# Benefit Inquiry Get a consolidated payload of benefit information, accumulator information, and eligility. Endpoint: POST /enrollment-benefit-inquiry Version: v1 Security: apiKeyAuth, bearerAuth ## Header parameters: - `vbasoftware-database` (string, required) Target database ## Request fields (application/json): - `subscriber_ID` (string,null) - `member_Seq` (string,null) - `alternate_ID` (string,null) - `group_ID` (string,null) - `plan_ID` (string,null) - `plan_Year` (string,null) - `diag_Code` (string,null) - `diag_Code_Type` (string,null) - `procedure_Code` (string,null) - `place_Of_Service` (string,null) - `serviceTypes` (array,null) - `taxonomy_Code` (string,null) - `provider_Type` (string,null) - `specialty_Code` (string,null) - `as_Of_Date` (string) ## Response 200 fields (text/plain): - `data` (object) - `data.subscriber` (object) - `data.subscriber.subscriber_ID` (string,null) - `data.subscriber.last_Name` (string,null) - `data.subscriber.first_Name` (string,null) - `data.subscriber.address` (string,null) - `data.subscriber.city` (string,null) - `data.subscriber.state` (string,null) - `data.subscriber.date_Enrolled` (string,null) - `data.subscriber.disenroll_Date` (string,null) - `data.subscriber.home_Phone` (string,null) - `data.subscriber.work_Phone` (string,null) - `data.subscriber.zip_Code` (string,null) - `data.subscriber.middle_Name` (string,null) - `data.subscriber.name_Suffix` (string,null) - `data.subscriber.salutation` (string,null) - `data.subscriber.county_Code` (string,null) - `data.subscriber.address2` (string,null) - `data.subscriber.country_ID` (string,null) - `data.subscriber.home_Country_Code` (string,null) - `data.subscriber.work_Country_Code` (string,null) - `data.subscriber.email` (string,null) - `data.member` (object) - `data.member.member_Seq` (string,null) - `data.member.relationship` (string,null) - `data.member.birth_Date` (string,null) - `data.member.sex` (string,null) - `data.member.alternate_ID` (string,null) - `data.member.ssn` (string,null) - `data.member.unique_ID` (string,null) - `data.eligDetails` (array,null) - `data.eligDetails.group_ID` (string,null) - `data.eligDetails.group_Name` (string,null) - `data.eligDetails.group_Date_Enrolled` (string,null) - `data.eligDetails.group_Disenroll_Date` (string,null) - `data.eligDetails.division_ID` (string,null) - `data.eligDetails.division_Date_Enrolled` (string,null) - `data.eligDetails.division_Disenroll_Date` (string,null) - `data.eligDetails.division_Name` (string,null) - `data.eligDetails.plan_ID` (string,null) - `data.eligDetails.plan_Description` (string,null) - `data.eligDetails.start_Date` (string,null) - `data.eligDetails.tier_Description` (string,null) - `data.eligDetails.plan_Start` (string,null) - `data.eligDetails.plan_End` (string,null) - `data.eligDetails.volume` (number,null) - `data.memberInsurances` (array,null) - `data.memberInsurances.subscriber_ID` (string, required) References Members.Subscriber_ID value on the parent record. - `data.memberInsurances.member_Seq` (string, required) References Members.Member_Seq value on the parent record. - `data.memberInsurances.seq_Number` (integer, required) Unique sequence value for each Insurance record for this Member. Note: This field is marked as NOT NULL in the database and therefore required by the API. - `data.memberInsurances.carrier_Key` (integer,null) Identifies the 'Other Insurance' Carrier. - `data.memberInsurances.carrier_Name` (string,null) Carrier name for this other insurance record. - `data.memberInsurances.coverageType` (string,null) Coverage Type of 'Other Insurance' policy. - `data.memberInsurances.end_Date` (string,null) Date when the 'Other Insurance' expires/expired. - `data.memberInsurances.entry_Date` (string) Date when the record was first added to the system. - `data.memberInsurances.entry_User` (string,null) User that first added the record to the system. - `data.memberInsurances.group_Number` (string,null) Group number of 'Other Insurance' policy. - `data.memberInsurances.insurance_Type` (integer,null) Insurance type of the 'Other Insurance' policy. - `data.memberInsurances.limits` (number,null) Dollar amount of the 'Other Insurance' policy. - `data.memberInsurances.plan_Type` (string,null) Plan type associated with the 'Other Insurance'. - `data.memberInsurances.policyHolderName` (string,null) Name of the 'Other Insurance' primary policy holder. - `data.memberInsurances.policy_Number` (string,null) Number of the 'Other Insurance' policy. - `data.memberInsurances.priority` (integer, required) Priority of the Member's 'Other Insurance'. Note: This field is marked as NOT NULL in the database and therefore required by the API. - `data.memberInsurances.secondary_Member_Seq` (string,null) For purposes of utlizing Auto-COB processing, this indicates the member who is covered by Secondary Insurance under this Insured record. - `data.memberInsurances.secondary_Subscriber_ID` (string,null) For purposes of utlizing Auto-COB processing, this indicates the member who is covered by Secondary Insurance under this Insured record. - `data.memberInsurances.start_Date` (string,null) Date when the 'Other Insurance' becomes/became effective. - `data.memberInsurances.update_Date` (string) Date when the record was last updated in the system. - `data.memberInsurances.update_User` (string,null) User that last updated the record in the system. - `data.memberProviders` (array,null) - `data.memberProviders.memberProvider_Key` (integer, required) Unique identifier for each PCP record attached to this member. Note: This field is marked as NOT NULL in the database and therefore required by the