APIs for VBASoftware
Plan Maximums
API Reference
Accounting
Check Batches
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Funding
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State Surcharge Basis
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Adv. Accounting
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Adv. Claim
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Adv. Grievance
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Auth
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Benefit Categories
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Disability Event Case Changes
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Issue Duration Value Detail
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Plan Accumulator Benefits
Plan Accumulators
Plan Auth Penalties
Plan Auth Penalty Benefits
Plan Benefit Cascades
Plan Benefit Clusters
Plan Benefit Diagnosis Ex Codes
Plan Benefit Diagnostic Codes
Plan Benefit Levels
Plan Benefit Maximums
Plan Benefit Modifier Ex Codes
Plan Benefit PBM Co-Pays
Plan Benefit Place Authorizations
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Plan Benefit Place Ex Codes
Plan Benefit Places
Plan Benefit Procedure Ex Codes
Plan Benefit Procedure Maximums
Plan Benefit Procedures
Plan Benefit Provider Types
Plan Benefit Rates
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Plan Benefit Tooth Maximums
Plan Benefits
Plan Coordination
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Plan Diagnosis Age Restrictions
Plan Disability Limits
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Call Destinations
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Capitations
Care Case Actions
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Care Case Treatments
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Care Case Work Logs
Care Cases
Care Manager Care Plans
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Care Manager Mappings
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Care Managers
Care Plan Categories
Care Plan Custom Values
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Care Plan Rule Criterias
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VBAssist
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Context4 Lists
Context4Health Cost Containment CaseIndex
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Context4Health Cost Containment Default Action
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Cost Contain Zelis ExCodes
Country
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Filter Types
Filters
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Forfeiture Statuses
Frequency Intervals
Gender
Group Codes
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HIPAA Claim Status Codes
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HIPAA Tiers
ID Code Types
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Image
Insurance Carrier Types
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Interface Types
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Language Skill Levels
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Tooth
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Transplant Types
Treatment Types
UC Network
Unit Type Conversions
Unit Types
VBA Plan Types
Visium Code ExCode
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Volume Types
Yes No List
Zelis Cost Containment Claim Detail Repricing
Zelis Cost Containment Claim Repricing
Zelis Cost Containment Edit Codes
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Credentialing Amounts
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Disenroll Log
Disenroll Log Rates
Enrollment Accumulators
Enrollment Waiting Period Subscribers
Enrollment Waiting Periods
Member Account Plan Payments
Member Account Plans
Member Accounts
Member Accum
Member Address
Member Address History
Member Alternate Payee
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Member Beneficiary
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Member Networks
Member Occupations
Member Payments
Member Plan Years
Member Pre-existing Diagnostic Codes
Member PreEx Disclosed Diags
Member Prior Accumulators
Member Provider Alternates
Member Providers
Member Taxes
Member Tooth
Member Tooth Ex Codes
Member VBA Plan Type IDs
Members
Subscriber Accumulators
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Waiting Period Types
Event Args
Event Schedules
Events
Fee Schedule Anesthesias
Fee Schedule Details
Fee Schedule Effective Dates
Fee Schedule Modifier Discounts
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Fee Schedule Procedure Group Adjustments
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Fee Schedules
Grievance Admin Change Types
Grievance Categories
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Grievance Resolution Types
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Grievance Types
Grievances
Classes
Contribution Schedules
Flex Issuance Types
Flex Vendor Card Status
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Flex Vendors
Group Account Periods
Group Account Reports
Group ACH Pulls
Group Advice to Pay
Group Calculate Interest Network Options
Group Calculate Interest Options
Group Classes
Group Company Data Ex-Code Overrides
Group Contract Network Types
Group Contract Plan Premiums
Group Contract Plan Rider External IDs
Group Contract Plan Riders
Group Contract Plans
Group Contract Tiers
Group Contracts
Group Coverage Calculations
Group Day Interval
Group Disenroll Affected Claims
Group Division Captives
