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vericred_client

Vericred's API allows you to search for Health Plans that a specific doctor accepts.

Getting Started

Visit our Developer Portal to create an account.

Once you have created an account, you can create one Application for Production and another for our Sandbox (select the appropriate Plan when you create the Application).

SDKs

Our API follows standard REST conventions, so you can use any HTTP client to integrate with us. You will likely find it easier to use one of our autogenerated SDKs, which we make available for several common programming languages.

Authentication

To authenticate, pass the API Key you created in the Developer Portal as a Vericred-Api-Key header.

curl -H 'Vericred-Api-Key: YOUR_KEY' "https://api.vericred.com/providers?search_term=Foo&zip_code=11215"

Versioning

Vericred's API default to the latest version. However, if you need a specific version, you can request it with an Accept-Version header.

The current version is v3. Previous versions are v1 and v2.

curl -H 'Vericred-Api-Key: YOUR_KEY' -H 'Accept-Version: v2' "https://api.vericred.com/providers?search_term=Foo&zip_code=11215"

Pagination

Endpoints that accept page and per_page parameters are paginated. They expose four additional fields that contain data about your position in the response, namely Total, Per-Page, Link, and Page as described in RFC-5988.

For example, to display 5 results per page and view the second page of a GET to /networks, your final request would be GET /networks?....page=2&per_page=5.

Sideloading

When we return multiple levels of an object graph (e.g. Providers and their States we sideload the associated data. In this example, we would provide an Array of States and a state_id for each provider. This is done primarily to reduce the payload size since many of the Providers will share a State

{
  providers: [{ id: 1, state_id: 1}, { id: 2, state_id: 1 }],
  states: [{ id: 1, code: 'NY' }]
}

If you need the second level of the object graph, you can just match the corresponding id.

Selecting specific data

All endpoints allow you to specify which fields you would like to return. This allows you to limit the response to contain only the data you need.

For example, let's take a request that returns the following JSON by default

{
  provider: {
    id: 1,
    name: 'John',
    phone: '1234567890',
    field_we_dont_care_about: 'value_we_dont_care_about'
  },
  states: [{
    id: 1,
    name: 'New York',
    code: 'NY',
    field_we_dont_care_about: 'value_we_dont_care_about'
  }]
}

To limit our results to only return the fields we care about, we specify the select query string parameter for the corresponding fields in the JSON document.

In this case, we want to select name and phone from the provider key, so we would add the parameters select=provider.name,provider.phone. We also want the name and code from the states key, so we would add the parameters select=states.name,states.code. The id field of each document is always returned whether or not it is requested.

Our final request would be GET /providers/12345?select=provider.name,provider.phone,states.name,states.code

The response would be

{
  provider: {
    id: 1,
    name: 'John',
    phone: '1234567890'
  },
  states: [{
    id: 1,
    name: 'New York',
    code: 'NY'
  }]
}

Benefits summary format

Benefit cost-share strings are formatted to capture:

  • Network tiers
  • Compound or conditional cost-share
  • Limits on the cost-share
  • Benefit-specific maximum out-of-pocket costs

Example #1 As an example, we would represent this Summary of Benefits & Coverage as:

  • Hospital stay facility fees:

    • Network Provider: $400 copay/admit plus 20% coinsurance
    • Out-of-Network Provider: $1,500 copay/admit plus 50% coinsurance
    • Vericred's format for this benefit: In-Network: $400 before deductible then 20% after deductible / Out-of-Network: $1,500 before deductible then 50% after deductible

  • Rehabilitation services:

    • Network Provider: 20% coinsurance
    • Out-of-Network Provider: 50% coinsurance
    • Limitations & Exceptions: 35 visit maximum per benefit period combined with Chiropractic care.
    • Vericred's format for this benefit: In-Network: 20% after deductible / Out-of-Network: 50% after deductible | limit: 35 visit(s) per Benefit Period

Example #2 In this other Summary of Benefits & Coverage, the specialty_drugs cost-share has a maximum out-of-pocket for in-network pharmacies.

