Provider DRG

Create ProviderDRG

Creates a new ProviderDRG

SecurityapiKeyAuth and bearerAuth
Request
path Parameters
providerID
required
string

Provider ID

header Parameters
vbasoftware-database
required
string

Target database

Request Body schema:
required
providerDRG_Key
required
integer <int32>

Unique identifier for each DRG configuration setting. Note: This field is marked as NOT NULL in the database and therefore required by the API.

apply_OON
required
boolean

Indicates whether the line is applied to OON claims. Note: This field is marked as NOT NULL in the database and therefore required by the API.

cost_To_Charge
number or null <double>

Cost to charge ratio used for DRG calculations.

drG_Cluster
string or null <= 32 characters

Specifies a User-defined DRG cluster required for adjudication matching.

drG_Rate
number or null <double>

Rate used for DRG calculations

drG_Schedule
string or null <= 16 characters

Allows the User to select an existing DRG schedule to base their pricing upon. These DRG Schedules need to be provided by the User and uploaded by VBA.

effective_Date
required
string <date-time>

Start of the range of acceptable service dates for the rate line. Note: This field is marked as NOT NULL in the database and therefore required by the API.

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

Ex code associated with the price line.

max_Allowed_At_Billed
required
boolean

When selected, if the DRG rate exceeds the Bill Price, set the price to the Bill Price Note: This field is marked as NOT NULL in the database and therefore required by the API.

min_Amount
number or null <double>

If the total billed amount is greater than or equal to the ‘Outlier Amount’, the ‘Outlier Type’ calculation is considered.

network_ID
string or null <= 50 characters

Identifies the required Network for adjudication matching.

outlier_Type
string or null <= 1 characters

This indicates the outlier calculation to be performed as part of the DRG calculation.

provider_ID
required
string [ 1 .. 20 ] characters

The Provider ID this DRG setting is being applied.

term_Date
string or null <date-time>

End of the range of acceptable service dates for the rate line.

trim_Point
number or null <double>

Trim point used for DRG calculations.

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.

variable_Cost_Factor
number or null <double>

Variable cost factor used for DRG calculations.

Responses
200

Success

401

Unauthorized

post/providers/{providerID}/drgs
Request samples
{
  • "providerDRG_Key": 0,
  • "apply_OON": true,
  • "cost_To_Charge": 0.1,
  • "drG_Cluster": "string",
  • "drG_Rate": 0.1,
  • "drG_Schedule": "string",
  • "effective_Date": "2019-08-24T14:15:22Z",
  • "entry_Date": "2019-08-24T14:15:22Z",
  • "entry_User": "string",
  • "ex_Code": "string",
  • "max_Allowed_At_Billed": true,
  • "min_Amount": 0.1,
  • "network_ID": "string",
  • "outlier_Type": "s",
  • "provider_ID": "string",
  • "term_Date": "2019-08-24T14:15:22Z",
  • "trim_Point": 0.1,
  • "update_Date": "2019-08-24T14:15:22Z",
  • "update_User": "string",
  • "variable_Cost_Factor": 0.1
}
Response samples
{
  • "data": {
    },
  • "error": {
    },
  • "debug": {
    }
}

List ProviderDRGs

List all ProviderDRG for a specific Provider

SecurityapiKeyAuth and bearerAuth
Request
path Parameters
providerID
required
string

Provider ID

header Parameters
vbasoftware-database
required
string

Target database

Responses
200

Success

401

Unauthorized

get/providers/{providerID}/drgs
Request samples 
Response samples 
No sample
Get ProviderDRG
Gets ProviderDRG


SecurityapiKeyAuth and bearerAuth 
Request 
path Parameters
providerID
required
string
Provider ID


 
providerDRGKey
required
integer <int32> 
ProviderDRG Key


 
header Parameters
vbasoftware-database
required
string
Target database


 
Responses 
200
Success


401
Unauthorized


get/providers/{providerID}/drgs/{providerDRGKey}
Request samples 
Response samples 
No sample
Update ProviderDRG
Updates a specific ProviderDRG.


SecurityapiKeyAuth and bearerAuth 
Request 
path Parameters
providerID
required
string
Provider ID


 
providerDRGKey
required
integer <int32> 
ProviderDRG Key


 
header Parameters
vbasoftware-database
required
string
Target database


 
Request Body schema: 
required
providerDRG_Key
required
integer <int32> 
Unique identifier for each DRG configuration setting. Note: This field is marked as NOT NULL in the database and therefore required by the API.


 
apply_OON
required
boolean
Indicates whether the line is applied to OON claims. Note: This field is marked as NOT NULL in the database and therefore required by the API.


 
cost_To_Charge
number or null <double> 
Cost to charge ratio used for DRG calculations.


 
drG_Cluster
string or null  <= 32 characters 
Specifies a User-defined DRG cluster required for adjudication matching.


 
drG_Rate
number or null <double> 
Rate used for DRG calculations


 
drG_Schedule
string or null  <= 16 characters 
Allows the User to select an existing DRG schedule to base their pricing upon. These DRG Schedules need to be provided by the User and uploaded by VBA.


 
effective_Date
required
string <date-time> 
Start of the range of acceptable service dates for the rate line. Note: This field is marked as NOT NULL in the database and therefore required by the API.


