Patient Data Exchange API

This outlines the API to send PioneerRx patient data to vendor system for onboarding as well as updates and to receive data from vendor system to update PioneerRx patients.

Technology partners can implement web methods as described below for PioneerRx to consume.

Change Log

Version	Date	Change	Comments
2.2	02/15/2017	Created API Document for New Format
2.2	04/05/2017	Added field “mpr” to Prescription Data Definition

Communication

The api will use HTTPS Web Services to communicate between the 2 systems. Insecure http traffic will not be allowed.

We will use “application/json; charset=utf-8” for the ContentType Header.

When we receive a Http Status Code of 200, we will treat the response as successful and everything else will be treated as an error or failure.

Endpoints

PioneerRx will connect to an endpoint for each api call with each endpoint having the same base url.

Examples:
https://mydomain.com/api/CreatePatient
https://mydomain.com/api/UpdatePatient
https://mydomain.com/api/GetPatient
https://mydomain.com/api/GetUnmatchedPatients

Authentication

PioneerRx supports the following methods for authentication for this service:

username (basic auth)
password (basic auth)
ApplicationKey(header)
LocationKey(header)

Data Definitions

Insurance

Field Name	Data Type	Description
insurance_id	CHAR(36)	Guid/Uniqueidentifier
insurance_name	VARCHAR(100)
bin	VARCHAR(50)
cardholder_id	VARCHAR(50)	Policy Number
group_number	VARCHAR(50)
pcn	VARCHAR(50)
payer_type	INT	1: Cash 2: Medicaid 3: Commercial (Third Party) 4: Medicare 5: Other
coverage_type	INT	1: Medical Coverage 2: Pharmaceutical Coverage 3: Patient Assistance (Free-drug) Program

Prescriber

Field Name	Data Type	Description
prescriber_id	CHAR(36)	Guid/Uniqueidentifier
dea_number	VARCHAR(9)
npi_number	VARCHAR(50)
specialty	VARCHAR(100)
first_name	VARCHAR(50)
last_name	VARCHAR(50)
phone_number	VARCHAR(15)
fax_number	VARCHAR(15)
address_line_1	VARCHAR(200)
address_line_2	VARCHAR(200)
city	VARCHAR(40)
state	CHAR(2)
zip_code	VARCHAR(15)

Prescription

Field Name	Data Type	Description
rx_number	INT
refill_number	INT
date_written	Date	Format: yyyyMMdd
date_filled	Date	Format: yyyyMMdd
amount_paid	MONEY
number_of_refills_allowed	INT	Authorized Number of Fills
number_of_refills_remaining	INT
directions_translated	VARCHAR(MAX)
prescriber_id	CHAR(36)	Prescriber Id associated with rx Ties prescription to prescriber information from prescriber collection Guid/Uniqueidentifier
prescribed_name	VARCHAR(100)
prescribed_ndc	VARCHAR(20)
prescribed_qty	DECIMAL(15, 5)
dispensed_name	VARCHAR(100)
dispensed_ndc	VARCHAR(20)
dispensed_qty	DECIMAL(15, 5)
dispensed_acquisition_cost	MONEY
mpr	DECIMAL(18, 6)	Medication Possession Ratio
lot_number	VARCHAR(50)
icd10_code	VARCHAR(20)	Primary ICD10 code on Rx
icd10_text	VARCHAR(200)	Primary ICD10 text
lot_expiration_date	Date	Format: yyyyMMdd
primary_insurance_id	CHAR(36)	Ties prescription to primary insurance information Guid/Uniqueidentifier
secondary_insurance_id	CHAR(36)	Ties prescription to secondary insurance information Guid/Uniqueidentifier
tertiary_insurance_id	CHAR(36)	Ties prescription to tertiary insurance information Guid/Uniqueidentifier
primary_amount_paid	MONEY
secondary_amount_paid	MONEY
tertiary_amount_paid	MONEY
workflow_status_code	INT	1: Waiting for Data Entry 2: Waiting for Pre-check 3: Waiting for Fill 4: Waiting for Check 5: To Be Put in Bin 6: Waiting for Pick up 7: Waiting for Delivery 8: Waiting to Transmit 9: Reject Third Party 10: Completed 11: Out for Delivery 12: Reversed 13: Reject Secondary Third Party 14: Reject Profit 15: Reversed Secondary 16: Cancelled 17: Waiting for Print
workflow_status_text	VARCHAR(50)