API. - `data.memberProviders.capitation_Category` (string,null) Specifies the capitation category. - `data.memberProviders.effective_Date` (string, required) Date when the Provider became the Member's PCP. Note: This field is marked as NOT NULL in the database and therefore required by the API. - `data.memberProviders.end_Date` (string,null) Date when the Member left the Provider as their PCP. - `data.memberProviders.ipA_Number` (string,null) Information field used for custom reporting and interfaces. - `data.memberProviders.provider_ID` (string, required) Provider designated this Member's PCP. - `data.memberProviders.reason_Code` (integer,null) Specifies the reason for the Member leaving the Provider as their PCP. - `data.memberEligibilityStatuses` (array,null) - `data.memberEligibilityStatuses.memberEligibilityStatus_Key` (integer, required) Unique identifier for each Eligiblity Status value for this Member. Note: This field is marked as NOT NULL in the database and therefore required by the API. - `data.memberEligibilityStatuses.effective_Date` (string,null) Date when the eligibility status becomes/became effective. - `data.memberEligibilityStatuses.eligibility_Status` (string, required) Identifies the eligibility status to be tied to the Member. This can be configured within Enrollment Services > Enrollment Configuration > Eligibility Status. - `data.memberEligibilityStatuses.end_Date` (string,null) Date when the eligibility status expires/expired. - `data.codeValues` (array,null) - `data.codeValues.idCodeValue_Key` (integer,null) - `data.codeValues.iD_Code` (string,null) - `data.codeValues.iD_Code_Description` (string,null) - `data.codeValues.type` (string,null) - `data.codeValues.type_Description` (string,null) - `data.codeValues.dataType` (string,null) - `data.codeValues.iD_Code_Data_String` (string,null) - `data.codeValues.iD_Code_Data_Date` (string,null) - `data.codeValues.iD_Code_Data_Number` (integer,null) - `data.codeValues.iD_Code_Data_Decimal` (number,null) - `data.codeValues.iD_Code_Data_Option` (boolean,null) - `data.plans` (object) - `data.plans.plan_ID` (string, required) Unique identifier assigned to the Plan. - `data.plans.annual_Max` (number,null) Total In-Network and Out of Network annual maximum the plan will pay out for the Familiy. - `data.plans.annual_Max_Net` (number,null) In-Network annual maximum that the plan will pay out for the Familiy. - `data.plans.annual_Max_OON` (number,null) Out of Network annual maximum that the plan will pay out for the Familiy. - `data.plans.auto_Create_Flex` (boolean, required) Indicates if this plan allows auto-creation of Flex claims based on Group level configuration for flex auto-creation. Note: This field is marked as NOT NULL in the database and therefore required by the API. - `data.plans.cobrA_Plan_Type_Desc` (string,null) Used for custom reporting and information. - `data.plans.coB_Savings_Max` (number,null) Indicates the maximum amount that can be held in COB savings. - `data.plans.coB_Type` (string,null) Indicates the type of COB to be used with the selected plan. - `data.plans.capitated` (boolean, required) No longer in use. All captiation logic and processing now resides in the capitation tables. Note: This field is marked as NOT NULL in the database and therefore required by the API. - `data.plans.cash_Value_Default` (integer,null) Default cash value when Policy & Forfeiture is used in enrollment. - `data.plans.coIns_In_To_Out` (boolean, required) Indicates whether In-Network Coinsurance amounts apply toward the satisfaction of Out of Network amounts. Note: This field is marked as NOT NULL in the database and therefore required by the API. - `data.plans.coIns_Max_Mem` (number,null) In Network Co-Insurance amount for the Family. - `data.plans.coIns_Max_Net_Mem` (number,null) Total Co-Insurance amount for the Member. - `data.plans.coIns_Max_Net_Sub` (number,null) Out of Network Co-Insurance amount for the Family. - `data.plans.coIns_Max_OON_Mem` (number,null) Out of Network Co-Insurance amount for the Member. - `data.plans.coIns_Max_OON_Sub` (number,null) In Network Co-Insurance amount for the Member. - `data.plans.coIns_Max_Sub` (number,null) Total Co-Insurance amount for the Family. - `data.plans.coIns_Out_To_In` (boolean, required) Indicates whether Out of Network CoInsurance amounts apply toward the satisfaction of the In-Network amounts. Note: This field is marked as NOT NULL in the database and therefore required by the API. - `data.plans.coIns_Out_To_In_Limit` (boolean, required) When active, this will let the system know to limit the amount of co-insurance that applies to IN from OON by the Max. Note: This field is marked as NOT NULL in the database and therefore required by the API. - `data.plans.coIns_Out_To_In_Limit_Max` (number,null) The max with which the co-insurance is limited by when CoIns_Out To In Limit is selected. - `data.plans.context4_ClmUcrPct` (integer,null) Claim UCR percentage provided by Context. Required for Context claim edits and repricing. - `data.plans.context4_ClmUcrPct_OON` (integer,null) Out of network claim UCR percentage provided by context. Required for Context claim edits and repricing. - `data.plans.context4_FeeSelector` (string,null) Fee Selector provided by Context. Required for Context claim edits and repricing. - `data.plans.context4_FeeSelector_OON` (string,null) Out of network fee selector provided by context. Required for Context claim edits and repricing. - `data.plans.context4_MedicarePct` (integer,null) Medicare percentage provided by Context. Required for Context claim edits and repricing. - `data.plans.context4_MedicarePct_OON` (integer,null) Out