Submit electronic claim
curl --request POST \
--url https://api.example.com/api/v2/clearinghouse/claim \
--header 'Content-Type: application/json' \
--data '
{
"tradingPartnerServiceId": "<string>",
"submitter": {
"contactInformation": {
"name": "<string>",
"phoneNumber": "<string>",
"faxNumber": "<string>",
"email": "<string>",
"phoneExtension": "<string>"
},
"organizationName": "<string>",
"lastName": "<string>",
"firstName": "<string>",
"middleName": "<string>",
"submitterIdentification": "<string>"
},
"receiver": {
"organizationName": "<string>"
},
"subscriber": {
"memberId": "<string>",
"ssn": "<string>",
"organizationName": "<string>",
"subscriberGroupName": "<string>",
"firstName": "<string>",
"lastName": "<string>",
"middleName": "<string>",
"suffix": "<string>",
"dateOfBirth": "<string>",
"policyNumber": "<string>",
"groupNumber": "<string>"
},
"billing": {
"providerType": "<string>",
"npi": "<string>",
"ssn": "<string>",
"employerId": "<string>",
"commercialNumber": "<string>",
"locationNumber": "<string>",
"stateLicenseNumber": "<string>",
"providerUpinNumber": "<string>",
"taxonomyCode": "<string>",
"firstName": "<string>",
"lastName": "<string>",
"middleName": "<string>",
"suffix": "<string>",
"organizationName": "<string>",
"contactInformation": {
"name": "<string>",
"phoneNumber": "<string>",
"faxNumber": "<string>",
"email": "<string>",
"phoneExtension": "<string>"
}
},
"claimInformation": {
"claimChargeAmount": "<string>",
"healthCareCodeInformation": [
{
"diagnosisCode": "<string>"
}
],
"serviceLines": [
{
"serviceDate": "<string>",
"professionalService": {
"procedureCode": "<string>",
"lineItemChargeAmount": "<string>",
"serviceUnitCount": "<string>",
"compositeDiagnosisCodePointers": {
"diagnosisCodePointers": [
"<string>"
]
},
"procedureModifiers": [
"<string>"
],
"description": "<string>",
"placeOfServiceCode": "<string>",
"emergencyIndicator": "Y",
"epsdtIndicator": "Y",
"familyPlanningIndicator": "Y",
"copayStatusCode": "0"
},
"assignedNumber": "<string>",
"serviceDateEnd": "<string>",
"serviceLineSupplementalInformation": [
{
"attachmentControlNumber": "<string>"
}
],
"ambulanceCertification": [
{
"conditionCodes": []
}
],
"hospiceEmployeeIndicator": true,
"serviceLineDateInformation": {
"prescriptionDate": "<string>",
"certificationRevisionOrRecertificationDate": "<string>",
"beginTherapyDate": "<string>",
"lastCertificationDate": "<string>",
"treatmentOrTherapyDate": "<string>",
"hemoglobinTestDate": "<string>",
"serumCreatineTestDate": "<string>",
"shippedDate": "<string>",
"lastXRayDate": "<string>",
"initialTreatmentDate": "<string>"
},
"ambulancePatientCount": 123,
"obstetricAnesthesiaAdditionalUnits": 123,
"testResults": [
{
"testResults": "<string>"
}
],
"serviceLineReferenceInformation": {
"repricedLineItemReferenceNumber": "<string>",
"adjustedRepricedLineItemReferenceNumber": "<string>",
"priorAuthorization": [
{
"priorAuthorizationOrReferralNumber": "<string>",
"otherPayerPrimaryIdentifier": "<string>"
}
],
"mammographyCertificationNumber": "<string>",
"clinicalLaboratoryImprovementAmendmentNumber": "<string>",
"referringCliaNumber": "<string>",
"immunizationBatchNumber": "<string>",
"referralNumber": [
"<string>"
]
},
"salesTaxAmount": "<string>",
"postageTaxAmount": "<string>",
"fileInformation": [
"<string>"
],
"additionalNotes": "<string>",
"goalRehabOrDischargePlans": "<string>",
"thirdPartyOrganizationNotes": "<string>",
"purchasedServiceProvider": {
"providerType": "<string>",
"npi": "<string>",
"stateLicenseNumber": "<string>",
"commercialNumber": "<string>",
"payerIdentificationNumber": "<string>",
"ssn": "<string>",
"employerId": "<string>",
"locationNumber": "<string>",
"employerIdentificationNumber": "<string>",
"claimOfficeNumber": "<string>",
"naic": "<string>",
"providerUpinNumber": "<string>",
"taxonomyCode": "<string>",
"firstName": "<string>",
"lastName": "<string>",
"middleName": "<string>",
"suffix": "<string>",
"organizationName": "<string>",
"contactInformation": {
"name": "<string>",
"phoneNumber": "<string>",
"faxNumber": "<string>",
"email": "<string>",
"phoneExtension": "<string>"
},
"otherIdentifier": "<string>",
"secondaryIdentifier": [
{
"qualifier": "<string>",
"identifier": "<string>",
"otherIdentifier": "<string>"
}
]
},
"orderingProvider": {
"providerType": "<string>",
"npi": "<string>",
"ssn": "<string>",
"employerId": "<string>",
"commercialNumber": "<string>",
"locationNumber": "<string>",
"payerIdentificationNumber": "<string>",
"employerIdentificationNumber": "<string>",
"claimOfficeNumber": "<string>",
"naic": "<string>",
"stateLicenseNumber": "<string>",
"providerUpinNumber": "<string>",
"taxonomyCode": "<string>",
"firstName": "<string>",
"lastName": "<string>",
"middleName": "<string>",
"suffix": "<string>",
"organizationName": "<string>",
"otherIdentifier": "<string>",
"secondaryIdentifier": [
{
"qualifier": "<string>",
"identifier": "<string>",
"otherIdentifier": "<string>"
}
]
},
"lineAdjudicationInformation": [
{
"otherPayerPrimaryIdentifier": "<string>",
"serviceLinePaidAmount": "<string>",
"procedureCode": "<string>",
"paidServiceUnitCount": "<string>",
"adjudicationOrPaymentDate": "<string>",
"procedureModifier": [
"<string>"
],
"procedureCodeDescription": "<string>",
"bundledOrUnbundledLineNumber": "<string>",
"claimAdjustmentInformation": [
{
"adjustmentDetails": [
{
"adjustmentReasonCode": "<string>",
"adjustmentAmount": "<string>",
"adjustmentQuantity": "<string>"
}
]
}
],
"remainingPatientLiability": "<string>"
}
],
"formIdentification": [
{
"formIdentifier": "<string>",
"supportingDocumentation": [
{
"questionNumber": "<string>",
"questionResponse": "<string>",
"questionResponseAsDate": "<string>",
"questionResponseAsPercent": "<string>"
}
]
}
]
}
],
"propertyCasualtyClaimNumber": "<string>",
"relatedCausesCode": [],
"autoAccidentStateCode": "<string>",
"autoAccidentCountryCode": "<string>",
"patientAmountPaid": "<string>",
"fileInformation": "<string>",
"fileInformationList": [
"<string>"
],
"deathDate": "<string>",
"patientWeight": "<string>",
"patientSignatureSourceCode": true,
"pregnancyIndicator": "Y",
"claimDateInformation": {
"symptomDate": "<string>",
"initialTreatmentDate": "<string>",
"lastSeenDate": "<string>",
"acuteManifestationDate": "<string>",
"accidentDate": "<string>",
"lastMenstrualPeriodDate": "<string>",
"lastXRayDate": "<string>",
"hearingAndVisionPrescriptionDate": "<string>",
"disabilityBeginDate": "<string>",
"disabilityEndDate": "<string>",
"lastWorkedDate": "<string>",
"authorizedReturnToWorkDate": "<string>",
"admissionDate": "<string>",
"dischargeDate": "<string>",
"assumedAndRelinquishedCareBeginDate": "<string>",
"assumedAndRelinquishedCareEndDate": "<string>",
"repricerReceivedDate": "<string>",
"firstContactDate": "<string>"
},
"claimSupplementalInformation": {
"reportInformations": [
{
"attachmentControlNumber": "<string>"
}
],
"priorAuthorizationNumber": "<string>",
"referralNumber": "<string>",
"claimControlNumber": "<string>",
"cliaNumber": "<string>",
"repricedClaimNumber": "<string>",
"adjustedRepricedClaimNumber": "<string>",
"investigationalDeviceExemptionNumber": "<string>",
"claimNumber": "<string>",
"mammographyCertificationNumber": "<string>",
"medicalRecordNumber": "<string>",
"demoProjectIdentifier": "<string>",
"carePlanOversightNumber": "<string>",
"medicareCrossoverReferenceId": "<string>"
},
"ambulanceCertification": [
{
"conditionCodes": []
}
],
"patientConditionInformationVision": [
{
"conditionCodes": []
}
],
"homeboundIndicator": true,
"anesthesiaRelatedSurgicalProcedure": [
"<string>"
],
"conditionInformation": [
{
"conditionCodes": [
"<string>"
]
}
],
"claimNote": {
"additionalInformation": "<string>",
"certificationNarrative": "<string>",
"goalRehabOrDischargePlans": "<string>",
"diagnosisDescription": "<string>",
"thirdPartOrgNotes": "<string>"
},
"otherSubscriberInformation": [
{
"otherSubscriberName": {
"otherInsuredLastName": "<string>",
"otherInsuredIdentifier": "<string>",
"otherInsuredFirstName": "<string>",
"otherInsuredMiddleName": "<string>",
"otherInsuredNameSuffix": "<string>",
"otherInsuredAdditionalIdentifier": "<string>"
},
"otherPayerName": {
"otherPayerOrganizationName": "<string>",
"otherPayerIdentifier": "<string>",
"otherPayerAdjudicationOrPaymentDate": "<string>",
"otherPayerSecondaryIdentifier": [
{
"qualifier": "<string>",
"identifier": "<string>",
"otherIdentifier": "<string>"
}
],
"otherPayerPriorAuthorizationNumber": "<string>",
"otherPayerPriorAuthorizationOrReferralNumber": "<string>",
"otherPayerClaimAdjustmentIndicator": true,
"otherPayerClaimControlNumber": "<string>"
},
"insuranceGroupOrPolicyNumber": "<string>",
"otherInsuredGroupName": "<string>",
"claimLevelAdjustments": [
{
"adjustmentDetails": [
{
"adjustmentReasonCode": "<string>",
"adjustmentAmount": "<string>",
"adjustmentQuantity": "<string>"
}
]
}
],
"payerPaidAmount": "<string>",
"nonCoveredChargeAmount": "<string>",
"remainingPatientLiability": "<string>",
"otherPayerReferringProvider": [
{
"otherPayerReferringProviderIdentifier": [
{
"qualifier": "<string>",
"identifier": "<string>",
"otherIdentifier": "<string>"
}
]
}
],
"otherPayerRenderingProvider": [
{
"otherPayerRenderingProviderSecondaryIdentifier": [
{
"qualifier": "<string>",
"identifier": "<string>",
"otherIdentifier": "<string>"
}
]
}
],
"otherPayerServiceFacilityLocation": [
{
"otherPayerServiceFacilityLocationSecondaryIdentifier": [
{
"qualifier": "<string>",
"identifier": "<string>",
"otherIdentifier": "<string>"
}
]
}
],
"otherPayerSupervisingProvider": [
{
"otherPayerSupervisingProviderIdentifier": [
{
"qualifier": "<string>",
"identifier": "<string>",
"otherIdentifier": "<string>"
}
]
}
],
"otherPayerBillingProvider": [
{
"otherPayerBillingProviderIdentifier": [
{
"qualifier": "<string>",
"identifier": "<string>",
"otherIdentifier": "<string>"
}
]
}
],
"patientSignatureGeneratedForPatient": true,
"medicareOutpatientAdjudication": {
"reimbursementRate": "<string>",
"hcpcsPayableAmount": "<string>",
"claimPaymentRemarkCode": [
"<string>"
],
"endStageRenalDiseasePaymentAmount": "<string>",
"nonPayableProfessionalComponentBilledAmount": "<string>"
}
}
]
},
"isTesting": true,
"controlNumber": "<string>",
"providers": [
{
"providerType": "<string>",
"npi": "<string>",
"ssn": "<string>",
"employerId": "<string>",
"commercialNumber": "<string>",
"locationNumber": "<string>",
"stateLicenseNumber": "<string>",
"providerUpinNumber": "<string>",
"taxonomyCode": "<string>",
"firstName": "<string>",
"lastName": "<string>",
"middleName": "<string>",
"suffix": "<string>",
"organizationName": "<string>",
"contactInformation": {
"name": "<string>",
"phoneNumber": "<string>",
"faxNumber": "<string>",
"email": "<string>",
"phoneExtension": "<string>"
}
}
],
"referring": {
"providerType": "<string>",
"npi": "<string>",
"commercialNumber": "<string>",
"stateLicenseNumber": "<string>",
"providerUpinNumber": "<string>",
"taxonomyCode": "<string>",
"firstName": "<string>",
"lastName": "<string>",
"middleName": "<string>",
"suffix": "<string>",
"organizationName": "<string>",
"contactInformation": {
"name": "<string>",
"phoneNumber": "<string>",
"faxNumber": "<string>",
"email": "<string>",
"phoneExtension": "<string>"
}
},
"rendering": {
"providerType": "<string>",
"npi": "<string>",
"commercialNumber": "<string>",
"locationNumber": "<string>",
"stateLicenseNumber": "<string>",
"providerUpinNumber": "<string>",
"taxonomyCode": "<string>",
"firstName": "<string>",
"lastName": "<string>",
"middleName": "<string>",
"suffix": "<string>",
"organizationName": "<string>",
"contactInformation": {
"name": "<string>",
"phoneNumber": "<string>",
"faxNumber": "<string>",
"email": "<string>",
"phoneExtension": "<string>"
}
},
"ordering": {
"providerType": "<string>",
"npi": "<string>",
"ssn": "<string>",
"employerId": "<string>",
"commercialNumber": "<string>",
"locationNumber": "<string>",
"payerIdentificationNumber": "<string>",
"employerIdentificationNumber": "<string>",
"claimOfficeNumber": "<string>",
"naic": "<string>",
"stateLicenseNumber": "<string>",
"providerUpinNumber": "<string>",
"taxonomyCode": "<string>",
"firstName": "<string>",
"lastName": "<string>",
"middleName": "<string>",
"suffix": "<string>",
"organizationName": "<string>",
"contactInformation": {
"name": "<string>",
"phoneNumber": "<string>",
"faxNumber": "<string>",
"email": "<string>",
"phoneExtension": "<string>"
}
},
"supervising": {
"providerType": "<string>",
"npi": "<string>",
"ssn": "<string>",
"employerId": "<string>",
"commercialNumber": "<string>",
"locationNumber": "<string>",
"stateLicenseNumber": "<string>",
"providerUpinNumber": "<string>",
"taxonomyCode": "<string>",
"firstName": "<string>",
"lastName": "<string>",
"middleName": "<string>",
"suffix": "<string>",
"organizationName": "<string>",
"contactInformation": {
"name": "<string>",
"phoneNumber": "<string>",
"faxNumber": "<string>",
"email": "<string>",
"phoneExtension": "<string>"
}
},
"tradingPartnerName": "<string>"
}
'import requests
url = "https://api.example.com/api/v2/clearinghouse/claim"
payload = {
"tradingPartnerServiceId": "<string>",
"submitter": {
"contactInformation": {
"name": "<string>",
"phoneNumber": "<string>",
"faxNumber": "<string>",
"email": "<string>",
"phoneExtension": "<string>"
},
"organizationName": "<string>",
"lastName": "<string>",
"firstName": "<string>",
"middleName": "<string>",
"submitterIdentification": "<string>"
},
"receiver": { "organizationName": "<string>" },
"subscriber": {
"memberId": "<string>",
"ssn": "<string>",
"organizationName": "<string>",
"subscriberGroupName": "<string>",
"firstName": "<string>",
"lastName": "<string>",
"middleName": "<string>",
"suffix": "<string>",
"dateOfBirth": "<string>",
"policyNumber": "<string>",
"groupNumber": "<string>"
},
"billing": {
"providerType": "<string>",
"npi": "<string>",
"ssn": "<string>",
"employerId": "<string>",
"commercialNumber": "<string>",
"locationNumber": "<string>",
"stateLicenseNumber": "<string>",
"providerUpinNumber": "<string>",
"taxonomyCode": "<string>",
"firstName": "<string>",
"lastName": "<string>",
"middleName": "<string>",
"suffix": "<string>",
"organizationName": "<string>",
"contactInformation": {
"name": "<string>",
"phoneNumber": "<string>",
"faxNumber": "<string>",
"email": "<string>",
"phoneExtension": "<string>"
}
},
"claimInformation": {
"claimChargeAmount": "<string>",
"healthCareCodeInformation": [{ "diagnosisCode": "<string>" }],
"serviceLines": [
{
"serviceDate": "<string>",
"professionalService": {
"procedureCode": "<string>",
"lineItemChargeAmount": "<string>",
"serviceUnitCount": "<string>",
"compositeDiagnosisCodePointers": { "diagnosisCodePointers": ["<string>"] },
"procedureModifiers": ["<string>"],
"description": "<string>",
"placeOfServiceCode": "<string>",
"emergencyIndicator": "Y",
"epsdtIndicator": "Y",
"familyPlanningIndicator": "Y",
"copayStatusCode": "0"
},
"assignedNumber": "<string>",
"serviceDateEnd": "<string>",
"serviceLineSupplementalInformation": [{ "attachmentControlNumber": "<string>" }],
"ambulanceCertification": [{ "conditionCodes": [] }],
"hospiceEmployeeIndicator": True,
"serviceLineDateInformation": {
"prescriptionDate": "<string>",
"certificationRevisionOrRecertificationDate": "<string>",
"beginTherapyDate": "<string>",
"lastCertificationDate": "<string>",
"treatmentOrTherapyDate": "<string>",
"hemoglobinTestDate": "<string>",
"serumCreatineTestDate": "<string>",
"shippedDate": "<string>",
"lastXRayDate": "<string>",
"initialTreatmentDate": "<string>"
},
"ambulancePatientCount": 123,
"obstetricAnesthesiaAdditionalUnits": 123,
"testResults": [{ "testResults": "<string>" }],
"serviceLineReferenceInformation": {
"repricedLineItemReferenceNumber": "<string>",
"adjustedRepricedLineItemReferenceNumber": "<string>",
"priorAuthorization": [
{
"priorAuthorizationOrReferralNumber": "<string>",
"otherPayerPrimaryIdentifier": "<string>"
}
],
"mammographyCertificationNumber": "<string>",
"clinicalLaboratoryImprovementAmendmentNumber": "<string>",
"referringCliaNumber": "<string>",
"immunizationBatchNumber": "<string>",
"referralNumber": ["<string>"]
},
"salesTaxAmount": "<string>",
"postageTaxAmount": "<string>",
"fileInformation": ["<string>"],
"additionalNotes": "<string>",
"goalRehabOrDischargePlans": "<string>",
"thirdPartyOrganizationNotes": "<string>",
"purchasedServiceProvider": {
"providerType": "<string>",
"npi": "<string>",
"stateLicenseNumber": "<string>",
"commercialNumber": "<string>",
"payerIdentificationNumber": "<string>",
"ssn": "<string>",
"employerId": "<string>",
"locationNumber": "<string>",
"employerIdentificationNumber": "<string>",
"claimOfficeNumber": "<string>",
"naic": "<string>",
"providerUpinNumber": "<string>",
"taxonomyCode": "<string>",
"firstName": "<string>",
"lastName": "<string>",
"middleName": "<string>",
"suffix": "<string>",
"organizationName": "<string>",
"contactInformation": {
"name": "<string>",
"phoneNumber": "<string>",
"faxNumber": "<string>",
"email": "<string>",
"phoneExtension": "<string>"
},
"otherIdentifier": "<string>",
"secondaryIdentifier": [
{
"qualifier": "<string>",
"identifier": "<string>",
"otherIdentifier": "<string>"
}
]
},
"orderingProvider": {
"providerType": "<string>",
"npi": "<string>",
"ssn": "<string>",
"employerId": "<string>",
"commercialNumber": "<string>",
"locationNumber": "<string>",
"payerIdentificationNumber": "<string>",
"employerIdentificationNumber": "<string>",
"claimOfficeNumber": "<string>",
"naic": "<string>",
"stateLicenseNumber": "<string>",
"providerUpinNumber": "<string>",
"taxonomyCode": "<string>",
"firstName": "<string>",
"lastName": "<string>",
"middleName": "<string>",
"suffix": "<string>",
"organizationName": "<string>",
"otherIdentifier": "<string>",
"secondaryIdentifier": [
{
"qualifier": "<string>",
"identifier": "<string>",
"otherIdentifier": "<string>"
}
]
},
"lineAdjudicationInformation": [
{
"otherPayerPrimaryIdentifier": "<string>",
"serviceLinePaidAmount": "<string>",
"procedureCode": "<string>",
"paidServiceUnitCount": "<string>",
"adjudicationOrPaymentDate": "<string>",
"procedureModifier": ["<string>"],
"procedureCodeDescription": "<string>",
"bundledOrUnbundledLineNumber": "<string>",
"claimAdjustmentInformation": [{ "adjustmentDetails": [
{
"adjustmentReasonCode": "<string>",
"adjustmentAmount": "<string>",
"adjustmentQuantity": "<string>"
}
] }],
"remainingPatientLiability": "<string>"
}
],
"formIdentification": [
{
"formIdentifier": "<string>",
"supportingDocumentation": [
{
"questionNumber": "<string>",
"questionResponse": "<string>",
"questionResponseAsDate": "<string>",
"questionResponseAsPercent": "<string>"
}
]
}
]
}
],
"propertyCasualtyClaimNumber": "<string>",
"relatedCausesCode": [],
"autoAccidentStateCode": "<string>",
"autoAccidentCountryCode": "<string>",
"patientAmountPaid": "<string>",
"fileInformation": "<string>",
"fileInformationList": ["<string>"],
"deathDate": "<string>",
"patientWeight": "<string>",
"patientSignatureSourceCode": True,
"pregnancyIndicator": "Y",
"claimDateInformation": {
"symptomDate": "<string>",
"initialTreatmentDate": "<string>",
"lastSeenDate": "<string>",
"acuteManifestationDate": "<string>",
"accidentDate": "<string>",
"lastMenstrualPeriodDate": "<string>",
"lastXRayDate": "<string>",
"hearingAndVisionPrescriptionDate": "<string>",
"disabilityBeginDate": "<string>",
"disabilityEndDate": "<string>",
"lastWorkedDate": "<string>",
"authorizedReturnToWorkDate": "<string>",
"admissionDate": "<string>",
"dischargeDate": "<string>",
"assumedAndRelinquishedCareBeginDate": "<string>",
"assumedAndRelinquishedCareEndDate": "<string>",
"repricerReceivedDate": "<string>",
"firstContactDate": "<string>"
},
"claimSupplementalInformation": {
"reportInformations": [{ "attachmentControlNumber": "<string>" }],
"priorAuthorizationNumber": "<string>",
"referralNumber": "<string>",
"claimControlNumber": "<string>",
"cliaNumber": "<string>",
"repricedClaimNumber": "<string>",
"adjustedRepricedClaimNumber": "<string>",
"investigationalDeviceExemptionNumber": "<string>",
"claimNumber": "<string>",
"mammographyCertificationNumber": "<string>",
"medicalRecordNumber": "<string>",
"demoProjectIdentifier": "<string>",
"carePlanOversightNumber": "<string>",
"medicareCrossoverReferenceId": "<string>"
},
"ambulanceCertification": [{ "conditionCodes": [] }],
"patientConditionInformationVision": [{ "conditionCodes": [] }],
"homeboundIndicator": True,
"anesthesiaRelatedSurgicalProcedure": ["<string>"],
"conditionInformation": [{ "conditionCodes": ["<string>"] }],
"claimNote": {
"additionalInformation": "<string>",
"certificationNarrative": "<string>",
"goalRehabOrDischargePlans": "<string>",
"diagnosisDescription": "<string>",
"thirdPartOrgNotes": "<string>"
},
"otherSubscriberInformation": [
{
"otherSubscriberName": {
"otherInsuredLastName": "<string>",
"otherInsuredIdentifier": "<string>",
"otherInsuredFirstName": "<string>",
"otherInsuredMiddleName": "<string>",
"otherInsuredNameSuffix": "<string>",
"otherInsuredAdditionalIdentifier": "<string>"
},
"otherPayerName": {
"otherPayerOrganizationName": "<string>",
"otherPayerIdentifier": "<string>",
"otherPayerAdjudicationOrPaymentDate": "<string>",
"otherPayerSecondaryIdentifier": [
{
"qualifier": "<string>",
"identifier": "<string>",
"otherIdentifier": "<string>"
}
],
"otherPayerPriorAuthorizationNumber": "<string>",
"otherPayerPriorAuthorizationOrReferralNumber": "<string>",
"otherPayerClaimAdjustmentIndicator": True,
"otherPayerClaimControlNumber": "<string>"
},
"insuranceGroupOrPolicyNumber": "<string>",
"otherInsuredGroupName": "<string>",
"claimLevelAdjustments": [{ "adjustmentDetails": [
{
"adjustmentReasonCode": "<string>",
"adjustmentAmount": "<string>",
"adjustmentQuantity": "<string>"
}
] }],
"payerPaidAmount": "<string>",
"nonCoveredChargeAmount": "<string>",
"remainingPatientLiability": "<string>",
"otherPayerReferringProvider": [{ "otherPayerReferringProviderIdentifier": [
{
"qualifier": "<string>",
"identifier": "<string>",
"otherIdentifier": "<string>"
}
] }],
"otherPayerRenderingProvider": [{ "otherPayerRenderingProviderSecondaryIdentifier": [
{
"qualifier": "<string>",
"identifier": "<string>",
"otherIdentifier": "<string>"
}
] }],
"otherPayerServiceFacilityLocation": [{ "otherPayerServiceFacilityLocationSecondaryIdentifier": [
{
"qualifier": "<string>",
"identifier": "<string>",
"otherIdentifier": "<string>"
}
] }],
"otherPayerSupervisingProvider": [{ "otherPayerSupervisingProviderIdentifier": [
{
"qualifier": "<string>",
"identifier": "<string>",
"otherIdentifier": "<string>"
}
] }],
"otherPayerBillingProvider": [{ "otherPayerBillingProviderIdentifier": [
{
"qualifier": "<string>",
"identifier": "<string>",
"otherIdentifier": "<string>"
}
] }],
"patientSignatureGeneratedForPatient": True,
"medicareOutpatientAdjudication": {
"reimbursementRate": "<string>",
"hcpcsPayableAmount": "<string>",
"claimPaymentRemarkCode": ["<string>"],
"endStageRenalDiseasePaymentAmount": "<string>",
"nonPayableProfessionalComponentBilledAmount": "<string>"
}
}
]
},
"isTesting": True,
"controlNumber": "<string>",
"providers": [
{
"providerType": "<string>",
"npi": "<string>",
"ssn": "<string>",
"employerId": "<string>",
"commercialNumber": "<string>",
"locationNumber": "<string>",
"stateLicenseNumber": "<string>",
"providerUpinNumber": "<string>",
"taxonomyCode": "<string>",
"firstName": "<string>",
"lastName": "<string>",
"middleName": "<string>",
"suffix": "<string>",
"organizationName": "<string>",
"contactInformation": {
"name": "<string>",
"phoneNumber": "<string>",
"faxNumber": "<string>",
"email": "<string>",
"phoneExtension": "<string>"
}
}
],
"referring": {
"providerType": "<string>",
"npi": "<string>",
"commercialNumber": "<string>",
"stateLicenseNumber": "<string>",
"providerUpinNumber": "<string>",
"taxonomyCode": "<string>",
"firstName": "<string>",
"lastName": "<string>",
"middleName": "<string>",
"suffix": "<string>",
"organizationName": "<string>",
"contactInformation": {
"name": "<string>",
"phoneNumber": "<string>",
"faxNumber": "<string>",
"email": "<string>",
"phoneExtension": "<string>"
}
},
"rendering": {
"providerType": "<string>",
"npi": "<string>",
"commercialNumber": "<string>",
"locationNumber": "<string>",
"stateLicenseNumber": "<string>",
"providerUpinNumber": "<string>",
"taxonomyCode": "<string>",
"firstName": "<string>",
"lastName": "<string>",
"middleName": "<string>",
"suffix": "<string>",
"organizationName": "<string>",
"contactInformation": {
"name": "<string>",
"phoneNumber": "<string>",
"faxNumber": "<string>",
"email": "<string>",
"phoneExtension": "<string>"
}
},
"ordering": {
"providerType": "<string>",
"npi": "<string>",
"ssn": "<string>",
"employerId": "<string>",
"commercialNumber": "<string>",
"locationNumber": "<string>",
"payerIdentificationNumber": "<string>",
"employerIdentificationNumber": "<string>",
"claimOfficeNumber": "<string>",
"naic": "<string>",
"stateLicenseNumber": "<string>",
"providerUpinNumber": "<string>",
"taxonomyCode": "<string>",
