{ "$schema": "http://json-schema.org/draft-07/schema", "$id": "http://example.com/example.json", "type": "object", "title": "SB418Q json schema - version 1.0", "description": "This is version 1.0 of the SB418Q json schema for the data file upload. It describes the structure of the data, required values, value data types, and validations", "default": {}, "examples": [ { "companyNAIC": 458, "year": 2021, "quarter": 1, "tpaLicenseNbr": "864868", "confidentialInformation": false, "contactName": "John Doe", "contactTitle": "Admin", "phoneNbr": "6876868686", "phoneExt": "123", "email": "jd@madisonins.com", "emailReleaseOk": true, "niClaimsReceived": 1000, "niMedicalCleanReceived": 400, "niPharmaCleanReceived": 360, "niMedicalPaidTimely": 280, "niPharmaPaidTimely": 100, "niMedicalPaidLate_1_45": 30, "niPharmaPaidLate_1_45": 60, "niAmtPaidLate_1_45": 2516.30, "niPenaltyPaid_1_45": 3000.50, "niClaimsPaidLate_1_45": [ { "uniqueIdentifier": "56377", "amountPaidLate": 2366.30, "penaltyAmount": 1000.50 }, { "uniqueIdentifier": "83699", "amountPaidLate": 150.00, "penaltyAmount": 2000.00 } ], "niMedicalPaidLate_46_90": 60, "niPharmaPaidLate_46_90": 40, "niAmtPaidLate_46_90": 7098.90, "niPenaltyPaid_46_90": 4067.95, "niClaimsPaidLate_46_90": [ { "uniqueIdentifier": "563771", "amountPaidLate": 2366.30, "penaltyAmount": 67.50 }, { "uniqueIdentifier": "12346753", "amountPaidLate": 2366.30, "penaltyAmount": 2000.45 }, { "uniqueIdentifier": "1234432", "amountPaidLate": 2366.30, "penaltyAmount": 2000.00 } ], "niMedicalPaidLate_91Plus": 6, "niPharmaPaidLate_91Plus": 7, "niAmtPaidLate_91Plus": 4732.60, "niPenaltyPaid_91Plus": 89.00, "niPenaltyInterestTDI_91Plus": 95.40, "niClaimsPaidLate_91_Plus": [ { "uniqueIdentifier": "084467", "amountPaidLate": 2366.30, "penaltyAmount": 79.50, "penaltyInterestTDI": 87.20 }, { "uniqueIdentifier": "3828", "amountPaidLate": 2366.30, "penaltyAmount": 9.50, "penaltyInterestTDI": 8.20 } ], "iReceived": 800, "iCleanReceived": 500, "iPaidTimely": 67, "iPaidLate_1_45": 45, "iAmtPaid_1_45": 7098.90, "iPenaltyPaid_1_45": 1790.10, "iPenaltyPaidTDI_1_45": 1790.10, "iClaimsPaidLate_1_45": [ { "uniqueIdentifier": "375", "amountPaidLate": 2366.30, "penaltyAmount": 1000.50, "penaltyAmountTDI": 1000.50 }, { "uniqueIdentifier": "27501", "amountPaidLate": 2366.30, "penaltyAmount": 500.10, "penaltyAmountTDI": 500.10 }, { "uniqueIdentifier": "83659", "amountPaidLate": 2366.30, "penaltyAmount": 289.50, "penaltyAmountTDI": 289.50 } ], "iPaidLate_46_90": 57, "iAmtPaid_46_90": 2366.30, "iPenaltyPaid_46_90": 1000.50, "iPenaltyPaidTDI_46_90": 1000.50, "iClaimsPaidLate_46_90": [ { "uniqueIdentifier": "35", "amountPaidLate": 2366.30, "penaltyAmount": 1000.50, "penaltyAmountTDI": 1000.50 } ], "iPaidLate_91Plus": 9, "iAmtPaid_91Plus": 9329.25, "iPenaltyPaid_91Plus": 79.50, "iPenaltyPaidTDI_91Plus": 79.50, "iClaimsPaidLate_91_Plus": [ { "uniqueIdentifier": "08564467", "amountPaidLate": 2366.30, "penaltyAmount": 79.50, "penaltyAmountTDI": 79.50 } ], "auditedClaimsPaid": 9, "verificationRequests": 6, "verificationsIssued": 7, "declinations": 3, "certificationOfCatastrophes": 2, "commentCatastrophes": "01-25-2021 - Flooding, 02-05-2021 - Covid-19", "businessInterruptedDays": 3, "noOfComplaints": 6, "comments": "test sample sb418q" } ], "required": [ "companyNAIC", "year", "quarter", "confidentialInformation", "contactName", "contactTitle", "phoneNbr", "email", "emailReleaseOk", "niClaimsReceived", "niMedicalCleanReceived", "niPharmaCleanReceived", "niMedicalPaidTimely", "niPharmaPaidTimely", "niMedicalPaidLate_1_45", "niPharmaPaidLate_1_45", "niAmtPaidLate_1_45", "niPenaltyPaid_1_45", "niClaimsPaidLate_1_45", "niMedicalPaidLate_46_90", "niPharmaPaidLate_46_90", "niAmtPaidLate_46_90", "niPenaltyPaid_46_90", "niClaimsPaidLate_46_90", "niMedicalPaidLate_91Plus", "niPharmaPaidLate_91Plus", "niAmtPaidLate_91Plus", "niPenaltyPaid_91Plus", "niPenaltyInterestTDI_91Plus", "niClaimsPaidLate_91_Plus", "iReceived", "iCleanReceived", "iPaidTimely", "iPaidLate_1_45", "iAmtPaid_1_45", "iPenaltyPaid_1_45", "iPenaltyPaidTDI_1_45", "iClaimsPaidLate_1_45", "iPaidLate_46_90", "iAmtPaid_46_90", "iPenaltyPaid_46_90", "iPenaltyPaidTDI_46_90", "iClaimsPaidLate_46_90", "iPaidLate_91Plus", "iAmtPaid_91Plus", "iPenaltyPaid_91Plus", "iPenaltyPaidTDI_91Plus", "iClaimsPaidLate_91_Plus", "auditedClaimsPaid", "verificationRequests", "verificationsIssued", "declinations", "certificationOfCatastrophes", "businessInterruptedDays", "noOfComplaints" ], "properties": { "companyNAIC": { "$id": "#/properties/companyNAIC", "type": "integer", "title": "Company NAIC", "description": "Company NAIC for the reported data", "default": 0, "maximum": 999999, "examples": [45813] }, "year": { "$id": "#/properties/year", "type": "integer", "title": "Year", "description": "Year for the reported data", "default": 0, "minimum": 2014, "maximum": 2050, "examples": [2021] }, "quarter": { "$id": "#/properties/quarter", "type": "integer", "title": "Year quarter", "description": "Year quarter for the reported data", "default": 0, "minimum": 1, "maximum": 