of network Medicare percentage provided by context. Required for Context claim edits and repricing. - `data.plans.context4_Password` (string,null) Password provided by Context. Required for Context claim edits and repricing. - `data.plans.context4_PayorType` (string,null) Payor type provided by context. Required for Context claim edits and repricing. - `data.plans.context4_PayorType_OON` (string,null) Out of network Payor type provided by context. Required for Context claim edits and repricing. - `data.plans.context4_PctOfChg` (integer,null) Percentage of change provided by context. Required for Context claim edits and repricing. - `data.plans.context4_PctOfChg_OON` (integer,null) Out of network percentage of change provided by context. Required for Context claim edits and repricing. - `data.plans.context4_PlanPriceNotGreaterBilledFg` (boolean, required) When using Context4, the Plan Price is never allowed to exceed the Billed Price, it'll set it to the Billed Price. Note: This field is marked as NOT NULL in the database and therefore required by the API. - `data.plans.context4_UserID` (string,null) User ID provided by Context. Required for Context claim edits and repricing. - `data.plans.context4_WebURI` (string,null) URL provided by Context. Required for Context claim edits and repricing. - `data.plans.context4_WebURI_Delete` (string,null) URL delete provided by Context. Required for Context claim edits and repricing. - `data.plans.currency_ID` (string,null) Indicates the currency being used. - `data.plans.ded_In_To_Out` (boolean, required) Indicates whether In-Network Deductible amounts apply toward the satisfaction of Out of Network amounts. Note: This field is marked as NOT NULL in the database and therefore required by the API. - `data.plans.ded_Out_To_In` (boolean, required) Indicates whether Out of Network Deductible amounts apply toward the satisfaction of In-Network amounts. Note: This field is marked as NOT NULL in the database and therefore required by the API. - `data.plans.ded_Out_To_In_Limit` (boolean, required) When active, this will let the system know to limit the amount of deductible that applies to IN from OON by the Max. Note: This field is marked as NOT NULL in the database and therefore required by the API. - `data.plans.ded_Out_To_In_Limit_Max` (number,null) The max with which the deducible is limited by when Ded_Out To In Limit is selected. - `data.plans.description` (string,null) A short description of the associated plan. - `data.plans.entry_Date` (string) Date when the record was added to the system. - `data.plans.extended_Term_Default` (integer,null) Deault extended term value assigned in Policy & Forfeiture when used in enrollment. - `data.plans.family_Level_Co_Ins` (boolean, required) Specifies that the number of Member level Coinsurance amounts should be used to satisfy the Family level Coinsurance amount. Note: This field is marked as NOT NULL in the database and therefore required by the API. - `data.plans.family_Level_Co_Ins_Member` (integer,null) Number of Members that must satisfy the Member level deductible before the Family level amount is considered met. - `data.plans.family_Level_Ded` (boolean, required) Specifies that the number of Member level deductible amounts should be used to satisfy the Family level deductible. Note: This field is marked as NOT NULL in the database and therefore required by the API. - `data.plans.family_Level_Ded_Member` (integer,null) Number of Members that must satisfy the Member level deductible before the Family level amount is considered met. - `data.plans.family_Level_OOP` (boolean, required) Specifies that the number of Member level Out of Pocket amounts should be used to satisfy the Family level Out of Pocket amount. Note: This field is marked as NOT NULL in the database and therefore required by the API. - `data.plans.family_Level_OOP_Member` (integer,null) Number of Members that must satisfy the Member level Out of Pocket before the Family level Out of Pocket is considered met. - `data.plans.flex_Advance_Fund` (boolean, required) Information field used in reporting to identify this plan as Flex Advance Fund. Note: This field is marked as NOT NULL in the database and therefore required by the API. - `data.plans.flex_Type` (string,null) Indicates what type of Flex account to be associated with the plan. - `data.plans.forfeiture_Status_Default` (string,null) Default forfeiture status assigned when Policy & Forteiture is used in enrollment. - `data.plans.illness_Ex_Code` (string,null) Ex Code associated with the illness waiting period. - `data.plans.illness_Waiting_Period` (integer,null) Waiting Period after an illness for Disability plans to start coverage. - `data.plans.include_Waiting_Period` (boolean,null) Indicates whether the Disability plan includes a waiting period. - `data.plans.injury_Ex_Code` (string,null) Ex Code associated with the injury waiting period. - `data.plans.injury_Waiting_Period` (integer,null) Waiting Period after an injury for Disability plans to start coverage. - `data.plans.ltC_Apply_Elimination_Period` (boolean, required) Indicates if this Plan has Elimination Period rules. Note: This field is marked as NOT NULL in the database and therefore required by the API. - `data.plans.ltC_Apply_Waiver_Of_Premium` (boolean, required) Indicates if Waiver of Premium rules should apply for this plan. Note: This field is marked as NOT NULL in the database and therefore required by the API. - `data.plans.ltC_Daily_Benefit` (number,null) This is the daily benefit amount - `data.plans.ltC_Daily_Benefit_Range_From` (number,null) The start