Overview

The following list provides an overview of the integration points that are available for exchanging data with Claims:

The list is sorted on alphabetical order.

Click the triangle in front of the name of the integration point to reveal available operations. Click the name of the integration point to go to the description page of the integration point.

Access Tokens

POST	/accesstokens/accesstoken retrieves an OAuth2 access token.
POST	/accesstokens/newaccesstoken retrieves a new OAuth2 access token.
POST	/accesstokens/anticsrftoken retrieves an anticsrf token.

Activities

POST	/activities creates an activity.
POST	/activities/start creates and starts an activity.
POST	/activities/{activityId}/start starts the activity.
POST	/activities/{activityId}/recover recovers the failed activity.
GET	/activities/{activityId} retrieves the status of an activity.
GET	/activities/{activityId}/messages retrieves the result messages of an activity.

---

The /generic/activities API supports only search and retrieval operations.

Authorizations

PUT	/authorizations creates or updates a policy.
GET	/authorizations/{id} retrieves the authorization.

Base Views

POST	/baseviews generates the base views.
POST	/{viewname}/regenerate regenerates the base view with given view name.
DELETE	/{viewname} drops the base view with the given view name.

Claim Financial Hold

PUT	/claimfinancialholds releases a claim financial hold.
POST	/claimfinancialholds sets a claim financial hold.

Claims

PUT	/claims creates or updates the claim.
GET	/claims/{id}/status retrieves the status of the claim.
POST	/claims/{id}/cancel cancels the claim regardless of it’s status.
POST	/claims/{id}/generateclaimevent generates claim events.
POST	/claims/{id}/resolveclaimlinepend/{pendReasonId} resolves the pend reason at claim line level.
POST	/claims/{id}/resolvepend/{pendReasonId} resolves the pend reason at claim level.
POST	/claims/{id}/submit submits a claim for processing.
POST	/claims/{id}/tochange brings a claim back in the Change status.
POST	/claims/{id}/tomanualbenefits brings a claim back to the ManualBenefits status.
POST	/claims/{id}/tomanualpricing brings a claim back to the ManualPricing status.
POST	/claims/{id}/undolinereplacements undoes claim line replacements.
POST	/claims/{id}/unfinalize brings a finalized, unsettled claim back in the Change status.
POST	/claims/{id}/unlocklines unlocks locked lines.
POST	/claims/{id}/updateskiptags updates the action of claim skip tags.

Claims Advice Service

POST	/claimsadviceservice checks if a specific medical service is contracted and/or covered based on the Oracle Health Insurance configuration, without processing an actual claim.

Claims Callout Response

PUT	/claimscalloutresponse receives a custom payload that is processed by the dynamic logic of the callout definition.
PUT	/claimscalloutresponse/claimsupdate receives a claims update payload, the claim will not be submitted.
PUT	/claimscalloutresponse/claimsupdate/submit receives a claims udpate payload, processes it and resubmits the claim.

Claims Pre Finalized Out

GET	/claimsprefinalizeout/{claimCode} retrieves a claim which is sent out for pre-processing or pricing.

Claims Reprocess

POST	/claimsreprocess submits a claim for reprocessing.
POST	/claimsreprocesscriteria submits claims for reprocessing based on provided criteria.
POST	/claimsreprocesscount retrieves the count of claims and amount based on provided criteria.

Claims Transaction Out

GET	/claimstransactionout/{claimcode} retrieves the highest claim transaction for the claim.
GET	/claimstransactionout/{claimcode}/{version} retrieves specific claim transaction version for the claim.
GET	/claimstransactionout/{claimcode}/all retrieves all claim transactions for the claim.

Claims Update

PUT	/claimsupdate/{claimCode} updates the claim
PUT	/claimsupdate/{claimCode}/submit updates the claim and submits it for processing

Contracted Provider

POST	/contractedproviders retrieves the contracted providers.

Contracted Procedures

POST	/contractedprocedures retrieves the contracted procedures.

Credentials

GET	/credentials retrieves an overview of the REST clients
GET	/credentials/{code} retrieves the credential with this code.
PUT	/credentials/{code} creates or updates the credential with this code.
DELETE	/credentials/{code} removes the credentials for the credential key with this code.
GET	/credential/export extracts a JSON file with credentials stored in secret.
POST	/credetials/import uploads a JSON file with credentials to an application.

Data Sets

POST	/import/datasetdefinition/{datasetDefinitionCode}/dataset/{dataSetCode} starts the data exchange import process.
POST	/import/datasetdefinition/{datasetDefinitionCode} starts the data exchange import process.
GET	/export/datasetdefinition/{datasetDefinitionCode}/dataset/{dataSetCode} retrieves the data set content.
POST	/export/datasetdefinition/{datasetDefinitionCode}/dataset/{dataSetCode} starts the data exchange export process.
POST	/createandexport/datasetdefinition/{datasetDefinitionCode}/dataset starts the full config migration and export process.
PATCH	/dataset/{id} updates the selected config migration set based on operation.
PUT	/datasetdefinition/{datasetDefinitionCode}/dataset creates or updates the config migration and export process.

