{"openapi":"3.0.3","info":{"title":"Real Dental Pre-Care Eligibility Intelligence API","description":"Enhanced Eligibility","version":"1.0.0"},"servers":[{"url":"https://sandbox-apigw.optum.com"}],"paths":{"/oihub/dnt/enh/eligibility/preservice/v1/healthcheck":{"get":{"summary":"Health Check","description":"Returns the health status for the Check Enhanced Dental Eligibility API.","operationId":"healthCheckEnhancedDentalEligibility","tags":["Health Check"],"security":[{"BearerAuth":[]}],"responses":{"200":{"description":"Health check successful","content":{"application/json":{"schema":{"type":"object","properties":{"status":{"type":"string","example":"UP"}}}}}},"401":{"description":"Unauthorized"},"500":{"description":"Internal Server Error"}}}},"/oihub/dnt/enh/eligibility/preservice/v1":{"post":{"summary":"Check Enhanced Dental Eligibility","operationId":"checkEnhancedEligibility","tags":["Check Enhanced Dental Eligibility"],"parameters":[{"name":"providertaxid","in":"header","required":true,"schema":{"type":"string","example":"204868609"}}],"requestBody":{"required":true,"content":{"application/json":{"schema":{"$ref":"#/components/schemas/EligibilityRequest"}}}},"responses":{"200":{"description":"Successful eligibility response","content":{"application/json":{"schema":{"$ref":"#/components/schemas/EligibilityResponse"}}}},"400":{"description":"Bad Request"},"401":{"description":"Unauthorized"},"500":{"description":"Internal Server Error"}},"description":"Checks enhanced dental eligibility.","security":[{"BearerAuth":[]}]}}},"components":{"schemas":{"EligibilityRequest":{"type":"object","required":["query","variables"],"properties":{"query":{"type":"string","description":"GraphQL query string"},"variables":{"$ref":"#/components/schemas/EligibilityVariables"}}},"EligibilityVariables":{"type":"object","properties":{"input":{"$ref":"#/components/schemas/EligibilityInput"}}},"EligibilityInput":{"type":"object","required":["dateOfBirth","firstName","lastName","memberId","payerId"],"properties":{"dateOfBirth":{"type":"string","format":"date"},"firstName":{"type":"string"},"lastName":{"type":"string"},"memberId":{"type":"string"},"payerId":{"type":"string"},"providerFirstName":{"type":"string"},"providerLastName":{"type":"string"},"providerNPI":{"type":"string"},"serviceStartDate":{"type":"string","format":"date"},"serviceEndDate":{"type":"string","format":"date"},"coverageTypes":{"type":"array","items":{"type":"string"}}}},"EligibilityResponse":{"type":"object","properties":{"data":{"type":"object","properties":{"checkEnhancedEligibility":{"type":"object","properties":{"eligibility":{"type":"array","items":{"$ref":"#/components/schemas/Eligibility"}}}}}}}},"Eligibility":{"type":"object","properties":{"eligibilityInfo":{"$ref":"#/components/schemas/EligibilityInfo"},"benefitNotes":{"$ref":"#/components/schemas/BenefitNotes"},"benefitSummary":{"$ref":"#/components/schemas/BenefitSummary"},"benefitUtilization":{"$ref":"#/components/schemas/BenefitUtilization"}}},"EligibilityInfo":{"type":"object","properties":{"trnId":{"type":"string","nullable":true},"member":{"$ref":"#/components/schemas/Member"},"insuranceInfo":{"$ref":"#/components/schemas/InsuranceInfo"}}},"Member":{"type":"object","properties":{"memberId":{"type":"string","example":"042137147"},"firstName":{"type":"string","example":"MUHAMMAD"},"lastName":{"type":"string","example":"ATA"},"middleName":{"type":"string","nullable":true},"dateOfBirth":{"type":"string","format":"date","example":"1974-09-07"},"gender":{"type":"string","example":"M"},"relationshipCode":{"type":"string"}}},"InsuranceInfo":{"type":"object","properties":{"policyNumber":{"type":"string","example":"0241816"},"planTypeDescription":{"type":"string","example":"Preferred Provider Org."},"groupName":{"type":"string","example":"HOUSTON LIVESTOCK SHOW AND ROD"},"productType":{"type":"string","example":"PPO"},"payerId":{"type":"string","example":"52133"},"insuranceType":{"type":"string","example":"COMM"},"eligibilityStartDate":{"type":"string"},"eligibilityEndDate":{"type":"string"},"planStartDate":{"type":"string"},"planEndDate":{"type":"string"},"policyStatus":{"type":"string"},"productId":{"type":"string"},"productCode":{"type":"string"}}},"BenefitNotes":{"type":"object","properties":{"result":{"type":"object","properties":{"benefitNotes":{"type":"object","properties":{"footNoteInfo":{"type":"array","items":{"$ref":"#/components/schemas/FootNoteInfo"}}}}}}}},"FootNoteInfo":{"type":"object","properties":{"benefitSummaryType":{"type":"string"},"benefitSummaryDescription":{"type":"string"},"benefitSummarySequenceNumber":{"type":"string"},"benefitSummaryText":{"type":"string"}}},"BenefitSummary":{"type":"object","properties":{"member":{"type":"object","properties":{"subscriberId":{"type":"string","example":"042137147"},"groupId":{"type":"string","example":"101651"}}},"planLevelBenefits":{"type":"array","items":{"type":"object"}},"categoryLevelBenefits":{"type":"array","items":{"type":"object"}}}},"BenefitUtilization":{"type":"object","properties":{"memberName":{"type":"object"},"memberRelationship":{"type":"string","example":"SUBSCRIBER"},"procedures":{"type":"array","items":{"$ref":"#/components/schemas/Procedure"}}}},"Procedure":{"type":"object","properties":{"procedure":{"type":"object","properties":{"codeValue":{"type":"string","example":"D0120"},"codeDesc":{"type":"string","example":"periodic oral evaluation - established patient"}}},"procedureCategory":{"type":"string","example":"01"},"inNetworkFrequency":{"type":"string","example":"2 - F - 12M"},"outOfNetworkFrequency":{"type":"string","example":"2 - F - 12M"},"ageLimit":{"type":"string"},"alternateBenefit":{"type":"string"},"serviceCount":{"type":"integer","example":0},"relatedCode":{"type":"array","items":{"type":"string"}},"services":{"type":"array","items":{"type":"object"}}}}},"securitySchemes":{"BearerAuth":{"type":"http","scheme":"bearer","bearerFormat":"JWT"}}},"security":[{"BearerAuth":[]}],"x-readme":{"explorer-enabled":true,"proxy-enabled":true}}