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PMJAY adjudicator

Adjudicator: role for a case

Asks the NHCX Payer Service which role in the State Health Agency's Transaction Management System holds a PMJAY case, and so which actions may be taken on it next.

POST/pmjay/sbxhcx/nhcxpayerservice/v1/get/user-role

### Business purpose

A PMJAY case is not decided over NHCX. The exchange carries the submission to the scheme and the verdict back, but the decision is taken in the SHA's own system, by a named role, on that system's schedule. This call is how an integrator reads that queue. It is also the only way to see where a PMJAY case stands, because a status Task sent to the scheme over NHCX is refused, first with PAYR-1018 and then with PAYR-1008.

### When to use

Before every call to Adjudicator: act on a case, because the role that answers is the only one whose action names are legal, and whenever a PMJAY case has gone quiet. The service moves cases on its own schedule, so read the role again rather than assuming the next step.

### Preconditions

- caseid is the scheme's case ID, the digits at the end of the case reference the payer issues, not the hospital's claim number. The sandbox hands it out inside the PAYR-1238 refusal of a later request for the same beneficiary, and in the payer's acknowledgement and status answers once a request is accepted. - payerid is the scheme payer's code. - An ordinary ABDM session token on bearer_auth, with Content-Type and Accept set to application/json.

### Postconditions

The service answers with the role that holds the case in currentuserrole, and errormessage empty. Once a case is decided, the lookup answers with no role at all. Asked about the hospital's own number, it answers No Data found with the caseid <id>. Please use the current active case id.

### Common mistakes

- Sending the hospital's claim number as caseid. - Acting on the case without reading the role first, and being refused because it has moved. - Reading a pre-authorisation role on a claim as an error. PPD-Trust while you are asking about a claim means the case has not yet left the pre-authorisation queue. - Expecting a status API over NHCX for a PMJAY case.

### Best practices

- Store the scheme's case ID beside your own claim number the moment it appears. - Read the role before every action, and again after it. - Expect this lookup and the action call to sit on different hosts. That is how the service is deployed, not a documentation error.

### Related scenario

A hospital has raised a pre-authorisation that sits at request.initiated. It takes the case ID from the payer's acknowledgement and posts it here with the payer code. The answer is PPD-Trust, so it approves the case as that role with Adjudicator: act on a case. After the claim is raised it reads the role again at every step, through CEX-Trust, CPD-Trust, ACO-Trust and SHA-Trust, until the lookup answers with no role and the verdict arrives on the claim's own callback.

### Specification

Chapter [PMJAY adjudication APIs](/docs/nhcx/v1/roles/provider/pmjay-adjudication-apis) of the NHCX integration specification.

Authorizations

Authorizationbearer tokenRequired

On every NHCX call, the token goes in a header called bearer_auth, with the word Bearer and a space in front. The sources are not unanimous: the authentication page and the FAQ both write the example as Authorization, and the notification endpoint uses Authorization. The safe course, and what the adapter does, is to send both headers with the same value.

Headers

bearer_authstringRequired

It is bearer_auth, not Authorization, on NHCX's own endpoints.

Body

caseidstring
payeridstring

Responses

200

The service answers with the role that holds the case in currentuserrole, and errormessage empty.