Patient

Field Name	Data Type	Always Present	Description
external_patient_id	VARCHAR(36)		Patient ID in vendor system or mutual identifier assigned by vendor
pioneerrx_patient_id	CHAR(36)	Y	PioneerRx Patient ID Guid/Uniqueidentifier
legacy_id	VARCHAR(50)		Patient ID from legacy pharmacy system
pharmacy_id	VARCHAR(30)
pharmacy_id_type	INT		1: NPI, 2: NCPDP
first_name	VARCHAR(50)
middle_name	VARCHAR(30)
last_name	VARCHAR(50)	Y
gender	CHAR(1)		M,F,U U = Unknown
birth_date	Date		Format: yyyyMMdd
weight_oz	INT
height_in	INT
race	INT		0: Not Specified 1: Caucasian 2: African American 3: Hispanic 4: Asian 5: American Indian 6: Pacific Islander 7: Other 8: Animal
ssn_last_four	CHAR(4)
email	VARCHAR(255)
primary_phone	VARCHAR(15)
address_line_1	VARCHAR(200)
address_line_2	VARCHAR(200)
city	VARCHAR(40)
state	CHAR(2)
zip_code	VARCHAR(15)
diagnosis_code	VARCHAR(20)	Future Support	Diagnosis ICD10 Code
diagnosis_text	VARCHAR(500)		Diagnosis Code Text
disease_group	INT
allergies	VARCHAR(MAX)		Concatenated list of allergies
primary_prescriber_id	CHAR(36)		Ties patient to primary prescriber information from prescriber collection Guid/Uniqueidentifier
profile_url	VARCHAR(500)		URL to link to patient’s profile in vendor system
created_on	VARCHAR(50)		Date patient is created in vnedor system Format: yyyy-mm-ddThh:mi:ss.mmmZ Example: 2016-03-15T14:27:01.093Z
status	INT		Active status in vendor system 0: Disabled 1: Enabled
status_changed_date	Date		Date patient’s status was changed in vendor system Format: yyyyMMdd
insurances	Insurance Array		Array of Insurance Objects
prescribers	Prescriber Array		Array of Prescriber Objects
prescriptions	Prescription Array		Array of Prescription Objects

CreatePatient Request

Field Name	Data Type	Always Present	Description
N/A	Patient	Y	Serialization of Patient object

UpdatePatient Request

Field Name	Data Type	Always Present	Description
N/A	Patient	Y	Serialization of Patient object

GetPatient Request

Field Name	Data Type	Always Present	Description
pharmacy_id	VARCHAR(30)
pharmacy_id_type	INT		1: NPI, 2: NCPDP
external_patient_id	VARCHAR(36)		Patient ID in vendor system or mutual identifier assigned by vendor
pioneerrx_patient_id	CHAR(36)	Y	PioneerRx Patient ID Guid/Uniqueidentifier

GetUnmatchedPatients Request

Field Name	Data Type	Always Present	Description
pharmacy_id	VARCHAR(30)
pharmacy_id_type	INT		1: NPI, 2: NCPDP

Response

Field Name	Data Type	Required	Description
success	INT	Y	0: api action not successful 1: api action successful
error_message	VARCHAR(MAX)	When success = 0	displayed to user
debug_message	VARCHAR(MAX)	When success = 0	logged message (provide any identifying info if possible)
error_code	VARCHAR(MAX)		01: Username/Password is incorrect 02: Patient does not exist in vendor system
results	Patient/Patient Array	When success = 1	Data Type will be a Patient list for GetUnmatchedPatients and a Patient for other API calls

Patient Profile URL

We recommend returning an endpoint for patient profile in vendor system (See Patient data field profile_url).

Example:
https://www.mydomain.com/api/ViewProfile?pharmacy_id=1174570840&pharmacy_id_type=1&external_patient_id=TestID

We have an extension to this api for token based single sign on for viewing the profile_url. Please visit http://www.pioneerrx.com/apidoc/PatientDataExchangeProfileSSO for this api document.

