| Name | Description | Type | Additional information |
|---|---|---|---|
| EndProcessing |
Gets or sets whether more benefit rules are processed if all criteria has been met |
boolean |
None. |
| SpecialCoinsuranceUrl |
Gets or sets the link to the coinsurance resource for the rule |
string |
None. |
| SpecialCoinsuranceNo |
Gets or sets the identifier for the coinsurance |
integer |
None. |
| SpecialOutOfPocketCoinsuranceUrl |
Gets or sets the link to the out of pocket coinsurance resource for the rule |
string |
None. |
| SpecialOutOfPocketCoinsuranceNo |
Gets or sets the identifier for the out of pocket coinsurance |
integer |
None. |
| SpecialPlanBenefitLimitMonthUrl |
Gets or sets the link to the monthly plan benefit limit resource for the rule |
string |
None. |
| SpecialPlanBenefitLimitMonthNo |
Gets or sets the monthly plan benefit limit identifier |
integer |
None. |
| SpecialPlanBenefitLimitPeriodUrl |
Gets or sets the link to the periodic plan benefit limit resource for the rule |
string |
None. |
| SpecialPlanBenefitLimitPeriodNo |
Gets or sets the periodic plan benefit limit identifier |
integer |
None. |
| SpecialPlanBenefitLimitLifeUrl |
Gets or sets the link to the lifetime plan benefit limit resource for the rule |
string |
None. |
| SpecialPlanBenefitLimitLifeNo |
Gets or sets the lifetime plan benefit limit identifier |
integer |
None. |
| SpecialPlanBenefitLimitRxOnlyMonthUrl |
Gets or sets the link to the Rx only monthly plan benefit limit resource |
string |
None. |
| SpecialPlanBenefitLimitRxOnlyMonthNo |
Gets or sets the Rx only monthly plan benefit limit identifier |
integer |
None. |
| SpecialPlanBenefitLimitRxOnlyPeriodUrl |
Gets or sets the link to the Rx only periodic plan benefit limit resource |
string |
None. |
| SpecialPlanBenefitLimitRxOnlyPeriodNo |
Gets or sets the Rx only periodic plan benefit limit identifier |
integer |
None. |
| SpecialPlanBenefitLimitRxOnlyLifeUrl |
Gets or sets the link to the Rx only lifetime plan benefit limit resource |
string |
None. |
| SpecialPlanBenefitLimitRxOnlyLifeNo |
Gets or sets the Rx only lifetime plan benefit limit identifier |
integer |
None. |
| SpecialPlanIncentiveUrl |
Gets or sets the link back to the incentive resource for special drugs for the rule |
string |
None. |
| SpecialPlanIncentiveNo |
Gets or sets the plan incentive identifier for special drugs |
integer |
None. |
| SpecialPeriodDeductibleUrl |
Gets or sets the link to the periodic deductible resource for the rule |
string |
None. |
| SpecialPeriodDeductibleNo |
Gets or sets the periodic deductible identifier |
integer |
None. |
| SpecialPeriodMaxOutOfPocketUrl |
Gets or sets the link to the periodic max out of pocket resource for the rule |
string |
None. |
| SpecialPeriodMaxOutOfPocketNo |
Gets or sets the periodic max out of pocket identifier |
integer |
None. |
| SpecialMonthlyDeductibleUrl |
Gets or sets the link to the monthly deductible resource for the rule |
string |
None. |
| SpecialMonthlyDeductibleNo |
Gets or sets the monthly deductible identifier |
integer |
None. |
| SpecialMonthlyMaxOutOfPocketUrl |
Gets or sets the link to the monthly max out of pocket resource |
string |
None. |
| SpecialMonthlyMaxOutOfPocketNo |
Gets or sets the monthly max out of pocket identifier |
integer |
None. |
| PharmacyPriceMin |
Gets or sets the minimum pharmacy price in order for the rule to apply |
decimal number |
None. |
| PharmacyPriceMax |
Gets or sets the minimum pharmacy price in order for the rule to apply |
decimal number |
None. |
| PharmacyPricePreTax |
Gets or sets the option for whether the pharmacy price range is the pre-tax amount |
boolean |
None. |
| PharmacyPriceCentsMin |
Gets or sets the minimum cents portion of the pharmacy price in order for the rule to apply |
decimal number |
None. |
| PharmacyPriceCentsMax |
Gets or sets the maximum cents portion of the pharmacy price in order for the rule to apply |
decimal number |
None. |
| PharmacyPriceCentsPreTax |
Gets or sets the option for whether the cents portion of the pharmacy price range is the pre-tax amount |
boolean |
None. |
| FirstFillByRx |
Gets or sets whether the rule applies to first fills |
boolean |
None. |
| RefillExpired |
Gets or sets whether the rule applies for expired refills (based on plan's Rx Expire Days) |
boolean |
None. |
| DiagnosisCodes |
Gets or sets the DiagnosisCodes for which the rule applies |
Collection of RuleDiagnosisCodeModel |
None. |
| Members |
Gets or sets members for which the rule applies; if the list is empty it applies to all |
Collection of RuleMemberModel |
None. |
| Networks |
Gets or sets networks for which the rule applies; if the list is empty it applies to all |
Collection of RuleNetworkModel |
None. |
| Headquarters |
Gets or sets headquarters for which the rule applies; if the list is empty it applies to all |
Collection of RulePharmacyHeadquarterModel |
None. |
| Pharmacies |
Gets or sets pharmacies for which the rule applies; if the list is empty it applies to all |
Collection of RulePharmacyModel |
None. |
| Prescribers |
Gets or sets prescribers for which the rule applies; if the list is empty it applies to all |
Collection of RulePrescriberModel |
None. |
| Facilities |
