{"openapi":"3.0.0","info":{"description":"The GraphQL Auth Referral Submission API allows users to search for providers, submit referrals, search referrals, and search prior authorizations using GraphQL queries and mutations.","title":"Auth Referral Submission API","version":"1.0.0"},"servers":[{"url":"https://sandbox-apigw.optum.com"}],"paths":{"/oihub/patient/auth/referral/v1":{"post":{"security":[{"oAuth":["read_healthcheck"]}],"operationId":"authReferralSubmission","tags":["Auth Referral Submission"],"parameters":[{"name":"providerTaxId","in":"header","description":"Provider Tax ID Number","required":true,"schema":{"example":"123456789","type":"string"}},{"name":"x-optum-consumer-correlation-id","in":"header","description":"Unique UUID to track the transaction","required":false,"schema":{"example":"4d4a8964-e5fa-42dc-a37d-12345789","type":"string"}},{"name":"environment","in":"header","description":"Environment","required":false,"schema":{"example":"sandbox","type":"string"}}],"requestBody":{"required":true,"content":{"application/json":{"schema":{"type":"object","required":["query"],"description":"GraphQL queries/mutations for Auth Referral Submission","properties":{"query":{"description":"GraphQL query or mutation","type":"string"},"variables":{"description":"Variables for the GraphQL query/mutation","type":"object","properties":{"providerSearchInput":{"properties":{"searchType":{"description":"REQUESTING,SERVICING","example":"SERVICING","type":"string"},"provider":{"$ref":"#/components/schemas/ProviderInput"},"patient":{"$ref":"#/components/schemas/PatientInput"},"pagination":{"$ref":"#/components/schemas/PaginationInput"},"payerId":{"description":"payerId","example":"87726","type":"string"}},"type":"object","required":["searchType","provider","patient","payerId"]},"referralSubmitInput":{"properties":{"requestingProvider":{"$ref":"#/components/schemas/ReferralSubmitProviderInput"},"patient":{"$ref":"#/components/schemas/PatientInput"},"service":{"$ref":"#/components/schemas/ServiceInput"},"servicingProvider":{"description":"Servicing provider information","$ref":"#/components/schemas/ReferralSubmitProviderInput"},"payerId":{"description":"payerId","example":"87726","type":"string"}},"type":"object","required":["requestingProvider","patient","service","servicingProvider","payerId"]},"referralSearchInput":{"properties":{"patient":{"$ref":"#/components/schemas/PatientInput"},"serviceStartDate":{"example":"2024-01-01","type":"string"},"serviceEndDate":{"example":"2024-12-31","type":"string"},"status":{"description":"default: APPROVED","example":"ALL","type":"string"},"pagination":{"$ref":"#/components/schemas/PaginationInput"},"payerId":{"description":"payerId","example":"87726","type":"string"}},"type":"object","required":["patient","serviceStartDate","serviceEndDate","payerId"]},"priorAuthSearchInput":{"properties":{"serviceReferenceNumber":{"description":"PriorAuth unique case Id reference number.","example":"AXXXXXX","type":"string"},"corporateTin":{"description":"Corporate Tax Identification Number.","example":"123456789","type":"string"},"provider":{"$ref":"#/components/schemas/PriorAuthSearchProviderInput"},"member":{"$ref":"#/components/schemas/PatientInput"},"serviceSetting":{"description":"Filter by service setting type.","example":"Inpatient","type":"string"},"status":{"description":"Filter by case status.","example":"Open","type":"string"},"startDate":{"description":"Start date for the service period search (YYYY-MM-DD). Default will be current date.","example":"2025-07-19","type":"string"},"endDate":{"description":"End date for the service period search (YYYY-MM-DD). Default will be current date.","example":"2025-10-17","type":"string"},"payerId":{"description":"payerId","example":"87726","type":"string"}},"type":"object","required":["corporateTin","provider","member","payerId"]}}},"operationName":{"description":"Name of the GraphQL operation to