Digital Health Data Risk Score

{
  "$schema": "https://json-schema.org/draft/2020-12/schema",
  "$id": "https://api-evangelist.github.io/reinsurance-group-of-america/json-schema/reinsurance-group-of-america-health-score-schema.json",
  "title": "Digital Health Data Risk Score",
  "description": "Schema for the risk score returned by RGA's Digital Health Data (DHD) scoring API based on structured electronic medical record and claims data.",
  "type": "object",
  "required": ["requestId", "applicationId", "scoreDate", "riskScore"],
  "properties": {
    "requestId": {
      "type": "string",
      "description": "Unique identifier for this scoring request."
    },
    "applicationId": {
      "type": "string",
      "description": "Identifier of the insurance application being scored."
    },
    "scoreDate": {
      "type": "string",
      "format": "date-time",
      "description": "Timestamp when the risk score was generated."
    },
    "riskScore": {
      "type": "number",
      "description": "Calculated risk score. Higher values indicate higher risk.",
      "minimum": 0
    },
    "riskCategory": {
      "type": "string",
      "description": "Risk category derived from the score.",
      "enum": ["Low Risk", "Moderate Risk", "High Risk", "Very High Risk", "Uninsurable"]
    },
    "scoreConfidence": {
      "type": "number",
      "description": "Confidence level of the score from 0.0 to 1.0.",
      "minimum": 0,
      "maximum": 1
    },
    "dataAvailability": {
      "type": "object",
      "description": "Summary of data sources available for scoring.",
      "properties": {
        "ehrDataAvailable": {
          "type": "boolean",
          "description": "Whether electronic health record data was available."
        },
        "claimsDataAvailable": {
          "type": "boolean",
          "description": "Whether medical claims data was available."
        },
        "rxDataAvailable": {
          "type": "boolean",
          "description": "Whether prescription drug data was available."
        },
        "labDataAvailable": {
          "type": "boolean",
          "description": "Whether lab result data was available."
        }
      }
    },
    "healthSignals": {
      "type": "array",
      "description": "Key health signals that contributed to the risk score.",
      "items": {
        "type": "object",
        "properties": {
          "signalType": {
            "type": "string",
            "description": "Type of health signal (e.g., 'Diagnosis', 'Medication', 'Lab Result')."
          },
          "code": {
            "type": "string",
            "description": "Medical code (ICD-10, NDC, LOINC, etc.)."
          },
          "description": {
            "type": "string",
            "description": "Human-readable description of the health signal."
          },
          "riskContribution": {
            "type": "number",
            "description": "Contribution of this signal to the overall risk score."
          }
        }
      }
    },
    "recommendation": {
      "type": "string",
      "description": "Underwriting action recommendation based on the score.",
      "enum": ["Straight Through Processing", "Accelerated Underwriting", "Refer for Review", "Order Additional Requirements", "Decline"]
    },
    "processingTimeMs": {
      "type": "integer",
      "description": "Time in milliseconds to process and return the score."
    }
  }
}