Due price from the pharmacy for the compound |
boolean |
None. |
CompoundCoinsuranceUrl |
Gets or sets the link to the Coinsurance resource for compound drugs |
string |
None. |
CompoundCoinsuranceNo |
Gets or sets the identifier for the Copay/Coinsurance used for compounds |
integer |
None. |
CompoundOutOfPocketCoinsuranceUrl |
Gets or sets the link to the Coinsurance resource for compound drugs after out of pocket limits have been reached |
string |
None. |
CompoundOutOfPocketCoinsuranceNo |
Gets or sets the identifier for the Copay/Coinsurance used for compounds after out of pocket limits have been reached |
integer |
None. |
CompoundDrugPricingUrl |
Gets or sets the link to the Drug Pricing resource for compound drugs |
string |
None. |
CompoundDrugPricingNo |
Gets or sets the identifier of the special drug pricing for a compound. |
integer |
None. |
AltCompoundDrugPricingNo |
Gets or sets the identifier representing the Alternate compound pricing option (If two options are defined, then the lower pricing option will be used) |
integer |
None. |
AltCompoundDrugPricingUrl |
Gets or sets the link to the Alt Drug Pricing resource for compound drugs |
string |
None. |
UnknownDrugPricingUrl |
Gets or sets the link to the Drug Pricing resource for unknown/undefined drugs |
string |
None. |
UnknownDrugPricingNo |
Gets or sets the identifier of the special drug pricing for an unknown/undefined drug. |
integer |
None. |
DURDrugDrugCheck | boolean |
None. |
|
DURDrugDrugLevel | string |
None. |
|
DURDrugDrugMessage | string |
None. |
|
DURDrugDrugActionTypeNo | integer |
None. |
|
MMEActionTypeNo |
Gets or sets the action to take when threshold is exceeded |
integer |
None. |
MMEThresholdCheck |
Gets or sets whether the system will determine if the patient is exceeding the daily dosage threshold for opioid medications |
boolean |
None. |
MMEThreshold |
Gets or sets the daily dosage threshold for opioid medications |
integer |
None. |
MMEResponseMessage |
Gets or sets the message to send in the claim response when MME Threshold is exceeded |
string |
None. |
TemplateOverrideOptions |
Gets or sets whether the plan overrides the template options when deriving from a Group Template |
boolean |
None. |
TemplateOverrideMessages |
Gets or sets whether the plan overrides the template messages when deriving from a Group Template |
boolean |
None. |
TemplateOverridePrescriptionEdits |
Gets or sets whether the plan overrides the template prescription edits when deriving from a Group Template |
boolean |
None. |
TemplateOverrideDUR |
Gets or sets whether the plan overrides the template DUR options when deriving from a Group Template |
boolean |
None. |
TemplateOverrideCompoundPricing |
Gets or sets whether the plan overrides the template compound pricing options when deriving from a Group Template |
boolean |
None. |
TemplateOverrideUnknownPricing |
Gets or sets whether the plan overrides the template unkown/undefined drug pricing options when deriving from a Group Template |
boolean |
None. |
TemplateOverrideFormulary |
Gets or sets whether the plan overrides the template formulary options when deriving from a Group Template |
boolean |
None. |
TemplateOverrideGlobalPricing |
Gets or sets whether the plan overrides the template Location/Global pricing when deriving from a Group Template |
boolean |
None. |
SubscribeToGlobalPricingACI |
Gets or sets whether the plan subscribes to Location/Global ACI pricing |
boolean |
None. |
SubscribeToGlobalPricingAcqCost |
Gets or sets whether the plan subscribes to Location/Global acquisition pricing |
boolean |
None. |
SubscribeToGlobalPricingCustomMAC |