4, "examples": [1] }, "tpaLicenseNbr": { "$id": "#/properties/tpaLicenseNbr", "type": "string", "title": "TPA license number", "description": "TPA license number for the reported data if applicable", "default": "", "pattern": "^[0-9]{0,15}$", "examples": ["864868"] }, "confidentialInformation": { "$id": "#/properties/confidentialInformation", "type": "boolean", "title": "Confidentiality", "description": "Does the company want TDI to keep the data entered into this report as confidential proprietary information? (Your answer will determine how TDI responds to requests made through the Public Information Act, Texas Government Code, Chapter 552.)", "default": false, "examples": [false] }, "contactName": { "$id": "#/properties/contactName", "type": "string", "title": "Contact name", "description": "Contact name", "default": "", "pattern": "^[a-zA-Z',.\\- ]{1,255}$", "examples": ["John Doe"] }, "contactTitle": { "$id": "#/properties/contactTitle", "type": "string", "title": "Contact title", "description": "Contact title", "default": "", "pattern": "^[a-zA-Z',.\\- ]{0,50}$", "examples": ["Admin"] }, "phoneNbr": { "$id": "#/properties/phoneNbr", "type": "string", "title": "Phone", "description": "Contact phone number", "default": "", "pattern": "^[0-9]{10}$", "examples": ["6876868686"] }, "phoneExt": { "$id": "#/properties/phoneExt", "type": "string", "title": "Phone extension ", "description": "Phone extension if applicable", "default": "", "pattern": "^[0-9]{0,10}$", "examples": ["123"] }, "email": { "$id": "#/properties/email", "type": "string", "title": "Email", "description": "Email", "default": "", "examples": ["jd@madisonins.com"] }, "emailReleaseOk": { "$id": "#/properties/emailReleaseOk", "type": "boolean", "title": "", "description": "Can TDI share this email address in response to public information requests?", "default": false, "examples": [true] }, "niClaimsReceived": { "$id": "#/properties/niClaimsReceived", "type": "integer", "title": "Non-institutional provider - Number of claims received", "description": "Number of claims received from Non-institutional providers (28 TAC §21.2821(c)(1))", "default": 0, "minimum": 0, "maximum": 9999999999, "examples": [1000] }, "niMedicalCleanReceived": { "$id": "#/properties/niMedicalCleanReceived", "type": "integer", "title": "Non-institutional provider - Number of clean claims (excluding pharmacy) received ", "description": "Number of clean claims (excluding pharmacy) received from non-institutional providers (28 TAC §21.2821(c)(3))", "default": 0, "minimum": 0, "maximum": 9999999999, "examples": [400] }, "niPharmaCleanReceived": { "$id": "#/properties/niPharmaCleanReceived", "type": "integer", "title": "Non-institutional provider - Number of electronically submitted, affirmatively adjudicated pharmacy claims received", "description": "Number of electronically submitted, affirmatively adjudicated pharmacy claims received from Non-institutional providers (28 TAC §21.2821(c)(19))", "default": 0, "minimum": 0, "maximum": 9999999999, "examples": [360] }, "niMedicalPaidTimely": { "$id": "#/properties/niMedicalPaidTimely", "type": "integer", "title": "Non-institutional provider - Number of clean claims (excluding pharmacy) paid timely", "description": "Number of clean claims (excluding pharmacy) from non-institutional providers paid within the applicable statutory claims payment period (28 TAC §21.2821(c)(5))", "default": 0, "minimum": 0, "maximum": 9999999999, "examples": [280] }, "niPharmaPaidTimely": { "$id": "#/properties/niPharmaPaidTimely", "type": "integer", "title": "Non-institutional provider - Number of electronically submitted, affirmatively adjudicated pharmacy clean claims paid timely", "description": "Number of electronically submitted, affirmatively adjudicated pharmacy clean claims from non-institutional providers paid within the applicable statutory claims payment period (28 TAC §21.2821(c)(20))", "default": 0, "minimum": 0, "maximum": 9999999999, "examples": [100] }, "niMedicalPaidLate_1_45": { "$id": "#/properties/niMedicalPaidLate_1_45", "type": "integer", "title": "Non-institutional provider - Number of clean claims (excluding pharmacy) paid on or before the 45th day after the applicable statutory claims payment period ", "description": "Number of clean claims (excluding pharmacy) from non-institutional providers paid on or before the 45th day after the applicable statutory claims payment period (28 TAC §21.2821(c)(6))", "default": 0, "minimum": 0, "maximum": 9999999999, "examples": [30] }, "niPharmaPaidLate_1_45": { "$id": "#/properties/niPharmaPaidLate_1_45", "type": "integer", "title": "Non-institutional provider - Number of electronically submitted, affirmatively adjudicated pharmacy clean claims paid on or before the 45th day after the applicable statutory claims payment period ", "description": "Number of electronically submitted, affirmatively adjudicated pharmacy clean claims from non-institutional providers paid on or before the 45th day after the applicable statutory claims payment period (28 TAC §21.2821(c)(21))", "default": 0, "minimum": 0, "maximum": 