"firstName": "<string>",
"lastName": "<string>",
"middleName": "<string>",
"suffix": "<string>",
"organizationName": "<string>",
"contactInformation": {
"name": "<string>",
"phoneNumber": "<string>",
"faxNumber": "<string>",
"email": "<string>",
"phoneExtension": "<string>"
}
},
"supervising": {
"providerType": "<string>",
"npi": "<string>",
"ssn": "<string>",
"employerId": "<string>",
"commercialNumber": "<string>",
"locationNumber": "<string>",
"stateLicenseNumber": "<string>",
"providerUpinNumber": "<string>",
"taxonomyCode": "<string>",
"firstName": "<string>",
"lastName": "<string>",
"middleName": "<string>",
"suffix": "<string>",
"organizationName": "<string>",
"contactInformation": {
"name": "<string>",
"phoneNumber": "<string>",
"faxNumber": "<string>",
"email": "<string>",
"phoneExtension": "<string>"
}
},
"tradingPartnerName": "<string>"
}
headers = {"Content-Type": "application/json"}
response = requests.post(url, json=payload, headers=headers)
print(response.text)const options = {
method: 'POST',
headers: {'Content-Type': 'application/json'},
body: JSON.stringify({
tradingPartnerServiceId: '<string>',
submitter: {
contactInformation: {
name: '<string>',
phoneNumber: '<string>',
faxNumber: '<string>',
email: '<string>',
phoneExtension: '<string>'
},
organizationName: '<string>',
lastName: '<string>',
firstName: '<string>',
middleName: '<string>',
submitterIdentification: '<string>'
},
receiver: {organizationName: '<string>'},
subscriber: {
memberId: '<string>',
ssn: '<string>',
organizationName: '<string>',
subscriberGroupName: '<string>',
firstName: '<string>',
lastName: '<string>',
middleName: '<string>',
suffix: '<string>',
dateOfBirth: '<string>',
policyNumber: '<string>',
groupNumber: '<string>'
},
billing: {
providerType: '<string>',
npi: '<string>',
ssn: '<string>',
employerId: '<string>',
commercialNumber: '<string>',
locationNumber: '<string>',
stateLicenseNumber: '<string>',
providerUpinNumber: '<string>',
taxonomyCode: '<string>',
firstName: '<string>',
lastName: '<string>',
middleName: '<string>',
suffix: '<string>',
organizationName: '<string>',
contactInformation: {
name: '<string>',
phoneNumber: '<string>',
faxNumber: '<string>',
email: '<string>',
phoneExtension: '<string>'
}
},
claimInformation: {
claimChargeAmount: '<string>',
healthCareCodeInformation: [{diagnosisCode: '<string>'}],
serviceLines: [
{
serviceDate: '<string>',
professionalService: {
procedureCode: '<string>',
lineItemChargeAmount: '<string>',
serviceUnitCount: '<string>',
compositeDiagnosisCodePointers: {diagnosisCodePointers: ['<string>']},
procedureModifiers: ['<string>'],
description: '<string>',
placeOfServiceCode: '<string>',
emergencyIndicator: 'Y',
epsdtIndicator: 'Y',
familyPlanningIndicator: 'Y',
copayStatusCode: '0'
},
assignedNumber: '<string>',
serviceDateEnd: '<string>',
serviceLineSupplementalInformation: [{attachmentControlNumber: '<string>'}],
ambulanceCertification: [{conditionCodes: []}],
hospiceEmployeeIndicator: true,
serviceLineDateInformation: {
prescriptionDate: '<string>',
certificationRevisionOrRecertificationDate: '<string>',
beginTherapyDate: '<string>',
lastCertificationDate: '<string>',
treatmentOrTherapyDate: '<string>',
hemoglobinTestDate: '<string>',
serumCreatineTestDate: '<string>',
shippedDate: '<string>',
lastXRayDate: '<string>',
initialTreatmentDate: '<string>'
},
ambulancePatientCount: 123,
obstetricAnesthesiaAdditionalUnits: 123,
testResults: [{testResults: '<string>'}],
serviceLineReferenceInformation: {
repricedLineItemReferenceNumber: '<string>',
adjustedRepricedLineItemReferenceNumber: '<string>',
priorAuthorization: [
{
priorAuthorizationOrReferralNumber: '<string>',
otherPayerPrimaryIdentifier: '<string>'
}
],
mammographyCertificationNumber: '<string>',
clinicalLaboratoryImprovementAmendmentNumber: '<string>',
referringCliaNumber: '<string>',
immunizationBatchNumber: '<string>',
referralNumber: ['<string>']
},
salesTaxAmount: '<string>',
postageTaxAmount: '<string>',
fileInformation: ['<string>'],
additionalNotes: '<string>',
goalRehabOrDischargePlans: '<string>',
thirdPartyOrganizationNotes: '<string>',
purchasedServiceProvider: {
providerType: '<string>',
npi: '<string>',
stateLicenseNumber: '<string>',
commercialNumber: '<string>',
payerIdentificationNumber: '<string>',
ssn: '<string>',
employerId: '<string>',
locationNumber: '<string>',
employerIdentificationNumber: '<string>',
claimOfficeNumber: '<string>',
naic: '<string>',
providerUpinNumber: '<string>',
taxonomyCode: '<string>',
firstName: '<string>',
lastName: '<string>',
middleName: '<string>',
suffix: '<string>',
organizationName: '<string>',
contactInformation: {
name: '<string>',
phoneNumber: '<string>',
faxNumber: '<string>',
email: '<string>',
phoneExtension: '<string>'
},
otherIdentifier: '<string>',
secondaryIdentifier: [{qualifier: '<string>', identifier: '<string>', otherIdentifier: '<string>'}]
},
orderingProvider: {
providerType: '<string>',
npi: '<string>',
ssn: '<string>',
employerId: '<string>',
commercialNumber: '<string>',
locationNumber: '<string>',
payerIdentificationNumber: '<string>',
employerIdentificationNumber: '<string>',
claimOfficeNumber: '<string>',
naic: '<string>',
stateLicenseNumber: '<string>',
providerUpinNumber: '<string>',
taxonomyCode: '<string>',
firstName: '<string>',
lastName: '<string>',
middleName: '<string>',
suffix: '<string>',
organizationName: '<string>',
otherIdentifier: '<string>',
secondaryIdentifier: [{qualifier: '<string>', identifier: '<string>', otherIdentifier: '<string>'}]
},
lineAdjudicationInformation: [
{
otherPayerPrimaryIdentifier: '<string>',
serviceLinePaidAmount: '<string>',
procedureCode: '<string>',
paidServiceUnitCount: '<string>',
adjudicationOrPaymentDate: '<string>',
procedureModifier: ['<string>'],
procedureCodeDescription: '<string>',
bundledOrUnbundledLineNumber: '<string>',
claimAdjustmentInformation: [
{
adjustmentDetails: [
{
adjustmentReasonCode: '<string>',
adjustmentAmount: '<string>',
adjustmentQuantity: '<string>'
}
]
}
],
remainingPatientLiability: '<string>'
}
],
formIdentification: [
{
formIdentifier: '<string>',
supportingDocumentation: [
{
questionNumber: '<string>',
questionResponse: '<string>',
questionResponseAsDate: '<string>',
questionResponseAsPercent: '<string>'
}
]
}
]
}
],
propertyCasualtyClaimNumber: '<string>',
relatedCausesCode: [],
autoAccidentStateCode: '<string>',
autoAccidentCountryCode: '<string>',
patientAmountPaid: '<string>',
fileInformation: '<string>',
fileInformationList: ['<string>'],
deathDate: '<string>',
patientWeight: '<string>',
patientSignatureSourceCode: true,
pregnancyIndicator: 'Y',
claimDateInformation: {
symptomDate: '<string>',
initialTreatmentDate: '<string>',
lastSeenDate: '<string>',
acuteManifestationDate: '<string>',
accidentDate: '<string>',
lastMenstrualPeriodDate: '<string>',
lastXRayDate: '<string>',
hearingAndVisionPrescriptionDate: '<string>',
disabilityBeginDate: '<string>',
disabilityEndDate: '<string>',
lastWorkedDate: '<string>',
authorizedReturnToWorkDate: '<string>',
admissionDate: '<string>',
dischargeDate: '<string>',
assumedAndRelinquishedCareBeginDate: '<string>',
assumedAndRelinquishedCareEndDate: '<string>',
repricerReceivedDate: '<string>',
firstContactDate: '<string>'
},
claimSupplementalInformation: {
reportInformations: [{attachmentControlNumber: '<string>'}],
priorAuthorizationNumber: '<string>',
referralNumber: '<string>',
claimControlNumber: '<string>',
cliaNumber: '<string>',
repricedClaimNumber: '<string>',
adjustedRepricedClaimNumber: '<string>',
investigationalDeviceExemptionNumber: '<string>',
claimNumber: '<string>',
mammographyCertificationNumber: '<string>',
medicalRecordNumber: '<string>',
demoProjectIdentifier: '<string>',
carePlanOversightNumber: '<string>',
medicareCrossoverReferenceId: '<string>'
},
ambulanceCertification: [{conditionCodes: []}],
patientConditionInformationVision: [{conditionCodes: []}],
homeboundIndicator: true,
anesthesiaRelatedSurgicalProcedure: ['<string>'],
conditionInformation: [{conditionCodes: ['<string>']}],
claimNote: {
additionalInformation: '<string>',
certificationNarrative: '<string>',
goalRehabOrDischargePlans: '<string>',
diagnosisDescription: '<string>',
thirdPartOrgNotes: '<string>'
},
otherSubscriberInformation: [
{
otherSubscriberName: {
otherInsuredLastName: '<string>',
otherInsuredIdentifier: '<string>',
otherInsuredFirstName: '<string>',
otherInsuredMiddleName: '<string>',
otherInsuredNameSuffix: '<string>',
otherInsuredAdditionalIdentifier: '<string>'
},
otherPayerName: {
otherPayerOrganizationName: '<string>',
otherPayerIdentifier: '<string>',
otherPayerAdjudicationOrPaymentDate: '<string>',
otherPayerSecondaryIdentifier: [{qualifier: '<string>', identifier: '<string>', otherIdentifier: '<string>'}],
otherPayerPriorAuthorizationNumber: '<string>',
otherPayerPriorAuthorizationOrReferralNumber: '<string>',
otherPayerClaimAdjustmentIndicator: true,
otherPayerClaimControlNumber: '<string>'
},
insuranceGroupOrPolicyNumber: '<string>',
otherInsuredGroupName: '<string>',
claimLevelAdjustments: [
{
adjustmentDetails: [
{
adjustmentReasonCode: '<string>',
adjustmentAmount: '<string>',
adjustmentQuantity: '<string>'
}
]
}
],
payerPaidAmount: '<string>',
nonCoveredChargeAmount: '<string>',
remainingPatientLiability: '<string>',
otherPayerReferringProvider: [
{
otherPayerReferringProviderIdentifier: [{qualifier: '<string>', identifier: '<string>', otherIdentifier: '<string>'}]
}
],
otherPayerRenderingProvider: [
{
otherPayerRenderingProviderSecondaryIdentifier: [{qualifier: '<string>', identifier: '<string>', otherIdentifier: '<string>'}]
}
],
otherPayerServiceFacilityLocation: [
{
otherPayerServiceFacilityLocationSecondaryIdentifier: [{qualifier: '<string>', identifier: '<string>', otherIdentifier: '<string>'}]
}
],
otherPayerSupervisingProvider: [
{
otherPayerSupervisingProviderIdentifier: [{qualifier: '<string>', identifier: '<string>', otherIdentifier: '<string>'}]
}
],
otherPayerBillingProvider: [
{
otherPayerBillingProviderIdentifier: [{qualifier: '<string>', identifier: '<string>', otherIdentifier: '<string>'}]
}
],
patientSignatureGeneratedForPatient: true,
medicareOutpatientAdjudication: {
reimbursementRate: '<string>',
hcpcsPayableAmount: '<string>',
claimPaymentRemarkCode: ['<string>'],
endStageRenalDiseasePaymentAmount: '<string>',
nonPayableProfessionalComponentBilledAmount: '<string>'
}
}
]
},
isTesting: true,
controlNumber: '<string>',
providers: [
{
providerType: '<string>',
npi: '<string>',
ssn: '<string>',
employerId: '<string>',
commercialNumber: '<string>',
locationNumber: '<string>',
stateLicenseNumber: '<string>',
providerUpinNumber: '<string>',
taxonomyCode: '<string>',
firstName: '<string>',
lastName: '<string>',
middleName: '<string>',
suffix: '<string>',
organizationName: '<string>',
contactInformation: {
name: '<string>',
phoneNumber: '<string>',
faxNumber: '<string>',
email: '<string>',
phoneExtension: '<string>'
}
}
],
referring: {
providerType: '<string>',
npi: '<string>',
commercialNumber: '<string>',
stateLicenseNumber: '<string>',
providerUpinNumber: '<string>',
taxonomyCode: '<string>',
firstName: '<string>',
lastName: '<string>',
middleName: '<string>',
suffix: '<string>',
organizationName: '<string>',
contactInformation: {
name: '<string>',
phoneNumber: '<string>',
faxNumber: '<string>',
email: '<string>',
phoneExtension: '<string>'
}
},
rendering: {
providerType: '<string>',
npi: '<string>',
commercialNumber: '<string>',
locationNumber: '<string>',
stateLicenseNumber: '<string>',
providerUpinNumber: '<string>',
taxonomyCode: '<string>',
firstName: '<string>',
lastName: '<string>',
middleName: '<string>',
suffix: '<string>',
organizationName: '<string>',
contactInformation: {
name: '<string>',
phoneNumber: '<string>',
faxNumber: '<string>',
email: '<string>',
phoneExtension: '<string>'
}
},
ordering: {
providerType: '<string>',
npi: '<string>',
ssn: '<string>',
employerId: '<string>',
commercialNumber: '<string>',
locationNumber: '<string>',
payerIdentificationNumber: '<string>',
employerIdentificationNumber: '<string>',
claimOfficeNumber: '<string>',
naic: '<string>',
stateLicenseNumber: '<string>',
providerUpinNumber: '<string>',
taxonomyCode: '<string>',
firstName: '<string>',
lastName: '<string>',
middleName: '<string>',
suffix: '<string>',
organizationName: '<string>',
contactInformation: {
name: '<string>',
phoneNumber: '<string>',
faxNumber: '<string>',
email: '<string>',
phoneExtension: '<string>'
}
},
supervising: {
providerType: '<string>',
npi: '<string>',
ssn: '<string>',
employerId: '<string>',
commercialNumber: '<string>',
locationNumber: '<string>',
stateLicenseNumber: '<string>',
providerUpinNumber: '<string>',
taxonomyCode: '<string>',
firstName: '<string>',
lastName: '<string>',
middleName: '<string>',
suffix: '<string>',
organizationName: '<string>',
contactInformation: {
name: '<string>',
phoneNumber: '<string>',
faxNumber: '<string>',
email: '<string>',
phoneExtension: '<string>'
}
},
tradingPartnerName: '<string>'
})
};
fetch('https://api.example.com/api/v2/clearinghouse/claim', options)
.then(res => res.json())
.then(res => console.log(res))
.catch(err => console.error(err));<?php
$curl = curl_init();
curl_setopt_array($curl, [
CURLOPT_URL => "https://api.example.com/api/v2/clearinghouse/claim",
CURLOPT_RETURNTRANSFER => true,
CURLOPT_ENCODING => "",
CURLOPT_MAXREDIRS => 10,
CURLOPT_TIMEOUT => 30,
CURLOPT_HTTP_VERSION => CURL_HTTP_VERSION_1_1,
CURLOPT_CUSTOMREQUEST => "POST",
CURLOPT_POSTFIELDS => json_encode([
'tradingPartnerServiceId' => '<string>',
'submitter' => [
'contactInformation' => [
'name' => '<string>',
'phoneNumber' => '<string>',
'faxNumber' => '<string>',
'email' => '<string>',
'phoneExtension' => '<string>'
],
'organizationName' => '<string>',
'lastName' => '<string>',
'firstName' => '<string>',
'middleName' => '<string>',
'submitterIdentification' => '<string>'
],
'receiver' => [
'organizationName' => '<string>'
],
'subscriber' => [
'memberId' => '<string>',
'ssn' => '<string>',
'organizationName' => '<string>',
'subscriberGroupName' => '<string>',
'firstName' => '<string>',
'lastName' => '<string>',
'middleName' => '<string>',
'suffix' => '<string>',
'dateOfBirth' => '<string>',
'policyNumber' => '<string>',
'groupNumber' => '<string>'
],
'billing' => [
'providerType' => '<string>',
'npi' => '<string>',
'ssn' => '<string>',
'employerId' => '<string>',
'commercialNumber' => '<string>',
'locationNumber' => '<string>',
'stateLicenseNumber' => '<string>',
'providerUpinNumber' => '<string>',
'taxonomyCode' => '<string>',
'firstName' => '<string>',
'lastName' => '<string>',
'middleName' => '<string>',
'suffix' => '<string>',
'organizationName' => '<string>',
'contactInformation' => [
'name' => '<string>',
'phoneNumber' => '<string>',
'faxNumber' => '<string>',
'email' => '<string>',
'phoneExtension' => '<string>'
]
],
'claimInformation' => [
'claimChargeAmount' => '<string>',
'healthCareCodeInformation' => [
[
'diagnosisCode' => '<string>'
]
],
'serviceLines' => [
[
'serviceDate' => '<string>',
'professionalService' => [
'procedureCode' => '<string>',
'lineItemChargeAmount' => '<string>',
'serviceUnitCount' => '<string>',
'compositeDiagnosisCodePointers' => [
'diagnosisCodePointers' => [
'<string>'
]
],
'procedureModifiers' => [
'<string>'
],
'description' => '<string>',
'placeOfServiceCode' => '<string>',
'emergencyIndicator' => 'Y',
'epsdtIndicator' => 'Y',
'familyPlanningIndicator' => 'Y',
'copayStatusCode' => '0'
],
'assignedNumber' => '<string>',
'serviceDateEnd' => '<string>',
'serviceLineSupplementalInformation' => [
[
'attachmentControlNumber' => '<string>'
]
],
'ambulanceCertification' => [
[
'conditionCodes' => [
]
]
],
'hospiceEmployeeIndicator' => true,
'serviceLineDateInformation' => [
'prescriptionDate' => '<string>',
'certificationRevisionOrRecertificationDate' => '<string>',
'beginTherapyDate' => '<string>',
'lastCertificationDate' => '<string>',
'treatmentOrTherapyDate' => '<string>',
'hemoglobinTestDate' => '<string>',
'serumCreatineTestDate' => '<string>',
'shippedDate' => '<string>',
'lastXRayDate' => '<string>',
'initialTreatmentDate' => '<string>'
],
'ambulancePatientCount' => 123,
'obstetricAnesthesiaAdditionalUnits' => 123,
'testResults' => [
[
'testResults' => '<string>'
]
],
'serviceLineReferenceInformation' => [
'repricedLineItemReferenceNumber' => '<string>',
'adjustedRepricedLineItemReferenceNumber' => '<string>',
'priorAuthorization' => [
[
'priorAuthorizationOrReferralNumber' => '<string>',
'otherPayerPrimaryIdentifier' => '<string>'
]
],
'mammographyCertificationNumber' => '<string>',
'clinicalLaboratoryImprovementAmendmentNumber' => '<string>',
'referringCliaNumber' => '<string>',
'immunizationBatchNumber' => '<string>',
'referralNumber' => [
'<string>'
]
],
'salesTaxAmount' => '<string>',
'postageTaxAmount' => '<string>',
'fileInformation' => [
'<string>'
],
'additionalNotes' => '<string>',
'goalRehabOrDischargePlans' => '<string>',
'thirdPartyOrganizationNotes' => '<string>',
'purchasedServiceProvider' => [
'providerType' => '<string>',
'npi' => '<string>',
'stateLicenseNumber' => '<string>',
'commercialNumber' => '<string>',
'payerIdentificationNumber' => '<string>',
'ssn' => '<string>',
'employerId' => '<string>',
'locationNumber' => '<string>',
'employerIdentificationNumber' => '<string>',
'claimOfficeNumber' => '<string>',
'naic' => '<string>',
'providerUpinNumber' => '<string>',
'taxonomyCode' => '<string>',
'firstName' => '<string>',
'lastName' => '<string>',
'middleName' => '<string>',
'suffix' => '<string>',
'organizationName' => '<string>',
'contactInformation' => [
'name' => '<string>',
'phoneNumber' => '<string>',
'faxNumber' => '<string>',
'email' => '<string>',
'phoneExtension' => '<string>'
],
'otherIdentifier' => '<string>',
'secondaryIdentifier' => [
[
'qualifier' => '<string>',
'identifier' => '<string>',
'otherIdentifier' => '<string>'
]
]
],
'orderingProvider' => [
'providerType' => '<string>',
'npi' => '<string>',
'ssn' => '<string>',
'employerId' => '<string>',
'commercialNumber' => '<string>',
'locationNumber' => '<string>',
'payerIdentificationNumber' => '<string>',
'employerIdentificationNumber' => '<string>',
'claimOfficeNumber' => '<string>',
'naic' => '<string>',
'stateLicenseNumber' => '<string>',
'providerUpinNumber' => '<string>',
'taxonomyCode' => '<string>',
'firstName' => '<string>',
'lastName' => '<string>',
'middleName' => '<string>',
'suffix' => '<string>',
'organizationName' => '<string>',
'otherIdentifier' => '<string>',
'secondaryIdentifier' => [
[
'qualifier' => '<string>',
'identifier' => '<string>',
'otherIdentifier' => '<string>'
]
]
],
'lineAdjudicationInformation' => [
[
'otherPayerPrimaryIdentifier' => '<string>',
'serviceLinePaidAmount' => '<string>',
'procedureCode' => '<string>',
'paidServiceUnitCount' => '<string>',
'adjudicationOrPaymentDate' => '<string>',
'procedureModifier' => [
'<string>'
],
'procedureCodeDescription' => '<string>',
'bundledOrUnbundledLineNumber' => '<string>',
'claimAdjustmentInformation' => [
[
'adjustmentDetails' => [
[
'adjustmentReasonCode' => '<string>',
'adjustmentAmount' => '<string>',
'adjustmentQuantity' => '<string>'
]
]
]
],
'remainingPatientLiability' => '<string>'
]
],
'formIdentification' => [
[
'formIdentifier' => '<string>',
'supportingDocumentation' => [
[
'questionNumber' => '<string>',
'questionResponse' => '<string>',
'questionResponseAsDate' => '<string>',
'questionResponseAsPercent' => '<string>'
]
]
]
]
]
],
'propertyCasualtyClaimNumber' => '<string>',
'relatedCausesCode' => [
],
'autoAccidentStateCode' => '<string>',
'autoAccidentCountryCode' => '<string>',
'patientAmountPaid' => '<string>',
'fileInformation' => '<string>',
'fileInformationList' => [
'<string>'
],
'deathDate' => '<string>',
'patientWeight' => '<string>',
'patientSignatureSourceCode' => true,
'pregnancyIndicator' => 'Y',
'claimDateInformation' => [
'symptomDate' => '<string>',
'initialTreatmentDate' => '<string>',
'lastSeenDate' => '<string>',
'acuteManifestationDate' => '<string>',
'accidentDate' => '<string>',
'lastMenstrualPeriodDate' => '<string>',
'lastXRayDate' => '<string>',
'hearingAndVisionPrescriptionDate' => '<string>',
'disabilityBeginDate' => '<string>',
'disabilityEndDate' => '<string>',
'lastWorkedDate' => '<string>',
'authorizedReturnToWorkDate' => '<string>',
'admissionDate' => '<string>',
'dischargeDate' => '<string>',
'assumedAndRelinquishedCareBeginDate' => '<string>',
'assumedAndRelinquishedCareEndDate' => '<string>',
'repricerReceivedDate' => '<string>',
'firstContactDate' => '<string>'
],
'claimSupplementalInformation' => [
'reportInformations' => [
[
'attachmentControlNumber' => '<string>'
]
],
'priorAuthorizationNumber' => '<string>',
'referralNumber' => '<string>',
'claimControlNumber' => '<string>',
'cliaNumber' => '<string>',
'repricedClaimNumber' => '<string>',
'adjustedRepricedClaimNumber' => '<string>',
'investigationalDeviceExemptionNumber' => '<string>',
'claimNumber' => '<string>',
'mammographyCertificationNumber' => '<string>',
'medicalRecordNumber' => '<string>',
'demoProjectIdentifier' => '<string>',
'carePlanOversightNumber' => '<string>',
'medicareCrossoverReferenceId' => '<string>'
],
'ambulanceCertification' => [
[
'conditionCodes' => [
]
]
],
'patientConditionInformationVision' => [
[
'conditionCodes' => [
]
]
],
'homeboundIndicator' => true,
'anesthesiaRelatedSurgicalProcedure' => [
'<string>'
],
'conditionInformation' => [
[
'conditionCodes' => [
'<string>'
]
]
],
'claimNote' => [
'additionalInformation' => '<string>',
'certificationNarrative' => '<string>',
'goalRehabOrDischargePlans' => '<string>',
'diagnosisDescription' => '<string>',
'thirdPartOrgNotes' => '<string>'
],
'otherSubscriberInformation' => [
[
'otherSubscriberName' => [
'otherInsuredLastName' => '<string>',
'otherInsuredIdentifier' => '<string>',
'otherInsuredFirstName' => '<string>',
'otherInsuredMiddleName' => '<string>',
'otherInsuredNameSuffix' => '<string>',
'otherInsuredAdditionalIdentifier' => '<string>'
],
'otherPayerName' => [
'otherPayerOrganizationName' => '<string>',
'otherPayerIdentifier' => '<string>',
'otherPayerAdjudicationOrPaymentDate' => '<string>',
'otherPayerSecondaryIdentifier' => [
[
'qualifier' => '<string>',
'identifier' => '<string>',
'otherIdentifier' => '<string>'
]
],
'otherPayerPriorAuthorizationNumber' => '<string>',
'otherPayerPriorAuthorizationOrReferralNumber' => '<string>',
'otherPayerClaimAdjustmentIndicator' => true,
'otherPayerClaimControlNumber' => '<string>'
],
'insuranceGroupOrPolicyNumber' => '<string>',
'otherInsuredGroupName' => '<string>',
'claimLevelAdjustments' => [
[
'adjustmentDetails' => [
[
'adjustmentReasonCode' => '<string>',
'adjustmentAmount' => '<string>',
'adjustmentQuantity' => '<string>'
]
]
]
],
'payerPaidAmount' => '<string>',
'nonCoveredChargeAmount' => '<string>',
'remainingPatientLiability' => '<string>',
'otherPayerReferringProvider' => [
[
'otherPayerReferringProviderIdentifier' => [
[
'qualifier' => '<string>',
'identifier' => '<string>',
'otherIdentifier' => '<string>'
]
]
]
],
'otherPayerRenderingProvider' => [
[
'otherPayerRenderingProviderSecondaryIdentifier' => [
[
'qualifier' => '<string>',
'identifier' => '<string>',
'otherIdentifier' => '<string>'
]
]
]
],
'otherPayerServiceFacilityLocation' => [
[
'otherPayerServiceFacilityLocationSecondaryIdentifier' => [
[
'qualifier' => '<string>',
'identifier' => '<string>',
'otherIdentifier' => '<string>'
]
]
]
],
'otherPayerSupervisingProvider' => [
[
'otherPayerSupervisingProviderIdentifier' => [
[
'qualifier' => '<string>',
'identifier' => '<string>',
'otherIdentifier' => '<string>'
]
]
]
],
'otherPayerBillingProvider' => [
[
'otherPayerBillingProviderIdentifier' => [
[
'qualifier' => '<string>',
'identifier' => '<string>',
'otherIdentifier' => '<string>'
]
]
]
],
'patientSignatureGeneratedForPatient' => true,
'medicareOutpatientAdjudication' => [
'reimbursementRate' => '<string>',
'hcpcsPayableAmount' => '<string>',
'claimPaymentRemarkCode' => [
'<string>'
],
'endStageRenalDiseasePaymentAmount' => '<string>',
'nonPayableProfessionalComponentBilledAmount' => '<string>'
]
]
]
],
'isTesting' => true,
'controlNumber' => '<string>',
'providers' => [
[
'providerType' => '<string>',
'npi' => '<string>',
'ssn' => '<string>',
'employerId' => '<string>',
'commercialNumber' => '<string>',
'locationNumber' => '<string>',
'stateLicenseNumber' => '<string>',
'providerUpinNumber' => '<string>',
'taxonomyCode' => '<string>',
'firstName' => '<string>',
'lastName' => '<string>',
'middleName' => '<string>',
'suffix' => '<string>',
'organizationName' => '<string>',
'contactInformation' => [
'name' => '<string>',
'phoneNumber' => '<string>',
'faxNumber' => '<string>',
'email' => '<string>',
'phoneExtension' => '<string>'
]
]
],
'referring' => [
'providerType' => '<string>',
'npi' => '<string>',
'commercialNumber' => '<string>',
'stateLicenseNumber' => '<string>',
'providerUpinNumber' => '<string>',
'taxonomyCode' => '<string>',
