Claim Custom Ex Code Rules

Create ClaimCustomExCodeRule

Creates a new ClaimCustomExCodeRule

SecurityapiKeyAuth and bearerAuth
Request
header Parameters
vbasoftware-database
required
string

Target database

Request Body schema:
required
claimCustomExCodeRule_Key
required
integer <int32>

Unique identifier for each custom Ex Code rule. This takes the combination of fields on this table and, if a claim fits in the configuration, assigns an ex code. Note: This field is marked as NOT NULL in the database and therefore required by the API.

benefit_Code
string or null <= 10 characters

Benefit code associated with the selected custom ExCode rule.

claim_Type
string or null <= 20 characters

The Claim Type for this Custom Ex Code rule.

date_Type
string or null <= 16 characters

The Date Type (service date, received date, etc.) to use in combination with effective dates to deterine if this rule applies.

detail_Amount
number or null <double>

The amount you want this edit to compare against. For example, if you wanted to apply a custom ex code for any claim with a Co Insurance greater than $50, you would set Detail_Amount_Field = "co_ins_amt", set the Detail_Amount_Field_Operator to ">", then set the Detail_Amount field to 50.00.

detail_Amount_Field
string or null <= 64 characters

The detail amount field drives the logic for what the Field Operator and Amount are compared against on the Service line: payable_amount: The amount payable based on rules applied (Allowed - (copay, coins, deductible, not covered, etc.). billed_price: The amount billed, represented by the Billed_Price field. plan_price: The price associated with the plan, represented by the Plan_Price field. deductible_amt: The deductible amount, represented by the Deductible_Amt field. co_pay_amt: The co-payment amount, represented by the Co_Pay_Amt field. co_ins_amt: The co-insurance amount, represented by the Co_Ins_Amt field. cob_amt: The coordination of benefits amount, represented by the COB_Amt field. cob_hold: The coordination of benefits hold amount, represented by the COB_Hold field. cob_mem_resp: The coordination of benefits member responsibility, represented by the COB_Mem_Resp field. mem_resp: The total member responsibility, calculated as the sum of Co_Ins_Amt, Co_Pay_Amt, and Deductible_Amt.

detail_Amount_Field_Operator
string or null <= 32 characters

Simple operator (Greater than, less than, or equal). This compares the value identified in Detail_Amount_Field against the value in the Detail_Amount field based on this opeator.

division_ID
string or null <= 20 characters

The Division ID for this Custom Ex Code rule.

effective_Date
string or null <date-time>

Effective Date for this Custom Ex Code rule.

entry_Date
string <date-time>

Date when the record was first added to the system.

entry_User
string or null <= 20 characters

User that first added the record to the system.

ex_Code
string or null <= 6 characters

The Ex Code that is applied if the identified criteria matched a claim during adjudication.

federal_ID
string or null <= 20 characters

The Tax ID for this Custom Ex Code rule.

from_Diag_Code
string or null <= 8 characters

The Diagnosis Range for this Custom Ex Code rule.

from_Procedure
string or null <= 8 characters

The Procedure Range for this Custom Ex Code rule.

group_ID
string or null <= 20 characters

The Group ID for this Custom Ex Code rule.

member_Seq
string or null <= 2 characters

The Member Sequence for this Custom Ex Code rule.

network_Option
string or null <= 6 characters

Option that allows custom claim rules to be applied in network, out of network or in all cases

plan_ID
string or null <= 20 characters

The Plan ID for this Custom Ex Code rule.

provider_ID
string or null <= 20 characters

The Provider ID for this Custom Ex Code rule.

subscriber_ID
string or null <= 9 characters

The Subscriber ID for this Custom Ex Code rule.

term_Date
string or null <date-time>

Term Date for this Custom Ex Code rule.

thru_Diag_Code
string or null <= 8 characters

The Diagnosis Range for this Custom Ex Code rule.

thru_Procedure
string or null <= 8 characters

The Procedure Range for this Custom Ex Code rule.

update_Date
string <date-time>

Date when the record was last updated in the system.

update_User
string or null <= 20 characters

User that last updated the record in the system.

use_Detail_Ex_Code
required
boolean

Indicates that this Custom Ex Code rule is going to apply the resulting Ex Code to the Service Line rather than the header. This assumes the use of Benefit_Code and the Detail_Amount fields. Note: This field is marked as NOT NULL in the database and therefore required by the API.

