## ENVIRONMENTS:
1. TEST
[BASE URL] (https://simplehealth.cloud)
2. PRODUCTION
TBC
## LOG IN:
| POST | /login-app|
| -------- | -------- |
| OK | 200 |
**Path Parameters:**
| Parameter | Data Type | Optionality |
| -------- | -------- | -------- |
| username | varchar | Required |
| password | varchar | Required |
**REQUEST BODY**
```
{
"username": "XXXXXXX",
"password": "*******"
}
```
## SUCCESSFUL CALL SAMPLE ##
| GET | /api/v1/membership/{membership_number}|
| -------- | -------- |
| OK | 200 |
Successful API calls e.g. sending an existent membership number will result in the following message:
```
{
"success": false,
"msg": null,
"data": { // full details
}
}
```
## UNSUCCESSFUL CALL SAMPLE ##
| GET | /api/v1/membership/{membership_number}/{suffix} |
| -------- | -------- |
| OK | 200 |
API calls with a business error, e.g. sending a non-existent ```membership_number``` will result in the following message:
```
{
"success": false,
"msg": "No such member was found",
"data": null
}
```
## MEMBER LOOKUP API
| GET | /api/v1/membership/{membership_number}|
| -------- | -------- |
| OK | 200 |
**Path Parameters:**
| Parameter | Data Type | Optionality |
| -------- | -------- | -------- |
| membership_number | varchar | Required
**RESPONSE**
```mermaid
{
"success": true,
"msg": null,
"data": {
"principal": {
"member_id": 14,
"national_id": "987654321",
"membership_number": "12599-00",
"suffix_number": "00",
"payer": "TNM",
"shortfall": false,
"wait_period": false,
"excess": false,
"waiver": false,
"phone_number": "08479983933",
"email_address": "rmatrutto@gmail.com",
"first_name": "FELIX",
"other_names": "NOAH",
"last_name": "KIM",
"gender": "MALE",
"date_of_birth": "1990-11-28",
"scheme_type": "CORPORATE",
"status": "ACTIVE",
"relationship": "PRINCIPAL",
"dependant_type": "PRINCIPAL",
"mra_number": 1234567,
"last_paid": "2024-04-01"
},
"dependants": [
{
"member_id": 15,
"national_id": "987654321",
"membership_number": "12599-01",
"suffix_number": "01",
"payer": "TNM",
"shortfall": false,
"wait_period": false,
"excess": false,
"waiver": false,
"phone_number": "098242232",
"email_address": "rmatrutto@gmail.com",
"first_name": "MARY",
"other_names": "ROSE",
"last_name": "KIM",
"gender": "FEMALE",
"date_of_birth": "1995-11-28",
"scheme_type": "CORPORATE",
"status": "ACTIVE",
"relationship": null,
"dependant_type": "ADULT",
"mra_number": 1234567,
"last_paid": "2024-04-01"
},
{
"member_id": 16,
"national_id": "987654321",
"membership_number": "12599-02",
"suffix_number": "02",
"payer": "TNM",
"shortfall": false,
"wait_period": false,
"excess": false,
"waiver": false,
"phone_number": "082323433",
"email_address": "rmatrutto@gmail.com",
"first_name": "DAN",
"other_names": "JAMES",
"last_name": "MWAYI",
"gender": "FEMALE",
"date_of_birth": "2000-11-28",
"scheme_type": "CORPORATE",
"status": "ACTIVE",
"relationship": null,
"dependant_type": "CHILD",
"mra_number": 1234567,
"last_paid": "2024-04-01"
}
]
}
}
```
## MEMBER BENEFIT API
| GET | /api/v1/membership/{member_id}/benefits |
| -------- | -------- |
| OK | 200 |
**Path Parameters:**
| Parameter | Data Type | Optionality |
| -------- | -------- | -------- |
| member_id | Number | Required |
```
{
{
"success": true,
"msg": null,
"data": [
{
"member_benefit_id": 39,
"balance": 0.0,
"member_id": 5,
"product_id": 11,
"product": "EXECUTIVE SILVER",
"benefit_status": "ACTIVE",
