Qodex.ai

Enhanced Eligibility API v1

Number of APIs: 7

Enhanced Eligibility

Setup

Pre-Requisites

  • Customer Onboarding (see Onboarding)
  • API Credentials (clientid, clientsecret) provided via email

Steps

  1. Fork this collection into your own Workspace.
  2. Fork the Sandbox environment into your own Workspace
  3. Fork the Production environment into your own Workspace
  4. Set the credentials in the Sandbox environment
    1. Open the Sandbox environment
    2. Copy/Paste the client_id from your email and save it in the CURRENT VALUE column for the variable named client_id
    3. Copy/Paste the client_secret from your email and save it in the CURRENT_VALUE column for the variable named client_secret
  5. Set the credentials in the Production environment
    1. Repeat 4b-c for the Production environment

Execute Requests

Please refer to the OpenAPI Spec (download here) for the API contract and more in-depth documentation.

API Authentication

Every request in the collection inherits its Authorization from the collection itself. The collection defines an OAuth2.0 Authorization workflow that utilizes the environment variables client_id and client_secret in a client_credentials grant flow. To generate a new token, simply click on the Enhanced Eligibility API v1 folder, go to the Authorization tab, scroll down and hit Get New Access Token. Qodex will automatically interact with the Token API on your behalf and store the token for you to use. Once it is stored, you can use this token in the Authorization tab, under the Current Token heading. You should see a dropdown of eligible tokens to select from. Select the token named RCM Enhanced Eligibility.

Sandbox Environment

Supported Sandbox Requests
Using the forked Qodex Collection, we recommend getting familiar with the Enhanced Eligibility API in the Sandbox environment by utilizing the sandbox values provided by the Medical Network team (see documentation here).
Simply populate the request values of your Eligibility request with the set of predefined fields and values listed in the above documentation. The Medical Network sandbox will return a canned response based on the received data.

  1. In the top right hand corner, select the Sandbox environment.
  2. Select the POST /New Eligibility Request.
  3. Edit the JSON body by using the provided sandbox values (seeSupported Sandbox Requestsabove).
  4. Press the Send button to execute the request.
    1. Note the id in the response body. You may retrieve the individual record using the Transactions/Get Transaction By Id endpoint.
  5. Repeat steps 3-4, experimenting with different sandbox values
  6. To retrieve all transactions, utilize the Transactions/Get All Transactions. You may use the provided query params to filter the data.
  7. If enrolled in standalone Coverage-Discovery, start with the CoverageDiscovery/Post New Discovery Request using the dryRun feature. See more about DryRun in the here.

Production Environment

After getting familiar with the Product using the Sandbox environment, sending Production traffic is the next step.

  1. In the top right hand corner, select the Production environment
  2. Select the POST /New Eligibility Request.
  3. Edit the JSON body with your request.
  4. Press the Send button to execute the request.
    1. Note the id in the response body. You may retrieve the individual record using the Transactions/Get Transaction By Id endpoint.
  5. Repeat steps 3-4 to send multiple transactions.
  6. To retrieve all transactions, utilize the Transactions/Get All Transactions. You may use the provided query params to filter the data.
  7. If enrolled in standalone Coverage-Discovery, start with the CoverageDiscovery/Post New Discovery Request using the dryRun feature. See more about DryRun in the OpenAPI Spec (download here).

Helpful Links

Please refer to our API documentation for details on supported functionality.

  1. New Eligibility Request POST {{url}}/rcm/eligibility/v1

  2. Healthcheck GET {{url}}/rcm/eligibility/v1/healthcheck

  3. Transactions - Get Transaction By Id GET {{url}}/rcm/eligibility/v1/transactions/:id

  4. Coverage Discovery - Get All Discovery Requests GET {{url}}/rcm/eligibility/v1/coverage-discovery

  5. Coverage Discovery - New Discovery Request POST {{url}}/rcm/eligibility/v1/coverage-discovery

  6. Coverage Discovery - Get Discovery Requests By Id GET {{url}}/rcm/eligibility/v1/coverage-discovery/:id

  7. Transactions - Get All Transactions GET {{url}}/rcm/eligibility/v1/transactions