Data File Sets

GET	/datafilesets gets defined data file sets in the system.
POST	/datafilesets creates the data file set with dat files.
PUT	/datafilesets updates the data file set with dat files.
POST	/datafilesets#multipart creates the data file set and uploads the zip file to it.
GET	/datafilesets/{datafilesetcode} retrieves the data file set.
POST	/datafilesets/{datafilesetcode} adds the data file to the data file set.
DELETE	/datafilesets/{datafilesetcode} deletes the data file set.
GET	/datafilesets/{datafilesetcode}/zip retrieves the zip file of the data file set.
POST	/datafilesets/{datafilesetcode}/zip adds the zip file to the data file set.
PUT	/datafilesets/{datafilesetcode}/zip zips the contents of all data files in the data file set.
PUT	/datafilesets/{datafilesetcode}/unzip unzips the contents of all data files in the data file set.
PUT	/datafilesets/{datafilesetcode}/datafiles updates the data file in the data file set.
DELETE	/datafilesets/{datafilesetcode}/datafiles/{datafilecode} deletes the data file from the data file set.
GET	/datafilesets/{datafilesetcode}/datafiles/{datafilecode}/data retrieves the data file content.
POST	/datafilesets/{datafilesetcode}/datafiles/{datafilecode}/data adds the data file content.

---

The generic datafilesets API supports, in addition to the standard generic API operations, the GET and the PATCH operation on /generic/datafilesets/key/{key}. This enables retrieving and updating a datafileset based on its datafileset code.

Data Replication

Data Replication synchronizes person data across multiple Oracle Health Insurance applications.

GET	/replicationentities returns an overview of the entities and their configuration details for which the system is able to track changes.
GET	/replicationentities/{entity} retrieves configuration details of the specified business entity.
PUT	/replicationentities/{entity} enables or disables change detection for the specified entity.

---

The integration point ignores GET request for changes to a disabled entity.
The PUT request does not change any detail of the entity. It only enables or disables change detection.

Diagnoses

PUT	/diagnoses creates or updates a diagnosis.
GET	/diagnoses/{id} retrieves the diagnosis.

Draft Provider Pricing Clauses

POST	/draftproviderpricingclauses requests the import of a pricing datafile set.
GET	/draftproviderpricingclauses/{id} retrieves the draft provider pricing clause batch long running operation.
GET	/draftproviderpricingclauses/payload/definition retrieves the structure of the file payload of Draft Provider pricing Clause Batch.

Dynamic Logic

Invalidate Dynamic Logic
POST	/dynamiclogic/invalidateall invalidates all dynamic logic.
Test Dynamic Logic
POST	/testdynamiclogic/{dynamicLogicCode} executes the dynamic logic of signature Test Unit.

Eligibility Checks

POST	/eligibilitychecks issues a new eligibility check
GET	/eligibilitychecks/{id} obtains the end and final result of a processed eligibility check
PUT	/eligibilitychecks/{id} oupdates the eligibility check
GET	/eligibilitychecks/{id}/status checks the status of an earlier submitted eligibility check

Enrollment

This integration point enables the claims flow to send a GET request for enrollment information to a configured uri, and to receive and store the response and use that information in the authorizations flow. This IP cannot be called as an API request by a user.

Extract

POST	/extracts starts the extract process.`
GET	/extracts/{id} retrieves status information on the extract process.

Fee Schedules

Fee Schedules
PUT	/feeschedules creates or updates the fee schedules and the fee schedule lines.
Write Fee Schedules
GET	/writefeeschedules/{id} retrieves the write fee schedule batch long running operation by id.
POST	/writefeeschedules requests the import of a feeScheduleLine datafile set.
Fee Schedules Procedures
PUT	/feescheduleprocedures creates or updates fee schedules along with the lines for a particular procedure/modifier.

Financial Transaction Process Data

PUT	/financialtransactionprocessdata updates financial transaction process data and financial transaction detail process data.

Key Stores

POST	/keystores creates a keystore.
GET	/keystores retrieves a keystore.
DELETE	/keystores/{keystorename} deletes the keystore.
GET	/keystores/{keystorename}/keys retrieves the list of keys that are configured for the given keystore.
POST	/keystores/{keystorename}/keys creates a private and public key pair.
GET	/keystores/{keystorename}/keys/{alias} retrieves the PEM string representation of the public key certificate.
DELETE	/keystores/{keystorename}/keys/{alias} deletes a key pair form the key store.
POST	/keystores/{keystorename}/keys/{alias} imports a new certificate.
GET	/keystores/export extracts a JSON file with keystores stored in secret.
POST	/keystores/import uploads a JSON file with keystore to an application.

Counters and Limits and Consumptions

Limit Consumptions
POST	/limitconsumptions writes consumptions on a counter.
Product Service Consumptions
POST	/productserviceconsumptions retrieves the maximum heights and consumptions for a person and a service option on a specific date
Read Consumption Batches
POST	/readconsumptionbatches requests the creation of a consumption report.
GET	/readconsumptionbatches/{id} retrieves the read consumption batch.
Write Consumption Batches
POST	/writeconsumptionbatches requests the import of a consumption datafile set.
GET	/writeconsumptionbatches/{id} retrieves the write consumption batch.