  • Specialty drugs:
    • Network Provider: 40% coinsurance up to a $500 maximum for up to a 30 day supply
    • Out-of-Network Provider Not covered
    • Vericred's format for this benefit: In-Network: 40% after deductible, up to $500 per script / Out-of-Network: 100%

BNF

Here's a description of the benefits summary string, represented as a context-free grammar:

root                      ::= coverage

coverage                  ::= (simple_coverage | tiered_coverage) (space pipe space coverage_modifier)?
tiered_coverage           ::= tier (space slash space tier)*
tier                      ::= tier_name colon space (tier_coverage | not_applicable)
tier_coverage             ::= simple_coverage (space (then | or | and) space simple_coverage)* tier_limitation?
simple_coverage           ::= (pre_coverage_limitation space)? coverage_amount (space post_coverage_limitation)? (comma? space coverage_condition)?
coverage_modifier         ::= limit_condition colon space (((simple_coverage | simple_limitation) (semicolon space see_carrier_documentation)?) | see_carrier_documentation | waived_if_admitted | shared_across_tiers)
waived_if_admitted        ::= ("copay" space)? "waived if admitted"
simple_limitation         ::= pre_coverage_limitation space "copay applies"
tier_name                 ::= "In-Network-Tier-2" | "Out-of-Network" | "In-Network"
limit_condition           ::= "limit" | "condition"
tier_limitation           ::= comma space "up to" space (currency | (integer space time_unit plural?)) (space post_coverage_limitation)?
coverage_amount           ::= currency | unlimited | included | unknown | percentage | (digits space (treatment_unit | time_unit) plural?)
pre_coverage_limitation   ::= first space digits space time_unit plural?
post_coverage_limitation  ::= (((then space currency) | "per condition") space)? "per" space (treatment_unit | (integer space time_unit) | time_unit) plural?
coverage_condition        ::= ("before deductible" | "after deductible" | "penalty" | allowance | "in-state" | "out-of-state") (space allowance)?
allowance                 ::= upto_allowance | after_allowance
upto_allowance            ::= "up to" space (currency space)? "allowance"
after_allowance           ::= "after" space (currency space)? "allowance"
see_carrier_documentation ::= "see carrier documentation for more information"
shared_across_tiers       ::= "shared across all tiers"
unknown                   ::= "unknown"
unlimited                 ::= /[uU]nlimited/
included                  ::= /[iI]ncluded in [mM]edical/
time_unit                 ::= /[hH]our/ | (((/[cC]alendar/ | /[cC]ontract/) space)? /[yY]ear/) | /[mM]onth/ | /[dD]ay/ | /[wW]eek/ | /[vV]isit/ | /[lL]ifetime/ | ((((/[bB]enefit/ plural?) | /[eE]ligibility/) space)? /[pP]eriod/)
treatment_unit            ::= /[pP]erson/ | /[gG]roup/ | /[cC]ondition/ | /[sS]cript/ | /[vV]isit/ | /[eE]xam/ | /[iI]tem/ | /[sS]tay/ | /[tT]reatment/ | /[aA]dmission/ | /[eE]pisode/
comma                     ::= ","
colon                     ::= ":"
semicolon                 ::= ";"
pipe                      ::= "|"
slash                     ::= "/"
plural                    ::= "(s)" | "s"
then                      ::= "then" | ("," space) | space
or                        ::= "or"
and                       ::= "and"
not_applicable            ::= "Not Applicable" | "N/A" | "NA"
first                     ::= "first"
currency                  ::= "$" number
percentage                ::= number "%"
number                    ::= float | integer
float                     ::= digits "." digits
integer                   ::= /[0-9]/+ (comma_int | under_int)*
comma_int                 ::= ("," /[0-9]/*3) !"_"
under_int                 ::= ("_" /[0-9]/*3) !","
digits                    ::= /[0-9]/+ ("_" /[0-9]/+)*
space                     ::= /[ \t]/+

This Python package is automatically generated by the Swagger Codegen project:

  • API version: 1.0.0
  • Package version: 0.0.11
  • Build package: class io.swagger.codegen.languages.PythonClientCodegen

Requirements.