"benefit_name": "Ophthalmology Limit"
},
{
"member_benefit_id": 40,
"balance": 0.0,
"member_id": 5,
"product_id": 11,
"product": "EXECUTIVE SILVER",
"benefit_status": "ACTIVE",
"benefit_name": "Mental Health Limit"
},
{
"member_benefit_id": 41,
"balance": 0.0,
"member_id": 5,
"product_id": 11,
"product": "EXECUTIVE SILVER",
"benefit_status": "ACTIVE",
"benefit_name": "Blood Transfusion (BLD)"
},
{
"member_benefit_id": 42,
"balance": 0.0,
"member_id": 5,
"product_id": 11,
"product": "EXECUTIVE SILVER",
"benefit_status": "ACTIVE",
"benefit_name": "Braces (OPD)"
},
{
"member_benefit_id": 266,
"balance": 0.0,
"member_id": 5,
"product_id": 11,
"product": "EXECUTIVE SILVER",
"benefit_status": "ACTIVE",
"benefit_name": "Ophthalmology Limit"
},
{
"member_benefit_id": 268,
"balance": 0.0,
"member_id": 5,
"product_id": 11,
"product": "EXECUTIVE SILVER",
"benefit_status": "ACTIVE",
"benefit_name": "Mental Health Limit"
},
{
"member_benefit_id": 270,
"balance": 0.0,
"member_id": 5,
"product_id": 11,
"product": "EXECUTIVE SILVER",
"benefit_status": "ACTIVE",
"benefit_name": "Blood Transfusion (BLD)"
},
{
"member_benefit_id": 272,
"balance": 0.0,
"member_id": 5,
"product_id": 11,
"product": "EXECUTIVE SILVER",
"benefit_status": "ACTIVE",
"benefit_name": "Braces (OPD)"
}
]
}
```
## SERVICE PROVIDER ALL TARIFFS API
| GET | /api/v1/provider/{provider_code}/tariffs |
| -------- | -------- |
| OK | 200 |
**Path Parameters:**
| Parameter | Data Type | Optionality |
| -------- | -------- | -------- |
| provider_code | Integer | Required |
**RESPONSE**
```
{
"success":true,
"msg":null,
"data": [
{
"code": 33046,
"description": "Abiraterone Acetate",
"authorization_required": true,
"tax": 0,
"value": 90000,
"category": "drug",
"class": "sample class",
"provider_id": 1234,
"provider_name": "Adventist Hospital Blantyre"
},
{
"code": 53021,
"description": "URINE ANALYSIS(CHEMICAL)",
"authorization_required": false,
"tax": 0,
"value": 119185,
"category": "lab",
"class": "sample class",
"provider_id": 1234,
"provider_name": "Adventist Hospital Blantyre"
}
]
}
```
## SERVICE PROVIDER SPECIFIC TARIFF API
| GET | /api/v1/provider/{provider_code}/tariffs/{tariff_code} |
| -------- | -------- |
| OK | 200 |
**Path Parameters:**
| Parameter | Data Type | Optionality |
| -------- | -------- | -------- |
| provider_code | Integer | Required |
| tariff_code | varchar | Required |
**RESPONSE**
```
{
"success":true,
"msg": null,
"data":{
"code": "33046",
"code_description": "Abiraterone Acetate",
"authorization_required": "Y",
"tax": 0,
"value": 90000,
"category": "drug",
"class": "sample class",
"provider_id": 1234,
"provider_name": "Adventist Hospital Blantyre"
}
}
```
## SERVICE PROVIDER API
| GET | /api/v1/providers |
| -------- | -------- |
| OK | 200 |
**Request Parameters:**
| Parameter | Data Type | Optionality |
| -------- | -------- | -------- |
| page | Integer | Required |
| size | Integer | Required |
**RESPONSE**
```
{
"success":true,
"msg":null,
"data":
[
{
"provider_code": "2120131",
"provider_type": "Hospital",
"provider_name": "MASM Clinic Kanjedza"
},
{
"provider_code": "2120132",
"provider_type": "Hospital",
"provider_name": "MASM Clinic Area 12"
}
],
"results":300
}
```
## CLAIMS SUBMISSION API
This API call will generate a claim number on the core system sent back in the ```data``` field of a successful ```JSON``` response.