Gets or sets whether the plan subscribes to Location/Global Custom MAC pricing |
boolean |
None. |
SubscribeToGlobalPricingRefPrice |
Gets or sets whether the plan subscribes to Location/Global reference pricing |
boolean |
None. |
PrescriberGraceDays |
Gets or sets the Prescriber Grace Days to be used in conjuction with prescriber effective dates in rules. If a prescriber's effective date has expired, but the grace period has not been exceeded, the claim will continue processing. |
integer |
None. |
EligibilityRejectMessage |
Get or sets the message for eligibility rejects |
string |
None. |
PrescriptionWrittenMaxDays |
Maximum number of days a prescription is valid from the date written |
integer |
None. |
RejectClaimIfNoCustomPrice |
Gets or sets whether claims should reject if there is no custom pricing |
boolean |
None. |
PlanTemplateNo |
Gets or sets the Plan Template from which this plan inherits |
integer |
None. |
PlanTemplateUrl |
Gets or sets the link to the Plan Template resource for this plan |
string |
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
{ "url": "sample string 23", "id": 24, "deductiblesUrl": "sample string 1", "planIncentivesUrl": "sample string 2", "planPricingGroupsUrl": "sample string 3", "planName": "sample string 4", "description": "sample string 5", "maxClaimDays": 1, "maxReversalDays": 1, "defaultDrugTier": 64, "enforceFormularyLimits": true, "standardMessage": "sample string 6", "approveMessage": "sample string 7", "requiredOverrideMessage": "sample string 8", "notCoveredMessage": "sample string 9", "outOfPocketMessage": "sample string 10", "unknownDispenseFee": 1.0, "unknownUseSubmittedDispenseFee": true, "unknownUseUsualAndCustomary": true, "unknownUseGrossAmountDue": true, "unknownCoinsuranceUrl": "sample string 11", "unknownCoinsuranceNo": 1, "unknownOutOfPocketCoinsuranceUrl": "sample string 12", "unknownOutOfPocketCoinsuranceNo": 1, "compoundPriceSubmittedDrugs": true, "compoundRequireValidNDC": true, "compoundMinimumDrugsToPrice": 64, "compoundMaxDrugsToPrice": 64, "compoundMinimumPrice": 1.0, "compoundDefaultFee": 1.0, "compoundEffort1Fee": 1.0, "compoundEffort2Fee": 1.0, "compoundEffort3Fee": 1.0, "compoundEffort4Fee": 1.0, "compoundEffort5Fee": 1.0, "compoundUseSubmittedDispenseFee": true, "compoundUseUsualAndCustomary": true, "compoundUseGrossAmountDue": true, "compoundCoinsuranceUrl": "sample string 13", "compoundCoinsuranceNo": 1, "compoundOutOfPocketCoinsuranceUrl": "sample string 14", "compoundOutOfPocketCoinsuranceNo": 1, "compoundDrugPricingUrl": "sample string 15", "compoundDrugPricingNo": 1, "altCompoundDrugPricingNo": 1, "altCompoundDrugPricingUrl": "sample string 16", "unknownDrugPricingUrl": "sample string 17", "unknownDrugPricingNo": 1, "durDrugDrugCheck": true, "durDrugDrugLevel": "sample string 18", "durDrugDrugMessage": "sample string 19", "durDrugDrugActionTypeNo": 1, "mmeActionTypeNo": 1, "mmeThresholdCheck": true, "mmeThreshold": 1, "mmeResponseMessage": "sample string 20", "templateOverrideOptions": true, "templateOverrideMessages": true, "templateOverridePrescriptionEdits": true, "templateOverrideDUR": true, "templateOverrideCompoundPricing": true, "templateOverrideUnknownPricing": true, "templateOverrideFormulary": true, "templateOverrideGlobalPricing": true, "subscribeToGlobalPricingACI": true, "subscribeToGlobalPricingAcqCost": true, "subscribeToGlobalPricingCustomMAC": true, "subscribeToGlobalPricingRefPrice": true, "prescriberGraceDays": 1, "eligibilityRejectMessage": "sample string 21", "prescriptionWrittenMaxDays": 1, "rejectClaimIfNoCustomPrice": true, "planTemplateNo": 1, "planTemplateUrl": "sample string 22" }