of the selection range for members taking this plan and choosing their daily benefit. - `data.plans.ltC_Daily_Benefit_Range_Increment` (number,null) The increment of each option in the range between the from and thru. If empty, the member can manually select a value between the from / thru range. - `data.plans.ltC_Daily_Benefit_Range_Thru` (number,null) The end of the selection range for members taking this plan and choosing their daily benefit. - `data.plans.ltC_Daily_Benefit_Type` (string,null) This is the type of daily benefit defined for this plan. The values are: A - a flat daily benefit enforced by the plan. B - member selected value utilizing the daily benefit range/increment settings. - `data.plans.ltC_Elimination_Period` (integer,null) This is the elimination period value based on Elimination_Period_Type. - `data.plans.ltC_Elimination_Period_Per_Claim` (boolean, required) Indicates if the elimination period is per claim. By default the elimination period is per plan/policy. Note: This field is marked as NOT NULL in the database and therefore required by the API. - `data.plans.ltC_Elimination_Period_Type` (string,null) This is the type of Elimination Period rule to apply for this Plan. Values are: A - Calendar Days B - Service Days C - Special Service Days (one day equals a week of elimination period) - `data.plans.ltC_Lifetime_Max_Days_From` (integer,null) The selectable range of days the member can pick for calculations based on days. - `data.plans.ltC_Lifetime_Max_Days_Thru` (integer,null) The selectable range of days the member can pick for calculations based on days. - `data.plans.ltC_Lifetime_Max_From` (number,null) The low end range for member lifetime max selection. - `data.plans.ltC_Lifetime_Max_Increment` (number,null) The increment of options the user can select within the max range. Empty value here means it is a free from entry of max between the range. - `data.plans.ltC_Lifetime_Max_Joint_Policy` (boolean, required) Indicates if plans of the same plan type, and both flagged as joint policy, can share a "Total" lifetime max between both plans as long as both plans have selected a shared benefit. Note: This field is marked as NOT NULL in the database and therefore required by the API. - `data.plans.ltC_Lifetime_Max_Thru` (number,null) The high end range for member lifetime max selection. - `data.plans.ltC_Lifetime_Max_Type` (string,null) Lifetime Max calculation type and will dicatate the max rules applied. Valid values are: STANDARD - DBM x 365 days x Lifetime Max Years selected LMDAYS - DBM x Lifetime Max Days selected FLAT - Lifetime Max Amount selected and not based on calculation LMMONTHS - MBA x 12 Months x Lifetime Max Years selected - `data.plans.ltC_Lifetime_Max_Years_From` (integer,null) the selectable range of years the member can pick for calculations based on years. - `data.plans.ltC_Lifetime_Max_Years_Thru` (integer,null) The selectable range of years the member can pick for calculations based on years. - `data.plans.ltC_Monthly_Benefit` (number,null) This is the monthly benefit amount - `data.plans.ltC_Monthly_Benefit_Range_From` (number,null) The start of the selection range for members taking this plan and choosing their monthly benefit. - `data.plans.ltC_Monthly_Benefit_Range_Increment` (number,null) The increment of each option in the range between the from and thru. If empty, the member can manually select a value between the from / thru range. - `data.plans.ltC_Monthly_Benefit_Range_Thru` (number,null) The end of the selection range for members taking this plan and choosing their monthly benefit. - `data.plans.ltC_Monthly_Benefit_Type` (string,null) This is the type of monthly benefit defined for this plan. The values are: A - a flat monthly benefit enforced by the plan. B - member selected value utilizing the monthly benefit range/increment settings. - `data.plans.ltC_Waiver_Of_Premium_Type` (string,null) This is the type/rules for LTC waiver of premium. Current Values are: A - 1st day of following month B - day of eligibility approval C - joint waiver D - survivorship waiver - `data.plans.lifetime_Max` (number,null) Total lifetime amount that the Plan will pay both In Network and Out of Network for the Familiy. - `data.plans.lifetime_Max_Net` (number,null) Lifetime amount that the Plan will pay In Network for the Familiy. - `data.plans.lifetime_Max_OON` (number,null) Lifetime amount that the Plan will pay Out of Network for the Familiy. - `data.plans.maturity_Age` (integer,null) Specifies the required age for maturity of policy inside enrollment. - `data.plans.maturity_Age_Type` (string,null) Defines the age type for maturity based upon birth date or anniversary of enrollment. - `data.plans.max_Disability_Weeks` (integer,null) Maximum number of weeks the specified Plan will pay Disability. - `data.plans.max_Includes_Waiting_Period` (boolean,null) Indicates whether the waiting period is included in the Max Disability Weeks. - `data.plans.mem_Ded_Credit` (number,null) Total deductible amount to be credited back to each Member during adjudication. - `data.plans.mem_Ded_Credit_OON` (number,null) Out of Network deductible amount to be credited back to each Member during adjudication. - `data.plans.mem_Ded_Credit_PPO` (number,null) In-Network deductible amount to be credited back to each Member during adjudication. - `data.plans.member_Annual_Max` (number,null) Total In-Network and Out of Network annual maximum the plan will pay out per Member. - `data.plans.member_Annual_Max_Net` (number,null) In-Network annual maximum that the plan will pay out per Member. - `data.plans.member_Annual_Max_OON` (number,null) Out