Retrieve Contracted Procedures Integration Point (HTTP)

This integration point returns procedures that a provider offers. The application stores pricing configuration that links healthcare providers to healthcare services. This information helps determine procedures that a provider offers with just a part of the Procedure Description.

Request

This integration point is available through the following path:

POST http://<HOST_ADDRESS>:<HOST_PORT>/<CONTEXT_ROOT>/contractedprocedures

The payload for this request contains the following selection criteria for the contracted Providers:

• Provider Code

• Service Date

• a part of the Procedure Description.

All parameters are required.

Consider the following example:

{ "providerIdentifier":    "12345"
, "serviceDate":           "2020-01-01"
, "procedureDescription":  "%Eye%"
}

The example requests Procedures from a Provider - either individual or organization - with code 12345 that mentions Eye in the description on the first of January 2020. You can add wildcards to the Procedure Description.

Response

If the application holds one or more Provider Pricing Clauses that link to a specified Procedure and Provider on the specified Service Date, this integration point sets a Procedure as eligible (to include in the response).

There are multiple ways Provider links to a Provider Pricing Clause:

• Provider → Provider Pricing Clause

• Provider → Provider Group → Provider Pricing Clause

For a Procedure, the integration point evaluates the Procedure Group on the Provider Pricing Clause:

• Provider Pricing Clause → Procedure Group → Procedure

Provider Matching

The integration point matches the Provider Identifier in the request first to the Provider Code and then to the Provider Identifiers.

Provider Pricing Clause Configuration

A configured Provider Pricing Clause has various conditions for applying the Provider Pricing Clause. The list includes required modifiers, required location types, dynamic logic conditions, etc. This integration point ignores all these conditions. The integration point uses Provider Pricing Clauses that link to a specified Procedure to determine the list of eligible Providers.

Non-Specific Provider Pricing Clauses

There are Provider Pricing Clauses that do not link to a Provider. The integration point does not evaluate such Clauses and treats them as non-specific Provider Pricing Clause. The integration point does not consider such clauses for deriving Procedures.

Fixed Criteria

The following are the criteria that always apply and user criteria do not override them:

• The integration point uses Provider Pricing Clauses that refer only to a reimbursement method to derive eligible Procedures.

• The integration point considers only a Provider Pricing Clause that has a Procedure Group.

• The integration point only considers Provider Pricing Clauses with either a Provider or a Provider Group.

• The integration point considers only the enabled configuration.

Response Payload

The response lists eligible Procedures for the requested Provider.

Consider the following example:

{
    "items": [
        {
            "provider": {
                "code": "<code>",
                "name": "<name>",
                "flexCodeDefinitionCode": "<flex code system code>"
            },
            "procedureList": [
                { //standard representation of the procedure resource as in IP
                    "code": "",
                    ....
                    ,
                    }
                }
               .....
            ],
            "hasMore": false
        }
        ....
    ]
}

The response displays a maximum of 150 Procedures. For a Provider with over 150 Procedures, the integration point sets the hasMore flag to true. The integration point returns the next 150 ordered by Procedure Code.

Error Messages

This integration point returns the following error messages:

Table 1. Error Messages

Code	Message
CLA-IP-CPPR-001	The request has to include a provider code
CLA-IP-CPPR-002	The request has to include a service date
CLA-IP-CPPR-003	The request has to include a procedure description of at least 3 characters

Authorization

This contractedProviderProcedures IP access restriction protects this integration point.