Non-Entity Cache

POST

/nonentitycache/invalidateall invalidates and re-populates no-entity caches, such as Flex Code System Setup, Dynamic Field Setup, Field Details Setup, Dynamic Record Setup. Since these no-entities are cached during application startup, this is important for scenarios where there is a mismatch between the data in the Database and in the cache.

Notes

POST	/notes/{subject} creates a note.
POST	/notes/{subject}/{id} creates a new version of the note.
GET	/generic/notes/{subject} retrieves all notes for the subject.
GET	/generic/notes/{subject}/search enables a search within the subject.
GET	/generic/notes/{subject}/{id} retrieves the specific note for the subject.
GET	/generic/notes/{subject}/{masterId}/audit retrieves all versions of the note.

OAuth2 Client Configuration

PUT	/{id}/setclientsecret cerates or updates the client secret.

Objects

GET	/objects/generate returns the object skeleton file.

Outbound Integration Point

GET	/outboundintegrationpoints retrieves all endpoints an Oracle Health Insurance application sends messages to. This IP is a runtime catalogue that shows all outbound integration points, their endpoints and the endpoint characteristics.

Pend Resolution

Pend Resolution Batch
POST	/pendresolutionbatch requests the resolution of the claims mentioned in the data file.
GET	/pendresolutionbatch/{id} retrieves the pend resolution batch long running operation.
Pend Resolution Criteria
POST	/pendresolutioncriteria submits claims for resolving pend reasons based on criteria.

Procedures

PUT	/procedures creates or updates a procedure.
GET	/procedures/{id} retrieves the procedure.

Properties

Properties The generic properties API supports, the standard generic API operations on properties.
Property definitions
GET	/properydefinitions/{propertyName} retrieves an overview of the Oracle Health Insurance system property definitions. Query parameters are: ** ?name=<prefix> (optional) Returning only the system property definitions that have their name starting with the given prefix.
GET	/properydefinitions/{propertyName} resource retrieves the system property definition with the given property name.
Current Properties
GET	/currentproperties retrieves all the properties currently set to value Query parameters are: ** ?name=<prefix> (optional) Returning only the properties that have their name starting with the given prefix.
GET	/currentproperties/{propertyName} retrieves the property with the given propertyName.

Provider Limit Counter Integration Point

POST	/providerlimitconsumptions writes consumption on a counter.

Providers

Individual Providers
PUT	individualproviders creates an individual provider.
GET	individualproviders/{id}` retrieves the individual provider.
Organizational Providers
PUT	organizationalproviders creates an individual provider.
GET	organziationalproviders/{id} retrieves the organizational provider.

Reference Sheet Lines

GET	/generic/referencesheetlines fetches the definition of the referencesheet resources including metadata and definition links for further details.
GET, PUT, DELETE, and PATCH	/generic/referencesheetlines/{reference-sheet-resource-name}/{id} support the standard functionality.
POST	/generic/referencesheetlines/{reference-sheet-resource-name}/search supports searching for reference sheet lines.

Relations (Persons, Organizations, and Banks)

Persons, organizations and banks use the same underlying data object, relations.

Persons

PUT	/persons creates or updates a person.
GET	/persons/{id} retrieves a person by its id.

The generic persons API supports, in addition to the standard generic API operations, the GET and the PATCH operation on /generic/persons/key/{key}. This enables retrieving and updating a person based on its code (the {key}).

Organizations

PUT	/organizations creates or updates an organization.
GET	/organizations/{id} retrieves an organization by its id.

The generic organizations API supports, in addition to the standard generic API operations, the GET and the PATCH operation on /generic/organizations/key/{key}. This enables retrieving and updating an organization based on its code (the {key}).

Banks

The generic banks API supports, in addition to the standard generic API operations, the GET and the PATCH operation on /generic/banks/key/{key}. This enables retrieving and updating a bank based on its code (the {key}).

Relations

The generic relations API supports, the GET operation on /generic/relations/{id} and /generic/relations/key/{key}. This enables retrieving a relation based on its id or on its code (the {key}). The generic relations API also supports, the POST operation on /generic/relations/search.

Replication Events

GET	/replicationevents/{id} retrieves the replication events that the source system logged for the given entity.

Task Processing

GET	/tasksprocessing returns the status and statistics of the queue.
POST	/taskprocessing starts or stops the task queue.
GET	/tasksprocessing/{id}/restart restarts the task with this id.

---

The /generic/tasks API supports only search and retrieval operations.

User Information

GET	/userinformation retrieves the userinformation of the logged in user.
PUT	/userinformation/userpreference updates a user’s preferences.

User Provisioning

PUT	/users creates or updates a user.
GET	/users/{loginName} retrieves the user.
DELETE	/users/{loginName} deletes the user.

The generic /users API supports only search and retrieval operations.

Write Product Benefit Specifications

POST	/productbenefitspecificationsbatch creates a product benefit specification batch.
GET	/productbenefitspecificationsbatch/{id} retrieves the write product benefit specifications batch long running operation.