of Network annual maximum that the plan will pay out per Member. - `data.plans.member_Ded_OON` (number,null) Deductible amount for the Member Out of Network. - `data.plans.member_Ded_PPO` (number,null) Deductible amount for the Member In Network. - `data.plans.member_Deductible` (number,null) Total deductible amount for the Member both In Network and Out of Network. - `data.plans.member_Lifetime_Max` (number,null) Total In-Network and Out of Network lifetime maximum that the plan will pay out per Member. - `data.plans.member_Lifetime_Max_Net` (number,null) In-Network lifetime maximum that the plan will pay out per Member. - `data.plans.member_Lifetime_Max_OON` (number,null) Out of Network lifetime that the plan will pay out per Member. - `data.plans.ooP_Calc_Option` (string,null) Formula used to calculate Out of Pocket amounts. - `data.plans.ooP_In_To_Out` (boolean, required) Indicates whether In-Network Out of Pocket amounts apply toward the satisfaction of Out of Network amounts. Note: This field is marked as NOT NULL in the database and therefore required by the API. - `data.plans.ooP_Max_Mem` (number,null) Total In-Network and Out of Network Out of Pocket maximum for the Member. - `data.plans.ooP_Max_Net_Mem` (number,null) In-Network Out of Pocket maximum for the Member. - `data.plans.ooP_Max_Net_Sub` (number,null) In-Network Out of Pocket maximum for the Family. - `data.plans.ooP_Max_OON_Mem` (number,null) Out of Network Out of Pocket for the Member. - `data.plans.ooP_Max_OON_Sub` (number,null) Out of Network Out of Pocket for the Family. - `data.plans.ooP_Max_Sub` (number,null) Total In-Network and Out of Network Out of Pocket maximum for the Family. - `data.plans.ooP_Out_To_In` (boolean, required) Indicates whether Out of Network Out of Pocket amounts apply toward the satisfaction of In-Network amounts. Note: This field is marked as NOT NULL in the database and therefore required by the API. - `data.plans.ooP_Out_To_In_Limit` (boolean, required) When active, this will let the system know to limit the amount of out of pocket that applies to IN from OON by the Max. Note: This field is marked as NOT NULL in the database and therefore required by the API. - `data.plans.ooP_Out_To_In_Limit_Max` (number,null) The max with which the out of pocket is limited by when OOP_Out To In Limit is selected. - `data.plans.payment_Interval` (integer,null) Payment Interval or frequency for Disability plans. - `data.plans.payor_ID` (string,null) No longer in use. - `data.plans.pend_Ex_Code` (string,null) Identifies the Ex Code that will be applied based upon the Pend_Flag field. - `data.plans.pend_Flag` (string,null) Specifies if an Ex Code will be assigned, which will apply to all claims adjudicated for this plan. The Ex Code can be an informational, denial, or pend code. All ExCodes impact adjudication. - `data.plans.plan_Document_URL` (string,null) Used for custom reporting and information. - `data.plans.plan_Type` (string,null) Identifies the Type of Plan (medical, dental, etc.). Keep in mind that Accumulators are tied to 'Plan Type' not the plan itself. - `data.plans.policy_Forfeiture_Grace_Period` (integer,null) Length of the grace period. - `data.plans.policy_Forfeiture_Grace_Period_Type` (string,null) Defines the type of grace period. Restricted to units of days. - `data.plans.policy_Status_Default` (string,null) Default policy status assigned when Policy & Forteiture is used in enrollment. - `data.plans.preEx_Ex_Code` (string,null) Identifies the Ex Code that will be applied to disability claims falling within the provided range. - `data.plans.preEx_From` (integer,null) No longer in use. Pre-Ex processing has been moved to a more detailed structure in PlanPrex tables. - `data.plans.preEx_Range` (integer,null) Defines a range of days that is determined by comparing the start date of the plan and the disability date. If a disability claim falls within this defined range, the specified Ex Code will be applied to that claim. - `data.plans.preEx_Thru` (integer,null) No longer in use. Pre-Ex processing has been moved to a more detailed structure in PlanPrex tables. - `data.plans.qpA_Method` (string,null) Determines the QPA Method to be used for claims under this Plan - `data.plans.reduced_Paid_Up_Default` (integer,null) Deault paid up value when Policy & Forfeiture is used in enrollment. - `data.plans.remove_Member_Amount_Edit` (boolean, required) No longer in use. Note: This field is marked as NOT NULL in the database and therefore required by the API. - `data.plans.situs_State` (string,null) State where the Plan originates or applies - `data.plans.sub_Ded_Credit` (number,null) Total deductible amount to be credited back to the Subscriber during adjudication. - `data.plans.sub_Ded_Credit_OON` (number,null) Out of Network deductible amount to be credited back to the Subscriber during adjudication. - `data.plans.sub_Ded_Credit_PPO` (number,null) In-Network deductible amount to be credited back to the Subscriber during adjudication. - `data.plans.subscriber_Ded_OON` (number,null) Deductible amount for the Family Out of Network. - `data.plans.subscriber_Ded_PPO` (number,null) Deductible amount for the Family In Network. - `data.plans.subscriber_Deductible` (number,null) Total deductible amount for the Family both In Network and Out of Network. - `data.plans.survivor_Benefit` (integer,null) Survivor Benefit associated with Disability plans. - `data.plans.use_COB_Savings` (boolean, required) Indicates whether the COB should be used. Note: This field is marked as NOT NULL in the database and therefore required by the API. - `data.plans.visium_Criteria_Key` (integer,null) This