execute (optional)","type":"string"}}},"examples":{"SearchProviders":{"summary":"Search Providers","value":{"query":"query SearchProviders($providerSearchInput: ProviderSearchInput!) { searchProviders(providerSearchInput: $providerSearchInput) { providers { name firstName middleName lastName providerOrganizationName npi taxId contactName phoneNumber fax networkStatus address { addressLine1 addressLine2 city state zip zip4 } uniqueProviderIdentifier providerType providerSpeciality { code description } gender distance handicapAccessible } pagination { totalRecords nextPageToken } } }","variables":{"providerSearchInput":{"searchType":"SERVICING","provider":{"zip":"90210","radius":50,"firstName":"Dr. Carlos","lastOrOrgName":"Rodriguez","npi":"9876543210","taxId":"987654321","preferredLanguage":"SPA","specialityCode":"CARD","gender":"M"},"patient":{"firstName":"Alice","lastName":"Johnson","id":"1234567890","dateOfBirth":"1990-12-31","groupNumber":"GRP321"},"pagination":{"nextPageToken":"2"},"payerId":"87726"}},"operationName":"SearchProviders"}},"SubmitReferral":{"summary":"Submit Referral","value":{"query":"mutation SubmitReferral($referralSubmitInput: ReferralSubmitInput!) { submitReferral(referralSubmitInput: $referralSubmitInput) { referralId referralStatus payer { id name messages } requestingProvider { name firstName middleName lastName providerOrganizationName npi taxId contactName phoneNumber fax networkStatus address { addressLine1 addressLine2 city state zip zip4 } } servicingProvider { name firstName middleName lastName providerOrganizationName npi taxId contactName phoneNumber fax networkStatus address { addressLine1 addressLine2 city state zip zip4 } } patient { id firstName middleName lastName dateOfBirth groupNumber relationshipCode relationshipDesc } decisions { decisionType certificationAction reviewDecisionReason startDate endDate referralQuantity { quantity qualifier qualifierDesc remaining } } x12Response rejectionReasons { rejectionLevel reasonDescription rejectionCode followUpAction rejectionReason validRequestIndicator } } }","variables":{"referralSubmitInput":{"requestingProvider":{"npi":"1234567890","taxId":"98765432","zip":"90201","firstName":"Carlos","lastOrOrgName":"Dr. Carlos Clinic","specialityCode":"CARD","gender":"M","city":"Healthcare City","state":"CA","radius":50,"contactName":"Carlos Benito","phoneNumber":"555-222-3333","preferredLanguage":"SPA"},"patient":{"firstName":"Alice","lastName":"Johnson","id":"1234567890","dateOfBirth":"1990-12-31","groupNumber":"GRP321"},"service":{"diagnosisCodes":["M79.3"],"referralQuantity":{"quantity":10,"qualifier":"VS"},"startDate":"2025-01-01","endDate":"2025-01-01","comment":"Patient requires physical therapy for knee pain"},"servicingProvider":{"npi":"1234567890","taxId":"98765432","zip":"90201","firstName":"Carlos","lastOrOrgName":"Dr. Carlos Clinic","specialityCode":"CARD","gender":"M","city":"Healthcare City","state":"CA","radius":50,"contactName":"Carlos Benito","phoneNumber":"555-222-3333","preferredLanguage":"SPA"},"payerId":"87726"}},"operationName":"SubmitReferral"}},"SubmitReferralRejection":{"summary":"Submit Referral Rejection","value":{"query":"mutation SubmitReferral($referralSubmitInput: ReferralSubmitInput!) { submitReferral(referralSubmitInput: $referralSubmitInput) { referralId referralStatus payer { id name messages } requestingProvider { name firstName middleName lastName providerOrganizationName npi taxId contactName phoneNumber fax networkStatus address { addressLine1 addressLine2 city state zip zip4 } } servicingProvider { name firstName middleName lastName providerOrganizationName npi taxId contactName phoneNumber fax networkStatus address { addressLine1 addressLine2 city state zip zip4 } } patient { id firstName middleName lastName dateOfBirth groupNumber relationshipCode relationshipDesc } decisions { decisionType certificationAction reviewDecisionReason startDate endDate