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Prospective APIs (1.2.0)

Download OpenAPI specification:

Prospective APIs to include additional field in patient, book and update appointment, patient listing

Service Token Retrieval

Obtaining a Bearer service token to make API requests

Authenticate and retrieve an access token

This endpoint authenticates users and provides access tokens for subsequent API calls. In production additional HTTP response headers like X-Frame-Options, X-XSS-Protection, and Content-Security-Policy would be included to enhance security against common web vulnerabilities. Please note this token expires every hour and a new token can be requested using the same API.

Authorizations:
apiKeyHeader
header Parameters
X-API-KEY
required
string
Request Body schema: application/json
required
clientId
required
string

Unique Allymar defined ID for the client

secret
required
string

Allymar provided client secret information

username
required
string

Name of the user using the system

organizationId
required
string

Allymar defined organization identifier

Responses

Request samples

Content type
application/json
{
  • "clientId": "string",
  • "secret": "string",
  • "username": "string",
  • "organizationId": "string"
}

Response samples

Content type
application/json
{
  • "accessToken": "string",
  • "tokenType": "Bearer",
  • "expiresIn": 3600
}

Patient

List, Create and Update Patient

Create patient API

This endpoint is used to create patient

Authorizations:
service
header Parameters
Authorization
required
string

Authentication Bearer token to allow request to be processed. This is the token that is provided during the 'token' API request.

Content-Type
required
string
Default: application/json

Media type of the body of the request.

Request Body schema: application/json
required
memberId
required
string

Member ID of the patient

subscriberKey
string

Subscriber key of the patient

firstName
required
string

First name of the patient

middleName
string

Middle name of the patient

lastName
required
string

Last name of the patient

dob
required
string

Date of birth of the patient

gender
required
string

Gender of the patient

socialSecurityNumber
Array of strings

Member Social Security Number

county
string

Member County

beneficiaryID
Array of strings

Medicare Beneficiary ID

race
string

Member's Race

ethnicityType
string

Member's ethnicity

raceSource
string

Member's Race Data Source

ethnicitySource
string

Member's Ethnicity Data Source

maritalStatus
string

Member's Marital Status

medicaidId
string

Member's Medicaid ID

MRN
Array of strings

MRNs of the patient

Array of objects
Array of objects
Array of objects
additionalDetails
object

Provide patient metadata in key-value pairs

Responses

Request samples

Content type
application/json
{
  • "memberId": "string",
  • "subscriberKey": "string",
  • "firstName": "string",
  • "middleName": "string",
  • "lastName": "string",
  • "dob": "string",
  • "gender": "string",
  • "socialSecurityNumber": [
    ],
  • "county": "string",
  • "beneficiaryID": [
    ],
  • "race": "string",
  • "ethnicityType": "string",
  • "raceSource": "string",
  • "ethnicitySource": "string",
  • "maritalStatus": "string",
  • "medicaidId": "string",
  • "MRN": [
    ],
  • "address": [
    ],
  • "phone": [
    ],
  • "email": [
    ],
  • "additionalDetails": { }
}

Response samples

Content type
application/json
{
  • "patientId": "string"
}

Get details for the Patient based on the MemberId or Unique Allymar Patient Id

To retrieve the Patient information using the MemberId or PatientId

Authorizations:
service
query Parameters
memberId
string

Unique member ID of the patient

patientId
string

Unique ID of the patient.

header Parameters
Authorization
required
string

Authentication Bearer token required for processing the request. This token is provided during the 'token' API request.

Content-Type
required
string
Default: application/json

Media type of the body of the request.

Responses

Response samples

Content type
application/json
{
  • "memberId": "string",
  • "subscriberKey": "string",
  • "firstName": "string",
  • "middleName": "string",
  • "lastName": "string",
  • "dob": "string",
  • "gender": "string",
  • "socialSecurityNumber": [
    ],
  • "county": "string",
  • "beneficiaryID": [
    ],
  • "race": "string",
  • "ethnicityType": "string",
  • "raceSource": "string",
  • "ethnicitySource": "string",
  • "maritalStatus": "string",
  • "medicaidId": "string",
  • "MRN": [
    ],
  • "address": [
    ],
  • "phone": [
    ],
  • "email": [
    ],
  • "additionalDetails": [
    ]
}

Update patient details

This endpoint is used to update the details of an existing patient.

Authorizations:
service
path Parameters
memberId
required
string

Unique identifier of the patient to be updated.

header Parameters
Authorization
required
string

Authentication Bearer token required for processing the request. This token is provided during the 'token' API request.

Content-Type
required
string
Default: application/json

Media type of the body of the request.