field is not currently used - future-proofing support for additional options - `data.plans.visium_Edit` (boolean, required) Flag for enabling Visium integration. Note: This field is marked as NOT NULL in the database and therefore required by the API. - `data.plans.visium_Setting_ID` (string,null) This field is not currently used - future-proofing for additional custom parameters - `data.plans.talon_Edit` (boolean) - `data.plans.talon_Criteria_Key` (integer,null) - `data.plans.clearity_Plan` (boolean) - `data.plans.clearity_Criteria_Key` (integer,null) - `data.coveredBenefits` (array,null) - `data.coveredBenefits.benefit_Code` (string,null) - `data.coveredBenefits.hipaA_Code` (string,null) - `data.coveredBenefits.description` (string,null) - `data.coveredBenefits.benefit_Category` (string,null) - `data.coveredBenefits.use_Plan_CoIns` (boolean) Indicates that the Plan Benefit Co-Insurance amounts will abide by the Plan level amounts. - `data.coveredBenefits.use_Plan_Ded` (boolean) Indicates that the Plan Benefit Deductible amounts will abide by the Plan level amounts. - `data.coveredBenefits.ded_Max_Sub` (number,null) Total deductible amount for the Family both In Network and Out of Network. - `data.coveredBenefits.ded_Max_Mem` (number,null) Total deductible amount for the Member both In Network and Out of Network. - `data.coveredBenefits.ded_Max_Net_Sub` (number,null) Deductible amount for the Family In Network. - `data.coveredBenefits.ded_Max_Net_Mem` (number,null) Deductible amount for the Member In Network. - `data.coveredBenefits.ded_Max_OON_Sub` (number,null) Deductible amount for the Family Out of Network. - `data.coveredBenefits.ded_Max_OON_Mem` (number,null) Deductible amount for the Member Out of Network. - `data.coveredBenefits.use_Plan_OOP` (boolean) Indicates that the Plan Benefit Out of Pocket amounts will abide by the Plan level amounts. - `data.coveredBenefits.covered` (boolean) Identifies whether the Benefit Code is covered for this Plan. This can be populated from the 'Plan' screen. - `data.coveredBenefits.pcP_Only` (boolean) Indicates that the selected Benefit applies to Primary Care Physician only. If a claim is processed against this Benefit Code without a PCP, the claim will apply the “PCP Only“ Ex Code defined on the VBA Control Panel. - `data.coveredBenefits.covered_In_Net_Only` (boolean) Checking this option indicates that the Benefit is covered only when services are rendered by an In-Network provider. If a claim is processed against this Benefit Code as Out of Network, the claim will apply the “Covered In-Network Only“ Ex Code defined on the VBA Control Panel. - `data.coveredBenefits.deductible_Before_CoPay` (boolean) This flag determines if adjudication calculates the Deductible before the CoPay is calculated. - `data.coveredBenefits.excluded` (boolean) Identifies whether the Benefit Code is excluded for this Plan. This allows the benefit to be on a claim preventing an error for no matching benefit and then applying a not covered ex code. - `data.coveredBenefits.apply_Ex_Code` (boolean) Indicates that an Ex Code should be applied to any service line with this Benefit Code. - `data.coveredBenefits.ex_Code` (string,null) If the Apply_Ex_Code flag is set, this field will contain the Ex Code to be applied. - `data.coveredBenefits.planBenLevels` (array,null) - `data.coveredBenefits.planBenLevels.planBenefitLevel_Key` (integer, required) Unique idenfitier assigned to the Plan Benefit Level. Note: This field is marked as NOT NULL in the database and therefore required by the API. - `data.coveredBenefits.planBenLevels.benefit_Code` (string, required) References the PlanBenefits.Benefit_Code value in parent table. - `data.coveredBenefits.planBenLevels.benefit_Level` (string, required) Unique identifier assigned to the Plan Benefit Level: Age by Service Date - age of the Member by the service date of the claim. Age by Received Date - age of the Member by the received date of the claim. Relationship Code - relationship of the Member to the Subscriber. Months Enrolled in Plan - range of months the Member has been enrolled in the plan. Days Enrolled in Plan - range of days the Member has been enrolled in the plan. Network - network of the claim. Out of Network - claim is out of network. Billed Amount - range of billed amount of the service line. Modifier - modifier exists on the service line. Exact Modifier - modifier exists in the exact location on the service line. No Modifier - no modifier exists on the service line. Exclude Modifier - modifier does not exist on the service line. Exclude Exact Modifier - modifier does not exist in the exact location on the service line. Gender - biological sex of the Member. Billing Taxonomy - taxonomy of the billing Provider must be included in the taxonomy group. Rendering Taxonomy - taxonomy of the rendering Provider must be included in the taxonomy group. Service Facility Taxonomy - taxonomy of the facility Provider must be included in the taxonomy group. Procedure Category - procedure code on the service line must fall into the indicated procedure category. Procedure Cluster - procedure code on the service line must fall into the indicated procedure cluster. Provider Federal ID - federal ID of the claim's Provider. - `data.coveredBenefits.planBenLevels.exclude` (boolean, required) Indicates whether the specified code is included or excluded. Note: This field is marked as NOT NULL in the database and therefore required by the API. - `data.coveredBenefits.planBenLevels.extra_Value1` (string,null) Additional value that may be associated with the Benefit