referralQuantity { quantity qualifier qualifierDesc remaining } } x12Response rejectionReasons { rejectionLevel reasonDescription rejectionCode followUpAction rejectionReason validRequestIndicator } } }","variables":{"referralSubmitInput":{"requestingProvider":{"npi":"1234567890","taxId":"98765432","zip":"90201","firstName":"Carlos","lastOrOrgName":"Dr. Carlos Clinic","specialityCode":"CARD","gender":"M","city":"Healthcare City","state":"CA","radius":50,"contactName":"Carlos Benito","phoneNumber":"555-222-3333","preferredLanguage":"SPA"},"patient":{"firstName":"Alice","lastName":"Johnson","id":"1234567890","dateOfBirth":"1990-12-31","groupNumber":"GRP321"},"service":{"diagnosisCodes":["M79.3"],"referralQuantity":{"quantity":10,"qualifier":"VS"},"startDate":"2025-01-01","endDate":"2025-01-01","comment":"Patient requires physical therapy for knee pain"},"servicingProvider":{"npi":"1234567890","taxId":"98765432","zip":"90201","firstName":"Carlos","lastOrOrgName":"Dr. Carlos Clinic","specialityCode":"CARD","gender":"M","city":"Healthcare City","state":"CA","radius":50,"contactName":"Carlos Benito","phoneNumber":"555-222-3333","preferredLanguage":"SPA"},"payerId":"87726"}},"operationName":"SubmitReferral"}},"SearchReferrals":{"summary":"Search Referrals","value":{"query":"query SearchReferrals($referralSearchInput: ReferralSearchInput!) { searchReferrals(referralSearchInput: $referralSearchInput) { referrals { referralId referralStatus referralStatusCode requestingProvider { name firstName middleName lastName providerOrganizationName npi taxId contactName phoneNumber fax networkStatus address { addressLine1 addressLine2 city state zip zip4 } providerSpeciality { code description } } servicingProvider { name firstName middleName lastName providerOrganizationName npi taxId contactName phoneNumber fax networkStatus address { addressLine1 addressLine2 city state zip zip4 } providerSpeciality { code description } } service { diagnosisCodes referralQuantity { quantity qualifier qualifierDesc remaining } startDate endDate comment } rejectionResponse { rejectionLevel reasonDescription rejectionCode followUpAction rejectionReason validRequestIndicator } } pagination { totalRecords nextPageToken } } }","variables":{"referralSearchInput":{"patient":{"firstName":"Alice","lastName":"Johnson","id":"1234567890","dateOfBirth":"1990-12-31","groupNumber":"GRP321"},"serviceStartDate":"2024-01-01","serviceEndDate":"2024-12-31","status":"ALL","pagination":{"nextPageToken":"2"},"payerId":"87726"}},"operationName":"SearchReferrals"}},"SearchPriorAuths":{"summary":"Search Prior Auths","value":{"query":"query SearchPriorAuths($priorAuthSearchInput: PriorAuthSearchInput!) { searchPriorAuths(priorAuthSearchInput: $priorAuthSearchInput) { caseSummary { serviceReferenceNumber memberID memberFirstName memberLastName serviceSetting placeOfService serviceDates caseStatus overallCoverageStatus } caseDescription { caseSearchMessages caseDetail { serviceReferenceNumber caseStatus caseStatusReason primaryCarePhysician advanceNotifyDateTime admissionNotifyDateTime expectedServiceStartDate expectedServiceEndDate actualServiceStartDate actualServiceEndDate } coverageStatus { overallCoverageStatus procedureCode description coverageStatus decisionDate geneticMolecularTestCode geneticMolecularTestReviewType } clinicalNotes { createdTime createdBy noteText } patientDetails { id firstName middleName lastName dateOfBirth groupNumber relationshipCode relationshipDesc product effectiveDate terminationDate insuranceType verbalLanguagePreference writtenLanguagePreference informationalMessage } submittingProvider { name firstName middleName lastName providerOrganizationName npi taxId contactName phoneNumber fax networkStatus address { addressLine1 addressLine2 city state zip zip4 } } admittingAttendingProvider { name firstName middleName lastName providerOrganizationName npi taxId contactName phoneNumber fax networkStatus