9999999999, "examples": [60] }, "niAmtPaidLate_1_45": { "$id": "#/properties/niAmtPaidLate_1_45", "type": "number", "title": "Non-institutional provider - The total dollar amount of the clean claims paid on or before the 45th day after the applicable statutory claims payment period", "description": "The total dollar amount of the clean claims from non-institutional preferred providers paid on or before the 45th day after the applicable statutory claims payment period (28 TAC §21.2821(e)(1)(A))", "default": 0.00, "minimum": 0, "maximum": 9999999999, "examples": [5773.00] }, "niPenaltyPaid_1_45": { "$id": "#/properties/niPenaltyPaid_1_45", "type": "number", "title": "Non-institutional provider - Total penalty dollar amount paid to providers for clean claims paid late on or before the 45th day after the applicable statutory claims payment period", "description": "Total penalty dollar amount paid to non-institutional providers for clean claims paid late on or before the 45th day after the applicable statutory claims payment period", "default": 0.00, "minimum": 0, "maximum": 9999999999, "examples": [799.50] }, "niClaimsPaidLate_1_45": { "$id": "#/properties/niClaimsPaidLate_1_45", "type": "array", "title": "Non-institutional provider - claim level data for clean claims paid on or before the 45th day after the applicable statutory claims payment period ", "description": "Claim level data for clean claims from non-institutional providers paid on or before the 45th day after the applicable statutory claims payment period (28 TAC §21.2821(e)(3)(A), (e)(5), and (f))", "default": [], "examples": [ [ { "uniqueIdentifier": "56377", "amountPaidLate": 2366.30, "penaltyAmount": 1000.50 }, { "uniqueIdentifier": "83699", "amountPaidLate": 150.00, "penaltyAmount": 2000.00 } ] ], "additionalItems": true, "items": { "$id": "#/properties/niClaimsPaidLate_1_45/items", "anyOf": [ { "$id": "#/properties/niClaimsPaidLate_1_45/items/anyOf/0", "type": "object", "title": "The first anyOf schema", "description": "", "default": {}, "examples": [ { "uniqueIdentifier": "56377", "amountPaidLate": 2366.30, "penaltyAmount": 1000.50 } ], "required": ["uniqueIdentifier", "amountPaidLate", "penaltyAmount"], "properties": { "uniqueIdentifier": { "$id": "#/properties/niClaimsPaidLate_1_45/items/anyOf/0/properties/uniqueIdentifier", "type": "string", "title": "Unique identifier for the claim", "description": "Unique identifier for the claim", "default": "", "pattern": "^[a-zA-Z0-9]{1,15}$", "examples": ["5637767"] }, "amountPaidLate": { "$id": "#/properties/niClaimsPaidLate_1_45/items/anyOf/0/properties/amountPaidLate", "type": "number", "title": "Dollar amount - Paid late", "description": "Dollar amount paid late", "default": 0.00, "minimum": 0, "maximum": 9999999999, "examples": [2366.30] }, "penaltyAmount": { "$id": "#/properties/niClaimsPaidLate_1_45/items/anyOf/0/properties/penaltyAmount", "type": "number", "title": "Dollar amount - Penalty paid to provider", "description": "Penalty dollar amount paid to provider for the claim", "default": 0.00, "minimum": 0, "maximum": 9999999999, "examples": [1000.50] } }, "additionalProperties": false } ] } }, "niMedicalPaidLate_46_90": { "$id": "#/properties/niMedicalPaidLate_46_90", "type": "integer", "title": "Non-institutional provider - Number of clean claims (excluding pharmacy) paid on or after the 46th day and on or before the 90th day after the applicable statutory claims payment period", "description": "Number of clean claims (excluding pharmacy) from non-institutional providers paid on or after the 46th day and on or before the 90th day after the applicable statutory claims payment period (28 TAC §21.2821(c)(8))", "default": 0, "minimum": 0, "maximum": 9999999999, "examples": [60] }, "niPharmaPaidLate_46_90": { "$id": "#/properties/niPharmaPaidLate_46_90", "type": "integer", "title": "Non-institutional provider - Number of electronically submitted, affirmatively adjudicated pharmacy clean claims paid on or after the 46th day and on or before the 90th day after the applicable statutory claims payment period", "description": "Number of electronically submitted, affirmatively adjudicated pharmacy clean claims from non-institutional providers paid on or after the 46th day and on or before the 90th day after the applicable statutory claims payment period (28 TAC §21.2821(c)(22))", "default": 0, "minimum": 0, "maximum": 9999999999, "examples": [40] }, "niAmtPaidLate_46_90": { "$id": "#/properties/niAmtPaidLate_46_90", "type": "number", "title": "Non-institutional provider - The total dollar amount of the clean claims paid on or after the 46th day and on or before the 90th day after the applicable statutory claims payment period", "description": "The total dollar amount of the clean claims from non-institutional preferred providers paid on or after the 46th day and on or before the 90th day after the applicable statutory claims payment period (28 TAC §21.2821(e)(1)(C))", "default": 0.00, "minimum": 0, "maximum": 9999999999, "examples": [5780.00] }, "niPenaltyPaid_46_90": { "$id": "#/properties/niPenaltyPaid_46_90", "type": "number", "title": "Non-institutional