Responses
200

Success

401

Unauthorized

post/claim-custom-ex-code-rules
Request samples
{
  • "claimCustomExCodeRule_Key": 0,
  • "benefit_Code": "string",
  • "claim_Type": "string",
  • "date_Type": "string",
  • "detail_Amount": 0.1,
  • "detail_Amount_Field": "string",
  • "detail_Amount_Field_Operator": "string",
  • "division_ID": "string",
  • "effective_Date": "2019-08-24T14:15:22Z",
  • "entry_Date": "2019-08-24T14:15:22Z",
  • "entry_User": "string",
  • "ex_Code": "string",
  • "federal_ID": "string",
  • "from_Diag_Code": "string",
  • "from_Procedure": "string",
  • "group_ID": "string",
  • "member_Seq": "st",
  • "network_Option": "string",
  • "plan_ID": "string",
  • "provider_ID": "string",
  • "subscriber_ID": "string",
  • "term_Date": "2019-08-24T14:15:22Z",
  • "thru_Diag_Code": "string",
  • "thru_Procedure": "string",
  • "update_Date": "2019-08-24T14:15:22Z",
  • "update_User": "string",
  • "use_Detail_Ex_Code": true
}
Response samples
{
  • "data": {
    },
  • "error": {
    },
  • "debug": {
    }
}

List ClaimCustomExCodeRule

Lists all ClaimCustomExCodeRule

SecurityapiKeyAuth and bearerAuth
Request
query Parameters
page
integer <int32>
Default: 1

Page

pageSize
integer <int32>
Default: 100

Page Size

sortBy
string

Comma separated string to sort by. Each sort field can be followed by :asc or :desc to specify sort direction, ascending is default. E.g., 'Property1:desc,Property2:asc,Property3:asc' sorts Property1 in descending order, Property2 in ascending, and Property3 in ascending.

header Parameters
vbasoftware-database
required
string

Target database

Responses
200

Success

401

Unauthorized

get/claim-custom-ex-code-rules
Request samples 
Response samples 
No sample
Get ClaimCustomExCodeRule
Gets ClaimCustomExCodeRule


SecurityapiKeyAuth and bearerAuth 
Request 
path Parameters
customExCodeRuleKey
required
integer <int32> 
ClaimCustomExCodeRule Key


 
header Parameters
vbasoftware-database
required
string
Target database


 
Responses 
200
Success


401
Unauthorized


get/claim-custom-ex-code-rules/{customExCodeRuleKey}
Request samples 
Response samples 
No sample
Update ClaimCustomExCodeRule
Updates a specific ClaimCustomExCodeRule.


SecurityapiKeyAuth and bearerAuth 
Request 
path Parameters
customExCodeRuleKey
required
integer <int32> 
ClaimCustomExCodeRule Key


 
header Parameters
vbasoftware-database
required
string
Target database


 
Request Body schema: 
required
claimCustomExCodeRule_Key
required
integer <int32> 
Unique identifier for each custom Ex Code rule. This takes the combination of fields on this table and, if a claim fits in the configuration, assigns an ex code. Note: This field is marked as NOT NULL in the database and therefore required by the API.


 
benefit_Code
string or null  <= 10 characters 
Benefit code associated with the selected custom ExCode rule.


 
claim_Type
string or null  <= 20 characters 
The Claim Type for this Custom Ex Code rule.


 
date_Type
string or null  <= 16 characters 
The Date Type (service date, received date, etc.) to use in combination with effective dates to deterine if this rule applies.


 
detail_Amount
number or null <double> 
The amount you want this edit to compare against.  For example, if you wanted to apply a custom ex code for any claim with a Co Insurance greater than $50, you would set Detail_Amount_Field = "co_ins_amt", set the Detail_Amount_Field_Operator to ">", then set the Detail_Amount field to 50.00.


 
detail_Amount_Field
string or null  <= 64 characters 
The detail amount field drives the logic for what the Field Operator and Amount are compared against on the Service line:            payable_amount: The amount payable based on rules applied (Allowed - (copay, coins, deductible, not covered, etc.).            billed_price: The amount billed, represented by the Billed_Price field.            plan_price: The price associated with the plan, represented by the Plan_Price field.            deductible_amt: The deductible amount, represented by the Deductible_Amt field.            co_pay_amt: The co-payment amount, represented by the Co_Pay_Amt field.            co_ins_amt: The co-insurance amount, represented by the Co_Ins_Amt field.            cob_amt: The coordination of benefits amount, represented by the COB_Amt field.            cob_hold: The coordination of benefits hold amount, represented by the COB_Hold field.            cob_mem_resp: The coordination of benefits member responsibility, represented by the COB_Mem_Resp field.            mem_resp: The total member responsibility, calculated as the sum of Co_Ins_Amt, Co_Pay_Amt, and Deductible_Amt.