Group Division Cobras
Group Division Deduction Types
Group Division ID Codes
Group Divisions
Group End Coverage Age Types
Group Ex-Code Criterias
Group Flex Auto-Create
Group Flex Schedules
Group Flexes
Group IRS 1094C
Group IRS 1095B
Group Multiplier Options
Group Network Add-Ons
Group Network Criteria Columns
Group Network Criterias
Group Networks
Group Participation Incentives
Group Pay Through Day Options
Group Payor Account Benefits
Group Payor Account Networks
Group Payor Account Pay To
Group Payor Account Plan Types
Group Payor Account Provider Federal IDs
Group Payor Account Senders
Group Payor Account Settings
Group Plan Prior Accum Auto Generators
Group Plan Years
Group Premium Rate Categories
Group Price Adjustments
Group Self Admin Settings
Group Start Date Rules
Group State Surcharge
Group Student Age Settings
Group Subscriber Reimbursements
Group Tax Day Limit Types
Group Term Rules
Group UC Percent Claim Types
Group UC Percent Criterias
Group UC Percent Settings
Group VBA Plan Types
Group Volumes
Groups
ID Card Record Statuses
ID Card Request Statuses
Invoice Levels
MessageAttachment
Payment Schedules
Reimburse Schedules
Tolerances
VBAGateway Messaging
Zelis Redcard
Note Attachments
Note Categories
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Note Data
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Note References
Note Sources
Note Types
Process Automation
Provider CLIA Certificates
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Provider
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Provider Benefit Admin Fees
Provider DRG
Provider Languages
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Provider Network Modifier
Provider Payees
Provider Per Diem
Provider Per Diem Procedure
Provider Practice Types
Provider Profile
Provider Rate Adjustments
Provider Rate Column
Provider Rate Criteria
Provider Rate Types
Provider Rates
Provider Roles
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Provider Suffix
Provider Taxonomy
Provider Withholds
Reinsurance Accumulators
Reinsurance Aggregating Specific Members
Reinsurance Conditional Specific
Reinsurance Conditional Specific Detail
Reinsurance Contract Criteria Details
Reinsurance Contract Criterias
Reinsurance Contract Cycles
Reinsurance Contract Factor Criterias
Reinsurance Contract Factors
Reinsurance Contract Levels
Reinsurance Contract Status
Reinsurance Contract Templates
Reinsurance Contract Transaction Claim Details
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Reinsurance Contract Transaction Claims
Reinsurance Contract Transaction Reimbursements
Reinsurance Contract Transaction Statuses
Reinsurance Contract Transactions
Reinsurance Contract Types
Reinsurance Contracts
Reinsurance Domestic Claims Criteria
Reinsurance Member Specific Deductibles
Reinsurance Notify User Groups
Reinsurance Notify Users
Reinsurance Options
Report Categories
Report Definitions
Report Queue Detail Arguments
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Report Queue Logs
Report Queue Schedules
Report Queues
Report Request Invoice
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Report Series
Report Series Process Arguments
Report Series Process Templates
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Report Series Step Args
Report Series Steps
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Report Static Lists
Report Tracking
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Security Area Objects
Security Area Overrides
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Security Field Set Details
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Support
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User
User Account
User Amount
User Amount Procedure
User Experience
User Group Mappings
User Groups
User LogTypes
User Note Access
UserAmount
UserStatus
VBAGateway Subscription
VBAGateway Subscription Detail
VBA Reports
VBAReporting
Workflow Details
Workflow Task Options
Workflow Task Users
Workflow Tasks
Workflow Type Task Options
Workflow Types
Workflow Users
Workflows
VBASoftware (v1)
Download OpenAPI description
Languages
Servers
VBAPI VBASoftware
https://vbapi.vbasoftware.com/vbasoftware/
Bodyrequired
- application/json
- text/json
- application/*+json
References the PlanBenefits.Plan_ID value in parent table.
References the PlanBenefits.Benefit_Code value in parent table.
Specifies the Dental Designation options including Tooth, Quadrant, and Arch.
Having effective and term dates for the maximums allows for changes throughout the life of the plan. The dates defined reference to the date of service of the claim to determine which maximum applies.
Having effective and term dates for the maximums allows for changes throughout the life of the plan. The dates defined reference to the date of service of the claim to determine which maximum applies.
The frequency defined here states how many of the Max Per apply for the Maximum line. This field has the logic of: Current minus Freq. A zero in this field will force the Maximum to calculate within the year, day, etc. defined in the Max Per. A 4 in this field will force the Maximum to calculate within 5 years, days, etc. defined in the Max Per.
Each maximum needs and Ex Code defined for explanation during adjudication and for Remittance and EOB's. A denial Ex Code can only be used Visit Maximums as payable type Maximums can have partially paid lines. A denial code on at claim detail line that should be partially paid will result in the entire line being denied and the Maximum not being fulfilled.