API Actions

CreatePatient

Add a patient to vendor system

Example Request

CreatePatient Request

{
    "external_patient_id": "TestID",
    "pioneerrx_patient_id": "AA42980E-C383-43DD-9DCC-869AEFCA1625",
    "legacy_id": "1122",
    "pharmacy_id": "1174570840",
    "pharmacy_id_type": 1,
    "first_name": "John",
    "last_name": "Doe",
    "gender": "M",
    "birth_date": "19800101",
    "primary_phone": "5551112222",
    "address_line_1": "123 Main St.",
    "city": "Shreveport",
    "state": "LA",
    "zip_code": "71115",
    "primary_prescriber_id": "A4DDA117-83ED-4D70-A814-001ED72B8EAB",
    "insurances": [{
        "insurance_id": "35EB92F6-0C5B-48C6-BF02-8D40781ADAAE",
        "insurance_name": "BC/BS Federal Employees",
        "bin": "610239",
        "cardholder_id": "R50622932",
        "group_number": "65006500",
        "pcn": "FEPRX",
        "payer_type": 3,
        "coverage_type": 1
    },
    {
        "insurance_id": "EDD23D35-416A-49CA-8EB0-2BC60F60B9DC",
        "insurance_name": "Cigna",
        "bin": "017010",
        "cardholder_id": "10198667103",
        "group_number": "00608630",
        "payer_type": 3,
        "coverage_type": 1
    },
    {
        "insurance_id": "2FB77D82-1664-42B9-A2A1-E5F7202B2978",
        "insurance_name": "North Carolina Medicaid",
        "bin": "610242",
        "cardholder_id": "938801283N",
        "group_number": "MAAQ",
        "payer_type": 2,
        "coverage_type": 1
    }],
    "prescribers": [{
        "prescriber_id": "A4DDA117-83ED-4D70-A814-001ED72B8EAB",
        "dea_number": "AD2123824",
        "npi_number": "1611123525",
        "specialty": "Physician Assistant",
        "first_name": "James",
        "last_name": "Bond",
        "phone_number": "3184445555",
        "fax_number": "3185556666",
        "address_line_1": "12 abc St. ",
        "city": "Shreveport",
        "state": "LA",
        "zip_code": "71115"
    },
    {
        "prescriber_id": "57BB2EAB-2662-44FE-B2CC-00911535B843",
        "dea_number": "MM1219319",
        "npi_number": "1601843708",
        "specialty": "Family Medicine",
        "first_name": "Jane",
        "last_name": "Bond",
        "phone_number": "3187775555",
        "fax_number": "3189993333",
        "address_line_1": "34 def St. ",
        "city": "Shreveport",
        "state": "LA",
        "zip_code": "71115"
    }],
    "prescriptions": [{
        "rx_number": 7324683,
        "refill_number": 0,
        "date_written": "20100405",
        "date_filled": "20100405",
        "amount_paid": 2.8000,
        "number_of_refills_allowed": 2,
        "number_of_refills_remaining": 2,
        "directions_translated": "TAKE ONE CAPSULE BY MOUTH TWO TIMES EACH DAY.",
        "prescriber_id": " A4DDA117-83ED-4D70-A814-001ED72B8EAB ",
        "prescribed_name": "Neurontin 300mg Capsule",
        "prescribed_ndc": "00071080524",
        "prescribed_qty": 10.00000,
        "dispensed_name": "Gabapentin 300 Mg Capsule",
        "dispensed_ndc": "59762502701",
        "dispensed_qty": 10.00000,
        "icd10_code": "G40",
        "icd10_text": "Epilepsy and recurrent seizures",
        "dispensed_acquisition_cost": 139.5973,
        "primary_insurance_id": "35EB92F6-0C5B-48C6-BF02-8D40781ADAAE",
        "secondary_insurance_id": "EDD23D35-416A-49CA-8EB0-2BC60F60B9DC",
        "tertiary_insurance_id": "2FB77D82-1664-42B9-A2A1-E5F7202B2978",
        "primary_amount_paid": 5.0000,
        "secondary_amount_paid": 5.0000,
        "tertiary_amount_paid": 3.0000,
        "workflow_status_code": 6,
        "workflow_status_text": "Waiting for Pick up"
    },
    {
        "rx_number": 7012283,
        "refill_number": 1,
        "date_written": "20120605",
        "date_filled": "20120821",
        "amount_paid": 30.00,
        "number_of_refills_allowed": 1,
        "number_of_refills_remaining": 0,
        "directions_translated": "TAKE ONE TABLET EVERY DAY",
        "prescriber_id": "57BB2EAB-2662-44FE-B2CC-00911535B843",
        "prescribed_name": "Restasis 0.05% Eye Emulsion",
        "prescribed_ndc": "00023916330",
        "prescribed_qty": 60.00000,
        "dispensed_name": "Restasis 0.05% Eye Emulsion",
        "dispensed_ndc": "00023916330",
        "dispensed_qty": 60.00000,
        "dispensed_acquisition_cost": 139.5973,
        "primary_insurance_id": "35EB92F6-0C5B-48C6-BF02-8D40781ADAAE",
        "secondary_insurance_id": "EDD23D35-416A-49CA-8EB0-2BC60F60B9DC",
        "tertiary_insurance_id": "2FB77D82-1664-42B9-A2A1-E5F7202B2978",
        "primary_amount_paid": 100.0000,
        "workflow_status_code": 10,
        "workflow_status_text": "Completed"
    }]
}

Refer to JSON request on the right

Example Responses

CreatePatient Response 1

{
    "success": 1,
    "debug_message": "SUCCESS: Patient created successfully in vendor system.",
    "results": {
        "external_patient_id": "TestID",
        "pioneerrx_patient_id": "AA42980E-C383-43DD-9DCC-869AEFCA1625"
    }
}

CreatePatient Response 2

{
    "success": 0,
    "debug_message": "pioneerrx_patient_id 'AA42980E-C383-43DD-9DCC-869AEFCA1625' already exists in vendor system.",
    "error_message": "Patient already exists in vendor system."
}

CreatePatient Response 3

{
    "success": 0,
    "debug_message": "Invalid credentials were provided.",
    "error_message": "Username/Password is incorrect.",
    "error_code": "01"
}