provider - Total penalty dollar amount paid to providers for claims paid late on or after the 46th day and on or before the 90th day after the applicable statutory claims payment period", "description": "Total penalty dollar amount paid to non-institutional providers for claims paid late on or after the 46th day and on or before the 90th day after the applicable statutory claims payment period", "default": 0.00, "minimum": 0, "maximum": 9999999999, "examples": [400.30] }, "niClaimsPaidLate_46_90": { "$id": "#/properties/niClaimsPaidLate_46_90", "type": "array", "title": "Non-institutional provider - claim level data for clean claims paid on or after the 46th day and on or before the 90th day after the applicable statutory claims payment period", "description": "Claim level data for clean claims from non-institutional providers paid on or after the 46th day and on or before the 90th day after the applicable statutory claims payment period (28 TAC §21.2821(e)(3)(B), (e)(5), and (f))", "default": [], "examples": [ [ { "uniqueIdentifier": "563771", "amountPaidLate": 2366.30, "penaltyAmount": 67.50 }, { "uniqueIdentifier": "12346753", "amountPaidLate": 2366.30, "penaltyAmount": 2000.45 } ] ], "additionalItems": true, "items": { "$id": "#/properties/niClaimsPaidLate_46_90/items", "anyOf": [ { "$id": "#/properties/niClaimsPaidLate_46_90/items/anyOf/0", "type": "object", "title": "The first anyOf schema", "description": "", "default": {}, "examples": [ { "uniqueIdentifier": "563771", "amountPaidLate": 2366.30, "penaltyAmount": 67.50 } ], "required": ["uniqueIdentifier", "amountPaidLate", "penaltyAmount"], "properties": { "uniqueIdentifier": { "$id": "#/properties/niClaimsPaidLate_46_90/items/anyOf/0/properties/uniqueIdentifier", "type": "string", "title": "Unique identifier for the claim", "description": "Unique identifier for the claim", "default": "", "pattern": "^[a-zA-Z0-9]{1,15}$", "examples": ["563771"] }, "amountPaidLate": { "$id": "#/properties/niClaimsPaidLate_46_90/items/anyOf/0/properties/amountPaidLate", "type": "number", "title": "Dollar amount - Paid late", "description": "Dollar amount paid late", "default": 0.00, "minimum": 0, "maximum": 9999999999, "examples": [2366.30] }, "penaltyAmount": { "$id": "#/properties/niClaimsPaidLate_46_90/items/anyOf/0/properties/penaltyAmount", "type": "number", "title": "Dollar amount - Penalty paid to provider", "description": "Penalty dollar amount paid to provider for the claim", "default": 0.00, "minimum": 0, "maximum": 9999999999, "examples": [67.50] } }, "additionalProperties": false } ] } }, "niMedicalPaidLate_91Plus": { "$id": "#/properties/niMedicalPaidLate_91Plus", "type": "integer", "title": "Non-institutional provider - Number of clean claims (excluding pharmacy) paid on or after the 91st day after the applicable statutory claims payment period", "description": "Number of clean claims (excluding pharmacy) from non-institutional providers paid on or after the 91st day after the applicable statutory claims payment period (28 TAC §21.2821(c)(10))", "default": 0, "minimum": 0, "maximum": 9999999999, "examples": [6] }, "niPharmaPaidLate_91Plus": { "$id": "#/properties/niPharmaPaidLate_91Plus", "type": "integer", "title": "Non-institutional provider - Number of electronically submitted, affirmatively adjudicated pharmacy clean claims paid late on or after the 91st day after the applicable statutory claims payment period", "description": "Number of electronically submitted, affirmatively adjudicated pharmacy clean claims from non-institutional providers paid late on or after the 91st day after the applicable statutory claims payment period (28 TAC §21.2821(c)(23))", "default": 0, "minimum": 0, "maximum": 9999999999, "examples": [7] }, "niAmtPaidLate_91Plus": { "$id": "#/properties/niAmtPaidLate_91Plus", "type": "number", "title": "Non-institutional provider - The total dollar amount of the clean claims paid on or after the 91st day after the applicable statutory claims payment period", "description": "The total dollar amount of the clean claims from non-institutional preferred providers paid on or after the 91st day after the applicable statutory claims payment period (28 TAC §21.2821(e)(1)(E))", "default": 0.00, "minimum": 0, "maximum": 9999999999, "examples": [4732.60] }, "niPenaltyPaid_91Plus": { "$id": "#/properties/niPenaltyPaid_91Plus", "type": "number", "title": "Non-institutional provider - Total penalty dollar amount paid to providers for claims paid late on or after the 91st day after the applicable statutory claims payment period", "description": "Total penalty dollar amount paid to non-institutional providers for claims paid late on or after the 91st day after the applicable statutory claims payment period", "default": 0.00, "minimum": 0, "maximum": 9999999999, "examples": [89.00] }, "niPenaltyInterestTDI_91Plus": { "$id": "#/properties/niPenaltyInterestTDI_91Plus", "type": "number", "title": "Non-institutional provider - Total interest dollar amount paid to TDI for claims paid late on or after the 91st day after the applicable statutory claims payment