Request Body schema: application/json
required
memberId
required
string

Member ID of the patient

subscriberKey
string

Subscriber key of the patient

firstName
required
string

First name of the patient

middleName
string

Middle name of the patient

lastName
required
string

Last name of the patient

dob
required
string

Date of birth of the patient

gender
required
string

Gender of the patient

socialSecurityNumber
Array of strings

Member Social Security Number

county
string

Member County

beneficiaryID
Array of strings

Medicare Beneficiary ID

race
string

Member's Race

ethnicityType
string

Member's ethnicity

raceSource
string

Member's Race Data Source

ethnicitySource
string

Member's Ethnicity Data Source

maritalStatus
string

Member's Marital Status

medicaidId
string

Member's Medicaid ID

MRN
Array of strings

MRNs of the patient

Array of objects
Array of objects
Array of objects
additionalDetails
object

Provide patient metadata in key-value pairs

Responses

Request samples

Content type
application/json
{
  • "memberId": "string",
  • "subscriberKey": "string",
  • "firstName": "string",
  • "middleName": "string",
  • "lastName": "string",
  • "dob": "string",
  • "gender": "string",
  • "socialSecurityNumber": [
    ],
  • "county": "string",
  • "beneficiaryID": [
    ],
  • "race": "string",
  • "ethnicityType": "string",
  • "raceSource": "string",
  • "ethnicitySource": "string",
  • "maritalStatus": "string",
  • "medicaidId": "string",
  • "MRN": [
    ],
  • "address": [
    ],
  • "phone": [
    ],
  • "email": [
    ],
  • "additionalDetails": { }
}

Response samples

Content type
application/json
{
  • "patientId": "ABcdefGhIjklmnoP",
  • "message": "Patient updated successfully"
}

Delete patient

This endpoint is used to Delete the details of an existing patient.

Authorizations:
service
path Parameters
memberId
required
string

Unique identifier of the patient to be deleted.

header Parameters
Authorization
required
string

Authentication Bearer token required for processing the request. This token is provided during the 'token' API request.

Content-Type
required
string
Default: application/json

Media type of the body of the request.

Responses

Response samples

Content type
application/json
{
  • "message": "Patient deleted successfully"
}

Get Patients List

Retrieves a paginated list of patients from the database.

Authorizations:
service
header Parameters
Authorization
required
string

Authentication Bearer token required for processing the request. This token is provided during the 'token' API request.

Content-Type
required
string
Default: application/json

Media type of the body of the request.

Request Body schema: application/json
required
page
required
integer

The page number.

pageSize
required
integer

The number of patient entries per page.

Responses

Request samples

Content type
application/json
{
  • "page": 1,
  • "pageSize": 20
}

Response samples

Content type
application/json
{
  • "recordCount": 0,
  • "page": 0,
  • "pageSize": 0,
  • "Patients": [
    ]
}

Activate the patient using memberId or Patient Document ID

Activate the patient using memberId or Patient Document ID

Authorizations:
service
header Parameters
Authorization
required
string

Authentication Bearer token to allow request to be processed. This is the token that is provided during the 'token' API request.

Content-Type
required
string
Default: application/json

Media type of the body of the request.

Request Body schema: application/json
required
One of
memberId
required
string

unique member ID of the patient

patientId
string

document ID of the patient

Responses

Request samples

Content type
application/json
{
  • "memberId": "string",
  • "patientId": "string"
}

Response samples

Content type
application/json
{
  • "message": "Patient is activated successfully."
}

Deactivate the patient using memberId or Patient Document ID

Deactivate the patient using memberId or Patient Document ID

Authorizations:
service
header Parameters
Authorization
required
string

Authentication Bearer token to allow request to be processed. This is the token that is provided during the 'token' API request.

Content-Type
required
string
Default: application/json

Media type of the body of the request.

Request Body schema: application/json
required
One of
memberId
required
string

unique member ID of the patient

patientId
string

document ID of the patient

Responses

Request samples

Content type
application/json
{
  • "memberId": "string",
  • "patientId": "string"
}

Response samples

Content type
application/json
{
  • "message": "Patient is deactivated successfully."
}

Get list of patients for a provider.

Fetches a list of patients who are attributed to the specified provider (tin).

Authorizations:
service
query Parameters
tin
integer

Unique TIN number.

header Parameters
Authorization
required
string

Authentication Bearer token to allow the request to be processed. This token is obtained through the 'token' API request.

Responses

Response samples

Content type
application/json
{
  • "data": [
    ]
}

Appointment

Create and update appointment details

API to schedule appointment

API to schedule appointment

Authorizations:
service
header Parameters
Authorization
required
string

Authentication Bearer token to allow request to be processed. This is the token that is provided during the 'token' API request.

Content-Type
required
string
Default: application/json

Media type of the body of the request.

Request Body schema: application/json
required
memberId
required
string

Unique identifier of the patient.

status
string
Enum: "proposed" "pending" "booked" "arrived" "fulfilled" "cancelled" "noshow"

The status of the appointment.

serviceCategory
string

Category of the service for the appointment.

type
string
Default: "checkup"
Enum: "checkup" "emergency" "followup" "routine" "walkin"

Type of the appointment. Defaults to "checkup."

appointmentStartDate
required
string <date-time>

The start date and time of the appointment in ISO 8601 format.

appointmentEndDate
required
string <date-time>

The end date and time of the appointment in ISO 8601 format.

renderingNPI
string

The rendering NPI used for the appointment scheduling.

vendor
string

The vendor associated with the appointment.

appointmentLocation
string

Location of the appointment - Facility name or practice name

Responses

Request samples

Content type
application/json
{
  • "memberId": "string",
  • "status": "proposed",
  • "serviceCategory": "string",
  • "type": "checkup",
  • "appointmentStartDate": "09-25-2019T14:15",
  • "appointmentEndDate": "09-24-2019T20:15",
  • "renderingNPI": "string",
  • "vendor": "string",
  • "appointmentLocation": "string"
}

Response samples

Content type
application/json
{
  • "message": {
    }
}

API to update an existing appointment

API to update the details of an existing appointment.

