RuleGeneralOptionModel

Gets or sets whether more benefit rules are processed if all criteria has been met

Gets or sets the pharmacy tier to be applied if the rule is enforced

Gets or sets whether to reject claim if flat tax is submitted

Gets or sets whether to only use the group plan

Gets or sets whether to process as short cycle, if eligible and rule is enforced

Gets or sets whether to send remit to pharmacy if rule is enforced

Gets or sets the days supply grace days allowed if the rule is enforced (i.e. number of days supply to allow after a future term date for the member's current status)

Gets or sets the Benefit Code Gen Option Url

Gets or sets the Benefit Code Gen Option number

Gets or sets the link to the Drug Pricing resource for compound drugs

Gets or sets the identifier of the special drug pricing for a compound.

Gets or sets the link to the Drug Pricing resource for unknown/undefined drugs

Gets or sets the identifier of the special drug pricing for an unknown/undefined drug.

Gets or sets the member claim fee, which is the amount added to the claim as ingredient cost that the member is responsible for

Gets or sets the Alternate Processor used to reroute the claim to a different plan

The url for the reroute plan alternate processor resource

Percentage amount of the ingredient cost added to the claim that the member is responsible for

Gets or sets the value indicating whether to recalculate amount of member claim fee for the network plan

Gets or sets the Alternate compound pricing option (If two options are defined, then the lower pricing option will be used)

Gets or sets whether the rule applies to claims identified as short cycle

Gets or sets whether the rule applies to new a start medication (based on plan's New Start Days)

Gets or sets whether the new start drug is based on the drug name (10 digit GPI)

Gets or sets whether the rule is applied for drugs recently added to the catalog

Gets or sets whether the rule applies to first fills

Gets or sets whether the rule applies for expired refills (based on plan's Rx Expire Days)

Gets or sets whether the rule applies when the drug is on the plan

Gets or sets whether the rule applies to compounds being priced using ingredients

Gets or sets the DiagnosisCodes for which the rule applies

Gets or sets members for which the rule applies; if the list is empty it applies to all

Gets or sets a value indicating whether the member list is treated as an exclusion list. If this is true, members in the list will be excluded from the rule; if false, only members in the list will be included in the rule. If the list is empty, it applies to all pharmacies regardless of this value.

Gets or sets a value indicating whether the member profile list is treated as an exclusion list. If this is true, member profiles in the list will be excluded from the rule; if false, only member profiles in the list will be included in the rule. If the list is empty, it applies to all pharmacies regardless of this value.

Gets or sets networks for which the rule applies; if the list is empty it applies to all

Gets or sets headquarters for which the rule applies; if the list is empty it applies to all

Gets or sets a value indicating whether the headquarter list is treated as an exclusion list. If this is true, headquarters in the list will be excluded from the rule; if false, only headquarters in the list will be included in the rule. If the list is empty, it applies to all pharmacies regardless of this value.

Gets or sets pharmacies for which the rule applies; if the list is empty it applies to all

Gets or sets a value indicating whether the pharmacy list is treated as an exclusion list. If this is true, pharmacies in the list will be excluded from the rule; if false, only pharmacies in the list will be included in the rule. If the list is empty, it applies to all pharmacies regardless of this value.

Gets or sets a value indicating whether the pharmacy profile list is treated as an exclusion list. If this is true, pharmacy profiles in the list will be excluded from the rule; if false, only pharmacy profiles in the list will be included in the rule. If the list is empty, it applies to all pharmacy profiles regardless of this value.

Gets or sets prescribers for which the rule applies; if the list is empty it applies to all

Gets or sets a value indicating whether the prescriber list is treated as an exclusion list. If this is true, prescribers in the list will be excluded from the rule; if false, only prescribers in the list will be included in the rule. If the list is empty, it applies to all pharmacies regardless of this value.

Gets or sets the Facilities for which the rule applies

Gets or sets the Alternate Processors for which the rule applies

Gets or sets the group plan id associated with the rule

Gets or sets the description

Gets or sets the priority

Gets or sets the reference code

Gets or sets the message

Gets the latest change note or sets a change note to be saved on a patch

Gets or sets the effective start date

Gets or sets the effective end date

Gets or sets whether the rule is active

Gets or sets the minimum days supply in order for the rule to apply

Gets or sets the maximum days supply in order for the rule to apply

Gets or sets the minimum age of the member in order for the rule to apply

Gets or sets the maximum age of the member in order for the rule to apply

Gets or sets the age units.

Gets or sets the dependent relationship code as a delimited list for which the rule applies.

Gets or sets the service category

Gets or sets the gender (if necessary) for which the rule applies

Gets or sets the list of acceptable pharmacy types

Gets or sets the rule's submission clarification code match criteria if applicable (possible values: Blank, Match, n/a)

Gets or sets the submission clarification codes for which the rule applies (This list is only used if SubmissionClarificationCodeCriteriaType is set to match)

Gets or sets the pharmacy service criteria type

Gets or sets the pharmacy service value. Uses standarded NCPDP values.

Gets or sets the patient residence criteria type

Gets or sets the patient residence value. Uses standarded NCPDP values.

Gets or sets the place of service criteria type

Gets or sets the place of service value. Uses standarded NCPDP values.

Gets or sets the Benefit Code Url

Gets or sets the Benefit Code number

Gets or sets the Prior Fills GPI Chars

Gets or sets the rule's submission clarification code match criteria if applicable (possible values: Blank, Match, n/a)

Gets or sets the acceptable DAW code values that apply to the rule

Gets or sets the list of contract codes associated with the general criteria

Gets or sets the list of AR codes associated with the general criteria

Gets or sets the coverage levels associated with the general criteria

Gets or sets the list of employee statuses associated with the general criteria

Gets or sets the list of other statuses associated with the general criteria

Gets or sets the list of US States associated with the general criteria

Gets or sets whether the rule is a template

Gets or sets the flag if this rule is overridden

Gets or sets the rule template thats being overridden

Gets or sets the rule template is enabled

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

Gets or sets the identifier for the resource