period", "description": "Total interest dollar amount paid to TDI for claims from non-institutional providers paid late on or after the 91st day after the applicable statutory claims payment period", "default": 0.00, "minimum": 0, "maximum": 9999999999, "examples": [95.40] }, "niClaimsPaidLate_91_Plus": { "$id": "#/properties/niClaimsPaidLate_91_Plus", "type": "array", "title": "Non-institutional provider - claim level data for clean claims paid on or after the 91st day after the applicable statutory claims payment period", "description": "Claim level data for clean claims from non-institutional providers paid on or after the 91st day after the applicable statutory claims payment period (28 TAC §21.2821(e)(3)(C), (e)(4), (e)(5), and (f))", "default": [], "examples": [ [ { "uniqueIdentifier": "084467", "amountPaidLate": 2366.30, "penaltyAmount": 79.50, "penaltyInterestTDI": 87.20 }, { "uniqueIdentifier": "3828", "amountPaidLate": 2366.30, "penaltyAmount": 9.50, "penaltyInterestTDI": 8.20 } ] ], "additionalItems": true, "items": { "$id": "#/properties/niClaimsPaidLate_91_Plus/items", "anyOf": [ { "$id": "#/properties/niClaimsPaidLate_91_Plus/items/anyOf/0", "type": "object", "title": "The first anyOf schema", "description": "", "default": {}, "examples": [ { "uniqueIdentifier": "084467", "amountPaidLate": 2366.30, "penaltyAmount": 79.50, "penaltyInterestTDI": 87.20 } ], "required": [ "uniqueIdentifier", "amountPaidLate", "penaltyAmount", "penaltyInterestTDI" ], "properties": { "uniqueIdentifier": { "$id": "#/properties/niClaimsPaidLate_91_Plus/items/anyOf/0/properties/uniqueIdentifier", "type": "string", "title": "Unique identifier for the claim", "description": "Unique identifier for the claim", "default": "", "pattern": "^[a-zA-Z0-9]{1,15}$", "examples": ["084467"] }, "amountPaidLate": { "$id": "#/properties/niClaimsPaidLate_91_Plus/items/anyOf/0/properties/amountPaidLate", "type": "number", "title": "Dollar amount - Paid late", "description": "Dollar amount paid late", "default": 0.00, "minimum": 0, "maximum": 9999999999, "examples": [2366.30] }, "penaltyAmount": { "$id": "#/properties/niClaimsPaidLate_91_Plus/items/anyOf/0/properties/penaltyAmount", "type": "number", "title": "Dollar amount - Penalty paid to provider", "description": "Penalty dollar amount paid to provider for the claim", "default": 0.00, "minimum": 0, "maximum": 9999999999, "examples": [79.50] }, "penaltyInterestTDI": { "$id": "#/properties/niClaimsPaidLate_91_Plus/items/anyOf/0/properties/penaltyInterestTDI", "type": "number", "title": "Dollar amount - Interest paid to TDI", "description": "Dollar amount of interest paid to TDI", "default": 0.00, "minimum": 0, "maximum": 9999999999, "examples": [87.20] } }, "additionalProperties": false } ] } }, "iReceived": { "$id": "#/properties/iReceived", "type": "integer", "title": "Institutional provider - Number of claims received", "description": "Number of claims received from Institutional providers (28 TAC §21.2821(c)(2))", "default": 0, "minimum": 0, "maximum": 9999999999, "examples": [80] }, "iCleanReceived": { "$id": "#/properties/iCleanReceived", "type": "integer", "title": "Institutional provider - Number of clean claims received", "description": "Number of clean claims received from Institutional providers (28 TAC §21.2821(c)(4))", "default": 0, "minimum": 0, "maximum": 9999999999, "examples": [50] }, "iPaidTimely": { "$id": "#/properties/iPaidTimely", "type": "integer", "title": "Institutional provider - Number of clean claims paid within the applicable statutory claims payment period", "description": "Number of clean claims from Institutional providers paid within the applicable statutory claims payment period (28 TAC §21.2821(c)(12))", "default": 0, "minimum": 0, "maximum": 9999999999, "examples": [67] }, "iPaidLate_1_45": { "$id": "#/properties/iPaidLate_1_45", "type": "integer", "title": "Institutional provider - Number of clean claims paid late on or before the 45th day after the applicable statutory claims payment period", "description": "Number of clean claims from institutional providers paid late on or before the 45th day after the applicable statutory claims payment period (28 TAC §21.2821(c)(7))", "default": 0, "minimum": 0, "maximum": 9999999999, "examples": [45] }, "iAmtPaid_1_45": { "$id": "#/properties/iAmtPaid_1_45", "type": "number", "title": "Institutional provider - The total dollar amount of the clean claims paid on or before the 45th day after the applicable statutory claims payment period", "description": "The total dollar amount of the clean claims from institutional preferred providers paid on or before the 45th day after the applicable statutory claims payment period (28 TAC §21.2821(e)(1)(B))", "default": 0.00, "minimum": 0, "maximum": 9999999999, "examples": [7098.90] }, "iPenaltyPaid_1_45": { "$id": "#/properties/iPenaltyPaid_1_45", "type": "number", "title": "Institutional provider - Total penalty dollar amount paid to provider for claims paid late on or before the 45th day after the applicable statutory claims payment period", "description": "Total penalty dollar amount