Authorizations:
service
path Parameters
Id
required
string

The unique identifier of the appointment to be updated.

header Parameters
Authorization
required
string

Authentication Bearer token to allow the request to be processed. This is the token that is provided during the 'token' API request.

Content-Type
required
string
Default: application/json

Media type of the body of the request.

Request Body schema: application/json
required
memberId
required
string

Unique identifier of the patient.

status
string
Enum: "proposed" "pending" "booked" "arrived" "fulfilled" "cancelled" "noshow"

The status of the appointment.

serviceCategory
string

Category of the service for the appointment.

type
string
Default: "checkup"
Enum: "checkup" "emergency" "followup" "routine" "walkin"

Type of the appointment. Defaults to "checkup."

appointmentStartDate
required
string <date-time>

The start date and time of the appointment in ISO 8601 format.

appointmentEndDate
required
string <date-time>

The end date and time of the appointment in ISO 8601 format.

renderingNPI
string

The rendering NPI used for the appointment scheduling.

vendor
string

The vendor associated with the appointment.

appointmentLocation
string

Location of the appointment - Facility name or practice name

Responses

Request samples

Content type
application/json
{
  • "memberId": "string",
  • "status": "proposed",
  • "serviceCategory": "string",
  • "type": "checkup",
  • "appointmentStartDate": "09-25-2019T14:15",
  • "appointmentEndDate": "09-24-2019T20:15",
  • "renderingNPI": "string",
  • "vendor": "string",
  • "appointmentLocation": "string"
}

Response samples

Content type
application/json
{
  • "message": {
    }
}

API to fetch an existing appointment

API to fetch the details of an existing appointment.

Authorizations:
service
path Parameters
Id
required
string

The unique identifier of the appointment to be fetched.

header Parameters
Authorization
required
string

Authentication Bearer token to allow the request to be processed. This is the token that is provided during the 'token' API request.

Content-Type
required
string
Default: application/json

Media type of the body of the request.

Responses

Response samples

Content type
application/json
{
  • "message": {
    }
}

API to delete an appointment

API to delete the details of an appointment.

Authorizations:
service
path Parameters
Id
required
string

The unique identifier of the appointment to be deleted.

header Parameters
Authorization
required
string

Authentication Bearer token to allow the request to be processed. This is the token that is provided during the 'token' API request.

Content-Type
required
string
Default: application/json

Media type of the body of the request.

Responses

Response samples

Content type
application/json
{
  • "message": "Appointment deleted successfully"
}

API to fetch existing appointments for a member

API to fetch all the existing appointments for a member.

Authorizations:
service
path Parameters
memberId
required
string

The unique identifier of the member.

header Parameters
Authorization
required
string

Authentication Bearer token to allow the request to be processed. This is the token that is provided during the 'token' API request.

Content-Type
required
string
Default: application/json

Media type of the body of the request.

Responses

Response samples

Content type
application/json
[
  • {
    }
]

Providers API

CRUD APIs for Provider details

Add new provider information.

Add new provider information.

Authorizations:
service
header Parameters
Authorization
required
string

Authentication Bearer token to allow request to be processed. This is the token that is provided during the 'token' API request.

Content-Type
required
string
Default: application/json

Media type of the body of the request.

Request Body schema: application/json
required
providerNPI
required
string

National Provider Identifier (NPI).

providerId
required
string

This is the internal (plan) Provider ID field and is unique to the Provider

type
required
string

Individual or Organization

groupName
string

Provider Group Name

firstName
required
string

Providers first name

middleName
string

Provider's Middle name

lastName
required
string

Providers last name

TIN
string

Provider's Tax ID

TINQualifier
string

Provider's Tax ID Qualifier

credentials
string

Provider's Credential

primaryTaxonomyCode
string

The Taxonomy code for this provider. If taxonomy is not available then the CMS specialty code can be provided.

additionalTaxonomyCode
string

Additional Taxonomy codes if provider has multiple taxonomy codes. Use as additional specialty codes if plan is not using taxonomy codes.

primarySpecialtyCode
string

The specialty code for this provider If the plan does not use taxonomy codes

additionalSpecialtyCode
string

Additional Specialty codes if provider has multiple specialty codes.

required
Array of objects
Array of objects
Array of objects

Responses

Request samples

Content type
application/json
{
  • "providerNPI": "string",
  • "providerId": "string",
  • "type": "string",
  • "groupName": "string",
  • "firstName": "string",
  • "middleName": "string",
  • "lastName": "string",
  • "TIN": "string",
  • "TINQualifier": "string",
  • "credentials": "string",
  • "primaryTaxonomyCode": "string",
  • "additionalTaxonomyCode": "string",
  • "primarySpecialtyCode": "string",
  • "additionalSpecialtyCode": "string",
  • "address": [
    ],
  • "phone": [
    ],
  • "email": [
    ]
}

Response samples

Content type
application/json
{
  • "message": "string",
  • "providerId": "areiu12"
}

Fetch Provider Information by NPI

Retrieve detailed information about a provider using their National Provider Identifier (NPI).