| POST | /api/v1/claims/submit |
| -------- | -------- |
| OK | 200 |
**REQUEST BODY**
```
{
"provider_id": 34,
"provider_name": "MASM CLinic 12",
"member_name": "John Banda",
"member_number": "JC9989-00",
"verification_mode": "BIOMETRIC",
"claim_date": "20-10-2023",
"benefit": "Outpatient",
"benefit_id": 45,
"sub_benefit": "Dental",
"sub_benefit_id": 50,
"booking_id": 1,
"documents": [
{
"id": 123,
"document_type": "INVOICE",
"path": "path/to/document",
"format": "tiff"
},
{
"id": 123,
"document_type": "INVOICE",
"path": "path/to/document",
"format": "tiff"
}
],
"diagnoses": [
{
"code": "J00",
"standard": "ICD10",
"description": "Acute nasopharyngitis [Common Cold]"
}
],
"invoices": [
{
"invoice_number": "HO12434",
"invoice_date": "20-10-2023",
"amount": 50000,
"currency": "MWK",
"line_items": [
{
"description": "Consultation",
"unit_price": 20000,
"quantity": 1,
"line_total": 20000
},
{
"description": "BRUFEN 200MG TABS 500",
"unit_price": 3000,
"quantity": 10,
"line_total": 30000
}
]
}
]
}
```
**RESPONSE**
```
{
"success": true,
"msg": null,
"data": {
"id": 9,
"claimNumber": null,
"providerName": "MASM CLinic 12",
"providerCode": 34,
"benefit": "Outpatient",
"memberNumber": "JC9989-00",
"memberName": "John Banda",
"preAuthNumber": null,
"diagnoses": [],
"status": "PENDED",
"datePicked": null,
"invoices": [],
"documents": [],
"verificationMode": "BIOMETRIC"
}
}
```
## BENEFIT BOOKING API
This API call will generate a booking number on the core system sent back in the ```data``` field of a successful ```JSON``` response.
| POST | /api/v1/claims/booking |
| -------- | -------- |
| OK | 200 |
**REQUEST BODY**
```
{
"provider_id":1,
"provider_name": "Adventist Hospital",
"benefit_id":1,
"membership_number": "HCP/90909-01",
"member_id":5,
"amount": 20000,
"transaction_date": "20-10-2023"
}
```
**RESPONSE**
```
{
"success": true,
"msg": null,
"data": {
"booking_id": 8,
"benefitId": 1,
"memberId": 5,
"providerId": 1,
"amount": 20000,
"startDate": "2024-03-22",
"expiry": "2024-03-24",
"treatmentDate": "2024-03-22",
"transactionDate": "2023-10-20",
"bookingType": 1,
"userId": 1,
"productVersionId": 1
}
}
```
## PRE-AUTHORIZATION API
This API call will generate a pre-authorization number on the core system sent back in the ```data``` field of a successful ```JSON``` response.
| POST | /api/v1/claims/pre_authorization |
| -------- | -------- |
| OK | 200 |
**REQUEST BODY**
```
{
"provider_id": 1,
"preauth_type": 1,
"benefit_id": 1,
"membership_number": "HCP/90909-01",
"member_id": 5,
"reserve": 20000,
"treatment_date": "20-10-2023",
"start_date": "20-10-2023",
"expiry_date": "20-10-2023",
"effective_date": "20-10-2023",
"pro_ver_id": 1
}
```
**RESPONSE**
```
{
,
"success": true,
"msg": null,
"data": {
"preauth_id": 3,
"provider_id": 1,
"preauth_type": 1,
"treatment_date": "2023-10-20",
"start_date": "2023-10-20",
"expiry_date": "2023-10-20",
"effective_date": "2023-10-20",
"benefit_id": 1,
"reserve": 20000,
"member_id": 5,
"transaction_date": "2024-03-22T06:57:50.628364363",
"productVersionId": 1,
"userId": 1
}
}
```
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