'firstName' => '<string>',
'lastName' => '<string>',
'middleName' => '<string>',
'suffix' => '<string>',
'organizationName' => '<string>',
'contactInformation' => [
'name' => '<string>',
'phoneNumber' => '<string>',
'faxNumber' => '<string>',
'email' => '<string>',
'phoneExtension' => '<string>'
]
],
'rendering' => [
'providerType' => '<string>',
'npi' => '<string>',
'commercialNumber' => '<string>',
'locationNumber' => '<string>',
'stateLicenseNumber' => '<string>',
'providerUpinNumber' => '<string>',
'taxonomyCode' => '<string>',
'firstName' => '<string>',
'lastName' => '<string>',
'middleName' => '<string>',
'suffix' => '<string>',
'organizationName' => '<string>',
'contactInformation' => [
'name' => '<string>',
'phoneNumber' => '<string>',
'faxNumber' => '<string>',
'email' => '<string>',
'phoneExtension' => '<string>'
]
],
'ordering' => [
'providerType' => '<string>',
'npi' => '<string>',
'ssn' => '<string>',
'employerId' => '<string>',
'commercialNumber' => '<string>',
'locationNumber' => '<string>',
'payerIdentificationNumber' => '<string>',
'employerIdentificationNumber' => '<string>',
'claimOfficeNumber' => '<string>',
'naic' => '<string>',
'stateLicenseNumber' => '<string>',
'providerUpinNumber' => '<string>',
'taxonomyCode' => '<string>',
'firstName' => '<string>',
'lastName' => '<string>',
'middleName' => '<string>',
'suffix' => '<string>',
'organizationName' => '<string>',
'contactInformation' => [
'name' => '<string>',
'phoneNumber' => '<string>',
'faxNumber' => '<string>',
'email' => '<string>',
'phoneExtension' => '<string>'
]
],
'supervising' => [
'providerType' => '<string>',
'npi' => '<string>',
'ssn' => '<string>',
'employerId' => '<string>',
'commercialNumber' => '<string>',
'locationNumber' => '<string>',
'stateLicenseNumber' => '<string>',
'providerUpinNumber' => '<string>',
'taxonomyCode' => '<string>',
'firstName' => '<string>',
'lastName' => '<string>',
'middleName' => '<string>',
'suffix' => '<string>',
'organizationName' => '<string>',
'contactInformation' => [
'name' => '<string>',
'phoneNumber' => '<string>',
'faxNumber' => '<string>',
'email' => '<string>',
'phoneExtension' => '<string>'
]
],
'tradingPartnerName' => '<string>'
]),
CURLOPT_HTTPHEADER => [
"Content-Type: application/json"
],
]);
$response = curl_exec($curl);
$err = curl_error($curl);
curl_close($curl);
if ($err) {
echo "cURL Error #:" . $err;
} else {
echo $response;
}package main
import (
"fmt"
"strings"
"net/http"
"io"
)
func main() {
url := "https://api.example.com/api/v2/clearinghouse/claim"
payload := strings.NewReader("{\n \"tradingPartnerServiceId\": \"<string>\",\n \"submitter\": {\n \"contactInformation\": {\n \"name\": \"<string>\",\n \"phoneNumber\": \"<string>\",\n \"faxNumber\": \"<string>\",\n \"email\": \"<string>\",\n \"phoneExtension\": \"<string>\"\n },\n \"organizationName\": \"<string>\",\n \"lastName\": \"<string>\",\n \"firstName\": \"<string>\",\n \"middleName\": \"<string>\",\n \"submitterIdentification\": \"<string>\"\n },\n \"receiver\": {\n \"organizationName\": \"<string>\"\n },\n \"subscriber\": {\n \"memberId\": \"<string>\",\n \"ssn\": \"<string>\",\n \"organizationName\": \"<string>\",\n \"subscriberGroupName\": \"<string>\",\n \"firstName\": \"<string>\",\n \"lastName\": \"<string>\",\n \"middleName\": \"<string>\",\n \"suffix\": \"<string>\",\n \"dateOfBirth\": \"<string>\",\n \"policyNumber\": \"<string>\",\n \"groupNumber\": \"<string>\"\n },\n \"billing\": {\n \"providerType\": \"<string>\",\n \"npi\": \"<string>\",\n \"ssn\": \"<string>\",\n \"employerId\": \"<string>\",\n \"commercialNumber\": \"<string>\",\n \"locationNumber\": \"<string>\",\n \"stateLicenseNumber\": \"<string>\",\n \"providerUpinNumber\": \"<string>\",\n \"taxonomyCode\": \"<string>\",\n \"firstName\": \"<string>\",\n \"lastName\": \"<string>\",\n \"middleName\": \"<string>\",\n \"suffix\": \"<string>\",\n \"organizationName\": \"<string>\",\n \"contactInformation\": {\n \"name\": \"<string>\",\n \"phoneNumber\": \"<string>\",\n \"faxNumber\": \"<string>\",\n \"email\": \"<string>\",\n \"phoneExtension\": \"<string>\"\n }\n },\n \"claimInformation\": {\n \"claimChargeAmount\": \"<string>\",\n \"healthCareCodeInformation\": [\n {\n \"diagnosisCode\": \"<string>\"\n }\n ],\n \"serviceLines\": [\n {\n \"serviceDate\": \"<string>\",\n \"professionalService\": {\n \"procedureCode\": \"<string>\",\n \"lineItemChargeAmount\": \"<string>\",\n \"serviceUnitCount\": \"<string>\",\n \"compositeDiagnosisCodePointers\": {\n \"diagnosisCodePointers\": [\n \"<string>\"\n ]\n },\n \"procedureModifiers\": [\n \"<string>\"\n ],\n \"description\": \"<string>\",\n \"placeOfServiceCode\": \"<string>\",\n \"emergencyIndicator\": \"Y\",\n \"epsdtIndicator\": \"Y\",\n \"familyPlanningIndicator\": \"Y\",\n \"copayStatusCode\": \"0\"\n },\n \"assignedNumber\": \"<string>\",\n \"serviceDateEnd\": \"<string>\",\n \"serviceLineSupplementalInformation\": [\n {\n \"attachmentControlNumber\": \"<string>\"\n }\n ],\n \"ambulanceCertification\": [\n {\n \"conditionCodes\": []\n }\n ],\n \"hospiceEmployeeIndicator\": true,\n \"serviceLineDateInformation\": {\n \"prescriptionDate\": \"<string>\",\n \"certificationRevisionOrRecertificationDate\": \"<string>\",\n \"beginTherapyDate\": \"<string>\",\n \"lastCertificationDate\": \"<string>\",\n \"treatmentOrTherapyDate\": \"<string>\",\n \"hemoglobinTestDate\": \"<string>\",\n \"serumCreatineTestDate\": \"<string>\",\n \"shippedDate\": \"<string>\",\n \"lastXRayDate\": \"<string>\",\n \"initialTreatmentDate\": \"<string>\"\n },\n \"ambulancePatientCount\": 123,\n \"obstetricAnesthesiaAdditionalUnits\": 123,\n \"testResults\": [\n {\n \"testResults\": \"<string>\"\n }\n ],\n \"serviceLineReferenceInformation\": {\n \"repricedLineItemReferenceNumber\": \"<string>\",\n \"adjustedRepricedLineItemReferenceNumber\": \"<string>\",\n \"priorAuthorization\": [\n {\n \"priorAuthorizationOrReferralNumber\": \"<string>\",\n \"otherPayerPrimaryIdentifier\": \"<string>\"\n }\n ],\n \"mammographyCertificationNumber\": \"<string>\",\n \"clinicalLaboratoryImprovementAmendmentNumber\": \"<string>\",\n \"referringCliaNumber\": \"<string>\",\n \"immunizationBatchNumber\": \"<string>\",\n \"referralNumber\": [\n \"<string>\"\n ]\n },\n \"salesTaxAmount\": \"<string>\",\n \"postageTaxAmount\": \"<string>\",\n \"fileInformation\": [\n \"<string>\"\n ],\n \"additionalNotes\": \"<string>\",\n \"goalRehabOrDischargePlans\": \"<string>\",\n \"thirdPartyOrganizationNotes\": \"<string>\",\n \"purchasedServiceProvider\": {\n \"providerType\": \"<string>\",\n \"npi\": \"<string>\",\n \"stateLicenseNumber\": \"<string>\",\n \"commercialNumber\": \"<string>\",\n \"payerIdentificationNumber\": \"<string>\",\n \"ssn\": \"<string>\",\n \"employerId\": \"<string>\",\n \"locationNumber\": \"<string>\",\n \"employerIdentificationNumber\": \"<string>\",\n \"claimOfficeNumber\": \"<string>\",\n \"naic\": \"<string>\",\n \"providerUpinNumber\": \"<string>\",\n \"taxonomyCode\": \"<string>\",\n \"firstName\": \"<string>\",\n \"lastName\": \"<string>\",\n \"middleName\": \"<string>\",\n \"suffix\": \"<string>\",\n \"organizationName\": \"<string>\",\n \"contactInformation\": {\n \"name\": \"<string>\",\n \"phoneNumber\": \"<string>\",\n \"faxNumber\": \"<string>\",\n \"email\": \"<string>\",\n \"phoneExtension\": \"<string>\"\n },\n \"otherIdentifier\": \"<string>\",\n \"secondaryIdentifier\": [\n {\n \"qualifier\": \"<string>\",\n \"identifier\": \"<string>\",\n \"otherIdentifier\": \"<string>\"\n }\n ]\n },\n \"orderingProvider\": {\n \"providerType\": \"<string>\",\n \"npi\": \"<string>\",\n \"ssn\": \"<string>\",\n \"employerId\": \"<string>\",\n \"commercialNumber\": \"<string>\",\n \"locationNumber\": \"<string>\",\n \"payerIdentificationNumber\": \"<string>\",\n \"employerIdentificationNumber\": \"<string>\",\n \"claimOfficeNumber\": \"<string>\",\n \"naic\": \"<string>\",\n \"stateLicenseNumber\": \"<string>\",\n \"providerUpinNumber\": \"<string>\",\n \"taxonomyCode\": \"<string>\",\n \"firstName\": \"<string>\",\n \"lastName\": \"<string>\",\n \"middleName\": \"<string>\",\n \"suffix\": \"<string>\",\n \"organizationName\": \"<string>\",\n \"otherIdentifier\": \"<string>\",\n \"secondaryIdentifier\": [\n {\n \"qualifier\": \"<string>\",\n \"identifier\": \"<string>\",\n \"otherIdentifier\": \"<string>\"\n }\n ]\n },\n \"lineAdjudicationInformation\": [\n {\n \"otherPayerPrimaryIdentifier\": \"<string>\",\n \"serviceLinePaidAmount\": \"<string>\",\n \"procedureCode\": \"<string>\",\n \"paidServiceUnitCount\": \"<string>\",\n \"adjudicationOrPaymentDate\": \"<string>\",\n \"procedureModifier\": [\n \"<string>\"\n ],\n \"procedureCodeDescription\": \"<string>\",\n \"bundledOrUnbundledLineNumber\": \"<string>\",\n \"claimAdjustmentInformation\": [\n {\n \"adjustmentDetails\": [\n {\n \"adjustmentReasonCode\": \"<string>\",\n \"adjustmentAmount\": \"<string>\",\n \"adjustmentQuantity\": \"<string>\"\n }\n ]\n }\n ],\n \"remainingPatientLiability\": \"<string>\"\n }\n ],\n \"formIdentification\": [\n {\n \"formIdentifier\": \"<string>\",\n \"supportingDocumentation\": [\n {\n \"questionNumber\": \"<string>\",\n \"questionResponse\": \"<string>\",\n \"questionResponseAsDate\": \"<string>\",\n \"questionResponseAsPercent\": \"<string>\"\n }\n ]\n }\n ]\n }\n ],\n \"propertyCasualtyClaimNumber\": \"<string>\",\n \"relatedCausesCode\": [],\n \"autoAccidentStateCode\": \"<string>\",\n \"autoAccidentCountryCode\": \"<string>\",\n \"patientAmountPaid\": \"<string>\",\n \"fileInformation\": \"<string>\",\n \"fileInformationList\": [\n \"<string>\"\n ],\n \"deathDate\": \"<string>\",\n \"patientWeight\": \"<string>\",\n \"patientSignatureSourceCode\": true,\n \"pregnancyIndicator\": \"Y\",\n \"claimDateInformation\": {\n \"symptomDate\": \"<string>\",\n \"initialTreatmentDate\": \"<string>\",\n \"lastSeenDate\": \"<string>\",\n \"acuteManifestationDate\": \"<string>\",\n \"accidentDate\": \"<string>\",\n \"lastMenstrualPeriodDate\": \"<string>\",\n \"lastXRayDate\": \"<string>\",\n \"hearingAndVisionPrescriptionDate\": \"<string>\",\n \"disabilityBeginDate\": \"<string>\",\n \"disabilityEndDate\": \"<string>\",\n \"lastWorkedDate\": \"<string>\",\n \"authorizedReturnToWorkDate\": \"<string>\",\n \"admissionDate\": \"<string>\",\n \"dischargeDate\": \"<string>\",\n \"assumedAndRelinquishedCareBeginDate\": \"<string>\",\n \"assumedAndRelinquishedCareEndDate\": \"<string>\",\n \"repricerReceivedDate\": \"<string>\",\n \"firstContactDate\": \"<string>\"\n },\n \"claimSupplementalInformation\": {\n \"reportInformations\": [\n {\n \"attachmentControlNumber\": \"<string>\"\n }\n ],\n \"priorAuthorizationNumber\": \"<string>\",\n \"referralNumber\": \"<string>\",\n \"claimControlNumber\": \"<string>\",\n \"cliaNumber\": \"<string>\",\n \"repricedClaimNumber\": \"<string>\",\n \"adjustedRepricedClaimNumber\": \"<string>\",\n \"investigationalDeviceExemptionNumber\": \"<string>\",\n \"claimNumber\": \"<string>\",\n \"mammographyCertificationNumber\": \"<string>\",\n \"medicalRecordNumber\": \"<string>\",\n \"demoProjectIdentifier\": \"<string>\",\n \"carePlanOversightNumber\": \"<string>\",\n \"medicareCrossoverReferenceId\": \"<string>\"\n },\n \"ambulanceCertification\": [\n {\n \"conditionCodes\": []\n }\n ],\n \"patientConditionInformationVision\": [\n {\n \"conditionCodes\": []\n }\n ],\n \"homeboundIndicator\": true,\n \"anesthesiaRelatedSurgicalProcedure\": [\n \"<string>\"\n ],\n \"conditionInformation\": [\n {\n \"conditionCodes\": [\n \"<string>\"\n ]\n }\n ],\n \"claimNote\": {\n \"additionalInformation\": \"<string>\",\n \"certificationNarrative\": \"<string>\",\n \"goalRehabOrDischargePlans\": \"<string>\",\n \"diagnosisDescription\": \"<string>\",\n \"thirdPartOrgNotes\": \"<string>\"\n },\n \"otherSubscriberInformation\": [\n {\n \"otherSubscriberName\": {\n \"otherInsuredLastName\": \"<string>\",\n \"otherInsuredIdentifier\": \"<string>\",\n \"otherInsuredFirstName\": \"<string>\",\n \"otherInsuredMiddleName\": \"<string>\",\n \"otherInsuredNameSuffix\": \"<string>\",\n \"otherInsuredAdditionalIdentifier\": \"<string>\"\n },\n \"otherPayerName\": {\n \"otherPayerOrganizationName\": \"<string>\",\n \"otherPayerIdentifier\": \"<string>\",\n \"otherPayerAdjudicationOrPaymentDate\": \"<string>\",\n \"otherPayerSecondaryIdentifier\": [\n {\n \"qualifier\": \"<string>\",\n \"identifier\": \"<string>\",\n \"otherIdentifier\": \"<string>\"\n }\n ],\n \"otherPayerPriorAuthorizationNumber\": \"<string>\",\n \"otherPayerPriorAuthorizationOrReferralNumber\": \"<string>\",\n \"otherPayerClaimAdjustmentIndicator\": true,\n \"otherPayerClaimControlNumber\": \"<string>\"\n },\n \"insuranceGroupOrPolicyNumber\": \"<string>\",\n \"otherInsuredGroupName\": \"<string>\",\n \"claimLevelAdjustments\": [\n {\n \"adjustmentDetails\": [\n {\n \"adjustmentReasonCode\": \"<string>\",\n \"adjustmentAmount\": \"<string>\",\n \"adjustmentQuantity\": \"<string>\"\n }\n ]\n }\n ],\n \"payerPaidAmount\": \"<string>\",\n \"nonCoveredChargeAmount\": \"<string>\",\n \"remainingPatientLiability\": \"<string>\",\n \"otherPayerReferringProvider\": [\n {\n \"otherPayerReferringProviderIdentifier\": [\n {\n \"qualifier\": \"<string>\",\n \"identifier\": \"<string>\",\n \"otherIdentifier\": \"<string>\"\n }\n ]\n }\n ],\n \"otherPayerRenderingProvider\": [\n {\n \"otherPayerRenderingProviderSecondaryIdentifier\": [\n {\n \"qualifier\": \"<string>\",\n \"identifier\": \"<string>\",\n \"otherIdentifier\": \"<string>\"\n }\n ]\n }\n ],\n \"otherPayerServiceFacilityLocation\": [\n {\n \"otherPayerServiceFacilityLocationSecondaryIdentifier\": [\n {\n \"qualifier\": \"<string>\",\n \"identifier\": \"<string>\",\n \"otherIdentifier\": \"<string>\"\n }\n ]\n }\n ],\n \"otherPayerSupervisingProvider\": [\n {\n \"otherPayerSupervisingProviderIdentifier\": [\n {\n \"qualifier\": \"<string>\",\n \"identifier\": \"<string>\",\n \"otherIdentifier\": \"<string>\"\n }\n ]\n }\n ],\n \"otherPayerBillingProvider\": [\n {\n \"otherPayerBillingProviderIdentifier\": [\n {\n \"qualifier\": \"<string>\",\n \"identifier\": \"<string>\",\n \"otherIdentifier\": \"<string>\"\n }\n ]\n }\n ],\n \"patientSignatureGeneratedForPatient\": true,\n \"medicareOutpatientAdjudication\": {\n \"reimbursementRate\": \"<string>\",\n \"hcpcsPayableAmount\": \"<string>\",\n \"claimPaymentRemarkCode\": [\n \"<string>\"\n ],\n \"endStageRenalDiseasePaymentAmount\": \"<string>\",\n \"nonPayableProfessionalComponentBilledAmount\": \"<string>\"\n }\n }\n ]\n },\n \"isTesting\": true,\n \"controlNumber\": \"<string>\",\n \"providers\": [\n {\n \"providerType\": \"<string>\",\n \"npi\": \"<string>\",\n \"ssn\": \"<string>\",\n \"employerId\": \"<string>\",\n \"commercialNumber\": \"<string>\",\n \"locationNumber\": \"<string>\",\n \"stateLicenseNumber\": \"<string>\",\n \"providerUpinNumber\": \"<string>\",\n \"taxonomyCode\": \"<string>\",\n \"firstName\": \"<string>\",\n \"lastName\": \"<string>\",\n \"middleName\": \"<string>\",\n \"suffix\": \"<string>\",\n \"organizationName\": \"<string>\",\n \"contactInformation\": {\n \"name\": \"<string>\",\n \"phoneNumber\": \"<string>\",\n \"faxNumber\": \"<string>\",\n \"email\": \"<string>\",\n \"phoneExtension\": \"<string>\"\n }\n }\n ],\n \"referring\": {\n \"providerType\": \"<string>\",\n \"npi\": \"<string>\",\n \"commercialNumber\": \"<string>\",\n \"stateLicenseNumber\": \"<string>\",\n \"providerUpinNumber\": \"<string>\",\n \"taxonomyCode\": \"<string>\",\n \"firstName\": \"<string>\",\n \"lastName\": \"<string>\",\n \"middleName\": \"<string>\",\n \"suffix\": \"<string>\",\n \"organizationName\": \"<string>\",\n \"contactInformation\": {\n \"name\": \"<string>\",\n \"phoneNumber\": \"<string>\",\n \"faxNumber\": \"<string>\",\n \"email\": \"<string>\",\n \"phoneExtension\": \"<string>\"\n }\n },\n \"rendering\": {\n \"providerType\": \"<string>\",\n \"npi\": \"<string>\",\n \"commercialNumber\": \"<string>\",\n \"locationNumber\": \"<string>\",\n \"stateLicenseNumber\": \"<string>\",\n \"providerUpinNumber\": \"<string>\",\n \"taxonomyCode\": \"<string>\",\n \"firstName\": \"<string>\",\n \"lastName\": \"<string>\",\n \"middleName\": \"<string>\",\n \"suffix\": \"<string>\",\n \"organizationName\": \"<string>\",\n \"contactInformation\": {\n \"name\": \"<string>\",\n \"phoneNumber\": \"<string>\",\n \"faxNumber\": \"<string>\",\n \"email\": \"<string>\",\n \"phoneExtension\": \"<string>\"\n }\n },\n \"ordering\": {\n \"providerType\": \"<string>\",\n \"npi\": \"<string>\",\n \"ssn\": \"<string>\",\n \"employerId\": \"<string>\",\n \"commercialNumber\": \"<string>\",\n \"locationNumber\": \"<string>\",\n \"payerIdentificationNumber\": \"<string>\",\n \"employerIdentificationNumber\": \"<string>\",\n \"claimOfficeNumber\": \"<string>\",\n \"naic\": \"<string>\",\n \"stateLicenseNumber\": \"<string>\",\n \"providerUpinNumber\": \"<string>\",\n \"taxonomyCode\": \"<string>\",\n \"firstName\": \"<string>\",\n \"lastName\": \"<string>\",\n \"middleName\": \"<string>\",\n \"suffix\": \"<string>\",\n \"organizationName\": \"<string>\",\n \"contactInformation\": {\n \"name\": \"<string>\",\n \"phoneNumber\": \"<string>\",\n \"faxNumber\": \"<string>\",\n \"email\": \"<string>\",\n \"phoneExtension\": \"<string>\"\n }\n },\n \"supervising\": {\n \"providerType\": \"<string>\",\n \"npi\": \"<string>\",\n \"ssn\": \"<string>\",\n \"employerId\": \"<string>\",\n \"commercialNumber\": \"<string>\",\n \"locationNumber\": \"<string>\",\n \"stateLicenseNumber\": \"<string>\",\n \"providerUpinNumber\": \"<string>\",\n \"taxonomyCode\": \"<string>\",\n \"firstName\": \"<string>\",\n \"lastName\": \"<string>\",\n \"middleName\": \"<string>\",\n \"suffix\": \"<string>\",\n \"organizationName\": \"<string>\",\n \"contactInformation\": {\n \"name\": \"<string>\",\n \"phoneNumber\": \"<string>\",\n \"faxNumber\": \"<string>\",\n \"email\": \"<string>\",\n \"phoneExtension\": \"<string>\"\n }\n },\n \"tradingPartnerName\": \"<string>\"\n}")
req, _ := http.NewRequest("POST", url, payload)
req.Header.Add("Content-Type", "application/json")
res, _ := http.DefaultClient.Do(req)
defer res.Body.Close()
body, _ := io.ReadAll(res.Body)
fmt.Println(string(body))
}HttpResponse<String> response = Unirest.post("https://api.example.com/api/v2/clearinghouse/claim")
.header("Content-Type", "application/json")
.body("{\n \"tradingPartnerServiceId\": \"<string>\",\n \"submitter\": {\n \"contactInformation\": {\n \"name\": \"<string>\",\n \"phoneNumber\": \"<string>\",\n \"faxNumber\": \"<string>\",\n \"email\": \"<string>\",\n \"phoneExtension\": \"<string>\"\n },\n \"organizationName\": \"<string>\",\n \"lastName\": \"<string>\",\n \"firstName\": \"<string>\",\n \"middleName\": \"<string>\",\n \"submitterIdentification\": \"<string>\"\n },\n \"receiver\": {\n \"organizationName\": \"<string>\"\n },\n \"subscriber\": {\n \"memberId\": \"<string>\",\n \"ssn\": \"<string>\",\n \"organizationName\": \"<string>\",\n \"subscriberGroupName\": \"<string>\",\n \"firstName\": \"<string>\",\n \"lastName\": \"<string>\",\n \"middleName\": \"<string>\",\n \"suffix\": \"<string>\",\n \"dateOfBirth\": \"<string>\",\n \"policyNumber\": \"<string>\",\n \"groupNumber\": \"<string>\"\n },\n \"billing\": {\n \"providerType\": \"<string>\",\n \"npi\": \"<string>\",\n \"ssn\": \"<string>\",\n \"employerId\": \"<string>\",\n \"commercialNumber\": \"<string>\",\n \"locationNumber\": \"<string>\",\n \"stateLicenseNumber\": \"<string>\",\n \"providerUpinNumber\": \"<string>\",\n \"taxonomyCode\": \"<string>\",\n \"firstName\": \"<string>\",\n \"lastName\": \"<string>\",\n \"middleName\": \"<string>\",\n \"suffix\": \"<string>\",\n \"organizationName\": \"<string>\",\n \"contactInformation\": {\n \"name\": \"<string>\",\n \"phoneNumber\": \"<string>\",\n \"faxNumber\": \"<string>\",\n \"email\": \"<string>\",\n \"phoneExtension\": \"<string>\"\n }\n },\n \"claimInformation\": {\n \"claimChargeAmount\": \"<string>\",\n \"healthCareCodeInformation\": [\n {\n \"diagnosisCode\": \"<string>\"\n }\n ],\n \"serviceLines\": [\n {\n \"serviceDate\": \"<string>\",\n \"professionalService\": {\n \"procedureCode\": \"<string>\",\n \"lineItemChargeAmount\": \"<string>\",\n \"serviceUnitCount\": \"<string>\",\n \"compositeDiagnosisCodePointers\": {\n \"diagnosisCodePointers\": [\n \"<string>\"\n ]\n },\n \"procedureModifiers\": [\n \"<string>\"\n ],\n \"description\": \"<string>\",\n \"placeOfServiceCode\": \"<string>\",\n \"emergencyIndicator\": \"Y\",\n \"epsdtIndicator\": \"Y\",\n \"familyPlanningIndicator\": \"Y\",\n \"copayStatusCode\": \"0\"\n },\n \"assignedNumber\": \"<string>\",\n \"serviceDateEnd\": \"<string>\",\n \"serviceLineSupplementalInformation\": [\n {\n \"attachmentControlNumber\": \"<string>\"\n }\n ],\n \"ambulanceCertification\": [\n {\n \"conditionCodes\": []\n }\n ],\n \"hospiceEmployeeIndicator\": true,\n \"serviceLineDateInformation\": {\n \"prescriptionDate\": \"<string>\",\n \"certificationRevisionOrRecertificationDate\": \"<string>\",\n \"beginTherapyDate\": \"<string>\",\n \"lastCertificationDate\": \"<string>\",\n \"treatmentOrTherapyDate\": \"<string>\",\n \"hemoglobinTestDate\": \"<string>\",\n \"serumCreatineTestDate\": \"<string>\",\n \"shippedDate\": \"<string>\",\n \"lastXRayDate\": \"<string>\",\n \"initialTreatmentDate\": \"<string>\"\n },\n \"ambulancePatientCount\": 123,\n \"obstetricAnesthesiaAdditionalUnits\": 123,\n \"testResults\": [\n {\n \"testResults\": \"<string>\"\n }\n ],\n \"serviceLineReferenceInformation\": {\n \"repricedLineItemReferenceNumber\": \"<string>\",\n \"adjustedRepricedLineItemReferenceNumber\": \"<string>\",\n \"priorAuthorization\": [\n {\n \"priorAuthorizationOrReferralNumber\": \"<string>\",\n \"otherPayerPrimaryIdentifier\": \"<string>\"\n }\n ],\n \"mammographyCertificationNumber\": \"<string>\",\n \"clinicalLaboratoryImprovementAmendmentNumber\": \"<string>\",\n \"referringCliaNumber\": \"<string>\",\n \"immunizationBatchNumber\": \"<string>\",\n \"referralNumber\": [\n \"<string>\"\n ]\n },\n \"salesTaxAmount\": \"<string>\",\n \"postageTaxAmount\": \"<string>\",\n \"fileInformation\": [\n \"<string>\"\n ],\n \"additionalNotes\": \"<string>\",\n \"goalRehabOrDischargePlans\": \"<string>\",\n \"thirdPartyOrganizationNotes\": \"<string>\",\n \"purchasedServiceProvider\": {\n \"providerType\": \"<string>\",\n \"npi\": \"<string>\",\n \"stateLicenseNumber\": \"<string>\",\n \"commercialNumber\": \"<string>\",\n \"payerIdentificationNumber\": \"<string>\",\n \"ssn\": \"<string>\",\n \"employerId\": \"<string>\",\n \"locationNumber\": \"<string>\",\n \"employerIdentificationNumber\": \"<string>\",\n \"claimOfficeNumber\": \"<string>\",\n \"naic\": \"<string>\",\n \"providerUpinNumber\": \"<string>\",\n \"taxonomyCode\": \"<string>\",\n \"firstName\": \"<string>\",\n \"lastName\": \"<string>\",\n \"middleName\": \"<string>\",\n \"suffix\": \"<string>\",\n \"organizationName\": \"<string>\",\n \"contactInformation\": {\n \"name\": \"<string>\",\n \"phoneNumber\": \"<string>\",\n \"faxNumber\": \"<string>\",\n \"email\": \"<string>\",\n \"phoneExtension\": \"<string>\"\n },\n \"otherIdentifier\": \"<string>\",\n \"secondaryIdentifier\": [\n {\n \"qualifier\": \"<string>\",\n \"identifier\": \"<string>\",\n \"otherIdentifier\": \"<string>\"\n }\n ]\n },\n \"orderingProvider\": {\n \"providerType\": \"<string>\",\n \"npi\": \"<string>\",\n \"ssn\": \"<string>\",\n \"employerId\": \"<string>\",\n \"commercialNumber\": \"<string>\",\n \"locationNumber\": \"<string>\",\n \"payerIdentificationNumber\": \"<string>\",\n \"employerIdentificationNumber\": \"<string>\",\n \"claimOfficeNumber\": \"<string>\",\n \"naic\": \"<string>\",\n \"stateLicenseNumber\": \"<string>\",\n \"providerUpinNumber\": \"<string>\",\n \"taxonomyCode\": \"<string>\",\n \"firstName\": \"<string>\",\n \"lastName\": \"<string>\",\n \"middleName\": \"<string>\",\n \"suffix\": \"<string>\",\n \"organizationName\": \"<string>\",\n \"otherIdentifier\": \"<string>\",\n \"secondaryIdentifier\": [\n {\n \"qualifier\": \"<string>\",\n \"identifier\": \"<string>\",\n \"otherIdentifier\": \"<string>\"\n }\n ]\n },\n \"lineAdjudicationInformation\": [\n {\n \"otherPayerPrimaryIdentifier\": \"<string>\",\n \"serviceLinePaidAmount\": \"<string>\",\n \"procedureCode\": \"<string>\",\n \"paidServiceUnitCount\": \"<string>\",\n \"adjudicationOrPaymentDate\": \"<string>\",\n \"procedureModifier\": [\n \"<string>\"\n ],\n \"procedureCodeDescription\": \"<string>\",\n \"bundledOrUnbundledLineNumber\": \"<string>\",\n \"claimAdjustmentInformation\": [\n {\n \"adjustmentDetails\": [\n {\n \"adjustmentReasonCode\": \"<string>\",\n \"adjustmentAmount\": \"<string>\",\n \"adjustmentQuantity\": \"<string>\"\n }\n ]\n }\n ],\n \"remainingPatientLiability\": \"<string>\"\n }\n ],\n \"formIdentification\": [\n {\n \"formIdentifier\": \"<string>\",\n \"supportingDocumentation\": [\n {\n \"questionNumber\": \"<string>\",\n \"questionResponse\": \"<string>\",\n \"questionResponseAsDate\": \"<string>\",\n \"questionResponseAsPercent\": \"<string>\"\n }\n ]\n }\n ]\n }\n ],\n \"propertyCasualtyClaimNumber\": \"<string>\",\n \"relatedCausesCode\": [],\n \"autoAccidentStateCode\": \"<string>\",\n \"autoAccidentCountryCode\": \"<string>\",\n \"patientAmountPaid\": \"<string>\",\n \"fileInformation\": \"<string>\",\n \"fileInformationList\": [\n \"<string>\"\n ],\n \"deathDate\": \"<string>\",\n \"patientWeight\": \"<string>\",\n \"patientSignatureSourceCode\": true,\n \"pregnancyIndicator\": \"Y\",\n \"claimDateInformation\": {\n \"symptomDate\": \"<string>\",\n \"initialTreatmentDate\": \"<string>\",\n \"lastSeenDate\": \"<string>\",\n \"acuteManifestationDate\": \"<string>\",\n \"accidentDate\": \"<string>\",\n \"lastMenstrualPeriodDate\": \"<string>\",\n \"lastXRayDate\": \"<string>\",\n \"hearingAndVisionPrescriptionDate\": \"<string>\",\n \"disabilityBeginDate\": \"<string>\",\n \"disabilityEndDate\": \"<string>\",\n \"lastWorkedDate\": \"<string>\",\n \"authorizedReturnToWorkDate\": \"<string>\",\n \"admissionDate\": \"<string>\",\n \"dischargeDate\": \"<string>\",\n \"assumedAndRelinquishedCareBeginDate\": \"<string>\",\n \"assumedAndRelinquishedCareEndDate\": \"<string>\",\n \"repricerReceivedDate\": \"<string>\",\n \"firstContactDate\": \"<string>\"\n },\n \"claimSupplementalInformation\": {\n \"reportInformations\": [\n {\n \"attachmentControlNumber\": \"<string>\"\n }\n ],\n \"priorAuthorizationNumber\": \"<string>\",\n \"referralNumber\": \"<string>\",\n \"claimControlNumber\": \"<string>\",\n \"cliaNumber\": \"<string>\",\n \"repricedClaimNumber\": \"<string>\",\n \"adjustedRepricedClaimNumber\": \"<string>\",\n \"investigationalDeviceExemptionNumber\": \"<string>\",\n \"claimNumber\": \"<string>\",\n \"mammographyCertificationNumber\": \"<string>\",\n \"medicalRecordNumber\": \"<string>\",\n \"demoProjectIdentifier\": \"<string>\",\n \"carePlanOversightNumber\": \"<string>\",\n \"medicareCrossoverReferenceId\": \"<string>\"\n },\n \"ambulanceCertification\": [\n {\n \"conditionCodes\": []\n }\n ],\n \"patientConditionInformationVision\": [\n {\n \"conditionCodes\": []\n }\n ],\n \"homeboundIndicator\": true,\n \"anesthesiaRelatedSurgicalProcedure\": [\n \"<string>\"\n ],\n \"conditionInformation\": [\n {\n \"conditionCodes\": [\n \"<string>\"\n ]\n }\n ],\n \"claimNote\": {\n \"additionalInformation\": \"<string>\",\n \"certificationNarrative\": \"<string>\",\n \"goalRehabOrDischargePlans\": \"<string>\",\n \"diagnosisDescription\": \"<string>\",\n \"thirdPartOrgNotes\": \"<string>\"\n },\n \"otherSubscriberInformation\": [\n {\n \"otherSubscriberName\": {\n \"otherInsuredLastName\": \"<string>\",\n \"otherInsuredIdentifier\": \"<string>\",\n \"otherInsuredFirstName\": \"<string>\",\n \"otherInsuredMiddleName\": \"<string>\",\n \"otherInsuredNameSuffix\": \"<string>\",\n \"otherInsuredAdditionalIdentifier\": \"<string>\"\n },\n \"otherPayerName\": {\n \"otherPayerOrganizationName\": \"<string>\",\n \"otherPayerIdentifier\": \"<string>\",\n \"otherPayerAdjudicationOrPaymentDate\": \"<string>\",\n \"otherPayerSecondaryIdentifier\": [\n {\n \"qualifier\": \"<string>\",\n \"identifier\": \"<string>\",\n \"otherIdentifier\": \"<string>\"\n }\n ],\n \"otherPayerPriorAuthorizationNumber\": \"<string>\",\n \"otherPayerPriorAuthorizationOrReferralNumber\": \"<string>\",\n \"otherPayerClaimAdjustmentIndicator\": true,\n \"otherPayerClaimControlNumber\": \"<string>\"\n },\n \"insuranceGroupOrPolicyNumber\": \"<string>\",\n \"otherInsuredGroupName\": \"<string>\",\n \"claimLevelAdjustments\": [\n {\n \"adjustmentDetails\": [\n {\n \"adjustmentReasonCode\": \"<string>\",\n \"adjustmentAmount\": \"<string>\",\n \"adjustmentQuantity\": \"<string>\"\n }\n ]\n }\n ],\n \"payerPaidAmount\": \"<string>\",\n \"nonCoveredChargeAmount\": \"<string>\",\n \"remainingPatientLiability\": \"<string>\",\n \"otherPayerReferringProvider\": [\n {\n \"otherPayerReferringProviderIdentifier\": [\n {\n \"qualifier\": \"<string>\",\n \"identifier\": \"<string>\",\n \"otherIdentifier\": \"<string>\"\n }\n ]\n }\n ],\n \"otherPayerRenderingProvider\": [\n {\n \"otherPayerRenderingProviderSecondaryIdentifier\": [\n {\n \"qualifier\": \"<string>\",\n \"identifier\": \"<string>\",\n \"otherIdentifier\": \"<string>\"\n }\n ]\n }\n ],\n \"otherPayerServiceFacilityLocation\": [\n {\n \"otherPayerServiceFacilityLocationSecondaryIdentifier\": [\n {\n \"qualifier\": \"<string>\",\n \"identifier\": \"<string>\",\n \"otherIdentifier\": \"<string>\"\n }\n ]\n }\n ],\n \"otherPayerSupervisingProvider\": [\n {\n \"otherPayerSupervisingProviderIdentifier\": [\n {\n \"qualifier\": \"<string>\",\n \"identifier\": \"<string>\",\n \"otherIdentifier\": \"<string>\"\n }\n ]\n }\n ],\n \"otherPayerBillingProvider\": [\n {\n \"otherPayerBillingProviderIdentifier\": [\n {\n \"qualifier\": \"<string>\",\n \"identifier\": \"<string>\",\n \"otherIdentifier\": \"<string>\"\n }\n ]\n }\n ],\n \"patientSignatureGeneratedForPatient\": true,\n \"medicareOutpatientAdjudication\": {\n \"reimbursementRate\": \"<string>\",\n \"hcpcsPayableAmount\": \"<string>\",\n \"claimPaymentRemarkCode\": [\n \"<string>\"\n ],\n \"endStageRenalDiseasePaymentAmount\": \"<string>\",\n \"nonPayableProfessionalComponentBilledAmount\": \"<string>\"\n }\n }\n ]\n },\n \"isTesting\": true,\n \"controlNumber\": \"<string>\",\n \"providers\": [\n {\n \"providerType\": \"<string>\",\n \"npi\": \"<string>\",\n \"ssn\": \"<string>\",\n \"employerId\": \"<string>\",\n \"commercialNumber\": \"<string>\",\n \"locationNumber\": \"<string>\",\n \"stateLicenseNumber\": \"<string>\",\n \"providerUpinNumber\": \"<string>\",\n \"taxonomyCode\": \"<string>\",\n \"firstName\": \"<string>\",\n \"lastName\": \"<string>\",\n \"middleName\": \"<string>\",\n \"suffix\": \"<string>\",\n \"organizationName\": \"<string>\",\n \"contactInformation\": {\n \"name\": \"<string>\",\n \"phoneNumber\": \"<string>\",\n \"faxNumber\": \"<string>\",\n \"email\": \"<string>\",\n \"phoneExtension\": \"<string>\"\n }\n }\n ],\n \"referring\": {\n \"providerType\": \"<string>\",\n \"npi\": \"<string>\",\n \"commercialNumber\": \"<string>\",\n \"stateLicenseNumber\": \"<string>\",\n \"providerUpinNumber\": \"<string>\",\n \"taxonomyCode\": \"<string>\",\n \"firstName\": \"<string>\",\n \"lastName\": \"<string>\",\n \"middleName\": \"<string>\",\n \"suffix\": \"<string>\",\n \"organizationName\": \"<string>\",\n \"contactInformation\": {\n \"name\": \"<string>\",\n \"phoneNumber\": \"<string>\",\n \"faxNumber\": \"<string>\",\n \"email\": \"<string>\",\n \"phoneExtension\": \"<string>\"\n }\n },\n \"rendering\": {\n \"providerType\": \"<string>\",\n \"npi\": \"<string>\",\n \"commercialNumber\": \"<string>\",\n \"locationNumber\": \"<string>\",\n \"stateLicenseNumber\": \"<string>\",\n \"providerUpinNumber\": \"<string>\",\n \"taxonomyCode\": \"<string>\",\n \"firstName\": \"<string>\",\n \"lastName\": \"<string>\",\n \"middleName\": \"<string>\",\n \"suffix\": \"<string>\",\n \"organizationName\": \"<string>\",\n \"contactInformation\": {\n \"name\": \"<string>\",\n \"phoneNumber\": \"<string>\",\n \"faxNumber\": \"<string>\",\n \"email\": \"<string>\",\n \"phoneExtension\": \"<string>\"\n }\n },\n \"ordering\": {\n \"providerType\": \"<string>\",\n \"npi\": \"<string>\",\n \"ssn\": \"<string>\",\n \"employerId\": \"<string>\",\n \"commercialNumber\": \"<string>\",\n \"locationNumber\": \"<string>\",\n \"payerIdentificationNumber\": \"<string>\",\n \"employerIdentificationNumber\": \"<string>\",\n \"claimOfficeNumber\": \"<string>\",\n \"naic\": \"<string>\",\n \"stateLicenseNumber\": \"<string>\",\n \"providerUpinNumber\": \"<string>\",\n \"taxonomyCode\": \"<string>\",\n \"firstName\": \"<string>\",\n \"lastName\": \"<string>\",\n \"middleName\": \"<string>\",\n \"suffix\": \"<string>\",\n \"organizationName\": \"<string>\",\n \"contactInformation\": {\n \"name\": \"<string>\",\n \"phoneNumber\": \"<string>\",\n \"faxNumber\": \"<string>\",\n \"email\": \"<string>\",\n \"phoneExtension\": \"<string>\"\n }\n },\n \"supervising\": {\n \"providerType\": \"<string>\",\n \"npi\": \"<string>\",\n \"ssn\": \"<string>\",\n \"employerId\": \"<string>\",\n \"commercialNumber\": \"<string>\",\n \"locationNumber\": \"<string>\",\n \"stateLicenseNumber\": \"<string>\",\n \"providerUpinNumber\": \"<string>\",\n \"taxonomyCode\": \"<string>\",\n \"firstName\": \"<string>\",\n \"lastName\": \"<string>\",\n \"middleName\": \"<string>\",\n \"suffix\": \"<string>\",\n \"organizationName\": \"<string>\",\n \"contactInformation\": {\n \"name\": \"<string>\",\n \"phoneNumber\": \"<string>\",\n \"faxNumber\": \"<string>\",\n \"email\": \"<string>\",\n \"phoneExtension\": \"<string>\"\n }\n },\n \"tradingPartnerName\": \"<string>\"\n}")
.asString();require 'uri'
require 'net/http'
url = URI("https://api.example.com/api/v2/clearinghouse/claim")
http = Net::HTTP.new(url.host, url.port)
http.use_ssl = true
request = Net::HTTP::Post.new(url)
request["Content-Type"] = 'application/json'
request.body = "{\n \"tradingPartnerServiceId\": \"<string>\",\n \"submitter\": {\n \"contactInformation\": {\n \"name\": \"<string>\",\n \"phoneNumber\": \"<string>\",\n \"faxNumber\": \"<string>\",\n \"email\": \"<string>\",\n \"phoneExtension\": \"<string>\"\n },\n \"organizationName\": \"<string>\",\n \"lastName\": \"<string>\",\n \"firstName\": \"<string>\",\n \"middleName\": \"<string>\",\n \"submitterIdentification\": \"<string>\"\n },\n \"receiver\": {\n \"organizationName\": \"<string>\"\n },\n \"subscriber\": {\n \"memberId\": \"<string>\",\n \"ssn\": \"<string>\",\n \"organizationName\": \"<string>\",\n \"subscriberGroupName\": \"<string>\",\n \"firstName\": \"<string>\",\n \"lastName\": \"<string>\",\n \"middleName\": \"<string>\",\n \"suffix\": \"<string>\",\n \"dateOfBirth\": \"<string>\",\n \"policyNumber\": \"<string>\",\n \"groupNumber\": \"<string>\"\n },\n \"billing\": {\n \"providerType\": \"<string>\",\n \"npi\": \"<string>\",\n \"ssn\": \"<string>\",\n \"employerId\": \"<string>\",\n \"commercialNumber\": \"<string>\",\n \"locationNumber\": \"<string>\",\n \"stateLicenseNumber\": \"<string>\",\n \"providerUpinNumber\": \"<string>\",\n \"taxonomyCode\": \"<string>\",\n \"firstName\": \"<string>\",\n \"lastName\": \"<string>\",\n \"middleName\": \"<string>\",\n \"suffix\": \"<string>\",\n \"organizationName\": \"<string>\",\n \"contactInformation\": {\n \"name\": \"<string>\",\n \"phoneNumber\": \"<string>\",\n \"faxNumber\": \"<string>\",\n \"email\": \"<string>\",\n \"phoneExtension\": \"<string>\"\n }\n },\n \"claimInformation\": {\n \"claimChargeAmount\": \"<string>\",\n \"healthCareCodeInformation\": [\n {\n \"diagnosisCode\": \"<string>\"\n }\n ],\n \"serviceLines\": [\n {\n \"serviceDate\": \"<string>\",\n \"professionalService\": {\n \"procedureCode\": \"<string>\",\n \"lineItemChargeAmount\": \"<string>\",\n \"serviceUnitCount\": \"<string>\",\n \"compositeDiagnosisCodePointers\": {\n \"diagnosisCodePointers\": [\n \"<string>\"\n ]\n },\n \"procedureModifiers\": [\n \"<string>\"\n ],\n \"description\": \"<string>\",\n \"placeOfServiceCode\": \"<string>\",\n \"emergencyIndicator\": \"Y\",\n \"epsdtIndicator\": \"Y\",\n \"familyPlanningIndicator\": \"Y\",\n \"copayStatusCode\": \"0\"\n },\n \"assignedNumber\": \"<string>\",\n \"serviceDateEnd\": \"<string>\",\n \"serviceLineSupplementalInformation\": [\n {\n \"attachmentControlNumber\": \"<string>\"\n }\n ],\n \"ambulanceCertification\": [\n {\n \"conditionCodes\": []\n }\n ],\n \"hospiceEmployeeIndicator\": true,\n \"serviceLineDateInformation\": {\n \"prescriptionDate\": \"<string>\",\n \"certificationRevisionOrRecertificationDate\": \"<string>\",\n \"beginTherapyDate\": \"<string>\",\n \"lastCertificationDate\": \"<string>\",\n \"treatmentOrTherapyDate\": \"<string>\",\n \"hemoglobinTestDate\": \"<string>\",\n \"serumCreatineTestDate\": \"<string>\",\n \"shippedDate\": \"<string>\",\n \"lastXRayDate\": \"<string>\",\n \"initialTreatmentDate\": \"<string>\"\n },\n \"ambulancePatientCount\": 123,\n \"obstetricAnesthesiaAdditionalUnits\": 123,\n \"testResults\": [\n {\n \"testResults\": \"<string>\"\n }\n ],\n \"serviceLineReferenceInformation\": {\n \"repricedLineItemReferenceNumber\": \"<string>\",\n \"adjustedRepricedLineItemReferenceNumber\": \"<string>\",\n \"priorAuthorization\": [\n {\n \"priorAuthorizationOrReferralNumber\": \"<string>\",\n \"otherPayerPrimaryIdentifier\": \"<string>\"\n }\n ],\n \"mammographyCertificationNumber\": \"<string>\",\n \"clinicalLaboratoryImprovementAmendmentNumber\": \"<string>\",\n \"referringCliaNumber\": \"<string>\",\n \"immunizationBatchNumber\": \"<string>\",\n \"referralNumber\": [\n \"<string>\"\n ]\n },\n \"salesTaxAmount\": \"<string>\",\n \"postageTaxAmount\": \"<string>\",\n \"fileInformation\": [\n \"<string>\"\n ],\n \"additionalNotes\": \"<string>\",\n \"goalRehabOrDischargePlans\": \"<string>\",\n \"thirdPartyOrganizationNotes\": \"<string>\",\n \"purchasedServiceProvider\": {\n \"providerType\": \"<string>\",\n \"npi\": \"<string>\",\n \"stateLicenseNumber\": \"<string>\",\n \"commercialNumber\": \"<string>\",\n \"payerIdentificationNumber\": \"<string>\",\n \"ssn\": \"<string>\",\n \"employerId\": \"<string>\",\n \"locationNumber\": \"<string>\",\n \"employerIdentificationNumber\": \"<string>\",\n \"claimOfficeNumber\": \"<string>\",\n \"naic\": \"<string>\",\n \"providerUpinNumber\": \"<string>\",\n \"taxonomyCode\": \"<string>\",\n \"firstName\": \"<string>\",\n \"lastName\": \"<string>\",\n \"middleName\": \"<string>\",\n \"suffix\": \"<string>\",\n \"organizationName\": \"<string>\",\n \"contactInformation\": {\n \"name\": \"<string>\",\n \"phoneNumber\": \"<string>\",\n \"faxNumber\": \"<string>\",\n \"email\": \"<string>\",\n \"phoneExtension\": \"<string>\"\n },\n \"otherIdentifier\": \"<string>\",\n \"secondaryIdentifier\": [\n {\n \"qualifier\": \"<string>\",\n \"identifier\": \"<string>\",\n \"otherIdentifier\": \"<string>\"\n }\n ]\n },\n \"orderingProvider\": {\n \"providerType\": \"<string>\",\n \"npi\": \"<string>\",\n \"ssn\": \"<string>\",\n \"employerId\": \"<string>\",\n \"commercialNumber\": \"<string>\",\n \"locationNumber\": \"<string>\",\n \"payerIdentificationNumber\": \"<string>\",\n \"employerIdentificationNumber\": \"<string>\",\n \"claimOfficeNumber\": \"<string>\",\n \"naic\": \"<string>\",\n \"stateLicenseNumber\": \"<string>\",\n \"providerUpinNumber\": \"<string>\",\n \"taxonomyCode\": \"<string>\",\n \"firstName\": \"<string>\",\n \"lastName\": \"<string>\",\n \"middleName\": \"<string>\",\n \"suffix\": \"<string>\",\n \"organizationName\": \"<string>\",\n \"otherIdentifier\": \"<string>\",\n \"secondaryIdentifier\": [\n {\n \"qualifier\": \"<string>\",\n \"identifier\": \"<string>\",\n \"otherIdentifier\": \"<string>\"\n }\n ]\n },\n \"lineAdjudicationInformation\": [\n {\n \"otherPayerPrimaryIdentifier\": \"<string>\",\n \"serviceLinePaidAmount\": \"<string>\",\n \"procedureCode\": \"<string>\",\n \"paidServiceUnitCount\": \"<string>\",\n \"adjudicationOrPaymentDate\": \"<string>\",\n \"procedureModifier\": [\n \"<string>\"\n ],\n \"procedureCodeDescription\": \"<string>\",\n \"bundledOrUnbundledLineNumber\": \"<string>\",\n \"claimAdjustmentInformation\": [\n {\n \"adjustmentDetails\": [\n {\n \"adjustmentReasonCode\": \"<string>\",\n \"adjustmentAmount\": \"<string>\",\n \"adjustmentQuantity\": \"<string>\"\n }\n ]\n }\n ],\n \"remainingPatientLiability\": \"<string>\"\n }\n ],\n \"formIdentification\": [\n {\n \"formIdentifier\": \"<string>\",\n \"supportingDocumentation\": [\n {\n \"questionNumber\": \"<string>\",\n \"questionResponse\": \"<string>\",\n \"questionResponseAsDate\": \"<string>\",\n \"questionResponseAsPercent\": \"<string>\"\n }\n ]\n }\n ]\n }\n ],\n \"propertyCasualtyClaimNumber\": \"<string>\",\n \"relatedCausesCode\": [],\n \"autoAccidentStateCode\": \"<string>\",\n \"autoAccidentCountryCode\": \"<string>\",\n \"patientAmountPaid\": \"<string>\",\n \"fileInformation\": \"<string>\",\n \"fileInformationList\": [\n \"<string>\"\n ],\n \"deathDate\": \"<string>\",\n \"patientWeight\": \"<string>\",\n \"patientSignatureSourceCode\": true,\n \"pregnancyIndicator\": \"Y\",\n \"claimDateInformation\": {\n \"symptomDate\": \"<string>\",\n \"initialTreatmentDate\": \"<string>\",\n \"lastSeenDate\": \"<string>\",\n \"acuteManifestationDate\": \"<string>\",\n \"accidentDate\": \"<string>\",\n \"lastMenstrualPeriodDate\": \"<string>\",\n \"lastXRayDate\": \"<string>\",\n \"hearingAndVisionPrescriptionDate\": \"<string>\",\n \"disabilityBeginDate\": \"<string>\",\n \"disabilityEndDate\": \"<string>\",\n \"lastWorkedDate\": \"<string>\",\n \"authorizedReturnToWorkDate\": \"<string>\",\n \"admissionDate\": \"<string>\",\n \"dischargeDate\": \"<string>\",\n \"assumedAndRelinquishedCareBeginDate\": \"<string>\",\n \"assumedAndRelinquishedCareEndDate\": \"<string>\",\n \"repricerReceivedDate\": \"<string>\",\n \"firstContactDate\": \"<string>\"\n },\n \"claimSupplementalInformation\": {\n \"reportInformations\": [\n {\n \"attachmentControlNumber\": \"<string>\"\n }\n ],\n \"priorAuthorizationNumber\": \"<string>\",\n \"referralNumber\": \"<string>\",\n \"claimControlNumber\": \"<string>\",\n \"cliaNumber\": \"<string>\",\n \"repricedClaimNumber\": \"<string>\",\n \"adjustedRepricedClaimNumber\": \"<string>\",\n \"investigationalDeviceExemptionNumber\": \"<string>\",\n \"claimNumber\": \"<string>\",\n \"mammographyCertificationNumber\": \"<string>\",\n \"medicalRecordNumber\": \"<string>\",\n \"demoProjectIdentifier\": \"<string>\",\n \"carePlanOversightNumber\": \"<string>\",\n \"medicareCrossoverReferenceId\": \"<string>\"\n },\n \"ambulanceCertification\": [\n {\n \"conditionCodes\": []\n }\n ],\n \"patientConditionInformationVision\": [\n {\n \"conditionCodes\": []\n }\n ],\n \"homeboundIndicator\": true,\n \"anesthesiaRelatedSurgicalProcedure\": [\n \"<string>\"\n ],\n \"conditionInformation\": [\n {\n \"conditionCodes\": [\n \"<string>\"\n ]\n }\n ],\n \"claimNote\": {\n \"additionalInformation\": \"<string>\",\n \"certificationNarrative\": \"<string>\",\n \"goalRehabOrDischargePlans\": \"<string>\",\n \"diagnosisDescription\": \"<string>\",\n \"thirdPartOrgNotes\": \"<string>\"\n },\n \"otherSubscriberInformation\": [\n {\n \"otherSubscriberName\": {\n \"otherInsuredLastName\": \"<string>\",\n \"otherInsuredIdentifier\": \"<string>\",\n \"otherInsuredFirstName\": \"<string>\",\n \"otherInsuredMiddleName\": \"<string>\",\n \"otherInsuredNameSuffix\": \"<string>\",\n \"otherInsuredAdditionalIdentifier\": \"<string>\"\n },\n \"otherPayerName\": {\n \"otherPayerOrganizationName\": \"<string>\",\n \"otherPayerIdentifier\": \"<string>\",\n \"otherPayerAdjudicationOrPaymentDate\": \"<string>\",\n \"otherPayerSecondaryIdentifier\": [\n {\n \"qualifier\": \"<string>\",\n \"identifier\": \"<string>\",\n \"otherIdentifier\": \"<string>\"\n }\n ],\n \"otherPayerPriorAuthorizationNumber\": \"<string>\",\n \"otherPayerPriorAuthorizationOrReferralNumber\": \"<string>\",\n \"otherPayerClaimAdjustmentIndicator\": true,\n \"otherPayerClaimControlNumber\": \"<string>\"\n },\n \"insuranceGroupOrPolicyNumber\": \"<string>\",\n \"otherInsuredGroupName\": \"<string>\",\n \"claimLevelAdjustments\": [\n {\n \"adjustmentDetails\": [\n {\n \"adjustmentReasonCode\": \"<string>\",\n \"adjustmentAmount\": \"<string>\",\n \"adjustmentQuantity\": \"<string>\"\n }\n ]\n }\n ],\n \"payerPaidAmount\": \"<string>\",\n \"nonCoveredChargeAmount\": \"<string>\",\n \"remainingPatientLiability\": \"<string>\",\n \"otherPayerReferringProvider\": [\n {\n \"otherPayerReferringProviderIdentifier\": [\n {\n \"qualifier\": \"<string>\",\n \"identifier\": \"<string>\",\n \"otherIdentifier\": \"<string>\"\n }\n ]\n }\n ],\n \"otherPayerRenderingProvider\": [\n {\n \"otherPayerRenderingProviderSecondaryIdentifier\": [\n {\n \"qualifier\": \"<string>\",\n \"identifier\": \"<string>\",\n \"otherIdentifier\": \"<string>\"\n }\n ]\n }\n ],\n \"otherPayerServiceFacilityLocation\": [\n {\n \"otherPayerServiceFacilityLocationSecondaryIdentifier\": [\n {\n \"qualifier\": \"<string>\",\n \"identifier\": \"<string>\",\n \"otherIdentifier\": \"<string>\"\n }\n ]\n }\n ],\n \"otherPayerSupervisingProvider\": [\n {\n \"otherPayerSupervisingProviderIdentifier\": [\n {\n \"qualifier\": \"<string>\",\n \"identifier\": \"<string>\",\n \"otherIdentifier\": \"<string>\"\n }\n ]\n }\n ],\n \"otherPayerBillingProvider\": [\n {\n \"otherPayerBillingProviderIdentifier\": [\n {\n \"qualifier\": \"<string>\",\n \"identifier\": \"<string>\",\n \"otherIdentifier\": \"<string>\"\n }\n ]\n }\n ],\n \"patientSignatureGeneratedForPatient\": true,\n \"medicareOutpatientAdjudication\": {\n \"reimbursementRate\": \"<string>\",\n \"hcpcsPayableAmount\": \"<string>\",\n \"claimPaymentRemarkCode\": [\n \"<string>\"\n ],\n \"endStageRenalDiseasePaymentAmount\": \"<string>\",\n \"nonPayableProfessionalComponentBilledAmount\": \"<string>\"\n }\n }\n ]\n },\n \"isTesting\": true,\n \"controlNumber\": \"<string>\",\n \"providers\": [\n {\n \"providerType\": \"<string>\",\n \"npi\": \"<string>\",\n \"ssn\": \"<string>\",\n \"employerId\": \"<string>\",\n \"commercialNumber\": \"<string>\",\n \"locationNumber\": \"<string>\",\n \"stateLicenseNumber\": \"<string>\",\n \"providerUpinNumber\": \"<string>\",\n \"taxonomyCode\": \"<string>\",\n \"firstName\": \"<string>\",\n \"lastName\": \"<string>\",\n \"middleName\": \"<string>\",\n \"suffix\": \"<string>\",\n \"organizationName\": \"<string>\",\n \"contactInformation\": {\n \"name\": \"<string>\",\n \"phoneNumber\": \"<string>\",\n \"faxNumber\": \"<string>\",\n \"email\": \"<string>\",\n \"phoneExtension\": \"<string>\"\n }\n }\n ],\n \"referring\": {\n \"providerType\": \"<string>\",\n \"npi\": \"<string>\",\n \"commercialNumber\": \"<string>\",\n \"stateLicenseNumber\": \"<string>\",\n \"providerUpinNumber\": \"<string>\",\n \"taxonomyCode\": \"<string>\",\n \"firstName\": \"<string>\",\n \"lastName\": \"<string>\",\n \"middleName\": \"<string>\",\n \"suffix\": \"<string>\",\n \"organizationName\": \"<string>\",\n \"contactInformation\": {\n \"name\": \"<string>\",\n \"phoneNumber\": \"<string>\",\n \"faxNumber\": \"<string>\",\n \"email\": \"<string>\",\n \"phoneExtension\": \"<string>\"\n }\n },\n \"rendering\": {\n \"providerType\": \"<string>\",\n \"npi\": \"<string>\",\n \"commercialNumber\": \"<string>\",\n \"locationNumber\": \"<string>\",\n \"stateLicenseNumber\": \"<string>\",\n \"providerUpinNumber\": \"<string>\",\n \"taxonomyCode\": \"<string>\",\n \"firstName\": \"<string>\",\n \"lastName\": \"<string>\",\n \"middleName\": \"<string>\",\n \"suffix\": \"<string>\",\n \"organizationName\": \"<string>\",\n \"contactInformation\": {\n \"name\": \"<string>\",\n \"phoneNumber\": \"<string>\",\n \"faxNumber\": \"<string>\",\n \"email\": \"<string>\",\n \"phoneExtension\": \"<string>\"\n }\n },\n \"ordering\": {\n \"providerType\": \"<string>\",\n \"npi\": \"<string>\",\n \"ssn\": \"<string>\",\n \"employerId\": \"<string>\",\n \"commercialNumber\": \"<string>\",\n \"locationNumber\": \"<string>\",\n \"payerIdentificationNumber\": \"<string>\",\n \"employerIdentificationNumber\": \"<string>\",\n \"claimOfficeNumber\": \"<string>\",\n \"naic\": \"<string>\",\n \"stateLicenseNumber\": \"<string>\",\n \"providerUpinNumber\": \"<string>\",\n \"taxonomyCode\": \"<string>\",\n \"firstName\": \"<string>\",\n \"lastName\": \"<string>\",\n \"middleName\": \"<string>\",\n \"suffix\": \"<string>\",\n \"organizationName\": \"<string>\",\n \"contactInformation\": {\n \"name\": \"<string>\",\n \"phoneNumber\": \"<string>\",\n \"faxNumber\": \"<string>\",\n \"email\": \"<string>\",\n \"phoneExtension\": \"<string>\"\n }\n },\n \"supervising\": {\n \"providerType\": \"<string>\",\n \"npi\": \"<string>\",\n \"ssn\": \"<string>\",\n \"employerId\": \"<string>\",\n \"commercialNumber\": \"<string>\",\n \"locationNumber\": \"<string>\",\n \"stateLicenseNumber\": \"<string>\",\n \"providerUpinNumber\": \"<string>\",\n \"taxonomyCode\": \"<string>\",\n \"firstName\": \"<string>\",\n \"lastName\": \"<string>\",\n \"middleName\": \"<string>\",\n \"suffix\": \"<string>\",\n \"organizationName\": \"<string>\",\n \"contactInformation\": {\n \"name\": \"<string>\",\n \"phoneNumber\": \"<string>\",\n \"faxNumber\": \"<string>\",\n \"email\": \"<string>\",\n \"phoneExtension\": \"<string>\"\n }\n },\n \"tradingPartnerName\": \"<string>\"\n}"
response = http.request(request)
puts response.read_body{
"claimSubmissionId": "<string>",
"patientControlNumber": "<string>"
}{
"error": "<string>",
"message": "<string>",
"statusCode": 123,
"details": {}
}{
"error": "<string>"
}Clearinghouse
Submit electronic claim
Submits an electronic claim for processing. The submission is handled asynchronously, and this endpoint returns an identifier to track the status of the claim submission.