Authorizations:
service
path Parameters
providerNPI
required
string

The unique National Provider Identifier (NPI) for the provider.

Responses

Response samples

Content type
application/json
{
  • "batchId": "string",
  • "Id": "string",
  • "providerNPI": "string",
  • "providerId": "string",
  • "type": "string",
  • "groupName": "string",
  • "firstName": "string",
  • "middleName": "string",
  • "lastName": "string",
  • "TIN": "string",
  • "TINQualifier": "string",
  • "credentials": "string",
  • "primaryTaxonomyCode": "string",
  • "primaryTaxonomyDescription": "string",
  • "additionalTaxonomyCode": "string",
  • "primarySpecialtyCode": "string",
  • "primarySpecialtyDescription": "string",
  • "additionalSpecialtyCode": "string",
  • "address": [
    ],
  • "phone": [
    ],
  • "email": [
    ],
  • "timestamp": "string",
  • "isDeleted": true
}

Update provider info by National Provider Identifi

Update provider info by National Provider Identifier (NPI).

Authorizations:
service
path Parameters
providerNPI
required
string

National Provider Identifier (NPI) of the provider whose information is being updated.

header Parameters
Authorization
required
string

Authentication Bearer token to allow the request to be processed. This token is obtained through the 'token' API request.

Request Body schema: application/json
required
providerNPI
required
string

National Provider Identifier (NPI).

providerId
required
string

This is the internal (plan) Provider ID field and is unique to the Provider

type
required
string

Individual or Organization

groupName
string

Provider Group Name

firstName
required
string

Providers first name

middleName
string

Provider's Middle name

lastName
required
string

Providers last name

TIN
string

Provider's Tax ID

TINQualifier
string

Provider's Tax ID Qualifier

credentials
string

Provider's Credential

primaryTaxonomyCode
string

The Taxonomy code for this provider. If taxonomy is not available then the CMS specialty code can be provided.

additionalTaxonomyCode
string

Additional Taxonomy codes if provider has multiple taxonomy codes. Use as additional specialty codes if plan is not using taxonomy codes.

primarySpecialtyCode
string

The specialty code for this provider If the plan does not use taxonomy codes

additionalSpecialtyCode
string

Additional Specialty codes if provider has multiple specialty codes.

required
Array of objects
Array of objects
Array of objects

Responses

Request samples

Content type
application/json
{
  • "providerNPI": "string",
  • "providerId": "string",
  • "type": "string",
  • "groupName": "string",
  • "firstName": "string",
  • "middleName": "string",
  • "lastName": "string",
  • "TIN": "string",
  • "TINQualifier": "string",
  • "credentials": "string",
  • "primaryTaxonomyCode": "string",
  • "additionalTaxonomyCode": "string",
  • "primarySpecialtyCode": "string",
  • "additionalSpecialtyCode": "string",
  • "address": [
    ],
  • "phone": [
    ],
  • "email": [
    ]
}

Response samples

Content type
application/json
{
  • "message": "string",
  • "providerId": "areiu12"
}

Delete particular provider details

Delete particular provider details

Authorizations:
service
path Parameters
providerNPI
required
string

National Provider Identifier (NPI) of the provider whose information is being deleted.

header Parameters
Authorization
required
string

Authentication Bearer token to allow the request to be processed. This token is obtained through the 'token' API request.

Responses

Response samples

Content type
application/json
{
  • "message": "string",
  • "providerId": "areiu12"
}

Provider Attribution

CRUD APIs for mapping provider to patient

Create provider attribution record

This endpoint creates a new provider attribution record.

Authorizations:
service
header Parameters
Authorization
required
string

Authentication Bearer token required for processing the request. This token is provided during the 'token' API request.

Content-Type
required
string
Default: application/json

Media type of the body of the request.

Request Body schema: application/json
required
memberId
required
string

Unique identifier for the patient/member.

providerId
required
string

This is the internal Provider ID field and is unique to the Provider.

pcpInd
required
string
Enum: "Y" "N"

PCP flag

effectiveDate
string <MM-DD-YYYY>

Effective Start Date of Attribution

endDate
string <MM-DD-YYYY>

Effective End date of Attribution

Responses

Request samples

Content type
application/json
{
  • "memberId": "string",
  • "providerId": "string",
  • "pcpInd": "Y",
  • "effectiveDate": "01-01-2024",
  • "endDate": "12-31-2024"
}

Response samples

Content type
application/json
{
  • "attributionId": "d1r2e24f",
  • "message": "string"
}

Fetch provider attribution by ID

Retrieve a provider attribution record by its unique ID.