 
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 
Ex code associated with the price line.


 
max_Allowed_At_Billed
required
boolean
When selected, if the DRG rate exceeds the Bill Price, set the price to the Bill Price Note: This field is marked as NOT NULL in the database and therefore required by the API.


 
min_Amount
number or null <double> 
If the total billed amount is greater than or equal to the ‘Outlier Amount’, the ‘Outlier Type’ calculation is considered.


 
network_ID
string or null  <= 50 characters 
Identifies the required Network for adjudication matching.


 
outlier_Type
string or null  <= 1 characters 
This indicates the outlier calculation to be performed as part of the DRG calculation.


 
provider_ID
required
string  [ 1 .. 20 ] characters 
The Provider ID this DRG setting is being applied.


 
term_Date
string or null <date-time> 
End of the range of acceptable service dates for the rate line.


 
trim_Point
number or null <double> 
Trim point used for DRG calculations.


 
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.


 
variable_Cost_Factor
number or null <double> 
Variable cost factor used for DRG calculations.


 
Responses 
200
Success


401
Unauthorized


put/providers/{providerID}/drgs/{providerDRGKey}
Request samples 
{
  • "providerDRG_Key": 0,
  • "apply_OON": true,
  • "cost_To_Charge": 0.1,
  • "drG_Cluster": "string",
  • "drG_Rate": 0.1,
  • "drG_Schedule": "string",
  • "effective_Date": "2019-08-24T14:15:22Z",
  • "entry_Date": "2019-08-24T14:15:22Z",
  • "entry_User": "string",
  • "ex_Code": "string",
  • "max_Allowed_At_Billed": true,
  • "min_Amount": 0.1,
  • "network_ID": "string",
  • "outlier_Type": "s",
  • "provider_ID": "string",
  • "term_Date": "2019-08-24T14:15:22Z",
  • "trim_Point": 0.1,
  • "update_Date": "2019-08-24T14:15:22Z",
  • "update_User": "string",
  • "variable_Cost_Factor": 0.1
}
Response samples 
{
  • "data": {
    },
  • "error": {
    },
  • "debug": {
    }
}
Delete ProviderDRG
Deletes an ProviderDRG


SecurityapiKeyAuth and bearerAuth 
Request 
path Parameters
providerID
required
string
Provider ID


 
providerDRGKey
required
integer <int32> 
ProviderDRG Key


 
header Parameters
vbasoftware-database
required
string
Target database


 
Responses 
204
Success


401
Unauthorized


delete/providers/{providerID}/drgs/{providerDRGKey}
Request samples 
Create or Update Batch ProviderDRG
Create or Update multiple ProviderDRG at once.  If the entity exists, it will be updated.  If the entity does not exist, it will be created.


SecurityapiKeyAuth and bearerAuth 
Request 
path Parameters
providerID
required
string
Provider ID


 
header Parameters
vbasoftware-database
required
string
Target database


 
Request Body schema: 
required
 Array 
providerDRG_Key
required
integer <int32> 
Unique identifier for each DRG configuration setting. Note: This field is marked as NOT NULL in the database and therefore required by the API.


 
apply_OON
required
boolean
Indicates whether the line is applied to OON claims. Note: This field is marked as NOT NULL in the database and therefore required by the API.


 
cost_To_Charge
number or null <double> 
Cost to charge ratio used for DRG calculations.


 
drG_Cluster
string or null  <= 32 characters 
Specifies a User-defined DRG cluster required for adjudication matching.


 
drG_Rate
number or null <double> 
Rate used for DRG calculations


 
drG_Schedule
string or null  <= 16 characters 
Allows the User to select an existing DRG schedule to base their pricing upon. These DRG Schedules need to be provided by the User and uploaded by VBA.


 
effective_Date
required
string <date-time> 
Start of the range of acceptable service dates for the rate line. Note: This field is marked as NOT NULL in the database and therefore required by the API.


 
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 
Ex code associated with the price line.


 
max_Allowed_At_Billed
required
boolean
When selected, if the DRG rate exceeds the Bill Price, set the price to the Bill Price Note: This field is marked as NOT NULL in the database and therefore required by the API.


 
min_Amount
number or null <double> 
If the total billed amount is greater than or equal to the ‘Outlier Amount’, the ‘Outlier Type’ calculation is considered.


 
network_ID
string or null  <= 50 characters 
Identifies the required Network for adjudication matching.


 
outlier_Type
string or null  <= 1 characters 
This indicates the outlier calculation to be performed as part of the DRG calculation.


 
provider_ID
required
string  [ 1 .. 20 ] characters 
The Provider ID this DRG setting is being applied.


 
term_Date
string or null <date-time> 
End of the range of acceptable service dates for the rate line.


 
trim_Point
number or null <double> 
Trim point used for DRG calculations.


 
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.


 
variable_Cost_Factor
number or null <double> 
Variable cost factor used for DRG calculations.


 
Responses 
207
Success


401
Unauthorized


put/providers/{providerID}/drgs-batch
Request samples 
[
  • {
    }
]
Response samples 
{
  • "data": [
    ],
  • "error": {
    },
  • "debug": {
    }
}