Level. - `data.coveredBenefits.planBenLevels.extra_Value2` (string,null) Additional value that may be associated with the Benefit Level. - `data.coveredBenefits.planBenLevels.from_Value` (string,null) Initial value in the range of values. - `data.coveredBenefits.planBenLevels.plan_ID` (string,null) References the PlanBenefits.Plan_ID value in parent table. - `data.coveredBenefits.planBenLevels.thru_Value` (string,null) Final value in the range of values. - `data.coveredBenefits.planBenLevels.value_Type` (string,null) Specifies the type or measure of the associated Benefit Level values. - `data.coveredBenefits.planBenLevelNetworks` (array,null) - `data.coveredBenefits.planBenLevelNetworks.networkID` (string, required) Unique identifier assigned to the network. - `data.coveredBenefits.planBenLevelNetworks.apC_Schedule` (string,null) Identifies the default APC schedule that is to be used for the network. - `data.coveredBenefits.planBenLevelNetworks.address` (string,null) Address line 1 of the network. - `data.coveredBenefits.planBenLevelNetworks.address_2` (string,null) Address line 2 of the network. - `data.coveredBenefits.planBenLevelNetworks.city` (string,null) City of the network's address. - `data.coveredBenefits.planBenLevelNetworks.claim_Days_Allowed` (integer,null) This option is informational only and currently has no functionality. - `data.coveredBenefits.planBenLevelNetworks.drG_Schedule` (string,null) Identifies the default DRG schedule that is to be used for the network. - `data.coveredBenefits.planBenLevelNetworks.eMail` (string,null) Email of the Network. - `data.coveredBenefits.planBenLevelNetworks.ex_Code` (string,null) Specifies the Ex Code that will be applied while the Ex Code flag is selected. - `data.coveredBenefits.planBenLevelNetworks.ex_Code_Flag` (string,null) This option tells adjudication to apply an Ex Code to claims associated with the network. - `data.coveredBenefits.planBenLevelNetworks.fax` (string,null) Fax number of the Network. - `data.coveredBenefits.planBenLevelNetworks.logo_File` (string,null) Allows the User to upload a logo that can be attached to custom reporting. - `data.coveredBenefits.planBenLevelNetworks.networkDescription` (string,null) Description of the associated network. - `data.coveredBenefits.planBenLevelNetworks.phone` (string,null) Phone number of the Network. - `data.coveredBenefits.planBenLevelNetworks.state` (string,null) State of the network's address. - `data.coveredBenefits.planBenLevelNetworks.withhold_Percent` (number,null) This option is informational only and currently has no functionality. - `data.coveredBenefits.planBenLevelNetworks.zip_Code` (string,null) Zip code of the Network's address. - `data.planBenAuths` (array,null) - `data.planBenAuths.plan_ID` (string, required) References the PlanBenefitsPlace.Plan_ID value in parent table. - `data.planBenAuths.benefit_Code` (string, required) References the PlanBenefitsPlace.Benefit_Code value in parent table. - `data.planBenAuths.place_Code` (string, required) References the PlanBenefitsPlace.Place_Code value in parent table. - `data.planBenAuths.amount_Before_Auth` (number,null) Specifies the amount of the associated amount type that is allowed before requiring an authorization. - `data.planBenAuths.amount_Type` (string,null) Specifies the amount type (Billed, Allowed, or Payable) that the 'Amount Before Auth' rule will be tied to. - `data.planBenAuths.auth_Reqd` (string, required) Indicates whether an authorization is required for the selected place code. Note: This field is marked as NOT NULL in the database and therefore required by the API. - `data.planBenAuths.visits_Before_Auth` (integer,null) Specifies the number of visits allowed before an authorization is required. - `data.planBenCoPays` (array,null) - `data.planBenCoPays.copay_Amt` (number,null) Out of Network Co-Pay amount. - `data.planBenCoPays.copay_Amt_Net` (number,null) In Network Co-Pay amount. - `data.planBenCoPays.copay_Amt_Net_OOP` (boolean, required) Indicates that the In Network Co-Pay will continue to be taken after the Out of Pocket has been met. Note: This field is marked as NOT NULL in the database and therefore required by the API. - `data.planBenCoPays.copay_Amt_OOP` (boolean, required) Indicates that the Out of Network Co-Pay will continue to be taken after the Out of Pocket has been met. Note: This field is marked as NOT NULL in the database and therefore required by the API. - `data.planBenCoPays.copay_Pct` (string, required) Indicates whether the Out of Network Co-Pay amount is a percentage. Note: This field is marked as NOT NULL in the database and therefore required by the API. - `data.planBenCoPays.copay_Pct_Net` (string, required) Indicates whether the In Network Co-Pay amount is a percentage. Note: This field is marked as NOT NULL in the database and therefore required by the API. - `data.planBenCoPays.copay_Per` (string,null) Indicates the frequency that Co-Pay is taken: 1. Day - per service date. 2. Occurrence - per occurrence date on the claim header. 