Refer to JSON responses on the right

UpdatePatient

Updates existing patient in vendor system

Example Request

UpdatePatient Request

{
    "external_patient_id": "TestID",
    "pioneerrx_patient_id": "AA42980E-C383-43DD-9DCC-869AEFCA1625",
    "legacy_id": "1122",
    "pharmacy_id": "1174570840",
    "pharmacy_id_type": 1,
    "first_name": "John",
    "last_name": "Doe",
    "gender": "M",
    "birth_date": "19800101",
    "primary_phone": "5551112222",
    "address_line_1": "123 Main St.",
    "city": "Shreveport",
    "state": "LA",
    "zip_code": "71115",
    "primary_prescriber_id": "A4DDA117-83ED-4D70-A814-001ED72B8EAB",
    "insurances": [{
        "insurance_id": "35EB92F6-0C5B-48C6-BF02-8D40781ADAAE",
        "insurance_name": "BC/BS Federal Employees",
        "bin": "610239",
        "cardholder_id": "R50622932",
        "group_number": "65006500",
        "pcn": "FEPRX",
        "payer_type": 3,
        "coverage_type": 1
    },
    {
        "insurance_id": "EDD23D35-416A-49CA-8EB0-2BC60F60B9DC",
        "insurance_name": "Cigna",
        "bin": "017010",
        "cardholder_id": "10198667103",
        "group_number": "00608630",
        "payer_type": 3,
        "coverage_type": 1
    },
    {
        "insurance_id": "2FB77D82-1664-42B9-A2A1-E5F7202B2978",
        "insurance_name": "North Carolina Medicaid",
        "bin": "610242",
        "cardholder_id": "938801283N",
        "group_number": "MAAQ",
        "payer_type": 2,
        "coverage_type": 1
    }],
    "prescribers": [{
        "prescriber_id": "A4DDA117-83ED-4D70-A814-001ED72B8EAB",
        "dea_number": "AD2123824",
        "npi_number": "1611123525",
        "specialty": "Physician Assistant",
        "first_name": "James",
        "last_name": "Bond",
        "phone_number": "3184445555",
        "fax_number": "3185556666",
        "address_line_1": "12 abc St. ",
        "city": "Shreveport",
        "state": "LA",
        "zip_code": "71115"
    },
    {
        "prescriber_id": "57BB2EAB-2662-44FE-B2CC-00911535B843",
        "dea_number": "MM1219319",
        "npi_number": "1601843708",
        "specialty": "Family Medicine",
        "first_name": "Jane",
        "last_name": "Bond",
        "phone_number": "3187775555",
        "fax_number": "3189993333",
        "address_line_1": "34 def St. ",
        "city": "Shreveport",
        "state": "LA",
        "zip_code": "71115"
    }],
    "prescriptions": [{
        "rx_number": 7324683,
        "refill_number": 0,
        "date_written": "20100405",
        "date_filled": "20100405",
        "amount_paid": 120.00,
        "number_of_refills_allowed": 2,
        "number_of_refills_remaining": 2,
        "directions_translated": "TAKE ONE CAPSULE BY MOUTH TWO TIMES EACH DAY.",
        "prescriber_id": " A4DDA117-83ED-4D70-A814-001ED72B8EAB ",
        "prescribed_name": "Neurontin 300mg Capsule",
        "prescribed_ndc": "00071080524",
        "prescribed_qty": 10.00000,
        "dispensed_name": "Gabapentin 300 Mg Capsule",
        "dispensed_ndc": "59762502701",
        "dispensed_qty": 10.00000,
        "icd10_code": "G40",
        "icd10_text": "Epilepsy and recurrent seizures",
        "dispensed_acquisition_cost": 139.5973,
        "primary_insurance_id": "35EB92F6-0C5B-48C6-BF02-8D40781ADAAE",
        "secondary_insurance_id": "EDD23D35-416A-49CA-8EB0-2BC60F60B9DC",
        "tertiary_insurance_id": "2FB77D82-1664-42B9-A2A1-E5F7202B2978",
        "primary_amount_paid": 5.0000,
        "secondary_amount_paid": 5.0000,
        "tertiary_amount_paid": 3.0000,
        "workflow_status_code": 6,
        "workflow_status_text": "Waiting for Pick up"
    },
    {
        "rx_number": 7012283,
        "refill_number": 1,
        "date_written": "20120605",
        "date_filled": "20120821",
        "amount_paid": 30.00,
        "number_of_refills_allowed": 1,
        "number_of_refills_remaining": 0,
        "directions_translated": "TAKE ONE TABLET EVERY DAY",
        "prescriber_id": "57BB2EAB-2662-44FE-B2CC-00911535B843",
        "prescribed_name": "Restasis 0.05% Eye Emulsion",
        "prescribed_ndc": "00023916330",
        "prescribed_qty": 60.00000,
        "dispensed_name": "Restasis 0.05% Eye Emulsion",
        "dispensed_ndc": "00023916330",
        "dispensed_qty": 60.00000,
        "dispensed_acquisition_cost": 139.5973,
        "primary_insurance_id": "35EB92F6-0C5B-48C6-BF02-8D40781ADAAE",
        "secondary_insurance_id": "EDD23D35-416A-49CA-8EB0-2BC60F60B9DC",
        "tertiary_insurance_id": "2FB77D82-1664-42B9-A2A1-E5F7202B2978",
        "primary_amount_paid": 100.0000,
        "workflow_status_code": 10,
        "workflow_status_text": "Completed"
    }]
}

