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 but does not start it.
POST	/activities/start creates and starts an activity.
POST	/activities/{activityId}/start starts the previously-created activity.
POST	/activities/{activityId}/recover recovers the failed activity.
GET	/activities/{activityId} retrieves the status of the activity.
GET	/activities/{activityId}/messages retrieves the result messages of an activity.

Oracle Health Insurance supports a generic activities API and a specific activities API.

The generic activities API supports the standard generic operations.
Oracle Health Insurance also supports generic APIs on

• /generic/groupaccountactivities

• /generic/basefinancialobjectactivities

• /generic/groupclientactivities

• /generic/financialtransactionsetactivities

• /generic/policyactivities

• /generic/connectorconfigurationactivities

• /generic/globalactivities.

These are all subsets of the data returned by the generic /activities API.

Authorizations

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

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).

Base Views

POST	/baseviews (re)generates base views
POST	/baseviews/\{view name}/regenerate (re)generates the base views
DELETE	/baseviews/\{view name} deletes the base views

This a long running operation through REST. See, "HTTP API/IP Concepts" chapter of the Developer Guide for more information on the general concepts of these operations.

This integration point can display PII data in an entity using the property ohi.baseview.exclude.pii.

A POST request on http://[hostName]:[portNumber]/[api-context-root]/generic/baseviews/search retrieves information about the generated base views.

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	/credentials/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 retrieves all data file sets in the system
POST	/datafilesets creates the data file set with data files
PUT	/datafilesets updates the data file set with data 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

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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

GET	/replicationentities returns entities and their configuration.
GET	/replicationentities/{entity} returns configuration details of the specified entity.
PUT	/replicationentities/{entity} changes configuration of the specified entity. Enables or disables change tracking on the specified entity. Does not change any detail of the entity. The integration point ignores requests for changes to any entity’s details.
GET	/replicationevents/{entity} returns the replication events that a source application logs for a specific entity.

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

Dynamic Logic Statistics

GET	/dynamiclogicstatistics retrieves the different links to see the dynamic logic statistics.
GET	/dynamiclogicstatistics/{dynamicLogicCode} retrieves the dynamic logic statistics based on provided Dynamic Logic Code.
GET	/dynamiclogicstatistics/elapsed retrieves Dynamic Logic Statistic data sorted over total elapsed time.
GET	/dynamiclogicstatistics/executions retrieves Dynamic Logic Statistics data sorted over total number of dynamic logic executions.
GET	/dynamiclogicstatistics/allocatedmemory retrieves Dynamic Logic Statistics data sorted over over total memory allocated.
GET	/dynamiclogicstatistics/reset clears the cache for Dynamic Logic Statistics data.

Invalidate Dynamic Logic

POST	http://<host>:<port>/<context-root>/dynamiclogic/invalidateall Invalidates all dynamic logic.

Test Dynamic Logic

POST	/testdynamiclogic/{dynamicLogicCode} xx

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.

Extracts

POST	/extracts starts the extraction process.
GET	/extracts/{id} returns the status of the extraction 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

GET	/keystores/export exports keystore’s data from an older version of an application
POST	/keystores/import imports keystore’s data to the newer version of the 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 all the no-entity caches.

Notes

POST	/notes/{subject} creates a note.
POST	/notes/{subject}/{id} creates a new version of the note ('updates' the note).
GET	/generic/notes/{subject} retrieves the latest version of 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.

The {subject} is the technical id of the claim, the gid of the policy or the code of the authorization.

OAuth2 Client Configuration

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

Objects

GET	/objects/generate creates a zip file that is downloaded.

The following options are provided as query parameters to the above endpoint:

• includeDynamicData

• withSerialization

Organizations

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

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

Outbound Integration Points

GET	/outboundintegrationpoints retrieves the integration points with a configured endpoint.

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.

Pricing Worksheets

POST	/pricingworksheets/{pricingWorksheetCode}/validate validates the pricing worksheet.
POST	/pricingworksheets/{pricingWorksheetCode}/build builds the pricing worksheet.
GET	/pricingworksheets/definition retrieves the structure of the pricing worksheet.
POST	/pricingworksheets/applyoptions applies pricing options to pricing worksheet.

Persons

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

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

Procedures

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

Properties

Property Definitions

GET	/propertydefinitions returns system property definitions, including the relevant characteristics.
GET	/propertydefinitions?name=<prefix> returns the system property definitions, for which the name starts with the given prefix
GET	/propertydefinitions/<property> returns the system property definition, for which <property> is the exact name of the property

Current Properties

GET	/currentproperties returns all properties
GET	/currentproperties?name=<prefix> returns the properties for which the name starts with the given prefix
GET	/currentproperties/<property> returns the property for which <property> is the exact name of the property

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

The generic relations API supports, in addition to the standard generic API operations, 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).

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.

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

User Information

GET	http://[hostName]:[portNumber]/[api-context-root]/userinformation fetches the user information of the logged in user
`POST	http://[hostName]:[portNumber]/[api-context-root]/userinformation/userpreference updates the user preferences of the logged in user

User Provisioning

PUT	/users create or update a user
GET	/users/{loginName} retrieve the user
DELETE	/users/{loginName} delete the user

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.