address { addressLine1 addressLine2 city state zip zip4 } } orderingProvider { name firstName middleName lastName providerOrganizationName npi taxId contactName phoneNumber fax networkStatus address { addressLine1 addressLine2 city state zip zip4 } } facilityDetails { name firstName middleName lastName providerOrganizationName npi taxId contactName phoneNumber fax networkStatus address { addressLine1 addressLine2 city state zip zip4 } coverage } serviceDetails { placeOfService serviceDescription serviceDetails } facilityServiceDetails { startDate endDate serviceDescription isPatientAdmitted expectedAdmissionDate expectedDischargeDate actualAdmissionDateTime isPatientDischarged dischargeDate dischargeLocation } diagnosisDetails { codePointer code description } procedureCodeDetails { codePointer code description coverageStatus servicingProvider { name firstName middleName lastName providerOrganizationName npi taxId contactName phoneNumber fax networkStatus address { addressLine1 addressLine2 city state zip zip4 } } serviceDetail expectedFromDate expectedToDate procedureUnitPerFrequencyCount procedureUnitOfMeasure procedureFrequency procedureUnitCount dmeProcurementType dmeTotalCost dmeClinicalIllnessDescText dmeSupplyDescText dmeEnternalFeedingSSONutrInd dmeFormulaNameText dmeMedicalConditionText } expeditedRequestReview initialContact { contactName phoneNumber fax } followUpContact { contactName phoneNumber fax departmentType contactRoleType emailAddress medicalRecordNumber memberPhone } } } }","variables":{"priorAuthSearchInput":{"serviceReferenceNumber":"AXXXXXX","corporateTin":"123456789","provider":{"firstName":"Dr. Carlos","lastOrOrgName":"Rodriguez","address":{"addressLine1":"1234 Street","addressLine2":"Building A","city":"Healthcare City","state":"AZ","zip":"90210","zip4":"0001"}},"member":{"firstName":"Alice","lastName":"Johnson","id":"1234567890","dateOfBirth":"1990-12-31","groupNumber":"GRP321","stateCode":"AZ","zipCode":"90210"},"serviceSetting":"Inpatient","status":"Open","startDate":"2025-07-19","endDate":"2025-10-17","payerId":"87726"}},"operationName":"SearchPriorAuths"}}}}}},"responses":{"200":{"description":"SearchProviders\n\n - MISSING_REQUIRED_FIELD\n
\n - Missing mandatory field: XXXX
\n
\n \n - INVALID_SEARCH\n
\n - At least one provider detail must be provided
\n
\n \n - BACKEND_VALIDATION_FAILED\n
\n - Invalid or missing fields: XXXX
\n - PCP not available for this member
\n - Requested tin is not matching with Primary care provider tin
\n - No provider found for the given search criteria
\n - This Service does not support the selected member plan or platform
\n - Member lookup failed. Verify input
\n - No Member Policy found for the member
\n - The member’s plan does not have an active policy
\n - This service is not supported for NICE-migrated members
\n - This service does not support delegated members.
\n - Primary care provider is not found for the member
\n - Primary care provider Tin is empty or not applicable
\n - Derived Line of Business is blank
\n
\n \n
\n\nSubmitReferral\n\n - MISSING_REQUIRED_FIELD\n
\n - Missing mandatory field: XXXX
\n
\n \n - INVALID_SEARCH\n
\n - Invalid value for XXXX
\n
\n \n - BACKEND_VALIDATION_FAILED\n
\n - Invalid or missing fields: XXXX
\n - No Member Policy found for the member
\n - The member's plan does not have an active policy
\n - This member's plan does not require referrals
\n - This service is not supported for NICE-migrated members
\n - This service does not support delegated members
\n - Primary care provider Tin is empty or not applicable
\n - Requesting Provider tin is not matching with Pcp tin
\n - No Provider found for the requesting provider combination
\n - No Unique Provider found for the requesting provider combination
\n - Valid address not found for the requesting provider
\n - Valid contract not found for the requesting provider
\n - No matching policies with plan benefits.