Refer to JSON request on the right

Example Response

UpdatePatient Response

{
    "success": 1,
    "debug_message": "SUCCESS: Patient updated successfully in vendor system.",
    "results": {
        "external_patient_id": "TestID",
        "pioneerrx_patient_id": "AA42980E-C383-43DD-9DCC-869AEFCA1625"
    }
}

Refer to JSON response on the right

GetPatient

Retrieve patient from vendor system

Example Requests

GetPatient Request 1

{
    "pharmacy_id": "1174570840",
    "pharmacy_id_type": 1,
    "external_patient_id": "TestID"
}

GetPatient Request 2

{
    "pharmacy_id": "1174570840",
    "pharmacy_id_type": 1,
    "pioneerrx_patient_id": "AA42980E-C383-43DD-9DCC-869AEFCA1625"
}

Refer to JSON requests on the right

Example Responses

GetPatient Response 1

{
    "success": 1,
    "debug_message": "SUCCESS: Patient retrieved successfully from vendor system.",
    "results": {
        "external_patient_id": "TestID",
        "legacy_id": "1122",
        "pioneerrx_patient_id": "AA42980E-C383-43DD-9DCC-869AEFCA1625",
        "pharmacy_id": "1174570840",
        "pharmacy_id_type": 1,
        "first_name": "John",
        "last_name": "Doe",
        "gender": "M",
        "birth_date": "19800101",
        "primary_phone": "5551112222",
        "address_line_1": "123 Main St.",
        "city": "Shreveport",
        "state": "LA",
        "zip_code": "71115",
        "primary_prescriber_id": "A4DDA117-83ED-4D70-A814-001ED72B8EAB",
        "insurances": [{
            "insurance_id": "35EB92F6-0C5B-48C6-BF02-8D40781ADAAE",
            "insurance_name": "BC/BS Federal Employees",
            "bin": "610239",
            "cardholder_id": "R50622932",
            "group_number": "65006500",
            "pcn": "FEPRX",
            "payer_type": 3,
            "coverage_type": 1
        },
        {
            "insurance_id": "EDD23D35-416A-49CA-8EB0-2BC60F60B9DC",
            "insurance_name": "Cigna",
            "bin": "017010",
            "cardholder_id": "10198667103",
            "group_number": "00608630",
            "payer_type": 3,
            "coverage_type": 1
        },
        {
            "insurance_id": "2FB77D82-1664-42B9-A2A1-E5F7202B2978",
            "insurance_name": "North Carolina Medicaid",
            "bin": "610242",
            "cardholder_id": "938801283N",
            "group_number": "MAAQ",
            "payer_type": 2,
            "coverage_type": 1
        }],
        "prescribers": [{
            "prescriber_id": "A4DDA117-83ED-4D70-A814-001ED72B8EAB",
            "dea_number": "AD2123824",
            "npi_number": "1611123525",
            "specialty": "Physician Assistant",
            "first_name": "James",
            "last_name": "Bond",
            "phone_number": "3184445555",
            "fax_number": "3185556666",
            "address_line_1": "12 abc St. ",
            "city": "Shreveport",
            "state": "LA",
            "zip_code": "71115"
        },
        {
            "prescriber_id": "57BB2EAB-2662-44FE-B2CC-00911535B843",
            "dea_number": "MM1219319",
            "npi_number": "1601843708",
            "specialty": "Family Medicine",
            "first_name": "Jane",
            "last_name": "Bond",
            "phone_number": "3187775555",
            "fax_number": "3189993333",
            "address_line_1": "34 def St. ",
            "city": "Shreveport",
            "state": "LA",
            "zip_code": "71115"
        }],
        "prescriptions": [{
            "rx_number": 7324683,
            "refill_number": 0,
            "date_written": "20100405",
            "date_filled": "20100405",
            "amount_paid": 120.00,
            "number_of_refills_allowed": 2,
            "number_of_refills_remaining": 2,
            "directions_translated": "TAKE ONE CAPSULE BY MOUTH TWO TIMES EACH DAY.",
            "prescriber_id": "A4DDA117-83ED-4D70-A814-001ED72B8EAB",
            "prescribed_name": "Neurontin 300mg Capsule",
            "prescribed_ndc": "00071080524",
            "prescribed_qty": 10.00000,
            "dispensed_name": "Gabapentin 300 Mg Capsule",
            "dispensed_ndc": "59762502701",
            "dispensed_qty": 10.00000,
            "icd10_code": "G40",
            "icd10_text": "Epilepsy and recurrent seizures",
            "dispensed_acquisition_cost": 139.5973,
            "primary_insurance_id": "35EB92F6-0C5B-48C6-BF02-8D40781ADAAE",
            "secondary_insurance_id": "EDD23D35-416A-49CA-8EB0-2BC60F60B9DC",
            "tertiary_insurance_id": "2FB77D82-1664-42B9-A2A1-E5F7202B2978",
            "primary_amount_paid": 5.0000,
            "secondary_amount_paid": 5.0000,
            "tertiary_amount_paid": 3.0000,
            "workflow_status_code": 6,
            "workflow_status_text": "Waiting for Pick up"
        },
        {
            "rx_number": 7012283,
            "refill_number": 1,
            "date_written": "20120605",
            "date_filled": "20120821",
            "amount_paid": 30.00,
            "number_of_refills_allowed": 1,
            "number_of_refills_remaining": 0,
            "directions_translated": "TAKE ONE TABLET EVERY DAY",
            "prescriber_id": "57BB2EAB-2662-44FE-B2CC-00911535B843",
            "prescribed_name": "Restasis 0.05% Eye Emulsion",
            "prescribed_ndc": "00023916330",
            "prescribed_qty": 60.00000,
            "dispensed_name": "Restasis 0.05% Eye Emulsion",
            "dispensed_ndc": "00023916330",
            "dispensed_qty": 60.00000,
            "dispensed_acquisition_cost": 139.5973,
            "primary_insurance_id": "35EB92F6-0C5B-48C6-BF02-8D40781ADAAE",
            "secondary_insurance_id": "EDD23D35-416A-49CA-8EB0-2BC60F60B9DC",
            "tertiary_insurance_id": "2FB77D82-1664-42B9-A2A1-E5F7202B2978",
            "primary_amount_paid": 100.0000,
            "workflow_status_code": 10,
            "workflow_status_text": "Completed"
        }]
    }
}