 
detail_Amount_Field_Operator
string or null  <= 32 characters 
Simple operator (Greater than, less than, or equal).  This compares the value identified in Detail_Amount_Field against the value in the Detail_Amount field based on this opeator.


 
division_ID
string or null  <= 20 characters 
The Division ID for this Custom Ex Code rule.


 
effective_Date
string or null <date-time> 
Effective Date for this Custom Ex Code rule.


 
entry_Date
string <date-time> 
Date when the record was first added to the system.


 
entry_User
string or null  <= 20 characters 
User that first added the record to the system.


 
ex_Code
string or null  <= 6 characters 
The Ex Code that is applied if the identified criteria matched a claim during adjudication.


 
federal_ID
string or null  <= 20 characters 
The Tax ID for this Custom Ex Code rule.


 
from_Diag_Code
string or null  <= 8 characters 
The Diagnosis Range for this Custom Ex Code rule.


 
from_Procedure
string or null  <= 8 characters 
The Procedure Range for this Custom Ex Code rule.


 
group_ID
string or null  <= 20 characters 
The Group ID for this Custom Ex Code rule.


 
member_Seq
string or null  <= 2 characters 
The Member Sequence for this Custom Ex Code rule.


 
network_Option
string or null  <= 6 characters 
Option that allows custom claim rules to be applied in network, out of network or in all cases


 
plan_ID
string or null  <= 20 characters 
The Plan ID for this Custom Ex Code rule.


 
provider_ID
string or null  <= 20 characters 
The Provider ID for this Custom Ex Code rule.


 
subscriber_ID
string or null  <= 9 characters 
The Subscriber ID for this Custom Ex Code rule.


 
term_Date
string or null <date-time> 
Term Date for this Custom Ex Code rule.


 
thru_Diag_Code
string or null  <= 8 characters 
The Diagnosis Range for this Custom Ex Code rule.


 
thru_Procedure
string or null  <= 8 characters 
The Procedure Range for this Custom Ex Code rule.


 
update_Date
string <date-time> 
Date when the record was last updated in the system.


 
update_User
string or null  <= 20 characters 
User that last updated the record in the system.


 
use_Detail_Ex_Code
required
boolean
Indicates that this Custom Ex Code rule is going to apply the resulting Ex Code to the Service Line rather than the header.  This assumes the use of Benefit_Code and the Detail_Amount fields. Note: This field is marked as NOT NULL in the database and therefore required by the API.


 
Responses 
200
Success


401
Unauthorized


put/claim-custom-ex-code-rules/{customExCodeRuleKey}
Request samples 
{
  • "claimCustomExCodeRule_Key": 0,
  • "benefit_Code": "string",
  • "claim_Type": "string",
  • "date_Type": "string",
  • "detail_Amount": 0.1,
  • "detail_Amount_Field": "string",
  • "detail_Amount_Field_Operator": "string",
  • "division_ID": "string",
  • "effective_Date": "2019-08-24T14:15:22Z",
  • "entry_Date": "2019-08-24T14:15:22Z",
  • "entry_User": "string",
  • "ex_Code": "string",
  • "federal_ID": "string",
  • "from_Diag_Code": "string",
  • "from_Procedure": "string",
  • "group_ID": "string",
  • "member_Seq": "st",
  • "network_Option": "string",
  • "plan_ID": "string",
  • "provider_ID": "string",
  • "subscriber_ID": "string",
  • "term_Date": "2019-08-24T14:15:22Z",
  • "thru_Diag_Code": "string",
  • "thru_Procedure": "string",
  • "update_Date": "2019-08-24T14:15:22Z",
  • "update_User": "string",
  • "use_Detail_Ex_Code": true
}
Response samples 
{
  • "data": {
    },
  • "error": {
    },
  • "debug": {
    }
}
Delete ClaimCustomExCodeRule
Deletes an ClaimCustomExCodeRule


SecurityapiKeyAuth and bearerAuth 
Request 
path Parameters
customExCodeRuleKey
required
integer <int32> 
ClaimCustomExCodeRule Key


 
header Parameters
vbasoftware-database
required
string
Target database


 
Responses 
204
Success


401
Unauthorized


delete/claim-custom-ex-code-rules/{customExCodeRuleKey}
Request samples 
Create or Update Batch ClaimCustomExCodeRule
Create or Update multiple ClaimCustomExCodeRule at once.  If the entity exists, it will be updated.  If the entity does not exist, it will be created.