Authorizations:
service
path Parameters
attributionId
required
string

The unique identifier of the provider attribution record.

Responses

Response samples

Content type
application/json
{
  • "data": {
    },
  • "message": "SUCCESS"
}

Update provider attribution details

This endpoint updates an existing provider attribution record.

Authorizations:
service
path Parameters
attributionId
required
string

The unique identifier of the provider attribution record to be updated.

header Parameters
Authorization
required
string

Authentication Bearer token required for processing the request.

Content-Type
required
string
Default: application/json

Media type of the body of the request.

Request Body schema: application/json
required
memberId
required
string

Unique identifier for the patient/member.

providerId
required
string

This is the internal Provider ID field and is unique to the Provider.

pcpInd
required
string
Enum: "Y" "N"

PCP flag

effectiveDate
string <MM-DD-YYYY>

Effective Start Date of Attribution

endDate
string <MM-DD-YYYY>

Effective End date of Attribution

Responses

Request samples

Content type
application/json
{
  • "memberId": "string",
  • "providerId": "string",
  • "pcpInd": "Y",
  • "effectiveDate": "01-01-2024",
  • "endDate": "12-31-2024"
}

Response samples

Content type
application/json
{
  • "attributionId": "d1r2e24f",
  • "message": "string"
}

Delete provider attribution record

This endpoint deletes a provider attribution record by its ID.

Authorizations:
service
path Parameters
attributionId
required
string

The unique identifier of the provider attribution record to be deleted.

header Parameters
Authorization
required
string

Authentication Bearer token required for processing the request.

Responses

Response samples

Content type
application/json
{
  • "attributionId": "d1r2e24f",
  • "message": "string"
}

Member Baseline

Create and get member baseline

Add a record to the member baseline

Add a diagnosis of the patient in member baseline

Authorizations:
service
header Parameters
Authorization
required
string

Authentication Bearer token to allow request to be processed. This is the token that is provided during the 'token' API request.

Content-Type
required
string
Default: application/json

Media type of the body of the request.

Request Body schema: application/json
required
memberId
required
string

Unique member ID of the patient

serviceYear
required
integer

The current service year

icdCode
string

It is required if hccDetails is not present

Array of objects

HCC Info details

Array of objects

Encounter data

Responses

Request samples

Content type
application/json
{
  • "memberId": "string",
  • "serviceYear": 0,
  • "icdCode": "string",
  • "hccDetails": [
    ],
  • "encounter": [
    ]
}

Response samples

Content type
application/json
{
  • "Id": "string",
  • "memberId": "string",
  • "icdCode": "string",
  • "icdModelVersion": "string",
  • "serviceYear": 0,
  • "codeFlag": "string",
  • "hccDetails": [
    ],
  • "encounter": [
    ],
  • "batchId": "string",
  • "isDeleted": true,
  • "timestamp": "string"
}

Get record from the Member Baseline using Member ID along with the service year details.

Get member baseline details

Authorizations:
service
query Parameters
memberId
required
string

Unique member ID of the patient

serviceYear
required
integer

The current service year.

header Parameters
Authorization
required
string

Authentication Bearer token to allow request to be processed. This is the token that is provided during the 'token' API request.

Content-Type
required
string
Default: application/json

Media type of the body of the request.

Responses

Response samples

Content type
application/json
[
  • {
    }
]

Member Regression

CRUD APIs for member regression

Member Regression Create API

Member regression API

Authorizations:
service
header Parameters
Authorization
required
string

Authentication Bearer token to allow request to be processed. This is the token that is provided during the 'token' API request.

Content-Type
required
string
Default: application/json

Media type of the body of the request.

Request Body schema: application/json
required
memberId
required
string

unique member id

paymentYearMonth
required
string

Year and Month of Payment

contractNumber
string

Plan Contract Number

planBenefitPackageId
string

Plan Benefit Package ID

stateAndCountyCode
string

State and Count Code

riskAdjustmentFactorTypeCode
string

Risk Adjustment Factor Type Code.

defaultRiskFactorCode
required
integer

Default Risk Factor Code

originalReasonForEntitlementCode
required
integer

Original Reason for Entitlement code.

medicaid
required
integer

If the member is eligible for medicaid

lti
integer

Indicator that beneficiary has Part C Long Term Institutional Status

esrd
integer

If the member has a current esrd status

partCMARiskAdjustedAmount
required
number <float>

Average Monthly Part A + Part B portion of the payment or adjustment dollars

dataSource
required
Array of strings

If the record comes from memberEligibility, MMR, or both. Data reconciliation of memberEligibility / MMR

Responses

Request samples

Content type
application/json
{
  • "memberId": "string",
  • "paymentYearMonth": "202503",
  • "contractNumber": "string",
  • "planBenefitPackageId": "string",
  • "stateAndCountyCode": "string",
  • "riskAdjustmentFactorTypeCode": "string",
  • "defaultRiskFactorCode": 0,
  • "originalReasonForEntitlementCode": 0,
  • "medicaid": 0,
  • "lti": 0,
  • "esrd": 0,
  • "partCMARiskAdjustedAmount": 0.1,
  • "dataSource": [
    ]
}