Python 2.7 and 3.4+

Installation & Usage

pip install

If the python package is hosted on Github, you can install directly from Github

pip install git+https://github.com/GIT_USER_ID/GIT_REPO_ID.git

(you may need to run pip with root permission: sudo pip install git+https://github.com/GIT_USER_ID/GIT_REPO_ID.git)

Then import the package:

import vericred_client

Setuptools

Install via Setuptools.

python setup.py install --user

(or sudo python setup.py install to install the package for all users)

Then import the package:

import vericred_client

Getting Started

Please follow the installation procedure and then run the following:

from __future__ import print_function
import time
import vericred_client
from vericred_client.rest import ApiException
from pprint import pprint

# Configure API key authorization: Vericred-Api-Key
vericred_client.configuration.api_key['Vericred-Api-Key'] = 'YOUR_API_KEY'
# Uncomment below to setup prefix (e.g. Bearer) for API key, if needed
# vericred_client.configuration.api_key_prefix['Vericred-Api-Key'] = 'Bearer'
# create an instance of the API class
api_instance = vericred_client.DrugCoveragesApi
ndc_package_code = '07777-3105-01' # str | NDC package code
audience = 'individual' # str | Plan Audience (individual or small_group)
state_code = 'CA' # str | Two-character state code

try:
    # Search for DrugCoverages
    api_response = api_instance.get_drug_coverages(ndc_package_code, audience, state_code)
    pprint(api_response)
except ApiException as e:
    print("Exception when calling DrugCoveragesApi->get_drug_coverages: %s\n" % e)

Documentation for API Endpoints

All URIs are relative to https://api.vericred.com/

Class Method HTTP request Description
DrugCoveragesApi get_drug_coverages GET /drug_packages/{ndc_package_code}/coverages Search for DrugCoverages
DrugPackagesApi show_formulary_drug_package_coverage GET /formularies/{formulary_id}/drug_packages/{ndc_package_code} Formulary Drug Package Search
DrugsApi list_drugs GET /drugs Drug Search
FormulariesApi list_formularies GET /formularies Formulary Search
NetworkSizesApi list_state_network_sizes GET /states/{state_id}/network_sizes State Network Sizes
NetworkSizesApi search_network_sizes POST /network_sizes/search Network Sizes
NetworksApi create_network_comparisons POST /networks/{id}/network_comparisons Network Comparisons
NetworksApi list_networks GET /networks Networks
NetworksApi show_network GET /networks/{id} Network Details
PlansApi find_plans POST /plans/search Find Plans
PlansApi show_plan GET /plans/{id} Show Plan
ProviderNotificationSubscriptionsApi create_provider_notification_subscription POST /providers/subscription Subscribe
ProviderNotificationSubscriptionsApi delete_provider_notification_subscription DELETE /providers/subscription/{nonce} Unsubscribe
ProviderNotificationSubscriptionsApi notify_provider_notification_subscription POST /CALLBACK_URL Webhook
ProvidersApi get_provider GET /providers/{npi} Find a Provider
ProvidersApi get_providers POST /providers/search Find Providers
ProvidersApi get_providers_0 POST /providers/search/geocode Find Providers
ZipCountiesApi get_zip_counties GET /zip_counties Search for Zip Counties
ZipCountiesApi show_zip_county GET /zip_counties/{id} Show an individual ZipCounty

Documentation For Models

Documentation For Authorization

Vericred-Api-Key

  • Type: API key
  • API key parameter name: Vericred-Api-Key
  • Location: HTTP header

Author