SecurityapiKeyAuth and bearerAuth 
Request 
header Parameters
vbasoftware-database
required
string
Target database


 
Request Body schema: 
required
 Array 
claimCustomExCodeRule_Key
required
integer <int32> 
Unique identifier for each custom Ex Code rule. This takes the combination of fields on this table and, if a claim fits in the configuration, assigns an ex code. Note: This field is marked as NOT NULL in the database and therefore required by the API.


 
benefit_Code
string or null  <= 10 characters 
Benefit code associated with the selected custom ExCode rule.


 
claim_Type
string or null  <= 20 characters 
The Claim Type for this Custom Ex Code rule.


 
date_Type
string or null  <= 16 characters 
The Date Type (service date, received date, etc.) to use in combination with effective dates to deterine if this rule applies.


 
detail_Amount
number or null <double> 
The amount you want this edit to compare against.  For example, if you wanted to apply a custom ex code for any claim with a Co Insurance greater than $50, you would set Detail_Amount_Field = "co_ins_amt", set the Detail_Amount_Field_Operator to ">", then set the Detail_Amount field to 50.00.


 
detail_Amount_Field
string or null  <= 64 characters 
The detail amount field drives the logic for what the Field Operator and Amount are compared against on the Service line:            payable_amount: The amount payable based on rules applied (Allowed - (copay, coins, deductible, not covered, etc.).            billed_price: The amount billed, represented by the Billed_Price field.            plan_price: The price associated with the plan, represented by the Plan_Price field.            deductible_amt: The deductible amount, represented by the Deductible_Amt field.            co_pay_amt: The co-payment amount, represented by the Co_Pay_Amt field.            co_ins_amt: The co-insurance amount, represented by the Co_Ins_Amt field.            cob_amt: The coordination of benefits amount, represented by the COB_Amt field.            cob_hold: The coordination of benefits hold amount, represented by the COB_Hold field.            cob_mem_resp: The coordination of benefits member responsibility, represented by the COB_Mem_Resp field.            mem_resp: The total member responsibility, calculated as the sum of Co_Ins_Amt, Co_Pay_Amt, and Deductible_Amt.


 
detail_Amount_Field_Operator
string or null  <= 32 characters 
Simple operator (Greater than, less than, or equal).  This compares the value identified in Detail_Amount_Field against the value in the Detail_Amount field based on this opeator.


 
division_ID
string or null  <= 20 characters 
The Division ID for this Custom Ex Code rule.


 
effective_Date
string or null <date-time> 
Effective Date for this Custom Ex Code rule.


 
entry_Date
string <date-time> 
Date when the record was first added to the system.


 
entry_User
string or null  <= 20 characters 
User that first added the record to the system.


 
ex_Code
string or null  <= 6 characters 
The Ex Code that is applied if the identified criteria matched a claim during adjudication.


 
federal_ID
string or null  <= 20 characters 
The Tax ID for this Custom Ex Code rule.


 
from_Diag_Code
string or null  <= 8 characters 
The Diagnosis Range for this Custom Ex Code rule.


 
from_Procedure
string or null  <= 8 characters 
The Procedure Range for this Custom Ex Code rule.


 
group_ID
string or null  <= 20 characters 
The Group ID for this Custom Ex Code rule.


 
member_Seq
string or null  <= 2 characters 
The Member Sequence for this Custom Ex Code rule.


 
network_Option
string or null  <= 6 characters 
Option that allows custom claim rules to be applied in network, out of network or in all cases


 
plan_ID
string or null  <= 20 characters 
The Plan ID for this Custom Ex Code rule.


 
provider_ID
string or null  <= 20 characters 
The Provider ID for this Custom Ex Code rule.


 
subscriber_ID
string or null  <= 9 characters 
The Subscriber ID for this Custom Ex Code rule.


 
term_Date
string or null <date-time> 
Term Date for this Custom Ex Code rule.


 
thru_Diag_Code
string or null  <= 8 characters 
The Diagnosis Range for this Custom Ex Code rule.


 
thru_Procedure
string or null  <= 8 characters 
The Procedure Range for this Custom Ex Code rule.


 
update_Date
string <date-time> 
Date when the record was last updated in the system.


 
update_User
string or null  <= 20 characters 
User that last updated the record in the system.


 
use_Detail_Ex_Code
required
boolean
Indicates that this Custom Ex Code rule is going to apply the resulting Ex Code to the Service Line rather than the header.  This assumes the use of Benefit_Code and the Detail_Amount fields. Note: This field is marked as NOT NULL in the database and therefore required by the API.


 
Responses 
207
Success


401
Unauthorized


put/claim-custom-ex-code-rules-batch
Request samples 
[
  • {
    }
]
Response samples 
{
  • "data": [
    ],
  • "error": {
    },
  • "debug": {
    }
}