\n - Multiple matching policies found.
\n - No provider found for the servicing provider combination
\n - No Unique Provider found for the serving provider combination
\n - No exact match found for the diagnosis code: XXXX
\n - Invalid diagnosis code provided: XXXX
\n - This Service does not support the selected member plan or platform
\n - Derived Line of Business is blank
\n
\n \n
\n\nSearchReferrals\n\n - MISSING_REQUIRED_FIELD\n
\n - Missing mandatory field: XXXX
\n
\n \n - BACKEND_VALIDATION_FAILED\n
\n - Invalid or missing fields: XXXXX
\n - This Service does not support the selected member plan or platform
\n - Member lookup failed. Verify input.
\n
\n \n
\n\nPriorAuth Search\n\n - MISSING_REQUIRED_FIELD\n
\n - Missing mandatory header field: XXXX
\n - Missing mandatory field: XXXX
\n
\n \n - BACKEND_VALIDATION_FAILED\n
\n - Provider not found for the requested corporateTin
\n - Provider not found for the requested provider.firstName/provider.lastOrOrgName
\n - No records found
\n - Member not found
\n - Service setting is invalid. Please update your request with one of the following - Inpatient, Outpatient Facility, Outpatient, or All and resubmit your request
\n - Status is invalid. Please update your request with one of the following - Cancelled, Open, Closed or All and resubmit your request
\n - corporateTin/provider.firstName/provider.lastOrOrgName is invalid, please provide a valid input
\n - The case search results in excessive number of cases returned. Please refine the search criteria or date range
\n - No Case Detail record found
\n
\n \n - CASE_SUMMARY_NOT_FOUND\n
\n - Provider and Member SRN not found
\n
\n \n - INFORMATION\n
\n - Multiple SRNs found for the requested details. For case details, include a SRN number on the request
\n
\n \n
\n","content":{"application/json":{"examples":{"SearchProviders":{"summary":"Search Providers","value":{"data":{"searchProviders":{"providers":[{"name":"John J Doe","firstName":"John","middleName":"J","lastName":"Doe","providerOrganizationName":"Dr. John Doe Clinic","npi":"1234567890","taxId":"987654321","contactName":"Alison Johnson","phoneNumber":"555-222-3333","fax":"555-222-4444","networkStatus":"IN_NETWORK","address":{"addressLine1":"123 Healthcare Drive","addressLine2":"Suite 200","city":"Healthcare City","state":"CA","zip":"90210","zip4":"0001"},"uniqueProviderIdentifier":"enc_pvd_123456789abcdef","providerType":"INDIVIDUAL","providerSpeciality":[{"code":"207Q00000X","description":"Family Medicine"}],"gender":"Male","distance":"2.5","handicapAccessible":true}],"pagination":{"totalRecords":"147","nextPageToken":"3"}}}}},"SubmitReferral":{"summary":"Submit Referral","value":{"data":{"submitReferral":{"referralId":"REF123456789","referralStatus":"APPROVED","payer":{"id":"PAY001","name":"UnitedHealthcare","messages":["Referral approved for 12 visits"]},"requestingProvider":{"name":"John J Doe","firstName":"John","middleName":"J","lastName":"Doe","providerOrganizationName":"Dr. John Doe Clinic","npi":"1234567890","taxId":"987654321","contactName":"Alison Johnson","phoneNumber":"555-123-4567","fax":"555-222-4444","networkStatus":"IN_NETWORK","address":{"addressLine1":"123 Medical Drive","addressLine2":"Building A","city":"Healthcare City","state":"CA","zip":"90210","zip4":"0001"}},"servicingProvider":{"name":"John J Doe","firstName":"John","middleName":"J","lastName":"Doe","providerOrganizationName":"Dr. John Doe Clinic","npi":"1234567890","taxId":"987654321","contactName":"Alison