Used for dollar maximums. The Ex Code in field 11 would be an informational code which allows the amount over the max to roll to the next line and apply the Denial Ex Code.
Defines the timeframe that applies to the Maximum: Day - per service date. Month - per every 30 or 31 days. Calendar Month - per calendar month in which the services were rendered. Calendar Year - per calendar year in which the services were rendered. Plan Year - per plan year as defined for the Member. Lifetime - per lifetime. Occurrence - per occurrence date on the claim header. Birth Date Year - per year defined by the Member's date of birth. Visit - per service date per Provider.
Each Maximum needs to be sequenced in order for adjudication to determine which Maximum line should apply first.
Indicates the type of Maximum: Visits - per service date. Svc Count - per units on service line. Payable Amount - payable amounts from claims. Co-pay Amount - co-pay amounts from claims. Co-Ins Amount - co-ins amounts from claims. Deductible Amount - deductible amounts from claims. Occurrence Payable - payable amount per occurrence date. Occurrence - per occurrence date on the claim header. Svc Count_Payable - payable amount on the service line divided by the number of units on the claim. This will pay the amount per unit for the number of units that are allowed by the rule.
Indicates whether both In and/or Out of Network benefits apply.
Indicates whether the Maximum applies to the Family or each Member. Note: This field is marked as NOT NULL in the database and therefore required by the API.
Defines the dollar or count quantity that should apply to the Maximum.
Checking this box indicates that this benefit maximum represents a maximum that must be paid out in full regardless of the billed amount on the claim or allowable. A new claim will be created to pay any difference to the Subscriber. Note: The database will apply a default value of False for this field if a value is not provided.
- VBAPI VBASoftwarehttps://vbapi.vbasoftware.com/vbasoftware/plans/{planID}/benefits/{benefitCode}/maximums
- curl
- JavaScript
- Node.js
- Python
- Java
- C#
- PHP
- Go
- Ruby
- R
- Payload
curl -i -X POST \
'https://vbapi.vbasoftware.com/vbasoftware/plans/{planID}/benefits/{benefitCode}/maximums' \
-H 'Authorization: Bearer <YOUR_JWT_HERE>' \
-H 'Content-Type: application/json' \
-H 'vbasoftware-database: string' \
-H 'x-api-key: YOUR_API_KEY_HERE' \
-d '{
"plan_ID": "string",
"benefit_Code": "string",
"max_ID": "string",
"dental_Designation": "s",
"effective_Date": "2019-08-24T14:15:22Z",
"entry_Date": "2019-08-24T14:15:22Z",
"entry_User": "string",
"expire_Date": "2019-08-24T14:15:22Z",
"frequency": 0,
"max_Description": "string",
"max_Ex_Code": "string",
"max_Payable_Ex_Code": "string",
"max_Per": "s",
"max_Sequence": 0,
"max_Type": "s",
"max_Type_Net": "s",
"member_Family": "s",
"quantity": 0.1,
"subscriber_Reimbursement": true,
"update_Date": "2019-08-24T14:15:22Z",
"update_User": "string",
"visit_Criteria": 0,
"cross_Plan_Max": true
}'Response
No response example- VBAPI VBASoftwarehttps://vbapi.vbasoftware.com/vbasoftware/plans/{planID}/benefits/{benefitCode}/maximums
- curl
- JavaScript
- Node.js
- Python
- Java
- C#
- PHP
- Go
- Ruby
- R
- Payload
curl -i -X GET \
'https://vbapi.vbasoftware.com/vbasoftware/plans/{planID}/benefits/{benefitCode}/maximums' \
-H 'Authorization: Bearer <YOUR_JWT_HERE>' \
-H 'vbasoftware-database: string' \
-H 'x-api-key: YOUR_API_KEY_HERE'Response
No response example- VBAPI VBASoftwarehttps://vbapi.vbasoftware.com/vbasoftware/plans/{planID}/benefits/{benefitCode}/maximums/{maxID}
- curl
- JavaScript
- Node.js
- Python
- Java
- C#
- PHP
- Go
- Ruby
- R
- Payload
curl -i -X GET \
'https://vbapi.vbasoftware.com/vbasoftware/plans/{planID}/benefits/{benefitCode}/maximums/{maxID}' \
-H 'Authorization: Bearer <YOUR_JWT_HERE>' \
-H 'vbasoftware-database: string' \
-H 'x-api-key: YOUR_API_KEY_HERE'Response
No response example