Response samples

Content type
application/json
{
  • "batchId": "string",
  • "Id": "string",
  • "memberId": "string",
  • "paymentYearMonth": "string",
  • "contractNumber": "string",
  • "planBenefitPackageId": "string",
  • "age": 0,
  • "gender": "string",
  • "stateAndCountyCode": "string",
  • "riskAdjustmentFactorTypeCode": "string",
  • "defaultRiskFactorCode": 0,
  • "originalReasonForEntitlementCode": 0,
  • "disabled": 0,
  • "origDisabled": 0,
  • "medicaid": 0,
  • "lti": 0,
  • "esrd": 0,
  • "regressionPartC": "string",
  • "regressionPartCDescription": "string",
  • "regressionPartD": "string",
  • "regressionPartDDescription": "string",
  • "partDMARiskAdjustedAmount": 0,
  • "dataSource": [
    ],
  • "partCMARiskAdjustedAmount": 0.1,
  • "timestamp": "string",
  • "isDeleted": true
}

Member Regression Read API

Member regression API

Authorizations:
service
query Parameters
memberId
required
string

Unique member ID of the patient

paymentYearMonth
required
string

Year and Month of Payment

header Parameters
Authorization
required
string

Authentication Bearer token to allow request to be processed. This is the token that is provided during the 'token' API request.

Content-Type
required
string
Default: application/json

Media type of the body of the request.

Responses

Response samples

Content type
application/json
[
  • {
    }
]

Member Regression Delete API

Member regression API

Authorizations:
service
query Parameters
memberId
required
string

Unique member ID of the patient

paymentYearMonth
required
string

Year and Month of Payment

header Parameters
Authorization
required
string

Authentication Bearer token to allow request to be processed. This is the token that is provided during the 'token' API request.

Content-Type
required
string
Default: application/json

Media type of the body of the request.

Responses

Response samples

Content type
application/json
{
  • "message": "Member regression deleted successfully"
}

Member Regression Update API

Member regression API

Authorizations:
service
path Parameters
memberRegressionId
required
string

Unique identifier of the member regression

header Parameters
Authorization
required
string

Authentication Bearer token to allow request to be processed. This is the token that is provided during the 'token' API request.

Content-Type
required
string
Default: application/json

Media type of the body of the request.

Request Body schema: application/json
required
memberId
required
string

unique member id

paymentYearMonth
required
string

Year and Month of Payment

contractNumber
string

Plan Contract Number

planBenefitPackageId
string

Plan Benefit Package ID

stateAndCountyCode
string

State and Count Code

riskAdjustmentFactorTypeCode
string

Risk Adjustment Factor Type Code.

defaultRiskFactorCode
required
integer

Default Risk Factor Code

originalReasonForEntitlementCode
required
integer

Original Reason for Entitlement code.

medicaid
required
integer

If the member is eligible for medicaid

lti
integer

Indicator that beneficiary has Part C Long Term Institutional Status

esrd
integer

If the member has a current esrd status

partCMARiskAdjustedAmount
required
number <float>

Average Monthly Part A + Part B portion of the payment or adjustment dollars

dataSource
required
Array of strings

If the record comes from memberEligibility, MMR, or both. Data reconciliation of memberEligibility / MMR

Responses

Request samples

Content type
application/json
{
  • "memberId": "string",
  • "paymentYearMonth": "202503",
  • "contractNumber": "string",
  • "planBenefitPackageId": "string",
  • "stateAndCountyCode": "string",
  • "riskAdjustmentFactorTypeCode": "string",
  • "defaultRiskFactorCode": 0,
  • "originalReasonForEntitlementCode": 0,
  • "medicaid": 0,
  • "lti": 0,
  • "esrd": 0,
  • "partCMARiskAdjustedAmount": 0.1,
  • "dataSource": [
    ]
}

Response samples

Content type
application/json
{
  • "message": "string",
  • "memberId": "string",
  • "paymentYearMonth": "string"
}

Patient Identification

Identify the patient based on personal identifiable information

Identify a patient in the system

Identifies a patient by their personal details and membership information.

Authorizations:
service
header Parameters
Authorization
required
string

Authentication Bearer token to allow request to be processed. This is the token that is provided during the 'token' API request.

Content-Type
required
string
Default: application/json

Media type of the body of the request.

Request Body schema: application/json
required
firstName
required
string

Patient first name

lastName
required
string

Patient last name

dob
required
string <date>

Patient date of birth

memberId
string

Member insurance ID. Conditional field.

mrn
string

Patient EHR unique identifier. Conditional field.

zipCode
string

Patient Zip code. Conditional field.

Responses

Request samples

Content type
application/json
{
  • "firstName": "John",
  • "lastName": "Doe",
  • "dob": "07-19-1990",
  • "memberId": "123445455",
  • "mrn": "a1b2c3d4",
  • "zipCode": "90210"
}

Response samples

Content type
application/json
{
  • "isEligible": "string",
  • "patientId": "string"
}

Identify a patient in the system

Identifies a patient by their personal details and membership information.