Johnson","phoneNumber":"555-123-4567","fax":"555-222-4444","networkStatus":"IN_NETWORK","address":{"addressLine1":"123 Medical Drive","addressLine2":"Building A","city":"Healthcare City","state":"CA","zip":"90210","zip4":"0001"}},"patient":{"id":"123456789","firstName":"Alice","middleName":"A","lastName":"Johnson","dateOfBirth":"1990-12-31","groupNumber":"GRP321","relationshipCode":"18","relationshipDesc":"SELF"},"decisions":[{"decisionType":"EVENT","certificationAction":"A1","reviewDecisionReason":"MEETS_CRITERIA","startDate":"2024-11-30","endDate":"2024-11-30","referralQuantity":{"quantity":12,"qualifier":"VS","qualifierDesc":"visits","remaining":8}}],"x12Response":"ISA*00* *00* *ZZ*SENDER *ZZ*RECEIVER *241010*1234*^*00501*000000001*0*P*:~","rejectionReasons":[{"rejectionLevel":"REFERRAL","reasonDescription":"Insufficient medical documentation provided","rejectionCode":"R001","followUpAction":"RESUBMIT_WITH_DOCUMENTATION","rejectionReason":"MISSING_DOCUMENTATION","validRequestIndicator":"N"}]}}}},"SubmitReferralRejection":{"summary":"SubmitReferral Rejection","value":{"data":{"submitReferral":{"referralId":"","referralStatus":"REJECTED","payer":{"id":"PAY001","name":"UnitedHealthcare","messages":["Referral denied - see rejection reasons"]},"rejectionReasons":[{"rejectionLevel":"REFERRAL","reasonDescription":"Insufficient medical documentation provided","rejectionCode":"R001","rejectionReason":"MISSING_DOCUMENTATION","followUpAction":"RESUBMIT_WITH_DOCUMENTATION","validRequestIndicator":"N"}]}}}},"SearchReferrals":{"summary":"Search Referrals","value":{"data":{"searchReferrals":{"referrals":[{"referralId":"REF123456789","referralStatus":"APPROVED","referralStatusCode":"A1","requestingProvider":{"name":"John J Doe","firstName":"John","middleName":"J","lastName":"Doe","providerOrganizationName":"Dr. John Doe Clinic","npi":"1234567890","taxId":"987654321","contactName":"Alison Johnson","phoneNumber":"555-222-3333","fax":"555-222-4444","networkStatus":"IN_NETWORK","address":{"addressLine1":"123 Healthcare Drive","addressLine2":"Suite 200","city":"Healthcare City","state":"CA","zip":"90210","zip4":"0001"},"providerSpeciality":{"code":"207Q00000X","description":"Family Medicine"}},"servicingProvider":{"name":"John J Doe","firstName":"John","middleName":"J","lastName":"Doe","providerOrganizationName":"Dr. John Doe Clinic","npi":"1234567890","taxId":"987654321","contactName":"Alison Johnson","phoneNumber":"555-222-3333","fax":"555-222-4444","networkStatus":"IN_NETWORK","address":{"addressLine1":"123 Healthcare Drive","addressLine2":"Suite 200","city":"Healthcare City","state":"CA","zip":"90210","zip4":"0001"},"providerSpeciality":{"code":"207Q00000X","description":"Family Medicine"}},"service":{"diagnosisCodes":["M79.3"],"referralQuantity":{"quantity":12,"qualifier":"VS","qualifierDesc":"visits","remaining":8},"startDate":"2024-11-01","endDate":"2024-11-30","comment":"Physical therapy for knee pain"},"rejectionResponse":{"rejectionLevel":"REFERRAL","reasonDescription":"Insufficient medical documentation provided","rejectionCode":"R001","followUpAction":"RESUBMIT_WITH_DOCUMENTATION","rejectionReason":"MISSING_DOCUMENTATION","validRequestIndicator":"N"}}],"pagination":{"totalRecords":"147","nextPageToken":"3"}}}}},"SearchPriorAuths":{"summary":"Search PriorAuths","value":{"data":{"searchPriorAuths":{"caseSummary":[{"serviceReferenceNumber":"AXXXXXXXXX","memberID":"953333333","memberFirstName":"Alison","memberLastName":"Johnson","serviceSetting":"Inpatient","placeOfService":"Acute Hospital","serviceDates":"10/02/2025-10/03/2025","caseStatus":"Open","overallCoverageStatus":"Covered/Approved"}],"caseDescription":{"caseSearchMessages":["A