3. Service - per service line. 4. Unit - per unit on the service line. 5. Visit - per day per Provider. - `data.planBenCoInsurances` (array,null) - `data.planBenCoInsurances.co_Ins_Net_Pct` (string, required) Indicates whether the In Network Co-Insurance amount is a percentage. Note: This field is marked as NOT NULL in the database and therefore required by the API. - `data.planBenCoInsurances.co_Ins_Pct` (string, required) Indicates whether the Out of Network Co-Insurance amount is a percentage. Note: This field is marked as NOT NULL in the database and therefore required by the API. - `data.planBenCoInsurances.co_Insurance` (number,null) Out of Network Co-Insurance amount. - `data.planBenCoInsurances.co_Insurance_Net` (number,null) In Network Co-Insurance amount. - `data.accumulatorDetail` (array,null) - `data.accumulatorDetail.ooP_Calc_Option` (string,null) - `data.accumulatorDetail.member_Deductible` (number,null) - `data.accumulatorDetail.member_Ded_PPO` (number,null) - `data.accumulatorDetail.member_Ded_OON` (number,null) - `data.accumulatorDetail.mem_Ded_Credit` (number,null) - `data.accumulatorDetail.mem_Ded_Credit_PPO` (number,null) - `data.accumulatorDetail.mem_Ded_Credit_OON` (number,null) - `data.accumulatorDetail.deductible_Used` (number,null) - `data.accumulatorDetail.ded_PPO_Used` (number,null) - `data.accumulatorDetail.deductible_Used_OON` (number,null) - `data.accumulatorDetail.ded_Credit_Used` (number,null) - `data.accumulatorDetail.ded_Credit_PPO_Used` (number,null) - `data.accumulatorDetail.ded_Credit_OON_Used` (number,null) - `data.accumulatorDetail.subscriber_Deductible` (number,null) - `data.accumulatorDetail.subscriber_Ded_PPO` (number,null) - `data.accumulatorDetail.subscriber_Ded_OON` (number,null) - `data.accumulatorDetail.sub_Ded_Credit` (number,null) - `data.accumulatorDetail.sub_Ded_Credit_PPO` (number,null) - `data.accumulatorDetail.sub_Ded_Credit_OON` (number,null) - `data.accumulatorDetail.fam_Deductible_Used` (number,null) - `data.accumulatorDetail.fam_Ded_PPO_Used` (number,null) - `data.accumulatorDetail.fam_Deductible_Used_OON` (number,null) - `data.accumulatorDetail.fam_Ded_Credit_Used` (number,null) - `data.accumulatorDetail.fam_Ded_Credit_PPO_Used` (number,null) - `data.accumulatorDetail.fam_Ded_Credit_OON_Used` (number,null) - `data.accumulatorDetail.coIns_Max_Mem` (number,null) - `data.accumulatorDetail.coIns_Max_Net_Mem` (number,null) - `data.accumulatorDetail.coIns_Max_OON_Mem` (number,null) - `data.accumulatorDetail.coIns_Amt` (number,null) - `data.accumulatorDetail.coIns_Amt_Net` (number,null) - `data.accumulatorDetail.coIns_Amt_OON` (number,null) - `data.accumulatorDetail.coIns_Max_Sub` (number,null) - `data.accumulatorDetail.coIns_Max_Net_Sub` (number,null) - `data.accumulatorDetail.coIns_Max_OON_Sub` (number,null) - `data.accumulatorDetail.fam_CoIns_Amt` (number,null) - `data.accumulatorDetail.fam_CoIns_Amt_Net` (number,null) - `data.accumulatorDetail.fam_CoIns_Amt_OON` (number,null) - `data.accumulatorDetail.ooP_Max_Mem` (number,null) - `data.accumulatorDetail.ooP_Max_Net_Mem` (number,null) - `data.accumulatorDetail.ooP_Max_OON_Mem` (number,null) - `data.accumulatorDetail.out_Of_Pocket` (number,null) - `data.accumulatorDetail.out_Of_Pocket_Net` (number,null) - `data.accumulatorDetail.out_Of_Pocket_OON` (number,null) - `data.accumulatorDetail.ooP_Max_Sub` (number,null) - `data.accumulatorDetail.ooP_Max_Net_Sub` (number,null) - `data.accumulatorDetail.ooP_Max_OON_Sub` (number,null) - `data.accumulatorDetail.fam_Out_Of_Pocket` (number,null) - `data.accumulatorDetail.fam_Out_Of_Pocket_Net` (number,null) - `data.accumulatorDetail.fam_Out_Of_Pocket_OON` (number,null) - `data.accumulatorDetail.plan_Year_Paid` (number,null) - `data.accumulatorDetail.plan_Year_Max` (number,null) - `data.accumulatorDetail.lifetime_Paid` (number,null) - `data.accumulatorDetail.lifetime_Max` (number,null) - `data.accumulatorDetail.fam_Plan_Year_Paid` (number,null) - `data.accumulatorDetail.plan_Year_Max_Sub` (number,null) - `data.accumulatorDetail.fam_Lifetime_Paid` (number,null) - `data.accumulatorDetail.lifetime_Max_Sub` (number,null) - `data.accumulatorDetail.coB_Savings_Max` (number,null) - `data.accumulatorDetail.coB_Savings` (number,null) - `data.accumulatorDetail.coB_Savings_Used` (number,null) - `data.accumulatorDetail.currency_ID` (string,null) - `data.accumulatorDetail.fmD_Max_ID` (integer,null) - `data.planMaxSummaryResults` (array,null) - `data.planMaxSummaryResults.as_Of_Date` (string,null) - `data.planMaxSummaryResults.amount_Met` (number,null) - `data.planMaxSummaryResults.visits_Met` (integer,null) - `data.planMaxSummaryResults.max_ID` (string,null) - `data.planMaxSummaryResults.max_Type` (string,null) - `data.planMaxSummaryResults.max_Type_Net` (string,null) - `data.planMaxSummaryResults.quantity` (number,null) - `data.planMaxSummaryResults.max_Per` (string,null) - `data.planMaxSummaryResults.frequency` (integer,null) - `data.planMaxSummaryResults.from_Procedure` (string,null) - `data.planMaxSummaryResults.thru_Procedure` (string,null) - `data.planMaxSummaryResults.max_From` (string,null) - `data.planMaxSummaryResults.max_Thru` (string,null) - `error` (object) - `error.detail` (string,null) A human-readable explanation specific to this occurrence of the problem. - `error.instance` (string,null) A URI reference that identifies the specific occurrence of the problem.It may or may not yield further information if dereferenced. - `error.status` (integer) The HTTP status code([RFC7231], Section 6) generated by the origin server for this occurrence of the problem. - `error.title` (string,null) A short, human-readable summary of the problem type.It SHOULD NOT change from occurrence to occurrence of the problem, except for purposes of localization(e.g., using proactive content negotiation; see[RFC7231], Section 3.4). - `error.type` (string,null) A URI reference [RFC3986] that identifies the problem type. This specification encourages that, when dereferenced, it provide human-readable documentation for the problem type (e.g., using HTML [W3C.REC-html5-20141028]). When this member is not present, its value is assumed to be "about:blank". - `debug` (object) - `debug.activityID` (string, required) ## Response 401 fields