paid to provider for claims from institutional providers paid late on or before the 45th day after the applicable statutory claims payment period", "default": 0.00, "minimum": 0, "maximum": 9999999999, "examples": [1790.10] }, "iPenaltyPaidTDI_1_45": { "$id": "#/properties/iPenaltyPaidTDI_1_45", "type": "number", "title": "Institutional provider - Total penalty dollar amount paid to TDI for claims paid late on or before the 45th day after the applicable statutory claims payment period", "description": "Total penalty dollar amount paid to TDI for claims from institutional providers paid late on or before the 45th day after the applicable statutory claims payment period", "default": 0.00, "minimum": 0, "maximum": 9999999999, "examples": [1790.10] }, "iClaimsPaidLate_1_45": { "$id": "#/properties/iClaimsPaidLate_1_45", "type": "array", "title": "Institutional provider - claim level data for clean claims paid on or before the 45th day after the applicable statutory claims payment period", "description": "Claim level data for clean claims from institutional providers paid on or before the 45th day after the applicable statutory claims payment period (28 TAC §21.2821(e)(2)(A), (e)(5), and (f) and 28 TAC §21.2815(a)(4-6))", "default": [], "examples": [ [ { "uniqueIdentifier": "375", "amountPaidLate": 2366.30, "penaltyAmount": 1000.50, "penaltyAmountTDI": 1000.50 }, { "uniqueIdentifier": "27501", "amountPaidLate": 2366.30, "penaltyAmount": 500.10, "penaltyAmountTDI": 500.10 } ] ], "additionalItems": true, "items": { "$id": "#/properties/iClaimsPaidLate_1_45/items", "anyOf": [ { "$id": "#/properties/iClaimsPaidLate_1_45/items/anyOf/0", "type": "object", "title": "The first anyOf schema", "description": "", "default": {}, "examples": [ { "uniqueIdentifier": "375", "amountPaidLate": 2366.30, "penaltyAmount": 1000.50, "penaltyAmountTDI": 1000.50 } ], "required": [ "uniqueIdentifier", "amountPaidLate", "penaltyAmount", "penaltyAmountTDI" ], "properties": { "uniqueIdentifier": { "$id": "#/properties/iClaimsPaidLate_1_45/items/anyOf/0/properties/uniqueIdentifier", "type": "string", "title": "Unique identifier for the claim", "description": "Unique identifier for the claim", "default": "", "pattern": "^[a-zA-Z0-9]{1,15}$", "examples": ["375"] }, "amountPaidLate": { "$id": "#/properties/iClaimsPaidLate_1_45/items/anyOf/0/properties/amountPaidLate", "type": "number", "title": "Dollar amount - Paid late", "description": "Dollar amount paid late", "default": 0.00, "minimum": 0, "maximum": 9999999999, "examples": [2366.30] }, "penaltyAmount": { "$id": "#/properties/iClaimsPaidLate_1_45/items/anyOf/0/properties/penaltyAmount", "type": "number", "title": "Dollar amount - Penalty paid to provider", "description": "Penalty dollar amount paid to provider for the claim", "default": 0.00, "minimum": 0, "maximum": 9999999999, "examples": [1000.50] }, "penaltyAmountTDI": { "$id": "#/properties/iClaimsPaidLate_1_45/items/anyOf/0/properties/penaltyAmountTDI", "type": "number", "title": "Dollar amount - Penalty paid to TDI", "description": "Penalty dollar amount paid to TDI for the claim", "default": 0.00, "minimum": 0, "maximum": 9999999999, "examples": [1000.50] } }, "additionalProperties": false } ] } }, "iPaidLate_46_90": { "$id": "#/properties/iPaidLate_46_90", "type": "integer", "title": "Institutional provider - Number of clean claims paid late on or after the 46th day and on or before the 90th day after the applicable statutory claims payment period", "description": "Number of clean claims from institutional providers paid late on or after the 46th day and on or before the 90th day after the applicable statutory claims payment period (28 TAC §21.2821(c)(9))", "default": 0, "minimum": 0, "maximum": 9999999999, "examples": [57] }, "iAmtPaid_46_90": { "$id": "#/properties/iAmtPaid_46_90", "type": "number", "title": "Institutional provider - The total dollar amount of the clean claims paid on or after the 46th day and on or before the 90th day after the applicable statutory claims payment period", "description": "The total dollar amount of the clean claims from institutional providers paid on or after the 46th day and on or before the 90th day after the applicable statutory claims payment period (28 TAC §21.2821(e)(1)(D))", "default": 0.00, "minimum": 0, "maximum": 9999999999, "examples": [2366.30] }, "iPenaltyPaid_46_90": { "$id": "#/properties/iPenaltyPaid_46_90", "type": "number", "title": "Institutional provider - Total penalty dollar amount paid to providers for claims paid late on or after the 46th day and on or before the 90th day after the applicable statutory claims payment period", "description": "Total penalty dollar amount paid to institutional providers for claims paid late on or after the 46th day and on or before the 90th day after the applicable statutory claims payment period", "default": 0.00, "minimum": 0, "maximum": 9999999999, "examples": [1000.50] }, "iPenaltyPaidTDI_46_90": { "$id": "#/properties/iPenaltyPaidTDI_46_90", "type": "number", "title": "Institutional provider - Total penalty dollar amount paid to TDI for claims paid