POST
/
api
/
v2
/
clearinghouse
/
claim
Submit electronic claim
curl --request POST \
--url https://api.example.com/api/v2/clearinghouse/claim \
--header 'Content-Type: application/json' \
--data '
{
"tradingPartnerServiceId": "<string>",
"submitter": {
"contactInformation": {
"name": "<string>",
"phoneNumber": "<string>",
"faxNumber": "<string>",
"email": "<string>",
"phoneExtension": "<string>"
},
"organizationName": "<string>",
"lastName": "<string>",
"firstName": "<string>",
"middleName": "<string>",
"submitterIdentification": "<string>"
},
"receiver": {
"organizationName": "<string>"
},
"subscriber": {
"memberId": "<string>",
"ssn": "<string>",
"organizationName": "<string>",
"subscriberGroupName": "<string>",
"firstName": "<string>",
"lastName": "<string>",
"middleName": "<string>",
"suffix": "<string>",
"dateOfBirth": "<string>",
"policyNumber": "<string>",
"groupNumber": "<string>"
},
"billing": {
"providerType": "<string>",
"npi": "<string>",
"ssn": "<string>",
"employerId": "<string>",
"commercialNumber": "<string>",
"locationNumber": "<string>",
"stateLicenseNumber": "<string>",
"providerUpinNumber": "<string>",
"taxonomyCode": "<string>",
"firstName": "<string>",
"lastName": "<string>",
"middleName": "<string>",
"suffix": "<string>",
"organizationName": "<string>",
"contactInformation": {
"name": "<string>",
"phoneNumber": "<string>",
"faxNumber": "<string>",
"email": "<string>",
"phoneExtension": "<string>"
}
},
"claimInformation": {
"claimChargeAmount": "<string>",
"healthCareCodeInformation": [
{
"diagnosisCode": "<string>"
}
],
"serviceLines": [
{
"serviceDate": "<string>",
"professionalService": {
"procedureCode": "<string>",
"lineItemChargeAmount": "<string>",
"serviceUnitCount": "<string>",
"compositeDiagnosisCodePointers": {
"diagnosisCodePointers": [
"<string>"
]
},
"procedureModifiers": [
"<string>"
],
"description": "<string>",
"placeOfServiceCode": "<string>",
"emergencyIndicator": "Y",
"epsdtIndicator": "Y",
"familyPlanningIndicator": "Y",
"copayStatusCode": "0"
},
"assignedNumber": "<string>",
"serviceDateEnd": "<string>",
"serviceLineSupplementalInformation": [
{
"attachmentControlNumber": "<string>"
}
],
"ambulanceCertification": [
{
"conditionCodes": []
}
],
"hospiceEmployeeIndicator": true,
"serviceLineDateInformation": {
"prescriptionDate": "<string>",
"certificationRevisionOrRecertificationDate": "<string>",
"beginTherapyDate": "<string>",
"lastCertificationDate": "<string>",
"treatmentOrTherapyDate": "<string>",
"hemoglobinTestDate": "<string>",
"serumCreatineTestDate": "<string>",
"shippedDate": "<string>",
"lastXRayDate": "<string>",
"initialTreatmentDate": "<string>"
},
"ambulancePatientCount": 123,
"obstetricAnesthesiaAdditionalUnits": 123,
"testResults": [
{
"testResults": "<string>"
}
],
"serviceLineReferenceInformation": {
"repricedLineItemReferenceNumber": "<string>",
"adjustedRepricedLineItemReferenceNumber": "<string>",
"priorAuthorization": [
{
"priorAuthorizationOrReferralNumber": "<string>",
"otherPayerPrimaryIdentifier": "<string>"
}
],
"mammographyCertificationNumber": "<string>",
"clinicalLaboratoryImprovementAmendmentNumber": "<string>",
"referringCliaNumber": "<string>",
"immunizationBatchNumber": "<string>",
"referralNumber": [
"<string>"
]
},
"salesTaxAmount": "<string>",
"postageTaxAmount": "<string>",
"fileInformation": [
"<string>"
],
"additionalNotes": "<string>",
"goalRehabOrDischargePlans": "<string>",
"thirdPartyOrganizationNotes": "<string>",
"purchasedServiceProvider": {
"providerType": "<string>",
"npi": "<string>",
"stateLicenseNumber": "<string>",
"commercialNumber": "<string>",
"payerIdentificationNumber": "<string>",
"ssn": "<string>",
"employerId": "<string>",
"locationNumber": "<string>",
"employerIdentificationNumber": "<string>",
"claimOfficeNumber": "<string>",
"naic": "<string>",
"providerUpinNumber": "<string>",
"taxonomyCode": "<string>",
"firstName": "<string>",
"lastName": "<string>",
"middleName": "<string>",
"suffix": "<string>",
"organizationName": "<string>",
"contactInformation": {
"name": "<string>",
"phoneNumber": "<string>",
"faxNumber": "<string>",
"email": "<string>",
"phoneExtension": "<string>"
},
"otherIdentifier": "<string>",
"secondaryIdentifier": [
{
"qualifier": "<string>",
"identifier": "<string>",
"otherIdentifier": "<string>"
}
]
},
"orderingProvider": {
"providerType": "<string>",
"npi": "<string>",
"ssn": "<string>",
"employerId": "<string>",
"commercialNumber": "<string>",
"locationNumber": "<string>",
"payerIdentificationNumber": "<string>",
"employerIdentificationNumber": "<string>",
"claimOfficeNumber": "<string>",
"naic": "<string>",
"stateLicenseNumber": "<string>",
"providerUpinNumber": "<string>",
"taxonomyCode": "<string>",
"firstName": "<string>",
"lastName": "<string>",
"middleName": "<string>",
"suffix": "<string>",
"organizationName": "<string>",
"otherIdentifier": "<string>",
"secondaryIdentifier": [
{
"qualifier": "<string>",
"identifier": "<string>",
"otherIdentifier": "<string>"
}
]
},
"lineAdjudicationInformation": [
{
"otherPayerPrimaryIdentifier": "<string>",
"serviceLinePaidAmount": "<string>",
"procedureCode": "<string>",
"paidServiceUnitCount": "<string>",
"adjudicationOrPaymentDate": "<string>",
"procedureModifier": [
"<string>"
],
"procedureCodeDescription": "<string>",
"bundledOrUnbundledLineNumber": "<string>",
"claimAdjustmentInformation": [
{
"adjustmentDetails": [
{
"adjustmentReasonCode": "<string>",
"adjustmentAmount": "<string>",
"adjustmentQuantity": "<string>"
}
]
}
],
"remainingPatientLiability": "<string>"
}
],
"formIdentification": [
{
"formIdentifier": "<string>",
"supportingDocumentation": [
{
"questionNumber": "<string>",
"questionResponse": "<string>",
"questionResponseAsDate": "<string>",
"questionResponseAsPercent": "<string>"
}
]
}
]
}
],
"propertyCasualtyClaimNumber": "<string>",
"relatedCausesCode": [],
"autoAccidentStateCode": "<string>",
"autoAccidentCountryCode": "<string>",
"patientAmountPaid": "<string>",
"fileInformation": "<string>",
"fileInformationList": [
"<string>"
],
"deathDate": "<string>",
"patientWeight": "<string>",
"patientSignatureSourceCode": true,
"pregnancyIndicator": "Y",
"claimDateInformation": {
"symptomDate": "<string>",
"initialTreatmentDate": "<string>",
"lastSeenDate": "<string>",
"acuteManifestationDate": "<string>",
"accidentDate": "<string>",
"lastMenstrualPeriodDate": "<string>",
"lastXRayDate": "<string>",
"hearingAndVisionPrescriptionDate": "<string>",
"disabilityBeginDate": "<string>",
"disabilityEndDate": "<string>",
"lastWorkedDate": "<string>",
"authorizedReturnToWorkDate": "<string>",
"admissionDate": "<string>",
"dischargeDate": "<string>",
"assumedAndRelinquishedCareBeginDate": "<string>",
"assumedAndRelinquishedCareEndDate": "<string>",
"repricerReceivedDate": "<string>",
"firstContactDate": "<string>"
},
"claimSupplementalInformation": {
"reportInformations": [
{
"attachmentControlNumber": "<string>"
}
],
"priorAuthorizationNumber": "<string>",
"referralNumber": "<string>",
"claimControlNumber": "<string>",
"cliaNumber": "<string>",
"repricedClaimNumber": "<string>",
"adjustedRepricedClaimNumber": "<string>",
"investigationalDeviceExemptionNumber": "<string>",
"claimNumber": "<string>",
"mammographyCertificationNumber": "<string>",
"medicalRecordNumber": "<string>",
"demoProjectIdentifier": "<string>",
"carePlanOversightNumber": "<string>",
"medicareCrossoverReferenceId": "<string>"
},
"ambulanceCertification": [
{
"conditionCodes": []
}
],
"patientConditionInformationVision": [
{
"conditionCodes": []
}
],
"homeboundIndicator": true,
"anesthesiaRelatedSurgicalProcedure": [
"<string>"
],
"conditionInformation": [
{
"conditionCodes": [
"<string>"
]
}
],
"claimNote": {
"additionalInformation": "<string>",
"certificationNarrative": "<string>",
"goalRehabOrDischargePlans": "<string>",
"diagnosisDescription": "<string>",
"thirdPartOrgNotes": "<string>"
},
"otherSubscriberInformation": [
{
"otherSubscriberName": {
"otherInsuredLastName": "<string>",
"otherInsuredIdentifier": "<string>",
"otherInsuredFirstName": "<string>",
"otherInsuredMiddleName": "<string>",
"otherInsuredNameSuffix": "<string>",
"otherInsuredAdditionalIdentifier": "<string>"
},
"otherPayerName": {
"otherPayerOrganizationName": "<string>",
"otherPayerIdentifier": "<string>",
"otherPayerAdjudicationOrPaymentDate": "<string>",
"otherPayerSecondaryIdentifier": [
{
"qualifier": "<string>",
"identifier": "<string>",
"otherIdentifier": "<string>"
}
],
"otherPayerPriorAuthorizationNumber": "<string>",
"otherPayerPriorAuthorizationOrReferralNumber": "<string>",
"otherPayerClaimAdjustmentIndicator": true,
"otherPayerClaimControlNumber": "<string>"
},
"insuranceGroupOrPolicyNumber": "<string>",
"otherInsuredGroupName": "<string>",
"claimLevelAdjustments": [
{
"adjustmentDetails": [
{
"adjustmentReasonCode": "<string>",
"adjustmentAmount": "<string>",
"adjustmentQuantity": "<string>"
}
]
}
],
"payerPaidAmount": "<string>",
"nonCoveredChargeAmount": "<string>",
"remainingPatientLiability": "<string>",
"otherPayerReferringProvider": [
{
"otherPayerReferringProviderIdentifier": [
{
"qualifier": "<string>",
"identifier": "<string>",
"otherIdentifier": "<string>"
}
]
}
],
"otherPayerRenderingProvider": [
{
"otherPayerRenderingProviderSecondaryIdentifier": [
{
"qualifier": "<string>",
"identifier": "<string>",
"otherIdentifier": "<string>"
}
]
}
],
"otherPayerServiceFacilityLocation": [
{
"otherPayerServiceFacilityLocationSecondaryIdentifier": [
{
"qualifier": "<string>",
"identifier": "<string>",
"otherIdentifier": "<string>"
}
]
}
],
"otherPayerSupervisingProvider": [
{
"otherPayerSupervisingProviderIdentifier": [
{
"qualifier": "<string>",
"identifier": "<string>",
"otherIdentifier": "<string>"
}
]
}
],
"otherPayerBillingProvider": [
{
"otherPayerBillingProviderIdentifier": [
{
"qualifier": "<string>",
"identifier": "<string>",
"otherIdentifier": "<string>"
}
]
}
],
"patientSignatureGeneratedForPatient": true,
"medicareOutpatientAdjudication": {
"reimbursementRate": "<string>",
"hcpcsPayableAmount": "<string>",
"claimPaymentRemarkCode": [
"<string>"
],
"endStageRenalDiseasePaymentAmount": "<string>",
"nonPayableProfessionalComponentBilledAmount": "<string>"
}
}
]
},
"isTesting": true,
"controlNumber": "<string>",
"providers": [
{
"providerType": "<string>",
"npi": "<string>",
"ssn": "<string>",
"employerId": "<string>",
"commercialNumber": "<string>",
"locationNumber": "<string>",
"stateLicenseNumber": "<string>",
"providerUpinNumber": "<string>",
"taxonomyCode": "<string>",
"firstName": "<string>",
"lastName": "<string>",
"middleName": "<string>",
"suffix": "<string>",
"organizationName": "<string>",
"contactInformation": {
"name": "<string>",
"phoneNumber": "<string>",
"faxNumber": "<string>",
"email": "<string>",
"phoneExtension": "<string>"
}
}
],
"referring": {
"providerType": "<string>",
"npi": "<string>",
"commercialNumber": "<string>",
"stateLicenseNumber": "<string>",
"providerUpinNumber": "<string>",
"taxonomyCode": "<string>",
"firstName": "<string>",
"lastName": "<string>",
"middleName": "<string>",
"suffix": "<string>",
"organizationName": "<string>",
"contactInformation": {
"name": "<string>",
"phoneNumber": "<string>",
"faxNumber": "<string>",
"email": "<string>",
"phoneExtension": "<string>"
}
},
"rendering": {
"providerType": "<string>",
"npi": "<string>",
"commercialNumber": "<string>",
"locationNumber": "<string>",
"stateLicenseNumber": "<string>",
"providerUpinNumber": "<string>",
"taxonomyCode": "<string>",
"firstName": "<string>",
"lastName": "<string>",
"middleName": "<string>",
"suffix": "<string>",
"organizationName": "<string>",
"contactInformation": {
"name": "<string>",
"phoneNumber": "<string>",
"faxNumber": "<string>",
"email": "<string>",
"phoneExtension": "<string>"
}
},
"ordering": {
"providerType": "<string>",
"npi": "<string>",
"ssn": "<string>",
"employerId": "<string>",
"commercialNumber": "<string>",
"locationNumber": "<string>",
"payerIdentificationNumber": "<string>",
"employerIdentificationNumber": "<string>",
"claimOfficeNumber": "<string>",
"naic": "<string>",
"stateLicenseNumber": "<string>",
"providerUpinNumber": "<string>",
"taxonomyCode": "<string>",
"firstName": "<string>",
"lastName": "<string>",
"middleName": "<string>",
"suffix": "<string>",
"organizationName": "<string>",
"contactInformation": {
"name": "<string>",
"phoneNumber": "<string>",
"faxNumber": "<string>",
"email": "<string>",
"phoneExtension": "<string>"
}
},
"supervising": {
"providerType": "<string>",
"npi": "<string>",
"ssn": "<string>",
"employerId": "<string>",
"commercialNumber": "<string>",
"locationNumber": "<string>",
"stateLicenseNumber": "<string>",
"providerUpinNumber": "<string>",
"taxonomyCode": "<string>",
"firstName": "<string>",
"lastName": "<string>",
"middleName": "<string>",
"suffix": "<string>",
"organizationName": "<string>",
"contactInformation": {
"name": "<string>",
"phoneNumber": "<string>",
"faxNumber": "<string>",
"email": "<string>",
"phoneExtension": "<string>"
}
},
"tradingPartnerName": "<string>"
}
'import requests
url = "https://api.example.com/api/v2/clearinghouse/claim"
payload = {
"tradingPartnerServiceId": "<string>",
"submitter": {
"contactInformation": {
"name": "<string>",
"phoneNumber": "<string>",
"faxNumber": "<string>",
"email": "<string>",
"phoneExtension": "<string>"
},
"organizationName": "<string>",
"lastName": "<string>",
"firstName": "<string>",
"middleName": "<string>",
"submitterIdentification": "<string>"
},
"receiver": { "organizationName": "<string>" },
"subscriber": {
"memberId": "<string>",
"ssn": "<string>",
"organizationName": "<string>",
"subscriberGroupName": "<string>",
"firstName": "<string>",
"lastName": "<string>",
"middleName": "<string>",
"suffix": "<string>",
"dateOfBirth": "<string>",
"policyNumber": "<string>",
"groupNumber": "<string>"
},
"billing": {
"providerType": "<string>",
"npi": "<string>",
"ssn": "<string>",
"employerId": "<string>",
"commercialNumber": "<string>",
"locationNumber": "<string>",
"stateLicenseNumber": "<string>",
"providerUpinNumber": "<string>",
"taxonomyCode": "<string>",
"firstName": "<string>",
"lastName": "<string>",
"middleName": "<string>",
"suffix": "<string>",
"organizationName": "<string>",
"contactInformation": {
"name": "<string>",
"phoneNumber": "<string>",
"faxNumber": "<string>",
"email": "<string>",
"phoneExtension": "<string>"
}
},
"claimInformation": {
"claimChargeAmount": "<string>",
"healthCareCodeInformation": [{ "diagnosisCode": "<string>" }],
"serviceLines": [
{
"serviceDate": "<string>",
"professionalService": {
"procedureCode": "<string>",
"lineItemChargeAmount": "<string>",
"serviceUnitCount": "<string>",
"compositeDiagnosisCodePointers": { "diagnosisCodePointers": ["<string>"] },
"procedureModifiers": ["<string>"],
"description": "<string>",
"placeOfServiceCode": "<string>",
"emergencyIndicator": "Y",
"epsdtIndicator": "Y",
"familyPlanningIndicator": "Y",
"copayStatusCode": "0"
},
"assignedNumber": "<string>",
"serviceDateEnd": "<string>",
"serviceLineSupplementalInformation": [{ "attachmentControlNumber": "<string>" }],
"ambulanceCertification": [{ "conditionCodes": [] }],
"hospiceEmployeeIndicator": True,
"serviceLineDateInformation": {
"prescriptionDate": "<string>",
"certificationRevisionOrRecertificationDate": "<string>",
"beginTherapyDate": "<string>",
"lastCertificationDate": "<string>",
"treatmentOrTherapyDate": "<string>",
"hemoglobinTestDate": "<string>",
"serumCreatineTestDate": "<string>",
"shippedDate": "<string>",
"lastXRayDate": "<string>",
"initialTreatmentDate": "<string>"
},
"ambulancePatientCount": 123,
"obstetricAnesthesiaAdditionalUnits": 123,
"testResults": [{ "testResults": "<string>" }],
"serviceLineReferenceInformation": {
"repricedLineItemReferenceNumber": "<string>",
"adjustedRepricedLineItemReferenceNumber": "<string>",
"priorAuthorization": [
{
"priorAuthorizationOrReferralNumber": "<string>",
"otherPayerPrimaryIdentifier": "<string>"
}
],
"mammographyCertificationNumber": "<string>",
"clinicalLaboratoryImprovementAmendmentNumber": "<string>",
"referringCliaNumber": "<string>",
"immunizationBatchNumber": "<string>",
"referralNumber": ["<string>"]
},
"salesTaxAmount": "<string>",
"postageTaxAmount": "<string>",
"fileInformation": ["<string>"],
"additionalNotes": "<string>",
"goalRehabOrDischargePlans": "<string>",
"thirdPartyOrganizationNotes": "<string>",
"purchasedServiceProvider": {
"providerType": "<string>",
"npi": "<string>",
"stateLicenseNumber": "<string>",
"commercialNumber": "<string>",
"payerIdentificationNumber": "<string>",
"ssn": "<string>",
"employerId": "<string>",
"locationNumber": "<string>",
"employerIdentificationNumber": "<string>",
"claimOfficeNumber": "<string>",
"naic": "<string>",
"providerUpinNumber": "<string>",
"taxonomyCode": "<string>",
"firstName": "<string>",
"lastName": "<string>",
"middleName": "<string>",
"suffix": "<string>",
"organizationName": "<string>",
"contactInformation": {
"name": "<string>",
"phoneNumber": "<string>",
"faxNumber": "<string>",
"email": "<string>",
"phoneExtension": "<string>"
},
"otherIdentifier": "<string>",
"secondaryIdentifier": [
{
"qualifier": "<string>",
"identifier": "<string>",
"otherIdentifier": "<string>"
}
]
},
"orderingProvider": {
"providerType": "<string>",
"npi": "<string>",
"ssn": "<string>",
"employerId": "<string>",
"commercialNumber": "<string>",
"locationNumber": "<string>",
"payerIdentificationNumber": "<string>",
"employerIdentificationNumber": "<string>",
"claimOfficeNumber": "<string>",
"naic": "<string>",
"stateLicenseNumber": "<string>",
"providerUpinNumber": "<string>",
"taxonomyCode": "<string>",
"firstName": "<string>",
"lastName": "<string>",
"middleName": "<string>",
"suffix": "<string>",
"organizationName": "<string>",
"otherIdentifier": "<string>",
"secondaryIdentifier": [
{
"qualifier": "<string>",
"identifier": "<string>",
"otherIdentifier": "<string>"
}
]
},
"lineAdjudicationInformation": [
{
"otherPayerPrimaryIdentifier": "<string>",
"serviceLinePaidAmount": "<string>",
"procedureCode": "<string>",
"paidServiceUnitCount": "<string>",
"adjudicationOrPaymentDate": "<string>",
"procedureModifier": ["<string>"],
"procedureCodeDescription": "<string>",
"bundledOrUnbundledLineNumber": "<string>",
"claimAdjustmentInformation": [{ "adjustmentDetails": [
{
"adjustmentReasonCode": "<string>",
"adjustmentAmount": "<string>",
"adjustmentQuantity": "<string>"
}
] }],
"remainingPatientLiability": "<string>"
}
],
"formIdentification": [
{
"formIdentifier": "<string>",
"supportingDocumentation": [
{
"questionNumber": "<string>",
"questionResponse": "<string>",
"questionResponseAsDate": "<string>",
"questionResponseAsPercent": "<string>"
}
]
}
]
}
],
"propertyCasualtyClaimNumber": "<string>",
"relatedCausesCode": [],
"autoAccidentStateCode": "<string>",
"autoAccidentCountryCode": "<string>",
"patientAmountPaid": "<string>",
"fileInformation": "<string>",
"fileInformationList": ["<string>"],
"deathDate": "<string>",
"patientWeight": "<string>",
"patientSignatureSourceCode": True,
"pregnancyIndicator": "Y",
"claimDateInformation": {
"symptomDate": "<string>",
"initialTreatmentDate": "<string>",
"lastSeenDate": "<string>",
"acuteManifestationDate": "<string>",
"accidentDate": "<string>",
"lastMenstrualPeriodDate": "<string>",
"lastXRayDate": "<string>",
"hearingAndVisionPrescriptionDate": "<string>",
"disabilityBeginDate": "<string>",
"disabilityEndDate": "<string>",
"lastWorkedDate": "<string>",
"authorizedReturnToWorkDate": "<string>",
"admissionDate": "<string>",
"dischargeDate": "<string>",
"assumedAndRelinquishedCareBeginDate": "<string>",
"assumedAndRelinquishedCareEndDate": "<string>",
"repricerReceivedDate": "<string>",
"firstContactDate": "<string>"
},
"claimSupplementalInformation": {
"reportInformations": [{ "attachmentControlNumber": "<string>" }],
"priorAuthorizationNumber": "<string>",
"referralNumber": "<string>",
"claimControlNumber": "<string>",
"cliaNumber": "<string>",
"repricedClaimNumber": "<string>",
"adjustedRepricedClaimNumber": "<string>",
"investigationalDeviceExemptionNumber": "<string>",
"claimNumber": "<string>",
"mammographyCertificationNumber": "<string>",
"medicalRecordNumber": "<string>",
"demoProjectIdentifier": "<string>",
"carePlanOversightNumber": "<string>",
"medicareCrossoverReferenceId": "<string>"
},
"ambulanceCertification": [{ "conditionCodes": [] }],
"patientConditionInformationVision": [{ "conditionCodes": [] }],
"homeboundIndicator": True,
"anesthesiaRelatedSurgicalProcedure": ["<string>"],
"conditionInformation": [{ "conditionCodes": ["<string>"] }],
"claimNote": {
"additionalInformation": "<string>",
"certificationNarrative": "<string>",
"goalRehabOrDischargePlans": "<string>",
"diagnosisDescription": "<string>",
"thirdPartOrgNotes": "<string>"
},
"otherSubscriberInformation": [
{
"otherSubscriberName": {
"otherInsuredLastName": "<string>",
"otherInsuredIdentifier": "<string>",
"otherInsuredFirstName": "<string>",
"otherInsuredMiddleName": "<string>",
"otherInsuredNameSuffix": "<string>",
"otherInsuredAdditionalIdentifier": "<string>"
},
"otherPayerName": {
"otherPayerOrganizationName": "<string>",
"otherPayerIdentifier": "<string>",
"otherPayerAdjudicationOrPaymentDate": "<string>",
"otherPayerSecondaryIdentifier": [
{
"qualifier": "<string>",
"identifier": "<string>",
"otherIdentifier": "<string>"
}
],
"otherPayerPriorAuthorizationNumber": "<string>",
"otherPayerPriorAuthorizationOrReferralNumber": "<string>",
"otherPayerClaimAdjustmentIndicator": True,
"otherPayerClaimControlNumber": "<string>"
},
"insuranceGroupOrPolicyNumber": "<string>",
"otherInsuredGroupName": "<string>",
"claimLevelAdjustments": [{ "adjustmentDetails": [
{
"adjustmentReasonCode": "<string>",
"adjustmentAmount": "<string>",
"adjustmentQuantity": "<string>"
}
] }],
"payerPaidAmount": "<string>",
"nonCoveredChargeAmount": "<string>",
"remainingPatientLiability": "<string>",
"otherPayerReferringProvider": [{ "otherPayerReferringProviderIdentifier": [
{
"qualifier": "<string>",
"identifier": "<string>",
"otherIdentifier": "<string>"
}
] }],
"otherPayerRenderingProvider": [{ "otherPayerRenderingProviderSecondaryIdentifier": [
{
"qualifier": "<string>",
"identifier": "<string>",
"otherIdentifier": "<string>"
}
] }],
"otherPayerServiceFacilityLocation": [{ "otherPayerServiceFacilityLocationSecondaryIdentifier": [
{
"qualifier": "<string>",
"identifier": "<string>",
"otherIdentifier": "<string>"
}
] }],
"otherPayerSupervisingProvider": [{ "otherPayerSupervisingProviderIdentifier": [
{
"qualifier": "<string>",
"identifier": "<string>",
"otherIdentifier": "<string>"
}
] }],
"otherPayerBillingProvider": [{ "otherPayerBillingProviderIdentifier": [
{
"qualifier": "<string>",
"identifier": "<string>",
"otherIdentifier": "<string>"
}
] }],
"patientSignatureGeneratedForPatient": True,
"medicareOutpatientAdjudication": {
"reimbursementRate": "<string>",
"hcpcsPayableAmount": "<string>",
"claimPaymentRemarkCode": ["<string>"],
"endStageRenalDiseasePaymentAmount": "<string>",
"nonPayableProfessionalComponentBilledAmount": "<string>"
}
}
]
},
"isTesting": True,
"controlNumber": "<string>",
"providers": [
{
"providerType": "<string>",
"npi": "<string>",
"ssn": "<string>",
"employerId": "<string>",
"commercialNumber": "<string>",
"locationNumber": "<string>",
"stateLicenseNumber": "<string>",
"providerUpinNumber": "<string>",
"taxonomyCode": "<string>",
"firstName": "<string>",
"lastName": "<string>",
"middleName": "<string>",
"suffix": "<string>",
"organizationName": "<string>",
"contactInformation": {
"name": "<string>",
"phoneNumber": "<string>",
"faxNumber": "<string>",
"email": "<string>",
"phoneExtension": "<string>"
}
}
],
"referring": {
"providerType": "<string>",
"npi": "<string>",
"commercialNumber": "<string>",
"stateLicenseNumber": "<string>",
"providerUpinNumber": "<string>",
"taxonomyCode": "<string>",
"firstName": "<string>",
"lastName": "<string>",
"middleName": "<string>",
"suffix": "<string>",
"organizationName": "<string>",
"contactInformation": {
"name": "<string>",
"phoneNumber": "<string>",
"faxNumber": "<string>",
"email": "<string>",
"phoneExtension": "<string>"
}
},
"rendering": {
"providerType": "<string>",
"npi": "<string>",
"commercialNumber": "<string>",
"locationNumber": "<string>",
"stateLicenseNumber": "<string>",
"providerUpinNumber": "<string>",
"taxonomyCode": "<string>",
"firstName": "<string>",
"lastName": "<string>",
"middleName": "<string>",
"suffix": "<string>",
"organizationName": "<string>",
"contactInformation": {
"name": "<string>",
"phoneNumber": "<string>",
"faxNumber": "<string>",
"email": "<string>",
"phoneExtension": "<string>"
}
},
"ordering": {
"providerType": "<string>",
"npi": "<string>",
"ssn": "<string>",
"employerId": "<string>",
"commercialNumber": "<string>",
"locationNumber": "<string>",
"payerIdentificationNumber": "<string>",
"employerIdentificationNumber": "<string>",
"claimOfficeNumber": "<string>",
"naic": "<string>",
"stateLicenseNumber": "<string>",
"providerUpinNumber": "<string>",
"taxonomyCode": "<string>",
"firstName": "<string>",
"lastName": "<string>",
"middleName": "<string>",
"suffix": "<string>",
