| Name | Description | Type | Additional information |
|---|---|---|---|
| EndProcessing |
Gets or sets whether more override rules are processed if all criteria has been met |
boolean |
None. |
| RuleActionTypeUrl |
Gets or sets the link to the rule action type resource |
string |
None. |
| RuleActionTypeNo |
Gets or sets the identifier to the rule action type |
integer |
None. |
| RuleOverride |
Gets or sets the rule override values |
RuleOverrideModel |
None. |
| DAWEnforceRule |
Gets or sets whether to enforce drug criteria checks that would normally be skipped due to DAW |
boolean |
None. |
| ShortCycle |
Gets or sets whether the rule applies to claims identified as short cycle |
boolean |
None. |
| NewStartDrug |
Gets or sets whether the rule applies to new a start medication (based on plan's New Start Days) |
boolean |
None. |
| NewStartDrugByDrugName |
Gets or sets whether the new start drug is based on the drug name (10 digit GPI) |
boolean |
None. |
| NewDrug |
Gets or sets whether the rule is applied for drugs recently added to the catalog |
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. |
| OnPlan |
Gets or sets whether the rule applies when the drug is on the plan |
boolean |
None. |
| InCompound |
Gets or sets whether the rule applies to compounds being priced using ingredients |
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. |
| 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. |
| IsBrand |
Gets or sets whether the drug criteria is based on brand |
boolean |
None. |
| IsRx |
Gets or sets whether the drug criteria is for prescription only (non-OTC) |
boolean |
None. |
| IsMultiSourced |
Gets or sets whether the drug criteria is based on multi-source |
boolean |
None. |
| IsRepackaged |
Gets or sets whether the drug criteria is based on repackaged value |
boolean |
None. |
| GenericAvailable |
Gets or sets whether the drug criteria applies if a generic is available |
boolean |
None. |
| OTCAvailable |
Gets or sets whether the drug criteria applies if an OTC is available |
boolean |
None. |
| IsMaintenanceDrug |
Gets or sets whether the drug criteria applies to maintenance drug |
boolean |
None. |
| DEAClassCodes |
Gets or sets the applicable DEA schedules for the drug criteria |
Collection of DEAScheduleModel |
None. |
| BrandNameCodes |
Gets or sets the applicable brand codes for the drug criteria |
Collection of BrandNameCodeModel |
None. |
| MultiSourceCodes |
Gets or sets the applicable multi-source codes for the drug criteria |
Collection of MultiSourceCodeModel |
None. |
| IncludeCustomDrugs |
Gets or sets whether the drug criteria applies to custom drugs |
boolean |
None. |
| GPIs |
Gets or sets the list of GPIs associated with the drug criteria |
Collection of RuleGPIModel |
None. |
| PricingGroups |
Gets or sets the list of pricing groups associated with the drug criteria |
Collection of RulePricingGroupModel |
None. |
| ROAs |
Gets or sets the list of ROAs associated with the drug criteria |
Collection of RuleROAModel |
None. |
| DosageForms |
Gets or sets the dosage forms associated with the drug criteria |
Collection of RuleDosageFormModel |
None. |
| FormularyTiers |
Gets or sets the list of formulary tiers associated with the drug criteria |
Collection of RuleFormularyTierModel |
None. |
| isSpecialty |
Gets or Sets a flag indicating whether this rule's criteria should include specialty drugs |
boolean |
None. |
| DrugProfiles |
Gets or Sets a a list of which drug profiles are associated with this rule |
Collection of RuleDrugProfileModel |
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. |