decision has already been rendered on this case, though some updates are permitted as indicated in the enabled fields below.","To request an additional service for this member, please submit a new notification/prior authorization request for the member."],"caseDetail":{"serviceReferenceNumber":"AXXXXXXXXX","caseStatus":"Open","caseStatusReason":"Open","primaryCarePhysician":"John","advanceNotifyDateTime":"2025-01-01:00:00:01","admissionNotifyDateTime":"2025-01-01:00:00:01","expectedServiceStartDate":"2025-10-02","expectedServiceEndDate":"2025-10-03","actualServiceStartDate":"2025-10-02","actualServiceEndDate":"2025-10-03"},"coverageStatus":[{"overallCoverageStatus":"Covered/Approved","procedureCode":"99213","description":"Established patient office or other outpatient visit","coverageStatus":"Covered","decisionDate":"2025-09-15","geneticMolecularTestCode":null,"geneticMolecularTestReviewType":null}],"clinicalNotes":[{"createdTime":"2025-01-01:00:00:01","createdBy":"doctor","noteText":"note text detail"}],"patientDetails":{"id":"123456789","firstName":"Alice","middleName":"A","lastName":"Johnson","dateOfBirth":"1990-12-31","groupNumber":"GRP321","relationshipCode":"18","relationshipDesc":"SELF","product":"PPO - Options PPO","effectiveDate":"2025-03-01","terminationDate":"2025-12-31","insuranceType":"Medicare","verbalLanguagePreference":"English","writtenLanguagePreference":"English","informationalMessage":"A future timeline may be available for this member. For future coverage please call the telephone number located on the back of the member's Medical ID card."},"submittingProvider":{"name":"John J Doe","firstName":"John","middleName":"J","lastName":"Doe","providerOrganizationName":"Dr. John Doe Clinic","npi":"1234567890","taxId":"987654321","contactName":"Alison Johnson","phoneNumber":"555-123-4567","fax":"555-222-4444","networkStatus":"IN_NETWORK","address":{"addressLine1":"123 Medical Drive","addressLine2":"Building A","city":"Healthcare City","state":"CA","zip":"90210","zip4":"0001"}},"admittingAttendingProvider":{"name":"John J Doe","firstName":"John","middleName":"J","lastName":"Doe","providerOrganizationName":"Dr. John Doe Clinic","npi":"1234567890","taxId":"987654321","contactName":"Alison Johnson","phoneNumber":"555-123-4567","fax":"555-222-4444","networkStatus":"IN_NETWORK","address":{"addressLine1":"123 Medical Drive","addressLine2":"Building A","city":"Healthcare City","state":"CA","zip":"90210","zip4":"0001"}},"orderingProvider":{"name":"John J Doe","firstName":"John","middleName":"J","lastName":"Doe","providerOrganizationName":"Dr. John Doe Clinic","npi":"1234567890","taxId":"987654321","contactName":"Alison Johnson","phoneNumber":"555-123-4567","fax":"555-222-4444","networkStatus":"IN_NETWORK","address":{"addressLine1":"123 Medical Drive","addressLine2":"Building A","city":"Healthcare City","state":"CA","zip":"90210","zip4":"0001"}},"facilityDetails":{"name":"John J Doe","firstName":"John","middleName":"J","lastName":"Doe","providerOrganizationName":"Dr. John Doe Clinic","npi":"1234567890","taxId":12345678,"contactName":"Alison Johnson","phoneNumber":"555-123-4567","fax":"555-123-4568","networkStatus":"In Network","address":{"addressLine1":"123 Medical Drive","addressLine2":"Building A","city":"Healthcare City","state":"CA","zip":"90210","zip4":"0001"},"coverage":"Covered/Approved"},"serviceDetails":{"placeOfService":"Acute