GetPatient Response 2

{
    "success": 0,
    "debug_message": "pioneerrx_patient_id 'AA42980E-C383-43DD-9DCC-869AEFCA1625' does not exist in vendor system.",
    "error_message": "Patient does not exist in vendor system.",
    "error_code": "02"
}

Refer to JSON responses on the right

GetUnmatchedPatients

Gets list of unmatched patients (patients without a value for pioneerrx_patient_id) in vendor system for pharmacy

If no pharmacy ID provided, assumption is that all unmatched patients associated with PioneerRx pharmacies will be returned. PioneerRx will route data accordingly.

Patients matched within PioneerRx will be updated in vendor system with an UpdatePatient call, providing the external_patient_id and pioneerrx_patient_id.

Patients that cannot be matched will be placed into a queue for the pharmacy to handle manually.

The following criteria will be used for matching:

Date of Birth
Last Name
First Name Initial
SSN Last Four or First 3 Characters of Address

Example Request

GetUnmatchedPatients Request

{
    "pharmacy_id": "1174570840",
    "pharmacy_id_type": 1
}

Refer to JSON request on the right

Example Responses

GetUnmatchedPatients Response 1

{
    "success": 1,
    "debug_message": "SUCCESS: Unmatched Patients retrieved successfully from vendor system.",
    "results": []
}