Gets or sets the Facilities for which the rule applies |
Collection of RuleFacilityBranchModel |
None. |
| ExemptFromDeductible |
Gets or sets the Exempt from Deductible indicator |
boolean |
None. |
| ExemptFromOutOfPocketLimit |
Gets or sets the Exempt from Out of Pocket Limit indicator |
boolean |
None. |
| ApplyCoinsuranceAsDeductible |
Gets or sets the Apply Coinsurance as Deductible indicator |
boolean |
None. |
| QuantityMin |
Gets or sets the minimum quantity in order for the rule to apply |
decimal number |
None. |
| QuantityMax |
Gets or sets the maximum quantity in order for the rule to apply |
decimal number |
None. |
| CompoundDrugs |
Gets whether the special drug criteria applies to compound drugs |
boolean |
None. |
| UnknownDrugs |
Gets whether the special drug criteria applies to unknown drugs |
boolean |
None. |
| UndefinedDrugs |
Gets whether the special drug criteria applies to undefined drugs |
boolean |
None. |
| CompoundLevelOfEffort |
Gets level of effort values applicable to the special drug criteria |
Collection of LevelOfEffortModel |
None. |
| GroupPlanNo |
Gets or sets the group plan id associated with the rule |
integer |
None. |
| Description |
Gets or sets the description |
string |
None. |
| Priority |
Gets or sets the priority |
integer |
None. |
| ReferenceCode |
Gets or sets the reference code |
string |
None. |
| Message |
Gets or sets the message |
string |
None. |
| ChangeNote |
Gets the latest change note or sets a change note to be saved on a patch |
string |
None. |
| EffectiveStartDate |
Gets or sets the effective start date |
date |
None. |
| EffectiveEndDate |
Gets or sets the effective end date |
date |
None. |
| Active |
Gets or sets whether the rule is active |
boolean |
None. |
| DaysSupplyMin |
Gets or sets the minimum days supply in order for the rule to apply |
integer |
None. |
| DaysSupplyMax |
Gets or sets the maximum days supply in order for the rule to apply |
integer |
None. |
| MemberAgeMin |
Gets or sets the minimum age of the member in order for the rule to apply |
integer |
None. |
| MemberAgeMax |
Gets or sets the maximum age of the member in order for the rule to apply |
integer |
None. |
| MemberAgeUnits |
Gets or sets the age units. |
string |
None. |
| DependentRelationshipCodes |
Gets or sets the dependent relationship code as a delimited list for which the rule applies. |
Collection of RelationshipModel |
None. |
| ServiceCategory |
Gets or sets the service category |
string |
None. |
| MemberGender |
Gets or sets the gender (if necessary) for which the rule applies |
string |
None. |
| PharmacyTypes |
Gets or sets the list of acceptable pharmacy types |
Collection of RulePharmacyTypeModel |
None. |
| SubmissionClarificationCodeCriteriaType |
Gets or sets the rule's submission clarification code match criteria if applicable (possible values: Blank, Match, n/a) |
string |
None. |
| SubmissionClarificationCodes |
Gets or sets the submission clarification codes for which the rule applies (This list is only used if SubmissionClarificationCodeCriteriaType is set to match) |
Collection of RuleSubmissionClarificationCodeModel |
None. |
| PharmacyServiceTypeCriteriaType |
Gets or sets the pharmacy service criteria type |
string |
None. |
| PharmacyServiceType |
Gets or sets the pharmacy service value. Uses standarded NCPDP values. |
string |
None. |
| PatientResidenceCriteriaType |
Gets or sets the patient residence criteria type |
string |
None. |
| PatientResidence |
Gets or sets the patient residence value. Uses standarded NCPDP values. |
string |
None. |
| PlaceOfServiceCriteriaType |
Gets or sets the place of service criteria type |
string |
None. |
| PlaceOfService |
Gets or sets the place of service value. Uses standarded NCPDP values. |
string |
None. |
| BenefitCodeUrl |
Gets or sets the Benefit Code Url |
string |
None. |
| BenefitCodeNo |
Gets or sets the Benefit Code number |
integer |
None. |
| PriorFillsGPIChars |
Gets or sets the Prior Fills GPI Chars |
string |
None. |
| DiagnosisCodeCriteriaType |
Gets or sets the rule's submission clarification code match criteria if applicable (possible values: Blank, Match, n/a) |
string |
None. |
| DAWCodes |
Gets or sets the acceptable DAW code values that apply to the rule |
Collection of DAWCodeModel |
None. |
| ContractCodes |
Gets or sets the list of contract codes associated with the general criteria |
Collection of RuleContractCodeModel |
None. |
| ARCodes |
Gets or sets the list of AR codes associated with the general criteria |
Collection of RuleARCodeModel |
None. |
| CoverageLevels |
Gets or sets the coverage levels associated with the general criteria |
Collection of RuleCoverageLevelModel |
None. |
| EmployeeStatuses |
Gets or sets the list of employee statuses associated with the general criteria |
Collection of RuleEmployeeStatusModel |
None. |
| OtherStatuses |
Gets or sets the list of other statuses associated with the general criteria |
Collection of RuleOtherStatusModel |
None. |
| PharmacyStates |
Gets or sets the list of US States associated with the general criteria |
Collection of RuleStateModel |
None. |
| isTemplate |
Gets or sets whether the rule is a template |
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. |