Hospital","serviceDescription":"Scheduled","serviceDetails":"Surgical"},"facilityServiceDetails":{"startDate":"2025-10-02","endDate":"2025-10-02","serviceDescription":"Scheduled","isPatientAdmitted":"Yes","expectedAdmissionDate":"2025-10-02","expectedDischargeDate":"2025-10-02","actualAdmissionDateTime":"2025-10-02","isPatientDischarged":"Yes","dischargeDate":"2025-10-02","dischargeLocation":"Home"},"diagnosisDetails":[{"codePointer":"Primary","code":"J01.90","description":"acute sinusitis"}],"procedureCodeDetails":[{"codePointer":"Primary","code":"99213","description":"Established patient office or other outpatient visit","coverageStatus":"Covered/Approved","servicingProvider":{"name":"John J Doe","firstName":"John","middleName":"J","lastName":"Doe","providerOrganizationName":"Dr. John Doe Clinic","npi":"1234567890","taxId":"987654321","contactName":"Alison Johnson","phoneNumber":"555-123-4567","fax":"555-222-4444","networkStatus":"IN_NETWORK","address":{"addressLine1":"123 Medical Drive","addressLine2":"Building A","city":"Healthcare City","state":"CA","zip":"90210","zip4":"0001"}},"serviceDetail":"Surgical","expectedFromDate":"2025-10-02","expectedToDate":"2025-10-02","procedureUnitPerFrequencyCount":"1","procedureUnitOfMeasure":"UN","procedureFrequency":"1","procedureUnitCount":"1","dmeProcurementType":"durable medical equipment procurement type","dmeTotalCost":"durable medical equipment total cost","dmeClinicalIllnessDescText":"durable medical equipment clinical description","dmeSupplyDescText":"durable medical equipment supply description","dmeEnternalFeedingSSONutrInd":false,"dmeFormulaNameText":"durable medical equipment formula name","dmeMedicalConditionText":"durable medical equipment condition text"}],"expeditedRequestReview":true,"initialContact":{"contactName":"Bruce Wayne","phoneNumber":"555-123-4567","fax":"555-123-4568"},"followUpContact":{"contactName":"Bruce Wayne","phoneNumber":"555-123-4567","fax":"555-123-4568","departmentType":null,"contactRoleType":"Other","emailAddress":"tonystark@avengers.com","medicalRecordNumber":"EPIC 123456 987654","memberPhone":"555-111-1234"}}}}}}},"schema":{"properties":{"errors":{"description":"List of errors if occurred during operation","type":"array","items":{"properties":{"description":{"description":"Detailed error message","type":"string"},"code":{"description":"Error code identifying the specific error","type":"string"}},"type":"object"}},"data":{"properties":{"searchProviders":{"$ref":"#/components/schemas/ProviderSearchResponse"},"searchPriorAuths":{"$ref":"#/components/schemas/PriorAuthSearchResponse"},"searchReferrals":{"$ref":"#/components/schemas/ReferralSearchResponse"},"submitReferral":{"$ref":"#/components/schemas/ReferralSubmitResponse"}},"type":"object"}},"type":"object"}}}},"400":{"description":"Bad Request","content":{"application/json":{"example":{"errors":[{"description":"Cannot query field...","code":"GRAPHQL_VALIDATION_FAILED"}]},"schema":{"properties":{"errors":{"items":{"properties":{"description":{"type":"string"},"code":{"type":"string"}},"type":"object"},"type":"array"}},"type":"object"}}}},"401":{"description":"Unauthorized","content":{"application/json":{"example":{"errors":[{"description":"Invalid or expired token","code":"AUTH_FAILURE"}]},"schema":{"properties":{"errors":{"items":{"properties":{"description":{"type":"string"},"code":{"type":"string"}},"type":"object"},"type":"array"}},"type":"object"}}}},"500":{"description":"Internal server error","content":{"application/json":{"example":{"errors":[{"description":"An unexpected error 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