GetUnmatchedPatients Response 2

{
    "success": 1,
    "debug_message": "SUCCESS: Unmatched Patients retrieved successfully from vendor system.",
    "results": [{
        "external_patient_id": "TestID2",
        "legacy_id": "1234",
        "pharmacy_id": "1174570840",
        "pharmacy_id_type": 1,
        "first_name": "Jane",
        "last_name": "Doe",
        "gender": "F",
        "birth_date": "19810101",
        "primary_phone": "5552223333",
        "address_line_1": "123 Main St.",
        "city": "Shreveport",
        "state": "LA",
        "zip_code": "71115",
        "primary_prescriber_id": "A4DDA117-83ED-4D70-A814-001ED72B8EAB",
        "insurances": [{
            "insurance_id": "35EB92F6-0C5B-48C6-BF02-8D40781ADAAE",
            "insurance_name": "BC/BS Federal Employees",
            "bin": "610239",
            "cardholder_id": "R50622932",
            "group_number": "65006500",
            "pcn": "FEPRX",
            "payer_type": 3,
            "coverage_type": 1
        },
        {
            "insurance_id": "EDD23D35-416A-49CA-8EB0-2BC60F60B9DC",
            "insurance_name": "Cigna",
            "bin": "017010",
            "cardholder_id": "10198667103",
            "group_number": "00608630",
            "payer_type": 3,
            "coverage_type": 1
        },
        {
            "insurance_id": "2FB77D82-1664-42B9-A2A1-E5F7202B2978",
            "insurance_name": "North Carolina Medicaid",
            "bin": "610242",
            "cardholder_id": "938801283N",
            "group_number": "MAAQ",
            "payer_type": 2,
            "coverage_type": 1
        }],
        "prescribers": [{
            "prescriber_id": "A4DDA117-83ED-4D70-A814-001ED72B8EAB",
            "dea_number": "AD2123824",
            "npi_number": "1611123525",
            "specialty": "Physician Assistant",
            "first_name": "James",
            "last_name": "Bond",
            "phone_number": "3184445555",
            "fax_number": "3185556666",
            "address_line_1": "12 abc St. ",
            "city": "Shreveport",
            "state": "LA",
            "zip_code": "71115"
        },
        {
            "prescriber_id": "57BB2EAB-2662-44FE-B2CC-00911535B843",
            "dea_number": "MM1219319",
            "npi_number": "1601843708",
            "specialty": "Family Medicine",
            "first_name": "Jane",
            "last_name": "Bond",
            "phone_number": "3187775555",
            "fax_number": "3189993333",
            "address_line_1": "34 def St. ",
            "city": "Shreveport",
            "state": "LA",
            "zip_code": "71115"
        }],
        "prescriptions": [{
            "rx_number": 7324683,
            "refill_number": 0,
            "date_written": "20100405",
            "date_filled": "20100405",
            "amount_paid": 120.00,
            "number_of_refills_allowed": 2,
            "number_of_refills_remaining": 2,
            "directions_translated": "TAKE ONE CAPSULE BY MOUTH TWO TIMES EACH DAY.",
            "prescriber_id": "A4DDA117-83ED-4D70-A814-001ED72B8EAB",
            "prescribed_name": "Neurontin 300mg Capsule",
            "prescribed_ndc": "00071080524",
            "prescribed_qty": 10.00000,
            "dispensed_name": "Gabapentin 300 Mg Capsule",
            "dispensed_ndc": "59762502701",
            "dispensed_qty": 10.00000,
            "icd10_code": "G40",
            "icd10_text": "Epilepsy and recurrent seizures",
            "dispensed_acquisition_cost": 139.5973,
            "primary_insurance_id": "35EB92F6-0C5B-48C6-BF02-8D40781ADAAE",
            "secondary_insurance_id": "EDD23D35-416A-49CA-8EB0-2BC60F60B9DC",
            "tertiary_insurance_id": "2FB77D82-1664-42B9-A2A1-E5F7202B2978"
        },
        {
            "rx_number": 7012283,
            "refill_number": 1,
            "date_written": "20120605",
            "date_filled": "20120821",
            "amount_paid": 30.00,
            "number_of_refills_allowed": 1,
            "number_of_refills_remaining": 0,
            "directions_translated": "TAKE ONE TABLET EVERY DAY",
            "prescriber_id": "57BB2EAB-2662-44FE-B2CC-00911535B843",
            "prescribed_name": "Restasis 0.05% Eye Emulsion",
            "prescribed_ndc": "00023916330",
            "prescribed_qty": 60.00000,
            "dispensed_name": "Restasis 0.05% Eye Emulsion",
            "dispensed_ndc": "00023916330",
            "dispensed_qty": 60.00000,
            "dispensed_acquisition_cost": 139.5973,
            "primary_insurance_id": "35EB92F6-0C5B-48C6-BF02-8D40781ADAAE",
            "secondary_insurance_id": "EDD23D35-416A-49CA-8EB0-2BC60F60B9DC",
            "tertiary_insurance_id": "2FB77D82-1664-42B9-A2A1-E5F7202B2978"
        }]
    },
    {
        "external_patient_id": "TestID3",
        "legacy_id": "5678",
        "pharmacy_id": "1174570840",
        "pharmacy_id_type": 1,
        "first_name": "Jacob",
        "last_name": "Doe",
        "gender": "M",
        "birth_date": "19990101",
        "primary_phone": "5552223333",
        "address_line_1": "123 Main St.",
        "city": "Shreveport",
        "state": "LA",
        "zip": "71115",
        "primary_prescriber_id": "94160EA3-4A14-4899-A9BF-00CB8900135D",
        "Insurances": [{
            "insurance_id": "2FB77D82-1664-42B9-A2A1-E5F7202B2978",
            "insurance_name": "North Carolina Medicaid",
            "bin": "610242",
            "cardholder_id": "947801283N",
            "payer_type": 2,
            "coverage_type": 1
        },
        {
            "insurance_id": "EDD23D35-416A-49CA-8EB0-2BC60F60B9DC",
            "insurance_name": "Cigna",
            "bin": "017010",
            "cardholder_id": "10198667103",
            "group_number": "00608630",
            "payer_type": 3
        }],
        "prescribers": [{
            "prescriber_id": "94160EA3-4A14-4899-A9BF-00CB8900135D",
            "dea_number": "AL6853196",
            "npi_number": "1752317322",
            "specialty": "Internal Medicine",
            "first_name": "Gary",
            "last_name": "Larsen",
            "phone_number": "3181237890",
            "fax_number": "3185559876",
            "address_line_1": "56 hij St. ",
            "city": "Shreveport",
            "state": "LA",
            "zip_code": "71115"
        },
        {
            "prescriber_id": "8C7C3834-7029-4EDA-9580-00DCE7CFB869",
            "dea_number": "MH0579370",
            "npi_number": "1556427442",
            "specialty": "Urology",
            "first_name": "William",
            "last_name": "Jones",
            "phone_number": "3184563210",
            "fax_number": "3184446543",
            "address_line_1": "78 klm St. ",
            "city": "Shreveport",
            "state": "LA",
            "zip_code": "71115"
        }],
        "prescriptions": [{
            "rx_number": 7240341,
            "refill_number": 0,
            "date_written": "20120405",
            "date_filled": "20120405",
            "amount_paid": 200.00,
            "number_of_refills_allowed": 2,
            "number_of_refills_remaining": 2,
            "directions_translated": "TAKE ONE CAPSULE BY MOUTH TWO TIMES EACH DAY.",
            "prescriber_id": "94160EA3-4A14-4899-A9BF-00CB8900135D",
            "prescribed_name": "Simvastatin 10 Mg Tablet",
            "prescribed_ndc": "55111019890",
            "prescribed_qty": 10.00000,
            "dispensed_name": "Simvastatin 10 Mg Tablet",
            "dispensed_ndc": "55111019890",
            "dispensed_qty": 10.00000,
            "dispensed_acquisition_cost": 139.5973,
            "primary_insurance_id": "2FB77D82-1664-42B9-A2A1-E5F7202B2978",
            "secondary_insurance_id": "EDD23D35-416A-49CA-8EB0-2BC60F60B9DC"
        },
        {
            "rx_number": 7332666,
            "refill_number": 1,
            "date_written": "20120605",
            "date_filled": "20120821",
            "amount_paid": 50.00,
            "number_of_refills_allowed": 1,
            "number_of_refills_remaining": 0,
            "directions_translated": "TAKE ONE TABLET EVERY DAY",
            "prescriber_id": "8C7C3834-7029-4EDA-9580-00DCE7CFB869",
            "prescribed_name": "Aripiprazole Tab 2 Mg 30 Teva",
            "prescribed_ndc": "00093761356",
            "prescribed_qty": 60.00000,
            "dispensed_name": "Aripiprazole Tab 2 Mg 30 Teva",
            "dispensed_ndc": "00093761356",
            "dispensed_qty": 60.00000,
            "dispensed_acquisition_cost": 139.5973,
            "primary_insurance_id": "2FB77D82-1664-42B9-A2A1-E5F7202B2978",
            "secondary_insurance_id": "EDD23D35-416A-49CA-8EB0-2BC60F60B9DC"
        }]
    }]
}