"organizationName": "<string>",
"contactInformation": {
"name": "<string>",
"phoneNumber": "<string>",
"faxNumber": "<string>",
"email": "<string>",
"phoneExtension": "<string>"
}
},
"supervising": {
"providerType": "<string>",
"npi": "<string>",
"ssn": "<string>",
"employerId": "<string>",
"commercialNumber": "<string>",
"locationNumber": "<string>",
"stateLicenseNumber": "<string>",
"providerUpinNumber": "<string>",
"taxonomyCode": "<string>",
"firstName": "<string>",
"lastName": "<string>",
"middleName": "<string>",
"suffix": "<string>",
"organizationName": "<string>",
"contactInformation": {
"name": "<string>",
"phoneNumber": "<string>",
"faxNumber": "<string>",
"email": "<string>",
"phoneExtension": "<string>"
}
},
"tradingPartnerName": "<string>"
}
headers = {"Content-Type": "application/json"}
response = requests.post(url, json=payload, headers=headers)
print(response.text)const options = {
method: 'POST',
headers: {'Content-Type': 'application/json'},
body: JSON.stringify({
tradingPartnerServiceId: '<string>',
submitter: {
contactInformation: {
name: '<string>',
phoneNumber: '<string>',
faxNumber: '<string>',
email: '<string>',
phoneExtension: '<string>'
},
organizationName: '<string>',
lastName: '<string>',
firstName: '<string>',
middleName: '<string>',
submitterIdentification: '<string>'
},
receiver: {organizationName: '<string>'},
subscriber: {
memberId: '<string>',
ssn: '<string>',
organizationName: '<string>',
subscriberGroupName: '<string>',
firstName: '<string>',
lastName: '<string>',
middleName: '<string>',
suffix: '<string>',
dateOfBirth: '<string>',
policyNumber: '<string>',
groupNumber: '<string>'
},
billing: {
providerType: '<string>',
npi: '<string>',
ssn: '<string>',
employerId: '<string>',
commercialNumber: '<string>',
locationNumber: '<string>',
stateLicenseNumber: '<string>',
providerUpinNumber: '<string>',
taxonomyCode: '<string>',
firstName: '<string>',
lastName: '<string>',
middleName: '<string>',
suffix: '<string>',
organizationName: '<string>',
contactInformation: {
name: '<string>',
phoneNumber: '<string>',
faxNumber: '<string>',
email: '<string>',
phoneExtension: '<string>'
}
},
claimInformation: {
claimChargeAmount: '<string>',
healthCareCodeInformation: [{diagnosisCode: '<string>'}],
serviceLines: [
{
serviceDate: '<string>',
professionalService: {
procedureCode: '<string>',
lineItemChargeAmount: '<string>',
serviceUnitCount: '<string>',
compositeDiagnosisCodePointers: {diagnosisCodePointers: ['<string>']},
procedureModifiers: ['<string>'],
description: '<string>',
placeOfServiceCode: '<string>',
emergencyIndicator: 'Y',
epsdtIndicator: 'Y',
familyPlanningIndicator: 'Y',
copayStatusCode: '0'
},
assignedNumber: '<string>',
serviceDateEnd: '<string>',
serviceLineSupplementalInformation: [{attachmentControlNumber: '<string>'}],
ambulanceCertification: [{conditionCodes: []}],
hospiceEmployeeIndicator: true,
serviceLineDateInformation: {
prescriptionDate: '<string>',
certificationRevisionOrRecertificationDate: '<string>',
beginTherapyDate: '<string>',
lastCertificationDate: '<string>',
treatmentOrTherapyDate: '<string>',
hemoglobinTestDate: '<string>',
serumCreatineTestDate: '<string>',
shippedDate: '<string>',
lastXRayDate: '<string>',
initialTreatmentDate: '<string>'
},
ambulancePatientCount: 123,
obstetricAnesthesiaAdditionalUnits: 123,
testResults: [{testResults: '<string>'}],
serviceLineReferenceInformation: {
repricedLineItemReferenceNumber: '<string>',
adjustedRepricedLineItemReferenceNumber: '<string>',
priorAuthorization: [
{
priorAuthorizationOrReferralNumber: '<string>',
otherPayerPrimaryIdentifier: '<string>'
}
],
mammographyCertificationNumber: '<string>',
clinicalLaboratoryImprovementAmendmentNumber: '<string>',
referringCliaNumber: '<string>',
immunizationBatchNumber: '<string>',
referralNumber: ['<string>']
},
salesTaxAmount: '<string>',
postageTaxAmount: '<string>',
fileInformation: ['<string>'],
additionalNotes: '<string>',
goalRehabOrDischargePlans: '<string>',
thirdPartyOrganizationNotes: '<string>',
purchasedServiceProvider: {
providerType: '<string>',
npi: '<string>',
stateLicenseNumber: '<string>',
commercialNumber: '<string>',
payerIdentificationNumber: '<string>',
ssn: '<string>',
employerId: '<string>',
locationNumber: '<string>',
employerIdentificationNumber: '<string>',
claimOfficeNumber: '<string>',
naic: '<string>',
providerUpinNumber: '<string>',
taxonomyCode: '<string>',
firstName: '<string>',
lastName: '<string>',
middleName: '<string>',
suffix: '<string>',
organizationName: '<string>',
contactInformation: {
name: '<string>',
phoneNumber: '<string>',
faxNumber: '<string>',
email: '<string>',
phoneExtension: '<string>'
},
otherIdentifier: '<string>',
secondaryIdentifier: [{qualifier: '<string>', identifier: '<string>', otherIdentifier: '<string>'}]
},
orderingProvider: {
providerType: '<string>',
npi: '<string>',
ssn: '<string>',
employerId: '<string>',
commercialNumber: '<string>',
locationNumber: '<string>',
payerIdentificationNumber: '<string>',
employerIdentificationNumber: '<string>',
claimOfficeNumber: '<string>',
naic: '<string>',
stateLicenseNumber: '<string>',
providerUpinNumber: '<string>',
taxonomyCode: '<string>',
firstName: '<string>',
lastName: '<string>',
middleName: '<string>',
suffix: '<string>',
organizationName: '<string>',
otherIdentifier: '<string>',
secondaryIdentifier: [{qualifier: '<string>', identifier: '<string>', otherIdentifier: '<string>'}]
},
lineAdjudicationInformation: [
{
otherPayerPrimaryIdentifier: '<string>',
serviceLinePaidAmount: '<string>',
procedureCode: '<string>',
paidServiceUnitCount: '<string>',
adjudicationOrPaymentDate: '<string>',
procedureModifier: ['<string>'],
procedureCodeDescription: '<string>',
bundledOrUnbundledLineNumber: '<string>',
claimAdjustmentInformation: [
{
adjustmentDetails: [
{
adjustmentReasonCode: '<string>',
adjustmentAmount: '<string>',
adjustmentQuantity: '<string>'
}
]
}
],
remainingPatientLiability: '<string>'
}
],
formIdentification: [
{
formIdentifier: '<string>',
supportingDocumentation: [
{
questionNumber: '<string>',
questionResponse: '<string>',
questionResponseAsDate: '<string>',
questionResponseAsPercent: '<string>'
}
]
}
]
}
],
propertyCasualtyClaimNumber: '<string>',
relatedCausesCode: [],
autoAccidentStateCode: '<string>',
autoAccidentCountryCode: '<string>',
patientAmountPaid: '<string>',
fileInformation: '<string>',
fileInformationList: ['<string>'],
deathDate: '<string>',
patientWeight: '<string>',
patientSignatureSourceCode: true,
pregnancyIndicator: 'Y',
claimDateInformation: {
symptomDate: '<string>',
initialTreatmentDate: '<string>',
lastSeenDate: '<string>',
acuteManifestationDate: '<string>',
accidentDate: '<string>',
lastMenstrualPeriodDate: '<string>',
lastXRayDate: '<string>',
hearingAndVisionPrescriptionDate: '<string>',
disabilityBeginDate: '<string>',
disabilityEndDate: '<string>',
lastWorkedDate: '<string>',
authorizedReturnToWorkDate: '<string>',
admissionDate: '<string>',
dischargeDate: '<string>',
assumedAndRelinquishedCareBeginDate: '<string>',
assumedAndRelinquishedCareEndDate: '<string>',
repricerReceivedDate: '<string>',
firstContactDate: '<string>'
},
claimSupplementalInformation: {
reportInformations: [{attachmentControlNumber: '<string>'}],
priorAuthorizationNumber: '<string>',
referralNumber: '<string>',
claimControlNumber: '<string>',
cliaNumber: '<string>',
repricedClaimNumber: '<string>',
adjustedRepricedClaimNumber: '<string>',
investigationalDeviceExemptionNumber: '<string>',
claimNumber: '<string>',
mammographyCertificationNumber: '<string>',
medicalRecordNumber: '<string>',
demoProjectIdentifier: '<string>',
carePlanOversightNumber: '<string>',
medicareCrossoverReferenceId: '<string>'
},
ambulanceCertification: [{conditionCodes: []}],
patientConditionInformationVision: [{conditionCodes: []}],
homeboundIndicator: true,
anesthesiaRelatedSurgicalProcedure: ['<string>'],
conditionInformation: [{conditionCodes: ['<string>']}],
claimNote: {
additionalInformation: '<string>',
certificationNarrative: '<string>',
goalRehabOrDischargePlans: '<string>',
diagnosisDescription: '<string>',
thirdPartOrgNotes: '<string>'
},
otherSubscriberInformation: [
{
otherSubscriberName: {
otherInsuredLastName: '<string>',
otherInsuredIdentifier: '<string>',
otherInsuredFirstName: '<string>',
otherInsuredMiddleName: '<string>',
otherInsuredNameSuffix: '<string>',
otherInsuredAdditionalIdentifier: '<string>'
},
otherPayerName: {
otherPayerOrganizationName: '<string>',
otherPayerIdentifier: '<string>',
otherPayerAdjudicationOrPaymentDate: '<string>',
otherPayerSecondaryIdentifier: [{qualifier: '<string>', identifier: '<string>', otherIdentifier: '<string>'}],
otherPayerPriorAuthorizationNumber: '<string>',
otherPayerPriorAuthorizationOrReferralNumber: '<string>',
otherPayerClaimAdjustmentIndicator: true,
otherPayerClaimControlNumber: '<string>'
},
insuranceGroupOrPolicyNumber: '<string>',
otherInsuredGroupName: '<string>',
claimLevelAdjustments: [
{
adjustmentDetails: [
{
adjustmentReasonCode: '<string>',
adjustmentAmount: '<string>',
adjustmentQuantity: '<string>'
}
]
}
],
payerPaidAmount: '<string>',
nonCoveredChargeAmount: '<string>',
remainingPatientLiability: '<string>',
otherPayerReferringProvider: [
{
otherPayerReferringProviderIdentifier: [{qualifier: '<string>', identifier: '<string>', otherIdentifier: '<string>'}]
}
],
otherPayerRenderingProvider: [
{
otherPayerRenderingProviderSecondaryIdentifier: [{qualifier: '<string>', identifier: '<string>', otherIdentifier: '<string>'}]
}
],
otherPayerServiceFacilityLocation: [
{
otherPayerServiceFacilityLocationSecondaryIdentifier: [{qualifier: '<string>', identifier: '<string>', otherIdentifier: '<string>'}]
}
],
otherPayerSupervisingProvider: [
{
otherPayerSupervisingProviderIdentifier: [{qualifier: '<string>', identifier: '<string>', otherIdentifier: '<string>'}]
}
],
otherPayerBillingProvider: [
{
otherPayerBillingProviderIdentifier: [{qualifier: '<string>', identifier: '<string>', otherIdentifier: '<string>'}]
}
],
patientSignatureGeneratedForPatient: true,
medicareOutpatientAdjudication: {
reimbursementRate: '<string>',
hcpcsPayableAmount: '<string>',
claimPaymentRemarkCode: ['<string>'],
endStageRenalDiseasePaymentAmount: '<string>',
nonPayableProfessionalComponentBilledAmount: '<string>'
}
}
]
},
isTesting: true,
controlNumber: '<string>',
providers: [
{
providerType: '<string>',
npi: '<string>',
ssn: '<string>',
employerId: '<string>',
commercialNumber: '<string>',
locationNumber: '<string>',
stateLicenseNumber: '<string>',
providerUpinNumber: '<string>',
taxonomyCode: '<string>',
firstName: '<string>',
lastName: '<string>',
middleName: '<string>',
suffix: '<string>',
organizationName: '<string>',
contactInformation: {
name: '<string>',
phoneNumber: '<string>',
faxNumber: '<string>',
email: '<string>',
phoneExtension: '<string>'
}
}
],
referring: {
providerType: '<string>',
npi: '<string>',
commercialNumber: '<string>',
stateLicenseNumber: '<string>',
providerUpinNumber: '<string>',
taxonomyCode: '<string>',
firstName: '<string>',
lastName: '<string>',
middleName: '<string>',
suffix: '<string>',
organizationName: '<string>',
contactInformation: {
name: '<string>',
phoneNumber: '<string>',
faxNumber: '<string>',
email: '<string>',
phoneExtension: '<string>'
}
},
rendering: {
providerType: '<string>',
npi: '<string>',
commercialNumber: '<string>',
locationNumber: '<string>',
stateLicenseNumber: '<string>',
providerUpinNumber: '<string>',
taxonomyCode: '<string>',
firstName: '<string>',
lastName: '<string>',
middleName: '<string>',
suffix: '<string>',
organizationName: '<string>',
contactInformation: {
name: '<string>',
phoneNumber: '<string>',
faxNumber: '<string>',
email: '<string>',
phoneExtension: '<string>'
}
},
ordering: {
providerType: '<string>',
npi: '<string>',
ssn: '<string>',
employerId: '<string>',
commercialNumber: '<string>',
locationNumber: '<string>',
payerIdentificationNumber: '<string>',
employerIdentificationNumber: '<string>',
claimOfficeNumber: '<string>',
naic: '<string>',
stateLicenseNumber: '<string>',
providerUpinNumber: '<string>',
taxonomyCode: '<string>',
firstName: '<string>',
lastName: '<string>',
middleName: '<string>',
suffix: '<string>',
organizationName: '<string>',
contactInformation: {
name: '<string>',
phoneNumber: '<string>',
faxNumber: '<string>',
email: '<string>',
phoneExtension: '<string>'
}
},
supervising: {
providerType: '<string>',
npi: '<string>',
ssn: '<string>',
employerId: '<string>',
commercialNumber: '<string>',
locationNumber: '<string>',
stateLicenseNumber: '<string>',
providerUpinNumber: '<string>',
taxonomyCode: '<string>',
firstName: '<string>',
lastName: '<string>',
middleName: '<string>',
suffix: '<string>',
organizationName: '<string>',
contactInformation: {
name: '<string>',
phoneNumber: '<string>',
faxNumber: '<string>',
email: '<string>',
phoneExtension: '<string>'
}
},
tradingPartnerName: '<string>'
})
};
fetch('https://api.example.com/api/v2/clearinghouse/claim', options)
.then(res => res.json())
.then(res => console.log(res))
.catch(err => console.error(err));<?php
$curl = curl_init();
curl_setopt_array($curl, [
CURLOPT_URL => "https://api.example.com/api/v2/clearinghouse/claim",
CURLOPT_RETURNTRANSFER => true,
CURLOPT_ENCODING => "",
CURLOPT_MAXREDIRS => 10,
CURLOPT_TIMEOUT => 30,
CURLOPT_HTTP_VERSION => CURL_HTTP_VERSION_1_1,
CURLOPT_CUSTOMREQUEST => "POST",
CURLOPT_POSTFIELDS => json_encode([
'tradingPartnerServiceId' => '<string>',
'submitter' => [
'contactInformation' => [
'name' => '<string>',
'phoneNumber' => '<string>',
'faxNumber' => '<string>',
'email' => '<string>',
'phoneExtension' => '<string>'
],
'organizationName' => '<string>',
'lastName' => '<string>',
'firstName' => '<string>',
'middleName' => '<string>',
'submitterIdentification' => '<string>'
],
'receiver' => [
'organizationName' => '<string>'
],
'subscriber' => [
'memberId' => '<string>',
'ssn' => '<string>',
'organizationName' => '<string>',
'subscriberGroupName' => '<string>',
'firstName' => '<string>',
'lastName' => '<string>',
'middleName' => '<string>',
'suffix' => '<string>',
'dateOfBirth' => '<string>',
'policyNumber' => '<string>',
'groupNumber' => '<string>'
],
'billing' => [
'providerType' => '<string>',
'npi' => '<string>',
'ssn' => '<string>',
'employerId' => '<string>',
'commercialNumber' => '<string>',
'locationNumber' => '<string>',
'stateLicenseNumber' => '<string>',
'providerUpinNumber' => '<string>',
'taxonomyCode' => '<string>',
'firstName' => '<string>',
'lastName' => '<string>',
'middleName' => '<string>',
'suffix' => '<string>',
'organizationName' => '<string>',
'contactInformation' => [
'name' => '<string>',
'phoneNumber' => '<string>',
'faxNumber' => '<string>',
'email' => '<string>',
'phoneExtension' => '<string>'
]
],
'claimInformation' => [
'claimChargeAmount' => '<string>',
'healthCareCodeInformation' => [
[
'diagnosisCode' => '<string>'
]
],
'serviceLines' => [
[
'serviceDate' => '<string>',
'professionalService' => [
'procedureCode' => '<string>',
'lineItemChargeAmount' => '<string>',
'serviceUnitCount' => '<string>',
'compositeDiagnosisCodePointers' => [
'diagnosisCodePointers' => [
'<string>'
]
],
'procedureModifiers' => [
'<string>'
],
'description' => '<string>',
'placeOfServiceCode' => '<string>',
'emergencyIndicator' => 'Y',
'epsdtIndicator' => 'Y',
'familyPlanningIndicator' => 'Y',
'copayStatusCode' => '0'
],
'assignedNumber' => '<string>',
'serviceDateEnd' => '<string>',
'serviceLineSupplementalInformation' => [
[
'attachmentControlNumber' => '<string>'
]
],
'ambulanceCertification' => [
[
'conditionCodes' => [
]
]
],
'hospiceEmployeeIndicator' => true,
'serviceLineDateInformation' => [
'prescriptionDate' => '<string>',
'certificationRevisionOrRecertificationDate' => '<string>',
'beginTherapyDate' => '<string>',
'lastCertificationDate' => '<string>',
'treatmentOrTherapyDate' => '<string>',
'hemoglobinTestDate' => '<string>',
'serumCreatineTestDate' => '<string>',
'shippedDate' => '<string>',
'lastXRayDate' => '<string>',
'initialTreatmentDate' => '<string>'
],
'ambulancePatientCount' => 123,
'obstetricAnesthesiaAdditionalUnits' => 123,
'testResults' => [
[
'testResults' => '<string>'
]
],
'serviceLineReferenceInformation' => [
'repricedLineItemReferenceNumber' => '<string>',
'adjustedRepricedLineItemReferenceNumber' => '<string>',
'priorAuthorization' => [
[
'priorAuthorizationOrReferralNumber' => '<string>',
'otherPayerPrimaryIdentifier' => '<string>'
]
],
'mammographyCertificationNumber' => '<string>',
'clinicalLaboratoryImprovementAmendmentNumber' => '<string>',
'referringCliaNumber' => '<string>',
'immunizationBatchNumber' => '<string>',
'referralNumber' => [
'<string>'
]
],
'salesTaxAmount' => '<string>',
'postageTaxAmount' => '<string>',
'fileInformation' => [
'<string>'
],
'additionalNotes' => '<string>',
'goalRehabOrDischargePlans' => '<string>',
'thirdPartyOrganizationNotes' => '<string>',
'purchasedServiceProvider' => [
'providerType' => '<string>',
'npi' => '<string>',
'stateLicenseNumber' => '<string>',
'commercialNumber' => '<string>',
'payerIdentificationNumber' => '<string>',
'ssn' => '<string>',
'employerId' => '<string>',
'locationNumber' => '<string>',
'employerIdentificationNumber' => '<string>',
'claimOfficeNumber' => '<string>',
'naic' => '<string>',
'providerUpinNumber' => '<string>',
'taxonomyCode' => '<string>',
'firstName' => '<string>',
'lastName' => '<string>',
'middleName' => '<string>',
'suffix' => '<string>',
'organizationName' => '<string>',
'contactInformation' => [
'name' => '<string>',
'phoneNumber' => '<string>',
'faxNumber' => '<string>',
'email' => '<string>',
'phoneExtension' => '<string>'
],
'otherIdentifier' => '<string>',
'secondaryIdentifier' => [
[
'qualifier' => '<string>',
'identifier' => '<string>',
'otherIdentifier' => '<string>'
]
]
],
'orderingProvider' => [
'providerType' => '<string>',
'npi' => '<string>',
'ssn' => '<string>',
'employerId' => '<string>',
'commercialNumber' => '<string>',
'locationNumber' => '<string>',
'payerIdentificationNumber' => '<string>',
'employerIdentificationNumber' => '<string>',
'claimOfficeNumber' => '<string>',
'naic' => '<string>',
'stateLicenseNumber' => '<string>',
'providerUpinNumber' => '<string>',
'taxonomyCode' => '<string>',
'firstName' => '<string>',
'lastName' => '<string>',
'middleName' => '<string>',
'suffix' => '<string>',
'organizationName' => '<string>',
'otherIdentifier' => '<string>',
'secondaryIdentifier' => [
[
'qualifier' => '<string>',
'identifier' => '<string>',
'otherIdentifier' => '<string>'
]
]
],
'lineAdjudicationInformation' => [
[
'otherPayerPrimaryIdentifier' => '<string>',
'serviceLinePaidAmount' => '<string>',
'procedureCode' => '<string>',
'paidServiceUnitCount' => '<string>',
'adjudicationOrPaymentDate' => '<string>',
'procedureModifier' => [
'<string>'
],
'procedureCodeDescription' => '<string>',
'bundledOrUnbundledLineNumber' => '<string>',
'claimAdjustmentInformation' => [
[
'adjustmentDetails' => [
[
'adjustmentReasonCode' => '<string>',
'adjustmentAmount' => '<string>',
'adjustmentQuantity' => '<string>'
]
]
]
],
'remainingPatientLiability' => '<string>'
]
],
'formIdentification' => [
[
'formIdentifier' => '<string>',
'supportingDocumentation' => [
[
'questionNumber' => '<string>',
'questionResponse' => '<string>',
'questionResponseAsDate' => '<string>',
'questionResponseAsPercent' => '<string>'
]
]
]
]
]
],
'propertyCasualtyClaimNumber' => '<string>',
'relatedCausesCode' => [
],
'autoAccidentStateCode' => '<string>',
'autoAccidentCountryCode' => '<string>',
'patientAmountPaid' => '<string>',
'fileInformation' => '<string>',
'fileInformationList' => [
'<string>'
],
'deathDate' => '<string>',
'patientWeight' => '<string>',
'patientSignatureSourceCode' => true,
'pregnancyIndicator' => 'Y',
'claimDateInformation' => [
'symptomDate' => '<string>',
'initialTreatmentDate' => '<string>',
'lastSeenDate' => '<string>',
'acuteManifestationDate' => '<string>',
'accidentDate' => '<string>',
'lastMenstrualPeriodDate' => '<string>',
'lastXRayDate' => '<string>',
'hearingAndVisionPrescriptionDate' => '<string>',
'disabilityBeginDate' => '<string>',
'disabilityEndDate' => '<string>',
'lastWorkedDate' => '<string>',
'authorizedReturnToWorkDate' => '<string>',
'admissionDate' => '<string>',
'dischargeDate' => '<string>',
'assumedAndRelinquishedCareBeginDate' => '<string>',
'assumedAndRelinquishedCareEndDate' => '<string>',
'repricerReceivedDate' => '<string>',
'firstContactDate' => '<string>'
],
'claimSupplementalInformation' => [
'reportInformations' => [
[
'attachmentControlNumber' => '<string>'
]
],
'priorAuthorizationNumber' => '<string>',
'referralNumber' => '<string>',
'claimControlNumber' => '<string>',
'cliaNumber' => '<string>',
'repricedClaimNumber' => '<string>',
'adjustedRepricedClaimNumber' => '<string>',
'investigationalDeviceExemptionNumber' => '<string>',
'claimNumber' => '<string>',
'mammographyCertificationNumber' => '<string>',
'medicalRecordNumber' => '<string>',
'demoProjectIdentifier' => '<string>',
'carePlanOversightNumber' => '<string>',
'medicareCrossoverReferenceId' => '<string>'
],
'ambulanceCertification' => [
[
'conditionCodes' => [
]
]
],
'patientConditionInformationVision' => [
[
'conditionCodes' => [
]
]
],
'homeboundIndicator' => true,
'anesthesiaRelatedSurgicalProcedure' => [
'<string>'
],
'conditionInformation' => [
[
'conditionCodes' => [
'<string>'
]
]
],
'claimNote' => [
'additionalInformation' => '<string>',
'certificationNarrative' => '<string>',
'goalRehabOrDischargePlans' => '<string>',
'diagnosisDescription' => '<string>',
'thirdPartOrgNotes' => '<string>'
],
'otherSubscriberInformation' => [
[
'otherSubscriberName' => [
'otherInsuredLastName' => '<string>',
'otherInsuredIdentifier' => '<string>',
'otherInsuredFirstName' => '<string>',
'otherInsuredMiddleName' => '<string>',
'otherInsuredNameSuffix' => '<string>',
'otherInsuredAdditionalIdentifier' => '<string>'
],
'otherPayerName' => [
'otherPayerOrganizationName' => '<string>',
'otherPayerIdentifier' => '<string>',
'otherPayerAdjudicationOrPaymentDate' => '<string>',
'otherPayerSecondaryIdentifier' => [
[
'qualifier' => '<string>',
'identifier' => '<string>',
'otherIdentifier' => '<string>'
]
],
'otherPayerPriorAuthorizationNumber' => '<string>',
'otherPayerPriorAuthorizationOrReferralNumber' => '<string>',
'otherPayerClaimAdjustmentIndicator' => true,
'otherPayerClaimControlNumber' => '<string>'
],
'insuranceGroupOrPolicyNumber' => '<string>',
'otherInsuredGroupName' => '<string>',
'claimLevelAdjustments' => [
[
'adjustmentDetails' => [
[
'adjustmentReasonCode' => '<string>',
'adjustmentAmount' => '<string>',
'adjustmentQuantity' => '<string>'
]
]
]
],
'payerPaidAmount' => '<string>',
'nonCoveredChargeAmount' => '<string>',
'remainingPatientLiability' => '<string>',
'otherPayerReferringProvider' => [
[
'otherPayerReferringProviderIdentifier' => [
[
'qualifier' => '<string>',
'identifier' => '<string>',
'otherIdentifier' => '<string>'
]
]
]
],
'otherPayerRenderingProvider' => [
[
'otherPayerRenderingProviderSecondaryIdentifier' => [
[
'qualifier' => '<string>',
'identifier' => '<string>',
'otherIdentifier' => '<string>'
]
]
]
],
'otherPayerServiceFacilityLocation' => [
[
'otherPayerServiceFacilityLocationSecondaryIdentifier' => [
[
'qualifier' => '<string>',
'identifier' => '<string>',
'otherIdentifier' => '<string>'
]
]
]
],
'otherPayerSupervisingProvider' => [
[
'otherPayerSupervisingProviderIdentifier' => [
[
'qualifier' => '<string>',
'identifier' => '<string>',
'otherIdentifier' => '<string>'
]
]
]
],
'otherPayerBillingProvider' => [
[
'otherPayerBillingProviderIdentifier' => [
[
'qualifier' => '<string>',
'identifier' => '<string>',
'otherIdentifier' => '<string>'
]
]
]
],
'patientSignatureGeneratedForPatient' => true,
'medicareOutpatientAdjudication' => [
'reimbursementRate' => '<string>',
'hcpcsPayableAmount' => '<string>',
'claimPaymentRemarkCode' => [
'<string>'
],
'endStageRenalDiseasePaymentAmount' => '<string>',
'nonPayableProfessionalComponentBilledAmount' => '<string>'
]
]
]
],
'isTesting' => true,
'controlNumber' => '<string>',
'providers' => [
[
'providerType' => '<string>',
'npi' => '<string>',
'ssn' => '<string>',
'employerId' => '<string>',
'commercialNumber' => '<string>',
'locationNumber' => '<string>',
'stateLicenseNumber' => '<string>',
'providerUpinNumber' => '<string>',
'taxonomyCode' => '<string>',
'firstName' => '<string>',
'lastName' => '<string>',
'middleName' => '<string>',
'suffix' => '<string>',
'organizationName' => '<string>',
'contactInformation' => [
'name' => '<string>',
'phoneNumber' => '<string>',
'faxNumber' => '<string>',
'email' => '<string>',
'phoneExtension' => '<string>'
]
]
],
'referring' => [
'providerType' => '<string>',
'npi' => '<string>',
'commercialNumber' => '<string>',
'stateLicenseNumber' => '<string>',
'providerUpinNumber' => '<string>',
'taxonomyCode' => '<string>',
'firstName' => '<string>',
'lastName' => '<string>',
'middleName' => '<string>',
'suffix' => '<string>',
'organizationName' => '<string>',
'contactInformation' => [
'name' => '<string>',
'phoneNumber' => '<string>',
'faxNumber' => '<string>',
'email' => '<string>',