Authorizations:
service
header Parameters
Authorization
required
string

Authentication Bearer token to allow request to be processed. This is the token that is provided during the 'token' API request.

Content-Type
required
string
Default: application/json

Media type of the body of the request.

Request Body schema: application/json
required
One of
firstName
string

Patient first name

lastName
string

Patient last name

dob
string <date> ^(0[1-9]|1[0-2])-(0[1-9]|[12][0-9]|3[01])-(19...

Patient date of birth

memberId
required
string

Member insurance ID. Conditional field.

mrn
string

Patient EHR unique identifier. Conditional field.

zipCode
string

Patient Zip code. Conditional field.

patientInfoRequired
boolean

Flag to retrieve patient information, If provided true then retrieve else not.

Responses

Request samples

Content type
application/json
{
  • "firstName": "John",
  • "lastName": "Doe",
  • "dob": "07-19-1990",
  • "memberId": "123445455",
  • "mrn": "a1b2c3d4",
  • "zipCode": "90210",
  • "patientInfoRequired": true
}

Response samples

Content type
application/json
{
  • "isEligible": "string",
  • "patientId": "string",
  • "firstName": "string",
  • "lastName": "string",
  • "dob": "string",
  • "gender": "string"
}

Get Patient Diagnosis Gaps

Identify patient's Diagnosis Gaps

Identify patient's Diagnosis Gaps

Identify patient's Diagnosis Gaps - HCC and non-HCC Gaps are indicated by the same function

Authorizations:
service
header Parameters
Authorization
required
string

Authentication Bearer token to allow request to be processed. This is the token that is provided during the 'token' API request.

Content-Type
required
string
Default: application/json

Media type of the body of the request.

Request Body schema: application/json
required
patientId
required
string
YoS
string
gapStatus
string
Enum: "Open" "Closed"

Responses

Request samples

Content type
application/json
{
  • "patientId": "d4fon0UkvtdfNBW1JfD5",
  • "YoS": "2023",
  • "gapStatus": "Open"
}

Response samples

Content type
application/json
[
  • {
    }
]

Get Patient Diagnosis Gaps Feedback

Get feedback from the EHR (PCP) about the Diagnosis Gap Feedback

Submit feedback on diagnostic gaps

Authorizations:
service
header Parameters
Authorization
required
string

Authentication Bearer token to allow request to be processed. This is the token that is provided during the 'token' API request.

Content-Type
required
string
Default: application/json

Media type of the body of the request.

Request Body schema: application/json
required
patientId
required
string

The unique ID of the patient.

gapId
required
string

The unique ID of the gap selected by the user.

gapType
string
Enum: "Known" "Suspected"

Indication for a previously known diagnosis or a suspected diagnosis.

organizationName
required
string

The organization name associated with the user.

vimOrganizationKey
required
string

The unique organization ID as available in the Vim system.

userFirstName
string

The user's first name.

userLastName
string

The user's last name.

ehrUsername
required
string

The user's EHR username.

userNpi
string

The user's National Provider Identifier (NPI).

encounterId
string

The EHR encounter ID.

encounterDate
string <date>
gapSystem
required
string

The main gap system as displayed in the application.

gapCode
required
string

The original code provided by the customer, which corresponds to the selected code(s) by the user.

gapDescription
string

The description of the gap selected by the user.

selectedMedicalCodes
required
Array of strings

The ICD code(s) selected by the user.

actionDate
required
string <date>

The date of the reported action (EST).

actionType
required
string
Enum: "agree" "dismiss" "undo"

The reason of the reported action.

actionReason
required
string

The reason of the reported action.

actionAdditionalComments
string

The free text added by the user for the reported action. Available only for the "dismiss" actionType

Responses

Request samples

Content type
application/json
{
  • "patientId": "d4fon0UkvtdfNBW1JfD5",
  • "gapId": "Ae3uywUB0YwdwxxdA4M5",
  • "gapType": "Known",
  • "organizationName": "Test Medical",
  • "vimOrganizationKey": "string",
  • "userFirstName": "John",
  • "userLastName": "Doe",
  • "ehrUsername": "JDoe",
  • "userNpi": "1676809742",
  • "encounterId": "string",
  • "encounterDate": "2024-01-20",
  • "gapSystem": "HCC",
  • "gapCode": "59",
  • "gapDescription": "Major Depressive, Bipolar, and Paranoid Disorders",
  • "selectedMedicalCodes": [
    ],
  • "actionDate": "2024-02-07",
  • "actionType": "undo",
  • "actionReason": "NOT_PRESENT",
  • "actionAdditionalComments": "Patient did not display symptoms"
}

Response samples

Content type
application/json
{
  • "updateStatus": "SUCCESS",
  • "code": 1
}

Get Patient Care & Quality Gaps

Identify patient's Care & Quality Gaps

Retrieve care & quality gaps for a patient

Returns a list of care & quality gaps for a given patient based on their patientId.