late on or after the 46th day and on or before the 90th day after the applicable statutory claims payment period", "description": "Total penalty dollar amount paid to TDI for claims from institutional providers paid late on or after the 46th day and on or before the 90th day after the applicable statutory claims payment period", "default": 0.00, "minimum": 0, "maximum": 9999999999, "examples": [1000.50] }, "iClaimsPaidLate_46_90": { "$id": "#/properties/iClaimsPaidLate_46_90", "type": "array", "title": "Institutional provider - claim level data for clean claims paid on or after the 46th day and on or before the 90th after the applicable statutory claims payment period", "description": "Claim level data for clean claims from institutional providers paid on or after the 46th day and on or before the 90th after the applicable statutory claims payment period (28 TAC §21.2821(e)(2)(B), (e)(5), and (f) and 28 TAC §21.2815(a)(4-6))", "default": [], "examples": [ [ { "uniqueIdentifier": "35", "amountPaidLate": 2366.30, "penaltyAmount": 1000.50, "penaltyAmountTDI": 1000.50 } ] ], "additionalItems": true, "items": { "$id": "#/properties/iClaimsPaidLate_46_90/items", "anyOf": [ { "$id": "#/properties/iClaimsPaidLate_46_90/items/anyOf/0", "type": "object", "title": "The first anyOf schema", "description": "", "default": {}, "examples": [ { "uniqueIdentifier": "35", "amountPaidLate": 2366.30, "penaltyAmount": 1000.50, "penaltyAmountTDI": 1000.50 } ], "required": [ "uniqueIdentifier", "amountPaidLate", "penaltyAmount", "penaltyAmountTDI" ], "properties": { "uniqueIdentifier": { "$id": "#/properties/iClaimsPaidLate_46_90/items/anyOf/0/properties/uniqueIdentifier", "type": "string", "title": "Unique identifier for the claim", "description": "Unique identifier for the claim", "default": "", "pattern": "^[a-zA-Z0-9]{1,15}$", "examples": ["35"] }, "amountPaidLate": { "$id": "#/properties/iClaimsPaidLate_46_90/items/anyOf/0/properties/amountPaidLate", "type": "number", "title": "Dollar amount - Paid late", "description": "Dollar amount paid late", "default": 0.00, "minimum": 0, "maximum": 9999999999, "examples": [2366.30] }, "penaltyAmount": { "$id": "#/properties/iClaimsPaidLate_46_90/items/anyOf/0/properties/penaltyAmount", "type": "number", "title": "Dollar amount - Penalty paid to provider", "description": "Penalty dollar amount paid to provider for the claim", "default": 0.00, "minimum": 0, "maximum": 9999999999, "examples": [1000.50] }, "penaltyAmountTDI": { "$id": "#/properties/iClaimsPaidLate_46_90/items/anyOf/0/properties/penaltyAmountTDI", "type": "number", "title": "Dollar amount - Penalty paid to TDI", "description": "Penalty dollar amount paid to TDI for the claim", "default": 0.00, "minimum": 0, "maximum": 9999999999, "examples": [1000.50] } }, "additionalProperties": false } ] } }, "iPaidLate_91Plus": { "$id": "#/properties/iPaidLate_91Plus", "type": "integer", "title": "Institutional provider - Number of clean claims paid late on or after the 91st day after the applicable statutory claims payment period", "description": " Number of clean claims from institutional providers paid late on or after the 91st day after the applicable statutory claims payment period (28 TAC §21.2821(c)(11))", "default": 0, "minimum": 0, "maximum": 9999999999, "examples": [9] }, "iAmtPaid_91Plus": { "$id": "#/properties/iAmtPaid_91Plus", "type": "number", "title": "Institutional provider - The total dollar amount of the clean claims paid on or after the 91st day after the applicable statutory claims payment period", "description": "The total dollar amount of the clean claims from institutional prefered providers paid on or after the 91st day after the applicable statutory claims payment period (28 TAC §21.2821(e)(1)(F))", "default": 0.00, "minimum": 0, "maximum": 9999999999, "examples": [9329.25] }, "iPenaltyPaid_91Plus": { "$id": "#/properties/iPenaltyPaid_91Plus", "type": "number", "title": "Institutional provider - Total penalty dollar amount paid to provider for claims paid late on or after the 91st day after the applicable statutory claims payment period", "description": "Total penalty dollar amount paid to institutional provider for claims paid late on or after the 91st day after the applicable statutory claims payment period", "default": 0.00, "minimum": 0, "maximum": 9999999999, "examples": [500.20] }, "iPenaltyPaidTDI_91Plus": { "$id": "#/properties/iPenaltyPaidTDI_91Plus", "type": "number", "title": "Institutional provider - Total penalty dollar amount paid to TDI for claims paid late on or after the 91st day after the applicable statutory claims payment period", "description": "Total penalty dollar amount paid to TDI for claims from institutional providers paid late on or after the 91st day after the applicable statutory claims payment period", "default": 0.00, "minimum": 0, "maximum": 9999999999, "examples": [79.50] }, "iClaimsPaidLate_91_Plus": { "$id": "#/properties/iClaimsPaidLate_91_Plus", "type": "array", "title": "Institutional provider - claim level data for clean claims paid on or after the 91st day after the applicable statutory