VericredClient

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 PHP package is automatically generated by the Swagger Codegen project:

• API version: 1.0.0
• Package version: 0.0.9
• Build package: class io.swagger.codegen.languages.PhpClientCodegen

Requirements

PHP 5.4.0 and later

Installation & Usage

Composer

To install the bindings via Composer, add the following to composer.json:

{
  "repositories": [
    {
      "type": "git",
      "url": "https://github.com/Vericred/VericredClient.git"
    }
  ],
  "require": {
    "Vericred/VericredClient": "*@dev"
  }
}

Then run composer install

Manual Installation

Download the files and include autoload.php:

    require_once('/path/to/VericredClient/autoload.php');

Tests

To run the unit tests:

composer install
./vendor/bin/phpunit lib/Tests

Getting Started

Please follow the installation procedure and then run the following:

<?php
require_once(__DIR__ . '/vendor/autoload.php');

// Configure API key authorization: Vericred-Api-Key
Vericred\Client\Configuration::getDefaultConfiguration()->setApiKey('Vericred-Api-Key', 'YOUR_API_KEY');
// Uncomment below to setup prefix (e.g. Bearer) for API key, if needed
// Vericred\Client\Configuration::getDefaultConfiguration()->setApiKeyPrefix('Vericred-Api-Key', 'Bearer');

$api_instance = new Vericred\Client\Api\DrugCoveragesApi();
$ndc_package_code = "07777-3105-01"; // string | NDC package code
$audience = "individual"; // string | Plan Audience (individual or small_group)
$state_code = "CA"; // string | Two-character state code

try {
    $result = $api_instance->getDrugCoverages($ndc_package_code, $audience, $state_code);
    print_r($result);
} catch (Exception $e) {
    echo 'Exception when calling DrugCoveragesApi->getDrugCoverages: ', $e->getMessage(), PHP_EOL;
}

?>

Documentation for API Endpoints

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

Class	Method	HTTP request	Description
DrugCoveragesApi	getDrugCoverages	GET /drug_packages/{ndc_package_code}/coverages	Search for DrugCoverages
DrugPackagesApi	showFormularyDrugPackageCoverage	GET /formularies/{formulary_id}/drug_packages/{ndc_package_code}	Formulary Drug Package Search
DrugsApi	listDrugs	GET /drugs	Drug Search
FormulariesApi	listFormularies	GET /formularies	Formulary Search
MedicalPlansApi	findPlans	POST /plans/medical/search	Find Plans
MedicalPlansApi	showPlan	GET /plans/medical/{id}	Show Plan
NetworkSizesApi	listStateNetworkSizes	GET /states/{state_id}/network_sizes	State Network Sizes
NetworkSizesApi	searchNetworkSizes	POST /network_sizes/search	Network Sizes
NetworksApi	createNetworkComparisons	POST /networks/{id}/network_comparisons	Network Comparisons
NetworksApi	listNetworks	GET /networks	Networks
NetworksApi	showNetwork	GET /networks/{id}	Network Details
PlansApi	findPlans	POST /plans/search	Find Plans
PlansApi	showPlan	GET /plans/{id}	Show Plan
ProviderNotificationSubscriptionsApi	createProviderNotificationSubscription	POST /providers/subscription	Subscribe
ProviderNotificationSubscriptionsApi	deleteProviderNotificationSubscription	DELETE /providers/subscription/{nonce}	Unsubscribe
ProviderNotificationSubscriptionsApi	notifyProviderNotificationSubscription	POST /CALLBACK_URL	Webhook
ProvidersApi	getProvider	GET /providers/{npi}	Find a Provider
ProvidersApi	getProviders	POST /providers/search	Find Providers
ProvidersApi	getProviders_0	POST /providers/search/geocode	Find Providers
ZipCountiesApi	getZipCounties	GET /zip_counties	Search for Zip Counties
ZipCountiesApi	showZipCounty	GET /zip_counties/{id}	Show an individual ZipCounty

Documentation For Models

• ACAPlan
• ACAPlan2018
• ACAPlan2018SearchResponse
• ACAPlan2018SearchResult
• ACAPlan2018ShowResponse
• ACAPlanPre2018
• ACAPlanPre2018SearchResponse
• ACAPlanPre2018SearchResult
• ACAPlanPre2018ShowResponse
• Base
• BasePlanSearchResponse
• Carrier
• CarrierGroupRequest
• CarrierRequest
• CarrierSubsidiary
• County
• CountyBulk
• DentalPlan
• DentalPlanBenefits
• DentalPlanShowResponse
• DentalPlanUpdate
• DentalPlanUpdateRequest
• Drug
• DrugCoverage
• DrugCoverageResponse
• DrugPackage
• DrugSearchResponse
• Formulary
• FormularyDrugPackageResponse
• FormularyResponse
• IssuerRequest
• Meta
• MetaPlanSearchResponse
• Network
• NetworkComparison
• NetworkComparisonRequest
• NetworkComparisonResponse
• NetworkDetails
• NetworkDetailsResponse
• NetworkSearchResponse
• NetworkSize
• NotificationSubscription
• NotificationSubscriptionResponse
• Plan
• PlanCounty
• PlanCountyBulk
• PlanDeleted
• PlanIdentifier
• PlanMedicare
• PlanMedicareBulk
• PlanPricingMedicare
• PlanSearchResponse
• PlanShowResponse
• Provider
• ProviderDetails
• ProviderGeocode
• ProviderNetworkEventNotification
• ProviderShowResponse
• ProvidersGeocodeResponse
• ProvidersSearchResponse
• RateRequest
• RatingArea
• RequestPlanFind
• RequestPlanFindApplicant
• RequestPlanFindDrugPackage
• RequestPlanFindProvider
• RequestProviderNotificationSubscription
• RequestProvidersSearch
• RxCuiIdentifier
• RxCuiIdentifierSearchResponse
• ServiceArea
• ServiceAreaZipCounty
• State
• StateNetworkSizeRequest
• StateNetworkSizeResponse
• VisionPlan
• VisionPlanBenefits
• VisionPlanShowResponse
• VisionPlanUpdate
• VisionPlanUpdateRequest
• ZipCode
• ZipCountiesResponse
• ZipCounty
• ZipCountyBulk
• ZipCountyResponse

Documentation For Authorization

Vericred-Api-Key

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

Author