'phoneExtension' => '<string>'
]
],
'rendering' => [
'providerType' => '<string>',
'npi' => '<string>',
'commercialNumber' => '<string>',
'locationNumber' => '<string>',
'stateLicenseNumber' => '<string>',
'providerUpinNumber' => '<string>',
'taxonomyCode' => '<string>',
'firstName' => '<string>',
'lastName' => '<string>',
'middleName' => '<string>',
'suffix' => '<string>',
'organizationName' => '<string>',
'contactInformation' => [
'name' => '<string>',
'phoneNumber' => '<string>',
'faxNumber' => '<string>',
'email' => '<string>',
'phoneExtension' => '<string>'
]
],
'ordering' => [
'providerType' => '<string>',
'npi' => '<string>',
'ssn' => '<string>',
'employerId' => '<string>',
'commercialNumber' => '<string>',
'locationNumber' => '<string>',
'payerIdentificationNumber' => '<string>',
'employerIdentificationNumber' => '<string>',
'claimOfficeNumber' => '<string>',
'naic' => '<string>',
'stateLicenseNumber' => '<string>',
'providerUpinNumber' => '<string>',
'taxonomyCode' => '<string>',
'firstName' => '<string>',
'lastName' => '<string>',
'middleName' => '<string>',
'suffix' => '<string>',
'organizationName' => '<string>',
'contactInformation' => [
'name' => '<string>',
'phoneNumber' => '<string>',
'faxNumber' => '<string>',
'email' => '<string>',
'phoneExtension' => '<string>'
]
],
'supervising' => [
'providerType' => '<string>',
'npi' => '<string>',
'ssn' => '<string>',
'employerId' => '<string>',
'commercialNumber' => '<string>',
'locationNumber' => '<string>',
'stateLicenseNumber' => '<string>',
'providerUpinNumber' => '<string>',
'taxonomyCode' => '<string>',
'firstName' => '<string>',
'lastName' => '<string>',
'middleName' => '<string>',
'suffix' => '<string>',
'organizationName' => '<string>',
'contactInformation' => [
'name' => '<string>',
'phoneNumber' => '<string>',
'faxNumber' => '<string>',
'email' => '<string>',
'phoneExtension' => '<string>'
]
],
'tradingPartnerName' => '<string>'
]),
CURLOPT_HTTPHEADER => [
"Content-Type: application/json"
],
]);
$response = curl_exec($curl);
$err = curl_error($curl);
curl_close($curl);
if ($err) {
echo "cURL Error #:" . $err;
} else {
echo $response;
}package main
import (
"fmt"
"strings"
"net/http"
"io"
)
func main() {
url := "https://api.example.com/api/v2/clearinghouse/claim"
payload := strings.NewReader("{\n \"tradingPartnerServiceId\": \"<string>\",\n \"submitter\": {\n \"contactInformation\": {\n \"name\": \"<string>\",\n \"phoneNumber\": \"<string>\",\n \"faxNumber\": \"<string>\",\n \"email\": \"<string>\",\n \"phoneExtension\": \"<string>\"\n },\n \"organizationName\": \"<string>\",\n \"lastName\": \"<string>\",\n \"firstName\": \"<string>\",\n \"middleName\": \"<string>\",\n \"submitterIdentification\": \"<string>\"\n },\n \"receiver\": {\n \"organizationName\": \"<string>\"\n },\n \"subscriber\": {\n \"memberId\": \"<string>\",\n \"ssn\": \"<string>\",\n \"organizationName\": \"<string>\",\n \"subscriberGroupName\": \"<string>\",\n \"firstName\": \"<string>\",\n \"lastName\": \"<string>\",\n \"middleName\": \"<string>\",\n \"suffix\": \"<string>\",\n \"dateOfBirth\": \"<string>\",\n \"policyNumber\": \"<string>\",\n \"groupNumber\": \"<string>\"\n },\n \"billing\": {\n \"providerType\": \"<string>\",\n \"npi\": \"<string>\",\n \"ssn\": \"<string>\",\n \"employerId\": \"<string>\",\n \"commercialNumber\": \"<string>\",\n \"locationNumber\": \"<string>\",\n \"stateLicenseNumber\": \"<string>\",\n \"providerUpinNumber\": \"<string>\",\n \"taxonomyCode\": \"<string>\",\n \"firstName\": \"<string>\",\n \"lastName\": \"<string>\",\n \"middleName\": \"<string>\",\n \"suffix\": \"<string>\",\n \"organizationName\": \"<string>\",\n \"contactInformation\": {\n \"name\": \"<string>\",\n \"phoneNumber\": \"<string>\",\n \"faxNumber\": \"<string>\",\n \"email\": \"<string>\",\n \"phoneExtension\": \"<string>\"\n }\n },\n \"claimInformation\": {\n \"claimChargeAmount\": \"<string>\",\n \"healthCareCodeInformation\": [\n {\n \"diagnosisCode\": \"<string>\"\n }\n ],\n \"serviceLines\": [\n {\n \"serviceDate\": \"<string>\",\n \"professionalService\": {\n \"procedureCode\": \"<string>\",\n \"lineItemChargeAmount\": \"<string>\",\n \"serviceUnitCount\": \"<string>\",\n \"compositeDiagnosisCodePointers\": {\n \"diagnosisCodePointers\": [\n \"<string>\"\n ]\n },\n \"procedureModifiers\": [\n \"<string>\"\n ],\n \"description\": \"<string>\",\n \"placeOfServiceCode\": \"<string>\",\n \"emergencyIndicator\": \"Y\",\n \"epsdtIndicator\": \"Y\",\n \"familyPlanningIndicator\": \"Y\",\n \"copayStatusCode\": \"0\"\n },\n \"assignedNumber\": \"<string>\",\n \"serviceDateEnd\": \"<string>\",\n \"serviceLineSupplementalInformation\": [\n {\n \"attachmentControlNumber\": \"<string>\"\n }\n ],\n \"ambulanceCertification\": [\n {\n \"conditionCodes\": []\n }\n ],\n \"hospiceEmployeeIndicator\": true,\n \"serviceLineDateInformation\": {\n \"prescriptionDate\": \"<string>\",\n \"certificationRevisionOrRecertificationDate\": \"<string>\",\n \"beginTherapyDate\": \"<string>\",\n \"lastCertificationDate\": \"<string>\",\n \"treatmentOrTherapyDate\": \"<string>\",\n \"hemoglobinTestDate\": \"<string>\",\n \"serumCreatineTestDate\": \"<string>\",\n \"shippedDate\": \"<string>\",\n \"lastXRayDate\": \"<string>\",\n \"initialTreatmentDate\": \"<string>\"\n },\n \"ambulancePatientCount\": 123,\n \"obstetricAnesthesiaAdditionalUnits\": 123,\n \"testResults\": [\n {\n \"testResults\": \"<string>\"\n }\n ],\n \"serviceLineReferenceInformation\": {\n \"repricedLineItemReferenceNumber\": \"<string>\",\n \"adjustedRepricedLineItemReferenceNumber\": \"<string>\",\n \"priorAuthorization\": [\n {\n \"priorAuthorizationOrReferralNumber\": \"<string>\",\n \"otherPayerPrimaryIdentifier\": \"<string>\"\n }\n ],\n \"mammographyCertificationNumber\": \"<string>\",\n \"clinicalLaboratoryImprovementAmendmentNumber\": \"<string>\",\n \"referringCliaNumber\": \"<string>\",\n \"immunizationBatchNumber\": \"<string>\",\n \"referralNumber\": [\n \"<string>\"\n ]\n },\n \"salesTaxAmount\": \"<string>\",\n \"postageTaxAmount\": \"<string>\",\n \"fileInformation\": [\n \"<string>\"\n ],\n \"additionalNotes\": \"<string>\",\n \"goalRehabOrDischargePlans\": \"<string>\",\n \"thirdPartyOrganizationNotes\": \"<string>\",\n \"purchasedServiceProvider\": {\n \"providerType\": \"<string>\",\n \"npi\": \"<string>\",\n \"stateLicenseNumber\": \"<string>\",\n \"commercialNumber\": \"<string>\",\n \"payerIdentificationNumber\": \"<string>\",\n \"ssn\": \"<string>\",\n \"employerId\": \"<string>\",\n \"locationNumber\": \"<string>\",\n \"employerIdentificationNumber\": \"<string>\",\n \"claimOfficeNumber\": \"<string>\",\n \"naic\": \"<string>\",\n \"providerUpinNumber\": \"<string>\",\n \"taxonomyCode\": \"<string>\",\n \"firstName\": \"<string>\",\n \"lastName\": \"<string>\",\n \"middleName\": \"<string>\",\n \"suffix\": \"<string>\",\n \"organizationName\": \"<string>\",\n \"contactInformation\": {\n \"name\": \"<string>\",\n \"phoneNumber\": \"<string>\",\n \"faxNumber\": \"<string>\",\n \"email\": \"<string>\",\n \"phoneExtension\": \"<string>\"\n },\n \"otherIdentifier\": \"<string>\",\n \"secondaryIdentifier\": [\n {\n \"qualifier\": \"<string>\",\n \"identifier\": \"<string>\",\n \"otherIdentifier\": \"<string>\"\n }\n ]\n },\n \"orderingProvider\": {\n \"providerType\": \"<string>\",\n \"npi\": \"<string>\",\n \"ssn\": \"<string>\",\n \"employerId\": \"<string>\",\n \"commercialNumber\": \"<string>\",\n \"locationNumber\": \"<string>\",\n \"payerIdentificationNumber\": \"<string>\",\n \"employerIdentificationNumber\": \"<string>\",\n \"claimOfficeNumber\": \"<string>\",\n \"naic\": \"<string>\",\n \"stateLicenseNumber\": \"<string>\",\n \"providerUpinNumber\": \"<string>\",\n \"taxonomyCode\": \"<string>\",\n \"firstName\": \"<string>\",\n \"lastName\": \"<string>\",\n \"middleName\": \"<string>\",\n \"suffix\": \"<string>\",\n \"organizationName\": \"<string>\",\n \"otherIdentifier\": \"<string>\",\n \"secondaryIdentifier\": [\n {\n \"qualifier\": \"<string>\",\n \"identifier\": \"<string>\",\n \"otherIdentifier\": \"<string>\"\n }\n ]\n },\n \"lineAdjudicationInformation\": [\n {\n \"otherPayerPrimaryIdentifier\": \"<string>\",\n \"serviceLinePaidAmount\": \"<string>\",\n \"procedureCode\": \"<string>\",\n \"paidServiceUnitCount\": \"<string>\",\n \"adjudicationOrPaymentDate\": \"<string>\",\n \"procedureModifier\": [\n \"<string>\"\n ],\n \"procedureCodeDescription\": \"<string>\",\n \"bundledOrUnbundledLineNumber\": \"<string>\",\n \"claimAdjustmentInformation\": [\n {\n \"adjustmentDetails\": [\n {\n \"adjustmentReasonCode\": \"<string>\",\n \"adjustmentAmount\": \"<string>\",\n \"adjustmentQuantity\": \"<string>\"\n }\n ]\n }\n ],\n \"remainingPatientLiability\": \"<string>\"\n }\n ],\n \"formIdentification\": [\n {\n \"formIdentifier\": \"<string>\",\n \"supportingDocumentation\": [\n {\n \"questionNumber\": \"<string>\",\n \"questionResponse\": \"<string>\",\n \"questionResponseAsDate\": \"<string>\",\n \"questionResponseAsPercent\": \"<string>\"\n }\n ]\n }\n ]\n }\n ],\n \"propertyCasualtyClaimNumber\": \"<string>\",\n \"relatedCausesCode\": [],\n \"autoAccidentStateCode\": \"<string>\",\n \"autoAccidentCountryCode\": \"<string>\",\n \"patientAmountPaid\": \"<string>\",\n \"fileInformation\": \"<string>\",\n \"fileInformationList\": [\n \"<string>\"\n ],\n \"deathDate\": \"<string>\",\n \"patientWeight\": \"<string>\",\n \"patientSignatureSourceCode\": true,\n \"pregnancyIndicator\": \"Y\",\n \"claimDateInformation\": {\n \"symptomDate\": \"<string>\",\n \"initialTreatmentDate\": \"<string>\",\n \"lastSeenDate\": \"<string>\",\n \"acuteManifestationDate\": \"<string>\",\n \"accidentDate\": \"<string>\",\n \"lastMenstrualPeriodDate\": \"<string>\",\n \"lastXRayDate\": \"<string>\",\n \"hearingAndVisionPrescriptionDate\": \"<string>\",\n \"disabilityBeginDate\": \"<string>\",\n \"disabilityEndDate\": \"<string>\",\n \"lastWorkedDate\": \"<string>\",\n \"authorizedReturnToWorkDate\": \"<string>\",\n \"admissionDate\": \"<string>\",\n \"dischargeDate\": \"<string>\",\n \"assumedAndRelinquishedCareBeginDate\": \"<string>\",\n \"assumedAndRelinquishedCareEndDate\": \"<string>\",\n \"repricerReceivedDate\": \"<string>\",\n \"firstContactDate\": \"<string>\"\n },\n \"claimSupplementalInformation\": {\n \"reportInformations\": [\n {\n \"attachmentControlNumber\": \"<string>\"\n }\n ],\n \"priorAuthorizationNumber\": \"<string>\",\n \"referralNumber\": \"<string>\",\n \"claimControlNumber\": \"<string>\",\n \"cliaNumber\": \"<string>\",\n \"repricedClaimNumber\": \"<string>\",\n \"adjustedRepricedClaimNumber\": \"<string>\",\n \"investigationalDeviceExemptionNumber\": \"<string>\",\n \"claimNumber\": \"<string>\",\n \"mammographyCertificationNumber\": \"<string>\",\n \"medicalRecordNumber\": \"<string>\",\n \"demoProjectIdentifier\": \"<string>\",\n \"carePlanOversightNumber\": \"<string>\",\n \"medicareCrossoverReferenceId\": \"<string>\"\n },\n \"ambulanceCertification\": [\n {\n \"conditionCodes\": []\n }\n ],\n \"patientConditionInformationVision\": [\n {\n \"conditionCodes\": []\n }\n ],\n \"homeboundIndicator\": true,\n \"anesthesiaRelatedSurgicalProcedure\": [\n \"<string>\"\n ],\n \"conditionInformation\": [\n {\n \"conditionCodes\": [\n \"<string>\"\n ]\n }\n ],\n \"claimNote\": {\n \"additionalInformation\": \"<string>\",\n \"certificationNarrative\": \"<string>\",\n \"goalRehabOrDischargePlans\": \"<string>\",\n \"diagnosisDescription\": \"<string>\",\n \"thirdPartOrgNotes\": \"<string>\"\n },\n \"otherSubscriberInformation\": [\n {\n \"otherSubscriberName\": {\n \"otherInsuredLastName\": \"<string>\",\n \"otherInsuredIdentifier\": \"<string>\",\n \"otherInsuredFirstName\": \"<string>\",\n \"otherInsuredMiddleName\": \"<string>\",\n \"otherInsuredNameSuffix\": \"<string>\",\n \"otherInsuredAdditionalIdentifier\": \"<string>\"\n },\n \"otherPayerName\": {\n \"otherPayerOrganizationName\": \"<string>\",\n \"otherPayerIdentifier\": \"<string>\",\n \"otherPayerAdjudicationOrPaymentDate\": \"<string>\",\n \"otherPayerSecondaryIdentifier\": [\n {\n \"qualifier\": \"<string>\",\n \"identifier\": \"<string>\",\n \"otherIdentifier\": \"<string>\"\n }\n ],\n \"otherPayerPriorAuthorizationNumber\": \"<string>\",\n \"otherPayerPriorAuthorizationOrReferralNumber\": \"<string>\",\n \"otherPayerClaimAdjustmentIndicator\": true,\n \"otherPayerClaimControlNumber\": \"<string>\"\n },\n \"insuranceGroupOrPolicyNumber\": \"<string>\",\n \"otherInsuredGroupName\": \"<string>\",\n \"claimLevelAdjustments\": [\n {\n \"adjustmentDetails\": [\n {\n \"adjustmentReasonCode\": \"<string>\",\n \"adjustmentAmount\": \"<string>\",\n \"adjustmentQuantity\": \"<string>\"\n }\n ]\n }\n ],\n \"payerPaidAmount\": \"<string>\",\n \"nonCoveredChargeAmount\": \"<string>\",\n \"remainingPatientLiability\": \"<string>\",\n \"otherPayerReferringProvider\": [\n {\n \"otherPayerReferringProviderIdentifier\": [\n {\n \"qualifier\": \"<string>\",\n \"identifier\": \"<string>\",\n \"otherIdentifier\": \"<string>\"\n }\n ]\n }\n ],\n \"otherPayerRenderingProvider\": [\n {\n \"otherPayerRenderingProviderSecondaryIdentifier\": [\n {\n \"qualifier\": \"<string>\",\n \"identifier\": \"<string>\",\n \"otherIdentifier\": \"<string>\"\n }\n ]\n }\n ],\n \"otherPayerServiceFacilityLocation\": [\n {\n \"otherPayerServiceFacilityLocationSecondaryIdentifier\": [\n {\n \"qualifier\": \"<string>\",\n \"identifier\": \"<string>\",\n \"otherIdentifier\": \"<string>\"\n }\n ]\n }\n ],\n \"otherPayerSupervisingProvider\": [\n {\n \"otherPayerSupervisingProviderIdentifier\": [\n {\n \"qualifier\": \"<string>\",\n \"identifier\": \"<string>\",\n \"otherIdentifier\": \"<string>\"\n }\n ]\n }\n ],\n \"otherPayerBillingProvider\": [\n {\n \"otherPayerBillingProviderIdentifier\": [\n {\n \"qualifier\": \"<string>\",\n \"identifier\": \"<string>\",\n \"otherIdentifier\": \"<string>\"\n }\n ]\n }\n ],\n \"patientSignatureGeneratedForPatient\": true,\n \"medicareOutpatientAdjudication\": {\n \"reimbursementRate\": \"<string>\",\n \"hcpcsPayableAmount\": \"<string>\",\n \"claimPaymentRemarkCode\": [\n \"<string>\"\n ],\n \"endStageRenalDiseasePaymentAmount\": \"<string>\",\n \"nonPayableProfessionalComponentBilledAmount\": \"<string>\"\n }\n }\n ]\n },\n \"isTesting\": true,\n \"controlNumber\": \"<string>\",\n \"providers\": [\n {\n \"providerType\": \"<string>\",\n \"npi\": \"<string>\",\n \"ssn\": \"<string>\",\n \"employerId\": \"<string>\",\n \"commercialNumber\": \"<string>\",\n \"locationNumber\": \"<string>\",\n \"stateLicenseNumber\": \"<string>\",\n \"providerUpinNumber\": \"<string>\",\n \"taxonomyCode\": \"<string>\",\n \"firstName\": \"<string>\",\n \"lastName\": \"<string>\",\n \"middleName\": \"<string>\",\n \"suffix\": \"<string>\",\n \"organizationName\": \"<string>\",\n \"contactInformation\": {\n \"name\": \"<string>\",\n \"phoneNumber\": \"<string>\",\n \"faxNumber\": \"<string>\",\n \"email\": \"<string>\",\n \"phoneExtension\": \"<string>\"\n }\n }\n ],\n \"referring\": {\n \"providerType\": \"<string>\",\n \"npi\": \"<string>\",\n \"commercialNumber\": \"<string>\",\n \"stateLicenseNumber\": \"<string>\",\n \"providerUpinNumber\": \"<string>\",\n \"taxonomyCode\": \"<string>\",\n \"firstName\": \"<string>\",\n \"lastName\": \"<string>\",\n \"middleName\": \"<string>\",\n \"suffix\": \"<string>\",\n \"organizationName\": \"<string>\",\n \"contactInformation\": {\n \"name\": \"<string>\",\n \"phoneNumber\": \"<string>\",\n \"faxNumber\": \"<string>\",\n \"email\": \"<string>\",\n \"phoneExtension\": \"<string>\"\n }\n },\n \"rendering\": {\n \"providerType\": \"<string>\",\n \"npi\": \"<string>\",\n \"commercialNumber\": \"<string>\",\n \"locationNumber\": \"<string>\",\n \"stateLicenseNumber\": \"<string>\",\n \"providerUpinNumber\": \"<string>\",\n \"taxonomyCode\": \"<string>\",\n \"firstName\": \"<string>\",\n \"lastName\": \"<string>\",\n \"middleName\": \"<string>\",\n \"suffix\": \"<string>\",\n \"organizationName\": \"<string>\",\n \"contactInformation\": {\n \"name\": \"<string>\",\n \"phoneNumber\": \"<string>\",\n \"faxNumber\": \"<string>\",\n \"email\": \"<string>\",\n \"phoneExtension\": \"<string>\"\n }\n },\n \"ordering\": {\n \"providerType\": \"<string>\",\n \"npi\": \"<string>\",\n \"ssn\": \"<string>\",\n \"employerId\": \"<string>\",\n \"commercialNumber\": \"<string>\",\n \"locationNumber\": \"<string>\",\n \"payerIdentificationNumber\": \"<string>\",\n \"employerIdentificationNumber\": \"<string>\",\n \"claimOfficeNumber\": \"<string>\",\n \"naic\": \"<string>\",\n \"stateLicenseNumber\": \"<string>\",\n \"providerUpinNumber\": \"<string>\",\n \"taxonomyCode\": \"<string>\",\n \"firstName\": \"<string>\",\n \"lastName\": \"<string>\",\n \"middleName\": \"<string>\",\n \"suffix\": \"<string>\",\n \"organizationName\": \"<string>\",\n \"contactInformation\": {\n \"name\": \"<string>\",\n \"phoneNumber\": \"<string>\",\n \"faxNumber\": \"<string>\",\n \"email\": \"<string>\",\n \"phoneExtension\": \"<string>\"\n }\n },\n \"supervising\": {\n \"providerType\": \"<string>\",\n \"npi\": \"<string>\",\n \"ssn\": \"<string>\",\n \"employerId\": \"<string>\",\n \"commercialNumber\": \"<string>\",\n \"locationNumber\": \"<string>\",\n \"stateLicenseNumber\": \"<string>\",\n \"providerUpinNumber\": \"<string>\",\n \"taxonomyCode\": \"<string>\",\n \"firstName\": \"<string>\",\n \"lastName\": \"<string>\",\n \"middleName\": \"<string>\",\n \"suffix\": \"<string>\",\n \"organizationName\": \"<string>\",\n \"contactInformation\": {\n \"name\": \"<string>\",\n \"phoneNumber\": \"<string>\",\n \"faxNumber\": \"<string>\",\n \"email\": \"<string>\",\n \"phoneExtension\": \"<string>\"\n }\n },\n \"tradingPartnerName\": \"<string>\"\n}")
req, _ := http.NewRequest("POST", url, payload)
req.Header.Add("Content-Type", "application/json")
res, _ := http.DefaultClient.Do(req)
defer res.Body.Close()
body, _ := io.ReadAll(res.Body)
fmt.Println(string(body))
}HttpResponse<String> response = Unirest.post("https://api.example.com/api/v2/clearinghouse/claim")
.header("Content-Type", "application/json")
.body("{\n \"tradingPartnerServiceId\": \"<string>\",\n \"submitter\": {\n \"contactInformation\": {\n \"name\": \"<string>\",\n \"phoneNumber\": \"<string>\",\n \"faxNumber\": \"<string>\",\n \"email\": \"<string>\",\n \"phoneExtension\": \"<string>\"\n },\n \"organizationName\": \"<string>\",\n \"lastName\": \"<string>\",\n \"firstName\": \"<string>\",\n \"middleName\": \"<string>\",\n \"submitterIdentification\": \"<string>\"\n },\n \"receiver\": {\n \"organizationName\": \"<string>\"\n },\n \"subscriber\": {\n \"memberId\": \"<string>\",\n \"ssn\": \"<string>\",\n \"organizationName\": \"<string>\",\n \"subscriberGroupName\": \"<string>\",\n \"firstName\": \"<string>\",\n \"lastName\": \"<string>\",\n \"middleName\": \"<string>\",\n \"suffix\": \"<string>\",\n \"dateOfBirth\": \"<string>\",\n \"policyNumber\": \"<string>\",\n \"groupNumber\": \"<string>\"\n },\n \"billing\": {\n \"providerType\": \"<string>\",\n \"npi\": \"<string>\",\n \"ssn\": \"<string>\",\n \"employerId\": \"<string>\",\n \"commercialNumber\": \"<string>\",\n \"locationNumber\": \"<string>\",\n \"stateLicenseNumber\": \"<string>\",\n \"providerUpinNumber\": \"<string>\",\n \"taxonomyCode\": \"<string>\",\n \"firstName\": \"<string>\",\n \"lastName\": \"<string>\",\n \"middleName\": \"<string>\",\n \"suffix\": \"<string>\",\n \"organizationName\": \"<string>\",\n \"contactInformation\": {\n \"name\": \"<string>\",\n \"phoneNumber\": \"<string>\",\n \"faxNumber\": \"<string>\",\n \"email\": \"<string>\",\n \"phoneExtension\": \"<string>\"\n }\n },\n \"claimInformation\": {\n \"claimChargeAmount\": \"<string>\",\n \"healthCareCodeInformation\": [\n {\n \"diagnosisCode\": \"<string>\"\n }\n ],\n \"serviceLines\": [\n {\n \"serviceDate\": \"<string>\",\n \"professionalService\": {\n \"procedureCode\": \"<string>\",\n \"lineItemChargeAmount\": \"<string>\",\n \"serviceUnitCount\": \"<string>\",\n \"compositeDiagnosisCodePointers\": {\n \"diagnosisCodePointers\": [\n \"<string>\"\n ]\n },\n \"procedureModifiers\": [\n \"<string>\"\n ],\n \"description\": \"<string>\",\n \"placeOfServiceCode\": \"<string>\",\n \"emergencyIndicator\": \"Y\",\n \"epsdtIndicator\": \"Y\",\n \"familyPlanningIndicator\": \"Y\",\n \"copayStatusCode\": \"0\"\n },\n \"assignedNumber\": \"<string>\",\n \"serviceDateEnd\": \"<string>\",\n \"serviceLineSupplementalInformation\": [\n {\n \"attachmentControlNumber\": \"<string>\"\n }\n ],\n \"ambulanceCertification\": [\n {\n \"conditionCodes\": []\n }\n ],\n \"hospiceEmployeeIndicator\": true,\n \"serviceLineDateInformation\": {\n \"prescriptionDate\": \"<string>\",\n \"certificationRevisionOrRecertificationDate\": \"<string>\",\n \"beginTherapyDate\": \"<string>\",\n \"lastCertificationDate\": \"<string>\",\n \"treatmentOrTherapyDate\": \"<string>\",\n \"hemoglobinTestDate\": \"<string>\",\n \"serumCreatineTestDate\": \"<string>\",\n \"shippedDate\": \"<string>\",\n \"lastXRayDate\": \"<string>\",\n \"initialTreatmentDate\": \"<string>\"\n },\n \"ambulancePatientCount\": 123,\n \"obstetricAnesthesiaAdditionalUnits\": 123,\n \"testResults\": [\n {\n \"testResults\": \"<string>\"\n }\n ],\n \"serviceLineReferenceInformation\": {\n \"repricedLineItemReferenceNumber\": \"<string>\",\n \"adjustedRepricedLineItemReferenceNumber\": \"<string>\",\n \"priorAuthorization\": [\n {\n \"priorAuthorizationOrReferralNumber\": \"<string>\",\n \"otherPayerPrimaryIdentifier\": \"<string>\"\n }\n ],\n \"mammographyCertificationNumber\": \"<string>\",\n \"clinicalLaboratoryImprovementAmendmentNumber\": \"<string>\",\n \"referringCliaNumber\": \"<string>\",\n \"immunizationBatchNumber\": \"<string>\",\n \"referralNumber\": [\n \"<string>\"\n ]\n },\n \"salesTaxAmount\": \"<string>\",\n \"postageTaxAmount\": \"<string>\",\n \"fileInformation\": [\n \"<string>\"\n ],\n \"additionalNotes\": \"<string>\",\n \"goalRehabOrDischargePlans\": \"<string>\",\n \"thirdPartyOrganizationNotes\": \"<string>\",\n \"purchasedServiceProvider\": {\n \"providerType\": \"<string>\",\n \"npi\": \"<string>\",\n \"stateLicenseNumber\": \"<string>\",\n \"commercialNumber\": \"<string>\",\n \"payerIdentificationNumber\": \"<string>\",\n \"ssn\": \"<string>\",\n \"employerId\": \"<string>\",\n \"locationNumber\": \"<string>\",\n \"employerIdentificationNumber\": \"<string>\",\n \"claimOfficeNumber\": \"<string>\",\n \"naic\": \"<string>\",\n \"providerUpinNumber\": \"<string>\",\n \"taxonomyCode\": \"<string>\",\n \"firstName\": \"<string>\",\n \"lastName\": \"<string>\",\n \"middleName\": \"<string>\",\n \"suffix\": \"<string>\",\n \"organizationName\": \"<string>\",\n \"contactInformation\": {\n \"name\": \"<string>\",\n \"phoneNumber\": \"<string>\",\n \"faxNumber\": \"<string>\",\n \"email\": \"<string>\",\n \"phoneExtension\": \"<string>\"\n },\n \"otherIdentifier\": \"<string>\",\n \"secondaryIdentifier\": [\n {\n \"qualifier\": \"<string>\",\n \"identifier\": \"<string>\",\n \"otherIdentifier\": \"<string>\"\n }\n ]\n },\n \"orderingProvider\": {\n \"providerType\": \"<string>\",\n \"npi\": \"<string>\",\n \"ssn\": \"<string>\",\n \"employerId\": \"<string>\",\n \"commercialNumber\": \"<string>\",\n \"locationNumber\": \"<string>\",\n \"payerIdentificationNumber\": \"<string>\",\n \"employerIdentificationNumber\": \"<string>\",\n \"claimOfficeNumber\": \"<string>\",\n \"naic\": \"<string>\",\n \"stateLicenseNumber\": \"<string>\",\n \"providerUpinNumber\": \"<string>\",\n \"taxonomyCode\": \"<string>\",\n \"firstName\": \"<string>\",\n \"lastName\": \"<string>\",\n \"middleName\": \"<string>\",\n \"suffix\": \"<string>\",\n \"organizationName\": \"<string>\",\n \"otherIdentifier\": \"<string>\",\n \"secondaryIdentifier\": [\n {\n \"qualifier\": \"<string>\",\n \"identifier\": \"<string>\",\n \"otherIdentifier\": \"<string>\"\n }\n ]\n },\n \"lineAdjudicationInformation\": [\n {\n \"otherPayerPrimaryIdentifier\": \"<string>\",\n \"serviceLinePaidAmount\": \"<string>\",\n \"procedureCode\": \"<string>\",\n \"paidServiceUnitCount\": \"<string>\",\n \"adjudicationOrPaymentDate\": \"<string>\",\n \"procedureModifier\": [\n \"<string>\"\n ],\n \"procedureCodeDescription\": \"<string>\",\n \"bundledOrUnbundledLineNumber\": \"<string>\",\n \"claimAdjustmentInformation\": [\n {\n \"adjustmentDetails\": [\n {\n \"adjustmentReasonCode\": \"<string>\",\n \"adjustmentAmount\": \"<string>\",\n \"adjustmentQuantity\": \"<string>\"\n }\n ]\n }\n ],\n \"remainingPatientLiability\": \"<string>\"\n }\n ],\n \"formIdentification\": [\n {\n \"formIdentifier\": \"<string>\",\n \"supportingDocumentation\": [\n {\n \"questionNumber\": \"<string>\",\n \"questionResponse\": \"<string>\",\n \"questionResponseAsDate\": \"<string>\",\n \"questionResponseAsPercent\": \"<string>\"\n }\n ]\n }\n ]\n }\n ],\n \"propertyCasualtyClaimNumber\": \"<string>\",\n \"relatedCausesCode\": [],\n \"autoAccidentStateCode\": \"<string>\",\n \"autoAccidentCountryCode\": \"<string>\",\n \"patientAmountPaid\": \"<string>\",\n \"fileInformation\": \"<string>\",\n \"fileInformationList\": [\n \"<string>\"\n ],\n \"deathDate\": \"<string>\",\n \"patientWeight\": \"<string>\",\n \"patientSignatureSourceCode\": true,\n \"pregnancyIndicator\": \"Y\",\n \"claimDateInformation\": {\n \"symptomDate\": \"<string>\",\n \"initialTreatmentDate\": \"<string>\",\n \"lastSeenDate\": \"<string>\",\n \"acuteManifestationDate\": \"<string>\",\n \"accidentDate\": \"<string>\",\n \"lastMenstrualPeriodDate\": \"<string>\",\n \"lastXRayDate\": \"<string>\",\n \"hearingAndVisionPrescriptionDate\": \"<string>\",\n \"disabilityBeginDate\": \"<string>\",\n \"disabilityEndDate\": \"<string>\",\n \"lastWorkedDate\": \"<string>\",\n \"authorizedReturnToWorkDate\": \"<string>\",\n \"admissionDate\": \"<string>\",\n \"dischargeDate\": \"<string>\",\n \"assumedAndRelinquishedCareBeginDate\": \"<string>\",\n \"assumedAndRelinquishedCareEndDate\": \"<string>\",\n \"repricerReceivedDate\": \"<string>\",\n \"firstContactDate\": \"<string>\"\n },\n \"claimSupplementalInformation\": {\n \"reportInformations\": [\n {\n \"attachmentControlNumber\": \"<string>\"\n }\n ],\n \"priorAuthorizationNumber\": \"<string>\",\n \"referralNumber\": \"<string>\",\n \"claimControlNumber\": \"<string>\",\n \"cliaNumber\": \"<string>\",\n \"repricedClaimNumber\": \"<string>\",\n \"adjustedRepricedClaimNumber\": \"<string>\",\n \"investigationalDeviceExemptionNumber\": \"<string>\",\n \"claimNumber\": \"<string>\",\n \"mammographyCertificationNumber\": \"<string>\",\n \"medicalRecordNumber\": \"<string>\",\n \"demoProjectIdentifier\": \"<string>\",\n \"carePlanOversightNumber\": \"<string>\",\n \"medicareCrossoverReferenceId\": \"<string>\"\n },\n \"ambulanceCertification\": [\n {\n \"conditionCodes\": []\n }\n ],\n \"patientConditionInformationVision\": [\n {\n \"conditionCodes\": []\n }\n ],\n \"homeboundIndicator\": true,\n \"anesthesiaRelatedSurgicalProcedure\": [\n \"<string>\"\n ],\n \"conditionInformation\": [\n {\n \"conditionCodes\": [\n \"<string>\"\n ]\n }\n ],\n \"claimNote\": {\n \"additionalInformation\": \"<string>\",\n \"certificationNarrative\": \"<string>\",\n \"goalRehabOrDischargePlans\": \"<string>\",\n \"diagnosisDescription\": \"<string>\",\n \"thirdPartOrgNotes\": \"<string>\"\n },\n \"otherSubscriberInformation\": [\n {\n \"otherSubscriberName\": {\n \"otherInsuredLastName\": \"<string>\",\n \"otherInsuredIdentifier\": \"<string>\",\n \"otherInsuredFirstName\": \"<string>\",\n \"otherInsuredMiddleName\": \"<string>\",\n \"otherInsuredNameSuffix\": \"<string>\",\n \"otherInsuredAdditionalIdentifier\": \"<string>\"\n },\n \"otherPayerName\": {\n \"otherPayerOrganizationName\": \"<string>\",\n \"otherPayerIdentifier\": \"<string>\",\n \"otherPayerAdjudicationOrPaymentDate\": \"<string>\",\n \"otherPayerSecondaryIdentifier\": [\n {\n \"qualifier\": \"<string>\",\n \"identifier\": \"<string>\",\n \"otherIdentifier\": \"<string>\"\n }\n ],\n \"otherPayerPriorAuthorizationNumber\": \"<string>\",\n \"otherPayerPriorAuthorizationOrReferralNumber\": \"<string>\",\n \"otherPayerClaimAdjustmentIndicator\": true,\n \"otherPayerClaimControlNumber\": \"<string>\"\n },\n \"insuranceGroupOrPolicyNumber\": \"<string>\",\n \"otherInsuredGroupName\": \"<string>\",\n \"claimLevelAdjustments\": [\n {\n \"adjustmentDetails\": [\n {\n \"adjustmentReasonCode\": \"<string>\",\n \"adjustmentAmount\": \"<string>\",\n \"adjustmentQuantity\": \"<string>\"\n }\n ]\n }\n ],\n \"payerPaidAmount\": \"<string>\",\n \"nonCoveredChargeAmount\": \"<string>\",\n \"remainingPatientLiability\": \"<string>\",\n \"otherPayerReferringProvider\": [\n {\n \"otherPayerReferringProviderIdentifier\": [\n {\n \"qualifier\": \"<string>\",\n \"identifier\": \"<string>\",\n \"otherIdentifier\": \"<string>\"\n }\n ]\n }\n ],\n \"otherPayerRenderingProvider\": [\n {\n \"otherPayerRenderingProviderSecondaryIdentifier\": [\n {\n \"qualifier\": \"<string>\",\n \"identifier\": \"<string>\",\n \"otherIdentifier\": \"<string>\"\n }\n ]\n }\n ],\n \"otherPayerServiceFacilityLocation\": [\n {\n \"otherPayerServiceFacilityLocationSecondaryIdentifier\": [\n {\n \"qualifier\": \"<string>\",\n \"identifier\": \"<string>\",\n \"otherIdentifier\": \"<string>\"\n }\n ]\n }\n ],\n \"otherPayerSupervisingProvider\": [\n {\n \"otherPayerSupervisingProviderIdentifier\": [\n {\n \"qualifier\": \"<string>\",\n \"identifier\": \"<string>\",\n \"otherIdentifier\": \"<string>\"\n }\n ]\n }\n ],\n \"otherPayerBillingProvider\": [\n {\n \"otherPayerBillingProviderIdentifier\": [\n {\n \"qualifier\": \"<string>\",\n \"identifier\": \"<string>\",\n \"otherIdentifier\": \"<string>\"\n }\n ]\n }\n ],\n \"patientSignatureGeneratedForPatient\": true,\n \"medicareOutpatientAdjudication\": {\n \"reimbursementRate\": \"<string>\",\n \"hcpcsPayableAmount\": \"<string>\",\n \"claimPaymentRemarkCode\": [\n \"<string>\"\n ],\n \"endStageRenalDiseasePaymentAmount\": \"<string>\",\n \"nonPayableProfessionalComponentBilledAmount\": \"<string>\"\n }\n }\n ]\n },\n \"isTesting\": true,\n \"controlNumber\": \"<string>\",\n \"providers\": [\n {\n \"providerType\": \"<string>\",\n \"npi\": \"<string>\",\n \"ssn\": \"<string>\",\n \"employerId\": \"<string>\",\n \"commercialNumber\": \"<string>\",\n \"locationNumber\": \"<string>\",\n \"stateLicenseNumber\": \"<string>\",\n \"providerUpinNumber\": \"<string>\",\n \"taxonomyCode\": \"<string>\",\n \"firstName\": \"<string>\",\n \"lastName\": \"<string>\",\n \"middleName\": \"<string>\",\n \"suffix\": \"<string>\",\n \"organizationName\": \"<string>\",\n \"contactInformation\": {\n \"name\": \"<string>\",\n \"phoneNumber\": \"<string>\",\n \"faxNumber\": \"<string>\",\n \"email\": \"<string>\",\n \"phoneExtension\": \"<string>\"\n }\n }\n ],\n \"referring\": {\n \"providerType\": \"<string>\",\n \"npi\": \"<string>\",\n \"commercialNumber\": \"<string>\",\n \"stateLicenseNumber\": \"<string>\",\n \"providerUpinNumber\": \"<string>\",\n \"taxonomyCode\": \"<string>\",\n \"firstName\": \"<string>\",\n \"lastName\": \"<string>\",\n \"middleName\": \"<string>\",\n \"suffix\": \"<string>\",\n \"organizationName\": \"<string>\",\n \"contactInformation\": {\n \"name\": \"<string>\",\n \"phoneNumber\": \"<string>\",\n \"faxNumber\": \"<string>\",\n \"email\": \"<string>\",\n \"phoneExtension\": \"<string>\"\n }\n },\n \"rendering\": {\n \"providerType\": \"<string>\",\n \"npi\": \"<string>\",\n \"commercialNumber\": \"<string>\",\n \"locationNumber\": \"<string>\",\n \"stateLicenseNumber\": \"<string>\",\n \"providerUpinNumber\": \"<string>\",\n \"taxonomyCode\": \"<string>\",\n \"firstName\": \"<string>\",\n \"lastName\": \"<string>\",\n \"middleName\": \"<string>\",\n \"suffix\": \"<string>\",\n \"organizationName\": \"<string>\",\n \"contactInformation\": {\n \"name\": \"<string>\",\n \"phoneNumber\": \"<string>\",\n \"faxNumber\": \"<string>\",\n \"email\": \"<string>\",\n \"phoneExtension\": \"<string>\"\n }\n },\n \"ordering\": {\n \"providerType\": \"<string>\",\n \"npi\": \"<string>\",\n \"ssn\": \"<string>\",\n \"employerId\": \"<string>\",\n \"commercialNumber\": \"<string>\",\n \"locationNumber\": \"<string>\",\n \"payerIdentificationNumber\": \"<string>\",\n \"employerIdentificationNumber\": \"<string>\",\n \"claimOfficeNumber\": \"<string>\",\n \"naic\": \"<string>\",\n \"stateLicenseNumber\": \"<string>\",\n \"providerUpinNumber\": \"<string>\",\n \"taxonomyCode\": \"<string>\",\n \"firstName\": \"<string>\",\n \"lastName\": \"<string>\",\n \"middleName\": \"<string>\",\n \"suffix\": \"<string>\",\n \"organizationName\": \"<string>\",\n \"contactInformation\": {\n \"name\": \"<string>\",\n \"phoneNumber\": \"<string>\",\n \"faxNumber\": \"<string>\",\n \"email\": \"<string>\",\n \"phoneExtension\": \"<string>\"\n }\n },\n \"supervising\": {\n \"providerType\": \"<string>\",\n \"npi\": \"<string>\",\n \"ssn\": \"<string>\",\n \"employerId\": \"<string>\",\n \"commercialNumber\": \"<string>\",\n \"locationNumber\": \"<string>\",\n \"stateLicenseNumber\": \"<string>\",\n \"providerUpinNumber\": \"<string>\",\n \"taxonomyCode\": \"<string>\",\n \"firstName\": \"<string>\",\n \"lastName\": \"<string>\",\n \"middleName\": \"<string>\",\n \"suffix\": \"<string>\",\n \"organizationName\": \"<string>\",\n \"contactInformation\": {\n \"name\": \"<string>\",\n \"phoneNumber\": \"<string>\",\n \"faxNumber\": \"<string>\",\n \"email\": \"<string>\",\n \"phoneExtension\": \"<string>\"\n }\n },\n \"tradingPartnerName\": \"<string>\"\n}")
.asString();require 'uri'
require 'net/http'
url = URI("https://api.example.com/api/v2/clearinghouse/claim")
http = Net::HTTP.new(url.host, url.port)
http.use_ssl = true
request = Net::HTTP::Post.new(url)
request["Content-Type"] = 'application/json'
request.body = "{\n \"tradingPartnerServiceId\": \"<string>\",\n \"submitter\": {\n \"contactInformation\": {\n \"name\": \"<string>\",\n \"phoneNumber\": \"<string>\",\n \"faxNumber\": \"<string>\",\n \"email\": \"<string>\",\n \"phoneExtension\": \"<string>\"\n },\n \"organizationName\": \"<string>\",\n \"lastName\": \"<string>\",\n \"firstName\": \"<string>\",\n \"middleName\": \"<string>\",\n \"submitterIdentification\": \"<string>\"\n },\n \"receiver\": {\n \"organizationName\": \"<string>\"\n },\n \"subscriber\": {\n \"memberId\": \"<string>\",\n \"ssn\": \"<string>\",\n \"organizationName\": \"<string>\",\n \"subscriberGroupName\": \"<string>\",\n \"firstName\": \"<string>\",\n \"lastName\": \"<string>\",\n \"middleName\": \"<string>\",\n \"suffix\": \"<string>\",\n \"dateOfBirth\": \"<string>\",\n \"policyNumber\": \"<string>\",\n \"groupNumber\": \"<string>\"\n },\n \"billing\": {\n \"providerType\": \"<string>\",\n \"npi\": \"<string>\",\n \"ssn\": \"<string>\",\n \"employerId\": \"<string>\",\n \"commercialNumber\": \"<string>\",\n \"locationNumber\": \"<string>\",\n \"stateLicenseNumber\": \"<string>\",\n \"providerUpinNumber\": \"<string>\",\n \"taxonomyCode\": \"<string>\",\n \"firstName\": \"<string>\",\n \"lastName\": \"<string>\",\n \"middleName\": \"<string>\",\n \"suffix\": \"<string>\",\n \"organizationName\": \"<string>\",\n \"contactInformation\": {\n \"name\": \"<string>\",\n \"phoneNumber\": \"<string>\",\n \"faxNumber\": \"<string>\",\n \"email\": \"<string>\",\n \"phoneExtension\": \"<string>\"\n }\n },\n \"claimInformation\": {\n \"claimChargeAmount\": \"<string>\",\n \"healthCareCodeInformation\": [\n {\n \"diagnosisCode\": \"<string>\"\n }\n ],\n \"serviceLines\": [\n {\n \"serviceDate\": \"<string>\",\n \"professionalService\": {\n \"procedureCode\": \"<string>\",\n \"lineItemChargeAmount\": \"<string>\",\n \"serviceUnitCount\": \"<string>\",\n \"compositeDiagnosisCodePointers\": {\n \"diagnosisCodePointers\": [\n \"<string>\"\n ]\n },\n \"procedureModifiers\": [\n \"<string>\"\n ],\n \"description\": \"<string>\",\n \"placeOfServiceCode\": \"<string>\",\n \"emergencyIndicator\": \"Y\",\n \"epsdtIndicator\": \"Y\",\n \"familyPlanningIndicator\": \"Y\",\n \"copayStatusCode\": \"0\"\n },\n \"assignedNumber\": \"<string>\",\n \"serviceDateEnd\": \"<string>\",\n \"serviceLineSupplementalInformation\": [\n {\n \"attachmentControlNumber\": \"<string>\"\n }\n ],\n \"ambulanceCertification\": [\n {\n \"conditionCodes\": []\n }\n ],\n \"hospiceEmployeeIndicator\": true,\n \"serviceLineDateInformation\": {\n \"prescriptionDate\": \"<string>\",\n \"certificationRevisionOrRecertificationDate\": \"<string>\",\n \"beginTherapyDate\": \"<string>\",\n \"lastCertificationDate\": \"<string>\",\n \"treatmentOrTherapyDate\": \"<string>\",\n \"hemoglobinTestDate\": \"<string>\",\n \"serumCreatineTestDate\": \"<string>\",\n \"shippedDate\": \"<string>\",\n \"lastXRayDate\": \"<string>\",\n \"initialTreatmentDate\": \"<string>\"\n },\n \"ambulancePatientCount\": 123,\n \"obstetricAnesthesiaAdditionalUnits\": 123,\n \"testResults\": [\n {\n \"testResults\": \"<string>\"\n }\n ],\n \"serviceLineReferenceInformation\": {\n \"repricedLineItemReferenceNumber\": \"<string>\",\n \"adjustedRepricedLineItemReferenceNumber\": \"<string>\",\n \"priorAuthorization\": [\n {\n \"priorAuthorizationOrReferralNumber\": \"<string>\",\n \"otherPayerPrimaryIdentifier\": \"<string>\"\n }\n ],\n \"mammographyCertificationNumber\": \"<string>\",\n \"clinicalLaboratoryImprovementAmendmentNumber\": \"<string>\",\n \"referringCliaNumber\": \"<string>\",\n \"immunizationBatchNumber\": \"<string>\",\n \"referralNumber\": [\n \"<string>\"\n ]\n },\n \"salesTaxAmount\": \"<string>\",\n \"postageTaxAmount\": \"<string>\",\n \"fileInformation\": [\n \"<string>\"\n ],\n \"additionalNotes\": \"<string>\",\n \"goalRehabOrDischargePlans\": \"<string>\",\n \"thirdPartyOrganizationNotes\": \"<string>\",\n \"purchasedServiceProvider\": {\n \"providerType\": \"<string>\",\n \"npi\": \"<string>\",\n \"stateLicenseNumber\": \"<string>\",\n \"commercialNumber\": \"<string>\",\n \"payerIdentificationNumber\": \"<string>\",\n \"ssn\": \"<string>\",\n \"employerId\": \"<string>\",\n \"locationNumber\": \"<string>\",\n \"employerIdentificationNumber\": \"<string>\",\n \"claimOfficeNumber\": \"<string>\",\n \"naic\": \"<string>\",\n \"providerUpinNumber\": \"<string>\",\n \"taxonomyCode\": \"<string>\",\n \"firstName\": \"<string>\",\n \"lastName\": \"<string>\",\n \"middleName\": \"<string>\",\n \"suffix\": \"<string>\",\n \"organizationName\": \"<string>\",\n \"contactInformation\": {\n \"name\": \"<string>\",\n \"phoneNumber\": \"<string>\",\n \"faxNumber\": \"<string>\",\n \"email\": \"<string>\",\n \"phoneExtension\": \"<string>\"\n },\n \"otherIdentifier\": \"<string>\",\n \"secondaryIdentifier\": [\n {\n \"qualifier\": \"<string>\",\n \"identifier\": \"<string>\",\n \"otherIdentifier\": \"<string>\"\n }\n ]\n },\n \"orderingProvider\": {\n \"providerType\": \"<string>\",\n \"npi\": \"<string>\",\n \"ssn\": \"<string>\",\n \"employerId\": \"<string>\",\n \"commercialNumber\": \"<string>\",\n \"locationNumber\": \"<string>\",\n \"payerIdentificationNumber\": \"<string>\",\n \"employerIdentificationNumber\": \"<string>\",\n \"claimOfficeNumber\": \"<string>\",\n \"naic\": \"<string>\",\n \"stateLicenseNumber\": \"<string>\",\n \"providerUpinNumber\": \"<string>\",\n \"taxonomyCode\": \"<string>\",\n \"firstName\": \"<string>\",\n \"lastName\": \"<string>\",\n \"middleName\": \"<string>\",\n \"suffix\": \"<string>\",\n \"organizationName\": \"<string>\",\n \"otherIdentifier\": \"<string>\",\n \"secondaryIdentifier\": [\n {\n \"qualifier\": \"<string>\",\n \"identifier\": \"<string>\",\n \"otherIdentifier\": \"<string>\"\n }\n ]\n },\n \"lineAdjudicationInformation\": [\n {\n \"otherPayerPrimaryIdentifier\": \"<string>\",\n \"serviceLinePaidAmount\": \"<string>\",\n \"procedureCode\": \"<string>\",\n \"paidServiceUnitCount\": \"<string>\",\n \"adjudicationOrPaymentDate\": \"<string>\",\n \"procedureModifier\": [\n \"<string>\"\n ],\n \"procedureCodeDescription\": \"<string>\",\n \"bundledOrUnbundledLineNumber\": \"<string>\",\n \"claimAdjustmentInformation\": [\n {\n \"adjustmentDetails\": [\n {\n \"adjustmentReasonCode\": \"<string>\",\n \"adjustmentAmount\": \"<string>\",\n \"adjustmentQuantity\": \"<string>\"\n }\n ]\n }\n ],\n \"remainingPatientLiability\": \"<string>\"\n }\n ],\n \"formIdentification\": [\n {\n \"formIdentifier\": \"<string>\",\n \"supportingDocumentation\": [\n {\n \"questionNumber\": \"<string>\",\n \"questionResponse\": \"<string>\",\n \"questionResponseAsDate\": \"<string>\",\n \"questionResponseAsPercent\": \"<string>\"\n }\n ]\n }\n ]\n }\n ],\n \"propertyCasualtyClaimNumber\": \"<string>\",\n \"relatedCausesCode\": [],\n \"autoAccidentStateCode\": \"<string>\",\n \"autoAccidentCountryCode\": \"<string>\",\n \"patientAmountPaid\": \"<string>\",\n \"fileInformation\": \"<string>\",\n \"fileInformationList\": [\n \"<string>\"\n ],\n \"deathDate\": \"<string>\",\n \"patientWeight\": \"<string>\",\n \"patientSignatureSourceCode\": true,\n \"pregnancyIndicator\": \"Y\",\n \"claimDateInformation\": {\n \"symptomDate\": \"<string>\",\n \"initialTreatmentDate\": \"<string>\",\n \"lastSeenDate\": \"<string>\",\n \"acuteManifestationDate\": \"<string>\",\n \"accidentDate\": \"<string>\",\n \"lastMenstrualPeriodDate\": \"<string>\",\n \"lastXRayDate\": \"<string>\",\n \"hearingAndVisionPrescriptionDate\": \"<string>\",\n \"disabilityBeginDate\": \"<string>\",\n \"disabilityEndDate\": \"<string>\",\n \"lastWorkedDate\": \"<string>\",\n \"authorizedReturnToWorkDate\": \"<string>\",\n \"admissionDate\": \"<string>\",\n \"dischargeDate\": \"<string>\",\n \"assumedAndRelinquishedCareBeginDate\": \"<string>\",\n \"assumedAndRelinquishedCareEndDate\": \"<string>\",\n \"repricerReceivedDate\": \"<string>\",\n \"firstContactDate\": \"<string>\"\n },\n \"claimSupplementalInformation\": {\n \"reportInformations\": [\n {\n \"attachmentControlNumber\": \"<string>\"\n }\n ],\n \"priorAuthorizationNumber\": \"<string>\",\n \"referralNumber\": \"<string>\",\n \"claimControlNumber\": \"<string>\",\n \"cliaNumber\": \"<string>\",\n \"repricedClaimNumber\": \"<string>\",\n \"adjustedRepricedClaimNumber\": \"<string>\",\n \"investigationalDeviceExemptionNumber\": \"<string>\",\n \"claimNumber\": \"<string>\",\n \"mammographyCertificationNumber\": \"<string>\",\n \"medicalRecordNumber\": \"<string>\",\n \"demoProjectIdentifier\": \"<string>\",\n \"carePlanOversightNumber\": \"<string>\",\n \"medicareCrossoverReferenceId\": \"<string>\"\n },\n \"ambulanceCertification\": [\n {\n \"conditionCodes\": []\n }\n ],\n \"patientConditionInformationVision\": [\n {\n \"conditionCodes\": []\n }\n ],\n \"homeboundIndicator\": true,\n \"anesthesiaRelatedSurgicalProcedure\": [\n \"<string>\"\n ],\n \"conditionInformation\": [\n {\n \"conditionCodes\": [\n \"<string>\"\n ]\n }\n ],\n \"claimNote\": {\n \"additionalInformation\": \"<string>\",\n \"certificationNarrative\": \"<string>\",\n \"goalRehabOrDischargePlans\": \"<string>\",\n \"diagnosisDescription\": \"<string>\",\n \"thirdPartOrgNotes\": \"<string>\"\n },\n \"otherSubscriberInformation\": [\n {\n \"otherSubscriberName\": {\n \"otherInsuredLastName\": \"<string>\",\n \"otherInsuredIdentifier\": \"<string>\",\n \"otherInsuredFirstName\": \"<string>\",\n \"otherInsuredMiddleName\": \"<string>\",\n \"otherInsuredNameSuffix\": \"<string>\",\n \"otherInsuredAdditionalIdentifier\": \"<string>\"\n },\n \"otherPayerName\": {\n \"otherPayerOrganizationName\": \"<string>\",\n \"otherPayerIdentifier\": \"<string>\",\n \"otherPayerAdjudicationOrPaymentDate\": \"<string>\",\n \"otherPayerSecondaryIdentifier\": [\n {\n \"qualifier\": \"<string>\",\n \"identifier\": \"<string>\",\n \"otherIdentifier\": \"<string>\"\n }\n ],\n \"otherPayerPriorAuthorizationNumber\": \"<string>\",\n \"otherPayerPriorAuthorizationOrReferralNumber\": \"<string>\",\n \"otherPayerClaimAdjustmentIndicator\": true,\n \"otherPayerClaimControlNumber\": \"<string>\"\n },\n \"insuranceGroupOrPolicyNumber\": \"<string>\",\n \"otherInsuredGroupName\": \"<string>\",\n \"claimLevelAdjustments\": [\n {\n \"adjustmentDetails\": [\n {\n \"adjustmentReasonCode\": \"<string>\",\n \"adjustmentAmount\": \"<string>\",\n \"adjustmentQuantity\": \"<string>\"\n }\n ]\n }\n ],\n \"payerPaidAmount\": \"<string>\",\n \"nonCoveredChargeAmount\": \"<string>\",\n \"remainingPatientLiability\": \"<string>\",\n \"otherPayerReferringProvider\": [\n {\n \"otherPayerReferringProviderIdentifier\": [\n {\n \"qualifier\": \"<string>\",\n \"identifier\": \"<string>\",\n \"otherIdentifier\": \"<string>\"\n }\n ]\n }\n ],\n \"otherPayerRenderingProvider\": [\n {\n \"otherPayerRenderingProviderSecondaryIdentifier\": [\n {\n \"qualifier\": \"<string>\",\n \"identifier\": \"<string>\",\n \"otherIdentifier\": \"<string>\"\n }\n ]\n }\n ],\n \"otherPayerServiceFacilityLocation\": [\n {\n \"otherPayerServiceFacilityLocationSecondaryIdentifier\": [\n {\n \"qualifier\": \"<string>\",\n \"identifier\": \"<string>\",\n \"otherIdentifier\": \"<string>\"\n }\n ]\n }\n ],\n \"otherPayerSupervisingProvider\": [\n {\n \"otherPayerSupervisingProviderIdentifier\": [\n {\n \"qualifier\": \"<string>\",\n \"identifier\": \"<string>\",\n \"otherIdentifier\": \"<string>\"\n }\n ]\n }\n ],\n \"otherPayerBillingProvider\": [\n {\n \"otherPayerBillingProviderIdentifier\": [\n {\n \"qualifier\": \"<string>\",\n \"identifier\": \"<string>\",\n \"otherIdentifier\": \"<string>\"\n }\n ]\n }\n ],\n \"patientSignatureGeneratedForPatient\": true,\n \"medicareOutpatientAdjudication\": {\n \"reimbursementRate\": \"<string>\",\n \"hcpcsPayableAmount\": \"<string>\",\n \"claimPaymentRemarkCode\": [\n \"<string>\"\n ],\n \"endStageRenalDiseasePaymentAmount\": \"<string>\",\n \"nonPayableProfessionalComponentBilledAmount\": \"<string>\"\n }\n }\n ]\n },\n \"isTesting\": true,\n \"controlNumber\": \"<string>\",\n \"providers\": [\n {\n \"providerType\": \"<string>\",\n \"npi\": \"<string>\",\n \"ssn\": \"<string>\",\n \"employerId\": \"<string>\",\n \"commercialNumber\": \"<string>\",\n \"locationNumber\": \"<string>\",\n \"stateLicenseNumber\": \"<string>\",\n \"providerUpinNumber\": \"<string>\",\n \"taxonomyCode\": \"<string>\",\n \"firstName\": \"<string>\",\n \"lastName\": \"<string>\",\n \"middleName\": \"<string>\",\n \"suffix\": \"<string>\",\n \"organizationName\": \"<string>\",\n \"contactInformation\": {\n \"name\": \"<string>\",\n \"phoneNumber\": \"<string>\",\n \"faxNumber\": \"<string>\",\n \"email\": \"<string>\",\n \"phoneExtension\": \"<string>\"\n }\n }\n ],\n \"referring\": {\n \"providerType\": \"<string>\",\n \"npi\": \"<string>\",\n \"commercialNumber\": \"<string>\",\n \"stateLicenseNumber\": \"<string>\",\n \"providerUpinNumber\": \"<string>\",\n \"taxonomyCode\": \"<string>\",\n \"firstName\": \"<string>\",\n \"lastName\": \"<string>\",\n \"middleName\": \"<string>\",\n \"suffix\": \"<string>\",\n \"organizationName\": \"<string>\",\n \"contactInformation\": {\n \"name\": \"<string>\",\n \"phoneNumber\": \"<string>\",\n \"faxNumber\": \"<string>\",\n \"email\": \"<string>\",\n \"phoneExtension\": \"<string>\"\n }\n },\n \"rendering\": {\n \"providerType\": \"<string>\",\n \"npi\": \"<string>\",\n \"commercialNumber\": \"<string>\",\n \"locationNumber\": \"<string>\",\n \"stateLicenseNumber\": \"<string>\",\n \"providerUpinNumber\": \"<string>\",\n \"taxonomyCode\": \"<string>\",\n \"firstName\": \"<string>\",\n \"lastName\": \"<string>\",\n \"middleName\": \"<string>\",\n \"suffix\": \"<string>\",\n \"organizationName\": \"<string>\",\n \"contactInformation\": {\n \"name\": \"<string>\",\n \"phoneNumber\": \"<string>\",\n \"faxNumber\": \"<string>\",\n \"email\": \"<string>\",\n \"phoneExtension\": \"<string>\"\n }\n },\n \"ordering\": {\n \"providerType\": \"<string>\",\n \"npi\": \"<string>\",\n \"ssn\": \"<string>\",\n \"employerId\": \"<string>\",\n \"commercialNumber\": \"<string>\",\n \"locationNumber\": \"<string>\",\n \"payerIdentificationNumber\": \"<string>\",\n \"employerIdentificationNumber\": \"<string>\",\n \"claimOfficeNumber\": \"<string>\",\n \"naic\": \"<string>\",\n \"stateLicenseNumber\": \"<string>\",\n \"providerUpinNumber\": \"<string>\",\n \"taxonomyCode\": \"<string>\",\n \"firstName\": \"<string>\",\n \"lastName\": \"<string>\",\n \"middleName\": \"<string>\",\n \"suffix\": \"<string>\",\n \"organizationName\": \"<string>\",\n \"contactInformation\": {\n \"name\": \"<string>\",\n \"phoneNumber\": \"<string>\",\n \"faxNumber\": \"<string>\",\n \"email\": \"<string>\",\n \"phoneExtension\": \"<string>\"\n }\n },\n \"supervising\": {\n \"providerType\": \"<string>\",\n \"npi\": \"<string>\",\n \"ssn\": \"<string>\",\n \"employerId\": \"<string>\",\n \"commercialNumber\": \"<string>\",\n \"locationNumber\": \"<string>\",\n \"stateLicenseNumber\": \"<string>\",\n \"providerUpinNumber\": \"<string>\",\n \"taxonomyCode\": \"<string>\",\n \"firstName\": \"<string>\",\n \"lastName\": \"<string>\",\n \"middleName\": \"<string>\",\n \"suffix\": \"<string>\",\n \"organizationName\": \"<string>\",\n \"contactInformation\": {\n \"name\": \"<string>\",\n \"phoneNumber\": \"<string>\",\n \"faxNumber\": \"<string>\",\n \"email\": \"<string>\",\n \"phoneExtension\": \"<string>\"\n }\n },\n \"tradingPartnerName\": \"<string>\"\n}"
response = http.request(request)
puts response.read_body{
"claimSubmissionId": "<string>",
"patientControlNumber": "<string>"
}{
"error": "<string>",
"message": "<string>",
"statusCode": 123,
"details": {}
}{
"error": "<string>"
}Body
application/json
Minimum string length:
1Show child attributes
Show child attributes
Show child attributes
Show child attributes
Show child attributes
Show child attributes
Show child attributes
Show child attributes
Show child attributes
Show child attributes
Show child attributes
Show child attributes
Required array length:
1 - 2147483647 elementsShow child attributes
Show child attributes
Show child attributes
Show child attributes
Show child attributes
Show child attributes
Show child attributes
Show child attributes
Show child attributes
Show child attributes
Show child attributes
Show child attributes
Show child attributes
Show child attributes
Show child attributes
Show child attributes
Response
Claim submission initiated successfully. Returns an ID to track the claim submission.
⌘I