Authorizations:
service
header Parameters
Authorization
required
string

Authentication Bearer token to allow request to be processed. This is the token that is provided during the 'token' API request.

Content-Type
required
string
Default: application/json

Media type of the body of the request.

Request Body schema: application/json
required
patientId
required
string
YoS
string
gapStatus
string
Enum: "Open" "Closed"

Responses

Request samples

Content type
application/json
{
  • "patientId": "d4fon0UkvtdfNBW1JfD5",
  • "YoS": "2023",
  • "gapStatus": "Open"
}

Response samples

Content type
application/json
[
  • {
    }
]

Get Patient Care & Quality Gaps Feedback

Get feedback from the EHR (PCP) about the Care & Quality Gaps Feedback

Submit feedback on care & quality gaps

Submits feedback for a specific care gap based on the provided information.

Authorizations:
service
header Parameters
Authorization
required
string

Authentication Bearer token to allow request to be processed. This is the token that is provided during the 'token' API request.

Content-Type
required
string
Default: application/json

Media type of the body of the request.

Request Body schema: application/json
required
patientId
required
string

The unique ID of the patientId.

gapId
required
string

The unique ID of the gap selected by the user.

gapType
string
Enum: "Known" "Suspected"

Indication for a previously known diagnosis or a suspected diagnosis.

organizationName
required
string

The organization name associated with the user.

vimOrganizationKey
required
string

The unique organization ID as available in the Vim system.

userFirstName
string

The user's first name.

userLastName
string

The user's last name.

ehrUsername
required
string

The user's EHR username.

userNpi
string

The user's National Provider Identifier (NPI).

encounterId
string

The EHR encounter ID.

encounterDate
required
string <date>

The EHR encounter date according to the organization's timezone.

gapSystem
string

The main gap system as displayed in the application.

gapCode
required
string

The original code provided by the customer, which corresponds to the selected code(s) by the user.

gapDescription
string

The description of the gap selected by the user.

selectedMedicalCodes
Array of strings

The ICD code(s) selected by the user.

actionDate
required
string <date>

The date of the reported action (EST).

actionType
required
string
Enum: "agree" "dismiss" "undo"

The reason of the reported action.

actionReason
required
string

The reason of the reported action.

actionAdditionalComments
string

The free text added by the user for the reported action. Available only for the "dismiss" actionType

Responses

Request samples

Content type
application/json
{
  • "patientId": "d4fon0UkvtdfNBW1JfD5",
  • "gapId": "Ae3uywUB0YwdwxxdA4M5",
  • "gapType": "Known",
  • "organizationName": "Test Medical",
  • "vimOrganizationKey": "string",
  • "userFirstName": "John",
  • "userLastName": "Doe",
  • "ehrUsername": "J_doe",
  • "userNpi": "1676809742",
  • "encounterId": "string",
  • "encounterDate": "2024-01-20",
  • "gapSystem": "HCC",
  • "gapCode": "59",
  • "gapDescription": "Major Depressive, Bipolar, and Paranoid Disorders",
  • "selectedMedicalCodes": [
    ],
  • "actionDate": "2024-02-07",
  • "actionType": "undo",
  • "actionReason": "NOT_PRESENT",
  • "actionAdditionalComments": "Patient did not display symptoms"
}

Response samples

Content type
application/json
{
  • "updateStatus": "SUCCESS",
  • "code": 1
}

Get CPT Codes

Get CPT Codes

Fetches CPT codes and their description based on the GAP Code

Fetches CPT codes and their description based on the GAP Code

Authorizations:
service
header Parameters
Authorization
required
string

Authentication Bearer token to allow the request to be processed. This token is obtained through the 'token' API request.

Content-Type
required
string
Default: application/json

Media type of the body of the request

Responses

Response samples

Content type
application/json
{
  • "gapCode": [
    ]
}

Get Evidence and Annotations

Get All the evidences and annotations for the given DxGap Id

Get All the evidences and annotations for the given DxGap Id

Authorizations:
service
header Parameters
Authorization
required
string

Authentication Bearer token to allow request to be processed. This is the token that is provided during the 'token' API request.

Content-Type
required
string
Default: application/json

Media type of the body of the request.

Request Body schema: application/json
required
patientId
required
string

Id of the Patient

gapId
required
string

Id of the specific DxGap

chartId
string

Id of the specific Chart

evidenceId
string

Id of the specific Evidence

Responses

Request samples

Content type
application/json
{
  • "patientId": "string",
  • "gapId": "string",
  • "chartId": "string",
  • "evidenceId": "string"
}

Response samples

Content type
application/json
Example
[ ]

Document API

Fetch the ToC Document from documentId.

Retrieves the Table of Contents (ToC) document associated with a specific patient by using the given documentId.

Authorizations:
service
query Parameters
patientId
string

Unique ID of the patient.

documentId
string

Unique ID of the document.

header Parameters
Authorization
required
string

Authentication Bearer token to allow the request to be processed. This token is obtained through the 'token' API request.

Responses