Refer to JSON responses on the right

Browser Support

If a profile_url is returned from GetPatient or GetUnmatchedPatients, the user has the ability to view the returned url. PioneerRx will either open the profile_url inside a popup window of the PioneerRx application, or open using the default browser of the workstation. PioneerRx may change between these based on the interactions made by the user and both should be assumed can occur at a pharmacy.

Due to technical requirements of the .net framework, Internet Explorer is used when PioneerRx opens the URL as a popup within the application. In addition, most pharmacies do not alter their workstation’s default browser, and being Windows based, the default is most commonly Internet Explorer. PioneerRx’s currently requires Internet Explorer 8 or higher. We do not support lower versions of IE.

If your product cannot support current versions of alternative browsers (such as Edge, Chrome, Firefox, Opera, etc), please notify PioneerRx Development during your onboarding so that we can discuss options for forcing Internet Explorer.

PioneerRx Contact Information

For all technical and business questions, concerns, or issues, please email PioneerRxDataPrograms@PioneerRx.com.

This email is monitored by our data integration team and someone will be in contact once reviewed. If a call is needed, please email us your topics and questions and we will setup a call with the appropriate individuals.

This is not meant to be given to users (ie, pharmacies). The most appropriate solution for them, if to use the PioneerRx Support Request features we have to ask for assistance.

If not contacted in the appropriate ways, persons may have to wait longer than necessary as requests then have to be internally re-routed at PioneerRx.

Questions To Answer for Integration

The following is a recap of the questions PioneerRx will need to have each Vendor answer for the integration to make sure they are configured correctly:

What is the base POST URL that PioneerRx will call for the api actions (we will append the api action to this base url)? e.g. https://www.mydomain.com/api
What authentication method(s) will we be utilizing? e.g. Basic Auth Only, ApplicationKey Only, LocationKey Only, or a combination of these 3 options
If issues occur in vendor system, who should users contact for assistance (name, email, phone, etc)? e.g. Vendor Support, support@vendor.com, 1-555-555-1234
Who is the technical contact for the integration with PioneerRx at the Vendor (name, email, phone, etc)? i.e. this is the person(s) that PioneerRx technical team can reach for future issues, this will not be shared with users.