claims payment period", "description": "Claim level data for clean claims from institutional providers paid on or after the 91st day after the applicable statutory claims payment period (28 TAC §21.2821(e)(2)(C), (e)(5), and (f) and 28 TAC §21.2815(a)(6)(A))", "default": [], "examples": [ [ { "uniqueIdentifier": "08564467", "amountPaidLate": 2366.30, "penaltyAmount": 79.50, "penaltyAmountTDI": 79.50 } ] ], "additionalItems": true, "items": { "$id": "#/properties/iClaimsPaidLate_91_Plus/items", "anyOf": [ { "$id": "#/properties/iClaimsPaidLate_91_Plus/items/anyOf/0", "type": "object", "title": "The first anyOf schema", "description": "", "default": {}, "examples": [ { "uniqueIdentifier": "08564467", "amountPaidLate": 2366.30, "penaltyAmount": 79.50, "penaltyAmountTDI": 79.50 } ], "required": [ "uniqueIdentifier", "amountPaidLate", "penaltyAmount", "penaltyAmountTDI" ], "properties": { "uniqueIdentifier": { "$id": "#/properties/iClaimsPaidLate_91_Plus/items/anyOf/0/properties/uniqueIdentifier", "type": "string", "title": "Unique identifier for the claim", "description": "Unique identifier for the claim", "default": "", "pattern": "^[a-zA-Z0-9]{1,15}$", "examples": ["08564467"] }, "amountPaidLate": { "$id": "#/properties/iClaimsPaidLate_91_Plus/items/anyOf/0/properties/amountPaidLate", "type": "number", "title": "Dollar amount - Paid late", "description": "Dollar amount paid late", "default": 0.00, "minimum": 0, "maximum": 9999999999, "examples": [2366.30] }, "penaltyAmount": { "$id": "#/properties/iClaimsPaidLate_91_Plus/items/anyOf/0/properties/penaltyAmount", "type": "number", "title": "Dollar amount - Penalty paid to provider", "description": "Penalty dollar amount paid to provider for the claim", "default": 0.00, "minimum": 0, "maximum": 9999999999, "examples": [79.50] }, "penaltyAmountTDI": { "$id": "#/properties/iClaimsPaidLate_91_Plus/items/anyOf/0/properties/penaltyAmountTDI", "type": "number", "title": "Dollar amount - Penalty paid to TDI", "description": "Penalty dollar amount paid to TDI for the claim", "default": 0.00, "minimum": 0, "maximum": 9999999999, "examples": [79.50] } }, "additionalProperties": false } ] } }, "auditedClaimsPaid": { "$id": "#/properties/auditedClaimsPaid", "type": "integer", "title": "Number of audited claims paid", "description": "Number of audited claims paid pursuant to Section 21.2809 (28 TAC §21.2821(c)(13))", "default": 0, "minimum": 0, "maximum": 9999999999, "examples": [9] }, "verificationRequests": { "$id": "#/properties/verificationRequests", "type": "integer", "title": "Number of requests for verification", "description": "Number of requests for verification received pursuant to Section 19.1719 (28 TAC §21.2821(c)(14))", "default": 0, "minimum": 0, "maximum": 9999999999, "examples": [6] }, "verificationsIssued": { "$id": "#/properties/verificationsIssued", "type": "integer", "title": "Number of verifications issued pursuant", "description": "Number of verifications issued pursuant to Section 19.1719 (28 TAC §21.2821(c)(15))", "default": 0, "minimum": 0, "maximum": 9999999999, "examples": [7] }, "declinations": { "$id": "#/properties/declinations", "type": "integer", "title": "Number of declinations", "description": "Number of declinations pursuant to Section 19.1719 (28 TAC §21.2821(c)(16))", "default": 0, "minimum": 0, "maximum": 9999999999, "examples": [3] }, "certificationOfCatastrophes": { "$id": "#/properties/certificationOfCatastrophes", "type": "integer", "title": "Number of catastrophic events reported to TDI", "description": "Number of catastrophic events reported to TDI. (28 TAC §21.2821(c)(17))", "default": 0, "minimum": 0, "maximum": 9999999999, "examples": [2] }, "commentCatastrophes": { "$id": "#/properties/commentCatastrophes", "type": "string", "title": "Date and description of catastrophic event", "description": "Date and description of catastrophic event", "default": "", "pattern": "^[a-zA-Z0-9!@$%&*()\\-+;_:',<.>/?\\s\"]{0,255}$", "examples": ["01-25-2021 - Flooding, 02-05-2021 - Covid-19"] }, "businessInterruptedDays": { "$id": "#/properties/businessInterruptedDays", "type": "integer", "title": "Total number of days business was interrupted for catastrophic events", "description": "Total number of days business was interrupted for catastrophic events. (28 TAC §21.2821(c)(18))", "default": 0, "minimum": 0, "maximum": 9999999999, "examples": [3] }, "noOfComplaints": { "$id": "#/properties/noOfComplaints", "type": "integer", "title": "Total number of complaints received from institutional and non-institutional providers regarding failure to pay claims promptly", "description": "Total number of complaints received from institutional and non-institutional providers regarding failure to pay claims promptly. (28 TAC §21.2821(e)(6))", "default": 0, "minimum": 0, "maximum": 9999999999, "examples": [6] }, "comments": { "$id": "#/properties/comments", "type": "string", "title": "Comments", "description": "Comments", "default": "", "pattern": "^[a-zA-Z0-9!@$%&*()\\-+;_:',<.>/?\\s\"]{0,255}$", "examples": ["test sample sb418q"] } }, "additionalProperties": false }